Adolescent Gynecology Program

The Adolescent Gynecology Program at CHOP Specialty Care, Market Street provides evaluation, treatment and support for young women as they transition to gynecologic care. Our multidisciplinary team of physicians and nurses — led by Aletha Y. Akers, MD, MPH, and Monica Mainigi, MD — works together to provide care that meets the needs of each patient and her family. We offer family-centered care with compassion and respect, giving special consideration to the physical and emotional needs of young women.

Most young women are referred to us by their pediatrician or other healthcare professional. We see many young women who may be seeking our opinion and recommendations for managing special health concerns. We will communicate with your child’s primary care office to make sure they are aware of our assessment and recommendations.

For most patients, an adolescent medicine specialist typically does initial evaluation and management of care. More complicated cases, or those requiring surgery will be referred directly to the adolescent gynecologist. For cases that require complex surgery that cannot be performed at CHOP, our gynecology team may coordinate with surgeons at the Hospital of the University of Pennsylvania.

Conditions we treat

Our group evaluates and treats the following gynecological issues:

  • Contraception, including in adolescents with complicated family-planning needs
  • Delayed puberty/delayed sexual development
  • Dysmenorrhea (painful menstrual cramps)
  • Hirsutism (excessive, male-pattern hair growth on women)
  • Menstrual problems (absent, irregular, heavy or infrequent menstrual bleeding)
  • Menstrual problems due to other chronic diseases, such as bleeding disorders
  • Ovarian cysts
  • Polycystic ovarian syndrome, which can affect a woman’s hormone levels, periods, and ovulation
  • Vulvar abnormalities
  • Vaginal discharge, infections and ulcers
  • Sexually transmitted diseases (STD) testing and treatment

Patients may be referred to the adolescent gynecologist at CHOP for:

  • Placement of long-acting reversible contraceptives (LARC). Pre-procedure counseling will usually be done by one of our adolescent medicine specialists). These include:
    • Mirena® intrauterine device
    • Skyla® intrauterine device
    • Paraguard® (copper intrauterine device)
    • Subdermal implant (Nexplanon®)
  • Colposcopy
  • Exam under anesthesia for:
    • Foreign bodies
    • Examinations for adolescents with physical or developmental disability
  • Surgical evaluation or management of ovarian cysts
  • Vulvar lesions
  • Congenital anomalies of the female genital tract
  • Chronic pelvic pain
  • Endometriosis (when the lining of the uterus grows outside the uterus, often producing pain)

Our approach to care

Many of the diseases we treat require a coordinated approach. This means we work closely with other pediatric services at CHOP, such as endocrinology, dermatology, gastroenterology, pediatric surgery, and urology. Our patients also have access to a social worker and nurses who specialize in the care of young adults.

We welcome parents and caregivers as key partners in supporting a young woman’s care. To help young women learn to develop skills for being responsible for their own health, we usually ask to spend time alone with our patients during each visit. This helps young women become comfortable talking with their healthcare providers about their concerns. It also allows patients to ask questions that may be more difficult to express in front of their parents and caregivers.

We respect the privacy and confidentiality of our young patients, while ensuring that young people are safe and connected to the appropriate services and resources they need.