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Patterns of Pediatric and Adolescent Gynecological Problems in China: A Hospital-Based Retrospective Study of 97,252 Patients and a Systematic Review

Background: Gynecological and reproductive problems that arise during childhood and adolescence can have a significant impact on individuals, families and society, and they are increasingly recognized as a public health priority. 
 
Methods: We conducted a retrospective study based on the electronic medical records of 207,287 gynecological visits over a period of 13 years (January 2006 to December 2018) at the Department of Pediatric and Adolescent Gynecology of The Children’s Hospital, Zhejiang University Medical School. The final analyses included 97,252 patients with gynecological problems. Additionally, we conducted a systematic review focused on previous studies examining PAG problems in China. 
 
Findings: The number of first-visit PAG patients increased from 4,582 to 11,876 during 2006-2018. Overall, genital inflammation was the most common presentation (57·0%), followed by early puberty (18·2%) and consultation of growth and development (10·2%). The proportion of other problems such as gynecological examination, menstrual disorder, other endocrine problems, genital trauma, masturbation syndrome, anomalies of the genital tract, and genital tumor, ranged from 0·5% to 5·6%. The disease pattern varied across age groups: among the 0-6 age group, over 78·0% had genital inflammation; for the 7-9 age group, genital inflammation and early puberty accounted for 43·4% and 39·6% of the cases, respectively; for ages 10-18, the most common problems were consultation of growth and development (34·9%), genital inflammation (21·4%), and menstrual disorder (20·7%). Twenty-two studies analyzing patterns of PAG issues in outpatient settings in China were included in the systematic review, showing an average weighted percentage of 48·8% for genital inflammation and 25·2% for menstrual disorder. 
 
Interpretation: Genital inflammation was the most common issue for pediatric and adolescent patients with gynecological problems. Other common issues included early puberty for children and teenagers, and consultation of growth and development and menstrual disorder for adolescents. 
 
Funding: The National Nature Science Foundation of Zhejiang (LQ18H040001, LY20H040011) 
Medical Scientific Projects from Health department of Zhejiang Province(2017KY101). 
 
Declaration of interests: The authors report no conflict of interests. 
 
Ethical Approval: The study was approved by the Human Subjects Committees of the Children’s Hospital, Zhejiang University School of Medicine.