Ny forskning om jente- og kvinnehelse

Pelvic floor physical therapy (PFPT) is recommended for conditions including constipation and fecal incontinence. There is limited evidence exploring characteristics of physical therapy practices, attitudes toward treating evacuation disorders, and potential barriers to care that may influence treatment outcomes. Therefore, a better understanding of these aspects of PFPT is needed. The purpose of this study was to survey PFPT practices, using the Chicagoland area as a microcosm. We aimed to explore practice characteristics, available treatment modalities, and attitudes toward treatment of evacuation disorders. We conducted a cross-sectional phone and email-based survey of pelvic floor physical therapists across 17 counties in the Chicagoland area. Of 149 eligible contacts, there were 48 respondents representing 58 total PFPT practices. Mixed methods were used to aggregate data quantitatively and perform mapping analysis and thematic analysis. There were geographic disparities in PFPT provider density. Most practices served all gender identities but consisted primarily of female therapists. Levels of PFPT-specific training and certification varied. Respondents felt that education on lifestyle, including diet, was an important therapeutic goal. Biofeedback in a variety of forms was used by most respondents (81%); some suggested that biofeedback was not as effective for chronic constipation as other therapies. Themes of potential barriers to satisfactory outcomes included delayed and vague referrals from other clinicians, as well as patient misinformation and inappropriate expectations. This study provides preliminary insights to guide further work on improving access to PFPT and improving treatment outcomes for bowel symptoms. To strengthen collaboration, we suggest that referring clinicians actively communicate and develop networks with local PFPT offices, and offer earlier, more detailed PFPT referrals to patients.

Although urinary incontinence (UI) is highly prevalent among women, treatment seeking remains low, in part due to limited knowledge of the condition. Awareness and knowledge of pelvic floor dysfunction (PFD) among young women in the United States remains poorly characterized despite growing interest in early pelvic floor health education. This study aimed to assess baseline knowledge of UI, identify sources of information, and evaluate predictors of higher knowledge among female undergraduate students. We administered an online survey to 175 female undergraduates at a single institution that included year in school, background knowledge items, and the validated Prolapse and Incontinence Knowledge Quiz (PIKQ-UI). Responses were analyzed using descriptive statistics, one-way analysis of variance (ANOVA), and multivariable linear regression. Although 54.9% of respondents reported prior awareness of PFD, we found that overall knowledge was poor (57.7% correct), significantly below the 80% competency threshold (p < 0.001). Online and social media platforms were the most reported sources of information (42.9%). Prior knowledge of UI was independently associated with higher PIKQ-UI scores (p = 0.03), whereas advancing year in school, personal UI history, and familiarity with someone affected by UI were not associated with higher performance. Knowledge gaps were most pronounced regarding age-related risk, treatment, and diagnostic testing (43%, 49%, 48% correct, respectively). Nearly all participants (91.4%) expressed interest in learning more about PFD. Despite widespread exposure to pelvic floor health information through online and social media sources, knowledge of UI among female undergraduate students remained low. Although prior awareness of UI was associated with higher knowledge scores, substantial gaps persisted, suggesting that exposure alone does not translate into understanding. Leveraging online platforms to deliver accurate, evidence-based education may improve pelvic floor health literacy and reduce the burden of untreated UI.

To compare surgical outcomes and sexual quality of life following pelvic floor reconstruction using human acellular dermal matrix (ADM) versus polypropylene mesh (PM). This retrospective study included patients with anterior compartment and uterine prolapse who underwent transvaginal anterior sacrospinous ligament fixation between September 2021 and July 2023. Patients were grouped by graft type: ADM (n = 16) or PM (n = 25). Primary outcomes included operative data, complications, Pelvic Organ Prolapse Quantification scores, and quality-of-life questionnaires (Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire-7, and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12) at 3 and 12 months postoperatively. Both groups showed significant postoperative improvements in Pelvic Organ Prolapse Quantification parameters and functional scores compared to baseline (P < 0.05). No significant differences were found between groups regarding blood loss, complication rates, or recurrence. The ADM group required significantly longer operative time than the PM group (88.06 vs. 61.68 minutes, P < 0.001). Postoperative dyspareunia was lower in the ADM group (7.7%) compared to the PM group (20%), though this difference was not statistically significant. Both ADM and PM provide comparable anatomical success and improved patient well-being in pelvic floor reconstruction. ADM may offer advantages in preserving sexual function by reducing dyspareunia, although larger multicenter studies are needed to confirm these findings.

Pelvic floor dysfunction is a common and underdiagnosed condition affecting urinary, gastrointestinal, and sexual function. Imaging plays a pivotal role in diagnosis and treatment planning, yet approaches to technique, interpretation, and reporting remain inconsistent. This article, authored by members of the ESUR Pelvic Floor Working Group, provides practical recommendations for the use of fluoroscopic defecography, MR defecography, and pelvic floor ultrasound, including standardized protocols, key measurements, and a structured, compartment-based interpretation strategy. We detail the imaging features of anterior, middle, and posterior compartment disorders and highlight common pitfalls. Implementing these recommendations by adopting the suggested protocols and reporting approach in routine practice will help ensure consistent, clinically relevant pelvic floor assessments. KEY POINTS: Pelvic floor dysfunction frequently involves multiple compartments, and MRI provides a detailed structural and functional assessment of all pelvic compartments. Fluoroscopic defecography remains the mainstay for the evaluation of defecatory disorders. Pelvic floor ultrasound is increasingly valuable for triaging pelvic floor dysfunction and for detailed assessment of pelvic floor anatomy and anal sphincter integrity.

Urinary incontinence is highly prevalent among older women, affecting more than one-third of this population and significantly impairing quality of life, independence, and healthcare utilization. Older women often present with complex needs that may require broader rehabilitation strategies. This systematic review evaluated randomized controlled trials of physical therapy interventions for urinary incontinence in older women. PubMed, Embase, and Scopus were searched to October 2025. Eligible studies included women ≥60 years and assessed interventions such as Pelvic floor muscle training (PFMT), bladder training, Yoga, Pilates, general resistance training, electrical stimulation, or multimodal programs. Methodological quality was appraised using the PEDro scale, and random-effects meta-analysis was performed where appropriate. Twenty studies involving 2002 women across 13 countries were included. Eleven trials were rated as good quality and nine as fair. Meta-analysis demonstrated that PFMT significantly reduced urinary incontinence severity compared with usual care (SMD = -1.27, 95% CI: -2.18 to -0.36, p = 0.006). Multimodal programs combining PFMT with mobility, strength, or fall-prevention training also showed significant benefits (SMD = -0.98, 95% CI: -1.60 to -0.36, p = 0.002). Comparative studies indicated that PFMT was similarly effective to Yoga and Pilates, while adjuncts such as general resistance training or tibial nerve stimulation provided additional improvements. Physical therapy interventions, particularly PFMT and multimodal programs, are effective in reducing urinary incontinence severity and improving functional outcomes among older women. These findings support prioritizing physical therapy as an important management strategy, with multimodal approaches offering added value for enhancing functional independence and fall prevention.

To prospectively evaluate the perineal card, a risk-based scoring system, for identifying women at increased risk of postpartum urinary incontinence (UI). This prospective observational study included women without previous vaginal delivery who underwent vaginal birth at a tertiary referral center between June 2023 and October 2024. The perineal card was completed at hospital discharge to assess obstetric and perineal risk factors and classify patients into low-, intermediate-, and high-risk groups. Postpartum pelvic floor outcomes were assessed at follow-up using a standardized screening tool with validated questionnaires. Logistic regression identified factors independently associated with UI, and discriminative performance was evaluated by receiver operating characteristic analysis. Of 296 enrolled women, 265 were included in the final analysis. At follow-up, 18.3% reported UI. Women with UI had higher median perineal card scores than asymptomatic women. UI during pregnancy, pre-pregnancy body mass index (BMI), labor induction, and postpartum urinary retention lasting more than 24 h were independently associated with postpartum UI. The perineal card showed moderate discriminative ability, with an area under the curve of 0.65. Use of the perineal card at discharge may help identify women at increased risk of postpartum UI and support timely referral for pelvic floor rehabilitation.

This study examined the impact of incontinence severity on the outcomes of pelvic floor and abdominal muscle strengthening training in women with stress urinary incontinence (UI). Sixteen women with stress and mixed UI were divided into two groups based on 24-h pad test results: mild (4-20 g, n = 9) and moderate-severe (⩾ 21 g, n = 7). Both groups underwent a 6-week home-based program including Pelvic Floor Muscle Training (PFMT) and Abdominal Muscle Training. Outcomes assessed before and after intervention included UI severity (24 h pad test), pelvic floor muscle strength (EMG biofeedback), quality of life (King's Health Questionnaire), symptom distress (UDI-6), and pelvic floor dysfunction (GPFBQ). Both groups showed significant reductions in UI severity and improvements in pelvic floor muscle strength, quality of life, and symptom scores after the intervention. The decrease in UI severity was more pronounced in the moderate-to-severe group ( p < 0.05). No significant differences were found between groups regarding muscle strength or quality of life. These preliminary results suggest that home-based combined PFMT and abdominal muscle training can effectively reduce UI severity and improve pelvic floor function and quality of life in women with UI, regardless of initial severity. These findings support integrating abdominal muscle exercises into the conservative management of UI. Further large-scale studies are required to confirm these findings. NCT05549193, 22/09/2022, retrospectively registered.

Pelvic organ prolapse (POP) is a common condition affecting elderly women. This study aimed to evaluate whether combining pelvic floor muscle training (PFMT) with electromagnetic stimulation (EMS) provides better outcomes than PFMT alone, using objective three-dimensional (3D) ultrasound parameters. We conducted a retrospective analysis of 240 elderly women with POP treated between January 2023 and January 2025. Based on the received treatment, patients were grouped to a PFMT group (n = 114) or a PFMT-EMS group (n = 126). All patients underwent a standardized 15 week intervention. We assessed pelvic floor 3D ultrasound parameters, Pelvic Organ Prolapse Quantification (POP-Q) stage, pelvic floor muscle strength metrics, and symptom scores pre- and post-treatment. This analysis included 240 patients. The PFMT-EMS group showed significantly greater improvement in key ultrasound parameters, including a smaller levator ani hiatus area on Valsalva (P < 0.001) and reduced bladder neck descent (P < 0.001). This group also achieved better POP-Q stage improvement (P = 0.013), greater enhancement in muscle strength and symptom relief (all P < 0.001), and a higher total effective rate (P = 0.027). Combining PFMT with EMS produces superior anatomical and functional outcomes in elderly women with POP than PFMT alone.

Pelvic floor dysfunctions (PFDs) are highly prevalent in adult women. Although pelvic health physiotherapy (PHP) has been found to provide evidence-based interventions to women presenting these conditions, access to such services may be limited. The objective of this study was to explore women's perceptions and experiences regarding access to pelvic health physiotherapy (PHP). This study was a qualitative descriptive study using semi-structured interviews. An interview guide was used to interview women having experienced PFD, who had or not accessed PHP services. The content of the interviews was transcribed and analyzed through inductive reflective thematic analysis. The transcripts were coded, and key themes were identified using an iterative process. The participants were 15 women over the age of 18 years. Three main themes were identified: 1) lacking guidance on PFDs and PHP services; 2) neglecting PFDs and their effects; 3) needing access to quality PHP services. The results of this study provide valuable insights into the access issues faced by women regarding their pelvic health. Findings highlight numerous unmet needs, among which the need to improve knowledge and awareness of PFDs, to address the trivialization of PFD symptoms, and to ensure access to PHP in rural areas. Access to pelvic health physiotherapy is essential for women experiencing pelvic floor dysfunctions, as these conditions can significantly affect physical, mental, and sexual health.Women’s perspectives on this access highlight unmet needs, including insufficient guidance on pelvic floor dysfunctions and pelvic health physiotherapy services, the trivialization of their symptoms and impacts, and the demand for high-quality care.Addressing these unmet needs is crucial to enhance access to pelvic health physiotherapy and improve the quality of life of women.

Pelvic floor dysfunction (PFD) includes urinary and bowel dysfunction, chronic pelvic pain, and sexual dysfunction and can substantially impair quality of life. Sacral neuromodulation (SNM) is uesd for selected refractory urinary and bowel disorders, while evidence for other PFD domains continues to develop. We aimed to characterize publication patterns, contributors, collaboration networks, co-citation structures, and keyword trends in the literature on SNM for PFD. Publications on SNM for PFD from January 2000 to November 2025 were retrieved from the Web of Science Core Collection. Bibliometric and visual analyses were conducted using VOSviewer, CiteSpace, and R software to evaluate temporal trends, geographic and institutional distributions, journal and author productivity, reference co-citation networks, and keyword dynamics. A total of 1986 publications (1520 original articles and 466 reviews) were included. Annual publication output increased overall during the study period, with year-to-year fluctuations. The United States (n = 681), the United Kingdom (n = 276), the Netherlands (n = 135), and China (n = 125) contributed the largest numbers of publications. Neurourology and Urodynamics, Colorectal Disease, and Diseases of the Colon & Rectum were the most productive journals. The strongest reference bursts were observed for Wexner SD (2010; strength 32.91), Matzel KE (2017; strength 30.40), and Lightner DJ (2019; strength 30.19). Keyword analyses were dominated by sacral neuromodulation, sacral nerve stimulation, fecal incontinence, efficacy, and quality of life; keywords with bursts continuing through 2025 included percutaneous tibial nerve stimulation, overactive bladder, and urgency urinary incontinence. This bibliometric analysis maps publication growth, major contributors, collaboration patterns, co-citation structures, and keyword themes in the literature on SNM for PFD. Urinary and bowel dysfunction were the most prominent research themes, whereas chronic pelvic pain and sexual dysfunction were less represented in the keyword analyses. By identifying major thematic concentrations, patterns of scientific collaboration, and comparatively underrepresented topics, these findings may support hypothesis generation, prioritization of future studies on SNM across different PFD domains, and stronger international and interdisciplinary collaboration.

Stress urinary incontinence (SUI) after childbirth has both clinical risk factors and measurable changes in urethral support. Whether integrating these complementary features can identify affected women at six weeks postpartum remains uncertain. This retrospective, single-centre study included 454 women, divided chronologically into development (n=351) and temporal internal-validation (n=103) cohorts. LASSO selected ultrasound predictors. Ultrasound-only and combined clinical-ultrasound models were evaluated for discrimination, calibration and clinical utility. SUI prevalence was 17.7 % and 26.2 % in the development and validation cohorts, respectively. LASSO retained bladder-neck mobility (BNM) and urethral funneling; the combined model additionally included age, vaginal delivery and overweight. The combined model outperformed the ultrasound-only model in development (C-statistic, 0.780 [95 % CI, 0.717-0.843] vs. 0.703 [0.634-0.771]; p=0.002). In validation, the corresponding C-statistics were 0.805 (0.716-0.894) and 0.737 (0.633-0.841), but the difference was not significant (p=0.141). The validation calibration intercept, slope and Brier score were 0.704, 1.054 and 0.161, respectively. Decision-curve analysis indicated potential net benefit at selected thresholds; continuous-predictor analysis yielded similar discrimination. Combining clinical and transperineal ultrasound features improved concurrent SUI identification over ultrasound features alone. External validation is required before clinical implementation.

Pelvic floor therapists are incorporating mid-sagittal two-dimensional (2D) perineal pelvic floor ultrasound (pPFUS) to augment their pelvic floor digital examination. Although the mid-sagittal plane gives crucial information about pelvic floor function, it does not allow the operator to directly ascertain the integrity and thickness of the levator ani muscle (LAM). We aimed to evaluate the correlation between LAM thickness obtained with 2D pPFUS in the coronal plane and three-dimensional (3D) endovaginal ultrasound (EVUS) in the axial plane in women without pelvic organ prolapse (POP) at or beyond the hymen to evaluate if 2D pPFUS is an effective tool for visualization of LAM. In a retrospective descriptive analysis, 2D pPFUS and 3D (EVUS) were compared to attempt visualization and quantitatively measure the puborectalis (PR), pubococcygeus (PC), and iliococcygeus (IC) within the same patient cohort. LAM thickness was recorded at mid-urethra, mid-vagina, and mid-anorectum coronal levels. Statistical analyses included comparing measurements and calculating predictive values and correlation between 2D pPFUS and 3D EVUS. Coronal 2D pPFUS could not be used to discretely visualize the PC and IC in any patient. Comparison of PR thickness between 2 and 3D ultrasound at different levels showed positive predictive values ranging from 0.70 to 0.86, while negative predictive values ranged from 0 to 1.00 across all three levels. Moderate to high correlations were observed between measurements taken at the mid-urethra and mid-vagina using both ultrasound modalities. At the mid-anorectum level, correlation was weak and inconsistent between sides, with only a low positive correlation on the right and no significant correlation on the left. Measurements of the LAM at the level of the PR obtained with 2D pPFUS show good correlation with those obtained using 3D EVUS at the mid-urethra and mid-vagina levels. However, 2D pPFUS is limited by its inability to visualize PC and IC muscles.

As the traditional risk factors cannot account for all hypertension (HTN) incidents, it is of great importance to determine other risk factors. This study aimed to identify long-term HTN risk associated with annual change of estimated glomerular filtration rate (eGFR) and prior adverse pregnancy outcomes (APOs) among women participating in a population-based study of Tehran Lipid and Glucose Study (TLGS). This study was performed using prospectively ascertained data of TLGS. A total of 2,404 women with recorded data of eGFR measurements and APO status participated. Data collection was conducted according to the standard guide of TLGS. Cox proportional-hazards regression models were used to estimate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for the incidence of HTN. A total of 2,404 women were enrolled. Adjusted model shows that, a one z-score positive eGFR change was associated with a reduced risk of developing HTN among women with a history of APOs (HR= 0.816, 95% CI: 0.708-0.939, p = 0.005). In contrast, no significant association was observed among women without a history of APOs (HR= 1.027, 95% CI: 0.913-1.156, p = 0.645). We also observed a statistically significant interaction between APO status and annual eGFR change for HTN incidence in total population (interaction p = 0.02). The history of APOs is accompanied by alterations in kidney function in the long term. In women with a history of APOs, a positive change in eGFR levels was independently associated with a lower risk of HTN.

Acute aerobic exercise activates physiological stress systems yet is widely viewed as a strategy for improving cognitive and emotional functioning. While studies in humans suggest that a single bout of exercise can alter responses to stress, relatively little is known about the behavioral effects of acute exercise in rodents, particularly in females. We investigated the effects of a brief bout of voluntary wheel running on spatial working memory, anxiety-like behavior, cognitive bias, and corticosterone concentrations in adult Long-Evans rats. Male and female rats were tested separately using within-subjects designs under baseline conditions and following acute loud music stress. In male rats, acute stress elevated corticosterone concentrations and slowed performance on a radial arm maze without increasing memory errors. Acute wheel running prevented this stress-induced slowing, increased open-arm exploration on the elevated plus-maze, and promoted more optimistic responding during cognitive bias testing. In contrast, female rats displayed a different pattern of effects. Acute wheel running increased corticosterone concentrations, impaired radial arm maze performance, and promoted more pessimistic responses to ambiguous cues. Although running increased open-arm exploration in females, it generally failed to buffer the behavioral effects of stress and often produced responses resembling those observed following stress exposure. Individual running distance was unrelated to behavioral performance in either sex. Together, these findings suggest that acute exercise rapidly alters behavioral responses to stress and ambiguity, but that these effects differ substantially between males and females. Acute wheel running may function as a stress-buffering experience in males while producing stress-like effects in females.

To investigate the developmental onset and sex-specific nonlinear trajectories of first-recorded episodes of self-harm among children and young people, examining variations across methods and settings. We conducted a population-based surveillance study using statewide data from Santa Catarina, Southern Brazil, including individuals aged 5-25 years. Generalised additive models and spline-based mixed models were used to estimate continuous age-specific incidence rates. Spatial and contextual risks were assessed using incidence rate ratios (IRRs). Out of 63,773 notifications, 12,322 first-recorded cases were identified (68.5% female; 81.1% aged 15-25 years). Overall incidence peaked at 16.0 years. Distinct non-linear developmental trajectories emerged by sex: among females, incidence rose abruptly from age 11 and peaked at 14.0 years, whereas males showed a more gradual increase, peaking five years later at 19.0 years. Sex differences temporarily converged between ages 15 and 19. Method-specific analyses revealed a marked female predominance for self-poisoning (peak at 14.7 years) and sharp objects (peak at 14.0 years), whereas hanging was heavily male-predominant, peaking in young adulthood (20.5 years). School-based self-harm showed the earliest and most concentrated developmental peak (13.7 years), disproportionately affecting females (IRR = 1.73; 95% CI: 1.22-2.46). Conversely, sex differences were attenuated and no longer statistically significant in public spaces (IRR = 0.81; 95% CI: 0.40-1.64). First-recorded episodes of self-harm follow highly distinct, age- and sex-specific trajectories. The early-adolescent peak among females contrasts with the delayed trajectory observed in males, highlighting critical, setting-specific windows of developmental vulnerability that argue against 'one-size-fits-all' prevention and support targeted clinical and school-based strategies.

Working memory is one of the core cognitive functions that declines in older adulthood. Brain reserve (BR) refers to neurobiological status of the brain that supports cognition, offering a valuable neurostructural framework for understanding working memory decline among older adults. However, most existing studies rely on gross, whole-brain measures of BR which may lack sensitivity to specific cognitive functions, and few studies have examined their sex differences. Based on 131 healthy older adults (aged 52-86) from Australia, this study used multimodal imaging data, including grey matter volume, cortical thickness, and white matter tract integrity, to identify BR proxies for older adults' working memory, and to test for sex differences and their interaction effects with age. Results indicate that BR proxies for older adults' working memory were primarily concentrated in white matter tracts related to sensory processing and hemispheric integration, including the acoustic, optic, and thalamic radiations, as well as the corpus callosum, while whole-brain BR proxies showed no significant correlations with working memory performance. Meanwhile, BR proxies significantly mediated the negative correlation between age and working memory performance. No sex differences were observed in behavioral measures of working memory; however, women exhibited higher structural integrity and smaller age-related differences in multiple critical white matter pathways compared to men during late adulthood. These findings suggest that older women have better preserved working memory-related BR, supporting the theory that BR acts as "neurobiological capital" to buffer supposed age-related cognitive decline. Our study provides new empirical evidence for understanding sex differences in BR, which shows a female advantage in later life, as well as the protective mechanisms during working memory aging.

Acute myocardial infarction (AMI) remains one of the leading causes of death in Germany, accounting for 41 258 deaths in 2024. The evidence on sex differences in mortality after AMI is mixed, especially for outcomes beyond the acute phase. We used data from a large nationwide database to study sex differences in 12-month mortality after AMI in Germany. This retrospective cohort study is based on data from the German Health Data Lab ( Forschungsdatenzentrum Gesundheit ). Adults who had a principal inpatient discharge diagnosis of incident AMI in 2023 were included in the analysis. The endpoint was all-cause mortality within 12 months. Cox models were fitted with sequential adjustment for age, infarction type, comorbidities, and prior cardiovascular medication. 62 884 women and 113 019 men were included in the analysis. The women were older and had more comorbidities. The crude 12-month mortality was higher in women than in men (21.0% vs 17.8%; 251 vs 207 per 1000 person-years). After adjustment for age, however, the reverse was true: mortality was lower in women than in men (hazard ratio [HR] 0.88; 95% CI 0.86-0.90). This remained the case in the fully adjusted model (HR 0.84; 95% confidence interval [CI] 0.82-0.85). In exploratory stratified analyses, men and women under age 60 did not differ in mortality, while in older age groups and after non-ST-segment elevation myocardial infarction (NSTEMI), mortality was lower in women (but not after ST-segment elevation myocardial infarction [STEMI]). Multivariable analysis revealed a slightly lower 12-month mortality among women after the diagnosis of an acute myocardial infarction. Because the adjustment included variables that may act as mediators on the causal pathway between sex and mortality, the adjusted estimates should be interpreted with caution.

We analysed sex differences in global cancer incidence and mortality using a national development index to better understand how broader socioeconomic factors may contribute to or mitigate sex differences in cancer outcomes. Cancer incidence and mortality data (2012-2017) were obtained from the International Agency for Research on Cancer, covering 43 countries for incidence and 60 for mortality. Only nonsex-specific cancers were included and categorised into 12 groups. Age-standardised incidence rates (ASIR) and age-standardised mortality rates (ASMRs) were calculated, with sex differences analysed using men-to-women ratios (MWRs). Linear regression was used to assess the association between Human Development Index (HDI) and MWRs across cancer types. Among the cancer types included in this study, cancers of the colorectum, stomach, and lungs showed the highest incidence and mortality. Men are 12-13 times more likely to be diagnosed with oesophageal cancer (MWR ≈ 13), over nine times more likely to die from head and neck cancers, and >6 times more likely to die from lung cancer. Thyroid cancer incidence is up to five times higher in women than in men. No clear link was found between HDI and MWRs in incidence, but HDI relates to mortality and MWRs for several cancer types, with brain and thyroid cancers showing higher male mortality, while lung cancer showing relatively higher female mortality in high-HDI countries. Sex differences in cancer burden vary substantially across cancer types. National development was associated with sex differences in mortality, but not incidence, suggesting that factors related to health care and survival differ more between countries with different HDIs and contribute to these differences more than exposure to risk factors, which relates more to incidence.

Posterior tibial tendon dysfunction (PTTD) disproportionately affects women. This review explores the multifactorial influences contributing to this sex disparity, including hormonal fluctuations, structural tendon differences, and life events such as pregnancy and weight gain. Sex hormones, particularly estrogen and relaxin, appear to modulate tendon collagen synthesis and mechanical properties, potentially predisposing women to PTTD. Genetic polymorphisms in estrogen receptors may further affect susceptibility. Pregnancy and weight gain may also be associated with PTTD. While direct studies are limited, the collective evidence supports a hormonal and biomechanical basis for sex differences in PTTD, warranting further targeted research.

Alcohol use varies by sex, but studies in Ghana have not formally tested whether sociodemographic correlates of drinking patterns differ between males and females. This study examined drinking patterns, their sociodemographic correlates and sex differences among Ghanaians aged 15-49 years. Dataset from 21,291 Ghanaians aged 15-49 years in the 2022 Ghana Demographic and Health Survey was analysed. Drinking patterns of respondents were classified on the basis of self-reported quantity per drinking day. Multinomial logistic regression was used to estimate the adjusted odds ratios (AOR) accounting for sociodemographic confounders. Sex differences in sociodemographic correlates were tested using a single combined model with sex-interaction terms. Overall, prevalence of abstinence, moderate, low-risk and heavy drinking were 81.6%, 11.3%, 4.1% and 3.0%, respectively. Males were strongly associated with moderate (AOR = 3.235; 95% CI = 2.801, 3.737), low-risk (AOR = 1.809; 95% CI = 1.389, 2.355) and heavy drinking (AOR = 3.910; 95% CI = 2.881, 5.305). Older age, parenthood and employment increased odds of drinking patterns; marriage was protective. Significant sex interactions for heavy drinking versus abstinence contrast were found for age ( p < 0.001), education ( p < 0.001), marital status ( p < 0.001), wealth ( p = 0.009), parenthood ( p < 0.001) and employment ( p < 0.001). This study found that 18.4% of Ghanaians aged 15-49 years drink alcohol in varying patterns. Sociodemographic correlates of heavy drinking differ significantly between males and females. Sex-stratified estimates suggest similar patterns for other drinking categories, though these were not formally tested. This supports the need for tailored, sex-sensitive alcohol interventions.

Excessive alcohol (ETOH) consumption is associated with alterations in the opioid system, including β-endorphin deficiency and differential expression of the mu opioid receptor (MOR) in brain areas involved in reward. This system also contributes to the rewarding properties of psychostimulants, such as cocaine and amphetamines; however, its role in this regard has been little studied, particularly with respect to sex differences. The aim of this study was to determine whether male and female Wistar rats with high ETOH consumption also exhibit higher intake of the psychostimulant phentermine (PHEN), and to analyze its relationship with MOR expression in the nucleus accumbens (Acb), ventral pallidum (VP), and ventral tegmental area (VTA). Rats of both sexes were classified as high or low consumers after a period of voluntary ingestion of 10% ethanol. Subsequently, self-administration of PHEN solution (0.1 mg/ml) was recorded. The results showed that females showed higher ETOH consumption, whereas males had higher PHEN consumption. High ETOH consumers did not show higher stimulant consumption. When MOR expression was examined, males showed higher density in the Acb and VP, while females showed higher density in the VTA. High ETOH consumers showed higher MOR expression in Acb than low consumers, regardless of sex. Taken together, these findings suggest that sex differences, such as MOR distribution, modulate the consumption of different drugs, which appear to be intrinsic differences that are not linked to a specific psychoactive substance use. Additionally, it was observed that high ETOH consumption does not necessarily indicate greater vulnerability to psychostimulant use.

BackgroundDespite established sex differences in disease risk and clinical presentation, most clinical machine-learning models treat sex as a simple covariate without explicitly incorporating detailed sex-specific clinical history. Whether such information improves predictive performance, clinical utility, and between-sex fairness in multimorbid populations remains unclear. MethodsUsing baseline data from the PLCO cohort (≈155,000 participants), we developed XGBoost models for prevalent disease identification by comparing a reference model based on shared predictors and biological sex with an augmented model incorporating sex-specific clinical history. Leave-one-center-out internal-external validation was performed across multimorbidity subgroups. Discrimination, calibration, clinical utility, and between-sex fairness were evaluated. A structural-missingness ablation was additionally performed to distinguish the contribution of the original sex-specific clinical values from that of their missingness pattern. ResultsSex-specific clinical history improved discrimination and calibration, with larger gains at higher multimorbidity burden. In the three-disease group, the augmented model achieved an AUC of 0.814 (95% CI 0.804-0.826), a PR-AUC of 0.624 (95% CI 0.577-0.672), and a Brier score of 0.172 (95% CI 0.165-0.180), outperforming the reference model. Decision-analytic utility was negligible in the single-disease setting but increased with multimorbidity burden. Structural-missingness ablation showed negligible gains from the missingness pattern alone (ΔAUC = 0.00017), whereas restoring the original sex-specific values yielded substantially greater improvement (ΔAUC = 0.01019). Performance gains did not consistently reduce between-sex disparities, with effects varying across disease phenotypes and multimorbidity settings. Conclusions Sex-specific clinical history provides clinically relevant predictive information beyond predictors shared across women and men, with the greatest value observed in more complex multimorbid settings. However, improvements in predictive performance and clinical utility do not necessarily translate into reduced between-sex disparities. These findings support joint evaluation of predictive performance, calibration, clinical utility, and fairness when assessing the value of sex-specific information in clinical AI.

To investigate the sex-related differences in clinical manifestations, sleep characteristics, and symptom evolution of Chinese patients with narcolepsy type 1 (NT1). A total of 1415 NT1 patients were recruited from Peking University People's Hospital and other sleep centers in China. Clinical and sleep characteristics were compared between sex groups across different age groups adjusted for potential confounders. Telephone interviews assessed the evolution of daytime sleepiness and cataplexy frequency in a subset of patients. In children with NT1, girls showed a slight higher spontaneous arousal index during sleep compared with boys (9.31 ± 5.81 vs. 8.2 ± 5.13). Girls had less sleep apnea hypopnea index ≥1 than boys (56.6% vs. 65.9%). Although both had high HLA-DQB1*06:02 positivity, girls had a lower rate than that in boys (96.1% vs. 99.2%). In adults, women experienced longer diagnostic delays (11.2 ± 12.2 vs. 6.54 ± 7.79 years). Women had less apnea-hypopnea index ≥15 (22.2% vs. 46.1%) and less sleep-onset rapid eye movement periods (3.06 ± 1.27 vs. 3.6 ± 1.31) on MSLT than men. Hypocretin-1 levels were slight higher in women versus men (27.2 ± 19 vs. 20.2 ± 12.4). Patients with childhood-onset NT1 diagnosed in adulthood showed different sex-related differences in these parameters. At follow-up, untreated male NT1 showed improvements in cataplexy frequency and daytime sleepiness (17.5 ± 4.61 vs. 13.8 ± 5.88) than female NT1. Sex associates with NT1 features differently in children and adults. Prospective longitudinal studies are warranted to clarify sex-specific disease progression and optimize management strategies for NT1.

Sex differences in the prevalence, age of onset of symptoms, and symptom presentation have been widely described in autism spectrum disorders, yet the mechanisms underlying these sex differences remain poorly characterized. Exposing rats prenatally to valproic acid (VPA) is widely used as a model to study autism-like phenotypes. Using this model, sex-specific neuroanatomical and functional characteristics were examined in adolescent rats. We found sex differences in cortical pyramidal neuron complexity, spine density, and morphology in VPA-prenatally exposed animals. The expression of autism has been linked to various processes such as inflammation, cell signalling, endothelial function, and myelination. Sex-specific analysis of cortical gene expression showed that male VPA-prenatally exposed rats had elevated expression of genes related to neuropeptide signaling (Pdyn, Adora2a, Drd2), whereas female VPA-prenatally exposed rats had lower expression of genes related to vascular permeability (Angptl4, Cldn5) and inflammation (Cyr61, Usp18). Dimethyl fumarate, an activator of nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and clinically approved to treat multiple sclerosis, alleviated VPA-induced behavioural alterations in object recognition, anxiety-like behaviour, and social behaviour in female VPA-exposed rats. In addition, dimethyl fumarate corrected the associated VPA-induced changes in neuronal oscillatory power and cross-frequency coupling and suppressed microglial activity, with the latter occurring selectively in female animals. Together, these findings indicate sex as an essential consideration in the development of novel pharmacotherapies for autism. Dimethyl fumarate had therapeutic properties in VPA-prenatally exposed female rats, however further studies examining its therapeutic efficacy in other models of autism are required.

Sex differences in sleep-disordered breathing (SDB) are well recognized, but whether equivalent disease severity confers similar physiologic and symptomatic burden remains uncertain. Data from a community-based cohort of 826 adults free of major cardiopulmonary and metabolic comorbidity were analyzed. Study participants were classified as having no SDB (apnea-hypopnea index [AHI] <5 events/h), mild SDB (5.0-14.9 events/h), or moderate-to-severe SDB (≥15 events/h). Within each stratum, men and women were matched 1:1 on age, race, body mass index, and AHI. Objective polysomnographic measures and subjective assessments of daytime sleepiness, insomnia symptoms, and quality of life were compared using regression models with sex-by-severity interaction terms. Objective sleep measures were largely similar between sexes in the absence of SDB. With mild SDB, men slept 22.2 min less than women (p = 0.006) and had higher overall and NREM arousal rates (p = 0.002 and p = 0.001, respectively). With moderate-to-severe SDB, men had lower sleep efficiency (-8.6%; p < 0.001), longer wake after sleep onset (+22.7 min; p = 0.001), and greater daytime sleepiness (p = 0.06), whereas women had more insomnia symptoms and lower physical and mental quality-of-life scores (both p = 0.001). Across all AHI strata, women had greater N3 sleep (all p < 0.003). Significant sex-by-severity interactions were observed for sleep efficiency, wake after sleep onset, and daytime sleepiness (all p ≤ 0.006). Comparable levels of SDB severity carry different physiologic and symptomatic consequences in men and women, indicating that assessment should extend beyond AHI alone to include sleep disruption, symptom profile, and functional impact.

Working memory (WM) depends on coordinated interactions among distributed brain systems. Although sex differences in WM have been widely studied, most previous work has focused on group-level activation differences. As a result, it remains unclear whether males and females can be characterized by distinct functional connectivity-based models of WM performance. We analyzed 622 participants (311 females and 311 males) from the Human Connectome Project who were retained after data quality and completeness screening, with the male and female groups matched on relevant covariates and showing no significant between-group differences. Using n-back task functional magnetic resonance imaging data and corresponding behavioral measures, we constructed connectome-based predictive models of WM performance separately in females and males. WM performance could be predicted in both sexes. However, cross-sex validation showed that the female-trained model significantly predicted male WM performance, whereas the male-trained model did not significantly predict female WM performance. To examine factors associated with this asymmetry, we analyzed inter-subject consistency within each sex group. Females showed greater within-sex neural dynamic consistency than males across multiple brain regions, and subsampling analyses further linked higher inter-subject consistency to greater predictive feature stability and better cross-sex prediction performance. Importantly, sex differences extended beyond model performance to the predictive connectivity patterns themselves, mainly involving higher-order cognitive control and lower-level visual systems. Functional connectivity gradient analyses provided convergent support for this pattern. Together, these findings deepen our understanding of WM network mechanisms and provide a basis for understanding sex-related differences in WM impairment and for exploring potential interventions. The online version contains supplementary material available at 10.1007/s11571-026-10525-0.

Reinterventions after lower extremity revascularization (LER) for peripheral arterial disease (PAD) are common. Previous studies observed increased reintervention rates in females; however, the frequency of reinterventions between males and females has not been compared. This study highlights sex differences in outcomes of LER focusing on reintervention patterns. A retrospective analysis of patients undergoing LER for PAD between 2013 and 2020 at a tertiary care center was conducted. Perioperative and long-term outcomes were compared, as well as reinterventions after initial LER between males and females. A total of 1,987 patients underwent LER, of whom 736 (37%) were female. Females were older (70.5 vs. 69.2, P = 0.015) and more likely to be Black (18% vs. 12.3%, P = 0.003). Males were more likely to have coronary artery disease (59.3% vs. 45.6%, P < 0.0001), diabetes (60.2% vs. 51.9%, P = 0.0003), and renal insufficiency (20.1% vs. 15.8%, P = 0.016). Perioperative complications were similar except return to operating room, which was higher in males (17.7% vs. 13.9%, P = 0.029). After mean follow-up of 3.1 years, there was no difference in major amputation or mortality. Kaplan-Meier survival curves showed no difference in freedom from MALE and MALE-free survival. Females were more likely to have 2 or more ipsilateral reinterventions (P = 0.030) and higher mean ipsilateral reinterventions (2.0 ± 1.5 vs. 1.7 ± 1.4, P = 0.050). Despite fewer comorbidities, females underwent higher frequency of reinterventions with no difference in major amputation or mortality. Effectiveness of reinterventions in females versus males warrants further investigation.

Depression is a highly heterogeneous disorder with a similarly heterogeneous neurobiological background. Understanding separate depressive phenotypes, driven by distinct aetiological pathways like early trauma and neurobiological contributors, can improve treatment. Furthermore, sex differences must be considered, as both the development and treatment of depression may be sex-specific. We aimed to investigate the sex-dependent association between polygenic risk for chronotypes, childhood traumas, and depression. In a discovery sample of 273,033 participants GWASs were ran and polygenic risk scores (PRS) were calculated in a target sample of 25,476 participants, separately for morning and evening chronotypes. Effects of chronotype-PRS in interaction with childhood adversities were analysed. We identified 39 significant lead-SPNs (single nucleotide polymorphisms) and 44 genes associated with morning chronotype, and 69 significant lead-SNPs and 76 genes for evening chronotype. Heritability was comparable, at 12.1% for morning and 11.8% for evening chronotypes. No significant main effect of either chronotype-PRS was found on depressive symptom scores, however, in interaction with childhood traumas, morningness-PRS showed a significant effect on depressive symptom scores in women. Our findings highlight important sex differences in the aetiological role of known risk factors for depression, such as chronotype or early trauma, and may have implications in the prevention of mood disorders in those genetically vulnerable and exposed to early risk factors.

Sex differences in outcomes after percutaneous coronary intervention (PCI) remain debated, and evidence from large Asian populations is limited. We analyzed 136 109 patients (101 301 men; 34 808 women) without prior major cardiovascular events who underwent PCI between 2004 and 2020, using data from the Korean National Health Insurance Service. Baseline characteristics, in-hospital events, and long-term clinical outcomes were compared. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, nonfatal myocardial infarction, repeat PCI, coronary artery bypass surgery, and ischemic stroke. Women were older and had higher rates of hypertension and diabetes, whereas men had higher smoking and alcohol consumption rates. In-hospital adverse events, including death, ischemic stroke, and bleeding were more frequent in women ( P < 0.001). However, during a mean follow-up of 3.1 years, women had a lower incidence of MACE compared to men (58.0 vs. 65.3%; P < 0.001). Multivariable Cox regression confirmed that female sex was independently associated with a lower long-term risk of MACE (adjusted hazard ratio: 0.69-0.82, P < 0.001). Despite worse in-hospital outcomes, women had a more favorable long-term prognosis after PCI compared to men. These findings emphasize the importance of sex-specific approaches in risk assessment and long-term management after PCI.