Association of Anticipated Insertional Pain With Intrauterine Device Initiation.

PURPOSE: Many providers cite pain as a barrier to intrauterine device (IUD) initiation. Our objective was to determine if young women who initiate other contraceptive methods anticipate more pain with IUD insertion than those who initiate IUDs. METHODS: In this prospective cohort study, we enrolled women ages 14-24 initiating contraception at a family planning clinic. Participants rated expected pain with IUD insertion on a 0-10 scale. IUD and implant initiators additionally rated experienced pain and whether they would recommend their method, both after procedure and at 6 months. We compared anticipated pain between IUD and other contraceptive initiators. For IUD and implant initiators, we compared pre- and postprocedure pain. RESULTS: Of 172 participants, 29% initiated IUDs, 30% initiated implants, and 41% initiated other methods. The median age was 20 years (range 14-24), participants were racially diverse (39.5% white, 40.1% Hispanic, 11.0% black, 9.3% other), and 92% were nulliparous. IUD initiators were older and more likely to be white. The median pain anticipated with IUD insertion was similar among IUD (6.0, range 0-10), implant (5.0, range 0-10), and other contraceptive initiators (6.0, range 2-10) (p = .65). IUD initiators reported higher pain than expected (7.0, range 1-10) (p = .004), yet most recommended the IUD after procedure and at 6 months (78% and 74%, respectively). CONCLUSIONS: Insertional pain may not be a barrier to IUD initiation. Women initiating other contraceptives anticipated similar pain with insertion than those initiating IUDs. IUD initiators experienced higher pain than expected, but most still recommended the method.

Atrazine induces complete feminization and chemical castration in male African clawed frogs (Xenopus laevis).

The herbicide atrazine is one of the most commonly applied pesticides in the world. As a result, atrazine is the most commonly detected pesticide contaminant of ground, surface, and drinking water. Atrazine is also a potent endocrine disruptor that is active at low, ecologically relevant concentrations. Previous studies showed that atrazine adversely affects amphibian larval development. The present study demonstrates the reproductive consequences of atrazine exposure in adult amphibians. Atrazine-exposed males were both demasculinized (chemically castrated) and completely feminized as adults. Ten percent of the exposed genetic males developed into functional females that copulated with unexposed males and produced viable eggs. Atrazine-exposed males suffered from depressed testosterone, decreased breeding gland size, demasculinized/feminized laryngeal development, suppressed mating behavior, reduced spermatogenesis, and decreased fertility. These data are consistent with effects of atrazine observed in other vertebrate classes. The present findings exemplify the role that atrazine and other endocrine-disrupting pesticides likely play in global amphibian declines.