Intracavernosal injection therapy with and without sexological counselling in men with erectile dysfunction.

OBJECTIVE: To compare the acceptance of and satisfaction with intracavernosal injection (ICI) therapy with and without sexological counselling in men with erectile dysfunction (ED). PATIENTS AND METHODS: In a prospective randomized study, men were alternately assigned to ICI without sexological counselling (-SC) or with sexological counselling (+SC). In all, 70 patients were included, i.e. 35 in each group; 57 (28 -SC, 29 +SC) were interviewed by telephone after a mean follow-up of 11.3 months to determine their use of ICI and reasons for discontinuing. RESULTS: There were no differences between the groups in discontinuation of ICI (overall 30%), in reasons for discontinuing ICI (24% did so because of the return of spontaneous erections) or in sexual functioning. CONCLUSION: There was no positive contribution from additional sexological counselling but extensive information and support by the urologist seems to be sufficient, resulting in a high acceptance rate of ICI. The discontinuation rate (30%) is one of the lowest reported.

Demographers converge on Chicago.

PIP: The Chicago annual meeting of the Population Association of America (PAA) attracted some 1100 demographers and populationists. This paper discusses some of the sessions during the meeting's week. Some of the meetings included: 1) the Association for Population/Family Planning Libraries and Information Centers - International (APLIC), and 2) a Psychosocial Workshop. Some of the sessions included: 1) Nonmarital Sexuality and Fertility in the Third World, 2) Acceptability of New Contraceptive Methods, 3) Family Change in Western Countries, 4) Social Policy in Aging Populations, 5) The Future of Marriage, 6) Computers, 7) USSR, 8) AIDS, and 9) Women's Caucus. Some of the themes included: 1) Demographers in the Courtroom, and 2) Applied Demographers.^ieng

Population pressures in Latin America.

PIP: In 1950 Latin America's population of 165 million was on a par with the 166 million of North America. 2 decades of growth at nearly 3% a year pushed the total to 405 million in 1985, vs. 264 million in North America. Despite substantial fertility declines since the 1960s, continued growth is ensured by the demographic momentum built into the region's large and youthful population bases. UN medium projections put the 2025 total at 779 million, compared to 345 million in North America. This Bulletin examines the main demographic changes in Latin America since World War II and their links to economic and social changes in the region as well as their implications for international and social relations. The post World War II population surge was accompanied by massive rural-ruban and international migration, rapid urbanization, large labor shifts out of agriculture into industry and services, increased education for both men and women, and higher labor force participation for females. The rural exodus was spurred by extreme land tenure inequalities and the urban bias of postwar industrialization. The labor-saving bias of this industrialization forced exploding city populations to turn to the informal sector for jobs. Population pressures on city services and housing as well as jobs have been further exacerbated by overconcentration in a few large cities and economic downturns of the 1980s. Recent fertility declines seem to be the result of both increased access to family planning and the economic and social pressures posed by the gap between young adults' aspirations and their ability to realize them. Population and economic pressures could induce faster fertility declines than now projected but in the short run are likely to mean more employment problems, continued rapid urban growth, and even larger international immigration flows within the hemisphere, particularly to the US.^ieng

Survey report: Kenya.

PIP: In Kenya, women still average about 8 children each, but the average family size desired by ever-married women dropped by 1 child, from 7.2 to 6.2, between 1978-84. The percentage of currently married women using contraception more than doubled, from 7 to 17%. These are highlights of trends revealed by comparison of the recently released results of the Kenya Contraceptive Prevalence Survey of 1984 with the Kenya Fertility Survey of 1977-78. The latest trends in Kenya's fertility and family planning can be expected to be of worldwide interest in view of the country's record high population growth rate of 4.2% a year. Estimated at 21 million in 1986, the population of Kenya is projected by the UN to quadruple to 83 million by 2025 and could reach as high as 116 million by 2100, according to the World Bank. Among the reasons cited for the failure of Kenya's government family planning program, established in 1968, are bureaucratic snarls, shortages of supplies and trained personnel, and short business hours and long waits in clinics that are not always easily accessible in rural areas. These problems are now being dealt with, but there remains the obstacle of a persistent desire for large families among the population. Over 80% of the 6581 women aged 15-49 interviewed in the 1984 survey knew of at least 1 contraceptive method. The survey report terms the more than doubling of current contraceptive use between 1978-84 as a major success for the family planning program. Yet, the 1984 level is low. Also, the contraceptive mix shifted toward less effective methods. Among currently married women using contraception, the proportion using modern methods was down from 61% in 1978 to 52% in 1984, with oral contraceptive (OC) use dropping from 29 to 19% of the total and rhythm increasing from 16 to 25%. Fertility change was negligible. There was a slight increase in children ever born among women 45-49 from 7.9-8.2 per woman, along with a small decrease in the current total fertility rate from 7.9-7.7 per woman. The 1984 survey found that family size desires and fertility are lower and contraceptive use higher among better educated women. The 1984 survey found little support for the widespread view that Kenyan men are the major obstacle to progress in lowering fertility. Of the reasons for nonuse of contraception given by women who knew of at least 1 method but were not using contraception and were not pregnant, husbands' disapproval accounted for only 9%.^ieng

The invisible hand in San Francisco.

PIP: Over 1000 population enthusiasts found their way to San Francisco for the 1986 meetings of the Population Association of America (PAA) April 3-5. 2 pre-meetings included: 1) the Association for Population/Family Planning Libraries and Information Centers-International (APLIC), and 2) the psychosocial workshop. Sexual activity was a major topic of the session on "Fertility: Early and Late." Further investigation of the effects of marriage and fertility on behavior was reviewed in a session entitled "Trends in Household Composition and Living Arrangements." The session "Demography of Crime and Justice" gave the demographic answer to such questions as: Is the crime rate really falling? Opinions in a panel on the future of US international population policy were sharply divided; Agency for International Development representative Alison Rosenberg outlined the re-examination of the Agency's population program that had taken place since the population conference in Mexico City in 1984. The Presidential Address was preceded by the annual awards ceremony. PAA President Paul Demeny focused on an issue that has been at the core of the debate about whether population has good, bad, indifferent, or indeterminate effects on economic development: the extent to which society can entrust the solution of population problems to market forces. This year's PAA meeting echoed growing concern in the population field about low fertility in the more developed world as well as increasing skepticism over the negative consequences of rapid developing country population growth.^ieng

Our population predicament: a new look.

PIP: Issued to mark the Population Reference Bureau's 50th anniversary, this issue updates the story of world population presented in its popular predecessor of 1971, "Man's Population Predicament." Estimated at 1/2 billion in 1650, world population reached about 2 billion in 1930, 4 billion in 1975, and is projected to be about 6 billion in 2000. Most of today's rapid growth is occurring among the 3/4 of the world's peoples living in less developed countries where the post-World War II gap between high birth rates and falling death rates has only recently begun to narrow. This growth, coupled with high consumption in developing countries, is putting tremendous pressures on the Earth's resources, environment, and social fabric. New evidence on Europe's population transition and from China, Indonesia, and Thailand in the 1970s suggests that well-designed family planning programs can speed fertility decline but rapid worldwide attainment of replacement level fertility will also require special development efforts and measures that go beyond family planning. Current projections of the world's ultimate peak population range from 8 billion in the mid 21st century to 11 billion in about 2125, depending on when replacement-level fertility is reached. China's drive for a drastic birth rate reduction and the oil crisis might change fertility behavior more rapidly than most demographers have heretofore thought likely.^ieng

Major trends in recent abortion research.

PIP: Abortion research continues actively. 1 finding has been that abortion has distinct regional features. In Western Europe the rights of the woman in relation to the rights of the fetus are under study while Eastern European researchers examine the effect of long standing available abortion on birthrates, women's health, subsequent pregnancies, and contraceptive use. The increase in illegal abortion shows that improved health and contraceptive services, better data, and changes in restrictive laws are necessary. Changes in the laws, either from less to more liberal or the opposite, have brought about national studies of subsequent trends in abortion, maternal and infant mortality, service facilities, contraceptive practice and fertility. The technique of menstrual regulation, performed within 14 days of a missed menstrual period and before pregnancy can be determined, has created new research problems. It raises the questions of whether menstrual regulation can legally be considered an abortion and whether effectiveness rates can be reliably determined if a large proportion of the women are not even pregnant. The relative risks of menstrual regulation in very early pregnancy and vacuum aspiration and dilation and curretage at a later stage are now being researched. The World Health Organization is planning research of the psychosocial aspects of the relationship between the users and providers of abortion services. Also receiving research attention is the incidence of repeat abortions and the effects of an abortion refused. The fact that overall birthrates have not been substantially changed by the liberalization of abortion laws in the last 20 years appears to be associated with the improvement of contraceptive methods.^ieng