S-Nitroso-N-acetylpenicillamine impregnated latex: A new class of barrier contraception for the prevention of intercourse-associated UTIs.

Urinary tract infections (UTIs) are some of the most common infections seen in humans, affecting over half of the female population. Though easily and quickly treatable, if gone untreated for too long, UTIs can lead to narrowing of the urethra as well as bladder and kidney infections. Due to the disease potential, it is crucial to mitigate the development of UTIs throughout healthcare. Unfortunately, sexual activity and the use of condoms have been identified as common risk factors for the development of sexually acquired UTIs. Therefore, this study outlines a potential alteration to existing condom technology to decrease the risk of developing sexually acquired UTIs using S-nitroso-N-acetylpenicillamine (SNAP), a nitric oxide (NO) donor. Herein, varying concentrations of SNAP are integrated into commercialized condoms through a facile solvent swelling method. Physical characterization studies showed that 72%-100% of the ultimate tensile strength was maintained with lower SNAP concentrations, validating the modified condom's mechanical integrity. Additionally, the evaluation of room-temperature storage stability via NO release analysis outlined a lack of special storage conditions needed compared to commercial products. Moreover, these samples exhibited >90% relative cell viability and >96% bacterial killing, proving biocompatibility and antimicrobial properties. SNAP-Latex maintains the desired condom durability while demonstrating excellent potential as an effective new contraceptive technology to mitigate the occurrence of sexually acquired UTIs.

Are LARC Users Less Likely to Use Condoms? An Analysis of U.S. Women Initiating LARC in 2008-2018.

INTRODUCTION: Public health professionals have raised concern that increased use of long-acting reversible contraceptives (LARC) could raise women's risk for sexually transmitted infections (STIs), because LARC's superior pregnancy protection may decrease women's motivation to use a barrier method for supplemental pregnancy prevention. This study uses population-based data to examine whether condom use is lower, particularly among young women who are at increased STI risk, after initiating LARC versus moderately effective methods. METHODS: With the 2011-2019 data files of the National Survey of Family Growth, we examine the percent of sexually active months with condom use in the year after LARC or moderately effective method initiation for a nationally representative sample of 2,018 women aged 15-44 years. Multinomial logistic models regressed condom use on method type and age group, as well as their interaction, while adjusting for key confounders. RESULTS: The unadjusted likelihood of any condom use is substantially lower among women who initiated LARC versus moderately effective methods (12% vs. 37%), and this difference is greater among younger versus older women. After accounting for differences in women's reproductive and sociodemographic profiles, however, a statistically significant difference in condom use by method initiated remains only for those aged 20-34 years. CONCLUSIONS: Crude estimates suggest that condom use is lower after initiating LARC versus moderately effective methods, especially among young women. After accounting for the confounding effects of LARC users' distinct profiles-particularly in terms of parity and teenage childbearing-the difference is decreased overall and no longer significant for adolescent women. Overall results indicate a need for new STI prevention strategies and policies that emphasize the importance of dual prevention for LARC users at risk of STIs.

Tendencias temporales en el uso de métodos de barrera durante las relaciones sexuales en Argentina y eficacia de intervenciones para promover su implementación / Trends in the use of barrier methods during sexual intercourse in Argentina and the effectiveness of interventions to promote their implementation

Durante la última década, presenciamos en Argentina un aumento de la incidencia de infecciones de transmisión sexual(ITS) vinculado con una disminución en el uso de métodos de barrera (MB). De acuerdo a la bibliografía, existen varias categorías de obstáculos para el uso de MB: desigualdades de género, dificultades económicas y/o de accesibilidad, desconfianza respecto de los MB provistos por el Estado respecto de su calidad y/o fecha de vencimiento, o bien, creencias acerca de que la utilización de MB disminuye el placer sexual o que no es necesario su uso cuando la relación de pareja es estable y/o basada en la confianza, el amor y/o la fidelidad. A partir de esta problemática, los autores de este artículo realizamos una búsqueda bibliográfica y revisamos cual es la evidencia que respalda diferentes intervenciones para promover el uso de MB. Encontramos evidencia de moderada calidad que avala la eficacia de intervenciones a nivel comunitario basadas en la teoría sociocognitiva y en el aumento de la oferta y la disponibilidad de preservativos para mejorar el conocimiento sobre el HIV y el uso de estos métodos, sin impacto sobre la incidencia de ITS a nivel poblacional. (AU)

Over the last decade, Argentina has shown an increase in the incidence of sexually transmitted infections (STIs) linked to a decrease in the use of barrier methods (BM). According to the literature, there are several categories of obstacles for the use of BM: gender inequalities, economic and/or accessibility difficulties, mistrust regarding the quality and/or expiry date of state-provided BMs, as well as beliefs that the use of BMs reduces sexual pleasure or that their use is not necessary when the couple's relationship is stable and/or based on trust, love and/or fidelity. In light of this issue, the authors of this article conducted a literature search and reviewed the evidence supporting different interventions to promote the use of BM. They found moderate quality evidence that supports the efficacy of community-level interventions based on socio-cognitive theory and on increasing the supply and availability of condoms to improve knowledge about HIV and the use of these methods, with no impact on the incidence of STIs at the population level. (AU)

Análisis en el uso del condón femenino en estudiantes de una universidad privada de Cali-Colombia / Analysis of the use of the female condom in students of a private university in Cali, Colombia / Análise do uso do preservativo feminino em estudantes de uma universidade privada em Cali-Colômbia

Introducción. El condón femenino es un método de barrera eficaz para prevenir las enfermedades de transmisión sexual y los embarazos, permite la mejora de la salud sexual y reproductiva de las mujeres y sus parejas. Presenta barreras al utilizarse en aspectos socioculturales, económicos, religiosos y psicológicos, los cuales pueden ser superados a través de la promoción y educación. El objetivo del presente artículo es analizar el uso del condón femenino en estudiantes universitarios de un programa de salud. Metodología. Estudio cuasiexperimental, con muestreo por conveniencia realizado en 82 estudiantes, organizados en un grupo de 74 mujeres y otro de 8 hombres, quienes utilizaron el condón femenino en sus relaciones sexuales durante un período de tres meses. Reconocieron las ventajas, desventajas, sensaciones y reacciones de la pareja. Resultados. Las ventajas establecidas por todos los hombres y el 70% de las mujeres es colocar el condón femenino antes de la relación sexual, del mismo modo, el 39.2% de las mujeres y el 37.2% de los hombres indican como ventaja poder usarlo hasta el final de la relación. Las desventajas identificadas comprenden que el 54.1% de las parejas de las mujeres no les gusta utilizarlo, al 40.5% de las mujeres les parece difícil su colocación, y al 33.8% le disminuye el placer sexual. En los hombres se identifican como desventajas la disminución del placer en la relación sexual, al 87.5% de sus parejas no le gusta utilizarlo, y el 62.5% de los hombres expresa dificultad para su colocación. Discusión. El uso del condón femenino está limitado por las condiciones de acceso y disponibilidad. El procedimiento de inserción del dispositivo en las mujeres requiere entrenamiento previo e información específica para su uso. Conclusión. La utilización del condón femenino es una alternativa viable para tener sexo seguro, los hombres presentan mayor rechazo al verse afectado el placer sexual.

Introduction. The female condom is an effective barrier method to prevent sexually transmitted diseases and pregnancy; it allows the improvement of the sexual and reproductive health of women and their partners. Using it presents barriers in sociocultural, economic, religious and psychological aspects, which can be overcome through promotion and education. The objective of this article is to analyze the use of the female condom in university students of a health program. Methodology. Quasi-experimental study, with convenience sampling carried out in 82 students, organized in a group of 74 women, and another of 8 men, who used the female condom in their sexual intercourse during a period of three months. They recognized the advantages, disadvantages, feelings and reactions of the partner. Results. The advantages established by all men and 70% of women is to place the female condom before sexual intercourse; in the same way, 39.2% of women and 37.2% of men indicate as an advantage the possibility to use it until the end of the intercourse. The identified disadvantages include that 54.1% of women's partners do not like to use it, 40.5% of women find it difficult to insert, and for 33.8% of them, it decreases sexual pleasure. In men, the disadvantages identified were the decrease in pleasure in sexual intercourse, 87.5% of their partners do not like to use it, and 62.5% of men express difficulty in inserting it. Discussion. The use of the female condom is limited by the conditions of access and availability. The procedure for inserting the device in women requires prior training and specific information for its use. Conclusion. The use of the female condom is a viable alternative to have safe sex. Men show greater rejection when sexual pleasure is affected.

Introdução. O preservativo feminino é um método de barreira eficaz na prevenção de doenças sexualmente transmissíveis e gravidez, melhorando a saúde sexual e reprodutiva da mulher e dos seus parceiros. Apresenta limitações no seu uso com relação a aspectos socioculturais, econômicos, religiosos e psicológicos, que podem ser superadas por meio de promoção e educação. O objetivo deste artigo é analisar o uso do preservativo feminino em estudantes de universidade de um programa de saúde. Metodologia. Estudo quase experimental, com amostragem por conveniência realizada em 82 estudantes, organizados em um grupo de 74 mulheres e outro de 8 homens, que usaram o preservativo feminino nas suas relações sexuais durante um período de três meses. Eles reconheceram as vantagens, desvantagens, sensações e reações do casal. Resultados. As vantagens estabelecidas por todos os homens e 70% das mulheres é colocar o preservativo feminino antes da relação sexual, da mesma forma, 39.2% das mulheres e 37.2% dos homens apontam como vantagem poder usá-lo até o fim da relação sexual. As desvantagens identificadas incluem que 54.1% dos parceiros das mulheres não gostam de usá-lo, 40.5% das mulheres têm dificuldade em colocá-lo e 33.8% acham que diminui o prazer sexual. Nos homens, identificam-se como desvantagens diminuição do prazer na relação sexual, 87.5% das parceiras não gostam de usá-lo e 62.5% dos homens expressam dificuldade em colocá-lo. Discussão. O uso do preservativo feminino é limitado pelas condições de acesso e disponibilidade. O procedimento de inserção do dispositivo em mulheres requer treinamento prévio e informações específicas para seu uso. Conclusão. O uso do preservativo feminino é uma alternativa viável para a prática de sexo seguro, os homens apresentam maior rejeição quando o prazer sexual é afetado.

History of unintended pregnancy and patterns of contraceptive use among racial and ethnic minority women veterans.

BACKGROUND: Nearly half of all pregnancies in the United States each year are unintended, with the highest rates observed among non-Hispanic black and Hispanic women. Little is known about whether variations in unintended pregnancy and contraceptive use across racial and ethnic groups persist among women veteran Veterans Affairs users who have more universal access than other populations to health care and contraceptive services. OBJECTIVES: The objectives of this study were to identify a history of unintended pregnancy and describe patterns of contraceptive use across racial and ethnic groups among women veterans accessing Veterans Affairs primary care. STUDY DESIGN: Cross-sectional data from a national random sample of women veterans (n = 2302) aged 18-44 years who had accessed Veterans Affairs primary care in the previous 12 month were used to assess a history of unintended pregnancy (pregnancies reported as either unwanted or having occurred too soon). Any contraceptive use at last sex (both prescription and nonprescription methods) and prescription contraceptive use at last sex were assessed in the subset of women (n = 1341) identified as being at risk for unintended pregnancy. Prescription contraceptive methods include long-acting reversible contraceptive methods (intrauterine devices and subdermal implants), hormonal methods (pill, patch, ring, and injection), and female or male sterilization; nonprescription methods include barrier methods (eg, condoms, diaphragm), fertility-awareness methods, and withdrawal. Multivariable logistic regression models were used to examine the relationship between race/ethnicity with unintended pregnancy and contraceptive use at last sex. RESULTS: Overall, 94.4% of women veterans at risk of unintended pregnancy used any method of contraception at last sex. Intrauterine devices (18.9%), female surgical sterilization (16.9%), and birth control pills (15.9%) were the 3 most frequently used methods across the sample. Intrauterine devices were the most frequently used method for Hispanic, non-Hispanic white, and other non-Hispanic women, while female surgical sterilization was the most frequently used method among non-Hispanic black women. In adjusted models, Hispanic women (adjusted odds ratio, 1.60, 95% confidence interval, 1.15-2.21) and non-Hispanic black women (adjusted odds ratio, 1.84, 95% confidence interval, 1.44-2.36) were significantly more likely than non-Hispanic white women to report any history of unintended pregnancy. In the subcohort of 1341 women at risk of unintended pregnancy, there were no significant racial/ethnic differences in use of any contraception at last sex. However, significant differences were observed in the use of prescription methods at last sex. Hispanic women (adjusted odds ratio, 0.51, 95% confidence interval, 0.35-0.75) and non-Hispanic black women (adjusted odds ratio, 0.69, 95% confidence interval, 0.51-0.95) were significantly less likely than non-Hispanic white women to have used prescription contraception at last sex. CONCLUSION: Significant racial and ethnic differences exist in unintended pregnancy and contraceptive use among women veterans using Veterans Affairs care, suggesting the need for interventions to address potential disparities. Improving access to and delivery of patient-centered reproductive goals assessment and contraceptive counseling that can address knowledge gaps while respectfully considering individual patient preferences is needed to support women veterans' decision making and ensure equitable reproductive health services across Veterans Affairs.

CE: An Evidence-Based Update on Contraception.

Contraception is widely used in the United States, and nurses in all settings may encounter patients who are using or want to use contraceptives. Nurses may be called on to anticipate how family planning intersects with other health care services and provide patients with information based on the most current evidence. This article describes key characteristics of nonpermanent contraceptive methods, including mechanism of action, correct use, failure rates with perfect and typical use, contraindications, benefits, side effects, discontinuation procedures, and innovations in the field. We also discuss how contraceptive care is related to nursing ethics and health inequities.

[Natural Family Planning methods and Barrier: CNGOF Contraception Guidelines]. / Méthodes de contraception naturelle et méthodes barrières. RPC contraception CNGOF.

OBJECTIVE: To develop clinical practice recommendations for the use of natural contraception and female and male barrier methods. MATERIALS AND METHODS: A systematic review of English and French literatures related to the safety and effectiveness of natural contraceptive methods based on PubMed, Cochrane Library, practice recommendations issued by international scientific societies and guidelines provided by the World Health Organization (WHO) as well as updates from the Center for Disease Control and Prevention (CDC). RESULTS: Natural contraceptives methods include fertility awareness-based methods, lactational amenorrhea method (LAM) and withdrawal method. The prevalence is low (4.6% of users) and remains stable over the years. Identification of the fertile period can be symptom-based cervical mucus (Billings), two-day method, basal body temperature, symptom-thermal method or based on calendar calculation (Ogino-Knauss, standard day method). Pregnancy rate after one-year utilization varies from 0.4% to 5% in perfect use but 8% in common practice. Effectiveness increases with absence of vaginal sex and decreases when combined to barriers method inadequately implemented. Data is scarce on reliability and effectiveness of ovulation predictor kits readily available on internet. Lactational amenorrhea method (LAM) can be very effective (98%) provided three conditions are fulfilled: within 6 months after birth, amenorrhea is effective, and breastfeeding is exclusive or quasi exclusive (day/night). Withdrawal method is constraining and of limited effectiveness. Male and female condom, diaphragm, cervical cap and spermicides are mechanical and chemical barrier methods, preventing spermatozoids from passing through the cervix into the uterus and therefore preventing fecundation. Female and male condoms offer a double protection to avoid pregnancy and prevent STD's. They are effective provided strict conditions of use are fulfilled. Male condom is favored by teenagers (45.6% among 15 to 19 years old), sometimes in combination with contraceptive pill (16% of cases). Women on the pill decreases according to their age. Pregnancy rates within the first year of consistent and correct use of these methods vary between 5 to 26% and reach 20 to 32% in practical use. Diaphragm and cervical cap need to be used in combination with spermicides. Spermicides have limited effectiveness when used alone. CONCLUSION: In common practice, natural and barrier contraceptive methods are more constraining and less effective than modern contraceptive method. They can be an alternative at given time and/or in situations where the women or the couple accept the possibility of an unexpected pregnancy which might be terminated or not. Women/couples need to be properly informed on how to use such methods, on their disadvantages and possible failures in common practice. Reminders are to be given on emergency contraceptive methods (IUD, hormonal) after unprotected sex.

Put a Ring in It: Exploring Women's Experiences with the Contraceptive Vaginal Ring in Ontario.

BACKGROUND: Although the contraceptive vaginal ring (CVR) has been available in Canada since 2001, overall use and availability remain low compared with other combined hormonal contraceptive methods. We aimed to explore women's experiences with the CVR in Ontario as well as factors that influenced their decisions to choose the method and continue/discontinue use. METHODS: We conducted a multimethod qualitative study that consisted of an anonymous online survey and in-depth telephone interviews with a subset of survey participants. We used descriptive statistics to analyze the survey data and analyzed our interviews for content and themes using both deductive and inductive techniques. RESULTS: From May to July 2015, we received 103 survey responses and conducted 29 in-depth interviews. Many participants described positive experiences with the CVR and found it to be an especially convenient method. Women who discontinued use of the CVR cited high costs, access barriers, and negative media reports as important factors in their decision. Our participants primarily relied on their physicians for contraceptive information but did not feel fully informed about potential side effects. Several women identified the CVR as an "in between" method in the transition from oral contraceptive pills to the intrauterine device. CONCLUSIONS: Our findings suggest that the CVR represents a convenient and desirable contraceptive option for some women. However, participants expressed a desire for health care providers to provide more comprehensive information about a full range of contraceptive methods. Improving access to a full range of low-cost contraceptives in Ontario seems to be warranted.

Use of an electronic health record data sharing system for identifying current contraceptive use within the WWAMI region Practice and Research Network.

OBJECTIVE: To evaluate the ability of electronic health record (EHR) data extracted into a data-sharing system to accurately identify contraceptive use. STUDY DESIGN: We compared rates of contraceptive use from electronic extraction of EHR data via a data-sharing system and manual abstraction of the EHR among 142 female patients ages 15-49 years from a family medicine clinic within a primary care practice-based research network (PBRN). Cohen's kappa coefficient measured agreement between electronic extraction and manual abstraction. RESULTS: Manual abstraction identified 62% of women as contraceptive users, whereas electronic extraction identified only 27%. Long acting reversible (LARC) methods had 96% agreement (Cohen's kappa 0.78; confidence interval, 0.57-0.99) between electronic extraction and manual abstraction. EHR data extracted via a data-sharing system was unable to identify barrier or over-the-counter contraceptives. CONCLUSIONS: Electronic extraction found substantially lower overall rates of contraceptive method use, but produced more comparable LARC method use rates when compared to manual abstraction among women in this study's primary care clinic. IMPLICATIONS: Quality metrics related to contraceptive use that rely on EHR data in this study's data-sharing system likely under-estimated true contraceptive use.

A Randomized Crossover Study Evaluating the Use and Acceptability of the SILCS Diaphragm Compared to Vaginal Applicators for Vaginal Gel Delivery.

INTRODUCTION: This study aimed to assess acceptability and preferences for the SILCS diaphragm for vaginal gel delivery compared to a prefilled applicator. METHODS: A randomized crossover study among 115 women in South Africa, using both methods during five sex acts. RESULTS: We found no significant differences in acceptability between the two products. Experience of gel leakage after sex was greater when inserted via applicator. More women were interested in SILCS/gel for multipurpose protection (68%) than in either SILCS alone (17%) or microbicide gel alone (14%). CONCLUSIONS: A SILCS gel delivery system for multipurpose prevention seems feasible and acceptable.

Women's preferences for menstrual bleeding frequency in 12 European countries: the Inconvenience Due to Women's Monthly Bleeding (ISY) survey.

OBJECTIVES: Our aim was to assess the level of inconvenience associated with menstrual bleeding and determine how many women across 12 European countries would prefer a bleeding frequency of less than once a month and what would motivate their choice. METHODS: A 15-min quantitative online survey was conducted in two waves among 5728 women aged between 18 and 45 years, with an equal distribution of women using a combined hormonal contraceptive (CHC group, n = 2739) and women using a non-hormonal contraceptive or no contraceptive (non-HC group, n = 2989). The first wave was carried out in Austria, Belgium, France, Italy, Poland and Spain, in February 2015, and the results have been published. The second wave was conducted in the Czech Republic, Germany, Hungary, Portugal, Latvia and the Netherlands, between August and September 2015. RESULTS: The menstrual period was significantly longer (5.0 versus 4.6 days) and heavier (15 versus 7%) in non-HC users than in CHC users (p < .0001). Given the choice, ∼60% of women would like less frequent menstrual bleeding. There was heterogeneity in the preference across countries. Sexuality, social life, work and sporting activities were key factors affecting women's preference. CONCLUSION: The majority of women in the 12 European countries would prefer to reduce the frequency of menstrual periods. Quality of life was the main factor affecting their preference.

The effect of a drospirenone-containing combined oral contraceptive on female sexual function: a prospective randomised study.

OBJECTIVES: The study investigated the effects on female sexual function of a progestogen-containing combined oral contraceptives (COCs) with an antiandrogenic profile taken in a continuous regimen. METHODS: In this prospective randomised single-institution study, 80 healthy women with a monogamous partner and an active sexual life were randomised into two groups for a period of 3 months. Women in the exposed group (n = 40) took a COCs containing 30 µg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) in a 21/7 regimen. Women in the control group (n = 40) used either a barrier contraceptive method (BCM) or a natural family planning method (NFPM). Participants were asked to complete a set of validated questionnaires to assess sociodemographic variables and measure Female Sexual Function Index (FSFI). RESULTS: The total FSFI score (p < 0.0001), as well as the desire (p = 0.04) and arousal (p = 0.03) scores, were significantly lower in the COCs group after 3 months of hormonal contraceptive use compared with baseline. Women using BCM or NFPM showed an improvement in total FSFI score (p = 0.02). Hormonal contraception with DRSP increased the likelihood of worse sexual function in the desire (odds ratio [OR] 2.47; 95% confidence interval [CI] 1.22, 4.98; p = 0.01) and arousal domains (OR 2.85; 95%CI 1.34, 5.93; p = 0.005) and in total FSFI score (OR 2.01; 95%CI 1.45, 2.79; p < 0.001). The results remained statistically significant even after adjustment for smoking status. CONCLUSIONS: The study found evidence that women taking a combined EE/DRSP COCs for 3 months may have a worsening of sexual function as measured by FSFI.

Current status of frameless anchored IUD for immediate intracesarean insertion.

Immediate postpartum intrauterine device (IUD) insertion deserves great attention as it can provide immediate, timely and convenient contraception plus the added benefit of preventing repeat unintended pregnancies. Although women post vaginal delivery can benefit from immediate post-placenta contraception, women undergoing Cesarean section clearly need contraception, as an inter-delivery interval shorter than 18 months places them at a high risk for uterine rupture. The main drawback of currently available framed IUD devices for immediate postpartum insertion of an IUD is their high expulsion and displacement rates when inserted immediately postpartum after both vaginal and Cesarean delivery. Current research suggests that a brief window of opportunity exists of 10 minutes for insertion of conventional IUDs after which time expulsion rates both immediately and over time are greatly enhanced. This paper summarizes the current research conducted to overcome the expulsion problems associated with conventional T-shaped devices as well as through the use of an anchored frameless device. In the 1970s and 1980s, attempts were made to solve the expulsion problem by modifying existing devices, such as adding absorbable sutures (Delta-T) or additional appendages. These attempts proved to be clinically unsuccessful as the catgut suture added to the transverse arms did not provide sufficient resistance to prevent downward displacement and expulsion. An anchoring technique to suspend a copper IUD to the fundus of the uterus was developed in Belgium in the 1980s and has been the subject of extensive ongoing clinical research since 1985. Recently the frameless copper releasing anchor IUD, GyneFix, has been tested for postplacental insertion. Initially, the anchor was modified by the inclusion of a biodegradable cone which was added below the anchoring knot. Clinical studies confirmed the adequacy of this approach suggesting that it was technically possible to anchor an IUD immediately following Cesarean section as well as after vaginal delivery with minimal incidence of expulsion. However, it was found that removal of the IUD was difficult in a number of women who requested early removal, due to the slow disintegration time of the cone. Based on these prior experiences, a new approach for anchoring of a frameless IUD immediately after delivery of the placenta was invented and developed specifically for use immediately post-Cesarean delivery. Beyond providing convenient and timely contraception the intended use allows a woman adequate time to recover from both the surgery and the burden of childbirth, while ensuring adequate future contraception. It is anticipated that it will also have an added benefit of allowing a greater number of women to have follow-on vaginal deliveries. The anchoring procedure is conducted under direct vision. It can be performed immediately after placental removal without the burden of timing restraints. It consists of the precise placement of the anchor of the frameless IUD immediately below the serosa of the uterus, followed by fixing the anchoring knot in place with a very thin absorbable suture. Early stage studies have confirmed the suitability and ease of use of this approach with additional clinical trials currently being conducted. The anchoring technique is easy, quick, safe and effective with no expulsions at 12 months. The method is considered a major advance, suitable for general use due to its simplicity requiring limited training.

Immediate postpartum insertion of intrauterine device for contraception.

BACKGROUND: Women who want to start intrauterine contraception (IUC) during the postpartum period might benefit from IUC insertion immediately after delivery. Postplacental insertion greatly reduces the risk of subsequent pregnancy and eliminates the need for a return visit to start contraception. Without the option of immediate insertion, many women may never return for services or may adopt less effective contraception. OBJECTIVES: Our aim was to examine the outcomes of IUC insertion immediately after placenta delivery (within 10 minutes), especially when compared with insertion at other postpartum times. We focused on successful IUC placement (insertion), subsequent expulsion, and method use. SEARCH METHODS: We searched for trials until 1 April 2015. Sources included PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials (CENTRAL), POPLINE, Web of Science, EMBASE, LILACS, ClinicalTrials.gov, and ICTRP. For the original review, the authors contacted investigators to identify other trials. SELECTION CRITERIA: We sought randomized controlled trials (RCTs) with at least one treatment arm that involved immediate IUC placement (i.e., within 10 minutes of placenta delivery). Comparison arms could have included early postpartum insertion (from 10 minutes postplacental to hospital discharge) or standard insertion (during a postpartum visit). Trials could also have compared different IUC methods or insertion techniques. Delivery may have been vaginal or cesarean. Primary outcomes were placement (insertion), subsequent expulsion, and method use at study assessment. DATA COLLECTION AND ANALYSIS: For dichotomous outcomes, we used the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). Earlier studies primarily reported results as life-table rates. We aggregated trials in a meta-analysis if they had similar interventions and outcome measures. A sensitivity analysis included studies with moderate or high quality evidence and sufficient outcome data. MAIN RESULTS: We included 15 trials. Seven studies reported from 2010 to 2014 were added to eight from the original 2001 review. Newer trials compared immediate postplacental insertion versus early (10 minutes to 48 hours) or standard insertion (during the postpartum visit). Of four with full reports, three were small trials. The other three studies had conference abstracts. The eight early trials examined immediate insertion of different devices or insertion techniques. Most studies were published in the 1980s, some with limited reporting.Our sensitivity analysis included trials with sufficient outcome data and moderate or high quality evidence. Four newer trials comparing insertion times met the inclusion criteria. Two studies used the levonorgestrel-releasing intrauterine system (LNG-IUS) after vaginal delivery. The other two trials placed IUC after cesarean section; one used the CuT 380A intrauterine device (IUD) and the other used the LNG-IUS.A pilot trial compared immediate insertion versus early or standard insertion. In groups comparing immediate versus early insertion (N = 30), all women had the LNG-IUS inserted. By six months, the groups had the same expulsion rate and did not differ significantly in IUC use.For immediate versus standard insertion, we conducted meta-analyses of four trials. Insertion rates did not differ significantly between study arms. However, the trial from Uganda showed insertion was more likely for the immediate group, although the estimate was imprecise. In the meta-analysis, expulsion by six months was more likely for the immediate group, but the confidence interval was wide (OR 4.89, 95% CI 1.47 to 16.32; participants = 210; studies = 4). IUC use at six months was more likely with immediate insertion than with standard insertion (OR 2.04, 95% CI 1.01 to 4.09; participants = 243; studies = 4). Study arms did not differ in use at 3 or 12 months in individual small trials. AUTHORS' CONCLUSIONS: Recent trials compared different insertion times after vaginal or cesarean delivery. Evidence was limited because studies with full reports generally had small sample sizes. Overall, the quality of evidence was moderate; abstracts and older studies had limited reporting. Ongoing trials will add to the evidence, although some are small. Trials of adequate power are needed to estimate expulsion rates and side effects.The benefit of effective contraception immediately after delivery may outweigh the disadvantage of increased risk for expulsion. Frequent prenatal visits during the third trimester provide the opportunity to discuss effective contraceptive methods and desired timing for initiation. Clinical follow-up can help detect early expulsion, as can educating women about expulsion signs and symptoms.

Impacto de la asesoría sobre anticoncepción en la selección de métodos hormonales combinados en Colombia / Impact of contraception counseling on choice of combined hormonal methods in Colombia

OBJETIVO: Determinar el impacto de la asesoría anticonceptiva informada sobre la elección de método anticonceptivo. MÉTODOS: Estudio descriptivo multicéntrico de evaluación antes y después en nueve ciudades de Colombia. Se invitó a participar mujeres que consideraban usar métodos hormonales combinados de autoadministración al momento de la consulta. Se indagó sobre el uso y preferencia de método anticonceptivo, previa firma del consentimiento informado. En una etapa posterior, se brindó asesoría médica estandarizada en anticoncepción y, a continuación, se preguntó nuevamente por la preferencia de método anticonceptivo y las motivaciones para su elección. RESULTADOS: Ingresaron 858 mujeres al estudio. Al inicio del estudio, 538 (62,7%) mujeres usaban píldora combinada y 281 (32,8%) no utilizaban ningún método anticonceptivo. Antes de recibir asesoría, las mujeres mostraron una preferencia por la píldora (62,7%), seguida por el anillo intravaginal (28,4%) y el parche transdérmico (14%). Luego de la asesoría, la preferencia fue la siguiente: píldora (40,8%), anillo intravaginal (31,5%) y parche transdérmico (11,3%). También luego de la asesoría, 32,5 %, 26,8% y 7,5% de las que consideraban usar píldora, parche y anillo, respectivamente, cambiaron su intención de uso. La región de origen, el estatus laboral, el deseo de concebir un hijo en el futuro y tener una relación estable presentaron una relación estadística con la selección del método, pero la edad, el número de hijos o el grado de escolaridad no fueron factores determinantes. CONCLUSIONES: La asesoría médica tiene impacto en la selección del anticonceptivo hormonal combinado autoadministrado, lo que ayuda a las mujeres a utilizar el método de su preferencia y presentar una mejor adherencia al método acorde a sus condiciones particulares.

OBJECTIVE: Determine the impact of informed contraceptive counseling on choice of contraceptive method. METHODS: Multicenter descriptive study using before-and-after evaluation in nine cities in Colombia. Women considering use of self-administered combined hormonal methods at the time of consultation were invited to participate. They were asked about contraceptive method use and preference, following signing of informed consent. Later, they were given standardized medical advice on contraception and then asked again about contraceptive preference and reasons for their choice. RESULTS: The study enrolled 858 women. At the beginning of the study, 538 (62.7%) women were using the combined pill and 281 (32.8%) were not using any contraceptive method. Before receiving counseling, women showed a preference for the pill (62.7%), followed by the intravaginal ring (28.4%), and transdermal patch (14%). After counseling, preferences were as follows: pill (40.8%), intravaginal ring (31.5%), and transdermal patch (11.3%). After counseling, 32.5%, 26.8%, and 7.5% of those considering the pill, patch, and ring, respectively, changed their intended choice. Region of origin, employment status, desire to conceive a child in the future, and having a stable relationship showed a statistical relationship to choice of method. However, age, number of children, and level of education were not determining factors. CONCLUSIONS: Medical advice has an impact on choice of self-administered combined hormonal contraceptives, which helps women to use the method of their choice and improves adherence to the method in accordance with its particular conditions.

A randomized noninferiority crossover controlled trial of the functional performance and safety of new female condoms: an evaluation of the Velvet, Cupid2, and FC2.

OBJECTIVES: New designs of female condoms have been developed to lower cost and/or improve acceptability. To secure regulatory approvals, clinical studies are required to verify performance. We aimed to assess the functional performance and safety of two new female condom types - Velvet and Cupid2 female condom - against the existing FC2 female condom. STUDY DESIGN: This was a three-period crossover, randomized noninferiority clinical trial with 300 women randomized to condom-type order in one South African site. Primary end points were total clinical failure and total female condom failure. Noninferiority of component modes, clinical breakage, nonclinical breakage, slippage, misdirection and invagination were also determined. Safety data were also assessed for each female condom. Participants were asked to use five of each female condom type and to collect information on use in a condom diary at home and were interviewed after use of each type. Frequencies and percentages were calculated by condom type for each failure mode, and differences in performance of the three female condoms using FC2 as reference, with 95% confidence intervals, were estimated using generalized estimating equation models. RESULTS: A total of 282 (94%) participants completed follow-up, using at least one condom of each type. Total clinical failure (clinical breakage, invagination, misdirection, slippage) was <5% for all female condoms: FC2 (4.50%), Cupid2 (4.79%) and Velvet (3.93%). Noninferiority was demonstrated for all condom failure modes for the two new female condoms with respect to FC2, within the margin of 3% difference in mean failure, at the 5% significance level. CONCLUSION: Noninferiority for the two new female condoms was demonstrated with respect to the marketed FC2. These data are used to support manufacturer dossiers for World Health Organization (WHO)/United Nations Population Fund (UNFPA) prequalification. IMPLICATIONS: Data from this study have been submitted to WHO/UNFPA and will contribute to the prequalification submission requirements for the Cupid2 and Velvet female condoms.

Esterilização histeroscópica ambulatorial pelo procedimento Essure: stent tubário / Outpatient hysteroscopic sterilization by the Essure procedure: stent tubal

A esterilização cirúrgica é um dos métodos contraceptivos mais populares. Métodos tradicionais de esterilização permanente (por exemplo, ligadura tubária abdominal ou laparoscópica) utilizam a anestesia geral ou regional, necessitando de incisão na parede abdominal ou introdução de trocaters, expondo a paciente aos riscos intrínsecos ao procedimento cirúrgico e à obrigatoriedade da recuperação pós-operatória. A Food and Drug Administration (FDA) dos Estados Unidos aprovou em 2002 o sistema de stent tubário Essure. O Essure oclui as trompas estimulando a fibrose tecidual e a subsequente cicatrização. Esse é um artigo de revisão, que tem o objetivo de apresentar esse método aos tocoginecologistas brasileiros, como uma alternativa eficaz e segura para uso na nossa população. O Hospital da Mulher Mariska Ribeiro é atualmente Centro de Referência no Brasil para o Essure já tendo realizado cerca de 1000 procedimentos.

Surgical sterilization is a popular contraceptive method. Traditional methods of permanent sterilization (eg, abdominal or laparoscopic tubal ligation) use general or regional anesthesia, requiring incision in the abdominal wall or introduction of trocars, exposing the patient to the inherent risks of the surgical procedure and the requirement of postoperative recovery. The Food and Drug Administration (FDA) of the United States in 2002 approved the Essure tubal stent system. The Essure occludes the fallopian tubes stimulating tissue fibrosis and subsequent healing. This is a review article, which aims to present this method to Brazilian obstetricians and gynecologists as an effective and safe alternative for use in our population. The Hospital da Mulher Mariska Ribeiro is currently a Reference Center in Brazil for the Essure having already performed about 1000 procedures.

Barrier methods for human immunodeficiency virus prevention.

Condoms remain the most effective barrier against the sexual transmission of the human immunodeficiency virus (HIV). Male condoms have proven to be 80% to 90% effective, and female condoms have similar results. Poor adherence and improper use limit their effectiveness. In addition to condoms, microbicides are a promising barrier against HIV transmission. More than 50 candidate topical microbicide compounds have undergone preclinical or clinical testing in the last 10 years, but there are currently no US Food and Drug Administration (FDA)-approved compounds. Rectal microbicides are also being developed, as anal receptive sex is an effective mode of HIV transmission.

Reducing barriers to the use of the intrauterine contraceptive device as a long acting reversible contraceptive.

The intrauterine device (IUD) is the oldest long acting reversible contraceptive (LARC) method. There remain widespread barriers to its general acceptance, although some have been overcome, others remain. These stem from a lack of understanding of uterine anatomy and physiology. Uterine measuring techniques did not become popular, probably because of the extra effort required prior to IUD insertion. Unfortunately the information they provided regarding IUD design was also not heeded. In some countries varying sizes of other IUDs (second generation) are now available. The third generation hormonal carrying IUDs have also reduced barriers by lowering side effects and producing added health benefits. Fourth generation IUDs will provide added health benefits in addition to contraception and should further reduce barriers to IUD use. Most remaining IUD barriers are due to provider perceptions. Most are based on psychological, moral and religious prejudices. These should not be allowed to interfere with the provision of LARC methods of contraception. There are also acceptor barriers which can be modified by providing education about the method. The use of the IUD as a LARC method is increasing in many developed and developing countries. New technology should help propel the IUD into a more mainstream contraceptive.

Effects of contraception on cervical cytology: data from Mardin City.

OBJECTIVE: Mardin is an area of low socioeconomic level with low rates of contraceptive method use. Our aim in this study was to evaluate the effects of the contraceptive methods used in the area on epithelial cell abnormalities and vaginal flora changes. MATERIAL AND METHOD: Cervical smear samples received at the Pathology Department between 2010 and 2012 of 526 patients who had used a contraceptive method and 112 who had never used one were included in the study. The cases were divided into 3 groups as those using hormonal contraception (107, 20.3%), those using an intrauterine device (343, 65.2%) and those using a barrier method (76, 14.4%). The evaluation was made using the Bethesda 2001 criteria for cervical epithelial abnormalities and specific cervicovaginal infections. RESULTS: There was no significant difference between the groups for epithelial cell abnormalities while bacterial vaginitis (12%, p=0.03) and Trichomonas vaginalis (7.6%) were more common in the IUD users. The Actinomyces rate in RIA users was 1.3%. There was only 1 case of bacterial vaginitis in the barrier group and none of the other patients had a specific infection. DISCUSSION: We did not find a significant cytopathic effect of using a IUD or hormonal contraception in our study. There was a low rate of epithelial abnormality in the barrier method group. IUD was seen to increase the incidence of bacterial vaginitis, Trichomonas vaginalis and Actinomyces. We did not find a significant effect of hormone use on the vaginal flora.