History of Policy and Activities of the American College of Obstetricians and Gynecologists in Adolescent Health and Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) has had a long-term interest in the development of adequate and comprehensive services for adolescents, especially in regard to reproductive health services.

History of Policy and Activities of the American College of Obstetricians and Gynecologists in Adolescent Health and Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) has had a long-term interest in the development of adequate and comprehensive services for adolescents, especially in regard to reproductive health services.

1964 - ORGANIZED EFFORTS BEGAN
ACOG began its first formal activities in the area of adolescent health and pregnancy in 1964. In that year, the Committee on Maternal Health published, "Sex Education is a Professional Responsibility." This pamphlet provided obstetrician-gynecologists and others with an extensive up-to-date listing of resources for family life education. The Committee on Education in Family Life was also established by the Executive Board in 1964 and continued until 1977. This committee first focused its attention on the issues of family life and sex education, developing, in 1967, a statement emphasizing the responsibility of the ob-gyn in supporting family life education in the community, which declared:

"An obstetrician-gynecologist has a responsibility for assisting in programs of family life education in communities and schools. This may be done by active support of such programs and/or by actual participating in accordance to his knowledge or interest."

This statement was reexamined and strongly reaffirmed in 1969 by the Executive Board:

"The College should vigorously support extensive programs of instruction, sex education and family responsibility."

1970 - THE UNMARRIED MOTHER SHOULD BE KEPT IN SCHOOL
In 1970, the College addressed the issue of the provision of services to unmarried pregnant women. Noting the extent and complexity of the problem, the Statement on the Unmarried Mother, recognized the need for the contributions of many disciplines in the provision of comprehensive services to unmarried pregnant women. Ob-gyns were urged to take an active part in: educating medical students to see the social and psychological aspects of caring for unmarried pregnant women; working with community to "replace punitive attitudes where they exist with those that promote optimal obstetric and rehabilitative care;" supporting school officials in keeping pregnant adolescents in school or providing alternative educational opportunities; assisting in targeting resources to provide obstetric, social and emotional services to this population; developing cooperation with other family-serving professionals to remove barriers to early prenatal care and to provide services to prevent subsequent out-of-wedlock pregnancies; and expressing concern over any legal barriers to obstetric and social care for this population.

1970 - FIRST STATEMENT ON ADOLESCENT PREGNANCY
Also in 1970, the first Statement on Teenage Pregnancy was issued by the Executive Board, calling attention to the "medical and health problems of the sexually involved adolescent, the school-age pregnant girl, the teenage mother and father and the child of adolescent parents." This statement recommended that sexually active teenage girls should have access to medical consultation and the most effective contraception available and that the physician should be free to exercise his/her "best medical judgment, so that the recommended treatment is in the best interests of the patient".

1970 - FAMILY LIFE EDUCATION
The Committee on Education in Family Life also issued a technical bulletin, Family Life Education: A Checklist for Speakers, in 1970. This document, reprinted as A Checklist for Getting Involved and still useful today, provides helpful guidelines for the ob-gyn who is asked to make a presentation regarding this topic in her/his community.

In 1970, the Committee on Education and Family Life began offering a postgraduate course in family life education at the ACOG Annual Clinical Meeting. In 1972 an advanced course in family life education was also developed.

1971 - PHYSICIAN RESPONSIBILITY AND FREEDOM TO TREAT ADOLESCENTS - PROVIDING EFFECTIVE CONTRACEPTION
The first statement on adolescent pregnancy was superseded in 1971 by the statement Providing Effective Contraception to Minors, in which ACOG stated clearly and unequivocally that:

"The unmarried sexually active female of any age whose sexual behavior exposes her to possible conception should have access to the most effective methods of contraception."

"In order to accomplish this, the individual physician...should be free to exercise his best judgment in prescribing contraception and therefore, the legal barriers which restrict his freedom should be removed... even in the case of an unemancipated minor who refuses to involve her parents."

This statement also called for the provision of contraceptive services in the context of counseling which would also cover mental health and venereal disease, with every effort being made to involve male partners. It has since been incorporated into a more comprehensive policy statement, Access to Reproductive Health Care for Adolescents, which has been incorporated into Guidelines for Women’s Health Care and Guidelines for Adolescent Health Care.

1972 - ADOLESCENTS AND PARENTAL CONSENT
In a report published in 1972, entitled The Management of Sexual Crises in the Minor Female, the Committee on Education in Family Life explored expanded questions of the physician's responsibility in dealing with the sexually active minor female. While affirming the desirability of involving parents in the decision-making of adolescent girls about reproductive health issues, the main recommendation from this report was that the law should allow a minor female who is responsibly mature to turn to the physician for contraception or legal abortion without the necessity of her parent's consent when she is unwilling to involve them. Noting that laws increasingly enable the physician to treat minors for venereal disease and drug abuse with the guarantee of privacy and without parental consent, this report recommended the removal of direct and indirect legal barriers to contraceptive services for this population. It also recommended that physicians provide appropriate counseling and guidance to minor females who are sexually active, utilizing consultation with another physician or other recognized helping profession in those situations where it is required.

1978 - ADOLESCENT PREGNANCY TASK FORCE APPOINTED
The Health Care Commission in 1978 reaffirmed the commitment of the College to solving the problems presented by adolescent pregnancy in the appointment of the Task Force on Adolescent Pregnancy. This group actively involved membership from several other organizations outside ACOG, including the March of Dimes, the American Academy of Pediatrics, the American Academy of Family Physicians, and the Nurses Association of ACOG. In the three years the Task Force operated, it carried out a number of activities.

1979-80 - GUIDEBOOK AND TRAINING WORKSHOPS
The Task Force wrote and produced Adolescent Perinatal Health - A Guidebook, a forty-page publication that includes clinical guidelines and information important to physicians serving adolescents. Over 80,000 copies were printed and distributed, but the document is no longer in print.

Based on the educational needs identified in a survey of ob-gyns, pediatricians, and family practice physicians regarding services provided to adolescents, the Task Force recruited a cadre of health professionals with experience and skill in working with adolescents, developed a 150-page reference syllabus, and conducted a series of intensive two-day workshops, training more than 700 health professionals.

1979 - ADOLESCENT POLICY STATEMENT PUBLISHED
In the statement, Adolescent Reproductive Health Services, published as policy by the Executive Board in 1979, guidelines and recommendations for comprehensive services responsive to the reproductive health needs of adolescents were outlined. Recognizing that many services needed by adolescents were beyond the immediate scope of clinical medicine, the statement called upon ob-gyns to provide leadership in the development of comprehensive services accessible and acceptable to adolescents. This statement also appended sections from the 1977 Maternal Health Policy Statement that stated, "Information regarding human reproduction must occupy a significant part of the basic education of every American." It called for education to begin in childhood and continue through adolescence into adulthood and "be offered in schools, churches and colleges as well as in family settings and social organizations." It has since been incorporated into a more comprehensive statement that is included in Guidelines for Women's Health Care.

1985 - ACOG PRESIDENT INITIATES NATIONAL CAMPAIGN
In 1985, ACOG president Luella Klein, MD initiated a nationwide campaign to combat unintended pregnancy. The public service announcements prepared as a part of that campaign were initially refused by all the national television networks. The ensuing publicity was unanimously in favor of the College, and the networks finally agreed to show the announcements after eliminating the word "contraceptive." The I Intend program, including Public Service announcements and a toll free telephone line to request additional written information, was continued for six years, providing public awareness and information to adolescents and the parents of adolescents. The American Academy of Family Physicians jointly sponsored the final three years of the campaign.

1985 - STANDING ACOG COMMITTEE ESTABLISHED
In 1985, the Executive Board established a permanent Committee on Adolescent Health Care. This committee is charged with developing and implementing plans for ACOG involvement in solutions to the problems of adolescent health care. The committee is concentrating on the following issues:

  • To educate College members, other professionals, parents, adolescents, and the general public about child and adolescent development, health, and illness, especially as related to sexual and reproductive health.
  • To increase the availability, accessibility, and utilization of high quality, developmentally appropriate health care services, designed for adolescents.
  • To encourage collaborative, community-wide participation in the provision of adolescent health promotion and integrated services.
  • To promote the development and implementation of public policy, which results in improved health for adolescents.
  • To foster research in adolescent development, reproductive health, and health care services.

1986 - FIRST TECHNICAL BULLETIN PRODUCED
In 1986, the Committee on Technical Bulletins produced The Adolescent Obstetric-Gynecologic Patient that provides guidance to practitioners on the provision of reproductive health services to adolescents. This bulletin was revised and updated in 1990. It has since been withdrawn and replaced with separate documents on each of the topics covered in the original bulletin.

PATIENT EDUCATION MATERIALS PRODUCED
Over the years, several patient education pamphlets specific to adolescents have been published and are available to the public. These include Teaching Your Children about Sexuality; Growing Up; Especially for Teens: You and Your Sexuality; Especially for Teens: Birth Control; Menstruation and the Menstrual Cycle; and Special Needs of Pregnant Teens. Other patient education materials, such as Emergency Contraception and How to Prevent Sexually Transmitted Diseases, are suitable for use with adolescents although they do not target them specifically.

1986 - AMICI CURIAE BRIEF IN HARTIGAN V. ZBARAZ
In 1986, ACOG, along with several other medical organizations, filed an amicus brief in the U.S. Supreme Court challenging the Illinois statute that required a physician to notify both parents and wait twenty-four hours before performing a medically indicated abortion on a minor.

1987 - ADVOCATE GREATER ACCESS TO REPRODUCTIVE HEALTH SERVICES
In early 1987, the Executive Board approved as policy a recommendation from the Committee on Adolescent Health Care that endorsed the development of programs, including those located in schools, to provide reproductive health services to adolescents where such services are not available and where they have the support and input of the parents and community. This statement called upon the College to work with other groups to make such services more comprehensive in order to meet all the health needs of this underserved population.

1988 - JOINT STATEMENT ON CONFIDENTIALITY IN ADOLESCENT HEALTH CARE
In 1988, the statement Confidentiality in Adolescent Health Care, developed by the Committee on Adolescent Health Care, was issued jointly by the American Academy of Pediatrics, the American Academy of Family Physicians, NAACOG - the Organization for Obstetric, Gynecologic and Neonatal Nurses, the National Medical Association, and ACOG.

Outlining the need to improve access to health care services for adolescents and to address urgent adolescent health problems, the statement recommends principles for individual health professionals and for public policy development including:

"Health professionals have an ethical obligation to provide the best possible care and counseling for adolescent patients. This obligation includes every reasonable effort to encourage the adolescent to involve parents, whose support can...increase the potential for dealing with the adolescent's problems on a continuing basis."

The provider must clarify the necessity and limits for confidentiality with both the adolescent and his/her parents in the transition to an independent provider-patient relationship with the adolescent.

"Providers, parents, and adolescents need to be aware of the...laws and regulations in their jurisdiction that introduce further constraints on these relationships. Some of these laws and regulations are unduly restrictive and in need of revision as a matter of public policy. Ultimately, the health risks to the adolescents are so impelling that legal barriers and deference to parental involvement should not stand in the way of needed health care."

This statement can now be found in Guidelines for Adolescent Health Care.

1989 - ADOLESCENT SEXUALITY: GUIDES FOR PROFESSIONAL INVOLVEMENT
In 1989, the Committee on Adolescent Health Care published a manual designed to assist health professionals as they present the issues of adolescent sexuality and related topics to community groups. This manual contains presentation outlines, slides, background articles, bibliographies and sample handouts for ten different aspects of adolescent reproductive health. The issues covered are physical and psychosocial growth and development, sexual development, psychosocial concerns such as incest and abuse, special issues such as confidentiality, pregnancy, sexually transmitted diseases, AIDS, preventive services, communication with adolescents, sex and family life education, and sex education for adolescent with special health care needs.

1989 - AMICI CURIAE BRIEF IN MINNESOTA V. HODGSON
In 1989, ACOG with seven other organizations filed an amicus brief in the U.S. Supreme Court addressing the question of "whether a state can burden a minor's constitutional right to decide whether to terminate her pregnancy by requiring in every case that one or both parents be notified without providing and effective, confidential and expeditious alternative procedure that does not require parental notification."

1990 - COMMITTEE OPINION - THE SAFETY OF ORAL CONTRACEPTIVES FOR TEENAGERS
In 1990, the Committee on Adolescent Health Care prepared a Committee Opinion outlining the safety of oral contraceptives for adolescents. The Committee Opinion analyzes the risks and benefits and concludes that the benefits associated with the use of oral contraceptives outweigh the risks, which are negligible. It also notes, however, that teenagers at risk for sexually transmitted diseases should be advised to use barrier contraceptives along with oral contraceptives. It can now be found in Guidelines for Adolescent Health Care.

1991 - ADOLESCENT SEXUALITY: GUIDELINES FOR PROFESSIONAL INVOLVEMENT - SECOND EDITION
In 1991, the Committee on Adolescent Health Care revised and republished the manual designed to assist health professionals as they present the issues of adolescent sexuality and related topics to community groups.

1992 - COMMITTEE OPINION - ADOLESCENT ACQUAINTANCE RAPE
In 1992, the Committee on Adolescent Health Care issued a Committee Opinion on Adolescent Acquaintance Rape. This document brings the prevalence of acquaintance rape among high school and college-aged women to the attention of ACOG Fellows and to assist them in identifying victims and providing necessary treatment and care. This committee opinion was withdrawn in 1998 upon publication of a more comprehensive educational bulletin on sexual assault. This bulletin is now a chapter in Special Issues in Women’s Health.

1994 - COMMITTEE OPINION - ADOLESCENT'S RIGHT TO REFUSE LONG-TERM CONTRACEPTIVES
In 1994, the Committee on Adolescent Health Care issued a Committee Opinion on the Adolescent's Right to Refuse Long-Term Contraceptives. This document addresses the adolescent's right to refuse medical care with regard to long-term contraceptives. It can now be found in Guidelines for Adolescent Health Care

1994 - SPOUSE PROGRAM ON ADOLESCENT PREGNANCY
Each year, the American College of Obstetricians and Gynecologists hosts the Annual Clinical Meeting. In 1994, the Spouse Program on Adolescent Pregnancy was added to the program. Participants learn about national and state trends in adolescent pregnancy and discuss efforts to reduce this problem. This program has been expanded to include an audience of ACOG Fellows as well as their spouses. It is always well attended and has been facilitated each year since its inception.

1995 - COMMITTEE OPINION - CONDOM AVAILABILITY FOR ADOLESCENTS
In 1995, the Committee on Adolescent Health care issued a Committee Opinion, Condom Availability for Adolescents. This document serves as a means of educating Fellows on the importance of condom distribution programs in the prevention of STDs and unintended pregnancies. It can now be found in Guidelines for Adolescent Health Care.

1995 - ADOLESCENT PREGNANCY PREVENTION PROGRAMS
In 1995, ACOG produced the document, Adolescent Pregnancy Prevention Programs, for ACOG Fellows who have an interest in adolescent health care and who wish to become active in community efforts to prevent teen pregnancy. The document discusses various strategies for preventing adolescent pregnancy, describes models of effective and replicable programs, provides a selection of current literature on teen pregnancy prevention programs and evaluations, and lists publications and other resources available on the subject.

1996 - ADOLESCENT PREGNANCY PREVENTION NETWORK
The Adolescent Pregnancy Prevention Network was established in 1996. It is composed of over 440 ACOG Fellows and Junior Fellows who are interested in working to decrease the number of adolescent pregnancies, knowledgeable on ways to accomplish this, and willing to assist other Fellows and individuals to do the same. Quarterly newsletters are sent to members of this network to inform them of ACOG's activities pertaining to adolescent pregnancy, as well as national, state, and local news and resources.

1997 - COMMITTEE OPINION - HEPATITIS B IMMUNIZATION FOR ADOLESCENTS
In 1997, the Committee on Adolescent Health Care issued a Committee Opinion, Hepatitis B Immunization for Adolescents. This document informs Fellows of the recommendation to provide universal vaccination against hepatitis B for adolescents 11-12, with immunization for older adolescents to be based on risk status. It can now be found in Guidelines for Women's Health Care and Guidelines for Adolescent Health Care.

1997- STRATEGIES FOR ADOLESCENT PREGNANCY PREVENTION
ACOG revised and retitled the 1995 document Adolescent Pregnancy Prevention Programs based upon a comprehensive review of adolescent pregnancy prevention programs and their evaluations by the National Campaign to Prevent Teen Pregnancy. A listing of relevant Internet sites was added, as were additional resources on this topic.

1997- COMMITTEE OPINION - PREVENTION OF ADOLESCENT SUICIDE
This committee opinion, produced by the Committee on Adolescent Health Care, provided data on the increasing rates of adolescent suicide, identified risk factors for suicide, discussed risk assessment, and offered suggestions for prevention efforts. It can now be found in Guidelines for Adolescent Health Care.

1998 - EDUCATIONAL BULLETIN - CONFIDENTIALITY IN ADOLESCENT HEALTH CARE
Produced by the Committee on Adolescent Health Care, this document discussed the significance of confidentiality in the provision of adolescent health care, and suggested a model office visit that implements the principles of confidentiality. It can now be found in Guidelines for Adolescent Health Care.

1998 - POLICY STATEMENT - THE LIMITATIONS OF ABSTINENCE-ONLY SEXUALITY EDUCATION
Prepared by the Committee on Adolescent Health Care in response to the availability of federal funds to promote abstinence-only education, this policy statement called for the implementation of scientifically accurate and rigorously evaluated sexuality education programs. This document has been combined with the previously published document on sexuality education and can be found in both Guidelines for Women's Health Care and Guidelines for Adolescent Health Care.

1998 - STAY ALERT! STAY SAFE! POCKET CARDS
Targeting adolescents and young women, these pocket-sized cards contained acquaintance rape and date rape prevention messages. Such messages encouraged teens to set sexual limits and reject unwanted sexual attention. Although nothing can guarantee protection against sexual assault, girls can lower their risk and stay safe.

1998 - EDUCATIONAL BULLETIN: ADOLESCENT VICTIMS OF SEXUAL ASSAULT
This document was written by the Committee on Adolescent Health Care to replace the Committee Opinion, Adolescent Acquaintance Rape. This educational bulletin defined the various categories of sexual assault and discussed the prevalence of each. It also summarized adolescents' perceptions of sexual assault, methods for identifying victims of assault, and ways to prevent sexual assault. These prevention messages are included in the above mentioned Stay Alert! Stay Safe! Pocket Cards. This information can now be found in Special Issues in Women’s Health.

1998 - ADOLESCENT SEXUALITY: A PRESENTATION RESOURCE KIT - THIRD EDITION
In 1998, the Committee on Adolescent Health Care revised, retitled, and republished the manual designed to assist health professionals as they present the issues of adolescent sexuality and related topics to community groups. Two of the 11 modules were designed for presentations to teen audiences. Topics included physical and psychological development, sexual development, sexual violence, adolescent pregnancy, sexually transmissible diseases, HIV/AIDS, prevention strategies, and reproductive health care.

1999 - ADOLESCENT PREGNANCY PREVENTION LUNCHEON
The first Annual Adolescent Pregnancy Prevention Luncheon was held in May 1999 at the American College of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting. It was designed to bring together ACOG Fellows and Junior Fellows who are interested in adolescent pregnancy prevention. Speakers discussed national trends in adolescent pregnancy and suggested ways for attendees to become involved in community efforts to reduce this problem. Due to its success, this luncheon will be held at upcoming Annual Clinical Meetings, as well.

1999 - EDUCATIONAL BULLETIN: PRIMARY AND PREVENTIVE HEALTH CARE FOR FEMALE ADOLESCENTS
This educational bulletin was developed by the Committee on Adolescent Health Care to help physicians to provide primary and preventive health care for female adolescents. It is based upon the American Medical Association's, Guidelines for Adolescent Preventive Services and discusses such topics as adolescent development, screening recommendations, and immunization schedules. As a companion to this document, the Tool Kit for Teen Care was developed to assist members in implementing the recommendations of the bulletin. It can now be found in Guidelines for Adolescent Health Care.

1999 - EDUCATIONAL BULLETIN: ORAL CONTRACEPTIVES FOR ADOLESCENTS: BENEFITS AND SAFETY
In order to provide new statistics and findings related to the safety of oral contraceptives for adolescents, the 1990 Committee Opinion, the Safety of Oral Contraceptives For Teenagers, was revised into this educational bulletin. In addition, common concerns of adolescents pertaining to use of oral contraceptives and appropriate responses to be given by the health care provider were added. It can now be found in Guidelines for Adolescent Health Care.

2000 - STATE CHILD HEALTH; IMPLEMENTING REGULATIONS FOR THE STATE CHILDREN'S HEALTH INSURANCE PROGRAM
In early 2000, the American College of Obstetricians and Gynecologists submitted comments to the Health Care Financing Administration (HCFA) on the proposed rule entitled, "State Child Health; Implementing Regulations For The State Children's Health Insurance Program." These comments encouraged HCFA to recognize that the health care needs of adolescents often differ from those of other youth and develop its policies appropriately.

2000 - RESEARCH AWARD IN ADOLESCENT HEALTH
One of the goals of the Committee on Adolescent Health Care is to further research in adolescent health. To that end, the committee sought and received for an annual research award in adolescent health. This award of $16,000 for one year is intended to provide an opportunity for an investigator to perform clinical research related to adolescent health with a focus on intervention and prevention. It is now offered annually.

2000 - DRAWING THE LINE: A GUIDE TO DEVELOPING EFFECTIVE SEXUAL ASSAULT PREVENTION PROGRAMS FOR MIDDLE SCHOOL STUDENTS
Designed for professionals and parents who work with youth, this publication was developed by ACOG's National Rape and Sexual Assault Prevention Project's Advisory Committee. It represented the first national consensus of what components should be included in any comprehensive sexual assault prevention effort. Other items related to sexual assault included rolodex cards include tools for screening teens and information on sexual assault. This document is no longer available.

2000 - POLICY STATEMENT - ACCESS TO REPRODUCTIVE HEALTH CARE FOR ADOLESCENTS
The Committee on Adolescent Health Care combined the information in the policy statements, Providing Effective Contraception to Minors and Reproductive Health Services for Adolescents into this more comprehensive document. This statement, which can now be found in Guidelines for Women's Health Care and Guidelines for Adolescent Health Care, details the need for physicians to provide comprehensive services to adolescents, including sexuality education, counseling, mental health assessment, diagnosis and treatment regarding pubertal development, access to contraceptives and abortion, pregnancy-related care, prenatal and delivery care, and diagnosis and treatment of sexually transmitted diseases. It also states the following:

"The potential health risks to adolescents if they are unable to obtain reproductive health services are so compelling that legal barriers and deference to parental involvement should not stand in the way of needed health care for patients who request confidentiality. Therefore, laws and regulations that are unduly restrictive of adolescents' confidential access to reproductive health care should be revised."

2002 - STRATEGIES FOR ADOLESCENT PREGNANCY PREVENTION
ACOG revised the 1997 document Adolescent Pregnancy Prevention Programs based upon an updated review of adolescent pregnancy prevention programs and their evaluations by the National Campaign to Prevent Teen Pregnancy.

2002 - COMMITTEE OPINION - NONSURGICAL DIAGNOSIS AND MANAGEMENT OF VAGINAL AGENESIS
This Committee Opinion was published in the July 2002 Green Journal to discuss vaginal agenesis as a condition that usually can be managed nonsurgically with the use of successive dilators if it is correctly diagnosed and the patient is sufficiently motivated. Besides correct diagnosis, effective management also includes evaluation for associated congenital, renal, or other anomalies and careful psychologic preparation of the patient before any treatment or intervention. If surgery is preferred, a number of approaches are available; the most common is the Abbe-McIndoe operation.  This opinion was revised in 2006 and reaffirmed in 2009.

2003 - ADOLESCENT PREGNANCY FACTS (REVISED ANNUALLY)
Since the 1980s, ACOG has been publishing, Adolescent Pregnancy Facts to provide new data on pregnancy, birth, and abortion rates, as well as adolescent sexual behavior and sexually transmitted diseases. The 2009 version is the latest version and is available on the ACOG website. Hard copies are available upon request.

2003 - TOOL KIT FOR TEEN CARE
This kit is designed to help health care providers to provide primary and preventive health care to female adolescents. Tools provided in this kit include laminated cards on Tanner staging of pubertal development, information on billing issues pertaining to adolescent health care, and an adolescent visit questionnaire and record. Kits can be ordered at http://sales.acog.org. This kit was revised in early 2009.

2003 - HEALTH CARE FOR ADOLESCENTS
Health Care for Adolescents provides all previously published ACOG documents on adolescents as well as two new documents on eating disorders and screening for gonorrhea and chlamydia in one concise document. It was revised in 2011 into a more comprehensive document entitled, Guidelines for Adolescent Health Care.

2004 – RESOURCE GUIDES
In 2004, the Committee on Adolescent Health Care began developing Resource Guides on adolescent specific topics to assist health professionals in helping patients and their families to understand these topics more completely. Current resource guides on the following topics are available at www.acog.org/goto/teens: children, adolescents, and the media; adolescent sexuality and sex education; the overweight adolescent, body modification, and adolescents and nonsexual violence. These guides were revised in 2010.

2004 - COMMITTEE OPINION – CERVICAL CANCER SCREENING IN ADOLESCENTS
This Committee Opinion was published in the October 2004 Green Journal to discuss the American Cancer Society’s recommendation that cervical cancer screening begin approximately 3 years after the onset of vaginal intercourse or no later than 21 years of age. Once initiated, screening should occur annually for young women. The Opinion stated that the decision about the initiation of cervical cytology screening in an adolescent patient should be based on the clinician’s assessment of risks, including 1) age of first sexual activity; 2) behaviors that may place the adolescent patient at greater risk for human papillomavirus infection; and 3) risk of non-compliance with follow-up visits. It also discussed the need to educate parents and adolescents about this recommendation, concerns about over-treatment of abnormal cervical cytology. This opinion was revised in 2010 in light of new recommendations that cervical cancer screening begin at 21 years of age, regardless of sexual activity.

2004 – FACT SHEET- GENITAL HPV IN ADOLESCENTS
The fact sheet for adolescents on HPV can be accessed both by ACOG members and non-members at www.acog.org/goto/teens. It serves as a companion piece to the Committee Opinion on cervical cancer screening. As of 2005, the fact sheet is available for sale through the ACOG Distribution Center and as part of the Tool Kit for Teen Care.

2004 - COMMITTEE OPINION – SEXUALLY TRANSMITTED DISEASES IN ADOLESCENTS
This Committee Opinion was published in the October 2004 Green Journal to highlight the high prevalence of sexually transmitted diseases (STDs) among adolescents in the United States and discuss the need for clinicians treating adolescent females to be prepared to offer confidential and comprehensive STD counseling, screening, and treatment according to established guidelines. This information can now be found in Guidelines for Adolescent Health Care.

2004 - COMMITTEE OPINION – GUIDELINES FOR ADOLESCENT HEALTH RESEARCH
This Committee Opinion was published in the October 2004 Green Journal to clarify the informed consent and parental permission issues as they pertain to adolescent health research. This information can now be found in Guidelines for Adolescent Health Care.

2005 - COMMITTEE OPINION – ENDOMETRIOSIS IN ADOLESCENTS
This Committee Opinion was published in the April 2005 Green Journal to highlight the differences in adolescent and adult types of endometriosis. Early diagnosis and treatment during adolescence may decrease disease progression and prevent subsequent infertility. This information can now be found in Guidelines for Adolescent Health Care.

2005 - COMMITTEE OPINION – MENINGOCOCCAL VACCINATION FOR ADOLESCENTS
This Committee Opinion was published in the September 2005 Green Journal to support the Centers for Disease Control and Prevention recommendations for meningococcal vaccination before entry into high school, at approximately 15 years of age. The American College of Obstetricians and Gynecologists encourages all health care providers caring for adolescent and young adult patients to provide meningococcal vaccination with MCV4 when appropriate. Health care providers also are encouraged to discuss meningococcal vaccination with patients whose children have reached preadolescence, adolescence, or young adulthood and to increase awareness of the signs and symptoms of meningococcal disease. This information can now be found in Guidelines for Adolescent Health Care.

2006 - COMMITTEE OPINION – EVALUATION AND MANAGEMENT OF ABNORMAL CERVICAL CYTOLOGY AND HISTOLOGY IN THE ADOLESCENT
This Committee Opinion was published in the April 2006 Green Journal to highlight that the management of abnormal cervical cytology in adolescents differs from that for the adult population in many cases. Certain characteristics of adolescents may warrant special management considerations. It is important to avoid aggressive management of benign lesions in adolescents because most cervical intraepithelial neoplasia lesions of grades 1 and 2 regress. Surgical excision or destruction of cervical tissue in a nulliparous adolescent may be detrimental to future fertility and cervical competency. Care should be given to minimize destruction of normal cervical tissue whenever possible. A compliant, health-conscious adolescent may be adequately served with observation in many situations. This opinion was revised in 2010 in light of new recommendations that cervical cancer screening begin at 21 years of age, regardless of sexual activity.

2006 - COMMITTEE OPINION – INITIAL REPRODUCTIVE HEALTH VISIT
This Committee Opinion was published in the May 2006 Green Journal to highlight ACOG’s recommendation stating that the first visit to the obstetrician-gynecologist for health guidance, screening, and the provision of preventive health care services take place between the ages of 13 and 15 years.   This Committee Opinion clarifies the services provided during this initial visit. It was revised in 2010.

2006 - COMMITTEE OPINION – HUMAN PAPILLOMAVIRUS VACCINATION
This Committee Opinion was published in the September 2006 Green Journal to recommend the provision of vaccination against HPV to females aged 9 to 26 years of age. The benefits and limitations of this vaccine were discussed in this opinion as was the need for continued routine cervical cytology screening. This opinion was revised in 2010 in light of the availability of an additional vaccination against HPV.

2006 - COMMITTEE OPINION – MENSTRUATION IN GIRLS AND ADOLESCENTS: USING THE MENSTRUAL CYCLE AS A VITAL SIGN
This Committee Opinion was published in the November 2006 Green Journal to discuss normal bleeding patterns in girls and adolescents. It encourages using the menstrual cycle as an additional vital sign as it is a powerful tool for the assessment of normal development and the exclusion of serious pathologic conditions. It was published jointly with the American Academy of Pediatrics and reaffirmed in 2009.

2006 - COMMITTEE OPINION – BREAST CONCERNS IN THE ADOLESCENT
This Committee Opinion was published in the November 2006 Green Journal to highlight that benign breast disease overwhelmingly dominates the differential diagnosis and dictates a different protocol for care in the adolescent compared with the adult patient to avoid inappropriately high assessments of risk and unnecessary diagnostic procedures and surgery. This information can now be found in Guidelines for Adolescent Health Care.

2006 - COMMITTEE OPINION – THE OVERWEIGHT ADOLESCENT: PREVENTION, TREATMENT, AND OBSTETRIC-GYNECOLOGIC IMPLICATIONS
This Committee Opinion was published in the November 2006 Green Journal to highlight that the number of overweight adolescents has grown to epidemic proportions in the United States and provide screening and treatment recommendations. The obstetric-gynecologic implications of being an overweight adolescent female are also discussed. This information can now be found in Guidelines for Adolescent Health Care.

2006 - COMMITTEE OPINION – VAGINAL AGENESIS: DIAGNOSIS, MANAGEMENT, AND ROUTINE CARE
This Committee Opinion was published in the December 2006 Green Journal as a revision to an earlier opinion on this subject published in 2002. This opinion continues to highlight that vaginal agenesis occurs in 1 of every 4,000.10,000 females and that the condition usually can be successfully managed nonsurgically with the use of successive dilators if it is correctly diagnosed and the patient is sufficiently motivated. It goes on to discuss that routine care for women who have a history of vaginal agenesis and have created a functional vagina require routine gynecologic care and can be considered in a similar category to that of women without a cervix and thus annual cytologic screening for cancer may be considered unnecessary in this population. This opinion was reaffirmed in 2009.

2007 - STRATEGIES FOR ADOLESCENT PREGNANCY PREVENTION
ACOG revised the 2002 document Adolescent Pregnancy Prevention Programs based upon an updated review of adolescent pregnancy prevention programs and their evaluations. It is available online at www.acog.org/goto/teens. Hard copies are available on request.

2007 – COMMITTEE OPINION - INTRAUTERINE DEVICE AND ADOLESCENTS
This Committee Opinion was published in the December 2007 Green Journal to address the major benefits of IUD use in adolescents, a population at particular risk of unintended pregnancy.

2008 – COMMITTEE OPINION - DEPOT MEDROXYPROGESTERONE ACETATE AND BONE EFFECTS
This Committee Opinion was published in the September 2008 Green Journal as a joint opinion with the Committee on Gynecologic Practice.  It highlights that although depot medroxyprogesterone acetate (DMPA) is associated with bone mineral density (BMD) loss during use, current evidence suggests that partial or full recovery of BMD occurs at the spine and at least partial recovery occurs at the hip after discontinuation of DMPA. Given the efficacy of DMPA, particularly for populations such as adolescents for whom contraceptive adherence can be challenging or for those who feel they could not comply with a daily contraceptive method or a method that must be used with each act of intercourse, the possible adverse effects of DMPA must be balanced against the significant personal and public health impact of unintended pregnancy. Concerns regarding the effect of DMPA on BMD should neither prevent practitioners from prescribing DMPA nor limit its use to 2 consecutive years. Practitioners should not perform BMD monitoring solely in response to DMPA use because any observed short-term loss in BMD associated with DMPA use may be recovered and is unlikely to place a woman at risk of fracture during use or in later years.

2008 – COMMITTEE OPINION - ADDRESSING HEALTH RISKS OF NONCOITAL SEXUAL ACTIVITY
This Committee Opinion was published in the September 2008 Green Journal as a joint opinion with the Committee on Gynecologic Practice.  It highlights that noncoital sexual behaviors, which include mutual masturbation, oral sex, and anal sex, are common expressions of human sexuality. Couples may engage in noncoital sexual activity instead of penile–vaginal intercourse hoping to reduce the risk of sexually transmitted diseases and unintended pregnancy. Although these behaviors carry little or no risk of pregnancy, women engaging in noncoital behaviors may be at risk of acquiring sexually transmitted diseases. Practitioners can assist by assessing patient risk and providing risk reduction counseling for those participating in noncoital sexual activities.

2009 – CLINICAL CASES IN PEDIATRIC & ADOLESCENT GYNECOLOGY
In January 2009, Clinical Cases in Pediatric & Adolescent Gynecology was released. It is an interactive cd-rom program developed by the American College of Obstetricians and Gynecologists and the North American Society for Pediatric and Adolescent Gynecology. The generalist obstetrician-gynecologist who completes the program will be able to: 1) Describe gynecologic problems experienced by pediatric and adolescent patients; 2) Determine the etiology of a variety of pediatric and adolescent gynecologic disorders; 3) Apply appropriate diagnostic procedures in evaluating pediatric and adolescent gynecologic disorders; 4) Identify appropriate medical and surgical treatments for a variety of pediatric and adolescent gynecologic disorders; and 5) Describe the long-term prognosis for pediatric and adolescent patients with gynecologic disorders. The American College of Obstetricians and Gynecologists designates this educational activity for a maximum of 20 AMA PRA Category 1 Credits™ or up to a maximum of 20 Category 1 ACOG Cognate Credits. The CD-ROM can be purchased through the ACOG bookstore at www.acog.org.

2009 - TOOL KIT FOR TEEN CARE, SECOND EDITION
The second edition of ACOG's Tool Kit for Teen Care was published in early 2009 to assist clinicians and health care providers in caring for adolescent patients. Developed by the ACOG Committee on Adolescent Health Care, the kit is designed to help clinicians incorporate adolescent primary and preventive health care into their practices and to provide the necessary resources. The Tool Kit for Teen Care contains resources for an adolescent-friendly office and adolescent assessment, as well as CPT coding information and educational materials on health care for girls. Among the new materials is a parent questionnaire, in addition to an adolescent visit questionnaire, and a new vaccine administration record for the clinicians use. Educational materials include 6 ACOG Patient Educational Pamphlets, sexual assault prevention and screening pocket and rolodex cards, and 36 fact sheets - 27 for teens and 9 for parents - covering a wide range of topics. This kit is available for purchase through the ACOG bookstore at www.acog.org and online at www.acog.org/goto/teens.

2009 – COMMITTEE OPINION - MENSTRUAL MANIPULATION FOR ADOLESCENTS WITH DISABILITIES
This Committee Opinion was published in the December 2009 Green Journal. It states that defining the reasons for intervention and the precise goal of treatment are the most critical issues regarding use of interventions to alter menstrual flow in adolescents with disabilities. Reasons for intervention may relate to abnormal uterine bleeding, hygiene, mood issues, fear of pregnancy, and acute onset of other medical conditions. Goals of treatment may include a decrease in the amount of bleeding, periodic amenorrhea, or treatment of symptoms, such as mood issues or dysmenorrhea. First-line treatment options should be safe, minimally invasive, and nonpermanent. Endometrial ablation has not been studied in adolescents, has not been studied long-term, is considered irreversible and, therefore, is not recommended in teenagers.

2009 – COMMITTEE OPINION - VON WILLEBRAND DISEASE IN WOMEN
This Committee Opinion was published in the December 2009 Green Journal as a joint opinion with the Committee on Gynecologic Practice.  It highlights that approximately 3 million women in the United States have inherited bleeding disorders. The prevalence of bleeding disorders is particularly high among women with menorrhagia. Von Willebrand disease is the most common inherited bleeding disorder. Once a diagnosis is made, collaboration with a hematologist is helpful for long-term management. Women with von Willebrand disease may be at increased risk for gynecologic and obstetric complications. Many treatments are available for the control of menorrhagia in women with von Willebrand disease, but the first-line therapy remains combined hormonal contraception.

2010 – COMMITTEE OPINION - THE INITIAL REPRODUCTIVE HEALTH VISIT
This Committee Opinion was published in the July 2010 Green Journal as a revision to an earlier opinion on this subject published in 2006. This opinion continues to highlight ACOG’s recommendation stating that the first visit to the obstetrician-gynecologist for health guidance, screening, and the provision of preventive health care services take place between the ages of 13 and 15 years.   This Committee Opinion clarifies the services provided during this initial visit.  It also notes that preventive medicine services provided to asymptomatic patients may be used only once a year by any health care provider. This is problematic because some health care providers offer the full range of care from general preventive care to reproductive health care, but many times no one clinician provides all the recommended care an adolescent needs. Therefore, "well-child" care may require two visits, a general preventive visit and a dedicated reproductive health visit. The opinion states that both are critical and each of these visits should be covered.

2010 – COMMITTEE OPINION -  CERVICAL CANCER IN ADOLESCENTS: SCREENING, EVALUATION, AND MANAGEMENT
This Committee Opinion was published in the August 2010 Green Journal as a revision to an earlier opinion on this subject published in 2006. The opinion continues to highlight that the management of abnormal cervical cytology in adolescents differs from that for the adult population in many cases. It now includes the new recommendations that cervical cancer screening should begin at 21 years of age, regardless of sexual activity.

2010 – COMMITTEE OPINION - HUMAN PAPILLOMAVIRUS VACCINATION
This Committee Opinion was published in the September 2010 Green Journal as a revision to an earlier opinion on this subject published in 2006. The opinion continues to recommend the provision of vaccination against HPV to females aged 9 to 26 years of age. It now highlights the availability of two different HPV vaccines.

2011 – GUIDELINES FOR ADOLESCENT HEALTH CARE
Guidelines for Adolescent Health Care is a revision of Health Care for Adolescents and is designed to provide the information necessary for the provision of health services to adolescent patients in a comprehensive fashion. It contains a statistical overview on adolescent health and behavior, as well as new information on topics including adolescent development, contraception, immunization, mental health disorders, substance abuse, and body modification. Also included are revised and expanded versions of previously published opinions on adolescent health research, endometriosis in adolescents, breast concerns in adolescents, and the overweight adolescent. It is available to members on the ACOG website.

 

For additional information, contact Lisa Smith Goldstein, MS, Director, Adolescent Health Care, American College of Obstetricians and Gynecologists, (202) 863-2497 phone, (202) 484-3917 fax, lgoldstein@acog.org.

 

June 2011

Contact:

Caitlin Phelps, MA
Director of Gynecology
cphelps@acog.org

Lyndona Charles
Special Assistant, Gynecology and Ethics
lcharles@acog.org