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Influence of family planning counseling in an adolescent clinic on sexual activity and contraceptive use.

We evaluated whether family planning counseling (FPC) in an adolescent clinic promoted the onset of sexual activity among the non-sexually active teens and/or increased contraceptive use among the sexually active teens. The FPC focused on the teens' establishing sexual values, the right to say "no," abstinence and alternate forms of intimacy, consequences of intercourse, and the various contraceptive methods. Data for one year were collected on the adolescents' first and subsequent visits to a medically oriented, municipal outpatient adolescent clinic. There were 383 teenagers who qualified for the study. Of these, 35% (134) reported premarital sexual activity. During the study period, 3% (8) of the 249 nonsexually active teens reported becoming sexually active. Among the 134 sexually active teens at clinic entry, 27% reported using a contraceptive method at their most recent sexual encounter. Among the 142 sexually active adolescents at the conclusion of the study, 76% reported contraceptive use at their most recent sexual encounter (p less than 0.001). We conclude that the provision of FPC to nonsexually active and sexually active teens does not appear to promote the onset of sexual activity significantly among the non-sexually active group, although it significantly increases contraceptive use among the sexually active group.

Adolescent↗

Intracavernous Alprostadil Alfadex--an effective and well tolerated treatment for erectile dysfunction. Results of a long-term European study.

Long-term efficacy and safety of Alprostadil-Alfadex (EDEX/VIRIDAL) in intracavernous self-injection therapy for chronical erectile failure was investigated in a four year running multicenter European trial. Of the 16,886 protocolled injections 93% (15,713) resulted in rigid erections followed by successful sexual intercourse. Reported side effects by patients were prolonged erections > 6 h only occurring during the first year in 1.2% (2 out of 162), painful erections in 29% (47 out of 162) during the first year and decreasing to 12.1% by year 4, hematomas, neither requiring therapeutic measures nor impeding sexual performance in 33.3% (54 out of 162) in year 1 with a decrease to 12.1% by year 4, fibrotic penile alterations such as nodules, plaques or deviations in 11.7% (19 out of 162) with spontaneous healing in 48% (9 out of 19). Of the 162 patients involved in this trial 54 completed the 4 y. Of the 54 completers 91.4% considered the tolerability good or very good and were satisfied or very satisfied with self-injection therapy with Alprostadil-Alfadex. The respective rates of the female partners were 51.7% very satisfied and 39.7% satisfied. These data of the world-wide longest running prospective trial with a vasoactive drug in self-injection therapy provided impressive proof that Alprostadil-Alfadex represents a very effective and safe treatment for erectile dysfunction of both psychogenic and organogenic origin.

Adult↗

[Modification of semen quality by acupuncture in subfertile males].

Our first attempt in treating subfertility by acupuncture was carried out on 28 males. The results obtained from the experiences in veterinary medicine encouraged us to attempt this type of therapy. Each patient received a total of 10 treatments for a period of three weeks. Several spermiograms were made after diagnosis subfertility. We checked spermiograms and hormone levels before and after acupuncture. Total count, concentration and motility were evaluated. In all cases we observed a statistically significant improvement of sperm quality. Having obtained these good results in our first studies, we now intend to continue acupuncture therapy in subfertile males for insemination or intercourse at the time of the ovulation of their female partners.

Acupuncture Therapy↗

Sexual functioning and attitudes of eating-disordered women: a follow-up study.

The sexual experiences and attitudes of eating disorder patients are receiving increased professional attention. However, empirical work in this area has generally focused on these patients at the point of initial evaluation. In the current study we report the results of a follow-up questionnaire completed by women who had been treated in our clinic (N = 42) for either anorexia nervosa (restricting type) or bulimia nervosa (purging type). We found that former anorectic patients were less likely to return the questionnaire and, of those who did, there was a trend toward anorectic women's being less likely to be in a romantic/erotic relationship. Almost all of the women had engaged in sexual intercourse, and former anorectic patients did not differ from bulimics with regard to age at first coitus. Anorectics were less likely than bulimics to have engaged in masturbation and also scored lower on a measure of sexual esteem. Although there were no differences between the two groups with regard to current level of sexual functioning, erotophobia/erotophilia, or sexual satisfaction, the women in our sample exhibited less sexual interest and more negative affect during sex than did a normative sample. Also, nearly 40% of our sample indicated clinically significant levels of sexual discord with their current partner. Results are discussed with regard to prior research, interventions, and further study.

Adolescent↗

HIV antibody testing among the Hong Kong mainland Chinese cross-border sex networking population in Hong Kong.

The present study reports the results of 2 surveys examining the likelihood of performing HIV antibody test among the Hong Kong mainland China traveller population. The 2 studies interviewed 1325 and 2074 male adult Hong Kong residents. Among those who had had sexual intercourse with a female sex worker (FSW) in the past 6 months, 31.1% in the first sample indicated that they intended to take an HIV antibody test in the future, whereas 16.4% in the second sample reported they had actually taken a blood test for HIV antibody. In both samples, no association was found between demographic variables, attitudinal/knowledge-related variables and intention to do a blood test for HIV antibody and actual testing behaviour. Moreover, in both samples, those who had more female sexual partners in the past 6 months were more likely to report an intention for HIV test or to have taken an HIV test.

AIDS Serodiagnosis↗

The spouse: a factor in recovery after acute myocardial infarction.

Literature supports the concept that the response of a patient's spouse influences the recovery process of a patient after an acute myocardial infarction (AMI). This was a 6-month, longitudinal, descriptive study of 17 married couples in which one of the pair experienced his or her first AMI. The study examined the question: "Is there a relationship between the spouse's social support, family stress, marital satisfaction, and sexual comfort and the patient's recovery after AMI?" Data were collected at three times during the 6-month period after AMI. Results showed a significant relationship between the spouse's family stress, marital satisfaction, and sexual comfort and the patient's recovery. Also, a significant relationship was found between the spouse's sexual comfort and marital satisfaction. This was the first reported study that examined sexual comfort over time and investigated sexual activities other than intercourse.

Adult↗

[Induratio penis plastica].

The symptoms of Peyronie's disease consist of fibrotic plaque formation, penile deviation and painful erection. The etiology is still unknown. During its progress the disease can cause erectile failure. The plaques mainly involve the dorsal tunica of the penis. The diagnosis is made by palpation of the penis. The ultrasound examination evaluates the plaque localization and possible calcifications. Autophotography of penile deviation and duplex sonography of the cavernous arteries used to measure arterial blood flow complete the diagnostic efforts. Spontaneous remissions occur as well as chronic courses. Oral medication is the first step in therapy. In cases with severe penile deviation leading to disability to perform intercourse, persisting pain or erectile failure operative management is indicated. Plaque surgery, modified corporal plication or implantation of a penile prosthesis must be evaluated individually.

Diagnosis, Differential↗

Correlates of heterosexual behavior among 23-87 year olds in Denmark and Sweden, 1992-1998.

Correlates of heterosexual behavior, with a particular focus on early and high sexual activity, anal intercourse, prostitute visits, and HIV test activity, were studied. Telephone interviews were conducted with 852 randomly chosen persons who participated as controls in nationwide case-control studies of anogenital cancers in Denmark and Sweden, 1992-1998. While partner numbers and the practice of anal intercourse increased, age at sexual debut declined by 4-5 years (p < 0.001) and the maturation interval between menarche and first coitus halved (from 7 to 3 years, p < 0.001) between persons born in or before 1920 and those born in or after 1960. Women having high sexual activity were more often tested for HIV than less sexually active women, but men visiting prostitutes and those with prior STDs were not HIV tested more than other men. The increasing practice of anal intercourse, particularly among women with many partners, deserves attention, since this practice may erroneously be considered a safe sexual activity. Along with their partners, men with a history of STDs and those visiting prostitutes should be targeted in future safe sex campaigns, since these men appear to be inadequately HIV tested.

Adult↗

Sexual abstinence at age 21 in New Zealand: the importance of religion.

Most research on adolescent sexual behaviour has focused on early initiation and consequent risks. We have instead examined the circumstances of young people who have not had sexual intercourse before age 21, in order to throw light on the ways in which young people might resist societal pressures for early sexual intercourse. The sample was a cohort born in Dunedin, New Zealand in 1972/73, formed at age 3, and followed with regular assessments of personal, family and educational functioning to age 21. At age 18 and 21 information on sexual behaviour was collected, using a computer presented questionnaire. The response rate at age 21 was 935/1020 (91.7%) of the survivors of the original cohort. Overall 11.3% of the men and 8.1% of the women reported never having sexual intercourse. Sex with a man was reported by 20 men (4.5%), of whom only two reported having sex only with men. Being first born and being persistently involved in religious activities, measured at both 11 years and 21 years, were significant predictors of abstinence for both sexes. Examination of perceptions of an ideal lifestyle, sexual behaviour and religious involvement showed that religion was an important factor in decisions to delay sexual intercourse past age 20, especially for men. It would be helpful to examine further the features of moral decision making which are characteristic of religious experiences.

Adult↗

Intra-uterine insemination versus cyclic, low-dose prednisolone in couples with male antisperm antibodies.

A total of 46 couples with male immunological infertility entered the trial at the infertility clinic of the Family Federation of Finland. The men all showed a positive mixed antiglobulin reaction to immunoglobulin G in their semen; 31 men were also tested for sperm-bound IgA immunoglobulins by flow cytometry. Serum antisperm antibodies were checked in a tray agglutination test. The women showed normal reproductive endocrinology and at least one patent Fallopian tube. The couples were randomized to undergo either up to three intra-uterine inseminations (IUI), or timed intercourse with cyclic, low-dose (20 mg) prednisolone therapy of the men. Cross-over was carried out if no pregnancy occurred in the first stage. Timing of ovulation was based on urinary luteinizing hormone assay and transvaginal ultrasonographic measurements. In all, 40 couples either completed the study or the female partner conceived. IUI was significantly better (P = 0.04) with nine pregnancies than timed intercourse with prednisolone (one pregnancy). There were no significant associations between antibody levels, sperm count or motility versus the incidence of pregnancy. In male immunological infertility, well-timed IUI is an effective treatment method: results are obtained rapidly and steroidal side-effects can be avoided.

Adult↗

Reevaluation of the clinical importance of evaluating sperm morphology using strict criteria.

Several studies suggest that sperm with < or =4% normal morphology (NM) using strict criteria are subfertile and IVF with ICSI may be needed. However, not all studies agree on the clinical importance of the use of NM with strict criteria. One study of males with oligozoospermia found a lower pregnancy rate (PR) following intercourse with sperm with NM > 14% compared to specimen with < or = 4%. The study presented herein evaluated the efficacy of intrauterine insemination (IUI) according to NM using strict criteria. The clinical PRs for first IUI cycles were 30% (28/91 ) for 0-4% normal forms, 26% (71/268) for range of 5-14%, and 20% (11/53) for >14%. This study corroborates previous data with intercourse only, suggesting that sperm with NM < or =4%, using strict criteria are not necessarily associated with lower fecundity.

Humans↗

Barrier versus oral contraceptive use: a study of female college students.

Although they provide birth control and are easier to use, oral contraceptives (OCPs) are not the preferred approach to preventing sexually transmitted disease (STD). Do the knowledge, attitudes, and experiences of oral contraceptive users place them at greater risk for STDs than those who employ barrier methods? This study examined differences between sexually active female college students (ie, those who reported ever having had vaginal intercourse) who used OCPs and those who employed barrier methods of contraception at the time of their most recent intercourse. The authors analyzed HIV- and other STD-related knowledge, attitudes, and behaviors from three consecutive annual health surveys of young women about to begin their first year of college. Findings showed barrier and OCP users to be comparable in knowledge about the effectiveness of various contraceptive methods in protecting them against STDs, perceived personal susceptibility to HIV, and experiences with alcohol before sexual intercourse. Oral contraceptive users, compared with those in the group who used barrier methods, reported a greater number of recent partners (p less than .03) and greater perceived vulnerability to STDs (p less than .03). Student healthcare providers must develop creative educational strategies to encourage simultaneous use of both oral contraceptives and barrier methods to protect students against STDs and pregnancy.

Adolescent↗

Laparoscopic radical prostatectomy: assessment after 550 procedures.

PURPOSE: To evaluate our experience in laparoscopic radical prostatectomy. MATERIALS AND METHODS: Between January 1998 and December 2000, 550 consecutive patients eligible for radical prostatectomy, were operated laparoscopically. Data concerning surgery and post-operative course were assessed and recorded. Oncological data were assessed by pathological examination and post-operative PSA level. Functional results were assessed with a self-questionnaire. RESULTS: The mean operating time was 170 min for the last 350 patients. Surgical conversion was necessary in seven patients (1.3%). Mean intra-operative bleeding was 290 ml (range: 50-1500 ml) for the last 350 patients. The overall transfusion rate was 5.27%. Mean bladder catheterization time was 4.2 days and median postoperative stay was 5 days in the last 350 patients. By pathological stage, 4 pT2a specimens (3.3%), 48 pT2b specimens (15%), 21 pT3a specimens (33%), 19 pT3b specimens (47%) were found to have positive surgical margins. For pT2a and pT2b stages, non-biological recurrence probability (PSA<0.1 ng/ml) is, respectively, 92.3% at 36 months, and 86.3% at 31 months. The continence rate (no pad) was 82.3% at 12 months among the 255 first patients. For 47 consecutive selected patients, spontaneous erection rate was 85 and 66% experienced spontaneous intercourse. CONCLUSIONS: Laparoscopic radical prostatectomy is currently feasible, with low perioperative morbidity. Taking into account the postoperative follow-up, oncological results are identical to those obtained with conventional surgery. The functional results are encouraging.

Humans↗

Time to pregnancy: results of the German prospective study and impact on the management of infertility.

BACKGROUND: The likelihood of spontaneous conception in subsequent cycles is important for a balanced management of infertility. Previous studies on time to pregnancy are mostly retrospective and biased because of exclusion of truly infertile couples. The study aim was to present a non-parametric estimation of cumulative probabilities of conception (CPC) in natural family planning (NFP) users illustrating an ideal of human fertility potential. METHODS: A total of 346 women was observed who used NFP methods to conceive from their first cycle onwards. The couples practising NFP make optimal use of their fertility potential by timed intercourse. The CPC were estimated for the total group and for couples who finally conceived by calculating Kaplan-Meier survival rates. RESULTS: A total of 310 pregnancies occurred among the 346 women; the remaining 36 women (10.4%) did not conceive. Estimated CPC for the total group (n = 340 women) at one, three, six and 12 cycle(s) were 38, 68, 81 and 92% respectively. For those who finally conceived (truly fertile couples, n = 304 women), the respective pregnancy rates were 42, 75, 88 and 98% respectively. Although the numbers of couples in both groups were similar, the impact of age on time to conception, as judged by the Wilcoxon test, was less in the truly fertile than in the total group. CONCLUSIONS: Most couples conceive within six cycles with timed intercourse. Thereafter, every second couple is probably either subfertile or infertile. CPC decline with age because heterogeneity in fecundity increases. In the subgroup of truly fertile couples, an age-dependent decline in CPC is statistically less obvious because of high homogeneity, even with advancing age.

Aging↗

Factors related to delayed diagnosis of HIV infection in southeastern France. EVALVIH group.

We aimed to identify risk factors associated with delayed diagnosis of HIV infection in a French region highly affected by AIDS. Data were collected in southeastern France through the HIV-surveillance system based upon anonymous declarations by laboratories and physicians prescribing HIV testing. From January 1996 to December 1997, 825 persons were diagnosed for the first time as HIV infected (female: 32%; >40 years: 28%); 46% had been infected through heterosexual intercourse, 26% through homosexual intercourse, and 19% through intravenous drug use. The semestrial (6 monthly) incidence rate decreased from 122.7 to 69.7 per million inhabitants (P<0.001). County of residence, age, sex, country of birth, and transmission category did not change significantly during the observation period. Twenty-seven per cent had a delayed diagnosis of HIV infection. This proportion did not differ significantly according to sex or country of birth, or during the observation period. However, after controlling for the other factors, delay was more frequent among injecting drug users (IDUs) (35%, P<10(-2)) than other transmission categories; it was also positively associated with age (47% above 50 years vs 13% under 30 years, P<10(-2)). This study highlights that, in spite of the current AIDS prevention policy and wide access to HIV screening, the proportion of delayed diagnosis of HIV infection remains high. Physicians should concern themselves with this public health issue, and campaigns should target people insufficiently aware, especially IDUs and older people. Further research is needed to understand better the causes of delayed diagnoses and of inequalities in access to HIV screening.

AIDS Serodiagnosis↗

[The sexuality of adolescents from 14 to 19 in a given population].

A study by a survey about sexuality in adolescents was performed in 218, subjects aged 14-19 years with the aim of knowing the level of sexual intercourse practice, the degree of sexual information and the use of contraceptive methods and history of pregnancy by age and sex. In the analysis made it was found that 51% of the sample have sexual intercourse since early adolescents. The majority has information about contraceptive methods. Only 66% of adolescents who have sexual intercourse is protected against impregnation or infections; 38 have no protection at all. The most effective contraceptive methods for this group such as condom or diaphragm are not known or not used by them. 61% of young people who has sexual intercourse had a history of pregnancy, most of them having given birth to a child in first place, followed by uterine curettage and as a result they left school and a few began to work. The family doctor and the nurse must provide sexual education to the family due to the relation they have with their population.

Adolescent↗

[A clinical evaluation of AMS Hydroflex in the treatment of impotence].

The AMS Hydroflex penile prosthesis was implanted in 34 organic impotence patients between June 20, 1986 and Aug. 6, 1990. Patients ages ranged between 26 and 71 with an average of 50.5. The causes of impotences were; 17 cases of post-radical pelvic surgery, 7 cases of injury, 6 cases of diabetes and 4 of others. First evaluation was made after 12 weeks of implantation in terms of patient satisfaction with sexual intercourse and post operative complication. Sixteen patients (47.1%) were highly satisfied with intercourse, 13 (38.2%) satisfied with intercourse, 2 (5.9%) slightly dissatisfied even with successful intercourse, 1 (2.9%) with no improvement and 2 (5.9%) could not follow. Utility of the prosthesis, e.g. effectiveness and safety was; high utility in 20 (58.8%), good utility in 11 (32.4%), slight utility in 1 (2.9%), no favorable in 1 (2.9%) and no judgement in 1 (2.9%). The overall effectiveness and safety of the Hydroflex was demonstrated based on the above findings. Long term evaluation was made from the initial implantation of the device up to the termination of the trial with average of 19.2 months and was mentioned altogether.

Adult↗

[Unusual cause for the development of hemoperitoneum].

The authors describe an unusual origin of haemoperitoneum in a young woman. The hemoperitoneum appeared twice in a period of 10 months. The first attack was mild and atypic. In both cases the hemoperitoneum was preceded by a sexual intercourse, during which the ovary resp. the ovarian cyst were injured. The authors suggest that the coital rupture of the ovary is a very common cause of these states. The diagnosis of inapparent bleeding in the abdominal cavity is always very difficult and without laparoscopic examination almost impossible. The full developed hemoperitoneum with all its clinical signs does not implicate diagnostic difficulties, but the state of these women is very serious. The diagnosis will be a problem, when the bleeding occurs slowly, without pain and without known aetiology.

Adult↗