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Since its first discovery as a bioactive phospholipid inducing potent platelet aggregation, platelet-activating factor (PAF) has been shown to be involved in a wide variety of inflammatory and allergic disease states. Many pharmacological studies in the 1980s and 1990s also showed that PAF induces endothelium-dependent vascular relaxation and contraction of various smooth muscles (SMs), including those in the airway, gastrointestinal organs, and uterus. However, since the late 1990s, there have been few reports on the SM contractions induced by PAF. The lower urinary tract (LUT), particularly the urinary bladder (UB) has attracted recent attention in SM pharmacology research because patients with LUT dysfunctions including overactive bladder are increasing as the population ages. In addition, recent clinical studies have implicated the substantial role of PAF in the inflammatory state in LUT because its production increases with smoking and with cancer. However, the effects of PAF on mechanical activities of LUT SMs including UBSM have not been investigated to date. Recently, we found that PAF very strongly increased mechanical activities of UBSM in guinea pigs and mice, and partly elucidated the possible mechanisms underlying these actions of PAF. In this review, we describe the effects of PAF on LUT SMs by introducing our recent findings obtained in isolated UBSMs and discuss the physiological and pathophysiological significance. We also introduce our data showing the effects of PAF on the SM mechanical activities of genital tissues (prostate and vas deferens).

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Human Papillomavirus (HPV), a prevalent sexually transmitted infection, comprises high-risk (HR-HPV) and low-risk (LR-HPV) viruses, the former posing a high risk for developing malignancies whereas the latter mainly for benign warts. Despite increasing awareness of HPV's impact on men's health, the influence of HR-HPV and LR-HPV urogenital infections on male fertility potential remains uncertain. This study aimed to investigate whether male urogenital infection with HR- or LR-HPV associates with impaired sperm quality, oxidative stress, and inflammation. A total of 205 male patients attending an urology clinic were enrolled. Semen samples were analyzed for HPV using PCR and genotyped by RFLP. Semen quality was evaluated following WHO guidelines. Semen leukocytes, reactive oxygen species (ROS), and sperm viability were analyzed using flow cytometry. HPV was detected in 19% (39/205) of semen samples. HR-HPV infections were more prevalent, with HPV-16 being the most frequent genotype. Neither HR-HPV nor LR-HPV were associated with significant alterations in routine sperm quality parameters. However, HR-HPV+ individuals showed significantly higher levels of sperm necrosis and exhibited increased proportions of ROS+ spermatozoa compared to LR-HPV+ or control individuals. Furthermore, no significant semen inflammation was detected in patients infected with either HR-HPV or LR-HPV, and unexpectedly reduced semen leukocytes and inflammatory cytokines (IL-6 and IL-1ß) were observed in HR-HPV+ patients compared to controls. These observations underscore the importance of comprehensive HPV screening, including genotyping, in urology and fertility clinics to understand the progression of the infection, potential adverse effects on reproductive health, and the oncogenic risks involved.

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PROBLEM: Female sex workers (FSW) experience a disproportionately high burden of HIV infection, yet characterization of the vaginal immune microenvironment that may impact biological risk is not well studied among FSW in the United States. Additionally, feasible methodology for collecting biological materials has not been evaluated in this population. METHODS: We enrolled 10 FSW (5 premenopausal, 5 postmenopausal) who participated in a survey and provided vaginal swabs. Biomarkers were assessed by ELISA, and included cytokines, chemokines, and antimicrobial/wound-healing mediators. RESULTS: One hundred percent of FSW were African American, with a median age of 43.5. The median age when participants started sex work was 17.5, with 60% working 7 days per week and seeing up to 10 clients per night. Eighty percent reported recent unprotected sex and only 30% used some form of contraception. One self-reported sexually transmitted infection at the time of visit and two reported living with HIV. Vaginal secretions showed detectable levels of all biomarkers tested, except MIP3α and MIP1α, which were undetectable in all samples. When stratified by age/menopause status, no significant changes were observed except for Serpin A1 with higher median levels in premenopausal compared to postmenopausal FSW (median 5.79 vs. 5.205 log pg/mL, p = 0.016). Comparison with samples from an existing repository of non-FSW women showed significantly reduced chemokines IL8 (p = 0.045), MIP3α (p ≤ 0.001), and MIP1ß (p = 0.015) in the FSW group. CONCLUSIONS: We report characterization of the vaginal secretome in a cohort of FSW in the United States. Understanding of the genital immune microenvironment can inform future research in HIV prevention and therapeutic options in this population.

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Dysbiosis, an imbalance in microbial communities, significantly impacts the health and functionality of the human genital tract, with profound implications for fertility and reproductive health. This review explores the intricate relationship between genital tract microbiota and reproductive outcomes, highlighting the composition and dynamics of these microbial communities in both females and males. In females, the vaginal microbiota, primarily dominated by Lactobacillus species, is essential for maintaining a healthy vaginal environment, preventing infections, and supporting reproductive functions. In males, the genital microbiota influences sperm quality and reproductive health. Dysbiosis in the genital tract, manifesting as bacterial vaginosis, yeast infections, urethritis, or prostatitis, disrupts these microbial communities, leading to adverse reproductive outcomes such as infertility, pregnancy, and increased susceptibility to sexually transmitted infections. This review delves into the mechanisms through which dysbiosis affects fertility, including alterations in vaginal pH, mucosal immunity, inflammation, sperm viability, and motility. It also evaluates diagnostic methods, clinical implications, and management strategies, including probiotics, prebiotics, antibiotics, antifungal treatments, lifestyle interventions, and emerging therapeutic approaches. By understanding the microbial landscape of the genital tract and its impact on fertility, this review aims to inform targeted interventions that restore microbial balance and enhance reproductive health, ultimately improving fertility outcomes and the potential for healthy pregnancies.

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The caloric content and macronutrient ratio of diet consumed is a major source of phenotypic variation in most animal populations. While these nutritional effects have been well-documented for a variety of life-history and morphological traits, the effects of nutrition on male genitals are poorly understood but genitals are thought to be more canalised than general morphology and hence less susceptible to variation in nutrition. Even less is known about the effects of nutrition on female genital form, which to our knowledge, have never been investigated. Here we tested for effects of juvenile dietary macronutrients (protein and carbohydrate) on larval survival, adult morphology, including genital size and shape in male and female flour beetles (Tribolium castaneum). We found there was nutritionally induced plasticity in larval survival and morphology, although the latter effect was variable, with body size being most responsive to dietary macronutrients and genital size and shape being least responsive. Functionally equivalent morphological traits in the sexes responded similarly to nutrition. Previously, we showed that the genitalia of male and female T. castaneum are subject to strong stabilizing sexual selection, and our current findings suggest that developmental mechanisms reduce the nutritional sensitivity of male and female genitals, possibly to ensure matching during mating.

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OBJECTIVE: Childbirth is considered to be both beautiful and traumatic. Following a vaginal delivery, some women express discontent with the appearance of their genitalia on social media and/or websites. This study explored how some women perceived their genitalia, post childbirth. Three groups were compared: women with a vaginal delivery, those with a cesarean-section, and those who had never given birth. METHODS: After the study received approval from the institutional review board, 224 female participants living in Puerto Rico and aged 21 to 42 years completed a questionnaire about their genital self-image. RESULTS: Approximately 51% (n = 115) of the participants had never given birth; the others had given birth via C-section 23% (n = 51) or vaginally 26% (n = 58). In all 3 groups, 84% felt positive about their genitals, 79% expressed their satisfaction with the appearance of their genitals and 84%, with their size; 81% were not ashamed of their genitals. CONCLUSION: Logistic regression found no significant difference in genital self-perception between delivery groups or nulliparous women. The adjusted odds ratios for positive genital image varied slightly between delivery methods but were not statistically significant (ranging from 0.65 to 1.11 for vaginal deliveries, and 0.42 to 1.00 for C-sections; P > .05). This suggests that the method of delivery does not have a significant impact on women's genital self-perception. However, for the 21% with negative perceptions, targeted support is essential; for those struggling with their self-image after childbirth, our results can inform support services to address concerns.

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Purpose: The aim of this study was to compare the menstrual symptoms and dysmenorrhea in university students who underwent Female genital mutilation/cutting (FGM/C), in Mogadishu, Somalia, and students who did not undergo FGM/C in Ankara, Türkiye. Methods: A comparative cross-sectional study design was used. Results: Among the participants with FGM/C, 88.5% were Type 1 and the age at FGM/C was 8 years. The pain severity was 6.20±2.54 in women with FGM/C and was higher than that of those without FGM/C (5.97±2.32), but no significant difference was found. Among those who had FGM/C, 66% had a menstrual duration of 3-5 days, while 52.0.% of those who did not have FGM/C had a menstrual duration of 6-8 days (p<0.05). While 85.1% of those without FGM/C had a menstrual cycle of 21-35 days, 35% of those with FGM/C had a menstrual cycle of less than 20 days (p<0.05). It was found that 95% of those who have undergone female circumcision and 90.2% of those who have not had dysmenorrhea (p<0.05). Painkillers were always used by 28% of women with FGM/C and 26.3% of women without FGM/C (p<0.05). The total MSS score of those who have not had FGM/C was 3.34±0.72 and the score of those who have had FGM/C was 2.91±0.74 (p<0.05). The negative effects sub-dimension score was found to be higher in the non-FGM/C group with 3.20±0.75, while the coping methods sub-dimension score was higher in the FGM/C group with 2.91±1.13 (p<0.05). Conclusion: FGM/C is still common in Somalia. Our study results showed that having FGM/C may cause differences in dysmenorrhea and menstrual symptoms. Efforts to increase students' effective coping with menstrual symptoms and dysmenorrhea are thought to be useful.

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BACKGROUND: Congenital malformations of the female genital tract (CM-FGT) are characterized by abnormal development of the fallopian tubes, uterus, and vagina, often accompanied by malformations in the urinary system, bones and hearing. However, no definitive pathogenic genes and molecular genetic causes have been identified. METHODS: We present the largest whole-genome sequencing study of CM-FGT to date, analyzing 590 individuals in China: 95 patients, 442 case-controls, and 53 familial controls. RESULTS: Among the patients, 5.3% carried known CM-FGT-related variants. Pedigree and case-control analyses in two dimensions of coding and non-coding regulatory regions revealed seven novel de novo copy number variations, 12 rare single-nucleotide variations, and 10 rare 3' untranslated region (UTR) mutations in genes related to CM-FGT, particularly highlighting ASH1L as a pathogenic gene. Single-cell sequencing data showed that the majority of CM-FGT-related risk genes are spatiotemporally specifically expressed early in uterus development. CONCLUSIONS: In conclusion, this study identified novel variants related to CM-FGT, particularly highlighting ASH1L as a pathogenic gene. The findings provide insights into the genetic variants underlying CM-FGT, with single-cell sequencing data revealing spatiotemporal specific expression patterns of key risk genes early in uterine development. This study significantly advances the understanding of CM-FGT etiology and genetic landscape, offering new opportunities for prenatal screening.

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BACKGROUND: There is a growing body of evidence suggests a strong link between female genital prolapse (FGP) and mental health. However, the causal relationship between FGP and psychological disorders remains unclear. OBJECTIVES: Bidirectional Mendelian Randomization (MR) analysis has been applied to investigate the potential impact of FGP on the risk of seven common psychiatric disorders. METHODS: The two-sample MR analysis was conducted using genetic instruments such as Inverse variance weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode from the genome-wide association study (GWAS) summary data in European populations. In addition, the Cochrane's Q test, MR-Egger intercept test, MR pleiotropy residual sum and outliers (MR-PRESSO) test and leave-one-out analysis were employed to assess the sensitivity and heterogeneity. RESULTS: The MR results revealed that FGP exhibited a potential marginal protective effect on bipolar disorder (BD) (odds ratio(OR) = 0.92, 95%confidence interval (95%CI: 0.85-0.99, P = 0.03) as well as schizophrenia(OR = 0.91, 95%CI:0.85-0.98, P = 0.01). Nevertheless, there was no causal correlation between genetically predicted FGP and obsessive compulsive disorder (OCD) (OR = 0.98, 95%CI:0.80-1.20, P = 0.84),depression (broad) (OR = 1.00, 95%CI:0.99-1.01, P = 0.76), major depression(OR = 0.98, 95%CI:0.94-1.03, P = 0.43), anxiety disorders (OR = 1.00, 95%CI:0.94-1.07,P = 0.97) and post-traumatic stress disorder(PTSD) (OR = 1.18, 95%CI:0.88-1.57,P = 0.27),respectively. In addition, BD was found to have a potential significant influence on FGP in the inverse MR analysis (OR = 0.83, 95%CI:0.72-0.97, P = 0.02). No significant heterogeneity or horizontal pleiotropy detected, and the results were deemed stable based on sensitivity analysis and leave-one-out test . LIMITATIONS: There are shortcomings such as data limitations, population bias, potential pleiotropy, and stratified analysis. CONCLUSIONS: While there is potential causal relationship between FGP and BD or schizophrenia, it does not exhibit any correction with OCD, depression (broad), major depression, anxiety disorders and PTSD among European populations.

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PURPOSE: Gender-affirming surgery is being increasingly performed for transgender and gender-diverse individuals diagnosed with gender dysphoria. However, there is a group of patients who may seek outcomes that are either a combination of or altogether different from those of binary procedures such as penile inversion vaginoplasty or phalloplasty. METHODS: We describe surgical techniques for less commonly performed gender-affirming genital procedures, in order to introduce these procedures to the medical and surgical community. RESULTS: Operative techniques for phallus-preserving vaginoplasty, vagina-preserving phalloplasty, and removal of genitalia with creation of perineal urethrostomy are described. Demographic characteristics and complications of these procedures in 16 patients are reported. CONCLUSION: Individually customized gender-affirming genital procedures, such as phallus-preserving vaginoplasty, vaginal-preserving phalloplasty, and removal of genitalia and creation of perineal urethrostomy, may better affirm the identities of some gender-diverse patients, and may also preserve desired sexual function of natal genitalia.

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PURPOSE: Human papillomavirus (HPV) is the most common sexually transmitted infection, responsible for multiple HPV-related diseases, including almost all cervical cancers. The highly effective HPV vaccination has been recommended under the German HPV national immunization program (NIP) since 2007 and is reimbursed by health insurances. Vaccination uptake rates, however, remain suboptimal and data on the real-world impact of HPV vaccination in Germany are lacking. This study aims to demonstrate the population-level impact of Germany's NIP on HPV-related anogenital diseases among young women. METHODS: Retrospective claims data analysis using a classic impact study design comparing disease prevalence among 28- to 33-year-old women before and after introduction of the HPV-immunization program in Germany. Claims data representing approximately two thirds of German health insurances were used. HPV-related disease outcomes included cervical cancer and high grade precancers (cervical intraepithelial neoplasia (CIN) 2+), anogenital warts, as well as vulvar, vaginal, and anal precancer/cancer. RESULTS: Significant declines were seen for CIN2+, anogenital warts, and vaginal precancer/cancer. Prevalence of CIN2+ declined 51.1% from 0.92% (95% CI = 0.78%, 1.08%) to 0.45% (95% CI = 0.38%, 0.53%). There was a 38.6% decline in anogenital warts prevalence from 0.44% (95% CI = 0.36%, 0.54%) to 0.27% (95% CI = 0.22%, 0.32%) and 75.0% decline in vaginal precancer/cancer prevalence from 0.04% (95% CI = 0.02%, 0.07%) to 0.01% (95% CI = 0.00%, 0.02%). CONCLUSION: The German HPV-immunization program has led to significant declines in female anogenital disease among young women in Germany, highlighting the importance of the vaccination. Moreover, the data suggest that increasing vaccination coverage in Germany could further strengthen the public-health impact of its HPV-immunization program.

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We describe here the sexual histories and characteristics of 338 individuals with interests in castration (orchiectomy) and, more broadly, genital ablation (i.e., orchiectomy, penectomy, and/or nullification), recruited from the Eunuch Archive. We compared four groups: those who only fantasize about castration (Fantasy, n = 66), those who wish to be castrated in the future (Aspiring, n = 166), and those who have been castrated (Eunuchs) both with (n = 42) or without (n = 64) androgen replacement therapy (ART). In our sample, 35.6-53.8% had sexual fantasies of castrating someone, 83.3-90.8% had fantasies of being castrated, 20.6-33.3% had fantasies of removing someone's penis, and 45.3-61.9% had fantasies of having a penectomy. The four groups had similar arousal by high-risk sex behaviors, anal sex play, attraction to people under 18, common sex behaviors, and fetishistic behaviors. Fantasy of being castrated by someone was associated with elevated high-risk sexual behaviors and attraction to individuals aged 18 to 49 after controlling for age, groups, and sexual attraction. In addition, after adjusting for age, groups, and sexual attraction, fantasy of castrating someone was associated with more attraction to individuals under the age of 18 and being aroused by interaction with a stranger, whereas fantasy of cutting off someone's penis was associated with less tendency for common sexual behaviors and digital sex communication. Fantasy of being penectomized was associated with high risk and fetishistic sexual behaviors. These results support screening for high-risk behaviors in individuals who endorse an interest in genital ablation, with treatments focused on harm reduction.

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BACKGROUND: From 2009 until 2021, bivalent HPV vaccination was offered only to girls in the Netherlands. We aimed to study the impact of girls-only HPV vaccination on genital HPV prevalence among young adults. METHODS AND FINDINGS: PASSYON is a biennial repeated cross-sectional study (2009-21) among sexual health clinic clients aged 16-24 years old. Questionnaires elicited data on demographics, sexual behaviour and HPV vaccination status. Genital samples were collected and analysed using a PCR-based assay (SPF10-LiPA25). Type-specific prevalence trends of 12 high-risk (hr) genotypes were analysed as the adjusted average annual change (aAAC), estimated using Poisson GEE models. The relation between aAAC and phylogenetic distance to HPV-16/18 was assessed by means of regression and rank correlation analysis. Questionnaires and genital samples were collected from 8,889 females and 3,300 heterosexual males (HM). 4,829 females reported to be unvaccinated (54·3%). Among females (irrespective of vaccination status), prevalences of HPV-16/18/31/33/35/45 decreased significantly over time. Increasing trends were observed for HPV-39/52/56. Among both HM and unvaccinated females HPV-16/18 prevalence significantly declined, as did HPV-31 among HM. In contrast, HPV-52/58 increased significantly among HM and unvaccinated females. The type-specific aAAC correlated well with the phylogenetic distance to HPV-16/18. CONCLUSIONS: During twelve years girls-only bivalent HPV vaccination in the Netherlands, decreasing trends of the vaccine types and cross-protected types were observed among females. Herd protection of vaccine-types was observed for HM and unvaccinated females, and one cross-protected type for HM. Increasing prevalence trends of HPV types with large phylogenetic distance to the vaccine types might indicate type-replacement.

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BACKGROUND: Molluscum contagiosum (MC) is a poxvirus that manifests as firm, smooth, dome-shaped, umbilicated, flesh-colored papules. In adults, MC is commonly spread by sexual contact, and is self-limited in patients with intact immune systems but more widely distributed and difficult to treat in immunocompromised persons. We analyzed cases of adult MC for associations with immunosuppression, lifestyle risk factors, and sexually transmitted infections (STIs). METHODS: Using the All of Us Research Program database, adults with MC were identified and matched with controls 1:10 based on demographic factors. Comorbidities, lifestyle risk factors, and medication exposures were analyzed. Odds ratios were calculated using logistic regression. RESULTS: Our analysis included 146 cases of adults with MC and 1460 demographic-matched controls. Patients with MC were 48 years old on average, 59% female, and majority White (82.5%). Controls were similar for all demographic features. Adults with MC were more likely to have syphilis (odds ratio (OR) 16; 95% confidence interval (CI) 2.57-99.5), human immunodeficiency virus (HIV) (OR 9.54; 95% CI 3.95-23.0), chlamydia (OR 6.24; 95% CI 2.38-16.4), condyloma acuminata (OR 13.9; 95% CI 7.36-26.2), genital herpes (OR 4.13; 95% CI 1.87-9.15), or atopic dermatitis (AD) (OR 2.85; 95% CI 1.5-5.4) (all p < .01). There were no differences in prevalence of other comorbidities, lifestyle risk factors, nor medication exposures (all p > .05). CONCLUSIONS: We showed that adult MC is associated with AD and STIs, including HIV, chlamydia, condyloma acuminata, genital herpes, and syphilis. Sexually active adolescents and adults and those diagnosed with AD may be screened for MC and counseled on their potentially increased risk.

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Sexual conflict is widespread among sexually reproducing organisms. Phenotypic plasticity in female resistance traits has the potential to moderate the harm imposed by males during mating, yet female plasticity has rarely been explored. In this experiment, we investigated whether female seed beetles invest more in immunocompetence, measured as phenoloxidase (PO) capacity, when exposed to cues signalling a greater risk of sexual conflict. Risk perception was manipulated by housing focal individuals alone or with a companion as developing larvae, followed by exposure to a mating-free male- or female-biased social environment when adults. We predicted that females exposed to cues of increased sexual conflict would have increased PO capacity. However, PO capacity did not differ between either larval or adult social treatments. Our results suggest that females may not perceive a risk to their fitness on the basis of increased male presence or are unable to adjust this aspect of their phenotype in response to that risk.

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Background: Female genital mutilation (FGM) is widely acknowledged globally as a violation of the fundamental human rights of girls and women. FGM is still widely practiced in Nigeria but at diminishing rates. Primary care physicians must educate and campaign to end this hazardous practice in Nigeria, especially in high-incidence areas. This study fills the knowledge gap by identifying FGM determinants to help policymakers reduce it. Method: The study employed a retrospective cross-sectional design using data from the United Nations International Children's Emergency Fund for 2011, 2016-2017, and 2021. The sampling involved multistage cluster sampling. Data analysis utilized IBM-SPSS, presenting FGM prevalence across years and exploring associations with various factors. Results: This study analyzed 63,365 Nigerian women across a decade (2011, 2016-2017, and 2021). FGM awareness fluctuated (35.1% in 2016-2017, 33.0% in 2011, and 31.9% in 2021), while FGM prevalence increased from 46.6% (2011) to 69.5% (2021). Education correlated with lower FGM prevalence. Geographic disparities were observed, with the Southwest having the highest (70.1%) and the Northeast having the lowest (34.5%) prevalence. Religion influenced FGM rates, with Christians (54.2%) and those with other/no religion (58.0%) showing higher rates than Muslims (52.6%). Urban women had a slightly lower prevalence (52.6%) than rural women (54.2%), and wealth quintiles displayed variations. Variability was also evident among states, ranging from 2.0% to 86.3%. Daughters' circumcision was influenced by maternal circumcision status, education, region, religion, and wealth quintile. Common FGM procedures involved removing genital flesh (63.7%) and nicking without removal (55.1%), often performed by nurses/midwives (63.7%). Conclusion: The study emphasized the urgent need for continuous awareness campaigns and education to combat FGM among Nigerian women. Education emerged as a critical factor in reducing FGM, highlighting the importance of investing in girls' education.

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BACKGROUND: Patients undergoing treatment for prostate cancer may develop lymphoedema of the midline region. This has a substantial impact on a patient's quality of life and its diagnosis is often delayed or missed. Therefore, the purpose of this study is to compare the characteristics of patients with leg and midline lymphoedema to patients with only leg lymphoedema. METHODS: We retrospectively collected patient-, cancer-, lymphoedema- and lymphoedema treatment-related data of 109 men with lymphoedema after treatment for prostate cancer. First, 42 characteristics were compared between both groups. Second, factors predicting presence of midline lymphoedema were explored by multivariable analyses. RESULTS: The mean age of the patients with lymphoedema was 68 ( ±7) years and mean BMI is 28 (±4) kg/m2. Median duration of lymphoedema before the first consultation was 27 (9;55) months. Based on univariable analyses, patients with leg and midline lymphoedema had more frequently upper leg lymphoedema (89% (31/35) vs. 69% (51/74), p = 0.026), skin fibrosis (34% (12/35) vs. 16% (12/74), p = 0.034) and lymphatic reconstructive surgery (9% (3/35) vs. 0% (0/71), p = 0.020) than patients with only leg lymphoedema. Additionally, patients with leg and midline lymphoedema reported less frequently lower leg lymphoedema (77% (27/35) vs. 95% (70/74), p = 0.007). Based on the multivariable analysis, not having lower leg lymphoedema, skin fibrosis, performing self-bandaging and self-manual lymphatic drainage appear to be predictors for having midline lymphoedema. CONCLUSIONS: If patients with lymphoedema after prostate cancer do not have lower leg lymphoedema, have skin fibrosis, perform self-bandaging or self-manual lymphatic drainage, they possibly have midline lymphoedema.

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Female Genital Mutilation (FGM) is a universal issue which affects girls in Africa, the Middle East, Asia and South America, and immigrant communities in Western Europe, North America, Australia and New Zealand. FGM is a cultural practice in approximately 29 countries in Africa, affecting over 140 million girls. FGM is practiced as a rite of passage, where girls are initiated into womanhood. This practice is promoted as a means for incorporation, thus ascribing personhood, and belonging for girls to their communities. African scholars hold conflicting positions about FGM, with some arguing that it is essential for relational fullness and harmony. While others believe FGM is unjustified because of the health and social risks associated with the practice. We argue, applying sustainable social harmony and Gyekye's views on cultural revitalization, that FGM is morally unjustified and should be prohibited. We believe the claims that FGM fosters harmony, a value of Ubuntu, are fallacious, and this perceived harmony is pretentious and unsustainable. We claim that FGM is inauthentic, unjust and steeped in patriarchal underpinnings that are unsustainable, thus it is a disharmonious practice. Cultural practices that are disharmonious should be refined and pruned and must be dynamic and responsive to current realities.

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Purpose To compare diffusion-weighted imaging (DWI) with thermal dosimetry as a noncontrast method to predict ablation margins in individuals with prostate cancer treated with MRI-guided focused ultrasound (MRgFUS) ablation. Materials and Methods This secondary analysis of a prospective trial (ClinicalTrials.gov no. NCT01657942) included 17 participants (mean age, 64 years ± 6 [SD]; all male) who were treated for prostate cancer using MRgFUS in whom DWI was performed immediately after treatment. Ablation contours from computed thermal dosimetry and DWI as drawn by two blinded radiologists were compared against the reference standard of ablation assessment, posttreatment contrast-enhanced nonperfused volume (NPV) contours. The ability of each method to predict the ablation zone was analyzed quantitively using Dice similarity coefficients (DSCs) and mean Hausdorff distances (mHDs). Results DWI revealed a hyperintense rim at the margin of the ablation zone. While DWI accurately helped predict treatment margins, thermal dose contours underestimated the extent of the ablation zone compared with the T1-weighted NPV imaging reference standard. Quantitatively, contour assessment between methods showed that DWI-drawn contours matched postcontrast NPV contours (mean DSC = 0.84 ± 0.05 for DWI, mHD = 0.27 mm ± 0.13) better than the thermal dose contours did (mean DSC = 0.64 ± 0.12, mHD = 1.53 mm ± 1.20) (P < .001). Conclusion This study demonstrates that DWI, which can visualize the ablation zone directly, is a promising noncontrast method that is robust to treatment-related bulk motion compared with thermal dosimetry and correlates better than thermal dosimetry with the reference standard T1-weighted NPV. Keywords: Interventional-Body, Ultrasound-High-Intensity Focused (HIFU), Genital/Reproductive, Prostate, Oncology, Imaging Sequences, MRI-guided Focused Ultrasound, MR Thermometry, Diffusionweighted Imaging, Prostate Cancer ClinicalTrials.gov Identifier no. NCT01657942 Supplemental material is available for this article. © RSNA, 2024.

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