Patient embarrassment represents a significant yet often underrecognized barrier to effective gynecological care. This review integrates multidisciplinary evidence from Embase, PubMed, PsycINFO, and the Cochrane Library (2000–2025) to examine the relationship between embarrassment, shame, and modesty and their impact on care-seeking behaviors, clinical outcomes, and healthcare utilization. Available data indicate that embarrassment is consistently associated with reduced participation in preventive screening, with up to one-third of non-attenders citing modesty-related concerns. In symptomatic patients, these emotional barriers contribute to clinically meaningful diagnostic delays, particularly in conditions such as cervical cancer, vulvar cancer, and endometriosis. Embarrassment also affects in-consultation behavior, with a substantial proportion of patients reporting withheld concerns or incomplete disclosure of medically relevant information. The consequences extend beyond delayed diagnosis to include reduced treatment adherence, increased disease severity at presentation, and higher healthcare costs due to more complex and resource-intensive interventions. Contributing factors include cultural stigma, prior negative clinical experiences, fear of judgment, and aspects of the clinical environment that may heighten patient vulnerability.

Background and Clinical Significance: A paratubal cyst, which makes up about 10% of all adnexal masses, is a specific type of adnexal cyst that develops from the mesothelium in the broad ligament located between the fallopian tube and the ovary. Interestingly, the majority of paratubal cyst cases are initially misidentified as ovarian cysts, with suspicion arising in only 1 out of every 15 patients before undergoing surgery. Case Presentation: We report a case of a giant paratubal cyst mimicking an ovarian cyst in a 21-year-old woman supported by some representative images along with a literature review. The cyst’s therapeutic management was surgical removal of the adnexa and the final postoperative histopathological diagnosis was that of a benign paratubal cyst. Conclusions: This case highlights the need to include a paratubal cyst in the differential diagnosis of pelvic masses, especially in women of reproductive age. To the best of our knowledge, this represents the largest paratubal cyst reported in the literature to date, based on overall dimensions and the highest recorded volume of aspirated fluid, successfully managed via laparoscopy. A further notable aspect of this case is the coexistence of the giant paratubal cyst with an ovarian mucinous cystadenoma.

Atypical polypoid adenomyoma (APAM) is a rare polypoid benign tumor of the uterus that causes irregular vaginal bleeding in women of reproductive age. It has the potential for malignant transformation, but it does not metastasize. APAM may coexist with endometrial hyperplasia and adenocarcinoma, usually leading to misdiagnosis. Histopathologically, it is a biphasic tumor, represented by the endometrioid glands with a complex histoarchitecture, with sometimes squamous morular metaplasia or cytologic atypia, interspersed with a fibromyomatous stroma. This tumor has a high incidence of recurrence. We present a very rare case of a 21-year-old patient, a virgin, without a significant medical history, with a bleeding mass occupying the vagina. The mass was excised using forceps, scissors, and a suture of the visible pedicle. After a four-year follow-up and no additional medical treatment, no relapse was observed. Given the risk of recurrence and progression, APAM might be treated via a hysterectomy in patients with no desire for pregnancy. Due to a lower recurrence rate, the conservative treatment of atypical polypoid adenomyoma performed via an operative hysteroscopy represents the best choice. Previously diagnosed in hysterectomy specimens, with the introduction of better-performing indirect imaging techniques, adenomyosis is a clinical entity that has the possibility of being diagnosed in the presurgical stage.

The link between endometriosis and ovarian carcinoma has been recognized early on, initially termed endometriosis-associated ovarian carcinoma and subsequently referred to as endometriosis-associated ovarian carcinoma (EAOC). The relationship between endometriosis and cancer is well supported by epidemiological evidence, highlighting common risk factors. Two potential mechanisms have been proposed: one involving the direct malignant transformation of endometriotic lesions, and the other suggesting a shared origin in precursor mechanisms or risk factors, followed by distinct molecular pathways. This chapter explores the epidemiological links, molecular mechanisms, and clinical implications of endometriosis-associated ovarian carcinoma, highlighting its distinct subtypes and risk factors.

The perception that hormonal contraception causes weight gain is a general belief that frequently hinders the initiation and continuation of effective family planning. This narrative review analyses data from Cochrane systematic reviews and recent pharmacogenomic studies to separate patient perception from metabolic reality. Analysis of high-quality data, including Cochrane systematic reviews, indicates that the association between Combined Hormonal Contraceptives (CHCs)—including oral pills, the transdermal patch, and the vaginal ring—and weight gain is not supported by consistent high-quality evidence. Placebo-controlled trials demonstrate that these methods are weight-neutral on average. Perceived weight increases in CHC users are likely mediated in part by fluid retention linked to the estrogenic stimulation of the Renin–Angiotensin–Aldosterone System (RAAS), rather than adipose tissue accumulation. Conversely, Depot Medroxyprogesterone Acetate (DMPA) represents a verified clinical risk for weight gain, showing a demonstrated clinical association with significant fat mass accumulation. Hypothesized biological mechanisms for this increase include hypothalamic appetite stimulation and glucocorticoid-like activity. The etonogestrel implant occupies a complex middle ground. While population-level data suggests weight neutrality, recent exploratory pharmacogenomic research has identified a specific variant in the Estrogen Receptor 1 (ESR1) gene. For the minority of women carrying this variant, the implant may trigger clinically significant weight gain, suggesting a biological basis for their subjective experience despite statistical evidence. Ultimately, the persistence of the weight gain concern is fueled by the nocebo effect and the misattribution of natural age-related weight trajectories to contraceptive use.

Background: Low-grade endometrial stromal sarcoma (LG-ESS) is a rare uterine mesenchymal neoplasm characterized by indolent progression and strong hormonal responsiveness. Accurate diagnosis remains challenging due to its overlapping clinical, pathological, and imaging features with other benign or malignant uterine entities. Case Presentation: This article presents a case of LG-ESS in a 50-year-old woman, encompassing the clinical presentation, imaging features, histopathological and immunohistochemical findings, the surgical management and postoperative course, as well as a focused synthesis of the current literature on this pathology. The patient presented with recurrent abnormal uterine bleeding and secondary anemia. Imaging data, including magnetic resonance imaging (MRI), revealed a heterogeneous intracavitary lesion with cystic components, suggestive of submucosal fibroids. Surgical management via total hysterectomy with bilateral salpingo-oophorectomy was performed due to suspicion of sarcoma and the need to suppress hormonal stimulation. Histopathological and immunohistochemical evaluation confirmed LG-ESS. The patient had no lympho-vascular invasion, presenting a favorable postoperative evolution. Conclusions: This case highlights the need to maintain a strong clinical suspicion for uterine sarcomas in patients presenting with atypical bleeding and presumed fibroids, especially among perimenopausal women. A multidisciplinary approach, including imaging, surgery, pathology, molecular profiling, and oncology, is essential for accurate diagnosis and optimal management.