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PubMed2005

Contraception usage over the age of 40 in Polish female population aged 45 - 54.

OBJECTIVE: Analysis of particular contraception method usage over the age of 40 as declared by Polish women aged 45-54 according to their education level and place of residence. METHOD: The research was conducted with help of a standardized questionnaire in a Polish nationwide representative sample of women aged 45-54 years (n = 1083) in April 2004. RESULTS: 28% of sexually active women over 40 years old did not use any contraception methods. Most of them were country dwellers (41%), a lower proportion lived in small/moderate towns (27%), and a significantly lower percentage was made by big city dwellers (14%). Among the most popular contraception methods the respondents indicated coitus interruptus (32%), condoms (30%) and the calendar method (26%). Oral contraception was used by 12% of women. CONCLUSION: A considerable percentage of sexually active women aged more than 40 years do not use any contraception method at all or use unreliable methods. Highly reliable methods (condoms, contraception pills) are much more popular among city dwellers. Contraception pills are used by twice as many city dwellers as rural dwellers (16% versus 8%) and by 12% of women from small/moderate towns. Rates of condom usage are also differentiated and vary from 42% in big cities to 26-27% in rural areas and small/moderate towns. Although poor availability of the contraception pill might explain some differences in its usage, it is difficult to quote this factor in the case of condoms.

Adult↗
PubMed2004

Attitudes and behavior towards contraception among Greek women during reproductive age: a country-wide survey.

OBJECTIVES: The study objectives were to explore current contraceptive behavior of Greek women during reproductive age. STUDY DESIGN: Data were drawn from a country-wide survey, conducted with the use of a self-administered questionnaire. The sample, numbering 797 women of ages 16-45 years, was representative of the Greek female population of reproductive age. RESULTS: The most common contraceptive method reported was the male condom (MC) (33.9%) followed by coitus interruptus (CI) (28.8%), oral pill (4.8%), and coil (3.6%). Other methods counted for a 5% and no use of contraception reached a 23.8%. Attitudes over responsibility of using contraception were also explored. The majority of respondents (52%) stated that contraception use is the responsibility of men. The probability of reporting that women should be responsible in using contraception was higher in women aged 25-34 years, in those with higher level of knowledge over contraception issues and in those with an experience of abortion. CONCLUSIONS: The need for sexual education and easy access to counseling services is apparent in order to promote optimal contraception decision-making. The role of women in taking active responsibility over contraception use should be of great importance in reproductive health promotion projects.

Adolescent↗
PubMed2002

Challenging the stereotypes: men, withdrawal, and reproductive health in Lebanon.

In Lebanon, coitus interruptus or withdrawal remains a widely practiced method of family planning. Our research sought to understand the role of men in reproductive health in Lebanon by focusing on this common practice. Our main questions were: Why is it that the practice persists when more effective modern methods of family planning are available? How is the decision taken to practice withdrawal? When is withdrawal practiced and with whom? And, finally, does the practice of withdrawal affect sexual pleasure and the sexual relationship more generally?To answer these questions, we embarked on a small exploratory study using in-depth interviews with 16 open-ended questions. We found that the most important reason for the continuing practice of withdrawal is fear of side effects from other methods. Men and women expect pleasure and fulfillment in sexual relations, but they are willing to limit their pleasure to limit their fertility by means they consider safe. No one prototypical practice of withdrawal seems to exist, and this may explain whether or not the method fails to prevent pregnancy.

Adult↗
PubMed2001

Immediate postabortal contraception with the levonorgestrel intrauterine device, Norplant, and traditional methods.

Women seeking legal first trimester abortion were counseled concerning contraception methods available for use immediately postabortion. Fifty women each accepted hormonal methods that were available only in the clinic and were novel to the country, the levonorgestrel IUD and Norplant implants, whereas another 50 chose either coitus interruptus or abstinence. All were experienced contraceptors, but larger percentages of women selecting the levonorgestrel IUD or implants had used the pill or IUDs previously, were under age 30, and weighed less than 60 kg compared to the other study participants. In the initial 2-6 weeks postabortion, women using the long-acting hormonal methods resumed sexual activity earlier and experienced more bleeding and spotting days than did other study participants, but their hematocrits were not adversely affected. No clinically significant side effects were noted in any group in the 6 weeks following the abortion. At the end of 1 year of follow-up, women using the hormonal methods had experienced no pregnancies and had high rates of continuation. IUD and implant participants had greater weight gain than did the other participants, but their mean weight remained below that of participants using traditional methods. No significant between-group differences in levels or changes in levels from admission were noted in hematocrit and blood pressure. The women found the levonorgestrel implants and IUDs easy and safe to use and highly effective. Bleeding disturbances, including amenorrhea, were the principal features the women disliked.

Abortion, Induced↗
PubMed2004

The determinants of withdrawal use in Turkey: a husband's imposition or a woman's choice?

This paper seeks to understand why Turkey has one of the highest rates of withdrawal (coitus interruptus) use in the world. Despite a pronounced fertility decline, a marked increase in contraceptive prevalence, and expansion of family planning activities, in 1998 one in four Turkish couples relied on withdrawal, and this fraction has remained stable since 1983. In contrast to previous research that has focused on women's reports, here we use the husbands' module of the 1998 Turkish Demographic and Health Survey to examine user characteristics and attitudes, as well as the determinants of withdrawal use among a representative sample of 1950 currently married men in Turkey. Multivariate methods are employed to estimate these effects and the likelihood of using withdrawal rather than other methods. Among other findings, less egalitarian-minded husbands were more likely to select withdrawal over other contraceptive methods, but measures of male authority had only partial predictive power after controlling for other variables. Although withdrawal use typically reflects husbands' preferences, it is widely practiced as it satisfies user requirements and simplifies women's lives. The results of this study are discussed in a broader historical and cultural context and used to provide insight into how Turkey's family planning and reproductive health programs might be improved. In contrast to neighboring countries, there is little sign of withdrawal being displaced in Turkey anytime soon by modern methods.

Adult↗
PubMed1993

Prospective European multi-center study of natural family planning (1989-1992): interim results. The European Natural Family Planning Study Groups.

Since 1989 an international multicenter prospective study to evaluate the effectiveness and acceptability of natural family planning (NFP) methods in Europe has been conducted by the NFP Research Center at the University of Düsseldorf in collaboration with the European Zone of the International Federation for Family Life Promotion (IFFLP). Fourteen NFP-organizations from nine European countries participate in the study. Cycle data from women in the fertile age group are transferred to a special standard computer sheet by the respective organizations and forwarded at three-monthly intervals to the study center for analyses. To date, 10,045 cycles from 900 women aged between 19 and 54 years have been analyzed. This paper presents the pregnancy rate for the women aged between 19 and 45 years of age, who contributed 9284 cycles. In the analyses the cycles were subdivided into two categories consequent to sexual practices during the fertile phase: group I (NFP only--4277 cycles) use only NFP to avoid a pregnancy; group II (FA/mix--5007 cycles) where barrier methods or coitus interruptus during the fertile phase, at least in some cycles, were used to avoid a pregnancy. The women used different clinical indicators such as basal body temperature (BBT), cervical mucus, calculations, cyclical cervical changes or combinations of these to determine the beginning and the end of the fertile phase necessitating a further division into four subgroups, A, B, C, D, and different efficiency rates for each of these groups. In group A (symptothermal method, double check) 15 unintended pregnancies (UIP) occurred in 7404 cycles, giving a pregnancy rate of 2.4 Pearl Index (PI); in group B (muco-thermal method) there were 12 UIP in 1352 cycles with a pregnancy rate of 10.6 (PI); in group C (mucus to detect the beginning and mucus and BBT to determine the end of the fertile phase) there was one UIP in 434 cycles, and in group D (mucus method only) there was one IUP in 70 cycles. The numbers in group C and D are too small to calculate a pregnancy rate (PI). No pregnancy was observed in women over 40 years of age. Our conclusion from these preliminary results is that in the continent of Europe, the symptothermal method when used with periodic abstinence (NFP only = group I) and fertility awareness with the use of barriers during the fertile phase (FA/mix = group II) are effective methods of family planning.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1977

[Intrauterine contraceptive devices (IUD'S) (author's transl)].

The IUD is an excellent and very effective contraceptive method. As contraception and coitus are separated, this technique is acceptable to many couples. It provides prolonged protection and cannot be "forgotten" like the Pill, the diaphragm, or the condom. Its pregnancy rate is 2 per 100 women per year. The greatest clinical experience exists with the Lippes loop. The loop should be the method of choice for parous women, the Copper-T for the nullipara and nulligravida. Regularly menstruating women should be advised to use additional contraceptive protection (condom, diaphragm, coitus interruptus, foam) during the week of highest fertility. This will make the IUD as effective as the Pill. Physicians prescribing this method should be available 24 hours per day for their patients, as emergency situations such as P.I.D., ectopic pregnancy, septic abortion--rare as they are--would need prompt attention.

Coitus↗
PubMed1978

Sperm procurement and analysis in Jewish law.

Whether, and how, a husband whose marriage has proved barren may procure a sample of his semen for a fertility test is a question that has often been discussed in rabbinic writings. It is permissible according to most rabbis to obtain sperm from the husband both for analysis and for insemination, but a difference of opinion exists as to the method to be used in the procurement of it. Masturbation should be avoided if at all possible and coitus interruptus or the use of a condom seem to be the preferred methods. Since many important legal and moral considerations, which cannot be enunciated in the presentation of general principles, may weigh heavily upon the verdict in any given situation, it seems advisable to submit each individual case to rabbinic judgment, which, in turn, will be based upon expert medical advice and other prevailing circumstances.

Female↗
PubMed2004

Norplant insertions at the Zeynep Kamil Gynecologic and Pediatric Training Research Hospital in Istanbul.

OBJECTIVE: This study was conducted to determine sociodemographic characteristics and usage interval according to insertion period, observed side effects and reasons for discontinuation in 756 cases where Norplant was inserted and removed for any reasons at our hospital since 1994. METHODS: Seven-hundred and fifty-six cases in whom Norplant was inserted and removed since 1994 were included in our study. Sociodemographic characteristics, former contraception method, reasons for choosing this method and side effects seen during the usage period were determined. In all cases, reasons for discontinuation, sociodemographic characteristics and usage interval according to the insertion period were investigated. Statistical analysis of this study was performed with SPSS 9.0 (analysis of variance). RESULTS: Mean age of cases was 26.5 +/- 4.9 years, mean number of living children was 2.0 +/- 1.2, and 50.4% of cases had no health insurance. Most of the cases used coitus interruptus previously as a contraceptive method and chose Norplant use because of its effectiveness. Insertion periods were as follows: interval, n = 513 (67.9%); postpartum, n = 127 (16.8%) and postabortion, n = 116 (15.3%). Various side effects were detected in 79.8% of the cases. Bleeding problems were seen in 69.8%. Pregnancy occurred in only one case. Mean Norplant usage interval was 3.08 +/- 1.68 years. The longer usage interval was seen in cases with lower educational level. When we compared the usage intervals between interval, postpartum and postabortion periods, we found that the interval group had a shorter mean duration of Norplant use. Discontinuation because of bleeding problems occurred in 38.1%. Removal of all Norplant implants was performed at a single session in 731 cases (96.4%). After Norplant removal, most cases selected either condom or IUD as the contraceptive method. CONCLUSION: It is concluded that despite the frequent occurrence of side effects, Norplant is a modern, long-acting, highly effective, reversible, easy-to-use, satisfactory form of birth control, especially in selected cases.

Adult↗
PubMed2004

The long-term effects of DDT exposure on semen, fertility, and sexual function of malaria vector-control workers in Limpopo Province, South Africa.

Hormonally active chemicals in the environment such as DDT have been associated with declining male reproductive health, especially semen quality. A cross-sectional study of 60 workers was performed near the Malaria Control Center (MCC) in Tzaneen, Limpopo Province, South Africa. Tests included a questionnaire (sexual function, fertility, and job history), a physical examination of the reproductive system, and semen analysis (produced via coitus interruptus or masturbation). Sperm count, density, and motility using the World Health Organization criteria and morphology using the strict Tygerberg criteria were determined. Serum o'p' and p'p' isomers of DDE, DDT, and DDD were measured. Forty-eight (81.0%) participants produced a semen sample, while all completed the questionnaires and physical examination. The mean sperm count was 93.8+/-130.3 million, and sperm density was 74.6+/-85.1 million/mL. The mean normal morphology score was 2.5+/-1.8% of subjects. Eighty-four percent of morphology scores were below either the WHO or the Tygerberg criteria, with the highest individual score being 6%. Self-perceived current problems with sexual function ranged between 10% and 20%. The most prevalent genital abnormality was abnormal testis disposition at 71%. There were few significant associations between DDT exposure measures (measured as years worked at MCC and serum DDT) and reproductive outcomes. p'p'-DDT was negatively associated with semen count (beta=-3.7+/-1.7; P=0.04; R2=0.05 adjusted for age, abstinence, physical abnormality, and fever in last 2 months). While the semen quality in the study was less than normal, no strong evidence for a DDT effect was found.

Animals↗
PubMed1985

Characteristics of women undergoing induced abortion: results of a case-control study from Northern Italy.

In order to identify subgroups of women at elevated risk of induced abortion, personal characteristics and habits, selected medical histories and contraceptive practices of 873 women undergoing legal abortion in various areas of Northern Italy were compared with those of 504 control subjects identified in family planning clinics of the same hospitals or area health authorities. When age was allowed for, the risk of induced abortion was not strongly influenced by marital status, education or other indicators of social class. However, women who were employed, independently from the type of occupation, showed markedly lower abortion risks than housewives. Among various indicators of sexual habits investigated, the strongest determinant of legal abortion was the frequency of sexual intercourses over the previous six months, women with less frequent intercourses showing a markedly elevated risk estimate (RR = 2.82). Induced abortion was less frequent among ex-smokers and more frequent in heavy smokers, but was not appreciably influenced by several other indicators of lifestyle habits and history of gynaecological or psychiatric complaints. The risk of abortion was not influenced by the number of livebirths, but was lower for women with later age at first birth. Less than 5% of case and control subjects reported more than two previous induced abortions, thus indicating that abortion is more of an "accidental" event rather than a widespread contraceptive practice. However, over three-quarters of abortions occurred in women reporting no contraception at all or coitus interruptus, thus underlining the scope for family planning education in this population.

Abortion, Legal↗
PubMed2006

Surgical termination of pregnancy: evaluation of 14,903 cases.

OBJECTIVE: To evaluate the demographic and clinical characteristics of patients who underwent surgical termination of pregnancy and to assess the efficacy of the termination methods. MATERIALS AND METHODS: This retrospective study was carried out on 14,903 healthy women who had intrauterine pregnancy of <or= 10 weeks of gestation as determined by transvaginal ultrasonography. All patients underwent either suction curettage (SC) with dilatation or SC only. Family planning counseling was given to all patients before the procedure and subjects were evaluated for any complications after the procedure. RESULTS: SC with dilatation was performed in 43.2% of patients and SC only was performed in 56.8%. Mean age was 31 +/- 4.3 years. Only 5% of cases were primigravidas and 87% had formal education; 91% had one or more surgical abortions for previous pregnancies. Before the procedure, 67% were using coitus interruptus, 10% condom, 6% intrauterine device, 5% vaginal lavage, and 3% oral contraceptives as the contraceptive method, and 9% did not use any contraception. Infection, excessive bleeding, retention of fetoplacental material and uterine perforation were reported as complications of the procedure. After the procedure and following family planning counseling, 92% began to use an efficient, modern contraceptive method. CONCLUSION: This study points out that surgical abortion is not a contraceptive method. Most surgical abortions can be prevented by effective usage of modern contraceptive methods. The importance of well-planned contraceptive counseling and education is emphasized. Better family planning counseling and education, and the availability of modern contraceptive methods can easily decrease the incidence of surgical abortions.

Abortion, Induced↗
PubMed2003

Does preejaculatory penile secretion originating from Cowper's gland contain sperm?

PURPOSE: To determine if spermatozoa are present in the preejaculatory penile secretion, originating from Cowper's gland. METHODS DESIGN: Prospective clinical and laboratory study. SETTING: Andrology and Sex Counseling Unit, Department of Obstetrics and Gynecology, Academic Teaching Hospital. PATIENTS: Five patients referred for premature ejaculation, three for excessive fluid secreted during foreplay and four normal healthy volunteers. INTERVENTION: Glass slide smears of preejaculatory Cowper's gland secretion obtained during foreplay from at least two different occasions, and semen samples after masturbation. MAIN OUTCOME MEASURES: Microscopic examination of air-dried smears, and routine semen analyses. RESULTS: None of the preejaculatory samples contained sperm. All the patients had sperm in routine sperm analyses. CONCLUSIONS: Preejaculatory fluid secreted at the tip of the urethra from Cowper's gland during sexual stimulation did not contain sperm and therefore cannot be responsible for pregnancies during coitus interruptus.

Adult↗
PubMed1990

[Use of oral contraceptives in East Germany by middle-aged females].

This study was based on the data from 1214 women included in the controlled group within a hospital-based case-control study on the association between breast cancer and the use of oral contraceptives. This is a sample of middle-aged women. Women with a reason for referral, presumably associated with infertility, were excluded. Oral contraceptives are (apart from coitus interruptus) in 76% of the cases the method of contraception most frequently used, followed by the rhythm method and condoms. The use depends strongly on the age. Only 40% of the women, now 55-60 years of age, ever used oral contraceptives, whereas 91% of those now under 40 have been using them. Other connections can be seen with level of education, marital status, and reproduction and sex life. With the use of special preparations, there are differences between women of younger and older generations, partially based on the different times these preparations were introduced to the market. The exclusive use of sequential oral contraceptives decreases in the older cases.

Breast Neoplasms↗
PubMed2001

Ukrainian medical students' experiences, attitudes, and knowledge about reproductive health.

In a 1999 classroom survey of sexual behavior among 689 1st-year medical students at Donetsk State Medical University, Ukraine, 59% of the women and 83% of the men revealed they had "ever" had sexual intercourse. The mean age of first intercourse was 15.7 years for the men and 16.6 years for the women. Thirty-two percent of the students reported they did not use contraceptives at their first intercourse, and 19% said they used no contraceptives at their most recent coitus. Condoms were the most frequent means of contraception, followed by coitus interruptus. Less than 5% used oral contraceptives, and 73% of students reported being afraid to use them. About 6% of the students reported they had had sexually transmitted infections (STI) and 10% had had an abortion. Improving knowledge concerning unwanted pregnancies and STI among Ukraine's future health providers may contribute to improving reproductive health issues in general in Ukraine.

Abortion, Induced↗
PubMed2000

Sexual behavior of secondary-school students in Slovenia.

OBJECTIVES: The aim of this study was to analyze the sexual behavior of secondary-school students in Slovenia. METHODS: The research was carried out on a representative sample of 4706 secondary-school students aged 15-19 years in Slovenia. The data were obtained by a self-administered questionnaire in April 1996. RESULTS: The average age of the students was 17.5 years. Most students had experiences in kissing (70%) and caressing (59%); a lower number had experiences in petting (43%). Sexual intercourse had been experienced by 38% of the students. The median age at the first sexual intercourse was 18.5 years. The main motives for the first sexual intercourse were love (45%), accident (22%) and curiosity (15%). Contraceptive methods currently used were condoms (60%), the pill (14%), coitus interruptus (4%), other methods (3%) and no method (19%). According to the students, the most appropriate sources of information on sexuality were friends (26%), parents (19%), different sources (19%) and professionals (15%). CONCLUSION: By the age of 18.5 years, approximately one-half of secondary-school students in Slovenia experience sexual intercourse. Most students currently use effective contraception, condoms being the most popular method. The students expect to receive information about sexuality from friends, parents and professionals, but not from the school environment.

Adolescent↗
PubMed2005

Demographic analysis of post-abortive and interval-administered hormonal contraceptive methods.

OBJECTIVE: To compare, using method type and application time, the demographic characteristics of women using hormonal contraceptive methods administered after abortion or during the interval period with those of intrauterine device (IUD) users. METHODS: The demographic characteristics of women to whom oral contraception (OC), monthly injection, depot medroxyprogesterone acetate (DMPA), or IUD were administered in the post-abortive and interval periods between January 1998 and September 2001 in our clinic, were evaluated with the help of a registration system based on the Microsoft Access software used in our clinic. Demographic characteristics recorded were: age, reproductive expectation, previous contraceptive method, education level, number of live children, number of induced and spontaneous abortuses. RESULTS: A total of 10 500 women were included in the study. Of these, 6601 women had taken a contraceptive method during the interval period, and 3899 women had taken a contraceptive method post-abortion. Only 4.6% of the cases were younger than 20 years, 48.3% were between 21 and 30 years, 37.2% were between 31 and 40 years and 9.9% were 41 years old or over. The DMPA-administered group contained the highest number of women > or = 41 years when compared to other groups (22.8%). In reproductive expectations, 65.8% of the cases wanted no more children; 1.3% wanted to have a baby within a 2-year period whereas 23.7% wanted a child after 2 years. The proportion of women wanting no more children was greatest in the DMPA-administered group (77.3%). No previous use of contraceptive methods was reported by 20.7% of women; 27% were using coitus interruptus. The education level of the women was as follows: 10% had no education, 58.3% had education to primary school level, 23.2% to secondary-high-school level and 2.1% to university level. The group of women who chose OC as their contraceptive method contained the highest proportion of university graduates (6.5%). Only 6.26% of the women had no children. The proportion of women in the DMPA-use group with three or more children was higher compared to that in other groups (33.2%). CONCLUSION: The evaluation of demographic characteristics plays an important role in counseling, and in the efficacy and continued use of contraceptive methods.

Abortion, Spontaneous↗
PubMed2005

Change in contraceptive choices and the effect of education on use of contraception at the family planning clinic of Sişli Etfal Training and Research Hospital, Istanbul, Turkey.

OBJECTIVE: To investigate change in contraceptive use and the effect of education on fertility and contraceptive attitudes at our family planning clinic. METHODS: For this retrospective review, medical charts from Sişli Etfal Training and Research Hospital Family Planning Center were obtained. Records were evaluated for 2514 women in 1997 and 2268 women in 2002. RESULTS: During the 6-year period studied, significant decreases occurred in the number of births, elective abortions, gravidity and number of living children (p < 0.001). When the patterns of method use were compared, use of intrauterine devices and of coitus interruptus diminished whereas pill and condom use increased. Parallel with the rise in educational level, intrauterine device use declined whereas pill and condom use rose significantly (p < 0.001). CONCLUSION: The sociocultural and educational levels of women affect their contraceptive choices. Policies aimed at raising the socioeconomic and educational level of women should be supported to prevent maternal and fetal complications as a result of unwanted pregnancies.

Adult↗