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Cytologic and direct fluorescent antibody techniques were used to detect the presence of Actinomyces israelii and Arachnia propionica in cervicovaginal smears collected from 100 women, 94 of whom did not use intrauterine contraceptive devices. In no case were these organisms found. The possible significance of these results is discussed.
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Women in their forties are still potentially fertile, and pregnancy in this age group is attended with increased maternal mortality, spontaneous abortion, fetal anomalies and perinatal mortality. Contraception for women in this age group has special risks and benefits; both should be balanced to choose between the different options available. Recent epidemiological and clinical pharmacology studies have indicated the safety of extending the use of combined oral contraceptives (COCs) beyond the age of 35 years and up to menopause. Women who have reasons for avoiding COCs can use progestogen-only contraceptives like pills, depot injectables and implants. Implant combines high efficacy and long-term effect. Both copper-releasing and levonorgestrel-releasing intrauterine contraceptive device (LNG-IUD) combine the advantages of high efficacy and long-term effect. The reduced fecundity above the age of forty can allow extending the use beyond the accepted term, and up to one or two years beyond the menopause without the need for replacement. The levonorgestrel IUD has the advantage of reducing the amount of menstrual bleeding. The condom has the added benefit of protection against sexual transmitted diseases (STDs). Male or female sterilization is an excellent contraceptive option, provided that this approach is culturally acceptable and available at reasonable cost and low risk.
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We report on factors related to the prevalence of bacteria in the vagina of 1498 women who were attending a family planning clinic. Anaerobes were significantly commoner in women with an abnormal vaginal discharge on clinical examination, in women with a history of a troublesome vaginal discharge and in women who used an intrauterine contraceptive device (IUCD) than in others. The association between anaerobes and abnormalities of vaginal discharge was found both in women who used the IUCD and in women who did not. We found no significant associations between symptoms and other bacterial species or combinations of species. Coliforms were significantly commoner in women who did not use tampons, in women who used the diaphragm and in women who had received recent antibacterial or antifungal treatment than in others. Lactobacilli were significantly commoner in women who used the contraceptive pill, and were significantly less common in women who harboured Candida albicans, anaerobes, coliforms or enterococci and in women who had been treated with antibacterial drugs, than in others. We found no important associations between the presence of bacteria and the patients' age, parity or social class.
Diabetic women present an interesting challenge to the reproductive health-care physician and gynecologist. Good preconceptual counselling reduces the risk of adverse consequences of the pregnancy to the mother and the fetus and should be encouraged. Poor metabolic control has been linked with an increased risk of congenital malformations. The low-dose combined pill (COC) does not appear to increase the risk of diabetes in women with a history of gestational diabetes. Young healthy diabetic women under 25 years old may be prescribed the low-dose COC with careful metabolic monitoring. The copper intrauterine contraceptive device is a useful choice in diabetic women with vascular disease, proliferative retinopathy and nephropathy. The progestogen-only pill and barrier methods may sometimes have unacceptable failure rates in diabetic women who may require to avoid a pregnancy at any cost. When a couple's family is complete, sterilization and vasectomy should be encouraged.
BACKGROUND: Carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT) are the most commonly used markers for alcohol abuse, but their sensitivity and specificity are lower and have different reference values among females compared with males. In the present study, we evaluated the effect of women's hormone balance on these two alcohol markers, as well as on their mathematical combination, named gamma-CDT. METHODS: An age-stratified random sample of 3962 women, between 25-74 years old, was drawn from the normal population. Pregnancy, the use of oral contraceptives, intrauterine device for contraception, hormone replacement therapy, and hormone treatment for infertility were considered. A comparison between fertile, peri- and postmenopausal women was also done. RESULTS: Existing pregnancy increased CDT levels but decreased GGT values. Lower CDT and higher GGT levels were observed among those women using oral contraceptives and in postmenopausal women compared with women at the fertile stage. gamma-CDT was not influenced by hormone balance. CONCLUSIONS: The different hormonal status had an opposite effect on CDT and GGT. Women who were close to late menopause had levels of both markers closer to the values of men. It must be pointed out that the findings presented here are based on measurements of absolute CDT values and that no measurements of total transferrin were done. gamma-CDT, not influenced by hormone balance, indicates promising clinical utility among women.
We studied past contraceptive use in 283 nulliparous infertile women who had a diagnosis of tubal adhesions or occlusion and in 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with barrier contraceptive use or oral contraceptive use was calculated using multivariate logistic regression to control for confounding by region, age, religion, education, smoking, number of sexual partners, time since menarche, and use of other contraceptive methods. Women who had ever used barrier methods of contraception were at a significantly decreased risk of tubal infertility (relative risk = 0.6; 95% confidence limits, 0.5 and 0.8). When type of barrier method used for the longest time was evaluated, those who used the diaphragm or condoms plus spermicides were at lower risk than those who used condoms or spermicides alone. Overall, past use of oral contraceptives neither increased nor decreased a woman's risk of tubal infertility, but there was evidence that the association between oral contraceptives and tubal infertility may vary by the amount of estrogen and type of progestogen in the oral contraceptive used. We conclude that contraceptive users who use barrier methods that combine both a mechanical and chemical barrier, such as diaphragms, cervical caps, and condoms plus spermicides, have the clearest protection against tubal damage.
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Although existence and functioning of a sexual relationship is of outstanding importance for the abortion decision as well as for the postabortive emotional adjustment, until now there are only some case studies focussing on the postabortive reaction of the sexual relationship. Results of a representative and controlled follow-up-study investigating the effects of legal abortion on the relationship with a partner are reported here. 117 women, a representative sample of all 263 women having a socially indicated legal abortion during the first 3 months of 1982 in Kiel, were interviewed some days before and 1 year after the abortion. The effects of abortion on the sexual relationship are described in comparison with a control group with similar preabortive characteristics of partnership using hormonal or intrauterine contraceptive devices. Rate and circumstances of separation, especially the role of abortion for the separation, as well as the quality of the remaining relationships have been analysed. We could find preabortive variables easily accessible for the counselor, predicting the development of the sexual relationship regarding quality and stability in the year after abortion.
The Dalkon shield was withdrawn from the market in the United States of America last year because of the reports of 11 maternal deaths and 209 cases of septic midtrimester abortions associated with the device in situ. Four cases of late midtrimester septic abortions resulting in neonatal deaths are presented. In one of these, the mother developed septicaemic shock and almost died. The true pregnancy rate with the Dalkon shield is much higher than was initially claimed, particularly if it is inserted in the puerperium. Surveys on the outcome of the pregnancy indicate that 50% end in spontaneous abortion and one in 20 pregnancies are ectopic. A high percentage of the abortions are septic. The Dalkon shield, therefore, has no advantages over other intrauterine contraceptive devices and it remains to be seen whether the recent modification of the device has overcome the disadvantages of the earlier version. If pregnancy is diagnosed with the device in situ, it should be removed if the string is visible. If pregnancy continues with the shield in place, the patient should be observed closely. Should septic abortion occur, active management is indicated and early evacuation of the uterus is recommended.
Despite the high popularity of the intrauterine contraceptive device (IUCD) among family planning clients at University College Hospital, Ibadan, some users discontinued its use for a variety of reasons. This study was to determine the discontinuation rate among IUCD users at UCH, Ibadan. It was a 5-year retrospective analytical study. The records of patients using an IUCD seen at the Family Planning Clinic between 1 January, 1998 and 31 December, 2003 were analysed. A total of 867 clients were seen during the study period; 258(29.8%) clients discontinued within 5 years with the highest rate at 1 year 10.1% and least after 5 years 2.8%. The most common reason for discontinuation was the desire for pregnancy (57.0%). Other reasons included: side-effects (28.3%), husband's views (7.0%) and the menopause (8.0%). The reason for discontinuation varied significantly with the age of the clients (92.5% of clients that discontinued were less than 35 years), educational status, husband coercion, number of living children and religion. The discontinuation rate for the IUCD is high inspite of the high initial acceptability of the method in Nigeria. In a country experiencing a very rapid population growth where the prevalence of contraceptive use hardly attains double figures, it is imperative that policy makers double their efforts at ensuring an appreciable continuation rate of contraceptive use in general and IUCD in particular, among Nigerian women.
Postcoital contraception has been prescribed for more than two decades. The current regimen is given within 72 hours of unprotected intercourse. After this period, not many choices remain; either the woman may wait until her next menses hoping she is not pregnant or she may have a postcoital intrauterine contraceptive device inserted. Since these alternatives are not always acceptable, we reviewed the literature looking for evidence supporting the current maximum time limit for treatment. Our conclusion is that the limit could theoretically be extended; therefore we think it is time to challenge the time period of current treatment by conducting clinical trials.
Actinomycosis is subacute or chronic disease manifested by a defined granulomatous inflammation with the development of infiltrates, abscesses and fistulae. A 35-year-old female patient was admitted and operated at the Second Surgical Clinic because of symptoms of diffuse peritonitis. Laparotomy revealed a duplicit tumour of the small intestine, an abscess of the abdominal wall in the left mesogastrium and pyoovarium bilaterale. 70 cm of the small intestine were resected, incision of the abscess and bilateral adnexotomy were performed. Histological examination revealed a suppurative, partly fibroproductive inflammation with an actinomycotic etiopathology. After antibiotic treatment the patient was discharged home, the gynaecologist removed an intrauterine device. Three months after the first operation the patient in a serious septic condition was readmitted to the clinic with signs of diffuse peritonitis. A double perforation of the small intestine was found and an end-to-end anastomosis was made after resection of the small intestine. The postoperative course was complicated by respiratory failure and failure of the circulation associated with septic shock and subsequent death. In the conclusion the authors emphasize the problem of preoperative diagnosis of the abdominal form of actinomycosis, its possible development in relation to intrauterine contraceptive devices and its clinical manifestation as acute abdomen.