Qualitative Analysis of Program Director Perspectives on Conscientious Objection Policies to Gender-Affirming Care.

Introduction: Emerging reports of objection to gender-affirming care by resident physicians in obstetrics and gynecology (OBGYN), plastic surgery, urology, and pediatric training programs have begun to highlight the rising incidence and ethical complexities of trainee-objection scenarios. This study examines perspective of residency program leadership toward trainee objection to gender-affirming care.

Methods: Program directors from accredited U.

Transgender Vulvar and Clitoral Anatomy: A Guide for Gynecologists.

Background: It is important for gynecologists to understand postoperative anatomy to provide inclusive and competent care to patients who have undergone gender-affirming vaginoplasty. The neoclitoris and neovula differ from cisgender anatomy. This article and associated video address these knowledge gaps to enhance gynecologic care for transgender patients.

Assessment of Sexual Activity and Contraceptive Counseling Among Transgender Individuals Initiating Testosterone.

Context: Testosterone, which some transgender and non-binary (TGNB) individuals born with a uterus will use for gender affirmation, is not a form of contraception. Gaps remain in understanding how well clinicians address contraceptive needs with individuals initiating testosterone.

Methodology: This was an IRB-approved retrospective analysis of TGNB individuals on testosterone for gender affirmation.

Outcomes at 12, 24, and 36 Months in Women Treated for Pelvic Organ Prolapse With Pessary or Surgery: Results From the Multicenter Pelvic Floor Disorders Registry.

Objective: The aim of this study was to describe real-world outcomes in women treated for pelvic organ prolapse (POP) with pessary or surgery over 36 months.

Study Design: We report outcomes of patients in a multicenter, prospective registry who opted for treatment of POP with either pessary (discontinuation or retreatment with surgery rates and subjective improvement) or surgery (retreatment rates or subjective improvement).

Results: Among 1,153 patients, follow-up was available for 248 (84%), 123 (42%), and 98 (33%) in the pessary group and 717 (93%), 407 (53%), and 331 (43%) in the surgery group at 12, 24, and 36 months, respectively.

The Survey of Barriers for Vaginal Access Surgery Study.

Study Objective: The primary objective of this study was to describe vaginal hysterectomy practice patterns as well as facilitators and inhibitors to performing vaginal hysterectomy among gynecologic surgeons. Secondary objectives were to describe facilitators and inhibitors to the teaching and training of vaginal hysterectomy.

Design: A quantitative analysis of an online survey and qualitative analyses of the one-on-one interviews with gynecologic surgeons were conducted.

Evaluation of Comprehensive Documentation After Obstetric Anal Sphincter Injury.

Introduction And Hypothesis: The incidence of obstetric anal sphincter injuries (OASI) has increased in recent years, which may be due to improved recognition and documentation. There is limited evidence regarding the effects of thorough documentation of obstetric anal sphincter injury repairs on postpartum clinical outcomes. Our objectives were to (1) compare the incidence of perineal wound complications between documentation groups, (2) compare other adverse events, and (3) to describe factors associated with adequate documentation.

Virtual Compared With In-Office Postoperative Visits After Urogynecologic Surgery: A Randomized Controlled Trial.

Objective: To compare patient satisfaction, health care resource utilization, and adverse events among patients receiving a virtual video compared with in-office postoperative visit after urogynecologic surgery. We hypothesized that virtual video visits would be noninferior to in-office visits.

Methods: This was a randomized noninferiority clinical trial of patients undergoing surgery for pelvic organ prolapse and urinary incontinence at a single academic tertiary referral center.

Dynamic Changes of the Genital Hiatus at the Time of Prolapse Surgery: 1-Year Follow-Up Study.

Importance: The genital hiatus (GH) has been identified as a predictor of pelvic organ prolapse. An enlarged preoperative GH is a risk factor for recurrent prolapse after surgery.

Objective: The objective of this study was to determine the changes in preoperative and postoperative GH size compared with the intraoperative resting GH at 6 weeks and 12 months after native-tissue pelvic organ prolapse surgery.

Management of breakthrough bleeding in transgender and gender diverse individuals on testosterone.

Background: While many transgender and gender diverse individuals rapidly achieve amenorrhea on testosterone, emerging data have identified that breakthrough bleeding can occur in up to one-third of individuals with long-term use. Breakthrough bleeding can worsen dysphoria and patients may seek management to reattain amenorrhea. Because of this, there is a need to assess efficacy of management approaches.

Same-day Discharge Following Vaginal Hysterectomy and Native-tissue Apical Repair for Uterovaginal Prolapse: A Prospective Cohort Study.

Introduction And Hypothesis: The safety and feasibility of same-day discharge (SDD) has been consistently reported across the benign and gynecologic oncology literature. However, outcomes of SDD in the urogynecology population are sparse. The objectives of this study were to describe the success of SDD following vaginal hysterectomy and native-tissue colpopexy, and to compare the incidence of postoperative adverse events in patients discharged same-day versus postoperative day 1 (POD1).

Does the setting for intradetrusor onabotulinumtoxinA injection for management of overactive bladder matter?

Introduction: Intradetrusor onabotulinumtoxinA (Botox) injections, to treat idiopathic overactive bladder (OAB), can be performed in the office setting under local analgesia alone or in the operating room (OR) under local and/or sedation. The objective of this study was to compare the symptomatic improvement in patients with OAB who underwent treatment with intradetrusor onabotulinumtoxinA injections in an in-office versus the OR setting.

Methods: We performed a multicenter retrospective cohort study of women with the diagnosis of refractory non-neurogenic OAB who elected to undergo treatment with intradetrusor onabotulinumtoxinA injections between January 2015 and December 2020.

Classification and treatment of vaginal strictures at the donor-recipient anastomosis after uterus transplant.

Objective: To describe the incidence and management of vaginal stricture after uterus transplantation (UTx) in the US, to propose a grading system to classify stricture severity, and to identify risk factors for stricture formation.

Design: Prospective cohort study.

Setting: University Hospital.

Patient Perspectives Following Obstetric Anal Sphincter Injury.

Importance: An obstetric anal sphincter injury can significantly affect patients. Support for these patients is both limited and not well understood.

Objective: The aim of this study was to describe patient experiences after an obstetric anal sphincter injury.

Breast Cancer Screening Referral Patterns and Compliance in Transgender Male Patients.

Purpose: Screening guidelines for breast cancer (BC) in transgender male (TM) patients are not well defined. This study describes referral patterns and compliance with referral for BC screening among TM patients receiving care at a tertiary care center.

Methods: This was a retrospective cohort study of TM patients, 40-74 years of age, presenting for care between 2017 and 2020.

Pelvic Floor Dysfunction Among Persons With Marfan and Loeys-Dietz Syndrome.

Importance: Connective tissue disorders are proposed in the literature to be predisposing risk factors for pelvic floor disorders. Prior data characterizing the prevalence of and symptom burden related to pelvic floor disorders are limited for individuals with Marfan syndrome and are nonexistent for those with Loeys-Dietz syndrome.

Objective: The objective of this study was to determine the prevalence and severity of symptoms related to pelvic floor disorders among individuals with Marfan syndrome and Loeys-Dietz syndrome using the Pelvic Floor Distress Inventory-20 (PFDI-20).

Healthcare Resource Utilization Following Minimally Invasive Sacrocolpopexy: Impact of Concomitant Rectopexy.

Introduction And Hypothesis: Combined surgical procedures with sacrocolpopexy (SCP) and rectopexy (RP) are more commonly being performed for treatment of multicompartment pelvic organ prolapse. This study aimed to compare healthcare resource utilization (HRU) within 6 weeks following combined surgery (SCP-RP) versus SCP alone (SCP-only). We hypothesized that concomitant RP does not impact HRU.

Persistent and De Novo Stress Urinary Incontinence After Minimally Invasive Sacrocolpopexy.

Importance: Data on stress urinary incontinence (SUI) after minimally invasive sacrocolpopexy (SCP) with or without midurethral sling placement are limited.

Objective: The aim of the study was to determine the incidence of SUI after minimally invasive sacrocolpopexy.

Study Design: This was a secondary analysis of 2 randomized clinical trials of participants undergoing SCP.

Characterization of Pain Associated With Pelvic Organ Prolapse: Is Surgery the Answer?

Importance: Data on the incidence of pelvic organ prolapse (POP)-related pain, risk factors for its development, and treatment effects of surgery remain sparse.

Objectives: The aims of the study were to evaluate the incidence and characteristics of POP-related pain in patients presenting with POP and assess the outcome of pain after surgery.

Study Design: This was a retrospective study of patients presenting for initial evaluation of POP from May 2019 to May 2020.

Transgender women's perspectives on mental health care related to vaginoplasty for gender affirmation.

Purpose: This study aimed to describe patient experiences and attitudes about the role of the mental health professional as it relates to pursuing gender affirmation surgery.

Methods: This was a mixed-models study with semi-structured interviews. Participants who presented for gender affirming vaginoplasty and had completed pre-surgical requirements but had not yet had the procedure were invited to participate in the study.

Gynecologic Care of Transgender and Gender-Diverse People.

The visibility and care of transgender and gender-diverse (TGD) people is an important component of gynecology. Transmasculine individuals require routine gynecologic and preventative care. Guidelines can be extrapolated from the cisgender female population, and using affirming language, acknowledging the challenges patients face with pelvic examination, and discussing individual gynecologic needs are important components of care.

Comparison of Morbidity and Retreatment After Urethral Bulking or Midurethral Sling at the Time of Pelvic Organ Prolapse Repair.

Objective: To compare postprocedure retreatment rates for stress incontinence in patients who underwent either midurethral sling or urethral bulking at the time of concomitant repair of pelvic organ prolapse (POP).

Methods: This was a retrospective cohort study using data from the Premier Healthcare Database. Using Current Procedural Terminology codes, we identified patients who were undergoing POP repair and concomitant urethral bulking or midurethral sling between the years 2001 and 2018.

Comparing endometrial biopsy results with hysteroscopic pathology in women presenting with abnormal and postmenopausal uterine bleeding.

Objective: To compare pathology results after office-based blind endometrial biopsy and pathology results from hysteroscopy in women presenting with abnormal uterine bleeding (AUB).

Methods: A retrospective cohort study of biologic women presenting with AUB at a tertiary care referral care center. Patients were included if they underwent evaluation with blind endometrial biopsy performed in the office followed by hysteroscopy within one year.