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Sexual and reproductive health experiences and care of adult women with cystic fibrosis

Published:October 06, 2022DOI:https://doi.org/10.1016/j.jcf.2022.09.013

      Highlights

      • Women with cystic fibrosis (wwCF) age ≥25 years have significantly different sexual and reproductive health (SRH) experiences than non-CF peers.
      • Most wwCF view their CF doctor as their main physician and almost half report no primary care provider (PCP).
      • WwCF report suboptimal SRH care compared to their preferences.
      • There is an urgent need to improve access to and delivery of SRH care for wwCF of all ages.
      • Innovative partnerships and initiatives may benefit SRH care and improve outcomes for wwCF.

      Abstract

      Background

      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.

      Keywords

      Abbreviations:

      SRH (sexual and reproductive health), wwCF (women with cystic fibrosis), HEMT (highly effective modulator therapy), CFTR (CF transmembrane conductance regulator), AYA (adolescent and young adult), STI (sexually transmitted infection)
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