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PubMed2005

Gynecologic health care for the adolescent solid organ transplant recipient.

The improved survival of pediatric recipients of solid organ transplants has prompted increased attention to quality of life issues. These include attainment of normal growth, involvement in romantic relationships, and the desire to control fertility. As an increasing number of adolescent transplant recipients are involved in normal social and sexual relationships, they require careful attention to their gynecologic and reproductive health care needs. Anticipating the onset of sexual activity before it occurs may help to prevent a mistimed pregnancy by providing or prescribing condoms and emergency contraception in advance. In addition, many transplant recipients can safely use the currently available methods of hormonal contraception provided there is careful attention to organ function, other medical problems, and concurrently prescribed medications. In adolescent patients, issues such as pubertal development and menstruation, contraception, and routine gynecologic health care are typically addressed by the patient's primary care provider. However, the complexity of the adolescent transplant recipient's medical care necessitates close collaboration among all health care providers caring for the patient. This review is intended to help the transplant team better understand the gynecologic health care needs and treatment options of their adolescent patients.

Adolescent↗
PubMedDate not supplied

Acceptability of the vaginal diaphragm among current users.

CONTEXT: Interest in the diaphragm has been growing, in part because it is a female-controlled method that might protect against HIV and other sexually transmitted diseases (STDs). A better understanding of diaphragm acceptability is needed. METHODS: In 2001-2002, female members of a managed care organization were interviewed by telephone. The 215 participants, aged 19-49, who reported diaphragm use during the past three months were asked about their experience with the method and background characteristics. Characteristics associated with women's satisfaction with and consistent use of the diaphragm were identified through multiple logistic regression analysis. RESULTS: Most participants had a low risk for HIV and other STDs. The mean duration of diaphragm use was 8.5 years. Although only 42% of participants reported consistent use in the past three months, most were satisfied with the method (79%) and planned to use it at next vaginal intercourse (85%). Satisfied users had significantly higher diaphragm use self-efficacy and more positive perceptions of the method than those not satisfied. Consistent use was significantly associated with older age and having had some college education rather than none. More than half of women cited dissatisfaction with previous methods (72%) and provider recommendation (61%) as moderately to extremely important in their decision to begin diaphragm use. When asked what they would change about the diaphragm, 32% mentioned concerns related to inserting or removing it. CONCLUSIONS: From an acceptability point of view, the diaphragm appears to be a viable candidate for a female-controlled method for prevention of HIV and other STDs. Our findings have important implications for the reintroduction of the traditional diaphragm and development of new diaphragm-like products.

Adult↗
PubMedDate not supplied

The prevalence of Chlamydia trachomatis in a young, sexually-active population.

A prospective study was carried out to determine the prevalence of Chlamydia trachomatis among 1000 sexually-active women at the Family Planning Association Clinic in Melbourne. This organism was isolated from the cervices of 5.1% of screened women. The women were surveyed about their sexual and gynaecological history, and symptoms of discharge or pain. It was found that women who gave positive results for the presence of Chlamydia were younger, and had commenced intercourse at an earlier age. Risk factors of multiple sexual partners, cervical ectopy and symptoms of urethritis were identified. We recommend that women who have more than one sexual partner should ask their partners to use condoms or, failing this, undergo annual screening for Chlamydia by immunofluorescent staining.

Adult↗
PubMedDate not supplied

The impact of sex education on sexual activity, contraceptive use and premarital pregnancy among American teenagers.

Sixty percent of women and 52 percent of men now in their 20s took a sex education course by age 19, according to the 1984 National Longitudinal Survey of Work Experience of Youth. Whites are more likely than either blacks or Hispanics to have had a course by that age--57 percent compared with 53 percent and 48 percent, respectively. The survey also shows that large proportions of teenagers initiate coitus before they have taken a sex education course. Among young women who first have sex at age 15, for example, only 48 percent have already taken a course (i.e., have taken it at a younger age or at the same age); and among young women who first have intercourse at age 18, the proportion is 61 percent. Young men are even less likely than young women to take a course before they begin coitus--at age 15, the figure is 26 percent, and at age 18, 52 percent. Adolescent women who have previously taken a sex education course are somewhat more likely than those who have not to initiate sexual activity at ages 15 and 16 (though they are no more likely to do so at ages 17 and 18). However, the effect of prior sex education is small, and is weaker than that of virtually every other variable found to have a significant relationship with first intercourse at ages 15-16. Among the strongest determinants of first coitus at those ages are infrequent church attendance, parental education of fewer than 12 years and black race. Older sexually active girls who have previously had a course are significantly more likely to use an effective contraceptive method (73 percent) than are those who have never taken a course (64 percent). This relationship may offset any effect that a sex education course may have in raising the likelihood of early first coitus, since no significant association can be found between taking a sex education course and subsequently becoming premaritally pregnant before age 20.

Adolescent↗
PubMed1988

Lessons from an audit of unplanned pregnancies.

To determine the effectiveness of contraceptive use a two year audit of pregnant women registered in one group practice was carried out. The methods of contraception used by women with unplanned pregnancies were studied and the rates of failure assessed. Of the 518 pregnancies during the study, 187 (36%) were unplanned. Unplanned pregnancies were most common in the 15-19 age group (54 out of 187), and women aged under 25 used contraceptives less reliably than women aged 25 and over. The combined pill was the most effective method of contraception in all age groups. The methods that resulted in most unplanned pregnancies were the sheath in women aged 25 and over and incorrect use of oral contraceptive or no contraception in those aged under 25. The fear of side effects was an important reason why women did not use the combined pill, being cited by 22 out of 134 women, and inappropriate medical advice was cited by a further 20 women. More discussion between doctors and patients and readily available information on the use of oral contraceptives might help to reduce the number of unplanned pregnancies.

Adolescent↗
PubMed1996

Influence of family head's reproductive behaviour on the use of modern contraceptive methods by other members of the family in rural Bangladesh.

A study in Bangladesh showed that the probability of use of modern contraception by eligible family members of a household increases significantly if the household head himself is a user. Multinomial logistic regression showed that contraceptive use was also significantly related with maternal age, parity, education, socioeconomic status and experience of child mortality. Inclusion of ever use of modern contraceptives by the family head or his wife, showed family head's religiosity to be a significant predictor of use, apart from his age and parity, and after controlling for socioeconomic correlates.

Adolescent↗
PubMed1999

Area variations in use of modern contraception in rural Bangladesh: a multilevel analysis.

This study in Bangladesh found that inter-cluster variation in the use of modern reversible methods of contraception was significantly attributable to the educational levels of the female family planning workers working in the clusters. Women belonging to clusters served by educated workers had a higher probability of being contraceptive users than those whose workers had only completed primary education. At the household level, important determinants of use were socioeconomic status and religion. At the individual level, the woman being the wife of the household head and having some education were positively related to her being a user. The model also found that inter-household variation was significantly greater than inter-cluster variation. Finally, the study concludes that after controlling for various covariates at all three levels, the clusters do not have significantly different levels of use of modern reversible methods of contraception. There are, however, some special areas where contraceptive use is dramatically low, and these contribute significantly to the observed inter-cluster variation.

Adolescent↗