Painful catamenial vulvar lesions misleading gynecologist

Endometriosis usually presents as cyclical pain in the pelvis but may also present as painful cutaneous lesions. Many diseases may mimic hidradenitis suppurativa (HS) since HS, a chronic inflammatory painful skin disease, is a clinical diagnosis. A 32-year-old woman presented with painful lumps on her vulva and groin accompanied with bloody discharge during menstruation. She was followed up with preliminary diagnosis of endometriosis. Previous excision without definitive diagnosis resulted in temporary relief. She was prescribed oral contraceptive pills that alleviated her symptoms but quitted due to headache. Surgical excision was performed for definitive diagnosis and therapeutic relief. Pathology report revealed HS. She was prescribed oral doxycycline. She responded well to the therapy and has symptom-free for the last 2 years. She delivered one healthy girl via cesarian section 2 years after the treatment. Endometriosis and HS should be included in the differential diagnosis when women present with menstrual painful lesions around external genitalia for diagnosis and treatment.

Opinions, Attitudes, and Prescribing Practices of Oral Contraceptive Pills of General Practitioners and Gynecologists in India

Background Prescribing behavior of oral contraceptive pills (OCPs) by physicians, gynecologists, and alternative medicine practitioners (AMPs). Materials and Methods Close-ended questionnaire-based cross-section study was performed between 1st September 2012 and 28th February 2014 in three groups of responders, i.e., AMP, general medical practitioners (GMPs), and obstetricians and gynecologists (ObGy). A stratified random cluster sample was used. Data of 400 subjects in all three groups were obtained using both univariate and multi-variate sophisticated statistical analyses for analyzing attitude and practices and were recorded on an ordinal scale using appropriate non-parametric test. Results Of the 1,237 subjects surveyed, 400 completed questionnaires were received from each of the three groups viz; AMPs, GMPs, and ObGy. Remaining 37 incomplete questionnaires were not included in the final analysis. Conclusion There are equal misconceptions regarding OCPs among users and prescribing physicians. Preference for OCPs in married and unmarried women is also equally low. OCP usage and their prescription practices can be improved by removing potential barriers, developing public–private partnership, and training promoters.

Acute Nonatherosclerotic Coronary Thromboembolism Presenting with an Inferior STEMI in a Patient on Oral Contraception

Background. Direct coronary embolism in the setting of oral contraceptive pill (OCP) use is a rare adverse effect. It is known for OCP to increase the risk of thrombosis; however, leading to an inferior ST elevated myocardial infarction (STEMI) due to an acute occlusive embolism is a rare entity. Coronary embolism occurs in about 3% of patients with acute coronary syndrome. Case Report. We present a case of a young 41-year-old female with a past medical history significant for dysfunctional uterine bleeding on oral contraceptive pills, who presented to the hospital with chest pain. Her workup was significant for troponin elevation and an electrocardiogram showing inferior ST elevations. The patient was taken emergently to the cardiac catheterization lab. A coronary angiogram revealed a coronary thrombus involving the distal left main and proximal left anterior descending (LAD) with no evidence of atherosclerotic disease. The patient subsequently received anticoagulation therapy leading to complete resolution of symptoms and ST elevations. Conclusion. Coronary embolism is rare and often not considered in the differential of acute coronary syndrome. It is of utmost importance for clinicians to keep a wide differential of nonatherosclerotic causes of STEMI especially when the patient is young, without significant cardiac risk factors.

Preliminary report of sexual assaults at Ekiti Sexual Assault Referral Centre, Ado-Ekiti, Southwest, Nigeria (Moremi Clinic)

There has been a surge in the incidence and severity of sexual assaults globally with the insurgence of COVID-19 owing to lockdown restrictions. Ekiti Sexual Assault Referral Centre, Ado-Ekiti also known as Moremi Clinic was established in June 2020 as a multisectoral response centre to this surge. Seventy-four survivors accessed medical services from June 2020 to May 2021. Adolescents made up 54.1% while the median age was 14.5 years. Only seven survivors were seen within 24 h of the event and around a quarter had follow-up visits. A quarter of survivors reported repeat episodes of sexual assault. Complications documented were sexually transmitted infections (13.5%), depression (4.1%) and posttraumatic stress disorder (5.4%). There was a failure of contraception in 4.5% of survivors who had taken emergency contraceptive pills. For improvements in quality of care, strategies to ensure early presentation and encourage follow-up visits must be introduced.

Hubungan Antara Penggunaan Pil Keluarga Berencana Dengan Kejadian Hipertensi Pada Pasangan Usia Subur : Literature Review

Indonesia is a country that ranks 5th with the highest incidence of hypertension. Hypertension is the leading cause of death in the world (52%). There are two factors that can trigger hypertension: controlled and controlled factors. One of the trigger factors that can be controlled is the use of hormonal contraception (KB Pills). To determine the correlation between the use of oral contraceptive pills and the incidence of hypertension in couples of childbearing age through a literature review. This study used a literature review method by searching for articles through the Google Scholar database. The search for articles was carried out using the keywords: '-Hypertension", '-Contraception Pill". "Couples of Childbearing Age" then the researcher used the STROBE instrument with the limitation of articles in 2011-2021. Participants in this study were couples of childbearing age who used oral contraceptive pills. The results of this literature review of 5 articles showed that 3 articles which stated that there was correlation between the use of birth control pil.ls with the incidence of hypertension in couples of childbearing age with a result of p less than 0.05. The other 2 stated that there was no correlation between the use of oral contraceptive pills with the incidence of hypertension in couples of childbearing age. The use of contraceptive pills is one of the factors that can lead to an increase in blood pressure.Keywords: Hypertension; Contraceptive Pills; Couples' of Childheclring Age AbstrakIndonesia merupakan negara yang menduduki peringkat ke 5 dengan kejadian hipertensi terbanyak. Hipertensi merupakan pencetus kematian terbanyak didunia yaitu sebanyak 52%, terdapat dua faktor yang pemicu hipertensi yaitu faktor pemicu yang dapat dikontrol dan faktor pemicu tidak dapat dikontrol. Faktor pemicu yang dapat dikontrol salah satunya yaitu penggunaan kontrasepsi hormonal (Pil KB). Mengetahui Hubungan Antara Penggunaan Pil Keluarga Berencana Dengan Kejadian Hipertensi Pada Pasangan Usia Subur melalui Literature Review. Penelitian ini menggunakan metode literature review. Untuk pencarian artikel dengan mengakses database Google Schoolar. Pencarian artikel dilakukan dengan menggunakan kata kunci: “Hipertensi”, “Kontrasepsi Pil”, “Pasangan Usia Subur” kemudian peneliti telaah menggunakan instrumen STROBE dengan batasan artikel tahun 2011-2021. Partisipan pada studi ini adalah pasangan usia subur yang menggunakan kontrasepsi pil. Hasil penelitian literature review dari 5 artikel menunjukan bahwa 3 artikel ada hubungan antara pengggunaan pil KB dengan kejadian hipertensi pada pasangan usia subur dengan hasil p<0,05, sedangkan untuk 2 artikel menunjukan tidak ada hubungan antara penggunaan pil keluarga berencana dengan kejadian hipertensipada pasangan usia subur. Penggunaan kontrasepsi pil merupakan salah satu faktor yang dapat mengakibatkan terjadinya peningkatan tekanan darah.Kata kunci: Hipertensi; Kontrasepsi Pil; Pasangan Usia Subur.

Effect of the Monthly Injectable Combined Contraceptives versus Oral Contraceptive Pills on Mood

Background: Contraceptive agents are widely used by women of reproductive age, and resulting depression is the most common side effect of this usage. This study aimed to study the effect of monthly injectable combined contraceptives versus that of combined oral contraceptive pills (COC) on patients’ mood.Methods: A prospective cohort study was conducted on 124 females aged 18–45 years attending the Kom-Ashfeen Family Medicine Unit, El-Kalyubia, Egypt. Participants were divided into three groups according to their choice: group A included 44 participants who received monthly combined injectable contraceptives (CIC); group B included 40 participants who took COC; and group C included 40 participants who used the copper intrauterine device (IUD). The Patient Health Questionnaire-9 (PHQ-9) score was assessed at the beginning of the study and after 6 months of follow-up.Results: After 6 months of follow-up, there were mild but statistically significant increases in the PHQ-9 score in groups A and B, with group A (CIC users) showing the highest increase. Approximately 34.1%, 27.5%, and 15% of CIC, COC, and IUD users, respectively, moved from the non-depression stage to mild depression after 6 months; this change was statistically significant in groups A and B only.Conclusion: Monthly injectable combined contraceptives and oral contraceptive pills were associated with an increased risk of developing mild depression; this risk was higher in users of CICs, although the difference was not statistically significant. Thus, it is crucial to counsel patients about this possible risk and to follow them up. However, further studies are required to confirm our results.

Knowledge and Attitude Toward Emergency Contraceptive Pills Among First-Year Undergraduate Students in Southern Thailand

Background: The objective of this study was to investigation of the knowledge and attitude towards emergency contraceptive pills (ECPs) among first-year undergraduate students in a university in Thailand.Methods: This cross-sectional survey study was performed using the developed questionnaires that was validated by four experts. The questionnaires were distributed to all the first-year students in the university via an online platform. The characteristic data were descriptively analyzed and the knowledge data were analyzed using Chi-square test, Mann-Whitney U test and one-way ANOVA.Results: A total of 335 students who responded to the questionnaires and met the eligible criteria for the study was analyzed. The mean knowledge score of all respondents was 7.76±0.15 out of 15. The most correct-answered questions were the questions relating to efficacy and safety of ECPs in pregnant women (78.5% and 72.2% corrected, respectively). On the contrary, the least correct-answered questions were about the ECP regimens and using ECPs instead of combined oral contraception (COC) (30.4% and 34.9%, respectively). In addition, the results indicated that experience in using ECPs and in ECP education were significant factors in high scores of knowledge. Moreover, most respondents trusted and would like to receive the information on ECPs from health professionals in hospitals, academic institutions, or pharmacies.Discussion: The average knowledge of ECPs of first-year students in a university in Thailand was at a moderate level. More knowledge about the regimens of the drug and using ECPs instead of COC should be advised to students, particularly at the university or pharmacies, and should be done by healthcare staff.

Survey of Available Information on the Risks and Contraindications of Oral Hormonal Contraceptives on Higher Education Websites

Background: Venous thromboembolism (VTE) is one of the most common cardiovascular disorders after myocardial infarction and stroke. Primary manifestations include deep vein thrombosis and pulmonary embolism, which are often preventable and often underdiagnosed. Patients with inherited thrombophilia or family history of VTE are at increased risk for VTE. Acquired VTE risk factors include the use of oral hormonal contraceptives, such as combined oral contraceptive pills (COCPs) containing estrogen and progestin. Women with a family history of VTE are advised not to take COCPs; possible alternatives include use of progestin-only contraceptive pills or non-oral contraceptive methods. Currently it is unknown if young women at college are given information regarding this potential risk when seeking oral contraceptives. Thus, higher education websites can provide a potential venue to promote awareness of this risk. In this study, we reviewed a sample of higher education websites in the US to assess availability of information on oral hormonal contraceptives and their risks for young women. Methods: US higher education institutions for this survey and categorized into 5 major types: community colleges, liberal arts institutions, private for-profit institutions, public non-profit institutions, and private non-profit institutions; 25 institutions from each category were included for analysis. The study was conducted using the Google search terms "birth control pills," "oral contraceptive pills," OR plus the university name. Mention of contraindications, risk factors, and blood clot warnings was noted for each website and categorized as to whether the information appeared on the institution's webpage or as a link to an external reference source. Information listed was further classified by risk factors and contraindications mentioned. Results: A total of 125 US higher education institution websites were assessed. Eighteen (14.4%) of the 125 offered information on COCP-related clotting risks. Community colleges and private, for-profit institutions had no information on birth control available either on their webpage or through an external link. Only 3 of 25 (12%) liberal arts institutions discussed clotting risk information. Five of the 25 (20%) public, nonprofit institutions surveyed provided information on their student webpages; three of these 5 offering information through their website as well as through a link to an external website. Of the private, non-profit institutions surveyed, 2 (8%) provided information through their institution's website and 4 (16%) provided information through external sources. Regarding contraindications, 2 (8%) liberal arts schools provided information on their website only, identical to the percentages seen with private and public non-profit institutions. Additionally, 4 (16%) private non-profit universities and 2 (8%) public, non-profit institutions provided information only through external sources. Two (8%) public non-profit institutions provided information both on their website and through external links. Overall, only 6 (4.8%) of the 125 institutions described family history or inherited prothrombotic blood disorder as a potential contraindication or risk factor for COCP-related clotting, all 6 of which were public or private non-profit institutions. Conclusion: The results of this study raise the question of whether higher education institutions are providing the appropriate risk and contraindication information for women considering oral contraceptives as a birth control method. This suggests that there is an opportunity for more birth control education to be provided by higher education institutions. Figure 1 Figure 1. Disclosures Sarmiento: Quest Diagnostics: Current Employment. Sahud: Quest Diagnostics: Current Employment. Wong: Quest Diagnostics: Current Employment, Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company.