Faubion, Stephanie S.

Objectives Bilateral oophorectomy has commonly been performed in conjunction with hysterectomy even in women without a clear ovarian indication; however, oophorectomy may have long-term deleterious consequences. To better understand this surgical practice from the woman’s perspective, we studied the possible association of adverse childhood or adult experiences with the subsequent occurrence of bilateral oophorectomy. Design Population-based case–control study. Setting Olmsted County, Minnesota (USA). Participants From an established population-based cohort study, we sampled 128 women who underwent bilateral oophorectomy before age 46 years for a non-cancerous condition in 1988–2007 (cases) and 128 age-matched controls (±1 year). Methods Information about adverse experiences was abstracted from the medical records dating back to age 15 years or earlier archived in the Rochester Epidemiology Project (REP) records-linkage system. Adverse childhood experiences were summarised using the Adverse Childhood Experience (ACE) score. Results We observed an association of bilateral oophorectomy performed before age 46 years with verbal or emotional abuse, physical abuse, any abuse, substance abuse in the household, and with an ACE score ≥1 experienced before age 19 years (OR=3.23; 95% CI 1.73 to 6.02; p<0.001). In women who underwent the oophorectomy before age 40 years, we also observed a strong association with physical abuse experienced during adulthood (OR=4.33; 95% CI 1.23 to 15.21; p=0.02). Several of the associations were higher in women who underwent oophorectomy at a younger age (<40 years) and in women without an ovarian indication for the surgery. None of the psychosocial or medical variables explored as potential confounders or intervening variables changed the results noticeably. Conclusions Women who suffered adverse childhood experiences or adult abuse are at increased risk of undergoing bilateral oophorectomy before menopause. We suggest that the association may be explained by a series of biological, emotional, and psychodynamic mechanisms.

Abstract Immunizations protect individual persons and contribute to public health by reducing morbidity and mortality associated with common infectious diseases. In this Practice Pearl, we review guidelines for adult immunizations and recent and potential changes in vaccines.

Background: Sexual dysfunction is common among US women of reproductive age, many of whom use contraception. Various contraceptive methods have been associated with changes in sexual function. Methods: In this narrative review, we selected key articles based on our collective clinical experience. We summarized findings and best practice recommendations for addressing a woman's contraception and its potential relationship to sexual function. Results: Although some hormonal contraception is associated with sexual dysfunction, studies show mixed results based on route of administration and progestin component. Interestingly, nonuse of contraception also appears to be associated with sexual dysfunction and dissatisfaction. Low-dose vaginal estrogen, lubricants, and moisturizers may be used for treating vaginal dryness in the setting of hypoestrogenic states in reproductive-age women. Conclusion: A review of current contraception is appropriate for women presenting with sexual health concerns. Sexual dysfunction chronologically associated with a contraceptive may be addressed by trial of an alternative method. A multidisciplinary approach to treatment is recommended, including sex therapy, pelvic floor physical therapy, and consultation with a women's health specialist as needed.