Pain that occurs during sexual activity is highly prevalent during a woman's lifetime, affecting ∼15% of women. The etiology of dyspareunia is multifactorial. Therefore, treatment must be individualized. This paper reviews the evaluation and treatment of the several common causes of dyspareunia and/or pelvic pain, including hormonally associated vestibulodynia, inflammation-associated vestibulodynia, neuroproliferative vestibulodynia, overactive pelvic floor muscle dysfunction, vulvar dysesthesia, persistent genital arousal disorder, and painful bladder syndrome.

This review evaluates pharmacologic treatments for female sexual dysfunction (FSD), focusing on hypoactive sexual desire disorder (HSDD). We provide clinically relevant applications for Food and Drug Administration (FDA)-approved medications (flibanserin and bremelanotide) and investigational therapies (Lorexys and testosterone combinations). Detailed study outcomes, safety profiles, and clinical strategies guide clinicians in appropriate diagnosis, patient selection, expectation setting, side effect management, and patient education, improving treatment outcomes and patient satisfaction.

As the majority of female cancer survivors can now expect to live long lives beyond cancer diagnosis and treatment, there is a growing need to address the significant late effects of treatment. Unfortunately, sexual health remains a primary concern that often goes unaddressed among female cancer survivors. Sexual dysfunction is one of the most common and distressing effects of treatment. Management of issues related to sexual health and sexual function depends upon the type of malignancy, stage and other tumor characteristics, treatment, and the history, concerns, and goals of the individual patient.

Placental imaging is crucial in prenatal care, offering insights into both normal and abnormal pregnancies. Traditional methods like grayscale ultrasound and magnetic resonance imaging evaluate placental anatomy, whereas Doppler ultrasound is used for functional assessment. Recent advancements include functional magnetic resonance imaging and advanced Doppler software for demonstrating placental density and visualizing spiral arteries. B-flow and spatio-temporal image correlation are pivotal, sensitive tools for quantifying spiral artery distensibility and volume flow in early pregnancy. These techniques enhance our understanding of placental vascular architecture and promise early diagnosis and intervention for pregnancies at risk. This paper emphasizes the importance of advanced imaging in prenatal care.

The clinical implications of placental chromosomal mosaicism can be challenging for patients and health care providers. Key considerations include the specific characteristics of the chromosomal abnormality (such as size, gene content, and copy number), the timing of the mosaicism's onset during embryogenesis or fetal development, the types of tissues involved, and the level of mosaicism (the ratio of normal to abnormal cells within those tissues). Genetic counseling can help inform patients about the chances of having a live-born child with a chromosomal abnormality. Each case requires individual assessment to provide accurate guidance. This chapter will explore the clinical implications of detecting mosaicism at 3 critical diagnostic stages: (1) chorionic villus sampling (CVS); (2) amniocentesis; and (3) cell-free DNA (cfDNA) testing.

Ischemic placental disease (IPD) is a constellation of obstetrical complications that include preeclampsia, placental abruption, and fetal growth restriction and affects 12% to 15% of pregnancies. The unifying pathophysiological mechanism that precedes all 3 complications is uteroplacental ischemia as a consequence of inadequate (or failure of) physiological transformation of the maternal uterine spiral arteries, endothelial cell dysfunction, and increased oxidative stress. This review summarizes the IPD literature, focusing on the epidemiology and risk factors, the effects of IPD on short and long-term maternal complications, and the association of IPD with perinatal, childhood, and long-term complications in offspring.

In this symposium, we introduce a collection of reviews that delve into the diverse clinically relevant aspects of the placenta and umbilical cord. The symposium addresses placenta previa and abruption; pathology, genetics, and imaging of the placenta; infections of the placenta; and ischemic placental disease. The umbilical cord's essential function as a fetal lifeline is explored, with an emphasis on the clinical repercussions of its dysfunction, including vasa previa and other umbilical cord abnormalities. This curated collection of reviews, which synthesizes the placenta's and umbilical cord's fundamental role in maternal-fetal health, underscores the clinical importance of these structures in pregnancy.

Placenta previa is an important and potentially life-threatening cause of bleeding. Historically, it was a major contributor to maternal mortality until advancements in obstetric care, including prenatal ultrasound, cesarean delivery, and transfusion medicine, drastically improved outcomes. Today, placenta previa is typically identified during routine second-trimester ultrasound, with the overwhelming majority of cases resolving before term. Key risk factors include prior cesarean delivery, advanced maternal age, and smoking. When placenta previa is diagnosed, it is essential to assess for associated conditions like placenta accreta and vasa previa. A planned cesarean delivery is recommended in cases that persist into the late third trimester.

To describe orgasm disorders in women.

Testosterone levels vary throughout a woman's reproductive life, reaching their lowest level following menopause, and their nadir at about age 60, when they experience higher levels of sexual dysfunction. Testosterone improved the frequency of sexually satisfying events, desire, arousal, and orgasm in several randomized, controlled studies of surgically and naturally postmenopausal women. Available evidence from large cohort and registry studies does not show potentially concerning cardiovascular or breast safety signals with physiological levels of testosterone. Although no female testosterone products are currently approved in most of the world, one-tenth of the male dose can enhance female sexual function.

This comprehensive review examines the effects of various infections on pregnancy, focusing on maternal symptoms, fetal outcomes, diagnostic methods, and placental pathology. The paper covers bacterial, viral, and parasitic infections, their mechanisms of transmission, clinical presentations, and histopathologic findings in the placenta. It emphasizes the importance of early detection and intervention, highlighting the challenges in diagnosis due to often asymptomatic presentations. The review also discusses the placenta's role as a protective barrier and its immune defense mechanisms against pathogens. Overall, this paper serves as a comprehensive resource for understanding the complex interplay between maternal infections, placental pathology, and fetal outcomes.

The umbilical cord is the connection between mother and fetus through which gases and nutrients are exchanged. It's remarkable structure allows for freedom of movement while providing a cushioned, protected conduit from mother to fetus. Fetal development and survival are dependent upon the umbilical cord. This article reviews abnormalities of the umbilical cord that can be seen with structural and chromosomal abnormalities and altered umbilical cord flow associated with fetal growth restriction and poor pregnancy outcomes.

The pelvic floor muscles, integral to urinary, bowel, and sexual function, can cause various symptoms when impaired, including pelvic pain, bowel and bladder dysfunction, incontinence, pelvic organ prolapse, and sexual dysfunction. This chapter explores pelvic floor anatomy, symptoms, and associated diagnoses. It provides screening tools for OBGYNs to use in practice, language to help address patient fears around sexual dysfunction, and emphasizes the role of pelvic floor physical and occupational therapy in treating these conditions.

Vasa previa is an abnormality of the umbilical cord and fetal membranes that affects ∼1 in 1300 pregnancies. The diagnosis is made by visualization of velamentous fetal vessels coursing within the membranes over the cervix unprotected by Wharton jelly or placenta. When it is not diagnosed prenatally, it is associated with a high risk of fetal death. Prenatal diagnosis of vasa previa using ultrasound, followed by close surveillance, and appropriately timed late preterm delivery by cesarean is associated with intact survival in >95% of cases. In this review, we review epidemiology, risk factors, diagnosis, and management of patients with vasa previa.

Placental abruption is a complete or partial separation of the placenta from the uterine decidua. Clinical manifestations include vaginal bleeding, abdominal pain, uterine contractions, and abnormalities in the fetal heart rate tracing. Placental abruption occurs in 0.4% to 1.0% of all pregnancies. However, the pathophysiology remains incompletely understood. We present a review of the pathophysiology, diagnosis, and management of placental abruption, exploring overlapping processes which contribute to premature placental separation. Classic findings and limitations of ultrasound in evaluating placental abruption are explained. Finally, we discuss the management of placental abruption based on gestational age, fetal status, and maternal hemodynamic stability.

Interventional Radiology (IR) can be a crucial player in managing placenta accrete spectrum disorder (PAS), offering minimally invasive angiographic techniques that can prevent or control hemorrhage and preserve fertility. These include prophylactic balloon occlusion of the aorta or iliac arteries, preoperative catheter placement in the iliac or uterine arteries for subsequent embolization, or pre-emptive arterial embolization preceding hysterotomy and delivery. This review provides obstetricians with an overview of IR's role in the management of PAS by describing specific endovascular techniques; existing outcomes data; and considerations for protocol development, preoperative planning, and intraoperative dynamics for when IR assists with PAS cases.

The anesthetic management of the patient with placenta accreta spectrum begins before surgery by assessing the patient and their comorbidities and providing psychological preparation for the perioperative period. Choosing neuraxial or general anesthesia for surgery balances the procedure's clinical needs with the patient's desires. Intraoperatively, management of homeostasis during acute blood loss requires assessments of central volume to avoid over-transfusion. Viscoelastic testing may be useful to assess coagulation to target the replacement of coagulation factors. Postoperative care is an essential continuum of the procedure, and the availability of bedside ultrasound can aid rapid decision-making.