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PubMed1990

Cultural differences in a family planning clinic.

An analysis of the use of contraception in a multi-racial family planning clinic in relation to age, parity and ethnicity (Asian or non-Asian) was carried out in the London Borough of Newham. Whether follow-up appointments were given and kept and the taking of cervical smears were noted. Asian patients favoured the sheath (44%) and the IUD (31%); the Pill was less used at 20% with the cap little used at 3%. Non-Asian patients favoured the Pill (50%), and IUD (22%) with the sheath being used by 15% and the cap by 13%. Parity increased with age in both groups. The 16-20-year-old Asian patients chose the Pill (54%) in preference to the sheath (27%) whereas the older Asian patients chose the sheath in preference to all other methods. When follow-up appointments were given the failure rate was equal in both groups. 29% of the Asian patients had a cervical smear taken as against 45% of the non-Asian patients.

Adolescent↗

PubMed2004

Improving adolescent sexual and reproductive health. A view from Australia: learning from world's best practice.

There is increasing awareness worldwide of the importance of sexual and reproductive health in adolescents. Australia's high rates of teenage pregnancy and increasing rates of sexually transmitted infections in young people reflect a failure to prioritise adolescent sexual and reproductive health on the public health agenda. This paper reviews adolescent sexual and reproductive health in Australia in comparison with international data, and examines the systemic, social and cultural factors that influence it. Based on comparisons with international best practice, recommendations are included for improvement in adolescent sexual and reproductive health within the Australian context.

Abortion, Induced↗

PubMedDate not supplied

Contraceptive use among U.S. women having abortions in 2000-2001.

CONTEXT: Knowing the extent to which contraceptive nonuse, incorrect or inconsistent use, and method failure account for unintended pregnancies ending in abortion, as well as reasons for nonuse and imperfect use, can help policymakers and family planning providers support effective contraceptive use. METHODS: Contraceptive use patterns among a nationally representative sample of 10,683 women receiving abortion services in 2000-2001 were examined, as well as reasons for nonuse, problems with the most frequently used methods and the impact emergency contraceptive pills have had on abortion rates. RESULTS: Forty-six percent of women had not used a contraceptive method in the month they conceived, mainly because of perceived low risk of pregnancy and concerns about contraception (cited by 33% and 32% of nonusers respectively). The male condom was the most commonly reported method among all women (28%), followed by the pill (14%). Inconsistent method use was the main cause of pregnancy for 49% of condom users and 76% of pill users; 42% of condom users cited condom breakage or slippage as a reason for pregnancy. Substantial proportions of pill and condom users indicated perfect method use (13-14%). As many as 51,000 abortions were averted by use of emergency contraceptive pills in 2000. CONCLUSIONS: Women and men need accurate information about fertility cycles and about the risk of pregnancy when a contraceptive is not used or is used imperfectly. Increased use of emergency contraceptive pills could further reduce levels of unintended pregnancy and abortion.

Abortion, Induced↗

PubMed2006

Hormonal contraception in adolescents: special considerations.

With the rates of unintended pregnancies in teenagers remaining high, it is crucial to present adolescents with all of the contraceptive options available to them. While barrier methods, for example, male condoms, are easily accessible and do not have adverse effects, their use must be consistent and correct with each act of intercourse. Hormonal contraception affords much better efficacy in preventing pregnancy when used with full compliance. Oral contraceptives are a popular method of contraception among adolescents and offer many non-contraceptive benefits along with the prevention of pregnancy. They have very few significant adverse effects, which are outweighed by the significant morbidity associated with teenage pregnancies, and can be used by most adolescent females. However, their minor bothersome effects do contribute to the high discontinuation rates seen. In addition, many girls find it difficult to remember to take a pill every day, leading to higher failure rates in teenagers than in adult women. The advent of long-acting, progestogen (progestin)-only methods, such as injectables and implantables, has been generally accepted by adolescents and these methods have proven to be more efficacious by avoiding the need for daily compliance. However, progestogen-only methods cause irregular bleeding and amenorrhea, which is not acceptable to many teenagers. In addition, the most widely used implant was taken off the market a few years ago and newer forms are not yet widely accessible. Other novel methods are currently available, including the transdermal patch and the vaginal ring. Both are combinations of estrogen and progestogen and have similar efficacy and adverse effect profiles to oral contraceptives. Their use may be associated with greater compliance by adolescents because they also do not require adherence to a daily regimen. However, there may be some drawbacks with these newer methods, for example, visibility of the patch and difficulty with insertion of the vaginal ring. When regular contraceptive modalities fail, emergency contraception is available. Choices include combination oral contraceptives, progestogen-only pills, mifepristone, or placement of a copper-releasing intrauterine device. These methods can be very useful for preventing pregnancy in adolescents as long as adolescents are aware of their existence and have easy access to them.

Adolescent↗

PubMed2004

Can changes in sexual behaviors among high school students explain the decline in teen pregnancy rates in the 1990s?

PURPOSE: To explore the utility of using national data from high school students to explain changes in national declines in pregnancy rates. Although declines in teen pregnancy and birthrates in the 1990s have been welcome news to those interested in adolescent health and welfare, the reasons for these declines are not readily apparent. Previous attempts to explain these declines focused on the period before 1995 and did not directly calculate the impact of improved contraceptive use. METHODS: The national Youth Risk Behavior Survey provided estimates for sexual activity and contraceptive use among teens aged 15-17 years between 1991 and 2001 (n = 31,058). These data were combined with method-specific contraceptive failure rates (CFRs) derived from the 1988 and 1995 National Survey of Family Growth and pregnancy rates from the National Vital Statistics System. We calculated weighted-average CFRs (WACFR) and used the annual rate of change in the WACFR and sexual activity to estimate their relative contributions to the annual change in risk of pregnancy. Weighted least-squares regression in SUDAAN was used to test change over time. RESULTS: Between 1991 and 2001, annual rates of change in sexual behaviors were -1.7% for sexual experience and -1.6% for the WACFR. Improvements in WACFR resulted primarily from a decline in use of withdrawal (from 20% to 13%) and use of no method (from 17% to 13%) and an increase in condom use (40% to 51%). Recent sexual intercourse (i.e., intercourse during the past 3 months among teens who had ever had intercourse) did not change over time. The change in the estimated risk of pregnancy closely approximated the annual decline in the pregnancy rates for blacks and Hispanics but underestimated the actual decline for whites. Overall, 53% of the decline in pregnancy rates can be attributed to decreased sexual experience (95%CI 26% to 79%) and 47% to improved contraceptive use (95%CI 21% to 74%). CONCLUSIONS: Use of school-based behavior data reflects well the pregnancy experience for school-age black and Hispanic adolescents, but does not track well with the pregnancy risk of white adolescents. Care should be taken in attributing changes in pregnancy rates to changes in behavior, given broad confidence intervals around these estimates. These data suggest that both delayed initiation of sexual intercourse and improved contraceptive practice contributed equally to declines in pregnancy rates among high school-aged teens during the 1990s; however, estimates varied among racial and ethnic groups.

Adolescent↗

PubMed1999

[Syphilis in adolescent mothers in the city of Posadas, Province of Misiones].

During three months (April to June 1997) 1,238 consecutive pregnant women were studied at the time of delivery at the Madariaga public Hospital. Syphilis was confirmed in 26 (2.1%) women, and 15 cases (57.7%) of congenital syphilis were demonstrated in newborns one of whom was a stillborn. Of the syphilitic women 61.5% were 20 years old (average), 65.4% were single, 19.2% had a stable partner and 15.4% were married; 70% of them had finished elementary school (seven years), but despite this discrete level of instruction and that they were benefited with free health attention, 73% of them had not started or completed the pregnancy control. None of these women acted as sexual workers or were drug users; 57.7% were unemployed and the remainder worked as domestic servants or were still going to school. Menarca started at 13 (average) and the age of the first sexual activity was 15 (average). The distribution of the cases of syphilis within the city area shows four clusters that coincide with the lower income population, but not with marginal groups. The failure to submit to medical control during pregnancy among syphilitic women is directly linked with an increased risk for congenital syphilis. The specific prevalence of syphilis in women (20 years old or less) pregnant or not, shows an alarming hidden epidemic situation. An interinstitutional and communitary program, with direct interventions within the detected population clusters, is now underway in order to control syphilis. Undesired pregnancy and syphilis seem to be associated with adolescent unsafe sex conducts. A coordinated program between Public Health Service and National Misiones University is operating, visiting home by home, in order to decrease or eliminate congenital syphilis and is considered a priority health problem. Unfortunately, if sexual conducts do not undergo changes in the near future, at least by the correct use of condoms, HIV will replace syphilis.

Adolescent↗

PubMedDate not supplied

Seroprevalence of human immunodeficiency virus type I (HIV-1) antibodies in a family-planning population.

Blind testing of 743 women who attended an inner-city hospital family-planning clinic showed 8 (1.1%) patients to have serum antibodies to human immunodeficiency virus type I (HIV-1). A retrospective chart survey did not show an association between HIV-1 antibody seropositivity and ethnicity, marital status, education, history of sexually transmitted diseases, drug and/or alcohol use, and contraceptive method. This failure to establish previously reported correlation may be a function of methods, sample size, or reflect a different population. Nonetheless, the seroprevalence the authors found shows that all patients in a family-planning clinic setting should be offered HIV-1 antibody testing.

Adult↗

PubMedDate not supplied

Women's experience and satisfaction with emergency contraception.

CONTEXT: If any new contraceptive technology is to become a viable option for decreasing unintended pregnancies, women must be willing to use the method and find it acceptable. However, because emergency contraceptive pills have not been widely used, very little is known about this method's acceptability. METHODS: Telephone interviews were conducted with 235 women who had received emergency contraceptive pills through a demonstration project at 13 Kaiser Permanente medical offices in San Diego to assess women's experience and satisfaction with the pills. RESULTS: More than two-thirds of the women (70%) were using a contraceptive method prior to their need for emergency contraception, and 73% of these users were relying on condoms. When asked about the situation that led to unprotected intercourse, 45% reported that their condom broke or slipped, while 23% said they had had unplanned sex. More than three-quarters of the sample (81%) experienced at least one side effect. The overwhelming majority were satisfied with emergency contraceptive pills (91%) and would recommend them to friends and family members (97%). Just one-quarter of the sample (28%) believed that emergency contraceptive pills should be dispensed over the counter, and an even lower proportion agreed that they should be available from vending machines (6%). CONCLUSIONS: Because women were overwhelmingly accepting of emergency contraceptive pills, found them easy to use and did not intend to substitute them for regular contraceptive use, this new method is an important addition to the contraceptive options available to women, providing a way to prevent pregnancy after unprotected intercourse or method failure.

Adolescent↗

PubMed1996

Assessing the National HIV/AIDS Strategy evaluation.

The report is a useful compilation of data on Australia's HIV/AIDS epidemic and the response to it. The report produces firm evidence for endorsing Australia's success in limiting the spread of HIV by a number of routes. Australia has been successful in preventing iatrogenic spread, spread through commercial sex and spread through injecting drug use. In the latter case however, the hepatitis C epidemic cautions against complacency. The report, unfortunately, does not recognise very serious weaknesses in the evidence it uses as a basis for its endorsement of current efforts against HIV in the male homosexual community and the general heterosexual community. The report recognises failure of current policies in Aboriginal and Torres Strait Islander communities and recognises the threat posed here by HIV but recommends no major policy change. There is some recognition of the limitation of the data, but no recommendation for increased surveillance. The report ignores methods of prevention other than public health education. In my view, there is sufficient evidence to recommend routine neonatal circumcision, at least in Aboriginal and Torres Strait Islander communities. There is a clear need for a more effective approach to STD control, particularly in these communities. Adequate STD and HIV control may well require contact tracing and surveillance using traditional public health methods. Measurement of objective indicators of the success of HIV prevention campaigns needs to be improved with more comprehensive collection of data on HIV and STD incidence and condom sales, stratified by relevant covariates. Survey evidence of behavioural change should be collected from those too young to be affected by the selective mortality factor. The international comparisons await a proper statistical study which may be able to identify the elements of an effective approach to AIDS. In future reviews of the effectiveness of Australia's response to AIDS, all methods of limiting the spread of the epidemic should be considered objectively. It is unacceptable for the AIDS program to be declared optimal simply because it accords with current public health ideology.

Australia↗

PubMedDate not supplied

Failure to disclose HIV risk among gay and bisexual men attending sexually transmitted disease clinics.

We analyzed data from a multisite study of 1,063 gay or bisexual men attending sexually transmitted disease clinics to evaluate factors predicting failure to disclose human immunodeficiency virus (HIV) risk behaviors to clinic staff and the extent of such failure. We compared data from a brief screening assessment on unprotected anal and oral sex with data on the same behaviors from a subsequent detailed interview. We also compared behavioral data from screening and the interview with data on diagnoses of rectal gonorrhea abstracted from medical charts. Of 523 men reporting unprotected anal sex at interview, 29% failed to report this behavior at screening. Men failing to disclose unprotected anal sex were also less likely to disclose engaging in unprotected oral sex. Among men reporting no unprotected anal sex, either at screening or interview, 1.6% were diagnosed with rectal gonorrhea. Logistic regression analyses comparing men who did and did not disclose at screening having engaged in unprotected anal sex showed that men who failed to disclose reported greater involvement in gay organizations, greater perceived peer support for condoms, fewer episodes of unprotected anal sex in the last four months, and lower rates of substance abuse treatment. Our data suggest that men who failed to disclose may have lower risk levels, and may be more integrated into the gay community. Brief interviews, as opposed to detailed ones, also may underestimate incidence of unsafe sex. Where feasible, HIV risk assessment and counseling and laboratory screening should be routinely provided to all clinic attendees, regardless of self-reports.

Adolescent↗

PubMed2000

Breaking the silence: setting realistic priorities for AIDS control in less-developed countries.

The AIDS pandemic is a human tragedy that is threatening development in the poorest countries. There is no cure or vaccine, but the tools to control the epidemic already exist. Nevertheless, there are few examples of national AIDS control programmes that have had an impact on the epidemic. We (an economist and a planner) attribute this to the reluctance of governments to confront AIDS and a failure to prioritise activities in the face of severe financial and administrative constraints. When implementation capacity is weak, expanding the number of activities may not improve programme effectiveness. Rather, by implementing a smaller, core set of the most cost-effective activities on a national scale, policymakers could have a huge effect on the overall epidemic in a sustained way and provide a foundation for expansion. We propose three core priorities for AIDS control in poor countries for prevention, treatment, and mitigation of the impact.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Sexual tourism: implications for travelers and the destination culture.

Health care providers in a variety of settings need to improve their ability--along with the capabilities of supporting laboratories, surveillance systems, and services for sex partner management--to diagnose and treat STI. Whether the travel health care sector, as such, is willing to take on the additional burden of STI-related screening and risk reduction counseling has been raised by some authors. Currently, the burden of providing formalized STI care falls on the public sector; however, in the United States, most STI are actually diagnosed in the offices of private physicians. Given that the United States has the highest STI rates of any industrialized country, the undeniable synergy between STI and HIV acquisition, the failure of many American providers to screen for C trachomatis despite clear guidelines, the global resurgence of syphilis and extension of resistant N gonorrhoeae and of HIV, and the risk behaviors consistently reported by travelers, it is hard to argue against travel specialists' joining the daunting battle against these recalcitrant infections and their often devastating consequences. Most of the relevant diagnostic tests are relatively affordable, and patient-centered risk-reduction counseling, once mastered, can be brief and easily integrated into the overall conversation about protecting oneself during travel.

Condoms↗

PubMed2003

Hindrances to family planning program: findings from Banke, Nepal.

Reducing population growth through programs is a high priority for many developing countries. Why particularly in the rural regions of these countries, do these initiatives fail? Using a case study of a recent initiative in rural Nepal between 1998 and 2002 as an example, this opinion piece discusses possible reasons for such failure and recommends that a broader strategic approach is necessary, particularly in relation to empowering women in these communities. Banke district, Nepal, is mainly rural, consisting of 47 villages. Scarcity of family planning provisions is a dominant problem in most parts of the district. District Public Health Office (DPHO), the major family service provider lacks resources and technical capabilities. In recent years, non-government organizations (NGOs) have been collaborating and coordinating their efforts with DPHO in order to cover the larger section of the district population. A local NGO called Banke Mahila Arthick Swawlamban Sangathan (BMASS) provided family planning services in 5 of the 47 villages of Banke district, Nepal, from 1998 through 2002. Outreach activities and clinical services were the two major components of BMASS family planning program. Outreach activities included door-to-door/mass counseling, street drama, and condom distribution. Clinical services that included counseling, testing, temporary sterilization, and referrals for permanent sterilization were provided through a centrally located static clinic and mobile clinics. BMASS family planning program had almost no impact in the target villages. There was no significant increase in contraceptive use, people's motivation to limit fertility, and number of people preferring a smaller family size. The contraceptive prevalence rate increased by less than 2% after 2 years of family planning program intervention. More than 80% of the family planning clients were reported to have discontinued contraceptive use within six months. The mean age of women at the time of first child delivery (16.2 years), total fertility rate (six children per woman), and the birth intervals (13-18 months) were reported to be the same for both periods: before and two years after family planning program intervention. Further assessment of the local factors revealed that women's lack of control over fertility and higher number of desired children could have hindered the community's response to BMASS family planning program. In the target villages a woman's fertility is dependent upon the preference of husbands and in-laws. The women in general are not empowered to voice their opinion with regards to delaying fertility, spacing child-births, and limiting the number of children to be born to them. Higher number of desired children in the target villages is the outcome of low cost of child rearing and high benefits from the children. Children not only contribute significantly in household economy and provide old age security to their parents, but also consume less. To be effective, family planning programs need to be integrated into broader societal reforms that address rural economic development and the role of women in society.

Journal Article↗

PubMed1994

Multicenter trial in North America of UroLume urinary sphincter prosthesis.

We investigated the effectiveness and associated complications of treatment with an endoluminal urethral sphincter prosthesis in 153 spinal cord injury men (mean age 36 years, range 16 to 74 years) with urodynamically diagnosed detrusor-external sphincter dyssynergia. These patients were prospectively treated with a urethral sphincter stent at 15 centers in North America. Followup ranged from 2 to 33 months. Voiding pressures averaged 76 +/- 28, 42 +/- 21, 44 +/- 38, 35 +/- 18 and 32 +/- 20 cm. water, respectively, before prosthesis insertion in 153 patients and at 3 months in 123, 6 months in 114, 12 months in 98 and 24 months in 22. A significant decrease in voiding pressure was noted in the 22 patients at 24 months compared with matched preoperative data (80 +/- 25 cm. water, p = 0.03). The residual urine decreased from 181 +/- 154 ml. before insertion to 82 +/- 93 ml. at 24 months (p = 0.01). Maximum cystometric capacity remained constant, with a mean of 195 +/- 158 ml. before insertion to 248 +/- 122 ml. at 24 months (p = 0.17). No significant differences were apparent after 24 months of followup in any of the urodynamic parameters between 44 patients with and 109 without previous external sphincterotomy. Hemorrhage requiring blood transfusion, obstructive hyperplastic epithelial overgrowth and soft tissue erosion did not occur. No deleterious effects were observed on renal or erectile function. Of the patients 43 (28.1%) required 2 prostheses to bridge the external sphincter completely. Stent removal was required in 10 patients. Seven explantations were required for prosthesis migration, 1 for pain and urethral edema, 1 for inability to maintain a condom catheter, and 1 for nonepithelialization and secondary bladder neck obstruction. A total of 13 patients (8.5%) required a subsequent operation for bladder neck obstruction. Therefore, the sphincter prosthesis is an attractive modality for the treatment of external sphincter dyssynergia in patients with and without previous external sphincterotomy because of its ease of deployment and minimal associated morbidity.

Adolescent↗

PubMed1997

The use of behavioral methods of contraception in women seeking abortion.

AIMS: To determine the extent to which behavioural methods, used alone or with other methods of contraception, contribute to contraceptive failure in women seeking termination of pregnancy. METHOD: A clinical audit was conducted of the use of behavioural methods of contraception, in 1342 women attending the Parkview Clinic for termination of pregnancy, over a four year period 1992-6. The information was obtained through standard interview and patient records. RESULTS: The women seen were representative of New Zealand women undergoing termination of pregnancy. Approximately one third of women (34.9%) used one or more behavioural methods in the month prior to conception. The two most common methods were periodic abstinence and coitus interruptus, both used by approximately 17%. Other methods used less frequently and not solely for contraceptive purposes, were cleansing of the vagina and breastfeeding. Pacific Island and Asian women were more likely to use behavioural methods than European and Maori women. Many women (45.6%) using behavioural methods also used other methods of contraception, especially the condom. CONCLUSIONS: Behavioural methods were found more commonly than previously reported. Greater understanding of the use of behavioural methods will assist in the implementation of preventive programmes to reduce the number of terminations.

Abortion, Legal↗

PubMed1996

Continued sexual risk behavior among HIV-seropositive, drug-using men--Atlanta; Washington, D.C.; and San Juan, Puerto Rico, 1993.

Behaviors associated with increased risk for sexual transmission of human immunodeficiency virus (HIV) by infected persons include unprotected intercourse, multiple sex partners, use of crack cocaine, failure to disclose serostatus to sex partners, and trading sex for money or drugs. Some sexually active, HIV-infected persons in the United States continue to practice risky behaviors. To characterize continued sexual risk behaviors among HIV-positive, illicit-drug using men, in 1993 CDC analyzed data from such men recruited for a small group-intervention program in three cities - Atlanta; Washington, D.C.; and San Juan, Puerto Rico. This report summarizes the results of that analysis, which indicate that some seropositive men continue to engage in unprotected sex.

Adult↗

PubMed1989

Factors related to seroconversion among homo- and bisexual men after attending a risk-reduction educational session.

Thirteen homosexual men, volunteers in a study of the natural history of HIV, who seroconverted to HIV after participating in an educational program on HIV prevention, were interviewed about the circumstances leading to their seroconversion. Six men had participated in unprotected anal intercourse with at least one partner whom they believed was HIV-negative. Four men attributed their conversion to mental health problems or to drug and alcohol use. Two men's seroconversions could not be ascertained and one man attributed seroconversion to a condom break. Most men who had learned how to avoid infection, and had successfully done so for a time, had knowingly engaged in unsafe behaviors because of strong emotional responses to certain partners or because of mental health or drug and alcohol-related problems. Skills training for dealing with partners who pressure men to behave unsafely is needed, as is mental health and drug and alcohol counseling for men at risk for HIV infection.

Acquired Immunodeficiency Syndrome↗

PubMed2003

[Premature orgasm in the male].

To date, we have no uniform definition of ejaculatio praecox. In a qualitative approach, premature ejaculation is ascribed to a failure to control excitement. As causes, organic disorders and erectile dysfunction must be excluded. The majority of cases, however, are due to psychological or partnership problems. The history-taking should aim, in particular, to uncover possible anxiety in conjunction with premature orgasm, and also to establish the reactions of the partner. As therapy, medication (local anesthetics, antidepressive agents, PDE-5 inhibitors) and sexual-therapeutic measures are available. Since few sufferers take the initiative in seeking treatment, particular importance attaches to providing the public with information about the therapeutic options for treating this common disorder.

Anesthetics, Local↗