Abstract Study Objective Although underutilized, the vaginal contraceptive ring has several advantages over other contraceptive methods that could benefit adolescents. We examined factors that may ...influence willingness to try the vaginal ring including: sexual and contraceptive history, genital comfort, and vaginal ring characteristics. Design Cross sectional Setting Midwestern adolescent health clinics Participants Adolescent women (N = 200; 14–18 years; 89% African-American) Interventions/Main Outcome Measures All participants received education about the vaginal ring and viewed pictures demonstrating insertion; they then completed a visual/audio computer-assisted self interview. The primary outcome variable, willingness to try the vaginal ring, was a single Likert-scale item. Results Over half the participants reported knowledge of the vaginal ring with healthcare providers identified as the most important source of contraceptive information. Comfort with one’s genitals, insertion and removal, using alternative methods of insertion, and knowing positive method characteristics were significantly associated with willingness to try the vaginal ring. A decreased willingness to try the vaginal ring was related to concerns of the ring getting lost inside or falling out of the vagina. Conclusions Willingness to try the ring was associated with positive feelings about genitals (e.g., comfort with appearance, hygiene, function). Thus, to increase willingness to try the vaginal ring among adolescents, providers should make it common practice to discuss basic female reproductive anatomy, raise awareness about female genital health and address concerns about their genitals. Providers can offer alternative insertion techniques (e.g., gloves) to make use more accessible. These strategies may increase vaginal ring use among adolescents.
Abstract Purpose Structural discrimination is associated with negative health outcomes among sexual minority populations. Recent changes to state-level and national legislation provide both the ...opportunity and the need to further explore the impact of legislation on the health indicators of sexual minorities. Using an ecosocial theory lens, the present research addresses the relationship between structural support or discrimination and satisfaction with one's health care provider among sexual minority women. Methods Data were drawn from an online survey of sexual minority women's health care experiences. Using the Andersen Behavioral Model of Health Services Utilization to operationalize the variables in our model, we examined the relationship between state-level nondiscrimination legislation and satisfaction with provider—a widely used measure of health care quality—through regression analysis. Findings Participants in structurally supportive states (i.e., those with nondiscrimination legislation) were more likely to disclose their sexual identity to their providers and to report higher satisfaction with their providers. The absence of nondiscrimination legislation was associated negatively with satisfaction with providers. Conclusions Results of our study show that the external environment in which sexual minority women seek health care, characterized by structural support or lack thereof, is related to perceived quality of health care.
Abstract Study Objective Contraceptive withdrawal, or coitus interruptus, is a widespread method in adolescents, but factors affecting usage have not been longitudinally investigated. Study ...objectives were to examine usage numbers of withdrawal among a group of sexually active adolescent females and to investigate the influence of personal, partner, and family factors on usage patterns. Design/Setting/Participants Subjects (N = 387; 14 to 17 years at enrollment; 92% African American) were recruited from primary care adolescent health clinics in areas with high rates of pregnancy and sexually transmitted infection. As part of a larger longitudinal study, subjects contributed face-to-face quarterly and annual questionnaires assessing contraceptive behavior, recent sexual behaviors, as well as partner- and family-based attitudes/beliefs. Interventions, Main Outcome Measures The outcome variable was: withdrawal use during the previous 12 weeks (no/yes); predictor variables included 19 individual, family and partner variables. All models additionally controlled for any current hormonal use (no/yes; any method), current condom use (no/yes) and past withdrawal use (past 30 days; no/yes). Logistic regression, with GEE estimation to adjust for repeated within-subject observations, was performed in SUDAAN, 9.0. Results Subjects supplied 1632 quarterly interviews; withdrawal was mentioned in about 25% of the interviews (392/1632). Controlling for primary contraceptive method, withdrawal was mentioned in 13.2% (51/307) of interviews with hormonal methods, in 32.4% (255/787) of the interviews with condoms and in 4.7% (78/1632) of interviews with no method. Current hormonal use was associated with a decreased likelihood of also using withdrawal (OR = 0.34), whereas past withdrawal use increased the likelihood of current withdrawal by about 4-fold (OR = 4.18). Condom use was not associated with withdrawal use. Current withdrawal use was more likely with a more diverse sexual repertoire (OR = 1.65), more sexual partners in the past 3 months (OR = 1.46), higher sexual control (OR = 1.15), lower perceived STI risk (OR = 0.46), higher sexual self-efficacy (OR = 1.24), lower sexual coercion (OR = 0.56) higher condom negativity (OR = 1.16), living with a boyfriend (OR = 2.17) and lower family sexual health support (OR = 0.88). Conclusion Contraceptive withdrawal in adolescents should not be considered ‘rare.’ Careful clinical consideration of usage within the context of other contraceptive behaviors, sexual behaviors/attitudes, and relationship issues could better inform effective contraceptive counseling efforts.
Abstract Study Objective The study sought to expand the minimal understanding of the prevalence of gynecological symptoms, such as vulvovaginal pain, pelvic cramps, and vaginal discharge, and the ...prevalence of the relationship of symptom duration to event-level sexual behaviors. Design Data were daily diaries collected from an ongoing, longitudinal cohort with the three symptom variables Main Outcome Measures Symptom duration was calculated, and event-level sexual behaviors were included. Results It was reported with relative frequency that single symptoms had positive and negative effects, whereas multiple symptoms and long duration of symptoms decreased the likelihood of all noncoital sexual behaviors. Conclusions Gynecological symptoms influence the likelihood of sexual behaviors, suggesting a complex relationship between the occurrences.
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