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PubMed1997

Vulvar vestibulitis in the north of Sweden. An epidemiologic case-control study.

OBJECTIVE: To determine the epidemiologic characteristics of patients with vulvar vestibulitis. STUDY DESIGN: During the years 1992-1994, 32 women with vulvar vestibulitis were referred to the Vulva Clinic, University Hospital, Umeå, Sweden. They were asked questions regarding age, age at first intercourse, pregnancies, number of lifetime partners, use of oral contraceptives and past gynecologic history, including infections and previous treatments. The cases were compared to 17 healthy controls. For statistical evaluation, the two-tailed Wilcoxon rank sum test was used. RESULTS: There were no differences between the groups regarding age, age at first intercourse, pregnancies, number of lifetime partners or history of genital infections, with the exception of human papillomavirus. The cases had been treated significantly more often for suspected papillomavirus infection and had also used oral contraceptives for a significantly longer period. CONCLUSION: This study provided support for the hypothesis of a steroidal etiology of the syndrome.

Adolescent↗

PubMed1996

Increased use of condoms among female university students: a 5-year follow-up of sexual behavior.

OBJECTIVE: To ascertain any changes in sexual behavior and attitudes as an indication of the impact of intensified information activities aiming at decreasing the risk of spread of sexually transmitted diseases among university students. METHODS: In 1989 questionnaires were offered to 275 consecutive female students visiting the Student Health Center. Identical questionnaires were mailed to 200 randomly selected women registered at Uppsala University. The study was repeated in 1994. The study was carried out in Uppsala, a city in Sweden with 27,000 university students. RESULTS: At the Student Health Center 241 (88%) participated in the study in 1989 and 262 (95%) in 1994. Corresponding figures in the postal survey were 137 (69%) in 1989 and 151 (76%) in 1994. Compared with the findings in 1989, in 1994 the sexual behavior was unchanged in terms of mean age at first intercourse (17.6 years), median number of life partners (3-4) and median number of sexual partners during the last 12 months (1), but the awareness of sexually transmitted diseases had increased. Their attitudes to using condoms had become more positive and the actual use of a condom had also increased both at the first intercourse and when changing partner, from 40 to 60%. Concerns about safety of oral contraceptives decreased significantly. CONCLUSIONS: This follow-up shows that awareness of sexually transmitted diseases and condom use had increased between 1989 and 1994, possibly as a result of intensified information efforts.

Adolescent↗

PubMedDate not supplied

Social and behavioral determinants of self-reported STD among adolescents.

CONTEXT: Adolescents have among the highest sexually transmitted disease (STD) rates. Rich data are now available to characterize the social and behavioral factors that affect adolescent STD risk. METHODS: Data from Wave 1 (1995) of the National Longitudinal Study of Adolescent Health (Add Health) are used to estimate school, neighborhood, family and individual level effects on acquiring an STD. Data from Waves 1 and 2 (1996) of Add Health are also used to estimate the effects of prior STD acquisition and other factors on STD occurrence between waves. Random intercept logistic regression and random intercept piecewise exponential hazard regression are used to account for possible clustering in the Add Health data. RESULTS: Seven percent of sexually experienced teenagers reported ever having had an STD as of Wave 1, and almost 7% reported having had an STD between Waves 1 and 2. Respondents' age, gender, race or ethnicity, and their family background, neighborhood and school characteristics affect STD acquisition at Wave 1. Among teenagers who were sexually experienced at Wave 1, younger age at first intercourse elevates STD risk. Other factors contribute, but to a lesser degree. For acquisition of an STD between Waves 1 and 2, females, blacks, teenagers with lower levels of mother's education and those who have had a prior STD are at higher risk. CONCLUSIONS: Multiple social and behavioral factors influence lifetime history of STD. Age at first intercourse and STD history affect subsequent STD acquisition. Self-reports of STD acquisition in probability samples of the general population are useful.

Adolescent↗

PubMedDate not supplied

High-grade cervical squamous intraepithelial lesion during pregnancy.

AIMS AND BACKGROUND: An increasing incidence of high-grade squamous intraepithelial lesion (HSIL) has been observed among young women. Consequently, an increased number of cases are being discovered during pregnancy. We analyzed the clinical and therapeutic management of HSIL during pregnancy. METHODS: A retrospective study was conducted from 1979 to 1998, and 58 registries of women with a cytological or histological diagnosis of HSIL during the pregnant-puerperal period were reviewed. Information obtained from medical records included age, gestational age at diagnosis, parity, age of first intercourse, number of sexual partners before pregnancy, tobacco use, cytologic and colposcopic findings, route of delivery, postpartum follow-up, and treatment. This information was compared with a non-pregnant control group with HSIL. RESULTS: The average age of pregnant women with HSIL was 27.9 +/- 5.2 years. The cytologic or histologic diagnosis of HSIL was made in the first trimester in 12 (20.7%) women and in the second trimester in 30 (51.7%) women. Average parity was 2.8 +/- 2 deliveries. Age of first intercourse ranged from 13 to 29 years (16.1 +/- 3.3). Thirty-two women (55.1%) had more than one sexual partner before pregnancy. Thirty-seven (63.8%) refereed tobacco use. According to the aforementioned aspects, no statistical difference was found in relation to control, except to cervical ectopia, which was more frequent in pregnant women (56.9% versus 42.6%). From the total of 58 pregnant women with cytologic or biopsy HSIL diagnosis, 53 had HSIL diagnosis made on cervical biopsy directed by colposcopy performed during the pregnancy; 44 (83%) of them were submitted to conservative management. HSIL was diagnosed by cervical biopsy in postpartum evaluation in 76% pregnant women with vaginal delivery and 78.6% women who underwent cesarean section. CONCLUSIONS: A conservative management of HSIL in pregnancy is proposed, with colposcopic evaluation during gestation and postpartum, regardless of route of delivery.

Adolescent↗

PubMed2003

Sexual activity among adolescents in Ilorin, Kwara State, Nigeria.

With the aid of a self-administered questionnaire, sexual activity was investigated among 1,200 students aged 10-19 years. Two hundred and sixty-four (23.7%) respondents indicated they were sexually active. The mean age at first intercourse was 11.3 years (SD=5.8 years), while the average number of sex partner was 2-3. Multiple sexual partners were found in 99 (69.2%) of the males and in 16 (32.7%) of the females (P < 0.05). Males were more sexually active, 189 (32.8%) compared with 73 (13.7%) females (P=0.000001; RR=2.4 (1.88-3.05). Two hundred and fifty-three (23.4%) ofthose respondents who claimed to be highly religious had sexual intercourse compared with 7 (50%) of those who claimed not to be religious (P=0.02; PR=0.47 (0.27-0.80). Those whose parents lived together were less likely to be sexually active. 184 (21.2%) versus 47 (34.8%) (P=0.005). It is therefore concluded that our adolescents especially males remain sexually active. It also demonstrates the dramatic lowering of age at first intercourse. Family supervision and level of religious activity were recognized as factors that have significant impact on sexual activity. Preventive efforts must therefore focus on these issues with the active involvement of the Pediatrician, parents and religious leaders.

Adolescent↗

PubMed1989

Reproductive and sexual risk factors and human papilloma virus infection in cervical cancer among Hong Kong Chinese.

In this case-control study of cervical neoplasia in Hong Kong, 48 dysplasia and 68 cancer patients were matched with 116 surgical in-patient controls. The cases had an earlier age at first intercourse and more sex partners than the controls. The cases' husbands also had more sex partners and were less likely to use condoms regularly. In a multiple regression model the odds ratio were 6.0 (95% Confidence Interval 2.5-14.6) for the husband having more than one sex partner, 4.0 (1.5-10.7) for the woman having more than one sex partner, and 1.15 (1.05-1.28) per year younger for the woman's age at first intercourse. The odds ratio of 5.4 for women whose partners did not habitually use condoms was not significantly different from 1.0. In a sub-sample, 37% of cancer patients and 18% of dysplasia patients, but only 6% of gynaecological controls, showed a positive DNA hybridization to Human Papilloma Virus (Type 16). These findings suggest that cervical cancer and dysplasia are sexually transmitted in our population, with a possible viral aetiology.

Adult↗

PubMed1993

Risk factors for cervical cancer by histology.

A case-control study in four Latin American countries enabled assessment of risk factors for different histologic types of invasive cervical cancers, with the main analyses focusing on 667 patients with squamous cell cancers and 43 with adenocarcinomas. The epidemiology of the squamous cell tumors resembled that found in other studies, namely a high risk associated with multiple sexual partners (RR = 1.5 for > or = 2 vs 1), early ages at first intercourse (RR = 2.3 for < 16 vs > or = 20), history of a sexually transmitted disease (RR = 1.8), multiple births (RR = 2.2 for > or = 7 vs 1-3), absence of prior Pap smear screening (RR = 3.0 vs Pap within 24 months), detection of HPV DNA (RR = 3.6), and limited years of schooling (RR = 1.9 for < 4 vs > or = 7). The adenocarcinomas appeared less affected by sexual, reproductive, or socioeconomic factors. There was no relationship with age at first intercourse, history of a sexually transmitted disease or education, and only marginal associations with number of sexual partners or parity. Absence of prior Pap smear screening as well as detection of HPV DNA, however, were associated with relationships equally strong as those for the squamous cell tumors. Oral contraceptive use distinctly affected risk of the adenocarcinomas, increasing risk by approximately two-fold. Analyses of the 18 subjects with adenosquamous cancer suggested some resemblance to the squamous cell tumors, especially with respect to the role of sexual and sociodemographic variables. These findings support the need for detailed studies of etiologic differences between the different histologic types of cervical cancers, with an emphasis on careful pathologic review and precise measurement of HPV.

Adenocarcinoma↗

PubMed2000

Evaluation of a sexuality education program for young adolescents in Jamaica.

Despite their increasing numbers, few of the sexuality education and pregnancy prevention programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P = .08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 Project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact.

Adolescent↗

PubMed1988

Contraceptive use in a sample of young Danish females.

During the period April 1984-February 1985, 4 test samples of totally 380 young Danish women aged 16-20 years old were invited to interview about contraception and sexual behaviour. The response rate was 75.3%. There were 208 (74.0%) who had had sexual debut. Median age was estimated to 16.8 years. At first intercourse 168 (80.8%) used contraception, 36.5% used condom and 36.1% oral contraception (OC). Among teenage-girls with sexual debut before 15 years old 32.5% were unprotected against pregnancy. At the time of the interview 64.4% did use contraception. The most frequently used contraceptive device was OC (46.6%). Teenage-girls changed the contraceptive method from condom to OC after sexual debut. A small proportion of sexually active girls (8%) did not use contraception neither at first intercourse nor at the moment.

Adolescent↗

PubMed2002

[Emergency contraception. Characteristics of the demand].

OBJECTIVE: Define the profile of the women that ask for emergency contraception (EC).Design. Transversal descriptive investigation. SETTING: Familiar Planning Center of 4th Area of Instituto Madrileño de Salud. in Madrid. Participants. All the women that went in the year 2000 requiring EC (n=404). Measurements. Was carried out a survey with sociodemographic variables, related with the EC and with the sexual life. RESULTS: The average age was of 23.9 years (age range 14 to 49) were inquired, 9.9 were under 18. They had an average of 6.7 intercourses per month, the first intercourse when they were 18 years old on average, and 4.9 years of sexual relationships. 90.9% stated to have a couple. 75% were graduated from high school or university, and 55.7% said they had never received information about contraceptives. For 19.5% this was not the first time they asked for EC. 6.5% had interrupted on purpose pregnancy and 36% of them had used EC before. The reasons to demand EC were: condom break (69.3%), held condom (16.9%) and intercourse without any protection (12%). 7% acknowledged other risky intercourses during the same period. 33.2% had been sent by a General Practitioner, 26.1% knew the center, 19% were sent by acquaintances and 16% from Emergency Services. EC was not prescribed in 12.2% of the cases because of minimum risk to pregnancy. The evaluation was made by a nurse (52.6%), by a doctor (34.4%) and by a gynecologist (13%). CONCLUSIONS: There is a lack of information about contraceptive methods. Most of the patients are sent from other sanitary services.

Adolescent↗

PubMed2007

Sex of experimenter and social norm effects on reports of sexual behavior in young men and women.

Past studies indicate that men generally report having had more sexual experience and sexual partners than women, as well as an earlier age at first intercourse. At least some of these findings may partially reflect different responses to certain contextual variables in research. College students (266 men and 463 women) were asked to anonymously report their sexual attitudes and behavior after reading one of three fictitious statements about research findings regarding gender differences in sexuality. Some past findings were replicated, with men reporting somewhat more sexual experience and more permissive sexual attitudes than women. However, women reported a significantly younger age at first intercourse than did men. While there was no significant sex difference for total number of sexual partners, there was a significant interaction. With female research assistants (but not with male assistants), men reported more sexual partners when they were told that women are now more sexually permissive than men. This finding appeared to be largely a function of the men who scored higher on measures of hypermasculinity and ambivalent sexism. Women's reports were not significantly affected by the wording of the cover sheet, regardless of the sex of the research assistant. Even in this anonymous survey, the sex of the experimenter and the nature of the statement about research findings had an impact on the sex differences that were found. In light of these results, some previous conclusions about male-female differences in sexual behavior may need to be examined more closely.

Adult↗

PubMed2004

Cervicovaginal infections during pregnancy: epidemiological and microbiological aspects.

OBJECTIVE: The assessment of the association of cervicovaginal infections during pregnancy with preterm (pPROM) and term (PROM) premature rupture of membranes, preterm delivery, mid-trimester miscarriage and intrauterine death, and the definition of the risk factors that identify pregnant women who should have a cervicovaginal culture. METHODS: We retrospectively studied the relationship between pregnancy outcomes and cervicovaginal infections in 3217 pregnant women between January 1998 and December 1999. Microbiological assessment included Gram staining and specific cultures; bacterial vaginosis was diagnosed by Amsel's criteria. We also studied the medical, obstetric, sexual, demographic and social history of 11,212 pregnant women who underwent cervicovaginal culture between January 1992 and December 2001. RESULTS: Overall, 1425 of the 3217 cultures (44.3%) were positive. The micro-organisms most frequently found were: yeasts (44%), Ureaplasma urealiticum (29%); group B streptococcus (15%); and bacterial vaginosis (11%). Cervicovaginal cultures were found positive in 84.6% of pPROM, 55.0% of PROM, 50.8% of preterm deliveries, 43.8% of mid-trimester miscarriages, 31.4% of intrauterine deaths and in 33.5% of controls. Among the 11 212 cervicovaginal cultures considered in the second study, an overall 6301 (56.2%) were positive, 2711 (43%) in asymptomatic women. Cervicovaginal infections were associated with country of origin, age under 25 years, age at first intercourse under 15 years, more than ten partners, more than one partner in the past 6 months, prior abortions, past sexually transmitted diseases (STDs) and HIV infection. CONCLUSION: Cervicovaginal infections were significantly associated with PROM (p<0.0001), pPROM (p<0.0001) and preterm delivery (p<0.0001), but not with intrauterine death. The association with mid-trimester miscarriage approached statistical significance (p=0.06). The main risk factors for cervicovaginal infections were country of origin, age under 25 years, age at first intercourse under 15 years, more than ten partners, more than one partner in the past 6 months, prior abortions, past STDs and HIV infection.

Adult↗

PubMed1995

Psychosocial variables associated with teenage pregnancy.

This study investigated whether psychosocial factors differentiate sexually active teenagers who become pregnant from those who do not. Data were collected from 64 unmarried adolescents who attended a suburban health clinic for a pregnancy test or for contraceptive care. Thirty-nine percent of the sample had been or were now pregnant, and 61% had never been pregnant. Each teenager completed a questionnaire and three self-report measures (Life Events Checklist, Self-Worth, Health Locus of Control) prior to her medical visit. Information about family, medical, and psychosocial history was obtained from chart review. When girls who had positive pregnancy tests, and sexually active girls who had never been pregnant were compared, no significant differences emerged on socioeconomic status, race, religion, age or psychological variables. However, when adolescents with a previous or current history of pregnancy (N = 25) were compared with girls who had never been pregnant (N = 39), using the Mann Whitney test, two significant differences were found: adolescents with a history of pregnancy had first intercourse at the mean age of 15 rather than 16 (p < .02) and scored higher than never-pregnant teenagers on the "Powerful Other" Health Locus of Control subscale, a measure of strong belief in external control by others (p < .01). No significant differences were detected between the groups for self-worth or life events perceived as stressful during the past year. These data indicate that in a middle-class suburban population of sexually active teenagers, earlier age at first intercourse and the influence of powerful others are important variables associated with pregnancy.

Adolescent↗

PubMed1995

Transmission of cervical human papillomavirus infection by sexual activity: differences between low and high oncogenic risk types.

Not all studies have proven that cervical human papillomavirus (HPV) infection is a sexually acquired condition. Determinants of HPV infection were analyzed in a survey of 718 asymptomatic women in northeastern Brazil. HPV DNA was detected and typed by polymerase chain reaction. HPV types were classified into low- and high-risk groups on the basis of their association with cervical carcinomas. Overall HPV prevalence (18.3%) was moderately associated with age at first intercourse (P = .111, trend) and number of lifetime sex partners (P = .005, trend). However, separate analyses by risk revealed different degrees of association with sexual activity. Except for a positive association with multiple partners among women < 40 years old (P = .034, trend), infection with low-risk types (9.7%) was not correlated with sexual behavior. On the other hand, infection with high-risk HPV types (11.6%) was strongly and independently associated with both multiple partners (P = .009, trend) and age at first intercourse (P = .007, trend) in all age groups.

Adult↗

PubMedDate not supplied

Female university students in Sweden: sex, contraception and STDs.

Female university students (n = 241) visiting the Student Health Center participated in a study concerning sexual behavior (study I). A randomized postal survey (study II) with similar questions was also performed to verify the findings in the first study (n = 137). The mean age was 23 years in both studies. Sexual experience was reported by 96% in study I and 87% in study II. Mean age at first intercourse and mean number of partners were similar; 17.6 years and 6 partners, respectively. Change of contraceptive type was frequent, and about one third had done so within the past two years. A common reason for adopting a new method was a change in social life. More than half the women were afraid of using oral contraceptives. Twenty-six percent of the students in study I and 29% in study II had had at least one sexually transmitted disease (STD). Forty-three percent claimed to have changed their sexual behavior as a result of AIDS publicity but condoms were used by less than 50% at the first intercourse with a new partner. Although this group of intelligent young people have access to information, many of them were risk-takers with respect to both unwanted pregnancies and STD. Misconceptions were frequent concerning the safety of OCs. It is clear that new approaches must be made to educate them about safe sexual practices.

Adult↗

PubMed1986

Risk factors for invasive cervical cancer among Latinas and non-Latinas in Los Angeles County.

A case-control study among white women in Los Angeles County was conducted to investigate etiologic factors that might explain the high rates of invasive cervical cancer among Latinas. Two hundred patients with invasive squamous cell carcinoma of the uterine cervix and matched (age, sex, preferred language, and neighborhood) controls were interviewed, 98 pairs in English and 102 pairs in Spanish. Seven factors were found to contribute independently and significantly (P less than .01) to risk, each after adjustment for the other six: years since last Pap smear, years of education (protective), frequency-years douching, pack-years of smoking, years of barrier contraceptive use (protective), number of sexual partners before age 20, and recognized episodes of genital warts. An eighth variable, interval in years between menarche and first intercourse, was the second variable to enter the stepwise logistic regression analysis but lost its statistical significance when sexual partners before age 20 entered the model. Together, these eight variables accounted for almost 99% of the risk. There were no significant interactions between any of these variables and age, language of interview, or birth in a Latin country. There was no increased risk associated with use of oral contraceptives, either before or after adjustment for the other significant factors. Compared to English-speaking controls, Spanish-speaking controls smoked less, douched less, had fewer sexual partners before 20, and had essentially the same average interval between menarche and first intercourse and the same average number of episodes of genital warts; however, they had had a longer interval since their last Pap smear, fewer years of barrier contraceptive use, and fewer years of education. Education, presumably a correlate of an inadequately measured etiologic risk factor (possibly papillomavirus infection), was responsible for the greatest difference in risk between the Spanish- and English-speaking cases.

Adolescent↗

PubMedDate not supplied

Risk factors for cervical intraepithelial neoplasia grade III/carcinoma in situ in Spain and Colombia.

A case-control study of 525 histologically confirmed cases of cervical intraepithelial neoplasia grade III and 512 controls was done in Spain and Colombia to assess the role of various risk factors taking into account the effect of human papillomavirus (HPV). The presence of HPV DNA, assessed by a polymerase chain reaction-based method, was the strongest risk factor identified. In Spain the adjusted odds ratio (OR) and 95% confidence interval (CI) (numbers in parentheses) were 56.9 (24.8-130.6) and, in Colombia, were 15.5 (8.2-29.4). In addition to HPV, the multivariate analysis revealed independent effects of early age at first intercourse (in Spain ORa, 4.3; 95% CI, 2.0-9.3 for ages < 17 versus 20+ years and in Colombia ORa, 9.0; 95% CI, 2.6-30.9 for ages < 14 versus 20+ years), and antibodies to Chlamydia trachomatis (in Spain ORa, 2.3; 95% CI, 1.1-4.5; and in Colombia ORa, 1.7; 95% CI, 1.1-2.7). High parity showed a significant effect only in Colombia (ORa, 2.0; 95% CI, 1.0-5.0 for > or = 6 versus 1) while number of partners of the woman and specially of her husband showed a strong effect in Spain only (ORa, 6.9; 95% CI, 3.1-15.3 for partners of the husband > or = 21 versus 1-5). Smoking and use of oral contraceptives did not show significant or consistent associations. Among HPV-DNA positive women early age at first intercourse and high parity increased the risk of cervical intraepithelial neoplasia III but the effect was statistically significant only for the former.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Determinants of genital human papillomavirus infection in young women.

Carcinoma of the cervix has several well-established epidemiologic risk factors, including multiple sexual partners and early age at first intercourse. Human papillomavirus (HPV) infection appears to have an etiologic role in the development of cervical neoplasia, but evidence linking HPV infection to known risk factors for cervical cancer has been inconsistent. The lack of expected correlations may be due to the inaccuracy of HPV assays previously used. A polymerase chain reaction DNA amplification method for the detection of HPV was used to investigate the determinants of genital HPV infection in a cross-sectional sample of 467 women attending a university health service. In contrast to studies using less accurate detection methods, the risk factors for HPV infection found here were consistent with those for cervical neoplasia. The risk of HPV infection was strongly and independently associated with increasing numbers of sexual partners in a lifetime, use of oral contraceptives, younger age, and black race. Age at first intercourse, smoking, and history of a prior sexually transmitted disease were correlated with, but not independently predictive of, HPV infection. These results demonstrate that the key risk factors for cervical carcinoma are strongly associated with genital HPV infection. This correlation suggests that HPV has an etiologic role in cervical neoplasia and reaffirms the sexual route of HPV transmission.

Adolescent↗