Coronavirus Disease 2019 (COVID-19)-Related Stress and Menstrual Changes.

OBJECTIVE: To evaluate how stress related to the coronavirus disease 2019 (COVID-19) pandemic has affected women's menstrual cycles. We hypothesized that women with high levels of COVID-19-related stress would have more menstrual changes compared with those with lower levels of stress. METHODS: Using a cross-sectional study design, we recruited a representative sample of U.S. adult women of reproductive age (18-45 years) using nonhormonal birth control to participate in an online REDCap (Research Electronic Data Capture, Vanderbilt University) survey. COVID-19-related stress was assessed with the PSS-10-C (COVID-19 Pandemic-related Perceived Stress Scale) and dichotomized as low stress (scores lower than 25) and high stress (scores 25 or higher). Self-reported menstrual outcomes were identified as changes in cycle length, duration, or flow and increased frequency of spotting between cycles. We used χ 2 and Fisher exact tests to compare differences in outcome between the two stress groups and logistic regression models for effect estimates. RESULTS: A total of 354 women of reproductive age across the United States completed both the menstrual and COVID-19-related stress components of our survey. More than half of these women reported at least one change in their menstrual cycles since the start of the pandemic (n=191), and 10.5% reported high COVID-19-related stress (n=37). Compared with those with low COVID-19-related stress, a greater proportion of women with high COVID-19-related stress reported changes in cycle length (shorter or longer; P =.008), changes in period duration (shorter or longer; P <.001), heavier menstrual flow ( P =.035), and increased frequency of spotting between cycles ( P =.006) compared with prepandemic times. After adjusting for age, smoking history, obesity, education, and mental health history, high COVID-19-related stress was associated with increased odds of changes in menstrual cycle length (adjusted odds ratio [aOR] 2.32; 95% CI 1.12-4.85), duration (aOR 2.38; 95% CI 1.14-4.98), and spotting (aOR 2.32; 95% CI 1.03-5.22). Our data also demonstrated a nonsignificant trend of heavier menstrual flow among women with high COVID-19-related stress (aOR 1.61; 95% CI 0.77-3.34). CONCLUSION: High COVID-19-related stress is associated with significant changes in menstrual cycle length, alterations in period duration, and increased intermenstrual spotting as compared with before the pandemic. Given that menstrual health is frequently an indicator of women's overall well-being, clinicians, researchers, and public health officials must consider the association between COVID-19-related stress and menstrual disturbances.

Mild traumatic brain injury/concussion and female sexuality, a scoping review of the literature.

BACKGROUND: The American Congress of Rehabilitation Medicine (ACRM) in 2010 called for more head injury research on gender disparities to bridge the gender gap for the short-and long-term effects of TBI, including sexual and reproductive outcomes. In this paper, we review the state of the literature before and after the ACRM announcement, and evaluate how research teams have considered females and mildly injured TBI(mTBI)/concussion groups in post-TBI-related changes in sexual functioning. METHODS: The research question for this scoping review was "what is the state of the literature in the evaluation of post-TBI sexual changes for women, and individuals with mTBI?" Using the 2010 ACRM call for action as a line of demarcation, we compared our findings before and after the 2010 announcement. RESULTS: We identified 9 research studies that addressed sexual functioning changes in females and mTBI/concussion groups. Four of the nine were published before the 2010 ACRM announcement, and five were published after. The representation of female research participants increased steadily over the 28-year timespan. The proportion of individuals with mTBI included in the post-2010 era was higher than the earlier time period. Consistently, women with mTBI reported more adverse sexual outcomes compared to male cohorts, orthopaedic, and non-injured comparison groups. This observation persisted regardless of recruitment site (rehabilitation center/Emergency Department (ED)/Community) or time of outcome assessment (acute versus chronic). The findings also remained despite the heterogeneity of survey questionnaires used to evaluate sexual functioning outcomes. Excluding the most recent 2019 study, none of the research groups compared the findings by TBI severity, making it difficult to fully understand how concussion-related sexual changes compare to more severe forms of the head injury. The long term impacts of the sexual changes, such as infertility and relationship discord were also absent across all studies; even though most evaluated outcomes chronically (some as far out as 20 years post injury). CONCLUSION: The number of publications in the era before the ACRM call for action and afterwards were almost identical. In order to tailor interventions for the appropriate groups of TBI patients, more neurosexuality research is needed to increase awareness of the importance of sexuality as a health outcome for individuals with neurodisabilities.