Adolescent gynaecology is increasingly recognized as an area in which specific knowledge and expertise is required to ensure that patients achieve the best outcome. Gynaecological problems in adolescents are common, and although serious pathology is rare, distress and discomfort can be significant. Adolescent girls are under greater pressure than ever before, particularly in terms of examination performance; they find menstrual dysfunction particularly difficult to manage. Careful and sympathetic assessment is crucial, and simple treatment remedies may be all that is required. However, complex and rare medical conditions can also occur and must not be missed. Some congenital disorders present for the first time in adolescence. Early detection and appropriate treatment will ensure the best possible outcomes in terms of sexual function and potential fertility. © 2014 Elsevier Ltd.

© 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved. (S.M. Creighton). Objective: In 2001, this team published an observational study of the clinical outcomes of a cohort of adolescent girls born with ambiguous genitalia. The poor outcomes observed represented a major scientific challenge to the standard practice of childhood feminising genital surgery. That publication was one of several contributing to a call for change in surgical practice, which culminated in the publication of the Chicago Consensus Document in 2006. The aim of this current study was to repeat the same evaluation of clinical outcomes on a recent cohort of adolescent girls and compare the two cohorts to identify differences in adolescent outcomes which may indicate a change in paediatric surgical practice. Methods: This was an observational study of a current cohort of adolescent girls treated in childhood for ambiguous genitalia and referred to a specialist adolescent disorders of sex development (DSD) service for assessment. Data were collected on surgical history, genital examination findings and treatment recommendations for 30 consecutive adolescents over a 5-year period. Findings were compared with those of a similar cohort of adolescent girls published over a decade previously. Results: Clitoral surgery remained common (93{%} vs 100{%}, current cohort vs historical cohort). However, concomitant vaginoplasty was performed less frequently (80 vs 100{%} current vs historical). Vaginoplasty revision surgery was also less commonly required (65 vs 81{%}), although 24{%} of the recent cohort still required major revision surgery prior to intercourse. There was some improvement to the cosmetic outcomes as deemed by the surgical team using the same criteria as the previous report. Conclusions: This study provides someslight evidence of recent practice change.Therewas asmall reduction in the number of vaginoplasties performed in childhood and an improvement in vaginoplasty outcomes and cosmesis.However, therewas no identifiable change inmanagement of clitoromegaly and the numbers of clitoral reduction operations remained high. This is surprising given the clear evidence of a detrimental impact of surgery on clitoral sensation and sexual function.

The Chicago consensus statement of 2005 was created at the point of cumulative criticisms and debates around the clinical practice of childhood genital surgery. It was drawn up at a time when it had become clearer that medically non-essential paediatric genital operations were associated with poor adult cosmetic outcomes and sexual functioning. However, data were not available for non-intervention. Therefore, parents and clinicians had no reliable information on how a child growing up with atypical genitalia might fare. The most positive recommendation in the consensus statement was the strong recommendation for decisions to be reached by a multidisciplinary team in collaboration with affected families. Importantly, the value of user groups was likewise formally acknowledged. For many services, there has been a sea change in the way surgeons work. Whilst some surgeons may continue with the standard practice of childhood genital surgery, it is becoming clearer that with adequate support, more individuals and families choose to postpone elective interventions. However, these are our observations only. Authoritative evidence must be based on high-quality multi-centre multidisciplinary research to prospectively monitor the long-term multiple outcomes of surgery and no surgery. There is as yet no obvious move towards such an endeavour. © 2013 © 2013 Taylor {&} Francis.

© Clinical and Experimental Rheumatology 2014. With current advances in medical treatment, reproductive issues have become more important for women with chronic immune-mediated diseases. Most, if not all, patients report that their disease affects their personal relationships, their decision to have children, and the size of their family. These decisions are multi-factorial, influenced mainly by concerns over the effect of pregnancy on the rheumatic disease, the impact of disease activity during pregnancy on foetal health, the patient's ability to care for the child, and the possible harmful effects medication could have on the child, both pre- and post-natally during breastfeeding. Apart from that, women's health issues tend to be overlooked in favour of the management of the underlying rheumatic disease. To this end, we convened an expert panel to review the published literature on women's health and reproductive issues and provide evidence- and eminence-based points to consider for the treating physicians. We conclude that there is a need for a change in mind-set from one which "cautions against pregnancy" to one which "embraces pregnancy" through the practice of individualised, pre- and post-conceptual, multi-disciplinary care.