Treatment Of Women Research Articles

Ovarian reserve and IVF outcomes in patients with inflammatory bowel disease: A systematic review and meta-analysis.

SummaryBackgroundInflammatory bowel disease (IBD) mainly affects people during reproductive age. However, it is unclear whether IBD might be associated with impaired ovarian reserve in female patients or with in vitro fertilization (IVF) outcomes.MethodsThis systematic review and meta-analysis included articles from inception to May, 2022. Random-effect model was applied to calculate the standardized mean differences (SMDs) and odds ratios (ORs) and their 95% confidence intervals (95%CIs). Studies comparing the ovarian reserve or IVF outcomes of patients with IBD with the population were considered. To be included in this study, necessary measurements such as OR, relative risk (RR), SMD or hazard ratio (HR) or any necessary information to calculate them were provided in the articles. Letters, case reports, review articles including meta-analyses and expert opinions were excluded. For different articles studying the same population, the article with larger scale was selected.FindingsWe included in our analysis 9 studies and data from 2386 IBD records and matched controls. Comparing with women without IBD, women with IBD had lower anti-mullerian hormone (AMH) levels (SMD = -0.38, 95%CI: -0.67, -0.09); (I2 = 79.0%, p = 0.000). Patients with IBD of different ages showed distinct ovarian reserves, with patients below 30 years old not showing any decline in ovarian reserve compared to the control group (SMD = -0.56, 95%CI: -2.28, 1.16); (I2 = 96.3%; p = 0.000), while patients with IBD over 30 years old (SMD = -0.75, 95%CI: -1.07, -0.43); (I2 = 0.0%; p = 0.608) showed a decline compared to control group. Patients with IBD in remission stage had similar ovarian reserves to population (SMD = -0.10, 95%CI: -0.32, 0.12); (I2 = 0.0%; p = 0.667), while patients in active stage showed an impaired ovarian reserve (SMD = -1.30, 95%CI: -1.64, -0.96); (I2 = 0.0%; p = 0.318). Patients with IBD showed a pregnancy rate after receiving IVF treatment comparable to the control population (OR = 0.87, 95%CI: 0.55, 1.37); (I2 = 70.1%, p = 0.035).InterpretationThe result of this study suggest that IBD may reduce reproductive age women's ovarian reserve and IVF treatment might help pregnancy outcomes in patients with impaired fertility. These results should be further validated in additional studies given the heterogeneity and quality of the studies included.FundingThis study was supported by the National Natural Science Foundation of China (No. 81671423), National Key Research and Development Program of China (No. 2016YFC1000603), 2020 Shenyang Science and Technology Plan Program (No. 20-205-4-006), Scientific and Technological Talents Applied Technology Research Program of Shenyang (No. 18-014-4-56).

P-627 Pregnancy Rate and Outcomes Following a Randomized Controlled Three-component Lifestyle Intervention in Women with PCOS

Abstract Study question What is the impact of a three-component lifestyle intervention on the pregnancy rate, time to pregnancy and pregnancy complications in women with polycystic ovary syndrome? Summary answer A non-significant positive trend in pregnancy outcomes was demonstrated in favor of the lifestyle intervention groups, in line with the weight loss achieved per group. What is known already PCOS (polycystic ovary syndrome) is associated with overweight and obesity. Women with PCOS and overweight or obesity present with more pronounced reproductive derangements. Moreover, when pregnant, pregnancy complications such as gestational diabetes, hypertensive disorders and preterm birth seem to be more prevalent in this population. The first line treatment for women with PCOS and overweight or obesity is a multi-component lifestyle intervention. Data on pregnancy outcomes after multi-component lifestyle interventions in women with PCOS are scarce. Study design, size, duration The present study is a one-year randomized controlled trial to investigate the effect of a three-component (cognitive behavioral therapy, healthy diet and physical therapy) lifestyle intervention (LSI) with or without Short Message Service (SMS) on pregnancy leading to live birth, pregnancy complications and outcomes within 24 months after the start of the lifestyle intervention compared to care as usual (CAU). Participants/materials, setting, methods Women diagnosed with PCOS according to the Rotterdam 2003 criteria and a BMI above 25 kg/m² were included. A total of 183 participants were randomly assigned to three groups: 1) three-component lifestyle intervention with SMS (SMS+); 2) three-component lifestyle intervention without SMS (SMS-); 3) care as usual (CAU): encourage to lose weight autonomously (control group). Pregnancy and neonatal outcomes were collected from the Dutch Bureau of Statistics (CBS) combined with the Dutch Perinatal registry (Perined). Main results and the role of chance Within 24 months after the start of the intervention the pregnancy rate leading to live birth was 41.7% (25/60) within SMS+, 38.1% (24/63) within SMS- and 38.3% (23/60) within CAU. This was non-significant between the groups. Mean time to pregnancy for SMS+ was 18.3 months, 19.1 months for SMS- and 19.4 months for CAU (p = 0.775). Gestational diabetes (LSI: 8.2% vs CAU: 21.7%, p = 0.133), hypertensive disorders (LSI: 8.2% vs CAU: 13.0%, p = 0.673) and preterm birth (LSI: 12.2% vs CAU: 17.4%, p = 0.716) rates were all lower in the LSI groups (SMS+ and SMS- combined) compared to CAU. Limitations, reasons for caution Although significantly less than the LSI groups, even the CAU group achieved weight loss, which may give an underestimation of the effect of the lifestyle intervention with regard to pregnancy outcomes. Wider implications of the findings Weight loss overall seems to have a positive effect on pregnancy outcomes, and multi-component lifestyle interventions are needed to achieve weight loss. Trial registration number NTR2450

Content Validity of a Scale Measuring Psychosocial Stress Factors among Infertile Women in Treatment

Content Validity of a Scale Measuring Psychosocial Stress Factors among Infertile Women in Treatment

1509-PUB: Effects of an Early Postpartum Lifestyle Intervention in Women with Gestational Diabetes Mellitus and Newly Diagnosed Diabetes

Very few studies have assessed short-term and long-term cardiovascular effects of an early postpartum lifestyle intervention among women with gestational diabetes mellitus and diabetes. The aim of the present study was to examine whether an early postpartum 9-month intensive lifestyle intervention can lead to weight loss and improve cardiovascular risk factors among women with both GDM and newly diagnosed diabetes, and also to investigate these effects in a long term. A total of 83 women who had GDM and were newly diagnosed as type 2 diabetes at 2.6 year after delivery participated in a 9-month intensive lifestyle intervention and a follow-up survey at 6-9 years post-intervention. A total of 68 women finished the 9-month lifestyle intervention and 39 women finished the 6-9 years post-intervention survey. During the first 9-month intervention, women lost their weight at 2.76 kg (-3.81% initial weight) , decreased their waist circumference (-2.88 cm) , body fat (-1.69%) , diastolic blood pressure (-3.49 mm Hg) , fasting glucose (-0.98 mmol/L) and HbA1c (-0.71%) . During the 6-9 years post intervention, women still lost weight (-3.49 kg; -5.14% initial weight) , decreased their waist circumference (-4.03 cm) , and body fat (-1.93%) , but slightly increased their HbA1c (0.26%) , total cholesterol (0.29 mmol/L) and triglycerides (0.17 mmol/L) . The prevalence of using glucose-lowering agents increased from 2.9% at baseline to 35.3% after the 9 month lifestyle intervention, and to 48.7% at 6-9 years post-intervention. An early postpartum 9-month intensive lifestyle intervention could have effects on weight loss, decreased HbA1c and other cardiovascular risk factors among women with GDM and newly diagnosed diabetes. The weight loss effect with a lifestyle intervention can persist for at least 6 years, however, HbA1c levels slightly increased in the long term. Disclosure G.Hu: None. J.Leng: None. H.Liu: None. L.Wang: None. S.Zhang: None. W.Li: None. W.Li: None. X.Yang: None. J.Tuomilehto: Stock/Shareholder; Orion Pharma. Funding This study is supported by the grant from European Foundation for the Study of Diabetes (EFSD) /Chinese Diabetes Society (CDS) /Lilly program for Collaborative Research between China and Europe. Dr. Hu was partly supported by the grant from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790) and the National Institute of General Medical Sciences (U54GM104940) of the National Institutes of Health.

28-LB: Increased Expression of Insulin Signaling Intermediates after Six Months of Metformin Medical Intervention in Women with Obesity and Polycystic Ovary Syndrome

Objective: We hypothesize that in women experiencing obesity and PCOS, the women with higher levels of free androgen index will display more dysregulation in the insulin signaling pathway in adipose tissue. More specifically, we believe that visceral more than subcutaneous adipose tissue in the women in the study will display more dysregulation; and lastly that bariatric surgery will alleviate insulin signaling dysregulation. Methods: Here, we performed molecular analyses (Western blots and qPRC) exploring the insulin signaling pathway in visceral and subcutaneous (SubQ) adipose tissue from women with obesity and PCOS undergoing RYGB bariatric surgery; and SubQ WAT from women with obesity and PCOS at baseline and six-months after medical intervention with metformin (MTF) . Results: Subcutaneous (SubQ) white adipose tissue (WAT) displayed a trending (p=0.2) but non-significant increase in p-ACC compared to visceral WAT from women with PCOS and obesity pre-bariatric surgery. Six months of MTF increased p-ACC in SubQ WAT by 5-fold compared to zero months (baseline) in women with PCOS and obesity. IR displayed similar expression in the visceral compared to SubQ WAT in women with PCOS and obesity pre-bariatric surgery. IR expression increased by 20-fold at 6-months of MTF compared to baseline in SubQ WAT of women with PCOS and obesity. Phosphorylated forkhead box 01 (p-FOXO1) displayed similar expression in the visceral compared to SubQ WAT in women with PCOS and obesity. However, p-FOXO1 was decreased at 6-months of MTF compared to baseline in women with PCOS and obesity. p-AKT levels were similar in visceral compared to SubQ WAT in women with PCOS and obesity pre-bariatric surgery. However, p-AKT levels were significantly increased by 4-fold at 6-months of MTF compared to 0-months in women with PCOS and obesity. Conclusion: None of the insulin signaling intermediates measured were altered in visceral compared to SubQ in women with obesity and PCOS. Disclosure S. Andrisse: None.

Bladder HOTline: The Impact of COVID-19 and Telemedicine on Empiric Urinary Tract Infection Treatment in Women [A345

INTRODUCTION: Urinary tract infection (UTI) is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic on UTI treatment are largely unknown. We evaluated the impact of COVID-19 and telemedicine on empiric UTI treatment in women, hypothesizing that increased telemedicine during the pandemic would increase empiric UTI treatment. METHODS: This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with and without hematuria during the first 6 months of the pandemic versus the preceding 6 months. Our primary outcome was empiric antibiotic treatment, defined by treatment based on clinical picture with/without pending urine testing. To reach 80% power, we included 222 patients. RESULTS: The average age of participants was 42. Fifty-two percent were White, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (P<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% pandemic (P=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (P<.0001). Nitrofurantoin or trimethoprim/sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The treatment adjustment rate was 17.1%. CONCLUSION: COVID-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine’s impact on treatment of this common condition.

Incidence of Alopecia in Treatment of Women With Uterine Fibroids: Results of Two Phase 3 Trials of Linzagolix [A104

INTRODUCTION: Although hair loss (alopecia) is a benign disorder, it can negatively affect patient's self-esteem, self-image, and overall quality of life. Linzagolix is an oral GnRH antagonist being developed at full and partial suppression doses with and without hormonal add-back therapy (ABT) for treatment of uterine fibroid-related symptoms. Alopecia was previously reported with other GnRH antagonists. METHODS: PRIMROSE 1 and 2 are two randomized, double-blind, placebo-controlled phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, +/- ABT in the treatment of uterine fibroids for 52 weeks. RESULTS: Up to week 24, alopecia was reported in total of five subjects (0.5%) in the pooled safety analysis set (N=1037). There was a similar incidence in the placebo (two subjects; 1.0%), 100 mg (one subject; 0.5%), and 200 mg+ABT groups (two subjects; 1.0%), and no reports in the 100 mg+ABT or 200 mg groups. Four of the cases resolved. For one subject (200 mg+ABT group) mild alopecia had not resolved. For this subject, the study drug was continued, and no concomitant therapy was administered for the alopecia. Up to week 52, one (0.1%) subject in the 200 mg+ABT group reported alopecia, which resolved. None of the cases led to treatment discontinuation. No subjects reported alopecia during the post-treatment follow-up. CONCLUSION: Hair loss (alopecia) was rarely observed in the PRIMROSE trials of linzagolix in the treatment of uterine fibroids.

MP02-07 THE IMPACT OF COVID-19 AND TELEMEDICINE ON EMPIRIC UTI TREATMENT IN WOMEN

You have accessJournal of UrologyCME1 May 2022MP02-07 THE IMPACT OF COVID-19 AND TELEMEDICINE ON EMPIRIC UTI TREATMENT IN WOMEN Madeline Epsten, Jennifer Ferraro, Fareesa Khan, Cynthia Brincat, and Kristin Jacobs Madeline EpstenMadeline Epsten More articles by this author , Jennifer FerraroJennifer Ferraro More articles by this author , Fareesa KhanFareesa Khan More articles by this author , Cynthia BrincatCynthia Brincat More articles by this author , and Kristin JacobsKristin Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI), one of the most common reasons women seek acute care, is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic and telemedicine on UTI treatment are largely unknown. Here, we evaluated the impact of Covid-19 and telemedicine on empiric UTI treatment in women. We hypothesized that increased use of telemedicine during the pandemic would increase the rate of empiric UTI treatment. METHODS: This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with (N30.00) and without (N30.01) hematuria during the first 6 months of the pandemic (March 2020 – August 2020) versus the 6 months preceding the pandemic (September 2019 – February 2020). Our primary outcome was presence of empiric antibiotic treatment, defined by treatment based on clinical picture with or without pending urine testing. Secondary analysis included determining which antibiotics were most commonly prescribed and treatment adjustment. To reach 80% power to detect a 10% difference with p≤0.05, we included 222 patients. Exclusion criteria included inpatient encounter, long-term facility residence, urinary procedure in last 2 weeks, previous UTI treatment within 30 days. RESULTS: The average age of participants was 42 years. Fifty-two percent were white, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (p<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% during the pandemic (p=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (p<.0001). Nitrofurantoin or trimethoprim/sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The overall rate of treatment adjustment was 17.1%; there was no significant difference by time period. CONCLUSIONS: Covid-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine’s impact on treatment of this common condition. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e12 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Madeline Epsten More articles by this author Jennifer Ferraro More articles by this author Fareesa Khan More articles by this author Cynthia Brincat More articles by this author Kristin Jacobs More articles by this author Expand All Advertisement PDF DownloadLoading ...

Calcifediol (25OHD) Deficiency and Its Treatment in Women's Health and Fertility.

Currently, there is abundant scientific evidence showing that the vitamin D endocrine system (VDES) is a highly complex endocrine system with multiple actions in different regions of the body. The unequivocal presence of vitamin D receptors in different tissues related to fertility, and to specific aspects of women’s health such as pregnancy, undoubtedly implies functions of this steroid hormone in both male and female fertility and establishes relationships with different outcomes of human gestation. In order to review the role of the VDES in human fertility, we evaluated the relationships established between 25-hydroxyvitamin D (calcifediol) deficiency and in vitro fertilization, as well as aspects related to ovarian reserve and fertility, and commonly diagnosed endocrinopathies such as polycystic ovary disease. Likewise, we briefly reviewed the relationships between calcifediol deficiency and uterine fibroids, as well as the role that treatment may have in improving human fertility. Finally, the best scientific evidence available on the consequences of calcifediol deficiency during pregnancy is reviewed in relation to those aspects that have accumulated the most scientific literature to date, such as the relationship with the weight of the newborn at the time of delivery, the appearance of preeclampsia, and the risk of developing gestational diabetes and its final consequences for the pregnancy. To date, there is no definitive consensus on the necessary dose for treatment of calcifediol deficiency in the therapeutic management of infertility or during pregnancy. Large prospective clinical intervention studies are needed to clarify the benefits associated with this supplementation and the optimal dose to use in each situation. Although most intervention studies to date have been conducted with cholecalciferol, due to its much longer history of use in daily care, the use of calcifediol to alleviate 25-hydroxyvitamin D deficiency seems safe, even during pregnancy. The unequivocal presence of vitamin D receptors in very different tissues related to human fertility, both male and female, as well as in structures typical of pregnancy, allows us to investigate the crucial role that this steroid hormone has in specific aspects of women’s health, such as pregnancy and the ability to conceive. Well-designed clinical studies are needed to elucidate the necessary dose and the best form of treatment to resolve the very common calcifediol deficiency in women of reproductive age.

Reshaping the Gut Microbiota Through Lifestyle Interventions in Women with PCOS: A Review.

Polycystic ovary syndrome (PCOS) is an endocrine disorder evolving as a global threat to women's health. However, its multifactorial etiology causes difficulty in eliminating it. The interrelation between the gut microbiota and metabolic disorders has been trending recently, giving rise to new opportunities on the etiology and pathogenesis of PCOS. Lifestyle interventions such as healthy diet, physical exercises, and behavioral interventions such as regulation of stress and sleep cycles have been identified to improve the symptoms of PCOS across the endocrinological, metabolic and psychological scales and are recommended as the first line of treatment for PCOS. The impact of the unhealthy lifestyle factors on intestinal dysbiosis that cause PCOS is summarized in this review. This review also provides an insight on the therapeutic approaches that primarily target the gut microbiota and offers novel gut microflora-associated treatment strategies for PCOS. Further, this survey also highlights the need for the implementation of lifestyle management strategies and strongly recommends a healthy and stress-free lifestyle to promote gut health and manage PCOS.

Allostatic Load as an Insight into the Psychological Burden after Primary Treatment in Women with Breast Cancer: Influence of Physical Side Effects and Pain Perception.

Breast cancer (BC) diagnosis and treatment have become a cumulative long-standing chronic disease impairment, causing stress and turning into an allostatic load (AL) framework. This study aimed to investigate the relationship between physical issues and mental health in patients with BC after medical treatment. We conducted an observational study of 61 female patients with BC, and clinical and psychological markers have been detected. We conducted descriptive statistics, ANOVA analyses, correlations, and mediation analyses to verify the effect of the comorbidity index on psychological dimensions. The findings showed high levels of distress and moderate pain, and 32.8% of the patients showed moderate physical impairment. Significant effects of “age” and “physical issues” were found. The adult group reported a higher incidence of physical issues, and the group of patients reporting moderate physical impairment seemed more depressed than patients with mild physical issues. Finally, the comorbidity condition mediated the presence of signs of depression. Patients with BC seemed to experience negative emotions related to comorbidities associated with compromised activities of daily living. Our findings highlighted allostatic overload as a predictive framework to better understand the mental health of women with BC diagnoses to tailor effective psychological treatments for enhanced recovery.

The Role of Pessaries in the Treatment of Women With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Pessaries are an important conservative therapy for stress urinary incontinence (SUI), but few studies have comprehensively evaluated their utility. The objective of this study is to evaluate the existing evidence on the efficacy and safety of pessaries for the treatment of SUI. We searched for the terms "stress urinary incontinence" and "pessar/y/ies/ium" in PubMed, Embase, and Cinhal on June 10, 2020. Studies that characterized subjective and/or objective data were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for SUI were excluded. Two reviewers independently screened and assessed data quality and risk of bias according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ten studies, including 376 patients, were included. In terms of subjective outcomes, 76% of 72 patients reported feeling continent after pessary treatment compared with 0% of 86 patients surveyed before pessary use (P < 0.0001). Both Urinary Distress Inventory and Incontinence Impact Questionnaire scores decreased significantly by 46.7% (n = 155 baseline, n = 139 follow-up; P < 0.0001) and 67.8% (n = 139 baseline, n = 107 follow-up; P < 0.0001), respectively. Significant objective measures associated with pessary use included increased urethral closure pressure (n = 122; g = 0.56; 95% confidence interval [CI], -0.66 to 1.77; P < 0.049) and decreased pad weight (n = 129 baseline; n = 118 follow-up; g = -0.89; 95% CI, -1.986 to 0.19; P = 0.009). Adverse events significantly decreased at greater than 6 months follow-up compared with less than 6 months follow-up, including pain (31.5%, n = 29/92 vs 14.3%, n = 5/35; P = 0.0513) and discomfort (50%, n = 46/92 vs 29.3%, n = 12/41; P = 0.0268). Based on both subjective and objective measures, pessaries are an effective conservative treatment option for SUI. This supports pessary use, though larger studies with longer-term follow-up are warranted.

Matching Intent With Intensity: Implementation Research on the Intensity of Health and Nutrition Programs With Women's Self-Help Groups in India.

In India, a large network of self-help groups (SHGs) implements interventions to improve women's and children's health and nutrition. There is growing evidence on the effectiveness of women's group interventions to improve health but limited information on implementation intensity, including how often groups meet, for how long, and with whom, despite this often being cited as a key factor for success. We aimed to assess the implementation intensity of large SHG-based health and nutrition interventions with rural, low-income women, to inform program design, delivery, and measurement. We synthesized process data from surveys, meeting observations, and process evaluations across 8 maternal and child health and nutrition interventions in India. We examined the implementation intensity of 3 common intervention delivery channels: group meetings, home visits, and community-level activities. SHG members spent approximately 30 minutes in monthly meetings discussing health or nutrition. SHG dissolution or limited participation in meetings was a common challenge. Beyond group meetings, home visits reached approximately 1 in 3 households with an SHG member. Pregnant and breastfeeding women's participation in community events varied across interventions. Interventions that aim to capitalize on existing networks of financial women's groups not specifically formed for health and nutrition objectives, such as SHGs, will need to have an implementation intensity that matches the ambition of their health objectives: substantial changes in behavioral or mortality outcomes are unlikely to be achieved with relatively light intensity. Interventions that require sustained interactions with members to achieve health outcomes need to ensure adequate community and individual outreach to supplement group meetings, as well as improved participation through more intensive community mobilization approaches. Evaluations of group-based interventions should report on implementation intensity to support the interpretation of evaluation evidence and to inform further scale-up.

The 12:00 Region of the Vestibule: Often Overlooked during Examination and Treatment of Women with Entrance Dyspareunia

ABSTRACT Introduction The vestibule is an endodermal tissue located on the skin surface between Hart's line at the inner aspect of the labia minora (ectoderm), and the hymen, at the vaginal opening (mesoderm). The vestibule contains the urethral meatus and minor and major vestibular glands. The vestibule releases mucinous lubrication during sexual arousal that is achieved, in part, by vestibular innervation, likely from somatic (pudendal branch) and autonomic (pelvic branch) nerves. As part of an evaluation of patients with entrance dyspareunia, providers should perform a cotton-tip swab test to assess pain intensity and degree of erythema. Typically, the locations assessed are the 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations of the posterior and right/left anterior vestibule. This testing strategy, however, does not include the entire vestibule. The 12:00 region of the vestibule is located above the urethral meatus, just below the clitoris and medial to Hart's line. The 12:00 region can also be painful during cotton-tip swab testing. Few providers examine this region or consider it during treatment. Objective The main objective of this study was to compare the pain scores of cotton-tip swab testing and degree of erythema of the 12:00 region to those of the 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations in women presenting with entrance dyspareunia. The secondary objective was to examine the 12:00 region for the presence of minor vestibular glands. Methods Women presenting to our clinic with complaints of entrance dyspareunia underwent vulvoscopy with photography and cotton-tip swab testing including the 12:00 region while using a vulvoscope (Wallach Zoomscope) with attached camera (Cannon). Pain intensity was rated by the patient (0 – 10), with pain &amp;gt;3 considered clinically significant. Erythema was rated by the provider (absent, mild, moderate or severe) with any erythema considered clinically significant. Results A total of 144 women (mean age 43 +/- 20, range 13-83 years) underwent vulvoscopy at the standard 1:00, 3:00, 5:00, 6: 00, 7:00, 9:00 and 11:00 locations. In addition, they were tested concomitantly at the 12:00 location. Among this group of women, 26 (18%) had absent pain and absent erythema throughout all locations; 25 (18%) had positive findings of pain and erythema in at least 3 of the usual vestibular locations but not at 12:00; and 92 (64%) had pain and erythema in at least 1 of the usual vestibular locations and at 12:00. Photographs revealed 27% of those experiencing pain at the 12:00 had obvious single/multiple ostia of minor vestibular glands at that location. Conclusions Women with entrance dyspareunia commonly have pain and erythema at the 12:00 region of the vestibule. Photography reveals the presence of minor vestibular glands at the 12:00 location. Providers should examine the entire vestibule including the 12:00 region during examination. Providers should consider including the 12:00 vestibule when treating entrance dyspareunia with medication such as compounded testosterone and estradiol and/or surgery. Disclosure No

Potential Feasibility of an Online Hypnosis Intervention for Women with Persistent Pelvic Pain

ABSTRACT This study aimed to examine the potential feasibility of an online hypnotic intervention for women with persistent pelvic pain. The secondary aim was to explore the effect of the hypnosis intervention on anxiety, depression, pain severity, coping, pain catastrophizing, and pain disability in comparison to a no-intervention control. Twenty women with persistent pelvic pain completed assessment questionnaires and were recruited from a variety of social media sites related to persistent pelvic pain and randomized to either control or hypnotic intervention groups. The intervention group completed a 7-week online hypnotic intervention. Results found a 30% dropout rate and modest compliance (90%-40%) with practice of audio recordings. Comments from the 7 participants who completed the hypnosis intervention indicated it was acceptable. Significant reductions in screening measures of anxiety and depression were found; however, there were no significant effects shown for pain severity, avoidant coping, pain catastrophizing, or pain disability. The intervention is potentially feasible, but further refinement and optimization is needed to increase retention, compliance, and potential effects.

Loss to follow-up among human immunodeficiency virus-positive postpartum women and its predictive factors: A retrospective study.

Antiretroviral treatment (ART) is essential in preventing mother-to-child transmission of human immunodeficiency virus (HIV), and postpartum discontinuation of ART is associated with adverse outcomes. This study identified factors associated with postpartum follow-up of HIV-positive women. This was a retrospective cohort study of 170 HIV-infected pregnant women who received regular obstetric examination and delivered successfully in Beijing between 2003 and 2020.The women's sociodemographic, clinical, treatment, obstetric, and gestational characteristics were analyzed. Cox proportional hazards models were used to estimate adjusted hazard ratios (AHRs) of loss to follow-up between levels of confounders. In the multivariable Cox proportional hazard models, women with a longer time from HIV diagnosis to delivery per year had a 1.4-timeshigher risk (AHR=1.433, 95% CI: 0.897-2.229) and a higher rate of loss to follow-up than the other women. Perinatal health care (AHR=0.003,95% CI: 0.000-0.105) and gestational age above 37weeks at delivery (AHR=0.294, 95% CI: 0.005-15.818) were associated with a longer follow-up of postpartum HIV-positive women, when compared to women who did not receive perinatal healthcare and who delivered before 37weeks of gestation, respectively. The longer time from HIV diagnosis to delivery, access to perinatal care, and full-term gestation at delivery improved postpartum ART adherence and follow-up among HIV-positive women. Early initiation of ART, integration of adult ART into prevention of mother-to-child transmission, combination ART with maternal healthcare, and enhanced pregnancy care will improve ART adherence among HIV-positive women after delivery.

Determinants of contraceptive decision making among married women in Sub-Saharan Africa from the recent Demographic and Health Survey data

BackgroundDifferent evidence suggested that couples often disagree about the desirability of pregnancy and the use of contraceptives. Increased women's decision-making on contraceptives is identified as a key solution that can change the prevailing fertility and contraceptive utilization pattern in SSA. Therefore, this study aimed to determine determinants of contraceptive decision-making among married women in Sub-Saharan Africa.MethodsThe data source of this study was the standard demographic and health survey datasets of 33 Sub-Saharan Africa countries. Reproductive age group women aged (15–49 years) currently married who are not pregnant and are current users of contraceptive preceding three years the survey was included from the individual record (IR file) file between 2010 and 2018. Since the outcome variable is composed of polychotomous categorical having multiple-choice, the Multinomial logistic regression (MNLR) model was applied.ResultsA total of 76,516 married women were included in this study. Maternal age 20–35 and 36–49 years were more likely to had decision making on contraceptive use in both women-only and joint (women and husband/partner category (referance = husband/partner) (RRR = 1.2; 95% CI = 1.05–1.41, RRR = 1.18; 1.04–1.33 and RRR = 1.38; 95% CI = 1.17–1.61, RRR = 1.27; 1.11–1.47)] respectively. Married women with higher education were more likely to decide by women-only category on contraceptive use (referance = husband/partner) (RRR = 1.26; 95% CI = 1.06–1.49). Women only decision-making to use contraceptives relative to the husband/partner only decreases by a factor of 0.86 (95% CI = 0.80–0.93) among rural than urban residences. Women only or joint decision making to use contraceptives was 1.25 and 1.35 times more likely relative to husband/partner decision making respectively among women who had work than that of had no work. The relative risk of women's decision to use family planning relative to husband increased among couples who had a marital duration of ≥ 10 years (RRR = 1.14; 95% CI = 1.06–1.22). But it has no significant effect on joint decision making. Respondents found in the richest wealth index category increase the relative risk of joint decision-making relative to husband/partner (RRR = 1.33; 95% CI = 1.20–1.47) compared to the poorest category.ConclusionsDecision-making to use contraceptives among married women varies greatly by socio-demographic characteristics. The finding of this study showed that women's age, women educational status, residence, duration of the marriage, family economy, and country income were significantly associated with contraceptive decision-making. Therefore to promote ideal family planning decision making, there is a need to formulate policies and design programs that target women's socio-demographic characteristics and modern contraceptive interventions should be promoted by considering empowering women on decision making.

The effect of stigma on level of ınfertility-related psychological distress in women with infertility.

This study was conducted to examine the effect of stigma on level of ınfertility-related psychological distress of women with infertility. Descriptive study was conducted in infertility clinics in Turkey. This study was completed with 198 infertile women. Infertility Distress Scale was 42.69±7.79, the mean total score of the Infertility Stigma Scale was 52.80±23.44. It was found that the psychological effect of infertility increased among women as the Infertility Stigma Scale total scores and its sub-dimension scores increased. Developing appropriate interventions by considering infertility and the level of being affected by stigma allows women to cope with this process in a healthier way, which is thought to increase the success of women's treatment.

Effect of Mindfulness-based Intervention on the Treatment of Women’s Sexual Dysfunction: A Literature Scoping Review

Introduction: The significance and role of sexual function in quality of life is an undeniable fact that should be taken into account in the care provided for individuals. The use of modern non pharmacological methods in the treatment of sexual dysfunction, especially in women, is required to be investigated. Aim: To review the effect of mindfulness-based interventions in the treatment of women’s sexual dysfunction in the previous studies. Materials and Methods: This literature scoping review was conducted on all observational and experimental studies published in Persian and English languages, from 2008 to 2021.The databases that were searched for relevant studies were Google Scholar, Web of Sciences, PubMed and Scopus. The keywords used for the search included, mindfulness, mindfulness-based interventions, sexual dysfunction, women. Data related to the study year of publication, place, type of study, sample population, and the effect of mindfulness-based interventions in the treatment of women’s sexual dysfunction were recorded. Results: A total of 742 studies were found, of which 23 studies were extracted. Among the reviewed articles, five articles (21.74%) are published in Persian and 18 articles (78.26%) in English. In total, 22 articles confirmed positive effects and one article found no effects on mindfulness-based interventions in improving sexual function in women suffering sexual dysfunction. Conclusion: Mindfulness-based interventions, though it is implemented based on different approaches (stress reduction, cognitive-behavioral and sex therapy), are effective in treating all types of sexual dysfunction in women.

Reducing Tobacco and Nicotine Use Among Women in Treatment for Substance Use Disorder: Evaluation of the Knit to Quit Program

Reducing Tobacco and Nicotine Use Among Women in Treatment for Substance Use Disorder: Evaluation of the Knit to Quit Program