BACKGROUND: The origin of the lactic acid that acidifies the vagina is not well established. It is widely accepted that during times of high oestrogen (during the neonatal period and again during a woman's reproductive years) large amounts of glycogen are deposited in the vaginal epithelium and that the glycogen is anaerobically metabolized to lactic acid. What is not established is whether lactic acid is primarily produced by vaginal bacteria or by vaginal epithelial cells. Human cells can make only l-lactate, while bacteria can produce both d- and l-, thus the d- to l-lactate ratio can indicate the relative contribution of bacterially derived lactic acid. METHODS: In this study, we used chiral HPLC to examine the percentages of d- and l-lactate in vaginal secretions, in primary cultures of bacteria from these vaginal secretions, and in cultures of lactobacillus isolates of vaginal origin. RESULTS: We found that in most vaginal secretion samples, >50% of the lactic acid was the d-isoform (mean 55%, range 6–75%, n = 14). CONCLUSIONS: Our results thus support the hypothesis that vaginal bacteria, not epithelial cells, are the primary source of lactic acid in the vagina.

BMD does not entirely explain an individual's risk of fracture. The purpose of this study was to assess whether specific differences in spatially resolved bone composition also contribute to fracture risk. These differences were assessed using Fourier transform infrared spectroscopic imaging (FTIRI) and analyzed through multiple logistic regression. Models were constructed to determine whether FTIRI measured parameters describing mineral content, mineral crystal size and perfection, and collagen maturity were associated with fracture. Cortical and cancellous bone were independently evaluated in iliac crest biopsies from 54 women (32 with fractures, 22 without) who had significantly different spine but not hip BMDs and ranged in age from 30 to 83 yr. The parameters that were significantly associated with fracture in the model were cortical and cancellous collagen maturity (increased with increased fracture risk), cortical mineral/matrix ratio (higher with increased fracture risk), and cancellous crystallinity (increased with increased fracture risk). As expected, because of its correlation with cortical but not cancellous bone density, hip BMD was significantly associated with fracture risk in the cortical but not the cancellous model. This research suggests that additional parameters associated with fracture risk should be targeted for therapies for osteoporosis.

Studies estimate that there are likely to be more than 1 million transgender and gender-dysphoric individuals living in the United States alone.¹ Individuals with gender dysphoria experience intense discomfort owing to identifying as a gender that is different than how they are perceived by society and/or a gender different than that commonly associated with their physiological sex. Many individuals with gender dysphoria undergo medical and/or surgical treatments to address various sources of somatic discomfort (ie, dysphoria). In most but not all cases, the initial medical treatment involves the use of cross-sex hormone therapy (CSHT) and/or medications that block the effects of endogenous hormones (Table 1).^2,4

Transgender and gender diverse (TGD) adolescents experience mental health challenges at higher rates than cisgender peers due to a combination of minority stress and gender dysphoria. Many TGD youth use video games to cope with stress and access informal networks of support. However, very little is known about the potential positive influence avatar customization has for this group of youth. To address this gap in the literature, in-depth, semi-structured qualitative interviews were conducted with ten TGD adolescents about their experiences with avatar customization. Thematic analysis revealed four primary themes including that (1) video game avatar customization offers a low stakes environment for gender exploration, (2) avatars offer both internal and external validation of gender identity and transition goals, (3) avatars allow players to enact aspirational appearance goals, and (4) video games and avatars offer immersion and escapism for TGD adolescents. These novel findings underscore the range of positive impacts avatar customization can have for TGD adolescents, particularly for youth with gender dysphoria. Video game avatar customization can be a key part of the gender exploration and affirmation for some TGD adolescents.

Studies of vaginal physiology and pathophysiology sometime require larger volumes of undiluted cervicovaginal secretions than can be obtained by current methods. A convenient method for self-sampling these secretions outside a clinical setting can facilitate such studies of reproductive health. The goal was to develop a vaginal self-sampling method for collecting large volumes of undiluted cervicovaginal secretions. A menstrual collection device (the Instead cup) was inserted briefly into the vagina to collect secretions that were then retrieved from the cup by centrifugation in a 50-ml conical tube. All 16 women asked to perform this procedure found it feasible and acceptable. Among 27 samples, an average of 0.5 g of secretions (range, 0.1–1.5 g) was collected. This is a rapid and convenient self-sampling method for obtaining relatively large volumes of undiluted cervicovaginal secretions. It should prove suitable for a wide range of assays, including those involving sexually transmitted diseases, microbicides, vaginal physiology, immunology, and pathophysiology.

The COVID-19 pandemic has wrought widespread devastation upon children and families across the United States, widening existing health disparities and inequities that disproportionately affect communities of color. In health care settings specifically, social work is the key workforce tasked with responding to patient and family psychosocial needs, both of which have increased substantially since the emergence of COVID-19. There is a need to understand ways in which hospital social workers’ roles, responsibilities, and integration within interprofessional teams have evolved in response to these challenges. In this qualitative study, focus groups were conducted with 55 social workers employed across multiple settings in a large, urban, pediatric hospital in Spring 2020. Thematic analyses revealed salient superordinate themes related to the pandemic’s impact on social work practice and social workers themselves, institutional facilitators and impediments to effective social work and interprofessional practice, and social work perspectives on future pandemic recovery efforts. Within each theme, a number of interrelated subthemes emerged elucidating nuances of telehealth adoption in the context of remote work, the salience of social determinants of health, and the critical role of social work in social justice oriented pandemic preparedness and response efforts. Implications for interprofessional practice and the profession at large are discussed.