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April 10, 2002


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.

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