Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, 22(2), 223-233, 2023
Sexual and reproductive health experiences and care of adult women with cystic fibrosis
Jennifer L. Taylor‐Cousar, Gregory S Sawicki, Manu Jain
J J Billings, Denis Hadjiliadis, Raksha Jain, Moira L Aitken , Tara L Barto , Alana Fields, Emily M Godfrey, Traci M Kazmerski, Sigrid L Ladores, Daniel R Lavage, Olivia M Stransky, Sandra Sufian
Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, PA...ROR
School of Nursing, The University of Alabama at Birmingham, 1720 S. 2nd Ave., NB485-A, Birmingham, AL 35294, United States.ROR
University of Illinois-Chicago, 5001N. Wolcott Ave. #205 Chicago, IL 60640, United States.ROR
As survival and health improve in people with cystic fibrosis (CF), more women with CF (wwCF) are considering their sexual and reproductive health (SRH). This study compared SRH experiences, behaviors, and care utilization of wwCF to the general population and defined CF-impacted considerations and care preferences.
Methods
We surveyed wwCF aged ≥25 years regarding SRH and compared results to the US National Survey of Family Growth (NSFG;n = 4357) and friend controls(n = 123). We used descriptive statistics and chi-squared/Fisher's exact testing and linear regression for comparisons.
Results
A total of 460 wwCF (mean age 36.1 years) completed the survey. WwCF were less likely to report current contraceptive use (43%vs76% NSFG, p<0.001;60% friends, p = 0.005). Nearly 25% of wwCF reported worsened CF symptoms during their menstrual cycles, 50% experienced urinary incontinence, and 80% vulvovaginal candidiasis. WwCF were significantly less likely to be parents (46%vs62% friends, p = 0.015) and to have experienced pregnancy (37%vs78% NSFG, p<0.001;58% friends, p = 0.002). More wwCF required medical assistance to conceive (29%vs12% NSFG, p<0.001 and 5% friends, p<0.001). Eighty-four percent of wwCF view their CF doctor as their main physician and 41% report no primary care provider (vs19% friends; p<0.001). WwCF report suboptimal rates of contraceptive and preconception counseling/care and are less likely to have received HPV vaccination (42%vs55%friends, p = 0.02). Despite desiring SRH conversations with their CF team, <50% report discussing SRH topics.
Conclusion
WwCF have significantly different SRH experiences than non-CF peers. They report suboptimal SRH care compared to their preferences highlighting an urgent need to encourage SRH counseling/care in the CF model.
cystic fibrosis women sexual reproductive health experiences, contraceptive use women with cystic fibrosis, cystic fibrosis fertility infertility medical assistance conception, menstrual cycle symptoms cystic fibrosis worsening, vulvovaginal candidiasis urinary incontinence cystic fibrosis women, preconception counseling chronic disease cystic fibrosis, Kazmerski cystic fibrosis reproductive health survey, HPV vaccination rates women chronic illness, cross-sectional survey reproductive health National Survey Family Growth comparison, CF care model sexual health counseling gaps, suboptimal gynecologic care chronic disease population
PMID 36210323 36210323 DOI 10.1016/j.jcf.2022.09.013 10.1016/j.jcf.2022.09.013 Kazmerski et al. 2023, Kazmerski 2023
Cite this article
Kazmerski, T. M., Stransky, O. M., Lavage, D. R., Taylor-Cousar, J. L., Sawicki, G. S., Ladores, S. L., Godfrey, E. M., Aitken, M. L., Fields, A., Sufian, S., Jain, M., Barto, T. L., Billings, J., Hadjiliadis, D., & Jain, R. (2023). Sexual and reproductive health experiences and care of adult women with cystic fibrosis. Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, 22(2), 223-233. https://doi.org/10.1016/j.jcf.2022.09.013
Kazmerski TM, Stransky OM, Lavage DR, Taylor-Cousar JL, Sawicki GS, Ladores SL, et al. Sexual and reproductive health experiences and care of adult women with cystic fibrosis. J Cyst Fibros. 2023;22(2):223-233. doi:10.1016/j.jcf.2022.09.013
Kazmerski, Traci M., et al. "Sexual and reproductive health experiences and care of adult women with cystic fibrosis." Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society, vol. 22, no. 2, 2023, pp. 223-233.
Royal College of Obstetricians and Gynaecologists, 2026·Royal College of Obstetricians and Gynaecologists
RCOG response (July 2026) to the NICE draft early-use guidance on Endotest and EndoSure. Underlines that it is draft guidance for consultation, not final approval. Notes Endotest's high reported accuracy comes from carefully selected groups of women with long-standing pelvic pain already at high risk of endometriosis, largely in specialist centres, with most evidence from teams linked to the test's developer in France; robust independent validation in other countries, age and ethnic groups and routine pathways including primary care is limited and urgently needed. Considers EndoSure experimental: near-perfect performance claims arise mainly from small developer-led studies, and both the biological mechanism and real-world performance are unvalidated. Supports linking early use to structured evidence generation.
Shenoy-Bhangle AS et al., 2026·J Magn Reson Imaging·
Endometriosis is a chronic multisystem disease caused by the presence of endometrium-like tissue outside the endometrial canal, inciting inflammation and fibrosis. Transvaginal ultrasound (TVUS) and MRI have replaced diagnostic laparoscopy as the noninvasive imaging modalities of choice for diagnosis and pre-surgical planning. Advanced disease in the pelvis can distort/obliterate anatomic planes and obscure the extent of pelvic organ involvement at laparoscopy. Unlike laparoscopy, MRI is not limited by anatomic distortion and provides accurate multi-compartment assessment of deep pelvic endometriosis involving the uterus and its ligaments, adnexa, bowel, distal ureters, urinary bladder, and pelvic nerves. Additionally, MRI can help detect extra-pelvic organ involvement in the same study. Use of a dedicated MRI protocol and structured reporting template improves multidisciplinary communication and provides a pre-surgical road map; helps patient counseling as well as assessing the need for additional intraoperative organ-specific expertise such as colorectal surgery or urology. Knowledge of MRI and laparoscopic correlation enhances recognition of the key MRI findings to include in the report for optimizing surgical outcomes. This article focuses on the role of MRI in the diagnosis and pre-surgical mapping of pelvic endometriosis, with correlation to laparoscopic findings. Evidence level: 1. Technical efficacy: 5.
Nutrition and Metabolic Health · Body Weight and Composition
Brito J et al., 2025·Journal of applied physiology (Bethesda, Md. : 1985)·
Open Access
Understanding changes to gut microbiota composition in response to hormonal birth control (HBC) may provide insight into the microbial mechanisms underlying the metabolic effects of HBC, for example, altered short-chain fatty acid (SCFA) production. Athletes' unique physiological demands may interact with these microbial mechanisms in distinct ways; however, there is limited research on HBC and gut microbiota diversity and composition across different menstrual cycle phases in physically active females. A pilot cohort of physically active females using HBC (oral contraceptives, hormone-based intrauterine devices, or arm implants) and a control group not using HBC (n = 12 per group; 22 ± 2 yr, 24 ± 4 kg/m2 vs. 22 ± 4 yr, 23 ± 4 kg/m2; Ps ≥ 0.496) provided fecal samples alongside self-reported menstrual phase and circulating sex hormones. α-diversity (microbial richness and evenness) was assessed using the Shannon index whereas β-diversity (microbial composition differences) was analyzed using PERMANOVA based on Bray-Curtis dissimilarity. Circulating estrogen and luteinizing hormone increased from early (days 1-5) to mid-cycle (days 12-17) in both groups (time effect Ps ≤ 0.01), with greater changes in Control (Ps ≤ 0.046) than HBC (Ps ≥ 0.231). Although no menstrual phase effect was observed on either diversity measure (Ps ≥ 0.473), β-diversity differed between Control and HBC groups (P = 0.015), reflecting distinct gut microbiota profiles irrespective of menstrual phase. Seven taxa linked to SCFA production were less abundant in the HBC group (unadjusted Ps ≤ 0.046), though significance was lost after adjusting for multiple comparisons. These findings suggest that in physically active females, hormonal contraception influences gut microbial composition, which may have downstream effects on metabolism and performance.NEW & NOTEWORTHY This study is the first to investigate interactions between hormonal contraception and the gut microbiota in a cohort of physically active young females across the menstrual cycle. Our findings suggest that hormonal contraception may influence gut microbiota composition, potentially through a reduced relative abundance of short-chain fatty acid-producing taxa. Experimental studies are needed to confirm these associations and explore their potential implications for metabolism, health, and performance.
De Corte P, 2025·BJOG : an international journal of obstetrics and gynaecology
Endometriosis diagnosis reportedly faces delays of up to 10 years. Despite growing awareness and improved guidelines, information on the current status is limited. To systematically assess the published evidence on the status of time to diagnosis in individuals with endometriosis, with respect to the definition of time to diagnosis, geographical location and patient characteristics. MEDLINE (via PubMed) and Embase were searched for publications reporting time to diagnosing endometriosis since 2018. No restrictions to population or comparators were applied. All publications were screened by two independent reviewers. Search results were limited to primary publications of randomised controlled trials, non-randomised trials and observational studies. Case reports, secondary publications and grey literature were excluded. No restrictions were made regarding language, provided that an English title and abstract were available. Publications were assessed with respect to time to diagnosis, diagnostic methods, study type, study country and potential bias. The 17 publications eligible for inclusion in this literature review were all observational studies. The publications reported diagnosis times between 0.3 and 12 years, with variations depending on the definition of time to diagnosis (overall, primary, or clinical), geographical location and characteristics of the included study population. Evidence was of poor to good quality overall. Diagnostic delay is still present, primarily driven by physicians, and this review underscores the need for standardised definitions, increased awareness and targeted diagnostic interventions.