Pediatric and Adolescent Gynecology
What is pediatric and adolescent gynecology?
Pediatric and adolescent gynecology focuses on conditions of the uterus, ovaries, vagina and vulva.
Pediatric and Adolescent Gynecology at Seattle Children’s
Our team provides comprehensive evaluation and specialized treatment for gynecological conditions in children, adolescents and young adults. We treat people from birth to age 21 and often care for adolescents who are medically complex or may need surgical treatment. We work closely with experts from other clinics to provide the best care possible, including:
- Cloacal anomalies and bladder exstrophy
- Differences in sex development
- Gender care
- Gynecological care for females with cancer or bleeding disorders
- Vascular anomalies of the reproductive tract
Why choose Seattle Children’s Pediatric and Adolescent Gynecology team?
Our Pediatric and Adolescent Gynecology team works closely with you, your child and other members of the healthcare team to meet the unique needs of your child.
At Seattle Children’s, your family has a team helping you from diagnosis through treatment and follow-up. We work together with providers who are experts in many different fields. From our appointment schedulers to our pediatric nurses, our team is specially trained to work with children, adolescents and their families.
Research shows that a person’s physical, emotional and social development during adolescence can affect their overall health throughout their life. Our Pediatric and Adolescent Gynecology specialists are board-certified in obstetrics and gynecology and have a certificate of specialized practice in pediatric and adolescent gynecology. This training gives us a deeper understanding of the development that happens during infancy, childhood, adolescence and into early adulthood. It also helps us create a care plan that uniquely addresses your child’s development now and in the future.
Our team is involved in research that is transforming the diagnosis, treatment and care of conditions affecting adolescents and young adults. We are studying new ways to improve gynecological and reproductive health for adolescents. Some of the topics we have studied or are currently studying are:
- Experiences of adolescents who use long-acting contraception (LARC), like intrauterine devices (IUDs)
- Providing the best treatments for conditions, including congenital differences (anomalies) of the reproductive system and differences of the labia
- Caring for the gynecological concerns for patients with other medical conditions, like Ehlers-Danlos, or those who have undergone organ transplantation or hematopoietic stem cell transplantation
- Educating providers in other specialties about how to treat children and adolescents with gynecological health needs
Conditions We Treat
We care for children and teens with a broad range of gynecological concerns, including:
Fluid (discharge) from the vagina helps to clean the vagina and protect it from infection. Unusual discharge may be a sign of a problem. Before puberty, it may be a sign of an infection, skin irritation, allergy, inflammation of the vulva (outer part of the female genitals) or having something in the vagina (like pieces of toilet paper). After puberty, unusual discharge is often caused by a yeast infection, bacterial infection or sexually transmitted infection.
Androgen insensitivity syndrome happens when the body is unable to respond to androgens, like testosterone. Most people who have androgen insensitivity syndrome have female genitals and are diagnosed with the condition after they have breast development with puberty but never have a menstrual period. Some people are diagnosed as infants when they are evaluated for inguinal hernias.
Some babies have differences (anomalies) in their reproductive organs that happen as the organs form. These differences are present at birth (congenital). They may be found at birth or later in life, such as at puberty. The organs inside the body (uterus, cervix, vagina and hymen) and outside the body (labia and clitoris) may be affected. Learn more about developmental differences of the female reproductive organs. (PDF)
Signs of puberty, such as developing breasts and starting menstrual periods, usually begin in the early teens. The age range varies. Development may begin later for many reasons. Sometimes medical problems can cause delayed puberty. In these cases, careful treatment with hormone medicines may help.
Our doctors care for babies, children and adolescents with all types of DSDs through the Pediatric and Adolescent Gynecology Clinic and the Differences in Sex Development program. DSDs include intersex conditions and conditions that affect how genitals develop. Conditions we treat include changes in genes or chromosomes, problems with hormones or issues with the testicles or ovaries.
Signs of puberty, such as developing breasts and starting menstrual periods, usually begin in the early teens. The age range varies. Development may begin earlier for many reasons. Sometimes medical problems can cause early puberty.
Endometriosis is when tissue that is similar to the lining of the uterus grows outside of the uterus. The most common places where endometriosis occurs are the ovaries; the fallopian tubes; the bowel; and the areas in front, back and to the sides of the uterus. Some people with endometriosis have few or no symptoms, while others have pain or difficulty getting pregnant. The best treatment depends on your individual situation.
The skin around the outside of the vagina (labia) may grow together in places (labial adhesions). Some children and adolescents have labia that are larger than average. This may cause discomfort. Medicines like estrogen or steroid creams may be needed for conditions that affect the labia. Rarely, surgery is considered for labial conditions. Read more on labial adhesions (PDF) and labia minora hypertrophy (PDF).
In MRKH syndrome, a baby is born with a small or not fully developed vagina. There may also be a small or absent uterus. People with MRKH experience normal puberty but never have a period. We offer evaluation and management of MRKH. Read more on MRKH syndrome (PDF).
Youth may have a range of problems with menstrual periods. Their periods may be hard to predict, painful, too frequent or too heavy, or they may not get periods. Youth with other medical conditions may require special consideration for the management of their menstrual symptoms because of medication interactions or worsening of their other condition during menstruation. Learn more about the symptoms, causes and treatments of painful periods (PDF) (Spanish).
Ovarian cysts (fluid-filled sacs) tend to happen when the ovary is making an egg (follicle). Surgery may be needed if your child has cysts that are large, cause pain, limit blood flow to the ovaries or might be tumors. Often, we can remove cysts with surgery using small incisions (minimally invasive techniques) and preserve the ovary and fallopian tubes. Our goal is to preserve your child’s option to have children in the future. Read more on ovarian cysts (PDF) (Spanish).
Primary ovarian insufficiency is a condition where the ovaries stop releasing eggs and hormones earlier than expected (or never start). Learn more about primary ovarian insufficiency (PDF).
Your child may have swelling, pain, itching or sores (ulcers) in the skin on the outside of their genitals (vulva). An infection, irritation or inflammatory disorder may trigger these symptoms. Treatment to control these problems and to soothe the skin may help.
Turner syndrome is a genetic condition. It happens when a person assigned female at birth is born with only 1 X chromosome instead of 2 or is missing part of an X chromosome. About 1 in every 2,000 people assigned female at birth has Turner syndrome. Seattle Children’s Turner Syndrome Clinic cares for people with Turner syndrome from birth through age 21. Our team in the Pediatric and Adolescent Gynecology Clinic offers evaluation and treatment of gynecological issues in people with Turner syndrome.
Vaginitis is an infection or inflammation of the vagina. If it also involves the outside of the genitals (vulva), it’s called vulvovaginitis. It can happen because of a yeast infection, sexually transmitted infection or other infection. It can also happen because the skin is irritated by laundry soap or bath products, for example. Some children may get vaginitis if they are too small to fit well on the toilet seat. This may cause urine to enter their vagina when they urinate. Read more on vulvovaginitis (PDF) (Spanish).
Services We Provide
When young people are thinking of using birth control (contraceptives) for family planning, healthcare providers can help them find a safe and effective method that fits their needs. Birth control pills (oral contraceptives) may also help treat certain conditions, including some problems with menstrual periods. We also offer long-term contraceptives that are reliable and safe for teens, such as Mirena and the etonorgestrel implant.
Medicines may help with many gynecological problems, like vaginal infections or skin irritations. Hormones may improve some conditions like polycystic ovary syndrome (PCOS) or endometriosis. We offer a full range of medical treatments for reproductive health concerns.
Taking steps to control your child’s menstrual period may help with many kinds of issues. We offer treatment for heavy or painful periods, seizures linked to periods, endometriosis and other conditions. We can also help if your child has disabilities that make it hard to manage periods. The best options depend on the needs of each child or adolescent. In our clinic, options include hormones taken by mouth (orally) or through a skin patch (transdermally), Depo-Provera shots, intrauterine devices and other treatments.
This is surgery done through small cuts (incisions). The advantage of this technique is that surgeons don’t need to cut through as much tissue as when they make a longer incision. Your child is likely to have less pain and to recover faster. This means a quicker return to school, sports or other activities. This technique only leaves a small scar on the outside of the bellybutton, which may be unnoticeable. It also causes less scar tissue inside, making it less likely to affect fertility. Gynecological surgery is used most often to treat ovarian cysts and pelvic pain. Learn more about laparoscopy for gynecological procedures (PDF).
Objects can sometimes get stuck in the vagina. The most common objects are pieces of toilet paper. Small toys or other objects can also get stuck. Sometimes a trapped object is the reason for unusual discharge. Our doctors may be able to remove an object during a clinic visit. In some cases, we may need to remove the object with sedation.
We see many children and adolescents with differences in the way their reproductive organs formed. We work closely with providers from other clinics and services, including our Differences in Sex Development program, to diagnose and treat these conditions. Our team offers a range of surgical and nonsurgical treatment options.
Scheduling an Appointment With Pediatric and Adolescent Gynecology
- If you would like a referral to Pediatric and Adolescent Gynecology, talk to your primary care provider. If you already have a referral, please call 206-987-2028, option 2, to schedule an appointment
- If you already have an appointment, learn more about what to expect and how to prepare.
- Learn about Pediatric and Adolescent Gynecology resources such as useful links, videos and recommended reading for you and your family.
For more information, contact Pediatric and Adolescent Gynecology at 206-987-2028. If you would like an appointment, please call us. We see patients in Seattle, Bellevue, Everett and Federal Way. We may ask your primary care provider for more information in order to provide the most complete care.
Telemedicine at Seattle Children’s
You may be offered a telehealth (virtual) appointment. Learn more.
Confidentiality in Washington State
Parents and caregivers are very important for ensuring the growth and development of adolescents into healthy adults. We encourage our patients to speak with their parents or caregivers about their health.
As providers, we are also dedicated to helping children, adolescents and young adults develop independence and practice being involved in medical decisions. As recommended by the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, and the American College of Obstetrics and Gynecology, we offer our patients time in the Adolescent Medicine Clinic to talk with their provider alone.
Under Washington state law, adolescents have the right to seek medical care for the following conditions even without parent or caregiver consent if they are capable of making sound decisions:
- Birth control and pregnancy-related treatment
- Mental health conditions if 13 or older
- Alcohol and drug problems if 13 or older
- Sexually transmitted infections, including HIV/AIDS testing, if 14 or older
Your child’s medical records are private and confidential. They will need to consent to releasing medical information to anyone, including their parents or caregivers.
Washington state privacy laws make it complicated for parents and caregivers to access teen health information. If your child’s health or someone else’s health or well-being is in immediate danger, however, we will tell you immediately and include you in the plan to keep your child or someone else safe.