Acceptability of human papillomavirus self testing in female adolescents.

OBJECTIVES: To develop scales assessing acceptability of human papillomavirus (HPV) testing in adolescents, to compare acceptability of self to clinician testing, and to identify adolescent characteristics associated with acceptability. METHODS: Female adolescents 14-21 years of age attending a hospital based teen health centre self collected vaginal samples and a clinician, using a speculum, collected cervicovaginal samples for HPV DNA. Acceptability of and preferences for self and clinician testing were assessed at baseline and 2 week visits. RESULTS: The mean age of the 121 participants was 17.8 years and 82% were black. The acceptability scales demonstrated good internal consistency, reliability, test-retest reliability, and factorial validity. Scores were significantly lower for self testing than clinician testing on the acceptability scale and three subscales measuring trust of the test result, confidence in one's ability to collect a specimen, and perceived effects of testing (p < 0.01). Of those who reported a preference, 73% preferred clinician to self testing. Acceptability scores for both self and clinician testing increased significantly pre-examination to post-examination (p < 0.01). Multivariable analyses demonstrated that race was independently associated with pre-examination and post-examination acceptability of self testing, and that sexual behaviours and gynaecological experiences were associated with specific acceptability subscales. CONCLUSIONS: This sample of adolescents found clinician testing for HPV to be more acceptable than self testing and preferred clinician to self testing. If self testing for HPV is offered in the future, clinicians should not assume that adolescent patients will prefer self testing. Instead, they should educate adolescents about available testing options and discuss any concerns regarding self collection technique or accuracy of test results.

Family involvement in the gynecologic care of adolescents.

The purpose of this paper is to address the issues of family involvement in gynecologic care for adolescent girls. This is accomplished by reviewing pertinent literature and its implication for health-care delivery. Specific aspects of adolescent development including changes in cognitive development and relationships are reviewed. In addition, the implications of communication between parent and adolescent, degree of parental monitoring, and the type of parenting style are discussed. Using this information as a background, recommendations for family involvement in gynecologic care are given. Methods for handling appointments are addressed; including the structure and content of the appointment and also the follow-up appointment, especially for high-risk families. Issues of confidentiality for both adolescent and parent are discussed. This information should aid clinicians in supporting those features of families that promote positive growth in adolescent girls.

Contraceptive use and attitudes among U.S. women.

PIP: More than half of the 6.3 million pregnancies which occur annually in the US are unintended. Approximately 50% of the unintended pregnancies which occurred in 1987 were among women not using birth control, while the other 50% occurred among women who were using some form of birth control when they became pregnant and most likely suffered method- or user-related contraceptive failure. The incidence and outcomes of unintended pregnancies vary with women's age. Oral contraceptives are the most popular of reversible birth control methods among US women, with nearly 30% of American couples choosing the pill as their method of reversible contraception. 25% chose tubal sterilization and 11% vasectomy. A 1992 survey found 25% of contraceptive users to use condoms, 8% withdrawal, and 1% the subdermal hormonal implant. As for method satisfaction, 94% of OC users are content with their method compared to only 17% and 57% who are satisfied using rhythm and withdrawal, respectively. The following factors affect women's choice of a contraceptive method: childbearing plans and age, women's perceptions of birth control methods, past experience with contraception, physician's influence, religious factors, education, access and cost factors, and health concerns. Future trends in contraception will likely be shaped by the changing demographics of the US population and increased awareness of sexually transmitted diseases along with the continuation of the AIDS pandemic.^ieng

Complications of cervical cryotherapy in adolescents.

Cervical dysplasia and human papillomavirus (HPV) infections in sexually active adolescents appear to be increasing. Cervical cryotherapy offers the advantages of inexpensive outpatient therapy that is well tolerated without anesthesia. Previous series have focused on women beyond adolescence and have concluded that the risks and complications are rare. Sixty-seven adolescents underwent cervical cryotherapy for cervical intraepithelial neoplasia (CIN) or HPV infection. Pelvic inflammatory disease developed in 9% within one month of treatment. Two patients developed cervical stenosis and hematometra. Cervical cultures performed prior to cryotherapy were documented to be negative, but the interval from negative cultures to treatment exceeded four weeks in 54% of the patients because of problems with patient compliance with appointments. The risk of infectious complication in our adolescent population prompted a recommendation for aggressive preventive measures, including documentation of recent negative cultures for Neisseria gonorrhoeae and Chlamydia. The use of prophylactic antibiotics should be investigated for adolescents undergoing cervical cryotherapy.

Self-reported health concerns and sexual behaviors in adolescents with cervical dysplasia. A pilot study.

A group of 46 women attending an adolescent dysplasia clinic were surveyed regarding the reported impact of cervical dysplasia on sexual beliefs and behaviors. The adolescents reported being concerned about their future health and having changed their sexual practices. There were no clear relationships between demographic variables or sexual attitudes and changes. The adolescents' self-reports of their behavior were not consistent; those adolescents who reported safer sex practices did not have lower rates of sexually transmitted diseases postbiopsy. The results of this study indicate the important but complex impact of sexually transmitted disease on adolescents and suggests that this impact on adolescents may be different from that on adults.

Genital human papillomavirus infection in adolescents.

Genital HPV infections are much more prevalent than previously believed. The most common clinical manifestation of HPV--the subclinical papillomavirus infection, or SPI--is missed on routine examination. No single diagnostic test is adequate in the assessment of HPV infections, and the more recent studies involving newer nucleic acid technologies have brought about a better understanding of the behavior of HPV. There are different oncogenic potentials regarding specific HPV DNA types. Other possible cofactors include age at diagnosis, method of contraception, and use of tobacco.