Paediatric and adolescent gynaecology services in a tertiary teaching hospital

This was a retrospective review of a tertiary Paediatric and Adolescent Gynaecology (PAG) referral service catering to the South Yorkshire population in the UK. All patients referred to the PAG clinic from May 2014 to May 2018 were included. Treatments offered in clinic (surgical and pharmacological) were assessed and referral made to alternative services were analysed. Reasons for referral and the number of patients requiring intervention, pharmacological or surgical including a breakdown of the treatments offered were analysed. Forty-four percent (44%) of referrals were for menstrual disorders, with pain (15%) and vulvar problems (13%) being the next common causes. Only 5% of patients needed specialist surgery. Patients attending a PAG clinic are predominantly managed with pharmacological intervention and this could be provided in primary care with referrals limited to complex patients or those who require surgery. By understanding the case load for the PAG clinics, commissioners can better streamline the services.IMPACT STATEMENTWhat is already known on this subject? PAG services are relatively new and there are no clear pathways of how these should be configured. A better understanding of the case load in PAG clinics will allow configuration of services with better stratification of care to primary secondary and tertiary care providers.What do the results of this study add? The results of this study identify that the vast majority of patients attending PAG services do so with menstrual problems and relatively minor problems that can be addressed by primary care physicians with adequate training.What are the implications of these findings for clinical practice and/or further research? For more rare congenital anomalies, patients are best managed in a specialised centre that can offer a range of different treatments.