Kenneth A Rasinski Archives - Protection of Conscience Project Library

What we don’t talk about when we don’t talk about sex: results of a national survey of U.S. obstetricians/gynecologists

Janelle N Sobecki, Farr A Curlin, Kenneth A Rasinski, Stacy Tessler Lindau

Abstract
Introduction
Sexuality is a key aspect of women’s physical and psychological health. Research shows both patients and physicians face barriers to communication about sexuality. Given their expertise and training in addressing conditions of the female genital tract across the female life course, obstetrician/gynecologists (ob/gyns) are well-positioned among all physicians to address sexuality issues with female patients. New practice guidelines for management of female sexual dysfunction and the importance of female sexual behavior and function to virtually all aspects of ob/gyn care, and to women’s health more broadly, warrant up-to-date information regarding ob/gyns’ sexual history-taking routine.

Aims
To determine obstetrician/gynecologists’ practices of communication with patients about sexuality, and to examine the individual and practice-level correlates of such communication.

Methods
A population-based sample of 1154 practicing U.S. obstetrician/gynecologists (53% male; mean age 48 years) was surveyed regarding their practices of communication with patients about sex.

Main Outcome Measures
Self-reported frequency measures of ob/gyns’ communication practices with patients including whether or not ob/gyns discuss patients’ sexual activities, sexual orientation, satisfaction with sexual life, pleasure with sexual activity, and sexual problems or dysfunction, as well as whether or not one ever expresses disapproval of or disagreement with patients’ sexual practices. Multivariable analysis was used to correlate physicians’ personal and practice characteristics with these communication practices.

Results
Survey response rate was 65.6%. Sixty-three percent of ob/gyns reported routinely assessing patients’ sexual activities; 40% routinely asked about sexual problems. Fewer asked about sexual satisfaction (28.5%), sexual orientation/identity (27.7%), or pleasure with sexual activity (13.8%). A quarter of ob/gyns reported they had expressed disapproval of patients’ sexual practices. Ob/gyns practicing predominately gynecology were significantly more likely than other ob/gyns to routinely ask about each of the five outcomes investigated.

Conclusion
The majority of U.S. ob/gyns report routinely asking patients about their sexual activities, but most other areas of patients’ sexuality are not routinely discussed.

Sobecki JN, Curlin FA, Rasinski KA, Lindau ST. What we don’t talk about when we don’t talk about sex: results of a national survey of U.S. obstetricians/gynecologists. J Sex Med. 2012;9(1285-1294. Available from:

Obstetrician-gynecologists’ beliefs about when pregnancy begins

Grace S Chung, Ryan E Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

American Journal of Obstetrics & Gynecology

Abstract
Objective: The purpose of this study was to assess obstetrician- gynecologists’ regarding their beliefs about when pregnancy begins and to measure characteristics that are associated with believing that pregnancy begins at implantation rather than at conception.

Study Design: We mailed a questionnaire to a stratified, random sample of 1800 practicing obstetrician-gynecologists in the United States. The outcome of interest was obstetrician-gynecologists’ views of when pregnancy begins. Response options were (1) at conception, (2) at implantation of the embryo, and (3) not sure. Primary predictors were religious affiliation, the importance of religion, and a moral objection to abortion.

Results: The response rate was 66% (1154/1760 physicians). One-half of US obstetrician-gynecologists (57%) believe pregnancy begins at conception. Fewer (28%) believe it begins at implantation, and 16% are not sure. In multivariable analysis, the consideration that religion is the most important thing in one’s life (odds ratio, 0.5; 95% confidence interval, 0.20.9) and an objection to abortion (odds ratio, 0.4; 95% confidence interval, 0.20.9) were associated independently and inversely with believing that pregnancy begins at implantation.

Conclusion: Obstetrician-gynecologists’ beliefs about when pregnancy begins appear to be shaped significantly by whether they object to abortion and by the importance of religion in their lives.

Chung GS, Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician-gynecologists’ beliefs about when pregnancy begins. Am J Obstet Gynecol. 2012;206(2):132.e1-132.e7.

Obstetrician-gynecologists’ objections to and willingness to help patients obtain an abortion

Lisa H Harris, Alexandra Cooper, Kenneth A Rasinski, Farr A Curlin, Anne Drapkin Lyerly

Abstract
Objective: To describe obstetrician-gynecologists’ (ob-gyns’) views and willingness to help women seeking abortion in a variety of clinical scenarios.

Methods: We conducted a mailed survey of 1,800 U.S. ob-gyns. We presented seven scenarios in which patients sought abortions. For each, respondents indicated if they morally objected to abortion and if they would help patients obtain an abortion. We analyzed predictors of objection and assistance.

Results: The response rate was 66%. Objection to abortion ranged from 16% (cardiopulmonary disease) to 82% (sex selection); willingness to assist ranged from 64% (sex selection) to 93% (cardiopulmonary disease). Excluding sex selection, objection was less likely among ob-gyns who were female (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.4-0.8), urban (OR 0.3, 95% CI 0.1-0.7), or Jewish (OR 0.3, 95% CI 0.1-0.7) compared with male, rural, or religiously unaffiliated ob-gyns. Objection was more likely among ob-gyns from the South (OR 1.9, 95% CI 1.2-3.0) or Midwest (OR 1.9, 95% CI 1.2-3.1), and among Catholic, Evangelical Protestant, or Muslim ob-gyns, or those for whom religion was most important, compared with reference. Among ob-gyns who objected to abortion in a given case, approximately two-thirds would help patients obtain an abortion. Excluding sex selection, assistance despite objection was more likely among female (OR 1.8, 95% CI 1.1-2.9) and United States-born ob-gyns (OR 2.2, 95% CI 1.1-4.7) and less likely among southern ob-gyns (OR 0.3, 95% CI 0.2-0.6) or those for whom religion was most important (OR 0.3, 95% CI 0.1-0.7).

Conclusion: Most ob-gyns help patients obtain an abortion even when they morally object to abortion in that case. Willingness to assist varies by clinical context and physician characteristics.

Harris LH, Cooper A, Rasinski KA, Curlin FA, Lyerly AD. Obstetrician-gynecologists’ objections to and willingness to help patients obtain an abortion. Obstet Gynecol. 2011;118(4):905-912.

Adolescents, contraception, and confidentiality: a national survey of obstetrician-gynecologists

RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

Abstract
Background
Given recent legislative efforts to require parental notification for the provision of reproductive health care to minors, we sought to assess how ob/gyns respond to requests for confidential contraceptive services.

Study Design
Mailed survey of 1800 U.S. Obstetrician-Gynecologists, utilizing a vignette where a 17-year-old college freshman requests birth control pills and does not want her parents to know. Criterion variables were the likelihood of: encouraging her to abstain from sexual activity until she is older; persuading her to involve her parents in this decision; and prescribing contraceptives without notifying her parents. Covariates included physicians’ religious, demographic, and clinical characteristics.

Results
Response rate 66%. Most (94%) would provide contraceptives without notifying her parents. Half (47%) would encourage her to involve a parent, and half (54%) would advise abstinence until she is older. Physicians who frequently attend religious services were more likely to encourage her to involve her parents (OR 1.9), and to abstain from sex until she is older (OR 4.4), but equally likely to provide the contraceptives.

Conclusions
Most obstetrician-gynecologists will provide adolescents with contraceptives without notifying their parents.

Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Adolescents, contraception, and confidentiality: a national survey of obstetrician-gynecologists. Contraception. 2011;84(3):259-265.

Obstetrician–gynecologists’ beliefs about safe-sex and abstinence counseling

RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

International Journal of Gynecology & Obstetrics

Abstract
Objective
To examine obstetrician–gynecologists’ beliefs about safe-sex and abstinence counseling.

Methods
Between October 2008 and January 2009, a survey was mailed to a national randomized sample of 1800 practicing US obstetrician–gynecologists. Study variables were agreement with 2 statements. (1) “If physicians counsel patients about safe-sex practices, the patients will be less likely to engage in risky sexual behaviors”. (2) “If physicians counsel patients about abstinence, the patients will be much less likely to engage in sexual activity”. Covariates included demographic, clinical, and religious characteristics of the physician.

Results
The response rate was 66% (1154/1760 eligible physicians). Most respondents somewhat (62%) or strongly (25%) agreed that counseling patients about safe-sex practices makes patients less likely to engage in risky sexual behaviors. Fewer agreed strongly (3%) or somewhat (28%) that counseling patients about abstinence makes patients less likely to engage in sexual activity. The belief that safe-sex counseling reduces risky behaviors was less common among males (odds ratio [OR] 0.6) and more common among immigrants (OR 2.0). Religious physicians were more likely to believe that abstinence counseling reduces sexual activity (OR 2.2–5.3).

Conclusions
Most obstetrician–gynecologists believed that counseling about safe sex is effective, and a significant minority endorsed abstinence counseling.

Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician–gynecologists’ beliefs about safe-sex and abstinence counseling. Int J Gyn Obst 2011; 114(3):281-285.

Obstetrician-gynecologists’ opinions about conscientious refusal of a request for abortion: results from a national vignette experiment

Kenneth A Rasinski, John D Yoon, Youssef G Kalad, Farr A Curlin

Abstract
Background and objectives: Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners’ opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists’ (OB/GYN) support for the recommendations.

Design: A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee–whether the doctor referred and whether the doctor disclosed their objection to the abortion.

Participants and setting: 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases.

Measurement: Physicians indicated their approval for the vignette doctor’s decision.

Main results: Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure.

Conclusion: OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor-patient relationship.

Rasinski KA, Yoon JD, Kalad YG, Curlin FA. Obstetrician-gynecologists’ opinions about conscientious refusal of a request for abortion: results from a national vignette experiment. J Med Ethics. 2011;37(12):711-714.

Obstetrician-gynecologists’ views on contraception and natural family planning: a national survey

RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

Abstract
Objective
To characterize beliefs about contraception among obstetrician-gynecologists (Ob/Gyns).

Study design
National mailed survey of 1800 U.S. Ob/Gyns. Criterion variables were whether physicians have a moral or ethical objection to – and whether they would offer – six common contraceptive methods. Covariates included physician demographic and religious characteristics.

Results
1154 of 1760 eligible Ob/Gyns responded (66%). Some Ob/Gyns object to intrauterine devices (4.4% object, 3.6% would not offer), progesterone implants and/or injections (1.7% object, 2.1% would not offer), tubal ligations (1.5% object, 1.5% would not offer), oral contraceptive pills (1.3% object, 1.1% would not offer), condoms (1.3% object, 1.8% would not offer), and the diaphragm or cervical cap with spermicide (1.3% object, 3.3% would not offer). Religious physicians were more likely to object (OR 7.4) and to refuse to provide a contraceptive (OR 1.9).

Conclusion
Controversies about contraception are ongoing, but among Ob/Gyns objections and refusals to provide contraceptives are infrequent.

Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician-gynecologists’ views on contraception and natural family planning: a national survey. Am J Obstet Gynecol. 2011;204(2):124e1-124e7.

Factors influencing physicians’ advice about female sterilization in USA: a national survey

RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

Abstract
Background
Tubal ligation can be a controversial method of birth control, depending on the patient’s circumstances and the physician’s beliefs.

Methods
In a national survey of 1800 US obstetrician-gynecologist (Ob/Gyn) physicians, we examined how patients’ and physicians’ characteristics influence Ob/Gyns’ advice about, and provision of, tubal ligation. Physicians were presented with a vignette in which a patient requests tubal ligation. The patient’s age, gravida/parity and her husband’s agreement/disagreement were varied in a factorial experiment. Criterion variables were whether physicians would discourage tubal ligation, and whether physicians would provide the surgery.

Results
The response rate was 66% (1154/1760). Most Ob/Gyns (98%) would help the patient to obtain tubal ligation, although 9–70% would attempt to dissuade her, depending on her characteristics. Forty-five percent of physicians would discourage a G2P1 (gravida/parity) woman, while 29% would discourage a G4P3 woman. Most physicians (59%) would discourage a 26-year-old whose husband disagreed, while 32% would discourage a 26-year-old whose husband agreed. For a 36-year-old patient, 47% would discourage her if her husband disagreed, while only 10% would discourage her if her husband agreed. Physicians’ sex had no significant effect on advice about tubal ligation.

Conclusions
Regarding patients who seek surgical sterilization, physicians’ advice varies based on patient age, parity and spousal agreement but almost all Ob/Gyns are willing to provide or help patients obtain surgical sterilization if asked. An important limitation of the study is that a brief vignette, while useful for statistical analysis, is a rough approximation of an actual clinical encounter.

Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Factors influencing physicians’ advice about female sterilization in USA: a national survey. Hum Reprod. 2011;26(1):106-111.

Obstetrician-gynecologist physicians’ beliefs about emergency contraception: a national survey

Ryan E Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

Abstract
Background: Although emergency contraception (EC) is available without a prescription, women still rely on doctors’ advice about its safety and effectiveness. Yet little is known about doctors’ beliefs and practices in this area.

Study design: We surveyed 1800 US obstetrician-gynecologists. Criterion variables were doctors’ beliefs about EC’s effects on pregnancy rates, and patients’ sexual practices. We also asked which women are offered EC. Predictors were demographic, clinical and religious characteristics.

Results: Response rate was 66% (1154/1760). Most (89%) believe EC access lowers unintended pregnancy rates. Some believe women use other contraceptives less (27%), initiate sex at younger ages (12%) and have more sexual partners (15%). Half of physicians offer EC to all women (51%), while others offer it never (6%) or only after sexual assault (6%). Physicians critical of EC, males and religious physicians were more likely to offer it never or only after sexual assault (odds ratios 2.1-12).

Conclusion: Gender, religion and divergent beliefs about EC’s effects shape physicians’ beliefs and practices.

Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician-gynecologist physicians’ beliefs about emergency contraception: a national survey. Contraception. 2010;82(324-330.