Introduction

Preceding chapters have discussed the specialist management of paediatric and adolescent patients with gynaecological problems. They have also addressed some of the generic issues associated with their care. When many of us began to be interested in this area of gynaecological care, we did not fully appreciate its breadth. Adolescent and paediatric gynaecology covers any gynaecological condition presenting in a girl less than 19 years of age and includes intersex, developmental and endocrine disorders as well as menstrual dysfunction, infection, vulval disorders and the sequelae of oncological treatment of childhood tumours.

In the past, children with complex problems who outgrew the paediatric clinic were either discharged to their general practitioners (GPs) or care was transferred to a variety of adult clinics. Many of these adolescents have gynaecological problems. These require a specific approach, both in consultation and subsequent management, that involves an understanding of both gynaecology and the specific needs of adolescents. The adolescent gynaecologist acts as a transitional carer between the paediatricians and the adult physician and needs to act in liaison with both. Some adolescents with gynaecological problems, and in particular those with genetic problems, also need to see a variety of other specialists. A lack of coordinated care and multiple visits has negative implications both socially and emotionally. Throughout this book we have, therefore, advocated a multidisciplinary approach to our patients.