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

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

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

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

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

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

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

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

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

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

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

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

Sexual behaviour survey in a rural area of northwest Tanzania.

OBJECTIVE: Little is known about variations in patterns of sexual behaviour in different countries, cultures, and subpopulations that determine the spread of HIV-1. Quantitative studies are required to improve understanding. METHODS: To assess reported patterns of sexual behaviour, we administered a standardized questionnaire to 416 men and 498 women aged 15-49 years from a rural population in northwest Tanzania. RESULTS: Reported levels of sexual activity were highest in men and among younger age groups. The number of sexual partners and number of sex acts per unit of time were strongly correlated: men reported 10 times as many lifetime partners than women. Frequency of sexual partner exchange plateaued earlier in women (by age 25 years) than in men (by age 35 years). For the great majority, age of first intercourse was 15 years or younger; older subjects were older at first intercourse and had fewer lifetime partners than younger subjects. CONCLUSIONS: This age-related pattern suggests that more recent birth cohorts have behaviour patterns that increase the risk of sexually transmitted infectious agents such as HIV. Preventive education programmes should be targeted at young adults, who adopt higher risk profiles of frequent partner exchange linked with first intercourse at an early age.

Gonorrhea as a risk factor for HIV acquisition.

OBJECTIVE: The role of gonorrhea in facilitating acquisition of HIV infection has only recently been studied. A previous nested case-control analysis in a cohort of female sex workers in Zaïre found a strong association between HIV seroconversion and prior gonorrheal infection. The objective of this study was to replicate the Zaïre study analysis in a cohort of 273 Cameroonian sex workers to determine whether gonorrhea increased the risk of HIV acquisition, and if the crude association between gonorrheal infection and HIV acquisition was weakened when the level of unprotected coitus was more carefully controlled. METHODS: We conducted a nested case-control study of initially HIV-1-negative women (n = 273) followed prospectively (with monthly sexually transmitted disease check-ups and 3-monthly HIV-1 serology). As in Zaïre, cases (seroconverters, n = 17) were compared with controls (women who remained HIV-1-negative, n = 68) for incidence of gonorrhea and sexual exposure during the presumed period of HIV-1 acquisition. RESULTS: The association between gonorrheal infection and subsequent HIV acquisition was stronger in Zaïre than in Cameroon [crude odds ratios (OR), 6.3 versus 2.2]. In both the Zaïre and Cameroon data the crude OR were reduced (6.3 to 4.8, and 2.2 to 1.7, respectively) by controlling for risk factors including a dichotomous variable indicating irregular or no condom use. When this variable was replaced in the Cameroon data with a more precise continuous variable indicating the percentage of unprotected coital acts, the gonorrhea OR was further reduced to 1.4 (95% confidence interval, 0.4-4.9). CONCLUSION: These results suggest that in the Cameroon cohort, gonorrheal infection did not facilitate HIV acquisition, but that having gonorrhea was a marker for unprotected coitus that facilitated HIV acquisition. The data demonstrate how OR can be overestimated when imprecise dichotomous measures of unprotected coitus are used. Future studies should plan for better control of self-reported condom use.

PIP: The objective was to replicate a Zaire study with a cohort of 273 Cameroonian sex workers to determine whether gonorrhea increased the risk of HIV acquisition, and whether the crude association between gonorrheal infection and HIV acquisition was weakened when unprotected coitus was more carefully controlled. 303 Cameroonian female sex workers were enrolled in Yaounde between 1989 and 1990. Eligibility criteria included age 18 years or older; no pregnancy during the previous 42 days; no history of adverse reaction to a spermicidal product; negative enzyme-linked immunosorbent assay (ELISA) HIV-antibody test; and monthly follow-up visits for 1 year. Women were asked to use condoms and suppositories containing N-9 at every sexual activity and coital logs were reviewed monthly. 17 women were identified as cases and 68 as controls. Unlike in Zaire, where 8% of the cases and controls reported never using condoms, none of the women reported unprotected coitus more than 50% of the time in Cameroon. Almost 30% of both cases and controls in Cameroon had evidence of genital ulcers, compared with less than 5% of the cases and controls in Zaire. The crude OR of HIV infection among those who had gonorrhea during the exposure period was much higher in Zaire than in Cameroon (6.3 vs. 2.2). In both the Zaire and Cameroon data the crude OR were reduced (6.3 to 4.8 and 2.2 to 1.7, respectively) by controlling for risk factors of young age, number of partners per week, trichomoniasis, genital ulcers, and a dichotomous variable indicating irregular or no condom use. In the 1st alternative model, the OR for gonorrhea was 2.0 when the dichotomous measure of unprotected coitus (i.e., more than 25% of coital acts were unprotected) was used. When a more precise continuous estimate of level of unprotected coitus was used (i.e., the percentage of acts where neither condoms nor N-9 was used) the OR for gonorrhea was reduced to 1.4.

Risk factors for HIV among prostitutes in Chiangmai, Thailand.

The discovery of a 44% (44 out of 100) prevalence rate of HIV infection among female prostitutes working in brothels in Chiangmai in Thailand in June 1989, prompted this follow-up study in August to confirm the high prevalence rate and to look for risk factors for infection. We studied 238 female prostitutes working in 14 brothels and confirmed this high prevalence rate. Eighty-seven (36.5%) out of 238 prostitutes were found to be HIV-positive by enzyme-linked immunosorbent assay with IFA or Western blot confirmation. Logistic regressions found a significant association between HIV infection and frequency of sexual intercourse greater than 3 times per day [odds ratio (OR) = 2.82, 95% confidence interval (CI) = 1.47-5.41], sexual service charge less than 150 Baht (OR = 9.1, 95% CI = 2.9-33.3), and post sexual cleansing with water alone (OR = 3.85, 95% CI = 1.90-7.80). Of 56 women found seronegative in the June survey, 35 were re-tested in the August study. Seven (20%) of them were seropositive, giving an HIV seroconversion incidence rate of 10% per month. The findings of this study prompted intensive health education programmes among prostitutes, their customers, and owners of brothels.

Health behavior and urinary tract infection in college-aged women.

We conducted a case-control study to examine the associations between various behavioral risk factors and urinary tract infection among college-aged women. Cases were collected from a University Health Service, and were compared to Health Service controls and to a population-based control group. Sexual intercourse, diaphragm use, and urinating after sexual intercourse were each associated with urinary tract infection (UTI). The magnitude of the association of diaphragm use with UTI was reduced when urination habits around sexual intercourse were considered.

PIP: 468 women using the University of Michigan Health Service because of urinary symptoms, completed questionnaires regarding medical history, stress, clothing, diet, sexual activity, and birth control method during the previous 4 weeks. 1484 potential Health Service controls without urinary symptoms were selected as well as 115 student-population -based controls. Urinary tract infection (UTI) criteria were 100,000 colonies of bacteria/ml urine and 10,000 colonies of a single bacteria/ml urine. After exclusions, the sample numbered 1641 women: 237 UTI cases, 1296 Health Service controls, and 108 student-population controls with an average age of 21.9 years. 63.2% of cases, 36.4% of Health Service controls, and 25.2% of population controls reported previous UTIs. UTIs significantly increased with the frequency of sexual intercourse. There was a weak link between a new sexual relationship in the prior 4 weeks and UTI and no association between multiple partners and UTI. Women without UTI used a diaphragm with spermicides (DIS) 8 times more often than oral contraceptives (OCs) compared to controls. Women who had had 1 or 2 UTIs used the DIS twice as often as OCs. Cases were more likely never of rarely to urinate after intercourse than controls. Always urinating before or after intercourse tended to protect against UTI. The odds ratio (OR) among women without UTI using a D/S urinating only before was 3.4, less than the OR of 9.5 associated with constant urination habits. The OR with D/S use before and after. Vitamin C appeared to protect against UTI, and the stress scale was somewhat linked to UTI. Sexual intercourse, D/S use, and urinating after sex (among women without previous UTI incidence) were associated with UTI.

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

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

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

Predictors of vulnerability to AIDS risk behavior relapse.

Sixty-eight gay men who earlier attended AIDS prevention sessions were longitudinally followed for 16 months and categorized as successful or unsuccessful in change maintenance. Psychological and behavioral data obtained prior to entry in the prevention program were used as variables to predict long-term change. Resumption of high-risk sexual practices was associated with younger age, earlier history of frequent unprotected receptive anal intercourse with multiple partners, greater number of past sex partners, reinforcement value levels of high-risk practices and condom use, intoxication preceding sex, lower scores on a depression measure, greater belief that HIV infection is largely determined by external factors such as chance or luck, and homosexuality "outness." Discriminant analysis revealed that 86% of Ss could be classified as relapsers or change-maintainers on the basis of these variables. Prevention implications are discussed.

PIP: The longitudinal research study of 68 gay men from a Southern town in 1987 was able to successfully identify 86% of those who were likely to relapse in unprotected anal intercourse. The men were followed 16 months after receiving 12 AID's health risk reduction sessions. The mean age of the population was 32.7 years; 945 were white and 6% African-Americans or Hispanics. Multivariate discriminant analysis was used to identify the relative magnitude of each predictor variables contribution (minimum coefficient of + or - .30). Predictor variables included demographic data and sexual risk behaviors which the subject ranked by the degrees of pleasure on a 4 point scale. Also included were the role of intoxication in sexual behavior, the Beck Depression Inventory, the State Trait Anxiety Inventory, the Health Locus of Control Scale (HLOC), and the AID's Risk Behavior Knowledge Scale. Role plays involving each subject were rated by 2 judges on the overall skill in resisting coercive sexual pressures. After 16 months, 41 reported no occurrence of unprotected anal sex during the preceding 16 months and 27 reported some occurrence, of which the mean frequency was 5.9 occurrences in the preceding 4 months. The relapse population tended to be younger and more out about their homosexuality. The number of sexual partners, use of intoxicants with sex, and frequency of unprotected receptive anal intercourse were the strongest predictors. These predictors were the same for the relapsed men before the risk reduction sessions. These relapsed men also reported lower depression levels and higher scores on HLOC. Similar to cigarette smoking, resuming risk behavior was related to the strength, frequency, and reinforcement value level of past behavior. Outness may be related to frequency of sexual contact and HLOC to beliefs that luck, fate, or other determine risk. Serostatus data was not collected. The limitation of this study was that situational dimensions such as the environment, cognitive, affective, and interpersonal patterns were relevant but not included. Identification of such factors is a needed future research objective.

Sexual behavior in pregnancy among Hong Kong Chinese women.

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

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

Personality and sexuality in relation to an index of gonadal steroid hormone balance in a 70-year old population.

Relationships between an index of gonadal steroid hormone function and personality as well as sexual activity were studied in a sample representative for 70-year-olds in Gotenburg, Sweden. Personality was described by means of inventories, sexual activity through a systematic interview and the balance between androgen and oestrogen activity by the quotient between lecithin and lysolecithin in plasma. Men with a relative dominance of oestrogen activity reported a lower frequency of sexual intercourse than other men. Women with a relative dominance of oestrogen activity described themselves as more resourceful, active, confident, unconcerned with the opinion of others, and able to take care of themselves than other women. There were no associations in women between the hormonal balance and the frequency of sexual intercourse.

Irregular bleeding, body mass index and coital frequency in Norplant contraceptive users.

Seventy-five women with a mean age of 27.5 years who requested Norplant implants for contraception were studied over a five-year period. The patients kept daily diaries of their vaginal bleeding and coital frequency, and were seen at least every six months at which time their weight was measured. This study examines the impact of Norplant implants use on menstrual regularity, body mass index and coital frequency. Irregular bleeding was most prevalent during the first two years of Norplant implants use and accounted for the primary reason for discontinuation of this method. No increase in Body Mass Index (BMI) was noted in Norplant implants users over the five-year study period. Women with irregular bleeding did not have a higher or lower BMI compared to women with regular bleeding and irregular bleeding patterns did not impact on coital frequency. Over five years, four pregnancies occurred during Norplant implant use. Norplant implants are a highly effective contraceptive method and women using this method should not expect an increase in body weight. Irregular bleeding is most frequent during the first two years of use and menstrual cyclicity resumes in the majority of women by the third year of use and continues to the fifth year of use.

PIP: Medical researchers recruited 75 women to participate in a 5-year prospective study of Norplant use that examined their bleeding patterns, changes in Body Mass Index (BMI), the effect BMI had on the bleeding pattern, and the effect irregular bleeding had on coital frequency. Clinicians took a complete medical and sexual history and performed a physical and pelvic examination. Follow up visits occurred at 1, 3, 6, and 12 months after insertion of the Norplant contraceptive implant and every 6 months thereafter until removal at 5 years. The clients maintained a daily record of coital activity and bleeding/spotting patterns. Thirty women completed 5 years of Norplant use. Irregular bleeding occurred most frequently during the 1st 2 years of Norplant use. Its frequency decreased as duration of Norplant use increased. For example, 22.35% of the women experienced spotting and bleeding between menstrual periods in the 1st year, 12.25% in the 2nd year, and 3.1% at 5 years. BMI was similar for women with and without irregular bleeding patterns. BMI did not change significantly over the 5 years. Irregular bleeding did not affect coital frequency. The mean coital frequency for the women was 18-20 acts of sexual intercourse per month. Irregular bleeding (32%) and planned pregnancy (12%) were the leading reasons for discontinuation of Norplant. Most of the women who quit using Norplant for irregular bleeding reasons did so during the 1st 2 years. Just 5 pregnancies occurred during Norplant use. These results suggest that clinicians should adequately counsel potential Norplant users about irregular bleeding to reduce discontinuation for irregular bleeding.

The impact of oral contraception on vulvovaginal candidiasis.

To evaluate risk factors related to sociodemographic and clinical variables, oral contraception and sexual behavior of women with recurrent vulvovaginal candidiasis, we conducted a case-control study comparing 153 patients with recurrent vulvovaginal candidiasis with both asymptomatic women with negative vaginal cultures and patients with nonrecurrent symptomatic vulvovaginal candidiasis. In logistic regression analysis, patients with recurrent Candida vaginitis were more likely than negative controls to have used any contraceptive method in the year before evaluation, to have used antibiotics in the month preceding the visit, and to have a higher number of lifetime sex partners. Compared to patients with nonrecurrent Candida vaginitis, patients with recurrent infection were more likely to use oral contraception and to have a higher frequency of monthly intercourse. The proportion of recur rent disease attributable to the pill averages 11-12%. We conclude that oral contraceptives may influence the recurrence of symptomatic vulvovaginal candidiasis.

PIP: Researchers in Italy compared data on 153 patients with recurrent vulvovaginal candidiasis (cases) with data on 306 asymptomatic patients (control group A) and data on 306 patients with nonrecurrent symptomatic vulvovaginal candidiasis (control group B). They wanted to examine the sociodemographic and clinical characteristics, sexual habits, and contraceptive histories of women with recurrent vulvovaginal candidiasis. Cases were more likely than asymptomatic women to have previously used any contraceptive method (odds ratio [OR] = 2.08 for the pill, p = 0.0032; OR = 4.15 for the IUD, p = 0.0019; OR = 2.55 for barrier methods, p = 0.014). They were also more likely to have used antibiotics in the last month before the visit (OR = 2.1; p = 0.009) and to have more lifetime sexual partners than asymptomatic women (OR = 3.82 for 7 partners; p = 0.009). Patients with recurrent vulvovaginal candidiasis were more likely than those with nonrecurrent vulvovaginal candidiasis to have used low-dose oral contraceptives (OCs) (OR = 1.59; p = 0.036) and to have a higher rate of monthly intercourse in the last 6 months (OR = 2.51 for 10 times; p = 0.048). The attributable risk of OC use for recurrent vulvovaginal candidiasis was insignificant (11-12%). These results suggest that OCs may contribute to the recurrence of symptomatic vulvovaginal candidiasis.

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

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

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

The effect of oral medroxyprogesterone acetate and methyltestosterone on sexual functioning in a male contraceptive trial.

Twenty-three men who participated in a 15-month clinical trial to assess the potential effectiveness of using a combination of varying doses of medroxyprogesterone acetate (MPA) and methyltestosterone (MT) as a male contraceptive agent, completed a "sexual problem checklist" every two weeks. The study was divided into three phases: pre-treatment (3 months), treatment (6 months), post-treatment (6 months). The questionnaire evaluated changes in various aspects of sexual behaviour and sexual perception and explored whether the treatment influenced any of the parameters considered. The results indicated a small, but significant, decrease in subjective assessment of sexual drive. This was not, however, accompanied by a change in sexual behaviour, in that subjects experienced the same number of erections, ejaculations and frequency of intercourse. It is concluded that the combination of MPA and MT in the doses used may produce a slight decrease in subjective assessment of sexual drive, but no change in actual sexual behaviour.

A comparative study of Neo Sampoon, Ortho Vaginal Tablets and Emko Vaginal Tablets in Accra, Ghana.

Neo Sampoon is an effervescent contraceptive vaginal tablet manufactured in Japan that contains 60 mg of the spermicide menfegol. Ortho Vaginal Tablets (OVT) and Emko Vaginal Tablets (EVT), both containing 100 mg of the spermicide nonoxynol-9, were manufactured in the USA. The three products were compared in a randomized clinical trial conducted at the family planning clinics of the Korle-Bu Teaching Hospital and the Kotobaabi Polyclinic in Accra, Ghana. Three-hundred volunteers participated. At 12 months, the life-table pregnancy rates were 9.6, 11.3 and 12.5 per 100 women in the Neo Sampoon, OVT and EVT groups, respectively (p greater than 0.10). More EVT than Neo Sampoon or OVT users discontinued because of discomfort as well as for other product-related reasons (p less than 0.01). The most common reason for discontinuation was the temporary absence of sexual partner, with more than 40% of the women overall terminating for this reason. The 12-month life-table continuation rates per 100 women were higher for the Neo Sampoon group (62.4) than the OVT group (48.6) or the EVT group (38.5) (p less than 0.01). The effectiveness of the three products seems to be similar, but Neo Sampoon and OVT appear to be more acceptable than EVT in this Ghanaian population.

PIP: The effectiveness and acceptability of 3 vaginal tablets (VTs)--Neo Sampoon, Ortho (OVT) and Emko (EVT)--were compared in a clinical trial conducted at the family planning clinics of Korle-Bu Teaching Hospital and Kotobaabi Polyclinic in Accra, Ghana. Subjects included 300 sexually active women ages 18-40 years who were randomly allocated to 1 of the 3 contraceptive methods. The results suggest that, although the effectiveness of the 3 tablets is comparable, Neo Sampoon and OVT are more acceptable than EVT. EVT acceptors reported poorer product compliance, more method-related complaints, and a higher rate of discontinuation. The proportion of women reporting 1 or more method-related complaints (e.g., burning or stinging) during the 1-year study period was 8.9% among Neo Sampoon acceptors, 11.5% among women in the OVT group, and 32.6% among subjects in the EVT group. However, the prevalence of these complaints, and that of increased vaginal discharge, diminished with time in all 3 study groups. Within 12 months, there had been 33 discontinuations in the Neo Sampoon group, 47 among OVT acceptors, and 57 in the EVT group. Over 40% of these discontinuations were a result of temporary absence of the sexual partner, and another 19% reflected non-method-related reasons such as desiring a pregnancy. On the other hand, discontinuation for discomfort or product-related reasons was significantly higher among EVT acceptors compared to Neo Sampoon and OVT acceptors. There were 7 unplanned pregnancies in the Neo Sampoon group (12 month cumulative pregnancy rate 9.6/100), 8 in OVT group (11.3/100), and 9 among EVT acceptors (12.5/100). 9 (38%) of the 24 pregnancies occurred in the 1st month of tablet use and only 1 pregnancy occurred 6 months or more after admission, suggesting that lack of familiarity contributed to method failure. 12-month continuation rates were significantly higher among Neo Sampoon acceptors (62.4/100) than among OVT (48.6/100) or EVT (38.5/100) acceptors.

Characteristics of women undergoing induced abortion: results of a case-control study from Northern Italy.

In order to identify subgroups of women at elevated risk of induced abortion, personal characteristics and habits, selected medical histories and contraceptive practices of 873 women undergoing legal abortion in various areas of Northern Italy were compared with those of 504 control subjects identified in family planning clinics of the same hospitals or area health authorities. When age was allowed for, the risk of induced abortion was not strongly influenced by marital status, education or other indicators of social class. However, women who were employed, independently from the type of occupation, showed markedly lower abortion risks than housewives. Among various indicators of sexual habits investigated, the strongest determinant of legal abortion was the frequency of sexual intercourses over the previous six months, women with less frequent intercourses showing a markedly elevated risk estimate (RR = 2.82). Induced abortion was less frequent among ex-smokers and more frequent in heavy smokers, but was not appreciably influenced by several other indicators of lifestyle habits and history of gynaecological or psychiatric complaints. The risk of abortion was not influenced by the number of livebirths, but was lower for women with later age at first birth. Less than 5% of case and control subjects reported more than two previous induced abortions, thus indicating that abortion is more of an "accidental" event rather than a widespread contraceptive practice. However, over three-quarters of abortions occurred in women reporting no contraception at all or coitus interruptus, thus underlining the scope for family planning education in this population.