BritSPAG: Advancing Paediatric and Adolescent Gynaecology Across the UK
The British Society for Paediatric and Adolescent Gynaecology (BritSPAG) was established in 2000 with the aim of promoting the sub-specialty, profile, study, and clinical practice of paediatric and adolescent gynaecology (PAG), complex congenital gynaecology, and differences in sex development. Over the past 25 years, the society has become a leading voice in this specialist field, supporting healthcare professionals through education, training, research, and multidisciplinary collaboration, alongside providing patients and families with information and a platform to share their lived experiences. Today, BritSPAG comprises approximately 200 members from a range of clinical backgrounds, united by a shared commitment to improving gynaecological care for children and adolescents, and young adults living with differences in sex development.
OVERVIEW
Language and framing in PAG are fundamental to delivering safe, effective, and trauma-informed care. For example, by avoiding terms like disorder and anomaly, and including terms such as differences or diversity. The society strives to learn from patients and communication experts with a view to delivering holistic care and keeping patients engaged in the medical services. Children and adolescents are particularly vulnerable to the lasting psychological impact of how healthcare encounters are conducted. Topics intersect with identity, puberty, sexuality, and body image, and clinicians must be mindful of shame, embarrassment, or fear when discussing sensitive issues.
PAG is a rapidly evolving specialty, and the past 6–12 months have seen several important developments that are shaping clinical practice. One of the most significant changes has been the move towards renaming polycystic ovary syndrome as polyendocrine metabolic ovarian syndrome (PMOS). This shift reflects growing recognition of the metabolic features that often accompany the condition and aims to improve diagnostic accuracy and long-term health outcomes in young people.
Alongside this change in terminology, there has been increasing emphasis on appropriate metabolic screening for adolescents with PMOS. As evidence continues to emerge regarding the broader health implications of the condition, clinicians are adopting a more holistic approach to assessment and management, with greater attention paid to metabolic risk factors and preventative care.
Another notable development has been the evolving approach to suspected endometriosis in adolescents. Historically, diagnostic laparoscopy was often considered the gold standard for confirming a diagnosis. However, there is now a growing movement towards less invasive investigation and management strategies. Clinicians are increasingly relying on a combination of clinical assessment and advanced imaging techniques, particularly MRI, to support diagnosis and guide treatment decisions. This approach enables earlier symptom management while reducing the potential risks associated with surgery in younger patients.
Empirical treatment based on clinical suspicion is also widely accepted, allowing adolescents to access symptom relief without necessarily undergoing invasive procedures. In parallel, several promising non-invasive diagnostic tests for endometriosis are currently under investigation. While these tests are not yet available for use in individuals under 18 years of age, and are not currently accessible through the NHS, ongoing research may help transform diagnostic pathways in the very near future.
BritSPAG continues to closely monitor emerging evidence in this area, including the outcomes of the ESPriT2 trial. The aim of this multicentre randomised trial is to determine whether laparoscopic excision/ablation is of clinical benefit to women with chronic pelvic pain where the only finding is superficial peritoneal endometriosis, the form of endometriosis most commonly identified in adolescents. The results are eagerly anticipated and are expected to contribute significantly to future
clinical guidance.
Guideline development continues to be a key area of activity for the society. One of the current priorities is the update of the BritSPAG guideline on ovarian cysts in PAG. This widely used resource supports clinicians in the assessment and management of ovarian cysts in children and young people, helping to ensure consistent, high-quality care across the UK.
Education and professional development remain central to BritSPAG’s mission. The
society’s annual conference provides a valuable opportunity for healthcare professionals to share knowledge, discuss challenging cases, and learn about the latest advances in PAG. The next Annual BritSPAG Conference will take place in Birmingham, UK, on 8th–9th March 2027.
As PAG continues to evolve, BritSPAG remains dedicated to advancing knowledge, improving clinical practice, and advocating for the needs of young patients. The society continues to shape the future of PAG and ensure that children and adolescents receive the highest standards of gynaecological care.
