Bladder Endometriosis: Current Knowledge and Future Directions

Bladder Endometriosis: Current Knowledge and Future Directions By Selma Oransay

About 70-80% of urinary tract endometriosis occurs in the bladder, particularly affecting the base and dome regions. Endometriotic lesions can penetrate the detrusor muscle either partially or completely. Endometriosis affecting the uterovesical fold peritoneum or deep endometriosis that does not involve…

Key Points Lay Summary

Endometriosis relief: How vitamins C and E can make a difference

Endometriosis relief: How vitamins C and E can make a difference By Eylül GÜN

Recent studies indicate that oxidative stress significantly contributes to the onset and progression of endometriosis. High levels of reactive oxygen species (ROS) can cause cellular damage and enhance inflammation, leading to the pain associated with the condition. Antioxidants like vitamins…

Key Points Lay Summary

Diminished physical activity in women with endometriosis due to chronic pelvic pain

Diminished physical activity in women with endometriosis due to chronic pelvic pain By Hale Goksever Celik

Endometriosis is a systemic, chronic, inflammatory disease defined as the localization of endometrial-like tissue outside the uterine cavity. Pelvic pain is the most common symptom in these women resulting in abstinence from school or work and psychosocial problems. Physical activity…

Key Points Lay Summary

Dysmenorrhea in adolescent girls and the quality of life

Dysmenorrhea in adolescent girls and the quality of life By Hale Goksever Celik

Dysmenorrhea, also known as period pain, painful periods, or menstrual cramps, is pain during menstruation. Despite its high incidence, dysmenorrhea is often a stigmatized and normalized condition. However, it is known that painful periods cause abstinence from work or school…

Key Points Lay Summary

Ultrasonographic findings and the clinical symptoms of pelvic endometriosis

Ultrasonographic findings and the clinical symptoms of pelvic endometriosis By Selma Oransay

Imaging techniques achieve the clinical diagnosis of endometriosis, which affects 10-15% of all women of reproductive age. Suspected patients with clinical history and symptoms need a systemic examination of the uterus, ovaries, adnexa, and peritoneal covering the rectouterine, retrocervical, and…

Key Points Lay Summary

Women's willingness to donate menstrual blood for endometriosis research

Women's willingness to donate menstrual blood for endometriosis research By Selma Oransay

The menstrual blood is 50-100 ml/per cycle, with 80% lost during the first three days. On the heaviest bleeding day, 2 to 8 ml may be collected from a cup worn for four hours. This fluid could be investigated by…

Key Points Lay Summary

Early use of hormonal contraceptives and the probability of endometriosis diagnosis later in life

 Early use of hormonal contraceptives and the probability of endometriosis diagnosis later in life By Selma Oransay

Hormonal contraceptives are the first-line medical treatment of endometriosis. If an adolescent has chronic pelvic pain and is an "unresponder" to hormonal therapy, the likelihood of having an "endometriosis diagnosis" is higher. This sign should warn clinicians about endometriosis diagnosis…

Key Points Lay Summary

Early diagnosis of deep infiltrating endometriosis in adolescence

 Early diagnosis of deep infiltrating endometriosis in adolescence By Selma Oransay

Dysmenorrhea is widely observed in adolescence, and endometriosis is one of its causes. However, endometriosis diagnosis is usually made after 25 years of age. It is clear that early diagnosis and management of this progressive disease is essential and will…

Key Points Lay Summary

Complementary and alternative therapies for managing acyclic pelvic pain in women with endometriosis

Complementary and alternative therapies for managing acyclic pelvic pain in women with endometriosis By Hale Goksever Celik

The quality of life in women with endometriosis is affected depending on the symptoms and signs of endometriosis such as dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Because of different clinical spectrum and diagnostic delays, there is no optimum management…

Key Points Lay Summary

Underestimation of Dysmenorrhea in adolescents

Underestimation of Dysmenorrhea in adolescents By Hale Goksever Celik

Women with endometriosis may suffer from painful symptoms, especially during menstruation or sexual intercourse. One of the main etiologic reasons for secondary dysmenorrhea is endometriosis, and it has a poor impact on life quality. Underestimation of dysmenorrhea and consideration of…

Key Points Lay Summary

Omitted facet of endometriosis : mental health related to stigma

Omitted facet of endometriosis : mental health related to stigma By Nasuhi Engin Aydin

A team of clinical psychologists involved in women’s health led by Deniz Kocas has published a recent review on the mental health aspect of endometriosis patients in the European Journal of Obstetrics & Gynecology and Reproductive Biology. Endometriosis is a notoriously…

Key Points Lay Summary

Endometriosis and Physical Activity

Endometriosis and Physical Activity By Hale Goksever Celik

Endometriosis causes abstinence from their daily life, especially during painful periods. Decreased physical function might result in reduced physical activity. Sachs et al., from Switzerland, published a study titled “Physical Activity in Women with Endometriosis: Less or More Compared with…

Key Points Lay Summary

A Starch-Based Gel Barrier Reduces Pain and Improves Fertility After Endometriosis Surgery

A Starch-Based Gel Barrier Reduces Pain and Improves Fertility After Endometriosis Surgery By Özge Özkaya

The development of pain was reduced in women with endometriosis who underwent surgery for deep infiltrating endometriosis (DIE) resection and the "gel barrier 4DryField® PH" was used during the operation, according to results from a randomized controlled trial. Moreover, fertility was improved. "4DryField® PH"…

Key Points Lay Summary

Pain Scoring System for Deep Endometriosis

 Pain Scoring System for Deep Endometriosis By Selma Oransay

The numeric pain scale is commonly used to interpret pain score values. According to the National Comprehensive Cancer Network guidelines, pain scores of 4-7 points indicate moderate, and  8-10 points indicate severe pain. Patients with a local pain score of…

Key Points Lay Summary

Headaches Appear Years Before a Diagnosis of Endometriosis

Headaches Appear Years Before a Diagnosis of Endometriosis By Özge Özkaya

Headache is associated with different forms of migraine, is related to pain, and often appears before diagnosis in women with endometriosis, according to a new study published in the scientific journal Reproductive Biomedicine Online. This knowledge can help ensure women with…

Key Points Lay Summary

Laparoscopic resection of bladder endometriosis

 Laparoscopic resection of bladder endometriosis By Selma Oransay

When we talk about deep-infiltrating endometriosis, one of the most commonly affected organs in the urinary tract is the bladder, with a prevalence of 80%. Bladder endometriosis can be defined as the existence of the endometrial glands and stroma inside…

Key Points Lay Summary

Comparison of two surgical approaches for endometriosis.

Comparison of two surgical approaches for endometriosis. By Selma Oransay

Endometriosis is one of the causes of infertility in women. But the pathophysiology of infertility caused by endometriosis is not yet clear. Hormonal disorders, abnormal peritoneal function, distorted pelvic anatomy, and multiple cesarean deliveries are among the accused.  Dr. Li…

Key Points Lay Summary

The effectiveness of acupuncture in the treatment of dysmenorrrhea

The effectiveness of acupuncture in the treatment of dysmenorrrhea By Selma Oransay

Asymptomatic endometriosis does not adversely affect women's quality of life and mental health. But the quality of life of women with endometriosis who suffer endometriosis-related pelvic pain, dysmenorrhea, dyspareunia, and dysuria declines as they become more susceptible to anxiety and…

Key Points Lay Summary

Weighting (side)effects when dealing with endometriosis-associated pain.

Weighting (side)effects when dealing with endometriosis-associated pain. By Bahar Yuksel

The treatment options for endometriosis-related pain are so many. And the guidelines leave the selection to the clinicians, which causes obscurity between preferences. In the study by Christine Poulos et al, the authors analyzed the response of clinicians on the…

Key Points Lay Summary

The most common gynecologic admissions to the emergency: Endometriosis and adenomyosis

The most common gynecologic admissions to the emergency: Endometriosis and adenomyosis By Hale Goksever Celik

Women with endometriosis demand therapy for the most common symptoms, which are pelvic pain and infertility. Adenomyosis occurs when the endometrial glandular and stromal tissue grows into the muscular wall of the uterus, called the myometrium. Women having adenomyosis also…

Key Points Lay Summary

Endometriosis-Associated Pain: The Role of Sensitization

Endometriosis-Associated Pain: The Role of Sensitization By Eylül GÜN

As the most common symptom of the disease, endometriosis-associated pain (EAP) is experienced as dysmenorrhea, non-cyclical pelvic pain, and cyclical pain related to organ function. EAP is contributed to by different mechanisms, including local factors, peripheral sensitization, central sensitization, cross-sensitization,…

Key Points Lay Summary

Younger Women With Endometriosis Feel More Pain

Younger Women With Endometriosis Feel More Pain By Özge Özkaya

Younger women with endometriosis feel more period pain (dysmenorrhea) and pain during intercourse (dyspareunia) compared to older women with the disease, found a new study published in the Journal of Pediatric and Adolescent Gynecology.  Acknowledging this fact can make sure…

Key Points Lay Summary

What causes pelvic pain? Androgens or estrogens?

What causes pelvic pain? Androgens or estrogens? By Selma Oransay

A comparison between women and men reveals that women suffer more pelvic pain. This reality raises the possibility of the pain-relieving effect of testosterone or androgens. It would be a wise solution to investigate how androgens affect pain at different…

Key Points Lay Summary

Educational Programs Important to Raise Endometriosis Awareness

Educational Programs Important to Raise Endometriosis Awareness By Özge Özkaya

An educational program consisting of lectures and group discussions motivated nursing and medical students to seek medical attention so endometriosis can be detected and managed early, reported a new study published in the scientific journal Reproductive Biomedicine Online. However, this…

Key Points Lay Summary

Web-based resource to improve menstrual health awareness

Web-based resource to improve menstrual health awareness By Selma Oransay

Many women consider "menstrual pain" a normal part of being female, and do not seek medical help but rather use self-management methods such as heat, rest, and analgesics. They are often unsure which self-management strategies are effective or what the…

Key Points Lay Summary

Pelvic pain characteristics in young girls with endometriosis.

 Pelvic pain characteristics in young girls with endometriosis. By Selma Oransay

The occurrence of severe and frequent pelvic pain in young women is a piece of evidence that endometriosis begins and develops at an early age. Two-thirds of women with endometriosis who were diagnosed in their adulthood reported the onset of…

Key Points Lay Summary

Endometrioma and its relation with fibrosis, dysmenorrhea, and AMH levels.

Endometrioma and its relation with fibrosis, dysmenorrhea, and AMH levels. By Bahar Yuksel

Endometrioma is an indicator of endometriosis which makes it easy to diagnose the disease for most clinicians. But the symptoms and relationship of endometrioma with menstrual pain severity and the ovarian reserve as well as its markers are not well…

Key Points Lay Summary

Prevalence of endometriosis and adenomyosis by transvaginal ultrasound.

Prevalence of endometriosis and adenomyosis by transvaginal ultrasound. By Selma Oransay

Women who present dyspareunia, dysmenorrhea, dysuria, dyschezia, chronic abdominal, and pelvic pain, and infertility would benefit from the early investigation. If the correct diagnosis of endometriosis and/or adenomyosis can be made in advance, early treatment will improve the quality of…

Key Points Lay Summary

A trial of exogenous melatonin on dysmenorrhea in women "without endometriosis"

A trial of exogenous melatonin on dysmenorrhea in women By Nasuhi Engin Aydin

In their recent article published in “European Journal of Clinical Pharmacology”,  Dr. Söderman and associates from Stockholm report the results of their randomized, double-blind, placebo-controlled trial on the effects of oral melatonin in women with dysmenorrhea -unrelated to endometriosis-. Melatonin is a hormone…

Key Points Lay Summary

Pharmacological Therapy for Endometriosis Pain

Pharmacological Therapy for Endometriosis Pain By Eylül GÜN

The negative effects of endometriosis on women’s quality of life are indisputable. Women who suffer from endometriosis might have to deal with problems in many aspects such as psychological, sexual, social, and economic. Pain which is one of the most…

Key Points Lay Summary

The new Endometriosis Surgical Complexity Classification: AAGL 2021

The new Endometriosis Surgical Complexity Classification: AAGL 2021 By Selma Oransay

Multiple endometriosis categorizations have been approved in the recent forty years. The American Fertility Society proposed ASRM with a desire to score the impact of the endometriosis in 1996,  which was updated several times later (rASRM), to predict infertility after laparoscopic operations. For…

Key Points Lay Summary

Endogenous cannabinoids are related to endometriosis pain

Endogenous cannabinoids are related to endometriosis pain By Eylül GÜN

Pain, specifically dysmenorrhea is the most important symptom of endometriosis. Prostaglandins are the main director of the pain process in dysmenorrhea, therefore the mechanisms affecting the prostaglandin metabolism have been studied in order to find a treatment for pain, and found that…

Key Points Lay Summary

Endometrioma post-surgical-recurrence risk factors

Endometrioma post-surgical-recurrence risk factors By Nasuhi Engin Aydin

Jiang and associates from Dailan Medical University, China published their review manuscript “Risk factors for ovarian endometrioma recurrence following surgical excision: a systematic review and meta‑analysis” in the June 2021 issue of "Archives of Gynecology and Obstetrics". The most common form of endometriosis, "ovarian…

Key Points Lay Summary

The incidence and prevalence of endometriosis in a United States population-based study .

The incidence and prevalence  of endometriosis in a United States population-based study . By Selma Oransay

To define the accurate incidence and prevalence estimates of endometriosis among nonselected cohorts in the USA, Christ et al. from the Departments of Obstetrics and Gynecology of the University of Washington, Seattle, planned a retrospective cohort study using the electronic KPWA…

Key Points Lay Summary

Impact of adenomyosis on sexual life

Impact of adenomyosis on sexual life By Selma Oransay

Considering the similar etiopathogenesis and pain symptoms between adenomyosis and deep infiltrating endometriosis, Alcalde et al. from the Department of Gynecology, University of Barcelona, Spain, aimed to call attention to the presence of potential sexual dysfunction not only in patients with deep…

Key Points Lay Summary

The higher the cyst fluid iron concentration, the more severe the pain symptom for endometrioma

The higher the cyst fluid iron concentration, the more severe the pain symptom for endometrioma By Hale Goksever Celik

Endometriosis usually is encountered in three different forms: superficial peritoneal endometriosis, ovarian cysts (endometrioma) and deep infiltrating endometriosis. Endometrioma can be identified as cystic lesions consisting of dark brown endometrial fluid and are sometimes referred to as "chocolate cysts." The presence…

Key Points Lay Summary

CA125 do not correlate with pain and its severity among adolescents

CA125 do not correlate with pain and its severity among adolescents By Ellen Tumimbang

Cancer antigen 125 (CA125) is a high molecular weight glycoprotein expressed in tissue derived from the coelomic and Mullerian epithelia including the uterus endometrium. Previous studies reported that CA125 is the most studied endometriosis marker. Women with endometriosis experienced different…

Key Points Lay Summary

The peculiarity of adolescent endometriosis

The peculiarity of adolescent endometriosis By Selma Oransay

Recent studies showed the prevalence of endometriosis in adolescents with chronic cyclic or acyclic pelvic pain is about 60-70%. Moreover, all stages of endometriosis, including deeply infiltrating endometriosis can be found in this population. Gubbels et al. from the Department…

Key Points Lay Summary

Sexual Quality of Life in Women With Endometriosis

Sexual Quality of Life in Women With Endometriosis By Özge Özkaya

Painful intercourse, more severe period pain, worse health-related quality of life, and unemployment are all associated with worse sexual quality of life in women with endometriosis. This is according to a Dutch study published in the scientific journal Sexual Medicine.…

Key Points Lay Summary

Deep Endometriosis or Recto-uterine Obliteration Without Endometrioma

Deep Endometriosis or Recto-uterine Obliteration Without Endometrioma By Selma Oransay

The diagnostic help of ultrasound is increasing by its ability to diagnose deep infiltrating and rectouterine pouch obliteration in patients who are suffering from chronic pelvic pain. Clinicians are used to evaluating the rectal and parametrial areas of the endometriotic…

Key Points Lay Summary

Diagnosis and treatment of endometriosis in adolescents

Diagnosis and treatment of endometriosis in adolescents By Irem Onur

The belief that dysmenorrhea, the primary symptom of endometriosis, in adolescents is an inevitable condition seen in menstruation as well as unwillingness to perform diagnostic laparoscopy may cause the delay of diagnosis of endometriosis. This is according to a recent…

Key Points Lay Summary

Adolescent dysmenorrhea diagnosis and management

Adolescent dysmenorrhea diagnosis and management By Hale Goksever Celik

Endometriosis is usually diagnosed in reproductive-aged women. However, recent literature proved that clinical symptoms of endometriosis are also seen the adolescent girls and young women. Dysmenorrhea, the most common gynecologic complaint among this age group, can develop due to endometriosis.…

Key Points Lay Summary

The effect of endometriosis on the quality of life

The effect of endometriosis on the quality of life By Hale Goksever Celik

Endometriosis, the disease defined as the localization of endometrial glandular and stromal tissue outside the uterine cavity, can be diagnosed in the reproductive-aged women with an incidence of 7-15%. However, endometriosis is observed in women with chronic pelvic pain syndrome…

Key Points Lay Summary

Cycle-related gastrointestinal complaints in reproductive age young women

Cycle-related gastrointestinal complaints in reproductive age young women By Timur Seckin

An analysis of 1-year data on 266 patients who presented to the Clinic and Polyclinic for Gynecology and Reproductive Medicine at Jena University Hospital to undergo surgery for endometriosis and its symptoms was performed by Nicolaous K. et al., a…

Key Points Lay Summary

Surgery and the endometriosis associated-pain: A systematic review

Surgery and the endometriosis associated-pain: A systematic review By Selma Oransay

The surgical approach for pelvic pain-related to endometriosis depends on the stage and the type of the endometriotic lesion and ranging from ablation and the excision of the lesions to radical surgery as hysterectomy with removal of ovaries and presacral…

Key Points Lay Summary

Recurrent endometriosis is a real challenge both for the patients and clinicians

Recurrent endometriosis is a real challenge both for the patients and clinicians By Hale Goksever Celik

Endometriosis is defined as the localization of endometrial stromal and glandular cells outside the uterine cavity. Current medical and surgical treatment options have several limitations including the side effects, costs, risk of recurrence, effects on conception capability. Recurrence is a…

Key Points Lay Summary

How does pregnancy affect endometriosis?

How does pregnancy affect endometriosis? By Hale Goksever Celik

Endometriosis is the localization of endometrial stromal and glandular cells outside the uterine cavity. Pregnancy is offered as a treatment option for patients with endometriosis because it causes atrophy of endometrial cells similar to progesterone treatment. Progesterone predominance during pregnancy,…

Key Points Lay Summary

Patients preferences for the treatment of endometriosis-associated pain

Patients preferences for the treatment of endometriosis-associated pain By Hale Goksever Celik

Endometriosis is defined as the location of endometrial stroma and glands outside the uterine cavity. The most common presenting complaints are mainly dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility, most of which relate to the menstrual period. Those women affected…

Key Points Lay Summary

Adolescent dysmenorrhea and future endometriosis

Adolescent dysmenorrhea and future endometriosis By Selma Oransay

Dysmenorrhoea is typically classified as primary, or secondary due to underlying pathologies like fibroids, endometriosis, adenomyosis or uterine anomalies. Generally, long-term dysmenorrhea is present in endometriotic patient's anamnesis, but until recently, the research to clarify this connection remained retrospective. Knox et…

Key Points Lay Summary

Clinical trial for the use of oral lactobacillus on endometriosis pain severity

Clinical trial for the use of oral lactobacillus on endometriosis pain severity By Yu Yu

The standard treatment of endometriosis consists of surgery and hormonal based treatment. There is evidence for the efficacy of these types of treatment, although their side effects remain a critical consideration for women. Based on molecular studies, changes in the…

Key Points Lay Summary

Impact of Menstrual Symptoms on Everyday Life

Impact of Menstrual Symptoms on Everyday Life By Dr. Youngran Park

Menstrual symptoms, including heavy menstrual bleeding, dysmenorrhea, and significant perimenstrual mood disorders, are common gynecological conditions. About 30% of women consider their menstrual bleeding heavy, and 34–94% of women experience pain during their menstrual period. Menstrual symptoms have a significant…

Key Points Lay Summary

Endometriosis-associated pain control by contraceptive implant or intrauterine system

Endometriosis-associated pain control by contraceptive implant or intrauterine system By Hale Goksever Celik

Endometriosis is defined as the localization of endometrial glandular and stromal cells outside the uterine cavity. The most common symptoms are dysmenorrhea, dyspareunia, and chronic pelvic pain, all of which affect the quality of women’s lives. Several studies investigating the…

Key Points Lay Summary

Endometriosis: A review on anatomic principles and the management

Endometriosis: A review on anatomic principles and the management By Irem Onur

In the study of Alimi et al. which has been published in the journal Cureus, various aspects of endometriosis such as the pathophysiology, the anatomy, the pain mechanism, the perineural spread theory, clinical manifestations, diagnosis, and imaging, infertility, unusual cases,…

Key Points Lay Summary

The diagnosis and management of endometriosis in Korea

The diagnosis and management of endometriosis in Korea By Selma Oransay

The Korean Society of Endometriosis has scrutinized the present published literature of endometriosis in the domestic and international platform to provide new guidelines and the clinical management of the disease. The study was recently published in the journal "Obstetrics and Gynecology…

Key Points Lay Summary

Best endometriosis articles of the past year.

Best endometriosis articles of the past year.  By Selma Oransay

Dr.Stowall, from the Department of Obstetrics and Gynecology of Methodist Hospital, Dallas, Texas, USA penned this letter and recently published it in the Journal of Obstetrics and Gynecology to show his remarks of importance on four best publications of the…

Key Points Lay Summary

Endometriosis, Pain and Quality of Life

Endometriosis, Pain and Quality of Life By Deniz Kocas

Although studies show that pain in endometriosis is associated with decreased health-related quality of life (HRQoL), details as to which pain symptoms contribute to such a decline have not been explored. For the first time in this study, researchers from…

Key Points Lay Summary

Health-related quality of life in women with Endometriosis and Rheumatoid Arthritis

Health-related quality of life in women with Endometriosis and Rheumatoid Arthritis By Murat Osman

Endometriosis is a chronic inflammatory disease that is defined by the presence of ectopic endometrial tissue outside of the uterus. Unfortunately, endometriosis continues to be a leading cause of chronic pelvic pain and long-term morbidity in women of reproductive age.…

Key Points Lay Summary

Contraceptives for the management of endometriosis pain

Contraceptives for the management of endometriosis pain By Murat Osman

Endometriosis is a common gynecologic disease that affects many women of reproductive age and is associated with significant morbidity. One of the treatment options for women with endometriosis is the use of oral contraceptives (OCPs) for pain management. However, its…

Key Points Lay Summary

Difficulties Associated with Diagnosing Ascites and Encapsulating Peritonitis in Endometriosis

Difficulties Associated with Diagnosing Ascites and Encapsulating Peritonitis in Endometriosis By Kasthuri Nair

De Magalhães et al. recently published a paper titled “Ascites and Encapsulating Peritonitis in Endometriosis: a Systematic Review with a Case Report” in Revista Brasileira de Ginecologia e Obstetrícia. The team from the Universidade Federal do Ceará and the Universidade…

Key Points Lay Summary

Reduced vascularization in ovarian endometriomas associated with less pain

Reduced vascularization in ovarian endometriomas associated with less pain By Yu Yu

Angiogenesis, i.e., the development of new blood vessels is believed to play an important role in endometriosis pathogenesis and symptoms. Endometriosis is associated and requires neovascularization to proliferate, invade surrounding normal structure in order to establish an endometriotic lesion. Ovarian…

Key Points Lay Summary

Combo Therapy of Micronized palmitoylethanolamide/trans-polydatin for Endometriosis Pain

Combo Therapy of Micronized palmitoylethanolamide/trans-polydatin for Endometriosis Pain By Kasthuri Nair

Endometriosis is a painful illness and many researchers in the field work to offer women with the disease some form of respite from the suffering. Indraccolo, Indraccolo, and Mignini are three such researchers and they recently published a paper titled…

Key Points Lay Summary

Dienogest for endometriosis pain in clinical practice

Dienogest for endometriosis pain in clinical practice By Yu Yu

Dienogest is a synthetic progestogen that has been marketed as a medical treatment for endometriosis. Previous randomized controlled clinical trials have shown that it is effective in women with endometriosis at different stages of the disease. Given its recent introduction,…

Key Points Lay Summary

The Benefits of Primary Surgery

The Benefits of Primary Surgery By Kasthuri Nair

Ahmad, Hussin, and Ahmad recently conducted a cohort study, and they published the results within an article titled “An evaluation of the quality of life in women with endometriosis who underwent primary surgery: a 6-month follow-up in Sabah Women &…

Key Points Lay Summary