contraceptives--postcoital and Infections

Following the development of hormonal interception after coitus the post-coital insertion of an intrauterine contraceptive device was proposed by Tatum . The advantage of this treatment is the avoidance of the ingestion of large doses of estrogen which causes much nausea and vomiting although it is a very effective post-coital method of contraception. The recently proposed alternative administration of 200 micrograms Ethynol Estradiol combined with 2 mg of DL norgesterol in 2 equal doses at 12 hour intervals has the same disadvantage of a high percentage of side effects. The post-coital insertion of an intrauterine contraceptive device is the first method which is effective up to five days following unprotected intercourse which is three days longer than treatment by estrogen. In addition the method can be offered to women who would want to continue to wear the intrauterine contraceptive device for long term contraception. The disadvantage of the post-coital insertion of an intrauterine contraceptive device is the ability of serious complications if the patient has a vaginal or venereal infection or an asymptomatic cervicitis or salpingitis. Following appropriate physical examination women who present themselves for post-coital treatment are selected. Cases of rape are usually not suitable for treatment with intrauterine contraceptives devices. However, when cases of rape are seen early enough the appropriate investigations may be done and the treatment with the intrauterine device started within five days. The potential risk of future infertility must be considered since salpingitis is 7 times more common in nulliparous wearers of intrauterine devices than in nulliparous non-wearers. Young sexually active nulliparous women especially of lower socio economic background are patients with a high risk. Over 70% of the women who present themselves for interception treatment are nulliparous.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Coitus; Contraception; Contraceptives, Postcoital; Female; Humans; Infections; Infertility, Female; Intrauterine Devices, Copper; Pregnancy; Pregnancy, Ectopic; Risk; Time Factors

The experience of the Utrecht State University with postcoital estrogens in high and low combined doses and with postcoital placement of IUDs since 1964 with over 4000 patients is summarized. The high dose postcoital estrogen treatment consists of 5 mg ethinyl estradiol for 5 days, either orally, or in case of vomiting not controlled by an antiemetic, estradiol benzoate 30 mg by injection. Side effects recorded in 3016 women were nausea in 54%, vomiting in 24%, tender breasts in 23%, menorrhagia in 11%, altered cycle length in 24%. Complications were 1 case of non-fatal pulmonary edema and 1 case of an 8 kg weight gain during treatment. There were 3 pregnancies. The overall failure rate in the whole series was 0.15%, with 10% ectopic pregnancies. There were no thromboembolisms or teratogenic effects. The combined estrogen treatment consisted of 50 mc ethinyl estradiol with 250 mc levonorgestrel (Neogynon oral contraceptive), 2 pills followed by 2 pills 12 hours later. A double-blind randomized trial resulted in no significant differences in pregnancy rates or side effects between the high and low dose regimens. The alternate treatment, if the woman presents more than 72 hours after intercourse, or if estrogens are contraindicated, is postcoital insertion of an IUD. The Dept. of Obstetrics and Gynecology does not place an IUD in a woman with infection nor in case of rape unless there is time for a complete work-up. Nulliparas are informed of the increased risk of pelvic inflammatory disease. Recently, the Multiload-copper 250 and later ML 375 were used exclusively, to achieve better blastocidal effect and lower expulsion rates. The ethical debate over use of postcoital methods centers around the morality of "procuring a miscarriage," but this argument is not relevant since these methods will not terminate a pregnancy once implantation has occurred. In the Netherlands, 25% of all abortion clients become pregnant during their 1st intercourse. In 1982, 35,000 postcoital contraceptives were administered, (roughly 16% of all pregnancies), compared to 15,000 abortions (7% of pregnancies; a total of 23% of pregnancies terminated). Compare these figures with 29% unwanted pregnancies all terminated by abortion in Sweden in that year. The postcoital methods are cheap, effective, and invaluable in emergency cases of rape, incest, intoxication, failure of barrier contraceptives, or unwanted pregnancy in women fearful or opposed to abortion.

Topics: Biology; Birth Rate; Breast; Contraception; Contraception Behavior; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Demography; Developed Countries; Digestive System; Disease; Embryo Implantation; Embryonic Development; Endocrine System; Ethics; Ethinyl Estradiol; Europe; Family Planning Services; Fertility; Hormones; Infections; Intrauterine Devices; Intrauterine Devices, Copper; Levonorgestrel; Menstruation Disturbances; Nausea; Netherlands; Parity; Pelvic Inflammatory Disease; Physiology; Population; Population Dynamics; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Pregnancy, Ectopic; Reproduction; Signs and Symptoms; Vomiting

If used correctly, only 2 out of every 100 women using a diaphragm would conceive over a year; however, because of forgetfulness the figure increases to 19 out of every 100. With good care they can last up to 12 years. The contraceptive sponge works because of the sperm-killing ingredients in the spermicide and because it blocks the cervix. The condom may also provide some protection against a variety of sexually transmitted diseases (STDs), such as herpes and gonorrhea. Missing one day of a low-dose oral contraceptive formulation (35 mcg) will have no consequences since the pill works by keeping hormone levels in the body elevated over time. With IUDs the only potential pitfall is forgetting to check for the tail every week of the first month and once a month thereafter to be sure the IUD is still in place. Some physicians suggest using a second form of contraception for the first three months after an IUD is inserted, since the odds are slightly higher it will be dislodged during this time. The manufacturers of Cu-7's and Cu-T's, as well as most physicians, recommend replacement of this device every three years. Experts are in agreement, however, that copper-containing IUDs carry a slightly lower risk of infection than Progestasert and the Lippes Loop. For postcoital contraception douching or using a spermicide within 10 minutes may help a bit. Although an IUD insertion can prevent pregnancy 90-95% of the time if it is done within five days of unprotected intercourse, because of the infection risk, this is not recommended unless a woman is planning on leaving the device in place as a contraceptive. The morning-after pill also works by preventing implantation of the fertilized egg. Taking two within 24 hours and two more 12 hours later prevents pregnancy 90-95% of the time, possibly with mild nausea or headache.

Topics: Condoms; Contraception; Contraceptive Agents; Contraceptive Devices, Female; Contraceptives, Oral; Contraceptives, Postcoital; Disease; Family Planning Services; HIV Infections; Infections; Intrauterine Devices; Sexually Transmitted Diseases; Spermatocidal Agents; Virus Diseases

Topics: Abortion, Legal; Contraceptives, Postcoital; England; Female; Humans; Infections; Intraoperative Complications; Menstruation Disturbances; Postoperative Complications; Pregnancy; Pregnancy, Ectopic; Progestins; Prostaglandins; Rh-Hr Blood-Group System; Sterilization, Reproductive; Uterine Hemorrhage; Uterus; Vacuum Extraction, Obstetrical; Wales

Menstrual regulation as a contraceptive method, as well as a form of early pregnancy termination, was studied in 200 patients presenting at the All India Institute of Medical Sciences Hospital for pregnancy termination. Findings supported the contention that menstrual regulation is a simple, safe, and effective procedure. Recommendations were made to incorporate the procedure into family planning services. Women were deemed eligible for the menstrual regulation study if no more than 45 days had elapsed since their last menstrual cycle and if their medical history did not contraindicate the use of the procedure. The women were given a pregnancy test prior to aspiration. The menstrual regulation procedure was performed with an electric vaccum aspirator and the patients received no anesthetic. Following the procedure the aspirate was histologically examined for pregnancy determination. Four weeks later the patients were given a pelvic examination and a urine pregnancy test. Histological examination of the aspirate confirmed pregnancy in 80.5% of the patients. When the findings were compared to the preoperative pregnancy test results, 2.5% of the pregnancy tests were false positives and 4% were false negatives. No severe complications occurred at the time of the procedure an only 2% of the patients required additional curettage. In the 4 week follow-up examination, 10% of the patients reported minor symptoms, 3% reported minor infections, and all pregnancy tests were negative. Following the procedure, 20% of the patients accepted IUDs, 15% accepted horomonal contraceptives, and the remaining 65% opted for conventional methods. Tables show 1) age distribution of patients; 2) distribution of patients by gestation and amount of aspirate; 3) accuracy of pregnancy test compared to histological findings; 4) frequency of histological findings; 5) reported follow-up symptoms for those patients who accepted IUDs and those who did not accept IUDs immediately after menstrual regulation.

Topics: Asia; Asia, Southeastern; Contraceptives, Postcoital; Developing Countries; Disease; Family Planning Services; Follow-Up Studies; General Surgery; Gynecologic Surgical Procedures; Health Planning; Histology; India; Infections; Intrauterine Devices; Menstruation; Pain; Patient Acceptance of Health Care; Pelvic Inflammatory Disease; Postoperative Care; Pregnancy; Pregnancy Tests; Pregnancy Trimester, First; Preoperative Care; Reproduction; Research; Signs and Symptoms; Therapeutics; Women

The current status of and prospects for contraceptive methods is reviewed. Regulations governing the development, safety, and effectiveness of contraceptive methods are discussed, as well as the nature of the female and male reproductive system. Methods reviewed include coitus interruptus, the condom, spermicidal contraceptive agents, postcoital douching, the vaginal diaphragm, male and female sterilization, the rhythm method, oral contraceptives, IUDs, induced abortion, progesterone-releasing IUDs, postcoital estrogens, abortifacient agents (prostaglandins), immunization against human chorionic gonadotropin (HCG), pharmacologic suppression of the corpus luteum, long-acting injections of Depo-Provera, implantation of capsules containing norgestrel, the intravaginal ring, intracervical devices, release of contraceptive steroids through an arm bracelet, and male contraceptive agents. New areas of contraceptive research include influencing the release of luteininzing hormone-releasing hormone, ''turning-off'' corpus luteum function in early pregnancy by competitors for HCG, affecting sperm or ovarian membranes to prevent fertilization, and interferring with sperm and egg development.

Topics: Abortifacient Agents; Abortion, Induced; Biology; Blood; Blood Coagulation; Chorionic Gonadotropin; Coitus Interruptus; Condoms; Contraception; Contraception, Immunologic; Contraceptive Agents; Contraceptive Agents, Female; Contraceptive Agents, Male; Contraceptive Devices, Female; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Corpus Luteum; Culdoscopy; Curettage; Diagnosis; Diethylstilbestrol; Disease; Economics; Electrocoagulation; Endocrine System; Endoscopy; Estrogens; Family Planning Services; Fertilization; General Surgery; Genitalia; Genitalia, Female; Germ Cells; Gonadotropins; Gonadotropins, Pituitary; Hormones; Infections; Intrauterine Devices; Intrauterine Devices, Copper; Intrauterine Devices, Medicated; Laparoscopy; Laparotomy; Luteinizing Hormone; Membrane Proteins; Menstruation; Menstruation Disturbances; Natural Family Planning Methods; Norgestrel; Obstetric Surgical Procedures; Ovary; Ovum; Pelvic Inflammatory Disease; Physical Examination; Physiology; Pituitary Hormone-Releasing Hormones; Prostaglandins; Reproduction; Research; Spermatocidal Agents; Spermatozoa; Sterilization, Reproductive; Sterilization, Tubal; Technology; Therapeutics; Urogenital System; Vacuum Curettage; Vasectomy

122 patients with histologically confirmed squamous cell carcinoma of the cervix admitted to the gynecological wards of Charity Hospital in New Orleans from July 1, 1959, through March 31, 1960, were studied; suitable controls were selected from the same wards. All interviews were conducted by the same interviewer nurse who was unaware of the diagnoses. Hospital charts were later examined. Educational level of patients, occupation of husband and father, residence, original diagnosis, and religion were similar to those of controls. Less than 1/3 had more than grammar school education. Most husbands and fathers were farmers of unskilled laborers. In only 1/5 of the patients had the original cancer diagnosis been made by private physicians or at noncharity hospitals. About 45% were Catholics, 45% Baptists, and the remaining 10% other Protestant denominations. 49% of the patients and 43% of the controls reported 6 or more pregnancies. Douching practices were similar to controls; few had ever used other contraceptive measures. 13 patients and 6 controls had positive serological tests for syphilis. Only 6, 1 patient and 5 controls, had never been married. Of cancer patients, 47% had been married more than once vs. 16% of controls. 34% of the patients with cancer were married before the age of 17 vs. 14% of controls. 54% of patients with cancer and 26% of controls reported extramarital partners. 53% of patients had 1st coitus before age 17 vs. 26% of the controls. There was a considerably higher frequency of coitus in patients than in controls. It is concluded that no relation between number of pregnancies and cancer was shown. Douching with coal tar derivatives was not a factor. The association of carcinoma and syphilis was not certain as many had never had a serological test. The effect of circumcision of partners was not determined as it was often unknown. A significant association was shown with early marriage, extramarital relations, coitus at an early age, and frequent coitus at all ages.

Topics: Age Factors; Behavior; Birth Rate; Coitus; Contraception; Contraception Behavior; Contraceptives, Postcoital; Demography; Disease; Education; Epidemiologic Methods; Family Planning Services; Fertility; Infections; Marital Status; Marriage; Neoplasms; Parity; Population; Population Characteristics; Population Dynamics; Religion; Reproduction; Research; Sexual Behavior; Sexually Transmitted Diseases; Social Class; Uterine Cervical Neoplasms