Subject(s)
Homosexuality, Female , Intrauterine Devices , Sexual and Gender Minorities , Female , Humans , Bisexuality , Sexual BehaviorABSTRACT
INTRODUCTION: The intrauterine device (IUD) is a long-acting and highly efficacious form of contraception that can also be used for menstrual suppression. Although IUD use is increasing, the type chosen, appeal, and satisfaction among individuals who are transgender and gender diverse and assigned female at birth (TGD-AFAB) is unknown. The purpose of this study is to evaluate IUD usage among TGD-AFAB individuals. METHODS: TGD-AFAB individuals who had an IUD for a minimum of 6 months at the time of completing the survey or had one in the past completed an anonymous online survey. Descriptive statistics were used to analyze the data. RESULTS: One hundred and five TGD-AFAB individuals completed the survey. Among participants who were sexually active, 88% reported they were in a relationship in which it was possible to get pregnant. There were 85 individuals who currently had an IUD: 62 (73%) chose a 52-mg levonorgestrel (LNG) IUD, 5 (6%) chose a lower-dose LNG IUD, 17 (20%) chose the copper IUD, and one chose an IUD unavailable in the United States. Menstrual suppression was the primary reason for choosing a 52-mg LNG IUD (58%). Most individuals who opted for a copper IUD did so to avoid hormonal contraception (71%). Participants reported experiencing IUD side effects; however, few desired removal. Among the 36 respondents who had an IUD in the past, the most frequent reasons for removal were expiration of the device (LNG IUDs) and undesired side effects (copper IUD). Approximately half of participants who had an IUD removed had it replaced with another IUD. DISCUSSION: Pregnancy can occur among TGD-AFAB individuals even if they are on testosterone and amenorrheic. IUDs are well tolerated in this population, with few current users desiring removal for unwanted side effects. Clinicians should counsel TGD-AFAB individuals about the contraceptive and noncontraceptive benefits of IUDs and expected side effects.
Subject(s)
Intrauterine Devices, Copper , Intrauterine Devices, Medicated , Transgender Persons , Contraception , Female , Humans , Infant, Newborn , Levonorgestrel , PregnancyABSTRACT
OBJECTIVE: The aim of the study was to test the hypothesis that vaginal administration of surfactant lipids, which may counter-balance the proinflammatory effects of vaginal surfactant protein A, will decrease proinflammatory cytokines and increase anti-inflammatory cytokines in vaginal mucosal fluid in healthy women. MATERIALS AND METHODS: Three groups of healthy cycling women were randomized to receive vaginally a single dose of the following: (1) low-dose calfactant, a type of surfactant lipids, 0.8 mg/ml; (2) high-dose calfactant 8.0 mg/ml; or (3) placebo, at the time of resolution of menses. Vaginal mucosal fluid was collected before administration and also 1 and 8 days after administration of each treatment. After 1 mo, each group was randomized to each alternative treatment; thus, for a 3-month treatment period, each group received each of the 3 treatments. Vaginal fluid was tested using a Multiplex Immunoassay System. Cytokine concentrations on day 1 and day 8 were compared with day zero and tested for significance with the Student's t test. RESULTS: Six healthy subjects completed each treatment. Subjects given high-dose calfactant had, by day 8, a significant reduction in macrophage chemotactic protein-1 and interleukin 15 (IL-15) compared with low-dose calfactant or placebo. High-dose calfactant resulted in an increase in anti-inflammatory cytokines that trended toward significance on day 1 (IL-1RA) or day 8 (IL-10). CONCLUSIONS: This pilot study in healthy women demonstrates that calfactant reduces proinflammatory cytokines and increases anti-inflammatory cytokines in the vagina. We propose that calfactant may be an effective vaginal anti-inflammatory therapy for inflammatory vaginitis and similar disorders for which current therapy is ineffective.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Biological Products/administration & dosage , Body Fluids/chemistry , Cytokines/analysis , Lipids/administration & dosage , Pulmonary Surfactants/administration & dosage , Vagina/chemistry , Adult , Cross-Over Studies , Double-Blind Method , Female , Healthy Volunteers , Humans , Middle Aged , Pilot Projects , Placebos/administration & dosage , Treatment Outcome , Young AdultABSTRACT
PROBLEM: Our knowledge of the innate host defenses in the vagina, a site where these defenses are essential to protecting the host upper reproductive tract from invasion by pathogens, is as yet rudimentary. Specifically, little is known about the pattern-recognition component of vaginal innate immunity, the relationship of pattern-recognition molecules to known cytokine levels, and the role of gonadal hormones in their regulation. METHOD OF STUDY: We measured levels of Surfactant Protein-A (SP-A), a prototypic innate pattern-recognition protein, in vaginal fluid (VF) and correlated them with levels of IL-1ß and IL-8, two cytokines known to be present in VF. Assays were carried out on VF collected over three consecutive cycles from ten healthy naturally cycling women who were sampled at three specific time points in the menstrual cycle. The three time points were chosen to enable correlation with distinct hormonal states. RESULTS: Both SP-A and cytokines levels were highest 5-6 days after menses (P < 0.05) and were significantly lower at ovulation and mid-luteal phase. CONCLUSION: Surfactant Protein-A, like other host defense molecules in the reproductive tract, appears to be regulated by gonadal hormones.
