The Australian New Zealand Consortium in Children, Adolescents, and Young Adults Oncofertility action plan.

International and national oncofertility networks, including the US-led Oncofertility Consortium, FertiProtekt, and the Danish Network, have played pivotal roles in advancing the discipline of oncofertility over the last decade. Many other countries lack a shared approach to pediatric oncofertility health service delivery. This study aims to describe baseline oncofertility practices at Australian New Zealand Children's Haematology/Oncology Group centers in 2019-2021, describe binational priorities for care, and propose a 5-year action plan for best practice to be implemented by the newly formed Australian New Zealand Consortium in Children, Adolescents, and Young Adults (CAYA) Oncofertility (ANZCO).

Joint developmental trajectories of internalizing and externalizing problems from mid-childhood to late adolescence and childhood risk factors: Findings from a prospective pre-birth cohort.

There is limited evidence on heterogenous co-developmental trajectories of internalizing (INT) and externalizing (EXT) problems from childhood to adolescence and predictors of these joint trajectories. We utilized longitudinal data from Raine Study participants (n = 2393) to identify these joint trajectories from 5 to 17 years using parallel-process latent class growth analysis and analyze childhood individual and family risk factors predicting these joint trajectories using multinomial logistic regression. Five trajectory classes were identified: Low-problems (Low-INT/Low-EXT, 29%), Moderate Externalizing (Moderate-EXT/Low-INT, 26.5%), Primary Internalizing (Moderate High-INT/Low-EXT, 17.5%), Co-occurring (High-INT/High-EXT, 17%), High Co-occurring (Very High-EXT/High-INT, 10%). Children classified in Co-occurring and High Co-occurring trajectories (27% of the sample) exhibited clinically meaningful co-occurring problem behaviors and experienced more adverse childhood risk-factors than other three trajectories. Compared with Low-problems: parental marital problems, low family income, and absent father predicted Co-occurring and High Co-occurring trajectories; maternal mental health problems commonly predicted Primary Internalizing, Co-occurring, and High Co-occurring trajectories; male sex and parental tobacco-smoking uniquely predicted High Co-occurring membership; other substance smoking uniquely predicted Co-occurring membership; speech difficulty uniquely predicted Primary Internalizing membership; child's temper-tantrums predicted all four trajectories, with increased odds ratios for High Co-occurring (OR = 8.95) and Co-occurring (OR = 6.07). Finding two co-occurring trajectories emphasizes the importance of early childhood interventions addressing comorbidity.

Supportive Care Needs of Young Adults With Endometriosis: An Open-Ended Online Survey and Exploration of Unmet Needs.

OBJECTIVE: The aim of this study is to identify and explore the unmet needs of adolescents and young adults living with endometriosis. DESIGN: An open-ended online survey was conducted, with questions derived from prior research looking at areas of unmet need in healthcare, career and work, financial, information, psychological, social and cultural domains. SETTING AND POPULATION: Self-selecting 18-25 year olds with surgically diagnosed endometriosis (self-reported) currently living in Australia were included as participants. METHODS: Invitation to participate in an open-ended online survey was shared through the social media of Australian endometriosis organisations and the Royal Women's Hospital, Melbourne. Surveys were analysed qualitatively through template analysis. MAIN OUTCOME MEASURES: Recording of the unmet supportive care needs of this population was carried out. RESULTS: One hundred and thirty-one respondents fit the eligibility criteria of being aged 18-25 years (median age 23 years). Most were born in Australia (94%), university-educated (54%) and lived in a metropolitan setting (69%). There was a range of unmet needs that were presented across education, work, healthcare and relationships. Group-specific challenges were identified: doctors either over- or underemphasising future fertility; disrupted sexual and romantic life due to painful sex; managing pain in the classroom and workplace where periods are taboo; and being gender-queer in gynaecological medical spaces. CONCLUSIONS: The increasingly young age at which patients are receiving an endometriosis diagnosis precipitates a shift in patient care. The treatment decisions that are being made must be reflective of the unique needs of the adolescents who carry the burden of the disease. Clinicians are advised to be aware of and discuss needs with their patients. PATIENT OR PUBLIC CONTRIBUTION: The nine open-ended questions in this survey were developed from data from a preliminary series of interviews with endometriosis patients in a tertiary women's healthcare centre. In asking these data-informed questions to the online endometriosis community, patients across broader sociocultural demographics and disease states (including less symptomatic endometriosis) have provided a broader understanding of their supportive care needs.

Adolescent risk behaviours are associated with educational attainment in early adulthood: results from the Raine Study cohort.

BACKGROUND: Higher educational attainment is important for economic wellbeing and associated with better health and longevity. Previous research focused on intelligence, socioeconomic status and mental health or individual risk behaviours as predictors of educational attainment, but the role of multiple domains of adolescent risk behaviours is less clear. This study examined the association between multiple domains of risk behaviour in adolescence and educational attainment by 22 years-of-age. METHODS: Young people (Generation 2, Gen2) and their parents (Generation 1, Gen1) participating in the Raine Study completed questionnaires at years 1, 5, 8, 10 (Gen1 only), 14, 17 (both) and 22 (Gen2 only). The Raine Study is an ongoing longitudinal study initiated in Perth, Western Australia, between 1989 and 1991. The 1,102 Gen2 participants who responded to questions about highest educational attainment were included in this study. The association between Gen2 self-reported risk behaviours (including age at commencement of drinking alcohol, smoking, sexual intercourse and drug use) and educational attainment (defined as self-reported years of completed high school: ≤10, 11, 12 or tertiary education (> 12)) at year 22, after adjusting for mother's age and combined parental education level, participant sex, and family income, educational performance and adolescent mental health, was explored using ordinal regression models and presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Ordinal models suggested that never smoking or starting older than 18 compared with smoking before age 15 (OR 2.02, 95%CI: 1.28-2.14); first drinking alcohol between 15 and 17 years compared with younger than 15 (OR 1.52, 95%CI: 1.08-2.14); and, first sexual intercourse aged ≥ 18 years compared with under 15 (OR 1.67, 95%CI: 1.08-2.57) were associated with higher levels of educational attainment at 22-year follow-up. Additionally, lower ("better") behavioural scores increased the odds of higher levels of attainment. CONCLUSIONS: Absence of health risk behaviours at a younger age or later commencement was associated with higher educational attainment. Evidence-based interventions that address the societal influences underpinning risk behaviours in adolescents may support longer school retention.

Prevalence, distribution, and inequitable co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people in Australia: epidemiological findings from a population-based cohort study.

PURPOSE: To estimate the prevalence, distribution, and co-occurrence of mental ill-health and substance use among gender and sexuality diverse young people relative to their cisgender and heterosexual peers in Australia using population-level, nationally representative data. METHODS: We utilised Wave 8 (2018) data from the Longitudinal Study of Australian Children (N = 3037, Mage = 18.4) collected via an assessment protocol comprising interviews, direct observations, and assessments (on average 60 min per survey occasion). Weighted prevalence ratios and logistic regression models adjusted for demographic confounders were used to estimate the prevalence and distribution of mental ill-health (psychological distress, past 12-month self-harm thoughts and behaviours, past 12-month suicidal ideation, planning, attempt/s) and substance use outcomes (past 12-month cigarette, alcohol, and marijuana use) across gender identity (trans vs. cisgender), sexuality (gay/lesbian, bisexual, queer [those identifying with an 'other' sexuality identity that is not 'gay', 'lesbian', 'bisexual', or 'heterosexual'] vs. heterosexual) and sexuality diversity status (sexuality diverse vs heterosexual) subgroups. Sex-stratified prevalence rates and accompanying adjusted logistic regression models were also used to assess mental ill-health and substance use disparities by sexuality diversity status. Adjusted multinominal logistic regression models were used to test disparities in co-occurring outcomes by sexuality identity) sexuality status sub-groups, and Fisher's Exact Test of Independence for co-occurring disparities by gender identity (due to small sample size). All analyses used Wave 8 sample weights and adjusted for postcode-level clustering. RESULTS: Among gender and sexuality diverse participants, 59 - 64% reported high or very high levels of psychological distress, 28 - 46% reported past 12-month self-harm ideation or attempts, and 26 - 46% reported past 12-month suicidal ideation, planning, or behaviour. We found significant disparities in high/very high levels of psychological distress, self-harm behaviours and suicidal behaviours among trans participants (adjusted odds ratios (aORs) ranged from 3.5 to 5.5) and sexuality diverse participants (aORs ranged from 3.5 to 3.9), compared with cisgender and heterosexual participants, respectively. Highest disparities in any past 12-month self-harm and suicidal behaviours appeared most pronounced among trans participants and queer participants compared with their cisgender, heterosexual counterparts. Minor differences by sex among sexuality diverse participants were observed for select mental ill-health outcomes. Sexuality diverse participants, and particularly sexuality diverse females, were significantly more likely to report past 12-month cigarette use and past 12-month marijuana use (adjusted odds ratio (aORs) ranging 1.4-1.6). Trans young people were at significantly elevated risk of mental ill-health in co-occurrence with cigarette and marijuana use compared with their cisgender peers (Fisher's Exact Test of Independence p < 0.05 for all), whereas sexuality diverse young people were at greater risk of co-occurring mental ill-health and cigarette co-use and marijuana co-use, compared with their non-sexuality diverse peers (adjusted multinomial odds ratios (aMORs) ranging 2.2-6.0). CONCLUSION: Mental ill-health, substance use, and their co-occurrence disproportionately affects gender and sexuality diverse young people in Australia. Further research should study the longitudinal development of these disparities through adolescence, with close attention to the social, embodied contexts of substance use among LGBTQ + young people with the view to building LGBTQ + affirming models of harm reduction.

Minority stressors, traumatic events, and associations with mental health and school climate among gender and sexuality diverse young people in Australia: Findings from a nationally representative cohort study.

INTRODUCTION: Population-level, nationally representative data on the prevalence of minority stressors and traumatic events, mental ill-health effects, and the preventative utility of school climate, among gender and sexuality diverse young people in Australia, is significantly lacking. In this study, we estimated the prevalence and distribution of minority stressors and traumatic events among young people by sexuality identity (gay/lesbian, bisexual, other sexuality, heterosexual), sexuality diversity (sexuality diverse, not sexuality diverse), and gender identity (transgender, cisgender) and assessed associations with mental ill-health and the moderating role of school climate factors. METHODS: Using Wave 8 (2018) follow-up data from a population-level, nationally representative longitudinal cohort study, the sample comprised 3037 young people aged 17-19 years in Australia. Prevalence ratios for minority stressors and traumatic events were calculated for gender and sexuality diverse categories using logistic regression models. Linear regression models were used to test associations between traumatic events and minority stressors, and mental ill-health. Multivariate linear regression tested school climate factors as effect modifier between minority stressors and mental ill-health among sexuality diverse young people. RESULTS: Rates of traumatic events and minority stressors were highest among bisexual and gay/lesbian young people and were significantly associated with mental ill-health among all gender and sexuality diverse young people. Highest mental ill-health effects were observed among trans young people. Among sexuality diverse young people, positive and negative feelings toward school climate were associated with decreased and increased mental ill-health, respectively. After accounting for sexuality diversity, positive overall school climate appeared protective of mental ill-health effects of sexuality-based discrimination. DISCUSSION: Minority stressors, traumatic events, and associated mental ill-health are prevalent among gender and sexuality diverse young people in Australia, especially trans, bisexual, and gay/lesbian young people. Promotion of affirmative, safe, and inclusive school climate demonstrates significant promise for the prevention and early intervention of mental ill-health among gender and sexuality diverse young people.

Exploring the experiences and priorities of women with a diagnosis of ovarian cancer.

PURPOSE: Ovarian cancer is the third most common gynaecological cancer among women, yet remains under-researched. Past studies suggest that women who present with ovarian cancer have more supportive care needs compared to women experiencing other gynaecological cancers. This study explores the experiences and priorities of women with a diagnosis of ovarian cancer and whether age may influence these needs and experiences. METHODS: Participants were recruited by a community organization, Ovarian Cancer Australia (OCA), via a social media campaign promoted on Facebook. Participants were asked to rank priorities around living with ovarian cancer, and to endorse which supports and resources they had used to address those priorities. Distributions of priority rankings and resource use were compared by age (19-49 vs. 50+ years). RESULTS: Two hundred and eighty-eight people completed the consumer survey and most respondents were 60-69 years (33.7%). Priorities did not vary by age. Fear of cancer recurrence was identified by 51% respondents as the most challenging aspect of having ovarian cancer. Compared with older respondents, a higher proportion of young participants were more inclined to use a mobile app version of the OCA resilience kit (25.8% vs 45.1%, p=0.002) and expressed interest in using a fertility preservation decision aid (2.4% vs 25%, p<0.001). CONCLUSION: Fear of recurrence was participants' primary concern, presenting an opportunity to develop interventions. Information delivery needs to consider age-specific preferences to better reach the target audience. Fertility is more important to younger women and a fertility preservation decision aid may address this need.

Exposure to Pornography and Adolescent Sexual Behavior: Systematic Review.

BACKGROUND: Formative experiences in adolescence lay the foundation for healthy and pleasurable romantic and sexual relationships. Exposure to pornography may affect these experiences. OBJECTIVE: We aimed to synthesize evidence published in the past decade on the relationship between exposure to pornography and sexual behavior (earlier age of first sex [<16 years], condomless sex, past-year multiple partners [>1], lifetime multiple partners [>1], group sex, sexual aggression including forced sex, paid sex, teenage pregnancy, and history of sexually transmitted infection) in adolescents aged between 10 and 19 years. METHODS: We identified 19 eligible studies by searching MEDLINE, PsycINFO, Cochrane, CINAHL, Embase, and Web of Science databases from January 2010 to November 2022. RESULTS: Out of 8 studies that assessed earlier age of first sex, 5 studies, including 1 longitudinal study, found a statistically significant association with exposure to pornography. Given that most studies were cross-sectional or had substantial limitations, causal inference could not be made. Also, exposure to pornography was not measured consistently. The evidence was conflicting or insufficient to draw any conclusions regarding other outcomes. CONCLUSIONS: More quantitative research is needed to elucidate the association between pornography exposure and sexual behavior, and sex education should adopt evidence-based approaches to minimize the potential harms from pornography. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42021227390; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227390.

Social Media Use and Health and Well-being of Lesbian, Gay, Bisexual, Transgender, and Queer Youth: Systematic Review.

BACKGROUND: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at higher risk of poor mental health and well-being. Social media platforms can provide LGBTQ youths with a space that counters heteronormative environments and potentially supports mental health and well-being. Mental health includes an individual's state of psychological and emotional well-being and not merely the absence of mental disorders. OBJECTIVE: We sought to identify how LGBTQ youths and adolescents use social media for connection with other LGBTQ peers and groups, identity development, and social support and how these affect mental health and well-being. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures were used to guide this review. Searches were conducted in ACM Digital Library, CINAHL, Ovid Embase, Ovid MEDLINE, and Web of Science in March 2021. This review focused on LGBTQ youths aged 10 to 24 years. Included peer-reviewed studies must comprise social media; explore peer connection, identity development, or social support; and be published from 2012 onward. In total, 2 researchers extracted data and performed quality assessments independently using the Newcastle-Ottawa Scale for quantitative articles and the Critical Appraisal Skills Programme for qualitative articles. Qualitative synthesis was performed on articles that satisfied the eligibility criteria. RESULTS: A total of 26 studies (n=15, 58% qualitative; n=8, 31% quantitative; n=3, 12% mixed methods) met the inclusion criteria. Of the 8 quantitative studies, 6 (75%) were cross-sectional, and 2 (25%) were cohort studies. All studies ranged from moderate to high quality. Social media was a popular tool used by LGBTQ youths to connect with LGBTQ communities. In qualitative data, we found that LGBTQ youths negotiated and explored identity and obtained support from peers on social media. Instagram, Tumblr, and Twitter were commonly used to access LGBTQ content owing to ease of anonymity. Identity management was the most studied social media affordance, important to LGBTQ youths for strategic disclosure. Key strategies for managing identities included being anonymous, censoring locations or content, restricting audiences, and using multiple accounts. Quantitative studies (3/8, 38%) showed that social media was associated with reduced mental health concerns and increased well-being among LGBTQ youths. Mental health concerns arising from social media use were attributed to discrimination, victimization, and policies that did not accommodate changed identities. CONCLUSIONS: We found that social media may support the mental health and well-being of LGBTQ youths through peer connection, identity management, and social support, but findings were limited by weaknesses in the evidence. More robust and longitudinal studies are needed to determine the relationship between social media use and LGBTQ mental health, particularly among adolescents. The findings may inform interventions to promote social media health literacy and the mental health and well-being of this vulnerable group. TRIAL REGISTRATION: PROSPERO CRD42020222535; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=222535.

Corrigendum to: Social media's role in support networks among LGBTQ adolescents: a qualitative study.

Background:Adolescents use social media more frequently than other age groups. Social media has been described as a safe environment for lesbian, gay, bisexual, transgender and queer and/or questioning (LGBTQ) adolescents. As part of mixed-methods research investigating the association between social networks and sexual agency, we present qualitative findings on how LGBTQ adolescents connect online to form support networks.Methods:We recruited 30 adolescents aged 14-17years who identified as LGBTQ in terms of their gender or attraction in the longitudinal Social Networks and Agency Project. Semi-structured interviews were conducted online or face-to-face across Australia. Thematic analysis was used to explore perceptions and experiences of participants in relation to social media use and relationships.Results:Two overarching themes were identified: LGBTQ adolescents use social media for identity, relationships and wellbeing support. Social media is not always free of discrimination for LGBTQ adolescents. Many LGBTQ participants joined Facebook groups to connect with LGBTQ peers. Facebook was considered a vital support for those with mental health concerns including suicidal ideation. Participants gave and received support from group members, which was considered useful for those feeling isolated or victimised. LGBTQ adolescents formed friendships, romantic relationships and gained information on sex, relationships, and sexual health from these groups. Participants described negative experiences including discrimination within Facebook groups, mismanaged groups and exposure to anti-LGBTQ sentiments.Conclusion:Social media is an environment where LGBTQ adolescents can connect, educate and support each other, which may have beneficial effects for this marginalised group. There remain issues with social media including discrimination against and within LGBTQ communities.

Social media's role in support networks among LGBTQ adolescents: a qualitative study.

Background Adolescents use social media more frequently than other age groups. Social media has been described as a safe environment for lesbian, gay, bisexual, transgender and queer and/or questioning (LGBTQ) adolescents. As part of mixed-methods research investigating the association between social networks and sexual agency, we present qualitative findings on how LGBTQ adolescents connect online to form support networks. Methods We recruited 30 adolescents aged 14-17years who identified as LGBTQ in terms of their gender or attraction in the longitudinal Social Networks and Agency Project. Semi-structured interviews were conducted online or face-to-face across Australia. Thematic analysis was used to explore perceptions and experiences of participants in relation to social media use and relationships. Results Two overarching themes were identified: LGBTQ adolescents use social media for identity, relationships and wellbeing support. Social media is not always free of discrimination for LGBTQ adolescents. Many LGBTQ participants joined Facebook groups to connect with LGBTQ peers. Facebook was considered a vital support for those with mental health concerns including suicidal ideation. Participants gave and received support from group members, which was considered useful for those feeling isolated or victimised. LGBTQ adolescents formed friendships, romantic relationships and gained information on sex, relationships, and sexual health from these groups. Participants described negative experiences including discrimination within Facebook groups, mismanaged groups and exposure to anti-LGBTQ sentiments. Conclusion Social media is an environment where LGBTQ adolescents can connect, educate and support each other, which may have beneficial effects for this marginalised group. There remain issues with social media including discrimination against and within LGBTQ communities.

Women's expectations of healthcare providers in the context of reproductive abuse in Australia.

Reproductive abuse is a poorly understood form of violence against women. It is defined as a deliberate attempt to interfere with or control a women's reproductive choices and is usually perpetrated by a male intimate partner. Reproductive abuse is associated with a range of poor health outcomes for women, increasing the likelihood that they will visit a healthcare provider. Despite this, there is a dearth of evidence to inform best practice in health settings, particularly research that highlights the voices of survivors. Qualitative studies to date have focused on intimate partner or sexual violence more broadly, yet it is likely that reproductive abuse presents its own nuance in terms of a supportive response. In this paper, we address this gap by reporting qualitative data from 14 women who self-identified as survivors of reproductive abuse. Findings suggest that healthcare providers have an important role to play in responding to reproductive abuse, focusing on taking the problem seriously, reinforcing that the behaviour is wrong, asking about other forms of violence and addressing women's needs and priorities for contraception and reproductive autonomy. This study has important implications for the development of best practice guidelines for healthcare providers responding to reproductive abuse in female patients.

Exploring the gray areas between "stealthing" and reproductive coercion and abuse.

The aim of this qualitative study was to understand and differentiate between women's experiences of "stealthing" (non-consensual condom removal) and reproductive coercion and abuse (RCA) which is defined as any deliberate attempt to control a woman's reproductive choices or interfere with her reproductive autonomy. These two experiences are often conflated within the literature, yet little is known about whether this understanding reflects women's lived reality. We recruited female participants from a large Australian metropolitan hospital who self-identified as having experienced a partner interfering with contraception or trying to force them to get pregnant or end a pregnancy against their wishes. Fourteen women (predominantly white, educated and employed) participated in an in-depth interview. Interviews were transcribed verbatim and a process of thematic narrative analysis was undertaken, focusing on the meanings women assigned to their experiences and the differences and similarities across the stories. Analysis revealed that stories about stealthing were characterized by disrespect and selfishness, whereas RCA stories highlighted control with intent. The concepts of intent and control can therefore be understood as central to defining RCA and differentiating it from stealthing. It seems likely that stealthing is primarily a form of sexual violence, as it lacks the specific reproductive intent that characterizes RCA. These findings have important implications for how RCA and stealthing are addressed and measured in research and responded to in practice.

"A Huge, Hidden Problem": Australian Health Practitioners' Views and Understandings of Reproductive Coercion.

Reproductive coercion is understood as behavior interfering with a woman's reproductive autonomy. It is usually perpetrated by a male partner, and sometimes by other family members. Reproductive coercion encompasses violence, threats, or coercion to force a woman to become or remain pregnant, or to terminate a pregnancy. To date, few studies have focused on this topic, particularly using qualitative methods. In this article, we aim to explore how Australian health practitioners understand and perceive reproductive coercion. We conducted semistructured interviews with health practitioners from an Australian public hospital, and the resulting data were analyzed thematically. Overall, reproductive coercion was described as complex and hidden. There were diverse understandings around its parameters and scope, which were shaped by the participants' disciplines and paradigms. Our findings point toward a need for greater clarity around reproductive coercion and how it sits within a broader framework of violence against women, to facilitate cross-disciplinary collaborative responses.

Managing menopausal symptoms after cancer: an evidence-based approach for primary care.

Impaired ovarian function and menopausal symptoms are common after cancer treatment. Menopausal symptoms often occur at an earlier age in women with cancer, and may be more severe than in natural menopause; they may be the most persistent and troubling sequelae of cancer. A third of female patients with cancer report dissatisfaction with the quality and length of physician-patient discussions about reproductive health, including menopause. Systemic menopausal hormone therapy is the most effective treatment for menopausal symptoms, but it is not suitable for all patients after cancer - where it is unsuitable, alternative effective non-hormonal treatments are available. Effective pharmacological agents available to treat vasomotor symptoms include selective serotonin reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors, clonidine and gabapentin. There is increasing evidence supporting cognitive behavioural therapy for the treatment of vasomotor symptoms, in self-help or group settings. Vaginal atrophy can be treated with vaginal (topical) oestrogen with minimal systemic absorption; topical vaginal lubricants may help with vaginal dryness and dyspareunia, with some evidence suggesting that silicone-based products may be more effective than water-based ones. Bone health may be impaired in post-menopausal women with cancer or in cancer survivors, particularly in women with treatment-related menopause or in women receiving anti-oestrogen therapies; this should be managed in addition to menopausal symptoms. Primary care physicians should be aware of the troublesome and ongoing nature of menopausal symptoms after cancer, should discuss them with all patients after cancer treatment, and should consider treatment or referral to a specialist for appropriate management.

A randomized, double-blind, crossover trial comparing a silicone- versus water-based lubricant for sexual discomfort after breast cancer.

Discomfort during sexual activity is common after breast cancer. Vaginal estrogens are effective but commonly avoided due to systemic absorption. Despite the large commercial market for vaginal lubricants, no randomized studies have compared products. We aimed to compare efficacy and acceptability of two major types of lubricant for discomfort during sexual activity in postmenopausal breast cancer patients. In a single-center, randomized, double-blind, AB/BA crossover design, sexually active postmenopausal breast cancer patients used each lubricant for 4 weeks. The primary patient-reported efficacy outcome was total discomfort related to sexual activity (Fallowfield Sexual Activity Questionnaire Discomfort subscale SAQ-D). Acceptability was measured by patient preference and reported intention to continue using the products. Of 38 women analyzed, over 90 % experienced clinically significant sexually related distress at baseline. Water- and silicone-based lubricants did not differ statistically in efficacy based on total sexual discomfort (difference 0.7, 95 % confidence interval (CI) 0-1.4, p = 0.06). In a post hoc analysis, pain/discomfort during penetration improved more during silicone-based lubricant use than during water-based lubricant use (odds ratio 5.4, 95 % CI 1.3-22.1, p = 0.02). All aspects of sexual discomfort measured with diaries were reported more commonly with water- than silicone-based lubricant. Almost twice as many women preferred silicone-based to water-based lubricant than the converse (n = 20, 65 %, vs. n = 11, 35 %). 88 % continued to experience clinically significant sexually related distress despite use of either lubricant. Total sexual discomfort was lower after use of silicone-based lubricant than water-based, but many women continue to experience sexually related distress.

Identification of genes differentially expressed in menstrual breakdown and repair.

STUDY QUESTION: Does the changing molecular profile of the endometrium during menstruation correlate with the histological profile of menstruation. SUMMARY ANSWER: We identified several genes not previously associated with menstruation; on Day 2 of menstruation (early-menstruation), processes related to inflammation are predominantly up-regulated and on Day 4 (late-menstruation), the endometrium is predominantly repairing and regenerating. WHAT IS KNOWN ALREADY: Menstruation is induced by progesterone withdrawal at the end of the menstrual cycle and involves endometrial tissue breakdown, regeneration and repair. Perturbations in the regulation of menstruation may result in menstrual disorders including abnormal uterine bleeding. STUDY DESIGN, SIZE DURATION: Endometrial samples were collected by Pipelle biopsy on Days 2 (n = 9), 3 (n = 9) or 4 (n = 6) of menstruation. PARTICIPANTS/MATERIALS, SETTING, METHODS: RNA was extracted from endometrial biopsies and analysed by genome wide expression Illumina Sentrix Human HT12 arrays. Data were analysed using 'Remove Unwanted Variation-inverse (RUV-inv)'. Ingenuity pathway analysis (IPA) and the Database for Annotation, Visualization and Integrated Discovery (DAVID) v6.7 were used to identify canonical pathways, upstream regulators and functional gene clusters enriched between Days 2, 3 and 4 of menstruation. Selected individual genes were validated by quantitative PCR. MAIN RESULTS AND THE ROLE OF CHANCE: Overall, 1753 genes were differentially expressed in one or more comparisons. Significant canonical pathways, gene clusters and upstream regulators enriched during menstrual bleeding included those associated with immune cell trafficking, inflammation, cell cycle regulation, extracellular remodelling and the complement and coagulation cascade. We provide the first evidence for a role for glutathione-mediated detoxification (glutathione-S-transferase mu 1 and 2; GSTM1 and GSTM2) during menstruation. The largest number of differentially expressed genes was between Days 2 and 4 of menstruation (n = 1176). We identified several genes not previously associated with menstruation including lipopolysaccharide binding protein, serpin peptidase inhibitor, clade B (ovalbumin), member 3 (SERPINB3) and -4 (SERPINB4), interleukin-17C (IL17C), V-set domain containing T-cell activation inhibitor 1 (VTCN1), proliferating cell nuclear antigen factor (KIAA0101/PAF), trefoil factor 3 (TFF3), laminin alpha 2 (LAMA2) and serine peptidase inhibitor, Kazal type 1 (SPINK1). Genes related to inflammatory processes were up-regulated on Day 2 (early-menstruation), and those associated with endometrial repair and regeneration were up-regulated on Day 4 (late-menstruation). LIMITATIONS, REASONS FOR CAUTION: Participants presented with a variety of endometrial pathologies related to bleeding status and other menstrual characteristics. These variations may also have influenced the menstrual process. WIDER IMPLICATIONS OF THE FINDINGS: The temporal molecular profile of menstruation presented in this study identifies a number of genes not previously associated with the menstrual process. Our findings provide valuable insight into the menstrual process and may present novel targets for therapeutic intervention in cases of endometrial dysfunction. LARGE SCALE DATA: All microarray data have been deposited in the public data repository Gene Expression Omnibus (GSE86003). STUDY FUNDING AND COMPETING INTERESTS: Funding for this work was provided by a National Health and Medical Research Council of Australia (NHMRC) Project Grant APP1008553 to M.H., P.R. and J.G. M.H. is supported by an NHMRC Practitioner Fellowship. P.P. is supported by a NHMRC Early Career Fellowship. The authors have no conflict of interest to declare.

Teenage mothers.

BACKGROUND: Australia's teenage birth rate has fallen to historic lows, but teenage motherhood still occurs and can be challenging for mother and baby. OBJECTIVE: The aim of this article is to review current evidence on the epidemiology and clinical care of teenage pregnancy and parenting, and provide recommendations around management of these young people in Australia. DISCUSSION: Teenage mothers may have experienced family, sexual, and partner violence, family disruption, and socioeconomic disadvantage. Outcomes on a range of peripartum measures are worse for teenage mothers and their babies. Longer term risks for the mother include depression and rapid repeat pregnancy; for the child, intergenerational teenage parenthood; and for both, socioeconomic disadvantage. Teenage motherhood occurs more often within communities where poverty, Aboriginal and Torres Strait Islander status and rural/remote location intersect. General practitioners play a critical role in identification of at-risk teens, preventing unintended teenage pregnancy, clinical care of pregnant teens, and promoting the health and wellbeing of teenage mothers and their children.

Interventions to improve oncofertility knowledge and decision-making in patients with low health literacy: A systematic review.

OBJECTIVE: To conduct a systematic review of interventions that improve knowledge, health and decision-related outcomes in cancer, fertility or the intersection of both among low health literacy (LHL) patients. METHODS: Articles published from 2000 to March 2022 in English were identified through searching MEDLINE, PsycInfo, and Embase databases on 29/03/2022. Studies were independently screened against eligibility criteria and appraised for quality. A narrative synthesis of data was presented. RESULTS: Of 235 citations, 11 studies (2585 participants) investigating three categories were included: decision-support tools (n = 8), mobile health applications (n = 2) and communication tools (n = 1). No eligible study was identified for fertility or oncofertility. All interventions integrated multimedia or interactivity to supplement plain-language text. Decision aids and mobile health applications improved knowledge, reduced decisional conflict and increased clarity around cancer-related choices. Overall, findings favoured the use of online interventions tailored for LHL patients. CONCLUSION: There is a lack of data on LHL interventions in fertility and oncofertility. In cancer, LHL interventions improved knowledge and decision-making outcomes. The ideal intervention remains inconclusive. PRACTICE IMPLICATIONS: Lack of engagement with LHL needs in oncofertility and fertility settings have implications for informed treatment decision-making. In cancer, further research is required to ascertain most effective intervention format.