Paula J. Adams Hillard, M.D., is Professor of Obstetrics and Gynecology at Stanford University School of Medicine where she serves as Associate Chair for Medical Student Education. She earned a B.S. in Zoology from the University of North Carolina and obtained her M.D. from Stanford University School of Medicine. She completed a residency in OB/Gyn at the University of North Carolina, Chapel Hill. She was on the faculty at the University of Virginia, and served as Professor in the Departments of OB/Gyn and Pediatrics at the Cincinnati Children’s Hospital (CCHMC) /University of Cincinnati Medical Center for 23 years. At CCHMC she was the founder of a postgraduate fellowship training program in Pediatric and Adolescent Gynecology. She currently directs the program in Pediatric and Adolescent Gynecology at the Lucile Packard Children’s Hospital at Stanford.

She has been active on a number of national medical committees, including chair of the American College Obstetricians and Gynecologists' (ACOG) Committees on Patient Education, Adolescent Health, and Guidelines for Women’s Health; she is a past member of the Gynecologic Practice Committee, the Gynecology Document Review Committee, and the Ethics Committee. She was been an examiner for the American Board of Obstetricians and Gynecologists from 1991-2015. She is a Board Member of the Association of Professors of Gynecology and Obstetrics, and was elected a fellow of the American Gynecological and Obstetrical Society. She is a past president of the North American Society for Pediatric and Adolescent Gynecology, and is an active contributor to the literature in adolescent gynecology and contraception with over 200 journal articles and abstracts published. She serves as Editor-in-Chief of the Journal of Pediatric and Adolescent Gynecology. She is the sole editor of two textbooks: the 5-Minute Consult in Obstetrics and Gynecology (2008) and Practical Pediatric and Adolescent Gynecology (2013). She is the author of over 120 book chapters on women’s health. She has been a consultant and a member of tasks forces and committees for the CDC, the U.S. FDA, the NICHD, the AMA, American Cancer Society, and ACOG. In addition to her work as a member of editorial boards and as an ad hoc reviewer for professional publications, Dr. Hillard has extensive experience with the consumer press. She was a contributing editor to Parents magazine from 1982-1990, writing a monthly column on pregnancy and birth--and currently acts as an editorial consultant to women’s publications such as Good Housekeeping, Family Circle, Woman’s Day, Cosmopolitan, Redbook, Glamour, YM, and Seventeen, as well as ABC News. She is a consultant to and a member of the medical advisory board of Clue, a menstrual cycle tracking app. She has been recognized for her teaching, and has been selected as one of 18 senior faculty master teachers/mentors for medical students at the Stanford University School of Medicine in a formal mentoring program called Educators for CARE: Compassion, Advocacy, Responsibility, and Empathy.

Academic Appointments

Administrative Appointments

  • Chief, Division of Gynecologic Specialties, Department of Obstetrics and Gynecology (2007 - 2011)
  • Associate Chair of Medical Student Education, Department of Obstetrics and Gynecology (2011 - Present)

Honors & Awards

  • Phi Beta Kappa, UNC-CH (1971)
  • GB Hayden Memorial Award for surgical teaching, Univ of Cincinnati Dept. OB/Gyn (1996)
  • Best Doctors for Women, Good Housekeeping (1997)
  • Alpha Omega Alpha, University of Cincinnati (1997)
  • Educators for CARE, Stanford University School of Medicine (2008)

Boards, Advisory Committees, Professional Organizations

  • Editor in Chief, Journal of Pediatric and Adolescent Gynecology (2016 - Present)
  • Medical Advisory Board, Clue by Biowink (2016 - Present)
  • Board of Directors, Association of Professors of Gynecology and Obstetrics (APGO) (2015 - 2018)
  • Ethics Committee Member, American Congress of Obstetricians and Gynecologists (2015 - 2017)
  • Obstetrics and Gynecology Devices Panel, U.S. FDA (2010 - Present)

Professional Education

  • B.S., Univ of N.C., Chapel Hill, Zoology (1973)
  • M.D., Stanford Univ School of Medicine, Medicine (1977)

Community and International Work

  • Arbor Free Clinic, Women's Health Faculty Advisor


    free clinical care for underserved women

    Populations Served

    low income, uninsured



    Ongoing Project


    Opportunities for Student Involvement


Clinical Trials

  • A Multicenter Study to Evaluate the Effects of a 91-day Oral Contraceptive on Bone Mineral Density in Adolescent Females Not Recruiting

    This study is being conducted to compare the effects of a 91-day oral contraceptive (OC) to a 28-day OC regimen on bone mineral density (BMD) in adolescent females.

    Stanford is currently not accepting patients for this trial. For more information, please contact Kelsey Lynd, (650) 721 - 1237.

    View full details

  • A Trial Using Novel Markers to Predict Malignancy in Elevated-Risk Women Not Recruiting

    The Novel Markers Trial will compare the safety, feasibility and effectiveness of two different epithelial ovarian cancer screening strategies that use CA125 and add HE4 as either a first or second line screen. This study is the next step in a larger research effort to develop a blood test that can be used as a screening method for the early detection of epithelial ovarian cancer.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ashley Powell, (650) 724 - 3308.

    View full details

  • Blood and Marrow Transplant Clinical Research Network Not Recruiting

    The purpose of this network is to accelerate research in hematopoietic stem cell transplantation by comparing novel therapies to existing ones.

    Stanford is currently not accepting patients for this trial.

    View full details

2023-24 Courses

All Publications

  • Thoughts on Pediatric Gynecology and Vaginal Bleeding in the Prepubertal Child. Journal of pediatric and adolescent gynecology Hillard, P. J. 2023; 36 (5): 433-434

    View details for DOI 10.1016/j.jpag.2023.08.003

    View details for PubMedID 37716711

  • Normal menstrual cycles Hillard, P. ELSEVIER. 2022: E19-E20
  • Adnexal torsion in a pediatric population: Acute presentation with question of chronicity. European journal of obstetrics, gynecology, and reproductive biology Joudi, N., Adams Hillard, P. J. 2021; 268: 82-86


    OBJECTIVES: To establish the frequency of torsion with multiple twists of the adnexa in girls 19years old and younger surgically diagnosed with torsion.STUDY DESIGN: A retrospective chart review using an institutional tool to review charts of female patients 19years old or younger who presented with acute abdominal pain leading to a surgical diagnosis of adnexal torsion.RESULTS: Of 141 pediatric patients with torsion, 61 (43%) had documentation of multiple twists, with 2 to 12 rotations present. 33% reported acute pain (<24 hrs) whereas most (67%) had pain>24h up to 4weeks without abatement (23%) or experienced discrete episodes with pain resolution between episodes (44%). Even when vascular flow was demonstrated, multiple twists were frequently found (14/36=39%). When multiple twists were documented, more patients had an extirpative procedure due to a nonviable appearing ovary than when a single or unstated number of twists twist was found, although the results were not statistically significant (53.5% vs 42.9%, p=0.098).CONCLUSIONS: Forty-three percent of girls presenting with symptoms of torsion had multiple twists in the adnexa. Many had provided a history of previous similar episodes of pain and presentation to emergency departments, suggesting possible previous undiagnosed episodes of torsion. Earlier diagnosis may provide a better opportunity for ovarian conservation prior to a recurrent torsion. Further study may reveal whether multiple twists are more likely to result in a nonviable ovary and need for oophorectomy.

    View details for DOI 10.1016/j.ejogrb.2021.11.435

    View details for PubMedID 34883338

  • Pediatric and Adolescent Gynecology Is Care for the Underserved. Journal of pediatric and adolescent gynecology Hillard, P. J. 2021; 34 (2): 109–11

    View details for DOI 10.1016/j.jpag.2021.01.017

    View details for PubMedID 33766326

  • Daily, weekly, seasonal and menstrual cycles in women's mood, behaviour and vital signs. Nature human behaviour Pierson, E., Althoff, T., Thomas, D., Hillard, P., Leskovec, J. 2021


    Dimensions of human mood, behaviour and vital signs cycle over multiple timescales. However, it remains unclear which dimensions are most cyclical, and how daily, weekly, seasonal and menstrual cycles compare in magnitude. The menstrual cycle remains particularly understudied because, not being synchronized across the population, it will be averaged out unless menstrual cycles can be aligned before analysis. Here, we analyse 241 million observations from 3.3 million women across 109 countries, tracking 15 dimensions of mood, behaviour and vital signs using a women's health mobile app. Out of the daily, weekly, seasonal and menstrual cycles, the menstrual cycle had the greatest magnitude for most of the measured dimensions of mood, behaviour and vital signs. Mood, vital signs and sexual behaviour vary most substantially over the course of the menstrual cycle, while sleep and exercise behaviour remain more constant. Menstrual cycle effects are directionally consistent across countries.

    View details for DOI 10.1038/s41562-020-01046-9

    View details for PubMedID 33526880

  • Foreword: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know CLINICAL OBSTETRICS AND GYNECOLOGY Hillard, P. 2020; 63 (3): 475–78
  • Pediatric and Adolescent Gynecology: What the Generalist OB/GYN Needs to Know. Clinical obstetrics and gynecology Hillard, P. J. 2020

    View details for DOI 10.1097/GRF.0000000000000550

    View details for PubMedID 32604239

  • Family planning in adolescents. Current opinion in obstetrics & gynecology Ganti, A. K., Hillard, P. J. 2019


    PURPOSE OF REVIEW: As politics continue to shape contraception and abortion care, providers have a responsibility to address the specific needs of the adolescent patient. Here we review the current literature on contraception and abortion in adolescents.RECENT FINDINGS: Shared decision-making among patients, parents, and providers is the cornerstone of successful adolescent family planning. Providers should be aware of local state regulations related to consent in minors. When provided directive and noncoercive contraception counseling at no cost, adolescents are motivated and effective decision-makers in their care. Long-acting reversible contraceptives should be offered as the first-line method of contraception in adolescents.SUMMARY: Family planning in adolescents presents unique challenges to obstetrician-gynecologists. Improved access to contraception and abortion services is significantly lowering unintended pregnancies rates in adolescents, but more data assessing the effectiveness of interventions in marginalized communities are needed.

    View details for DOI 10.1097/GCO.0000000000000577

    View details for PubMedID 31652151

  • Dilators for the Vajayjay JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. 2019; 32 (4): 347–48

    View details for DOI 10.1016/j.jpag.2019.07.002

    View details for Web of Science ID 000484407500001

    View details for PubMedID 31511175

  • Practical Tips for Intrauterine Device Counseling, Insertion, and Pain Relief in Adolescents: An Update. Journal of pediatric and adolescent gynecology Hillard, P. J. 2019


    The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have endorsed intrauterine devices as first-line contraceptive choices for nulliparous and parous adolescents. Practical concerns about intrauterine devices might be barriers to use for teens and clinicians; this review is devoted to "practical tips" for clinicians, on the basis of an update of the available literature as well as the author's clinical experience. Counseling about contraceptive choices, preventive guidance about possible side effects, informed consent, and pain management are addressed to promote successful use of this long-acting reversible contraption option.

    View details for DOI 10.1016/j.jpag.2019.02.121

    View details for PubMedID 30802602

  • Unusual Cause of Pediatric Vaginal Bleeding: Infantile Capillary Hemangioma of the Cervix JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Ganti, A. K., Ray, J., Mooney, K. L., Zambrano, E., Hillard, P. A., Fok, W. 2019; 32 (1): 80–82
  • Assessment of menstrual health status and evolution through mobile apps for fertility awareness. NPJ digital medicine Symul, L., Wac, K., Hillard, P., Salathe, M. 2019; 2: 64


    For most women of reproductive age, assessing menstrual health and fertility typically involves regular visits to a gynecologist or another clinician. While these evaluations provide critical information on an individual's reproductive health status, they typically rely on memory-based self-reports, and the results are rarely, if ever, assessed at the population level. In recent years, mobile apps for menstrual tracking have become very popular, allowing us to evaluate the reliability and tracking frequency of millions of self-observations, thereby providing an unparalleled view, both in detail and scale, on menstrual health and its evolution for large populations. In particular, the primary aim of this study was to describe the tracking behavior of the app users and their overall observation patterns in an effort to understand if they were consistent with previous small-scale medical studies. The secondary aim was to investigate whether their precision allowed the detection and estimation of ovulation timing, which is critical for reproductive and menstrual health. Retrospective self-observation data were acquired from two mobile apps dedicated to the application of the sympto-thermal fertility awareness method, resulting in a dataset of more than 30 million days of observations from over 2.7 million cycles for two hundred thousand users. The analysis of the data showed that up to 40% of the cycles in which users were seeking pregnancy had recordings every single day. With a modeling approach using Hidden Markov Models to describe the collected data and estimate ovulation timing, it was found that follicular phases average duration and range were larger than previously reported, with only 24% of ovulations occurring at cycle days 14 to 15, while the luteal phase duration and range were in line with previous reports, although short luteal phases (10 days or less) were more frequently observed (in up to 20% of cycles). The digital epidemiology approach presented here can help to lead to a better understanding of menstrual health and its connection to women's health overall, which has historically been severely understudied.

    View details for DOI 10.1038/s41746-019-0139-4

    View details for PubMedID 31341953

  • Menstrual Cycles: Who Cares? We All Should JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. 2018; 31 (6): 547–48

    View details for DOI 10.1016/j.jpag.2018.10.001

    View details for Web of Science ID 000449180800001

    View details for PubMedID 30315864

  • The Peer Review Process and Celebrating Journal Reviewers JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. 2018; 31 (5): 437–40

    View details for DOI 10.1016/j.jpag.2018.08.002

    View details for Web of Science ID 000442913200001

    View details for PubMedID 30170661

  • Contraception for Women With Intellectual and Developmental Disabilities Reproductive Justice OBSTETRICS AND GYNECOLOGY Hillard, P. 2018; 132 (3): 555–58
  • Unusual Cause of Pediatric Vaginal Bleeding: Infantile Capillary Hemangioma of the Cervix. Journal of pediatric and adolescent gynecology Ganti, A. K., Ray, J., Mooney, K. L., Zambrano, E., Hillard, P. J., Fok, W. 2018


    BACKGROUND: The differential diagnosis for pediatric prepubertal vaginal bleeding is wide. Rare etiologies include vascular malformations and tumors, such as infantile hemangiomas (IH), which validate the usefulness of exam under anesthesia, vaginoscopy, and tissue diagnosis.CASE: We report a case of an infantile hemangioma in a 6 year-old girl causing vaginal bleeding requiring transfusion. Vaginoscopy revealed a less than 1 cm cervical IH. Expectant management and oral propranolol were successful management options.SUMMARY AND CONCLUSION: Rare, even small soft tissue tumors such as IH can lead to impressive blood loss via vaginal bleeding. Accurate tissue diagnosis and a multidisciplinary approach are essential to planning safe, effective treatment and follow up.

    View details for PubMedID 30107231

  • Contraception for Women With Intellectual and Developmental Disabilities: Reproductive Justice. Obstetrics and gynecology Hillard, P. J. 2018

    View details for PubMedID 30095755

  • What is Pediatric and Adolescent Gynecology? JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. 2018; 31 (2): 77–78

    View details for PubMedID 29566847

  • Resident Education in Pediatric and Adolescent Gynecology JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. 2018; 31 (1): 2

    View details for DOI 10.1016/j.jpag.2017.12.001

    View details for Web of Science ID 000425871600001

    View details for PubMedID 29223412

  • Surgical Decision-Making in Pediatric and Adolescent Gynecology: Just Because You Can, Doesn't Mean You Should JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. 2017; 30 (6): 601–2

    View details for PubMedID 28923750

  • Pediatric and Adolescent Gynecology: The Science JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. 2017; 30 (3): 333–34

    View details for PubMedID 28385610

  • Adolescents and Contraception: The Updated US Medical Eligibility Criteria for Contraceptive Use JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. 2017; 30 (2): 147–48

    View details for DOI 10.1016/j.jpag.2017.01.001

    View details for Web of Science ID 000401122900001

    View details for PubMedID 28082083

  • National Sleep Foundation's updated sleep duration recommendations: final report SLEEP HEALTH Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Hillard, P., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O'Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J. 2015; 1 (4): 233–43


    To make scientifically sound and practical recommendations for daily sleep duration across the life span.The National Sleep Foundation convened a multidisciplinary expert panel (Panel) with broad representation from leading stakeholder organizations. The Panel evaluated the latest scientific evidence and participated in a formal consensus and voting process. Then, the RAND/UCLA Appropriateness Method was used to formulate sleep duration recommendations.The Panel made sleep duration recommendations for 9 age groups. Sleep duration ranges, expressed as hours of sleep per day, were designated as recommended, may be appropriate, or not recommended. Recommended sleep durations are as follows: 14-17 hours for newborns, 12-15 hours for infants, 11-14 hours for toddlers, 10-13 hours for preschoolers, 9-11 hours for school-aged children, and 8-10 hours for teenagers. Seven to 9 hours is recommended for young adults and adults, and 7-8 hours of sleep is recommended for older adults. The self-designated basis for duration selection and critical discussions are also provided.Consensus for sleep duration recommendations was reached for specific age groupings. Consensus using a multidisciplinary expert Panel lends robust credibility to the results. Finally, limitations and caveats of these recommendations are discussed.

    View details for PubMedID 29073398

  • Intrauterine Device Use in Adolescents JOURNAL OF ADOLESCENT HEALTH Hillard, P. 2015; 57 (4): 359–60

    View details for PubMedID 26403839

  • National Sleep Foundation's sleep time duration recommendations: methodology and results summary SLEEP HEALTH Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E. S., Kheirandish-Gozal, L., Neubauer, D. N., O'Donnell, A. E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R. C., Setters, B., Vitiello, M. V., Ware, J., Hillard, P. 2015; 1 (1): 40–43


    The objective was to conduct a scientifically rigorous update to the National Sleep Foundation's sleep duration recommendations.The National Sleep Foundation convened an 18-member multidisciplinary expert panel, representing 12 stakeholder organizations, to evaluate scientific literature concerning sleep duration recommendations. We determined expert recommendations for sufficient sleep durations across the lifespan using the RAND/UCLA Appropriateness Method.The panel agreed that, for healthy individuals with normal sleep, the appropriate sleep duration for newborns is between 14 and 17 hours, infants between 12 and 15 hours, toddlers between 11 and 14 hours, preschoolers between 10 and 13 hours, and school-aged children between 9 and 11 hours. For teenagers, 8 to 10 hours was considered appropriate, 7 to 9 hours for young adults and adults, and 7 to 8 hours of sleep for older adults.Sufficient sleep duration requirements vary across the lifespan and from person to person. The recommendations reported here represent guidelines for healthy individuals and those not suffering from a sleep disorder. Sleep durations outside the recommended range may be appropriate, but deviating far from the normal range is rare. Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being.

    View details for PubMedID 29073412

  • Primary ovarian insufficiency in adolescents: a case series. International journal of pediatric endocrinology Pederson, J., Kumar, R. B., Adams Hillard, P. J., Bachrach, L. K. 2015; 2015 (1): 13-?


    Primary ovarian insufficiency (POI) is characterized by 4 to 6 months of amenorrhea and elevated serum FSH and LH in females less than 40 years. Ovarian insufficiency is uncommon in pediatrics and typically results from a chromosomal abnormality or treatment for malignancy. Idiopathic POI in which no apparent precipitant is identified is even rarer. After encountering three teens with idiopathic POI in recent months, we utilized an informatics-enabled search of the electronic medical records from our hospital to identify all cases of idiopathic POI presenting from 1998-2013.15 girls (ages 14.4 to 17.9 years) met criteria for idiopathic POI. At diagnosis, breast development ranged from Tanner stage 1 to 5; 6 of 15 patients had secondary amenorrhea. All patients presented in the past 11 years and 13 of 15 in the past 5 years.In this first case series of POI from the United States, we observed a clustering at our institution in recent years. If an increased incidence of idiopathic POI is identified at other institutions, further investigation into potential environmental and genetic precipitants is warranted.

    View details for DOI 10.1186/s13633-015-0009-z

    View details for PubMedID 25983758

    View details for PubMedCentralID PMC4433018

  • Menstruation in Adolescents: What Do We Know? and What Do We Do with the Information? JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. 2014; 27 (6): 309–19


    The menstrual cycle has been recognized as a vital sign that gives information about the overall health of an adolescent or young adult female. Significant deviations from monthly cycles can signal disease or dysfunction. This review highlights the evidence based parameters for normal puberty, menarche, cyclicity, and amount of bleeding. The review addresses sources of information available online, noting inaccuracies that appear in web sites, even and especially those targeting adolescents. The review includes a call to action to provide accurate information about the menstrual cycle as a VITAL SIGN.

    View details for DOI 10.1016/j.jpag.2013.12.001

    View details for Web of Science ID 000345057100002

    View details for PubMedID 25438706

  • Menstrual suppression for adolescents. Current opinion in obstetrics & gynecology Altshuler, A. L., Hillard, P. J. 2014; 26 (5): 323-331


    The purpose of this review is to highlight the recent literature and emerging data describing clinical situations in which menstrual suppression may improve symptoms and quality of life for adolescents. A variety of conditions occurring frequently in adolescents and young adults, including heavy menstrual bleeding, and dysmenorrhea as well as gynecologic conditions such as endometriosis and pelvic pain, can safely be improved or alleviated with appropriate menstrual management.Recent publications have highlighted the efficacy and benefit of extended cycle or continuous combined oral contraceptives, the levonorgestrel intrauterine device, and progestin therapies for a variety of medical conditions.This review places menstrual suppression in an historical context, summarizes methods of hormonal therapy that can suppress menses, and reviews clinical conditions for which menstrual suppression may be helpful.

    View details for DOI 10.1097/GCO.0000000000000098

    View details for PubMedID 25110977

  • Use of CA125 and HE4 Serum Markers to Predict Ovarian Cancer in Elevated-Risk Women CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION Karlan, B. Y., Thorpe, J., Watabayashi, K., Drescher, C. W., Palomares, M., Daly, M. B., Paley, P., Hillard, P., Andersen, M. R., Anderson, G., Drapkin, R., Urban, N. 2014; 23 (7): 1383-1393


    Serum markers are used before pelvic imaging to improve specificity and positive predictive value (PPV) of ovarian cancer multimodal screening strategies.We conducted a randomized controlled pilot trial to estimate surgical PPV of a "2 of 3 tests positive" screening rule, and to compare use of HE4 as a first-line (Arm 1) versus a second-line (Arm 2) screen, in women at high and elevated risk for epithelial ovarian cancer (EOC) at five study sites. Semiannual screening was offered to 208 women ages 25 to 80 years with deleterious BRCA germline mutations and to 834 women ages 35 to 80 years with pedigrees suggesting inherited susceptibility. Annual screening was offered to 130 women ages 45 to 80 years (Risk Group 3) with epidemiologic and serum marker risk factors. Rising marker levels were identified using the parametric empirical Bayes algorithm.Both strategies yielded surgical PPV above 25%. Protocol-indicated surgery was performed in 6 women, identifying two ovarian malignancies and yielding a surgical PPV in both arms combined of 33% (95% confidence interval: 4%-78%), 25% in Arm 1 and 50% in Arm 2. Surgical consultation was recommended for 37 women (26 in Arm 1 and 11 in Arm 2). On the basis of 12 women with at least 2 of 3 tests positive (CA125, HE4, or imaging), an intent-to-treat analysis yielded PPV of 14% in Arm 1 and 20% in Arm 2.Positive screens were more frequent when HE4 was included in the primary screen.HE4 may be useful as a confirmatory screen when rising CA125 is used alone as a primary screen.

    View details for DOI 10.1158/1055-9965.EPI-13-1361

    View details for Web of Science ID 000345273700029

    View details for PubMedID 24789859

  • Menstrual suppression: current perspectives INTERNATIONAL JOURNAL OF WOMENS HEALTH Hillard, P. 2014; 6: 631–37


    Menstrual suppression to provide relief of menstrual-related symptoms or to manage medical conditions associated with menstrual morbidity or menstrual exacerbation has been used clinically since the development of steroid hormonal therapies. Options range from the extended or continuous use of combined hormonal oral contraceptives, to the use of combined hormonal patches and rings, progestins given in a variety of formulations from intramuscular injection to oral therapies to intrauterine devices, and other agents such as gonadotropin-releasing hormone (GnRH) antagonists. The agents used for menstrual suppression have variable rates of success in inducing amenorrhea, but typically have increasing rates of amenorrhea over time. Therapy may be limited by side effects, most commonly irregular, unscheduled bleeding. These therapies can benefit women's quality of life, and by stabilizing the hormonal milieu, potentially improve the course of underlying medical conditions such as diabetes or a seizure disorder. This review addresses situations in which menstrual suppression may be of benefit, and lists options which have been successful in inducing medical amenorrhea.

    View details for PubMedID 25018654

  • Infliximab for the treatment of granulomatous peritonitis. Digestive diseases and sciences Yeh, A. M., Kerner, J., Hillard, P., Bass, D. 2013; 58 (12): 3397-3399

    View details for DOI 10.1007/s10620-013-2726-6

    View details for PubMedID 23817923

  • Gynecologic Knowledge Is Low in College Men and Women JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Volck, W., Ventress, Z. A., Herbenick, D., Hillard, P. J., Huppert, J. S. 2013; 26 (3): 161-166


    Although men may influence women's reproductive choices, little is known about men's knowledge regarding gynecologic matters (eg, sex, anatomy, and contraception). This study aimed to evaluate the level of gynecologic knowledge among college students, particularly to investigate the differences in knowledge between men and women.We administered a survey to assess knowledge of sex, contraception, and female anatomy to college students at a Midwestern university during the spring 2010 semester.The survey included demographic and behavioral questions, 9 general gynecology knowledge items, and 11 female anatomy items. A total gynecology score was generated by summing the correct responses to 20 items.The 236 respondents included 98 men and 138 women (aged 18-36 years). Women scored higher than men on 19 of 20 individual items, with mean total scores of 13.4 vs 10.1 (P < .01). There was a trend for gynecologic knowledge to be higher among those who reported having had been STI tested (P = .13), and whose parents had discussed anatomy with them (P = .07). In multivariable modeling, being male was associated with lower mean knowledge scores, whereas increasing age and having a parent who discussed anatomy were associated with greater knowledge scores, even while controlling for having a gynecologist parent, multiple sexual partners, and prior STI testing.College men have lower gynecologic knowledge than women. Increasing age and having a parent who discussed anatomy with them served as predictors of higher knowledge scores. Because men influence women's reproductive choices, efforts to increase men's knowledge are needed.

    View details for DOI 10.1016/j.jpag.2012.12.004

    View details for Web of Science ID 000319489100008

    View details for PubMedID 23518361

  • No Papanicolaou tests in women younger than 21 years or after hysterectomy for benign disease. JAMA internal medicine Morioka-Douglas, N., Hillard, P. J. 2013; 173 (10): 855-856

    View details for DOI 10.1001/jamainternmed.2013.316

    View details for PubMedID 23568165

  • Practical Tips for Intrauterine Devices Use in Adolescents JOURNAL OF ADOLESCENT HEALTH Hillard, P. J. 2013; 52 (4): S40-S46


    The American Congress of Obstetricians and Gynecologists (ACOG) has endorsed intrauterine devices (IUDs) as first-line contraceptive choices for both nulliparous and parous adolescents. The committee opinion did address some of the practical elements of IUD use in adolescents, but because these practical concerns may be barriers to use for both teens and clinicians, this review is devoted to "practical tips," based on the available literature as well as the author's clinical experience. Counseling, informed consent, techniques of pain management, and preventive guidance about possible side effects are addressed in an effort to promote successful use of this long-acting reversible contraception (LARC) option.

    View details for DOI 10.1016/j.jadohealth.2012.09.023

    View details for Web of Science ID 000316661000007

    View details for PubMedID 23535056

  • Use of Levonorgestrel Intrauterine System for Medical Indications in Adolescents JOURNAL OF ADOLESCENT HEALTH Bayer, L. L., Hillard, P. J. 2013; 52 (4): S54-S58


    The levonorgestrel intrauterine system (LNG-IUS) is an underused contraceptive method in adolescent populations. In addition to being a highly effective, reversible, long-acting contraception, the LNG-IUS has many noncontraceptive health benefits including reduced menstrual bleeding, decreased dysmenorrhea and pelvic pain related to endometriosis, and menstruation suppression in teens with physical or developmental disabilities. The LNG-IUS can also provide endometrial protection in teens with chronic anovulation, and may be used to treat endometrial hyperplasia and cancer. This review examines the evidence supporting the use of the LNG-IUS in adolescents for these noncontraceptive benefits.

    View details for DOI 10.1016/j.jadohealth.2012.09.022

    View details for PubMedID 23535058

  • What Is LARC? And Why Does It Matter for Adolescents and Young Adults? JOURNAL OF ADOLESCENT HEALTH Hillard, P. J. 2013; 52 (4): S1-S5
  • Ovarian torsion in a patient with müllerian agenesis: increased risk? Journal of pediatric and adolescent gynecology Sullivan, E. M., Golden, N. H., Adams Hillard, P. J. 2012; 25 (6): e125-8


    Patients with müllerian agenesis may be at an increased risk of ovarian torsion due to the absence of the utero-ovarian ligament and the fact that the ovary is not tethered to a fixed and relatively non-mobile structure, the uterus.We report a case of a 14-year-old female with abdominal pain who had a physical examination suggestive of müllerian agenesis. Imaging was non-diagnostic and demonstrated an abdominal mass. Emergent surgery revealed ovarian torsion.We present this case of ovarian torsion and müllerian agenesis, in order to highlight the association and to review potential risk factors.

    View details for DOI 10.1016/j.jpag.2012.08.001

    View details for PubMedID 23095528

  • What's clinically relevant and new in pediatric and adolescent gynecology? CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Hillard, P. J. 2012; 24 (5): 273-274

    View details for DOI 10.1097/GCO.0b013e328357e3cd

    View details for Web of Science ID 000308866200001

    View details for PubMedID 22954762

  • Menstrual Suppression with the Levonorgestrel Intrauterine System in Girls with Developmental Delay JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Hillard, P. J. 2012; 25 (5): 308-313


    To describe the experiences of 21 girls with developmental delay accompanied by multiple other medical problems, seen over a 3-year interval, who underwent insertion of the levonorgestrel intrauterine system (LNG-IUS) for menstrual suppression.Retrospective chart review.A referral pediatric and adolescent gynecology clinic within a tertiary care medical center with referrals from community pediatricians, pediatric subspecialists including developmental and behavioral pediatricians, community gynecologists, and adolescent medicine specialists.Adolescents and young women with developmental delay and multiple comorbid conditions who were seen for consultation with their families requesting menstrual suppression.Participants were offered hormonal options, for menstrual suppression including the LNG-IUS.Satisfaction with menstrual suppression among families electing the LNG-IUS.Adolescents and young women seen at CCHMC with developmental delay and multiple comorbid conditions with requests for menstrual suppression were offered hormonal options, including the LNG-IUS. Twenty-one families chose this option. Fifteen of 21 girls had previously used hormonal menstrual suppression. General anesthesia was required for 20 of 21 insertions, and 9 of 20 of these insertions were combined with other surgical procedures. There were no unsuccessful insertions or major complications. Mean duration of follow-up was 11 months, and families were satisfied with this option for menstrual suppression. There was 1 request for removal.LNG-IUS for menstrual suppression, in girls with developmental delay and multiple comorbid medical conditions for which amenorrhea is desirable and therapeutic, appears promising.

    View details for DOI 10.1016/j.jpag.2012.05.005

    View details for Web of Science ID 000309324100007

    View details for PubMedID 22831901

  • Pediatric Residents' Knowledge, Use, and Comfort With Expedited Partner Therapy for STIs PEDIATRICS Hsii, A., Hillard, P., Yen, S., Golden, N. H. 2012; 130 (4): 705-711


    We examined California pediatric residents' knowledge, practices, and comfort of providing expedited partner therapy (EPT) for sexually transmitted infections, by postgraduate year of training and presence of an adolescent medicine fellowship. We hypothesized that few residents are aware of EPT, and fewer are comfortable providing it; knowledge, practices, and comfort increase during residency; and presence of an adolescent medicine fellowship increases knowledge, practices, and comfort.Online anonymous questionnaires were completed by pediatric residents from 14 California programs.Two hundred eighty-nine pediatric residents (41% response; mean age, 29.4 ± 2.7 years; 78% female) responded. Twenty-two percent reported being moderately or very familiar with EPT. Most correctly identified several EPT methods. Incorrectly identified as EPT included patient (55%), health department (42%), and provider (37%) referrals. Only 8% were aware of California's legal status regarding EPT. Sixty-nine percent knew that California law allows EPT for chlamydia and gonorrhea, but 38% incorrectly stated that EPT can be used to treat trichomoniasis. Fifty-two percent reported ever providing EPT, but 30% of them were uncomfortable doing so. Postgraduate year 1 residents were significantly more likely to report lack of experience as a barrier to prescribing EPT. Residents in programs with the presence of an adolescent medicine fellowship had significantly higher global knowledge scores and were more likely to practice EPT with fewer concerns.California pediatric residents have knowledge gaps and discomfort providing EPT, and the presence of adolescent medicine fellowship is associated with increased EPT knowledge, use, and comfort among residents. Our findings demonstrate a need to improve EPT education in pediatric residencies.

    View details for DOI 10.1542/peds.2011-3764

    View details for PubMedID 22987881

  • A Family Systems Approach to Primary Ovarian Insufficiency JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Covington, S. N., Hillard, P. J., Sterling, E. W., Nelson, L. M. 2011; 24 (3): 137-141


    Receiving the diagnosis of Primary Ovarian Insufficiency (POI) can be emotionally difficult and confusing for young girls and their families. Parents need assistance in knowing how to help their daughters understand and live with the diagnosis in a way that allows for healthy growth and development. This paper provides a starting point for parents and clinicians with "Tips and Tools for Talking: Helping Your Daughter Understand Primary Ovarian Insufficiency".

    View details for DOI 10.1016/j.jpag.2010.12.004

    View details for Web of Science ID 000291333800008

    View details for PubMedID 21269850

    View details for PubMedCentralID PMC3094722

  • Contraception: Adherence? Compliance? Successful Use? And How Do We Know? JOURNAL OF WOMENS HEALTH Hillard, P. 2010; 19 (12): 2157–58

    View details for DOI 10.1089/jwh.2010.2433

    View details for Web of Science ID 000284626900003

    View details for PubMedID 20973673

  • What is pediatric gynecology? CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Hillard, P. J. 2010; 22 (5): 361-362

    View details for DOI 10.1097/GCO.0b013e32833ef226

    View details for Web of Science ID 000281621100001

    View details for PubMedID 20724924

  • IUDs and Adolescents An Under-Utilized Opportunity for Pregnancy Prevention JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Yen, S., Saah, T., Hillard, P. J. 2010; 23 (3): 123-128


    Most pregnancies in adolescents are unintended and preventable if contraception were utilized. IUDs provide an under-utilized highly effective form of contraception. IUDs are appropriate for nulliparous women, including adolescents. IUDs do not increase: the incidence of Pelvic Inflammatory Disease after the 1st month of insertion, the odds of infertility, nor rate of ectopic pregnancy. Adolesecnts need more education about and increased access to IUDs. Practical points regarding IUD selection and insertion in adolescents are reviewed, including pain prophylaxis, anticipatory guidance, side effects and complications. In summary, IUDs are safe for contraception in most adolescents. IUDs are effective and eliminate the need for ongoing adherence and thus have the potential to decrease unplanned pregnancies.

    View details for DOI 10.1016/j.jpag.2009.09.004

    View details for Web of Science ID 000278173800002

    View details for PubMedID 19896396

  • Vaginal burn injury due to alkaline batteries. Journal of pediatric and adolescent gynecology Huppert, J., Griffeth, S., Breech, L., Hillard, P. 2009; 22 (5): e133-6


    Alkaline batteries are known to cause caustic burns to the esophagus when ingested. We report a case of alkaline burns to the vagina.A 13-year-old female presented to the Emergency Department with abdominal pain. She was admitted for necrotic vaginal burns after batteries were removed from her vagina. Examination under anesthesia revealed multiple third degree burns without perforation into adjoining structures. Management included topical estrogen, topical antibiotic, and an oral nonsteroidal anti-inflammatory. She was re-examined under anesthesia at 5 days, then weekly as an outpatient. Follow-up examinations at 5 and 36 months later confirmed complete healing.In this unique case, we discuss the treatment options and postulate reasons for the excellent outcome in this patient.

    View details for DOI 10.1016/j.jpag.2008.10.009

    View details for PubMedID 19576810

  • Behavioral Correlates of Biologic Maturity of the Cervix in Adolescents JOURNAL OF ADOLESCENT HEALTH Hillard, P. J. 2009; 44 (2): 97-98
  • Group A Streptococcus vulvovaginitis in breastfeeding women AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Rahangdale, L., Lacy, J., Hillard, P. A. 2008; 199 (2): E4-E5


    Group A beta-hemolytic streptococcus-associated vulvovaginitis is uncommon in adult women. Clinicians should include group A beta-hemolytic streptococcus as a possible cause of vulvovaginal symptoms in breastfeeding women. Along with appropriate antibiotic therapy, vaginal estrogen therapy may be considered to diminish susceptibility to recurrent infection in women with vaginal atrophy.

    View details for DOI 10.1016/j.ajog.2008.02.045

    View details for PubMedID 18674653

  • Menstruation in adolescents: what's normal? Medscape journal of medicine Adams Hillard, P. J. 2008; 10 (12): 295-?

    View details for PubMedID 19242601

    View details for PubMedCentralID PMC2644006

  • Pediatric and adolescent gynecology CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Hillard, P. 2007; 19 (5): 413–14
  • Development of an HPV educational protocol for adolescents JOURNAL OF PEDIATRIC AND ADOLESCENT GYNECOLOGY Wetzel, C., Tissot, A., Kollar, L. M., Hillard, P. A., Stone, R., Kahn, J. A. 2007; 20 (5): 281-287


    To develop an educational protocol about HPV and Pap tests for adolescents, to evaluate the protocol for understandability and clarity, and to evaluate the protocol for its effectiveness in increasing knowledge about HPV.In phase 1, investigators and adolescents developed the protocol. In phase 2, adolescents evaluated the protocol qualitatively, investigators evaluated its effectiveness in increasing HPV knowledge in a sample of adolescents, and the protocol was revised. In phase 3, investigators evaluated the effectiveness of the revised protocol in an additional adolescent sample.Urban, hospital-based teen health center.A total of 252 adolescent girls and boys in the three study phases.Pre- and post-protocol knowledge about HPV, measured using a 10- or 11-item scale.Scores on the HPV knowledge scale increased significantly (P < 0.0001) among adolescents who participated in phases 2 and 3 after they received the protocol. Initial differences in scores based on race, insurance type, and condom use were not noted post-protocol.The protocol significantly increased knowledge scores about HPV in this population, regardless of sociodemographic characteristics and risk behaviors. Effective, developmentally appropriate educational protocols about HPV and Pap tests are particularly important in clinical settings as cervical cancer screening guidelines evolve, HPV DNA testing is integrated into screening protocols, and HPV vaccines become available. In-depth, one-on-one education about HPV may also prevent adverse psychosocial responses and promote healthy sexual and Pap screening behaviors in adolescents with abnormal HPV or Pap test results.

    View details for DOI 10.1016/j.jpag.2006.12.002

    View details for Web of Science ID 000255588800004

    View details for PubMedID 17868894

  • US findings of adnexal torsion in children and adolescents: size really does matter PEDIATRIC RADIOLOGY Linam, L. E., Darolia, R., Naffaa, L. N., Breech, L. L., O'Hara, S. M., Hillard, P. J., Huppert, J. S. 2007; 37 (10): 1013-1019


    Adnexal torsion is rare, and symptoms are nonspecific. Clinicians often rely on US examinations to evaluate girls with abdominal or pelvic pain.To determine which sonographic findings can predict adnexal torsion by comparing pediatric and adolescent patients with surgically confirmed torsion (cases) to those without torsion (controls).Cases and controls were identified retrospectively by searching 7 years of medical record and radiology databases. An adnexal ratio was calculated as the volume of the affected adnexa divided by the volume of the unaffected adnexa.We identified 61 menarchal subjects: 33 cases and 28 controls. Adnexal volume was larger in cases than in controls (185 vs. 37.8 ml, P < 0.001). A volume of >75 ml was more common in cases than in controls (64 vs. 15%, P < 0.001). No cases had an adnexal volume of <20 ml (P < 0.001). The adnexal ratio was larger in cases than in controls (16.1 vs. 6.7, P < 0.001). An adnexal ratio of >15 was seen in 40% of cases and in no controls (P = 0.08). Doppler US results were not predictive of torsion.An adnexal volume of <20 ml is strong evidence against adnexal torsion in menarchal females. In this age group, the diagnosis of torsion cannot be established by US examination alone.

    View details for DOI 10.1007/s00247-007-0599-6

    View details for Web of Science ID 000249407500008

    View details for PubMedID 17768612

  • Bariatric surgery and adolescent gynecology CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Miller, R. J., Xanthakos, S. A., Hillard, P. J., Inge, T. H. 2007; 19 (5): 427-433


    This review summarizes the impact of bariatric surgery on gynecologic complications in the context of the extremely obese adolescent and reviews contraceptive considerations before and after adolescent bariatric surgery.Eighteen percent of children and adolescents have a body mass index greater than the 95th percentile, with 4% of adolescents being greater than the 99th percentile. Gynecologic morbidities identified in obese adolescents include anovulatory complications such as acute menorrhagia, polycystic ovary syndrome and endometrial hyperplasia, and cancer. When conventional dietary and behavioral therapy fail to result in weight loss, specific criteria have been identified to justify bariatric surgery in extremely obese adolescents. Bariatric surgery in adult women often results in resumption of ovulatory menses, resolution of clinical and laboratory evidence of hyperandrogenism, and return of fertility. Adolescents are at risk for unintended pregnancies, and there are special concerns regarding pregnancy in bariatric patients. Specific contraceptive methods have particular potential risks, benefits, and drawbacks for use in obese adolescents.Clinicians who provide care for extremely obese adolescents must be aware of the potential for gynecologic morbidities including polycystic ovary syndrome, dysfunctional bleeding and endometrial hyperplasia, expected gynecologic and fertility outcomes of weight loss surgery for teens, as well as the implications on contraceptive options.

    View details for Web of Science ID 000249972000004

    View details for PubMedID 17885457

  • Personal meaning of human papillomavirus and pap test results in adolescent and young adult women HEALTH PSYCHOLOGY Kahn, J. A., Slap, G. B., Bernstein, D. I., Tissot, A. M., Kollar, L. M., Hillard, P. A., Rosenthal, S. L. 2007; 26 (2): 192-200


    As new cervical cancer screening recommendations are adopted, more adolescents may learn they are infected with human papillomavirus (HPV). The objective of this study was to explore personal meaning of HPV and Pap test results in adolescent and young adult women.The authors recruited sexually active 14- to 21-year-old adolescent girls from an urban teen health center. Participants underwent HPV and Pap testing at baseline and returned 2 weeks later to receive test results and to be interviewed about their responses to test results. The authors analyzed interview transcripts using qualitative methods and developed a conceptual framework to explain participants' responses.Of the 100 participants, 51% were HPV positive and 23% had an abnormal Pap test. Personal meaning was comprised of four core dimensions: labeling of results, perceived risk of HPV-related disease, personal accountability, and anticipated shame or stigma. The association between test result and personal meaning was mediated through cognitive understanding of test results, which in turn was influenced by education about HPV and prior health experiences.Clinicians who communicate HPV and Pap test results to adolescent girls should provide accurate information in a nonjudgmental manner, take into account adolescents' personal experiences with sexually transmitted infections and cancer, and explore personal meaning of results such as anticipated risk and stigma. In this way, clinicians may be able to minimize adverse psychosocial outcomes while promoting positive reproductive health behaviors.

    View details for DOI 10.1037/0278-6133.26.2.192

    View details for Web of Science ID 000245137300009

    View details for PubMedID 17385971

  • Impaired reproductive fitness in mothers of children with juvenile autoimmune arthropathies RHEUMATOLOGY Chaudhari, M., Moroldo, M. B., Shear, E., Hillard, P., Thompson, S. D., Lan, D., Huang, B., Brunner, H. I., Glass, D. N. 2006; 45 (10): 1282-1287


    To assess the reproductive fitness of mothers of children with juvenile idiopathic arthritis (JIA).A mail survey assessing pregnancy outcome was carried out among mothers of children with JIA (JIA mothers) treated at a tertiary paediatric rheumatology centre. The best friends of the JIA mothers served as controls. Besides family history, sociodemographics and reproductive outcomes were measured, including the number of pregnancies, pregnancy complications and gestational age at the time of delivery.JIA mothers (n = 227) and controls (n = 235) had similar sociodemographics and racial backgrounds. On average, JIA mothers reported a greater number of conceptions than controls (3.5 vs 3.1; P = 0.01) but had significantly higher rates of pregnancy complications (25% vs 15%; P<0.001). Corrected for differences in the absolute number of pregnancies between groups, the chances of having a miscarriage [mean (s.d.), 0.12 (0.18) vs 0.09 (0.16); P = 0.02] or preterm delivery [0.08 (0.21) vs 0.04 (0.15); P<0.02] were significantly greater among JIA mothers than controls.Mothers of children with JIA have impaired reproductive fitness. This phenomenon is unlikely to be the result of difficulty with conception but rather to be due to higher rates of pregnancy loss and premature delivery.

    View details for DOI 10.1093/rheumatology/kel092

    View details for Web of Science ID 000240927100018

    View details for PubMedID 16595515

  • Vulvar ulcers in young females: a manifestation of aphthosis. Journal of pediatric and adolescent gynecology Huppert, J. S., Gerber, M. A., Deitch, H. R., Mortensen, J. E., Staat, M. A., Adams Hillard, P. J. 2006; 19 (3): 195-204


    To examine the etiology, clinical course, and outcomes of non-sexually transmitted vulvar ulcers in young females.A prospective cohort study of subjects referred to a tertiary center who had active vulvar ulcers and no evidence of sexually transmitted infections were evaluated with a structured clinical and laboratory protocol and followed with visits or telephone calls.Twenty eligible subjects had a mean age of 14 years (range 10-19), and five were premenarchal. Nineteen reported systemic symptoms such as fever, malaise, and headache. Most ulcers were >1cm in diameter (range 0.3-5 cm) and were located on the medial aspect of the labia minora. All viral, bacterial, and fungal cultures were negative. Serologic testing for Epstein-Barr virus (EBV) infection demonstrated 10 subjects with evidence of prior infection, two with acute infection, one indeterminate, and seven negative for infection. Two subjects had evidence of possible acute cytomegalovirus (CMV) infection. Other laboratory findings were nonspecific. The median duration of pain was 10 days (range 6-30), and 75% healed by 21 days. Follow up was available for 19 subjects (median 14 months). Seven experienced recurrent ulcers 2-16 months after the initial episode, and 10 had experienced oral aphthous ulcers. None met criteria for other etiologies of vulvar ulcers reported in the literature.No single infectious agent was identified as a cause of vulvar ulcers. Most cases were not temporally associated with either acute EBV or CMV infection. These ulcers are consistent with aphthous major or complex aphthosis that arise in response to acute illness.

    View details for PubMedID 16731413

  • Consultation with the specialist - Dysmenorrhea PEDIATRICS IN REVIEW Hillard, P. J. 2006; 27 (2): 64-71

    View details for Web of Science ID 000235977500007

    View details for PubMedID 16452276

  • Adolescent menstrual health. Pediatric endocrinology reviews : PER Adams Hillard, P. J. 2006; 3: 138-145


    Attention to pubertal development and menstrual health is an important aspect of primary care for adolescents. Textbooks may not provide sufficient evidence-based guidance to facilitate the early detection of gynecologic disease states and conditions. Conversely, the typical guidelines for pubertal development may lead to over-evaluation of normal girls. Chaotically irregular and unpredictable bleeding is NOT the norm during adolescence. On the contrary, although many early menstrual cycles are anovulatory, most adolescents have menstrual cycles that fall within the parameters of 21-45 days. Adolescents with menstrual bleeding that is less frequent than every 45 days, is prolonged > 7 days, or is excessively heavy should be evaluated in order to detect conditions such as eating disorders, polycystic ovary syndrome, and von Willebrand disease. Clinicians who attend to adolescent menstrual cycles can help set the stage for future health.

    View details for PubMedID 16641848

  • Understanding and preventing human papillomavirus infection during adolescence and young adulthood JOURNAL OF ADOLESCENT HEALTH Hillard, P. J., KAHN, J. A. 2005; 37 (6): S1-S2
  • Female genital mutilation CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Kelly, E., Hillard, P. J. 2005; 17 (5): 490-494


    The purpose of this review is to aid the healthcare practitioner in caring for children, girls, and women who have undergone female genital mutilation or who are at risk for female genital mutilation.The bulk of the literature published in the area of female genital mutilation over the past year addresses the laws, social needs, immigration status and assimilation of African women who immigrate into western countries. Clinicians continue to publish case reports of complications and the surgical management of type III female genital mutilation during labor. Additionally, as people continue to try to eliminate female genital mutilation through human rights campaigns and the legal system, they have also become increasingly aware that understanding the motives behind this traditional practice may be an avenue towards change.The fundamental understanding of female genital mutilation will allow the clinician to address the emotional and physical needs of the children, girls, and women who have undergone this traditional practice or who are at risk for undergoing this practice. This understanding will allow the practitioner to individualize the history and physical examination, and to provide appropriate management with recognition and treatment of complications. Increased knowledge of the laws against female genital mutilation will allow the healthcare provider to educate and advise at-risk girls and women as well as their parents.

    View details for Web of Science ID 000232499500008

    View details for PubMedID 16141763

  • US adolescent pregnancy rates: declining, but more progress is needed: editorial review. Current opinion in obstetrics & gynecology Hillard, P. J. 2005; 17 (5): 453-455

    View details for PubMedID 16141756

  • Overview of contraception. Adolescent medicine clinics Hillard, P. J. 2005; 16 (3): 485-493


    The United States has the highest rates of adolescent pregnancy of any Western industrialized country. Addressing these high rates and preventing adolescent pregnancy are complicated tasks. This article addresses some of the issues involved with preventing adolescent pregnancy, focusing on contraception.

    View details for PubMedID 16183535

  • Contraceptive behaviors in adolescents PEDIATRIC ANNALS Hillard, P. J. 2005; 34 (10): 794-802


    A wide range of factors influence adolescents' contraceptive behaviors, from personal characteristics to family context to social support to knowledge about and access to contraception. Improving knowledge about contraception and counseling about successful contraceptive use can be helpful in decreasing the remarkably high US rates of adolescent pregnancy. Encouraging the postponement of sexual activity until an individual adolescent is developmentally capable of participating in a mature, healthy, mutually respectful relationship that incorporates effective contraception clearly is a goal that most clinicians, parents, teachers, and other responsible adults can support. Contraceptive technologies that incorporate delivery systems that are "user-friendly" and long-acting also will help to further lower US adolescent pregnancy rates that, while improving, are currently among the highest in the world.

    View details for Web of Science ID 000232475800007

    View details for PubMedID 16285633

  • Adnexal torsion in pediatric and adolescent girls CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Breech, L. L., Hillard, P. J. 2005; 17 (5): 483-489


    This review provides timely information to assist in solving the diagnostic dilemma of adnexal or ovarian torsion. Knowledge and awareness of current literature is essential to help clinicians improve diagnostic accuracy and avoid potentially catastrophic consequences, including loss of ovarian tissue and function.This article reviews recent evidence regarding radiologic tools used for efficient, timely diagnosis and management strategies for adnexal torsion, including detorsion. The role of oophoropexy in the pediatric and adolescent population is also reviewed.The discussion reinforces the role of detorsion in lieu of oophorectomy or adnextomy in an effort to preserve reproductive capacity in a young population. Long-term follow-up, including reproductive outcomes, is needed to determine the role of oophoropexy.

    View details for Web of Science ID 000232499500007

    View details for PubMedID 16141762

  • Acceptability of human papillomavirus self testing in female adolescents SEXUALLY TRANSMITTED INFECTIONS Kahn, J. A., BERNSTEIN, D. I., Rosenthal, S. L., Huang, B., Kollar, L. M., Colyer, J. L., Tissot, A. M., Hillard, P. A., Witte, D., Groen, P., Slap, G. B. 2005; 81 (5): 408-414


    To develop scales assessing acceptability of human papillomavirus (HPV) testing in adolescents, to compare acceptability of self to clinician testing, and to identify adolescent characteristics associated with acceptability.Female adolescents 14-21 years of age attending a hospital based teen health centre self collected vaginal samples and a clinician, using a speculum, collected cervicovaginal samples for HPV DNA. Acceptability of and preferences for self and clinician testing were assessed at baseline and 2 week visits.The mean age of the 121 participants was 17.8 years and 82% were black. The acceptability scales demonstrated good internal consistency, reliability, test-retest reliability, and factorial validity. Scores were significantly lower for self testing than clinician testing on the acceptability scale and three subscales measuring trust of the test result, confidence in one's ability to collect a specimen, and perceived effects of testing (p < 0.01). Of those who reported a preference, 73% preferred clinician to self testing. Acceptability scores for both self and clinician testing increased significantly pre-examination to post-examination (p < 0.01). Multivariable analyses demonstrated that race was independently associated with pre-examination and post-examination acceptability of self testing, and that sexual behaviours and gynaecological experiences were associated with specific acceptability subscales.This sample of adolescents found clinician testing for HPV to be more acceptable than self testing and preferred clinician to self testing. If self testing for HPV is offered in the future, clinicians should not assume that adolescent patients will prefer self testing. Instead, they should educate adolescents about available testing options and discuss any concerns regarding self collection technique or accuracy of test results.

    View details for DOI 10.1136/sti.2004.012047

    View details for Web of Science ID 000232230700011

    View details for PubMedID 16199741

  • Psychological, behavioral, and interpersonal impact of human papillomavirus and pap test results JOURNAL OF WOMENS HEALTH Kahn, J. A., Slap, G. B., BERNSTEIN, D. I., Kollar, L. M., Tissot, A. M., Hillard, P. A., Rosenthal, S. L. 2005; 14 (7): 650-659


    The purpose of this study was to explore the short-term psychological, behavioral, and interpersonal impact of human papillomavirus (HPV) and Pap results in adolescent and young adult women.Sexually active young women 14-21 years of age were recruited using a purposeful sampling strategy from a hospital-based teen health center. Participants underwent HPV DNA and Pap testing at baseline. At a follow-up visit 2 weeks later, they received test results and participated in individual interviews designed to examine the impact of test results. Interview data were analyzed using framework analysis, a qualitative analytical method.The mean age of the 100 participants was 17.2 years, and 82% were black. Fifty-one percent were HPV positive, and 23% had abnormal Pap tests. Psychological responses consisted of affective reactions to abnormal results, empowerment through knowledge of results, and self-confidence to prevent future disease. Personal behavioral intentions encompassed safe sexual behaviors, partner monitoring, and return for screening. Anticipated interpersonal consequences focused on the impact of communication about test results on relationships. Psychosocial and behavioral responses were influenced by the personal meaning participants derived from HPV and Pap results (e.g., perceptions of personal risk and anticipated stigma), cognitive understanding of test results, and such factors as coping mechanisms, locus of control, and relationship quality.An understanding of young women's responses to HPV and Pap test results may help guide clinical interventions designed to prevent possibly harmful psychosocial and interpersonal responses to HPV and Pap testing but promote healthy sexual behaviors and regular screening.

    View details for Web of Science ID 000232404100009

    View details for PubMedID 16181021

  • Oral contraceptives and the management of hyperandrogenism-polycystic ovary syndrome in adolescents ENDOCRINOLOGY AND METABOLISM CLINICS OF NORTH AMERICA Hillard, P. J. 2005; 34 (3): 707-?


    Appropriate management of polycystic ovary syndrome in adolescents depends on recognizing the syndrome, which can have a variety of presenting complaints and must be differentiated from other causes of hyperandrogenism, as well as not dismissed as "normal adolescence." Oral contraceptives have long been considered the first line of treatment by obstetrician/gynecologists and have many advantages in treating the aspects of PCOS that are most bothersome to teens. Because of the potential risk for cardiovascular disease, early diagnosis and management may be helpful in minimizing the risk of the early metabolic correlates of adult disease.

    View details for DOI 10.1016/j.ecl.2005.04.012

    View details for Web of Science ID 000231677400013

    View details for PubMedID 16085167

  • Menstrual disorders in the college age female PEDIATRIC CLINICS OF NORTH AMERICA Hillard, P. J., Deitch, H. R. 2005; 52 (1): 179-?


    College-age young women frequently experience a variety of menstrual-related complaints, including dysmenorrheal, menorrhagia, irregular menses, and menstrual-related mood changes. These problems deserve careful evaluation; they may reflect normal ovulatory menstrual symptoms or be suggestive of significant pathology that can have a major impact on future reproductive and general health. The menstrual cycle is a vital sign whose normalcy suggests an overall good health and whose abnormality requires evaluation. Eating disorders and the female athlete triad increase the risk of osteoporosis; polycystic ovary syndrome is associated with future cardiovascular risks. Diagnosis and management of these problems will not only improve a young woman's current health, sense of well-being, and overall quality of life but may also lower her risks for future disease and ill-health. This article addresses normal menstrual function, excessive bleeding, infrequent or absent menses, pain with menses, menstrual-related mood disorders, and recommendations about routine gynecologic examinations and evaluation.

    View details for DOI 10.1016/j.pcl.2004.10.004

    View details for Web of Science ID 000227426100011

    View details for PubMedID 15748930

  • Pediatric and adolescent gynecology in practice and residency training CURRENT OPINION IN OBSTETRICS & GYNECOLOGY Hillard, P. J. 2004; 16 (5): 363-365

    View details for Web of Science ID 000224191600001

    View details for PubMedID 15353943

  • Provision of emergency contraception to adolescents. journal of adolescent health Gold, M. A., Sucato, G. S., Conard, L. A., Hillard, P. J. 2004; 35 (1): 67-70

    View details for PubMedID 15230259

  • Provision of emergency contraception to adolescents - Position paper of the Society for Adolescent Medicine JOURNAL OF ADOLESCENT HEALTH Gold, M. A., Sucato, G. S., Conard, L. A., Hillard, P. J. 2004; 35 (1): 66-70
  • Human papillomavirus and cervical cytology in adolescents. Adolescent medicine clinics Kahn, J. A., Hillard, P. A. 2004; 15 (2): 301-?


    Human papillomavirus (HPV) infection is highly prevalent in adolescent girls and young women and may be associated with substantial morbidity and mortality. HPV infection may lead to condylomata (genital warts), cervical intraepithelial neoplasia (CIN), and cervical cancer. Recent research focused on the virology, natural history, and sequelae of HPV infection has led to evidence-based revisions of the system for classification of cervical cytology results, recommendations for cytologic screening, and guidelines for management of CIN. Vaccines to prevent HPV infection and its sequelae are under investigation.

    View details for PubMedID 15449847

  • Comparison of adolescent and young adult self-collected and clinician-collected samples for human papillomavirus OBSTETRICS AND GYNECOLOGY Kahn, J. A., Slap, G. B., Huang, B., Rosenthal, S. L., Wanchick, A. M., Kollar, L. M., Hillard, P. A., Witte, D., Groen, P., BERNSTEIN, D. I. 2004; 103 (5): 952-959


    To examine the concordance between self-collected and clinician-collected samples for human papillomavirus (HPV) DNA.Sexually active adolescent and young adult women aged 14-21 years (N = 101) were enrolled in a prospective cohort study of HPV testing. Participants self-collected vaginal samples for HPV DNA, and clinicians collected cervicovaginal samples for HPV DNA and a cervical cytology specimen. We determined concordance between the results of self- and clinician-collected specimens using a kappa statistic and McNemar's test.Of the 51% of participants who were HPV positive, 53% had 1 type, 25% had 2 types, and 22% had 3 types or more; 25 different HPV types were identified. Self-collected samples detected more participants with HPV than clinician-collected samples (45% versus 42%, P =.65). When results were categorized into presence or absence of high-risk HPV types, agreement between self- and clinician-collected specimens was high (kappa 0.72) and the difference between test results was not significant (McNemar's P =.41). However, when all HPV types detected were considered, agreement was perfect in only 51% of those with 1 or more types of high-risk HPV type. There was no association between agreement and age or HPV type.Self testing for HPV DNA may be sufficiently sensitive for the detection of high-risk HPV DNA among adolescent and young adult women in clinical settings.

    View details for DOI 10.1097/01.AOG.0000124569.61462.8d

    View details for Web of Science ID 000225414200019

    View details for PubMedID 15121570

  • Clinical and metabolic findings in adolescent females with hyperandrogenism. Journal of pediatric and adolescent gynecology Huppert, J., Chiodi, M., Hillard, P. J. 2004; 17 (2): 103-108


    The purpose of this study was to characterize the population of adolescent females with laboratory evidence of hyperandrogenism and to explore clinical and laboratory features that may facilitate the diagnosis and management of this condition. We further investigated these characteristics by race, weight, and type of androgen abnormality.A 4-year retrospective chart review was undertaken. Female patients were included if they attended Adolescent Medicine Clinic and had at least one abnormal laboratory parameter on a testing panel that included total and free testosterone, calculated percent free testosterone, and sex hormone binding globulin levels.Our final sample included 154 females, 70% of whom were white, 28% African-American and 2% of other ethnicities. The mean age was 16.1 years (range 11-23). The mean body mass index (BMI) was 30.4, ranging from 16.6 to 45.0, and 78% were obese (BMI>95th percentile for age). Initial reason for visit included irregular menses in 75.3%, acne or hirsutism in 7.1%, and other reason in 17.5%. Non-whites were more likely than whites to present with other reason for visit (28 vs. 13%, P<0.05). Non-white patients had a higher chronologic and gynecologic age at presentation than whites. Total testosterone was elevated in 82.6% of the non-white compared to 62.0% of the white patient group (P<0.05). There was no difference in BMI or obesity between whites and non-whites. The subgroup of adolescents with an isolated elevated testosterone was leaner, had a younger gynecologic age, and was more likely to have an abnormal glucose to insulin ratio than were those girls with other androgen abnormalities. Of those tested for other metabolic abnormalities, 55% had at least one abnormal lipid value, and 68% had an abnormal glucose to insulin ratio.Adolescent females with hyperandrogenism are at risk for other metabolic abnormalities. The higher gynecologic age and higher testosterone levels in our non-white patient group may reflect a delay in referral. Primary care physicians need to be sensitive to signs and symptoms of hyperandrogenism in the non-white population and in lean adolescents.

    View details for PubMedID 15050986

  • Unusual vulvar ulcerations in young adolescent females. Journal of pediatric and adolescent gynecology Deitch, H. R., Huppert, J., Adams Hillard, P. J. 2004; 17 (1): 13-16


    To review a series of young female patients who presented to the Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio, from July of 1996 to November of 2001 with new, unexplained vulvar ulcerations, in order to elucidate common factors.Retrospective case series.Cincinnati Children's Hospital Medical Center and its satellite offices.Female patients who have never been sexually active or abused who presented with the diagnosis of vulvar ulcerations.None.Description of clinical features.Nine patients who developed vulvar ulcerations and denied sexual contact or sexual abuse were identified. Eight of nine were premenarchal. All nine had negative Herpes Simplex Virus (HSV) cultures from the lesions, and three had negative HSV serology. Negative Epstein Barr virus (EBV) tests were documented in six patients. Lesions were recurrent in three patients. The diagnosis of Behcet's disease was considered in three patients. The remaining six patients had systemic complaints consistent with a viral syndrome at the time of the vulvar ulcerations, but no definite etiology could be documented.The rare finding of a vulvar ulcer in a sexually inexperienced patient can result in a diagnostic dilemma in the absence of signs of systemic illness such as Crohn's disease, Behcet's syndrome or EBV infection. These ulcers could be a local manifestation of a non-sexually transmitted systemic viral infection that has yet to be identified. The occurrence in premenarchal females suggests the possibility of mediating hormonal factors.

    View details for PubMedID 15010033

  • Screening for sexually transmitted diseases in adolescent girls. Current women's health reports Adams Hillard, P. J. 2003; 3 (6): 431-432

    View details for PubMedID 14613662

  • Sexually transmitted disease screening in teens. Current women's health reports Huppert, J. S., Adams Hillard, P. J. 2003; 3 (6): 451-458


    Sexually transmitted diseases (STDs) impose a tremendous health burden on women, and adolescent females are the group at the highest risk. Universal annual screening of all women younger than 25 years of age has been a best practice recommendation since 1997. When implemented, such screening leads to a decrease in disease prevalence and of serious sequelae, such as pelvic inflammatory disease (PID). However, STD screening rates in actual clinical practice fail to approach recommendations. In this review, we summarize findings from recent surveys of providers and adolescents, discuss barriers to STD screening, and offer strategies for individual clinicians to improve STD screening rates in practice.

    View details for PubMedID 14613666

  • Cervical cytology screening and management of abnormal cytology in adolescent girls. Journal of pediatric and adolescent gynecology Kahn, J. A., Hillard, P. J. 2003; 16 (3): 167-171

    View details for PubMedID 12804942

  • Electives in obstetric/gynecology residencies - Evidence of flexibility JOURNAL OF REPRODUCTIVE MEDICINE Huppert, J. S., Hillard, P. J. 2002; 47 (12): 1011-1015


    To describe the patterns of electives in obstetric and gynecology (OB/GYN) residencies.A cross-sectional survey of all 274 U.S. and Canadian residency directors assessed the type and number of electives offered by residency programs and correlated these with program characteristics. A separate survey evaluated resident satisfaction with electives at the University of Cincinnati (UC).Electives were offered by 53.8% of U.S. programs (95% CI: 45.2, 60.4), and 92% of electives were offered in the third year. The median length was four weeks, and surgical experience was the most common type of elective. A larger proportion of Canadian programs offered electives, which were of longer duration. The proportion of programs reporting electives did not vary with city size, program size or location. Among 29 UC residents, 62% arranged an optional elective, 92% were satisfied with the experience, and 5 residents (28%) reported that electives influenced their career choice.The prevalence of electives appears higher than listed in currently available directories, although lower than in other primary care residencies.

    View details for Web of Science ID 000180153300003

    View details for PubMedID 12516319

  • Women's health in the medical school curriculum: Building support for the adoption of core competencies AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Rinto, B. A., Hillard, P. J. 2002; 187 (3): S28-S29


    Local adoption of the Association of Professors in Gynecology and Obstetrics women's health care competencies for medical students must be preceded by significant institutional groundwork. Nationally developed guidelines play an important role in persuading teaching faculty of the importance of including women's health and in augmenting institution-specific efforts.

    View details for DOI 10.1067/mob.2002.127364

    View details for Web of Science ID 000178345700010

    View details for PubMedID 12235436

  • Challenges in pubertal development. Journal of pediatric and adolescent gynecology Schroeder, B., Omar, H. A., Swedler, J., Hillard, P. J. 2002; 15 (4): 245-250

    View details for PubMedID 12459233

  • Menstruation in young girls: A clinical perspective OBSTETRICS AND GYNECOLOGY Hillard, P. J. 2002; 99 (4): 655-662


    The ACOG has recommended that the initial visit to an obstetrician-gynecologist for health guidance, screening, and provision of preventive services should take place around age 13-15. At this visit, clinicians can provide guidance to young girls and their parents on adolescent physical development based on data that define parameters for normal pubertal development, menarche, and menstrual cyclicity, and address menstrual hygiene and emerging adolescent concerns. Adolescent menstrual cycles are initially variable, but this variability does not imply that there are no useful parameters for menstrual cyclicity. Data indicate that cycles typically range from 21 to 45 days, even in the first few gynecologic years. Individuals with cycles that vary widely from this norm may have significant pathology, most commonly hyperandrogenism or polycystic ovary syndrome. Controversy now exists regarding the lower limits for the onset of pubertal development in girls; data suggest that pubertal growth may be occurring earlier than had previously been described. The age of menarche has remained constant. Clinicians can furnish information about menstrual hygiene and menstrual protection and provide parental and teen guidance with printed patient education materials and suggested Web-based sources of information. The provision of anticipatory guidance and information to young girls and their parents can help ease the transition from childhood through puberty and a healthy adolescence.

    View details for Web of Science ID 000174635200028

    View details for PubMedID 12039130

  • Care of the adolescent sexual assault victim PEDIATRICS Kaplan, K. W., Feinstein, R. A., Fisher, M. M., Klein, J. D., Olmedo, L. F., Rome, E. S., Yancy, W. S. 2001; 107 (6): 1476-1479


    Sexual assault is a broad-based term that encompasses a wide range of sexual victimizations, including rape. Since the American Academy of Pediatrics published its last policy statement on this topic in 1994, additional information and data have emerged about sexual assault and rape in adolescents, the adolescent's perception of sexual assault, and the treatment and management of the adolescent who has been a victim of sexual assault. This new information mandates an updated knowledge base for pediatricians who care for adolescent patients. This statement provides that update, focusing on sexual assault and rape in the adolescent population.

    View details for Web of Science ID 000169105500067

    View details for PubMedID 11389281

  • Condom use by adolescents PEDIATRICS Kaplan, D. W., Feinstein, R. A., Fisher, M. M., Klein, J. D., Olmedo, L. F., Rome, E. S., Yancy, W. S. 2001; 107 (6): 1463-1469


    The use of condoms as part of the prevention of unintended pregnancies and sexually transmitted diseases (STDs) in adolescents is evaluated in this policy statement. Sexual activity and pregnancies decreased slightly among adolescents in the 1990s, reversing trends that were present in the 1970s and 1980s, while condom use among adolescents increased significantly. These trends likely reflect initial success of primary and secondary prevention messages aimed at adolescents. Rates of acquisition of STDs and human immunodeficiency virus (HIV) among adolescents remain unacceptably high, highlighting the need for continued prevention efforts and reflecting the fact that improved condom use can decrease, but never eliminate, the risk of acquisition of STDs and HIV as well as unintended pregnancies. While many condom education and availability programs have been shown to have modest effects on condom use, there is no evidence that these programs contribute to increased sexual activity among adolescents. These trends highlight the progress that has been made and the large amount that still needs to be accomplished.

    View details for Web of Science ID 000169105500064

    View details for PubMedID 11389278

  • The pill at 40--a new look at a familiar method. Mothers, daughters and the pill. Family planning perspectives Hillard, P. J. 2000; 32 (2): 91-92

    View details for PubMedID 10779242

  • Adolescents' knowledge of human papillomavirus and cervical dysplasia. Journal of pediatric and adolescent gynecology Gerhardt, C. A., Pong, K., Kollar, L. M., Hillard, P. J., Rosenthal, S. L. 2000; 13 (1): 15-20


    This study examined adolescents' knowledge of human papillomavirus (HPV) and cervical dysplasia (CD). Factors associated with knowledge and self-reported change in health-related behaviors were identified.Interviews were conducted at an average of 2.5 years following the diagnosis of HPV/CD. Medical charts were reviewed.The study was conducted at a university-based adolescent dysplasia clinic.Fifty females, ages 15-23 participated in the study: 88% African-American, 12% Caucasian.On average, participants responded correctly to 86% of the questions regarding HPV/CD. However, the following key points were routinely missed: 52% did not know cigarette smoking increased the risk for cervical cancer; 42% believed that HPV/CD was always symptomatic; and 22% did not know condoms decreased the transmission of HPV. According to participants, their health care provider explained the diagnosis and treatment of HPV/CD using words they understood "some" or "most of the time." Higher academic skills significantly correlated with greater knowledge of HPV/CD. Forty-one percent of participants with a smoking history reportedly increased their smoking since the diagnosis, and only 40% used condoms "most of the time." However, 90% had maintained or increased their frequency of Pap tests.Adolescent girls had knowledge of most factors related to HPV/CD, but many did not understand the risks of cigarette smoking and failure to use condoms. To improve understanding and compliance, health care providers should tailor educational strategies to the functional level of adolescents.

    View details for PubMedID 10742668

  • Therapeutic amenorrhea JOURNAL OF PEDIATRIC HEMATOLOGY ONCOLOGY Hillard, P. J. 1999; 21 (5): 350-353

    View details for Web of Science ID 000082935400004

    View details for PubMedID 10524445

  • Promoting women's health via the World Wide Web. Journal of obstetric, gynecologic, and neonatal nursing : JOGNN / NAACOG Hern, M. J., Weitkamp, T., Hillard, P. J., Trigg, J., Guard, R. 1998; 27 (6): 606-610


    Women, as a segment of society at risk for chronic illnesses and complications from normal life events, such as pregnancy and menopause, are seeking information to improve their health status. One tool on the World Wide Web provided by a team of Ohio health care providers, including nurses, physicians, pharmacists, and dietitians, is the Ask an Expert feature of NetWellness. Designed as a consumer health information resource, NetWellness ( also is a valuable tool to health care professionals.

    View details for PubMedID 9836154

  • Case report: Clear cell adenocarcinoma of the vagina in a 5-year-old girl: Imaging findings CLINICAL RADIOLOGY Donnelly, L. F., Gylys-Morin, V. M., Warner, B. W., Hillard, P. J. 1998; 53 (1): 69-72

    View details for Web of Science ID 000075812700015

    View details for PubMedID 9464442

  • Adolescent girls' understanding of Papanicolaou smear results. Journal of pediatric and adolescent gynecology Biro, F. M., Rosenthal, S. L., Rymarquis, L., Kollar, L. M., Hillard, P. J. 1997; 10 (4): 209-212


    Human papillomavirus (HPV) urogenital infections are common in sexually active adolescents. Previous research has indicated that adolescent girls do not reliably report histories of HPV infection. This study examined whether asking an adolescent girl if she had ever had an abnormal Papanicolaou (PAP) smear was a good screening question for evidence of HPV urogenital infection.The responses to the question about abnormal PAP smears, were compared with their charts for documented abnormal PAP smear, HPV infection, and sexually transmitted infection.An urban, hospital-based adolescent clinic.Fifty adolescent girls (mean age, 14.8 years).Degree of agreement (kappa statistic).Using a kappa statistic, reported history of an abnormal PAP smear had "fair" agreement with documented dysplasia on PAP smear and "moderate" agreement with documented HPV infection (i.e., either condyloma on PAP smear or genital warts noted on examination). This reported history of an abnormal PAP smear agreed better with documented HPV infection than with documented dysplasia on PAP smear.There appears to be considerable confusion among adolescent girls regarding their PAP smear results. Care providers need to be sensitive to this when they are collecting historical information and when they are diagnosing HPV infection or an abnormal PAP smear.

    View details for PubMedID 9391904

  • Opinions in pediatric and adolescent gynecology. Journal of pediatric and adolescent gynecology Hillard, P., WILDEY, L. S., Shulman, L. P. 1996; 9 (4): 209-211

    View details for PubMedID 8957777

  • Adolescent pap smear screening: yes or no. Journal of pediatric and adolescent gynecology Hillard, P. 1996; 9 (2): 93-97

    View details for PubMedID 8795784

  • Family involvement in the gynecologic care of adolescents. Journal of pediatric and adolescent gynecology Rosenthal, S. L., Cohen, S. S., Burklow, K. A., Hillard, P. A. 1996; 9 (2): 59-65


    The purpose of this paper is to address the issues of family involvement in gynecologic care for adolescent girls. This is accomplished by reviewing pertinent literature and its implication for health-care delivery. Specific aspects of adolescent development including changes in cognitive development and relationships are reviewed. In addition, the implications of communication between parent and adolescent, degree of parental monitoring, and the type of parenting style are discussed. Using this information as a background, recommendations for family involvement in gynecologic care are given. Methods for handling appointments are addressed; including the structure and content of the appointment and also the follow-up appointment, especially for high-risk families. Issues of confidentiality for both adolescent and parent are discussed. This information should aid clinicians in supporting those features of families that promote positive growth in adolescent girls.

    View details for PubMedID 8795778



    Levonorgestrel implants (Norplant) have been recommended as a contraceptive method for teenage women. Our experience suggests that the use of Norplant implants in adolescents is associated with bleeding irregularities and modest weight gain. There is no effect on condom use or STD acquisition. Despite the bleeding irregularities, we documented high continuation rates, suggesting that with appropriate pre-insertion counseling, Norplant implants can be a successful contraceptive method for adolescent women.

    View details for Web of Science ID A1995TD10400003

    View details for PubMedID 8585884

  • COMPLIANCE AND ORAL-CONTRACEPTIVES - A REVIEW CONTRACEPTION Rosenberg, M. J., Burnhill, M. S., Waugh, M. S., Grimes, D. A., Hillard, P. J. 1995; 52 (3): 137-141


    Compliance difficulties are more common among oral contraceptive (OC) users than generally appreciated by clinicians, in part because unintended pregnancy is a relatively infrequent consequence and in part because more common manifestations such as spotting and bleeding may not be recognized as resulting from poor compliance. While improving compliance is a shared responsibility of patients, clinicians, and manufacturers, the clinician is the focal point for these efforts. Counseling must be individualized, which requires knowledge of factors that predict compliance and an understanding of the patient's decision-making process as it relates to medications. Most OC compliance research has focused on adolescents, where predictors of poor compliance include multiple sex partners, low evaluation of personal health, degree of concern about pregnancy, and previous abortion. Good compliance has been linked with patient satisfaction with the clinician, the absence of certain side effects, establishing a regular daily routine to take OCs, and reading information distributed with OC packaging.

    View details for Web of Science ID A1995RR62300001

    View details for PubMedID 7587184

  • Contraceptive use and attitudes among U.S. women. Women's health issues : official publication of the Jacobs Institute of Women's Health Hillard, P. A. 1994; 4 (3): 138-143

    View details for PubMedID 7950393



    As an increasing percentage of adolescents reach their sexual debut at younger ages, effective contraceptive methods, which will decrease the risks of unintended pregnancies and sexually transmitted diseases (STDs), become even more critical. Contraceptive methods which are less 'compliance-dependent', such as the implantable subdermal levonorgestrel and the injectable depot formulation of medroxyprogesterone acetate, are popular in adolescents but careful counseling before method selection and on-going counseling when side-effects are experienced are necessary and essential. The use of condoms to decrease the risks of STDs will continue to be important for adolescents, and it remains to be seen what impact the long-term methods will have on effective condom use. Adolescents' access to abortions when contraceptive methods fail, or when no method is used, is being challenged with state laws which mandate parental notification or permission. A greater knowledge about the option of emergency contraception could potentially lead to increased use of this method, particularly when the option of medications such as RU486 becomes available. The potential for a reduction in unintended pregnancies in adolescents, and a reduced need for abortions is a welcome prospect.

    View details for Web of Science ID A1993MH18700016

    View details for PubMedID 8286693



    Cervical dysplasia and human papillomavirus (HPV) infections in sexually active adolescents appear to be increasing. Cervical cryotherapy offers the advantages of inexpensive outpatient therapy that is well tolerated without anesthesia. Previous series have focused on women beyond adolescence and have concluded that the risks and complications are rare. Sixty-seven adolescents underwent cervical cryotherapy for cervical intraepithelial neoplasia (CIN) or HPV infection. Pelvic inflammatory disease developed in 9% within one month of treatment. Two patients developed cervical stenosis and hematometra. Cervical cultures performed prior to cryotherapy were documented to be negative, but the interval from negative cultures to treatment exceeded four weeks in 54% of the patients because of problems with patient compliance with appointments. The risk of infectious complication in our adolescent population prompted a recommendation for aggressive preventive measures, including documentation of recent negative cultures for Neisseria gonorrhoeae and Chlamydia. The use of prophylactic antibiotics should be investigated for adolescents undergoing cervical cryotherapy.

    View details for Web of Science ID A1991GL31600005

    View details for PubMedID 1956010



    A group of 46 women attending an adolescent dysplasia clinic were surveyed regarding the reported impact of cervical dysplasia on sexual beliefs and behaviors. The adolescents reported being concerned about their future health and having changed their sexual practices. There were no clear relationships between demographic variables or sexual attitudes and changes. The adolescents' self-reports of their behavior were not consistent; those adolescents who reported safer sex practices did not have lower rates of sexually transmitted diseases postbiopsy. The results of this study indicate the important but complex impact of sexually transmitted disease on adolescents and suggests that this impact on adolescents may be different from that on adults.

    View details for Web of Science ID A1991GF34200007

    View details for PubMedID 1751508


    View details for Web of Science ID A1990ET79500012

    View details for PubMedID 2130986



    Genital HPV infections are much more prevalent than previously believed. The most common clinical manifestation of HPV--the subclinical papillomavirus infection, or SPI--is missed on routine examination. No single diagnostic test is adequate in the assessment of HPV infections, and the more recent studies involving newer nucleic acid technologies have brought about a better understanding of the behavior of HPV. There are different oncogenic potentials regarding specific HPV DNA types. Other possible cofactors include age at diagnosis, method of contraception, and use of tobacco.

    View details for Web of Science ID A1990DX29500012

    View details for PubMedID 2167414



    Approximately 14 million American women currently use oral contraceptives. This represents only 32% of those at risk for pregnancy. Many studies suggest that bleeding irregularities are a primary reason for discontinuation of oral contraceptives, especially among adolescents. The Triphasic Randomized Clinical Trial study and several others suggest that intermenstrual bleeding may be experienced by at least one third of women taking oral contraceptives at one time or another. The socioeconomic costs of these episodes, realized in calls and visits to physicians, as well as pill discontinuation, pregnancy, and perhaps abortion, carry their own unique set of risks. Absence of withdrawal bleeding, or amenorrhea, is another concern because, to the woman, it signals pregnancy. Roughly two thirds of patients who have amenorrhea while taking oral contraceptives will consult a physician. Physicians should select oral contraceptives with the lowest doses of hormones and fewest side effects such as breakthrough bleeding or amenorrhea, which are major obstacles to compliance.

    View details for Web of Science ID A1989CA61800068

    View details for PubMedID 2589465



    Suburethral diverticula have been reported to occur in 3-5% of adult females. They are rarely found in adolescents. We describe such a lesion that arose secondary to an abscess of Skene's glands in a 14-year-old sexually active adolescent.

    View details for Web of Science ID A1987H971600011

    View details for PubMedID 3112048


    View details for Web of Science ID A1986E512200002

    View details for PubMedID 3785993



    In the past it was assumed that medical students would be able to perform an adequate pelvic examination by the end of the third-year clinical clerkship. At the University of Virginia, students completing the clinical clerkship were evaluated by trained gynecology teaching associates (GTAs), acting as patients and chaperones, who systematically evaluated students' examination and interpersonal skills using both an objective scale including 86 specific items and two 12-point subjective rating scales. Interrater reliability was demonstrated, as was the correlation between the subjective scores and objective ratings. Thirty-two percent of the students were evaluated as having either inadequate or marginal examination skills, and 29% were rated as having interpersonal skills that fell into the same unsatisfactory category. GTAs can be used as evaluators of skills in a competency-based clerkship.

    View details for Web of Science ID A1986D069800006

    View details for PubMedID 3735261



    Screening interviews to determine the extent of physical abuse were conducted for 742 women seen in the University of Virginia obstetric clinics. Eighty-one women (10.9%) reported that they had experienced abuse at some point in the past. These women were more likely to be divorced or separated, indigent, and less educated than were the non-abused control patients. They were more likely to have had emotional problems, and 20% had attempted suicide. Twenty-nine of the 81 women reported abuse during the current pregnancy, with 21% reporting increased abuse and 36% noting decreased abuse during pregnancy. Women living with an abusive partner did not experience a greater frequency of adverse pregnancy outcomes than did those who had left abusive relationships. An awareness of the extent of the problem and direct questioning will result in an increased identification of women who are at risk for physical abuse during pregnancy.

    View details for Web of Science ID A1985AMX7100007

    View details for PubMedID 4022481



    Bulimia, anorexia nervosa, and diabetes often coexist, and eating disorders among diabetics frequently go unrecognized. This combination of conditions can have life-threatening effects. Consequently, diagnosis and the medical and psychological management of these patients is of critical importance. The authors outline the complex interactions among the biologic, psychological, and social factors involved in these disorders.

    View details for Web of Science ID A1984SZ73800014

    View details for PubMedID 6382202


    View details for Web of Science ID A1984TJ13500013

    View details for PubMedID 6471090

  • Disseminated herpes simplex in pregnancy: two cases and a review. Obstetrical & gynecological survey Hillard, P., Seeds, J., Cefalo, R. 1982; 37 (7): 449-453


    Documented disseminated infection with herpes simplex virus has been reported only five times in pregnancy. All cases have been severe and demonstrated common clinical features, including hepatitis and adenopathy. These reports are reviewed and two new cases added. Dissemination is undoubtedly more common, and commonly less dramatic in presentation then previously suspected. Hepatocellular dysfunction and generalized adenopathy should be clues to dissemination. Dissemination has occurred only in the second half of pregnancy, and even with infected amniotic fluid, has not always resulted in an infected infant. Transplacental maternal IGG has been documented, but is not protective, though newer antiviral drugs do show therapeutic potential. The clinician should be aware of the possibility of dissemination in any patient with oral or genital herpes and generalized signs or symptoms of disease.

    View details for PubMedID 6752785


    View details for Web of Science ID A1981MD91600029

    View details for PubMedID 6115587