[Entry into sexuality and its hazards]. / L'entrée dans la sexualité et ses aléas.

It is estimated that approximately 20% of adolescents (girls and boys) have their first intercourse experience before 15 years of age. Between 17 and 18 years, approximately 50% have had at least one complete sexual intercourse, and more than one-third have developed a long-lasting relationship. Girls often have an affective link associated with sexual activity. This paper deals with adolescent psychosexual maturation, gender differences, and motivations and feelings concerning their first intercourse experiences.

[Sex disorders in cancer patients]. / Perturbations sexuelles chez les malades cancéreux.

The diagnosis of cancer can interfere with a patient's sexual relationship. It has an important impact on his "quality of life". The organ site of the cancer may be the primary cause of sexual dysfunction. Treatment modalities increase such dysfunction. The way the patient lives his disease with his family, the treatment he receives and the spectrum of death wielded by the word cancer lead to a multifactorial dysfunction which is often difficult to analyse. Although each individual member of the therapeutic team usually concentrates on one technical aspect of the disease, but prevention and treatment of sexual dysfunction has other requirements. One must listen to the patient, help coordinate the interaction between the patient's family, his personal physician and the oncology team. Coordinated efforts are difficult to achieve and not always sufficient.

[Chlamydia trachomatis: risk factors in women in the Parisian region. Importance of smoking and cervical ectropion]. / Chlamydia trachomatis: facteurs de risque chez les femmes de la région parisienne. Importance du tabagisme et de l'ectropion cervical.

A study of chlamydial infection and its clinical correlates was undertaken collaboratively among french women attending sexually transmitted disease (STD, prenatal, and teen clinics (n = 148). A complete sexual and gynecologic history and pelvic exam was performed on all women. Endocervical and urethral cultures were obtained for C. trachomatis and N. gonorrhoeae. Reason for visit included suspected STD in 97% of STD, 5% of prenatal and 17% of teen women. N. gonorrhoeae was isolated from STD clinic patients only (17%). C. trachomatis was found in 22% of teen, 17% of STD and 2% of prenatal clinic women. C. trachomatis was significantly associated with smoking, a history of urethral discharge in the male partner, and endocervical ectopy > 50% of total cervical surface.

[Hormonal modulation in disseminated lupus erythematosus: the preliminary results with danazol and cyproterone acetate]. / L'hormonomodulation dans le lupus érythémateux disséminé: résultats préliminaires avec le danazol et l'acétate de cyprotérone.

In an open prospective study, we have tested clinical efficacy and tolerance of two antigonadotropic drugs, that is danazol (D) and cyproterone-acetate (CA). This study was performed in 11 female patients ranging in age from 19 to 47 years, who suffered from midly-active SLE, during 12 therapeutic periods on the whole (that is 6 for each drug), the minimum period of which was one year. Because of side-effects, D had to be early withdrawn in 2 patients, whereas (the) AC appeared to be well-tolerated in all of them. On the whole, 16 clinical exacerbations of DLE were observed during the 12 months pre-treatment period, versus 9 exacerbations during the 12 months treatment period (p less than 0.05, Wilcoxon test), whereas the average dose of prednisone was reduced from 9.6 to 3.5 mg/day. A dramatic improvement was then observed in 3 patients suffering from mucous ulcerations. Increased plasma testosterone level without any change in estradiol level was observed in patients treated with D. Conversely, plasma estradiol decreased without any change in testosterone level in patients treated with CA. Both drugs induced reduction in plasma sex-hormone binding protein. These preliminary results suggest that D and CA may both reduce lupus disease activity, in parallel with an hormonal environment modification, towards a lower estrogen-androgen balance, along with a better tolerance as for CA.

Hormonal modulation in systemic lupus erythematosus. Preliminary clinical and hormonal results with cyproterone acetate.

We prospectively studied the effects of hormonal modulation using the antigonadotropic drug, cyproterone acetate (CA), in 7 female patients who had moderately active systemic lupus erythematosus. CA was taken orally at a mean daily dose of 50 mg for 21-33 months by 6 patients (9 months by the seventh patient) without any side effects. The number of clinical lupus exacerbations during CA treatment was lower than that during the corresponding pretreatment period (15 of 170 patient-months versus 27 of 156 patient-months; P less than 0.05), despite a reduction in the daily maintenance dose of corticosteroids or antimalarial drugs. Mean plasma testosterone levels were low initially and remained unchanged (0.66 +/- 0.31 to 0.59 +/- 0.23 nmoles/liter), whereas plasma estradiol decreased markedly (from 0.6 +/- 0 38 to 0.11 +/- 0.03 nmoles/liter), resulting in a significant reduction in the estradiol:testosterone ratio (from 1.19 +/- 0.68 to 0.23 +/- 0.12) and in the plasma concentration of the sex hormone-binding protein. Thus, cyproterone acetate induced improvement in clinical lupus activity in parallel with the expected lower estradiol:testosterone balance.

[Plasma androgens in women with disseminated lupus erythematosus]. / Etude des androgènes plasmatiques chez les femmes atteintes de lupus érythémateux disséminé.

Plasma androgen levels were determined by radio-immunoassay in 19 female patients (aged 14 to 42 years) with systemic lupus erythematosus (SLE). In 11 patients studied in the active phase of the disease, prior to any corticosteroid therapy, mean (+/- SEM) plasma concentrations (ng/ml) of the following androgens were significantly reduced as compared with controls (12 normal women aged 19-37 years): testosterone (0.119 +/- 0.021 vs 0.330 +/- 0.034, p less than 0.001), dihydrotestosterone (0.078 +/- 0.013 vs 0.150 +/- 0.014, p less than 0.01), dehydroepiandrosterone (1.60 +/- 0.16 vs 4.30 +/- 0.50, p less than 0.001), dehydroepiandrosterone sulfate (480 +/- 102 vs 1020 +/- 92, p less than 0.001), and androstenedione (0.69 +/- 0.22 vs 1.45 +/- 0.18, p less than 0.02). In 8 patients studied while in post-therapeutic remission, six months to seven years after corticosteroid withdrawal, plasma concentrations of the same androgens (except androstenedione) were also significantly reduced as compared with controls, although to a lesser degree. In neither of the two patient groups were cortisol and estradiol levels significantly different from controls. Our results suggest that low plasma androgen levels could be a permanent disorder in female SLE patients, at least in severe forms of the disease.

[Choice of contraception for the diabetic woman]. / Choix d'une contraception chez la femme diabétique.

PIP: The absolute need to limit and program pregnancies in diabetic women demands choice of an adequate contraceptive method. Combined oral contraceptives (OCs) do not seem appropriate because of their diabetogenic effects and the added vascular risks they present to already fragile women. The diabetogenic effects of combined OCs are believed to result from a reduced number and affinity of insulin receptors, augmented secretion of STH, vitamin B6 deficiency, or hepatic effects. Some progestagens have been shown to stimulate deleterious effects of estrogens on OCs. The estrogen component of OCs is associated with elevation of triglyceride levels and stimulation of very low density lipoprotein synthesis. To these vascular risks are added an augmented blood pressure which reaches hypertensive levels in 50% of cases. The effects of synthetic estrogens on coagulation factors and vessel walls have been well deomonstrated. Macrodosed progestagen pills taken in 20-day cycles appear to be an interesting alternative, but those with the most constant antigonadotropic activity are derived from nortestosterone and all have to some degree an anabolizing androgenic effect which may result in weight gain. Derivatives of 17-hydroxyprogesterone appear to be without secondary metabolic effects. Cyproterone acetate should be evaluated as a possible OC for diabetic women. Continuous-dose progestagen micropills are highly recommended for diabetic women because of their excellent metabolic tolerance. The action of this type of pills is essentially peripheral. The pill may cause menstrual irregularity, spotting, or amenorrhea, and an increased rate of ectopic pregnancy. The Pearl index is between .8-2/1009 IUDs are a possibility for diabetic women, but because of their increased vulnerability to infection, such women should be carefully screened for prior adnexial or uterine infection, the device should be inserted in completely aseptic conditions, the woman's hygiene should be impeccable, the women should be informed about sexually transmitted diseases and regular follow-up should be arranged. A diaphragm with spermicide is without side effects and is effective if use properly. After age 40, tubal ligation is an ideal method, but it should not be proposed just because a woman has diabetes. Vaginal rings, which avoid most shortcomings of OCs, will surely be of interest to diabetic patients in the future as they become commercially available. Male contraceptive methods also deserve consideration.^ieng