© 2015 North American Society for Pediatric and Adolescent Gynecology. Study Objective: Precocious pseudopuberty in girls occurs as a result of peripheral estrogen production, most commonly through an autonomous ovarian cyst or in patients with McCune Albright syndrome. Current management is either conservative or surgical. The aim of this study was to identify available literature on presentation, course and treatment of such cases. Design: We performed a medline literature search using the key words 'ovarian autonomous cyst' and 'pseudopuberty'. We included articles published in English, from 1980 to date relating to females aged 2 to 8 years. We excluded papers on other endocrine conditions resulting in premature puberty. Outcome Measures: Type of management, time of resolution, recurrence, progression to Central Precocious Puberty and McCune Albright Syndrome. Results: We identified 9 articles referring to 26 cases of autonomous ovarian cysts. All patients had suppressed LHRH testing and had simple ovarian cysts producing estradiol. Median age of patients was 5 years (range 2.2-8) and size of cyst was 41.5mm (9-60). Ten patients underwent cystectomy or oophorectomy, three were given cyproterone acetate and 13 were managed conservatively. Nine of 13 patients that were managed conservatively and two of those that had a cystectomy had a recurrence. There were three cases that progressed to central precocious puberty (CPP) and one case that was then identified to have McCune Albright (MCA) syndrome. One further case with multiple recurrences was given long term treatment with letrozole. Conclusion: We conclude that although a conservative approach should always be proposed in the first instance, one should be aware of the risk of recurrence and progression to CPP or MCA. Antiestrogen treatment appears promising; however data comparing it with surgical options and particularly long term consequences with regards to future reproductive outcomes are not available.

© Springer-Verlag London 2015. Aim: To present the technique and the results of treatment of vaginal aplasia with the use of Frank's Dilators and to critically report its potential advantages and limitations.Brief description of the reviewed data: Vaginal dilation involves the insertion of graduated dilators in the vaginal dimple and applying pressure. It is recognized as the first line method for creating a vagina in women with Mayer Rokitansky Kuster Hauser syndrome (MRKH) and Complete Androgen Insensitivity Syndrome (CAIS). An 80 {%} success rate is reported with improvement of sexual satisfaction and anxiety scores. There are only few complications reported in the literature making it a low risk and low cost method to create a vagina. Clinical implications: Vaginal dilation therapy should be offered to all women presenting with MRKH or CAIS prior to embarking on a surgical vaginoplasty. Adequate psychological support during the process is likely to improve success rates as well as the overall wellbeing of patients diagnosed with uterovaginal aplasia.Open issues for further research: More research is required on long term outcomes of vaginal dilation therapy as well as on the comparison between surgical and conservative methods to create a vagina.

© 2015 North American Society for Pediatric and Adolescent Gynecology. Introduction: Minor breast concerns in childhood and adolescence are common and lead to increased anxiety among young patients and their families, particularly due to high correlation with breast cancer. However, most breast services aim at managing adults and triaging patients with breast cancer, whereas adolescent medicine specialists or pediatricians are usually not appropriately trained to identify and treat breast pathology. Methods: We reviewed hospital records of all patients attending a pediatric and adolescent gynecology or breast clinic of a tertiary referral hospital, with a breast related symptom, between January 2009 and December 2011. We collected information regarding age at presentation, age at menarche, diagnosis, management and outcome. Results: We identified 81 patients of which 11 presented with an abnormal nipple or areolar secretion, 33 had a palpable lump, 20 had mastitis, and 16 had unequal breast development. One patient presented with virginal breast hypertrophy. Three out of 11 of the patients with an abnormal secretion had a cyst identified on ultrasonography. Out of the palpable lumps 12 were fibroadenomas, 3 were phyllodes tumors, and 14 were cystic in nature. The phyllodes tumors and half of the fibroadenomas were removed. The remaining fibroadenomas remain under regular ultrasonographic follow-up. All cases of mastitis were treated conservatively and resolved with broad spectrum antibiotic treatment. Conclusion: In our series, no malignancies were identified. Although 8 patients required surgical treatment, the majority of cases were treated conservatively.

© 2015 by John Wiley {&} Sons Ltd. All rights reserved. Female genital reconstruction remains a highly controversial and emotive topic. Whilst short-term surgical complications of such procedures occur and are important to manage correctly, it is the long-term complications that have caused such concern and debate. Correlation of any particular surgical procedure to its later success or failure can be almost impossible. Complications of genital surgery such as vaginal stenosis may make intercourse painful or impossible, but the pediatric surgeon responsible for the initial vaginal reconstruction will never have the opportunity to follow patients into adult life when such complications become apparent. The success of genital reconstruction in sexual function and reproduction is often not tested until many years after the procedure. Surgeons and procedures change and adult patients may have had operations that have long been modified or abandoned in favor of something else.

© Springer-Verlag London 2015. Aim: To critically evaluate treatment options for patients with vaginal aplasia and present an algorithm taking into account the complexity, the advantages and the potential risks of each vaginoplasty method.Brief description of the reviewed data: Current available techniques for creating a neovagina range from conservative to complex surgical. No comparative studies exist between methods and at present most centers appear to prefer one method over another. Based on the best available evidence, it seems that vaginal dilation, being risk free and non-invasive, is the first line treatment option for patients with a vaginal dimple present and no previous perineal surgery. Patients with failed vaginal dilation should be directed to surgical traction techniques or peritoneal vaginoplasty depending on the presence or not of a vaginal dimple and on the familiarity of the surgical team with these techniques. Peritoneal vaginoplasty could be also applied in cases of failed surgical traction. Skin and intestinal vaginoplasties should be kept only for failures of other surgical techniques and for complex cases.Clinical implications: While the superiority of each method remains to be assessed objectively, we propose indications for each available method and a treatment algorithm.Open issues for further research: Evidenced based comparisons in the form of randomized controlled trials are required in order to objectively assess the place and superiority of each available method.

© 2014 Informa UK Ltd. The phenotype of polycystic ovarian syndrome (PCOS) is known to worsen with weight gain, increased ingestion of carbohydrates and a sedentary lifestyle. The purpose of this study was to assess the dietary habits in a group of adolescent girls with PCOS. Adolescents with PCOS were recruited and asked to complete a questionnaire on their eating habits and a recall dietary diary, from which their caloric and macronutrient intake was calculated. Results were compared with those from a group of normal controls. Thirty-five women with PCOS and 46 controls were included. Girls with PCOS were less likely to have cereals for breakfast (20.7 versus 66.7{%}) and as a result consumed less fibre than controls. They were more likely to eat an evening meal (97.1 versus 78.3{%}) and eat this over an hour later when compared to controls. Despite having comparable body mass indexes, girls with PCOS ate a daily surplus calorie average of 3{%} versus controls that had a negative calorie intake of 0.72{%} (p=0.047). Ameliorating eating habits early in adolescence in girls with PCOS may improve future metabolic concerns related to a genetic predisposition and worsened by an unhealthy lifestyle.