Women's health (London, England)最新文献

Background: Adolescents worldwide engage in sexual activity, with the proportion rising gradually from the middle to late stages of adolescence. The incidence of early sexual initiation among female youth in sub-Saharan Africa is reported to be 46%. The increasing number of teenage pregnancies in Rwanda indicates that adolescents do not correctly use sexual and reproductive health services. In 2019, the Eastern Province of Rwanda documented 36% of all teenage pregnancies. Despite the availability of these services to youth through adolescent sexual and reproductive health (ASRH) focal persons, nurses, or midwives leading youth corners at the Health Center level, why they are not used remains unknown.

Objectives: To explore teenage mothers' perspectives, knowledge, and attitudes toward pregnancy and the utilization of sexual and reproductive health services in the Eastern Province of Rwanda.

Design: Qualitative descriptive study.

Methods: A qualitative descriptive design combined with the theory of reasoned action was used to capture teenagers' unique perspectives on knowledge about teenage pregnancy and attitudes toward ASRH service utilization. An in-depth interview was used to collect data from 25 informants across 3 districts in the Eastern Province of Rwanda, followed by traditional content analysis.

Results: Three major themes emerged, including lack of knowledge about teenage pregnancy, unfavorable attitudes toward ASRH service utilization, and the perceived negative impact of teenage pregnancy, including disrupting education, limiting career opportunities, and posing health risks to both mothers and infants.

Conclusion: While all young mothers were under pressure from the multitude of impacts of teenage pregnancy, parenthood, and social responsibilities, they had limited knowledge and selective utilization of ASRH services, mimicking potential gaps in education and mobilization of youth on available ASRH services with special emphasis on preventive components. Exploring the perceived enablers and challenges facing ASRH service utilization among the study population is necessary.

Background: Schoolgirls in resource-limited settings encounter significant challenges in maintaining proper menstrual hygiene management practices. Studies on associated factors in menstrual hygiene management practices among schoolgirls in Bahir Dar City are limited.

Objectives: The study aimed to evaluate the menstrual hygiene practices of schoolgirls and identify factors that influence these practices in the limited settings of Bahir Dar City.

Design: This study was a school-based, analytical, cross-sectional study conducted among schoolgirls between the ages of 11 and 25.

Methods: A total of 701 schoolgirls, selected at random based on their consent, participated in this school-based, analytical, cross-sectional study. The data collection process was comprehensive, involving a self-administered questionnaire and 5 rounds of observations at 10 schools using the Joint Monitoring Program for Water, Sanitation, and Hygiene monitoring tool. The study used a binary logistics regression model to determine the strength of the association between predictor and outcome variables, ensuring a rigorous analysis with a p-value < 0.05.

Results: In this study, 375 (53.50%) participants were found to have good menstrual hygiene practices. Factors such as the mothers' education (diploma and above vs not read and write (AOR = 26.29, 95% CI: 11.69-59.12), fathers' education (diploma and above vs not read and write (AOR = 19.21, 95% CI: 8.51-43.32), having access to basic water service (AOR = 14.62, 95% CI: 5.12-41.73), having access to basic sanitation services (AOR = 21.02, 95% CI: 7.87-56.15), being older among the schoolgirls (AOR = 19.69, 95% CI: 10.18-38.07), having private work (AOR = 15.58, 95% CI: 6.99-34.73), having open discussions with sisters (AOR = 27.01, 95% CI: 11.45-63.73), having friendly discussions about menstrual hygiene with schoolgirl friends (AOR = 18.67, 95% CI: 8.45-41.24), and residing in urban areas (AOR = 6.43, 95% CI: 3.52-11.73)) were significantly associated with good menstrual hygiene practices.

Conclusion: The schoolgirls in the study area had good menstrual hygiene practices. However, uneducated parents, inadequate facilities, limited access to absorbent materials, and lack of support were challenges that affected proper menstrual hygiene management practice. To improve menstrual hygiene practices, it is crucial to address these identified modifiable factors and consider education programs, better facilities, community support, and policy changes that prioritize menstrual hygiene management in schools for schoolgirls to manage menstruation.

Background: Estrogen deficiency during menopause, aging, reproductive history, and factors increasing intra-abdominal pressure may lead to structural and functional failure in the pelvic floor. Lifestyle choices, such as eating behavior, may contribute to pelvic floor disorders.

Objectives: The objective of the study was to investigate associations of eating behavior with symptoms of pelvic floor disorders, that is, stress urinary incontinence, urgency urinary incontinence, fecal incontinence, and constipation or defecation difficulties among middle-aged women.

Design: A cross-sectional, observational study was performed using a population sample of 1098 Finnish women aged 47-55 years.

Methods: Eating behavior, food consumption frequency, demographical, gynecological, and physical activity variables were assessed using self-report questionnaires. Logistic regression models were used to assess the associations of eating behavior, food frequency, and symptoms of pelvic floor disorders. Models were adjusted with demographical, gynecological, and physical activity variables.

Results: In adjusted models, middle-aged women with disordered eating style were more likely to experience the symptoms of stress urinary incontinence (odds ratio (OR) 1.5, p = 0.002), and constipation or defecation difficulties (OR 1.4, p = 0.041). Adding body mass index into the models abolished associations. Of the studied food items, more frequent consumption of ready-made, highly processed foods (OR 1.5, p = 0.001), and fast foods (OR 1.5, p = 0.005) were independently associated with symptoms of stress urinary incontinence regardless of eating style, whereas consuming ready-made foods (OR 1.4, p = 0.048) was associated with symptoms of urgency urinary incontinence. Daily consumption of fruits (OR 0.8, p = 0.034) was independently associated with symptoms of stress urinary incontinence. Furthermore, we observed that daily consumption of porridge was associated with symptoms of constipation or defecation difficulties (OR 1.7, p = 0.010) independently of eating style. Alcohol consumption (OR 0.9, p = 0.015) was inversely associated with constipation and defecation difficulties. Women with overall higher quality diet had lower odds for stress urinary incontinence (OR 0.9, p = 0.002).

Conclusion: This study provides proof-of-concept evidence to the hypothesis that eating behavior and consuming certain food items are associated with perceived pelvic floor disorders. As a preventive action, eating behavior of women with the risk of these symptoms should be assessed, and guidance toward healthy eating patterns should be provided.

Background: Women may receive suboptimal pain management compared with men, and this disparity might be related to gender stereotypes.

Objectives: To assess the influence of patient gender on the management of acute low back pain.

Design: We assessed pain management by 231 physicians using an online clinical vignette describing a consultation for acute low back pain in a female or male patient. The vignette was followed by a questionnaire that assessed physicians' management decisions and their gender stereotypes.

Methods: We created an online clinical vignette presenting a patient with acute low back pain and assessed the influence of a patient's gender on pain management. We investigated gender-related stereotyping regarding pain care by emergency physicians using the Gender Role Expectation of Pain questionnaire.

Results: Both male and female physicians tended to consider that a typical man was more sensitive to pain, had less pain endurance, and was more willing to report pain than a typical woman. These stereotypes did not translate into significant differences in pain management between men and women. However, women tended to be referred less often for imaging examinations than men and were also prescribed lower doses of ibuprofen and opioids. The physician's gender had a modest influence on management decisions, female physicians being more likely to prescribe ancillary examinations.

Conclusion: We observed gender stereotypes among physicians. Our findings support the hypothesis that social characteristics attributed to men and women influence pain management. Prospective clinical studies are needed to provide a deeper understanding of gender stereotypes and their impact on clinical management.

Background: Musculoskeletal changes occur during pregnancy; one-half of pregnant women experienced low back pain and/or pelvic pain during pregnancy. Prescription opioid use for Medicaid enrolled pregnant women has increased dramatically due to severe low back pain/pelvic pain.

Objectives: This study aimed to explore the prevalence of low back pain/pelvic pain and related risk factors among a broader population.

Design: This is a retrospective cohort study.

Methods: This study utilized de-identified Medicaid claims data provided by the South Carolina Revenue and Fiscal Affairs Office, including individuals who gave birth between 2016 and 2021 during pregnancy. Low back pain/pelvic pain and a group of musculoskeletal risk factors were identified with International Classification of Diseases v10. Comparisons were made for the prevalence of low back pain and pelvic pain between those with pregnancy-related musculoskeletal risk and those without.

Results: Among 167,396 pregnancies, 65.6% were affected by musculoskeletal risk factors. The overall prevalence of low back pain was 15.6%, and of pregnancy-related pelvic pain was 25.2%. The overall prevalence for either low back pain or pelvic pain was 33.3% (increased from 29.5% in 2016 to 35.3% in 2021), with 24.6% being pregnancy-induced. Pregnancies with musculoskeletal risk factors were more likely to be diagnosed with low back pain (20.7% versus 5.7%, p < 0.001) or pelvic pain (35.3% versus 6.0%, p < 0.001) than those without.

Conclusion: This study found a very high prevalence of musculoskeletal risk and a high prevalence of low back pain or pelvic pain, with an increasing trend, among South Carolina pregnancies enrolled in Medicaid during the period 2016-2021. Most of the diagnosed low back pain or pelvic pain were pregnancy induced. Musculoskeletal risk factors were associated with low back pain or pelvic pain.

Dysorgasmia in women is an infrequent reason for consulting a clinician. In this article, the authors describe the case of a woman with right-sided pelvic pain immediately after orgasm. Dysorgasmia is likely to negatively impact sexual health but is rarely discussed in medical literature. Furthermore, assessment and treatment guidelines for clinicians are currently lacking. Therefore, the authors conducted a literature review and created a preliminary assessment guide, considering both medical and gray literature. A brief flowchart was developed which can facilitate the assessment of dysorgasmia in women for clinicians and improve the quality of care for patients. Further research on the etiology and pathophysiology of dysorgasmia in women is warranted, as is a more proactive attitude of clinicians to discuss sexual health. More guidance on diagnosis and treatment is needed.

Transgender and gender-diverse (TGD) persons represent a small but growing population in the United States. Accessing inclusive, equitable, and evidence-based healthcare remains a challenge for this patient population. Many TGD persons seek gender-affirming care, including gender-affirming hormonal therapy (GAHT) and gender-affirming surgery (GAS), to help ameliorate the physical and mental aspects of their gender incongruence. Both GAHT and GAS induce clinically important histopathologic and anatomic changes in breast tissue. Consequently, breast care in TGD persons has become an increasingly recognized topic of importance in gender-affirming care. However, there remains a scarce but growing base of literature specifically addressing the unique healthcare needs of breast care in TGD patients. This article will review how to establish trusting patient-provider relationships for TGD patients, gender inclusivity in breast clinics and imaging centers, the influence of GAHT and GAS on breast tissue, breast cancer screening recommendations and barriers, and breast cancer risk and treatment considerations in TGD persons.

Background: We created a survey to assess menstrual side effects after COVID-19 vaccination when we noticed news stories that denied or discounted the experiences of tens of thousands of menstruating and formerly menstruating people who reported experiencing bleeding changes. This survey had an unprecedented response hundreds of times higher than we had anticipated (n = 101,824).

Objectives: We investigated what motivated our sample to participate without remuneration to understand both general motivations for survey participation as well as why this survey captured the interest of so many.

Design: We used open-ended responses from our online, mixed-method survey collected from April to October 2021.

Methods: Using computer-assisted qualitative data analysis tools in R, we conducted a thematic analysis on open-ended responses. We used topic modeling to cluster the data, synthesize responses across 22,737 participants, and inform the themes summarizing the responses to "What is your interest in this project?" We compared and contrasted responses across groups (racial identity, ethnicity, gender) to examine whether the themes were representative across the demographic groups in our study.

Results: The themes that characterized participants' interest in participating were vaccine effects and women's/people's health, personal experience related to the vaccine, and a love for science and data. We compared responses among demographic subgroups to avoid an overfocus on majority group responses and found the themes were reflected across each group. Lastly, we found our themes reflected multiple types of altruism.

Conclusion: These results were important in showing how emergent research that focuses on the concerns of potential participants can encourage high response rates from both marginalized and majority communities. Inclusive practices and familiarity with the research team built credibility that engendered trust with the public.

Background: After menopause, reductions in ovarian hormones increase the risk of cardiovascular disease. Aerobic exercise training has been shown to reduce cardiovascular risk in older adults, but its effectiveness in postmenopausal females is less definitive.

Objectives: The objectives of this study were to examine the: (1) effects of aerobic training, and (2) association between aerobic training intensity and cardiometabolic health outcomes in postmenopausal females.

Design: Systematic review and meta-analysis of randomized controlled trials.

Data sources and methods: Six electronic databases were searched from inception to July 21, 2023 for aerobic training interventions reporting cardiometabolic outcomes in postmenopausal females. Data were synthesized qualitatively and random-effects meta-analyses and subgroup analyses (light, moderate, and vigorous intensity) were performed. Grading of Recommendations, Assessment, Development and Evaluation was used to assess the certainty of evidence.

Results: Fifty-nine studies (n = 4,225; 45-78 years old) were identified, 53 (n = 3,821) were included in the quantitative analyses. Aerobic training interventions varied in frequency (3-21×/week), intensity, type, time (8-60 min/session), and duration (3-52 weeks). Aerobic training improved systolic blood pressure (mean difference (MD) = -4.41 mmHg, 95% confidence interval (95%CI) [-7.29, -1.52], p = 0.01), resting heart rate (MD = -3.08 bpm, 95%CI [-5.11, -1.05], p < 0.01), body mass index (BMI, MD = -0.65 kg/m², 95%CI [-0.99, -0.31], p < 0.01), waist circumference (MD = -2.03 cm, 95%CI [-2.65, -1.41], p < 0.01), body fat (MD = -2.57 kg, 95%CI [-3.65, -1.49], p < 0.01), low-density lipoprotein cholesterol (MD = -10.46 mg/dL, 95%CI [-16.31, -4.61], p < 0.01), high-density lipoprotein cholesterol (MD = 3.28 mg/dL, 95%CI [0.20, 6.36], p = 0.04) and cardiorespiratory fitness (standardized MD = 1.38, 95%CI [1.13, 1.64], p < 0.01). There was a very low certainty of evidence for all outcomes. In subgroup analyses, light- and vigorous intensities were beneficial for BMI with no effect for moderate-intensity exercise (p < 0.01). Light intensity showed a beneficial effect (p = 0.02) for glucose levels (p < 0.01) and triglycerides; there was no effect with moderate or vigorous intensities.

Conclusion: Aerobic training may improve cardiometabolic health outcomes in postmenopausal females. There may be differential effects of exercise intensity on BMI, blood triglycerides, and blood glucose; however, this warrants further investigation.

Registration: PROSPERO-CRD42022313350.

Background: Pubic hair removal (PHR) is common among women in the United States, and understanding current practices is important for public health efforts. The most recent national study focusing on U.S. women's PHR habits and their correlates was conducted over a decade ago.

Objectives: The current study aims to provide an updated understanding of PHR practices among U.S. women, examining prevalence, methods, frequency, and motivations. We also examine characteristics of women who choose to remove their pubic hair.

Design: A cross-sectional, nationally representative survey administered in Spring 2023 via Ipsos KnowledgePanel.

Methods: Women (N = 522, ages 18-85 years) responded to items inquiring about their demographic characteristics, sexual behaviors, and social media use, as well as methods, prevalence, and motivations associated with PHR. We examine various demographic and behavioral correlates of lifetime and recent PHR among women.

Results: Findings reveal that the majority of U.S. women have removed their pubic hair at some point in their lifetime, and almost half have done so within the past month. Frequency and preferred styles of PHR varied among women, indicating a wide range of individual preferences. Among top motivating factors for PHR were perceived cleanliness, comfort, and wanting to look good in a bikini. Race, age, and history of sexual activity were all statistically significant predictors of lifetime and recent PHR.

Conclusions: Findings from the current study may assist skincare professionals in better addressing patient/client PHR needs and concerns while promoting health. Studies should continue examining trends in PHR over time, its relation to societal perceptions of beauty, and its implications for health and well-being.