Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 36, Number 4, July/August 2004
FYI


THERE'S NO THERE THERE

In 2002, 69% of U.S. women who had undergone a complete hysterectomy said that they had had a Pap smear within the previous three years; this proportion had not changed since the early 1990s, even though a federal task force recommended in 1996 against routine Pap smears for women without a cervix.1 Using data from an annual population-based survey, analysts estimated that in 2002, 15 million women aged 18 and older had undergone hysterectomy yet had had a Pap smear in the past three years. When they subtracted from this total women whose hysterectomy could have preceded the Pap smear, those who still had a cervix and those who had had the hysterectomy to treat a cervical malignancy, the result indicated that approximately 10 million women—almost half of those who had undergone hysterectomy—had needlessly obtained a Pap smear. The analysts speculate that their findings may stem from women's misunderstanding of hysterectomy and the purpose of Pap smears, from physicians' reluctance to discontinue screening for fear that patients will question their judgment or from systemic factors, such as Pap smear performance measures.

1. Sirovich BE and Welch HG, Cervical cancer screening among women without a cervix, Journal of the American Medical Association, 2004, 291(24):2990-2993.

GOOD HABITS START EARLY

Teenagers who used a condom the first time they had intercourse have elevated odds of saying that they also used one at most recent intercourse, according to an analysis of data on 4,024 sexually active participants in the National Longitudinal Study of Adolescent Health.1 Sixty-two percent of the young people said that they had used a condom the first time they had sex; 57% said they had done so the last time. When a wide range of personal, behavioral and attitudinal factors were controlled for, teenagers who had used a condom at first intercourse were significantly more likely than others to report use at last intercourse (odds ratio, 2.3). No other factor related to respondents' sexual or contraceptive history was associated with the odds of condom use at most recent intercourse. Young women and white teenagers had reduced odds of use at last sex, as did adolescents who had been drunk or high on that occasion (0.4-0.8); those who were concerned about unplanned pregnancy, who considered themselves able to negotiate birth control with a partner or who were motivated to use contraceptives had elevated odds of having used a condom (1.2-1.4). The analysts urge that sex education begin "before the onset of sexual debut to develop safe sexual habits among all adolescents."

1. Shafii T et al., Is condom use habit forming? condom use at sexual debut and subsequent condom use, Sexually Transmitted Diseases, 2004, 31(6):366-372.

THE LAST WORD ON ABORTION AND BREAST CANCER?

"The totality of the worldwide epidemiological evidence indicates that pregnancies ending as either spontaneous or induced abortions do not have adverse effects on women's subsequent risk of developing breast cancer": This is the conclusion of an analysis of data from 53 studies of women with invasive breast cancer that included information on abortion history.1 The studies took place in 16 countries with liberal abortion laws and included a total of about 83,000 women. In analyses pooling data from the 12 studies in which information about spontaneous abortion was recorded before women's breast cancer was diagnosed (and which presumably suffer from less underreporting of abortion than those in which this information was collected retrospectively), the risk of breast cancer was statistically indistinguishable between women who had ever had a spontaneous abortion and those who had not. Thirteen studies reporting prospective data on induced abortion showed a small but statistically significant reduction in risk for women who had terminated a pregnancy. Results were similar regardless of women's age, whether they had given birth, the number of abortions they had had or the timing of their abortions.

1. Collaborative Group on Hormonal Factors in Breast Cancer, Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 16 countries, Lancet, 2004, 363(9414):1007-1016.

SCHOOLS AND PRENATAL CARE

School-based prenatal services may help keep pregnant young women in school, according to an analysis of data on students at Baltimore's alternative high school for pregnant and parenting teenagers.1 Among 431 students who delivered in 1995- 1997, those who had gone to the school's on-site clinic for prenatal services were absent from school 12 fewer days during the year of their pregnancy than were those who had gotten care elsewhere (60 vs. 72 days); dropout rates were 6% and 15%, respectively. However, these statistically significant differences were not sustained into the following school year, when absenteeism and dropout rates were high for both groups. In an analysis controlling for several socioeconomic and school-related variables, the odds of dropping out during the year of a pregnancy were significantly reduced among students who had received school-based prenatal services (odds ratio, 0.4). The researchers comment that "investing in comprehensive approaches that include [school-based health centers] may help low-income childbearing adolescents succeed," but that specialized services for teenagers who become pregnant may need to extend beyond the year in which they deliver.

1. Barnet B, Reduced school dropout rates among adolescent mothers receiving school-based prenatal care, Archives of Pediatrics and Adolescent Medicine, 2004, 158(3):262-268.

CAN YOU HEAR MY SPERM NOW?

Cell phone use may be hazardous to the health of sperm, according to a study of 221 Hungarian men.1 Researchers found that men who carried their phones all day in a hip pocket or a holster, even in standby mode, had a 30% reduction in sperm count; sperm quality also was reduced among heavy users of the ubiquitous device. Although the findings have caught the attention of fertility experts and other scientists, they are hardly conclusive. The study has been criticized for not controlling for factors such as men's stress levels and smoking habits that could influence sperm production; furthermore, as some scientists have pointed out, male fertility has been declining for decades. Most research to date has concluded that exposure to radiofrequency waves from cell phones poses no health threat, but the World Health Organization and other scientific bodies stress the importance of further investigation.

1. CNN, Sperm count, cell phone link dismissed, June 28, 2004,<http:// www.cnn.com/2004/HEALTH/06/28/mobiles.sperm.reut>, accessed July 2, 2004.

RAPID AND AVAILABLE

A test that takes only 20 minutes to detect HIV antibodies in saliva or blood from a finger stick has received U.S. government approval for use in doctors' offices and HIV counseling centers.1 Although OraQuick Rapid HIV-1/2 was approved by the Food and Drug Administration (FDA) last March, its use has been permitted only in government-certified laboratories; under the terms of an FDA waiver granted in June, the test will soon be available in roughly 180,000 sites. The FDA's decision to permit wider use of the product came on the heels of its approval of the test for detecting the virus in saliva, rather than just in blood samples. Public health officials believe that many HIV-infected individuals fail to get tested because they fear needles, and an estimated 8,000 people who undergo testing at public clinics do not return to the clinic to learn their test results. The new test's noninvasive nature and rapid results could help lower the number of individuals who are unaware that they are infected with HIV.

1. McNeil DG, Jr., Quick HIV test is more widely available, New York Times, June 26, 2004, <http:// www. nytimes.com/2004/06/26/national/ 26brfs.html>, accessed July 2, 2004.

SEX EDUCATION UTOPIA?

Imagine, if you can, a national government that deals with the inevitability of teenage sexual activity not by trying to frighten young people into abstaining but by advising them to try less risky behavior than intercourse, including oral sex and mutual masturbation. It may be a stretch for Americans, but across the Pond, the British government is supporting a school curriculum that takes just this tack.1 Oh, sure, the curriculum has its detractors, who warn of the emotional risks of any sexual experimentation and the physical risks of oral sex. Nevertheless, the Health Development Agency backs the curriculum's approach, and the Department of Education is expected to publish a report documenting substantial reductions in rates of intercourse among students attending schools that use it. Although the education department's role in issuing the report is seen as a tacit endorsement of the curriculum, the department maintains that it does not recommend resources for use in schools and urges teachers to exercise "professional judgment."

1. Doughty S, 'Outercourse': oral sex lessons for teens, Daily Mail, May 11, 2004, <http://www.dailymail.co.uk/ pages/live/articles/health/thehealthnews.html?in_article_id=302349&in_page_id=1797>, accessed June 30, 2004.

ONE LESS TREATMENT OPTION

A rapidly increasing proportion of gonorrhea cases among men who have sex with men are resistant to a class of antibiotics commonly used to treat gonococcal infection, prompting the Centers for Disease Control and Prevention (CDC) to recommend that these drugs, fluoroquinolones, no longer be given as first-line treatment for this population.1 According to a CDC study based on data from clinics in 23 cities, the proportion of men with gonorrhea whose infection was fluoroquinolone-resistant doubled overall between 2002 and 2003, but tripled among men who have sex with men. The rate for that group (5%) was 12 times the rate for men reporting only heterosexual behavior. In place of the oral antibiotics, the CDC is now recommending injectable alternatives for treating gonorrhea in men who have sex with men.

1. Centers for Disease Control and Prevention (CDC), Increasing cases of drug-resistant gonorrhea prompt new treatment recommendation for gay and bisexual men, news release, Atlanta: CDC, Apr. 29, 2004.

CHANGES IN TEENAGERS' SEXUAL BEHAVIOR STALL

For better or worse, virtually no change occurred in high school students' sexual behavior between the 2001 and 2003 rounds of the biennial National Youth Risk Behavior Survey.1 The most recent figures on a couple of measures—the proportion of youth in grades 9-12 who are sexually experienced (47%) and the proportion who have had four or more partners (14%)—represent overall improvement since 1991. But for other measures, even over the long term, changes have not occurred or have been in the opposite direction from what one might hope: The proportion of youth who are currently sexually active has held steady at about one-third, and the proportion of sexually active youth who use substances before intercourse has risen from 22% to 25%. Pill use has dropped since 1991, but all of the decline had occurred by 1999; and the proportion of students who have had HIV or AIDS education in school has decreased since 1997 (after rising steadily earlier in the decade). The one change that occurred between the last two surveys represents consistent improvement in risk-related behavior: Sixty-three percent of sexually active students in 2003 had used a condom at last intercourse, compared with 58% in 2001 and 46% in 1991.

1. Centers for Disease Control and Prevention, National Youth Risk Behavior Survey: 1991-2003 - trends in the prevalence of sexual behaviors, 2004, , accessed July 6, 2004.