BMC Women's Health[JOURNAL]
Sun
200 papers
Prostate-specific membrane antigen immunostaining in endometriosis: preliminary findings and a case of in vivo imaging with gallium-68 positron emission tomography/computed tomography.
Martyna M, Łukasz K, Michał C … +3 more , Kacper P, Magdalena B, Jolanta K
BMC Womens Health · 2026 Apr · PMID 42010619 · Full text
BACKGROUND: Endometriosis is a systemic, estrogen-dependent inflammatory disorder affecting approximately 10% of women of reproductive age and is even more common among those with chronic abdominal pain and infertility....
BACKGROUND: Endometriosis is a systemic, estrogen-dependent inflammatory disorder affecting approximately 10% of women of reproductive age and is even more common among those with chronic abdominal pain and infertility. Despite research advances, understanding its pathogenesis and distinguishing endometriotic cysts remain challenging. Prostate-specific membrane antigen (PSMA), traditionally used in the imaging and treatment of prostate cancer, has been detected in various benign and malignant conditions. This study evaluated PSMA expression in endometriosis tissues as a marker to differentiate ovarian endometriotic cysts from other cysts. METHODS: Formalin-fixed, paraffin-embedded tissue samples from 10 patients with histopathologically confirmed endometriosis who underwent surgery in 2023 were analyzed. Tissue sections were stained with hematoxylin and eosin, and immunohistochemical analysis was performed using an antibody against PSMA. PSMA expression was assessed in microvascular endothelial cells and non-endothelial cells using a semi-quantitative immunoreactivity scoring system. In addition, a case study involving Gallium-68-labeled PSMA positron emission tomography/computed tomography (PET/CT) imaging was conducted in one patient. RESULTS: PSMA immunostaining was positive in 28 of 33 endometriosis tissue samples. Notably, strong and diffuse PSMA expression was observed exclusively in the microvessels of ovarian endometriotic cyst capsules, with all 11 slides of this subtype demonstrating high vascular expression. In contrast, no PSMA expression was detected in other ovarian cyst types, such as follicular and corpus luteum cysts. Weak PSMA staining in non-endothelial cells was noted in 15 slides, primarily within endometrial glands in cases of scar endometriosis and in fallopian tubes. High vascular PSMA expression was unique to ovarian endometriosis among the three forms evaluated (scar, tubal, and ovarian). Two out of five uterine fibroid samples also exhibited high vascular PSMA expression, while the rest showed low expression. The PET/CT examination confirmed significant tracer accumulation in an ovarian endometriotic cyst. CONCLUSIONS: The study demonstrates that PSMA expression is predominantly localized to the microvessels of ovarian endometriotic cyst capsules, effectively distinguishing them from other ovarian cysts. The limited or absent PSMA staining in non-ovarian endometriosis supports its potential role as a diagnostic marker. These findings warrant further investigation into the utility of PSMA in imaging and possibly therapeutic targeting of ovarian endometriosis.
Effects of prehabilitation interventions on pelvic floor muscle outcomes in patients with gynecological cancers: a systematic review.
Umar L, Bappah BS, Gamawa AU … +5 more , Tafida BA, Mohammed S, Dahiru ZU, Tijjani AA, Bello UM
BMC Womens Health · 2026 Apr · PMID 42010611 · Full text
PURPOSE: Pelvic floor dysfunction (PFD) is a highly prevalent sequela of gynecological cancer therapy (surgery, radiotherapy, chemotherapy), severely impacting quality of life (QoL). This systematic review evaluates evid...
PURPOSE: Pelvic floor dysfunction (PFD) is a highly prevalent sequela of gynecological cancer therapy (surgery, radiotherapy, chemotherapy), severely impacting quality of life (QoL). This systematic review evaluates evidence on prehabilitation interventions initiated before or during primary cancer therapy for improving pelvic floor muscle (PFM) function, reducing PFD symptoms, and enhancing QoL. METHODS: Following PRISMA 2020 guidelines, we searched MEDLINE, EMBASE, CINAHL, AMED, and Web of Science (2010–2025) for randomized controlled trials, cohort, and quasi-experimental studies. The review was prospectively registered (PROSPERO CRD42024580658). Included studies involved gynecological cancer patients receiving structured prehabilitation reporting PFM outcomes, PFD symptoms, or QoL. Risk of bias was assessed using JBI tools and GRADE. RESULTS: Five heterogeneous studies (N = 255; endometrial, ovarian, cervical, uterine, vulvar cancers; mean age 42–66 years) were included. One comparative cohort study demonstrated improved postoperative recovery (6MWT: 404 m vs. 371 m, p < 0.001) and reduced complications (30% vs. 54%, p = 0.02). Uncontrolled studies showed potential benefits including improved lean mass (+ 1.0 kg, p = 0.015), reduced incontinence (urinary: 53.6%→46.4%; fecal: 39.3%→25.0%), and enhanced QoL domains, with adherence 52–98%. However, direct evidence for improved objective PFM strength remains lacking. Evidence quality was “very low” (GRADE) due to heterogeneity, uncontrolled designs, small samples, and moderate-to-high risk of bias. CONCLUSION: Prehabilitation is feasible but evidence is insufficient for definitive conclusions on pelvic-floor-specific efficacy. Findings are hypothesis-generating. High-quality RCTs with standardized PFD outcome measures are urgently needed. This review identifies critical knowledge gaps and provides recommendations for future research.
Integrated single-cell and spatial transcriptomics reveal divergent immunological and stromal programs in peritoneal versus ovarian endometriosis.
He F, Zu S, Lin Y … +2 more , Shi J, Lin S
BMC Womens Health · 2026 Apr · PMID 42010552 · Full text
BACKGROUND: Endometriosis encompasses heterogeneous lesions, primarily peritoneal and ovarian subtypes, with distinct immunological and fibrotic features. The subtype-specific roles of the immune microenvironment in path...
BACKGROUND: Endometriosis encompasses heterogeneous lesions, primarily peritoneal and ovarian subtypes, with distinct immunological and fibrotic features. The subtype-specific roles of the immune microenvironment in pathogenesis remain unclear. Integrated analysis combining high-resolution cellular atlases with spatial context is needed to decipher these mechanisms. METHODS: We performed an integrative analysis of published single-cell RNA sequencing (n = 81,676 cells) from control endometrium (Ctrl), eutopic endometrium (EuE), peritoneal endometriosis (EcP), and ovarian endometriosis (EcO), and spatial transcriptomic (n = 60 segments) data from Ecp and match EuE. Analytical pipelines include cellular atlas construction, differential expression, spatial co-expression, and cell-cell communication inference. RESULTS: Our single-cell atlas revealed fundamentally distinct cellular ecosystems. EcP was enriched for CCL19 + perivascular cells (6.4-fold vs. control) and immune-active niches, whereas EcO exhibited pronounced smooth muscle differentiation and NNMT upregulation. Spatial analysis compartmentalized these programs, with the CCL19-CCR7 chemokine axis localized to stromal niches in EcP strongly correlated (ρ = 0.872). In contrast, EcO showed enhanced smooth muscle gene expression (MYH11, log₂FC = 3.87). Cell-cell communication networks diverged, with EcP dominated by chemokine and TGF-β signaling, and EcO dominated by smooth muscle and PDGF pathways. Therapeutic target analysis revealed subtype-specific patterns: immune checkpoints (CTLA4 and PDCD1) were upregulated in EcP, whereas MMP9 was dramatically downregulated in EcO. CONCLUSION: EcP and EcO exhibit fundamentally divergent programs. We propose to conceptualize these as an ‘immune-hot’, chemokine-driven inflammatory niche (EcP) versus an ‘immune-cold’, fibromuscular survival niche (EcO). These findings underscore that lesion-specific immune-stromal crosstalk may dictates pathogenesis and suggest a potential paradigm shift toward immunologically-informed, subtype-specific precision therapeutics, which warrant further experimental validation.
Factors associated with suicidal ideation among unmarried Korean women in their twenties: a cross-sectional study.
Choe MH
BMC Womens Health · 2026 Apr · PMID 42002811 · Full text
BACKGROUND: Suicide among women in their twenties has emerged as an important public health concern in South Korea, yet empirical studies focusing specifically on this population remain limited both in South Korea and in...
BACKGROUND: Suicide among women in their twenties has emerged as an important public health concern in South Korea, yet empirical studies focusing specifically on this population remain limited both in South Korea and internationally. This study examined factors associated with suicidal ideation among unmarried Korean women in their twenties using a literature-informed exploratory framework that considered psychological distress and economic stress as potential risk correlates, and resilience, religion, and gender-related beliefs as potential protective or context-dependent correlates. METHODS: A cross-sectional descriptive survey was conducted using a structured online questionnaire. The participants consisted of 209 unmarried South Korean women in their twenties. Convenience sampling was used through online communities, and recruitment was monitored to obtain an approximately balanced distribution of participants with and without labor income. Measures included suicidal ideation, psychological distress, economic stress, gender sensitivity, and resilience. Hierarchical binary logistic regression was used to examine associations with suicidal ideation. Data were collected from October 2, 2023, to March 10, 2024, using a structured self-report online survey. RESULTS: Thirty participants (14.4%) reported suicidal ideation. In the final model, greater psychological distress, greater economic stress, and absence of religion were associated with higher odds of suicidal ideation, whereas higher benevolent sexism scores were associated with lower odds of suicidal ideation; the model explained 41.2% of the variance. CONCLUSIONS: Suicidal ideation among unmarried Korean women in their twenties appears to be associated with psychological, economic, sociocultural, and religious factors. These findings support the need for multifaceted prevention strategies that strengthen psychological support, reduce economic strain, and take into account the broader sociocultural context surrounding young women’s lives.
Effect of bisphosphonates on the risk of surgical site infection after anterior cervical discectomy and fusion (ACDF) in postmenopausal women with osteoporosis.
Zhang W, Zhou B, Chen C … +8 more , Feng D, Zhang J, Li Z, Liang J, Huang S, Dai Z, Luo C, Wei J
BMC Womens Health · 2026 Apr · PMID 42001088 · Full text
OBJECTIVE: To investigate the effect of bisphosphonates on surgical site infection (SSI) and their safety in postmenopausal women undergoing Anterior Cervical Discectomy and Fusion (ACDF). METHODS: This was a single-cent...
OBJECTIVE: To investigate the effect of bisphosphonates on surgical site infection (SSI) and their safety in postmenopausal women undergoing Anterior Cervical Discectomy and Fusion (ACDF). METHODS: This was a single-center retrospective cohort study analyzing female patients who underwent ACDF from the hospital database between 2016 and 2024. All surgeries were performed by certified spine surgeons. The primary outcome was surgical site infection (SSI) within 30 days postoperatively (or within 90 days if implants were present). Patients were divided into a group receiving intravenous zoledronic acid (medication group, the median postoperative day for the first intravenous infusion of zoledronic acid (5 mg) being Day 2 (IQR: 1–3)) and a non-medication group based on postoperative bisphosphonate use. Propensity score matching was used to balance baseline characteristics. Binary logistic regression analysis was employed to identify factors associated with SSI. RESULTS: Among 987 eligible patients, 224 were in the bisphosphonate group and 763 were in the non-bisphosphonate group. The incidence of SSI was lower in the intravenous zoledronic acid group (2.2% vs. 7.5%). After propensity score matching (221 medication users vs. 412 non-users), all baseline variables were well balanced (absolute standardized mean differences all < 0.1). Logistic regression analysis in the matched cohort showed that intravenous zoledronic acid use was an independent protective factor against SSI (adjusted odds ratio [aOR] = 0.136, 95% CI: 0.048–0.384, P < 0.001), while smoking was a risk factor (aOR = 3.856, 95% CI: 1.153–12.900, P = 0.028). There was no significant difference in adverse events between the two groups. CONCLUSION: In postmenopausal osteoporotic women undergoing ACDF, postoperative bisphosphonate use was significantly associated with a reduced risk of surgical site infection and did not increase short-term adverse events.
The association of fungal infection in cervical cancer: a systematic review and meta-analysis.
Wu Y, Zhang Y, Qian X … +1 more , Li Y
BMC Womens Health · 2026 Apr · PMID 41992269 · Full text
BACKGROUND: Emerging evidence suggests a potential link between the fungal mycobiome and carcinogenesis. However, the relationship between fungal infection and cervical cancer progression remains inconclusive. This meta-...
BACKGROUND: Emerging evidence suggests a potential link between the fungal mycobiome and carcinogenesis. However, the relationship between fungal infection and cervical cancer progression remains inconclusive. This meta-analysis aimed to determine the pooled prevalence of fungal infection across different cervical pathological stages and assess its association with cervical lesions and HPV infection. PROSPERO CRD42024588513 is the registration number for the systematic review. METHODS: We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. We systematically searched PubMed, Web of Science, and Embase for studies published between January 1, 2004, and December 1, 2025. Observational studies (cross-sectional, case-control, cohort) with sample sizes ≥ 100 were included. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale. Pooled prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models in STATA. RESULTS: Seventeen studies involving 97,382 patients with cervical lesions and 450,724 controls were included. The overall pooled prevalence of fungal infection was significantly higher in cervical cancer patients (19%, 95% CI: 0.07-0.30) compared to non-cancer patients (8%, 95% CI: 0.06-0.10). In patients with precancerous lesions (CIN1, CIN2/3), the fungal infection rate was similar to that in normal controls (NILM). Subgroup analysis among non-NILM patients revealed a higher risk of fungal infection in HPV-positive individuals than in HPV-negative individuals (OR = 1.39, 95% CI: 1.07-1.81). Meta-regression identified geographic region (Europe) as a significant source of heterogeneity. CONCLUSIONS: Fungal infection was more prevalent in invasive cervical cancer than in precancerous lesions or normal cervix, suggesting a potential association with late-stage carcinogenesis rather than early initiation. The observed association between fungal infection and HPV-positive status warrants further investigation. These findings highlight the need for prospective studies to clarify the role of the cervical mycobiome in cervical cancer progression.
Association of exposure to organophosphate pesticides with reproductive lifespan.
Zhou X, Yu W, Xie J … +5 more , Huang S, Zhan Y, Cao L, Chen X, Li X
BMC Womens Health · 2026 Apr · PMID 41981623 · Full text
BACKGROUND: Organophosphate pesticides (OPs) have been found to have reproductive toxicity with overt endocrine disruption potential, yet the relationships between OPs with reproductive lifespan remain unexplored. OBJECT...
BACKGROUND: Organophosphate pesticides (OPs) have been found to have reproductive toxicity with overt endocrine disruption potential, yet the relationships between OPs with reproductive lifespan remain unexplored. OBJECTIVE: We aimed to investigate associations between urinary OP concentrations with reproductive lifespan. METHOD: This study included 1,356 postmenopausal women who participated in the National Health and Nutrition Examination Survey from 1999 to 2018 to evaluate the relationship between OP exposure and reproductive lifespan. Urine was analysed using gas chromatography coupled with mass spectrometry for concentrations of six dialkyl phosphate (DAP) metabolites of OPs. RESULT: Multivariate linear regression and Bayesian kernel machine regression (BKMR) models revealed that total urinary DAP metabolite concentrations (β = 0.10, 95% CI: 0.03–0.17, p = 0.006) were positively associated with age at menopause. Urinary dimethyl phosphate (DMP) concentration was positively associated with age at menopause (β = 0.67, 95% CI: 0.30–1.03, p = 0.001) and reproductive lifespan (β = 0.64, 95% CI: 0.26–1.02, p = 0.001). Furthermore, BKMR and weighted quantile sum models identified DMP as the primary risk contributor amongst the six detected DAP metabolites (weight = 0.573 for age at menopause and weight = 0.634 for reproductive lifespan). CONCLUSION: For the mixed analysis, the overall exposure to DAP metabolites was associated with delayed age at menopause. For the individual analysis, DMP exposure was associated with delayed age at menopause and longer reproductive lifespan, and DMP was identified as the major risk factor amongst the six detected DAP metabolites. Future research should prioritise DMP to further elucidate impacts of OPs exposure on female reproductive health.
Isolated axillary metastasis from early-stage dMMR endometrial carcinoma: a case report and mini-review.
Yu Y, Chang X, Hou X … +1 more , Zhang F
BMC Womens Health · 2026 Apr · PMID 41981588 · Full text
INTRODUCTION: Axillary lymph node metastasis (ALNM) from endometrial carcinoma is extremely rare, particularly in tumors with early-stage, endometrioid histology. The clinical characteristics, underlying mechanisms, and...
INTRODUCTION: Axillary lymph node metastasis (ALNM) from endometrial carcinoma is extremely rare, particularly in tumors with early-stage, endometrioid histology. The clinical characteristics, underlying mechanisms, and optimal management strategies for this rare metastatic pattern remain insufficiently defined. CASE PRESENTATION: We report a case of a 63-year-old woman diagnosed with FIGO 2023 stage IIB, grade 2 endometrioid endometrial carcinoma exhibiting mismatch repair deficiency (dMMR) and substantial lymphovascular space invasion (LVSI). She underwent surgery followed by adjuvant pelvic radiotherapy and vaginal brachytherapy. Approximately one year later, the patient developed isolated right axillary lymphadenopathy. Histopathological and immunohistochemical analyses confirmed metastatic endometrioid adenocarcinoma of uterine origin. The patient was treated with tislelizumab and lenvatinib but experienced progressive disease, with enlarging axillary nodes and new chest wall involvement. Salvage radiotherapy with a simultaneous integrated boost was administered and achieved tumor regression. A focused review of previously reported cases of axillary lymph node metastasis from endometrial carcinoma was conducted to summarize clinicopathologic features and treatment approaches. CONCLUSION: This case highlights an unusual metastatic pattern of endometrial cancer and underscores the need for individualized risk stratification, long-term surveillance, and timely integration of local therapy when systemic treatment proves insufficient.
Beyond the placebo effect: a systematic review and a network meta-analysis of treatment strategies for vulvodynia.
Spinillo A, Dominoni M, Tiranini L … +3 more , Cassani C, Nappi RE, Gardella B
BMC Womens Health · 2026 Apr · PMID 41975391 · Full text
BACKGROUND: To comprehensively evaluate the comparative and absolute effectiveness of available treatments for vulvodynia on pain and sexual function outcomes through network meta-analysis (NMA). METHODS: Systematic sear...
BACKGROUND: To comprehensively evaluate the comparative and absolute effectiveness of available treatments for vulvodynia on pain and sexual function outcomes through network meta-analysis (NMA). METHODS: Systematic searches extracted data from randomized controlled trials (blinded or unblinded) evaluating pharmacological and non-pharmacological treatments in women with vulvodynia, from inception through September 2025. Of 40 studies assessed for eligibility, 34 studies involving 1,893 participants were included in the final analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2 tool.Confidence in network meta-analysis results was evaluated using the Confidence in Network Meta-analysis (CINeMA) framework. RESULTS: Pain and sexual function outcomes were rescaled to percentage of maximum possible score (POMP, 0–100 scale) to enable pooling across heterogeneous measurement instruments. Both relative treatment effects (comparing interventions to placebo/no treatment) and absolute effects (pre-post changes) were evaluated using Bayesian NMA. Ten treatment categories were analysed: acupuncture, botulinum toxin, topical anaesthetics, topical non-anaesthetics, multimodal/physical therapy, psychological approaches, surgery, tissue-based therapies (photobiomodulation, low-level laser, vaginal transcutaneous electrical nerve stimulation, shockwave therapy), placebo, and no treatment. For pain immediately post-therapy (33 studies, 1,873 women), tissue-based therapies demonstrated superior efficacy compared to placebo in both NMA (POMP difference: -16.1, 95% CI: -24.1, -7.9, mixed evidence, moderate confidence), and pairwise meta-analyses (POMP difference: -20.2, 95% CI: -28.6, -11.7, I2 = 77%) and ranking highest in surface under the cumulative ranking curve (SUCRA) analysis (85.2%). Pharmacological interventions showed no superiority over placebo. Compared to no treatment, multimodal-physical therapy (POMP: -25.3, 95% CI: -40.8, -9.7, mixed evidence, low confidence), acupuncture (POMP: -25.6, 95% CI: -43.4, -8.1, mixed evidence, moderate confidence), and psychological approaches (POMP -27.4, 95% CI: -44.6, -10.3, indirect evidence, low confidence) all demonstrated moderate-to-high pain reduction. At 3–6 months follow-up (16 studies, 1,106 women), tissue-based treatments remained the only therapy significantly superior to placebo (POMP: -24.5, 95% CI: -42.2, -6.7, mixed evidence, moderate confidence; SUCRA = 77.9%). In absolute effects analysis, placebo produced significant pain reduction (Absolute effect: -13.7, 95% CI: -18.3, -9.3 immediately; -11.7, 95% CI: -17.7, -6.0 at 3–6 months), with confidence intervals overlapping all treatments except tissue-based therapies (Absolute effect: -28, 95% CI: -33.4, -21.7 immediately; -31.6, 95% CI: -43.9, -19.1 at follow-up). Placebo had no effect on sexual function improvement (14 studies, 942 women), (Absolute effect: 2.5, 95% CI: -8., 12.9). At 3–6 months of follow-up (8 studies, 429 women), psychological-based treatments, when added to multimodal treatment (POMP = 9.0, 95% CI = 1.8, 16.7, I2 = 41.6%), improved modestly sexual functioning. CONCLUSIONS: In NMA, tissue-based therapies were the most effective treatment for vulvodynia-associated pain, achieving reductions that clearly exceeded placebo effects with moderate evidence quality. Commonly prescribed pharmacological interventions lack robust evidence of superiority over placebo. Multimodal approaches combined with psychological interventions show promise, particularly for sexual function recovery.
Multiple endocrine dysfunctions in twins with Wilson's disease: two case reports Deng et al. endocrine dysfunctions in Wilson's disease.
Deng HR, Lin SY, Zhang FY … +3 more , Yan JH, Li XH, Yang XB
BMC Womens Health · 2026 Apr · PMID 41975374 · Full text
Wilson’s disease (WD) is a rare disorder characterized by abnormal copper metabolism, which could induce endocrine dysfunctions. Here, we report two cases of twins with both WD and multiple endocrine dysfunctions, includ...
Wilson’s disease (WD) is a rare disorder characterized by abnormal copper metabolism, which could induce endocrine dysfunctions. Here, we report two cases of twins with both WD and multiple endocrine dysfunctions, including one twin with primary hypothyroidism and polycystic ovary syndrome, and the other with serious hepatic dysfunction and hypopituitarism.
The connection between nutrition education, behavior, and body composition in women following the Mediterranean diet: a sustainable approach.
Kahve AN, Horzum SB, Kangalgil M
BMC Womens Health · 2026 Apr · PMID 41975354 · Full text
BACKGROUND: This study aimed to examine the relationship between sustainable healthy eating behaviors and body composition in women who received sustainable nutrition education. METHODS: The study was conducted with wome...
BACKGROUND: This study aimed to examine the relationship between sustainable healthy eating behaviors and body composition in women who received sustainable nutrition education. METHODS: The study was conducted with women aged 20–49 years attending a Nutrition and Diet Counseling Center. Participants were randomly assigned to either an intervention group, which participated in an 8-week sustainable nutrition education program delivered biweekly by a dietitian face-to-face, or a control group, which received traditional nutrition education throughout the study. Demographic data were collected at the beginning of the study. The Sustainable Eating Behavior Scale, which assesses sustainable eating behaviors, was collected at the beginning of the study and again at the end of the 8-week period, while anthropometric measurements were taken at the beginning and in the 4th and 8th weeks. RESULTS: There is no statistical difference between the demographic and clinical characteristics of the two groups (p > 0.05). Significant decreases in weight, Body Mass Index, percent body fat, body fat mass, body muscle mass, and waist circumference were observed within the intervention and control groups over time (p < 0.001). The intervention group experienced greater mean decreases in weight, BMI, percent body fat, body fat mass, and waist circumference compared to the control group during the intervention period. Group-time interaction effects were found to be significant for body weight (F = 3.723, p = 0.027, η²=0.058) and BMI (F = 3.492, p = 0.034, η²=0.055). CONCLUSION: These results suggest that sustainable nutrition education can positively contribute to both sustainable eating behaviors and anthropometric parameters, highlighting its potential value in promoting healthier and more environmentally friendly dietary patterns. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (Registration number: NCT07247578, Registered on 15 November 2025). URL: https://clinicaltrials.gov/study/NCT07247578 .
"Self-burning is the only way to show how painful women's lives are". A qualitative study of the social context of suicidal self-burning among Iraqi Kurdish women.
Ahmed DR, Ahmed JO, Kakamad KK … +3 more , Rahim TJ, HamahAmeen NR, Heun R
BMC Womens Health · 2026 Apr · PMID 41975346 · Full text
BACKGROUND: This study aimed to understand suicidal self-burning among Iraqi Kurdish women in Iraq by exploring survivors’ motivations, cultural and social influences, community attitudes, and the structural conditions t...
BACKGROUND: This study aimed to understand suicidal self-burning among Iraqi Kurdish women in Iraq by exploring survivors’ motivations, cultural and social influences, community attitudes, and the structural conditions that sustain this phenomenon. METHODS: A study was conducted in the Kurdistan region of Iraq between November 2024 and February 2025. Thirteen interviews were conducted with female suicidal self-burning survivors, and six focus groups were held with 36 family and community informants (i.e., religious leaders, community police, healthcare professionals, community members, and civil society representatives). These data were analysed thematically. RESULTS: Six interconnected themes were identified. (1) Context, meanings, and reasons for Iraqi Kurdish women’s suicidal self-burning: Suicidal self-burning most often occurred in private areas of the home. Survivors described the act as a cry for help and a means of communicating unbearable psychological pain, frequently arising from abuse within the family and community, including forced marriage. (2) Why Iraqi Kurdish women choose self-burning over other suicide methods: Survivors cited accessibility, cultural familiarity, and the symbolic power of fire as key reasons for selecting self-burning over other suicide methods. (3) Historical, cultural, religious, and social roots of Iraqi Kurdish women’s suicidal self-burning: Most informants said that religion, cultural traditions, generational narratives, and media coverage normalize female suicidal self-burning. (4) Community and family responses to Iraqi Kurdish women’s suicidal self-burning: Survivors and their families encountered mixed reactions, including emotional support, stigma, social exclusion, and religious condemnation. (5) Violations of human rights as social determinants of Iraqi Kurdish women’s suicidal self-burning: Survivors and informants identified violations of women’s human rights, particularly systemic inequalities at the disadvantage of women and male violence against women, as drivers of female suicidal self-burning. (6) Access to support and the prevention of Iraqi Kurdish women’s suicidal self-burning: Survivors reported substantial barriers to accessing mental health and social services while informants emphasised that prevention requires comprehensive educational, legal, and economic reforms and psychosocial interventions. CONCLUSIONS: Suicidal self-burning by Iraqi Kurdish women is an act of despair and a culturally shaped protest against structural injustices. The prevention of female suicidal self-burning requires multilayered strategies based on a human rights approach, including systemic (e.g. cultural, legal, policy) changes to eliminate female-male inequalities. It also requires improving women’s access to mental health services.
Unraveling the fibrotic microenvironment in intrauterine adhesions through integrated metabolomics and proteomics.
He S, Yuan H, Zhao X … +3 more , Peng E, Xu D, Zhang A
BMC Womens Health · 2026 Apr · PMID 41965617 · Full text
BACKGROUND: Intrauterine adhesions (IUA) result from endometrial basal layer injury, leading to fibrous tissue formation and impaired fertility. Current treatments fail to fully reverse the fibrotic microenvironment. Thi...
BACKGROUND: Intrauterine adhesions (IUA) result from endometrial basal layer injury, leading to fibrous tissue formation and impaired fertility. Current treatments fail to fully reverse the fibrotic microenvironment. This study aimed to elucidate molecular mechanisms underlying IUA-associated fibrosis through integrated metabolomics and proteomics. METHODS: Fibrotic tissues from 35 moderate-to-severe IUA patients and normal endometrial samples from 20 controls were collected during hysteroscopy. Metabolomic profiling was performed using UPLC-MS, and proteomic analysis using label-free quantitative mass spectrometry. Differential metabolites (DEMs) and proteins (DEPs) were identified via OPLS-DA and statistical criteria (VIP > 1, P < 0.05 for DEMs; FDR-adjusted P < 0.05, FC ≥ 2 or ≤ 0.5 for DEPs). KEGG enrichment and integrated correlation analyses were conducted to explore pathway alterations and metabolite-protein interactions. RESULTS: A total of 565 DEMs were identified, primarily lipids, organic acids, and organooxygen compounds. KEGG enrichment revealed significant alterations in carbohydrate and amino acid metabolism pathways, with downregulation of TCA cycle intermediates and upregulation of glucose-6-phosphate, arginine, and methionine sulfoxide. Proteomics identified 2763 DEPs, with up-regulated proteins enriched in focal adhesion and ECM-receptor interaction pathways, and down-regulated proteins in DNA replication and complement cascades. Integrative analysis showed that carbohydrate and amino acid metabolism-related DEMs correlated negatively with fibrosis-related DEPs (e.g., collagens, TGF-β-related proteins), while focal adhesion-related DEPs correlated positively with fibrosis markers. Notably, fumarate showed strong negative correlations with COL18A1 (r=-0.71) and positive correlation with E-cadherin (r = 0.61). CONCLUSIONS: This multi-omics study reveals that metabolic reprogramming, particularly involving glycolysis and amino acid metabolism, is closely associated with activation of the integrin-focal adhesion signaling pathway in IUA fibrosis. These findings provide new insights into potential therapeutic targets for endometrial repair and fertility preservation.
Serum 25-hydroxyvitamin D levels among women newly diagnosed with breast cancer at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
Meles M, Gutema G, Tsegaye M … +10 more , Bashea C, Challa F, Bikila D, Gebremicael G, Getahun T, Habtu W, Alem M, Edao A, Carobene A, Tola HH
BMC Womens Health · 2026 Apr · PMID 41965576 · Full text
BACKGROUND: Breast cancer (BC) is among the most frequently diagnosed cancers in women, accounting for approximately one in ten new cancer cases annually. The relationship between vitamin D status and BC risk remains unc...
BACKGROUND: Breast cancer (BC) is among the most frequently diagnosed cancers in women, accounting for approximately one in ten new cancer cases annually. The relationship between vitamin D status and BC risk remains unclear; while some observational studies suggest an association, others show no link, and causality is unproven. However, data from sub-Saharan Africa, and specifically Ethiopia, are scarce. This study aimed to assess serum 25-hydroxyvitamin D [25(OH)D] levels in Ethiopian women newly diagnosed with BC compared to healthy controls. METHODS: A comparative cross-sectional study was conducted from January to March 2024 at Tikur Anbessa Specialized Hospital, Addis Ababa. Sixty-nine women with newly diagnosed BC and sixty-nine healthy controls were enrolled. Serum 25(OH)D concentrations were measured via electrochemiluminescence immunoassay. Data analysis was performed with SPSS v20. Median differences were evaluated using the Mann–Whitney U test with Hodges–Lehmann estimates and 95% confidence intervals (CI). Logistic regression identified factors associated with BC, and sensitivity analyses were conducted using alternative clinical cut-offs for severe vitamin D deficiency (SVDD). RESULTS: Vitamin D deficiency was prevalent in both groups; however, SVDD (< 10 ng/mL) was significantly more prevalent among BC patients than among controls (26.1% vs. 7.2%, p = 0.006). A significant median difference in 25(OH) D levels was observed between cases and controls (median difference: 2.1 ng/mL; 95% CI: 0.07–4.4; p = 0.043). Serum 25(OH)D levels were also significantly lower in stage IV BC compared with controls and stage I. SVDD was independently associated with BC (adjusted odds ratio = 7.1; 95% CI: 1.7–30.1), and this association remained robust when alternative clinical cut-offs were applied. Reduced sunlight exposure and overweight/obesity were also independently associated with BC. CONCLUSION: SVDD and higher Body Mass Index were significantly associated with BC status. Lower 25(OH)D levels are most pronounced in metastatic (Stage IV) disease. While reduced sunlight exposure was also associated with BC, the direction of these relationships cannot be determined with certainty. These findings highlight an association that warrants further investigation. Further prospective studies with pre-diagnostic 25(OH)D measurements are needed to clarify causality and to determine whether strategies to address VDD may contribute to BC risk reduction.
Female sexual function, urinary incontinence, and sexual position use 5 years after bariatric surgery: a prospective cohort study.
Sternau M, Czajkowski M, Błaczkowska A … +2 more , Proczko-Stepaniak M, Matuszewski M
BMC Womens Health · 2026 Apr · PMID 41965573 · Full text
BACKGROUND: Female sexual dysfunction and urinary incontinence are common among women with obesity. Bariatric surgery may improve sexual health, but long-term data are limited, and evidence on the use of sexual positions...
BACKGROUND: Female sexual dysfunction and urinary incontinence are common among women with obesity. Bariatric surgery may improve sexual health, but long-term data are limited, and evidence on the use of sexual positions is lacking. We prospectively assessed female sexual function, urinary incontinence, and selected sexual positions before and 5 years after bariatric surgery. METHODS: In this single-centre prospective cohort study, women who underwent bariatric surgery completed the Female Sexual Function Index (FSFI) and the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF) preoperatively and at the 5-year follow-up. A study-specific questionnaire was used to assess the frequency and perceived pleasure of eight predefined coital positions. Paired comparisons were performed using the Wilcoxon signed-rank and exact McNemar tests. Predictors of changes in total FSFI (ΔFSFI) were examined using robust linear regression. RESULTS: Seventy women were enrolled in this study, and a total of 40 patients provided paired baseline and 5-year data. The mean age at the time of surgery was 39.8 years, and the mean body mass index (BMI) decreased from 39.1 to 30.7 kg/m². The proportion of patients who met the study definition of urinary incontinence decreased from 67.5% to 37.5% (p = 0.004). The total FSFI score increased modestly from 25.83 ± 7.96 to 27.16 ± 7.38, but the change was not statistically significant (p = 0.107), and no FSFI domain showed a significant within-subject change. In exploratory regression analyses, a lower baseline FSFI and a lower postoperative body mass index were associated with greater improvement in the FSFI. In the correlation analysis, urinary incontinence severity showed a negative association with the FSFI score, but did not reach statistical significance. Sexual position frequency and pleasure ratings were largely stable over time, with no significant changes in any position. CONCLUSIONS: Five years after bariatric surgery, overall FSFI scores showed only modest, nonsignificant improvement. Urinary incontinence improved, but the negative correlation with FSFI scores was not significant. Women with poorer baseline sexual function and lower postoperative body mass index appeared more likely to experience improvement. These findings should be interpreted in light of the modest sample size and the substantial loss to follow-up.
Women's experiences with diagnosis and management of vaginal symptoms of menopause: a mixed-methods study.
Li FG, Street DJ, Deans R … +3 more , De Abreu Lourenco R, Abbott J, Church J
BMC Womens Health · 2026 Apr · PMID 41963957 · Full text
BACKGROUND: Vaginal symptoms associated with menopause affect around 50% of women. Although the multi-factorial impact of vaginal symptoms has been well explored, experience of management and treatment preferences are po...
BACKGROUND: Vaginal symptoms associated with menopause affect around 50% of women. Although the multi-factorial impact of vaginal symptoms has been well explored, experience of management and treatment preferences are poorly understood. METHODS: A mixed-methods study was conducted in Australia to explore patient attitudes and experience related to the recognition and management of vaginal symptoms associated with menopause. In part 1, symptomatic post-menopausal women were recruited from hospital clinics and by word-of-mouth. Semi-structured interviews were conducted, transcribed, and coded by two researchers independently using a reflexive thematic analysis guided by interpretative phenomenological approach. In part 2, a quantitative online survey investigating attitudes towards care-seeking and management of vaginal symptoms associated with menopause in symptomatic or previously symptomatic, peri- or post-menopausal women was conducted. This study provides the context for a separate DCE investigating patient treatment preferences for this condition. RESULTS: Data were collected from 7 semi-structured interview participants (February-September 2023) and 578 survey respondents (April-May 2024). We identified considerable variation in experience of vaginal symptoms between interview participants. Core themes were extracted from the semi-structured interviews: recognition and attitudes towards vaginal symptoms, impact of symptoms, healthcare experience, and treatment of vaginal symptoms. Although bothersome vaginal symptoms were reported by 194/349 (56%) respondents, they were less frequently reported as a respondent’s most bothersome symptom compared to other menopausal symptoms, ranked by respondents in their top three most bothersome symptoms by 83/349 (24%). Whilst 320/349 (92%) of symptomatic respondents were aware of treatments for vaginal symptoms associated with menopause, only 182/349 (52%) had tried any treatment, and 159/349 (46%) had presented to a health practitioner for this indication. There was no significant difference in rates of previous treatment or consultation with healthcare practitioner, whether vaginal symptoms were ranked in a respondent’s top three most bothersome symptoms or not. CONCLUSIONS: Impact and experience of vaginal symptoms associated with menopause is variable between individuals, necessitating personalised care. Relative bother of vaginal symptoms is not associated with rates of treatment or presentation to a healthcare practitioner for this condition and suggests other factors may influence engagement with care. Understanding patient preferences in management and treatment of vaginal symptoms associated with menopause is essential to guiding clinical practice and health funding in improving delivery of menopause care.
Rural female veterans' experiences of VA care and a VA telehealth outreach program.
Zamora-Rogoski KA, McLean CL, Jacob M … +2 more , Stacker T, Cohen J
BMC Womens Health · 2026 Apr · PMID 41963942 · Full text
BACKGROUND: Female U.S. military veterans are the fastest growing segment of Veteran’s Health Affairs (VA) users, comprising 11.3% of veterans in 2023, and this number is projected to grow to 17.2% of veterans by 2043. W...
BACKGROUND: Female U.S. military veterans are the fastest growing segment of Veteran’s Health Affairs (VA) users, comprising 11.3% of veterans in 2023, and this number is projected to grow to 17.2% of veterans by 2043. While improving access to care for female veterans is a VA priority, female veterans still underutilize healthcare services relative to male veterans. Issues related to accessing appropriate female-specific healthcare services are often amplified among those who reside in rural communities. In this qualitative study, we examine perceptions and experiences of VA care among rural female veterans, views of a pilot VA clinician-delivered telehealth outreach program for female veterans aimed at using a tailored approach to bridging gaps in care, and recommendations for VA programming. METHODS: We conducted this qualitative analysis as part of a larger quality improvement project evaluating a clinician-delivered telehealth outreach program, called the Boost Program, aimed at improving access to and engagement with VA services among rural female veterans. We conducted 30-minute virtual semi-structured interviews and used a rapid qualitative analysis approach developed for health services research settings to analyze and synthesize data. RESULTS: Three primary themes emerged: (1) veterans described how the landscape of female-specific healthcare has expanded at the VA in recent decades, but still has a long way to go; (2) veterans valued the way the Boost Program outreach calls communicate to them that the VA cares about them and their unique needs, both as female veterans and as rural veterans; and (3) the Boost Program outreach call works against the perception that the VA does not offer female-specific healthcare services. CONCLUSIONS: Our findings highlighted multiple areas in which services for rural female veterans can be further enriched. Future studies will examine how clinician-delivered outreach impacts utilization of specialty care among rural female veterans as well as how the Boost outreach model can be scaled nationally across the VA.
Comparative effectiveness of two hysteroscopic fixation techniques (suture vs. GyneFix anchor) for levonorgestrel-releasing intrauterine system: a retrospective study.
Wang J, Yang Z, Wang Y … +2 more , Gu J, Li X
BMC Womens Health · 2026 Apr · PMID 41963908 · Full text
BACKGROUNDS: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment for adenomyosis; however, its therapeutic benefits are frequently limited by a high expulsion risk. This study aimed to co...
BACKGROUNDS: The levonorgestrel-releasing intrauterine system (LNG-IUS) is an effective treatment for adenomyosis; however, its therapeutic benefits are frequently limited by a high expulsion risk. This study aimed to compare the safety and efficacy of two hysteroscopic fixation techniques in patients at high risk for LNG-IUS expulsion. METHODS: This retrospective cohort study included 42 adenomyosis patients with an increased expulsion risk, underwent hysteroscopic LNG-IUS fixation between 2023 and 2025. The primary outcome was the rate of expulsion at 3 months postoperatively. Data were analyzed using the Shapiro-Wilk test, with between-group comparisons performed via the t-test, χ² test, or Fisher’s exact test as appropriate. RESULTS: According to the surgical technique used, patients were allocated to either the suture fixation group (n = 20) or the anchor fixation group (n = 22). No statistically significant differences in baseline characteristics were detected between the two groups. At three months postoperative, the expulsion rate was 10.0% (2/20) in the suture group and 9.1% (2/22) in the anchor group, showing no statistically detectable difference within the limits of the sample. Both groups demonstrated significant improvements in dysmenorrhea (suture group: P = 0.0001; anchor group: P = 0.006). Operative time was significantly shorter in the anchor fixation group(P = 0.04). CONCLUSION: In this exploratory cohort of patients with adenomyosis at high risk of LNG-IUS expulsion, both hysteroscopic fixation techniques were associated with low early expulsion rates and clinically meaningful relief of dysmenorrhea. However, due to the small sample size and exploratory nature of this study, these findings should be considered preliminary. Although no statistically significant difference in expulsion rates was observed between the two methods, the anchor technique demonstrated a procedural advantage in terms of shorter operative time.
Women's empowerment and health facility utilization during childbirth in Cameroon.
Totouom A, Djal-Gadom G
BMC Womens Health · 2026 Apr · PMID 41963894 · Full text
Low levels of women’s empowerment probably constitute a key obstacle to healthcare utilization in Africa, given the importance of gender inequalities in this region. However, evidence on the relationship between women’s...
Low levels of women’s empowerment probably constitute a key obstacle to healthcare utilization in Africa, given the importance of gender inequalities in this region. However, evidence on the relationship between women’s empowerment and facility delivery in Cameroon is scarce. This paper examines the link between women’s empowerment and health facility childbirth in Cameroon. For empirical analysis, we used a sample of nationally representative data from the fifth Cameroon Demographic and Health Survey. The study demonstrates that women’s intra-household decision-making power, high women’s economic status and human capital, and opposing attitudes toward wife beating are associated with a higher probability of using health facilities during childbirth. This result remained when we accounted for the endogeneity of empowerment measures in our analysis. Relevant policy implications are discussed in the paper.
The effect of estrogen and its receptors on the progression of cervical intraepithelial neoplasia in postmenopausal women through synergistic interaction with HPV.
Liu H, He Y, Geng W … +4 more , Huang Y, Gao H, Zhai Y, Wang Z
BMC Womens Health · 2026 Apr · PMID 41957783 · Full text
OBJECTIVE: To observe the progression of cervical intraepithelial neoplasia (CIN) in Human papillomavirus (HPV)-positive women receiving vaginal local estrogen therapy during the postmenopausal window period versus the n...
OBJECTIVE: To observe the progression of cervical intraepithelial neoplasia (CIN) in Human papillomavirus (HPV)-positive women receiving vaginal local estrogen therapy during the postmenopausal window period versus the non-window period, and to analyze differences in CIN progression across different stages of menopause. To compare differences in estrogen receptor (ER) expression across different postmenopausal stages and during the progression of CIN. To clarify that the use of local estrogen in postmenopausal women requires careful evaluation of benefits versus risks to avoid indiscriminate medication. To provide scientific evidence for clinical decision-making regarding estrogen use at different postmenopausal stages and for the prevention and control of CIN. METHODS: The study population consisted of postmenopausal women who were HPV-positive and had a first-time colposcopy diagnosis of cervicitis or CIN1. Follow-up examinations were conducted 6 months to 2 years later, with local vaginal estrogen application prior to follow-up. Participants were divided into a “window period” group and a “non-window period” group based on the timing of menopause, and colposcopy results were recorded and compared between the two groups. Additionally, normal cervical epithelial tissue samples were independently collected from both time periods. Cervical tissue samples from cases of cervicitis, CIN1, CIN2, and CIN3 were collected and categorized into cervicitis/CIN1 and CIN2/CIN3 groups. All specimens underwent ER immunohistochemistry, and differences in ER expression were compared across groups. RESULTS: The window-period group included 44 participants, and the non-window-period group included 41 participants. Follow-up results showed that 7 patients (15.9%) in the window period group had CIN2 or higher, while 15 patients (36.6%) in the non-window period group had CIN2 or higher. Compared with the window period group, the progression rate was significantly higher in the non-window period group, with a statistically significant difference (P < 0.05). Ten cervical tissue samples were collected from each of the window period and non-window period groups, for a total of 20 samples. There were 5 cases each in the cervical inflammation, CIN1, CIN2, and CIN3 groups, totaling 20 cases. Immunohistochemical results indicated that ER levels in cervical epithelium were significantly higher in the window period group than in the non-window period group, with a statistically significant difference (P < 0.05). ER levels decreased significantly during the progression from cervical inflammation/CIN1 to CIN2/CIN3, and the difference was statistically significant (P < 0.05). CONCLUSION: Estrogen and its receptors interact synergistically with HPV to influence CIN progression; compared to the window period, estrogen use during the non-window period may further accelerate CIN progression.
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