Biomedical subjects

A N Poindexter

Publications and source records attributed to A N Poindexter.

At least 19 recordsLinked to original sources

PubMed2003

Extra-relational sex among Hispanic women and their condom-related behaviours and attitudes.

Limited data are available concerning sexual behaviour of Hispanic women. A total of 318 Hispanic women were surveyed concerning extra-relational sex and their condom-related attitudes. Fifteen per cent of the sample had a secondary sex partner (apart from the first partner) during the three months preceding the survey. Of these women, 77 and 53% used condoms with their secondary and primary partners, respectively. Among women in monogamous relationships, condom use was low (17%), and nearly two-thirds (61%) of those with a high-risk partner did not use condoms. The most common concerns about condom use among these Hispanic women were a reduction in pleasurable sensations and embarrassment associated with buying condoms. Women with concurrent partners as compared to those with a single partner felt more at risk for HIV and STDs, were less likely to believe condoms have side effects or are unacceptable to their male partners and were more able to use condoms in long-term relations. In conclusion, extra-relational sex among Hispanic women may be higher than previously reported, although more favourable attitudes to condom use are seen among women with concurrent than those with a single partner. HIV/STD programmes in the Hispanic community should tailor to the sexual behaviour of their participants.

Adult↗

PubMed2001

Condom use among sterilized and nonsterilized Hispanic women.

BACKGROUND: Women who use sterilization for contraception are at risk for various sexually transmitted diseases, unless they use a barrier method. Use of condoms is significantly lower among sterilized women than among hormonal-contraceptive users. Among Hispanics, women's perception of risk and the influence of male partners are strong correlates of dual-method use. Limited data are available concerning use of condoms among sterilized women, in particular among Hispanics. GOALS: Past and future use of condoms was examined and compared among 224 sterilized women and 104 hormonal-contraceptive users of Hispanic origin, and the reasons for use or nonuse of condoms were examined. STUDY DESIGN: Cross-sectional survey. RESULTS: As compared with hormonal-contraceptive users, sterilized women were significantly less likely to have used condoms in the 3 months before the study or to have plans to use them in the future (P < 0.001). Despite similarities between various HIV-related characteristics of sterilized and nonsterilized women, the former group had significantly lower perceptions of being at risk for both HIV and other sexually transmitted diseases. Sterilized women were also more likely to have used condoms for the purposes of dual protection from pregnancy. The strongest correlates of consistent condom use by both sterilized and nonsterilized Hispanic women were their perceived susceptibility to disease, male partners' positive opinion about condoms, and the women's ability to use condoms in long-term relationships. Furthermore, the practice of concealing the use of a contraceptive from a male partner was not uncommon, although this characteristic was not related to increased dual-method use. CONCLUSIONS: Sterilized women may be at a higher risk of disease than hormonal-contraceptive users. Among Hispanics, women's perception of risk and male partners' influences predict whether the women protect themselves from pregnancy and disease simultaneously.

Condoms↗

PubMed2001

Previous cesarean section. A contraindication to vaginal hysterectomy?

OBJECTIVE: To compare surgical outcomes of vaginal hysterectomy between women who have had one or more cesarean deliveries and those who have not. STUDY DESIGN: A retrospective, chart review study was performed on women undergoing vaginal hysterectomy during a four-year period. Of 275 women who met the study criteria, 104 had a history of previous cesarean deliveries, and 171 did not. The groups were compared for indications for surgery, operative time, length of hospitalization and surgical complications. RESULTS: Previous cesarean delivery did not affect hemoglobin loss, hospital stay or operative time among women undergoing vaginal hysterectomy. The complication rate (either operative or postoperative) was 12.3% among women without a history of cesarean section, 6.8% among those with one, 3.7% among those with two and 11.1% among those with three or more (chi 2 = 2.8, P = .4). The odds for surgical complications were not significantly different between women with one or more prior cesarean deliveries as compared to those without after adjustment for possible confounders. CONCLUSION: Surgical complications with vaginal hysterectomy do not appear to be higher among women with a prior cesarean section as compared to those without a history of such operation.

Adult↗

PubMed2000

A qualitative study of perceptions, attitudes, and experiences of long-term levonorgestrel implant users.

The present study examined the perceptions, attitudes, and experiences of long-term contraceptive implant users. Group interviews were conducted to obtain qualitative in-depth attitude and opinion data from 31 women who had used the implant for a minimum of four years. Results indicated that many women had experienced side effects with implant use, in particular during the first year. The primary motivations for continuing the use of implant were: women's strong desire for a long-term, reversible, and convenient method that offered effective protection from pregnancy, a strong need for control over one's life, and general dissatisfaction with alternative methods. Exposure to negative media reports, and peer commentaries did not influence implant's continued use. However, intensive educational counseling prior to insertion played a significant role in the long-term use of implant. Findings from this study indicate that women are willing to accept side effects as the price to be paid for an effective and convenient contraceptive method, and for gaining control over their lives. Furthermore, women appear to be less influenced by opposing social climate, in the absence of negative personal experiences. Our findings underscore the importance of educational counseling prior to implant insertion.

Adult↗

PubMed1998

Planned condom use among women undergoing tubal sterilization.

BACKGROUND AND OBJECTIVES: Women who are undergoing tubal sterilization are at risk for various sexually transmitted diseases (STDs) if they do not use a barrier method of contraception. There is a paucity of data concerning dual use of condoms among sterilized women. GOAL: Planned use of condoms for protection against STDs was examined among 2,782 women undergoing surgical sterilization from 1991 to 1996. STUDY DESIGN: Cross-sectional survey. RESULTS: Planned condom use increased significantly over the 6-year study period. Of women who were using condoms before sterilization (n = 646), nearly half indicated no plans to do so after becoming sterilized. Thus, 11% of the total sample experienced an increased risk for exposure to human immunodeficiency virus or other STDs. Condom abandonment was significantly higher among Hispanic and married women. Multiple regression analysis was used to examine the association between condom use and various characteristics. Factors associated with future condom use were younger age, black ethnicity, being unmarried, previous STD, not having a steady partner, higher number of previous sexual partners, having used condoms for disease prevention in the past, and lack of partner involvement in the decision to undergo sterilization. CONCLUSIONS: Use of condoms among sterilized women appears to be on the rise, women at higher risk for disease are more likely than others to be using condoms, and only a small group of women experience an increased risk for exposure to disease as a result of selecting this permanent method of contraception.

Adult↗

PubMed1997

Third-generation oral contraceptives and thromboembolism risk.

Recently, observational studies have suggested an increased risk of nonfatal venous thromboembolic complications in women using oral contraceptives (OCs) containing the third-generation progestins, gestodene and desogestrel. Because of the observational, rather than randomized, nature of these trials, the clinical relevance of these findings is difficult to interpret. Each study included one or more potential sources of bias. In particular, cases came almost exclusively from hospitalized patients with nonfatal venous thromboembolism, which represents only a minority of patients diagnosed with this condition according to current clinical practice. In the absence of a sound biologic rationale to explain the increased risk with third-generation OCs, and considering the potential sources of bias within the current studies, an alternative view argues against causality. Oral contraceptives remain safe and effective. Clearly, additional research is needed to determine the relationship between thromboembolic disease and the use of third-generation OCs. In the interim, women should be informed thoroughly with objective data on all risks associated with the use of OCs.

Contraceptives, Oral, Combined↗

PubMed1997

Factors associated with unintended pregnancy.

This research was designed to identify determinants of unintended pregnancy among women attending family practice or family planning clinics. Survey data were collected from 95 women who were categorized according to whether or not they had experienced an unintended pregnancy. Women reporting unintended pregnancy were younger, reported earlier sexual debut and a greater number of sexual partners than those not having experienced an unintended pregnancy. Those who had avoided unintended pregnancy displayed higher levels of preventive sexual self-efficacy, had more confidence in their ability to use contraceptive methods, perceived more negative consequences associated with having children in the near future, and believed pregnancy among unmarried women to be less acceptable than did women who had had unintended pregnancies.

Adult↗

PubMed1996

Comparison of spermicides on vulvar, vaginal, and cervical mucosa.

The objective of this study was to compare the tolerability of Advantage 24 to two other spermicides containing non-oxynol-9 (N-9). These spermicides were Today Sponge (Sponge) and Conceptrol. In order to examine the incidence of complaints and the clinical observation of vaginal ulceration and irritation of the three spermicides, a randomized, open label, three period cross-over trial was conducted. Thirty-three women, ages 18-45, with a normal vaginal environment based on physical exam, Pap smear, vaginal wet prep, colposcopy, and serum N-9 were randomized into four treatment groups. Each treatment was for seven consecutive days with a 21-day washout. Data obtained were studied by one-way analysis of variance, chi-square, and Kruskal-Wallis test. No vulvar or vaginal abnormality was observed from either spermicide. Subjects had fewer and less severe cervical lesions by colposcopy during treatment with Advantage 24 than with Conceptrol or Sponge (p < 0.01). Comparison of the incidence of abnormal gynecological findings, serum N-9 levels, and the incidence of adverse events before and after treatment with the three study drugs indicate that most subjects had normal examinations pre- and post-treatment. Pap smear and colposcopy changes from normal to abnormal accounted for about 50% of all gynecological findings during the Conceptrol and Sponge treatments, but less than 20% during treatment with Advantage 24. All serum N-9 levels were below the level of detection (< 1.9 microgram/ml). Advantage 24 is better tolerated than Conceptrol or the Sponge. Furthermore, the cervical mucosa appears to be less resilient to spermicides than vulvo-vaginal mucosa.

Adolescent↗

PubMed1996

Sperm transport and survival post-application of a new spermicide contraceptive. Advantage 24 Study Group.

The present study was undertaken to evaluate the effectiveness of Advantage 24 to inhibit sperm transport and survival when applied at 24 hours, 12 hours, and 15-30 minutes prior to a single act of intercourse. Conceptrol, applied at 15-30 minutes before intercourse, was employed as the comparative spermicide. One-hundred-thirty-nine women, aged 22 to 45 years, were enrolled into the study and 111 completed the trial. The ability of the spermicides to immobilize sperm was assessed by postcoital testing (PCT) and by examining the proportion of sperm immobilization failure (SIF) rates. SIF was a postcoital test result with > or = 10 sperm with progressive motility (either sluggish or rapid) per x 400 power field. Conceptrol and Advantage 24 used at 15-30 minutes were similar with respect to their ability to inactivate sperm (0% and 2% SIF, respectively, p = 0.5). At longer intervals between spermicidal application and intercourse, less inhibition of sperm motility was noted (9% and 14% SIF for 12 and 24 hours, respectively). The present study indicates that Advantage 24 is an effective agent to immobilize sperm. The action of Advantage 24 may decrease if it is applied earlier than 15-30 minutes before intercourse.

Administration, Intravaginal↗

PubMed1996

Experiences of injectable contraceptive users in an urban setting.

OBJECTIVE: To examine method-related experiences and acceptability of depot medroxyprogesterone acetate (DMPA) among women using this contraceptive for the first time. METHODS: Five hundred thirty-six women who received an injection of DMPA from any of seventeen clinical settings in southeast Texas, United States, were followed for 1 year. At each follow-up visit, patients were asked about their experiences with DMPA during the past 3 months and their plans to use this method in the future. RESULTS: Amenorrhea, irregular bleeding, and weight gain were the conditions reported most frequently. Reports of amenorrhea, weight gain, and acne or skin problems increased over time, but complaints of longer periods decreased (P < .001). Two pregnancies occurred during the study period. However, of these, one existed before the first injection. Depot medroxyprogesterone acetate's continuation rate at 1 year was 28.6%. Heavier and more frequent bleeding, increased cramping, amenorrhea, weight gain, headaches, depression, and nervousness were more frequent complaints of women who discontinued DMPA (P < .05), whereas lighter and less frequent bleeding were reported more often by those who continued to use this method (P <.05). Women who discontinued use of DMPA were more likely to be married and have a concern about injectable contraceptives than those who continued to use this method. CONCLUSION: Intolerable side effects and changes in menstrual pattern are the most frequently indicated reasons for discontinuing DMPA use. Our results suggest that DMPA's 1-year continuation rate may be lower than previously reported.

Adolescent↗

PubMed1996

Insulin-like growth factor binding proteins in peritoneal fluid of women with minimal and mild endometriosis.

This prospective cohort study was carried out in a university-based infertility clinic to determine the profile of insulin-like growth factor binding proteins (IGFBPs) in patients with mild endometriosis and no obvious mechanical factor contributing to infertility. A total of 26 patients with minimal and mild endometriosis and 10 controls contributed peritoneal fluid at surgery. The variety, expression and levels of IGFBPs were determined by radio-immunoassay and Western ligand blots (WLBs) with quantitation by laser densitometer. A 27 kDa species was significantly lower and 31 kDa species tended to be lower in patients with endometriosis as determined by quantitative laser densitometer. The levels of IGFBP-3 detected by radioimmunoassay and by WLB were correlated in the control group and in the patients with endometriosis in the follicular phase but not in patients with endometriosis in the luteal phase. The level of 27 kDa species seen on WLBs did not appear to correspond to IGFBP-1 determined by radioimmunoassay and IGFBP-3 levels in luteal phase endometriosis patients also departed from values determined by radioimmunoassay. These discrepancies suggest a complex system to control levels of IGF in the peritoneum involving multiple binding proteins and proteases. The IGFBPs of patients with endometriosis may contribute to reproductive dysfunction and be able to serve as markers.

Adult↗

PubMed1995

Characteristics and experiences of American women electing for early removal of contraceptive implants.

The study describes the experiences of 430 women who had Norplant(R) contraceptive implants removed prior to the five years of method effectiveness. Each subject was surveyed when the implants were inserted and again at the time of removal. Descriptive data are presented concerning perceptions of the method before insertion and after removal, reactions to the contraceptive and experiences associated with the removal procedure. Subjects' use of Norplant implants ranged from 14 days to 40 months, with a mean of 13.3 and median of 13 months. Over 95% reported changes in menstrual bleeding patterns and 95% experienced other non-bleeding related side effects. Non-bleeding side effects were the most frequently indicated reasons for removal, followed by bleeding changes. The mean removal time was 34 minutes with a median of 25 minutes. Over 48% reported experiencing significant pain during the removal procedure, and 27% stated that the pain was greater than expected. Despite electing for early removal of implants,the majority of women surveyed indicated satisfaction with all aspects of the method save its effect on their overall health. Although method-related side effects were intolerable for most subjects, their overall perception of the method was generally satisfactory.

Adolescent↗

PubMed1995

Epidemiology of endometriosis among parous women.

OBJECTIVE: To report the prevalence of endometriosis and its associated risk factors among multiparous women, and to determine the relationship between the location and depth of this disease and certain medical and behavioral characteristics. METHODS: Over a 6-year period, 3384 multiparous women underwent laparoscopy for tubal sterilization. Endometriosis was detected in 126 patients (3.7%), who were consequently evaluated for severity of the disease. To conduct a case-control study, 504 patients with no evidence of endometriosis were randomly selected from a group of women who underwent sterilization. Information obtained through physical examination and a self-administered questionnaire was studied by multivariate logistic regression analysis. RESULTS: Most endometriosis lesions were minimal. Factors associated with an increased risk for endometriosis included: advanced age (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.1-3.7), Asian race (OR 8.6, 95% CI 1.4-20.1), long cycle length (OR 1.8, 95% CI 1.1-2.7), one live birth (OR 2.2, 95% CI 1.1-4.3), long duration of intrauterine device use (OR 3.0, 95% CI 1.1-8.1), and long duration of uninterrupted menstrual cycles (OR 2.9, 95% CI 1.3-6.4). Present oral contraceptive use was protective for disease (OR 0.5, 95% CI 0.2-0.9). The role of these factors varied among different disease locations (ovary, uterus and tubes, posterior broad ligaments and cul-de-sac), and depth (superficial or deep). CONCLUSIONS: The prevalence of endometriosis is relatively low among multiparous women, and certain menstrual and reproductive characteristics are associated with its development. Furthermore, the relationship between various factors and endometriosis appears to be site and depth specific. Our findings suggest that asymptomatic endometriosis may be clinically important.

Adult↗

PubMed1995

Leukaemia inhibitory factor in human endometrium during the menstrual cycle: cellular origin and action on production of glandular epithelial cell prostaglandin in vitro.

Leukaemia inhibitory factor (LIF) is a pleiotrophic cytokine which plays an obligatory role in mouse implantation. To investigate its potential role in the regulation of uterine function in the human, LIF secretion by isolated human endometrial glandular epithelial and stromal cells in primary culture was determined. Endometrial cells secreted a detectable amount of LIF protein during the first 48 h of culture. In the follicular and late-luteal phases, LIF secretion by both cell types was low. At every stage of the menstrual cycle, the epithelial cells secreted significantly more LIF than did stromal cells. Glandular epithelial cells of the mid-luteal phase, at the expected time of implantation in the human, secreted significantly more LIF than at other stages of the cycle. Stromal cells showed a similar, but nonsignificant, LIF secretion pattern. It could be concluded that endometrial LIF expression was dependent on cell type and stage of the menstrual cycle, and might thus play a role in human implantation. Oestradiol-17 beta stimulated both prostaglandin (PG) F and E release by the epithelial cells in both follicular and luteal phases. PGE release during the luteal phase was greater than in the follicular phase. However, addition of recombinant human LIF did not change either PGF or PGE release in either follicular or luteal phases, in the presence or absence of oestradiol.

Adult↗

PubMed1995

A cross-sectional survey of condom use in conjunction with other contraceptive methods.

A cross-sectional survey of 3,136 women attending family planning clinics in Texas was conducted to examine past use of and future plans for use of condoms by partners during sexual intercourse for disease prevention in conjunction with other contraceptive methods. Following the receipt of clinical services, including counseling about family planning and disease prevention, both contraceptive and planned condom use reporting increased for the majority of subjects. However 22% of the sample indicated that they intended to reduce condom use in the future and instead use a contraceptive which protects from pregnancy but not from disease. Condom use was indicated more frequently for those who reported at least one risk factor for HIV, but 17% of those at risk indicated lower future condom use than past use. This suggests that without changes in risk behavior, these women will be at increased risk of HIV or another sexually transmitted disease.

Adolescent↗

PubMed1995

Aggressive angiomyxoma of the pelvis and perineum. A case report.

BACKGROUND: Aggressive angiomyxoma of the female perineum and pelvis is a slowly growing neoplasm occurring almost exclusively in women of reproductive age. The tumor is characterized by its locally infiltrative behavior. The high recurrence rate has been attributed to incomplete surgical excision. CASE: A case of a huge, recurrent, aggressive angiomyxoma of the perineum and pelvis was treated. CONCLUSION: Correct preoperative diagnosis and assessment of simultaneous perineal and pelvic involvement indicate a combined abdominoperineal surgical approach to achieve wide, tumor-free margins.

Adult↗

PubMed1994

Characteristics of teens tested for HIV in a metropolitan area.

PURPOSE: This article describes the status of HIV infection in an adolescent population attending publicly supported HIV testing clinics in Houston. METHODS: Records were reviewed of 4017 teenagers receiving HIV counseling and testing services over a period of three years (January 1990 to December 1992). We analyzed demographic characteristics, risk exposure groups, results of HIV antibody testing, and post-test counseling return rates. RESULTS: An overall seroprevalence rate of 10.2 per 1000 was observed, with the majority of cases seen among black females. Forty-nine percent of teens with the virus failed to acknowledge a risk factor, but of those who did, male-to-male sexual contact was the most frequently reported. None who tested positive reported injected drug use. The majority of teens tested never returned to obtain their test results and post-test counseling. CONCLUSIONS: In order to reinforce preventive behavior, institutional and other barriers should be examined and priority given to contacting both seropositive and high-risk clients who have sought testing. Interventions that encourage condom use or address sexual behavior may be more beneficial to teens than those that simply focus on drug use.

AIDS Serodiagnosis↗

PubMed1994

High doses of oral contraceptives do not alter endometrial alpha 1 and alpha v beta 3 integrins in the late implantation window.

OBJECTIVE: To assess the effects of an emergency contraceptive agent on the distribution of integrin heterodimers during that part of the implantation window. DESIGN: Prospective, case-controlled study in a university-based Population Program. In the first ovulatory control cycle after the detection of LH surge, patients had endometrial sampling 11 days after the surge. In the next cycle the procedure was repeated 2 days after the administration of a postcoital contraceptive agent on day 9 after LH surge (100 g ethinyl E2 and 2 mg norgestrel). MAIN OUTCOME MEASURES: The effects of postcoital contraceptives on the expression of integrin heterodimers (alpha 1 and alpha v beta 3 subunits) reported to be unique to secretory phase was determined. RESULTS: All six specimens were consistent histologically with days 24 and 25 of the menstrual cycle by light microscopy. Using immunohistochemistry, strong membrane staining of endometrial glandular cells and superficial epithelium for both alpha 1 subunit and vitronectin (alpha v beta 3) receptor was observed in treatment and controls. No diminution of intensity or distribution was observed relative to pretreatment controls. CONCLUSIONS: There is no apparent change in the level of these two integrins in the human endometrium when high-dose oral contraceptives are given in the later stages of the implantation window. This suggests that the high doses of steroids used in emergency contraceptives may exert their effect through more complex mechanisms than endometrial cell surface changes.

Contraceptives, Oral↗