Pediatric vulvar lichen sclerosus: Does it resolve or does it persist after menarche?

BACKGROUND AND OBJECTIVES: Although data regarding the rates of remission and progression of the disease are still scarce, it is generally now acknowledged that pediatric vulvar lichen sclerosus (pVLS) can persist beyond puberty. Recent studies reveal that this condition may persist in as many as 75% of cases. The present study aims to answer the following query: how does pVLS evolve after menarche? METHODS: This observational retrospective study conducted on premenarchal girls diagnosed with pVLS in our institution between 1990 and 2011 describes 31 patients who returned for multidisciplinary clinical evaluation following menarche. RESULTS: The mean follow-up time was 14 years. At the post-menarche clinical examination, patients were classified as follows: 58% were still affected by VLS, 16% presented with a complete remission of disease, and 26% were completely asymptomatic although with persistent clinical signs of VLS. CONCLUSIONS: In our series, pVLS persists following menarche in the majority of patients. These findings suggest the importance of a long-term follow-up even among patients who report resolution of symptoms following menarche.

[Differential diagnosis and management of abnormal uterine bleeding in adolescence].

Abnormal uterine bleeding (AUB) is defined as any atypical genital bleeding originating from the uterine cavity, without the characteristics of normal menstrual period. AUB is an important symptom both for adolescents and their parents, and it usually leads to a state of anxiety. Although about 95% of AUB could be considered as a dysfunctional disorder, AUB requires well-defined diagnostic procedures in order to detect a physical cause, ruling out complex or systemic diseases, including oncological ones. Diagnostic procedures require the acquisition of a full and detailed history, and it is also crucial to obtain as much compliance from the patient as possible. A complete gynecological evaluation (whenever possible) and a full physical examination are useful to detect any kind of general disease which can compromise the hormonal reproductive system. Auxiliary tools such as gynecological ultrasonography for pelvic examination are allowed in sexually-active women, otherwise transrectal ultrasonography could be considered, if needed. Hematic ß-hCG must be dosed in every fertile woman with AUB and laboratory tests must be tailored on each patient. The first-line treatment consists of combined oral contraceptives and, when they are contraindicated, progesterone alone, medicated intrauterine devices, GnRH-analogues, or desmopressin are the most common second-line treatments.

Temporal trends in adolescent pregnancies in Lombardy, Italy: 1996-2010.

OBJECTIVES: Data from southern European countries concerning teenage pregnancy have not been properly analysed so far. We provide the temporal trend of adolescent pregnancy rates in Lombardy, Northern Italy. METHODS: Using the hospital discharge register (1996-2010), teenage pregnancy-related admission rates per 1000 girls aged 13 to 19 years, residing in Lombardy, were computed. Miscarriage-, induced abortion-, and delivery ratios/100 pregnancies, and caesarean section ratio/100 deliveries, were calculated. RESULTS: The pregnancy rate increased from 9.07 in 1996-2000 to 10.20 in 2001-2005, and remained at that level (10.27) in 2006-2010. However, the rates by country of birth (native Italian and non-native Italian) showed a steady decline in 2003-2010, when data about residents in Lombardy, categorised by sex, age and country of birth, were available. The induced abortion rate rose from 5.38/1000 to 5.55/1000, then decreased slightly in 2006-2010. The abortion ratio/100 pregnancies diminished from 59.3 in 1996-2000 to 50.3 in 2006-2010. CONCLUSIONS: Between 1996 and 2010, the overall teenage pregnancy rate has risen in Lombardy. When the rates were calculated separately for adolescents born in Italy and immigrants, the trends reverted in the period 2003-2010: in both groups pregnancy- and birth rates steadily declined. Pregnancy-, abortion-, and birth rates in non-native Italians, after having dropped, are all still much higher than those among native Italians. Because the number of non-native Italian adolescent girls markedly increased over the last two decades, their group--with decreasing, but still higher, birth- and abortion rates--has caused the observed rise in those rates when all adolescents residing in Lombardy are considered indistinctly.

Child sexual abuse: an Italian perspective.

The problem of child sexual abuse is a growing reality in Italy. The experience of over 200 children seen by the SVS (Soccorso Violenza Sessuale) Centre in Milan (the first Italian large-scale study) may give more information on the European situation. This study is a retrospective study based on information contained in the files of children beneath the age of 14 seen at the SVS Centre between May 1996 and May 2003, who arrived with a suspicion of child sexual abuse. Over 80% of all cases fell within the normal-aspecific category according to Adams' 2001 classification. This first Italian survey, though not based on substantiated cases but only on cases of suspected sexual abuse, supplies a perspective on a large northern European city such as Milan. Data seem similar to those published in other non-European studies, particularly as regards clinical signs observed. Thus, the results of this study, with all their limitations, start to give a perspective on the frequency and type of child population reaching this Italian center, what the scenarios are, what signs the children present and how infrequent it is to find clinical anogenital signs concerning for sexual abuse.

Pregnancy outcome after cabergoline treatment in early weeks of gestation.

We collected information on 61 pregnancies in 50 women treated with cabergoline. These pregnancies resulted in 12 (19.7%) early terminations (five induced abortions, six spontaneous abortions, one hydatidiform mole) and 49 (80.3%) live births. In one case, malformations were suspected by a gynecologist based on ultrasound at 12 gestational weeks and the pregnancy was terminated; additional information was not available. There was one case of trisomy 18. The frequency of spontaneous and induced abortions and major congenital malformations was comparable with rates in the general population. The data did not indicate any potential adverse effect of the drug on pregnancy. The data from this study in combination with previous reports can exclude a congenital malformation risk greater than 10% associated with pregnancy exposure to cabergoline.