Decisions regarding contraception for women with coexisting medical problems may be complicated. In some cases, medications taken for certain chronic conditions may alter the effectiveness of hormonal contraception, and pregnancy in these cases may pose substantial risks to the mother as well as her fetus. In addition, differences in content and delivery methods of hormonal contraceptives may affect patients with certain conditions differently. When selecting one of the many effective contraceptive methods available, healthcare providers and women need to consider each method's risk/benefit profile relative to the specific underlying illness. The purpose of this document is to provide information to help healthcare providers and women with coexisting medical conditions make sound decisions regarding the selection and appropriateness of various hormonal contraceptives and facilitate use of contraceptive choices that do not exacerbate medical problems. Addressed in this document are; to recognize that increased risks are associated with pregnancy in women with various medical conditions and evaluate evidence-based risks and benefits of use of intrauterine devices (IUDs) in women with various medical conditions.Read More

For many women, safe and effective hormonal contraception is a mainstay of successful pregnancy planning and a source of important non-contraceptive benefits. Several new formulations and delivery systems for hormonal contraception offer long-term, non-daily, reversible alternatives to daily oral regimes. The availability of these new products and the continued viability of the older hormonal and non-hormonal methods allow physicians to individualize therapy according to patients' needs and preferences. The purpose of this document to summarize both technical and programmatic aspects of hormonal contraceptive use. The methods of hormonal contraception are discussed in order of efficacy from highest to lowest. We hope to help healthcare providers in clinical decision making regarding hormonal contraception use in their population and to identify and discourage the unnecessary practices, tests and procedures. Facilitating contraceptive use and reducing barriers to contraceptive provision are also discussed. The public is often aware of the risks of hormonal contraceptives that are all-too-often described by sensational reports in media; these drugs remain among the most studied products on the market, helping millions of women worldwide to safely and effectively prevent unintended or unplanned pregnancy.Read More

New vaccines designed to prevent human papillomavirus (HPV) infection have the potential to reduce the incidence of serious illness and death worldwide among women, substantially reduce emotional suffering associated with abnormal Papanicolaou (Pap) test results and the diagnosis of cervical cancer, and save significant healthcare dollars. HPV vaccines are expected to significantly reduce HPV-associated morbidity and mortality. The purpose of this article is to review some of the barriers to HPV vaccine acceptance, with a particular focus on factors relevant to female patients, parents, and healthcare providers. It also explores avenues for service delivery of HPV vaccines and critical information gap that must be bridged in order to inform future sexual and reproductive health programming. It proposes the role that the sexual reproductive health community, together with immunization and cancer control programs, could have in supporting the introduction of HPV vaccines within the context of current health systems. The benefits of HPV vaccine may not be fully realized until the vaccine is accepted by patients, parents, and healthcare practitioners. Furthermore, there may be unique issues related to the acceptance of a vaccine designed to prevent a sexually transmitted infection that is poorly understood by many women.Read More

Adolescent is a time of psychosocial, cognitive, and physical development as young people make the transition from childhood to adulthood. The Women's Health and Education Center (WHEC) believes healthcare professionals have an obligation to provide the best possible care to respond to the needs of their adolescent patients. The delivery of preventive services to adolescents differs from the delivery of preventive services to adults. Furthermore, not all adolescents of the same age are at the same stage of development, thus necessitating further examination of adolescent's physical, sexual, psychosocial, and cognitive development. Understanding the milestones and developmental stages of adolescence is beneficial to obstetricians and gynecologists treating adolescents. Comprehensive services may be delivered to adolescents in a variety of sites, including schools, physician offices, and community-based and other health care facilities. Legal barriers that restrict the freedom of healthcare practitioners to provide these services are also discussed.Read More

An estimated 10% to 15% of couples who want to have a child have difficulty conceiving. At least 6.2 million couples in USA are infertile. Some experts place that number closer to 8 million. It is clear that infertility is an immense problem, not only because of the vast number of people affected, but also because of the heartache they suffer and the costs incurred by the healthcare system. The purpose of this document is to provide the understanding of evaluation of infertile couple and strategies for the management of infertility. One of the main challenges before us today is matching the right patient with the right intervention. Fertility decreases with age, especially in women; therefore the common practice of delaying childbearing for a variety of economic and social reasons has probably added to number of couples who are unable to conceive naturally. The incidence of sexually transmitted diseases that can damage reproductive structures in both men and women has risen significantly. Fortunately, we have more resources than ever for investigating the causes of infertility and then treating the condition effectively.Read More

Sexually transmitted diseases (STDs) represent a prevalent and compelling problem for women. As such, healthcare providers need to take a proactive approach in identifying vaginal symptoms, diagnosing infections, treating these conditions effectively, and maintaining careful follow-up with patients to help reduce the risk of recurrence or re-exposure. We hope that these materials provide valuable information and ideas that can be used to enhance the everyday care of the patients. Clinicians treating female adolescents should be prepared to offer confidential and comprehensive counseling, screening, and treatment according to established guidelines. They should also work within their communities and at the state and national levels to ensure access to medical care for all adolescents. Most importantly, clinicians can help to address this problem when caring for adolescent patients. Specifically, when providing health care for adolescents who have not yet become sexually active, abstinence from all risky behaviors should be encouraged.Read More

Vaginal infections represent an enormous, yet often underestimated element of female healthcare. Each year millions of women report symptoms of vaginitis to their clinician. Vaginitis can create a great deal of discomfort, stress, and anxiety in patients; furthermore these conditions may exert untoward and long-term effects on well-being, reproductivity and even mortality. The success with which vaginitis is managed depends largely on the counseling methods used by the healthcare provider. The purpose of this document is to understand three most common vaginal infections: bacterial vaginosis; candida vaginitis (yeast); and trichomonas vaginitis. Pelvic inflammatory disease (PID) and its management are also discussed to understand its causes and appropriate treatment. Vaginal infections can raise very serious concerns for patients. The manner in which women respond to the information about their infection, and how well they succeed with practices to treat it and prevent recurrences, depends largely on their healthcare provider's counseling methods.Read More

Toxic shock syndrome (TSS) was first described in children in 1978 but was quickly identified as an illness occurring primarily in menstruating women 12-24 years of age. During the 1979-1981 epidemic, tampon users were demonstrated to be 18 times more likely to develop menstrual TSS than non-users. Recent focus has shifted in conjunction with wound infections, postpartum endometritis and vaginitis; the predominance of cases continues to be related to menstruation. The purpose of this document is to understand the pathogenesis of toxic shock syndrome (TSS), clinical picture, early diagnosis and the latest advances in treatment. Of the approximately 30 million menstruating women in USA, it is estimated that 70% use tampons and over 50% of those use super-absorbent types. Almost 1,000,000 women are at theoretic risk. The incidence in menstruating women is now 6-7: 100,000 annually. The incidence on non-menstrual disease has shown only a slight increase in the past 10 years.Read More

Endometriosis is the presence of tissue that resembles normal endometrium at site outside of the uterus. The anatomical areas most commonly affected by endometriosis are the ovaries, the pelvic peritoneum, the uterosacral ligaments, the fallopian tubes, the appendix and the bowel serosa. Endometriomas, or "chocolate cysts" are cysts of endometriosis within the ovary. The "gold standard" for diagnosing endometriosis is laparoscopy, with visual recognition of endometriosis lesions. The severity of endometriosis is defined by the American Society for Reproductive Medicine using a surgical staging system based on the size and location of endometriosis implants and the severity of pelvic scarring. The stages are: Stage I-minimal, Stage II-mild, Stage III-moderate and Stage IV-severe.Read More

Uterine leiomyomata are among the most frequent entities encountered in the practice of gynecology. It occurs in 20-40% of women during their reproductive years. Approximately 600,000 hysterectomies are performed per year in the United States for uterine myomas. Many surgical procedures other than hysterectomy are also commonly performed to deal with myomas. The purpose of this document is to review the literature and medical and surgical advances in the management of uterine myomas. Authors hope this helps healthcare providers the decision-making process as logical as possible.Read More