Human papillomavirus frequency of women at low risk of developing cervical cancer: a preliminary study from a Turkish university hospital

PURPOSE: To investigate the frequency of human papillomavirus (HPV) infection among low-risk women for cervical cancer in our region. METHODS: In one year period, 230 consecutive women at low risk of developing cervical cancer were enrolled to the study. HPV DNA testing was performed by Hybrid Capture-I System (HC-I) and groups were constituted by HPV-positive and HPV-negative women. A comparison of the groups according to age, obstetric history and age at the beginning of sexual intercourse was made. Statistical analysis was performed. RESULTS: The frequency rate of HPV infection was demonstrated to be 6.1% (n = 14) in our study (5.9% in women < or = 45 years and 7.7% in women > 45 years). Age-dependent differences were not observed between groups. There was no significant difference between HPV-positive and negative women regarding obstetric characteristics and mean age at first intercourse. CONCLUSION: This study provided significant information on the frequency of HPV infection of low-risk women in our region. When considered with studies performed in other countries, our study may give some help on the natural history of HPV infection and cervical squamous lesions.     

Increased infertility with age in men and women

OBJECTIVE: To estimate the effects of aging on the percentage of outwardly healthy couples who are sterile (completely unable to conceive without assisted reproduction) or infertile (unable to conceive within a year of unprotected intercourse). METHODS: A prospective fecundability study was conducted in a sample of 782 couples recruited from 7 European centers for natural family planning. Women aged 18-40 years were eligible. Daily intercourse records were used to adjust for timing and frequency of intercourse when estimating the per-menstrual-cycle probability of conception. The number of menstrual cycles required to conceive a clinical pregnancy and the probability of sterility and infertility were derived from the estimated fecundability distributions for men and women of different ages. RESULTS: Sterility was estimated at about 1%; this percent did not change with age. The percentage infertility was estimated at 8% for women aged 19-26 years, 13-14% for women aged 27-34 years and 18% for women aged 35-39 years. Starting in the late 30s, male age was an important factor, with the percentage failing to conceive within 12 cycles increasing from an estimated 18-28% between ages 35 and 40 years. The estimated percentage of infertile couples that would be able to conceive after an additional 12 cycles of trying varied from 43-63% depending on age. CONCLUSION: Increased infertility in older couples is attributable primarily to declines in fertility rates rather than to absolute sterility. Many infertile couples will conceive if they try for an additional year.     

Vulvar pain,sexual behavior and genital infections in a young population: a pilot study

BACKGROUND: To study the prevalence of pain during intercourse in a young population and analyze factors that may be associated with vulvar pain. METHODS: During a 2-month period, 172 women (aged 12-26 years) consulting four different adolescent health centres in Stockholm, Sweden, responded to a questionnaire concerning sexual habits, history of infections, and genital symptoms a priori vulvar pain. Multiple logistic regression model was used to evaluate the independent effects of the variables associated with vulvar pain. RESULTS: One-third of the women reported regular pain during and/or after intercourse. Having regular sexual intercourse before the age of 16 years and using oral contraception for more than 2 years were independent variables increasing the risk of vulvar pain. There was a correlation trend between vulvar pain and lack of sexual desire, recurrent candida infections, and urinary tract infections. However, there was no correlation to sexually transmitted diseases. More than 4 years of regular intercourse and coitus at least 4 times a week were factors that inversely correlated to vulvar pain. CONCLUSIONS: One-third of young women answering a questionnaire at adolescent health centres reported regular pain during and/or after intercourse. Early regular coitus and long-time use of oral contraceptives were factors associated with vulvar pain. Frequently rubbing a vulnerable mucosa may result in irreversible damage and vulvar vestibulitis syndrome.     

Congenital adrenal hyperplasia: long-term results following vaginal reconstruction

Forty-two women with virilizing congenital adrenal hyperplasia who had attempted coitus were studied retrospectively a mean of 23.6 years after vaginal repair. Satisfactory intercourse, as defined by the patient, was observed in 62% of the subjects. The functional success rate was higher if repeat operations were performed after the age of 16 years (61% versus 12%, P less than 0.05) or if the patient suffered from the non-salt-losing variety of the disorder (87% versus 46%, P less than 0.05). The outcome of the initial attempt to exteriorize the vagina did not differ significantly by age at surgery. In cases of moderate virilization, vaginal repair may be delayed until the patient's menarche, maturity, and desires for sexual activity are well established. Clitoroplasty should be performed as soon as possible.     

Sexual behavior of secondary-school students in Slovenia.

OBJECTIVES: The aim of this study was to analyze the sexual behavior of secondary-school students in Slovenia. METHODS: The research was carried out on a representative sample of 4706 secondary-school students aged 15-19 years in Slovenia. The data were obtained by a self-administered questionnaire in April 1996. RESULTS: The average age of the students was 17.5 years. Most students had experiences in kissing (70%) and caressing (59%); a lower number had experiences in petting (43%). Sexual intercourse had been experienced by 38% of the students. The median age at the first sexual intercourse was 18.5 years. The main motives for the first sexual intercourse were love (45%), accident (22%) and curiosity (15%). Contraceptive methods currently used were condoms (60%), the pill (14%), coitus interruptus (4%), other methods (3%) and no method (19%). According to the students, the most appropriate sources of information on sexuality were friends (26%), parents (19%), different sources (19%) and professionals (15%). CONCLUSION: By the age of 18.5 years, approximately one-half of secondary-school students in Slovenia experience sexual intercourse. Most students currently use effective contraception, condoms being the most popular method. The students expect to receive information about sexuality from friends, parents and professionals, but not from the school environment.     

Sexual behavior of secondary-school students in Slovenia

Objectives The aim of this study was to analyze the sexual behavior of secondary-school students in Slovenia.

Methods The research was carried out on a representative sample of 4706 secondary-school students aged 15–19 years in Slovenia. The data were obtained by a self-administered questionnaire in April 1996.

Results The average age of the students was 17.5 years. Most students had experiences in kissing (70%) and caressing (59%); a lower number had experiences in petting (43%). Sexual intercourse had been experienced by 38% of the students. The median age at the first sexual intercourse was 18.5 years. The main motives for the first sexual intercourse were love (45%), accident (22%) and curiosity (15%). Contraceptive methods currently used were condoms (60%), the pill (14%), coitus interruptus (4%), other methods (3%) and no method (19%). According to the students, the most appropriate sources of information on sexuality were friends (26%), parents (19%), different sources (19%) and professionals (15%).

Conclusion By the age of 18.5 years, approximately one-half of secondary-school students in Slovenia experience sexual intercourse. Most students currently use effective contraception, condoms being the most popular method. The students expect to receive information about sexuality from friends, parents and professionals, but not from the school environment.     

Comparison of costs and benefits of breast cancer screening with mammography, ultrasonography, and MRI

Screening mammography performed annually on all women beginning at age 40 years has reduced breast cancer deaths by 30% to 50%. The cost per year of life saved is well within the range for other commonly accepted medical interventions. Various studies have estimated that reduction in treatment costs through early screening detection may be 30% to 100% or more of the cost of screening. Magnetic resonance imaging (MRI) screening is also cost-effective for very high-risk women, such as BRCA carriers, and others at 20% or greater lifetime risk. Further studies are needed to determine whether MRI is cost-effective for those at moderately high (15%-20%) lifetime risk. Future technical advances could make MRI more cost-effective than it is today. Automated whole-breast ultrasonography will probably prove cost-effective as a supplement to mammography for women with dense breasts.     

Reproductive patterns among Swedish women born 1936-1960.

An analysis was made of a cross-sectional survey of 4,299 women born in Sweden in the period 1936-1960, regarding their reproductive performance. Fecundability was only 12% lower for women in the 30-39 year age interval than for women up to 29 years of age. Cumulative pregnancy rates for individual years fell in the range 93-96%. No difference in fecundability could be discerned between women born in 1936-45 vis-à-vis 1946-60. Primary and secondary infertility were noted for 6.6% and 11.0% respectively of the entire population surveyed. Primary infertility, more prevalent among those born in 1946-60, was found to be related to a higher level of education, an urban life style and low age at first coitus. The risk of suffering a spontaneous abortion increased with advancing maternal age.     

Sexual behaviour in relation to age: a study of 205 puerperal women

Sexual desire, frequency of coitus, frequency of orgasm, which partner took the first sexual initiative, and the level of sexual satisfaction were studied in 205 women in puerperium in relation to age in the year preceding pregnancy and during pregnancy. It seems evident that sexual desire and the frequency of coitus and orgasm diminish during pregnancy independently of age. The group of younger women (16 to 20 years old) in our study maintained a relatively higher level of sexual activity especially in comparison to older women (36 to 40 years old). The number of women who took the first sexual initiative increased considerably in pregnancy.     

2008年辽宁省汉族育龄妇女月经现况的调查

目的 了解辽宁省汉族育龄妇女的月经现况.方法 2008年4至12月,采取流行病学整群抽样的方法,抽取辽宁省沈阳市、营口市、本溪县及彰武县共1611例年龄19～45岁的健康育龄妇女为研究对象,通过现场问卷形式进行调查,调查内容包括:月经初潮年龄、月经规律性、月经周期及痛经情况.结果 在接受调查的1611例育龄妇女中,平均月经初潮年龄为14.4岁,其中城市女性的初潮年龄为(14.2±1.5)岁,县乡女性的初潮年龄为(14.6±1.5)岁,城乡女性初潮年龄比较,差异有统计学意义(t=6.58,P<0.01).对被调查者年龄和初潮时间进行回归分析,可以得出其直线回归方程为:Y=0.074X+11.855,即初潮年龄平均每年提前0.074岁.月经周期正常(21～35 d)且规律者占86.34%(1391/1611),月经稀发(周期>35 d)者占11.05%(178/1611),月经频发(周期<21 d)者占2.61%(42/1611),其中初潮后周期即规律者占65.67%(1058/1611),初潮后两年内规律者占94.97%(1530/1611).痛经者占42.09%(678/1611),其中重度痛经92例(13.6%,92/678),中度痛经147例(21.7%,147/678),轻度痛经439例(64.7%,439/678).结论 辽宁省汉族育龄妇女月经初潮年龄呈逐年降低趋势,城市较县乡女性初潮年龄更低;初潮后95%的育龄妇女在两年内月经逐渐规律.     

Emergency contraception in Cuba with 10 mg of mifepristone.

BACKGROUND: Mifepristone in a dose of 10 mg is an effective emergency contraceptive when administered up to 120 hours after unprotected coitus. METHODS: Between May 2003 and February 2005, we conducted in Cuba a single-arm trial to evaluate the effectiveness of 10 mg mifepristone for emergency contraception up to 6 days after unprotected coitus. A total of 635 women who requested emergency contraception after a single act of unprotected intercourse were included in the study. RESULTS: After treatment there were 7/635 (1.1%) pregnancies (95% CI 0.4-2.3%). Pregnancy that might have occurred was prevented in 88.0% of the cases (95% CI 77.1-95.1%). The most common side effects reported by participants were fatigue (10.7%), dizziness (6.1%) and nausea (4.9%); vomiting was only reported by 0.6%. In 38/635 (6.0%) women menstruation was delayed more than 7 days. CONCLUSIONS: Mifepristone 10 mg administered is an effective emergency contraceptive with an acceptable profile of side effects up to five days, but greater studies are necessary to verify its efficacy up to 6 days after unprotected intercourse.     

Prevalence of cervical intraepithelial neoplasia in sexually active teenagers and young adults. Results of data analysis of mass Papanicolaou screening of 796,337 women in the United States in 1981

One of the largest nationally reported cases of carcinoma in situ in the teenage population of the United States is based on 1 year's computerized data from Cancer Screening Services. In 1981, 796,337 women were screened with an average age of 25.9. Of these, 18,589 (2.33%) had abnormal cytology. In 194,069 (24.3%) of the 796,337 patients aged 15 to 19, 3,651 (1.9%) had abnormal cytology. In 17% of all patients with abnormal cytology biopsy of the cervix was performed. The prevalence rate of dysplasia and carcinoma in situ was 18.8/1,000 for ages 15 to 19 and 28.8/1,000 for ages 20 to 24. Biopsy-proved cases of all grades of cervical intraepithelial neoplasia in the teenage population indicates a prevalence of 13.3/1,000. Sixty cases of grade 3 cervical intraepithelial neoplasia (carcinoma in situ) were diagnosed by biopsy in the teenage population for a projected prevalence rate of 2.6/1,000. No invasive squamous cell carcinoma was found in this age group. This emphasizes the importance of cervical intraepithelial neoplasia as a developing medical and public health problem in this age group and indicates that teenagers of any "permissive society" should be considered as "high risk" and included in screening programs.     

Correlation between an early sexual debut, and reproductive health and behavioral factors: a multinational European study.

OBJECTIVE: To investigate whether women who made an early sexual debut differ from those with a later debut regarding genital signs and symptoms. METHODS: The study included women who considered themselves gynecologically healthy and who attended 17 family planning centers in 13 European countries for contraceptive advice. There were 629 women who made their sexual debut at the age of 16 years or earlier (study population) and 927 women who had their first sexual intercourse at the age of 19 years or later (comparison group). Genital symptoms and signs, contraceptive use, smoking, and genital hygiene habits and previous genital infections were recorded on a structured patient record form. Detection of Chlamydia trachomatis was made by means of a polymerase chain reaction on first-void urine. The study was made, on average, 7-10 years after the women's sexual debut. RESULTS: The mean age of first intercourse was 15.3 years for the study group versus 20.7 years for the control group (p < 0.001). The study population had significantly more symptoms, such as vaginal discharge and pruritus, and signs, such as abnormal discharge, erythema of the vaginal mucosa and lower genital tract infections, than the comparison group. Twice as many women in the study group were smokers and there was a ten-fold increase among these subjects of using low-pH solutions for genital hygiene. The prevalence of C. trachomatis infection did not differ between the two groups (p = 0.22). CONCLUSION: Age at first intercourse is not only a predictor of sexual risk behavior, but also a predictor, regarding both signs and symptoms, of future gynecological problems.     

Cervical intraepithelial neoplasia. The role of age at first coitus in its etiology

A case-control study was done on 115 women attending a colposcopy clinic. All the patients had definitive histologic confirmation of cervical intraepithelial neoplasia (CIN). A specially designed questionnaire sought information about their age, age at first coitus, gravidity, ethnic origin, religion and social class. Cases and controls were closely matched for age and the last three parameters mentioned above. There was no statistical difference between nulliparas and multiparas in the incidence of CIN. The time interval between age at first coitus and the diagnosis of CIN varied widely, with 47 years the maximum. Statistically significant differences existed between the age at first coitus for cases and controls under and over age 18. The estimated relative risk was 3.64-fold higher in those under 18 than in those 18 or over at first coitus.     

Which contraceptive methods are suitable for the older woman?

This discussion considers contraceptive options for older women (over age 35 years) in terms of efficacy, safety, tolerability, reversibility, coital independence, and protection from sexually transmitted diseases. The discussion is illustrated with figures showing the number of births to older women in the US, maternal mortality rates according to age in the US, abortions/1000 live births by age in the US, failure rates for contraceptive methods (per 100 woman years) by age, the lowest expected and typical failure rates for various contraceptive methods, the safety of various contraceptives for women aged 35-39 years (death rates/100,000/year), and the mortality risk according to oral contraceptive use and smoking status. Information is then presented on various methods to prevent pregnancy if contraception fails, including the Yuzpe method, administration of Danazol, use of Mifepristone, and insertion of IUDs. The percentage of women beginning menstruation on given days in relation to expected onset of menstruation is illustrated schematically for the Yuzpe method and administration of mifepristone postcoitally. Treatment with Nonoxynol-9 following unprotected intercourse to reduce the possibility of sexually transmitted disease is mentioned. New contraceptives which are on the market or are under study include FlexiGard, a new type of IUD; hormone-releasing IUDs; injectable steroids; implants; vaginal rings; and skin patches. Finally, mention is made of new male contraceptives in the form of injectables, implants, and vaccines as well as the contraceptive use of gossypol.     

Effect of coitus at term on length of gestation, induction of labor, and mode of delivery

OBJECTIVE: To determine coital incidence at term and to estimate its effect on labor onset and mode of delivery. METHODS: Healthy women with uncomplicated pregnancies and established gestational age were recruited to keep a diary of coital activity from 36 weeks of gestation until birth and to answer a short questionnaire. Two hundred women with complete coital diaries were available for analysis. Outcome measures include coitus, postdate pregnancy (defined as pregnancy beyond the estimated date of confinement), gestational length of at least 41 weeks, labor induction at 41 weeks of gestation, and mode of delivery RESULTS: Reported sexual intercourse at term was influenced by a woman's perception of coital safety, her ethnicity, and her partner's age. After multivariable logistic regression analysis controlling for the women's ethnicity, education, occupation, perception of coital safety, and partner's age, coitus at term remained independently associated with reductions in postdate pregnancy (adjusted odds ratio [AOR] 0.28, 95% confidence interval [CI] 0.13-0.58, P = .001), gestational length of at least 41 weeks (AOR 0.10, 95% CI 0.04-0.28, P < .001), and requirement for labor induction at 41 weeks of gestation (AOR 0.08, 95% CI 0.03-0.26, P < .001). At 39 weeks of gestation, 5 (95% CI 3.3-10.3) couples needed to have intercourse to avoid one woman having to undergo labor induction at 41 weeks of gestation. Coitus at term had no significant effect on operative delivery (adjusted P = .15). CONCLUSION: Reported sexual intercourse at term was associated with earlier onset of labor and reduced requirement for labor induction at 41 weeks. LEVEL OF EVIDENCE: II-2.     

Age and fertility (author's transl)

Increased life expectancy among human populations has been accompanied by little change in the reproductive age span, and the age groups of highest fertility are actually contracting. According to Leridon, in 18th century France 30% of births were to women 35 and over, compared to 18.5% in the early 20th century, 14% in 1964, and 8% in 1975. Among evidence of declining fecundity with age, the waiting time to conception after stopping contraception is 12.6 +or- 21 months after 35, while it is only 3.6 +or- 4.8 months for those aged 20-24. Risks of stillbirth and perinatal mortality are elevated in the years preceding menopause, and the proportion of children with chromosomal anomalies is higher particularly after 40. Study of the true influence of age on fecundity requires a population not using contraception and attempting to conceive as frequently as possible, such as the North American Hutterites, among whom a slow and progressive fecundity decline is apparent beginning at 20-25 years and becoming more rapid after age 40. 1/3 of women aged 39 and 1/10 of those aged 46 give birth each year. A demographic study of the early 20th century Irish population indicated that male fecundity does not begin to decline until 40 or 45 years, after which the decline is gradual. An 11-center study of results of artificial insemination in France indicates that conceptions decline markedly after 35. It is probable that the decline in female fecundity is due less to an alteration in the quality of the ova than to modifications in the uterine environment, perhaps as a result of an inadequate nutritional or hormonal environment. In 1 study of men aged 60 or over, 61% were found to produce sperm, and in another study 48% of subjects continued to produce sperm in their 8th decade. The decline in male fecundity appears to be associated with a diminution in the proportion of motile and normal sperm, perhaps explained by modifications at the level of the seminiferal epithelium. Vascular changes could also explain the declining number of volume and Leydig cells that occurs with age.     

Unwanted premarital pregnancies

Recent research suggests that 40% of adolescents aged 16-17 and 65% aged 18-20 have experienced sexual intercourse. 30,000 adolescents in Quebec become pregnant each year, the majority of whom are unmarried. Fear of the girl at the absence of her menstrual period, possible deterioration of family relationships as the problem becomes known, abandonment of school, hasty and unpromising marriages, and abortion may be among the unfavorable consequences of early pregnancy. Although family planning centers and contraceptive information are available, 7 in 10 adolescents who become pregnant were not using contraception at the time of conception. The typical adolescent does not begin to seek contraceptive information until 6 months-2 years after initiating relations, and those using contraception from the beginning most often use a less reliable method. Many adolescents are not motivated to seek contraception because they do not view sexual relations as normal or natural for girls their age; they would have preferred to retain their virginity, but were swayed by pressure from peers or the partner. Their attitudes are reinforced by adults in general and the school system, which regard the provision of information on contraception as inappropriate. The feeling that contraceptive use is unnatural, fostered by films and books where the subject never comes up, the idea that discussion of contraception will destroy the romantic atmosphere of the act, or the fear of being thought promiscuous if they take the initiative in supplying or using contraceptives prevent many girls from using contraception. Psychological difficulties encountered when seeking contraceptives or incorrect use are other factors in the lack of contraceptive protection. It does not appear realistic to try to reverse the trend toward increased sexual activity among adolescents. Sex education beginning in the home at a very young age and at all stages of the school system, including information on contraception, is 1 possible solution to the problem of adolescent pregnancy. Discussion and presentation of contraception as a normal part of life, acceptance of premarital sex as a positive phenomenon as long as it is in a context of responsibility, autonomy, pleasure, and consideration for the partner, improving access to contraception for adolescents, and encouragement of sexual relations stopping short of full coitus are other possible approaches.