Sexual and Reproductive Health Care after Gonadotoxic Treatment in Females at a Tertiary Pediatric Hospital.

STUDY OBJECTIVES: Recommendations from the Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancer emphasize the importance of reproductive health care, yet little is known regarding adherence to these recommendations and non-fertility-related sexual and reproductive health (SRH) outcomes. METHODS: Follow-up of outcomes on the basis of the COG-LTFU guidelines was assessed in female patients who underwent fertility preservation consultation before gonadotoxic therapy between 2016 and 2022 at a single institution and were at least 6 months from treatment completion. RESULTS: We included 140 patients, with a mean time of 2.7 years from treatment completion. Eighty-six patients were 12 years old or older, of whom sexual activity was recorded in 59 (68.7%), and 12 of 31 (38.7%) sexually active patients underwent sexual function assessment. The 57 (66.3%) patients at high risk of premature ovarian insufficiency (POI) at diagnosis were more likely than minimal-risk counterparts (29, 33.7%) to have abnormal uterine bleeding (42.1% vs 17.2%, P = .03), to be diagnosed with POI (29.8% vs 0%, P = .01), and to have sexual activity recorded (77.2% vs 51.7%, P = .03). Of 17 patients with POI, 82.4% were on hormone replacement therapy, and 58.8% had undergone bone mineral density testing. CONCLUSION: This study adds to the limited literature regarding non-fertility-related SRH outcomes after gonadotoxic therapy and illustrates opportunities to improve adherence to the COG-LTFU guidelines. Increased attention to SRH guidelines may increase detection and treatment of SRH conditions, improving the health and quality of life of female cancer survivors.

Experience with intrauterine device insertion in never sexually active adolescents: a retrospective cohort study.

BACKGROUND: Intrauterine devices can offer both contraceptive and noncontraceptive benefits to never sexually active adolescents. There are increasing data on intrauterine device use in adolescents; however, most data on intrauterine devices in adolescents are related to contraceptive use. There is very limited literature on intrauterine device placement in adolescents who have never been sexually active. OBJECTIVE: The objective of the study was to compare intrauterine device insertion success between never sexually active and sexually active cohorts. STUDY DESIGN: We performed a retrospective chart review of patients aged 10-20 years with attempted intrauterine device insertion at a children's hospital between October 2015 and September 2017. RESULTS: A total of 210 patients were included, of whom 82 were never sexually active. Never sexually active adolescents were younger at insertion (15.6 vs 16.7 years, P < .001), more likely to have at least 1 medical problem (75.6% vs 54.7%, P = .046), and to have special needs (23.2% vs 4.7%, P < .001). Never sexually active adolescents were less likely to have intrauterine device insertion performed in the office setting (52.4% vs 94.5%, P < .001). There was no significant difference in success of intrauterine device insertion on the first attempt (90.2% vs 96.1%, P = .086). In a subanalysis of office insertions alone, never sexually active adolescents were more likely to have an unsuccessful intrauterine device insertion (16.3% vs 4.3%, P = .015) and less likely to tolerate the procedure well (81.4% vs 94.2%, P = .026). CONCLUSION: To our knowledge, this is the first study describing intrauterine device insertion in never sexually active patients. Although office success rates were lower, intrauterine device insertion in never sexually active adolescents was very successful overall, and intrauterine devices should be offered to this population.

Baseline correlates of inconsistent and incorrect condom use among sexually active women in the contraceptive CHOICE Project.

BACKGROUND: : To provide protection against sexually transmitted infections and pregnancy, condoms must be used consistently and correctly. However, a significant proportion of couples in the United States fail to do so. Our objective was to determine the demographic and behavioral correlates of inconsistent and incorrect condom use among sexually active, condom-using women. METHODS: : Analysis of baseline data from a prospective cohort of sexually active, condom-using women in the Contraceptive CHOICE Project (n = 2087) using self-reported demographic and behavioral characteristics. Poisson regression was used to determine the relative risk of inconsistent and incorrect condom use after adjusting for variables significant in the univariate analysis. RESULTS: : Inconsistent and incorrect condom use was reported by 41% (n = 847) and 36% (n = 757) of women, respectively. A greater number of unprotected acts was most strongly associated with reporting 10 or more sex acts in the past 30 days, younger age at first intercourse, less perceived partner willingness to use condoms, and lower condom use self-efficacy. Incorrect condom use was associated with reporting 10 or more sex acts in the past 30 days, greater perceived risk for future STIs, and inconsistent condom use. CONCLUSIONS: : Inconsistent and incorrect condom use is common among sexually active women. Targeted educational efforts and prevention strategies should be implemented among women at highest risk for STIs and unintended pregnancies to increase consistent and correct condom use.