Michelle M. Isley

Sex education and contraceptive use at coital debut in the United States: Results from Cycle 6 of the National Survey of Family Growth

BACKGROUND The study was conducted to characterize the relationship between formal sex education and the use and type of contraceptive method used at coital debut among female adolescents. METHODS This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Contraceptive use and type used were compared among sex education groups [abstinence only (AO), birth control methods only (MO) and comprehensive (AM)]. Analyses also evaluated the association between demographic, socioeconomic, behavioral variables and sex education. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest. RESULTS Of 1150 adolescent females aged 15-19 years, 91% reported formal sex education (AO 20.4%, MO 4.9%, AM 65.1%). The overall use of contraception at coitarche did not differ between groups. Compared to the AO and AM groups, the proportion who used a reliable method in the MO group (37%) was significantly higher (p=.03) (vs. 15.8% and 14.8%, respectively). CONCLUSIONS Data from the 2002 NSFG do not support an association between type of formal sex education and contraceptive use at coitarche but do support an association between abstinence-only messaging and decreased reliable contraceptive method use at coitarche.

Oral contraceptives vs injectable progestin in their effect on sexual behavior

OBJECTIVE We sought to compare sexual function and hormone concentrations in combined oral contraceptive (COC) and injectable progestin users. STUDY DESIGN Sexually active COC and depot medroxyprogesterone acetate (DMPA) users completed the Female Sexual Function Index (FSFI) questionnaire, a demographic data form, and had serum testosterone and estradiol levels measured. Multiple linear regression was used to measure associations of interest. RESULTS Among 50 subjects enrolled, COC users had lower levels of free testosterone compared to DMPA users (0.2 vs 0.6 pg/mL; P < .0001) and higher levels of estradiol (75.8 vs 62.8 pg/mL; P = .0057), but scores of desire (4.2 vs 3.8; P = .27), scores of arousal (5.0 vs 4.8; P = .46), or total scores (30.1 vs 28.8; P = .28) were no different. Demographic characteristics were similar except for ethnicity, level of education, gravidity, parity, and frequency of intercourse. In multivariate analysis, birth control type was not significantly associated with desire score or total FSFI score. CONCLUSION While users of COC and DMPA have significantly different sex hormone levels, they are not different in sexual function as measured by the FSFI.

Blood loss at the time of first-trimester surgical abortion in anticoagulated women

BACKGROUND The objective of this study was to compare blood loss resulting from surgical termination of pregnancy up to 12 weeks of gestation between women receiving anticoagulation therapy and healthy controls. STUDY DESIGN Women using heparin, low-molecular-weight heparin or warfarin requesting surgical abortion were enrolled and prospectively matched with nonanticoagulated controls. The primary outcome was procedural blood loss. Additional outcomes included postprocedure blood loss (prior to discharge and 7 days following the procedure using standardized feminine hygiene products) and hemoglobin change (preoperative vs. Postoperative Day 1). RESULTS Four anticoagulated subjects and six control subjects were included in the analysis. The median blood loss at the time of the procedure was 70 mL (range 6-187) for the anticoagulated group and 22.5 mL (range 10-100) for the control group (p=.33). The median blood loss in the postoperative period prior to discharge was 10.5 mL (range 1-11) for the anticoagulated group and 5.5 mL (range 2-35.4) for the control group (p=.82). There were no differences in use of hygiene products or mean hemoglobin change between groups. No interventions for bleeding were necessary at the time of the procedure. CONCLUSIONS Anticoagulated women appear to have an increase in blood loss during and immediately following first trimester surgical abortion as compared to healthy controls. However, this increase does not appear to be clinically significant.

Intrauterine lidocaine infusion for pain management during outpatient transcervical tubal sterilization: a randomized controlled trial.

BACKGROUND The study was conducted to examine the effects of a 4% intrauterine lidocaine infusion on patient-perceived pain during transcervical sterilization. STUDY DESIGN This was a randomized, double-blind, placebo-controlled trial. Subjects received standard premedication with 800 mg ibuprofen, 2 mg lorazepam, a 10-mL 1% lidocaine paracervical block and transcervical instillation of 5 mL of either 4% lidocaine or saline 3 min prior to insertion of the hysteroscope. Subjects completed a series of 100-mm visual analog scales to measure their perceived pain at set time points during and after the procedure. Serum lidocaine levels were obtained in a subset of subjects. RESULTS Pain scores at all evaluation points did not significantly differ between groups (lidocaine n=29, saline n=29). Mean lidocaine levels did not differ between groups, and no subject demonstrated symptoms of lidocaine toxicity. The highest serum lidocaine level (4022 ng/mL) occurred 20 min after infusion in a lidocaine-treated subject. CONCLUSION Intrauterine lidocaine prior to outpatient transcervical sterilization does not decrease pain.

Sterilization. A Review and Update.

Sterilization is a frequently used method of contraception. Female sterilization is performed 3 times more frequently than male sterilization, and it can be performed immediately postpartum or as an interval procedure. Methods include mechanical occlusion, coagulation, or tubal excision. Female sterilization can be performed using an abdominal approach, or via laparoscopy or hysteroscopy. When an abdominal approach or laparoscopy is used, sterilization occurs immediately. When hysteroscopy is used, tubal occlusion occurs over time, and additional testing is needed to confirm tubal occlusion. Comprehensive counseling about sterilization should include discussion about male sterilization (vasectomy) and long-acting reversible contraceptive methods.

Management of a rapidly enlarging new adnexal mass: a rare case of desmoplastic small round cell tumor of the ovary arising in pregnancy

Background Desmoplastic small round cell tumor (DSRCT) is an extremely rare sarcomatous tumor, which is most commonly seen in men. Clinicians managing a patient with a rapidly enlarging mass in pregnancy should be aware of the risk for malignancy. Case A 31-year-old woman was found to have a newly enlarged ovarian mass in the second trimester. She subsequently underwent a laparotomy for removal, with chemotherapy for presumed poorly differentiated ovarian malignancy. Ultimately she was diagnosed with a desmoplastic small round cell tumor of the ovary and had progression at time of delivery. Following cesarean delivery, she had a tumor reductive surgery. She has completed 12 cycles of intensive chemotherapy and is alive with disease at 14 months. Conclusion Care should be taken not to delay evaluation of a rapidly enlarging mass in pregnancy. While this tumor type is extremely rare, a malignancy in pregnancy must be ruled out in this clinical scenario.

Progestin-Only Contraception and Bone Health

Purpose of ReviewProgestin-only contraceptive methods are important and effective options for women trying to prevent unintended pregnancy. There is concern about progestin-only methods and bone health, particularly for depot medroxyprogesterone acetate (DMPA), because progestin-only methods can lower estradiol levels through ovarian suppression. This is of particular concern for adolescents building bone and perimenopausal women heading towards menopause.Recent FindingsDMPA does cause temporary bone loss, but this is reversible after discontinuation. Evidence is limited as to whether the decreased bone density and subsequent reversal that is seen with DMPA use leads to an increased risk of fracture in the future. Two observational studies indicate a weak association between DMPA use and fracture risk. Progestin-only implants, pills, and the intrauterine device do not have an impact on bone mineral density or fracture risk.SummaryUse of DMPA or any other progestin-only method should not be restricted due to a theoretical risk of fractures when reproductive-age women face the very real risk of pregnancy.