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OBJECTIVES To provide management guidelines according to Pap test specimen adequacy based on literature review and expert opinion. METHODS A task force named by the American Society for Colposcopy and Cervical Pathology conducted a literature review and discussed appropriate management. The steering committee of the American Society for Colposcopy and Cervical Pathology and other experts reviewed the guidelines. RESULTS The guidelines recommend a repeat Pap test in 12 months for most women who are undergoing routine annual/biennial screening if the current Pap test is negative but either lacks an endocervical/transformation zone component or is partially obscured. Indications for considering an earlier repeat are also provided. The preferred management for unsatisfactory Pap tests is a repeat Pap test within a short interval of 2 to 4 months. CONCLUSIONS The management guidelines will help promote optimal and uniform follow-up of women's Pap tests, according to Pap test specimen adequacy.

External genital warts (EGWs) are sexually transmitted benign epidermal growths caused by the human papillomavirus (HPV), on the anogenital areas of both females and males. About 50% to 60% of sexually active women aged 18 to 49 years have been exposed to HPV infection, but only 10% to 15% will have genital warts.We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for external genital warts? What are the effects of interventions to prevent transmission of external genital warts? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).We found 55 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.In this systematic review we present information relating to the effectiveness and safety of the following interventions: bi- and trichloroacetic acid; condoms; cryotherapy; electrosurgery; imiquimod; intralesional, topical, or systemic interferons; laser surgery; podophyllin; podophyllotoxin; surgical excision; and vaccines.

Treatment of human papillomavirus (HPV)-associated vaginal lesions (vaginal intraepithelial neoplasia [VAIN]) can be expensive, tedious, and morbidity inducing. Imiquimod 5% cream, a safe and effective treatment of external genital warts, enhances the immune response to HPV infection.Imiquimod 5% cream was used to treat 56 young women with VAIN. One sachet of cream (0.25 g) was placed in the vagina with an applicator once weekly for 3 weeks (except for the first four patients, who were treated twice weekly).Thirty-six of the 42 patients (86%) available for follow-up were clear of VAIN lesions (as assessed by colposcopy) 1 week or later after the last dose of treatment. The remaining six patients cleared after a total of two (five patients) and three (one patient) treatment cycles. Vulvar or vestibular excoriation was reported in only 2 of 56 patients. No patients had vaginal ulceration.A very low dosing regimen of imiquimod 5% cream appears to be an effective and well-tolerated treatment for VAIN (primarily low grade.).

Objective: The study was undertaken to determine whether metoclopramide pretreatment attenuates side effects associated with high-dose estrogen/progestin emergency contraception in at-risk patients. Study design: This was a randomized, prospective, double-blind, placebo-controlled study at the University of Kansas. Patients (141) requesting emergency contraception and lacking contraindications were offered entry in the study. Both the treatment (metoclopramide 10 mg) and placebo groups received active emergency contraception. Participants evaluated symptom severity with a 12-question survey tool developed for this study. Results: Metoclopramide pretreatment provided protection against nausea and cramping associated with estrogen/progestin emergency contraception. The average scores on a 10-point scale for the treatment group and placebo group were as follows: nausea 3.2 versus 4.8 ( P = .01) and cramping 0.9 versus 2.2 ( P Conclusion: Metoclopramide pretreatment attenuates the nausea and cramping associated with Yuzpe emergency contraceptive treatment. (Am J Obstet Gynecol 2003;188:330-3.)

THE INCIDENCE of and mortality from cervical cancer in the United States have decreased dramatically over the past 40 years, in part because of early diagnosis and treatment of cervical cancer precursor lesions. The success of cervical cytological screening has served as a model for early diagnosis of other types of cancer. Although numerous studies have shown that lack of cytological screening is a major risk factor for the development of invasive cervical cancer, 1-3 it is important to emphasize that none of the screening, diagnostic, or therapeutic techniques used in medicine are perfect. Accordingly, a few women will develop cervical cancer despite adherence to accepted screening protocols . In addition, problems inherent with sampling, interpretation, and effective clinical follow-up preclude total prevention of cervical cancer. In recent years it has become evident that the cost and morbidity associated with the detection and treatment of low-grade cervical lesions have escalated, probably

Twenty-one married couples, recruited from childbirth classes (mean age 29.6 years), were administered questionnaires measuring 20 different moods during the third trimester of pregnancy (prepartum period), during the postpartum period, and at 6 months after birth (follow-up period). In each questionnaire period individual questionnaires were filled out daily by both the mother and father for 10 consecutive days. The results indicated that the postpartum period, compared with the prepartum and follow-up periods, is an emotionally unique time but not a period marked by depression. The moods that were rated as being experienced more strongly by men and women during the postpartum period were associated with anxiety and concern for one's ability to cope such as “nervousness,” “worried,” “helpless,” and “anxious” or positive emotions such as “enthusiastic” and “happy.” It is concluded that men and women in this sample tend to experience the postpartum period in an emotionally similar way.