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Gynecology

• Editor's Note
• List of Articles

List of Articles

• Clinical Management of Endometriosis
  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.
  
  
• Vaccines & Immunizations (PDF)
  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.
  
  
• Female Sexual Dysfunction
  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.
  
  
• Emergency Contraception
  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.
  
  

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