Browsing by Author "Christman, Megan"

Now showing 1 - 3 of 3
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    The Case of the Vanishing Yoni Pearl
    (2022-03) Brown, Lucy; Heitz, Adaline; Cox, Natalie; Hulsman, Luci; Christman, Megan
    Case: A 41-year-old female presented to the Emergency Department (ED) with a retained vaginal foreign body (VFB). She reported inserting a detoxifying “yoni” pearl 36 hours prior. She was unable to remove it herself. She denied fever, vaginal pain, discharge, or dysuria. A gynecologist was consulted, and the VFB was removed manually without complications. Conclusions: The authors reviewed 29 case studies and series. Overall, tampons, condoms, menstrual cups, items used for sexual gratification, and unconventional items used for barrier contraception (e.g., aerosol caps) are among the most common VFBs in premenopausal adult women. Among postmenopausal adult women, medical devices such as pessaries can be neglected in the vagina leading to retained VFB. While most cases had no contributing risk factors, associated medical and social determinants include mental health disorders, history of sexual assault, and uninsured status. This is the first documented case of a detoxifying vaginal pearl VFB. Clinical Significance: VFB is a common presentation in the United States; from 2010 to 2014, 89,160 female patients presented to the ED with a vulvar/vaginal foreign body, many requiring gynecologic or urologic consultations and invasive procedures. Although this case was without complications, VFBs can have significant morbidity. Depending on the consistency of the foreign body, VFBs can serve as a nidus for infection with subsequent sepsis, most notably toxic shock syndrome. Other serious complications of VFBs are compression of tissue, which can lead to compromise of blood flow to that region, necrosis, perforation, and fistulas (i.e., rectovaginal or vesicovaginal). Fistula formation has also been reported as a direct result of the surgical trauma from removal of the VFB. Prevention efforts should be aimed at education about what can safely be placed in the vagina, and providers should focus on dispelling misinformation surrounding vaginal detoxification and cleanliness.
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    Impact of Dobbs Decision on Retention of Indiana Medical Students for Residency
    (Elsevier, 2023-10-08) Hulsman, Luci; Bradley, Paige K.; Caldwell, Amy; Christman, Megan; Rusk, Debra; Shanks, Anthony L.
    Background: As medical students consider residency training programs, access to comprehensive training in abortion care and the legal climate influencing abortion care provision are likely to affect their decision process. Objective: This study aimed to determine medical students' desire to stay in a state with an abortion ban for residency. Study design: A cross-sectional survey was distributed to all medical students at a large allopathic medical school. Anonymous survey questions investigated the likelihood of seeking residency training in states with abortion restrictions and the likelihood of considering obstetrics and gynecology as a specialty. Qualitative responses were also captured. Results: The survey was distributed to 1424 students, and 473 responses yielded a 33.2% completion rate; 66.8% of students were less likely to pursue residency training in Indiana following a proposed abortion ban. Moreover, 70.0% of students were less likely to pursue residency in a state with abortion restrictions. Approximately half of respondents (52.2%) were less likely to pursue obstetrics and gynecology as a specialty after proposed abortion restrictions. Qualitative remarks encompassed 6 themes: comprehensive health care access, frustration with the political climate, impact on health care providers, relocation, advocacy, and personal beliefs and ethical considerations. Conclusion: Most medical students expressed decreased likelihood of remaining in Indiana or in states with abortion restrictions for residency training. The field of obstetrics and gynecology has been negatively affected, with medical students indicating lower likelihood to pursue obstetrics and gynecology. Regardless of specialty, the physician shortage may be exacerbated in states with abortion restrictions. The overturn of Roe v Wade has the potential for significant effects on medical student plans for residency training location, thereby shaping the future of the physician workforce.