Adolescent Gynecology –Hina J

Adolescent Gynecology –Hina J. Talib Editor

Adolescent Gynecology A Clinical Casebook Editor –Hina J. Talib, M.D. Assistant Professor, Pediatrics Program Director, Post-doctoral Fellowship in Adolescent Medicine Division of Adolescent Medicine Children’s Hospital at Montefiore The Pediatric Hospital for Albert Einstein College of Medicine Bronx, NY, USA

ISBN 978-3-319-66977-9 ISBN 978-3-319-66978-6 (eBook) https://doi.org/10.1007/978-3-319-66978-6

Library of Congress Control Number: 2017959188

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This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland For my mother, a physician and educator in the specialty of Pediatrics, whose footsteps I follow with confidence that comes from her unwavering support. Foreword

The gynecologic and reproductive health care of female infants, children, and adolescents has often been fragmented without well-accepted guidelines and bodies of evidence. However, fortunately for girls and young women, a multidisciplinary medical/surgical subspecialty is now emerging into the mainstream of medical practice in the USA and to a lesser extent in other countries. This subspecialty is called pediatric and adolescent gynecology (PAG), and its practitioners include adolescent medicine specialists, endocrinologists, gynecologists, nurse practitioners, pediatri- cians, urologists, and psychologists/psychiatrists, all of whom have training and expertise in PAG. The case discussions in Adolescent Gynecology: A Clinical Casebook are written by many of the foremost US and Canadian experts in PAG and will serve as a clinical guide for PAG fellowship trainees as well as for medical students and resident trainees and primary care practitioners who are the frontline caregivers for adolescents. The clinical case discussion format is particularly useful for addressing the many intersecting and often competing considerations that must be taken into account when providing gynecologic and reproductive health care to the adolescent age group. Approaches to common problems including pain with menstruation, exces- sive menstrual bleeding, menstrual hygiene for girls with special needs, vaginal discharge, and contraception are thoroughly discussed with many helpful sugges- tions for counseling teens and parents. For example, Drs. Sieke and Rome offer insights and advice for addressing gynecological concerns of the special needs population. They comment that “Although adolescents with disabilities may not have the same level of understanding about pubertal and sexual development as their peers, clinicians must not assume that they are not sexually active or do not have a sexual drive… Education [for] adolescents with intellectual disability … should include hygiene, contraception, consent, sexually transmitted infections, and sexual abuse prevention measures.” The issues of consent and confidentiality are central to the practice of adolescent gynecology but also quite difficult to manage in the clinical encounter. Drs. Scott and Alderman in their “Case of a Girl with a Secret” answer the question, “How should providers balance the rights of adolescents’ privacy regarding certain elements of their health with parents’ responsibility

vii viii Foreword to be a part of their adolescent child’s health?” Unintended teen pregnancy, while decreasing in recent years, remains a significant problem in the USA. Access to effective contraception is an important part of the solution. Drs. Northridge and Maslyanskaya in their “Case of a Girl Seeking Birth Control” provide an in-depth discussion of the use of long-acting reversible contraception in adolescents, including medical eligibility criteria, the insertion procedure, and counseling. In addition to cases that discuss common adolescent gynecological issues, Adolescent Gynecology: A Clinical Casebook also provides valuable information about some highly specialized or rare gynecological conditions affecting adolescent girls such as fertility preservation in girls undergoing cancer treatment as well as diagnosis and management of rare causes of primary amenorrhea including uterine and vaginal agenesis [Mayer-Rokitansky-Kuster-Hauser (MRKH)] and primary ovarian insufficiency (POI). Surgical and nonsurgical techniques for creation of a neovagina in adolescents with MRKH are thoroughly reviewed by Drs. Adeyemi- Fowode and Dietrich in the “Case of a Girl with Primary Amenorrhea, Cyclic Pelvic Pain, and Absent Vagina.” Drs. Kanj and Gordon in their comprehensive case discussion of POI, “Case of a Girl with Delayed Puberty and High Gonadotropin Levels,” not only point out the appropriate diagnostic testing for this condition but also remind us that “However, even after a thorough evaluation, approximately 90% of cases of spontaneous POI—i.e., those not secondary to cytotoxic therapy such as chemotherapy or radiation—will remain without an identifiable cause.” And they further advise us that “In all cases of POI, the various components of this chronic condition must be considered, including effects on physical, emotional, and mental health…,” excellent advice that applies to most adolescent gynecological problems. In the “Case of the Girl with Vulvar Swelling,” Dr. Simms-Cendan clearly addresses the current controversy over cosmetic labiaplasty in teenagers and the lack of an accepted definition of labia minora hypertrophy as well as the large increase in the number of teens requesting this surgical procedure. This excellent casebook provides an overview of many of the most common and important gynecological conditions affecting adolescent girls and distills the clinical insights of experienced PAG practitioners to help guide diagnosis and management. Its format makes it an accessible, easy-to-use resource for trainees and primary care clinicians. I believe, and sincerely hope, that it will contribute to improved gynecologic care for adolescent girls.

Susan M. Coupey, M.D. Professor of Pediatrics Chief, Division of Adolescent Medicine Children’s Hospital at Montefiore The Pediatric Hospital for Albert Einstein College of Medicine Bronx, NY USA Preface

Pediatric and adolescent gynecology is a multidisciplinary medical/surgical subspecialty that I am passionate about, as it centers on caring for girls and young women, with and without chronic illnesses, as they navigate their changing bodies and developing sexuality, a process that can be rife with physical and emotional challenges. These challenges are often undiscovered by health professionals, as adolescent girls may not be forthcoming unless asked directly about symptoms or emotions in a sensitive manner ensuring confidentiality. This book aims to raise awareness of common and not-so-common adolescent gynecologic issues; to empower student, physician, and nursing trainees, as well as practicing providers in caring for young girls; and to update readers with advances in adolescent gynecology. Although education in the subspecialty of pediatric and adolescent gynecology is a core element of medical training, especially in the disciplines of pediatrics and obstetrics and gynecology, it faces many barriers in training programs including lack of faculty with expertise in the field, lack of a formalized curriculum, and lim- ited opportunities for trainees to evaluate and treat young girls with gynecologic concerns. In planning and editing this book, I have been fortunate to draw from my experience as program director of the Adolescent Medicine Fellowship Training Program at the Children’s Hospital at Montefiore and as associate editor of the Journal of Pediatric and Adolescent Gynecology. Puberty is a hallmark event in the development of adolescent girls, and it is a time of great physical, emotional, and social change. With this in mind, this book is organized in four sections, starting with Part I, “General and Developmental Approach to Adolescents,” which includes chapters addressing adolescent confidentiality, puberty, and well care. Part II, “Menstrual Disorders,” recognizes that menstrual complaints are a leading reason for physician office visits by adolescent girls in the USA. Chapters here discuss the varied concerns girls often have with their menses ranging from too heavy, to too painful, to too irregular. Part III, “Sexually Active Adolescents,” highlights issues in reproductive health care including sexually transmitted infection and adolescent pregnancy both of which cause significant morbidity in adolescent girls. Finally, Part IV, “Special

ix x Preface

Populations of Adolescents,” includes chapters on girls who have sex with girls, girls who are victims of abuse, and girls with special health-care needs and chronic health conditions. Here, common gynecologic health issues are discussed in the context of these special populations to increase sensitivity to and comprehensive care of these girls. This book uses clinical cases, a preferred method of learning by trainees, to provide a concise and clinically relevant survey of adolescent gynecology. Teaching highlights unique to this text include the case-based format, clinical pearls and pitfalls, and suggested further reading that focuses on clinical references informed by professional society guidelines, up-to-date reviews, and the Centers for Disease Control and Prevention and other large health organizations. It is my hope that readers will enjoy learning from these clinical cases just as much as I have and that they will gain knowledge and clinical skills in the care of adolescent girls and young women.

Hina J. Talib, M.D. Acknowledgments

This book would not be possible without the support and mentorship of Susan M. Coupey, MD, Chief, Division of Adolescent Medicine at Children’s Hospital at Montefiore. Her assistance in conception and organization of the book as well as her review of the chapters was invaluable. I would also like to thank the contributing authors, who took time from their clinical practices to share their experiences and educational discussions, which I believe will be an asset to learners looking to increase their knowledge base in adolescent gynecology. I also thank Elise M. Paxson, our developmental editor at Springer for her assistance, patience, and gentle guidance in the lengthy process of completing this book. Lastly, I must credit the love and support of my husband, Nilam Patel, and the smiles and snuggles from our infant son, Isa, for carrying me through this endeavor and so much more.

Hina J. Talib, M.D.

xi Abbreviations

ACIP Advisory Committee on Immunization Practices ACS Administration for Child Services ADHD Attention-deficit hyperactivity disorder AFP Alpha-fetoprotein ACOG American College of Obstetricians and Gynecologists AUB Abnormal uterine bleeding BDNF Brain-derived neurotrophic factor β-hCG Beta human chorionic gonadotropin BMD Bone mineral density BMI Body mass index BV Bacterial vaginosis CA-125 Cancer antigen 125 CACIS Complete androgen insensitivity syndrome CAH Congenital adrenal hyperplasia CBT Cognitive behavior therapy CDC Centers for Disease Control and Prevention CLIA Clinical Laboratory Improvement Amendments CMT Cervical motion tenderness CNS Central nervous system COC Combined oral contraceptive COCP Combined oral contraceptive pill CPP Chronic pelvic pain CSEC Commercial sexual exploitation of children CYP3A Cytochrome P4503A DMPA Depot medroxyprogesterone acetate DMST Domestic minor sex trafficking DRSP Daily Record of Severity of Problems DSD Disorder of sex development DSM-5 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition DXA Dual-energy X-ray absorptiometry ED Emergency Department

xiii xiv Abbreviations

EE Ethinyl estradiol EMR Electronic medical record EPT Expedited partner therapy FDA US Food and Drug Administration FHR Fetal heart rate FSH Follicle-stimulating hormone GI Gastrointestinal GISP Gonococcal Isolate Surveillance Project GnRH Gonadotropin-releasing hormone Hb Hemoglobin HFI Hormone-free interval HIV Human immunodeficiency virus HPG Hypothalamic-pituitary-gonad HPO Hypothalamic-pituitary-ovarian IBD Inflammatory bowel disease IEP Individualized educational plan IHH Idiopathic hypogonadotropic hypogonadism INR International normalized ratio IPV Intimate partner violence IUD Intrauterine device IUFD Intrauterine fetal death IUGR Intrauterine growth restriction IVF In vitro fertilization LARC Long-acting reversible contraception LBW Low birth weight LDHC Lactate dehydrogenase LGBTQ Lesbian gay bisexual transgender queer LH Luteinizing hormone MBSR Mindfulness-based stress reduction MGD Mixed gonadal dysgenesis MRKH Mayer-Rokitansky-Kuster-Hauser MRI Magnetic resonance imaging MSK Musculoskeletal MSM Men who have sex with men NAAT Nucleic acid amplification test NAS Neonatal abstinence syndrome NHTSC National Human Trafficking Resource Center NSAID Nonsteroidal anti-inflammatory drug OR Odds ratio PAIS Partial androgen insensitivity syndrome PCOS Polycystic ovary syndrome PID Pelvic inflammatory disease PMD Premenstrual disorder PMDD Premenstrual dysphoric disorder PMS Premenstrual syndrome Abbreviations xv

POI Primary ovarian insufficiency POP Progestin-only pill PPROM Premature preterm rupture of membranes PRL Prolactin PROM Premature rupture of membranes PSST-A Premenstrual Symptoms Screening Tool for Adolescents PT Prothrombin time PTB Preterm birth PTL Preterm labor PTT Partial thromboplastin time PTSD Post-traumatic stress disorder RCT Randomized controlled trial REI Reproductive endocrinology and infertility SA Spontaneous abortion SGA Small for gestational age SNRI Serotonin-norepinephrine reuptake inhibitor SSRI Selective serotonin reuptake inhibitor SRI Serotonin reuptake inhibitors STI Sexually transmitted infection TRH Thyrotropin-releasing hormone TSH Thyroid-stimulating hormone US Ultrasound VTE Venous thromboembolism VVC Vulvovaginal candidiasis WHO World Health Organization WSW Women who have sex with women WSWM Women who have sex with women and men Contents

Part I General and Developmental Approach to Adolescents 1 Case of a Girl with a Secret �� 3 Nadia L. Scott and Elizabeth M. Alderman 2 Case of a Girl Due for Human Papillomavirus Immunization �� 13 Maria H. Rahmandar and Paula K. Braverman 3 Case of a Girl with Delayed Puberty and Inflammatory Bowel Disease �� 23 Kristina Derrick and Aristotle Panayiotopoulos 4 Case of a Girl with Vulvar Swelling �� 35 Judith Simms-Cendan and Xiomara Santos 5 Case of the Girl with Abdominal Pain �� 41 Hanna R. Goldberg, Jasmine Multani, and Sari Kives Part II Menstrual Disorders 6 Case of a Girl with Irregular Periods, Acne, and Hirsutism �� 49 Lauren A. Kanner and Ellen L. Connor 7 Case of a Girl with Painful Periods, Pain with Bowel Movements, and Dyspareunia �� 57 Elizabeth Bonagura and S. Paige Hertweck 8 Case of a Girl with Heavy, Prolonged Periods and Anemia �� 65 Risa L. Fridy and Susan M. Coupey 9 Case of a Girl with Irritability and Mood Swings with Her Periods �� 73 Alexandra C. Nevin Lam and Simone Vigod

xvii xviii Contents

10 Case of a Girl with Secondary Amenorrhea and an Eating Disorder �� 83 Nancy A. Dodson 11 Case of a Girl with Primary Amenorrhea, Cyclic Pelvic Pain, and Absent Vagina �� 93 Oluyemisi A. Adeyemi-Fowode and Jennifer E. Dietrich 12 Case of a Girl with Primary Amenorrhea, Delayed Puberty, and High Gonadotropin Levels �� 103 Rula V. Kanj and Catherine M. Gordon Part III Sexually Active Adolescents 13 Case of a Girl with Vaginal Discharge Who Has Sex with Boys �� 113 Alison Eliscu and Gale R. Burstein 14 Case of a Girl with Vaginal Discharge Who Has Sex with Girls �� 127 Chanelle Coble and Donna Futterman 15 Case of a Girl with Lower Abdominal Pain �� 137 Megan Jacobs and Paritosh Kaul 16 Case of a Girl with Vulvar Ulcers �� 151 Marina Catallozzi, Susan L. Rosenthal, and Lawrence R. Stanberry 17 Case of a Girl with a Positive Pregnancy Test �� 161 Bianca Stortini and Nathalie Fleming 18 Case of a Girl Seeking Birth Control �� 173 Jennifer L. Northridge and Sofya Maslyanskaya 19 Case of a Girl with Condom Failure �� 187 Karen Browner-Elhanan 20 Case of a Girl with Obesity Seeking Birth Control �� 193 Jessica Rieder, Courtney Sims, and Elissa Gross 21 Case of a Girl on Psychotropic Medications Seeking Birth Control �� 203 Jean Someshwar and Rollyn M. Ornstein Part IV Special Populations of Adolescents 22 Gynecologic Care and Contraception in the Medically Complex Adolescent �� 213 Amanda M. Jacobs 23 Case of a Girl with Cancer Seeking Fertility Counseling �� 225 Priscilla Rahmer, Catherine Benedict, and Jonathan D. Fish Contents xix

24 Case of a Girl with Special Needs Seeking Menstrual Management �� 235 Erin H. Sieke and Ellen S. Rome 25 Case of a Girl with Chronic Abdominal Pain, Frequent Emergency Room Visits, and Opioid Abuse �� 251 Kanani E. Titchen and Hina J. Talib

Erratum to: Case of a Girl with a Secret �� E1

Index �� 267 Contributors

Oluyemisi A. Adeyemi-Fowode, M.D. Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA Elizabeth M. Alderman, M.D. Division of Adolescent Medicine, Pediatric Residency Program, The Childern’s Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY, USA Catherine Benedict, Ph.D. Department of Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY, USA Elizabeth Bonagura, M.S., M.D. Kosair Children’s Hospital Gynecology Specialists, Louisville, KY, USA Paula K. Braverman, M.D. Baystate Adolescent Medicine, Baystate Health, Baystate Children’s Specialty Center, Springfield, MA, USA Division of Adolescent and Transition Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Karen Browner-Elhanan, M.D. Pediatrics-Adolescent Medicine, Renown Children’s Hospital, Reno, NV, USA Gale R. Burstein, M.D., M.P.H. Erie County Department of Health, Buffalo, NY, USA Marina Catallozzi, M.D., M.S.C.E. Division of Child and Adolescent Health, Department of Pediatrics, Heilbrunn Department of Population and Family Health, Columbia University Medical Center, Morgan Stanley Children’s Hospital at New York Presbyterian, New York, NY, USA Chanelle Coble, M.D. Department of Pediatrics, NYU School of Medicine/ Bellevue Hospital, New York, NY, USA

xxi xxii Contributors

Ellen L. Connor, M.D. University of Wisconsin, Adolescent PCOS Clinic, American Family Children’s Hospital, Madison, WI, USA Susan M. Coupey, M.D. Professor of Pediatrics, Chief, Division of Adolescent Medicine, Children’s Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY, USA Kristina Derrick, M.D., Sc.M. Department of Pediatric Endocrinology, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA Jennifer E. Dietrich, M.D., M.Sc. Obstetrics and Gynecology and Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA Nancy A. Dodson, M.D., M.P.H. Division of Adolescent Medicine, Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY, USA Allison Eliscu, M.D., F.A.A.P. Division Chief of Adolescent Medicine, Department of Pediatrics, Stony Brook Children’s Hospital, Stony Brook, NY, USA Jonathan D. Fish, M.D. Pediatric Hematology/Oncology and Stem Cell Transplantation, Steven and Alexandra Cohen Children’s Medical Center of New, New York, NY, USA Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA Nathalie Fleming, M.D., F.R.C.S.C. Division of Gynecology, Department of Surgery, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada Risa L. Fridy, M.D. Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA Donna Futterman, M.D. Adolescent AIDS Program, Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY, USA Hanna R. Goldberg, M.S. Faculty of Medicine, University of Toronto, Toronto, ON, Canada Catherine M. Gordon, M.D., M.Sc. Division of Adolescent and Transition Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Elissa Gross, D.O., M.P.H. Division of Hospital Medicine, The Pediatric Hospital for Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY, USA S. Paige Hertweck, M.D. University of Louisville School of Medicine, Kosair Children’s Hospital, Louisville, KY, USA Contributors xxiii

Amanda M. Jacobs, M.D. Division of Adolescent Medicine, Department of Pediatrics, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA Megan Jacobs, M.D., F.A.A.P. Section of Adolescent Medicine, Department of Pediatrics, University of Colorado – School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA Rula V. Kanj, M.D. Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA Lauren A. Kanner, M.D. Division of Pediatric Endocrinology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Madison, WI, USA Paritosh Kaul, M.D. Section of Adolescent Medicine, Department of Pediatrics, University of Colorado – School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA Sari Kives, M.D. Section of Gynecology, Hospital for Sick Children, Toronto, ON, Canada Sofya Maslyanskaya, M.D. Division of Adolescent Medicine, Children’s Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY, USA Jasmine Multani, H.B.Sc. Faculty of Medicine, University of Toronto, Toronto, ON, Canada Alexandra C. Nevin Lam, M.D. Department of Obstetrics and Gynecology, North York General, Toronto, ON, Canada Jennifer L. Northridge, M.D. Division of Adolescent Medicine, Joseph M Sanzari Children’s Hospital, The Pediatric Hospital for Hackensack University Medical Center, Hackensack, NJ, USA Rollyn M. Ornstein, M.D. Division of Adolescent Medicine and Eating Disorders, Penn State Hershey Children’s Hospital, Hershey, PA, USA Aristotle Panayiotopoulos, M.D. Department of Pediatric Endocrinology, Northwell Health, Staten Island, NY, USA Priscilla Rahmer, F.N.P. Pediatric Hematology/Oncology and Stem Cell Transplantation, Steven and Alexandra Cohen Children’s Medical Center of New York, New York, NY, USA Maria H. Rahmandar, M.D. Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Hempstead, NY, USA xxiv Contributors

Division of Pediatric and Adolescent Gynecology, Cincinnati Children’s Hospital Medical Center, Chicago, IL, USA Jessica Rieder, M.D., M.S. Division of Adolescent Medicine, The Pediatric Hospital for Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY, USA Ellen S. Rome, M.D., M.P.H. Cleveland Clinic Lerner College of Medicine at Case, Cleveland, OH, USA Center for Adolescent Medicine, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA Susan L. Rosenthal, Ph.D., A.B.P.P. Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, Morgan Stanley Children’s Hospital at New York Presbyterian, New York, NY, USA Xiomara Santos, M.D. Department of Obstetrics and Gynecology, Orlando Health Physicians Group, Orlando, FL, USA Nadia L. Scott, M.D., M.H.S. Division of Adolescent Medicine, Department of Pediatrics, The Children’s Hospital at Montefiore, Bronx, NY, USA Erin H. Sieke, B.A. Cleveland Clinic Lerner College of Medicine at Case, Cleveland, OH, USA Courtney Sims, M.D. Department of Pediatrics, The Pediatric Hospital for Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY, USA Judith Simms-Cendan, M.D. Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, FL, USA Jean Someshwar, M.D. Division of Adolescent and Young Adult Medicine, Children’s National Health System, George Washington University, Washington, DC, USA Lawrence R. Stanberry, M.D., Ph.D. Department of Pediatrics, Columbia University Medical Center, Morgan Stanley Children’s Hospital at New York Presbyterian, New York, NY, USA Bianca Stortini, M.D. Division of Gynecology, Department of Surgery, Children’s Hospital of Eastern Ontario, Ottawa, Canada Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada Hina J. Talib, M.D. Assistant Professor, Pediatrics, Program Director, Post- doctoral Fellowship in Adolescent Medicine, Division of Adolescent Medicine, Children’s Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY, USA Contributors xxv

Kanani E. Titchen, M.D. Division of Adolescent Medicine, Children’s Hospital at Montefiore, the Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY, USA Simone Vigod, M.D., M.Sc., F.R.C.P.C. Psychiatry, Reproductive Life Stages Program, Women’s Mental Health Program, Women’s College Hospital, Toronto, Ontario, Canada