Young Nulliparous Women Research Articles

Effect of perineal body tone on sexual dysfunctions in young nulliparous women

Effect of perineal body tone on sexual dysfunctions in young nulliparous women

Quantitative 3D Analysis of Levator Ani Muscle Subdivisions in Nulliparous Women: MRI Feasibility Study.

The levator ani muscle (LAM) is crucial for pelvic floor stability, yet its quantitative MRI assessment is only a recent focus. Our study aims to standardize the quantitative analysis of the LAM morphology within the 3D Pelvic Inclination Correction System (3D-PICS). We analyzed 35 static MR datasets from nulliparous women examining the pubovisceral (PVM), iliococcygeal (ICM), coccygeal (COC), and puborectal muscle (PRM). The PVM consists of three origin-insertion pairs, namely the puboanal (PAM), puboperineal (PPM) and pubovaginal muscle (PVaM). The analysis included a quantitative examination of the morphology of LAM, focusing on the median location (x/y/z) (x: anterior-posterior, y: superior-inferior, z: left-right) of the origin and insertion points (a), angles (b) and lengths (c) of LAM. Inter-rater reliability was calculated. Interindividual variations in 3D coordinates among muscle subdivisions were shown. In all, 93% of all origin and insertion points were found within an SD of <8 mm. Angles to the xz-plane range between -15.4° (right PRM) and 40.7° (left PAM). The PRM is the largest pelvic muscle in static MRI. The ICC indicated moderate-to-good agreement between raters. The accurate morphometry of the LAM and its subdivisions, along with reliable inter-rater agreement, was demonstrated, enhancing the understanding of normal pelvic anatomy in young nulliparous women.

UMBILICAL ENDOMETRIOSIS: A CASE REPORT

Introduction: We report a recently observed case of secondary umbilical endometriosis (UE), with the main aim to discuss diagnosis and the management of this rare condition. Observation: A 41-year-old woman admitted to our facility with a nodular, bluish umbilical swelling, non- painful, gradually increasing in size, bleeding with her menstrual cycle. Ultrasonography did not reveal any images indicative of pelvic endometriotic lesions. A pelvic MRI was performed wich showed an ovoid formation at the umbilical level, suggestive of a UE implant. A biopsy of the lesion was also carried out, showing a morphological appearance compatible with parietal endometriosis. Histopathological analysis confirmed the diagnosis of UE. Neither symptoms or signs of local recurrence have been observed after 6 months. Discussion: Extra-pelvic endometriosis sites are not common, especially the umbilicus. It usually occurs secondary to surgical scars, specifically after laparoscopy or open abdominal surgery. UE should be taken into accounting differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. UE can be treated medically or surgically. Surgical treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis. Conclusion: Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.

Considering Cuteness Enhances Smiling Responses to Infant Faces1,2

AbstractLaboratory and field research has reported that the appearance of infants causes observers to smile. The current study examined whether this smiling response is modulated by the observer's task and evaluative dimension. Thirty‐nine young nulliparous women were asked to rate the cuteness or beauty levels of 6‐month‐old infants' faces using a 7‐point scale in different blocks. Facial electromyograms (EMGs) were recorded of participants' facial muscles related to both smiling (the zygomaticus major [ZM] and orbicularis oculi [OO]) and frowning (the corrugator supercilii [CS]). The results showed that cuteness and beauty ratings were highly correlated with each other (r = .90), indicating that these evaluations were based on similar attractiveness‐related physical features. Facial EMG responses on the smiling muscle sites, ZM and OO, increased significantly from the baseline when participants rated the faces' cuteness, and the responses were larger than when participants rated the faces' beauty. CS activity was not found to have any effect. The perceived cuteness level of the infant faces did not affect the facial EMG responses. Moreover, the magnitude of the smiling response was shown to be much smaller than that associated with voluntary smiling. These findings suggest that facial expressions while viewing infant faces do not exhibit a fixed pattern but are modulated by observers' tasks and that considering cuteness, which is based on more affective evaluations than beauty, can enhance smiling responses.

Age and parous-experience dependent changes in emotional contagion for positive infant sounds.

Emotional contagion is achieved by inferring and emotionally resonating with other persons' feelings. It is unclear whether age-related changes in emotional contagion for infant sounds are modulated by the experience of childbirth or childcare. This study aims to evaluate changes in inference and emotional resonance for positive and negative infant sounds (laughter and crying) among women, based on age and parous experience. A total of 241 women (60 young nulliparous, 60 young parous, 60 old nulliparous, and 61 old parous) completed a web-based questionnaire. After listening to three types of infant sounds (laughter, cooing, and crying), participants responded with their valence for hearing infant sounds and estimated infant valence on an 11-point Likert scale. The analysis for emotional resonance revealed that the correlation coefficient between self and estimated infant valences was greater in young parous and old nulliparous women than in young nulliparous women, in laughter and cooing sounds. However, correlation coefficients for crying did not differ among any of the four groups. The degree of emotional resonance for infant valence increased depending on age and parous-experience for positive infant sounds.

Fertility preservation and protection: young women’s decision-making about contraceptive use in Zimbabwe

The study explored social and health system influences on young women’s decision-making about family planning in a community setting with low uptake. Seventy-two semi-structured interviews were conducted between April 2020 and November 2021, with both young women accessing, and healthcare workers providing, a community-based integrated package of HIV and sexual and reproductive health services (CHIEDZA) in Zimbabwe. Data were thematically analysed. Although long-acting contraception was freely available as part of the CHIEDZA initiative, uptake was low. Young women’s contraception choices were influenced by a desired reproductive sequence, which reflected prevailing social norms and was conveyed by peers and female relatives. Nulliparous young women preferred short-term contraception and avoided hormonal contraceptives prepartum to ‘preserve’ their fertility. Once fertility had been confirmed within marriage through the birth of a child, hormonal contraceptive use became socially permissible. Healthcare workers, cognisant of community discourse, sensitively proposed alternative approaches. Increasing the availability of correct and adequate information and commodities is critical to improving the uptake of contraceptives for young women, but it is insufficient alone. Recognising and responding to local contextual understandings which frame considerations of appropriateness is paramount. Successful implementation of family planning interventions requires engaging with social norms and the influential groups that perpetuate them.

Endometrial stromal tumor in a young nulliparous women mimicking fibroid uterus – A case report

Endometrial stromal tumor is a rare malignant tumor seen in perimenopausal women. This is a case of endometrial stromal tumour in a young nulliparous woman around her early thirties mimicking Fibroid uterus. She presented with a 34 weeks size mass abdomen with six months duration without any menstrual irregularities. The mass was diagnosed to be a huge sub serous fibroid by both clinical and ultrasonographic examination. MRI revealed a well demarcated, pedunculated mass in the uterine cavity. After the pre operative work up, she was planned for myomectomy where intraoperatively a huge mushroom shaped firm mass was seen arising from the fundus of the uterus with a pedicle which was deep-rooted into the uterus. Histopathological examination of mass confirmed as a Low grade endometrial stromal sarcoma. CT scan was done and revealed no metastatic lesion.

Cardiovascular profiles associated with white matter hyperintensities in healthy young women.

Women who experience hypertension in pregnancy have increased risk of both chronic hypertension and dementia. High blood pressure is associated with increased evidence of white matter hyperintensities (WMH) in brain imaging. WMH are disruptions of the white matter of the brain that occur with demyelination and axonal degeneration, are associated with vascular disease, occur more frequently in people with hypertension, and are associated with cognitive impairment. We evaluated the relationship between WMH and subclinical cardiovascular function in healthy young nulliparous women and women with a history of early-onset preeclampsia. Sixty-two reproductive-aged women were assessed during the follicular phase of the menstrual cycle after a 3-day sodium/potassium-controlled diet. Half of participants had a history of early-onset preeclampsia, and half were nulliparous. Blood was drawn to assess inflammatory markers. Cardiovascular assessments included tonometric blood pressure monitoring, volume loading to assess vascular compliance, echocardiography to assess cardiac ejection time, brachial pulse wave velocity of the brachial artery, assessing cardiovascular stiffness, and brachial artery flow mediated vasodilation to assess endothelial mediated dilatory response. T2 fluid-attenuated inversion recovery (FLAIR) MRI imaging was obtained. Two raters, blinded to cardiovascular assessments and pregnancy history, reviewed MRI scans for evidence of WMH using the Fazekas rating scale. WMHs were detected in 17 women; 45 had normal white matter structure. Participants with Fazekas score>0 had exaggerated response to volume loading compared to women with a Fazekas score of 0 and longer cardiac ejection times. Fazekas scores >0 had lower brachial flow-mediated vasodilation and increased white blood count compared to those with no evidence of WMH. Women with WMH had reduced cardiovascular compliance, and a trend towards decreased endothelial responsiveness compared to those without WMH. These data demonstrated that the relationship between cardiovascular and brain health was detectable in young, healthy, reproductive-aged women, and may play a role in later development of clinical disease. These findings may help identify women who are at risk for cognitive decline and pathological aging.

Reproductive risk factors associated with breast cancer in young women by molecular subtype

BackgroundFew studies have examined detailed features of pregnancy and the postpartum period as potential risk factors for early onset breast cancer (BC) by molecular subtype. These data may have value for improving risk assessment and prevention. MethodsWe surveyed parous enrollees in the prospective Mayo Clinic Breast Disease Registry (MCBDR) who had been diagnosed with BC at age <55 years between 2015 and 2020. Summary statistics were used to describe survey responses and reproductive risk factors by BC subtype (defined by estrogen/progesterone receptors and human epidermal growth factor receptor expression, nurse-abstracted from the medical record). Associations were assessed with Kruskal-Wallis and Chi-Square tests, followed by age-adjusted linear and logistic regression models. We compared results from this parous cohort to those from a separate cohort of nulliparous MCBDR participants with BC diagnosed at age <55 years. ResultsIn 436 parous respondents with subtype data abstracted, we identified a higher frequency of BRCA1 mutation, earlier age at diagnosis, and lower BI in patients with triple negative BC. Comparing parous to nulliparous young women with breast cancer, the proportion with TNBC was larger in the latter (12.2% vs. 15.1%, p = 0.03). ConclusionsEarly age at diagnosis and deleterious BRCA1 mutation were more frequent among TNBC patients. In addition, parous young women with TNBC had a lower BI than those with other BC subtypes, a hypothesis-generating finding that supports the need for additional research on the cycle of pregnancy-lactation-postpartum involution and BC etiology.

Borderline ovarian tumors: a retrospective cohort study on single institution experience, practice patterns and outcomes

Borderline ovarian tumours (BOTs) commonly affect young nulliparous women, thus making fertility-preserving approaches more desirable. Women who opt for conservative management should be counselled about disease recurrence. In this retrospective study, the medical records of 57 women with BOT treated at the American University of Beirut Medical Centre between January 1986 and May 2018 were reviewed. Clinical, pathologic, and demographic data were collected and analysed to identify variables associated with poor clinical outcomes including advanced disease and risk of recurrence. Younger and nulliparous women were more likely to undergo fertility-sparing surgery. The open approach was adopted for women with larger adnexal masses and was associated with more blood loss with a mean difference of 172 mL (95% CI [110–235], p-value < .001) but no significant difference in operative time and length of hospital stay compared to the laparoscopic approach. CA-125 correlated with an advanced International Federation of Gynaecology and Obstetrics (FIGO) stage (p = .004). The recurrence rate was found to be 7% with a median recurrence time of 41.5 months. IMPACT STATEMENT What is already known on this subject? BOTs are common in young nulliparous women who often desire fertility-sparing procedures. Prognostic factors associated with disease severity and recurrence remain controversial. What do the results of this study add? This study presents an opportunity to understand the disease behaviour and compare local practices and outcomes to what was reported in the literature. CA-125 appears to be a useful marker in predicting the stage of BOT. What are the implications of these findings for clinical practice and/or further research? Future research should focus on exploring whether BOTs with micropapillary features represent an aggressive histologic subtype more prone to recurrence.

Systematic review of copper intrauterine contraception continuation in young nulliparous women based on intrauterine device type

ObjectivesNo copper intrauterine device (IUD) type is known to better suit young nulliparous women who tend to experience higher rates of IUD discontinuation compared with their older parous counterparts. A...

Recombinant human chorionic gonadotropin induces signaling pathways towards cancer prevention in the breast of BRCA1/2 mutation carriers.

Strategies for breast cancer prevention in women with germline BRCA1/2 mutations are limited. We previously showed that recombinant human chorionic gonadotropin (r-hCG) induces mammary gland differentiation and inhibits mammary tumorigenesis in rats. The present study investigated hCG-induced signaling pathways in the breast of young nulliparous women carrying germline BRCA1/2 mutations. We performed RNA-sequencing on breast tissues from 25 BRCA1/2 mutation carriers who received r-hCG treatment for 3 months in a phase II clinical trial, we analyzed the biological processes, reactome pathways, canonical pathways, and upstream regulators associated with genes differentially expressed after r-hCG treatment, and validated genes of interest. We observed that r-hCG induces remarkable transcriptomic changes in the breast of BRCA1/2 carriers, especially in genes related to cell development, cell differentiation, cell cycle, apoptosis, DNA repair, chromatin remodeling, and G protein-coupled receptor signaling. We revealed that r-hCG inhibits Wnt/β-catenin signaling, MYC, HMGA1 , and HOTAIR , whereas activates TGFB/TGFBR-SMAD2/3/4, BRCA1, TP53, and upregulates BRCA1 protein. Our data suggest that the use of r-hCG at young age may reduce the risk of breast cancer in BRCA1/2 carriers by inhibiting pathways associated with stem/progenitor cell maintenance and neoplastic transformation, whereas activating genes crucial for breast epithelial differentiation and lineage commitment, and DNA repair.

URINARY INCONTINENCE IN YOUNG AND NULLIPAROUS WOMEN: ASSOCIATED FACTORS AND PREVALENCE

Objective: To verify the prevalence and risk factors associated with urinary incontinence in nulliparous young women. Methods: Integrative literature review, performed by searching the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), Spanish Bibliographic Index in Health Sciences (IBECS) and in the Nursing Database (BDENF), from March to June 2021, using the descriptors: “urinary incontinence”, “prevalence”, “women”, “students” and “young adult” combined with the Boolean operator “AND”. Results: The initial search resulted in 234 articles and, after applying the eligibility criteria, a final sample of 5 articles was obtained. After the analyses, a prevalence of urinary incontinence in young nulliparous women of 48% was evidenced. Risk factors were: high-impact physical activity, duration of physical activity, concomitant bowel and urinary symptoms. Conclusion: It was observed that the occurrence of urinary incontinence in nulliparous young women is a common condition. The associated risk factors demonstrate the need for health guidance to these women to avoid the chronification of the disease.

Long-term treatment of endometriosis-related pain among women seeking hormonal contraception

Objective To evaluate the different effects of a progestin-only contraceptive with desogestrel (DSG) vs combined oral contraceptives (COCs) for a first line long-term treatment of endometriosis-related pain among patients seeking hormonal contraception. Methods An observational retrospective cohort study was conducted in collaboration with a local outpatient clinic for endometriosis among a group of nulliparous young women (n = 216) with endometriosis-related pain and seeking contraception. The cohort was subdivided into a group (n = 73) treated as first line by DSG and another group (n = 75) treated by a COC. During the study, clinical symptoms, side effects and possible changes in OC type use were recorded. Results No significant difference was found between the two groups in terms of clinical characteristics and pain scores before treatment. After 6 months both treatments were effective in reducing endometriosis-related pain, and those treated with DSG showed lower levels of dysmenorrhea, dyspareunia and nonmenstrual pelvic pain than COCs group (p < .01). After 12 months, in DSG Group some patients (15%) switched from DSG to a COC for breakthrough bleeding, whereas in COC Group 48% of patients switched to another type of COC for reduced efficacy on pain and/or for side effects. After 3 years of OC treatment, in DSG Group 79% of patients maintained the same therapy, whereas in COC Group only 14% continued the same COC type, 37% switched to another COC and 47% to DSG. Conclusions A progestin-only contraceptive with DSG is a valid option for long term management of endometriosis-related pain in patients seeking hormonal contraception.

Overactive bladder syndrome in nulliparous female university students: prevalence and risk factors including waterpipe smoking.

The objective was to assess the prevalence of symptoms of overactive bladder syndrome (OAB) among healthy nulliparous female university students, and to evaluate the correlation of these symptoms with a variety of factors, including waterpipe (WP) smoking. This is a cross-sectional study. A questionnaire was administered to evaluate symptoms of OAB in healthy nulliparous female university students. Variables assessed included body mass index (BMI), cigarette smoking, WP smoking, consumption of alcohol, coffee, and tea with and without artificial sweeteners, soft drinks, and energy drinks. Adjusted odds ratio were calculated to determine the correlation of these variables with OAB symptoms. A total of 767 out of 2,900 females responded to the questionnaire. Bothersome frequency was reported in 32.3%, and nocturia in 47.5% of the women. Urgency and urgency urinary incontinence (UUI) were present in 25.5 and 24.7% of the study participants respectively. Urgency was associated with WP smoking (p value 0.048). Bothersome frequency was associated with artificial sweeteners used with coffee and tea (p value 0.013). UUI was associated with cigarette smoking (p value 0.034) and elevated BMI (p value < 0.001). OAB symptoms were not found to be significantly associated with soft drink and energy drink consumption. A lower prevalence of nocturia (p value 0.009) and urgency was associated with alcohol consumption (p value 0.017). More than two-thirds (69.2%) of WP smokers expressed readiness to decrease WP smoking if this would improve their lower urinary tract symptoms (LUTS). Overactive bladder is common in healthy young nulliparous women and is associated with multiple risk factors, including WP smoking.

Sexual and reproductive health concerns of women with epilepsy beginning in adolescence and young adulthood

BackgroundWomen with epilepsy (WWE) have potentially unique concerns regarding their sexual and reproductive health (SRH). Prior studies of WWE have focused narrowly on pregnancy and preconception experiences, and have not addressed concerns of nulliparous adolescent and young adult women not actively seeking pregnancy. MethodsWe conducted individual semi-structured interviews with WWE 18–45 years of age. We sampled to maximize diversity of age and parity, and intentionally included many adolescent and young adult nulliparous women not actively planning pregnancy. Interviews broadly addressed participants’ SRH concerns and experiences. Interviews were audio-recorded and transcribed. Two coders performed qualitative analysis using thematic analysis with deductive and inductive approaches. ResultsTwenty WWE (median age 23 years, range 18–43 years) completed interviews. Twelve were nulliparous, six had children, one had a history of miscarriage only, and two were currently pregnant. WWE’s narratives revealed significant concerns about family planning and reproductive health in the context of epilepsy, including: 1) seizures endangering pregnancies and children 2) teratogenic effects of antiseizure medication, 3) heritability of epilepsy, 4) antiseizure medication and epilepsy impacting fertility, and 5) interactions between antiseizure medication and contraception. ConclusionWWE, including nulliparous adolescent and young adult women who are not actively planning pregnancy, have significant concerns about how their epilepsy interacts with SRH. SRH counseling for WWE should begin during adolescence and be incorporated into the transition process from pediatric to adult healthcare. Insights from WWE may aid in the creation of relevant patient-facing educational resources as well as provider-facing training and tools to meaningfully support the reproductive decision-making of WWE throughout their childbearing years.

Serous Borderline Ovarian Tumor Diagnosis, Management and Fertility Preservation in Young Women.

Borderline ovarian tumors (BOT) represent about 10 to 20 percent of all epithelial tumors of the ovary. They constitute intermediate lesions between benign ovarian cysts and invasive carcinomas. They often occur in young women of reproductive age, and, albeit with a favorable prognosis, it may recur on the ipsilateral or contralateral ovary. Controversies surround the diagnostic criteria used for their assessment, and the optimal management to minimize their risk of recurrence and/or transformation into malignant carcinoma. Fertility preservation (FP) is considered a priority in the management of these patients, and studies aim at finding the safest and most effective way to help women with BOT history conceive with minimal risk. We present the experience of a single institution in managing three cases of serous BOT in young nulliparous women, followed by a thorough review of the existing literature, highlighting controversies and exploring the possible FP techniques for these women.

Reliability of Pelvic Floor Muscle Assessment with Transabdominal Ultrasound in Young Nulliparous Women.

The aim of this study was to assess the reliability of pelvic floor muscles evaluation via transabdominal ultrasonography in young nulliparous women and to present the methodology for quantitative assessment of the ultrasound image of the pelvic floor muscles visible as displacement of the posterior wall of the bladder, caused by action of the pelvic floor muscles. The study comprised 30 young, Caucasian, nulliparous women (age 22–27; 168.6 ± 5.1 cm; 57.1 ± 11.8 kg) without pelvic floor muscle dysfunctions. The intra-rater, test-retest and inter-rater reliability of pelvic floor muscles evaluation was performed using transabdominal ultrasound at rest and during voluntary contraction. The reliability was assessed at three points of the image (at the middle, on the right and left side). The reliability of the three-point measurement of the pelvic floor muscles transabdominal ultrasound is excellent in the case of intra-rater assessments, both at rest (ICC = 0.98–0.99) and during contraction (ICC = 0.97–0.98); moderate at rest (ICC = 0.54–0.62) and poor during contraction (ICC = 0.22–0.50) in the case of test–retest assessment; excellent at rest (ICC = 0.95–0.96), and good during contraction (ICC = 0.81–0.87) in the case of inter-rater assessment. Transabdominal ultrasound is a reliable method of pelvic floor muscle evaluation. The three-points of assessment used in our study allowed for broader and more comprehensive imaging of the pelvic floor muscle, e.g., for quantitative detection contractility imbalances between the left and right side Due to the fact that understanding mechanisms of pelvic floor muscle functioning is crucial in the therapy of pelvic floor dysfunctions, therefore, reliable, valid tests and instruments are important.

A Case of a Rare Malignant Mixed Ovarian Germ Cell Tumor Masquerading as an Ectopic Pregnancy

Malignant ovarian germ cell tumors (MOGCTs) are rare but disproportionately affect young women and adolescent girls. Although clinical presentation varies, these tumors can present with an adnexal mass and raised serum beta-human chorionic gonadotrophin (beta-hCG), mimicking an ectopic pregnancy. We present the case of a 20-year-old nulliparous woman, who was initially treated both medically and surgically as an ectopic pregnancy, and was eventually diagnosed with a malignant mixed germ cell tumor (MMGCT) following laparoscopy. We highlight the diagnostic challenges of ectopic pregnancies versus MOGCTs, and the importance of adopting a fertility-sparing approach in young nulliparous women. J Clin Gynecol Obstet. 2021;10(2):55-58 doi: https://doi.org/10.14740/jcgo743

The effect of mobile video training for healthcare providers on long-acting reversible contraceptive (LARC) use among adolescents and young women.

To assess whether improving providers' education by video training using a mobile phone could affect providers' knowledge and attitude toward long-acting reversible contraceptives (LARCs), and thus further affect adolescents' and young nulliparous women's decisions to use LARCs. DESIGN, SETTING, PARTICIPANTS, INTERVENTION, AND MAIN OUTCOME MEASURES: This prospective case-control study was performed between 2019 and 2020. A total of 40 healthcare providers participated, of which 20 received "LARC First" video training, whereas the other 20 served as the control group and received no training. Surveys were conducted of 244 adolescents and young women who were consulted by these 2 groups of healthcare providers before abortion surgery. The data were used to analyze the relationship between providers' knowledge scores and the percentage of women who received counseling on LARCs decided to use LARCs, and what percentage continued to do so 12 months after surgery. Providers from the study group scored higher in LARC knowledge than the control group. Compared to the control group, women in the study group reported receiving more counseling on LARCs (81.4% vs 7.9%) and more often chose to use LARCs (24.6% vs 2.4%). Twelve months later, there was no significant difference in contraceptive continuation between study and control groups, but study group participants were more likely to be using LARCs (P < .001). Video training for providers improved both their knowledge and willingness to recommend LARCs and increased the probability of adolescent and young nulliparous women using these methods to reduce unintended pregnancy.