Advancing Sexual and Reproductive Health and Rights
 
Perspectives on Sexual and Reproductive Health
Volume 40, Number 1, March 2013
FYI


THE MEASURE OF THE MAN

When it comes to condoms, one size does not fit all, and poor fit may mean problems with use.1 In a sample of 178 men surveyed at a black gay pride event in Atlanta, 61% of respondents said that condoms generally fit correctly, 21% said that they are too tight, 18% that they are too short, 9% that they are too loose and 7% that they are too long. Men who reported condom breakage within the past 30 days were more likely than others to say that condoms feel too tight, and men who reported no breakage were more likely than others to say that condoms fit well. Reports of slippage were similarly associated with perceptions of fit. Three in 10 participants said that they used condoms designed for “larger penises,” but only a negligible proportion used ones designed for “smaller penises.” The investigators encourage researchers and health care professionals to “work with condom manufacturers to ensure that new condoms are consistent with men’s experiences with condom fit and feel.” Moreover, they note that the packaging and marketing of condoms of varying sizes “may … require increased sensitivity to men who might be uncomfortable with seeking, purchasing and using condoms with smaller dimensions.”

1. Reece M, Experiences of condom fit and feel among African-American men who have sex with men, Sexually Transmitted Infections, 2007, 83(6):454–457.

NO CUT MIGHT MAKE THE CUT

An independent advisory panel has recommended that the Food and Drug Administration approve a device for performing female sterilization without making an incision, provided that the manufacturer conduct a number of postmarketing studies.1 The Adiana sterilization system uses a catheter to implant a silicone device in the fallopian tubes, where the device causes the growth of scar tissue, which blocks the tubes. According to the manufacturer, it takes about 15 minutes to implant the device, and the procedure can be performed in a doctor’s office under local anesthesia; the extent of scarring, and hence the method’s effectiveness, is assessed by X-ray three months later. In a clinical trial, the method was effective for nearly 99% of women available for follow-up after one year. The panel’s recommendations included long-term follow-up of women who have already been sterilized with the Adiana system.

1. Reuters, Hologic sterilization device approvable—US advisors, Dec. 14, 2007, <http://www.reuters.com/articlePrint?articleId=USN1324114520071214>, accessed Dec. 26, 2007.

LIFE AFTER PREECLAMPSIA

Women who have had preeclampsia are at increased risk of developing cardiovascular disease later in life.1 In a review encompassing studies published between 1960 and 2006, researchers identified 25 that were suitable for inclusion in a meta-analysis assessing the relationship between preeclampsia and subsequent disease; together, these studies described the experiences of more than three million women, of whom nearly 200,000 had had preeclampsia. Average follow-up periods for the diseases studied ranged from five to 17 years. Women with a history of preeclampsia had significantly elevated risks of subsequent hypertension (relative risk, 3.7), ischemic heart disease (2.2), stroke (1.8) and venous thromboembolism (1.8); they were not at increased risk for cancer in general or, specifically, for breast cancer. Preeclampsia was associated with an increased risk of death from any cause later in life (1.5), particularly if it had occurred before 37 weeks’ gestation (2.7). The researchers comment that “a history of preeclampsia should be considered in the evaluation of women’s risk of cardiovascular disease.”

1. Bellamy L et al., Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis, BMJ, 2007, doi: 10.1136/bmj.39335.385301.BE, accessed Nov. 29, 2007.

MEN BEHAVING BADLY

Missouri men who lived with a pregnant partner reported in a telephone survey that their partner’s smoking and drinking habits changed during pregnancy, but their own did not.1 Forty-one percent of the 96 respondents said that their partner had smoked before conceiving, but only 19% reported that she smoked while pregnant; similarly, the proportion of women who reportedly drank fell from 53% to 4%. After giving birth, some women resumed smoking or drinking, but the proportions doing so (roughly three in 10 for each) remained below the prepregnancy levels. In contrast, the proportion of men who smoked was the same (close to half) before, during and after their partner’s pregnancy; the proportion who drank dropped from 70% to 51% during the pregnancy and remained at about that level after the birth. In addition, men were as likely to binge on alcohol after their partner’s delivery as during the pregnancy. Because men’s behavior may influence their partner’s behavior and their infant’s health, the researchers urge their inclusion in interventions aimed at improving prenatal health behavior.

1. Everett KD et al., Men’s tobacco and alcohol use during and after pregnancy, American Journal of Men’s Health, 2007, 1(4):317–325.

TAKE THE TEST TO THE PEOPLE

Rapid HIV testing conducted in community settings provides opportunities to identify infected individuals who would otherwise not know that they are HIV-positive and to point them toward treatment services, according to results of a two-year demonstration project funded by the Centers for Disease Control and Prevention.1 The project, conducted by community-based organizations in seven cities, recruited participants at places where people considered to be at high risk socialize, live or seek medical services; it tested nearly 24,000 individuals. Most participants were male (63%) and were black or Hispanic (70%); 60% had seen a health care provider in the past year, but 50% lacked insurance. During the past year, 66% had had multiple sex partners, 17% had had male-male sex and 6% had injected drugs. Seven in 10 participants had had an HIV test before, but almost half of these had not been tested within the last year. Overall, 1% tested positive for HIV; of those who had a confirmatory test, 93% were infected. Three-quarters of participants who tested positive returned for their confirmatory results, and nine in 10 of those who returned accepted referrals for medical care.

1. Aguirre D et al., Rapid HIV testing in outreach and other community settings—United States, 2004–2006, Morbidity and Mortality Weekly Report, 2007, 56(47):1233–1237.

MORE ON THE LINK BETWEEN CERVICAL CANCER AND THE PILL

Analyses using pooled data from 24 studies conducted around the world have confirmed that pill users have an increased risk of developing cervical cancer but that the risk differential declines, and eventually disappears, when women stop using the method.1 The pooled data set included information on 16,573 women with cervical cancer and 35,509 without the disease, and permitted analyses that took into account women’s age, number of partners, age at first intercourse, parity, smoking and cervical cancer screening status. Current users of combined pills had a significantly higher cancer risk than never-users (relative risk, 1.6), and the relative risk increased with duration of use (to 1.9 among women who had been using the pill for five or more years). The relative risk fell off within 2–4 years after women discontinued pill use, and by 10 years after quitting the method, former users no longer had an elevated risk. Results were similar for women of different characteristics.

1. International Collaboration of Epidemiological Studies of Cervical Cancer, Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies, Lancet, 2007, 370(9599):1609–1621.

AVOIDANCE≠PREVENTION

“Selective avoidance” of sex does not prevent the spread of STDs among teenagers, according to findings from a clinic-based sample of sexually active black adolescent women.1 One-third of the sample said that they had recently refrained from having sex because they had been concerned about acquiring an STD, and one-quarter had avoided sex because of concerns about infecting a partner. However, neither the prevalence of unprotected vaginal intercourse nor STD prevalence differed between teenagers who had taken this approach and those who had not. The researchers therefore recommend that “clinicians and prevention programs discourage the use of [selective avoidance] as an STD prevention strategy” and encourage consistent, correct condom use.

1. DiClemente RJ et al., Prevalence, correlates, and efficacy of selective avoidance as a sexually transmitted disease prevention strategy among African American adolescent females, Archives of Pediatrics and Adolescent Medicine, 2008, 162(1):60–65.

DOES ABORTION PREDICT POOR BIRTH OUTCOMES LATER?

Women who have had an abortion, whether spontaneous or induced, may have an elevated risk of subsequent adverse birth outcomes, according to an analysis of data from the U.S. Collaborative Perinatal Project.1 The data included 45,617 live, singleton births at 12 medical centers between 1959 and 1966. In this sample, the prevalence of both low birth weight (less than 2,500 g) and preterm birth (delivery before 37 weeks’ gestation) rose steadily as the number of abortions among previously pregnant women increased from zero to three or more. Results of analysis controlling for a broad range of variables confirm these relationships. The analysts acknowledge the age of the data and the combining of spontaneous and induced abortions as shortcomings of the study, but contend that the sample size and the large number of control variables in the multivariate model are unique strengths. They add that the findings could be useful in developing countries where women face medical risks similar to those faced by U.S. women in the 1950s and 1960s.

1. Brown JS, Jr., Adera T and Masho SW, Previous abortion and the risk of low birth weight and preterm births, Journal of Epidemiology and Community Medicine, 2008, 62(1):16–22.

IUDs FOR TEENAGERS?

Emphasizing the “importance of appropriate contraception” for teenagers, the American College of Obstetricians and Gynecologists’ Committee on Adolescent Health Care has come out strongly in favor of providing IUDs to adolescents.1 In an opinion statement that addresses common misperceptions about teenagers’ use of these devices as well as possible adverse effects and contraindications to use, the committee reviews data on IUD safety and efficacy, and draws the following conclusion: “Because adolescents contribute disproportionately to the epidemic of unintended pregnancy in this country, top tier methods of contraception, including IUDs…, should be considered as first-line choices” for them. “After thorough counseling regarding contraceptive options,” the committee continues, “health care providers should strongly encourage young women who are appropriate candidates to use this method.”

1. American College of Obstetricians and Gynecologists, Intrauterine device and adolescents: ACOG committee opinion no. 392, Obstetrics & Gynecology, 2007, 110(6):1493–1495.