Internalized Body Stigma as a Barrier to Accessing Preventative Healthcare for Young Women

Loss, shame and secrecy in women's experiences of a vulval skin condition: A qualitative study

Vulval lichen sclerosus (LS) is a chronic dermatological condition affecting the anogenital area, causing intense itching, pain and bleeding. It can change the terrain of the vulva, causing loss of vulval anatomy and altered texture and appearance of the skin. There has been little research into how women experience the materialities of a dermatological vulval disease. We aimed to understand experiences of living with LS, using a feminist lens to examine the influence of societal attitudes towards women's bodies and the vulva. We conducted qualitative interviews with 20 women with vulval LS, taking a critical feminist grounded theory approach. While we found that women's experiences of vulval LS symptoms was normalised as a part of womanhood, there was a silencing of speech about the vulva generally, and vulval symptoms more specifically. This caused profound shame and loneliness, and was a barrier to disclosing and seeking help for vulval symptoms, leading to delayed diagnosis and disease progression. Loss of vulval architecture resulted in a loss of (feminine) self and the sense of a body which was whole.

Navigating the Challenges: A Comprehensive Review of Adolescent Gynecological Problems

This comprehensive review delves into the spectrum of adolescent gynecological problems, shedding light on the multifaceted challenges faced by individuals between the ages of 10 and 19. Covering normal developmental changes, common issues such as menstrual disorders, and the intricate interplay of psychosocial and cultural factors, the review provides a holistic understanding of adolescent gynecological health. Key findings underscore the importance of tailored education, destigmatizing reproductive health discussions, and recognizing the critical role of mental health in overall well-being. The conclusion issues a compelling call to action, urging healthcare providers to adopt patient-centered practices, educators to integrate comprehensive sexual education, and policymakers to advocate for inclusive policies. This review serves as a valuable resource, guiding collective efforts to enhance the well-being of adolescents as they navigate the challenges of gynecological health on their journey to adulthood.

The EMeRGE theory of emerging adult-aged women's sexual and reproductive health self-management: A grounded theory study

AIMS

To explore how emerging adult-aged women self-manage their sexual and reproductive health and to generate a grounded theory of these self-management processes.

DESIGN

Grounded theory methods using a constructivist approach.

METHODS

Between September 2019 and September 2020, 18- to 25-years-old women (n = 13) were recruited from a 4-year university, a 2-year community college, and neighbourhoods surrounding the institutions of higher education. Individual interviews were transcribed verbatim and qualitatively analysed using a constant comparative method and inductive coding.

RESULTS

The theory purports that core processes of sexual and reproductive health self-management used by the women in this study included both passive and (re)active processes. These processes expanded upon and/or maintained the women's accessible sexual and reproductive health knowledge, behaviour and beliefs, defined as the sexual and reproductive health repertoire. The processes appeared to be cyclical and were often initiated by a catalysing event or catalyst and resulted in conversations with confidantes, or trusted individuals. A catalyst was either resolved or normalized by expanding or maintaining the sexual and reproductive health repertoire.

CONCLUSION

The resulting theory, EMeRGE Theory, offers insight into the complex and cyclical processes emerging adult-aged women use to simultaneously develop and adapt their foundational sexual and reproductive health knowledge, behaviours and beliefs.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This explication of emerging adult-aged women's sexual and reproductive health self-management processes can be used by nurses and nurse researchers to better address this population's unique health needs.

IMPACT

The EMeRGE Theory provides valuable guidance for future exploratory and intervention research aimed at improving the health and well-being of emerging adult-aged women.

REPORTING METHOD

The authors adhered to the Consolidated Criteria for Reporting Qualitative studies (COREQ) in preparation of this publication.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Optimizing menstrual health and hygiene management in the U.S.: A mixed-methods study of the barriers and the role of healthcare professionals

OBJECTIVE

Menstrual health (MH) practices have been understudied in the U.S. This study aimed to assess patient and medical staff views of MH.

METHODS

The mixed-methods approach included medical staff and patient surveys, and patient interviews on MH experiences. Quantitative survey data generated descriptive statistics. Thematic content analysis (TCA) evaluated qualitative interviews. Convergent Parallel Triangulation Analysis (CPTA) evaluated both datasets in tandem.

RESULTS

The medical staff survey's response rate was 72% (54 participants/75 invited staff). Only 7% (4/54) of staff consistently asked patients about menstrual products (MP), while 54% (29/54) were concerned about patients affording MP. The patient survey's response rate was 90% (186/207); 22% (40/186) of respondents showed MH insecurity, which was associated with annual income <$30,000 (p < 0.01); 45% (85/186) missed commitments during menses; 53% (98/186) never discussed MP with healthcare providers. To reach thematic saturation 10/17 invited patients were interviewed. Five themes were identified through TCA: menstruation as a social barrier; menstrual education comes from a variety of sources; MP choice is a balance of comfort, cost, and convenience; patients value relationships with their providers; adolescence is the window for establishing MH. Three threads were identified through CPTA: MH insecurity is common; MH screening and education are limited; menstruation impacts patients' ability to engage in daily activities.

CONCLUSION

A holistic approach toward MH is needed; education and screening are inconsistent. Comprehensive MH can enhance a patient's understanding of and capacity to advocate for their health. These findings are specific to this population and may not be generalizable.

Menstrual Health and Hygiene among Adolescents in the United States

STUDY OBJECTIVE

Menstrual health in adolescents has been understudied in the United States. We aimed to assess patient and provider perspectives surrounding menstrual health management and screening.

DESIGN

Our mixed-methods approach consisted of provider surveys, patient surveys, and patient interviews.

SETTING

Participants were recruited from a pediatric gynecology practice or an adolescent medicine clinic at an urban tertiary academic center.

PARTICIPANTS

Providers were pediatrics faculty or residents. Patients aged 13-24 years were eligible.

INTERVENTION

Participants completed an anonymous survey or semi-structured interview about their experiences with menstrual health.

MAIN OUTCOME MEASURES

Descriptive statistics and thematic content analysis were used for quantitative and qualitative data, respectively. Convergent parallel analysis elucidated key findings in both data sets.

RESULTS

The provider survey response rate was 65% (69/106); 15% (9/69) of providers consistently asked patients about menstrual products, whereas 44% (27/68) were concerned patients could not afford products. The patient survey response rate was 85% (101/119); 19% (19/101) of respondents reported menstrual hygiene insecurity, 55% (55/101) missed commitments during menses, and 45% (45/101) discussed menstrual products with providers. Fifteen patients were invited for qualitative interviews; 10 were conducted, and thematic saturation occurred. Interviews highlighted the importance of comprehensive early menstrual health education and providers' role in menstrual management.

CONCLUSION

Adolescence is a crucial point of entry into health care. Because taboos surrounding menstruation could limit access to health care, menstrual health education must be emphasized. Menstrual health education is provided piecemeal by parents, schools, and providers. Current practice should be reevaluated to consider comprehensive educational approaches in which health care leads.

Exploring Audience Engagement and Critical Narrative Intervention With the Celling Sex Film

Young women who trade sex experience high rates of stigma that exacerbate existing health inequities. The products of participatory visual methodologies show promising potential for challenging stigma. In total, 15 young women who trade sex created individual brief videos to share their experiences. Following a participatory analysis, the videos were edited into one composite movie to highlight key messages. Eight facilitated screenings (cohosted by participant filmmakers and research team members) were organized with diverse community and health organizations. Audiences were led through a series of interactive writing, drawing, viewing, and discussion activities. Sessions were audio recorded, transcribed verbatim, and inductively analyzed to assess the impacts of the film on audiences. Audience reactions were categorized into four overarching themes to describe main impacts: consciousness raising, commitments to practice and organizational change, effectiveness of the approach, and limitations. Audience responses demonstrated that facilitated screenings can challenge harmful stereotypes and help viewers consider pathways to enact positive change in their personal and professional lives. However, changing deep-rooted patterns of stigma takes time, dedication, and accountability.