[Applying consent, in healthcare and beyond]. / Appliquer le consentement, dans les soins et au-delà.

Sexual violence constitutes a form of gender-based violence, to the extent that the victims are mainly women. Other groups of vulnerable people are also more affected, in particular gender and sexual diversity persons. Sexual and gender-based violence can also occur in healthcare. To respect the legal framework and people's rights, but also to promote safety and quality in healthcare, it is essential to obtain and respect consent. Consent must be informed, explicit, freely given, and reiterated throughout the consultation. This article reviews the concept of consent and offers practical tools for its application in healthcare.

Les violences sexuelles constituent une violence de genre, dans la mesure où les victimes sont principalement des femmes et les auteurs des hommes. D'autres groupes de personnes vulnérables sont également davantage concernés, en particulier les personnes de la diversité sexuelle et de genre. Ces violences sexuelles et de genre existent également dans les soins. Afin de respecter le cadre légal et les droits des personnes, mais aussi de favoriser des soins de qualité et en sécurité, il est primordial de recueillir et respecter le consentement. Celui-ci doit être éclairé, explicite, libre et réitéré tout au long de la consultation. Cet article fait le point sur le concept du consentement et offre des outils pratiques pour son application dans les soins.

[Interdisciplinary care for gender diverse adolescents. The example of the Centre hospitalier universitaire vaudois (CHUV)]. / Prise en charge interdisciplinaire des adolescent-e-s transgenres et non binaires. L'exemple du Centre hospitalier universitaire vaudois (CHUV).

This article outlines the management of transgender and non-binary adolescents at CHUV. The current rise in visibility of this topic is associated with an increased demand for intervention and at the same time with an increased generation of continuously expanding medical evidence to guide interventions. The close collaboration among various specialized adolescent health services enables an interdisciplinary evaluation of diagnostic elements and indications for potential psychological, social or medical interventions. This article underscores the significance of an interdisciplinary and individualized approach to transgender and non-binary adolescents, respecting the diversity of the human being.

Cet article présente la prise en charge des adolescent-e-s transgenres et non binaires (TNB) au Centre hospitalier universitaire vaudois (CHUV). L'actuel gain en visibilité de la thématique conduit à une augmentation des demandes de prise en charge et, parallèlement, à une augmentation de la production d'évidence médicale pour orienter les prises en charge. La collaboration étroite entre les différents services spécialisés en santé des adolescents permet une évaluation interdisciplinaire des éléments diagnostiques et des indications aux éventuelles interventions psychologiques, sociales ou médicales. Cet article souligne l'importance d'une approche interdisciplinaire, basée sur l'évidence médicale et individualisée des adolescent-e-s TNB, dans le respect de la diversité de l'être humain.

Mosaic RASopathies concept: different skin lesions, same systemic manifestations?

BACKGROUND: Cutaneous epidermal nevi are genotypically diverse mosaic disorders. Pathogenic hotspot variants in HRAS, KRAS, and less frequently, NRAS and BRAF may cause isolated keratinocytic epidermal nevi and sebaceous nevi or several different syndromes when associated with extracutaneous anomalies. Therefore, some authors suggest the concept of mosaic RASopathies to group these different disorders. METHODS: In this paper, we describe three new cases of syndromic epidermal nevi caused by mosaic HRAS variants: one associating an extensive keratinocytic epidermal nevus with hypomastia, another with extensive mucosal involvement and a third combining a small sebaceous nevus with seizures and intellectual deficiency. Moreover, we performed extensive literature of all cases of syndromic epidermal nevi and related disorders with confirmed pathogenic postzygotic variants in HRAS, KRAS, NRAS or BRAF. RESULTS: Most patients presented with bone, ophthalmological or neurological anomalies. Rhabdomyosarcoma, urothelial cell carcinoma and pubertas praecox are also repeatedly reported. KRAS pathogenic variants are involved in 50% of the cases, especially in sebaceous nevi, oculoectodermal syndrome and encephalocraniocutaneous lipomatosis. They are frequently associated with eye and brain anomalies. Pathogenic variants in HRAS are rather present in syndromic keratinocytic epidermal nevi and phacomatosis pigmentokeratotica. CONCLUSION: This review delineates genotype/phenotype correlations of syndromic epidermal nevi with somatic RAS and BRAF pathogenic variants and may help improve their follow-up.

Adolescent pregnancy: An important issue for paediatricians and primary care providers-A position paper from the European academy of paediatrics.

Adolescent pregnancy and childbearing, remain a widespread health-related problem with potential short and long-term consequences. Comprehensive social, economic, environmental, structural, and cultural factors heavily impact on adolescents' sexual and reproductive health and early pregnancy. Health professionals can play a pivotal role in the prevention of unplanned pregnancy. Improved access to family planning, sexuality education in schools, community-based interventions, and policies contribute greatly to reduce the risk of adolescent pregnancy and the adoption of respectful and responsible sexual behaviour. Additionally, health care professionals can support pregnant adolescents in making decisions under these circumstances and provide adequate health care. This review highlights actions that can guide healthcare professionals in empowering young adolescents to become more aware and capable of making informed decisions about their sexual life, health, and future.

Ulcus Vulvae Acutum Lipschütz-UVAL: case series at a Swiss university hospital emergency room.

Background: Ulcus Vulvae Acutum Lipschütz (UVAL) is a largely unknown disease with a broad and complex differential diagnosis. Objectives: To provide a description of the main characteristics of UVAL, determine the most appropriate diagnostic process and describe the current therapeutic approach. Methods: We designed a retrospective, descriptive cohort study using the gynecological-ER database of our institution. Inclusion criteria: female patients aged between 10 and 20 years old with suspicion of a UVAL diagnosis at CHUV's gynecological ER. Data extraction: epidemiological characteristics, clinical presentation, laboratory tests, established diagnostics, treatment, and ulcer outcomes. Results: 15 patients were included for the analysis; average age: 15 years old; 60% of patients were virgo at the time of ulcer onset; all patients had at least one flu-like symptom concomitant with the vulvar lesion; the most-performed serology was for EBV and acute disease was present in only one patient; for diagnostic purposes two biopsies were performed with both inconclusive histopathology analysis; the main prescribed treatments were: oral NSAIDs, Paracetamol, and Lidocaine gel; 93% of cases presented signs of regression; the average follow-up time was 10 days. The diagnostic algorithm of Sadoghi et al: 10 out of 15 cases were retrospectively diagnosed with UVAL by the algorithm; half were diagnosed with UVAL, and the other half received a diagnosis of "ulcers of unknown origin" at the time of the gynecological ER visit. Conclusions: We highly recommend the diagnostic and therapeutic algorithms developed by Sadoghi et al. as valuable tools to guide clinical reasoning and, consequently, improve acute vulvar ulcers management.

Prevalence of anal dysplasia and HPV genotypes in gynecology patients: The ANGY cross-sectional prospective clinical study protocol.

BACKGROUND: Human Papillomaviruses (HPV) are highly prevalent in the sexually active populations, with a significant burden in terms of health and psychological cost in all class ages. High-risk (HR) HPV genotypes are associated with anogenital dysplasia and cancers, and anal HPV-induced cancer is increasingly observed in women. The interactions of HPV genotype's between the anus and the cervix, and the subsequent occurrence of dysplasia remains unclear. This clinical study set out to test the hypothesis that risk factors for anal HR-HPV and dysplasia may differ in women with or without cervical dysplasia or in HIV-positive women. METHODS: Cervical and anal HPV genotypes and cytology testing will be performed prospectively in a cohort of women recruited in a tertiary university hospital in Switzerland. Women will be allocated to three groups: 1) normal previous cervical smear; 2) high-grade cervical dysplasia (H-SIL) at previous cervical smear; 3) HIV+, independently of previous cervical smear result. General inclusion criteria comprised the followings: Female-Age > = 18 years; Satisfactory understanding of French; No objection to HIV testing. Specific inclusion criteria are: Group 1, no past or current gynecological dysplasia and HIV negative; Group 2, Gynecological dysplasia (H-SIL) or carcinoma in situ demonstrated by histology (vulvar, vaginal or cervical) and HIV negative; Group 3: HIV-positive (regardless of viremia or CD4 count) with or without gynecological dysplasia. General exclusion criteria are: Pregnancy; History of anal dysplasia/cancer; Status after pelvic radiotherapy; Absence of anus and anal canal. Estimated prevalences of anal dysplasia are: in group 1, 1% (0-2%); in group 2, 15% (5-27%), and in group 3, 30% (19-45%). With a 10% margin error, a sample size of 120 women per group is required to reach 90% power for detecting statistical significance (unilateral α error of 5%). DISCUSSION: The primary endpoint is the prevalence of anal and cervical dysplasia, and description of the respective HPV genotypes in each group. The results of this study could improve the standard of screening of cervical and anal dysplasia in women through evidence of concomitant presence of HPV's and/or dysplasia in anus or cervix to support vaccination for instance. Beginning of recruitment started in September 2016. Results should be presented in end of 2022. Preliminary analysis for first 100 patients reveals that the mean age of the population is 39.6 (± 10.9) years with mean age of first sexual intercourse of 18.5 (± 3.9) years. In this cohort, 12% are vaccinated and 38% having had anal intercourse. Overall, 43% of the studied population had cervical HR-HPV in the studied population, and 53% had normal cytology. Anal LR HPV and HR HP were found in 27.6% and 38.4% of all patients respectively. Eighty percent had normal anal cytology. Groups 1,2 and 3 had a significant difference in terms of age, gestity, parity, age of first sexual intercourse, systematic use of condom, number of cervical LR HPV and HR HPV and abnormal cervical cytologies. TRIAL REGISTRATION: The study was approved by the institutional review board-CER-VD#2015-00200-on the 29th of June 2016 and is registered on the Swiss National Clinical Trials Portal (SNCTP), SNCTP000002567, Registered 29 June 2016, https://www.kofam.ch/en/snctp-portal/study/40742/.

[Human Papillomavirus: screening of cervical and anal cancers]. / Papillomavirus humain : dépistage des cancers du col et de l'anus.

Cervical cancer is preventable through primary and secondary prevention. Vaccination against the human papillomavirus (HPV), the virus necessary for the development of precancerous lesions, can prevent most of them. Screening by cytology for these precancerous (or cancerous) lesions can be replaced by screening for certain types of HPV, high risk (HR-HPV), causing cervical cancer. The presence of HR-HPV on the cervix should raise suspicion of concomitant infection in the anus, as both epithelia are highly susceptible. This attitude is dictated by the increase incidence in anal cancer in the population, which is also HPV-dependent and therefore also potentially preventable through vaccination and screening.

Le cancer du col utérin est évitable, au travers d'une politique de prévention primaire et secondaire. Une vaccination contre le papillomavirus humain (HPV), et plus particulièrement contre les HPV dits à haut risque (HR-HPV) qui induisent le développement des états précancéreux, permet ainsi d'éviter une majeure partie de ceux-ci. Un dépistage par cytologie à la recherche de ces lésions précancéreuses (ou cancéreuses) peut être supplanté par la recherche de la présence des HR-HPV. La présence de HR-HPV sur le col doit faire suspecter une infection concomitante au niveau de l'anus car les deux épithéliums y sont très sensibles. Cette attitude est dictée par l'augmentation des cancers de l'anus dans la population, cancer lui aussi dépendant du HPV, et donc aussi potentiellement évitable au travers de la vaccination et du dépistage.

[Pregnancy of undetermined location: how to find it?] / Grossesse de localisation indéterminée : comment la trouver ?

Early pregnancy is frequently accompanied by abnormal symptoms such as pelvic pain and metrorrhagia. In these situations, it is quite frequent to be unable to identify the pregnancy and in particular its location, even if the pregnancy test is clearly positive. Many clinical, biological and ultrasound approaches have been proposed to try to predict the location and development of the suspected pregnancy, without the individualization of a truly reliable tool. Currently the HCG dosage at 48 heures-interval remains one of the best tools available, but it is challenged by mathematical models such as the M6 model. The M6 model has shown in our experience a very good predictive value with also an ability to reduce the follow-up of patients with low progressive risk, thus allowing a reduction in costs and anxiety for patients and caregivers.

Le début des grossesses est fréquemment accompagné de symptômes anormaux tels que douleurs pelviennes et métrorragies. Dans ces situations, il n'est pas rare de ne pas pouvoir identifier la grossesse et, en particulier, sa localisation même si le test de grossesse est nettement positif. De nombreuses approches clinique, biologique et échographique ont été proposées pour essayer de prédire la localisation et l'évolutivité de la grossesse suspectée, sans individualisation d'un outil vraiment fiable. Actuellement, le dosage de HCG à 48 heures d'intervalle reste un des meilleurs outils disponibles, mais il est concurrencé par des modèles mathématiques comme le M6. Ce dernier a démontré, selon notre expérience, une très bonne valeur prédictive avec aussi une capacité à réduire le suivi des patientes à faible risque évolutif, en permettant ainsi une baisse des coûts et de l'anxiété des patientes et soignants.

Women with Cervical High-Risk Human Papillomavirus: Be Aware of Your Anus! The ANGY Cross-Sectional Clinical Study.

Anogenital human papillomaviruses (HPV) are highly prevalent in sexually active populations, with HR-HPV being associated with dysplasia and cancers. The consequences of cervical HPV infection are well-known, whereas those of the anus are less clear. The correlation of cervical and anal HPVs with the increasing number of anal cancers in women has not been studied yet. The objective of our prospective study was to determine whether cervical and anal HPV correlated in a cohort of women recruited in a university hospital in Switzerland. Recruitment was conducted in the gynecology clinic, the colposcopy clinic, and the HIV clinic. Cervical and anal HPV genotyping and cytology were performed. Overall, 275 patients were included (360 were initially planned), and among them, 102 (37%) had cervical HR-HPV. Patients with cervical HR-HPV compared to patients without cervical HR-HPV were significantly younger (39 vs. 44 yrs, p < 0.001), had earlier sexual intercourse (17.2 vs. 18.3 yrs, p < 0.01), had more sexual partners (2.9 vs. 2.2, p < 0.0001), more dysplastic cervical cytology findings (42% vs. 19%, p < 0.0001) and higher prevalence of anal HR-HPV (59% vs. 24%, p < 0.0001). Furthermore, the HR-HPV group reported more anal intercourse (44% vs. 29%, p < 0.015). Multivariate analysis retained anal HR-HPV as independent risk factor for cervical HR-HPV (OR3.3, CI 1.2−9.0, p = 0.02). The results of this study emphasize that it is of upmost importance to screen women for anal HR-HPV when diagnosing cervical HR-HPV.

[Specialized, global and interdisciplinary care for (young) sportswoman]. / Prise en charge spécialisée, globale et interdisciplinaire de la (jeune) femme sportive.

Women have made a place for themselves in sport, but there are still inequalities and specific characteristics compared to men. Puberty is marked by hormonal changes that give the female athlete advantages and disadvantages. She then goes through various periods of life that condition her relationship to her body and her performance. Anatomical and hormonal factors influence certain injuries. Proper management of the menstrual cycle can optimize performance. She is more at risk of nutritional deficiencies or energy deficit. Moreover, she suffers more from a negative body image, aggravated by the pressure of the perfect sportswoman! All of these aspects should be considered when taking care of her and following up regularly, in order to avoid long-term consequences.

La femme s'est fait une place dans le sport, mais il persiste des inégalités et certaines caractéristiques spécifiques par rapport à l'homme. La puberté est marquée par des modifications hormonales conférant à l'athlète féminine des avantages mais aussi des inconvénients. Elle traverse ensuite diverses périodes de vie qui conditionnent sa relation à son corps et ses performances. Des facteurs anatomiques et hormonaux influencent certaines blessures. Une gestion adaptée du cycle menstruel peut optimiser les performances. Elle est plus à risque de carences nutritionnelles ou de déficit énergétique. De plus, elle souffre davantage d'une image négative de son corps, aggravée par la pression de la femme sportive parfaite ! Tous ces aspects sont à considérer lors de sa prise en charge et de son suivi régulier, afin d'éviter des séquelles à long terme.

[Taking an inclusive sexual health history of adolescents]. / Pour une anamnèse inclusive de la santé sexuelle à l'adolescence.

Sexual health is an integral part of overall health. Every individual who wishes to do so should have the opportunity to experience safe, enjoyable sex, free of coercion, discrimination and violence. These sexual rights mean not only being able to protect oneself from STIs and unwanted pregnancies when appropriate, but also feeling good about one's sexuality. Adolescence is a time of discovery and exploration of sexuality. The purpose of this article is to provide health professionals with strategies for reflection and action in order to conduct an inclusive sexual health history with adolescent patients, particularly with respect to sexual and gender diversity issues, so that everyone has optimal access to sexual health information and care.

La santé sexuelle fait partie intégrante des critères essentiels à la santé globale. Chaque individu-e-x le souhaitant devrait avoir la possibilité d'expérimenter une vie sexuelle agréable, sécuritaire, sans coercition, discrimination ni violence. Ces droits sexuels signifient non seulement pouvoir se protéger contre les infections sexuellement transmissibles et les grossesses non désirées le cas échéant, mais aussi se sentir bien dans sa sexualité. Or, l'adolescence est marquée par l'explo­ration de la sexualité. Cet article vise à donner aux profes­sionnel-le-x-s de la santé des outils et des pistes de réflexion afin de réaliser auprès des patient-e-x-s adolescent-e-x-s une anamnèse de la santé sexuelle inclusive, notamment par rapport aux questions de diversité sexuelle et de genre, pour améliorer l'accès optimal aux informations et aux soins en matière de santé sexuelle.

Is women's sexual function impaired by an abnormal pap smear?

OBJECTIVE: Although the stressful psychological impact on women of an abnormal Pap smear is well documented, little research has been undertaken on its sexual impact. Our objective was to assess the impact of an abnormal Pap smear on the sexual function of affected women. METHODS: A prospective study compared the sexual function of 48 women with an abnormal Pap smear (case group) with that of 48 women with a normal Pap smear (control group). Sexual function was assessed using the Female Sexual Function Index and the Hospital Anxiety Depression Scale. The questionnaires were mailed to the participants. RESULTS: Surprisingly, the risk of sexual dysfunction was comparable between women with and without an abnormal Pap smear (odds ratio [OR] 0.7; p = 0.4). The OR remained statistically non-significant after adjustment for risk factors. Multivariable analysis showed that only older age at first intercourse, depression and anxiety were identified as factors significantly associated with sexual dysfunction. CONCLUSION: Contrary to our clinical experience, female sexual function is not impaired by an abnormal Pap smear. Further research is needed to better understand how sexuality in women with abnormal Pap smears may be affected.

HIV testing in termination of pregnancy and colposcopy services: a scoping review.

BACKGROUND: Women and girls are relatively under-represented across the HIV treatment cascade. Two conditions unique to women, pregnancy and cervical cancer/dysplasia, share a common acquisition mode with HIV. This scoping review aimed to explore HIV testing practices in voluntary termination of pregnancy (TOP) and colposcopy services. METHODS: The scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We searched articles published up to 20 December 2020 using three electronic databases (PubMed/Medline, Embase, Google Scholar) and including the keywords "HIV Testing", "Abortion, Induced", "Colposcopy", "HIV screen*" and "termination of pregnancy". RESULTS: A total of 1496 articles were identified, of which 55 met the inclusion criteria. We included studies providing background HIV prevalence in addition to prevalence in the study population and studies of women seeking TOP rather than presenting with TOP complications. This limited our review to high-income, low HIV prevalence settings. We observed two study phases: studies pre-antiretroviral therapy (ART) using unlinked anonymous testing data and examining HIV risk factors associated with positive HIV tests and studies post-ART using routine testing data and exploring HIV testing uptake. HIV prevalence was estimated at >0.2% in most TOP settings and >1% (range 1.7%-11.4%) in colposcopy services. Many TOP providers did not have local HIV testing policies and HIV testing was not mentioned in many specialist guidelines. Testing uptake was 49%-96% in TOP and 23%-75% in colposcopy services. CONCLUSION: Given the estimated HIV prevalence of >0.1% among women attending TOP and colposcopy services, HIV testing would be economically feasible to perform in high-income settings. Explicit testing policies are frequently lacking in these two settings, both at the local level and in specialist guidelines. Offering HIV testing regardless of risk factors could normalise testing, reduce late HIV presentation and create an opportunity for preventive counselling.

Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy.

OBJECTIVE: The aim of this study was to describe the evolution of high-grade cervical dysplasia during pregnancy and the postpartum period and to determine factors associated with dysplasia regression. METHODS: Pregnant patients diagnosed with high-grade lesions were identified in our tertiary hospital center. High-grade lesions were defined either cytologically, by high squamous intraepithelial lesion/atypical squamous cells being unable to exclude HSIL (HSIL/ASC-H), or histologically, with cervical intraepithelial neoplasia (CIN) 2+ (all CIN 2 and CIN 3) during pregnancy. Postpartum regression was defined cytologically or histologically by at least a one-degree reduction in severity from the antepartum diagnosis. A logistic regression model was applied to determine independent predictive factors for high-grade cervical dysplasia regression after delivery. RESULTS: Between January 2000 and October 2017, 79 patients fulfilled the inclusion criteria and were analyzed. High-grade cervical lesions were diagnosed by cytology in 87% of cases (69/79) and confirmed by histology in 45% of those (31/69). The overall regression rate in our cohort was 43% (34/79). Univariate analysis revealed that parity (p = 0.04), diabetes (p = 0.04) and third trimester cytology (p = 0.009) were associated with dysplasia regression. Nulliparity (OR = 4.35; 95%CI = (1.03-18.42); p= 0.046) was identified by multivariate analysis as an independent predictive factor of high-grade dysplasia regression. The presence of HSIL on third-trimester cervical cytology (OR = 0.17; 95%CI = (0.04-0.72); p = 0.016) was identified as an independent predictive factor of high-grade dysplasia persistence at postpartum. CONCLUSION: Our regression rate was high, at 43%, for high-grade cervical lesions postpartum. Parity status may have an impact on dysplasia regression during pregnancy. A cervical cytology should be performed at the third trimester to identify patients at risk of CIN persistence after delivery. However, larger cohorts are required to confirm these results.

[Equity of care in gynecology-obstetrics for the deaf and hard of hearing†: issues]. / Équité des soins en gynécologie-obstétrique pour les personnes sourdes et malentendantes†: enjeux.

The deaf and hard of hearing population suffers from difficulties in accessing the health care system due to communication barriers with health care and administrative personnel who are often insufficiently trained in deafness issues. Gynecology-obstetrics consultations represent a gateway to the health system. Since 2011, there is a gynecology and obstetrics consultation dedicated to deaf people at the CHUV. This article presents the means of communication support put in place within the context of this specific consultation as well as the experience of a group of patients. Awareness of deafness among all staff in contact with patients as well as the use of professional interpreters are the key elements of care that respects the needs and rights of deaf people.

La population sourde et malentendante souffre de difficultés d'accès au système de santé en raison de barrières de communication avec le personnel soignant et administratif, souvent insuffisamment formé aux enjeux de la surdité. Les consultations de gynécologie-obstétrique représentent une porte d'entrée dans le système de santé. Depuis 2011, une consultation de gynécologie-obstétrique dédiée aux personnes sourdes existe au CHUV. Cet article présente les moyens d'aide à la communication mis en place dans le cadre de cette consultation spécialisée ainsi que le vécu d'un collectif de patientes. Une sensibilisation à la surdité de l'ensemble du personnel au contact des patient·e·s ainsi que la sollicitation d'interprètes professionnel·le·s sont les piliers d'une prise en charge respectueuse des besoins et des droits des personnes sourdes.

Safety and Efficacy of an Atraumatic Uterine Cervical Traction Device: A Pilot Study.

Introduction: Alignment of the uterine cervix with the vaginal canal is often required during insertion of an intrauterine contraceptive device (IUD). Currently available instruments are traumatic tenacula, which can cause pain and bleeding and represent an obstacle for certain patients to pursue their medical follow-up. A novel investigational cervical vacuum tenaculum, enables atraumatic traction of the cervix using a semi-circular suction pad, designed to conform to the anatomical shape of the external cervical os. Suction is generated by manually pulling out a sliding tube in a vacuum chamber. Methods: We performed a single arm non-comparative pilot study to assess the safety and efficacy of the cervical vacuum tenaculum in 13 women receiving an IUD. Data on procedural efficacy, safety, patient-reported pain scores at specific time points during IUD insertion procedure and patient satisfaction were collected prospectively. Results: Insertion of IUD was successful with use of the study device in 7 of the 13 enrolled patients (54%). No bleeding or only limited ecchymosis were caused by the device. No adverse events were reported. Participants reported very little pain (mean Visual Analog Scale <10) when applying the device. Participants who achieved IUD insertion with the device reported strong overall satisfaction with the procedure. Conclusions: The suction-based atraumatic tenaculum can be used to manipulate the cervix during IUD insertion with satisfactory efficacy and safety. The results of this pilot study support further studies of this device in larger populations comparing with standard single-tooth tenaculum. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04441333.

[Is there still a space for the vaginal examination in the gynecological consultation ?] / Y a-t-il encore une place pour l'examen vaginal en consultation gynécologique ?

The vaginal examination is too often part of the routine in periodic gynecological consultations. However, its performance as a screening examination for gynecological diseases such as cancers and infections is poor when performed in the asymptomatic patient. It is appropriate for cervical cancer screening every 3 years from the age of 21. Moreover, the intrusive nature of the vaginal examination, which is sometimes experienced as traumatic by patients, encourages the targeting of indications for its practice. Fear of this examination may also result in avoidance of care. The gynecological consultation is a privileged setting for screening for sexual risk taking or domestic violence, but also for exploring overall sexual health and promoting women's health.

L'examen vaginal est trop souvent ancré dans la routine des consultations périodiques en gynécologie. Or, sa performance comme examen de dépistage des maladies gynécologiques telles que cancers et infections est mauvaise lorsqu'il est effectué chez la patiente asymptomatique. Il est justifié tous les 3 ans à partir de 21 ans dans le cadre du dépistage du cancer du col utérin. De plus, le caractère intrusif de l'examen vaginal parfois vécu comme traumatisant par les patientes incite à cibler les indications à sa pratique. La crainte de cet examen peut en outre se manifester par un évitement des soins. La consultation gynécologique est un espace privilégié pour dépister des prises de risque sur le plan sexuel ou des violences domestiques, mais aussi pour l'exploration de la santé sexuelle globale et la promotion de la santé des femmes.

Including adolescents of childbearing potential in clinical trials with possible exposure to teratogenic medication: a challenge for paediatricians and researchers.

The issue of contraception and pregnancy tests among minor adolescent women participating in clinical trials, whether healthy or suffering from a disease, represents a challenging issue for paediatricians and researchers, given the potential harmful effect of various therapeutic procedures being tested. First, they need to gauge at what age or developmental stage they need to impose pregnancy tests and contraception. Second, if the adolescent denies any sexual activity, it may be ethically questionable to impose such procedures. Third, these professionals must deal with the issue of confidentiality, taking into account the fact that some adolescents engage in penetrative sexual intercourse without their parents or caregivers knowing. Fourth, in such cases, they must assess the extent to which a minor adolescent can be considered as competent (capable of making autonomous decisions) and deserves privacy and confidentiality. There is indeed a legal obligation for the provider to check that sexual experiences and intercourse take place within a safe relationship. Fifth, if the prescription of contraception is warranted, they have to decide who should assist the adolescent in choosing the method. Finally, with the occurrence of a positive pregnancy test, they may face the rare instance of a competent minor adolescent who refuses to inform her parents. This article has been developed by a group of experts under the auspices of swissethics, the Swiss Association of Research Ethics Committees and SwissPedNet, the umbrella organisation that coordinates the paediatric research in Switzerland. The paper reviews how to address practical and ethical questions regarding minor adolescents of childbearing potential enrolled in a clinical trial that may involve teratogenic medication and offers a series of concrete advice and tools for dealing with problematic situations. Most paediatric protocols stipulate that adolescents included in clinical trials involving potentially teratogenic drugs should undergo pregnancy tests and use contraception. The circumstances in which such requirements are undertaken, however, has not been sufficiently addressed. The recommendations presented in this article will assist researchers in assessing which circumstances apply when considering minor adolescents as individuals with childbearing potentials. It also offers concrete suggestions for tackling such situations.

[Chlamydia trachomatis infection's eradication†: a daily goal]. / L'éradication de l'infection à Chlamydia trachomatis†: un objectif quotidien.

Chlamydia trachomatis (CT) infection is the most frequent notifiable sexually transmitted infection (STI) in Switzerland. The infection is most frequently observed in 15 to 24 year-old-women and in 25 to 34 year-old-men. 50-75 % of the Chlamydia trachomatis carriage are asymptomatic, making the infection difficult to diagnose and increasing the untreated specimen, leading to complications like infertility, ectopic pregnancy or pelvic inflammatory disease. Despite having a sexual prevention at school, the youths seem to have a lack of knowledge about CT, her transmission and her complications. We performed a survey, which showed that 60.5 % of the participants ignored that this bacteria is mostly asymptomatic. We also found that 11 % of the participants believed that there is no possible relapse of the infection. The prevention must be strengthened, mostly because there is no program in Switzerland, letting every physician to his own beliefs. The medical consultation is an ideal opportunity for this prevention and the youths shared their wish to discuss more about it with health professionals.

L'infection à Chlamydia trachomatis (en italique) (CT) est l'infection sexuellement transmissible à déclaration obligatoire la plus fréquente de Suisse. L'infection touche les femmes de 15 à 24 ans. Son caractère souvent asymptomatique (50-75%) rend sa détection difficile et accroît le risque de ne pas être traitée et de développer des complications : infertilité, grossesse extra-utérine, douleurs abdominales chroniques. Malgré une éducation en santé sexuelle dispensée dans les écoles, les jeunes manquent d'informations au sujet de CT comme notre enquête l'a révélé, ainsi 61% de la population sondée ignore le caractère asymptomatique de cette bactérie. Les messages de prévention doivent être améliorés. La consultation médicale est un contexte idéal pour effectuer cette prévention, les jeunes souhaitant en discuter avec un professionnel de la santé.

Vaginal Enterobius vermicularis diagnosed on liquid-based cytology during Papanicolaou test cervical cancer screening: A report of two cases and a review of the literature.

Enterobiasis is one of the most common human parasitic infections. It is considered an intestinal parasite, but cases of extra-intestinal affections exist, notably infections of the female genital tract. Enterobius vermicularis (EV) eggs (or ova) have been found in the cervical smears of two patients in our institute during the last 16 years. No gynaecological or gastrointestinal symptoms were reported, and there was no known intestinal infection in these two cases. A review of the available literature revealed rare cases of vaginal enterobiasis, with a wide range of clinical presentations, many patients being asymptomatic. The diagnosis may sometimes be difficult, mainly because of the lack of clinical suspicion. However, cytological identification of EV in cervico-vaginal smears is important, especially when considering the risk of ascending infections of the genital tract associated with severe complications.