News Highlights
Past Oral Contraceptive Use has no Effect on Mortality in Women with Breast Cancer
Women with breast cancer who have used the oral contraceptive pill (OCP) are not at a greater risk of dying from the disease than women who never used the OCP, new studies suggest.
The amount of time since first use, age at first use, or use of specific pill formulation also pose no greater threat to the survival of women diagnosed with breast cancer.
The findings were the result of two U.S studies that were linked, the Cancer and Steroid Hormone Study (CASH) conducted from 1980-82, and the Surveillance Epidemiology and End Results (SEER) cancer registry data. Overall, oral contraceptive use had neither a harmful nor beneficial effect on breast cancer mortality.
Women between the ages of 20 and 54 who were diagnosed with breast cancer between December of 1980 and 1982 were given a standardized interview that focused on reproductive, contraceptive, and disease histories, as well as personal characteristics and behaviours.
Wingo PA et al. Oral contraceptives and the risk of death from breast cancer. Obstet Gynecol. 2007; 110:793-800
Sexual activity and health among older Americans
A recent study looked at the prevalence of sexual activity, behaviors, and problems in elderly U.S. citizens, and described the association of these variables with age and health status. The national probability sample included 3005 adults (1,550 women and 1,455 men) between the ages of 57 and 85.
Among respondents who were sexually active, about half of both men and women reported at least one bothersome sexual problem. Men and women who rated their health as being poor were less likely to be sexually active and, among respondents who were sexually active, were more likely to report sexual problems.
The most prevalent sexual problems among women were:
- low desire (43%);
- difficulty with vaginal lubrication (39%);
- and inability to have an orgasm (34%).
Among men, the most prevalent sexual problems were erectile difficulties (37%). Fourteen percent of all men reported using medication or supplements to improve sexual function.
Women were less likely than men at all ages to report sexual activity, and the prevalence of sexual activity among both genders declined with age:
- 73% among respondents who were 57 to 64 years of age;
- 53% among respondents who were 65 to 74 years of age;
- and 26% among respondents who were 75 to 85 years of age.
An accompanying editorial noted that despite the high prevalence of sexual problems among the participants in this study, only 38% of men and 22% of women reported discussing sex with a doctor since the age of 50 years. Until recently, older adults tended to keep quiet about their sexuality because younger people assumed that they were not and should not be sexually active. Now the pendulum has swung, and the emphasis is increasingly on the sexuality of older adults and the provision of medical treatment to help it.
Health care providers were encouraged to choose a middle ground in discussions about sexual health with aging patients – offering counseling or medication if the couple desires help, but accepting the sexual changes of aging if they fit with the individual’s lifestyle and wishes.
Lindau ST. et al. A study of sexuality and health among older adults in the United States. NEJM 2007; 357(8):762-74 Bancroft JH. Sex and aging. NEJM 2007; 357(8):820-2
FOR HEALTH PROFESSIONALS
The Mirena IUS reduces menstrual cramps and bleeding due to adenomyosis
Adenomyosis is a gynecological disorder involving endometrial glands and stroma abnormally located deep within the muscle layers of the uterus.
This causes painful and heavy menstrual periods, and is often not diagnosed until medical therapies have failed and a woman elects to have a hysterectomy. The diagnosis is then confirmed when the uterus is examined (pathology).
Magnetic Resonance Imaging (MRI) is a fairly accurate non-invasive way to diagnose adenomyosis. A recent study followed adenomyosis (MRI diagnosed) in women who had painful heavy menstrual periods at baseline and six months after Mirena insertion. Visual analogue scale (VAS) pain scores decreased from a mean of approximately 8/10 at baseline down to 2/10 at both 3 and 6 month follow-up visits.
All women had a significant decrease in menstrual flow and most women had spotting or amenorrhea by six months. Reduction in MRI estimated adenomyosis lesion size was observed in 26/29 subjects with a mean decrease of 24% in thickness of the junctional zone between endometrium and myometrium. Overall uterine volume was not significantly reduced. This study adds to our understanding of how the levonorgestrel intrauterine system (Mirena®) benefits women with painful heavy periods.
Bragheto AM et al. Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging. Contraception 2007; 76:195-199
Do you know what the age of consent is? Do you have to give your name to get an HIV/AIDS test?
There’s a lot people don’t know about the legalities of sex in Canada. That’s why sexualityandu is featuring a new article, Sex and the Law.
Know your rights. Click here to read Sex and the Law.
Ask Sexualityandu
If you are on the pill and have sex without a condom during your seven sugar pill days, or while you are on your period, does the pill become less effective and increase your pregnancy chances and why?
Absolutely not. The pill, when taken properly, is extremely effective for contraception. Sexual activity in the pill-free week does not increase the risk of pregnancy. The risk of pregnancy does increase if two or more pills are missed in the first or last week of the 21 active pills.
If my boyfriend uses a flavoured condom for intercourse will it give me an infection?
No. If you are experiencing some irritation you should see if the same problem occurs after using a non-flavoured variety. It is possible that you have a sensitivity to latex, the material that most condoms are made from. If this is possible try using a non-latex condom. Ask your pharmacist for help in selecting one.
I take a prostate pill which has decreased the number of times I have to run to the bathroom. But I feel the pill has affected my sex drive. Would you give me answer on this subject?
Medical treatments for enlargement of the prostate include alpha1 adrenergic blocking drugs such as prazosin and 5-alpha reductase inhibitors such as finasteride.
The most important side effect with prazosin is lightheadedness when standing suddenly but occasionally men may report decreased ejaculate because the ejaculate goes backward into the bladder (so-called retrograde ejaculation).
Finasteride blocks the conversion of testosterone to the more potent dihydrotestosterone. This reduces the levels of male hormones that stimulate prostate growth. It has a very low risk of side effects and few interactions with other medications, but in clinical trials 2% of patients stopped using finasteride because of adverse sexual side effects which included a decrease in the volume of ejaculate, impotence and decreased libido.
Surgery is the only alternative to medical therapy for benign enlargement of the prostate, however, it also carries risks for sexual side effects such as retrograde ejaculation.
FAQS FOR HEALTH PROFESSIONALS:
True or False: Use of an intrauterine device increases the prevalence of bacterial vaginosis.
False. Bacterial vaginosis can be found in up to one third of women. Most cases are asymptomatic. The fact that it may be found in 15% of women with no history of sexual intercourse indicates that it is not exclusively a sexually transmitted infection. The IUD does not increase the risk for this condition.
[Allsworth JE et al. Prevalence of bacterial vaginosis. 2001-2004 National Health and Nutrition Examination Survey Data. Obstet Gynecol 2007; 109(1): 114-120]
If a woman becomes pregnant while taking the combined oral contraceptive, is the risk for fetal abnormalities increased above the baseline population riskk?
Modern oral contraceptives have not been shown to increase the risk of any congenital anomaly. Some pills containing first generation progestins such as norethisterone (derived from testosterone) were shown to result in masculinization of the genitalia of the female fetus.
Under what circumstances may women with high blood pressure use combined oral contraception?
High blood pressure is not an absolute contraindication to use of an oral contraceptive, but it is a relative contraindication. If the blood pressure is controlled with medication or if the blood pressure ranges from 140-159/90-99 oral contraceptives may be considered as an option if potential benefits outweigh potential risks. Uncontrolled hypertension is an absolute contraindication to combined hormonal contraceptive methods (pills, patches, and rings).
Methods: Low-dose combined oral contraceptives (COCs) p.5 in Medical Eligibilty Criteria for Contraceptive Use 3rd ed. Geneva: WHO; 2004.
