Women

Female Genital Mutilation (FGM) remains a deeply entrenched cultural practice affecting millions of women and girls worldwide, with particularly high prevalence in Sierra Leone. Despite international efforts to eradicate FGM due to its severe consequences, it persists as a social norm, often reinforced by traditional institutions such as the Bondo society. This paper explores the historical, cultural, and social dimensions of FGM in Sierra Leone, examining the role of the Bondo society in perpetuating the practice and its implications for women’s rights and health. This study analyzes the existing literature to understand both the resilience of FGM as a practice and the challenges faced by intervention programs. A total of eight peer-reviewed studies were included in the final synthesis. The findings highlight the complex intersection of tradition, gender identity, and societal expectations, which sustain FGM despite legal and advocacy efforts. The paper further discusses potential strategies for mitigating FGM, including community-based awareness programs, legal reforms, and engagement with cultural gatekeepers to promote alternative rites of passage. The study concludes that while progress is being made, a culturally sensitive, grassroots approach is essential for the long-term eradication of FGM in Sierra Leone. Full article

Fibromyalgia is a condition that primarily affects women and compromises the quality of life (QoL), life satisfaction (SWL), mental health and cognitive function of sufferers. This study aimed to analyze the effects of a physical activity program based on Virtual Square Step Exercise on the above conditions in women with FM. A 12-week randomized controlled trial was designed with 61 women with FM assigned to a control group (CTL) and an experimental group (VSEE). The VSSE group performed VSSE sessions three times a week for 12 weeks, while the CTL continued with their usual treatment. The applicability and safety of the program was tested in this population. In addition, the participants’ QoL, SWL, mental health status, and cognitive function were assessed before and after the intervention program using different questionnaires and tests. VSEE was found to be applicable (with adherence greater than 85%) and safe (with no accidents, injuries, or health-compromising incidents) in women with FM. The VSEE showed a significant reduction in self-perceived depressive symptoms compared to the control group (p < 0.05). In contrast, no significant changes in QoL, SWL, mental health and cognitive function were observed in the VSEE compared to the CTL (p > 0.05). Therefore, even though our VSEE-based intervention was found to be applicable and safe in women with FM, it did not produce significant changes in improving QoL, SWL, mental health, and cognitive function in our sample. The small sample size and post-pandemic context may have affected the findings. More research with a larger sample size is needed to confirm the effects and applicability of VSEE in women with FM. Full article

Urinary tract infections (UTIs) are among the most prevalent infectious diseases in older women, especially those over 65 years of age. Physiological changes related to aging, comorbidities, and frequent use of medical devices such as urinary catheters increase susceptibility. Increasing antimicrobial resistance further complicates treatment strategies. This study aims to describe the epidemiological profile of UTI in women over 65 years of age, focusing on the characterization of etiological agents, observed antimicrobial resistance patterns, and commonly reported risk factors. We conducted a retrospective analysis of microbiological and clinical data from elderly women diagnosed with UTIs. Bacterial isolates were identified and antimicrobial susceptibility profiles were evaluated over a specified period. A statistical analysis was performed to determine the prevalence of different pathogens and antibiotic resistance trends. Escherichia coli was the predominant uropathogen, consistent across different clinical scenarios and patient conditions. The four most common bacterial strains—E. coli, Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecalis—aligned with global epidemiological data. In Escherichia coli a significant increase in resistance to nitrofurantoin was observed, possibly indicating excessive empirical use, while resistance to other antibiotics, such as amoxicillin/clavulanic acid and ertapenem, remained stable or decreased. Institutional antibiotic stewardship programs likely contributed to this trend. The study highlights E. coli as the main etiological agent in elderly women with UTIs. The observed resistance patterns emphasize the need for localized antimicrobial surveillance and personalized therapeutic approaches. Continuous microbiological monitoring and rational use of antibiotics are crucial to optimize treatment outcomes and control the development of resistance. Full article

The sleep–wake rhythm, regulated by the suprachiasmatic nucleus (SCN) and peripheral clocks, is influenced by light, nutrition, stress, and exercise. Recent findings suggest that estrogen receptors in the SCN may link ovarian hormone regulation to circadian rhythms, highlighting the need to consider hormonal fluctuations throughout the menstrual cycle when examining the effects of exercise on the sleep–wake rhythm in females. Therefore, we conducted a scoping review to compile existing studies involving human participants, aiming to provide a foundation for research focused on the specific physiological phenomena in females. Based on 228 literature sources, only 6 met the inclusion criteria. Despite variations in the exercise type, intensity, and duration, transient exercise demonstrated a significant impact on the expression of the clock genes BMAL1, PER2, and CRY1, suggesting their susceptibility to such activities. This review highlights the absence of studies examining the effects of exercise on clock gene expression in females, particularly in relation to menstrual cycles and ovarian hormone fluctuations, emphasizing the need for future investigations that incorporate these factors. Full article

Background: The introduction of the human papilloma virus (HPV) vaccine has allowed for incredible strides in the reduction in HPV-related cancers. Despite widespread availability and a recent age group expansion for the vaccine, uptake remains low. Particularly, concerning disparities exist in the state of Tennessee and among minority women. This study aimed to identify key influences of decision-making to receive the HPV vaccine in minority women living in Tennessee. Methods: This study used a prospective, observational, qualitative methods approach. Minority women residing in Tennessee were recruited through flyers posted in various community-based locations around the state. Narrative interviews of participants were conducted until thematic saturation was achieved. Interviewing occurred telephonically, with questions focused on participant perceptions of HPV and its vaccine. Verbatim transcripts were created via external software, and then inductively coded by three researchers. These codes were grouped into categories based on similarities, which facilitated the emergence of themes. Results: A total of 21 participants were interviewed between July and October 2024. Thematic analysis revealed two themes: (1) Awareness of HPV: Determining if the Vaccine is Right for Me; and (2) Intrinsic Motivators for HPV Vaccine adoption: “Like going to the salon and getting your hair half-done”. While some participants had an accurate understanding of HPV, its health consequences, and had received the vaccine, most were unvaccinated and had little understanding of the benefits of this preventative method. Those who received the HPV vaccination were influenced by proactive healthcare workers who provided in-depth education about its benefits. Those who did not elect to receive the vaccine described how its lack of mandate and seldom informational opportunities impacted their decision. Conclusions: Overall, minority women in Tennessee could benefit from improved access to information regarding HPV and its vaccine, as well as direct provider influence and counseling on receiving the vaccine to avoid detrimental health consequences. Full article

Women with schizophrenia have distinct health and social needs compared to men. The Mutua Terrassa Functional Unit for Women with Schizophrenia has designed a new intervention called the Community Therapeutic Space (CTS), which is based on individual and group interventions focused on physical and mental health, and social factors. We carried out a narrative review focusing on green and blue spaces, climate change, light, digitalization and health, and gynecological screening in women with schizophrenia, to propose content for seven topics of the CTS. The personalized space offers individual appointments with mental health professionals with particular attention to pharmacological and social issues. The health space focuses mainly on groups of healthy habits, and links women to community activities. The interaction space focuses mainly on social connections, and the connection with nature. The content of these three spaces has been divided into seven colors: green and blue corners (related to green and blue spaces), red corner (climate change), yellow corner (light and health), white corner (mainly focused on mindfulness), black corner (digitalization in healthcare), and purple corner (related to gynecological screening). In the future, peer-to-peer and volunteer programs may help our healthcare unit to ensure and maintain the positive effects of these interventions. Full article

Previous cross-sectional studies have investigated social determinants of health (SDOH) among pregnant women with COVID-19. However, there are scant data on the impact of these determinants on maternal outcomes from cohorts of pregnant women with COVID-19. We evaluated the association between social determinants of health and both COVID-19 severity and adverse pregnancy outcomes (APOs) in a cohort of pregnant women in Los Angeles (L.A.) County, California. The APOs considered were fetal loss, gestational hypertensive disorders, prolonged rupture of membranes, and maternal death. We recruited pregnant women with confirmed SARS-CoV-2 and collected data on maternal COVID-19 severity, trimester at diagnosis, comorbidities, mode of delivery, COVID-19 vaccination, APOs, maternal age, medical insurance type, race/ethnicity, and neighborhood income. Participants who were obese were more likely to experience severe COVID-19 (OR: 3.61, 95% CI: 1.44–9.46), while even one vaccine dose before COVID-19 infection was associated with reduced odds of severe disease (OR:0.14, 95% CI: 0.02–0.52). Pregnant participants living in low-income areas were more likely to experience APOs (p = 0.01) and severe COVID-19 (p = 0.009). This suggests that economic inequities could negatively impact maternal outcomes among pregnant women with COVID-19. We also found that SDOH moderated severity effects on APOs in Black women vs. non-Black women. These findings underscore the importance of considering social determinants of health to improve maternal health. Full article

Congenital CMV (cCMV) is the leading cause of hearing loss and neurodevelopmental disabilities in children, affecting 15–18% of births in the United States (U.S.). Despite its strong presence, the lack of routine prenatal screening limits its detection and prevention, especially in low-resource communities. The aim of this scoping review is to describe the scope of the CMV interventions and the policies on CMV screening in the United States, identify successful strategies for the implementation of improved CMV screening rates, and make recommendations for future efforts aimed at improving CMV screening in U.S. healthcare settings. The Joanna Briggs Institute recommendations for scoping reviews and the Arksey and O’Malley (2005) York methodology guided the different review steps. These included (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; (5) collating, summarizing, and reporting results. A total of six studies were retained for analysis. A common barrier reported across studies was the lack of generalizability of findings due to small sample size. Challenges encountered by patients often centered around awareness, emotional resistance, and cultural norms. Providers also faced significant barriers, particularly related to time constraints, knowledge gaps, and the prioritization of CMV education in prenatal care. Furthermore, a recurrent theme across included studies was the critical role of education in increasing awareness and reducing CMV transmission risks. Findings will contribute to the advancement of CMV prevention through the identification of gaps in education, policy, and practice, thus assuring better health outcomes for mothers and infants. Full article

The World Health Organization recommends Tranexamic acid (TXA) in the treatment of postpartum haemorrhage (PPH) as part of the PPH care bundle. We conducted integrative review of 36 studies from three databases namely PubMed, Google Scholar, and Dimensions. The integrative review followed PRISMA guidelines and evaluated clinical efficacy of TXA, prophylactic use, cost-effectiveness, alternative administration routes, and real-world implementation challenges and facilitators. The review found that early administration of TXA within three hours of PPH onset significantly reduces maternal mortality by 31%. Despite concerns about thrombosis, pooled data from large-scale cohorts demonstrate minimal thromboembolic risk which reinforces the safety profile of TXA. However, the WOMAN-2 trial revealed no significant benefit in women with moderate-to-severe anaemia which highlights the necessity for patient-specific TXA protocols. Economic evaluations reveal that integrating TXA into national guidelines requires a modest budget increase (approximately 2.3%) but promises substantial cost savings through reduced surgeries and hospital stays. While intravenous TXA remains recommended route by WHO, emerging evidence supports intramuscular and topical administration which is crucial in rural or primary-care settings lacking intravenous facilities. Yet, questions about bioavailability and rapid haemostatic efficacy persist, awaiting outcomes from ongoing trials such as I’M WOMAN, which is currently recruiting women aged 18 years from five countries with results anticipated by late 2025. Significant barriers to widespread adoption of TXA include limited healthcare provider training, lack of budgetary allocation by government and cultural misconceptions associating TXA with “dangerous clotting” in some settings. Successful initiatives, like China’s Strategies and Tools to Enhance Parturient Safety (STEPS) programme, illustrate how enhanced perinatal care bundles, interdisciplinary team training, and continuous monitoring using statistical process control (SPC) tools can overcome these obstacles. To accelerate progress towards reducing preventable maternal deaths globally, future research must address variable effectiveness when TXA is used as prophylaxis, clarify subpopulations most likely to benefit, and rigorously assess alternative routes of TXA administration. Full article

This study aimed to assess pregnant women’s knowledge regarding the benefits and practice of antenatal perineal massage (APM) and their acceptance of APM. A descriptive cross-sectional correlation design was applied to a convenience sample of 104 pregnant women who completed an online questionnaire. The online questionnaire was divided into four categories: (1) sociodemographic and obstetric history and general information about APM, (2) knowledge regarding the benefits of APM, (3) knowledge regarding the practice of APM, and (4) acceptance of APM. Data analysis was performed in SPSS v.26. Frequencies and percentages were taken from all qualitative variables. Most pregnant women had good knowledge: 78.8% had knowledge regarding the benefits of APM, 85.6% had knowledge regarding the practice of APM, and 54.8% reported acceptance of APM. There was a significant correlation between knowledge and practice of APM, indicating that a higher knowledge level leads to good practice of APM. This study highlighted participants’ significantly high amount of knowledge regarding the benefits and practice of APM. Additionally, based on the percentage of participants who had not heard about APM, the study revealed the failure of health-care providers to provide education regarding APM to pregnant women. Further research is needed to establish interventions that improve knowledge and encourage APM practice among pregnant women. Full article

Physical activity is recognized for its physical and mental health benefits, including reducing sedentary behavior and improving mood, anxiety, and self-esteem. Individuals with severe mental illness tend to be more sedentary, contributing to poorer health outcomes. Water aerobic exercise has shown promise in improving physical and mental health, but sex differences in response to such interventions remain underexplored. This study investigates the effects of a water aerobic exercise intervention on 74 individuals with severe mental illness, focusing on sex differences. Participants engaged in a 45–60 session, once a week for 6 months. Assessments were conducted before and after the intervention and included measures of clinical, functioning, quality of life, and sedentary behavior outcomes. Both men and women significantly reduced sedentary behavior. Men showed significant improvements in self-stigma, functioning, and general quality of life. In contrast, women demonstrated significant improvements in self-esteem. These findings suggest that water aerobic exercise may be effective in reducing sedentary behavior and improving mental health outcomes in individuals with severe mental illness. However, the benefits appear to differ by sex. These results underscore the importance of sex-tailored physical activity interventions in mental health care. Full article

Congenital cystic adenomatoid malformation (CCAM) is a rare fetal lung anomaly characterized by benign multicystic masses that can lead to severe complications, such as pulmonary hypoplasia, fetal hydrops, and neonatal death. This literature review examines current knowledge on antenatal therapies for CCAM, focusing on pharmacological, procedural, and surgical interventions. Betamethasone, the first-line pharmacological treatment, has shown efficacy in reducing lesion size and resolving hydrops, particularly in microcystic CCAM. Procedural options, such as thoracoamniotic shunting, are effective for macrocystic lesions but carry risks including preterm labor and thoracic deformities. Open fetal surgery remains a last-resort intervention for severe cases, while emerging techniques, like percutaneous laser ablation and sclerotherapy, offer promising minimally invasive alternatives. A proposed treatment algorithm emphasizes individualized care based on lesion type, gestational age, and the presence of complications. The authors searched the US National Library of Medicine Database, Google Scholar, and PubMed Central to gather information on antenatal therapies for CCAM. This review emphasizes that, despite significant advancements, considerable challenges persist, underscoring the need for prospective studies to refine therapeutic protocols and assess long-term outcomes. Full article

Human milk is recognized as the optimal nutrition for infants, with evidence showing it can prevent childhood death. While there are approximately 756 milk banks worldwide, predominantly located in high-income countries, human milk banking remains limited in Africa, where infant mortality rates are highest. The purpose of this review was to examine the current landscape of human milk banking in Africa, analyzing its potential to decrease infant mortality and enhance neonatal health outcomes. We explore implementation challenges, opportunities for expansion, and strategies for establishing sustainable milk banking systems across the continent. Following Arksey and O’Malley’s scoping review framework, we conducted a comprehensive analysis of peer-reviewed literature, case studies, and reports from the PubMed, Google Scholar, and African Journals Online databases through 2024. Results: South Africa leads the continent, with over 20 milk banks, while countries like Kenya, Nigeria, and Uganda have recently established programs. Significant challenges include cultural barriers and a lack of infrastructure and funding. Despite current limitations, evidence supports the significant potential of human milk banking to reduce infant mortality in Africa. Success requires addressing cultural barriers, strengthening healthcare infrastructure, and developing sustainable funding models by integrating existing maternal and child health services. Full article

Physical inactivity is a significant global health challenge, contributing to increased morbidity and mortality rates. Regular physical activity (PA) improves both physical and mental health, particularly for women, who are at higher risk of chronic conditions associated with inactivity. This study examines barriers and enablers to PA participation among women aged 18–65 in port and coastal communities in East England, a population disproportionately affected by socioeconomic and logistical challenges. Using a mixed-methods convergent parallel design, data were collected from 112 women recruited through local PA and weight loss programmes. Quantitative data were gathered using the International Physical Activity Questionnaire (IPAQ) and the Exercise Benefits and Barriers Scale (EBBS) and analysed using descriptive statistics and logistic regression in SPSS. Qualitative data obtained through scenario-based and open-ended questions were thematically analysed in NVivo. Key findings indicate that healthcare professionals were the primary source of PA information (40%), while health benefits (36%) were the most frequently cited motivator for participation. Barriers to engagement included family responsibilities (45%), low self-confidence (31%), and limited access to facilities (27%). Women with caregiving roles or chronic health conditions were significantly less likely to engage in PA. Qualitative analysis highlighted additional psychological and environmental barriers but also identified motivators such as social support, medical advice, and personal goals. The study concludes that addressing socioenvironmental and psychological barriers to PA requires community-based, multilevel interventions. Leveraging support networks and culturally relevant programming can play a crucial role in sustaining PA engagement among women in these underserved port and coastal communities. Full article

Perimenopause, the transitional phase leading up to menopause, affects millions of women worldwide, yet it remains poorly understood and under-addressed in healthcare. Despite the availability of treatment options like hormone replacement therapy (HRT) and non-hormonal alternatives, the awareness and utilization of these options vary significantly among women. Here, we conducted a cross-sectional survey with 1000 adults, both men and women, from the United States and Canada. We evaluated the perceived familiarity of participants with the timing, duration, and symptoms of perimenopause, as well as their satisfaction with their treatment options and communication with their healthcare providers. We found that, in general, women and older people were more likely to feel familiar with perimenopause, although the youngest age group surveyed also reported relatively high familiarity. We also found that there is a disconnect between people reporting high familiarity with perimenopause and its symptoms but overall middling and lower familiarity with the age and duration of onset and satisfaction with treatment options. Our results suggest further investigation into where people obtain their information concerning perimenopause, as well as into how knowledge of perimenopause may vary based on demographics. Full article

Black mothers with preterm infants face unique challenges during their stay in the NICU and after discharge. Racism-related barriers impact access to care for Black preterm infants. Understanding their experiences in caring for preterm infants is crucial to developing equity-focused interventions to address racism in the NICU and promote Black preterm infant health outcomes. The purpose of this scoping review is to shed light on Black mothers’ experiences of having a preterm infant. A search was conducted in CINAHL, Medline, Maternity and Infant Care, and Google Scholar. A total of 287 articles were retrieved and screened. Twelve (12) articles included in the final review were from the United States. The findings highlight the need to address racism among healthcare providers in the NICU through training and education. Gaps in understanding the experiences of Black parents with preterm infants from other Western contexts remain and require further research. Full article

Intrauterine devices (IUDs) are highly effective long-acting contraceptives. However, pain associated with insertion deters some women and impacts satisfaction. This systematic review critically evaluates the effectiveness of local anesthetics, misoprostol, nonsteroidal anti-inflammatory drugs (NSAIDs), and conscious sedation for managing pain associated with IUD insertion. A comprehensive database search including PubMed, Web of Science, Google Scholar, ClinicalTrials.gov, and ProQuest was conducted from inception to July 2023 for randomized controlled trials (RCTs). RCTs assessing interventions for IUD insertion pain were included. Case reports, non-randomized studies, and non-English papers were excluded. Two independent reviewers extracted data on pain outcomes and adverse effects. The risk of bias was assessed using Cochrane tools. Thirty-nine RCTs (n = 12,345 women) met the inclusion criteria. Topical lidocaine effectively reduced pain on consistent findings across multiple high-quality RCTs. Misoprostol pretreatment facilitated easier insertions through cervical ripening. However, evidence for NSAIDs was inconclusive, with some RCTs finding no additional benefits versus placebo. Results also remained unclear for nitrous oxide conscious sedation due to variability in protocols. Nulliparity predicted higher reported pain consistently. Lidocaine and misoprostol show promise for minimizing IUD insertion pain and difficulty. Further optimization is required to standardize conscious sedation and fully evaluate NSAIDs. Improving pain management may increase favorable experiences and uptake of this reliable method. Full article

Spontaneous rupture of the utero-ovarian vessels is an exceptionally rare but potentially life-threatening condition, especially in the case of non-pregnant women with a history of complex gynecological conditions. We report the case of a 45-year-old woman presenting with severe abdominal pain and hemoperitoneum, 15 years after surgical eradication of stage IV endometriosis. Diagnostic imaging revealed significant free fluid and vascular disruption near the uterus. Emergency laparotomy confirmed blood in the peritoneal cavity and identified a rupture of the left paracervical vessels. This case underscores the critical role of timely surgical intervention and the challenges of diagnosing spontaneous vascular rupture in the context of chronic conditions such as endometriosis and fibromyalgia. A review of the literature revealed very limited cases with similar presentations, emphasizing the rarity of such vascular events, although without active endometriotic lesions. This report highlights the importance of considering spontaneous vascular rupture in differential diagnoses for acute abdominal pain with hemoperitoneum. Advanced imaging and multidisciplinary management are pivotal in ensuring favorable outcomes. Full article

Geophagy is an ancient widespread practice that is common amongst women of childbearing age globally. Geophagy is one of the leading causes of iron deficiency and pregnancy complications amongst women of childbearing age resulting in maternal, neonatal, and child morbidities and mortalities globally. The concept of geophagy has yet to be incorporated in the reproductive health services in the healthcare facilities. A qualitative study was conducted using focus group discussions and in-depth interviews to explore the views/perspectives of nurses regarding geophagic women of childbearing age accessing healthcare in the reproductive healthcare services in Tshwane District, Gauteng Province. The findings revealed that nurses perceived geophagic women of childbearing age to be iron deficient and lack proper knowledge and understanding of the potential health risks and dangers of soil eating. Mental health and substance use disorders, food and nutrition deficiencies, absence of geophagy health education, and promotion programs were highlighted as some of the aspects that play a role towards the practice of geophagy amongst women of childbearing age accessing healthcare in Tshwane District, Gauteng Province. Thus, a conclusion can be made that geophagy health education and promotion programs in the antenatal care units must be prioritized by government. Full article