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

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

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

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