Tendencias temporales en el uso de métodos de barrera durante las relaciones sexuales en Argentina y eficacia de intervenciones para promover su implementación / Trends in the use of barrier methods during sexual intercourse in Argentina and the effectiveness of interventions to promote their implementation

Durante la última década, presenciamos en Argentina un aumento de la incidencia de infecciones de transmisión sexual(ITS) vinculado con una disminución en el uso de métodos de barrera (MB). De acuerdo a la bibliografía, existen varias categorías de obstáculos para el uso de MB: desigualdades de género, dificultades económicas y/o de accesibilidad, desconfianza respecto de los MB provistos por el Estado respecto de su calidad y/o fecha de vencimiento, o bien, creencias acerca de que la utilización de MB disminuye el placer sexual o que no es necesario su uso cuando la relación de pareja es estable y/o basada en la confianza, el amor y/o la fidelidad. A partir de esta problemática, los autores de este artículo realizamos una búsqueda bibliográfica y revisamos cual es la evidencia que respalda diferentes intervenciones para promover el uso de MB. Encontramos evidencia de moderada calidad que avala la eficacia de intervenciones a nivel comunitario basadas en la teoría sociocognitiva y en el aumento de la oferta y la disponibilidad de preservativos para mejorar el conocimiento sobre el HIV y el uso de estos métodos, sin impacto sobre la incidencia de ITS a nivel poblacional. (AU)

Over the last decade, Argentina has shown an increase in the incidence of sexually transmitted infections (STIs) linked to a decrease in the use of barrier methods (BM). According to the literature, there are several categories of obstacles for the use of BM: gender inequalities, economic and/or accessibility difficulties, mistrust regarding the quality and/or expiry date of state-provided BMs, as well as beliefs that the use of BMs reduces sexual pleasure or that their use is not necessary when the couple's relationship is stable and/or based on trust, love and/or fidelity. In light of this issue, the authors of this article conducted a literature search and reviewed the evidence supporting different interventions to promote the use of BM. They found moderate quality evidence that supports the efficacy of community-level interventions based on socio-cognitive theory and on increasing the supply and availability of condoms to improve knowledge about HIV and the use of these methods, with no impact on the incidence of STIs at the population level. (AU)

Análisis en el uso del condón femenino en estudiantes de una universidad privada de Cali-Colombia / Analysis of the use of the female condom in students of a private university in Cali, Colombia / Análise do uso do preservativo feminino em estudantes de uma universidade privada em Cali-Colômbia

Introducción. El condón femenino es un método de barrera eficaz para prevenir las enfermedades de transmisión sexual y los embarazos, permite la mejora de la salud sexual y reproductiva de las mujeres y sus parejas. Presenta barreras al utilizarse en aspectos socioculturales, económicos, religiosos y psicológicos, los cuales pueden ser superados a través de la promoción y educación. El objetivo del presente artículo es analizar el uso del condón femenino en estudiantes universitarios de un programa de salud. Metodología. Estudio cuasiexperimental, con muestreo por conveniencia realizado en 82 estudiantes, organizados en un grupo de 74 mujeres y otro de 8 hombres, quienes utilizaron el condón femenino en sus relaciones sexuales durante un período de tres meses. Reconocieron las ventajas, desventajas, sensaciones y reacciones de la pareja. Resultados. Las ventajas establecidas por todos los hombres y el 70% de las mujeres es colocar el condón femenino antes de la relación sexual, del mismo modo, el 39.2% de las mujeres y el 37.2% de los hombres indican como ventaja poder usarlo hasta el final de la relación. Las desventajas identificadas comprenden que el 54.1% de las parejas de las mujeres no les gusta utilizarlo, al 40.5% de las mujeres les parece difícil su colocación, y al 33.8% le disminuye el placer sexual. En los hombres se identifican como desventajas la disminución del placer en la relación sexual, al 87.5% de sus parejas no le gusta utilizarlo, y el 62.5% de los hombres expresa dificultad para su colocación. Discusión. El uso del condón femenino está limitado por las condiciones de acceso y disponibilidad. El procedimiento de inserción del dispositivo en las mujeres requiere entrenamiento previo e información específica para su uso. Conclusión. La utilización del condón femenino es una alternativa viable para tener sexo seguro, los hombres presentan mayor rechazo al verse afectado el placer sexual.

Introduction. The female condom is an effective barrier method to prevent sexually transmitted diseases and pregnancy; it allows the improvement of the sexual and reproductive health of women and their partners. Using it presents barriers in sociocultural, economic, religious and psychological aspects, which can be overcome through promotion and education. The objective of this article is to analyze the use of the female condom in university students of a health program. Methodology. Quasi-experimental study, with convenience sampling carried out in 82 students, organized in a group of 74 women, and another of 8 men, who used the female condom in their sexual intercourse during a period of three months. They recognized the advantages, disadvantages, feelings and reactions of the partner. Results. The advantages established by all men and 70% of women is to place the female condom before sexual intercourse; in the same way, 39.2% of women and 37.2% of men indicate as an advantage the possibility to use it until the end of the intercourse. The identified disadvantages include that 54.1% of women's partners do not like to use it, 40.5% of women find it difficult to insert, and for 33.8% of them, it decreases sexual pleasure. In men, the disadvantages identified were the decrease in pleasure in sexual intercourse, 87.5% of their partners do not like to use it, and 62.5% of men express difficulty in inserting it. Discussion. The use of the female condom is limited by the conditions of access and availability. The procedure for inserting the device in women requires prior training and specific information for its use. Conclusion. The use of the female condom is a viable alternative to have safe sex. Men show greater rejection when sexual pleasure is affected.

Introdução. O preservativo feminino é um método de barreira eficaz na prevenção de doenças sexualmente transmissíveis e gravidez, melhorando a saúde sexual e reprodutiva da mulher e dos seus parceiros. Apresenta limitações no seu uso com relação a aspectos socioculturais, econômicos, religiosos e psicológicos, que podem ser superadas por meio de promoção e educação. O objetivo deste artigo é analisar o uso do preservativo feminino em estudantes de universidade de um programa de saúde. Metodologia. Estudo quase experimental, com amostragem por conveniência realizada em 82 estudantes, organizados em um grupo de 74 mulheres e outro de 8 homens, que usaram o preservativo feminino nas suas relações sexuais durante um período de três meses. Eles reconheceram as vantagens, desvantagens, sensações e reações do casal. Resultados. As vantagens estabelecidas por todos os homens e 70% das mulheres é colocar o preservativo feminino antes da relação sexual, da mesma forma, 39.2% das mulheres e 37.2% dos homens apontam como vantagem poder usá-lo até o fim da relação sexual. As desvantagens identificadas incluem que 54.1% dos parceiros das mulheres não gostam de usá-lo, 40.5% das mulheres têm dificuldade em colocá-lo e 33.8% acham que diminui o prazer sexual. Nos homens, identificam-se como desvantagens diminuição do prazer na relação sexual, 87.5% das parceiras não gostam de usá-lo e 62.5% dos homens expressam dificuldade em colocá-lo. Discussão. O uso do preservativo feminino é limitado pelas condições de acesso e disponibilidade. O procedimento de inserção do dispositivo em mulheres requer treinamento prévio e informações específicas para seu uso. Conclusão. O uso do preservativo feminino é uma alternativa viável para a prática de sexo seguro, os homens apresentam maior rejeição quando o prazer sexual é afetado.

Relationships matter: contraceptive choices among HIV-positive women in Tanzania

Efforts to eliminate mother-to-child transmission of HIV in Tanzania are guided by a four-prong strategy advocated by the World Health Organization (WHO). Prong 2, prevention of unintended pregnancies among women living with HIV, has, however, received the least attention and contraceptive use to prevent unintended pregnancies remains low. This study explored the perceived barriers to the use of modern methods of contraception, and factors influencing contraceptive choice among HIV-positive women in urban Dar-es-Salaam, Tanzania. A qualitative multi-site study was conducted, utilising in-depth interviews and focus group discussions with 37 sexually active HIV-positive women aged between 20 and 44 years, attending three health facilities within Dar-es-Salaam. The theoretical framework was a patient centred model. Four barriers were identified: the influence of the women's spousal relationships; personal beliefs and the relationship of these in understanding her disease; the influence of the social demands on the woman and her relationships; and the importance of a woman's relationship with her healthcare provider/healthcare system. Being the bearers of bad news (HIV-positive status) the pregnant women experienced conflicts, violence, abandonment and rejection. The loss in negotiating power for the women was in relation to their intimate partners, but also in the patient­healthcare provider relationship. The role of the male partner as a barrier to contraceptive use cannot be understated. Therefore, the results suggest that healthcare providers should ensure patient-focused education and provide support that encompasses the importance of their relationships. Additional research is required to elucidate the functional association between contraceptive choices and personal and social relationships

Utilisation des méthodes contraceptives modernes en République Démocratique du Congo: prévalence et barrières dans la zone de santé de Dibindi à Mbuji-Mayi

Introduction: l'objectif de cette étude était de déterminer la prévalence contraceptive moderne et les barrières à l'utilisation des méthodes contraceptives modernes chez les couples de la Zone de Santé Dibindi, à Mbuji-Mayi en République Démocratique du Congo.Méthodes: de Mai à Juin 2015, nous avons réalisé une étude descriptive transversale. Nous avons inclus les femmes âgées de 15 à 49 ans, en union maritale, non enceinte au moment de l'enquête, qui habitaient la Zone de santé Dibindi depuis deux ans et ayant consenti librement de participer à l'étude. La collecte des données a été réalisée par interview libre des femmes. La prévalence contraceptive moderne se référait aux femmes en cours d'utilisation, au moment de l'enquête, des contraceptifs modernes. La comparaison des proportions a été réalisée au seuil de signification de 5%. Le test de Bonferroni a été utilisé pour comparer, deux à deux, les proportions des barrières à l'utilisation des contraceptifs modernes.Résultats: la prévalence contraceptive moderne à Dibindi, en 2015, était de 18,4%. Elle était faible eu égard aux services de planification familiale disponibles dans cette Zone de santé. Plusieurs femmes refusaient d'utiliser les méthodes contraceptives modernes malgré l'information dont elles disposaient à cause de leur désir de maternité, l'interdiction religieuse, l'opposition du conjoint et la crainte des effets secondaires.Conclusion: l'information suffisante et centrée sur chaque cliente ou son couple, sur la planification familiale, devrait être renforcée de façon à éliminer les fausses croyances, ce qui accroitrait l'utilisation des méthodes contraceptives modernes

Impacto de la asesoría sobre anticoncepción en la selección de métodos hormonales combinados en Colombia / Impact of contraception counseling on choice of combined hormonal methods in Colombia

OBJETIVO: Determinar el impacto de la asesoría anticonceptiva informada sobre la elección de método anticonceptivo. MÉTODOS: Estudio descriptivo multicéntrico de evaluación antes y después en nueve ciudades de Colombia. Se invitó a participar mujeres que consideraban usar métodos hormonales combinados de autoadministración al momento de la consulta. Se indagó sobre el uso y preferencia de método anticonceptivo, previa firma del consentimiento informado. En una etapa posterior, se brindó asesoría médica estandarizada en anticoncepción y, a continuación, se preguntó nuevamente por la preferencia de método anticonceptivo y las motivaciones para su elección. RESULTADOS: Ingresaron 858 mujeres al estudio. Al inicio del estudio, 538 (62,7%) mujeres usaban píldora combinada y 281 (32,8%) no utilizaban ningún método anticonceptivo. Antes de recibir asesoría, las mujeres mostraron una preferencia por la píldora (62,7%), seguida por el anillo intravaginal (28,4%) y el parche transdérmico (14%). Luego de la asesoría, la preferencia fue la siguiente: píldora (40,8%), anillo intravaginal (31,5%) y parche transdérmico (11,3%). También luego de la asesoría, 32,5 %, 26,8% y 7,5% de las que consideraban usar píldora, parche y anillo, respectivamente, cambiaron su intención de uso. La región de origen, el estatus laboral, el deseo de concebir un hijo en el futuro y tener una relación estable presentaron una relación estadística con la selección del método, pero la edad, el número de hijos o el grado de escolaridad no fueron factores determinantes. CONCLUSIONES: La asesoría médica tiene impacto en la selección del anticonceptivo hormonal combinado autoadministrado, lo que ayuda a las mujeres a utilizar el método de su preferencia y presentar una mejor adherencia al método acorde a sus condiciones particulares.

OBJECTIVE: Determine the impact of informed contraceptive counseling on choice of contraceptive method. METHODS: Multicenter descriptive study using before-and-after evaluation in nine cities in Colombia. Women considering use of self-administered combined hormonal methods at the time of consultation were invited to participate. They were asked about contraceptive method use and preference, following signing of informed consent. Later, they were given standardized medical advice on contraception and then asked again about contraceptive preference and reasons for their choice. RESULTS: The study enrolled 858 women. At the beginning of the study, 538 (62.7%) women were using the combined pill and 281 (32.8%) were not using any contraceptive method. Before receiving counseling, women showed a preference for the pill (62.7%), followed by the intravaginal ring (28.4%), and transdermal patch (14%). After counseling, preferences were as follows: pill (40.8%), intravaginal ring (31.5%), and transdermal patch (11.3%). After counseling, 32.5%, 26.8%, and 7.5% of those considering the pill, patch, and ring, respectively, changed their intended choice. Region of origin, employment status, desire to conceive a child in the future, and having a stable relationship showed a statistical relationship to choice of method. However, age, number of children, and level of education were not determining factors. CONCLUSIONS: Medical advice has an impact on choice of self-administered combined hormonal contraceptives, which helps women to use the method of their choice and improves adherence to the method in accordance with its particular conditions.

Esterilização histeroscópica ambulatorial pelo procedimento Essure: stent tubário / Outpatient hysteroscopic sterilization by the Essure procedure: stent tubal

A esterilização cirúrgica é um dos métodos contraceptivos mais populares. Métodos tradicionais de esterilização permanente (por exemplo, ligadura tubária abdominal ou laparoscópica) utilizam a anestesia geral ou regional, necessitando de incisão na parede abdominal ou introdução de trocaters, expondo a paciente aos riscos intrínsecos ao procedimento cirúrgico e à obrigatoriedade da recuperação pós-operatória. A Food and Drug Administration (FDA) dos Estados Unidos aprovou em 2002 o sistema de stent tubário Essure. O Essure oclui as trompas estimulando a fibrose tecidual e a subsequente cicatrização. Esse é um artigo de revisão, que tem o objetivo de apresentar esse método aos tocoginecologistas brasileiros, como uma alternativa eficaz e segura para uso na nossa população. O Hospital da Mulher Mariska Ribeiro é atualmente Centro de Referência no Brasil para o Essure já tendo realizado cerca de 1000 procedimentos.

Surgical sterilization is a popular contraceptive method. Traditional methods of permanent sterilization (eg, abdominal or laparoscopic tubal ligation) use general or regional anesthesia, requiring incision in the abdominal wall or introduction of trocars, exposing the patient to the inherent risks of the surgical procedure and the requirement of postoperative recovery. The Food and Drug Administration (FDA) of the United States in 2002 approved the Essure tubal stent system. The Essure occludes the fallopian tubes stimulating tissue fibrosis and subsequent healing. This is a review article, which aims to present this method to Brazilian obstetricians and gynecologists as an effective and safe alternative for use in our population. The Hospital da Mulher Mariska Ribeiro is currently a Reference Center in Brazil for the Essure having already performed about 1000 procedures.

Assessment of correlation between unprotected coitus and preeclampsia

Preeclampsia is a common complication of pregnancy often leading to significant maternal and fetal complications Preeclampsia occurs more frequently in primigravidae and in multigravidae who have a change in paternity. Length of sperm exposure has been proposed to influence the risk of preeclampsia. The aim of this study was to assess the relationship between unprotected coitus and preeclampsia. A case-control design was used to compare 91 women with preeclampsia [cases] with 91 matched ones in control group. The age range was from 20 to 35 years. Subjects were selected from mothers referred to Mahdieh and Akbar-Abadi hospitals. Data were gathered by interview method and were analyzed by independent t-test, Mann-Whitney, chi-square, and logistic regression using SPSS software. Women with a short period of co-habitation [<4 months] or the ones who used barrier methods for contraception had a substantially higher risk for development of preeclampsia compared with women with more than 4 months of cohabitation before conception [P = 0.0001]. Oral contraceptive users had a lower preeclampsia rate than women who used no oral contraceptive [P = 0.003]. No relationship was observed between coital rate before and during pregnancy and the risk of preeclampsia. This study suggests that the risk of developing preeclampsia in primigravidae is inversely proportional to the duration of sexual co-habitation

Preservativo feminino: uma nova perspectiva de proteção / Female condom: a new perspective of protection

O presente trabalho objetiva analisar uma das mais recentes e provavelmente a mais importante alternativa feminina, não só para prevenir as doenças sexualmente transmissíveis, mas de proteção contra a gravidez, o preservativo feminino. Aborda características importantes do novo condom, como suas vantagens e desvantagens, bem como a aceitabilidade por parte das clientes, enfatizando sua contribuição para o aumento da autonomia das mulheres.