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PubMed1988

Risk factors for adenocarcinoma of the cervix: a case-control study.

To assess risk factors for cervical adenocarcinoma data were collected in a case-control study of 39 cases and 409 controls conducted in the greater Milan area. Questions were asked about personal characteristics and habits, gynaecologic and obstetric data, history of lifetime use of oral contraceptives and other female hormones, and general indicators of sexual habits (age at first intercourse and total number of sexual partners). The relative risk of cervical adenocarcinoma increased with number of births and abortions, early age at first birth and early age at first intercourse. These estimates did not materially change after adjustment for the potential reciprocal confounding effect. Further, there was a positive association with overweight, but an apparent association with lower education was not significant. No relationship emerged with oral contraceptive use. Thus, despite the similarities with the epidemiology of squamous cell cancer, reproductive patterns and other factors related to the risk of endometrial cancer (i.e., overweight) seem to play an important role in the risk of adenocarcinoma of cervix uteri.

Abortion, Spontaneous↗

PubMed1998

Determinants of risk of invasive cervical cancer in young women.

We analysed determinants of risk of cervical cancer in women aged less than 45 years using data from a case-control study conducted in Italy. Cases were 261 women aged < 45 years with histologically confirmed invasive cervical cancer. Controls were 257 women aged < 45 years, with acute, non-neoplastic conditions, judged to be unrelated to any of the known or suspected risk factors for cervical cancer. In comparison with women reporting one or no sexual partner, the multivariate odds ratio (OR) of cervical cancer was 2.4 (95% confidence interval, CI, 1.3-4.6), for women reporting two or more sexual partners, and, in comparison with women reporting their first intercourse at 17 years of age or before, the multivariate OR was 0.5 (95% CI 0.3-0.9) in women aged > or =23 years at first intercourse. The risk of cervical cancer was higher in parous women and increased with number of births (OR = 8.1 for three or more births). Among parous women the risk tended to increase with later age at last birth; in comparison with parous women reporting their last birth before age 25, the OR was 1.9 in those reporting their last birth at > or =35 years. No clear association emerged between oral contraceptive use, smoking, education, social class and risk of cervical cancer.

Acute Disease↗

PubMed1980

Characteristics of women with dysplasia or carcinoma in situ of the cervix uteri.

To identify risk factors for various cervical abnormalities, 237 women with abnoromal cervical smears and 422 control women were interviewed. Cervical biopsy specimens taken from the patients with abnormal smears were reviewed according to standard criteria by one pathologist and classified as follows: 65 carcinoma in situ, 81 severe dysplasia, 44 mild dysplasia and 47 normal histology. Factors associated with risk of mild dysplasia, severe dysplasia and carcinoma in situ were similar to those previously identified for invasive carcinoma, and included age at first intercourse, multiple sexual partners and pregnancy outside marriage. Analysis to disentangle correlated factors revealed that number of sexual partners exerted effects independently of age at first intercourse, whereas the reverse was not true. This finding fails to support suggestions that adolescence is a period when the cervix is most vulnerable to the effects of sexual behaviour. Other factors relating to risk of cervical abnormalities were smoking and use of oral contraceptives. It was not possible to show that these relationships were incidental, but further investigation is required to establish whether they are causal.

Adolescent↗

PubMed1986

Male influences on cervical cancer risk.

Risk factors for squamous cell carcinoma of the uterine cervix were studied among low income, married Hispanic women and their husbands, using a case-control design. A total of 45 eligible cases were identified at public hospitals and community clinics in the San Francisco Bay Area. For each case, a control was selected within two years of age from among Hispanic women seen at the same institution. Thirty-nine matched pairs of couples were interviewed to assess histories of sexual behavior and other possible risk factors. Cases and controls differed markedly in the number of past sexual partners of their husbands. Cases were 5.3 times more likely to be married to husbands who had had 20 or more sexual partners than were controls. Cases and controls themselves did not differ in their number of sexual partners, but cases were younger at first intercourse than were controls. The association with husband's sexual history persisted after adjusting for the woman's number of sexual partners or age at first intercourse. These results support the infectious and venereal transmission of cervical cancer and indicate the important role of husbands in its occurrence in a population with high incidence rates.

Adult↗

PubMed1980

Sexual experience, birth control usage, and sex education of unmarried Canadian university students: changes between 1968 and 1978.

Changes in coital experience, birth control usage, and sex education between 1968, 1971, 1974, and 1978 were studied in unmarried Canadian university students. The percentage of coitally experienced females increased from 32% in 1968 to 58% in 1978 and of males from 40% to 62%. There was no significant change between 1974 and 1978 for either sex, nor were there sex differences in coital experience in either year. Coitally experienced females were more likely to have had intercourse in the 3 months preceding both 1974 and 1978 surveys, but otherwise there were no sex differences in coital frequency, lifetime number of coital partners, or age at first intercourse. Religion was a more reliable indicator of coital experience in 1968 than in 1978. Males were more likely than females to report postpubertal sexual contacts which they classified as homosexual (16.5% vs. 7%) whereas 12-13% of both sexes reported no sexual contacts of any kind with another person. Contraceptive risk-taking was high at first intercourse and among those having infrequent coitus. However, both this group and more coitally active students were less likely to take such risks in 1978 than in 1968, almost entirely because of increased pill use. Coitally experienced vs. inexperienced students differed in their ranking of the major influences on their knowledge and attitudes about sex.

Abortion, Induced↗

PubMed2001

Human papillomaviruses and cervical cancer in Bangkok. I. Risk factors for invasive cervical carcinomas with human papillomavirus types 16 and 18 DNA.

Personal interviews, tests for antibodies to herpes simplex virus type 2, Treponema pallidum, and hepatitis B, tests for hepatitis B surface antigen (HBsAg), and polymerase chain reaction-based assays for human papillomavirus (HPV) DNA in cervical scrapings were obtained from 190 women with squamous cell and 42 women with adenomatous cervical carcinoma and from 291 hospitalized controls diagnosed in Bangkok, Thailand, between September 1991 and September 1993. Risk was strongly associated with oncogenic HPV types, with types 16 and 18 predominating in squamous and adenomatous lesions, respectively. The 126 cases with HPV-16 and the 42 cases with HPV-18 were compared with 250 controls with no evidence of any HPV. The risk of both viral tumor types increased with decreasing age at first intercourse in this predominantly monogamous population, which may be explained by more visits to prostitutes by the husbands of cases with early than late age at first intercourse. HPV-16 tumors were weakly associated with HBsAg carrier state and smoking. The risk of tumors of both viral types increased with parity and use of oral contraceptives but not with injectable progestogens. Factors that may predispose to persistent, oncogenic HPV-16 or -18 infection may include estrogens or progestins in the presence of estrogens, immunosuppression, and smoking, but other factors related to low socioeconomic status are also involved.

Adult↗

PubMed1989

Variation in the duration of protection given by screening using the Pap test for cervical cancer.

The duration of protection offered by Pap screening for cervical cancer was examined using data on 101 cases of invasive cervical cancer and 396 controls from a Maryland case-control study. Receipt of a Pap test up to 4 years ago afforded significant protection, compared to women screened 11 or more years ago, or never screened. Smoking, intercourse before age 19, and a history of sexually transmitted disease were significant risk factors for cervical cancer; barrier contraception use was protective. Variation in protection from Pap screening was examined by age, race, age at first intercourse, barrier contraception use, and source of last Pap test (obstetrician-gynecologist vs other provider type). Results showed older women, women with earlier age of first intercourse, and non-users of barrier contraception received slightly less protection from Pap tests, while women who received their last Pap test from an obstetrician-gynecologist received significantly more protection than women who did not. Issues of quality of screening and follow-up are discussed in regard to these results.

Aged↗

PubMed2002

[Genital human papillomavirus infection identification by molecular biology among asymptomatic women].

OBJECTIVE: To evaluate whether epidemiological factors may be associated to genital human papillomavirus (HPV) infection. METHODS: A cross-sectional study was carried out among 975 women seen at a public health service for cervical cancer screening in Porto Alegre, Brazil. Women were considered infected if tested positive to HPV either by Polymerase Chain Reaction (PCR) or Hybrid Capture II (HC-II) methods. Women with genital HPV infection were compared to women without infection drawn from the same population. RESULTS: The study enrolled 975 women. The HPV prevalence (both methods combined) in this population was 27%. However, when each diagnostic method is analyzed separately, HPV prevalence was 15% and 16% for HC-II and PCR, respectively. Unconditional multiple logistic regression was used to correlate disease status to women characteristics. A positive association was found with HPV infection for the following variables: years of schooling (11 years: OR=2.05; 95%CI =1.31; 3.20), married (OR=1.69; 95%CI=0.78; 2.00), number of lifetime sexual partners (2 partners: OR=1.67; 95%CI=1.01; 2.77; 4 or +: OR=2.18; 95%CI=1.15; 4.13), age at first intercourse (15-16 years: OR=4.05; 95%CI=0.89; 18.29). CONCLUSIONS: Various factors may contribute to genital HPV infection, especially those related to sexual behavior (young age at first intercourse, high number of lifetime sexual partners, and marital status), and those related to social and economic status (years of schooling).

Adolescent↗

PubMed2005

Features of patients with vulvar dermatoses in dermatologic and gynecologic practice in Turkey: is there a need for an interdisciplinary approach?

AIM: Vulvar dermatoses are very common problems in women and they are associated with significant morbidity. The aims of the present study were to evaluate the features of patients with vulvar diseases in gynecology and dermatology out-patient clinics in Turkey, and to determine the need for a multidisciplinary vulvar clinic in this country. METHODS: A total of 310 patients with vulvar problems as their primary complaints were included in the study. There were 144 women from a dermatology clinic and 166 women from a gynecology clinic. The following factors were recorded for all patients: physical examination findings, menarche age, age at first intercourse, education level, marital status, clinical diagnoses and associated gynecologic problems. RESULTS: There were no significant differences between the two groups when the mean age, menarche age and age at first intercourse were compared (P > 0.05). The number of unmarried women was statistically significantly higher in the dermatology group than in the gynecology group (P < 0.0001). The number of women who graduated from high school and university was also statistically significantly higher in the dermatology group than in the gynecology group (P < 0.01). The frequency of gynecologic problems was statistically significantly higher in the gynecology group than in the dermatology group (P < 0.001); however, dermatologic conditions were the most frequent diagnosis overall (33.54%). Forty patients in the gynecology group were referred to the dermatology clinic. CONCLUSIONS: The approach to patients with vulvar disorders varies from country to country. However, multidisciplinary clinics seem to improve the understanding of vulvar diseases, to make correct diagnoses and to raise patients' quality of life. The need for a multidisciplinary vulvar clinic should not be ignored by the physicians in Turkey.

Adolescent↗

PubMed1986

[Sex behavior following primary radiotherapy of cervix cancer].

57 women with invasive cervical carcinoma treated by primary irradiation were asked by means of a questionnaire about their partnership, especially about their sexual life. 9 women (15.7%) had no more sexual intercourse. 50% of those 48 patients who were sexually active also after the treatment had marked discomfort during coitus due to lack of lubrication. They reported pain caused by a short or narrow vagina less often (20.8%). Only 33.3% had their first intercourse 3 months after the irradiation, frequency of cohabitation was reduced in 68.4% of the patients. The reason for this was fear of recurrence of the cancer, fear of pain and lack of libido: 57.9% of the women mentioned reduced libido. Before irradiation 14% had no orgasm during the coitus, but 52% had none after treatment. The sexual life was not disturbed in those women who had been well informed about the consequences of the irradiation and who had their first intercourse soon after the therapy.

Adult↗

PubMedDate not supplied

Family characteristics and sexual risk behaviors among black men in the United States.

CONTEXT: Past research indicates that family characteristics are associated with sexual risk-taking behaviors in adolescence and adulthood Because the prevalence of sexually transmitted diseases is higher among black males than among males of other races, it is important to understand factors associated with sexual risk in this group. METHODS: Data from 1,125 black men participating in the 1991 National Survey of Men were used in structural equation modeling to examine the association of individual and family characteristics with age at sexual initiation and the lifetime number of sexual partners. RESULTS: Men whose mothers worked were likely to have first intercourse at a younger age than others (beta, -.104), whereas those raised by both parents were likely to delay sexual initiation (.072) and to have fewer partners during their lifetime (-.062). Men who were married or had had first intercourse at an old erage were likely to have a lower total number of partners than others (-.297 and -.369, respectively). CONCLUSIONS: School and community programs should provide culturally appropriate and accessible activities for black youth, and should reach black males early, while they are still in elementary school. Programming targeted at parents mayhelp them learn skills for communicating effectively with children about sexuality-related issues.

Adult↗

PubMed2001

[Entry into sexuality and its hazards].

It is estimated that approximately 20% of adolescents (girls and boys) have their first intercourse experience before 15 years of age. Between 17 and 18 years, approximately 50% have had at least one complete sexual intercourse, and more than one-third have developed a long-lasting relationship. Girls often have an affective link associated with sexual activity. This paper deals with adolescent psychosexual maturation, gender differences, and motivations and feelings concerning their first intercourse experiences.

Adolescent↗

PubMed1989

Prediction of sexual behaviour in a group of young Norwegian adults.

The purpose of the present study was to identify predictors of sexual promiscuity and use of condoms. The empirical data stem from a postal survey of a representative sample of persons aged 19-24 in a medium-sized Norwegian town (n = 565). Four selected predictors explained 28.1% and 17.8% of the variance in promiscuity among men and women, respectively. The strongest predictors of sexual promiscuity of men were "la dolce vita" (i.e. alcohol consumption and visits to discoteque/cinema) and marital status. For women the strongest predictors of sexual promiscuity were marital status and age at first intercourse. Knowledge of HIV/AIDS had no significant effect upon either female nor male promiscuity. Six predictors, including promiscuity and knowledge of HIV/AIDS, did not explain a substantial proportion of the variance of condom use neither among men nor women. Age at first intercourse was the only significant predictor upon use of condoms for both men and women.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Sexual behavior among U.S. high school students, 1990-1995.

CONTEXT: High rates of unintended pregnancy and sexually transmitted diseases (STDs), including HIV infection, among adolescents are major public health concerns that have created interest in trends in teenage sexual activity. METHODS: Nationally representative data from Youth Risk Behavior Surveys conducted in 1990, 1991, 1993 and 1995 are used to examine levels of sexual experience, age at first intercourse, current sexual activity and condom use at last intercourse among students in grades 9-12. RESULTS: The proportion of students who reported being sexually experienced remained at 53-54% from 1990 through 1995, while the percentage of sexually active students who used condoms at last intercourse rose from 46% to 54% between 1991 and 1995. Black students were more likely than white students to report being sexually experienced, being currently sexually active and having had four or more lifetime sexual partners; black students also reported a significantly younger age at first intercourse. Gender differences in sexual behavior were found more frequently among black students than among white or Hispanic students. CONCLUSIONS: Although levels of sexual experience for high school students in the United States have not risen during the 1990s, a very high percentage of students continue to be at risk for unintended pregnancy and STDs, including HIV infection.

Adolescent↗

PubMed2006

Increased sexual risk taking behavior among Swedish female university students: repeated cross-sectional surveys.

BACKGROUND: The aim of this study was to perform a repeated cross-sectional study of female university students' sexual and contraceptive behavior, as well as experiences of pornography and sexual harassment and compare the findings with those from earlier studies. METHODS: Waiting-room questionnaires to female university students (n = 315) visiting a Student Health Centre in Sweden. Similar investigations had been performed earlier, which enabled comparisons. RESULTS: Almost all women (98%) had experienced intercourse and giving oral sex (94%). Condoms were most often used at first intercourse (72%) and combined oral contraceptives at latest intercourse (67%). The ever use of emergency contraceptive pills had increased from 22% to 52% over five years and there was a tendency towards more risk-taking behavior with more sexual partners (mean 5.4 in 1999 and mean 7.4 in 2004), more experience of first-date intercourse without a condom (37-45%), and more self-reported sexually transmitted infections (14-21%). The proportion of women who had undergone an abortion remained stable (6%) and fewer women reported ever being sexually harassed in 2004 compared to 1999. CONCLUSIONS: In conclusion, contraceptive use remained stable over time, but there was a trend towards more risky sexual behavior with more sexual partners, more unprotected first-date intercourse, and more self-reported sexually transmitted infections. Induced abortions, however, had not increased, but the use of emergency contraceptive pills had more than doubled in the five years between 1999 and 2004.

Adolescent↗

PubMed1995

Sexual behavior, sexually transmitted diseases, and risk of cervical cancer.

To explore sexually transmitted diseases and sexual behavior as risk factors for cervical cancer, we analyzed data from a population-based case-control study of breast and cervical cancer in Costa Rica. Data from 415 cases of cervical carcinoma in situ, 149 cases of invasive cervical cancer, and 764 controls were included in the analysis. Multivariate analysis showed that lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, herpes simplex virus type 2 seropositivity, and serologic evidence of previous chlamydial infection were predictors of carcinoma in situ. Serologic evidence of previous syphilis was not associated with carcinoma in situ. Predictors for invasive cervical cancer included lifetime number of sex partners, first intercourse before age 15 years, number of livebirths, serologic evidence of previous syphilis, herpes simplex type 2 infection, and chlamydial infection. Cigarette smoking, socioeconomic status, self-reported history of sexually transmitted diseases, and douching were not associated with either carcinoma in situ or invasive cervical cancer.

Adult↗

PubMed1991

The effects of family structure on the sexual behavior of adolescents.

The effects of two family structures, single- and two-parent homes, on adolescent sexual behavior were studied. The variables of race, age, and gender were controlled. The analysis compared the age at first intercourse, frequency of intercourse in the last four weeks, and virgin/nonvirgin status of adolescents from black single-parent families, white single-parent families, black two-parent families, and white two-parent families. For males, the two-parent family was related to less sexual activity and older age at first intercourse. For females, the two-parent family was not as important as race in influencing sexual behavior. The white females from two-parent families were more likely to be virgins, but once having had sexual intercourse, tended to have a higher level of sexual activity than did black females from two-parent homes.

Adolescent↗

PubMed1990

Relative and attributable risk for cervical cancer: a comparative study in the United States and Italy.

The attributable risk for invasive cervical cancer in the US and Italian populations has been estimated in relation to main 'aetiological' factors (number of sexual partners, age at first intercourse, parity, oral contraceptive use and smoking) and history of Pap smear using data from two case-control studies conducted in the US (466 cases and 788 controls) and Italy (528 cases and 456 controls). The risk of cervical cancer increased in both studies with multiple sexual partners, decreasing age at first intercourse, higher parity, oral contraceptive use and smoking. Levels of exposure to various risk factors were markedly different in the two countries (ie number of sexual partners, frequency of oral contraceptive use and smoking were greater in the US). Multiple Pap smears and a short interval since last Pap smear strongly reduced risk of cervical cancer in both populations, although screening was much more widespread in the US study population, with only 9% of controls reporting no previous smear versus 38% of the Italian control series. The combined population attributable risk for the five 'aetiological' risk factors was slightly greater in the US study (76%) than in the Italian one (69%), chiefly because of a higher prevalence of exposure to sexual factors in US study women. A substantially larger proportion of Italian cases were due in part to deficiency in screening (46% in US and 84% in Italy). Thus, further inclusion of the effect of screening programmes (number of Pap smears and time since last Pap) led to an overall proportion of cases attributable to the examined risk factors of 87% in the US and 95% in Italy.

Adult↗