BACKGROUND:Sexual health in the postpartum period contributes to a patient's overall well-being, highlighting the importance of addressing concerns that may arise related to sexual dysfunction. The comprehensive postpartum visit should include providing guidance on sexuality, management of dyspareunia, and resumption of intercourse. There is little literature examining the incidence of such counseling. METHODS:Patients who attended their postpartum visit at a large, urban academic medical center were invited to complete a web-based survey at their postpartum visit as part of a quality initiative. The survey consisted of a total of 34 questions evaluating frequency and quality of sexual health counseling, as well as sexual experience after delivery. Descriptive statistics, chi-squared tests, and multivariable logistic regression were used to analyze our findings. RESULTS:Our survey study had a 41.5% response rate (277/668). A total of 91% of participants reported receiving some sexual health counseling at their postpartum visit but only half of participants reported the counseling as helpful. Providers were statistically more likely to discuss sexual health with primiparous over multiparous participants (94.9% vs 87.9%; P = 0.037) and patients who had not yet resumed intercourse (93.5% vs 85.7%; P = 0.039). Providers had longer conversations with patients who delivered vaginally versus via cesarean (P = 0.039). CONCLUSIONS:Providers at this institution are almost universally offering some sexual health counseling to patients. However, we found that parity, delivery mode, and resumption of intercourse may impact providers' likelihood of discussing sexual health with postpartum patients.

Objectives:The second largest government funding source for cancer research is the Department of Defense (DOD). The Peer Reviewed Cancer Research Program (PRCRP) is the funding mechanism for uterine cancer under the DOD. Our objective was to compile cancer research funding granted through the PRCRP by organ site and stratify by incidence of disease to highlight uterine cancer funding. Methods:To gather funding information from the PRCRP, a thorough review was done of the CDMRP website, where records of grants funded and the total budgets for the PRCRP had to be manually abstracted from archives. Results:Uterine cancer has the second highest incidence of these areas (29.4 per 100,000 in 2021), after colorectal cancer (CRC) (37.5 per 100,000 in 2021). CRC has been funded the longest at 15 years. Mesothelioma, for comparison, has the lowest incidence (0.7 per 100,000 in 2021) and has been funded for 14 years. CRC, with the highest incidence and the longest funded area, has received a total of ∼$60 million through the PRCRP. Mesothelioma, with the lowest incidence and the second longest funded area has received ∼$25 million. Uterine cancer, with the second highest incidence, and one of the shortest funded areas, has received only ∼$14 million. Additionally, the incidence of uterine cancer is rising and has seen a 14.8% increase in incidence from 2009 to 2021 whereas CRC has seen a 15.0% decrease. Conclusions:This analysis highlights a proportionate inequity in government funding for uterine cancer when considering the rising incidence of this disease.

To characterize long-term (LT) and short-term (ST) responders to the Poly (ADP-ribose) polymerase inhibitor olaparib in the primary and recurrent maintenance setting. Clinical and molecular data was collected for patients receiving maintenance olaparib between January 2014 and July 2021. ST responders were defined as those experiencing progression < 6 months from initiating olaparib, whereas LT responders exhibited response ≥ 2 years. Molecular analysis included germline BRCA1/2 status, Myriad MyChoice CDx Homologous Recombination Deficiency (HRD) somatic testing, and STRATA Select comprehensive genomic profiling. 124 patients who received olaparib were included; 45 (36.3

BACKGROUND: Workplace microaggressions are a longstanding but understudied problem in the surgical specialties. Microaggressions in health care are linked to negative emotional and physical health outcomes and can contribute to burnout and suboptimal delivery of patient care. They also negatively impact recruitment, retention, and promotion, which often results in attrition. Further attrition at the time of an impending surgical workforce shortage risks compromising the delivery of health care to the diverse US population, and may jeopardize the financial stability of health care organizations. To date, studies on microaggressions have consisted of small focus groups comprising women faculty or trainees at a single institution. To our knowledge, there are no large, multiorganizational, gender-inclusive studies on microaggressions experienced by practicing surgeons. OBJECTIVE: This study aimed to examine the demographic and occupational characteristics of surgeons who do and do not report experiencing workplace microaggressions and whether these experiences would influence a decision to pursue a career in surgery again. STUDY DESIGN: We developed and internally validated a web-based survey to assess surgeon experiences with microaggressions and the associated sequelae. The survey was distributed through a convenience sample of 9 American College of Surgeons online Communities from November 2022 to January 2023. All American College of Surgeons Communities comprised members who had completed residency or fellowship training and had experience in the surgical workforce. The survey contained demographic, occupational, and validated micro- aggression items. Analyses include descriptive and chi-square statistics, t tests, and bivariable and multivariable logistic regression. RESULTS: The survey was completed by 377 American College of Surgeons members with the following characteristics: working as a surgeon (80.9%), non-Hispanic White (71.8%), general surgeons (71.0%), aged >= 50 years (67.4%), fellowship-trained (61.0%), and women (58.4%). A total of 254 (67.4%) respondents reported experiencing microaggressions. Younger surgeons (P=.002), women (P<.001), and fellowship-trained surgeons (P=.001) were more likely to report experiencing microaggressions than their counterparts. Surgeons working in academic medical centers or health care systems with teaching responsibilities were more likely to experience microaggressions than those in private practice (P<.01). Surgeons currently working as a surgeon or those who are unable to work reported more experience with micro- aggressions (P=.003). There was no difference in microaggressions experienced among respondents based on surgical specialty, race/ ethnicity, or whether the surgeons reported having a disability. In multi- variable logistic regression, women had higher odds of experiencing microaggressions compared with men (adjusted odds ratio, 15.9; 95% confidence interval, 7.7-32.8), and surgeons in private practice had significantly lower odds of experiencing microaggressions compared with surgeons in academic medicine (adjusted odds ratio, 0.3; 95% confidence interval, 0.1-0.8) or in health care systems with teaching responsibilities (adjusted odds ratio, 0.2; 95% confidence interval, 0.1-0.6). Among surgeons responding to an online survey, respondents reporting micro- aggressions were less likely to say that they would choose a career in surgery again (P<.001). CONCLUSION: Surgeons reporting experience with microaggressions represent a diverse range of surgical specialties and subspecialties. With the continued expansion of surgeon gender and race/ethnicity representation, deliberate efforts to address and eliminate workplace micro- aggressions could have broad implications for improving recruitment and retention of surgeons.

OBJECTIVES:The incidence of venous thromboembolism (VTE) following radical surgery for vulvar carcinoma remains poorly characterized, and recommendations for postoperative chemoprophylaxis are varied. Our objective was to assess the incidence of postoperative VTE in patients undergoing surgery for vulvar carcinoma and to determine if VTE incidence differs by radical vulvectomy with or without lymph node assessment. METHODS:The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients with a diagnosis of vulvar cancer undergoing radical vulvectomy with or without lymph node assessment from 2012 to 2020. Clinical characteristics and 30-day incidence of VTE as well as other postoperative outcomes were abstracted. Variables were compared using Chi-square test and Fischer's exact test, as well as Kruskal-Wallis and Wilcoxon rank sum tests where appropriate. RESULTS:A total of 1672 patients underwent radical vulvectomy for vulvar carcinoma. 11 patients (0.7%) experienced postoperative VTE within 30 days of surgery. The incidence of VTE was similar when radical vulvectomy was performed alone or with lymph node dissection by any method (p = 0.116). Longer operative times (p = 0.033) and greater postoperative length of stay (p = 0.001) were associated with increased risk of postoperative VTE. CONCLUSIONS:The incidence of postoperative VTE is low in patients undergoing radical vulvar surgery in this national cohort. Inguinofemoral lymph node dissection by any method does not appear to be a risk factor for VTE when compared to radical vulvectomy alone. Further research is needed to determine if extended VTE prophylaxis is beneficial in this population.

INTRODUCTION:In June 2022, the United States Supreme Court announced its decision in Dobbs v Jackson Women's Health Organization to overturn Roe v Wade. As a result, half of US states now face proposed or in-effect abortion bans, which affect the ability of obstetrics and gynecology (ObGyn) residency programs to provide abortion training. We sought to establish ObGyn residents' pre-Dobbs attitudes toward abortion, desire to learn about abortion, and intentions about providing abortion care in their future practice. METHODS:From January through December 2021, we surveyed 70 ObGyn residents at 4 programs in Wisconsin and Minnesota to assess their attitudes toward abortion, desire to learn about abortion, and intentions about providing abortion care in their future practice. RESULTS:Fifty-five out of 70 (79%) ObGyn residents completed the survey. Most reported highly favorable attitudes toward abortion, nearly all found the issue of abortion important, and the majority planned to incorporate abortion care into their future work. There were no differences in median attitude scores or behavioral intentions among institutions. CONCLUSIONS:Prior to the Dobbs decision, ObGyn residents in Minnesota and Wisconsin viewed abortion as important health care and intended to provide this care after graduation.

INTRODUCTION:On June 24, 2022, the United States Supreme Court decided Dobbs v Jackson Women's Health Organization (Dobbs), overturning Roe v Wade and banning abortions in almost all circumstances in Wisconsin. We tested the hypothesis that the rate of interval tubal sterilizations in people capable of pregnancy increased after the Dobbs decision. METHODS:We conducted a retrospective cohort study of all pregnancy-capable patients ages 18 to 55 years old who underwent interval surgical sterilization at an academic hospital in Wisconsin from June 24, 2016, through June 23, 2023. We defined the annual sterilization rate by dividing the number of sterilizations by total gynecologic surgeries performed each year. We compared the annual rates of interval surgical sterilization in the 6 years prior to the Dobbs decision to the year following the Dobbs decision. RESULTS:There were 1088 interval tubal sterilization procedures for pregnancy-capable people during the study period. The sterilization rate increased from 4.6% to 8.1% (P  < .001) from the year before the Dobbs decision to the year after. In the 6 years prior to Dobbs, 23.6% of patients receiving sterilizations were aged 20 - 29, compared to 35% post-Dobbs (P  < .001). Patients who were nulligravid (never been pregnant) increased from 23.0% in the 6 years pre-Dobbs to 54.7% post-Dobbs (P  <.001). Similarly, 28.0% of patients pre-Dobbs were nulliparous (never had a live birth) versus 60.4% post-Dobbs (P  < .001). CONCLUSIONS:There was an increase in the rate of interval sterilization procedures for pregnancy-capable people - particularly among younger and nulliparous patients - at a single academic institution in Wisconsin in the year following the Dobbs decision.

BACKGROUND: Limited English proficiency is associated with worse health outcomes regardless of health literacy. Prior research suggests that using interpreter services for low English proficiency helps mitigate the language barrier, is associated with improved health outcomes, and patient satisfaction; however, obstetric and neonatal outcomes and pregnancy risks in this population are not well studied. OBJECTIVES: The primary purpose of this study was to determine if low English proficiency is an independent risk factor for small for gestational age infants by utilizing interpreter use as a proxy for low English proficiency. Due to the known challenges in communication with a language barrier and discrimination against people whose first language is not English, we hypothesized that this could result in an increase in high risk conditions in pregnancy such as SGA. Our hypothesis was that the need for an interpreter would be associated with having small for gestational age infants. STUDY DESIGN: We performed a retrospective cohort study at a single center using data between 1/1/2016 and 12/31/2021; we included singleton, live births >= 21 weeks gestation. We excluded multiple gestations, intrauterine fetal demise, and delivery < 21 weeks. The primary outcome was rate of small for gestational age. Small for gestational age was defined as birthweight < 10th percentile for gestational age using the 2018 Fenton newborn growth curve. Multivariable logistic regression was performed to control for confounding variables. RESULTS: Of the 26,260 patients included in the study, 71.3% were non-Hispanic White, 9.5% were Hispanic/Latino, and 7.9% were non-Hispanic Black. Overall, 1,662 (6.3%) patients utilized an interpreter. Over half (58.0%) of patients requesting interpreter services were Hispanic. In unadjusted analyses, the rate of small for gestational age was not different between patients who used interpreter services (n=106, n =106, 6.4%) and those who did not (n=1612, n =1612, 6.6 %), P =.779. After adjusting for race/ethnicity, gravidity, gestational age, private insurance, diabetes, hypertension, and prepregnancy body mass index, the use of interpreter services was associated with decreased odds of small for gestational age (aOR 0.67, 95% CI 0.53-0.84). CONCLUSIONS: Our findings suggest that use of an interpreter is associated with a lower incidence of small for gestational age when controlling for patient characteristics and social determinants of health. Additional research is required to explore this association, but our results indicate that recognizing demographic risk factors and providing patients with social resources such as access to interpreter services may positively impact obstetric and neonatal outcomes.

Evaluate whether the relationship between PCOS and pregnancy complications is influenced by race/ethnicity. Cross-sectional analysis of PRAMS (Pregnancy Risk Assessment Monitoring System), a survey from the Centers for Disease Control administered by 46 states to postpartum individuals between 2016-18. Multivariable logistic regression was used to compare odds of composite pregnancy complications (perinatal death, hypertensive disorders, small or large for gestational age (SGA, LGA), preterm delivery (PTD)) and secondary outcomes (gestational diabetes, cesarean delivery) between individuals with and without PCOS among racial/ethnic groups. Data on self-reported PCOS status was available for 45,817 individuals, representing 2,337,951 people after weighting. 6.1% of individuals reported PCOS. Prevalence of PCOS by race/ethnicity includes Black non-Hispanic: 3.8%, Hispanic: 4.2%, White non-Hispanic: 7.2%. In adjusted analysis, PCOS individuals had lower odds of the composite outcome, LGA, and PTD. After stratifying by race and ethnicity (Table 1), White non-Hispanic individuals with PCOS had lower odds of composite outcome than those without PCOS. We found higher odds of perinatal death among Hispanic individuals with PCOS and lower odds of LGA and PTD among White Non-Hispanic individuals with PCOS. Despite the association of both PCOS and race/ethnicity with pregnancy complications, there is not a significant additive effect for most outcomes once adjusted for other factors. For pregnancy complications impacted by both PCOS and race/ethnicity, there may be unmeasured confounders not captured by our study.