1,720,976 research outputs found
Update on male hormonal contraception
Full text linkDespite increases in female contraceptive options, 40–45% of pregnancies across the world are still unplanned. While several effective female contraceptive methods have been developed, contraceptive choices for men are still limited to the male condom with its high failure rates and to vasectomies, which are invasive and not reliably reversible. Several studies have demonstrated a great interest among men and women for effective, reversible, and safe male contraceptive methods. Over the years, numerous studies have been performed to develop male hormonal and nonhormonal safe and effective contraceptives. A variety of new molecules are under development as oral or transdermal hormonal contraceptives for men demonstrating few side effects. In our overpopulated world, the development and commercialization of a male contraceptive method that will allow both men and women to take an active role in family planning is mandatory and further research on this topic is required
Air pollution and gynecological diseases
No full textImplementation of industry and vehicular traffic led to a great diffusion of air pollution with a major impairment of air quality especially in urban areas over the last decades. Air pollution is an environmental contaminant containing thousands of harmful compounds derived from exhaust emissions containing a mixture of gaseous, liquid, and solid substances. Evidences associating air pollution exposure to respiratory and cardiovascular systems have been growing in the last decades as these are the most frequently affected organs. Anyway, constantly increasing data are available regarding an increased risk of women’s health disorders after exposure to air pollution. In fact, recent studies have underlined that common and widespread air pollutants could affect both reproductive health and pregnancy outcomes. Indoor and outdoor air pollution has been associated to a higher risk of malignant and benign gynecological diseases. Furthermore, exposure to toxic air pollution particles can have a detrimental role on ovarian function starting from the intrauterine time of life both affecting time of puberty and of menopause but also harming the fertility potential of women. It has been demonstrated that air pollutants are able to decrease the success rate of IVF techniques. These results are derived from animal and human epidemiological data, even if some limitations of the available literature should be acknowledged; in fact, evidences of the biological mechanisms are still limited, and the reliability of information on personal exposures is sometimes scarce. Future toxicological and clinical studies are mandatory to confirm previously hypothesized associations and to clarify the involved mechanism. If possible, they should be also useful in identifying which subgroups of subjects are most prone to air pollution exposure in order to implement public health strategies and preventive efforts against the dangerous effects of air pollution
Air pollution effects in pregnancy
No full textGreater diffusion of industries and vehicular traffic caused a major impairment of air quality especially in urban areas.
The adverse impact on respiratory and cardiovascular systems and the association with lung cancer have been highlighted in several reports. Furthermore, recent evidences highlighted air pollution as a risk factor for the development of type 2 diabetes. It is well known that children, elderly, and pregnant women are more vulnerable to the effects of air pollution. Embryos and fetuses are particularly subject to damage from air pollutants given the susceptibility of developing organs. Consistent data from different continents have demonstrated an increased risk of negative gestational outcomes in mothers exposed to air pollution. In particular, air pollutants have been associated with several adverse birth outcomes such as preterm delivery and low birth weight. However, from available data it is not clear whether the effects are due to a specific pollutant or to the interactions of different molecules, and it is still not clear in which trimester the exposure is more harmful to the fetal development. The exact mechanism of maternal air pollution exposure on adverse birth outcomes is still partially unknown, but some authors hypothesized that oxidative stress, inflammation, and hemodynamic changes associated with air pollutants can impair oxygen and nutrient transport to the fetus. Despite an ever-growing volume of studies, scientific literature regarding this topic is still characterized by enormous heterogeneity in designs and settings leading to several inconclusive results. Further research is therefore needed to identify molecules and mechanism through which air pollution can impair gestational outcomes. These data could lead to implementation of prevention politics and help health-care providers to give useful and more detailed information to mothers
Therapy with Anti-androgens in Gender Dysphoric Natal Males
No full textIn adult gender dysphoric natal males, where full development of male secondary sexual characteristics has already taken place, the goal of cross-sex hormonal therapy is the suppression of testosterone secretion to achieve regression of male characteristics and the development of feminine secondary sexual characteristics. For this reason, in transwomen an almost complete suppression of endogenous androgen production and action with combined administration of estrogens is required. The aim of therapy is to maintain hormone levels within the normal physiological range for the individual’s desired gender. Practice guidelines describe eligibility for puberty suppression in adolescents that have met the criteria for gender dysphoria and that have experienced at least Tanner stage 2 puberty. In these subjects if dysphoria persists, cross-hormonal therapy is generally started after 16 years of age
Urogenital and Reproductive Disorders
No full textBiological and social gender differences should always be acknowledged when considering the presentation, the severity, the treatment, and the consequences of 6 both reproductive and general health diseases. Gender has a significant impact on health, and it should be considered in the development of strategies for prevention and treatment of health conditions.
• Biological differences can make women more prone than men to certain medical conditions during reproductive years. Women are more susceptible to HIV and other sexually transmitted infections with potential long-term consequences.
• Even if a large number of men would welcome the opportunity to use male contraceptive methods and recognize that sharing family planning should be an individual right other than responsibility, family planning continues to be demanded to women because options available for male contraception are still obsolete and affected by high failure rates. Women are still often stigmatized and blamed in case of infertility even if infertility can have also a male factor.
• Also after menopause, biological differences make women more susceptible to certain medical conditions such as genital organ prolapse, urinary incontinence, and vaginal atrophy with related sexual dysfunction.
• In certain societies women continue to face discrimination or gender prejudice limiting their access to knowledge and health resources and making them more susceptible to diseases. In rural and poor communities, women’s healthcare needs are barely addressed, and also in countries with a higher progress, there is still a need for continuous investment in greater gender equality
Bone mineral density, body composition and metabolic profiles in adult women with complete androgen insensitivity syndrome and removed gonads using oral or transdermal estrogens
No full textObjectives: To assess bone health in adult women with complete androgen insensitivity syndrome (CAIS) and removed gonads compared with age-matched healthy controls. To evaluate the e ects of transdermal oestradiol 2 mg or oral estradiol valerate 2 mg on bone, biochemical and clinical characteristics. Design: Cohort study. Methods: Bone, body composition and anthropometric parameters were assessed in 32 adult CAIS and 32 healthy controls. In 28 cases, CAIS evaluations of metabolic, bone and body composition were performed also after a maximum of 6 years of therapy. Results: Lumbar, femoral and total body bone mineral density (BMD) were signi cantly lower in those with CAIS when compared with controls. The prevalence of vertebral osteoporosis and osteopenia was signi cantly higher in the CAIS group (P = 0.038, OR = 9.67, 95% CI: 1.13–82.83 and P = 0.012, OR= 3.85, 95% CI: 1.34–11.16, respectively). Prevalence of femoral osteopenia was signi cantly higher in the CAIS group (P = 0.0012, OR = 7.93, 95% CI: 2.26–27.9). During follow-up, lumbar BMD signi cantly increased suggesting a signi cant e ect of treatment on BMD (P = 0.0016), while femoral and total body BMD did not show any signi cant change. Total body BMD values were positively associated to the duration and route of oestrogen administration and to serum estradiol levels. Transdermal administration of estrogens was associated with better total body BMD in comparison to oral administration. Conclusions: Our results reinforce the importance of adequate hormonal treatment for women living with CAIS, suggesting a better e ect from the transdermal route over the oral route
Mental Health and Endocrine Telemedicine Consultations in Transgender Subjects During the COVID-19 Outbreak in Italy: A Cross-Sectional Web-Based Survey
No full textBackground: Transgender people are a vulnerable group with a higher incidence of mental health issues and,
during the COVID-19 outbreak, they may have faced psychological, physical and social obstacles.
Aim: To evaluate the impact of the pandemic and the access to health care services during the COVID-19
pandemic on the mental health of the transgender people living in Italy.
Methods: An anonymous web-based survey was conducted among transgender people living in Italy.
Outcomes: The survey consisted of 41 questions (to address socio-demographic and COVID-19 related variables,
general health problems and trans-related health issues) and three validated questionnaires (the Impact of
Event Scale [IES], the Beck Depression Inventory [BDI-II] and the SF-12.
Results: In total 108 respondents were included in the analysis, of these 73.1% were transmen and 26.9% transwomen.
The mean age was 34.3 § 11.7 years with 88.9% undergoing gender affirming hormonal treatment
(GAHT). Of these respondents 55.6% were not working during the COVID-19 pandemic, mainly because they
lost their jobs due to the lockdown (30.5%) or because they were otherwise unemployed (25.0%). Only four subjects
were quarantined at home because of a positive COVID-19 swab. The mean total IES score was 21.1 § 14.9
with 24.1% of subjects scoring over the cut-off score of 26 thereby suggesting a moderate-to-severe impact of the
pandemic event. Mean BDI score was 8.6 § 8.4. SF-12 total mean score was 96.1 § 11.9 with a Mental Component
Summary (MCS) score of 42.8 § 9.1. Access to endocrinological consultations for hormonal prescription via
telemedicine services was associated with better IES total scores (P = .01).
Clinical Implications: Our results highlight the impact of the pandemic on the mental health of this particular
population and how telemedicine services may serve to mitigate negative psychological effects.
Strengths & Limitations: Internet-based surveys may select a group of people not necessary representative of
the whole population. The self-reporting bias should also be considered. Those who responded to our survey
were mainly from northern Italy were COVID-19 has had a greater impact.
Conclusion: Vulnerable groups such as the transgender population should receive more consideration also during
pandemic events and their access to health services especially for endocrine and mental health care should be
improved. A nationwide plan for the extended use of telemedicine should be established with targeted intervention
to reduce psychological distress
Problematiche endocrine della disforia di genere
No full textIl ruolo dell’endocrinologo nel percorso di transizione del soggetto con disforia di genere (DG) è fondamentale, in relazione alla necessità emergente di coniugare le indicazioni degli standard d’intervento con l’opportunità di effettuare terapie sempre più individualizzate. Questi nuovi scenari richiedono risposte efficaci sul piano della salute generale e dell’effetto fenotipico richiesto. All’insegna di queste considerazioni è doveroso valutare gli aspetti salienti dei trattamenti ormonali nelle due sottopopolazioni di soggetti con DG che necessitino di tale trattamento
Prevalence and Psychopathological Determinants of Sexual Dysfunction and Related Distress in Women With and Without Multiple Sclerosis
No full textIntroduction:Sexual dysfunction (SD) is common but still underdiagnosed in women with multiple sclerosis(MS); in fact, the lack of a consistent use of validated diagnostic tools makes the prevalence of SD and relateddistress difficult to define precisely.Aim:To assess the prevalence of SD in Italian women with MS compared with age-matched healthy controlsubjects (HC) and the association with demographic, psychological, and MS-related characteristics.Methods:The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale were administered to153 women with MS and 153 HC. Demographic, gynecologic, and neurologic data were obtained. Disabilitywas assessed using the Expanded Disability Status Scale. Psychological symptoms were evaluated in MS patientswith Profile of Mood State and the Beck Depression Inventory II.Main Outcomes Measures:Prevalence of SD and sexual distress in women with MS compared with HC.Results:Among women sexually active in the last month, we found an increased prevalence of SD in MS patientscompared with HC subjects (42.0% vs 16.0%,P1⁄4.0001). The prevalence of dysfunctional FSFI global scores(<26.55) was higher in women with MS compared with HC (49.6% vs 33.6%,P1⁄4.014). In the MS group, theprevalence of SD was similar between pre- and post-menopausal women. Both premenopausal and postmenopausalMS women presented a greater prevalence of SD if compared with the premenopausal and postmenopausal HCgroups (30/79 [37.9%] vs. 5/74 [6.8%],P1⁄4.0001 and 20/40 [50.0%] vs 16/57 [28.1%],P1⁄4.03, respectively). Anegative correlation was observed between the FSFI global score and age and Expanded Disability Status Scale.Depressive symptoms were more common in women with MS and SD than in those without.Clinical Implications:This study suggests that sexual function investigation should always be a standard part ofthe consultation with healthcare professionals for MS.Strength & Limitations:The strength of this study was the comparison with an age-matched healthy controlgroup and the use of validated questionnaires to assess both sexual function and sexual distress. Larger andmulticenter studies may further support ourfindings.Conclusion:In our cohort, the prevalence of SD and sexual distress was higher in women with MS compared tothe HC group. Age, disability, and depressive symptoms were associated with increased SD
- …
