PAG over Pastries

We trace the line from “bad cramps” to a careful, compassionate evaluation for endometriosis, showing how physiology, history, and practical treatment choices restore a teen’s daily life. Evidence, empathy, and clear steps help shorten the long road to relief and reduce missed school and stress.• defining primary and secondary dysmenorrhea and why prostaglandins matter• prevalence figures and diagnostic uncertainty in adolescents• first line management with timed NSAIDs and continuous hormonal therapy• what to ask in the menstrual and symptom history• when to suspect endometriosis after failed therapy• broad differential including GI, GU, musculoskeletal and psychological causes• limits of labs and imaging and the value of diaries• multimodal care: PT, TENS, CBT, neuropathic agents• GnRH options with add back and prudent use of surgery• staging limits and mismatch with pain severity• mental health, trauma awareness and inclusive care for trans patientsWhat is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

We walk through a clear roadmap for evaluating heavy menstrual bleeding in teens, from what counts as normal to when labs and treatment should start. A case of a 15-year-old with 10-day periods and nosebleeds anchors a practical workup and evidence-based care plan.• Normal adolescent cycle ranges and red flags for heavy bleeding• Definitions that guide when to test and treat• Key causes in teens: anovulation and coagulopathy• Focused history and exam without routine pelvic exams• Labs that matter: pregnancy, ferritin, thyroid, coagulation, von Willebrand• When imaging helps and when it delays care• Iron repletion strategies and when to use IV iron• Hormonal vs nonhormonal therapy, adherence, and expectations• Acute management thresholds, IV estrogen, and layering therapy• Long-term options including levonorgestrel IUD and progestinsWhat is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

walk through what a healthy teen menstrual cycle looks like, why early cycles are often irregular, and how to recognize red flags that need care. We share practical ways to track flow, choose products, reduce pain, and support teens with sensitivity and clarity.• menarche timing, influences, and normal ranges• early anovulatory cycles and HPO axis maturation• typical cycle intervals and expected variability• defining normal flow, duration, and clot size• dysmenorrhea care with NSAIDs and heat• assessing heavy bleeding using product charts• clear red flags for evaluation and amenorrhea criteria• headaches, fainting, nausea, and quality of life• cycle tracking options and privacy cautions• product choices, period poverty, and advocacy• focused adolescent history, nutrition, and activity• culturally sensitive education and reassuranceWhat is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Dr. Susan Kaufman, pediatric gynecologist at Virtua Health, is joined by Dr. Tania Dumont, pediatric gynecologist from CHEO and the University of Ottawa, to break down how to perform a pediatric gynecologic exam with empathy, clarity, and evidence, from newborn anatomy to adolescent assessment. We show how language, positioning, and choice reduce fear while improving visualization, diagnosis, and outcomes.Reference: NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 4What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Dr. Susan Kaufman, PAG physician at Virtua health in New Jersey, and Dr. Olga Kciuk, PAG physician at Stanford University, walk through laparoscopic care for pediatric and adolescent patients from consent and anatomy to entry, pain control and recovery. The focus stays on safety, physiology, and teen-centered decisions that protect fertility and speed return to life.Reference: NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 30What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Venture into the intricate world of complex genitourinary anomalies with pediatric and adolescent gynecologists Drs. Susan Kaufman and Megan Sumida. Their discussion unravels the challenges and approaches to conditions that fundamentally alter the anatomical landscape for young patients.ReferenceNASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 25What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Dr. Susan Kaufman and Dr. Yossie Ahmadieh, an adolescent medicine doctor with Physicians for Reproductive Health, explore the vital topic of gender-affirming care for transgender and gender-diverse adolescents, discussing how appropriate medical interventions can be life-saving for these vulnerable youth.OutlineIntroduction to Transgender Healthcare BasicsBarriers and Mental Health ConsiderationsCreating Safe Spaces in Clinical SettingsPuberty Blockers and Treatment OptionsGender-Affirming Hormone Therapy ApproachesMonitoring Testosterone TherapyEstrogen Therapy and Anti-AndrogensSurgical Options and Cancer ScreeningReferenceNASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 3What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Dr. Vrunda Patel, a PAG physician at Nemours Children's Hospital in Wilmington, Delaware, and Dr. Camille Imbo PGY6 PAG fellow discuss the increasing trend of teenage patients seeking evaluation for labial concerns, often driven by appearance rather than medical issues. Many teens and parents lack understanding about what constitutes normal genital appearance.OutlineNormal Vulvar Development in PubertyCommon Labial Concerns and InfluencesDefining Labial Hypertrophy and AsymmetryPsychological Aspects and AssessmentTreatment Options and Self-CareSurgical Considerations and RecoveryReferenceNASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 16Labial Anatomy Concerns in the Adolescent - JPAG What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Fertility preservation options have dramatically expanded for children and adolescents in recent decades, offering hope to patients undergoing gonadotoxic therapies for cancer and other conditions. Dr. Stephanie DuFour, PAG and REI attending at CHEO in Ottawa, Canada, joins Dr. Susan Kaufman to discuss the latest advances in preserving reproductive potential for young patients facing treatments that may compromise their fertility.OutlineCase Presentation: 7-Year-Old with LeukemiaIntroduction to Fertility PreservationWho Needs Fertility PreservationExternal Impacts on FertilityFertility Preservation OptionsAssessing and Monitoring PatientsBarriers and Insurance CoverageCase Resolution and ConclusionReferences:  NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 23 What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Dr. Jane Su, a PGY4 OBGYN resident at university of Ottawa, joins Dr. Susan Kaufman to discuss POI with a special emphasis on Turner's syndrome. Both important and life changing diagnoses that cannot be missed!OutlineCase PresentationIntroduction to POI Defining POI: Causes and PrevalenceClinical Presentation and Diagnostic ApproachTreatment Strategies for POITurner Syndrome: Characteristics and ManagementCase Conclusion and Key TakeawaysReferences:  NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 18What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Dr. Julie Cron, an OBGYN with PAG certification at Presbytarian and Cornell, joins Dr. Camille Imbo PGY6 to explore amenorrhea - the absence of menstruation - breaking down how to evaluate and diagnose this important vital sign in adolescent patients.OutlineIntroduction to Amenorrhea TypesPhysical Exam ImportanceHormonal Evaluation & CausesUnderstanding Lab ResultsGenetics and Structural CausesSecondary Amenorrhea & PCOSCase Discussion and ConclusionReferences:  NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 11What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

This episode, we are joined by Dr. Aliah Fonteh, a PGY2 resident, and Dr. Alla Vash-Margita a PAG attending at Yale to break down what every provider should know about sexually transmitted infections. OutlineIntroducing STIs in Adolescent CareConfidential Interviews with Teen PatientsCommon STIs: Chlamydia, Gonorrhea, TrichomonasSyphilis: Screening and Diagnostic ChallengesHPV and Vaccination: Preventing CancerHSV and HIV PrEP ManagementSTI Testing Recommendations and PIDCase Discussion and ConclusionReferences:  NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 20Human Papillomavirus Vaccine Efficacy and Effectiveness against Cancer by Supitcha Kamolratanakul and Punnee Pitisuttithum What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Dive into the fascinating world of Pediatric and Adolescent Gynecology (PAG) with this week's guest, Dr. Lissa Yu from Seattle Children's Hospital. This conversation shatters common misconceptions about what PAG specialists actually do - far beyond just teen pregnancy and contraception.OutlineWhat is PAG? History and ScopeWhy Choose PAG as a Specialty?Common Conditions and Patient CareResearch Opportunities and Typical DayBecoming a PAG: Training PathwaysProfessional Resources and OrganizationsWhat is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Dr. Susan Kaufman is joined by Dr. Mary Romano, a PAG physician from Vanderbilt and the current president of NASPAG, to discuss Relative Energy Deficiency in Sports (RED-S) previously knows as the Female Athlete Triad. Outline:• Highlights of a case study involving a 17-year-old athlete• Identifying high-risk sports for developing energy deficiency• Psychological and physiological impacts of inadequate energy• Importance of early detection and intervention strategies• Key roles of nutrition and hydration in athlete health• Holistic approaches to treatment, involving multiple disciplines• Empowering parents and coaches to support athletes effectively• Importance of addressing hormonal imbalances with appropriate therapiesReferences: - NASPAG Essentials of Pediatric and Adolescent Gynecology: Chapter 13- Reproductive Health Management of Female Adolescent Athletes With Relative-Energy Deficiency in Sport by Mary Romano and Amy Sass in Journal of Pediatric and Adolescent GynecologyWhat is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Camille Imbo, MD PGY6 and Susan Kaufman, MD talk about how to work up and examine prepubertal bleeding, as well as differential diagnoses. OutlinePatient and Family HistoryExamination techniques and consentpositioning and observation techniquesdifferential diagnoses of prepubertal bleedingCommon CausesRare CausesCase reviewCheck out the episode visuals on YouTube.References:Clinical Review: Prepubertal Bleeding, Valerie Bloomfield, MD, FRCSC, Abigail Iseyemi, MD,FRCSC, Sari Kives, MD, MSc, FRCSC, JPAG, 2023Current review of prepubertal vaginal bleeding, Dwiggins, Gomez-Lobo, 2017Essentials of Pediatric and Adolescent Gynecology: Chapter 7What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Camille Imbo, MD PGY6 and Susan Kaufman, MD discuss delayed puberty, the last in their series on puberty. The episode provides an in-depth exploration of delayed puberty, discussing key signs and the clinical evaluation process for young teens facing this challenge. It addresses common causes, the importance of physical exams, and appropriate treatments while offering reassurance and guidance for families.Check out the video on YouTube. Outline• Defining delayed puberty by breast development and menstruation standards • Importance of comprehensive medical and family history in evaluations • Role of growth charts in monitoring physical development • Value of physical exams in diagnosing anatomical issues • Differentiating between hypogonadotropic and hypergonadotropic hypogonadism • Exploring hormonal treatments and lifestyle changes • Addressing oncofertility considerations for young patients • Understanding eugonadotropic amenorrhea and its anatomical causes • Concluding reassurance and guidance for families on managing delayed pubertyReferences:Essentials of Pediatric and Adolescent Gynecology: Chapter 6What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

In this next part of the puberty series, Camille Imbo, MD and Susan Kaufman, MD discuss precocious puberty including isolated, peripheral, and central precocious puberty. They also discuss treatment and management goals. Outline- Understanding Abnormal Puberty- Types of precocious puberty- Peripheral precocious Puberty- McCune Albright Syndrome- Central Precocious Puberty- Treatment- Case discussion and managementCheck out the visual post on YouTube. References:Essentials of Pediatric and Adolescent Gynecology: Chapter 6What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

A short introduction to what is PAG over Pastries, its format, and what we hope you get out of it. Check out the visual post on YouTube. What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content. 

Camille Imbo, MD PGY6 and Susan Kaufman, MD talk about normal puberty, the many axes involved, the milestones, and expected timing of each.References:Essentials of Pediatric and Adolescent Gynecology: Chapter 5Check out the visual post on YouTube.What is PAG?Pediatric and Adolescent Gynecology is a subspecialty of OBGYN (2 year fellowship) focusing on reproductive healthcare for children and young adults. It fills the overlap between general gynecologists and pediatricians. It is a multi-disciplinary field involving work with pediatric endocrinology, dermatology, hematology, surgery, ect. Go to NASPAG.org for more PAG educational resources.Want to test your knowledge?PAG WebEd cases are a great way to review our podcast content.