Faculty Bibliography

PURPOSE/OBJECTIVE:Infertility affects one in four female physicians, yet current availability of fertility benefits within Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs in the United States (US) is unknown. Our objective was to examine publicly available fertility benefits information for residents and fellows. METHODS:The top 50 medical schools in the US for research were identified using US News & World Report 2022. In April 2022, we reviewed fertility benefits available to residents and fellows at these medical schools. Websites of their associated graduate medical education (GME) websites were queried for details surrounding fertility benefits. Two investigators collected data from GME and publicly available institutional websites. The primary outcome was fertility coverage and rates are reported as percentages. RESULTS:Within the top 50 medical schools, 66% of institutional websites included publicly available medical benefits, 40% included any mention of fertility benefits, and 32% had no explicit information on fertility or medical benefits. Fertility benefit coverage included infertility diagnostic workup (40%), intrauterine insemination (32%), prescription coverage (12%), and in vitro fertilization (IVF, 30%). No information on coverage for third party reproduction or LGBT family building was available on public websites. Most programs with fertility benefits were in the South (40%) or Midwest (30%). CONCLUSION/CONCLUSIONS:To support the reproductive autonomy of physicians in training, it is critical to ensure access to information on fertility care coverage. Given the prevalence of infertility among physicians and the impact of medical training on family planning goals, more programs should offer and publicize coverage for fertility care.

In this article, we discuss the role of formal advocacy education with high-effort advocacy activities among pediatricians. We discuss the historical role of advocacy in the field of pediatrics and the changing role of advocacy education in pediatric training programs. We describe our survey of pediatricians in New York, in which we asked about a history of formal child health advocacy education, current high- and low-effort advocacy activities, perceived barriers to advocacy work, and child health advocacy issues of interest. Our findings demonstrate an association between a history of formal child health advocacy education and recent participation in high-effort advocacy activities on behalf of children's health. We also found that practicing pediatricians were more likely to participate in high-effort advocacy work than individuals still in pediatric residency training. Our findings imply that education in child health advocacy should be considered an important part of pediatric training. Advocacy education should not only be included in residency and fellowship training programs but also made available as part of continuing medical education for pediatricians. Time for professional advocacy work should be allotted and encouraged.

STUDY OBJECTIVE/OBJECTIVE:We aimed to describe fertility desires in healthy adolescent females and to explore associations of fertility desire with conditions and therapies potentially compromising fertility. DESIGN/METHODS:This was a cross-sectional, anonymous survey. SETTING AND PARTICIPANTS/METHODS:A total of 323 female adolescents aged 13-19 years were recruited from clinic waiting areas at a children's hospital. We oversampled on days when clinics serving adolescents with potential fertility compromise were scheduled. MAIN OUTCOME MEASURES/METHODS:We measured fertility desire by agreement with the statement "I want to have children someday." To measure compromised fertility we asked "In the past year, has a doctor, nurse or other medical professional ever talked to you about the possibility that you may have decreased fertility and may not be able to have your own biological child someday?" To measure depression severity, we used a validated scale, the PHQ-9, scores were dichotomized into no/mild and moderate/severe depression. RESULTS:Mean age was 16.06 ± 1.87 years. Of the 323 participants, 57% identified as Hispanic, 24% as Black, 93.5% as cisgender, 6.5% as transgender/gender diverse, 70% as heterosexual, and 30% as sexual minority. A total of 35% had moderate/severe depression, and 12% had compromised fertility. Overall, 89% wanted children. Fewer transgender/gender diverse than cisgender participants wanted children (67% vs 93%, P < .001), as did fewer with moderate/severe versus no/mild depression (83% vs 93%, P < .05), whereas those with compromised fertility versus those without and heterosexual versus sexual minority participants had similar fertility desires. Transgender/gender diverse identity (odds ratio, 0.33; 95% confidence interval, 0.11-0.97; P < .05) and moderate/severe depression (odds ratio, 0.45; 95% confidence interval, 0.22-0.93; P < .05) were independently associated with lower fertility desire. CONCLUSIONS:We found a high overall proportion of female adolescents desiring future children, and only 2 independent predictors of decreased fertility desire, namely, transgender/gender diverse identity and moderate/severe depression.

Vaginitis presents with vaginal discharge, odor, pruritis, and/or discomfort and affects up to 75% of girls and women over the course of their lifetimes, with most women experiencing their first episode during adolescence. Given the prevalence of this disorder, this article aims to provide an overview of vaginitis for the general pediatrician. We start with prepubertal etiologies of vaginitis, then discuss pubertal and normal physiologic discharge, and then focus on the most common etiologies of adolescent vulvovaginitis. The three most common microbial etiologies of vaginitis (bacterial vaginosis, vulvovaginal candidiasis, and trichomonas) are addressed, as well as their diagnosis and treatment in adolescents. [Pediatr Ann. 2020;49(4):e170-e175.].