Background: Patient comfort and safety are prerequisites for office procedures. Study objective: comparison of the fentanyl transdermal patch with injection of local anesthesia for intraoperative/postoperative pain from in-office Thermachoice III ablations. Methods: Single-center prospective randomized (1:1) cohort study. Primary endpoint: intraoperative and postoperative VAS pain scores (0 as no pain, 10 as extreme pain). Secondary endpoints: patient satisfaction between cohorts and adverse events. Results: 41 patients were randomized [21 patch protocol (FP), 20 injection protocol (IP)]. For patch users, the median VAS scores were 2.60 (range 1–4) intraoperatively and 3.30 (range 2–5) postoperatively (p = 0.09, CI = –0.8 to 0.4), with the most common adverse events being nausea (62%) and vomiting (38%). Compared to injection, there was no significant difference in intraoperative VAS score (FP median VAS = 2.60, IP median VAS = 2.59; p = 0.15, CI = –0.05 to 0.48), but a significant difference postoperatively (FP median VAS = 3.30, IP median VAS = 6.0; p = 0.01, CI = –2.6 to –1.4). Less NSAIDs were used postoperatively with the FP. At 24 h, more FP patients were ‘very satisfied’ or ‘satisfied’ than IP patients. Conclusion: Patch intraoperative VAS pain scores are comparable to uterine block scores; postoperative VAS pain scores were statistically lower with the FP. FP resulted in more favorable ‘satisfaction’ rates compared to IP.

Background An estimated 25,000 pregnancies result from sexual assault in the United States annually. Numerous professional healthcare organizations endorse offering emergency contraception (EC) as an integrated aspect of post-sexual-assault care. Lack of knowledge surrounding EC's mechanism of action, including misinterpreting ECs as abortifacients, might restrict patient access to this important healthcare option. Purpose We evaluated sexual assault nurse examiners' understanding of the mechanism of action of oral ECs levonorgestrel (LNG) and ulipristal acetate (UPA). Methods A cross-sectional survey of practicing sexual assault nurse examiners was conducted through the International Association of Forensic Nurses. Results Among 173 respondents, 96.53% reported they prescribed/dispensed EC at the time of medical forensic examinations. LNG was prescribed more frequently than UPA (57.80% vs. 38.2%, respectively). When asked if they agreed or disagreed if LNG and UPA can disrupt an established pregnancy, 83.2% selected disagree/strongly disagree for LNG versus 78.6% for UPA, which were not significantly different. When asked whether the Supreme Court ruling overturning Roe v. Wade would change their EC prescribing, 79.77% reported it will have no change, 6.94% said it would increase, and 12.72% reported they were unsure. Several commented they were concerned whether state laws would prohibit EC and at least one program stopped prescribing EC because of their state laws. Implications Addressing misinformation regarding EC's mechanism of action and increasing access to oral EC options after sexual assault have the potential to reduce the incidence of rape-related pregnancy.

ObjectiveTo determine patient preference for laparoscopic tubal occlusion or hysteroscopic tubal occlusion, two common sterilization interventions, and the acceptability of a postprocedure confirmation test for a hysteroscopic approach.Participants and methodsA total of 100 patients were offered two procedures. A description of each procedure was developed and read to each patient by a research nurse on site. Patients were then asked to respond to a questionnaire concerning options. Final informed consent, procedure review, and procedural date determination were provided by a physician upon completion of the questionnaire. Patients were not allowed to change their questionnaire responses after completion. No interviewer or physician input was allowed during the questionnaire. The study was completed in English or Spanish, as per patient request, by a bilingual/fluent speaker. Physicians completing informed consent were unaware of the questionnaire responses. Patients were not financially incentivized.ResultsOf 100 participants, 93 (93%) preferred hysteroscopic sterilization to laparoscopy. The reasons were as follows: fear of general anesthesia (24/93 [26%]), fear of incision (25/93 [27%]), cost (32/93 [34%]), and time (12/93 [13%]) to return to routine activity. All 93 viewed “office-based location” as the main advantage over laparoscopy; 88/93 (94.6%) considered a confirmation test to be a benefit of the procedure. After informed consent was obtained, one additional patient switched from a laparoscopic decision to hysteroscopy (total = 94/100); 89/94 (95%) hysteroscopic decisions underwent hysteroscopic sterilization; 4/6 (67%) laparoscopic decisions proceeded to that surgery. The remainder (N = 7) cancelled due to lack of financial resources.ConclusionA nonincisional, office-based approach to sterilization has high patient acceptability. Patients viewed a confirmatory test for tubal occlusion as a benefit after sterilization.

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