Menarche among Brazilian women: memories of experiences.

OBJECTIVE: to present women's experiences of menarche and related memories. DESIGN: qualitative study using focus groups for data collection. SETTING: the city of Campinas, São Paulo state, Brazil. PARTICIPANTS: 64 women aged 21-51 years, experiencing menstrual periods, with former or current sexual activity and no perceived infertility. METHODS: eight focus groups were carried out using a semi-structured guideline. Discussions were recorded with participants' consent, and transcribed and revised. Thematic content analysis was carried out using gender relations as the theoretical framework. FINDINGS: menarche was experienced as a passage from childhood to womanhood, associated with belonging to a new group and acquiring a new status in the family. The experiences of menarche were not always welcomed or expected, but were recalled as associated with body changes and awareness of sexual issues. The mother's behaviour and attitudes towards menarche were clearly seen as generators of strong and everlasting impressions, either in a positive or negative way. Memories related to the experience of menarche extended through their life, interfering with their relation with their own body, including their reproductive health. KEY CONCLUSIONS: the way in which menarche is experienced may exert an impact on women's reproductive health, sexuality and lifestyle behaviours. IMPLICATIONS FOR PRACTICE: the acknowledgement of menarche experiences can be useful to guide health-care providers towards more effective education of girls on sexual and reproductive health issues and better attention to women's needs.

Association between characteristics of current menses and preference for induced amenorrhea.

BACKGROUND: Several studies suggest that many women would prefer to avoid menses altogether, but few studies have examined the social or clinical predictors of such preference. STUDY DESIGN: In total, 1224 healthy women of reproductive age were surveyed in Brazil, Germany and the United States regarding social, menstrual and reproductive characteristics and preferences for various dimensions of menstruation, including the ideal interval between menses. The extent to which a preference to never bleed was predicted by current experiences with menses was evaluated. RESULTS: Long menses, menstrual pain and a perceived high cost of pads and tampons were predictive of preferring amenorrhea over all other menstrual patterns after controlling for age, parity and education. Independent significant associations were also found with increasing degrees of life stress and ever use of injectable contraceptives. CONCLUSION: A negative experience with menstruation, a high ranking of life stress and ever use of injectable contraception were independently associated with a preference to avoid menses altogether.

Preferências de mulheres brasileiras quanto a mudanças na menstruação / Preference of Brazilian women regarding menstrual changes

OBJETIVO: avaliar a associação entre a experiência menstrual de mulheres e as mudanças preferidas na menstruação. MÉTODOS: estudo de corte transversal, no qual 420 mulheres foram entrevistadas, alocadas em três grupos de idade (18-20, 25-34 e 45-49 anos), e em dois grupos de escolaridade (<8 séries e >12 séries), que tinham menstruado nos três meses que antecederam a entrevista. As mulheres foram selecionadas em Campinas (SP), em nove serviços de saúde privados e em sete públicos. Para a coleta de dados, foi utilizado um questionário construído com base nos resultados de um estudo piloto prévio realizado com grupos focais. Um banco de dados foi preparado com as informações registradas nos questionários e os dados foram analisados com o software SAS versão 8.2. Para análise estatística, foram utilizados o teste do chi2 de Pearson e o teste exato de Fisher para avaliar a associação entre as variáveis estudadas (p<0,05). RESULTADOS: a maioria das mulheres preferia intervalos entre menstruações maiores que uma vez ao mês. Houve associação dos intervalos característicos da menstruação das mulheres, bem como do grau de interferência da menstruação nas atividades diárias, com o intervalo preferido entre menstruações, que é o maior que uma vez por mês (p=0,0248 e p=0,048, respectivamente). Não houve associação das características da dor: duração, intensidade e uso de medicação com o intervalo preferido pelas mulheres. CONCLUSÕES: os resultados sugerem que as mulheres gostariam de menstruar em intervalos maiores do que um mês ou até gostariam de nunca menstruar.

PURPOSE: to evaluate the association between women's menstrual experience and preferred changes in their menstrual cycles. METHODS: a cross-sectional study design was used. A total of 420 women were interviewed. Participants complied with the following criteria: age (18 to 20, 25 to 34 and 45 to 49 years); schooling (<8 years and >12 years); having menstruated during the three months previous to the study. Subjects were selected in the city of Campinas (SP), in nine private and seven public health services. For data collection, a questionnaire was prepared on the basis of the results of a previous pilot study that consisted of small groups. A data bank was prepared with the information registered in the questionnaires and the analysis was carried out with SAS, version 8.2. For the statistical analysis, the Pearson chi2 test and the Fisher exact test were used to evaluate the association between variables (p<0.05). RESULTS: most subjects preferred greater than once a month intervals between menstruations. There was an association of the typical menstrual intervals experienced by women (p=0.0248) and the degree of interference of menstruation with daily activities (p=0.048) with the preferred interval between menses. However, there was no association between preferred intervals by women and the following characteristics of pain: duration, intensity and use of medication. CONCLUSIONS: the results suggest that women would like intervals longer than one month or to never menstruate.

Menstruation and amenorrhea: opinion of Brazilian women.

Contemporary women experience more menstrual cycles than their predecessors, and their menstrual patterns are modified by contraceptives. Amenorrhea is one side effect that has recently been advocated as desirable. This qualitative study investigated Brazilian women's views regarding the suppression of menstruation using hormones. Data were collected through eight focus groups, following a semistructured guideline. Sixty-four women, 21-51 years old, all menstruating regularly and all of whom had already initiated sexual activity and had no perceived infertility participated. Discussions were recorded, transcribed and entered into the computer, using the Ethnograph V 5.0 software to aggregate similar patterns. Thematic content analysis revealed that menstruation and amenorrhea were both seen with ambiguity. Although regarded as a nuisance, menstruation was associated with femaleness, youth, fertility and health. Most women, although they would like to be free from menstruation, feared negative consequences of induced amenorrhea and even regarded the proposition as a male intrusion into what they consider a natural female condition.

Pesquisa em contracepção: opinião de pesquisadores, sujeitos e defensoras dos direitos das mulheres / Research on contraception: opinion of researchers, subjects and advocates of women rights

OBJETIVO: Conhecer a opinião de pesquisadores, de mulheres - sujeitos de pesquisa, e de defensoras dos direitos das mulheres sobre o significado de "pesquisa" e "cobaia". MÉTODOS: Pesquisadores (11), mulheres (18) e defensoras (10) foram entrevistados. O estudo foi qualitativo e a análise dos dados foi temática. RESULTADOS: Os participantes tiveram dificuldade em explicar o que é pesquisa; alguns não conseguiram. Para pesquisadores e maioria das mulheres, sujeitos de pesquisa não são cobaias, porque têm liberdade de escolha. Para a maioria das defensoras, sujeitos são cobaias, ainda que consintam em participar de um estudo. CONCLUSÕES: Foi surpreendente a dificuldade dos pesquisadores em explicar o que é pesquisa. As diferentes opiniões sobre o termo "cobaia" refletem a controvérsia sobre seu significado em pesquisa. Seguramente o termo "cobaia" não se aplica à maior parte dos estudos realizados hoje no Brasil, mas os diferentes significados identificados servem para alertar os pesquisadores a prestar atenção aos aspectos éticos de seus estudos.

Comitês de Ética em Pesquisa: adequação à Resolução 196/96 / Institutional Review Boards: compliance with Resolution 196/96

OBJETIVO: Este artigo apresenta a avaliação da estrutura, funcionamento e atuação de 17 Comitês de Ética em Pesquisa, na opinião de seus presidentes, considerando as determinações da Resolução 196/96 do Conselho Nacional de Saúde, Ministério da Saúde, Brasil. MÉTODOS: Foram identificados os presidentes de 33 Comitês que avaliavam projetos de pesquisa em regulação da fecundidade. Eles foram indicados pelos responsáveis dos serviços de ginecologia de 46 faculdades de medicina no Brasil e pelos diretores de quatro centros de pesquisa em reprodução humana. Uma carta foi enviada aos presidentes, convidando-os a participar voluntariamente de uma pesquisa, preenchendo um questionário. RESULTADOS: Dezessete presidentes responderam o questionário. Os resultados mostraram uma série de violações à Resolução 196/96. Três Comitês não tinham representantes da comunidade; quatro demoravam mais de um mês para emitir o parecer final dos protocolos e 13 não acompanhavam o desenvolvimento dos projetos. A composição e arquivamento dos protocolos estavam de acordo com a Resolução, porém, o tempo de mandato era diferente do estabelecido em oito dos Comitês avaliados. Quase todos os presidentes (entre 14 e 17) consideraram a composição e atuação de seus CEPs adequados. A grande maioria dos presidentes (11) qualificou a Resolução como sendo apropriada, porém, difícil de ser cumprida. CONCLUSAO: Os resultados sugerem que um amplo debate sobre a viabilidade operacional da Resolução seria oportuno. Este processo resultaria em sugestões valiosas para o aperfeiçoamento e aplicabilidade das normas. Isto contribuiria para a melhoria da qualidade cientifica e ética dos estudos desenvolvidos no Brasil.

Women and AIDS: gender relations and condom use with steady partners.

An educational project on sexuality, STDs, and AIDS was conducted for four years with some 500 women. As a result, changes were observed in HIV-related knowledge and attitudes, but not in risk behaviors for infection. This fact motivated the development of a qualitative study to learn the reasons why women failed to incorporate HIV preventive behaviors into their daily lives. Six focus groups were conducted with women who had participated in the educational project. The analysis was thematic. Women were familiar with HIV transmission routes and preventive measures. They admitted not using condoms due to fear of being suspected of infidelity and because this might lead to separation of the couple. Women reported that relationships with their partners had been difficult because of lack of dialogue and that men always had the final word. Although women had information about AIDS, they did not use preventive measures in steady relationships because they did not wield decision-making power. Gender inequality and fidelity were two significant issues related to the increase in AIDS among women.

Women and AIDS: gender relations and condom use with steady partners

Um projeto educativo sobre sexualidade, DST e AIDS foi realizado durante quatro anos com cerca de quinhentas mulheres. Como resultado, houve mudanças em conhecimentos e atitudes em relação ao HIV, mas não em comportamentos de risco para a infecção. Isto motivou a realização de um estudo qualitativo para conhecer as razões pelas quais as medidas de prevenção de AIDS não são incorporadas ao cotidiano das mulheres. Foram realizados seis grupos focais com mulheres que haviam participado do projeto educativo citado. A análise foi temática. As mulheres citaram todas as vias de transmissão e prevenção de AIDS. Reconheceram que não usavam condom porque tinham medo de despertar suspeita de infidelidade e provocar a separação do casal. Relataram que a relação a dois era difícil por falta de diálogo e que a palavra final era sempre do homem. Apesar das mulheres terem informação e conhecerem os riscos, não usavam medidas preventivas em relacionamento estável porque não tinham poder de decisão. Relações desiguais de gênero e questões relacionadas à fidelidade foram apontadas como fatores que contribuem para a disseminação do HIV nas mulheres.

[Research on contraception: opinion of researchers, subjects and advocates of women rights]. / Pesquisa em contracepção: opinião de pesquisadores, sujeitos e defensoras dos direitos das mulheres.

OBJECTIVE: To survey the opinion of researchers, women -- subjects of research-- and of advocates of women's rights about the meaning of "research" and "guinea pigs". METHODS: Researchers (11), women (18) and advocates (10) were interviewed. The study was qualitative and a thematic analysis was carried out. RESULTS: Participants experienced difficulty to explain what research meant and some were unable to do so. For the researchers and most of the women, subjects are not guinea pigs, because they have freedom of choice. Most of the advocates, however, said that subjects are guinea pigs, even when they consent to participate in a study. CONCLUSIONS: The difficulty experienced by researchers when explaining the meaning of research was surprising. The different opinions about "guinea pig" reflect the controversy about its meaning in research. Certainly the expression "guinea pig" does not apply to all studies however the different meanings identified should make researchers cautious about the ethical issues involved in their studies.

[Institutional Review Boards: compliance with Resolution 196/96]. / Comitês de Etica em Pesquisa: adequação à Resolução 196/96.

PURPOSE: This article intends to evaluate the structure, functioning and performance of 17 Institutional Review Boards (IRB), from the viewpoint of their presidents, in relation to the instructions of Resolution 196/96 of the National Council of Health, Ministry of Health, Brazil. METHODS: Presidents of 33 IRBs, that evaluated proposals for research on fertility control, were indicated by the professionals responsible for the area of gynecology in 46 Brazilian medical schools and by the directors of four research centers on human reproduction . A letter with a questionnaire were sent to the presidents, asking them to volunteer for the study. RESULTS: Seventeen presidents completed the questionnaire. Results disclosed a series of violations of Resolution 196/96. Three IRBs did not include representatives of the community among their members; four took over a month to release the Board's decision on proposals and 13 did not follow-up the studies. Composition and filing of the research proposals were in agreement with the Resolution. However, in eight IRBs time of mandate differed from that set forth in the Resolution. Almost all presidents (about 14 of the 17) thought that the composition and activities of their IRBs were adequate. Eleven considered the Resolution appropriate but difficult to comply with. CONCLUSION: These results suggest that an extensive debate on the operational viability of the Resolution would be timely. This endeavor could bring forth valuable suggestions for the improvement and applicability of the Resolution contributing to the improvement of the scientific and ethical quality of research.

Women's preferences for vaginal antimicrobial contraceptives. V: attitudes of Brazilian women to the insertion of vaginal products.

The rapid spread of HIV/AIDS in the female population increases the urgency of developing new formulations that offer protection from this disease as well as other sexually transmitted infections. In many cultures, women do not readily accept touching their genitals or inserting products into their vaginas. Information on this subject was collected during a study involving 635 women in Brazil to determine the preferred attributes of vaginal products. Seventy-six percent would use an idealized contraceptive method that offered dual protection even though it could only be inserted with a finger and 96% would use this method if it could only be placed with an applicator. Qualitative analyses of responses to open questions suggest that the majority of Brazilian women studied did not like to touch their vagina with their finger or to insert devices. Although the introduction of safe and effective vaginal microbicides into many cultural settings can be successful, it should be accompanied by significant efforts to educate women about their bodies.

Consentimento informado na pesquisa clínica: teoria e prática / Informed consent in a clinical trial: theory and practice

Objetivo: avaliar a concordância entre a teoria sobre consentimento informado, representada pela Resolução 01/88, e a prática de sua obtenção de acordo com o relato de pesquisadores e de mulheres que participaram de suas pesquisas. Métodos: onze pesquisadores de três centros de excelência em pesquisa sobre regulação da fecundidade e 18 mulheres, sujeitos de suas pesquisas. A informação foi obtida por meio de entrevistas em profundidade e foi realizada análise de conteúdo. Resultados: o relato dos pesquisadores estava de acordo com as exigências da Resolução, entretanto, o relato das mulheres mostrou que a maioria dos tópicos exigidos näo foi tratada com elas quando convidadas para a pesquisa. Conclusão: observou-se discordância entre teoria e prática em obter o consentimento. Isto pode dever-se a dificuldades no cumprimento das exigências da Resolução então em vigor. Por outro lado, também é possível pensar em dificuldades dos pesquisadores para abordar as mulheres e/ou que elas tenham esquecido as informações recebidas. Finalmente, a obtenção do consentimento dos pesquisadores e das mulheres para participarem neste estudo pode ter colaborado para a ocorrência desta discordância