Genital Health Research Articles

Exploring Stigma Communication About Urinary Tract Infections in the United States

ABSTRACT Urinary tract infections (UTIs) have steadily increased in prevalence and severity among women in the United States and can lead to serious complications if left untreated. Yet, women are often reluctant to discuss such infections due to potential stigmatization. Indeed, UTI treatment and prevention often involves communication with intimate partners and physicians, and this communication can require stigma management. Further, stigma communication can influence women’s experiences with UTI symptoms and treatment. The theory of stigma management communication is well-suited to explore how stigma-related communication unfolds about the experience, diagnosis, and treatment of UTIs. The current study uses in-depth interviews conducted in 2022 to learn about experiences with stigma communication surrounding UTIs. Findings reveal that participants perceived UTIs as stigmatized due to associations between UTIs and female gender, sexual behavior, genital health, and hygiene. Participants described using stigma management strategies to accept, ignore, avoid, reduce responsibility for, and challenge stigmas related to UTIs. This analysis has implications for theorizing choice in stigma management research and for provider-patient interactions surrounding UTIs.

Should I stay for local hormone therapy or should I go for radiofrequency to treat vulvovaginal atrophy? A patient preference trial.

To compare patient satisfaction rate in postmenopausal women who chose dynamic quadripolar radiofrequency or topical estrogens as their preferred treatment for genitourinary syndrome of menopause. Patients were divided into two groups according to their preference: one was treated with estrogen therapy (ET) and the other with dynamic quadripolar radiofrequency treatment (RF). All patients included fulfilled a series of validated questionnaires, at baseline and at the 6-mo follow-up, in order to evaluate the discomfort degree associated with the presence of vulvovaginal atrophy and the impact of the reported symptoms on QoL and sexuality. After propensity score matching, the proportion of women considering themselves satisfied with their genital health conditions was extremely small at study entry (5.2% of the RF group and 6.9% of the ET group), while at a 6-mo follow-up, it increased to 46.7% and 46.6%, respectively. No statistically significant between-group differences were found regarding mean numerical rating scale scores for dryness and dyspareunia at follow-up (5.6 ± 2.6 vs 5.3 ± 2.3, P = 0.5; and 2.9 ± 2.5 vs 3.0 ± 2.7, P = 0.46). At 6-mo follow-up, we observed no statistically significant differences between the two groups regarding the other items evaluated. RF treatment was overall well tolerated. The use of quadripolar radiofrequency devices seems effective, but it is not associated with better clinical outcomes compared with topical hormone treatment, which is a substantially cheaper and more convenient treatment for genitourinary syndrome of menopause. Therefore, we suggest limiting the use of dynamic quadripolar radiofrequency selectively when topical estrogens are not effective, not tolerated, or contraindicated.

Exploring the Experiences of Muslim Early Childhood Educators in Teaching Sexuality Education

Early childhood sexuality education is essential for safeguarding young children against inappropriate sexual content and potential abuse. This study underscores the importance of such education within the context of Muslim teachers. The primary objective of this research is to gain insights into the practical implementation of sexuality education during early childhood. The study encompasses the participation of 248 Muslim early childhood teachers. By collecting open-ended inquiries, analyzing responses verbatim, and categorizing the results, the research illuminates the multifaceted responsibilities of these teachers. Their roles include providing guidance on toileting, mitigating self-touch behaviors, addressing sexual curiosity, promoting genital health and hygiene, preventing sexual harassment, and recognizing the spectrum of gender roles. The findings highlight the urgency of developing a well-structured curriculum, fostering collaboration between parents and teachers, providing specialized teacher training, promoting a positive public perception of sexuality education, and ensuring substantial government involvement in early childhood sexual education.

(088) CONTRALATERAL SYMMETRY IN THE TOPOGRAPHY OF SELF-REPORTED VULVAR PAIN

Abstract Introduction Vulvar pain is a transdiagnostic symptom that is associated with diverse end organs, neurological, and musculoskeletal mechanisms. A better understanding of the neural mechanisms behind the spreading/worsening of vulvar pain across different sites on the vulva, could guide future research, classification, and treatment of vulvar pain-related conditions. Objective Examine the topographic correlations of vulvar pain and provide insights regarding the involvement of neural pathways underlying the topographic distribution of such pain. Methods Self-reports of sexual and genital health were collected from 2199 women through online questionnaires, as part of a larger study. Efforts were made to recruit a heterogenous sample, oversampling for women with genito-pelvic pain. Participants were asked about the presence and location of vulvar and/or vaginal pain. In addition, participants were asked about history and types of non-genital injuries. If a participant reported chronic vulvar pain, they were then presented with a drawing of a vulva divided into 24 areas, asking them to indicate the location(s) of their pain (localization of vaginal pain not included). Correlations were conducted on the presence of pain across vulvar areas that were contralaterally distributed (horizontal) vs spatially close but ipsilaterally distributed (vertical and radial), and distinguishing between women with vs without a history of back and/or pelvic injury. Results 911 women reported experiencing chronic vulvar or vulvar-vaginal pain. Results from correlations across vulvar areas are reported in Figure 1, 2 and 3, distinguishing between women with and without a history of back/pelvic injury. In both groups, horizontal correlations across left and right sides of the same tissue/structure were the strongest (Figure 1), whereas areas that were spatially close on the ipsilateral side (vertical and radial) showed weaker correlations (Figures 2 & 3). Statistical tests confirmed differences in correlations both between-groups and within-groups, across different spatial relations (horizontal, vertical, radial). Conclusions The observed pattern of topographic correlations suggests specific constraints on the mechanisms involved in the spreading of vulvar pain, showing a horizontally symmetrical distribution of correlations (within tissue/structure), as opposed to a proximity-based distribution of correlations. This appears to reflect symmetrically contralateral sensitization within the same structure, even if the areas were relatively distant (e.g., right and left labia minora). According to our results, this applies more to women without a history of back/pelvic injury, compared to women with a history back/pelvic injury. Consistent with past research showing that a temporary nociceptive stimulus induces hyperalgesia and allodynia in the ipsilateral and symmetrically contralateral site of noxious stimulation (Shenker et al.,2008), our results suggest that similar neural mechanism(s) might be involved in chronic vulvar pain. The pattern of correlations found could be mediated by chronic pain-induced activation of the commissural fibers that connect, and perhaps sprout into, the symmetrically contralateral sides at the level of the dorsal horn. This would constitute a form of central sensitization (Latremoliere & Woolf, 2007). Whether a comparable central sensitization process also occurs at the level of the sensory cortex (or other brain regions), or whether different forms of synaptic potentiation at the neural level are involved, must also be considered. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Adamo Bioscience.

(100) MASTURBATION: AN UNDERUTILIZED TREATMENT?

Abstract Introduction Certain types of masturbation have been shown to affect genital and genitourinary health. However, the full range of health benefits associated with masturbation and its various forms remains inadequately studied. Objective This study aimed to investigate the literature addressing utilization of masturbation for various health conditions among females. Methods We conducted a systematic literature review of PubMed, Embase, and Medline from January 1980 to November 2023, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search incorporated keywords such as “masturbation,” “sexual pleasure,” “benefits of masturbation,” “sexual self-stimulation,” “solo sex,” “onanism,” and “self-pleasure.” Inclusion criteria for the analysis were clinical trials, cohort studies, and reviews with cisgender women over 18 years old as participants, and masturbation utilized as an intervention. Exclusion criteria were case reports, surveys, studies involving men, or those with a history of gender dysphoria. Results A total of 176 studies were initially identified. Only five studies met all inclusion and exclusion criteria. Among these, four were clinical trials, and one was a systematic review. All but one study investigated the role of masturbation in the ability to orgasm with or without a partner. Orgasmic function was noted to be improved among participants in these four studies. One study investigated the endocrine changes associated with orgasm and found a significant elevation in post-orgasmic prolactin, similar to men. Participants in all the studies were cisgender women aged 18 to 55, predominantly heterosexual. The intervention duration ranged from 10 minutes per session to multiple sessions over the course of five weeks, with only one study specifying the mode of masturbation (vibrators). Four of the studies used erotica and pornography as augmentation to masturbation, and a partner was involved in the intervention in two of the studies. Only one study employed formal quantitative methods for outcome assessment. Conclusions Masturbation has primarily been investigated as an intervention for orgasmic dysfunction. There is a significant need for studies examining different types of masturbation and their effects on general and genitourinary health. Disclosure No.

Educating a diverse group of women in Los Angeles County on ovarian and uterine cancers and clinical trials.

e23105 Background: Ovarian and uterine cancers are among the deadliest cancers for women and due to vague symptoms, diagnosis is often delayed. In addition, there are ethnic disparities in time to diagnosis, treatment, and outcome for these cancers. The purpose of this study was to assess a diverse group of Los Angeles (LA) County women’s understanding of both ovarian and uterine cancers and assess the impact of intervention by community health organizations. Methods: A Qualtrics survey was administered online and in-person to 185 women aged 18 and older in LA County between May 3rd and July 15th 2023. The survey aimed to investigate participants’ knowledge, awareness, and attitudes on women’s cancers’ risk factors, symptoms, screening, treatment options, and clinical trials. Information on participant demographics was also collected. Chi-square analysis, descriptive statistics, filtering and sub-setting, correlation analysis were utilized using R-Studio. MiOra Health Educators provided face-to-face education on ovarian and uterine cancers as well as clinical trials to this sample of participants. Results: Out of 185 respondents, 117 (63.2%) were Hispanic or Latina and 65 (35.1%) reported completing 4 year of college education. 137 (74.0%) reported attending their annual women’s wellness visit. Women with insurance (143, 77.0%) were more likely to report having women’s cancer screening compared to those who were uninsured (71, 38.0%). 93 women (50.3%) reported going to their primary physicians for advice on sexual and/or genital organ health rather than visiting a gynecologist; however older women (aged 41-50) reported seeing their gynecologist more often than the women in younger groups. Moreover, 127 women (68.6%) were aware of clinical trials (the majority being college-educated) however, a majority of the total participants (154, 83.2%) did not know where to locate clinical trials or that one may leave a clinical trial at any time (123, 66.5 %). Prior to educational intervention, only 104 women (56.2%) reported being “somewhat knowledgeable” about women’s cancers’ risk factors and symptoms. Following educational intervention, 143 (77.7%) reported feeling more knowledgeable about women’s cancers’ risk factors and symptoms and 122 (66.6%) reported feeling more knowledgeable about clinical trials and comfortable participating in one. Conclusions: In this pilot study we found that a majority of diverse LA County women attend their annual wellness visits; however, only a small portion receive women’s cancer screening. Lack of insurance appears to be a significant barrier for access to screening tests. In addition to awareness of clinical trials, the ability to locate a clinical trial appears to influence participation in one. Although primary care providers and obstetricians are the most trusted health resources, community health educators may be effective in educating women to close these gaps.

(003) Taking a Step Back for a (Future) Step Forward: Latent Class Analyses of Vulvo-Vaginal Pain Symptoms

Abstract Introduction Persistent genital pain represents a significant health issue among females, with prevalence ranging from 18.5% for lower genital tract discomfort [2], 20% for chronic dyspareunia [3], and 8.3%-27.9% for vulvodynia [6, 7]. Latent class analyses (LCA) allow the identification of groups of individuals who share common symptom profiles and have been used to subgroup vulvodynia patients based on psychological distress and pain sensitivity [1], spontaneous vs provoked pain and pain comorbidities [8] and based only on comorbid pain conditions [5]. Nonetheless, to our knowledge no study has been conducted investigating clusters of symptom-types commonly reported for persistent genital pain. Objective Test for latent classes (clusters) of individuals based on symptom-types profiles among women with vulvar and/or vaginal pain. Methods Self-reports on sexual and genital health were collected from 2199 women through online questionnaires, as part of a larger study. Efforts were made to recruit a heterogenous sample, with an oversampling of females with genito-pelvic pain. Participants were asked about the presence of specific vulvo-vaginal symptoms. Specifically, eight types of vulvar pain (itching, burning, irritation, needles, cut, electric-shock, bladder weight and urinary urgency) and nine types of vaginal pain (dryness, itching, burning, pulsating, needles, cut, electric shocks, spontaneous spasms and spasms at penetration) were measured. LCA were conducted to identify clusters of individuals sharing similar symptom profiles. Analyses were first done including all women with genital pain, then separately for women experiencing only vaginal and only vulvar pain. Results Of the 2199 participants, 1116 (51%) reported experiencing some type of genital pain, with 52% experiencing vulvar and vaginal pain, 17% only vaginal pain and 31% only vulvar pain. Results from LCA analyses suggest that women experiencing vulvo-vaginal pain could best be grouped into 5 clusters, based on the presence of vulvar and vaginal symptoms (Figure 1). Women with only vaginal pain were grouped into 3 clusters based on vaginal symptoms (Figure 2) and women with only vulvar pain were grouped into 3 clusters based on vulvar symptoms (Figure 3). Across all sets of analyses, clusters were clearly differentiated by specific symptoms. Conclusions Although rates of genital pain are high among females, classification of genito-pelvic pain conditions have been, and still are, a matter of debate. While in the DSM-5 vaginismus and dyspareunia were combined into one diagnostic entity, many clinicians continue referring to them as two distinct conditions, creating incoherence in terminology. In addition, chronic vulvar pain (or Vulvodynia) remains often undiagnosed [7], with women waiting an average of a 6-years before receiving a diagnosis [4]. Our data, obtained from a large sample, allowed us to identify profiles based on an empirical/data driven strategy, and provides an innovative approach to defining genital pain conditions. These results offer a starting point to re-think and discuss how diagnoses currently used to categorize female vulvo-vaginal pain can be improved. Longitudinal studies should be conducted to test whether the current strategy of grouping women with vulvo-vaginal pain provides improved diagnoses, more accurate prognoses, or improves our ability to identify patients who will or will not respond to specific treatments. Disclosure No.

(124) An Open-Label, Vulvoscopic Pilot Study of Intravaginal Prasterone in Menopausal Women with Dyspareunia Examining Vestibular Tissue Changes

Abstract Introduction Prasterone (DHEA), a daily 6.5 mg intravaginal insert, is approved in the US and Canada for moderate to severe dyspareunia, a symptom of vulvovaginal atrophy from menopause. Prasterone converts intracellularly in vaginal epithelial cells into active androgens and estrogens without affecting systemic hormone blood levels. Although prasterone is a vaginal insert, the significant reduction of pain in the phase 3 registration trials suggests improvement of the vestibular endodermal genital tissue health associated with dyspareunia in androgen and estrogen deficient states like menopause. To the best of our knowledge, there have not been previous prospective studies documenting visible changes to the vestibule with daily administration of 6.5 mg prasterone in menopausal women with vulvovaginal atrophy and moderate to severe dyspareunia. Objective It is the aim of this study to investigate whether an intravaginal therapy, prasterone, could affect the vestibular tissue, assessing for changes in visual appearance, pain, and responses on sexual event diaries over the 20-week administration of intravaginal 6.5 mg prasterone. Methods This 20-week, open-label, prospective, pilot study included 11 menopausal women (median age = 56 y) treated daily with 6.5 mg prasterone intravaginal inserts and assessed every 4 weeks. During vulvoscopy, vestibular pain was assessed by cotton-tipped swab testing and vestibular and vaginal health were independently assessed using the Visual Scale (VS). In addition, vulvoscopic photographs were obtained and assessed using the Vulvoscopic Genital Tissue Appearance (VGTA) scale to evaluate overall genital tissue health. Mean changes from baseline for genital tissue health and pain assessments were analyzed by repeated measures one-way analysis of variance, followed by Dunnett’s post-hoc test. Sexual event diaries were completed, and adverse events recorded. Results Eleven participants completed the study, with a total of 1607 vulvoscopic photographs, showing reduction in vestibular erythema and pallor at end of study. Total VGTA scores at week 20 showed improvement from baseline (mean change = -7.9, p = 0.0016). Changes in VS scores were significantly reduced from baseline after active treatment by week 4 and maintained through week 20 for the vestibule (3.00, p = 0.004) and vagina (4.00, p = 0.002) respectively), suggesting improved vestibular and vaginal tissue health. Cotton-tipped swab test scores were significantly reduced from baseline after week 8 through week 20 (mean change = (-7.27, p = 0.019), suggesting decreased pain. Diary results showed decrease in pain from 81.3% during the first month to 8.3% during the last month of the study, with sexual activities discontinued due to discomfort reduced from 45.8% to 6.3% respectively. No prasterone related adverse events were reported. Conclusions This is the first prospective vulvoscopic study showing that intravaginal hormone therapy significantly improves total VGTA, VS and cotton-tipped swab test scores. This observation may explain the robust effect of prasterone in lowering dyspareunia in menopausal women with moderate to severe dyspareunia. Our findings suggest that intravaginal prasterone exerts biologic activity on the androgenic endodermal vestibule, as the medication passes from vagina to vestibule, resulting in amelioration of pain associated with sexual activity. Disclosure Yes, this is sponsored by industry/sponsor: AMAG Pharmaceuticals, Inc. Clarification: Industry funding only - investigator initiated and executed study.

Analysis of Risk Factors for External Genital Health of Women of Childbearing Age in Purwakarta Regency, Indonesia

Introduction: The health of women's external genitalia is an important aspect of reproductive health. This study aims to analyze the health risk factors for the external genitalia of women of childbearing age in Purwakarta Regency, Indonesia.
 Methods: This research is an analytical observational study with a cross-sectional design. The research sample was 240 women of childbearing age in Purwakarta Regency who were selected randomly. Data was collected through questionnaires and physical examination. Data analysis was carried out univariate and bivariate.
 Results: The results of the study showed that the risk factors for the health of the external genitalia of women of childbearing age in Purwakarta Regency were age, parity, and a history of sexually transmitted infections (STIs). Women aged more than 35 years have a higher risk of external genital health than women aged less than 35 years (OR = 2.65; 95% CI: 1.22-5.83). Women with parity more than 2 have a higher risk of external genital health than women with parity 1-2 (OR = 2.32; 95% CI: 1.14-4.71). Women with a history of STIs have a higher external genital health risk than women without a history of STIs (OR = 3.52; 95% CI: 1.58-8.17).
 Conclusion: Age, parity, and history of STIs are risk factors for external genital health in women of childbearing age in Purwakarta Regency.

Maintaining vulvar, vaginal and perineal health: Clinical considerations.

Knowledge of female genital anatomy and physiology is often inadequate or incorrect among women. Precise patient-physician conversations can be inhibited by a reluctance or inability to speak accurately about the vulva and vagina, with the terms often being used interchangeably. There is a paucity of scientific evidence and clinical guidelines to support women and physicians in ensuring best practices in feminine hygiene. In this review, the unmet needs in the field are highlighted. Evidence is provided for the complex array of physiological and pathological systems, mechanisms and behaviours that either protect or, if inappropriate, predispose the vulva and vagina to infections, irritation or other conditions. The need for attention to perineal health is recommended, given the interdependence of perineal and vulvar microbiota and the risk of colonic pathogens reaching the vulva and the vagina. Differences in feminine hygiene practices can vary widely across the world and among varying age groups, and suboptimal habits (such as vaginal douching or the use of certain cleansers) can be associated with increased risks of vulvar and vaginal conditions. Critical areas for discussion when advising women on their intimate health include: advice surrounding aesthetic vulvar cosmetic trends (such as depilation and genital cosmetic surgery), bowel health and habits, and protection against sexually transmitted infections. Routine, once-daily (maximum twice-daily) washing of the vulva with a pH-balanced, mild cleanser is optimal, ideally soon after bowel voiding, when feasible. Due to the finely balanced ecosystems of the vulva, the vagina and the perineal area, a scientific and clinical perspective is essential when determining the most appropriate vulvar cleansers based on their components. Correct intimate care may contribute to improved genital and sexual health and overall well-being. An increased awareness of correct practices will empower women to be the advocates of their own intimate health.

Empowering Teachers in The Genital Childhood Health

Abstract. The age of early childhood education (ECE) students are 2-6 years old. They have the period when students enter the learning period for toilet training well. The ECE teachers and parents have a role in collaborating in toilet training so that children can urinate and defecate correctly and follow Islamic rules. Community service activities aimed at increasing the knowledge and skills of ECEP Aisyiyah teachers in Ngaglik. The activity is implemented in the form of lectures, discussions, and practices, as well as the distribution of handkerchiefs to dry the genital area after the child urinates or defecates. In this community service activity, we have distributed medicine packets for the first treatment of sick children at school. Evaluation at the end of the activity showed that there was an increase in knowledge of 15%.

Integrating compositional and functional content to describe vaginal microbiomes in health and disease

BackgroundA Lactobacillus-dominated vaginal microbiome provides the first line of defense against adverse genital tract health outcomes. However, there is limited understanding of the mechanisms by which the vaginal microbiome modulates protection, as prior work mostly described its composition through morphologic assessment and marker gene sequencing methods that do not capture functional information. To address this gap, we developed metagenomic community state types (mgCSTs) which use metagenomic sequences to describe and define vaginal microbiomes based on both composition and functional potential.ResultsMgCSTs are categories of microbiomes classified using taxonomy and the functional potential encoded in their metagenomes. MgCSTs reflect unique combinations of metagenomic subspecies (mgSs), which are assemblages of bacterial strains of the same species, within a microbiome. We demonstrate that mgCSTs are associated with demographics such as age and race, as well as vaginal pH and Gram stain assessment of vaginal smears. Importantly, these associations varied between mgCSTs predominated by the same bacterial species. A subset of mgCSTs, including three of the six predominated by Gardnerellavaginalis mgSs, as well as mgSs of L. iners, were associated with a greater likelihood of bacterial vaginosis diagnosed by Amsel clinical criteria. This L. iners mgSs, among other functional features, encoded enhanced genetic capabilities for epithelial cell attachment that could facilitate cytotoxin-mediated cell lysis. Finally, we report a mgSs and mgCST classifier for which source code is provided and may be adapted for use by the microbiome research community.ConclusionsMgCSTs are a novel and easily implemented approach to reduce the dimension of complex metagenomic datasets while maintaining their functional uniqueness. MgCSTs enable the investigation of multiple strains of the same species and the functional diversity in that species. Future investigations of functional diversity may be key to unraveling the pathways by which the vaginal microbiome modulates the protection of the genital tract. Importantly, our findings support the hypothesis that functional differences between vaginal microbiomes, including those that may look compositionally similar, are critical considerations in vaginal health. Ultimately, mgCSTs may lead to novel hypotheses concerning the role of the vaginal microbiome in promoting health and disease, and identify targets for novel prognostic, diagnostic, and therapeutic strategies to improve women’s genital health.6QiSoF_fVWyny-AcPZFxWyVideo

GENITAL, PARAGENITAL AND EXTRAGENITAL INJURIES IN FEMALE SEXUAL VIOLENCE CRIMES IN PRIMARY HEALTH CARE

GENITAL, PARAGENITAL AND EXTRAGENITAL INJURIES IN FEMALE SEXUAL VIOLENCE CRIMES IN PRIMARY HEALTH CARE

A-269 Post-pandemic Opportunities for Commercial Laboratories in Infectious Disease Diagnostics and Public Health

Abstract Background Aegis launched COVID-19 testing with a daily capacity of 3000 tests and scaled to over 100 000 tests/day in one year. The lab has performed over 14.2M COVID-19 tests to date, servicing a broad network of physicians, urgent care centers, nursing homes, public schools, departments of health, and retail pharmacies across the United States. As SARS-CoV-2 infections reach an equilibrium, Aegis recognized the opportunity to address broader public health needs and leveraged the partnerships, technologies, and infrastructure developed to build the Infectious Disease Testing (IDT) menu aimed at limiting the spread of health risks within the community. Methods Real-time polymerase chain reaction (RT-PCR) tests for common and rare bacterial, viral, and parasitic pathogens associated with genital health (GH) and sexually transmitted infections (STI), as well as infections of the urinary (UTI), gastrointestinal (GI), and respiratory tracts (RTI) were validated. These tests are performed in 384-well custom PCR plates, pre-spotted with primers and probes capable of detecting the presence of DNA or RNA (LOD = 10 copies/µL) from 30 different organisms in up to 12 patient samples simultaneously. Syndromic panels were developed for ordering based on similar intended use, and providers have the option to order panels or stand-alone tests based on medical necessity. Following receipt into the lab, the total nucleic acid is extracted from the primary specimen and pipetted into the PCR assay plate with Taq DNA polymerase master mix, and analysis and reporting of ordered targets are complete within nine hours, on average. Results and de-identified demographic data are parsed from the laboratory information management system (LIMS) to Microsoft PowerBI software to internally track testing trends, positivity rates, and outbreaks of infectious diseases. Results Historical data including ordered profiles, matrices, and pathogens detected combined with de-identified demographic data such as patient age, gender, race, residing state, and collection month were imported into PowerBI and used to create interactive visuals for a dashboard to monitor trends and predict future testing patterns. The IDT panels ordered most frequently include STI (27.1%), upper RTI (23.6%), bacterial vaginosis (21.0%), GI bacterial (15.1%), candidiasis (13.7%), and GI viral (13.0%). The majority (74%) of GH/STI tests were ordered for patients between the ages of 15 to 34 years, and the most prevalent infections detected were bacterial vaginosis (35%), mycoplasma hominis (22%), and chlamydia trachomatis (4%). Sixty-one percent (61%) of upper RTI tests were ordered for patients between the ages of 0 to 14 years, and fluctuations in positivity rates followed seasonal trends for pathogens such as rhinovirus, influenza, adenovirus, RSV, and enterovirus D68. GI profiles were predominantly ordered for the younger (0–14 years, 35%) and the older (>65 years, 18%) population with e. coli O157 (11%), norovirus (9%), sapovirus (6%), and astrovirus (4%) infections detected at the highest rates. Conclusion The COVID-19 pandemic underscored the importance of molecular diagnostics for SARS-CoV-2 infection and surveillance. Experience gained during the COVID-19 response allowed Aegis to repurpose the resources, capacity, and infrastructure to create business development opportunities aimed at laboratory growth in infectious diseases and public health.

Parenting desire among men who have sex with men in a heteronormative context.

The desire for parenthood in the LGBT+ community is still a matter of critical debate worldwide. We aimed to (i) analyse the prevalence of desire for fatherhood in a cohort of white-European sexually active men who have sex with men and (ii) explore the characteristics of men who have sex with men with respect to those without the desire for fatherhood. An anonymous self-compiled survey with 23 closed socio-demographic general questions, one section aimed to assess medical history and recreational habits and two sections devoted to investigate genital and sexual health, was provided to each participant. Likewise, all participants were invited to complete a number of questionnaires, including the Male Sexual Health Questionnaire and the Beck Inventory for Depression. Of 191 men who have sex with men white-European participants who eventually completed the survey, 112 (58.6%) clearly expressed their desire for fatherhood. Of all, the wish to become a parent was strong in 99 (51.8%) individuals and higher in younger participants (35 [28-46] vs. 43 [32-50] years, p=0.01). No other significant differences in terms of educational level and relational status were identified between the two groups. Of all, the wish to become a parent was strong in 99 (51.8%) individuals and higher in younger participants (35 [28-46] vs. 43 [32-50] years, p=0.01). Current preliminary findings highlight that more than one in two men who have sex with men has a desire for fatherhood, with almost 81% of all having a high desire for fathering, which is clearly more intense in younger men.

Pre- and post-LEEP: analysis of the female urogenital tract microenvironment and its association with sexual dysfunction.

The loop electrosurgical excision procedure (LEEP) to treat cervical dysplasia (CD) is known to alter the cervical microbiota, the community of bacteria that play a central role in female genital health. Perturbations to the microbiota of the female urogenital tract (FUT), including the urethra, vagina, and cervix, have been linked with symptoms of sexual dysfunction (SD), though correlations among LEEP, the microenvironment, and SD have not yet been described. To characterize the FUT microbiota before and after LEEP and investigate possible associations with SD. Females undergoing LEEP for CD were recruited to participate in the study. Urinary samples and vaginal and cervical swabs were collected immediately before and 3 months after treatment. Bacterial communities were characterized by 16S rRNA next-generation sequencing. Self-report surveys assessing demographics, medical history, and sexual function were completed at the same intervals. Microbiota taxonomy and Female Sexual Function Index (FSFI) scores. Alpha diversity revealed a significant decrease in species richness in the FUT microbiota post-LEEP. Beta diversity demonstrated significant differences among the cervical, urinary, and vaginal microenvironments pre- and post-LEEP. Lactobacillus spp were the dominant microbial genus in the cervical microenvironment pre- and post-LEEP. Although the vaginal and urinary microenvironments were characterized by Prevotella pre-LEEP, they were colonized by Lactobacillus post-LEEP. Following LEEP, some participants experienced a significant increase in proinflammatory bacteria, including the genera Gardnerella, Megasphaera, Sneathia, Parvimonas, and Peptostreptococcus. Others experienced significant decreases in inflammatory and protective bacteria post-LEEP, including Butyricicoccus, Terriporobacter, Intestinimonas, and Negativibacillus. Overall there were no significant changes in pre- and post-LEEP FSFI scores. However, post-LEEP FSFI scores were seemingly associated with changes in inflammatory bacteria in some participants. There is an overall reduction in FUT microbiota dysbiosis post-LEEP. However, we show variability as some participants experienced persistent dysbiosis of FUT microbiota and elevated FSFI scores, suggesting that therapies to treat dysbiosis of FUT microbiota may reduce FSFI scores, thereby improving SD symptoms. We demonstrate novel associations among urogenital sites, microbiota changes, LEEP, and SD. The small sample size and inability of species classification are limitations. Diverse inflammatory microbiota characterizes CD in the FUT, and LEEP mostly returns microenvironments to a healthy state. However, some participants have persistent inflammatory bacteria post-LEEP, suggesting a non-uniform healing response. This study provides an impetus for future longitudinal studies to monitor and restore FUT microenvironments post-LEEP, aimed at mitigating postoperative SD symptoms.

Crosstalk between the Resident Microbiota and the Immune Cells Regulates Female Genital Tract Health.

The female genital tract (FGT) performs several functions related to reproduction, but due to its direct exposure to the external environment, it may suffer microbial infections. Both the upper (uterus and cervix) and lower (vagina) FGT are covered by an epithelium, and contain immune cells (macrophages, dendritic cells, T and B lymphocytes) that afford a robust protection to the host. Its upper and the lower part differ in terms of Lactobacillus spp., which are dominant in the vagina. An alteration of the physiological equilibrium between the local microbiota and immune cells leads to a condition of dysbiosis which, in turn, may account for the outcome of FGT infection. Aerobic vaginitis, bacterial vaginosis, and Chlamydia trachomatis are the most frequent infections, and can lead to severe complications in reproduction and pregnancy. The use of natural products, such as probiotics, polyphenols, and lactoferrin in the course of FGT infections is an issue of current investigation. In spite of positive results, more research is needed to define the most appropriate administration, according to the type of patient.

Incidence and Prevalence of Vaginal Infections in Women of Reproductive Age in North Macedonia.

In the available literature on this subject there are many studies which describe the effects of sexually transmitted infections on pregnancy and fertility of women. Because of the frequency of the infections with the atypical bacteria of the Ureaplasma Spp., Mycoplasma Spp., Chlamydia Trachomatis, as well as HPV infections in women of reproductive age, it is easy to underestimate their importance when establishing the basis of the genital health of women of reproductive age. In this prospective analysis, conducted from 2014 to 2018 in the laboratory for HPV and Molecular diagnostics at the University Clinic of Gynaecology and Obstetrics in Skopje, North Macedonia, we analysed the results of 10,387 patients of all ages, of which 973 patients were of reproductive age. A Panel analysis was also conducted (including the above-mentioned pathogens). An HPV analysis was also conducted on 643 patients in this group. Within the group of 643 patients, there was a positive result for HPV in 26.7% of them, while in 40.9% there was a positive result for one or more pathogens on the Panel analysis of bacterial pathogens. The statistical analysis of the results showed that the most frequent of all bacterial pathogens within the Macedonian population of women of reproductive age is Ureaplasma Spp, with an incidence of 33%, followed by Mycoplasma Spp., with 7.8%, while Chlamydia Trachomatis was present in 6.4% of the cases. We should highlight that a co-infection with HPV was present in 18.5% of all the patients where there was analysis of both diagnostic procedures. The analysis of the results in the patients co-infected with HPV and at least one bacterial pathogen on the Panel Analysis, showed a very high statistical correlation (p<001).

Vestibular tissue changes following administration of intravaginal prasterone: a vulvoscopic open-label pilot study in menopausal women with dyspareunia.

Prasterone, an intravaginal dyspareunia treatment in menopausal women, improves vaginal health through intracellular conversion of dehydroepiandrosterone into androgens and estrogens. Phase 3 trials for prasterone showed significant improvement in vaginal tissue health and reduction of pain. To assess vestibular changes with daily use of intravaginal prasterone in menopausal women with moderate to severe dyspareunia. This open-label prospective pilot study was conducted over 20 weeks. It included 11 menopausal women (median age,56 years) who were treated daily with intravaginal inserts of 6.5-mg prasterone and assessed monthly. During vulvoscopy, vestibular pain was assessed by cotton-tipped swab testing, and vestibular and vaginal health was independently assessed with the Visual Scale (VS). In addition, vulvoscopic photographs were obtained and assessed via the Vulvoscopic Genital Tissue Appearance (VGTA) scale to evaluate overall genital tissue health. Mean changes from baseline for genital tissue health and pain assessments were analyzed by repeated measures 1-way analysis of variance, followed by a Dunnett post hoc test. Sexual event diaries were completed and adverse events recorded. Outcomes included indices of genital tissue health: pain assessment by cotton-tipped swab testing, VS of the vestibule and vagina, VGTA, and sexual event diary. Aggregate scores from the cotton-tipped swab test progressively improved, reaching statistical significance at week 16, which was maintained through week 20 (-7.27, P= .019). VS scores significantly improved from baseline by week 4 and were maintained through week 20 for the vestibule (-3.00, P= .004) and vagina (-4.00, P= .002). An overall 1607 vulvoscopic photographs were examined; all showed reduction in vestibular erythema and pallor at the end of the study. The mean change from baseline at week 20 for the VGTA score was -7.9 (P= .0016). Intercourse associated with pain was reduced from 81.3% of initiated events during the first month of the study to 8.3% during the last month. Sexual activities that were discontinued due to discomfort were reduced from 45.8% to 6.3%. No prasterone-related serious adverse events were reported. Prasterone, a safe and effective intravaginal hormone treatment, significantly improves vestibular health parameters. Strengths are the prospective study design and the use of multiple outcome measures to assess vestibular tissue health and pain associated with sexual activity. Limitations are the small study cohort and use of nonvalidated outcome measures. Our findings suggest that intravaginal prasterone exerts biologic activity on the androgenic endodermal vestibule, as the medication passes from vagina to vestibule, resulting in amelioration of pain associated with sexual activity.

Abstract 71: Regional College Women in the United States (U.S.) Report Low Health Literacy Regarding Basic Genital Biology and Cervical Cancer Risk Factors

Abstract Purpose: Oncogenic genital diseases, triggered by genital dysbiosis and Human Papillomavirus (HPV) infection, can be prevented by improved health literacy in women. However, uptake of preventative strategies such as the HPV vaccine, are low in some U.S. communities (&amp;lt;50%). This study evaluated health literacy (language framing for and understanding of) basic genital biology and cervical cancer risk factors in U.S. college women. Methods: English-speaking undergraduates (n=36) at public (mostly Texas) and private (mostly California) institutions, self-directed to participate in individual, structured interviews via video or phone. Data transcripts were analyzed and scored for thematic responses to open-ended questions. Results: Over 80% of women wanted to know more about genital biology (“what is normal”) and cancer prevention. Individual understanding of genital biology and cervical cancer risk factors was low (scoring range from 0 = know nothing to 5 = understanding a lot). Knowledge (mean +/- SD) about normal vaginal bacterial physiology, and cervical cancer risk factors, both scored very low at only 1 +/- 1. Over 2/3 of women lacked the words and/or agency to describe genital symptoms without stress to healthcare providers. About 1/3 of women had no ability to list any cervical cancer risk factors, with most in this group not recalling any prior genital health education. Recurrent barriers to improved health literacy included: 1) belief that information lacked pertinence to them based on faith or culture, 2) inhibited care-seeking due to privacy issues (e.g. family insurance or campus clinics), 3) misinformation about genital biology or cancer causes, and 4) poor willingness or opportunity to discuss genital health with providers. The most requested change to genital healthcare was a desire for a biology curriculum taught from a functional perspective (for greater accessibility across faiths and cultures) with closer implementation to college and sexual debut. Conclusions: Knowledge of genital biology and cervical cancer risks was low in this group of U.S. college women (mean score 1/5 for some aspects). Prevention of genital cancers requires a multi-pronged approach that addresses genital biology, while accepting varied social determinants of health and diverse domains of influence for women across the U.S. Citation Format: Joanna Ellington, Dennis Clifton, Jenny Fremlin, Erisa Stokes, Jessica Shuster. Regional College Women in the United States (U.S.) Report Low Health Literacy Regarding Basic Genital Biology and Cervical Cancer Risk Factors [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 71.