Original research publications

Uterine perforation with migration of an intrauterine device (IUD) into the urinary bladder is a well-documented complication that usually presents with lower urinary tract symptoms, recurrent urinary tract infection, hematuria, or a secondary bladder calculus. We report a 35-year-old woman (G2P2) with a copper IUD inserted 5 years earlier who presented with progressive chronic pelvic pain and no urinary symptoms. Pelvic ultrasound showed an abnormally positioned device, and contrast-enhanced computed tomography (CT) demonstrated a T-shaped device of metallic density traversing the anterior uterine wall, with one arm protruding into the bladder dome and coated by a small encrustation. The fixed, non-dependent position of the linear metallic core, its continuity with the myometrium, and its T-shaped morphology distinguished the device from a primary bladder calculus. Cystoscopy confirmed partial intravesical protrusion of the encrusted arm, which was extracted intact with forceps without complication, and the patient was asymptomatic at follow-up. Compared with published intravesical cases, in which urinary complaints or a bladder stone usually prompt investigation, this case shows that bladder involvement may remain silent from a urinary perspective. In IUD users with unexplained pelvic pain, imaging should specifically assess the bladder, and a delayed excretory CT phase is advisable to evaluate bladder-wall integrity before removal.

To evaluate Doppler ultrasonography and placental shear wave elastography findings in pregnancies complicated by preeclampsia. This prospective observational comparative study included 60 pregnant women, consisting of 30 patients with preeclampsia and 30 healthy controls. Bilateral uterine artery and umbilical artery Doppler ultrasonography was performed, and peak systolic velocity, pulsatility index, and resistance index values were recorded. Placental shear wave elastography was obtained from the right peripheral, central, and left peripheral placental regions on both fetal and maternal surfaces. Elastography measurements were expressed as stiffness values in kilopascals and velocity values in meters per second. Perinatal outcomes, including gestational age at birth, Apgar scores, and umbilical cord blood gas parameters, were recorded. Right uterine artery PI (1.19 ± 0.65 vs 0.74 ± 0.24, p = 0.003) and left uterine artery PI (1.35 ± 0.57 vs 0.84 ± 0.26, p < 0.001) were significantly higher in the preeclampsia group than in controls. All placental shear wave elastography parameters were significantly increased in the preeclampsia group, including right peripheral fetal placental stiffness (22.42 ± 11.36 vs 4.16 ± 1.45 kPa, p < 0.001) and central fetal placental stiffness (17.89 ± 6.60 vs 4.86 ± 2.73 kPa, p < 0.001). Gestational age at birth was lower in the preeclampsia group (35.0 ± 3.3 vs 37.2 ± 2.1 weeks, p = 0.002), with lower first- and fifth-minute Apgar scores and higher cord lactate levels. Right peripheral fetal placental shear wave velocity showed the highest apparent discriminatory performance in ROC analysis (AUC = 0.998). Placental shear wave elastography may complement Doppler ultrasonography in assessing placental involvement in preeclampsia.

Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality in low-resource settings globally. In Ghana, PPH accounts for approximately 27% of maternal deaths, driven by inaccurate or inaccessible blood loss quantification methods. To address this gap, we developed and verified Quantavag, a novel device designed to accurately measure uterine blood loss for timely PPH diagnosis and treatment in low-resource settings. We conducted 45 customer discovery interviews with healthcare professionals, midwives, and patients in Ghana and the United States to identify clinical needs and define device requirements. Benchtop verification testing was conducted using 3D-printed prototypes and anatomical models to assess anatomical fit, stability, flow rate capacity, collection accuracy, and cost. Verification testing confirmed that Quantavag fits securely within a postpartum pelvic model and remained stable during simulated movement. Using water, the device achieved mean fluid collection accuracy exceeding 80% across 100-500 mL input volumes. The device collected water at an average rate of 87,849 mL/hour, far exceeding clinical PPH flow requirements. Estimated per-use cost was $1.50 (16 Ghanaian Cedis). These early benchtop findings support continued development of Quantavag as a potential approach to support timely PPH diagnosis in low resource settings by enabling accurate, objective, and affordable blood loss quantification. Additional benchtop testing is required to evaluate device performance with blood-mimicking fluid and clots, and address flow interruptions and accuracy during collection. The next phase will involve clinical validation tests with health care professionals and patients in Ghana to assess usability and safety and guide further development. Successful implementation of Quantavag could reduce delayed PPH diagnosis and improve maternal outcomes globally.

To evaluate oxytocin-induced perfusion changes in uterine fibroids using contrast-enhanced ultrasound(CEUS) and determine their predictive value for high-intensity focused ultrasound (HIFU) ablation efficacy. Fifty-five patients (mean age 42.15 ± 5.34 years). with 78 uterine fibroids underwent oxytocin-enhanced HIFU therapy. CEUS was performed before and after intravenous oxytocin infusion (0.10 U/ml over 10 min). Perfusion changes were assessed using two parameters:(1) Arterial-phase Perfusion Delay Time difference (APDTΔt), defined as the time difference in enhancement onset of fibroids before and after oxytocin exposure; (2) Visual Perfusion Grading (VPG), based on relative contrast perfuse reduction of fibroids at the end of the arterial phase(Grade1:≤30%;Grade2:30-70%;Grade3:≥70%). Post-treatment contrast-enhanced pelvic MRI was used to calculate fibroid volume and non-perfused volume(NPV),from which ablation ratio was derived. Fibroids were dichotomized by ablation efficacy (≥70%vs < 70%), and correlation analyses and ROC curves were used to evaluate predictive performance. Fibroids in the <70% ablation group showed a mean APDT(Δt) of 8.32 ± 5.61s and 52.2%(12/23) VPG as Grade1. In the ≥70% group, APDT(Δt) was significantly longer (16.76 ± 12.12 s), and 54.5%(30/55) VPG were Grade3. Both APDT(Δt) and VPG differed significantly between groups ( p < 0.05), Showing strong correlations with ablation ratio ( r = 0.577 and r = 0.585; both p < 0.001). Thresholds of APDT(Δt) >3.5 s and VPG >1.5 yielded sensitivities of 83.6% and 87.3%, specificity of 65.2% and 52.3%, with AUCs of 0.791 and 0.725, respectively. CEUS can effectively detect oxytocin-mediated perfusion changes in uterine fibroids. These changes are strongly associated with HIFU ablation outcomes, and in particular, Arterial-phase Perfusion Delay Time demonstrates robust predictive value for treatment efficacy.

To investigate differences in corticomotor excitability to the pelvic floor muscles (PFMs) between females with and without provoked vestibulodynia (PVD) using transcranial magnetic stimulation (TMS). Adult females with and without PVD underwent TMS over the cortical vertex to target motor representations within the central sulcus. Electromyographic responses were recorded from the pubovisceral (PV), bulbocavernosus (BC), and external anal sphincter (EAS) muscles at rest and during PFM contraction. MEP characteristics and SPs were compared between those with and without PVD using independent samples t-tests, with Cohen's d effect sizes computed. Eighty-five females participated (42 PVD, 43 controls). Compared to controls, those with PVD exhibited larger MEP amplitudes in the BC (1477.6 μV vs 478.9 μV, d = -0.64) and EAS (369.1 μV vs 103.3 μV, d = -0.43) at rest and during contraction (2813.1 μV vs 1260.3 μV, d = -0.71; 1034.3 μV vs 340.8 μV, d = -0.54; respectively), shorter MEP onset latencies in the PV (16.5 ms vs 17.2 ms, d = 0.42) and BC (17.0 ms vs 18.3 ms, d = 0.62), and shorter SPs in the EAS (119.4 ms vs 144.2 ms, d = 0.53). Those with PVD demonstrated increased corticomotor drive and/or impaired central motor inhibition to the PFMs. These findings support the exploration of targeted neuromodulation therapies as a component of therapeutic management of PVD.

This study aimed to investigate whether a static weighted ensemble of multiple UNet-based expert models (MoUNets) can achieve more accurate segmentation of the levator hiatus in pelvic floor ultrasound images than any single expert model. This retrospective single-center study included women diagnosed with pelvic organ prolapse who underwent transperineal ultrasound examinations between July 2020 and November 2023. The cohort was randomly divided into the training (n = 106), validation (n = 37) and testing (n = 43) cohorts. Model performance was evaluated on the test set using the Dice similarity coefficient (DSC) and Jaccard index (JI) and compared across all competing architectures. The study included 186 women (median age, 33.5 y [IQR, 30.0-48.8 y]). Comparative experiments on our in-house levator hiatus dataset confirmed that MoUNets is effective. Among the six conventional UNet models, the standard UNet achieved the best segmentation consistency. MoUNets, which combines different expert models of similar performance, showed higher numerical values than individual expert models. The best ensemble, MoUNets UNet&ACCUNet , yielded a DSC of 0.9653 and a JI of 0.9333. However, paired t-tests revealed no statistically significant difference between the ensemble and the UNet (p = 0.888). In contrast, statistically significant differences were observed between the best ensemble model and each of the other five individual models (all p < 0.01). The ensemble model leverages complementary advantages among different experts to significantly improve the segmentation performance of weaker models, particularly in difficult cases, demonstrating clear clinical value.

To investigate whether serum micro (miR)-145-5p for postoperative complications in patients with scarred uterus undergoing caesarean section, suggesting its potential as an adjunctive molecular biomarker for clinical preoperative risk assessment. A total of 198 women were divided into high-expression and low-expression groups based on the mean relative serum miR-145-5p level. Pelvic floor function, vaginal microecology, and abdominal adhesion status were assessed, and postoperative complications were monitored. Spearman's rank correlation was used to analyse the correlation between miR-145-5p expression and scar scores, while Receiver operating characteristic (ROC) curves were employed to evaluate its predictive efficacy for complications. Serum miR-145-5p was negatively correlated with abdominal scar Patient-Observation Scar Assessment Scale (POSAS) scores. The level of miR-145-5p was lower in the moderate-to-severe pelvic floor dysfunction (PFD) group, vaginal microecological disorder group, abdominal adhesion group, and postoperative complication group compared with the corresponding control groups. ROC curve analysis showed that miR-145-5p had good predictive value for these complications. miR-145-5p is closely correlated with abdominal scar, PFD, vaginal microecological disorders, abdominal adhesions, and other postoperative complications in patients with scarred uterus after caesarean section, which may serve as a potential molecular biomarker for preoperative risk assessment. Many women who have a previous caesarean birth have a scar on their uterus. These women often face higher risks of health problems after another caesarean delivery, including poor wound healing, weak pelvic floor muscles, imbalanced vaginal health, and internal tissue attachments. Among 198 patients, those with lower preoperative miR-145-5p levels showed poorer abdominal scar healing (higher POSAS scores) and higher rates of pelvic floor dysfunction, vaginal microecological disorders, abdominal adhesions, and other complications. ROC analysis demonstrated that miR-145-5p had good predictive value for these complications, with area under the curve (AUC) values ranging from 0.821 to 0.883. Specifically, lower miR-145-5p was associated with weaker pelvic floor muscle strength, abnormal vaginal inflammation markers, more severe abdominal adhesions, and other complications. Multivariate analysis confirmed high miR-145-5p as an independent protective factor. These findings suggest that preoperative serum miR-145-5p testing may serve as an adjunctive molecular biomarker to identify high-risk patients and guide early intervention strategies for improved postoperative outcomes.

The purpose of this review is to summarize and highlight contemporary studies evaluating sexual function after urogynecologic surgery. As nearly one in five women will undergo surgery for pelvic organ prolapse (POP) or urinary incontinence, it is critical to understand the impact of surgery on postoperative sexual function. This review includes a discussion of reconstructive surgeries for POP, uterine-preserving techniques, mesh-based prolapse repairs, and anti-incontinence procedures for both stress urinary incontinence (SUI) and urge urinary incontinence (UUI) and the associated effects on sexual function. Women who undergo reconstructive POP surgery have many options for repair, including native tissue repair or mesh-based repairs, as well as uterine-sparing procedures or hysterectomy. Studies have shown general improvements in sexual functioning among all POP repair modalities, with no significant differences between modalities. Anti-incontinence procedures for SUI and UUI are also associated with improved sexual functioning. The majority of research in reconstructive pelvic surgery includes heterosexual, cisgender women. Pelvic floor disorders are common and negatively affect sexual functioning. Surgical treatments for POP and urinary incontinence generally improve sexual functioning. Further research is needed given the ever-changing landscape of gynecologic surgery.

DNA methylation profiling is emerging as a powerful ancillary molecular tool for tumor classification in gynecologic pathology. This article provides a practical overview of the technology and its emerging applications, with emphasis on diagnostically challenging settings including rare mesenchymal neoplasms (eg, uterine tumors resembling ovarian sex cord tumor, SMARCA4-deficient uterine sarcoma) and lineage-ambiguous tumors. Beyond classification, methylation profiling enables copy number analysis, tumor microenvironment deconvolution, epigenetic age estimation, and cell-free DNA-based detection, with growing relevance to gynecologic pathology, albeit mostly in research setting. Current barriers include limited access, incomplete classifier development for gynecologic entities, and the need for clinical validation.

Transmucosal drug delivery presents a complex interfacial materials challenge where continuous mucus turnover, tight epithelial junctions, and dynamic fluid clearance fundamentally restrict therapeutic efficacy. Electrospun nanofibers have emerged as advanced polymeric platforms capable of overcoming these biological barriers through precision structural engineering and tunable physicochemical properties. This critical review evaluates the solid-state behavior and architectural design of electrospun transmucosal systems, with a specific focus on the dynamic material-mucosa interface. We dissect the mechanistic basis of nanofiber performance, detailing how polymer chemistry, hydration dynamics, and solid-state drug amorphization collectively govern mucoadhesion, mucus penetration, and release kinetics. Furthermore, we critically analyze advanced architectural strategies, including fast-dissolving matrices, sequential-release multilayers, core-shell configurations, and hierarchical nanoparticle-in-nanofiber assemblies, and highlight how the spatial manipulation of polymeric materials dictates functionality across the oral, nasal, and vaginal mucosa. Finally, we address prevailing translational bottlenecks in materials processing, such as the thermodynamic instability of amorphous solid dispersions during scale-up, while outlining future perspectives in stimuli-responsive smart polymers and device-integrated 3D-printed composite scaffolds. Ultimately, this review establishes that the rational engineering of nanofiber morphology, surface chemistry, and solid-state properties is paramount to advancing next-generation mucosal delivery platforms.

Adenomyosis is a benign uterine disease that has been associated with endometrial proliferative disorders. Adenomyosis and endometrial cancer (EC) are sex-steroid-dependent conditions that may coexist, but their estrogen receptor (ER) and progesterone receptor (PR) signaling landscape is poorly defined. The present multicenter study aimed to characterize the expression of estrogen (ESR1 / ESR2 plus the coregulators NCOA1 , CCND1 , BRCA1 ) and progesterone ( PGR plus FOXO1 , and CYP26A1 ) receptor pathway-related genes in hysterectomy specimens of patients with adenomyosis and coexisting EC. Specimens from three groups of patients ( n = 10 per group) referred to two tertiary hospitals were studied: adenomyosis plus EC (Group 1), only adenomyosis (Group 2), and only EC (Group 3). Gene expression was assessed by droplet digital PCR using a compartment-matched design. Analysis was compartment-specific, and no cross-compartment comparisons were performed. Compared with isolated adenomyosis, adenomyotic lesions from uteri with coexisting EC showed higher ESR2 ( p = 0.0082) and BRCA1 ( p = 0.0007) expression, with no differences in ESR1 , NCOA1 , or CCND1 . PR-related gene expression ( PGR , FOXO1 , and CYP26A1 ) did not differ between adenomyosis groups. Although preliminary, the present findings indicate that adenomyosis coexisting with EC is characterized by elevated expression of ESR2 and BRCA1 , suggesting an enriched ER-related microenvironment that may be relevant to local estrogen responsiveness.

Diabetes mellitus profoundly impairs female reproductive health by inducing uterine atrophy, follicular loss, and hormonal dysregulation. Oxidative stress and profibrotic signaling, particularly transforming growth factor-β (TGF-β), are central to this pathology, while the role of heat shock protein 70 (HSP70) remains insufficiently characterized. Alpha-lipoic acid (ALA), a mitochondrial cofactor and potent antioxidant, has shown efficacy against diabetic complications; however, its protective effects on reproductive tissues in type 1 diabetes are not well established. Thirty adult female Wistar rats were allocated into control, diabetic, and diabetic + ALA groups ( n = 10 each). Diabetes was induced by a single intraperitoneal injection of streptozotocin (60 mg/kg). ALA was administered orally (200 mg/kg/day) for four weeks. Histopathological evaluation focused on uterine gland degeneration, stromal fibrosis, and ovarian follicular integrity. Plasma anti-Müllerian hormone (AMH), uterine TGF-β, and ovarian HSP70 levels were quantified using ELISA. Streptozotocin-induced diabetes caused significant uterine gland degeneration, stromal fibrosis, ovarian follicular loss, reduced AMH, and elevated TGF-β and HSP70 ( p < 0.001). ALA treatment attenuated glandular and stromal injury, reduced fibrosis, and improved follicular morphology. Biochemically, ALA increased AMH, decreased uterine TGF-β, and further upregulated ovarian HSP70, indicating activation of cytoprotective pathways. Although glucose levels remained elevated, partial glycemic reduction was observed. ALA exerts antifibrotic and cytoprotective effects in diabetic reproductive tissues, mitigating uterine and ovarian damage through modulation of TGF-β and HSP70 pathways.

Uterine tumor resembling ovarian sex cord-stromal tumor (UTROSCT) is a rare uterine neoplasm characterized by sex cord-like differentiation. Although typically indolent and confined to the uterus, UTROSCT can occasionally exhibit atypical clinical and pathological behavior, complicating preoperative diagnosis. A 52-year-old postmenopausal woman (G3P3A0) with no significant medical history presented with a painless umbilical swelling persisting for eight months. Physical and radiological assessment revealed a paraumbilical hernia and she was scheduled for elective laparoscopic repair. Intraoperatively, a large amount of viscous gelatinous material was unexpectedly discovered in the peritoneal cavity, with no visible peritoneal or visceral mass. Peritoneal biopsies and cytology suggested a low-grade neoplasm of uncertain origin, initially raising suspicion of pseudomyxoma peritonei (PMP). Computed tomography showed a large soft-tissue lesion occupying the lower abdomen and pelvic cavity, extending to the umbilicus and supplied by a branch of the uterine artery. Multidisciplinary tumor board discussion favored a uterine source, and cytoreductive surgery with total hysterectomy and peritonectomy was performed. A 40 cm encapsulated gelatinous uterine mass weighing 6.3 kg was excised. Histopathology and immunohistochemistry confirmed UTROSCT with positivity for sex cord markers and hormone receptors. Margins were negative and there was no lymphovascular invasion. The postoperative course was uneventful. The patient received adjuvant tamoxifen therapy and remained disease-free during 48 months of follow-up. This case illustrates an exceedingly rare presentation of UTROSCT, with much large tumor size than previously reported.

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder characterized by ovarian dysfunction and metabolic abnormalities, including insulin resistance. Letrozole (LET)‑based animal models reproduce hyperandrogenic features but often lack the metabolic phenotype of obesity‑associated PCOS. Therefore, in the present study, a high‑fat diet (HFD) was combined with LET and alterations in insulin signaling in metabolic tissues were examined. Female Sprague‑Dawley rats were assigned to control (CON), LET‑induced PCOS (LV) and HFD plus LV (HLV) groups. Body weight, fasting glucose, serum lipids, histology of the liver, visceral adipose tissue (VAT), ovaries and uterus, pancreatic and ovarian immunofluorescence, and hepatic and VAT quantitative PCR for insulin signaling markers were evaluated. Both LV and HLV groups showed increased body weight and fasting glucose, with impaired hepatic and VAT insulin receptor (INSR)/insulin receptor substrate 1 (IRS‑1)/phosphoinositide 3‑kinase (PI3K)/protein kinase B (AKT) signaling relative to the CON group, with no significant differences between the LV and HLV groups for these parameters. However, HLV further increased hepatic phosphoenolpyruvate carboxykinase and glucose‑6‑phosphatase, and VAT sterol regulatory element‑binding protein 1c and acetyl‑CoA carboxylase, beyond the levels observed in the LV group, and produced more severe hepatic steatosis and adipocyte hypertrophy compared with the LV group. Ovarian cytochrome P450 family 19 subfamily A member 1 and anti‑Müllerian hormone dysregulation was also more pronounced in the HLV group than in the LV group. By contrast, no significant difference was observed between the LV and HLV groups for serum lipid levels, pancreatic β‑cell area or apoptosis, INSR, IRS1, IRS2, AKT, PI3K, glucose transporter 4, carnitine palmitoyltransferase 1A or acyl‑CoA oxidase 1. These findings indicated that HFD selectively exacerbates specific molecular and histopathological features of PCOS beyond those induced by LET alone, partially recapitulating obesity‑related PCOS and providing a practical preclinical platform for studying the metabolic‑reproductive axis and evaluating interventions targeting insulin resistance.

Adolescents in Sub-Saharan Africa (SSA) continue to face significant barriers to accessing contraceptive services, despite global and regional commitments to improve sexual and reproductive health (SRH) outcomes. This scoping review synthesises current evidence on the barriers adolescents encounter when seeking contraceptive services across SSA. Following the Arksey and O'Malley framework and the Joanna Briggs Institute guidelines, a comprehensive literature search of peer-reviewed and grey literature published between January 2010 and January 2025 across multiple databases was conducted. A total of 30 studies met the inclusion criteria. Thematic synthesis revealed five major categories of barriers: individual-level [limited knowledge, fear of side effects, misconceptions], sociocultural [stigma, religious beliefs, parental disapproval], economic [cost of services and transportation], health system-related [provider attitudes, confidentiality concerns, facility accessibility], and policy/legal [age restrictions, mandatory parental consent, poor coordination among agencies]. The findings highlight how these multi-level barriers intersect to impede adolescents' access to contraception, contributing to high rates of early pregnancy, unsafe abortion, and sexually transmitted infections. Notably, research gaps remain regarding marginalised groups such as LGBTQ+ youth and adolescents with disabilities. The review emphasises the need for adolescent-centred policy reforms, improved provider training, expanded community engagement, and equitable financing mechanisms to support adolescent access to contraception. These findings can inform strategies for achieving the Sustainable Development Goals (SDGs) related to health and gender equality in Sub-Saharan Africa. Main findings: There exist persistent individual, sociocultural, economic, policy and legal restrictions, and health system barriers that reinforce adolescents’ resistance to accessing contraceptive services in Sub-Saharan Africa. Added knowledge: This review provides consolidated evidence on the barriers that reinforce adolescents’ resistance to accessing contraceptive services in Sub-Saharan Africa, by providing a structured overview to guide research, practice, and policy discussions. Global health impact for policy and action: By consolidating current knowledge, the review guides global health strategies and policy actions to strengthen adolescent-centred contraceptive service delivery and advance sexual and reproductive health equity across low-resource settings.

This study evaluated the cost-effectiveness of female-only vaccination (FOV) and gender-neutral vaccination strategies (GNV) using 4-valent (4vHPV) and 9-valent HPV (9vHPV) vaccines among adolescents aged 12-16 years in Japan. It provides the first comprehensive assessment of all feasible vaccine-population combinations using a unified dynamic transmission model. An age- and sex-structured dynamic transmission model simulated HPV transmission and disease progression over 100 years, incorporating cervical, vulvar, vaginal, anal, head and neck, and penile cancers. Six vaccination strategies were evaluated: no further vaccination, FOV with 4vHPV, FOV with 9vHPV, GNV with 9vHPV for females and 4vHPV for males, GNV with 4vHPV for both sexes, and GNV with 9vHPV for both sexes. Analyses adopted a healthcare payer perspective, with costs in 2025 Japanese yen, discounted at 3%. Incremental cost-effectiveness ratios (ICERs) were calculated using a willingness-to-pay threshold of ¥5 million per quality-adjusted life year (QALY). FOV with 4vHPV yielded an ICER of ¥171,725/QALY versus no vaccination, and FOV with 9vHPV yielded ¥1,366,226/QALY versus FOV with 4vHPV - both below the willingness-to-pay threshold. Furthermore, GNV with 9vHPV for both sexes provided the greatest health gains and remained below the threshold (¥3,594,296/QALY) versus FOV with 9vHPV. GNV with 4vHPV and mixed 9vHPV/4vHPV schedules were dominated and excluded. The healthcare payer perspective excludes indirect costs. The model hypothetically includes 9vHPV for boys despite its unavailability for males in Japan. Both female-only 4vHPV and 9vHPV strategies are cost-effective under Japan's economic standards. Furthermore, GNV with 9vHPV provides greater health benefits and cost-effectiveness. Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and a major cause of cervical, vulvar, vaginal, anal, head and neck, and penile cancers. In Japan, HPV vaccination coverage dropped sharply after the government suspended its recommendation in 2013 due to safety concerns, although it was reinstated in 2021. The 9-valent HPV vaccine was added to Japan’s National Immunization Program in 2023. Currently, girls aged 12–16 years can receive either vaccine free of charge, whereas boys must pay out-of-pocket, limiting access and creating gender inequality in protection. This study evaluated the cost-effectiveness of female-only and gender-neutral vaccination strategies using both vaccines among adolescents aged 12–16 years. Using a dynamic transmission model over a 100-year time horizon, we compared six strategies incorporating multiple HPV-related diseases. Two strategies were (weakly) dominated and excluded: gender-neutral 4-valent vaccination for both sexes, and 9-valent for girls with 4-valent for boys. Among the remaining strategies, female-only 4-valent vaccination showed an incremental cost-effectiveness ratio (ICER) of approximately ¥171,725 per quality-adjusted life year (QALY) compared with no further vaccination. Upgrading to 9-valent vaccine yielded an ICER of ¥1.4 million per QALY. Gender-neutral 9-valent vaccination for both sexes showed an ICER of ¥3.6 million per QALY, providing the largest health gains. All strategies remained below Japan’s willingness-to-pay threshold of ¥5 million per QALY. Sensitivity analyses at 70% coverage confirmed robustness. This study demonstrates that gender-neutral 9-valent vaccination achieves the greatest health impact while remaining cost-effective.

Vulvar cancer is a rare malignancy whose development involves environmental, immunologic, genetic and viral factors, including high-risk HPV infection. MicroRNAs (miRNAs/miRs) regulate key oncogenic pathways and may serve as biomarkers in gynecological cancers. However, limited data are available on the role of miR-205, miR-223 and miR-590 in vulvar carcinoma. The present study thus assessed their expression and clinical relevance. A total of 38 women with vulvar carcinoma were included in the study. miRNA expression was quantified using reverse transcription-quantitative PCR from formalin-fixed paraffin-embedded surgical specimens. Among the enrolled patients, 25 had both tumor tissue and matched non-malignant vulvar tissue available for analysis, enabling paired comparisons and fold-change calculations, whereas 13 patients contributed tumor tissue only due to insufficient RNA yield from the matched non-malignant specimen. Statistical analyses included paired t-tests and Kaplan-Meier survival analysis. Clinicopathological features were evaluated using International Federation of Gynecology and Obstetrics (FIGO) staging and histological grading. The results revealed that miR-205 expression was higher in patients with advanced disease, with a significant difference observed between FIGO I-III and FIGO IV tumors. miR-223 expression exhibited a tendency toward an association with poorer tumor differentiation, suggesting its potential as an unfavorable prognostic indicator. miR-590 expression was associated with tumor grade, with higher levels detected in well-differentiated lesions; additionally, the absence of miR-590 expression was linked to a lower likelihood of malignancy, supporting its diagnostic value. A reduced expression of miR-223 was independently associated with an improved overall survival (log-rank, P=0.013). No significant associations between miR-205 or miR-590 and overall survival were identified. On the whole, the present study demonstrated that miR-205, miR-223 and miR-590 expression patterns are associated with the tumor stage, grading and survival outcomes of patients with vulvar cancer. These miRNAs may thus serve as diagnostic or prognostic biomarkers, with miR-223 exhibiting the strongest prognostic significance and miR-590 demonstrating diagnostic specificity. Due to the rarity of vulvar cancer, larger multicenter studies and international datasets are required to validate these findings and to further elucidate the biological roles of miRNAs in this malignancy.

Artificial intelligence (AI) holds considerable promise for strengthening sexual, reproductive and maternal health (SRMH) by enhancing diagnosis, optimising service delivery and expanding access to information. In Latin America and the Caribbean (LAC), however, the scope, focus and maturity of AI applications in SRMH remain poorly described. To identify, map and analyse existing applications of AI in SRMH priority services in LAC, characterising thematic areas, target populations, and types of AI tools, whilst highlighting gaps and future research needs. We conducted a scoping review guided by the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Searches were performed in PubMed, SciELO, Cochrane and LILACS up to August 2023, complemented by targeted Google searches and snowballing. We included records reporting AI applications in SRMH services in LAC and extracted data on setting, population, SRMH domain, AI techniques and implementation stage. A total of 1,518 records were identified, of which 143 met the inclusion criteria. Most were published between 2020 and 2023 and originated from Mexico, Colombia, Peru, Brazil and Argentina. Over half were peer-reviewed articles, with additional theses and web-based reports. Applications concentrated on prenatal, childbirth and postnatal care (36%) and reproductive organ cancers (31%), with far fewer initiatives addressing sexual health, contraception, gender-based violence, sexual satisfaction or counselling. Machine learning methods predominated (52%), followed by deep learning (41%). Almost half of initiatives (48%) were exploratory projects, 17% implemented tools without outcome data and 35% reported performance in real-world contexts. AI applications in SRMH in LAC are expanding but remain thematically narrow, population-selective and predominantly exploratory, highlighting the need for more diverse, rigorously evaluated and equity-oriented tools. This review explores how artificial intelligence (AI) is being used to improve health care access and information about sexual, maternal, and reproductive health in Latin America and the Caribbean. These include access to contraception, care during pregnancy and childbirth, prevention and treatment of sexually transmitted infections, among others.We reviewed 143 publications and found that most AI tools focus on pregnancy care and cancer detection. Far fewer initiatives focus on sexual health or contraception. Many tools are still in early development and have not yet been tested in real health care settings. Others have been implemented but lack reports about their efficiency and/or effectiveness.This study highlights the need to expand the use of AI to a broader range of health services and populations. AI has the potential to reduce inequalities and improve access to care, but only if it is designed in a responsible way.

To investigate the long-term systemic effects of tubal sterilisation using the silver clip technique, a commonly used yet understudied permanent contraceptive method, by evaluating its impact on inflammatory responses and coagulation function. A multicentre ambispective cohort study will be conducted in ten hospitals. Women with a history of silver clip sterilisation, silk ligation, or condom contraception who require surgical management for benign gynaecological diseases will be recruited. Participants will be followed up at 1 day, 1 month, 6 months, and 12 months postoperatively. Key measurements will include serum silver concentrations ( via inductively coupled plasma mass spectrometry), cytokine levels (e.g. tumour necrosis factor-α, interleukin-6), and comprehensive coagulation profiles, assessed preoperatively and throughout the follow-up period. The data obtained will characterise baseline and longitudinal changes in systemic silver concentrations, inflammatory cytokines, and coagulation parameters. Analyses will compare these outcomes across the silver clip, silk ligation, and condom contraception groups, and evaluate their associations with intraoperative findings (tissue stereology and pelvic adhesions) and adverse events. This study will provide evidence to support long-term safety monitoring of silver levels in women who have undergone silver clip sterilisation. It may increase awareness of potential health concerns, including inflammation and coagulation abnormalities. The findings may also contribute to the development of updated contraceptive guidelines for policymakers and women of childbearing age.

This systematic review and meta-analysis aimed to compare the long-term efficacy and safety of physical therapies (laser and photodynamic therapy) versus conventional topical glucocorticoids for the treatment of vulvar lichen sclerosus (VLS). A total of ten randomized controlled trials (RCTs) published between 2010 and 2025 were included and analyzed to evaluate clinical symptom improvement, safety profiles, and long-term recurrence rates. Analysis indicates that physical therapies are generally superior to topical glucocorticoids in improving clinical symptoms, with photodynamic therapy (PDT) demonstrating the most significant relief. In terms of safety, adverse events associated with physical therapies were predominantly mild and transient local reactions (e.g., burning or redness), whereas topical glucocorticoid use carried risks of secondary infections, such as candidiasis. Furthermore, physical therapies, particularly PDT, showed better long-term recurrence control compared to glucocorticoids, which had high recurrence rates after discontinuation. Laser therapy and PDT are effective and safer alternative treatments for VLS. These modalities offer distinct advantages in sustained symptom relief and recurrence reduction, especially for patients with refractory disease or concerns regarding long-term steroid use.

Contraceptive counseling is an essential component of endocrine care because many endocrine disorders and treatments influence fertility, pregnancy outcomes, and contraceptive eligibility. This article outlines a patient-centered approach that incorporates reproductive goals, shared decision-making, and assessment using The Centers for Disease Control and Prevention medical eligibility criteria. It summarizes the efficacy, mechanisms, benefits, and risks of nonhormonal and hormonal contraceptive methods. Special considerations for patients with obesity, diabetes, thyroid disorders, and polycystic ovarian syndrome are discussed, along with potential medication interactions. Integrating contraception counseling into endocrinology practice can reduce unintended pregnancies and support optimal reproductive health outcomes.

Intravaginal rings (IVRs) are redefining women's health by enabling sustained, localized and user-independent drug delivery that overcomes the limitations of conventional vaginal dosage forms. This review provides a comprehensive perspective on next generation IVR technologies, emphasizing the convergence of biomaterials engineering, advanced manufacturing and clinical translation. We critically discuss how key elastomeric platforms -including ethylene-vinyl acetate, silicones and thermoplastic polyurethanes- govern drug release, mechanical performance and compatibility with the dynamic vaginal microenvironment. Particular focus is placed on the technological evolution of IVR fabrication, from traditional injection molding to disruptive additive manufacturing strategies like three-dimensional (3D) printing and photopolymerizable resin-based systems. These emerging technologies unlock unprecedented opportunities for personalized medicine and sophisticated multi-compartment architectures capable of delivering multiple therapeutics with independently tunable release profiles. In parallel, we examine analytical and regulatory considerations underpinning IVR development, including physicochemical characterization, in vitro release testing and bio-relevant in vivo pharmacokinetic and safety models. Beyond their established role in contraception and hormone replacement, IVRs are rapidly expanding into anti-infective and preventative applications targeting candidiasis, bacterial vaginosis and HIV-1 transmission. In this context, multipurpose prevention technologies (MPTs) are emerging as a transformative strategy capable of simultaneously addressing contraception and sexually transmitted infections within a single long-acting platform. Finally, we discuss the critical challenges that continue to shape the field, including microbiome preservation, user acceptability, regulatory complexity and large-scale manufacturing. Collectively, this review highlights IVRs as a versatile and rapidly evolving drug delivery platform poised to drive the future of personalized and long-acting therapeutics in women's health.

Vulvar and vaginal cancers represent rare malignancies for which high-quality evidence remains scarce, largely due to their low incidence and biological heterogeneity. Therefore, the clinical management of these tumors poses significant challenges for multidisciplinary teams. To address this unmet need, an interdisciplinary expert panel developed the present position paper based on the best available evidence regarding surgical, locoregional and systemic treatment strategies. In addition, considerations relevant to the care of transgender and gender-diverse individuals are incorporated. This document aims to support multidisciplinary clinical decision-making in vulvar and vaginal cancers by synthesising current evidence, identifying areas of uncertainty, and outlining available resources to promote the implementation of structured, evidence-informed, and patient-centered treatment approaches.

There are numerous terms used to describe variant locations of intrauterine devices (IUDs) in US reports, such as displaced, low lying, and malpositioned. These vague terms are frequently misinterpreted by providers and patients, which may lead to an incorrect inference of inadequate contraception. Current consensus guidelines from the American College of Obstetricians and Gynecologists (ACOG) indicate that the greatest risk of unintended pregnancy may be due to the unnecessary removal of a nonfundal IUD. Many providers now advocate leaving an IUD in place if it is located entirely above the internal os, as the device still provides effective contraception. The ACOG recommends counseling for patients, whether symptomatic or asymptomatic, before removal of the IUD. The authors outline a simple lexicon to describe the location of IUDs in US reports that includes terms understood by obstetrics and gynecology providers and that better align with current gynecologic literature. © RSNA, 2026 Supplemental material is available for this article.

Category X medicines are those which have such a high risk of causing foetal harm that they are contraindicated in pregnancy. When used in reproductive age women, risk management strategies are warranted to reduce unintended pregnancy exposure. To identify documentation of pregnancy risk management strategies for Category X medicines across Australian medicine information sources. The TGA Prescribing Medicines in Pregnancy Database (PMPD) was searched to identify Category X medicines licensed for indications relevant to reproductive age women. For each Category X medicine included in this evaluation, regulatory documents (Product Information [PI] and Consumer Medicine Information [CMI]) and corresponding monographs/chapters in clinical resources (Australian Medicines Handbook [AMH] and Therapeutic Guidelines [TG]) were reviewed for boxed warnings relating to pregnancy risks, pregnancy testing and contraception recommendations, and formal pregnancy prevention programs. Thirty-nine Category X medicines were retrieved through the TGA PMPD, 19 of which met the inclusion criteria. Boxed warnings documenting pregnancy risks were present for 47% (9/19) of medicines. Pregnancy testing and contraception recommendations appeared in most PIs and CMIs (89%, 17/19), as well as in 15 of 17 (88%) medicines listed in the AMH, but were only present for one of 12 (8%) medicines listed in the TG. Structured pregnancy prevention programs exist for only 16% (3/19) of medicines. Pregnancy risk management strategies for Category X medicines are inconsistently employed across Australian medicine information sources. Improving the quality and consistency of pregnancy risk management strategies is necessary to avoid harms from inadvertent exposure during pregnancy.

Male contraception is relied upon by many couples around the world in the form of condoms, vasectomy, and withdrawal. Novel male contraceptives are a collection of interventions in development including hormonal, non-hormonal, immunological and reversible vas-occlusive methods. A large multinational trial of a novel hormonal contraceptive has recently concluded, and while the results are awaited, this narrative review discusses the field and potential methods on the horizon. Current contraception methods do not meet the needs of couples, with high rates of unintended pregnancy worldwideExisting male methods are either low efficacy (withdrawal and condoms) or are irreversible (vasectomy), and novel high efficacy reversible methods are neededSeveral hormonal methods are in development, with the most advanced being a combined progestogen-testosterone transdermal gel investigated in a phase 2b clinical efficacy trialNon-hormonal methods have recently entered first-in-human trials, including a retinoic acid receptor antagonist, and reversible occlusion of the vasa deferentia (‘reversible vasectomy’)This review article summarizes the evidence in the field to date.

In 2021, North Carolina (NC) authorized pharmacists to initiate hormonal contraceptives. The objectives of this pilot study were to: (1) determine where hormonal contraception (HC) services were provided; (2) evaluate patient characteristics; and (3) describe pharmacist interventions. Pharmacists who completed training and prescribed HC between April 2022 and December 2023 were invited to participate. Participants completed an online survey about pharmacy demographics and descriptive statistics were used to summarize characteristics. De-identified patient encounters were uploaded into a secure website and data was analyzed using descriptive statistics. 1309 pharmacists completed HC training. Seventeen pharmacists (1.3%) participated in the study and completed demographic surveys. Four pharmacists (24%) saw 34 patients during the study period and provided intervention data for 21 patients. Seventy percent of pharmacists worked in independent pharmacies, and 47% of pharmacies were in rural communities. Seventy percent of patients had commercial insurance (50%) or NC Medicaid (20%). Fifty-three percent of patients reported that they had a primary care provider (PCP). Pharmacists prescribed a hormonal contraceptive in 95% of patient encounters, most frequently the combined HC pill (70%). One patient was referred to a primary care clinic due to elevated blood pressure. All pharmacists in this early-adopter pilot study of contraception pharmacists practiced in independent pharmacies. Seventy percent of patients who sought care from a pharmacist were insured, approximately half did not have a primary care provider, and pharmacists initiated HC for 95% of patients. The most common HC prescribed was the combined HC pill.