NASPAG Clinical Consensus Guidelines 

Abstract: Heavy menstrual bleeding is a common condition encountered in the adolescent patient population. The objective of this consensus guideline is to provide the latest evidence regarding the use of tranexamic acid as a treatment modality for heavy menstrual bleeding in this age group.

Lacy B, French A, Berger-Chen S, Shah-Bruce M, Haamid F. NASPAG Clinical Consensus: Use of Tranexamic Acid in the Treatment of Heavy Menstrual Bleeding. J Pediatr Adolesc
Gynecol. 2025 Aug;38(4):452-457. doi:10.1016/j.jpag.2025.02.008. PMID: 40651840.  

Abstract: The objective of this document is to guide the screening, diagnosis, and management of Relative Energy Deficiency in Sport (RED-S) in Adolescent/Young Adult (AYA) athletes to treat symptoms and reduce long-term sequelae with a focus on gynecologic aspects of the disorder. RED-S is a more comprehensive term for the condition previously known as the Female Athlete Triad. An overview of the clinical presentation, evaluation, and management of the reproductive health aspects of RED-S for female athletes is provided. For the purposes of this document, “female” refers to those designated female at birth, and “athlete” is defined as an individual who participates in regular physical activity. This document is intended for use by healthcare providers who care for female AYA athletes with RED-S.

Romano ME, Sass A. Reproductive Health Management of Female Adolescent Athletes With Relative-Energy Deficiency in Sport. J Pediatr Adolesc Gynecol. 2025 Apr;38(2):108-116. doi:10.1016/j.jpag.2024.11.008. Epub 2024 Dec 19. PMID: 39709115.

Abstract: The objective of this document is to provide guidance on the recognition, diagnosis and management of non-sexually acquired genital ulcers in the pediatric and adolescent patient. Commonly known as genital or vulvar aphthous ulcers, lesions are typically seen in the peri‑menarchal population, are exquisitely painful, generally self-limited and managed with supportive care. Details of ulcer physical appearance, proposed etiology and options for management are provided to familiarize clinicians with this entity, which can be alarming for patients and families.

Abstract: Transgender and gender nonbinary (TGNB) adolescents and young adults (AYA) may present to clinicians with reproductive health expertise for the spectrum of gynecologic, sexual, and reproductive care. As such, clinicians should be knowledgeable in the many facets of gender-affirming care. This clinical opinion reviews language associated with gender diversity and gender-affirming care; current clinical, social, and political barriers faced by TGNB AYA; and the creation of welcoming and inclusive clinical spaces for TGNB AYA. It discusses social, medical, and surgical affirmation processes, and focuses on gynecologic care topics which may arise in the care of TGNB AYA, including those who undergo medical or surgical therapies. This includes menstrual suppression, breakthrough bleeding on testosterone, sexual health, fertility, and the pelvic care of individuals following gender affirming vulvovaginoplasty.

Abstract: Prepubertal bleeding is a common presentation in the pediatric office and can be distressing for patients and families. A comprehensive approach to diagnosis and management allows clinicians to identify patients at risk for worrisome pathology and arrange timely care.

Abstract: This Clinical Opinion replaces the NASPAG Clinical Recommendation: Pediatric Lichen Sclerosus published in 2014. The objective of this document is to provide guidance in the diagnosis and management of vulvar lichen sclerosus (LS) in the pediatric and adolescent patient in order to treat patient symptoms and reduce long-term sequelae. LS is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, loss of pigmentation and vulvar adhesions with loss of normal vulvar architecture. Management includes topical agents for induction and maintenance therapy, as well as long-term follow-up for identification and treatment of recurrence and sequelae. This document is intended for use by both primary and specialty pediatric and adolescent gynecology (PAG) providers, including specialists in pediatrics, gynecology, adolescent medicine, and dermatology.

Simms-Cendan J, Hoover K, Marathe K, Tyler K. NASPAG Clinical Opinion: Diagnosis and Management of Lichen Sclerosis in Pediatric and Adolescent Patients. J Pediatr Adolesc Gynecol. 2022 Apr;35(2):112-120. doi:10.1016/j.jpag.2021.09.008. Epub 2021 Oct 2. PMID: 34610442.

Abstract: Adnexal torsion is an uncommon gynecologic disorder caused by the partial or complete rotation of the ovary and/or the fallopian tube on its vascular support. Delay in treatment can impact fertility adversely. The objective of this report is to provide clinical recommendations based on the latest evidence. Specifically we discuss epidemiology, clinical presentation, diagnostic approach and management of adnexal torsion in adolescents.

Abstract: Heavy menstrual bleeding (HMB) is a very common gynecological condition in female adolescents and a frequent presenting complaint of those with bleeding disorders. Recommendations have been established to screen for bleeding disorders in this age group where appropriate. The purpose of this document is to impart clinical recommendations regarding HMB in adolescents. Specifically, in this article we provide a description of the epidemiology, clinical presentation, diagnostic approach, and treatment of HMB in adolescents.

Abstract: Vulvovaginitis is a commonly encountered condition among prepubertal and adolescent females. The objective of this report is to provide the latest evidence regarding the diagnosis and management of vulvovaginitis in prepubertal and adolescent females. In this systematic review we used the Grading of Recommendations Assessment, Development and Evaluation evidence system. Vulvovaginal complaints are common in the pediatric and adolescent age group. The patient's age in conjunction with history and associated complaints will guide evaluation, diagnosis, and treatment. Treatment should include counseling on hygiene and voiding techniques as well as therapy for any specific pathogens identified.

Abstract: Labial adhesions, also known as labial agglutination, are a common finding in prepubertal adolescents. They are defined as fusion of the labia minora in the midline or are termed vulvar adhesions when they occur below the labia minora (inner labia). Patients are often asymptomatic but might present with genitourinary complaints. The decision for treatment is based on symptoms. The mainstay of treatment in asymptomatic patients is conservative, with careful attention to vulvar hygiene and reassurance to parents. In symptomatic patients, topical treatment with estrogen and/or steroid cream is often curative. Less often, corrective surgery is necessary. Recurrence is common until a patient goes through puberty. These recommendations are intended for pediatric and gynecologic health care providers who care for pediatric and adolescent girls to facilitate diagnosis and treatment.

Abstract: Approximately 7% of girls will have an anatomic abnormality in their reproductive tract, diagnosed before or after puberty.

Abstract: The nonobstructive group of anatomic variants involving the reproductive tract includes vaginal agenesis as well as the congenital anomalies of the vagina and uterus, occurring without pain during the pubertal years.