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Gynecology

• Editor's Note
• List of Articles

List of Articles

• Female Sexual Dysfunction
  Sexual intimacy is an integral part of life and is closely linked to emotional and physical well-being. Sexual dysfunction encompasses a broad spectrum of issues in the psychological, physical, interpersonal, and physiological realms. The purpose to this document is to discuss the etiology and diagnosis of female sexual dysfunction and the discussion below offers basic therapeutic approaches to the management of sexual complaints. While pharmacologic options for treating male sexual dysfunction continue to proliferate, the development of such drugs for women has lagged far behind. Now, however, a number of agents are emerging that may help to fill this gap. A discussion of the detailed evaluation and management of dyspareunia and vaginismus is beyond the scope of this article; however, diagnosis of an underlying etiology for the pain should be sought. Both disorders can benefit from education, pelvic floor physical therapy (including biofeedback and massage), and psychological counseling.
  
  
• Emergency Contraception
  Emergency contraception (EC), also known as post-coital contraception and the morning-after pill, refers to the use of drugs or a device as an emergency measure to prevent pregnancy. Women, who have had recent unprotected intercourse, including those who have had a failure of another method of contraception, are potential candidates for this intervention. It is intended for occasional or back-up use, not as a primary contraceptive method for routine use. The purpose of this document is to address the progestin-only and combined oral contraceptive methods (which are the most frequently used methods and also approved by the U.S. Food and Drug Administration [FDA] specifically for emergency contraception) and briefly address the use of the copper intrauterine device (IUD) because of its use as both long-term contraception and emergency contraception. Recently approved 5-day emergency contraceptive (ulipristal acetate) by FDA is explored. Future possibilities are also reviewed. To maximize effectiveness, women should be educated about the availability of emergency contraception methods. Clinical evaluation is indicated for women who have used emergency contraceptive if menses are delayed by a week or more after the expected time or if lower abdominal pain or persistent irregular bleeding develops. Increasing emergency contraception (EC) awareness and knowledge are important priorities in the effort to prevent unwanted and unintended pregnancy.
  
  
• Intrauterine Contraception
  Intrauterine device (IUD) is the second most popular contraceptive method worldwide, after sterilization. Today's women have more birth control options than ever before. And with the increased options come increased expectations. The purpose of this document is to discuss evidence regarding the safety and efficacy of the levonorgestrel intrauterine system (LNG-IUS) and copper-bearing (TCu380A) intrauterine contraception. To achieve more widespread use of IUDs among women who are appropriate candidates, health care providers should understand the risks, benefits, indications, and contraindications of IUD use. Two IUDs currently are available in the United States: 1) the copper TCu380A, and 2) the levonorgestrel intrauterine system (LNG-IUS). A growing body of evidence attests to the safety and effectiveness of IUDs and their potential role in rates of unintended pregnancy.
  
  
• Sterilization
  Worldwide, sterilization (tubal sterilization and vasectomy) is used by more people than any other method of contraception. Female surgical sterilization is the second most commonly used method of contraception among women in the United States. The purpose of this document is to provide an overview of surgical sterilization, with a focus on tubal sterilization and the major clinical alternatives to this procedure -- vasectomy and long-acting contraceptives. The emphasis should be on the safety and effectiveness of tubal sterilization as compared with these alternatives. For women who no longer desire family, sterilization is a safe and highly effective option. With today's technology, transcervical sterilization can easily be performed both comfortably and cost-effectively in an office setting rather than operating room, making sterilization a convenient and private choice for non-reversible birth control.
  
  

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