Sexually-active Women Research Articles

Cervical cancer vaccination indications, efficacy, and side effects

Due to the limited contact of the human papillomavirus (HPV) with the immune system, past infection does not guarantee lasting protection. Two preventive vaccines (Gardasil® and Cervarix®) that can impede persistent HPV infection and its consequences are now available. They use structural L1 capsular proteins obtained by genetic recombination and antigens for genotypes 16 and 18, which are responsible for around 70% of cases of uterine cancer worldwide. Evaluation of their protective efficacy is based on the capacity of the vaccine to prevent persistent infection and cervical intraepithelial neoplasia (CIN). Phase I and II trials showed the safety of these vaccines and their capacity to produce very-high titers of antibodies (low or non-existent after natural infection). Phase II and III trials have confirmed these aspects and shown an efficacy of nearly 100% in the protocol analysis in preventing infection and the CIN associated with oncogenic vaccine genotypes. Some trials have also shown cross-protection against infections produced by other genotypes (such as 45 and 31). The optimal vaccination strategy is vaccination of girls aged 8–14 years. Other strategies should include the catch-up of adolescent and women not yet sexually-active, as well as the vaccination of sexually-active women. The progressive development of primary prevention strategies should coexist with secondary prevention with redesigned screening programs. The successful development of vaccination programs will require the support of public health authorities, the coordination of health workers from different areas and increased public awareness.

Acceptability of the diaphragm in Mombasa Kenya: A 6-month prospective study

Objectives If proven acceptable, safe and effective, the diaphragm could be used as a female-controlled method of preventing both sexually-transmitted infections (STIs) and pregnancy. This study's aim was to assess the acceptability and safety of the diaphragm among sexually-active women in Mombasa, Kenya.Methods We conducted a 6-month prospective study among female sex workers (FSWs), and women attending sexual and reproductive health services. Diaphragm acceptability was assessed using continuation rates and factors associated with acceptability. Safety evaluations included colposcopy findings and incidence of urinary tract infections (UTIs) and STIs.Results Half the 185 participants were FSWs who had less schooling and were less likely to be married than other women. After 6 months, 55% (56/102) of sexually-active women reported having used the diaphragm each sex act during the preceding month. Women liked using the diaphragm (95%, 104/109), and 96% (125/130) reported willingness to continue using it. Colposcopy did not reveal significantly more vaginal or cervical lesions. Use of the diaphragm was not associated with an increase in bacterial vaginosis or UTIs. A pregnancy rate of 12 per 100 women/years was observed.Conclusion After 6 months of diaphragm use in this setting, continuation rates were sustained, user satisfaction was high and adverse effects were few.

Women who put condoms on male partners: correlates of condom application.

To identify correlates of women applying condoms. Cross-sectional survey of 533 sexually-active women; questionnaire. Of the condom users (n = 322), 31.7% reported applying condoms at least once--an average on 59.7% of the occasions. Compared to nonappliers, appliers had more positive affect toward sexually related situations (erotophilia, P = .004) and a higher frequency of sex (P = .003). Condom users, compared to nonusers, were significantly younger (P = .001), were less likely to be in sexually exclusive relationships (P = .001) or married (P = .01), and reported more partners in the past 3 months (P = .001). Condom-applying women may have more positive attitudes toward sexuality and engage in a higher frequency of sexual activity.

Knowledge of the abortion legislation among South African women: a cross-sectional study

BackgroundIn order to ensure that legalized abortion in South Africa improves reproductive health, women must know that abortion is a legal option in the case of unwanted pregnancy. This study investigated knowledge of abortion legislation eight years after the introduction of legal abortion services in one province of South Africa.MethodsIn 2004/2005, we conducted a cross-sectional study among 831 sexually-active women attending 26 public health clinics in one urban and one rural health region of the Western Cape Province.ResultsThirty-two percent of women did not know that abortion is currently legal. Among those who knew of legal abortion, few had knowledge of the time restrictions involved.ConclusionIn South Africa there is an unmet need among women for information on abortion. Strategies should be developed to address this gap so that women are fully informed of their rights to a safe and legal termination of pregnancy.

Libido and orgasm in middle-aged woman

Objectives: Determine which social, demographic and sexual function variables that most influence libido or desire and orgasm domains in the premenopausal and postmenopausal women. Methods: A cross-sectional analysis of 231 Colombian-born women, aged 40–62 years. The sexual function was measured by self-questionnaire. The analysis was performed by using the χ 2-test and multivariate regression analysis. The sexual function was divided in five domains: desire, arousal, lubrication, orgasm, pain; additionally satisfaction was included. Results: The women with a higher level of education and with a good perception of their satisfaction with their partners, reported better performance in the desire. Age and the non existence of sexual partner influenced in a negative way on the desire. In sexual active women the orgasm was negatively influenced by low satisfaction scores, lack of emotional closeness with their partners and low educational level. High scores in lubrication and desire were associated with a good performance in the orgasm. The hormone therapy (HT) was associated with better scores in orgasm. Conclusions: Age, level of education, the presence or lack of sexual partner, degree of satisfaction with emotional closeness with the partner and adequate lubrication, influence the desire and orgasm domains in a significant way. By identifying these associations we can then perform some inexpensive interventions. Improving lubrication for menopausal women. Including men in educational activities to sensitize them toward women's feelings. Organizing educational campaigns for middle-aged women to demystify that sexuality is only for young people.

Prevalence and risk factors of syphilis infection among drug addicts

BackgroundRecent epidemiological data show an increased trend of official estimates for syphilis infection in the general population. Many of the infected cases remain undetected leaving an underestimation of the true prevalence of syphilis in the general population, but also among subpopulations such as illicit drug users. There is limited epidemiological data published on the proportion and risk factors of syphilis infections associated with illicit drug abuse.MethodsIllicit drug addicts (n = 1223) in inpatients units in Germany were screened (2000–01) for syphilis and interviewed regarding patterns of drug use and sexual behaviour. TPHA-test for initial screening and FTA-ABS-IgM test in TPHA-positive patients were used.ResultsIn total, TPHA-tests were positive in 39 (3.3%) and 7 patients (0.6%) were IgM positive. The prevalence rate for syphilis in males was 1.9% and for women it was 8.5%. Female patients were 4.56 (CI 95% 2.37–8.78) times more likely to have a positive TPHA test than males. Sexual behaviours such as high number of sexual partners, sex for drugs/money, sex on the first day were associated with syphilis infection only in women. Females with frequent sex for drugs or money had 4.31 (CI 95% 2.32–8.52) times more likely a reactive TPHA test than remaining patients. Neither the sociodemographic factors nor sexual behaviour were statistically significant associated with syphilis infection among men at all.ConclusionOur data suggest the need for screening for syphilis among these illicit drug users in inpatient settings, in particular among sexual active women. This conclusion is corroborated by the finding of increasing numbers of syphilis infections in the general population. The identification of syphilis cases among drug addicts would give treatment options to these individuals and would help to reduce the spread of infection in this population, but also a spread into heterosexual populations related to prostitution.

Perception of risk of HIV infection in marital and cohabiting partnerships

The purpose of this paper is to understand how married and cohabiting men and women define risk and to identify the factors that influence risk perceptions in a setting with a high prevalence of HIV infection. A combination of qualitative and quantitative methods was used during a cross-sectional survey conducted among 248 men and 289 women in KwaZulu-Natal, South Africa. Forty in-depth interviews were conducted with sexually-active men and women in the same population. The majority of men and women perceived themselves at risk of HIV infection. Women were more likely than men to report a higher risk of HIV infection. Nearly 46% of women and 28% of men perceived themselves at medium or high risk of HIV infection. The qualitative and quantitative data show that perception of risk of HIV infection was influenced both by a person's own sexual behaviour and a partner's sexual behaviour. Men were significantly more likely to perceive themselves at risk because of their own risky sexual behaviour (P < 0.01). In general, few women reported engaging in risky sexual behaviour. However, women were more likely to report that their partners had other sexual partners. Thus, women were significantly more likely to perceive themselves at risk because of their partner's sexual behaviour (P < 0.05). Also, rural women were significantly more likely than urban women to perceive a high risk of HIV infection (P < 0.05). Prevention programmes have an important role to play in creating awareness of the risk of HIV, especially among men. The belief that they are not at risk of HIV infection may result in their failure to adopt self-protective behaviour.

Cost-effectiveness of an HIV prevention intervention for mentally ill adults.

Adults with severe mental illness are at high risk for human immunodeficiency virus (HIV) infection and transmission. Small-group interventions that focus on sexual communication, condom use skills, and motivation to practice safer sex have been shown to be effective at helping mentally ill persons reduce their risk for HIV. However, the cost-effectiveness of these interventions has not been established. We evaluated the cost-effectiveness of a 9-session small-group intervention for women with mental illness recruited from community mental health clinics in Milwaukee, Wisconsin. We used standard techniques of cost-utility analysis to determine the cost per quality-adjusted life year (QALY) saved by the intervention. This analysis indicated that the intervention cost $679 per person, and over $136,000 per QALY saved. When the analysis was restricted to the subset of women who reported having engaged in vaginal or anal intercourse in the 3 months prior to the baseline assessment, the cost per QALY saved dropped to approximately $71,000. These estimates suggest that this intervention is marginally cost-effective in comparison with other health promotion interventions, especially if high-risk, sexual-active women are preferentially recruited.

Outcomes of a community-based HIV/AIDS education programme for rural older women in Botswana

This article describes the experience and outcomes of a community-based educational programme to prevent HIV infection in older rural women in Botswana and to utilize the women as resources to educate members of their communities in the prevention of the disease. The programme used the primary health-care approach to develop and test gender-specific and culturally-relevant materials for the older women. Programme evaluation employed a quasiexperimental design with older women in a second village serving as a control group. Six months after programme implementation, the older women in the target village were more knowledgeable about HIV/AIDS than those in the control village. The sexually-active women were practising safer sex, and all were collaborating with health personnel in community activities for HIV/AIDS prevention and care. These activities are continuing and are being sustained by the village health committee.

Bacteriuria in a cohort of predominantly HIV-1 seropositive female commercial sex workers in Nairobi, Kenya

Although significant bacteriuria and urinary tract infection are more common in immunocompetent women than men, studies linking HIV immunosuppression with an increased risk of developing urinary infection have so far only been carried out in men. We therefore examined the relationship between bacteriuria and HIV status and CD4+cell count in a relatively homogeneous cohort of female commercial sex workers (CSW) attending a community clinic in Nairobi. Two hundred and twenty-two women were enrolled, and grouped according to HIV status and CD4 count. Group 1 were HIV seronegative (n = 52); Group 2 were HIV seropositive with CD4 + counts above 500 x 10(6)/l (n = 51); Group 3 were HIV seropositive with CD4 + counts between 201 and 500 x 10(6)/l (n = 67); Group 4 were HIV seropositive with CD4+counts below 200 x 10(6)/l (n = 52). Clinical signs and symptoms were noted and mid-stream specimens of urine obtained for culture and sensitivity. Overall 23% (50/222) had significant bacteriuria. The rates in each group respectively were 25%, 29%, 19% and 23% and there was no significant association between bacteriuria and HIV status; or between bacteriuria and level of immuno-suppression as indicated by CD4 + count. Overall 19% (30/222) of women had symptoms (frequency; dysuria; loin pain; smelly urine) or signs (fever; loin tenderness) compatible with urinary tract infection. However there was no significant association between symptoms or signs of infection and bacteriuria or HIV status. A typical range of pathogens, predominantly Enterobacteriaceae, were isolated and there were high rates of resistance to commonly used antimicrobials as well as 10% resistance to ciprofloxacin. Although high rates of significant bacteriuria can occur in highly sexually-active women, this appears unrelated to HIV infection or the level of HIV-related immunosuppression and is generally asymptomatic or clinically indistinct.

The prevalence of Chlamydia trachomatis in a young, sexually‐active population

A prospective study was carried out to determine the prevalence of Chlamydia trachomatis among 1000 sexually-active women at the Family Planning Association Clinic in Melbourne. This organism was isolated from the cervices of 5.1% of screened women. The women were surveyed about their sexual and gynaecological history, and symptoms of discharge or pain. It was found that women who gave positive results for the presence of Chlamydia were younger, and had commenced intercourse at an earlier age. Risk factors of multiple sexual partners, cervical ectopy and symptoms of urethritis were identified. We recommend that women who have more than one sexual partner should ask their partners to use condoms or, failing this, undergo annual screening for Chlamydia by immunofluorescent staining.

Sex life after radical operations for cervical cancer

75 sexual active women with invasive cervical carcinoma up to 55 years of age were treated by radical hysterectomy, part of them also with postoperative irradiation. Of primary interest were interviews with those 57 women (87,7%) whose marital relationship was not disturbed in the postoperative phase. No harmony in the partnership was found in 7,7%, manifestation occurred within 1 year after treatment. The causes were in many cases of psychosomatic nature. Reduced libido was found in 60,8%, 62,0% had their first sexual relationship within 3 months after treatment. No orgasm was reported before operation by 7,6%, by 23% after operation. 57,7% had sexual climax always or mostly after treatment. Reduced orgasm was rare in those women, whose partnership was not disturbed. Frequency of cohabitations was reduced. 11,5% reported preoperative painful coitus, 50,8% postoperative. The interviews of women by means of standardized questionnaires should become a routine measure within the rehabilitation and postoperative control program of gynecologic cancer patients. The establishment of self-help groups is recommended in order to control also the psychosocial components of the disease.

Oral contraceptives and emotional state

The profile of Mood States [5] was administered to 67 young sexually-active women who were attending a Family Planning Clinic for the first time. A discriminant function analysis indicated that users of oral contraceptives (OC users, n=15) were older and higher scores on the Depression and Fatigue subscales of the POMS than non-OC users ( n=52) who had higher Anger-Hostility scores. The significance and implications of these results are discussed.