Reliable Contraception Research Articles

A fixed-dose combination of bisoprolol and amlodipine in daily practice treatment of hypertension: Results of a non-investigational study in the Czech Republic

Summary Objective: This non-investigational study with the primary goal to assess patient adherence to the fixed dose combination (FDC) of bisoprolol and amlodipine in daily practice was carried out in six countries in Eastern Europe, in Czech Republic, Hungary, Poland, Romania, Serbia and Slovakia. In this paper, the results of 740 patients recruited in Czech Republic are presented. Secondary objectives included the assessment of blood pressure, pulse pressure values and heart rate. Material and Methods Patients eligible for recruitment were over 18 years of age, had essential hypertension, had already been switched from a free combination of bisoprolol 5–10mg/d and amlodipine 5–10mg/d to the FDC at least 4 weeks prior to recruitment, and gave informed consent. Women in childbearing age were under reliable contraception. Exclusion criteria included pregnancy, lactation, any contraindication to the FDC according to the local label and any other antihypertensive medication. The primary target parameter was patient adherence under the FDC. Adherence was measured by tablet count (tablets taken divided by tablets prescribed, times 100). The definition was as follows: excellent >90%, good 76-90%, moderate 51-75%, bad <50%. The study hypothesis was that at least 90% of the patients showed good to excellent adherence. All other patient data, clinical findings and laboratory values were recorded upon availability at study start and after 6 months. Results There were more male (383, 52%) than female (357, 48%) patients. The mean age was 58.8 years with a Q1 – Q3 interval of 51 to 68 years. The youngest patient was 23 years and the oldest 95 years old. All patients had been pretreated once daily with a free combination of bisoprolol (mean 5.8mg) and amlodipine (mean 5.9mg). In most patients, the doses were not changed at the switch to the FDC or later during the study, resulting in a mean of 6.2mg for bisoprolol and 5.9mg for amlodipine. Over the 6 months of treatment, the adherence of 98% of the patients was good to excellent. Thus, the study expectation was more than met. Potentially due to the excellent adherence, there was a 12.1mmHg reduction in mean systolic and a 6.9mmHg reduction in mean diastolic blood pressure after 6 months compared to study start. The benefits of patient adherence on blood pressure control are confirmed by the improvement of the pulse pressure by an average of 59.1mmHg±13 at study start versus 54.1mmHg±10 after 6 month of treatment. Heart rate decreased by a mean of 5.6bpm. Only in 2 patients (0.3%), two adverse drug reactions probably related to the study medication were documented after 6 months: one case of hypotension and one case of edema. None of the adverse drug reactions (ADR) was considered serious and both patients fully recovered. Overall, the FDC of bisoprolol and amlodipine was well tolerated. The study results clearly show that the high adherence under the FDC of bisoprolol and amlodipine may contribute to better blood pressure control and, thus, to a better risk reduction for cardiovascular events.

Male hormonal contraception: past, present, future

In certain regions of the world the enormous rate of population growth raises economic and public health concerns and widely accessible contraceptive methods would be desired. In contrast, in other countries the use of effective contraception is a question of individual preferences. Today, most of the reliable contraceptive methods are applied by women, while the options for male methods are quite limited. It is well known that significant portion of pregnancies are still unplanned and several data revealed men's willingness to take part in family planning. Based on these needs, remarkable efforts have been made to develop a suitable hormonal contraceptive agent for men. With the exogenous suppression of follicle stimulating hormone and luteinizing hormone secretion, the inhibition of the testicular testosterone production and the spermatogenesis can be achieved. In the beginning, testosterone-derivatives, or testosterone-progestin combinations were administered, later synthetic androgen agents were developed. Despite of these efforts, unfortunately, there is no safe, widely feasible male hormonal contraception to date, but in the future this goal can be achieved by solving the key hurdles. Orv Hetil. 2017; 158(46): 1819-1830.

Pregnancy after endometrial ablation: a systematic review

Pregnancies have been reported after endometrial ablation but there is little data regarding subsequent pregnancy outcomes. To review systematically the available evidence regarding pregnancy outcomes after endometrial ablation, in order to equip physicians effectively to counsel women considering endometrial ablation. MEDLINE, Embase, Cochrane, and ClinicalTrials.gov were searched through January 2017. Published and unpublished literature in any language describing pregnancy after endometrial ablation or resection was eligible. Data about preconception characteristics and pregnancy outcomes were extracted and analysed according to study design of source and pregnancy viability. We identified 274 pregnancies from 99 sources; 78 sources were case reports. Women aged 26-50 years (mean 37.5 ± 5 years) conceived a median of 1.5 years after ablation (range: 3 weeks prior to 13 years after). When reported, 80-90% had not used contraception. In all, 85% of pregnancies from trial/observational studies ended in termination, miscarriage or ectopic pregnancy. Pregnancies that continued (case report and non-case report sources) had high rates of preterm delivery, caesarean delivery, caesarean hysterectomy, and morbidly adherent placenta. Case reports also frequently described preterm premature rupture of membranes, intrauterine growth restriction, intrauterine fetal demise, uterine rupture, and neonatal demise. An unexpectedly high rate of pregnancy complications is reported in the available literature (which may reflect publication bias) and high-quality evidence is lacking. However, based on the existing evidence, women undergoing endometrial ablation should be informed that subsequent pregnancy may have serious complications and should be counselled to use reliable contraception after the procedure. Systematic review - pregnancies reported after endometrial ablation have an increased risk of adverse outcomes.

Health Insurance, Fertility, and the Wantedness of Pregnancies: Evidence from Massachusetts

Health insurance reform in Massachusetts lowered the financial cost of both pregnancy (by increased coverage of pregnancy-related medical events) and pregnancy prevention (by increasing access to reliable contraception and family planning). We examine fertility responses for women of childbearing age in Massachusetts and, on net, find no effect from increasing health insurance coverage. This finding, however, masks substantial heterogeneity. For married women aged 20 to 34 – who have high latent fertility and for whom pregnancies are typically wanted – fertility increased by approximately 1 percent. For unmarried women in the same age range – for whom pregnancies are typically unwanted – fertility declined by 10 percent. Fertility rates changed very little for other groups, in part because of low latent fertility or minimal gains in insurance coverage.

HEALTH INSURANCE, FERTILITY, AND THE WANTEDNESS OF PREGNANCIES: EVIDENCE FROM MASSACHUSETTS

Health insurance reform in Massachusetts lowered the cost of both pregnancy (by increased coverage of pregnancy‐related medical events) and pregnancy prevention (by increasing access to reliable contraception). We empirically examine fertility responses and find no overall effect from increased coverage due to the Massachusetts reform. This finding, however, masks substantial heterogeneity. For married women aged 20 to 34—with high latent fertility and pregnancy wantedness—fertility increased by approximately 1%. For unmarried women in the same age range—for whom pregnancies are typically unwanted—fertility declined by 8%. (JEL I13, I18, J13)

P037 Why do women discontinue long acting reversible methods of contraception? – findings from an integrated sexual health clinic

IntroductionLong acting methods of contraception, namely the progestogen only implant and the intra-uterine devices are reliable methods of contraception, favoured by commissioners of integrated sexual health. However in practice, a...

Uptake of hormonal contraceptives and correlates of uptake in a phase III clinical trial in rural South Western Uganda

BackgroundUse of a reliable contraception method has become an inclusion criterion in prevention trials to minimize time off product. We report on hormonal contraceptive prevalence, uptake, sustained use and correlates of use in the Microbicides Development Programme (MDP 301) trial at the Masaka Centre in Uganda.MethodsHIV negative women in sero-discordant relationships were enrolled and followed-up for 52 to 104 weeks from 2005 to 2009. Contraceptive use data was collected through self-report at baseline and dispensing records during follow-up. Hormonal contraceptives were promoted and provided to women that were not using a reliable method at enrolment. Baseline contraceptive prevalence, uptake and sustained use were calculated. Uptake was defined as a participant who reported not using a reliable method at enrolment and started using a hormonal method at any time after. Logistic regression models were fitted to investigate predictors of hormonal contraceptive uptake.ResultsA total of 840 women were enrolled of whom 21 aged ≥50 years and 12 without follow-up data were excluded; leaving 807 (median age 31 IQR 26–38) in this analysis. At baseline, 228 (28%) reported using a reliable contraceptive; 197 hormonal, 28 female-sterilisation, two IUCD and one hysterectomy. As such 579 were not using a reliable contraceptive at enrolment, of whom 296 (51%) subsequently started using a hormonal contraceptive method; 253 DMPA, four oral pills, and two norplant. Overall 193 (98%) existing users and 262 (88%) new users sustained use throughout follow-up. Independent correlates of hormonal contraceptive uptake were: younger women ≤30 years, aOR = 2.5, 95% CI: 1.7–3.6 and reporting not using contraceptives at baseline due to lack of access or money, breastfeeding or other reasons, in comparison to women who reported using unreliable method.ConclusionPromotion and provision of hormonal contraception doubled the proportion of women using a reliable method of contraception. Uptake was pronounced among younger women and those not previously using a reliable method because of lack of access or money, and breastfeeding. Promotion and provision of hormonal contraceptives in trials that require the interruption or discontinuation of investigational products during pregnancy is important to reduce the time off product.Trial registrationProtocol Number ISRCTN64716212.

Premarital sexual relationships: Contraceptive knowledge and practice among iranian youths

Objective: The youths' sexual behaviors are counted as the main priorities of the public health due to the high prevalence of unwanted pregnancies, illegal abortions, and sexually transmitted infections. This research was carried out to explain the youths' contraceptive knowledge and practice in premarital sexual relationships. Methods: This qualitative research was carried out on 30 single boys and girls aged 18–24, living in Isfahan, Iran, who had already started sexual activities. Data collection was done with semi-structured interviews. The data were analyzed by using conventional content analysis. Results: Two main categories were extracted including inadequate awareness regarding contraception (with subcategories “unreliable information sources” and “gender inequality in familiarity with contraceptive methods”) and inappropriate contraceptive practice (with sub-categories “use of unreliable contraceptive methods” and “gender inequality in applying contraceptive methods”). Conclusion: Sexual health education programs should equip the youths with adequate knowledge on contraception and use of reliable contraceptive methods. Furthermore, attempts should be made along with tackling gender inequality is very significant for youths' sexual and reproductive health security.

Study on readiness for pre- and postabortion consultation among midwives

One of the strategies for solving the problem „abortion` is the use of effective, modern and reliable contraception. This aspect of the problem is connected with the creation of consulting rooms for family planning, their proper functioning and ensuring trained midwives providing adequate contraceptive services. The purpose of this study is to assess the readiness and competence of health care professionals (midwives) to provide activities related to pre-abortion and post- abortion consulting. Material and Methods : In the study on a random basis are included 127 midwives working in Varna, Dobrich, Shumen, Ruse, Plovdiv and Pleven. We used the original questionnaire with open and closed questions. Results : Based on qualitative and quantitative analysis of the data obtained, a connection is established between participation in courses on family planning and skills of the participants for consultation on family planning. Respondents who feel prepared to conduct independent consultations on family planning are 48%, those who are unable to do so - 29%, and 23% cannot decide. It is not surprising that only 16% of midwives have participated in courses on family planning over the past five years. The rest (84%) were not included in courses because such were not organized. Preferences for courses in postgraduate training topics are: 1) Information on methods of contraception 2) Counseling skills 3) Family knowledge 4) Communication skills

Recent developments have made female permanent contraception an increasingly attractive option, and pregnant women in particular ought to be counselled about it.

BackgroundDespite the increased prevalence of reversible contraception, global unintended pregnancy rates are stable. Mistakes, method failures, side effects, alcohol, stock-outs, fears, costs, delays, myths, religious interference, doctors with other priorities, traditions and lack of health professionals may all factor in. Yet these unintended pregnancies ― nearly a hundred million annually ― cause much individual suffering, and in the long run, can aggravate conflicts, poverty, forced emigration and climate change. Presently, non-poor women postpone childbearing because of longer educational trajectories and careers. Sterilisations are therefore less often regretted or coerced. For poor-resourced women with a completed family, an unwanted pregnancy often has serious consequences, including crossing the (extreme) poverty line in the wrong direction, choosing an unsafe abortion, or even death. Caesarean sections (CSs), which currently stand at around 23 million annually, are increasing. On an “intention-never-to-become-pregnant-again” analysis, choosing a partial, and even more so a total bilateral tubectomy to be implemented during an ― anyway performed ― CS is by far the most reliable and safe contraceptive choice compared to meaning to start female or male sterilisation or any other contraceptive method later, and it reduces the chance of a future ovarian carcinoma substantially. CSs make subsequent pregnancies more dangerous. Simultaneously, they provide convenient, potentially cost-free opportunities for voluntary permanent contraception (PC): particularly important if there is no guaranteed future access to reliable contraception, safe abortion and well-supervised labour.Partial solutionMillions of women are within reach of attaining freedom from the “tyranny of excessive fertility” when they have a CS. Therefore, any woman who might conceivably be of the firm opinion that her family will be (over) completed after delivery should antenatally have “what if you have a CS” counselling to assess whether she would like a tubectomy/ligation. Yet many are not provided with this option: leading to frequent regret, more often than having been giving that choice would.ConclusionWithholding antenatal counselling about the option of PC for in case the delivery might become a CS is very prevalent, yet often more medically risky, and morally questionable than when, even in labour, a doctor sometimes decides in the absence of earlier counselling, considering numerous factors, to provide the choice to undergo a concurrent sterilisation if s/he is convinced that would be in the patient’s best interest.

Models of health behaviour predict intention to use long acting reversible contraception use.

The aim of this study was to investigate women’s intention to use long-acting reversible contraception using two established models of health behaviour: the theory of planned behaviour and the health belief model. A questionnaire was completed by a convenience sample of 128 women attending a community sexual health clinic. The independent variables were constructs of theory of planned behaviour (attitude, subjective norm and perceived behavioural control) and health belief model (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, health motivation and cues to action). The dependent variable was intention to use long-acting reversible contraception. The theory of planned behaviour and the health belief model accounted for 75% of the variance in intention to use. Perceived behavioural control, perceived barriers and health motivation predict the use of long-acting reversible contraception. Public health information for women considering using long-acting reversible contraception should be based around addressing the perceived barriers and promoting long-acting reversible contraception as a reliable contraceptive method.

The use of contraception for patients after bariatric surgery.

Obesity in women of reproductive age is a serious concern regarding reproductive health. In many cases of infertility in obese women, reduction of body weight may lead to spontaneous pregnancy, without the need for more specific methods of treatment. Bariatric surgery is safe and is the most effective method for body weight reduction in obese and very obese patients. In practice there are two bariatric techniques; gastric banding, which leads to weight loss through intake restriction, and gastric bypass, leads to weight loss through food malabsorption. Gastric bypass surgery (the more frequently performed procedure), in most cases, leads to changes in eating habits and may result in vomiting, diarrhea and rapid body mass reduction. There are reliable data describing the continuous increase in the number of women who are trying to conceive, or are already pregnant, following bariatric surgery. Most medical specialists advise women to avoid pregnancy within 12-18 months after bariatric surgery. This allows for time to recover sufficiency from the decreased absorption of nutrients caused by the bariatric surgery. During this period there is a need for the use of reliable contraception. As there is a risk for malabsorption of hormones taken orally, the combined and progestogen-only pills are contraindicated, and displaced by non-oral hormonal contraception or non-hormonal methods, including intrauterine devices and condoms.

The contraceptive implant

The introduction of contraception has significantly improved lifestyle choices for women. The majority of women go to their general practice for contraception, and therefore, GPs have an important role in helping to guide their decision-making. The progesterone-only implant is one of the four available long-acting methods of contraception; it works mainly by preventing ovulation. It is a small 40-mm rod that is implanted into the subdermal tissue in the upper arm, where it provides contraception for up to 3 years. It is both one of the most reliable methods of contraception and is more cost-effective than traditional methods.

Combined oral contraceptives, thrombophilia and the risk of venous thromboembolism: a systematic review and meta‐analysis

Essentials We performed a meta-analysis on thrombosis risk in thrombophilic oral contraceptive (COC)-users. The results support discouraging COC-use in women with a natural anticoagulant deficiency. Contrary, additive risk of factor V Leiden (FVL) or prothrombin-G20210A (PT) mutation is modest. Women with a FVL/PT-mutation as single risk factor can use COCs if alternatives are not tolerated. Background Combined oral contraceptives (COCs) are associated with an increased risk of venous thromboembolism (VTE), which is shown to be more pronounced in women with hereditary thrombophilia. Currently, WHO recommendations state that COC-use in women with hereditary thrombophilias (antithrombin deficiency, protein C deficiency, protein S deficiency, factor V Leiden and prothrombin-G20210A mutation) is associated with an unacceptable health risk. Objective To perform a meta-analysis evaluating the additional risk of VTE in COC-users with thrombophilia. Methods The MEDLINE and EMBASE databases were searched on 10 February 2015 for potential eligible studies. A distinction was made between 'mild' (factor V Leiden and prothrombin-G20210A mutation) and 'severe' thrombophilia (antithrombin deficiency, protein C deficiency, protein S deficiency, double heterozygosity or homozygosity of factor V Leiden and prothrombin-G20210A mutation). Results We identified 12 case-control and three cohort studies. In COC-users, mild and severe thrombophilia increased the risk of VTE almost 6-fold (rate ratio [RR], 5.89; 95% confidence interval [CI], 4.21-8.23) and 7-fold (RR, 7.15; 95% CI, 2.93-17.45), respectively. The cohort studies showed that absolute VTE risk was far higher in COC-users with severe thrombophilia than in those with mild thrombophilia (4.3 to 4.6 vs. 0.49 to 2.0 per 100 pill-years, respectively), and these differences in absolute risks were also noted in non-affected women (0.48 to 0.7 vs. 0.19 to 0.0), but with the caveat that absolute risks were estimated in relatives of thrombophilic patients with VTE (i.e. with a positive family history). Conclusion These results support discouraging COC-use in women with severe hereditary thrombophilia. By contrast, additive VTE risk of mild thrombophilia is modest. When no other risk factors are present, (e.g. family history) COCs can be offered to these women when reliable alternative contraceptives are not tolerated.

The Unmet Contraceptive Need of Incarcerated Women in Ontario.

Studies from the United States have shown that women in correctional facilities have higher rates of unintended pregnancy and unmet need for contraception compared with the general population, and that the provision of family planning services in correctional facilities may improve access to contraception. No study has examined these issues in women in correctional facilities in Canada. We aimed to describe the rates of unintended pregnancy and contraceptive use for incarcerated women in Ontario. Women in a provincial correctional facility in Ontario completed a written survey in 2014. We calculated the prevalence of prior unintended pregnancy, prior therapeutic abortion, and contraception use. We calculated the unmet need for contraception, defined as the proportion of women who were not using reliable contraception among women who were sexually active and were not trying to conceive. Of 85 participants, 82% had been pregnant, and of these women, 77% had experienced an unintended pregnancy and 57% reported having undergone a therapeutic abortion. Regarding the most recent pregnancy, 72% of women scored their pregnancy intention as unplanned or ambivalent. Of women who were at risk for unintended pregnancy prior to incarceration, 80% were not using a reliable form of contraception. Incarcerated women in Ontario have higher rates of unintended pregnancy and unmet need for contraception than does the general population. The provision of family planning services during and after incarceration may improve the health of individuals and reduce costs for society overall.

Usage patterns and attitudes towards emergency contraception: the International Emergency Contraception Research Initiative

Objectives: The aim of the survey was to gain understanding of women’s usage patterns and attitudes towards emergency contraception (i.e., the ‘morning after pill’) and to gain insight into the role and attitudes of pharmacists as providers of emergency contraception.Methods: As part of the International Emergency Contraception Research Initiative, approximately 6500 women (15–49 years) and nearly 500 pharmacists from 14 countries in Western, Central and Eastern Europe, and Central Asia completed questionnaires via web-based interrogation or computer-assisted/paper-assisted personal interviews.Results: Common to almost all countries and cultures was that, while awareness of emergency contraception was high (≥84% of respondents, except in Kazakhstan), usage was generally low (4–18%). In Austria, the Czech Republic, Spain, and the UK, better underlying protection with hormonal contraceptives or male condoms would have meant less need for emergency contraception. In Bulgaria, Lithuania, Romania, and Russia, greater dependence on less reliable contraceptive methods such as calendar + withdrawal was associated with higher use of the emergency contraceptive pill (11–18%) but also with higher abortion rates (19–21%). Overt rejection of emergency contraception in the event of an accident was low, except in countries (e.g., Austria, Poland) where the misperception that it acts as an abortifacient was common. Except for Bulgaria, pharmacists elsewhere tended to have limited knowledge and moralistic attitudes towards emergency contraception.Conclusions: Improved educational efforts, probably country-specific, are required to increase the use of highly effective methods of regular contraception and overcome barriers to acceptance of emergency contraception as a suitable postcoital solution to avoid unwanted pregnancy or abortion.

Unintended pregnancy during the first year after breast cancer diagnosis

Objectives: Young women experience high levels of anxiety and distress during cancer diagnosis and therapy, and it can be devastating to become pregnant in this vulnerable state. Pregnancy during cancer treatment is strongly discouraged, as radiotherapy and chemotherapy administered during the first trimester of pregnancy result in increased congenital malformations.Methods: In this study, we analysed an unselected, consecutive cohort of young breast cancer (BC) patients with regard to unintended pregnancy during the first year after BC diagnosis. We analysed all patients who were ≤40 years of age at initial BC diagnosis (n = 100, mean age at diagnosis: 35.9 years), according to data from the Basel Breast Cancer Database. The frequency of unintended pregnancy was assessed, and particular attention was given to patients’ obstetric and reproductive history.Results: Forty-two percent of the cohort (mean age 36.5 years) were identified as not at risk of unintended pregnancy during the first year after BC diagnosis. However, 58% of the cohort (mean age 35.6 years) were using an ineffective contraceptive method and thus were at risk of unintended pregnancy. The rate of unintended pregnancy was 3.5% in this group (two patients). Oncologists should be aware that the use of reliable contraception should be discussed before starting, and also during, adjuvant therapy.Conclusions: Oncologists should consider actively referring young BC patients to a gynaecologist to ensure proper contraceptive counselling.

Levonorgestrel Intrauterine System Continuation in Adolescents and Adult Women [14N

INTRODUCTION: Up to 60% of women elect to remove the levonorgestrel intrauterine system (LNG-IUS) prematurely for side effects (SEs). Removal rates may differ between adolescents and adult women. We investigated the effect of age on removal patterns in first time LNG-IUS users. METHODS: We retrospectively reviewed women ages 15–44 undergoing LNG-IUS placement for contraception at an academic tertiary care center from 2006–2009. Women with previous LNG-IUS were excluded. Continuation rates without removal for SEs were estimated using the Kaplan-Meier method. Associations with time to removal were evaluated using Cox models. RESULTS: Of 1,062 eligible women, 79% had follow-up. Of these, 24.7% requested removal for SEs, most commonly bleeding. At 1, 3, and 5 years post-insertion, continuation rates without removal for SEs were 87%, 76%, and 71%, respectively. Each 1-year increase in age was associated with a 3% decrease in removal risk for SEs (HR 0.97, P=.004). Adolescents ages 15–21 (n=60) were compared to adult women ages 22–44 (n=778). Thirty five percent of adolescents and 23.9% of adult women requested removal for SEs. Continuation rates without removal for SEs at t 1, 3, and 5 years were 82%, 66%, and 49%, respectively, for adolescents and 88%, 76%, and 72%, respectively, for adults. Adolescents were 69% more likely to request removal for SEs (HR 1.69; P=.02) and chose less reliable alternative contraception (P=.001). CONCLUSION: Adolescents request LNG-IUS removal for SEs more frequently than adult women, though the method is overall well accepted across all age groups. Understanding removal patterns and patient expectations helps guide contraceptive counseling.

Knowledge of university students in Szeged, Hungary about reliable contraceptive methods and sexually transmitted diseases

Promiscuity and lack of use of reliable contraceptive methods increase the probability of sexually transmitted diseases and the risk of unwanted pregnancies, which are quite common among university students. The aim of the study was to assess the knowledge of university students about reliable contraceptive methods and sexually transmitted diseases, and to assess the effectiveness of the sexual health education in secondary schools, with specific focus on the education held by peers. An anonymous, self-administered questionnaire survey was carried out in a randomized sample of students at the University of Szeged (n = 472, 298 women and 174 men, average age 21 years) between 2009 and 2011. 62.1% of the respondents declared that reproductive health education lessons in high schools held by peers were reliable and authentic source of information, 12.3% considered as a less reliable source, and 25.6% defined the school health education as irrelevant source. Among those, who considered the health education held by peers as a reliable source, there were significantly more females (69.3% vs. 46.6%, p = 0.001), significantly fewer lived in cities (83.6% vs. 94.8%, p = 0.025), and significantly more responders knew that Candida infection can be transmitted through sexual intercourse (79.5% versus 63.9%, p = 0.02) as compared to those who did not consider health education held by peers as a reliable source. The majority of respondents obtained knowledge about sexual issues from the mass media. Young people who considered health educating programs reliable were significantly better informed about Candida disease.

The current state of male hormonal contraception.

World population continues to grow at an unprecedented rate, doubling in a mere 50years to surpass the 7-billion milestone in 2011. This steep population growth exerts enormous pressure on the global environment. Despite the availability of numerous contraceptive choices for women, approximately half of all pregnancies are unintended and at least half of those are unwanted. Such statistics suggest that there is still a gap in contraceptive options for couples, particularly effective reversible contraceptives for men, who have few contraceptive choices. Male hormonal contraception has been an active area of research for almost 50years. The fundamental concept involves the use of exogenous hormones to suppress endogenous production of gonadotropins, testosterone, and downstream spermatogenesis. Testosterone-alone regimens are effective in many men but high dosing requirements and sub-optimal gonadotropin suppression in 10-30% of men limit their use. A number of novel combinations of testosterone and progestins have been shown to be more efficacious but still require further refinement in delivery systems and a clearer understanding of the potential short- and long-term side effects. Recently, synthetic androgens with both androgenic and progestogenic activity have been developed. These agents have the potential to be single-agent male hormonal contraceptives. Early studies of these compounds are encouraging and there is reason for optimism that these may provide safe, reversible, and reliable contraception for men in the near future.