Racialized differences across experiences and measurements of pain in genitopelvic pain/penetration disorder.

BACKGROUND: Despite a growing body of research on genitopelvic pain/penetration disorder (GPPPD), few studies have examined racial and ethnic differences. AIM: The goal of this study was to examine differences across racial groups pertaining to GPPPD with sexual vaginal intercourse in young college women at 2 public US universities. METHODS: Data were collected from 1197 students from 2 public US universities. We limited our sample to 667 sexually active participants aged ≥18 years (mean, 19.21). Participants responded to survey items on their sexual history, wellness, and practices and to the Female Sexual Function Index. Data were analyzed through standard bivariate and regression analyses. OUTCOMES: Participants were asked, "In general, do you feel pain with sexual intercourse?" and categorized into 1 of 3 pain groups: occasional (10%-25% of the time), frequent (≥50%), and no pain (<10%). RESULTS: GPPPD was prevalent among young college women, with 162 (24.3%) reporting pain occasionally, 119 (17.8%) frequently, and 386 (57.9%) never or very seldom. While there were no differences in pain between Latina and non-Latina participants, our analysis indicated that pain was significantly higher among all other minoritized racial groups as compared with White women but particularly high in Black women, who had 2.15-higher odds of reporting pain than White women. Differences persisted when adjusting for socioeconomic status. Specific descriptors for pain sensation were more aligned with traditional descriptors of GPPPD (eg, burning, stinging, cramping, and pinching) in the White sample than among participants of color. Pain intensity did not differ among racial groups. We also found that a significant number of participants, particularly Black women, reported experiencing painful sex occasionally. No differences were noted across racial groups when assessing sexual function with the Female Sexual Function Index. CLINICAL IMPLICATIONS: Existing surveys and physician intake forms should be critically examined for usability with patients of color. As evidenced, Black women's GPPPD seems to go underdetected/undetected by current measures. STRENGTHS AND LIMITATIONS: This study is the first to explicitly compare racial differences among adolescents/young adults. The most notable limitation is the reliance on participant self-report and the absence of gynecologic examination to determine pain-contributing etiologies. CONCLUSION: Painful intercourse affects young Black women at a higher rate than White women. Further research is needed into categories and metrics that capture their experiences of pain.

Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S.

INTRODUCTION: Despite a growing body of research on psychosocial factors in Genito-Pelvic Pain/Penetration Disorder (GPPPD) during sexual intercourse, there are few studies examining adolescent and young adult women's experiences with painful sex and the effects of religiosity, sexual education, and sex guilt. AIM: The purpose of the study was to examine the occurrence of GPPPD among sexually active female college students, including psychosocial factors of religiosity and religious practice, sexual education, sex guilt, and sexual distress. METHODS: Data were collected from 974 college women from a university in the Northeastern U.S. We limited our sample to sexually active women (n = 593, 60.9%; mean age: 18.96) who responded to the questionnaire item, "In general, do you feel pain with sexual intercourse?" Participants completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Revised Mosher Sex Guilt Scale, Abbreviated Santa Clara Strength of Religious Faith Questionnaire, 10-item Gender Role Beliefs Scale, and measures on sexual wellness and practice and sexual education experiences. Data were analyzed using standard bivariate and regression analyses as well as path analysis. MAIN OUTCOME MEASURES: Women were asked, "In general, do you feel pain with sexual intercourse?" and categorized into one of three pain groups: occasional (10%-25% of the time), frequent (50% or more), and no pain (less than 10%). RESULTS: GPPPD with sex was prevalent among young college women, with 113 (19.1%) reporting frequent pain and 143 (24.1%) occasional pain (control n = 337, 56.8%). Numerous statistically significant factors were identified, including frequency of sex, ability to orgasm, sensations during intercourse, presence of a steady sexual partner, expectations of painful sex, sex guilt, and sexual distress. Sex guilt acted as full mediator between religiosity and painful sex. IMPLICATIONS: Healthcare providers should proactively initiate conversations with young female patients about painful intercourse to identify issues and normalize language on pain with sex. Educators are urged to teach evidence-based information on pain-free and guilt-free sexual experiences inside and outside religious contexts. CONCLUSION: Painful sex affects adolescent and young adult women at a similar rate as non-college adult women and while religiosity does not directly impact young women's GPPPD, religiosity does lead to painful sex if it causes sex guilt. Further research is needed into the mechanisms of religion-based sexual shaming and among religiously conservative women who practice abstinence until marriage. Azim KA, Happel-Parkins A, Moses A, et al. Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021;18:770-782.

Higher Speed and No Glide Path: A New Protocol to Increase the Efficiency of XP Shaper in Curved Canals-An In Vitro Study.

INTRODUCTION: This in vitro study compared the performance of the XP-endo Shaper (XP; FKG, La Chaux-de-Fonds, Switzerland) in curved canals when used with a higher speed (3000 rpm) without a glide path with the manufacturer's protocol. METHODS: Twenty extracted mandibular molars with separate mesial curved canals were matched to obtain 2 standardized groups (n = 20). For the XP 1000 group, a glide path up to a size 15 hand file was performed followed by rotary instrumentation with the XP shaper at 1000 rpm, following the manufacturer's recommendations. For the canals in the XP 3000 group, the file was rotated at 3000 rpm after only negotiation the canal with a size 8 hand file (patency file). The operating time and the number of strokes taken to reach the working length (WL) and fit a 30/.04 gutta-percha cone to the WL were recorded. The shaping abilities were evaluated by micro-computed tomographic imaging and file deformation by scanning electron microscopy. Data were analyzed using analysis of variance and chi-square tests at a 5% significance level. RESULTS: The XP 3000 group required less time and strokes to reach the WL (P < .05) and resulted in a higher percentage of adequate cone fit (P < .05). No difference was found between groups regarding the micro-CT parameters, except for the taper, which was larger in the XP 3000 group in the apical and middle thirds (P < .05). No difference was found regarding file deformation between the 2 groups. CONCLUSIONS: The suggested protocol for the use of the XP (3000 rpm without a glide path) appears to be more efficient than the manufacturer's recommended protocol to prepare curved canals in vitro.

Comparison between Single-file Rotary Systems: Part 2-The Effect of Length of the Instrument Subjected to Cyclic Loading on Cyclic Fatigue Resistance.

INTRODUCTION: The aim of this study was to compare the cyclic fatigue resistance of XP Shaper (XP), HyFlex EDM One File (EDM), and WaveOne Gold Primary (WOG) when operated according to their manufacturers' recommendations at different lengths and to investigate the cyclic fatigue limit of XP Shaper when operated at 3000 rpm. METHODS: One hundred fifty instruments from 4 different rotary systems (F2 Protaper Universal [PTU], WOG, EDM, and XP) were tested for their cyclic fatigue resistance in a simulated 90° curved canal at a 37°C water bath temperature at 3 different working lengths (15 mm, 17 mm, and 19 mm). The time taken for instruments to fracture was recorded, and the number of cycles to failure was calculated. Statistical analyses were performed by using Levene's test, Kruskal-Wallis test to identify specific groups with statistically significantly higher cyclic fatigue resistance at 5% significance level. Weibull analysis was performed to determine the predictability of survival for each instrument. RESULTS: XP Shaper had the highest cyclic fatigue resistance compared with all other instruments, followed by EDM, WOG, and then PTU. There was no statistically significant difference in the number of cycles to failure between the XP operated at 3000 or 1000 rpm in any of the tested working lengths. There was a reduction in the number of cycles to failure when the working length increased from 15 to 19 mm in EDM, WOG, and PTU. Scanning electron microscopy showed ductile fractures with classic dimpled features in all samples. CONCLUSIONS: XP has a very high resistance to cyclic fatigue compared with WOG, EDM, and F2 PTU. The time to fracture will decrease by almost one third when XP is operated at 3000 rpm. The results of both parts of this study suggest that XP appears to be safe to operate at 3000 rpm in endodontic retreatment.

Comparison between Single-file Rotary Systems: Part 1-Efficiency, Effectiveness, and Adverse Effects in Endodontic Retreatment.

INTRODUCTION: The aim of this study was to evaluate in vitro the performance of 3 single-file systems: WaveOne Gold Primary (WOG; Dentsply Sirona, Ballaigues, Switzerland), Hyflex EDM "one file" (EDM; Coltene/Whaledent, Alstatten, Switzerland), and XP Shaper (XP; FKG, La Chaux de Fonds, Switzerland), for nonsurgical endodontic retreatment on mandibular anterior teeth in regard to the amount of remaining filling material inside the canal, debris extrusion, and operation time. METHODS: Sixty extracted standardized mandibular incisors presenting with a single oval canal were prepared to size 30.04 and obturated using warm vertical condensation. After 30 days (37°C, 100% humidity), teeth were randomly divided into 3 groups (n = 20) according to the file used for retreatment (WOG, EDM, or XP operated at 3000 rpm). During the retreatment procedures, preweighed vials were used to collect apically extruded debris, and the time required to remove the filling material was recorded in seconds. Cone-beam computed tomographic scans were taken before and after the retreatment to determine the amount of remaining filling material inside the root canal space. Statistical analysis was performed using the Kruskal-Wallis test, 1-way analysis of variance, and the Pearson test at a 5% significance level. RESULTS: There was a statistically significant difference among the groups regarding the instrumentation time (P < .05). XP was the fastest to remove gutta-percha from the canals (40.54 ± 28.03 seconds) followed by EDM (55.77 ± 19.76 seconds) and WOG (105.92 ± 53.92 seconds). The percentage of remaining filling was significantly greater for WOG (26.65% ± 14.63%) (P < .05). No difference was found between EDM (13.51% ± 9.53%) and XP (8.60% ± 7.28%). No difference was found regarding the amount of extruded debris among the 3 groups (P > .05). CONCLUSIONS: XP was the most efficient in gutta-percha removal from the canals when operated at a higher speed (3000 rpm) followed by EDM and WOG.

XP Shaper, A Novel Adaptive Core Rotary Instrument: Micro-computed Tomographic Analysis of Its Shaping Abilities.

INTRODUCTION: The aim of this study was to investigate the shaping abilities of the XP Shaper (FKG, La Chaux-de-Fonds, Switzerland) and compare the findings with Vortex Blue (Dentsply Tulsa Dental Specialties, Tulsa, OK) using micro-computed tomographic imaging. METHODS: Twenty matched, extracted, mandibular, central incisors with a single, oval canal were scanned preoperatively at 25-µm resolution and postoperatively after instrumentation with either Vortex Blue in a crown-down manner up to size 30.04 or XP Shaper. The percent of untouched walls, changes in canal volume and surface area, the amount of dentin removed, debris remaining in the canal, and the preparation taper were determined. The total time required for instrumentation using each technique was calculated in seconds. Statistical analysis was used to compare between both groups using repeated measures multivariate analysis of variance with Bonferroni correction for post hoc comparison and independent sample t tests. RESULTS: The XP Shaper significantly increased the canal volume (F = 77.948, P < .001), surface area (F = 5.543, P = .030), and amount of dentin removed (F = 10.044, P = .001) and had significantly less untouched walls (38.6% ± 8.1%) compared with VB (58.8% ± 8.5%). There was less debris at all levels of the canal in the XP Shaper group. Results were almost significant (P = .059). The XP Shaper was also significantly faster in completing the mechanical preparation of the root canal space by almost 1 minute (t = 6.216, P < .001). CONCLUSIONS: The XP Shaper can expand beyond its core size to adapt to the anatomy of the root canal space. The XP Shaper can prepare and touch more canal walls in oval-shaped canals compared with Vortex Blue. However, the final preparation taper will vary according to the anatomy of the treated tooth.

Prevalence of inter-appointment endodontic flare-ups and host-related factors.

OBJECTIVES: The aims of this study were to report the prevalence of inter-appointment flare-ups following adequate root canal disinfection and to investigate the host factors contributing to its occurrence. MATERIALS AND METHODS: One thousand five hundred patient records were reviewed and the prevalence of flare-up was recorded. Patients' root canal space status (vital, non-vital or retreatment), medical condition and demographics (age, gender, tooth type and position) were recorded from their dental records. Statistical analyses were performed to determine the impact of the recorded factors on flare-up occurrence. RESULTS: Nine hundred fifty-one patient records met the inclusion criteria. The prevalence of flare-up was 2.3 %. There was a correlation between the canal space status and patient's age with flare-up development (P < 0.05). There was no association between flare-up occurrence and tooth type, location, gender or medical condition (P > 0.5). CONCLUSION: The root canal space status was the primary factor affecting flare-up occurrence. Patients >50 years had the highest risk in developing flare-ups. CLINICAL RELEVANCE: This article provides evidence that patients suffering from inflamed pulp will not develop flare-up if adequate cleaning and shaping of the root canal space was performed. It also shows that patients above the age of 50 are a high-risk group that is prone to flare-up development.

At pains to consent: A narrative inquiry into women's attempts of natural childbirth.

BACKGROUND: With only 1.2% of all annual U.S. births registered as out-of-hospital births, national trends show an increase in medicalised hospital births. Caesarean sections have become the most common surgical procedure in the U.S.; Caesarean section rates have increased from 20.6% in 1997 to 31.5% in 2009. Furthermore, in 2009, 67% of hospital births utilised epidural analgesia and 26% used oxytocin augmentation. In response to the increased medicalisation of childbirth within the U.S., some women resist standardised medical procedures and instead choose to labour and birth without medical intervention. AIM: The purpose of this study was to understand and contextualise the childbirth experiences of first-time mothers who planned to have a natural childbirth (without medical intervention) in the Midsouthern United States. METHODS: Using narrative inquiry, we collected data from six participants through semi-structured life-story interviews. FINDINGS: Utilising thematic analysis, four recurring themes emerged: (1) benefits and limitations of pre-labour self-education; (2) labouring women's experiences of relationality; (3) the importance of birth stories and expectations; and (4) the creation of false dilemmas and complexities of "informed choice." DISCUSSION AND CONCLUSION: The women's stories suggest that U.S. medical establishments, the media, and society need to empower pregnant and birthing women by creating new narratives of labour and positive spaces of relationality. Furthermore, health care professionals need to critically examine their usage of the medical model of care while respecting women's choices and agency.

Acquisition of anatomic parameters concerning molar pulp chamber landmarks using cone-beam computed tomography.

INTRODUCTION: Cone-beam computed tomographic (CBCT) imaging is a valuable tool for endodontic therapy. The aim of this study was to verify whether clinical use of CBCT imaging can accurately acquire parameters concerning molar pulp chamber landmarks, which are important data to help start a successful access cavity and avoid iatrogenic furcation perforations. METHODS: Seventy CBCT images were used to measure 118 maxillary and 104 mandibular molars. The following vertical distances were measured: from the cusp tip/central fossa to the pulp chamber floor, to the pulp chamber ceiling, and to furcation; from the pulp chamber ceiling to furcation; from the pulp chamber floor to furcation; and the pulp chamber height. Measurements were read to the nearest 0.05 mm. RESULTS: The measurements were as follows: the pulp chamber floor to furcation (maxillary molar: 1.97 ± 0.58 [mean ± standard deviation, mm], mandibular molar: 2.24 ± 0.47), the pulp chamber ceiling to furcation (maxillary molar: 4.09 ± 0.68, mandibular molar: 3.78 ± 0.70), the central fossa to furcation (maxillary molar: 8.78 ± 0.79, mandibular molar: 8.53 ± 0.65), the central fossa to the pulp chamber floor (maxillary molar: 6.81 ± 0.83, mandibular molar: 6.29 ± 0.65), the central fossa to the pulp chamber ceiling (maxillary molar: 4.69 ± 0.59, mandibular molar: 4.75 ± 0.56); and pulp chamber height (maxillary molar: 2.12 ± 0.81, mandibular molar: 1.53 ± 0.68). Measurements showing the least standard deviation were the central fossa to furcation and the central fossa to the pulp chamber floor. CONCLUSIONS: CBCT imaging may be used for precise clinical acquisition of the pulp chamber landmark measurements for molars thereby facilitating successful access cavity.