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Cosmetic gynecology, a field which has garnered substantial attention over recent years, lacks a universally accepted nomenclature. The aim of this systematic review is to evaluate techniques, outcome measures reported, and adverse events in patients undergoing cosmetic gynecology procedures and offer recommendations to improve reporting metrics. A systematic literature search was performed using electronic databases from inception to April 2019. The search was based on 51 unique cosmetic gynecology keywords such as: “labiaplasty,” “vaginal rejuvenation,” and “liposuction mons pubis.” All English full-text prospective and retrospective observational and interventional studies with at least five subjects that describe a cosmetic gynecology procedure were included. Only full-text articles were included. This protocol has been registered with PROSPERO (CRD 42019131860). A total of 1837 articles were identified from the search strategy with 42 included in the quantitative synthesis. Procedures described included: labia minora reduction with or without clitoral hood reduction, labia majora augmentation, surgical vaginal caliber reduction, mons pubis reduction/suspension, and energy-based therapy for vaginal laxity or vulvar laxity. Efficacy and satisfaction metrics were highly variable ranging from validated questionnaires to no outcome subjectively or objectively quantified. Complication rates varied by procedure but were generally low and ranged between Clavien-Dindo grades I–III. Although there is a breadth of literature on cosmetic gynecology surgical techniques and short-term complication rates, the terminology and outcome measures utilized are heterogeneous. To address this, standardized terminology along with uniform cosmetic and functional endpoints must be developed.

Over the years, many different imaging modalities including Computed tomography (CT), Magnetic resonance imaging (MRI), Positron emission tomography (PET), and ultrasound have been utilized to image the pelvis. Ultrasound is one of the oldest, most reliable, and inexpensive ways to image the structures in female pelvis, with the capability of two-dimensional imaging, three-dimensional volume imaging, Doppler study, three-dimensional doppler study, and the addition of saline infusion techniques. Additionally, ultrasonography does not carry the same risk and burden associated with exposure to radiation or the need for sedation in comparison to other imaging modalities. This chapter will highlight the techniques and positioning for imaging, normal imaging of the reproductive tract and imaging associated with pathology. It is intended to cover the basics of non-obstetrical ultrasonography of the female pelvis. It is important to understand normal imaging and the benign variants of the female pelvis in order to detect abnormal pathology.

Objective The objective of this study was to determine if there is a clinically meaningful variation in pain perception when using lidocaine gel versus plain lubricant prior to office-based diagnostic flexible cystoscopy. Methods This was a randomized, controlled, double-blind trial comparing lidocaine gel and water-based lubricant for the performance of diagnostic flexible cystoscopy. Women undergoing cystoscopy were randomized to either transurethral 2% lidocaine (Uro-Jet) or water-based lubricant prior to cystoscopy. Participants and physicians were blinded, and pain was assessed using an 11-point numeric rating scale (NRS). A priori sample size calculation indicated the need for 40 patients per group to achieve 90% power. Descriptive statistics and Student t test were utilized. Results The study included 116 patients, 61 in the lidocaine group and 55 in the plain lubricant group. Numeric rating scale in the lidocaine group (2.43 [SD, 1.95]) was significantly lower than that in the plain lubricant group (3.58 [SD, 2.73]) (P = 0.01). After controlling for age and ethnicity, separately as well as together, the procedural NRS scores were 1.37 points (P = 0.002), 0.97 points (P = 0.04), and 1.22 points (P = 0.01) lower in those receiving lidocaine. After the procedure, fewer patients in the lidocaine group (2/61 = 3.3%) requested pain medicine when compared with the plain lubricant group (11/55 = 20%) (P = 0.01). Although anticipated pain scored similarly between groups, actual pain compared with anticipated pain was significantly lower in the lidocaine group (P = 0.02). Conclusions Pain perception during flexible cystoscopy decreased when using 2% transurethral lidocaine gel. The use of 2% lidocaine gel is suggested for the reduction of pain at the time of diagnostic flexible cystoscopy in women.

A growing number of people in the United States are learning about the impact of the arts therapies. In retrospect creative arts is miraculous that dramatherapy, art therapy, music therapy, writing and poetry therapy, yoga therapy, mindfulness of breathing, a men's group, and healing retreats are the heart of a therapeutic model of care in a conservative Midwestern state. Inspired by United Kingdom strategies to help people recover from homelessness, this integrated programme was designed to support veterans' recovery. In the chapter, the author aims to share the voices and experiences of many of the arts therapists involved in the programme. S. Vinogradov and I. D. Yalom point out that group psychotherapy provides an environment where group members interact with each other as well as the therapist. This makes group psychotherapy an ideal tool for veterans who are re-socialised into the brotherhood of military service.

The purpose of this study was to evaluate the safety, efficacy and acceptability of Lea's Shield, a new vaginal contraceptive barrier device, when used with either spermicidal or non-spermicidal lubricant. One-hundred-eighty-five (185) women enrolled at six centers. Half were randomized to use the device with spermicide and half with a non-spermicidal lubricant. To be eligible, volunteers had to be 18-40 years old (inclusive), in good health with regular menses, sexually active in an ongoing relationship and at risk for pregnancy, and willing to use Lea's Shield as their sole means of contraception for six months. Participants were seen at admission, one week, one month, three months and six months. Gross cumulative life table rates were calculated for pregnancy and others reasons for discontinuation. Adverse experiences and responses to an acceptability questionnaire were evaluated. One-hundred-eighty-two (182) volunteers contributed data to the analysis of safety and 146 to that of contraceptive efficacy. The unadjusted six-month life table pregnancy rate was 8.7 per 100 women for spermicide users and 12.9 for non-spermicide users (p = 0.287). After controlling for age, center, and frequent prior use of barrier methods, the adjusted six-month life table pregnancy rate was 5.6 for spermicide users and 9.3 for non-spermicide users (p = 0.086), indicating that use of spermicide lowered pregnancy rates, although not significantly, during typical use. For purposes of comparison, it is important to note that this study differed from the cap/diaphragm and sponge/ diaphragm studies in that a high percentage (84%) of volunteers were parous. For reasons that are unclear, pregnancy rates among parous women using barrier contraceptives tend to be higher than among nulliparous women. Indeed, in this study there were no pregnancies among nulliparous users of Lea's Shield. Standardization of parity of this study population on those of the cap/diaphragm and sponge/diaphragm studies suggests that unadjusted pregnancy rates for this device would have been considerably lower (2.2 and 2.9 per 100 users of spermicide and non-spermicide, respectively) had the study been done using the populations of earlier studies. Since no directly comparative study has been done, these figures provide a tentative estimate of the relative efficacy of Lea's Shield compared with the sponge, cap, and diaphragm. There were no serious adverse experiences attributed to the use of Lea's Shield. Acceptability was very good. Seventy-five percent (75%) of women responded to an end-of-study questionnaire; 87% of these reported that they would recommend Lea's Shield to a friend. Lea's Shield is a new vaginal contraceptive that does not require clinician fitting. Pregnancy rates in this study compare favorably with other studies of barrier contraceptive methods including the cervical cap, diaphragm, and sponge, even though this study was done with greater rigor and with a greater percentage of parous women than previous barrier studies. Lea's Shield appears to be safe and very acceptable to study volunteers.At six US centers, between August 1991 and October 1993, a prospective, double-blind, randomized clinical trial was conducted to evaluate the contraceptive efficacy of Lea's Shield (a new vaginal contraceptive barrier device) used with and without a spermicidal lubricant as well as its safety and acceptability. The clinical researchers enrolled 185 healthy women aged 18-40 who menstruated regularly, were sexually active, and at risk for pregnancy. 84% of the women were parous. They were asked to use Lea's Shield as their only contraceptive method for 6 months. The analysis of safety included 182 women, while that of contraceptive efficacy included 146 women. The adjusted 6-month life table pregnancy rate for spermicide users was lower than that for non-spermicide users (5.6% vs. 9.3%), but not significantly so (p = 0.086). None of the nulliparous women conceived, however. When the researchers standardized parity in this study population comparable to the parity of cap/diaphragm and sponge/diaphragm studies, the unadjusted and adjusted pregnancy rates would have been much lower (2.2% for spermicide users vs. 2.9% for non-spermicide users and 1.3% vs. 2.6%, respectively). No woman experienced serious or unexpected adverse effects using Lea's Shield. Discontinuation rates for device-related reasons were low (7.8% for spermicide users and 6.7% for non-spermicide users). 87% of women who completed an end-of-study questionnaire and 69% of men would recommend Lea's Shield to a friend. 84% of women and 55% of their partners liked Lea's Shield. 84% of women who had an opinion on the diaphragm preferred Lea's Shield. The aspects most liked were convenience and ease of insertion. These findings suggest that this new vaginal barrier contraceptive (available in one size fits all) has a relatively good contraceptive efficacy compared with other barrier methods and is safe and acceptable.