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What should the physician ask?

The physician who deals with the general public rather than with high risk groups has a considerable disadvantage to overcome. This is because the effectiveness or impact of a control program is directly related to the prevalence of the condition sought in the population at hand. Thus, the physician must develop a set of "verbal screens" which will permit him to select the sub-segments of his general population which should be screened conventionally. These verbal screens may be of two types: 1) a simple inquiry as to whether a generally accepted screening test has been applied within the last year or two, and 2) an inquiry as to whether any risk factors of the more common cancers are present. For cancer of the cervix, women who have first intercourse at an early age or who are of the lower social strata should be identified for screening. For breast cancer, women who are nulliparous, have first birth at a late age, or a family history of breast cancer should be identified.

Age Factors↗

Heterosexual behaviour of 18-year-olds in the Glasgow area.

This paper describes heterosexual behaviour, and protection against pregnancy and sexually transmitted diseases, among 908 18-year-olds in the Glasgow area in 1990. The proportion who reported having experienced sexual intercourse was similar to, though slightly lower than, that reported in most recent studies elsewhere. There were marked sex differences, with males reporting being significantly younger at first intercourse and having had more sexual partners than females. The reported prevalence of unprotected sex (without any contraception) and of "unsafe" sex (without a condom) was high. Being male, of no religious affiliation, an early school leaver, and not in higher education were independently associated with sexual experience. Among the sexually experienced, lower education was also associated with "unsafe" sex, and Catholicism with unprotected sex. The overall pattern of findings, particularly in relation to sex differences, suggests that young people in the Glasgow area may be subject to more traditional influences than those elsewhere.

Adolescent↗

Sexual behaviour of secondary school adolescents in Ilesa, Nigeria: implications for the spread of STIs including HIV/AIDS.

This research examined the sexual behaviour and perception of the risk of HIV/AIDS and other sexually transmitted infections (STIs) among adolescents in Nigerian secondary schools. Quantitative data was collected from 450 senior secondary school 1 and 2 students who were selected from 5 of the 22 co-educational secondary schools in Ilesa using a multistage sampling technique. In addition qualitative data was collected by focus group discussion (FGD) with 8 groups (4 for each of the sexes) of ten randomly selected respondents from 4 other secondary schools. Sixty three per cent had had sexual intercourse. There was no statistically significant (p>0.05) difference between the genders [females (52.3%) males (77.8%)], although males appeared to be more sexually active. The median age at first intercourse was 12 years with a range of 6-19 years. Many of the respondents had multiple sexual partners. There is poor perception of the risk of sexually transmitted infections (STIs) including that of human immune deficiency virus (HIV). It was concluded that there is a high risk of the spread of STIs, including HIV/AIDS in the study population. In view of the high prevalence of sexual intercourse and the reproductive health problems associated with STI, HIV/AIDS, it is recommended that a structured family life education (FLE) curriculum should be instituted for all schools starting at an early age.

Adolescent↗

Sexual behavior among adolescents in Uppsala, Sweden.

The purpose of this study was to compare the sexual behavior of Swedish teenagers in the late 1980s with that in the late 1970s, when a similar study was performed in the same city. Another aim was to discover differences between boys and girls, smokers and nonsmokers, and pupils in theoretical and practical classes. A total of 383 high-school students answered a questionnaire about their sexual behavior, education, and attitudes. Almost one-half of the teenagers had already had intercourse. The median age at sexual debut was about 17 years. Among girls who had had intercourse, the median age at debut was lower than 10 years ago. A majority stated that their sexual behavior had been affected by the acquired immunodeficiency syndrome (AIDS) debate. This was, however, not clearly seen in their sexual behavior. Intercourse seemed to take place earlier in the relationship than 10 years ago, and the wish for more sexual experience had increased. The use of alcohol at the time of first intercourse had decreased significantly. Only 2% thought that they had too much sex education at school. As many as 41% felt they could not talk about sex with their parents. Efforts should be made both to enhance the quantity of sex education at school and to improve its quality. This might increase the chances of young people avoiding unwanted pregnancies and sexually transmitted diseases.

Acquired Immunodeficiency Syndrome↗

[Sexual attitudes and scenarios among students in France, Quebec, and Spain].

Sexual behaviors and attitudes were surveyed among 787, 17-21 years-old students in Lyon (France), Montreal (Quebec) and Salamanque and Madrid (Spain). Near 55% have had intercourse and oral sex in France, while this was the case of almost 80% in Quebec and only about 30% in Spain. Students from France and Quebec were younger at first intercourse, have had more sexual partners, and higher frequencies of intercourse and oral sex than those from Spain. Girls from Quebec have shown higher sexual permissiveness than other girls. Spanish students, particularly girls, consider their parents' sexual attitudes as far less permissive. Religiosity and church attendance seem to still put a strong damper, in Spain, on young people's sexual behaviors.

Adolescent↗

Secular trends and sociodemographic regularities of coital debut age in Norway.

Gender and birth cohort differences and the influence of social background variables on the coital debut age were investigated in the general population of Norway. The data derive from a 1987 questionnaire on sexual behavior mailed to a random sample of 10,000 Norwegians of both sexes, ages 18 through 60; 63% responded to the questionnaire. 94.5% reported that they had experienced intercourse. The median coital debut age was 18.2 years. There were both cohort and gender differences. Younger cohorts have lower coital debut ages, and women younger than 35 years experienced their first intercourse at an earlier age than men in the same age group. When each independent variable was analyzed separately, there were substantial differences between educational levels and social classes with respect to age of coital debut. Multivariate analysis of six separate cohorts revealed independent effects of gender in the two youngest cohorts, whereas educational level had significant independent effects in all but the oldest cohort. Social class did not reveal any independent effect on coital debut age. Population density of the place of residence of the respondents was not substantially related to age of coital debut. Seen together, the independent variables explain about 13% of the variance in coital debut age (by multiple regression).

Adolescent↗

Contraception among young women attending high school in rural Nova Scotia.

OBJECTIVE: To examine contraceptive methods used by rural adolescent women and socio-demographic factors associated with not using effective contraception. METHODS: Students in three Nova Scotia high schools participated in a survey concerning sexual activity, behaviours, and contraception used at last intercourse. Proportions using no effective contraception were examined with respect to socio-demographic variables. RESULTS: The overall response rate was 80%; 46% of 922 young women aged 15-19 had had intercourse in the previous year. Of these, 87% used effective contraception at last intercourse. Average school mark < 80%, and having a father with less than high school education were associated with not using effective contraception. Mother's education and employment, family structure, age of first intercourse and importance of religion were not associated with lack of contraception. INTERPRETATION: Using no, or ineffective, contraception at last intercourse was seen in fewer young women than has been seen in other Canadian studies. In addition to examining use of contraception in rural Canadian adolescents, the study provides evidence concerning factors for consideration in targeted interventions.

Adolescent↗

Sexual intercourse: an unusual cause of vesicovaginal fistula.

Voluntary sexual intercourse in an adult woman with normal vagina is not a known cause of vesicovaginal fistula (VVF), though sexual abuse or sexual intercourse with young girls before reaching physical maturity can result in VVF. Postcoital VVF in an adult woman without these predisposing factors is very infrequent. A nulliparous woman who had VVF after first intercourse is presented, as it is unusual by virtue of etiology.

Adult↗

Historical and clinical factors associated with Chlamydia trachomatis genitourinary infection in female adolescents.

Five hundred sixty-eight adolescent female patients receiving routine gynecologic care at urban clinics were screened by culture for Chlamydia trachomatis infection at both the urethra and endocervix. Culture results for 562 were available from either or both sites. Positive cultures were obtained from 139 (25%). Urethral infection was not associated with either urinary tract symptoms or sterile pyuria, but urethral or endocervical infection was associated with cervical friability (P = less than 0.0001), endocervical mucopus (P = 0.0001), cervical erythema (P = 0.0002), and cervical ectopy or erosion (P = 0.01). Increased chlamydial infection rates were associated with older age (P = 0.01), history of more frequent intercourse (P = 0.01), and history of more than one lifetime partner (P = 0.023), with a marginal association for being black (P = 0.05). Method of contraception, reason for attending clinic, age at menarche, age at first intercourse, years sexually active, number of sexual partners in preceding 6 months, parity, and prior history of sexually transmitted disease were not associated with having chlamydial genitourinary infection.

Adolescent↗

Factors related to sexual intercourse frequency in a group of French pre-retirement managers.

A group of 175 managerial Parisian males, 63 or 64 years old, still working full time were questioned about their sexual activity during a standardized medical examination. Twenty subjects in this group were impotent (ISs), the others, sexually potent (PSs), had had intercourse at least once during the course of the year. Distribution of PSs according to yearly frequency of sexual intercourse (YFSI) fits well with a log-normal distribution. Twenty-two factors assessing psychosocial variables, personality traits and measures of the state of health were studied. Stepwise procedures were used to select sequentially first the variables which best differentiate PSs from ISs, second the variables which best allow us to predict the YFSI among PSs. In our sample of elderly men, sexual potency and also YFSI are closely linked to age at the first intercourse and to certain personality traits. The state of health does not differentiate ISs from PSs, but is significantly linked to YFSI among PSs.

Coitus↗

The sexual and contraceptive socialization of black adolescent males (black adolescent sexuality).

The major source, quantity, and quality of sex and contraceptive information African-American males received as teenagers, and the impact of that information on sexual and contraceptive behavior, were examined among 250 males ranging in age from 12 to 70 years. Mothers were the major sources of sex and birth control information for the adolescent, young adult, and middle adult groups. Fathers and male friends were the second sources most indicated. All of the sample received sex information, and only a small proportion received no birth control information. The amount of sex information received was found to be a significant predictor (P = 0.0018) of the age at first intercourse and the regularity of use of birth control after that. The amount of birth control information received was also a significant predictor (P = 0.0093) of the regularity of use of birth control after the first coitus. Because parents influence their children's behavior through a socialization process, their support of their teenage sons in matters of sexuality and contraception may be of potential value in mitigating the effects of early, unprotected sex.

Adolescent↗

Sexual initiation among adolescent girls and boys: trends and differentials in sub-Saharan Africa.

This paper examined trends in adolescent sexual initiation in sub-Saharan Africa, with emphasis on differentials in social determinants across gender and contexts. Data were drawn from Demographic and Health Surveys in 8 countries that had at least 2 surveys conducted approximately 5 years apart, each with distinct questionnaires for women and men of reproductive age regardless of marital status. The data were useful both for testing of substantive hypotheses about the correlates of adolescent sexual intercourse as well as for elaborating sexual health interventions in contexts of development. The main analytical tool was multivariate logistic models using a generalized estimating equation to consider the probability of a young man or young woman having first intercourse during adolescence. In some countries, observed declines over time in the proportion of adolescents having had sex were not statistically significant after taking into account changes in background characteristics, especially education. Important gender differentials were also found. While secondary schooling was associated with lower probability of early sex among girls in all countries, the relationship was often in the opposite direction among boys. Influences of other sociodemographic and community status variables were generally less important.

Adolescent↗

[Epidemiology of cervical and endometrial cancer].

In 1995, in France, the estimation of the cervix cancer incidence, with 3,300 new cases, is of 10.3 per 100,000, and the incidence of the endometrial cancer with 3,268 new cases, is of 13.8 per 100,000. The decrease of the incidence of the cervical cancer is of more than 50%, in 1975, the incidence was of 22.4 per 100,000. For the endometrial cancer, the decrease is insignificant, as in 1975, the incidence was of 14.4 per 100,000. This phenomenon has been observed in most european countries. The incidence of the adenocarcinoma of the cervix remains stable. The relative survival at 5 years, at all ages in the French cancer registry of Bas-Rhin is of 65% for the cervical cancer and of 73% for the corpus uteri cancer. However, no improvement has been observed since 1975. The risk factors are quite well-known concerning the cervical cancer, there is a strong correlation with the sexual activities, age at first intercourse, the multiplicity of the partners, which clearly shows that the cervical cancer is a sexually transmitted disease. Concerning the endometrial cancer, the risk factors are mostly linked with the reproductive life: age at menarche, parity, age at first birth, menstrual irregularities, infertility and menopause.

Adult↗

Case-controlled study on relevant factors of adolescent sexual coercion in China.

This was a case-controlled study to determine factors related to sexual coercion among adolescent abortion seekers in China. We considered the abortion-seeking women who had experienced sexual coercion as the case group and the abortion-seeking women who had never experienced sexual coercion as the control group. The results of the study indicated that the factors more likely to be related to sexual coercion include lower educational level [odds ratio (OR) = 1.55], not living with parents (OR) = 1.57, floating population (OR = 1.63), beaten by her partner (OR = 2.87), abused by her partner (OR = 1.84), multiple partners (OR = 2.10), sex after excessive drinking (OR = 5.02), younger age at first intercourse (OR = 1.68), and large difference in age between men and women (OR = 2.02). The relevant factors most likely to be associated with sexual coercion are poorly educated, not living with parents, floating population, multiple partners, younger age at first sex, and inequality between men and women.

Abortion, Induced↗

Differences between alcoholic and non alcoholic female psychiatric patients.

Sixty-four consecutive DSM-III alcoholic female psychiatric patients (A-group) were compared with 65 non alcoholic women from the same psychiatric units. The A-women more often had nervous sisters. They were younger at the first intercourse, had had more frequent intercourses during the last year, more often had a poor relationship with their children. They had had more heterosexual partners, living-together relationships and divorces, and had more often a dependent adult relationship. The mean age of the first nervous symptoms and of coming to psychiatry was significantly lower in the A-group, and they had more suicidal attempts and criminality. During childhood, adolescence and adult age, they reacted more often to losses with acting out and alcohol abuse. Nervous problems and close contact difficulties seem to have manifested themselves mostly before the alcohol abuse was established.

Acting Out↗

Reproductive factors and the risk of invasive and intraepithelial cervical neoplasia.

The relation between reproductive factors and cervical neoplasia was evaluated in a case-control study of 528 cases of invasive cancer compared with 456 control subjects in hospital for acute conditions unrelated to any of the established or suspected risk factors for cervical cancer, and of 335 cases of cervical intraepithelial neoplasia compared with 262 outpatient controls. The risk of invasive cervical cancer increased with number of livebirths, the estimated multivariate relative risk (RR) being 4.39 in women with five or more births compared with nulliparous women. There was also an inverse relation with age at first livebirth (RR = 0.42 for greater than or equal to 30 vs. less than 20 years) which, however, disappeared after inclusion of parity in multiple logistic regression analysis. Likewise, cases of invasive cervical cancer tended more frequently to report induced abortions. However, this association was not statistically significant after allowance for confounding factors, including parity. No relation emerged with number of spontaneous abortion and age at last pregnancy. When the interaction between parity and sexual habits was analysed, the relative risk increased in subsequent strata of parity with increasing number of sexual partners or decreasing age at first intercourse, thus suggesting an independent effect of sexual and reproductive factors, and hence multiplicative on the relative risk of invasive cervical cancer. No consistent association emerged between the risk of intraepithelial cervical neoplasm and parity, number of abortions and age at first or last birth.

Abortion, Induced↗

Sex in Australia: attitudes towards sex in a representative sample of adults.

OBJECTIVE: To describe social attitudes towards sex of Australian adults and correlates of a scale of sexual liberalism. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents were asked about their agreement with nine attitude statements. Factor analysis and examination of internal consistency resulted in a six-item scale of liberalism. Correlates of attitude statements and the liberalism scale were examined. RESULTS: Most people agreed that premarital sex was acceptable, that oral sex was considered 'sex', that sex was important for a sense of well-being and that extramarital sex was unacceptable. Men were more likely (36.9%) to disapprove of sex between two men than women were to disapprove of sex between two women (25.1%). Higher levels of education were associated with increased liberalism for men and women, as was speaking English at home, identifying as homosexual or bisexual, vaginal intercourse before age 16, having had more than one sexual partner in the year before interview, having had heterosexual anal intercourse, having no religion or faith, smoking tobacco, and drinking more alcohol. CONCLUSION: Sexual attitudes of Australians largely support a heterosexual paradigm with no sex outside the relationship. High levels of approval of premarital sex are consistent with decreasing age of first intercourse in Australia. Higher levels of liberalism were associated with greater sexual adventurism and health risk taking.

Adolescent↗

Reproductive health knowledge, attitude and practice among high school students in Bahir Dar, Ethiopia.

This study was carried out to investigate the reproductive health knowledge, attitude and practice of high school students in Bahir Dar, Ethiopia. Data were collected using self-administered questionnaire and focus group discussions. The study revealed that the students had high level knowledge of contraceptives and where to obtain contraceptive services; however, level of use was low. Some of the reasons given for not using contraceptives include lack of access to services, carelessness, unplanned sexual intercourse and pressure from sexual partner. The study indicates that young people engage in sexual relationships at an early age without protection or with unsafe non-conventional methods. There was no significant difference between the demographic variables and contraceptive use at first intercourse. Educational level of the respondents was the only demographic variable that had significant association with sexual experience (p < 0.05). We recommend improved access to family planning information and services and family life education programmes based on the needs and experience of these young people as a potential solution to alleviate their reproductive health problems.

Adolescent↗