Objective To determine the prevalence and associated risk factors of pelvic lesions in apparently normal Thai women undergoing laparoscopic tubal sterilization at Siriraj Hospital. Study design Retrospective descriptive study. Setting Siriraj Reproductive Health Research Center, WHO collaborating center for research in human reproduction, Faculty of Medicine Siriraj Hospital, Mahidol University. Materials and Methods Case recorded forms of 1,700 women who had normal pelvic examination and underwent laparoscopic tubal sterilization at the center during 1984-2002 were reviewed. Result Of 1,700 women, 276 (16.24%) had at least one pelvic lesion. The most common abnormality was tubal lesions (9.94%), followed by ovarian lesions (3.94%), uterine myoma (2.82%), and endometriosis and/or pelvic adhesion (2.24%). Factors associated with an increased risk for pelvic lesions included age, obesity, abortion, dysmenorrhea, and duration of menstruation. Conclusion It is not uncommon to discover various pelvic lesions during laparoscopic tubal sterilization in Thai women with normal pelvic examination. Although all of the lesions were benign and seemed to have no clinical significance, the information from this study would be useful for counseling, which is one important step of patient care.
Objective To investigate the contraceptive efficacy, safety and acceptability of a new single-rod, progestogen-only contraceptive implant (Implanon®).Methods In an open, non-comparative pilot study, 100 healthy women received a contraceptive implant containing the progestogen etonogestrel (3-ketodesogestrel) for 2 years with an optional extension up to 4 years.Results Subjects were exposed to Implanon for 296.1 woman-years. There were no pregnancies during the study. Per 90-day reference period, the median number of bleeding-spotting days was 10 and the median number of bleeding-spotting episodes was 2. Amenorrhea occurred in 24–39% of subjects during the first 2 years and in about 20% in those who continued in the 3rd and 4th years. The most common drug-related adverse event was headache (7%). A slight increase in body mass index was observed. Only a few subjects discontinued treatment early, due to bleeding irregularities (6%) or amenorrhea (1%). The cumulative discontinuation rates were 13.4% after 2 years, 25.3% after 3 years and 28.0% after 4 years of use. Within 3 months of implant removal, six normal pregnancies occurred, indicating a rapid return of fertility. The average time taken for insertion of the implant was 0.5 min, compared with 2.5 min for removal.Conclusions Implanon demonstrated excellent contraceptive efficacy and was well tolerated during up to 4 years of use. The vaginal bleeding pattern was variable and was characterized by relatively few bleeding events, but proved acceptable to most subjects. Because of its single-rod design, Implanon was quickly inserted and removed without complications.
Abstract The use of depot‐medroxyprogesterone acetate (DMPA), a long‐acting progestational contraceptive, in relation to risk of epithelial ovarian cancer was examined in a hospital‐based case‐control study conducted in Mexico and Thailand. Women with histologically confirmed epithelial ovarian cancer (n = 224) diagnosed between 1979 and 1988 were compared with hospital controls (n = 1,781) matched on age, hospital and year of interview. Overall, 9.8% of cases and 12.9% of controls had ever used DMPA. The relative‐risk (RR) estimate in women who had ever used DMPA, controlling for the confounding effects of number of live births and oral contraceptive use, was 1.07 (95% CI 0.6, 1.8). No consistent patterns of increasing or decreasing risk were noted according to duration of use, time since first or most recent use or age at first use of DMPA. These results suggest that the risk of epithelial ovarian cancer is not altered by the use of DMPA.
The male condom is the most effective barrier method available for protection against sexually transmitted diseases (STDs), including HIV infection. There is an urgent need to develop and evaluate other prevention methods, such as the female condom. This study estimated the additional protection against STDs offered to sex workers by giving them the option of using the female condom when clients refused to use a male condom.Sex establishments in four cities in Thailand were randomized into two study groups: one in which sex workers were instructed to use male condoms consistently (male condom group); and one in which sex workers had the option of using the female condom if clients refused or were not able to use male condoms (male/female condom group). Randomization was done by sex establishments, and not by individuals, to minimize sharing of female condoms across study groups. The proportion of unprotected sexual acts (defined as sexual acts in which condoms were not used, tore, or slipped in or out) and incidence rate of STDs (gonorrhoea, chlamydial infection, trichomoniasis and genital ulcer disease) were measured over a 24-week period and compared between the two study groups.Results are available from 34 sex establishments (249 women) in the male/female condom group, and 37 sex establishments (255 women) in the male condom group. Condom use was very high in both groups (97.9 and 97.3 % of all sexual acts, respectively, P > 0.05). Male condom use was lower in the male/female condom group when compared with the male condom group (88.2 and 97.5%, respectively, P < 0.001). However, this reduction in male condom use was counterbalanced by the use of female condoms in 12.0% of all sexual acts in the male/female condom group, contributing to a 17% reduction in the proportion of unprotected sexual acts in this group when compared to the male condom group (5.9 versus 7.1%, respectively, P = 0.16). Female condom use was sustained over the entire study period. There was also a 24% reduction in the weighted geometric mean incidence rate of STDs in the sex establishments of the male/female condom group compared to the male condom group (2.81 versus 3.69 per 100 person-weeks, P = 0.18).
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