~ Clinical Perspectives in Obstetrics and Gynecology ~ Series Editor: J. Herbert Buchsbaum, M.D. ~ Clinical Perspectives in Obstetrics and Gynecology ~ perspective noun: ... the capacity to view sub jects in their true relations or relative importance. Each volume in Clinical Perspectives in Obstetrics and Gynecology covers in depth a major clinical area in the health care of women. The objective is to present to the reader the pathophysiologic and biochemical basis of the condition under discussion) and to provide a scientific basis for clinical management. These volumes are not intended as "how to» books) but as a ready reference by authorities in the field. Though the obstetrician and gynecologist may be the primary of provider health care for the female) this role is shared with family practitioners) pediatricians) medical and surgical specialists) and geriatricians. It is to all these physicians that the series is addressed. J. Series Editor: Herbert Buchsbaum, M.D. Buchsbaum (ed): The Menopause Aiman (ed.): Irifertility Futterweit: Polycystic Ovarian Disease Lavery and Sanfilippo (eds.): Pediatric and Adolescent Obstetrics and Gynecology Forthcoming Volumes: Galask (ed.): Infectious Diseases in the Female Patient Buchsbaum and Walton (eds.): Strategies in Gynecologic Surgery Pediatric and Adolescent Obstetrics and Gynecology Edited by J.P. Lavery · J.S. Sanfilippo With 106 Illustrations Springer-Verlag New York Berlin Heidelberg Tokyo J. Patrick Lavery, Associate Professor, Department of Obstetrics and Gynecology, Director, Division of Maternal-Fetal Medicine, University of Louisville, Medical Director, Teenage Parent Program, Louisville, Kentucky, U.S.A. Joseph S. Sanfilippo, Associate Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Co-Director, Pediatric Adolescent Gynecology, University of Louisville, Louisville, Kentucky, U.S.A. Series Editor: Herbert J. Buchsbaum, M.D., Department of Obstetrics and Gynecology, University of Pittsburgh-Magee Women's Hospital, Pittsburgh, Pennsylvania, U.S.A. Library of Congress Cataloging in Publication Data Main entry under title: Pediatric and adolescent obstetrics and gynecology. (Clinical perspectives in obstetrics and gynecology) Bibliography: p. Includes index. 1. Pediatric gynecology. 2. Pregnancy, Adolescent. 3. Adolescent girls-Diseases. I. Lavery, J. Patrick. II. Sanfilippo, Joseph S. III. Series RJ478.P434 1985 618.92'098 84-26728 © 1985 by Springer-Verlag New York, Inc. Softcover reprint of the hardcover 1st edition 1985 All rights reserved. No part of this book may be translated or reproduced in any form without written permission from Springer-Verlag, 175 Fifth Avenue, New York, New York 10010, U.S.A. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trademarks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information of this book is believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Typeset by Ampersand Publisher Services Incorporated, Rutland, Vermont. 9 8 7 6 543 2 1 ISBN-13: 978-1-4612-9547-1 e-ISBN-13: 978-1-4612-5064-7 DOl: 10.1007/978-1-4612-5064-7 To our children-Cathryn, Angela, Andrea, and Luke who have taught us much about pediatrics and adolescence Contents Preface ............................................... IX Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Xl Physical Maturation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Susan M. Coupey, Deborah S. Saunders 2 Neuroendocrine Maturation 12 Peter A. Lee 3 Psychologic Maturation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Barbara Ann Fitzgerald 4 The Initial Gynecologic History and Physical Examination . . . . . 34 Najib Wakim, Frank D. DeLeon 5 The Child with Ambiguous Genitalia ...................... 38 Richard H. Reindollar, Paul G. McDonough 6 Gynecologic Problems of Adolescence 61 joseph S. Sarifilippo, Marvin A. Yussman 7 Androgens in the Adolescent 84 Robert Wild 8 Breast Disorders 96 john Pietsch 9 Surgical Emergencies in the Newborn 105 Thomas R. Weber, jay L. GrosJeld 10 Gynecologic Surgery in the Adolescent 115 Thomas R. Weber, jay L. GrosJeld 11 Gynecologic Neoplasms 124 john A. Carlson viii Contents 12 Diethylstilbestrol Exposure in Utero 149 Elizabeth K. Senekjian, Arthur L. Herbst 13 Dysmenorrhea and Premenstrual Syndrome 162 Christine L. Cook 14 Endocrine Disturbances of Puberty 172 Alvin F. Goldfarb 15 Anorexia Nervosa ...................................... 184 John D. Lo~ Emery Wilson 16 Adolescent Nutrition 206 Starr Gantz 1 7 Sexually Transmitted Diseases ............................ 218 Major I. Keith Stone, Byron]. Masterson 18 Contraception ......................................... 234 Donald E. Greydanus 19 Hematologic Disorders 262 Salvatore Bertolone 20 Drug and Alcohol Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272 G. Randolph Schrodt, Jr., Kenneth N. Schikler 21 Obstetric Problems 285 ]. Patrick Lavery 22 Pregnancy and Parenting: Psychosocial Perspectives 296 Elizabeth A. McGee, Laura Schiller 23 Pelvic Ultrasonography .................................. 304 William L. Koontz, Richard Fellows 24 The Adolescent Athlete .................................. 313 Mona M. Shangold, Gabe Mirkin 25 Dermatologic Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319 Melissa L.F. Knuckles, Lafayette G. Owen 26 Legal Rights of Minors 338 Steven R. Smith Index ....................................... ..•.. . . . . . . 353 Preface This book covers a broad area-the problems associated with female develop ment-from the appearance of gender abnormalities in the delivery room, through the trials of pubescence, early maturation, and precocious child bearing. Experts from many diverse fields of scholarship have contributed chapters covering a wide range of subjects. The contributors have concentrated on their areas of expertise. The broad range of this book is unique; no other textbook covers as many areas. The diversity of subjects covered will help the reader (gynecologist, pediatrician, nurse, health counselor, social worker, or psy chologist) to understand both the physical and psychological problems which beset the female, from birth to adolescence. Because of the wealth of information presented, we hope that this volume will serve as a reference source and as a basis for further in-depth studies. The editors wish to express sincere thanks for the efforts "above and beyond the call of duty" on the part of many members of our staff. A special thank you to Carrie Marcell R.N., our research nurse and University of Louisville coordinator for this project, for her time and effort in putting up with the vagaries of the editors; and to Betty Jones and Linda Grear for their fine secretarial work. Special recognition is due Sue Koenig, whose patience with us in adapting the text to our word processor made our job a great deal easier. Mrs. Koenig recently passed away after a short illness, we will miss her. Our further appreciation goes to the staff of Springer-Verlag for their support and cooperation in this project, and to Herbert J. Buchsbaum M.D., initial collaborator and senior editor of this series, whose thoughts, advice and encouragement enabled this project to be completed. J. Patrick Lavery Joseph S. Sanfilippo Contributors Salvatore Bertolone, M.D. Associate Professor, Department of Pediatrics, University of Louisville, Kosair Children's Hospital, Louisville, Kentucky, U.S.A. John A. Carlson, M.D. Associate Director, Division of Gynecologic Oncology, Department of Ob stetrics and Gynecology, Hospital of the University of Pennsylvania, Phila delphia, Pennsylvania, U.S.A. Christine L. Cook, M.D. Associate Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Louisville, Louisville, Kentucky, U.S.A. Susan M. Coupey, M.D. Assistant Professor, Department of Pediatrics, Montefiore Medical Center/ Albert Einstein College of Medicine, Bronx, New York, U.S.A. Frank D. DeLeon, M.D. Assistant Professor, Department of Obstetrics and Gynecology, Texas Tech University Medical School, Louisville, Kentucky, U.S.A. Richard Fellows, M.D. Clinical Associate Professor, Department of Radiology, University of Louisville, Kosair-Children's Hospital, Louisville, Kentucky, U.S.A. Barbara Ann Fitzgerald, M.D. Assistant Professor, Department of Psychiatry, University of Louisville, Kosair Children's Hospital, Louisville, Kentucky, U.S.A. Starr Gantz, R.D. Department of Pediatrics, University of Kentucky College of Medicine, Lex ington, Kentucky, U.S.A. Alvin F. Goldfarb, M.D. Professor of Obstetrics and Gynecology, Jefferson Medical College of Thomas xii Contributors Jefferson University, Program Director of Department of Obstetrics and Gynecology, Delaware Medical Center, Newark, Delaware, U.S.A. Donald E. Greydanus, M.D. Director, Adolescent Medicine Program, Raymond Blank Memorial Hospital for Children, Des Moines, Iowa, and Clinical Associate Professor of Pediatrics, University of Iowa Hospitals & Clinics, Iowa City, Iowa, U.S.A. Jay L. Grosfeld, M.D. Professor and Director, Section of Pediatric Surgery, Indiana University School of Medicine, and Surgeon and Chief, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana, U.S.A. Arthur L. Herbst, M.D. Joseph Bolivar Delee Distinguised Service Professor and Chairman, Department of Obstetrics and Gynecology, The University of Chicago School of Medicine, Chicago Lying-In Hospital, Chicago, Illinois, U.S.A. Melissa L.F. Knuckles, M.D. Division, of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky, U.S.A. William L. Koontz, M.D. Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky, U.S.A. J. Patrick Lavery, M.D. Associate Professor, Department of Obstetrics and Gynecology, Director, Division of Maternal-Fetal Medicine, University of Louisville, Medical Director, Teenage Parent Program, Louisville, Kentucky, U.S.A. Peter A. Lee, M.D. Professor of Pediatrics, University of Pittsburgh, Children's Hospital, Pitts burgh, Pennsylvania, U.S.A. John D. Looff, M.D. Clinical Instructor, Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A. Byron J. Masterson, M.D. Professor and Chairman, Department of Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky, U.S.A. Paul G. MCDonough, M.D. Professor, Department of Obstetrics and Gynecology, Director, Reproductive Endocrine Section, Medical College of Georgia, School of Medicine, Augusta, Georgia, U.S.A. Elizabeth A. McGee, M.D. Assistant Director, Center for Public Advocacy Research, New York, New York, U.S.A.