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- abortion
- induced
- early detection of cancer
- health policy
- intrauterine devices
- long-acting reversible contraception
- sexual dysfunctions
- psychological
No single treatment for recurrent prostate cancer is superior in terms of recurrence-free survival, but repeat radiotherapy may be least toxic
There are many treatment options for local recurrence of prostate cancer after primary treatment with radiotherapy; however, there is debate regarding benefits and side effect profiles. This systematic review and meta-analysis of 150 studies of various salvage therapies did not identify a single treatment that was superior in terms of 5-year recurrence-free survival. However, there was some evidence that repeat radiotherapy (in the form of stereotactic body radiotherapy, high dose rate brachytherapy or low dose rate brachytherapy) had lower incidence of gastrointestinal and genitourinary side effects when compared with other treatments. Further prospective study is required.
Eur Urol 2020; doi: 10.1016/j.eururo.2020.11.010
Treatment with testosterone does not increase risk of major injury in men or women
Clinicians may be concerned that treatment with testosterone may lead to more violent behaviour and subsequent increased risk of physical injury. A Canadian study conducted a self-matched analysis of individual patients before and after commencing testosterone with respect to frequency of acute traumatic events necessitating emergency care. The study did not find any differences in injury rates following initiation of testosterone therapy but there was an increase in rates of thromboembolic events. Analysis of subgroups of interest—transgender patients, body builders and those using supraphysiological doses—was unfortunately not possible, but need to be considered in future studies.
Am J Med 2021; doi: 10.1016/j.amjmed.2020.07.037
Compared with placebo, ibuprofen and metoclopramide in combination reduce the frequency of side effects and need for additional pain relief in early medical abortion
Evidence for the optimal management and prevention of pain during first trimester medical abortion is scarce. Clinical guidance encourages the use of non-steroidal anti-inflammatory drugs, particularly ibuprofen; however, the studies underpinning this guidance used doses that were much higher than standard regimens. This multicentre randomised controlled trial compared tramadol 50 mg versus combination ibuprofen 400 mg and metoclopramide 10 mg versus placebo. Pain scores were statistically significantly lower with both drug interventions than placebo; however neither led to the prespecified clinically important reduction of 2 points on an 11-point pain rating scale. The ibuprofen–metoclopramide group experienced fewer side effects than the tramadol and placebo groups and required fewer additional analgesic medications and so this combination may have clinical benefits more broadly than pain relief.
Contraception 2021; doi: 10.1016/j.contraception.2020.12.004
Postplacental intrauterine contraception initiation leads to high rates of method continuation at 1 year
Postplacental IUC, following vaginal and caesarean delivery, has garnered increasing attention in recent years. There has been some evidence from observational studies that expulsion rates may be different between copper and hormonal IUC. This randomised controlled trial compared expulsion rates for copper and hormonal IUC at 1 year and found a slightly higher proportion of copper devices expelled. However, the sample size was small and combined insertion after vaginal and caesarean delivery. What is clear is that high proportions (two-thirds) of IUC were continued in both arms at 1 year and contributes to the growing evidence to support this practice.
AOGS 2021; doi: 10.1111/aogs.14081
No unique clinical, attitudinal or behavioural risk factors identified to explain ethnicity-related differences in sexually transmitted infection rates
Ethnic disparities in STI rates have been recognised for many years; however, more detailed information about risk factors has not been available. This multicentre study of sexual health clinics in England combined routinely collected clinical outcome data with detailed questionnaires on sexual health behaviours and attitudes. Differences were compared for those of white British or Irish versus black Caribbean backgrounds. STI rates were approximately four times higher among black Caribbean respondents; however, there were no behavioural or attitudinal measures that correlated with this difference. Qualitative research may be of benefit in identifying further more nuanced risk factors for STI acquisition in this group.
STI 2021; doi: 10.1136/sextrans-2020-054784
Post-traumatic stress disorder and rate of combat exposure influences sexual dysfunction in male military staff
Members of the military are recognised as having higher rates of sexual dysfunction than the general public; however, the reasons for this are poorly understood. The Millennium Cohort study is a longitudinal study examining the health of 200 000 US military staff. A subset of this group (n=15 330 men) completed questionnaires on sexual health and well-being, which were combined with other health data collected during the cohort study. Experiencing high levels of combat duty, when combined with symptoms of PTSD, had a significant impact on rates of sexual dysfunction and poor sexual health. Military staff need robust psychological (and psychosexual) support when experiencing PTSD after combat.
J Sex Res 2021; doi: 10.1080/00224499.2020.1855622
Women from more deprived areas may be more likely to die from recurrent endometrial cancer
Endometrial cancer is a common gynaecological cancer and is usually detected at early stages when it is highly treatable, although there is a minority who presents with later disease. A prospective cohort study in northwest England analysed the socioeconomic status of women attending with endometrial cancer and how this correlated with survival. They found that after adjusting for confounding factors, being in more deprived socioeconomic groups was associated with an increased risk of recurrent and metastatic disease and subsequent mortality. Addressing socioeconomic inequity is essential for improving sexual and reproductive health outcomes and population health in general.
BJOG 2020; doi: 10.1111/1471–0528.16618
Footnotes
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.