Holding a few test sheets in hand, walking out of the consultation room, Lei Ming was instantly much more relaxed.

"This time I was finally able to find out what was going on with my child. Director Yin is very professional, I didn't expect her to do such a detailed gynecological examination for my daughter, who is less than 3 years old. Lei Ming himself is also a doctor, and his feeling about the experience of taking his daughter to see a doctor this time is: finally found the department and found the right doctor.

On June 2022, 6, the Department of Obstetrics and Gynecology of Peking University First Hospital opened the Pediatric Gynecology Clinic, which is the first gynecological clinic for children and adolescents opened by a tertiary general hospital in Beijing. For more than half a year, Yin Ling, the initiator of the project and chief physician of the Department of Obstetrics and Gynecology of Peking University First Hospital, led a team to receive 25 to 20 patients every Saturday morning.

Pediatric and Adolescent Gynecology (PAG), as a subdiscipline and branch of gynecology, has a history of more than 80 years internationally and has developed rapidly, but it is still a "new thing" in China.

At present, the number of hospitals offering pediatric gynecology clinics in the country is limited, and only a few hospitals, such as the Children's Hospital Affiliated to Zhejiang University School of Medicine, can insist on opening around the clock. This clearly does not match the increasing needs of patients.

Engaged in gynecological clinical work for more than 30 years, Yin Ling found that the number of children and adolescents who come to see the disease is increasing, and the types of diseases are becoming more and more complex and changeable.

"The development of child and adolescent gynaecology is already a priority, and the establishment of paediatric gynaecology clinics and wards is just the beginning." Yin Ling hopes that the children's gynecology clinic can solve the problem of medical treatment for patients with minor gynecological diseases. "Looking at these little patients, we hope to see them again in years, probably in obstetrics, not in the fertility center."

Neglected needs: children without access to medical care

When children encounter "children's gynecology" problems, even many doctors and parents have no way to seek medical treatment!

For a long time, parents like Lei Ming took their children to see a doctor, often children's specialist hospitals recommended "find a gynecology", some gynecologists said "the child is too young to see, look for pediatrics", or in the face of small patients do not know how to check the medication. Some children are not treated in time, and their condition is repeated, aggravated, and even difficult to cure.

A case in 2019 left Yin Ling with a deep memory.

It was a 4-and-a-half-year-old patient with severe encephalitis and a series of critical symptoms. During hospitalization screening, doctors found a teratoma on the patient's left ovary. Under certain triggers, lesions cause the body to produce a special autoimmune antibody, known as anti-NMDAR antibodies, which can lead to encephalitis. Yin Ling performed laparoscopic minimally invasive surgery on the young patient and removed the teratoma.

"The little baby recovered exceptionally well afterwards. This joint consultation between departments also gave me the idea of opening a 'children's gynecology', because babies really need our help when they encounter gynecological diseases. "In recent years, Yin Ling has clearly felt that the number of children plagued by gynecological diseases is increasing." Previously, seeing more than 40 gynecological clinics, one or two underage patients might be encountered. In recent years, this number has multiplied several times. Sometimes, five or six children can be seen in the morning. ”

Yin Ling began to think, why can't there be a children's gynecology department that specializes in solving the problem of minor children seeing gynecological diseases?

Once deeper, Yin Ling found herself stepping into another field. Understanding the history and current situation of the global development of pediatric gynecology, she sighed: "Children's gynecology was established in 1939 abroad, and later a professional society was established, holding annual clinical and research conferences every year, publishing academic journals, and promoting the development of the discipline. We should keep up as soon as possible! ”

In June 2022, Yin Ling submitted an application to establish a "children's gynecology group" and open an outpatient clinic, and was approved by the hospital in less than 6 days. On June 20, the Children's Gynecology Clinic opened. On the first day, 6 patients were treated.

Since its opening, the Peking University First Hospital Pediatric Gynecology Clinic has received more than 1,000 patients. Yin Ling has received many letters of thanks. One of the doctors' parents wrote: "Every time I look back on my daughter's visit and think of the confusion and contradiction of not knowing which department to see in the first place, I feel the importance of the subspecialty of 'pediatric gynecology'. ”

The concept that needs to be clarified: science popularization and diagnosis and treatment, no one can be less

"Dr. Yin, I have overcome great difficulties to be able to come here today to see a doctor and communicate with you normally. I hope more people like me will come to you sooner and stop coming to where I am today. ”

Yin Ling always remembered the "girl" who said this.

In September 2022, Yin Ling received a patient with "androgen insensitivity syndrome". Due to congenital developmental abnormalities, patients were raised as girls since childhood, because they had not seen a doctor for menstruation, only to find that their chromosomal test results were male.

When I came to the children's gynecology clinic to find Yin Ling, "she" had already had two failed surgeries and underwent non-standard drug treatment, and the effect was not ideal. "If we had seen this child earlier, 'her' could have had a happier life." Yin Ling said.

Pediatric gynecology has its own peculiarities and cannot simply be regarded as a "scaled-down version" of adult gynecology.

Yin Ling explained that the reproductive organs and endocrine levels of children and adolescents are in the process of dynamic changes of continuous maturity, and the disease spectrum, treatment and long-term management plans are different from adults. This also puts forward higher requirements for doctors' diagnosis, medication and surgical treatment, which requires comprehensive consideration of patients' future quality of life and reproductive health.

Surgeries such as genital tumors in girls were traditionally performed by paediatric surgeons. Due to professional limitations, it is sometimes difficult to take into account the protection of ovarian function, and there have even been cases of the fallopian tube being mistakenly removed as an appendix.

Some traditional perceptions also urgently need to be corrected. For example, it is shameful to have gynecological diseases, and only when you are married do you need a gynecological examination ... During the consultation, many parents will ask Yin Ling, can children also do gynecological examinations? "That's a misunderstanding. Women should have regular gynecological examinations from an early age. Yin Ling said.

After the establishment of the Children's Gynecology Clinic, in addition to diagnosis and treatment, Yin Ling actually did the most health education and psychological counseling.

"Baby, remember, until you grow up, no one is allowed to touch this place except your mother and doctor!"

"Baby, the physical examination is very important, not only the mother has the physical examination!"

......

"Treating a child takes several times as much time as an adult." Yin Ling said. It takes more time for the child to tell the medical history and needs to be supplemented by the parent; Many adolescent patients have a sense of privacy, will strongly ask their parents to go out, and are also resistant to examinations; Some parents have all kinds of doubts about doing gynecological examinations for their children...

According to reports, the children's gynecology clinic covers all gynecological related problems from birth to 18 years old, solves different problems that occur in children in young girls, girls, adolescent girls, etc., and also provides diagnosis and treatment of chromosomal diseases such as sexual malformations and gonad dysplasia. Reproductive system tumors, endocrine diseases, HPV vaccination, teenage pregnancy and sexual assault are also covered by pediatric gynecology.

According to statistics, in the past 10 years, there have been nearly 300 children operated on various gynecological tumors in the Department of Obstetrics and Gynecology of Peking University First Hospital. Yin Ling said, "Unplanned or unintended pregnancy of minors will cause many sequelae that affect physical and mental health. The occurrence of pediatric gynecological tumors is closely related to living habits, environmental pollution, endocrine disorders, mental stress, etc. These require the attention of the whole society. ”

Pioneer doctors: It's just the beginning

Yin Ling is good at diagnosing and treating a variety of gynecological diseases, but when it comes to children's gynecology, she confesses that she is still "crossing the river by feeling the stones".

Since she wanted to open a children's gynecology clinic, Yin Ling has successively bought thousands of yuan of subject monographs, in addition to reading literature every day, and regularly organizing team members to study and discuss together.

On the first day of the pediatric gynecology clinic, Yin Ling brought professional books to the consultation room. Some parents brought their 8-year-old child to check for precocious puberty, did the examination, explained the situation to the parents in detail, and she opened the book again, asked the other party to take pictures of the relevant content, and went home for observation.

"The diagnosis and treatment of pediatric gynecology involves many fields and has a certain professional threshold. How to make this subdiscipline develop independently is a real problem. Yin Ling said.

At present, Yin Ling and the doctors in the team work part-time in the form of receiving consultations every Saturday. She has asked some young doctors if they would like to do this full-time, and most of them are hesitant.

Yin Ling expressed understanding: "Young doctors are facing a specialty field that started late and has unknown prospects. People don't have a concept in their heads, and they can't see what the future can become. ”

Despite the difficulties, the doctors who pioneered in this field are still moving forward step by step.

Yin Ling mentioned a consultation she had participated in. A baby born with congenital pituitary dysplasia just 21 days old was transferred from the outer hospital to Peking University First Hospital and entered the pediatric ICU.

"It's only been 21 days since I was born, what do you think? The ovaries are too small! Quickly flip through the book and look it up. We checked the little one's ovarian and hormone levels. Because the case was rare, Yin Ling invited Director Gong Chunxiu of the Department of Endocrinology of Beijing Children's Hospital to successfully solve the child's problems through multidisciplinary consultation inside and outside the hospital.

"Director Gong then sent me all 18 related papers published by their team." Yin Ling said.

Along the way, she has continued to harvest and give such generosity and warmth.

Not long ago, Yin Ling received a call: "Director Yin, can you come to us to do a project and let us do it with you?" ”

The call came from an obstetrician and gynecologist from Xianghe County People's Hospital in Hebei Province, who had followed Yin Ling's further studies. The other party said that they often encounter pediatric gynecological patients in their work, and they feel tricky about many problems and need to learn relevant knowledge.

Similarly, Lu Li, a doctor at Qinghai Provincial Maternal and Child Health Care Hospital whom Yin Ling met when she was helping in Qinghai more than 20 years ago, also called when she learned that she was leading the children's gynecology department at Peking University First Hospital, and said excitedly: "I'm doing this too, let's do it together!" ”

Through Lu Li, Yin Ling got in touch with Sun Liying, director of the "Pediatric and Adolescent Gynecology" Specialist Clinic of the Children's Hospital Affiliated to Zhejiang University School of Medicine, which has been established for more than 20 years.

Huang He, a young doctor in Yin Ling's team, said: "My supervisor, Professor Tian Qinjie, is a well-known gynecological endocrinologist at Peking Union Medical College Hospital, and he is very happy to know that I am doing this direction. ”

Shi Yifu, one of the early advocates of pediatric gynecology in China and former president of the Obstetrics and Gynecology Hospital Affiliated to Zhejiang University School of Medicine, has published several articles over the years, repeatedly explaining the particularity and social value of pediatric and adolescent gynecology. In March last year, Shi Yifu once again appealed in relevant academic journals that China must pay attention to the development of pediatric and adolescent gynecology.

(Lei Ming is a pseudonym in the text)

(Reporter Qiang Xiaoling and Wang Jingxue)