Impact of Violence against Women on Sexual and Reproductive Health: Research Protocol and Results from a Pilot Study

Objectives: Violence against women (VAW) is associated with a deterioration of endocrine function with consequences similar to those of premature ovarian failure in women. The main objective of this study is to evaluate the hormonal repercussions of VAW and, secondly, to analyse the cardio-metabolic, bone, cognitive, psychological, and psychosexual consequences of hypoestrogenism secondary to VAW. Materials and Methods: A cross-sectional study will be conducted on women of any age who have suffered VAW at some point in their lifespan, whether psychological, sexual, or physical. Clinical, hormonal, cardio-metabolic, bone, psychological, and psychosexual parameters will be analysed. Results: The pilot study from the first 23 women show that all of them are suffering from severe sexual dysfunction. In addition, all women reported menstrual irregularity and hypoestrogenism (including two cases of premature ovarian failure) since the VAW episode. Conclusions: VAW is a pandemic that affects all women equally, regardless of their age, status, social background, or education. Despite the claims made by certain groups, VAW does not depend on women, but rather it affects women and is clearly harmful to their sexual, reproductive, and general health.Vice-rectorate for Equality of the University of Granada CTS.515-30G570000

Treatment of Female Sexual Dysfunction Due to Dyspareunia with Solid-State Vaginal Laser and Recombinant Platelet-Derived Epidermal Growth Factors: A Viable Possibility?

Objective: To examine the efficacy and safety of non-pharmacological and non-ablative options (or a combination of these) for postmenopausal dyspareunia. Mechanism: Narrative review on non-pharmacological and non-ablative options (or a combination of these) for postmenopausal dyspareunia. Findings in Brief: Dyspareunia is the most bothersome symptom of the genitourinary syndrome of menopause, often complicated by decreased sexual interest and arousal. Solid-state vaginal laser (SSVL) and recombinant plateletderived epidermal growth factors (RGFs) are new alternatives are new alternatives that improve female sexual dysfunction resulting from dyspareunia. Conclusions: SSVL is a new alternative the treatment of postmenopausal dyspareunia either alone or in combination with other alternatives with efficacy and safety similar to the classical options

Impact of violence against women on quality of life and menopause-related disorders

Violence against women is a pressing global issue that poses a number of significant health risks. The influence of violence on women's health during the menopause has been underestimated, especially its impact on the early onset of menopause and on the exacerbation of symptoms that determine quality of life. The objectives of our study were to analyse whether experiencing any type of violence increases the risk of early menopause, worsens menopausal symptoms, and results in a lower quality of life. This cross-sectional observational study recruited 29 postmenopausal women who had experienced violence from a partner in their lifetimes. Additionally, 89 postmenopausal who had not suffered from violence were included as a control group. All the women who had experienced violence from a partner reported psychological and economic violence, 75 % reported physical violence, 57.1 % reported sexual violence, and 39.3 % reported all types of violence. Violence was found to be associated with menopausal symptoms and poorer quality of life. These associations persisted after adjustment for multiple factors, and women who had experienced any form of violence reported a worse quality of life during menopause. Moreover, violence-exposed women reached menopause approximately 20 months earlier (p < 0.05), and 20.7 % of these women developed premature ovarian insufficiency (p < 0.001).Vice-rectorate for Equality of the University of GranadaFunding for open access charge: Universidad de Granada / CBU

Effects of violence against women on health during menopause: a systematic review and metanalysis

Objective(s): This review aimed to respond to the question of how a history of violence against women (VAW) influences their health during menopause. Mechanism: We searched all articles (published in peer-reviewed journals up to March 2021) related to menopausal symptoms, sexual dysfunction, and chronic complications in postmenopausal women affected by VAW. Findings in brief : The literature search strategy identified 194 articles, of which 19 were selected for analysis. All articles described cross-sectional or cohort studies concerning menopausal or genitourinary symptoms, psychological health, physical conditions, sexual health, and cardiovascular or metabolic problems. The analyzed data set included 16436 women who reported experiencing violence in the USA, Brazil, and Australia. The combined data on the effect of VAW on menopausal symptoms suggest that the risk of suffering from such effects is 1.51 (95% CI: 1.23–1.86), while for sexual health, the risk was 1.4875 (95% CI: 1.2060–1.8346). Conclusions: A history of VAW increases the symptoms of menopause and worsens the physical conditions and sexual and psychological health after the age of 40. Thus, it is essential to investigate these antecedents in routine clinical practice when treating menopausal women with additional symptoms and to warn of the long-term general health risks for any woman who has experienced an episode of violence

Application of a new ultrasound criterion for the diagnosis of polycystic ovary syndrome

Objective: To define which ultrasound criteria could replace the classic Rotterdam criteria as the best indicator of the risk of developing endocrine– metabolic changes in women with polycystic ovary syndrome (PCOS). Materials and methods: This multicenter cross-sectional study included 200 women with PCOS and one control group of 111 women without PCOS. The primary outcomes to be considered were follicular count, hirsutism, total testosterone levels, free androgen index (FAI), and insulin sensitivity (HOMAIR), and the secondary outcome was the anti-Müllerian hormone (AMH) level. Results: The main finding in this study points toward a different ultrasound criterion—23 or more follicles of any size in at least one ovary, which is postulated as an alternative to the classic criterion described in the Rotterdam consensus. This criterion correlates better with the other two PCOS criteria and also identifies women at increased risk of hirsutism (Ferriman–Gallwey score: 6.08 ± 3.54 vs. 4.44 ± 3.75, p < 0.0001), total testosterone levels (2.24 ± 0.298 vs. 1.42 ± 1.530, p = 0.0001), FAI (4.85 ± 0.83 vs. 2.12 ± 1.93, p < 0.001), and insulin resistance (HOMA-IR: 1.74 ± 0.182 vs. 1.504 ± 0.230, p = 0.001) more accurately. Regarding AMH, large differences in their mean values were observed between the groups (7.07 vs. 4.846 ng/ml, p = 0.000). However, these differences depended on age. Conclusion: The ovarian ultrasound examination with 23 or more follicles of any size in any of the ovaries constitutes a powerful tool to accurately diagnose PCOS and to associate it with metabolic–endocrine processes such as hyperandrogenism and insulin resistance

Women’s knowledge about the genitourinary syndrome of menopause: adherence to its treatments in the COVID‑19 era in a sample of them: COMEM‑GSM study

The surveys have been carried out by the COMEM Study Spanish investigators in the following hospitals: Hospital Universitario Miguel Servet of Zaragoza, Hospital San Jorge of Huesca, Hospital Universitario La Zarzuela of Madrid, Hospital San Carlos of San Fernando, Hospital Insular-Materno Infantil of Las Palmas, Hospital Quirón Salud of Zaragoza, Hospital Clínico San Carlos of Madrid, Hospital Universitario of Castellón, Complejo Hospitalario of Jaén, Hospital Universitario Central of Asturias, Clínica Diatros of Barcelona, Instituto Palacios of Madrid and European Institute of Sexology, Marbella. The team of seven menopause experts who made the survey was made up of: L Baquedano, P Coronado, N Mendoza, I Ramirez, E de la Viuda, B Otero and S Sánchez.Objective: To study knowledge regarding genitourinary syndrome of menopause (GSM) and the treatments for it and to analyze treatment adherence during the COVID-19 confinement. Methods: Multi-center observational study including women between 35 and 75 years. An extension study of treatment adherence was conducted during the coronavirus pandemic between March and April 2020. Results: A sample of 2355 women were included. Vaginal dryness was the most frequently identified symptom (74.3%). Lubricants were the best-known treatments (69.6%), followed by local estrogens (25.7%); 66% of the women did not speak to their gynecologist about sexuality. Comparative analyses were conducted according to age, menopausal status, type of menopause, place of residence, type of health care received and level of education. During the coronavirus confinement period, adherence to treatments for vulvovaginal atrophy was poor in 72.5% asked (n = 204). Reduced sexual activity (p > 0.001) and coronavirus diagnosis (p = 0.003) were significantly associated with poorer treatment compliance. Conclusions: There is great lack of knowledge of the treatments used for GSM. Most women do not talk to their gynecologist about sexuality. Adherence to treatments during the coronavirus confinement has been worryingly low

Observer Influence with Other Variables on the Accuracy of Ultrasound Estimation of Fetal Weight at Term

Background and Objectives: The accuracy with which the estimation of fetal weight (EFW) at term is determined is useful in order to address obstetric complications, since it is a parameter that represents an important prognostic factor for perinatal and maternal morbidity and mortality. The aim of this study was to determine the role of the experienced observers with other variables that could influence the accuracy of the ultrasound used to calculate EFW at term, carried out within a period of seven days prior to delivery, in order to assess interobserver variability. Materials and Methods: A cross-sectional study was performed including 1144 pregnancies at term. The validity of the ultrasound used to calculate EFW at term was analyzed using simple error, absolute error, percentage error and absolute percentage error, as well as the percentage of predictions with an error less than 10 and 15% in relation to maternal, obstetric and ultrasound variables. Results: Valid predictions with an error less than 10 and 15% were 74.7 and 89.7% respectively, with such precision decreasing according to the observer as well as in extreme fetal weights. The remaining variables were not significant in ultrasound EFW at term. The simple error, absolute error, percentage error and absolute percentage error were greater in cases of extreme fetal weights, with a tendency to overestimate the low weights and underestimate the high weights. Conclusions: The accuracy of EFW with ultrasound carried out within seven days prior to birth is not affected by maternal or obstetric variables, or by the time interval between the ultrasound and delivery. However, accuracy was reduced by the observers and in extreme fetal weights

Sexuality in Postmenopausal Women with Genital Prolapse

Background: One of the most common complaints among menopausal women concerns changes in sexual function. This is attributed to various factors, including anatomical defects in the genital tract, with pelvic organ prolapse (POP) being one of the most prevalent problems affecting women during this stage of their lives. Additionally, symptoms resulting from gonadal hypofunction can also contribute to the development of sexual dysfunction during menopause. This research aimed to explore the way in which postmenopausal patients with POP experienced their sexuality in our setting. Methods: To achieve the proposed objective, we conducted a descriptive, crosssectional study involving a total of 133 postmenopausal women with POP. Results: The results of our series are consistent with the scarce literature available in our setting and suggest a high rate of sexual dysfunction in postmenopausal patients with POP. Conclusions: We can conclude that POP is associated with the presence of female sexual dysfunctio

Assessing the testicular sperm microbiome: a low-biomass site with abundant contamination

We thank all men who generously donated testicular material for the purpose of this study. We also acknowledge the research support by Copan Italia S.p.A Inc., and Clearblue, SPD Swiss Precision Diagnostics GmbH. This study is part of a PhD Thesis conducted at the Official Doctoral Program in Biomedicine of the University of Granada, Spain. This work was supported by the Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and European Regional Development Fund (FEDER): grant numbers RYC-2016-21199 and ENDORE (SAF2017-87526-R); by FEDER/Junta de Andalucia-Consejeria de Economia y Conocimiento: MENDO (B-CTS-500-UGR18); by Junta de Andalucia: (PAIDI P20_00158) by the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES), and the Junta de Andalucia, Consejeria de Conocimiento, Investigacion y Universidades and European Regional Development Fund: (SOMM17/6107/UGR); by Spanish Ministry of Science, Innovation, and Universities: (PRE2018085440 and FPU19/01638); and by Spanish Ministry of Education, Culture, and Sport: (FPU15/01193). Funding for open access charge: Universidad de Granada/CBUA Sequence data of all testicular spermatozoa and negative control samples have been deposited in the National Centre for Biotechnology Information (NCBI) Sequence Read Archive (SRA) database (http://www.ncbi.nlm.nih.gov/sra) under the BioProject ID PRJNA643898. The preliminary results of this study were presented as a poster communication at the 35th Annual ESHRE Meeting (Vienna, 2019).Research question: The semen harbours a diverse range of microorganisms. The origin of the seminal microbes, however, has not yet been established. Do testicular spermatozoa harbour microbes and could they potentially contribute to the seminal microbiome composition? Design: The study included 24 samples, comprising a total of 307 testicular maturing spermatozoa. A high-throughput sequencing method targeting V3 and V4 regions of 16S rRNA gene was applied. A series of negative controls together with stringent in-silico decontamination methods were analysed. Results: Between 50 and 70% of all the detected bacterial reads accounted for contamination in the testicular sperm samples. After stringent decontamination, Blautia (P = 0.04), Cellulosibacter (P = 0.02), Clostridium XIVa (P = 0.01), Clostridium XIVb (P = 0.04), Clostridium XVIII (P = 0.02), Collinsella (P = 0.005), Prevotella (P = 0.04), Prolixibacter (P = 0.02), Robinsoniella (P = 0.04), and Wandonia (P = 0.04) genera demonstrated statistically significant abundance among immature spermatozoa. Conclusions: Our results indicate that the human testicle harbours potential bacterial signature, though in a low-biomass, and could contribute to the seminal microbiome composition. Further, applying stringent decontamination methods is crucial for analysing microbiome in low-biomass site.Copan Italia S.p.A Inc.ClearblueSPD Swiss Precision Diagnostics GmbHSpanish GovernmentEuropean Commission RYC-2016-21199 SAF2017-87526-RFEDER/Junta de Andalucia-Consejeria de Economia y Conocimiento: MENDO B-CTS-500-UGR18 Junta de Andalucia PAIDI P20_00158University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of ExcellenceUnit of Excellence on Exercise and Health (UCEES)Junta de Andalucia Consejeria de Conocimiento, Investigacion y UniversidadesEuropean Commission SOMM17/6107/UGRSpanish Government PRE2018085440 FPU19/01638 FPU15/01193Universidad de Granada/CBUA Sequence BioProject PRJNA64389

The AHAWOMEN project: study protocol of a multi‑design research for exploring HAPA predictors of exercise in postmenopausal women

This research is funded by FEDER/Junta de Andalucía — Consejería de Transformación Económica, Industria, Conocimiento y Universidades (I + D + I Programa Operativo FEDER de Andalucía 2014–2020). Research Project B-CTS-342-UGR20 (2021–23). This research project has obtained formal ethical review by the Ethics Committee on Human Research of the University of Granada (Spain), reg. B-CTS-342-UGR20 (17/11/2021) and has undergone independent peer-review from the funding body (29/07/2021). The funding body has no role in the design of the study, the collection, analysis and interpretation of data and the writing of the manuscript.Background The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions. Methods/design This study was approved by the authors’ Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated. Discussion This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women’s adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.FEDER/Junta de Andalucía B-CTS-342-UGR20University of Granada B-CTS-342-UGR2