Adolescents experience barriers in access to sexual and reproductive health care, leading to a disproportionately high burden of disease and morbidity. Teens and young adults may avoid or delay accessing care due to perceived or experienced bias or judgement from healthcare providers or perceived or experienced inability to access care independently. Establishing positive, trusting relationships with adolescents is key to promotion of life-long health. Confidentiality plays a critical role in developing strong client-provider relationships, particularly for adolescent clients. Perception of confidentiality impacts an adolescent’s decision to seek care, disclose behaviors and concerns, as well as return for follow-up care. This chapter addresses the specific sexual and reproductive health needs of adolescents including care for common gynecologic conditions in adolescence as well as pregnancy. There is also information about mental health, suicide prevention, bullying, sexting, and age specific vaccination recommendations.

Telehealth is a term that has been used interchangeably with telemedicine. It is defined as the use of medical information exchanged from one site to another through electronic communication to improve a patient’s health. Goals of telehealth include the following: Enhance overall patient outcomes; Make health care accessible to individuals in rural or isolated communities; Allow services to be more readily available for people with limited mobility, time, or transportation options; Lower healthcare costs. This chapter explores the basics of telehealth in women’s healthcare. Telehealth in women’s health is essential to providing accessible, innovative, and equitable health care services to the women’s health gender-related population. In an ever-evolving healthcare landscape, understanding the key components of telehealth service in women’s health is critical to ensuring patients receive optimal care and health outcomes. Telehealth services can be delivered in the following four ways: synchronously, asynchronously, mHealth, and remote patient monitoring.

Lesbian women, or women who have sex with women, experience health disparities in terms of prevention screening and desired health outcomes as compared to heterosexual women. Lesbian women are less likely to seek out care due to: stigma associated with being identified as lesbian, and previously experienced negative encounters with healthcare providers. This chapter discusses screening recommendations for sexual-minority women (lesbian, bisexual, and women who have sex with women). The screening includes breast cancer screening, cervical cancer screening and human papillomavirus, and screening for sexually transmitted infections. It explains the importance of using inclusive language, and presents sexual history questions. The chapter describes the approach to patient and provider communication. It also presents terminology used among lesbian women to describe their sexual practices. The chapter also discusses risk assessment and reduction.

Intimate partner violence (IPV) is a global public health problem, linked to long-term health, social, and economic consequences. IPV, domestic violence, and family violence are terms that have been used to refer to physical, sexual, and psychological violence, and stalking, within intimate partner relationships. The overwhelming majority of violence and abuse is perpetrated by men against women, however, IPV does occur in same-sex relationships. There are four main forms of IPV. They are physical violence, sexual violence, stalking, and psychological aggression. The United States Preventive Services Task Force (USPSTF) recommends IPV screening for all women of reproductive age. IPV is the most common cause of injury among women of child-bearing age and their children. Health care professionals should screen for IPV and learn the abuse indicators, supportive care, safety planning, and community resources available to support women victims of IPV.

Polyps are the most common benign tumors of cervix and are found most often during the menstruating years. They are soft, pear-shaped (finger-like), red to purple lesions, and are usually pedunculated growths from the surface of the cervical canal. They are very friable and contain a large number of blood vessels, particularly near the surface. Typically, polyps are not cancerous (benign) and are easy to remove. Polyps do not usually grow back. However, women who have polyps once are at risk of growing more polyps. Pelvic examination will reveal smooth, red, or purple finger-like growths on the cervix. They are often removed during a routine pelvic examination. A cervical biopsy will most often show cells that are consistent with a benign polyp. Rarely, there may be abnormal, precancerous, or cancer cells in a polyp.

Women veterans deserve high-quality compassionate care in a safe, secure environment. Since the recent military reduction in force, there are more military men and women exiting the armed forces and transitioning to civilian life. The fastest growing sub-population of veterans is women veterans. Women comprise 15% of the armed forces. The military experiences of women veterans can and often do impact the remainder of their lives, physically and mentally. Many women veterans access health care through the Veterans Health Administration (VHA) via their local Veterans Affairs (VA) health care systems. However, most women veterans are seen in civilian medical care facilities. Health care providers need to recognize that the woman they are seeing today may have been in the military and is a former woman warrior. This chapter discusses specific areas of concern for female veterans in primary care, mental health care, trauma-informed care, VHA/VA services, and reproductive health care.

Cancers of the breast and ovary impose a significant burden on women’s health. Most cancers are sporadic and there is limited ability to predict who will be affected. Family history of cancer is common, but specific features in the family pedigree can suggest a hereditary pattern and increased cancer risk for family members. Approximately 5% to 10% of breast and ovarian cancers are hereditary, due to a single gene germline mutation. Identification and screening of high-risk women are essential skills for healthcare practitioners. BRCA1 and BRCA2 gene mutations are responsible for hereditary breast and ovarian cancer syndrome, accounting for a large percentage of heritable cancers of the breast and ovary. A mutation in one of these genes has a profound impact on cancer risk. This chapter discusses the genetic testing for hereditary breast and ovarian cancer and details the management options for the unaffected woman who tests BRCA positive.

Human trafficking, also known as trafficking in persons or modern-day slavery, is a crime that involves compelling or coercing a person to provide labor or services or to engage in commercial sex acts. The coercion can be subtle or overt, physical, or psychological. The exploitation of a minor for commercial sex is human trafficking, regardless of whether any form of force, fraud, or coercion was used. Sex trafficking is the recruitment, harboring, transportation, provision, obtaining, patronizing, soliciting, or advertising of a person for a commercial sex act. Sex trafficking is divided into two distinct subcategories: adult sex trafficking and child sex trafficking. This chapter discusses etiology and incidence, and risk factors of human trafficking, and guidelines for primary care providers responding to suspicion or disclosures of human trafficking. It also discusses trauma-informed care, treatment and management, definition and types of female genital mutilation.