RESUMO
PURPOSE: The current study sought to evaluate the sexual function of transgender men and women and to identify associated factors. METHODS: Trans individuals who were outpatients at our gender incongruence (GI) center for follow-up of gender-affirming hormone therapy with age ranging 27 to 50 years were invited to participate in this cross-sectional study. Clinical data were collected from the medical records. Two scales, the Female Sexual Function Index (FSFI) and the Male Sexual Function Index (MSFI), were administered to all females (n = 50) and all males (n = 58). Each participant also responded to a semi-structured questionnaire that assessed feelings regarding being transgender and satisfaction with sexual life. RESULTS: Relative to trans women, trans men had a higher total FSFI score, and higher scores in the FSFI domains of arousal, lubrication, orgasm, and satisfaction (all p < 0.01), and in the total MSFI score, and higher scores in the MFSI domains of arousal, erection, orgasm, and satisfaction (all p < 0.01). A separate semi-structured evaluation indicated that more than half of the trans men and almost half of the trans women were satisfied or very satisfied with their sexual life. CONCLUSIONS: The total scores from the FSFI and MSFI indicated a high risk of sexual dysfunction in trans men and especially, in trans women. However, the semi-structured evaluation showed that more than half of the trans men and almost half of the trans women were satisfied with their sexual life.
Assuntos
Orgasmo , Pessoas Transgênero , Humanos , Masculino , Feminino , Adulto , Estudos Transversais , Pessoas Transgênero/psicologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Satisfação Pessoal , Comportamento Sexual , Disfunções Sexuais Fisiológicas/etiologiaRESUMO
Abstract Objective To identify the age when individuals first perceive gender incongruence (GI) and to compare sociodemographic data of female-to-male (FtM) and male-tofemale (MtF) transgender individuals assisted at an outpatient service. Methods The present cross-sectional study was conducted through a review of the medical records of individuals diagnosed with GI at a single specialized outpatient service in the city of Ribeirão Preto, state of São Paulo, Brazil. Results A total of 193 medical records from 2010 to 2018 were evaluated, and 109 (56.5%) patients had GI since childhood. The FtM transgender individuals perceived GI in childhood more often than the MtF transgender individuals (odds ratio [OR]: 2.06, 95% confidence interval [95%CI]: 1.11-3.81) Unattended hormone use was highest among the MtF group (69.6% versus 32.3%; OR: 4.78, 95%CI: 2.53-9.03). All of the individuals who were engaged in prostitution or were diagnosed with a sexuallytransmitted infection, including HIV, were in the MtF group. Conclusion Despite the more prevalent perception of GI in childhood among the FtM group, social issues were more prevalent among the MtF group, which may be the result of social marginalization.
Resumo Objetivo Identificar o período da vida emque indivíduos indentificaram pela primeira vez sua incongruência de gênero (IG), e comparar os dados sociodemográficos de homens e mulheres transgêneros (trans) atendidos em um ambulatório. Métodos Estudo transversal realizado por meio de revisão dos prontuários de pessoas com IG em ambulatório especializado de Ribeirão Preto, São Paulo, Brasil. Resultados Foram avaliados 193 prontuários de 2010 a 2018, e 109 (56.5%) pacientes apresentavamIG desde a infância. Homens trans perceberam a IG na infância com mais frequência do que as mulheres trans (razão de probabilidades [RP]: 2.06, intervalo de confiança de 95% [IC95%]: 1.11-3.81). O uso de hormônio sem supervisão foi maior entre as mulheres trans (69.6% versus 32.3%; RP: 4.78; IC95%: 2.53-9.03). Todos as pessoas que estavam inseridas na prostituição ou que apresentavam algum diagnóstico de infecção sexualmente transmissível, incluindo o HIV, eram mulherestrans. Conclusão Apesar da percepção mais prevalente da IG na infância entre homens trans, os agravos sociais foram mais prevalentes entre as mulheres trans, o que pode ser resultado da marginalização social.
Assuntos
Humanos , Masculino , Feminino , Infecções Sexualmente Transmissíveis/diagnóstico , Profissionais do Sexo , Disforia de Gênero , Minorias Sexuais e de GêneroRESUMO
OBJECTIVE: To identify the age when individuals first perceive gender incongruence (GI) and to compare sociodemographic data of female-to-male (FtM) and male-to-female (MtF) transgender individuals assisted at an outpatient service. METHODS: The present cross-sectional study was conducted through a review of the medical records of individuals diagnosed with GI at a single specialized outpatient service in the city of Ribeirão Preto, state of São Paulo, Brazil. RESULTS: A total of 193 medical records from 2010 to 2018 were evaluated, and 109 (56.5%) patients had GI since childhood. The FtM transgender individuals perceived GI in childhood more often than the MtF transgender individuals (odds ratio [OR]: 2.06, 95% confidence interval [95%CI]: 1.11-3.81) Unattended hormone use was highest among the MtF group (69.6% versus 32.3%; OR: 4.78, 95%CI: 2.53-9.03). All of the individuals who were engaged in prostitution or were diagnosed with a sexually-transmitted infection, including HIV, were in the MtF group. CONCLUSION: Despite the more prevalent perception of GI in childhood among the FtM group, social issues were more prevalent among the MtF group, which may be the result of social marginalization.
OBJETIVO: Identificar o período da vida em que indivíduos indentificaram pela primeira vez sua incongruência de gênero (IG), e comparar os dados sociodemográficos de homens e mulheres transgêneros (trans) atendidos em um ambulatório. MéTODOS: Estudo transversal realizado por meio de revisão dos prontuários de pessoas com IG em ambulatório especializado de Ribeirão Preto, São Paulo, Brasil. RESULTADOS: Foram avaliados 193 prontuários de 2010 a 2018, e 109 (56.5%) pacientes apresentavam IG desde a infância. Homens trans perceberam a IG na infância com mais frequência do que as mulheres trans (razão de probabilidades [RP]: 2.06, intervalo de confiança de 95% [IC95%]: 1.113.81). O uso de hormônio sem supervisão foi maior entre as mulheres trans (69.6% versus 32.3%; RP: 4.78; IC95%: 2.539.03). Todos as pessoas que estavam inseridas na prostituição ou que apresentavam algum diagnóstico de infecção sexualmente transmissível, incluindo o HIV, eram mulheres trans. CONCLUSãO: Apesar da percepção mais prevalente da IG na infância entre homens trans, os agravos sociais foram mais prevalentes entre as mulheres trans, o que pode ser resultado da marginalização social.
Assuntos
Disforia de Gênero , Transexualidade , Assistência Ambulatorial , Brasil/epidemiologia , Estudos Transversais , Feminino , Disforia de Gênero/epidemiologia , Humanos , MasculinoRESUMO
Unwanted pregnancy is a major public health problem both in developed and developing countries. Although the reduction in the rates of these pregnancies requires multifactorial approaches, increasing access to long-acting contraceptive methods can contribute significantly to change this scenario. In Brazil, gynecologists and obstetricians play a key role in contraceptive counseling, being decisive in the choice of long-acting reversible methods, characterized by intrauterine devices (IUDs) and the contraceptive implant. The vast scope due to the reduced number of situations to indicate long-acting methods should be emphasized in routine contraceptive counseling. On the other hand, gynecologists and obstetricians should adapt the techniques of insertion of long-acting methods, and engage in facilitating conditions to access these contraceptives through public and private health systems in Brazil. This study is part of a project called Diretrizes e Recomendações FEBRASGO (Guidelines and Recommendations of the FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations from the Portuguese acronym). It aims to review the main characteristics of long-acting contraceptives and critically consider the current situation and future prospects to improve access to these methods, proposing practical recommendations of interest in the routine of gynecologists and obstetricians.
A gravidez não planejada representa importante problema de saúde pública tanto em países desenvolvidos quanto naqueles em desenvolvimento. Embora a redução das taxas dessas gestações requeira abordagens multifatoriais, o aumento no acesso aos métodos contraceptivos de longa ação pode contribuir de forma expressiva na mudança desse cenário. No Brasil, os ginecologistas e obstetras têm papel fundamental no aconselhamento contraceptivo, sendo decisivos na escolha dos métodos reversíveis de longa ação, caracterizados pelos dispositivos intrauterinos (DIUs) e pelo implante anticoncepcional. A grande abrangência decorrente do pequeno número de situações que contraindicam os métodos de longa ação deve ser enfatizada no aconselhamento contraceptivo de rotina. Por outro lado, os ginecologistas e obstetras devem se adaptar às técnicas de inserção dos métodos de longa ação, bem como se engajar na facilitação de condições para o acesso a esses contraceptivos por meio do sistema de saúde pública e privada no Brasil. Este estudo, parte do projeto denominado "Diretrizes e Recomendações FEBRASGO", tem por objetivo revisar as principais características dos contraceptivos de longa ação, além de considerar de forma crítica o panorama atual e as perspectivas futuras, visando melhorar o acesso a esses métodos, com recomendações práticas de interesse na rotina do ginecologista e obstetra.
Assuntos
Contracepção Reversível de Longo Prazo , Feminino , Humanos , Contracepção Reversível de Longo Prazo/efeitos adversos , Contracepção Reversível de Longo Prazo/métodos , Guias de Prática Clínica como AssuntoRESUMO
Abstract Unwanted pregnancy is a major public health problem both in developed and developing countries. Although the reduction in the rates of these pregnancies requires multifactorial approaches, increasing access to long-acting contraceptive methods can contribute significantly to change this scenario. In Brazil, gynecologists and obstetricians play a key role in contraceptive counseling, being decisive in the choice of long-acting reversible methods, characterized by intrauterine devices (IUDs) and the contraceptive implant. The vast scope due to the reduced number of situations to indicate long-acting methods should be emphasized in routine contraceptive counseling. On the other hand, gynecologists and obstetricians should adapt the techniques of insertion of long-acting methods, and engage in facilitating conditions to access these contraceptives through public and private health systems in Brazil. This study is part of a project called Diretrizes e Recomendações FEBRASGO (Guidelines and Recommendations of the FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations from the Portuguese acronym). It aims to review the main characteristics of long-acting contraceptives and critically consider the current situation and future prospects to improve access to these methods, proposing practical recommendations of interest in the routine of gynecologists and obstetricians.
Resumo A gravidez não planejada representa importante problema de saúde pública tanto em países desenvolvidos quanto naqueles em desenvolvimento. Embora a redução das taxas dessas gestações requeira abordagens multifatoriais, o aumento no acesso aos métodos contraceptivos de longa ação pode contribuir de forma expressiva na mudança desse cenário. No Brasil, os ginecologistas e obstetras têm papel fundamental no aconselhamento contraceptivo, sendo decisivos na escolha dos métodos reversíveis de longa ação, caracterizados pelos dispositivos intrauterinos (DIUs) e pelo implante anticoncepcional. A grande abrangência decorrente do pequeno número de situações que contraindicam os métodos de longa ação deve ser enfatizada no aconselhamento contraceptivo de rotina. Por outro lado, os ginecologistas e obstetras devem se adaptar às técnicas de inserção dos métodos de longa ação, bem como se engajar na facilitação de condições para o acesso a esses contraceptivos por meio do sistema de saúde pública e privada no Brasil. Este estudo, parte do projeto denominado "Diretrizes e Recomendações FEBRASGO", tem por objetivo revisar as principais características dos contraceptivos de longa ação, além de considerar de forma crítica o panorama atual e as perspectivas futuras, visando melhorar o acesso a esses métodos, com recomendações práticas de interesse na rotina do ginecologista e obstetra.
Assuntos
Humanos , Feminino , Contracepção Reversível de Longo Prazo/efeitos adversos , Contracepção Reversível de Longo Prazo/métodos , Guias de Prática Clínica como AssuntoRESUMO
Objectives To assess the prevalence of hypovitaminosis D, altered arterial blood pressure, and serum levels of glucose and lipids in community-dwelling women in the city of Ribeirão Preto, in the southeast of Brazil. Methods This was a cross-sectional study of women aged 40-70 years old. Calcium intake and level of sun exposure were assessed by means of a questionnaire. A blood sample was used to determine glucose, lipid profile and 25-hydroxyvitamin D (25[OH]D) concentration. Results Ninety-one women were enrolled (age = 54.2 ± 7.1 years). The mean serum 25(OH)D concentration was 25.7 ± 8.9 ng/mL. A total of 24 (26.4%) women had 25(OH)D levels < 20 ng/mL. Seventy women (76.9%) had 25(OH)D levels < 30 ng/mL. Seventy-five women (90.4%) had inadequate calcium intake, and 61 women (67%) had appropriate sun exposure, 49 of whom (80.3%) had serum 25(OH)D levels < 30 ng/mL. Conclusion This study indicates that even in community-dwelling women, living in a city with high sun exposure, serum levels of 25(OH)D > 30 ng/ml are hardly reached. Thus, it is probable that other intrinsic factors besides sun exposure may regulate the levels of vitamin D.
Assuntos
Luz Solar , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Vitamina D/sangueRESUMO
Abstract Objectives To assess the prevalence of hypovitaminosis D, altered arterial blood pressure, and serum levels of glucose and lipids in community-dwelling women in the city of Ribeirão Preto, in the southeast of Brazil. Methods Thiswas a cross-sectional studyof women aged40-70years old.Calciumintake and level of sun exposure were assessed by means of a questionnaire. A blood sample was used to determine glucose, lipid profile and 25-hydroxyvitaminD(25[OH]D) concentration. Results Ninety-one women were enrolled (age = 54.2 ± 7.1 years). Themean serum 25(OH)D concentration was 25.7 ± 8.9 ng/mL. A total of 24 (26.4%) women had 25 (OH)D levels < 20 ng/mL. Seventy women (76.9%) had 25(OH)D levels < 30 ng/mL. Seventy-five women (90.4%) had inadequate calcium intake, and 61 women (67%) had appropriate sun exposure, 49 of whom (80.3%) had serum 25(OH)D levels < 30 ng/mL. Conclusion This study indicates that even in community-dwelling women, living in a city with high sun exposure, serum levels of 25(OH)D > 30 ng/ml are hardly reached. Thus, it is probable that other intrinsic factors besides sun exposure may regulate the levels of vitamin D.
Resumo Objetivos Estimar a prevalência de hipovitaminose D, hipertensão arterial, e níveis séricos de glicose e perfil lipídico em uma comunidade de mulheres de Ribeirão Preto, no Sudeste brasileiro. Métodos Estudo transversal com mulheres de 40 a 70 anos de idade, submetidas a um questionário para determinar ingestão diária de cálcio e nível de exposição solar, e coleta de sangue para determinar glicose, perfil lipídico e concentração de 25- hidroxivitamina D (25[OH]D). Resultados Noventa e uma mulheres foram incluídas (idade = 54,2 ± 7,1 anos). O nível sérico médio de 25(OH)D foi 25,7 ± 8,9 ng/mL. Um total de 24 (26,4%) mulheres teve níveis de 25(OH)D < 20 ng/mL. Setenta mulheres (76.9%) tiveram níveis de 25 (OH)D < 30 ng/mL. Setenta e uma mulheres (90.4%) tiveram uma ingesta inadequada de cálcio e 61 mulheres (67%) tiveram exposição solar adequada; 49 das quais (80.3%) tiveram níveis séricos de 25(OH)D < 30 ng/mL. Conclusão Este estudo indica que mesmo morando em uma cidade com exposição solar adequada, níveis séricos de 25(OH)D > 30 ng/mL dificilmente são atingidos por mulheres climatéricas. Logo, é provável que outros fatores intrínsecos podem regular o nível de vitamina D.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Luz Solar , Deficiência de Vitamina D/epidemiologia , Vitamina D/análogos & derivados , Brasil/epidemiologia , Estudos Transversais , Prevalência , Vitamina D/sangueRESUMO
BACKGROUND: Although the use of combined oral contraceptives (COCs) is associated with an increased risk of arterial and venous thromboembolic events, less is known about the impact of COCs on endothelial function. The present study evaluated the effects on the endothelium of healthy women of combinations of 30 mcg ethinylestradiol (EE)/2 mg chlormadinone acetate (CMA) and 30 mcg EE/150 mcg levonorgestrel (LNG). STUDY DESIGN: Sixty-four healthy women were evaluated, 21 using a nonhormonal contraceptive method (control) and 43 using COCs, randomized to EE 30 mcg /CMA 2 mg or to EE 30 mcg/LNG 150 mcg. Anthropometric parameters, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), ultrasound markers of endothelial function, flow-mediated dilation (FMD) of the brachial artery, intima-media thickness (IMT) and common carotid artery stiffness were measured at randomization and 6 months later. RESULTS: Relative to baseline, EE/CMA users showed a significant reduction in mean DAP at 6 months (p=.02), and EE/LNG users showed a significant increase in mean IMT (p=.02) and a significant reduction in mean FMD (p=.01) at 6 months. DAP at 6 months was significantly lower in COC users than in controls (p=.01). Intergroup evaluations showed that, at 6 months, mean SAP (p=.02) was significantly lower in EE/LNG users than in controls (p=.02) and that mean DAP was significantly lower in EE/CMA (p<.01) and EE/LNG (p=.01) users than in controls. EE/LNG users experienced a mean FMD reduction almost threefold greater than that of EE/CMA users. Compared to controls, EE/LNG users experienced a 7.5-fold greater reduction in mean FMD. CONCLUSIONS: COC containing LNG is associated with more pronounced changes in the FMD and IMT of healthy women than a COC containing CMA and nonhormonal contraception. Further studies are needed to determine whether these differences may lead to higher risk of arterial thromboembolic events.
Assuntos
Acetato de Clormadinona/efeitos adversos , Anticoncepcionais Orais Combinados/efeitos adversos , Endotélio Vascular/efeitos dos fármacos , Levanogestrel/efeitos adversos , Progestinas/efeitos adversos , Vasoconstrição/efeitos dos fármacos , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/efeitos dos fármacos , Brasil/epidemiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/efeitos dos fármacos , Espessura Intima-Media Carotídea , Anticoncepcionais Orais Combinados/farmacologia , Endotélio Vascular/diagnóstico por imagem , Etinilestradiol/efeitos adversos , Feminino , Humanos , Estudos Longitudinais , Risco , Tromboembolia/induzido quimicamente , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Rigidez Vascular/efeitos dos fármacos , Vasoconstritores/efeitos adversos , Adulto JovemRESUMO
BACKGROUND: The objective of this study was to evaluate the effect of three contraceptive pills containing ethinylestradiol (EE) (20 or 30 mcg) in combination with drospirenone (DRSP) and levonorgestrel (LNG) on plasma concentration of adhesion molecules vascular cell adhesion molecule -1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1) and E-selectin. STUDY DESIGN: A cross-sectional study was conducted with 72 participants (18-30 years old) distributed into three groups that used oral contraceptives containing EE 20 or 30 mcg combined with DRSP 3 mg or EE 30 mcg/LNG 150 mcg for at least 6 months. The control group was comprised of nonusers of contraceptives. Soluble VCAM-1, soluble ICAM-1 and soluble E-selectin were evaluated by enzyme-linked immunosorbent assay. RESULTS: Compared to the control group, a significant decrease was found in VCAM-1 and ICAM-1 concentrations with use of DRSP/20 EE and LNG/30 EE. CONCLUSIONS: DRSP/20 EE and LNG/30 EE induce favorable changes in endothelial function.
Assuntos
Androstenos/administração & dosagem , Anticoncepcionais Orais Combinados/administração & dosagem , Etinilestradiol/administração & dosagem , Molécula 1 de Adesão Intercelular/sangue , Levanogestrel/administração & dosagem , Molécula 1 de Adesão de Célula Vascular/sangue , Adolescente , Adulto , Brasil , Estudos Transversais , Combinação de Medicamentos , Selectina E/sangue , Feminino , HumanosRESUMO
STUDY OBJECTIVE: To compare the effects of ethinylestradiol (EE) and 17ß-estradiol (E(2)) on nitric oxide (NO) production and protection against oxidative stress in human endothelial cell cultures. DESIGN: Experimental study. SETTINGS: Research laboratory. MATERIAL: Human ECV304 endothelial cell cultures. INTERVENTION(S): The NO synthesis was determined by flow cytometry, and oxidative stress was determined by a cell viability assay, after exposure to hydrogen peroxide (H(2)O(2)) and stimulation of endothelial cells with EE at concentrations similar to those of a contraceptive containing 30 µg EE. MAIN OUTCOME MEASURE(S): The effects of EE were compared with those of E(2) at concentrations similar to those occurring during the follicular phase. RESULT(S): Ethinylestradiol did not increase NO synthesis and did not protect cells against oxidative stress. The viability of the cells incubated with E(2) in combination with H(2)O(2) was greater than the viability obtained with H(2)O(2) only or with H(2)O(2) in combination with EE. The cells stimulated with E(2) presented a significant increase in NO production compared with control. CONCLUSION(S): In contrast to the effects of E(2), EE did not protect human ECV304 endothelial cells against oxidative stress and did not increase their production of NO.