“Complementary Medicine”: Complementary and Alternative Health Approaches in Pediatric and Adolescent Gynecology

Complementary and alternative health care approaches are prevalent in the patients and families served by practitioners in pediatric and adolescent gynecology. This article addresses gaps in knowledge, including new terminology, prevalence of use, rates of and reasons behind nondisclosure, and potential interactions of herbal products with prescribed medication. It closes with practical complementary health approaches to the adolescent with dysmenorrhea.     

Does an Advanced Pelvic Simulation Curriculum Improve Resident Performance on a Pediatric and Adolescent Gynecology Focused Objective Structured Clinical Examination? A Cohort Study

Study ObjectiveTo determine the effect of an advanced pelvic simulation curriculum on resident performance on a pediatric and adolescent gynecology (PAG) focused objective structured clinical examination (OSCE).DesignObstetrics and gynecology residents in a single academic Canadian center participated in a PAG simulation curriculum. An OSCE on prepubertal vaginal bleeding was administered at the biannual OSCE examination 2 months before the simulation curriculum and again 3 months after the simulation curriculum.SettingAcademic half-day at the University of Ottawa Skills and Simulation Centre.ParticipantsObstetrics and gynecology residents from the University of Ottawa.InterventionsParticipants completed 4 stations teaching PAG-appropriate history-taking, genital examination, Tanner staging, vaginal sampling and flushing, hymenectomy, vaginoscopy, laparoscopic adnexal detorsion, and approach to the child and/or adolescent. Advanced pelvic models were used for procedure-specific stations.Main Outcome MeasuresThe primary outcome measure was change in mean score on a prepubertal vaginal bleeding OSCE station. Secondary outcome measures were changes in individual component scores.ResultsFourteen residents completed the simulation curriculum and the PAG OSCE at the 2 separate time points (before and after simulation curriculum). The mean OSCE score before the simulation curriculum was 54.6% (20.5 of 37) and mean score after the curriculum was 78.1% (28.9 of 37; P < .001). Significant score increases were found in history-taking, examination, differential diagnosis, identification of organism, surgical procedures, and identification of foreign body (P < .01 for all).ConclusionThis innovative PAG simulation curriculum significantly increased residents' knowledge in PAG history-taking, examination skills, operative procedures, and approach to the child and/or adolescent. Obstetrics and Gynecology Program Directors should consider incorporating PAG simulation training into their curriculum to ensure that residents meet their learning objectives and increase their knowledge and confidence, which will ultimately benefit patient care.     

Sjögren syndrome in Obstetric and Gynecology: literature review

Sjogren syndrome (SS) is an immune disease characterized by a progressive degeneration of exocrine glands. It leads to dryness of mucosa and conjunctivitis. Gynecologists and obstetricians may encounter this disease in women at any age, including during pregnancy. Knowledge of the main characteristics is required for early diagnosis and multidisciplinary program. In the event of secondary Sj?gren syndrome occurring during pregnancy, treatment focuses on the associated disease, mainly systemic lupus erythematosus. In primary Sj?gren syndrome, pregnancy does not appear to influence disease course. However, patients with both primary and secondary Sj?gren syndrome must be monitored carefully. There is a risk of neonatal lupus and congenital atrioventricular bloc associated with high morbidity and mortality. These patients should benefit from multidisciplinary care in a hospital with a neonatal intensive care unit.     

What is the purpose of launching the World Journal of Obstetrics and Gynecology?

World Journal of Obstetrics and Gynecology (WJOG) is a new member of the World Series journals and is launched in June 10, 2012. WJOG is an open access peer-reviewed bimonthly journal that will cover obstetrics and gynecology including reproductive medicine. The intention of WJOG is to publish papers that describe and influence the situation all around the world. The journal will publish both basic research and well as clinical findings. The focus shall be on translational work. Please send your important findings and comments to WJOG.     

Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies—A Resident Physician Survey

BackgroundMany women will experience a sexual health concern and present to their Obstetrics and Gynecology (Ob-Gyn) care provider, yet a large portion of graduating Ob-Gyn resident physicians in the United States may not feel comfortable helping patients with some sexual health issues.AimTo perform a cross-sectional study of U.S. Ob-Gyn resident physicians that assesses sexual health education didactic sessions and comfort level with sexual health clinical vignettes.MethodsA 32-item anonymous survey was sent to all 4,065 Ob-Gyn residents on June 7, 2016. Respondents voluntarily completed the survey electronically.OutcomesThe primary outcome measures are the comfort level of Ob-Gyn resident physicians in taking a sexual history and providing counseling to patients represented in clinical vignettes, which were based on sexual health learning objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG).ResultsOf the 4,065 eligible U.S. examinees, 968 (23.8%) agreed to participate in the study, and 802 (19.7%) completed the survey and were included in the final analysis. Nearly two-thirds of the residents indicated that sexual health training was a priority in residency. However, more than half were not able to describe the disorders of sexual function or list common medications that effect sexual function. When posed with clinical vignettes, residents felt very comfortable obtaining a sexual history (98.5%) and providing counseling (97.0%) for a 16-year-old seeking contraception, yet fewer felt very comfortable obtaining a history and providing counseling for a 26-year-old who is a refugee from Somalia (77.2% and 73.8%). Smaller cohorts felt prepared to take a sexual history and provide counseling for a 17-year-old who discloses that she is a victim of sex trafficking (61.2% and 57.7%), and for a 58-year-old transgender patient planning hormone therapy and surgery (49.9% and 37.9%). In logistic regression analysis, the factors that were influential in an Ob-Gyn resident physician's program to prepare them to describe the disorders of sexual function were post-graduate year (OR 1.387, 95% CI 1.189, 1.618; P = .0001), those that rated the importance of a sexual health curriculum highly (OR 0.701, 95% CI 0.569, 0.864; P = .0012), and a greater number of didactic sessions on sexual health in the residency curriculum (OR 0.685, 95% CI 0.626, 0.750; P < .0001).ConclusionThese findings highlight strengths in the comfort of Ob-Gyn resident physicians about sexual health and illustrate areas of opportunity to engage resident learners by improving the sexual health curriculum.Worly B, Manriquez M, Stagg A, et al. Sexual Health Education in Obstetrics and Gynecology (Ob-Gyn) Residencies—A Resident Physician Survey. J Sex Med 2021;18:1042–1052.     

Messages About Contraception and Condoms in Mother–Adolescent Dyadic Conversations: Knowledge,Risks, and Effectiveness

Study ObjectiveLittle is known about the content of parental discussions with young adolescents about reproductive health topics. We sought to characterize the messages mothers share about contraception and condoms.DesignRecruitment occurred between January 2012 and May 2013. Mothers and their 12- to 14-year-old adolescent son or daughter were invited to participate in a semistructured conversation about everyday issues and health topics, including reproductive health topics. Discussions were audio-recorded, transcribed, and a grounded theory approach to content analysis was performed. Content analysis was performed to characterize maternal messages regarding contraception and condoms.SettingUrban city in western Pennsylvania.ParticipantsTwenty-five dyads; 14 mother–daughter dyads and 11 mother–son dyads.InterventionsNone.Main Outcome MeasuresMaternal reproductive health messages during conversations with early adolescent children.ResultsFour key themes emerged. Theme 1 focused on general facts about condoms and contraceptive methods, how each works, and how to obtain them. Theme 2 emphasized the consequences of sexual behaviors and the advantages of safe sex. Theme 3 conveyed the effectiveness of condoms and contraceptive methods for preventing pregnancy and sexually transmitted infections. Theme 4 described where adolescents could get more information about condoms and contraception.ConclusionMothers convey a broad range of information about contraceptives and condoms to young adolescents.     

Have we met the educational challenges of obstetrics and gynecology? A response to the Association of Professors of Gynecology and Obstetrics Initiative of 1986

OBJECTIVE: The purpose of this study was to assess the progress that has been made toward meeting the educational challenges in obstetrics and gynecology that were made at an Association of Professors of Obstetrics and Gynecology special forum in 1986. STUDY DESIGN: We placed the five major issues and specific problems that were identified within the context of developments that have occurred in medical education, the Association of Professors of Obstetrics and Gynecology, and the specialty over the last 15 years. We used the medical education literature and the accomplishments of the members of the Association of Professors of Obstetrics and Gynecology to measure progress. RESULTS: Many of the challenges that were raised at the original forum remain. Significant progress, much of it spearheaded by the Association of Professors of Obstetrics and Gynecology, has been made in the areas of teaching methods and skills, evaluation techniques, faculty development, computer usage, teaching recognition, counseling for the fourth-year student, and an integrated curriculum in women's health. CONCLUSION: Progress has occurred within the context and demands of a changing health care system that constricts the time and funding that are available for medical education.     

Tubo-Ovarian Abscess in Non−Sexually Active Adolescent Girls: A Case Series and Literature Review

Study ObjectiveWe investigated risk factors and common causes of tubo-ovarian abscess (TOA) in non?sexually active females in order to aid in earlier diagnosis, treatment, and improved outcomes.DesignThis is a retrospective observational case series of all non?sexually active females younger than age 25 years who were diagnosed with TOA. Review of the existing literature was also performed.SettingAcademic tertiary care children's hospital.ParticipantsTen patients meeting study inclusion criteria were identified for the study, and 33 other patients were identified in the literature.ResultsAverage age at time of diagnosis was 14 years. Average body mass index was 24 kg/m². Most presented with abdominal pain, often associated with fevers, nausea, vomiting, and diarrhea. Seven of 10 patients were treated surgically with pelvic washout (4 primarily and 3 after failing empiric antibiotic therapy). Most frequently, anaerobic gut flora were isolated on culture. All patients received broad-spectrum intravenous antibiotics, and were then discharged on a course of doxycycline and metronidazole or clindamycin. Three patients required additional admissions and multiple rounds of antibiotics due to persistent symptoms. The average length of stay was 3 days for patients treated with antibiotics only and 6 days for patients requiring surgical intervention. Six patients had complete resolution of symptoms and improvement on ultrasound within 2-4 weeks. The remainder were lost to follow-up.ConclusionThese cases, in conjunction with previous case reports, emphasize the importance of considering TOA in patients with concerning imaging or examination findings despite lack of sexual activity. Given the large proportion of cases attributable to anaerobic gut flora, treatment with antibiotics with adequate anaerobic coverage is recommended. Surgical drainage is not always necessary, but is often needed for diagnostic purposes or in patients not clinically improving with conservative measures.     

European Society for Sexual Medicine Position Statement “Assessment and Hormonal Management in Adolescent and Adult Trans People,With Attention for Sexual Function and Satisfaction”

BackgroundThere is a general lack of recommendations for and basic information tailored at sexologists and other health-care professionals for when they encounter trans people in their practice.AimWe present to clinicians an up-to-date overview of clinical consensus statements on trans health care with attention for sexual function and satisfaction.MethodsThe task force consisted of 7 clinicians experienced in trans health care, selected among European Society for Sexual Medicine (ESSM) scientific committee. The consensus was guided by clinical experience and a review of the available literature and by interactive discussions on trans health, with attention for sexual function and satisfaction where available.OutcomesThe foci of the study are assessment and hormonal aspects of trans health care.ResultsAs the available literature for direct recommendations was limited, most of the literature was used as background or indirect evidence. Clinical consensus statements were developed based on clinical experiences and the available literature. With the multiple barriers to care that many trans people experience, basic care principles still need to be stressed. We recommend that health-care professionals (HCPs) working with trans people recognize the diversity of genders, including male, female, and nonbinary individuals. In addition, HCPs assessing gender diverse children and adolescents should take a developmental approach that acknowledges the difference between prepubescent gender diverse children and pubescent gender diverse adolescents and trans adults. Furthermore, trans people seeking gender-affirming medical interventions should be assessed by HCPs with expertise in trans health care and gender-affirming psychological practice. If masculinization is desired, testosterone therapy with monitoring of serum sex steroid levels and signs of virilization is recommended. Similarly, if feminization is desired, we recommend estrogens and/or antiandrogen therapy with monitoring of serum sex steroid levels and signs of feminization. HCPs should be aware of the influence of hormonal therapy on sexual functioning and satisfaction. We recommend HCPs be aware of potential sexual problems during all surgical phases of treatment.Clinical ImplicationsThis is an up-to-date ESSM position statement.Strengths & LimitationsThese statements are based on the data that are currently available; however, it is vital to recognize that this is a rapidly changing field and that the literature, particularly in the field of sexual functioning and satisfaction, is limited.ConclusionThis ESSM position statement provides relevant information and references to existing clinical guidelines with the aim of informing relevant HCPs on best practices when working with transgender people.T'Sjoen G, Arcelus J, De Vries ALC, et al. European Society for Sexual Medicine Position Statement “Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction”. J Sex Med 2020;17:570–584.     

Supporting Patient-centered Communication on Adolescent Sexual and Reproductive Health—Perspectives to Build an Appointment Planning Tool

Study Objective: Input from adolescents and healthcare providers is needed to develop electronic tools that can support patient-centered sexual and reproductive (SRH) care. This study explores facilitators and barriers to patient-centered communication in the context of developing an electronic appointment planning tool to promote SRH communication in clinic settings.Design: In-depth interviews were conducted to explore what constitutes adolescent-friendly SRH care and communication, as well as on the design of the appointment planning tool. Interviews were coded iteratively, and analyzed using the software Atlas.TI v8.Setting: An adolescent primary care clinic, and a pediatric and adolescent gynecology clinic.Participants: Adolescent girls (N=32; ages 14-18) and providers who care for adolescent girls (N=10).Main Outcome Measures: Thematic analyses explored facilitators/barriers to SRH communication and care and preferences for the tool.Results: Facilitators identified by adolescents and providers included: direct patient/provider communication; adolescent-driven decision-making regarding care and contraceptive choice; supplementing clinic visits with electronic resources; and holistic care addressing physical, mental, and social needs. Barriers identified by participants included: limited time for appointments; limited adolescent autonomy in appointments; and poor continuity of care when adolescents cannot see the same provider. Given the complexity of issues raised, adolescents and providers were interested in developing an appointment planning tool to guide communication during appointments, and contributed input on its design. The resulting Appointment Planning Tool app pilot is in progress.Conclusions: Qualitative interviews with adolescents and providers offer critical insights for the development and implementation of mobile health (mHealth) tools that can foster patient-centered care.     

Menstrual History-Taking at Annual Well Visits for Adolescent Girls

Study Objective

To determine the rates at which primary care providers elicit menstrual histories from adolescent girls at well visits.