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)

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.

[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.

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.

Divergent trends in abortion and birth control practices in belarus, Russia and Ukraine.

CONTEXT: The last decade witnessed growing differences in abortion dynamics in Belarus, Russia, and Ukraine despite demographic, social, and historical similarities of these nations. This paper investigates changes in birth control practices in the three countries and searches for an explanation of the diverging trends in abortion. METHODS: Official abortion and contraceptive use statistics, provided by national statistical agencies, were analysed. Respective laws and other legal documents were examined and compared between the three countries. To disclose inter-country differences in prevalence of the modern methods of contraception and its association with major demographic and social factors, an analysis of data from national sample surveys was performed, including binary logistic regression. RESULTS: The growing gap in abortion rate in Belarus, Russia, and Ukraine is a genuine phenomenon, not a statistical artefact. The examination of abortion and prevalence of contraception based on official statistics and three national sample surveys did not reveal any unambiguous factors that could explain differences in abortion dynamics in Belarus, Russia, and Ukraine. However, it is very likely that the cause of the inter-country discrepancies lies in contraceptive behavior itself, in adequacies of contraceptive knowledge and practices. Additionally, large differences in government policies, which are very important in shaping contraceptive practices of the population, were detected. CONCLUSION: Since the end of the 1990s, the Russian government switched to archaic ideology in the area of reproductive health and family planning and neglects evidence-based arguments. Such an extreme turn in the governmental position is not observed in Belarus or Ukraine. This is an important factor contributing to the slowdown in the decrease of abortion rates in Russia.

Breast cancer hypothesis 1978: Shift of the conceptual framework.

One hundred medical hypotheses from the 1970s were reviewed, in a book in London, UK, in order to reassess the predictive values and practical realizations of hypotheses suggested more than 30 years ago. The hypothesis-testing study of breast cancer of 1978, corroborating evidence of a significant association between barrier contraception (condom use) and breast cancer in American married women was also included (No. 44). As a reply, presented is the evolving line of the hypothesis into evidence of the potential of primary prevention of the disease, and a Table of the envisioned shift of the conceptual framework (paradigm) of breast cancer.

Barrier contraception among adolescents and young adults in a tertiary institution in Southwestern Nigeria: a cross-sectional descriptive study.

Nigeria, like most African nations, is basically conservative, but the young people are becoming more sexually liberated, and the incidence of STD/HIV, unwanted pregnancies and abortions among these young people is on the increase. The use of barrier contraception (BC), which is a cost-effective method of preventing STD/HIV, unwanted pregnancies and its attending complications, has therefore become an important issue in reproductive health. This descriptive cross-sectional study was carried out among first year students of Osun State University, Nigeria. Four hundred respondents were studied using pre-tested semi-structured questionnaires. The respondents were selected by balloting. Most respondents (93%) had heard about the male condom as a method of barrier contraception. Most respondents (79.1%) supported the use of barrier contraceptives, but many (62.5%) thought it would promote sexual promiscuity, 33.4% believed that the use of barrier contraception reflected a lack of trust from the partner, and 38.7% felt barrier contraception is not necessary with a stable partner. One hundred and sixty one (40.5%) had used a form of barrier contraception before, but only 130 (32.7%) are currently using BC. The male condom was the most commonly used method (88.2%), followed by female condom and diaphragm (5.6% respectively). The prevention of STI and unwanted pregnancies were the main reasons (59%) given by respondents for using BC, while religion was the main reason given by non-users. The attitudes of these students toward barrier contraception and their practice were poor. The role of sex education at homes and religious gatherings cannot be over-emphasized.

Urban female family medicine patients' perceptions about intrauterine contraception.

AIMS: Improper and inconsistent contraceptive use contributes to the unintended pregnancy rate. The intrauterine device (IUD) is an effective, safe method of contraception that cannot be used improperly or inconsistently. However, it is relatively underused in the United States. We developed a qualitative study to better understand patient beliefs and attitudes that may act as a barrier to acceptance or use of an IUD. METHODS: We conducted semistructured interviews with a convenience sample of 40 reproductive aged women from two Bronx, New York, family medicine practices. Self-report of having heard of the IUD was the main eligibility criterion. We used an iterative process of data collection and analysis. RESULTS: Although respondents appreciate the advantages of an IUD, they express a number of conceptual concerns and fears about the device. These are primarily related to voluntarily placing a device inside the body for a prolonged period of time and to a knowledge gap about internal female reproductive anatomy. The IUD is viewed as a contraception option to use when other methods have failed or after childbearing. Additionally, respondents report a lack of discussion and information about the IUD from healthcare providers, the media, and informal networks. CONCLUSIONS: Directly addressing patient reservations that might otherwise be left unsaid could potentially increase acceptance of the IUD. The issues elucidated in this study begin to shed light on specific patient concerns that providers or public health messages may address during IUD contraception counseling. Given the high efficacy and safety of IUDs, increasing use could impact rates of unplanned pregnancy.

Anticoncepción en la mujer con diabetes / Contraception in diabetic women

a mujer con diabetes, como cualquier mujer o incluso con más motivo, va a necesitar consejo contraceptivo, lo que en ocasiones puede resultar complejo. La elección del método más adecuado debe basarse en su efi cacia y en su interacción con la diabetes. El uso de anticoncepción hormonal es posible en mujeres sin enfermedad vascular ni factores de riesgo añadido y con un buen control glucémico. No es el método ideal, sino que su uso debe ser temporal y la Sociedad Española de Contracepción exhorta a un control más estricto por su endocrinólogo de referencia. Se recomienda el uso de preparados con dosis bajas de estrógenos y con gestágenos antiandrogénicos

Diabetic women may need, as other women or even more, contraceptive advice, which may be difficult in some cases. To determine the most adequate method, we need to take into consideration its efficacy and possible interaction with diabetes. It’s an acceptable choice the use of hormonal contraception’s methods among diabetic women with no vascular disease or additional risk factors, and with a good glycemic control. But it’s not the ideal method, and should not be used in the long-term, but always with strict periodic endocrinological controls. Low-dose estrogen and antiandrogenic gestagen combined contraceptives are recommended

Consistent use of a combination product versus a single product in a safety trial of the diaphragm and microbicide in Harare, Zimbabwe.

BACKGROUND: We examined the use and acceptability of a combination product (diaphragm and gel) compared to a single product (gel) during a 6-month safety trial in Zimbabwe. STUDY DESIGN: Women were randomized to the use of a diaphragm with gel or the use of gel alone, in addition to male condoms. Ever use and use of study product on the last act of sexual intercourse were assessed monthly by Audio Computer-Assisted Self-Interviewing. Acceptability, correct use and consistent use (use at every sexual act during the previous 3 months) were measured on the last visit by face-to-face interview. Predictors of consistent use were examined using multivariate logistic regression analyses. RESULTS: In this sample of 117 sexually active, monogamous, contracepting women, rates of consistent use were similar in both groups (59.7% for combination method vs. 56.4% for gel alone). Product acceptability was high, but was not independently associated with consistent use. Independent predictors of consistent use included age [adjusted odds ratio (AOR)=1.08; 95% confidence interval (95% CI)=1.01-1.16], consistent condom use (AOR=3.85; 95% CI=1.54-9.63) and having a partner who approves of product use (AOR=2.66; 95% CI=1.10-6.39). CONCLUSIONS: Despite high reported acceptability and few problems with the products, the participants reported only moderate product adherence levels. Consistent use of condoms and consistent use of products were strongly associated. If observed in other studies, this may bias the estimation of product effectiveness in future trials of female-controlled methods.

Use of self home-made diaphragm for protection against pregnancy and sexually-transmitted infections: case report.

This is a case report of a 44-year-old woman who used a home-made diaphragm for 16 years to protect herself from pregnancy and sexually-transmitted infections. The woman stitched a piece of cloth with folded polythene inside. This case report provides a vivid illustration of the limitations of available methods of protection for women. It consists of an introduction to the topic, a description of her experiences using her home-made diaphragm and a discussion of the significance of the case. This report supports the need for additional research on female-controlled methods of protection against sexually-transmitted infections, methods that can be used without male knowledge and co-operation, such as vaginal microbicides and cervical barriers against infection, including the diaphragm.

Implante hormonal subcutáneo: experiencia en una unidad clínica / Subdermal hormonal implant: an experience in a clinical unit

En España el número de Interrupciones Voluntarias de Embarazo (IVE) es elevado, así como la tasa de embarazos no deseados. en los últimos años ha variado notablemente el abanico de métodos anticonceptivos disponibles en nuestro país. Algunos de ellos, ya disponibles en otros países, se han introducido aquí, como es el caso del implante hormonal subcutáneo (IHS), considerado en la actualidad el anticonceptivo más eficaz, presentando además un excelente balance riesgo/beneficio. En el presente trabajo se analiza el perfil de las usuarias, así como los efectos adversos, grado de satisfacción e indicación del implante hormonal subcutáneo (IHS)

In Spain, the number of Volutary Interruptions of Pregnancy is high, as well as the rate of unintended pregnancies. Recently, the range of contraceptive methods available for Spaniards has widened considerably. Some of them, which were already available in other countries, have been introduced in Spain, such as the Subcutaneous Hormoonal Implant, regarded as the most effective contraceptive nowadays. Furthermore, it shows a great risk/benefit balance. The aim of this paper is the analysis of the users profile, the adverse effects, the degree of satisfaction and the methos used for women to carry the subdermal hormonal implant

Do participant characteristics influence the effectiveness of behavioral interventions? Promoting condom use to women.

OBJECTIVES: This study assessed whether participant baseline characteristics modified the effects of a skill-based intervention promoting condom use. STUDY: The randomized, controlled trial enrolled 427 women from a sexually transmitted disease clinic in Birmingham, Alabama. The main outcome measures: consistent (100%) and problem-free (correct, no breakage or slippage) condom use were verified by sexual diary self-report and contraceptive product counts. RESULTS: The enhanced intervention group had a 60% higher consistent condom use rate compared to the basic group (risk ratio [RR], 1.6; 95% confidence interval [CI], 1.4-1.8). There was no statistically significant difference between groups in relationship to problem-free, consistent use (RR, 1.0; 95% CI, 0.9-1.1). A binomial regression analysis identified the following factors as significant modifiers of intervention effectiveness on consistent condom use: intention to use condoms next time, early-age sexual debut, marital status combined with place of intercourse, and substance use before sex. CONCLUSIONS: The results suggest that participant baseline characteristics can be modifiers of intervention effectiveness.

A randomized trial of clinician-delivered interventions promoting barrier contraception for sexually transmitted disease prevention.

OBJECTIVE: The objective of this study was to compare 2 interventions promoting condoms and vaginal microbicides to prevent sexually transmitted disease (STD). STUDY: Women (N = 427) attending an STD clinic were randomly assigned to 2 clinician-delivered interventions and followed up monthly to assess condom/microbicide use and incidence of gonorrhea, chlamydia, and syphilis. RESULTS: During follow up, condom use rates were 69% (enhanced) and 49% (basic) and microbicide use rates were 44% and 29%, respectively. STD rates did not significantly differ between intervention groups. Perfect condom use (regardless of intervention arm) was associated with a 3-fold decrease in STD rates (relative risk [RR], 0.3; 95% confidence interval [CI], 0.1-0.8). Using a vaginal microbicide during > or =50% of the acts of intercourse was associated with reduced STD rates (RR, 0.5; 95% CI, 0.3-1.0) across intervention groups and condom use categories. CONCLUSIONS: The enhanced intervention increased use of condoms and vaginal microbicide; however, STD rates did not decrease because a protective effect was seen only among perfect barrier users, and the enhanced intervention only modestly increased perfect use.

Barrier and spermicidal contraceptives in adolescence.

This article describes both barrier and spermicide methods of contraception including the male and female condom, diaphragm, contraceptive sponge, Lea Shield, cervical cap and multiple spermicide options. Their efficacy, differences and proper use are discussed with an emphasis on the adolescent user.

Development and validation of an acceptability and satisfaction questionnaire for a contraceptive vaginal ring, NuvaRing.

OBJECTIVE: To validate an acceptability questionnaire for NuvaRing, a new combined contraceptive vaginal ring. METHODS: A 21-item questionnaire was developed covering: ease of ring use, ease of package use, clarity of instructions, sexual comfort, cycle-related characteristics, compliance and satisfaction. A total of 2145 women completed the questionnaire after 3, 6 or 13 cycles of NuvaRing use. The psychometric properties and predictive value of the questionnaire were assessed using cycle 3 data (n = 1950). The quality of completed questionnaires, item content analysis, construct validity, internal consistency reliability, known groups validity and predictive validity were evaluated. RESULTS: Excluding non-ordinal items, 0.6% of the data were missing. Principal component analysis of 15 ordinal items indicated that two hypothesised dimensions ('ease of package use' and 'clarity of instructions') were consistently linked and so were combined into a single 'ease of comprehension' scale. Item convergent validity (the degree of correlation between an item and its own scale) was 100% for 'ease of ring use' (r = 0.44) and 'satisfaction' (r = 0.58), 83% for 'ease of comprehension' (r = 0.25-0.62) and 67% (r = 0.38-0.54) for 'sexual comfort', but 0% for 'cycle-related characteristics' (r = 0.31). Item discriminant validity (the degree to which an item correlates with its own scale compared with other scales) was >/=96% for all dimensions. Internal consistency reliability was acceptable for all dimensions (adjusted Cronbach's alpha coefficient >0.70). Satisfaction was higher than in the complementary groups for respondents who had no adverse events, chose NuvaRing as the best method of contraception or completed the study; this indicated good known groups validity. Low satisfaction with the method was a good predictor of early discontinuation after cycle 3, indicating that the questionnaire had good predictive validity. CONCLUSIONS: The acceptability questionnaire has good psychometric properties and can predict early discontinuation of the NuvaRing vaginal ring method of contraception.