For children with chronic illnesses, need for gynecologic care is on rise. (Many are Sexually Active).

MIAMI BEACH -- Improved survival rates in children with chronic illnesses mean they have a growing need for gynecologic care, Dr. Elizabeth Alderman said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology

"Twenty-five years ago, many of these children with cystic fibrosis, leukemia, chronic kidney disease, or severe asthma were not always surviving into adolescence. Now they are entering puberty, menarche-even getting pregnant-and they're bringing the special needs of their illness into this new stage of life," said Dr. Alderman of the division of adolescent medicine at Albert Einstein College of Medicine, New York.

Six percent of all adolescents in the United States have a chronic illness, she said.

Asthma is the most prevalent of these conditions, occurring in 38 per 1,000 teenagers, followed by mental illness, congenital heart disease, seizure disorders, cerebral palsy, arthritis, and diabetes.

"Studies show that many girls with these illnesses are sexually active and are concerned about their sexuality. And on top of this, their illnesses and medications may exacerbate their risks of sexually transmitted diseases, their contraceptive choices may be limited, and pregnancy could pose a significant health risk to them," she said.

Physicians need to be aware how certain chronic illnesses can impact a girl's sexuality, Dr. Alderman said. For example, diabetes and inflammatory bowel disease can impact growth; sickle cell disease, chronic renal disease, and cystic fibrosis can delay puberty; and chronic renal disease, thyroid dysfunction, uncontrolled diabetes, ovarian hyperandrogenism, and cancer may cause future fertility problems.

"Both we as health care providers and often the parents of these children are not used to thinking about our patients in terms of sexuality. Parents of children with chronic illnesses tend to infantilize them, and often we as ...