[An atlas on Female Genital Mutilation/ Cutting among children and adolescents]. / Un atlas des mutilations génitales féminines chez les enfants et les adolescentes.

This article translates and synthesizes a reference guide containing iconographic material of the pre- and post-pubertal female external genitals with and without genital mutilation/cutting (FGM/C). The literature focuses on adults, whereas FGM/C are usually performed before the age of 15. Signs of FGM/C can be subtle and depend on the type of mutilation as well as the experience of the examiner. Published in 2022 and produced with the collaboration of 23 professionals, this illustrated guide "Female Genital Mutilation/Cutting in Children and Adolescents: Illustrated Guide to Diagnose, Assess, Inform and Report, https://link.springer.com/book/10.1007/978-3-030-81736-7 " is currently available in open access. It is aimed at facilitating the training of health professionals in making diagnosis, clinical management, and reporting to child safeguarding/law enforcement agencies, where required.

Cet article traduit et synthétise un guide de références contenant du matériel iconographique sur la vulve pré et postpubère avec et sans mutilation génitale féminine ou excision (MGF/E). La littérature disponible se concentre sur les adultes alors que les MGF/E sont généralement pratiquées avant l'âge de 15 ans. Les signes peuvent être subtils et dépendent du type de mutilation ainsi que de l'expérience de l'examinateur-ice. Paru en 2022 et réalisé grâce à la collaboration de 23 professionnel-les, « Female Genital Mutilation/Cutting in Children and Adolescents: Illustrated Guide to Diagnose, Assess, Inform and Report, https://link.springer.com/book/10.1007/978-3-030-81736-7 ¼ est disponible en libre accès. Il vise à former les professionnel-les à l'établissement de diagnostics, à une prise en charge adaptée, ainsi qu'au signalement auprès des organismes de protection de l'enfance, si nécessaire.

Hymen and virginity: What every paediatrician should know.

Paediatricians may face the notion of 'virginity' in various situations while caring for children and adolescents, but are often poorly prepared to address this sensitive topic. Virginity is a social construct. Despite medical evidence that there is no scientifically reliable way to determine virginity, misconceptions about the hymen and its supposed association with sexual history persist and lead to unethical practices like virginity testing, certificate of virginity or hymenoplasty, which can be detrimental to the health and well-being of females of all ages. The paediatrician has a crucial role in providing evidence-based information and promoting positive sexual education to children, adolescents and parents. Improving knowledge can help counter misconceptions and reduce harms to girls and women.

Contraception: what is the resistance all about?

PURPOSE: The aim of this study is to identify the aspects associated with resistance to contraception, providing healthcare workers with the necessary tools to increase compliance with contraception and, ultimately, reduce the rate of voluntary abortions. MATERIAL AND METHODS: We performed a review of the literature published in Medline between 1st January 2000 and 31st July 2020. We included studies based on qualitative analyses, describing women's perception and attitudes towards contraception, including a population aged 15 years or older and conducted in either Europe or North America. RESULTS: A total of 23 articles were included in the study. Resistance to contraceptive uptake was most frequently due to ambivalence about pregnancy, with up to 54% of ambivalent women reporting not using any means of contraception, and communication issues with the partner and/or health care provider, with a positive association found between communication with the partner and contraceptive use (OR 1.07; p < .050). Additional barriers to contraceptive use were the quality of the relationship with the partner, the perception of the risk of becoming pregnant after unprotected sexual intercourse, and unfamiliarity with contraception. CONCLUSIONS: Family planning consultations should acknowledge the aspects that influence contraceptive uptake and address them as part of their consultations.

[News on progestatives in gynaecology]. / Actualités sur les progestatifs en gynécologie.

Progesterone (P4), a steroid primarily secreted by the corpus luteum, placenta and adrenal glands, plays an essential role on female reproductive function. Progestins (PS) are synthetic analogues of P4 with specific steroid receptor affinities. A progestin-only-pill (POP) with an antimineralocorticoid effect was recently marketed with a tolerance and safety profile superior to existing POPs. In contrast, PS with antiandrogenic properties used at high doses for the treatment of hirsutism have been associated with an increased meningioma risk. New clinical and fundamental data open paths for research into the therapeutic use of P4 in cognition, neuroprotection and bone.

La progestérone (P4), stéroïde sécrété principalement par le corps jaune, le placenta et les glandes surrénales, joue un rôle essentiel dans le contrôle de la fonction reproductive de la femme. Les progestatifs de synthèse (PS) sont des analogues avec des affinités spécifiques sur les divers récepteurs stéroïdiens. Une pilule progestative (POP) aux effets antiminéralocorticoïdes a récemment été commercialisée avec un profil de tolérance et de sécurité supérieur aux POP existants. En revanche, des PS aux propriétés antiandrogènes utilisés en forte dose pour le traitement de l'hirsutisme ont été associés à un risque accru de méningiome. De nouvelles données cliniques et fondamentales ouvrent de nouvelles voies de recherche sur l'utilisation thérapeutique de la P4 dans les champs de la cognition, de la neuroprotection et de l'os.

[Transgender and non-binary teenagers : management in primary care]. / Adolescents transgenres et non ­binaires : approche et prise en charge par les médecins de premier recours.

Transgender, non-binary and questioning teenagers are increasingly visible. However, they face barriers in accessing appropriate care that meet their needs, both specific and regarding their general health. Primary care physicians increasingly see them in consultations but often lack elements of communication and recent knowledge that is needed to accompany them and their close ones in their -individual trajectories. This article aims to answer this need and provides a synthesis about recent evidence and suggested communication approaches for primary care physicians, who play a central role for the health of all patients.

Les adolescents transgenres, non binaires ou en questionnement sont de plus en plus visibles et font face à de nombreux obstacles pour accéder à des soins appropriés, tant pour leurs besoins de santé spécifiques que généraux. Les médecins de premier recours les rencontrent au cabinet et peuvent manquer d'éléments de communication et de connaissances spécifiques récentes pour mener la consultation et accompagner ces personnes et leurs proches dans leurs trajectoires individuelles. Cet article propose une synthèse des éléments et des ressources utiles pour le médecin de premier recours, dont le rôle est ­central pour la santé de tous les patients.

Real-world experience with the IUB Ballerine MIDI copper IUD: an observational study in the French-speaking region of Switzerland.

Objective: The aim of the study was to assess the acceptability of the intrauterine ball IUB Ballerine MIDI copper intrauterine device (IUD), using real-world data collected from users and physicians. Methods: In this retrospective, observational study, conducted in the French-speaking region of Switzerland, healthy women (n= 207) who had had an IUB Ballerine MIDI inserted ≥12 months before enrolment, and their physicians completed questionnaires relating to device insertion, user experience and outcome. Questions relating to current menstrual patterns, physical comfort and product satisfaction were only posed to women still using the device. Results: The mean age at insertion was 30.8 ± 7.2 years, with an average 14.2 ± 2.9 month lapse from time of insertion until study commencement. At the time of the study, 140 (67.6%) women were still using the device. The expulsion rate was 5.3% (n= 11) and the pregnancy rate was 1.4% (n= 3). Most of the women still using the device reported no to moderate pain or cramps (80.7%). The majority of women reported moderate to high (65.7%) satisfaction with the device, with 81.4% claiming they would recommend it to friends and relatives. Over 84.8% of physicians reported that the device was easy to insert, with no difficulties encountered during the procedure. Conclusions: The IUB Ballerine MIDI was demonstrated to be safe and acceptable in different clinical settings and risk groups among a socioeconomically and demographically diverse study population.

[Update on Mycoplasma genitalium among women]. / Le point sur Mycoplasma genitalium chez la femme.

Mycoplasma genitalium (MG) is a sexually transmitted pathogen with a poorly understood natural history. Often asymptomatic, it has been associated with urogenital conditions. The implementation of NAAT (Nucleic Acide Amplification Test) has not only improved the detection of MG, but also brought to light the emergence of antibiotic resistances, hence challenging the proposed treatment strategies and questioning the indication for systematic screening. This article summarizes current knowledge on MG among women, over viewing incidence, prevalence and clinical implications. It resumes the last guidelines in terms of screening and treatment.

Mycoplasma genitalium (MG) est un pathogène sexuellement transmissible souvent asymptomatique, dont la pathogénicité est méconnue. Source croissante d'intérêt car mieux détecté depuis l'implémentation des NAAT (Nucleic Acide Amplification Test), MG serait incriminé dans diverses pathologies uro-génitales. L'émergence des résistances aux antibiotiques est un enjeu de taille dans le traitement de l'infection et soulève le débat sur l'utilité d'un dépistage systématique. Cet article résume l'état des connaissances actuelles au sujet de MG chez la femme : son incidence, sa prévalence ainsi que ses implications cliniques. Il fait la synthèse des dernières recommandations en termes de dépistage et de traitement.

[Adolescence and sexuality: a risky business How best to inform parents ?] / Sexualité et adolescence :liaisons dangereuses ?: Guide des meilleures pratiques pour informer les parents.

Parents are often reluctant to discuss sexuality and romantic relationships with their teenagers. However, these discussions can have a strong impact on their children's health. Care providers can act as a reliable source of information to support parents in this task. Through repeated short interactions with their child over their adolescence, parents can cover most topics related to sexuality, based on teenagers' questions and the situations that they face (e.g. LGBT bullying at school). This article summarizes current best practice on how to facilitate parental dialogue with adolescents about sexuality and offer care providers guidance in transmitting this information to parents.

Les parents sont souvent réticents à parler de sexualité et de relations amoureuses avec leurs adolescents. Cependant, ces discussions ont un rôle majeur pour la santé de leurs enfants. Les professionnels de santé sont une source d'informations fiable et de soutien pour les parents dans cette démarche. De nombreuses interactions courtes durant les années de l'adolescence, entre parents et adolescents, basées sur des questions et des situations rencontrées permettent de couvrir les nombreuses thématiques liées à la sexualité. Cet article propose une aide pour les professionnels de santé afin d'informer les parents et les encourager à ouvrir le dialogue avec leurs enfants. Il résume les meilleures pratiques pour favoriser la communication avec des adolescents concernant la sexualité.

Sexual Anatomy and Function in Women With and Without Genital Mutilation: A Cross-Sectional Study.

INTRODUCTION: Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations. AIM: To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image. METHODS: A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d'Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index). MAIN OUTCOME MEASURES: Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores. RESULTS: Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs. They scored significantly lower on sexual function and desire than women without FGM. They did not score lower on Female Sexual Function Index sub-scores for orgasm, desire, and satisfaction and on the Questionnaire d'Image Corporelle but did report significantly more dyspareunia. A larger total volume of clitoris and bulbs did not correlate with higher Female Sexual Function Index and Sexual Desire Inventory scores in women with FGM compared with uncut women who had larger total volume that correlated with higher scores. CONCLUSION: Women with FGM have sexual erectile tissues for sexual arousal, orgasm, and pleasure. Women with sexual dysfunction should be appropriately counseled and treated.

An exploration of sexual desire and sexual activities of women with psychosis.

Sexual disturbances in patients with severe mental disorders can be related to medication, to psychological issues such as self-stigma and anhedonia, but also to the social context. This research aims to gain knowledge of desire and sexual practices in women suffering from schizophrenia. Women outpatients suffering from schizophrenia were compared with healthy women. Contrary to previous research, women with schizophrenia featured dyadic and individual desire similar to women of comparable age. Yet, only half of women with psychosis had sexual practice, either alone or with a partner. They were less satisfied with their activity, both in terms of function and psychological issues such as sexual self-esteem. Keeping into account the fact that most clinicians avoid this topic, this finding underscores the stigmatization these women suffer from, which prevents the opportunity of a possible improvement in this important interpersonal domain.

[A new perspective in adolescent contraception--why prescribe an IUD first?]. / Un nouveau regard sur la contraception des adolescentes: pourquoi prescrire un dispositif intra-utérin en première intention?

Adolescent girls are very fertile and therefore need a reliable contraceptive strategy in order to prevent unwanted pregnancies. Although highly recommended by international gynecological and adolescent societies and in spite of its high efficiency, good tolerance and ease of use, only minority of adolescents use IUD as a contraceptive method. This article will focus on available IUDs suitable for adolescents and will address misconceptions and barriers to use of IUDs in this age group. We believe this information will encourage physicians in recommending IUD use to adolescents during their most vulnerable years.

[Specialized adolescent health clinic: who should be referred to it?]. / Consultations spécialisées en médecine de l'adolescent: à qui s'adressent-elles?

Adolescent health clinics were created in response to the specific health needs of this age-group. Adolescents may present complex health problems which require a multidisciplinary and global assessment. The aim of this article is to provide an overview of the type of health problems for which adolescents are referred to our clinics and the care they receive in response to them.

Safety and efficacy of a suction cervical stabilizer for intrauterine contraceptive device insertion: Results from a randomized, controlled study.

OBJECTIVES: To compare patient-reported pain, bleeding, and device safety between intrauterine contraceptive device (IUD) insertion procedures employing a suction cervical stabilizer or single-tooth tenaculum. STUDY DESIGN: This was a randomized, prospective, single-blinded study conducted at two centers, enrolling women aged 18 years or older, eligible for IUD insertion. The primary end point measure was patient-reported pain, measured on a 100-mm Visual Analogue Scale. Safety was assessed on the amount of bleeding, adverse events, and serious adverse events. RESULTS: One hundred women were randomized, 48 to the investigational device and 52 to control. There were no statistically significant differences between the groups in factors potentially associated with pain on IUD insertion. IUD insertion was successful in 94% of all subjects. Subjects in the investigational device group reported pain scores ≥14 points lower than in the control group at cervix grasping (14.9 vs 31.3; p < 0.001) and traction (17.0 vs 35.9; p < 0.001), and smaller differences in pain scores at the IUD insertion (31.5 vs 44.9; p = 0.021) and cervix-release (20.6 vs 30.9; p = 0.049) steps. Nulliparous women experienced the greatest pain differences to control. Mean blood loss was 0.336 (range 0.022-2.189) grams in the investigational device group and 1.336 (range 0.201-11.936) grams in the control group, respectively (p = 0.03 for the comparison). One adverse event (bruising and minor bleeding) in the investigational device group was considered causally related to the study device. CONCLUSIONS: The suction cervical stabilizer had a reassuring safety profile and its use was associated with significant reductions in pain during the IUD insertion procedure compared with standard single-tooth tenaculum use, particularly among nulliparous women. IMPLICATIONS: Pain can be an important barrier to greater use of IUD devices among prescribers and users, particularly nulliparous women. The suction cervical stabilizer may provide an appealing alternative to currently available tenacula, filling an important unmet need.

Coexpression of factor VIII and factor von Willebrand variants in a woman with heavy menstrual bleeding.

Heavy menstrual bleeding is one of the most common causes of consultation in haematology. We present the clinical case of a 20-year-old woman referred by her gynaecologist due to heavy menstrual bleeding since menarche, complicated by iron deficiency anaemia. Haemostasis work-up was initially suggestive of a von Willebrand disease type 1. Genetic analyses by whole exome sequencing lead to a fortuitous discovery of haemophilia by identifying a heterozygous missense mutation in F8 , exon 8 c.1127T>G:p.Val376Gly, previously reported in a patient with mild haemophilia A. The bleeding phenotype worsened by concomitant low von Willebrand factor (VWF) due to VWF variants influencing VWF levels. Our case highlights how whole exome sequencing can help to correct an erroneous diagnosis and identify polymorphisms that eventually contribute to the overall haemostatic balance.

Can a 3 months treatment with oral Desogestrel prior to insertion of the etonogestrel-releasing contraceptive implant improve continuation rate at 1 year? A randomized trial.

OBJECTIVE: To evaluate if daily oral 75 µg of Desogestrel (DSG) for 3 months prior to the insertion of etonogestrel-releasing contraceptive implant (ENG-IMPLANT) might help reduce its premature discontinuation. RESULTS: A total of 66 women were randomized in the ENG-IMPLANT group (26) and in the DSG + ENG-IMPLANT group (40), respectively, in the Geneva University Hospitals and Basel University Hospital, from August 15th, 2016 through September 30th, 2019. In the DSG + ENG-IMPLANT group, patients were given a 3 months' supply of 75 µg of DSG before the insertion of the ENG-IMPLANT. All women were seen after 3 months for bleeding and satisfaction evaluation, and at 12 months post ENG-IMPLANT insertion. Higher levels of satisfaction at 12-months were found in the ENG-IMPLANT group compared to the DSG + ENG-IMPLANT group (8.5 ± 1.7 vs. 6.6 ± 2.9, p = 0.012). There were no statistically significant differences regarding tolerance (7.8 ± 2.5 vs 6.8 ± 2.6, p = 0.191) and contraceptive continuation (80% vs 72.4%, p = 0.544) between groups. CONCLUSION: DSG prior to insertion of the ENG-IMPLANT did not improve its continuation rate neither its satisfaction at 1 year. Trial registration NCT05174195. Retrospectively registered, the 30th December 2021.

[Contraception and bone health in adolescence]. / Contraception chez les adolescentes et santé osseuse.

Adolescents' access to contraception has improved and indication for their use have been extended beyond pregnancy prevention. For adolescents, this implies the use of hormonal contraception before the accrual of peak bone mass. Sexual hormones, notably estrogens, play a major role in skeletal development, growth and acquisition of maximal bone mass density (BMD). This article will review different contraceptive methods and their impact on BMD, with particular attention to low-dose pills and medroxyprogesterone acetate, both of which seem to alter peak bone mass acquisition. Nevertheless, benefits from appropriate contraception should be weighed against safety concerns, and recommended on an individual basis.

[Gynecology/Obstetrics. Magnesium sulfate for fetal neuroprotection in preterm delivery. Latest advances in contraception.]. / Gynécologie - obstétrique.

Morbidity of neonates born before 32 weeks remains significant. Cerebral palsy is found in up to 8 to 10% of survivors. Three randomized controlled trials evaluated the effectiveness of magnesium sulphate given to mothers with a risk of imminent very preterm delivery to prevent perinatal death or cerebral palsy in children. These studies suggest a reduction of the risk of cerebral palsy by magnesium sulphate from 6.5% to 4.8% (relative risk 0.71, 95% CI 0.55-0.91). These results remain controversial, but warrant information to the parents and the implementation of treatments protocols for selected cases.

Remote self-assessment follow-up for medical termination of pregnancy at Geneva University Hospitals: an insight into its acceptability, success rate and costs.

AIMS OF THE STUDY: Remote follow-up based on self-assessment plus a telephone call with a healthcare provider is a safe and reliable method for assessing the success of medical termination of pregnancy (mTOP) and can lead to an important reduction in costs. The aim of the study was to analyse its efficacy, acceptability and associated costs. METHODS: This was a retrospective comparative study analysing two follow-up protocols for home-based mTOP. A total of 201 women were included: 56 for a standard in-clinic follow-up and 145 for a remote follow-up based on self-assessment with a low-sensitivity urine pregnancy test and a questionnaire. The main outcome was the total number of outpatient consultations needed for each procedure and the associated costs (according to the Swiss tariff system); acceptability and satisfaction were assessed using questionnaires. RESULTS: Demand for home-based termination increased by 7.8% in the observation period. There was a reduction in diagnosis of retained products of conception, with a consequent decrease of follow-up consultations from 1.47 to 0.41 appointments per patient. A reduction of 38.9% in the average cost per patient (including supplementary follow-up appointments) was observed. Moreover, the remote alternative led to higher patient satisfaction (95.1% vs 55.0%) and acceptability (84.8%). The choice for long-acting reversible contraceptives was not affected by the removal of in-person consultation. CONCLUSION: A remote follow-up procedure is an acceptable and less costly alternative to hospital-based follow-up with a higher rate of acceptability and adherence by the studied population.

FertiSTAT: A Potential Tool for Adolescent Sexual Health.

STUDY OBJECTIVE: The FertiSTAT (fertility status awareness) tool provides personalized advice on reducing risk factors for infertility and seeking medical advice on the basis of lifestyle and reproductive profile. The aim of our research was to test the FertiSTAT tool in younger patients (14-24 years). A secondary objective was to screen for and evaluate knowledge of risk factors that affect fertility. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Patients aged 14-24 years attending consultations at Geneva University Hospitals received a quantitative questionnaire before consultations. Questions covered lifestyle, gynecological history, perception of fertility, and pregnancy intent. We investigated respondents' beliefs with regard to risk factors for infertility through "true/false" questions. We selected questions relevant to our population from the original FertiSTAT questionnaire to calculate each respondent's FertiSTAT score. Scores ranged from "blue" (low risk, score 1) to "red" (risk of infertility, score 4). RESULTS: A total of 279 women aged 14-24 years were included. Nonpregnant patients had overall higher FertiSTAT scores (2.7 ± 0.8). Upon logistic regression analysis, with every additional FertiSTAT point, the odds of being pregnant at the time of survey decreased by 0.48. Risk factors for infertility and knowledge of these risk factors were equally distributed between pregnant and nonpregnant women. CONCLUSION: Our findings suggest FertiSTAT might be a useful tool in the younger population to whom we extended it, and highlight gaps in knowledge on risk factors for infertility. These findings are of interest when considering FertiSTAT as a starting point to discuss contraception and risk factors for infertility at an age at which risk mitigation would prove most effective in preserving future fertility.

Spontaneously conceived 17-week heterotopic pregnancy: a challenging and unusual diagnosis.

A 37-year-old woman, gravida 2 para 1, arrived in our emergency clinic at 16 2/7 weeks of a spontaneously conceived pregnancy for abdominal pain. She was on oral antibiotics for 2 days to treat a suspected urinary tract infection with no improvement. Blood tests, abdominal ultrasound and intrauterine fetus were all normal. She left our emergency unit with laxatives. Four days later, she returned to our clinic with severe abdominal pain. We repeated abdominal and foetal ultrasonography and identified a left para-uterine 7×5 cm mass. As adnexal torsion was suspected, we performed an emergency laparoscopy. At laparoscopy, we found a left haematosalpinx and realised a left salpingectomy. Histology confirmed the presence of a heterotopic pregnancy (HP). This case illustrates the importance of exploring the adnexa in a gravid woman presenting with abdominal pain in the first and early second trimesters. Although rare, excluding a HP may prevent a life-threatening haemorrhage.