Copper intrauterine device placement 6-14 days after unprotected sex.

OBJECTIVE: To evaluate pregnancy risk following copper (CuT380A) intrauterine device (IUD) placement 6-14 days after unprotected intercourse. STUDY DESIGN: We used a combined dataset from four protocols in which participants had received a CuT380A IUD regardless of recent unprotected intercourse. At entry, participants had negative point of care urine pregnancy testing and reported all acts of unprotected intercourse in the two weeks prior to IUD placement. We identified a subset of women who had placement 6-14 days after unprotected intercourse and provided follow-up information on pregnancy status 2-4 weeks after IUD insertion. This follow-up within the four protocols included self -administered home urine pregnancy test (UPT) results 2-4 weeks after IUD placement or continued contact for up to 6 months. RESULTS: We identified 134 women who had a CuT380A IUD placed 6-14 days after unprotected intercourse and provided follow-up information on pregnancy status. Ninety-five (71%) participants reported UPT results 2-4 weeks after placement and the other 39 women were followed for 6 months after IUD placement to assess pregnancy status. Zero (97.5% CI 0-2.7%) participants reported a pregnancy within four weeks of CuT380A IUD placement. CONCLUSION: In these collected data, no women with recent unprotected intercourse became pregnant within 1 month of CuT380A IUD placement. IMPLICATION: These data indicate a low likelihood of pregnancy among women who reported unprotected intercourse 6-14 days preceding IUD insertion. For many women and their providers, these data may be sufficient to support same-day placement of a copper IUD rather than delaying IUD placement until the next menses.

Knowledge of and Interest in the Copper Intrauterine Device Among Women Seeking Emergency Contraception.

OBJECTIVE: Emergency contraception (EC) includes hormonal pills (levonorgestrel or ulipristal acetate) and the copper IUD (Cu-IUD). The Cu-IUD is more effective for EC than hormonal pills but remains underused, possibly because of lack of knowledge or interest. The objective of this study was to examine knowledge of and interest in the Cu-IUD for EC among Canadian women seeking EC. METHODS: The study used a cross-sectional convenience survey of English-speaking women presenting for EC at two sexual health clinics in Toronto. The anonymous paper-based survey was completed in the waiting room. The main outcome measures were women's knowledge of and interest in the Cu-IUD for EC. Demographic and reproductive health data were also collected. RESULTS: Between January and December 2013, 124 surveys were completed. Mean age of respondents was 26 years (SD ± 6.9). Most were single (85%), and over one half had completed postsecondary education. Overall, 77% had heard of the Cu-IUD, but only 21% were aware of its use for EC. Over 50% were aware that the Cu-IUD is hormone-free and may be used for long-term contraception. Women were less familiar with the window of administration of the Cu-IUD for EC (26%) and its efficacy (6%). In total, 23% (28 of 124) of women were interested in the Cu-IUD, including eight women scheduled to receive one that day. CONCLUSION: Women presenting for EC were unaware of the Cu-IUD but were moderately interested in it once informed. Public education and routine counselling about the Cu-IUD at EC visits may increase the uptake of this method.

Determinantes de las conductas sexuales de riesgo en jóvenes de Cataluña / Factors associated with sexual risk behaviour among Young people in Catalonia

Fundamentos: la conducta sexual en jóvenes se ve influida por factores externos que pueden favorecer una disminución del control de la situación y mayor desprotección. Objetivo: describir y comparar según sexo la conducta sexual y otros indicadores de salud sexual y reproductiva en jóvenes (16-24 años) en Cataluña e identificar factores asociados a las conductas sexuales de riesgo. Métodos: estudio transversal realizado en 2012 mediante encuesta en línea a partir de un panel de población (n=800). Se identificaron factores asociados al no uso del preservativo (no UP) en la última relación sexual con penetración (RS) mediante modelos de regresión logística multivariantes. Resultados: el 76,1% de los chicos y el 83,3% de las chicas declararon RS alguna vez (p=0,012). El 39,7% de los chicos y el 22,5% de las chicas tuvieron parejas ocasionales, siendo el uso de Internet para contactar parejas del 31,4% y 10,3%, respectivamente. Entre los factores asociados al no UP durante la última RS destacó no haber usado preservativo en la primera RS (OR=2,50 en chicos y OR=3,18 en chicas). Haber contactado parejas sexuales por Internet se mostró asociado en chicos (OR=2,29) y haber usado la anticoncepción de emergencia ≥3 veces en chicas (OR=3,38). Conclusiones: se observan diferencias en la conducta sexual de los jóvenes según sexo, siendo el uso del preservativo en la primera relación sexual un buen predictor de su uso en la última. Los chicos presentan mayor número de parejas ocasionales que las chicas y utilizan más las nuevas tecnologías de la información para contactar estas parejas (AU)

Background: sexual behavior in young people is influenced by external factors that may increase their vulnerability. Objective: to describe sexual behavior and other indicators of sexual and reproductive health among young people (16 to 24 years) in Catalonia and to identify factors associated with sexual risk behaviors. Methods: cross-sectional study in 2012 carried out by an online survey from a panel of population (n=800). Factors associated with not using a condom at last sexual intercourse were evaluated using multivariate logistic regression models. Results: 76.1% of boys and 83.3% of girls reported having had complete sexual intercourse (p=0.012). The proportion of boys and girls who reported casual partners was 39.7% and 22.5%, respectively. 31.4% of boys and 10.3% of girls reported having contacted partners through Internet. Not using a condom at first sexual intercourse showed significant association with reporting not using a condom in the last sexual intercourse, for both, boys (OR= 2.50) and girls (OR= 3.18). Having contacted partners through the Internet (OR=2.29) was associated with this risky sexual behavior in boys, and having used the emergency contraception 3 or more times (OR=3.38) was associated in girls. Conclusions: there are differences in the sexual behavior of young people by sex, being condom use at first sexual relationship a good predictor of condom use at last sexual intercourse. Boys show a higher number of casual partners than girls, as well as a higher use of the Internet to contact sexual partners (AU)

Emergency contraception.

This review summarises the development of emergency contraception (EC) methods, and provides an overview on the currently available options of EC which are effective and safe back-up methods in case of non-use or failure of the regular contraception. The copper intrauterine contraceptive device is currently the most effective method. In most countries, a single dose of levonorgestrel 1.5 mg is the first-line hormonal EC given within 72 h of unprotected intercourse. The oral anti-progestogens such as mifepristone and ulipristal acetate are promising alternatives with better efficacies and a wider treatment window of up to 120 h post coitus, probably resulting from more diverse ancillary mechanisms of actions. Education on EC should be part of any contraceptive counselling. Improving access to EC by providing it over the counter or in advance would not promote its abuse nor encourage risky sexual behaviours, but may further facilitate the timely use so as to achieve the best efficacy.

Intrauterine contraceptives: a review of uses, side effects, and candidates.

This article reviews the two intrauterine devices (IUDs) available in the United States: the TCu380A, marketed as ParaGard (Duramed Pharmaceuticals, Inc. Pomona, NY), and the levonorgestrel-releasing intrauterine system (LNG-IUS), marketed as Mirena (Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ). The properties of the two devices are detailed, as well as noncontraceptive indications and appropriate candidates for use. Studies consistently demonstrate that the devices are safe, effective, and provide cost savings when compared with other reversible methods. The TCu380A may be used as postcoital contraception with close to 100% effectiveness. Menstrual blood loss is likely to increase with the TCu380A and decrease with the LNG-IUS. Reduction in menstrual blood loss and endometrial suppression make the LNG-IUS an increasingly popular treatment for menorrhagia, endometriosis, adenomyosis, and as an adjunct to estrogen therapy. IUDs may be inserted immediately after a first- or second-trimester abortion, immediately postpartum, and >or=4 weeks postpartum. Candidacy for IUDs has expanded, and includes nulliparous women, adolescents, and women with immunocompromised conditions including HIV.

Cambio en la accesibilidad a la píldora poscoital y análisis de la influencia sobre la incidencia en las infecciones de transmisión sexual / Change in the accesibility of the emergency contraceptive pills and analysis concerning the influence on the incidence of sexually transmitted disease

Introducción: En España se ha puesto en marcha la dispensación gratuita de la píldora poscoital en los servicios de urgencias de atención primaria, lo que permite el acceso rápido y gratuito a las usuarias. Objetivos: Evaluar la influencia que ha tenido la administración gratuita de la píldora poscoital en atención primaria sobre su consumo, y comparar su evolución con las tendencias evolutivas de la incidencia de infecciones de transmisión sexual(ITS). Material y método: Estudio observacional y descriptivo. Se incluyeron datos de consumo de la píldora poscoital en farmacias y centros de salud e ITS de declaración obligatoria durante un periodo de 6 años (2002-2007). Variables de medida: tasa de consumo anual (consumo en número de envases de píldora poscoital por 1.000 habitantes y año), incidencia (número de nuevos casos acontecidos en un año) y tasa de incidencia (por 100.000 habitantes) para la sífilis e infecciones gonocócicas. Resultados: Tasa de consumo de la píldora poscoital al inicio del estudio (dispensación en oficinas de farmacia) de 3,02 frente a 12,44 en el año 2007. La tendencia al aumento de la tasa de consumo total de la píldora poscoital se relacionó de manera significativa (p= 0,024) y de tipo lineal con la tendencia al aumento de la incidencia de sífilis. Conclusiones: Se detecta un elevado incremento del consume de la píldora poscoital y una probable asociación con el aumento de la incidencia de sífilis (AU)

Introduction: In Spain they have implemented, the free dispensing of the emergency contraceptive pills in the primary care emergency departments, which allows the rapid and free access for the users. Objective: To evaluate the influence that free administration of emergency contraception in Primary Care has had on its consumption and compare the evolution of consumption of the above mentioned over time with incidence of sexually transmitted diseases (STDs). Materials and Method: Descriptive observational study Data on the consumption of the emergency contraceptive pill from drugstores and health centres of Obligatorily Declared sexually transmitted diseases were collected over 6 years (2002-2007). Main outcome measures: Annual level of consumption (consumption in number of emergency contraceptive pill boxes per 1,000 inhabitants per year, incidence (number of new cases detected in a year), and incidence rate (incidence per 100,000 inhabitants) for syphilis and gonococcal infections. Results: The consumption rate of the emergency contraceptive pill at the beginning of the study (distributed in drugstores) was3.02 versus to 12.44 in the year 2007. The tendency of the consumption rate of the emergency contraceptive pill to increase was found to be significant (p=0.024) and lineally related with the tendency of the syphilis rate to increase. Conclusions: An increased consumption of the emergency contraceptive pill and a probable association with the increase in the occurrence of syphilis was detected (AU)

Behind-the-counter status and availability of emergency contraception.

OBJECTIVE: The objective of the study was to determine whether the 2006 Food and Drug Administration approval of Plan B for behind-the-counter status increased availability. STUDY DESIGN: We conducted a survey in 2005 and 2007 of pharmacies listed in Atlanta, GA, Boston, MA, and Philadelphia, PA. We measured ability to dispense Plan B within 24 hours. Also measured were reasons for lack of availability and cost of Plan B. RESULTS: Pharmacists were interviewed at 1087 pharmacies (75% response rate) in 2005 and 795 pharmacies (82% response rate) in 2007. In 2007, 8% of pharmacies were unable to provide Plan B within 24 hours, compared with 23% of pharmacies in 2005 (P < .001). The total refusal rate in 2007 was half the rate of 2005 (2% vs 4%, P = .004). The average cost of Plan B was $43. CONCLUSION: Availability of Plan B in Atlanta and Philadelphia increased after it was awarded behind-the-counter status.

Contracepción poscoital de urgencia / No disponible

La contracepción de emergencia puede definirse como la administración de fármacos o el uso de un dispositivo para prevenir un posible embarazo después de una relación sexual sin protección y dentro de las 72 horas tras el contacto. El mecanismo de acción es impedir la ovulación o la fertilización o la implantación. Si el óvulo fecundado está implantado, ya no actuaría. Existe evidencia de que actúa en distintos momentos del ciclo reproductivo. Si sólo actuase sobre la ovulación y la fertilización, sólo podría prevenir muchos, pero no todos, los embarazos. El efecto sobre el endometrio y sus consecuencias sobre la implantación hacen necesario que los médicos conozcan todos los posibles mecanismos de estos medicamentos cuando se informa al paciente y la familia. La eficacia depende del régimen usado y del tiempo transcurrido entre la relación y la toma de la medicación. Tiene escasos efectos secundarios. La Asociación Americana de Pediatría propone, entre varias medidas, esta opción terapéutica para disminuir los embarazos no deseados en adolescentes. No obstante, con el uso de estos medicamentos deberían evaluarse algunas variables (AU)

Emergency postcoital contraception may be defined as the administration of a drug or use of a device to prevent a possible pregnancy after a sexual unprotected and within 72 hours after intercourse. Mode of action could work by inhibiting ovulation, interfering with fertilization or inhibiting implantation in the endometrium. If a fertilized egg is implanted prior to taking pills, it will not work. There is evidence of effects at several stages of the reproductive cycle. The method that affected ovulation or fertilization would prevent most but no all pregnancies. The effects on the endometrium and impact on implantation requires the physicians be knowledgeable about all potential mechanism when offering treatment to patients and families. The effectiveness depends on the regimen used and on the time between intercourse and treatment. It has low rate of side effects. The American Academics of Pediatrics proposes this measurement, besides others, to disminish the pregnancies nowished in adolescent. However, some variables, would have to be evaluated with the use of theses preparations (AU)