Obstetrics and Gynecology Commons^™

Beyond The Cycle: How Menstruation Influences Gender Identity And Well-Being In Binary And Non-Binary Adults, Rin Nguyen

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Approximately 1.8 billion people worldwide menstruate, including transgender and gender-diverse (TGD) people, yet their experiences remain underrepresented in research. Given that menstruation can affect gender alignment and psychological well-being, understanding its impact on TGD people is critical. Gender congruence, or alignment between one’s gender identity and expression, is a key factor influencing well-being, with research linking it to reduced depression and anxiety. Furthermore, emerging research on gender euphoria, the joy experienced when gender congruence is experienced, suggests it may serve as a protective factor for mental health and well-being. Gender euphoria has been associated with reduced psychological distress and increased …

Advancing Screening For Intimate Partner Violence In Pregnant Individuals Throughout The Perinatal Period To Prevent Adverse Pregnancy And Maternal Outcomes, Emilia R. Valdez

Nursing | Senior Theses

Background: Intimate Partner Violence experienced by pregnant individuals contributes to adverse pregnancy outcomes and maternal health. A mother’s exposure to Intimate Partner Violence (IPV) can affect their ability to carry a healthy pregnancy to term (38 – 40 weeks gestational age) and places them at risk for comorbidities including; Preterm birth, Intrauterine Growth Restriction, Low Birth Weight/ Small for Gestational Age, Premature Rupture of Membranes and Miscarriage. The incidence of IPV screening is not accessible to all pregnant individuals due to healthcare providers lack of education, time constraints in the workplace, bias and discomfort towards IPV. The implementation of IPV …

The Knowledge, Experiences, And Attitudes Of Nurses Regarding Trauma-Informed Care For Sexually Abused Intrapartum Patients, Kayleigh Mcgraw

Honors Undergraduate Theses

Labor and delivery nurses care for women from diverse backgrounds who are preparing for a life-changing event, often marked by fear, excitement, sadness, and joy. However, 1 in 5 women in the United States have experienced rape or attempted rape, and for these survivors, labor can become re-traumatizing. Many report flashbacks, dissociation, and a sense of “being back in the rape” during childbirth. Research further links prior sexual assault to unplanned cesareans, traumatic births, and childbirth-related PTSD. Trauma-informed care (TIC) provides a framework to reduce these risks by encouraging providers to understand trauma, recognize signs of distress, and act to …

Minimizing Travel Burden Of Gynecologic Cancer Surveillance Through A Unique Multidisciplinary Telehealth Program, Avni Shridhar, Suzanne Viator, Tara Castellano, Holly Provost, Navya Nair, Elizabeth Neupert, Amma Agyemang, Amelia Jernigan

School of Medicine Faculty Publications

OBJECTIVE: STEEL MAGNOLIAS (shared telehealth for multidisciplinary gynecologic cancer survivorship) is a novel gynecologic cancer surveillance care-delivery program in which rural patients see a close-by gynecologist in person with simultaneous virtual gynecologic oncology consultation. This study assesses feasibility of STEEL MAGNOLIAS by examining travel burden reduction, cancer outcomes, visit activities, guideline adherence, and patient satisfaction. METHODS: We retrospectively reviewed charts of patients with gynecologic cancer in remission under the STEEL MAGNOLIAS program in rural south Louisiana (March 2020-September 2023). Travel metrics, patient satisfaction, cancer outcomes, survival status, reasons for visit, and adherence to follow-up as per National Comprehensive Cancer Network …

A Religious Etiology Of Genito-Pelvic Pain And Pain With Penetration, Emily L. Carlson

Theses and Graduate Projects

Pelvic pain during penetration (PPDP) has been described using various diagnostic terms, including vaginismus, dyspareunia, and vulvodynia. The most recent and comprehensive classification is Genito-pelvic pain/penetration disorder (GPPPD) which is characterized by psychological distress associated with pain during or in anticipation of vaginal penetration (DSM-5-TR; American Psychiatric Association [APA], 2022). The etiology of PPDP is multifactorial, involving a complex interplay of biological, psychological, and relational factors. Religious and cultural influences may play a significant role in shaping individuals’ experiences of sexual pain. This study investigated the etiology of PPDP in relation to the religious influences among women raised in Judeo-Christian …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

Asking About Gender Identity In Pediatric And Adolescent Gynecology Clinic: Patient, Family And Provider Perspectives (The Reflective Study), Madeline Ross, Hariye Sema Baghaki, Hannah Suffian, Lauren Roth, Jeanette Higgins, Tazim Dowlut-Mcelroy

Research Days

Background

The provision of medical and psychosocial support requires the identification of gender diverse individuals in health care settings. However, in primary care settings, some adolescents and parents expressed that gender identity screening (GIS) was offensive and clinicians expressed that GIS negatively affected their workflow. We sought to assess the acceptability and feasibility of GIS in Pediatric and Adolescent Gynecology (PAG) clinics of a large tertiary care children’s hospital in the United States (US) Midwest.

Methods

A GIS survey developed in the US West Coast was modified with permission. After IRB approval, the anonymous single-site cross-sectional survey was administered to …

The Impact Of Environmental Deficiencies On Maternal Health Outcomes, Zahra Wallizadeh, Emiyah Bullock, Antoinette Jones, Katarina Rusinak

Rowan-Virtua Research Day

This study examines the environmental factors contributing to adverse maternal health outcomes in New Jersey, with particular focus on their disproportionate impact on minority women. Analysis of data from PubMed, Policy Map, NIH, CDC, EPA, and the New Jersey Department of Health reveals that women living in low-income areas face significant environmental challenges, including food deserts, air pollution, unsafe living conditions, inadequate infrastructure, and limited transportation options. These environmental determinants exacerbate maternal stress and contribute to complications such as preterm birth and hypertension. Black women are nearly three times more vulnerable to these adverse outcomes compared to white women, highlighting …

The Association Between Economic Outcomes And Abortion: A Scoping Review, Larisa Nicole Stephenson

Capstone Experience: Master of Public Health

Background: Abortion access is not just an issue of autonomy, but an economic issue as well. Evidence of the intersectionality of abortion health care and economics has endured due to the financial cascading effects a denial of an abortion, or the inability to access an abortion, has on one’s personal, professional, and economic upward mobility. A change in recent policies impacting access to abortion warrants an updated synthesis examining the relationships between economic outcomes and abortion access for people of reproductive age in the United States (U.S.).

Aim: This scoping review summarizes evidence pertaining to the association …

Advanced Screening For Intimate Partner Violence To Prevent Adverse Pregnancy And Maternal Outcomes, Emilia R. Valdez

Nursing | Student Research Posters

Background: Intimate Partner Violence experienced by pregnant individuals contributes to adverse pregnancy outcomes and maternal health. A mother’s exposure to Intimate Partner Violence (IPV) can affect their ability to carry a healthy pregnancy to term (38 – 40 weeks gestational age) and places them at risk for comorbidities including; Preterm birth, Intrauterine Growth Restriction, Low Birth Weight/ Small for Gestational Age, Premature Rupture of Membranes and Miscarriage. The incidence of IPV screening is not accessible to all pregnant individuals due to healthcare providers lack of education, time constraints in the workplace, bias and discomfort towards IPV. The implementation of …

The Camden Study - A Pregnancy Cohort Study Of Pregnancy Complications And Birth Outcomes In Camden, New Jersey, Usa., Stephanie Shiau, Xinhua Chen, Ayana April-Sanders, Ellen C Francis, Shristi Rawal, Megan Hansel, Kehinde Adeyemi, Zorimar Rivera-Núñez, Emily S Barrett

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Pregnancy is a unique stage of the life course characterized by trade-offs between the nutritional, immune, and metabolic needs of the mother and fetus. The Camden Study was originally initiated to examine nutritional status, growth, and birth outcomes in adolescent pregnancies and expanded to study dietary and molecular predictors of pregnancy complications and birth outcomes in young women.

METHODS: From 1985-2006, 4765 pregnant participants aged 12 years and older were recruited from Camden, NJ, one of the poorest cities in the US. The cohort reflects a population under-represented in perinatal cohort studies (45% Hispanic, 38% non-Hispanic Black, 17% White …

Demographic Characteristics, Perinatal Smoking Patterns, And Risk For Neonatal Health Complications Among Pregnant Smokers In The United States Who Begin Using Electronic Cigarettes During Pregnancy: A Descriptive Study Using Population-Based Surveillance Data., Hui Nian, Rachel Odland, Samantha Mindlin, Lin Ammar, Hilary Tindle, Angela M Miller, Kelli K Ryckman, Ethan Xie, Tina V Hartert, Brittney M Snyder, Steven M Brunwasser, Pingsheng Wu

Rowan-Virtua School of Osteopathic Medicine Departmental Research

INTRODUCTION: Health agencies have called for research evaluating e-cigarette (EC) use in supporting prenatal smoking cessation. This study aimed to describe (1) the characteristics of smokers who begin using electronic cigarettes (ECs) during pregnancy, (2) how frequently smokers reduce or eliminate pre- and post-natal combustible cigarette (CC) use, and (3) the risk for neonatal health complications among smokers who initiate ECs during pregnancy.

AIMS AND METHODS: Pregnant women using CCs exclusively during prepregnancy, who participated in a U.S. surveillance study, were classified by their reported late-pregnancy smoking behavior as CC-exclusive users, EC initiators, or quitters. EC initiators were further subclassified …

Infertility’S Impact On Couples’ Functioning, Elizabeth Sanders

Dissertations

Historically, infertility has been a taboo topic of discussion and is often avoided in conversation because of the stigmatization of the diagnosis. According to the World Health Organization (2022), infertility affects 186 million individuals globally. However, there seems to be a gap in the research as it pertains to the psychological well-being and treatment of men and women diagnosed with this condition. While it has become less of a feared topic, it still is not discussed or researched enough, thus further exacerbating the gap in research on mental health and treatment options. The following dissertation completed a critical review of …

Maternal Mortality In American Indian And Alaska Native Women: It Is Time To Prevent The Preventable, Brynn Cusack

Theses and Graduate Projects

Background: A concerning disparity exists between maternal mortality rates of American Indian and Alaska Native (AIAN) women and White women. Contributing factors include historical trauma, systemic inequities, inadequate funding, and deprioritization of the health of AIAN people.

Purpose: This literature review aims to address the research question: “Why were American Indian and Alaska Native women two times more likely to die of pregnancy-related causes than White women in the US during the period of 2017 through 2019?” The review explores historical context, current evidence, potential causes and interventions that can address AIAN maternal mortality.

Methods: A comprehensive literature review was …

Contraception And Menstrual Management In Transmasculine And Gender-Diverse Individuals, Adrian Chiem, Maria Cristina Marcos, Beth I. Schwartz

Department of Obstetrics and Gynecology Faculty Papers

Purpose of Review This review outlines the current evidence on the contraceptive and menstrual management methods that are used for transmasculine or gender-diverse (TGD) individuals, as well as the gaps in the literature for this population.

Recent Findings Contraception and menstrual management continue to be an understudied area in the care of TGD individuals, with much of existing research extrapolated from cisgender populations. Emerging studies have looked at contraceptive and menstrual management choices and outcomes in adolescents and highlight the 52 mg LNG-IUD as an option that is efficacious for both indications, as well as high-dose progestin-only pills for menstrual …

Improving Primary And Gynecological Care In Transmasculine Patients, Alison N. Mautner, Joanna Petrides

Rowan-Virtua Research Day

Introduction: This study aimed to assess the healthcare experiences of transmasculine individuals in primary and gynecological care settings. An online, anonymous survey was conducted to gather insights into positive and adverse encounters, factors influencing care-seeking behaviors, and strategies for improving care delivery in this population.

Methods: A survey was administered between June 1st and July 23rd, 2023, recruiting participants from three LGBTQ+ affirming healthcare offices in South Jersey and via Reddit. Data analysis involved SPSS to gain information from 499 valid responses.

Results: The majority of participants (55%) were aged 18-24, with 51% identifying as transgender men. Over two-thirds (68.5%) …

Association Between Cultural Factors And Postpartum Depression, Usha Modukuru

Rowan-Virtua Research Day

Postpartum depression (PPD) is present in 17.22% of the world population. The negative physical and psychological impacts of PPD impact not only the mother, but also those around her. This raises the importance of identifying factors contributing to its onset. Studies have shown that PPD prevalence rates vary between non-Western and Western regions of the world. Cultural postpartum practices differed significantly region to region. Search terms including postpartum depression and cultures were used to find peer-reviewed articles, primary surveys, and patient interviews between 2013-2023. Qualitative analyses were performed on the results. Ethnokinship cultures, commonly present in non-Western countries, prioritized social …

Addressing The Black Maternal Mortality Rate, Kennedy Sanders, Venkateswar Venkataraman, Kate Whelihan

Rowan-Virtua Research Day

Introduction: As of 2021, the Black maternal mortality rate in the United States was 69.9 deaths per 100,000 live births as compared to the national average of 32.9 and the White American average of 26.61. It has been demonstrated that this discrepancy is not fully explained by socioeconomic status. Doulas are professionals who provide support and guidance throughout pregnancy, birth, and early parenthood. Encouraging the use of doulas may be an effective approach to improve the birth experience for Black mothers. Methods: A literature review was performed using PubMed and the following search strings: maternal mortality rate (+race, +race +ethnicity, …

El Derecho A La Interrupción Voluntaria Del Embarazo A Inicios Del Gobierno De Javier Milei (Argentina, 2024) / The Right To The Voluntary Interruption Of Pregnancy At The Beginning Of The Government Of Javier Milei (Argentina, 2024), Willa Rudel

Independent Study Project (ISP) Collection

El objetivo de esta investigación fue entender las realidades del activismo en relación con el derecho al aborto en Argentina en el período después de la aprobación de la ley 27.610 del derecho a la interrupción voluntaria del embarazo, particularmente en 2020 y durante el gobierno actual de Javier Milei. Para responder la pregunta que articula la presente investigación, realicé seis entrevistas con activistas procedentes de una variedad de formaciones y con distintos tipos de participación en el movimiento. Primero describo la historia del activismo a favor del aborto en Argentina hasta la aprobación de la ley y el estado …

Exploring The Medicalization Of Menstruation: Analyzing Menstrual Hygiene Initiatives By Igos, Non-Profits And National Government In Switzerland, Victoria Wright

Independent Study Project (ISP) Collection

Menstrual health serves as a critical indicator of reproductive health. It is pivotal in achieving various Sustainable Development Goals (SDGs) related to women's and girls' comfort, agency, participation, safety, well-being, and dignity (Loughnan et al., 2020). This research investigates the medicalization of menstruation in Switzerland through a mixed-methods approach examining the strategies and roles of key stakeholders such as the WHO, local government initiatives, and NGOs in shaping the landscape of menstrual medicalization.

The findings reveal that while medicalization has brought about progressive changes, including the introduction of menstrual leave policies, it has resulted in a complex regulatory landscape, increased …

Conceptualizando La Movilidad Y Movimiento De Mujeres Indígenas Embarazadas En Búsqueda De Servicios Médicos Bajo Una Perspectiva Migratoria, Nazareth Castro

Independent Study Project (ISP) Collection

El traslado de mujeres indígenas embarazadas en Oaxaca hacia la ciudad de Oaxaca de Juárez debido a la falta de centros de salud en sus localidades se ha convertido en una realidad arraigada, impulsada en gran medida por el impacto del flujo migratorio por razones económicas durante finales del siglo XX. Sin embargo, este proceso de migración plantea una serie de complejidades para las mujeres, quienes enfrentan experiencias negativas debido a sus múltiples identidades que resultan en una exclusión social tanto dentro como fuera de sus comunidades de origen. Esta dinámica puede entenderse desde una perspectiva feminista multicéntrado, que las …

Racial/Ethnic Disparities In The Association Between Patient Care Experiences And Receipt Of Initial Surgical Breast Cancer Care: Findings From Seer-Cahps, Mariana Arevalo, Trevor A Pickering, Sally W Vernon, Kayo Fujimoto, Melissa F Peskin, Albert J Farias

Faculty, Staff and Student Publications

PURPOSE: We determined whether racial/ethnic differences in patient experiences with care influence timeliness and type of initial surgical breast cancer treatment for a sample of female Medicare cancer patients.

METHODS: We conducted a retrospective cohort study using the linked Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset. The outcomes were: (1) time-to-initial surgical treatment, and (2) type of treatment [breast conserving surgery (BCS) vs. mastectomy]. The indicators were reports of four types of patient experiences with care including doctor communication, getting care quickly, getting needed care, and getting needed Rx. Interaction terms in each multivariable logistic …

Facilitators To Cervical Cancer Screening In A Minority, Urban, Underserved Population, Noel Higgason, Linh Nguyen, Yen-Chi Le, Ogochukwu Juliet Ezeigwe, Tong Han Chung, Natalia Williams, Xochitl K Olguin, Abigail S Zamorano

Faculty, Staff and Student Publications

OBJECTIVES: Cervical cancer has markedly declined due to widespread use of screening, but Hispanic women continue to bear a disproportionate amount of the cervical cancer burden due to under-screening. Previous studies have explored barriers to screening but have failed to identify targetable facilitators in this group. We aimed to assess facilitators to cervical cancer screening among a predominantly urban, Hispanic population who presented to a no-cost, community-based clinic.

METHODS: Patients completed demographic and health information, a validated social determinants of health (SDOH) screen, and a self-reported facilitators survey on factors which enabled them to present to clinic. Descriptive statistics were …

Health Consequences Of Racial Disparity In Access To Abortion: A Systematic Review, Lacy M. Frye, Calvin Odhiambo

University of South Carolina Upstate Student Research Journal

Prior to the 2022 Dobbs decision, Black women already experienced negative maternal health outcomes at an alarmingly disparate rate in comparison to White women. Given that the Dobbs decision emboldens state power to enforce abortion restrictions or protections, there has been significant strides made in both directions. Nonetheless, within states where reproductive rights have been significantly eroded, the heightened abortion restrictions may compound the limited access that Black women previously had before Dobbs. This, in turn will exacerbate the already disparate negative maternal outcomes that Black women experience. However, research on the relationship between the lack of access to abortion …

Rural Racial Disparities And Barriers In Mammography Utilization Among Medicare Beneficiaries In Texas: A Longitudinal Study, Zhaoli Liu, Yong Shan, Yong-Fang Kuo, Sharon H Giordano

Faculty, Staff and Student Publications

This study examined rural racial/ethnic disparities in long-term mammography screening practices among Medicare beneficiaries. A retrospective longitudinal study was conducted using 100% Texas Medicare data for women aged 65-74 who enrolled in Medicare between 2010-2013. Of the 114,939 eligible women, 21.2% of Hispanics, 33.3% of non-Hispanic Blacks (NHB), and 38.4% non-Hispanic Whites (NHW) in rural areas were regular users of mammography, compared to 33.5%, 44.9%, and 45.3% of their counterparts in urban areas, respectively. Stratification analyses showed rural Hispanics and NHB were 33% (95% CI, 25% - 40%) and 22% (95% CI, 6% - 36%) less likely to be regular …

Multilevel Community Engagement To Inform A Randomized Clinical Trial, Kirby L. Wycoff, Jabina G. Coleman, Christine M. Santoro, Leah L. Zullig, Niesha Darden, Porsche M. Holland, Jane F. Cruice, Shukriyyah Mitchell, Michelle Smith, Saleemah J. Mcneil, Sharon J. Herring

Counseling and Behavioral Health Faculty Papers

OBJECTIVE: To explore how patients, community-based perinatal support professionals, and health system clinicians and staff perceived facilitators and barriers to implementation of a randomized clinical trial (RCT) designed to optimize Black maternal heart health.

METHODS: This article describes the formative work that we believed needed to occur before the start of the Change of H.E.A.R.T (Here for Equity, Advocacy, Reflection and Transformation) RCT. We used a qualitative, descriptive design and community-based, participatory approach, the latter of which allowed our team to intentionally focus on avoiding harm and equalizing power dynamics throughout the research process. Data were collected between November 2021 …

Can The Date Of Last Menstrual Period Be Trusted In The First Trimester? Comparisons Of Gestational Age Measures From A Prospective Cohort Study In Six Low-Income To Middle-Income Countries, Archana Patel, Carla M. Bann, Vanessa R. Thorsten, Sowmya R. Rao, Adrien Lokangaka, Antoinette Tshefu Kitoto, Melissa Bauserman, Lester Figueroa, Nancy F. Krebs, Fabian Esamai, Sherri Bucher, Sarah Saleem, Robert L. Goldenberg, Elwyn Chomba, Waldemar A. Carlo, Shivaprasad Goudar, Richard Derman, Marion Koso-Thomas, Elizabeth Mcclure, Patricia L. Hibberd

Global Health Articles

OBJECTIVES: We examined gestational age (GA) estimates for live and still births, and prematurity rates based on last menstrual period (LMP) compared with ultrasonography (USG) among pregnant women at seven sites in six low-resource countries.

DESIGN: Prospective cohort study SETTING AND PARTICIPANTS: This study included data from the Global Network's population-based Maternal and Newborn Health Registry which follows pregnant women in six low-income and middle-income countries (Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan and Zambia). Participants in this analysis were 42 803 women, including their 43 230 babies, who registered for the study in their first trimester based …

A Pre-Medical Student’S Reconciliation Of Feminist Narratives Regarding Women’S Health: A Consideration Of Perspectives On Childbirth In The U.S., Laura Clayton

sprinkle: an undergraduate journal of feminist and queer studies

Many feminists argue that one major negative aspect of reproductive healthcare in the U.S. is the common over-medicalization of women during childbirth, including potentially unnecessary procedures such as cesarean-section and episiotomy. As a solution, they advocate for increased involvement of midwives in childbirth practices, as midwives allow women to give birth at home with minimal medical intervention. This paper analyzes the benefits of midwifery as well as the current increased risk associated with homebirth in the U.S. Additionally, it questions the damaging stigma associated with assumptions of cesarean-section as a suboptimal outcome. A false dichotomy has developed in our culture …

Medicaid Expansion, Chemotherapy Delays, And Racial Disparities Among Women With Early-Stage Breast Cancer, Mariana Chavez-Macgregor, Xiudong Lei, Catalina Malinowski, Hui Zhao, Ya-Chen Shih, Sharon H Giordano

Faculty, Staff and Student Publications

BACKGROUND: Medicaid expansion under the Affordable Care Act extends eligibility for participating states and has been associated with improved outcomes by facilitating access to care. Delayed initiation of adjuvant chemotherapy is associated with worse outcomes among patients with early-stage breast cancer (BC). The impact of Medicaid expansion in narrowing delays by race and ethnicity has not been studied, to our knowledge.

METHODS: This was a population-based study using the National Cancer Database. Patients diagnosed with primary early-stage BC between 2007 and 2017 residing in states that underwent Medicaid expansion in January 2014 were included. Time to chemotherapy initiation and proportion …

Digital Health Technologies For Peripartum Depression Management Among Low-Socioeconomic Populations: Perspectives From Patients, Providers, And Social Media Channels, Alexandra Zingg, Tavleen Singh, Amy Franklin, Angela Ross, Sudhakar Selvaraj, Jerrie Refuerzo, Sahiti Myneni

Faculty, Staff and Student Publications

BACKGROUND: Peripartum Depression (PPD) affects approximately 10-15% of perinatal women in the U.S., with those of low socioeconomic status (low-SES) more likely to develop symptoms. Multilevel treatment barriers including social stigma and not having appropriate access to mental health resources have played a major role in PPD-related disparities. Emerging advances in digital technologies and analytics provide opportunities to identify and address access barriers, knowledge gaps, and engagement issues. However, most market solutions for PPD prevention and management are produced generically without considering the specialized needs of low-SES populations. In this study, we examine and portray the information and technology needs …