Actinomyces in vaginal smears

Canadian Contraception Consensus (Part 2 of 4).

The vaginal flora of healthy adult women of reproductive age group constitutes predominantly Lactobacilli which inhibits the growth of other microorganisms (by maintaining acidic pH). The vaginal microflora is altered in favour of anaerobes in women using Intra Uterine Contraceptive Device (IUCD). Also, it can cause morphologic changes in both squamous and endocervical columnar cells. Similarly, the prevalence of vaginal lactobacilli is reduced among women using diaphragm-spermicide or spermicide alone. To study the effects of different contraceptive methods on cervical cytology and vaginal flora. Two years prospective study included 120 women of reproductive age group using barrier, tubal ligation, IUCDs, Oral Contraceptive Pills (OCPs) and injectable methods of contraception and a control group including 60 women not using any contraceptive. Cervical and vaginal smears were obtained. Cervical smears were reported using the Bethesda system and Gram stained vaginal smears were scored using Nugent scoring. SPSS (Statistical Package for the Social Sciences) software for Windows Version 19.0 and test of significance applied was Chi-square test. The most common contraception used was barrier (68.3%) followed by tubal ligation (14.2%), IUCD (9.2%), OCPs (6.6%) and injectable (1.7%). The presenting complaints were pain lower abdomen (46.7%) followed by menstrual complaints (22.5%). Epithelium showed reactive changes (45%) followed by metaplasia (25%), koilocytotic change (5%), cytolytic effect (5%) and satellitosis (4.2%). Women showed normal flora in 51.7%, altered in 30% and bacterial vaginosis in 18.3%. Cervico-vaginal changes were more frequent in contraceptive users as compared to the control group.

The prevalence of Actinomyces-like organisms in cervicovaginal smears of 2,347 Brazilian women, including 151 (6.4%) intrauterine devices (IUD) users for at least six months and as controls 2,196 (93.6%) non-wearers of similar age using hormonal, barrier, or other contraceptive methods or none, living in Salvador, Bahia, has been investigated. Cervical smears were stained by the Papanicolaou method for the microscopic examination of Actinomyces-like organisms. The relationship between Actinomyces-like organisms infection and contraceptive methods, age and number of sexual partners has been analyzed. The result showed that the overall detection rate of Actinomyces-like organisms in 2,347 women was 0.17%. The detection rates in IUD users and non-users were 1.32% and 0.09% respectively. The prevalence rate (1.32/0.09) was of 14.7, indicating a risk fourteen times greater for the presence of Actinomyces-like organisms in cervical smears of IUD users. No contraceptive methods were used by 43% of the patients. Most patients were between 21 and 30 years old, having 3-5 sexual partners.

Post abortion contraception and its effect on repeat abortions in Auckland, New Zealand

Introduction: Intra Uterine Device (IUD) and Depo-medroxy Progesterone Acetate (DMPA) are effective contraceptive methods that their usage may not be continued due to the occurrence of side effects. This study was performed with aim to evaluate the weight changes in DMPA compared to IUD users. Method: This retrospective cohort study was performed in 2017 on 150 IUD consumers and 150 DMPA users. Samples were collected from 34 health centers in Tehran by simple random sampling. Baseline weight) W1), 6 months (W2) and then 12 to 18 months (W3) after IUD and DMPA usage was measured. Data were analyzed by SPSS software (version 20). Independent t-test was used to compare the weight difference between the two time stages and repeated measures test was used in three time stages. p < 0.05 was considered statistically significant. Results: Baseline weight in IUD group was significantly higher than DMPA group (P=0.003). After 6 months, weight gain reversed in two groups and mean difference between W2-W1 showed significant increases in DMPA group in comparison of IUD users (P˂0.001). Also, 12-18 months later, mean difference between W3-W1 indicated significant weight gain in DMPA users than IUD consumers (P˂0.001). Weight gain during 12-18 months in DMPA users was about 2 Kg. Repeated measure analysis showed significant differences between two groups during time (P˂0.001). DMPA usage (P= 0.0001, B=2.39) and Cesarean delivery (P= 0.029, B=0.72) were two significant factors on weight gain. Conclusion: Weight gain, albeit small is one of the complications of DMPA usage that should be considered.

Characteristics of users of intrauterine devices and other reversible contraceptive methods in the United States

An intrauterine device (IUD), used by millions of women worldwide, is one of the most efficient methods of contraception. The goal of our study was to compare a group of women using the IUD to a control group. The survey included 236 women of fertile age from gynaecological practices in the area of Split and Dalmatia County, Croatia. The subjects were divided into two groups: IUD users and a control group (women not using any contraception methods). Sampling, transportation, sample processing in the laboratory and interpretation of results were conducted using standard microbiological procedures and methods. Opportunistic bacteria were statistically more frequently isolated among IUD users (P < 0.001). The most frequently isolated bacteria in both groups were Escherichia coli and Ureaplasma urealyticum with significantly higher rates in IUD users (P < 0.001). Both colonization and infection had higher rates in IUD users (P < 0.001). There were no significant differences either in the frequency of bacteria isolation regarding different IUD types (P = 0.93), or in relation to duration of IUD use (P = 0.67). Based on the data in our study IUD users have an increased chance of developing a cervical infection caused by the bacteria Escherichia coli and Ureaplasma urealyticum. Therefore, before IUD insertion women should be screened and treated for asymptomatic vaginal or cervical infections to prevent possible serious IUD-associated infections.

The aim of this study was to compare the frequency of asymptomatic bacteriuria in women who use intrauterine devices (IUDs) as a contraceptive method with subjects who use tubal ligation (TL). A cohort study was conducted on women who were candidates for IUD insertion or TL (control). The patients were followed for 3 months, and urine cultures were assessed for bacteriuria at the end of the study. Overall, 131 women (mean age, 31.9 +/- 4.25 years) in the IUD group and 78 (mean age, 32.1 +/- 4.0 years) in the control group were studied. The parity score was 2 or more in 72% of the women in the IUD group and in 74% of the controls. The average intercourse frequency was twice per week in 82% of IUD users and 80% of controls. Fifty-seven percent of the women in the IUD group and 55% of the women in the control group had graduated secondary school (high school). Asymptomatic bacteriuria was detected in 13 IUD users (9.9%) and in 1 woman (1.3%) in the control group (risk ratio = 7.74, confidence interval: 1.03 to 58.03; P = .019). The detected microorganism in the urine culture was Escherichia coli in 12 IUD users and in 1 patient in control group. Klebsiella was found in 1 IUD user. Use of an IUD is a risk factor for urinary tract infection and should be considered, especially in women with recurrent urinary tract infections.

IntroductionDespite reliable evidence of the safety and effectiveness of intrauterine devices (IUDs), this contraceptive method remains under-utilised in many countries due to persistent fears that it causes pelvic infection. The...

The comparative trial of TCu 380A IUD and progesterone-releasing vaginal ring used by lactating women

To examine the effect of hormonal contraception on sexual desire. We performed a cross-sectional analysis of 1,938 of the 9,256 participants enrolled in the Contraceptive CHOICE Project. This subset included participants enrolled between April and September 2011 who completed a baseline and 6-month telephone survey. Multivariable logistic regression was used to assess the association between contraceptive method and report of lacking interest in sex controlling for potential confounding variables. More than 1 in 5 participants (23.9%) reported lacking interest in sex at 6 months after initiating a new contraceptive method. Of 262 copper intrauterine device (IUD) users (referent group), 18.3% reported lacking interest in sex. Our primary outcome was more prevalent in women who were young (younger than 18 years: adjusted odds ratio [OR] 2.04), black (adjusted OR 1.78), and married or living with a partner (adjusted OR 1.82). Compared with copper IUD users, participants using depot medroxyprogesterone (adjusted OR 2.61, 95% confidence interval [CI] 1.47-4.61), the vaginal ring (adjusted OR 2.53, 95% CI 1.37-4.69), and the implant (adjusted OR 1.60, 95% CI 1.03-2.49) more commonly reported lack of interest in sex. We found no association between use of the hormonal IUD, oral contraceptive pill, and patch and lack of interest in sex. CHOICE participants using depot medroxyprogesterone acetate, the contraceptive ring, and implant were more likely to report a lack of interest in sex compared with copper IUD users. Future research should confirm these findings and their possible physiologic basis. Clinicians should be reassured that most women do not experience a reduced sex drive with the use of most contraceptive methods.

Background: Each year, the current level of modern contraceptive use averts 188 million unintended pregnancies, which in turn results in 112 million fewer abortions. Of the 867 million women in the developing world who are sexually active and want to avoid becoming pregnant, about 222 million of them have an unmet need for modern contraception. Objectives: To identify the determinant factors for utilization of intra uterine contraceptive device among women visiting primary health care facilities in Mekelle city. Method: The facility based unmatched case-control study design was conducted among 234 women (78 cases and 156 controls). Data was collected by questionnaire. Data entry and cleaning was done using EPI- Info version 5.3.1 and analysis done using SPSS version 20. The study used a logistic regression model to identify the association between independent variables with Intra Uterine Contraceptive Device. Result: Marital status ([AOR (95%CI) =8.59(2.60 - 28.43)], number of pregnancies (AOR (95%) CI=5.69(1.020-31.802), and number of alive children [AOR (95%CI) =3.5 (1.03-11.9) had a significant association with the use of Intra Uterine Contraceptive Device. Other determinants found to have significant association includes awareness about Intra Uterine Contraceptive Device, visual exposure to Intra Uterine Contraceptive Device, and participants told about the availability of health care provider able to insert Intra Uterine Contraceptive Device. Conclusion: The study identified marital status, gravidity, number of alive children, information on availability of IUCD provider and visual exposure to IUCD and awareness to Intra Uterine Contraceptive Device as major determinants for use of Intra Uterine Contraceptive Device. Thus, stake holders like Tigray Regional health bureau, health care facilities and others stakeholder should work to strength in service quality to increase the utilization of this effective and safe modern contraceptive method IUCD. Key word: Case control, Determinant factors, Intra Uterine Contraceptive Device, Logistic regression

The intrauterine device (IUD) is an effective and reversible form of birth control. The term "postpartum family planning" (PPFP) refers to measures taken during the first year after giving birth to reduce the likelihood of unwanted pregnancies and those with very close spacing. To evaluate the safety profile and efficacy of intrapartum and post puerperium IUCD so that It's a viable option for those seeking a healthy family planning strategy. This prospective cohort study was conducted at the tertiary care hospital at the Gynecology and Obstetrics department at Al-Azhar University Hospital of new Damietta and family planning department of Damanhur National Medical Institute (DMNI) from March 2023 till November 2023 and performed on a total of 304 patients who recruited from outpatient clinic and needed to use the copper IUD for post puerperium contraception. Post-placental IUD insertion as an alternative to delayed IUD insertion is strongly recommended in patients with long-term reversible contraception. Applications of an intrapartum IUD is a safe, effective, and convenient contraceptive method.

Stress, a major risk factor for mental health problems, is influenced by hormonal fluctuations from the menstrual cycle and hormonal oral contraceptives (OC). Despite widespread use, the impact of hormonal intrauterine devices (IUDs) on stress is limited to one study. This study examines psychoendocrine stress responses in women using IUDs, OCs and women with a natural, regular menstrual cycle (NC) to better understand how endogenous and exogenous hormones influence stress. Using a repeated-measures design, we investigated stress responses in IUD and OC users and NC women. The Maastricht Acute Stress Task and its control task were applied twice within 4 months to assess subjective, endocrine and physiological stress correlates. Detailed endogenous and exogenous hormonal profiles were obtained, and women completed a 7-day diary (via ecological momentary assessment) after each appointment. Based on subjective, physiological and cortisol responses, stress induction was successful in all groups. IUD users reported higher subjective stress, negative affect and anxiety and lower positive affect compared to NC women. OC users exhibited a blunted cortisol response and higher heart rate but reported less acute stress and negative emotions than the other groups in the 7-day diary. Oestradiol and progesterone were suppressed in OC and IUD users compared with NC women. Progesterone, testosterone and oestradiol were differently associated with skin conductance, socio-emotional stress and negative affect. IUD and OC use distinctly affect stress response, possibly because of their diverging metabolic pathways and hormone levels. IUD users showed higher emotional reactivity to stress in both lab and daily life, while OCs influenced physiological correlates. These findings highlight that exogenous hormone administration, previously thought to have limited systemic effects, affects women's psychological well-being, underscoring the need for further research into stress-related disorders among women using hormonal contraceptives.

Methamphetamine (Meth) use disorder continues to be highly prevalent worldwide. Meth users have higher impulsivity and brain abnormalities that may be different between current and past Meth users. The current study assessed impulsivity and depressive symptoms in 94 participants (27 current Meth users, 32 past Meth users and 35 non-drug user controls). Additionally, brain microstructure was assessed using diffusion tensor imaging (DTI); fractional anisotropy (FA) and mean diffusivity (MD) were assessed in the striatum, and FA, MD, radial and axial diffusivity were quantified in five white matter structures using DtiStudio.Across the three subject groups, current users had the highest self-reported impulsivity scores, while both Meth user groups had larger striatal structures than the controls. Past Meth users had the highest FA and lowest MD in the striatum, which is likely due to greater magnetic susceptibility from higher iron content and greater dendritic spine density. In white matter tracts, current Meth users had higher AD than past users, indicating greater water diffusion along the axons, and suggesting inflammation with axonal swelling. In contrast, past users had the lowest AD, indicating more restricted diffusion, which might have resulted from reactive gliosis. Although current Meth users had greater impulsivity than past users, the brain microstructural abnormalities showed differences that may reflect different stages of neuroinflammation or iron-induced neurodegeneration. Combining current and past Meth users may lead to greater variability in studies of Meth users. Longitudinal studies are needed to further evaluate the relationship between recency of Meth use and brain microstructure.