# Gynecological issues in children and adolescents seen at rare-disease referral centers: an observational retrospective cohort study

## TL;DR

This study examines gynecological issues in children and adolescents with rare diseases, highlighting the most common conditions and reasons for seeking care.

## Contribution

The study provides insights into the prevalence and management of rare gynecological conditions in pediatric patients.

## Key findings

- Gynecological repercussions of rare chronic diseases were the most common reason for visits (78.8%).
- Dysmenorrhea and menorrhagia were the leading specific reasons for gynecology consultations.
- Collaboration among specialists is essential due to the complex interactions between rare diseases and gynecological conditions.

## Abstract

The current development of gynecology services for children and adolescents seeks to meet needs both in the overall population and in patients with rare diseases. In France, the referral center for rare gynecological diseases specializes in four major types of conditions, namely, uterovaginal malformations, hereditary hemorrhagic diseases, rare benign breast diseases, and gynecological repercussions of rare chronic diseases.

To describe consecutive patients who had a first visit in 2018–2023 at the referral center for rare gynecological diseases at the Necker Pediatric University Hospital in Paris, France, and who were diagnosed with a condition in any of the four categories listed above.

For this single-center retrospective observational cohort study, data from the referral-center database were collected and reviewed. These data included year of birth, age at and reason for first gynecology visit, and rare chronic disease and referring rare-disease center for patients seen for gynecological repercussions of rare chronic diseases.

The 704 included patients had a median age of 15.2 years (interquartile range 3.8) at the first visit. Among them, 100 (14.2%) had uterovaginal malformations, 32 (4.6%) hereditary hemorrhagic diseases, 17 (2.4%) rare benign breast diseases, and 555 (78.8%) gynecological repercussions of rare chronic diseases. The leading reasons for the visit were dysmenorrhea (15.6%), menorrhagia (15.5%), uterovaginal malformations (15.2%), and irregular periods (14.9%).

Repercussions of rare chronic diseases managed at rare-disease referral centers were by far the leading reason for seeking gynecological expertise in rare diseases. In this complex situation, the underlying disease and its treatments interact with the gynecological manifestations and their treatment, requiring close collaboration among all specialists caring for each patient.