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Gynecologists For Young Girls?

For Certain Rare Problems—Even Before Puberty—This Specialist Can Be Needed

Often ignorance triggers fear, but for 6-year-old Valentina Quintero’s mom it was knowledge. A pediatrician herself, Eastchester resident Marieta Quintero, M.D., knew that once a stomach virus and appendicitis had been ruled out as causes of her daughter’s persistent abdominal pain, many of the remaining possibilities—including malignancy—were scary.

In May 2012, Valentina suffered diarrhea and a bellyache that wouldn’t go away. When for the second day in a row she experienced vomiting, Dr. Quintero took her to the emergency room at Maria Fareri Children’s Hospital, where an ultrasound was negative for appendicitis.

“I was going crazy,” confesses the doctor-mom. “I was thinking the worst-case scenario.” Happily, the diagnosis was a relief, comparatively. A CT (computed tomography) scan showed that Valentina had a treatable condition—a small tumor called a Dermoid cyst on one ovary. In what doctors call ovarian torsion, the cyst was twisting the ovary, compromising its blood supply and causing the pain.

“I’d seen it in my practice,” says Dr. Quintero, “but never in a girl so young.”

Though most female reproductive problems don’t appear until puberty, when hormonal changes start to kick in, there are issues that can surface in “tweens” and younger girls. At these times, a pediatric gynecologist is the best specialist to call on. These doctors, however, are found only in a few medical centers, and Maria Fareri Children’s Hospital at Westchester Medical Center is the only one between New York City and Albany to have such specialists on staff. They are Monique Regard, M.D. and Amy Vallerie, M.D. Valentina was placed under the care of Dr. Regard.

Making a correct diagnosis of pediatric gynecologic problems is easier than it was a few years ago, thanks to improved imaging available in most emergency rooms. Ovarian torsion, the doctor explains, “comes on very suddenly and causes terrible pain.” It needs immediate surgical treatment. “If we can go in and untwist it in less than 24 hours, we can save the ovary,” she says. “Any longer and the ovary may die, which could affect the girl’s fertility later in life.”

In a more than three-hour procedure, Dr. Regard worked intricately to remove the tumor and spare the ovary. And this time, Dr. Quintero’s knowledge enabled her to appreciate her daughter’s good fortune.

“Dr. Regard did a beautiful job,” says the grateful mom. “In many hospitals, a child with this condition would be referred to a general pediatric surgeon, who might not have the expertise to do this procedure. She might lose the ovary.”

Other problems Dr. Regard and her colleagues see—all relatively rare—include early vaginal bleeding, abnormal reproductive structures, abnormal discharge and ovarian tumors that do not cause twisting. She treats ovarian torsion in girls under age 10 about once every three years, she says. Cases of early bleeding present about six times a year, and the others every week or two. Besides treating the problem she looks for a cause—early hormone release, infections, ovarian tumors— and then, with her colleagues, works to relieve that cause.

Of course, Valentina doesn’t yet appreciate the clinical subtleties of her treatment. But she does have a doctor’s kid’s matter-of-fact understanding of what happened.

“I had my surgery,” she explains when people ask, “and Dr. Regard made me better.”

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