[Family planning program directed by Ministry of Health: the continuity of the services to acceptants of the program and contraceptive methods].
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The Third Contraceptive Prevalence Survey in Thailand was conducted in 1984. Results indicate a continuation of the rapid rise in contraceptive use among married couples that has been taking place over the past 15 years. Prevalence levels are approaching those common in economically advanced countries. Sterilization is now the most common method, although a fairly broad range of other methods is also widely used. Only modest levels of unmet need for contraception for either limiting family size or spacing children now exist. Fertility rates have fallen since the previous survey, done three years earlier, but to a lesser extent than would be expected from the increased use of contraceptives. Family size preferences are concentrated at small family sizes. A comparison between the Buddhist majority and Moslem minority, made possible through a special sample design, reveals substantial differences between the two groups. Contraceptive use is lower and fertility levels and preferences are higher among Moslems than among Buddhists.
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A review of 205 primary hepatic cancers from different geographic areas reveals that HCC which forms the vast majority (86%) of these, commonly presents as the trabecular variety (76%). The compact and pseudoglandular forms are rare (18% and 6%). Relatively fewer cases of undifferentiated cancer, hepatoblastoma and cholangiocarcinoma are encountered. HCC is often associated with the presence of hepatitis B virus surface antigen (HBsAg) in the liver. This is particularly true of the trabecular variety (81%). A proportion of the compact variety as well as undifferentiated cancers do not appear to be related to HBV infection. Cholangio carcinomas are considered to be related to infection by liver flukes. Hepatoblastomas occur in infancy and childhood and show no known aetiologic association. Aflatoxin may be aetiologically related to same cases of HCC. Continued use of oral contraceptives can occasionally induce HCC.
OBJECTIVE: To determine the acceptability of the female condom (Femidom). DESIGN: Questionnaire survey following the use of the Femidom during sexual intercourse. SETTING: Groote Schuur and Somerset Hospitals, Cape Town. PARTICIPANTS: Nurses, secretaries, doctors and domestic staff of Groote Schuur and Somerset Hospitals who volunteered-61 women were recruited, 8 did not use any female condoms, and 1 did not return. Many women refused, mainly because of the unaesthetic appearance of the Femidom and the fact that they had to continue using their regular contraceptive and they did not think their partners would co-operate. OUTCOME MEASURES: Sexual responsivity compared with that without Femidom; acceptability of the method; women's and their partners' enjoyment of using the method; comparison with the male condom; awareness of HIV-AIDS and protective measures that can be used. RESULTS: Of the 52 participants, 23 used all 10 Femidoms issued to them. Thirteen women and 18 of their partners did not enjoy using the method and 9 had problems with it. Sex with the Femidom was the same or better in 51.9%. The Femidom was unacceptable in 32.7%, acceptable in 52% and very acceptable in 13.4%. Compared with the male condom, 50% of women and 44.2% of men considered the Femidom as good or better. Of the 61 women, 59 had heard of AIDS, and awareness of protective measures was good. CONCLUSION: There was resistance to accepting the Femidom, mainly because of its unaesthetic appearance and because women were participating for altruistic reasons. Acceptance and ease of application improved with use. Comments regarding problems and subjects' and their partners' enjoyment varied from extremely positive to extremely negative; 65.4% considered sex using the Femidom acceptable or very acceptable. It is important to inform and obtain co-operation from the male partner. The female condom has been developed as an alternative for women to use if their partners refuse or dislike using male condoms. Perfect use of the Femidom may reduce the annual risk of acquiring HIV by more than 90% in women who are sexually active with an infected male. The efficacy of the female condom has been described as equal to that of the diaphragm. The Femidom will increase the range of choices of contraceptives and prophylactic methods available for protective sex. It should become accepted as a method of contraception and an adjunct to other contraceptive methods as a prophylactic against sexually transmitted diseases and AIDS, particularly in relationships that are not mutually monogamous.
This is a report on the pathology of the liver in two patients under continuous and prolonged oral contraceptives (11 and 8 years): the first had peliose, the other had focal nodular hyperplasia. Present etiopathogenetic theories are reminded: anabolic steroids in peliose and contraceptives in focal nodular hyperplasia. These lesions should be searched systematically in such patients at any laparotomy.
The determinants of contraceptive implant discontinuation within six months of insertion were examined among 786 low-income women attending family planning clinics in three U.S. cities. The six-month cumulative life-table discontinuation rate was 7.6%. Menstrual side effects were the most common reasons given for early implant removal, although women who discontinued use were no more likely than those who continued with the method to report menstrual irregularities. Women who opted for early removal were more likely than those who continued with the method to experience headaches, hair loss, weight gain and arm infection. Logistic regression analysis indicates that dissatisfaction with prior contraceptive methods, a partner who wants a child within the next two years, perceived pressure from health care providers to choose the implant, exposure to negative media coverage and the number of implant side effects significantly predict early implant discontinuation. Women's social and demographic characteristics, Medicaid status and motivation to avoid an unplanned pregnancy were not significantly related to early removal.
The frequency of menstruation was reduced to once every three months in 196 women by the continuous administration of the oral contraceptive pill, Minilyn, for 84 days (tri-cycle regimen). No pregnancies occurred. One hundred and sixty-one women (82%) welcomed the reduction in the number of periods with the associated freedom from menstrual and premenstrual symptoms, and many found the tri-cycle regimen easier to follow. Weight gain of more than 2 kg, irregular cycle control, especially in the first three months, breast tenderness, and headaches were the main side effects. Menstrual loss was unchanged or reduced in all but seven women. The doctors and nurses on the clinic staff were less enthusiastic about this regimen than the volunteers themselves.
This study evaluates the incidents associated with GyneFIX insertion and first-year expulsion and continuity rates within the usual intrauterine contraceptive practice of a working group of Spanish professionals (GESEG), formed specifically with this aim. It is a prospective, multicenter, observational study of GyneFIX insertion in 1684 women. Data were prospectively collected on a structured form and processed centrally. Interest was focused on difficulties encountered during the insertion procedure and symptoms experienced during insertion. All terms were defined by consensus. Among the total, 18.6% of the women were nulliparous. GyneFIX insertion was rated easy in 92%, with more difficulty in nulliparous women, who showed significantly more symptoms during insertion of the device. First-year expulsion and continuity rates were 5.6 and 88 per 100 women, respectively. The pregnancy rate was 0.3 per 100 women/years. The GyneFIX system is an interesting alternative to standard IUDs for intrauterine contraception with copper, particularly in women who have experienced expulsion of other types of IUDs. Experienced professionals in IUD insertion quickly acquire familiarity with the GyneFIX insertion system, but proper implantation does not completely eliminate the risk of expulsion. Thus, the insertion system should be further modified to achieve a simpler, safer technique.
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During their development, spermatozoa are continually bathed in fluid provided by epithelial secretions of the seminiferous tubule and the epididymal duct. This fluid or microenvironment is probably very important for spermatozoal maturation and survival. Micropuncture and microanalytic studies have revealed the occurrence of several biochemical changes of this specialized microenvironment along the epididymal duct; these changes seem to be linked to sperm maturation. The interactions between maturing spermatozoa and their microenvironment must be understood before interference in sperm maturation through intervention of the formation of the microenvironment is possible. Several compounds have been shown to interfere in spermatozoal maturation in the epididymis although their use as male contraceptives requires further investigation.
Analyses of the frequency of reporting of rheumatoid arthritis have been undertaken as part of the continuing major prospective survey of oral contraceptives. The rate of reporting in oral-contraceptive users (takers) is half of the rate in non-users (controls). The rates for ex-takers and controls are not materially different. The expected rise in the rate of reporting in women over 35 is apparent in controls but suppressed in takers. In the absence of any accountable bias, it is concluded that oral contraceptives protect against the development of rheumatoid arthritis. Although the effect is small, the observation may be valuable in understanding the aetiology of the disease and the mechanism of action of oral contraceptives.
A comparative study of Norinyl 1/35 and Norinyl 1/50 was conducted at the Dom Zdravlja Stari Grad in Belgrade, Yugoslavia. The study sought to evaluate the differences in continuation rates as well as the frequency of selected side effects which might contribute to method discontinuation. The trial included 299 women who were randomly allocated to one of the two oral contraceptives. In the Norinyl 1/35 group, significantly more women (p less than .05) reported a complaint of vaginal discharge as well as an increase in the occurrence of vaginal discharge compared to the Norinyl 1/50 group. There was no significant difference in continuation rates or for particular discontinuation reasons for the Norinyl 1/35 and Norinyl 1/50 groups. No accidental pregnancies were reported during this study. Both oral contraceptives appear to be safe and effective; there appears to be no difference in the acceptability of one oral contraceptive over the other among this group of Yugoslavian women.
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An updated review of research into contraceptives for men is presented. New concepts of the pharmacologic effects of chemical agents on germinal stem cells and spermatogenic arrest, and the effect of new compounds that act at the post-testicular level but do not affect androgen production are discussed. The latest results of studies on steroidal compounds that inhibit pituitary secretion of gonadotropin and hence result in suppression of spermatogenesis and testosterone secretion are presented. The newer contraceptive pills for men are also evaluated. The major drawback to the development of chemical contraceptives for men is the fear of genetic damage and impotence. New and continued research into this type of contraception is urgently needed.
Cystic vaginal adenosis was diagnosed in a 31-year-old woman. This lesion regressed promptly following the cessation of an oral contraceptive (Ovulen-21) which had been used continuously for 5 years. The temporal relationship between discontinuation of contraceptive treatment and the regression strongly suggests that the medication played a causal role in producing cystic vaginal adenosis. A possible mechanism may have been the stimulation of quiescent glands to growth and cystic dilatation, which finally produced a lesion associated with clinical symptoms.
In normal women sedation following intravenous administration of the alpha 2-adrenoceptor agonist clonidine (1.3 micrograms/kg) was significantly greater following 3 weeks' continuous treatment with the combined contraceptive pill than at the end of the 7-day withdrawal period. In contrast, sedative responses to the dopamine agonist apomorphine (5 micrograms/kg subcutaneously) were decreased when subjects were taking the contraceptive pill. These findings are in agreement with animal experimental studies, indicating that oestrogen can alter alpha-adrenoceptor and dopamine autoreceptor sensitivity. Such interactions may be involved in the effects of female sex steroids on mood.
UNLABELLED: Little is known about the use of depot medroxyprogesterone acetate (Depo-Provera, DMPA) in U.S. adolescents before the FDA approved its usage for contraception in 1992. PURPOSE: To determine the experience with DMPA use in adolescents for contraception in the United States. METHODS: A questionnaire survey was sent to U.S. physicians identified as adolescent health care providers. RESULT: DMPA had been prescribed by 41% of surveyed physicians who prescribe contraception for adolescents. Eighty-five percent of patients continued use beyond nine months and 40% continued beyond 21 months. Sixty-seven percent of physician/respondents reported using DMPA in mentally retarded patients. CONCLUSIONS: Many providers used DMPA for contraception in adolescents prior to its FDA approval for contraception. DMPA has a high rate of continuation of use as a contraception in adolescents.