Knowledge and Awareness of HPV Infection and Vaccination Among Urban Adolescents in India: A Cross-Sectional Study

Aim of the Study

To assess the level of awareness and knowledge of HPV infection and vaccination among 1,000 adolescent girls from secondary schools and colleges in five metro cities of India—Ahmedabad, Cuttack, Lucknow, Gwalior, and Visakhapatnam. To evaluate participants own interest and barriers toward HPV vaccination for cervical cancer prevention.

Materials

This cross-sectional study was conducted by Adolescent Health Committee of FOGSI from April 2009 to March 2010 under the project “protecting young girls.” Girls of 13–19 years, with an average of 16 years are targeted.

Methods

A written questionnaire with two parts has been applied. A preliminary written questionnaire included questions of knowledge on cancer cervix and HPV awareness. Then, health talk on HPV is given by the researcher and group discussions lasting for 20 min. Second questionnaire was then applied to evaluate effectiveness of the talk.

Results

The study group participants are poorly aware about HPV infection and vaccination but are intensely willing to know about it and get vaccinated. 72 % of them did not know about cervical cancer or HPV. 77.2 % were not aware of the virus that causes cancer cervix. After the health talks. there is an overall significant positive improvement in both knowledge and awareness. 74.4 % of them agreed to get vaccinated.

Conclusions

This study brings out the unawareness about HPV infection and vaccination in urban adolescent girls in five metro cities in India. Results show a changing positive trend of acceptance toward HPV vaccination. Adolescent understanding of HPV is needed to have successful vaccination programs in India.     

Obstetrician-gynecologists and the HPV Vaccine: Practice Patterns, Beliefs, and Knowledge

Study ObjectiveHuman papillomavirus (HPV), the most common sexually transmitted infection in the United States, can be contracted by young girls shortly after sexual debut. Human papillomavirus can lead to cervical and anogenital cancers and genital warts. A vaccine has been developed to protect against precancerous lesions. We examined obstetrician-gynecologists' practices, opinions, and knowledge regarding this vaccine.DesignA 37-item questionnaire was sent out by the American College of Obstetricians and Gynecologists (ACOG) to its fellows and junior fellows between May and November of 2007.ParticipantsSurveys went to 3896 fellows and junior fellows of ACOG. Of these surveys, 771 were Collaborative Ambulatory Research Network (CARN) members who have volunteered to receive several surveys per year. The remaining 3125 questionnaires were sent to all fellows and junior fellows in ACOG's District V (Ohio, Kentucky, Indiana, Michigan and Ontario, Canada). Response rates were 51.0% and 30.7% for CARN and District V, respectively.ResultsOf those who administer vaccines, most offer the HPV vaccine. Most know this vaccine protects against 4 HPV types. Fewer knew the percentages of cervical cancers and genital warts prevented. Over 20% knew all 3 answers. Only a minority answered all incorrectly. Approximately 15% view HPV vaccine as safe in pregnancy. Many agree cost is a reason for patient refusal and a deterrent from mandating the vaccine.ConclusionObstetrician-gynecologists are knowledgeable of the HPV vaccine and are incorporating it into practice. Financial concerns may limit widespread immunization.     

Racial and Ethnic Differences in HPV Knowledge,Attitudes, and Vaccination Rates among Low-income African-American,Haitian, Latina,and Caucasian Young Adult Women

ObjectiveTo examine facilitators and barriers to HPV vaccine uptake in African-American, Haitian, Latina, and White women aged 18-22 and to determine vaccination completion rates among participants over 5 years.DesignUsing semi-structured interviews and medical record review, we assessed HPV knowledge and attitudes towards HPV vaccination among young women. We then determined their subsequent HPV vaccination initiation and completion rates. We used constructs from the Health Belief Model and methods based in grounded theory and content analysis to identify attitudes towards HPV vaccination cues to initiate vaccination, perception of HPV, and how communication about issues of sexuality may impact vaccine uptake.ParticipantsWe enrolled 132 African-American, Haitian, Latina, and White women aged 18-22 years who visited an urban academic medical center and 2 affiliated community health centers between the years 2007 and 2012.Main Outcome MeasuresIntent to vaccinate and actual vaccination rates.ResultsOf 132 participants, 116 (90%) stated that they were somewhat or very likely to accept HPV vaccination if offered by their physician, but only 51% initiated the vaccination over the next 5 years. Seventy-eight percent of those who initiated vaccination completed the 3 doses of the HPV vaccine series. Forty-five percent (45%, n = 50) of the adolescents who started the series completed 3 doses over a 5-year period: 42% of African-American (n = 16), 33% of Haitian (n = 13), 63% of Latina (n = 10), and 65% of White young women (n = 11) completed the 3-dose series. Despite low knowledge, they reported high levels of trust in physicians and were willing to vaccinate if recommended by their physicians.ConclusionDesire for HPV vaccination is high among older adolescents, physician recommendation, and use of every clinic visit opportunity may improve vaccine uptake in young women. More White young women completed the HPV vaccine series compared with other race and ethnic young women.     

Female genital mutilation: Knowledge,attitudes and practices of Flemish gynaecologists

Objective?To assess the knowledge, attitudes and practices with regard to female genital mutilation (FGM) among gynaecologists in Flanders, Belgium.

Methods?A questionnaire-based survey was sent to 724 Flemish gynaecologists and trainees.

Results?Three-hundred-and-thirty-four questionnaires were returned. The survey revealed gaps in the knowledge of FGM and the provision of care by Flemish gynaecologists to women who had been mutilated. It also appeared that FGM was not properly addressed in the basic and specialized medical training in Flanders, that little was known about codes of conduct issued by the hospitals when these were not lacking altogether, and that knowledge about legislation concerning FGM was deficient. There was much confusion whether re-infibulation is authorized, and what its legal status is. Some respondents considered cosmetic vaginal surgery as a form of FGM and many were in favour of the medicalization of FGM. Gynaecologists were most commonly confronted with complaints related to sexual problems caused by FGM. Finally, the study also showed that only about a third of the gynaecologists were discouraging women from having their daughters excised.

Conclusion?There is a need for a thorough discussion among all those concerned of the ethical and legal aspects of re-infibulation, medicalization of FGM and cosmetic vaginal surgery.     

Female university students' attitudes to future motherhood and their understanding about fertility

Objectives As highly educated women tend to postpone childbearing, the purpose was to explore female university students' attitudes to future motherhood and their understanding about fertility.

Methods Female students (n = 300), visiting a Student Health Centre in Sweden, answered a questionnaire with mainly multiple choice questions and verbal rating scales.

Results The women wanted to have two to three children at the age of 29 for the first birth and 35 for the last. Only 2.7% did not plan to have any children. Six out of 10 would consider having an abortion if confronted with an unplanned pregnancy ‘right now’. The most important circumstances for women's decision to have children were to be sufficiently mature, have a stable partner to share parenthood with, have completed studies and have a good economy. Having children before they got ‘too old’ was only ranked as very important by 18% of women. The women had an acceptable understanding about fertility.

Conclusions It appears that female university students are not very concerned about having children before they get ‘too old’. Therefore, it is important that caregivers, working with contraceptive counselling also include information about fertility, especially to women who intend to postpone their motherhood.     

Cognitive-Affective Factors and Female Orgasm: A Comparative Study on Women With and Without Orgasm Difficulties

BackgroundOrgasmic difficulties are one of the most common sexual complaints among women. Although models of sexual dysfunction propose that cognitive-affective factors are involved in the development and maintenance of sexual difficulties, there is a need to further examine how these factors are associated with orgasmic difficulties specifically.AimTo analyze differences between women who reported orgasm difficulties and controls in regard to sexual inhibition, sexual excitation, sexual beliefs, as well as negative automatic thoughts and affect during sexual activity.MethodsA total of 500 women, aged 18 to 72 years, completed a Web survey focused on cognitive-affective factors and sexual health. Two hundred fifty women reported orgasm difficulties and were compared with 250 age-matched women who reported no sexual difficulties.OutcomesDifferences between groups regarding sexual inhibition and sexual excitation (Sexual Inhibition/Sexual Excitation Scales–Short Form), sexual beliefs (Sexual Dysfunctional Beliefs Questionnaire), negative automatic thoughts (Automatic Thoughts Subscale of the Sexual Modes Questionnaire), and affect (Positive and Negative Affect Schedule) during sexual activity.ResultsWomen with orgasm difficulties scored higher on sexual inhibition than controls. They also reported more negative automatic thoughts during sexual activity (concerning failure and disengagement, sexual abuse, lack of affection from partner, passivity, body image) and less erotic thoughts. Women with orgasm difficulties reported experiencing higher negative affect and lower positive affect during sexual activity than women who reported no sexual difficulties. No significant differences were found regarding sexual excitation and endorsement of sexual beliefs.Clinical ImplicationsHelping women shift their focus from non-erotic, negative thoughts to erotic stimuli, as well as addressing sexual inhibition, can be relevant targets of interventions aimed at women's orgasm difficulties.Strengths & LimitationsStrengths of the study include the use of a large sample of women who reported orgasm difficulties, offering new insights into the clinical importance of these psychological processes. Limitations include the reliance on self-report measures and a relatively homogeneous sample regarding sexual orientation, education, and age.ConclusionResults highlight the role of cognitive-affective factors on women's orgasm difficulties and emphasize the potential benefit of cognitive-behavioral and/or mindfulness interventions for orgasm difficulties.Moura CV, Tavares IM, Nobre PJ. Cognitive-Affective Factors and Female Orgasm: A Comparative Study on Women With and Without Orgasm Difficulties. J Sex Med 2020;17:2220–2228.     

Change in knowledge of women about cervix cancer,human papilloma virus (HPV) and HPV vaccination due to introduction of HPV vaccines

Objectives

Test knowledge of HPV, cervix cancer awareness and acceptance of HPV vaccination of women now and a year ago.

Study design

Questionnaires were filled out by 305 women visiting four gynaecologists of the Regional Hospital Heilig Hart, Tienen, Belgium during two subsequent weeks. Fisher T or Chi² were used as statistical methods to compare the data with the survey of 381 women exactly one year before.

Results

Knowledge about HPV as a cause of cervix cancer and the presence of a vaccine rose from roughly 50% in 2007 to over 80% in 2008 (p < 0.0001). Level of education and having daughters, sons or no children no longer influenced the level of knowledge or willingness to accept the vaccine. Most parents favor the age group 12–16 years as an ideal time for vaccination. In contrast with the 2007 survey, women below 26 years had now acquired almost equivalent knowledge to older women about the virus, cervix cancer and the vaccine, but they were far less likely to accept the vaccine due to its cost, unless it would be reimbursed (OR 4.2 (1.6–11) p = 0.0055).

Conclusion

One year after introduction of the first two HPV vaccines, over 75% of women attending an ambulatory gynaecology clinic know HPV causes cervix cancer and that you can get vaccinated against it. Compared with a year earlier, young and lower educated women had dramatically improved their knowledge. However, women below 26 years are less prepared to pay the cost for vaccination if it is not reimbursed.     

Knowledge, awareness, and attitudes of female sex workers toward HPV infection, cervical cancer, and cervical smears in Thailand

Objective

To determine the knowledge, attitudes, and awareness of female sex workers (FSWs) regarding cervical cancer and its prevention in Thailand.

Method

From August through November 2008, 402 consecutive FSWs were recruited for interviews.

Results

The mean knowledge score was 4.9 (maximum possible, 15; range, 0-14). Approximately 60% of the FSWs had knowledge scores less than 5. Low education and a lack of health insurance were significant independent predictors of low knowledge scores (adjusted odds ratios, 3.17 and 1.97, respectively). More than half of the FSWs were unaware of being at higher risk for HPV infection or of the possible consequences of HPV infection. The negative attitude regarding cervical screening was caused by the fear of abnormal results (27.9%), experiencing pain (18.4%), and embarrassment (14.7%).

Conclusion

The knowledge and awareness of HPV infection, cervical cancer, and utility of cervical smears is low among FSWs in Thailand. Designing and implementing effective interventions is crucial and merits attention in future research.     

Prevalence of Female Circumcision among Young Women in Beni-Suef,Egypt: A Cross-Sectional Study

Study Objective

Female circumcision (FC) is a deeply rooted practice in Egypt with deblitating physical and psychological consequences. During the past 2 decades there have been sincere efforts to reduce this practice. The objective of this study was to investigate the prevalence of circumcision.

A National Survey of Canadian Physicians on HPV: Knowledge,Barriers, and Preventive Practices

Objective

Physicians are the sole prescribers of the human papillomavirus (HPV) vaccine for adults in Canada. This survey of Canadian physicians aimed to explore knowledge, barriers, and preventive practices regarding HPV vaccination.

Knowledge of the Female Athlete Triad,and Prevalence of Triad Risk Factors among Female High School Athletes and their Coaches

Study ObjectiveThis study aimed to determine awareness/knowledge of the Triad and its health implications among female high school athletes and their coaches, and to evaluate coaches' Triad screening/intervention practices.DesignCross-sectional survey.SettingTwo high schools in the western United States.ParticipantsFemale athletes from a variety of sports (N = 240) ages 14-18 years and their coaches (N = 10).InterventionParticipants completed surveys that assessed Triad knowledge and athlete Triad risk factors.Main Outcome MeasuresFrequency of responses to Triad knowledge, Triad risk factor, and Triad education/screening procedures questions; athlete summative knowledge score.ResultsHalf (N = 120) of participants reported menstrual irregularity, and 42% (N = 101) had 2 or more Triad risk factors: past amenorrhea (N = 39), past stress fracture (N = 41), self-reported not eating enough (N = 53), underweight (BMI-for-age < 5^th percentile) (N = 10), pressure to be a certain weight (N = 143), and wanting to lose >10 pounds when self-reported weight was in a healthy range (N = 34). Average athlete Triad knowledge score was 2.97 ± 1.61 out of 8. Coach Triad knowledge was limited; however, most (9/10) were comfortable discussing menstruation with their athletes. Barriers to Triad screening/education were coaches' insufficient time, knowledge, and educational resources.ConclusionTriad risk factors were prevalent among athletes and coach and athlete Triad knowledge was low. Providing coaches with Triad screening/education training may increase Triad knowledge and decrease Triad risk among high school athletes.     

A National Survey of Canadian Adults on HPV: Knowledge,Attitudes, and Barriers to the HPV Vaccine

ObjectiveIdentifying human papillomavirus (HPV) vaccination motivators and barriers among adults could lead to new approaches to improve HPV vaccination rates in non-pediatric populations. This Canadian survey aimed to assess current knowledge of, attitudes towards, and barriers to the HPV vaccine among the general public.MethodsAn online panel was used to survey HPV unvaccinated women (n = 802) and vaccinated women (n = 250) 18 to 45 years old, as well as 18- to 26-year-old men (n = 200), in May and June 2016. A 16-item questionnaire collected data on sociodemographic factors, health-seeking behaviours, knowledge of HPV infection and its consequences, and the HPV vaccine. Data were stratified by sex and by vaccination status among women.ResultsThe majority of individuals somewhat or strongly agreed that vaccination is an important aspect of disease prevention (vaccinated women, 93%; unvaccinated women, 85%; and men, 59%). However, a high proportion of patients were concerned about vaccine safety (vaccinated women, 26%; unvaccinated women, 40%; and men, 36%). Moreover, 58% to 61% of participants were generally cautious about taking any vaccine. The number one reported barrier to vaccination was not having a recommendation from a doctor (38%). Cost was seen as a barrier by only 18% to 20% of participants.ConclusionCanadian participants show a broad diversity in HPV knowledge and regarding barriers to vaccination. The youngest populations (vaccinated women and men) showed higher levels of knowledge regarding HPV.     

全子宫切除术后远期女性性生活现状的调查研究

目的:了解全子宫切除术后远期女性性生活现状。方法:对因妇科良性疾病行全子宫切除术具有完整随访资料的68例患者进行随访调查,随访内容:妇科检查、性生活质量问卷调查,包括中国女性性生活质量问卷和女性性功能指数(FSFI)问卷。结果:全子宫切除术后7年,48例(70.6%)对目前性生活满意;36例(52.9%)能够与伴侣在性问题上进行有效的沟通交流;41例(60.3%)存在不同程度的性交痛及对性生活厌恶、焦虑、恐惧、担忧等负性情绪;45例(66.2%)性唤起满意,能够经常体验到性高潮;42例(61.8%)对自慰有正确的认识;38例(55.9%)对自己的形象满意。68例患者中国女性性生活质量问卷总分平均127.45±20.20分,FSFI问卷总分平均60.71±11.33分。中国女性性生活质量问卷总分、标准分总分、性满意度、性交流与调适、性反应以及性体像与患者收入呈正相关(r=0.432,P=0.007;r=0.338,P=0.038;r=0.356,P=0.028;r=0.475,P=0.003;r=0.421,P=0.009;r=0.324,P=0.047)。FSFI问卷总分、性欲、性唤起与患者年龄呈中度负相关(...     

Human Papillomavirus Vaccination Uptake before and after the Affordable Care Act: Variation According to Insurance Status,Race, and Education (NHANES 2006-2014)

Study Objective

The purpose of the study was to compare human papillomavirus (HPV) vaccination rates before and after Affordable Care Act (ACA) implementation among women, and examine differences according to insurance status and other sociodemographic variables.

Knowledge,attitude, and practices regarding miscarriage: A cross-sectional study among Flemish midwives

Objectiveto examine the knowledge, attitude and practices (KAP) of Flemish midwives regarding miscarriage.Design and settinga cross-sectional KAP study was conducted in 28 hospitals in Flanders (Northern region of Belgium) from September 2015 to January 2016.Participantsa total of 647 out of 1200 midwives (53.9%) working on maternity, labour and gynaecological wards, maternal and neonatal (intensive) care units, antenatal consultations, and reproductive medicine were recruited.Measurementsdata were collected using a semi-structured, self-administered questionnaire.Findingsthe mean knowledge score was 6.31 out of 10. Of all participants, 47% recently cared for couples with miscarriage, and the majority (97%) indicated a key role for midwives in the psychosocial support of those couples. Lack of time, incapability and fear of being overwhelmed by their own feelings were identified as main barriers for psychosocial support. Knowledge was more often evaluated as adequate when miscarriage was included in the midwifery education (31% vs. 17.3%, χ² = 12.965, df = 1, p<0.001). Midwives trained for the topic ‘miscarriage’ more often valued their role in miscarriage care (98.8% vs. 94.1%, χ² = 11.002, df = 1, p = 0.001). They considered themselves being more capable to provide adequate psychosocial support when feeling sufficiently trained in communicative skills (77.7% vs. 33.8%, χ² = 96.574, df = 1, p<0.001). The majority (72.4%) indicated a lack of knowledge regarding miscarriage. Almost 89% expressed a need for extra training.Conclusions and implications for practicemidwives in Flanders assist in the care for couples with miscarriage and consider themselves as a key healthcare provider in the psychosocial support. This study highlighted several barriers regarding miscarriage care, e.g. a lack of knowledge and incapability. Adequate training in knowledge and communication skills is important and necessary in order to promote appropriate care to couples experiencing pregnancy loss and increase awareness among all health professionals involved in obstetric care. Further research should investigate to what extent miscarriage is included in the educational midwifery programmes, and how the current healthcare practice regarding miscarriage care is organised.     

A Population-Based Epidemiologic Study of Female Sexual Dysfunction Risk in Mainland China: Prevalence and Predictors

BackgroundEpidemiologic data on female sexual dysfunction in China are sparse.AimTo assess the prevalence of risk of female sexual dysfunction in mainland China and its regional and sociodemographic variations and physiologic, pathologic, and behavioral risk factors.MethodsA survey of the general female population was conducted in mainland China from February 2014 through January 2016. Women were randomly selected using multistage, stratified, cluster sampling. The prevalence rate of sexual dysfunction, as measured by the Female Sexual Function Index and a score lower than 23.45 as the cutoff threshold, was determined. Multivariate logistical regression models were used to examine the effects of sociodemographic, physiologic, pathologic, and behavioral factors on women’s risk of experiencing sexual dysfunction and domain-specific sexual problems.OutcomesThe questionnaire on sexual dysfunction was completed by 25,446 women 20 to 70 years old.ResultsThe prevalence of sexual dysfunction in women 20 to 70 years old in mainland China was estimated at 29.7% (99% CI = 28.9–30.4), with large regional variations. The prevalence rates of potential domain-specific sexual problems were 21.6% (99% CI = 20.9–22.2) for low desire, 21.5 (99% CI = 20.8–22.2) for arousal disorder, 18.9% (99% CI = 18.3–19.6) for lubrication disorder, 27.9% (99% CI = 27.2–28.7) for orgasm disorder, and 14.1% (99% CI = 13.6–14.7) for sexual pain. Higher educational attainment and urban residency were associated with a decreased risk of sexual dysfunction. Women of ethnic minorities (or non-Han ethnicity) had fewer reports of sexual dysfunction than women of Han ethnicity (odds ratio = 0.67, 99% CI = 0.47–0.97). Diabetes, cancers, pelvic inflammatory disease, and pelvic organ prolapse significantly increased the reports of sexual dysfunction.Clinical TranslationThis survey provided the prevalence and risk factors of female sexual dysfunction in China, information that could be useful for potential prevention and clinical treatment.Strengths and LimitationsThis is the first large-scale, nationally based epidemiologic study of female sexual dysfunction in mainland China. The limitations of the study design included an overpowered study caused by the large sample, the under-representation of younger and unmarried women, and no information on the women’s partners, their values and knowledge, and detailed medical conditions.ConclusionsThe prevalence rate of female sexual dysfunction in mainland China was modest overall, although variations existed across regions and social groups.Zhang C, Tong J, Zhu L, et al. A Population-Based Epidemiologic Study of Female Sexual Dysfunction Risk in Mainland China: Prevalence and Predictors. J Sex Med 2017;14:1348–1356.