Primary amenorrheas: normogonadotropic, hypogonadotropic, hypergonadotropic

Primary amenorrheas: normogonadotropic, hypogonadotropic, hypergonadotropic

Vincenzina Bruni 1 Orcid, Metella Dei Orcid

1 – University of Florence

2 – Endocrinologist gynecologist. Freelancer

Corresponding Author: Vincenzina Bruni

vbruni@unifi.it


DOI: 10.53146/lriog1202160

Abstract

Menarche is a critical cue of female sexual and reproductive health. Therefore, the absence of menses at appropriate age needs a competent evaluation. The article outlines the various pathogenesis behind the symptom of primary amenorrhea, starting from situations not related to endocrine disorders such as outflow tract obstruction or uterine underdevelopment. The diagnostic assessment in situations of hypogonadism is often a challenge for the clinician and may require successive rounds of investigation, especially in the differential diagnosis between pubertal delay and hypogonadotropic hypogonadism. An impaired development of the gonads is, for females, one of the leading causes of primary amenorrhea: understanding the genetics behind gonadal dysgenesis improves the ongoing care of the girl and the prediction of associated medical problems. Therapeutic options for these different situations will be the topic of a following review.

Keywords: primary amenorrhoea; constitutional pubertal delay, hypogonadotropic hypogonadism; functional hypogonadism; premature ovarian deficiency.


Available in LRIOG Nr.1 – 2022

e-ISSN: 1824-0283


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Sexual abuse: how to recognize symptoms and signs in a child and in an adolescent

Sexual abuse: how to recognize symptoms and signs in a child and in an adolescent
Vincenzina BruniOrcid, Metella DeiOrcid , Pina MertinoOrcid

1 – University of Florence

2 – Endocrinologist gynecologist. l. p. Florence

3 – Childhood and Adolescent Gynecology Operational Structure, University Hospital, Careggi Florence

Corresponding Author: Vincenzina Bruni

vbruni@unifi.it


DOI: 10.53146/lriog1202144

Abstract

Sexual abuse toward children and adolescents, i.e. the involvement of a child in sexual acts that she or he does not comprehend and cannot give consent to, is a common occurrence. The intervention in suspected sexual abuse is complex and requires an expert multidisciplinary team. A medical exami- nation is also mandatory, ideally by a professional who specialized in child sexual abuse evaluation, even if in chronic abuse clinical evidence is scanty. Sometimes a gynaecologist must suddenly face a disclosure of abuse or a suspect arising by a genital examination or by the unexpected finding of a sexually transmitted infection in a child. So it is important to know what to do and what to avoid.
The article is a systematic description of the procedures validated by the in- ternational guidelines for performing a clinical examination in a child or in an adolescent when sexual abuse is suspected. We start with the documenta- tion of parents’ information and the registration of eventual child’s disclosu- re, with complete medical history and a thorough physical examination. The anogenital region examination is necessary to rule out injuries in cases of re- cent abuse and should be completed with tests for sexually transmitted infec- tions and the collection of forensic evidences. An adequate documentation of the findings, filling in a specific medical record and using photographs, is of paramount importance.

Keywords: sexual abuse; methodology of consultation for abuse; sexually transmitted infections in children.


Available in LRIOG Nr.4 – 2021

e-ISSN: 1824-0283


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