Original research publications

Background: Women who are incarcerated (WI) face a disproportionately high prevalence of exposure to potentially traumatic events (PTEs) and related posttraumatic stress disorder (PTSD) symptoms. However, there remains a deficit of low-barrier, evidence-based, trauma-focused interventions for this highly vulnerable population. Aim: This study sought to determine the feasibility and preliminary effects of Narrative Exposure Therapy (NET) on PTSD and co-occurring mental health symptoms in WI across multiple correctional settings. Methods: We conducted a pilot study of NET across three women's correctional facilities. Feasibility was operationalized via protocol completion rates. We used linear effects modelling and Cohen's d to analyse pre- to post-NET changes and strength in effects in primary (PTSD, PCL-5) and secondary outcomes (depressive symptoms, PHQ-9; anxiety, GAD-7; somatization, SSS-8). Results: Thirty-eight women completed the intervention. Feasibility was demonstrated by an 86% NET intervention and assessment completion rate. Significant symptom reductions were observed in all measured symptom domains one-week post-NET. NET resulted in large effect size in reducing PTSD symptoms (PCL-5 = 21.8 points, d = 1.11) and depressive symptoms (PHQ-9 = 5.4 points, d = .92), and medium effect sizes in reducing anxiety (GAD-7 = 4.0 points, d = .68). Conclusion: NET appears to be a highly feasible and preliminarily beneficial intervention for reducing PTSD and co-occurring mental health symptoms in WI. These findings suggest the utility of NET in correctional contexts. A fully powered, randomized controlled trial is warranted to definitively determine long-term effects of NET in WI. Narrative Exposure Therapy (NET) significantly reduced symptoms of Post-Traumatic Stress Disorder (PTSD), depression, and anxiety in women who are incarcerated.NET was observed to be highly feasible, with a completion rate of 86%, suggesting that this treatment modality is particularly feasible and agreeable treatment for this population.NET may be as a low-barrier, brief, evidence-based intervention to address the high rates of trauma exposure, impact, and co-occurring mental health concerns, able to be delivered effectively by nurses with women in correctional settings. Antecedentes : Las mujeres privadas de libertad (MP) presentan una prevalencia desproporcionadamente alta de exposición a eventos potencialmente traumáticos (EPTs) y a síntomas relacionados con el trastorno de estrés postraumático (TEPT). No obstante, persiste una carencia de intervenciones focalizadas en trauma, basadas en evidencia y fácil acceso, dirigidas a esta población altamente vulnerable. Objetivo : Este estudio buscó determinar la factibilidad y los efectos preliminares de la Terapia de Exposición Narrativa (NET por sus siglas en inglés) sobre el TEPT y los síntomas de salud mental concurrentes en mujeres privadas de libertad, en distintos contextos penitenciarios. Métodos : Se llevó a cabo un estudio piloto de la NET en tres establecimientos penitenciarios femeninos. La factibilidad se operacionalizó mediante las tasas de finalización del protocolo. Se emplearon modelos lineales de efectos y d de Cohen para analizar los cambios pre – a post-NET y la magnitud de los efectos en los desenlaces primarios (TEPT, PCL-5) y secundarios (síntomas depresivos, PHQ-9; ansiedad, GAD-7; somatización, SSS-8). Resultados : Treinta y ocho mujeres completaron la intervención. La factibilidad fue demostrada por una tasa de finalización de la intervención y la evaluación de NET del 86%. Se observaron reducciones significativas de los síntomas en todos los dominios evaluados una semana después de la finalización de la NET. La NET produjo un gran tamaño del efecto en la reducción de los síntomas de TEPT (PCL-5 = 21,8 puntos; d = 1,11) y de los síntomas depresivos (PHQ-9 = 5,4 puntos; d = ,92), así como tamaños del efecto moderados en la reducción de la ansiedad (GAD-7 = 4,0 puntos; d = , 68). Conclusión : La NET parece constituir una intervención altamente factible y preliminarmente beneficiosa para la reducción de los síntomas de TEPT y de la sintomatología concurrente en salud mental en MP. Estos hallazgos sugieren la utilidad de la NET en contextos penitenciarios. Se justifica la realización de un ensayo clínico aleatorizado con potencia estadística adecuada para determinar de manera concluyente los efectos a largo plazo de la NET en MP.

To evaluate the awareness and understanding of breast cancer (BC) etiology among Jordanian women and identify associated demographic factors. A multiregional cross-sectional survey of 381 women was conducted via online snowball sampling. BC knowledge was assessed using a translated version of the Breast Cancer Awareness Measure. Statistical analyses included univariate and bivariate tests, followed by a multivariate ordinal logistic regression to adjust for potential confounders. Only 39.9% of participants demonstrated proficient comprehension of BC etiology. Knowledge correlated significantly with age, marital status, and expertise (p < 0.05). Awareness was highest among single pharmacy students; notably, 64.8% were single pharmacy students, potentially inflating overall scores. A misconception was identified: 66.1% believed a diagnosis in one breast reduces risk in the other. Age 41-50 (OR = 5.23) and holding a diploma (OR = 0.09) were significant predictors of knowledge compared to postgraduates, while marital status was not significant in the model. Educational backgrounds significantly influence breast cancer awareness among Jordanian women. There is an urgent need for targeted, community-based training programs to address persistent clinical misconceptions and knowledge gaps, specifically focusing on married women and individuals working or studying in non-medical fields, to improve overall public health standards nationwide. Breast cancer (BC) is the most common cancer among women in Jordan. Timely identification is the most effective method to enhance survival, contingent on women’s awareness of the circumstances that increase their risk. This study surveyed 381 Jordanian women regarding their understanding of the etiology of BC.Our findings indicate that general awareness is merely moderate. Only 40% of women demonstrated a robust understanding of the issues. Knowledge was most prevalent among younger women (aged 20–30) and those pursuing a pharmacy education. This indicates that medical education is exceptionally beneficial; however, women who do not pursue health-related disciplines or who are older may lack crucial information.Crucially, we identified a perilous misconception: numerous women assume that having cancer in one breast reduces the likelihood of developing it in the contralateral breast. This is inaccurate; experiencing cancer once indeed elevates the risk for the other side. Our findings indicate that despite possessing adequate knowledge, women may still refrain from undergoing checkups due to fear or the societal stigma associated with cancer in Jordan.The results suggest that Jordan necessitates more efficacious health awareness initiatives. These seminars should not just present general information but also address and rectify prevalent misconceptions. Education should be provided in schools and community centers to reach women who are no longer participating in the university system.

Background: Homeless-experienced women face disproportionately high rates of trauma exposure and posttraumatic stress disorder (PTSD) compared to the general population. Despite this, there is little research into the effectiveness of accessible, trauma-focused interventions for this population. Objective: This pilot study sought to determine the feasibility and preliminary effects of Narrative Exposure Therapy (NET) on PTSD and co-occurring mental health symptoms in homeless-experienced women. Methods: We conducted a single-arm, open pilot study of NET with 53 women in three urban women's homelessness organisations. Feasibility was assessed via intervention and study protocol completion rates. We used linear mixed effects models and effect size metrics to analyse pre - to post-NET changes and strength in effects in primary (PTSD, PCL-5) and secondary outcomes variables (depressive symptoms, PHQ-9; anxiety, GAD-7; somatisation, SSS-8) in all participants who completed NET. Results: Fifty-three women began the NET protocol; 43 completed at least one outcome measurement, and 36 of these women completed the full protocol (81% treatment completion rate, 68% study protocol completion rate). We observed significant symptom reductions in all measured symptom domains one-week post-NET. Participants showed large changes in PTSD symptoms (PCL-5 change: 20.8 points, p < .001, d = 0.9) and medium changes in depressive symptoms (PHQ-9 change: 3.1 points, d = 0.57), anxiety (GAD-7 change: 3.8 points, d = 0.7), and somatisation (SSS-8 change: 3.7 points, d = 0.49). Conclusions: NET may be a feasible and clinically pragmatic intervention for reducing PTSD and co-occurring mental health symptoms in HEW. A fully powered, randomised trial to evaluate NET in this population is necessary to definitively determine intervention effects. Narrative Exposure Therapy (NET) proved to be a highly feasible intervention for homeless-experienced women, achieving a strong treatment completion rate in this multiply-traumatised and often difficult-to-engage population.The brief, structured NET intervention yielded noteworthy improvements, showing a large effect size in reducing posttraumatic stress disorder symptoms. NET also demonstrated capacity to improve co-occurring mental health symptoms, including depression, anxiety, and somatisation.Our study confirms the potential of NET as a low-barrier, pragmatic strategy for addressing the complex mental health burden that is often under-recognised and under-treated in homeless-experienced women. Antecedentes: Las mujeres sin hogar se enfrentan a tasas desproporcionadamente altas de exposición a traumas y trastorno de estrés postraumático (TEPT) en comparación con la población general. A pesar de ello, hay pocos estudios sobre la eficacia de las intervenciones accesibles y centradas en el trauma para esta población. Objetivo: Este estudio piloto buscó determinar la viabilidad y los efectos preliminares de la terapia de exposición narrativa (NET por sus siglas en inglés) sobre el TEPT y los síntomas de salud mental concurrentes en mujeres sin hogar. Métodos: Realizamos un estudio piloto abierto de un solo grupo sobre la NET con 53 mujeres de tres organizaciones urbanas para mujeres sin hogar. La viabilidad se evaluó mediante las tasas de finalización de la intervención y del protocolo del estudio. Utilizamos modelos lineales de efectos mixtos y métricas de tamaño del efecto para analizar los cambios antes y después de la NET y la intensidad de los efectos en las variables de resultado primarias (TEPT, PCL-5) y secundarias (síntomas depresivos, PHQ-9; ansiedad, GAD-7; somatización, SSS-8) en todas las participantes que completaron la NET. Resultados: Cincuenta y tres mujeres comenzaron el protocolo NET; 43 completaron al menos una medición de resultados y 36 de ellas completaron el protocolo completo (tasa de finalización del tratamiento del 81%, tasa de finalización del protocolo del estudio del 68%). Observamos reducciones significativas de los síntomas en todos los ámbitos medidos una semana después de la NET. Las participantes mostraron grandes cambios en los síntomas de TEPT (cambio en el PCL-5: 20,8 puntos, p < 0,001, d = 0,9) y cambios medios en los síntomas depresivos (cambio en el PHQ-9: 3,1 puntos, d = 0,57), ansiedad (cambio en el GAD-7: 3,8 puntos, d = 0,7) y somatización (cambio en el SSS-8: 3,7 puntos, d = 0,49). Conclusiones: La NET puede ser una intervención viable y clínicamente pragmática para reducir el TEPT y los síntomas de salud mental concurrentes en las mujeres sin hogar. Es necesario realizar un ensayo aleatorizado con potencia estadística suficiente para evaluar la NET en esta población y determinar de forma definitiva los efectos de la intervención.

Anaemia remains widespread among Indian women and reflects persistent structural and gendered inequities. This study examines how socio-demographic-economic, autonomy, and empowerment indicators interact to influence anaemia risk among married women in the Sixth Schedule districts of Assam, Northeast India. This study analysed 5245 married women aged 18-49 years from Assam's seven Sixth Schedule districts using the NFHS-5 (2019-2021) data. Anaemia was modelled against sociodemographic-economic, autonomy, and empowerment indicators derived from contextually adapted indices (WAI-M and SWPER-M) using logistic regression to estimate unadjusted and adjusted odds ratios. Anaemia affected 66.0% of women, ranging from 58.0% in Kokrajhar to 83.7% in Udalguri; women in Udalguri remained nearly five times more likely to be anaemic than those in Kokrajhar (AOR = 4.76; 95% CI = 2.46-9.24). Low decision-making power (AOR = 2.24; 95% CI = 1.28-3.94) and limited social independence (AOR = 3.09; 95% CI = 1.70-5.60) were significant predictors of anaemia. Counterintuitively, women with medium-high (AOR = 95% CI = 0.56; 0.32-1.00) and medium-low (AOR = 0.48; 95% CI = 0.26-0.86) tolerance of wife-beating were less likely to be anaemic than those categorised as highly empowered. Anaemia is not solely a biomedical condition but a manifestation of constrained autonomy, limited social independence, and unequal decision-making power. High-burden districts such as Udalguri and Baksa require structural interventions. Effective anaemia reduction necessitates a structural shift toward empowerment-centred interventions that integrate gender-transformative health and nutrition strategies. Main findings: Anaemia among married women in Assam’s Sixth Schedule areas is rooted in structural disempowerment, manifested through limited autonomy, restricted decision-making, and constrained social independence. Added knowledge: Women’s agency mediates how structural hierarchies influence embodied health inequalities, with empowerment operating through thresholds and gradients, where limited autonomy increases anaemia risk but full assertion of agency may trigger social backlash in patriarchal contexts. Global health impact for policy and action: Reducing anaemia requires gender-transformative, empowerment-centred approaches addressing structural disempowerment, beyond behavioural or dietary interventions, supporting Sustainable Development Goals 2, 3, and 5.

Breast cancer (BC) remains a significant challenge to women's health, and identifying effective molecular targets is crucial for therapeutic advancement. Krüppel-like factor 5 (KLF5), an oncogenic transcription factor, is highly expressed in BC, yet its development as a therapeutic target has been hindered by its intrinsically disordered structure. In this study, we identified Brevilin A (BrA), a natural sesquiterpenoid from Centipeda minima, as a potent KLF5 degrader. We demonstrated that BrA directly binds to KLF5 and promotes its ubiquitin-mediated degradation through the E3 ligase WWP2. BrA significantly inhibited BC cell proliferation and induced severe mitochondrial dysfunction and endoplasmic reticulum (ER) stress, as evidenced by reduced mitochondrial respiration and activation of the PERK-EIF2α pathway. Mechanistically, BrA enhanced the recruitment of WWP2 to KLF5, leading to its polyubiquitination and subsequent proteasomal degradation. KLF5 overexpression effectively rescued the mitochondrial and ER homeostasis disrupted by BrA, whereas KLF5 knockdown rendered cells insensitive to BrA-induced cytotoxicity. In vivo studies using zebrafish and nude mouse xenograft models confirmed that BrA suppressed tumor growth by downregulating KLF5 and its downstream metabolic effectors. Collectively, our findings reveal that BrA exerts antitumor effects by promoting WWP2-mediated ubiquitination and degradation of KLF5, thereby disrupting mitochondrial and ER integrity, highlighting its potential as a natural lead compound for BC treatment.

Cervical cancer is a malignant tumor that threatens women's health and radiotherapy represents a major therapeutic approach for its treatment; however, radioresistance frequently leads to treatment failure. The present study aimed to investigate whether loperamide (LOP), a µ‑opioid receptor agonist commonly used as an antidiarrheal agent, could enhance the radiosensitivity of cervical cancer cells by regulating ferroptosis. A Cell Counting Kit‑8 assay was used to evaluate the cytotoxicity of LOP in SiHa and HeLa cells, and EdU and colony formation assays were performed to assess cell proliferation. In addition, wound‑healing and Transwell assays were performed to detect cell migration. Flow cytometry was applied to measure cell apoptosis and intracellular reactive oxygen species (ROS) levels, and colorimetric assays were used to determine malondialdehyde (MDA) and glutathione (GSH) contents. The mRNA and protein expression levels of the ferroptosis‑related markers GSH peroxidase 4 (GPX4) and solute carrier family 7 member 11 (SLC7A11) were analyzed using reverse transcription‑quantitative PCR and western blotting. The results showed that LOP significantly inhibited the viability of SiHa and HeLa cells, and exerted a synergistic effect with radiotherapy (combination index <1) to suppress cell proliferation and migration. Combined treatment with LOP and radiotherapy markedly increased apoptosis and ROS accumulation, elevated MDA levels and reduced GSH levels. Moreover, the combination treatment significantly downregulated the expression of GPX4 and SLC7A11. These findings indicated that LOP enhances the radiosensitivity of cervical cancer cells, with ferroptosis induction via inhibition of the GPX4/SLC7A11 axis as a contributing mechanism. Both apoptosis and ferroptosis were induced by the combination treatment, suggesting that the radiosensitizing effect may involve multiple cell death pathways. These observations provide a basis for further investigation into LOP as a potential radiosensitizing agent in cervical cancer.

Menopause presents unique clinical challenges for women with epilepsy, with hormonal changes, antiseizure medication interactions, and comorbid health risks converging to potentially influence seizure susceptibility, treatment requirements, and long-term health outcomes. To provide a clinical guide for the parallel assessment and management of epilepsy and menopausal health. Review of the literature and consensus of expert opinion. Women with epilepsy may be at increased risk of early menopause and are more likely to develop cardiovascular disease, osteoporosis, and cognitive impairment than women without epilepsy. There is a paucity of data regarding the optimal management of menopausal symptomatology and treatments for osteoporosis in women with epilepsy, since the condition is often an exclusion criterion in randomized controlled trials and observational studies. A personalized approach is required. Systemic menopausal hormone therapy (MHT) can be considered if the potential benefits outweigh the risks. The use of transdermal estrogen may be preferred to minimize dose-related fluctuations in hormone levels. Potential drug interactions between antiseizure medications and systemic MHT should be taken into consideration and alterations to antiseizure medication may be necessary. Healthcare providers should be appropriately trained to assess and manage epilepsy at the menopause and beyond, with provision of multidisciplinary teams.

Menopausal symptoms are influenced by hormonal as well as psychosocial factors. Social isolation and loneliness are related but distinct constructs, and their specific associations with menopausal symptom burden remain unclear. We examined their associations with scores on the Greene Climacteric Scale (GCS) and severe symptomatology in women from the CLIMATERE population survey. This cross-sectional analysis included 4124 women with an available GCS score from the nationwide web-based CLIMATERE cohort. Social isolation and loneliness were combined into four mutually exclusive categories. The GCS was analysed continuously, in sample-specific quartiles, and as severe symptom burden (GCS ≥31) using multivariable linear, proportional-odds ordinal, and binary logistic regression. Age was modelled with a restricted cubic spline; heteroscedasticity-robust standard errors were used for the linear model. The GCS median was 17 (interquartile range 12-24). In fully adjusted analyses, loneliness alone was associated with a higher continuous GCS score (B = 2.91, 95% CI 1.61 to 4.22), with greater odds of belonging to a higher GCS quartile (OR = 1.77, 95% CI 1.36 to 2.30), and with having severe symptom burden (OR = 1.68, 95% CI 1.13 to 2.50). Co-occurring loneliness and social isolation was associated with the continuous and ordinal outcomes but not significantly with GCS ≥31. Social isolation alone was inversely associated in the prespecified continuous and ordinal models, but this finding changed direction or disappeared when alternative isolation thresholds or the full isolation score were used. Loneliness was consistently associated with greater menopausal symptom burden across complementary outcome definitions. The association with objective social isolation was threshold-dependent and should not be interpreted as protective.

Unpaid care and domestic work (UCDW) is an important determinant of women's health and wellbeing in sub-Saharan Africa (SSA). While its gendered burden and health consequences are increasingly documented, less is understood about how women interpret these consequences and how the unequal responsibility for UCDW becomes normalised as ordinary, unavoidable, or morally valued. Guided by necrosocial incorporation, a framework we develop by bringing ecosocial theory into conversation with necropolitics, we examine these processes across the life course in Kenya and Uganda. We conducted a reflexive thematic analysis of 36 in-depth interviews with women aged 18 to 59 and 30 oral histories with women aged 60 and above. Our analysis identified five interconnected pathways linking UCDW to poor health and diminished wellbeing. These involved persistent stress around household survival, cumulative physical strain from repetitive labour, time poverty from competing responsibilities, curtailed sleep and recovery from extended working days, and deprioritisation of women's own health and care needs. Participants' accounts also reflected three configurations through which unequal responsibility for UCDW became normalised: (1) constrained recognition, (2) resigned acceptance, and (3) joy, duty, and fulfilment through UCDW. Across these configurations, normalisation lay in women's continued primary accountability for ensuring that UCDW was completed, including where they recognised harm, desired support, or experienced care as meaningful. Read through necrosocial incorporation, these findings show how structurally produced harm becomes embodied and entwined with gendered understandings of care, duty, and moral worth. Addressing these harms requires public investment that reduces the demands of UCDW and redistributes responsibility within and beyond households.

ACEs were highly prevalent among women with schizophrenia and depression in this Singaporean clinical sample. These findings highlight the importance of routine trauma assessment and the integration of trauma-informed approaches within mental-health services. Prevalence of Adverse Childhood Experiences (ACEs) is high (77.6%) in Singaporean women with severe mental illness.Depression diagnosis is associated with higher ACE exposure than schizophrenia.Cumulative ACEs show a dose–response link to symptom severity and poor QoL. Antecedentes: Las experiencias adversas en la infancia (ACEs por sus siglas en inglés) son determinantes importantes de la salud mental en la adultez; sin embargo, los datos sobre su prevalencia y sus consecuencias entre mujeres con trastornos mentales severos en contextos asiáticos siguen siendo limitados. Objetivo: Examinar la epidemiología de las ACEs y sus asociaciones con la gravedad de los síntomas, la calidad de vida (CdV), el consumo de sustancias y la violencia de pareja íntima (VPI) entre mujeres con esquizofrenia y depresión. Métodos: Un total de 255 mujeres de 21 a 65 años con diagnóstico clínico de esquizofrenia o depresión fueron reclutadas en un hospital psiquiátrico terciario de Singapur. Las ACEs fueron evaluadas mediante el cuestionario ACE-10. Los resultados incluyeron gravedad de los síntomas, calidad de vida, consumo de sustancias y violencia de pareja íntima. Se utilizaron modelos de regresión lineal y logística para evaluar las asociaciones, ajustando por factores de confusión. Resultados: Más de tres cuartas partes de las participantes (77,7%) reportaron al menos una ACE, siendo el abuso emocional el más frecuente (51,0%). Se observó una clara relación dosis-respuesta: las mujeres que reportaron 3 ACEs presentaron mayor gravedad de la depresión ( B = 5,44, p < 0,001) y mayor carga global de síntomas psiquiátricos ( B = 6,27, p < 0,001), peor calidad de vida en todos los dominios (por ejemplo, salud física B = –16,32, p < 0,001), y mayores probabilidades de VPI psicológica (OR = 6,03, p < 0,001) y física (OR = 3,79, p = 0,007). Conclusiones: Las ACEs fueron altamente prevalentes entre mujeres con esquizofrenia y depresión en esta muestra clínica de Singapur. Estos hallazgos destacan la importancia de la evaluación rutinaria del trauma y de la integración de enfoques de cuidado informado en trauma dentro de los servicios de salud mental.

This article examines the shift in social reactions toward women with mental illness in the Federated Malay States between 1930 and 1950, tracing the complex intersections between colonial medical policy, gender norms, and community attitudes. Using archival sources such as British medical department reports, asylum records, and administrative correspondence, the study identifies three distinct phases in public responses: exclusion and isolation (1930-1933), growing reliance on institutional treatment (1936-1940s), and the emergence of limited social support (1950s). In the early period, mentally ill women were often abandoned or confined at home, reflecting both fear of contagion and moral judgment rooted in patriarchal expectations of women's domestic roles. As colonial medical institutions expanded, families increasingly entrusted care to asylums such as the Tanjong Rambutan and Central Mental Hospitals, although this shift often represented social abandonment rather than medical trust. By the 1950s, rising education and the influence of welfare organizations marked a gradual, through partial, transformation in social attitudes, leading to community-based assistance and charitable support. The article argues that these evolving reactions reveal how colonial rule medicalized social deviance while simultaneously reinforcing gendered hierarchies of care and control. Through the lens of women's mental health, this study contributed to broader discussions of colonial governance, medicalization, and the social construction of "madness" in British Malaya. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Sexual violence against women is a major public health problem in Latin America, yet evidence on its social determinants is scarce and often conflates partner and non-partner forms. We characterised determinants of intimate partner sexual violence (IPSV), non-partner sexual assault (NPSA), and non-partner sexual harassment (NPSH) in Chile and compared their risk profiles. We analysed pooled 2017 and 2020 rounds of the Chilean National Survey on Violence in the Family and Other Settings, representative of urban women aged 15 years or older; fieldwork preceded Chile's first COVID-19 case. We fitted multilevel logistic regression for past-year outcomes, women nested in municipalities. The sample comprised 13,128 women (8335 for IPSV models). Past-year prevalence was 2.8% (95% confidence interval [CI] 2.4-3.3) for IPSV, 2.5% (2.1-3.0) for NPSA, and 11.3% (10.4-12.3) for NPSH. IPSV was associated with relational factors: dominant relationship (adjusted odds ratio [OR] 6.40, 4.68-8.76) and partner violence elsewhere (2.79, 1.75-4.43); between-municipality variance was negligible. NPSA and NPSH concentrated in younger women and the Metropolitan Region (OR 2.92 [2.00-4.28] and 2.29 [1.77-2.96]); both were associated with social participation (1.49 [1.11-2.00] and 1.26 [1.09-1.46]). Childhood sexual abuse was associated with all three (OR 2.05 [1.45-2.89], 3.03 [2.20-4.20], and 2.06 [1.72-2.46]). Reported non-partner victimisation rose between 2017 and 2020, pre-pandemic. Risk profiles differed: relational and life-course for IPSV, age-graded and metropolitan for NPSA and NPSH; childhood sexual abuse was common to all three, supporting trauma-informed responses. Agencia Nacional de Investigación y Desarrollo, Chile (Doctoral Scholarship 21212141). La violencia sexual contra las mujeres es un problema de salud pública relevante en América Latina; sin embargo, la evidencia sobre sus determinantes sociales es escasa y combina las formas ejercidas por la pareja con las ejercidas fuera de ella. Caracterizamos los determinantes de la violencia sexual por parte de la pareja íntima (IPSV, por su sigla en inglés), la agresión sexual fuera de la pareja (NPSA) y el acoso sexual fuera de la pareja (NPSH) en Chile, y evaluamos si sus perfiles de riesgo difieren. Analizamos de forma conjunta las rondas 2017 y 2020 de la Encuesta Nacional de Violencia Intrafamiliar y en Otros Espacios de Chile, representativa de las mujeres de 15 años o más residentes en zonas urbanas; el trabajo de campo concluyó antes del primer caso de COVID-19 en Chile. Ajustamos modelos de regresión logística multinivel para los desenlaces de los últimos 12 meses, con las mujeres anidadas en comunas. La muestra conjunta incluyó 13 128 mujeres (8335 en los modelos de IPSV). La prevalencia en los últimos 12 meses para IPSV fue de 2,8% (intervalo de confianza [IC] 95% 2,4–3,3), para NPSA 2,5% (2,1–3,0) y 11,3% (10,4–12,3) para NPSH. La IPSV se asoció con factores relacionales: relación dominante (odds ratio ajustado [OR] 6,40; 4,68–8,76) y pareja violenta en otros ámbitos (2,79; 1,75–4,43); la varianza entre comunas fue insignificante. NPSA y NPSH se concentraron en las mujeres más jóvenes y en la Región Metropolitana (2,92 [2,00–4,28] y 2,29 [1,77–2,96]); ambas se asociaron con la participación social (1,49 [1,11–2,00] y 1,26 [1,09–1,46]). El abuso sexual en la infancia se asoció con las tres formas (2,05 [1,45–2,89]; 3,03 [2,20–4,20] y 2,06 [1,72–2,46]). La victimización reportada fuera de la pareja aumentó entre 2017 y 2020, antes de la pandemia. Los perfiles de riesgo difirieron: relacionales y de curso de vida para la IPSV; asociados a la edad y a la Región Metropolitana para NPSA y NPSH. El abuso sexual en la infancia fue común a las tres formas, lo que respalda respuestas con enfoque de trauma. Agencia Nacional de Investigación y Desarrollo (ANID), Chile (Beca de Doctorado Nacional 21212141).

Hidradenitis suppurativa is a chronic, inflammatory skin disease that predominantly affects women of reproductive age and may require continuous therapeutic control during pregnancy and lactation. This review summarizes current evidence on the safety and practical use of topical, systemic, biologic, metabolic, and procedural therapies for HS throughout the preconception, gestational, peripartum, and breastfeeding periods. Topical clindamycin, benzoyl peroxide, chlorhexidine, and selected beta-lactam antibiotics appear to represent preferred options for mild disease or acute flares, whereas tetracyclines, retinoids, spironolactone, apremilast, Janus kinase inhibitors, and most glucagon-like peptide-1 (GLP-1) receptor agonists require avoidance or discontinuation because of fetal or neonatal safety concerns. Among biologics, tumor necrosis factor-α inhibitors remain the best-characterized agents, with certolizumab pegol offering minimal placental transfer and adalimumab or infliximab requiring individualized decisions regarding continuation and timing of discontinuation. Evidence for newer agents, including secukinumab and bimekizumab, is evolving but remains more limited. The review also highlights the importance of preconception counseling, medication transition, multidisciplinary delivery planning, postpartum flare prevention, breastfeeding-compatible therapy, and individualized procedural management. The management considerations presented herein are intended to support individualized clinical decision-making and should not be interpreted as formal guideline recommendations.Graphical abstract available for this article.

Parnell, S, Kaylor, MG, Johnson, MF, Addison, A, Braun-Trocchio, R, and Graybeal, AJ. Concurrent changes in body composition, body image, and eating behaviors in NCAA Division 1 female distance runners across an indoor and outdoor track and field season. J Strength Cond Res 40(11): 1400-1415, 2026-This exploratory study evaluated concurrent body composition and psychological changes across competitive indoor and outdoor track seasons in NCAA Division I (DI) female distance runners. Eleven athletes (body mass index: 20.2 ± 1.3 kg·m -2 ; body fat percentage: 21.7 ± 3.1%; Cross-country 5k-PR: 18.8 ± 1.2 minutes; Miles/wk: 43 ± 9) completed anthropometric, body composition, body image (BI), disordered eating behaviors (DE), mood, depression, and female athlete triad risk factor (TRF) assessments on 3 occasions throughout a competitive track season (preseason, end-of-indoor, end-of-outdoor). Training loads and social media usage were also recorded. Significance was set at p < 0.050. Total, appendicular, and leg lean soft tissue (LST) increased from preseason-to-indoor ( p ≤ 0.043), whereas weight and total, appendicular, and leg LST decreased from indoor-to-outdoor ( p ≤ 0.038). Fat mass remained stable throughout. BI distortion and dissatisfaction were present at all timepoints. Although group-level psychological outcomes did not significantly change, early-season increases in body size were significantly associated with worsening BI, DE, and depression, with these adverse patterns persisting despite subsequent, later-season reductions in body size. Greater social media usage was significantly associated with weight loss and depression, and higher training loads were associated with DE severity. All athletes demonstrated low energy availability (EA) and accumulated additional TRF throughout. In this cohort of DI female distance runners, subtle seasonal fluctuations in body composition were associated with maladaptive BI and DE that persists despite weight loss. These findings highlight the importance of proactive, season-long monitoring by coaches and strength and conditioning professionals and programming strategies focused on preserving lean tissue, supporting EA, and mitigating sociocultural pressures endemic to endurance sport culture.

To deepen the understanding of the phenomenon of co-occurring obesity and ACEs for adult women. A qualitative, phenomenological, Reflective Lifeworld Research (RLR) approach was used. Fourteen women living with obesity (BMI ≥ 30) who were between the ages of 18 and 64, and who had at least one ACE participated. The results revealed three essential meanings of the phenomenon: a boundaryless childhood existence, being in and out of control, and a vague or distorted sense of self. Six intertwined constituent meanings further elucidate the phenomenon: obesity as an existential response to ACEs; a chaotic, abusive existence with caregivers; indoctrination into the world of food misuse, weight concerns, and body focus; the critical gaze of others and its impact on the self; burdened with obesity and other persistent health conditions, and adult perspectives on surviving life's challenges. The women's existential struggles with their bodies and self-worth are compounded by the early genesis of ACEs, the violence and upheaval from ACEs, and the lifelong impact of co-occurring obesity and ACEs. Novel ways for treating co-occurring obesity and ACEs in women are presented. Implications for practice that include establishing concurrent obesity and ACEs management strategies to achieve better health outcomes for women seeking assistance in health care settings are included.

To compare healthcare utilization and spending among women enrolled in an employer-sponsored, artificial intelligence (AI) structured pelvic care program with those receiving usual in-person care for pelvic floor dysfunction (PFD) in routine clinical settings. This retrospective payor-perspective economic evaluation used exact and propensity score-matched cohorts derived from a third-party U.S. nationwide claims database from July 2022 to May 2025. Eligible participants were adult females with a pelvic-related condition, at least 24 months of continuous health-insurance coverage, and a minimum of one pelvic claim in the prior year. Intervention group (IG) comprised women who participated in the AI pelvic care program (consisting of biofeedback-mediated pelvic floor muscle training asynchronously monitored by a physical therapist specialized in pelvic health). Comparator group (CG) included women who sought a medical or physical therapy evaluation visit for PFD. Self-reported clinical outcomes available for the IG were assessed using latent-basis growth analysis. The matched cohort included 602 women (301 per group). Relative to CG, IG patients had substantially lower healthcare spending over 12 months, with mean gross per-person pelvic-related savings of $3,082.4 (95% CI $1,270.2 to $4,894.7, p <.001). Savings were primarily associated with fewer surgical procedures (per-person difference of $2,534.2; 95% CI $831.2 to $4,237.2, p =.004), with differences also noted in medical office visits and imaging utilization. IG participants demonstrated significant improvements in pelvic floor symptom burden, work productivity, and mental health. Claims-based analyses cannot exclude unmeasured confounding, misclassification, or selection bias. The one-year follow-up limits assessment of long-term economic impact. Participation in this AI pelvic care program was associated with markedly lower healthcare utilization and spending compared with usual care, largely linked to fewer surgical interventions. These findings highlight the potential of accessible, guideline-concordant AI pelvic care to lessen healthcare spending associated with PFD and inform payor-oriented care delivery models.

Traumatic brain injury (TBI) is often associated with cognitive impairments, with episodic memory deficits among the most prevalent sequelae. While clinical evidence indicates that females tend to experience worse long-term cognitive outcomes following TBI, biological sex remains poorly characterized in preclinical neuromodulation studies. Deep brain stimulation (DBS) has emerged as a promising neuromodulatory approach for cognitive rehabilitation, but its sex-dependent efficacy following TBI remains poorly understood. We investigated the effects of chronic anterior nucleus of the thalamus (ANT) DBS on spatial learning and recognition memory following moderate-severe fluid percussion injury in male and female rats. DBS-treated animals underwent ANT electrode implantation and received either active stimulation or sham treatment. TBI produced sex- and domain-specific cognitive impairments, with females showing greater deficits in novelty-based recognition memory and males exhibiting more pronounced impairments in spatial acquisition. ANT-DBS improved cognitive outcomes in a manner that tracked these vulnerabilities, most robustly restoring recognition memory in females. Animals receiving sham stimulation also showed improvements across several outcomes, suggesting substantial electrode insertion effects. DBS increased the use of spatial search strategies in the Barnes maze, with broadly similar effects across sexes. In females, TBI selectively upregulated the expression of hippocampal estrogen receptor alpha (ERα), while estrogen receptor beta (ERβ) was largely unaffected. ERα levels were normalized in DBS-treated animals. Our findings demonstrate the potential of ANT-DBS to improve cognitive outcomes following TBI in a sex- and task-dependent manner and highlight the importance of considering biological sex in the development of neuromodulatory therapies for post-injury cognitive dysfunction.

Sex differences in gallstone formation involve the gut microbiota, but the specific mediating mechanisms remain unclear. This study established gallstone and pseudo-germ-free mouse models and found that male mice maintained higher gut microbiota diversity, whereas females showed an increased Firmicutes/Bacteroidota ratio, with enrichment of Clostridium_sensu_stricto_13 and Lactobacillus. This shift led to increased production of toxic secondary bile acids-deoxycholic acid and lithocholic acid-resulting in elevated bile hydrophobicity and higher cholesterol saturation, which significantly increased gallstone susceptibility in females. Following antibiotic-induced microbiota depletion, male mice exhibited higher levels of glycodeoxycholic acid and taurodeoxycholic acid, along with reduced hepatic Cyp7a1 expression. These changes promoted cholesterol absorption and impaired bile acid synthesis, thereby increasing gallstone risk in males compared to females. Gut microbiota eradication further revealed that hepatic Abcc4, Sult2a5, Slco1a1, and Slco1a4 are regulated not only by sex hormones but also exhibit sex-specific responses to microbial modulation. Collectively, these results highlight gut microbiota-mediated bile acid metabolism as a key modifiable driver of sex differences in gallstone formation under a lithogenic diet.

H5N1 vaccines have been poorly immunogenic in humans, creating a challenge for vaccine development. Seasonal influenza vaccines offer some cross-protection against H5N1, but there has been no consideration of whether protection differs between the sexes. We investigated sex differences in antibody responses following receipt of either beta-propiolactone inactivated whole virus H1N1 or H5N1 (LAIV backbone) vaccines in C57BL/6 mice. Using systems serology assays, vaccination induced strong homologous and heterologous antibody responses, with females generating greater IgG titers than males against whole virus H1N1 and H5N1, which was primarily mediated by greater IgG responses to neuraminidase (NA) than hemagglutinin (HA) protein. Cross-reactive H5N1 IgG titers were greater among H1N1-vaccinated females, and primarily mediated by greater N1-specific IgG titers. IgG2b and IgG2c were the primary antibody isotypes generated in response to these vaccines, with females having greater IgG2b titers and enhanced binding to FcγRIV for avian and human NA than males following either homologous or heterologous vaccination. Antibody-dependent complement deposition was measured as an FcR-mediated non-neutralizing response against HA and NA and was more robust among H1N1 and H5N1 vaccinated females than their male counterparts in response to homologous HA only. Vaccinated females tended to have greater neutralizing antibody titers than males against the homologous vaccine strain, with limited cross-neutralizing antibodies detected in either sexes. Neuraminidase inhibition titers were greater in vaccinated females than males against the heterologous virus following H1N1 vaccination and against both the vaccine and heterologous viruses following H5N1 vaccination. When H1N1 and H5N1 vaccinated mice were challenged with a lethal dose of A/Texas/37/2024 H5N1, all H5N1 vaccinated mice were protected, regardless of sex. Among H1N1 vaccinated mice, while both sexes were protected against disease, H1N1 vaccinated females restricted virus to the upper respiratory tract and had lower pulmonary virus titers than males at 3 days post challenge. These findings highlight that sex differences in vaccine-induced NA-specific antibody responses are associated with differential respiratory dissemination of H5N1 and that sex should be considered in studies of vaccine-induced cross-reactive influenza immunity.

Pelvic and genital pain is a common symptom among women with endometriosis and may negatively affect sexual functioning. Pelvic floor muscle training (PFMT) may improve sexual functioning, but whether this applies to women with endometriosis remains to be explored. This study is a planned secondary analysis in which we aimed to examine how general exercise and PFMT, when added to pain management, affect sexual functioning among women with endometriosis. Planned secondary analysis of a two-armed, parallel-group randomized controlled trial with intention-to-treat analysis. Women aged 18-45 years with laparoscopically confirmed endometriosis and experiencing pelvic/genital pain were eligible. All participants attended a pain management course. In addition to weekly home training, the exercise group (n = 41) participated in weekly supervised general exercise training, including PFMT, for 4 months. The control group (n = 40) received no further intervention. Between-group differences in sexual function were assessed using the total score of the Female Sexual Function Index (FSFI) at the end of the 4-month intervention and at the 12-month follow-up. We also examined differences in the subdomains-desire, arousal, lubrication, orgasm, satisfaction, and pain-at these time points. NCT05091268. Four months post-intervention, the exercise group showed significantly higher total FSFI scores compared to the control group (mean difference = 3.52, 95% CI 0.49-6.54, p = 0.023). Significant between-group differences were also observed for the subdomains lubrication (mean difference = 0.90, 95% CI 0.17-1.63, p = 0.016) and orgasm (mean difference = 0.81, 95% CI 0.07-1.55, p = 0.033). No significant between-group differences were found for desire, arousal, or pain at the end of the 4-month intervention, or at 12 months follow-up for any domain. The findings suggest that the combined intervention of supervised exercise and PFMT, when added to pain management, may lead to short-term improvements in sexual function at the end of the 4-month intervention. Whether this effect is attributable to general exercise, PFMT, or their combination cannot be determined from the present study. However, the findings should be interpreted cautiously due to differences in sexual activity status between groups.

Pelvic organ prolapse significantly impacts women's physical and mental health. Although current research primarily focuses on the analysis of extracellular matrix components, the underlying pathologic imbalances of pelvic organ prolapse remain incompletely understood. The functional roles and phenotypic changes of fibroblasts within the complex microenvironment of prolapsed tissue warrant further investigation. To decipher the pathological basis of pelvic organ prolapse at single-cell resolution through analyzing the heterogeneity of fibroblasts, exploring prolapse-specific fibroblast subtypes and their functional characteristics. A total of 6 full-thickness prolapsed vaginal wall tissue samples were collected from patients with stage III or IV pelvic organ prolapse (pelvic organ prolapse group), along with 3 control tissue samples from patients with stage 0-I prolapse who underwent total hysterectomy for benign gynecologic diseases (CTRL group). Nuclei were isolated from frozen tissues and processed into single-nucleus suspensions for single-nucleus RNA sequencing. The sequencing data were subjected to dimensionality reduction, clustering, cell type annotation, and subpopulation identification to construct a single-nucleus transcriptome atlas of the anterior vaginal wall, with a focused exploration of fibroblast heterogeneity. Gene Ontology biological process enrichment analysis was performed to investigate dysregulated cellular functions and the functional characteristics of fibroblast subpopulations. Pseudotime trajectory analysis was performed to construct fibroblast differentiation trajectories and investigate fibroblast subpopulation specific differentiation aberrations. The main findings of bioinformatics analysis were validated by immunofluorescence staining and in vitro functional assays. The transcriptomes of 96,622 vaginal wall cell nuclei isolated from pelvic organ prolapse and CTRL group were profiled. Fibroblasts, endothelial cells, and epithelial cells were the major cell populations in the anterior vaginal wall. Fibroblasts exhibited significantly higher enrichment scores for extracellular matrix and related gene sets compared to other cell types, underscoring their critical role in regulating extracellular matrix homeostasis in pelvic floor tissues. In the pelvic organ prolapse group, we observed an increased proportion of proinflammatory (IL6ST + _FIB) and matrix-degrading (MMP2 + _FIB) fibroblast subpopulations, alongside a decreased proportion of extracellular matrix-synthesis (COL1A1 + _FIB) and mesenchymal (POSTN + _FIB) fibroblast subpopulations. Pseudotime trajectory analysis further revealed that fibroblast differentiation in pelvic organ prolapse samples shifted away from an extracellular matrix-synthesis phenotype toward pro-inflammatory and matrix-degradating phenotypes. Functional enrichment analysis of fibroblasts showed that biological processes related to extracellular matrix remodeling and negative regulation of cell migration and growth were upregulated. Consistently, fibroblasts isolated from prolapsed tissue exhibited impaired proliferation and migration capabilities. Fibroblasts in prolapsed vaginal wall exhibited marked heterogeneity compared to nonprolapsed tissue, comprising 6 functionally distinct subpopulations, including those involved in extracellular matrix synthesis, pro-inflammatory, and matrix degradation. In the prolapse microenvironment, an aberrant phenotypic shift was observed that fibroblasts transitioned from an extracellular matrix-stable phenotype predominantly characterized by COL1A1 + _FIB toward proinflammatory (IL6ST + _FIB) and matrix-degrading (MMP2 + _FIB) phenotypes, which contributes to extracellular matrix disorganization and impaired tissue repair capacity. These findings further enhance the understanding of the fibroblast phenotype imbalance underlying pelvic organ prolapse and provide novel therapeutic strategies targeted at modulating fibroblast function to restore pelvic floor.

Stress urinary incontinence (SUI) is a prevalent condition in women, characterized by involuntary urine leakage during physical exertion. Electroacupuncture (EA) is an effective therapy for SUI, offering minimal side effects, a low economic burden, and good patient compliance. To our knowledge, no systematic review or meta-analysis has specifically evaluated EA for mild-to-moderate SUI in women. We systematically searched eight Chinese and English databases for randomized controlled trials (RCTs) published between 2002 and 2025. Methodological quality was assessed using the Cochrane Risk of Bias tool (ROB-2), RevMan 5.3, and GRADEpro GDT (version 3.6). Meta-analysis was conducted where feasible, while a qualitative systematic review approach was adopted for outcomes with limited data. A total of 652 studies were retrieved, of which 10 met the inclusion criteria. The results indicate that EA may be effective in treating mild-to-moderate SUI in women, but the overall quality of evidence is limited and only two studies were categorized as having a low risk of bias, while the remaining eight were appraised as presenting "some concerns". Key limitations include small sample sizes, regional restriction to China, simplistic statistical methods in some studies, limited accuracy, and insufficient trial protocols. Based on small-scale Chinese trials, EA appears more effective than sham EA, medication, or pelvic floor muscle training (PFMT) in reducing urine leakage and improving ICIQ-SF scores, with superior long-term effects. However, due to limited, low-quality evidence restricted to Chinese populations, we cannot conclusively demonstrate EA's superiority over PFMT or pharmacotherapy for mild-to-moderate SUI in women.

To investigate the association between the duration of the second stage of labour (SSL) and early postpartum pelvic floor dysfunction (PFD) in primiparous women delivering macrosomic foetuses. 200 eligible primiparous women were stratified by SSL duration into Group A (t ≥ 3h), Group B (2h ≤ t < 3h), and Group C (t < 2h). At six weeks postpartum, transperineal ultrasound was performed to determine bladder neck position and levator ani hiatus (LAH) area. Pelvic floor muscle (PFM) strength was evaluated using the Oxford scale, while PFM function was measured via vaginal pressure testing. The occurrences of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) were recorded. The incidence of POP was significantly higher in Group A (23.33%) compared with Group B (6.67%) and C (5%) ( P < 0.05). Weak PFM strength was observed in 56.67% of women in Group A versus 21.67% and 21.25% in Groups B and C, respectively (P < 0.05). Vaginal pressure in Group A (class I fibres: 61.38 ± 4.97; class II fibres: 80.63 ± 3.18) was markedly lower than in Group B (I: 78.35 ± 5.08; II: 93.73 ± 4.39) and C (I: 76.55 ± 4.49; II: 92.10 ± 4.40) ( P < 0.001). Muscle fatigue was notably higher in Group A (I: 8.65 ± 0.95; II: 3.98 ± 0.65) compared with Group B (I: 4.78 ± 0.61; II: 2.28 ± 0.49) and C (I: 4.25 ± 0.56; II: 2.53 ± 0.55) (P < 0.001). LAH area during Valsalva was significantly larger in Group A (25.48 ± 3.77) than in Groups B (18.55 ± 2.87) and C (17.68 ± 2.72) ( P < 0.001), with corresponding LAH expansion rate of 75%, 40%, and 43.75% ( P < 0.05). A prolonged SSL (≥ 3 h) is associated with weaker PFM strength, greater muscle fatigue, enlarged levator hiatus, and a higher incidence of POP in primiparous women delivering macrosomic foetuses. This study investigated how the duration of the second stage of labour (the pushing phase during childbirth) affects pelvic floor health in first-time mothers who delivered large infants weighing more than 4000 g. At six weeks postpartum, we examined 200 eligible mothers using ultrasound to assess pelvic floor structure, measured pelvic floor muscle strength, and recorded symptoms such as urinary incontinence or pelvic organ prolapse. Our findings showed that women who pushed for three hours or longer were more likely to have weaker and more easily fatigued pelvic muscles. They also demonstrated a larger opening of the pelvic floor on ultrasound and a higher rate of pelvic organ descent compared with women who had shorter pushing times. These results suggest that prolonged pushing during childbirth can negatively affect pelvic floor function shortly after delivery, particularly in women giving birth to larger babies. Recognising the potential risks associated with extended pushing may help clinicians make informed decisions during labour and guide early rehabilitation strategies to protect long-term pelvic health.

Neurogenic lower urinary tract dysfunction (NLUTD) describes a wide range of symptoms depending on neurologic diagnosis and the resulting bladder and sphincter dysfunction. This narrative review is designed to address the question regarding which NLUTD population benefits most from pelvic floor therapy and behavioral interventions, and how to deliver these therapies. Most NLUTD treatment guidelines encourage least-invasive, low-risk therapies like behavioral therapy (BT) and pelvic floor muscle therapy (PFMT)/pelvic floor physical therapy (PFPT), but they are often underutilized because of a multitude of reasons. Studies show that PFMT along with electrostimulation or biofeedback to facilitate understanding of the pelvic floor activity, may offer significant improvement in urinary symptoms and quality of life in certain NLUTD populations. Education, adherence support, and supervised exerciseappear to enhance outcomes. Finally, evidence suggests that telerehabilitation-based PFMT is feasible, effective and associated with higher adherence and satisfaction compared with home exercise alone.

This study aimed to examine the chain mediating roles of eHealth literacy and pelvic floor muscle training (PFMT) adherence in the association between urinary incontinence (UI) severity and anxiety. A cross-sectional study was conducted using convenience sampling to recruit 240 patients with prostate cancer one month after surgery. Validated instruments were used to assess PFMT adherence (PFMT Adherence Scale), eHealth literacy (eHEALS), UI severity (International Consultation on Incontinence Questionnaire-Short Form), and anxiety (Generalized Anxiety Disorder-7). Structural equation modeling (SEM) was performed using AMOS 24.0 to evaluate direct and indirect effects. Mediation effects were tested using bias-corrected bootstrap analyses with 5000 resamples and 95% CI. At one month postoperatively, 45.05% of patients experienced anxiety, 60.40% reported moderate-to-severe urinary incontinence, and 71.78% demonstrated low eHealth literacy. High adherence to PFMT was observed in only 36.63% of participants. UI severity was indirectly associated with anxiety through three pathways: eHealth literacy ( β = 0.154, P < 0.01), PFMT adherence ( β = -0.047, P < 0.05), and a sequential pathway involving both eHealth literacy and PFMT adherence ( β = 0.038, P < 0.01). eHealth literacy accounted for 22.3% of the total effect, PFMT adherence for 6.8%, and their combined chain mediation effect for 5.5%. Urinary incontinence severity one month after prostate cancer surgery is a significant predictor of anxiety, exerting both direct and indirect effects. eHealth literacy and PFMT adherence function as important psychological and behavioral mediators, together explaining 34.6% of the total effect. Interventions aimed at enhancing eHealth literacy and promoting structured pelvic floor muscle training may help reduce postoperative anxiety and support recovery in this population.

Pelvic floor dysfunction (PFD) commonly affects postpartum women, yet surgical interventions carry invasiveness and recurrence risks. This retrospective study aims to investigate the effects of pelvic floor electrical muscle stimulation (EMS) combined with proprioceptive training (PT) on pelvic floor function and structural integrity in women with PFD. A total of 320 women with PFD treated at Ningde Municipal Hospital from October 2022 to December 2024 were stratified into control group, EMS group, PT group and combined group, with 80 patients in each group. All patients received routine pelvic floor functional training; the EMS group additionally received pelvic floor EMS, the PT group received PT and the combined group received pelvic floor EMS following PT. Pelvic floor resting/tonic contraction electromyography (EMG) value, muscle fibre strength, pelvic floor distress inventory-short form 20 (PFDI-20) scores, and pelvic floor ultrasound parameters were assessed before and after treatment. Post-treatment, all groups showed significant improvements in resting/tonic contraction EMG value, muscle fibre strength, PFDI-20 scores and pelvic floor ultrasound parameters (levator ani muscle (LAM) thickness, bladder neck descent, etc.) compared to baseline ( p < 0.001). The combined group achieved superior outcomes across all measures ( p < 0.0001), with higher EMG value, greater structural restoration (e.g. increased LAM thickness, reduced hiatus area). No baseline differences were observed among groups ( p > 0.05), confirming treatment-specific efficacy of the combined approach. Pelvic floor EMS combined with PT effectively promotes recovery of pelvic floor function and structural integrity in women with PFD. This combined therapy warrants clinical application and dissemination. Pelvic floor dysfunction (PFD) is a common health problem for women after childbirth. It can cause symptoms like accidental urine leakage and a feeling of pelvic organ heaviness or prolapse. While surgery is an option, it is invasive and can have risks. This study looked at whether combining two non-surgical treatments – pelvic floor electrical muscle stimulation (EMS) and proprioceptive training (PT), a type of sensory awareness training – could help women with PFD recover better than using either treatment alone or standard care. We studied 320 women with PFD who were divided into four groups: one group did only standard pelvic floor exercises; another group did exercises plus EMS; a third did exercises plus PT; and the final group did exercises followed by both EMS and PT combined. We measured muscle activity, strength, symptom severity using a questionnaire, and pelvic structure using ultrasound before and after treatment. All groups showed improvement, but the group that received the combined EMS and PT treatment showed the greatest benefit. These women had stronger pelvic muscles, better relief from symptoms, and greater improvement in pelvic structure (such as thicker muscles and less bladder neck descent) compared to the other groups. This study shows that combining EMS and PT is a highly effective, non-surgical approach to improving pelvic floor health after childbirth and is worth using in clinical practice.

Pelvic floor muscle training (PFMT) is the first-line conservative treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI), but its effectiveness is often limited by poor adherence and performance. We developed a third-generation home-based PFMT device incorporating real-time artificial intelligence (AI)-assisted assessment. This study aimed to evaluate the efficacy of this device in women with POP or SUI. This prospective single-arm study was conducted at Taipei Veterans General Hospital. Women with stage I-II POP or SUI performed home-based PFMT using a noninvasive wireless pressure-sensing device with real-time AI-assisted assessment. Outcomes were assessed at baseline (M0), 1 (M1), and 2 (M2) months. Primary outcomes included the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and the 1-h pad test. Contraction patterns were analyzed and categorized as optimal or non-optimal. A total of 27 women (mean age 59.0 ± 14.3 years) were enrolled and completed the study. POPDI-6 decreased from 8.6 ± 2.6 to 5.2 ± 3.0 (p < 0.01), and UDI-6 from 6.4 ± 4.9 to 3.4 ± 3.4 (p < 0.05). The 1-h pad test decreased from 30.9 ± 41.9 g to 14.3 ± 23.5 g (p < 0.01); IIQ-7 reduction was also significant. Subjective and objective improvement rates were 89% and 54%, respectively. Physician-directed pattern optimization significantly improved contraction patterns, with 52.9% of patients converting from non-optimal to optimal patterns and increased the optimal contraction rate from 37.0% to 70.4% (p < 0.01). Real-time AI-assisted PFMT significantly improved symptom scores, objective urinary leakage, and contraction quality in women with POP or SUI. While limited by a small sample size, a short follow-up period, and a single-arm design, this approach effectively identifies and optimizes dysfunctional contraction patterns to enhance pelvic floor rehabilitation.

This pilot study aimed to: (1) evaluate the effects of high-intensity focused electromagnetic (HIFEM) therapy on pelvic organ prolapse (POP) symptoms and pelvic floor function; (2) compare outcomes across HIFEM, pelvic floor muscle training (PFMT) with biofeedback and/or electrostimulation, and usual care; and (3) explore participant acceptability of the interventions. A mixed-methods pilot study was conducted in women aged >20 years with stage I-III POP. Participants were randomized to HIFEM, PFMT, or usual care. The HIFEM group underwent twice-weekly 28-min sessions for eight weeks using a non-invasive electromagnetic chair. PFMT consisted of supervised sessions incorporating biofeedback and/or electrostimulation. Usual care included lifestyle advice. Outcomes were assessed using validated questionnaires for POP symptoms and pelvic floor distress, digital palpation, and transperineal ultrasound. Twenty-eight women completed the study (HIFEM, n = 10; PFMT, n = 9; usual care, n = 9). Compared with usual care, HIFEM significantly improved pelvic floor muscle endurance (p = 0.001), whereas PFMT significantly improved muscle strength (p = 0.034), endurance (p = 0.023), and rapid contractions (p = 0.019). Only HIFEM demonstrated significant improvements in POP symptom severity (p = 0.015) and pelvic floor distress (p = 0.041). No serious adverse events were reported. Participant satisfaction was highest in the HIFEM group (100%). Qualitative analysis supported intervention acceptability, with participants reporting increased pelvic floor awareness, improved symptom control, and enhanced psychological well-being. Both HIFEM and PFMT with biofeedback appear to be safe, acceptable, and effective non-surgical treatment options for women with POP. Although no significant differences were observed between the two interventions, these findings should be interpreted with caution because of the small sample size. Larger studies are needed to confirm comparative efficacy and inform clinical implementation. NCT06532292. URL OF THE REGISTRATION SITE: https://clinicaltrials.gov/study/NCT06532292?cond=Pelvic%20Organ%20Prolapse&intr=high-intensity&rank=1.