Intrauterine devices and risk of uterine perforation: current perspectives.

Uterine perforation is an uncommon complication of intrauterine device insertion, with an incidence of one in 1,000 insertions. Perforation may be complete, with the device totally in the abdominal cavity, or partial, with the device to varying degrees within the uterine wall. Some studies show a positive association between lactation and perforation, but a causal relationship has not been established. Very rarely, a device may perforate into bowel or the urinary tract. Perforated intrauterine devices can generally be removed successfully at laparoscopy.

The effect of mifepristone (RU486) on the endocannabinoid system in human plasma and first-trimester trophoblast of women undergoing termination of pregnancy.

INTRODUCTION: High anandamide (AEA) concentrations are detrimental for implantation and early pregnancy. Progesterone, essential for pregnancy, may keep AEA levels low by increasing fatty acid amide hydrolase (FAAH) expression. Here the effect of RU486, a P4 antagonist used to initiate medical termination of pregnancy (MTOP), on plasma AEA concentrations and the endocannabinoid system (ECS) in trophoblasts was examined. OBJECTIVE: Quantification of the endocannabinoid concentrations and expression of the ECS in trophoblast tissue of MTOP women and women undergoing surgical termination of pregnancy (STOP). DESIGN AND SETTING: A prospective study at the University Hospitals of Leicester National Health Service Trust. PATIENTS AND METHODS: AEA, N-oleoylethanolamine (OEA), and N-palmitolylethanolamine (PEA) concentrations in trophoblast tissues and blood samples from 68 MTOP and 15 STOP were analyzed by ultra-high-performance liquid chromatography-tandem mass spectrometry. ECS expression was determined by immunohistochemistry, quantitative RT-PCR, and Western blotting. RESULTS: Concentrations of AEA, OEA, and PEA were significantly higher in MTOP than STOP trophoblasts (P = .0062, P = .016, and P = .0029, respectively), whereas no significant differences in plasma AEA, OEA, and PEA concentrations were observed even though plasma AEA and PEA concentrations were significantly (P = .005 and P = .025, respectively) increased the day after RU486 administration in women undergoing MTOP. Changes in the immunohistochemical densities of the AEA modifying enzymes N-acylphophatidylethanolamine-phospholipase D (NAPE-PLD) and FAAH, and the cannabinoid receptors (CB1 and CB2) were observed with increased NAPE-PLD, FAAH, and CB1 expression seen in the trophoblast of MTOP patients. CONCLUSIONS: Trophoblast after MTOP demonstrated high AEA concentrations with increased expression of NAPE-PLD, FAAH, and CB1.

Asian women's use of specialist Contraception, Sexual and Reproductive Health Services in Leicester, UK.

BACKGROUND: There is evidence to suggest that Asian women in the UK have specific contraceptive and sexual health needs. It has been reported that Asian women may use less reliable contraceptive methods and that cultural influences can affect access to sexual health services. As part of a wider needs assessment project we compared Asian women's usage of our specialist Contraception, Sexual and Reproductive Health Services to that of non-Asian women. METHODS: An anonymous questionnaire was offered to all service users between October and December 2007. Data were analysed separately for Asian and non-Asian women. RESULTS: The response rate was low for Asian women with only 26% completing questionnaires. There were no significant differences between the groups for proportions of women attending for each contraceptive method. A smaller proportion of Asian women were using the service for contraception and a greater proportion were attending for other sexual health reasons compared to non-Asian women. Confidentiality, female staff and not wanting to see their general practitioner were stated more often as reasons for using our service by Asian women. CONCLUSIONS: The National Strategy for Sexual Health and HIV emphasises the need for services targeted at ethnic minorities. Asian women use our clinics for a variety of their sexual health needs. Our service is used by some in preference to general practice, which may reflect ease of access and the perceived confidentiality that a dedicated Contraception and Sexual Health Service offers. These preferences should be considered by primary care trusts when commissioning services.

A community-based vasectomy service in Leicestershire and Rutland - The patients' perspective.

OBJECTIVES: To evaluate the community-based vasectomy service from the patients' perspective and consider service provision in terms of access, process, quality and outcome. METHOD: A prospective questionnaire was handed to 150 consecutive men attending for vasectomy from February to June 2007, for completion two weeks after surgery. Postal reminders were sent at four and eight weeks. RESULTS: The response rate was 73%, with 93% (n = 102) of the respondents considering the vasectomy unit to be of high quality. The comprehension of written information (93%) and the approachability of staff (83%) were both considered highly satisfactory. Most men were equivocal regarding proposed 'holistic' changes to the service. Men under 40 were more likely to be neutral or agree that vasectomy was embarrassing and preferred a male surgeon. The occurrence of complications did not affect satisfaction but increased the mean number of disturbed nights sleep and days taking analgesia. Suggestions for improvement pertained to the pre-operative information and the use of skin sutures. CONCLUSIONS: The patients' evaluation of our vasectomy unit identified areas for improvement and reinforced good clinical practice. More research is needed to clarify the impact of age, ethnicity and other factors on the accessibility, acceptability and experience of vasectomy.

Usage of Long Acting Reversible Contraceptive Methods (LARC) in couples attending for vasectomy counselling.

OBJECTIVE: Vasectomy is a safe and effective method of permanent contraception. A proportion of men will regret the procedure and some may experience chronic testicular pain. National recommendations in the UK advocate that couples requesting sterilization should be counselled and given access to Long Acting Reversible Contraceptive (LARC) methods. This study aims to ascertain usage of LARC methods in couples attending for vasectomy counselling. METHOD: A case notes review of 200 consecutive couples attending for vasectomy counselling between January and May 2006. RESULTS: Most couples were using condoms for contraception (51%) prior to vasectomy counselling. Only 11% of couples were using a LARC and 25% of couples had ever used one. The copper intrauterine device was the most popular LARC with 16% having ever used it; hormonal LARCs were unpopular. Some couples (9.5%) expressed dissatisfaction with current methods and associated health risks. CONCLUSION: Usage of LARC methods was low but similar to that of the background population in the UK. Couples attending for vasectomy are seeking effective contraception but prefer non-hormonal methods. LARC uptake in the UK is poor; there is a need for wider education and awareness of all LARC methods including side effects and safety.

Does the use of the combined oral contraceptive pill cause changes in the nasal physiology in young women?

BACKGROUND: Changes in nasal physiology have been observed during pregnancy and the menstrual cycle. The role of female hormones in these changes is unclear. The aim is to investigate the effect of the modern combined oral contraceptive pill (COCP). METHODS: Eleven women were recruited from a family planning clinic. Anterior rhinoscopy, peak inspiratory flow rate, acoustic rhinometry, anterior rhinomanometry, mucociliary clearance time, and rhinitis quality-of-life questionnaire (RQLQ) scores were recorded at days 1 and 14 pre- and post-COCP. RESULTS: Increased nasal obstruction midcycle pre-COCP, with significant differences for anterior rhinoscopy (p = 0.001) and peak inspiratory flow rate (p = 0.022), was found. No statistical difference was shown between pre- and post-COCP results apart from day 1 anterior rhinoscopy findings (p = 0.05). CONCLUSION: The modern COCP has no significant effect on nasal physiology.