Historical Overview of PAG

The first gynecological unit for pediatric and adolescent patients was established in 1940 in Prague under the direction of Gynecologist R. Peter. Shortly before that, Hungarian Pediatrician L. Dobsay had written the first book on Pediatric Gynecology. Other important publications soon followed, including works by G. Schauffler (1958), G. Mitolo (1968) in Italy, Peter and Vesely (1968), S. Hoyme (1972 and 1976) in Berlin, French Pediatrician D. Sersiron (1974), and Sir John Dewhurst in Great Britain, with his book Practical Pediatric and Adolescent Gynecology. A milestone in the specialty was the re-publication of John Huffman’s book in Chicago (1981), and more recently by Professors Sir John Dewhurst and Joe Sanfilippo under the title Gynecology of Childhood and Adolescence, which provides in detail all conditions that may occur in girls from birth through puberty.

In parallel with these publications, numerous studies have been published on specific issues in Pediatric and Adolescent Gynecology, such as congenital anomalies of the genital system, tumors, infections, chromosomal and endocrine disorders, and others. In Greece, the undersigned has published the textbook Gynecology and Obstetrics of Young Age.

The late Professor R. Contamin in Grenoble, France, conceived the idea of founding an international society to promote and maintain the reproductive health of girls and to foster communication among specialists through international symposia and congresses. This society was named the Fédération Internationale de Gynécologie Infantile et Juvénile (FIGIJ) and today has numerous branches and members worldwide. The Board of Directors for the period 1999–2001 consisted of: President G. Kreatsas, Vice-President H. Pons (Uruguay), Secretary General D. Apter (Finland), J. Horejsi (Czech Republic), G. Gitwani (USA), F. Navratil (Switzerland), G. Tscherne (Austria), H. Maria-Ribas (Argentina), and M. Heinz (Germany). Later, the European Society of Pediatric and Adolescent Gynecology (EURAPAG) was founded.

Following the establishment of the first Pediatric and Adolescent Gynecology center in Prague in 1940 by R. Peter, the specialty spread widely in Eastern Europe. This was due to Peter’s appointment in 1953 as Professor of the first Chair of Pediatric Gynecology at Charles University, enabling his students to disseminate the specialty throughout neighboring countries.

In Great Britain, Sir John Dewhurst directed, first at Queen Charlotte’s Hospital and later at Chelsea Hospital for Women, a specialized department for many years where cases related to Pediatric and Adolescent Gynecology were examined and treated surgically. His experience in the field was so extensive that he attracted cases not only from across England but also from other parts of the world. Among his collaborators were the late Dr. David Grand, a renowned specialist in Pediatric Endocrinology, and pediatric urologist Phillip Ransley at the Hospital for Sick Children. Sir J. Dewhurst was later succeeded by Mr. Keith Edmonds, and a local Society of Pediatric and Adolescent Gynecology was established.

In 1955, in Paris, Pediatrician D. Sersiron created an outpatient clinic of Pediatric and Adolescent Gynecology at Bretonneau Hospital. Ten years later, A. Huber founded a similar clinic in Innsbruck.

In Berlin, Pediatric and Adolescent Gynecology was first introduced at Oskar Ziethen Krankenhaus by Hoyme and Heinz. In subsequent years, similar clinics were established across nearly all European countries and in many cities, including Grenoble, Bordeaux, Brussels, Florence (V. Bruni), Vienna, Graz (G. Tscherne), Munich, and others.

In Switzerland, the first Pediatric and Adolescent Gynecology clinic was founded in 1969 at the University Pediatric Clinic of Lausanne, followed by similar clinics in Zurich and Basel. Another such clinic was established under Dr. Irmi Rey-Stocker and later continued by F. Navratil.

In Turku, Finland, the development of Pediatric and Adolescent Gynecology was led by the late Professor L. Rauramo, former President of FIGIJ, and subsequently by his colleague D. Apter.

In the United States, Professor John W. Huffman in Chicago was the first to engage in Pediatric and Adolescent Gynecology, organizing a pioneering clinic for the gynecological examination of young girls, with specially designed instruments, including the colposcope that bears his name.

Soon after, Professor Vincent Capraro established similar clinics at Millard Fillmore Hospital in Buffalo, New York, and at the Children’s Hospital of the same city, which gained recognition throughout North America and internationally. He also trained many gynecologists and pediatricians and, through the University of Buffalo, offered a fellowship titled Pediatric and Adolescent Gynecology and Corrective Gynecologic Surgery, which the undersigned obtained. Additionally, Professor Capraro organized annual seminars in Buffalo, attended with great interest by physicians from across the United States. His associates included Professor Margaret MacGilivray, Chair of Pediatrics at the same university, and the Professor of Urology. His work was continued by the late Professor Marcos G. Gallego at the same hospitals.

In Greece, the Hellenic Society of Pediatric and Adolescent Gynecology was founded in 1977 by the late Professor of Gynecology at the University of Athens, Dionysios Kaskarelis, supported by Professors Dionysios Aravantinos and Stelios Michalas. This society is a branch of the International Federation of Pediatric and Adolescent Gynecology (FIGIJ).

In March 1981, the first Pediatric and Adolescent Gynecology clinic in Greece was founded at the 1st Department of Obstetrics and Gynecology of the University of Athens, where girls from birth to puberty were examined. The clinic was initially directed by the author of this article, who had been trained in Pediatric and Adolescent Gynecology abroad. Together with the Hellenic Society of Pediatric and Adolescent Gynecology and the Millard Fillmore Hospital of the University of New York, the first Symposium on Pediatric and Adolescent Gynecology was successfully organized. This two-day symposium was attended by 350 physicians of various specialties, mainly obstetricians-gynecologists, pediatricians, endocrinologists, microbiologists, and others.

Such symposia are now held annually in many parts of the world. Professor A. Altcheck of the University of New York used to organize postgraduate seminars in Pediatric and Adolescent Gynecology each year at Mount Sinai Hospital in New York.

In 1981, two major FIGIJ events took place: (a) the European Symposium on Pediatric and Adolescent Gynecology in Munich, Germany, and (b) the VI World Symposium on Pediatric and Adolescent Gynecology in Punta del Este, Uruguay. In Athens, the Hellenic Obstetrics and Gynecology Society has also incorporated into its conferences topics on gynecological and obstetric problems of young age.

Finally, FIGIJ has established a Fellowship titled IFEPAG, awarded after examinations to physicians specialized in Pediatric and Adolescent Gynecology. Information is available online at figij.org.

The congresses and seminars of the Hellenic Society of Pediatric and Adolescent Gynecology, FIGIJ, and other related societies continue worldwide, as does subspecialty training offered in many regions by specialized departments and clinics of Pediatric and Adolescent Gynecology.

In Greece today, Pediatric and Adolescent Gynecology clinics already operate in public hospitals and private clinics.

Our purpose is to reduce infertility in Greece through the prevention and treatment of gynecological problems from fetal life through puberty, ensuring that the healthy children of today will become the healthy adults of tomorrow.

Introduction
G. Kreatsas, FACS, FACOG, FRCOG
Former Vice-Rector, National and Kapodistrian University of Athens
Emeritus Professor, University of Athens

About twenty years ago in the United States, I had the opportunity to encounter a new field within Obstetrics and Gynecology: Pediatric and Adolescent Gynecology. I believed, and continue to believe, that the prevention of diseases of the female reproductive system begins in childhood, if not in the neonatal or even fetal period. Indeed, conditions such as hydrocolpos, hermaphroditism, and congenital adrenal hyperplasia must be recognized at birth. This leads directly to the conclusion that the gynecologist, midwife, and neonatologist must dedicate time and attention to examining the external genitalia of the newborn in the delivery room.

In the United States, I began writing the first edition of my book Neonatal, Pediatric and Adolescent Gynecology, which I completed a year later. During this time, I met Professors V. Capraro and M. Gallego, Irmi Rey-Stocker, and through them I became connected with the International Federation of Pediatric and Adolescent Gynecology. In Chicago, I first met Professors J. Huffman and Sir John Dewhurst, and later in Washington, D.C., Professor Paul McDonough. I mention these names because they inspired my enthusiasm to continue working in Pediatric and Adolescent Gynecology.

Upon returning from the United States to England and then back to Greece, the late Professor D. Kaskarelis recognized my passion for this subspecialty. Having already received a letter from FIGIJ founder R. Contamin, he encouraged me to continue this work. Initially, we examined about one patient per week, until the Pediatric and Adolescent Gynecology Unit at Alexandra Maternity Hospital became well known throughout Greece and internationally, eventually reaching about 30 patients per day, and later at Aretaieio University Hospital.

I had the privilege of meeting colleagues from around the world, including Professor V. Bruni from Italy and many others. At the same time, we founded the Hellenic Society of Pediatric and Adolescent Gynecology, and with the encouragement of distinguished colleagues such as the late Professors D. Kaskarelis, D. Aravantinos, and S. Michalas, we developed the departments at Alexandra Maternity Hospital and Aretaieio University Hospital, making them known in Europe and America. This international recognition culminated in my election as Secretary General of FIGIJ in 1996 and as President of this Federation, with re-election in 1999 until 2001.

I am grateful that upon my election as Professor and my transfer to Aretaieio Hospital, I founded, together with my associate Dr. E. Deligeoroglou, a second Pediatric and Adolescent Gynecology department. Additional similar departments have since been established in clinics throughout Greece. I regret that esteemed colleagues such as E. Hassan, E. Kardamakis, and others, who greatly supported these efforts, are no longer with us.

This subspecialty offers many rewarding experiences, as physicians engaged in this field encounter conditions requiring corrective surgery, disorders linked to genetics and endocrinology, and also issues of a social nature connected with the psychological sphere of the child.

The young physician must, above all, be familiar with all conditions of the reproductive system affecting the young girl.

I therefore thank all former professors and colleagues who, over the years, contributed to the prevention and treatment of obstetric and gynecological conditions in childhood and adolescence; the authors of chapters who shared their expertise in our books; and the new Board of Directors. For “the children of today in Greece, who will become the adults of tomorrow.”