Summary of 2014 EURAPAG MEETING, RCOG

“London’s Calling to the faraway towns”. And so started the 2014 EuraPAG conference, hosted by BritSPAG, with the iconic “London’s Calling” by The Clash ringing through the Royal College of Obstetricians and Gynaecologists.

Over 350 delegates and faculty took part in 3 and ½ days of conference and social activities, with the London Youth Gospel Choir providing music within the opening ceremony. All were warmly welcomed to the congress by Paul Wood, Chair of BritSPAG, Dr David Richmond, President of the RCOG, Associate Professor Tamas Csermely, President of EuraPAG, and Professor Chiara Benedetto, President of EBCOG.

The proceedings started on Thursday morning with a session reviewing the organising of PAG care, and challenging clinicians and care-providers to consider how they communicate within the service. A comparison between the UK and Europe was drawn, highlighting the development of PAG over the last decade. The following session considered all things ovarian, ranging from an update on fertility preservation for girls, how to manage PCOS in 2014, and the use of ultrasound in identifying which ovaries can be managed conservatively and identifying torsions and tumours, from cysts.

Professor Sarah Creighton from UCL Hospitals, London, UK was invited to give the 7th Sir Jack Dewhurst Memorial Lecture. Sir Jack Dewhurst was one of the leading doctors in paediatric and adolescent gynaecology dealing with difficult and complex cases with care and compassion. After his death in 2007, with the support of Lady Dewhurst, the annual Sir Jack Dewhurst Memorial Lecture was instituted where a leading clinician in the world of PAG is invited to give a lecture. Professor Creighton’s lecture was entitled “The XY female: a 21st century approach”.

Further talks included an update on uterine transplantation, showing that the first uterine transplants have taken place in Sweden, and are planned within the UK in 2015. The HPV vaccine was also shown to be widely adopted in adolescents in Europe, as in the UK, and ongoing long-term studies are continuing. The afternoon brought the What the Textbooks Don’t Teach You session which covered recorded surgery of laparoscopic vaginoplasties, and also had an expert panel discussion which considered breaking bad news to adolescents, the management of those with large ovarian cysts, and parents as donors or hosts.

The evening brought the boat party down the river Thames, with the weather being kind to us. We sailed past the Houses of Parliament, the London Eye, Tower Bridge and to the Thames Barrier, before returning past the Greenwich Dome, the Tower of London, and back to Temple Pier. For those that were present, there was also the unforgettable sight of dozens of PAG clinicians performing The Macarena in the balmy evening air!

The second full day of conference started with safeguarding and how to talk to child about trauma and abuse. Finding the right space and time was paramount, and managing the expectations of the young person was also important. Understanding online behaviour and the risks the internet poses was also reviewed, with social media forming an ever–bigger part of young people’s lives. The last talk was given by Camila Batmanghelidjh from Kids Company who has carried out pioneering and inspiring work for adolescents in London. A strong theme was the level of emotional trauma which many had suffered and the need for them to have a space to be themselves and recover, whether it was just for a few hours a week, or longer.

Following on, the urogynaecology section covered an update on the management of adolescent detrusor instability, with advice on non-pharmacological options as well as which and when to offer medication. Neuropathic bladder in adolescents has been a challenging problem, and the latest treatments were reviewed.

The afternoon brought two parallel streams covering the psychological and medical management of disorders of sex development in one, and a live-surgery link from University College London Hospital in the other, kindly sponsored by Storz. The psychology section drew on the psychosocial concerns of women with XY chromosomes, including sexual experiences and function, and looked at new research in sex development and the clinical implications of this in multi-disciplinary team work. The genetic background and current medical management of MRKH syndrome were reviewed in the medical stream. In contrast the surgical stream showed live operating for a patient with complete androgen insensitivity syndrome having a laparoscopic gonadectomy, and  a second patient having a laparoscopic removal of a transverse vaginal septum.  The audience were able to ask questions of Professor Creighton and Alfred Cutner to discuss the current surgical and ongoing post-operative management of the patients.

Friday night concluded with a truly spectacular gala dinner at the House of Lords, kindly hosted by Baroness Finlay of Llandaff. This was preceded by a tour of the House of Commons, and the House of Lords, followed by a drinks reception on the Houses of Parliament famous terrace.

Saturday morning opened with a European view of teenage pregnancy, followed by oral presentations of original research. The morning continued with opinions on puberty as given by a gynaecologist and an endocrinologist, before concluding with the challenges on managing the timing of puberty of children with developmental delay.

Before the final closing remarks it was a pleasure to announce that the BritSPAG prize for the best presentation, as judged by the chairs of each session, was awarded to Professor Sarah Creighton presenting “Transverse vaginal septa: management and long-term outcomes”. The EURAPAG prize for best trainee’s presentation was presented to Stefanie Cardamone for “Screening for mutations for 17 Beta-hydroxysteroid dehydrogenase and androgen receptor in an adolescent and adult 46 XY DSD clinic”. The best poster prize was awarded to Caroline Sanders for “Professional, parent and young persons dialogues around fertility within disorder of sex development multidisciplinary clinics”.

Finally, Professor Milko Sirakov as president of EuroPAG, Professor Ellen Rome as president of FIGIJ, and Paul Wood as chair of BritSPAG drew the meeting to a close and thanked all for participating in what was a very special 3 days in London.

Summary provided by Naomi Crouch, Secretary, BritSPAG