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PubMed2006

Pharmacokinetic and pharmacodynamic features of dapoxetine, a novel drug for 'on-demand' treatment of premature ejaculation.

OBJECTIVE: To describe the relationship between the pharmacokinetic and pharmacodynamic properties of dapoxetine, a drug specifically developed for treating premature ejaculation (PE). METHODS: Data from various stages of the clinical development programme were analysed using validated methods for assessing ejaculatory latency. The clinical characteristics were then compared with the pharmacokinetic profile, determined from measured plasma drug concentrations. RESULTS: Pharmacodynamic and pharmacokinetic measurements confirm that 'on demand' dapoxetine has a rapid onset of action and is rapidly cleared after sexual intercourse. CONCLUSION: Dapoxetine may represent the first of a new category of selective serotonin transport inhibitors. Although dapoxetine has pharmacological similarities to other selective serotonin transport inhibitors, its efficacy after acute administration sets it apart and suggests a different mode of action. Its physicochemical and pharmacokinetic properties and its clinical efficacy make dapoxetine suitable for on-demand treatment of PE.

Benzylamines↗
PubMed2001

Emergency contraception: pediatricians' knowledge, attitudes, and opinions.

UNLABELLED: Emergency contraception (EC) is the use of a method of contraception after unprotected intercourse to prevent unintended pregnancy. Although first described over 20 years ago, physician awareness of EC has been limited and many feel uncomfortable prescribing it. OBJECTIVE: To assess the knowledge, attitudes, and opinions of practicing pediatricians regarding the use of EC in adolescents. METHODS: An anonymous questionnaire was mailed to all 954 active members of New York Chapter 2, District II of the American Academy of Pediatrics. The questionnaire assessed basic knowledge, attitudes, and opinions regarding EC in adolescents. Data were analyzed by physician age, gender, year completed residency, and practice type. RESULTS: Two hundred thirty-three practicing pediatricians (24.4%) completed the survey. Of the respondents, 23.7% had been asked to prescribe EC to an adolescent and 49% of these cases involved a rape victim. Only 16.7% of pediatricians routinely counsel adolescent patients about the availability of EC, with female pediatricians more likely to do so. Most respondents (72.9%) were unable to identify any of the Food and Drug Administration-approved methods of EC. Only 27.9% correctly identified the timing for its initiation and only 31.6% of respondents felt comfortable prescribing EC. Inexperience with use was cited as the primary reason for not prescribing EC by 70% of respondents. Twelve percent cited moral or religious reasons and 17% were concerned about teratogenic effects. There were no differences in comfort level based on age, gender, or practice type. Twenty-two percent of respondents believed that providing EC encourages adolescent risk-taking behavior and 52.4% would restrict the number of times they would dispense EC to an individual patient. A minority of respondents (17%) believed that adolescents should have EC available at home to use if necessary and only 19.6% believed that EC should be available without a prescription. The vast majority (87.5%) were interested in learning more about EC. CONCLUSIONS: Despite the safety and efficacy of EC, the low rate of use is of concern. Pediatricians are being confronted with the decision to prescribe EC but do not feel comfortable prescribing it because of inadequate training in its use. Practicing pediatricians are aware of their lack of experience and are interested in improving their knowledge base.

Adolescent↗
PubMed1975

A seven-cell human egg recovered from the oviduct.

A seven-cell human egg recovered from the proximal middle quarter of the oviduct is described. Whether or not it is a normal representative of this stage of human development cannot be established at the present time. The specimen was recovered 83 hours after intercourse and 77 hours after the first significant elevation of the luteinizing hormone level in the urine. According to these data and the results of the endometrial and corpus luteum biopsies, the age of the egg was estimated to be approximately 72 hours. An analysis of size and the reaction of the blastomeres to toluidine blue suggests that they already show some differentiation at this early stage of development. The addition of these findings to previous reports of eggs recovered from human oviducts and uteri gives support to the concept that human eggs are delivered to the endometrial cavity when they contain between 7 and 12 blastomeres.

Adult↗
PubMed1999

Predictors of sixth graders engaging in sexual intercourse.

Researchers explored factors related to sixth graders' sexual behavior. First, level of sexual behavior and sexual behavior intentions were examined. Second, health-related risk behaviors and constructs from Social Support and Social Cognitive theories were analyzed based on race and gender to determine their predictive value for sixth graders engaging in sexual intercourse. Findings indicated that very few sixth graders engaged in sexual intercourse or in high-risk behaviors such as smoking. Of the risk factors examined, smoking was the highest predictor of engaging in sexual intercourse for all categories of race and gender. Of the constructs, Efficacy Expectations consistently predicted engaging in sexual intercourse for all race and gender categories.

Attitude to Health↗
PubMed1996

High risk of HIV disease progression after infection through a sexual partner with AIDS.

OBJECTIVE: To investigate whether HIV-1 infection acquired through a severely immunodepressed sexual partner increases the risk of disease progression. DESIGN: A prospective cohort of patients infected through sexual contact at a known date and enrolled a few months (median, 2 months) after their first HIV-positive test. At enrolment, 12 subjects stated having had unprotected intercourse (anal or vaginal penetration) with a partner with AIDS within the 6 months prior to their first HIV-positive test. For the same period, 60 subjects stated having had unprotected intercourse with a partner, known to be HIV-positive, but who had not developed AIDS. METHOD: The endpoint was the first occurrence of an HIV-related illness (group IV or AIDS, 1987 Centers for Disease Control and Prevention revised classification). Event-free survival curves since infection were constructed using the Kaplan-Meier method and compared by the log-rank test. The Cox model was used for multivariate analysis. RESULTS: Disease progression was more rapid among the 12 subjects who stated having sex with a person with AIDS at a time close to infection, than among the other subjects (P = 0.03). Homosexuality and age at infection were also related to HIV disease progression. The adjusted relative risk of developing an HIV-related illness among those 12 subjects was 3.9 (95% confidence interval, 1.5-9.9). CONCLUSION: Our results confirm the influence of virus-related factors on the onset of immunodepression in subjects infected through sexual contact.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Earliest time to onset of action leading to successful intercourse with vardenafil determined in an at-home setting: a randomized, double-blind, placebo-controlled trial.

INTRODUCTION: Vardenafil, a potent and selective oral PDE5 inhibitor, is efficacious and generally well-tolerated in men with erectile dysfunction (ED). Of considerable interest to patients and physicians is an understanding of the time required after dosing to attain penile erection sufficient for successful sexual intercourse. AIM: To determine the earliest time to onset of action of vardenafil 10 and 20 mg leading to successful intercourse compared to placebo in men with ED. METHODS: A prospective, randomized, double-blind, parallel-group, at-home study of 732 men with ED (mean age 55.5 years) was conducted at 64 sites in North America and Europe. Following a 4-week run-in period, patients were randomized to either vardenafil 10 (N = 237) or 20 mg (N = 248) or placebo (N = 247) to be taken on demand over 4 weeks. Using a stopwatch, patients recorded the elapsed time from dosing to attainment of an erection perceived to be adequate for penetration that led to intercourse completion. Earliest time of onset was defined as the fastest time among the first four doses for each patient. Time points from 25 to 5 minutes were tested for significance (alpha = 0.025) using a backward stepping procedure. RESULTS: Mean baseline erectile function domain score (13.4) indicated moderate ED. Within 25 minutes after dosing, 50%/53% of men on vardenafil 10/20 mg had at least one erection in the first four doses perceived to be sufficient for penetration with subsequent intercourse completion compared to 26% on placebo (P < 0.0001). A statistically superior response to vardenafil vs. placebo was observed in these responders at all times >or= 10 and >or= 11 minutes (P < 0.025) in the 10 and 20 mg groups, respectively. In a retrospective analysis using time intervals of <or= 15, <or= 20, <or= 25 and <or= 30 minutes between dosing and erection adequate for penetration, 75-77% of these intercourse attempts were successful (SEP3 positive) by patients receiving vardenafil 10/20 mg, compared to 45-47% of attempts by those who received placebo. Vardenafil 10/20 mg was generally well-tolerated with headache (7%/12% vs. 1%) and flushing (6%/9% vs. < 1%) reported more frequently than with placebo. No patient discontinued vardenafil therapy due to adverse events. CONCLUSION: In this large, at-home study, the onset of action of vardenafil with subsequent intercourse completion was recognized as early as 10 minutes after dosing.

Adult↗
PubMed2005

Breastfeeding and sexuality immediately post partum.

OBJECTIVE: To examine the relationship between breastfeeding and resumption of vaginal intercourse; to determine the association between these behaviours and age, parity, marital status, mode of delivery, and contraceptive use; and to identify factors associated with resumption of intercourse among Canadian women in the early postpartum period. DESIGN: Prospective survey. SETTING: Eleven obstetricians' offices in three Ontario communities between August and December 2002. PARTICIPANTS: Women attending their first postpartum visit. MAIN OUTCOME MEASURES: Resumption of vaginal intercourse. RESULTS: Of 316 respondents, 181 (57.3%) were currently breastfeeding, and 167 (52.8%) had not yet resumed vaginal intercourse. Mean age of the mothers was 28.7 +/- 5.3 years; mean age of their babies was 6.5 +/- 1.1 weeks. This was a first child for 50.3% and a second child for 32.6%. Most women (72.8%) were married; another 19.3% were in common-law relationships. Married women were more likely to breastfeed (P = .001), as were those with higher parity (P = .008). Multivariable logistic regression identified five variables significantly associated with resumption of intercourse by 6 weeks post partum. The two most statistically significant variables were breastfeeding (exclusively or supplementing with bottle) and baby's age in weeks (P < .001 for both). Mode of delivery (vaginal delivery with no tearing, compared with cesarean section or vaginal delivery with tearing) was also a highly significant predictor (P = .003), as was higher parity (P = .003). Older maternal age was weakly associated with resumption of intercourse (P = .049). The 167 women who had not resumed intercourse were asked to indicate their main reasons: 161 responded, citing a total of 215 reasons (54 cited more than one reason). The most common reasons were lack of interest (18.6%), being too tired (16.8%), being afraid of intercourse being painful (16.8%), physician told them not to (15.6%), and thinking they should wait 6 weeks (14.4%). CONCLUSION: Breastfeeding women who delay resumption of intercourse during the postpartum period might benefit from open discussion of breastfeeding, sexuality, and contraception immediately post partum.

Adult↗
PubMedDate not supplied

Stages of change and condom use among an Internet sample of gay and bisexual men.

The purpose of this descriptive correlational study using the transtheoretical model was to determine the relationship between stages of change and condom use among gay and bisexual men with primary (steady) and casual (occasional) partners. A convenience sample of 241 gay and bisexual men was recruited from the Internet. The majority of men (n = 198, 82%) never used condoms during anal, vaginal, or oral intercourse with primary partners, indicating they were in the first of five stages of change (precontemplation). Thirty percent (n = 71) of men reported using condoms every time during anal intercourse with casual partners and were in the last stage of change (maintenance). Multiple regression analysis revealed that older bisexual men who informed partners of their HIV status and who were confident and perceived more advantages in using condoms were in higher stages of change. By placing participants into various stages of change, stage specific interventions can be designed.

Adolescent↗
PubMed2000

Adolescent cigarette smoking: health-related behavior or normative transgression?

Relations among measures of adolescent behavior were examined to determine whether cigarette smoking fits into a structure of problem behaviors-behaviors that involve normative transgression-or a structure of health-related behaviors, or both. In an ethnically and socioeconomically diverse sample of 1782 male and female high school adolescents, four first-order problem behavior latent variables-sexual intercourse experience, alcohol abuse, illicit drug use, and delinquency-were established and together were shown to reflect a second-order latent variable of problem behavior. Four first-order latent variables of health-related behaviors-unhealthy dietary habits, sedentary behavior, unsafe behavior, and poor dental hygiene-were also established and together were shown to reflect a second-order latent variable of health-compromising behavior. The structure of relations among those latent variables was modeled. Cigarette smoking had a significant and substantial loading only on the problem-behavior latent variable; its loading on the health-compromising behavior latent variable was essentially zero. Adolescent cigarette smoking relates strongly and directly to problem behaviors and only indirectly, if at all, to health-compromising behaviors. Interventions to prevent or reduce adolescent smoking should attend more to factors that influence problem behaviors.

Adolescent↗
PubMed1991

A prospective trial of intrauterine insemination of motile spermatozoa versus timed intercourse.

STUDY OBJECTIVE: The efficacy of intrauterine insemination (IUI) of selected motile sperm. DESIGN: Prospective randomized sequential alternating cycle trial comparing IUI with luteinizing hormone (LH)-timed intercourse. SETTING: Clinical infertility service. PATIENTS: Couples selected included unexplained infertility (n = 73), cervical mucus hostility (n = 24), moderate semen defect (n = 110), and severe semen defect (n = 78). Two hundred eighty-five couples undertook 600 IUI cycles and 505 LH-timed intercourse. RESULTS: Overall, IUI was slightly more effective than LH-timed intercourse with a pregnancy rate of 6.2% versus 3.4% per cycle. When individual categories were considered only, IUI for severe semen defect was significantly better (5.6% versus 1.3%, P less than 0.05). The first IUI cycle was more effective when compared with both subsequent IUI cycles and the initial LH-timed cycle. Overall, 74% (27/37) of IUI pregnancies occurred in the first cycle. CONCLUSIONS: Compared with LH-timed intercourse, IUI provided little or no improved expectation of pregnancy but was beneficial in couples with severe semen defect. The occurrence of pregnancy was limited per cycle and confined essentially to the initial cycle of treatment. Continued IUI is considered to be unrewarding.

Cervix Mucus↗
PubMed1997

Sexuality and contraception in adolescents from Barcelona, Spain.

STUDY OBJECTIVE: To describe the sexual behavior and contraception use among a sample of high school and vocational school adolescents in Barcelona, Spain. DESIGN: Cross-sectional study. METHODS: A random sample of 3139 students, aged 14 to 19 years, living in the city of Barcelona, were surveyed by means of an anonymous, self-administered questionnaire. SPSS/PC+ was used for statistical analysis. Significance criterion was set at 0.01. MAIN RESULTS: 13% of the students had previously participated in sexual intercourse; percentages between the sexes was equal. Frequency increased with age. Boys had their first experience at a significantly earlier age, but girls participated in sexual intercourse more often. The majority of adolescents used condoms as their primary contraceptive method; seven (3.3%) of the sexually active girls had been pregnant, and two (1%) boys had caused their partners to become pregnant. CONCLUSIONS: The rate of sexual activity among adolescents in Barcelona is low compared with those in both European and American studies. However, a higher rate of condom use is observed.

Adolescent↗
PubMed1995

Paternity after cryptorchidism: lack of correlation with age at orchidopexy.

OBJECTIVE: To determine whether paternity is decreased among men who were formerly unilaterally or bilaterally cryptorchid and to ascertain whether paternity is related to their age at orchidopexy. SUBJECTS AND METHODS: Men who underwent orchidopexy between 1955 and 1969 at the Children's Hospital of Pittsburgh (363) and a group of age-matched control men (336) were surveyed by questionnaire and their medical records reviewed. RESULTS: Of the married men, significantly more of the unilateral cryptorchid (75%) and control (76%) groups had fathered children than had the bilateral cryptorchid group (P < 0.005). Furthermore, when the groups were compared during the period of regular intercourse with no contraception until conception of their first child, the bilateral group had relatively fewer conceptions during the first year and more after the first year. When the unilateral and bilateral groups were analysed separately, there was no relationship between either age at orchidopexy and paternity or between the age at orchidopexy and the duration of regular unprotected intercourse before conception. CONCLUSIONS: Compared with a control group, paternity was compromised after bilateral, but not unilateral, cryptorchidism. Age at orchidopexy was not correlated with paternity.

Adolescent↗
PubMed1992

Heterosexually acquired HIV-1 infection: cases reported in England, Wales and Northern Ireland, 1985 to 1991.

By the end of 1991, there had been 417 reports of AIDS and 1620 reports of HIV-1 infection in persons in England, Wales and Northern Ireland who probably acquired their infection through sexual intercourse between men and women. Between 1986 and 1991, the proportion of AIDS cases attributable to heterosexual transmission increased from 2% to 14% and of diagnosed HIV-1 infections from 4% to 23%. Reported HIV-1 infections inadequately reflect the extent of infection as only individuals choosing to be tested can be reported. HIV-1 infection acquired during heterosexual intercourse may be the result of transmission from partners who were infected by routes other than heterosexual transmission (first generation transmission) or of transmission from infected partners who were themselves infected through heterosexual intercourse (second generation transmission). Of the 417 cases in which AIDS was acquired through heterosexual intercourse, 42 (10%) were categorised as due to first generation transmission, 328 (79%) as second generation transmission--abroad, and 47 (11%) as second generation transmission--UK. Transmission categories could be allocated to 1438 of the 1620 reports of HIV infection: 17% were categorised as first generation, 74% as second generation--abroad, and 9% as second generation--UK. Heterosexual transmission of HIV infection is increasing, both in individuals acquiring their infection abroad as well as those who become infected in the United Kingdom.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Sexual practices in the transmission of hepatitis B virus and prevalence of hepatitis delta virus infection in female prostitutes in the United States.

OBJECTIVE: To evaluate heterosexual transmission of hepatitis B virus (HBV) and the prevalence of hepatitis delta virus (HDV) infection in female prostitutes. DESIGN: Survey. SETTING: Sexually transmitted disease clinics, drug treatment programs, detention centers, and/or outreach efforts in eight areas in the United States. PARTICIPANTS: A total of 1368 female prostitutes 18 years of age or older. OUTCOME MEASURES: Seropositivity for HBV and HDV infection. RESULTS: The overall prevalence of past or present HBV infection was 56%: 74% in women who were injecting-drug users (IDUs), 38% in women reporting no history of injecting-drug use (non-IDUs), 51% in whites, 55% in blacks, and 67% in Hispanics. Of 21 HBV carrier IDUs, 21% had HDV infection; of 18 HBV carrier non-IDUs, 6% had HDV infection. In non-IDUs (49%), risk factors for HBV infection were a history of having penile-anal intercourse (odds ratio [OR], 3.1; 95% confidence limits [CL], 1.3, 7.3) and seropositivity for syphilis and human immunodeficiency virus (HIV) infection. In IDUs, factors associated with an increased risk of infection, in addition to behaviors related to injecting-drug use, were the number of lifetime sexual partners, having sexual partners from groups at high risk for HBV infection, and seropositivity for syphilis and HIV infection; spermicide and/or diaphragm use was associated with a markedly decreased risk of HBV infection among blacks (OR, 0.1; 95% CL, 0.03, 0.4) and Hispanics (OR, 0.2; 95% CL, 0.06, 0.9). CONCLUSION: This is the first study to suggest that having anal intercourse and failing to use vaginal contraceptives may facilitate transmission of HBV to women. Our data support guidelines that recommend hepatitis B vaccination for prostitutes and persons with a history of sexually transmitted diseases or multiple sexual partners.

Adolescent↗
PubMed2004

Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse.

OBJECTIVE: To compare the morphology of the hymen in adolescent girls who have and have not had sexual intercourse involving penile-vaginal penetration. SUBJECTS: Female patients aged 13 to 19 years, recruited from an urban adolescent medicine practice. METHODS: Subjects were interviewed in private after completing detailed questionnaires and then underwent a physical examination. External genital inspections were performed using a colposcope with an attached 35-mm camera to document the appearance of the hymen. The presence of notches or clefts was recorded during the examination, and photographs taken at x10 magnification were used to take measurements of the width of the posterior hymenal rim. RESULTS: Posterior hymenal notches and clefts were more common among girls admitting past intercourse (13/27 [48%]) than in girls who denied intercourse (2/58 [3%]; P =.001), but the mean width of the posterior hymenal rim was not significantly different between the 2 groups (2.5 mm vs 3.0 mm; P =.11). Two subjects who denied intercourse but had posterior hymenal clefts described a painful first experience with tampon insertion. CONCLUSIONS: Deep notches or complete clefts in the posterior rim of the hymen were rare in girls who denied intercourse. Subjects who admitted past intercourse still had nondisrupted, intact hymens in 52% of cases.

Adolescent↗
PubMed1993

Long-term results of penile vein ligation for impotence from venous leakage.

Between 1986 and 1991, 46 men with organic impotence documented by dynamic pharmacocavernosometry and cavernosography to have venous leakage underwent penile vein ligation. Despite initial improvement in erections allowing normal intercourse in 34 men (74%) within the first 6 months, long-term (more than 12 months) evaluation revealed sustained potency without adjunctive therapy in only 11 (24%). Of the remaining 35 men 6 (13%) progressed to a penile prosthesis, 8 (17%) required intracavernous vasoactive injection therapy and 21 (46%) have not sought further therapy despite continued impotence. Of the 14 patients who had isolated distal leakage 6 (43%) had sustained erectile function while only 5 of the 32 patients (16%) with proximal leakage maintained potency. Associated complications included penile shortening in 20 (43%) and penile hypoesthesia in 9 men (20%). Therefore, we conclude that the long-term success of penile vein ligation is poor, with only 24% of the patients able to have normal intercourse more than 1 year later, although those patients with distal penile shaft leakage appear to have a greater chance of success than those with more proximal leakage.

Adult↗
PubMed1993

Sexual behaviors relevant to HIV transmission in a rural African population. How much can a KAP survey tell us?

KAP surveys have been proposed as a means to gather quantitative information on AIDS-related sexual behaviors, but the validity of survey results has not been tested. The validity of data gathered during a KAP survey in a rural district in Northern Uganda (N = 1486) was examined analyzing expected behavioral patterns, agreement of partner reports, and concordance of number of sexual contacts across gender. Patterns of sexual behavior and age trends are as expected. More men (50%) than women (18.5%) reported premarital sex. The likelihood of sexual intercourse before marriage increases with age at first marriage and with education. Women marry 5 years earlier than men, and the number of marriages increases with age. Peak incidence of casual sex occurs before age 25. The male/female ratio of casual sex is 4, as compared to about 3 in other African surveys. Single men are 2.5 times more likely to engage in casual sex than married males. Agreement of partner reports was examined for 392 couples selected by chance. 86% of the couples agreed on being polygamous or monogamous. On average men reported 1.3 (SD = 0.7) wives as compared to women reporting 1.5 (SD = 0.89) wives (P < 0.001). 16.8% of women declared more, and 2.8% less cowives than their husband (r = 0.65). Self-reports on frequency of sexual intercourse in the past month were examined for 256 monogamous couples. Mean frequencies differ (5.24 +/- 5.1 for men, 4.43 +/- 4.7 for women, P < 0.001). 42.8% of couples are in agreement within +/- 1 unit (r = 0.44). The total number of extra-marital and marital sex acts, as well as the total number of partners reported by each gender are similar. There is, however, a striking gender difference in reporting of casual partners in the past year. Data were found to be accurate at the aggregate level. However, accuracy of reporting at the individual level was found to be low. The gender difference in reporting of casual partners may be due to female underreporting, to not having captured prostitutes or to a different perception of the meaning of casual partnership. All KAP surveys should include a validity analysis, so as to provide a sense of the accuracy of the surveys and allow for comparison of the quality of different KAP surveys. There is an urgent need for a standardized approach to validating the findings from AIDS-related KAP surveys. Some of the indirect methods described here could be relevant for further use.

Adolescent↗
PubMed2000

Risk factors for second urinary tract infection among college women.

To better understand the etiology of recurrent urinary tract infection (UTI), the authors followed a cohort of 285 female college students with first UTI for 6 months or until second UTI. A first UTI due to Escherichia coli was followed by a second UTI three times more often than was a non-E. coli first UTI (24 vs. 8%; p = 0.02). In a logistic regression analysis limited to the 224 women from the University of Michigan Health Service and the University of Texas at Austin Health Service from September 1992 to December 1994, with a first UTI due to E. coli, vaginal intercourse increased the risk of a second UTI with both a different (odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.19, 2.15) and the same (OR = 1.37, 95% CI: 0.91, 2.07) uropathogen, as did using a diaphragm, cervical cap, and/or spermicide (same uropathogen: OR = 1.53, 95% CI: 0.95, 2.47; different uropathogen: OR = 1.77, 95% CI: 1.22, 2.58). Condom use decreased the risk of a second UTI caused by a different uropathogen (OR = 0.68, 95% CI: 0.48, 0.99) but had no effect on a second UTI caused by the same E. coli (OR = 0.99; 95% CI: 0.66, 1.50). Type or duration of treatment was not associated with a second UTI. Although the risk of second UTI is strongly influenced by sexual behavior, women with a first UTI caused by E. coli are more likely than are those with a non-E. coli first UTI to have a second UTI within 6 months.

Adolescent↗