For each problem or diagnosis, the educational effort begins with the first appointment as history, physical examination, and treatment options are discussed. Diagnoses may range from vaginitis to menstrual disorders to vaginal agenesis to life-threatening cancers. Sometimes the diagnosis is apparent at the first visit, but often further tests are needed to confirm a suspected diagnosis. When testing is done following the initial consultation, health care providers generally arrange to meet with girls and their parents for a follow-up visit to explain the results of the tests, address questions, provide educational materials, and formulate a treatment plan. We find this approach more effective than conveying results and treatment options over the phone. Visual aids such as a pelvic model or diagrams can be extremely helpful when explaining the reproductive system to adolescents. A learning opportunity often follows with a discussion of treatment options and allows time for questions and answers by the patient and her parent(s). The second or follow-up visit is a key opportunity for dialogue of treatment options and to engage the adolescent so that she is involved in her treatment plan. The health care provider can also assess the adolescent’s understanding of her diagnosis as well as her ability and desire to adhere to specific treatment strategies. For example, if the health care provider is considering continuous oral contraceptives for the treatment of endometriosis, it is important to understand the adolescent’s lifestyle, her concerns, and any preconceived ideas that she may have such as worry over weight gain. Having this knowledge will ultimately help the health care provider to assess whether the adolescent will be able to take her medication consistently or if some other formulation such as the use of a hormone ring would be more effective.

Pamphlets and our Web-based materials from the Center for Young Women’s Health at Children’s Hospital Boston (www.youngwomenshealth.org) can further clarify information discussed in the office about a particular diagnosis and specific treatment options and provide patients and their parents with material to read at home under less stressful conditions. Compliance with treatment plans often improves when myths are dispelled and medical information is clarified. For example, the information guide on lichen sclerosis on our Web site is especially helpful to parents of young children as much of the information on the Web is written for adult women and parents are often hesitant to use the prescribed medication after researching this diagnosis. Health information guides that are appealing to teens, are developmentally appropriate, and have simple diagrams and content with key educational messages help the teen to understand her condition and get her involved in her treatment plan (1).

With the advancement of Web-based resources, teens and families have access to a plethora of medical information. Unfortunately, not all of the information available online is accurate. It is therefore highly recommended that health care providers become familiar with online resources so that they can recommend reliable and teen-friendly Web sites to their patients and parents. Online health education materials including health guides, quizzes, chats, blogs, and other resources can greatly enhance a teen’s awareness about her disease and proposed treatment plan. We provide these resources at no charge to teens, families, and health care providers at www.youngwomenshealth.org. These resources, however, should not replace ongoing discussions between patients and health care providers. Reinforcement of information and ongoing dialogue are critical since questions may be repeated at each visit.

Comprehensive preoperative preparation of patients undergoing surgical procedures is essential to ensure a positive experience for the patient and her parent(s) or legal guardian. Preoperative teaching prepares a child of any age, thus decreasing anxiety and the fear of the unknown that surrounds impending surgical procedures. Frisch and colleagues concluded that presurgical educational programs and parental involvement in the surgical experience can help alleviate the anxiety of both children and parents during the pediatric surgical experience (2). For patients undergoing pediatric and adolescent gynecologic surgery, the developmental issues of childhood and adolescence and issues of sexuality increase the need for an educational approach that is both comprehensive and respectful of sensitive topics.

The need for surgical preparation is twofold—to prepare the patient and her parents for surgery and to assess the patient for medical needs that may require further evaluation before she receives anesthesia and surgery. Most gynecology patients are scheduled for day surgical procedures. A child with von Willebrand disease may require desmopressin (DDAVP) in the preoperative area, and the patient with diabetes will need orders for insulin during surgery. In our practice, the nurse meets with the patient and family after they meet with the surgeon. The family will have already discussed the surgical procedure and signed an informed consent form with the gynecologist. The patient and/or guardian then fills out a detailed medical history form
that the nurse then reviews with the family, carefully questioning them and obtaining further details about any medical conditions that might have been checked on the form such as a “heart murmur” under “cardiac history.” Records will be obtained from the cardiologist or the patient will be scheduled for a cardiac evaluation at our institution. Girls with an eating disorder must be asked additional questions as the anesthesiologist may require a recent electrolyte workup.

Effective preoperative and perioperative teaching in the pediatric setting must always include consideration of the parents’ needs and fears. Children are very adept at sensing their parents’ feelings and level of stress. A study by Li and colleagues showed that both children and their parents reported lower anxiety scores in the pre- and postoperative periods when the parents were involved in the preparation for surgery. Also, children exhibited fewer instances of negative emotional behaviors and parents reported greater satisfaction (3). Procedures involving the reproductive organs, whether the patient is an infant, a child, or an adolescent, may create a higher level of anxiety than procedures involving other parts of the body. The social, cultural, and psychological effects of genital surgery can be significant and must be addressed preoperatively. Parents may have fears about a child’s virginity during procedures such as a vaginal examination under anesthesia or repair of a hymenal abnormality. Because parents report that their own anxiety and stress may prevent them from understanding or remembering all of the information provided before surgery, health care providers should recognize the need to reintroduce concepts, repeat information, and provide Web-based resources and printed materials that are culturally sensitive (4). The details of the procedure, intraoperative care, and postoperative management should be clearly outlined and the risks and benefits of the surgery discussed with the child’s parent(s) or legal guardian. The patient and guardian should be given ample opportunity to express concerns and fears, and to ask questions, in a relaxed setting (4). Based on the parents’ level of stress, it is best to obtain surgical informed consent prior to the day of the procedure.

Generally, the overall experience is much less stressful when a child/young adolescent is prepared for surgery. Additionally, it has been demonstrated that children who have support throughout their hospitalization recover more quickly and have fewer emotional problems, such as separation anxiety and sleep disturbances, than those who are not prepared (5). Written instructions and educational pamphlets should be given to adolescents and their parents to review at home and surgical masks and head covers given to small children to take home for role-playing.