Lesley Breech, assistant professor of obstetrics and gynecology
at Grady Hospital, is among a growing number of adolescent gynecologists
in the country who specialize in providing reproductive health care
services to young adults.
While 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 (STDs) are
highly prevalent among young
The field itself is known as adolescent and pediatric gynecology.
Breechs 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, Breech
treats menstrual disorders, pubertal delay, early puberty, congenital
anomalies, sexual assaults and STDs, 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 Breech,
who also serves as medical director of the Teen Services Program
within the Grady Health System. The clinic serves 2,500 teenagers
According to Breech, the American College of Obstetrics and Gynecology
recommends 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,
a precursor to cancer.
At Gradys Teen Services Clinic, the prevalence of STDs among
the female adolescent population, for example, is more than 60 percent
among girls ages 1219. 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), an
STD 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 provided. Over the past
18 months, the clinic also has increased the rate of HIV screenings
for girls. So far, Breech said, there have been very few incidences
of HIV in the Grady population.
She 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, Breech
treats an increasing number of young patients with early pre-cancerous
changes often associated with HPV. The majority of her patients,
she said, have been exposed to HPV. 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 precancerous changes compared to that of older women.
In this population here at Grady, Im obviously very
concerned about STDs and what that means to the patients future,
said 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 precancerous change that
you find in adolescent young women.
While Breechs patient population is mostly teens, she also
treats pediatric patients. This includes treating young girls for
ovarian cysts or 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. Breech performs the surgeries
at Egleston Childrens Hospital.
Aside from the medical component of her practice, Breech said education
is one of the most important aspects of her job. She strives to
teach young peopleespecially young girlsthe importance
of reproductive health, as well as the responsibility of sexual
involvement and use of contraception.
For me, Breech said, this is an opportunity to
have a positive influence in young womens 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 lifetime.