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Sexual and reproductive health education is not yet formally introduced in Bangladesh without which the International Conference on Population and Development (ICPD) in Cairo's goal to ensure young people's right to access to such information and services will remain unfulfilled. The Population Council provided technical assistance to a governmental department to pilot youth reproductive health education. Study findings from the pre- and posttests of 379 matched respondents revealed significant changes in knowledge, attitudes, and life-skills. Knowledge about long-term contraceptives and skills on negotiating safe sex improved significantly by 63% and 26%, respectively. Youths who do not consider menstruation as a disease nearly doubled, and misunderstandings about the mother's role in sex determination of a child were significantly dispelled. Decisions not to accompany friends in visiting sex workers and to use condoms, ignoring friends' disapproval, were increased over 18%. Over 98% of students reported that teachers discussed condoms, while only 12% alleged unfriendly behavior. Findings motivated the department to scale up the reproductive health curriculum. [ABSTRACT FROM AUTHOR]

Identify the number and duration of hormonal management modalities utilized by patients with endometriosis prior to undergoing initial surgical evaluation. Cross-sectional study. Tertiary care academic hospital. Forty-four patients with pathology proven endometriosis. Patients were provided with a standardized questionnaire regarding the use of preoperative hormonal medical therapy. Medical therapy categories included: combined oral contraceptive pills (COCP), progesterone only pills (POPs), progesterone intrauterine devices (IUD), injections, implants, gonadotropin releasing hormone agonists (GnRH), selective progesterone receptor modulators, aromatase inhibitors, danazol, and GnRH antagonists. Of 111 patients screened with pathology proven endometriosis, 52 patients met eligibility criteria. The response rate was 84.62% (n=44). Median age of patients was 33 years old. Mean number of gynecologic procedures patients had was 2.6. The mean use of medication was <1 (0.8) prior to undergoing initial surgery for endometriosis (p=0.87). Mean use according to age by decade were the following: 1.1 (20-29 years), 0.7 (30-39 years), 0.6 (40-50 years). Of patients surveyed, 50% used 1 or more hormonal medications whereas 50% did not use any. The mean length of time from the first medication use to initial surgery was 8.1 years. Patients who reported medication use prior to surgery used at least one of the following (N=22): COCP, POP, progesterone IUDs, injections, implants, and selective progesterone receptor modulators. Despite available medical management options for endometriosis treatment, many patients do not use any hormonal medications before choosing surgical intervention. Although multiple modalities exist for medical management, this cohort mainly used progesterone based methods. These medications are used for many years and patients with endometriosis are at high risk for multiple gynecologic procedures. [ABSTRACT FROM AUTHOR]

Describe considerations for pre-operative surgical planning and identify techniques for a cornual wedge resection to adequately remove Essure® coils. A premenopausal female with history of Essure® hysteroscopic sterilization with subsequent development of chronic pelvic pain desiring removal with a uterine sparing procedure. After confirmation of location and number of Essure® coils by pelvic ultrasound and X-ray, a robotic cornual wedge resection was performed using gentle traction-counter traction, sharp dissection and minimal electrosurgery to remove both fallopian tubes without exposure or fragmentation of the coils. The cornua was then closed with delayed absorbable barbed suture. Adequate removal of Essure® coils involve proper pre-operative imaging and complete resection of the tubal interstitium with minimal coil exposure or fragmentation. This prevents breaking or incompletely removing the metallic coils and pro-inflammatory PET fibers. [ABSTRACT FROM AUTHOR]

Determine if providing two opioid prescriptions postoperatively is an effective strategy to decrease total number of opioids obtained. Retrospective descriptive study. Tertiary care academic institution. Thirty-nine patients undergoing gynecologic surgery. Two oral narcotic prescriptions were provided post-operatively. Patients were instructed to initially fill the first prescription with 10 pills. If the patient continued to have opioid requirement for pain control, she was instructed to fill the second prescription with an additional 20 pills. Opioids obtained within 6 weeks post-operatively were confirmed utilizing the Arizona Board of Pharmacy Controlled Substance Monitoring Program. Thirty-nine patients underwent gynecologic surgery via laparoscopy or robotics (N=26), laparotomy (N=3), or vaginal routes (N=10). In the post-operative period, 24 patients (61.5%) filled only 10 pills and 15 patients (38.4%) filled the additional 20 pills (CI 44.62%-76.64% p-value 0.15). Patients filling only one prescription versus two prescriptions were not affected by age (49.6 years vs. 43.2 years, p-value 0.193), BMI (26.9 kg/m2 vs. 29.3 kg/m2 p-value 0.157), history of chronic pain (25% vs. 46.7%, p-value 0.163), smoking history (never smokers 66.7% vs. 66.7%, p-value 0.713), or post-operative IV narcotic use (morphine milligram equivalents) prior to discharge (23.3 mg vs. 31.2 mg p-value 0.187). There were no pain related post-operative clinic visits. Providing dual narcotic prescriptions after gynecologic surgery can decrease the number of opioids obtained by patients postoperatively. Patient characteristics cannot be used to predict who fills the second prescription. This strategy was not associated with pain related post-operative visits. [ABSTRACT FROM AUTHOR]