Systematic review
The summarized result for all studies in China were shown in Figure 3A. In general, the top two diseases based on the weighted average ratio were genital inflammation and menstrual disorder across 33 studies. The random pooled ES was 33·7% (95% CI 22·7% to 45·5%) for genital inflammation, and 23·0% (95% CI 15·9% to 31·0%) for menstrual disorders (Figure S4A and S4B). Overall heterogeneity was significant among studies evaluating genital inflammation and menstrual disorder with I2 (test for heterogeneity) being 99·80% and 99·62% respectively, indicating substantial heterogeneity in different studies. In the stratified analyses by clinic setting, we observed a different pattern of PAG issues between outpatients and inpatients studies. For inpatient studies, the most frequent diseases were genital tumor, menstrual disorder and genital inflammation (Figure 3B). For outpatient studies, genital inflammation is the mainly observed among all gynecological diseases (48·8%), followed by menstrual disorders (25·2%), other endocrine problems (7·2%), early puberty (5·6%) and genital trauma (4·7%). The proportion of other diseases were less than 4% (Figure 3C).