News Highlights

• CDC and Health Canada announce the release of 2006 STI Guidelines
• Update on HPV vaccine
• More support for bone recovery after Depo-Provera use
• Sex After Baby

Ask sexualityandu.ca

• What do the different colors in a birth control pill mean?
• I missed the last pill of my pack and had unprotected sex during my pill-free week. What should I do?
• If I am overweight, will the patch still work?

Tips

• NuvaRing Info

Quick facts

• FDA approves over the counter sales for Plan B

Did you know?

• An increasing percentage of new Canadian HIV infections are in women

CDC and Health Canada announce the release of 2006 Sexually Transmitted Infection Guidelines

This past August, the U.S. Centers for Disease Control (CDC) announced the release of the 2006 Sexually Transmitted Infection (STI) guidelines.  These have replaced the 2002 version.  The highlights include updated information on the investigation and management of STIs in men who have sex with men, the HPV vaccine, and new treatment strategies for Chlamydia and Trichomonas infections.

This 2006 STI Guidelines Document is produced by a group of both CDC and external experts and the latest reviews of relevant literature.  It is updated every three to four years.  The new version is available online at: http://www.cdc.gov/std/treatment/.

The Public Health Agency of Canada (PHAC)  has also released the Canadian Guidelines on Sexually Transmitted Infections 2006 Edition, which is an update of the previous 1998 guidelines.  The new version is available on the PHAC website and at:  
http://www.phac-aspc.gc.ca/std-mts/sti_2006/sti_intro2006_e.html

Update on HPV vaccine

HPV is a common infection, and approximately 75% of sexually active adults will have been exposed to it in their lifetimes.  It is often asymptomatic, and is linked to the development of cervical cancer and anal and genital warts.

In June, the Food and Drug Administration (FDA) in the United States approved the release of an HPV vaccine, known as Gardasil, to be used on females aged 9-26.  This particular vaccine works against the four strains of HPV (6, 11, 16, and 18) most commonly associated with genital and anal warts as well as cervical cancer.  The three-shot series will cost approximately $360 in the United States.  In clinical trials, the HPV vaccines have been up to 100% effective at preventing cervical cancer from the included viral strains.  Gardasil has also been effective at significantly reducing the development of genital and anal warts.

On July 18, Health Canada approved the same vaccine for Canadian girls and women aged 9-26.  In Canada, approximately 1400 women will be diagnosed with cervical cancer this year and 400 women will die of cervical cancer.  On a larger scale, thousands will face the socially difficult diagnosis of genital warts.  The cost will be around $135 CDN for each of three doses.  Ideally, the vaccine series should be given before exposure to the virus (i.e. before becoming sexually active).

http://www.edmontonsun.com/News/Columnists/Jacobs_Mindelle/2006/07/25/pf-1701313.html

More support for bone recovery after Depo-Provera use

A study published in the journal Contraception provided more reassurance on bone health and the use of Depo-Provera.  A multi-center trial in the United States compared 248 women aged 25-35 who used Depo-Provera for up to 240 weeks of treatment, to 360 women who used non-hormonal contraception for the same time period. 

The womens’ bone density measurements were taken three times: before starting the injections, at the end of the treatment period, and again, 96 weeks after finishing treatment.  At week 240 of treatment, the average changes from baseline in the Depo-Provera users compared to the women taking a non-hormonal contraceptive were: −5.16% (n=21) vs. +0.19% (n=65), at the hip (p<.001); −5.38% (n=33) vs. +0.43% (n=105), at the lumbar spine (p<.001). At week 96 after treatment, these values were: −0.20% (n=25) vs. +0.84% (n=43), total hip (p=.047); −1.19% (n=41) vs. +0.47% (n=66), lumbar spine (p=.017).

These data add to the growing evidence that although bone loss is seen with the use of Depo-Provera, it does recover after discontinuation.  Depo-Provera remains a good option for women who require contraception or menstrual suppression for other reasons.

Kaunitz AM, Miller PD, Rice VM, Ross D, McClung MR.  Bone mineral density in women aged 25-35 years receiving depot medroxyprogesterone acetate: recovery following discontinuation.  Contraception. 2006 Aug;74(2):90-9.

Sex After Baby

Getting back to sex after a pregnancy can be daunting, as many women may have questions or apprehensions about that first time. Last month, sexualityandu released a new section to help take the mystery out of having sex after childbirth.

The new section provides answers to the questions most new mothers face such as:  “When is it safe to have sex again?” “What can I expect the first time?” and “How soon after delivery can I get pregnant again?” The section also includes advice on contraceptive options after pregnancy and during breastfeeding.

Visit sexualityandu.ca’s new section on Sex After Baby (http://www.sexualityandu.ca/adults/sex-10.aspx) 

What do the different colors in a birth control pill mean?

The different colours helps to tell which pills contain hormones (the “active pills”) and which pills do not contain hormones (“sugar pills”).

If you use a pill that varies the amount of hormones that you are taking from week to week (for example, Triphasil®, Triquilar®, Tri-Cyclen®, Tri-Cyclen Lo®), the different colour pills correspond to different amounts of hormone.

If you use a pill that contains the same amount of hormones from week to week (for example MinEstrin®, Alesse®, Marvelon®, Cyclen®, Yasmin®), the one colour of pill represents the pills that contain the active hormones, while the other colour represents the pills that contain no hormones (the placebo pills or “sugar pills”). 

Birth control pills come in either a 21-day or a 28-day pack.  Packs with 28 pills have 21 pills that contain hormones (active pills) and 7 pills that contain no medication (placebo or sugar pills).  Packs with 21 pills only have 21 active pills.  When using 21-pill packs, women have to remember to start taking pills again after the 7 days off, and for some this can be difficult.  The reason that pills also come in 28 packs is to help women remember to take their pills at the right time.  With a 28 pack, you take the 21 active pills, followed by the 7 sugar pills.  Once that pack is finished, you start a new pack the next day. 

I have a 21-day pack of pills. I missed the last pill of my pack and did not notice until today, the first day I should start my next pack. I had unprotected sex during my pill-free week. What should I do? Should I take emergency contraception (EC)? If I take EC, do I start my new pill pack on time?

If you have missed one pill (and have had 8 days off instead of 7), you should consider using EC if you have had unprotected intercourse within the last 5 days.  Although EC is most effective if taken within 3 days of unprotected intercourse (the sooner the better!), it may still be effective up to 5 days after an act of unprotected intercourse.  You can start your new pack of birth control pills the next day.  You should also use condoms for the first week of the new pack.

If I am overweight, will the patch still work?

The answer is yes.  There is some concern that the effectiveness of the patch for birth control is slightly lower in women who weigh more than 90 kg (198 lbs).  The typical effectiveness rate for the patch is around 99%, which is similar to the pill.  The initial effectiveness research studies looked at 3300 women who used the patch for over 22,000 months in total.  There were more patch failures in women who weighed over 198 lbs, although there were only 15 unexpected pregnancies in all.  So, if you are overweight, the patch will still work to protect you from an unwanted pregnancy, and will definitely work better than using no contraception at all.

An increasing percentage of new Canadian HIV infections are in women

In August 2006, the Public Health Agency of Canada (PHAC) released their findings of HIV prevalence in Canada based on 2005 estimates.  The estimated number of people living with HIV/AIDS in Canada is up 16% from the 2002 estimates, and now reaches 58,000.  There were an estimated 2300-4500 new infections, 45% of which occurred in men who have sex with men (MSM).

The number of women living with the infection has increased to 11,800 women.  In 2005, women represented 27% of new HIV infections, increased from 24% in 2002.  About 76% of the new infections in women were attributed to heterosexual sexual activity, and the remainder to intravenous drug use.

Aboriginal populations continue to make up a disproportionate number of the population of HIV-infected persons.  Although the Aboriginal people account for 3.3% of the Canadian population, they make up 7.5% of all HIV infections.  The majority of the infections were a result of intravenous drug use.

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/06vol32/dr3215ea.html

FDA approves over the counter sales for Plan B

One of the most contentious issues in recent years for the United States Food and Drug Administration (FDA) has finally been resolved.  Plan B, also known as the morning-after pill, has finally been licensed by the FDA for over-the-counter sales, without a prescription, to women over the age of 18.  This particular issue has been under review for over three years and has led to the resignation or dismissal of several FDA senior administrative personnel in the last year.

Plan B is available in Canada without a prescription from a pharmacist

NuvaRing Info and Tips

NuvaRing is one of the newest methods of birth control to hit the Canadian market.  It is a soft silicone ring that is placed in the vagina for three weeks at a time, and then is removed for the fourth week so you can have a period.  After the seven days without a ring in, a new ring is inserted.

Because it is a new way of taking birth control, there have been several questions regarding its use.  Just like the birth control pill, NuvaRing starts to work right away.  If you start using it during the first week of your cycle (with day one being the first day of your period) no additional backup method of contraception is required.  If you use what is known as the “Quick Start” method, and insert the ring at any time during your cycle, you need to use a second method of contraception (such as condoms) for one week.

It is safe to use tampons with NuvaRing? 

Tampons are safe to use with the ring, although you have to be careful not to pull the ring out with the tampon.  If the ring does come out with the tampon, simply rinse the ring off under the tap (lukewarm water) and reinsert it.