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- abortion
- hormonal contraception
- qualitative research
- reproductive health politics
- sexually transmitted infections
Auricular acupuncture improves pain in women undergoing first-trimester surgical abortion under local anaesthetic
Optimising pain control is a key focus of research into improving women’s experiences of a range of gynaecological procedures. This double-blind, three-arm randomised controlled trial (RCT) of auricular acupuncture versus placebo versus standard care only has shown a significant reduction in pain and anxiety as rated using a visual analogue scale. Acupuncture was used as an adjunct to the standard analgesia regime of ibuprofen and paracervical block. This may be a simpler and safer alternative to sedation for more painful gynaecological procedures.
Contraception 2019; https://doi.org/10.1016/j.contraception.2018.08.011
In Canada, women with schizophrenia are more likely to undergo induced abortion
Women with schizophrenia struggle to access all kinds of healthcare, including effective contraception. A population-based, serial cross-sectional study conducted between 2011 and 2013 in Ontario in Canada found that women with schizophrenia were 1.3 times more likely to have had an abortion than women without schizophrenia. This study highlights an unmet need in this population, and partnership working between mental health and reproductive health providers is essential in order to widen access for vulnerable women.
Br J Psychiatry 2018; https://doi.org/10.1192/bjp.2018.262
International dating app data suggest many MSM are taking PrEP outside of traditional healthcare settings
Dating apps are ubiquitous in the men who have sex with men (MSM) community and have the potential to provide rich data on sexual health behaviours. By partnering with the dating app Hornet®, the European Centre for Disease Control distributed a self-completed questionnaire in eight languages to over 12 000 men across Europe and Central Asia. Those taking pre-exposure prophylaxis (PrEP) reported sexual behaviours that were high risk for HIV acquisition and so considered that their PrEP use was appropriate. The authors found that approximately one-quarter of respondents were sourcing PrEP online and that one-third had not disclosed their PrEP use to a doctor. The highest rate of internet acquisition was in the UK at 76.7%, likely reflecting the absence of National Health Service provision in England. We need to empower men to disclose their PrEP use to their clinicians so that they can get appropriate monitoring and support.
Sex Transm Infect 2019; https://doi.org/10.1136/sextrans-2018-053705
Two types of COCPs reduce recurrence of endometriosis
Much debate is had about the best hormonal preparation to use in the treatment of endometriosis or indeed if hormones are the best treatment available. A Cochrane systematic review has evaluated the use of hormonal contraceptives in women with endometriosis. They found evidence that two types of combined oral contraceptive pills (COCPs) were able to prevent recurrence of endometriosis following surgery when compared with placebo: ethinylestradiol-norithisterone acetate and ethinylestradiol-drospirinone combinations. However, when managing dysmenorrhoea, pelvic pain and dyspareunia, all combined hormonal methods and progestogen-only contraceptives were effective and no single regime was more effective than another.
Eur J Contracept Reprod Health Care 2019; https://doi.org/10.1080/13625187.2018.1550576
Rapid POCT testing for STI improves rates of antibiotic overtreatment for PID
Antimicrobial resistance, particularly in Neisseria gonorrhoeae, is a major concern globally. An RCT conducted in a North American emergency department compared a rapid point-of-care test (POCT) for Chlamydia trachomatis and N. gonorrhoeae to standard testing in women presenting with clinical pelvic inflammatory disease (PID). The group tested with the POCT had significantly lower levels of inappropriate antibiotic prescription compared to standard testing. This study highlights the difficulties of trying to accurately clinically assess PID, and that rapid POCT could be used in diverse healthcare settings to reduce the amount of empirical treatment used in order to minimise antibiotic resistance.
Ann Emerg Med 2018; https://doi.org/10.1016/j.annemergmed.2018.09.012
Racial discrimination is associated with sexual risk behaviours in young black men
Racial discrimination is thought to affect health outcomes across many domains. A computer-assisted self-interview study conducted in non-urban settings in Georgia and Michigan, USA found that young black men who reported experiencing racial discrimination were more likely to report emotional distress, concurrent sexual partners and inconsistent condom use. Positive social ties had a mitigating effect on the association between racial discrimination and sexual risk behaviour. While a cross-sectional study like this cannot establish causality, it fits with wider evidence that racial discrimination can negatively impact on all areas of a person’s life. It is important to remember this context when working with people from black and minority ethnic backgrounds to provide sexual and reproductive healthcare.
Arch Sex Behav 2019; https://doi.org/10.1007/s10508-018-1341-1
Have sexual side effects of the OCP been neglected for too long?
Oral contraception remains one of the main methods of contraception used in the UK, despite the promotion of long-acting reversible contraception (LARC) methods. In a BMJ editorial, Professor of Sexual and Reproductive Health, Cynthia Graham argues for greater research into the adverse side effects of impaired sexual function when using oral contraceptive methods. There is a huge variability in women’s experience of using OCPs and its impact on their sexual function. High-quality RCT data are lacking, and future studies should consider investigating this outcome as it can account for many of those who discontinue a contraceptive method.
BMJ 2019; https://doi.org/10.1136/bmj.l335
Footnotes
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
Patient consent for publication Not required.