Gynecologic Health Research Articles

(056) Theo Mei Technique (TMT) – A Specific Method Eliminating or Reducing Menstrual Ppain

Abstract Introduction A large portion of women experience significant menstrual pain for one to three days every month that interferes with daily activities and sleep causing lost time from work, school, family or other activities and reduced productive life. Objective Provide women a natural solution to reduce or eliminate period pain using the body’s own hormones (endorphins and oxytocin) without the side effects medicinal approaches. Methods Triggering the body’s pain fighting hormones is the central theme. There are two key elements of this technique (TMT): multiple self-induce orgasms and specific time spacing. A woman’s body is capable of multiple orgasms and each time releases the necessary hormones to fight pain. The intensity of each orgasm greatly contributes to the amount of endorphins released and typically is apparent by full body shaking contractions. The timing of the orgasms allows the hormones to distribute throughout the body and builds upon the previous hormone amounts. The technique was explained in detail to each patient to ensure a consistent understanding level and methodology. Each participant provided feedback how much pain was reduced and how long this effect lasted if the pain reoccurred. They also provided other observations about physiological changes or effects from the technique. Results This research study has spanned 42 months with 46 participants. Some of the women have been using TMT for 36 – 42 months, most of the women for at least 15 months and more recently three additional women for 4 months. The women ages ranged from 21 to 48 years. There are nine related combinations (mother /daughter/sister). After each patient completed the technique the effects were immediate and each patient reported an exhilarated feeling for the first time being free of period pain. The data revealed each time the patient used TMT the pain was completely eliminated. Duration of effects lasted from 7 to 10 hours. If the patient felt pain returning the patient simply repeated the technique for another painless span of time. All the participants continue to voluntarily use this technique each month. The participants voluntarily provide information concerning quality of sexual activity and gynecological health changes (typically improved). The authors and participants were surprised how completely this technique worked. The results show this technique is very effective in eliminating the pain women suffer during menstruation. The patients felt medications were not needed and stopped using them on their own. The intensity of the technique and repeated use also strengthened the pelvic floor muscles. The study is collecting more data about the additional benefits of this technique. Conclusions The participants in this research study group significantly improved their lives by using TMT every month. All of these women are essentially pain free during their monthly period. The TMT effects were obvious to others around the participants and kept asking what had changed. The effectiveness of long term participation of these patients has not diminished. Disclosure No

Telemedicine: A Natural Evolution of Obstetric and Gynaelogical health Care System of Bangladesh during COVID-19 Pandemic

Background: The word Telemedicine literally translates to ‘healing at a distance’. Here remote diagnosis and treatment of patients is done by means of telecommunication technology. First published record of telemedicine is in the first half of the 20th century when ECG was transmitted over the telephone line. In Bangladesh telemedicine was not so popular as patients prefer face to face visit to a medical practitioner. But in Covid-19 Pandemic to prevent transmission and Lock down situation telemedicine becomes popular and emerges as a natural evolution of Obstetrics and Gynaecologic health care system in Bangladesh.
 The Aim of the study: To see the outcome of patients taking telemedicine for their Obstetric and Gynaecologic problems. The reasons of seeking consultation through telemedicine are also studied.
 Materials and Methods: This is a Cross sectional prospective study done during Lock down period in Bangladesh. Study period was 27th March to 20th May. Total 201 women got telemedicine service free of cost via sms, messenger, imo, whatsapp, email using smart phone were included in this study. The data was collected, edited and tabulated by hand tabulation. Calculation was done on scientific calculator.
 Results: About 96.51% patients suffering from Obstetrics and Gynaecological diseases were cured by taking medicine, counselling and assurance through telemedicine. Majority of pregnant women(23.88%) sought telemedicine service for consultation about advice regarding diet, medicine, anxiety about ANC visits. 2.48% women were worried about Tetanus Toxoid vaccine.Women (.99%) suffering from Gynaecological diseases such as Fibroid uterus, Uterine Prolapse were seeking for operation.3.48% women suffereing from DUB and managed by medication . Only 3.48% patients were required to refer to Hospital for Emergency admission.
 Conclusion: Telemedicine can’t give solution to all problems, but it definitely helps in managing women suffering from Obstetric and Gynaecological diseases at a large extent especially during awakward situation like Covid 19 pandemic.
 Bangladesh J Obstet Gynaecol, 2021; Vol. 36(1): 23-27

La santé sexuelle des hommes trans : entre problèmes de catégorisation et invisibilisation

Sexual minorities have been disproportionally impacted by the HIV-Aids epidemic. Their high prevalence motivated sexual health research that first focused on gay men, then trans women. Trans men have been considered at very low risk of exposition, Hence the scarce number of research about them. However, an emerging literature is showing diversified and surprising results regarding the reasons for their initial exclusion. This article seeks to establish the state of knowledge on trans men's sexual health through a French and international literature review. Trans men have a variety of partners, sexual and non-sexual practices (IDU) that leads to categorize them at high risk of HIV exposure. The proportion of trans men who are HIV positive still is difficult to assess. It is estimated to be high in the USA, and close to zero in France. Low screening rates, difficulties accessing health care, and identification problems in the very classification of people suggest that they might be more of them. Trans men also report discriminations in access to health care services, and specific health vulnerabilities. Gynecology and reproductive health are rarely even mentioned. Rethinking the categories used in research would produce a more accurate representation of the varied realities of trans people.

Gynecological morbidity and treatment-seeking among older adult (aged 45–59) women in India

BackgroundWomen’s gynecological health needs are not limited to the reproductive years of their life. Women are at risk of hormonal changes, gynecological malignancies, and various genitourinary conditions as they move toward menopause and beyond. Concerns about older women’s sexual and reproductive health and rights (SRHR) continue to be taboo in many countries, of little interest to researchers and professionals in the field of healthcare, and a “blind spot” in discussions about policy as a whole. Despite the widespread agreement, the life course approach to addressing SRHR concerns has received minimal attention. The study estimates the prevalence, assesses the correlates, and treatment-seeking of gynecological morbidity (GM) among older adult women aged 45–59 years (N = 18,547) in India.MethodThe analysis was based on the nationally representative Longitudinal Ageing Study (2016–2017) data that adopted a multistage stratified area probability cluster sampling to select respondents. The outcome variables used in this analysis were ‘had any GM’ and ‘sought treatment for any GM.’ Women with any morbidity such as per vaginal bleeding, foul-smelling vaginal discharge, uterus prolapses, mood swings/irritability, fibroid/cyst, and dry vagina causing painful intercourse were considered to have any GM. Of the respondents with GM, who sought a doctor’s consultation or treatment were considered ‘sought treatment for any GM.’ Binary logistic regression was conducted to examine the adjusted effect of socioeconomic and demographic predictors of GM and treatment-seeking. Stata (V 16) was used for statistical analyses with a 5% significance level.ResultsFifteen percent of the women had any GM, and only 41% of them sought treatment. Age, marital status, education, number of pregnancies, hysterectomy, involvement in household decision-making, social group, religion, wealth status, and region were significantly associated with GM. The odds of treatment-seeking were higher among women with 10+ years of schooling (OR 1.66, CI 1.23, 2.23), with hysterectomy (OR 7.36, CI 5.92, 9.14), with five-plus pregnancies (OR 1.25, CI 0.96, 1.64), and those from the richest (OR 1.91, CI 1.40, 2.60) households than their respective counterparts.ConclusionMany older adult women experience GM, and treatment-seeking is inadequate. The GM prevalence and treatment-seeking vary considerably by socioeconomic and demographic characteristics. Results suggest community-level awareness generation and the inclusion of this otherwise ignored group in programs targeting better health and wellbeing of women.

Population-level use of gynecological health services by female youth with intellectual/developmental disabilities in British Columbia Canada

BackgroundThere is evidence that female youth with intellectual/developmental disabilities (IDD) experience poorer gynecological care compared to female youth without disabilities. ObjectiveThe objective of this study was to obtain baseline data on visits to a health care provider for a gynecological issue for females with IDD and compare that information to the experiences of female youth without IDD. MethodsThis study is a retrospective cohort study using population-level administrative health data from 2010 to 2019 for females aged 15–24 years, with and without IDD. Results6452 female youth with IDD and 637,627 female youth without IDD were identified in the data. Over the ten-year period, 53.77% of youth with IDD and 53.68% of youth without IDD had a visit to a physician for a gynecological issue. However, as females with IDD aged, the number of people seeing a physician for a gynecological issue decreased. In the group aged 20–24 years, 15.25% of females with IDD and 24.47% of females without IDD (p < 0.0001) had a Pap test done at any time; 25.94% of females with IDD had a visit for contraception management and 28.38% of females (p < 0.0001) without IDD had a visit for contraception management. Gynecological care also varied by type of IDD. ConclusionsFemales with IDD had a similar number of visits for a gynecological issue as female youth without IDD. However, the reasons for visits and the age at which visits occurred differed between youth with and without IDD. As females with IDD transition into adulthood, gynecological care must be maintained and improved.

Re: Working remotely: a perspective on telemedicine in delivery of obstetrics and gynaecology health care

The Obstetrician & GynaecologistVolume 25, Issue 2 p. 157-158 Letters and Emails Re: Working remotely: a perspective on telemedicine in delivery of obstetrics and gynaecology health care Jacqueline Sia MBChB BSc (Hons) MRCOG, Corresponding Author Jacqueline Sia MBChB BSc (Hons) MRCOG [email protected] orcid.org/0000-0002-1820-3194 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKCorresponding Author:[email protected]Search for more papers by this authorSophie Strong MBBS BSc (Hons) MRCOG, Sophie Strong MBBS BSc (Hons) MRCOG orcid.org/0000-0002-4724-0998 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorTriada Doulgeraki MBBS, Triada Doulgeraki MBBS orcid.org/0000-0002-2542-4542 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorEmily Benson MBChB BA (Hons), Emily Benson MBChB BA (Hons) Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorElizabeth Ball MD PhD FRCOG, Elizabeth Ball MD PhD FRCOG orcid.org/0000-0001-8739-090X Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UK Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UKSearch for more papers by this author Jacqueline Sia MBChB BSc (Hons) MRCOG, Corresponding Author Jacqueline Sia MBChB BSc (Hons) MRCOG [email protected] orcid.org/0000-0002-1820-3194 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKCorresponding Author:[email protected]Search for more papers by this authorSophie Strong MBBS BSc (Hons) MRCOG, Sophie Strong MBBS BSc (Hons) MRCOG orcid.org/0000-0002-4724-0998 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorTriada Doulgeraki MBBS, Triada Doulgeraki MBBS orcid.org/0000-0002-2542-4542 Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorEmily Benson MBChB BA (Hons), Emily Benson MBChB BA (Hons) Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UKSearch for more papers by this authorElizabeth Ball MD PhD FRCOG, Elizabeth Ball MD PhD FRCOG orcid.org/0000-0001-8739-090X Department of Obstetrics and Gynaecology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel High Street, London, E1 1FR UK Centre for Maternal & Child Health Research, School of Health Sciences, City University of London, London, UKSearch for more papers by this author First published: 03 February 2023 https://doi.org/10.1111/tog.12859Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume25, Issue2April 2023Pages 157-158 RelatedInformation

Association of laparoscopically-confirmed endometriosis with long COVID-19: a prospective cohort study

Women are at greater risk than men of developing chronic inflammatory conditions and "long COVID." However, few gynecologic health risk factors for long COVID-19 have been identified. Endometriosis is a common gynecologic disorder associated with chronic inflammation, immune dysregulation, and comorbid presentation with autoimmune and clotting disorders, all of which are pathophysiological mechanisms proposed for long COVID-19. Therefore, we hypothesized that women with a history of endometriosis may be at greater risk of developing long COVID-19. This study aimed to investigate the association between history of endometriosis before SARS-CoV-2 infection and risk of long COVID-19. We followed 46,579 women from 2 ongoing prospective cohort studies-the Nurses' Health Study II and the Nurses' Health Study 3-who participated in a series of COVID-19-related surveys administered from April 2020 to November 2022. Laparoscopic diagnosis of endometriosis was documented prospectively in main cohort questionnaires before the pandemic (1993-2020) with high validity. SARS-CoV-2 infection (confirmed by antigen, polymerase chain reaction, or antibody test) and long-term COVID-19 symptoms (≥4 weeks) defined by the Centers for Disease Control and Prevention were self-reported during follow-up. Among individuals with SARS-CoV-2 infection, we fit Poisson regression models to assess the associations between endometriosis and risk of long COVID-19 symptoms, with adjustment for potential confounding variables (demographics, body mass index, smoking status, history of infertility, and history of chronic diseases). Among 3650 women in our sample with self-reported SARS-CoV-2 infections during follow-up, 386 (10.6%) had a history of endometriosis with laparoscopic confirmation, and 1598 (43.8%) reported experiencing long COVID-19 symptoms. Most women were non-Hispanic White (95.4%), with a median age of 59 years (interquartile range, 44-65). Women with a history of laparoscopically-confirmed endometriosis had a 22% greater risk of developing long COVID-19 (adjusted risk ratio, 1.22; 95% confidence interval, 1.05-1.42) compared with those who had never been diagnosed with endometriosis. The association was stronger when we defined long COVID-19 as having symptoms for ≥8 weeks (risk ratio, 1.28; 95% confidence interval, 1.09-1.50). We observed no statistically significant differences in the relationship between endometriosis and long COVID-19 by age, infertility history, or comorbidity with uterine fibroids, although there was a suggestive trend indicating that the association may be stronger in women aged <50 years (<50 years: risk ratio, 1.37; 95% confidence interval, 1.00-1.88; ≥50 years: risk ratio, 1.19; 95% confidence interval, 1.01-1.41). Among persons who developed long COVID-19, women with endometriosis reported on average 1 additional long-term symptom compared with women without endometriosis. Our findings suggest that those with a history of endometriosis may be at modestly increased risk for long COVID-19. Healthcare providers should be aware of endometriosis history when treating patients for signs of persisting symptoms after SARS-CoV-2 infection. Future studies should investigate the potential biological pathways underlying these associations.

Improving the Health and Readiness of Military Women.

Women comprise approximately one-fifth of the total force in the U.S. Military. Gynecologic and reproductive health issues not only affect the health and wellness of individual servicewomen but may also impact the mission of the DoD. Unintended pregnancies can result in adverse maternal and infant outcomes and can negatively impact the careers of military women and mission readiness. Gynecologic conditions such as abnormal uterine bleeding, fibroids, and endometriosis can also limit women's optimal health and performance, and a significant proportion of military women have indicated their desire to manage and/or suppress menstrual cycles, especially when deployed. Access to the full range of contraceptive methods is an important strategy to allow women to achieve their reproductive goals and address other health concerns. This report reviews rates of unintended pregnancy and contraceptive utilization among servicewomen and examines factors that influence these measures of health. Overall rates of unintended pregnancy are higher among servicewomen than the general population and rates of contraceptive use among servicewomen are lower than the general population. Congress mandates that servicewomen have access to contraceptive options, but the DoD has not established target measures for contraceptive access and use, unlike that present for the civilian population. Four potential courses of action are proposed to improve the health and readiness of military women.Recommendation 1: The Military Health System (MHS) should develop and maintain reliable sources of data to assess the gynecologic health of servicewomen, including rates of unintended pregnancy.Recommendation 2: When menstrual suppression, treatment for a medical condition, or contraception is desired, servicewomen should have ready access to the information they need to select the option that is best suited for their personal preferences and situation.Recommendation 3: In order to ensure that servicewomen have optimal access to the full range of contraceptive methods, the MHS should determine true access at all their facilities and identify actions to address any barriers.Recommendation 4: The MHS should establish service delivery targets for use of women's preventive health services, particularly contraception, to prevent unintended pregnancies.

Impacto y consecuencias de la violencia ginecológica en la vida de las mujeres

Objective: The objective was to analyze a set of results on gynecological violence and relate them to their impact on the perception of the body, sexuality, self-image and self-esteem. Methods: A descriptive cross-sectional study was carried out. 812 stories of women from different regions of Chile were analyzed. Results: Three kinds of consequences of violence were detected: adoption of protection and shelter measures, impact on the experience of themselves and their bodies, and physical and emotional consequences of violence in their lives. Additionally, some experiences of autonomy recovery in gynecological health care are presented. Conclusion: Gynecological violence is part of the common experience of women and can constitute a serious public health problem and become a barrier to women’s access to health services.

Pelvic Pain in Transgender People Using Testosterone Therapy.

Purpose: This descriptive study aimed to assess the characteristics of pelvic pain and explore predictive factors for pelvic pain in transgender (trans) individuals using testosterone therapy. Methods: An online cross-sectional survey was open between August 28, 2020, and December 31, 2020, to trans people presumed female at birth, using testosterone for gender affirmation, living in Australia, and >16 years of age. The survey explored characteristics of pelvic pain following initiation of testosterone therapy, type and length of testosterone therapy, menstruation history, and relevant sexual, gynecological, and mental health experiences. Logistic regression was applied to estimate the effect size of possible factors contributing to pain after starting testosterone. Results: Among 486 participants (median age = 27 years), 351 (72.2%)* reported experiencing pelvic pain following initiation of testosterone therapy, described most commonly as in the suprapubic region and as "cramping." Median duration of testosterone therapy was 32 months. Persistent menstruation, current or previous history of post-traumatic stress disorder, and experiences of pain with orgasm were associated with higher odds of pelvic pain after testosterone therapy. No association was observed with genital dryness, intrauterine device use, previous pregnancy, penetrative sexual activities, touching external genitalia, or known diagnoses of endometriosis, vulvodynia, vaginismus, depression, anxiety, or obesity. Conclusions: Pelvic pain is frequently reported in trans people following initiation of testosterone therapy. Given the association with persistent menstruation and orgasm, as well as the known androgen sensitivity of the pelvic floor musculature, further research into pelvic floor muscle dysfunction as a contributor is warranted.

Management of obesity across women's life course: FIGO Best Practice Advice

Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long-term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma-informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre-, ante-, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre-existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.

Gynecological Health Complaints Among College Women With Sexual Victimization Histories: Examination of Depression and Anxiety as Potential Mediators.

The study's purpose was to examine the relation between sexual victimization history and gynecological health complaints among college women. A further aim was to explore whether anxiety and depression are mediators of this relation, as well as to examine the size of these indirect relations among individuals with different types of victimization histories (childhood sexual abuse, adolescent/adult sexual assault, combined childhood sexual abuse/adolescent/adult sexual assault). A sample of 1,759 undergraduate cisgender women attending a large Southeastern U.S. university completed online measures of lifetime sexual victimization history, current anxiety and depression, and current gynecological health complaints (dysmenorrhea, dyspareunia, vaginal discharge, pain during urination, and pelvic pain). Mediation analyses with bootstrapping were conducted to explore the relations among study variables. College women with a history of sexual victimization were significantly more likely to report experiencing the gynecological health complaints in the past month than women with no sexual victimization history (all ps<.05). There was a significant indirect path from sexual victimization to gynecological health complaints through both anxiety and depression for all three victimization types (βs=0.12-0.26). The indirect paths were stronger for women with combined childhood sexual abuse/adolescent/adult sexual assault histories as compared with the other two types of victimization history. Health care providers working with college women should implement a trauma-informed approach to addressing gynecological health complaints that recognizes that sexual victimization survivors are at an increased risk for these issues. Further, anxiety and depression represent possible mechanisms of risk for gynecological health complaints among survivors.

Influence of "Decide + Be Ready" Contraceptive Decision Aid on Pre-deployment Health Decisions.

The number of active duty servicewomen and the career opportunities available to them continue to increase. Of the approximately 350,000 women in uniform, 97% are estimated to be of reproductive age, underscoring the importance of reproductive health care. This study aimed to explore the influence of the Decide + Be Ready (DABR) contraceptive decision aid on providing contraceptive knowledge, facilitating a servicewoman's contraceptive choice before and during deployment, and enabling understanding of individual preferences around contraception in a population of active duty women most at risk for unintended pregnancy. We conducted a qualitative study, recruiting active duty women between the ages of 17 and 24 with at least one prior deployment who were stationed at Naval Station Norfolk and presented for evaluation at a primary care clinic. Participants downloaded and reviewed the DABR application. A semi-structured interview was conducted and audio-recorded. Interviews were transcribed and underwent thematic analysis. Twenty women participated in the study over 2 weeks. Analysis revealed three overarching themes: perceived utility of and attitudes toward DABR, knowledge of and comfort with contraceptive options, and challenges specific to active duty women. In total, eight subthemes were also identified and explored. The DABR app provided study participants with new information about contraception. Participants reported improved knowledge of gynecologic and reproductive health options available during deployment. Other findings raise interest for future studies exploring incorporation of peer validation in counseling and decision-making tools, challenges with the deployed environment for obstetric/gynecologic health, and medical support on naval deployments.

Vaginal microbiome-host interactions modeled in a human vagina-on-a-chip

BackgroundA dominance of non-iners Lactobacillus species in the vaginal microbiome is optimal and strongly associated with gynecological and obstetric health, while the presence of diverse obligate or facultative anaerobic bacteria and a paucity in Lactobacillus species, similar to communities found in bacterial vaginosis (BV), is considered non-optimal and associated with adverse health outcomes. Various therapeutic strategies are being explored to modulate the composition of the vaginal microbiome; however, there is no human model that faithfully reproduces the vaginal epithelial microenvironment for preclinical validation of potential therapeutics or testing hypotheses about vaginal epithelium-microbiome interactions.ResultsHere, we describe an organ-on-a-chip (organ chip) microfluidic culture model of the human vaginal mucosa (vagina chip) that is lined by hormone-sensitive, primary vaginal epithelium interfaced with underlying stromal fibroblasts, which sustains a low physiological oxygen concentration in the epithelial lumen. We show that the Vagina Chip can be used to assess colonization by optimal L. crispatus consortia as well as non-optimal Gardnerella vaginalis-containing consortia, and to measure associated host innate immune responses. Co-culture and growth of the L. crispatus consortia on-chip was accompanied by maintenance of epithelial cell viability, accumulation of D- and L-lactic acid, maintenance of a physiologically relevant low pH, and down regulation of proinflammatory cytokines. In contrast, co-culture of G. vaginalis-containing consortia in the vagina chip resulted in epithelial cell injury, a rise in pH, and upregulation of proinflammatory cytokines.ConclusionThis study demonstrates the potential of applying human organ chip technology to create a preclinical model of the human vaginal mucosa that can be used to better understand interactions between the vaginal microbiome and host tissues, as well as to evaluate the safety and efficacy of live biotherapeutics products.AsSRkJhp7GmswS9e3XcXgrVideo

A brief qualitative study of indigenous traditional medicine providers in Timor-Leste

Providers of Traditional Timorese Medicine are an essential resource in rural communities, contributing greatly to the overall health of individuals in Timor-Leste. Their identity and role in healthcare has not been widely investigated and functions outside of the National Health System. The objective of this qualitative study is to describe the role of providers of Timorese Traditional Medicine in Timor-Leste and their practice of medicine. To perform this research, semi-structured interviews were performed with providers of Traditional Timorese Medicine in the rural district of Viqueque. Interviews took place at providers’ homes in Tetun and, after translation into English, interview content was analyzed and emergent common themes identified. The seven providers of Timorese Traditional Medicine interviewed mostly identified themselves as either a Liman Badain, Matan-Dook, or reported no title. Another identified himself by his political position as village chief, Xefe-Suku. Emergent themes from interview content included 1) Medical pluralism, reflecting that Timorese frequently use more than one medical system; 2) Spiritual sickness, reflecting illness and treatments commonly involving ancestral spirits or supernatural forces; and 3) Familial knowledge, reflecting healing practices and knowledge often kept within a family and passed down across generations. Generally, providers reported that the most common symptoms they treated in their practice were illnesses/misfortunes related to a woman’s gynecologic health and were obstetric in nature, especially concerns regarding reproductive health. This qualitative study provides information about the key role of select individual providers of Timorese Traditional Medicine and adds to the limited existing knowledge. Further qualitative and quantitative research must be done to further characterize the identities and role of different providers of Traditional Timorese Medicine.

A Black Feminist Analysis of Patient Provider Concordance in Sexual Health Care

Racial disparities in gynecological health have persisted over time. Interestingly, there is a dearth of research that centers Black women’s experiences with gynecologists and even less research that uses Black feminist theory and methods. We use semi-structured interviews ( N = 39) to understand the sexual health care related experiences of Black women at a Predominately White Institution (PWI) and a Historically Black College or University (HBCU). We found that the following themes captured Black women’s experiences: (1) Feeling Ignored, (2) Having Their Intelligence Insulted, (3) Receiving Proper Help and Education, (4) Benefits of Concordance across Race and Sex Categories, (5) Discomfort Due to Sexual Taboos, (6) Perceived Medical Racism, (7) Impact of other Intersectional Identities, and (8) No Impact. Implications for enhancing experiences with sexual health care appointments and improving patient provider relationships are discussed.

Trauma-Informed Care for Obstetric and Gynecologic Settings.

Trauma is common among those seeking Ob-Gyn care and may have pervasive impact on obstetrical and gynecological health, social functioning, and healthcare engagement. While guidelines exist on the detection and treatment of perinatal mood and anxiety disorders within Ob-Gyn care, the role of Ob-gyn clinicians in identifying and addressing patients' traumatic experiences and related symptoms is less clearly delineated. This manuscript provides an overview of trauma-related symptoms in the context of Ob-Gyn care and practical guidance of clinicians aiming to improve their detection and response to trauma in their clinical practice. Posttraumatic stress disorder (PTSD) describes a psychiatric illness which develops as a response to a traumatic event. Women who have experienced trauma are also at increased risk for borderline personality disorder and other psychiatric comorbidities. Postpartum PTSD has particular relevance to obstetrical care. Screening for trauma in Ob-Gyn care can provide an opportunity to address risk and offer targeted intervention. Several brief evidence-based screening tools are available. Individuals who screen positive require assessment of immediate safety and targeted referrals. Trauma informed care describes an approach to healthcare aimed to enhance physical and emotional safety for patients and clinicians. Given the prevalence and the potentially devastating and enduring impact of trauma and trauma-related symptoms, there is a critical need to address trauma within Ob-Gyn care. By recognizing the signs of trauma and initiating or referring to appropriate treatments, Ob-Gyn clinicians have a unique opportunity to better understand their patients and to improve their care.

Cerveau maternel : Théorie bayésienne de l’intéroception maternelle pendant la grossesse et le postpartum

The perinatal period, including pregnancy and postpartum, causes major morphological, endocrinal, and thermal transitions in women. As the fetus grows, abdominal muscle fibers stretch, internal organs such as the bladder or colon move, and the uterine anatomy changes. Many of these changes involve interoception, the perception of internal body signals such as muscle and visceral sensations. Despite the importance of these interoceptive signals, few studies have explored perinatal interoception. We propose an innovative theory of maternal interoception based on recent findings in neuroscience. We show that interoceptive signals processing during pregnancy is crucial for understanding perinatal phenomenology and psychopathology, such as maternal perception of fetal movements, maternal-infant bonding, denial of pregnancy, phantom fetal movements after childbirth, pseudocyesis or even puerperal delusion. Knowing the importance of these interoceptive mechanisms, clinicians in obstetrics, gynecology and mental health should be particularly vigilant to maternal interoception during the perinatal period.

Roles of the Microbiota of the Female Reproductive Tract in Gynecological and Reproductive Health.

The microbiome of the female reproductive tract defies the convention that high biodiversity is a hallmark of an optimal ecosystem. Although not universally true, a homogeneous vaginal microbiome composed of species of Lactobacillus is generally associated with health, whereas vaginal microbiomes consisting of other taxa are generally associated with dysbiosis and a higher risk of disease. The past decade has seen a rapid advancement in our understanding of these unique biosystems. Of particular interest, substantial effort has been devoted to deciphering how members of the microbiome of the female reproductive tract impact pregnancy, with a focus on adverse outcomes, including but not limited to preterm birth. Herein, we review recent research efforts that are revealing the mechanisms by which these microorganisms of the female reproductive tract influence gynecologic and reproductive health of the female reproductive tract.

Recours au soin gynécologique chez les femmes rapportant des violences sexuelles : étude qualitative

IntroductionSexual violence can be followed by different levels of gynecological care. Our objective was to characterise gynecological care and to identify the related factors among women who had reported sexual violence. MethodsTwenty-five semi-structured interviews were conducted among adult women who reported sexual violence during childhood or as adults. Topics addressed included gynecological health, gynecological care and experienced violence, ResultsInterviewed women, aged 20-60, had a good professional integration and a high level of education. The violence had often been committed by a relative or acquaintance. For the women interviewed, the least use of gynecological care was motivated by a desire to avoid the gynecological examination. Among women who had regular check-ups, the desire to conform to the norm explained their need for gynecological check-ups, which was similar to that of women who had never been subjected to violence. Lastly, some care pathways were characterised by multiple recourse of gynecological care for complaints with identical motives. The women interviewed expected professionals to spontaneously identify the violence they had suffered and the gynecological consequences attributed to such violence. ConclusionIndividual and interpersonal differences in levels of gynecological care use were related to the characteristics of the violence and its perceived effects on gynecological health. It would be interesting to extend this research by examining the care pathways of women with other socioeconomic characteristics. A quantitative study would measure the association between violence and the use of gynecological care.