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PubMed2006

Virological, serological and epidemiological study of 255 consecutive cases of genital herpes in a sexually transmitted disease clinic of Paris (France): a prospective study.

Some studies (mostly retrospective) have pointed to an increasing frequency (up to 60%) of herpes simplex virus type 1 (HSV-1) in genital herpes (GH), but they were biased towards severe or atypical cases. We wished to evaluate the frequency of HSV-1 in patients attending our clinic for both first and recurrent episodes of GH. All patients (men and women) with genital lesions compatible with GH were included in a prospective study between May 1999 and April 2002. For all patients a standardized questionnaire, clinical examination, MRC5 culture (Dade Behring), polymerase chain reaction (PCR)-herpes consensus (Argène Biosoft) in case of negative culture and type-specific herpes serology HSV-1 and HSV-2 (Elisa Eurobio) were obtained. Predictive factors associated with HSV-1 and HSV-2 GH were studied by uni- and multivariable analyses. In all, 255 patients had a positive culture (n = 216) or PCR (n = 39). A total of 248 patients had typable herpes (148 men and 100 women). Median age was 33 (27-43); 20% had anal herpes; 48% had clinically recurrent lesions; 21% were HIV +; 20% of men were homosexual; 77% practised oral sex. In all, 36 were HSV-1 (14.5%): more in women, 25/100 (25%), than in men, 11/148 (7.5%) (odds ratio [OR]: 4 [1.8-9.1], P = 0.008). HSV-1 accounted for 23% of cases of first clinical episodes (women: 31.5%; men: 14.7%) (P = 0.02) and 6% of clinically recurrent episodes (women: 15%; men: 1.2%) (OR: 3.8 [1.6-9.1], P = 0.0033). Serological study was done in 239: primary infection was disclosed in 33 (HSV-1: 61%), HSV-2 non-primary first episode in 22 and recurrence in 184 (HSV-1: 8%). In all, 37% of recurrent episodes presented as a first clinical episode. HSV-1 was linked in men with homosexuality (P<0.01) and anilingus (P<0.01), in women with younger age (P<0.01), more sexual intercourses (P<0.0001) and more oral sex (P<0.001). Although HSV-1 is frequent in first clinical (23%) and primary (61%) episodes of GH, recurrent GH remains mostly due to HSV-2 (94%).

Adult↗
PubMed1993

[Menarche, orgasmic capacity and coitarche].

A group of 609 Czech 16 to 18 years old girls was divided according to the age of the first menses into three subgroups: first with menarche between 10 to 12 years, second in 13 and 14 years, third in 15 and 16 years. It was found that the age of menarche did not distinctly influence the course of their sexual development during the puberal period. The mean age of first rendezvous and coitarche did not significantly differ between the followed three subgroups. Out of the whole group of 609 probands 304 girls already had sexual intercourse. The percentage of coitally orgastic girls was highest in the subgroup with an early first menstrual bleeding between 10 and 12 years of age and the difference to the other two subgroups with a later menarche was statistically highly significant (p < 0.005). The opinion is expressed that changes in brain which enable girls to fall in love for the first time are from the point of view of biological prerequisites more important for the beginning of full sexual life in pubertal girls than hormonal development manifested by first menstrual bleeding.

Adolescent↗
PubMed2005

Evaluation of a peer provider reproductive health service model for adolescents.

CONTEXT: The use of peer providers in family planning clinics has been proposed as a strategy that could better serve sexually active adolescent populations. METHODS: Baseline and follow-up survey data from 1,424 female and 166 male adolescent clients of five California community health clinics were analyzed to assess the effectiveness of a peer provider model between 1996 and 1999. Multivariable analyses examined differences in outcomes between clients' first and last clinic visits, and by whether clients received only clinical services or other components of the model (outreach and telephone follow-up) as well. RESULTS: Female clients were significantly more likely at their last visit than at their first visit to report consistent birth control use (odds ratio, 1.9), use at last intercourse (1.8) and use of effective methods (3.5), and were significantly less likely to report consistent condom use (0.7). There were no significant differences in male birth control or condom use between first and last visits. Females who received all components of the model were more likely than those who received only clinical services to return for an annual exam (2.2) and to make three or more visits during the study period (1.7). The full model was particularly effective for females who were Hispanic, had been born to adolescent mothers or had had more than one sexual partner in the six months before their first clinic visit. CONCLUSIONS: The peer provider model appears to be a promising addition to the mix of service delivery models, particularly for certain subgroups of clients. The findings underscore the importance of tailoring programs on the basis of clients' risk profiles.

Adolescent↗
PubMed1986

Black teenage pregnancy: an obstetrician's viewpoint.

The Black pregnant teen is a microcosm of the impact of society on the most vulnerable. Who is the pregnant adolescent? What racial and ethnic connotations are implied? What is the quality of her progeny? What health risks and mortality attend Black pregnant adolescents? What measures are indicated to address teen pregnancy? Health providers must more intensively address the essentials of the socio-medical phenomenon of Black teenage pregnancy. The United States leads other developed countries of the world by substantial margins in births to teenagers, ranging from 3/1,000 in Japan to 52/1,000 in the United States. In 1983 in New York City, 40,000 teenagers became pregnant resulting in 14,000 births, 20,000 abortions, and 6,000 miscarriages. Sixty-six percent of the births occurred in areas with large concentrations of residents of lower socio-economic status. Special attention, then, needs to be focused on both pregnancy prevention and early prenatal care in these high risk areas. Most teenagers do not intend to become pregnant. There are suggested racial differences regarding both the intention of becoming pregnant and teen births. Twenty percent of pregnant teenagers conceive during the first sexual exposure and fifty percent become pregnant within the first six months. The younger the age at initiation of intercourse, the greater the likelihood of pregnancy. The desire to terminate a teen pregnancy is more closely associated with socio-economic status than ethnicity. The course of pregnancy in teenagers is more likely to be complicated by a variety of clinical problems than in adults. Further, the maternal mortality rate in pregnant black teenagers is significantly higher than in white teenagers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

The association of early adolescent problem behavior and adult psychopathology: a multivariate behavioral genetic perspective.

Research has documented a strong association between early adolescent problem behavior and adult disinhibitory psychopathology, leading some to suggest that the latter can be reduced by preventing or delaying the former. But the prevention implications of this association necessarily depend upon the causal mechanisms that produce it. The current study was designed to test implications of a model that posits that early problem behavior and disinhibitory psychopathology are associated because they are both manifestations of a common inherited liability. At their age-17 assessment, 1080 twins from the older cohort of the Minnesota Twin Family Study reported whether and the age at which they first: drank alcohol, used tobacco, used illicit drugs, had sexual intercourse, and had police contact. An Early Problem Behavior index was computed by summing the number of these experiences each participant reported having before age 15. Outcome measures of disinhibitory psychopathology were assessed by clinical interview at the age-20 follow-up and included number of symptoms of nicotine dependence, alcohol abuse and dependence, drug abuse and dependence, and adult antisocial behavior. Biometric analysis of the multivariate twin data showed that: (1) early adolescent problem behavior is weakly heritable (approximately 20%), (2) the common factor underlying disinhibitory psychopathology is strongly heritable (approximately 75%), and (3) the phenotypic correlation between early adolescent problem behavior and disinhibitory psychopathology was strong (approximately 0.60) and accounted for primarily by genetic factors common to the two domains. Findings are discussed in the context of research on the prevention and developmental nature of substance use disorders and related psychopathology.

Adolescent↗
PubMed2001

A comparison of three daily coital diary designs and a phone-in regimen.

Barrier contraceptive trials and disease intervention studies often utilize coital diaries to measure sexual exposures: dates and frequency of intercourse, product use, additional or alternative contraceptive use, and menstrual bleeding. The validity of these self-reported data is a matter of debate, but if used, better diary designs are sought. We studied 3 different coital diaries, plus a phone-in regimen (none or weekly) in a 3 x 2 factorial design to compare participant ratings and promptness of recording. Our underlying presumption was that ease of and satisfaction with use, and promptness of data collection, are associated with greater accuracy. A self-completed questionnaire at the end of the study collected comparative retrospective data. Diary 1 captured information about a single day on one page and had three columns, for up to three possible acts of intercourse. Diary 2 had the same question format as the first diary, but contained 7 days per page. Diary 3 had 7 days on a page, but instead of a column for each act, participants enumerated the number of acts, the types of contraception used, and condom use details. Half of the women in each diary group phoned in their data weekly. Phone-in improved participants' satisfaction with the diary design as reflected by higher ratings of diary features. Phone-in did not improve recall of data at the end of the study for any of the diaries. There were no differences in the promptness of diary completion. Diaries 1 and 2 showed good concordance with recalled data, and participants expressed a preference for the layout of Diary 2. Women assigned to Diary 3 expressed dissatisfaction with the design and were worse at recalling data at the end of the study, probably due to the complexity of that diary design.

Adolescent↗
PubMed2005

A randomized controlled trial to test an HIV-prevention intervention for Latino gay and bisexual men: lessons learned.

At the time of this writing, no randomized controlled trial (RCT) of an intervention to reduce unsafe sex among Latino gay and bisexual men (LGBM) had been published. We report the results of an RCT conducted in New York City in which 180 LGBM were assigned either to an intervention developed specifically for this population or to a wait-list control group. The intervention was based on empowerment theory and used factors identified in prior research as determinants of unsafe sex. By eligibility criteria, all men had engaged in unprotected anal intercourse (UAI) within two months of the baseline assessment. At first (two months) and second (six months later) follow-up assessments, approximately half of the men in the experimental group reported no UAI. Yet, a similar proportion of the control group also reported no UAI. Baseline data indicate that although the men had been the subject of social oppression and sexual prejudice (homophobia), they did not feel disempowered, externally controlled or fatalistic, and they reported self-efficacy and intentionality to enact safer sex. Lessons learned are discussed, as well as notes of caution for future research employing a similar conceptual framework.

Adolescent↗
PubMed2001

Dislodgment of polyethylene liners in first and second-generation Harris-Galante acetabular components. A report of eighteen cases.

BACKGROUND: Dislodgment of the polyethylene liner is an increasingly common complication following total hip arthroplasty. The purposes of this study are to present the results in a series of patients with this complication and to analyze the mode of failure. METHODS: Between November 1995 and January 2001, eighteen patients who had had a total hip arthroplasty presented with dislodgment of the polyethylene liner from a Harris-Galante metal acetabular shell. The medical records, radiographs, operative notes, and retrieved components were reviewed. In addition, scanning electron microscopy was used to study the fractured surfaces in a shell that had four broken tines. RESULTS: The components had been in situ for an average of seven years (range, three to eleven years). Seventeen components were second generation, and one was first generation. Symptoms developed spontaneously in sixteen patients, during sexual intercourse in one, and following a fall on the hip in one. Radiographs showed eccentric positioning of the head in all of the hips and broken tines in six. All of the shells were well fixed. Treatment consisted of revision of the shell in four patients, exchange of the liner in four, cementation of a new liner into the shell in seven, and cementation of an all-polyethylene cup in three. The liners had severe damage of the rim. Scanning-electron microscopy of the fractured surfaces of four tines revealed a fatigue pattern. CONCLUSIONS: We believe that, as the liner wears and becomes loose because of an inadequate locking mechanism, progressive micromotion occurs and the load increases on the polyethylene rim until it deforms and/or fractures. Subsequently, nothing prevents the liner from rotating out of the shell. As this mechanism of failure appears to include fatigue failure of the locking tines and wear of the liner, this complication is likely to increase as the components age in situ.

Acetabulum↗
PubMed1994

[Immorals III. Midwives].

This article is the third and last part of a complex anthropological study on 17th and 18th century southern Hungarian sexual customs and deviations as they appeared in witch trials. The first two parts came out in our Com. Art. Hist. Med. vols. 117-120 (1987) pp 87-102, and 133-140 (1991-1992) pp 171-216. The author has studied the papers of 1040 cases and compared it to the most important issues of Hungarian secondary literature of folklore, cultural and social anthropology, and occasionally to history as well. The three papers presented different subjects of these themes. Whereas the first paper dealt with aggression and especially aggression during sexual intercourses, the second one collected those cases which revealed other various forms of deviated sexual behaviour, and prostitution. In this essay the author studied another related area, the job of midwives in village society including not only their main activities in helping labouring women, but their additional work in giving sexual advice, curing various illnesses, and providing baby care. His main concern in this essay, nevertheless, is about witch charges against medwives. ...

History, 17th Century↗
PubMed1993

[Practicability of panoramic hysteroscopy with CO2. Clinical experience: 923 cases].

Between 1987 and 1990, Diagnostic Panoramic Hysteroscopies with CO2 as distending medium was proposed in 890 cases. Age groups, complications and failures are discussed. The notion of "insufficient" hysteroscopy is defined as well as the attitude toward this situation. A technique, vaginoscopy is described, making possible to perform the examination in patients that never had sexual intercourse or senile patients. Vaginoscopy and repetitive hysteroscopy after the first hysteroscopy found insufficient are important tools to achieve good diagnosis and fewer than 1% failure of the procedure among patients with narrow introitus.

Adult↗
PubMed1997

Longitudinal development of distress, coping and quality of life in HIV-positive persons.

BACKGROUND: Longitudinal study on burdens, quality of life and coping strategies of HIV-positive persons to identify patterns of successful adaptation to the demands of the infection. METHODS: In a semiprospective multimodal approach, 61 HIV-positive persons in all stages of the infection attending an HIV ambulatorium were assessed by inventories (3 times) and by a half-standardized interview (baseline T1 focussing on first reactions after diagnosis, follow-up T3 1.5 years later). Subjects had a mean age of 35.3 years and 69% were male. Forty-four percent were infected via homosexual intercourse, 46% via intravenous needle sharing and 10% via heterosexual intercourse or an unknown source. RESULTS: Global, psychic and familial distress decreased significantly from the first period after the diagnosis of HIV to the third time of measurement, while somatic complaints increased. Most test persons were able to deal effectively with the demands of the infection and showed a great degree of flexibility in their use of cognitive-actional and emotional-palliative strategies; they achieved a high quality of life. In contrast, highly distressed individuals, mainly drug users, tended to cope in an evasive-regressive way and reported a low quality of life. Correlations between ineffective coping strategies and low quality of life were found to be significant. CONCLUSIONS: After an initial phase of sorrow and lack of orientation regarding their future life, most HIV-positive persons deal effectively with the demands of the HIV infection and report a good quality of life. In contrast, HIV-positive persons with a high degree of distress and an evasive-regressive coping pattern need professional support, such as psychotherapy.

Adaptation, Psychological↗
PubMed1993

Early initiation of sex and its lack of association with risk behaviors among adolescent African-Americans.

OBJECTIVE: High rates of adolescent homicide, pregnancy, substance abuse, and sexually transmitted diseases underscore the importance of interventions designed to reduce problem behaviors. However, the definition of "problem" behavior and the association with other activities may change between youth cultures. Therefore, greater attention to defining the "problem" behaviors to be targeted will permit more effective utilization of primary vs secondary intervention strategies and identification of high-risk individuals. DESIGN: Two studies of African-American adolescents regarding sexual intercourse, school truancy, substance abuse, and drug trafficking are presented. The first study involved 57 youths (10 to 14 years of age) from a pediatric primary health center and gathered data through pile-sorting. The second study of 300 youths (9 to 15 years of age) from six public housing sites used a questionnaire administered by a "talking" computer. Both studies assessed different self-reported behaviors, feelings about engaging in specific behaviors, and perceptions of friends' behaviors. RESULTS: While 40% of subjects reported having had sex, substantially smaller proportions reported school truancy (14%), illicit drug use (2% to 6%), or drug trafficking (6%). Analyses of reported behaviors, feelings, and perceived peer norms revealed that sex was consistently depicted as forming a different domain from other problem behaviors. CONCLUSIONS: Interventions that rely on primary prevention strategies for sexual intercourse and that identify sexually active youths as at risk for problem behaviors may not be appropriate for African-American adolescents growing up in resource-depleted urban areas.

Adolescent↗
PubMed1985

Epidemiology of urinary tract infection: I. Diaphragm use and sexual intercourse.

In the present case-control study of college-aged women, we examined the associations of sexual intercourse and diaphragm use with primary and secondary urinary tract infection (UTI), and measured the treatment and functional costs of primary, secondary, and recurrent UTI. All of the cases but only half of the controls had engaged in sexual intercourse during the past four weeks. When compared to using oral contraceptives, diaphragm use was associated with both first attack UTI (when compared with controls) and second attack UTI (when compared to women with primary UTI) even after controlling for frequency of sexual intercourse (Primary UTI: RRMH = 3.5; 95% CI: 0.9, 13.0; Secondary UTI: RRMH = 2.2; 95% CI: 0.3, 15.4). Women with all types of UTI reported 6.1 symptom days, 2.4 restricted-activity days, 1.6 office visits and laboratory tests, and spent $62 for treatment of UTI, based on prices of a subsidized student health service.

Adolescent↗
PubMedDate not supplied

Adolescent sexual behavior: estimates and trends from four nationally representative surveys.

CONTEXT: Accurate information about trends over time in adolescent sexual behavior is essential to understand changes in adolescent pregnancy and sexually transmitted diseases and to monitor the progress of health promotion activities in the United States METHODS: Estimates from the National Survey of Family Growth (NSFG), the National Survey of Adolescent Males (NSAM), the Youth Risk Behavior Survey (YRBS) and the National Longitudinal Study of Adolescent Health (Add Health) were compared. While methodologies and populations varied by survey, adolescents aged 15-17 who attend high school were a common subpopulation among all four. For each survey, the prevalence of sexual intercourse, contraceptive use and multiple sexual partners was measured in this population. RESULTS: Trend comparisons fell into four categories. First, some similar significant trends were found across surveys. The proportion of all males and of white males who reported ever having had sexual intercourse decreased significantly, while condom use rose significantly among males in both the NSAM and the YRBS. For such behaviors as ever having had sexual intercourse (among Hispanic males and black females), using the pill and using the condom (among all females) and having four or more lifetime sexual partners (among white males), a significant trend was found in one survey while a similar but nonsignificant trend was found in another. Several trend comparisons were not significant in any survey. Finally, having had intercourse in the past three months (among all males and all females), having had two or more partners in the past three months (for males) and having had four or more lifetime sexual partners (among white females and all males) showed a significant trend in one survey but lacked a parallel nonsignificant trend in another. Prevalence estimates in 1995 differed significantly in at least one comparison of surveys for all behaviors except having four or more lifetime sexual partners (both genders) and having two or more recent sexual partners (females). Gender differences within the YRBS and between the NSFG and the NSAM generally were consistent. CONCLUSIONS: Trends over time and gender differences were similar across surveys, underscoring their value for tracking adolescent sexual behaviors. Differences in prevalence estimates across surveys probably result from differences in question wording, diverse interview settings and modes of data collection, and varying statistical power. These findings suggest a need to increase our understanding of how methodologies influence survey response in research on adolescents.

Adolescent↗
PubMed2004

Erectile dysfunction in heart disease patients.

Atherosclerosis is a general health problem that not only affects the coronary arteries but also (in men) the penile arteries, thus contributing to organic causes of erectile dysfunction (ED) in heart disease patients. These organic causes are intertwined with psychological and pharmacological causes because medication prescribed for heart disease patients may also cause ED. The incidence of ED after myocardial infarction ranges from 38 to 78%. As sexual intercourse involves physical exertion, the medical history, ventricular function determined through echocardiography, and stress testing are used to classify patients into various groups where coital activity represents a greater or lesser cardiovascular risk. The energy requirements for intercourse are not high, ranging from 3.7 metabolic equivalents (METs) of energy expenditure at resting state during the preorgasmic phase to 5 METs during orgasm. The Bruce protocol for exercise stress testing is a six-stage protocol with changes in the slope and speed of the treadmill. As a general rule, a patient who completes the first two stages of the Bruce protocol has a functional capacity greater than 7 METs, which is considered sufficient for sexual intercourse. The physician or cardiologist concerned should institute first-line treatment with oral drugs according to the indications listed below. If sexual activity is not contraindicated, the treatment of choice for ED in heart disease patients is oral therapy with sildenafil, except in those cases in which its use is contraindicated. Specific recommendations are discussed.

Arteriosclerosis↗
PubMed1984

Improved conception rate after intrauterine insemination of washed spermatozoa from men with poor quality semen.

The efficacy of high intrauterine insemination of a washed motile fraction of spermatozoa from men with poor quality semen on the day after the luteinising hormone (LH) surge was compared with that of natural intercourse based on symptothermal methods and a single act of intercourse timed on the day after the LH surge in the same 35 couples in a controlled and randomised trial of the three types of cycle. Each couple had been trying to conceive for at least 3 years, the woman being potentially fertile and the only detectable defect related to poor semen quality. After 39 intrauterine insemination cycles, 8 women conceived (all in their first insemination cycle); this procedure was significantly more successful than LH-timed intercourse (0/38; p less than 0.05) and natural intercourse timed by symptothermal methods (1/34; p = 0.022). The technique of intrauterine AIH, with a 'Tomcat' catheter, was simple, painless, and uncomplicated.

Clinical Trials as Topic↗
PubMed1995

Contraception in the adolescent patient.

Having presented an overview of the available methods of contraception, the authors present one approach to prescribing contraceptives based on their experience. First, adolescent patients in our practice are discouraged from engaging in sexual intercourse. Abstinence is the only fail-safe method of contraception and provides benefits both emotionally and physically (i.e., prevention from sexually transmitted diseases and unwanted pregnancies). If the adolescent plans to be sexually active, however, she is encouraged to select some form of hormonal contraception, namely Norplant, Depo-Provera, or oral contraceptives, in conjunction with condoms. The authors have had little success recommending barrier methods alone. Condoms are used sporadically and the diaphragm is very awkward for adolescents who are still uncomfortable with their bodies and with touching themselves. Of the three hormonal methods, Depo-Provera seems to be well-accepted by our patients. It offers several advantages that we believe make it attractive. First, it does not require any forethought by the patient other than coming in for the injection every 3 months. There is an effective grace period, so the patient is afforded good contraception even if she is up to a month late for her injection. The frequent visits for injections actually can be looked upon as positive, frequent contacts with the patient and can provide opportunities for counseling. In addition, some patients become amenorrheic, which teens view as an advantage, increasing compliance. If it is not likely that a patient will be compliant with every-3-month injections, Norplant is recommended. Studies have shown good acceptance of Norplant by adolescents and that has been the experience of the authors. With appropriate counseling prior to insertion and a counseling session with patients who request removal, the number of actual Norplant removals has been limited. If Depo-Provera and Norplant are not acceptable to the patient, then oral contraceptives are recommended. Of the three methods, more opportunities for failure exist with oral contraceptives. Pills are missed for a variety of reasons, including going away for the weekend; not having a regular schedule, which can interrupt pill-taking; and even ambivalence about becoming pregnant. One recent study demonstrated certain patient characteristics that were associated with good compliance with oral contraceptives, including white race, higher education level, suburban residence, and older age of both the patient and her mate. Keeping these characteristics in mind may be helpful when prescribing oral contraceptives. Of course, it is the patient's prerogative to choose the type of contraception she feels will be best suited for her.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2001

Perceived versus actual knowledge about correct condom use among U.S. adolescents: results from a national study.

PURPOSE: To assess the prevalence of three misconceptions about correct condom use and determine whether prevalence of these misconceptions varied by gender, sexual intercourse experience, experience using condoms, and the relationship between adolescents' actual and perceived knowledge about correct condom use. Variables that predicted misconceptions about correct condom use were also identified. METHODS: Data from the National Longitudinal Study of Adolescent Health were analyzed to determine prevalence of misconceptions among 16,677 adolescents. Misconceptions were: (a) no space at the tip of the condom, (b) Vaseline can be used with condoms, and (c) lambskin protects against the acquired immunodeficiency virus better than latex. Chi-square analyses determined differences in prevalence of misconceptions between male and female adolescents based on their sexual and condom use experience as well as their level of perceived knowledge about correct condom use. Logistic regression models identified predictors of reporting misconceptions. RESULTS: Depending on intercourse experience and experience using condoms, about one-third to one-half believed the first two misconceptions and about one-fifth believed the latter one. Perception of knowledge about correct condom use was infrequently related to actual knowledge. Misconceptions were less likely among older adolescents, those ever having intercourse, those reporting four or more lifetime intercourse partners, those who had used condoms, females, and those not reporting a religious affiliation. CONCLUSIONS: Misconceptions about correct condom use are common among adolescents. Sexually active adolescents need more complete information about correct condom use.

Adolescent↗