Women's Sexual Health Research Articles

Medical abortion.

Medical abortion (using mifepristone followed by misoprostol to end an early pregnancy) isa more accessible and less invasive option than surgical termination and can be provided in primary care settings. However, few general practitioners (GPs) currently provide this service, and there remains great inequity in access to abortion across Australia, particularly foryoung women and those living in rural and remote area. The aim of this article is to help Australian GPs better understand the practical and legal considerations of providing medical abortion to patients. Provision of medical abortion is well within the scope of community general practice and improves the comprehensiveness of women's sexual and reproductive health services that GPs can deliver. This article will help GPs to better understand the process involved in providing medical abortion, including the practical considerations for patients; be better equipped to support patients who have decided that medical abortion is an appropriate choice for them; and make aninformed decision as to whether to become a provider of medical abortion.

Pilot Results from the First HIV/AIDS Intervention Among Transgender Women in the Middle East: Gender Affirmation and Social Support from Within Trans Communities in Beirut, Lebanon.

Transgender women are 49 times more likely to become HIV positive than all adults worldwide. Data were unavailable for trans women's sexual and mental health in the Middle East and North Africa until 2015–2016, when HIV prevalence (10%) and suicide attempt (46%) rates were established in Lebanon. Because of the lack of evidence-based interventions for this marginalized group, the purpose of this study was to pilot test an adapted intervention, “Baynetna,” to assess preliminary impact on mental and sexual health. Using the gender affirmative model and community connectedness and social cohesion constructs, we pilot tested Baynetna among sixteen trans women, who attended 6 weekly 3-h trans-facilitated group-delivered sessions in Beirut with post-test assessments at 1, 3, and 6 months. Each participant acted as her own control; we used paired t-tests to assess changes at follow-up to evaluate potential differences in outcomes. Positive directionality in intervention impact on gender affirmation satisfaction, community connectedness, and social cohesion was demonstrated. An increase in HIV testing proportion between 6 months before and after enrollment was achieved. Higher social cohesion was associated with less suicidal thoughts (p = .05). There was a significant (p = .019) relationship between more community connectedness and lower depression scores. War event exposure was associated with higher anxiety (p = .02; p = .004). Those who reported never having had a sexually transmitted infection had higher gender affirmation satisfaction scores (7.5, 95% confidence interval: 1.4–13.6) (p = .019). Increases in community connectedness, social cohesion, and gender affirmation satisfaction scores confirm Baynetna's proposed mechanisms of impact. Proportional HIV testing increases demonstrate prevention objectives' progress. The significant results contribute to confidence in Baynetna's mechanisms of action and support the hypothesis that the Gender Affirmation model is applicable to the Lebanese context. We have shown for the first time that the adapted intervention, and its constructs, are applicable in this context outside the United States.

Effects of a Sexual Health Interview among Arab American Women: An Experimental Disclosure Study.

Although sexuality is an important aspect of peoples' health and well-being, many people-professionals and patients alike-find sexuality uncomfortable to discuss. In Arab culture, certain sexual thoughts and behaviors are taboo, particularly for women, and it is not known whether an interview in which Arab American women disclose their sexuality to a health professional would be well-received and beneficial or upsetting and harmful. This experimental study tested whether engaging in a disclosure-oriented sexual health interview affects Arab American women's sexual and psychological health. A sample of 134 Arab American women, ages 18-35 years (M = 20.6), completed self-report measures of sexual health and attitudes and psychological symptoms, and then were randomized to an interview or control (waitlist) condition. The 60-min disclosure interview inquired about sexual attitudes, experiences, and conflicts. Five weeks later, all participants completed follow-up measures. Post-interview reports suggest that participants responded favorably to the interview and generally benefited from participation. Analyses of covariance (controlling for baseline levels of the outcome measure) indicated that the interview led to significantly greater sexual satisfaction and less discomfort with sexual self-disclosure at 5-week follow-up, compared to controls; the two conditions did not differ on follow-up sexual self-schema, sexual self-esteem, or psychological symptoms. Moderation analyses revealed that participation in the interview differentially improved the sexual self-schema of women with no past sexual experience, compared to women with sexual experience. These experimental findings suggest the value, rather than the risk, of clinicians encouraging Arab American women to openly disclose and discuss their sexual experiences and attitudes in a confidential, empathic setting.

Sexual Health in Women with Inflammatory Bowel Disease in the Danish National Birth Cohort.

Previous studies indicate an increased risk of sexual dysfunction in women with inflammatory bowel disease [IBD] but none have examined sexual function in a large population-based cohort. To investigate the risk of sexual dysfunction in women with IBD, we used data from the Danish National Birth Cohort, a nationwide study of 92 274 pregnant women recruited during 1996-2002. We performed a cross-sectional study based on mothers who participated in the Maternal Follow-up in 2013-14. The outcome was self-reported sexual health. Information regarding demographics and IBD characteristics was retrieved from the Danish National Patient Register. Using regression models and adjusting for important confounders, we compared sexual function in women with and without IBD. The study population consisted of 38 011 women including 196 [0.5%] with Crohn's disease [CD] and 409 [1.1%] with ulcerative colitis [UC]. Median age was 44 years. Compared to women without IBD, women with UC did not have significantly decreased sexual function, while women with CD had more difficulty achieving orgasm (adjusted odds ratio [aOR] 1.53; 95% confidence interval [CI] 1.02-2.30], increased dyspareunia [aOR 1.71; 95% CI 1.11-2.63] and deep dyspareunia [aOR 2.00; 95% CI 1.24-3.22]. The risk for difficulty achieving orgasm and deep dyspareunia was further increased within 2 years of an IBD-related contact/visit [aOR 1.81; 95% CI 1.11-2.95; and aOR 2.37; 95% CI 1.34-4.19]. Women with CD have significantly increased difficulty achieving orgasm and increased dyspareunia. Physicians should be cognizant of and screen for sexual dysfunction in this group of patients.

Abstract P2-12-07: Vaginal and sexual health of hormone-receptor positive breast cancer survivors on oral endocrine therapy: A cross-sectional study

Abstract Background: Tamoxifen and Aromatase Inhibitors (AI) are highly effective forms of oral endocrine therapy (ET) used to prevent recurrences in women with hormone-receptor positive (HR+) breast cancer, often with a treatment duration of five or more years. However, the host of side effects women may experience, some related to vaginal health and sexual functioning, greatly impact quality of life (QoL). Those who experience side effects from oral ET are more likely to become non-adherent to their treatment protocol, adversely affecting survival outcomes. Despite this, general communication between cancer patients and their oncologists about sexual health is limited. Few studies have focused specifically on vaginal and sexual health when investigating ET side effects and patient-provider communication in women with HR+ breast cancer. This study aimed to determine the prevalence of vaginal and sexual-related side-effects in women with HR+ breast cancer on oral ET. Secondary objectives were to examine patient-provider communication around sexual health, female sexual dysfunction (FSD), and QoL in this patient population. Methods: We conducted a cross-sectional study between July 2017 and June 2018 in the outpatient oncology clinic at St. Michael’s Hospital (SMH), a tertiary-care center in Toronto, Canada. English-speaking women with HR+ breast cancer who had a treatment history with Tamoxifen or an AI (Anastrozole, Letrozole or Exemestane) for ≥ 6 consecutive months were eligible to participate. We developed a questionnaire to obtain self-reported information about vaginal and sexual-related side effects, sexual history, and patient-provider communication around sexual health. Two validated questionnaires were also used. Total scores for the Female Sexual Function Index (FSFI) could range from 1.2 to 36.0, with ≤ 26.55 indicating possible female sexual dysfunction (FSD). Domain scores within the 1-week recall version of the Menopause-Specific Quality of Life Questionnaire (MENQOL) range from one to eight, with higher scores indicating worse QoL. Additional demographic and clinical variables were collected from electronic medical records. Results: The mean age of the 151 respondents was 56.2 (±10.3), 51.0% of which were receiving Tamoxifen and 49.0% an AI. Ninety-six (63.6%) reported having a current sexual partner, and 71 (47.0%) reported being sexually active. Hot flashes/insomnia (41.7%), decreased libido (32.5%), and vaginal dryness (27.8%) were the three most commonly reported side effects that women experienced “all the time” in the past year. Only 44 (29.1%) women reported ever having been asked about their vaginal and/or sexual health by their oncologist, but 123 (81.5%) reported that they would be comfortable discussing this topic with them. Almost half of participants (68/151, 45.0%) indicated that their current vaginal or sexual-related side effects are not severe enough to want treatment. Thirty-four (22.5%) indicated wanting to know what their options are to best address side effects, 28 (18.5%) would be open to potential treatment for side effects, and 21 (13.9%) would be interested in seeing a physician specialist. Of the 87 women who fully completed the FSFI, 67 (77%) were classified as likely experiencing FSD. The mean score in the MENQOL’s sexual QoL domain was 3.89 ± 2.38 (n = 119), which indicated greater rates of vaginal dryness, avoidance of intimacy, and decreased sexual desire in this group. Conclusion: Our results support the notion that side effect management and patient-provider communication should be prioritized to optimize the vaginal and sexual health of women with HR+ breast cancer receiving oral ET. Women may be unaware of potential treatment options that can help manage side effects accompanying this therapy, and possibly accept these as a new standard of life. Citation Format: Amy Skitch, Alexandra Moskalewicz, Samantha Scime, Rosane Nisenbaum, Ronita Lee, Rashida Haq, Christine Dzerko, Christine Brezden-Masley. Vaginal and sexual health of hormone-receptor positive breast cancer survivors on oral endocrine therapy: A cross-sectional study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-12-07.

Methodological Challenges in Studying Testosterone Therapies for Hypoactive Sexual Desire Disorder in Women

IntroductionTestosterone has been studied for its benefits on sexual health for decades. The research regarding testosterone in women has produced evidence that this is a potential treatment for women suffering from female sexual dysfunction. There are several limitations of the testosterone trials that can affect their interpretation and challenges posed by some regulatory agencies that have prevented approval of any testosterone treatment for women in several countries. AimTo summarize the challenges of testosterone trials in terms of study populations, patient-reported outcomes, validated instruments in research, confounders, and regulatory barriers. MethodsA thorough review of published data on testosterone for the treatment of women's sexual health problems was undertaken. A detailed evaluation of the limitations of these trials was conducted and incorporated with the published evidence on the regulatory processes involved in moving testosterone from clinical research to drug approval. Main Outcome MeasureMain outcome measures are assessment of clinical trial populations, survey tools, confounders, and regulatory barriers. ResultsThere is some heterogeneity of study populations included in testosterone trials in women. Similarly, there have been differences in instruments used to assess patient-reported outcomes and often minimal control for potential confounders. The regulatory agency had posed a challenge to approve any testosterone treatment for women based on unproven concerns and a lack of regulatory guidance for drug developers. Clinical ImplicationsThere is strong evidence that shows testosterone is effective for treating sexual health concerns in the women included in clinical trials. Strength & LimitationsStrengths include thorough review of published literature and trial design for sexual health concerns. Limitations include being restricted to English Language publications and not having access to unpublished clinical trial data. ConclusionsTestosterone trials in women have been limited by homogeneity in the study populations and outcomes measured. Drug development has been hampered by inconsistent regulatory barriers.Rowen TS, Davis SR, Parish S, et al. Methodological Challenges in Studying Testosterone Therapies for Hypoactive Sexual Desire Disorder in Women. J Sex Med 2020;17:585–594.

Sexual Health in the Era of Cancer Genetic Testing: A Systematic Review

Genetic testing for germline cancer mutations allows individuals to gain specific knowledge of their hereditary cancer risks. Although risk-reducing strategies such as increased screening, prophylactic surgeries, and chemoprevention may be potentially lifesaving, these options can also significantly impact sexual health and function. This study overviews current challenges at the intersection of cancer genetic testing and sexual health and describes a systematic review that summarizes this evidence, identifies methodological limitations, and provides future research directions. Articles on the intersection of genetic testing and/or family history of cancer, cancer risk, and sexual health were searched in Medline, PsycINFO, and PsycARTICLES databases. The main outcome measure was sexual health in women who pursued risk-reducing surgery. On the basis of the inclusion criteria, 32 studies were reviewed. 31 contained empiric data from 3,367 participants; one was a conceptual study. All studies were published between 2000 and 2019. Mean ages ranged from 38 to 51.2. Given the prevalence of sexual dysfunction after risk-reducing surgery, evidence-based interventions are needed. Furthermore, quality of life that includes sexual health, in at-risk women who pursue preventive surgery, remains an understudied aspect of cancer genetic testing. Yusufov M, Bober SL. Sexual Health in the Era of Cancer Genetic Testing: A Systematic Review. Sex Med Rev 2020;8:231-241.

145 Addressing Sexual Health in Women After Pelvic Fracture: A Cross-Sectional Survey

While the association of pelvic fracture with sexual dysfunction is well known, most of the data pertains to men. How women are counseled about sexual health issues after pelvic trauma and how they interact with the healthcare system remains unknown. To describe the prevalence and spectrum of sexual health issues in women after pelvic fracture, and to identify factors associated with obtaining care for these concerns. Women treated for traumatic pelvic fractures at a single level 1 trauma center over a 5-year period were invited to participate in an online cross-sectional survey. Sexual health concerns and care-seeking behaviors were examined. Inverse probability weighting was utilized to adjust for nonresponse based on common variables within the trauma registry. All proportions presented are of weighted data unless otherwise stated. 98 of the 780 potential subjects responded to the survey (12.6% crude response rate). After weighting, 71% of responders were white and 42% had private insurance, with a mean age at the time of injury of 42.2 (SD 22.4) years and median time since injury of 45 (IQR 30.0, 57.4) months. Overall, 49.5% reported that sexual function was important to very important to their quality of life, with an additional 25.3% stating it was moderately important. While 17.1% (95% CI 8.4 – 26.0%) of women reported some pre-injury sexual health concerns, 59.0% (95% CI 47.1 – 71.0%) reported post-injury sexual dysfunction. Specific complaints included genital pain (17.8%), difficulty with orgasm (26.0%), difficulty with sexual desire (31.3%), dyspareunia (37.1%), genital numbness (7.5%), difficulty with arousal or lubrication (9.6%), and difficulty with sexual satisfaction (34.4%). 30.4% of women with post-injury sexual dysfunction reported resolution without treatment (18.2% within 6 months, 36.4% between 6-12 months, and 45.5% after 1 year). An additional 15.4% stated that they continue to have concerns and desire treatment, with only 11.6% stating they have received treatment. The remaining 42.6% continue to report sexual dysfunction but do not view treatment as a health priority. Overall, 26.4% of all responders recalled having sexual health discussions after injury, with 87.5% of these conversations being patient-initiated. Of those with post-injury sexual dysfunction, 60.8% had sexual health discussions with providers, 83.3% of which were patient-initiated. Only white race and rural residence were significantly associated with occurrence of sexual health discussions (p<0.001). The most common reasons for patients not raising the topic of sexual health with providers among those with sexual dysfunction were embarrassment/fear (23.6%), assuming the issue would resolve with time (23.5%), feeling the topic was inappropriate (17.2%), lack of information about condition/available treatments (19.9%) and sexual health not being a health priority (22.4%).

Designing and determining psychometric properties of a questionnaire on assessment of men's attitudes toward male participation in women's sexual and reproductive health issues

Context: Men's participation in sexual and reproductive health (SRH) issues can help countries achieve their national development goals, such as reducing maternal mortality, increasing the use of contraceptives, and reducing the prevalence of human immunodeficiency virus infection and acquired immunodeficiency syndrome. Aims: The purpose of this study is to design and to determine the psychometric properties of a questionnaire on the assessment of men's attitudes toward male participation in women's SRH issues. Setting and Design: In this study, 449 married men from cities of Nowshahr and Chalus in Iran who were selected by the available sampling method completed Questionnaire on Assessment of Men's Attitudes in 2018. Materials and Methods: An exploratory sequential mixed-methods approach was used in the present study and focused on research instrument design performed in two qualitative and quantitative phases. Statistical Analysis: The formal validity, content, and structure (convergent and divergent validity) and the reliability of the scale were investigated. Confirmatory and exploratory factor analysis was performed using SPSS Amos 24 software. Results: Four factors fit to the assessment of men's attitudes are confirmed according to standard indicators that include “emotional and gender-based attention,” “support for girls,” “attention and supply of SRH, and prevention of violence.” Convergent and divergent validity for all factors, as well as internal consistency and structural stability, are acceptable. Conclusions: Given the importance and the necessity of male participation in women's reproductive health, this questionnaire was endowed with sufficient validity and reliability and could be useful to precisely assess men's attitudes in this regard.

COVID-19 and (Un)Desired Fertility: The Effect of Stay-at-Home Orders on Abortions in Mexico City

COVID-19 mitigation policies, including stay-at-home (SAH) orders, have been implemented in Mexico leading to unintended consequences for women's sexual and reproductive health. We study the effects of SAH orders on the number of abortions performed by Mexico City's public abortion program and analyze effects on desired fertility. Using difference-in-difference estimations and event study analyses, we show that SAH orders lead to a decrease in abortions of at least 25%. By complementing our analysis using call data from the government's helpline for women, we anticipate effects of the COVID-19 lockdown on fertility and present evidence of an increase in unwanted pregnancies.

Zika and women's sexual and reproductive health: Critical first steps to understand the role of gender in the Colombian epidemic.

ObjectivesTo describe the mechanisms of implementation of Zika virus diagnosis, prevention, and management guidelines in Colombia, and to characterize their influence on efforts to defend sexual and reproductive rights.MethodsA qualitative study performed between February and April 2018 in three municipalities in Colombia. We conducted 30 semistructured interviews and five focus groups with key informants who played a role during the epidemic. These included decision‐makers, program coordinators, healthcare providers, pregnant women diagnosed with Zika virus, and members of affected communities.ResultsWe identified barriers to and facilitators for the implementation of the national Zika virus response plan. Barriers included a lack of coordination between vector control efforts and in the realms of sexual and reproductive rights. Facilitators included healthcare providers’ response to the epidemic, the development of technical skills, and the establishment of coordination and referral networks across different institutions.ConclusionA multidimensional approach that considers healthcare services, gender issues, and the environment is crucial. We highlight the epidemic's effects on women's sexual and reproductive rights, mainly related to inequalities in sexual and reproductive health such as the increased risk of sexually transmitted infections experienced by the poorest and most vulnerable women.

Assessing sexual and reproductive health dimensions tools in women with type 1 diabetes mellitus with regard to Consensus-based Standards for the selection of health status Measurement Instruments checklist.

A valid tool is of paramount importance in determining women's sexual and reproductive health status, meeting their health needs, and recognizing the effectiveness of some interventions. This review study aimed to assess sexual and reproductive health dimensions tools in women with type 1 diabetes mellitus with regard to Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist. In this review study, in addition to Iranian databases (MagIran, Sid, Irandoc), non-Iranian databases (PubMed, Scopus, Embase, and Web of Science) and Google Scholar search engine were considered. The mentioned databases were searched for articles in English and Persian published within 2000–2019, using the search strategy for each database and Boolean operators along with appropriate keywords according to the MESH term. Articles with nonresearcher-made tools measuring the sexual and reproductive health concepts and dimensions were included in the present study. Afterward, the psychometric properties of the tools were assessed according to the COSMIN checklist. In the selected articles, there were 14 psychometrically valid tools to be assessed from 151 articles containing the sexual and reproductive health dimensions; among which, seven tools were evaluated with regard to COSMIN. None of the tools also had all the features noted in COSMIN. Moreover, all the concerned scales were not interpretable and accountable; however, a majority of them had internal consistency and construct validity. In this study, there was no valid and specific tool for measuring sexual-reproductive health status in this population group. Therefore, it is necessary to develop a valid tool according to the dimensions and needs of specific reproductive health in type 1 diabetes.

Woman's Sexual Health Knowledge and Needs Assessment in Behavioral Clinics and Shelters in Tehran

Objective: The aim of this study was to assess the sexual health knowledge among females seeking consultation in behavioral clinics or shelters with emphasis on sexual routs of HIV transmission. Materials and methods: In this study 250 women who have attended behavioral clinics or shelters in Tehran were recruited and a standardized questionnaire which asked about demographics, sexual partner and knowledge about HIV/STDs was used. Results: The median age of our cases was 40.82% and among them 16% were married but lived alone. Among the total 250 cases, 56% (140) were sexually active in the last 30 days, 19.2% (48) had a history of a one-night stand and 2.4% had more than 1 sexual partner. 212 cases answered questions about condom use, 60% (127) of them did not use condoms at all. For knowledge about signs and symptoms related to STDs, 63% believed that abdominal pain has no relation to STDs. Also 44%, 43%, 37%,and 40% believed that dyspareunia, dysuria, malodorous vaginal discharge and change in color of vaginal discharge, respectively had no relation to STDs and 13% of whom presented with these symptoms in the past 30 days had not seek medical evaluation. Conclusion: It is a necessity to emphasize the use of condoms among the male population however in this study it was a challenge to do so because it goes against the government's campaign of pro-natalism. Improving the knowledge of protected sex should start from the teenage years and at school to have maximum STD prevention planning. Most women in our study did not know about healthy sexual lifestyle and this shows the need of sexual health education before marriage or even at school.

The effects of ageing on female genital and sexual health.

This article will explore the impact of ageing on sexual function in older women and will reflect on the social influences on women's sexual ageing, identify the effects of ageing on sexual activity, particularly on genital skin, and consider the concerns from the perspective of older women. The article will then focus on vulval skin conditions and the functional aspects of living with these conditions. Finally, the article provides a starting point for nurses to consider their own knowledge, skills and attitudes through a series of reflective questions and recommendations for those working with older women to aid the identification of issues relating to older women's sexual health and vulval skin conditions, leading to further discussions to promote genital health.

Global Consensus Position Statement on the use of Testosterone Therapy for Women

This Statement is being simultaneously published in the journals Climacteric, Maturitas, Journal of Sexual Medicine, and Journal of Clinical Endocrinology and Metabolism on behalf of the International Menopause Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, and The Endocrine Society, respectively. This Position Statement has been endorsed by the International Menopause Society, The Endocrine Society, The European Menopause and Andropause Society, The International Society for Sexual Medicine, The International Society for the Study of Women's Sexual Health, The North American Menopause Society, The Federacion Latinoamericana de Sociedades de Climaterio y Menopausia, The Royal College of Obstetricians and Gynaecologists, The International Society of Endocrinology, The Endocrine Society of Australia, and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Saúde sexual da mulher lésbica e/ou bissexual: especificidades para o cuidado à saúde e educação sexual

The production of knowledge about the sexual health of lesbian and/or bisexual women is scarce, in order to collaborate to keep this social group exposed and at risk of transmitting Sexually Transmissible Infections (STIs) and HIV/AIDS. This reality has prompted us to conduct this review article on the sexual health of women who have sex with women (WSW). This is an integrative review in the Scopus, Cinahl, Lilacs and Scielo databases. The 16 articles found generally investigate: (1) WSW knowledge of STI and HIV/Aids transmission, (2) WSW sexual behaviors, and (3) Particularities in the health care of lesbian and/or bisexual women. The articles reveal the need to invest in public health policies, as well as in the qualification of professionals in sex education in order to provide information and guidelines focused on specific strategies to prevent STIs and HIV/AIDS.

International Travel as a Context for Sexual and Contraceptive Behaviors: A Qualitative Study of Young Women Traveling Outside the U.S.

International travel is popular worldwide, yet its implications for sexual and reproductive health are not fully understood. Few studies have examined the contextual factors that shape women's sexual and contraceptive behaviors-and thus, their risk of unintended pregnancy and sexually transmitted infections (STIs)-while traveling outside their home country. In this qualitative study, female university students with recent (n = 25) or upcoming (n = 19) travel outside the U.S. completed semi-structured interviews from October 2015 to March 2017. Transcripts were analyzed for themes related to contraceptive and sexual behaviors: (1) participants' pre-travel expectations of sex; (2) the circumstances surrounding sexual encounters with men while traveling; (3) negotiation about condom and contraception use with partners; and (4) factors affecting contraceptive adherence. Participants generally expected to be abstinent during travel, citing myriad rationales that included personal values, no perceived opportunities for sex, and the nature of the trip. Some travelers had unexpected sexual encounters, involving health-protecting behaviors and risk-taking (e.g., unprotected sex, substance use). New sexual partnerships were fueled by increased attention from men, situational disinhibition, and perceived heightened intimacy. International travel brought many contraceptive considerations (adequacy of supplies, access to refrigeration, time zone differences, etc.) as well as obstacles that triggered contraceptive lapses and discontinuation. Pill users described the most challenges, while travelers using intrauterine devices expressed appreciation for their maintenance-free contraception. This study suggests complex associations between international travel and young women's sexual and reproductive health. Some travelers were more vulnerable to situational risk factors, while others may have been more insulated. We identify potential intervention opportunities via clinical services, education, and policy to reduce young women's risk of adverse sexual and reproductive health outcomes while traveling abroad. We urge greater recognition of and conversations about contraceptive lapse and unintended pregnancy as potential health risks for female travelers of reproductive age, just as clinical guidelines acknowledge travel-associated STI.

082 Nomegestrol Acetate/17beta-estradiol does not Negatively alter the Vascular Resistance of Clitoral Arteries

Recently, a monophasic combined oral contraceptive (COC) containing 1.5 mg 17-beta estradiol (E2) and 2.5 mg nomegestrol acetate (NOMAC) has been developed with a 24/4 regimen. While E2 is identical to the endogenous estrogen, NOMAC is a 19-nor progestogen derivative with no androgenic effects. NOMAC/E2 has demonstrated a good safety profile and less effects on cardiovascular risk, hemostatic, metabolic, and endocrine factors in comparison to COCs containing ethinyl estradiol in combination with levonorgestrel or drospirenone. Evidence suggests that NOMAC/E2 may be a good choice for preserving sexual health in women complaining about sexual side-effect of COCs. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. Moreover, clitoral PI has been reported to be directly associated with cardiovascular risk factors and self-reported poor peripheral arousal during sexual activity. Our aim was to evaluate, in women consulting our Outpatient Clinic for contraceptive needs, the possible changes in clitoral hemodynamic parameters after 6 months treatment with NOMAC/E2 as compared with other COCs.

Sexual Functioning and Opioid Maintenance Treatment in Women. Results From a Large Multicentre Study

Opioid maintenance treatment (OMT) is the most widespread therapy for both females and males opioid addicts. While many studies have evaluated the OMT impact on men’s sexuality, the data collected about the change in women’s sexual functioning is still limited despite the fact that it is now well-known that opioids - both endogenous and exogenous - affect the endocrine system and play an important role in sexual functioning. The present study aims to determine how OMT with buprenorphine (BUP) or methadone (MTD) affects sexual health in women; examining also any possible emerging correlation between sexual dysfunction (SD), type of opioid and patients’ mental health. This multi-center study case recruited 258 female volunteers attending Italian public Addiction Outpatients Centers that were stabilized with OMT for at least 3 months. SD was assessed with the Arizona Sexual Experience Scale. The twelve-item General Health Questionnaire was used to assess participants’ mental health conditions. The results show that 56.6% of women receiving OMT for at least 3 months presented SD without significant differences between MTD e BUP groups. The majority of the subjects with SD have a poorer quality of intimate relationships and worse mental health than the average. To the best of our knowledge, the present study is the largest report on the presence of SDs in women as a side effects of MTD and BUP used in OMT. Since SDs cause difficulties in intimate relationships, lower patients’ quality of life and interfere with OMT beneficial outcomes, we recommend that women undertaking an opioid therapy have routine screening for SD and we highlight the importance to better examine opioid-endocrine interactions in future studies in order to provide alternative potential treatments such as the choice of opioid, opioid dose reduction and hormone supplementation.

Beyond Hormonal Impact: A Qualitative Analysis of the Intravaginal Ring (IVR) on Women's Sexual Experiences [1B

INTRODUCTION: Current contraceptive literature includes limited studies focusing on the impact of contraceptive methods (exclusive of condom-only contraception) on women's sexual experiences. Many of these focus on hormonal effects of oral contraceptive pills (OCPs). Though important, women's experiences with contraception extend far beyond hormonal impacts. This study aims to add depth to the knowledge base by exploring the meaningful effects of intravaginal rings (IVR) on women's sexual experiences, highlighting the IVR as a device physically experienced by both the user and her sexual partner(s). METHODS: Twelve women, aged 18-45 years, used the IVR for 3-6 months, and completed daily phone surveys, monthly web surveys, and in-depth interviews regarding IVR use. This thematic content analysis of qualitative data explores how the IVR affects participants' sexual experiences. RESULTS: Sexual experiences with the IVR elicited a range of user reactions. Women reported impacts on their sexual experiences related to physical (e.g., feeling the IVR during sex), administrative (e.g., navigating IVR removal before sex), and relationship factors (e.g., partner's sexual comfort and pleasure). Women derived both positive and negative meaning from these experiences, which then altered and individualized their use and subsequent opinions of the IVR. CONCLUSION: The range of IVR impacts on women's sexual experiences shape their use and opinions of the product, leading to either increased motivation or poor adherence and discontinuation. Awareness of these individualized experiences can help providers better understand and guide their patients through effective IVR use. Research on user experiences across contraceptive methods is necessary to support women's sexual and reproductive health.