Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial.

BACKGROUND: Levonorgestrel, a standard drug for emergency contraception (EC), is not effective if administered post-ovulation. A cyclo-oxygenase inhibitor could contribute synergistic effects. We investigated whether a single 40 mg oral dose of piroxicam as co-treatment with levonorgestrel improved emergency contraceptive efficacy. METHODS: This was a randomised double-blind placebo-controlled trial carried out in a major community sexual and reproductive health service in Hong Kong. Women who required levonorgestrel EC within 72 h of unprotected sexual intercourse were recruited and block-randomised in a 1:1 ratio to receive a single supervised dose of levonorgestrel 1·5 mg plus either piroxicam 40 mg or placebo orally. Group assignment was concealed in opaque envelopes and masked to the women, clinicians, and investigators. At follow-up 1-2 weeks after the next expected period, the pregnancy status was noted by history or pregnancy test. The primary efficacy outcome was the proportion of pregnancies prevented out of those expected based on an established model. All women randomised to receive the study drug and who completed the follow-up were analysed. The trial was registered with ClinicalTrials.gov, NCT03614494. FINDINGS: 860 women (430 in each group) were recruited between Aug 20, 2018, and Aug 30, 2022. One (0·2%) of 418 efficacy-eligible women in the piroxicam group were pregnant, compared with seven (1·7%) of 418 in the placebo group (odds ratio 0·20 [95% CI 0·02-0·91]; p=0·036). Levonorgestrel plus piroxicam prevented 94·7% of expected pregnancies compared with 63·4% for levonorgestrel plus placebo. We noted no significant difference between the two groups in the proportion of women with advancement or delay of their next period, or in the adverse event profile. INTERPRETATION: Oral piroxicam 40 mg co-administered with levonorgestrel improved efficacy of EC in our study. Piroxicam co-administration could be considered clinically where levonorgestrel EC is the option of choice. FUNDING: None.

Longitudinal study on sexual function and quality of life in infertile couples undergoing intrauterine insemination.

BACKGROUND: Cross-sectional studies have shown that sexual dysfunction and poor quality of life were prevalent among couples undergoing assisted reproduction at specific time points, but nothing is known about how these outcomes change over the course of their intrauterine insemination (IUI) journey. AIM: We investigated the longitudinal changes in sexual function and quality of life of infertile couples undergoing IUI. METHODS: Sixty-six infertile couples completed an anonymous questionnaire at 3 time points: after IUI counseling (T1), 1 day before IUI (T2), and 2 weeks after IUI (T3). The questionnaire consisted of demographic data, Female Sexual Function Index (FSFI) or International Index of Erectile Function-5, and Fertility Quality of Life (FertiQoL). OUTCOMES: Descriptive statistics, significance testing with the Friedman test, and post hoc analysis with the Wilcoxon signed rank test were used to compare changes in sexual function and quality of life at different time points. RESULTS: Overall, 18 (26.1%), 16 (23.2%), and 12 (17.4%) women and 29 (42.0%), 37 (53.6%), and 31 (44.9%) men were at risk for sexual dysfunction at T1, T2, and T3, respectively. There were significant differences in mean FSFI scores in arousal (3.87, 4.06, 4.10) and orgasm (4.15, 4.24, 4.39) domains at T1, T2, and T3. After post hoc analysis, only the increase in mean orgasm FSFI scores between T1 and T3 was statistically significant. Men's FertiQoL scores remained high during IUI (74.33-75.63 out of 100). Men also scored significantly higher than women on all FertiQoL domains except environment at the 3 time points. Post hoc analysis showed significant improvement in women's FertiQoL domain scores between T1 and T2: mind-body, environment, treatment, and total. Women's FertiQoL score at T2 for the treatment domain was also significantly higher than that at T3. CLINICAL IMPLICATIONS: Men should not be neglected during IUI as their erectile function got worse in the process, with half of the men being affected. Although women's quality of life showed some improvement during IUI, most of their scores were lower than men's. STRENGTHS AND LIMITATIONS: The use of psychometrically validated questionnaires and a longitudinal approach are the major strengths; a small sample size and the lack of a dyadic approach are the major limitations. CONCLUSION: During IUI, women's sexual performance and quality of life improved. The proportion of men having erectile problems was high for this age group, but men's FertiQoL scores remained good and were better than their partners' throughout IUI.

Osteoporosis knowledge, health beliefs, and self-efficacy in Hong Kong Chinese men.

A total of 277 Hong Kong Chinese men participated in this prospective cohort study. Their osteoporosis knowledge was average. Their perceived susceptibility to osteoporosis was low. Barriers to lifestyle modifications were the strongest predictor for self-efficacy in adopting these activities. These results are useful for planning osteoporosis public awareness campaigns for men. PURPOSE: Male osteoporosis had long been neglected despite one-third of fractures occurring in men. Lifestyle modification through education is the main tactic in osteoporosis prevention, but current programs and strategies are designed for postmenopausal women. Understanding men's knowledge, health belief, and self-efficacy in adopting osteoporosis prevention strategies can help to design a specific program for men. METHODS: A prospective cohort study was conducted in three men's health clinics in Hong Kong from September to October 2020, recruiting 277 men aged ≥ 20 years. They completed a questionnaire consisting of sociodemographic data, 14 general questions from the Facts on Osteoporosis Quiz (FOOQ), Male Osteoporosis Knowledge Quiz (MOKQ), Osteoporosis Health Belief Scale (OHBS), and Osteoporosis Self-Efficacy Scale (OSES). Scores from these scales and their association with sociodemographic data were reported. Correlations between age, knowledge, health beliefs, and self-efficacy were studied using the Health Belief Model. RESULTS: The mean age was 36.4 years old, and 52% had university education. Their mean FOOQ + MOKQ score was 10.8 out of 20; mean OHBS score was 129.2 out of 210; and mean OSE-Exercise and OSE-Calcium scores were 66.4 and 68.9 out of 100 respectively. Self-efficacy of exercise was correlated with young age, perceived exercise benefits, and little barriers to exercise (p < 0.01). Self-efficacy of calcium intake was positively correlated with health motivation and self-efficacy of exercise and negatively correlated with barriers to calcium intake (p < 0.01). CONCLUSION: Male osteoporosis awareness programs should focus on improving knowledge, enhancing awareness on susceptibility, promoting benefits of lifestyle modification, and helping men overcome perceived barriers.

Sexual function and quality of life in Chinese couples undergoing assisted reproductive treatment: a prospective cohort study.

Couples undergoing assisted reproductive technologies (ART) are prone to sexual dysfunction and lower quality of life (QoL), but whether the incidence of these problems differs with the type of ART is unknown. As such, we conducted this cross-sectional survey to compare the sexual function and QoL of 75 couples undergoing intrauterine insemination (IUI), and 160 couples undergoing in vitro fertilization (IVF). They completed an anonymous questionnaire which included: (i) demographic characteristics; (ii) female sexual function index (FSFI) or (iii) international index of erectile function-5 (IIEF-5); and (iv) fertility QoL questionnaire (FertiQoL). Overall, 22.6% of wives and 39.1% of husbands were at risk for sexual dysfunction, and the risk was similar in IUI and IVF groups. Mean core/treatment/total FertiQoL scores of husbands were higher than wives: 74.98 vs. 68.24/70.02 vs. 65.87/73.52 vs. 67.54 (all p < 0.001). FertiQoL scores were similar in IUI and IVF groups except wives' treatment FertiQoL score was significantly higher in the IUI group (68.93 vs. 64.44; p = 0.009). This study confirms that risks for sexual dysfunction were similar in IUI and IVF couples. Wives undergoing IVF had significantly lower treatment FertiQoL score. In both IUI and IVF groups, husbands' QoL was better than wives' QoL.

Female Sexual Assertiveness and Sexual Satisfaction Among Chinese Couples in Hong Kong: A Dyadic Approach.

Western studies have demonstrated that female sexual assertiveness is positively associated with sexual satisfaction in a committed heterosexual relationship. Furthermore, the ability of women to refuse sex has been shown to protect them from unwanted sexual contact and to lead to fewer sexual victimization experiences and less risky sexual behavior. However, there is little research on female sexual assertiveness that included both the own (actor effect) and partner (partner effect) impact of female sexual assertiveness on sexual satisfaction from a dyadic approach, involving both members of a couple. The data for the present study came from a representative sample of Chinese couples collected by the Hong Kong Family Planning Association in 2017. Using the actor-partner interdependence model, the results indicated that female sexual initiation was positively associated with both their own and their partner's sexual satisfaction. However, female sexual refusal was not associated with the sexual satisfaction of either party. These findings suggest the importance of adopting a dyadic approach in sex research to capture the mutual influences between partners. Couples should be encouraged to express their sexual desires and refuse unwanted sex requests honestly to improve their and their partner's sexual satisfaction.

Acceptability of different mechanisms of action of contraception in women: a questionnaire survey.

BACKGROUND: The mechanism of action of a contraceptive method is an importantg consideration in a woman's choice of contraception. For the development of new methods of contraception it is important to understand the acceptability of different contraceptive mechanisms within a population. METHODS: We recruited women attending contraceptive, termination of pregnancy or postnatal care services in Hong Kong for a questionnaire survey on their acceptability of the different ways in which contraceptive methods prevent pregnancy. Univariable and multivariable analyses were used to establish factors which may predict acceptability of the mechanism of action. RESULTS: A total of 1448 women completed the survey. The acceptability of contraceptive methods that act by preventing fertilisation ranked highest (78%), followed by those that inhibit ovulation (52%), disrupt implantation (43%) and dislodge an implanted embryo (30%). A history of termination of pregnancy was associated with greater acceptance of all posited contraceptive mechanisms. There was a very low degree of agreement between the declared acceptance of the various contraceptive mechanisms and the ever use of a method with the respective mechanism of action (Cohen's kappa coefficient range 0.017-0.162). CONCLUSIONS: In this population the acceptability of contraceptive methods that act by preventing fertilisation ranked highest, followed by those that inhibit ovulation, disrupt implantation and dislodge an implanted embryo. Women who had ever had a termination of pregnancy were more likely to accept all the posited contraceptive mechanisms.

Prevalence of osteoporosis in elderly women in Hong Kong.

OBJECTIVES: To determine the prevalence of osteoporosis and the proportion who needed treatment after screening women aged 65 years or older; their treatment acceptance and continuation. METHODS: This is an observational study conducted between May 2017 and April 2020.Participants underwent clinical assessment and bone mineral density measurement of lumbar spine, total hip, and femoral neck by dual energy X-ray absorptiometry. Those with osteoporosis at any site or osteopenia with 10-year major fracture risk ≥ 20% or hip fracture risk ≥ 3% by Fracture Risk Assessment Tool® were offered drug treatment. RESULTS: Among 1800 participants, 15.9% were normal, 33.2% were low-risk osteopenic, 27.2% were high-risk osteopenic, and 23.7% were osteoporotic. Their mean age was 69.4 years and 6.3% had low-energy fractures after menopause. After stepwise logistic regression analysis, only prior low-energy fractures after menopause and low body mass index (BMI) remained significantly correlated with osteoporosis. Those who needed treatment were significantly older, menopaused at age 45 years or earlier, had a parent with hip fracture, had low-energy fractures after menopause, and low BMI. Drug was offered to 916 women but 67.6% refused because they worried about side effects, interaction with existing drugs, and were reluctant to take more drugs. Treatment acceptance was significantly higher among osteoporotic patients. Treatment continuation at 6th and 12th months was also significantly higher in osteoporotic patients. CONCLUSIONS: Osteoporosis screening in elderly women identified a significant proportion who needed treatment. Encouraging them to initiate drug, especially high-risk osteopenic patients, remained a challenge.

Prevalence and Risk Factors for Sexual Problems and Distress in Chinese Unmarried Young Women: An Observational Study.

INTRODUCTION: Research conducted in the West has shown that sexual function and distress was common in white women from younger to older adulthood; however, little research attention to date has been given to Chinese young women. AIM: Our primary aim is to assess the prevalence and factors associated with sexual problems and distress in Chinese unmarried young women. METHODS: Between November 2015 and June 2017, 431 young women who visited 3 sexual health clinics completed an anonymous questionnaire detailing their demographics, sexual behavior, current sexual relationship, sexual function, and sexual distress. Descriptive bivariate analysis and logistic regression analyses were performed. MAIN OUTCOME MEASURES: Sexual function and distress were assessed by the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R), respectively. RESULTS: Overall, 76 young women (17.6%) obtained total FSFI score ≤23.45 (Chinese cut-off), 47 of whom scored 11 or above for FSDS-R. Individual domain and total FSFI scores were significantly correlated with FSDS-R score (P < .001). Based on domain scores, 35.5%, 18.8%, 12.8%, and 10.7% of them were at risk for orgasmic, pain, arousal, and desire problems, respectively. Arousal and lubrication problems were strongly associated with distress. Sexual problems were associated with not initiating sex (odds ratio [OR] 2.50, P = .001), often had sexual fantasy (OR 0.55, P = .036), and willingness for vaginal sex (OR 0.49, P < .001). Sexual distress was associated with having life stressors (OR 1.88, P = .012) and willingness for vaginal sex (OR 0.61, P = .003). Self-perception of body being unattractive to boyfriend (OR 3.33, P = .015), not initiating sex (OR 3.21, P = .001), willingness for vaginal sex (OR 0.39, P < .001), and no life stressors (OR 0.46, P = .036) were associated with both sexual problem and distress. CLINICAL IMPLICATIONS: Physicians should be alerted to sexual problems in young women and encourage those with distress to seek help. STRENGTHS & LIMITATIONS: Using validated psychometric tools to assess sexual problems and distress provides reference for future comparison. Admission and recall biases are unavoidable in observational questionnaire study. Depression was not evaluated and might bias the estimation of distress. CONCLUSION: About 11% of Chinese young women had sexual problems and were distressed (ie, sexual dysfunction). They were characterized by having a self-perception that their body was unattractive to their boyfriend, not initiating sex, unwilling for vaginal sex, and having life stressors. Lo SS-T, Kok W-m. Prevalence and Risk Factors for Sexual Problems and Distress in Chinese Unmarried Young Women: An Observational Study. J Sex Med 2018;15:1620-1628.

Sexual functioning and quality of life of Hong Kong Chinese women with infertility problem.

Infertility is estimated to affect 10-15% of couples in industrialized countries and many of them are under tremendous stress. Stress can lead to poor quality of life and sexual dysfunction in general, but little is known about their prevalence in infertile women. We, therefore, conducted this cross-sectional survey in two primary care subfertility clinics between August 2012 and April 2013. A total of 159 women completed two validated Chinese questionnaires: Female Sexual Function Index and core Fertility Quality of Life. The overall Female Sexual Function Index score (mean ± SD) of the whole group was 24.99 ± 4.22. Using the urban Chinese cut-off, the prevalence of female sexual dysfunction, low desire, arousal disorder, lubrication disorder, orgasmic disorder and sexual pain were 32.5%, 15.7%, 19.3%, 22.3%, 33.1% and 15.1%. The core Fertility Quality of Life score of the whole group was 59.76 ± 13.59 and the subgroup of infertile women with sexual dysfunction (n = 50) had significantly lower mean core Fertility Quality of Life score than those without sexual dysfunction (n = 109) (55.03 versus 61.88) (p = 0.005). Among the subscales, the relational score had the strongest correlation with sexual dysfunction. Infertile women with sexual dysfunction had significantly worse quality of life especially in the relational aspect.

Emergency contraception.

This review summarises the development of emergency contraception (EC) methods, and provides an overview on the currently available options of EC which are effective and safe back-up methods in case of non-use or failure of the regular contraception. The copper intrauterine contraceptive device is currently the most effective method. In most countries, a single dose of levonorgestrel 1.5 mg is the first-line hormonal EC given within 72 h of unprotected intercourse. The oral anti-progestogens such as mifepristone and ulipristal acetate are promising alternatives with better efficacies and a wider treatment window of up to 120 h post coitus, probably resulting from more diverse ancillary mechanisms of actions. Education on EC should be part of any contraceptive counselling. Improving access to EC by providing it over the counter or in advance would not promote its abuse nor encourage risky sexual behaviours, but may further facilitate the timely use so as to achieve the best efficacy.

Sexual behavior and symptoms among reproductive age Chinese women in Hong Kong.

INTRODUCTION: As sexual medicine evolves, much advancement has been achieved in understanding male sexuality and treating male sexual dysfunction. Less is known about female sexual pattern, the prevalence of sexual problems, and their correlation with confounding factors. AIM: To enhance our understanding of female sexuality and the risk factors that contributed to sexual problems in reproductive age women. METHOD: A cross-sectional survey was conducted in family planning and prepregnancy checkup clinics from December 2007 to December 2009, with 2,146 sexually active Chinese women aged 21 to 40 years completed the entire questionnaire. MAIN OUTCOME MEASURES: Prevalence of sexual symptoms, coital frequency, and other sexual behavior-related activities were measured. RESULTS: Overall, 59.0% of respondents had at least one sexual problem. In this sample, 31.8% of respondents reported no desire; 31.7% had arousal problems; 40% had anorgasmia, and 33.8% experienced coital pain for at least 3 months within the past 1 year. Chi-square test showed significant correlation among the four types of sexual problems(P < 0.001). Univariate regression model showed that all sexual symptoms were significantly correlated with unidirectional coitus initiation, low coital frequency, and low foreplay enjoyment. Loglinear model revealed that desire, arousal, and orgasmic problems were correlated with low foreplay enjoyment. Arousal problem was correlated with high acceptance toward pornography and history of medical disease. Coital pain was correlated with secondary education and planning to have more children. Both unidirectional coitus initiation and low coital frequency were major contributors to all four sexual symptoms. CONCLUSIONS: Sexual problem is a prevalent health issue among reproductive age women. A number of risk factors are identified, which provide useful direction to the design of counseling and education materials that might help to enhance sexual performance in women.

Sexuality of Chinese women around menopause.

OBJECTIVE: To study the sexual activities and prevalence of sexual dysfunctions in midlife Chinese women and their correlations with demographic factors, sexual dissatisfaction and interpersonal difficulty. STUDY DESIGN: This is a cross-sectional survey of a convenience sample of women aged 40-60, who requested gynecological checkup or attend social activities at Women's Club. MAIN OUTCOME MEASURES: Sexual activities, sexual dysfunctions, sexual dissatisfaction, demographic factors and interpersonal difficulty were assessed by self-administered questionnaire. RESULTS: Among 371 eligible subjects, 22.4% and 39.6% women had low intimacy and coitus frequency (0 to <12 acts in one year), respectively. The odds ratios for low coital frequency in the natural menopausal and surgical menopausal subgroups were 3.00 and 5.09, respectively (95% confidence interval: 1.73-5.19 and 1.77-14.69, respectively). Overall, 77.2% women had at least one type of sexual dysfunctions; this proportion was highest in the surgically menopausal subgroup (88.9%) followed by the naturally menopausal subgroup (79.3%), the perimenopausal subgroup (78.2%) and the premenopausal subgroup (72.2%) (p=0.003). No lubrication (42.9%) was the commonest sexual dysfunction and predominantly affected naturally and surgically menopaused women (p=0.001). Sexual dysfunction was the major contributor to sexual dissatisfaction (0.80), followed by interpersonal difficulty (0.2). Arousal disorder was the pivot of interaction between sexual dissatisfaction, menopausal status and low coital frequency. CONCLUSIONS: Chinese women had fewer intimate contacts and less coitus when menopause progressed. No lubrication was the commonest sexual dysfunction and predominantly affected menopaused women. Our model showed that sexual dysfunction is the main contributor to sexual dissatisfaction.

Prevalence and risk factors of Human Papillomavirus (HPV) infection in southern Chinese women - a population-based study.

BACKGROUND: Persistent high-risk type Human papillomavirus (HPV) infection is recognized as a necessary cause of cervical cancer. This study aimed to compare the HPV prevalence and risk factors between women residing in Hong Kong (HK) and Guangzhou (GZ) region of China. METHODOLOGY/PRINCIPAL FINDINGS: A total of 1,570 and 1,369 women were recruited from HK and GZ, respectively. The cytology samples were collected and tested for HPV infection. The overall and type-specific HPV prevalence and the potential risk factors for acquisition of HPV infection were studied. Women with normal cytology in the GZ cohort had significantly higher HPV prevalence (10%) than those in the HK cohort (6.2%, p<0.001). The patterns of the age-specific HPV prevalence were also different between the two cohorts. In the HK cohort, women at the age of 20-29 years old had the highest prevalence and a second peak was observed in the age of ≥ 60 years old. In the GZ cohort, the highest HPV prevalence was also observed in 20-29 years old but declined as the age increased and a second peak was not seen. HPV16 and HPV52 were the most common high-risk types found in the HK and GZ cohorts, respectively. Age was the most consistently observed independent risk factor for HPV infection in the HK, while the number of sexual partners had association in the GZ cohort. CONCLUSIONS/SIGNIFICANCE: Our study provides the current status and the epidemiological characteristics of HPV prevalence in Southern Chinese women. The results strongly suggested that population education and the effective cervical cancer screening would be vital in the prevention of cervical cancer.

Models of preconception care implementation in selected countries.

Globally, maternal and child health faces diverse challenges depending on the status of the development of the country. Some countries have introduced or explored preconception care for various reasons. Falling birth rates and increasing knowledge about risk factors for adverse pregnancy outcomes led to the introduction of preconception care in Hong Kong in 1998, and South Korea in 2004. In Hong Kong, comprehensive preconception care including laboratory tests are provided to over 4000 women each year at a cost of $75 per person. In Korea, about 60% of the women served have known medical risk history, and the challenge is to expand the program capacity to all women who plan pregnancy, and conducting social marketing. Belgium has established an ad hoc-committee to develop a comprehensive social marketing and professional training strategy for pilot testing preconception care models in the French speaking part of Belgium, an area that represents 5 million people and 50,000 births per year using prenatal care and pediatric clinics, gynecological departments, and the genetic centers. In China, Guangxi province piloted preconceptional HIV testing and counseling among couples who sought the then mandatory premarital medical examination as a component of the three-pronged approach to reduce mother to child transmission of HIV. HIV testing rates among couples increased from 38% to 62% over one year period. In October 2003, China changed the legal requirement of premarital medical examination from mandatory to "voluntary." This change was interpreted by most women that the premarital health examination was "unnecessary" and overall premarital health examination rates dropped. Social marketing efforts piloted in 2004 indicated that 95% of women were willing to pay up to RMB 100 (US$12) for preconception health care services. These case studies illustrate programmatic feasibility of preconception care services to address maternal and child health and other public health challenges in developed and emerging economies.