Fifteen-minute consultation: The overweight teenage girl with acne

Polycystic ovary syndrome (PCOS) is a common endocrine condition which often presents in adolescence. The symptoms and signs, which include obesity, acne, hirsutism and irregular menstrual periods, can have profound psychosocial, metabolic and reproductive consequences. Diagnosis in the adolescent population can be particularly difficult as there is significant overlap between the clinical features of PCOS and those of normal pubertal development. International guidelines published in 2018 have produced diagnostic criteria for adolescents to aid the physician, but there will still be many cases in which diagnostic uncertainty remains. In this article, we present a structured approach to adolescents with symptoms of PCOS, covering clinical assessment, investigation, diagnosis and management. We emphasise that intervention, with lifestyle advice and combined oral contraception should be considered even in the absence of a definitive diagnosis.

Over a third of childbearing women with HIV would like to breastfeed: A UK survey of women living with HIV

The World Health Organisation advice for post-partum women living with HIV (WLHs) in low- and middle-income countries is to breastfeed on suppressive antiretroviral treatment and use infant postnatal prophylaxis. In resource-rich settings, where formula feeding is safe, avoidance of breastfeed is advised. A questionnaire was created to survey attitudes to breastfeeding in WLHs in the United Kingdom. This was offered to all eligible pregnant women in the third trimester or within 3 months post-partum who attended HIV outpatient clinics from 2017 to 2018. Ninety-four women completed the questionnaire, 69% were Black African and 92% had an undetectable HIV viral load. Thirty eight percent stated they would like to breastfeed and 89% said they would breastfeed if they were HIV negative. Sixty two percent had community members question why they did not breastfeed, and 66% felt forced to invent a reason why they were not breastfeeding. Current UK guidelines recommend formula feeding, proposing a harm reduction approach to support women with suppressed HIV who wish to breastfeed. Over a third of respondents said they would like to breastfeed because stigma and secrecy remain an issue for WLHs. This suggests that over time more women may choose this option.

Fifteen-minute consultation: History and examination in adolescent gynaecology

Disorders of reproductive and sexual health are commonly encountered in paediatric clinics and can present many challenges to the general paediatrician. In this article we aim to discuss general consultation skills relevant to adolescents, appropriate screening questions for reproductive health concerns and the comprehensive assessment of any gynaecological symptoms identified. Crucially a vast array of conditions can be diagnosed with history and examination alone, sometimes with the addition of simple and readily available investigations, without the need for specialist gynaecology referral. Often reassurance that a concern is simply part of normal reproductive development is all that is required.