Technology has been integrated into every facet of human life, and whether it is completely advantageous remains unknown, but one thing is for sure; we are dependent on technology. Medical advances from the integration of artificial intelligence, machine learning, and augmented realities are widespread and have helped countless patients. Much of the advanced technology utilized by medical providers today has been borrowed and extrapolated from other industries. There remains no great collaboration between providers and engineers, which may be why medicine is only in its infancy of innovation with regards to advanced technologic integration. The purpose of this narrative review is to highlight the different technologies currently being utilized in a variety of medical specialties. Furthermore, we hope that by bringing attention to one shortcoming of the medical community, we may inspire future innovators to seek collaboration outside of the purely medical community for the betterment of all patients seeking care.

Background: Obstetric Anal Sphincter Injuries (OASI) are associated with significant morbidity. Data regarding induction of labor (IOL) and risk of OASI is conflicting. The objective of this study is to evaluate if IOL increases the odds of OASI when compared to spontaneous labor. Methods: This is a retrospective case–control study in women with term, singleton pregnancies, who had a vaginal delivery at a single, academic center in an urban setting from October 2015 to December 2021. Individuals with the primary outcome, OASI, were identified and matched with controls (no OASI) by delivery date. Results: 303 OASI individuals were identified and matched with 1106 controls. Women with OASI were more likely to be White or Asian, have commercial insurance, and have a previous cesarean delivery (CD). IOL increased the likelihood of OASI by 49% compared to spontaneous labor (OR 1.49, 95% CI [1.138, 1.949]). IOL was no longer significant when adjusting for confounding variables and known risk factors. Conclusion: IOL was not associated with OASI when accounting for known antepartum and intrapartum risk factors. Further investigation of modifiable and non-modifiable risks during labor is imperative to decrease the risk of OASI and associated pelvic floor disorders.

Background: Limited research exists on postoperative orgasmic function following feminizing genital gender affirmation surgery (vulvoplasty/vaginoplasty). Aim: To describe the incidence of orgasm following vulvoplasty/vaginoplasty surgery and compare factors between patients who report the ability to orgasm and patients who do not. Methods: A retrospective cohort study was conducted of transgender women undergoing gender-affirming vulvoplasty with and without vaginoplasty between January 2016 and June 2023. Patients were included if they had in-office follow-up for at least 12 months following surgery and documentation of an ability to orgasm. Outcomes: Of 223 patients, 41 underwent vulvoplasty alone and 182 underwent vulvoplasty with vaginoplasty. The mean (SD) age and body mass index of the cohort were 38 (16) years and 26 (4.8) kg/m2. At 6 months after surgery, 90.1% (n = 201; 95% CI, 78.3%-94.6%) reported an ability to orgasm. Patients who reported an inability to orgasm were older (53 vs 36 years, P = .002) and had higher body mass indexes (27.6 vs 25.8 kg/m2, P = .04), a higher incidence of medical comorbidities (45.5% vs 18.5%, P = .003), and a history of prostate cancer (13.6% vs 0%, P = .003). Inability to orgasm was also associated with patients undergoing a vulvoplasty-only procedure (72.7% vs 27.3%, P = .003), but this was not significant when controlling for age and comorbidities. There were no significant differences in intraoperative complications between the groups, but patients who were unable to orgasm had a higher incidence of postoperative bleeding and reoperation. Results: Among transgender women undergoing genital gender affirmation surgery, 90% reported the ability to orgasm within 6 months of surgery. Age and medical comorbidities were associated with an ability to orgasm. Clinical Implications: These findings suggest that most patients undergoing feminizing gender affirmation surgery can orgasm within 6 months postsurgery. This information is critical for preoperative counseling, enabling patients to make more informed decisions and set realistic expectations regarding surgical outcomes. Strengths and Limitations: Strengths include inclusion of patients with vulvoplasty only and patients with vulvoplasty and vaginoplasty. Limitations include the experience of a single surgeon and the retrospective nature of our study. Conclusion: Our study’s findings are encouraging for individuals considering feminizing genital surgery, as 90% of the transgender women in our cohort reported an ability to orgasm within 6 months of surgery. This study adds to the growing body of literature that can help patients make informed decisions and set realistic expectations for their gender-affirming surgical outcomes.

Introduction and Hypothesis: Obstetric anal sphincter injuries (OASIs) complicate 5.8% of vaginal deliveries. Our objective was to assess if the primary delivery provider, a nurse-midwife versus physician obstetrician, is associated with OASIs. Methods: We performed a secondary analysis of the Consortium of Safe Labor, a multicenter, retrospective cohort study. Included were nulliparous women with singleton, vaginal delivery at ≥37 weeks from 2002 to 2008. Women were excluded if delivery was complicated by shoulder dystocia or from sites without midwife deliveries. Student’s t-tests, chi-squared analysis, and Fisher’s exact test were used as appropriate. Multivariable logistic regression and propensity score-matching analyses were performed. Results: Of 228,668 births at 19 sites, 2735 births from 3 sites met the inclusion criteria: 1551 physician and 1184 midwife births. Of all births, 4.2% (n = 116) were complicated by OASIs. Physician patients were older, more often White, privately insured, with higher BMI, more medical co-morbidities, and labor inductions/augmentations. Midwife patients had higher fetal gestational age and infant birth weights (all p < 0.05). OASIs were more common in physician compared to midwife births (5.9% vs. 2.0%, p < 0.0001). This difference persisted in multivariable logistic regression. OASIs were 2.4 (95%CI 1.5–3.9) times more likely with physician delivery when controlling for maternal heart disease, episiotomy, increasing maternal age, decreasing maternal BMI, non-White race, and increasing birthweight. The AUC was 0.78. With propensity score matching, OASI rates remained higher amongst physician births (6.6% vs. 1.8%, p < 0.0001; aOR 3.8 (95%CI 2.0–7.1)). Conclusion: OASIs were more common in physician compared to midwife deliveries even when controlling for other associated factors.