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Introduction: The ethics committee at the Sackler Faculty of Medicine, Tel Aviv University deals with complaints which are not necessarily related to teaching or to issues in the realm of the Institutional Review Board (Helsinki Commission). Virtually all complaints reaching the committee are based on disputed authorship of scientific publications. Researchers and clinicians are interested in publishing their research in order to share knowledge but also in order to comply with the dictum "Publish or Perish". They are publishing to enhance their reputation, to improve chances for funding and to increase the likelihood for clinical and academic promotion. Yet, lack of appropriate planning and agreements on authorship ahead of time may lead to frictions, misunderstandings and outright belligerence between authors. The issue of authorship is being addressed by scientific journals, academic institutions and committees of editors. All of them have published appropriate guidelines which form the basis for the work of the ethics committee. We deal with "honorary authorship", that is individuals who are listed as authors, although they have not contributed sufficiently to the research in order to merit authorship and we deal with "Ghost Authorship" that is when contributing researchers are not listed, as they should be among authors of a scientific publication. Specific case studies are presented.

We review the concept of informed consent in clinical medicine and in research. Informed consent is a complex practice designed to protect the legal rights of the patient, to maintain ethics in support of the patient's autonomy to arrive at his own decisions related to medical interventions, to ensure appropriate quality of care, and to build trust between the physician and the patient regarding medical procedures, medication or clinical research. It must be borne in mind that the patient's signature on a document of informed consent does not automatically imply comprehension. Physicians need to provide the information about the patient's condition, and in the case of research, they need to provide an exhaustive explanation related to benefits and the risks of the research project for the patient and to society. Physicians need to be available to readily answer patients' questions. Signing an informed consent form should not become a mere bureaucratic procedure of "going through the motions". Without emphasis on delivering understandable and relevant information, tailored to the recipient and clarifying that explanations have been properly understood, informed consent becomes but a bureaucratic burden. There is an urgent need to complete the process of conveying information by a structured mechanism aimed to ensure adequate comprehension. Only then will the process of obtaining informed consent become meaningful.

The "30 minute rule" is a clinical guideline of obstetrical organizations in several countries of the Western world. It dictates a lag time of no more than 30 minutes between the decision to terminate a delivery by cesarean section when fetal distress is suspected and the implementation. There is no scientific foundation for this rule and physicians may be unjustly exposed to claims when they fail to comply. In this review, we criticalLy discuss the pertinent literature, the relevant guidelines and propose a modification of the "30-minutes rule", which is aimed to differentiate between emergent and urgent operations.

Asphyxiophilic sex is a form of autoerotic activity, in which the user creates mechanical means (such as hanging or bondage) in order to achieve cerebral hypoxia, which, in turn, enhances sexual, as well as orgasmic, stimulus. Failure of safety mechanisms, created by the user, may lead to instant death as a result of asphyxiation or strangulation. This kind of sexual practice is more prevalent among men than in women. In cases of death, it is difficult to relate it to the sexual practice itself. Suicide and homicide are the main differential diagnoses. Closely related derivatives of asphyxiophilic sex are anesthesiophilia (inhalation of variable volatile substances) and electrophilia (use of electric current during sexual activity)--both also intended to enhance the sexual stimulation. These forms of sexual practice are less prevalent than asphyxiophilia.

Contemporary data indicate female dominance of obstetrics and gynecology. The authors sought to look for the effects of this domination on the discipline and further understand the reasons for these effects as reflected from the relevant current literature. Data clearly show a worldwide "creeping" process of female domination in the field of obstetrics and gynecology. Gender bias is present in hiring policies both for residency and afterwards. Female physicians encounter specific gender problems such as pregnancy, maternity leave and the additional burden of taking care of their family. These tasks may interfere with academic medicine. Furthermore, personal characteristics of women, which favor them for patients, may affect their productivity within the framework of community medicine. None of the alleged problems, which were linked to female obstetrician-gynecologists, is irresolvable, assuming professional establishment, as well as government acceptance and proper planning.

With the increasing demand of Laparoscopic surgery, many departments are considering the development of surgical skills centers. The authors describe their hospitaLs endoscopic training program which includes a theoretical curriculum and an inexpensive laparoscopic simulator The system is designed in order to improve basic skills of laparoscopic surgery. Other systems available elsewhere are discussed.

West Nile virus infection has been known since 1937, yet only in 2002 primary reports about its prevalence among pregnant women appeared in the Western medical Literature. The questions of maternal-fetal transfer of the infecting virus through the placenta or via breastfeeding in the neonate are currently unresolved. There is no specific treatment against the infection during pregnancy and currently only supportive therapy is available. Recommendations regarding prevention, as well as fetal or neonatal follow-up for an offspring of an infected mother exist, but their validity is questionable. Experience with the natural expression of this infection during pregnancy is still being gathered. In Israel, no cases of West Nile virus infection during pregnancy have been reported. Considering that this infection is endemic in Israel and based on reported cases from the U.S.A., this disease merits attention.

Disabled women constitute a significant part of the general female population and this prevalence increases with age. These women need equal obstetric and gynecological services, the same as their healthy counterparts. Yet, their accessibility to these services is often prevented by environmental, information, attitude and economical barriers. In this article, the nature of these barriers is discussed. In addition, obstetricians/gynecologists often lack the appropriate expertise to treat disabled patients with specific limitations. In this review, we discuss several issues throughout the woman's life cycle in which obstetric/gynecological care is required. Medical organizations in Israel need to invest more in dissemination of information and in improving infrastructure, equipment and trained staff, in order to provide better medical care for this unique population.

Uterine fibroids (leiomyoma) are the most common benign tumors in women. Better understanding of the pathophysiology, as well as recent technical advancements opened the gates for new options for women who suffer from symptomatic uterine fibroids. Treatments are categorized in four groups: surgical removal, minimally invasive or noninvasive approach causing damage to cellular viability, medical treatments to reduce volume and relieve symptoms, and complementary medicine. This review may assist in tailoring the type of treatment according to age, desire for future fertility, size and location of the fibroids.

Sexual harassment is quite prevalent in medical organizations. The two most affected groups are medical students and nurses. In its broad perspective, sexual harassment is defined as any type of offensive behavior with sexual connotation aimed at any individual or minority. In Israel, sexual harassment is regarded as such only in the literal sense, although recently, courts tend to adopt a more comprehensive approach in their ruling. Final legislation of the law against sexual harassment, which includes employer liability for the actions of its workers, caused increased awareness of the phenomenon of sexual harassment and may serve in reducing its prevalence in the medical environment.

Nowadays, millions of people travel by air every day and it is common to find pregnant women among the passengers. Travelling during pregnancy raises the question of the woman's safety during the flight. This is due to the risk of exposure to cosmic radiation, the drop in air pressure, and the possibility of thromboembolism due to seating conditions and flight duration. Other risks include obstetric emergencies, such as hemorrhage, premature contractions and actual labor. Further issues associated with air travel during pregnancy have to do with the safety of pregnant aircrew, if emergency evacuation becomes necessary and the airline's view regarding the admittance of pregnant women on flights. We discuss these issues extensively in our review. We conclude that for a healthy woman whose pregnancy involves no risk factors, air travel is safe up to the 36th gestational week.

Hysterectomy for benign conditions, whether total or subtotal, with or without oophorectomy, and by abdominal or vaginal approach, is a common procedure in gynecologic surgery. Early concerns about a negative impact on postoperative sexuality following hysterectomy can no longer be maintained. Currently, sufficient data is available to indicate that hysterectomy does not adversely affect post-operative female sexuality and may even improve it. The addition of testosterone to post-operative hormonal treatment may further improve sexual response in women, although this approach is still controversial. There is only scarce information accessible related to the impact of surgery for pelvic organ prolapse and urinary incontinence on the sexual response in women. The limited data available on the postoperative effect on womens' sexuality of new surgical techniques such as laparoscopic hysterectomy, hysteroscopy or ablation, show improvement even in comparison with traditional surgical methods.

Superfecundation and superfetation are rare and obscure phenomena with no clear clinical significance but with legal and moral-social meanings. These obstetric rarities are known since the times of the ancient Greeks. There are several physiological explanations that account for superfecundation but not for superfetation, yet, both have been described. In this era of assisted reproductive techniques it is reasonable to assume that the prevalence of superfecundation increases, which may also apply to superfetation. Today, there are several reliable diagnostic techniques to verify heteropaternity in multifetal pregnancies, hence superfecundation. Nevertheless, our knowledge regarding these amazing phenomena remains limited due to both ethical and medico-legal barriers that prevent their implementation.

Domestic violence against women is a worldwide phenomenon affecting women of all age groups and socio-economic backgrounds. It may take the form of mental, as well as physical or sexual abuse. Pregnant women are not excluded from being abused. The physical and mental health of women who suffer domestic violence is compromised in comparison with women who are not subjected to violence. These women are reluctant to report their problem to physicians and they, in turn, do not sufficiently investigate the possibility of exposure to domestic violence with their patients. In Israel there is comprehensive protective legislation concerning domestic violence against women and a developed welfare system managed by social workers. Nevertheless, the efforts to protect and help these women will remain futile without early recognition, identification and referral of such women by the attending physicians. Among physicians, the obstetrician/gynecologists have a unique role, since on many occasions they serve as the primary care physicians of women who suffer from domestic violence. They are therefore able to recognize and offer help to these women.