SASGOG's Pearls of Exxcellence

Contraception in Women with Cardiovascular Risk Factors

Cardiovascular risk factors include hypertension, diabetes, obesity, smoking and increasing age, and may limit options for contraception, particularly hormonal methods. Clinicians should use the USMEC to guide their counseling and...

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Management of Vaginal Cysts

Vaginal cysts occur in 1% of all women. Most are benign, asymptomatic, discovered incidentally, and should be managed expectantly. Common benign causes of vaginal cysts include remnants of the embryonic...

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Secondary Amenorrhea

Secondary amenorrhea is defined as no menses for 3 months in patients with previously regular menstrual cycles or 6 months in patients with irregular menstrual cycles. The differential diagnosis for...

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Evaluation of Stress Urinary Incontinence

Stress urinary incontinence is an involuntary urinary loss from physical exertion related to increased abdominal pressure, resulting in a reduced quality of life. Of the 16% of adult women...

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Non-surgical Management of Stress Urinary Incontinence

Treatments options for stress urinary incontinence (SUI) include conservative therapies (pelvic floor exercises, behavioral modifications, continence support devices, and urethral inserts) and surgical treatments options (retropubic urethropexies, autologous, fascial slings,...

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Management of Primary and Recurrent HSV 2 Vulvar Infections

Serologic surveys show 26% of women 12 years and older have antibodies to HSV-2. While the initial presentation is similar for HSV-1 and HSV-2, most recurrences are caused by HSV-2....

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Contraception in Women with Thromboembolism and Thrombophilia

Estrogen administration increases the risk of venous thromboembolism (VTE) in women with a history of prior thromboembolism or known thrombogenic mutation by increasing hepatic production of coagulant factors. Additive risk...

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Metabolic Syndrome

The metabolic syndrome encompasses a cluster of risk factors including central obesity, dyslipidemia, elevated blood pressure, and raised fasting glucose. Together these factors increase the risk of atherosclerotic cardiovascular disease,...

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Contraception in Patients with Lupus

Systemic Lupus Erythematosus (SLE) is an autoimmune disease with a highly variable presentation that occurs more commonly in females than males (10:1 ratio) and is most common in women of...

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Anal Incontinence

Fecal incontinence is defined as the involuntary loss of liquid or solid stool, whereas anal incontinence, commonly termed “accidental bowel leakage” (ABL), also includes the loss of flatus. The prevalence...

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Hormonal Contraception in Women Taking Medications with Potential Drug Interactions

Interactions between hormonal contraceptives and other medications can cause alteration of therapeutic medication level, increased toxicity, and decreased contraceptive efficacy. Combined hormonal contraceptives (CHCs) include products with estrogen and progestin,...

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Evaluation of the Adnexal Mass in an Older Patient

The evaluation and management of an adnexal mass in an older patient is an important clinical challenge. Primary ovarian lesions include functional cysts, neoplastic cysts and solid masses (benign, borderline,...

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Management of Persistent and Recurrent Trichomoniasis

Trichomonas vaginalis (T. vaginalis) is a protozoan parasite, and is the most common nonviral sexually transmitted infection (STI), with 3-5 million cases annually, in the United States. Health disparities...

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Management of Women on Hormonal Therapy or Contraception in Women Undergoing Surgery

Hormone therapy and use of combination hormonal contraceptives are associated with an increased risk of venous thromboembolism. Menopausal women taking oral estrogen plus progesterone therapy are twice as likely to...

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Postmenopausal Vulvar Disorders

A decline in skin barrier function associated with aging and estrogen deficiency contributes to an increased susceptibility to various postmenopausal vulvar conditions. The most common symptoms are itching and burning....

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Non-proliferative Breast Masses in Young Women

The differential diagnosis of a breast mass in a young patient includes benign cyst, fibrocystic changes, fibroadenoma, breast abscess, galactocele, fat necrosis, and malignancy. Evaluation should include history, exam, and...

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Management of a Patient who has Suffered Intimate Partner Violence

Domestic violence, or intimate partner violence (IPV), is threatening or controlling behavior inflicted on a person by another person in the context of an intimate relationship. Intimate partner violence...

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Evaluation of Postmenopausal Vaginal Bleeding

Postmenopausal bleeding (PMB) is defined as any staining, spotting, or bleeding that occurs more than 12 months after a woman’s last menstrual period. PMB most commonly results from vaginal or...

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Fertility-Sparing Fibroid Treatments

Although the presence of fibroids does not usually impair fertility or affect an ongoing pregnancy, some patients with fibroids may face several pregnancy-related risks. Fibroid location plays an important role...

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Proximal Tubal Occlusion

Proximal tubal occlusion is a common finding on hysterosalpingogram, occurring in up to 15% of studies. The occlusion is seen at the utero-tubal junction, where radiographic contrast fails to enter...

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Ongoing Care of a Woman with Breast Cancer on an Aromatase Inhibitor

Breast cancer is the second leading cause of cancer death among women in the United States. Seventy five percent of breast cancers are estrogen receptor (ER) or progesterone receptor (PR)...

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Management of Atypical Glandular Cells

Though atypical glandular cells (AGC) are uncommon, occurring in approximately 3 per 1000 specimens, the associated risk of invasive malignancy is as high as 2-5%. All patients with...

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Hyperprolactinemia

Prolactin is a protein mainly synthesized and secreted by the lactotroph cells in the pituitary gland. Hyperprolactinemia is defined by a high level of serum prolactin above the standard limit...

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Hypothyroidism

ETIOLOGY Hypothyroidism is much more common in women than men. It occurs in up to 5% of women, with approximately 0.3-0.5% being overt and 0.7% subclinical. Hypothyroidism is more...

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Primary Amenorrhea in a Teenager

Primary amenorrhea (PA) is defined absence of menarche by 15 years old. Secondary amenorrhea is defined as the cessation of regular menses for 3 months or the cessation of irregular...

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Management of Adnexal Cysts

Adnexal cysts may be identified based on gynecologic symptoms or may be incidentally noted during pelvic exam or imaging for other reasons. Further actions depend on imaging characteristics and symptoms....

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Management of Paget Disease of the Vulva

Extramammary Paget Disease (EMPD) of the vulva is a rare intra-epithelial adenocarcinoma of the vulvar skin presenting most commonly with pruritus. Unfortunately, diagnosis is often delayed as both patients and...

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Management of a Thyroid Nodule

The prevalence of thyroid nodules varies with the level of iodine sufficiency. Because iodine deficiency is relatively rare in the United States, only about 5% of US women will have...

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Overactive Bladder

Overactive bladder (OAB) is defined by the International Continence Society (ICS) as “urinary urgency, typically accompanied by frequency and nocturia, with and without urge urinary incontinence, in the absence of...

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Contraception for Patients with Migraines

Migraine headache is a common condition that affects up to 24% of females aged 18-39. A migraine is a headache lasting 4 to 72 hours and must have nausea,...

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Contraception for Women with Diabetes

The prevalence of diabetes mellitus is increasing worldwide, including among women of childbearing age, with an additional 150 million adult cases projected by 2030. Diabetes poses significant...

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Lynch Syndrome

Lynch syndrome is an autosomal dominant hereditary cancer syndrome which commonly presents with colon cancer, endometrial cancer, or ovarian cancer. It is also associated with cancers of the stomach,...

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Infertility in patients with PCOS

Polycystic ovarian syndrome (PCOS) is the leading cause of infertility in reproductive-age women. Anovulation is typically the cause of infertility in PCOS. However, evaluating anatomic reasons using an...

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Abnormal Uterine Bleeding in Adolescents

Abnormal uterine bleeding (AUB) in adolescents is defined as excessive bleeding occurring between menarche and 19 years of age. During the first 12–18 months after the onset of menstruation, immaturity...

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Complications of Pessary Use

Pessary devices have been used for a number of indications including pelvic organ prolapse, urinary incontinence, preterm labor, and cervical insufficiency. They are considered a safe and reasonable long-term option...

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Vaginal Squamous Intraepithelial Lesions

Vaginal intraepithelial neoplasia (VaIN) affects 0.2 per 100,000 women in the United States. VaIN, like cervical intraepithelial neoplasia (CIN), is caused by human papillomavirus (HPV). High-risk HPV (hrHPV)...

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Management of Hirsutism in a PCOS Patient

Hirsutism is often a primary complaint in women with PCOS. The most effective treatment includes a long-term approach that reduces androgen receptor activity, thus decreasing new terminal hair development, and...

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Evaluation and Management of Bleeding in Perimenopausal Women

The perimenopause is defined as the onset of intermenstrual cycle variability (±7 days) and/or classic menopausal symptoms through two years after the final menstrual period. Menopause is achieved after 12...

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Management of Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a severe form of Premenstrual Syndrome (PMS) associated with marked behavioral, emotional, and potentially physical symptoms. According to the American Psychiatric Association Diagnostic and Statistical...

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Evaluation of Sexual Dysfunction

Female sexual dysfunction is defined as any sexual complaint or problem that results from disorders of desire, arousal, orgasm, or sexual pain and causes marked distress or interpersonal difficulty lasting...

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Migraine, Cluster, and Tension Headaches

Headaches may be classified as primary or secondary. Primary headaches have no associated underlying pathologic abnormalities. The principal primary headaches include cluster, migraine, and tension-type headaches. These syndromes...

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Urodynamics: Indications for the Procedure and Systematic Interpretation

Urinary incontinence evaluation includes a detailed history, physical examination, demonstration of stress incontinence, assessment of urethral mobility, determination of symptom severity, and identification of treatment goals. Patients who screen positive...

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Transgender Care

The terms transgender male or transgender man describe individuals who were sex-assigned female at birth who identify on the more masculine spectrum of gender identity. The transgender and gender-diverse experience...

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Management of Lost Subdermal Contraceptive Implant

When an etonogestrel contraceptive implant cannot be palpated, pregnancy must first be excluded, and the patient should use an alternative method of contraception until the presence of the implant can...

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Recurrent Bacterial Vaginosis

Bacterial vaginosis occurs when the vaginal microbiota dominant species shifts from Lactobacillus to Gardnerella vaginalis and anaerobic bacteria. Bacterial vaginosis affects 15% to 30% of individuals. Risk factors include cigarette...

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Intrauterine Device in Place During Pregnancy

The risk of becoming pregnant with an intrauterine device (IUD) in place is very low, similar to the risk of pregnancy occurring following tubal sterilization, about 2% over 10 years....

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Physician Guide to Promoting Equitable and Socially Just Obstetric Care

Significant inequities in obstetric clinical outcomes persist despite advancement in technology and social protections such as higher education and income. The disproportionate burden of premature death and morbidity affects historically...

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Addressing Microaggression in Women's Health Care Settings

Microaggressions are subtle, often recurrent, verbal and nonverbal interactions that are demeaning or engender hostility toward marginalized communities and nondominant groups. Microaggressions may be conscious or unconscious and include several...

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Evaluating Pelvic Floor Dysfunction in Chronic Pelvic Pain or Dyspareunia

Pelvic floor dysfunction is a broad term used to describe the abnormal activity or function of the pelvic floor musculature. Pelvic floor relaxation can lead to pelvic organ prolapse or...

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Medication Abortion

Editor’s Note: This article is accurate and current as of the publication and review date. Practitioners need to be aware of the laws concerning this subject, and the variability of...

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Female Sexual Interest/Arousal Disorder and Female Orgasmic Disorder

Sexual function is a complex interaction among biological, medical, psychosocial, interpersonal, and sociocultural factors. Almost half of women (43%) experience sexual dysfunction and 12% of women report related personal distress...

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Management of Lactational Mastitis

Mastitis spectrum conditions are common disorders of lactation that can contribute to early cessation of lactation. Prompt recognition and consistent treatment recommendations can prevent worsening complications and assist patients with...

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