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.     

Live Your Life Out Loud

Susan Love, MD, MBA, has dedicated her professional life to the eradication of breast cancer. Author of the bestselling Dr. Susan Love's Breast Book, Dr. Susan Love's Menopause and Hormone Book, and Live a Little, Susan is Chief Visionary Officer of the Dr. Susan Love Research Foundation where she oversees an active research program centered on breast cancer cause and prevention. Susan co-founded the National Breast Cancer Coalition in the early 1990s, and she served on President Clinton's National Cancer Advisory Board from 1998–2004. Her recent projects include recruiting 377,000 women for the Love Army of Women, an Internet program that partners women and scientists to accelerate breast cancer research; and the online Health of Women Study designed to identify the cause of breast cancer. A recipient of six honorary doctorate degrees, Susan is Clinical Professor of Surgery at the David Geffen School of Medicine at the University of California, Los Angeles. In June of 2012, Susan was diagnosed with acute myelogenous leukemia and was treated with an allogenic stem cell transplant.     

College student contraceptive use: A multivariate analysis

This study investigated the relationship of 22 variables—categorized as relating to sexual history, relationship, social support, contraception beliefs, and personality factors—to contraceptive use by college women and men. The use of effective contraception by both women and men was primarily associated with partner support for contraception; and the choice between oral contraceptives and condoms was associated with frequency of intercourse.     

Commenting on PC and Multiculturalism

ABSTRACT

Women Veterans who experience homelessness are at high risk of unintended pregnancy and adverse outcomes. Contraception could mitigate risks, yet access barriers exist across the Veterans Health Administration (VHA). We identified all US women Veterans, age 18–44y with evidence of homelessness in VHA administrative data between fiscal years 2002–2015, in order to document the geographic distribution of ever-homeless women Veterans in relation to VA Medical Centers (VAMCs) and assess geographic associations between long-acting reversible contraceptives (LARC) or permanent contraception (PC) use. We calculated VAMC travel distance from last known ZIP Code. We used multivariate logistic regression models to explore contraceptive method associations. We included 41,722 ever-homeless women Veterans; 9.2% had LARC exposure and 7.5% PC. We found 29% of ever-homeless women Veterans resided >40miles from the nearest VAMC and increasing drive distance was negatively correlated with contraceptive exposure, especially for Veterans residing >100miles from a VAMC. Increasing distance to the nearest VAMC results in a geographic barrier to the most effective contraceptive options for women Veterans. The VHA is uniquely positioned to leverage its rural and homeless healthcare expertise to address geographic barriers and integrate comprehensive contraceptive services into established programs for high-risk Veterans.     

Coitus‐dependent contraceptives: Factors associated with effective use

The factors associated with adequate contraceptive use among university women relying on coitus‐dependent contraceptives were examined. Sixty‐nine sexually active women between the ages of 18 and 34 completed daily logs of their sexual activity, contraceptive behavior and basal body temperature over three menstrual cycles. Contraceptive use was analyzed by menstrual cycle phase and results indicated that frequency of use was significantly higher during the ovulatory phase as compared to the menstrual period. Additional findings using discriminant function analysis indicated that compared to risk takers, non‐risk takers were more likely to initiate sexual intercourse, have more orgasms, have a non‐Catholic background, be living with their partners and have been in their relationships longer. These data suggest that women in less stable relationships and with more sexual inhibitions may be more at risk of an unwanted pregnancy.     

Sexual decision making and safer sex behavior among young female injection drug users and female partners of IDUs

Data from interviews with 94 young women who were injection drug users (IDUs) or partners of IDUs were analyzed to examine associations between self-reported sexual decision making and condom use, contraceptive use, and relationship characteristics. Most women (73-85%) reported participating in decisions about condom use, contraception, and when to have sex. Adjusting for potential covariates, respondents who reported participating in decisions about condom use and when to have sex were 7 and 19 times, respectively, more likely than others to report recently using condoms. Respondents who reported participating in decisions about contraception were 20 times more likely than others to report recently using contraceptives. Longer sexual relationships were associated with decreased likelihood of condom or contraceptive use.     

Community and individual acceptance: family planning services in the Sudan

The Sudan Community-Based Health Project, initiated by the University of Khartoum in cooperation with the Ministry of Health in 1980, sought to test the proposition that government-trained village midwives could provide maternal-child health and birth spacing services in addition to their ongoing obstetrical duties. The project area encompassed 92,000 people in 93 villages. The 120 midwives serving the project area received training in 4 interventions -- oral rehydration therapy, maternal and child nutrition, immunization, and birth spacing -- and introduced these services by means of 3 rounds of household visits over a 5-month period. Comparison of pre- and post-intervention survey data indicates that village midwives can indeed be used successfully to promote not only contraceptive use, but also health attitudes and practices that are positively associated with fertility regulation. Between the 2 surveys, the percentage of women who ever used contraception increased from 22% to 28%, while the percentage of current users rose from 10% to 13%. Parity was significantly related to current use; each child born multiplied the likelihood of contraceptive acceptance (by a factor of 0.76 in the post-intervention sample). Maternal education was the socioeconomic variable that most enhanced receptivity to contraceptive acceptance after the project's interventions. In terms of community-level variables, village location along the Nile and proximity to a paved road were significant correlates of contraceptive use. When variables related to the project itself were analyzed, women with vaccinated children were found to be twice as likely to contracept as those with nonvaccinated children and women who believed breast feeding should be continued during diarrhea episodes were 1.5 times more likely to use birth spacing than those who did not. Although midwives did not specifically emphasize contraceptive use, it appears women who were encouraged by midwives to take positive steps in the area of child health were also likely to become more innovative in terms of fertility regulation.     

Not Such Strange Bedfellows After All

Abstract

The irritable bowel syndrome (IBS) is best defined as abdominal pain of greater than three months duration, with or without a change in bowel habits. Barium studies, sedimentation rate, and the lactose tolerance test are usually within normal limits. The underlying physiology includes a predominance of 3 cycles/minute basal electrical rhythm (BER). The abdominal pain is poorly localized and usually intermittent, without a clear relationship to medication. Differential diagnosis should include inflammatory bowel disease, infectious colitis or gastroenteritis, lactose intolerance, gallbladder disease, peptic ulcer disease, pelvic inflammatory disease, ovarian cysts and tumors, and endometriosis. A sedimentation rate is an important part of the diagnostic workup which may or may not include barium studies. Anticholinergics have been shown to alter the abnormal BER of irritable bowel syndrome and have proven to be of use in treating this syndrome. Dietary counseling should include advising the patient to eat slowly and at regular hours, and heat applied to the abdomen in the form of a hot water bag has been useful. “Overprogrammed” individuals with irritable bowel syndrome should be advised to modify their activities as this type of stress may give rise to the symptoms.

“Effect of Estrogen/Progestin Potency on Lipid/Lipoprotein Cholesterol,” PATRICIA WAHL, CAROLYN WALDEN, ROBERT KNOPP, JOANNE HOOVER, ROBERT WALLACE, GERARDO HEISS, and BASH RIFKIND. We studied 374 women taking oral contraceptives, 284 women taking estrogen preparations after menopause, and 1086 women taking no hormones, to determine the relation of plasma lipids and lipoprotein cholesterol concentrations to various types of estrogen/progestin formulations. Premenopausal women using oral contraceptives containing a relatively low dose of estrogen combined with a medium or high dose of progestin (Norlestrin, Ovral, or Demulen) had a 24 per cent higher median concentration of low-density-lipoprotein cholesterol than did those not using hormones (P < 0.05). Women using oral contraceptives that are high in estrogen and low in progestin (Envoid or Oracon) had significantly higher concentrations of high-density-lipoprotein cholesterol than did nonusers; those using Ovral, a low-estrogen and high-progestin formulation, had significantly lower levels of high-density-lipoprotein cholesterol. In postmenopausal women the use of estrogen was associated with concentrations of low-density-lipoprotein cholesterol that were 11 to 19 per cent below the levels in postmenopausal women who did not use hormones. The effects of estrogen-progestin balance on low-density and high-density lipoproteins may underlie the increased incidence of stroke and myocardial infarction in women of childbearing age who take oral contraceptives. (New England Journal of Medicine 1983;308:862–7.)     

College Health Nursing: State of the Art

Abstract

“Mucopurulent Cervicitis—The Ignored Counterpart in Women of Urethritis in Men,” Robert C. Brunham, et al. Among 100 randomly selected nonmenstruating women attending a clinic for sexually transmitted diseases, we assessed objective criteria for the clinical diagnosis of mucopurulent cervicitis. Visualization of yellow mucopurulent endocervical secretions on a white swab and the presence of 10 or more polymorphonuclear leukocytes per microscopical field (at a magnification of 1000) in satisfactory gram-stained endocervical smears were independently correlated with cervical Chlamydia trachomatis infection. Neither finding correlated with gonorrhea or genital herpes, although herpes caused characteristic cervical ulcerations. C. trachomatis was isolated from the cervix of 20 of 40 women with mucopurulent cervicitis but of only 2 of 60 without it. The overall prevalence of mucopurulent cervicitis among women attending the clinic (40 per cent) exceeded that of nongonococcal urethritis among men in the same clinic, and the prevalence of C. trachomatis infection was higher in mucopurulent cervicitis than in nongonococcal urethritis, a condition that is conventionally treated with tetracyclines. These findings support recommendations for the treatment of mucopurulent cervicitis and should guide the selective use of confirmatory diagnostic tests for C. trachomatis infection. (New England Journal of Medicine 1984;311:1–6.)

“Oral Contraceptives, Chlamydia trachomatis Infection, and Pelvic Inflammatory Disease: A Word of Caution About Protection,” A. EUGENE WASHINGTON, et al. Management of pelvic inflammatory disease (PID) and decisions about contraception are being influenced by reports that oral contraceptives decrease the risk of PID. To evaluate the validity of this association, we have examined published epidemiologic evidence and reviewed relevant information from other disciplines. Current information does not permit the generalization that oral contraceptives protect against all forms of PID. Most studies conducted (1) have been limited to hospitalized women, who represent less than 25% of all PID cases and are likely to have relatively severe forms of the disease, and (2) have failed to distinguish between gonococcal and nongonococcal PID. While oral contraceptives may provide some protection against gonococcal PID, no basis exists for assuming similar protection is provided against chlamydial PID. In fact, epidemiologic and biologic evidence suggests that infection with Chlamydia trachomatis, the leading cause of nongonococcal PID, is enhanced by oral contraceptives. We judge the conclusion that oral contraceptives protect against all PID to be premature, and urge caution in its application in health policy and clinical decisions. (Journal of the American Medical Association 1985;253:2246–50.)     

Women's acceptance of the diaphragm: the role of relationship factors

The vaginal diaphragm is a candidate for a female-controlled method of reducing risk of HIV/STI acquisition. We examined the association between relationship and partner factors and three measures of diaphragm acceptability: current use, consistency of use, and satisfaction with use. We conducted a telephone survey with 448 female members of a managed care organization, aged 18-49, who currently used contraception (including 140 diaphragm users, 187 pill users, and 121 male condom users). Use of a specific contraceptive was significantly associated with relationship length, condom-use negotiation self-efficacy, importance of covert use, perceived motivation of partner to prevent HIV/STIs, and perceived satisfaction of partner with current method. In addition, among diaphragm users, communication about HIV/STIs and perceived partner motivation to use a diaphragm were related to consistent use. These results suggest that acceptability of contraceptive methods among women is influenced by their perceptions of their male partner and relationship factors.     

A Survey of Sexual States of Married,Healthy, Reproductive Age Women

The sexual states of 1,800 married, healthy, reproductive- age women were surveyed. Sexual dissatisfaction occurred in 10.1% of women but in 5.3% of their husbands (P < 0.01). Statistically, stepwise logistic regression analysis was used Factors that substantially influenced the wives' sexual feelings were associated with precoital caressing, the occurrence and time of orgasm, husband's sexual satisfaction, who initiated coitus, and the wife's agreement to sexual activity if the husband was the initiator. Factors that substantially influenced the husbands' sexual feelings were frequency of coitus, successful ejaculation, wife's sexual satisfaction, and the husband's attitude toward the contraceptive method the wife had adopted     

Gendered Dimensions of the HIV Pandemic: A Cross‐National Investigation of Women's International Nongovernmental Organizations,Contraceptive Use,and HIV Prevalence in Less‐Developed Nations

The human immunodeficiency virus (HIV) pandemic has a profound impact on women as a result of social and biological vulnerabilities to the infection. In this article, we explore the influence of democracy, women's international nongovernmental organizations (INGOs), and contraceptive use on female HIV rates, using indirect‐effect modeling techniques to properly test the interrelationships among key variables. Structural equation models reveal that democracy and women's INGOs work to reduce female HIV rates indirectly, by promoting the use of contraceptives among women in less‐developed nations. Despite these promising findings, the analyses also reveal that INGOs are negatively associated with sociohealth dimensions of female empowerment, which thus serves to promote HIV rates. The results suggest that interventions undertaken by INGOs may not be as successful as government programs in addressing inequalities in health and social resources for women in poor nations.     

Women's acceptance of the diaphragm: The role of relationship factors

The vaginal diaphragm is a candidate for a female‐controlled method that could reduce risk of HIV/STI acquisition. We examined the association between relationship and partner factors and three measures of diaphragm acceptability: current use, consistency of use, and satisfaction with use. We conducted a telephone survey with 448 female members of a managed care organization, aged 18–49, who currently used contraception (including 140 diaphragm users, 187 pill users, and 121 male condom users). Use of a specific contraceptive was significantly associated with relationship length, condom‐use negotiation self‐efficacy, importance of covert use, perceived motivation of partner to prevent HIV/STIs, and perceived satisfaction of partner with current method. In addition, among diaphragm users, communication about HIV/STIs and perceived partner motivation to use a diaphragm were related to consistent use. These results suggest that acceptability of contraceptive methods among women is influenced by their perceptions of their male partner and relationship factors.     

Testosterone and the breast

Although women have been treated with testosterone (T) for female sexual dysfunction since the 1950s, the role of T in normal female physiology is not yet fully defined. One of the major safety concerns of androgen therapy is whether androgens have a stimulatory effect on the breast that could lead to breast carcinomas. The proposed mechanisms for such stimulation include local estrogen production from the aromatase enzyme complex present in the breast tissue or by the direct stimulation of the androgen receptor. Predominant data from in vitro studies have shown that androgens actually have apoptotic and antiproliferative effects and not stimulatory effects. Animal models have shown similar results to in vitro studies, finding that androgens inhibit breast cancer growth. Prospective and retrospective epidemiological analyses have shown mixed outcomes, with no clear consensus regarding androgen use and breast cancer risk. Hyperandrogenism in patients with polycystic ovarian syndrome with elevated levels of endogenous T is not associated with an increased risk of breast cancer and may, in fact, be protective. Another human model with excess of T is female-to-male transgenderism, in which genotypic women are treated with large doses of exogenous T with no increased risk. High-dose androgen therapy also has been effective in treating patients with advanced breast cancer. Thus, the preponderance of data suggests that T use in females is not associated with an increased risk of breast carcinoma.     

Young People's Use and Perceptions of Emergency Contraceptives in Sub‐Saharan Africa: Existing Insights and Knowledge Gaps

Despite growing international attention to the sexual and reproductive health and rights of young people, their uptake of modern contraceptive methods remains low, especially in Sub‐Saharan Africa. This article focuses on young people's use of a relatively new contraceptive method, emergency contraceptives (ECs). Emergency contraceptives can be used after intercourse and have been marketed to be used when other contraceptives fail or after unplanned, unprotected intercourse. This article reviews qualitative evidence from seven studies on young people's experiences with this contraceptive method. Many users of ECs were in their twenties, well‐educated, and either single or in a relationship. Repeated use was found in four of the studies, and ECs may fit within an existing range of post‐coital methods used to prevent pregnancies. While concerns about side effects were reported frequently among non‐users of ECs, other women preferred ECs above other hormonal contraceptive methods. Men were actively involved, for example, as providers of information to their partners, and as purchasers of ECs. Young people's understandings of ECs hence differ from the meanings inscribed to these pills at an international level. Further research on this topic is needed to ensure that young people's (emergency) contraceptive needs are well understood and responded to.     

The role of need for contraception in the evaluation of interventions to improve access to family-planning methods

A nonrandomized experiment carried out in Jharkhand, India, shows how the effects of interventions designed to improve access to family-planning methods can be erroneously regarded as trivial when contraceptive use is utilized as dependent variable, ignoring women's need for contraception. Significant effects of the intervention were observed on met need (i.e., contraceptive use by women who need contraception) but not on contraceptive use (i.e., contraceptive use by women who may or may not need contraception). Met need captures the woman's success in overcoming barriers to access to family planning, whereas contraceptive use confounds this construct with risk of pregnancy and fertility desires. Exceptions to this rule are identified.     

After Breast Cancer: Sexual Functioning of Sexual Minority Survivors

Research on sexual difficulties after cancer has neglected sexual minority women (SMW); for example, lesbian and bisexual women. Clinicians treating these women are therefore at a disadvantage as they lack information about sexual problems in this population. This study tested the hypothesis that SMW with breast cancer have poorer sexual function than SMW without breast cancer, distinguishing partnered from unpartnered women. Using convenience sample recruitment, we conducted a case-control study to compare survivors of breast cancers who are SMW, in other words, cases to controls, that is, SMW without cancer. Anonymous survey data were collected from 85 cases after they had completed active cancer treatment and 85 age- and partner-status matched controls with no history of any cancer. Participants' self-reported sexual frequency and sexual function measured by the Female Sexual Function Index were evaluated. Cases and controls did not differ in risk of sexual dysfunction or the level of overall sexual functioning; however, cases had lower sexual frequency and scored lower on desire and ability to reach orgasm, and higher on pain compared to controls. Results inform clinicians about sexual minority survivors' sexual domains affected by cancer. When discussing sexual problems and therapeutic options, sexual orientation should be ascertained.     

Determinants of contraceptive choice among Japanese women: ten years after the pill approval

The Japanese government approved the use of oral contraception (OC) in 1999, but OC users remain a small minority in Japan. Using the results of an online survey conducted in 2010, I examine the factors determining Japanese women’s choice of contraceptive method by estimating multinomial choice models. The estimation results indicate that OC use is positively associated with age, willingness to pay for contraceptive effectiveness, frequency of intercourse and experience with abortion or emergency contraception. These findings suggest that OC use increases as women learn from experience and that the low and declining frequency of intercourse in Japan offers one explanation for the slow diffusion of OC. Additionally, the findings indicate that OC use is more prevalent among women with a higher risk of unintended pregnancies. Subjective probabilities regarding each contraceptive method’s contraceptive effectiveness, disruption of romantic moods, partner disapproval, side benefits and minor, non-life-threatening side effects are important determinants of contraceptive choice. The perceived risk levels of OC side effects are significantly higher than the population-based probabilities, implying that increased medical knowledge might increase OC use.     

The Barbie Mystique: Satisfaction with Breast Size and Shape across the Lifespan

ABSTRACT

The prevalence of breast augmentation and breast lift surgery suggests that many women are dissatisfied with their breasts. This study analyzed women's and men's views about breast size and shape among 52,227 heterosexual adults, ages 18–65, who responded to an online survey. Although most women (70%) were dissatisfied with the size or shape of their breasts, most men (56%) were satisfied with their partner's breasts. Younger and thinner women worried that their breasts were too small; older and heavier women were more concerned with breast droopiness. Women who were dissatisfied with their breasts were more likely to report lower body satisfaction and to express concern about wearing a bathing suit in public. Further, dissatisfied women were also less willing to undress in front of their partner and were more likely to conceal their breasts from their partner during sex. These findings suggest that dissatisfaction with breasts is widespread among adult women.     

Contraceptive behavior in Ghana: a two-sex model

This report uses data of the 1988 Ghana Demographic and Health Survey (GDHS), a nationally representative self-weighting sample of 4488 female respondents 15-49 years old. 943 co-resident husbands of the surveyed women were also interviewed, thus the data provided 1010 dyads, which facilitated a couple-level analysis of contraceptive behavior. The determinants of modern contraceptive adoption were examined among dependent variables, including both modern and traditional methods, and the predictors of future usage among the nonusers were also assessed. For each of dependent variables, two logistic regressions were estimated, one for females, and the second one for couple measures of intentions and male preferences. Males were older and more educated than their female counterparts, and women were more likely than men to want to cease and space childbearing. 68.8% of women were in monogamous marriages, and the average age of women was 31.8 years, compared to 41 years for men among 1008 people in the sample. 43.5% of women had lost more than 1 child, and 22.9% had urban residence. 11.7% of couples agreed that contraceptives were needed for stopping childbearing. However, 14.9% said that there was no need for contraception, while 27.7% wanted contraception for spacing of births. 46% of the sample disagreed about contraceptive need and use. 6% of the women used modern contraceptives, while 8.7% used traditional methods. In addition, 29.7% of the women intended to use contraception in the future, while 55.6% did not intend to do this. Examination of contraceptive use and selected background variables indicates urban-rural differences. Also, the advancing age of wives and all levels of female schooling means increasing contraceptive use, but secondary schooling was associated with lower use for men than primary schooling. Use of contraception was also positively associated with the desire to cease childbearing for both sexes whether users or non-users. The findings indicate that female preferences were more significant than male preferences in predicting contraceptive use in Ghana.