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PubMed1978

Menstrual regulation in Ibadan, Nigeria.

Menstrual regulation (MR) (i.e., vacuum aspiration of the uterus with a small diameter, flexible cannula before pregnancy can be determined by a conventional pregnancy test) has been proven safe and effective in many clinics around the world. The present study, which we believe is the first such study of MR in Subsaharan Africa, shows that, for women in an urban African setting, MR is an acceptable backup for other contraceptive methods. Data on 507 MR patients treated at the University College Hospital in Ibadan, Nigeria, between January 1974 and April 1976, showed that the procedure was both safe and effective for 93.4% of the study subjects: there was an overall complication rate of 3.4% and MR failed in seven cases (3.2%). Data also showed that MR is an effective method of recruiting new contraceptive acceptors, as well as an effective back-up procedure in case of contraceptive failure.

Adult↗
PubMedDate not supplied

Contraceptive choices--turning back the clock.

Contraceptive choices are being reduced rather than being expanded in many parts of the world, particularly in Western countries. Although this paper presents an Australian perspective, the concerns are shared by family planners in other countries. The reasons for this are multiple and complex and often interrelated but ultimately depend on commercial considerations. The community expectation is that an ideal contraceptive can and does exist, but the media sensationalization of contraceptive problems has given many contraceptive methods a poor image. Contraceptive availability is also affected by liability issues, which have increased the cost of product liability insurance, and medical liability insurance of health professionals, increasing both the cost of contraceptives to the individual and the availability of services such as IUD insertions and sterilization, as practitioners withdraw their services, due to cost of insurance. The cost of marketing a new contraceptive from the time the idea is first developed until it is approved for marketing also deters manufacturers from developing new contraceptives. Delays in drug evaluation procedures in many countries deters companies with already well established contraceptives from marketing them in such countries. The effect of political stands by radical feminists or consumer groups, also effect both the image and the availability of contraceptives, as can be seen with the saga of Depo-Provera, RU486 and intrauterine devices. Similarly, the moral perceptions of anti-abortion groups and health care providers is also a threat to fertility control services. Possible solutions to some of these problems are offered in the paper.

Contraception↗
PubMed2006

Surgical methods of contraception and sterilization.

Many techniques for surgically sterilizing dogs and cats have been described; each technique offers advantages and disadvantages to both the patient and surgeon. Techniques that have been described include traditional midline ovariohysterectomy, lateral flank ovariohysterectomy, castration, early age gonadectomy, ovariectomy, laparoscopic ovariohysterectomy and ovariectomy, and vasectomy. Regardless of the technique selected, strict adherence to sound surgical technique and asepsis is mandatory for good surgical outcome with minimal complications. This review will discuss surgical principles, complications, outcomes, as well as relevant current literature associated with each of these techniques of surgical sterilization.

Animals↗
PubMedDate not supplied

[Contraception at 40].

During forty, fertility decreases but the risk of spontaneous pregnancy is not negligible, so contraception for forty years old women remains necessary. Several contraceptive methods are available: local contraception, intra-uterine devices, hormonal contraception. Progestogen-only pills, microdosed and continuously administered are to be avoided at this time of life because they can result in hyperestrogenic adverse events. Progestin implants are interesting if the woman presents contraindication with estrogens or if she is non compliant with oral contraceptives. Oral contraceptive use is associated with numerous benefits during forty: it controls properly cycles and menstruations, it decreases bone loss and it decreases gynaecological disorders and risk of endometrial and ovarian cancer... But cardiovascular risk (venous and arterial thrombo-embolism) remains increased, whatever oral contraceptive is used, second or third generation, and in spite of lower dose of ethinylestradiol, even if a trend towards the decrease of this risk is observed. Contraindication for one kind of oral contraceptive means contraindication for all oral contraceptives and necessarily bare respect of this. These contraindications led to contraceptive use of progestin with antigonadotropic activity; however if pregnane derivatives are devoid of any deleterious metabolic effects, they have no indication for contraception in their marketing authorization.

Adult↗
PubMed1999

The intrauterine device and its dynamics.

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health--a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (1) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs.

Contraindications↗
PubMed1990

Antifertility effects of neem (Azadirachta indica) oil by single intrauterine administration: a novel method for contraception.

A novel use of neem (Azadirachta indica) oil, a traditional plant product, for long-term and reversible blocking of fertility after a single intrauterine application is described. Female Wistar rats of proven fertility were given a single dose (100 microliters) of neem oil by intrauterine route; control animals received the same volume of peanut oil. Whereas all control animals became pregnant and delivered normal litters, the rats treated with neem oil remained infertile for variable periods ranging from 107 to 180 days even after repeated matings with males of proven fertility. The block in fertility was, however, reversible as half of the animals regained fertility and delivered normal litters by five months after treatment, without any apparent teratogenic effects. Unilateral administration of neem oil in the uterus blocked pregnancy only on the side of application whereas the contralateral uterine horn treated with peanut oil had normally developing foetuses; no sign of implantation or foetal resorption was noted in the neem-oil-treated horn. The ovaries on both sides had 4-6 corpora lutea indicating no effect of treatment on ovarian functions. The animals treated with neem oil showed a significant leukocytic infiltration in the uterine epithelium between days 3 and 5 post coitum, i.e. during the pre-implantation period. Intrauterine application of neem oil appears to induce a pre-implantation block in fertility; the possible mechanisms of the antifertility action are discussed.

Animals↗
PubMed1999

Integrated maternal and infant health care in the postpartum period in a poor neighborhood in Santiago, Chile.

An integrated postpartum health-care program was established by the Consultorio San Luis de Huechuraba (CSLH), a nongovernmental organization in a neighborhood of extreme poverty in Santiago, Chile. The main components were education, maternal and infant health care, support for the mothers, and active participation of women from the community served. The program was evaluated through indicators of contraceptive use, breastfeeding performance, infant growth and health, and a qualitative assessment of women's satisfaction. Controls were women of similar characteristics attending the nearby public clinic. Acceptability of contraceptive methods was similar but contraceptive options differed between clinics. The total number of pregnancies and of respondents lost to follow-up was significantly higher for the public clinic than for the CSLH. Breastfeeding duration was significantly longer and infant growth and health were found to be significantly better at the CSLH than at the public clinic. Women valued being treated with respect, receiving education and support, and being offered timesaving services and wider contraceptive choices at the CSLH. This study demonstrates that such interventions are possible for poor communities, providing significant advantages for women and children.

Adult↗
PubMed2003

Sexual knowledge, attitudes, and risk behaviors of students in Turkey.

This survey produced baseline information about student knowledge of sexually transmitted diseases (STDs), their sexual attitudes, and their behavior to help establish control and education programs. The study was conducted at Ege University, Izmir, Turkey, during the 1999-2000 academic year. A total of 2,217 first- and fourth-year students determined by stratified sampling constituted the study group. All students who volunteered to participate completed a questionnaire assessing sociodemographic and knowledge factors, sexual attitudes, behavior, and history of STDs. The rate of students having had sexual experience was 36.6%. Males were more sexually active than females. Most students (71.4%) began sexual activity at ages 15-19 without any difference by gender. Males reported significantly more sexual partners than females. Similarly, the rate of male students never using condoms was significantly higher than females. Condom was the most frequent contraception method, followed by oral contraceptives and withdrawal. Mean score on the knowledge questions was 16.29 (highest score 30). The most widely known STD was HIV infection and AIDS. Students' knowledge of transmission routes, signs and symptoms, and risk groups of STDs was insufficient. Main sources of knowledge were visual and print media, and friends. Most students (84.7%) viewed prevention from STDs as a person's own responsibility. Young people in Turkey are sexually active and tend to engage in high-risk behavior. However, their knowledge on sexual health and sexually transmitted diseases is insufficient. Study results suggest a need for implementation of STD control programs and provision of school sexuality education for adolescents and young adults.

Adolescent↗