Methods: Social and cultural barriers influencing endometriosis reporting and management in LMICs were examined through a systematic literature review. Online databases yielded a list of relevant studies. Then, use of MAXQDA, a qualitative data analysis software program, helped to extract and code specific text segments from each study that pertain to the research topic. In-context analysis of coded segments revealed the most common trends, which were organized into broader themes.
Results: Findings demonstrated that social and cultural ideas regarding vaginal bleeding influenced the lack of disease reporting and management of endometriosis in LMICs. Socioeconomic challenges include a lack of hygiene and sanitation measures and education regarding menstruation and vaginal bleeding. Also, many diseases associated with the abnormal vaginal bleeding are often disregarded and not prioritized in clinical settings. It also became clear that cultural taboos regarding menstruation and vaginal bleeding often create feelings of anxiety and fear in women and girls throughout communities in LMICs. However, further research is needed to examine the ways in which women in those communities treat symptoms of irregular vaginal bleeding related to endometriosis.
Conclusions: Socioeconomic, gender, and sex-related factors may influence the ways in which endometriosis is reported and treated and may affect the way the related diseases are understood. Evidence-based policies using a culturally competent understanding of abnormal vaginal bleeding in LMICs may help positively affect the reproductive health of women and girls in such areas.
On 29 June 1988, in Bowen v. Kendrick, the US Supreme Court ruled in a five-to-four decision that the 1981 Adolescent Family Life Act, or AFLA, was constitutional. Under AFLA, the US government could distribute federal funding for abstinence-only sexual education programs, oftentimes given to groups with religious affiliations. As a federal taxpayer, Chan Kendrick challenged the constitutionality of AFLA, claiming it violated the separation of church and state. The Supreme Court found that although AFLA funded programs that aligned with certain religious ideologies, it was constitutional because it did not encourage government involvement in religion, and it held a valid secular purpose in seeking to prevent adolescent pregnancy and premarital sexual relations. By upholding AFLA, Bowen v. Kendrick enabled the US government to continue funding abstinence-only education, which researchers have found to be ineffective.
In 1997, physicians and researchers Ambre Olsen, Virginia Smith, John Bergstrom, Joyce Colling, and Amanda Clark published, “Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence,” in the journal Obstetrics and Gynecology. In their article, the authors retrospectively analyzed data from patients who underwent surgery for pelvic organ prolapse or urinary incontinence two years prior in 1995. Often due to a weakening of or damage to their pelvic muscles, women with pelvic organ prolapse can experience a descent of pelvic organs into the lower pelvis and vagina. People with urinary incontinence can experience bladder control issues and urinary leaks. According to the authors, an estimated fifty percent of women who have previously given birth have had a prolapse. In their article, Olsen and colleagues analyze factors such as race, age, and weight in women who had surgery to treat pelvic organ prolapse and ultimately advocate for a standard assessment for the severity of those conditions.
In 1996, a team of researchers associated with the International Continence Society published “The Standardization of Terminology of Female Pelvic Organ Prolapse and Pelvic Floor Dysfunction” in American Journal of Obstetrics and Gynecology. Pelvic organ prolapse is characterized by the descent of the pelvic organs into the lower portion of the pelvis and is often caused by a weakening of the muscles and ligaments that normally hold the organs in place. The authors concluded that physicians and researchers needed to develop a system of standardized terms to use to describe the anatomical position of pelvic organ prolapse in women. They propose using terms that emphasize the location of the prolapse rather than just the involved organ. They also suggest that the system utilizes a series of examinations and imaging to uniformly describe and quantify pelvic organ prolapse. The article by Bump and colleagues was one of the first to call for a standardized system using specific terms to communicate findings about pelvic organ prolapse systematically across clinical and academic research settings.
In 2013, Cynthia Daniels and a team of researchers at Rutgers University in New Brunswick, New Jersey, founded the Informed Consent Project. Daniels and the researchers assessed the medical accuracy of information within state-authored informational materials for abortion. States give those materials to women who want an abortion, but using their research, the Informed Consent Project found some information from those materials to be inaccurate, misleading, and coercive. The Informed Consent Project gathered a panel of researchers and medical specialists to review the information about embryological and fetal development from twenty-three states’ informational materials. They found that approximately one-third of that information was inaccurate. The work of the Informed Consent Project challenges abortion-specific informed consent laws, highlighting medical inaccuracies in state-authored informational materials as evidence that women’s consent to abortion may be based on false or misleading statements.
In 1983, researchers Alan Trounson, John Leeton, Carl Wood, Mandy Besanko, and Angelo Conti published the article “Pregnancy Established in an Infertile Patient After Transfer of a Donated Embryo Fertilized In Vitro” in The British Medical Journal. In the article, the authors discuss one of the first successful experiments using in vitro fertilization, or IVF, with the use of a human donor embryo at the Monash University and Queen Victoria Medical Center in Melbourne, Australia. Prior to the article’s publication, it was uncertain whether scientists could successfully use human donor embryos in IVF techniques. Although the pregnancy ended in a miscarriage ten weeks later, it showed that IVF was possible for those who needed to use someone else’s donated egg cells. Trounson and his colleagues’ paper provided a basis for future IVF pregnancies using donated embryos and helped develop a treatment option for men and women who could not conceive through sexual intercourse alone.
Edwin Carlyle Wood, also known as Carl Wood, was a physician who helped develop in vitro fertilization, or IVF, treatments. From 1964 to 1992, Wood worked as a professor of obstetrics and gynecology at Monash University in Melbourne, Australia, where he was one of the first in the world to lead a team of physicians to establish IVF as a proven treatment for infertility. IVF refers to a medical procedure in which scientists inseminate an egg cell with a sperm cell outside of the body, such as in a glass dish in a clinical setting. Wood helped establish some of the first successful IVF pregnancies and births, and his findings throughout his years of practice helped to standardize the procedure. Wood also advocated for the right for women to have an abortion, and co-founded the Family Planning Association of Victoria in Australia at a time when there were not many abortion clinics in operation. Through his early contributions to IVF, Wood provided new options for people to have offspring, which as of 2021, has up to a 21.3 percent chance of producing a live birth.
On 29 September 1973, researchers David De Kretzer, Peter Dennis, Bryan Hudson, John Leeton, Alexander Lopata, Ken Outch, James Talbot, and Carl Wood published “Transfer of a Human Zygote,” in The Lancet. In the article, the authors describe an experiment that resulted in one of the first pregnancies established via in vitro fertilization, or IVF. Prior to the article’s publication in 1973, there was no published evidence demonstrating whether IVF treatment would work in humans, although evidence existed showing that IVF worked in other mammals for breeding purposes. At the end of the article, the authors state that the embryo failed to implant into the wall of the patient’s uterus, leading to a miscarriage less than a week after the authors found evidence of pregnancy in the patient. The authors of “Transfer of a Human Zygote” were some of the first researchers to perform IVF, although unsuccessfully, which contributed to the overall understanding of IVF as an emerging technology.
In 2007, Ishola Agbaje, Deirdre Rogers, Carmel McVicar, Neil McClure, Albert Atkinson, Con Mallidis, and Sheena Lewis published “Insulin Dependent Diabetes Mellitus: Implications for Male Reproductive Function,” hereby “Diabetes Mellitus: Implications,” in the journal Human Reproduction. In their article, the authors explore the effects of elevated blood sugar in the form of diabetes mellitus on the quality of male sperm. When investigating possible fertility issues, fertility specialists often study semen, the male reproductive fluid that contains sperm cells to detect changes in sperm count, movement, and structure. In “Diabetes Mellitus: Implications,” the authors use both conventional semen analysis and technical molecular methods to assess the quality of sperm from diabetic and non-diabetic men. The authors found that men with diabetes had higher levels of DNA damage within their sperm and highlighted a need for additional research on the link between diabetes and male reproductive health.