A 50-Year Commitment to American Indian and Alaska Native Women.

Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.

Pelvic applications of MR-guided high intensity focused ultrasound.

MR-guided high intensity focused ultrasound (MRg HIFU) is a novel method of tissue ablation that incorporates high energy focused ultrasound for tissue heating and necrosis within an MR scanner that provides simultaneous stereotactic tissue targeting and thermometry. To date, MRg HIFU has been used primarily to treat uterine fibroids, but many additional applications in the pelvis are in development. This article reviews the basic technology of MRg HIFU, and the use of MRg HIFU to treat uterine fibroids, adenomyosis, and prostate cancer.

Knowledge, Awareness, Perceptions, and Use of Emergency Contraceptives among Survivors of Intimate Partner Violence.

The study examines emergency contraception (EC) knowledge, awareness, perceptions, and prior use and identifies predictors of EC use among a sample of survivors of intimate partner violence (IPV). The majority (66.2%) of 154 survivors at risk of pregnancy reported EC awareness, only 15.3% reported prior EC use. Logistic regression identified perceived abusive intimate partner approval (OR = 2.25; 95% CI = 1.15-4.41) and lack of moral/religious objections (OR = 12.83; 95% CI = 5.48-30.03) as the strongest predictors of EC use. Health care provider interventions acknowledging barriers to EC use, such as partner approval, and education that improves awareness of and knowledge about EC, may have the impact of empowering survivors in their reproductive choices, reducing unwanted pregnancies.

Quality of life and sexual function after evaluation and treatment at a referral center for vulvovaginal disorders.

OBJECTIVES: This study was undertaken to assess sexual function and quality of life of women after evaluation and treatment of vulvovaginal problems at a University Center. STUDY DESIGN: Subjects were mailed a cover letter and follow-up survey. All new patients (322) referred for evaluation of vulvar problems at a University Vulvar Specialty Clinic between January 1, 1996, and December 31, 1999, were mailed a survey instrument containing specific questions concerning general, vulvar, and sexual health. Medical records from clinic visits were manually abstracted. Groups defined with descriptive statistics and proportional change in symptoms analyzed with chi(2) statistics. RESULTS: Of the 322 women who met the study criteria, 195 returned valid surveys for an overall response rate of 60.5%. The mean duration of follow-up was 28 months. The most common presenting symptoms were vulvar pain (86%), dyspareunia (71%), itching (35%), and skin changes (20%). At follow-up, 128 (66%) reported improvement in symptoms compared with 14 (7%) that worsened (P <.001). Although subjects did not report an increase in the frequency of sexual activity, significantly more women reported an increase in enjoyment (n = 77, 43%) of sexual activity than a decrease (n = 30, 17%, P <.001). CONCLUSION: Most women presenting for evaluation of vulvar pain will report improvement in symptoms and sexual function after treatment in a Vulvar Specialty Clinic.