Awareness, Clinical Experience and Knowledge of Female Genital Mutilation/Cutting Among Female Pelvic Medicine and Reconstructive Surgeons in the United States.

OBJECTIVE: To promote the recognition and care of patients with female genital mutilation/cutting (FGM/C), we aimed to evaluate the awareness, clinical experience and knowledge of FGM/C among female pelvic medicine and reconstructive surgery (FPMRS) specialists. FGM/C is a cultural practice whereby there is removal of external female genitalia for non-therapeutic reasons. Despite the high prevalence of urogynecologic complications, there is a paucity of literature discussing FGM/C from the lens of urologists and urogynecologists. METHODS: By cross-sectional design, we distributed a 27-item survey via email to members of the Society of Urodynamics, Female Pelvic Medicine and Reconstructive Surgery. We collected variables pertaining to previous FGM/C education, clinical confidence, cultural and medical knowledge, and desire for future education. RESULTS: A total of 54 US-based, mostly urologists and FPMRS specialists, completed the survey. All providers had heard of FGM/C; however only 13% received formal education during medical training. Over 50% had encountered a patient with FGM/C in clinical practice. Only 19% and 13% felt completely confident recognizing and discussing FGM/C, respectively. Seventy percent believed religious doctrine informed FGM/C practice and 24% correctly identified FGM/C type on clinical representation. Finally, only 17% of respondents were aware of FGM/C guidelines, and providers expressed a desire for increased availability of multimodal resources. CONCLUSION: Education regarding FGM/C remains sparse and variable for US FPMRS specialists. Cultural and clinical knowledge is also lacking, which is a detriment to patient care. In order to strengthen awareness and knowledge, we must develop high-quality FGM/C educational resources for urologists and gynecologists.

Female Genital Self-Image and Modification.

There has been an increase in genital cosmentic surgeries over the past decade, with the most common procedure being labiaplasty. This trend has many origins, but a significant motivator is genital self image, which has been shown to be very culturally influenced. Furthermore genital self modification, by way of grooming also is felt to play a role in the desire to surgically alter one's genital appearance. Given the cultural aspect of these practices, sexual health proivders should be aware of the role of self image and self modification in the drive towards persuing surgical changes to the genitals. Schmidt CN, Rowen TS. Female Genital Self-Image and Modification. J Sex Med 2021;18:1945-1949.

Postoperative Opioid Use Using Enhanced Recovery After Surgery Guidelines for Benign Gynecologic Procedures.

STUDY OBJECTIVE: To evaluate opioid use after benign gynecologic surgery after implementation of Enhanced Recovery After Surgery (ERAS) opioid prescribing recommendations. DESIGN: A prospective cohort study. SETTING: An academic tertiary care hospital. PATIENTS: All patients undergoing elective benign gynecologic surgery at a large academic institution between August 2017 and December 2017, 1 year after ERAS postoperative opioid prescribing recommendations were implemented for the benign gynecologic surgery department. INTERVENTIONS: A chart review determining opioid prescription quantity and a patient telephone survey 7 days after surgery were both performed. Total opioid use was calculated. Physician adherence to the institution's ERAS postoperative opioid prescribing recommendations after benign gynecologic surgery was then determined. Patients were classified as either in the physician adherent to ERAS group or the physician nonadherent to ERAS group. After this stratification, patients' total opioid use within each group was then compared. MEASUREMENTS AND MAIN RESULTS: A total of 241 consecutive benign gynecologic surgical procedures were reviewed. Opioids were prescribed for outpatient postoperative pain management in 186 (77.2%) of these procedures. Physician adherence to the ERAS postoperative opioid prescribing recommendations occurred in 150 (62.2%) of all surgical cases. The telephone survey was completed by 144 (59.8%) patients 7 days after their surgery. Among survey participants, a total of 13 783.5 morphine milligram equivalents (MMEs) or 64.7% of all opioids prescribed were unused 7 days after surgery. This is equivalent to 1838 oxycodone 5-mg tablets unused by the end of the study period. For all surgical procedure types, the ERAS-nonadherent group was prescribed statistically significantly more opioids per patient than the ERAS-adherent group (246.2 ± 22.8 MME vs 81.1 ± 6.2 MME, p < .005), resulting in more opioids unused among the ERAS-nonadherent group. Consequently, the ERAS-nonadherent group contributed 63.5% (8747.5 MMEs) of the total unused opioids by the end of the study period despite only making up 39.6% of the completed patient surveys. CONCLUSION: Patients require significantly less opioids after benign gynecologic surgery than they are being prescribed. Physician adherence to the ERAS postoperative opioid recommendations is suboptimal and contributes significantly to the quantity of unused opioids after surgery for benign gynecologic indications. Almost two thirds of all opioids prescribed are not used by 1 week after benign gynecologic surgery.

Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women's Sexual Health.

The objective of The North American Menopause Society (NAMS) and The International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel was to create a point of care algorithm for treating genitourinary syndrome of menopause (GSM) in women with or at high risk for breast cancer. The consensus recommendations will assist healthcare providers in managing GSM with a goal of improving the care and quality of life for these women. The Expert Consensus Panel is comprised of a diverse group of 16 multidisciplinary experts well respected in their fields. The panelists individually conducted an evidence-based review of the literature in their respective areas of expertise. They then met to discuss the latest treatment options for genitourinary syndrome of menopause (GSM) in survivors of breast cancer and review management strategies for GSM in women with or at high risk for breast cancer, using a modified Delphi method. This iterative process involved presentations summarizing the current literature, debate, and discussion of divergent opinions concerning GSM assessment and management, leading to the development of consensus recommendations for the clinician.Genitourinary syndrome of menopause is more prevalent in survivors of breast cancer, is commonly undiagnosed and untreated, and may have early onset because of cancer treatments or risk-reducing strategies. The paucity of evidence regarding the safety of vaginal hormone therapies in women with or at high risk for breast cancer has resulted in avoidance of treatment, potentially adversely affecting quality of life and intimate relationships. Factors influencing decision-making regarding treatment for GSM include breast cancer recurrence risk, severity of symptoms, response to prior therapies, and personal preference.We review current evidence for various pharmacologic and nonpharmacologic therapeutic modalities in women with a history of or at high risk for breast cancer and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research. Treatment of GSM is individualized, with nonhormone treatments generally being first line in this population. The use of local hormone therapies may be an option for some women who fail nonpharmacologic and nonhormone treatments after a discussion of risks and benefits and review with a woman's oncologist. We provide consensus recommendations for an approach to the management of GSM in specific patient populations, including women at high risk for breast cancer, women with estrogen-receptor positive breast cancers, women with triple-negative breast cancers, and women with metastatic disease.

Group Medical Visits to Provide Gynecologic Care for Women Affected by Breast Cancer.

PURPOSE: Women with breast cancer have complex and unique gynecologic needs that are challenging to effectively and comprehensively meet in a traditional gynecology visit format. Group medical visits are an effective and well-received model of care in other disease settings and can provide comprehensive health education as an adjunct to one-on-one evaluation and treatment. There are limited data regarding the use of this type of health care delivery in providing gynecology-focused care to women affected by breast cancer. METHODS: A group medical visit model was created for gynecology providers to see new breast cancer patient consults. From May 2012 to February 2014, 148 patients (3-6 per group) participated in a 1-hour informational session followed by a 15- to 30-minute individual visit with a physician that included history, physical examination and evaluation. We surveyed 101 women who attended these visits to evaluate a group model for providing gynecologic care and educational support to women with breast cancer. RESULTS: Of those who responded to the survey question, 100% agreed or somewhat agreed that their expectations for an initial intake visit were met during the group visit; 81% agreed or somewhat agreed that they felt a group visit was preferable to an individual introductory visit. More than 95% agreed or somewhat agreed that the information was understandable and their questions were answered during the visit. Only 5 respondents expressed dissatisfaction with the additional time commitment for this type of visit. CONCLUSIONS: The majority of women surveyed expressed satisfaction with their experience with a group visit format. The women who participated preferred this format compared to an individual intake appointment when establishing gynecology care after breast cancer diagnosis/treatment, regardless of age, menopausal status, cancer stage or hormone receptor status. While further studies are warranted to directly compare and further assess satisfaction and efficacy, gynecologists may consider using a group model to provide comprehensive education and care to this patient population.

A qualitative assessment of Ugandan women's perceptions and knowledge of contraception.

OBJECTIVE: To determine Ugandan women's perceptions and knowledge of contraception. METHODS: Healthy prepartum women were recruited from a national referral and university teaching hospital to participate in 1 of 5 focus group discussions on contraception. Transcripts were translated and coded by 2 researchers using inductive and deductive methods. RESULTS: Forty-six women participated in the focus group discussions. The major themes that emerged were around family planning as a method to space pregnancies and manage finances, as well as men's roles in decision making regarding contraception. Notable among the many incorrect notions about adverse effects of contraception were fears about cancer and infertility. CONCLUSION: The results indicate that, among the study group of Ugandan women, decision making regarding family planning involves a complex negotiation among women, partners, and families. Furthermore, pervasive myths may hinder a woman's ability to choose safe and effective contraception. These findings are useful to healthcare providers and the greater public-health community.