PAG patterns overall and by age groups
In terms of PAG problems, more than half (57·0%) of adolescents presented with gynecologic inflammation symptoms at the first clinical visit (Table 2). Diagnoses related to early puberty and consultation of growth and development accounted for 18·2% and 10·2% of first visits, respectively. The proportion of other conditions such as gynecological examination, menstrual disorder, other endocrine problems, genital trauma, masturbation syndrome, anomalies of the genital tract, and genital tumor ranged from 0·5% to 5·6%. The patterns of PAG problems were different across different age groups. Among pediatric patients under 6 years of age, genital inflammation was the most common presentation (78·5%), followed by early puberty, and gynecological examination, accounting for 11·4% and 5·2% of the cases, respectively. Among patients aged 7 to 9 years, the top three diagnoses were genital inflammation (43·4%), early puberty (39·6%), and consultation of growth and development (10·4%). As for the patients aged 10 to 18 years, 34·9% of their first PAG clinic visits were for consultation of growth and development; the remaining cases were genital inflammation (21·4%), menstrual disorder (20·7%), gynecological examination (9·4%), early puberty (7·2%) and other endocrine problems (4·1%). The distribution of PAG problems across different age groups with an interval of two years is shown in Figure S1. The age range for which genital inflammation represented the highest proportion of cases was 0-8 years, while the percentage of the disease dropped below 50% for patients aged 8 and above. Other diseases with significant age peaks included early puberty (ages 6-10), consultation of growth and development (ages 10-14), and menstrual disorder (ages 12-18).