Christine Mary Barry

Knowledge exchanges between Indigenous and scientific communities occur regularly, with researchers frequently seeking and benefiting from Indigenous Knowledge holders. These exchanges inherently demonstrate the value and authority of Indigenous Knowledges within academia; however, the traditional academic system lacks formal processes for crediting and citing such Knowledges. Given the complexity, diversity, and uniqueness of Indigenous cultures around the world, different approaches to assigning appropriate credit are required for different cultural groups—there is no “one size fits all” approach. In Australia, Aboriginal and Torres Strait Islander (First Nations) communities have knowledge traditions reaching back millennia, with high diversity in knowledge reproduction, partitioning, access, and governance among nations. We demonstrate the complexity of crediting and citing Indigenous Knowledges across Australia, so that other regions of the world can adapt to their own contexts; the structural complexity of First Nations groups requires careful, considered, and context-specific approaches. In this Perspective, we highlight important components that should be considered and implemented when citing Indigenous Knowledges, with the aim of supporting discussion within relevant communities. Prior to citing Indigenous Knowledges, certain prerequisites must be established and met: (i) clear definitions of “Knowledges” and free, prior, and informed consent that is neither constrained nor coerced, (ii) an established relationship between the relevant First Nations group and the researchers (the latter being either non-Indigenous or Indigenous), (iii) a clear understanding of the two-way benefits of the Knowledge transfer, (iv) an acknowledgement that citation does not replace co-authorship and the legal rights the latter confers, (v) acknowledgement that Indigenous Knowledges are dynamic, including the ways that Knowledge holders want to exercise sovereignty over their data and resources, and (vi) institutional infrastructure to support the citation process. Crediting approaches must also be available to account for heterogeneity within and across First Nations groups, such as different authorities of Knowledges, “Country” itself as an authority, as well as gendered, initiated, sensitive, or sacred Knowledges. Maintaining autonomy is essential—First Nations groups must retain the ability to retract shared information if they so desire. As such, the accompanying digital object identifier (DOI) or data repository holding the cited information must be managed within the relevant country (here, Australia) or by an organization that can meet these requirements. A homogeneous citation solution within Australia, or elsewhere, seems unlikely and potentially undermines the celebrated diversity among First Nations. We therefore suggest the development of a dynamic citation protocol, where a decision tree can assist researchers in partnering with First Nations communities to cite information in ways that support the data sovereignty aspirations of First Nations peoples, rather than a static citation protocol. Although elevating the status of Indigenous Knowledges within academia, the citation process also provides the opportunity to enhance transparency and deepen relationships between researchers and First Nations Knowledge holders in Australia and globally.

Background: Endometriosis is a significant and prevalent health issue. Delayed diagnosis is common and the associated delay to treatment is associated with high socioeconomic and personal costs including chronic pain, infertility and reduced quality of life. There is a lack of studies documenting endometriosis pathways in Australia. Aims: To explore lived experiences of individuals with endometriosis in South Australia and identify perceived barriers to timely diagnosis. Materials and Methods: Semi‐structured interviews were conducted with 50 participants aged over 18 years living in South Australia with a surgical diagnosis of endometriosis and data was analysed using reflexive thematic analysis. Results: Participants reported significant delays between the onset of symptoms and their diagnosis. Barriers were identified at personal and systemic levels. Personal barriers include societal and self‐normalisation of symptoms and stigma associated with discussing menstrual health. Systemic hurdles include symptom dismissal and insufficient endometriosis education within healthcare and community settings. These barriers significantly hinder equitable and empathetic healthcare access. Diagnosis delivery is a key point in the endometriosis care pathway and must be conducted thoroughly and empathetically by health professionals with a patient‐centred focus. Conclusions: This study highlights the need to improve care pathways for the timely recognition and management of persistent pelvic pain. In patients presenting with chronic pelvic pain, endometriosis should be considered as part of the differential diagnosis. Results call for multi‐faceted improvements in technology, advocacy, and education for students and health practitioners to improve timely diagnosis and patient‐centred outcomes. We suggest re‐orientating the healthcare system to centre the individual as the expert in their own journey, fostering a more patient‐centred approach.

Pelvic anatomy is considered challenging to teach and learn, partly because its complexity can make it difficult to conceptualize. Educational researchers recognize the value of a spiraling curriculum to develop clinically orientated anatomy knowledge for health professionals, but most studies have focused on the preclinical years. It is unclear how the complexities of pelvic anatomy are taught in the clinical setting by clinician educators. Understanding pelvic anatomy teaching from the perspectives of clinician educators is important because of their critical role in supporting medical students to become knowledgeable, safe practitioners. This study sought to examine factors that influence clinician educators' teaching of pelvic anatomy to medical students during clinical placement. Using established qualitative research methods, this exploratory study used semi‐structured interviews with 10 participants from obstetrics/gynecology (n = 4) and urology (n = 6) in Australia. Interviews were transcribed, and data were analyzed using a reflexive thematic analysis framework. Two overarching factors were identified as influencing clinician educators' teaching: (1) how they defined the scope of knowledge, and (2) pedagogical understanding. Scope of knowledge was underpinned by patient safety considerations and guided by past experience and student aspirations. Pedagogical understanding also relied on experience and encompassed multiple teaching strategies, including approaches informed by sensitivities surrounding pelvic anatomy. Multiple factors influence how clinician educators define the scope of pelvic anatomy knowledge required of medical students. Clinician educators' awareness of syllabus and teaching approaches can enable them to support students to attain threshold concepts such as three‐dimensional spatial relationships and sociocultural sensitivities associated with pelvic anatomy.

Background: Endometriosis is a debilitating chronic condition that is commonly associated with chronic pelvic pain, affecting approximately 10% of women of reproductive age worldwide. The general principle of pain management in this population involves both pharmacological and surgical interventions. There is also increasing interest in the use of exercise as an alternative non-pharmacological analgesic, but adherence and accessibility to face-to-face exercise-delivery modalities are poor. This study aims to determine the immediate impact of a single session of ‘supervised’ telehealth-delivered exercise compared to ‘self-managed’ virtual reality (VR)-delivered exercise on pelvic pain associated with endometriosis. Methods: Twenty-two women experiencing pelvic pain due to endometriosis were included and randomized into three groups: (i) VR-delivered exercise group (n = 8); (ii) telehealth-delivered exercise group (n = 8); and (iii) control group (n = 6). The visual analogue scale (VAS) was used to assess the severity of pelvic pain. Results: There was no statistically significant between-group difference (p = 0.45) in the participants’ pain score following a single session of the study interventions (VR or telehealth) or the control. However, a ‘medium-to-large’ group x time interaction effect (η² = 0.10) was detected, indicating a more favorable pain score change following a single session of telehealth- (pre-post ∆: +10 ± 12 mm) and VR-delivered exercise (pre-post ∆: +9 ± 24 mm) compared to the control group (pre-post ∆: +16 ± 12 mm). Conclusions: Our study suggests that a single bout of a ‘self-managed’ VR-delivered exercise may be as efficacious as a single session of ‘supervised’ telehealth-delivered exercise in providing immediate relief from pelvic pain associated with endometriosis.

Introduction: Improved understanding of vestibulodynia pathophysiology is required to develop appropriately targeted treatments. Established features include vulvovaginal hyperinnervation, increased nociceptive signalling and hypersensitivity. Emerging evidence indicates macrophage-neuron signalling contributes to chronic pain pathophysiology. Macrophages are broadly classified as M1 or M2, demonstrating pro-nociceptive or anti-nociceptive effects respectively. This study investigates the impact of clodronate liposomes, a macrophage depleting agent, on nociceptive signalling in a mouse model of vestibulodynia.Methods: Microinjection of complete Freund’s adjuvant (CFA) at the vaginal introitus induced mild chronic inflammation in C57Bl/6J mice. A subgroup was treated with the macrophage depleting agent clodronate. Control mice received saline. After 7 days, immunolabelling for PGP9.5, F4/80+CD11c+ and F4/80+CD206+ was used to compare innervation density and presence of M1 and M2 macrophages respectively in experimental groups. Nociceptive signalling evoked by vaginal distension was assessed using immunolabelling for phosphorylated MAP extracellular signal-related kinase (pERK) in spinal cord sections. Hyperalgesia was assessed by visceromotor response to graded vaginal distension.Results: CFA led to increased vaginal innervation (p < 0.05), increased pERK-immunoreactive spinal cord dorsal horn neurons evoked by vaginal-distension (p < 0.01) and enhanced visceromotor responses compared control mice (p < 0.01). Clodronate did not reduce vaginal hyperinnervation but significantly reduced the abundance of M1 and M2 vaginal macrophages and restored vaginal nociceptive signalling and vaginal sensitivity to that of healthy control animals.Conclusions: We have developed a robust mouse model of vestibulodynia that demonstrates vaginal hyperinnervation, enhanced nociceptive signalling, hyperalgesia and allodynia. Macrophages contribute to hypersensitivity in this model. Macrophage-sensory neuron signalling pathways may present useful pathophysiological targets.

Vulvodynia is an idiopathic chronic pain disorder and a leading cause of dyspareunia, or pain associated with sexual intercourse, for women. The key pathophysiological features of vulvodynia are vaginal hyperinnervation and nociceptor sensitization. These features have been described consistently by research groups over the past 30 years, but currently there is no first-line recommended treatment that targets this pathophysiology. Instead, psychological interventions, pelvic floor physiotherapy and surgery to remove painful tissue are recommended, as these are the few interventions that have shown some benefit in clinical trials. Recurrence of vulvodynia is frequent, even after vestibulectomy and questions regarding etiology remain. Vestibular biopsies from women with vulvodynia contain increased abundance of immune cells including macrophages as well as increased numbers of nerve fibers. Macrophages have multiple roles in the induction and resolution of inflammation and their function can be broadly described as pro-inflammatory or anti-inflammatory depending on their polarization state. This state is not fixed and can alter rapidly in response to the microenvironment. Essentially, M1, or classically activated macrophages, produce pro-inflammatory cytokines and promote nociceptor sensitization and mechanical allodynia, whereas M2, or alternatively activated macrophages produce anti-inflammatory cytokines and promote functions such as wound healing. Signaling between macrophages and neurons has been shown to promote axonal sprouting and nociceptor sensitization. This mini review considers emerging evidence that macrophages may play a role in nociceptor sensitization and hyperinnervation relevant to vulvodynia and considers the implications for development of new therapeutic strategies.

Neural Regen Res, Official publication of Publishing House of Neural Regeneration Research China Association of Rehabilitation Medicine,China

Background: Peptidergic nerve fibers provide important contributions to urethral function. Urethral innervation of female mice is not well documented.Aims: To determine the distribution and projection sites of nerve fibers immunoreactive for vasoactive intestinal peptide (VIP), calcitonin gene‐related peptide (CGRP), substance P (SP), and neuropeptide Y (NPY) in the urethra of wild‐type control mice and compare innervation characteristics between the proximal and distal urethra of young nullipara and older multipara mice. Furthermore, to identify the location and neurochemical coding of the spinal afferent nerve endings in the urethra, whose sensory neurons reside in lumbosacral dorsal root ganglia (DRG).Methods: Multiple labeling immunohistochemistry of urethral sections of nulliparous (6‐8 weeks old), and multiparous (9‐12 months old) mice, and anterograde axonal tracing from L5‐S2 (DRG) in vivo.Results: Abundant VIP‐, CGRP‐, SP‐, and NPY‐immunoreactive nerve fibers were identified in the adventitia, muscularis, and lamina propria of proximal and distal segments of the urethra. A proportion of fibers were closely associated with blood vessels, glands, and cells immunoreactive for PGP9.5. The epithelium contained abundant nerve fibers immunoreactive for CGRP and/or SP. Epithelial innervation was increased in the distal urethra of multipara mice. Abundant fibers were traced from L5‐S2 DRG to all urethral regions.Conclusions: We present the first identification of spinal afferent endings in the urethra. Peptidergic nerve fibers, including multiple populations of spinal afferents, provide rich innervation of the female mouse urethra. The morphology of fibers in the epithelium and other regions suggests multiple nerve‐cell interactions impacting on urethral function.