Bleeding disorders have serious implications for the practice of obstetrics and gynecology. The most common inherited bleeding disorder is von Willebrand disease (VWD), which is caused by a deficiency, dysfunction, or absence of von Willebrand factor (VWF). This disorder is caused by either a quantitative or qualitative defect in VWF. It is a common cause of heavy menstrual bleeding and other bleeding problems in women and adolescent girls. Obstetricians and gynecologists should include VWD and other bleeding disorders in the differential diagnosis when evaluating patients with heavy menstrual bleeding, regardless of age. Available treatment options for adolescents are similar to those for other women. Despite the therapeutic physiologic effect of pregnancy on patients with VWD, bleeding complications remain a significant risk to both mother and fetus. Because the risk of bleeding varies by subtype, accurate diagnosis of the disease is an essential step of care to provide recommendations regarding optimal therapy and genetic counseling. Overall, the preferred management for pregnancy that is complicated by VWD is anticipating complications by monitoring bleeding parameters. Therefore, with adequate monitoring, prophylaxis, and observation, patients with VWD can be expected to tolerate the course of pregnancy with minimal risk. Because of the importance of these guidelines for the practice of obstetrics and gynecology, the information relevant to women's health is summarized here.Read More

Nearly one in six women will experience chronic vulvar symptoms at some point, from ongoing itching to sensations of rawness, burning, or dyspareunia. In many chronic cases, more than one entity is the cause. Specific skin diseases, sensations of rawness from various external and internal irritants, neuropathy, and psychological issues are all much more common causes of chronic vulvar symptoms than infections. Vulvar skin disorders can interfere with sexual function because of discomfort, pain, and embarrassment. Chronic vulvar conditions impact not only a woman’s sexual well-being but also her overall quality of life. As women become more comfortable with vulvar health, they will seek the advice of their healthcare providers, especially about their sexual health. Gynecologist must be prepared to diagnose and treat vulvar conditions, including chronic vulvar skin disorders. A detailed history and physical examination, backed by a confident knowledge of the vulvar dermatoses, will aid in diagnosis and treatment. Focus of this review is on common benign conditions of vulvar skin: contact dermatitis; lichnoid vulvar dermatoses; extramammary Paget’s disease and squamous cell hyperplasia: their diagnosis and current management.Read More

The review describes the diagnostic criteria, helpful screening tools, and initial treatment guidelines in order to better equip the obstetricians and gynecologists to manage these patients with depressive episodes, memory loss, Alzheimer’s disease and female sexual dysfunctions. Sexual concerns should be addressed routinely as part of all comprehensive women’s health visits. Gynecologists are often the first health care provider a woman turns to when seeking help for sexual problems. It is important to provide a safe and non-judgmental environment that facilitates discussion of these issues. Patients and their clinicians can be reassured that for the majority of women, cognitive function is not likely to worsen in postmenopause in any pattern other than that expected with normal aging. Although it not likely that in postmenopause, a woman’s cognitive function will return to what it was premenopause, she may adapt to and compensate for the symptoms with time. Stimulant medication may have a role in the treatment of subjective cognitive impairment, particularly for women with comorbid fatigue or impaired concentration who are not showing evidence of objective impairment. There is some evidence that modifying lifestyle factors can decrease the risk of dementia and even cognitive decline associated with normal aging. It is hoped that the continued research into the causes of Alzheimer’s disease will provide some of the necessary information about the prevention and treatment of this relentless and socially damaging disease.Read More

Osteoporosis is an important health problem affecting mature women. Americans with osteoporosis or with low bone mass, approximately 80% are women. Osteoporosis-related fractures will occur in more than 40% of women over the age of 50. Hip fractures will occur in more than 40% of women over the age of 50. An estimated 1.3 to 1.5 million fractures occurring annually are attributed to osteoporosis, accounts for about 15% of the total. Within 1 year after a hip fracture, up to 20% of the victims will die, 25% of the survivors will be confined to long-term care facilities, and 50% will experience long-term loss of mobility. Spinal fractures can be associated with pain, loss of height, and deformities. Osteoporosis also is associated with tooth loss and the resorption of alveolar ridge. Obstetricians and gynecologists play a major role in the prevention, diagnosis, and treatment of osteoporosis as outlined in this document. It is intended as an educational tool that presents current information.Read More

Endometriosis is a chronic and recurrent reproductive disorder with variable clinical presentations. Management varies depending on the patient’s age, symptoms, extent of the disease, reproductive goals, treatment risks, side effects, and cost considerations. The purpose of this document is to review the agents used in the medical management of endometriosis and discuss the use of assisted reproduction technique (ART) for patients with endometriosis who desire pregnancy. The etiology, the relationship between the extent of disease and the degree of symptoms, the effect on fertility, and the most appropriate treatment of endometriosis remain incomplete. This review also presents the evidence, including risks and benefits, for the effectiveness of medical and surgical therapy for adult women who are symptomatic with pelvic pain or infertility or both. The latest approaches using the variety of available medical and surgical treatments are discussed as they specifically relate to the adolescent population. Endometriosis is a relatively common chronic gynecologic disorder that usually presents with chronic pelvic pain or infertility. The societal effect of this disorder is enormous both in monetary costs and in quality of life.Read More

The Advisory Committee on Immunization Practices (ACIP) recently issued the 2011 Recommended Adult Immunization Schedule. The schedule includes a recommendation in effect as of December 21, 2010. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Considerations should include provider assessment, patient preference, and the potential for adverse events. Each schedule must be read with foot-notes regarding dosage and other important information, which can be found at the CDC website (link has been provided). The language in several foot-notes is changed to clarify previous wording.Read More

Sexual intimacy is an integral part of life and is closely linked to emotional and physical well-being. Sexual dysfunction encompasses a broad spectrum of issues in the psychological, physical, interpersonal, and physiological realms. The purpose to this document is to discuss the etiology and diagnosis of female sexual dysfunction and the discussion below offers basic therapeutic approaches to the management of sexual complaints. While pharmacologic options for treating male sexual dysfunction continue to proliferate, the development of such drugs for women has lagged far behind. Now, however, a number of agents are emerging that may help to fill this gap. A discussion of the detailed evaluation and management of dyspareunia and vaginismus is beyond the scope of this article; however, diagnosis of an underlying etiology for the pain should be sought. Both disorders can benefit from education, pelvic floor physical therapy (including biofeedback and massage), and psychological counseling.Read More

Emergency contraception (EC), also known as post-coital contraception and the morning-after pill, refers to the use of drugs or a device as an emergency measure to prevent pregnancy. Women, who have had recent unprotected intercourse, including those who have had a failure of another method of contraception, are potential candidates for this intervention. It is intended for occasional or back-up use, not as a primary contraceptive method for routine use. The purpose of this document is to address the progestin-only and combined oral contraceptive methods (which are the most frequently used methods and also approved by the U.S. Food and Drug Administration [FDA] specifically for emergency contraception) and briefly address the use of the copper intrauterine device (IUD) because of its use as both long-term contraception and emergency contraception. Recently approved 5-day emergency contraceptive (ulipristal acetate) by FDA is explored. Future possibilities are also reviewed. To maximize effectiveness, women should be educated about the availability of emergency contraception methods. Clinical evaluation is indicated for women who have used emergency contraceptive if menses are delayed by a week or more after the expected time or if lower abdominal pain or persistent irregular bleeding develops. Increasing emergency contraception (EC) awareness and knowledge are important priorities in the effort to prevent unwanted and unintended pregnancy.Read More

Intrauterine device (IUD) is the second most popular contraceptive method worldwide, after sterilization. Today's women have more birth control options than ever before. And with the increased options come increased expectations. The purpose of this document is to discuss evidence regarding the safety and efficacy of the levonorgestrel intrauterine system (LNG-IUS) and copper-bearing (TCu380A) intrauterine contraception. To achieve more widespread use of IUDs among women who are appropriate candidates, health care providers should understand the risks, benefits, indications, and contraindications of IUD use. Two IUDs currently are available in the United States: 1) the copper TCu380A, and 2) the levonorgestrel intrauterine system (LNG-IUS). A growing body of evidence attests to the safety and effectiveness of IUDs and their potential role in rates of unintended pregnancy.Read More

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