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Our aim was to investigate the inclusion of sexual and reproductive health and rights (SRHR) topics in medical curricula and the perceived need for, feasibility of, and barriers to teaching SRHR. We distributed a survey with questions on SRHR content, and factors regulating SRHR content, to medical universities worldwide using chain referral. Associations between high SRHR content and independent variables were analyzed using unconditional linear regression or χ2 test. Text data were analyzed by thematic analysis. We collected data from 219 respondents, 143 universities and 54 countries. Clinical SRHR topics such as safe pregnancy and childbirth (95.7%) and contraceptive methods (97.2%) were more frequently reported as taught compared with complex SRHR topics such as sexual violence (63.8%), unsafe abortion (65.7%), and the vulnerability of LGBTQIA persons (23.2%). High SRHR content was associated with high-income level (P = 0.003) and low abortion restriction (P = 0.042) but varied within settings. Most respondents described teaching SRHR as essential to the health of society. Complexity was cited as a barrier, as were cultural taboos, lack of stakeholder recognition, and dependency on fees and ranking.

This study aimed to compare downstream utilization of medical services among critically ill infants admitted to intensive care units who received rapid exome sequencing (ES) and those who followed alternative diagnostic testing pathways.Using propensity score-weighted regression models including sex, age at admission, and severity indicators, we compared a group of 47 infants who underwent rapid ES with a group of 211 infants who did not receive rapid ES. Utilization and cost indicators were compared between cohorts using negative binomial models for utilization and two-part models for costs.After controlling for patients' sociodemographic and clinical characteristics, we found no statistically significant difference in outpatient visits, hospitalizations, intensive care unit or total length of stay, or length of stay-associated costs between the cohorts at 12- or 26-month follow-up. Similarly, there was no evidence of higher utilization or costs by the ES group when infants who died were removed from the analysis.When examining utilization during and beyond the diagnostic trajectory, there is no evidence that ES changes frequency of outpatient visits or use of in-hospital resources in critically ill infants with suspected genetic disorders.

Introduction We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID‐19) pandemic and what is being done to mitigate its impact. Material and methods We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple‐choice questions on access to SRHR services and risk of SRHR violations, and written responses to open‐ended questions on threats to access and required response. Results The survey was answered by 51 people representing 29 countries. Eighty‐six percent reported that access to contraceptive services was less or much less because of COVID‐19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender‐based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P

Objective To strengthen the national framework for care of adolescents and women affected by female genital cutting (FGC) in Canada by providing health care professionals with: (1) information intended to strengthen their knowledge and understanding of the practice; (2) directions with regard to the legal issues related to the practice; (3) clinical guidelines for the management of obstetric and gynaecological care, including FGC related complications; and (4) guidance on the provision of culturally competent care to adolescents and women with FGC. Evidence Published literature was retrieved through searches of PubMed, CINAHL, and The Cochrane Library in September 2010 using appropriate controlled vocabulary (e.g., Circumcision, Female) and keywords (e.g., female genital mutilation, clitoridectomy, infibulation). We also searched Social Science Abstracts, Sociological Abstracts, Gender Studies Database, and ProQuest Dissertations and Theses in 2010 and 2011. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Values The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).

Resume Objectif Offrir des conseils aux cliniciens qui participent au processus de choix eclaire en ce qui a trait au don d'embryons humains a des fins de recherche. Recommandations 1.Comme le stipulent les lignes directrices des Instituts de recherche en sante du Canada et la Loi sur la procreation assistee, le consentement explicite tant des donneurs de gametes que des donneurs d'embryons est requis avant que des embryons ne puissent etre utilises a des fins de recherche. Les donneurs de gametes et les fournisseurs d'embryons peuvent ne pas etre les memes personnes lorsque la creation d'embryons fait appel a des dons de gametes. 2.Le processus de consentement doit indiquer ce qui suit aux donneurs potentiels: les types possibles (et, dans le cas du consentement final, le type particulier) de projet de recherche dans le cadre desquels les embryons seront utilises; les risques associes au don d'embryons a la recherche, tel que le risque de ne plus avoir par la suite acces a ces embryons a des fins genesiques; le fait que la femme / le couple ne tireront pas personnellement profit du don d'embryons a la recherche; les gains commerciaux que pourront potentiellement en tirer des tierces parties; la possibilite que l'on communique avec eux a l'avenir au sujet de la disposition des embryons; le fait que la confidentialite ne peut faire l'objet d'une protection absolue. 3.La designation selon laquelle les embryons cryoconserves n'etant plus requis a des fins genesiques doivent etre donnes a la recherche, donnes a un autre couple ou elimines doit faire l'objet d'une discussion avant la recuperation des gametes et etre etablie au moment de la cryoconservation, les personnes concernees comprenant bien que, a l'avenir, un consentement final sera requis. La decision finale quant au don d'embryons cryoconserves ne devrait pas etre prise avant que la femme / le couple n'aient decide qu'ils n'ont plus besoin des embryons en question a des fins genesiques. La decision de mettre fin a la cryoconservation des embryons et la decision quant a leur disposition doivent etre prises separement. La femme / le couple devront etre consultes a nouveau en ce qui a trait a la disposition finale de leurs embryons. 4.Compte tenu du manque de donnees scientifiques quant a la previsibilite de la caracterisation microscopique des embryons et de leur potentiel d'engendrer une grossesse, il est recommande d'offrir a toutes les femmes / tous les couples l'occasion de cryoconserver tous les embryons n'ayant pas ete transferes au cours du cycle de traitement et de les aviser que le fait de ne pas proceder a la cryoconservation de ces embryons peut accroitre leur risque de devoir subir un cycle supplementaire de FIV afin d'atteindre leurs objectifs genesiques. 5.Les participants a la recherche doivent etre avises du fait qu'ils peuvent retirer leur consentement en tout temps avant la decongelation des embryons a des fins de recherche ou, dans le cas de la recherche sur les cellules souches, la creation d'une lignee de cellules souches. 6.Les donneurs potentiels doivent etre avises que leurs soins medicaux ne seront aucunement affectes par leur decision quant au don d'embryons.

Background:We undertook a study to examine the fertility intentions and reproductive health issues of women living with HIV in a broad-based sample in British Columbia, Canada.Methods:Between November 2003 and December 2004, we invited women with HIV at all HIV clinics and AIDS service organizations

The question of cesarean section by choice (that is, cesarean delivery in the absence of medical indications) has been hotly debated by the obstetrical profession in recent years. The debate has focused around questions of risks and benefits, and has revolved around questions of obstetrical practice. In this paper, the question will be framed in a reproductive rights context. How does the phenomenon of CSBC (cesarean section by choice) impact women's empowerment? Which reproductive rights might be affected by this question, and what policies are related to its use? FIGO's 1998 statement "Ethical Aspects regarding Cesarean Delivery for Non-Medical Reasons" is revisited, and, in light of these considerations, its contents are endorsed once again.

To provide Canadian gynaecologists with evidence-based direction for female genital cosmetic surgery in response to increasing requests for, and availability of, vaginal and vulvar surgeries that fall well outside the traditional realm of medically-indicated reconstructions.Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in 2011 and 2012 using appropriate controlled vocabulary and key words (female genital cosmetic surgery). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Recommendations 1. The obstetrician and gynaecologist should play an important role in helping women to understand their anatomy and to respect individual variations. (III-A) 2. For women who present with requests for vaginal cosmetic procedures, a complete medical, sexual, and gynaecologic history should be obtained and the absence of any major sexual or psychological dysfunction should be ascertained. Any possibility of coercion or exploitation should be ruled out. (III-B) 3. Counselling should be a priority for women requesting female genital cosmetic surgery. Topics should include normal variation and physiological changes over the lifespan, as well as the possibility of unintended consequences of cosmetic surgery to the genital area. The lack of evidence regarding outcomes and the lack of data on the impact of subsequent changes during pregnancy or menopause should also be discussed and considered part of the informed consent process. (III-L) 4. There is little evidence to support any of the female genital cosmetic surgeries in terms of improvement to sexual satisfaction or self-image. Physicians choosing to proceed with these cosmetic procedures should not promote these surgeries for the enhancement of sexual function and advertising of female genital cosmetic surgical procedures should be avoided (III-L) 5. Physicians who see adolescents requesting female genital cosmetic surgery require additional expertise in counselling adolescents. Such procedures should not be offered until complete maturity including genital maturity, and parental consent is not required at that time. (III-L) 6. Non-medical terms, including but not restricted to vaginal rejuvenation, clitoral resurfacing, and G-spot enhancement, should be recognized as marketing terms only, with no medical origin; therefore they cannot be scientifically evaluated. (III-L).

Health promotion is a set of strategies for positively influencing health through a range of individual, community-based, and population interventions. Despite international recognition that gender is a primary determinant of health and that gender roles can negatively affect health, the health promotion field has not yet articulated how to integrate gender theoretically or practically into its vision. For example, interventions often fail to critically consider women’s or men’s diverse social locations, gender-based power relations, or sex-based differences in health status. Yet without such analyses, interventions can result in the accommodation or exploitation of gender relations that disadvantage women and compromise their health. In this paper, we seek to ignite an agenda for health promotion for women. We discuss the need for a conceptual framework that includes a sex-gender-diversity analysis and critically considers ‘what counts’ as health promotion to guide the development and implementation of evidence-based practice. We also consider how innovative knowledge translation practices, technology developments and action research can advance this agenda in ways that foster the participation of a wide range of stakeholders.

Simone, collegue de confiance et amie de longue date, vient tout juste de feter son 42e anniversaire. Il y a quatre mois, a la suite de la reussite de la fecondation in vitro apres des annees d’essai, elle s’est soumise a la reimplantation de deux embryons. Elle dispose de cinq autres embryons qui sont maintenant congeles. Il y a deux semaines, apres environ 11 semaines de gestation, Simone a connu une effroyable fausse couche. Elle vient tout juste de nous confier qu’elle souhaite faire don de ses cinq embryons congeles aux fins de la recherche sur les cellules souches. « Je ne peux tout simplement pas revivre cette experience », affirme-t-elle. « Je ressens plus le besoin de voir cette experience aboutir a des resultats positifs, que de tenter le coup a nouveau. »

Resume Objectif Fournir aux gynecologues canadiens des directives factuelles en matiere de chirurgie esthetique genitale chez la femme, en reponse au nombre grandissant de demandes (et d'interventions) de chirurgie vaginale et vulvaire se situant bien au-dela des reconstructions traditionnellement indiquees sur le plan medical. Resultats La litterature publiee a ete recuperee par l'intermediaire de recherches menees dans PubMed ou MEDLINE, CINAHL et The Cochrane Library en 2011 et en 2012 au moyen d'un vocabulaire controle et de mots cles appropries (« female genital cosmetic surgery »). Les resultats ont ete restreints aux analyses systematiques, aux essais comparatifs randomises / essais cliniques comparatifs et aux etudes observationnelles. Aucune restriction n'a ete appliquee en matiere de date ou de langue. Les recherches ont ete mises a jour de facon reguliere et integrees a la directive clinique jusqu'en mai 2012. La litterature grise (non publiee) a ete identifiee par l'intermediaire de recherches menees dans les sites Web d'organismes s'interessant a l'evaluation des technologies dans le domaine de la sante et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et aupres de societes de specialite medicale nationales et internationales. Valeurs La qualite des resultats est evaluee au moyen des criteres decrits dans le rapport du Groupe d'etude canadien sur les soins de sante preventifs (Tableau). Recommandations 1.Un des roles importants des obstetriciens-gynecologues devrait consister a aider les femmes a comprendre leur anatomie et a en respecter les variantes qui leur sont propres. (III-A) 2.Lorsqu'une femme demande la tenue d'interventions esthetiques vaginales, une anamnese medicale, sexuelle et gynecologique exhaustive devrait etre obtenue et l'absence de tout dysfonctionnement sexuel ou psychologique majeur devrait etre etablie. La presence possible de coercition ou d'exploitation devrait egalement etre ecartee. (III-B) 3.Le counseling devrait constituer une priorite dans le cas des femmes qui demandent la tenue d'une chirurgie esthetique genitale. Les sujets abordes dans le cadre du counseling devraient comprendre les variations normales et les modifications physiologiques qui se manifestent au cours de la vie, ainsi que la possibilite de connaitre des consequences imprevues a la suite de la tenue d'une chirurgie esthetique visant les organes genitaux. Le manque de donnees en ce qui concerne les issues de la chirurgie et les effets des modifications subsequentes attribuables a la grossesse ou a la menopause devrait egalement faire l'objet de discussions et etre considere comme faisant partie du processus de consentement eclaire. (III-L) 4.Peu de donnees soutiennent l'amelioration de la satisfaction sexuelle ou de l'image de soi qui serait attribuable aux interventions de chirurgie esthetique genitale chez la femme. Les medecins qui choisissent de proceder a de telles interventions esthetiques ne devraient pas en faire la promotion a des fins d'amelioration de la fonction sexuelle; de surcroit, le recours a la publicite pour promouvoir les interventions de chirurgie esthetique genitale chez la femme devrait etre evite. (III-L) 5.Les medecins qui recoivent des demandes de chirurgie esthetique genitale de la part d'adolescentes doivent chercher a obtenir des competences additionnelles en ce qui a trait a l'offre de services de counseling aux adolescentes. De telles interventions chirurgicales ne devraient pas etre offertes avant l'atteinte de la pleine maturite physiologique (y compris la maturite genitale); le consentement parental n'est alors pas requis. (III-L) 6.Les termes non medicaux (y compris, entre autres, le rajeunissement vaginal, le resurfacage clitoridien et l'augmentation du point G) devraient etre reconnus comme n'etant que des termes de marketing, sans aucune origine medicale; ainsi, ils ne peuvent faire l'objet d'une evaluation scientifique. (III-L)

Objective: To determine the risks and benefits of an elective Caesarean section (CS) at term in healthy nulliparous women. Methods: We conducted a population-based cohort study of deliveries between 1994 and 2002. Using bivariate and multivariable techniques, we compared maternal and neonatal outcomes in healthy nulliparous women who had undergone elective pre-labour CS (using breech presentation as a surrogate) with those in women who had undergone spontaneous labour with anticipated vaginal delivery (SL) at full term. Results: There were 1046 deliveries in the pre-labour CS group and 38 021 in the SL group. Life-threatening maternal morbidity was similar in each group. Life-threatening neonatal morbidity was decreased in the CS group (RR 0.34; 99% CI 0.12 to 0.97). Subgroup analysis of the SL group by mode of delivery demonstrated the increased neonatal risk was associated with operative vaginal delivery and intrapartum CS but not spontaneous vaginal delivery. Conclusion: An elective pre-labour Caesarean section in a nulliparous woman at full term decreased the risk of life-threatening neonatal morbidity compared with spontaneous labour with anticipated vaginal delivery. However, the 63% of women with spontaneous labour who achieved a spontaneous vaginal delivery would not have benefited from delivery by Caesarean section. Further research is needed to better identify women with an increased likelihood of an operative vaginal or intrapartum Caesarean section, as this may assist maternity caregivers in decision-making about childbirth. Further research is also needed to determine if these findings can be confirmed in a prospective study. Resume

Objective To develop guidance for clinicians participating in the informed choice process with respect to the donation of human embryos for research purposes. Recommendations 1.As indicated in the Canadian Institutes of Health Research Guidelines and the Assisted Human Reproduction Act, specific consent from both the gamete and embryo providers is required before embryos can be used for research purposes. The gamete donors may be different individuals than the embryo providers when donated gametes are used to create embryos. 2.The consent process should inform potential donors of the possible types of (and for final consent, the specific) research project(s) for which the embryos will be used; the risks involved in donating embryos to research, such as not having these embryos available for their reproductive purposes; the fact that the woman/couple will not benefit personally from donating embryos to research; the potential for commercial gain by others; the possibility that they will be contacted in future about the disposition of the embryos; the fact that confidentiality cannot be absolutely guaranteed. 3.Designation of cryopreserved embryos no longer be required for reproductive purposes to be donated to research, donated to another couple, or discarded should be discussed prior to gamete retrieval and made at the time of cryopreservation, with the understanding that in the future, final consent will be requested. The final decision as to the donation of cryopreserved embryos research should not be made until after the woman/ couple decide they no longer require the embryos for their reproductive purposes. The decision to end cryopreservation should be made separately from the decision regarding disposition of the embryos. The woman/couple will have to be re-contacted regarding the final disposition of their embryos. 4.As a result of lack of scientific data regarding the predictability of microscopic characterization of embryos and potential for pregnancy, it is recommended that all women/couples be offered the opportunity to cryopreserve all embryos not transferred during the treatment cycle and be informed that a failure to cryopreserve all embryos may increase the chance of having to undergo an additional in vitro fertilization cycle to achieve reproductive goals. 5.Research participants should be informed that they may withdraw their consent at any time before the embryos are thawed for research purposes, or, in the case of stem cell research, before a stem cell line is created. 6. Potential donors should be informed that their medical care will not be affected by their decision regarding embryo donation.

Simone, a trusted colleague and dear friend, has just turned 42. Four months ago, after years of trying, and finally after successful in vitro fertilization, she had two embryos reimplanted. She has five other embryos that are now frozen. Two weeks ago, at about 11 weeks’ gestation, Simone had a gut-wrenching miscarriage. She has just told us that she wants to donate her remaining frozen embryos for stem cell research. “I just can’t go through it again,” she says. “I need to see something good come out of this more than I need to try again.”

The recent Women's Health Initiative study report evaluated the long-term benefits and risks of hormone replacement therapy among healthy postmenopausal women. The report showed that the risk-benefit profile of continuous combined hormone replacement therapy was not consistent with the primary Prevention of coronary heart disease. The Women's Health Initiative study of continuous combined hormone replacement therapy is a landmark study and the results provide valuable information for patients and clinicians. However, the most common indication for hormone replacement therapy is menopausal symptoms, for which it is effective, not prevention of disease and the most common use is for less than three years. Nevertheless, even short-term use has small effects on some outcomes. This statement discusses how the findings of the Women's Health Initiative study can be applied to reach appropriate clinical decisions.

The management of a 28-year-old primigravida with placenta accreta diagnosed during Caesarean section is described. A hysterectomy was required to control massive haemorrhage, and the patient made a full recovery. The increased incidence of placenta accreta over the last three decades is thought to be associated with the concomitant increased frequency of Caesarean section, resulting in an increased incidence of placenta praevia (1.9 per cent to 3.9 per cent). Patients with placenta praevia who have had a previous Caesarean section have a remarkably increased risk of placenta accreta. Management of placenta accreta is primarily by control of haemorrhage on delivery of the placenta. Control can be assisted by infrarenal cross-clamping of the aorta and/or intra-myometrial injection of prostaglandin F2 alpha which produces myometrial and vascular contraction. Identification of patients at increased risk, preparation for treatment and effective treatment of placenta accreta will minimize maternal morbidity and mortality.

Background: Women living with HIV (WHIV) are disproportionately impacted by cervical dysplasia and cancer. The burden is greatest in low-income countries where limited or no access to screening exists. The goal of this study was to describe knowledge and intentions of WHIV towards HPV self-collection for cervical cancer screening, and to report on factors related to HPV positivity among women who participated in testing. Methods: A validated survey was administered to 87 HIV positive women attending the Kisenyi Health Unit aged 30–69 years old, and data was abstracted from chart review. At a later date, self-collection based HPV testing was offered to all women. Specimens were tested for high risk HPV genotypes, and women were contacted with results and referred for care. Descriptive statistics, Chi Square and Fischer-exact statistical tests were performed. Results: The vast majority of WHIV (98.9%) women did not think it necessary to be screened for cervical cancer and the majority of women had never heard of HPV (96.4%). However, almost all WHIV found self-collection for cervical cancer screening to be acceptable. Of the 87 WHIV offered self-collection, 40 women agreed to provide a sample at the HIV clinic. Among women tested, 45% were oncogenic HPV positive, where HPV 16 or 18 positivity was 15% overall. Conclusions: In this group of WHIV engaged in HIV care, there was a high prevalence of oncogenic HPV, a large proportion of which were HPV genotypes 16 or 18, in addition to low knowledge of HPV and cervical cancer screening. Improved education and cervical cancer screening for WHIV are sorely needed; self-collection based screening has the potential to be integrated with routine HIV care in this setting.