Transgender Education Experiences Among Obstetrics and Gynecology Residents: A National Survey.

Purpose: To assess the current state of training among U.S. Obstetrics and Gynecology (OB/Gyn) residents in the field of transgender medicine. Methods: An anonymous survey was sent to current OB/Gyn residents in the United States, which contained a series of questions regarding their training experiences caring for transgender patients. Results: Roughly half of respondents (49.4%) reported having formal didactics in transgender medicine or personal experience caring for a transgender patient (46.8%). Only 14.5% of respondents had any surgical training, and 59% responded that they had at least some comfort level caring for transgender patients. Of the areas of care assessed, residents felt most comfortable providing appropriate cancer screening to transgender patients and least comfortable with gender-affirming hormone therapy management. Just 50.3% of respondents felt that they worked with at least one faculty member with expertise in transgender medicine, and more than half (51.1%) responded that they felt there were barriers to training in their program, with 14% reporting a perceived atmosphere of bias or discrimination toward this patient population. The majority of residents (82.6%) expressed interest in additional training in this field, with direct patient exposure and didactic lectures identified as being the most desired learning modalities. Conclusion: Approximately half of resident respondents reported didactic exposure to transgender medicine in their current programs, with far fewer having surgical training. At least half of respondents felt that there were barriers to their training in transgender medicine, and a majority of respondents were interested in further training in this field.

Pregnancy success and outcomes after uterine fibroid embolization: updated review of published literature.

Females with symptomatic leiomyomas (fibroids) wishing to maintain fertility are faced with difficult treatment choices. These include uterine fibroid embolization (UFE), myomectomy, hormonal therapy, MRI high intensity focused ultrasound, and myolysis. This review focuses on UFE, one of the most commonly accepted minimally invasive procedural choices among patients with symptomatic fibroids wishing to retain the option of becoming pregnant in the future, and makes comparisons to myomectomy which has historically been the surgical choice for fertility-preserving fibroid treatment. Pubmed and Google Scholar searches using keywords such as: uterine artery embolization, uterine fibroid embolization, pregnancy, complications, infertility were performed between Jan 1, 2019 and May 10, 2019. Publications were chosen based on their inclusion of information pertaining to fertility or pregnancy after UFE without being limited to single case reports.Randomized controlled trials comparing myomectomy and UFE are limited due to study size and confounding variables, but through registry data and familiarity with referring clinicians, UFE has gained wide acceptance. Healthy pregnancies following UFE have been sporadically reported but the actual fertility rate after UFE remains uncertain. Conversely, low birth weight, miscarriage and prematurity have been associated with UFE. Despite inherent risks of possible fertility issues after UFE, the procedure remains an option for females with clinically symptomatic fibroids who desire pregnancy. However, additional research regarding rates of conception and obstetrical risks of infertility following UFE is necessary.

Endometriosis: A Malignant Fingerprint.

BACKGROUND: Endometriosis is complex, but identifying the novel biomarkers, inflammatory molecules, and genetic links holds the key to the enhanced detection, prediction and treatment of both endometriosis and endometriosis related malignant neoplasia. Here we review the literature relating to the specific molecular mechanism(s) mediating tumorigenesis arising within endometriosis. METHODS: Guidance (e.g. Cochrane) and published studies were identified. The Published studies were identified through PubMed using the systematic review methods filter, and the authors' topic knowledge. These data were reviewed to identify key and relevant articles to create a comprehensive review article to explore the molecular fingerprint associated with in endometriosis-driven tumorigenesis. RESULTS: An important focus is the link between C3aR1, PGR, ER1, SOX-17 and other relevant gene expression profiles and endometriosis-driven tumorigenesis. Further studies should also focus on the combined use of CA-125 with HE-4, and the role for OVA1/MIA as clinically relevant diagnostic biomarkers in the prediction of endometriosis-driven tumorigenesis. CONCLUSIONS: Elucidating endometriosis' molecular fingerprint is to understand the molecular mechanisms that drive the endometriosis-associated malignant phenotype. A better understanding of the predictive roles of these genes and the value of the biomarker proteins will allow for the derivation of unique molecular treatment algorithms to better serve our patients.