Adolescent gynaecology: anaesthetic and peri‐operative care implications

Abstract

Summary Adolescents represent a quarter of the world’s population, yet their specific healthcare needs have often not been acknowledged. Whilst many operations in this population will be performed in specialist tertiary centres and children’s hospitals, it is likely that care will be sought in a variety of healthcare settings, and so it is important to have an understanding of the particular approach to this age group. Paediatric and adolescent gynaecology emerged as a speciality in 2000 with the inauguration of the British Society for Paediatric and Adolescent Gynaecology, a specialist society of the Royal College of Obstetricians and Gynaecologists. This is a multidisciplinary group, comprising paediatricians, paediatric surgeons, psychologists and nurses, although the majority of the members are gynaecologists. In this review, we will describe the peri‐operative implications of adolescent gynaecological surgery and the considerations that need to be applied to this specific age group, such as consent, the operative setting and key personnel. We will also discuss specialist situations which are likely to fall to an adolescent gynaecology setting, such as management of those with Mullerian abnormalities, which often present with pelvic pain in adolescence. We discuss those with a history of ritual female genital cutting (female genital mutilation), trans men and those with significant learning difficulties. In all circumstances, teamwork, reflection and pragmatism are key.

Heavy menstrual bleeding in adolescence: who to investigate and how to manage it

“…41 The LNG-IUS can be fitted in gynaecology outpatients; however, specific groups may benefit from placement under general anaesthesia: girls who are not sexually active or those with learning disabilities. 42 Consideration should be given to the list order and location of post-operative care to minimise anxiety and maintain dignity. The hymen may become inadvertently stretched during the procedure and it is important that girls and carers are aware of this possibility.…”