Introduction:Hymen anatomy and physiology remain poorly understood, even among health-care providers. Misconceptions about virginity testing, virginity certification, and hymenoplasty can lead to harmful practices and place women who are unable to prove their virginity at risk of violence or even death. The aim of this study is to investigate the knowledge, attitudes, and practices of gynecologists and pediatricians in Switzerland regarding virginity testing, virginity certification, and hymenoplasty, and to identify gaps to inform future training and professional guidelines. Methods:Gynecologists, pediatricians, and medical students completed a 22-question survey. Group differences were assessed using chi-square or Fisher's exact tests, with significance set at 5%. Results:A total of 542 participants completed the survey. Overall, 97.5% believed that the absence of bleeding during the first vaginal penetration does not mean that someone is not a "virgin." However, for 13.3% of respondents, hymenal rupture does define the loss of virginity, and 24.5% believed that a gynecologist can determine virginity status, with a significant association with medical practice settings (P < .001), university hospitals (P = .01), private clinics (P = .009), and public institutions (P < .001). Hymenoplasty was considered effective by 16.2% of the participants in ensuring bleeding at subsequent penetration. The right of patients or family to request a virginity check was acknowledged by 18.9% of participants, even if most respondents (85.9%) believed that practicing hymenal reconstruction reinforces gender inequalities. In addition, 68% of participants agreed that a virginity certificate should be issued in life-threatening situations.A little over one-third (39.3%) of the responding physicians had received at least one request for virginity testing, certification, or hymenal reconstructive surgery; 30.4% of them accepted the request, but only 28.8% of all requests offered multidisciplinary management. Discussion:Women may encounter different approaches depending on the health-care professional they consult, reflecting a lack of standardized care. This national survey highlights substantial knowledge gaps and variability in practice among Swiss health-care professionals, underscores the absence of official guidelines and a coordinated support network, and calls on Swiss medical societies to establish clear, evidence-based recommendations that prioritize patient information, safety, and support while integrating these topics into education, residency training, and medical school curricula.

Menstrual issues, such as dysmenorrhea and abnormal uterine bleeding, are common during adolescence and may negatively impact quality of life. Transgender and non-binary adolescents may experience the same menstrual disorders as their cisgender peers, and they often report worsening gender dysphoria associated with menstruation. Various hormonal treatment options exist to alleviate menstrual issues, with certain specificities to consider in adolescents in general, and in transgender and non-binary adolescents in particular. Primary care physicians should explore menstrual health in their young patients to improve access to appropriate care for all adolescents.

INTRODUCTION:Child sexual abuse (CSA) is a critical public health concern with enduring physical and psychological consequences. OBJECTIVE:This study aimed to describe the sociodemographic profiles, contextual circumstances, and clinical findings of reported CSA cases involving girls aged ≤14, recorded between 2018 and 2021 at two university hospitals in Switzerland: Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV) and Geneva University Hospitals (Hôpitaux Universitaires de Genève - HUG) to inform prevention and intervention strategies. METHODS:This retrospective observational study included 95 cases identified through forensic consultations at CHUV and HUG. All eligible cases recorded between 2018 and 2021 were analyzed. Collected data included sociodemographic characteristics, assault circumstances, perpetrator-victim relationship, and clinical findings. RESULTS:The median age of children exposed to sexual assault was 7 years (IQR 4-14). Intra-familial abuse predominated among premenarcheal girls (41.7%), while postmenarcheal girls were more frequently assaulted by non-familial perpetrators (76.2%) and experienced higher rates of physical violence (47.6%). Genital lesions were documented in 41% of cases, with a higher prevalence among younger patients, and were rarely specific to CSA. CONCLUSION:This study provides a detailed descriptive overview of CSA cases involving girls aged ≤14 in two Swiss cantons. It highlights age-related patterns in perpetrator profiles, assault characteristics, and clinical findings. Prevention strategies should be age-specific, addressing intra-familial risk in younger children and peer-related or situational vulnerabilities in adolescents. These findings support the implementation of standardized forensic practices, improved surveillance systems, and targeted prevention and care strategies.

Purpose. We aimed 1) to translate and adapt the English version of Low Literacy Decisional Conflict Scale (LL-DCS) into French and 2) to assess its psychometric properties in adolescents. Methods. The original LL-DCS was translated into French by 2 independent translators, with discrepancies resolved by a multidisciplinary team. The reconciled version was back-translated into English by 2 other translators to ensure accuracy. We tested the prefinal version among 14 adolescents, who evaluated the clarity of the items. Second, we conducted psychometric testing of the final version among 85 adolescents participating in a pilot study evaluating a decision aid for contraception and menstrual management. Participants completed the French version of LL-DCS before (T0) and after (T1) their clinical encounter. We assessed internal consistency with Cronbach’s alphas and model fit with confirmatory factorial analyses. We evaluated discriminant validity by comparing scores at T0 and T1 based on participants’ responses regarding treatment preference. Results. Internal consistency of the French LL-DCS was acceptable, with a Cronbach’s alpha of 0.72 at both T0 and T1, although there was variability in reliability at the subscale level. Model fit was adequate at T0, indicating good factor validity. There was evidence for the original 4-factor model at T0, but exploratory analysis suggested a 3-factor solution with Informed and Values Clarity as one factor. Discriminant validity was strong, as the scale distinguished between adolescents who had decided on treatment and those who remained undecided. Conclusion. The French version of the LL-DCS demonstrates satisfactory psychometric properties, including internal consistency, factor validity, and discriminant validity. However, caution should be exercised when interpreting individual subscales, as their internal consistency is somewhat lower than the original English version of LL-DCS. Highlights We translated, adapted, and tested the French version of Low Literacy Decisional Conflict Scale in adolescents. The French version of the Low Literacy Decisional Conflict Scale is adapted to people with limited literacy skills. We hope that it might facilitate the participation of vulnerable populations in clinical research projects.

Pregnancy is associated with an increased risk of severe COVID-19. In addition, SARS-CoV-2 infection during gestation has been linked to adverse obstetrical outcomes and placental abnormalities. Nevertheless, the susceptibility of early trophoblast cells to SARS-CoV-2 and the potential consequences of infection on trophoblast function remain unclear. In this study, we assessed the permissiveness of first trimester trophoblast cells to SARS-CoV-2 infection and its impact on trophoblast cells fusion. To address this, we isolated primary cytotrophoblast (CTB) cells from first trimester human placentas and allow their differentiation into STB in vitro. These cells were infected with SARS-CoV-2 variants of concern, including Delta and Omicron (BA.1, BA.2, BA.5). Viral replication was assessed by RT-qPCR and immunofluorescence, while host cell responses, including expression of viral entry receptors and innate immunity genes, were measured by RT-qPCR. Trophoblast fusion was evaluated by staining and calculating the fusion index. In parallel, placental tissues from SARS-CoV-2-infected pregnancies were analyzed by immunohistochemistry to quantify syncytial knots (SK) formation in vivo. Our results demonstrate that both first trimester CTB and STB are permissive to SARS-CoV-2 infection in a variant- and donor-dependent manners, with Delta exhibiting higher replication efficiency compared to Omicron variants. In STB, viral replication did not correlate with the induction of entry receptors or type III interferon responses. However, in CTB, viral replication was significantly associated with enhanced cell fusion. In parallel, an increased number of SK was observed in infected placental areas in vivo compared to non-infected regions from the same placenta and to gestational age-matched controls. Altogether, these in vitro and in vivo results suggest that SARS-CoV-2 infection in early pregnancy may alter STB turnover, potentially contributing to placental dysfunction and adverse pregnancy outcomes.

Study Objective Puberty is associated with important changes in secondary sexual characteristics, but the changes occurring in female external genitalia are not thoroughly described. The aim of this systematic review is to summarize and assess the current scientific knowledge regarding vulvar changes and development during puberty. Methods PubMed, Embase, Web of Science, and Cochrane were searched, using keywords related to “puberty”, “vulva”, and “morphology”. Inclusion criteria were observational studies describing vulvar development in individuals between the ages of 8 and 16 years. The outcomes of interest were quantitative and/or qualitative descriptions of the vulva, including anatomical, physiological and histological changes. Results Of the 1658 articles screened, 10 were included. The mean clitoral glans diameter increases during puberty, as does the length of the clitoral hood. The clitoral hood changes, to become more retractile and rugose. The inner labia width and length increases throughout puberty, and the development of inner labia varies between individuals, with labial asymmetry being a common characteristic. The most frequent hymenal configuration found during puberty is the crescentic form, and features such as hymenal mounds, longitudinal intravaginal ridges, and most notches, are physiological. Conclusion Reliable data on pubertal development of the external female genital organs is scarce. Future research is needed in order to provide more precise data to help categorize vulvar development into stages. A detailed description of vulvar maturation into sequential stages throughout puberty (as done by the Tanner scale for the male homologous structures) can increase knowledge of its morphological diversity and help reach clinical consensus on the nature of pathological variants. In addition, better knowledge of vulvar diversity is of importance to both healthcare professionals and individuals, and may empower and promote self-esteem.

STUDY OBJECTIVE:To present the successful laparoscopic management of a rare case of congenital obstructive Müllerian anomaly, identified as partial vaginal aplasia and cervical agenesis. DESIGN:Surgical technique description. SETTING:A 13-year-old girl was referred for management of cyclic pelvic pain. Despite not having reached menarche, she exhibited secondary sexual characteristics. Magnetic resonance imaging revealed the presence of a uterus with a 6.4 × 5.2 cm hematometra. However, imaging could not conclusively confirm the presence of a proximal vagina and a cervix. Both ovaries and kidneys were observed to be in their normal positions. Because of the failure of hormonal and analgesic therapy to alleviate her pain, the patient underwent a mini-invasive surgical procedure. INTERVENTION:Under general anesthesia, the external genitalia appeared normal. A 2 cm vaginal cul-de-sac was identified with the absence of the upper two-thirds of the vagina. Laparoscopy revealed endometriotic peritoneal lesions with widespread deposits of hemosiderin throughout the abdominal cavity. An enlarged uterus with a dilated isthmic portion (hematometra) was confirmed. In this video presentation, we describe the surgical steps involved in performing a direct laparoscopic utero-vaginal anastomosis to restore continuity of the genital tract. The patient experienced immediate relief postoperatively. Two months later, an elective vaginoscopy revealed a 3 cm long vagina with a permeable opening at the level of the anastomosis. Hysteroscopy indicated an endocervical canal, still dilated, with the presence of mucus. Passage through the endocervix allowed visualization of a uterus presenting a partial septum. Repeated hysteroscopy at 5 months showed no stenosis, and the patient reported regular and painless menstrual cycles after 2-year follow-up. Long-term follow-up is crucial to monitor for vaginal stenosis, prevent recurrence of pain and secondary amenorrhea. Fertility prognosis remains uncertain, as the functionality of the cervical anastomosis to sustain pregnancy is unknown. Nonetheless, pregnancy remains possible given the resolution of obstruction. Careful obstetrical monitoring will be required, and cesarean delivery is recommended. CONCLUSION:Cervical agenesis can be effectively managed conservatively, with long-term success achievable using a direct laparoscopic utero-vaginal anastomosis. This case highlights the importance of a multidisciplinary approach involving pediatricians, gynecologists, and radiologists in the management of complex and rare Müllerian anomalies.

BACKGROUND:Adolescents with developmental disability (DD) may experience similar menstrual disorders as their peers, as well as unique challenges associated with their underlying conditions. They have access to the same hormonal medications as the general population, but little is known about the effects of menstrual management in adolescents with DD. The aim of this study was to assess the efficacy, satisfaction with, side effects and complications of hormonal medications that are used for menstrual management in adolescents and young adults with DD. METHODS:A systematic review was performed in Medline, Embase, Cochrane library and PsycNet, using keywords related to menstrual management, hormonal medications, adolescents and disability. Meta-analyses of proportions were conducted for outcomes that could be combined across studies. RESULTS:Of the 2088 articles identified, 20 studies were included. The total number of participants was 3317 and varied significantly across studies (from 14 to 1560 individuals). Menstrual management was associated with a reduction in bleeding and high rates of amenorrhoea. We found that 45.4% (95% CI, 32.1-59%) of levonorgestrel-intrauterine device users experienced amenorrhoea. Satisfaction was high with all methods and correlated with the reduction in bleeding. Breakthrough bleeding was the most common side effect and the primary reason for ceasing or switching medication. No case of venous thromboembolism was reported. CONCLUSIONS:Menstrual management was associated with improvement in menstrual symptoms and high levels of satisfaction in adolescents with DD. Side effects and complication rates were low in this population. This should support the use of menstrual management in adolescents with DD, who deserve similar access to menstrual health care as their peers.

Objectives:To report the developing process and acceptability testing of a decision aid designed for adolescents and young adults with developmental disabilities, focusing on treatment options for menstrual management. Methods:We developed a paper-based encounter decision aid to support shared decision-making about treatment options for menstrual management for adolescents and young adults with developmental disabilities. This tool was designed to be both evidence-based and user-centered. We conducted a feasibility study to assess its acceptability. Results:The decision aid was used during consultations with 18 adolescents and young adults with developmental disabilities and their caregivers. Participants reported high levels of acceptability and found the tool helpful in facilitating decision-making. They particularly valued the ability to compare treatment options side by side. The tool also promoted meaningful conversations between patients and clinicians. Conclusions:The decision aid was well-accepted and successfully facilitated the discussion about menstrual management options between patients and clinicians. Further research is needed to evaluate its long-term impact on decision making outcomes and patient satisfaction. Innovation:This innovative tool may support shared decision-making for adolescents and young adults with developmental disabilities and their caregivers, and provide additional insight on how to engage individuals with developmental disabilities in healthcare decisions.

Vulvar Lichen Sclerosus(VLS) is an uncommon, often misdiagnosed condition with a chronic course. Children presenting with VLS may have a wide variety of complaints, which complicates diagnosis. The differentiation of symptoms in the course of VLS causes great diagnostic difficulties. Delayed diagnosis may have an impact on vulvar architecture and long-term sexual health, and can often lead to frustration for both the patient and her parents. The aim of this study was to determine the reasons for delayed diagnosis of VLS in girls and adolescents and to investigate the number of different doctors and specialists consulted before the diagnosis of VLS, the symptoms reported, and the clinical presentation at time of diagnosis. We conducted a retrospective descriptive unicentric cohort study by reviewing medical charts of paediatric and adolescent girls diagnosed with VLS in a tertiary Swiss Centre. The average delay from first symptoms to VLS diagnosis was three years. Many symptoms went unrecognised despite consultations with a wide range of specialists. Once topical corticosteroids were prescribed, relief of symptoms was very quick, usually within one month. Conclusion : Even for a wealthy country such as Switzerland, with ample access to healthcare and specialists, it still takes a long time to arrive at the correct diagnosis and treatment of VLS. Improving knowledge and understanding of VLS disease among paediatricians and healthcare providers could lead to earlier diagnosis and treatment, and thereby significantly improve patient outcomes. What is Known: • VLS is a chronic, often misdiagnosed condition with a variety of symptoms in children. • Delayed diagnosis can impact vulvar anatomy and long-term sexual health. What is New: • In Switzerland (Canton od Geneva), the average delay from symptoms to diagnosis is three years, despite specialist access. • Many patients see multiple doctors before diagnosis, highlighting the need for better awareness among healthcare providers.

Gender affirming hormone therapy may be used to relieve dysphoria among transgender or gender-diverse individuals. However, the long-term effects of these treatments on reproductive health remain uncertain. Before initiating hormone therapy, it is essential that patients are fully informed about the potential impact on their reproductive capabilities. Fertility preservation options, such as oocyte cryopreservation, should be offered to gender diverse individuals who were assigned female at birth. To assist healthcare providers in navigating the complexities of fertility preservation for these patients, we conducted a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis focused of oocyte cryopreservation. This analysis aims to ensure that decisions are both clinically sound and aligned with the patient's reproductive goals.

OBJECTIVE: To assess the characteristics of all people reporting sexual assault at the obstetrics and gynaecology emergency departments of Geneva University Hospitals (HUG) and Lausanne University Hospitals (CHUV) between 2018 and 2021. METHODS: Retrospective analysis of medicolegal reports for all people reporting sexual assault at the obstetrics and gynaecology emergency departments of HUG and CHUV between 2018 and 2021. Included: cisgender women, non-binary, queer persons, transgender men with a vulva and vagina and transgender women, regardless of sexual orientation, aged at least 14 years old. Excluded: Children and adolescents <14, cisgender men and trans men with a penis (who usually do not consult obstetrics and gynaecology emergency departments after a sexual assault) and recurrent patients with more than three sexual assaults reported at a participating centre within the study period (the first three assaults were included). During the study period, the two regional university hospitals used the same forensic sexual assault reporting forms, which allows a uniform description of the sociodemographic and clinical characteristics of patients reporting sexual assault as well as the characteristics of the sexual assault itself. KEY FINDINGS: Of the 962 sexual assault records during the 48-month study, 740 were retained for the analysis. Median age of victims: 24 years (interquartile range: 19 to 33 years; range: 14 to 93 years). On weekend days, the number of assaults was twice as high as on weekdays (45% of all sexual assaults took place during the weekend, on either a Saturday or Sunday). During the summer, the monthly number of assaults was increased by half. The summer months had the highest number of consultations (34%). 58% of victims reported knowing their assaulter, 28% did not, and due to amnesia, 14% did not know whether they knew their attacker or not. 24% of the patients were unable to recall or specify which types of penetration they were subjected to (if any), because of amnesia. 67% of patients reported vaginal penetration, 17% anal and 21% oral. 63% of victims reported some type of substance use (alcohol, drugs) prior to the assault. The police or public prosecutor ordered 40% of the sexual assault medicolegal examinations, while 60% of the victims came to the emergency department seeking care on their own. 56% of assaults take place at someone’s home (victim’s home, assailant’s home, friend/family member’s home, couple’s home). 83% of patients were examined within 72 hours of the sexual assault. Ano-genital injuries were found in 28% of patients who underwent a gynaecological exam (n = 705). 21% of patients who underwent a gynaecological exam and reported anal penetration presented with anal injury. 28% of patients who underwent a gynaecological exam and reported vaginal penetration presented with genital injury. CONCLUSIONS AND RECOMMENDATIONS: Such data can inform the general population as well as actors working in this field, including legislators, about the use of services after sexual assault, prevention and health education strategies and how to improve services for people who are sexually assaulted. There is no countrywide observatory of persons consulting for sexual assault in Swiss hospitals. We aim to create a national observatory that can inform prevention, care and education campaigns against sexual assault and its consequences for both men and women.

To assess the characteristics of all persons reporting sexual assault at the obstetrics and gynecology emergency departments of Geneva University Hospital and Lausanne University Hospitals (CHUV), between 2018 and 2021. Retrospective analysis of medico-legal reports for all persons reporting sexual assault at the obstetrics and gynecology emergency departments of the HUG and CHUV between 2018 and 2021. 962 sexual assault records during the 48-month study, 740 were retained for the analysis. Such data have shaped the creation of the informatic medical file and prospective study to inform services after sexual assault, prevention and health education strategies for all. No Conflicts of Interest to declare.

Abnormal uterine bleeding (AUB) are common in adolescents and young adults. They may be secondary to inherited bleeding disorders such as von Willebrand disease or platelet function disorders. These conditions are often under-recognized, leading to diagnostic delays and inadequate management. Treatments include hormonal and hemostatic options, tailored to the individual patient's needs and underlying hemostatic disorder. A coordinated approach between gynecologists, pediatricians, and hemostasis specialists is crucial to optimize management and improve patients' quality of life. This article explores the epidemiology, diagnostic approach, and multidisciplinary management of AUB in people with inherited bleeding disorders.

OBJECTIVES:To compare patient-reported pain, bleeding, and device safety between intrauterine contraceptive device (IUD) insertion procedures employing a suction cervical stabilizer or single-tooth tenaculum.STUDY DESIGN:This was a randomized, prospective, single-blinded study conducted at two centers, enrolling women aged 18 years or older, eligible for IUD insertion. The primary end point measure was patient-reported pain, measured on a 100-mm Visual Analogue Scale. Safety was assessed on the amount of bleeding, adverse events, and serious adverse events.RESULTS:One hundred women were randomized, 48 to the investigational device and 52 to control. There were no statistically significant differences between the groups in factors potentially associated with pain on IUD insertion. IUD insertion was successful in 94% of all subjects. Subjects in the investigational device group reported pain scores ≥14 points lower than in the control group at cervix grasping (14.9 vs 31.3; p < 0.001) and traction (17.0 vs 35.9; p < 0.001), and smaller differences in pain scores at the IUD insertion (31.5 vs 44.9; p = 0.021) and cervix-release (20.6 vs 30.9; p = 0.049) steps. Nulliparous women experienced the greatest pain differences to control. Mean blood loss was 0.336 (range 0.022-2.189) grams in the investigational device group and 1.336 (range 0.201-11.936) grams in the control group, respectively (p = 0.03 for the comparison). One adverse event (bruising and minor bleeding) in the investigational device group was considered causally related to the study device.CONCLUSIONS:The suction cervical stabilizer had a reassuring safety profile and its use was associated with significant reductions in pain during the IUD insertion procedure compared with standard single-tooth tenaculum use, particularly among nulliparous women.IMPLICATIONS:Pain can be an important barrier to greater use of IUD devices among prescribers and users, particularly nulliparous women. The suction cervical stabilizer may provide an appealing alternative to currently available tenacula, filling an important unmet need.

Heavy menstrual bleeding is one of the most common causes of consultation in haematology. We present the clinical case of a 20-year-old woman referred by her gynaecologist due to heavy menstrual bleeding since menarche, complicated by iron deficiency anaemia. Haemostasis work-up was initially suggestive of a von Willebrand disease type 1. Genetic analyses by whole exome sequencing lead to a fortuitous discovery of haemophilia by identifying a heterozygous missense mutation in F8, exon 8 c.1127T>G:p.Val376Gly, previously reported in a patient with mild haemophilia A. The bleeding phenotype worsened by concomitant low von Willebrand factor (VWF) due to VWF variants influencing VWF levels. Our case highlights how whole exome sequencing can help to correct an erroneous diagnosis and identify polymorphisms that eventually contribute to the overall haemostatic balance.

This article translates and synthesizes a reference guide containing iconographic material of the pre- and post-pubertal female external genitals with and without genital mutilation/cutting (FGM/C). The literature focuses on adults, whereas FGM/C are usually performed before the age of 15. Signs of FGM/C can be subtle and depend on the type of mutilation as well as the experience of the examiner. Published in 2022 and produced with the collaboration of 23 professionals, this illustrated guide "Female Genital Mutilation/Cutting in Children and Adolescents: Illustrated Guide to Diagnose, Assess, Inform and Report, https://link.springer.com/book/10.1007/978-3-030-81736-7 " is currently available in open access. It is aimed at facilitating the training of health professionals in making diagnosis, clinical management, and reporting to child safeguarding/law enforcement agencies, where required.Cet article traduit et synthétise un guide de références contenant du matériel iconographique sur la vulve pré et postpubère avec et sans mutilation génitale féminine ou excision (MGF/E). La littérature disponible se concentre sur les adultes alors que les MGF/E sont généralement pratiquées avant l’âge de 15 ans. Les signes peuvent être subtils et dépendent du type de mutilation ainsi que de l’expérience de l’examinateur-ice. Paru en 2022 et réalisé grâce à la collaboration de 23 professionnel-les, « Female Genital Mutilation/Cutting in Children and Adolescents: Illustrated Guide to Diagnose, Assess, Inform and Report, https://link.springer.com/book/10.1007/978-3-030-81736-7 » est disponible en libre accès. Il vise à former les professionnel-les à l’établissement de diagnostics, à une prise en charge adaptée, ainsi qu’au signalement auprès des organismes de protection de l’enfance, si nécessaire.

Objective To evaluate if daily oral 75 µg of Desogestrel (DSG) for 3 months prior to the insertion of etonogestrel-releasing contraceptive implant (ENG-IMPLANT) might help reduce its premature discontinuation. Results A total of 66 women were randomized in the ENG-IMPLANT group (26) and in the DSG + ENG-IMPLANT group (40), respectively, in the Geneva University Hospitals and Basel University Hospital, from August 15th, 2016 through September 30th, 2019. In the DSG + ENG-IMPLANT group, patients were given a 3 months’ supply of 75 µg of DSG before the insertion of the ENG-IMPLANT. All women were seen after 3 months for bleeding and satisfaction evaluation, and at 12 months post ENG-IMPLANT insertion. Higher levels of satisfaction at 12-months were found in the ENG-IMPLANT group compared to the DSG + ENG-IMPLANT group (8.5 ± 1.7 vs. 6.6 ± 2.9, p = 0.012). There were no statistically significant differences regarding tolerance (7.8 ± 2.5 vs 6.8 ± 2.6, p = 0.191) and contraceptive continuation (80% vs 72.4%, p = 0.544) between groups. Conclusion DSG prior to insertion of the ENG-IMPLANT did not improve its continuation rate neither its satisfaction at 1 year. Trial registration NCT05174195. Retrospectively registered, the 30th December 2021