De Sanctis V. - Soliman A. - Mohamed Y.

Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.



The Centres for Disease Control and Prevention have defined a chronic diseases as an "illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely". Approximately 20% of all children have a chronic illness and 65% of them the illness is severe enough to interfere with daily activities. Failure of pubertal growth, delay or absence of sexual development, infertility and sexual dysfunction due to hypogonadism and defective spermatogenesis are well recognized disturbances among adolescents and young male adult patients with chronic diseases.

The causes are multifactorial and can be due to disease itself, associated complications or drugs. Haemoglobinopathies, endocrine disorders, gastrointestinal and renal diseases are some examples that frequently cause some degree of disability. Infertility affects the future quality of life of these patients and is a predictor of stress in current and future relationships. 

Health care providers often neglect the reproductive health of chronically ill adolescents and young adults, although many studies indicate that they are sexually active and interested in knowing about their future fertility. This review article provides an overview of the literature concerning the impact of some chronic diseases in adolescents and young adults on reproductive health but will not address patients with cancer because it has been tackled adequately in the literature.

MEDLINE database search of English-language medical journal articles published between 1975 and 2012 for papers related to reproductive health in adolescents and young adults with chronic diseasessince childhood was done. Several Authors, recommend that all young adult patients with severe/prolonged chronic disease in childhood should be offered reproductive health care in a specialized center with appropriate expertise, involving a multidisciplinary team, including endocrinologists, andrologists, geneticists, psychologists, urologists and specialist nurses. Adequate information must be provided to these patients about adolescentreproductive health, including types of contraception, pregnancy, sexually transmitted infections and fertility.

The importance of transitional care between pediatric and adult medical care should not be ignored. In the development of this process the adolescent must be involved in decision-making regarding treatment or referral. Reproductive health medicine should take a wider view to create a physical, psychological and genetic wellbeing of these patients.