Vulnerabilidade de mulheres que fazem sexo exclusivamente com mulheres e de mulheres que fazem sexo com mulheres e com homens à vaginose bacteriana.
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Data
2022-04-12
Autores
Ignacio, Mariana Alice de Oliveira
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Universidade Estadual Paulista (Unesp)
Resumo
A vaginose bacteriana (VB) é a alteração mais comum da microbiota vaginal e pode ocasionar repercussões negativas à saúde sexual e reprodutiva da mulher. A literatura aponta elevadas prevalências de VB entre mulheres que se relacionam sexualmente com outras mulheres, o que fundamenta a necessidade de estudo de vulnerabilidade dessas mulheres ao agravo. Não foram encontrados estudos que utilizassem o referencial teórico da vulnerabilidade para analisar essa relação. Assim, o objetivo do estudo foi analisar a vulnerabilidade de mulheres que fazem sexo com mulheres e de mulheres que fazem sexo com mulheres e com homens à VB. Método: estudo transversal que incluiu 453 mulheres, classificadas em três grupos, segundo o tipo de parceria sexual nos 12 meses que antecederam à coleta de dados: grupo 1- 149 mulheres que fazem sexo exclusivamente com mulheres (MSM); grupo 2- 80 mulheres que fazem sexo com mulheres e com homens (MSMH) e grupo 3- 224 mulheres que fazem sexo exclusivamente com homens (MSH). A captação da amostra se deu em dois momentos distintos: de janeiro de 2015 a abril de 2017 e de janeiro de 2019 a janeiro de 2020 junto a dois projetos de pesquisa mais amplos, que investigaram diversos aspectos sobre a vulnerabilidade e saúde sexual e reprodutiva de mulheres que se relacionavam sexualmente com outras mulheres. Os dados foram obtidos por meio da aplicação de questionários, que abordaram as variáveis de interesse e exame ginecológico. O diagnóstico da VB foi realizado por exame microscópico do conteúdo vaginal, corado pelo método de Gram e classificado segundo Nugent et al., 1991 e os diagnósticos de papiloma vírus humano e Chlamydia trachomatis por reação em cadeia da polimerase. A classificação das variáveis de vulnerabilidade foi baseada no quadro de vulnerabilidade proposto por Ayres et al. em 2012. A análise de vulnerabilidade dos grupos à VB foi realizada por comparação das frequências das variáveis de vulnerabilidade e medianas dos escores de vulnerabilidade, empregando-se os testes Qui-quadrado ou Exato de Fisher e Mann-Whitney. A comparação das prevalências de VB entre os grupos foi realizada pelo teste Qui-quadrado. Foram realizadas regressões múltiplas de Cox para verificar se o tipo de parceria sexual se associou à VB e na identificação das variáveis de vulnerabilidade associadas ao agravo em cada um dos três grupos estudados. Diferenças estatisticamente significativas foram consideradas se p < 0.05. Ambas as pesquisas mães das quais este subprojeto foi derivado foram aprovadas pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de Botucatu sob os pareceres n° 3.320.951 e n° 820.717. Resultados: A mediana de idade das participantes foi de 26 anos (18-55), a maioria era branca (74,8%), tinha 12 anos ou mais de estudo (76,1%), não vivia com parceria (79,2%) e tinha atividade remunerada (65,1%). As MSM e MSMH apresentaram maior perfil de vulnerabilidade à VB que as MSH, e as MSMH foram as mais vulneráveis à VB quando comparadas aos demais grupos. A análise do escore de vulnerabilidade apontou que as MSMH possuíam mediana de escore de vulnerabilidade significativamente maior que os demais grupos. As prevalências de VB entre MSM e MSMH foram significativamente semelhantes e superiores que a de MSH (35,6%a vs 36,3%a vs 23,2%b; p=0,013). O tipo de parceria sexual não se associou à VB - MSM [1,13 (IC95%: 0,71-1,78); p= 0,613] e MSMH [0,94 (IC95%: 0,56-1,56); p= 0,802]. As variáveis de vulnerabilidade associadas independentemente a esse desfecho foram diferentes entre os grupos estudados: anos de estudo concluídos foi fator protetor à VB [0,91 (IC95%: 0,82-0,99); p= 0,048] entre as MSM; cor da pele não branca [2,34 (IC95%: 1,05-5,19); p=0,037] entre as MSMH e troca de parceria sexual nos últimos três meses [2,09 (IC95%: 1,14-3,82); p= 0,017], o uso inconsistente de preservativo [2,61 (IC95%: 1,10-6,20); p= 0,030] e diagnóstico positivo de C. trachomatis [2,40 (IC95%: 1,01-5,73); p= 0,048] entre as MSH. Conclusão: As MSM e MSMH são mais vulneráveis à VB que MSH, sendo as MSMH o grupo mais vulnerável. As prevalências de VB foram significativamente superiores entre MSM e MSMH quando comparadas às MSH, entretanto, o tipo de parceria sexual não se associou a esse desfecho. As variáveis de vulnerabilidade associadas à VB foram diferentes entre os grupos estudados. Os resultados tomados em conjunto apontam para a necessidade de os profissionais de saúde considerarem o histórico de parceria sexual das mulheres, com vistas à proposição de estratégias eficazes para redução da sua vulnerabilidade a esse agravo.
Bacterial vaginosis (BV) is the most common alteration in the vaginal microbiota which can cause negative repercussions on women's sexual and reproductive health. Literature shows high prevalence of BV among women who have sexual relationships with other women, but no studies were found with the theoretical framework of vulnerability to analyze this relationship. Thus, the aim of this study was to analyze the vulnerability of women who have sex with women and women who have sex with women and men to BV. Method: A cross-sectional study comprising a broader research called "Vulnerability of women who have sex with women to health problems related to mental, sexual and reproductive health and situations of violence", developed in Botucatu-SP. The sample consisted intentionally of 453 women classified into three groups, according to the type of sexual partnership in the past 12 months of the data collection: Group 1 - 149 women who reported having sex exclusively with women (WSW), Group 2 - 80 women who reported having sex with women and men (WSWM) and Group 3 - 224 women who reported having sex exclusively with men (WSM). The sample and data collections were carried out in two periods: from January 2015 to April 2017 and from January 2019 to January 2020. Data were obtained through the application of a questionnaire, with the interest variables and gynecological examination. The diagnosis of BV was performed by microscopic examination according to Gram stain and classified according to Nugent et al. The diagnosis of human papilloma virus and Chlamydia trachomatis was performed by polymerase chain reaction. The classification of vulnerability variables was based on the vulnerability framework proposed by Ayres et al. in 2012. The vulnerability analysis of the groups to BV was performed by comparing the variables and the mean of the vulnerability scores using the Chi-square or Fisher's exact and Mann-Whitney tests. Comparison of BV prevalence among groups was performed using the chi-square test. Cox regressions were performed to verify whether the type of sexual partnership was associated with the prevalence of BV and to identify the vulnerability variables associated with BV in each of the three groups studied. Differences were considered statistically significant if p < 0.05. This research was approved by the ethics committee, reports 3.320.951 and 820.717. Results: The mean age of participants was 26 years old (18-55), most were white (74.8%), had more than 12 years of education (76.1%), did not live with a partner (79.2%) and had a paid job (65.1%). The WSW and WSWM had a higher profile of vulnerability to BV than WSM, and WSWM was more vulnerable to BV than WSW. The prevalences of BV among WSW and WSWM were significantly similar and higher than that of WSM (35.6%a X 36.3%a X 23.2%b; p=0.013). The type of sexual partnership was not associated with BV – WSW [1.13 (CI 95%: 0.71-1.78); p= 0.613] and WSWM [0.94 (CI95%: 0.56-1.56); p=0.802] and the vulnerability variables associated with this outcome was different in each of the groups studied. Among the WSW, education was a protective factor against BV [0.91 (CI 95%: 0.82-0.99); p= 0.048], among WSWM, non-white skin color was associated with an increased prevalence of BV [2.34 (CI 95%: 1.05-5.19); p= 0.037] and among WSM change of sexual partner in past three months [2.09 (CI 95%: 1.14- 3.82); p= 0.017], inconsistent condom use [2.61 (CI 95%: 1.10-6.20); p= 0.030] and positive diagnosis of C. trachomatis [2.40 (CI 95%: 1.01-5.73); p= 0.048] were the vulnerability variables independently associated with BV. Conclusion: WSW and WSWM are more vulnerable to BV than WSM, and the WSWM are the most vulnerable group. Although the prevalence of BV was significantly higher than WSW, the type of sexual partnership was not independently associated with BV in the present investigation. The vulnerability variables associated with BV among the groups were different showing the necessity of taking into consideration the history of women's sexual partnership in order to develop effective strategies to reduce such vulnerability.
Bacterial vaginosis (BV) is the most common alteration in the vaginal microbiota which can cause negative repercussions on women's sexual and reproductive health. Literature shows high prevalence of BV among women who have sexual relationships with other women, but no studies were found with the theoretical framework of vulnerability to analyze this relationship. Thus, the aim of this study was to analyze the vulnerability of women who have sex with women and women who have sex with women and men to BV. Method: A cross-sectional study comprising a broader research called "Vulnerability of women who have sex with women to health problems related to mental, sexual and reproductive health and situations of violence", developed in Botucatu-SP. The sample consisted intentionally of 453 women classified into three groups, according to the type of sexual partnership in the past 12 months of the data collection: Group 1 - 149 women who reported having sex exclusively with women (WSW), Group 2 - 80 women who reported having sex with women and men (WSWM) and Group 3 - 224 women who reported having sex exclusively with men (WSM). The sample and data collections were carried out in two periods: from January 2015 to April 2017 and from January 2019 to January 2020. Data were obtained through the application of a questionnaire, with the interest variables and gynecological examination. The diagnosis of BV was performed by microscopic examination according to Gram stain and classified according to Nugent et al. The diagnosis of human papilloma virus and Chlamydia trachomatis was performed by polymerase chain reaction. The classification of vulnerability variables was based on the vulnerability framework proposed by Ayres et al. in 2012. The vulnerability analysis of the groups to BV was performed by comparing the variables and the mean of the vulnerability scores using the Chi-square or Fisher's exact and Mann-Whitney tests. Comparison of BV prevalence among groups was performed using the chi-square test. Cox regressions were performed to verify whether the type of sexual partnership was associated with the prevalence of BV and to identify the vulnerability variables associated with BV in each of the three groups studied. Differences were considered statistically significant if p < 0.05. This research was approved by the ethics committee, reports 3.320.951 and 820.717. Results: The mean age of participants was 26 years old (18-55), most were white (74.8%), had more than 12 years of education (76.1%), did not live with a partner (79.2%) and had a paid job (65.1%). The WSW and WSWM had a higher profile of vulnerability to BV than WSM, and WSWM was more vulnerable to BV than WSW. The prevalences of BV among WSW and WSWM were significantly similar and higher than that of WSM (35.6%a X 36.3%a X 23.2%b; p=0.013). The type of sexual partnership was not associated with BV – WSW [1.13 (CI 95%: 0.71-1.78); p= 0.613] and WSWM [0.94 (CI95%: 0.56-1.56); p=0.802] and the vulnerability variables associated with this outcome was different in each of the groups studied. Among the WSW, education was a protective factor against BV [0.91 (CI 95%: 0.82-0.99); p= 0.048], among WSWM, non-white skin color was associated with an increased prevalence of BV [2.34 (CI 95%: 1.05-5.19); p= 0.037] and among WSM change of sexual partner in past three months [2.09 (CI 95%: 1.14- 3.82); p= 0.017], inconsistent condom use [2.61 (CI 95%: 1.10-6.20); p= 0.030] and positive diagnosis of C. trachomatis [2.40 (CI 95%: 1.01-5.73); p= 0.048] were the vulnerability variables independently associated with BV. Conclusion: WSW and WSWM are more vulnerable to BV than WSM, and the WSWM are the most vulnerable group. Although the prevalence of BV was significantly higher than WSW, the type of sexual partnership was not independently associated with BV in the present investigation. The vulnerability variables associated with BV among the groups were different showing the necessity of taking into consideration the history of women's sexual partnership in order to develop effective strategies to reduce such vulnerability.
Descrição
Palavras-chave
Vulnerabilidade em saúde, Vaginose bacteriana, Homossexualidade feminina, Minorias sexuais e de gênero, Identidade de gênero, Pessoas LGBT, Health vulnerability, Bacterial vaginosis, Female homosexuality, Sexual and gender minorities