Elevating and empowering reproductive futures: Pediatric and adolescent gynecology's specialized care across the globe

Despite notable advancements in PAG, critical gaps persist globally, particularly in low‐resource settings, where the specialty remains underrepresented. Many regions face substantial challenges to optimizing reproductive health care for young girls and women. This ranges from limited access to care, a scarcity or complete absence of training programs, insufficient funding, cultural stigmas around adolescent reproductive health, and competing healthcare priorities. Countries with established PAG fellowship programs, such as the United States, Canada, and Australia, can serve as models, while nations including India and Nigeria are beginning to explore local training pathways. Initiatives such as international fellowships, peer‐support networks, and standardized curriculum development can bolster expertise in underrepresented regions, fostering sustainable growth. To enhance global PAG care, effective collaboration between PAG specialists and non‐PAG clinicians is crucial. Multidisciplinary care models that integrate pediatricians, gynecologists, and mental health professionals can improve outcomes through shared expertise. Knowledge‐sharing platforms, such as FIGO‐led workshops or online repositories of evidence‐based protocols, can bridge gaps in training, while clearly defined referral pathways can help ensure timely access to specialized care. By prioritizing these strategies, we can close disparities, strengthen global PAG capacity, and promote equitable, comprehensive care for adolescents, supported by ongoing expert engagement to refine and further expand the global reach of PAG.

All authors contributed to the conception and drafting of the work. All authors reviewed and approved the final manuscript.

Collectively, these organizations are instrumental in elevating PAG as a recognized subspecialty, addressing health disparities, and advocating for the rights of young patients. Through collaborative efforts, facilitated by FIGIJ, a global network that disseminates best practices, from managing complex congenital anomalies to promoting comprehensive sexual education, was created. Furthermore, the development of training programs, such as NASPAG's fellowships and EURAPAG, ALOGIA, and AOSPAG's trainee congresses, is expanding the pipeline of skilled clinicians. Together, their advocacy for policies on HPV vaccination, STI prevention, and adolescent pregnancy prevention bridges clinical care with public health, particularly in low‐resource settings. Resources such as NASPAG's multilingual handouts, BritSPAG's clinical guidelines, and FIGIJ statements and guidelines in the field enhance accessibility and cultural competence. In addition, events including the FIGIJ World Congress and EURAPAG's European Congress foster knowledge exchange, shape health policy, and drive research to address increasing challenges, such as obesity, female genital mutilation/cutting, child marriage, and mental health in adolescents. Their work ensures that PAG remains a dynamic, patient‐centered field, empowering girls and young women worldwide to achieve their full potential in health and education, while having a voice to uplift others.

No funding was received to develop this article.

PAG specialists manage complex genetic conditions, including differences in sex development, with a focus on developmentally sensitive care. Conditions such as congenital adrenal hyperplasia, androgen insensitivity syndrome, and gonadal dysgenesis require a multidisciplinary approach, involving endocrinologists, geneticists, urologists, and psychologists. PAG providers coordinate care, offering expertise in gonadectomy, hormonal management, and advanced reconstructive surgeries when indicated. They also provide counseling to patients and families, fostering informed decision‐making and addressing the psychosocial implications of these diagnoses. Furthermore, PAG specialists assist families in managing menstrual hygiene in adolescents with developmental or physical disabilities. By prioritizing patient autonomy and family‐centered care, PAG clinicians can help young patients navigate their reproductive health with confidence.

PAG specialists are advocates for the reproductive health and rights of girls and adolescents, championing policies that promote access to contraception, STI prevention, and cervical cancer screening around the world. They lead efforts to address health disparities, particularly in underserved populations, and advocate for comprehensive sex education in schools. Within healthcare systems, PAG clinicians drive interdisciplinary collaboration, serving as liaisons between pediatric and adult care providers to ensure continuity of care. Their leadership extends to global organizations such as FIGO, where they participate in the Committee on Adolescent and Youth Health, shaping guidelines and policies to advance PAG care worldwide. By amplifying the voices of young patients, PAG specialists foster a future in which reproductive health is equitable, accessible, and empowering.

PAG specialists evaluate, diagnose, and treat a wide spectrum of gynecologic issues in children and adolescents, often serving as consultants for primary care providers, obstetricians and gynecologists, pediatricians, and pediatric subspecialists. Common referrals include the management of heavy, painful, or irregular menstrual cycles in young patients, which can be indicators for underlying conditions such as polycystic ovary syndrome (PCOS) or bleeding disorders. PAG specialists are experts in hormonal and nonhormonal therapies, including progestins, combined oral contraceptives, tranexamic acid, and intrauterine devices (IUDs), to manage bleeding and optimize quality of life. In severe cases, innovative techniques, such as intrauterine Foley catheters or small Bakri balloons, may be employed, while coordinating transfusions or intravenous immunoglobulin therapy with hematology colleagues. PAG experts frequently respond to vulvar concerns ranging from infections, pruritus, labial adhesions, ulcers, and trauma from falls or abuse, requiring sensitive evaluation. Adolescents seek PAG expertise for individualized contraception counseling, both before and after pregnancy. This also includes screening for STIs and sexual health. These visits often serve as a first introduction to confidential adolescent care, providing opportunities to discuss sensitive concerns about sexual health, body image, and mood. PAG clinicians also play a pivotal role in managing reproductive health for girls with less common complex medical conditions, such as developmental delays, autism, seizure disorders, organ transplants, cancer, or hematologic disorders. Through close collaboration with pediatric subspecialists, PAG providers ensure continuity of care, tailoring interventions to each patient's unique needs. For example, contraceptive methods may be tailored to accommodate drug interactions in patients with epilepsy or to optimize menstrual suppression for girls undergoing chemotherapy.

PAG specialists manage a broad range of surgical conditions with unique surgical skills to understand complex anatomic variations, aiming to always preserve reproductive function where possible and simultaneously alleviate obstructions and pain. PAG surgeons routinely perform surgery in children, such as vaginoscopy to remove retained foreign bodies, biopsies of vulvar lesions (e.g. to diagnose rhabdomyosarcomas), and repair sometimes extensive straddle injuries. In cases of ovarian torsion, they may perform oophoropexy to prevent recurrence and routinely optimize ovarian conservation in cases of benign ovarian cysts and pelvic masses. Endometriosis, often a neglected diagnosis in adolescence, 5 , 6 , 7 , 8 , 9 is another arena of PAG expertise. PAG surgeons diagnose and treat endometriosis in adolescents, routinely performing laparoscopy to biopsy and excise or ablate endometriosis in the teen patient, with simultaneous IUD insertion during endometriosis surgery. PAG providers tailor management to prevent chronic, often challenging, and complex, centralized pain syndromes that occur in patients with prolonged painful conditions such as endometriosis. Early intervention for diagnosis and management of endometriosis may not only improve quality of life but also support school attendance and long‐term psychosocial outcomes. In collaboration with pediatric surgeons, PAG specialists address complex congenital anomalies, such as differences in sex development, anorectal malformations, and urogenital sinus abnormalities. Their deep understanding of reproductive anatomy ensures that reconstructive surgeries prioritize future fertility and function, whether through vaginoplasty or correction of cloacal anomalies. These collaborative efforts highlight the subspecialty's commitment to interdisciplinary care.

PAG specialists are uniquely positioned to manage the endocrine aspects of puberty and the menstrual cycle. They evaluate and treat girls with precocious puberty, delayed puberty, or primary amenorrhea, addressing underlying causes such as hypothalamic dysfunction, ovarian insufficiency, or congenital anomalies. For patients requiring hormone therapy, whether to induce puberty in cases of hypogonadism, or to provide ongoing replacement therapy for conditions such as Turner syndrome, PAG providers tailor regimens to balance physical development, bone health, and psychosocial well‐being. Premature ovarian insufficiency, whether due to Turner syndrome, autoimmune disorders, or gonadotoxic treatments such as chemotherapy, is another area of expertise of the PAG physician. PAG clinicians counsel patients and families about fertility preservation options, such as oocyte cryopreservation, and provide hormone therapy to mitigate long‐term health risks, including osteoporosis and cardiovascular disease. Their holistic approach ensures that patients receive both medical and emotional support during critical developmental stages and into adulthood. Hypothalamic hypogonadism can present in adolescents due to delayed puberty, eating disorders such as anorexia nervosa, relative energy deficiency in sports, hyperprolactinemia, and significant chronic illness. PAG specialists facilitate the identification and management of these disorders to allow normal maturation, optimize nutrition, and protect bone health. PCOS is a diagnosis that can be challenging in young adolescents because of the overlap of adrenarche and the proliferation of follicles present in early puberty that can mimic PCOS ovarian morphology. PAG specialists diagnose and manage gynecologic conditions in adolescents, such as hypothalamic hypogonadism and PCOS, to support healthy development and safeguard long‐term health outcomes such as bone and endometrial health.

Adolescent pregnancy presents unique medical and psychosocial challenges, which PAG specialists are well suited to address. They provide comprehensive prenatal care tailored to the developmental needs of young patients, addressing nutritional deficiencies, mental health concerns, lifestyle opportunities, and social stressors. Contraception counseling following pregnancy is a priority to prevent rapid repeat pregnancies, with an emphasis on immediate postpartum long‐acting reversible contraceptives such as IUDs and implants. PAG clinicians also collaborate with social workers and recruit community resources to support young mothers, ensuring access to education and economic opportunities. In resource‐restricted settings, the principles of holistic care, core to the PAG service, inform adolescent obstetric care pathways that are embedded within the standard pediatric or adult health services. Given the high rate of forced pregnancy in young pregnant adolescents, a trauma‐informed approach to care is critical. Access to expert consultation, whether through telemedicine, established networks of specialists, or member organizations, enables tailored care that differs significantly from routine adult gynecologic approaches, yielding substantial benefits for patients' long‐term reproductive health. 10 , 11 By addressing the unique medical and social determinants of adolescent pregnancy, PAG specialists empower adolescents to make informed decisions about their reproductive futures, fostering healthier outcomes, encouraging continued education, and enhancing autonomy.

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PAG is a dynamic and essential subspecialty that addresses the unique reproductive health needs of girls and adolescents. From preventive care counseling, clinical care, and surgical expertise to endocrine management, genetic counseling, and advocacy, PAG specialists provide comprehensive, age‐appropriate care along the life course. As the field advances, with formalized training programs and global educational initiatives, it has the potential to make an even greater impact on the health and well‐being of young patients worldwide. By bridging pediatrics, gynecology, and related disciplines, PAG demonstrates the power of specialized care to continue to transform lives.

Pediatric and adolescent gynecology (PAG) is a vital medical specialty that addresses the unique reproductive health needs of adolescent girls, tackling issues such as high adolescent birth rates (42 per 1000 girls aged 15–19 years globally in 2021). 1 It also addresses prevalent menstrual disorders such as dysmenorrhea affecting school attendance, and rising sexually transmitted infections (STIs), with nearly half of new cases occurring in 15‐ to 24‐year‐olds. 1 By providing specialized and developmentally appropriate care, PAG experts empower girls and young women to navigate these challenges, fostering informed decision‐making and improved health outcomes. PAG providers are dedicated to the comprehensive care of young girls, adolescents, and their families. This specialty also adopts a biopsychosocial approach, emphasizing respect for diversity and inclusion. Furthermore, it addresses the emotional, psychological, social, and cultural aspects alongside medical needs. Girls and adolescents may present with a wide range of gynecologic conditions requiring tailored expertise to ensure that their unique healthcare needs are met. Pediatric and adolescent gynecologists provide holistic and personalized care that goes beyond traditional gynecological treatment, ensuring that patients are supported in their physical health, mental well‐being, and social development. This specialty spans various fields and actions, including the management of menstruation and sexual development and the diagnosis and treatment of congenital and acquired reproductive anomalies. This also includes sexual health education, prevention and management of STIs, and addressing psychosocial issues related to puberty and reproductive health and rights of the child. The interdisciplinary approach emphasizes close collaboration with mental health professionals, social workers, and other healthcare providers to serve the overall well‐being of the adolescent patient (Box  1 ). Menstrual Health Management Evaluation and treatment of heavy, painful, irregular, or absent menstrual cycles (menorrhagia, dysmenorrhea, amenorrhea). Management of conditions such as polycystic ovary syndrome (PCOS), endometriosis, or bleeding disorders (e.g. von Willebrand disease). Menstrual suppression for medical conditions worsened by menstruation (e.g. epilepsy, chemotherapy, hematologic disorders). Global consideration: addressing menstrual hygiene management in low‐resource settings, including access to affordable sanitary products, clean water, and safe sanitation facilities to prevent school absenteeism and infections. Evaluation and treatment of heavy, painful, irregular, or absent menstrual cycles (menorrhagia, dysmenorrhea, amenorrhea). Management of conditions such as polycystic ovary syndrome (PCOS), endometriosis, or bleeding disorders (e.g. von Willebrand disease). Menstrual suppression for medical conditions worsened by menstruation (e.g. epilepsy, chemotherapy, hematologic disorders). Global consideration: addressing menstrual hygiene management in low‐resource settings, including access to affordable sanitary products, clean water, and safe sanitation facilities to prevent school absenteeism and infections. Vulvar and Vaginal Conditions Diagnosis and treatment of infections, pruritus, labial adhesions, ulcers, and rashes. Management of genital injuries or trauma, including sensitive evaluations for cases involving falls or abuse. Care for vulvovaginal disorders, such as lichen sclerosus and chronic irritation. Global consideration: managing female genital mutilation/cutting complications, including infections, scarring, and psychological trauma, with culturally sensitive care and referral to specialized centers. Diagnosis and treatment of infections, pruritus, labial adhesions, ulcers, and rashes. Management of genital injuries or trauma, including sensitive evaluations for cases involving falls or abuse. Care for vulvovaginal disorders, such as lichen sclerosus and chronic irritation. Global consideration: managing female genital mutilation/cutting complications, including infections, scarring, and psychological trauma, with culturally sensitive care and referral to specialized centers. Contraception and Sexual Health Individualized contraception counseling, including long‐acting reversible contraception (LARC) such as intrauterine devices and implants (e.g. Nexplanon). Screening, prevention, and treatment of sexually transmitted infections (STIs). Confidential reproductive and sexual health counseling, addressing topics such as body image, mood, and respectful relationships. Prepregnancy and postpregnancy contraception guidance. Global consideration: promoting adolescent pregnancy prevention through access to youth‐friendly sexual and reproductive health services, especially in regions with high rates of early marriage and unintended pregnancies. Individualized contraception counseling, including long‐acting reversible contraception (LARC) such as intrauterine devices and implants (e.g. Nexplanon). Screening, prevention, and treatment of sexually transmitted infections (STIs). Confidential reproductive and sexual health counseling, addressing topics such as body image, mood, and respectful relationships. Prepregnancy and postpregnancy contraception guidance. Global consideration: promoting adolescent pregnancy prevention through access to youth‐friendly sexual and reproductive health services, especially in regions with high rates of early marriage and unintended pregnancies. Pubertal and Hormonal Disorders Management of delayed, early, or precocious puberty, including the use of puberty blockers when appropriate. Treatment of hormonal imbalances, such as those related to PCOS or primary ovarian insufficiency (POI). Care for adolescents with irregular pubertal development or atypical puberty signs. Global consideration: addressing nutritional impacts on pubertal development (e.g. malnutrition or obesity) in regions with food insecurity or changing dietary patterns due to urbanization. Management of delayed, early, or precocious puberty, including the use of puberty blockers when appropriate. Treatment of hormonal imbalances, such as those related to PCOS or primary ovarian insufficiency (POI). Care for adolescents with irregular pubertal development or atypical puberty signs. Global consideration: addressing nutritional impacts on pubertal development (e.g. malnutrition or obesity) in regions with food insecurity or changing dietary patterns due to urbanization. Congenital and Structural Anomalies Diagnosis and management of congenital reproductive anomalies (e.g. Müllerian anomalies, Mayer‐Rokitansky‐Küster‐Hauser syndrome). Vaginal dilation/creation and reconstructive surgeries for anomalies of the reproductive tract. Care for differences in sex development (DSD) or intersex conditions, including genetic, hormonal, or anatomical variations. Global consideration: ensuring access to diagnostic tools (e.g. ultrasound, magnetic resonance imaging) and surgical expertise for congenital anomalies in low‐ and middle‐income countries (LMICs), often requiring centralization to specialized centers. Diagnosis and management of congenital reproductive anomalies (e.g. Müllerian anomalies, Mayer‐Rokitansky‐Küster‐Hauser syndrome). Vaginal dilation/creation and reconstructive surgeries for anomalies of the reproductive tract. Care for differences in sex development (DSD) or intersex conditions, including genetic, hormonal, or anatomical variations. Global consideration: ensuring access to diagnostic tools (e.g. ultrasound, magnetic resonance imaging) and surgical expertise for congenital anomalies in low‐ and middle‐income countries (LMICs), often requiring centralization to specialized centers. Gynecologic Care for Complex Medical Conditions Tailored reproductive health care for patients with developmental delays, autism, seizure disorders, organ transplants, cancer, or hematologic disorders. Collaboration with subspecialists (e.g. hematology, oncology, endocrinology) to manage gynecologic issues in medically complex patients. Menstrual suppression or contraception adjustments to accommodate drug interactions or treatment side effects (e.g. chemotherapy, immunosuppressive therapies). Global consideration: managing gynecologic care for adolescents with HIV/AIDS, particularly in high‐prevalence regions, including contraception compatible with antiretroviral therapy and STI prevention. Tailored reproductive health care for patients with developmental delays, autism, seizure disorders, organ transplants, cancer, or hematologic disorders. Collaboration with subspecialists (e.g. hematology, oncology, endocrinology) to manage gynecologic issues in medically complex patients. Menstrual suppression or contraception adjustments to accommodate drug interactions or treatment side effects (e.g. chemotherapy, immunosuppressive therapies). Global consideration: managing gynecologic care for adolescents with HIV/AIDS, particularly in high‐prevalence regions, including contraception compatible with antiretroviral therapy and STI prevention. Ovarian and Pelvic Conditions Evaluation and management of ovarian cysts, masses, or tumors. Diagnosis and treatment of pelvic pain, including endometriosis or pelvic inflammatory disease. Surgical and nonsurgical interventions for ovarian and uterine abnormalities. Global consideration: addressing delays in diagnosis of ovarian torsion or masses in resource‐limited settings due to limited imaging access, emphasizing training for clinical diagnosis. Evaluation and management of ovarian cysts, masses, or tumors. Diagnosis and treatment of pelvic pain, including endometriosis or pelvic inflammatory disease. Surgical and nonsurgical interventions for ovarian and uterine abnormalities. Global consideration: addressing delays in diagnosis of ovarian torsion or masses in resource‐limited settings due to limited imaging access, emphasizing training for clinical diagnosis. Fertility Preservation and Reproductive Health Counseling and interventions for fertility preservation, particularly for patients at risk of ovarian failure (e.g. cancer survivors, those with POI). Hormone replacement therapy for patients experiencing ovarian insufficiency. Support for reproductive health concerns in cancer survivors or those with chronic conditions. Global consideration: expanding access to fertility‐sparing techniques (e.g. ovarian tissue cryopreservation) in LMICs, where oncologic treatments may outpace reproductive health infrastructure. Counseling and interventions for fertility preservation, particularly for patients at risk of ovarian failure (e.g. cancer survivors, those with POI). Hormone replacement therapy for patients experiencing ovarian insufficiency. Support for reproductive health concerns in cancer survivors or those with chronic conditions. Global consideration: expanding access to fertility‐sparing techniques (e.g. ovarian tissue cryopreservation) in LMICs, where oncologic treatments may outpace reproductive health infrastructure. Disorders of Sex Development and Gender Care Multidisciplinary care for patients with DSD, including intersex conditions or atypical genital development. Support for gender‐diverse youth, including menstrual suppression, hormonal therapy, and sexual/reproductive health needs. Collaboration with endocrinology, urology, and social services for comprehensive gender care. Global consideration: providing culturally sensitive care in regions with stigmatization or legal restrictions, ensuring psychological support and advocacy for patient rights. Multidisciplinary care for patients with DSD, including intersex conditions or atypical genital development. Support for gender‐diverse youth, including menstrual suppression, hormonal therapy, and sexual/reproductive health needs. Collaboration with endocrinology, urology, and social services for comprehensive gender care. Global consideration: providing culturally sensitive care in regions with stigmatization or legal restrictions, ensuring psychological support and advocacy for patient rights. Gynecologic Surgery Minimally invasive or complex surgical procedures for conditions such as ovarian masses, congenital anomalies, and endometriosis. Surgical management of genital injuries or reconstructive needs. Procedures for labial or vaginal anomalies, including labiaplasty for medical indications. Global consideration: training providers in minimally invasive surgery techniques (e.g. laparoscopy, robotics) to reduce recovery times and costs in resource‐constrained settings. Minimally invasive or complex surgical procedures for conditions such as ovarian masses, congenital anomalies, and endometriosis. Surgical management of genital injuries or reconstructive needs. Procedures for labial or vaginal anomalies, including labiaplasty for medical indications. Global consideration: training providers in minimally invasive surgery techniques (e.g. laparoscopy, robotics) to reduce recovery times and costs in resource‐constrained settings. Preventive and Psychosocial Care Preventive health guidance for teens and parents, including education on reproductive health and healthy behaviors. Confidential visits to foster independence and address sensitive concerns (e.g. sexual health, mental health, body image). Support for psychosocial issues related to reproductive health, including counseling for eating disorders, substance abuse, and mental health concerns. Global consideration: addressing social determinants of health (e.g. poverty, education access, gender‐based violence) that impact gynecologic outcomes, with community‐based interventions to improve health literacy. Preventive health guidance for teens and parents, including education on reproductive health and healthy behaviors. Confidential visits to foster independence and address sensitive concerns (e.g. sexual health, mental health, body image). Support for psychosocial issues related to reproductive health, including counseling for eating disorders, substance abuse, and mental health concerns. Global consideration: addressing social determinants of health (e.g. poverty, education access, gender‐based violence) that impact gynecologic outcomes, with community‐based interventions to improve health literacy. Multidisciplinary and Specialty Clinics Participation in specialized clinics, such as: Young Women's Blood Disorder Clinics (for heavy menstrual bleeding and bleeding disorders) Cancer survivorship programs (for reproductive health in cancer survivors). DSD programs Reconstructive pelvic medicine clinics (for complex congenital anomalies) Collaboration with pediatric surgery, urology, hematology, oncology, and adolescent medicine for comprehensive care. Global consideration: establishing regional referral networks to connect rural or underserved areas with specialized PAG centers, leveraging telemedicine for consultations where in‐person care is limited. Participation in specialized clinics, such as: Young Women's Blood Disorder Clinics (for heavy menstrual bleeding and bleeding disorders) Cancer survivorship programs (for reproductive health in cancer survivors). DSD programs Reconstructive pelvic medicine clinics (for complex congenital anomalies) Young Women's Blood Disorder Clinics (for heavy menstrual bleeding and bleeding disorders) Cancer survivorship programs (for reproductive health in cancer survivors). DSD programs Reconstructive pelvic medicine clinics (for complex congenital anomalies) Collaboration with pediatric surgery, urology, hematology, oncology, and adolescent medicine for comprehensive care. Global consideration: establishing regional referral networks to connect rural or underserved areas with specialized PAG centers, leveraging telemedicine for consultations where in‐person care is limited. Research and Education Engagement in clinical research to improve gynecologic and reproductive health outcomes (e.g. LARC use, endometriosis treatment, gynecologic care post‐transplant). Education of patients, families, and other providers on pediatric and adolescent gynecologic health. Training of medical students, residents, and fellows in PAG specialties. Global consideration: conducting research on global PAG disparities, such as access to care in conflict zones or post‐disaster settings, and developing low‐cost interventions for widespread adoption. Engagement in clinical research to improve gynecologic and reproductive health outcomes (e.g. LARC use, endometriosis treatment, gynecologic care post‐transplant). Education of patients, families, and other providers on pediatric and adolescent gynecologic health. Training of medical students, residents, and fellows in PAG specialties. Global consideration: conducting research on global PAG disparities, such as access to care in conflict zones or post‐disaster settings, and developing low‐cost interventions for widespread adoption. Emergency Gynecologic Care Management of acute conditions such as adnexal torsion, vulvovaginal lacerations, and nonsexually acquired genital ulcers in emergency settings, with protocols adapted for resource‐limited hospitals. Management of acute conditions such as adnexal torsion, vulvovaginal lacerations, and nonsexually acquired genital ulcers in emergency settings, with protocols adapted for resource‐limited hospitals. Advocacy for Policy and Access Advocating for policies to improve access to PAG care, including funding for reproductive health programs, training for healthcare providers, and integration of PAG into primary care systems in LMICs. Advocating for policies to improve access to PAG care, including funding for reproductive health programs, training for healthcare providers, and integration of PAG into primary care systems in LMICs. Despite its recognition, PAG remains underrepresented due to a limited number of trained clinicians, scarcity of dedicated training programs, and lack of acknowledgement as a distinct subspecialty in many regions, often leading to misconceptions about its scope and necessity among healthcare providers. 2 Further development of the PAG specialty and increased global representation of PAG specialists are essential steps toward improving access to specialized, developmentally appropriate care for girls and young women, empowering their reproductive futures, and improving the health and well‐being of young patients worldwide.

The authors declare that they have no conflicts of interest.

A cornerstone of PAG expertise lies in understanding the embryologic development of the reproductive tract, particularly Müllerian anomalies. PAG specialists are adept at interpreting imaging modalities, such as ultrasound and magnetic resonance imaging, to diagnose conditions including septate uterus, vaginal agenesis, or obstructed hemivagina with ipsilateral renal anomaly. These diagnoses inform critical decisions about surgical timing and approach. For instance, in cases of hematometra due to vaginal septa or atresia, PAG clinicians carefully weigh the benefit of surgical correction against medical suppression of menses to optimize surgical timing, prevent complications, and navigate and educate about vaginal dilating, when indicated. All of these are performed with preservation and optimization of future fertility in mind. 3 , 4 The PAG specialists' nuanced understanding of anatomy ensures that interventions maintain or improve reproductive potential and sexual health, whether through medical management, minimally invasive techniques, or complex reconstructive surgeries.