Lesbian and bisexual women's recommendations for improving the provision of assisted reproductive technology services

Qualitative focus groups were conducted with lesbian and bisexual women who were themselves or whose partners were in the process of trying to conceive (n = 6); who were biological parents of young children (n = 7); and who were nonbiological parents of young children or whose partners were currently pregnant (n = 10) to explore their donor insemination service needs and to provide recommendations for improved or additional services. The 10 recommendations generated by participants included providing cues that the service is lesbian and bisexual positive; offering lesbian- and bisexual-specific infertility support; providing opportunities for women to make informed choices about use of interventions consistent with their known or presumed fertility; and offering accessible services to known sperm donors, including gay men.     

Patient,provider, and system-level barriers and facilitators to addressing perinatal depression

Objective: To explore perinatal health care professionals’ perspectives on barriers and facilitators to addressing perinatal depression. Background: Perinatal depression is common and associated with deleterious effects on mother, foetus, child and family. Although the regular contact between mothers and perinatal health care professionals may make the obstetric setting ideal for addressing depression, barriers persist, and depression remains under-diagnosed and under-treated. Methods: Four 90-minute focus groups were conducted with perinatal health care professionals, including obstetric resident and attending physicians, licensed independent practitioners, nurses, patient care assistants, social workers and administrative support staff. Focus groups were transcribed, and resulting data were analysed using a grounded theory approach. Results: Participants identified patient-, provider- and system-level barriers and facilitators to addressing perinatal depression. Provider-level barriers included lack of resources, skills and confidence needed to diagnose, refer and treat perinatal depression. Limited access to mental health care and resources were identified as system-level barriers. Facilitators identified included targeted training for perinatal health care professionals’, structured screening and referral processes, and enhanced support and guidance from mental health providers. Conclusion: A complex set of interactions between women and perinatal health care professionals contributes to perinatal depression being untreated. Service gaps could be closed by addressing identified barriers through integrated obstetric and depression care and enhanced collaborations. Future intervention testing could include targeted training, improved access, and mental health provider support to empower perinatal health care professionals’ to address perinatal depression, and thereby improve delivery of depression treatment in obstetric settings.     

Canadian Refugee Women Are at Increased Risk of Postpartum Depression: How Can We Help?

Refugee women in Canada are at increased risk of postpartum depression (PPD) compared with Canadian-born women. Physicians specializing in women's health are in a unique position to intervene with refugee women experiencing PPD. Although there are common contributors to the development of PPD in both Canadian-born and refugee women, refugee women face a number of additional barriers to treatment. These can include factors unique to the refugee experience (e.g., family separation, uncertainty regarding legal status, social mores of the new country) as well as social determinants of health (e.g., poverty, language barriers, barriers to accessing health care). Some authors have argued that all recent immigrant women who are pregnant should be considered at risk for developing PPD and have stressed the importance of early intervention with this group. This commentary argues that effective strategies to address the needs of women refugees who are pregnant focus on the following areas: early identification of women at risk, advocacy efforts, and mitigation of broader relevant social factors (e.g., food insecurity, poverty, lack of social supports). In addition to these strategies, more research is needed to identify how factors interact to increase the risk of PDD in women refugees and to identify factors that protect against the development of PPD in this group.     

Social Justice Considerations for Lesbian and Bisexual Women's Health Care

Lesbian and bisexual women share much with heterosexual women such as the desire to parent and the risk for partner violence. However, these women have unique risks associated with heavy alcohol use, smoking, obesity, and nulliparity. As nurses become increasingly aware of the need for social justice advocacy for marginalized groups, they are in a good position to advocate for lesbian and bisexual women and to bring visibility to their poor treatment in the health care setting.     

Maternal psychological state and infant’s temperament at three months

Objective: The study aimed to investigate the possible relationship between maternal psychological state in the perinatal period and the child’s temperament at 3 months postpartum. Background: The perinatal period is a phase of intense psychological complexity which may increase the risk of the development, or a recurrence of psychological disturbances in parents. The current literature highlights the potential negative effects of a perturbed maternal psychological state on fetal and newborn development. Among the consequences of fetal exposure to maternal states of depression or anxiety are increased inconsolable crying and sleep disturbance in the newborn, difficult temperament, motor and cognitive development delays in children and a higher risk of depression in adolescence. Methods: A longitudinal design using self-report measures of maternal mood, and maternal report of the infant’s temperament, was used. The sample comprised 107 Italian, low-risk nulliparous women. Maternal and infant variables were assessed in the third trimester of pregnancy and at 3 months postpartum. The variables measured included: maternal depression, anxiety, prenatal attachment, alexithymia, social support, maternal bonding with parents, stressful events, and the infant’s temperament. Results: Higher scores of antenatal depression and postnatal state anxiety were independent predictors of increased temperamental difficulties of the baby. Conclusion: The results support the hypothesis that maternal perinatal states of depression or anxiety are associated with increased difficulty in the temperament of the baby as perceived by mothers. This therefore supports the need for prevention-treatment programmes from the early stages of pregnancy.     

Depression and Anxiety Disorders During Multiple Pregnancy and Parenthood

Depression or anxiety disorders may affect more than 25% of multiple birth parents during the perinatal period. Such parents often are uninformed, suffer in silence and fear, and are reticent to seek help. When depression, panic attacks, and obsessive-compulsive disorder are not recognized or are left untreated, parent health, parent-infants interaction, child development, and family stability may be seriously compromised. Nurses, as partners in care at the family and community levels, have a pivotal role to play in prevention-focused health, education, and social support programs; the identification of parents at risk; and the early recognition and support of women and families affected by these disorders.     

Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States

BackgroundSexual minority (lesbian, bisexual, mostly heterosexual) young women face many sexual and reproductive health disparities, but there is scant information on their experiences of chronic pelvic pain, including an absence of information on prevalence, treatment, and outcomes.AimThe purpose of this study was to describe the characteristics of chronic pelvic pain experiences of young women by sexual orientation identity and gender of sexual partners.MethodsThe analytical sample consisted of a nationwide sample of 6,150 U.S. young women (mean age = 23 years) from the Growing Up Today Study who completed cross-sectional questionnaires from 1996 to 2007.OutcomesAge-adjusted regression analyses were used to examine groups categorized by sexual orientation identity (completely heterosexual [ref.], mostly heterosexual, bisexual, lesbian) and gender of sexual partner (only men [ref.], no partners, both men, and women). We examined differences in lifetime and past-year chronic pelvic pain symptoms, diagnosis, treatment, and quality of life outcomes. Sensitivity analyses also examined the role of pelvic/gynecologic exam history and hormonal contraceptive use as potential effect modifiers.ResultsAround half of all women reported ever experiencing chronic pelvic pain, among whom nearly 90% had past-year chronic pelvic pain. Compared to completely heterosexual women, there was greater risk of lifetime chronic pelvic pain among mostly heterosexual (risk ratio [RR] = 1.30, 95% confidence interval [CI]: 1.22–1.38), bisexual (RR = 1.30, 95% CI: 1.10–1.52), and lesbian (RR = 1.23, 95% CI: 1.00–1.52) young women. Additionally, compared to young women with only past male sexual partners, young women who had both men and women as past sexual partners were more likely to report chronic pelvic pain interfered with their social activities (b = 0.63, 95% CI: 0.25–1.02), work/school (b = 0.55, 95% CI: 0.17–0.93), and sex (b = 0.53, 95% CI: 0.05–1.00).Clinical ImplicationsHealthcare providers, medical education, and field-wide standards of care should be attentive to the way sexual orientation-based healthcare disparities can manifest into differential prognosis and quality of life outcomes for women with chronic pelvic pain (particularly bisexual women).Strengths & LimitationsOur study is the first to examine a variety of chronic pelvic pain outcomes in a nationwide U.S. sample across different outcomes (ie, past-year and lifetime). Though limited by sample homogeneity in terms of age, race, ethnicity, and gender, findings from this article provide foundational insights about chronic pelvic pain experiences of sexual minority young women.ConclusionOur key finding is that sexual minority women were commonly affected by chronic pelvic pain, and bisexual women face pain-related quality of life disparities.Tabaac AR, Chwa C, Sutter ME, et al. Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States. J Sex Med 2022;19:1012–1023.     

Primary care of the lesbian/gay/bisexual/transgendered woman patient

Lesbian patients comprise a special population which has unique health care needs. Providing those needs is hindered by a number of factors: (1) difficulty characterizing a population whose members may identify themselves, or be identified, as lesbian, gay, bisexual or transgendered; (2) barriers to care due to patient discomfort with the health care system, and the system's discomfort with the lesbian patient; and (3) scarcity of medical evidence regarding healthcare risks and behaviors of lesbian patients, due to the lack of controlled medical studies. The primary care physician addresses these needs by careful analysis of known risk factors, preliminary information about lesbian health, and the health risks and behaviors of the individual patient. Through the template provided in this article, decisions about appropriate healthcare maintenance can be made. Finally, we address emerging issues regarding lesbian conception and childbirth, and the needs of the transgendered patient.     

Soziales Risiko – geburtshilfliches Risiko?

According to the report on poverty in young people in Germany the number of children in poor families is continually growing. Many of the single indicators for social inequality have major adverse effects on pregnancy, birth and the postpartum period. Therefore, it is clear that even in Germany relevant health issues for women and children are linked to social inequality. The impact of social factors in particular on the rate of preterm delivery, low birth weight and postnatal depression is well known. Socioeconomic factors are a relevant health risk in Germany and should not be neglected. Preventive strategies, an effective assessment of the social situation and social interventions are essential parts of perinatal care.     

How Do Previous Mental Health,Social Support,and Stressful Life Events Contribute to Postnatal Depression in a Representative Sample of Australian Women?

Introduction: The purpose of this study was to examine the risk factors for postnatal depression (PND) using longitudinal data in a representative sample of Australian women. Methods: Mailed survey data collected from the youngest cohort of the Australian Longitudinal Study on Women's Health were analyzed. Of the women in this cohort, 2451 had a child in the 4 years preceding survey 4 in 2006, and those who reported being diagnosed or treated for PND at survey 4 (n = 252) were compared to those who had no report of PND at survey 4 (n = 2324) in order to identify risk factors for PND. Results: Women with a history of depression (from survey 2 in 2000 and from survey 3 in 2003) were more likely to report postnatal depression (odds ratio [OR] 2.10; 95% confidence interval [CI], 1.39–3.18 and OR 2.15; 95% CI, 1.37–3.35, respectively). Contrary to previous research, demographic factors were not significantly related to PND. Women who rated their affectionate support and positive social interaction as being available some of the time were significantly more likely to experience PND (OR 2.37; 95% CI, 1.24–4.53) than those who rated this type of support as being available all of the time. Discussion: While previous mental health problems and a history of stressful life events were found to be significant risk factors for PND, the results of this study show that women with PND are also lacking some aspects of social support around the time of the birth of their children. Implications for treatment and policy are discussed.     

Anxiety and Depression Among Sexual Minority Women and Men in Sweden: Is the Risk Equally Spread Within the Sexual Minority Population?

IntroductionSexual minority individuals have a higher risk of anxiety and depression compared with heterosexuals. However, whether the higher risk is spread equally across the sexual minority population is not clear.AimTo investigate the association between sexual orientation and self-reported current anxiety and a history of diagnosis of depression, paying particular attention to possible subgroup differences in risks within the sexual minority population, stratified by sex and to examine participants' history of medical care for anxiety disorders and depression.MethodsWe conducted a population-based study of 874 lesbians and gays, 841 bisexuals, and 67,980 heterosexuals recruited in 2010 in Stockholm County. Data were obtained from self-administered surveys that were linked to nationwide registers.Main Outcome MeasuresBy using logistic regression, we compared risks of current anxiety, histories of diagnosed depression, and register-based medical care for anxiety and/or depression in lesbian and gay, bisexual, and heterosexual individuals.ResultsBisexual women and gay men were more likely to report anxiety compared with their heterosexual peers. Bisexual individuals and gay men also were more likely to report a past diagnosis of depression. All sexual minority groups had an increased risk of having used medical care for anxiety and depression compared with heterosexuals, with bisexual women having the highest risk.ConclusionBisexual women appear to be a particularly vulnerable sexual minority group. Advocating for non-discrimination and protections for lesbian, gay, and bisexual people is a logical extension of the effort to lower the prevalence of mental illness.Björkenstam C, Björkenstam E, Andersson G, et al. Anxiety and Depression Among Sexual Minority Women and Men in Sweden: Is the Risk Equally Spread Within the Sexual Minority Population? J Sex Med 2017;14:396–403.     

The Impact of the COVID-19 Pandemic on Sexual Health in Cis Women Living in Germany

BackgroundPreliminary research shows a substantial impact of the COVID-19 pandemic on women's sexual health, whereby empirical work on sexual well-being of minoritized sexual identities is still rare.AimThe objective of this study was to explore sexual health in heterosexual, lesbian and bisexual cis women during the first wave of COVID-19 pandemic in Germany.MethodsAn anonymous nationwide online survey was conducted among cis women during the first nationwide lockdown in Germany from April 20th to July 20th, 2020. The questionnaire was distributed via e-mail, online chats and social-media platforms.OutcomesDemographic variables and self-report measures from the Sexual Behavior Questionnaire (SBQ-G) "before the pandemic" and "since the pandemic" were collected.ResultsA total of 1,368 cis women participants were included: heterosexual women (n = 844), lesbian women (n = 293), bisexual women (n = 231). Results indicate overall decrease in frequency of sexual contacts and masturbation during the COVID-19 pandemic. Regarding differences before and during the pandemic lesbian women showed significant changes in sexual arousal whereas heterosexual women showed significant changes in all dimensions except capability to enjoy sexual intercourse. The data of bisexual women showed significant changes in almost all dimensions except for frequency of sexual intercourse and sexual arousal. Results of the multiple regression analysis revealed that being younger than 36 years-old, and being in a relationship as well as being heterosexual (compared with being lesbian) is positively associated with general satisfaction with sexual life during the pandemic.Clinical ImplicationsThe findings suggest that during a pandemic sexual and mental health care for (cis) women should be provided and address the specific needs of sexual minority groups.Strengths & LimitationsThis is the first study to describe sexual behavior in heterosexual, lesbian and bisexual women during the COVID-19 pandemic in Germany. Limitations, however, include the fact that the data described were obtained at only one time point so there is a possibility of recall bias, and that the results cannot be generalized because of the underrepresentation of women over age 46.ConclusionThis study examined the impact of the COVID-19 pandemic and resulting social constraints on the sexual health of particular groups of lesbian and bisexual women, which may improve preparedness for future public health and policy crises.Batz F, Lermer E, Hatzler L, et al. The Impact of the COVID-19 Pandemic on Sexual Health in Cis Women Living in Germany. J Sex Med 2022;19:907–922.     

Strategies for improving perinatal depression treatment in North American outpatient obstetric settings

Objective: To identify core barriers and facilitators to addressing perinatal depression and review clinical, programmatic, and system level interventions that may optimize perinatal depression treatment. Method: Eighty-four MEDLINE/PubMed searches were conducted using the terms perinatal depression, postpartum depression, antenatal depression, and prenatal depression in association with 21 other terms. Of 7768 papers yielded in the search, we identified 49 papers on barriers and facilitators, and 17 papers on interventions in obstetric settings aimed to engage women and/or providers in treatment. Results: Barriers include stigma, lack of obstetric provider training, lack of resources and limited access to mental health treatment. Facilitators include validating and empowering women during interactions with health care providers, obstetric provider and staff training, standardized screening and referral processes, and improved mental health resources. Conclusion: Specific clinical, program, and system level changes are recommended to help change the culture of obstetric care settings to optimize depression treatment.     

Promoting positive parenthood: emotional health in pregnancy

Depression is a common problem in the general population and is projected to be one of the major health issues facing the world in 2020 (WHO). Serious consequences exist for the sufferer, and the family. Given that women are twice as likely to suffer from depression, and are at particular risk in the child bearing years, children from infancy may be affected, with long term ramifications. Postnatal depression (PND) occurs in 14% of women, and there may be a similar number affected antenatally. The perinatal period thus is a crucial time to identify depression, and offers an excellent opportunity to screen women due to their increased contact with health services. In order to do so, services need to reevaluate their priorities, and assess barriers to screening. These barriers include attitudes to mental illness, anxiety about how to deal with mental illness in health professionals who are not trained in this area, and--most importantly--resource implications. It is argued that without attempting to address this, identify and remedy the deficiencies, change will not occur. This paper looks to examine the prevalence of depression in the perinatal period, the associated concerns and the difficulties of identification at this time through a review of key relevant papers in this area, and proposes a framework to approach the problem.     

Lifetime Lubricant Use among a Nationally Representative Sample of Lesbian- and Bisexual-Identified Women in the United States

IntroductionThe diversity in self-identified lesbian and bisexual women's sexual interactions necessitates better understanding of how and when they integrate personal lubricant into different experiences. However, little is known about lesbian and bisexual women's lifetime lubricant use, particularly at the population level.AimsThe aim of this study was to examine the prevalence and characteristics of lubricant use among adult lesbian and bisexual women in the United States.MethodsData were drawn from a subset of lesbian and bisexual participants who participated in the 2012 National Survey of Sexual Health and Behavior, an online questionnaire administered to a nationally representative probability sample of U.S. adults ages 18 and older.Main Outcome MeasuresWe examined socio-demographic characteristics, recent and lifetime lubricant use, lubricant use in associated with specific sexual behaviors and condom use, frequency of use, motivations for use, as well as perception of lubricant when used.ResultsA majority of lesbian- (60.1%) and bisexual-identified (77.1%) women reported ever using lubricant; 25.7% of lesbian women and 32.7% of bisexual women used it in the last 30 days. Across most age groups, lubricant was commonly used during partnered sexual play, partnered sexual intercourse, or when a vibrator/dildo was used. Lesbian and bisexual women reported using lubricants to increase arousal/sexual pleasure/desire, to make sex more fun, or to increase physical comfort during sex.ConclusionsLubricant use is identified as a part of lesbian and bisexual women's sexual experience across the life span, as a part of both solo and partnered experiences. As part of evolving sexual health assessments, clinicians and health educators may find value in integrating lubricant-focused conversation with their lesbian and bisexual patients and clients, particularly. Hensel DJ, Schick V, Herbenick D, Dodge B, Reece M, Sanders SA, and Fortenberry JD. Lifetime lubricant use among a nationally representative sample of lesbian- and bisexual-identified women in the United States. J Sex Med 2015;12:1257–1266.     

Social issues of teenage pregnancy

The UK has the highest rate of teenage pregnancies in Western Europe and within the UK higher rates are found amongst women with certain social risk factors, such as those who live in areas of higher deprivation. Teenage pregnancy can be a positive event for some young women. However, there are a number of adverse social outcomes associated with teenage motherhood in the UK, including being more likely to live in poverty, being unemployed or having lower salaries and educational achievements than their peers. Furthermore, children of teenage mothers are more likely to become teenage parents themselves. Strategies to tackle social issues associated with teenage pregnancy need to involve concurrent interventions, including education, skill building, clinical and social support for teenage mothers and contraception services for young people and pregnant teenagers.     

Complexity of parental prenatal attachment during pregnancy at risk for preterm delivery

Objective: To clarify the links between parents’ prenatal attachment and psychosocial perinatal factors such as maternal depression, anxiety and social support.

Methods: Cross-sectional study including 43 couples with high-risk pregnancy (RP) and 37 with physiologic pregnancy (PP). Self-report measures (depression, anxiety, social support and prenatal attachment) are completed by mothers, prenatal attachment questionnaire by fathers.

Results: Depression (p?<?0.001) and state anxiety (p?<?0.001) are higher in RP. Both, maternal and paternal antenatal attachment is significantly lower in RP (p?<?0.001; p?<?0.005) but not related to depression or anxiety. Paternal antenatal attachment is strictly related to the maternal attachment scale in both groups (PP: r?<?0.034; RP: r?<?0.004) and paternal antenatal scores in RP have a negative significant correlation with mothers’ depression (r?<?0.095).

Conclusion: Hospitalized expecting parents at risk of preterm delivery develop less attachment to the fetus and higher levels of anxiety and depression compared to the physiologic pregnancy group. Maternal antenatal attachment is an independent variable related to the diagnosis of a possible preterm delivery. The promotion of prenatal psychological well-being and attachment for future mothers and fathers may serve to improve maternal health practices, perinatal health and neonatal outcome.     

Social issues of teenage pregnancy

The UK has the highest rate of teenage pregnancies in Western Europe and within the UK higher rates are found amongst women with certain social risk factors, such as those who live in areas of higher deprivation. Teenage pregnancy can be a positive event for some young women. However, there are a number of adverse social outcomes associated with teenage motherhood in the UK, including being more likely to live in poverty, being unemployed or having lower salaries and educational achievements than their peers. Furthermore, children of teenage mothers are more likely to become teenage parents themselves. Strategies to tackle social issues associated with teenage pregnancy need to involve concurrent interventions, including education, skill building, clinical and social support for teenage mothers and contraception services for young people and pregnant teenagers.