Purpose of Review <p>Pediatric and Adolescent Gynecology (PAG) is a growing subspecialty focused on the gynecologic care of children, adolescents, and young adults. Professionals in this field must navigate not only complex clinical decision-making related to sexual and reproductive health, but also the unique ethical challenges inherent in pediatric healthcare, including the role of caregivers as legal medical decision-makers for minors. Ethical controversies remain prevalent in PAG, and ongoing medical and surgical innovations continue to introduce novel clinical scenarios that challenge established norms.</p> Recent Findings <p>This paper reviews foundational ethical concepts and frameworks relevant to clinical medicine and gynecology, with particular emphasis on their application within PAG. Drawing on both historical precedents and emerging perspectives, we examine bioethical principles in relation to shared decision-making, disclosure, confidentiality, privacy, and fair distribution of health resources in pediatric and adolescent gynecology. </p> Summary <p> The ethical principles of autonomy, beneficence, non-maleficence, and justice are explored through scenarios commonly encountered in PAG practice, highlighting the evolving ethical landscape as the subspecialty continues to expand.</p>