Objective: To describe the pattern and population characteristics of pediatric and adolescent gynecological (PAG) problems in China. Design: A clinic-based retrospective study of gynecological patients (aged 0-18 years) over a period of 13 years, and a systematic review of related studies in China. Setting: Department of PAG at The Children’s Hospital of Zhejiang University School of Medicine. Population or Sample: The final analyses included 97,252 patients with gynecological problems. Methods: Descriptive analysis was conducted to evaluate the pattern of PAG problems. The weighted average of PAG problem percentages were calculated. Main Outcome Measures: Spectrum of PAG problems Results: The number of first-visit PAG patients increased from 4,582 to 11,876 from 2006 to 2018. Overall, genital inflammation was the most common presentation (57·0%), followed by early puberty (18·2%). The disease pattern varied across age groups, the most common problems were genital inflammation for age 0-6 years; genital inflammation and early puberty for age 7-9 years; consultation of growth and development, genital inflammation and menstrual disorder for age 10-18 years. Summarizing twenty previous studies of outpatient PAG patterns in China, we found an average weighted percentage of 48·8% for genital inflammation and 25·2% for menstrual disorder. Conclusion: Genital inflammation, early puberty, consultation of growth and development and menstrual disorder were common issue for pediatric and adolescent patients with gynecological problems in China. Funding The National Nature Science Foundation of Zhejiang (LQ18H040001, LY20H040011) Medical Scientific Projects from Health department of Zhejiang Province(2017KY101) Keywords: Pediatric and adolescent gynecological; disease patterns; retrospective study; systematic review