TOA is a severe and progressive complication of pelvic inflammatory disease (PID) resulting in an inflammatory mass that can involve and damage the fallopian tubes, ovaries, and other surrounding structures [4]. TOA complicates roughly one third of hospitalized PID cases with an estimated annual incidence of 100,000 cases of PID in the USA [5, 6]. TOAs are typically polymicrobial in nature, including aerobic, anaerobic, and facultative organisms [4]. Historically, the treatment was surgical, with the majority of women having a total abdominal hysterectomy and bilateral salpingo-oophorectomy [4]. However, advancements in radiologic techniques have led to increased use of percutaneous drainage procedures prior to proceeding with major surgery. The majority of TOAs (70 %) can now be successfully managed conservatively with broad-spectrum antibiotics and percutaneous or laparoscopic drainage of abscesses when necessary [7]. Major surgery, including bilateral oophorectomy, is currently reserved for life-threatening situations where conservative medical and surgical measures have failed or tubo-ovarian abscesses have ruptured [4, 8].

In 2012, 20,785 women in the USA were diagnosed with ovarian cancer, and 14,404 died from ovarian cancer [9]. The lifetime risk of ovarian cancer in the general population is 1 in 75 (1.3 %) [9]. There is currently no good screening test for early disease. Five to ten percent of ovarian cancer cases are related to inherited genetic risk. These include women with inherited mutations in the BRCA1 and/or BRCA2 genes and those with hereditary nonpolyposis colorectal cancer (HNPCC). The lifetime risk of developing ovarian cancer in women with BRCA1 and BRCA2 mutations is 54 % and 23 %, respectively [10], and 12 % with HNPCC [11]. Current recommendations by ACOG include prophylactic bilateral salpingo-oophorectomy in BRCA1, BRCA2, and HNPCC mutation carriers after completion of childbearing and preferably before age 40 [12]. Also, women with HNPCC will often have a hysterectomy at the time of their BSO because of their 60 % lifetime risk of developing endometrial cancer [12].

Endometriosis is a chronic gynecological disease characterized by the proliferation of endometrial glands and stroma outside of the uterine cavity [13, 14]. It is limited to the reproductive years and is estimated to afflict approximately 10 % of reproductive age women [15]. Definitive diagnosis requires histopathological examination of a surgical specimen. However, the diagnosis may be suspected based on clinical signs and symptoms such as severe pelvic pain, dysmenorrhea, deep dyspareunia, and cul-de-sac nodularity and/or tenderness on bimanual pelvic exam. The diagnosis may also be presumed when characteristic features of ovarian endometrioma are seen on imaging. Endometriosis-associated pain may be treated with nonsteroidal anti-inflammatory agents, combined oral contraceptive pills, progestins, danazol, and gonadotropin-releasing hormone agonists [16]. In women whose pain is recalcitrant or whose disease burden is heavy, i.e., large endometriomas or deeply infiltrating endometriosis implants, surgery may become necessary via laparoscopy or laparotomy depending on pelvic anatomy. For women who desire retention of childbearing capacity, a conservative surgical approach is often adopted with the aim of reducing disease burden and preserving as much ovarian tissue as possible for future natural or assisted reproduction. Women undergoing surgical resection of endometriomas should be counseled about the possibility of diminished ovarian reserve and of recurrent disease postoperatively [17]. For severely symptomatic women who have no desire for further childbearing and whose pain cannot be controlled with medical therapy, definitive surgical management with BSO often becomes indicated and is commonly performed with a hysterectomy. Even after definitive hysterectomy with BSO, about 15 % of women with endometriosis-associated pain may continue to experience some pain, the etiology of which is unclear [18]. It should be pointed out, however, that those in whom ovarian tissue is intentionally or unintentionally retained at hysterectomy have a sixfold higher risk of recurrent or persistent pain, emphasizing the importance of ovarian estrogen in the maintenance and propagation of endometriosis [19].

While premenopausal BSO may be indicated as a risk-reducing strategy in those with heritable cancer-predisposing genes or as part of the treatment plan for a benign (TOA or endometriosis) or malignant condition (endometrial cancer), elective BSO continues to be performed at hysterectomy in premenopausal women with unrelated gynecological disease. Data from 1994 to 1999 from the Centers of Disease Control and Prevention indicates that approximately 40 % of women ages 18–44 and 75 % of women ages 45–54 will have a concurrent oophorectomy at the time of hysterectomy [20]. Thus, conservative estimates suggest that approximately 300,000 women will have a prophylactic bilateral oophorectomy annually [21]. In a recent cross-sectional study spanning 1998–2006, the proportion of hysterectomies accompanied by an elective bilateral salpingo-oophorectomy increased from 38 % in 1998 to 41 % in 2001 and then decreased to 40 % in 2002 and 36 % in 2006. The highest rate of elective bilateral salpingo-oophorectomy was among women age 45–49 (26.5 per 10,000), of which a large proportion was likely premenopausal [22]. One should note here that the practice of elective BSO at hysterectomy in premenopausal women continues despite the recommendation by the American College of Obstetrics and Gynecology (ACOG) to retain normal-appearing ovaries when hysterectomy is being performed in premenopausal women who are considered to be at average risk of ovarian cancer [12].