Emergency pelvic packing to control massive intraoperative bleeding during pelvic posterior exenteration.
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Blood Loss, Surgical↗
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Anti-PMSG antibody levels in sheep subjected annually to oestrus synchronisation.
Estimation of the long-term consequences on reproduction performance of the oestrus synchronisation treatments that are annually applied to ewes was carried out on nine officially controlled dairy flocks in the Roquefort region of France. A hormonal treatment combining the insertion of a vaginal fluoro-gestone acetate (FGA) sponge for 14 days and the injection of about 500 IU of pregnant mare serum gonadotropin (PMSG) at withdrawal was applied to the ewes in seven of the nine flocks. The ewes in the two other flocks were used as controls. Blood samples were taken from each female just before the treatment (to test for the presence of residual antibodies) and 20 days after the PMSG injection. Anti-PMSG antibody binding rates were calculated for each blood sample. The residual binding rate increased with age and induce negative effects on the following years reproduction performances, i.e., they increased the probability that the ewes would not become pregnant.
Analysis of Variance↗
[Benzalkonium chloride tampons. Local tolerance and effects on cervix mucus].
Cylinders of soft polyvinyl soaked in benzalkonium chloride have been used as contraceptive tampons. Benzalkonium chloride is a powerful spermicide which belongs to the cationic or saponium detergents. It does not enter the blood stream. These contraceptive sponges are more efficient and better accepted by patients than spermicides used by themselves. One of the principal advantages of the method is to be able to place the tampon in position hours before sexual intercourse. The authors wanted to test if wearing a tampon for a long time did not have an adverse effect on the cervico-vaginal epithelium. 27 women were seen before and after having worn one of these contraceptive tampons for 24 hours: neither the smears nor colposcopy had changed. 21 vaginal biopsies were taken after the tampon had been removed from the area where it had been lying. Vaginal epithelium tolerates the prolonged presence of the sponge well. The authors carried out bacteriological controls before and immediately after removing the tampon 24 hours later. Commensals were still present. Pathogenic sexually transmitted organisms are moderately sensitive to bactericidal action of benzalkonium chloride except for candida albicans, which is resistant. There was no increase in the number of germs in 69 cases studied. The authors carried out scanning electromicroscopy at different magnifications to see the effect on normal cervical mucus at the time of ovulation when it came into contact with benzalkonium chloride. Ovulatory mucus which had been translucent and fluid became thicker and coagulated and the reticulated web took on the appearance of a bunched up web.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Parity and the effectiveness of the Today contraceptive sponge.
A comparative study of the Today sponge and diaphragm conducted in the United States found a significantly higher pregnancy rate for parous compared with nulliparous sponge users. The results of other studies of the sponge failed to confirm this finding. Studies of other vaginal contraceptive methods conducted in the United States also have reported a higher pregnancy rate for parous users. None of these studies have evaluated adequately motivational and other factors that affect contraceptive choice and use. We conclude that the higher pregnancy rate among parous sponge users is unrelated to the sponge per se, and most likely reflects motivational factors related to future childbearing intentions.
Actuarial Analysis↗
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↗
Barrier contraceptives and sexually transmitted diseases in women: a comparison of female-dependent methods and condoms.
INTRODUCTION: Most efforts at sexually transmitted disease (STD) protection center on condom use, but little is known about how condoms compare with other barrier methods, particularly those controlled by women. METHODS: To evaluate the effect of different barrier contraceptives on the prevalence of STDs and other vaginal infections, we retrospectively studied 5681 visits by women to an urban STD clinic. RESULTS: As compared with women using no contraceptive or with tubal ligations, women using the contraceptive sponge or diaphragm had at least 65% lower rates of infection with Neisseria gonorrhoeae and Trichomonas vaginalis, while condom users had 34% and 30% lower rates, respectively. For Chlamydia trachomatis, the reduction was 13% among sponge users, 72% among diaphragm users, and 3% among condom users, although these differences were not significant. When compared with women using condoms, women using female-dependent methods (sponge or diaphragm) had significantly lower rates of both gonorrhea and trichomoniasis. Vaginal candidiasis was more common among women using diaphragms but not other barrier methods, while rates of bacterial vaginosis were similar among all groups. CONCLUSIONS: Women using the contraceptive sponge or diaphragm experience protection from STDs to a greater extent than those relying on condoms. Female-dependent barrier contraceptives should receive more attention in STD risk-reduction programs.
Adult↗
Female control of sexuality: illusion or reality? Use of vaginal products in south west Uganda.
This paper reports on a trial of vaginal products that were distributed and used by 131 women and 21 men in south west Uganda. It focuses specifically upon the issue of female control in heterosexual relationships and examines whether methods which are ostensibly under women's control, will in practice give women greater control of their sexual health. Participants were invited to select two from a range of vaginal products that included the female condom, contraceptive sponge, film, tablets, foam and gel, and use each for five weeks and their favourite product for a further three months. They were interviewed up to seven times over a five-month period. Although the women perceived that a major advantage of the products (with the exception of the female condom) was that they could be used secretly, less than 40% were using the products without their partner's knowledge after one week and this proportion declined over time with only 22% using the products secretly after ten weeks. In the main male partners were told as women felt it their duty to inform them. In general the women were very much more positive about the products than they were about the male condom, as were the men. A contributory factor to their popularity among women was the greater control they gave them. Even though, use of these products in practice often involved negotiation with male partners, the fact that use was contingent on women's action was empowering and increased somewhat their ability to control their sexual health.
Adolescent↗
Gelfoam, vaginal smear, and biopsy in the diagnosis of uterine carcinoma.
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Female↗
Connotative meanings assigned to contraceptive options.
Healthy People 2000: National Health Promotion and Disease Prevention Objectives states that the reduction of unintended pregnancies is one of the primary health objectives for college-aged people. In addition, the reduction in rates of sexually transmitted diseases, with special emphasis on reducing the incidence of HIV infection, is an important objective for this population. One way of addressing these objectives is through promoting use of effective contraception methods. Attitudes toward a particular contraceptive option may play an important role in acceptance of, and predisposition toward, using a given method. The authors used semantic differential scaling to study the connotative meanings college students assigned to 13 contraceptive methods. They asked 751 students (mean age = 19.6 years) to rate each method of contraception, using 7-point scales composed of 15 bipolar adjective pairs. Scale internal consistency was estimated using Cronbach's alpha, and ranges were from .68 for douching to .92 for oral contraceptives. Respondents' rank-ordered approval ratings of the 13 options were as follows: oral contraceptives; abstinence; the condom; the diaphragm; the contraceptive sponge; female sterilization; rhythm; male sterilization; douching, the IUD, and vaginal suppositories (tied); spermicidal foam; and withdrawal. These results indicated general approval for methods that are effective in preventing conception. Semantic interpretation of selected contraceptive options differed by gender and race, but not by age. Implications for contraception education and future research issues are discussed.
Adolescent↗
Another use for the laparoscope and the dangers of using loose swabs at surgery.
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Female↗
Comparative trial of the contraceptive sponge and diaphragm. A preliminary report.
We evaluated the results from an ongoing comparative trial of the VLI contraceptive sponge and the diaphragm used with a spermicide. Among women who were not using vaginal contraceptives when enrolled in the study, the cumulative 12-month pregnancy rates were similar for the two contraceptive methods. Among women who were using vaginal contraceptives (principally diaphragms) when they were enrolled in the study, the group of women assigned to the diaphragm, as might be expected, had a significantly lower pregnancy rate. Rates of side effects and acceptability appeared to be similar for sponge and diaphragm users.
Adolescent↗
[Vaginal and intrauterine contraception].
Vaginal contraception (condom, diaphragm and spermicide in pessary, tablet, jelly, cream, or sponge form) have been little used in France and generally in Europe since the advent of modern contraception with "the pill" and the intrauterine contraceptive device. The former methods, when properly used, are nevertheless both effective and useful, at least as interim measures. In addition, the protection they afford against sexually transmitted diseases and, for the condom, against HIV, is not negligible. Finally, the "barrier" methods of contraception such as the diaphragm and the condom afford significant protection against cancer of the cervix. The intrauterine contraceptive device (IUCD), used in France by 14% of women between 15 and 49 years of age and by 90 million women throughout the world for whom it is the main reversible means of contraception, have a mechanism of action that is still not fully understood. Most IUCD now used are made of copper. There are also diffusion IUCD based on progesterone or a synthetic progestational hormone which are useful in case of anaemia, menorrhagia or dysmenorrhea.
Administration, Intravaginal↗
[White sponge naevus. Report of a family with respect to histopathologic, cytopathologic and DNA-cytometric aspects].
The white sponge naevus is a rare benign, hereditary autosomal dominant disorder of the mucosa. The oral mucosa is most often affected, but vaginal and anal mucosal surfaces may also be involved. Clinically, a whitish-grey, ragged, and folded surface that has no clear demarcation and appears sponge-like is characteristic, often creating problems in differential diagnosis. A potential risk for malignant transformation of white sponge naevus lesions has not been reported. The therapy for this benign hereditary disorder is unknown, however does not appear to be necessary. In the present report of a family with known white sponge naevus in three different generations, clinical, histopathologic, cytopathologic, DNA-cytomertric, and genetic aspects are described and discussed.
Adolescent↗
Obstetric hemorrhage: prophylactic and emergency arterial catheterization and embolotherapy.
The role of arterial catheterization and embolotherapy was evaluated in 18 patients with postpartum hemorrhage or a risk of hemorrhage. Nine patients underwent emergency arterial catheterization for unanticipated postpartum hemorrhage due to uterine and vaginal tears and/or placental abnormalities. Bleeding was controlled with embolization with gelatin sponge in eight patients, while bleeding in one patient stopped spontaneously during angiography. Nine patients underwent prophylactic arterial catheterization before cesarean section or for abnormalities associated with risk of hemorrhage. Two subsequently underwent embolization before surgery, and embolization in two others was performed intraoperatively in response to serious bleeding. Bleeding in the other five was controlled by the usual surgical means. Arterial embolotherapy in these patients was an effective means of controlling postpartum hemorrhage. Prophylactic arterial catheterization has a role in patients with an increased risk for obstetric hemorrhage.
Angiography↗
Effect of the contraceptive sponge on chlamydial infection, gonorrhea, and candidiasis. A comparative clinical trial.
To investigate the effect of the nonoxynol 9-impregnated contraceptive sponge on the incidence of chlamydial infection, gonorrhea, and candidiasis, we conducted a randomized comparative study among high-risk women in Bangkok, Thailand. The first (parallel) portion of the study covered 434 woman-weeks among sponge users and 494 woman-weeks among nonusers. As compared with women not using the sponge, sponge users were found to be less likely to become infected with chlamydia (relative rate, 0.67; 95% confidence interval, 0.42 to 1.07) and gonorrhea (relative rate, 0.31 [0.16 to 0.60]) but more likely to become infected with Candida (relative rate, 2.76 [0.96 to 7.98]). Women who continued in the study were crossed over to the alternate group, with former nonusers starting to employ the sponge and vice versa. The results of this second phase were similar to those of the larger parallel study. Overall, these results suggest that women using the sponge are protected against the two most common sexually transmitted pathogens, which are also those with the most serious health consequences. However, women using the sponge should be advised they may have an increased likelihood of a vaginal infection with Candida.
Candidiasis, Vulvovaginal↗
Primary management of postpartum vulvovaginal hematomas by angiographic embolization.
Three cases of large postpartum vulvovaginal hematomas are reported. After conservative measures including incision and drainage, ligation of bleeding sites, vaginal packing and replacement of volume and coagulation factors failed to control the bleeding in each, pelvic angiography was performed. Brisk arterial bleeding demonstrated on arteriography was controlled by Gelfoam embolization in all three cases. Intra- or postpartum hematologic evaluation revealed a previously undiagnosed coagulation disorder in each patient. The authors suggest that angiography be considered before hypogastric artery ligation whenever possible in patients with large postpartum hematomas and that all such patients be evaluated for coagulopathy.
Adult↗
Effects of nonoxinol-9 on the ability to obtain DNA profiles from postcoital vaginal swabs.
Nonoxinol-9, the active ingredient of many spermicide foams and creams, has been shown to inactivate effectively high titres of HIV in vitro. Therefore the early administration of nonoxinol-9, perhaps by a rape victim herself, has been suggested as a potential prophylactic therapy for prevention of a possible HIV infection. For forensic DNA identity testing, it becomes pertinent to determine whether nonoxinol-9 could have an adverse effect on the recovery of high molecular weight DNA from postcoital vaginal swabs and thereby have an impact on restriction fragment length polymorphism (RFLP) analysis. If high molecular weight DNA can not be recovered, it may still be possible to proceed with analyses using PCR-based tests. In order to investigate the potential effects of nonoxinol-9, inserts, gels, or sponges containing nonoxinol-9 were applied either 15 min pre- or 15 to 60 min post coitus. Postcoital vaginal swabs were taken one and six h after sexual intercourse, the DNA was isolated and DNA identity typing was performed. The results demonstrate that nonoxinol-9 has no negative effect on the ability to obtain DNA profiles, either RFLP or PCR-based, from postcoital vaginal swabs. The quantity of extractable high molecular weight DNA obtained (as determined by slot-blot analysis) was comparable with that from uncontaminated postcoital vaginal swabs. RFLP patterns and PCR-based typing results at the HLA-DQ alpha and D1S80 loci from the nonoxinol-9 treated swabs were consistent with the uncontaminated control swabs and the corresponding whole blood samples of the donors. Therefore an early prophylactic administration of the topical anti-HIV agent nonoxinol-9 is not an impedient for obtaining DNA profiles from evidentiary material.
Coitus↗
Immune response after vaginal application of antigens in the rhesus monkey.
The immune response after vaginal application of antigens was investigated in six sexually mature female rhesus monkeys. Two model antigens, i.e., lipopolysaccharide (LPS) OF Salmonella typhosa and abortive type T-4 coliphages were applied with or without adjuvant. A plastic sponge used as the antigen carrier was introduced into the upper vagina and placed against the ectocervix. For primary immunization, each monkey received 18 vaginal antigen applications and 10 applications for each booster course. For comparison, three other female rhesus monkeys were immunized systemically. Alum or LPS was used as adjuvant. Blood was obtained two times and cervical mucus three times weekly from each monkey. Antibodies were only barely detectable in cervical mucus after the primary vaginal immunization. However, booster treatments resulted in definite antibody responses. Specific antibodies were also detected in the circulating blood after vaginal booster immunization. The antibody level in cervical secretion in three of four cases was higher than that in circulatin blood. Systemic immunization resulted in high levels of circulating antibodies, but less than 10% appeared in cervical secretions. A characteristic decrease in antibody levels in cervical mucus was usually observed at midcycle after local immunization as well as after systemic immunization. More than 90% of T-4 coliphages applied vaginally were absorbed within 48 hours. Although alum appeared to retard the absorption of antigens, it seemed to enhance the local response. More than 90% of the antibodies to the T-4 coliphages could be removed from the serum and cervial mucus by treatment with anti-immunoglobuin G antiserum. The lymphocyte response to antigens was studied by measuring the 3H-thymidine uptake by peripheral blood lymphocytes in culture. A positive response was observed in three of three systemically immunized and in only two of six locally immunized aminals. In general, the immune response was significantly weaker after local vaginal immunization than after systemic immunization.
Animals↗