Women's Sexual Health Research Articles

Empowering Women’s Health: Transforming Maternal Health Care in India

An indicator of the reproductive health of women in an area is the maternal mortality rate. A lot of women in the reproductive age range pass away from difficulties during, during, or related to pregnancy, childbirth, or abortion. Maternal mortality, a critical indicator of a country's healthcare system and women's well-being, has been a persistent concern in India. The study examines the progress and strategies employed in reducing maternal mortality in India. The research explores the initiatives undertaken by the Indian government under the National Health Mission to address maternal health. The findings serve as a valuable resource for policymakers, healthcare professionals, and researchers striving to advance women's sexual and reproductive health rights while reducing maternal mortality globally.
 KEYWORDS: Maternal mortality, Reproductive health, women, India

The Effect of Clinical Pilates Exercises and Prenatal Education on Maternal and Fetal Health.

The mental, physical and sexual health of women as well as maternal and fetal health should be considered during the prenatal and postnatal periods. Investigating the effect of clinical Pilates exercises and prenatal education (CPE & PE) on obstetric and neonatal outcomes as well as the mental, physical, and sexual health of women was intended. In the second trimester, mothers with singleton pregnancies who attended (n=79, study group) or did not attend (n=80, control group) CPE & PR were recruited to this prospective cohort study, and were evaluated in the prenatal and postnatal periods. Depression was assessed with Beck Depression Inventory (BDI), sexual functions with Female Sexual Function Index (FSFI), muscle strength with Gross Muscle Scales (GMS), and labor pain with Visual Analogue Scale (VAS). In addition, the presence of low back pain (LBP) was questioned. No significant association of CPE & PE with obstetric outcomes such as cesarean rates, preterm birth, and neonatal outcomes such as birth weight and Apgar scores were identified. Changes in VAS scores, the incidence of perineal trauma, and episiotomy were not associated with CPE & PE. However, CPE & PE was associated with lower BDI scores, a gradual increase in the total scores of FSFI, increased GMS, and reduced LBP. CPE & PE had no adverse effects on obstetric and neonatal outcomes and was associated with improved mental, physical, sexual health scores during pregnancy and postpartum.

How To Apply Resfecfull Midwifery Care In Improving The Quality Of Midwifery Services?

Introduction: Midwives play a strategic role in shaping future generations and ensuring women's reproductive and sexual health. Every woman and newborn has the right to quality care and a positive birthing experience, which is best achieved through Respectful Midwifery Care (RMC). Method: This systematic review, conducted according to PRISMA guidelines, aims to explore the relationship between RMC and the improvement of midwifery service quality. Keywords such as “respectful midwifery care,” “women's empowerment,” “antenatal care,” “childbirth,” “family support,” and “pregnancy” were utilized. Out of 86 identified articles, 30 studies met the inclusion criteria. Results: The review included studies from various regions, examining characteristics like publication details, research design, and location. The findings consistently show a strong correlation between RMC practices—focused on women's empowerment, family support, and positive birthing experiences—and enhanced quality of midwifery services. Conclusion: The implementation of RMC, with an emphasis on empowerment and family involvement, significantly improves midwifery service quality. This review of 30 eligible studies from diverse global settings underscores the widespread effectiveness of RMC across different contexts.

(027) Socio-Cultural Practices and Sexuality Education among Families in Rural Ghana

Abstract Introduction Sexuality education is considered key to the sexual well-being of young people as it empowers them to make informed choices and attain more productive livelihoods. Although it contributes to advancing the sustainable development goals on health and well-being, it remains a challenge among families in sub-Saharan Africa due to socio-cultural norms and misconceptions. Underlining notions are that discussing sexuality issues with young people makes them curious and predisposes them to engage in early sexual activities. Objectives In this study, we accessed the knowledge, attitudes, practices, and highlight the experiences of young adolescent boys and girls, examine the content of sexuality information parents give to their wards, and highlight the gender differences to sexuality education among these families (i.e., parents and their wards). Methods Based on the narrative of parents and their wards (i.e., young people aged 16 – 19 years), data for the study was gathered through the use of in-depth interviews and group interviews aided by a semi-structured interview guide. Participants were reached through the purposive and snowballing sampling techniques. Field data were tape-recorded, transcribed, coded, and analyzed thematically. Results Our results revealed that adherence to morally and socially appropriate sexual norms among young people (i.e., bodily hygiene, menstrual hygiene, and abstinence from sex) were the central focus of sexuality discussions among families. Socio-economic factors (such as educational level) influenced the sort of sexuality issues discussed among families. Thus, parents with higher educational attainment had liberal views regarding sexuality education and were more open to discuss diverse sexuality issues with their wards than parents with lower educational attainment with conservative views regarding sexuality education. The results also indicated that adolescents who discussed diverse sexuality topics with their parents had “conservative” sexual values than adolescents who discussed diverse sexuality topics with their friends who in-turn had “liberal” sexual values. Conclusions Socio-cultural norms, conservative religious values, and gender disparities among parents and their wards have far-reaching implications on their attitude and behaviour towards sexuality education. Most adolescents preferred other alternative sources (such as their peers and social media) for sexuality information. This invariably influences their sexual attitudes and behaviours. Although these norms and dispositions influence adolescent’s sexual agency, empowering families (i.e., parents and young people) with adequate sexuality knowledge can help correct the misconceptions currently shaping the discourse on sexuality education. Creating supportive and enabling environments is also a key step to the realization of the sexual health needs of young people. Disclosure Yes - International Society for the Study of Women's Sexual Health. Industry funding only - investigator initiated and executed study – No.

Exploring the Role of Traditional Women Society Membership Among West African Immigrant Women Who Have Experienced Female Genital Mutilation/Cutting.

This study explores the complex nature of female genital mutilation/cutting (FGM/C) by juxtaposing the mental and sexual health of women who had undergone FGM/C as part of initiation/membership into a traditional women's society (TWS) with those who were also cut but not initiated into a TWS. While considerable differences emerged between TWS members and nonmembers, there was no evidence that TWS membership was protective against the physical and psychological trauma typically ascribed to FGM/C. In fact, the pattern of results would tend to suggest the opposite. Possible explanations for and implications of these findings are discussed.

Urinary Incontinence Affects the Quality of Life and Increases Psychological Distress and Low Self-Esteem.

Urinary incontinence is a common problem among women of reproductive age. The objectives of this study were to measure the prevalence of urinary incontinence and the association with quality of life, psychological distress and self-esteem in Saudi women in the city of Riyadh. A questionnaire-based cross-sectional study was conducted in primary healthcare centers with Saudi women aged between 30 and 75 years. The questionnaire consisted of Urinary Distress Inventory, Incontinence Impact Questionnaire, Kessler Psychological Distress Scale, Rosenberg Self-esteem Scale, and the Female Sexual Function Index. Around 47.5% of women were suffering from urinary incontinence. The most common type of incontinence was stress (79%), followed by urge (72%) and mixed type (51%). Multivariate logistic regression analysis found that stress (5.83 (3.1, 11.1)), urge (3.41 (2.0, 5.8)), mixed (8.71 (3.4, 22.4)) incontinence and severe urinary distress (8.11 (5.2, 12.7)) were associated with impaired quality of life. Women suffering from stress and urge incontinence were twice (2.0 (1.3, 2.2)) as likely of reporting moderate/severe mental distress. Women suffering from urge incontinence (1.92 (1.4, 2.7)) and severe urinary distress (1.74 (1.1, 2.8)) were at a higher prevalence of reporting low self-esteem. Urinary incontinence affects the physical, psychological, social, and sexual health of women. Healthcare providers should be knowledgeable about the adverse consequences of UI on women's personal and social life, and provide counseling and treatment accordingly.

The "oldest and the newest of nurses": Nursing and the Professionalization of Obstetrics and Gynecology.

When in the late nineteenth century American physicians increasingly replaced midwives in the care of obstetrical and gynecological patients, they could do so only because they were aided by another emerging group of healthcare professionals: nurses. Nurses were instrumental in assisting physicians in the care of patients in labor and during recovery. They were also necessary for male physicians because the vast majority of nurses were women and their presence during gynecological and obstetrical treatments made it more socially acceptable for men to examine female patients. In hospital schools in the northeast and through long-distance nursing programs, physicians taught students about obstetrical nursing and instructed them to protect the modesty of female patients. They also tried to instill strict professional hierarchies between nurses and physicians, emphasizing that nurses should never attempt to deliver a patient without a physician. But as nursing emerged into a unique professional practice separate from that of physicians, nurses were able to negotiate better education in the care of laboring patients. In order to take over women's sexual and reproductive health care from traditional providers, physicians conceded to nurses' demands for more authority in patient care.

The impact of cell-based therapy on female sexual dysfunction: a systematic review and meta-analysis.

Female sexual dysfunction (FSD) is a complex issue affecting women of all ages; it involves several overlapping body systems and profoundly affects quality of life. The use of cell-based therapy, such as mesenchymal stem cells, has recently been investigated as a potential treatment for FSD. This systematic review and meta-analysis aim to assess FSD outcomes following cell-based therapy. We evaluated peer-reviewed articles from multiple online databases through November 2022 to identify studies that used cell-based therapy and reported sexual function outcomes in women. We performed a meta-analysis using data pooled from 3 clinical trials at our institution: CRATUS (NCT02065245), ACESO (NCT02886884), and CERES (NCT03059355). All 3 trials collected data from the Sexual Quality of Life-Female (SQOL-F) questionnaire as an exploratory outcome. Existing literature on this topic is scarce. Five clinical studies and 1 animal study were included in the systematic review, and only 2 clinical studies were considered good quality: 1 reported significant SQOL-F improvement in women 6 months after cell therapy, and 1 reported posttherapy sexual satisfaction in all women. When individual patient data were pooled in a meta-analysis from 29 women across 3 trials at our institution, the SQOL-F was not significantly improved. Despite growing interest in cell-based therapy for women's sexual health, this important issue is understudied in the literature. The optimal route, source, and dose of cell therapy to produce clinically meaningful change have yet to be determined, and further research is needed in larger randomized placebo-controlled clinical trials.

Obserwacje kliniczne związane z opieką nad kobietą w czasie pandemii COVID-19

Introduction. Humanity faced the same enemy, the new SARS-CoV-2 coronavirus, and so the COVID-19 pandemic has become a common phenomenon faced by the modern world in the era of globalization. This has also proven to be a particular challenge for gynecologists. Aim. To demonstrate that in gynecology as a science about women, also in the context of the COVID-19 pandemic, a holistic approach to women’s care is important, and this care should include health-promoting activities, including sexual health. Material and methods. Analysis of the literature related to the problem of the COVID-19 pandemic, sexual health of women, as well as clinical observations from gynecological practice during the pre-vaccination pandemic period, which concerned the intensity of menstrual pain compared to the pre-pandemic period in 58 young, healthy women. The VAS scale was used. Results. There was a significant difference in the level of pain intensity in women before the pandemic and during the pandemic in 2020 (p < 0.0001). Before the pandemic, women felt less pain than during the pandemic. Conclusions. Clinical observations indicate that the stress associated with the pandemic and the restriction of movement related to lockdown during the pandemic may be associated with an increase in menstrual pain. Also in gynecological practice, the influence of bad experiences, suffering and pain related to the pandemic on the general condition, psyche, partnerships and functioning in the sexual sphere is observed.

Association of sexual relationship power with PrEP persistence and other sexual health outcomes among adolescent and young women in Kenya and South Africa.

Gendered power inequalities impact adolescent girls' and young women's (AGYW) sexual and reproductive health (SRH) outcomes. We investigated the influence of sexual relationship power on AGYW's SRH outcomes, including HIV pre-exposure prophylaxis (PrEP) persistence. The POWER study in Kisumu, Kenya, and Cape Town and Johannesburg, South Africa provided PrEP to 2,550 AGYW (aged 16-25). AGYW's perceived power in their primary sexual relationship was measured among the first 596 participants enrolled using the Sexual Relationship Power Scale's (SRPS) relationship control sub-scale. Multivariable regression was used to test for (1) key sociodemographic and relationship characteristics associated with relationship power; and (2) the association of relationship power with SRH outcomes including PrEP persistence. In this cohort, the mean SRPS score was 2.56 (0.49), 542 (90.9%) initiated PrEP; 192 (35.4%) persisted with PrEP at 1 month of which 46 (24.0% of 192) persisted at 6 months. SRPS were significantly lower among AGYW who cohabited with their sex partner (-0.14, 95% CI: -0.24 to -0.04, p = 0.01), or had ≥1 sex partner (-0.10, 95% CI: -0.19 to -0.00, p = 0.05). AGYW with lower SRPS were more likely to not know their partner's HIV status (aOR 2.05, 95% CI: 1.27 to 3.33, p < 0.01), but SRPS was not associated with PrEP persistence, STI infection, condom, or hormonal contraception use. AGYW's reasons for initiating PrEP and reasons for continuously using PrEP may be different. While low relationship power was associated with perceived HIV vulnerability, AGYW's PrEP persistence may be influenced by more than relationship power.

Student midwives' perspectives of women's sexual and reproductive health literacy in Turkey

ObjectiveThis study focused on the issues surrounding health literacy in the context of women’s sexual and reproductive health (SRH), the significance and availability of information for midwives and women; and the socio-cultural influences and barriers related to women’s level of health literacy. MethodsA cross sectional on-line survey was distributed to 280 student midwives in their 2nd 3rd and 4th year of a midwifery programme. This paper focuses on the responses from 138 students which were analysed using descriptive and non-parametric tests. ResultsStudent midwives indicated their level of agreement regarding women’s ability to access, understand, and appraise information they received verbally and in written form about the six main SRH topics (namely contraception, STIs, abortion, Pap tests and cervical cancer, and fertility and pregnancy), from their midwife but agreement was much lower regarding women’s access to SRH information from peers and their families. False beliefs were ranked as the most common barrier to accessing information and services. Students ranked being a refugee, being from a rural area, being educated to a primary school level or not formally educated, as having the greatest negative impact on women’s health literacy. ConclusionsFindings from this study indicate the role that the sociocultural background of Islamic culture plays in the disparities in sexual and reproductive health literacy (SRHL) for women from the perspective of student midwives. Our findings indicate the need for future research to focus on women as participants to gain their first-hand experiences of SRHL.

Impaired sexual health among women treated for vulvar cancer: An integrated review.

Although gynaecological cancer's negative effects on sexual function are well known, most studies on the subject have not included vulvar cancer patients or a multidimensional perspective on sexual health. Therefore, this review aimed to address this research gap and explored the impact of vulvar cancer on women's sexual health from a multidimensional perspective. An integrated review was conducted, as described by Whittemore and Knafl. The PubMed, CINAHL, PsycINFO and Embase databases were searched in March 2021 and updated in August 2022 and March 2023. The data were thematically analysed using NVivo, and the PRISMA-ScR and ENTREQ guidelines were followed. The following themes were identified in the 28 reviewed articles: impact of a changed female body, impact on women's sexual identity, consequences for women's sexual relationships and unmet needs and loneliness caused by taboos about sexual health. Women's impaired sexual health after vulvar cancer points to a great need to understand and holistically investigate sexual health. In addition, healthcare professionals have an obligation to care for the sexual health issues of patients with vulvar cancer. However, most questionnaires used in the selected studies revealed a narrow understanding of sexual health and focused on sexuality as a genital activity. The sexual health of women with vulvar cancer was tabooed and stigmatised for patients and healthcare professionals. Consequently, women received sparse sexual guidance, felt isolated and had unmet needs. Healthcare professionals need knowledge and training on how to break taboos and address the sexual needs of vulvar cancer patients. Systematic screenings for sexual health needs should be conducted using a multidimensional perspective. The protocol was preregistered at the Open Science Framework (www.osf.io), registration DOI: https://doi.org/10.17605/OSF.IO/YDA2Q PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Effect of an 8-Week Tailored Physiotherapy Program on Sexual Health in Women with Scleroderma and Myositis: A Controlled Pilot Study.

Systemic sclerosis (SSc) and idiopathic inflammatory myopathies (IIM) are very rare rheumatic diseases burdened by a high prevalence of sexual dysfunctions. However, no specific treatment has been proposed to date. To our knowledge, this is the first (pilot) study aiming to investigate the effect of an 8-week tailored physiotherapy program on the sexual health of women with SSc and IIM. In total, 12 women with SSc and 4 women with IIM were enrolled in the study. Based on the patients' capability to participate in the program, they were divided into an intervention group (IG) (mean ± SD age 46.8 ± 8.6years) and a control group (CG) (mean ± SD age 46.3 ± 8.5years). IG underwent the 8-week program (1h of supervised physiotherapy twice weekly), whereas CG received no physiotherapy. At weeks 0 and 8, all patients filled in questionnaires assessing sexual function (Female Sexual Function Index [FSFI], Brief Index of Sexual Functioning for Women [BISF-W]), sexual quality of life (Sexual Quality of Life-Female [SQoL-F]), functional ability (Health Assessment Questionnaire [HAQ]), quality of life (Medical Outcomes Short Form-36 [SF-36]), and depression (Beck's Depression Inventory-II [BDI-II]). The changes were analyzed with two-way ANOVA and Friedmann's test. Compared to the statistically significant deterioration in CG over weeks 0-8, we found statistically significant improvements in the total scores of FSFI and BISF-W, and some of their domains, functional status, and the physical component of quality of life. Our 8-week physiotherapy program not only prevented the natural course of progressive deterioration of functional ability but also led to a significant improvement in sexual function and quality of life in women with SSc and IIM. However, due to the lack of randomization and a relatively small sample size resulting from the strict inclusion criteria, further validation of our results is needed. ISRCTN91200867 (prospectively registered).

(282) Impact of Lichen Sclerosus on Menopausal Women's Sexual Health

Abstract Introduction Lichen sclerosus (LS) is a vulvar dermatosis of unknown origin that affects 1 in 70 women. There is a higher incidence in menopausal women, which may be due to detection bias. LS presents with skin texture changes, hypopigmentation, and scarring. Common symptoms include vulvar burning, pruritus, and dyspareunia. Objective This study was to understand the sexual health experience for menopausal women with LS and was part of a larger study on the microbiome and genetics of menopausal women with LS. Methods We interviewed 25 women with biopsy proven LS and 5 post-menopausal women who do not have LS or any other vulvar symptoms. This was part of a larger study on the microbiome and genetics of postmenopausal women with LS. We specifically surveyed them regarding the impact their diagnosis had on their sexual health. Results The majority (n=10) of the women reported a satisfactory sex life prior to being diagnosed with LS. However, the majority (n=11) of respondents reported that it negatively changed since being diagnosed and most reported their sex life as not being satisfactory (n=8). When asked how their sex life changed women responded with “too uncomfortable at times so hesitant to cause irritation,” “pain, avoidance for intercourse,” “no sex life,” or “no desire no sex.” Unfortunately, the majority (n=10) of the women were not told when they were diagnosed with LS about the possible changes to their sex life. Furthermore, the majority (n=28) were not prescribed medications or had procedures done to improve their sexual health. Conclusions Our study revealed that LS had a negative impact on our participants' sexual health and yet the women were not informed of this or given treatment options. We hope this study will call attention to providers to the need for patient education regarding LS' potential negative effects on women's sexual health. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Scynexis

Child marriage as a risk factor for non-communicable diseases among women in India.

Child marriage, defined as marriage under the age of 18 years, remains pervasive in India. Global evidence documents a negative association between child marriage and women's reproductive and sexual health outcomes; however, its relationship with non-communicable diseases (NCDs) remains underexplored. We utilize biomarkers and self-reported data from the nationally representative National Family and Health Survey 4 (2015-2016) to examine the associations between child marriage and hypertension, diabetes, heart disease, asthma and thyroid disorder among currently married women (N = 421 107). We use regression models adjusted for a range of demographic and socio-economic controls to assess the association between child marriage and NCDs among women in India. We further assess whether and to what extent these relationships are mediated by early motherhood using the Karlson, Holm and Breen method of decomposition. Child marriage was associated with hypertension [adjusted odds ratio 1.20 (95% CI: 1.17-1.24)], diabetes [1.29 (1.22-1.37)], heart disease [1.27 (1.18-1.36)], asthma [1.19 (1.11-1.28)] and thyroid disorder [1.10 (1.02-1.18)]. Early motherhood also increased the risk of NCDs among women. Furthermore, it emerged as a pathway linking child marriage with hypertension, diabetes and heart disease; however, it provided a partial explanation for the disadvantage associated with child marriages. Child marriage emerges as a risk factor for NCDs among women in India. Health systems need to recognize the enduring influence of child marriages on women's health and ensure early detection and effective treatment of NCDs for this vulnerable group.

Predictors of Unintended Pregnancy and Sexual Reproductive Health Conditions in Survivors of Violence

The effect of violence on women's sexual reproductive health is of significant importance; this study aimed to study the association between gender-based violence with unintended pregnancy and common sexual reproductive health conditions. The size of the study sample was 102, who were survivors of violence. Direct interviews collected the data, and the researchers used a structured 30-question questionnaire. Results showed that early marriage was significantly associated with unintended pregnancy. The mean of unintended pregnancy for the marriage age group &lt;=18 years was 1.79, which is higher than the mean of the&gt;18 years marriage age group. The t-value is 2.616, and the significance value is 0.010, meaning there are statistically significant differences in unintended pregnancy in favour of the age group &lt;=18 years. Results also indicated the prevalence of unmet needs for contraception in the study sample was 55% among survivors. 26% of women received inadequate antenatal visits primarily due to financial reasons, and almost half (47%) of births were delivered by the Cesarian section; the most popular method is IUD. In conclusion, gender-based violence is a consistent and strong risk factor for unintended pregnancy, especially in the child marriage age group, so it's necessary to overlook sexual reproductive health among survivors of violence as it might be threatened.

Preferred product attributes of a multipurpose vaginal ring: Findings from a phase 1 trial.

Most women face multiple and co-occurring risks from unwanted pregnancy, human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) at some point during their lifetime. While a range of contraceptive methods exist and options for HIV prevention are increasing, to date, only male and female condoms provide multipurpose protection from both pregnancy and disease. From September 2017 to December 2018, 60 women from the United States and the Dominican Republic, randomized 1:1 to continuous or interrupted use and 4:1 to active vs. placebo ring, participated in a Phase I trial to assess the safety and tolerability of a three-month multipurpose intravaginal ring (IVR) containing the antiviral tenofovir and the contraceptive levonorgestrel. This study examines survey responses from all participants and qualitative data from a subset of 17 women to assess acceptability of and preferences for IVR characteristics. Overall, women liked the concept of a multipurpose IVR and found it easy to insert and remove. Initial concerns about the size or thickness of the ring generally disappeared with use experience. Women weighed trade-offs between the ease of continuous use for a longer duration against concerns about hygiene and discoloration of the ring when left in place during menses. Whether randomized to continuous or interrupted use, most women found ring attributes (size, thickness, flexibility) very acceptable. They provided recommendations via survey and qualitative interviews for ring modifications that would further increase acceptability. Insights into women's use experiences also suggest the need for clear counseling messages and introduction strategies that can facilitate women's choice and use of prevention methods. Study findings suggest that a multipurpose IVR would make a valuable contribution to women's sexual and reproductive health options, and that both continuous and interrupted use strategies may be preferred.

Factors affecting women's sexual life after oncological treatment of breast cancer

Introduction and purpose: Breast cancer is the most common malignant tumor among Polish women. However, with the development of medicine, new methods of treating and detecting breast cancer are accessible. In consequence, there is a significant decrease in mortality and an increase in the number of detected cases. Therefore, the needs and difficulties faced by women with breast cancer, including those related to their sexuality, require a different approach. This paper aims to present the impact of breast cancer treatment on women's sexuality based on a review of the available literature.&#x0D; Description of the state of knowledge: There are many methods of treating breast cancer, but mastectomy, one of the most radical therapies, is performed in almost half of the patients. There is a high percentage of psychological complications associated with this procedure, among others, since female breasts are perceived as attributes of femininity. Women diagnosed with breast cancer face concerns about self-esteem and body image. Breast cancer has a notable impact on sexuality, and cancer diagnosis and oncological cancer treatment are associated with several physical and psychosocial uncertainties. The lack of a native breast can cause a sense of imperfection, shame, and fear of rejection by the partner. &#x0D; Summary: Health professionals should concentrate on the sexual health of women with breast cancer because it is frequently overlooked and assigned less priority. The return of sexual satisfaction and acceptance of the new body appearance should be a component of successful breast cancer treatment.

Women’s sexual and reproductive health in war and conflict: are we seeing the full picture?

ABSTRACT It is well established that women’s sexual and reproductive health (SRHR) is negatively affected by war. While global health research often emphasises infrastructure and systematic factors as key impediments to women’s SRHR in war and postwar contexts, reports from different armed conflicts indicate that women’s reproduction may be controlled both by state and other armed actors, limiting women’s choices and access to maternal and reproductive health care even when these are available. In addition, it is important to examine and trace disparities in sexual reproductive health access and uptake within different types of wars, recognising gendered differences in war and postwar contexts. Adding feminist perspectives on war to global health research explanations of how war affects women's sexual and reproductive health might then contribute to further understanding the complexity of the different gendered effects war and armed conflicts have on women’s sexual and reproductive health.

The influence of lichen sclerosus on women's sexual health from a biopsychosocial perspective: a mixed methods study.

Women with lichen sclerosus (LS) may suffer sexually because of dyspareunia, fissures, and introital narrowing. However, the literature remains limited on the biopsychosocial aspects of LS and its impact on sexual health. To examine the biopsychosocial aspects and impact of LS on the sexual health of Danish women with vulvar LS. The study was conducted with a mixed methods approach, including women with LS from a Danish patient association. The quantitative sample consisted of 172 women who completed a cross-sectional online survey that included 2 validated questionnaires: the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS). The qualitative sample consisted of 5 women with LS who volunteered for audiotaped, individual, semistructured interviews. This mixed methods study combined data from 2 quantitative questionnaires (FSFI and FSDS) with qualitative interviews to achieve a comprehensive insight into the biopsychosocial aspects of sexual health in women living with LS. The sexual function of women with LS was considerably affected, with FSFI scores below the cutoff value of 26.55, indicating a risk of sexual dysfunction. On average, 75% of the women were sexually distressed, with a total FSDS score of 25.47. Furthermore, 68% of the sexually active women were considerably affected in terms of sexual function and sexual distress, thus meeting international criteria for sexual dysfunction. However, a negative impact on sexual function was not always related to sexual distress and vice versa. The qualitative analysis identified 4 overarching themes: (1) decrease in or loss of sexual activity, (2) interference with relationship dynamics, (3) importance of sex and intimacy - loss and restoration, and (4) worries about sexual insufficiency. Insight into the influence of LS on sexual health is important for health care professionals, including doctors, nurses, sex therapists, and physiotherapists, to provide the best guidance, support, and management for women with LS. The strengths of the study are its use of a mixed methods design and the inclusion of sexual function and sexual distress. A limitation is related to the properties of the FSFI regarding women with no sexual activity. LS has a considerable influence on women's sexual health in terms of sexual function and sexual distress, as supported by quantitative and qualitative measures. Our understanding of the complex interactions among sexual activity, intimate relations, and causes of psychological distress has been enriched.