Sexual and reproductive risk factors for invasive squamous cell cervical cancer

A case-control study of 418 women with invasive squamous cell cervical cancer and 704 population controls enabled evaluation of risk factors for this relatively rare cancer. Consistent with an infectious etiology was a pronounced effect of multiple sexual partners, with those reporting 10 or more partners being at a significant threefold excess risk. Early first intercourse also was associated with some residual effect on risk, although the relationship was not linear, nor the explanation readily apparent. Those with multiple births were at significantly elevated risks, even after adjustment for sexual parameters. Menstrual and hygiene factors, including use of tampons, vaginal deodorants, and douching products, were not consistently related to risk. Histories of specific infections involving the genital tract were poor predictors of risk, since few women provided positive responses, but those with nonspecific diseases were at a significant twofold excess risk.

Human axillary secretions influence women's menstrual cycles: the role of donor extract from men

Menstrual cycle lengths of 29.5 +/- 3 days ("normal cycles") are more frequent in women who have weekly coital activity than in women who do not. In order to investigate potential mechanisms controlling the association between heterosexual activity and menstrual cycle length, and in light of the nonhuman literature suggesting that a chemical signal from males could be involved, menstrual cycle lengths of nulliparous women were evaluated following regular application of axillary extract from donor males. Compared to controls receiving only blank/ethanol applications, women receiving axillary extracts for 12.5 to 14.5 weeks showed the following changes: a reduced incidence in variability of cycle lengths; and a reduced proportion of aberrant length cycles.

Human axillary secretions influence women's menstrual cycles: the role of donor extract of females

Menstrual synchrony in human females has previously been demonstrated among women attending a predominantly female university as well as among women attending coeducational universities. In each of these studies, women who spent the most time together were most likely to show the menstrual synchrony. In this experiment, the possibility that substances in axillary secretions might mediate this effect was tested using a prospective, double-blind research design and a combined axillary extract from a group of female donors. Female subjects who reported themselves to have normal (29.5 +/- 3 day) cycles were exposed to the axillary extracts or blank/ethanol for 10 to 13 weeks. Recipients of the axillary extracts showed a significant reduction in "days' difference in menses onset" relative to the donor cycle, no change was evident for recipients of blank/ethanol. These results demonstrate that constituents from the axillary region of donor females can shift the time of menstrual onset of another group to conform with the donors' cycle and that this effect can occur even in the absence of social contact.

Long-term use of oral contraceptives and risk of invasive cervical cancer

To evaluate the relationship between use of oral contraceptives and risk of invasive cervical cancer, a case-control study involving 479 patients and 789 population controls was undertaken in 5 geographic regions of the US. Initially, the relationship was obscured by confounding variables, particularly the interval since last Pap smear. Control for this variable as well as for sexual and sociodemographic factors revealed an RR of 1.5 overall, with long-term users (5 or more years) being at a 2-fold higher risk than non-users. Pill associations prevailed for both adenocarcinomas and squamous-cell tumors, and risks were highest for those using pills containing high estrogen potencies. In addition, there was some evidence that pill associations were most pronounced among women who had never used barrier methods of contraception or who had histories of genital infections, suggesting that oral contraceptives may act as co-carcinogens with transmissible agents. Our findings provide further evidence that long-term use of oral contraceptives may have a carcinogenic effect on cervical epithelium, but emphasize the need for careful evaluation of confounding influences.

Sexual behavior and steroid levels among gynecologically mature premenopausal women

Twenty-seven gynecologically mature young women who participated in a 14-week study prospectively recorded daily sexual behavior and basal body temperature data. In addition, they supplied plasma three times during the last cycle of participation. Plasma was analyzed for estradiol (E2), testosterone (T), and progesterone (P) by radioimmunoassay. The levels of circulating sex steroid hormones during the luteal phase were examined in relation to measures of menstrual cycle length, sexual frequency, and coital total. The results indicated the following: (1) women who had weekly sex with men had higher levels of estrogen than women who did not; (2) total amount of coital behavior was not related to any of the hormones assayed; (3) neither T nor P were distinguished by the consistency of sexual behavior or by coital total; and (4) women with aberrant-length cycles tended to have lower levels of E2. Thus, E2 consistently showed relationships to sexual behavior and cycle length, whereas P and T did not.

Sexual behavior frequency and biphasic ovulatory type menstrual cycles

College students whose menarche had occurred 7 years previously, prospectively recorded menstrual and sexual behavior history for 14 weeks as well as basal body temperatures. Regular weekly coital activity associates with the highest incidence of fertile type cycles in this sample of young women as follows: (1) Regular weekly heterosexual behavior was associated with 29.5 +/- 3 day menstrual cycle length. Less frequent sexual activity (sporadic) and celibacy were associated with an increased frequency of aberrantly short and long cycle lengths. (2) Either of two heterosexual behaviors (coitus and/or genital stimulation by a man) were behaviors which were adequate as associates of 29.5 +/- 3 day cycles. (3) Self-stimulation (masturbation to orgasm) was inadequate as an associate of the above-described pattern of menstrual cyclicity. (4) Women with regular weekly coital activity had the highest incidence (90%) of fertile type basal body temperature (BBT) rhythms. Sporadically active women had the next highest incidence (55%) of fertile type BBT rhythms. Celibate women had the lowest incidence (44%) of fertile type BBT's.

Urban black adolescents who obtain contraceptive services before or after their first pregnancy. Psychosocial factors and contraceptive use

This paper compares three groups of urban black teenagers at their enrollment in a contraceptive program and at a one-year follow-up. The groups comprise 263 never-pregnant, postabortion, and postpartum teens ages less than or equal to 17 years at their initial family planning visit. Self-report questionnaires examined attitudes and information about pregnancy and contraceptive use, sources of contraceptive information, sexual and contraceptive experience, family and partner support for contraceptive use, and demographic background factors. Emotional, personality, and psychosocial factors were assessed with standard measures. Age, partner relationships, and items relating to the mother's communication about contraception and pregnancy were significant variables in the outcome of never-pregnant and delivery of pregnancy. Self-esteem was highest in the never-pregnant group. Personality factors, emotional distress, and social adjustment scores were in the normal ranges and did not differ between the groups. Contraceptive use at follow-up was most consistent in the never-pregnant group. These data suggest the need for earlier family involvement in educating and guiding teens together with access to contraceptive services in preventing unwanted adolescent pregnancies.

Intranasal administration of RA 27/3 rubella virus vaccine. A clinical trial in young adults

Of the vaccines and inoculation routes studied for the prevention of rubella, only the RA27/3 vaccine, administered intranasally, has the ability to stimulate a humoral antibody pattern very similar to that evoked by wild rubella infection. Because information about intranasal (IN) vaccination has only been obtained using the RA 27/3 vaccine manufactured in Europe, we conducted a trial of IN vaccination among young adults using Meruvax II which is manufactured in the USA. Of 597 family planning clinic patients screened in 1980-1981, 71 (11.9%) were susceptible to rubella; forty-one subjects were randomly assigned to receive IN or subcutaneous (SC) vaccine. All 20 SC vaccinees, but only 8/21 (38%) IN vaccinees, were successfully immunized. We conclude that standard doses of commercially available RA 27/3 vaccine are insufficient for IN immunization against rubella. Additional study of the dose-response relationship is needed if IN vaccination is to be recommended.

Complications of female sterilization: immediate and delayed

Surgical sterilization in women has changed dramatically over the past 20 years. The development of laparoscopy and minilaparotomy have made the procedure readily available even in developing countries. In the United States, changing social values and changes in hospital regulations have done as much as technology to account for the tremendous increases in the number of women undergoing sterilization. Improved sterilization procedures have resulted in lower costs for sterilization and lowered morbidity and mortality rates. Hysterectomy for sterilization alone carries unacceptable morbidity and mortality rates. Originally, laparoscopic techniques utilized unipolar cautery. However, bowel burns, a rare but serious complication, were reported, and this led to newer techniques. These techniques, using bands, clips, and bipolar cautery, have gained increasing popularity and have eliminated many of the serious complications of female sterilization. Historically, there has been concern that tubal sterilization by any method produces, in significant numbers of patients, the subsequent gynecologic and psychologic problems called "post-tubal ligation syndrome." A review of earlier literature indicates that many of these studies have serious methodologic problems, including recall bias, inappropriate control groups, failure to elicit prior history of gynecologic or psychologic problems, and failure to account for the use of oral contraceptives or IUDs. More recent large prospective epidemiologic studies that have controlled for prior gynecologic problems and contraceptive usage have failed to show increased incidence of gynecologic sequelae in large numbers of women. However, there are some data to support the concept that in certain individuals, sterilization may result in disruption of ovarian blood or nerve supply, producing gynecologic sequelae. Additional data from these ongoing large-scale studies and others should help to elucidate this problem in the future. Pregnancy after sterilization (even excluding pregnancies present at the time of the procedure) is more common the first year after the procedure with the risk decreasing in subsequent years.(ABSTRACT TRUNCATED AT 400 WORDS)

Mild cervical dysplasia. Experience in a family planning clinic

To evaluate mild cervical dysplasia, the results of Papanicolaou smears were reviewed for a six-month period in an inner-city family planning program. Papanicolaou smear evidence of mild dysplasia was consistent with the biopsy diagnosis in most cases. A single Papanicolaou smear is not a reliable indication of condylomata, nor is a single normal Papanicolaou smear in this setting completely reassuring. Persistent mild dysplasia is an indicator of high risk for cervical dysplasia and cervical infection. Aggressive initial cervical surgery is not indicated, but close follow-up is required.

Physiologic and psychologic profiles in a survey of women runners

The purpose of the present study is to report physiologic and psychologic factors in a survey of women runners. Psychologic factors were used in an investigation of differences in perceived emotional distress within a group of women runners. The psychologic information was compared with the results of two groups of infertility patients and a group of fertile control subjects. Among the physiologic factors, there was a significant difference in the mean weight and the height/weight ratio between amenorrheic and regularly cycling runners (P less than 0.001) and amenorrheic runners and runners with irregular cycles (P less than 0.01). The psychologic data showed no difference between runners and fertile control subjects. When runners were divided according to menstrual intervals or miles run per week, there were differences in perceived emotional distress.

Self-reports of emotional distress in a sample of urban black high school students

Emotional distress as assessed by the self-report Hopkins Symptom Checklist (HSCL) was examined in a sample of 607 urban black high school students aged 15–18. These adolescents reported high distress primarily about feelings of disadvantage, volatile anger, interpersonal sensitivity and loneliness. Females were significantly more likely than males to indicate emotional distress, although several of the leading distress items were endorsed equally by both groups. Male and female scores across the HSCL factors differed in degree rather than form. The great majority of these adolescents didnotreport significant emotional distress. These data provide a base from a non-clinical sample for comparison with other adolescent groups where emotional distress may play a role.

Never-pregnant adolescents and family planning programs: contraception, continuation, and pregnancy risk

Four hundred urban Black teenagers enrolling in a family planning program before pregnancies occurred were followed for one year to assess factors influencing continuation of contraceptive use. Over half the follow-up respondents claimed to always use contraception. Program discontinuers were less likely to use contraception, but nearly half had no sex activity when contacted at follow-up. Sex frequency reported in the sample was low. Background factors of age, grade, and household were associated with contraceptive use and with pregnancy. Girls who had pregnancies were significantly more likely to live in a single-parent household, to have sex more frequently, and to have stated at enrollment that they wanted their first child before age 20. A majority of the sample, nearly all of whom obtained oral contraception, did not know at the one year follow-up how to use any alternative methods for preventing conception, hence many would again be at risk of pregnancy when sex activity resumed.

Volatiles of exogenous origin from the human oral cavity

The volatiles found in the headspace above male and female saliva were examined by combined gas chromatography--mass spectrometry. This had led to the identification of a number of constituents of exogenous origin. The most likely source of these products are atmospheric and water pollutants as well as food stuffs and cosmetic products. Volatiles from saliva represent a potential medium for the detection of reproductive states as well as local and systemic diseases. Consequently, knowledge of compounds not arising from the body's metabolic process if important to prevent their identification as anomalous metabolites.

IUD use and unexplained vaginal bleeding

The Women's Health Study, a concurrent case-control study at 16 hospitals in 9 cities across the United States, examined the relationship between intrauterine contraceptive device (IUD) use and unexplained vaginal bleeding severe enough to require hospitalization. There were 545 eligible cases and 3453 controls. Analysis of all patients showed no association between IUD use and hospitalization for unexplained vaginal bleeding. When cases were analyzed separately with regard to prior episodes of vaginal bleeding, those patients with a history of vaginal bleeding had a decreased risk of hospitalization. Among cases, no significant differences between IUD users and nonusers were found in rates of anesthesia, blood transfusion, dilatation and curettage, or hysterectomy. The significant decreased risk between current IUD use (within 3 months before the study) and hospitalization for unexplained vaginal bleeding among women with a history of vaginal bleeding may reflect selective nonprescription for IUDs related to past episodes of vaginal bleeding.

Endocrine, cardiovascular, and psychological correlated of olfactory sensitivity changes during the human menstrual cycle

Signal detection measures olfactory sensitivity (d') and measures of blood pressure, heart rate, body temperature, nasal airflow, and respiration rate were repeatedly established within approximately 2.5-hr test sessions held every other day across 17 menstrual cycles of women not taking oral contraceptives, 6 menstrual cycles of women taking oral contraceptives, and 6 equivalent time periods of three men. In addition, radioimmunoassay-determined serum levels of luteinizing hormone, follicle stimulating hormone, estrone, estradiol, progesterone, and testosterone, as well as responses to the Moos Menstrual Distress Questionnaire (MDQ), were established daily or bidaily throughout the study periods. Peaks in olfactory sensitivity were noted during the second half of menses, midcycle, and midluteally in women taking and in women not taking oral contraceptives. The lack of correlation between the fluctuations in d' and the circulating hormone levels in the group using oral contraceptives suggests factors other than gonadal hormones were responsible for these changes. Significant fluctuations were also noted across the cycle phases of the normally cycling women for all the hormones examined, as well as for body temperature, nasal airflow, and the MDZ Water Retention and Pain Scales. In the oral contraceptive group, very small but statistically significant changes were observed across the cycle in body temperature and in circulating levels of luteinizing hormone and estrone. Interrelations between a number of the variables were noted both within and across the test periods in all three subject groups. The results are discussed in relation to fluctuations reported in a number of sensory systems during the menstrual cycle.

Adolescent contraceptive use: comparisons of male and female attitudes and information

Information and attitudes about contraception and pregnancy were assessed with a self-administered questionnaire in a sample of urban Black teenagers. Data were obtained from 607 male and female students in high school health classes and a demographically similar group of 123 never-pregnant teenage women in a family planning clinic who had not attended these classes. Males were less likely to recognize the risk of pregnancy, had less information about contraceptives, and fewer attitudes that supported contraceptive use than females who participated in the same shool health classes. More males than females indicated that school classes had been the main source of contraceptive information. Teenage women in the family planning clinic did not differ from the high school females in attitudes about contraceptives, but the school group had somewhat more contraceptive information. The female school group was more likely to have discussed contraception with parents, obtained more contraception information from their mothers, and discussed contraception more with male friends than the teenagers who requested contraceptives at the family planning clinic.

Emotional distress patterns among women having first or repeat abortions

Thirty-five percent of a sample of 413 women undergoing first-trimester abortions were repeating abortions. All patients rated their emotional symptoms on an SCL-90 scale and completed a brief demographic questionnaire. Preabortion and postabortion emotional distress factors and associated demographic characteristics were compared for women having first and those undergoing repeat abortions. Elevated distress levels were similar in both groups prior to abortion procedures, particularly depression, anxiety, and somatization. After abortion, repeat aborters continued to have significantly higher emotional distress scores in dimensions relating to interpersonal relationships. The variables that discriminated most between first and repeat abortion groups were number of living children, race, and phobic anxiety.

Alterations in the organic compounds of vaginal secretions caused by sexual arousal

The low-molecular weight organic constituents of human vaginal secretions from normally cycling subjects were analyzed both before and after sexual stimulation. Gas chromatography and combined gas chromatography-mass spectrometry were employed in the analyses of the secretions. Consistent increases were noted for a number of the lipid constituents of the secretions, suggesting that they are derived at least in part from the plasma and transude into the vaginal lumen during arousal. In addition, the increases in the concentrations of glycerol and stearic acid with respect to baseline levels were significant (P is equal to and less than 0.05). Compounds which are produced intravaginally appear to decrease in concentration during the arousal interval because of dilution by the transudate. No consistent qualitative changes were noted in the secretion.