contraceptives--postcoital and Uterine-Cervical-Neoplasms

Barriers and spermicides are being developed for the prevention of unwanted pregnancy and sexually transmitted infection. The inconvenience of current methods limits their acceptability and leads to higher user failure rates. New methods, such as female condoms, nonlatex male condoms, and new cervical caps are being developed: the Reality (Wisconsin Pharmacal, Jackson, WI) polyurethane vaginal pouch has already received conditional Food and Drug Administration approval for use in the United States. The material used in a Food and Drug Administration-approved nonallergenic glove is being tested for its effectiveness as a condom. In addition, the Fem Cap, a cervical cap that had a life table probability of failure within 1 year of 4.8%, is expected to be available within the next 2 years. It is important for clinicians to be informed of new options becoming available for those patients who may be good candidates for these barrier methods.. Reproductive health providers have long overlooked barrier and spermicide contraceptives, but they are rather effective when used consistently and correctly, have relatively few side effects, and protect against sexually transmitted diseases (STDs) and HIV. The mean percentage of women who have an unplanned pregnancy during the first year, if they have correctly and consistently used condoms is 2%, 3% for spermicides, 6% for cervical cap and diaphragm, 6% for nulliparous users of the sponge, and 9% for parous users of the sponge. If they do not use these methods and/or spermicides properly, however, failure rates increase 3-7 times. New barrier methods and spermicides should help people overcome obstacles, e.g., sensitivity or allergy to latex. One condom manufacturer is developing nonlatex male condoms for those who are sensitive or allergic to latex or the chemicals added to latex during the manufacturing process. Another manufacturer has altered the male condom by adding a silicone-lubricated pouch of latex to fit loosely around the glans penis, thereby reducing sensation loss. A new barrier method is the cervical cap which fits and covers the cervix snugly. Female condoms empower women to protect themselves against pregnancy, STDs, and HIV. They should be available to the US market soon. Some research indicates that spermicide use with barrier methods poses a risk of urinary tract infections, but the benefits exceed the risk. Barrier and spermicide methods appear to protect against cervical cancer and pregnancy complications. In conclusion, reproductive health providers need to realize their role in controlling patient use of barriers and spermicides, as well as the important role barrier methods play in protecting against pregnancy and STDs. Therefore, they should encourage patients to use the new methods and teach them to use them effectively.

Topics: Contraceptive Devices; Contraceptives, Postcoital; Evaluation Studies as Topic; Female; Humans; Male; Patient Acceptance of Health Care; Pregnancy; Pregnancy Complications; Pregnancy, Unwanted; Spermatocidal Agents; Urinary Tract Infections; Uterine Cervical Neoplasms

Topics: Abnormalities, Drug-Induced; Arrhythmias, Cardiac; Breast Neoplasms; Contraception; Contraceptive Devices; Contraceptives, Oral, Synthetic; Contraceptives, Postcoital; Estradiol Congeners; Female; Humans; Intrauterine Devices; Lactation; Male; Pelvic Inflammatory Disease; Pregnancy; Pregnancy, Ectopic; Progesterone; Progesterone Congeners; Prospective Studies; Spermatocidal Agents; Thromboembolism; Time Factors; Uterine Cervical Neoplasms

Topics: Animals; Carcinoma; Contraception; Contraceptive Agents; Contraceptive Devices; Contraceptives, Oral; Contraceptives, Postcoital; Corpus Luteum; Embryo Implantation; Female; Humans; Intrauterine Devices; Lactation; Male; Medical Laboratory Science; Methods; Ovulation; Ovum; Pelvic Inflammatory Disease; Pheromones; Pregnancy; Progestins; Semen; Spermatogenesis; Spermatozoa; Sterilization, Reproductive; Technology, Pharmaceutical; Therapeutic Irrigation; Thromboembolism; Uterine Cervical Neoplasms

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

Balancing needs for contraception and cervical cancer screening is challenging for clinicians. We assessed US obstetrician/gynecologists' practices regarding requirement of Pap testing before prescribing oral contraceptive or emergency contraceptive pills.. Questionnaires structured as clinical vignettes describing women desiring contraception with different risks of cervical dysplasia were mailed to a national sample of 355 obstetrician/gynecologists.. A minority (3%) of the 185 obstetrician/gynecologists who responded would refill 12 months of oral contraceptives without requiring Pap testing. However, most would provide a limited supply of oral contraceptives until Pap testing could be performed. A substantial proportion (11-16%) would refuse to prescribe emergency contraception to women who they felt required Pap testing. Younger physicians, those practicing in academic settings and those who follow American Cancer Society guidelines were more willing to prescribe contraceptives without Pap testing.. Cervical cancer screening continues to limit prescription of routine and emergency contraception by many US obstetrician/gynecologists.

Topics: Contraception; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Postcoital; Drug Prescriptions; Female; Humans; Middle Aged; Physicians; Practice Patterns, Physicians'; Surveys and Questionnaires; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Vaginal Smears

Oral, injectable, and implantable contraceptives offer women safe, effective, and reversible fertility regulation. In some cases, their use also confers important noncontraceptive benefits. By individualizing counseling and recommendations based on relevant behavioral and medical considerations, clinicians can maximize their patients' success with hormonal contraceptives. Even in women with relative contraindications to the use of hormonal contraceptives, the risks associated with pregnancy may be sufficiently great so as to warrant their use.

Topics: Breast Neoplasms; Cardiovascular Diseases; Contraceptive Agents, Female; Contraceptives, Oral, Hormonal; Contraceptives, Postcoital; Female; Humans; Levonorgestrel; Liver Neoplasms; Medroxyprogesterone Acetate; Risk Factors; Uterine Cervical Neoplasms

Topics: Adenocarcinoma; Animals; Breast Neoplasms; Contraceptives, Oral; Contraceptives, Postcoital; Diethylstilbestrol; Dogs; Drug Interactions; Estrogens; Female; Haplorhini; Humans; Male; Mammary Neoplasms, Experimental; Mice; Neoplasms, Experimental; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Progestins; Rats; Urogenital Neoplasms; Uterine Cervical Neoplasms; Vaginal Neoplasms

Topics: Adolescent; Animal Feed; Animals; Contraceptives, Postcoital; Diethylstilbestrol; Female; Humans; Uterine Cervical Neoplasms; Vaginal Neoplasms

Topics: Acne Vulgaris; Adenocarcinoma; Bile Ducts; Contraceptives, Postcoital; Diethylstilbestrol; Female; History, 20th Century; Humans; Lactation; Liver; Male; Maternal-Fetal Exchange; Menopause; Muscular Dystrophies; Phagocytosis; Pregnancy; Uterine Cervical Neoplasms

Topics: Body Temperature; Contraception; Contraceptive Agents; Contraceptive Devices; Contraceptives, Oral; Contraceptives, Postcoital; Delayed-Action Preparations; Dose-Response Relationship, Drug; Female; Humans; Intrauterine Devices; Ovulation; Patient Care Planning; Periodicity; Prostaglandins; Thromboembolism; Uterine Cervical Neoplasms

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