Role of gender in sexual behaviours and response to education in sexually transmitted infections in 17-year-old adolescents

Objective

to investigate gender differences in high school students with respect to sexual risk behaviours, and their perceptions of the effect of an educational programme on sexually transmitted infections (STIs). In addition, this study aimed to investigate differences between students in programmes preparing for university compared with vocational programmes.

Participants, setting and design

second-year high school adolescents from two communities in south-west Sweden were invited to participate in the study, and completed a questionnaire on sexual experience, sexual risk behaviours and the impact of the educational programme on STIs.

Findings

males took less responsibility for STI prevention than females. Furthermore, males perceived themselves to be less influenced by the STI education than females. Females had more experience of same-sex sexuality than males.

Conclusions and implications for practice

males take less responsibility for STI prevention than females. When planning STI education, it is important to consider gender, traditions and various learning styles. If STI education fails to reach males, the prevalence of these infections will continue to increase.     

Condom use among married women at risk for sexually transmitted infections and HIV in rural China

Objective

To assess factors associated with condom use among married women in rural China, and provide evidence for implementing education strategies to prevent sexually transmitted infections and HIV.

Methods

A total of 737 sexually active married rural women who were aged between 18 and 49 years and had heard of AIDS were selected by cluster sampling and interviewed in 8 villages of Anhui province, China.

Results

The rate of condom use was only 5.4%.There were no significant differences in sexual behavior and condom use between married women whose husbands were away as migrant workers and the wives of nonmigrant men, except in knowledge of free condom sources. Significant factors associated with condom use included age, level of education, knowledge about condoms, training about condoms, sources of condoms, and husbands' attitude toward condoms.

Conclusions

More educational interventions are needed to increase condom knowledge and promotion, especially among less educated women and married women left behind by migrant husbands.     

Sexual violations among married women in southeastern Nigeria

Objective

To investigate domestic sexual violations in southeastern Nigeria and the opinions of married women regarding sexual rights for women.

Method

Married women attending gynecologic clinics at 3 major hospitals in Enugu, Nigeria, completed a structured questionnaire.

Results

A culture of male dominance seemed to be the leading cause for the following high rates: husband's total monopoly on decisions regarding sex, 54.1%; inability to refuse the husband's demands for sex, 60.7%; sex-related verbal abuse, 39.3%; sex-related physical violence, 16.2%; and forced sex, 19.1%. Women with a university education and unemployed women reported sexual violations more frequently than did others. Most respondents supported sexual rights for women.

Conclusion

Married women in southeastern Nigeria still are denied sexual rights, apparently owing to a culture of male dominance. A higher education alone may not lead to the advent of sexual rights for women, and a greater emphasis should be placed on societal reorientation.     

Sexuality and psychological wellbeing in women with polycystic ovary syndrome compared with healthy controls

Objectives

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of fertile age. The aim was to study whether PCOS has an effect on sexual functioning.

Study design

Women meeting the Rotterdam criteria for PCOS (n = 49), and 49 age-matched controls identified from the population registry, were recruited. Sexual functioning was assessed by means of (i) an in-person, structured interview covering various aspects of sexuality, and (ii) the nine-item McCoy questionnaire of female sexual satisfaction. Participants also completed the Psychological General Well-Being Index.

Results

Almost half the women with PCOS reported that the disorder had a great impact on their sex life. Despite having the same number of partners and about the same frequency of sexual intercourse, women with PCOS were generally less satisfied with their sex lives compared to the population-based controls. Within the group of women with PCOS, high body mass index had only a minor effect on sexual functioning, while the total serum level of testosterone correlated positively to sexual satisfaction. PCOS women scored numerically lower than controls on the McCoy total score, but this difference was not statistically significant.

Conclusion

Women with PCOS reported decreased satisfaction with their sex life. Sexual function should be taken into account in treatment trials of PCOS, which traditionally target only symptoms related to insulin resistance, overweight, and hirsutism.     

Sexual Quality of Life and Association With HIV and Sexually Transmitted Infections Among a Cohort of Heterosexual Couples in Kenya

Introduction

Sexual quality of life (SQoL) is a critical component of sexual health and is understudied in Sub-Saharan African settings with endemic HIV and sexually transmitted infection (STI).

Transretropubic traction vaginoplasty for correction of vaginal aplasia

Objective

To introduce an alternative approach to vaginoplasty using transretropubic traction (TRT).

Methods

In this case series with 4 patients with complete vaginal aplasia, a plastic “olive” placed on the vaginal dimple was lifted by a mesh tape inserted through the space of Retzius and anchored to the anterior abdominal wall.

Results

On day 8 postoperatively all patients had a reasonable vaginal size, 2.5 to 3 cm in width and 6 to 7.5 cm in length. The mean satisfaction scores were 86 points for the patients and 89 points for their husbands, who also reported a mean penetration score of 90 points.

Conclusion

As a minimal-access and relatively simple operation, TRT vaginoplasty could be performed by trained gynecologists. Studies with larger populations are required to support this preliminary report.     

Anal dilation during labor

Objective

To determine the incidence and range of anal dilation during the final phase of the second stage of labor and shortly after delivery; determine whether parity affects anal dilation; and obtain anthropometric data for future projects.

Methods

The anal diameter was measured on admission, when the fetal head crowned, and after suturing perineal injury in 142 women delivered between August 2008 and May 2009 at University Hospital Pilsen and District Hospital Klatovy, in the Czech Republic.

Results

The anus was dilated during the second stage of labor in all women, and differences between primiparas and multiparas were not significant. The medians for both the anteroposterior and transverse diameters were 25 mm. No measured variable was statistically associated with anal sphincter dilation.

Conclusion

Anal dilation during the second stage of labor causes anthropometric changes to the perineum. This ought to be considered when designing anthropometric studies and in studies aiming at minimizing anal sphincter trauma during delivery.     

History of sex trafficking, recent experiences of violence, and HIV vulnerability among female sex workers in coastal Andhra Pradesh, India

Objectives

To estimate the prevalence of sex trafficking as a mode of entry into sex work, and to examine associations between sex trafficking and recent violence experiences and HIV vulnerability among female sex workers (FSWs).

Methods

In a cross-sectional study in 2006 in coastal Andhra Pradesh, India, 812 FSWs were recruited via respondent-driven sampling to take part in an oral survey of their experiences in sex work.

Results

One in 5 (19.3%) FSWs met the UN definition of sex trafficking. Women trafficked into sex work were more likely than other FSWs to report recent violence experiences (adjusted odds ratio [AOR], 1.93; 95% confidence interval [CI], 1.32-2.81), more clients per week (AOR, 1.63; 95% CI, 1.11-2.41), and more days of sex work per week (AOR, 1.76; 95% CI, 1.18-2.63), and were less likely to report use of FSW-focused services (AOR, 0.60; 95% CI, 0.42-0.86). No significant differences emerged regarding HIV knowledge or consistent condom use.

Conclusion

There was a high prevalence of sex trafficking. A history of sex trafficking was associated with a greater vulnerability to recent violence and HIV risk behaviors, underscoring the need for increased attention to the public health needs of trafficked populations.     

Sexual dysfunction among women of low-income status in an urban setting

Objective

To determine demographic and clinical conditions associated with sexual dysfunction among women of low-income status living in an urban setting.

Methods

Cross-sectional study of 102 consecutive women attending an urban gynecology clinic. Women were given validated questionnaires to measure sexual function, depression, urinary incontinence, and erectile dysfunction in the partner. The association of sexual dysfunction with demographic variables, depression, urinary incontinence, and sexual function in the partner was assessed by the respondent.

Results

The prevalence of sexual dysfunction was 37.3% (n = 38). Women with sexual dysfunction reported significantly lower scores on all subscales of sexual function compared with women without sexual dysfunction. Women with sexual dysfunction were more likely to be older (33 ± 11.2 vs 28.7 ± 8.6; P < 0.04), unemployed (68% vs 47%; P < 0.03), and report depression (OR 4.4; 95% CI, 1.7-11.3), urinary urge incontinence (OR 2.7; 95% CI, 1.2-7.3), and intake of multiple medications (OR 5.4; 95% CI, 1.6-20.1). On multivariate analysis, depression and urge urinary incontinence were independently associated with sexual dysfunction.

Conclusion

Female sexual dysfunction is associated with the presence of depression and urge urinary incontinence in women of low-income status living in an urban setting.     

Sex specific changes in placental growth and MAPK following short term maternal dexamethasone exposure in the mouse

Objectives

Maternal glucocorticoid (GC) exposure during pregnancy can alter fetal development and program the onset of disease in adult offspring. The placenta helps protect the fetus from excess GC exposure but is itself susceptible to maternal insults and may be involved in sex dependant regulation of fetal programming. This study aimed to investigate the effects of maternal GC exposure on the developing placenta.

Study design and main outcome measures

Pregnant mice were treated with dexamethasone (DEX-1 μg/kg/h) or saline (SAL) for 60 h via minipump beginning at E12.5. Placentas were collected at E14.5 and E17.5 and the expression of growth factors and placental transporters examined by real-time PCR and/or Western blot. Histological analysis was performed to assess for morphological changes.

Results

At E14.5, DEX exposed male and female fetuses had a lower weight compared to SAL animals but placental weight was lower in females only. Hsd11b2 and Vegfa gene expression was increased and MAPK1 protein expression decreased in the placentas of females only. At E17.5 placental and fetal body weights were similar and differences in MAPK were no longer present although HSD11B2 protein was elevated in placentas of DEX females. Levels of glucose or amino acid transporters were unaffected.

Conclusions

Results suggest sex specific responses to maternal GCs within the placenta. Decreased levels of MAPK protein in placentas of female fetuses suggest alterations in the MAPK pathway may contribute to the lower placental weights in this sex. This may contribute towards sex specific fetal programming of adult disease.     

Human papillomavirus DNA and mRNA positivity of the anal canal in women with lower genital tract HPV lesions: predictors and clinical implications

Objective

Women with HPV related pathology of the lower genital tract are at higher risk for AIN and anal cancer than the general population. A strategy to identify anal disease in these women has not been formulated. The aim of this study is to examine the feasibility of HPV related biomarker testing on anal smears, to identify the risk factors for anal HPV positivity and to provide information of the clinical implications of anal HPV infection in this population.

Methods

In women referred for colposcopy because of HPV related pathology of the lower genital tract (cervical cancer, CIN, VIN, warts) a detailed questionnaire, an anal smear and a cervical smear were taken. On each sample morphological cytology, flow cytometric evaluation of E6&7 mRNA, and HPV DNA detection and typing were performed. Women with a positive anal result were referred for high resolution anoscopy.

Results

So far 235 women have been included (mean age 34.3). HPV DNA, high-risk HPV DNA, high-risk mRNA was detected in 45%, 31% and 8% of the anal smears and in 56%, 39% and 25% of the cervical smears respectively. Absolute or partial concordance of the types between the cervix and the anus was seen in 74%. Positivity for mRNA was significantly lower in the anus than the cervix (8% vs 25%). Logistic regression analysis revealed risk factors for the presence of anal HPV DNA (> 3 lifetime sexual partners and presence of cervical HPV DNA), hr HPV DNA (presence of cervical hr HPV DNA), and hr mRNA (presence of cervical hr mRNA). Twelve months after LLETZ 53% of women were cervical HPV negative, but 25% of those were still HPV positive in the anus.

Conclusions

HPV infection of the anus is common in this group and is interlinked with the cervical infection. Anal HPV E6&7 mRNA expression is less common than in the cervix. Possible clinical implications of anal infection could be the development of AIN and recurrence of CIN after treatment due to cervical reinfection from the anal reservoir. The use of HPV biomarkers is feasible in anal smears, although especially DNA testing as triage method for referral to anoscopy is probably inappropriate due to high positivity rate.     

Knowledge about HIV infection and acceptability of HIV testing among women delivered in Podkarpackie Province, Poland

Objective

To assess the knowledge of pregnant Polish women regarding the risk of perinatal HIV transmission, the ways to reduce this risk, and the importance of HIV testing in pregnancy, as well as their willingness to be tested for HIV.

Methods

A multicenter survey was conducted with 2123 pregnant women from Podkarpackie Province using a 4-part questionnaire.

Results

Only 15.4% of the women, mainly those with higher education, correctly assessed the risk of perinatal HIV transmission; 61.9% showed adequate knowledge of perinatal HIV transmission, mainly older, well-educated, multiparas residing in towns; and 81.1% declared a willingness to undergo HIV testing, mainly well-educated primigravidas in the 26 to 30 years age group residing in towns.

Conclusion

These pregnant women from Poland, where prenatal HIV testing is rarely done, showed a limited knowledge of perinatal HIV transmission but a high willingness to undergo HIV testing.     

Manometric evaluation of anal sphincter function after vaginal and cesarean delivery

Objective

To compare anal sphincter function following spontaneous vaginal delivery and cesarean delivery, and assess the association of perineal length and sphincter injury with each delivery mode.

Method

Perineal length was measured and anal manometric measurements were performed in 120 primigravidas before and after delivery.

Results

Mean values for maximum anal resting and squeeze pressures were significantly lower after delivery irrespective of the mode of delivery, but there was a positive correlation between postpartum maximum anal resting pressure and perineal length (r = 0.24, P < 0.01).

Conclusion

Anal sphincter function was disturbed after both vaginal and cesarean delivery, a finding weakened by the fact that almost half of the cesareans were performed for cephalopelvic disproportion identified during labor.     

Collagen-coated polypropylene mesh in vaginal prolapse surgery: an observational study

Objective

To determine the incidence and factors associated with the development of bowel, urinary and sexual symptoms following obstetric anal sphincter injury (OASIS).

Study design

A prospective cohort study involving 435 women who sustained OASIS, over a five-year period, in a large UK teaching hospital. Details of bowel, urinary and sexual function were documented using a structured questionnaire. The outcome measures included the incidence of symptoms following OASIS and factors which modify the risk of developing symptoms.

Results

The majority (96%) of women were faecally continent three months after primary OASIS repair. Nevertheless, 34.2% reported faecal urgency, 25% suffered poor flatal control, and nearly 30% reported pain and bleeding on defaecation. Sixteen percent of women reported stress urinary incontinence, 15% experienced urgency and 20% reported urinary frequency. Fifty-seven percent of women had resumed intercourse but 32% of those women reported dyspareunia. Women who developed faecal symptoms were significantly more likely to develop urinary symptoms. Advancing maternal age and the use of forceps, in particular rotational forceps, significantly increase the risk of developing faecal and urinary symptoms.

Conclusions

Obstetric anal sphincter injuries continue to be responsible for significant morbidity, with approximately 30% of women reporting faecal, urinary or sexual symptoms, three months postpartum. This large prospective UK study provides up-to-date information relating to factors which increase the likelihood of such symptoms occurring. These data are useful for counselling and targeting more intensive follow up to women at higher risk of developing symptoms.     

Comparative study of dexamethasone and ondansetron for prophylaxis of postoperative nausea and vomiting in laparoscopic gynecologic surgery

Objective

To compare intravenous dexamethasone and ondansetron for the prophylaxis of postoperative nausea and vomiting (PONV), a main complaint that affects almost 40%-75% of patients undergoing laparoscopic gynecologic surgery.

Methods

In a prospective study, 93 women were divided into 3 groups receiving 4 mg of dexamethasone, 8 mg of dexamethasone, or 4 mg of ondansetron. PONV score was used for assessment during the first 24 hours after surgery.

Results

The incidence of PONV during the 24-hour postoperative period was highest in the ondansetron group (61%). In the first 3 hours, the incidence of PONV in the ondansetron group was also higher: 51.6% as compared with 22.6% and 36.6% in the dexamethasone 4 mg and 8 mg groups, respectively. The overall incidence of PONV was highest in the first 3 hours as compared with later time periods, and there was a linear trend in decreasing PONV among the groups (P = 0.017). In the dexamethasone 4 mg group, the request for a rescue antiemetic was significantly lower: 0% as compared with 6.7% and 16.1% in the dexamethasone 8 mg and ondansetron 4 mg groups, respectively.

Conclusion

Dexamethasone was found to be an efficacious and cost-effective drug for the prophylaxis of PONV.     

Tension-free vaginal tape-obturator in the treatment of stress urinary incontinence: a prospective study with five-year follow-up

Objective

To investigate the prevalence of anal incontinence (AI) in woman with urinary incontinence (UI) and pelvic organ prolapse (POP). We also evaluated the impact on quality of life (QoL).

Study design

One hundred and ninety patients with UI or POP and 73 controls were recruited. AI was investigated by the Wexner index and the prevalence rates were obtained in all groups. Patients with AI completed the Fecal Incontinence Quality of Life questionnaire (FIQL). QoL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36).

Results

AI prevalence was 40.54% in the UI group and 27.91% in the POP group (p < 0.0001). In the UI and POP groups correlations were found between the Wexner score and the domains of the FIQL and SF36.

Conclusion

The UI group had higher prevalence of AI than the other groups. The AI adversely affected the QoL of patients.     

Keratosis reduces sensitivity of anal cytology in detecting anal intraepithelial neoplasia

Objective

To identify factors that may contribute to poor sensitivity of anal cytology in contrast to the sensitivity of anoscopy in heterosexual women.

Methods

We analyzed 324 patients with biopsy confirmed diagnosis of genital intraepithelial neoplasia (either vulva, vaginal, or cervical) from 2006 to 2011 who underwent both anal cytology and anoscopy. Cytology, anoscopy, and biopsy results were recorded. Biopsy specimens underwent independent analysis for quality of specimen. Also, biopsy specimens were analyzed for characteristics that may contribute to correlation, or lack thereof, between anal cytology and anoscopic directed biopsy.

Results

133 (41%) patients had abnormal anoscopy and underwent directed biopsy. 120 patients with normal anal cytology had anoscopy directed biopsies, resulting in 58 cases of AIN (sensitivity 9.4%; 0.039-0.199). This cohort was noted to have extensive keratosis covering the entire dysplastic anal lesion. 18 patients yielded abnormal anal cytology. Of these patients, 13 had anoscopic directed biopsies revealing 6 with AIN and absent keratosis (specificity 88.6%; 0.78-0.95). The κ statistic for anal cytology and anoscopy was − 0.0213 (95% CI = − 0.128-0.086).

Conclusion

Keratosis reduces the sensitivity of anal cytology. Furthermore, anal cytology poorly correlates with anoscopy in the detection of AIN (κ statistic = − 0.0213).     

Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru

Objective

To examine the associations between lifetime physical and/or sexual intimate partner violence (IPV) with pregnancy intent among pregnant women in Lima, Peru.

Methods

A total of 2167 women who delivered at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during the postpartum recovery period. Logistic regression was used to estimate multivariable adjusted odds ratios and 95% confidence intervals.

Results

Lifetime physical or sexual violence (40.0%) and unintended pregnancies (65.3%) were common in the study population. Compared with non-abused women, abused women had a 1.63-fold increased risk for unintended pregnancy. Unintended pregnancy risk was 3.31-fold higher among women who experienced both physical and sexual abuse compared with non-abused women. The prevalence and severity of physical violence during pregnancy was greater among women with unintended pregnancies compared with women with planned pregnancies.

Conclusion

The findings indicate the need to include IPV screening and treatment in prenatal care and reproductive health settings.     

Availability and quality of emergency obstetric care in Shanxi Province, China

Objective

To investigate the availability and quality of emergency obstetric care (EmOC) received by women in a rural Chinese province.

Methods

The study was conducted in 7 rural counties and townships in Shanxi Province, China. Data sources included interviews with 7 hospital leaders, 5 maternal and child health workers, and 7 obstetricians; 118 records of complicated delivery were audited, 21 Maternal and Child Health Annual Reports analyzed, and observations conducted of facilities and advanced labor care.

Results

The number of comprehensive EmOC facilities was adequate in all counties. Three counties had fewer basic EmOC facilities than recommended and only 4 counties reached the recommended level. Most of the existing township hospitals did not provide birthing services. All the county hospitals could perform cesarean deliveries with rates from 6.8%-40.8%. The management of complications was not evidence-based. For example, women with pre-eclampsia and eclampsia were given too little magnesium sulfate; women were not closely monitored for hemorrhage after birth and the partograph was used incorrectly with consequences for obstructed labor.

Conclusion

Basic EmOC facilities are not adequate and township hospitals should be upgraded to provide birthing services. The quality of EmOC is poor and needs improvement.     

A report on the reproductive health of women after the massive 2008 Wenchuan earthquake

Objective

To evaluate the reproductive health of women in the aftermath of the 2008 Richter scale 8.0 Wenchuan earthquake in China.

Methods

Gynecologists surveyed 170 women using a questionnaire inquiring about symptoms of reproductive tract infection, menstruation disorders, satisfaction with sexual life, and desire for fertility.

Results

The rates of symptoms of lower genital tract infection were higher after than before the earthquake (50.0% vs 26.5%), as were the rates for pelvic inflammatory disease (35.9% vs 19.4%) and menstruation disorders (51.8% vs 22.4%) (P < 0.05 for all). At the same time, the women's satisfaction with their sexual life was markedly decreased; 89.4% of them said they would not pursue a plan to become pregnant; and 67.1% said they would request pregnancy termination if they became pregnant.

Conclusion

The findings of this first population-based assessment of reproductive health following the massive Wenchuan earthquake may help in shaping public health measures benefiting women surviving large-sale disasters.