Helena M. Obermair

Barriers to salpingectomy for permanent contraception: A qualitative study with obstetricians and gynaecologists

Consideration of risk‐reducing bilateral salpingectomy has been recommended instead of tubal occlusive procedures for female sterilisation due to the role of the Fallopian tubes in the aetiology of serous ovarian malignancies. This study identified barriers to performing salpingectomy for permanent contraception. Twenty‐two semi‐structured interviews were conducted with Australian gynaecologists, and transcripts analysed qualitatively. Barriers to performing bilateral salpingectomy included: (a) patient factors (younger age and risk of regret); (b) operative complexity and complications (particularly risk of bleeding); (c) surgeon factors (lack of awareness of guidelines supporting salpingectomy; less comfort with laparoscopic surgery); and (d) practical system challenges (including cost and equipment availability).

Implementing changes to cervical screening: A qualitative study with health professionals

BackgroundProfound changes were made to the Australian National Cervical Screening Program in December 2017, which included a reduction in the frequency of screening and a new cervical screening test.AimTo explore the attitudes and experiences of health professionals practising in Australia since implementation of these changes.Materials and MethodsThirty‐one semi‐structured interviews were conducted with general practitioners, obstetricians and gynaecologists, pathologists and nurses involved in cervical screening Australia‐wide. Data were analysed using Framework Analysis.ResultsOverall, health professionals had positive attitudes toward the changes but described many challenges associated with their implementation. Participants discussed practical system challenges, communication and education, finding ways around the guidelines and other perceived ‘collateral’. Practical system challenges included increased colposcopy referrals, limited access to the National Cancer Screening Register, a complex primary screening approach, and issues with self‐collection. In terms of communication and education, limited public education was recognised, in addition to challenges with particular age groups of women. Finding ways around the guidelines were described, for example over‐referring women for co‐testing by stating symptoms, which could lead to overtreatment. Other perceived collateral were demonstrated through reduced opportunistic screening opportunities due to less frequent primary care presentations, and concern over the potential for further underscreening in already under‐screened populations.ConclusionsThese findings provide insight into the challenges health professionals face with renewing programs, in terms of practical issues and unexpected downstream effects which need to be addressed to ensure future implementation of the program is streamlined.

“A Pap smear saved my life”: Personal experiences of cervical abnormalities shape attitudes to cervical screening renewal

Objective In 2017, the Australian National Cervical Screening Program changed from two-yearly Pap smears between ages 18 and 69, to five-yearly human papillomavirus screening between ages 25 and 74 (the “Renewal”). This study investigated attitudes towards the changes, among individuals previously affected by cervical abnormalities/cervical cancer, personally or through a friend/relative. Methods We conducted a thematic analysis of comments expressing personal history or a family/friend history of cervical abnormalities/cervical cancer as a reason for opposing changes to the cervical screening program. The comments were taken from a 20% random sample of 19,633 comments posted on the “Change.org” petition “Stop May 1st Changes to Pap Smears – Save Women's Lives” in February–March 2017. Results There were 831 (20.8%) commenters who reported that they were concerned about a change in screening due to: feelings of increased personal vulnerability to cervical cancer due to their own personal history of cervical abnormalities; comparison of extended screening intervals and later age of first screening to their own experiences; and a perception of increased personal risk due to family history. Conclusion Women previously affected by cervical abnormalities or cervical cancer, personally or through a friend/relative, expressed concern about changes to cervical screening due to perceived increased risk and feeling vulnerable due to personal history.

Australian National Cervical Screening Program renewal: Attitudes and experiences of general practitioners, and obstetricians and gynaecologists

BackgroundIn 2017, the Australian National Cervical Screening Program (NCSP) implemented five‐yearly primary human papillomavirus (HPV) screening for women aged 25–74. It is important that clinicians are able to explain the NCSP changes to women and confidently address concerns.AimsThis study examined Australian clinicians’ attitudes toward and experiences of the NCSP renewal since its implementation.Materials and MethodsCross‐sectional survey of clinicians (general practitioners, obstetricians and gynaecologists) involved in cervical screening, distributed two years after implementation of the renewed NCSP. Responses were analysed using descriptive statistics and thematic analysis.ResultsSix hundred and seven participants completed the survey. More than 80% of clinicians were comfortable with the main NCSP changes: extended screening intervals, increased age of first screening, and screening test used. However, only 47% of clinicians reported having utilised the National Cancer Screening Register, and a third of clinicians did not believe that self‐collection was a reasonable alternative to practitioner‐collected screening for under‐screened women. Increased demands for colposcopy were reported. All clinicians identified at least one area of educational need, including the management of women with a history of screen‐detected abnormalities in the previous program (34.9%), post‐colposcopy management for women with no abnormalities detected (25.5%), and screening in complex scenarios (eg immunocompromise) (26.5%).ConclusionsOverall, Australian clinicians are comfortable with the main changes to the cervical screening program. Certain areas may require further policy review, such as screening in complex clinical scenarios, colposcopy availability, accessibility of the Register and self‐collection. These issues could be meaningful for other countries switching to HPV‐based screening.

Silicon dioxide, sodium selenite and citric acid vaginal gel, HPV infection, and cervical preinvasive disease: a narrative review

Cervical cancer continues to be a major public health concern, particularly in low- and middle-income countries. It is mainly caused by persistent infection with human papillomavirus (HPV). Screening has been the most effective strategy to reduce mortality, but over the last 2 decades, vaccination has emerged as an important adjunct, helping to decrease incidence and mortality. Given the natural history of HPV infection, most low-grade lesions will spontaneously resolve over time; therefore, observation is the preferred approach for low-grade squamous intraepithelial lesions. Some authors have suggested that this period without intervention may cause anxiety among patients and physicians. A vaginal gel containing 10.0 mg of silicon dioxide, 24.8 mg citric acid, and 0.25 mg selenium per dose, marketed as DeflaGyn, Deflamin, or Deflamed, has been approved in Europe, the United Arab Emirates, Uzbekistan, and Colombia. A literature search was conducted to identify all published clinical trials on DeflaGyn. As of January 2025, 6 studies have been published: 1 retrospective study, 1 randomized clinical trial (RCT) with 2 post hoc analyses, 1 prospective non-randomized trial, and 1 in vitro study. A methodological risk-of-bias assessment was performed, revealing a number of domains with high or unknown risk of bias in the RCT and its post hoc analyses. This review aims to summarize the available evidence and perform a critical analysis of the research. Current evidence is insufficient to support its use for treating HPV infection or dysplasia.