[Climate and environmental crisis impacts on women's health: What specificities? What can be done?] / Impacts de la crise environnementale et climatique sur la santé de la femme : quelles spécificités ? Que peut-on faire ?

OBJECTIVE: Pollution is one of the world's largest risk factors for disease and premature death. In Europe, it is responsible for approximately 20% of mortality. Chemicals exposure can occur by inhalation, ingestion or skin contact and begins in utero. Pollutants can be divided into three categories: endocrine disruptors (pesticides, PFAS, plastics, dioxins, etc.), heavy metals (cadmium, mercury and lead…) and nanomaterials. Climate change and air pollution are other main health threats. METHODS: Literature review using PubMed and ResearchGate databases and institutional websites. RESULTS: Endocrine disruptors are identified as significant risk factors for the reproductive health with negative documented impacts following prenatal or adult exposure. Climate change and air pollution can cause gender-based health disparities. Numerous scientific arguments show that chemical pollution and climate change disproportionately impact women, both on a social and biological level. Populations in precarious situations among which women are over-represented suffer the most severe social consequences including in France. There are several gender-specific domestic or occupational exposures to pollutants, most often to the disadvantage of women compared to men. Finally, although very few gendered data exist in environmental health, there are sexual-based physiological vulnerabilities concerning the metabolism of pollutants and the capacity to adapt to heat. CONCLUSION: Facing this threat of gender inequity in sexual and reproductive health and rights' width, women's health professionals have a major role to play in initiating new ways to assess and reduce the environmental health burden in women.

[Vulnerability factors and care specific to women and addictions]. / Des facteurs de vulnérabilité et des soins spécifiques aux femmes face aux addictions.

Like behavioral addictions, substance misuse is a complex disorder, influenced by psychological, clinical and socio-environmental determinants. The processes that lead to addiction are common to both men and women, but patterns of use, risk behaviors and their repercussions differ. Women's access to care is often delayed because they are regularly subjected to stigmatization, violence, and economic or family constraints. Care must be better adapted to their specific needs.

[Knowledge, attitudes and practices in oral health of breastfeeding women]. / Connaissances, attitudes et pratiques en santé orale des femmes allaitantes.

The benefits of breastfeeding on the health of infants and mothers are no longer in doubt. On the other hand, the advantages in terms of maxillofacial development and the risks of prolonged breastfeeding on oral health are much less discussed. An exploratory qualitative study, carried out within the pediatric dentistry functional unit of the dental care service of the Lille University Hospital Center in 2022, aimed to analyze the knowledge, attitudes and practices in oral health of breastfeeding women. This article will discuss the gaps in prevention as well as the obstacles and levers to improving care.

[Women and alcohol: From risky use to addiction, the issues at stake]. / Les femmes et l'alcool : de l'usage à risque à l'addiction, les enjeux.

Present in all social circles with proven effects on health, alcohol is the second leading cause of avoidable death after tobacco. Like men, women can be affected by alcohol misuse, or even addiction. As the female organism is more vulnerable to the deleterious effects of alcohol, women are particularly exposed in terms of risks and complications for their physical and mental health.

[Women's vulnerability to alcohol and its impact on health]. / Vulnérabilité des femmes face à l'alcool et impacts sur la santé.

At the same level of consumption as men, specific vulnerabilities often expose women to the more rapid onset of more serious illnesses (cardiovascular and liver diseases, cancers, brain and cognitive damage, sleep disorders, risk of accidents, etc.). This worrying fact is still little known by the general population. Special prevention measures are needed, such as dedicated campaigns for women, specific guidelines for lower-risk drinking, systematic early detection of risky drinking among women, and brief intervention in the event of problem drinking.

[Women and alcohol, the addictologist's point of view and treatment]. / Les femmes et l'alcool, point de vue de l'addictologue et prise en charge.

Women have difficulty seeking help for alcohol-related problems. Shame and guilt are often present, which is why the caregiver must succeed in establishing a climate of trust so that things can be said, in order to best assess the impact of consumption and find alternatives. Treatment is often multidisciplinary. The nurse's role is essential, not only to identify drug use, but also to provide a link between the various players involved.

[The psychopathological dimension of female alcoholism]. / La dimension psychopathologique de l'alcoolisme féminin.

In France, as in other countries, more and more women are affected by alcoholism. Progress needs to be made in the early detection and management of their physical and psychological dependence on alcohol, as well as their psychopathological comorbidities.

[Alcohol and older women]. / Alcool et troisième âge chez la femme.

Frequently linked to social isolation (widowhood, estrangement from family and friends, etc.), alcoholism in elderly women is often invisible, with a high level of dependence. It potentiates the vulnerabilities and impact of aging. What approach to care and support can geriatric teams offer? What are the care objectives?

Neutral posture education during cough can reduce urine leakage in women with cough-related stress urinary incontinence.

BACKGROUND: Current literature highlights the difficulty in identifying an optimal educational technique for maintaining continence during cough. OBJECTIVE: To characterize the effects of an educational intervention focusing on neutral posture during cough in women with cough-induced urinary incontinence (UI). METHODS: This interventional study design included women with cough-induced UI. We recorded PFMs surface electromyographic (sEMG) peak activity, and assessed symptoms and quality of life (QoL) 6 weeks after the intervention. The effect of the experimental situation was estimated using a linear mixed model, sEMG measurements during coughing were indexed to each situation and adjusted to the resting value at, and a moderation analysis was used. RESULTS/FINDINGS: Eighteen participants were included. The measurement situations (control versus experimental) did not have a statistically significant impact on sEMG peak activity during coughing: mean effect [95% CI] 3.42 [-1.28; 7.66]. Six weeks post-intervention, participants reported statistically significant decrease in urinary symptoms (P=0.0246) and significant improvement in QoL (P=0.00776). This was also particularly marked on the dimension related to effort activities (P=0.00162). CONCLUSION: This study suggests that a brief educational intervention focusing on neutral posture during cough, without voluntary pre-contraction of the PFMs, has no clinically significant influence on sEMG peak activity of the PFMs in women with cough-induced UI. However, this intervention can lead to a significant improvement in urinary symptoms and QoL at 6 weeks. These improvements seem to be independent of electromyographic PFMs peak activity recorded during cough. As such, our preliminary results pave the way for future research. LEVEL OF EVIDENCE: NP4.

Mexicana and Chicanx Queer Kinship across Visual Art and Performance: Astrid Hadad and Ester Hernández.

This brief and personal essay discusses Ester Hernández's and Astrid Hadad's artistic relationship, which includes a beautiful friendship that spans time and space. In particular, and from an intimate vantage point, I read two of Hernández's images that feature Hadad, which the Mexican artist has displayed in her home in Mexico City, to ponder a larger question regarding contemporary cross-border feminist and genderqueer esthetics and relations. The queer kinship between these two artists, I humbly posit, extends to the fans that come out to support Hadad's shows when she performs in cities in the U.S. with large Latinx demographics, particularly in California.

[Genital gender affirming surgery in trans women: Vulvo-vaginoplasty review]. / Chirurgie génitale d'affirmation de genre pour les femmes trans : revue des vulvo-vaginoplasties.

INTRODUCTION: A trans woman is a woman who was assigned male at birth, and who has a female gender identity. The majority are requesting a gender affirming genital surgery by vulvo-vaginoplasty. The objective is to review this surgery based on its history, then by presenting the different surgical techniques and their success and complication rates. MATERIAL AND METHODS: A narrative review was performed, based on a bibliography search with keywords from 2000 to 2022 on Pubmed. RESULTS: Vulvo-vaginoplasty for trans women began in 1931, and the first case series date from 1969. The procedure includes excision of scrotal skin, orchiectomy, clitoroplasty, urethroplasty, labioplasty, recto-vesico-prostatic dissection and creation of a vaginal cavity (performed by penile skin inversion and graft, intestine, or peritoneum). Vulvo-vaginoplasty by penile skin inversion (VPPI) is today the reference surgical technique. It represents the vast majority of surgeries performed with the longest follow-up. The majority of trans women are satisfied with the procedure aesthetically (90%) and functionally (80%), with an active sexuality. Major complications are rare (< 5%), they correspond to fistulas or vaginal stenosis. CONCLUSION: VPPI is the gold standard technique with satisfactory overall results, but long-term follow-up is requested.

[The feminization of precariousness, a growing feature]. / La féminisation de la précarité, une particularité grandissante.

Precariousness (social, health, professional, financial, energy, etc.) affects women more than men. This has consequences for their access to healthcare. Raising awareness of gender inequalities and mobilizing actors to fight against them, make visible the levers to fight against the increase of women's precariousness.

[The female urologist in 2022, where are we?] / La femme urologue en 2022 : où en est-on ?

There are still significant disparities between the sexes even if we are now witnessing a feminization of the urological profession. Women's roles in historically male-dominated services still vary widely based on inherent gender biases. Interventions to minimize the gender gap in urology should not constitute a form of positive discrimination in favor of minorities but on the contrary a form of positive action to eliminate the obstacles present that block the acceptance of women or their promotion. Recognizing the factors responsible for gender disparities remains a key step towards improving equity in still male-dominated fields such as urology.

Mujeres hipnotizadoras, entre la femme fatale y la bruja en la ficción literaria de Arthur Conan Doyle / Hypnotizing women, between the femme fatale and the witch in Arthur Conan Doyle’s literary fiction

La historiografía sobre el mesmerismo y la hipnosis demuestra que hubo pocas mujeres que pusieran en práctica estos conocimientos. Así las cosas, la mujer que hipnotiza a un hombre se convierte en una revolucionaria, en un caso subversivo que da la vuelta no solo a una relación hipnótica clásica sino a una situación social e histórica de claro dominio patriarcal. En este trabajo analizo dos relatos de Arthur Conan Doyle (1859-1930) protagonizados por mujeres hipnotizadoras: John Barrington Cowles (1884) y El parásito (1894). En el caso de John Barrington Cowles la mujer hipnotizadora está basada en el estereotipo literario y fílmico de la femme fatale, que será muy usado en diferentes formatos narrativos durante todo el siglo XX llegando a la actualidad; por otra parte, en el caso de El parásito la mujer hipnotizadora está mucho más cerca del estereotipo literario y folclórico de la bruja. En este sentido, apunto el papel fundamental que el estereotipo de mujer hipnotizadora tiene para los recientes estudios culturales de género. (AU)

The historiography on mesmerism and hypnosis shows that there were few women who put this knowledge into practice. In this sense, it is significant that there are few images of a woman hypnotizing a man and no images of a woman hypnotizing another woman. Thus, the woman who hypnotizes a man becomes a revolutionary, a subversive case that turns around not only a classic hypnotic relationship but also a social and historical situation of clear patriarchal domination. In this paper, I analyze two stories by Arthur Conan Doyle (1859-1930) featuring female hypnotists: John Barrington Cowles (1884) and The Parasite (1894). In the case of John Barrington Cowles, the hypnotizing woman is based on the literary and filmic stereotype of the femme fatale, which will appear in many different narrative formats throughout the 20th century up to the present day. In the case of The Parasite, however, the hypnotizing woman is much closer to the literary and folkloric stereotype of the witch. In this sense, I point out the fundamental role that the stereotype of the hypnotizing woman has played in recent cultural gender studies. (AU)

[French Expert advice on the management of valproate in childbearing and pregnant women with bipolar disorder]. / Avis d'experts français sur la prise en charge des femmes en âge de procréer et enceintes souffrant d'un trouble bipolaire traitées par valproate.

INTRODUCTION: The perinatal period is associated with high risk of relapses in women with untreated bipolar disorder (BD) and can have significant consequences on foetal and child development. Valproate is an effective mood stabilizer in BD but it is also the anticonvulsant associated to the highest risks of neurodevelopmental disorders and congenital malformations. The National Agency for the Safety of Medicines and Health Products (ANSM) changed the conditions of use and prescription of valproate in France in 2015. Its prescription is now contraindicated (i.e., not to be prescribed) in women able to have children unless alternative treatments are ineffective or not tolerated. Moreover, valproate could only be prescribed if the protocol of a specific pregnancy prevention program is followed. METHODS: A panel of experts from the French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) provided consensus-based recommendations for switching and discontinuation of valproate in women with BD. The development of these recommendations consisted of an adaptation to French clinical practice based on a European expert opinion published in 2019. The experts discussed five real-world clinical situations in light of the scientific evidence and their clinical experience (a. Stable BD patient with valproate monotherapy who is planning pregnancy, b. Stable BD patient with valproate polytherapy who is planning pregnancy, c. Unstable BD patient with frequent relapses and valproate polytherapy who is planning pregnancy, d. Stable BD patient treated with valproate and unexpected pregnancy, e. Unstable BD patient treated with valproate and unexpected pregnancy) and developed, through several rounds of exchange drafts, a French version of clinical recommendations. RESULTS: First of all, some factors need to be considered for establishing personalized practical recommendations for a safe and effective switching or discontinuation of valproate in any clinical situations: planned pregnancy or unplanned pregnancy or current pregnancy, the existence or not of a pregnancy risk minimization program and a complete treatment history. Other factors that should be considered are the predominant polarity, the severity, the stability, the comorbidities associated with BD, the beliefs toward treatments, the family situation and the preference of the patient. The modalities for switching or discontinuation of valproate in women with BD were related to the clinical situation. First-line therapeutic alternatives such as lithium, lamotrigine, quetiapine, olanzapine or aripiprazole were preferred for patients suffering from a clinically stable BD considering pregnancy or pregnant. In patients suffering from clinically unstable BD, to reach stability was considered first. A shared decision-making should be systematically implemented and the patient must be fully informed of the risks related to an in-utero exposure to valproate, and the risks of the discontinuation/switch that is considered. CONCLUSION: Although the adaptation to French practice of the recommendations from the European expert opinion highlighted some differences in the criteria taken into consideration to guide the therapeutic decision, this expert advice will guide the clinician for switching and discontinuation of valproate in BD women able to have children or pregnant.

[Epidemiology, diagnosis and extension]. / Épidémiologie, diagnostic et bilan d'extension.

Breast cancer is the most common cancer in women. The elderly, whose numbers have been increasing, constitute a population in their own right, because of the many co-morbidities they suffer from. The epidemiology of breast cancer, particularly in elderly women, is described here, as well as the diagnosis and the assessment of extension, which do not differ from the rest of the population.

Evaluation of hymenal adhesions resection in the treatment of recurrent post-coital cystitis.

OBJECTIVE: To describe and evaluate the technique of hymenal adhesions resection in the treatment of recurrent post-coital cystitis. MATERIALS AND METHODS: Monocentric retrospective observational study including patients operated for hymenal adhesions resection between 2013 and 2020. The indication was based on the association of 4 conditions: at least 3 episodes of documented cystitis per year, a post-coital rhythm, a failure of preventing hygienic and dietary rules, a negative etiological assessment except for the existence of hymenal adhesions. RESULTS: Twenty-three patients were included. The procedures were performed on an outpatient basis. With a mean follow-up of 36.5 months (standard deviation: 22.3), 21 patients (91%) reported a correction of recurrent post-coital cystitis, 16 (70%) had 1 to 2 annual episodes of cystitis, 19 (83%) reported improvement with surgery and satisfaction was rated on average at 8.5/10 (standard deviation: 2.15). None of the 23 patients had persistent documented recurrent cystitis after surgery, 12 (52%) had 1 to 2 documented episodes annually, and 11 (48%) had no documented recurrence. Three cases of postoperative complications were observed: vulvovaginitis, delayed healing, and pyelonephritis. No cases of dyspareunia were reported during the follow-up. CONCLUSION: In case of post-coital cystitis, accompanied by hymenal adhesions, and without any other identified cause, the removal of hymenal adhesions could be an alternative to iterative antibiotic therapy.

[A partnership between midwives and RPNs for the benefit of perinatal mental health]. / Un partenariat entre sage-femme et IPA au bénéfice de la santé mentale périnatale.

Advanced practice nurses in psychiatry and mental health have the opportunity to become involved in perinatal health networks. By building a new form of partnership with maternal and child protection midwives, they can provide second-line skills for the mental health of vulnerable patients and participate in the quality and safety of care.