Comparing Self-Reported Pain During Intercourse and Pain During a Standardized Gynecological Exam at 12- and 24-Month Postpartum.

BACKGROUND: There is limited information about the physical indicators and biopsychosocial predictors of self-reported pain during intercourse and pain during a gynecological examination at 12- and 24-month following childbirth. AIM: This longitudinal study aimed to (i) Compare the findings from gynecological exams at 12- and 24-month postpartum for women with minimal vs clinically significant pain during intercourse; (ii) Assess the biomedical and psychosocial correlates of self-reported pain during intercourse and the vestibular pain index (VPI) from the cotton-swab test at 12- and 24-month postpartum; (iii) Establish the relationship between self-reported pain during intercourse and the cotton-swab test. METHODS: Women (N = 97 at 12 months postpartum and N = 44 at 24-month postpartum) recruited from a local women's hospital completed online surveys in their first trimester of pregnancy and at 12- and 24-month postpartum to assess pain during intercourse and biopsychosocial variables. Those with clinically significant (pain ≥4/10 on a visual analogue scale) were matched with those reporting minimal pain (pain <3/10) and underwent a gynecological exam including a cotton-swab test. Descriptive analyses, multiple regressions, and bivariate correlations were conducted to address each of the study aims, respectively. MAIN OUTCOME MEASURES: (i) Findings from the gynecological examination (ii) Numerical rating scale for the VPI; (iii) Visual analogue scale of pain during intercourse. RESULTS: The majority of women in both pain groups had normal physical findings in the gynecological exam. Greater sexual distress and pain catastrophizing at 12- and 24-month postpartum were significantly associated with greater pain during intercourse at each time-point, respectively. Greater pain catastrophizing at 12 months postpartum was significantly associated with greater pain during the cotton-swab test at that time-point. Lower relationship satisfaction at 12 months postpartum was associated with greater VPI ratings at 24 months postpartum. Pain during intercourse and the VPI were moderately and positively correlated. CLINICAL IMPLICATIONS: Addressing psychosocial variables may interrupt the maintenance of postpartum pain. Following an initial assessment, self-reported pain intensity may be a suitable proxy for repeated examinations. STRENGTHS & LIMITATIONS: This study is the first to describe the physical findings and psychosocial predictors of pain during intercourse and the VPI at 12- and 24-month postpartum. The homogenous and small sample may limit generalizability. CONCLUSION: There were no observable physical indicators of clinically significant postpartum pain during intercourse. Psychosocial variables were linked to women's greater postpartum pain during intercourse and VPI ratings. Rossi MA, Vermeir E, Brooks M, et al. Comparing Self-Reported Pain During Intercourse and Pain During a Standardized Gynecological Exam at 12- and 24-Month Postpartum. J Sex Med 2022;19:116-131.

Improving Healthcare Providers' Interactions with Trans Patients: Recommendations to Promote Cultural Competence.

Research indicates that trans people face a number of barriers to healthcare, including challenges in finding healthcare providers (HCPs) who are knowledgeable about, and sensitive to, trans identity and health issues. These and other barriers contribute to this population's under-usage of healthcare services and, in turn, their poor overall health outcomes compared to the general population. This article provides research-informed recommendations to improve HCPs' cultural competence, which may increase trans individuals' utilization of healthcare and thus contribute to better health outcomes for this population.

Barriers to primary and emergency healthcare for trans adults.

Trans individuals are less healthy than the general population in part because of their avoidance and underutilisation of healthcare. Using qualitative research methods, the objective of this study was to explore the barriers trans adults encounter when pursuing primary and emergency care in Nova Scotia, Canada. Findings reveal that trans adults often feel discriminated against and socially excluded in primary and emergency care settings. This marginalisation is manifested in relationships with healthcare providers and within both the physical care and social care environments. The findings suggest that there is a 'discrimination continuum' with experiences of discrimination ranging from subtle to overt. Findings indicate that subtle discriminatory experiences may be encountered most frequently. Both kinds of experiences are reported to have detrimental consequences. The findings also indicate that trans adults are often burdened by the expectation that they will take on a more active role in their care than cisgender patients, including educating their healthcare providers and remaining resilient in the face of discrimination.