1. Cervical cancer screening: interest in self-collected HPV testing
- Preferences Among U.S. Women for Cervical Cancer Screening with Self-Collected Specimens for Human Papillomavirus Testing in Obstetrics and Gynecology
Cervical cancer screening with cytology (Pap tests) and/or human papilloma virus (HPV) testing greatly decreases the number of cases of cervical cancer each year—and yet inadequate or missed screening still drives a disproportionate share of new diagnoses. While screening has traditionally been performed by clinicians during in-office visits, the FDA approved self-collected vaginal HPV testing in May of 2024. In In this cross-sectional analysis of survey data of more than 4000 21-49 year old women, 42.9% preferred HPV self-collection, 28.5% preferred clinician collection, and 28.6% had no preference; overall, about 71% were open to self-collection (preference or no preference). Interest was higher among respondents who were inadequately screened/never screened, nulliparous, nonheterosexual, and those reporting a history of nonvoluntary vaginal intercourse—groups for whom pelvic exams can be a major barrier. The authors conclude that the majority of respondents were open to self-collection, and suggest that a patient-centered approach to cervical cancer screening may improve screening rates especially among certain subpopulations.
2. HPV vaccination: one dose may be enough
- Noninferiority of One HPV Vaccine Dose to Two Doses in New England Journal of Medicine
Human papilloma virus (HPV) vaccination has the potential to significantly decrease the burden of cervical dysplasia and cancer in the world, but only 27% of adolescent girls worldwide have been vaccinated, with the majority of cervical cancers found in regions with low levels of vaccination. Decreasing the number of injections required for vaccination has the potential to improve vaccination rates. In this large randomized trial of more than 20,000 female participants ages 12–16, investigators compared 1 vs 2 doses of either the quadrivalent or nonavalent HPV vaccine and tracked persistent HPV-16/18 infection over 5 years. In a noninferiority analysis, the authors determined there was no significant difference between the groups up through 5 years after vaccination, and that all groups had vaccine effectiveness of at least 97%. This data suggests that single-dose HPV vaccination can be safely offered to adolescents without compromising effectiveness.
3. Importance of person-centered contraceptive counseling for adolescents
- Adolescents’ and Young Adults’ Receipt of Person-Centered Contraceptive Counseling in JAMA Network Open
It has been well-established that adolescents and young adults experience numerous barriers to contraceptive access, including a lack of information and counseling. Quality of contraceptive counseling has been linked to individual satisfaction with birth control and reproductive choices. Using the Person-Centered Contraceptive Counseling scale (PCCC scale), a validated instrument to assess a patient’s experiences with contraceptive counseling, the authors used national survey data from 2022-2023 to compare PCCC scale results among three age groups: adolescents (ages 15-19), young adults (ages 20-25) and adults (ages 25 and up). Overall, PCCC scales were low, indicating that few people in all age groups are receiving adequate person-centered contraceptive counseling. Adolescents’ results revealed that they receive significantly less contraception counseling than older individuals. But, when they did receive person-centered contraceptive counseling, 15-19 year olds expressed a high level of satisfaction with their chosen birth control methods. Healthcare providers who work with adolescents can use this data as inspiration to incorporate person-centered contraceptive counseling into their practice.
4. IUD expulsion rates after abortion or pregnancy loss
- Intrauterine Device Expulsion After Medication Versus Procedural Management of Induced and Spontaneous Abortion: A Retrospective Study in Journal of Women’s Health
IUDs are a highly effective form of reversible contraception, and may be safely used by the grand majority of patients seeking contraception. Patients seeking abortion care or pregnancy loss management may elect to have an IUD placed during their care, either at the time of procedural management or at time of follow up after medical management. While there is a known increased risk of IUD expulsion with post- abortion or post-miscarriage placement, it has been unclear whether this likelihood varies depending on type of management. In this retrospective cohort study, the authors identified more than 400 patients who had procedural or medication management for induced or spontaneous abortion, with an IUD placed at time of procedural management or within 30 days of medication management. IUD expulsion was diagnosed either clinically or based on imaging. The overall expulsion rate was 11%, and did not differ significantly between placement after procedural (11%) or medication (12%) management. Providers who offer IUDs after abortion or management of pregnancy loss can assure patients that IUD expulsion is uncommon and does not significantly vary depending on management modality.
5. LNG-IUDs and acne
Hormonal contraception methods may affect acne prevalence in users, and levonorgestrel in particular has androgenic effects that may contribute to worsening acne. Serum levonorgestrel levels are relatively low for hormonal IUD users, but it is less clear how this low level may still cause worsening acne in some patients. In this systematic review and meta-analysis, the authors identified nine randomized clinical trials including more than 6000 hormonal IUD users. The acne rates in the individual trial varied widely, but the authors determined that acne was prevalent in 15% of hormonal IUD users overall, with higher rates (19.5%) among 52mg LNG IUD users and lowest (13.1%) among 13.5mg LNG IUD users. While the authors note that acne is generally a common complaint among the young female population most likely to use IUDs and it is less clear from this data how much is “device-attributable” vs baseline acne risk, they note that the trend of increased acne among 52mg LNG IUD users compared to 13.5 LNG IUD users may be incorporated into patient-centered counseling for patients when acne is a top priority.
6. Postpartum permanent contraception: vasectomy is often mentioned—but rarely accessed
- Consideration of vasectomy among patients desiring postpartum permanent contraception and their obstetrician-gynecologists: A United States-based study in Contraception
Female patients who have completed childbearing or plan to remain childfree may consider the option of permanent contraception (PC) through bilateral salpingectomy or tubal ligation. While vasectomy may offer a less invasive and more cost-effective form of PC, this option is less commonly chosen. In this semi-structured interview study, the authors recruited 65 postpartum patients with a documented interest in female PC and 52 ObGyns who had provided care to these patients. In their interviews with patients, approximately half of patients recalled counseling that included vasectomy and many described being positioned as the “messenger” who had to educate and persuade their partner. Most OB-GYNs said they routinely mentioned vasectomy, but flagged predictable system barriers: limited referral pathways and no direct access to the partner. They also noted that they might not counsel a patient on vasectomy based on perceived relationship stability, and took into account clinical considerations such as surgical history, delivery mode, and future cancer risk. The authors conclude that while ObGyns must focus on patient-centered equitable contraception counseling to avoid assumptions about patients’ relationships and preferences, improved referral networks and counseling resources for vasectomy could increase providers’ comfort with discussing this option with potentially interested patients.
7. Gonorrhea treatment: two new oral options
Gonorrhea, which is caused by Neisseria gonorrhoeae bacteria, is a sexually transmitted infection (STI) which can cause serious complications, such as pelvic infection or sepsis, when not identified or fully treated. Until recently, the primary treatment recommendation for this STI was a single intramuscular injection of ceftriaxone. Because ceftriaxone administration requires a visit with a healthcare provider, it can be difficult to adequately treat patients and their partners, resulting in the persistence and spread of infection. Furthermore, the increase of resistant strains of N. gonorrhoeae has led to concern about only one available treatment option. However, the US Food and Drug administration recently approved two new oral medications to treat gonorrhea, significantly expanding treatment possibilities. Nuzolvence (zoliflodacin), a powder that can be dissolved in water, is approved for individuals 12 years and over who weigh more than 77 pounds. Bluejepa (gepotidacin), an oral tablet taken in two doses twelve hours apart, is approved for use in individuals 12 years and over who weigh more than 99 pounds. While it may be some time until these medications are widely available, this is an exciting and important update for any providers who see and treat gonorrhea infections.
8. Mail-order medication abortion among out-of-state patients
- Awareness of abortion medications by mail options among patients traveling out-of-state for abortion: an exploratory study in Contraception
Following the Dobbs decision in June 2022, 13 US states have enacted total abortion bans, and the majority of states have some restrictions. As a result, an estimated 20% of individuals travel across state lines to obtain abortion services, often incurring enormous personal and financial burdens. For many patients, medication abortion is a safe option that can be accessed in all 50 states through telehealth or other virtual platforms. However, little is known about what traveling abortion seekers understand about medication abortion options, and whether they would have used this alternative if they had been aware of it. For this study, the authors identified patients who had traveled out of state for abortion care, but would have been candidates for abortion medications by mail. Among respondents most were not aware that pills-by-mail were an option. Among those who were aware, common reasons for still traveling included concerns about managing medications at home and legal risk. This study expands on what is known about abortion seekers in restrictive states, who may have complex needs for information and support. Reproductive healthcare providers should continue to provide education about safe abortion options including online resources.
9. OTC pill safety
Opill (norgestrel 0.075mg) is a progestin-only contraceptive pill that was approved for over-the-counter use by the FDA in 2022. As part of Opill’s application for FDA approval, this study assessed whether consumers could understand key messages from the drug label to affirm its safety for widespread use. The authors conducted interviews with more than 700 individuals in two cohorts: one that represented the general population, and another that mainly consisted of subjects with a history of breast cancer. Participants were asked to read the label materials, and were then interviewed to assess their understanding of key Drug Facts Label messages (e.g., “do not use if you have or have had breast cancer,” what to do after vomiting, etc.). The authors found that the majority of high-yield messaging was correctly understood by study participants, including adolescents and individuals with lower health literacy. These results were used to support Opill’s successful application for over-the-counter use and highlight the safety of over-the-counter progestin-only contraceptives.