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Introduction Describe differences in sexual activity and function in women with and without pelvic floor disorders (PFDs). Methods Heterosexual women > 40 years of age who presented to either Urogynecology or general gynecology clinics at 11 clinical sites were recruited. Women were asked if they were sexually active with a male partner. Validated questionnaires and Pelvic Organ Prolapse Quantification (POPQ) examinations assessed urinary incontinence (UI), fecal incontinence (FI) and/or pelvic organ prolapse (POP). Sexual activity and function was measured by the Female Sexual Function Index (FSFI). Student’s t-tests were used to assess continuous variables; categorical variables were assessed with Fisher’s exact test and logistic regression. Univariate and multivariate analyses were used to assess the impact of PFDs on FSFI total and domain scores. Results 505 women met eligibility requirements and consent for participation. Women with and without PFDs did not differ in race, BMI, co-morbid medical conditions, or hormone use. Women with PFDs were slightly older than women without PFDs (55.6 + 10.8 vs. 51.6 + 8.3 years, P <0.001); all analyses were controlled for age. Women with PFDs were as likely to be sexually active as women without PFDs (61.6 vs. 75.5%, P=0.09). There was no difference in total FSFI scores between cohorts (23.2 + 8.5 vs. 24.4 + 9.2, P= 0.23) or FSFI domain scores (all p = NS). Conclusion Rates of sexual activity and function are not different between women with and without PFDs.

We found that proficiency-based simulation offers additional benefit to traditional education for all levels of residents. The use of easily accessible, low-fidelity tasks should be incorporated into formal laparoscopic training.

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Vaginal hysterectomy fulfills the evidence-based requirements as the preferred route of hysterectomy for benign gynecologic disease. Despite proven safety and effectiveness, the vaginal approach for hysterectomy has been and remains underused in surgical practice. Factors associated with underuse of vaginal hysterectomy include challenges during residency training, decreasing case numbers among practicing gynecologists, and lack of awareness of evidence supporting vaginal hysterectomy. Strategies to improve resident training and promote collaboration and referral among practicing physicians and increasing awareness of evidence supporting vaginal hysterectomy can improve the primary use of this hysterectomy approach.

Introduction and hypothesis-This study seeks to determine if total vaginal length (TVL) or genital hiatus (GH) impact sexual activity and function.

Concerns about medical malpractice and the medical liability crisis are not new. Their impact on the field of obstetrics and gynecology has been discussed since the 1970s and 1980s.1 Evaluations of the specific bearing of the liability crisis on obstetricians and gynecologists have demonstrated regional influence on providers.2,3 Nationally, more than 60% of obstetricians and gynecologists have made one or more changes to their practices as a result of the affordability or availability (or both) of professional liability insurance or because of the perceived risk or fear of professional liability claims or litigation. 4 To date, few studies have investigated the influence of the liability crisis on the decision patterns of residents. Mello and Kelly 5 surveyed Pennsylvania residency program directors and senior residents in anesthesiology, general surgery, emergency medicine, obstetrics and gynecology,The authors wish to recognize Mary Behneman, BS, Christine Himes, and LaShawn Jordan, BS, for administrative assistance in the production, tracking, and collection of the surveys. Special thanks to Andrea M. Carpentieri, MA, for assistance in data collection and analysis, and to Sterling Williams, MD, MS, for aid in the creation and conceptual development of the project. Mss Behneman, Himes, Jordan, and Carpentieri and Dr Williams received no compensation for their contributions.Corresponding author: May Hsieh Blanchard, MD, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, 11 South Paca Street, Suite 400, Baltimore, MD 21201, 410.328.5964, mblanchard@fpi.umaryland.edu Received June 20, 2011; revision received November 6, 2011 and December 6, 2011; accepted January 9, 2012. DOI: http://dx.doi.org/10.4300/JGME-D-11-00135.1 AbstractIntroduction The liability crisis may affect residency graduates' practice decisions, yet structured liability education during residency is still inadequate. The objective of this study was to determine the influence of medical liability on practice decisions and to evaluate the adequacy of current medical liability curricula.

Endometriosis is defined as the presence of endometrial glands and stroma outside the uterine cavity. Although the exact pathophysiology is unclear, endometriosis is a wellknown cause of pelvic pain and infertility in reproductive-aged women. Endometriosis can have extrapelvic manifestations relevant for colorectal surgeons to appreciate, such as cyclic constipation, diarrhea, hematochezia, and dyschezia. The treatment of endometriosis involves a combination of medical and surgical interventions where close collaboration between the gynecologist and colorectal surgeon can help achieve prolonged periods of symptom remission.