Vulvar symptoms of pain, dyspareunia, and pruritus are common and may significantly affect a woman's sense of well-being and sexual function. Despite this, vulvar symptoms are often underreported by women. When identified, however, vulvovaginal symptoms should be addressed by health care providers to optimize care.
View Article and Find Full Text PDFThis month we focus on current research in human papillomavirus-related lower anogenital tract disease prevention and screening. Dr. Boardman discusses four recent publications, which are concluded with a "bottom line" that is the take-home message.
View Article and Find Full Text PDFJ Low Genit Tract Dis
July 2015
Objective: The incidence of anal cancer is higher in women than men in the general population and has been increasing for several decades. Similar to cervical cancer, most anal cancers are associated with human papillomavirus (HPV), and it is believed that anal cancers are preceded by anal high-grade squamous intraepithelial lesions (HSIL). Our goals were to summarize the literature on anal cancer, HSIL, and HPV infection in women and to provide screening recommendations in women.
View Article and Find Full Text PDFVulvodynia is a complex disorder reported by up to 16% of women in the general population. While most patients describe it as burning, stinging, irritation, or rawness, it is underreported and underrecognized by providers. Vulvodynia is costly both economically and psychologically due to its negative impact on quality of life.
View Article and Find Full Text PDFLichen sclerosus is a chronic inflammatory condition affecting the anogenital region that may present in the prepubertal or adolescent patient. Clinical presentations include significant pruritus, labial adhesions, and loss of pigmentation. Treatment includes topical anti-inflammatory agents and long-term follow-up as there is a high risk of recurrence and an increased risk of vulvar cancer in adult women with history of lichen sclerosus.
View Article and Find Full Text PDFObstet Gynecol
March 2014
This month, we focus on current research in hormone management and menopause. Dr. Boardman discusses five recent publications, and each is concluded with a "bottom line" that is the take-home message.
View Article and Find Full Text PDFRecent guidelines from multiple organizations stress screening initiation no earlier than the age of 21 years and increased screening intervals for women aged 21 to 29 years. Primary prevention with human papillomavirus vaccination has the potential to significantly affect the development of high-grade cervical lesions, including cancer, and will likely affect screening guidelines in the future.
View Article and Find Full Text PDFTubal sterilization is a highly effective, permanent, and safe method of contraception. Many women who desire postpartum sterilization do not obtain the procedure due to barriers. We performed a retrospective cohort study examining patients from a single obstetrics practice who delivered between 1/1/07 and 6/30/07 at Women and Infants Hospital in Providence, RI.
View Article and Find Full Text PDFJ Int Assoc Physicians AIDS Care (Chic)
April 2016
Purpose: To compare Papanicolaou (Pap) smear readings to visual inspection with acetic acid (VIA) findings among HIV-infected women in Phnom Penh, Cambodia.
Methods: A total of 304 HIV-infected women presenting to the women's clinic at the Community Resource Center in Phnom Penh, Cambodia, were screened for cervical cancer by both Pap smear and VIA. The results of the 2 tests were compared.
Am J Obstet Gynecol
February 2011
Objective: We sought to identify patient characteristics associated with cervical intraepithelial neoplasia (CIN) 3 in adolescents.
Study Design: A cross-sectional cohort study was done using a colposcopic database. Data collected included demographic and clinical information as well as cytologic and histologic results.
Objective: To estimate the effects of patient and health care provider variables on rates of interpersonal violence screening in an ambulatory gynecology practice.
Methods: A cross-sectional study of 300 patients were chosen randomly from annual health care visits during 2007 at a university-affiliated ambulatory gynecology clinic. All encounters were recorded on a standardized health history form, which included questions about abuse history.
Background: This study was conducted to identify characteristics associated with US obstetric and gynecology graduating residents' intention to provide pregnancy termination services in their clinical practice.
Study Design: In this cross-sectional study, we surveyed all 1148 fourth-year residents in obstetrics and gynecology graduating from US training programs in 2004.
Results: Of 494 respondents, 187 (39%) planned to perform elective abortions after residency.
Sexual pain is an underrecognized and poorly treated constellation of disorders that significantly impact affected women and their partners. Recognized as a form of chronic pain, sexual pain disorders are heterogeneous and include dyspareunia (superficial and deep), vaginismus, vulvodynia, vestibulitis, and noncoital sexual pain disorder. Women too often tolerate pain in the belief that this will meet their partners' needs.
View Article and Find Full Text PDFThe Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommends human papillomavirus (HPV) vaccination of 11- to 12-year-old girls, with catch-up vaccination for girls and women aged 13 to 26 years. Although compulsory HPV vaccination is not currently mandated for any U.S.
View Article and Find Full Text PDFObstet Gynecol Clin North Am
December 2008
In the American Society for Colposcopy and Cervical Pathology 2006 Consensus Guidelines, several changes in the management of mildly abnormal cervical cytology and histology were made. The most notable changes involve the management of adolescents, pregnant women, and postmenopausal women. For adolescents, management of atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions is conservative, eliminating the need for immediate colposcopy.
View Article and Find Full Text PDFBackground: A chart review was conducted to evaluate patient and provider characteristics associated with having a documented antenatal plan regarding future contraception.
Study Design: A retrospective chart review of 528 parturients delivering between January and August 2002 was performed. Data obtained from chart review included demographics, antecedent pregnancy outcome, number of prenatal visits, provider type and documentation of an antenatal plan for postpartum contraception.
Obstet Gynecol
September 2008
Objective: To evaluate the clinical efficacy and tolerability of topical gabapentin in the treatment of women with vulvodynia.
Methods: A retrospective study was designed to ascertain clinical responses to topical gabapentin. Patient demographic and medical characteristics, including present and prior treatment for vulvodynia, were routinely collected.
Clin Obstet Gynecol
September 2008
Human papillomavirus is the most common sexually transmitted disease in the United States. For the majority of affected individuals, the virus remains subclinical. However, human papillomavirus infection may result in a broad spectrum of vulvar disease including genital warts, dysplasia, and invasive carcinoma.
View Article and Find Full Text PDFObjective: To compare the prevalence of cervical intraepithelial neoplasia (CIN) 2 or worse in a cohort of human immunodeficiency virus (HIV)-positive and HIV-negative women with mildly abnormal cervical cytology.
Methods: A cross-sectional cohort study was done using an established database of 3,013 women who underwent colposcopic evaluation between August 1999 and May 2006. Data collected included demographic information and cervical cytologic and histologic results.
Objective: To summarize and evaluate the patient-based outcome measures (PBOMs) that have been used to study women with abnormal uterine bleeding (AUB).
Design: Systematic review.
Setting: Original articles that used at least one PBOM and were conducted within a population of women with AUB.
J Low Genit Tract Dis
January 2008
Objective: To evaluate the prevalence of cervical intraepithelial neoplasia (CIN) 2 or worse among women undergoing cone biopsy for CIN 1, stratified by colposcopic adequacy.
Materials And Methods: A cross-sectional cohort study was performed using a colposcopic database of 3,004 women seen between August 1999 and December 2005. Data collected included demographic information, indications for treatment, adequacy of colposcopic examination, and final cone pathology.
J Pediatr Adolesc Gynecol
October 2007
Study Objective: To evaluate regression rates among adolescents (aged < or =21) with cervical intraepithelial neoplasia (CIN) 2 managed expectantly and to determine factors associated with disease regression.
Design: Cohort study using a colposcopic database of 2,996 women seen between August 1999 and November 2005.
Setting: Colposcopy clinic in urban, tertiary care medical center.
Objective: We sought to estimate the association of stressful life events on menstrual function in incarcerated women.
Methods: Project CONNECT is a study of reproductive health needs of incarcerated women conducted between June 2002 and December 2003. This analysis examines menstrual function in 446 women from this cohort who were under the age of 45.
Purpose: Whereas previous research has elucidated a number of risk factors for rapid repeat pregnancies among adolescents, we sought to assess both established and hypothetical risk factors in the context of the intendedness of the repeat pregnancy.
Methods: The study population, drawn from the 2002 National Survey of Family Growth (NSFG), consisting of women who experienced at least one pregnancy as an adolescent, were interviewed at least 24 months since that pregnancy's resolution and were aged 30 years and younger at the time of the NSFG interview. To evaluate the effect of various predictor variables on the intendedness of a rapid repeat pregnancy, we constructed a polytomous multiple logistic regression model.
Objective: To identify characteristics of programs which provide training in abortion, to calculate the number of procedures done during training, and to compare the availability of abortion training in 2004 with that of prior national surveys.
Methods: An investigator-designed questionnaire about abortion training in obstetrics and gynecology residency programs was mailed to all U.S.
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