User acceptability of a female condom (Reality) in Shanghai.

Thirty married couples evaluated the Reality female condom on questionnaires about its acceptability for 300 acts of coitus (10 per couple). An analysis of the summary questionnaires showed: 90% of couples considered the female condom an acceptable method and 87% felt it was a good contraceptive device; the majority of couples (87%) found it easy to use; and 80% of females and 73% of males reported that, in comparison with the male condom, the effect on sexual pleasure was either improved or no different. A little more than half of the couples (55%) preferred it to male condoms. To look at the learning curve effect, an additional analysis was completed by pooling the first 5 applications of each user and comparing the results with the pooled results of the second 5 uses. All the findings suggest that a certain proportion of couples of childbearing age will choose the Reality female condom for contraception if it enters into the Chinese market. As a new contraceptive barrier device, the female condom may require a certain amount of education and awareness before it will be fully recognized as an important option to help prevent pregnancy as well as sexually transmitted infections.

A comparative study of two techniques used in immediate postplacental insertion (IPPI) of the Copper T-380A IUD in Shanghai, People's Republic of China.

Chinese women in Shanghai who delivered vaginally and who chose to use an IUD for contraception received a Copper T-380A IUD inserted vaginally within 10 minutes after delivery of the placenta (i.e., immediate postplacental insertion, IPPI). Among them, 97.7% were primipara. The women were randomly divided into two groups: IUD inserted by hand and IUD via ring forceps. The follow-up rate of six months was 95.2%. Using Tietze's life table method and log rank test, the expulsion and other discontinuation rates were compared at three and six months postinsertion between these two different insertion techniques. Expulsions were the main reason for discontinuation. The six-month gross cumulative expulsion rates were 13.3 and 12.7 per 100 women in the hand-insertion group and ring forceps-insertion group, respectively. Discontinuation rates for medical removals (bleeding/pain) were 2.1 and 1.0 in these two groups, respectively. Neither of the differences was statistically significant (p > 0.05). No uterine perforation, infection or pregnancy occurred. The results suggest that these two different insertion techniques do not significantly affect discontinuation rates in vaginal IPPI using the TCu 380A, and the TCu 380A appears to be suitable for postpartum insertion in Chinese women. Other relevant issues, such as breastfeeding and IUD placement in uterine cavity, are also analyzed and discussed in this report.

PIP: During October 1993 to October 1994, in Shanghai, China, 910 women who delivered vaginally at 13 medical centers and requested IUD contraception were randomly allocated to the group in which the TCu 380A was inserted by hand (470) or to the group in which it was inserted by ring forceps (440) within 10 minutes after delivery of the placenta. This was the first birth for 97.7% of the women. The 6-month follow-up rate was 95.2%. 3-month and 6-month expulsion rates as well as rates for medical and non-medical removals between the two insertion techniques were not significantly different (p 0.05). For example, the 6-month gross cumulative expulsion rate was 13.3% for the hand-insertion group and 12.7% for the ring forceps-insertion group. The discontinuation rate for medical removals (e.g., bleeding, pain) was 2.1% for the hand-insertion group and 1% for the ring forceps-insertion group. The IUD expulsion rate was higher in non-breast feeding women than in breast-feeding women (22.4% vs. 11.9%; p 0.05). No woman in either group suffered from uterine perforation or an infection. No woman conceived. In conclusion, the two different IUD insertion techniques do not have a significant influence on discontinuation rates in vaginal immediate postplacental insertion using the TCu 380A.

Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesion. Clinical analysis of 70 patients.

This paper presents the results of diagnostic and therapeutic hysteroscopy in 70 patients with traumatic intrauterine adhesions. In all the patients, the diagnoses and types of intrauterine adhesions were confirmed by hysteroscopy. In 68 out of the 70 patients (97.14%) intrauterine adhesions were released successfully after 1-3 times of surgery. Of the 64 patients with amenorrhea or hypomenorrhea before treatment, 54 (84.38%) had regular menstruation. In 35 patients who desired to have a child and were followed up more than 6 months after the withdrawal of contraception, 30 (85.71%) had intrauterine pregnancies. Among the 30 patients, 17 had full-term pregnancies, 12 were in progress and 1 had early spontaneous abortion. The postpartum course was uneventful in the 17 patients with term delivery. We conclude that hysteroscopy is of value in the diagnosis and treatment of traumatic intrauterine adhesions.

[Comparison of clinical effects of stainless steel IUDs with and without copper].

PIP: The clinical efficacy of stainless steel rings with copper (SSRC) was compared to the efficacy of stainless steel rings without copper (SSR). 1154 SSRC cases and 1298 SSR cases were studied from January 1978 to April 1980. The clinical effects were evaluated according to the life table. The results of observation during the 2-year period were as follows. The gross cumulative pregnancy rate of SSRC (2.85/100 women) was significantly lower than that of SSR (7.90/100 women) (p0.01). The expulsion rate of SSRC was higher than that of SSR -- 19.28 versus 15.78/100 women (p0.05), and the medical removal rate was 8.74 and 7.60/100 women respectively (p0.05). The continuation rate during the 2 year period was 67.56 and 76.71 women respectively (p0.05), there being no significant statistical difference between the 2 groups. Women wearing the SSRC had a lower pregnancy rate, nor was the medical removal rate increased. It is suggested that the SSRC may be used more widely, despite its somewhat higher expulsion rate, which may lower with improvement in insertion technique.^ieng

[Duration of use for stainless steel ring--15 years of follow-up for 6250 cases].

This study was to observe the longterm safety in using stainless steel ring (metal ring). 6250 cases have been followed up for 15 years. The net cumulative pregnancy rate was 5.51, expulsion rate 17.74, rate of removal due to medical reasons 21.74, continuation rate 6.48/women (life table) after 15 years of insertion. Events took place more frequently in the 1st year of insertion, gradually decreased in the second, and tended to be stabilized to a low level thereafter. The removal rate for nonmedical reasons had been increasing with the increase in the period of insertion. 5 cases of cervical cancer and 2 of endometrial carcinoma occurred within the 15 years of observation. The incidence was not higher than that in the 1971-72 general survey at Shanghai. Among the 6250 cases, there were 43 cases (0.85%) of removal due to infection, and 9 cases of ectopic pregnancy, of which 6 cases occurred within the first 2 years of insertion, and 2 cases of intraperitoneal metal ring were found but with no severe complications. The duration of using the metal ring was also discussed. According to clinical and pathological observations, the metal ring did not increase the risk of uterine cancer and caused only a few mild complications. Therefore, it can be used for 15-20 years, provided there are no clinical symptoms. The relationship between the IUD and ectopic or PID remains to be further explored.