title: Pediatric and Adolescent Gynecology in Europe: Clinical Services, Standards of Care, and Training.
abstract: OBJECTIVE
  To identify current clinical services and training available across Europe within pediatric and adolescent gynecology (PAG) and establish the extent to which PAG services meet current European Board and College of Obstetrics and Gynecology (EBCOG) standards.
  
  
  METHODS
  Quantitative and qualitative questionnaire.
  
  
  METHODS
  European countries that are members of the EBCOG and the European Association of Pediatric and Adolescent Gynecology.
  
  
  METHODS
  Thirty-six countries that were approached beginning in September 2013; data were obtained from 27 countries.
  
  
  METHODS
  Questionnaires with 28 stems were sent to clinical leaders in 36 European countries.
  
  
  METHODS
  National society, national standards, legislation for female genital mutilation, protocols for transition to adult services, human papilloma virus vaccination programs, sex and contraception education, safeguarding, clinical leads for PAG, delivery of PAG services, and training available for PAG.
  
  
  RESULTS
  Of 36 countries, 27 responded. Seventy-seven percent had a national PAG society but only 44% had national standards in PAG. There was agreement that PAG cases should be multidisciplinary but not all have clinical networks in place to facilitate this. Human papilloma virus programs are available in some European countries and not all have legislation against female genital mutilation. A significant proportion of cases continue to be seen in adult gynecology clinics as opposed to designated PAG clinics with only 41% with processes to transfer patients into adult care.
  
  
  CONCLUSIONS
  In this article we provide a framework to explore areas for improvement within PAG services and training across Europe. The EBCOG standards of care are not being adhered to in many countries because processes and clinical networks are not in place to facilitate them.
authors.affiliation: Department of Obstetrics and Gynecology, Kettering General Hospital NHS Foundation Trust, Northamptonshire, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Richmond
authors.affiliation: Department of Reproductive Medicine, Addenbrookes Hospital, Cambridge University Hospitals Foundation Trust, Cambridgeshire, United Kingdom.
authors.forename: Sweta
authors.initials: S
authors.lastname: Priyanka
authors.affiliation: Department of Obstetrics and Gynecology, Victoria Hospital, Kirkcaldy, Fife, Scotland.
authors.forename: Tahir
authors.initials: T
authors.lastname: Mahmood
authors.affiliation: Department of Reproductive Medicine, Addenbrookes Hospital, Cambridge University Hospitals Foundation Trust, Cambridgeshire, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: MacDougall
authors.affiliation: Department of Obstetrics and Gynecology, Kettering General Hospital NHS Foundation Trust, Northamptonshire, United Kingdom. Electronic address: paul.wood@kgh.nhs.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000193:education / Q000379:methods / Q000592:standards*; D000328:Adult; D005060:Europe; D005260:Female; D006176:Gynecology / Q000193:education / Q000379:methods / Q000592:standards*; D006801:Humans; D010372:Pediatrics / Q000193:education / Q000379:methods / Q000592:standards*; D011247:Pregnancy; D036301:Qualitative Research; D059039:Standard of Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: EBCOG standards; Europe; Pediatric and adolescent gynecology