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PubMed1999

Contraceptive status and sexual function of climacteric Chinese women.

The objective of the present survey was to assess the contraceptive status and sexual function of climacteric Chinese women. One cross-sectional study randomly recruited 742 premenopausal, perimenopausal, and naturally menopausal women aged 45-55 years from Beijing. Contraceptive methods were used by 75.6% of premenopausal and 54.2% of perimenopausal women. The primary methods were the IUD and barrier method. The women's choices of methods were related to parity and frequency of sexual activities. Sexual activity was related to the satisfaction of contraceptive methods. Perimenopausal and postmenopausal women were about half as likely to enjoy sexual activity and to experience orgasms than premenopausal women. Women of higher socioeconomic status had a lower risk for decreased sexual functioning. The IUD was the most popular and the most appropriate contraceptive method for perimenopausal women. Sexual function was associated with the women's satisfaction with the contraceptive method used, their menopausal status, and their socioeconomic class.

China↗

PubMed1999

Prospective study of barrier contraception for the prevention of sexually transmitted diseases: study design and general characteristics of the study group.

BACKGROUND AND OBJECTIVES: The AIDS epidemic has brought barrier contraceptives to the forefront of public health research. A comprehensive evaluation of the efficacy of barrier contraceptive use in preventing sexually transmitted diseases (STDs), including AIDS, is necessary to inform both potential users and public health policy makers. This study was undertaken to evaluate the efficacy of condoms and vaginal spermicide products, used alone or in combination, in preventing gonorrhea and chlamydia among women attending an STD clinic. GOAL OF THIS STUDY: To describe the general characteristics of the study group and its follow-up experience. STUDY DESIGN: Women who met the eligibility criteria were invited to participate. The initial visit included an interview, a behavioral intervention promoting barrier methods, a physical examination, and instructions to complete a sexual diary. Participants received free barrier contraceptives and returned for six monthly follow-up visits. DESIGN RESULTS: Participants (n = 1,122) were low income, single (74%) black (89%) women with a median age of 24. The behavioral intervention led to the use of barrier protection in more than 70% of reported acts of vaginal intercourse. Barriers were used consistently (100% of sexual acts) during 51% of the months of follow-up. A total of 148 cases of gonorrhea (28 per 1,000 months) and 122 cases of chlamydia infection (23 cases per 1,000 months) were diagnosed during follow-up. CONCLUSION: This study represents a practical solution to a complex set of design considerations. The study protocol was successful in promoting consistent and proper use of barrier methods.

Adult↗

PubMed1989

Characteristics of reproductive life and risk of breast cancer in a case-control study of young nulliparous women.

Between 1982 and 1985, a case-control study of nulliparous women, aged 25-45, was conducted to analyse the relationships between the risk of breast cancer and causes of nulliparity, including contraceptive methods. Fifty-one cases of breast cancer diagnosed less than 3 months before interview were matched with 95 controls on age at diagnosis, year of interview, and medical center. The causes of nulliparity related to female sterility or subfertility (mechanical or hormonal disorders) were not found to be associated with a significantly higher risk of breast cancer. The causes related to fertilization failure, i.e. no sexual partner, rare sexual intercourse (less than once per month), or partner with abnormal semen, were found to lead to an increased risk. Detailed analysis of contraceptive methods showed that the risk of breast cancer increased (p = 0.02) with a longer duration of use of barrier methods (withdrawal or condom). Conversely, the risk significantly decreased (p = 0.004) with a longer duration of use of non-barrier methods (oral contraceptives, IUD, cap, local spermicides, vaginal douche, safe period, or no method), i.e. methods allowing a direct exposure to human semen.

Adult↗

PubMed1991

Failed contraception in Nigerian women: outcome of pregnancy and subsequent contraceptive choice.

The outcome of pregnancy in 56 patients who had contraceptive failure out of the 5,431 new acceptors at the Family Planning Clinic of the Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, between 1 January 1981 and 31 December 1989, were analysed. There were 40 IUD, 6 OC, and 4 injectable failures. Three patients had had voluntary surgical contraception (VSC) and 3 used barrier methods. The mean +/- SD age and parity were 32.2 +/- 4.4 years and 4.4 +/- 1.9, respectively. There were 17 (30.1%) live births, 34 (56.6%) terminations of pregnancy and 3 (5.2%) spontaneous abortions. Two (3.0%) patients were lost to follow-up. There was neither any statistically significant difference in the outcome of pregnancy between patients with 5 or more children and less than 5 children (p greater than 0.05), nor between patients less than 31 years of age and those older. Fifty per cent of the patients who had used the IUD continued with the method. Seven patients subsequently requested VSC. None of the patients using the injectable contraceptive or barrier methods continued with the method (p greater than 0.05).

Adult↗

PubMed1991

Effectiveness and acceptibility of the symptothermal method of natural family planning in Germany.

Throughout Germany, 851 women who were instructed in natural family planning participated in a prospective study. Of these, 255 women with 3174 cycles used only natural family planning for family planning and 274 women with 3995 cycles occasionally used barrier methods in the fertile phase. For natural family planning--only users, the Pearl rate for unplanned pregnancy was 2.3 and for mixed-method users 2.1. Most pregnancies resulted from unprotected intercourse during the fertile phase, and the use of barrier methods does not reduce risk-taking.

Body Temperature↗

PubMed1994

Practical problems which women encounter with available contraception in Australia.

Australian women face major difficulties with contraception because of the limited range of choices, the need for meticulous attention to compliance with most available methods and because of cost limitations for a significant minority of the population. The most commonly used methods are oral contraceptive pills and barrier methods, and each has substantial compliance problems which can be minimized with care and counselling. There is an urgent need for a wider range of options in Australia and for good information and publicity about them. Present progress in this direction gives some hope for the near future.

Australia↗

PubMed1995

Primary infertility and oral contraceptive steroid use.

OBJECTIVE: To determine the association between combined monophasic oral contraceptive (OC) use and primary infertility. DESIGN: Case-control. SETTING: Women serving as controls of the Cancer and Steroid Hormone Study. PARTICIPANTS: Women were 19 to 40 years of age at first conception or infertility diagnosis. Based on 24 consecutive months of unprotected intercourse without a recognized conception, 419 nulligravid women had primary infertility; controls were 2,120 fertile women. A calendar of each women's reproductive history was used to determine fertility status and contraceptive use before infertility diagnosis or first conception. MAIN OUTCOME MEASURE: Primary infertility. RESULTS: Combined monophasic OC use was associated with a lower frequency of primary infertility, particularly among younger (age 20 years) compared with older women (age 30 years) after adjusting for barrier method use and education. A similar association was found for duration of OC use. When adjusted for age at first conception or infertility and barrier method, both higher (> 50 micrograms) and lower (< or = 50 micrograms) estrogen dose use were associated with decreased risk of primary infertility. CONCLUSION: Combined monophasic OC use was associated with a lower frequency of primary infertility.

Adult↗

PubMed1976

Cervical gonorrhea in women using different methods of contraception.

Cultures were made from the cervix, rectum, and oropharynx of 2,019 women to determine the prevalence of gonorrhea. For patients of similar race and age, the rates of cervical gonorrhea among users of oral contraceptives (10.6/100) or IUD users (9.5/100) were significantly greater than observed with patients using barrier methods, condom-diaphragm-foam (1.7/100). On the other hand, there were no significant differences in rates of rectal or oral infection by method of contraception. Postpartum patients were found to have similar infection rates at all three sites as a comparable group of nonpuerperas. Recommendations for utilization of barrier methods are made for suitable patients, including those in the immediate puerperium.

Contraception↗

PubMed1986

One-year results using a risk scoring system in a family planning clinic.

During one year (from 1/1/85 to 12/31/85) 1038 women sought contraception at a family planning clinic. Contraception was recommended using a risk scoring system to increase the suitability of a method to the needs of an individual woman. Among the 546 women fitted with a IUD (copper or unmedicated), the continuation rate was 90.49%. Removal rates for pregnancy or bleeding were small compared with the rates published in the current literature. Among the 472 women using oral contraceptive pills (combined or triphasic), the continuation rate was 99.16%: the triphasic pill was well accepted, without discontinuation for menstrual disruption, pregnancy, or gastrointestinal side-effects. Only 20 women (1.92%) selected a barrier method (diaphragm with spermicide) suggesting the need to improve the image of barrier methods as safe and reliable. We conclude that prescribing contraception using a risk scoring system increases the appropriateness to the needs of the woman, thereby eliminating many complications and side-effects.

Adult↗

PubMed1991

Platelet separation from the blood of severely thrombocytopaenic patients.

An efficient method is described for the isolation of platelets from the blood of severely thrombocytopaenic patients. The method, based on centrifugation over a density medium, was compared with platelet-rich plasma obtained by conventional differential centrifugation at a relative centrifugal force of 200 x g. With samples from thrombocytopaenic patients (n = 10, platelet counts between 7 and 22 x 10(9)/l), the density barrier method gave significantly improved platelet recoveries (82.1% +/- 6.2%) compared with differential centrifugation (61.6 +/- 4.6%) (P less than 0.001). Platelets isolated by the density barrier method showed no tendency to aggregate and were suitable for use in tests to detect platelet-associated immunoglobulin.

Blood Platelets↗

PubMed1991

Cervical cancer and methods of contraception.

When evaluating whether the use of a particular method of contraception is associated with an increased or decreased risk of cervical cancer, it is important to be aware of the epidemiological factors which might lead to incorrect conclusions. After careful consideration of the issues, and examination of the available data, it is concluded that women who use oral contraceptives are possibly at increased risk of invasive cervical cancer; users of barrier methods probably have a decreased risk (although the protective effect may differ between the various types of barrier method); and that users of other methods of contraception do not have an altered risk.

Contraception↗

PubMed1989

Adolescent contraception: nonhormonal methods.

A comparison of the advantages, disadvantages, and costs of each method is presented in Table 1. Barrier methods of contraception offer adolescents protection against both pregnancy and STDs, but innovative approaches are needed to enhance availability and acceptability. Condom use in conjunction with a vaginal spermicide would provide optimal protection. The "female condom" may prove to be an effective alternative. Diaphragms and cervical caps can be prescribed for well-educated, highly motivated adolescents comfortable with insertion and removal. The vaginal contraceptive sponge provides many of the advantages of the diaphragm and cap without the need for an examination and fitting and also may be used as a backup method with the condom. Vaginal spermicides used alone are significantly less effective than in combination with a mechanical barrier. The IUD is not considered appropriate for most adolescents due to its association with an increased risk of pelvic infection. Periodic abstinence requires accurate identification of the fertile period, extensive education, and partner cooperation. Sterilization is rarely considered an option in adolescents. Alternate forms of sexual expression are available to adolescents who choose to abstain from intercourse.

Adolescent↗

PubMed1991

The role of contraception in the development of postmolar gestational trophoblastic tumor.

From January 1974 to June 1988, 299 evaluable patients were referred to the John I. Brewer Trophoblastic Disease Center of Northwestern University Cancer Center for treatment and/or follow-up of a hydatidiform mole (N = 162) or postmolar gestational trophoblastic tumor (N = 137). The type of contraception and other prognostic factors before and after evacuation were correlated with the development of gestational trophoblastic tumor using both univariate and multivariate analysis. There was no relationship between pre-hydatidiform mole contraception and the development of gestational trophoblastic tumor. Oral contraceptives (OCs) were used by 139 patients (46%), barrier methods by 141 patients (47%), intrauterine devices (IUDs) by two patients (1%), and no contraception by 17 patients (6%). The risk of developing gestational trophoblastic tumor was compared between patients using versus not using: OCs--33 versus 57% (P less than .001), barrier methods--53 versus 40% (P = .30), IUD--100 versus 46% (P = .21), and any contraceptive method--43 versus 88% (P less than .001). The dose of estrogens could be determined in 75 patients taking OCs; 14 of 49 (29%) of the patients taking less than 50 micrograms versus nine of 26 (35%) taking 50 micrograms or more developed gestational trophoblastic tumor (P = .78). Stepwise logistic regression analysis demonstrated that the type of contraceptive used was the most important prognostic factor in gestational trophoblastic tumor development (P less than .0001), followed by the occurrence of theca-lutein cysts (P less than .0001), Asian maternal race (P = .02), lesser time from the last menstrual period (P = .005), and greater maternal age (P = .04).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1998

Factors predicting upper genital tract inflammation among women with lower genital tract infection.

We sought to identify factors that discriminate between women with a lower genital tract infection and women with a lower genital tract infection and endometritis. This study enrolled women at risk for or having a lower genital tract infection with Chlamydia trachomatis or Neisseria gonorrhoeae and measured behavioral and clinical factors. Women were identified through contact tracing of male partners, presentation with cervicitis, or presentation with symptoms of pelvic inflammatory disease and classified as (1) having a lower genital tract infection without endometritis, (2) having a lower genital tract infection with endometritis, (3) having no lower genital tract infection with endometritis, and (4) having neither a lower genital tract infection nor endometritis. The primary comparison was between women having a lower genital tract infection without endometritis to women having a lower genital tract infection and endometritis. Women with a lower genital tract infection and endometritis were older and reported a history of more sexually transmitted diseases (70.0% vs. 56.7%), abdominal pain (82.2% vs. 60.0%), and use of barrier methods of contraception (28.9% vs. 8.6%) than women with a lower genital tract infection alone. The regression model found that women with a lower genital tract infection and endometritis were 7.1 times (95% CI = 2.2-23.0) more likely to report abdominal pain and 4.6 times (95% CI = 1.5-14.9) more likely to use barrier methods of contraception than women with a lower genital tract infection alone. These results suggest that behavioral factors, in addition to symptoms, can be used to identify women with and without upper genital tract involvement.

Abdominal Pain↗

PubMed1994

Potential acceptability of ovulation detection kits and RU-486 at two college campuses.

Two innovations in fertility research may expand birth control options in the United States. Ovulation detection kits, used alone or in conjunction with barrier methods of contraception, could be used to chart the fertile period. RU-486, when used in conjunction with a prostaglandin, induces early abortion, providing an alternative to conventional vacuum aspiration abortion. To measure the hypothetical acceptability of these methods, the authors surveyed 710 women at two college campuses in California regarding potential use of ovulation detection kits and RU-486. Seventy-one percent of the women in the final sample indicated an interest in using ovulation kits. Of these women, most (72%) were interested in using an ovulation detection kit as a supplement to barrier methods, and 22% indicated they would consider the kit as a sole method of birth control. More than 68% of the women in the sample indicated they would choose an abortion if faced with an unwanted pregnancy, and 60% would hypothetically choose RU-486 in preference to a conventional pregnancy termination. The most frequently cited reason for preferring RU-486 rather than conventional methods of abortion was to avoid the risks associated with the vacuum aspiration technique.

Abortion, Induced↗

PubMed1988

Prostitution in Sheffield: differences between prostitutes.

This study to assess differences between street walking prostitutes and sauna girls who attended this clinic in 1986 and 1987 showed that fewer street walkers used barrier methods for disease prevention with clients or accepted tests for antibody to human immunodeficiency virus (HIV) when offered and more street walkers practised their profession in both Sheffield and London. They therefore represent a potential pathway for the heterosexual spread of HIV to the region. Trichomonas vaginalis was the only organism more commonly isolated from street walkers. Other sexually transmitted diseases diagnosed, and the sources of acquisition of gonococcal cervicitis, were similar in both groups of prostitutes. Prostitutes rarely used barrier methods with their regular consorts, who were found to be responsible for most cases of gonorrhoea in both groups. As 11 out of 58 prostitutes attending were found to have dysplasia on routine cervical cytological examination, we suggest that all prostitutes be advised to undergo cytology yearly.

Contraception Behavior↗

PubMed1981

Simultaneous measurement of cerebral blood flow and unidirectional movement of substances across the blood-brain barrier: theory, method, and application to leucine.

The uptake of compounds by the brain depends upon cerebral blood flow. To determine the normal blood flow-cerebral extraction relationship, a method for rapid, simultaneous measurement of cerebral blood flow and brain extraction was developed and applied to blood-brain leucine transfer. Awake rats were injected intravenously with a mixture of n-[(14)C]butanol and [(3)H]leucine. The quantities of indicators accumulated over the following 5-12 s in brain and in a sample of arterial blood withdrawn at a know rate were used to determine the flux of butanol and leucine into brain. Butanol extraction was assessed independently by measuring arterial and cerebral venous concentrations of the indicator after a bolus injection. Cerebral blood flow was equal to the ratio of butanol flux into brain to butanol extraction by brain; leucine extraction was then calculated as the ratio of leucine influx to cerebral blood flow. Leucine extraction by brain and cerebral blood flow were shown to be related exponentially. The maximum velocity of active leucine transport was virtually the same at flows of 150 and 400 ml/100 g/min. The present method is theoretically applicable to the measurement of the extraction of any compound from blood by brain. By measuring the normal blood flow-extraction relationship, one can differentiate changes in extraction secondary to altered flow from changes intrinsic to pathologic conditions with inconstant cerebral blood flow.

1-Butanol↗

PubMedDate not supplied

Fertility and contraceptive adoption and discontinuation in rural Kenya.

After a long period of slow progress, the recent uptake of contraceptive use in Kenya has been dramatic. This report describes adoption of a method and method switching and discontinuation among a cohort of married women aged 25-34 in two contrasting rural areas. A retrospective "fertility diary" completed by each woman provided information on spousal separation, reproductive status, and contraceptive use over a period of 46-48 months. Contraceptive prevalence rose rapidly over the period in both areas, with significant net adoption of injectables in both areas and of IUDs in one only. Method discontinuation was concentrated among users of pills, barrier methods, and "natural" methods, and only one-third of all discontinuations were voluntary. The wide differences between the two rural areas in contraceptive prevalence were not totally reflected in recent fertility levels, and the contribution of other proximate determinants of fertility, particularly postpartum amenorrhea and spousal separation, are discussed.

Adult↗