Brian T. Nguyen

Evaluating the efficacy and safety of a progestin- and estrogen-releasing ethylene vinyl acetate copolymer contraceptive vaginal ring.

Introduction: Multiple studies confirm the safety and efficacy of the combined ethinyl estradiol (EE) and etonogestrel contraceptive vaginal ring (NuvaRing®). Advantages of continuous drug delivery through the vagina compared to oral administration include stable levels of contraceptive steroids without the need for daily drug administration. Although the combined contraceptive vaginal ring (CCVR) avoids the problem of missed pills, clinical data do not support greater efficacy. Vaginal administration avoids first-pass hepatic effects; however, EE is a potent inducer of hepatic globulins regardless of the route of administration. Consequently, thromboembolic risk during CCVR use is similar to that with combined oral contraceptives. Some epidemiologic and database studies suggest that the risk of thromboembolism is increased among users of the CCVR compared to levonorgestrel-containing combined pills. Areas covered: This review examined the available literature for level 1 and level 2 evidence of the CCVR and its associated efficacy and safety. Studies are presented in table format with significant findings and conclusions described. Expert opinion: A prospective study with 33,235 woman-years of exposure and with greater ability to control for covariates did not demonstrate an elevation of risk. The safety profile of the CCVR appears to be the same as with other combined hormonal contraceptives.

MALE ACCESS TO OVER-THE-COUNTER EMERGENCY CONTRACEPTION A Survey of Acceptability and Barriers in Providence, Rhode Island

BACKGROUND No studies have examined attitudes regarding male access to over-the-counter emergency contraception (EC). This study describes male and female attitudes on male EC access, as well as their experiences with and perceived barriers to purchasing EC. STUDY DESIGN In 2007, a cross-sectional sample of 303 men and women from Providence, Rhode Island, between the ages of 18 and 45 were asked their opinions of male access to EC. RESULTS Among the respondents, 81.8% knew about EC. Men were less likely than women to know about EC (p=.002); however, their rates of purchase (10.8% vs 18.3%) were not different statistically. Many men felt they should offer to buy EC if needed (56.1%), that their purchases would prevent unplanned pregnancies (67.6%), and that the decision to use EC was a womans (75.4%); 73.8% of women agreed that men should always have EC access. No perceived need, not knowing how to obtain EC, and preferring women to obtain EC were frequently cited barriers to male purchase. Only concerns about female user side effects predicted a decreased willingness to buy EC among men (odds ratio, 0.15; 95% confidence interval, 0.05-0.45). CONCLUSIONS Given our findings that men have bought and would buy EC while respecting a womans decision to use it, and that women would support male access, our study suggests that men have an interest in preventing unplanned pregnancy that considers the health and decisions of their female partners. Avenues for educating more men about EC and its pharmacy availability should be explored.

Male Partners’ Involvement in Abortion Care: A Mixed‐Methods Systematic Review

CONTEXT Although some women may desire the involvement of their partners when obtaining abortion care, male partners are not routinely included in the abortion process. A review of the literature on how male involvement relates to womens abortion experiences may help guide facilities that are considering incorporating male partners in abortion care. METHODS PubMed, PsycINFO (Ovid), the Cumulative Index to Nursing and Allied Health Literature, the Latin American and Caribbean Health Sciences Literature database, and the Cochrane Library were systematically searched without restrictions through September 23, 2015, to identify qualitative and quantitative primary studies investigating male partner accompaniment during the abortion process in noncoercive situations. Analysis focused on identifying different types of male involvement and their associations with womens abortion experiences. RESULTS Some 1,316 unique articles were reviewed; 15 were analyzed. These studies were conducted in six countries and published between 1985 and 2012, primarily with observational designs. Four types of male partner involvement emerged: presence in the medical facility, participation in preabortion counseling, presence in the room during the surgical abortion procedure or while the woman is experiencing the effects of abortifacient medications, and participation in postabortion care. Studies explored relationships between type of involvement and womens access to abortion care and their emotional and physical well-being. Most findings suggested that male involvement was positively associated with womens well-being and their assessment of the experience; no negative associations were found. CONCLUSION In noncoercive circumstances, women who include their male partners in the abortion process may find this involvement beneficial.

Putting the man in contraceptive mandate.

ARHP Commentary ― Thinking (Re)Productively Putting the man in contraceptive mandate Brian T. Nguyen⁎, Grace Shih, David K. Turok Department of Obstetrics and Gynecology, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, Box L466, Portland, OR 97239, USA Department of Family Medicine, University of Washington, Seattle, WA 98195, USA Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA

Offering the full range of contraceptive options: a survey of interest in vasectomy training in the US family planning community ☆ ☆☆ ★ ★★

OBJECTIVE To assess current practices regarding female and male sterilization counseling and provision, as well as determine interest in providing vasectomy among family planning specialists. METHODS Members of the US-based network of family planning fellowship physicians (current fellows, graduates and faculty) received a Web-based survey from November 2015 through January 2016 regarding current sterilization preferences and practices, as well as interest in obtaining training in vasectomy counseling and procedure. RESULTS Nearly 60% (n=178/302) of family planning fellowship providers responded to the survey. While 62% (111/178) of respondents reported counseling their patients about vasectomy at least most of the time and 57% (102/178) recommended vasectomy over female sterilization, few (8/178; 4 trained in family medicine and 4 trained in obstetrics and gynecology) had performed a vasectomy in the last year. Nearly 90% (158/178) of respondents were somewhat or very interested in receiving training on vasectomy counseling; 58% (103/178) desired procedural training. Desire for training was associated with being male and receiving residency training in family medicine. CONCLUSIONS Few family planning fellowship physicians provide vasectomy, and the majority expressed being at least somewhat interested in receiving further training. IMPLICATIONS Vasectomy is more effective, safer and less expensive than female sterilization but is less common than female sterilization. One barrier to vasectomy access is the low number of vasectomy providers. Creating a structured vasectomy training program through the family planning fellowship may help to increase the number of vasectomy providers.

Supporting Women at the Time of Abortion: A Mixed-Methods Study of Male Partner Experiences and Perspectives: Support from male partners at the time of abortion

CONTEXT Although men are commonly viewed as unaware, uninvolved and even obstructive regarding their partners abortion access, those who accompany women to an abortion appointment may be more supportive. A better understanding of mens motivations could inform clinic policies regarding their involvement. METHODS In 2015-2016, data were collected from male partners of women seeking an abortion at two clinics in a large Midwestern city. Twenty-nine interviews were conducted to explore how men wanted to be involved in the abortion and why they accompanied their partners. Thematic content analysis was used to examine these data, and emergent themes informed a survey, completed by 210 men, that focused on perceptions about and reasons for accompaniment. Descriptive statistics were calculated for the survey data. RESULTS Four in 10 interviewees were aged 25-34, as were half of survey respondents. Overall, most had at least some college education and were in long-term or committed relationships. Interviewees described providing primarily instrumental (e.g., transportation and financial) and emotional (e.g., companionship and reassurance) support during the abortion process. While 57% of survey respondents would not have chosen to terminate the pregnancy if the decision had been their own, all wanted to support their partners. Notably, 70% viewed the appointment as an opportunity to receive contraceptive counseling. CONCLUSIONS Positive narratives regarding mens support for the abortion decisions of their partners provide a counterpoint to commonly held negative narratives. Future research should explore how supportive men who accompany partners at the time of an abortion may improve womens abortion experiences.

Of mosquitoes and men: mitigating Zika risk via Men’s family planning and male contraception

BackgroundOutbreaks of mosquito-borne viral illnesses commonly occur after storms. As storms are predicted to worsen in intensity and frequency, mosquito-borne viruses, including the Zika virus are expected to spread, and with devastating consequences. While the disease is self-limited, pregnant women who contract Zika can transmit the virus to their fetuses, causing neurodevelopmental abnormalities, including microcephaly. An overlooked vector of the Zika virus, however, is men whose semen can transmit the virus at the time of sexual intercourse. Current recommendations for preventing the sexual transmission of Zika are inadequate and need to emphasize male reproductive responsibility, via expanding services for men’s family planning and developing novel male contraceptives.Main bodyTo prevent the sexual transmission of Zika, the World Health Organization recommends that couples use condoms or abstain from sexual activity for at least 6 months when traveling in Zika-infected areas. Strict adherence to these recommendations is neither practical nor adequate to address Zika’s sexual transmission. As up to 13% of couples who use condoms experience unintended pregnancy, semen and consequent viral exposure is imminent. The use of contraception beyond just barrier methods is essential. However, the burden of contraception largely falls upon women and efforts to prevent vertical transmission are often aimed at educating women, when the outcome is equally undesirable among their male partners. These short-comings highlight the lack of attention to men’s options for family planning. Educating men about the full range of contraceptive options, correcting misconceptions about the efficacy of withdrawal and barrier contraceptive methods, increasing access to vasectomy, and developing novel male contraceptive options would allow shared responsibility for the prevention of unintended pregnancy and Zika-related morbidity.ConclusionGaps in recommendations to prevent the sexual transmission of Zika provide an opportunity to develop men’s family planning initiatives and the range of accessible contraceptives to men.

Social media and the intrauterine device: a YouTube content analysis

Background YouTube’s online archive of video testimonials related to health information are more commonly viewed than those developed by clinicians and professional groups, suggesting the importance of the patient experience to viewers. We specifically sought to examine the accuracy of information on, and projected acceptability of, the intrauterine device (IUD) from these YouTube testimonials. Methods We searched YouTube for videos about individual uploaders’ IUD experiences, using the search terms ‘intrauterine device’, ‘IUD’, ‘Mirena’ and ‘Paragard’. Given interest in user testimonials, we excluded professional and instructional videos belonging to commercial or non-profit entities. Two reviewers independently analysed the videos using a structured guide, with attention to inaccurate information. Results Of 86 identified videos, four videos featured clinicians and were excluded; 62 met inclusion criteria. Interrater agreement on IUD portrayal was good (K=0.73). Young (mean age 25, range 19–38, years), white (75%), nulliparous (61%) women primarily uploaded content. Most described placement of the LNG-IUS (65%), were posted within 1 month of insertion (45%), and mentioned side effects (66%) – bleeding, pain, and partner sensation of the strings. About one-third of videos contained inaccurate information (34%) and were thought to project an overall negative experience (30%). Videos portraying IUDs negatively were associated with inaccurate information and/or mention of side effects. Conclusion While one-third of IUD user testimonials on YouTube contained inaccurate information, the majority of IUD experiences were perceived by our study viewers to be positive.