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User Controlled Implantable Contraception: Baby, You Can Turn Me On

26 Jan, 16 | by shaworth

Over the course of this month, there has been quite a bit of press attention given to the Bimek SLV, a device purporting to be the first attempt to achieve user-reversible, surgical, male contraception.

Men have, for a considerable amount of time, been left behind in the field of contraception. Women have both hormonal and non-hormonal methods of which both short and long acting are available. Men, on the other hand, have the dichotomy of condoms or vasectomy, with no halfway option between instantly reversible and surgical permanence. Unsurprisingly, those who wish permanent contraception sometimes wish to have the procedure reversed, which is not guaranteed to be successful.

On the face of it, the Bimek SLV seems to be a good idea. Implanted into the vas deferens, the device contains an occluding valve, which can be changed from an open to a closed position by the user pressing a switch attached to it. However, there were some worrying gaps in the press reports about the device: what were its success rates so far, for example? It transpires that the device is beginning Phase I trials soon, and that the only person in which the device has been implanted is the inventor himself.

Further review of the product information reveals that so far, no animal testing has been performed for the device at all, and this is revealed as a selling point, so that the device can be used by vegan men. Yet despite the lack of objective evidence, the product literature, and website, contain references to the apparent safety of the device, and that the procedure is “low risk”. It’s easier to find information on investing in the project that it is to find information on trial participation.

Bimek himself is not a medical professional, and has brought the device to preliminary trials under his own steam. He is seeking further funding in order to proceed, hence the attempt to drum up media support. In the age of crowd-funding and peer-to-peer lending, traditional methods of research and development are being bypassed. Perhaps this is of value, and perhaps the drive to implantable technology without animal testing will revolutionise healthcare research as we known it, but given that earlier this week a Phase I trial in France resulted in the death of a participant and the hospitalisation of several others, perhaps Bimek would do well to tone down their claims of safety, in the face of scant supporting evidence.

Ultimately, for the time being, what the Bimek SLV has done well to showcase, is that sensationalist reporting without a full grasp of the facts, remains depressingly popular as a way of communicating new science developments to the masses. Here’s hoping that time, and further research, means that it can prove its claims.

Constructing Information Requests: Making The New Normal

1 Jan, 16 | by shaworth

When we collect information from our patients, we ask, often unthinkingly, for quite a lot of it. Some of it has obvious value to our consultations: how long has it been there, and where does it itch? Some of it has additional use in research, and in auditing our practice. Today, we’re going to take a look at how we ask for some of these basic demographics and what it says about our perception of society, and of our patients’ lives, when we do.

In the UK, we classify infants at birth by many characteristics, and sex is one of those. This is obvious to anyone who has tried to pick a gift, or a card, to congratulate new parents: we, as a society as a whole, treat sex as a dichotomy of male or female. This is referred to as the gender binary. If this were a fundamental truth, it makes collecting information regarding sex to be as simple as checking a box for either, and in turn, stored in a binary form digitally; however, the truth is more complex. Many countries allow for the legal recognition of a third gender, and this is a state welcomed by people who do not identify with either, or with aspects of both. This may due to an intersex condition diagnosed at birth, or a subjective lack of affiliation with either sex despite sexual organs and characteristics of one sex. One can argue that the reasons are academic, as it is the end state of requiring an option outside of the gender binary that matters.

For many people, the definition of the word “gender” is roughly interchangeable with “sex”, and both terms are taken to mean the reproductive organs existing within a person and associated secondary sexual characteristics; however, some people and organisations define gender as being the abstract social roles based on sex, and diverging the definition of “sex” to be the definition stated above, pertaining to sexual organs and characteristics. In this post, we’ll be using the latter.

One organisation which collects vast amounts of personal data: Facebook, has come into focus as it demonstrates how to handle information outside of the gender binary in an attempt to sensitively reflect the real life experiences of users; however, as a recent paper reviewing Facebook’s handling of this information shows, the way that Facebook deals with the information regarding sex is not new, but over time has been changed by user pressure. When Facebook began to collect user data on sex, it allowed options for male, female or other and subsequently used this information to provide gender based pronouns describing user activity. Over time, the use of “they” as a gender neutral pronoun created some translation difficulties and was derided as grammatically incorrect, so an attempt was made to force users to choose a pronoun on the basis of sex, and this overrode the original sex identity e.g. if you chose a female pronoun, your choice of “other” was changed to female.

Users self-organised to protest this, driving change by producing guides on amending the source code of the pages to allow reversion to the original “other” state, raising the question why this needed changed in the first place if the choice was not removed from the database itself. Over time, Facebook amended its policy and in 2014, allowed limited use of gender neutral pronouns and a greater range of non-binary identities; although the choice of a gender specific pronoun reverts the stored identity to a binary one.

The multiple options presented when signing up for Facebook with relation to sex is potentially confusing and, whilst presenting many options, remains restrictive if your choice is not offered, raising the question if there is a better way of working when requesting information. Web designer Sarah Dopp, who wrote an open letter to web designers and developers regarding this in 2010, and reminding us that the dangers of the gender binary, and the promotion of it as normal at the expense of all else, marginalises those who already feel marginalised, something that we, as healthcare professionals, should be striving to avoid.

So, the next time we sit down to ask a patient, or client, for their gender, we should take the time to reflect that whilst this may be a single question in a page of several, and perhaps just a tick in a box to us, that for them it may be a huge part of their identity that we are refusing to acknowledge through ignorance, and souring our relationship with them before we start.

For those of us who are doctors, we have benefited from the privilege of a free gender-neutral pronoun as a by-product of completion of a degree. If it’s important to us to use this title as an expression of professional identity, we could at least extend the courtesy to our patients to express, fundamentally, who they are.

Nominations open for the UK Sexual Health Awards 2014

30 Sep, 13 | by shellraine, e-Media Editor

The UK Sexual Health Awards recognise outstanding work in and around sexual health. If you know of any incredible people, projects, services, campaigns, storyline or article – we want to hear about them.

Whether you’re nominating yourself, the organisation you work for, someone you work with, or something that has been done by someone else; if you think it deserves to be recognised and celebrated – make a nomination now!

There are seven categories open for nomination:

  • Sexual health professional of the year
  • Young person of the year
  • Adult sexual health service/project of the year
  • Young people’s sexual health service/project of the year
  • The Pamela Sheridan sex and relationships education award – recognising good practice in education in schools
  • Sexual health media campaign/storyline of the year
  • Rosemary Goodchild Award for excellence in sexual health journalism.

All shortlisted finalists get a free ticket to the glittering awards dinner and ceremony on Friday 14 March 2014 at 8 Northumberland Avenue – a stunning venue in the centre of London, Trafalgar Square.

Visit the Awards website to find out more or contact awards@brook.org.uk

ESC – 13thCongress and call for applications for project funding

16 Sep, 13 | by shellraine, e-Media Editor

Mark your calendar:

28 till 31 May 2014
Lisbon, Portugal

First announcement

Check out the first announcement including:

  • programme overview: 8 workshops, 21 congress sessions, 2 debates…
  • abstract submission instructions (deadline 1 December 2013)
  • registration form

Register now

Please find here an overview of the registration fees.
You can now register through the online registration form

General information / Programme overviewCall for abstracts (deadline = 1st December 2013)/ Registration

ESC newsletter

Call for project or course applications

The ESC provides funding to support a project within Europe

The available budget for applications received between 1 August and 31 December 2013 is 30,000 euro. Applications should meet the following minimal conditions:

  • The applicant must be a paid-up ESC member
  • The grant may be used to support an individual, group, institute or organisation with a project related to the aims of the ESC.
  • Examples of projects include: research, audit, review, needs assessment

Deadline for the application period:  31 December 2013

Application Form

 

 

July Journal published as Impact Factor soars to 2.1!

20 Jun, 13 | by shellraine, e-Media Editor

The July edition of the Journal is now available online and includes:

Venous thromboembolism and COCs: an ongoing saga

This ongoing controversy recently resulted in the decision of the French authorities to withdraw the combined oral contraceptive (COC) containing ethinylestradiol (EE) and cyproterone acetate (i.e. Diane 35®) from the market. This consensus statement from 26 international experts in contraception concludes that “Both epidemiological data and clinical trials must be taken into account when best practice is defined. Regulatory restrictions of previously registered methods should only be made after careful assessment of all the available evidence”. See page 156

Serum CA125 for ovarian cancer screening

This timely commentary raises questions about the widespread use of screening women with non-specific symptoms by measuring serum CA125 levels, following the publication of the NICE guideline on ovarian cancer in 2012. The authors acknowledge that there are barriers that prevent women with symptoms associated with ovarian cancer from presenting to their general practitioner. However, the authors also point out that this will lead to increased use of CA125 in general practice and raise concerns about how women with raised CA125 in the absence of evidence of any disease should be managed. See page 160

Ovarian cancer symptom awareness and help-seeking behaviour

Ovarian cancer symptom awareness is low in the UK, and varies widely between symptoms. In this study, Low et al. identify variables that may be implicated in a longer time to help-seeking for possible ovarian cancer symptoms, and highlights the need for more in-depth research into the factors related to time to help-seeking in real-world situations. See page 163

Fertility preservation decisions faced by women with breast cancer

This article presents a contemporary summary of fertility preservation techniques available to women of reproductive age with breast cancer. It offers unique insights into the difficult treatment decisions coupled with the difficult fertility preservation treatment decisions that these women face. The article highlights a number of themes that influence the decision-making process for these women. Egg and embryo banking appear to be the fertility preservation treatment of choice. Finally, this work may assist health care commissioners when deciding funding priorities within a health economy such as the NHS in the UK. See page 172

Correlates of unprotected sex in drug-injecting women

This study demonstrates that despite the high risk for HIV acquisition or transmission and unintended pregnancy, condom use among women who inject illicit drugs or who have sexual partners who inject drugs in St Petersburg in Russia is low. Programmes to investigate and improve contraceptive use, including condoms, among this vulnerable group of women are needed and might benefit from addressing alcohol misuse. See page 179

Contraception in a university environment

This is a very simple real-life observational study of a cohort of young, nulliparous women in a university-based general practice choosing and continuing with long-acting reversible contraceptive methods (LARCs) as their first line method of contraception. This article urges the health professional reader to consider offering this ‘fit and forget’ method of contraceptive to our younger population as a matter of routine. See page 186

Impact of UKMEC on CHC prescribing

Briggs et al. have assessed the effect of the UKMEC on prescribing of combined hormonal contraceptives (CHCs). Sadly, although there has been a small decrease in the proportion of higher-risk women being prescribed CHCs, their results suggest that in 2010 7.3% of CHC users had UKMEC Category 3 or 4 risk factors, particularly BMI ≥35 kg/m2. The authors point out that it is likely many of these women were being placed at an unnecessarily high risk of cardiovascular events, given the availability of lower-risk alternatives. See page 190

Financial cost to patients of a suspected ectopic pregnancy

In this article, Unger and colleagues in Edinburgh report on their assessment of an area of patient experience that is not often considered when assessing medical interventions. The financial impact on patients’ lives of the need to seek medical attention can be considerable and may become more significant as economic hardship increases. This article describes a well-conducted questionnaire study on the costs that patients themselves incurred in attending their general practitioners and a hospital clinic with a suspected ectopic pregnancy. The authors argue that such costs need to be factored into decisions regarding the cost-effectiveness of medical procedures. See page 197

Emergency contraception algorithm based on risk assessment

Introduction of a standardised protocol for the provision of emergency contraception (EC) has significantly increased the proportion of women offered an intrauterine device (IUD) as postcoital contraception, particularly in women at high risk of conception. Introduction of ulipristal acetate as an alternative method of EC has resulted in a reduction in the uptake of the emergency IUD. McKay and Gilbert state that this is cause for concern, and further investigation into the reasons behind this decrease in IUD uptake is needed. See page 201

No need for water torture

Cameron and colleagues set out to answer a simple question, namely does a full bladder assist insertion of intrauterine contraception? In the world of assisted conception a full bladder had been shown to aid intrauterine catheter insertion for embryo transfer, but could this knowledge be transferred usefully to the world of contraception? This simple question was answered in a simple and elegant way with a properly constructed and conducted randomised trial, which showed that we needn’t ask our clients requesting IUD/IUS insertion to arrive bursting – a fact for which both they and clinic staff will be duly grateful. See page 207

New monophasic natural estradiol COC

Lee Shulman reviews a new monophasic natural estradiol COC, Zoely®. This COC benefits from the progestogen nomegestrol acetate (NOMAC), which appears to result in good cycle control, with a 24/4 regimen. Since it is monophasic, it also has potential for extended cycle use. The great hope is that natural estradiol COCs will have a lower risk of venous thromboembolism (VTE) than EE-containing pills, but it should be stressed that there is currently no actual evidence for this. Studies are ongoing, but at present these COCs should be treated just like any other from the point of view of VTE. See page 211

Brook/FPA UK Sexual Health Awards 2013

The Journal’s Consumer Correspondent writes about the recently awarded Brook/FPA UK Sexual Health Awards, and opines that awards of this type are a good thing for the SRH profession generally and so rightly should be regarded as a highlight of the sexual health year. See page 219

Plus

An obituary for Dr Alison Bigrigg by Dr Audrey Brown; an organisational factfile on Tommys; a conference report from the FSRH Annual Scientific Meeting at University of Warwick;

And last, but by no means least, the Journal Impact Factor has risen, once again, to 2.1. Many congratulations to Anne Szarewski and her team.

 

New injectable – Sayana Press and Dianette VTE update

17 Jun, 13 | by shellraine, e-Media Editor

Sayana Press®

is a progestogen-only injectable contraceptive licensed for subcutaneous use. It contains 104mg of medroxyprogesterone acetate (MPA) in 0.65ml suspension and is bioequivalent to IM depot medroxyprogesterone acetate. It is administered at intervals of 13 weeks +/- 7 days via a new delivery system (Unijet) – a single dose pre-filled injector.

Sayana

Although ideal for self-administration it is not currently licensed for use in this way.  The April issue of the Journal included a commentary on SC MPA by Sharon Cameron from Edinburgh.

Further information for professionals including a step-by-step administration guide will be available via MedIsis website.

Dianette® and cyproterone acetate products: strengthening of warnings, new contraindications, and updated indication

In agreement with the MHRA and European Medicines Agency (EMA) Bayer has written to health professionals about Dianette®, co-cyprindiol and cyproterone acetate products. This follows the outcome of a review of the known risk of thromboembolic events by the EMA’s Pharmacovigilance Risk Assessment Committee (PRAC). There are no new data, but there has been a “scare” in France which led to this and other so-called third generation products being removed from the market leaving very limited options for women.

The PRAC recommendations include:

  • Dianette® and other medicines containing cyproterone acetate 2mg/ethinylestradiol 35 mcg are indicated for the treatment of moderate to severe acne related to androgen-sensitivity (with or without seborrhea) and/or hirsutism, in women of reproductive age.
  • For the treatment of acne, Dianette® and other cyproterone acetate 2mg/ethinylestradiol 35 mcg products should only be used after topical therapy or systemic antibiotic treatment have failed.
  • Since Dianette® and all other cyproterone acetate 2mg/ethinylestradiol 35 mcg products are also a hormonal contraceptive, they should not be used in combination with other hormonal contraceptives.
  • To increase awareness of the risk and risk factors of thromboembolism in relation to the use of Dianette® and other cyproterone acetate 2mg/ethinylestradiol 35 mcg products (e.g. increasing age, smoking, immobility), the warnings and precautions regarding this risk have been strengthened.

 

 

Copenhagen Impressions

3 Jun, 13 | by shellraine, e-Media Editor

European Society of Contraception and Reproductive Health
First Global Conference

Global

Highlights of the Congress included:

Crown Princess Mary opening the Congress followed by the amazing Copenhagen drummers                          drummers

 

 

 

Green contraception – estrogen in water an issue, rating methods for their ‘greenness’: hormones, packaging etc.

Lidegaard / Shulman / Dinger – continuing debate on VTE, interpreting research, epidemiology and practical applications.

Emergency Contraception – confirmation that pills have no impact globally on unintended pregnancy rates only IUDs do.

Meeting friends, old and new, from wider across the globe than usual, especially from the Baltic states, Africa and the Far East.

In addition the Board voted to set up a working group to investigate and promote multidisciplinary working across Europe.

bella sky

The startling Bella Sky hotel & conference centre

– especially the, trompe l’oeil, walkway between the 2 towers on the 23rd floor. It goes uphill from Tower 1 to 2 but from a distance appears to go the other way.

 

 

oresund  The Oresund Bridge

– the 5 mile rail and road link between Copenhagen and Malmo

 

 

 

bikesBicycles, bicycles and more bicycles

and particularly proper, separate, dedicated cycle lanes – at times quite scary and felt like being in the middle of the Tour de France peloton without the lycra and wrap-around shades!,

Great open sandwiches (smorrebrod) but hardly any danish pastries.

Herrrings, steak & frites. Not brilliant for veggies.

Good beer but not wine – used by next years hosts in Lisbon as an enticement to go there.

Lisbon

 

 

April Journal – 20th Anniversary of the FSRH

9 Apr, 13 | by shellraine, e-Media Editor

Hightlights from this edition include:

The FSRH’s 20th anniversary

It is 20 years since the establishment of the Faculty of Sexual and Reproductive Healthcare (FSRH). In celebrating its anniversary there is much to be proud of, and indeed Community Sexual and Reproductive Health is now a specialty in its own right. Readers should find the story of the birth and rise of the specialty interesting and some will be reminded of ‘old times’, while looking ahead to a bright future. See page 78

Does HRT cause breast cancer? Part 5

Shapiro and colleagues conclude the interesting and enlightening series of articles looking at the evidence around hormone replacement therapy (HRT) and breast cancer risk (page 80). The final part examines the evidence for there being a declining trend in breast cancer incidence as HRT use reduced. Although the two are widely held to be related, they conclude that it is not possible to say either way. In the accompanying
Commentary (page 72), Nick Panay reviews the whole series of five articles and reminds us that optimising the lives of millions of women going through the menopause should be our priority. See pages 72 and 80

COCs and the risk of VTE, ATE and cardiovascular death

Syd Shapiro provides another of his incisive reviews of the latest database study of the combined pill and venous (VTE) and arterial (ATE) thromboembolism risk. Unsurprisingly, he finds many of the same problems as in the other studies, and asks the question why do these studies keep being done badly when the methodological flaws have been so well established? See page 89

“Anything for the weekend – and beyond, madam?” Community pharmacies increase OC uptake

Parsons et al.‘s evaluation of a community pharmacy delivered oral contraceptive (OC) service in South-East London is of particular interest, as it demonstrates the value of providing OCs via this service outlet, especially for women who would not otherwise access long-term contraception. Specially trained pharmacists provided OCs under a patient group direction (PGD), and subsequent evaluation showed that these pharmacists were clinically competent to provide OCs according to a PGD, and that the service was successful in attracting the population identified as most in need.  See page 97

There’s a tale in this sting – The policing of abortion services in England

What was the background to last year’s Care Quality Commission inspections of all English abortion services? Why were medical and nursing colleagues reported to their regulatory Councils and why is a Metropolitan Police investigation still ongoing? Sam Rowlands’ commentary provides a fascinating and detailed account of the regulatory framework of abortion services in England and the unexpected consequences of a national newspaper’s ‘sting’ operation on certain clinics in February 2012. It suggests that the regulation of abortion goes further than the Law requires and that this is now out of step with progress in abortion practice, leading to unnecessary restriction for women with unwanted pregnancies in accessing the support they need. See page 121

Role of ambulatory hysteroscopy in reproduction

The relatively recent introduction of outpatient operative hysteroscopy enables investigation and treatment previously carried out in the operating theatre to be performed in the clinic setting without the need for general anaesthesia. A ‘see and treat’ style of management is being adopted, which is changing how we configure our gynaecological services. This review aims to summarise the role for ambulatory hysteroscopy in the diagnosis of conditions contributing to reproductive failure and in sterilisation. See page 127

LAM: why ignore this useful option?

In this interesting personal view article, the authors explore and elaborate on the reasons why health care providers and the public are hesitant in recommending/adopting the lactational amenorrhoea method (LAM), a valuable short-term postnatal contraceptive option. These include ignorance about the LAM criteria for correct use, mistrust of the method’s effectiveness despite a strong evidence base, inconsistencies in the advice given to breastfeeding women in the UK by health practitioners and public bodies (e.g. the National Health Service, Royal College of Obstetricians and Gynaecologists), and lack of awareness about potential benefits. See page 136

Internet: good or bad?

2013 marks the 30th anniversary of the Internet. Our Consumer Correspondent looks at whether this technological miracle is a ‘good idea’ for the health profession. See page 139

New subcutaneous DMPA injection

Sharon Cameron discusses the new subcutaneous injection of depo-medroxyprogesterone acetate (DMPA), Sayana® Press, which is soon to be released onto the market in the UK. It seems to be very similar to the intramuscular DMPA, but can be self-administered. Unfortunately, this advantage is not being utilised, as this contraceptive method is not yet licensed for self-administration in the UK. See page 75

Psychosocial factors affect semen quality

Semen quality appears to be declining and this cross-sectional study in China casts light upon some factors that may be associated with that decline. See page 102

The ‘Woman’s Condom’ – will the Chinese go for it?

The need for products that simultaneously protect against unwanted pregnancy and STIs, including HIV, has prompted interest in the development of multipurpose prevention technologies, including new variants of the female condom. In this issue, Coffey and colleagues describe their survey of initial reactions to the ‘Woman’s Condom’ (which obtained marketing approval in China in 2010) by potential user groups in Shanghai. See page 111

Depo-Provera does not increase fracture risk.

27 Feb, 13 | by shellraine, e-Media Editor

Results from a new study published in the March issue of Obstetrics and Gynaecology demonstrate that the use of depot medroxyprogesterone acetate (DMPA) does not appear to increase fracture risk. Whilst the use of DMPA reduces serum oestrogen levels and is associated with significant loss of bone mineral density (BMD), this study shows that it does not appear to have an effect on fracture risk.  In addition although DMPA users had higher fracture risk than non-users, the risk did not increase after starting DMPA but was similar to before it was initiated.

The retrospective cohort study by Lanza et al1 of 312,395 women, who had had 11,822 fractures, was designed to assess the extent to which DMPA increases fracture risk. Using data from the General Practice Research Database, the study compared fracture incidence in DMPA users with women using non-DMPA hormonal contraceptives. It also investigated fracture incidence before and after initiation of contraceptive use. The study reported that before contraceptive use started, DMPA users had a higher fracture risk than non-users (incidence rate ratio [IRR] 1.28; 95% confidence interval [CI] 1.07-1.73). After use began, crude fracture incidence was 9.1/1000 person-years for DMPA users and 7.3 for non-users (crude IRR 1.23; 95% CI 1.16-1.30). Fracture risk in DMPA users did not increase after starting DMPA  (IRR after/before 1.08; 95% CI 0.92-1.26). Fracture incidence was 9.4/1000 person years in low exposure DMPA users, and 7.8/1000 in high-exposure DMPA users. DMPA users had a higher fracture risk than non-users at the start of contraceptive use, with no discernable induction period.

Commenting on the results Professor Anna Glasier, Honorary Professor of the University of Edinburgh and the London School of Hygiene and Tropical Medicine, said “This study confirms what others have shown, that women who use Depo-Provera® appear to have a modest increase in fracture risk compared with women using other contraceptive methods. Importantly however, in this UK population the increased risk of fracture preceded the start of Depo-Provera®. The difference in fracture risk was mainly in fractures associated with trauma rather than those typical of osteoporosis. Further research is indicated to explore behavioural differences among populations of women choosing to use different contraceptive methods.”

1. Lanza L. et al. Use of depot medroxyprogesterone acetate contraception and incidence of bone fracture. Obs and Gynae. 2013; 121(3):593–600.

Journal Online First

13 Feb, 13 | by shellraine, e-Media Editor

The following Online Firsts have been published

Does a full bladder assist insertion of intrauterine contraception?: a randomised trial (Cameron, Glasier, Cooper,  Johnstone)

Cameron and colleagues set out to answer a simple question: does a full bladder assist insertion of intrauterine contraception? In the world of assisted conception a full bladder had been shown to aid intrauterine catheter insertion for embryo transfer, but could this knowledge be transferred usefully to the world of contraception? This simple question was answered in a simple and elegant way with a properly constructed and conducted randomised trial, which showed that we needn’t ask our clients requesting IUD/IUS insertion to arrive bursting – a fact for which both they and clinic staff will be duly grateful.

Impact of UK Medical Eligibility Criteria implementation on prescribing of combined hormonal contraceptives (Briggs, Praet, Humphreys, Zhao)

Briggs et al. have assessed the effect of the UKMEC on prescribing of combined hormonal contraceptives (CHC). Sadly, although there has been a small decrease in the proportion of higher-risk women being prescribed CHCs, their results suggest that in 2010 7.3% of CHC users had Category 3 or 4 risk factors, particularly BMI ≥35. The authors point out that it is likely many of these women were being placed at an unnecessarily high risk of cardiovascular events, given the availability of lower risk alternatives.

Understanding barriers to sexual health service access among substance-misusing women on the South East coast of England (Edelman, Patel, Glasper, Bogen-Johnston)

This interesting article explores why substance-abusing women have problems accessing SRH services in Hastings, UK. Drug use, low self-esteem and previous traumatic experiences all combine prevent women accessing help. This is a qualitative interview study and provides important insights into the care of these women; there are no easy answers but the authors have provided some suggestions as to how practitioners may make the service more accessible.

Coping after recurrent miscarriage: uncertainty and bracing for the worst (Ockhuijsen, Boivin, van den Hoogen, Macklon)

Pregnancy loss is a significant trauma for women, the more so if repeated.  In their study, Ockhuijsen and her colleagues investigated the ways in which women coped in the time after single and recurrent miscarriages and in the difficult period soon after conception while waiting for ongoing pregnancy to be confirmed. They found that coping strategies differed between the two groups of women and they investigated the use of a simple psychological support tool, the Positive Reappraisal Coping Intervention, that may be of help, particularly to those with greater concern for the future following recurrent miscarriage.

The role of ambulatory hysteroscopy in reproduction (Robinson, Cooper, Clark)

The relatively recent introduction of outpatient operative hysteroscopy enables investigation and treatment previously carried out in the operating theatre to be performed in the clinic setting without the need for general anaesthesia. A ‘see and treat’ style of management is being adopted, which is changing how we configure our gynaecological services. This review summarises the role for ambulatory hysteroscopy in the diagnosis of conditions contributing to reproductive failure and in sterilisation.

The use of local anaesthesia for intrauterine device insertion by health professionals in the UK (Akintomide, Sewell, Stephenson)

What to do now? How women with breast cancer make fertility preservation decisions (Snyder, Tate)

A service-based approach to nurse training in sexual and reproductive health care (Shawe, Cox, Penny, White, Wilkinson)

Increasing male participation in the uptake of vasectomy services (Singh, Mishra, Alam, Pandey)

Correlates of unprotected sexual intercourse among women who inject drugs or who have sexual partners who inject drugs in St Petersburg, Russia
(Abdala, Hansen, Toussova, Krasnoselskikh, Verevochkin, Kozlov, Heimer)

Plus Organisation Factfiles on Tommys and the College of Sexual and Relationship Therapists (COSRT) by Susan Quilliam and a letter to the editor “Learning from Romanian women’s struggle to manage their fertility” by Ann Furedi following the article in the January Journal

 

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Latest from JFPRHC