No abstract

Vestibulodynia, the most common type of chronic vulvovaginal pain, impairs the psychological, physical health of nearly 10% of women at some point in their lifetime. The aim of this investigation was to establish reliable standardized methodologies for assessment of pain sensitivity in vulvar mucosa and pelvic musculature. We enrolled 34 women with vestibulodynia and 21 pain-free controls. The participants underwent a nuanced exam that consisted of palpation of precisely located vulvar mucosal and pelvic muscle sites. These measurements remained highly stable when participants were reexamined after two weeks, with high within-examiner correlation. Vestibulodynia patients reported greater sensitivity than pain-free controls at the majority of examination sites, particularly at mucosal sites on the lower vestibule. The pain threshold measures at the lower mucosal sites were also associated with the participants’ self-reported pain levels during intercourse. These mucosal pain threshold measurements were used to discriminate between vestibulodynia cases and controls with high sensitivity and specificity. This data supports the feasibility of contemporaneous assessment of vulvar mucosa and underlying musculature in the pelvic region, offering the hope of a more precise case definition for vestibulodynia and related disorders.

The risk of uterine rupture among women with a prior cesarean delivery undergoing second-trimester abortion using misoprostol is less than 0.3%. This may be acceptable to both patients and providers.

No abstract

In response to the coronavirus disease 2019 pandemic, Texas Governor Greg Abbott issued an executive order on March 22, 2020, postponing surgeries and procedures that were not medic ally necessary. 1 Texas officials interpreted this to prohibit most abortions until the order expired on April 21, 2020, contrary to medical associations' recommendations. 2 The objective of this analysis was to assess changes in abortions following the executive order. We also hypothesized that abortions performed at 12 weeks' gestational age (GA) or more would increase after the order expired.

The number of women of childbearing age who are active duty service members or veterans of the U.S. military is increasing. These women may seek reproductive health care at medical facilities operated by the military, in the civilian sector or through the Department of Veterans Affairs. This article reviews the current data on unintended pregnancy and prevalence of and barriers to contraceptive use among active duty and veteran women. Active duty servicewomen have high rates of unintended pregnancy and low contraceptive use which may be due to official prohibition of sexual activity in the military, logistic difficulties faced by deployed women and limited patient and provider knowledge of available contraceptives. In comparison, little is known about rates of unintended pregnancy and contraceptive use among women veterans. Based on this review, research recommendations to address these issues are provided.

The number of women who are active duty service members or veterans of the U.S. military is increasing. Studies among young, unmarried, active duty servicewomen who are sexually active indicate a high prevalence of risky sexual behaviors, including inconsistent condom use, multiple sexual partners, and binge drinking, that lead to unintended and unsafe sex. These high-risk sexual practices likely contribute to chlamydia infection rates that are higher than the rates in the U.S. general population. Human papillomavirus (HPV) infection and cervical dysplasia may also be higher among young, active duty servicewomen. Little is known about the sexual practices and rates of sexually transmitted infections among older servicewomen and women veterans; however, women veterans with a history of sexual assault may be at high risk for HPV infection and cervical dysplasia. To address the reproductive health needs of military women, investigations into the prevalence of unsafe sexual behaviors and consequent infection among older servicewomen and women veterans are needed. Direct comparison of military and civilian women is needed to determine if servicewomen are a truly high-risk group. Additionally, subgroups of military women at greatest risk for these adverse reproductive health outcomes need to be identified.

The purpose of this prospective cohort study was to compare pain during IUD insertion between women with a history of vaginal delivery and women without a history of vaginal delivery. First-time IUD users chose either the CuT380A or the levonorgestrel IUS. We enrolled 49 women with previous vaginal delivery and 49 women with no history of vaginal delivery (either only caesarean deliveries or nulliparous). The mean pain score on a 0-100 mm visual analog scale during insertion in the vaginal delivery group was 34.7 (SD 31.6) compared with 51.2 (SD 29.2) in the group without previous vaginal delivery (p = 0.009). In multivariable analysis controlling for age, breast-feeding, expected pain, baseline anxiety, insertion timing (6-12 weeks postpartum, 2-4 weeks post-abortion or interval), and insertion difficulty, history of vaginal delivery was associated with a 15.5 point reduction in pain (95% CI, -27.4, -3.7). Other significant predictors of pain were 'expected pain' and 'insertion difficulty'.