Women's health (London, England)最新文献

Background: Since the Hamas attack on 7 October 2023, Israel has carried out an intensive bombing campaign and implemented a complete siege on Gaza, permitting extremely limited humanitarian aid. This has created a humanitarian catastrophe, yet little evidence exists on how it is experienced by adolescent girls and young women. A critical but overlooked challenge in conflict-affected contexts is the specific health needs of girls and young women, including menstrual hygiene management and sexual and reproductive health. In conflict, women and girls often struggle to access contraceptives, menstrual products, clean water and healthcare services, leading to significant immediate and longer-term risks.

Objectives: This article explored these challenges in Gaza, examining how the intersecting impacts of the humanitarian crisis are affecting adolescent girls' and young women's basic needs and health outcomes.

Design: It draws on a sequential mixed methods cross-sectional research study undertaken between August and December 2024.

Methods: The study combined data from a household survey (n = 1011) of young people aged 10-24, with qualitative data from in-depth interviews (n = 100) and key informant interviews (n = 24).

Results: The findings underscore severe and intersecting financial, physical and social obstacles in fulfilling girls' and young women's basic health needs in the context of the hostilities in Gaza, threatening their physical and mental health. Restricted access to clean water, sanitation, hygiene services and menstrual products heighten health risks, while the collapse of maternal health services threatens mothers and children. These deprivations are exacerbated by poverty from disrupted livelihoods and conservative gender norms that hinder girls' mobility and emphasise modesty, which is difficult to maintain in displacement contexts.

Conclusion: The findings highlight the disproportionate impact of armed conflict on adolescent girls and young women and the urgency of preventative and responsive actions to address their health needs and uphold their rights to health.

Background: Female genital cosmetic procedures (FGCPs) are becoming increasingly common but remain highly stigmatised and contested. This raises the question of how healthcare professionals justify performing FGCPs in such a context.

Objectives: To understand how medical professionals (MPs) justify their involvement in FGCPs within a context of social and professional scrutiny.

Design: Qualitative interview study using discursive thematic analysis.

Methods: We conducted 11 in-depth interviews with plastic surgeons and gynaecologists performing FGCPs in Belgium and the Netherlands.

Results: MPs employ two main discursive framings to justify performing FGCPs. The women's health framing depicts FGCPs as addressing issues that were considered functional and fulfilling "genuine" medical needs, while the women's choice framing emphasises a woman's autonomy to make decisions about her body, even in the absence of functional concerns. Both framings are shaped by and rely on a series of juxtapositions which MP negotiate in their framings: functional versus aesthetic; patient choice versus medical decision-making; and medical versus cultural.

Conclusion: MPs frame FGCPs in terms of women's health and choice, helping to legitimise them as ethical care. These framings, however, obscure key tensions - between function and aesthetics, autonomy and clinical judgement, and medical versus cultural motivations. Examining these discursive dynamics reveals how FGCPs are made acceptable within a contested field.

Background: Endometriosis affects approximately 190 million people globally and 2 million in Canada. Experiences of endometriosis can profoundly impact all aspects of life, including physical, mental, and financial well-being. The Coronavirus Disease 2019 (COVID-19) pandemic impacted endometriosis care, mental health outcomes, and increased overt racism towards Asian people internationally.

Objectives: In this study, we aimed to describe the impacts of the COVID-19 pandemic on the mental health of Asian women living with endometriosis.

Design: Qualitative, photovoice.

Methods: We used photovoice, an arts-based methodology, and thematic analyses of 22 interviews with East, South, and Southeast Asian cisgender women living in Canada regarding their experiences with endometriosis during the COVID-19 pandemic.

Results: Participant photographs and narratives conveyed how the COVID-19 pandemic caused disruptions in their lives, which influenced the ways they navigated, managed, and coped with endometriosis symptoms and, ultimately, their mental health. Some disruptions were exacerbated during the COVID-19 pandemic and impacted mental health, including worsening of and inability to manage symptoms as usual, deepening isolation and disconnection from self and society, and turbulent and transformational experiences in interpersonal relationships. Other disruptions were unrelated to the COVID-19 pandemic, including endometriosis invisibility and invalidation, the burden of necessary overplanning, and the complexities of grappling with uncertain fertility. Participants commonly described experiencing feelings of guilt, uncertainty, lack of control, fear, hopelessness, grief, anxiety, and depression.

Conclusion: The COVID-19 pandemic exacerbated disruptions affecting the mental health of participants, disruptions unrelated to COVID-19 remained in participants' lives. Considering the latter was particularly impactful on the mental health of participants as these disruptions existed prior to - and would continue beyond - the COVID-19 pandemic.

Background: Cervical cancer screening is a powerful tool in the prevention, early detection, and diagnosis of precancers and cancer. There is mounting evidence, however, demonstrating that Queer cisgender women experience disparities in cervical cancer screening access and uptake compared to their heterosexual counterparts. To close gaps in screening, Queer women's voices and visions must foreground recommendations aimed at remedying screening inequities.

Objectives: This study aims to explore perceptions on an ideal cervical cancer screening exam among a racially and ethnically diverse group of Queer women.

Design: This qualitative interview study is led in partnership with a multidisciplinary community steering committee. Our work is grounded in the Reproductive Justice Framework.

Methods: We held in-depth interviews with 19 Queer women to understand their recommendations for improving cervical cancer screening experiences for their community. Data from these interviews were analyzed through thematic analysis.

Results: We identified five themes around creating an ideal cervical cancer screening experience among Queer women: (1) community outreach and education, (2) cues of affirmation and safety, (3) Queer patient navigation and advocacy, (4) Queer-affirming and knowledgeable providers, and (5) trauma-informed care.

Conclusion: Engaging Queer women in developing solutions to address screening disparities is a missing link in cervical cancer prevention and the advancement of reproductive health equity. We share actionable strategies at the healthcare professional, community, and organizational levels to support healthcare systems in translating Queer women's visions into practice. Our findings also inform medical organizations, expert panels, and health authorities on patient-defined strategies and pathways to remedying screening inequity.

Background: Despite growing recognition of menstrual hygiene management (MHM) challenges in high-income countries (HICs), validated measurement tools specific to the context and experiences of these populations are lacking, with most tools being developed in low- and middle-income countries. The lack of validated instruments makes it difficult to examine the extent of menstrual product insecurity, period poverty, and menstrual hygiene in HICs, and limits researchers' ability to evaluate trends over time.

Objective: To summarize menstrual hygiene measurement tools developed and/or used in HICs, as well as the domains covered and psychometric properties of these tools, such as validity and reliability.

Eligibility criteria: Studies conducted in HICs, discuss MHM, and employ a quantitative or mixed-methods design.

Source of evidence: Published studies were sourced from OVID Medline, Scopus, and CINAHL Plus using standardized search strategies.

Charting methods: Data from the included studies were charted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR).

Results: Forty-five studies conducted in HICs between 1996 and 2024 met the inclusion criteria. Most were quantitative (n = 38), and the majority were conducted in the United States (n = 26). Across studies, 741 MHM measurement items were identified with menstrual product insecurity, psychosocial concerns, absenteeism, and menstruation-related consequences, and water, sanitation, and hygiene factors. Twelve studies reported psychometric properties; however, only five instruments were fully validated, and none comprehensively measured "period poverty." Items assessing product insecurity and absenteeism varied widely in wording, response options, and domains covered, limiting comparability across studies.

Conclusion: Despite growing research and policy attention, HICs lack standardized, validated tools to measure menstrual product insecurity, period poverty, and related outcomes. To advance menstrual equity, track progress, and improve menstrual health outcomes, there is an urgent need for reliable and validated measurement tools that support surveillance, policy evaluation, and intervention efforts.

Background: Mammogram and Papanicolaou (Pap) smear tests are essential screening to detect breast and cancer cervical, respectively.

Objective: Identify predisposing, enabling, and need factors associated with mammography and Paptest screenings among older Mexican American women over time.

Design: Longitudinal study of 912 Mexican American women aged ⩾ 67 years.

Methods: Participants were assessed five times (1995/1996-2007/2008). Independent variables were based on the Andersen's Behavioral Model of Health Services, including predisposing factors (e.g., age of menopause), enabling factors (e.g., financial strain), and need factors (e.g., medical conditions). Outcomes included having a mammogram in the past 2 years and a Pap test in the past three. Generalized Estimation Equation models estimated the odds ratio (OR) and 95% confidence interval (CI) for receiving a mammogram, Pap test, or both based on these factors.

Results: Higher education (OR = 1.04, 95% CI = 1.01-1.07), physician visits (OR = 1.85, 95% CI = 1.33-2.56), hypertension (OR = 1.26, 95% CI = 1.04-1.51), arthritis (OR = 1.31, 95% CI = 1.07-1.60), and greater handgrip strength (OR = 1.02, 95% CI = 1.01-1.04) were associated with greater odds of receiving both a mammogram and Pap. Older age and early menopause (OR = 0.96, 95% CI = 0.94-0.98 and OR = 0.71, 95% CI = 0.58-0.89, respectively) were associated with lower odds of receiving both tests. Spanish interview (OR = 0.71, 95% CI = 0.56-0.91) and financial strain (OR = 0.83, 95% CI = 0.70-0.99) were associated with lower odds of receiving a Pap test and mammogram test, respectively over time.

Conclusion: Language barriers and financial constraints reduce cancer screening rates among Mexican American women. Cultural tailored care and improved access, such as bilingual clinics and mobile screening are needed to address these gaps.

Background: Obstetric fistula, a preventable consequence of prolonged obstructed labor, inflicts profound physical, psychological, and social suffering, leaving many women described as "living dead." In Ethiopia, where the burden remains high, little is known about women lived experiences and coping strategies beyond clinical outcomes. This review was conducted to synthesize qualitative evidence, illuminate these challenges, and inform holistic interventions.

Objectives: To synthesize available evidence on the lived experiences and coping mechanisms of women with obstetric fistula in Ethiopia.

Design: This study employed a qualitative meta-synthesis approach.

Data sources and methods: This review was conducted in accordance with the Joanna Briggs Institute systematic review and meta-synthesis methodological guidance and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. ATLAS.ti software, Version 25, Lumivero was used for analysis. A comprehensive literature search was performed across multiple databases up to May 25, 2025, including both published and unpublished studies examining the lived experiences of women with obstetric fistula. All eligible studies were critically appraised using the Critical Appraisal Skills Program to ensure methodological rigor. Data were systematically extracted and analyzed using thematic synthesis, and the results are presented through tables, narrative summaries, and illustrative diagrams, providing a coherent and evidence-based synthesis of women's experiences and coping mechanisms.

Results: Eight studies met the inclusion criteria, encompassing the diverse experiences of women with obstetric fistula in Ethiopia. Four major themes were developed: physical challenges such as pain, foot drop, odor, and urinary incontinence; psychological challenges including hopelessness, grief, and suicidal ideation; socioeconomic challenges like stigma, isolation, divorce, loneliness, social disintegration, and economic difficulties; and coping mechanisms such as self-isolation and wearing multiple layers of clothing.

Conclusion: Women with obstetric fistula face intersecting physical, psychological, and socioeconomic burdens that erode dignity and social participation. Coping strategies such as self-isolation and layering clothes, while adaptive, often reinforce stigma and exclusion. These findings highlight the need for comprehensive interventions that go beyond surgical repair to include psychosocial support, stigma reduction, and economic reintegration programs.

Registration: Registered with PROSPERO 2025 CRD420251064015.

Background: Violence against women is a serious human rights violation and a public health problem. In Peru, more than 55% of women have suffered intimate partner violence (IPV), which has a negative impact on their health and breastfeeding.

Objective: To evaluate the association of IPV and early initiation of breastfeeding (EIBF) in Peruvian women.

Design: Cross-sectional study.

Methods: A secondary analysis was conducted using data from the Demographic and Family Health Survey (ENDES) of the period 2018-2022. The population included women of reproductive age (15-49 years). The outcome variable was the EIBF, and the main predictor variable was IPV. Crude prevalence ratios and adjusted prevalence ratios were estimated as a measure of association.

Results: We analyzed a final sample of 30,482 women. The prevalence of IPV was 16.25%, while the prevalence of mothers who did not initiate early breastfeeding was 33.37%. It was found that partner violence was associated with a lower likelihood of complying with EIBF.

Conclusion: We identified that women who experienced IPV were less likely to initiate early breastfeeding.

Background: Uninsured, low-income Spanish-speaking women face systemic barriers to accessing gynecologic care, especially within Fort Worth, Texas. Because of this health disparity, we elected to evaluate screening outcomes of patients receiving care at La Clínica de las Mujeres (LCDM), a student-run clinic (SRC) providing free, culturally competent care to this population in Fort Worth, Texas.

Objectives: To assess the structure and utilization of an SRC on cancer screening adherence among uninsured, Spanish-speaking women in Fort Worth, Texas.

Design: Retrospective descriptive pre-post study.

Methods: Chart review of patients seen at LCDM from August 2022 to September 2024 was conducted. Data included 147 clinical encounters with 114 individual patients, assessing demographics, screening history, services, and referrals. McNemar's test assessed changes in screening adherence.

Results: Patients (mean age: 47.5 years; 95.6% Hispanic) primarily resided in underserved zip codes (77.2% in 76110). Pre-intervention, 46% adhered to Pap smear guidelines and 64% to mammography guidelines. Post-intervention adherence approaches complete compliance among those with available post-intervention data (Pap χ²[1] = 66.0, p < 0.0001; Mammogram χ²[1] = 27.0, p < 0.0001). Services included pelvic ultrasounds (n = 20), specialist referrals (n = 11), and contraceptive access (n = 12).

Conclusions: LCDM was associated with significant improvements in gynecologic preventive care adherence for uninsured Spanish-speaking populations in Fort Worth, Texas. Student-run models may help address critical gaps in accessibility to women's health services and mitigate systemic barriers to care for underserved populations.

Background: Meningiomas, benign central nervous system tumors, express progesterone and estrogen receptors. Their proliferation has been associated with hormonal and demographic factors, including female sex, obesity, and race. Prior studies on oral contraceptive pill (OCP) use and meningioma risk have been limited in their analysis of the modifying effects of race, obesity, and polycystic ovary syndrome (PCOS).

Objectives: To assess the association between combined OCP use and meningioma development, and to assess how race, obesity, and PCOS influence this relationship.

Design: Retrospective cohort study using aggregated electronic health record data in Epic Cosmos.

Methods: Women aged 13-50 from 2005 to 2023 with and without combined OCP use were identified. Patients with history of radiation, neurofibromatosis 2, progestin-only contraceptive use, and hormone replacement therapy were excluded. The cohort was then stratified by PCOS status, obesity, and race.

Results: Combined OCP users saw a 40% lower risk of meningioma compared to non-users. PCOS was associated with a bidirectional effect on meningioma risk, modified by obesity. Among patients with obesity, those with PCOS had a 30% lower risk of developing meningioma compared to those without PCOS. Among non-obese patients, those with PCOS had a 108% greater risk of developing meningioma compared to those without PCOS. After adjusting for both PCOS and obesity, women with a history of combined OCP usage had 42% reduced odds of developing meningioma. When stratified by race, combined OCP use was associated with 47% decreased risk in White patients, 34% lower risk in Black patients, and 28% lower risk in Asian patients. Controlling for race overall, combined OCP use remained significantly protective, with 43% reduced odds of meningioma development.

Conclusion: Findings suggest a potential protective association between combined OCP use and meningioma that remained significant after controlling for obesity, PCOS status, and race. Additionally, this study found that meningioma risk in patients with PCOS differed based on obesity status.