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Paediatric and adolescent gynaecology: a multidisciplinary approach
  1. R J Hitchcock

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    Edited by Adam H Balen, Sarah M Creighton, Melanie C Davies, Jane MacDougall, Richard Stanhope. Cambridge: Cambridge University Press, 2004, pp 540, £150.00. ISBN 0 521 80961 4

    The management of young and adolescent girls with disorders of the genital tract and associated illnesses has long fallen between many subspecialties. With few adolescent gynaecologists in this country, paediatric surgeons and physicians, adult gynaecologists, and endocrinologists work with (or not as the case may be) clinical geneticists and psychologists to diagnose, explain, and manage sometimes simple and sometimes extremely complex problems. Pre-adolescent and adolescent gynaecology has always been on the margins of most professionals’ knowledge and practice and there is a dearth of supporting reference texts. The range of specialties involved may have made the area unappealing for reference publication except for a small chapter in a text largely on something else. Thus, textbooks in this area are scarce and modern thought even more so. This book has thus found a good potential niche for publication.

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    Naturally, however, in trying to draw together expert authors from multiple disciplines there are areas of overlap and gap, perhaps more so here than is common even in this type of text. A more consistent structured chapter template, and for those readers with an image based memory, a greater number of diagrams and images, would have been helpful in almost every chapter. To please a target readership from paediatric surgeons and paediatricians to adult gynaecologists and psychologists will always be difficult and I suspect that all groups will be frustrated at some level. I think this may be inevitable and should not detract from the value of the book as a modern and broad resource.

    The first part covers normal development well and is a good source of reference. Finding a pattern for the bulk of the book was clearly difficult and like many reviewers I would have organised it differently. While much of what one needs is present I found the layout confusing, perhaps due to the theme of an integrated approach. I would expect those general paediatricians and surgeons treating simple gynaecological problems to appreciate those chapters based on presentations such as pelvic pain, genital dermatology, and vaginal discharge and amenorrhoea being drawn together, and an adjacent separate section to those chapters on ovarian disorders and fertility together, etc while devoting a section to all the aspects of intersex. Grouping the chapters concerning intersex, which although always interesting, is a further subspecialty practiced now by progressively fewer doctors, would allow a progressive development of the diagnosis, management, and outcomes as viewed by each discipline.

    One of the practical issues that many doctors dealing with children and adolescents, particularly in the area of gynaecology and fertility face relates to the medico-legal aspects of “consent”, especially to that pertaining to genetic material, and should there be a second edition I would request more information than that presented within the chapter on “Preservation of fertility before cancer therapy”.

    In general, however, the book is written and edited by experts and provides a broad resource of information, for both the simple and complex problems which may be encountered in paediatric gynaecology. Its integrated multidisciplinary approach does make it an essential reference text for all doctors and psychologists involved in the care of children and young adults with complex gynaecological conditions and I am pleased to have it on my shelf to partially replace a loose leaf file stuffed with old and new articles gleaned from a variety of publications of variable quality and reliability.

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