Gynecological Symptoms Research Articles

Language-concordant, patient-centered gynecology oncology symptom screening.

85 Background: Patients with advanced gynecologic cancer experience symptoms at diagnosis, on treatment, at recurrence, and at the end of life. There is no standardized screening or interventions for these symptoms. Further, little is known about how primary language affects the screening and treatment of symptoms. Our aim was to understand patients’ preferences when screening for symptoms. The secondary aim was to explore patients’ attitudes using symptom screening tools and to understand obstacles in communication. Methods: Patients with advanced or recurrent gynecologic cancer (ovary, cervix, uterus, vulva), who speak Spanish or English, participated in focus groups facilitated by research staff in a semi-structured discussion on a virtual platform for 1 hour. Spanish language groups were led by native Spanish-speaking research staff. Transcripts of the discussions were translated by certified translators. A validated symptom screening tool and focused gynecologic symptoms screening tool were administered, and feedback elicited. Transcripts were independently reviewed by 3 investigators to identify common themes. Discrepancies were reconciled via consensus. Results: There was a total of 21 participants, 14% were Spanish primary speakers and 85% English speaking. Twenty-nine percent of participants were Black, half of whom identified as Afro-Latinas, 14% Asian, and 5% American Indian. Most patients had ovarian (65%) or uterine cancer (20%). Most patients had recurrent disease (57%), 33% were stage III, 10% were stage IV. Eighty-one percent completed a web-based symptoms survey. Using a symptom screening tool was readily accepted by Spanish- and English-speaking patients. Participants highlighted four important themes: 1) Education and attention to symptoms for early detection of recurrence; 2) mental health and support groups with a noted disparity in access for the Spanish-speaking patients; 3) palliation of treatment-related symptoms; and language concordance between patient; and 4) care team identified by the Spanish-speaking group. Conclusions: Clear communication and education about symptoms are important to patients. Patients experience many mental health symptoms and desire therapy and support groups. Patients want to be screened for symptoms, and there is a strong desire for bilingual resources. Next steps include conducting focus groups with physicians and staff who provide care for this patient population and implementing a screening tool in our clinics.

Dynamic Risk Prediction of Treatment Discontinuation Using Patient-Reported Outcomes Data in the Phase III NSABP B-35 Trial.

The dynamic prediction provided by partly conditional models offers valuable insights into the treatment discontinuation risks using PRO data collected over time from clinical trial participants. This tool may benefit healthcare professionals in identifying patients at high risk of premature treatment discontinuation and support interventions to prevent potential discontinuation.

Türkiye'deki Suriyeli Kadın Mülteciler Arasında Travmanın Bir Sonucu Olarak Yeni Başlayan Oligomenore

Introduction: Depression is a common psychological response to trauma and stress, and research suggests that depression may play a role in the development of menstrual irregularities in women, including oligomenorrhea. Aim: The aim of this study was to investigate the gynecological symptom of oligomenorrhea as a consequence of traumatic events and its relation with depression and sexual dysfunction in Syrian refugee women in Turkey. Materials and Methods: The study was held in one of the refugee camps in Turkey (Cevdetiye, Osmaniye) in April 2013. A total of 404 Syrian refugee women were interviewed during their medical visits at the gynecology and obstetrics outpatient clinic located in the refugee camp for menstrual cycle irregularities, depression and sexual dysfunction in regard to the parameters such as the level of linguistic communication skills, ethnic origin, marital status, active involvement of husband or loss of any first degree relative in civil war. Results: A total of 404 refugee women of different ethnicities (Turkish n=310 and Arabic n=94) were interviewed. Out of 404 participants, 200 (49.5%) had secondary oligomenorrhea (study group) and 204 (50.5%) had normal menstrual cycles (control group). Oligomenorrhea was found to be significantly associated with decreased sexual function, active involvement of husband in civil war and higher depression scores. Conclusion and suggestion: Depression is one of the major component of post-traumatic events and one of the known reasons of menstrual irregularities in women. Menstrual irregularities, particularly oligomenorrhea, may be an objective and initial gynecological sign in refugee women alerting the clinicians to refer the women for further psychiatric evaluation

A Qualitative Analysis of the Fertility Experience and Gender Identity in Young Women Following Hysterectomy for Benign Disease

Hysterectomy may impact young women’s perceptions of their gender identity and fertility status, with implications for quality of life. However, research into this important area is limited, particularly among women with benign disease. To investigate gender identity and fertility in this population, semi-structured interviews were conducted with 18 women who underwent hysterectomy for benign disease at age 39 or younger. Women were asked to describe their experience of hysterectomy and how it affected their perceptions of their gender identity, fertility status and overall quality of life. Thematic analysis was used to analyse and code responses. Three themes were identified; Implications of Infertility, I am a Woman and Womanhood Compromised. Within these themes, 3 sub-themes were identified. Implications of Infertility comprised three sub-themes describing women’s varied relationships with their post-hysterectomy infertility: Plans Fulfilled, Acceptable Compromise and Persistent Grief. A novel finding was that women engaged in a “trade-off”, whereby relief of gynaecological symptoms outweighed their desire for a child/further child/ren. The study also found that women with an extensive history of infertility may have more trouble adjusting to the outcomes of their hysterectomy than women who were satisfied with their fertility history. Counselling around identity and how this can be influenced by fertility status may be needed. Further research into the psychological processes involved in the “trade-off” is also needed.

Effectiveness of laparoscopic niche resection versus expectant management in patients with unexplained infertility and a large uterine caesarean scar defect (uterine niche): protocol for a randomised controlled trial (the LAPRES study)

IntroductionA uterine niche is a defect at the site of the uterine caesarean scar that is associated with gynaecological symptoms and infertility. Promising results are reported in cohort studies after...

Concurrent Surgery for Locoregional Gynecologic Cancers and Pelvic Floor Disorders in a Population of Patients With Medicare Insurance

(Abstracted from Obstet Gynecol 2023;141:629–641) Most women diagnosed with a gynecologic cancer report symptoms related to pelvic organ prolapse or urinary incontinence (POP-UI) before and during their cancer treatment. Often, these symptoms go untreated; however, several studies have suggested concurrent surgery for gynecologic cancer, and POP-UI symptoms is safe and may reduce total surgeries but lack long-term follow-up data.

P-439 Intimate hygiene practices and the correlation with abnormal vaginal microbiota in in vitro fertilization (IVF) patients – a cohort study in 1421 patients

Abstract Study question What are the intimate hygiene practices of women in IVF treatment and do they correlate with the vaginal microbiota? Summary answer Hygiene practices, in specific douching and use of intimate soap significantly increased the risk of abnormal vaginal microbiota (AVM). What is known already The normal vaginal microbiota acts as a defense system against infection. AVM is a molecularly defined vaginal dysbiosis, resembling bacterial vaginosis (BV) and is dominated by anaerobic bacteria such as Gardnerella vaginalis. Importantly, AVM is associated with an increased risk of genital tract infections, poor IVF outcomes, early miscarriage and preterm labor. The cause of AVM is multifactorial and hygiene practices may interrupt the normal microbiota. Previous small studies suggested vaginal douching to be associated with an increased risk of AVM. Few studies have investigated the possible correlation between intimate hygiene practices, menstrual practices and the vaginal microbiota. Study design, size, duration Observational cohort study, including a total of 1421 IVF patients from four Danish fertility centers. The inclusion period was from 2017 to January 2022. Participants/materials, setting, methods Patients aged 18-42 years and undergoing their first, second or third IVF stimulation cycle were eligible for inclusion. The intimate hygiene practices in terms of type of soap, menstrual protection, douching and probiotics, were reported in a structured questionnaire including a total of 40 questions. Vaginal swabs were obtained prior to ovarian stimulation and subsequently subjected to quantitative PCR testing, targeting DNA of dysbiotic bacteria. Main results and the role of chance AVM was present in a total of 34 % (479/1421) of women, and 20% (272/1384) reported vaginal douching, which significantly correlated with AVM (p < 0.01, OR = 1.62 [1.23-2.12]). Intimate soap was used by 39 % (535/1384) of patients, which also significantly increased the risk of AVM ( P = 0.04, OR = 1.35 [1.08-1.69]). Water only was used by 36% (492/1384), and regular soap was used by 27% (374/1384). No correlation between use of water only and regular soap and AVM was detected. For menstrual protection 40% (433/1078) used pads, followed by tampons alone 25% (265/1078) or a combination 21% (230/1078), and 14 % (148/1078) used a menstrual cup. A trend for an increased risk of AVM when using tampons, OR 1.21 [0.91-1.62] was seen whereas use of a menstrual cup seemed to lower the risk of AVM, OR 0.71 [0.48-1.04] Active smoking, higher BMI, drinking >7 units per week and previous chlamydia infection significantly correlated with AVM (p = 0.01, p = 0.01, p = 0.04 and p = 0.01). Finally, 84% (1190/1421) reported gynecological symptoms such as vaginal discharge, dyspareunia and fungal infection, but only fishy odor significantly correlated with AVM (p < 0.01). Limitations, reasons for caution To the best of our knowledge, this is the largest study investigating the intimate hygiene practice and its correlation with AVM in an IVF population. As these results describe the practices of a Scandinavian IVF population, results may differ from other settings and ethnicities. Wider implications of the findings Exploration of the cause-and-effect relations between intimate hygiene practices and AVM is needed, requiring intervention-based prospective studies. This would lead to evidence-based advice on intimate hygiene practices and AVM prevention, possibly increasing live birth rates. The unexpected high prevalence of douching in a Danish IVF population needs further exploration. Trial registration number NCT03420859

P-751 Comparing levonorgestrel intrauterine system versus hysteroscopic niche resection in women with postmenstrual spotting related to a niche in the uterine caesarean scar

Abstract Study question To compare the effectiveness of levonorgestrel-releasing intrauterine system (LNG-IUS 52mg) with hysteroscopic niche resection in the reduction of niche-related postmenstrual spotting. Summary answer In women with niche-related postmenstrual spotting, LNG-IUS did not more often reduce spotting days with 50% at 6th month than hysteroscopic niche resection. What is known already Both Levonorgestrel intrauterine system (LNG-IUS) and hysteroscopic niche resection are widely implemented to reduce niche-related postmenstrual spotting. The study aimed to compare the effectiveness of LNG-IUS 52mg with hysteroscopic niche resection in the reduction of niche-related postmenstrual spotting. Study design, size, duration A randomised, open-label, controlled trial conducted at one medical center in Shanghai, China. From September 2019 to January 2022, we randomised 208 women to LNG-IUS (N = 104) or hysteroscopic niche resection (N = 104).The primary outcome was reduction of postmenstrual spotting at 6th month after randomisation, defined as percentage of women with a reduction of at least 50% in spotting days from baseline. Efficacy and safety were assessed by an intention-to-treat analyses. Participants/materials, setting, methods Women with symptoms of postmenstrual spotting after CS, with a niche depth of at least 2 mm and residual myometrium of at least 2.2mm on Magnetic Resonance Imaging (MRI), and no intention to conceive within the next year were randomly assigned to treatment with LNG-IUS 52mg or a hysteroscopic niche resection. Main results and the role of chance At 6th month follow-up, a 50% reduction of spotting had occurred in 78.4% (80/102) women in the LNG-IUS group and 73.1% (76/104) women in the hysteroscopic niche resection group (RR = 1.07, [95%CI 0.92-1.25]; P = 0.370). Spotting reduced over time (Ptrend=0.001), with a stronger reduction in the LNG-IUS group (P = 0.001), while there was also a significant interaction between time and treatment (P = 0.007). From nine months onwards, reduction of spotting occurred significantly more after LNG-IUS than hysteroscopic niche resection (9th month 89.2% vs. 72.1%, RR = 1.24, [95% CI 1.08-1.42]; 12th month 90.2% vs. 70.2%, RR = 1.29, [95% CI 1.12-1.48]). Moreover, compared with the hysteroscopic niche resection group, the LNG-IUS group had significantly fewer postmenstrual spotting days and total bleeding days from six months onwards (all P < 0.001), and less pelvic pain from three months onwards (all P < 0.010). Intervention-related complications were not reported in any of the groups. During follow-up, eleven (10.8%) women reported hormonal related side-effects and two (2.0%) women had spontaneous partial expulsion in the LNG-IUS group, while in the hysteroscopic niche resection group three unintended pregnancies were reported. Limitations, reasons for caution Due to the nature of the intervention, it was not possible to blind participants and gynaecologists for treatment allocation.The cut-off value chosen for our primary outcome and the moment of assessment for our primary endpoint can both be debated. Wider implications of the findings LNG-IUS provides an alternative treatment for women with niche-related gynaecological symptoms and no active desire to become pregnant. Trial registration number Chinese Clinical Research Center (ChiCTR1900025677)

Lower genital tract infection: a community-based approach study

Introduction and objectives: Infections of the lower vaginal tract are one of the most prevalent diseases affecting women, and can cause not only acute illness but also complications and sequelae. This study aims to to determine the epidemiology and some related factors of lower genital tract infections in the community of Quang Tri province.
 Materials and Methods: A descriptive cross-sectional study was conducted with 1010 women aged 21 to 65 who had sex in 12 communes in three districts of Quang Tri province (Hai Lang, Trieu Phong and Gio Linh). The information was gathered between July 2019 and July 2020. Participants were inspected to determine the condition of the cervix and vagina, and to collect cervical/vaginal swab samples for wet mount evaluation by a parasitologist.
 Results: Itching was the most prevalent gynecological symptom (21.8%), followed by abnormal discharge (2.7% ). The macroscopic appearance of the cervix in 46.8% of patients was normal. Positive wet mount results were observed in 59.6% of cases. The most prevalent disorder was accounted for bacterial vaginosis (86.0%), followed by Candida species (13.7%) and parasites (0.3%). Positive wet mount microscopy results were associated with IUD (OR=0.699, 95% CI: 0.526 - 0.928) and farming occupation (OR=0.719, 95% CI: 0.554 - 0.932) (p<0.05).
 Conclusions: Lower genital tract infections are caused by a variety of pathogens and influenced by a number of variables, with bacterial pathogens being the most prevalent. The results of the study provide further clinical and epidemiological data that may aid in enhancing the quality of treatment for infections of the lower genital tract.

Severe pelvic pain is associated with sexual abuse experienced during childhood and/or adolescence irrespective of the presence of endometriosis.

Is endometriosis associated with childhood and/or adolescent sexual abuse? Endometriosis is not associated with a history of sexual abuse, unlike the presence of severe pelvic pain. Several studies have highlighted a link between pelvic pain and sexual abuse during childhood/adolescence. Moreover, an inflammatory state has been described in patients with a history of childhood maltreatment. Given that inflammation and pelvic pain are two entities often encountered with endometriosis, several teams have investigated whether endometriosis is associated with abuse during childhood/adolescence. However, the results are conflicting, and the link between sexual abuse and the presence of endometriosis and/or pain is hard to disentangle. A survey nested in a cohort study of women surgically explored for benign gynecological indications at our institution between January 2013 and January 2017. For each patient, a standardized questionnaire was completed during a face-to-face interview with the surgeon in the month preceding the surgery. Pelvic pain symptoms (dysmenorrhea, deep dyspareunia, non-cyclic chronic pelvic pain, and gastrointestinal or lower urinary tract symptoms) and their intensities were assessed with a 10 cm visual analog scale (VAS). Pain was considered to be severe when the VAS score was ≥7. A 52-question survey was sent in September of 2017 to evaluate abuses, especially sexual abuse during childhood and/or adolescence, and the psychological state during childhood and adolescence. The survey was structured to cover the following sections: (i) abuses and other life events during childhood and adolescence; (ii) puberty and body changes; (iii) onset of sexuality; and (iv) family relationships during childhood and adolescence. The patients were divided into groups according to whether or not they exhibited histologically proven endometriosis. Statistical analyses were conducted using univariate and multivariate logistic regression models. Two hundred and seventy-one patients answered all the questions of the survey: 168 with (endometriosis group) and 103 without endometriosis (control group). The mean ± SD overall population age was 32.2 ± 5.1 years. There were 136 (80.9%) and 48 (46.6%) women who experienced at least one severe pelvic pain symptom in the endometriosis and the control groups, respectively (P < 0.001). No differences were found between the two study groups regarding the following characteristics: (i) a history of sexual, physical, or emotional abuse; (ii) a history of abandonment or bereavement; (iii) the psychological state regarding puberty; and (iv) the family relationships. After multivariable analysis, we found no significant association between endometriosis and a history of sexual abuse during childhood and/or adolescence (P = 0.550). However, the presence of at least one severe pelvic pain symptom was independently associated with a history of sexual abuse (odds ratio = 3.6, 95% CI (1.2-10.4)). Evaluation of the psychological state during childhood and/or adolescence can be subject to recall bias. In addition, selection bias is also a possibility given that some of the patients surveyed did not return the questionnaire. Severe gynecological painful symptoms in women with or without histologically proven endometriosis may be linked to sexual abuse experienced during childhood and/or adolescence. Patient questioning about painful symptoms and abuses is important to provide comprehensive care to the patients, from a psychological to a somatic point of view. No funding or competing interests. N/A.

Clinical factors of the risk of hyperplastic endometry processes on tamoxifen therapy with breast cancer: Retrospective population study

Background. One of the main stages of the treatment of breast cancer (BC) is endocrine therapy with tamoxifen or aromatase inhibitors. Five years of adjuvant tamoxifen therapy reduces the risk of disease recurrence by 39%. Tamoxifen was approved by the U.S. Food and Drug Administration in 1977 as a treatment for ER-positive BC. However, sometime after the start of tamoxifen's wide use, reports have been published on its long-term adverse effects. Most common were hot flashes, gynecological symptoms (vaginal dryness, vaginal discharge), depression, forgetfulness, sleep changes, weight gain, and decreased libido. However, more serious adverse events such as venous thromboembolic disease and endometrial hyperplasia or cancer are the most clinically significant. The article presents the results of a retrospective population-based study on assessing hyperplastic processes of the endometrium (HPE) in patients with breast cancer during TAM therapy, conducted in 2017, approved by the Ethics Committee of the Scientific Research of the Russian Medical Academy of Continuing Professional Education. Aim. To identify clinical factors that may increase the risk of HPE during tamoxifen therapy in patients with a history of breast cancer living in the Moscow region. Materials and methods. We retrospectively reviewed 230 case histories of patients with breast cancer. Of these, 120 patients who received TAM therapy had the following HPE risk factors: average age, menopausal status, body mass index, and duration of TAM therapy. Results. It was found that patients with HPE taking TAM were older (p=0.017), more likely to be postmenopausal (p=0.035), overweight (p=0.023), and received TAM for a longer period (p=0.028) than patients without HPE. Conclusion. The data obtained indicate the need for continuous monitoring by gynecologists of patients with breast cancer taking tamoxifen, paying particular attention to women from high-risk groups, namely older postmenopausal women with high body mass index receiving TAM for more than 1.52 years.

Disparities in Women With Endometriosis Regarding Access to Care, Diagnosis, Treatment, and Management in the United States: A Scoping Review.

Endometriosis is a benign gynecological condition that elicits chronic pain in 2-10% of reproductive-age women in the United States and exists in approximately 50% of women with infertility. It creates complications such as hemorrhage and uterine rupture. Historically, the gynecologic symptoms of endometriosis have been associated with economic strain and inferior quality of life. It is suspected that endometriosis diagnosis and treatment are affected by health disparities throughout gynecological care. The goal of this review was to collate and report the current evidence on potential healthcare disparities related to endometriosis diagnosis, treatment, and care across race, ethnicity, and socioeconomic status. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched the Excerpta Medica Database (EMBASE), Medline Ovid, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and PsycInfo databases for relevant articles on the topic. Eligibility was established a priori to include articles written in English, published between 2015-2022, and reported on cohort, cross-sectional, or experimental studies conducted in the United States. Initially, 328 articleswere found, and after screening and quality assessment, four articles were retained for the final review.Results indicated that White women had higher rates of minimally invasive procedures versus open abdominal surgeries than non-White women. White women also had fewer surgical complications compared to all other races and ethnicities. Black women had higher rates of perioperative complications, higher mortality, and spent more time in the perioperative stage than any other race or ethnicity. In the management of endometriosis, the limited research available showed that all non-White women encountered an increased risk of perioperative and postoperative complications compared to White women. More research is needed to explore diagnostic and treatment disparities beyond surgical management, socioeconomic barriers, andimproved representation of racial and ethnic minority women.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Definition and Criteria for Diagnosing Cesarean Scar Disorder

Approximately 60% of women develop a uterine niche after a cesarean delivery (CD). A niche is associated with various gynecological symptoms including abnormal uterine bleeding, pain, and infertility, but there is little consensus in the literature on the distinction between the sonographic finding of a niche and the constellation of associated symptoms. To achieve consensus on defining the clinical condition that constitutes a symptomatic uterine niche and agree upon diagnostic criteria and uniform nomenclature for this condition. A consensus based modified electronic Delphi (eDelphi) study, with a predefined Rate of Agreement (RoA) of 70% or higher. Experts were selected according to their expertise with niche-related consultations, publications, and participation in expert groups and received online questionnaires between November 2021 and May 2022. Definition, nomenclature, symptoms, conditions to exclude, and diagnostic criteria of an illness caused by a symptomatic uterine niche. In total, 31 of the 60 invited experts (51.7%) participated, of whom the majority worked in university-affiliated hospitals (28 of 31 [90.3%]), specialized in benign gynecology (20 of 31 [64.5%]), and worked in Europe (24 of 31 [77.4%]). Three rounds were required to achieve consensus on all items. All participants underlined the relevance of a new term for a condition caused by a symptomatic niche and its differentiation from a sonographic finding only. Experts agreed to name this condition cesarean scar disorder, defined as a uterine niche in combination with at least 1 primary or 2 secondary symptoms (RoA, 77.8%). Defined primary symptoms were postmenstrual spotting, pain during uterine bleeding, technical issues with catheter insertion during embryo transfer, and secondary unexplained infertility combined with intrauterine fluid. Secondary symptoms were dyspareunia, abnormal vaginal discharge, chronic pelvic pain, avoiding sexual intercourse, odor associated with abnormal blood loss, secondary unexplained infertility, secondary infertility despite assisted reproductive technology, negative self-image, and discomfort during participation in leisure activities. Consensus was also achieved on certain criteria that should be met and conditions that should be excluded before making the diagnosis. In this modified Delphi study, a panel of 31 international niche experts reached consensus for the constellation of symptoms secondary to a uterine niche and named it cesarean scar disorder.

Risk factors based on myoma characteristics for predicting postoperative complications following cesarean myomectomy.

To evaluate the influence of myoma characteristics on cesarean myomectomy and to demonstrate its additional advantages. Retrospective data were collected from 292 women with myomas who had undergone cesarean section at Kangnam Sacred Heart Hospital between 2007 and 2019. We performed subgroup analysis according to the type, weight, number, and size of myomas. Preoperative and postoperative hemoglobin levels, operative time, estimated blood loss, length of hospital stay, incidence of transfusion, uterine artery embolization, ligation, hysterectomy, and postoperative complications were compared among subgroups. There were 119 patients who had cesarean myomectomy and 173 who had cesarean section only. An increase in postoperative hospitalization and operation time was observed in the cesarean myomectomy group compared to that in the caesarean section only group (mean difference, 0.7 days, p = 0.01, 13.5 minutes, p <0.001). Estimated blood loss, hemoglobin differences, and transfusion rates were higher in the cesarean myomectomy than in the cesarean section only group. There were no differences in postoperative complications (fever, bladder injury, and ileus) between the two groups. No hysterectomy cases were reported in the cesarean myomectomy group. In subgroup analysis, the larger and heavier the myoma, the higher the risk of bleeding that led to transfusion. Estimated blood loss, differences in hemoglobin, and transfusion rate increased depending on myoma size and weight. A significant increase in postoperative hospitalization was observed in women with larger and heavier myomas. However, there was no statistical difference among the three types of myomas. In cesarean myomectomy, larger (≥ 10 cm), and heavier myomas (≥ 500 g), were associated with postoperative outcomes, but not the number or type of myoma. The safety of cesarean myomectomy is not inferior to that of caesarean section only, considering its positive effects such as gynecological symptom relief and avoidance of the next surgery.

Urine CA125 and HE4 for the Detection of Ovarian Cancer in Symptomatic Women.

The symptoms of ovarian cancer are vague, and current risk assessment tools such as serum CA125 and transvaginal ultrasound scan fail to reliably detect the disease early. This study aimed to evaluate urine CA125 and HE4 as diagnostic biomarkers for ovarian cancer in symptomatic women. Paired urine and serum samples were collected from women undergoing treatment for ovarian cancer (cases) or investigations for gynaecological symptoms (controls). Biomarkers were measured using an automated chemiluminescent enzyme immunoassay analyser. Standard diagnostic accuracy metrics were calculated. In total, 114 women were included, of whom 17 (15%) were diagnosed with an epithelial ovarian malignancy. Levels of urine CA125 and HE4 were significantly elevated in women with ovarian cancer compared to controls [CA125: 8.5 U/mL (IQR: 2.4-19.5) vs. 2.3 U/mL (IQR: 1.0-6.4), p = 0.01. HE4: 12.0 nmol/L (IQR: 10.3-23.1) vs. 6.7 nmol/L (IQR: 3.4-13.6), p = 0.006]. Urine CA125 and HE4 detected ovarian cancer with an AUC of 0.69 (95% CI: 0.55-0.82) and 0.71 (95% CI: 0.69-0.82), respectively (p = 0.73). A combination of urine CA125 and HE4 at optimal thresholds had a sensitivity of 82.4% (95% CI: 56.6-96.2) and was comparable to the sensitivity of serum CA125 [88.2% (95% CI: 63.6-98.5)]. Larger studies are required to confirm our findings, standardise urine collection, and evaluate optimal biomarker thresholds. Urine CA125 and HE4 may be useful non-invasive diagnostic tools to triage women for formal ovarian cancer investigations.

Pelvic Ultrasound Imaging-Based Prevalence of Gynecological Morbidity in a Population of Asymptomatic Reproductive-Age Women Attending a Healthcare Outreach Program in the Andaman and Nicobar Islands of India.

Gynecological morbidity in the reproductive age is defined as any condition, disease, or dysfunction of the reproductive system that is not related to pregnancy, abortion, or childbirth. Common gynecological symptoms include irregular menstruation, white vaginal discharge, burning urination, itching of the vulva, inguinal swelling, and nonmenstrual bleeding or spotting and chronic pelvic pain. Masses of the reproductive tract, adnexal masses, and polycystic ovary syndrome also occur in the reproductive age group. Gynecological disease contributes to nearly 4.5% of the overall global disease burden and exceeds the prevalence of other major global diseases such as malaria, tuberculosis, ischemic heart disease, and maternal conditions. Ultrasound is a painless, noninvasive imaging modality that can be used for the detection of gynecological abnormalities. This study uses pelvic ultrasound imaging to estimate the prevalence of gynecological morbidity in a population of asymptomatic reproductive-age women attending a healthcare outreach program in the Andaman and Nicobar Islands of India.

Impact of COVID-19 vaccines on the health status of young female adults from India: A cross-sectional study.

Reports suggest that females experience more adverse events post-coronavirus disease 2019 (COVID-19) vaccination compared to males. However, no gender-specific data on the impact of vaccines on the Indian population are available. The present study was intended to understand the impact of COVID-19 vaccines on the health status of young Indian female adults and to identify the factors associated with experiencing adverse events post-vaccination. A web-based survey was conducted among 433 young female adults who have taken at least one dose of the COVID-19 vaccine. The prevalence and duration of systemic and generalized symptoms were analyzed using descriptive statistics. The factors associated with symptoms post-vaccination were analyzed using binary logistic regression. Adjusted odds ratios and 95% confidence intervals were computed. A P value of ≤ 0.05 was considered to be statistically significant. Of the 404 surveys returned (93.3%), 371 respondents have received both vaccine doses. COVISHIELD™ was the vaccine of choice among 73% of respondents and nearly 91% of the respondents reported a re-infection post-vaccination. At least one form of the symptom as a side effect of vaccination was experienced by 88.4% (n = 357) of the participants. This included generalized symptoms (77.5%) followed by musculoskeletal (53.2%), localized (38.9%), psychological (35.1%), gastrointestinal (25.5%), gynecological (24%), and endocrine symptoms (22.5%). Presence of chronic ailments was significantly associated with experiencing localized symptoms (OR 2.21, 95% CI 1.25-3.91), psychological symptoms (OR 2.41, 95% CI 1.34-4.34), neurological symptoms (OR 2.98, 95% CI 1.38-6.46), gastrointestinal symptoms (OR 4.76, 95% CI 2.59-8.75), respiratory symptoms (OR 2.45, 95% CI 1.29-4.67), endocrine symptoms (OR 2.92, 95% CI 1.58-5.38), and gynecological symptoms (OR 4.05, 95% CI 2.21-7.44). Older than 21 years was significantly associated with the experience of gynecologic symptoms (OR 2.12, 95% CI 1.24-3.64). Not being re-infected post-vaccination has lower odds of experiencing psychological, gastrointestinal, and respiratory symptoms. Our result suggests serious planning and counseling are warranted while disseminating COVID-19 vaccination among young female adults especially those with comorbidities to foster trust and coverage.

Cervical Cancer Care Seeking Behaviour Among Community Women, Jos-North, Plateau State

Most people are infected with HPV shortly after the onset of sexual activity. The screening rate has not reached the WHO's target. This study seeks to assess community women's care-seeking behavior toward cervical cancer screening participation. A cross-sectional design was employed, community women who met the criteria for inclusion were given a self-developed questionnaire conveniently. Results show that the majority (51.9%) of women were between the ages of 21-29, majority (83.0%) had only one sexual partner, majority (75.0%) were extremely poor with very low yearly income of less than 284,700.00 Naira, and 19.3% experienced gynecological symptoms. Majority (78.5%) have the fear of being diagnosed with cancer, and 69.6% fear exposing their genital area. Women agreed that HPV is the causative organism of cervical cancer and husband do not allow someone to touch their wives’ private parts. They moderately agreed that a woman must obtain consent from her husband before going for screening, that exposing their private part is culturally inappropriate. Only 14.1% of those surveyed had ever undergone a cervical cancer screening. Among the respondents who had screened, 57.9% had bad experience. There is a significant difference between age group and screening where majority who had screened were older women within the age group 30-65 years (X2=8.402; P-value=0.005) and having gynecological symptoms has positive influence on screening participation (X2=7.422; P-value=0.012). The majority (92.6%) believed that husband involvement and the caregiver's friendly attitude are among other facilitating conditions to screening. In conclusion, there was low screening participation among community women. Women's knowledge of cervical cancer and screening did not translate into participating in screening. Low socioeconomic status has a significant impact on screening, screening rates were higher among older women than younger ones, and experiencing gynecological symptoms has a positive impact on screening. It was therefore recommended that interventions aimed at enhancing care seeking behavior based on women's needs be implemented.

Disseminated Tuberculosis Presenting Primarily as Amenorrhoea- A Case Report

Mycobacterium Tuberculosis (MTB) primarily infects the lungs and spreads throughout the body after the initial infection. This dissemination occurs through the reactivation of a dormant focus, which is preceded by lymphohaematogenous spread. It can also spread through the bloodstream from active lung or miliary tuberculosis. Tuberculosis is the leading cause of amenorrhoea in young females in developing countries like India. Although disseminated tuberculosis with osteoarticular involvement is a rare occurrence, a 20-year-old female presented to Acharya Vinoba Bhave Rural Hospital (AVBRH) with primary complaints of amenorrhoea and swelling in the right knee joint, which were the primary symptoms of disseminated tuberculosis. The present case is exceptional because it lacks the typical pulmonary symptoms. The predominance of gynaecological symptoms over pulmonary involvement may have led to an incorrect diagnosis of malignancy instead of tuberculosis. Additionally, the suspicion of tuberculosis was delayed due to elevated ovarian tumour markers.