Scientists have proven that humans have been reading and writing for about 5,000 years.[4] This can be traced back to 3,000 BCE in Ancient Mesopotamia.[4] Literacy rates have drastically risen in the last 200 years.[4] Reading has not only been used for acquiring knowledge and information from academic fields, but has long been a staple activity done for pleasure. I am unsure if it was always consciously well-known, but reading has now been proven to impact mental health.
I fell in love with books at the tender age of 4. Once I learned how to read on my own, I became consumed by a plethora of stories written by children’s authors. My love for reading evolved as time went on. As a teen, reading became an escape from the effects of teenage angst. In a 2021 study by Civic Science, it was discovered that 44% of adults read for fun every single day. Therefore reading is a healthy escape.[3]
When you go to the doctor, they sometimes ask you if you have been experiencing any stress or anxiety lately. Stress levels are at an all-time high due to the state of the world. Relational and systemic problems plague our daily lives. If your doctor advised you to read more as a form of routine stress management, would you do it? We are often tense, we may feel our muscles aching and our chests tightening when feeling stressed. “Reading can lower your heart rate and ease tension in your muscles.”[2]
I mentioned that reading was an escape from my teenage angst and it is still one of my favorite escapes. Reading is deemed a healthy escape for a multitude of reasons. It helps us to become more creative, more understanding, feel less alone, etc. Most people can create visuals as they read. This allows them to become further entrenched in what they are reading. Literary fiction, in particular, has been found to improve empathy. This is due to the fact that “literary fiction focuses more on the psychology of characters and their relationships.”[1] I am an avid reader of literary fiction and I become enthralled by the inner worlds of a character or all characters presented in a story through introspective dialogues. Literary fiction is a genre that emphasizes social behaviors and often teaches readers about human differences. This, in turn, may help us to develop a better understanding or empathy for those who are different from us. At the same time, we must keep in mind that different book genres can help us become more resilient, and empathetic as well as help us with social skills, mindfulness, and so on.
I have recently discovered “Bibliotherapy.” According to Psychology Today, it is a mental health intervention that is basically reading therapy. “It mainly refers to structured book reading programs run by libraries, clinics, or schools with the purpose of promoting recovery in people with mental health difficulties. The term bibliotherapy is also used to refer to self-initiated book reading pursued by an individual with mental illness. This can be supported by a clinician, family member or peer supporter, or pursued alone.” [5]
“Several studies have examined whether bibliotherapy can facilitate recovery from mental illness.”[5] According to multiple studies, women read more than men do. However, reading can benefit everyone’s mental health, and I would like to encourage people to try finding books or genres that they enjoy reading. If you do not like to read physical books or e-books, you can try listening to audiobooks. While reading will not fully eradicate the mental health crisis in the United States, it can improve your mental health.
Reading should be accessible to everyone. There are often literacy programs at public libraries that will assist in learning how to read. I would also like to encourage others to obtain a library card. “I am aware that this is not always possible due to not having a permanent home address, among other reasons, among other reasons, but it is worth trying.” A library card can give you access to free books and programs in person and through apps like the Libby app. Additionally, places to purchase inexpensive books include eBay and local used bookstores. Since reading can be a healthy coping strategy, it is important to be aware of the benefits that reading can offer to individuals and the benefits to mental health. Reading may have a surprising impact on your life!
References
[1] Chiaet, J. (2013, October 4). Novel Finding: Reading Literary Fiction Improves Empathy. Scientific American. https://www.scientificamerican.com/article/novel-finding-reading-literary-fiction-improves-empa thy/
[2] National Alliance on Mental Illness. (2020). Why Reading is Good for Mental health. NAMI California. https://namica.org/blog/why-reading-is-good-for-mental-health/
[3] Rittenberg, J. (2021, June 10). 44% of U.S. Adults Who Like to Read, Do So for Fun Every Day. CivicScience. https://civicscience.com/44-of-u-s-adults-who-like-to-read-do-so-for-fun/#:~:text=In%20a%20ne w%20survey%2C%20CivicScience,for%20fun%20every%20single%20day.
[4] University of Texas Permian Basin. (2024). The Evolution of Literacy Education. University of Texas Permian Basin.
[5] Whitley, R. (2019, May 24). Can Reading Books Improve Your Mental Health?. Psychology Today. https://www.psychologytoday.com/us/blog/talking-about-men/201905/can-reading-books-improv e-your-mental-health
Despite the amount of biology, anatomy, and even sex education classes taught in schools, the vast majority of people still do not grasp the basic foundational knowledge of menstruation or female health and sexuality in general. Unfortunately, this can be for so many reasons such as the unwillingness of society or the government to invest in women’s health education, the idea of menstruation or female sexuality being shameful, a taboo, or just simply “disgusting” or “unimportant.”
It is time to start from scratch.
Menstruation is simply monthly bleeding that occurs in the female body, famously known as the “period,” or jokingly, “the time of month.” It is the biological flow of blood and tissue, from the shedding of the uterine lining traveling all the way to the cervix and then eventually unleashed through the vagina. Not the vulva. The vulva is the external part of the female genitals while the vagina is the inner muscular channel that connects the vulva to the cervix.
As a whole, the menstrual cycle is the sequence of events or phases that take place in the body to prepare for pregnancy and reproduction. The normal average length of a menstrual cycle is 28 days. There are four phases: menstrual, follicular, ovulation, and lumenal phases. This guide will explain all of the phases of cycles in the simplest ways possible.
Starting with day one, if pregnancy still has not occurred, the lining of the uterus( endometrium) shreds through the vagina.
Follicular Phase
This is the first day of the period when estrogen levels increase which leads to the uterine lining growth and thickness
Ovulation Phase
This is the last day of the period where you ovulate. At this time, estrogen is still on the rise but along the way, there was a sudden rise in another hormone. This hormone is called the luteinizing hormone aids in making the ovary unleash its eggs.
Luteal Phase
After the eggs get unleashed from the ovary and make their way through the fallopian tubes to the uterus, the level of progesterone begins to increase in the process of preparing the uterine lining for pregnancy.
Pregnancy will occur if the egg becomes fertilized with sperm and the egg becomes implanted too. However, if not then all levels of hormones will drop and the thick lining of the uterus sheds during the period.
If you would like to learn more about menstruation and the menstrual cycle in detail then stay tuned for future articles explaining cycles and more detailed information about menstruation.
References
[1] Parenthood, Planned. “What Is Menstruation?: Get Facts about Having Your Period.” Planned Parenthood, professional. [2] Cleveland Clinic Medical. “Menstrual Cycle (Normal Menstruation): Overview & Phases.” Cleveland Clinic.
Working Women: Barriers, Obstacles, and Solutions for Women in the Workforce
Jessica Shute
February 2024
You see it in your inbox once again. That email states that while you’re qualified, the company has hired someone else. Even when you are working, you may feel disregarded by your colleagues and in some cases, your bosses. These are only a few of the challenges that women face in today’s workforce and while we have come a long way, there’s still a lot to be done.
Some of the problems facing women in work have been around for many years, if not the past decade. One of the big issues is the increasing cost of childcare. Especially during the Covid era, when the majority of women took time off work to take care of their children. The fact that daycare costs are still continuing to rise in many parts of the US and throughout the world is leaving new mothers and parents with few alternative options. There are also businesses out there that don’t allow parental leave for women or for men. Even though there’s been a rise in stay-at-home fathers during the same time, it seems most of the impact is directed at working mothers.
I witnessed this at a previous job where some of my coworkers were working moms. Once in a while, they would have to call off to look after their sick kids. I could tell some of the coworkers and managers weren’t happy about it, even though some of them were also parents.
Then there’s the wage gap. Today it’s back to pre-pandemic levels of wage inequality, compared to around 2017-2018, where the difference was 93 cents[1]. According to Forbes Advisor, in 2022 women earned 82 cents for every dollar a man makes.[2] Some of the factors regarding the wage gap include industries such as nonprofits, finance, healthcare, transportation,[3] and STEM-based fields which are primarily dominated by men.
Other factors include socio-economic factors, the states where industries are located, rural vs. urban areas, and race. The same Forbes article reveals that Latinas and women of color are affected the most by the pay gap. Some of the states with the largest gaps in pay include Utah, Louisiana, Alabama, Montana, Wyoming, and Oklahoma.[4] Studies have shown that people who work in urban areas and communities are paid around twenty-four percent more than those who work in rural communities. For college students and graduates in rural areas, most of them stay in the city because there are more job opportunities than in their hometowns.[5] While the option to work remotely has helped a little, there’s more work to be done to close the economic divide between urbanized and rural communities.
These are far from the only issues that women face in the workforce, but they are among the biggest ones. Some of the solutions to these issues include increasing equity in the workforce to close the pay gap, including childcare benefits to help struggling mothers, and better security for women who have work nights, which continues to be an ongoing issue. Another option is for companies to improve representation for women,[6] whether they’re returning to work after a break, just out of college, or entering a new field altogether. Women do better when they have a system that supports them, the same holds true for the world of working women.
References
[1] United States Government Accountability Office. Gender Pay Differences: The Pay Gap for Federal Workers Has Continued to Narrow, but Better Quality Data on Promotions are Needed. December 03, 2020.
[2] Haan, Katherine. Kelly Riley. Forbes Advisor. Gender Pay Gap Statistics in 2024. February 27, 2023.
[3] [6] Smith, Morgan. CNBC. These 5 Industries Have the Biggest Gender Pay Gaps Here’s Why. March 30, 2022.
[4] Haines, Julia. Christopher Wolf. States With the Biggest Gender Wage Gaps. March 14, 2023.
[5] Tovall, Elizabeth. The Rural-Urban Income Divide Persists and It May Be Widening. November 30, 2023.
Visits to the Gynecologist Among Teenagers and Young Women
Isha Gupta
February 2024
Many teenagers and young women opt out of pap smears and mammograms, but are visits to the gynecologist still essential for teenagers and young women? Teenagers and young women are not usually medically advised to get regular mammograms like older women, since research has not found significant benefits regarding mammograms among this younger age group.[10] Moreover, some young women are not comfortable getting pap smears, even after they turn 21, because of personal and cultural beliefs, including bad experiences with previous gynecological tests and procedures, lack of social support, and facing discouragement from loved ones.[5] Although many teenagers and young women may not regularly get mammograms and pap smears, visiting the gynecologist can still help safeguard other aspects of their reproductive health and wellness. There is even a subspecialty within obstetrics and gynecology that is focused on the reproductive health of children and adolescents, known as pediatric and adolescent gynecology. By the same token, based on recommendations from the American College of Obstetrics and Gynecology (ACOG), the first pediatric gynecology exam should occur between 13 and 15 years of age, but it can happen earlier if gynecological health issues arise.[9] Furthermore, ACOG claims that there can be more than 21 reasons why teenagers should visit gynecologists.[1] A few of the most common reasons visits to the gynecologist are essential for teenagers and young women include concerns surrounding the menstrual cycle, preventing pregnancy, regulating hormones, and preventing, diagnosing, and treating sexually transmitted diseases.
Teenagers and young women can have concerns about their menstrual cycles,[4]including amenorrhea (absence of menstrual periods), dysmenorrhea (menstrual pain), and menorrhagia (heavy menstrual bleeding). Gynecologists can help address these important issues which can significantly affect diverse aspects of their lives, such as by leading to reduced academic performance due to absenteeism, inability to participate in social activities, and infertility later on in life.
Unplanned Pregnancy Prevention and Hormone Regulation
According to the Centers for Disease Control and Prevention (CDC), there are several different types of birth control methods for adolescents, ranging from barrier methods like condoms to short-acting hormonal methods like daily pills, and long-acting reversible contraceptives like intrauterine devices.[2] Gynecologists can help prevent teen pregnancy and unplanned pregnancies among young women, by offering a safe and non-judgmental space where they can learn more about different birth control methods, and even evaluate with their medical provider which form of birth control is best suitable for them. Some forms of birth control, namely, the pill may not only prevent unwanted pregnancies but also help regulate hormone levels. This, in turn, can simultaneously help address menstrual cycle-related irregularities and complaints.[8]
STD Prevention, Diagnosis, and Treatment
According to the CDC, sexually transmitted diseases (STDs) are more common in adolescents and young people. STDs are a major cause for concern especially among this population, due to risky health behaviors and because they may not feel comfortable sharing personal information about reproductive health with medical professionals.[3] Preventing, diagnosing, and treating STDs early on is important to help prevent adverse health outcomes associated with these diseases, such as the development of cervical cancer and infertility,[7] which can have profound consequences for young people throughout their lives. Gynecologists can provide access to vaccines, testing, and treatment to help prevent, diagnose, and treat STDs in a timely fashion. These medical specialists can help promote health literacy about STDs, along with other reproductive health issues, among teenagers and young women. This, in turn, can also help combat disinformation about the transmission of such diseases and promote this population’s health.
Although several gynecologic cancers and their associated risks of mortality are less common among teenagers and young women as compared to older women,[6] visits to the gynecologist are still significant among this age group. There are critical ways teenagers’ and young women’s gynecologic health can be affected. Some of the most common gynecological-related complaints teenagers and young women can have include concerns about their menstrual cycles, pregnancy prevention, hormone regulation, and STDs. Having access to a trusted medical professional specializing in gynecology where teenagers and young women can get accurate information about their health can empower them to make the best decisions for their reproductive health and well-being. Therefore, gynecologists can play significant roles in helping to promote teenagers’ and young women’s health and wellness.
References
[1] “21 Reasons to See a Gynecologist Before You Turn 21.” American College of Obstetricians and Gynecologists, American College of Obstetricians and Gynecologists, 2024, www.acog.org/womens-health/infographics/21-reasons-to-see-a-gynecologist-before-you-turn-2 1.
[3] “CDC Fact Sheet: Information for Teens and Young Adults: Staying Healthy and Preventing STDs.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 Apr. 2022,
[4] Cummings, Holly W. “Should My Teen See an Ob-Gyn? Here’s What I Tell Parents.” American College of Obstetricians and Gynecologists, American College of Obstetricians and Gynecologists, Mar. 2022, www.acog.org/womens-health/experts-and-stories/the-latest/should-my-teen-see-an-ob-gyn-here s-what-i-tell-parents.
[5] Hassani, L., PhD, Dehdari, T., PhD, Hajizadeh, E., PhD, Shojaeizadeh, D., PhD, Abedini, M., PhD, & Nedjat, S., PhD (2017). Barriers to Pap Smear Test for the Second Time in Women Referring to Health Care Centers in the South of Tehran: A Qualitative Approach. International journal of community based nursing and midwifery, 5(4), 376–385.
[6] McGonigle, K. F., Lagasse, L. D., & Karlan, B. Y. (1993). Ovarian, uterine, and cervical cancer in the elderly woman. Clinics in geriatric medicine, 9(1), 115–130.
[7] Monteiro, I. P., Azzi, C. F. G., Bilibio, J. P., Monteiro, P. S., Braga, G. C., & Nitz, N. (2023). Prevalence of sexually transmissible infections in adolescents treated in a family planning outpatient clinic for adolescents in the western Amazon. PloS one, 18(6), e0287633. https://doi.org/10.1371/journal.pone.0287633
[10] Qin, J., White, M. C., Sabatino, S. A., & Febo-Vázquez, I. (2018). Mammography use among women aged 18-39 years in the United States. Breast cancer research and treatment, 168(3), 687–693. https://doi.org/10.1007/s10549-017-4625-6
The speculum is often cited as the most uncomfortable part of a gynecologist visit.[10] It lies at the center of an important preventative health care service: the pelvic exam.[16] The speculum is a medical instrument that has two arms that meet at a hinge – the arms look similar to a duck’s bill.[6] The health care provider inserts the speculum into the vagina and opens the speculum to widen the vaginal walls so the provider can view the vagina and cervix more easily.[6] For many individuals, the speculum causes pain and discomfort.[4] This is unsurprising given that the modern speculum has remained essentially unchanged since 1870.[15] In addition, physicians have not yet widely adopted practices that may reduce a patient’s pain and anxiety during the pelvic exam.[7]
The speculum’s origins may inform some of the issues patients experience today. The modern speculum has a legacy of causing pain: it was invented by James Marion Sims in the 1840s when he conducted experiments on slave women – Lucy, Anarcha, and Betsey – without anesthesia even though it was available at the time.[12] Needless to say, the speculum was not designed with the patient’s comfort in mind. Sims did not use anesthesia while developing the speculum because he held the erroneous belief that black people did not experience pain like white people did.[12] In addition, the women were further stripped of their autonomy because Sims only required consent from their owners to conduct the experiments.[12] Today, around 35% of women* experience pain or discomfort during pelvic exams and about 35% of women experience fear, embarrassment, or anxiety before or during the pelvic exam.[4]
The speculum is not specialized enough to be used for all populations who require its use.[24] Since pain and emotional discomfort are subjective experiences, providers should utilize an individualized approach for speculum insertion and pelvic exams.[19] As Roger Fillingim, director of the Pain Research and Intervention Center of Excellence at the University of Florida, indicates, “you treat the pain that the patient has, not the pain that you think the patient should have.”[3] According to various studies, it appears that educating patients about pelvic exams and specula as well as encouraging patients’ personal control during the exam may decrease pain and emotional discomfort.[8],[19] Informing patients that pain is not normal and informing them of pain management options may improve patient outcomes during pelvic exams as patients can try to mitigate the pain before it occurs.[20] Given that the pelvic exam places people in a vulnerable position, it makes sense that bolstering the patient’s autonomy could ease the psychological discomfort surrounding the exam.[9] For example, based on research findings, certain women indicated that they would feel more comfortable with the speculum insertion if their provider informed them of each step of the process or allowed them to look at the speculum before the exam.[24],[9] Others indicated that they would likely feel more comfortable if the provider gave them the option to insert the speculum themselves.[2]
While pain and emotional discomfort should be considered for updating the speculum and how it is used, such issues are trivialized when reported by women. Women’s pain is often perceived as an overreaction rather than reality in part because women are more likely to express pain.[3] More often, physicians prescribe less pain medication for women than for men.[11]
Providers also seem unwilling to adopt new specula into practice if they have not been rigorously tested because the current speculum is the standard.[24] There are both economic barriers and social barriers to testing. Historically, women have been excluded from medical research. For example, the National Institute of Health did not require that scientists account for sex as a variable in medical research until 2015.[22] It also appears that there is a gender bias against studying medical issues that primarily affect women. When analyzing funding allocation among diseases, the United States National Institutes of Health applied a disproportionate portion of its resources to diseases primarily affecting men.[17] Issues arising from the use of the speculum or updates to the procedure have likely not been addressed or publicized to the majority of the population given that the last general overview of the speculum was published in 2008.[24]
In addition to the unwillingness to fund research surrounding speculum updates, doctors may not adopt new tools or updated practices due to cost. The current speculum is inexpensive, rarely needs replacing, and is easy for practitioners to use.[7] Lack of insurance coverage and limited provider time to see patients may affect the provider’s ability to utilize pain management options or individualized solutions to pain and emotional discomfort.[7]
By failing to address the physical and emotional harm the speculum causes, women’s health is impacted. For example, while cervical cancer is preventable through regular screenings, researchers have found that the rates of timely cervical cancer screenings for eligible adults have decreased since 2005.[23] One of the main ways to screen for cervical cancer is through a pap smear, also known as a pap test, during the pelvic exam.[18] Using the speculum, the health care provider checks for any irregularities and then collects cells from the cervix that are later tested for signs of cervical cancer.[6] According to data from 2018, only about 51% of women go to the gynecologist at least once per year[14]. Lack of access to health care remains a significant problem for marginalized groups, especially Black women.[13] However, lack of access as a reason for being overdue for a cervical screening declined overall.[23] By contrast, pain continues to be a significant factor in whether people continue seeking cervical cancer screenings.[13] More specifically, some studies indicate that people refrain from seeking cervical cancer screenings because they have experienced pain during the pap smear in the past.[13] The decline is screenings is concerning considering the American Cancer Society estimates that there will be approximately 13,820 new cases of invasive cervical cancer diagnosed in 2024.[1]
In order to improve patient experiences and reproductive health overall, it appears more funding is required for speculum updates. Patients should also be better informed about the speculum and the pelvic exam. Lastly, providers should become zealous advocates for their patients and make their patients feel comfortable undergoing these essential diagnostic procedures.
*This article uses “women” and “men” when the underlying source uses these categories. This article recognizes that women are not the only population that goes to the gynecologist.
References
[1] American Cancer Society. (2024, January 17). Key Statistics for Cervical Cancer. Cervical Cancer Statistics. https://www.cancer.org/cancer/types/cervical-cancer/about/key-statistics.html.
[2] Bergman, S. (2022, June 20). How enduring use of 150-year-old speculum puts women off smear tests. The Independent. Retrieved February 10, 2024, from
[4] Bloomfield H.E., Olson A., Cantor A., et al. Screening Pelvic Examinations in Asymptomatic Average Risk Adult Women. Washington (DC): Department of Veterans Affairs (US); 2013 Sep. RESULTS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224895/
[5] Chaney, P. (2020, March 18). Speculum Speculations: The Past and Future of an Iconic Gynecology Instrument. Empowered Women’s Health. https://www.volusonclub.net/empowered-womens-health/speculum-speculations-the-past-and-fut ure-of-an-iconic-gynecology-instrument/#:~:text=The%20speculum%20is%20a%20familiar,unc hanged%20for%20over%20150%20years.
[6] Cleveland Clinic. (2022, October 3). Speculum. Speculum: Design, Purpose, Types, Exams & What to Expect. https://my.clevelandclinic.org/health/drugs/24238-speculum
[10] Haar, E., Halitsky, V., & Stricker, G. (1977). Patientsʼ Attitudes toward Gynecologic Examination and to Gynecologists. Medical Care, 15(9), 787–795. https://doi.org/10.1097/00005650-197709000-00006.
[11] Hoffmann, D. E., & Tarzian, A. J. (2003). The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. The Journal of Law, Medicine & Ethics, 13–27. https://doi.org/10.2139/ssrn.383803.
[12] Holland, B. (2018, December 4). The ‘Father of Modern Gynecology’ Performed Shocking Experiments on Enslaved Women. History.com. https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experimen ts-on-slaves
[13] Hoyo, C., Yarnall, K. S. H., Skinner, C. S., Moorman, P. G., Sellers, D., & Reid, L. (2005). Pain predicts non-adherence to pap smear screening among middle-aged African American women. Preventive Medicine, 41(2), 439–445. https://doi.org/10.1016/j.ypmed.2004.11.021
[14] IPSOS Global Advisor. “Global Views On Healthcare.” IPSOS, 2018, www.ipsos.com/sites/default/files/ct/news/documents/2018-07/global_views_on_healthcare_201 8_-_graphic_report_0.pdf.
[15] Kent, C. (2020, September 10). Does the vaginal speculum need a redesign?. Medical Device Network. https://www.medicaldevice-network.com/features/does-the-vaginal-speculum-need-a-redesign/?c f-view.
[17] Mirin, A. A. (2021). Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health. Journal of Women’s Health, 30(7), 956–963. https://doi.org/10.1089/jwh.2020.8682
[18] National Cancer Institute. (2023, August). Cervical Cancer Screening. Cancer Trends Progress Report. https://progressreport.cancer.gov/detection/cervical_cancer.
[22] U.S. Department of Health and Human Services. (n.d.). Not-OD-15-102: Consideration of sex as a biological variable in NIH-funded research. National Institutes of Health. https://grants.nih.gov/grants/guide/notice-files/not-od-15-102.html?itid=lk_inline_enhanced-tem plate.
[23] Winstead, E. (2022, February 22). Why Are Many Women Overdue for Cervical Cancer Screening?. Rate of Overdue Cervical Cancer Screening Is Increasing.
[24] Wong, K., & Lawton, V. (2021). The Vaginal Speculum: A Review of Literature Focusing On Specula Redesigns and Improvements to the Pelvic Exam . Columbia Undergraduate Research Journal, 5(1). https://doi.org/10.52214/curj.v5i1.8084.
When a woman experiences pain during intercourse, the condition is known as dyspareunia. In the United States, the prevalence of dyspareunia ranges between ten and twenty percent and varies by age.[3][10] Women with this condition often describe feeling sadness, anxiety, heightened sensitivity to pain, negative body image, and low self-esteem; hence, a timely intervention is crucial to address this disorder.[9]
There are two types of dyspareunia that we need to be aware of– superficial and deep. When the woman experiences burning, stinging, or sharp pain at or near the entrance of the vagina on penetration, it is generally called superficial dyspareunia. Deep dyspareunia refers to pelvic pain experienced during deep vaginal penetration.[4]
Superficial Dyspareunia
Superficial dyspareunia has several causes. For example, it can be seen in patients with vaginismus—an involuntary response of the body causing spasms of the muscles in the vagina— or vulvodynia—a chronic pain condition of the vulva.[1][8][11] Other causes include congenital abnormalities such as vaginal agenesis—where a woman is born without a fully developed vagina—or imperforate hymen—where the hymen completely covers the vaginal opening.[4]
Superficial dyspareunia can also result from insufficient lubrication due to a drop in estrogen levels after menopause, childbirth, or during breastfeeding. Certain medications like antidepressants, antihistamines, antihypertensives, certain oral contraceptives, and sedatives may decrease sexual arousal, which in turn causes decreased lubrication, thereby leading to painful intercourse.[4]
Injury, trauma, or irritation to the vaginal region from accidents, pelvic surgery, procedures like female circumcision, and episiotomy—a surgical incision made between the vagina and anus— can also contribute to discomfort during sexual intercourse. Infections in the genital region, for example, candidiasis or herpes, or of the urinary tract can be another cause of pain. Women with conditions like eczema or dermatological issues such as psoriasis in the genital region may encounter discomfort during sexual intercourse.[4][6]
Deep Dyspareunia
Deep dyspareunia can result from scarring from hysterectomy, radiation therapy, and chemotherapy for cancer treatment. Other conditions associated with deep dyspareunia include cystitis, endometriosis, hemorrhoids, irritable bowel syndrome, ovarian cysts, pelvic floor dysfunction, pelvic inflammatory disease, and uterine fibroids.[4]
Treatments
During the treatment of dyspareunia, the goal is to treat both the physical and mental aspects associated with the condition. Here are some treatment approaches:
Proper Vulvar Care
It is important to stay away from irritants such as perfumed soaps, perfumed vaginal hygiene wipes, and perfumed paper sanitary napkins. Furthermore, prioritizing cotton underwear and avoiding snug clothing is essential. When cleansing, steer clear of hot water and apply a topical natural emollient or moisturizer. Olive oil and coconut oil are popular alternatives to off-the-shelf moisturizers. Always use a water-based lubricant without flavors, perfumes, or other irritants during intercourse.[6]
Pelvic Floor Physical Therapy
Under the guidance of a physical therapist, pelvic floor exercises can be quite helpful in the treatment of vulvodynia due to pelvic floor dysfunction.[2]
Cognitive behavioral therapy has proven to be a helpful tool when treating dyspareunia as it teaches pain controlling techniques.[7] Couples counseling can also be a beneficial tool as it might help reduce or eliminate feelings of shame and poor body image as well as enhance communication.[6]
Topical Treatments
Topical five percent lidocaine prior to intercourse (thirty minutes before) has also proven to be useful. Be mindful that lidocaine gel or ointment can result in an initial sensation of burning upon application and that the partner may experience numbing of the penis at first; hence, the use of condoms is encouraged.[6] Topical estrogen cream is another treatment option for vulvodynia.[12]
Oral Medications
Oral medications may be used alone or in combination with topical treatments. These medications include gabapentin, pregabalin, tricyclic antidepressants such as amitriptyline, serotonin and norepinephrine reuptake inhibitors, and selective serotonin reuptake inhibitors. For dyspareunia caused by endometriosis, the first line of treatment includes nonsteroidal anti-inflammatory drugs, combination hormonal contraceptives, and progestin-only contraceptives. If the patient does not experience significant pain relief, then the second line of treatment includes gonadotropin-releasing hormone agonists, gonadotropin-releasing hormone antagonists, danazol, and aromatase inhibitors.[4]
Surgical Intervention
Vestibulectomy, a surgical intervention, may be an option for the type of vulvodynia that is unresponsive to all forms of treatment. This, however, needs to be evaluated by a provider.[5]
When it comes to dyspareunia it is important to remember that addressing the condition is a journey. With the right support, there are treatments and coping strategies that can significantly improve comfort and well-being.
References
[1] Corsini-Munt, S., Rancourt, K. M., Dubé, J. P., Rossi, M. A., & Rosen, N. O. (2017). Vulvodynia: a consideration of clinical and methodological research challenges and recommended solutions. Journal of Pain Research, 10, 2425–2436. https://doi.org/10.2147/JPR.S126259
[2] Ghaderi, F., Bastani, P., Hajebrahimi, S., Jafarabadi, M. A., & Berghmans, B. (2019). Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial. International Urogynecology Journal, 30(11), 1849–1855. https://doi.org/10.1007/s00192-019-04019-3
[3] Hill, D. A., & Taylor, C. A. (2021). Dyspareunia in women. American Family Physician, 103(10), 597–604.
[4] Hrelic, D. A., Wax, E. M., & Saccomano, S. J. (2023). Dyspareunia: Etiology, presentation, and management. The Nurse Practitioner, 48(11), 27–34. https://doi.org/10.1097/01.NPR.0000000000000111
[5] Kliethermes, C. J., Shah, M., Hoffstetter, S., Gavard, J. A., & Steele, A. (2016). Effect of vestibulectomy for intractable vulvodynia. Journal of Minimally Invasive Gynecology, 23(7), 1152–1157. https://doi.org/10.1016/j.jmig.2016.08.822
[6] Kumar, K., & Robertson, D. (2017). Superficial dyspareunia. CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 189(24), E836. https://doi.org/10.1503/cmaj.161337
[7] Masheb, R. M., Kerns, R. D., Lozano, C., Minkin, M. J., & Richman, S. (2009). A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy. Pain, 141(1-2), 31–40. https://doi.org/10.1016/j.pain.2008.09.031
[8] Pacik, P. T. (2014). Understanding and treating vaginismus: a multimodal approach. International Urogynecology Journal, 25(12), 1613–1620. https://doi.org/10.1007/s00192-014-2421-y
[9] Seehusen, D. A., Baird, D. C., & Bode, D. V. (2014). Dyspareunia in women. American Family Physician, 90(7), 465–470.
[10] Sorensen, J., Bautista, K. E., Lamvu, G., & Feranec, J. (2018). Evaluation and treatment of female sexual pain: A clinical review. Cureus, 10(3), e2379. https://doi.org/10.7759/cureus.2379
[11] Tayyeb, M. & Gupta, V. Dyspareunia. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562159/
[12] Ventolini, G. (2011). Measuring treatment outcomes in women with vulvodynia. Journal of Clinical Medicine Research, 3(2), 59–64. https://doi.org/10.4021/jocmr526w
Premenstrual Syndrome: Causes, Symptoms and Their Meanings
Rebecca Johnson
February 2024
Premenstrual syndrome, or PMS, is a term associated with the symptoms a woman experiences in the days leading up to her period. Usually, these symptoms arise about a week before menstruation begins. Common symptoms are breast tenderness, abdominal cramps, mood swings, food cravings, and irritability.[3] We are going to take a closer look at the biological bases of these symptoms, and why they affect us the way that they do!
Tender Breasts
The reason our breasts get sore before our periods is because Estrogen, a primary female sex hormone, enlarges the breast ducts. A simultaneous decrease in and the decrease of Progesterone, a steroid hormone, that causes swelling of the milk glands. This is because Estrogen increases during this time of the menstrual cycle. The usual role of Estrogen in breast ducts is to it stimulate milk production and expand the ducts into the mammary glands.[4] The growth is the result of Estrogen binding to the receptor Era at the start of puberty. But it’s important to monitor the symptoms you are having because some may be connected to more serious issues and may cause problems later in life.[1]
Abdominal Cramps
Abdominal cramps are caused by the contraction of the uterine lining of the uterine lining and may become thinner and thicker throughout your menstrual cycle. Regulated by prostaglandins, the muscles contract causing inflammation and pain. This hormone plays a part in primary dysmenorrhea, which is one type of period pain. In this case, excess prostaglandin release causes tightening and subsequent relaxation of uterine muscle, causing the sensation known as cramps. Causes are endometriosis and uterine fibroids, but normally, period cramps get better as you get older. To relieve the pain, you can try exercising, using a heating pad, or taking a hot pack.[5]
Due to the fluctuation of estrogen and progesterone levels, you may feel more negative emotions before and during menstruation. Estrogen is connected to the hormone serotonin, which regulates happiness. However these two hormones aren’t always linear, and variations in them can cause mood changes. In fact, a study by Soyda Akyol E et al. showed that women who had PMS experienced more depression and nervousness.[2]
Food Cravings
Before or during your period, fluctuations in estrogen and progesterone cause certain food cravings. Usually, you tend to crave carbohydrates and sugary foods during this time, especially starchy foods. This is to make up for the low serotonin levels produced in your body during pre-menstruation and menstruation. It will balance out your mood and provide the stability that is normally serotonin’s job. Also, this is the period where your body is best at metabolizing carbohydrates, so if there is any right time to consume it, it’s during your period! You become more sensitive to insulin, so the carbohydrates will be easier to convert to energy while the body has low insulin.[6]
References
[1] Arendt, L. M., & Kuperwasser, C. (2015). Form and Function: how Estrogen and Progesterone Regulate the Mammary Epithelial Hierarchy. Journal of Mammary Gland Biology and Neoplasia, 20(1-2), 9–25. https://doi.org/10.1007/s10911-015-9337-0
[2] Genomind. (2023, May 4). How Hormones Affect Mood for Women – Genomind. Genomind.com. https://genomind.com/patients/how-hormones-affect-mood-for
[3] Mayo Clinic. (2022, February 25). Premenstrual syndrome (PMS) – symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms causes/syc-20376780
[4] Normal Breast Development and Changes. (n.d.). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/normal-breast-development and-changes#:~:text=The%20hormone%20estrogen%20is%20produced
[6] “There’s a Best Time in Your Cycle to Eat Carbs (and This Is It).” Eve Wellness, 22 June 2020, evewellness.com/blogs/news/there-s-a-best-time-in-your-cycle-to-eat-carbs-and-this-is-it. Accessed 12 Feb. 2024.
Tent Scraps as Menstrual Products and C-Sections Without Anesthesia: Gazan Women’s Hell
Lisa Samy
February 2024
October 7th, 2023. The day that Israel began its series of deadly onslaughts in the Gaza strip, displacing more than 85% of Palestians from their homes.[1] Supplies are scarce, hunger cripples the masses, and diseases run rampant.[1] But for women and girls, various unseen struggles haunt them for every moment the conflict persists.
Pregnant Women and the Future Generations
Around 183 women are estimated to give birth in Gaza daily.[2] Because of a shortage of drugs, functioning hospitals, and medical supplies, women in labor aren’t provided with the most basic care for their hygiene and physical/mental health.[2] Cesarean sections are performed without anesthesia, and women are forced out of hospital rooms in only a few short hours after giving birth.[2] These dire conditions exacerbate postpartum recovery, leading to a higher risk of maternal mortality.
On the other hand, poor care has already led to negative outcomes for the health of numerous newborns. Many Gazan healthcare providers have reported a sharp increase in the number of stillborns and miscarriages.[2] And for the babies who do survive, they are born into a world that fits one word: hell. Tess Ingram, a UNICEF communications specialist, says, “Seeing newborn babies suffer while some mothers bleed to death should keep us all up at night.”[3]
The devastating effects of mothers’ exposure to armed-conflict, violence, and starvation will without a doubt imprint themselves on their children.[2] However, we won’t know the severity of the long-term generational effects for years to come.
A woman in Gaza, Heba Gersof, can’t find a single pad in a pharmacy no matter how far she scours the streets.[1] And if she does miraculously find pads in stock, they are five or six times the price—an expense that the average Gazan women cannot afford.[1] Gazans are already deprived of food, water, and basic necessities, but the lack of accessible menstrual products only adds an extra layer of suffering.
What do these women do then? They use whatever they have at their disposal to replicate menstrual pads. These include old clothes, towels, or even scraps from their tents.[1] These unsanitary materials aren’t guaranteed to be washed properly and regularly either, as soap and water are a rarity.[3] Therefore, women who take the risk of using these as makeshift-pads are at high risk for infections, particularly the highly lethal bacterial infection Toxic Shock Syndrome.[3]
Other women choose to take contraceptive pills that suppress their menstrual cycles, but these pills are scarce and often not allowed to enter the “tent cities” Gazan refugees have set up.[3] In short, any alternatives are scarce, turning menstrual cycles into a deadly interval of humiliation and mental torment.
What Can We Do?
Unfortunately, these topics do not get the attention they deserve. The topic of menstruation is a taboo subject in Gaza’s traditional society, indicating it is rarely talked about amongst Gazan women.[3] Therefore, we urge the global community to spread awareness, whether it’s through sharing information on social media or championing volunteer groups, organizations, and aid relief programs to supply women’s health products to Gazan women.
Pious Projects
Want to help Gazan women, but unsure of where to start? Pious Projects is a registered 501(c)3 humanitarian group that is currently raising funds to send feminine hygiene kits to vulnerable Gazan women. To support them through donations or learn more about their mission, please see the link below.
[1] Batrawny, Aya. (2024). Women in Gaza are desperately in need of washrooms, privacy, and pads. NPR. https://www.npr.org/2024/01/05/1223193875/women-in-gaza-are-desperately-in-need-of-washro oms-privacy-and-pads
[2] Elkanib, Shatha. (2024). Pregnant women in Gaza require urgent protection. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02835-0/fulltext#:~:text=A pproximately%20183%20women%20are%20estimated,pregnancy%20or%20birth%2Drelated% 20complications.&text=occupied%20Palestinian%20territory-,oPT%20emergency%20situation %20update%20as,December%202023%20at%2015%3A00.
[3] Sky News. (2024). Women in Gaza having c-sections without painkillers as girls use tent scraps for period products. https://news.sky.com/story/women-and-girls-in-gaza-using-scraps-of-tent-material-in-place-of-pe riod-products-13053083?dcmp=snt-sf-twitter.
Unveiling the Ripple Effect: Navigating a World Transformed by the Reversal of Roe v. Wade
Roma Bhavsar
February 2024
Inequality
On June 24, 2022 Americans were left stunned and fearful as unexpected events unfolded. The Dobbs v. Jackson decision overturned Roe v. Wade, the Supreme Court decision that safeguarded a woman’s ability to choose to have an abortion or continue a pregnancy.[1,2] Consequently, the constitutional right to abortion was eliminated in the United States and this opened the door for states to enact legislation restricting or prohibiting access.[1] Roughly 50% of states have adopted some type of restriction and therefore limited access to proper healthcare for millions of women.[3] It has been almost two years since the reversal of Roe v. Wade, and American women are still reeling from the consequences of that dire decision and injustice. Without protective abortion laws, women are denied fundamental control over their own reproductive choices, potentially forcing them into unsafe and life-altering circumstances.
Surging Mental Health Burden, Financial Implications, Mortality, and More
Roughly 20% of pregnant women seek abortions in the United States every year. Limiting abortion access will force more women to carry pregnancies they do not want, causing them to potentially resort to unsafe procedures performed by untrained individuals in subpar conditions. The abortion ban heightens the risks associated with both pregnancies and abortions, making women’s outcomes worse and exacerbating existing inequalities.[3] There is plenty of evidence indicating that abortion restrictions disproportionately affect individuals who are already marginalized and oppressed including people of color, immigrants, and people with low incomes.[2]
There is a growing concern that the rate of maternal mortality will increase in the absence of legal abortion options. According to the World Health Organization, worldwide illegal abortions have a fatality rate of 350 times that of legal abortions. In the United States, the numbers suggest that having a legal abortion is no riskier than undergoing other minor surgeries. These findings strongly highlight the safety of legal abortion when compared to the potential risks of pregnancy. Surprisingly, pregnancy is associated with a maternal mortality rate 14 times higher than that of abortion.[4]
Furthermore, the psychological burden of being forced to carry a pregnancy to term can be traumatizing and daunting for both pregnant women and their families. This will exacerbate the existing mental health crisis which is already bursting at the seams. Studies have shown that unwanted pregnancies are linked to negative mental health outcomes such as perinatal depression, decreased self-esteem, and heightened anxiety.[3]
Financial distress and socioeconomic well-being are more obstacles for unwanted pregnancies.[3,5] While women have the option to travel to states where abortion is permitted, it comes at a significant cost. The cost of travel, hotel stay, time off from work, childcare, and the cost of the mediation or procedure required all add up, which makes getting an abortion impossible, unaffordable, and inaccessible for many women.[5] Women denied abortions suffer worse social, health, and financial outcomes. Data from a study in the United States found that 51% of women seeking abortion lived below the poverty line, had lower credit scores, and had more debt.[3]
At its core, having the freedom to choose abortion is a crucial part of medical care, involving open discussions between patients and their doctors. However, interference from lawmakers threatens this essential process. With the challenges posed by overturning Roe v. Wade, medical and nursing education is imperative for learners and educators to join forces to improve and enforce abortion education and the management of pregnancy complications in medical schools. Without this, there can be serious implications on the standard of care and skills needed to manage pregnant patients, particularly in states with abortion bans where healthcare resources are already very limited. Consequently, this may worsen existing disparities as some medical students may choose not to pursue clinical training or practice in states with strict abortion laws, opting for a more comprehensive education. To protect their own and their patients’ reproductive health, students might work in states where abortion is still accessible, adding to healthcare inequalities. Ultimately, this could lead to more shortages of doctors, a drop in school enrollment in states with abortion bans, and a decrease in the long-term quality of reproductive healthcare with adverse consequences for women’s health.[2,6] This is simply unacceptable.
My Body. My Choice.
No one should be forced to carry an unwanted pregnancy to term. Now more than ever, women feel trapped in a metaphorical prison when they are denied basic rights about what they can and cannot do with their bodies. This denial infringes on autonomy and control over their own lives. In order to regain some of that control back, it is our civil duty to make sure all women have access to basic healthcare information and know what their options are to get the proper care they need.
Promoting awareness through advocacy is crucial for disseminating evidence-based information regarding the negative consequences of denying abortion. The data clearly shows that women and families live better with access to safe abortion care.[3] To learn more about access to accurate, up-to-date general information on abortions, birth control, and out-of-state clinic options, please see the three links below.
After almost two years since Roe v. Wade fell, and with more restrictions likely to follow, the true extent of its impact remains uncertain and quite scary. The turmoil surrounding this issue is not just a concern for women today, but also an unsettling thought about the legacy we are leaving for the generations ahead.
References
[1] Lazzarini, Z. (2022). The End of Roe v. Wade — States’ Power over Health and Well Being. New England Journal of Medicine, 387(5). https://doi.org/10.1056/nejmp2206055.
[2] Berg, J. A., & Woods, N. F. (2023). Overturning Roe v. Wade: Consequences for Midlife Women’s Health and well-being. Women’s Midlife Health, 9(1). https://doi.org/10.1186/s40695-022-00085-8.
[3] Londoño Tobón, A., et al. (2023). The end of Roe v. Wade: implications for Women’s mental health and care. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1087045.
[4] Ginsberg, N. A., & Shulman, L. P. (2021). Life without Roe v Wade. Contraception and Reproductive Medicine, 6(1). https://doi.org/10.1186/s40834-021-00149-6.
[5] Kitchener, C., Roubein, R., Tran, A. B., Gilbert, C., & Dormido, H. (n.d.). A fragile new phase of abortion in America. Washington Post.
[6] Traub, A. M., Mermin-Bunnell, K., Pareek, P., Williams, S., Connell, N. B., Kawwass, J. F., & Cwiak, C. (2022). The implications of overturning Roe v. Wade on medical education and future physicians. The Lancet Regional Health – Americas, 14, 100334. https://doi.org/10.1016/j.lana.2022.100334.
The Underrepresentation of Women in Research and Clinical Trials
Emily Bergin
February 2024
Whether we are talking about the people conducting and authoring research or the individuals who serve as the participants in the studies, the same fact remains true; women are disproportionately underrepresented in medical research.
Background
This is not a new phenomenon. In fact, conditions today are much better than they used to be. Historically, researchers have held the misguided view that females’ biology is more “variable” than male’s due to their hormonal cycles, providing them a reason to exclude female subjects (both humans and rats) from clinical trials.[1]
True Differences
There are important differences to be noted between women and men on certain medications. Women tend to experience higher blood drug concentrations and often take longer to eliminate a drug from their body, making it incredibly necessary to test new drugs on both men and women.[1] In certain sectors such as cardiology, women are also found to be more likely than men to have side effects from medication at the same dose.[2]
The same remains true for women in the medical research workforce, with only 9% of graduates in 1970 identifying as women.3 Despite this growing to 48% in 2018, leadership positions in medicine have not reflected the same rising trend. Women remain underrepresented in full-time medical school staff, research investigators, department chairs, and deans.[3]
Despite progress in terms of the number of women authors of published research, the change is not reflected in positions of authority. Women are still underrepresented in senior authorship positions and significantly less likely to be named in the positions regarded as most prestigious, first and last, when the authors are listed.[4, 5]
Harmful Exclusion
Addressing this problem in clinical research involves first understanding the extent of harm caused by the unbalanced inclusion of participants in the scientific world. Once a study is complete, the findings are intended to be adopted into the target population to improve outcomes.[6] However, if the majority of male participants are included, the results will not be generalizable to the entire human population.
This can result in major consequences for women who are recommended a regimen of medication that has only been tested on men. For clinical trials in cardiovascular disease, the leading cause of death among women, rates of female participation sit around 29%.[2] This has huge consequences for drugs that affect the genders differently as a recent study found women obtained the optimal benefit from a heart failure drug at just 50% of the dose that men need.[2] This isn’t just true for medications either. When it comes to implantable devices like defibrillators, women are markedly underrepresented in trials.[2] Landmark research trials report rates as low as 14% for female participants, raising huge concerns over the efficacy of these devices in different bodies.[2]
Finding the Cause
There is a range of reasons as to why women disproportionately fail to participate in trials. Remaining beliefs surrounding the increased difficulty of studying women no doubt play a role. Women also face unique barriers to clinical trial participation such as the logistical barriers that come with often being responsible for children in a caregiving role.[2, 6] This holds true for those serving as research participants in clinical trials as well as those attempting to gain higher-ranking academic and industry positions.[3] Women also tend to be perceived as less committed or able due to their additional life responsibilities leading to less opportunities and income.[3] The issue of representation in research and medicine may seem benign, but in reality, it has far-reaching consequences for both women’s health and success in the workplace. Excluding women from these areas leads to medical consequences for inadequately studied pharmaceuticals as well as the perpetuation of harmful stereotypes surrounding the perception of women in medicine that only reinforces this dangerous cycle.[7]
References
[1] Zucker, I., Prendergast, B. J., & Beery, A. K. (2022). Pervasive Neglect of Sex Differences in Biomedical Research. Cold Spring Harbor perspectives in biology, 14(4), a039156. https://doi.org/10.1101/cshperspect.a039156
[2] Cho, L., Vest, A. R., O’Donoghue, M. L., Ogunniyi, M. O., Sarma, A. A., Denby, K. J., Lau, E. S., Poole, J. E., Lindley, K. J., Mehran, R., & Cardiovascular Disease in Women Committee Leadership Council (2021). Increasing Participation of Women in Cardiovascular Trials: JACC
Council Perspectives. Journal of the American College of Cardiology, 78(7), 737–751. https://doi.org/10.1016/j.jacc.2021.06.022
[3] Blumenthal, K. G., Bansal, P., Youssef, C. M., & Pappalardo, A. A. (2023). Women in Allergy and Immunology: The Future Is Female, Let Us Soar!. The journal of allergy and clinical immunology. In practice, 11(12), 3569–3577. https://doi.org/10.1016/j.jaip.2023.06.010
[4] Bagga, E., Stewart, S., Gamble, G. D., Hill, J., Grey, A., & Dalbeth, N. (2021). Representation of Women as Authors of Rheumatology Research Articles. Arthritis & rheumatology (Hoboken, N.J.), 73(1), 162–167. https://doi.org/10.1002/art.41490
[5] N. Pyatigorskaya & L. Di Marco. (2017). Women authorship in radiology research in France: An analysis of the last three decades, Diagnostic and Interventional Imaging, 98(11), 769-773. https://www.sciencedirect.com/science/article/pii/S2211568417301912
[6] Bierer, B. E., Meloney, L. G., Ahmed, H. R., & White, S. A. (2022). Advancing the inclusion of underrepresented women in clinical research. Cell reports. Medicine, 3(4), 100553. https://doi.org/10.1016/j.xcrm.2022.100553
[7] Wanted: women in research. (2010). Nature neuroscience, 13(3), 267. https://doi.org/10.1038/nn0310-267
