contraceptives--postcoital and Sexually-Transmitted-Diseases

We conducted a systematic review of peer-reviewed literature on youth access to, use of and quality of care of sexual and reproductive health (SRH) commodities through pharmacies.. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, we searched for publications from 2000 to 2016. To be eligible for inclusion, articles had to address the experiences of young people (aged 25 years and below) accessing SRH commodities (e.g., contraception, abortifacients) via pharmacies. The heterogeneity of the studies precluded meta-analysis - instead, we conducted thematic analysis.. A total of 2842 titles were screened, and 49 met the inclusion criteria. Most (n=43) were from high-income countries, and 33 examined emergency hormonal contraception provision. Seventeen focused on experiences of pharmacy personnel in provision, while 28 assessed client experiences. Pharmacy provision of SRH commodities was appealing to and utilized by youth. Increasing access to SRH commodities for youth did not correspond to increases in risky sexual behavior. Both pharmacists and youth had reservations about the ease of access and its impact on sexual behaviors. In settings where regulations allowing pharmacy access were established, some pharmacy personnel created barriers to access or refused access entirely.. With training and support, pharmacy personnel can serve as critical SRH resources to young people. Further research is needed to better understand how to capitalize on the potential of pharmacy provision of SRH commodities to young people without sacrificing qualities which make pharmacies so appealing to young people in the first place.

Topics: Abortifacient Agents; Adolescent; Attitude of Health Personnel; Contraceptive Agents; Contraceptives, Postcoital; Female; Health Services Accessibility; Humans; Male; Pharmacies; Reagent Kits, Diagnostic; Reproductive Health; Sexually Transmitted Diseases; Young Adult

Emergency contraception can prevent pregnancy when taken after unprotected intercourse. Obtaining emergency contraception within the recommended time frame is difficult for many women. Advance provision, in which women receive a supply of emergency contraception before unprotected sex, could circumvent some obstacles to timely use.. To summarize randomized controlled trials evaluating advance provision of emergency contraception to explore effects on pregnancy rates, sexually transmitted infections, and sexual and contraceptive behaviors.. In August 2006, we searched CENTRAL, EMBASE, POPLINE, MEDLINE via PubMed, and a specialized emergency contraception article database. We also searched reference lists and contacted experts to identify additional published or unpublished trials.. We included randomized controlled trials comparing advance provision and standard access, which was defined as any of the following: counseling which may or may not have included information about emergency contraception, or provision of emergency contraception on request at a clinic or pharmacy.. We evaluated all identified titles and abstracts found for potential inclusion. Two reviewers independently abstracted data and assessed study quality. We entered and analyzed data using RevMan 4.2.8. We calculated odds ratios with 95% confidence intervals for dichotomous data and weighted mean differences with 95% confidence intervals for continuous data.. Eight randomized controlled trials met our criteria for inclusion, representing 6389 patients in the United States, China and India. Advance provision did not decrease pregnancy rates (OR 1.0; 95% CI: 0.78 to 1.29 in studies for which we included twelve month follow-up data; OR 0.91; 95% CI: 0.69 to 1.19 in studies for which we included six month follow-up data; OR 0.49; 95% CI: 0.09 to 2.74 in a study with three month follow up data), despite increased use (single use: OR 2.52; 95% CI 1.72 to 3.70; multiple use: OR 4.13; 95% CI 1.77 to 9.63) and faster use (weighted mean difference (WMD) -14.6 hours; 95% CI -16.77 to -12.4 hours). Advance provision did not lead to increased rates of sexually transmitted infections (OR 0.99; 95% CI 0.73 to 1.34), increased frequency of unprotected intercourse, nor changes in contraceptive methods. Women who received emergency contraception in advance were equally as likely to use condoms as other women.. Advance provision of emergency contraception did not reduce pregnancy rates when compared to conventional provision. Advance provision does not negatively impact sexual and reproductive health behaviors and outcomes. Women should have easy access to emergency contraception, because it can decrease the chance of pregnancy. However, the interventions tested thus far have not reduced overall pregnancy rates in the populations studied.

Topics: Contraception, Postcoital; Contraceptives, Postcoital; Female; Humans; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; Sexually Transmitted Diseases

Topics: Contraception, Postcoital; Contraceptives, Postcoital; Female; Humans; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; Sexually Transmitted Diseases

Modern contraceptive methods represent more than a technical advance: they are the instrument of a true social revolution-the "first reproductive revolution" in the history of humanity, an achievement of the second part of the 20th century, when modern, effective methods became available. Today a great diversity of techniques have been made available and-thanks to them, fertility rates have decreased from 5.1 in 1950 to 3.7 in 1990. As a consequence, the growth of human population that had more than tripled, from 1.8 to more than 6 billion in just one century, is today being brought under control. At the turn of the millennium, all over the world, more than 600 million married women are using contraception, with nearly 500 million in developing countries. Among married women, contraceptive use rose in all but two developing countries surveyed more than once since 1990. Among unmarried, sexually active women, it grew in 21 of 25 countries recently surveyed. Hormonal contraception, the best known method, first made available as a daily pill, can today be administered through seven different routes: intramuscularly, intranasally, intrauterus, intravaginally, orally, subcutaneously, and transdermally. In the field of oral contraception, new strategies include further dose reduction, the synthesis of new active molecules, and new administration schedules. A new minipill (progestin-only preparation) containing desogestrel has been recently marketed in a number of countries and is capable of consistently inhibiting ovulation in most women. New contraceptive rings to be inserted in the vagina offer a novel approach by providing a sustained release of steroids and low failure rates. The transdermal route for delivering contraceptive steroids is now established via a contraceptive patch, a spray, or a gel. The intramuscular route has also seen new products with the marketing of improved monthly injectable preparations containing an estrogen and a progestin. After the first device capable of delivering progesterone directly into the uterus was withdrawn, a new system releasing locally 20 microg evonorgestrel is today marketed in a majority of countries with excellent contraceptive and therapeutic performance. Finally, several subcutaneously implanted systems have been developed: contraceptive "rods," where the polymeric matrix is mixed with the steroid and "capsules" made of a hollow polymer tube filled with free steroid crystals. New advances have also been made in

Topics: Condoms; Contraception; Contraceptive Agents; Contraceptives, Postcoital; Female; Global Health; Humans; Male; Sexually Transmitted Diseases

The improved survival of pediatric recipients of solid organ transplants has prompted increased attention to quality of life issues. These include attainment of normal growth, involvement in romantic relationships, and the desire to control fertility. As an increasing number of adolescent transplant recipients are involved in normal social and sexual relationships, they require careful attention to their gynecologic and reproductive health care needs. Anticipating the onset of sexual activity before it occurs may help to prevent a mistimed pregnancy by providing or prescribing condoms and emergency contraception in advance. In addition, many transplant recipients can safely use the currently available methods of hormonal contraception provided there is careful attention to organ function, other medical problems, and concurrently prescribed medications. In adolescent patients, issues such as pubertal development and menstruation, contraception, and routine gynecologic health care are typically addressed by the patient's primary care provider. However, the complexity of the adolescent transplant recipient's medical care necessitates close collaboration among all health care providers caring for the patient. This review is intended to help the transplant team better understand the gynecologic health care needs and treatment options of their adolescent patients.

Topics: Adolescent; Contraception Behavior; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Drug Interactions; Dysmenorrhea; Female; Gynecology; Humans; Immunocompromised Host; Intrauterine Devices; Medroxyprogesterone Acetate; Menstruation; Organ Transplantation; Postoperative Period; Puberty; Reproductive Health Services; Sexual Behavior; Sexually Transmitted Diseases; Vaginal Smears

Topics: Benchmarking; Clinical Protocols; Contraceptives, Postcoital; Criminal Law; Evidence-Based Medicine; Female; Forensic Medicine; Health Services Needs and Demand; Humans; Mass Screening; Physical Examination; Practice Guidelines as Topic; Rape; Sexually Transmitted Diseases; Time Factors; Women's Health

Topics: Adult; Aftercare; Boston; Clinical Protocols; Contraceptives, Postcoital; Drug Therapy; Emergency Nursing; Emergency Service, Hospital; Emergency Treatment; Forms and Records Control; Health Services Needs and Demand; Hospitals, General; Humans; Mass Screening; Medical Records; Patient Care Team; Pregnancy Tests; Rape; Sexually Transmitted Diseases; Tetanus Toxoid; Trauma Centers

The office-based clinician has an important role in preventing, diagnosing, and treating STIs in adolescents. Primary-care guidelines consistently recommend the annual screening of adolescents for sexual activity and its sequelae. Appropriate office-based care of adolescents requires a firm understanding of adolescent confidentiality laws as well as sensitivity to the adolescent's need for privacy. Counseling should be provided regarding abstinence, the use of condoms, and the value of dual contraception. Newer screening methods, such as the use of urine samples and nucleic-acid amplification techniques, may facilitate appropriate office-based screening for STIs in adolescent patients.

Topics: Adolescent; Condoms; Confidentiality; Contraceptives, Postcoital; Female; Humans; Male; Mass Screening; Patient Education as Topic; Practice Guidelines as Topic; Sexually Transmitted Diseases

Because sexual assault survivors often seek treatment in primary care settings, clinicians must be prepared to evaluate these patients in a nonjudgmental manner. The initial evaluation includes a medical and assault history. During the physical examination, physical injuries are noted and forensic evidence is collected. Treatment includes prophylaxis for pregnancy and sexually transmitted infections and counseling referrals. This article focuses on care of the adult female sexual assault survivor. Psychosocial support, physical examination, collection of evidence, treatment, and documentation are discussed.

Topics: Contraceptives, Postcoital; Documentation; Female; Humans; Medical History Taking; Nursing Assessment; Physical Examination; Rape; Referral and Consultation; Sexually Transmitted Diseases; Social Support

The purpose of this review is to provide an overview of sexual assault (in adults). In particular, the aim is to emphasize changes regarding medical, legal and management issues since the subject was reviewed in this journal in 1990. However some aspects will not have changed in the last 10 years.

Topics: Adolescent; Adult; Aftercare; Age Factors; Contraceptives, Postcoital; Female; Forensic Medicine; Humans; Male; Medical History Taking; Physical Examination; Population Surveillance; Practice Guidelines as Topic; Prevalence; Rape; Risk Factors; Sexually Transmitted Diseases; United Kingdom

Adolescents are frequently victims of sexual assault, often by a previously known assailant. This article discusses the initial management of adolescents who have been sexually assaulted, including obtaining the history and performing a careful physical examination, forensic evidence collection, and medical and psychologic therapy.

Topics: Adolescent; Contraceptives, Postcoital; Female; Humans; Medical History Taking; Physical Examination; Rape; Sexually Transmitted Diseases; Surveys and Questionnaires

Sexual assault continues to represent the most rapidly growing violent crime in America. Vital legal reforms are underway, but statistics prove a persistent rise in rape incidence with poor conviction rates. This knowledge, along with the vast multitude of emotional sequelae of rape and self-perceived inferior legal status of women, results in a high percentage of unreported cases. It is imperative that health care providers understand the horrific nature of sexual assault in order to provide appropriate care. All medical care personnel involved in the care of potential rape victims should be briefed in historic and modern legalities of sexual assault. Specific training in emergent and chronic care, both physical and mental, in conjunction with an understanding of rape legislation is vital if health care professionals are to appropriately care for victims of rape.

Topics: Child; Child Abuse, Sexual; Contraceptives, Postcoital; Female; Forensic Medicine; Humans; Rape; Sexually Transmitted Diseases; Spouse Abuse

It is estimated that half of unintended pregnancies could be averted if emergency contraception (EC) were easily accessible and used.. To evaluate the effect of direct access to EC through pharmacies and advance provision on reproductive health outcomes.. A randomized, single-blind, controlled trial (July 2001-June 2003) of 2117 women, ages 15 to 24 years, attending 4 California clinics providing family planning services, who were not desiring pregnancy, using long-term hormonal contraception or requesting EC.. Participants were assigned to 1 of the following groups: (1) pharmacy access to EC; (2) advance provision of 3 packs of levonorgestrel EC; or (3) clinic access (control).. Primary outcomes were use of EC, pregnancies, and sexually transmitted infections (STIs) assessed at 6 months; secondary outcomes were changes in contraceptive and condom use and sexual behavior.. Women in the pharmacy access group were no more likely to use EC (24.2%) than controls (21.0%) (P = .25). Women in the advance provision group (37.4%) were almost twice as likely to use EC than controls (21.0%) (P<.001) even though the frequency of unprotected intercourse was similar (39.8% vs 41.0%, respectively, P = .46). Only half (46.7%) of study participants who had unprotected intercourse used EC over the study period. Eight percent of participants became pregnant and 12% acquired an STI; compared with controls, women in the pharmacy access and advance provision groups did not experience a significant reduction in pregnancy rate (pharmacy access group: adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.58-1.64; P = .93; advance provision group: OR, 1.10; 95% CI, 0.66-1.84, P = .71) or increase in STIs (pharmacy access group: adjusted OR, 1.08, 95% CI, 0.71-1.63, P = .73; advance provision group: OR, 0.94, 95% CI, 0.62-1.44, P = .79). There were no differences in patterns of contraceptive or condom use or sexual behaviors by study group.. While removing the requirement to go through pharmacists or clinics to obtain EC increases use, the public health impact may be negligible because of high rates of unprotected intercourse and relative underutilization of the method. Given that there is clear evidence that neither pharmacy access nor advance provision compromises contraceptive or sexual behavior, it seems unreasonable to restrict access to EC to clinics.

Topics: Adolescent; Adult; California; Contraception Behavior; Contraception, Postcoital; Contraceptives, Postcoital; Drug Utilization; Family Planning Services; Female; Health Services Accessibility; Humans; Pharmacies; Pregnancy; Pregnancy Rate; Pregnancy, Unplanned; Safe Sex; Sexually Transmitted Diseases

Topics: Contraceptives, Postcoital; Early Detection of Cancer; Family Planning Services; Female; Humans; Intrauterine Devices, Copper; Intrauterine Devices, Medicated; Mass Screening; New Zealand; Nurse Practitioners; Nurse's Role; Nurses; Papanicolaou Test; Sexually Transmitted Diseases; Uterine Cervical Neoplasms; Vaginal Smears

Topics: Adult; Contraceptives, Postcoital; Female; General Practice; Humans; Referral and Consultation; Sexually Transmitted Diseases

In the United States (US), access to emergency contraceptive pills (ECPs) expanded to nationwide in 2006 when regulators allowed Plan B, a brand of emergency contraception, to be sold without prescription. Using data from the National Health and Nutrition Examination Survey from 2001 to 2010, I examined any association between increased access to these ECPs in the US and negative consequences. I found an association between increased access to ECPs and a 2.2 per cent higher probability of any sexual activity, a 5.2 per cent increase in the likelihood of reporting sex with multiple partners, an increase in the average number of partners by 0.35, and a -7.6 per cent decrease in the likelihood of injectable contraceptive use. These results suggest that policies in the US and other countries that expand access to ECPs should be paired with information on ECPs' lack of protection against sexually transmitted infections and relatively lower efficacy compared to other forms of contraception.

Topics: Adolescent; Adult; Contraception Behavior; Contraceptives, Postcoital; Female; Health Services Accessibility; Humans; Middle Aged; Nutrition Surveys; Risk Factors; Sexual Behavior; Sexual Partners; Sexually Transmitted Diseases; United States

Topics: Adolescent; Adult; Contraception; Contraceptives, Postcoital; Female; Health Education; Humans; Levonorgestrel; Middle Aged; Reproductive Health Services; Sexual Behavior; Sexually Transmitted Diseases; United Kingdom; Young Adult

Sexual exposure to STDs including HIV and hepatitis is common. Sexual assault is also prevalent and should be screened for in a patient presenting for medical care after potential sexual exposure to STDs. Primary care providers should be familiar with current recommendations for STD prophylaxis and treatment after sexual exposure to STDs, and be aware that HIV postexposure prophylaxis is effective and available if indicated after sexual exposure to HIV. Providers should also be aware of the need for prompt referal for evaluation and medical care of the adult patient after a sexual assault.

Topics: Contraceptives, Postcoital; Female; Hepatitis B; Hepatitis C; HIV Infections; Humans; Rape; Risk Assessment; Sexually Transmitted Diseases; Young Adult

Use of the levonorgestrel emergency contraception (EC) pill has become more common after being made formally available in pharmacies without prescription. It was investigated how pharmacists in the capital area of Reykjavik supply EC to clients.. A total of 46 pharmacists of all working ages and both genders were asked to answer a questionnaire concerning how they sold the emergency contraception pill over the counter (84.8% reply rate).. Four of five used <5 minutes to discuss emergency contraception with the client, but almost all enquired about time from intercourse. While only 20% asked about the woman s health, most considered concomitant drug use and potential interaction with levonorgestrel. Only about 50% pointed out that EC did not protect against sexually transmitted disease, (3/4) pointed out the need for permanent contraceptive use, 95% asked about previous EC use, but only 30% would provide EC again in the same menstrual cycle. One half of the pharmacists sold EC to men/teenage boys and wished to assist them with taking responsibility, while the others only sold the drug to the woman. Of those prepared to give the drug to the men, 55% asked to speak over the telephone with the woman to ensure correct prescription and information. Nearly a third would never or rarely provide consultation in private.. Pharmacists agree mostly about main points in supplying EC, but not as regards provision to women through their male partners. Provisons for consultation can be improved.

Topics: Attitude of Health Personnel; Clinical Competence; Community Pharmacy Services; Contraception Behavior; Contraception, Postcoital; Contraceptives, Postcoital; Drug Interactions; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Iceland; Levonorgestrel; Male; Nonprescription Drugs; Professional-Patient Relations; Referral and Consultation; Sexually Transmitted Diseases; Surveys and Questionnaires; Women's Health

Topics: Adolescent; Adult; Animals; Bioethical Issues; Contraceptives, Postcoital; Female; Humans; Incidence; Scotland; Sexually Transmitted Diseases

Topics: Adolescent; Contraception, Postcoital; Contraceptives, Postcoital; Family Practice; Female; Humans; Mass Screening; Pregnancy; Sexually Transmitted Diseases

Topics: Abortion, Induced; Christianity; Condoms; Contraception; Contraceptives, Postcoital; Cultural Diversity; Europe; Female; Government Regulation; Humans; Internationality; Legislation as Topic; Levonorgestrel; Mifepristone; Morals; Nonprescription Drugs; Politics; Pregnancy; Public Policy; Reproductive Rights; Sex Education; Sexual Abstinence; Sexual Behavior; Sexually Transmitted Diseases; United States; United States Food and Drug Administration; Value of Life

This study sought to determine how rape victims are managed in emergency departments with respect to disease and pregnancy prevention. Surveys were sent to directors of emergency medicine residencies and pediatric emergency medicine fellowships. Results indicate that there is some discrepancy between presence of an institutional policy and practice.

Topics: Academic Medical Centers; Adolescent; Child; Contraceptives, Postcoital; Emergency Service, Hospital; Female; Guideline Adherence; Health Care Surveys; Humans; Pregnancy; Rape; Sexually Transmitted Diseases

From 1 August 2001 to 31 July 2004, 137 patients were referred from the Association Concerning Sexual Violence Against Women to the Accident and Emergency Department at the Kwong Wah Hospital for alleged rape. Approximately half of the patients presented within 3 days of the alleged assault. Fifty-one patients were prescribed emergency contraception: one patient remained pregnant despite treatment and was referred with a further six patients to the Gynaecology Department for termination of pregnancy. Thirty-two patients received hepatitis B immunoglobulin injection. One patient had a positive result for rapid plasma reagin 3 months following the assault and was referred to the Social Hygiene Clinic. All tests for antibody to human immunodeficiency virus were negative. Antimicrobial therapy was prescribed for women who had an endocervical and/or high vaginal swab positive for Chlamydia trachomatis (n=9), Trichomonas vaginalis (n=1), and gonococcus (n=1).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Contraceptives, Postcoital; Emergency Service, Hospital; Female; Hong Kong; Humans; Middle Aged; Outcome Assessment, Health Care; Pregnancy; Rape; Sexually Transmitted Diseases

We sought to investigate contraceptive use in women attending a genitourinary medicine (GUM) clinic, and to assess the need for a contraceptive service in this setting. Female attendees at Nottingham GUM clinic were invited to complete an anonymous questionnaire regarding past and present contraceptive use and whether a contraceptive service within GUM would be utilized. Four hundred and eighty-nine questionnaires were analysed. The majority had previously used condoms (89.8%) or the combined oral contraceptive pill (COCP) (74.6%), and 46.6% and 37.4%, respectively were currently using these methods. Contraception was frequently used for the dual aims of avoiding both pregnancy and infection (48.5%). General practitioners (GPs) and family planning clinics were most frequently cited as sources of regular contraceptive advice, 58.1% and 47.2% respectively, and emergency contraception 50.8% and 37.3%, respectively. If a contraceptive service was available within GUM 56.9% of respondents indicated they would use it.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Condoms; Contraception Behavior; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Family Planning Services; Female; Humans; Needs Assessment; Patient Acceptance of Health Care; Pregnancy; Pregnancy, Unwanted; Sexually Transmitted Diseases; Surveys and Questionnaires; United Kingdom

The objective was to describe the demographic and sexual characteristics of clients attending a Sexual Health Clinic for emergency contraception (EC). Information about women attending the Parramatta Sexual Health Clinic (PSHC) who received EC between January 1999 and July 2002 was derived from the clinic database. Age-matched controls were randomly selected. Univariate and logistic regression analysis was performed to establish which factors were associated with use of EC. Two hundred and sixty-seven women requesting EC, and an equal number of controls, were studied. Factors that were independently associated with EC use were being a student, (OR=1.7 [95% CI 1.02-2.69]) and having a regular sexual partner (OR=2.3 [95% CI 1.14-4.73]). Women requiring EC were significantly less likely to have had a sexually transmitted infection (STI) (OR=0.3 [95% CI 0.16-0.60]) or a previous pregnancy (OR=0.2 [95% CI 0.09-0.67]) than controls. We concluded that users of EC are at low-risk for STIs, but need counselling about safer sex.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Australia; Case-Control Studies; Child; Contraception Behavior; Contraceptives, Postcoital; Databases as Topic; Female; Gravidity; Humans; Middle Aged; Multivariate Analysis; Sexual Partners; Sexually Transmitted Diseases; Students

The victims of sexual assault may attend GUM clinic without any referral from any other agency. The management of these cases need special care. We audited the management of females who were known to us as victims of sexual assault. In 15 months, 68 females attended our clinic. All were screened for sexually transmitted infections (STI). Emergency contraception was offered to only 38.4% at risk cases, and formal counselling support was offered to only 25% cases. Further care is necessary to improve counselling support and offering emergency contraception to the victims of sexual assault.

Topics: Adolescent; Adult; Ambulatory Care Facilities; Child; Contraceptives, Postcoital; Counseling; Drug Utilization; Female; Hepatitis B Antibodies; Hepatitis B Vaccines; Hepatitis C Antibodies; HIV Antibodies; Humans; Mass Screening; Medical Audit; Middle Aged; Rape; Sexually Transmitted Diseases; Syphilis Serodiagnosis; United Kingdom

Since emergency contraception (EC) users have a higher risk sexual profile, they may miss an opportunity for medical counseling if getting EC directly from a pharmacy. However, direct access to emergency contraception through pharmacies has been shown to increase EC use. Informational materials destined for EC users could alert women to the importance to check for sexually-transmitted infections considering health issues related to STDs.

Topics: Adolescent; Adult; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Counseling; Female; France; Humans; Patient Education as Topic; Pharmaceutical Services; Sexual Behavior; Sexually Transmitted Diseases; Surveys and Questionnaires

Topics: Contraception; Contraceptives, Postcoital; Female; Humans; Mental Health; Physical Examination; Rape; Risk Factors; Sexually Transmitted Diseases

Many aspects of sexual health relate to either preventative medicine (contraception) or managing normal physiological states (pregnancy, menopause). This article looks at some of the emergency aspects of female sexual health including genital tract trauma and genital infections.

Topics: Contraceptives, Postcoital; Emergency Medical Services; Female; Genital Diseases, Female; Genitalia, Female; Humans; Sexual Behavior; Sexually Transmitted Diseases

Much of the recent focus on emergency contraception (EC) has been on the need to increase the availability of EC without a prescription. Barriers to the wider accessibility of EC include the need to use the medication within a 72-hour window, cost, and knowledge about its availability. Concerns about the non-prescription accessibility of EC include missing the opportunity to see a physician, possible reduced use of barrier contraceptives and the resulting increase in sexually transmitted infections, and overuse of EC and underuse of regular contraception. As the wider availability of EC is a reality, and pressure to further increase its access is growing, it is timely that issues surrounding accessibility of EC be discussed. This paper explores the issues around making EC more accessible and the various models of obtaining EC, namely, prescription medication, pharmacist-physician collaboration, pharmacist-dispensed medication, schedule II (behind the counter) medication, or on-the-shelf medication. The ideal model will be the one that provides improved accessibility for adolescents, other low-income women, and indeed for all women. Increased accessibility of EC should also lead to cost savings for the health-care system because of fewer unwanted pregnancies.

Topics: Adult; Contraceptives, Postcoital; Female; Health Knowledge, Attitudes, Practice; Humans; Nonprescription Drugs; Sexual Behavior; Sexually Transmitted Diseases

Topics: Adolescent; Adult; Chlamydia Infections; Chlamydia trachomatis; Contraceptives, Postcoital; Female; Humans; Mass Screening; Pharmacies; Sexually Transmitted Diseases

The effort to make emergency contraception (EC) more easily available has been challenged by concerns that prescribing EC may tempt adolescents to have unprotected intercourse, resulting in higher rates of pregnancy and sexually transmitted infections (STIs). This study examined differences in reproductive health history and outcomes among girls who were prescribed EC compared with those seeking other reproductive health care. In a retrospective chart review, the subjects (182 total: 92 EC, 90 control) were girls aged 13 to 21 years, 63% black and 31% white, in an urban, hospital-based adolescent outpatient clinic. Pregnancies, STIs, and visits for first pelvic examination and Pap smear were compared for the 12 months before the identifying visit (IDV) and for up to 2 years after the IDV (mean: 10.9 months+/-8.2 months). Twenty-six subjects became pregnant with no significant difference between groups. Control subjects were found to have a higher incidence of chlamydia. Before the IDV, EC users were more likely than controls to have never had a pelvic examination (23% vs. 6%, P<0.002) or a Pap smear (24% vs. 6%, P<0.002). However, 80% of EC subjects who had never had a pelvic examination received one as a result of the initial visit and follow-up related to receiving EC. Using EC is not associated with increased risk for future STIs and pregnancy among adolescent girls. Requesting EC may initiate routine gynecologic care.

Topics: Adolescent; Adult; Contraceptives, Postcoital; Female; Humans; Papanicolaou Test; Pregnancy; Pregnancy in Adolescence; Retrospective Studies; Sexually Transmitted Diseases; Treatment Outcome; Vaginal Smears

Emergency contraception is used to prevent pregnancy after unprotected sex but before pregnancy begins. Currently, women can use emergency contraception by taking higher doses of the active ingredients found in ordinary oral contraceptive pills [either combined estrogen-progestogen (progestin) or progestogen-only formulations], or by having providers insert copper-bearing intrauterine devices (IUDs). The antiprogestogen mifepristone also has an excellent efficacy and safety profile as emergency contraception, but it is currently available for this indication only in China. Many studies have documented providers' and women's fears about the individual and public health safety risks of emergency contraception. Some of these concerns include potentially increased risks of cardiovascular events (including arterial and venous disease), worries about possible effects on future fertility, feared teratogenic consequences following method failure or inadvertent use during pregnancy, exaggerated or extreme fears of adverse tolerability, and concerns about drug interactions with other medications. Wider public health questions include feared reductions in the use of ongoing, more effective contraception, possible 'abuse' of emergency contraception through overly frequent use, and potential increases in risky sexual encounters (owing to the existence of a back-up, postcoital method) and therefore in rates of sexually transmitted infections, including HIV/AIDS. These fears can each be generally allayed. Direct and indirect investigations of emergency contraception in the biomedical and social science literature, the extensively documented safety profile of ordinary oral contraceptives, and more than 30 years of clinical experience since hormonal emergency contraception was first described, give strong evidence for its safety. This review confirms declarations by the World Health Organization and the US Food and Drug Administration, and shows that emergency contraception has an excellent safety profile in nearly all women. Finally, emergency contraception allows women a second chance to avoid unwanted pregnancies. Whether pregnancy is carried to term or terminated, the condition has inherent risks that are greater than any posed by emergency contraception.

Topics: Congenital Abnormalities; Contraceptives, Oral, Combined; Contraceptives, Postcoital; Drug Administration Schedule; Drug Interactions; Estrogens; Female; Fertility; Humans; Intrauterine Devices, Copper; Mifepristone; Pregnancy; Progestins; Public Health; Risk Assessment; Sexually Transmitted Diseases; United States; United States Food and Drug Administration; World Health Organization

The study describes a cross-section of women using the emergency contraceptive pill (ECP), with regard to demographics, ECP use, sexual health, sexually transmitted infection (STI)/HIV risk perception and attitudes to condom use. All women attending a London hospital for the ECP over a four-month period were invited to complete a 30-item questionnaire anonymously. Of the 150 women attending, 88 (59%) took part. Over 60% needed the ECP because of unprotected sexual intercourse (UPSI). A third had had UPSI in the previous three months, 70% had used ECP previously. The vast majority (>95%) did not think they were at high risk of STIs or HIV infection, and though the most likely explanations for UPSI were that it is more enjoyable and that people get 'carried away'. There are concerns that women are using the ECP as a form of contraception and are putting themselves at risk of STIs and HIV infection. Information regarding risk behaviour needs to be routinely given with the ECP in order to avoid further large increases in infection.

Topics: Adult; Attitude; Condoms; Contraception Behavior; Contraceptives, Postcoital; Female; HIV Infections; Humans; Risk-Taking; Sexual Behavior; Sexually Transmitted Diseases; Surveys and Questionnaires

Topics: Catholicism; Contraceptives, Postcoital; Emergency Treatment; Female; Hospitals, Religious; Humans; Pregnancy; Rape; Sexually Transmitted Diseases

Topics: Contraceptives, Postcoital; Female; Humans; Patient Education as Topic; Pharmacists; Sexually Transmitted Diseases

Topics: Contraceptives, Postcoital; Female; Humans; Incidence; Male; Pharmacies; Sexual Behavior; Sexually Transmitted Diseases

Topics: Contraceptives, Postcoital; Female; Genetic Predisposition to Disease; Humans; Interprofessional Relations; Patient Education as Topic; Pharmacies; Sexually Transmitted Diseases

The aim of this study was to examine the characteristics of patients requesting emergency postcoital contraception at a genitourinary medicine (GUM) clinic. We also compared the quality of information obtained during the consultation, before and after a proforma was introduced. A retrospective review of all clinical notes of patients who attended for postcoital contraception between January and December 1994 and April to June 1995 was performed. Eighty-three per cent of patients were aged 17-29 years, 68.8% were in relationship, 41.3% were not using regular contraception, 33.8% accepted a sexual health screen and of these, 14.8% had a concurrent sexually transmitted disease (STD). The introduction of a consultation proforma significantly improved certain areas of the consultation. The results suggest that sexual health screens should be encouraged in women attending GUM clinics for postcoital contraception and that the use of a proforma improves the quality of information obtained.. This study was undertaken to 1) identify the characteristics of emergency postcoital contraception clients, their acceptance of sexual health screening, and the incidence of sexually transmitted diseases in this group and 2) to determine the effect of the introduction of a consultation proforma on the quality of information obtained from the client. Data were gathered from a review of all clinical notes of 80 postcoital patients at a clinic and a hospital in England during 1994 and between April and June 1995, after introduction of the proforma. It was found that 83% of the patients were 17-29 years old, 68.8% were in a relationship, 41.3% were not using regular contraception, 33.8% accepted the offer of a sexual health screening, and 14.8% of these had a sexually transmitted disease. The introduction of the proforma improved the likelihood that vital history information was obtained and that the patient was offered sexual health screening. The results indicate that most of the patients were aware of the importance of timing in obtaining emergency contraception and that they should be more actively encouraged to undergo sexual health screening.

Topics: Adolescent; Adult; Contraceptives, Postcoital; Emergency Service, Hospital; Female; Humans; Pregnancy; Referral and Consultation; Retrospective Studies; Sexually Transmitted Diseases; Time Factors

Retrospective analysis of clinical data from 8 State/Territory Family Planning Organizations (FPO) was conducted to determine the reproductive health services used by young women. Between July, 1996 and June, 1997, a total of 185, 879 client visits were recorded at FPO clinics, of which 72,303 (39%) were by young clients. The results showed that young women tended to use a combined oral pill, postcoital pill and spermicides more than those older than 25 years (p<0.05). Young women were also more likely to use services for management of sexually transmitted disease (STD), counselling for HIV, STD and sexual assault (p<0.05). However, there were considerable differences among the 3 groups of women: Aboriginal clients, those who did not speak English at home, and those who were born outside Australia. This study confirms that young women are using FPO services especially for emergency/postcoital contraception, STD screening and counselling. FPOs need to continue their existing role of providing reproductive and sexual health services catering to the need of this special segment of the population.

Topics: Adolescent; Adult; Age Distribution; Australia; Community Health Centers; Contraceptives, Postcoital; Counseling; Family Planning Services; Humans; Middle Aged; Sexually Transmitted Diseases

Topics: Contraception; Contraceptives, Postcoital; Emergencies; Female; Humans; Male; Pregnancy; Pregnancy, Unwanted; Sexually Transmitted Diseases; United States

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: Adolescent; Child; Child Abuse; Child, Preschool; Clinical Laboratory Techniques; Contraceptives, Postcoital; Female; Forensic Medicine; Humans; Male; Physical Examination; Sex Offenses; Sexually Transmitted Diseases

Topics: Abortion, Therapeutic; Adolescent; Anti-Bacterial Agents; California; Chicago; Child; Coitus; Contraception; Contraceptives, Postcoital; Diethylstilbestrol; Emergency Service, Hospital; Estrogens, Conjugated (USP); Ethinyl Estradiol; Female; Fertilization; Forensic Medicine; Humans; Internship and Residency; Male; Medical Staff, Hospital; Medroxyprogesterone; Middle Aged; Pregnancy; Psychotherapy; Rape; Sexually Transmitted Diseases; United States; Vaginal Smears

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