Adela Montero

Comportamientos sexuales y diferencias de género en adolescentes usuarios de un sistema público de salud universitario

We studied 4,971adolescents of both sexes aged between 12 and 19 years, who consulted in a clinic for adolescentsbetween the years 1990 and 2005. Several variables related to adolescent sexuality were considered.Uni and bivariate analysis were carried out and a model of stratified lineal regression per sex wasfixed to explain the following variables: age at which sexual activity is initiated, number of sexualpartners, time period between start of dating and the start of sexual activity along time.

PERCEPCIONES Y EXPERIENCIAS DEL INICIO SEXUAL DESDE UNA PERSPECTIVA DE GÉNERO, EN ADOLESCENTES CONSULTANTES EN UN CENTRO UNIVERSITARIO DE SALUD SEXUAL Y REPRODUCTIVA

Antecedentes: El contexto en que se inicia la actividad sexual en adolescentes tiene importantes signifca-dos para las personas e implicancias en salud publica. Objetivo: Conocer con un enfoque exploratorio, los factores que infuyen en el inicio de la actividad sexual en adolescentes y explorar el contexto en el cual ocurre. Metodo: Muestra de adolescentes, hombres y mujeres, sexualmente activos entre 14 y 19 anos, re-clutados en el CEMERA, durante 2007. Se realizaron 117 entrevistas semiestructuradas. Se utilizo el analisis tematico de los datos. Los signifcados e interpretaciones fueron constantemente verifcados a traves de sucesivos analisis. Resultados: El grado de control personal que tuvieron sobre los factores que condujeron a su primera experiencia sexual, determino como ellos/as se sintieron con esta experiencia. Aquellos/as que dijeron que habia sido una buena experiencia, demoraron el inicio sexual hasta que se sintieron comodos/as con el momento y con quien debutaron sexualmente. Sin embargo, sentimientos de culpa marcaron el evento, porque ellos/as habian transgredido las normas sociales. En contraste, la coercion de sus parejas y los efectos del alcohol, fueron razones que llevaron a una experiencia sexual prematura y no deseada. Conclusiones: El rol de la interaccion con sus pares, el abuso de alcohol y la presion de la pareja, en el caso de las ninas, infuyen en la actividad sexual prematura y no deseada. Las intervenciones educacionales debieran considerar estos aspectos para que tengan relevancia personal y el impacto pueda ser mayor en la postergacion del inicio de la actividad sexual o que esta sea protegida.

Factores familiares asociados al inicio sexual temprano en adolescentes consultantes en un centro de salud sexual y reproductiva en Santiago de Chile

Background: Nowadays, adolescent population begins sexual activity earlier, a behavior with negativepsychological ana social consequences. Aim: To determine the association between family factors and early sexual activity in adolescents oflow and middle socioeconomic level. Material and Methods: A sample of 3,210 adolescents, who confidentially requested care in a sexual and reproductive health university center, between 2000 and 2007, was analyzed. Adolescents who started sexual activity before 15years ofage, and those who started sexual activity after 15years ofage, were compared. Data was collectedfrom structured interviews conducted at the adolescente firstvisit. Logistic regression was used to identify family factors associated with early sexual initiatingin both, men and women. Results: Family factors associated with early sexual activity startwere not being raised by both parents, apoor parent-child relationship, a poor family communication, mothers with a history of adolescent motherhood, mothers employed outside the home and family dysfunction. Among women, the variables associated with a higher risk of early sexual debut were not married parents and history of adolescent fatherhood record among parents. Among men, these variables were permissions without restriction during the week and punishment when family rules were broken. Conclusions: Family factors must be considered in the design ofstrategies to prevent early sexual activity.BACKGROUND Nowadays, adolescent population begins sexual activity earlier, a behavior with negative psychological ana social consequences. AIM To determine the association between family factors and early sexual activity in adolescents of low and middle socioeconomic level. MATERIAL AND METHODS A sample of 3,210 adolescents, who confidentially requested care in a sexual and reproductive health university center, between 2000 and 2007, was analyzed. Adolescents who started sexual activity before 15 years of age, and those who started sexual activity after 15 years of age, were compared. Data was collected from structured interviews conducted at the adolescente first visit. Logistic regression was used to identify family factors associated with early sexual initiating in both, men and women. RESULTS Family factors associated with early sexual activity start were not being raised by both parents, a poor parent-child relationship, a poor family communication, mothers with a history of adolescent motherhood, mothers employed outside the home and family dysfunction. Among women, the variables associated with a higher risk of early sexual debut were not married parents and history of adolescent fatherhood record among parents. Among men, these variables were permissions without restriction during the week and punishment when family rules were broken. CONCLUSIONS Family factors must be considered in the design of strategies to prevent early sexual activity.

Educación sexual: un pilar fundamental en la sexualidad de la adolescencia

Sexuality is more than reproduction, it is an intrinsic part of each of us, is how we develop and relate with others and with the environment of the society to which we belong. Adolescence is a period with special vulnerability for the development of risky behaviors. In Chile, a progressive decrease in the age of sexual activity onset is observed, particularly in lower socioeconomic strata. The main consequences in sexual health are teenage pregnancies and the risk of acquiring sexually transmitted infections such as HIV. The main strategy for the prevention of this risks is a thorough sexual education, that has to be timely, objective, based on scientific evidence, friendly and confidential.

Factores asociados a la continuidad del uso anticonceptivo en adolescentes solteras nulíparas

BACKGROUND Factors such as personal issues, family, sexuality and sexual partner characteristics are strongly associated with contraceptive continuation among single, nulliparous female adolescents. AIM To determine factors associated to contraceptive maintenance among female nulliparous adolescents. MATERIAL AND METHODS A cohort of 2,811 adolescents, who confidentially requested contraception in a sexual and reproductive health university center from 1990 to 2006 was analyzed. Two years after the request, their clinical records were reviewed to determine the time and length of contraception. Using life table analysis, the variables related to continuation or discontinuation of contraception were identified. RESULTS Factors associated with a longer contraceptive use were a lower age at the moment of initiating the method, a better academic achievement and aspirations, higher schooling of the partner, higher age of the mother, having an adolescent mother, supervision of permissions by people different than parents and not attending to religious services. Variables associated with a higher risk for abandonment were a higher age of the adolescent, greater number of sexual partners, lack of communication with parents, non-catholic religious affiliation, use of oral hormonal contraceptive, greater number of siblings, commenting sexual issues with relatives or friends, having a partner without academic activity or working and to live without parents. CONCLUSIONS Several personal, familial and environmental factors influence contraceptive use continuity among adolescents.

Comparative performance of a combined injectable contraceptive (50 mg norethisterone enanthate plus 5mg estradiol valerate) and a combined oral contraceptive (0.15 mg levonorgestrel plus 0.03 mg ethinyl estradiol) in adolescents.

STUDY OBJECTIVE To compare in a regular non-clinical trial experience the efficacy, acceptability, and continuation rates of an injectable contraceptive containing 50 mg norethisterone enanthate plus 5mg estradiol valerate (IC) and an oral contraceptive containing 0.15 mg levonorgestrel plus 0.03 mg ethinyl estradiol (OC), among adolescent users. DESIGN A total of 251 adolescents ages 14-19 were followed during 12 months. The IC group (124 subjects) was studied for 1044 cycles and the OC group (127 subjects) was studied for 1368 cycles. The users were not assigned in a random selection. Information was collected from clinical records. Groups were compared using Pearson chi-square, odds ratio (95% confidence interval), t-test, and proportion difference test. RESULTS The IC group had significant differences in baseline social risk, confidence, psychiatric problems, consumption of alcohol, and number of sexual partners. At 12 months, the IC group showed significant decrease in weight and increase in hypermenorrhea. In the OC group, dysmenorrhea decreased, and hypomenorrhea and regular cycles were significantly more frequent. One pregnancy occurred in the OC group (Pearl Index: 0.88). Final continuation rates at 12 months were 41.9% and 37.8% for IC and OC, respectively. CONCLUSIONS The monthly injectable is a recommended contraceptive option for adolescents, especially for those facing psychosocial risk factors.

Factores asociados al inicio sexual en adolescentes de ambos sexos de nivel socioeconómico medio-bajo de la Región Metropolitana

Antecedentes: Escasa evidencia esta disponible en Chile acerca del inicio de la actividad sexual adolescente. Objetivo: Examinar cuales variables identificadas previamente estan asociadas al inicio de la actividad sexual en una poblacion adolescente de nivel socioeconomico medio-bajo de la Region Metropolitana. Metodo: Los datos corresponden a adolescentes consultantes en CEMERA. Se compararon con adolescentes que habian iniciado actividad sexual y aquellos que no. La informacion fue recolectada en la primera consulta a 5.854 adolescentes de ambos sexos entre 12 y 19 anos. Se uso regresion logistica para identificar los factores asociados al inicio sexual. Resultados: 92,6% mujeres y 7,4% hombres. El 84,2% habia iniciado actividad sexual y no el 15,8%. Las variables asociadas al inicio sexual fueron: ser hombre; mayor edad; mayor escolaridad; aspiraciones academicas basicas; desempeno escolar bajo; repitencia escolar; no afiliacion religiosa; no asistencia a servicios religiosos; tener un trabajo; tener pareja mayor; tener una pareja que trabaje; conversar temas de sexualidad solo con la pareja; mas parejas romanticas; no participacion social; historia de abuso sexual; mayor numero de hijos; mala relacion padre-hijo; mala comunicacion familiar; supervision parental limitada; historia de paternidad y/o maternidad adolescente en los padres; padres con baja educacion; menor supervision parental. Conclusion: Se necesitan programas que motiven a retardar el inicio sexual. Los programas de educacion sexual deberian animar a la conversacion de los temas de sexualidad con los padres y capacitar a los educandos a demorar el inicio sexual y/o obtener anticonceptivos, en forma expedita, amigable y confidencial.

Características y consecuencias de las agresiones sexuales en adolescentes consultantes en un centro de salud sexual y reproductiva

Antecedentes: La agresion sexual es un evento traumatico y doloroso que afecta de manera transversal, a las victimas de ambos sexos, de todos los niveles socioeconomicos con graves consecuencias para la salud fisica, psicologica y social para quienes la sufren. Objetivo: Determinar las caracteristicas de las agresiones sexuales y sus consecuencias en adolescentes consultantes en un centro de atencion en Salud Sexual y Reproductiva. Metodo: Estudio analitico de corte transversal de 573 adolescentes atendidas en un centro de medicina reproductiva (CEMERA) en el periodo 2003-2010 y que reportaron antecedente de abuso sexual. Se estudiaron tanto las caracteristicas como las consecuencias del abuso, datos que se obtuvieron desde las fichas clinicas. Resultados: En el 86,5 % de los casos se reporto abuso sexual y en un 13,5% violacion. El 48,5% de los agresores son familiares. La edad mas vulnerable fue entre 5-9 anos con un 41,2%. En el 39,2% el abuso sexual fue reiterado. En un 43,4% el lugar fue el propio hogar de la victima. Un 70% revelo y de estos el 45,9% lo hizo en forma tardia. Solo en un 19% se hizo la denuncia legal. De las adolescentes que iniciaron actividad sexual voluntaria (83,3%), un 35,4% tenia menos de 15 anos. Un 11,8% reporto 3 y mas parejas sexuales. Conclusion: El antecedente de abuso sexual debe ser considerado en la atencion de adolescentes que consultan por salud sexual y reproductiva. El equipo de salud debe estar preparado para atender sus multiples necesidades.

PRINCIPALES CONSIDERACIONES BIOÉTICAS EN LA ATENCIÓN EN SALUD SEXUAL Y REPRODUCTIVA EN ADOLESCENTES

SUMMARY Background: Health care of adolescents in particular, on issues of Sexual and Reproductive Health, represents a special challenge for health teams and institutions, mainly in the field of bioethics. Aims: To analyze the major bioethical issues that may arise in clinical practice. Method: We analyze four basic bioethical principles, addressing other important aspects such as the professional relationship-patient, assessing the capacity/competence in decision making and confidentiality in care. Conclusions: The duty of institutions and health teams responsible for the care on the health of adolescents, is to maintain a proper balance between these principles, respecting the right of autonomy and confidentiality in the attention, framed within reasonable limits and that in no case will help to limit access to quality care. It is essential that there is a training and updating of professionals in the field of bioethics, in order to contribute to carefully analyze and resolve conflicts that arise, considering that health care should be framed with respect to rights and dignity of individuals.

FACTORES PSICOSOCIALES Y CULTURALES QUE INFLUYEN EN EL EVENTO DE LA MENARQUIA EN ADOLESCENTES POSMENÁRQUICAS

RESUMENIntroduccion: La menarquia es un evento de vida significativo con importantes implicaciones culturales, sociales y personales. Objetivo: Conocer y entender mejor el contexto psicosocial en que ocurre la menar-quia considerando la edad de ocurrencia, fuentes y calidad de la informacion o preparacion recibida, y las reacciones emocionales experimentadas. Metodo: Se entrevistaron adolescentes entre 11 y 19 anos que consultaron en CEMERA entre 2005 y 2006. Se aplico un cuestionario especialmente disenado y se asegu-ro confidencialidad y anonimato de sus respuestas. Resultados: Participaron 826 adolescentes. 34,6% de ellas tuvieron la menarquia entre los 9 y 11 anos, 53,1% entre 12 y 13 anos y 12,3% entre los 14 y 16 anos. 88,6% recibieron informacion sobre el tema previo a la menarquia. 81,3% de las madres fueron quienes informaron a sus hijas, seguidas por familiares mujeres en 6,8%, colegio en 4,6%; 78% de las adolescentes que recibieron informacion indicaron no sentirse preparadas al momento del evento. 23,6% reporto sentirse muy mal, 21% asustada, 20,5% extrana, 4% indiferente y 30,8% indico sentirse feliz con la menarquia. Conclusion: Si bien en la actualidad las ninas tienen acceso a una serie de fuentes de informacion acerca de la menstruacion es principalmente la madre, el colegio y los profesionales de salud quienes juegan un rol primordial en su preparacion en este aspecto. Pero esta informacion tiende a estar focalizada solo en as-pectos higienicos y biologicos inmediatos y obvios pero desconectados de la experiencia del propio cuerpo de las ninas como de su emocionalidad. PALABRAS CLAVE: Menarquia, fuentes de informacion, factores socioculturalesSUMMARYBackground: Menarche is a significant life event with important cultural, social and personal implications. Objectives: To know and to understand in a better way, the psychosocial context in which menarche takes place, considering age occurrence, sources and quality of information, training received and the emotional reactions experienced. Methods: In 2005 and 2006, adolescents from 12 to 19 years old, who consulted at an Adolescents Clinic, took a specially designed questionnaire and they were guaranteed confidentiality and anonymity in their answers. Results: 826 adolescents took part in this study; 34.6% of them had the menar-che between 9-12 years old, 53.1% between 12-13 years old and 12.3% between 12-14 years old; 88.6% got information previously to menarche; 81.3% mothers were who gave the corresponding information to their daughters, followed by their female relatives in a 6.8%, school in a 4.6%; 78% of the total number