Emory
Physician One of Few Gynecologists In Atlanta Specializing In Reproductive
Health Care of Teens
Lesley L. Breech,
M.D., assistant professor of obstetrics and gynecology with the Emory
University School of Medicine at Grady Memorial Hospital, is among a
growing number of adolescent gynecologists in the country who specialize
in providing reproductive health care services to young adults. While
Dr. Breech is one of the few adolescent gynecologists in Atlanta, the
specialty itself is gaining more attention, due largely to the fact
that more adolescents are developing earlier and experiencing sex younger,
and because sexually transmitted diseases are highly prevalent among
young people.
The field itself is known
as adolescent and pediatric gynecology. Dr. Breech's training, for example,
involves endocrinology (pubertal development), surgery, psychology,
and pediatric emergency medicine and trauma that includes straddle injuries
(injuries to the perineum, pelvis or vaginal areas). As an adolescent
gynecologist, Dr. Breech treats menstrual disorders, pubertal delay,
early puberty, congenital anomalies, sexual assaults, sexually transmitted
diseases, as well as well-woman care.
"Well-woman care is actually
progressing more into the teens than it used to because of an earlier
sexual debut," said Dr. Breech, who also serves as medical director
of the Teen Services Program within the Grady Health System. The clinic
serves 2,500 teenagers each year.
According to Dr. Breech,
the American College of Obstetrics and Gynecology recommends that women
begin having pap smears at age 18, or at the onset of sexual activity
because it is believed that STDs are associated with the development
of cervical cancer and cervical dysplasia, which is the precursor to
cancer. Therefore, when a woman becomes sexually active, Dr. Breech
says, the risk of a cervical abnormality increases, making it necessary
for pelvic exams and pap smears.
At Grady's Teen Services
Clinic, the prevalence of sexually transmitted diseases among the female
adolescent population, for example, is more than 60 percent among girls
ages 12 to 19. Many of the girls are screened and also treated for gonorrhea,
chlamydia, herpes, syphilis, or for pap smears that are suggestive of
the Human Papilloma Virus (HPV), a sexually transmitted disease that
causes venereal warts and can lead to cervical cancer. In addition to
the screenings, appropriate counseling regarding safe sex and protection
against STDs are also provided. Over the past 18 months, the clinic
has also increased the rate of HIV screenings for girls. Thus far, there
have been very few incidences of HIV in the population Dr. Breech serves
at Grady.
Dr. Breech is particularly
concerned, however, about the increasing prevalence of abnormalities
in pap smears or cervical pathology. Of those girls who have been referred
or evaluated for abnormal pap smears, Dr. Breech treats an increasing
number of young patients with early pre-cancerous changes, which are
often associated with HPV. The majority of her patients, she says, have
been exposed to HPV. And once a young woman has the virus, it cannot
be cured, but it can be managed and followed. It is not known how HPV
affects the adolescent cervix, nor the risk associated with such pre-cancerous
changes compared to that of older women.
"In this population here
at Grady, I'm obviously very concerned about STDs and what that means
to the patient's future," said Dr. Breech, who also sees patients at
the Emory Clinic one day each week. "But the advantage of the Teen Services
Clinic is that everything here is provided free of charge, and we have
the ability to follow patients and collect data about the natural history
of HPV and its affects on the cervix or pre-cancerous change that you
find in adolescent young women."
Girls with early pre-cancerous
changes are followed with more frequent pap smear evaluations, and Dr.
Breech said that as much as 70 percent of those changes regress without
any intervention. A colposcopy, which magnifies areas of the vagina
and cervix, is done to more closely examine cervical tissue to determine
mild, moderate or severe dysplasia.
"This is an opportunity for
this clinic to look into one of the most important issues in adolescent
gynecology, which is what is the natural history of this disease in
teens and what is the appropriate management," Dr. Breech. "With the
support of the hospital and the university, we have the patient need
and resources to define the history and appropriate management."
While Dr. Breech's patient
population is mostly teens, she also treats pediatric patients. This
includes treating young girls for ovarian cysts, those experiencing
early pubertal development, as well as congenital anomalies involving
ambiguous genitalia, or congenital adrenaline hyperplasia, in which
the external genitalia has been stimulated by hormones with male activity
and becomes more ambiguous. Surgical intervention is often necessary
to create a more distinguishable female appearance. Dr. Breech performs
the surgeries at Egleston Children's Hospital.
Aside from the medical component
of her practice, Dr. Breech says that education is one of the most important
aspects of her job. She strives to teach young people – especially young
girls - the importance of reproductive health, as well as the responsibility
of sexual involvement and use of contraception.
"For me, this is an opportunity
to have a positive influence in young women's lives and in some ways
help empower them about their reproductive selves, and to help them
feel comfortable in making sound, healthy decisions that will last a
life time," she said.
|