Clinical challenges.Pill 'Vacation' Unnecessary A married 24-year-old woman who has been using oral contraceptives (OCs) for several months comes to the clinic for advice. She is happy with her choice of contraceptive method. However, she has heard that she needs to give her reproductive system a "vacation" from OC use, or else she may not be able to "reactivate re·ac·ti·vate v. 1. To make active again. 2. To restore the ability to function or the effectiveness of. re·ac " it later when she wants to have children. The young woman is thinking of not taking the pills for a while. What should she be counseled to do? Since she is satisfied taking OCs, the woman should be advised to continue using them. Women do not need to periodically stop taking OCs to preserve fertility. Research has shown that contraceptive pills do not cause infertility, (1) regardless of duration of use. (2) Return to fertility may be immediate after OC users stop taking the pills. (3) However, several studies have shown that OC users often experience a temporary delay in return to fertility. Generally, it takes a woman a few months longer to conceive after discontinuing OCs than it would have if she had not taken them. (4) Taking a "vacation" from the pill would improve neither this woman's health nor her fertility. But it would increase her risk of unintended pregnancy if she had unprotected sexual intercourse or intercourse using a less effective contraceptive method during this time. Of note, use of OCs can protect against ectopic pregnancy (5) that could jeopardize long-term fertility. Can Douching douching Gynecology The rinsing of the vagina and cervix with water or other solutions; as a contraceptive method, it is essentially useless; because the vagina has a normal acidic environment which is protective, frequent douching is ill-advised Threaten Fertility? A 23-year-old sexually active, single woman wants to know whether regular vaginal douching is a good practice. Some of her friends and female family members have told her that douching can help protect her from acquiring sexually transmitted infections (STIs), but others have told her that it can be harmful and might even threaten her fertility. Based on the best research to date, should this practice be recommended? Many women douche douche (dldbomacsh) [Fr.] a stream of water directed against a part of the body or into a cavity. air douche , believing that the practice is hygienic, healthy, (6) and even prevents STI STI systolic time intervals. transmission. (7) However, douching has not been shown to either protect against STIs or provide other health benefits. Furthermore, a recent cross-sectional analysis found that douching--particularly frequent or recent douching--for symptoms such as vaginal discharge or for hygiene was associated with bacterial vaginosis (BV), an overgrowth of unhealthy bacteria. (8) These findings confirm those of several cross-sectional studies (9) and a single, small prospective cohort study (10) that have shown an association between douching and BV. BV can cause fertility-threatening pelvic inflammatory disease pelvic inflammatory disease (PID), infection of the female reproductive organs, usually resulting from infection with the bacteria that cause chlamydia or gonorrhea. (PID (1) (Process IDentifier) A temporary number assigned by the operating system to a process or service. (2) (Proportional-Integral-Derivative) The most common control methodology in process control. ) if either gonorrhea gonorrhea (gŏnərē`ə), common infectious disease caused by a bacterium (Neisseria gonorrhoeae), involving chiefly the mucous membranes of the genitourinary tract. or chlamydial infection is present. It can also harm a pregnancy. A recent meta-analysis of 18 studies involving some 20,000 patients has confirmed that BV, present early in pregnancy, is a strong risk factor for preterm delivery and spontaneous abortion. (11) How different douching products affect vaginal health has not been established yet. But, given growing concerns about the adverse health effects of douching, this practice should not be recommended. Of note, some studies have suggested that douching is associated with cervical chlamydial infection and PID. (12) However, this association was not observed in the recent study that linked douching with BV. That study, conducted among 1,200 U.S. women at high risk for STIs, found no association between douching and either gonorrhea or chlamydial infection of the cervix. (13) Similarly, in a recent randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. study conducted among 1,827 women, the risk of PID for women assigned to use a newly designed douche product was only slightly greater or no greater than for those women assigned to use a cloth towel wipe. (14) Vasectomy's Permanency per·ma·nen·cy n. Permanence: tourists who were in awe of the permanency of the great pyramids of Egypt. Noun 1. Could Cause Regret A 29-year-old man comes to the family planning clinic family planning clinic n → clínica de planificación familiar family planning clinic n → centre m de planning familial with his 25-year-old wife six months after the birth of their second child. They have been discussing their contraceptive options, and wonder whether vasectomy vasectomy, male sterilization by surgical excision of the vas deferens, the thin duct that carries sperm cells from the testicles to the prostate and the penis. would be a good choice. Struggling financially, they doubt that they will ever be able to afford more children; thus, they are considering a permanent contraceptive method. Would vasectomy be advisable in this case? Vasectomy is a good contraceptive for couples seeking a safe, effective, and permanent method. However, it may not be the best choice for a couple who, in reacting to immediate financial pressures, have not fully considered their ultimate reproductive goals. Since this couple wishes to delay fertility for an indefinite time, a long-acting method--such as the intrauterine device (IUD IUD Definition An IUD is an intrauterine device made of plastic and/or copper that is inserted into the womb (uterus) by way of the vaginal canal. One type releases a hormone (progesterone), and is replaced each year. )--might be a better option. Vasectomy involves a brief surgical procedure in which the vasa deferentia--the two tubes that carry sperm from the testicles Testicles Also called testes or gonads, they are part of the male reproductive system, and are located beneath the penis in the scrotum. Mentioned in: Testicular Cancer, Testicular Surgery, Vasectomy to the penis--are interrupted so that sperm can no longer enter the semen. Although vasectomy failure may be more common than previously thought, recent evidence from Nepal still shows pregnancy rates of only 2 percent in the first year and 4 percent in the three years following the procedure. (15) New techniques such as cautery cautery, searing or destruction of living animal tissue by use of heat or caustic chemicals. In the past, cauterization of open wounds, even those following amputation of a limb, was performed with hot irons; this served to close off the bleeding vessels as well as and fascial interposition in·ter·pose v. in·ter·posed, in·ter·pos·ing, in·ter·pos·es v.tr. 1. a. To insert or introduce between parts. b. To place (oneself) between others or things. 2. may make vasectomy even more effective. (16) Reversing a vasectomy is difficult, expensive, and has no guarantee of success, so it is important that providers counsel clients about the method's permanency. (17) To help clients make informed choices, provider-initiated counseling before vasectomy is performed should also include discussion of other long-term but reversible contraceptive options. (18) By exploring clients' feelings about ending fertility and their readiness for the procedure, providers can identify clients who have doubts or unrealistic expectations and those who have requested sterilization in response to short-term stresses or external pressure. These are all factors associated with post-operative regret. Young age at sterilization and changes in marital status are also common predictors of sterilization regret. (19) References (1) Doll H, Vessey M, Painter R. Return of fertility in nulliparous women after discontinuation of the IUD: comparison with women discontinuing other methods of contraception. Br J Obstet Gynaecol 2001;108(3):304-14; Bracken MB, Hellenbrand KG, Holford TR. Conception delay after oral contraceptive use: the effect of estrogen dose. Fertil Steril 1990;53(1):21-27; Vessey MP, Smith MA, Yeates D. Return of fertility after discontinuation of oral contraceptives: influences of age and parity. Br J Fam Plann 1986;11(4):120-24. (2) Doll. (3) World Health Organization. Improving Access to Quality Care in Family Planning. Medical Eligibility Criteria for Contraceptive Use. Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. , Switzerland: World Health Organization, 2000. (4) Spira A. Fertility following hormonal contraception. Contracept Fertil Sex 1983;11(7-8): 903-7; Linn S, Schoenbaum SC, Monson RR, et al. Delay in conception for former 'pill' users. JAMA JAMA abbr. Journal of the American Medical Association 1982;247(5):629-32; Pardthaisong T, Gray RH. The return of fertility following discontinuation of oral contraceptives in Thailand. Fertil Steril 1981;35(5):532-34; Bracken MB, Hellenbrand KG, Holford TR. Conception delay after oral contraceptive use: the effect of estrogen dose. Fertil Steril 1990;53(1):21-27. (5) Ankum WM, Mol BWJ BWJ Black Workers for Justice , Bussuyt PMM PMM Purchase Money Mortgage PMM Project Management Methodology PMM Perpetual Motion Machine PMM Permanent Magnet Motor PMM Professional Murder Music (band) PMM Precision Measuring Machine PMM Power Management Mode , et al. Contraception and the risk of ectopic pregnancy: a meta-analysis. Contraception 1995;52(6):337-41. (6) Ness RB, Hillier SL, Richter HE, et al. Why women douche and why they may or may not stop. Sex Trans Dis 2003;30(1):71-74; Oh MK, Funkhouser E, Simpson T, et el. Early onset of vaginal douching is associated with false beliefs and high-risk behavior. Sex Transm Dis 2003; 30(9):689-93. (7) Wilson TE, Uuskula A, Feldman J, et al. A case-control study of beliefs and behaviors associated with sexually transmitted disease sexually transmitted disease (STD) or venereal disease, term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, occurrence in Estonia. Sex Transm Dis 2001; 28(11):624-29. (8) Ness RB, Hillier SL, Richter HE, et al. Douching in relation to bacterial vaginosis, lactobacilli Lactobacilli, cariogenic, n a type of bacteria that may play an important role in tooth decay. It is usually found in small amounts in dental plaque. Its concentration increases with high sugar intake. , and facultative bacteria in the vagina. Obstet Gynecol 2002;100(4):765-72. (9) Royce RA, French JI, Savitz DA, et al. Vaginal douching, bacterial vaginosis, and preterm birth. Congr Epidemiol Abstr 2001;S161; Rajamanoharan S, Low N, Jones SB, et al. Bacterial vaginosis, ethnicity, and the use of genital cleaning agents: A case control study. Sex Transm Dis 1999;26(7):404-9; Fonck K, Kaul R, Keli F, et al. Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya. Sex Transm Infect 2001;77(4):271-75; Holzman C, Leventhal JM, Qiu H, et al. Factors linked to bacterial vaginosis in nonpregnant women. Am J Public Health 2001;91(10):1664-70. (10) Hawes SE, Hillier SL, Benedetti J, et al. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996;174(5):1058-63. (11) Leitich H, Bodner-Adler B, Brunbauer M, et al. Bacterial vaginosis as a risk factor for preterm delivery: a meta-analysis. Am J Obstet Gynecol 2003;189(1):139-47. (12) Stergachis A, Scholes D, Heidrich FE, et al. Selective screening for Chlamydia trachomatis infection in a primary care population of women. Am J Epidemiol 1993;138(3):143-53; Scholes D, Stergachis A, Ichikawa LE, et al. Vaginal douching as a risk factor for cervical Chlamydia trachomatis infection. Obstet Gynecol 1998;91(6):993-97; Wolner-Hanssen P, Eschenbach DA, Paavonen J, et al. Association between vaginal douching and acute pelvic inflammatory disease. JAMA 1990;263(14):1936-41; Beck-Sague CM, Farshy CE, Jackson TK, et al. Detection of Chlamydia trachomatis cervical infection by urine tests among adolescents clinics. J Adolesc Health 1998;22(3):197-204. (13) Ness, Hillier, Richter, 2002; Ness R, Richter H, Stamm C, et al. Does douching elevate the risk for incident gonococcal/chlamydial cervicitis cervicitis Inflammation of the cervix of the uterus, caused by infection or irritation. It is most common during the years of menstruation. Cervicitis can be acute or chronic and may worsen during pregnancy. It does not cause pain but may lead to polyps. and pelvic inflammatory disease (PID)? The 2003 International Society for Sexually Transmitted Diseases Sexually transmitted diseases Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely Research Congress, Ottawa, Canada, July 27-30, 2003. (14) Rothman KJ, Funch DP, Alfredson T, et al. Randomized field trial of vaginal douching, pelvic inflammatory disease and pregnancy. Epidemiology 2003;14(3):340-48. (15) Nazerali H, Thapa S, Hays M, et al. Vasectomy effectiveness in Nepal: a retrospective study. Contraception 2003;67(5):397-401. (16) Chen-Mok M, Bangdiwala SI, Dominik R, et al. Termination of a randomized controlled trial A randomized controlled trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. RCTs are considered the most reliable form of scientific evidence because it eliminates all forms of spurious causality. of two vasectomy techniques. Control Clin Trials 2003;24(1):78-84; Sokal D, Irsula B, Chen M, et al. A comparison of vas occlusion techniques: cautery vs. ligation ligation /li·ga·tion/ (li-ga´shun) the application of a ligature. tubal ligation sterilization of the female by constricting, severing, or crushing the uterine tubes. and excision with fascial interposition. Contraception 2003;68(2): 143 [abstract #14]. (17) Sandlow JI, Westefeld JS, Maples MR, et al. Psychological correlates of vasectomy. Fertil Steril 75(3):544-48; Sterilization. ACOG ACOG American College of Obstetricians and Gynecologists. ACOG American College of Obstetricians & Gynecologists technical bulletin. Int J Gynaecol Obstet 1996; 53(3):281-88. (18) Burkman RT. Contraceptive sterilization: trends, options, and surprising new data. Dialogues Contracept 1997;5(2):5-7. (19) EngenderHealth. Contraceptive Sterilization: Global Issues and Trends. (New York, NY: EngenderHealth, 2002)8,126-28. |
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