Gynaecology (paediatric and adolescent)

Overview

Please see the Children's and Adolescent Gynaecology page on the UHBW website.

UHBW runs a Tertiary Level Paediatric and Adolescent Gynaecology (PAG) service at St. Michael’s Hospital.  

The service provides age appropriate care to children and adolescents with gynaecological problems of all types in a welcoming and supportive environment. They also offer support through the period of transition from children’s to adult services for those patients requiring longer-term input, working closely with Bristol Royal Hospital for Children.

Clinics:

• Several general PAG clinics every month on Mondays and Fridays
• Monthly joint clinic with the adult endocrinologists where we see our older patients with conditions such as Turner Syndrome
• Four times a year they run a joint clinic with the paediatric endocrinology and psychology teams. This acts as a transition clinic to adult services
• A one-stop adolescent menorrhagia clinic where a trans-abdominal pelvic ultrasound may be performed is in development
• A psychologist for our older adolescents and adults as well as for the paediatric DSD patients

 They can see children/adolescents from age 2 years old with the following conditions:

• Vulval conditions (vulvovaginitis, labial fusion, lichen sclerosus). These patients can also be seen at the Star clinic.
• Vaginal discharge
• Period problems (heavy periods, painful periods, oligomenorrhoea, primary or secondary amenorrhoea)
• Pelvic pain
• Ovarian conditions (including ovarian and para-ovarian cysts) in post-pubertal patients. Pre-pubertal should be referred to Paedatrics.
• Mullerian duct anomalies (including Mayer-Rokitansky-Küster-Hauser Syndrome)
• FGM in post-pubertal children. (Pleae note requirements for mandatory reporting of FGM in children <18 - see FGM in children page for further details). FGM in pre-pubertal children should be seen at the STAR clinic.
• Late effects of childhood cancer, including primary ovarian insufficiency
• Differences in Sex Development (DSD), including Turner Syndrome

The Paediatric Endocrinology team will often review these last two types of patients if they present at a younger age. They will then progress through our transition clinic.

The British Society for Paediatric and Adolescent Gynaecology (BritSPAG) also has a resources page with useful patient leaflets. 

Red Flag

Pre-pubertal children with vaginal bleeding should be seen urgently via paediatrics, if extremely heavy this may be via Children's ED.​

FAQs

Labial adhesions

Please see the Bristol Royal Hospital for Children guideline about labial adhesions 

Imperforate hymen is an unusual diagnosis in a prepubertal girl and is often mistaken for labial adhesions.

There is a  helpful leaflet on the British Society of Paediatric and Adolescent Gynaecologists (BritSPAG) website:

Leaflets – BritSPAG

Surgery is not required, so advice and reassurance is usually all that is needed. Routine referral can be made if there are still concerns if patient is aged 2 or over. If referring for a patient aged under 2 this would require a general paediatric referral (but is rarely required).

Mullerian Anomalies (including imperforate hymen)

For imperforate hymen or any Mullerian Anomaly (picked up incidentally on scan) the gynaecologists recommend they don't see patients until early stage of puberty, which generally would be age 10 onwards. 

There is a helpful leaflet on the BritSPAG website:

Leaflets – BritSPAG

Vulvovaginitis

See the Parents Information leaflets section for information on Vulvovaginitis

Please note that the paediatric gynaecology team advise that thrush is very unlikely to be a cause of vulvovaginitis in pre-pubertal children so using anti-fungal creams in this age group should be avoided.

Referral

St Michaels Hospital

Referrals should be made to the Paediatric and Adolescent Gynaecology Service at St Michael's Hospital via eRS. Patients aged from the age of 2 and up to 20 years old can be referred to this service. Some patients continue to be seen into adulthood.

There is no upper age limit for DSD, Turner syndrome. Adult patients with Turner Syndrome can be referred and will be seen in the joint clinic with the endocrinologists

RUH Bath

Please note the RUH:

• Don’t have any formal joint clinics or psychologist for PAG
• See all patients referred and if need be, do internal referral to Paediatrics or endocrinology
• Dont have a specific age range and will see any appropriate referral

Patients can be referred to this service via eRS 

Exclusions:

• sexual health issues
• child protection concerns

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Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.