Displaying all 8 publications

  1. Knox B, Azurah AG, Grover SR
    Curr. Opin. Obstet. Gynecol., 2015 Oct;27(5):309-14.
    PMID: 26208045 DOI: 10.1097/GCO.0000000000000199
    Menstrual problems are known to be common amongst teenagers, but adequate recognition of the impact this may have on the adolescent and appropriate interventions that are focussed on the needs of the adolescents are limited.
  2. Zainuddin AA, Grover SR, Shamsuddin K, Mahdy ZA
    J Pediatr Adolesc Gynecol, 2013 Dec;26(6):296-304.
    PMID: 23507003 DOI: 10.1016/j.jpag.2012.08.004
    Congenital adrenal hyperplasia (CAH) is the commonest cause of ambiguous genitalia for female newborns and is one of the conditions under the umbrella term of "Disorders of Sex Development" (DSD). Management of these patients require multidisciplinary collaboration and is challenging because there are many aspects of care, such as the most appropriate timing and extent of feminizing surgery required and attention to psychosexual, psychological, and reproductive issues, which still require attention and reconsideration, even in developed nations. In developing nations, however, additional challenges prevail: poverty, lack of education, lack of easily accessible and affordable medical care, traditional beliefs on intersex, religious, and cultural issues, as well as poor community support. There is a paucity of long-term outcome studies on DSD and CAH to inform on best management to achieve optimal outcome. In a survey conducted on 16 patients with CAH and their parents in a Malaysian tertiary center, 31.3% of patients stated poor knowledge of their condition, and 37.5% did not realize that their medications were required for life. This review on the research done on quality of life (QOL) of female patients with CAH aims: to discuss factors affecting QOL of female patients with CAH, especially in the developing population; to summarize the extant literature on the quality of life outcomes of female patients with CAH; and to offer recommendations to improve QOL outcomes in clinical practice and research.
  3. Girling JE, Hawthorne SCJ, Marino JL, Nur Azurah AG, Grover SR, Jayasinghe YL
    J Pediatr Adolesc Gynecol, 2018 Oct;31(5):459-467.
    PMID: 29655581 DOI: 10.1016/j.jpag.2018.04.001
    STUDY OBJECTIVE: No studies have specifically considered paternal understanding of menstruation. This study aimed to establish the degree of understanding of fathers of adolescent girls with menstrual symptoms relative to mothers.
    DESIGN AND SETTING: This was a cross-sectional survey-based study. Adolescent patients attending an outpatient gynecology clinic for dysmenorrhea and/or heavy menstrual bleeding and their parents were invited to complete surveys.
    PARTICIPANTS: Sixty surveys were completed (24 of 40 daughters, 20 of 40 mothers, 16 of 40 fathers).
    INTERVENTIONS AND MAIN OUTCOME MEASURES: Surveys aimed to test parents' understanding of menstrual symptoms and potential medications, as well as fathers' concerns with their daughters' health.
    RESULTS: The fathers' knowledge of menstrual symptoms was poorer than mothers, although most knew heavy menstrual bleeding (15/16, 94%) and mood swings (14/16, 87%). Many parents answered "don't know" or did not answer questions about potential consequences of medications, although parents were clearly concerned about side effects. Most fathers (13/16, 81%) were open to discussing menstrual concerns with daughters; however, only 54% (13/24) of daughters were open to such discussions. Of fathers, 81% (13/16) were sympathetic/concerned, 56% (9/16) felt helpless, and 13% (2/16) were frustrated when daughters were in pain. When asked about effects, 88% (14/16) of fathers (79% [15/20] of mothers) were worried about their daughter's welfare and 63% (10/16) (55% [11/20] of mothers) about schooling.
    CONCLUSION: We present, to our knowledge, the first insight into fathers' knowledge of their daughters' menstrual health. Overall, parents have an incomplete picture of menstrual symptoms. Even in this cohort, which could be expected to be well informed because of their daughters' attendance at a tertiary hospital, it is clear that further knowledge would assist them caring for their daughters.
    Study site: Adolescent Gynaecology Outpatient Clinic, Royal Children’s Hospital, Victoria, Australia
  4. Thever Ramasamy V, Sivapatham L, Grover SR, Shanmugam SS, Ganesalingam M
    J Pediatr Adolesc Gynecol, 2021 Feb;34(1):61-64.
    PMID: 33010465 DOI: 10.1016/j.jpag.2020.09.003
    BACKGROUND: Uterine torsion is a rare event, which mostly reported in females with a gravid uterus and is exceptionally rare in children.

    CASE: A 9-year-old girl presented with 3 days of intermittent lower abdominal pain. Ultrasound revealed an ovarian mass, but laparotomy revealed an ischemic enlarged ovary and uterus rotated 180°. No reperfusion occurred after 60 minutes. A subtotal hysterectomy and right salpingoophorectomy were thus performed.

    CONCLUSION: Uterine and adnexal torsion presents with symptoms similar to those of adnexal torsion. Delays in diagnosis and referral continue to be an issue, resulting in suboptimal outcomes. Uterine torsion, although exceedingly rare in childhood, appears to occur only in the setting of ovarian masses, which provide the impetus for the rotational force to the elongated cervix of the prepubertal uterus.

  5. Sachedina A, Abu Bakar M, Dunford AM, Morris A, Nur Azurah AG, Grover SR
    J Obstet Gynaecol Res, 2021 Jan;47(1):352-358.
    PMID: 33084069 DOI: 10.1111/jog.14532
    AIM: To describe the characteristics, management and outcomes of a cohort of young people with dysmenorrhea presenting to a tertiary adolescent gynecology service, managed primarily with medical interventions.

    METHODS: A retrospective cohort study was conducted at the Royal Children's Hospital in Melbourne, Australia. Data were collected from medical records of patients presenting with dysmenorrhea and/or pelvic pain.

    RESULTS: Of 154 patients, mean age of presentation was 15.7 years (SD = 2.2) and mean duration of pain was 14.9 months (SD = 10.8). Regular cycles were reported by 64.5%, and heavy menstrual bleeding (HMB) in 67.8%. Patients self-reporting HMB reported less pain on the day prior to menses than those not reporting HMB (P

  6. Zainuddin AA, Grover SR, Soon CH, Ghani NAA, Mahdy ZA, Manaf MRA, et al.
    J Pediatr Adolesc Gynecol, 2020 Oct;33(5):477-483.
    PMID: 32376362 DOI: 10.1016/j.jpag.2020.04.008
    OBJECTIVE: To explore the impact of congenital adrenal hyperplasia (CAH) on body image in Malaysian females with CAH and to understand the perspectives of these young women and their parents toward feminizing genitoplasty (FG).

    DESIGN: Multi-center cross-sectional study.

    SETTING: Two tertiary medical centers in Malaysia.

    PARTICIPANTS: A total of 59 patients with CAH who were raised as females and more than 10 years old, and their parents.

    METHODS: The CAH respondents completed the validated and translated Body Image Disturbance Questionnaires (BIDQ). All CAH respondents and their parents underwent semi-structured interviews to explore their views on FG.

    MAIN OUTCOME MEASURES: Body image disturbance score and perspectives on FG.

    RESULTS: The 59 CAH respondents consisted of 12 children, 29 adolescents, and 18 adults. The majority were of Malay ethnicity (64.4%) with classical CAH (98.3%) and had undergone FG (n = 55, 93.2%). For the BIDQ scores, the median score (interquartile range) for general body image was 1.29 (0.71), range 1.00-3.29, whereas the genital appearance score was 1.07 (0.39), range 1.00-4.29, revealing a greater concern for general body parts over genitalia. With regards to FG, it was perceived as necessary. Infancy and early childhood were perceived as the best timing for first FG by both respondents and parents, most preferring single-stage over 2-stage surgery.

    CONCLUSIONS: General body appearance concerns were greater than for genital appearance, with more impact on the patients' lives. Contrary to much international opinion, feminizing surgery was perceived as necessary and appropriate by CAH respondents and their families, and should be offered in infancy or early childhood. Future qualitative studies are recommended.

  7. Zainuddin AA, Grover SR, Abdul Ghani NA, Wu LL, Rasat R, Abdul Manaf MR, et al.
    Health Qual Life Outcomes, 2020 Aug 01;18(1):258.
    PMID: 32738912 DOI: 10.1186/s12955-020-01515-9
    BACKGROUND: This study investigates the health-related quality of life (HRQOL) of female patients with congenital adrenal hyperplasia (CAH) in Malaysia. The objectives were to attain socio-demographic and medical data on these Malaysian females with CAH and establish their health-related quality of life (HRQOL) in comparison to age matched diabetic controls.

    METHODS: A cross-sectional study was conducted over 6 months in the two main tertiary centres for CAH patients in Malaysia. Participants including 59 female-raised CAH patients (mean age ± SD = 16.3 ± 4.2 years, range 10-28 years) compared to 57 age-matched female diabetic patients (mean age ± SD = 16.5 ± 3.4 years, range 10-26 years). Socio-demographic and medical profiles was obtained through semi-structured interviews. HRQOL of participants were evaluated utilising validated, Malay translated questionnaires which were age appropriate: Pediatric Quality of Life Inventory (PedsQL v4.0) scales for Child (8-12) and Adolescent (13-18) and Medical Outcome Survey 36-item Short Form version. These were then compared to the diabetic controls.

    RESULTS: The CAH participants consisted of children (ages 10-12 years, n = 12), adolescents (ages 13-17 years, n = 29) and adults (≥ 18 years, n = 18). The majority were Malays (64.4%) and had salt-wasting CAH (67.8%). There were no significant differences between the total mean score of the HRQOL of the combined children and adolescents CAH group (total mean score ± SD = 81.6 ± 17.9, 95% CI = 75.6-87.6) when compared to age-matched diabetic patients (total mean score ± SD = 80.8 ± 11.0, 95% CI = 77.0-84.5, P = 0.81, effect size = 0.05); no significant difference between the adult CAH and diabetic controls in the physical [median score (IQR) CAH vs diabetics; 49.3 (11.4) vs. 50.2 (6.1), P = 0.60, effect size = 0.09] and the mental composite scores [median score (IQR) CAH vs. diabetics; 47.8 (14.1) vs. 50.0 (10.8), P = 0.93, effect size = 0.01].

    CONCLUSIONS: The HRQOL of the Malaysian CAH cohort were comparable to the diabetic controls.

  8. Zainuddin AA, Grover SR, Soon CH, Nur Azurah AG, Mahdy ZA, Wu LL, et al.
    Front Pediatr, 2019;7:144.
    PMID: 31058121 DOI: 10.3389/fped.2019.00144
    Background: Girls born with congenital adrenal hyperplasia have virilized external genitalia. There is considerable debate regarding both the outcomes of feminizing genitoplasty and timing of the surgery in this population. Objective: To investigate outcomes of females 46,XX individuals with CAH in Malaysia, the surgical outcomes of feminizing genitoplasty (FG) and their attitudes toward surgery. Study Design: This is a cross-sectional study involving the two main tertiary centers in Malaysia. All 46,XX patients with CAH and raised female, who had undergone FG were identified and invited to participate. Data on socio-demographic, medical profiles, and attitudes toward surgery were collected. A standardized evaluation of the external genitalia was undertaken including the anatomic and cosmetic evaluation by independent gynecologists. Results: Of 61 individuals identified, 59 participated-consisting of children (n = 12), adolescents (n = 29) and adults (n = 18). All but one had classical CAH (98.3%) and had undergone FG (n = 55, 93.2%) with surgery mostly undertaken by pediatric surgeons trained in DSD work (n = 44, 74.6%). Complications overall were low (20.3%), with repeat surgery rate of 9.1%. External genital examination was performed in 38 participants. Overall 36.8% had absent clitoral glands and 39.5% had a persistent urogenital sinus and in 10.5%, no vaginal orifices were seen. Poor cosmetic outcomes were present in 42.1% with 55.3% recommended for further assessment under general anesthetic. Almost half participants did not venture an opinion on FG, those who did varied from having a positive attitude toward it (18 participants) to 3 opining that it should not be done, or avoided or delayed. From the participants, 35.5% preferred FG to be done early in life compared to 44.0% of the parents. Conclusions: The reoperation rates of the feminizing genitoplasty surgeries were low however due to the anatomic and cosmetic outcomes, reassessment of the external genitalia of these CAH patients may be required once they consider becoming sexually active as they may require further treatment. Many factors such as cultural sensitivities and access to medical treatment and late diagnoses have an impact on attitudes toward FG.
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