Worldwide, sterilization (tubal sterilization and vasectomy) is used by more people than any other method of contraception. Female surgical sterilization is the second most commonly used method of contraception among women in the United States. The purpose of this document is to provide an overview of surgical sterilization, with a focus on tubal sterilization and the major clinical alternatives to this procedure -- vasectomy and long-acting contraceptives. The emphasis should be on the safety and effectiveness of tubal sterilization as compared with these alternatives. For women who no longer desire family, sterilization is a safe and highly effective option. With today's technology, transcervical sterilization can easily be performed both comfortably and cost-effectively in an office setting rather than operating room, making sterilization a convenient and private choice for non-reversible birth control.Read More

Transvaginal approaches to sterilization involve gaining access to the fallopian tubes through the cervix. A device or occlusive material is then placed hysteroscopically or blindly block each tube. The purpose of this document is to review hysteroscopic sterilization. Past, current, and upcoming techniques are reviewed to determine how they measure up to tubal ligation. Although sterilization is intended to be permanent, expressions of regret and requests for reversal are not uncommon and are much likely to occur among women sterilized at young ages. The availability and use of contraception have contributed greatly to women's health. The emphasis will be on the safety and effectiveness of hysteroscopic sterilization as compared with the alternatives.Read More

Minimally invasive surgical techniques for performing hysterectomies and other gynecologic surgeries have been shown to reduce patient morbidity and shorten hospital stay. The purpose of this document is to review the recent adoption, experience, and applications of robot-assisted laparoscopy in gynecologic surgery. It will likely continue to develop as more gynecologic surgeons are trained and more patients seek minimally invasive surgical options. Well-designed, prospective studies with well-defined clinical, long-term outcomes, including complications, cost, pain, return to normal activity, and quality of life, are needed to fully assess the value of this new technology. Surgical innovation is necessary. There are ethical and societal issues that remain incompletely understood about the use of robotic surgery.Read More

An unintended pregnancy represents a lost opportunity for preconceptional care for the fetus and a higher risk of pregnancy-related morbidity in the mother. Unintended pregnancies have been also associated with higher rates of unhealthy behaviors, such as smoking or alcohol use, and the lower rates of prenatal vitamin use, which increase the risk of low-birth weight infants and other adverse pregnancy outcomes. A woman's use of her contraceptive method is affected by features of the method itself (dosing frequency, ease of use, cost and availability) as well as by her perceptions about the method. The purpose of this document is to describe advantages and disadvantages of depot medroxyprogesterone acetate (DMPA) use by individual adolescent and adult women. It also evaluates evidence regarding short- and long-term effects of DMPA on skeletal health. Counseling of all reproductive-age women, about the importance of maintaining a healthy lifestyle to minimize risks of osteoporotic fractures later in life, is essential. The review utilizes an evidence-based approach to the recently approved black box changes in DMPA product labeling.Read More