News Highlights
Vaccination against HPV shows encouraging results for 16-25 year old women
Vaccination against the human papillomavirus (HPV) is safe and effective, even for women who may have already been exposed to some types of HPV covered by the quadrivalent vaccine, according to a study that pooled the results of five others.
More than 5,000 women aged 16-25 took part in the study, receiving three doses of the quadrivalent vaccine against HPV, or a placebo—the second dose was given two months later and the third dose six months after the first—then they we’re followed for an average of 2.5 to 3.5 years.
At the time of vaccination, 76% of the women were negative for all four HPV types covered—which include HPV types, 6, 11, 16 and 18, and only 0.1% tested positive for all four types. As expected, the number of women who had HPV increased with age. Women who tested negative for HPV before vaccination were protected against 100% of precancerous lesions (CIN of any grade severity), and 95% of genital lesions related to the HPV types. Overall, the risks of HPV related disease decreased by 58% to 72%.
Vaccinating women aged 16-25 was shown to have a positive impact on the burden of HPV-related disease even though some women had already been exposed, developed lesions, or had Pap smear abnormalities prior to vaccination.
However, it takes time for HPV to cause genital lesions, and the proportion of exposed individuals increases with time. The effect of vaccination was more apparent as time passed, and would likely be more evident with a longer follow-up period. The duration of the protection provided by the HPV vaccination is not yet known and the risk of HPV exposure, although perhaps less in older age groups, is still lifelong. Studies examining this and other questions are ongoing.
Barr E, Gause CK, Bautista OM, Railkar RA, Lupinacci LC, Insinga RP, Sings HL, Haupt RM. Impact of a prophylactic quadrivalent human papillomavirus (types 6, 11, 16, 18) L1 virus-like particle vaccine in a sexually active population of North American women. Am J Obstet Gynecol 2008;198:261.e1-261.e11.
Copper contraceptive (IUD) rises in popularity
Intra-uterine devices (IUDs), the T-shaped contraceptives that once fitted inside a woman’s vagina can stay there for years to provide ongoing pregnancy protection, are increasingly being used by women who have not had children.
IUDs are safe and effective method of reversible contraception that is commonly used worldwide, though most studies of the device have involved women who had children before. This review examined various studies comparing copper containing IUDs, including many types which are not available in Canada to get a better idea of women’s experiences with the contraceptive. There was not enough evidence in this study to recommend a certain type of copper IUD for women who have not had children before, but more studies are ongoing to investigate this question.
Most consist of a T-shaped frame with thin copper wire wound around the arms or the stem. The copper in an IUD prevents fertilization by creating an environment within the uterus that is hostile to sperm. These IUDs may be a particularly good option for women who do not wish to use contraceptives containing any type of hormone. Pregnancy rates with copper IUD use range from 0.1-2.2% in the first year of use depending on the type of IUD.
An IUD can be used from three to 10 years, depending on the type. The Nova-T is available in Canada and is recommended for up to five years. Expulsion, or the uterus involuntarily pushing the IUD out, is uncommon, but is most likely to occur in the first year of use, and does not vary with type of IUD.
The IUD is inserted by a health professional after performing a physical examination. Complications related to insertion of the device, such as the IUD going through the wall of the uterus, are very rare. Infection is another uncommon complication that is only related to the insertion process itself, not to the presence of the IUD.
One of the most common side effects is increased volume or duration of menstrual bleeding. Occasionally this is enough to motivate removal of the device. The rates of removal were similar regardless of IUD type.
As with many other forms of contraception, they do not protect against sexually transmitted infections, so condoms should be used in risky situations.
Kulier R, O’Brien PA, Helmerhorst FM, Usher-Patel M, D’Arcangues C. Copper containing, framed intra-uterine devices for contraception. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005347. DOI:10.1002/14651858.CD005347.pub3.
New variation on the oral contraceptive pill may help ease symptoms related to decreased estrogen levels
Most combined oral contraceptives, the pills that contain the hormones estrogen and progestin, have been used cyclically so there is a period called the hormone free interval (HFI), the 4 to 7 days where pills are not taken or placebo pills are used. During this interval a woman usually has a period because of the withdrawal of the synthetic hormones.
Pills are now on the market that modify this HFI so that two days of placebo pills are followed by five days of a low dose estrogen. This regimen may benefit women by further suppressing the development and maturation of the eggs in the ovaries, potentially decreasing the risk of contraceptive failure. Less fluctuation in hormone levels may also improve the rates of perfect use.
More than 1,300 women participated for up to six months in a study examining the safety and effectiveness of a new pill as part of its approval process. The new pill contains 21 days of desogestrel and ethinyl estradiol followed by 7 days of ethinyl estradiol. The cumulative risk of pregnancy was 0.9% during six months of treatment. Only 3.2% of women reported bleeding and or spotting as an adverse effect. The unscheduled bleeding or spotting decreased after the first cycle.
There were a few serious adverse events. One woman developed severe headache four days after the last pill. Two women were diagnosed with breast cancer, but because the women were only exposed to pills for a short time, it is unlikely that these cases were related to the pill. Another woman developed a blot clot in her leg after a 22-hour car ride.
The authors conclude that contraceptive effectiveness and safety of this pill regimen is comparable to other combined contraceptive methods. These initial results are reassuring and this pill may soon provide women with another contraceptive option. It may particularly benefit women who experience symptoms related to decreased estrogen levels like headaches and hot flushes.
Poindexter A, Reape KZ, Hait H. Efficacy and safety of a 28-day oral contraceptive with 7 days of low-dose estrogen in place of placebo. Contraception 2008;78:113-9.
Ask Sexualityandu
My boyfriend and I have followed my doctor’s advice and we have always used condoms when having intercourse. We have been monogamous for a year now and plan to marry in six months. When is it safe to stop using condoms? If we need testing first, what tests do you recommend?
Being tested before discontinuing condom use is a good way to be safe andto reassure yourself and your partner that neither of you has any sexually transmitted infections (STIs). It is a great way to ensure you keep healthy and to demonstrate care for your partner. If you want to be all inclusive, tests should include swabs or a urine test for Gonorrhea and Chlamydia, and blood tests for HIV, Hepatitis B, and syphilis. Also consider whether or not you need some form of contraception.
I want to be a virgin when I get married but I plan to have oral sex with my boyfriend. Do I need to use a condom to be safe from any infections?
Yes. Any type of sexual activity can put you at risk of sexually transmitted diseases (STI) including any close contact with the genital area, oral sex, anal sex and vaginal intercourse. Read more about oral sex and STIs.
My boyfriend has complained that he feels the strings of my IUD poking the end of his penis. I like the IUD but now am wondering if I need to have it removed. Can anything be done to allow me to keep the IUD?
If you have recently had the IUD inserted, this may resolve. The strings will often soften over a few weeks. However, if it is still a problem it may still be possible to keep the IUD. There are two potential options. The first is the doctor cuts the strings shorter so that the ends are just inside the opening of your cervix where they will not be felt by your boyfriend. The potential difficulty with this option is that when it comes time to remove the IUD, the strings may be difficult to find. Usually it is still possible for your doctor to remove it in his or her office. In rare cases, you may need to have it removed under anaesthetic. The second option is having the IUD removed and replaced with another, ensuring your doctor cuts the strings longer, allowing them to bend up around the cervix so that the ends will not be sticking out.
I have major fullness and pain in my breasts the week before my period. It has become so bad that it hurts to wear a bra and I cannot lie on my stomach. I have tried Ibuprofen and other over-the-counter drugs without much relief. Can anything else be done to relieve the pain?
First, you should try wearing a bra with very good support both day and night. Do this as soon as the pain starts, and you may avoid getting to the point where it hurts to wear a bra. Second, you should also ensure that you are using the Ibuprofen optimally. Take the dose recommended on the bottle as often as it allows and use it regularly to get the best effect—for instance, every four hours. In addition, consuming flaxseed, in a muffin or cereal, can also help you to decrease the pain.
Some women have less premenstrual symptoms such as breast pain when they take a hormonal birth control method like the pill, the patch, or the ring. If the pain is not relieved, you can also talk with your doctor about using a topical non-steroidal anti-inflammatory drug or other medications such as Tamoxifen or Danazol.
It hurts every time I have sex with my boyfriend. It is difficult for him to insert his penis because I am so anxious. After sex I have a burning discomfort for at least a day. What can I do?
This is not an uncommon problem and it can be treated. You may be having muscle spasms in the pelvic floor which surrounds the vagina, causing pain with penile insertion and intercourse. If this is the case, pushing yourself to have sex when it is painful may only worsen the spasms and the pain. Sometimes using lubricants or having sex in a position where you control penetration may decrease the problem. However, you should talk to your doctor who may be able to help you or may choose to send you to a gynaecologist.
Is it safe to take Plan B several times in a month?
Plan B is a form of emergency contraception that contains a progestin hormone called levonorgestrel. No form of contraception is without risk. Plan B is a safe method of emergency contraception and multiple uses may not harm you, but it is not without side effects. It is not intended for consistent use - it is meant to be used when other regular methods have failed, such as a condom breaks, or you have had an episode of unprotected intercourse. There are better methods of birth control, both hormonal and non-hormonal, which may be used on a regular basis that are more effective than emergency contraception. Talk to your doctor about your options, and visit the contraception section of this website to learn more.
