Self-administered lidocaine gel for local anesthesia prior to osmotic dilator placement: a randomized trial.

Objective(s): To compare pain scores during cervical dilator placement prior to dilation and evacuation (D&E) with patient-administered vaginal lidocaine gel versus lidocaine paracervical block (PCB).

Study Design: We conducted an unblinded randomized trial of women ≥18 years of age undergoing surgical abortion at ≥16 weeks' gestation in two outpatient clinics. We randomized participants to receive self-administered lidocaine gel 2% 20 mL intravaginally 15-30 min before procedure initiation or lidocaine 1% 12 mL PCB immediately prior to dilator placement.

Contraceptive counseling for continuation and satisfaction.

Purpose Of Review: Quality contraceptive counseling has been identified as a potential means to reduce unintended pregnancy and to increase contraceptive continuation and satisfaction. Past approaches that focused on autonomous decision making and directive counseling have not been shown to meet these goals consistently. Women's health organizations globally are calling for improved counseling through more thorough discussion of side-effects and bleeding changes, and renewed focus on shared decision making and patient-centered care.

Contraception in the Developing World: Special Considerations.

The United States Agency for International Development (USAID) estimates that there are 225 million women and girls with unmet contraceptive need yearly. Unmet need for contraception is defined as women who desire a delay in childbearing and are not using a modern method of contraception. It is projected that providing contraception to these women would avert 36 million abortions, 70,000 maternal deaths, and 52 million unintended pregnancies overall.