Pediatric and Adolescent Gynecology Education Through Simulation (Pages): A Pilot Study

Participants: Patients younger than 22 years of age with chronic pelvic pain from January 2009 to December 2009. Main Outcome Measures: Results of operative laparoscopy including stage and description of endometrial lesions. Presenting symptoms of those with endometriosis was also evaluated. Results: Ninety-eight percent (115/117) of the study population was found to have endometriosis. The median age of the subjects at the time of laparoscopy was 16 years old (range 12 to 21). All subjects had either stage I or II disease as determined by the American Society for Reproductive Medicine's classification system. The median age of first symptoms was 13 (range 10-18) and the median age of menarche was 12 (range 9-14). The nature of pain in subjects with endometriosis was cyclic only in 58/115 (50.4%), acyclic only in 12/115 (10.4%), and both cyclic and acyclic in 45/115 (39.1%). Other presenting symptoms included gastrointestinal in 18 (15.7%), urinary in 3 (2.6%), irregular menses in 9 (7.8%), and menorrhagia in 4 (3.5%). Seventy-six percent (44/58) of participants of which we have data had a family history of endometriosis, severe dysmenorrhea, and/or infertility. Conclusions: Adolescents with chronic pelvic pain not responsive to conventional medical management have a significantly higher rate of endometriosis than previously perceived. These patients should be referred to gynecologists experienced with subtle laparoscopic findings of atypical endometriosis for diagnosis of etiologies of pelvic pain and for appropriate postoperative management. Several factors may account for this increase in diagnosis of endometriosis at our institution. These include improved laparoscopic optics, improvements in visualization of endometrial lesions using “close tip” and “underwater” techniques, biopsy of visually negative pelvises, and increasing experience of the surgeon. Further studies are needed to determine if early diagnosis and treatment prevents progression of endometriosis and infertility.