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PubMed1999

Family planning training in Maryland family practice and obstetrics/gynecology residency programs.

OBJECTIVE: To examine the extent of family planning and abortion training in Maryland family practice (FP) and obstetrics/gynecology (OB) residency training programs. METHODS: All final-year residents in every FP and OB residency training program in Maryland were asked in 1998 how many cases (0, 1-10, > 10) of ten methods of contraception and abortion they had managed. RESULTS: Seventy-five percent (55) of the 73 residents responded. Fifty percent of FP residents had never inserted an intrauterine device (IUD), 43% had never inserted an implant (Nor-plant), 37% had never prescribed emergency contraceptive pills, and 30% had never fitted a diaphragm. Ninety-seven percent of FP residents had no experience with elective termination of pregnancy, and 83% had no experience with sterilization. Twenty percent of OB residents had never inserted an IUD, 16% had never inserted implants or prescribed emergency contraceptive pills, 20% had never fitted a diaphragm, and 36% had no experience in elective termination of pregnancy. Not one FP resident had inserted or fitted more than ten IUDs, implants, diaphragms, or cervical caps. Except for oral and injectable contraception, the majority of OB residents had not managed more than ten cases of any other reversible contraceptive method: 80% had not inserted more than ten IUDs, 72% had not inserted more than ten implants, 88% had not fitted more than ten diaphragms, and 100% had not fitted more than ten cervical caps. CONCLUSION: These survey results indicate a need for more formal instruction in most contraceptive methods for OB and FP residency programs in Maryland. This study concurs with previous national studies showing deficits in family planning training.

Contraceptive Devices, Female↗
PubMed1990

A follow-up study of methods of contraception, sexual activity, and rates of trichomoniasis, candidiasis, and bacterial vaginosis.

A randomized, clinical trial was conducted to evaluate the spermicidal agent nonoxynol 9 as prophylaxis for sexually transmitted diseases. Eight hundred eighteen women using birth control who attended a sexually transmitted disease clinic were evaluated monthly for trichomoniasis, candidiasis, and bacterial vaginosis for 6 months. Women using the active spermicide experienced a somewhat lower incidence rate of trichomoniasis (relative rate 0.83; 95% confidence interval 0.61 to 1.12) and bacterial vaginosis (relative rate 0.86; 95% confidence interval 0.69 to 1.12) as compared with placebo users. The rate of candidiasis was nearly identical for spermicide and placebo users (relative rate 1.02; 95% confidence interval 0.77 to 1.35). The number of sexual partners during the preceding month was related directly to the occurrence of trichomoniasis (p = 0.047) and bacterial vaginosis (p = 0.009) but not candidiasis (p = 0.99). Subjects using oral contraceptives experienced a statistically significant lower rate of trichomoniasis than did women using an intrauterine contraceptive device or who had had a tubal ligation (relative rate 0.56; 95% confidence interval 0.39 to 0.81).

Adult↗
PubMed1975

[Pregnancies with intra-uterine devices in-situ (author's transl)].

Pregnancies occurring with an intra-uterine device in situ were reviewed. Of 438 insertions since 1966, 31 patients became pregnant. 25 pregancies occurred with a Lippes Loop C or D of 277 insertions. Six pregnancies occurred with the Dalkon Shield among 161 patients. About 50% of the pregnancies occurred in the age group from 26 to 29 years and only 13% in the age group 20 to 25 years. Pregnancy did not occur in the age group below 20 years and in the age group above 40 years. The highest number of pregnancies occurred in Para 2's and Para 3's. 84% of all pregnancies occurred within the first 18 months after the insertion of the I.U.C.D. 13 of the pregnancies ended in therapeutic abortion and nine of these were combined with sterilization. Five pregnancies (about 20%) ended in a spontaneous abortion and one pregnancy ended in a premature delivery at 22 weeks. Five pregnancies went to term and three of these patients had tubal ligations post-partum. -- The three ectopic pregnancies are described in detail. There was one ovarian pregnancy, one tubal pregnancy and one pregnancy in the uterosacral ligament. -- The intra-uterine device is considered to be an acceptable method of contraception. The incidence of spontaneous abortion and ectopic pregnancy with an intra-uterine device in situ is increased. Because of the increased incidence of infertility following an ectopic pregnancy, the intra-uterine contraceptive device is only recommended with great reservation as a contraceptive method for nulligravidas.

Abortion, Spontaneous↗
PubMed1982

Experience with Lippes loop and copper-T intrauterine devices in rural Bangladesh.

Experience with IUD use among rural Bangladeshi women within two programmatic efforts demonstrates that the Copper-T IUD suited the needs of younger, lower-parity women better than Lippes Loop. The differential performance by the device was especially marked within the program that offered a broad selection of contraceptive methods and occurred mainly because of lower rates of expulsion and lower rates of discontinuation for bleeding and pain among the Copper-T users. Nevertheless, the easy availability of a wide choice of methods during the second program successfully encouraged dissatisfied IUD discontinuers to try other methods of contraception.

Adult↗
PubMed2006

[Sexual behaviour among adolescents aged 16- and 18-years in Poland in 2005].

OBJECTIVES: Presentation of: frequency of sexual debut and its age among 16- and 18-year-olds; number of sexual partners and use contraception methods among sexually active adolescents. MATERIAL AND METHOD: Representative sample of adolescents aged 16 and 18 years in Poland, students of different type of high schools (N=2893; 1490 boys, 1403 girls) was used. Four questions concerning sexual behaviour were included in anonymous questionnaire and were derived from U.S. the Youth Risk Behavior Survey (YRBS). RESULTS: Among 18-year-olds 49.9% of boys and 47.3% of girls reported sexual debut with mean age 16.5 and 16.8 years respectively. 26.4% of students have had sexual intercourse at age 15 years or earlier. The frequency of sexual initiation increased with age, was higher among adolescents living in towns than in villages and was the highest among vocational school students. 26.3% of adolescents had three or more and 8,8% had six or more sexual partners. 11.1% of sexually active adolescents reported that either they or their partners had use any method of contraception during their last sexual intercourse. The most common contraception methods used was condom (it was reported by 82.9% of boys and 75.2% of girls). 41.1% of adolescents used ineffective methods: withdrawal and "natural methods". CONCLUSIONS: Approximately half of 18-year-olds started their sexual life. There is not gender differences in sexual debut frequency. The risk of unwanted pregnancy, STDs infections and other sexual and reproductive health problems is the highest among girls living in towns and students of vocational schools. The development of family planning and sexual and reproductive health services for young people in Poland is necessary.

Adolescent↗
PubMed2006

The acceptability of an injectable, once-a-month male contraceptive in China.

PURPOSE: An acceptability study of an injectable preparation of the synthetic steroid testosterone undecanoate as a once-a-month male contraceptive method was carried out concurrently with, but independently from, a clinical safety and efficacy trial of this preparation in China, from 1997 to 1999. METHOD: Three hundred eight men, the entire group of volunteers enrolled in the clinical trial, were interviewed using a structured questionnaire. In addition, 24 sessions of focus group discussions and 54 in-depth interviews were conducted with a broad range of stakeholders, including men enrolled in the trial and their wives, potential users, service providers, principal investigators of the six participating clinical trial centers, provincial and national policy makers, and experts engaged in research and development of male methods of contraception. RESULTS: Overall, men found the regimen to be acceptable, and most reported no change or an improvement in their well-being as a result of participating in the clinical study. The frequency of the injections, monthly semen analyses and the need to use another contraceptive method during the period of sperm suppression were reported inconveniences of the trial. CONCLUSION: Further research is needed to assess the long-term safety, continuation rates, satisfaction among users and issues related to service delivery.

Antispermatogenic Agents↗
PubMed1995

Compliance with return appointments for reproductive health care among adolescent Norplant users.

PURPOSE: Norplant's long duration of action may result in users being less motivated than non-users to return for reproductive health care appointments. This study determined compliance with scheduled return appointments among adolescents using Norplant and those using other methods of contraception. METHODS: We retrospectively reviewed the records of all teenagers (age < or = 18 years) who received Norplant between June 1991 and August 1993, as well as those of a comparison group of adolescents, matched for age and race, using other methods of contraception. Subjects receiving Norplant were given appointments for a two-week and an annual examination. Comparison subjects were given only an appointment for an annual examination. Norplant users not returning within 5 weeks or any subject not presenting within 12 months for an annual examination, were considered non-compliant. RESULTS: Eighty-eight adolescents received Norplant during the study period and the records of 85 were available for review. Only 48 of the 85 Norplant users returned for scheduled two-week check-up, while 18 of 43 subjects who had Norplant at least 12 months were compliant with annual examinations. The compliance rate with annual examinations among the 89 subjects not using Norplant was 38%, not dissimilar from that of the Norplant group. CONCLUSIONS: These data demonstrate that compliance with return appointments for reproductive health care among adolescent Norplant users is poor but not significantly worse than that of non-users of Norplant. Strategies promoting the benefits of return visits need to be improved for adolescents receiving contraception.

Adolescent↗
PubMed1982

Risk of ectopic pregnancy following tubal sterilization.

To determine the impact of tubal sterilization on the overall incidence of ectopic pregnancy, the authors compared reported incidence rates of ectopic pregnancy after tubal sterilization with the rates associated with other contraceptive methods or no contraception. For each contraceptive method they then calculated the cumulative lifetime risk of ectopic pregnancy from the age at which a final contraceptive choice was made. Tubal sterilization was found to be associated with a lower cumulative lifetime risk of ectopic pregnancy than no contraception or use of an intrauterine contraceptive device. Tubal sterilization carries a somewhat higher risk of ectopic pregnancy than do barrier methods of contraception. Oral contraceptives are associated with a much lower ectopic pregnancy for most than any other contraceptive method or no contraception. Overall, however, the risk of an ectopic pregnancy for most women undergoing tubal sterilization in the United States is estimated to be lower than if they had not been sterilized and had continued their previous contraceptive practices.

Adult↗
PubMed1988

Determinants of menstrual bleeding patterns among women using natural and hormonal methods of contraception. I. Regional variations.

Records of the occurrence of vaginal bleeding were obtained from women using either a natural method of contraception or one of four types of hormonal contraceptive. The relationships between their bleeding patterns and a number of demographic variables were examined, with the aim of identifying subgroups of women who, if they used a particular hormonal method of contraception, would be likely to suffer more or less disruption to their bleeding pattern than the 'norm'. Within contraceptive method, bleeding patterns were more closely related to the women's geographical region of residence than to any other factor. Some of the differences between regions were consistent across contraceptive methods. European women tended to have more bleeding/spotting days than women in other regions; Latin American women had relatively short episodes and long bleeding-free intervals, whether they were using the ovulation method, combined pills or a vaginal ring. Other differences were method-specific. Women using combined pills in India or Pakistan had fewer spotting episodes than women using the same method elsewhere; those using progestogen-only pills had more. Regional variations in bleeding patterns were particularly marked among women using DMPA, and increased over time: by their fourth injection interval, 25% of European women had amenorrhea, as compared with 72% of subjects in North Africa. These findings need to be confirmed by carefully controlled studies of menstrual bleeding patterns and their acceptability in various ethnic groups. The results would be valuable in counselling new contraceptive acceptors, and could eventually guide the choice of methods for introduction into national family planning programmes.

Administration, Intravaginal↗
PubMed1999

Three new methods for male contraception.

The methods devised for male contraception are meagre. In the current communication, we review 3 recently developed methods applied for male contraception: testicular suspension, polyester-induced azoospermia and prolactin injection. The testicle was suspended in the superficial inguinal pouch close to the scrotal neck using 2 methods: stitch and ball. The azoospermic effect of the polyester sling seems to be due to 1) creation of electrostatic field across the intrascrotal structures, and 2) disordered thermoregulation. Prolactin administration, as a contraceptive method is efficient and safe and has the potential to be developed as a male contraceptive. The effect of the above mentioned 3 methods is reversible. These methods, especially testicular suspension and polyester suspensors, are simple and easily applicable and were well acceptable by the subjects.

Contraception↗
PubMed1988

Practice and methods of contraception among Saudi women in Riyadh.

The use of contraceptives can have an impact on better spacing between children, better child care, improvement of children's health and preservation of the mother's health. In this study 2675 Saudi women attending a gynaecology out-patient clinic were interviewed about their contraceptive practices. The majority of the women (56.0%) were using or had used some form of contraceptive. Oral contraceptives were the most common method; 94.8% of the 1497 women who practised contraception were using or had used this form of contraception. Sterilization accounted for 0.9% of contraceptive practices, while the intrauterine device was a more common form of contraceptive among the more educated women.

Adolescent↗
PubMed1994

Methods of contraception and rates of genital infections.

Bacterial vaginosis, trichomoniasis and candidiasis are the most common genital infection. The aim of this study was to evaluate the various methods of contraception with regard to the prevalence of bacterial vaginosis and vulvo-vaginitis over a period of four years. We also evaluated in the same period the rates of trichomoniasis, candidiasis, bacterial vaginosis and vulvo-vaginitis between users and non users of contraceptional methods and the relationship between ages of patients and types of contraceptives. Finally we considered the change of contraceptive use with regard to age among two different periods. The IUD users showed a significant increase of B.V., T.v. and other bacteria and a decrease of the negatives compared to OC users. Barrier contraceptive users had a reduction (0.01 > p > 0.001) of B.V. and an increase (p < 0.001) of the negatives compared to IUD users. OC users had a significant (p < 0.05) increase in candidiasis, B.V. together with a reduction of the negatives compared to non users group. IUD users had a significant (p < 0.001) increase of B.V. and vulvo-vaginitis from other bacteria, and the reduction of the negatives. Teenagers use OC much more than adults, but less IUD (p < 0.001). The use of OC has increased and the use of IUD decreased among adults (p < 0.001). The barrier methods were seen to be statistically reduced.

Adult↗
PubMed1997

Contraceptive continuation and its determinants in Benin.

To understand better the rates of continuation of different contraceptive methods, a study in 12 family planning centers in Cotonou and Porto Novo, the two largest cities in Benin, was conducted. From January 1 to December 31, 1993, 944 questionnaires completed by new women acceptors of one of three methods of contraception (oral contraceptive, injection, or IUD) were analyzed. For all methods of contraception, the average length of follow-up was 9.5 months. From the start of the analysis, 44.4% (n = 419) of the women were regularly followed, 49.5% (n = 467) were not regularly followed, and 6.1% (n = 58) reported discontinuation of the method. One year after beginning the use of contraception, the cumulative proportion of women at risk of becoming pregnant, for all the methods together, was 42.0% (38.6-45.4%). Age was associated with the probability of abandoning oral contraception (p = 0.01). Three months after the start, the cumulative proportion of drop-out women having chosen oral contraceptive was 37.2% (22.8-51.6%) of the less than 20-year-olds, 19.0% (14.3-23.7%) of the 20- to 30-year-olds, and 23.4% (15.6-31.2%) of the over 30-year-olds. In contrast, drop-out was not associated with age for women using injection (p = 0.96) or the IUD (p = 0.47). Our results indicate a relatively high and rapid rate of discontinuation for modern contraceptive methods, particularly for young women having chosen oral contraceptive. This finding should incite the family planning educators to give more emphasis to the counseling programs, especially during the first three months.

Adolescent↗
PubMed2002

Quick start: novel oral contraceptive initiation method.

Conventional oral contraceptive (OC) starting instructions require waiting until menses to begin the OC. The conventional approach requires detailed patient education about when to begin and also may require the use of less effective or less acceptable interim contraceptive protection until menses. At our urban family planning clinic, we routinely offer patients starting the OC the option of taking the first tablet sooner. We prospectively evaluated predictors of short-term OC continuation among 250 OC requestors who were offered several approaches to OC initiation. Telephone follow-up of 91% of participants showed that women who swallowed the first OC in the clinic were more likely to continue the OC until the second package than women who planned to start the OC later (adjusted OR 2.8, 95% C.I. 1.1-7.3). Other factors associated with short-term continuation were: partner's knowledge of planned OC use, older age, and participant's agreement that she would be very unhappy about becoming pregnant in the next 6 months.

Abortion, Induced↗
PubMedDate not supplied

Contraceptive applications of estrogen.

Estrogens are a primary component of several contraceptive methods: combined oral contraceptive pills, a combined injectable contraceptive, the combined contraceptive vaginal ring, the combination transdermal contraceptive patch, and combined emergency contraceptive pills. Contraceptive formulations that contain estrogen are referred to as combined contraceptives because they also contain some form of progestin. This article reviews the contraceptive methods containing estrogen, beginning with a discussion of combined oral contraceptive pills. Formulations and clinical management, mechanisms of action, noncontraceptive benefits of use, therapeutic uses in addition to contraception, side effects, contraindications to use, and drug-drug interactions are described. Information follows about the newer combined contraceptive products including the injection, vaginal ring, and patch. Finally, combined emergency contraceptive pills are reviewed. Thorough knowledge of the contraceptive methods containing estrogen enables clinicians to provide expert care for women using these products.

Administration, Cutaneous↗
PubMed2000

Barrier methods of contraception.

Despite the problems associated with coitus-dependent methods of contraception, barrier methods have an important role. The fact that they work as contraceptives without systemic effects makes them particularly appropriate for women with medical conditions that prevent the use of hormonal contraception. In addition, condoms and perhaps all barrier methods provide protection from sexually transmitted infections, making them essential for sexually active women at risk for STDs. Their continued importance is evidenced by the ongoing research to develop and improve barrier methods of contraception.

Condoms↗