The female condom (Femidom)--a study of user acceptability.

OBJECTIVE: To determine the acceptability of the female condom (Femidom). DESIGN: Questionnaire survey following the use of the Femidom during sexual intercourse. SETTING: Groote Schuur and Somerset Hospitals, Cape Town. PARTICIPANTS: Nurses, secretaries, doctors and domestic staff of Groote Schuur and Somerset Hospitals who volunteered-61 women were recruited, 8 did not use any female condoms, and 1 did not return. Many women refused, mainly because of the unaesthetic appearance of the Femidom and the fact that they had to continue using their regular contraceptive and they did not think their partners would co-operate. OUTCOME MEASURES: Sexual responsivity compared with that without Femidom; acceptability of the method; women's and their partners' enjoyment of using the method; comparison with the male condom; awareness of HIV-AIDS and protective measures that can be used. RESULTS: Of the 52 participants, 23 used all 10 Femidoms issued to them. Thirteen women and 18 of their partners did not enjoy using the method and 9 had problems with it. Sex with the Femidom was the same or better in 51.9%. The Femidom was unacceptable in 32.7%, acceptable in 52% and very acceptable in 13.4%. Compared with the male condom, 50% of women and 44.2% of men considered the Femidom as good or better. Of the 61 women, 59 had heard of AIDS, and awareness of protective measures was good. CONCLUSION: There was resistance to accepting the Femidom, mainly because of its unaesthetic appearance and because women were participating for altruistic reasons. Acceptance and ease of application improved with use. Comments regarding problems and subjects' and their partners' enjoyment varied from extremely positive to extremely negative; 65.4% considered sex using the Femidom acceptable or very acceptable. It is important to inform and obtain co-operation from the male partner. The female condom has been developed as an alternative for women to use if their partners refuse or dislike using male condoms. Perfect use of the Femidom may reduce the annual risk of acquiring HIV by more than 90% in women who are sexually active with an infected male. The efficacy of the female condom has been described as equal to that of the diaphragm. The Femidom will increase the range of choices of contraceptives and prophylactic methods available for protective sex. It should become accepted as a method of contraception and an adjunct to other contraceptive methods as a prophylactic against sexually transmitted diseases and AIDS, particularly in relationships that are not mutually monogamous.

A study of bleeding patterns with two injectable contraceptives given postpartum and the effect of two non-hormonal treatments.

349 women were given Depo-Provera and 304 were given Nur-Isterate immediately after delivery. No significant difference in duration or amount of bleeding was found between the two injectables over 6 months. Although the incidence and duration of bleeding were greater when injectables were used postpartum than when used electively, they were not excessive. This option should therefore not be withheld. Treatment with anti-inflammatory and anti-fibrinolytic agents were not effective in controlling bleeding.

The clinical and biochemical effects of two combination oral contraceptive agents.

A comparison of the effects of two low-dose oral contraceptives on lipid metabolism was undertaken in an open-group comparative design study at the Family Planning Clinic, Groote Schuur Hospital, Cape Town. Sixty healthy women aged 18-35 years requesting oral contraception were allocated alternately to use a monophasic oral contraceptive containing 30 micrograms ethinyloestradiol and 150 micrograms desogestrel (Marvelon, group A), or a triphasic oral contraceptive containing 30-40 micrograms ethinyloestradiol and 50-125 micrograms levonorgestrel (Triphasil, group B). The changes in the lipoprotein profile elicited by the two preparations differed significantly. Group A subjects had a much greater triglyceridaemic response (42.4%) than group B (14.6%) and had a significant increase in high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A-1 (Apo-A1). In group B, HDL-C decreased and Apo-A1 showed little change. Non-HDL-C (NHDL-C) and Apo-B levels hardly changed in either group. The atherogenic ratios, NHDL-C/HDL-C and Apo-B/Apo-A1 were higher in group B. This study confirmed a significant difference in the response of plasma lipoproteins to the two oral contraceptive preparations. The evidence suggests that the desogestrel-containing oral contraceptive elicits a less atherogenic lipoprotein profile than does the levonorgestrel-containing preparation. Although unsupported by direct clinical evidence that changes in the lipoprotein pattern induced by oral contraceptives cause atherosclerosis, these effects should be considered when prescribing oral contraceptives for women who have risk factors for cardiovascular disease.

Education for sexuality.

PIP: Sex education provides a means to reduce the growing incidence of sexual abuse and of sexually transmitted diseases. Knowledge, which differs from permission, may protect. Sex education needs to provide factual information about anatomy and physiology and sexual development and responses. Further, it must guide young people towards healthy attitudes that develop concern and respect for others. This should enable them to make sound decisions about sexual behavior based on both knowledge and understanding of their own sexual identity and interpersonal relationships. The recent research shows that teenagers exposed to sex education are no more likely to engage in sexual intercourse than are other adolescents, and those who become sexually active are more likely to use a contraceptive method at 1st intercourse and are slightly less likely to experience premarital pregnancies. The nonuse of contraceptives is related to ignorance, lack of awareness of the consequences of sexual activity, and inaccessibility of suitable services. Consequently, young people need help to learn about the risks of pregnancy, how to avoid unwanted pregnancy, and where to go for counseling and services before they become sexually active. The provision of contraceptives must be made to meet the needs of adolescents. Formal sex education should be given in schools only with parental knowledge and cooperation. Youth leaders can influence young people positively by teaching about health and hygiene and promoting responsible attitudes toward sex and religion. Doctors and nurses have a unique opportunity to provide counseling throughout their patients' lives. The Department of Health (Capetown, South Africa) has appointed 445 nurses who oversee the youth program. They give sex education at schools, teaching colleges, youth camps, and at clinics. They also provide individual and group counseling for never pregnant, pregnant, and parent adolescents and their parents and partners at 8 youth health centers and existing family planning clinics. The Family Planning Association provides sex education at schools and teaching colleges and for parent teachers association groups and youth groups as well as church leaders and business executives. It is essential to promote honest communication with regard to sexuality and reproductive health care.^ieng

The effect of sterilization by bipolar cautery and falope ring on menstrual bleeding patterns.

Bleeding patterns in women sterilized by the laparoscopic route using bipolar cautery and Falope ring are compared with those in women whose husbands had been vasectomized 1 year previously. No significant association exists between the technique of sterilization used and a change in duration or amount of bleeding. Although there was an increase in the amount and duration of bleeding in some cases, there was an equivalent decrease in amount and duration of bleeding in others. There is no significant difference in bleeding patterns between women who have had laparoscopic sterilization and women whose husbands have been vasectomized.

Laparoscopic sterilization on a day-case basis.

A prospective series of 307 patients who underwent laparoscopic sterilization on a day-case basis is presented. Of these, 196 patients attended for the 6-month and 117 for the 1-year follow-up visit. There were 5 Blacks, 197 Coloureds and 105 Whites. Sterilization was done by means of tubal cauterization (137), Hulka-Clemens clips (34) and Falope rings (136). Although 18% of patients were under 30 years old, 16% were 40 years of age or older. A marked tendency to low parity was evident, 43% of Coloureds and 90% of Whites being para 3 or less. The main operative problem was uterine perforation. Of the patients 17% were not discharged on the day of operation. By the 5th postoperative day 86% had returned to normal working activities. Significantly more postoperative abdominal pain was reported in the clip and ring groups. Seven pregnancies occurred in the series, 6 after tubal cauterization and 1 after the application of Falope rings. On patient was probably pregnant at the time of the operation. Most patients reported no change in libido at the 1-year follow-up visit, and in 20% libido was increased Mild pelvic infection was the only significant finding at the 6-month and 1-year follow-up visits. Apart from the disturbingly high pregnancy rate and the relatively large number of patients who were not discharged on the day of operaton, the sterilization programme has been most acceptable.

Vasectomy as an outpatient procedure.

The technique of vasectomy performed at Groote Schuur Hospital on 250 men under local anesthesia is detailed. The importance and extent of adequate counselling are outlined. The procedure is acceptable, effective and safe, and complications have been minor and transient.

Technical problems and early complications of laparoscopic sterilization done on a day-case basis.

Two hundred and sixteen patients were selected for laparoscopic sterilization on a day-case basis. Patients were sterilized by electrocautery, by applying Silastic bands (Falope rings), and by means of Hulka-Clemens clips. Three patients required laparotomy and 35 patients were discharged the day after the operation. By the 3rd day 146 (69%) and by the 5th day 184 (86%) patients had returned to their routine work. From the technical and immediate postoperative point of view, there appears to be relatively little difference between the three techniques. There may be slightly more risk of thermal complications with bipolar cauterization, a slightly highly incidence of postoperative abdominal pain with the Silastic band applicator, and slightly more difficulty in applying the Hulka-Clemens clip. These problems are all reduced by experience and proper training of the operator, which is essential. Our experience confirms that laparoscopic sterilization is safe, efficient, and feasible as a day-case procedure, and that it has major advantages in terms of patient convenience and acceptability as well as reduction in hospitalization costs.

Postpartum insertion of the combined multiload copper intra-uterine device (M L Cu 250).

The results obtained from postpartum insertion of the combined multiload copper intra-uterine device (M L Cu 250) are presented. The study was prompted by a pilot study in the Netherlands which showed that few expulsions occurred with "postplacental" insertion of the multiload intra-uterine device. Seventy-five patients had devices inserted between 6 and 72 hours postpartum, and the patients were followed up for 6 months after insertion, with an overall continuation rate of 77,6%. This study showed that the postpartum insertion of this device is a safe and acceptable form of contraception, particularly in patients who are unlikely to continue with other forms of contraception.

Efficacy and acceptability of injectable medroxyprogesterone. A comparison of 3-monthly and 6-monthly regimens.

Five hundred Black Rhodesian women given injections of 150 mg Depo-Provera every 3 months (group A) and 500 women given an injection of 450 mg Depo-Provera every 6 months (group B) were reviewed after 6 months. Group B had a significantly lower rate of defaulters. There was no significant difference between the groups with regard to weight gain, systolic and diastolic blood pressure increase, overall abnormal bleeding patterns and complaints of side-effects. Among those women who reported abnormal bleeding patterns, significantly more in group B had amenorrhoea. There was no significant increase of prolonged bleeding in group B. Among those women who complained of side-effects, significantly more in group B complained of headaches and a bloated abdomen. No pregnancies occurred in either group. The increased annual cost of the 450 mg injections, which was the main reason for women not accepting this regimen, is outweighed by convenience and reduced travel costs. Depo-Provera 450 mg given by 6-monthly injection is well tolerated and effective, and appears to be even more satisfactory as regards continued acceptance than 150 mg given every 3 months.

The pattern of acceptance by Blacks of family planning facilities in relation to socio-economic status.

Two factors which are said to increase the acceptability of family planning in a developing country are, firstly, the ready availability of the facilities and, secondly, the raising of the socio-economic level of the community. This survey reports the effects on family planning of increasing socio-economic status on the one hand, and of urbanisation without an associated increase in the socio-economic level on the other. It is concluded that, although socio-economic status has some effect on family planning, it has a greater effect on the survival rate of children. Urbanisation, however, with family planning facilities more readily available, exerts a stronger influence upon the acceptance of family planning than socio-economic status.