Overview of the etiology and diagnostic evaluation of vulvovaginal complaints in the postmenopausal population including both estrogen's role in atrophic vaginitis and other causes of vulvovaginal complaints and how they relate to sexual function. Summary of various management options such as hormonal, nonhormonal, and botanical interventions.

Introduction Despite the high prevalence of both female sexual problems and bladder dysfunction in the premenopausal population, sexual history forms used in primary care offices rarely include questions about the impact of bladder dysfunction on sexual health. Aim To provide a review of the literature that illustrates the relationship between bladder problems and sexual performance of premenopausal women. Main Outcome Measures To objectively support by a review of the literature the need for a complete bladder history in when evaluating premenopausal women with female sexual dysfunction. Methods Pubmed was searched for all articles (from November 1980 to June 2007) that reported on the effect bladder dysfunction has on premenopausal female sexual function. Results The scant literature available strongly suggested that bladder dysfunction is a contributor to sexual dysfunction and that this medical concern should be considered in all women, regardless of age who present with sexual complaints. Conclusion Further studies need to be conducted in order to solidify a direct causal relationship between bladder dysfunction and premenopausal female sexuality. These studies should include a larger sample size, clearly defined types of sexual dysfunction and bladder dysfunction, and appropriate follow-up of patient responses using validated objective and subjective outcome modalities to confirm that the patient responses are factual.

Objective Opioid prescription after cesarean delivery is excessive and can lead to chronic opioid use disorder. We assessed the impact of an enhanced recovery after surgery (ERAS) pathway on inpatient opioid consumption after cesarean delivery. Study Design An ERAS pathway was implemented as a quality improvement initiative in December 2019. Preintervention (PRE) data were collected from March to May 2019 to assess baseline opioid consumption. Postintervention (POST) data were collected from January to March 2020. The primary outcome was inpatient postoperative opioid consumption in morphine milligram equivalents (MME). Secondary outcomes included the consumption of any opioids, postpartum length of stay, and opioid prescription at discharge. Results A total of 92 women were in the PRE group and 91 were in the POST group. Inpatient opioid consumption decreased by 87.3% from PRE to POST, from 124.7 (interquartile range [IQR]: 10–181.6) MME to 15.8 (IQR: 0–75) MME (p < 0.001). There was no difference in median postpartum length of stay (3.4 days PRE vs. 3.3 days POST; p = 0.12). The proportion of women who did not consume any opioids increased by 75.4% from PRE to POST (p = 0.02). The proportion of women discharged with an opioid prescription decreased by 25.6% from PRE to POST (p = 0.007), despite no formal change to prescribing practices. After adjustment for differences in race/ethnicity and gravidity, there was still a reduction in total inpatient opioid consumption (p < 0.001) and an increase in the proportion of women not consuming any opioids (adjusted relative risk (RR): 2.14, 95% confidence interval [CI]: 1.18–3.87), but the difference in rate of prescription of opioids at discharge was no longer statistically significant (adjusted RR: 0.70, 95% CI: 0.48–1.02). Conclusion Adoption of an ERAS pathway for cesarean delivery resulted in a marked reduction in inpatient opioid consumption. Such a pathway can be implemented across institutions and may be a powerful tool in combating the opioid epidemic. Key Points

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