Treatment of diminished sexual response associated with the use of oral contraceptives (author's transl)]

Loss of libido associated with the use of oral contraceptives has been studied in 113 women of reproductive age who had taken a combined pill for periods ranging from 1 to 3 years. The patients were divided in four groups. In the first group (I) of 24 women oral contraceptive treatment was discontinued and all women received in intra-uterine contraceptive device (IUCD). The second group (II) of 36 patients, the brand of oral contraceptive was changed. Women in group (III) had their oral contraceptive maintained receiving in addition a mixture of an androgen and an estrogen (methyltestosterone 4 mg and ethynilestradiol 0.002 mg) daily. To women of group (IV) the oral contraceptive was discontinued but the androgen-estrogen mixture was given. All women in this group received an IUCD. Evaluation of the psyco-sexual parameters included changes in libido, time to reach an orgasm, duration and intensity or orgasms. Frequency of intercourse and response to autostimulation was also investigated. Libido was restored in 94.2% of patients in group II, in 97.3% of group III and in 92.8% of group IV. In group I only 55.6% of patients had libido fully restored. In view of the prompt restoration of libido in all groups except in patients discontinuing oral contraceptive therapy, it is suggested that loss of libido in oral contraceptive users has an important physological component which can be overcome probably by psychotherapy. Short term treatment with a mixture of methyltestosterone and ethynilestradiol seems to be highly effective in restoring libido in all patients.     

Factors associated with uptake of post-abortion family planning in Shire town,Tigray, Ethiopia

Objectives

Post-abortion contraceptive service is pivotal for the prevention of unwanted pregnancy and alleviation of its complication. Worldwide half of the pregnancy is unplanned, whereas unwanted pregnancy ends up with abortion. This study assessed post-abortion contraceptive uptake and associated factors among abortion service users at health institution in Shire town, North Ethiopia. Institutional based cross-sectional study was conducted from December 15/2016 to March 15, 2017, in Shire town. Data were collected using systematic random sampling technique. Bivariate and multivariable analyses were done to determine the association of each independent variable with the dependent variable.

Results

Overall post-abortion contraceptive utilization in this study was 61.5%. Married [AOR 2.59, 95% CI (1.16, 5.65)], completed College education [AOR 5.69, 95% CI (1.61, 20.11)], previous contraceptive used [AOR 3.62, 95% CI (1.77, 7.40)], counseling of family planning [AOR 3.53 95% CI (1.69, 7.37)], grand multipara [AOR 7.91, 95% CI (1.66, 37.74)] and public health institution [AOR 5.95, 95% CI (3.03, 11.72)] were significantly associated with the post-abortion contraceptive utilization. In this study, post-abortion contraceptive utilization was about two-third. Being married, had been completing a college education, had been receiving family planning counseling, previous contraceptive usage, abortion care service at public health institution, and being grand multiparty were determinants of post-abortion contraceptive utilization.

     

Effective suppression of ovarian cyclicity in the lowland gorilla with an oral contraceptive

To determine the effects of a human oral contraceptive on normal and abnormal reproductive endocrine patterns in two lowland gorillas (Gorilla gorilla), daily urine samples were analyzed by radioimmunoassay for estrone conjugates (EC) and pregnanediol-3-glucuronide (PdG). During a pre-treatment period one female (F1) demonstrated regular menstrual cycles averaging 27.6 ± 1.8 days, whereas ovarian cyclicity in female 2 (F2) was consistently prolonged, ranging from 37–51 days. A 56 day regimen of an oral contraceptive (Demulen 50®) was administered to both females beginning in the late luteal phase, and within 6 and 7 days of treatment onset (F1 and F2, respectively) urinary EC and PdG declined to and remained at concentrations consistent with amenorrhea throughout the administration period. Ten and twenty days after contraceptive withdrawal (F1 and F2, respectively) an EC peak was observed with subsequent PdG elevations 1–2 days later. Mean cycle length and luteal phase durations were not different (P > 0.05) before or after treatment for either female, while combined peak PdG concentrations were greater (P < 0.05) for the first 3 months after treatment compared to pre-treatment values. These results indicate that a human oral contraceptive rapidly suppresses ovarian activity in female lowland gorillas, but that the abnormal endocrine pattern observed in F2 could not be redirected into a normal profile after contraceptive withdrawal. © 1992 Wiley-Liss Inc.     

Intrauterine Contraception with the Copper 7: Evaluation after Two Years

From 1,156 insertions of the copper 7 contraceptive device with 15,044 women-months of use we conclude that it offers advantages in intrauterine contraception. Continuity is improved for all users. It is a useful method for those who have not been pregnant and as an exchange device for patients having problems with other intrauterine devices or contraceptive methods. These advantages must be set against the necessity of replacing the copper 7 after a limited life span. In no cases in our series did cervical cytological examination show anything abnormal, and a 98·1% follow-up was achieved.     

Non-cross-reactivity of antibodies to murine LDH-C4 with LDH-A4 and LDH-B4

The induction of infertility by immunization with the sperm-specific lactate dehydrogenase, LDH-C4, suggests its use in a contraceptive vaccine. Development of an immunological contraceptive for human use, however, requires that there be no cross-reactions with somatic tissues. We have demonstrated, using enzyme-linked immunoabsorbence, solid-phase radioimmunoassay, and competitive inhibition radioimmunoassay, that antisera to LDH-C4 is specific and does not cross-react with the somatic isozymes, LDH-A4 and LDH-B4.     

Abortion as a backup method for contraceptive failure in China

Contraceptive failure rates for modern methods including sterilization are reported to be high in China, but little is known about the consequence of contraceptive failure and characteristics of women who decide to have an abortion if a contraceptive failure occurs. Using 6225 contraceptive failures from the 1988 Chinese Two-per-Thousand Fertility Survey, this study examines the resolution of contraceptive failure and assesses the impact of some women's sociodemographic characteristics on the decision to terminate contraceptive failure in abortion. This study has three important findings: (1) The abortion rate was 50.1%, 75.3% and 80.2% for IUD, condom and pill failures, respectively; (2) The abortion rates differed by contraceptive method and women's social and demographic characteristics. In particular, a woman with just one child was most likely to have the contraceptive failure aborted; (3) Some women experienced repeated abortions because of contraceptive failure. The results suggest that abortion was a backup method if contraception failed in China and the correlates of aborting an unwanted pregnancy reflect the strong impact of the Chinese family planning programme.     

Use of Medroxyprogesterone Acetate as a Contraceptive in conjunction with Early Postpartum Rubella Vaccination

During a 12-month period 170 women received early postpartum rubella vaccination. An injectable “depot” progestogen was given to each of these patients for contraceptive purposes at the same time as the vaccine was administered. Subsequent observations showed that the progestogen was effective as a contraceptive in this context and that it did not appear to affect the immune response of the patients to the vaccine.     

Effect of contraceptives on the prevalence of vaginal colonization with Candida species in Edo State, Nigeria

High vaginal swabs (HVS) obtained from 500 volunteers in Edo State, Nigeria which comprised 394 contraceptive users and 106 non-contraceptive users were screened for the prevalence of Candida species using standard procedures. Results revealed the isolation of Candida species in 246 of volunteers. These included Candida albicans 174 (38.4%), Candida pseudotropicalis 20 (4%), Candida stellatoidea 15 (3%), Candida krusei nine (1.8%), Candida guilliermondii 12 (2.4%), Candida tropicalis 11 (2.2%) and Candida glabrata five (1%). Of the 394 contraceptive users, 203 (51.5%) had Candida species isolated from them compared to 43 (40.6%) from 106 non-contraceptive users. There was significant relationship (P<0.001) between the type of contraceptive used and the prevalence of vaginal colonization. Age and marital status of the volunteers sampled had significant relationship (P<0.001) with the prevalence of vaginal colonization. Results have revealed an association between use of contraceptive and the prevalence of vaginal colonization in our environment.     

Clinical pharmacology studies with Centchroman.

A pharmacological evaluation of centchroman (3,4-trans-2,2,dimethyl-3-phenyl-4-p-(beta-pyrrolidino ethoxy)-phenyl-7-methoxychroman), a new postcoital contraceptive, in normal healthy human volunteers was performed to determine the maximum tolerated dose and to discover any abnormal toxic effects in humans. The study was carried out for both men and women as a double-blind noncrossover trial in 2 parts: 1) a single dose study (40 volunteers) and 2) a multiple dose study (28 females) for 30 days. Centchroman was well tolerated without significant side effects in single doses up to 320 mg, severalfold higher than the anticipated therapeutic dose. In the multiple dose schedule, the compound was found safe at doses of 60-120 mg/day. however, similar effects were observed in subjects receiving placebo and are not unexpected in a normal population over a 1-month period. Centchroman is presently undergoing clinical trials for postcoital contraceptive efficacy in humans.     

Son preference in Bangladesh: an emerging barrier to fertility regulation

This study investigates the effect of son preference on contraceptive use and desire for additional children using national level survey data from Bangladesh for the years 1969 and 1979. National probability samples of ever married women between the ages of 10 and 50 were selected and stratified by urban-rural residence. Specifically, the study focuses on contraceptive use and desire for additional children and separates the effect of sex preference from that of high parity on fertility control. Son preference has a negative effect on contraceptive use and a positive effect on the desire for additional children regardless of socioeconomic and demographic characteristics. This advese effect of son preference on fertility regulation seemed to have persisted over the years. Relevent socioeconomic conditions in Bangladesh are described. In 1979, the effect of sex composition on contraceptive use or desire for additional children varied by parity. The negative effect of fewer living sons on contraceptive use and its positive effect on desire for additional children was higher in parities between 2 and 4 than in other parities. The effect of sex composition was stronger on desire for additional children than on contraceptive usage. In 1969, however, there was no consistent positive relationship between sex composition and contraceptive use. The relationship between sex composition and desire for more children was positive. Among women of parities 2 to 4, an excess of daughters continued to have a major positive effect on desire for additional children, and a negative effect on contraceptive use, after controlling for other sociodemographic variables. For parities 1 and 5 or above, the effect was either weak or inconsistent.     

Use of the oral contraceptive pill by Austrian adolescents with emphasis on the age of onset,side effects,compliance and lifestyle

The present study investigated the use of the oral contraceptive pill in 880 Austrian high school girls. All participants filled in a questionnaire on lifestyle and menarche. Furthermore, subjects on the pill were asked about their preparation, age at first use, reasons why they take it, side effects and oral contraceptive compliance. All 139 subjects on the pill used low dose monophasic preparations. The girls started the pill at a mean age of 16.0 +/- 0.9 years for contraceptive and therapeutic reasons. The most commonly noted side effects were weight gain, an increase in breast size, fatigue and depression. The results also indicate that most users comply sufficiently. Regarding lifestyle, it can be stated that there is a correlation between the use of the pill and smoking, the frequency of consuming alcoholic drinks and being physically active.     

Contraception use and associations with intimate partner violence among women in Bangladesh

This study examines the association between contraception use and intimate partner violence (IPV) among women of reproductive age in Bangladesh. The observational study of 10,996 women used the chi-squared test and logistic regressions to assess the associations. Almost 80% of all respondents had used contraceptives at some point in their lives. About half of the respondents (48%) were victims of physical violence, while 11% experienced sexual abuse from their husbands. Urban residents, higher educated women and women aged 20-44 were more likely to use contraceptives than their peers in rural areas, those with lower education and those in their late forties (45-49 years). Women exposed to physical violence were almost two times (OR 1.93, CI 1.55-2.41) more likely to use contraceptives compared with their non-abused peers. Sexual abuse had no significant association with contraceptive use. Physical violence is a predictor for higher levels of contraceptive use among women in Bangladesh. The findings emphasize the importance of screening for IPV at health care centres. The differences in urban and rural contraceptive use and IPV exposure identified by the study have policy implications for service delivery and planning.     

The Role of Quality Health Services and Discussion about Birth Spacing in Postpartum Contraceptive Use in Sindh,Pakistan: A Multilevel Analysis

IntroductionRapid population growth, stagnant contraceptive prevalence, and high unmet need for family planning present significant challenges for meeting Pakistan’s national and international development goals. Although health behaviors are shaped by multiple social and environmental factors, research on contraceptive uptake in Pakistan has focused on individual and household determinants, and little attention has been given to community characteristics that may affect access to services and reproductive behavior.MethodsIndividual and community determinants of contraceptive use were identified using multivariable multilevel logistic regression to analyze data from a 2014 cross-sectional survey of 6,200 mothers in 503 communities in Sindh, Pakistan.ResultsOnly 27% of women who had given birth in the two years before the study reported using contraceptives. After adjusting for individual and community characteristics, there was no difference in the odds of contraceptive use between urban and rural women. Women who had delivered at a health facility had 1.4 times higher odds of contraceptive use than women who delivered at home. Those who received information about birth spacing from a doctor or relatives/friends had 1.81 and 1.38 times higher odds of contraceptive use, respectively, than those who did not. Living in a community where a higher proportion of women received quality antenatal care and where discussion of birth spacing was more common was significantly associated with contraceptive use. Community-wide poverty lowered contraceptive use.ConclusionsQuality of care at the community level has strong effects on contraceptive use, independent of the characteristics of individual households or women. These findings suggest that powerful gains in contraceptive use may be realized by improving the quality of antenatal care in Pakistan. Community health workers should focus on generating discussion of birth spacing in the community. Outreach efforts should target communities where the demand for contraception appears to be depressed due to high levels of poverty.     

Contraception with progestogens and progesterone during lactation

The growth and development of breastfed infants whose mothers used the contraceptive implants Norplant® containing levonorgestrel and the injectable containing norethisterone enanthate were studied. Each group comprised of 120 women who initiated the use during the 5th to 7th week postpartum and were compared with a similar number of IUD using mothers. The breastfeeding performance did not differ between groups. The infants of the three groups performed similarly as regards their physical growth and health as well as the time of acquisition of the various milestones of psychomental development. A vaginal ring releasing 10 mg of the “natural” progesterone per 24 h was tested in breastfeeding mothers. The continuous use of the ring produced a serum level of progesterone around 4 ng/ml. This was effective in augmenting lactational infertility even through the later phases of breastfeeding when such an effect starts to wane off. The use of the ring proved to be acceptable and had no ill-effect on breastfeeding or infant growth or health. Using the natural progesterone as a contraceptive adds a new measure of safety, since the amount of the steroid secreted in the mother's milk will not be effectively absorbed from the infant's gut. These studies suggest the possibility of using two new methods for breastfeeding mothers; Norplant and the progesterone vaginal contraceptive ring. These can be initiated early postpartum, whenever this is considered needed.     

Male contraception: expanding reproductive choice

The development of steroid-based oral contraceptives had revolutionized the availability of contraceptive choice for women. In order to expand the contraceptive options for couples by developing an acceptable, safe and effective male contraceptive, scientists have been experimenting with various steroidal/non-steroidal regimens to suppress testicular sperm production. The non-availability of a long-acting androgen was a limiting factor in the development of a male contraceptive regimen since all currently tested anti-spermatogenic agents also concurrently decrease circulating testosterone levels. A combination regimen of long-acting progestogen and androgen would have advantage over an androgen-alone modality since the dose of androgen required would be much smaller in the combination regimen, thereby decreasing the adverse effects of high steroid load. The progestogen in the combination regimen would act as the primary anti-spermatogenic agent. Currently, a number of combination regimens using progestogen or GnRH analogues combined with androgen are undergoing trials. The side effects of long-term use of androgens and progestogens have also undergone evaluation in primate models and the results of these studies need to be kept in view, while considering steroidal regimens for contraceptive use in men. Efforts are also being made to popularize non-scalpel vasectomy and to develop condoms of greater acceptability. The development of contraceptive vaccines for men, using sperm surface epitopes not expressed in female reproductive tract as source, still requires considerable research efforts.     

Delivering non-hormonal contraceptives to men: advances and obstacles

There have been major advances in male contraceptive research during the past two decades. However, for a contraceptive to be used by men, its safety requires more stringent scrutiny than therapeutic compounds for treatment of illnesses because the contraceptives will be used by healthy individuals for an extended period of time, perhaps decades. A wide margin is therefore required between the effective dose range and doses that cause toxicity. It might be preferable that a male contraceptive, in particular a non-hormone-based compound, is delivered specifically and/or directly to the testis and has a rapid metabolic clearance rate, reducing the length of exposure in the liver and kidney. In this article, we highlight the latest developments regarding contraceptive delivery to men and with the aim of providing useful information for investigators in future studies.     

Sequence of events following adoption of contraception: An exploratory analysis of 1973 fertility history data

Abstract

Fertility histories from the 1973 United States National Survey of Family Growth are analyzed in the context of a model of contraceptive use based on a Semi‐Markov processes. This model provides a means of constructing data‐based estimates of probabilities of pregnancy following initial acceptance of a contraceptive method. The algorithm used to construct these estimates recognizes multiple intervals of contraceptive used prior to the events: pregnancy, marital dissolution, or sterilization.

Estimated probabilities of the events marital dissolution and pregnancy for women seeking to delay pregnancy are presented, as are probabilities of contraceptive sterilization for women seeking to prevent subsequent pregnancy. These estimates are compared to one‐step transition probabilities and directly observed NSFG data on pregnancy, marital dissolution, or contraceptive sterilization in an attempt to judge the validity of the model and to assess biases which may result from its use.     

Effects of Progestogen Oral Contraception with Norethisterone on Blood Clotting and Platelets

The effects on clotting tests and platelet function of six months'' continuous administration of the 19-norsteroid, progestogen-only contraceptive, norethisterone, have been studied in four groups of women. In a group of women who have not previously taken oral contraceptive no acceleration of clotting or platelet factors was found, but in contrast a tendency to reduced coagulability was observed. Women who had previously been taking combined oestrogen-progestogen preparations showed reduced clotting and platelet parameters when norethisterone was substituted. No changes in clotting or platelets were found in women who changed from 17-acetoxysteroid progestogen chloramadinone acetate or in a group of women started postpartum.     

口服避孕药对中国女性乳腺癌发病风险影响的Meta分析

目的：评价口服避孕药对中国女性乳腺癌发病率的影响。方法：计算机及手动检索中国知网,万方,维普,中国生物医学文献数据库,纳入有关口服避孕药对乳腺癌发病影响的研究。在评价纳入研究的方法学质量和提取有效数据后,采用ReviewManager5．0进行Meta分析。结果：共纳入19篇病例对照研究,包括例5051患者和6023例对照。Meta分析结果显示：乳腺癌病例组比对照组有着较高的口服避孕药暴露比。结论：口服避孕药可能会增加中国女性乳腺癌的发病风险。     

Contraceptive use patterns in Matlab, Bangladesh: insights from a 1984 survey

An experimental maternal and child health and family planning programme has been in existence in Matlab for almost 10 years. During this time the project has achieved remarkable success in the area of family planning. Based upon a 1984 survey, this study examines the pattern of contraceptive use in the Matlab treatment area, and contrasts it with the regular government programme in the neighbouring comparison area. Important differences between the two areas are observed, with the treatment area characterized by substantially higher levels of current contraceptive use, greater reliance upon temporary methods for birth spacing and, among acceptors of sterilization, more prior experimentation with other methods. In the comparison area lower rates of contraceptive use are observed, with heavy reliance upon tubectomy for limiting family size. The findings suggest that an intensive and innovative family planning programme in rural Bangladesh can achieve success not only in terms of contraceptive prevalence, but can also attract users interested in child spacing and others wanting to limit their family size, by offering the widest range of contraceptive methods.