Intrauterine devices in adolescents.

PURPOSE OF REVIEW: The stubborn epidemic of teen pregnancy remains a major public health problem in the United States. This review discusses the use of intrauterine devices (IUDs) in United States teens as a potential strategy to reduce teen pregnancy. Traditionally, the IUD was not thought of as an appropriate teen contraceptive method. RECENT FINDINGS: Recently, IUDs have become a recommended contraceptive option for adolescent females. This change reflects an understanding of the safety of modern IUDs, the potential for this highly effective method to reduce teen pregnancy, and the promotion of this strategy in teens by national organizations/governmental agencies including the Centers for Disease Control and Prevention, the World Health Organization, and the American College of Obstetricians and Gynecologists. Current data do not support that IUDs affect long-term fertility or increase sexually transmitted diseases in teens. SUMMARY: IUDs are now considered by many experts as a first-line contraceptive option for teens in the United States.

Normal onset of puberty have definitions of onset changed?

Puberty is the sequence of events that culminates in the ability to procreate. It is widely accepted that the onset of puberty in girls occurs on average at 8 years of age and that onset prior to 8 years of age is precocious puberty. As a result of the cross-sectional study by the American Association of Pediatrics, a movement exists to change the age limit of the onset of puberty to 6 years of age in black girls and 7 years of age in white girls. We should be cautious in adhering to strict age limits when diagnosing precocious puberty. Also the rapidity and progression of puberty should be evaluated, and if appropriate, therapy to suppress pubertal development considered.

Analysis of cystic fibrosis transmembrane conductance regulator gene mutations in patients with congenital absence of the uterus and vagina.

The relationship between cystic fibrosis transmembrane conductance regulator gene (CFTR) mutations and congenital absence of the uterus and vagina (CAUV) was examined. CFTR mutations have previously been associated with congenital bilateral absence of the vas deferens (CBAVD). CBAVD is caused by a disruption in the vas deferens, a Wolffian duct derivative. Because the embryologic development of the Müllerian ducts directly depends on the prior normal development of the Wolffian ducts, the same gene products may be necessary for normal embryologic development of both ductal systems. This study evaluated the role of CFTR mutations in the development of CAUV. DNA samples from 25 patients with CAUV were tested for the presence of 33 of the most common CFTR mutations. Protein-coding DNA fragments from the CFTR gene were amplified in vitro by the polymerase chain reaction (PCR) and analyzed for mutations using allele-specific oligonucleotide (ASO) probes. Two patients were heterozygous for CFTR mutations. One was heterozygous for the W1282X mutation and the other was heterozygous for the DeltaF508 mutation. The incidence of the 33 CFTR mutations found in the patients with CAUV (8%) was twice that found in the general population (4%), but much less than the incidence of CFTR mutations in men with CBAVD (80%). This data suggests that it is unlikely for CFTR mutations to cause CAUV in females as they cause CBAVD in some males. Furthermore, the data suggest that CAUV in females may be the same disorder as CBAVD in males who do not have CFTR mutations.