Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Women's Health
Published in: BMC Women's Health 1/2024

Open Access 01-12-2024 | Overactive Bladder | Research

The impact of pharmacotherapy on sexual function in female patients being treated for idiopathic overactive bladder: a systematic review

Authors: Christopher Neal Bruce Evans, Anja Badenhorst, Frans Jacob Van Wijk

Published in: BMC Women's Health | Issue 1/2024

Login to get access

Abstract

Background

Overactive bladder (OAB) is a condition defined by urgency with or without incontinence which disproportionately affects female patients and has a negative impact on sexual enjoyment and avoidance behaviour. Pharmacotherapy can be considered one of the main options for treating OAB. This research set out to determine the impact of pharmacotherapy on sexual function in females with OAB.

Methods

This research used the robust methodology of a systematic review. The clinical question was formulated using the PICO (population, intervention, control, and outcomes) format to include females being treated with pharmacotherapy (anticholinergics or beta-3 adrenergic agonists) for idiopathic OAB with the use of a validated questionnaire assessing self-reported sexual function at baseline and post-treatment. The review incorporated the MEDLINE, PubMed and EMBASE databases. The AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) appraisal tool was used to guide the review process. Two reviewers worked independently in screening abstracts, deciding on the inclusion of full-texts, data extraction and risk of bias assessment.

Results

In female patients with OAB, pharmacotherapy does seem to offer at least partial improvement in self-reported sexual function outcomes after 12 weeks of therapy. Still, the value of this finding is limited by an overall poor quality of evidence. Patients with a higher degree of bother at baseline stand to benefit the most from treatment when an improvement within this health-related quality of life domain is sought.

Conclusion

This research should form the basis for a well-conducted randomized controlled study to accurately assess sexual function improvements in females being treated with pharmacotherapy for OAB.
Appendix
Available only for authorised users
Literature
1.
2.
Coyne KS, Sexton CC, Thompson CL, Milsom I, Irwin D, Kopp ZS, et al. The prevalence of lower urinary tract symptoms (LUTS) in the USA, the UK and Sweden: results from the Epidemiology of LUTS (EpiLUTS) study. BJU Int. 2009;104(3):352–60.PubMedCrossRef
3.
Proietti S, Giannantoni A, Sahai A, Khan MS, Dasgupta P. Overactive bladder and sexual function: a nightmare couple. BJU Int. 2012;110(7):921–4.PubMedCrossRef
4.
Naumann G, Hitschold T, Frohnmeyer D, Majinge P, Lange R. Sexual disorders in women with overactive bladder and urinary stress incontinence compared to controls: a prospective study. Geburtshilfe Frauenheilkd. 2021;81(9):1039–46.PubMedPubMedCentralCrossRef
5.
Abrams P, Kelleher C, Staskin D, Rechberger T, Kay R, Martina R, et al. Combination treatment with mirabegron and solifenacin in patients with overactive bladder: efficacy and safety results from a randomised, double-blind, dose-ranging, phase 2 study (Symphony). Eur Urol. 2015;67(3):577–88.PubMedCrossRef
6.
Herschorn S, Chapple CR, Abrams P, Arlandis S, Mitcheson D, Lee KS, et al. Efficacy and safety of combinations of mirabegron and solifenacin compared with monotherapy and placebo in patients with overactive bladder (SYNERGY study). BJU Int. 2017;120(4):562–75.PubMedCrossRef
7.
Otsuka A, Kageyama S, Suzuki T, Matsumoto R, Nagae H, Kitagawa M, et al. Comparison of mirabegron and imidafenacin for efficacy and safety in Japanese female patients with overactive bladder: A randomized controlled trial (COMFORT study). Int J Urol. 2016;23(12):1016–23.PubMedCrossRef
8.
Andersson KE. Antimuscarinic mechanisms and the overactive detrusor: an update. Eur Urol. 2011;59(3):377–86.PubMedCrossRef
9.
Wakuda H, Okura T, Maruyama-Fumoto K, Kagota S, Ito Y, Miyauchi-Wakuda S, et al. Effects of Anticholinergic Drugs Used for the Therapy of Overactive Bladder on P-Glycoprotein Activity. Biol Pharm Bull.42(12):1996–2001.
10.
Abrams P, Andersson KE, Buccafusco JJ, Chapple C, de Groat WC, Fryer AD, et al. Muscarinic receptors: their distribution and function in body systems, and the implications for treating overactive bladder. Br J Pharmacol. 2006;148(5):565–78.PubMedPubMedCentralCrossRef
11.
Basha M, Labelle EF, Northington GM, Wang T, Wein AJ, Chacko S. Functional significance of muscarinic receptor expression within the proximal and distal rat vagina. Am J Physiol Regul Integr Comp Physiol. 2009;297(5):R1486–93.PubMedPubMedCentralCrossRef
12.
13.
Igawa Y, Michel MC. Pharmacological profile of β3-adrenoceptor agonists in clinical development for the treatment of overactive bladder syndrome. Naunyn Schmiedebergs Arch Pharmacol. 2013;386(3):177–83.PubMedCrossRef
14.
Coelho A, Antunes-Lopes T, Gillespie J, Cruz F. Beta-3 adrenergic receptor is expressed in acetylcholine-containing nerve fibers of the human urinary bladder: An immunohistochemical study. Neurourol Urodyn. 2017;36(8):1972–80.PubMedCrossRef
15.
Herbison P, McKenzie JE. Which anticholinergic is best for people with overactive bladders? A network meta-analysis. Neurourol Urodyn. 2019;38(2):525–34.PubMedCrossRef
16.
Cui Y, Zong H, Yang C, Yan H, Zhang Y. The efficacy and safety of mirabegron in treating OAB: a systematic review and meta-analysis of phase III trials. Int Urol Nephrol. 2014;46(1):275–84.PubMedCrossRef
17.
Kelleher C, Hakimi Z, Zur R, Siddiqui E, Maman K, Aballéa S, et al. Efficacy and tolerability of mirabegron compared with antimuscarinic monotherapy or combination therapies for overactive bladder: a systematic review and network meta-analysis. Eur Urol. 2018;74(3):324–33.PubMedCrossRef
18.
Athanasiou S, Pitsouni E, Grigoriadis T, Zacharakis D, Salvatore S, Serati M. Mirabegron in female patients with overactive bladder syndrome: What’s new? A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;251:73–82.PubMedCrossRef
19.
Thomas HN, Neal-Perry GS, Hess R. Female Sexual Function at Midlife and Beyond. Obstet Gynecol Clin North Am.45(4):709–22.
20.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.PubMedCrossRef
21.
Apostolidis A, Rantell A, Anding R, Kirschner-Hermanns R, Cardozo L. How does lower urinary tract dysfunction (LUTD) affect sexual function in men and women? ICI-RS 2015—Part 2. Neurourol Urodyn. 2017;36(4):869–75.PubMedCrossRef
22.
Meston CM, Stanton AM. Understanding sexual arousal and subjective-genital arousal desynchrony in women. Nat Rev Urol. 2019;16:107.PubMedCrossRef
23.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358: j4008.PubMedPubMedCentralCrossRef
24.
25.
Sterne JAC, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355: i4919.PubMedPubMedCentralCrossRef
26.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366: l4898.PubMedCrossRef
27.
Granholm A, Alhazzani W, Møller MH. Use of the GRADE approach in systematic reviews and guidelines. Br J Anaesth. 2019;123(5):554–9.PubMedCrossRef
28.
29.
Jünemann KP, Hessdörfer E, Unamba-Oparah I, Berse M, Brünjes R, Madersbacher H, et al. Propiverine hydrochloride immediate and extended release: comparison of efficacy and tolerability in patients with overactive bladder. Urol Int. 2006;77(4):334–9.PubMedCrossRef
30.
Kelleher CJ, Cardozo L, Chapple CR, Haab F, Ridder AM. Improved quality of life in patients with overactive bladder symptoms treated with solifenacin. BJU Int. 2005;95(1):81–5.PubMedCrossRef
31.
Abrams P, Kelleher C, Huels J, Quebe-Fehling E, Omar MA, Steel M. Clinical relevance of health-related quality of life outcomes with darifenacin. BJU Int. 2008;102(2):208–13.PubMedCrossRef
32.
Choo MS, Lee JZ, Lee JB, Kim YH, Jung HC, Lee KS, et al. Efficacy and safety of solifenacin succinate in Korean patients with overactive bladder: a randomised, prospective, double-blind, multicentre study. Int J Clin Pract. 2008;62(11):1675–83.PubMedCrossRef
33.
Homma Y, Yamaguchi O. Long-term safety, tolerability, and efficacy of the novel anti-muscarinic agent imidafenacin in Japanese patients with overactive bladder. Int J Urol. 2008;15(11):986–91.PubMedCrossRef
34.
Kelleher CJ, Tubaro A, Wang JT, Kopp Z. Impact of fesoterodine on quality of life: pooled data from two randomized trials. BJU Int. 2008;102(1):56–61.PubMedCrossRef
35.
Homma Y, Yamaguchi O, Imidafenacin Study G. A randomized, double-blind, placebo- and propiverine-controlled trial of the novel antimuscarinic agent imidafenacin in Japanese patients with overactive bladder. Int J Urol. 2009;16(5):499–506.PubMedCrossRef
36.
Sand PK, Dmochowski RR, Zinner NR, Staskin DR, Appell RA. Trospium chloride extended release is effective and well tolerated in women with overactive bladder syndrome. Int Urogynecol J. 2009;20(12):1431–8.CrossRef
37.
Van Kerrebroeck PEV, Kelleher CJ, Coyne KS, Kopp Z, Brodsky M, Wang JT. Correlations among improvements in urgency urinary incontinence, health-related quality of life, and perception of bladder-related problems in incontinent subjects with overactive bladder treated with tolterodine or placebo. Health Qual Life Outcomes. 2009;7(1):13.PubMedPubMedCentralCrossRef
38.
Vardy MD, Mitcheson HD, Samuels TA, Wegenke JD, Forero-Schwanhaeuser S, Marshall TS, et al. Effects of solifenacin on overactive bladder symptoms, symptom bother and other patient-reported outcomes: results from VIBRANT – a double-blind, placebo-controlled trial. Int J Clin Pract. 2009;63(12):1702–14.PubMedCrossRef
39.
Gotoh M, Yokoyama O, Nishizawa O. Propiverine hydrochloride in Japanese patients with overactive bladder: A randomized, double-blind, placebo-controlled trial. Int J Urol. 2011;18(5):365–73.PubMedCrossRef
40.
Yamaguchi O, Nishizawa O, Takeda M, Yoshida M, Choo MS, Gu Lee J, et al. Efficacy, safety and tolerability of fesoterodine in asian patients with overactive bladder. Low Urin Tract Symptoms. 2011;3(1):43–50.PubMedCrossRef
41.
Park C, Park J, Choo MS, Kim JC, Lee JG, Lee JZ, et al. A randomised, prospective double-blind, propiverine-controlled trial of imidafenacin in patients with overactive bladder. Int J Clin Pract. 2014;68(2):188–96.PubMedCrossRef
42.
Yamaguchi O, Marui E, Kakizaki H, Homma Y, Igawa Y, Takeda M, et al. Phase III, randomised, double-blind, placebo-controlled study of the β3-adrenoceptor agonist mirabegron, 50 mg once daily, in Japanese patients with overactive bladder. BJU Int. 2014;113(6):951–60.PubMedCrossRef
43.
Yamaguchi O, Uchida E, Higo N, Minami H, Kobayashi S, Sato H, et al. Efficacy and safety of once-daily oxybutynin patch versus placebo and propiverine in Japanese patients with overactive bladder: A randomized double-blind trial. Int J Urol. 2014;21(6):586–93.PubMedCrossRef
44.
Kuo HC, Lee KS, Na Y, Sood R, Nakaji S, Kubota Y, et al. Results of a randomized, double-blind, parallel-group, placebo- and active-controlled, multicenter study of mirabegron, a β3-adrenoceptor agonist, in patients with overactive bladder in Asia. Neurourol Urodyn. 2015;34(7):685–92.PubMedCrossRef
45.
Song M, Kim JH, Lee KS, Lee JZ, Oh SJ, Seo JT, et al. The efficacy and tolerability of tarafenacin, a new muscarinic acetylcholine receptor M3 antagonist in patients with overactive bladder; randomised, double-blind, placebo-controlled phase 2 study. Int J Clin Pract. 2015;69(2):242–50.PubMedCrossRef
46.
Yamaguchi O, Marui E, Igawa Y, Takeda M, Nishizawa O, Ikeda Y, et al. Efficacy and safety of the selective β3 -adrenoceptor agonist mirabegron in japanese patients with overactive bladder: a randomized, double-blind, placebo-controlled. Dose-Finding Study Low Urin Tract Symptoms. 2015;7(2):84–92.PubMedCrossRef
47.
Chughtai B, Forde JC, Buck J, Asfaw T, Lee R, Te AE, et al. The concomitant use of fesoterodine and topical vaginal estrogen in the management of overactive bladder and sexual dysfunction in postmenopausal women. Post Reprod Health. 2016;22(1):34–40.PubMedCrossRef
48.
Yoshida M, Takeda M, Gotoh M, Nagai S, Kurose T. Vibegron, a novel potent and selective β(3)-Adrenoreceptor agonist, for the treatment of patients with overactive bladder: A randomized, double-blind, placebo-controlled phase 3 study. Eur Urol. 2018;73(5):783–90.PubMedCrossRef
49.
Hsiao S-M, Chang T-C, Lin H-H. The probability of re-treatment after discontinuation of a 3-month versus a 6-month course of solifenacin for female overactive bladder: A prospective randomized controlled study. Maturitas. 2019;126:11–7.PubMedCrossRef
50.
Mitcheson HD, Samanta S, Muldowney K, Pinto CA, Rocha BdA, Green S, et al. Vibegron (RVT-901/MK-4618/KRP-114V) Administered Once Daily as Monotherapy or Concomitantly with Tolterodine in Patients with an Overactive Bladder: A Multicenter, Phase IIb, Randomized, Double-blind, Controlled Trial. Eur Urol. 2019;75(2):274–82.
51.
Cartwright R, Srikrishna S, Cardozo L, Robinson D. Patient-selected goals in overactive bladder: a placebo controlled randomized double-blind trial of transdermal oxybutynin for the treatment of urgency and urge incontinence. BJU Int. 2011;107(1):70–6.PubMedCrossRef
52.
Rogers R, Bachmann G, Jumadilova Z, Sun F, Morrow JD, Guan Z, et al. Efficacy of tolterodine on overactive bladder symptoms and sexual and emotional quality of life in sexually active women. Int Urogynecol J. 2008;19(11):1551–7.CrossRef
53.
Sand PK, Goldberg RP, Dmochowski RR, McIlwain M, Dahl NV. The impact of the overactive bladder syndrome on sexual function: a preliminary report from the Multicenter Assessment of Transdermal Therapy in Overactive Bladder with Oxybutynin trial. Am J Obstet Gynecol. 2006;195(6):1730–5.PubMedCrossRef
54.
Hajebrahimi S, Azaripour A, Sadeghi-Bazargani H. Tolterodine immediate release improves sexual function in women with overactive bladder. J Sex Med. 2008;5(12):2880–5.PubMedCrossRef
55.
Kubota Y, Kojima Y, Shibata Y, Imura M, Kohri K, Sasaki S. Correlation between improvements in overactive bladder symptom score and health-related quality of life questionnaires in overactive bladder patients treated with an antimuscarinic drug. Neurourol Urodyn. 2011;30(7):1309–14.PubMedCrossRef
56.
Cardozo L, Hall T, Ryan J, Ebel Bitoun C, Kausar I, Darekar A, et al. Safety and efficacy of flexible-dose fesoterodine in British subjects with overactive bladder: insights into factors associated with dose escalation. Int Urogynecol J. 2012;23(11):1581–90.PubMedCrossRef
57.
Balachandran A, Curtiss N, Basu M, Duckett J. Third-line treatment for overactive bladder: should mirabegron be tried before intravesical botulinum toxin A therapy? Int Urogynecol J. 2015;26(3):367–72.PubMedCrossRef
58.
Schiavi MC, Faiano P, D’Oria O, Zullo MA, Muzii L, Benedetti PP. Efficacy and tolerability of treatment with mirabegron compared with solifenacin in the management of overactive bladder syndrome: A retrospective analysis. J Obstet Gynaecol Res. 2018;44(3):524–31.PubMedCrossRef
59.
Zachariou A, Mamoulakis C, Filiponi M, Dimitriadis F, Giannakis J, Skouros S, et al. The effect of mirabegron, used for overactive bladder treatment, on female sexual function: a prospective controlled study. BMC Urol. 2018;18(1):61.PubMedPubMedCentralCrossRef
60.
Cakir SS, Degirmentepe RB, Atalay HA, Canat HL, Ozbir S, Culha MG, et al. The effect of overactive bladder treatment with anticholinergics on female sexual function in women: a prospective observational study. Int Urol Nephrol. 2019;51(1):27–32.PubMedCrossRef
61.
Sönmez MG, Ecer G, Atici A, Özkent MS, Iyisoy MS, Öztürk A. Comparison of Oral Sodium Bicarbonate and Solifenacin Treatment in Female Overactive Bladder Patients With Acidic Urine pH. Female Pelvic Med Reconstr Surg. 2020;26(10).
62.
Sand P, Zinner N, Newman D, Lucente V, Dmochowski R, Kelleher C, et al. Oxybutynin transdermal system improves the quality of life in adults with overactive bladder: a multicentre, community-based, randomized study. BJU Int. 2007;99(4):836–44.PubMedCrossRef
63.
Yamaguchi O, Uchida E, Higo N, Minami H, Kobayashi S, Sato H, et al. Optimum Dose of Once-Daily Oxybutynin Patch in Japanese Patients with Overactive Bladder: A Randomized Double-Blind Trial Versus Placebo. Luts.8(3):150–8.
64.
Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol. 1997;104(12):1374–9.PubMedCrossRef
65.
Homma Y, Yamaguchi T, Yamaguchi O. A randomized, double-blind, placebo-controlled phase II dose-finding study of the novel anti-muscarinic agent imidafenacin in Japanese patients with overactive bladder. Int J Urol. 2008;15(9):809–15.PubMedCrossRef
66.
Sand M, Rosen R, Meston C, Brotto LA. The female sexual function index (FSFI): a potential & #x201c;gold standard” measure for assessing therapeutically-induced change in female sexual function. Fertil Steril. 2009;92(3):S129.CrossRef
67.
Stephenson KR, Toorabally N, Lyons L, C MM. Further Validation of the Female Sexual Function Index: Specificity and Associations With Clinical Interview Data. J Sex Marital Ther. 2016;42(5):448–61.
68.
Yule MA. Female Sexual Function Index. In: Michalos AC, editor. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht: Springer, Netherlands; 2014. p. 2244–6.CrossRef
69.
Gubbiotti M, Giannantoni A, Cantaluppi S, Coluccia AC, Ghezzi F, Serati M. The impact of Mirabegron on sexual function in women with idiopathic overactive bladder. BMC Urol. 2019;19(1):7.
70.
Lin XD, Lin N, Ke ZB, Xu N, Jiang P, Li H. Effects of overactive bladder syndrome on female sexual function. Medicine. 2021;100(20):e25761.
71.
Zachariou A, Filiponi M. The effect of extended release tolterodine used for overactive bladder treatment on female sexual function. International Braz J Urol. 2017;43(4):713–20.
72.
Suurmond R, van Rhee H, Hak T. Introduction, comparison, and validation of Meta-Essentials: A free and simple tool for meta-analysis. Res Synthesis Methods. 2017;8(4):537–53.CrossRef
73.
Boland A, Cherry MG, Dickson R. Doing a systematic review : a student's guide / edited by Angela Boland, M. Gemma Cherry, Rumona Dickson. 2nd edition. ed. Los Angeles: SAGE; 2017.
74.
Symonds T, Boolell M, Quirk F. Development of a questionnaire on sexual quality of life in women. J Sex Marital Ther. 2005;31(5):385–97.PubMedCrossRef
75.
Maasoumi R, Lamyian M, Montazeri A, Azin SA, Aguilar-Vafaie ME, Hajizadeh E. The sexual quality of life-female (SQOL-F) questionnaire: translation and psychometric properties of the Iranian version. Reprod Health. 2013;10:25.PubMedPubMedCentralCrossRef
76.
McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): reliability and validity. J Sex Marital Ther. 2000;26(1):25–40.PubMedCrossRef
77.
Gungor Uğurlucan F, Yasa C, Yuksel Ozgor B, Ayvacikli G, Gunaydin C, Balci BK, et al. Validation of the Turkish version of the ICIQ-FLUTS, ICIQ-FLUTS long-form, ICIQ-LUTS quality-of-life, and ICIQ-FLUTS sexual functions. Neurourol Urodyn. 2020;39(3):962–8.PubMedCrossRef
78.
Zahariou A, Karamouti M, Tyligada E, Papaioannou P. Sexual function in women with overactive bladder. Female Pelvic Med Reconstr Surg. 2010;16(1):31–6.PubMedCrossRef
79.
Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–20.PubMedCrossRef
80.
Benner JS, Nichol MB, Rovner ES, Jumadilova Z, Alvir J, Hussein M, et al. Patient-reported reasons for discontinuing overactive bladder medication. BJU Int. 2010;105(9):1276–82.PubMedCrossRef
81.
Levy G, Lowenstein L. Overactive bladder syndrome treatments and their effect on female sexual function: A review. Sex Med. 2020;8(1):1–7.PubMedCrossRef
82.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924.PubMedPubMedCentralCrossRef
Metadata
Title
The impact of pharmacotherapy on sexual function in female patients being treated for idiopathic overactive bladder: a systematic review
Authors
Christopher Neal Bruce Evans
Anja Badenhorst
Frans Jacob Van Wijk
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Women's Health / Issue 1/2024
Electronic ISSN: 1472-6874
DOI
https://doi.org/10.1186/s12905-024-03103-1

Other articles of this Issue 1/2024

BMC Women's Health 1/2024 Go to the issue

Case Report

Successful management of VTE with essential thrombocythemia and cavernous transformation of the portal vein in early pregnancy: a case report

Research

Clinical characteristics, HPV involvement, and demographic risk factors in women with cervical intraepithelial neoplasia complicated by vaginal intraepithelial neoplasia

Research

Knowledge of cervical cancer screening among Omani women attending a university teaching hospital: a cross-sectional study

Research

The role of adverse childhood experiences in predicting child abuse perpetration among married mothers in Alexandria, Egypt: a cross-sectional study

Research

Association between HIV Serostatus and premalignant cervical lesions among women attending a cervical cancer screening clinic at a tertiary care facility in southwestern Uganda: a comparative cross-sectional study

Research

Coping with breast cancer during medical and occupational rehabilitation: a qualitative study of strategies and contextual factors