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We hypothesized that a passive visual distraction would reduce pain and anxiety among women undergoing colposcopy.We assessed the association between exposure to a passive visual distraction during colposcopy and procedure-related pain and anxiety using a nonrandomized intervention design. Women presenting for initial or repeat colposcopy at Brigham and Women's Hospital Colposcopy Clinics were eligible for participation. Women undergoing colposcopy during the first 6 months of the study (n=168) were not exposed to the visual distraction, whereas women undergoing colposcopy during the second 6 months of the study (n=153) were exposed to a pleasing, passive visual distraction consisting of images on a light diffuser installed within the examination room's ceiling light. We used ordinal logistic regression to compare self-reported pain, measured using the visual analog scale, and anxiety, measured using the Spielberger State-Trait Anxiety Inventory-6, among women receiving and not receiving the intervention.Two hundred sixteen women with complete data were included in the final analyses. Women in both groups reported high levels of colposcopy-related anxiety. Compared to women who did not receive the visual distraction, women receiving the visual distraction during colposcopy had a 54% reduction in the odds of experiencing a given level of postexamination pain, holding preprocedure pain constant (odds ratio=0.46, 95% confidence interval=0.28-0.77). Visual distraction was not associated with postexamination anxiety (odds ratio=0.95, 95% confidence interval=0.60-1.51).A passive visual distraction reduced perceived pain, but not anxiety, after colposcopy.

To estimate cancer outcome and outcome predictors of women with endometrial intraepithelial neoplasia (EIN).Outcomes of women with first diagnosis of EIN ("index biopsy") were determined by follow-up pathology. Patient characteristics were correlated with EIN regression, EIN persistence, and progression to cancer.Fifteen percent (95% confidence interval [CI] 9.8-20.8%, 26 of 177) of index EIN biopsy samples had concurrent cancer. Of the women with cancer-free index EIN biopsy samples and follow-up by hysterectomy or more than 18 months of surveillance, 25% (95% CI 18.4-33.3%, 36 of 142) showed regression, 35% (95% CI 27.4-43.7%, 50 of 142) showed persistence, and 39% (95% CI 31.3-48.0%, 56 of 142) showed progression. Nonwhite ethnicity and progestin treatment reduced cancer outcomes (odds ratio [OR] 0.16, 95% CI 0.03-0.84 and OR 0.24, 95% CI 0.08-0.70, respectively), whereas body mass index greater than 25 increased malignant outcomes (body mass index 25 or higher, OR 3.05, 95% CI 1.10-8.45).Endometrial intraepithelial neoplasia confers a high risk of cancer, but individual patient outcomes cannot be predicted. Management should include exclusion of concurrent carcinoma and consideration of hysterectomy.

To compare physician practices, attitudes, and barriers toward human papillomavirus (HPV) vaccination.A Web-based survey that assessed the practice of HPV vaccination, perceived barriers, and opinions of potential vaccine effects was distributed to obstetrician/gynecologists, internists, and pediatricians within a single health care system. A total of 1,488 physicians located in tertiary, community, and private settings were sent the survey. Data were analyzed using multivariate logistic regression.A total of 424 (28.9%) of 1,488 physicians participated. Of these physicians, 80% offer the vaccine. Female, primary care, and community and private practice physicians were associated with increased vaccination, compared with male, subspecialty, and tertiary care physicians, respectively. Physicians who reported no barriers to vaccination were more likely to offer the vaccine (odds ratio = 1.74, 95% CI = 1.04-2.93, p =.04). The greatest barrier to vaccination was reimbursement concerns.Most physicians offer the HPV vaccine. Addressing barriers to vaccination and resolving practical concerns may increase HPV vaccination.

OBJECTIVE To describe current practices of chaperone use during pelvic examinations among obstetrician/gynecologists affiliated with a large tertiary care teaching hospital. STUDY DESIGN Questionnaires were distributed at department of obstetrics and gynecology grand rounds to all practicing attending physicians to obtain physician demographic data, including age, years in practice, practice type (solo or group) and whether chaperones were currently used when performing pelvic examinations at the first obstetric or gynecologic office visit. Physicians were also asked whether they were taught to use chaperones for pelvic examinations during medical school or residency. RESULTS Of the 59 attending physicians, 100% responded to the questionnaire. As compared to female physicians, male physicians used chaperones more at the first obstetric examination (76.9% vs. 27.8%, P < .002), at gynecologic office visits (70.0% vs. 22.2%, P < .002) and for breast examinations (51.2% vs. 11.1%, P < .01). Physicians greater than 40 years old, in practice longer than 10 years and taught as medical students or residents to use chaperones were statistically more likely to use chaperones. No attendings, male or female, reported losing a patient to another provider or being sued or threatened with legal action because of not using a chaperone. CONCLUSION Chaperones were used more frequently during pelvic examinations by male physicians, age greater than 40, solo practice, and physicians in practice longer than 10 years. Education affected current practices as specific medical student or residency training influenced the use of chaperones in private practice.