Prenatal care and pregnancy outcome among incarcerated pregnant individuals in the United States: a systematic review and meta-analysis.

This systematic review and meta-analysis assessed the risk of inadequate prenatal care and pregnancy outcome among incarcerated pregnant individuals in the United States. PubMed/MedLine, Embase, ClinicalTrials.gov and Web of Science were searched from inception up to March 30th, 2022. Studies were included if they reported the risk of inadequate prenatal care and/or pregnancy outcomes among incarcerated pregnant individuals in the United States jails or prisons. Adequacy of prenatal care was quantified by Kessner index. The random-effects model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CIs) using RevMan software. Nine studies were included in the final review. A total of 11,534 pregnant individuals, of whom 2,544 were incarcerated while pregnant, and 8,990 who were matched non-incarcerated pregnant individuals serving as control group, were utilized. Compared to non-incarcerated pregnancies, incarcerated pregnant individuals were at higher risk of inadequate prenatal care (OR 2.99 [95% CI: 1.60, 5.61], p<0.001) and were more likely to have newborns with low birthweight (OR 1.66 [95% CI: 1.19, 2.32], p=0.003). There was no significant difference between incarcerated and matched control pregnancies in the rates of preterm birth and stillbirth. The findings of the current systematic review and meta-analysis suggest that incarcerated pregnant individuals have an increased risk of inadequate prenatal care. Considering the limited number of current studies, further research is indicated to both assess whether the risk of inadequate prenatal care has negative impact on prenatal outcomes for this population and to determine the steps that can be taken to enhance prenatal care for all pregnant individuals incarcerated in the United States prisons.

Effects of participation in a U.S. trial of newborn genomic sequencing on parents at risk for depression.

Much emphasis has been placed on participant's psychological safety within genomic research studies; however, few studies have addressed parental psychological health effects associated with their child's participation in genomic studies, particularly when parents meet the threshold for clinical concern for depression. We aimed to determine if parents' depressive symptoms were associated with their child's participation in a randomized-controlled trial of newborn exome sequencing. Parents completed the Edinburgh Postnatal Depression Scale (EPDS) at baseline, immediately post-disclosure, and 3 months post-disclosure. Mothers and fathers scoring at or above thresholds for clinical concern on the EPDS, 12 and 10, respectively, indicating possible Major Depressive Disorder with Peripartum Onset, were contacted by study staff for mental health screening. Parental concerns identified in follow-up conversations were coded for themes. Forty-five parents had EPDS scores above the clinical threshold at baseline, which decreased by an average of 2.9 points immediately post-disclosure and another 1.1 points 3 months post-disclosure (both p ≤ .014). For 28 parents, EPDS scores were below the threshold for clinical concern at baseline, increased by an average of 4.7 points into the elevated range immediately post-disclosure, and decreased by 3.8 points at 3 months post-disclosure (both p < .001). Nine parents scored above thresholds only at 3 months post-disclosure after increasing an average of 5.7 points from immediately post-disclosure (p < .001). Of the 82 parents who scored above the threshold at any time point, 43 (52.4%) were reached and 30 (69.7%) of these 43 parents attributed their elevated scores to parenting stress, balancing work and family responsibilities, and/or child health concerns. Only three parents (7.0%) raised concerns about their participation in the trial, particularly their randomization to the control arm. Elevated scores on the EPDS were typically transient and parents attributed their symptomatology to life stressors in the postpartum period rather than participation in a trial of newborn exome sequencing.

Effect of gabapentin on sexual function in vulvodynia: a randomized, placebo-controlled trial.

BACKGROUND: Sexual dysfunction is common in women with vulvodynia. OBJECTIVE: The purpose of this study was (1) to evaluate whether extended-release gabapentin is more effective than placebo in improving sexual function in women with provoked vulvodynia and whether there is a relationship between treatment outcome and pelvic pain muscle severity that is evaluated by palpation with standardized applied pressure and (2) to evaluate whether sexual function in women with provoked vulvodynia would approach that of control subjects who report no vulvar pain either before or after treatment. STUDY DESIGN: As a secondary outcome in a multicenter double-blind, randomized crossover trial, sexual function that was measured by the Female Sexual Function Index was evaluated with gabapentin (1200-3000 mg/d) compared with placebo. Pain-free control subjects, matched by age and race, also completed Female Sexual Function Index for comparison. RESULTS: From August 2012 to January 2016, 230 women were screened at 3 academic institutions, and 89 women were assigned randomly to treatment. Gabapentin was more effective than placebo in improving overall sexual function (adjusted mean difference, 1.3; 95% confidence interval, 0.4-2.2; P=.008), which included desire (mean difference, 0.2; 95% confidence interval, 0.0-3.3; P=.04), arousal (mean difference, 0.3; 95% confidence interval, 0.1-0.5; P=.004), and satisfaction (mean difference, 0.3; 95% confidence interval, 0.04-0.5; P=.02); however, sexual function remained significantly lower than in 56 matched vulvodynia pain-free control subjects. There was a moderate treatment effect among participants with baseline pelvic muscle pain severity scores above the median on the full Female Sexual Function Index scale (mean difference, 1.6; 95% confidence interval, 0.3-2.8; P=.02) and arousal (mean difference, 0.3; 95% confidence interval, 0.1-0.6; P=.01) and pain domains (mean difference, 0.4; 95% confidence interval, 0.02-0.9; P=.04). CONCLUSION: Gabapentin improved sexual function in this group of women with provoked vulvodynia, although overall sexual function remained lower than women without the disorder. The most statistically significant increase was in the arousal domain of the Female Sexual Function Index that suggested a central mechanism of response. Women with median algometer pain scores >5 improved sexual function overall, but the improvement was more frequent than the pain domain. We hypothesize that gabapentin may be effective as a pharmacologic treatment for those women with provoked vulvodynia and increased pelvic muscle pain on examination.

Dyspareunia Related to GSM: Association of Total Vaginal Thickness via Transabdominal Ultrasound.

INTRODUCTION: It has previously been suggested in the literature that ultrasound measurement of total vaginal wall thickness (TVT) differs significantly between pre- and postmenopausal women, indicating that it may be a useful and noninvasive objective assessment to correlate the degree of vaginal atrophy to patient-reported symptoms. AIM: The purpose of this cross-sectional pilot study was to determine whether TVT in postmenopausal women, as measured with transabdominal ultrasound, is associated with patient-reported dyspareunia and symptoms related to genitourinary symptomatology. METHODS: Postmenopausal women presenting for pelvic ultrasound had TVT and total mucosal thickness (TMT) measured via transabdominal ultrasound. A questionnaire also was administered assessing menopausal status, relevant medical history, and self-report of dyspareunia and other symptoms related to the genitourinary syndrome of menopause (GSM). This questionnaire was derived from the Vulvovaginal Symptom Questionnaire, which has been validated in the literature. MAIN OUTCOME MEASURE: The main outcome measures included the average TVT and TMT for postmenopausal women reporting any symptom of GSM and average TVT and TMT of women reporting no symptoms of GSM. RESULTS: Data from 44 postmenopausal women showed no significant association between transabdominal ultrasound-measured TVT or TMT and patient report of dyspareunia or other genitourinary symptoms. Data were stratified by individual GSM symptoms, sexual symptoms as an aggregate, and individual sexual symptoms. Neither of these subgroups showed a statistically significant difference in TVT or TMT between symptomatic and asymptomatic women. CLINICAL IMPLICATIONS: Although no statistically significant data were derived from this study, we propose that future studies investigating the longitudinal relationship between TVT and GSM symptomatology may show an association between total vaginal thickness measurement change over time as determined by ultrasound with the presence of patient-reported dyspareunia and other GSM symptoms. STRENGTHS & LIMITATIONS: This study is limited by its small sample size as well as the patient population, which was restricted to postmenopausal women with a clinical indication for ultrasound. A major strength of this investigation is that it is the first study to look at the relationship between sexual pain and other GSM symptoms and TVT using transabdominal ultrasound, which is a readily available, non-invasive tool in most clinical settings. CONCLUSION: Based on the results of this small pilot study, transabdominal pelvic ultrasound cannot be used at this time to objectively quantify the presence of sexual pain or other GSM symptoms; however, future studies should continue to investigate the longitudinal relationship between these 2 variables. Balica AC, Cooper AM, McKevitt MK, et al. Dyspareunia Related to GSM: Association of Total Vaginal Thickness via Transabdominal Ultrasound. J Sex Med 2019; 16:2038-2042.

An Academic Tertiary Referral Center's Experience with a Vascular Surgery-Based Uterine Artery Embolization Program.

BACKGROUND: Despite growing endovascular experience within the vascular surgery community, some catheter-based interventions-such as uterine artery embolization (UAE)-remain outside the clinical scope of most vascular surgeons, owing in part to established referral patterns and limited awareness among referring colleagues. We present our experience with a vascular surgery-based, multidisciplinary UAE program at an academic tertiary referral center. METHODS: In a collaborative effort between vascular surgeons and gynecologists, a pelvic vascular disease program has been established to provide palliative, prophylactic, and therapeutic embolizations including, but not limited to, UAE. For UAE, inclusion criteria are women over the age of 18 years with symptomatic uterine fibroids demonstrated on magnetic resonance imaging and a negative endometrial biopsy. Exclusion criteria are desire for future pregnancy and previous embolization(s). Technique and perioperative protocol is presented. Data including symptom resolution, reintervention rates, and complications were prospectively gathered and retrospectively reviewed. RESULTS: Over an 18-month period, 30 patients with symptomatic fibroids were referred for potential UAE. Five patients were excluded because of uncertainty about future pregnancy wishes (4) and prior embolization (1). Twenty-four bilateral and 2 unilateral UAEs were performed (mean age, 46.3 years [range 28-53 years]). Presenting symptoms were pelvic and abdominal pain (25), cramps (25), menorrhagia (25), dysmenorrhea (25), urinary frequency (12), and dyspareunia (5). Technical success, defined as successful microcatheterization of uterine arteries and delivery of a particulate liquid embolic agent (embospheres, 500-700 microns), was 100%. There were no perioperative or delayed complications. Twenty-one patients (87.5%) reported complete symptomatic relief without further intervention at the time of last follow-up. Three patients (12.5%) reported pain relief but had persistent vaginal bleeding requiring hysterectomy 12 months after UAE. All patients underwent a 23-hr observation postoperatively for pain control. Mean follow-up was 7.4 months (1-23 months) and included pelvic ultrasound assessment of fibroid size at 1, 3, and 6 months after UAE and annually thereafter. One patient was lost to follow-up. Fibroid shrinkage was noted in all patients. Given the willingness and capability to work-up, admit, treat, and follow-up patients, vascular surgery was deemed the preferred service for UAE by the referring gynecologists. CONCLUSION: Within the framework of a collaborative, multidisciplinary program, vascular surgery can play a prominent role in providing safe and effective UAE.

Sonographically guided insertion of intrauterine device: Indications and results.

From 2011 to 2015, a total of 67 patients were referred for IUD insertion guided with transabdominal sonography (TAS). Fifty-six of the 67 patients had successful IUD insertion under TAS guidance. The clinical indications for referral included fibroids, uterine position, previous history of IUD expulsion, and limited tolerance of pelvic examination. Reasons for failed TAS-guided IUD insertion included patient discomfort, cervical stenosis, and inability to remove and replace an existing device. Ultrasound guidance could help broaden the patient population that may benefit from the therapeutic value of an IUD.

Recruitment methods in a clinical trial of provoked vulvodynia: Predictors of enrollment.

BACKGROUND: Successful recruitment in clinical trials for chronic pain conditions is challenging, especially in women with provoked vulvodynia due to reluctance in discussing pain associated with sexual intercourse. The most successful recruitment methods and the characteristics of women reached with these methods are unknown. OBJECTIVE: To compare the effectiveness and efficiency of four recruitment methods and to determine socioeconomic predictors for successful enrollment in a National Institutes of Health-sponsored multicenter clinical trial evaluating a gabapentin intervention in women with provoked vulvodynia. METHODS: Recruitment methods utilized mass mailing, media, clinician referrals and community outreach. Effectiveness (number of participants enrolled) and efficiency (proportion screened who enrolled) were determined. Socioeconomic variables including race, educational level, annual household income, relationship status, age, menopausal status and employment status were also evaluated regarding which recruitment strategies were best at targeting specific cohorts. RESULTS: Of 868 potential study participants, 219 were enrolled. The most effective recruitment method in enrolling participants was mass mailing ( p < 0.001). There were no statistically significant differences in efficiency between recruitment methods ( p = 0.11). Relative to clinician referral, black women were 13 times as likely to be enrolled through mass mailing (adjusted odds ratio 12.5, 95% confidence interval, 3.6-43.1) as white women. There were no differences in enrollment according to educational level, annual income, relationship status, age, menopausal status, or employment status and recruitment method. CONCLUSION: In this clinical trial, mass mailing was the most effective recruitment method. Race of participants enrolled in a provoked vulvodynia trial was related to the recruitment method.

Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery.

INTRODUCTION: Studies demonstrate the connection between adverse sexual function and medical conditions such as diabetes and heart disease. However, in the areas of spinal and spinal cord pathologies that require surgical interventions, there are scant data. OBJECTIVES: We undertook a narrative review to synthesize what is known on the topic, raise awareness, and call for action. METHODS: PubMed and Google Scholar identified case reports and primary studies evaluating female sexual dysfunction associated with spinal pathology as well as surgical intervention success were reviewed to contextualize and characterize female sexual dysfunction. RESULTS: Available case reports and primary studies suggest that female sexual dysfunction can result from traumatic spinal etiologies, malignant tumors, and benign tumors with and without bony involvement. Although identified as a key preoperative predictor in maintenance or improvement of neurologic status, sexuality is rarely addressed in the neurosurgical care plan. In spinal stenosis and degenerative spine disease, over half of patients report pain with sexual activity. Importantly, while pain can hinder sexual activity in females, there are other sexual issues, including desire and subjective arousal, lubrication, orgasm, and satisfaction that are usually not explored. Studies show the impact of spinal pathologies on frequency of sexual intercourse, hypoesthesia, anorgasmia, and depression. Surgical intervention of spinal pathologies has been cited to improve back pain however other types of sexual dysfunction usually fails to improve after surgical intervention. CONCLUSIONS: The lack of high-quality research with adequate numbers of female participants that appropriately characterizes the nuances of female sexual dysfunction across various spinal pathologies, with post-surgical intervention analysis and consideration of surgical approach, necessitates consideration for future study. A pre-op and post-op sexual history in all woman undergoing spinal surgery should be a standard of care. Moscicki P, Bachmann GA. Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery. Sex Med Rev 2022;10:493-498.

TranZap: A Transgender Resource for Identifying Gender-Affirming Providers.

INTRODUCTION: Many transgender individuals seeking healthcare have had at least one negative experience related to being transgender. As a result, transgender patients may forego seeking healthcare treatment atall, leading to adverse long-term health outcomes. With barriers to care and oftentimes suboptimal care provided to transgender individuals, TranZap, in collaboration with the PROUD Gender Center of NJ, was commenced. OBJECTIVES: To provide a review on the current transgender resources to finding healthcare, and the impetus behind creating a transgender health app to streamline this process. The vision of this app, TranZap, is to empower transgender individuals who are seeking healthcare such that they are better educated and knowledgeable regarding available healthcare providers. METHODS: With no data available from usual sources, such as Google Scholar, social media, as well as input from the transgender community through social media and word of mouth was utilized to identify the current resources for transgender patients seeking healthcare. This online search was done to identify any type of transgender focused healthcare databases that were community driven. RESULTS: Four resources were identified: TransBucket, TransAtlas, TransHealthCare, and Erin's Informed Consent hormone replacement therapy map of the US. Noting that there are limited resources, an app that is community driven and provides information on all types of healthcare providers, not exclusively surgeons or endocrinologists, was developed. CONCLUSION: Seeking gender-affirming healthcare providers is a strenuous task filled with uncertainty and few reliable resources. Resources that provide the input of transgender individuals on their experiences with healthcare providers is one step in addressing this issue. Resources, such as TranZap, must be developed to close the gaps in access to healthcare by providing a platform for transgender patients to share experiences about healthcare providers in the hopes that those using the app will be able to find a welcoming gender-affirming provider. Chiang T, Bachmann GA. The TranZap: A Transgender Resource for Identifying Gender-Affirming Providers. Sex Med Rev 2022;10:632-635.

Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery.

INTRODUCTION: Studies demonstrate the connection between adverse sexual function and medical conditions such as diabetes and heart disease. However, in the areas of spinal and spinal cord pathologies that require surgical interventions, there are scant data. OBJECTIVES: We undertook a narrative review to synthesize what is known on the topic, raise awareness, and call for action. METHODS: PubMed and Google Scholar identified case reports and primary studies evaluating female sexual dysfunction associated with spinal pathology as well as surgical intervention success were reviewed to contextualize and characterize female sexual dysfunction. RESULTS: Available case reports and primary studies suggest that female sexual dysfunction can result from traumatic spinal etiologies, malignant tumors, and benign tumors with and without bony involvement. Although identified as a key preoperative predictor in maintenance or improvement of neurologic status, sexuality is rarely addressed in the neurosurgical care plan. In spinal stenosis and degenerative spine disease, over half of patients report pain with sexual activity. Importantly, while pain can hinder sexual activity in females, there are other sexual issues, including desire and subjective arousal, lubrication, orgasm, and satisfaction that are usually not explored. Studies show the impact of spinal pathologies on frequency of sexual intercourse, hypoesthesia, anorgasmia, and depression. Surgical intervention of spinal pathologies has been cited to improve back pain however other types of sexual dysfunction usually fails to improve after surgical intervention. CONCLUSIONS: The lack of high-quality research with adequate numbers of female participants that appropriately characterizes the nuances of female sexual dysfunction across various spinal pathologies, with post-surgical intervention analysis and consideration of surgical approach, necessitates consideration for future study. A pre-op and post-op sexual history in all woman undergoing spinal surgery should be a standard of care.

TranZap: A Transgender Resource for Identifying Gender-Affirming Providers.

INTRODUCTION: Many transgender individuals seeking healthcare have had at least one negative experience related to being transgender. As a result, transgender patients may forego seeking healthcare treatment atall, leading to adverse long-term health outcomes. With barriers to care and oftentimes suboptimal care provided to transgender individuals, TranZap, in collaboration with the PROUD Gender Center of NJ, was commenced. OBJECTIVES: To provide a review on the current transgender resources to finding healthcare, and the impetus behind creating a transgender health app to streamline this process. The vision of this app, TranZap, is to empower transgender individuals who are seeking healthcare such that they are better educated and knowledgeable regarding available healthcare providers. METHODS: With no data available from usual sources, such as Google Scholar, social media, as well as input from the transgender community through social media and word of mouth was utilized to identify the current resources for transgender patients seeking healthcare. This online search was done to identify any type of transgender focused healthcare databases that were community driven. RESULTS: Four resources were identified: TransBucket, TransAtlas, TransHealthCare, and Erin's Informed Consent hormone replacement therapy map of the US. Noting that there are limited resources, an app that is community driven and provides information on all types of healthcare providers, not exclusively surgeons or endocrinologists, was developed. CONCLUSION: Seeking gender-affirming healthcare providers is a strenuous task filled with uncertainty and few reliable resources. Resources that provide the input of transgender individuals on their experiences with healthcare providers is one step in addressing this issue. Resources, such as TranZap, must be developed to close the gaps in access to healthcare by providing a platform for transgender patients to share experiences about healthcare providers in the hopes that those using the app will be able to find a welcoming gender-affirming provider.

Teaching Trans-Centric Curricular Content Using Modified Jigsaw.

Introduction: Transgender (trans) individuals have unique medical needs and difficulty accessing quality health care, exacerbated by inadequate provider knowledge. Incorporation of trans health care into medical school curricula has increased recently to address this gap. Jigsaw activities emphasize positive interdependence through structured cooperative learning, resulting in increased interest and self-confidence. We implemented a voluntary 2-hour modified jigsaw exercise on trans health care with changes designed to optimize the structure for medical students. Methods: The session was implemented both in person and virtually over 2 years with preclerkship medical students at the end of their endocrine/reproduction physiology course. The session featured a knowledge test with answer discussion followed by a clinical correlation-either a case discussion or video discussion. A pre- and posttest design compared students' knowledge, attitudes, and beliefs. Results: Eighty-nine students participated. Their initial attitudes and beliefs regarding trans health care were highly positive and remained elevated. Participants showed increases in knowledge and self-confidence discussing gender identity and clinical care postsession. All expressed interest in further training and felt the session enhanced their understanding of trans health and reproductive physiology. On 1-year follow-up, students showed decreased knowledge and self-confidence in discussing trans health; however, scores remained higher than presession. Student surveys suggested formal integration of more trans health education into the curriculum. Discussion: Medical students increased their knowledge and self-confidence regarding trans medicine and felt the modified jigsaw exercise was an effective teaching method. The results suggest that ongoing education is an important tool in optimizing trans health care.

Structural racism and the impact on incarcerated midlife women.

High recidivism rates indicate that current forms of imprisonment may be an ineffective response to problems that mainly burden those ensconced in poverty and marginalization. Homelessness, unemployment, racial disparities, drug use, and mental illness, disappear from public view when the afflicted individuals are relegated to a life behind bars. Women are the fastest growing prison population and most incarcerated women are from Black and Latinx groups. Structural racism encompasses the many ways in which society fosters racial discrimination through mutually reinforcing unfair systems of housing, education, employment, earnings, benefits, credit, media, health care, and criminal justice. In turn, this behavior reinforces discriminatory beliefs, values, and distribution of resources. Structural racism pervades every aspect of society, including the carceral system, from policing to prosecutorial decisions, pretrial release processes, sentencing, correctional discipline, and even reentry. Women constitute a minority within the carceral system, and as a result, their unique health care needs, especially during the midlife period, are inadequately addressed and often overlooked. There is also a general lack of gender sensitivity and special considerations in existing jail and prison policies and practices. This commentary highlights the impact of structural racism on the arrests and incarceration of women, and discusses their special health and wellness needs, with emphasis on midlife women. It also illuminates the need to address structural racism and its ripple effects within the carceral system.

Uterine fibroids: Correlations of anemia and pain to fibroid location and uterine weight.

OBJECTIVE: To estimate the prevalence of anemia, pelvic pain and heavy vaginal bleeding among symptomatic women with and without submucosal fibroids who presented for uterine fibroid embolization (UFE), and to determine if uterine weight was related to patient reports of heavy bleeding and pelvic pain. STUDY DESIGN: A case series study was performed that reviewed the ambulatory medical records of 357 symptomatic women with uterine fibroids seeking UFE from 2001 to 2009. Women with at least one submucosal fibroid were included as cases. Uterine weight was calculated by using ultrasound measurements. RESULTS: Women, regardless of fibroid location, were equally likely to report heavy bleeding or be diagnosed with anemia. However, among women with complaints of pelvic pain or heavy bleeding, uterine weight was found to be higher in women with at least one submucosal fibroid as compared to women with fibroids in locations other than submucosal. CONCLUSION: These data do not support the clinical perception that symptomatic women with at least one submucosal fibroid are at greater risk of becoming anemic or reporting heavy bleeding and pelvic pain than symptomatic women with fibroids in nonsubmucosal locations. It appears, however, that submucosal fibroids are related to increased patient symptoms with increasing uterine size.

The genitourinary syndrome of menopause.

ABSTRACT: Genitourinary syndrome of menopause (GSM) refers to a collection of symptoms resulting from diminished hormonal, primarily estrogenic stimulation to the vulvovaginal or lower urinary tract and may affect up to 50% of postmenopausal women. Symptoms, which are typically progressive and unlikely to resolve spontaneously, may include, but are not limited to, vulvovaginal dryness, burning or irritation, dyspareunia, or urinary symptoms of urgency, dysuria or recurrent urinary tract infection. These symptoms are typically progressive and unlikely to resolve spontaneously. Diagnosis is clinical. Telemedicine may play a role in diagnosis, initiation of treatment, and follow-up of women with GSM. Effective treatments include moisturizers and lubricants, local hormonal therapy with estrogen or dehydroepiandrosterone, and oral selective estrogen receptor agonists. Laser or radiofrequency procedures, although currently utilized, are being studied to comprehensively understand their overall effectiveness and safety. Additionally, the influence and effect of the vaginal microbiome, as well as potential of treatment via its manipulation, is being studied. We performed a literature search of PubMed, Google Scholar, and Ovid with search terms of vulvovaginal atrophy and GSM and reviewed major US Society Guidelines to create this narrative review of this topic. The literature suggests that healthcare providers can make a significant impact of the health and quality of life of women by being proactive about discussing and providing interventions for GSM. A systematic approach with consideration of current guidelines and attention to developing protocols for interventions should be employed.

Video Summary:http://links.lww.com/MENO/A702 .

Female sexual well-being scale (FSWB scale): development and psychometric validation in sexually functional women.

INTRODUCTION: No validated instrument exists for measuring female sexual well-being (FSWB) in women without medical/psychosocial conditions. AIMS: To develop and psychometrically validate a self-administered Female Sexual Well-Being Scale (FSWB Scale) for assessing sexual well-being in sexually functional women. METHODS: Important aspects of FSWB were identified via focus groups, debriefing interviews, and administration of an initial scale to 111 US women aged 21-72 years reporting normal sexual function (Female Sexual Function Index >26). Principal components analysis and psychometric validity testing of a FSWB Scale were conducted in a second study of 332 women. MAIN OUTCOME MEASURES: To develop a FSWB Scale, based on qualitative input from women reporting normal sexual function, and determine its factor structure and psychometric validity. RESULTS: Four aspects of FSWB were identified from the qualitative research. Women's preferred language to describe sexual well-being and preferred response formats were incorporated into the scale. A principle components analysis of quantitative study data from 332 women aged 21-72 years reporting normal sexual function identified 5 factors with eigenvalues >1: interpersonal domain (6 items), cognitive-emotional domain (5 items), physical arousal domain (3 items), orgasm-satisfaction domain (3 items), and external lubrication domain (2 items). The external lubrication domain did not demonstrate strong positive correlations with the other 4 domains, so it was not retained in the final scale. A high degree of internal consistency was demonstrated for the 4 domains (Cronbach's alpha values: 0.84-0.92). Test-retest reliability over a 2-week period was high (r > 0.80) or moderately high (r > 0.70) for the 4 domain scores. Correlation coefficients between FSWB Scale domain scores and standardized scale scores for female sexual function, depression, and social desirability demonstrated the construct validity of the FSWB Scale. CONCLUSION: A 17-item FSWB Scale was developed and psychometrically validated as a reliable, multidimensional, self-administered instrument for assessing sexual well-being in women of different ages.

Improved GI tolerability with monthly ibandronate in women previously using weekly bisphosphonates.

OBJECTIVE: This subanalysis of CURRENT, an open-label, 6-month, multicenter study, assesses changes in gastrointestinal (GI) tolerability with once-monthly oral ibandronate in women who switched from once-weekly bisphosphonates and had reported GI symptoms with their previous weekly bisphosphonate regimen. METHODS: Postmenopausal women currently taking a weekly bisphosphonate switched to 150 mg monthly ibandronate. At the start of the treatment phase and after 6 months of therapy, all participants completed the Osteoporosis Patient Satisfaction Questionnaire (OPSAT-Q), a validated instrument consisting of four domains: convenience, satisfaction, quality of life, and side effects. This subanalysis assessed GI tolerability in those women who reported GI symptoms at baseline in the side effects domain of OPSAT-Q and change in satisfaction in those who had reported stomach upset within 48 hours of taking their previous bisphosphonate at screening. RESULTS: Of women who reported GI symptoms at baseline, >60% reported an improvement in heartburn or acid reflux after switching to monthly ibandronate. Further, >70% reported improvements in stomach upset (excluding heartburn or acid reflux). Of those women who reported stomach upset within 48 hours of taking their previous weekly bisphosphonate at screening (n = 89), >80% reported improved overall satisfaction compared with baseline. Monthly ibandronate was generally well tolerated. CONCLUSION: A majority of women who experienced GI tolerability issues with weekly bisphosphonates reported improvements in GI symptoms after transitioning from a weekly bisphosphonate to monthly ibandronate for 6 months.

Transgender men, pregnancy, and the "new" advanced paternal age: A review of the literature.

Transgender men are assigned female at birth, but self-identify as male. Although some transgender men undergo gender-affirming hormonal treatment and/or surgery that preclude pregnancy, many (if not most) retain their female reproductive organs and, as a result, their capacity to become pregnant. Although the visibility of the transgender community has increased, the exposure of healthcare providers to transgender individuals, especially transgender men during pregnancy, as well as research that addresses evidence-based practice remain limited. In this review, we discuss obstetrical issues for transgender men who are ≥35 years old, termed the "new" advanced paternal age. We review preconception care and focus on fertility issues, the impact of stopping gender-affirming hormonal treatment, and age-appropriate health maintenance. We review antepartum and postpartum care, including labor and delivery, monitoring for perinatal depression, contraception, and chest feeding. Finally, we conclude with suggestions for areas for further research and study.