Development of Novel Male Contraceptives

Unintended pregnancy is surprisingly common, accounting for 40-50% of pregnancies worldwide. Contraception is the most effective means of preventing unintended pregnancy. Seventy percent of all contraceptives are used by women; however, some women are unable to use contraceptives due to health conditions or side effects. Many men wish to take a more active role family planning, but currently have only two effective male contraceptive options, condoms and vasectomy. Therefore, work to develop novel male contraceptives analogous to popular female methods, such as daily pills or long-acting shots and implants, is underway. This paper will briefly discuss the pros and cons of condoms and vasectomies, and then review the research into novel methods of male contraception.

Which young adults are most likely to use withdrawal? The importance of pregnancy attitudes and sexual pleasure

OBJECTIVES

Use of withdrawal (coitus interruptus) has consequences for reproductive health, but few nationally representative studies exist. We (1) examined patterns of withdrawal among 15- to 24-year-old women and men, and (2) explored withdrawal's associations with sociodemographic, psychological, and sexual factors.

STUDY DESIGN

Using data from the 2006-2010 National Survey of Family Growth, we assessed reports of any and only withdrawal use at last sexual episode in the last month from 3517 sexually active 15 to 24 year-old women and men at risk of unintended pregnancy. Logistic regression documented associations with withdrawal.

RESULTS

Fourteen percent of young women and 17% of young men reported any use of withdrawal at last sex; 7% and 6%, respectively, reported only use of withdrawal. Though associated with few sociodemographic factors, withdrawal was significantly linked with pregnancy- and condom attitudes. In regression models, compared to those who said they would be upset if they discovered they were pregnant, young women who said they would be pleased about a pregnancy were 2.2-2.6 times as likely to have used any/only withdrawal (p<.01). For both women and men, those who felt that condoms were likely to diminish sexual pleasure were more likely to have used any/only withdrawal (odds ratio=1.8-2.6, p<.05).

CONCLUSIONS

At their last sexual episode, a greater proportion of young adults used withdrawal in conjunction with other methods than by itself. The psychological and sexual variables of orientation toward pregnancy and attitudes about condoms and pleasure were more strongly linked with withdrawal practices than most sociodemographic variables.

IMPLICATIONS STATEMENT

Since a substantial minority of young adults use withdrawal, providers may wish to speak directly to contraceptive clients about this method, though they should distinguish between only versus any withdrawal use. Practitioners may also be well served by assessing and responding to pregnancy orientation and pleasure attitudes in contraceptive counseling.

Users of withdrawal method in the Islamic Republic of Iran: are they intending to use oral contraceptives? Applying the theory of planned behaviour

Many couples in the Islamic Republic of Iran rely on coital withdrawal for contraception. The purpose of this cross-sectional study was to use the theory of planned behaviour to explore factors that influence withdrawal users' intent to switch to oral contraception (OC). Participants were 336 sexually active, married women, who were current users of withdrawal and were recruited from 5 public family planning clinics in Tehran. A questionnair included measures of the theory of planned behaviour: attitude (behavioural beliefs, outcome evaluations), subjective norms (normative beliefs, motivation to comply), perceived behaviour control, past behaviour and behavioural intention. Linear regression analyses showed that past behaviour, perceived behaviour control, attitude and subjective norms accounted for the highest percentage of total variance observed for intention to use OC (36%). Beliefs-based family planning education and counsellingshould to be designed for users of the withdrawal method.

Coitus interruptus in female patients seeking services at Obstetrics and Gynecology Department in Rajavithi Hospital

OBJECTIVE

To study the using rate and demographic characteristic of female patients attending in Rajavithi Hospital who used coitus interruptus (CI) as a contraceptive method.

MATERIAL AND METHOD

Two hundred sexually active, reproductive age (15-44 years) female patients attending family planning, postpartum or gynecologic clinic in Rajavithi Hospital between March 1, 2004 and May 31, 2004 were interviewed to obtain demographic data and CI using designed questionnaires.

RESULTS

One hundred and forty out of 200 women were using CI as a choice of contraception (70%). The mean age of the CI groups was 27 years. Most were occupied as private sector employees (49.3%). Friend was the most common route for obtaining information about CI (46.4%). The women and their partners were satisfied with CI 68.6% and 34.3%, respectively.

CONCLUSION

Seventy percent of the female patients seeking services at Obstetrics and Gynecology Department in Rajavithi Hospital used CI as a choice of contraception. Friends were the most common route for obtaining information regarding this contraceptive method (46.4%).

Withdrawal (coitus interruptus) as a sexual risk reduction strategy: perspectives from African-American adolescents

This study examined adolescents' beliefs about the benefits and risks of withdrawal (coitus interruptus) with respect to both pregnancy and sexually transmitted infections (STIs). In the course of qualitative interviews with African-American youth aged 14-19 (n = 124) about sexuality and risk, 24 adolescents spontaneously introduced the subject of withdrawal as a sexual risk reduction strategy. Eighteen percent of the sexually experienced adolescents mentioned their own use of withdrawal as a contraceptive method. From adolescents' accounts of their own and their peers' use of withdrawal, we learned that the cultural meanings of withdrawal within the context of adolescent relationships were multifaceted. Using withdrawal could signal sexual prowess in male youth, was seen as promoting trust and caring within a stable relationship, and was seen as mitigating the risk of pregnancy. However, adolescents also recognized that withdrawal did not protect against most STIs. Beliefs about withdrawal as a gendered skill and as a sign of trust may undermine some adolescents' attempts to negotiate condom use for protection against STIs.

Family planning choices and some characteristics of coitus interruptus users in Gemlik, Turkey

The objectives of this study were to gain information about some fertility issues, contraceptive method choices, and the reasons for coitus interruptus (CI) use among married women aged 15-49, in Gemlik, Turkey. One thousand nine hundred ten women were interviewed for this cross-sectional study. The pregnancy rate per woman was 2.9. 716 women (37.5%) had at least one unwanted pregnancy. Of the study population, 79.6% were using a contraceptive method (45.1% were using a modern method, 34.5% a traditional method). CI was the most preferred method (33.7%). Fertility measures of women who had used CI continuously were compared with other women. It was found that most CI users were content with the method.

Immediate postabortal contraception with the levonorgestrel intrauterine device, Norplant, and traditional methods

Women seeking legal first trimester abortion were counseled concerning contraception methods available for use immediately postabortion. Fifty women each accepted hormonal methods that were available only in the clinic and were novel to the country, the levonorgestrel IUD and Norplant implants, whereas another 50 chose either coitus interruptus or abstinence. All were experienced contraceptors, but larger percentages of women selecting the levonorgestrel IUD or implants had used the pill or IUDs previously, were under age 30, and weighed less than 60 kg compared to the other study participants. In the initial 2-6 weeks postabortion, women using the long-acting hormonal methods resumed sexual activity earlier and experienced more bleeding and spotting days than did other study participants, but their hematocrits were not adversely affected. No clinically significant side effects were noted in any group in the 6 weeks following the abortion. At the end of 1 year of follow-up, women using the hormonal methods had experienced no pregnancies and had high rates of continuation. IUD and implant participants had greater weight gain than did the other participants, but their mean weight remained below that of participants using traditional methods. No significant between-group differences in levels or changes in levels from admission were noted in hematocrit and blood pressure. The women found the levonorgestrel implants and IUDs easy and safe to use and highly effective. Bleeding disturbances, including amenorrhea, were the principal features the women disliked.

Differentiation in contraceptive behavior of the female population in Thrace, Greece

OBJECTIVE

To investigate the factors influencing the contraceptive practice of the female population in the rural area of Thrace, Greece.

METHODS

We conducted a retrospective sociopsychological study on representatives of the two major religious subgroups in Thrace: 127 Orthodox Christians and 120 Muslims. The women were reasonably representative in terms of age, education, marital status and professional life. Interviews covered sexual history and contraceptive use in detail.

RESULTS

We observed a significant preference of Christians for condoms, and of Muslims for coitus interruptus. The use of the male condom was significantly higher in younger, compared to older, Christians (p < 0.001). Muslim women aged 30-39 years showed a significant preference for coitus interruptus and intrauterine devices, as compared with Christians. Highly educated women of both subgroups did not present statistically significant differences concerning contraception. It was found that, the more intense the sexual activity, the more common the use of the condom for Christians and the more popular the choice of interrupted intercourse for Muslims. Muslims with a permanent sexual relationship preferred interrupted intercourse, while all Muslims with multiple sexual partners used the male condom.

CONCLUSIONS

There is an urgent need to promote information concerning the variety of modern contraceptive options in order to improve the prevalence of contraceptive use and reproductive health in the region of Thrace.

Unprotected anal intercourse in gay men: the resolution to withdraw before ejaculating

734 gay men who had recently engaged in unprotected anal intercourse reported self-justifications they used at the time. A common self-justification involved a resolution to withdraw before ejaculating. Compared with other self-justifications, this resolution was associated with a "last minute" rather than a "premeditated" decision to have unprotected anal intercourse, suggesting that the resolution derived just from "heat of the moment" thinking. Implications for AIDS education are discussed.

Family planning in the Jewish population of Israel: correlates of withdrawal use

This report describes trends and differentials in contraceptive practices among Israeli Jews. Data from two fertility surveys show a heavy reliance on the IUD, little use of sterilization, and declining, but still significant use of withdrawal. The factors associated with the practice of withdrawal are explored. Evidence is found in support of Santow's hypotheses that the degree of sex-role differentiation within marriage and the belief that men hold the authority in reproductive decisionmaking are both positively related to the practice of withdrawal. Fear of oral contraceptives, a dislike of sterilization, and a reliance on the IUD only at greater parities imply a continuing role for withdrawal, especially among Israeli Jewish couples in which wives are less educated and have more traditional sex roles than the wives in other couples.