Although women are the traditional focus of gynecologic health, pediatric gynecology offers sensitivity and skill for addressing problems facing young girls.
When girls reach reproductive age, they sometimes pay a visit to a gynecologist because of recurrent abdominal pain linked to their ovaries and menstrual cycles. But Diane F. Merritt, MD, professor of obstetrics and gynecology, treats girls who are struggling with more unusual medical problems ranging from birth defects of the vagina and uterus to ovarian and uterine tumors to endometriosis. In 1985, she established Washington University's Program in Pediatric and Adolescent Gynecology — one of only a handful of programs of its kind in the United States — which fills an important clinical and academic niche in the medical field.
"I have a particular passion for the care of reproductive health in young women and children and for advancing the field for the benefit of all," says Merritt, director of the Program in Pediatric and Adolescent Gynecology. "For a long time, these patients were overlooked by the medical disciplines — too young to be seen by most gynecologists and off the radar screen for the busy pediatrician."
Fifteen-year-old Megan Eye was one of those patients. Then a high school sophomore who sang in her church choir, Eye spent time with friends and led the marching band at Friday night football games. That changed in 2004; Eye started missing school, saying "no" to friends' invitations and sitting out band practices. She was in terrible pain.
Despite numerous trips to specialists, ultrasounds and blood tests, no one could tell Eye why she had a chronic ache on the lower right side of her abdomen. One bout of acute pain landed her in St. Louis Children's Hospital. The day she was admitted, Merritt came into Eye's room.
"I thought she was going to tell me that there was nothing wrong or that the pain was in my head, like everyone else I'd seen," Eye says. "Instead, she changed my life."
Merritt remembers that Eye was in so much pain it was difficult to examine her. "She was tired, frustrated and emotionally spent," says Merritt, who promised to find the cause of the pain. When a sonogram proved inconclusive, Merritt performed a diagnostic laparoscopy to look for any acute process (like an ovary that has twisted on its blood supply or a blocked uterus) in need of immediate attention. Instead, Merritt found an oddly shaped uterus. Before committing Eye to major surgery, Merritt performed additional investigations to determine that Eye had a large tumor in her uterus. Merritt proceeded with surgery to remove the tumor — an adenomyotic cyst — and also repaired Eye's uterus to preserve her ability to bear children.
When Eye recovered from surgery, she was gratified to find herself pain-free for the first time in two years. But Merritt's diagnosis and surgical expertise were not the only things for which Eye was grateful: She also appreciated her physician's bedside manner. "Dr. Merritt came every day and would sit and ask me about school and tell me about her family," Eye recalls.
"At first she didn't smile," says Merritt. "Girls this age should have sparkle in their eyes and be thrilled about life, but Megan had been in so much pain, she had clearly become depressed. I knew we had turned the corner when Megan finally smiled."
In her practice, Merritt sees a broad spectrum of complex cases. Vaginal agenesis, which affects one in every 5,000 female infants, occurs when the reproductive system doesn't finish developing in utero, causing the vagina and uterus to be smaller than usual or even missing, while ovaries remain normal. Some infant girls are born with two uteruses, known as duplication disorder, a condition most commonly associated with renal anomalies. Merritt also is recognized for her work in the repair of genital injuries, which can occur as the result of trauma or sexual assault.
"Diane Merritt has developed a world-class program in pediatric and adolescent gynecology," says George A. Macones, MD, the Mitchell and Elaine Yanow Professor and head of the Department of Obstetrics and Gynecology. "This area is of tremendous importance regionally, nationally and internationally, and we are very fortunate to have one of its leaders on our faculty."
When Merritt chose obstetrics and gynecology as a specialty more than 30 years ago, medical schools taught very little about problems associated with pediatric and adolescent gynecology. She learned a great deal during her residency from Jessie L. Ternberg, PhD, MD, professor of surgery, during operations on patients with complicated congenital anomalies. "She's the one who said, 'Diane, you should become a pediatric gynecologist,'" Merritt recalls.
By developing protocols to diagnose specific problems, Merritt has done much to advance the field. She also has trained several generations of obstetrical and pediatric house staff to recognize the most common problems, conduct basic evaluations and treat teenagers in their practices. They send Merritt the more challenging cases.
"Diane Merritt filled a huge gap in care," says Ternberg, now professor emeritus of surgery. "She also made great strides in making adolescent and pediatric gynecology a viable entity."
In addition, Merritt spearheads an international fellows program. One fellow just returned to Bangkok, Thailand, to start her own pediatric and adolescent gynecology program; Merritt now is training a South Korean physician who will do the same when she returns home at the end of the year.
Lesley L. Breech, MD, one of Merritt's former fellows who now is director of pediatric and adolescent gynecology at Cincinnati Children's Hospital Medical Center, says she feels lucky to have trained with Merritt. "She's a person who cares a lot about education," Breech says. "She finds people who are interested and cultivates them to become excellent clinicians and educators."
It's an exciting time to be in the field because people are more open about gynecology and there's more emphasis on adolescent care, says Merritt, now president-elect of the North American Society of Pediatric and Adolescent Gynecology. "The goal is to enable these girls and young women to stay in school despite any gynecologic issues that may arise. We do not want them home in bed, missing out on life. We want them to have every opportunity to pursue their life goals."
When Eye met Merritt, she was planning a career in music education. But being treated by Merritt convinced her to revisit a goal she had as a child — to become a doctor.
"Dr. Merritt really listened to me and was determined to figure out what was wrong with me," Eye says. "I'd like to help people like that."
Now 18, Eye is enrolled in the life sciences program at Forest Park Community College, which she hopes will help her make a final decision about medical school. While grateful to Merritt for restoring her health, she also is thankful for something else — a renewed faith in doctors.
"I hope that girls with similar problems will not sit back and accept something like this," Eye says. "They should keep searching for someone who leads them to an answer."