Provoked vestibulodynia, the most common form of vulvodynia (unexplained pain of the vulva), is a prevalent, idiopathic pain disorder associated with a history of recurrent candidiasis (yeast infections). It is characterized by vulvar allodynia (painful hypersensitivity to touch) and hyperinnervation. We tested whether repeated, localized exposure of the vulva to a common fungal pathogen can lead to the development of chronic pain. A subset of female mice subjected to recurrent Candida albicans infection developed mechanical allodynia localized to the vulva. The mice with allodynia also exhibited hyperinnervation with peptidergic nociceptor and sympathetic fibers (as indicated by increased protein gene product 9.5, calcitonin gene–related peptide, and vesicular monoamine transporter 2 immunoreactivity in the vaginal epithelium). Long-lasting behavioral allodynia in a subset of mice was also observed after a single, extended Candida infection, as well as after repeated vulvar (but not hind paw) inflammation induced with zymosan, a mixture of fungal antigens. The hypersensitivity and hyperinnervation were both present at least 3 weeks after the resolution of infection and inflammation. Our data show that infection can cause persistent pain long after its resolution and that recurrent yeast infection replicates important features of human provoked vulvodynia in the mouse.

Our findings suggest that the transgender population is a racially diverse population present across US communities. Inequalities in the education and socioeconomic status have negative implications for the health of the transgender population.

BackgroundClinical research on psychological aspects of disorders of sex development (DSD) has focused on psychosexual differentiation with relatively little attention directed toward parents' experiences of early clinical management and their influence on patient and family psychosocial adaptation.ObjectivesTo characterize parental experiences in the early clinical care of children born with DSD.Study DesignContent analysis of interviews with parents (n = 41) of 28 children, newborn to 6 years, with DSD.ResultsFour major domains emerged as salient to parents: (1) the gender assignment process, (2) decisions regarding genital surgery, (3) disclosing information about their child's DSD, and (4) interacting with healthcare providers. Findings suggested discordance between scientific and parental understandings of the determinants of "sex" and "gender." Parents' expectations regarding the benefits of genital surgery appear largely met; however, parents still had concerns about their child's future physical, social and sexual development. Two areas experienced by many parents as particularly stressful were: (1) uncertainties regarding diagnosis and optimal management, and (2) conflicts between maintaining privacy versus disclosing the condition to access social support.ConclusionsParents' experiences and gaps in understanding can be used to inform the clinical care of patients with DSD and their families. Improving communication between parents and providers (and between parents and their support providers) throughout the early clinical management process may be important in decreasing stress and improving outcomes for families of children with DSD.

Pervasive gendered inequities and norms regarding the subordination of women give Ghanaian men disproportionately more power than women, particularly in relation to sex. We hypothesize that lack of sexual empowerment may pose an important barrier to reproductive health and adoption of family planning methods. Using the 2008 Ghana Demographic Health Survey, we examine the association between women's sexual empowerment and contraceptive use in Ghana among nonpregnant married and partnered women not desiring to conceive in the next three months. Increasing levels of sexual empowerment are found to be associated with use of contraceptives, even after adjusting for demographic predictors of contraceptive use. This association is moderated by wealth. Formal education, increasing wealth, and being in an unmarried partnership are associated with contraceptive use, whereas women who identify as being Muslim are less likely to use contraceptives than those who identify as being Christian. These findings suggest that to achieve universal access to reproductive health services, gendered disparities in sexual empowerment, particularly among economically disadvantaged women, need to be better addressed.

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Objective We characterized U.S. women's preferred and usual sources of reproductive health care. Study Design Data were drawn from the Women's Health Care Experiences and Preferences Study, an internet survey of 1,078 women aged 18-55 randomly sampled from a national probability panel. We described and compared women's preferred and usual sources of care (women's health specialists including ob/gyns and family planning clinics, primary care, other) for Pap/pelvic exam, contraception and STI services using Chi-square, logistic regression, and kappa statistics. Results Among women reporting health service utilization (n=984, 92% overall; 77% Pap/pelvic; 33% contraception; 8% STI), women's health specialists were the most used sources of care for Pap/pelvic (68%), contraception (74%), and STI (75%) services. Women's health specialists were also the most preferred care sources for Pap/pelvic 68%, contraception 49%, and STI 35% services, while the remainder of women preferred primary care/other sources or not to get care. Differences in preferred and usual care sources were noted across sociodemographic groups, including insurance status and income level (p-values<0.05). Preference for women's health specialists was the strongest predictor of women's health specialist utilization for Pap/pelvic (aOR 48.8, 95% CI 25.9, 91.8, p<0.001) and contraceptive (aOR 194.5, CI 42.3, 894.6, p<0.001) services. Agreement between preferred and usual care sources was high for Pap/pelvic (85%, kappa 0.63) and contraception (86%; kappa 0.64) services;, disagreement (range 15%-22%) was associated with insurance, employment, income, race, and religion (p-values<0.05). Conclusion Women's preferences for and use of women's health specialists for reproductive health care has implications for efforts to define the role of ob/gyns and family planning clinics in current health systems.

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Nine in 10 midwife respondents have never inserted an IUD or implant immediately postpartum, but more than half indicated they would like the opportunity to provide these services. Our findings highlight opportunities to enhance the immediate postpartum LARC-related knowledge and skills of the midwife workforce. They also suggest that logistic and institutional barriers to immediate postpartum LARC access must be removed in order to make this evidence-based reproductive health service available to all women who desire it.