Access to and use of sexual and reproductive health (SRH) services remain a global public health concern, particularly in developing countries. This study aimed to understand the attitudes and perceptions of pharmacists in Rwandan community pharmacies and to assess the availability of sexual and reproductive health products in these pharmacies.In a cross-sectional study conducted in Rwanda from 1 September 2023 to 30 November 2023, registered and licensed pharmacists from 864 community pharmacies were surveyed, employing a quantitative research approach. Systematic sampling was used to collect the data. A chi-square test was conducted for relationships between variables.SRH products for self-care were widely available in Rwandan community pharmacies, ranging from 82.3% to 97.3%, except for ovulation tests (28.4%). Chi-square tests indicated that married pharmacists were more likely to provide educational guidance on SRH products (χ2 =  8.81, P-value = 0.012). Community pharmacists had positive attitudes and self-reported confidence in dispensing and providing education to pharmacy-based SRH users.The Rwandan community pharmacies had extensive availability of SRH products for self-care use. Pharmacists in these pharmacies had positive attitudes and self-reported confidence in dispensing and guiding the community on SRH products. Continuous professional training is recommended to enhance the quality and standards of SRH.

BACKGROUND: Sexual and reproductive health and rights (SRHR) are vital for both individual well-being and development. Bangladesh has made long strides in improving SRHR over the last few decades. However, the progress has been uneven across various groups of reproductive-aged females, with the married adolescent girls (MAGs) often being more vulnerable to denial of SRHR than other women. This study intends to develop Balika Bodhu, a combined empowerment and social norm intervention for promoting SRHR among the MAGs and assess its impact.
METHODS: The evaluation will employ a mixed-method two-arm Cluster Randomized Controlled Trial (CRCT) design, where Arm 1 receives the intervention, and Arm 2 serves as the control. The trial will cover 32 clusters (villages) in Rajbari Sadar sub-district, randomized into two equally distributed study arms. A total of 1,120 MAGs aged 15-19 years will be randomly selected from the clusters (35 per cluster) to form a cohort. The MAGs, their husbands, selected elderly women (26 per village) and influential community members (26 per village) will receive group sessions in the intervention clusters. The MAGs and their husbands will be interviewed at baseline and endline. A randomly selected cross-sectional sample of community members aged 35-59 years at baseline and endline will also be surveyed to measure attitudes and social norm regarding SRHR of MAGs. Qualitative data will be collected using 32 In-depth Interviews, six Key Informant Interviews, and eight Focus Group Discussions from two intervention villages. Intention-to-treat (ITT) analysis will be performed to assess the impact of the intervention. Narrative analysis and the Grounded Theory approach will be used to analyze the qualitative data.
CONCLUSIONS: Rigorous evaluation of Balika Bodhu should contribute to the literature on what works and what does not in addressing denial of SRHR to MAGs using empowerment and social norm intervention and inform policies and programs.
BACKGROUND: Clinicaltrials.gov: identifier: NCT06126770; Date: Oct 7, 2023. Version 1.

Benign uterine tumors, known as leiomyomas or uterine fibroids, can result in severe pain, bleeding, and infertility. They impact a woman\'s overall well-being, ability to conceive, and the course of her pregnancy. Fibroids are associated with increasing maternal age. When a patient with fibroids is considering pregnancy, ultrasonography and a detailed pelvic examination should be performed to determine the size and location of any fibroids. This case study details a 30-year-old female patient who had fibroids during her pregnancy and responded well to treatment.

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BACKGROUND: Adequate literacy in reproductive and sexual health is essential for adolescents to obtain, comprehend, evaluate and apply information necessary for making well-informed decisions, as low literacy leads to harmful decision-making, risk-taking and poorer health and self-management. These factors increase the magnitude and severity of problems related to sexuality and reproduction, including unintended pregnancy, HIV/sexually transmitted infections, unsafe abortion and death. However, information regarding the status and affecting factors of literacy in the reproductive and sexual health of adolescents is scarce.
OBJECTIVE: To assess reproductive and sexual health literacy status and associated factors among late-adolescent high school students.
METHODS: A cross-sectional, institution-based study.
METHODS: The study included eight secondary schools in Arba Minch town (Gamo Zone) and three in Sawla town (Gofa Zone) in the South Ethiopia Region.
METHODS: The study was done between 20 May and 20 June 2023, among late adolescent high school students. Using multistage sampling, 577 students were recruited. Reproductive health literacy was assessed using the Health Literacy Measure for Adolescents tool. Data were loaded into EpiData-V.3.1 and analysed using SPSS-V.25. Binary logistic regression analyses were used to identify associated factors. Variables with a p value <0.25 in bivariable logistic regression were candidates for multivariable logistic regression. A Hosmer-Lemeshow goodness-of-fit statistic was checked and satisfied. Statistical significance was indicated at a p value<0.05.
RESULTS: The proportion of students with limited reproductive and sexual health literacy was 69.6% (CI 65.3% to 72.8%). The limited literacy status was significantly associated with school type (public school AOR 0.28 (0.17 to 0.46)), mother\'s occupation (merchant AOR 0.42 (0.23 to 0.76)), family monthly income (income 10 000-20 000 birr AOR 0.45 (0.22 to 0.95)), having regular physical exercise >30 min (more than once per week, AOR 0.44 (0.23 to 0.84)), and knowledge about condoms (poor AOR 2.23 (1.38 to 3.64)).
CONCLUSIONS: A notable segment of adolescents exhibited limited reproductive and sexual health literacy. The result emphasises the necessity of all relevant parties to work diligently to guarantee that school adolescents can easily obtain, comprehend, evaluate and use reproductive and sexuality-related information.

BACKGROUND: Adolescents and young women in low-middle-income countries face obstacles to accessing HIV, Sexual and Reproductive Health (SRH), and related Gender-Based Violence (GBV) services. This paper presents facilitators, opportunities, and barriers to enhance uptake of HIV, GBV, and SRH services among Adolescent Girls and Young Women (AGYW) in selected districts in Zambia.
METHODS: This study was conducted in Chongwe, Mazabuka, and Mongu Districts among adolescent girls and young women in Zambia. Key informants (n = 29) and in and out-of-school adolescents and young people (n = 25) were interviewed. Purposive sampling was used to select and recruit the study participants. Interviews were transcribed verbatim, and a content analysis approach was used for analysis.
RESULTS: The facilitators that were used to enhance the uptake of services included having access to health education information on comprehensive adolescent HIV and gender-based violence services. Non-governmental organisations (NGOs) were the main source of this information. The opportunities bordered on the availability of integrated approaches to service delivery and strengthened community and health center linkages with referrals for specialised services. However, the researchers noted some barriers at individual, community, and health system levels. Refusal or delay to seek the services, fear of side effects associated with contraceptives, and long distance to the health facility affected the uptake of services. Social stigma and cultural beliefs also influenced the understanding and use of the available services in the community. Health systems barriers were; inadequate infrastructure, low staffing levels, limited capacity of staff to provide all the services, age and gender of providers, and lack of commodities and specialised services.
CONCLUSIONS: The researchers acknowledge facilitators and opportunities that enhance the uptake of HIV, GBV, and SRH services. However, failure to address barriers at the individual and health systems level always negatively impacts the uptake of known and effective interventions. They propose that programme managers exploit the identified opportunities to enhance uptake of these services for the young population.

Labial fusion, though rare, can present during puberty, or even adolescence leading to challenges in diagnosis and management. This case report offers a detailed examination of the clinical manifestation, diagnostic process, and therapeutic approach in an adolescent girl with labial fusion. This report emphasizes the importance of early intervention to improve patient outcomes for this complex medical condition.

BACKGROUND: Patients find technology tools to be more approachable for seeking sensitive health-related information, such as reproductive health information. The inventive conversational ability of artificial intelligence (AI) chatbots, such as ChatGPT (OpenAI Inc), offers a potential means for patients to effectively locate answers to their health-related questions digitally.
OBJECTIVE: A pilot study was conducted to compare the novel ChatGPT with the existing Google Search technology for their ability to offer accurate, effective, and current information regarding proceeding action after missing a dose of oral contraceptive pill.
METHODS: A sequence of 11 questions, mimicking a patient inquiring about the action to take after missing a dose of an oral contraceptive pill, were input into ChatGPT as a cascade, given the conversational ability of ChatGPT. The questions were input into 4 different ChatGPT accounts, with the account holders being of various demographics, to evaluate potential differences and biases in the responses given to different account holders. The leading question, \"what should I do if I missed a day of my oral contraception birth control?\" alone was then input into Google Search, given its nonconversational nature. The results from the ChatGPT questions and the Google Search results for the leading question were evaluated on their readability, accuracy, and effective delivery of information.
RESULTS: The ChatGPT results were determined to be at an overall higher-grade reading level, with a longer reading duration, less accurate, less current, and with a less effective delivery of information. In contrast, the Google Search resulting answer box and snippets were at a lower-grade reading level, shorter reading duration, more current, able to reference the origin of the information (transparent), and provided the information in various formats in addition to text.
CONCLUSIONS: ChatGPT has room for improvement in accuracy, transparency, recency, and reliability before it can equitably be implemented into health care information delivery and provide the potential benefits it poses. However, AI may be used as a tool for providers to educate their patients in preferred, creative, and efficient ways, such as using AI to generate accessible short educational videos from health care provider-vetted information. Larger studies representing a diverse group of users are needed.

This study aimed to investigate changes in menstruation and the association of the severity of Omicron with menstruation after the nationwide outbreak of COVID-19 in China. A cross-sectional study adopted an electronic questionnaire to conduct an anonymous online survey. The survey targeted women of reproductive age who had been infected with SARS-CoV-2, and were menstruating regularly in the six months prior to the infection, and experienced at least one menstrual cycle after the infection. The 737 included participants were divided into mild and severe groups based on the severity of the infection. Deviations in first menstrual cycle post-infection were reported in 46.4% of participants (mild group 40.1% vs. severe group 55.2%, P<0.05). Menstrual changes were predominantly a late menstrual period (mild group 25.3% vs. severe group 30.4%), a shorter duration of menstrual flow (mild group 10.4% vs. severe group 14.7%), and a decrease in menstrual flow volume (mild group 16% vs. severe group 21.6%). Premenstrual syndrome symptoms in a small number of women were worse compared with pre-infection, especially in the severe group. During the second menstrual period after infection, most participants reported their menstrual characteristics had returned to those of pre-infection (mild group 88% vs. severe group 80.2%, P<0.05). In this investigation, SARS-CoV-2 infection had a substantial effect on women\'s menstrual characteristics, and the changes were mostly transient. Women with more severe COVID-19 symptoms experienced more significant changes. The potential long-term effects of SARS-CoV-2 on female reproductive health require further observation and research.
Cette étude visait à étudier les changements dans la menstruation et l\'association entre la gravité d\'Omicron et la menstruation après l\'épidémie nationale de COVID-19 en Chine. Une étude transversale a adopté un questionnaire électronique pour mener une enquête anonyme en ligne. L\'enquête visait les femmes en âge de procréer qui avaient été infectées par le SRAS-CoV-2, qui avaient leurs règles régulièrement au cours des six mois précédant l\'infection et qui ont connu au moins un cycle menstruel après l\'infection. Les 737 participants inclus ont été divisés en groupes légers et sévères en fonction de la gravité de l\'infection. Des écarts dans le premier cycle menstruel post-infection ont été signalés chez 46,4 % des participantes (groupe léger 40,1 % contre groupe sévère 55,2 %, P <0,05). Les changements menstruels étaient principalement une période menstruelle tardive (groupe léger 25,3 % contre groupe sévère 30,4 %), une durée plus courte du flux menstruel (groupe léger 10,4 % contre groupe sévère 14,7 %) et une diminution du volume du flux menstruel (groupe léger). 16 % contre groupe sévère 21,6 %). Les symptômes du syndrome prémenstruel chez un petit nombre de femmes étaient pires que ceux observés avant l\'infection, en particulier dans le groupe sévère. Au cours de la deuxième période menstruelle après l\'infection, la plupart des participantes ont déclaré que leurs caractéristiques menstruelles étaient revenues à celles d\'avant l\'infection (groupe léger 88 % contre groupe sévère 80,2 %, P <0,05). Dans cette enquête, l’infection par le SRAS-CoV-2 a eu un effet substantiel sur les caractéristiques menstruelles des femmes, et les changements ont été pour la plupart transitoires. Les femmes présentant des symptômes plus graves de la COVID-19 ont connu des changements plus importants. Les effets potentiels à long terme du SRAS-CoV-2 sur la santé reproductive des femmes nécessitent des observations et des recherches plus approfondies.

BACKGROUND: Over 265 000 women are living with HIV in the USA, but limited research has investigated the physical, mental and behavioural health outcomes among women living with HIV of reproductive age. Health status during the reproductive years before, during and after pregnancy affects pregnancy outcomes and long-term health. Understanding health outcomes among women living with HIV of reproductive age is of substantial public health importance, regardless of whether they experience pregnancy. The Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) study is a prospective observational cohort study designed to investigate physical and mental health outcomes of young women living with HIV as they age, including HIV disease course, engagement in care, reproductive health and choices and cardiometabolic health. We describe the HOPE study design, and characteristics of the first 437 participants enrolled as of 1 January 2024.
METHODS: The HOPE study seeks to enrol and follow 1630 women living with HIV of reproductive age, including those with perinatally-acquired HIV, at 12 clinical sites across 9 US states and Puerto Rico. HOPE studies multilevel dynamic determinants influencing physical, mental and social well-being and behaviours of women living with HIV across the reproductive life course (preconception, pregnancy, post partum, not or never-pregnant), informed by the socioecological model. Key research areas include the clinical course of HIV, relationship of HIV and antiretroviral medications to reproductive health, pregnancy outcomes and comorbidities and the influence of racism and social determinants of health. HOPE began enrolling in April 2022.
BACKGROUND: The HOPE study received approval from the Harvard Longwood Campus Institutional Review Board, the single institutional review board of record for all HOPE sites. Results will be disseminated through conference presentations, peer-reviewed journals and lay summaries.