‘Gynecology doesn’t start at age 18’: Novel UChicago Medicine program handles complex pediatric cases

While visiting her extended family in Michigan, 11-year-old Kayla* woke up one morning in March 2023 with terrible abdominal pain. Her mother, Ann*, figured it was menstrual cramps or indigestion, but the pain intensified with a fever.

Doctors at a local emergency department ran tests to identify the source of Kayla’s pain: a rare condition called fallopian tube torsion, or “tubal torsion,” which occurs when a fallopian tube twists and fills with blood and fluid, becoming enlarged.

Kayla stayed in Michigan for surgery to untwist and drain one of her fallopian tubes, which was also sutured down to avoid a relapse.

But two months later, the sutures gave way and Kayla’s fallopian tube re-twisted multiple times. The pain also returned, causing her to miss school and feel very anxious.

Further complicating matters, Kayla also has mast cell activation syndrome, an immune system disorder that can cause severe allergic reactions to certain drugs. Medications she received during treatment for anesthesia and menstrual suppression caused stroke-like symptoms such as slurred speech, dizziness and serious memory issues.

“We were fighting two things at once,” Ann said. “It was a complex case.”

Unique OB/GYN program focuses on younger patients

Back home in Chicago, the family sought answers. Doctors at another hospital proposed removing both of Kayla’s fallopian tubes — a drastic step neither mother nor daughter wanted.

They decided to search online for other options and found the University of Chicago Medicine's Pediatric and Adolescent Gynecologic Surgery (PAGS) program and Shashwati Pradhan, MD, a pediatric and adolescent gynecologist and surgeon. Ann quickly made an appointment.

PAGS — a unique specialty in the gynecology field — treats complex gynecological problems for girls ranging in age from infants to age 22.

Launched by Pradhan in 2020, PAGS was expanded in September 2023 with the addition of UChicago Medicine pediatric and adolescent gynecologist and surgeon Jessica Long, MD.

Pradhan studied Kayla’s case and came up with a treatment plan that would save one of her fallopian tubes so she could still have children one day.

In December 2023, Kayla had a salpingectomy to remove one of her fallopian tubes. Pradhan took additional steps to save her other fallopian tube and protect her ovaries. She also adjusted Kayla’s medications so nothing triggered her mast cell activation syndrome.

“Dr. Pradhan made some really good decisions for us,” Ann said. “After all we’d been through, it’s the best feeling in the world to find a doctor you trust who can help your child.”

Kayla, now 12, has resumed a normal, pain-free life. No future treatment is expected, Pradhan said.

Expert gynecology care for pre-teen girls

Gynecology for young girls is a unique specialty. Even toddlers can have problems with things like vaginal discharge or vulvar skin issues, but many OB-GYN physicians are uncomfortable treating elementary-aged or pre-teen girls.

“Gynecology doesn’t start at age 18,” Pradhan said. “There are a lot of providers who will say, ‘If you’re 16, I would do this. But at 12, I don’t know if that’s the right step.’ That’s valid — and that’s where we come in. We have experience with patients that age.”

PAGS is often a multidisciplinary specialty. Pradhan, Long and fellowship-trained providers at UChicago Medicine can ensure the most comprehensive care because they discuss unique cases and collaborate as necessary with experts such as pediatric urologists, pediatric endocrinologists, pediatric surgeons and pediatric hematologists.

“We have a great collection of people with great expertise and training,” Pradhan said. “PAGS is special because we don’t just do surgery, but we care for medically complex kids.”

*Names were changed to protect the family’s identity.