Factors influencing natural fecundity in fertile couples: a survey of puerperae and their partners.

RESEARCH QUESTION: What is the fecundity rate among fertile couples, and which factors influence it? DESIGN: Retrospective study of all puerperae attending Cruces University Hospital Human Reproduction Unit over 9 months. An anonymous questionnaire was circulated to all patients, and 2510 valid completed questionnaires were collected. The main inclusion criterion was natural conception resulting in delivery. Pregnancies resulting from ART and contraceptive method failure were excluded. Investigated parameters were time to pregnancy, age and smoking (in women and men), previous pregnancies and intercourse frequency. A mathematical formula was developed to predict the per-month fecundity rate (PMFR). RESULTS: The cumulative fecundity rate was 29.08%, 54.26%, 68.61%, 89.88%, 96.95% and 98.63% (at 1, 3, 6, 12, 24 and 36 months); between 12 and 36 months, the average PMFR ranged from 8.53-7.48%. Only 1.68% of pregnancies occurred between 24 and 36 months, and only 1.37% thereafter. The best fecundity markers were obtained in the group who had sexual intercourse seven to eight times a week. Women and men younger than 25 years had lower fecundity markers than those aged between 25 and 40 years. CONCLUSIONS: Fertile couples have a non-negligible per-month fecundity rate between 12 and 36 months, which should be considered when planning fertility studies. The lower fecundity rate observed in women and men aged younger than 25 years deserves more study. Coital frequencies of more than two or three times a week did not affect the fecundity rate and was better with frequencies of seven to eight times a week.

Factors influencing intercourse frequency among the young and middle-aged men. / å½±å“ä¸­é’å¹´ç”·æ€§æˆ¿äº‹é¢‘çŽ‡çš„å› ç´ .

OBJECTIVES: At present, there are few studies on the sexual activity of young and middle-aged men in China. This study aims to explore the factors that affect the frequency of intercourse among young and middle-aged men in China. METHODS: Data for 923 men aged 20-60 years were collected in the Health Management Center, Third Xiangya Hospital, Central South University from January 2019 to March 2019, and a questionnaire survey (including basic conditions and sexual function-related scales) was carried out in the subjects. Finally, the data were analyzed by multivariate logistic regression analysis. RESULTS: The age ( P <0.01), number of children ( P <0.01), total cholesterol ( P <0.05), low-density lipoprotein ( P <0.05), erectile function ( P <0.01) and premature ejaculation ( P <0.05) was significantly correlated with the frequency of intercourse in the young and middle-aged men in China. CONCLUSIONS: The sexual frequency in the middle-young men in China is closely related to factors such as age, number of children, total cholesterol, low-density lipoprotein, and sex function.

What Influences Coital Frequency Among Chinese Men?: A Cross-Sectional Study.

INTRODUCTION: There are many Western reports on factors influencing coital frequency among men. However, no articles could be found about the factors influencing sexual activity among Chinese men. AIM: The aim of this study was to identify the factors that influence the coital frequency of Chinese men. MAIN OUTCOME MEASURES: The main outcome measures included self-reported monthly coital frequency, age, occupation, education level, andrology-related scales and dietary habits. METHODS: Data for 1,407 men aged 18-79 years were collected in the Health Management Center of the Third Xiangya Hospital of Central South University from January 2019 to May 2019. The respondents completed the questionnaires independently or with the help of an interviewer (who read or explained the questionnaires to them) to analyse the factors that influence coital frequency. RESULTS: In the previous 6 months, the sample had a mean monthly coital frequency (±SD) of 4.34 ± 3.18. Univariate logistic regression results indicated that the number of children (P = 0.004), IIEF-5 scores (P <0.001), EHSs (P <0.001) and frequency of milk consumption (P = 0.001) were associated with more frequent sexual activity. These statistical associations did not change after further adjustment for age, occupation, and reproductive history. We observed that the frequency of sexual activity showed an increasing trend with a greater number of children, higher IIEF-5 scores, higher EHSs and greater frequency of milk consumption (test for trend, P<0.05). Both univariate and multivariate analysis results indicated that the frequency of sexual activity decreased with increasing age (test for trend, P<0.001). CONCLUSION: The coital frequency of Chinese men is associated with erectile function, anthropometric parameters, age, occupation, and dietary habits. Xiang Y, Peng J, Yang J, et al. What Influences Coital Frequency Among Chinese Men?: A Cross-Sectional Study. Sex Med 2021;9:100363.

Coital frequency and condom use in age-disparate partnerships involving women aged 15 to 24: evidence from a cross-sectional study in KwaZulu-Natal, South Africa.

OBJECTIVE: This study examines the role of age-disparate partnerships on young women's HIV risk by investigating coital frequency and condom use within age-disparate partnerships involving women aged 15 to 24. DESIGN: A community-based, cross-sectional study was conducted. SETTING: Participants were randomly selected using a two-stage random sampling method in uMgungundlovu district, KwaZulu-Natal, South Africa, between June 2014 and June 2015. PARTICIPANTS: A total of 1306 15-24-year-old women in an ongoing heterosexual partnership were included in the analysis. Participants had to be a resident in the area for 12 months, and able to provide informed consent and speak one of the local languages (Zulu or English). PRIMARY AND SECONDARY OUTCOME MEASURES: Sexual frequency was assessed by asking participants how many times they had sex with each partner in the past 12 months. The degree of condomless sex within partnerships was assessed in the survey by asking participants how often they used a condom with their partners. RESULTS: Age-disparate partnerships were associated with a higher order category (once, 2-5, 6-10, 11-20, >20) of coital frequency (adjusted OR (aOR) 1.32, p<0.05, 95% CI 1.02 to 1.71) and with sex on more than 10 occasions (aOR 1.48, p<0.01, 95% CI 1.12 to 1.96) compared with age-similar partnerships. Age-disparate partnerships were also more likely to involve sex on more than 10 occasions with inconsistent condom use (aOR 1.43, p<0.05, 95% CI 1.04 to 1.96) in the previous 12 months. CONCLUSION: The finding that increased sexual activity is positively associated with age-disparate partnerships adds to the evidence that age-disparate partnerships pose greater HIV risk for young women. Our study results indicate that interventions to reduce risky sexual behaviour within age-disparate partnerships remain relevant to reducing the high HIV incidence rates among adolescent girls and young women.

Do the interactions between coital frequency, cervical length, and urogenital infection affect obstetric outcomes?

OBJECTIVE: To determine whether interactions between coital frequency, cervical length, and urogenital infection affect obstetric outcomes. MATERIALS AND METHODS: A total of 268 unselected pregnant women were recruited in the study. The study population consisted of four groups of women: group 1 (n=203) screened negative for bacterial vaginosis (BV) both in the first and second trimesters; group 2 (n=18) screened negative for BV in the first trimester but positive in the second trimester; group 3 (n=33) screened positive for BV in the first trimester but negative in the second trimester; and group 4 (n=14) screened positive for BV both in the first and second trimesters. Urine culture, cervico-vaginal cultures, and bacterial vaginosis were screened between 11-14 weeks and 20-24 weeks. RESULTS: Two hundred fifty women were eligible for analysis in the study after lost-to-follow up patients were excluded. Previous abortion ≥1 and previous preterm delivery at 24-34 weeks ≥1 were statistically significantly higher in group 2. The number of patients who were diagnosed as having preterm premature rupture of membranes (PPROM) was statistically significantly higher in group 4. Sexual intercourse during the first trimester, cervical length during the second trimester, and history of preterm birth (PTB) were statistically significant risk factors for preterm birth <37 weeks (1.27; (1.12-1.44); 5.33; (1.84-15.41); 6.95; (1.58-30.54), respectively). CONCLUSION: Presence or treatment of BV did not influence rates of PTB. The probability of PPROM would be higher in patients who are BV positive both in the first and second trimesters.

Sexual activity of young men is not related to their anthropometric parameters.

INTRODUCTION: Many articles have been written about the deterioration of male sexual function, mainly in relation to metabolic diseases and aging. With younger men, unless they have a complaint, sexual issues are rarely discussed during medical consultations. No articles could be found about anthropometric parameters as factors potentially influencing sexual performance. AIM: The aim of this study was to find the anthropometric parameters with the closest correlation with sexual activity. MAIN OUTCOME MEASURES: Main outcome measures included self-reported weekly intercourses, age, body weight and height, body mass index (BMI), and waist circumference. METHODS: Data for 531 heterosexual men aged 20-54 years were collected in three andrological centers. Past and recent morbidity, medications, and some lifestyle elements were recorded; anthropometric parameters were measured; and andrological examination was performed. The average weekly number of intercourses was asked confidentially. RESULTS: The mean weekly coital frequency (±SD) was 2.55 ± 1.08. The highest self-reported weekly coital frequency was recorded for men between the ages of 25 and 29 (3.02 ± 1.27). Coital frequency was higher among men with a height of less than 175 cm (2.69 ± 1.24), weight of less than 78 kg (2.74 ± 1.18), normal BMI (2.74 ± 1.16), normal waist circumference (2.69 ± 1.19), and no metabolic disease (2.57 ± 1.11). Logistic regression described an inverse, statistically significant association between age and coital frequency, with the following odds ratios for coital frequency (ORcf ): ORcf≥2 = 0.932, P < 0.001; ORcf≥2.5 = 0.935, P < 0.001; ORcf≥3 = 0.940, P < 0.001; ORcf≥3.5 = 0.965, P = 0.041. Among men who reported a coital frequency of more than 3.5 times a week, waist circumference (ORcf≥3.5 = 0.986, P = 0.066) showed borderline association with lower sexual activity, while lesser height (ORcf≥3.5 = 0.951, P = 0.005) was associated with higher activity. CONCLUSION: In this study's age range, none of the examined anthropometric parameters was perfectly correlated with sexual activity. Obesity and metabolic diseases can cause all types of sexual function to deteriorate in older age, whereas their effects may not yet be prominent at younger ages (below 45 years). Health promotion for all ages should focus on prevention of obesity so as to improve quality of life and sexual health.

Coitus, the proximate determinant of conception: inter-country variance in sub-Saharan Africa.

There is a general consensus in the literature that fertility differences between populations can be accounted for by differences in just four key proximate determinants: nuptiality, the postpartum non-susceptible period, contraception and abortion. Natural fecundibility is generally assumed to be constant between populations. This paper puts the theoretical and empirical case for a re-evaluation of that assumption, drawing on the under-utilized data on sexual activity collected in the Demographic Health Surveys (DHSs). Using data for married women in nine African countries, the analysis finds substantial population level differences in mean monthly coital frequency, which, if accurate, suggest an important demographic effect. There is a clear regional patterning to these differences, with levels of activity considerably lower among women in the West African populations included in the study than those from East and southern Africa. For West Africa in particular the data indicate the normality of exceptionally long periods of very infrequent or no intercourse by married women outside the period of postpartum abstinence. The findings challenge prevailing presumptions concerning susceptibility to pregnancy in marriage on which statistics for unmet need for family planning are derived. While doubts are raised over the precision of the sexual activity data used, the paper argues for the need for a greater effort to operationalize the 'proximate determinant of conception', not only for more accurate fertility modelling, but also as a planning tool for a more sensitive provision of family planning services in Africa.

Recording sexual behavior: comparison of recall questionnaires with a coital diary.

OBJECTIVE: To compare sexual behavior data obtained using a weekly-recall questionnaire, a daily-recall questionnaire, and a coital diary. DESIGN: Cross-sectional survey of female sex workers from KwaZulu-Natal, South Africa between August and October 1998. METHODS: In this study, 52 weekly-recall questionnaires, 27 daily-recall questionnaires, and 79 coital diaries for dates corresponding to the questionnaires were obtained from female sex workers. Variables examined included: number of clients, number of condoms used with clients and partners, and number and type of sexual acts with clients and partners. Statistical analyses were conducted to examine the degree of agreement between the data collection methods and to assess differences between the mean values of the variables in the questionnaires versus the diary. RESULTS: Comparison of weekly-recall questionnaires with coital diaries indicated a significantly greater mean number of clients (P < 0.001), number of condoms used (P < 0.001), vaginal acts (P < 0.001), and anal acts (P = 0.044) reported in the diary versus the questionnaire. On comparison of daily-recall questionnaire with coital diary, significant differences were revealed between the means detected for the number of clients (P = 0.027), number of days worked (0.009), and anal acts with clients (P = 0.004). CONCLUSIONS: The use of coital diaries for the collection of sexual behavior data may be limited to cross-sectional community surveys. A recall questionnaire may provide more reliable and a better quality of data for longitudinal studies and for human immunodeficiency virus/sexually transmitted disease evaluation programs.

PIP: This study aimed to compare data obtained from coital diaries (CD) with those collected using weekly recall (WR) and daily recall (DR) questionnaires. 79 female sex workers aged 18-44 coming from KwaZulu-Natal, South Africa, were studied. They were followed up every month with clinical examination and treatment of STDs, provision of condoms, and CD collection. There were 52 WR, 27 DR, and 79 CD records collected from the participants. Results showed that CD records showed a significantly greater mean number of clients compared to the questionnaires (23.3 vs. 13.6, P 0.001), number of condoms used (2.7 vs. 0.5, P 0.001), vaginal acts (6.8 vs. 2.9, P 0.001), and anal acts (1.9 vs. 0.7, P = 0.044). Daily accounts of weekly sexual activity showed significant differences in 1) the number of days worked (6.2 vs. 5.2, P = 0.009), 2) the number of clients (21.7 vs. 17.4, P = 0.027), and 3) the number of anal acts with clients (3.9 vs. 0.8, P = 0.004), with higher means reported in the CD records for all cases. The CD records are an important instrument for gathering preliminary sexual behavioral information; however, their use is limited to long-term data collection. Therefore, a comprehensive recall questionnaire is recommended for future trials.

Measuring contraceptive use patterns among teenage and adult women.

CONTEXT: Measures of contraceptive use at one point in time do not account for its changing nature. A measure that addresses the pattern of method use over time may better predict the cumulative risk of unintended pregnancy. METHODS: Women at risk of unintended pregnancy were selected from the 1995 National Survey of Family Growth, and their contraceptive use patterns were compared across age-groups. Survival analysis was used to validate women's long-term use pattern as an indicator of pregnancy risk, and multivariate regression analyses were used to explore potential covariates of current patterns of contraceptive use. RESULTS: More than two-thirds of women aged 15-19 report long-term uninterrupted contraceptive use, but they are more likely to report sporadic use and less likely to report uninterrupted use of a very effective method than are women aged 25-34. Compared with women aged 25-34, women aged 20-24 have higher rates of sporadic use and lower rates of effective uninterrupted use. Among teenagers, nonusers are 12 times as likely as uninterrupted effective users to experience an unintended pregnancy within 12 months at risk. Women in less stable relationships, those having more infrequent intercourse and women who have recently experienced nonvoluntary intercourse for the first time are more likely than others to have a high-risk contraceptive pattern. Women aged 17 and younger whose current partner is more than three years older are significantly less likely to practice contraception than are their peers whose partner is closer in age. CONCLUSIONS: Long-term contraceptive use pattern is a valid predictor of unintended pregnancy risk. Policies aimed at reducing unintended pregnancies should target women who do not practice contraception and those who are sporadic users. Women in unstable relationships, those having infrequent sex and women who experience sexual coercion need access to methods, such as emergency contraception, that can be used sporadically or after unprotected intercourse.

PIP: This study examined determinants of unintended pregnancy in the US. Data were obtained from the 1995 National Survey of Family Growth among 7221 women 15-44 years old at risk of unintended pregnancy. Findings indicate that adolescents were not mainly sporadic method users in 1995. Most used a method without interruption for an extended period. Teenagers were more likely to report sporadic contraceptive use and were less likely to be uninterrupted users of effective methods. Women 20-24 years old were no more likely than 18-19 year old women to report long-term sporadic use and were more likely than women 25-34 years old to report long-term sporadic use. Nonusers and sporadic users contributed significantly to the high rate of unintended pregnancies. Logistic models reveal that women who were married or cohabiting were more likely to be uninterrupted effective contraceptive users than those not in long-term relationships. Frequency of intercourse had a consistent, strong positive relationship with contraceptive use. Women who had nonvoluntary intercourse and teenagers with significantly older partners were less likely to use contraceptives. Condoms are appropriate for infrequent intercourse, but couples must know the risks of pregnancy even with infrequent intercourse and know about postcoital methods of pregnancy prevention.

Influence of cycle variability and coital frequency on the risk of pregnancy.

Researchers have cautioned against generalizing results from contraceptive trials because these studies rely on self-selected participants meeting strict selection criteria who may differ from typical users. Using information collected on daily diaries, we reanalyzed data from the recently completed Reality female condom clinical trial to evaluate factors that influence the probability of pregnancy. Noncompliant women, women with less variable menstrual cycles (17-43 days), and women engaging in intercourse frequently (> or = 11 acts per month) were more likely to conceive during this 6-month trial. The adjusted hazard ratios and 95% confidence intervals for these three covariates were 6.1 (2.0-18.7), 7.2 (1.0-54.3), and 2.0 (0.7-5.3), respectively. The strict selection criteria used in this study failed to recruit a homogeneous cohort with respect to factors that influence the risk of pregnancy. The overall pregnancy rate does not pertain to individual study participants, but rather represent average effects for a population with the particular mix of characteristics found in this study. In particular, we not only confirm the well known importance of compliance and the obvious role of frequency of intercourse, but also demonstrate that women with cycles outside the range of 17-43 days appear to be at a much lower risk of pregnancy.

PIP: This article highlights the influence of cycle variability and coital frequency on the risk of pregnancy using data from the completed female condom trial. Daily diaries of women, which include coital frequency and menstrual cycle, were reanalyzed to evaluate the factors that affect the probability of pregnancy. A higher probability of pregnancy was reported among noncompliant women, women with less variable menstrual cycles, and women engaging in frequent intercourse during a 6-month trial. The adjusted hazard ratios and 95% confidence intervals for these three covariates were 6.1 and 2.0-18.7 (noncompliant women), 7.2 and 1.0-54.3 (less variable menstrual cycles), and 2.0 and 0.7-5.3 (frequent intercourse), respectively. The overall pregnancy rate obtained in this study represent average effects for a population with the particular mix of characteristics. This study appears to demonstrate a much lower risk of pregnancy for women with menstrual cycles outside the range of 17-43 days.

[Sexuality and pregnancy]. / Sexualidad y embarazo.

OBJECTIVE: We intend to describe the sexual behaviour of pregnancies women. LOCATION: Family Planning Center Nóvoa Santos, of Galician Health Service (SERGAS), of Ourense (SPAIN). POPULATION: 206 pregnancies women that are attended in a obstetric psychoprophylaxis's programme, during two years (January/93-January/95). MEASUREMENT: We analysed the social economic, of reproduction, of medical attention and psycho-sexual variables. We use the PRESTA and SPSS statistics programmes. RESULTS: The average age is 28 years old, is married, has elementary studies and this is the first pregnancy. Her pregnancy is desire and normally developed. Her sexual desire and intercourse frequency is the same (1-2 per week); the intercourse is pleasant and the more habitual position is she over. Some times, the couple has relations without coitus and she practises the masturbation, and she enjoy of this practice. CONCLUSION: The pregnancies women have different sexual behaviours. They are satisfied with all them. The health' professional should favour the complete enjoy of the sexuality during the pregnancy.

PIP: 206 randomly selected women in the 6th or 7th month of pregnancy participating in childbirth preparation classes at a center in Ourense, Spain, between January 1993 and January 1995, responded to anonymous questionnaires regarding their sexual behavior during pregnancy. The women were 28 years old on average, married, with secondary education, and employed in skilled jobs or as housewives. 88% were urban. 78% were childless. 93% stated the pregnancy was desired and 91% that it was normal. 73% of the pregnancies were attended by a gynecologist, 23% by a family doctor, and the rest by both. 63% of the women did not ask their physician about sexual activity during pregnancy. 26% did ask questions; 47% about sexual relations during pregnancy, 21% about whether the fetus would be harmed, and 13% about when relations should be discontinued. In an average week, 13% did not have coitus, 24% did so once, 28% twice, and 15% 3 times. 11% did not respond. 38% of the women responding reported always and 7% never reaching orgasm. 28% reported their sexual activity always included coitus and 29% that it almost always did so. 14% reported masturbating, 74% reported not masturbating, and 13% did not respond.

Coital frequency among married and cohabiting couples in the United States. A comment.

PIP: This commentary refers to Rao and DeMaris' (1995) study of coital frequency among married and cohabiting couples in the US. The findings indicate higher rates of coitus among cohabiting partners. The sample includes couples with relationship durations of under 5 years. The authors of this critique argue that coital rates are more closely associated in nonlinear ways to duration of the relationship than to age of either partner. One 1983 US study indicates that mean coital rates decline by 50% during the first year of marriage, while another (1953) study indicates that rates decline by 50% from age 20 to 40 years. These two findings are compatible with the understanding that coital rates vary widely across couples and that couples marry at varying ages. The authors argue that cohabiting relationships are of shorter mean duration than marriages, and that this explains the higher coital rates among cohabiting couples. Coital frequency research could test the relationship between duration and coital frequency by matching coarse age (5-year intervals) and 1-2 month duration relationships of cohabiting couples with control married couples. It is possible that data are flawed if married couples believe the duration begins at the start of the legal marriage rather than the consensual union leading to marriage.^ieng

Sexual behaviors and safer sex practices of college students on a commuter campus.

The sexual behaviors and safer sex practices of college students at a midwestern commuter university are described. Responses from a student sample of 1,919 indicated that slightly more than 10% used condoms consistently. The most frequently cited reasons for not using condoms were monogamy (83%) and preferring other forms of birth control (31%). The leading reason for consistent condom use was fear of HIV infection (72%). Approximately 75% indicated they talked with their sexual partners about HIV prevention; women reported communicating significantly more often than men did (p < 0.0001). Seventy percent of the sample reported they had only one sexual partner during the past year. Students who had multiple partners during the past year were more likely to practice such unsafe sexual practices as not using condoms and not communicating about HIV prevention. Unsafe sexual practices occur on nontraditional university campuses just as frequently as they do on more traditional campuses, thus supporting the need for HIV prevention programs on every college and university campus.

PIP: Findings are presented from the survey of sexual behavior among 1919 students at a midwestern commuter university. Respondents were 18-57 years old, with 85.1% under age 30 years. 80.7% were White, 13.6% Black, 75.4% single, 20.8% married, and 97.3% self-reported heterosexual. 16% reported not having had sex in the past year, while 40% reported having sex at least once per week. 68.2% of the sexually active students reported being in monogamous relationships, and 15% reported having had at least 3 sex partners in the past year. Half of the sexually active students reported never using a condom, while 10.7% reported the consistent use of condoms during sexual intercourse. The most frequently cited reasons for not using condoms were monogamy (83%) and the preference of other forms of birth control (31%). The main reason for consistent condom use was fear of HIV infection (72%). Approximately 75% of respondents indicated that they discussed HIV prevention with their sex partners, with women reporting such partner communication significantly more often than men did. Students with multiple partners in the past year were more likely to practice unsafe sexual practices such as not using condoms and not communicating about HIV prevention. These findings suggest that risky sexual behavior occurs on both nontraditional and traditional university campuses.

Reliability of self-reported sexual behavior in human immunodeficiency virus (HIV) concordant and discordant heterosexual couples in northern Thailand.

A partner study was conducted in northern Thailand between March 1992 and June 1996 which included data that allowed an assessment of the reliability of self-reports of sexual behavior and contraceptive use among heterosexual couples. The authors enrolled 529 couples among whom all male subjects were human immunodeficiency virus (HIV) seropositive voluntary blood donors and their female sexual partners were either HIV infected (n=246) or HIV seronegative (n=283). The levels of agreement within couples were assessed for recency of last sexual intercourse, sexual activity in the prior year, and contraceptive practices. For HIV discordant couples, a prospective study was conducted to examine risk factors for HIV transmission, the primary goal of the study. This allowed assessment of reliability of inter-partner reports over 6-12 months. Overall, agreement among couples was good for common sexual practices, especially vaginal intercourse and time since last intercourse, but was lower for condom use. Anal and oral sex were infrequently reported by these couples and there was greater disagreement for the occurrence of these practices. Partner agreement for contraceptive histories was good to excellent. Prospective data showed less frequent intercourse and more condom use but reliability remained good. Common sexual practices may be reliable for both HIV concordant and discordant couples in studies estimating prevalent infection. Estimates of incident heterosexually transmitted HIV may be made with greater reliability by studies which include assessment of reports of risk behavior by each member of a couple than studies of individuals.

PIP: A study conducted in northern Thailand in 1992-96 enabled assessment of the reliability of self-reports of sexual behavior and contraceptive use among heterosexual couples. Enrolled were 529 HIV-positive male voluntary blood donors and their female partners who were either HIV-infected (n = 246) or seronegative (n = 283). In addition, a prospective analysis was conducted among the HIV discordant couples to examine risk factors for HIV transmission and further assess the reliability of inter-partner reports. Among HIV discordant couples, women reported an average of 185 sexual events in the past 2 years while men reported 165 such events. In discordant couples, these averages were 206 and 186 events, respectively. Agreement of the time since last sex within 3 days was recorded for 63.2% of concordant and 65.0% of discordant couples. Positive agreement on use of any contraceptive method in the past year was 88% for concordant couples and 91% for discordant couples. The prospective analysis demonstrated similar levels of agreement; the frequency of sexual acts decreased by 50% after HIV was diagnosed and condom use increased. The high degree of overall concordance of reports of sexual activity and contraceptive use between partners in this analysis is encouraging in terms of the validity of research studies on HIV transmission. Estimates of incident heterosexually transmitted HIV may be made with greater reliability by studies that include assessment of reports of risk behavior by each member of a couple rather than studies of individuals.

Sexual networks in Uganda: casual and commercial sex in a trading town.

A longitudinal study of the sexual behaviour of high-risk men and women living in a trading town on the trans-Africa highway showed that distinct sexual networks operated within the town. Forty-eight prostitutes kept daily records for 6 months of all their sexual contacts including the occupation and place of residence of each client and the price paid. Details of 4573 sexual contacts of the women were recorded. Three classes of women were identified: (1) 20 "high-class' women who charged a mean price of over US $4/- per contact. The majority of their clients were from large urban areas of Uganda (55%) or neighbouring countries (32%)-70% were truck-drivers or their mates; (2) 18 "low-class' women, charging an average of US $0.4 per contact, who were patronized predominantly by men resident in the town (71%) who were unskilled casual workers (58%); (3) 10 women fell into an intermediate category in terms of price and the residence of their clients. Thirty-eight male potential clients were recruited in low-cost bars where some of the women worked. They provided similar details of their daily sexual contacts. All were resident in the town and 22 had occupations which were classified as unskilled. Of the 1621 sexual contacts recorded by the men 25% were with new partners.

PIP: A longitudinal study of the sexual behavior of men and women living in a trading town on the trans-Africa highway (100 km south-west of Kampala, Uganda) revealed the presence of distinct networks of casual and commercial sex. 48 commercial sex workers recruited from bars and hotels on or away from the main road and 38 potential male clients located in bars away from the road were followed for a mean period of 16 and 13 weeks, respectively. Among women, a total of 4573 sexual contacts were recorded over 787 woman-weeks of observation, for an average of 5.8 contacts per week; 472 contacts (10%) were with regular partners. Condoms were reportedly used in 99% of casual and 59% of regular contacts. Clients of high-class prostitutes (charging over US$4/contact) were generally drivers from other urban areas or neighboring countries, while those of middle-class sex workers (US$2/contact) tended to be from fishing villages and those of low-class sex workers (under US$0.50/contact) were predominantly local unskilled workers. Among male respondents, 1621 sexual contacts were reported during 516 man-weeks of observation, for an average of 3.1 contacts per week; 584 contacts (36%) were with regular partners and 406 (24%) were with new partners. Men reported condom use in 3% of regular contacts and 87% of casual contacts. In-depth interviews with a convenience sample of six men revealed a total of 32 sexual contacts in the previous 2 weeks, of which eight involved wives or regular partners, 11 were with a sex worker encountered in discos or on the road, and 13 were with a woman known for 2-3 days. The condom use rates reported by respondents for casual partners are considered inflated, especially in light of the drunkenness that usually accompanies sexual encounters initiated in lower-class bars.

Changes in the menstrual bleeding of users of a subdermal contraceptive implant of nomegestrol acetate (Uniplant) do not influence sexual frequency, sexual desire, or sexual enjoyment.

OBJECTIVE: To evaluate the effect of menstrual changes induced by a nomegestrol acetate subdermal contraceptive implant (Uniplant; Thermex, Bahia, Brazil) on users' sexuality. DESIGN: Prospective observational survey. SETTING: San Borja-Arriarán Hospital, University of Chile, School of Medicine. PATIENT(S): Normally cycling healthy women and their partners. INTERVENTION(S): Structured interview before and during use of the contraceptive. MAIN OUTCOMES MEASURE(S): Sexual frequency, desire, and enjoyment; perception of health; and contraceptive satisfaction. RESULT(S): During the use of the implant more women reported irregular cycles (32% versus 11%) and vaginal spotting (38% versus 19%). Frequency of sexual relations was unchanged (2.3 versus 2.5/wk) but the percent of couples engaging in sexual relations during vaginal spotting increased (28% versus 11%). There was no significant difference in the percent of men or women who reported an increase, or decrease, in perceived sexual desire, sexual enjoyment, or perception of health during the use of Uniplant. CONCLUSION(S): Despite the alterations in menstrual cyclicity and the occurrence of spotting, the use of a contraceptive subdermal implant of nomegestrol acetate did not effect desire for, enjoyment of, or frequency of sexual relations in users.

PIP: Findings are presented from a study evaluating the effect of menstrual changes induced by a nomegestrol acetate subdermal contraceptive implant (Uniplant) on users' sexuality. The Uniplant implant evaluated is manufactured by Thermex of Bahia, Brazil. New subjects enrolled in a phase III clinical trial of the implant at San Borja-Arriaran Hospital, University of Chile, School of Medicine were observed prospectively. The participants were 118 normally cycling healthy women of median age 28 years and 60 male partners of median age 31 years. A structured interview was held before and during use of the contraceptive. Before insertion of the implant, 11% of the women reported irregular menstrual cycles, 19% reported vaginal spotting, and 11% of the couples reported engaging in sexual relations during vaginal spotting. During use of the implant, 32% of the women reported irregular cycles, 38% reported vaginal spotting, and 28% of the couples reported engaging in sexual relations during vaginal spotting. The frequency of sexual relations remained unchanged at 2.3-2.5 acts of coitus per weeks. There was no significant difference in the percentage of men or women who reported an increase or decrease in perceived sexual desire, sexual enjoyment, or perception of health during the use of Uniplant.

Sexual activities and attitudes of adolescent Koreans.

Data regarding the sexual behaviors of 849 Korean adolescents (mean = 18.8 years) were collected. Behaviors reported for males vs. females were 36.5 vs. 27.0% for kissing, 27.2 vs. 14.8% for petting, and 22.9 vs. 9.8% for coitus. In addition to reporting a greater number of experiences, males reported a greater number of partners for all three behavior categories. Among those who participated in coitus, nearly one third of the males and two thirds of the females reported only one partner. Two thirds of the males considered their recent experiences with coitus to be satisfactory, whereas over half of the females gave a neutral response. About 37% of males and 55% of females reported that their most recent coital experience was less than a month ago. On average, the coitally active adolescents began sexual activity at about 18 years of age. Interpretations of these data must take into consideration the respondents' hesitancy in the Korean setting to admit to having sexual experiences. Because premarital sex for adolescents is considered very undesirable in the Korean social setting, the respondents' reporting bias might be in the direction of underreporting. Findings are discussed in the context of unplanned pregnancy and abortion.

Factors related to choosing oral contraception at age 15.

This report aims to identify factors which are related to use of oral contraceptives at an early age. A self-administered questionnaire was completed at schools in 1988 and 1992 in southern and western Finland (N = 1339). Sexually experienced girls (mean age 15.8 years) who had answered the question concerning their oral contraceptive use were included (N = 389). Logistic regression analysis was used to compare oral contraceptive users (N = 121) with the group of non-users. Total number of coital experiences was associated with oral contraceptive use: the odds ratio for those having at least 10 coital experiences was 6.30 compared with those with only one intercourse. The proportion was 73% among oral contraceptive users and 30% among non-users. Girls using oral contraceptives perceived more often (67%) that parents accept their sexual relationship (30% among non-users). Oral contraceptive users were less afraid of getting pregnant (9% compared with 31% among non-users) and felt more often that sex was very important in their life (31 and 13%, respectively). Other factors that entered the model were age at menarche, having a steady partner and frequency of disco visits. When a young girl asks for oral contraceptives, she is probably at true risk of pregnancy, and regular contraception should be considered both in view of effective prevention of pregnancies and sexually transmitted diseases.

PIP: 1339 ninth grade girls aged 15-16 years from schools in southern and western Finland were administered questionnaires on maturation, relationships, dating, and sexual behaviors during 1988 and 1992. 389 sexually experienced girls of mean age 15.8 years who answered the question on oral contraceptive (OC) use were included in the analysis of which factors are related to the use of OC at an early age. Logistic regression analysis was used to compare the 121 OC users with nonusers. The total number of coital experiences was found to be associated with OC use. Specifically, the odds ratio for OC use among girls having at least 10 coital experiences was 6.30 compared to girls who had experienced only one episode of intercourse. 73% of OC users and 30% of nonusers had engaged in at least 10 acts of sexual intercourse. 67% and 30% of girls using OC and not using OC, respectively, felt that their parents accepted their sexual relationship. Only 9% of OC users feared becoming pregnant compared to 31% of nonusers. 31% and 13% of OC users and nonusers, respectively, felt sex to be very important to them. Low age at menarche, having a steady dating partner, and infrequent visits to discos were positively associated with OC use.

Sexual behavior in pregnancy among Hong Kong Chinese women.

Sexual behavior during pregnancy was examined in a retrospective study of 150 Hong Kong Chinese women interviewed in the immediate postpartum period. Sexual activity was found to decline abruptly during the first trimester of pregnancy, and continued to decrease in frequency as the pregnancy advanced. The frequency of intercourse was lower both before and during pregnancy than has been reported in similar studies among Western populations. There was no consistent relationship between age, parity, level of education, or employment status and sexual behavior either before or during pregnancy. These results suggest that a relatively conservative attitude toward sexual activity persists within this population.

PIP: Changes in the sexual behavior of Hong Kong Chinese women during pregnancy were assessed through a retrospective study of 150 women randomly recruited from two teaching hospitals within 3 days after giving birth. The mean age of respondents was 28.7 years; 73.3% had had one lifetime sexual partner, while 20% reported two partners. Observed was a clear trend toward decreased sexual activity as pregnancy progressed. Before pregnancy, 116 couples (77.3%) were having intercourse less than three times a week. This statistic increased to 145 couples (96.7%) in the first trimester of pregnancy and 56 couples (37.3%) abstained from intercourse during this time. In the second trimester, no couples reported intercourse more than twice a week and 51 (34%) abstained. During the third trimester, 97 couples (64.7%) abstained. Concern about jeopardizing the pregnancy was the most commonly cited (62%) reason for the reduction in sexual activity. Frequency of orgasm and enjoyment of intercourse also decreased with advancing gestation. Although younger women were more likely than their older counterparts to experience both coitus and orgasm during the first trimester, there was no consistent relationship between age, parity, educational level, employment status, and sexual behavior either before or during pregnancy. These findings suggest that Chinese women living in Hong Kong are more conservative about sexual behavior during pregnancy than women in most cultures.

Scientific bases for NFP beyond question.

PIP: The Couple to Couple League (CCL) is pleased that an article and an editorial in the December 1995 issue of the well-respected New England Journal of Medicine confirm that natural family planning (NFP) has value and is scientifically based, a fact the CCL has known for many years. The research covered in the article entitled Timing of Sexual Intercourse in Relation to Ovulation found that the only fertile days were the five days before ovulation and the day of ovulation itself. Most conceptions (76.4%) occurred during the day of and the first and second days before ovulation. CCL's slide showing the extent of the fertile time reflects the data of the report, but also includes the possibility of a second ovulation occurring within 24 hours of the first ovulation. The study found that women conceived in only 37% of cycles in which intercourse took place during the six-day fertile period. This rate is not much different than that claimed by a NFP physician many years ago (about 30%). The study showed the highest conception probability to be when the couple had sexual intercourse every day during the fertile period (37% vs. 33% for every other day). CCL advises couples to abstain until the fertile period then follow one coital frequency period during one cycle (e.g., every day) and the other pattern the next cycle (e.g., every other day). The study refuted claims that the timing of coitus relative to ovulation was not associated to the sex of the baby and that aging sperm do not reduce the viability of the fetus and/or cause birth defects. In fact, aging sperm rarely fertilize the ovum. The only way to positively detect ovulation is seeing the ovum burst out of the ovary. Hormone analyses of blood or urine and observations of cervical mucus and basal body temperature allow an estimate of the day of ovulation. NFP is not based on detecting ovulation but on identifying the limits of the fertile period.^ieng