George R. Huggins

Changes in the intensity and pleasantness of human vaginal odors during the menstrual cycle.

Men and women estimated (by the method of magnitude estimation) the pleasantness and intensity of the odors of vaginal secretions sampled from consecutive phases of 15 ovulatory menstrual cycles of four women. On the average, secretions from preovulatory and ovulatory phases were slightly weaker and less unpleasant in odor than those from menstrual, early luteal, and late luteal phases. However, considerable variation in odor patterns was present across cycles from the same donor, as well as across cycles from different donors. These results indicate that human vaginal odors change slightly in both pleasantness and intensity during the menstrual cycle, but do not support the notion that such odors are particularly attractive to humans in an in vitro test situation.

Partner effects on a woman's intention to conceive: 'not with this partner'

CONTEXT Current definitions of pregnancy intention that are useful at aggregate levels are weak at the individual level. This is especially true in social contexts where childbearing and pregnancy often occur within casual or transient relationships. METHODS Extensive data on lifetime partnerships and sexual behaviors, including pregnancies and births, from 250 low-income women who had experienced a total of 839 pregnancies are used to explore correlates of intention to conceive, as well as the extent to which women attribute their intentions to a current partnership. RESULTS Some 57% of reported pregnancies were unintended. Overall, 21% of the women had not wished to conceive at least one of their pregnancies with the partner who impregnated them; that proportion rose to 33% among women who had had only unintended pregnancies. Even among women who had had no unintended pregnancies, 18% had had at least one conception that they had not wanted with their partner at the time of conception. Women were less likely to say they had not wanted to conceive with a particular partner if they were living with that partner than if they were not. The likelihood of not having wanted a pregnancy with a given partner rose with the lifetime number of serious partners. Pregnancies that were not wanted with a particular partner were more than twice as likely to end in abortion as were those that were (33% vs. 14%). CONCLUSIONS Among these women, the desire to avoid childbearing relates more to the couple involved in the conception than to abstract notions of completed family size. It would therefore be useful to include items pertaining to partner relationships in future studies of pregnancy intention.

COST-EFFECTIVENESS OF TREATMENT FOR DRUG-ABUSING PREGNANT WOMEN

Neonatal intensive care unit (NICU) and drug treatment costs were compared in two groups of pregnant drug abusing women: 100 admissions to a multidisciplinary treatment program and active in care at the time of delivery and 46 controls not entering drug treatment. Clinical measures included urine toxicology at delivery, infant birthweight. Apgar scores and need for and duration of NICU services. Cost measures included drug treatment and NICU costs. Treatment patients showed better clinical outcome at delivery, with less drug use and higher infant estimated gestational age, birthweight and Apgar scores. Infants of treatment patients were also less likely to require NICU services and, for those that did, had a shorter stay. When total cost was examined (including drug treatment), mean net savings for treatment subjects was

Cervical ectopic pregnancy: review of the literature and report of a case treated by single-dose methotrexate therapy.

4644 per mother/infant pair. The study demonstrates the cost-effectiveness of treatment for pregnant drug abusing women, with savings in NICU costs exceeding costs of drug treatment.

Oral contraceptives and neoplasia

Methotrexate with folinic acid rescue was used to terminate a clinically diagnosed cervical pregnancy while preserving reproductive capability in a young female patient. The chemotherapy was well tolerated except for transient elevation of liver enzymes. Beta HCG titers fell rapidly and became negative by 13 days. This is the first report showing successful treatment of a cervical pregnancy with single-dose chemotherapy. The literature is reviewed and discussed.

Adolescent contraceptive use: comparisons of male and female attitudes and information.

Some of the available data concerning the suspected association between oral contraceptive (OC) use and the development of cancer is surveyed, and the attempt is made to evaluate possible associations between OCs and human neoplasia in light of pregnancy risk or benefit of oral contraception. The principal investigative methods in humans include various epidemiologic approaches, and the methodologies most often used are case reports (tumor registries), disease rates and trends, case-control studies, and cohort studies. These methods cannot prove a causal relationship between exposure to a possible carcinogen and the occurrence of disease. Consistent positive or negative evidence, confirmed by multiple epidemiologic approaches, can be used to guide physicians and regulatory agencies in formulating policy for the clinical use of OCs. Both the progestogen-only and the combined OCs have been shown to have a protective effect on the development of benign breast disease with this protective effect not appearing until 2 years of use. Long-term combined OC use appears to be related to the development of benign liver neoplasia, and this risk increases with the dose of the steroid and the age of the user. These lesions are quite rare but may be life threatening because of potential spontaneous rupture and hemorrhage. Long-term postmenopausal use of estrogens appears to increase significantly the risk of developing endometrial hyperplasia and adenocarcinoma of the endometrium. Estrogens appear to be related to the growth of pre-existing uterine leiomyomas. Endocervical cells under the influence of progestogens may develop adenomatous changes, and these benign changes have on occasion been misinterpreted as carcinoma.

Changes in Concentration of Volatile Sulphur Compounds of Mouth Air During the Menstrual Cycle

Information and attitudes about contraception and pregnancy were assessed with a self-administered questionnaire in a sample of urban Black teenagers. Data were obtained from 607 male and female students in high school health classes and a demographically similar group of 123 never-pregnant teenage women in a family planning clinic who had not attended these classes. Males were less likely to recognize the risk of pregnancy, had less information about contraceptives, and fewer attitudes that supported contraceptive use than females who participated in the same shool health classes. More males than females indicated that school classes had been the main source of contraceptive information. Teenage women in the family planning clinic did not differ from the high school females in attitudes about contraceptives, but the school group had somewhat more contraceptive information. The female school group was more likely to have discussed contraception with parents, obtained more contraception information from their mothers, and discussed contraception more with male friends than the teenagers who requested contraceptives at the family planning clinic.

Preliminary experience with Norplant® in an inner city population

Five female subjects were studied to determine the applicability of volatile sulphur analysis of mouth air to monitor chemical, cytological and physiological changes observed during the menstrual cycle. Volatile sulphur results were compiled over twelve ovulatory cycles derived from two or three consecutive cycles from each subject. The results of mouth air evaluations were compared with concurrently determined levels of hormones in blood serum and organic metabolites in vaginal secretions. Distinct cyclic variations were observed in concentrations of all three volatile sulphur components (hydrogen sulphide, methyl mercaptan and dimethyl sulphide) of mouth air. There was a definite overall trend for the compounds to increase two- to four-fold immediately around mid-cycle and menstruation as well as during mid-proliferative and mid-luteal phases of each menstrual cycle. In those cycles in which hormonal profiles were obtained, the increase in volatile sulphur content closely coincided with the mid-cycle surge in luteinizing hormone, while the peak during the mid-luteal phase corresponded to a period of maximum level of progesterone and elevated oestrogens. The concentrations of lactic acid and urea in vaginal secretions also underwent cyclic changes analogous to those described for volatile sulphur components of mouth air. The occurrence of malodourous concentrations of hydrogen sulphide and methyl mercaptan immediately around menses in most of the cycles studied satisfactorily accounts for the reported incidence of breath malodour observed during this time.

Comparison of adolescent and adult experiences with norplant levonorgestrel contraceptive implants

Norplant, the five-year subdermal contraceptive system, is the first implantable contraceptive method approved for general use in the United States. We describe the preliminary experiences of 246 U.S. women who accepted Norplant between April, 1991 and September, 1991. Norplant was well accepted among this diverse general population. Intensive counselling about side effects, especially menstrual changes, is crucial for patient satisfaction. Although 48% of acceptors experienced menstrual cycle changes and 70% experienced at least one side effect, phone calls and unscheduled visits for problems were infrequent. Adequate counselling about side effects obviates the need for a routine follow-up visit one month after insertion.

Never-pregnant adolescents and family planning programs: contraception, continuation, and pregnancy risk.

Objective: To compare acceptability, tolerance of side effects, and continuation rates among adolescent and adult Norplant accepters. Methods: An 18‐month observational study was conducted of 136 adolescents and 542 adults who received Norplant at the Francis Scott Key Medical Center in Baltimore, Maryland. Data were collected from the following: a self‐administered history form completed at the preinsertion visit, a self‐administered follow‐up form completed at routine follow‐up visits, problem‐visit chart review, and telephone contact for patients noncompliant with follow‐up appointments. Results: The adolescents ranged in age from 13‐18 years (mean 16.4), and adults ranged in age from 19‐46 (mean 24.7). The mean parity among teenagers was 1.4; among adults, 3.2. Thirty‐nine percent of teenagers and 64% of adults had had one or more therapeutic abortions. Forty percent of adolescents and 47% of adults reported at least one contraceptive failure in the past. Both adolescent and adult Norplant accepters made few telephone calls or problem visits because of complaints or side effects. Compliance with routine annual follow‐up was poor for adolescents (24 of 136, 18%) and adults (72 of 542, 13%). Follow‐up of noncompliant patients revealed low rates of implant removal. Fifteen adolescents (11%) and 60 adults (11%) had Norplant removed. The most common reasons for removal included irregular bleeding, weight gain, headaches, and desire for pregnancy. Conclusions: Implant acceptability, continuation, and tolerance of side effects were high and comparable among adolescent and adult accepters. Initial implant users were primarily adolescents or adults who had experienced problems with other forms of reversible contraception. Adherence to scheduled follow‐up appointments was poor, regardless of age. (Obstet Gynecol 1994;83:1026‐32)