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PubMed1988

Fracture of the penis and the result of surgical management.

Twenty-nine patients with fracture of the penis were treated between January 1983 and January 1987. The mean age was 26 years (range 18-61 years) and 25 of them (86.2 per cent) were single. The first four patients were managed conservatively with bad results in three cases. Immediate exploration with repair of the tear of the tunica albuginea was carried out in 25 patients, who all had excellent results with retained potency and only mild pain during early intercourse that disappeared within the first 4 months. Urethral injury in association with fracture of the penis was not seen in this series. In view of the good results we recommend immediate surgical repair in cases of fracture of the penis.

Adolescent↗
PubMed1989

Effectiveness of the cavity-rim cervical cap: results of a large clinical study.

From 1981-1988, 3433 women were fitted with a cavity-rim cervical cap in a Food and Drug Administration-approved study. The estimated first-year pregnancy risk was 11.3% (95% confidence limits 10.0-12.8), with risks of 8.3 and 3.8% for user and method failures, respectively. Women who were younger, less educated, and more sexually active, and who intended to have children in the future, had higher pregnancy risks. "Near-perfect" users, ie, individuals who wore the cap for a maximum of 72 hours, used spermicide 100% of the time, and did not report unprotected sexual intercourse, had half the first-year pregnancy risk of others (6.1 versus 11.9%). There were no serious medical or gynecologic complications associated with cap use, although over 20% of users reported problems with cap dislodgment during or after intercourse, cap malodor, or partner discomfort.

Adult↗
PubMed2004

Behavioral and cognitive barriers to safer sex between men in steady relationships: implications for prevention strategies.

Steady partners are a major source of HIV infection among gay men. To better understand sexual risk taking in steady relationships, we examined characteristics of the first incident of unprotected anal intercourse (UAI) between steady male partners. We also examined cognitive barriers to safer sex by way of associating beliefs regarding UAI with protective behavior. Questionnaires assessing sexual behavior and related cognitions were completed by 324 gay men, aged 18-34. Of the men who had UAI with their steady partners, 55% (103/189) did so within the first 3 months of the relationship, and 46% did not discuss having UAI with their partner before it occurred. Analyses revealed that perceiving UAI as a symbol of trust and believing that the partner desired UAI were associated with less condom use but also with a higher likelihood that men established HIV-negative seroconcordance and made sexual agreements (i.e., practiced negotiated safety). Perceiving UAI as more gratifying was associated with having risky UAI. Our findings suggest that interventions can make use of beliefs regarding trust and partner's desire for UAI to promote negotiated safety. In relationships where negotiated safety cannot be implemented, HIV prevention should regard the above beliefs, in particular the perception that UAI is more gratifying, as important barriers to safer sex. Furthermore, our findings regarding the early onset of risk in relationships emphasize how little time is at hand to prevent sexual risk before it occurs. One solution could be to target single gay men for promoting safer sex with future steady partners.

Adolescent↗
PubMed1980

Changes in the frequency of marital intercourse from panel data.

Three waves of panel data from a sample of urban U.S. couples in which the wife was under 30 years of age at the first interview show that frequency of intercourse declined about 25% in a 4-year period. Declines were greatest among those with the shortest length of marriage.

Adult↗
PubMed1996

The Yuzpe regimen of emergency contraception: how long after the morning after?

OBJECTIVE: To determine whether failure of the Yuzpe method of emergency contraception (which involves taking a higher than usual dose of ordinary combined oral contraceptives within 72 hours after unprotected intercourse, with a second dose taken 12 hours later) depends on the interval between intercourse and treatment. DATA SOURCES: We searched the literature for studies in which investigators separately reported both the number of women treated with the Yuzpe regimen and the resulting pregnancies when treatment was started on the first, second, and third days after unprotected intercourse. Searches of the electronic data bases MEDLINE, POPLINE, EMBASE, and BIOSIS were supplemented by scrutiny of the bibliographies of all papers identified through the electronic search. METHODS OF STUDY SELECTION: We identified nine published studies that present the number of women treated and outcome of treatment by time since unprotected intercourse. We included all nine studies in our analysis. TABULATION, INTEGRATION, AND RESULTS: Differences in failure rates by time of treatment adjusted for study-site effects were analyzed using logistic regression. We found no significant differences in failure rates when therapy was started on the first, second, or third day after unprotected intercourse. The large sample size ensured a power of 76% to reject the null hypothesis of equal failure rates when the odds of failure on the third day are twice those on the first and second days. CONCLUSION: Our results have two clinical implications. First, insistence on taking the first dose as soon as possible may be counterproductive in circumstances when taking the second dose 12 hours later would be difficult. Second, clinical protocols that deny treatment after 72 hours may be excessively restrictive, particularly if the alternative of emergency insertion of a copper intrauterine device is not immediately available or appropriate.

Clinical Trials as Topic↗
PubMed1972

Sexual behaviour and contraceptive practice of unmarried female undergraduates at Aberdeen University.

After the sixth week of the spring term of 1971 the unmarried female undergraduates at Aberdeen University were sent a postal questionnaire about their sexual behaviour and contraceptive practice and 1,552 (90%) replied. Of these, 684 (44%) had experienced intercourse, 486 in the six-week period preceding the study, of whom 46% had had it more than six times in this period. It was found that 86% of the relationships were with fiancés or steady partners.Only half of the experienced and a quarter of the inexperienced girls thought that contraceptive advice and materials were adequately available. Contraceptives had not been used by 53% of the students on the first occasion that they had intercourse. In the previous six-week period 192 girls had intercourse without using a contraceptive -39% of those having sexual relations. The use of contraceptives increased with the frequency of intercourse and the stability of the relationship. During the previous six weeks 30% of those having intercourse were on the pill, 38% used the sheath, and 26% relied on the safe period or withdrawal as their most frequent method of contraception.Sixty-five girls had been pregnant in the past, six were pregnant at the time of the survey, and 49 thought that they might be.The uncertainty and difficulty that are experienced in obtaining contraceptives and the large number of occasions on which they are not used are discussed. Moral and pragmatic aspects of promoting a more effective use are examined and better publicity for the family planning clinics that already exist is urged.

Adolescent↗
PubMedDate not supplied

Evaluation of the efficacy of a nonlatex condom: results from a randomized, controlled clinical trial.

CONTEXT: To reduce unintended pregnancy and HIV infection, it is critical to develop reliable male condoms that will attract consumers who reject conventional latex condoms. METHODS: In a prospective clinical trial conducted in 1998-2000, 830 monogamous couples were randomized in equal numbers to use either a nonlatex condom or a commercial natural latex condom for six months as their only method of birth control. Couples completed detailed reports for the first five condom uses and recorded intercourse and condom use in coital diaries. Pregnancy rates associated with typical and consistent condom use were calculated using life-table analysis. Rates of clinical failure (condom breakage or slippage) were determined for the first five condom uses. RESULTS: During the first five uses, the nonlatex condom had a higher frequency of breakage or slippage during intercourse or withdrawal (4.0%) than latex condoms (1.3%); the breakage rate for the nonlatex condom was about eight times that of latex condoms. The six-cycle typical-use pregnancy rate did not differ significantly between users of nonlatex (10.8%) and latex condoms (6.4%). The six-cycle consistent-use pregnancy rate was higher for nonlatex condom users than for latex condom users (4.9% vs. 1.0%). CONCLUSIONS: The data present strong indirect support for public health messages that promote the use of latex condoms and, for individuals who cannot or are unwilling to use latex condoms, the use of nonlatex condoms for prevention of pregnancy and disease.

Adult↗
PubMed1992

Cumulative pregnancy rates in patients with apparently normal fertility and fertility-focused intercourse.

Fifty consecutive clients achieved pregnancy using a standardization modification of the Billings ovulation method (the Creighton Model Natural Family Planning System). Of 50 clients followed, 38 (76%) achieved pregnancy in the first cycle of fertility-focused intercourse, 45 of 50 (90%) achieved pregnancy by the third cycle and 49 of 50 achieved pregnancy by the sixth cycle (98%).

Adult↗
PubMed2004

A randomized trial to compare 24 h versus 12 h double dose regimen of levonorgestrel for emergency contraception.

BACKGROUND: Levonorgestrel (0.75 mg given for two doses 12 h apart) has been proven to be an effective regimen for emergency contraception when the first dose is given within 72 h of unprotected coitus. However, the dosing interval is inconvenient for those taking the first dose in the afternoon. We conducted a randomized study to evaluate two levonorgestrel dosing regimens for emergency contraception. Two doses of levonorgestrel 0.75 mg were administered with the first dose given up to 120 h after unprotected intercourse. The second dose was given 12 h later in the first regimen and 24 h later in the second regimen. METHODS: We conducted a double-blind, randomized trial between 1997 and 2003 at five centres in China. A total of 2071 women requesting emergency contraception within 120 h of unprotected intercourse were recruited. They were randomized to receive two doses of 0.75 mg of levonorgestrel, given either 24 h apart or 12 h apart. RESULTS: Outcome was unknown for 53 women (24 in the 24 h group and 29 in the 12 h group). Among the remaining 2018 women, the crude pregnancy rate was 1.9% in the 24 h group [95% confidence interval (CI) 1.17-2.94] and 2.0% in the 12 h group (95% CI 1.19-2.99). The proportion of pregnancies prevented was estimated to be 72% in the 24 h group and 75% in the 12 h group. Side-effects were mild in both groups. The efficacy of the 12 h regimen declined significantly when there were further acts of intercourse after treatment (5.0 versus 1.0%, P<0.01). This was not observed in the 24 h group. CONCLUSIONS: Two doses of 0.75 mg levonorgestrel given either 24 or 12 h apart are effective for emergency contraception up to 120 h after unprotected intercourse. Further research to investigative more effective methods of emergency contraception is warranted.

Adult↗
PubMed2000

Pathogenesis of urinary tract infections: an update.

The pathogenesis of uncomplicated urinary tract infection (UTI) is complex and influenced by many host biological and behavioural factors and by properties of the infecting uropathogens. Most uncomplicated UTIs in women are not associated with underlying functional or anatomical abnormalities of the urinary tract, whereas sexual intercourse, spermicide use, a history of recurrent UTI and recent antimicrobial chemotherapy are important risk factors. A maternal history of UTI and young age at first UTI, as well as sexual intercourse and spermicide use, are risk factors for recurrent UTI in young women. In some young healthy women, especially those with 'low UTI risk' behaviour, features of pelvic anatomy appear to be associated with UTI risk. In postmenopausal women, anatomical and functional characteristics of the genitourinary tract are more strongly associated with UTI risk than in younger women. A genetic predisposition to recurrent UTI is suggested by the association of recurrent UTI in certain age groups with the ABH blood group non-secretor phenotype, a maternal history of UTI and early age at onset of UTI. Virulence determinants of uropathogens are much more important in the normal host than in the host who has a functional or anatomical abnormality of the genitourinary tract.

Journal Article↗
PubMed2000

Pathogenesis of urinary tract infections: an update.

The pathogenesis of uncomplicated urinary tract infection (UTI) is complex and influenced by many host biological and behavioural factors and by properties of the infecting uropathogens. Most uncomplicated UTIs in women are not associated with underlying functional or anatomical abnormalities of the urinary tract, whereas sexual intercourse, spermicide use, a history of recurrent UTI and recent antimicrobial chemotherapy are important risk factors. A maternal history of UTI and young age at first UTI, as well as sexual intercourse and spermicide use, are risk factors for recurrent UTI in young women. In some young healthy women, especially those with 'low UTI risk' behaviour, features of pelvic anatomy appear to be associated with UTI risk. In postmenopausal women, anatomical and functional characteristics of the genitourinary tract are more strongly associated with UTI risk than in younger women. A genetic predisposition to recurrent UTI is suggested by the association of recurrent UTI in certain age groups with the ABH blood group non-secretor phenotype, a maternal history of UTI and early age at onset of UTI. Virulence determinants of uropathogens are much more important in the normal host than in the host who has a functional or anatomical abnormality of the genitourinary tract.

Adult↗
PubMed2004

Intravaginal metronidazole gel versus metronidazole plus nystatin ovules for bacterial vaginosis: a randomized controlled trial.

OBJECTIVE: We compared metronidazole 0.75% gel (containing 37.5 mg metronidazole per dose) with ovules containing metronidazole 500 mg and nystatin 100,000 U, for intravaginal treatment of bacterial vaginosis (BV). STUDY DESIGN: In a single-blinded trial, symptomatic women with BV by both Amsel and Nugent criteria were randomly assigned to gel or ovules, once nightly for 5 nights, and asked to return 3 times after treatment. Analyses were intent-to-treat. RESULTS: Of 151 women with BV by both criteria at enrollment, 138 (91%) returned at least once. Product limit estimates for persistence or recurrence of BV at 14, 42, and 104 days were 20% (95% CI 10%-29%), 38% (95% CI 25%-48%), and 52% (95% CI 37%-63%) after gel treatment, and 4% (95% CI 0%-9%), 17% (95% CI 7%-26%), and 33% (95% CI 21%-46%) after ovule treatment ( P = .01). Among women without BV at first follow-up, subsequent intercourse without condoms independently predicted subsequent recurrence ( P </= .01). CONCLUSION: Metronidazole/nystatin ovules were significantly more effective than metronidazole gel. Unprotected sex predicted recurrence after initial improvement.

Administration, Intravaginal↗
PubMed1993

Long-term results with vacuum constriction device.

From November 1985 to April 1990, 216 consecutive patients were treated with the vacuum constriction device. Patients were mailed an initial questionnaire (group 1) and a long-term questionnaire (group 2) at a median followup of 3 and 29 months, respectively. Of 202 available patients 161 in group 1 (75%) and 115 in group 2 (57%) responded. Regular use of the vacuum constriction device was reported by 69% group 1 and 70% group 2 patients. patient and partner satisfaction was 82% and 87% in group 1, and 84% and 89% in group 2, respectively. There were no significant differences between the groups with respect to regular use and patient or partner satisfaction (p < 0.05). Quality of erection was evaluated for hardness, length and circumference, and with satisfaction greater than 90% in both groups. Median times per month of successful intercourse were 1, 4 and 4 for the year before, during and after obtaining the vacuum constriction device in group 2. Also, 79% of the patients in group 2 reported a statistically significant increase in the frequency of intercourse per month in the first year, which was sustained beyond the first year in 77% (p < 0.01). Our results support the efficacy of the vacuum constriction device for the treatment of impotence. Overall regular use rates as well as patient and partner satisfaction appear to be high. Furthermore, excellent initial results appear durable in most patients.

Adult↗
PubMed2000

Sexual behaviour and contraception among unmarried adolescents and young adults in Greater Accra and Eastern regions of Ghana.

A fertility survey of unmarried adolescents and young adults (953 males and 829 females) in Greater Accra and Eastern regions of Ghana revealed that a substantial proportion of the respondents were sexually experienced. Overall, 66.8% of the males and 78.4% of the females were sexually experienced. The mean ages (+/- SD) of the males and females were 15.5 +/- 2.5 and 16.2 +/- 2.0 years, respectively. Most respondents claimed to have received adequate information on reproductive health and sexually transmitted diseases (STDs), including AIDS. However, 20% and 30% of the respondents in peri-urban and rural areas, respectively, did not know that a girl could get pregnant the first time she has sexual intercourse. The incidence of pregnancy among the unmarried female respondents was relatively high (37%), and was higher in urban than in rural areas. Approximately 47% of those who had ever been pregnant reported that they had had an abortion. Levels of contraceptive awareness were high (98.2% among males and 95.5% among females) but many still engaged in unprotected sexual relations. The most commonly used methods were the condom and the pill. The main reasons given for non-use were that they did not think about contraception, were concerned about the safety of contraceptives, and partner objection. These findings point to the need for targeting of unmarried adolescents and young adults with information on reproductive health and family planning to increase their awareness of the risks of pregnancy, STDs and HIV infection.

Abortion, Induced↗
PubMed1999

Hip fractures among infertile women.

A retrospective cohort study was conducted in a population-based inception cohort of 1,157 Olmsted County, Minnesota, women with infertility (failure to conceive after 1 year despite intercourse without contraception) that was first diagnosed at the Mayo Clinic (Rochester, Minnesota) between 1935 and 1964. In this relatively young cohort, 31 hip fractures were observed during 35,849 person-years of follow-up; 36.5 had been expected (standardized incidence ratio = 0.85, 95% confidence interval 0.58-1.20). Standardized incidence ratios did not differ by type or cause of infertility. The data suggested that women with consistently irregular menses may have a greater risk of hip fracture. This finding should be confirmed by additional studies with longer follow-up periods and with assessment of other fracture outcomes.

Adult↗
PubMed1996

Coital injury presenting in a 13 year old as abdominal pain and vaginal bleeding.

This 13-year-old girl presented with a four-day history of increasing lower abdominal pain associated with heavy vaginal bleeding which was now resolving. Her last normal menstrual period was 19 days before this incident, with a history of regular periods. Repeated questioning revealed a history of the patient engaging, for the first time, in consensual sexual intercourse one day prior to the onset of complaints. The abdominal examination revealed mild lower abdominal tenderness without rigidity or guarding. The pelvic examination failed to reveal any active bleeding, laceration, or findings suggestive of pelvic inflammatory disease. Routine laboratory studies revealed an elevated white cell count. As the patient's pain worsened over the next two to three hours, surgical and obstetric-gynecologic consultations were made, and both services advised overnight observation. Over the next 12 hours her abdominal examination revealed increased rigidity, and the patient was taken to the operating room with the a preoperative diagnosis of ruptured appendix. On exploratory laparotomy a hemoperitoneum was found, and approximately 600 ml of blood were suctioned from the peritoneal cavity. A 2-cm posterior vaginal wall laceration was subsequently repaired and a normal appendix removed.

Abdominal Pain↗
PubMed1999

Safety and effectiveness of hormonal postcoital contraception: a prospective study.

OBJECTIVE: The aim of this study was to evaluate the demographic characteristics of the population attending our hospital requesting postcoital contraception and to determine the effectiveness of the method and its side-effects. METHODS: A total of 503 women asking for postcoital contraception were included in a prospective open trial. After filling in a questionnaire dealing with demographic and contraceptive data, we prescribed an ethinylestradiol-levonorgestrel combination (100 micrograms/500 mg for two doses 12 h apart). RESULTS: Only 487 women were available for analysis of demographic data. A further 77 were excluded because they presented irregular menstrual cycles and 55 cases were lost for follow-up. Mean age was 22.6 +/- 5.25 years and 35.9% of cases came to the center within the first 5 h after unprotected intercourse. Only 18.8% had previously asked for postcoital contraception. Breakage of condom was the most common reason for request (81.9%). Two pregnancies occurred in the remaining 355 women. According to Dixon's method 15.5 pregnancies should be expected being the overall efficacy of 87.14%. There were no serious adverse effects. Nausea and vomiting (16.33%) were the most prevalent and 59% of the users menstruated at the expected time whilst menses were delayed in 6% of the cases. CONCLUSION: The combination of ethinylestradiol and levonorgestrel in low doses is an effective and safe method of postcoital contraception.

Adolescent↗
PubMed1998

Cutting unsafe abortions.

The use of drugs to terminate pregnancy could cut the number of unsafe abortions, according to the Wellcome Trust and the Population Council. A specialist conference in January this year concluded that the technique is safe and effective and would be particularly valuable in resource-poor countries. In an article in the journal Science staff of the two organizations outline the research that will be necessary before medical abortion can be made widely available in the developing world. It is estimated that half of all surgical abortions are conducted in unsafe conditions. Drug-induced (medical) abortion has been available in developed countries for over 10 years, usually involving the use of the drug mifepristone. A cheaper drug, misoprostol, is already in use in some developing countries. Meanwhile, WHO has published a booklet on "emergency contraception." The term refers to contraceptive methods that can be used by women in the first few days following unprotected intercourse to prevent an unwanted pregnancy. This would not be considered as abortion by most authorities. The emergency methods available are: increased doses of combined oral contraceptive pills, high doses of progestogen-only pills, or inserting of copper releasing IUDs.

Abortion, Induced↗