Obstetrics and Gynaecology Forum - latest Issue

This edition of the O&G Forum is dedicated to various aspects of Obstetrical and Gynaecological care of nadolescents.

Adolescence refers to the transitional phase of physical and psychological development that occurs from puberty to adulthood. This phase includes a desire for autonomy and an increase in sexual risk-taking behaviours, making adolescents particularly vulnerable to sexually transmitted diseases. The Youth Risk Behaviour Surveillance Systems trend from 1991 to 2015 reports a decrease in the rate of sexual activity from 54% to 41% and the rate of sex with more than four partners from 19% to 12%. In the United States, approximately 5 to 10% of teens identify as lesbian, gay, or bisexual. Youth from 15 to 24 years of age account for a disproportionate number of new sexually transmitted infections (STI’s) and approximately 25% of sexually active adolescent females have had a sexually transmitted infection. In South Africa young women between the ages of 15 and 24 years made up 37% of new HIV infections in 2016.7 Improvement of adolescent sexual behaviour should be one of the primary goals of the 21st century. This includes providing protection from sexually transmitted diseases, improvement of contraception compliance and the correct use of mass media. South Africa’s commitment to this is shown in one of the millennium development goals to combat HIV and other diseases. The World Health Organization also identifies adolescent health as a worldwide priority.

Menstrual disorders are common conditions in adolescents, with Heavy Menstrual Bleeding (HMB) having a prevalence of 37% in adolescents compared to 10-20% in adults, and dysmenorrhoea accounting for approximately 15% of adolescent complaints.

Ovarian masses are an uncommon finding in children and adolescents with an incidence of around 2.6/100000 per year excluding functional ovarian lesions of which the true incidence is unknown. While ovarian tumours account for less than 1% of all cancers in children, the likelihood of malignancy found in ovarian masses in children and adolescents ranges from 9% -11%. The most common ovarian masses identified in this age range are listed in Table 1. Up to 64% are neoplastic of which the large majority are germ cell tumours (GCT) (60-80%). Sex cord stromal cell tumours and surface epithelial tumours account for 5% and <20% respectively unlike in adult ovarian tumours where surface epithelial tumours predominate.

The female adolescent patient has a variety of gynaecological issues which the healthcare practitioner needs to understand and pay particular attention to, ranging from screening for sexual health history, teenage pregnancies, sexually transmitted infections (STI’s), contraceptive needs (both for the prevention of pregnancy as well as for medical indications such as acne, dysmenorrhoea or heavy menstrual bleeding), termination of pregnancy (TOP) and vulnerability to sexual assault, trafficking and rape. Proper management of these issues is crucial in order to promote healthy sexual choices in this age group, because risk-taking behaviours learnt at this stage of development are more than often carried into adulthood.

Teen pregnancy has serious consequences for young women, their children and communities as a whole. Teenage pregnancy is defined as a teenage girl, usually within ages of 13 – 19, becoming pregnant. This refers to girls who have not reached legal adulthood, who become pregnant. A significant number of these pregnancies are unplanned and unwanted. This contributes to the high maternal mortality plus obstetric complications and the burden of unsafe abortion. Teenage pregnancy is the leading cause of mortality in girls aged 15 to 19 years, and 90% of the deaths are occurring in low to middle income countries and most of them are preventable.

Polycystic ovarian syndrome (PCOS) is the most common endocrinopathy affecting female reproductive health. The diagnosis of PCOS in adolescence is challenging due to the high prevalence of menstrual dysfunction and acne in the normal adolescent population. Hirsutism should prompt further investigation and alert the clinician to the possibility of PCOS. Early identification of adolescents at risk of PCOS with timeous intervention may impact on long term metabolic and cardiovascular health.