Publications by authors named "Michal Yaron"

27 Publications

  • Page 1 of 1

Fertistat: a potential tool for adolescent sexual health.

J Pediatr Adolesc Gynecol 2021 May 11. Epub 2021 May 11.

Geneva University Hospitals, Department of Woman, Child and Adolescent, Catherine McCarey, Department of Woman, Child and Adolescent, Geneva University Hospitals, 30, boulevard de la Cluse, 1205 Geneva, Switzerland.

The FertiStat (fertility status awareness) tool provides personalized advice on reducing risk factors for infertility and seeking medical advice based on lifestyle and reproductive profile.

Study Objective: The aim of our research was to test the FertiStat tool in younger patients (14-24 years). A secondary objective was to screen for and evaluate knowledge of risk factors impacting fertility.

Methods: Patients aged 14-24 years attending consultations at Geneva University Hospitals received a quantitative questionnaire before consultations. Questions covered lifestyle, gynecological history, perception of fertility and pregnancy intent. We investigated respondents' beliefs with regard to risk factors for infertility through "true/false" questions. We selected questions relevant to our population from the original FertiStat questionnaire to calculate each respondent's FertiStat score. Scores range from "blue" (low-risk) to "red" (risk of infertility).

Results: A total of 279 women aged 14-24 were included. Non-pregnant patients had overall higher FertiStat scores (2.7±0.8). Upon logistic regression analysis, with every additional FertiStat point, the odds of being pregnant at the time of survey decreased by 0.48. Risk factors for infertility and knowledge of these risk factors were equally distributed between pregnant and non-pregnant women.

Conclusion: Our findings suggest FertiStat may be a useful tool in the younger population we extended it to and highlight gaps in knowledge on risk factors for infertility. These findings are of interest when considering FertiStat as a starting point to discuss contraception and risk factors for infertility at an age at which risk mitigation would prove most effective in preserving future fertility.
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http://dx.doi.org/10.1016/j.jpag.2021.04.007DOI Listing
May 2021

Spontaneously conceived 17-week heterotopic pregnancy: a challenging and unusual diagnosis.

BMJ Case Rep 2021 Mar 4;14(3). Epub 2021 Mar 4.

Division of Gynecology, Department of Pediatrics, Obstetrics and Gynecology, Hopitaux Universitaires de Geneve, Geneva, Switzerland.

A 37-year-old woman, gravida 2 para 1, arrived in our emergency clinic at 16 2/7 weeks of a spontaneously conceived pregnancy for abdominal pain. She was on oral antibiotics for 2 days to treat a suspected urinary tract infection with no improvement. Blood tests, abdominal ultrasound and intrauterine fetus were all normal. She left our emergency unit with laxatives. Four days later, she returned to our clinic with severe abdominal pain. We repeated abdominal and foetal ultrasonography and identified a left para-uterine 7×5 cm mass. As adnexal torsion was suspected, we performed an emergency laparoscopy. At laparoscopy, we found a left haematosalpinx and realised a left salpingectomy. Histology confirmed the presence of a heterotopic pregnancy (HP). This case illustrates the importance of exploring the adnexa in a gravid woman presenting with abdominal pain in the first and early second trimesters. Although rare, excluding a HP may prevent a life-threatening haemorrhage.
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http://dx.doi.org/10.1136/bcr-2016-215489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934718PMC
March 2021

Hypergonadotropic hypogonadism after ovarian tissue cryopreservation on a 13-year-old female: A case report and review of the literature.

J Gynecol Obstet Hum Reprod 2021 Feb 28;50(2):102029. Epub 2020 Nov 28.

Pediatric Onco-Hematology Unit, Department of Woman, Child and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland; CANSEARCH Research Laboratory, Department of Woman, Child and Adolescent Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Ovarian failure is a major long-term adverse event following gonadotoxic treatment of malignant diseases. Ovarian tissue cryopreservation can be offered in some conditions to preserve fertility. We report the case of a 13-year-old female with a diagnosis of acute myeloid leukemia, who presented with hypergonadotropic hypogonadism after unilateral ovariectomy for fertility preservation and before highly gonadotoxic treatment. Even though damage seemed only partial, this case suggests that the remaining contralateral ovarian function may be compromised after ovarian tissue cryopreservation, leading per se to a hypergonadotropic hypogonadism. Although indication of ovarian cryopreservation is not called into question in situations of highly gonadotoxic therapy, this procedure should only be performed after evaluation by a specialized multidisciplinary team and provided a solid indication.
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http://dx.doi.org/10.1016/j.jogoh.2020.102029DOI Listing
February 2021

Contraception: what is the resistance all about?

Eur J Contracept Reprod Health Care 2021 Feb 6;26(1):62-72. Epub 2020 Nov 6.

Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland.

Purpose: The aim of this study is to identify the aspects associated with resistance to contraception, providing healthcare workers with the necessary tools to increase compliance with contraception and, ultimately, reduce the rate of voluntary abortions.

Material And Methods: We performed a review of the literature published in Medline between 1st January 2000 and 31st July 2020. We included studies based on qualitative analyses, describing women's perception and attitudes towards contraception, including a population aged 15 years or older and conducted in either Europe or North America.

Results: A total of 23 articles were included in the study. Resistance to contraceptive uptake was most frequently due to ambivalence about pregnancy, with up to 54% of ambivalent women reporting not using any means of contraception, and communication issues with the partner and/or health care provider, with a positive association found between communication with the partner and contraceptive use (OR 1.07;  < .050). Additional barriers to contraceptive use were the quality of the relationship with the partner, the perception of the risk of becoming pregnant after unprotected sexual intercourse, and unfamiliarity with contraception.

Conclusions: Family planning consultations should acknowledge the aspects that influence contraceptive uptake and address them as part of their consultations.
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http://dx.doi.org/10.1080/13625187.2020.1837362DOI Listing
February 2021

Activated α-macroglobulin binding to cell surface GRP78 induces trophoblastic cell fusion.

Sci Rep 2020 06 15;10(1):9666. Epub 2020 Jun 15.

Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, 1206, Geneva, Switzerland.

The villous cytotrophoblastic cells have the ability to fuse and differentiate, forming the syncytiotrophoblast (STB). The syncytialisation process is essential for placentation. Nevertheless, the mechanisms involved in cell fusion and differentiation are yet to be fully elucidated. It has been suggested that cell surface glucose-regulated protein 78 (GRP78) was involved in this process. In multiple cancer cells, cell membrane-located GRP78 has been reported to act as a receptor binding to the active form of α-macroglobulin (αM*), activating thus several cellular signalling pathways implicated in cell growth and survival. We hypothesised that GRP78 interaction with αM* may also activate signalling pathways in trophoblastic cells, which, in turn, may promote cell fusion. Here, we observed that αM mRNA is highly expressed in trophoblastic cells, whereas it is not expressed in the choriocarcinoma cell line BeWo. We thus took advantage of forskolin-induced syncytialisation of BeWo cells to study the effect of exogenous αM* on syncytialisation. We first demonstrated that αM* induced trophoblastic cell fusion. This effect is dependent on αM*-GRP78 interaction, ERK1/2 and CREB phosphorylation, and unfolded protein response (UPR) activation. Overall, these data provide novel insights into the signalling molecules and mechanisms regulating trophoblastic cell fusion.
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http://dx.doi.org/10.1038/s41598-020-66554-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295802PMC
June 2020

[Transgender and non-binary teenagers : management in primary care].

Rev Med Suisse 2020 Apr;16(691):789-793

Unités de pédiatrie hospitalière, Consultation des adolescents, Unité santé jeunes, Service de pédiatrie générale, Département de la femme, de l'enfant et de l'adolescent, HUG, 1211 Genève 14, et Faculté de médecine, Université de Genève, 24 rue du Général-Dufour, 1211 Genève 4.

Transgender, non-binary and questioning teenagers are increasingly visible. However, they face barriers in accessing appropriate care that meet their needs, both specific and regarding their general health. Primary care physicians increasingly see them in consultations but often lack elements of communication and recent knowledge that is needed to accompany them and their close ones in their -individual trajectories. This article aims to answer this need and provides a synthesis about recent evidence and suggested communication approaches for primary care physicians, who play a central role for the health of all patients.
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April 2020

Female Child and Adolescent Sexual Abuse Cases Reported at the Geneva University Hospitals Between 2006 and 2014: A Retrospective Study.

J Pediatr Adolesc Gynecol 2020 Jun 11;33(3):260-263. Epub 2019 Nov 11.

Department of Woman, Child and Adolescent, Geneva University Hospitals, Geneva, Switzerland. Electronic address:

Study Objective: To provide an objective quantification of the demographic characteristics and clinical findings related to female child and adolescent sexual abuse cases reported at the Geneva University Hospitals.

Design: Retrospective study.

Setting: Obstetrics and gynecology emergency unit.

Participants: Female children (0-12 years old) and adolescents (13-20 years old) seeking primary care after sexual assault.

Interventions: None, observational study.

Main Outcome Measures: Delay from assault to time of presentation to primary care presentation, type of perpetrators, and the presence gynecological and bodily lesions.

Results: Compared with children, a significantly higher proportion of adolescents presented to the hospital within 24 hours (134/289 (46.4%) vs 7/33 (21.2%); P = .006). Perpetrators were family members in 15/36 (41.7%) of children and in only 14/304 (4.6%) of adolescent patients (P < .00001); perpetrators were unfamiliar/nonrelated people in 8/36 (22.2%) of children and in 166/304 (54.6%) of adolescent patients (P < .0003). We did not find a significant difference between the 2 age groups with regard to the presence of gynecological lesions (15/35 (42.9%) of children and 91/298 (30.5%) of adolescent patients). However, we found a significant difference in the proportion of patients with bodily lesions such that 11/36 (30.6%) of children and 175/300 (58.3%) of adolescents (P = .002) were afflicted with bodily lesions.

Conclusion: To our knowledge this is the first study to evaluate child and adolescent sexual abuse cases on the basis of real-life data collected in Switzerland. Our results highlight important differences in child and adolescent sexual assault in terms of delay in presentation to primary care, perpetrator's relation to the victim, and presence of bodily lesions. This study confirms that gynecological findings alone are not consistently present in the patients who seek primary care after sexual assault.
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http://dx.doi.org/10.1016/j.jpag.2019.11.003DOI Listing
June 2020

Real-world experience with the IUB Ballerine MIDI copper IUD: an observational study in the French-speaking region of Switzerland.

Eur J Contracept Reprod Health Care 2019 Aug 6;24(4):288-293. Epub 2019 Jun 6.

b OCON Healthcare , Modiin , Israel.

The aim of the study was to assess the acceptability of the intrauterine ball IUB Ballerine MIDI copper intrauterine device (IUD), using real-world data collected from users and physicians. In this retrospective, observational study, conducted in the French-speaking region of Switzerland, healthy women (= 207) who had had an IUB Ballerine MIDI inserted ≥12 months before enrolment, and their physicians completed questionnaires relating to device insertion, user experience and outcome. Questions relating to current menstrual patterns, physical comfort and product satisfaction were only posed to women still using the device. The mean age at insertion was 30.8 ± 7.2 years, with an average 14.2 ± 2.9 month lapse from time of insertion until study commencement. At the time of the study, 140 (67.6%) women were still using the device. The expulsion rate was 5.3% (= 11) and the pregnancy rate was 1.4% (= 3). Most of the women still using the device reported no to moderate pain or cramps (80.7%). The majority of women reported moderate to high (65.7%) satisfaction with the device, with 81.4% claiming they would recommend it to friends and relatives. Over 84.8% of physicians reported that the device was easy to insert, with no difficulties encountered during the procedure. The IUB Ballerine MIDI was demonstrated to be safe and acceptable in different clinical settings and risk groups among a socioeconomically and demographically diverse study population.
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http://dx.doi.org/10.1080/13625187.2019.1618447DOI Listing
August 2019

Swiss gynecologists' opinions and perceptions concerning the use of intrauterine devices by nulliparous and multiparous women: an online survey study.

Int J Womens Health 2019 6;11:153-159. Epub 2019 Mar 6.

Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland,

Objective: The aim of this study was to 1) evaluate the Swiss physicians' attitudes and beliefs on intrauterine device (IUD) use in multiparous and nulliparous women and 2) determine whether the woman's parity was a factor influencing the gynecologists' IUD practice.

Material And Methods: The Global Survey questionnaire investigating IUD use was modified and adapted to the Swiss guidelines. A link to the online questionnaire was sent to gynecologists practicing in the French- and German-speaking parts of Switzerland. We defined IUD use as frequent whenever it was prescribed by gynecologists for 25% or more out of all women consulting for contraception.

Results: A total of 299/1,696 gynecologists completed the online questionnaire (17.6%). Frequent IUD prescription was found in 72.9% of multiparous and in 11.8% of nulliparous women. The most frequently reported barriers to IUD use in nulliparous women were as follows: concern over a painful insertion, difficulty of insertion, higher risk of perforation, pelvic inflammatory disease, changes in bleeding pattern, high cost, and risk of extrauterine pregnancy. The presence of such perceived obstacles was associated with less frequent IUD insertion in nulliparous women.

Conclusion: The results of this study provide a valuable insight into the attitudes and opinions of Switzerland's gynecologists on the use of IUDs in nulliparous and multiparous women, showing that the women's parity is a factor influencing the physicians' attitudes and opinions. Further health education might help minimize the physicians' attitude discrepancies in IUD prescription to nulliparous and multiparous women.
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http://dx.doi.org/10.2147/IJWH.S189051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408924PMC
March 2019

Factors Influencing the Filing of Complaints, Their Investigation, and Subsequent Legal Judgment in Cases of Sexual Assault.

J Forensic Sci 2019 Jul 17;64(4):1119-1124. Epub 2018 Dec 17.

University Center of Legal Medicine, Geneva and Lausanne, Geneva site de Genève, 1 rue Michel Servet, 1211, Genève 4, Switzerland.

In Geneva, examination of victims of sexual assault is performed by a gynecologist and a medical examiner. 48% of the victims file a complaint and we wanted to investigate the factors leading to file a complaint, those leading the Prosecutor to go to trial, and those influencing a conviction. Between 2006 and 2012, 676 victims of sexual assault were investigated (averaged age 26 year, mean 22). Information on injuries, perpetrators, and circumstances of the assault was collected and analyzed. The attacker being the ex-spouse or a friend and the presence of semen were factors leading to file a complaint. The assailant being a family member or ex-spouse and the presence of genital/anal lesions were factors influencing the Prosecutor. The presence of nongenital lesions, the assailant being known by the victim, influenced conviction. This study shows that the medical examiner plays a vital role in the investigation of cases of sexual assault.
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http://dx.doi.org/10.1111/1556-4029.13971DOI Listing
July 2019

[Update on Mycoplasma genitalium among women].

Rev Med Suisse 2018 Oct;14(624):1893-1897

Service de gynécologie, Département de gynécologie et d'obstétrique, HUG, 1211 Genève 14.

Mycoplasma genitalium (MG) is a sexually transmitted pathogen with a poorly understood natural history. Often asymptomatic, it has been associated with urogenital conditions. The implementation of NAAT (Nucleic Acide Amplification Test) has not only improved the detection of MG, but also brought to light the emergence of antibiotic resistances, hence challenging the proposed treatment strategies and questioning the indication for systematic screening. This article summarizes current knowledge on MG among women, over viewing incidence, prevalence and clinical implications. It resumes the last guidelines in terms of screening and treatment.
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October 2018

[Adolescence and sexuality: a risky business How best to inform parents ?]

Rev Med Suisse 2018 Apr;14(603):843-848

Unités de pédiatrie hospitalière, Consultation des adolescents et Unité santé jeunes ; Service de pédiatrie générale, Département de l'enfant et de l'adolescent, HUG, 1211 Genève 14 et Département de pédiatrie, Faculté de médecine, Université de Genève, 1211 Genève 4.

Parents are often reluctant to discuss sexuality and romantic relationships with their teenagers. However, these discussions can have a strong impact on their children's health. Care providers can act as a reliable source of information to support parents in this task. Through repeated short interactions with their child over their adolescence, parents can cover most topics related to sexuality, based on teenagers' questions and the situations that they face (e.g. LGBT bullying at school). This article summarizes current best practice on how to facilitate parental dialogue with adolescents about sexuality and offer care providers guidance in transmitting this information to parents.
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April 2018

Who should be screened for Chlamydia trachomatis infection? Three years' experience at a University Hospital in Switzerland.

J Infect Dev Ctries 2018 Mar 31;12(3):208-210. Epub 2018 Mar 31.

Geneva University Hospital, 1211 Geneva, Switzerland.

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http://dx.doi.org/10.3855/jidc.10020DOI Listing
March 2018

Health-Related Quality of Life in Adolescents and Young Adults with Polycystic Ovary Syndrome: A Systematic Review.

J Pediatr Adolesc Gynecol 2016 Dec 1;29(6):551-557. Epub 2016 Jun 1.

Medical School, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland. Electronic address:

Study Objective: To review recent data exploring the relationship between polycystic ovary syndrome (PCOS) and health-related quality of life (HRQoL) in adolescents and its implication for management of adolescents with this syndrome.

Design And Setting: We performed a systematic literature search in MedLine, Embase and PsychInfo from 1980 to September 2015 and manual search in reference lists of selected articles. Inclusion criteria were articles in English or French with a focus on HRQoL in patients with PCOS aged between 13 and 24 years. Qualitative, cross-sectional, or interventional studies were considered as eligible. Two reviewers each independently selected and reviewed the relevant articles.

Results: Of a total of 93 publications, 7 were selected through a systematic search, and 2 were added after a manual search. Seven studies used quantitative methods and 2 studies used a qualitative one. A meta-analysis was not possible because of the methodological diversity among the selected articles. All articles showed that PCOS has a negative influence on HRQoL in adolescents. Body weight issues and body mass index (BMI) appeared to have the strongest effect on HRQoL; some studies reported a normalization of HRQoL scores after adjustment for BMI. Patient information and patient-provider relationship were also reported to affect HRQoL. Elements in favor of the effectiveness of multidisciplinary management, associated lifestyle modifications, and psychological support, in improving HRQoL were identified.

Conclusion: PCOS significantly reduces HRQoL in adolescent girls. The extent to which body weight issues and BMI mediate this effect deserves further evaluation. A detailed understanding of the psychosocial challenges that patients with PCOS face is limited, mainly because of the small number of studies available, restricted sample size, and the methodological diversity of the questionnaires used. The effect of early lifestyle modification, and medical and psychological treatment should continue to be explored.
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http://dx.doi.org/10.1016/j.jpag.2016.05.006DOI Listing
December 2016

Sexual Anatomy and Function in Women With and Without Genital Mutilation: A Cross-Sectional Study.

J Sex Med 2016 Feb 27;13(2):226-37. Epub 2016 Jan 27.

Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland.

Introduction: Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations.

Aim: To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image.

Methods: A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d'Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index).

Main Outcome Measures: Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores.

Results: Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs. They scored significantly lower on sexual function and desire than women without FGM. They did not score lower on Female Sexual Function Index sub-scores for orgasm, desire, and satisfaction and on the Questionnaire d'Image Corporelle but did report significantly more dyspareunia. A larger total volume of clitoris and bulbs did not correlate with higher Female Sexual Function Index and Sexual Desire Inventory scores in women with FGM compared with uncut women who had larger total volume that correlated with higher scores.

Conclusion: Women with FGM have sexual erectile tissues for sexual arousal, orgasm, and pleasure. Women with sexual dysfunction should be appropriately counseled and treated.
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http://dx.doi.org/10.1016/j.jsxm.2015.12.023DOI Listing
February 2016

Obstetric care of women with female genital mutilation attending a specialized clinic in a tertiary center.

Int J Gynaecol Obstet 2016 Feb 9;132(2):174-8. Epub 2015 Oct 9.

Department of Obstetrics and Gynaecology, Geneva University Hospitals, Geneva, Switzerland.

Objective: To study the obstetric outcomes of women attending a specialized clinic for women with female genital mutilation (FGM).

Methods: The medical charts of women with FGM who consecutively attended a specialized clinic between 2010 and 2012 were reviewed retrospectively. The present study focused on women attending for obstetric reasons. The outcome measures were type of delivery, reason for cesarean delivery or assisted delivery, blood loss, episiotomy, perineal tear, duration of the second stage of labor, postpartum complications, weight of the neonate, and Apgar score. Outcomes were compared between women with FGM type III who underwent defibulation, and patients with FGM type I and II.

Results: The clinic was attended by 129 women, 84 perinatally. Obstetric outcomes were similar to average outcomes for women without FGM presenting at the same department and in Switzerland generally. Specifically, 20 women had a cesarean delivery. An assisted delivery was performed for 18 patients; among these, only eight had experienced obstructed labor. No statistically significant differences were found for the outcome measures when women with FGM type III were compared to FGM type I and II.

Conclusions: Routine obstetric follow-up combined with specialized care for women with FGM, including defibulation, can avoid inappropriate obstetric practices and reduce obstetric complications known to be associated with FGM.
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http://dx.doi.org/10.1016/j.ijgo.2015.06.055DOI Listing
February 2016

[A new perspective in adolescent contraception--why prescribe an IUD first?].

Rev Med Suisse 2015 Jan;11(456-457):78-81

Adolescent girls are very fertile and therefore need a reliable contraceptive strategy in order to prevent unwanted pregnancies. Although highly recommended by international gynecological and adolescent societies and in spite of its high efficiency, good tolerance and ease of use, only minority of adolescents use IUD as a contraceptive method. This article will focus on available IUDs suitable for adolescents and will address misconceptions and barriers to use of IUDs in this age group. We believe this information will encourage physicians in recommending IUD use to adolescents during their most vulnerable years.
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January 2015

[Specialized adolescent health clinic: who should be referred to it?].

Rev Med Suisse 2014 Jun;10(434):1282, 1284-6

Adolescent health clinics were created in response to the specific health needs of this age-group. Adolescents may present complex health problems which require a multidisciplinary and global assessment. The aim of this article is to provide an overview of the type of health problems for which adolescents are referred to our clinics and the care they receive in response to them.
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June 2014

An exploration of sexual desire and sexual activities of women with psychosis.

Community Ment Health J 2015 Feb 27;51(2):229-38. Epub 2014 Jul 27.

Service of General Psychiatry, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Secteur Eaux-Vives, Rue du 31-Décembre 8, 1207, Geneva, Switzerland,

Sexual disturbances in patients with severe mental disorders can be related to medication, to psychological issues such as self-stigma and anhedonia, but also to the social context. This research aims to gain knowledge of desire and sexual practices in women suffering from schizophrenia. Women outpatients suffering from schizophrenia were compared with healthy women. Contrary to previous research, women with schizophrenia featured dyadic and individual desire similar to women of comparable age. Yet, only half of women with psychosis had sexual practice, either alone or with a partner. They were less satisfied with their activity, both in terms of function and psychological issues such as sexual self-esteem. Keeping into account the fact that most clinicians avoid this topic, this finding underscores the stigmatization these women suffer from, which prevents the opportunity of a possible improvement in this important interpersonal domain.
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http://dx.doi.org/10.1007/s10597-014-9768-xDOI Listing
February 2015

Missed opportunities for diagnosis of female genital mutilation.

Int J Gynaecol Obstet 2014 Jun 5;125(3):256-60. Epub 2014 Mar 5.

Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.

Objective: To investigate missed opportunities for diagnosing female genital mutilation (FGM) at an obstetrics and gynecology (OB/GYN) department in Switzerland.

Methods: In a retrospective study, we included 129 consecutive women with FGM who attended the FGM outpatient clinic at the Department of Gynecology and Obstetrics at the University Hospitals of Geneva between 2010 and 2012. The medical files of all women who had undergone at least 1 previous gynecologic exam performed by an OB/GYN doctor or a midwife at the study institution were reviewed. The type of FGM reported in the files was considered correct if it corresponded to that reported by the specialized gynecologist at the FGM clinic, according to WHO classification.

Results: In 48 (37.2%) cases, FGM was not mentioned in the medical file. In 34 (26.4%) women, the diagnosis was correct. FGM was identified but erroneously classified in 28 (21.7%) cases. There were no factors (women's characteristics or FGM type) associated with missed diagnosis.

Conclusion: Opportunities to identify FGM are frequently missed. Measures should be taken to improve FGM diagnosis and care.
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http://dx.doi.org/10.1016/j.ijgo.2013.11.016DOI Listing
June 2014

[Contraception and bone health in adolescence].

Rev Med Suisse 2012 Oct;8(359):2007-8, 2010

Service de gynécologie, Département de gynécologie et obstétrique, HUG, 1211 Genève 14.

Adolescents' access to contraception has improved and indication for their use have been extended beyond pregnancy prevention. For adolescents, this implies the use of hormonal contraception before the accrual of peak bone mass. Sexual hormones, notably estrogens, play a major role in skeletal development, growth and acquisition of maximal bone mass density (BMD). This article will review different contraceptive methods and their impact on BMD, with particular attention to low-dose pills and medroxyprogesterone acetate, both of which seem to alter peak bone mass acquisition. Nevertheless, benefits from appropriate contraception should be weighed against safety concerns, and recommended on an individual basis.
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October 2012

[Gynecology/Obstetrics. Magnesium sulfate for fetal neuroprotection in preterm delivery. Latest advances in contraception.].

Rev Med Suisse 2011 Jan;7(278):117-20

Département de gynécologie et d'obstétrique, HUG, Genève.

Morbidity of neonates born before 32 weeks remains significant. Cerebral palsy is found in up to 8 to 10% of survivors. Three randomized controlled trials evaluated the effectiveness of magnesium sulphate given to mothers with a risk of imminent very preterm delivery to prevent perinatal death or cerebral palsy in children. These studies suggest a reduction of the risk of cerebral palsy by magnesium sulphate from 6.5% to 4.8% (relative risk 0.71, 95% CI 0.55-0.91). These results remain controversial, but warrant information to the parents and the implementation of treatments protocols for selected cases.
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January 2011

Treatment of genital prolapse by laparoscopic lateral suspension using mesh: a series of 73 patients.

J Minim Invasive Gynecol 2008 Jan-Feb;15(1):49-55

Department of Obstetrics and Gynecology, Geneva University Hospital, Geneva, Switzerland.

Study Objective: To evaluate the efficacy of laparoscopic lateral suspension using mesh in patients with pelvic organ prolapse (POP).

Design: A prospective cohort study (Canadian Task Force classification II-2).

Setting: A tertiary referral center for operative laparoscopy.

Patients: In all, 73 patients with POP were assessed in the preoperative and postoperative stages. The assessment included a description of their functional symptoms and the degree of their POP condition, established according to the Baden-Walker prolapse classification system. The patients were followed in the postoperative stage for a median of 19 (range 12-41) months.

Interventions: Laparoscopic lateral suspension of pelvic organs using mesh carried out from January 2004 through September 2006.

Measurements And Main Results: Satisfactory anatomic results were obtained in 64 (87.7%) patients. Neither major complications, nor postoperative pelvic infection were reported. None of the operations required laparotomy.

Conclusion: Laparoscopic lateral suspension using mesh effectively treats POP with low morbidity.
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http://dx.doi.org/10.1016/j.jmig.2007.11.003DOI Listing
May 2008

The retroperitoneal approach in minimally invasive pelvic surgery.

Ann N Y Acad Sci 2006 Dec;1092:187-98

Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Genève, Switzerland.

The retroperitoneal approach is a minimally invasive surgery than can be performed through direct access or through indirect access, with abdominal penetration. The choice of indirect transabdominal approach is appropriate when additional abdominal surgery is indicated (radical hysterectomy, pelviabdominal exploration). The advantages of the direct retroperitoneal access are the absence of risk of creating intra-abdominal adhesions associated with those of intraperitoneal operative laparoscopy.
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http://dx.doi.org/10.1196/annals.1365.016DOI Listing
December 2006

Conservative management of ectopic pregnancy with fetal cardiac activity by combined local (sonographically guided) and systemic injection of methotrexate.

Gynecol Obstet Invest 2003 29;56(3):148-51. Epub 2003 Sep 29.

Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin (Affiliated with Sackler School of Medicine, Tel-Aviv University, Tel-Aviv), Israel.

Objective: To evaluate the efficacy of conservative management of ectopic pregnancy with fetal cardiac activity by combined local sonographically guided and systemic injection of methotrexate.

Study Design: The study group included 12 patients with ectopic pregnancy and fetal cardiac activity, treated by combined local and systemic injection of methotrexate in the period from January 1, 2000 to July 1, 2002. The outcome of these patients was compared with the outcome of 53 patients who had ectopic pregnancy without fetal cardiac activity and were being treated only by systemic injection of methotrexate during the same period of time.

Results: The success rate was 91.6% (11 out of 12) in the group of patients with ectopic fetal cardiac activity and 90.5% (48 out of 53) in the group of patients with ectopic pregnancy, but without fetal cardiac activity. There was also no significant difference between the two groups comparing the percentage of cases treated by an additional dose of methotrexate (8.3 and 13.2%, respectively), nor comparing the number of days to resolution of beta-human chorionic gonadotrophin (BHCG; 40 +/- 2 and 34 +/- 10 days, respectively). Conversely, there was a significant difference in the initial BHCG level comparing the group of patients treated by combined local and systemic injection of methotrexate (12,616 +/- 9,585 mIU/ml) and the group of patients treated by systemic injection of methotrexate (1,499 +/- 2,065 mIU/ml) (p < 0.00001). Seventy-five percent of patients (6 out of 8) diagnosed with ectopic fetal cardiac activity, who desired to become pregnant, succeeded to conceive within 6 months following the combined local and systemic injection of methotrexate.

Conclusion: The combined local sonographically guided and systemic injection of methotrexate is associated with a successful outcome in asymptomatic patients presenting with ectopic pregnancy and fetal cardiac activity.
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http://dx.doi.org/10.1159/000073774DOI Listing
March 2004

Tubo-ovarian abscess in older women: is the woman's age a risk factor for failed response to conservative treatment?

Gynecol Obstet Invest 2003 ;55(4):211-5

Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin 70300, Israel.

Objective: To assess retrospectively if there is a trend of change in the epidemiology of tubo-ovarian abscess (TOA) and to define the epidemiologic, clinical and laboratory risk factors associated with failed response to conservative antibiotic therapy.

Study Design: The charts of 60 patients, admitted with clinically and sonographically diagnosed TOA between January 1995 and December 2000, were reviewed. On admission, all patients were treated with broad-spectrum antibiotics, and were divided into two groups according to the response to medical treatment. Forty-three patients, responding to antibiotic therapy, constituted group A, whereas 17 patients who did not respond and were further treated by sonographically guided drainage or surgery, were included in group B. The groups were compared with respect to patient characteristics, clinical and sonographic presentation, laboratory findings, duration of hospital stay and recovery rate of different pathogens from the endocervix.

Results: The mean age of patients responding to medical therapy (group A) was significantly lower (39.6 +/- 8.3) than the age of patients who did not respond (group B) (45.3 +/- 6.6) (p = 0.02). The gravidity as well as the percentage of menopausal women were significantly increased in group B (p = 0.03 and p = 0.02, respectively). There was a significantly lower incidence of previous pelvic surgery and past history of PID in group B versus group A (p = 0.02 and p = 0.03, respectively), yet the duration of IUD use was significantly prolonged in group B (p = 0.02). The size of TOA, evaluated clinically and sonographically, was significantly increased in group B compared with group A (p = 0.04 and p = 0.009, respectively). Pelvic peritonitis was observed in 40% of group B patients and in none of group A patients (p = 0.0001). The only laboratory finding differentiating between the two groups was the mean sedimentation rate, being significantly higher in group B than in group A (p = 0.0005). The time interval from admission to afebrile condition as well as the duration of hospitalization were significantly shorter in group A (6.1 +/- 2.3 days) than in group B (10.7 +/- 4.7 days) (p = 0.00003). The incidence of positive culture from the endocervix was significantly higher in group B than in group A (p = 0.007). One hundred percent of patients in group B versus 65.2% of patients in group A were treated with triple agent therapy (p = 0.007).

Conclusion: The results of the current study strengthen our previous assumption that there is probably a new trend in the epidemiology of TOA, occurring in older women, who do not present the traditional risk factors for pelvic inflammatory disease and TOA.
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http://dx.doi.org/10.1159/000072076DOI Listing
January 2004

Mutational analysis of the hMSH6 gene in familial and early-onset colorectal and endometrial cancer in Israeli patients.

Genet Test 2002 ;6(4):323-6

Oncology Institute, the Elias Sourasky Medical Center, Tel-Aviv, Israel.

Familial colorectal cancer (CRC) is noted in about 15% of incident CRC cases, and at times is hallmarked by an age at diagnosis less than 50 years. Familial adenomatous polyposis (FAP) and hereditary non-polyposis colon cancer (HNPCC) account for about 40% of familial cases. Thus, the majority of familial and early-onset CRC remain genetically elusive. Similarly, the majority of familial and early onset endometrial cancer (EC), the most prevalent extracolonic tumor in HNPCC, are genetically undefined. An attractive candidate is the hMSH6 gene. Israeli patients with early onset (age under 50 years) (n = 44) and familial nonsyndromic (n = 23) CRC, and women with familial clustering of EC or CRC (n = 12), and those diagnosed with EC at, or under, the age of 50 years (n = 5) were genotyped for germ-line mutations within the hMSH6 gene. Exon-specific PCR was followed by denaturing gradient gel electrophoresis (DGGE) analysis, complemented by DNA sequencing of abnormally migrating fragments. No patients displayed a truncating mutation, and 1 CRC patient harbored a novel missense mutation (V878A). In addition, 6 previously described polymorphisms were detected. In conclusion, mutations in the hMSH6 gene occur uncommonly in Israeli patients with familial and early-onset CRC and EC.
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http://dx.doi.org/10.1089/10906570260471877DOI Listing
June 2003