REVCONTRIBUCIONES SOGIA 2006; 13(2): CHILENAS 39-43 PRESENTADAS AL X CONGRESO EUROPEO DE GINECOLOGÍA PEDIÁTRICA ... 39

Contribuciones Chilenas presentadas al X Congreso Europeo de Ginecología Pediátrica Adolescentes Budapest 10 y 13 de mayo de 2006 Xth European Pediatric and Adolescent Gynecological Congress Budapest 10 - 13 May, 2006

CHARACATERIZATION OF ginitis (VV) who consulted a Pediatric Gyne- PREPUBERTAL VULVOVAGINITIS cology Unit in Santiago, Chile and including IN A CLINIC FOR PEDIATRIC AND a short review about the subject of the last 5 ADOLESCENT GYNECOLOGY IN years. SANTIAGO, CHILE Methods: A retrospective chart review which included all the girls attended in San Barbosa G., MD1,2 and Olguí M. R., MD3 Borja Arriarán University Hospital’s Pediatric Gynecology Clinic from January 1st 2004 to 1Obstetrics and Gynecology Department, Pediatric and Adolescent Gynecology Unit, Hospital Uni- August 31st 2005 was done and all the girls versitario San Ignacio, Faculty of , who presented with VV as chief complain or Pontificia Universidad Javeriana, Bogotá, Colom- as second diagnosis or complain were iden- bia, South America, [email protected] tified and statistically analyzed. 2Centro de Medicina Reproductiva y Desarrollo Data, Results: Total consultations: 2235; Integral del Adolescente (CEMERA), Faculty of New patients: 699; Global incidence of VV Medicine, Universidad de Chile, Santiago, Chile, (pre and pubertal): 40.3%(n=282), of those South America, [email protected] 3Pediatrics 54%(n=152) were prepubertal, age ranging Department, Pediatric and Adolescent Gynecology from 3 years 8 months to 8 years 4 months, of Unit, Complejo Hospitalario San Borja Arriarán, those 78% were unspecific VV and 22% speci- Faculty of Medicine, Universidad de Chile, Santia- fic. From the cases of specific VV the isolated go, Chile, South America, [email protected] microorganisms were as follows: Staphylo- coccus aureus 25%, Enterobius vermicularis 21%, ABSTRACT Candida albicans 18%, Group A Streptococcus 12.5%, 6,2%, Haemophylus Aims: The objectives of this study are to influenzae 6.2%, HPV 3.1%, Gardnerella vagi- describe the epidemiology and the isolated nallis 3.1% and Streptococcus pneumoniae 3.1%. microorganisms in a population of prepuber- Of the 6 patients with Candida, 3 had Diabe- tal girls with diagnosis of specific Vulvova- tes Mellitus type 1, 2 were being treated with 40 CONTRIBUCIONES CHILENAS PRESENTADAS AL X CONGRESO EUROPEO DE GINECOLOGÍA PEDIÁTRICA ... broad spectrum antibiotics and 1 was HIV immaturity. Although HPV infection is a positive. very significative matter for active sexual Conclusion: Unspecific VV was the single women, we can see a lack of knowing about chief diagnosis in prepubertal patients. Spe- transmission, prevention and treatment cific cases were mainly due to Staphylococcus especially in these young people. The lack of aureus, followed by Enterobius vermicularis adherence of these people to consult, prevent as the second most frequent etiologic patho- and treat an abnormal cervical cytology rise gen. Candida albicans is a rare cause of VV in about 23 till 80 percent. otherwise healthy prepubertal girls and was Aims: To describe the adolescent people always associated to another immunocom- profile in control in our institute of reproduc- promising factor which warrants a thorough tive medicine (CEMERA) with abnormal cer- study in these patients. vical cytology. Summary: Present knowledge regarding Methods: Retrospective analysis of medi- prepubertal vaginal microbiology makes cal history of all patients in control in our it difficult to differentiate between normal institute who had a PAP smear which had an flora and pathologic microorganisms, for abnormal exam between January of 1998 till this reason it seems prudent to recommend November of 2005. We analyzed age of the use of specific antibiotics for sympto- consult, start of sexual activity, PAP smears, matic patients in which it is possible to and number of sexual partners and use of isolate a specific germ as probable etiologic contraceptive methods. agent. Results: 929 people had PAP smears only 5 were abnormal, in these patients, the age at KEY WORDS: Prepubertal Vulvovaginitis consult was 16.2; the age at first sexual Pediatric intercourse was 14.8 and the age at PAP Child Disease. smear was 17.6. The number of sexual partners was 1 to 6 (2.6), only one used permanently, the other ones had irregular use ,the time of sexual activity at ADOLESCENTS PROFILE WITH the time of PAP smear was about 27 months. ALTERED CERVICAL CYTOLOGY About the abnormal cytology result we found 2 ASCUS, 2 LSIL, and 1 HSIL this one Castiglione M., González E., Molina R., Mon- had 14 years old. tero A. Conclusion: although we found a low percent of abnormal PAP smear in the study Centro de Medicina Reproductiva y Desarrollo Inte- group, there is a subdiagnosis of the cervical gral del Adolescente (CEMERA), Facultad de Medi- because the first PAP smear in cina, Universidad de Chile, Santiago de Chile. general population is about at 24 years old, so we can recommend to start the PAP ABSTRACT smears at lower ages cause the high grade lesion was associated a lower age of first The adolescent people with sexual activity . All people with high grade have an special risk to present an abnormal and low grade lesions had 2 sexual partners cervical cytology due a precocious start of at least. sexual intercourses, number of sexual partners, Summary: By the analysis of these data higher incidence of sexual transmission di- we can conclude that adolescent people had a seases and tabaquism. This population is high risk to have an abnormal cervical cyto- more susceptible to acquire HPV infection, logy. and if they have active sexual intercourses form a high risk group, cause they have KEY WORDS: Adolescent, PAP smear, ab- cytological and endocrinologycal cervical normal cytology, sexual transmission infection. CONTRIBUCIONES CHILENAS PRESENTADAS AL X CONGRESO EUROPEO DE GINECOLOGÍA PEDIÁTRICA ... 41

PSYCHOLOGICAL FACTORS ASSOCIATE older 3 years that girls and greater drugs and TO ONSET OF SEXUAL ACTIVITY alcohol use were associated to onset of sexual IN CHILEAN ADOLESCENTS AGED activity. 11-15 YEARS KEY WORDS: Early adolescence, onset of González E., Díaz A., Leal I., Molina T. and sexual activity, associated factors. Molina R. Profesional address: Centro de Medicina Repro- ductiva y Desarrollo Integral del Adolescente, Fa- cultad de Medicina, Universidad de Chile (CEMERA). Prof. Zañartu 1030, Independencia, SYSTEMS AND MODELS FOR Santiago de Chile. Casilla 70011-7 Santiago ADOLESCENTS ATTENDANCE AT Fax: (56-2) 7356512 e-mail:[email protected] THE REGION OF LATIN AMERICA

Aims. To know the Psychological Factors Molina R. associate to onset of sexual activity in Chilean Centro de Medicina Reproductiva y Desarrollo Inte- adolescent girls aged 11-15 years. gral del Adolescente (CEMERA), Facultad de Medi- Methods: It is a descriptive, analytic, and cina, Universidad de Chile, Santiago de Chile. cross study. The sample corresponds to 172 adolescents of 11 to 15 years old who were ABSTRACT interviewed in 2004 at their first visit to a Centre of . Two The experience of a Sexual and Repro- groups were compared, adolescents who had ductive Health model in the last 20 years in initiated sexual activity and adolescents who Latin America and Chile is described. did not have initiated sexual activity at Through a qualitative and quantitative moment of interview. A set of personal and approach. The model by complexity levels is familial variables were selected for this analized. The information is based on analysis. The data was collected in Excel previous research and the evolution profile of program and processed in statistical software first visits. Stata 7.0. Uni and bivariate analyses were The succes of the comprehensive ado- conducted. lescent’s health care model is reached, when Data, results: 172 adolescents were inter- adolescent´s demand is satisfied with, pro- viewed. In a 69% they had initiated sexual fessionalism, medical care access and confi- activity, in a 61% among 13 to 14 years old. dential attention. The team work of multi More number of partner relationships was discipline to satisfy the demand, are among observed in sexual active girls. .In a 60% their the most important pears. The demand could partners were older in 3 or more years versus be stimulated by the sexual education.The 29% 40% of them initiated sexual activity model is compared with other experiences in before 3 months of partner relationship. Latin America. Drugs, and alcohol use were observed more The most important conclusion is: The frequently in active sexually adolescents, all training of manpower is the most important the differences were significant. Variables in a model that go from the curative to such as sexual information, academic achie- preventive approach and from the biology to vements, academic plans, familial structure, comprehensive care. The development de- familial function, familial communication, pends of the younger spontaneous demand. religious affiliation did not showed statistical The lack of State policy involvement is a differences by group. reflex of the non socially accepted behaviour Conclusion: In this study the greater of adolescents or the low priority among their number de partner relationships, partners health objectives. 42 CONTRIBUCIONES CHILENAS PRESENTADAS AL X CONGRESO EUROPEO DE GINECOLOGÍA PEDIÁTRICA ...

COMPARATIVE PERFORMANCE OF SURGICAL AND MEDICAL RESULTS NORETHISTERONE ENANTHATE IN PATIENTS WITH ROKITANSKY 50 Mg /ESTRADIOL VALERATE 5 Mg SYNDROME AS INJECTABLE CONTRACEPTIVE AND ORAL CONTRACEPTIVE OF Varela M.*, Castiglione M.**, Molina R.**, LEVONORGESTREL 0.15 Mg/ WITH Montero A.** 0.03 Mg OF ETHINIL ESTRADIOL IN *Unidad de Patología de Polo Caudal. Hospital ADOLESCENTS Luis Calvo Mackenna. Santiago de Chile. **Centro de Medicina Reproductiva y Desarrollo Integral Molina R., Sandoval J., Montero A., Oyarzún P., del Adolescente (CEMERA), Facultad de Medici- Molina T., González E. na, Universidad de Chile, Santiago de Chile. Centro de Medicina Reproductiva y Desarrollo In- tegral de la Adolescencia, CEMERA. Faculty of ABSTRACT Medicine. University of Chile The Mayer Rokitansky Küster Hauser ABSTRACT Syndrome is a condition characterized by agenesis of müllerian ducts including the Characteristics, side effects, efficacy and congenital absence of and . The continuation rates is described of a Combined incidence is 1/20000. For vaginal reconstruc- Injectable (CI), norethisterone enanthate 50 tion multiple techniques have been described, mg/estradiol valerate 5mg Oral Hormonal like the expansion of Frank, Abbe-Wharton- Combined (OHC), levonorgestrel 0.15mg/ McIndoe intervention, Williams vulvoplasty with 0.03 mg of ethinil estradiol. It was a and Pratt`s sigmoid transplant among others. comparative study.They were 251 adolescents Prognosis depends of a multidisciplinary between 14 and 19 years old. One group of management specially psychological support 124 subjects with CI, observed for 1,044 cycles as the first line of treatment . and 127 subjects with OHC, observed for Aim: To describe the characterization, 1,368 cycles. The attention was done by obste- treatment and follow-up of patients with trician and gynaecologist specialist on PAG. Mayer Rokitansky Küster Hauser Syndrome. Pearson Chi 2 was used and logistic regre- Methods: Retrospective analysis of pa- ssion for some variables. tient’s medical histories with Mayer Roki- tansky Küster Hauser Syndrome in Unit of The CI users had significant difference in Caudate Pole Pathology of Luis Calvo social risk,secrecy need, psychiatric morbi- Mackenna Hospital who were surgically dity, consumption of alcohol and number of taken part between October 2002 and No- sexual partners. 20% of both groups had vember 2005. We analyzed the age at diagno- overweight. The normal BMI was significant sis, associated pathology, type of , age in CI with weight decrease at 12 month. No at surgical moment, evolution time, compli- difference in blood pressure, breast tender- cations, acceptance level and sexual activity ness, and sppoting was beginning. observed. But , hypomeno- Results: We found 4 patients. The average rrhea, and regular cycles had significant more age to diagnose was 11, 7 years. Two patients frecuency in OHC. One was were monorrenal. The surgical procedure was observed in OHC group, with a Pearl Index a neovagina with handle of sigmoid by means of 0.88. In the CI group, no pregnancy was of combined boarding abdominal and sagital observed. The continuation rate at 12 months prerectal with excellent surgical evolution and was 41.9% and 37.8% for CI and OHC, they have not presented complications to the respectively. date. The average age at the surgical moment was 12,2 years. The average post surgical time was 28 months. The acceptance level has CONTRIBUCIONES CHILENAS PRESENTADAS AL X CONGRESO EUROPEO DE GINECOLOGÍA PEDIÁTRICA ... 43 been good and no one had initiated sexual Methods: Retrospective analysis of medi- activity until the last medical control. cal histories of patients with Androgen Insen- Conclusion: Vaginal reconstruction with sitivity Syndrome treated at Caudate Pole handle of sigmoid has had excellent results Pathology Unit in Luis Calvo Mackenna Hos- then in addition to the surgical technique pital between October 2002 and November considers a multidisciplinary approach with 2005. We analyzed presentation, age at diag- an important psychological support for the nosis, evolution, surgical and psychological patients and their familiar surroundings. handling. Summary: The treatment of these patients Results: We found 1 patient that debuted must be multidisciplinary with highly with genital ambiguity, assigning itself female specialized and motivated people. sex. It was derived to Caudate Pole Pathology Unit with 1 month 25 days, the external genitals was female with bilateral presence of inguinal , and structures that corres- COMPLETE ANDROGEN INSENSITIVITY pond to testes; 46 XY cariotype. Laparotomy SYNDROME founded absence of uteri and . It was made hernioplasty and gonadal biopsy that Varela M.*, Castiglione M.**, Molina R.**, was compatible with testis. Uretrogenital Montero A.** Endoscopy states normal uretra, female external genitals. Gonadectomy was made at *Unidad de Patología de Polo Caudal (UPPC). Hos- pital Luis Calvo Mackenna. Santiago de Chile. 5 years 4 months. Actually, with 8 years 4 **Centro de Medicina Reproductiva y Desarrollo months, it evolves favorably with medical Integral del Adolescente (CEMERA), Facultad de and psychological support to the familiar Medicina, Universidad de Chile, Santiago de Chile. group and will initiate hormonal substitution with 10 years of bony age, to obtain puberal ABSTRACT development. Conclusion: The Androgen Insensitivity The Androgen Insensitivity Syndrome is a Syndrome is a rare disease, which requires a male pseudohermafroditism characterized by multidisciplinary handling including psycho- a defect in the androgen receptor, presenta- logical support for the familiar group, to tion is variated and the common characteristic understand prognosis and impact of diagno- is 46 XY cariotype with regression of mülle- sis. rian ducts. Testes are present, with normal Summary: Being a rare disease, it requires secretion of testosterone, but their external an opportune diagnosis and multidisciplinary genitals are female. handling. Precocious gonadectomy is contro- Aims: Characterization, treatment and versial. follow up of patients with Androgen Insensi- tivity Syndrome.