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Birth Control
Birth control is a regimen of one or more actions, devices, or medications followed in order to deliberately prevent or
reduce the likelihood of a woman becoming pregnant or giving birth. Methods and intentions typically termed birth control
may be considered a pivotal ingredient to family planning. Mechanisms which are intended to reduce the likelihood of the
fertilisation of an ovum by a spermatozoon may more specifically be referred to as contraception. Contraception differs
from abortion in that the former prevents fertilization, while the latter terminates an already established pregnancy.
Methods of birth control which may prevent the implantation of an embryo if fertilization occurs are medically considered
to be contraception but characterized by some opponents as abortifacients.
Birth control is a controversial political and ethical issue in many cultures and religions, and although it is generally
less controversial than abortion specifically, it is still opposed by many. There are various degrees of opposition,
including those who oppose all forms of birth control short of sexual abstinence; those who oppose forms of birth control
they deem "unnatural", while allowing natural birth control; and those who support most forms of birth control that
prevent fertilisation, but oppose any method of birth control which prevents a fertilized embryo from attaching to the
uterus and initiating a pregnancy.
Current Research
For current research articles click
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History
Probably the oldest methods of contraception (aside from sexual abstinence) are coitus interruptus, certain barrier
methods, and herbal methods (emmenagogues and abortifacients).
Coitus interruptus (withdrawal of the penis from the vagina prior to ejaculation) probably predates any other form of
birth control. Once the relationship between the emission of semen into the vagina and pregnancy was known or suspected,
some men began to use this technique. This is not a particularly reliable method of contraception, as few men have
the self-control to correctly practice the method at every single act of intercourse. Although it is commonly believed
that pre-ejaculate fluid can cause pregnancy, modern research has shown that pre-ejaculate fluid does not contain viable
sperm.
There are historic records of Egyptian women using a pessary (a vaginal suppository) made of various acidic substances
(crocodile dung is alleged) and lubricated with honey or oil, which may have been somewhat effective at killing sperm.
However, it is important to note that the sperm cell was not discovered until Anton van Leeuwenhoek invented the
microscope in the late seventeenth century, so barrier methods employed prior to that time could not know of the details
of conception. Asian women may have used oiled paper as a cervical cap, and Europeans may have used beeswax for this
purpose. The condom appeared sometime in the seventeenth century, initially made of a length of animal intestine. It
was not particularly popular, nor as effective as modern latex condoms, but was employed both as a means of contraception
and in the hopes of avoiding syphilis, which was greatly feared and devastating prior to the discovery of antibiotic
drugs.
Various abortifacients have been used throughout human history, although many do not associate induced abortion with the
term 'birth control'. Some of them were effective, some were not; those that were most effective also had major side
effects. One abortifacient reported to have low levels of side effects—silphium—was harvested to extinction around the
1st century. The ingestion of certain poisons by the female can disrupt the reproductive system; women have drunk
solutions containing mercury, arsenic, or other toxic substances for this purpose. The Greek gynaecologist Soranus in
the 2nd century suggested that women drink water that blacksmiths had used to cool metal. The herbs tansy and pennyroyal
are well-known in folklore as abortive agents, but these also "work" by poisoning the woman. Levels of the active
chemicals in these herbs that will induce a miscarriage are high enough to damage the liver, kidneys, and other organs,
making them very dangerous. However, in those times where risk of maternal death from postpartum complications was high,
the risks and side effects of toxic medicines may have seemed less onerous. Some herbalists claim that black cohosh tea
will also be effective in certain cases as an abortifacient.
The fact that various effective methods of birth control were known in the ancient world sharply contrasts with a seeming
ignorance of these methods in wide segments of the population of early modern Christian Europe. This ignorance continued
far into the 20th century, and was paralleled by eminently high birth rates in European countries during the 18th and
19th centuries. Some historians have attributed this to a series of coercive measures enacted by the emerging modern
state, in an effort to repopulate Europe after the population catastrophe of the Black Death, starting in 1348. According
to this view, the witch hunts were the first measure the modern state took in an attempt to eliminate knowledge about
birth control within the population, and monopolize it in the hands of state-employed male medical specialists
(gynecologists). Prior to the witch hunts, male specialists were unheard-of, because birth control was naturally a female
domain.
Presenters at a family planning conference told a tale of Arab traders inserting small stones into the uteruses of their
camels in order to prevent pregnancy, a concept very similar to the modern IUD. Although the story has been repeated as
truth, it has no basis in history and was meant only for entertainment purposes. The first interuterine devices (which
occupied both the vagina and the uterus) were first marketed around 1900. The first modern intrauterine device (contained
entirely in the uterus) was described in a German publication in 1909, although the author appears to have never marketed
his product.
The Rhythm Method (with a rather high method failure rate of 10% per year) was developed in the early twentieth century,
as researchers discovered that a woman only ovulates once per menstrual cycle. Not until the mid-20th century, when
scientists better understood the functioning of the menstrual cycle and the hormones that controlled it, were oral
contraceptives and modern methods of fertility awareness (also called natural family planning) developed.
Methods
General
Barrier methods place a physical impediment to the movement of sperm into the female reproductive tract.
The most popular barrier method is the male condom, a latex or polyurethane sheath placed over the penis. The condom is
also available in a female version, which is made of polyurethane. The female condom has a flexible ring at each end—one
secures behind the pubic bone to hold the condom in place, while the other ring stays outside the vagina.
Cervical barriers are devices that are contained completely within the vagina. The cervical cap is the smallest cervical
barrier. It stays in place by suction to the cervix or to the vaginal walls. The Lea's shield is a larger cervical
barrier, also held in place by suction. The diaphragm fits into place behind the woman's pubic bone and has a firm but
flexible ring, which helps it press against the vaginal walls. The contraceptive sponge has a
depression to hold it in
place over the cervix.
Hormonal methods
There are variety of delivery methods for hormonal contraception.
Combinations of synthetic estrogens and progestins (synthetic progestogens) are commonly used. These include the combined
oral contraceptive pill ("The Pill"), the Patch, and the contraceptive vaginal ring ("NuvaRing"). Not currently available
for sale in the United States is Lunelle, a monthly injection.
Other methods contain only a progestin (a synthetic progestogen). These include the progestin only pill (the POP or
'minipill'), the injectables Depo Provera (a depot formulation of medroxyprogesterone acetate given as an intramuscular
injection every three months) and Noristerat (norethisterone acetate given as an intramuscular injection every 8 weeks),
and contraceptive implants. The progestin-only pill must be taken at more precisely remembered times each day than
combined pills. The first contraceptive implant, the original 6-capsule Norplant, was removed from the market in the
United States in 1999, though a newer single-rod implant called Implanon was approved for sale in the United States on
July 17, 2006. The various progestin-only methods may cause irregular bleeding while being used.
Ormeloxifene (Centchroman)
Ormeloxifene (Centchroman) is a selective estrogen receptor modulator, or SERM. It causes ovulation to occur
asynchronously with the formation of the uterine lining, preventing implantation of a zygote. It has been widely
available as a birth control method in India since the early 90s, marketed under the trade name Saheli®. Centchroman is
legally available only in India.
Intrauterine methods
These are devices that are placed in the uterus. They are usually shaped like a "T"—the arms of the T hold the device in
place inside the uterus. In the United States, all devices which are placed in the uterus to prevent pregnancy are
referred to as IUDs. In the UK, a distinction is made between the IUDs and IUS. This is probably because there are seven
different kinds of IUDs available in the UK, compared to two in the US.
Intrauterine Devices ("IUDs") contain copper (which has a spermicidal effect).
IntraUterine Systems ("IUS") release a progestogen (either progesterone or a progestin).
Emergency contraception
Some combined pills and POPs may be taken in high doses to prevent pregnancy after a birth control failure (such as a
condom breaking) or after unprotected intercourse. Hormonal emergency contraception is also known as the "morning after
pill," although it is licensed for use up to three days after intercourse.
Copper intrauterine devices may also be used as emergency contraception. For this use, they must be inserted within five
days of the birth control failure or unprotected intercourse.
Induced abortion
Abortion can be done with surgical methods, usually suction-aspiration abortion (in the first trimester) or dilation and
evacuation (in the second trimester). Medical abortion uses drugs to end a pregnancy and is approved for pregnancies of
less than 8 weeks gestation.
Some herbs are believed to cause abortion (abortifacients). Peer-reviewed research has proven the efficacy of some of
these substances, but the use of herbs to induce abortion is not recommended, due to the risk of serious side effects.
Abortion is subject to ethical debate.
Sterilization
Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men.
A non-surgical sterilization procedure, Essure, is also available for women.
Behavioral Methods
Fertility awareness methods
Fertility awareness (FA) methods involve a woman's observation and charting of one or more of her body's primary fertility
signs, to determine the fertile and infertile phases of her cycle. Unprotected sex is restricted to the least fertile
period. During the most fertile period, barrier methods may be availed, or she may abstain from intercourse. Different
methods track one or more of the three primary fertility signs: changes in basal body temperature, in cervical mucus,
and in cervical position, though cervical position is most frequently used as a cross-reference with one or both of the
others. If a woman tracks both basal body temperature and another primary sign, the method is referred to as symptothermal.
Other bodily cues such as mittelschmerz are considered secondary indicators. A woman may chart these events on paper or
with software.
The term natural family planning (NFP) is sometimes used to refer to any use of FA methods. However, this term
specifically refers to the practices which are permitted by the Roman Catholic Church — breastfeeding infertility, and
periodic abstinence during fertile times. FA methods may be used by NFP users to identify these fertile times.
Two common systems of symptothermal methods are that taught by Toni Weschler, and that taught by the Couple to Couple
League. Two common mucus-only systems are the Billings Ovulation Method and the Creighton Model. Some teachers or
organizations, such as the Couple to Couple League, include religious content in their FA classes.
Statistical methods
Statistical methods such as the Rhythm Method and Standard Days Method are dissimilar from observational fertility
awareness methods, in that they do not involve the observation or recording of bodily cues of fertility. Instead,
statistical methods estimate the likelihood of fertility based on the length of past menstrual cycles. Statistical
methods are much less accurate than fertility awareness methods, and are considered by many fertility awareness teachers
to have been obsolete for at least twenty years.
Coitus interruptus
Coitus interruptus (literally "interrupted sex"), also known as the withdrawal method, is the practice of ending sexual
intercourse ("pulling out") before ejaculation. The main risk of coitus interruptus is that the man may not make the
maneuver in time. Although concern has been raised about the risk of pregnancy from sperm in pre-ejaculate, several
small studies have failed to find any viable sperm in the fluid.
Avoiding vaginal intercourse
The risk of pregnancy from non-vaginal sex, such as outercourse (sex without penetration), anal sex, or oral sex is
low. (A very small risk comes from the possibility of semen leaking onto the vulva (with anal sex) or coming into contact
with an object, such as a hand, that later contacts the vulva). However, with this method, discipline is required to
prevent the progression to intercourse.
Abstinence
Sexual abstinence is the practice of refraining from all sexual activity. As with avoiding intercourse, the intention to
remain abstinent may not prevent pregnancy, due to the level of discipline required.
Lactational
Most breastfeeding women have a period of infertility after the birth of their child. The Lactational Amenorrhea Method,
or LAM, gives guidelines for determining the length of a woman's period of breastfeeding infertility.
Methods in Development
Experimental contraceptives for males
Research is being done into a variety of substances that have potential as male oral contraceptives, or implants or
injections that may be used as male hormonal contraceptives.
RISUG (Reversible Inhibition of Sperm Under Guidance), is an injection into the vas deferens that coats the walls of the
vas with a spermicidal substance. This method can be reversed by washing out the vas deferens with a second injection.
Vas-occlusive contraception would be analogous to intrauterine contraception in women.
Heat-based contraception involves heating the testicles to a high temperature for a short period of time.
Misconceptions
Modern misconceptions and urban legends have given rise to a great deal of false claims:
- The suggestion that douching immediately following intercourse works as a contraceptive is untrue. While it
may seem like a sensible idea to try to wash the ejaculate out of the vagina, it does not work. Due to
the nature of the fluids and the structure of the female reproductive tract–if anything, douching spreads
semen further towards the uterus. Some slight spermicidal effect may occur if the douche solution is
particularly acidic, but overall it is not scientifically observed to be a reliably effective method.
- The suggestion to shake a bottle of Coca-Cola and insert it into the vagina after ejaculation is not a form
of birth control, it does not prevent pregnancy, and doing this can also promote candidiasis (yeast
infections).
- It is a myth that a female cannot get pregnant the first time she engages in sexual intercourse.
- While women are usually less fertile for the first few days of menstruation, it is a myth that a woman cannot
get pregnant if she has sex during her period.
- Having sex in a hot tub does not prevent pregnancy, but may contribute to vaginal infections.
- Although some sex positions may encourage pregnancy, no sexual positions prevent pregnancy. Having sex while
standing up or with a woman on top will not keep the sperm from entering the uterus. The force of
ejaculation, the contractions of the uterus caused by prostaglandins in the semen, as
well as ability of sperm to swim overrides gravity.
- Sneezing or urinating after sex are also completely ineffective, they do not prevent pregnancy and are not
forms of birth control.
- Toothpaste cannot be used as an effective contraceptive.
Effectiveness
Effectiveness is measured by how many women become pregnant using a particular birth control method in a year. Thus, if
100 women use a method that has a 12% failure rate, then sometime during that year, 12 of the women should become
pregnant.
The most effective methods in typical use are those that do not depend upon regular user action. Surgical sterilization,
Depo-Provera, implants, and intrauterine devices (IUDs) all have failure rates of less than 1% per year for perfect use.
Depo-Provera, or the shot, has a typical failure rate of 3%, while sterilization, implants, and IUDs still have a typical
failure use under 1%.
Other methods may be highly effective if used consistently and correctly, but can have typical use failure rates that are
considerably higher due to incorrect or ineffective usage by the user. Hormonal contraceptives, fertility awareness
methods, and ecological breastfeeding, if used strictly, have failure rates of less than 1% per year. Typical use failure
rates of hormonal contraceptives are as high as 8% per year. Fertility awareness methods as a whole have typical-use
failure rates as high as 25% per year; however, as stated above, perfect use of these methods reduces the failure rate to
less than 1%.
Condoms and cervical barriers such as the diaphragm have similar typical use failure rates (15.0% and 16%, respectively),
but perfect usage of the condom is more effective (2% failure vs 6%) and condoms have the additional feature of helping
to prevent the spread of sexually transmitted diseases such as
HIV. The withdrawal method, if used consistently and
correctly, has a failure rate of 4%. Due to the difficulty of consistently using withdrawal correctly, it has a typical
use failure rate of 27% and is not recommended by some medical professionals, although others believe it deserves
more support.
Protection against sexually transmitted infections
Not all methods of birth control offer protection against sexually transmitted infections. Abstinence from all forms of
sexual behavior will protect against the sexual transmission of these infections. The male latex condom offers some
protection against some of these diseases with correct and consistent use, as does the female condom, although the
latter has only been approved for vaginal sex. The female condom may offer greater protection against sexually transmitted
infections that pass through skin to skin contact, as the outer ring covers more exposed skin than the male condom, and
can be used during anal sex to guard against sexually transmitted infections. However, the female condom can be difficult
to use. Frequently a woman can improperly insert it, even if she believes she is using it correctly.
The remaining methods of birth control do not offer significant protection against the sexual transmission of these
diseases.
However, so-called sexually transmitted infections may also be transmitted non-sexually, and therefore, abstinence from
sexual behavior does not guarantee 100% protection against sexually transmitted infections. For example,
HIV may be
transmitted through contaminated needles which may be used in tattooing, body piercing, or injections. Health-care workers
have acquired
HIV through occupational exposure to accidental injuries with needles.
Religious and Cultural Attitudes
Religious Views on Birth Control
Religions vary widely in their views of the ethics of birth control. In Christianity, the Roman Catholic Church accepts
only Natural Family Planning, while Protestants maintain a wide range of views from allowing none to very lenient. Views
in Judaism range from the stricter Orthodox sect to the more relaxed Reformed sect. In Islam, contraceptives are allowed
if they do not threaten health or lead to sterilty, although their use is sometimes discouraged. Hindus may use both
natural and artificial contraceptives.
Birth control education
Many teenagers, most commonly in developed countries, receive some form of sex education in school. What information
should be provided in such programs is hotly contested, especially in the United States and Great Britain. Possible topics
include reproductive anatomy, human sexual behavior, information on sexually transmitted diseases (STDs), social aspects
of sexual interaction, negotiating skills intended to help teens follow through with a decision to remain abstinent or
to use birth control during sex, and information on birth control methods.
One type of sex education program, called abstinence-only education, promotes abstinence until marriage and does not
provide information on birth control, or heavily emphasizes negative information such as failure rates. Because abstinence
offers better protection against pregnancy and disease than sexual activity with even the best birth control methods,
advocates of abstinence-only education believe they will result in decreased rates of teenage pregnancy and STD infection.
However, some studies have found that abstinence-only sex education programs actually increase the rates of pregnancy and
STDs in the teenage population.
(adapted from Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Birth_control)
Characteristics of Adolescent Women Who Stop Using Contraception After Use at First Sexual Intercourse.
Authors: Kinsella EO, Crane LA, Ogden LG, Stevens-Simon C.
Department of Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA.
STUDY OBJECTIVE: Identify correlates of contraceptive discontinuation, which if modified, might make teenagers more, not
less, effective contraceptors as they age. SETTING: Teen clinic. PARTICIPANTS: Teenagers who used contraception at first
intercourse (N = 120). Some "never" used contraception during the 4 months immediately prior to the survey ("contraceptive
stoppers"; n = 38). The others (n = 82) did so "always" or "most of the time" ("consistent contraceptive users").
INTERVENTIONS: Questionnaire responses were used to determine univariate and multivariate associations between contraceptive
use group and five categories of factors: inability to plan for sex, belief that pregnancy is unlikely to occur, belief
that contraceptives are unsafe, inability to negotiate contraceptive use, and lack of desire to remain non-pregnant. MAIN
OUTCOME MEASURE: Odds of being a contraceptive stopper. RESULTS: In univariate analyses contraceptive stoppers scored
significantly higher on scales that assessed inability to plan for sex, belief that pregnancy is unlikely, and lack of
desire to remain non-pregnant. Contraceptive stoppers were also older and more likely to have been sexually active for at
least 6 months. In multivariate analyses, those who were sexually active for at least 6 months (odds ratio [OR]: 2.9,
confidence interval [95%CI]: 1.1-7.1), those who believed that pregnancy was unlikely (OR: 3.8; 95% CI: 1.7-8.6), and those
who lacked the desire to remain non-pregnant (OR: 2.7; 95% CI: 1.4-5.1) were more likely to stop using contraception.
CONCLUSIONS: Our findings suggest that teens who use contraception at coitarche stop doing so as they mature sexually
because they begin to doubt the necessity and desirability of using contraceptives. Longitudinal studies are needed to
determine if such doubts are preventable and if doing so encourages teens to continue to use contraception.
Journal: J Pediatr Adolesc Gynecol. 2007 Apr;20(2):73-81.
Adapted from PubMed; click here to access full journal article.
Disruption of Androgen Receptor Signaling by Synthetic Progestins May Increase Risk of Developing Breast Cancer.
Authors: Birrell SN, Butler LM, Harris JM, Buchanan G, Tilley WD.
*Dame Roma Mitchell Cancer Research Laboratories, The University of Adelaide, Hanson Institute, Adelaide, South Australia, Australia; andSchool of Life Science, Queensland University of Technology, Brisbane, Queensland, Australia.
There is now considerable evidence that using a combination of synthetic progestins and estrogens in hormone replacement
therapy (HRT) increases the risk of breast
cancer compared with estrogen alone. Furthermore, the World Health Organization
has recently cited combination contraceptives, which contain synthetic progestins, as potentially carcinogenic to humans,
particularly for increased breast
cancer risk. Given the above observations and the current trend toward progestin-only
contraception, it is important that we have a comprehensive understanding of how progestins act in the millions of women
worldwide who regularly take these medications. While synthetic progestins, such as medroxyprogesterone acetate (MPA),
which are currently used in both HRT and oral contraceptives were designed to act exclusively through the progesterone
receptor, it is clear from both clinical and experimental settings that their effects may be mediated, in part, by binding
to the androgen receptor (AR). Disruption of androgen action by synthetic progestins may have serious deleterious side
effects in the breast, where the balance between estrogen signaling and androgen signaling plays a critical role in breast
homeostasis. Here, we review the role of androgen signaling in the normal breast and in breast
cancer and present new data
demonstrating that androgen receptor function can be perturbed by low doses of MPA, similar to doses achieved in serum of
women taking HRT. We propose that the observed excess of breast malignancies associated with combined HRT may be explained,
in part, by synthetic progestins such as MPA acting as endocrine disruptors to negate the protective effects of androgen
signaling in the breast. Understanding the role of androgen signaling in the breast and how this is modulated by synthetic
progestins is necessary to determine how combined HRT alters breast
cancer risk, and to inform the development of optimal
preventive and treatment strategies for this disease.
Journal: FASEB J. 2007 Apr 5;
Adapted from PubMed; click here to access full journal article.
Azoospermia Should Not be Given as the Result of Vasectomy
Authors: Rajmi O, Fernandez M, Rojas-Cruz C, Sevilla C, Musquera M, Ruiz-Castane E.
Servicio de Andrologia, Fundacio Puigvert, Barcelona, Espana. orajmil@fundacio-puigvert.es
OBJECTIVES: Vasectomy is a surgical method of male contraception. Azoospermia is offered as result of the technique and
this is not always attained, resulting in legal matters. The purpose of this study is to know the number of semen samples
needed to discharge a patient after intervention. To identify sperm count on semen analysis at time of discharge. METHODS:
Retrospective study of men who underwent vasectomy in a 15-month period with a 2 year follow up. Consecutive semen analyses
up to 5 samples were measured at 2 to 3 months interval in all men who had persistence of spermatozoa. RESULTS: 618 men
were intervened, 106 did not bring semen to the laboratory (17%), 2 (0.39%) presented motile sperm and were considered a
failure of the technique and excluded. 510 men completed controls. 316 (61.9%) were azoospermic in the first sperm analysis,
74 (14.5%) in the second, 27 (5.2%) in the third, 6 (1.2%) in the fourth and one (0,.%) in the fifth analysis. The remaining
86 men (16.8%) had persistence of immotile sperm in the ejaculate and were less than 100,000/ml. No pregnancy was reported
during 2 years follow up or after. CONCLUSIONS: Five or more semen analysis can be made after the surgery. Persistence of
immotile sperm in the ejaculate is frequent and may exist for a long period afterwards. Immotile sperm count of 100,000/ml
or less should be accepted as result of the procedure. The patient should be informed about the fact that persistent
immotile sperm can be found in his semen. In the informed consent azoospermia should not be a concern as it is frequent to
find immotile sperm in the ejaculate and this is an acceptable issue. As with other contraceptive methods, vasectomy should
be offered as a safe method although clearly stating that the possibilities of failure do exist.
Journal: Arch Esp Urol. 2007 Jan-Feb;60(1):55-8.
Adapted from PubMed; click here to access full journal article.
Inequalities in the Provision of Sexual Health Information for Young People.
Authors: McLaughlin M, Thompson K, Parahoo K, Armstrong J, Hume A.
Institute of Nursing Research and School of Nursing, University of Ulster, Coleraine, Northern Ireland, UK.
BACKGROUND: Sexual health has been emphasised in national and regional strategies as a target for health and social
well-being. In Northern Ireland (NI), the Sexual Health Promotion Strategy concentrates on reducing the incidence of
sexually transmitted infections (STIs), reducing the number of unplanned births to teenage mothers, providing appropriate,
effective and equitable sexual health information, and facilitating access to sexual health services. This article reports
on a study carried out within NI and explores young people's knowledge and sources of sexual health information. METHODS:
School pupils aged 14-18 years (n = 414) participated in the study and a self-administered questionnaire was used to collect
the data. RESULTS: Whilst approximately half of the respondents reported being sexually active, only 68.2% always used some
form of contraception. In fact, 40.8% of sexually active females had used the 'morning-after pill', with 37.5% of these
respondents using this method more than once. The results also indicated that students receive varying amounts of sexual
health information from schools resulting in inequalities with regard to sources of information. Students from a Roman
Catholic religious background were more likely to receive information on sexual health from informal sources such as friends,
books/magazines or television/radio than from within the school environment compared with their Protestant counterparts.
CONCLUSIONS: The provision of standard and accurate information appropriate to the target population is necessary in order
to reduce the increasing rates of STIs and help the Government reach their target of halving the teenage pregnancy rate by
the year 2010.
Journal: J Fam Plann Reprod Health Care. 2007 Apr;33(2):99-105.
Adapted from PubMed; click here to access full journal article.
Noncontracepting Behavior in Women at Risk for Unintended Pregnancy: What's Religion Got to Do With It?
Authors: Kramer MR, Rowland Hogue CJ, Gaydos LM.
From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
PURPOSE: In the United States, 49% of all pregnancies are unintended. Part of this high rate has been attributed to the
negative effects of higher levels of personal and community-level religiosity in this country. To explore the impacts of
individual-level religiosity on unintended pregnancy, we used 2002 National Survey of Family Growth (NSFG) data to model
the relationship between religion and noncontracepting behavior, a crucial precursor to unintended pregnancies. METHODS: We
tested logistic models with current and childhood religious affiliation as primary exposures and recent noncontracepting
behavior as the outcome, controlling for demographic covariates, religious service importance, and attendance frequency.
RESULTS: An estimated 32.7 million women are at risk for unintended pregnancy, 14 % of whom use no contraception. Proportions
of noncontraceptors were 15.5 % among Catholics, 10.3% among mainstream Protestants, and 15.0% among fundamentalist
Protestants. In multivariate modeling, religion was significantly related to not contracepting in teens, but noncontributory
for women from 20 to 44 years of age. Variables associated with contraceptive behavior included marital status, age,
education, and income. CONCLUSIONS: Among women, current and childhood religious affiliations modify odds ratio for
noncontracepting behavior only among teenage girls. For adults, odds ratio vary widely by marital status, education, and
income, but not by religious affiliation.
Journal: Ann Epidemiol. 2007 Mar 27;
Adapted from PubMed; click here to access full journal article.
A Decision Rule to Identify Adolescent Females with Cervical Infections.
Authors: Reed JL, Mahabee-Gittens EM, Huppert JS.
Division of Emergency Medicine , Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Objective: To develop a clinical decision rule to direct empiric treatment of adolescent females with Neisseria gonorrhoeae
(GC) or Chlamydia trachomatis (CT) (or both) cervical infections in a pediatric emergency department. Methods: This was a
cross-sectional study of adolescent females with symptoms necessitating sexually transmitted infection (STI) testing. The
outcome was defined as cervical specimens positive for either GC on culture or CT on nucleic amplification assay test.
Clinical variables included demographic, historical, physical, and laboratory findings. Bivariate associations were assessed
using chi-square for categorical data and Student's t test for continuous variables. Variables significant at p < 0.5
were eligible for logistic regression (LR). Recursive partitioning (RP) analysis was used to create a clinical decision
rule. Results: Of the 250 subjects, 83 (33.2%) were positive for GC/CT. The adjusted odds ratios (aOR) and 95% confidence
intervals (CI) of the LR model were African American race (aOR = 3.2, CI 1.3-7.9), new partner within 3 months (aOR = 1.9,
CI 1.0-3.5), cervical discharge (aOR = 2.0, CI 1.1-3.7), absence of yeast forms (aOR = 3.3, CI 1.3-10), and >10 white
blood cells (WBCs) (aOR = 2.5, CI 1.3-4.6) on vaginal gram stain. Variables comprising the RP analysis included partner
penile discharge, >10 WBCs on vaginal gram stain, African American race, absence of yeast forms on vaginal gram stain,
and no hormonal birth control use. This algorithm was 75% sensitive and 71% specific, with a negative predictive value of
85%. Conclusions: The LR model confirmed associations seen in other populations. Although STI testing is imperative, the RP
model can be used to direct empiric treatment among high-risk adolescent females.
Journal: J Womens Health (Larchmt). 2007 Mar;16(2):272-80.
Adapted from PubMed; click here to access full journal article.
Contraceptive Developments for Men.
Authors: Amory JK.
Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington, Seattle, Washington, USA. jamory@u.washington.edu.
Efforts are underway to develop new methods of contraception for men. The most promising approach to male contraceptive
development is hormonal and involves the administration of testosterone. When testosterone is administered to a man, it
functions as a contraceptive by suppressing the secretion of luteinizing hormone and follicle-stimulating hormone from the
pituitary gland, thereby depriving the testes of the signals required for spermatogenesis. After two to three months of
treatment, low levels of gonadotropins lead to markedly decreased sperm counts and effective contraception in a majority of
men. In many clinical trials, male hormonal contraception has proven to be free from serious adverse effects and is
well-tolerated by men. In addition, sperm parameters uniformly normalize when treatment is discontinued. The main drawback
to this approach is the observation that spermatogenesis is not suppressed to zero in all men, meaning that some potential
for fertility persists. Because of this, recent studies have combined testosterone with progestogens and/or gonadotropin-releasing
antagonists to synergistically suppress pituitary gonadotropins and improve suppression of spermatogenesis. Current
combinations of testosterone and progestogens severely suppress spermatogenesis without severe side effects in 80-90% of
men, with significant suppression in the remainder of individuals. Recent trials with newer, long-acting forms of injectable
testosterone, such as testosterone undecanoate, which can be administered every 8-10 weeks, combined with progestogens,
administered either orally or by long-acting implant, have yielded promising results and may soon result in the marketing
of a safe, reversible and effective hormonal contraceptive for men. (c) 2007 Prous Science. All rights reserved.
Journal: Drugs Today (Barc). 2007 Mar;43(3):179-92.
Adapted from PubMed; click here to access full journal article.
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