INTRODUCTION:We describe bleeding and cramping patterns during the first 90 days after intrauterine device (IUD) placement. METHODS:This was a planned sub-analysis of a prospective cohort study of IUD users in the United States who initiated the copper T380A (Cu-IUD) or the levonorgestrel 52 mg intrauterine device (LNG IUD) at any time in the menstrual cycle. Participants rated bleeding and cramping from 1 (no bleeding or cramping) to 4 (heavy bleeding or severe cramping). We included participants providing ≥ 60 days of continuous responses and described overall bleeding/cramping. RESULTS:Of 230 participants enrolled, 137 (60%) met inclusion criteria (Cu-IUD n = 69, 50% and LNG IUD n = 68, 50%). Cu-IUD users reported fewer days with any bleeding (26 days, IQR 18-31) compared with LNG IUD users (38 days, IQR 27-55, p < 0.001). LNG IUD users reported more spotting days (median 31 [IQR 17-41] vs. 13 [IQR 10-20], p < 0.01). Total bleeding/spotting days were similar for each IUD type regardless of placement timing or prior contraceptive method. Median reported cramping days were similar for both IUDs (Cu-IUD 18, IQR 7-29 and LNG IUD 18, IQR 10-38, p = 0.18). Cramping was most common in the week following placement for both IUD types, decreased over the 90-day period, and did not vary by IUD type. CONCLUSION:LNG IUD users reported more days with any bleeding in the first 90 days after placement overall compared with Cu-IUD users, largely driven by more than twice the number of spotting days. Cramping was most common in the first week following IUD placement and decreased over time. TRIAL REGISTRATION:Clinicaltrials.Gov Identifier: NCT01730911.
INTRODUCTION:A life course perspective on sexual activity is gaining attention due to increased longevity and the relationship between health and sexual behavior. Building on Lindau's and Gavrilova's concept of sexually active life expectancy, we examine how including non-partnered sexual behaviors and satisfaction influences sexual life expectancy by gender in France. METHODS:We estimate sexually active life expectancy using Sullivan's method, which integrates life table data from the 2023 vital registration with sexual activity prevalence from the CSF-2023 French national survey. We also calculate a quality-adjusted sexually active life expectancy that accounts for sexual satisfaction. Finally, we identify sociodemographic and health factors related to having a satisfying sexual activite life among individuals aged 50-89. RESULTS:A 20-24-year-old man has a sexually active life expectancy of 47.1 years, compared to 44.5 years for a woman. This figure expands to 52.9 years for men and 48.9 years for women when including masturbation. The gender gap narrows when considering sexual satisfaction, with men losing 11 years and women 8 years of sexual life expectancy due to poor sexual satisfaction. Among individuals aged 50-89, the gender gap in being sexually active and satisfied narrows from OR = 0.64 [0.57-0.72] after adjusting for age to OR = 0.76 [0.67-0.87] after further adjustments for partnership status, health, and sociodemographics. CONCLUSION:This study enhances population-level indicators of sexual health by broadening the understanding of sexuality beyond partnered behaviors. It reveals significant gender differences in sexual experiences throughout the life course, which lessen when considering sexual quality.
OBJECTIVE:The study's purpose was to determine the safety of two routes and doses of digoxin through assessment of systemic absorption, cardiac rhythm, and coagulation parameters injected as part of second-trimester dilation and evacuation abortion. METHODS:We randomized pregnant women between 19 and 23 weeks' gestation to receive either 1.5 mg digoxin through intra-amniotic injection (IAI) or 1.0 mg through intrathoracic injection (IFI). We measured subjects' serum digoxin levels and coagulation indices over 48 h post-injection and cardiac rhythm monitoring for 24 h. RESULTS:Ten patients in each group completed the study. All injections caused fetal demise within 24 h. In the IAI group, mean (±SD) digoxin peak concentration in the IAI group was 1.5. ±0.72 (range 0.7-2.9 ng/mL); in the IFI group 1.4 ± 0.74 ng/mL (range 0.5-2.4 ng/mL). Mean (±SD) time to peak digoxin level in the IAI group was 10.7 ± 8.5 h (range, 1-24 h); in the IFI group 1.5 ± 0.97 h (range, 1-4 h, p < 0.01). Five patients had laboratory-defined critical digoxin levels of uncertain significance. Cardiac rhythm monitoring showed no digoxin-associated rhythm or conduction abnormalities. Prothrombin and partial thromboplastin time levels remained normal in both groups. CONCLUSION:Neither 1.5 mg IAI nor 1.0 mg IFI of digoxin administered to induce fetal demise was associated with adverse maternal cardiac outcomes or coagulation parameter changes. Serum levels reflected significant digoxin absorption in both groups, generally resulting in maximum digoxin concentration peaks in the low therapeutic range. Injecting digoxin to cause fetal demise in abortion care appears safe and effective.
OBJECTIVE:Few studies have examined how abortion referrals occur in settings that criminalize or restrict most abortion care. We aimed to document how Wisconsin obstetrician-gynecologists (OB-GYNs) facilitated abortion care for patients while practicing under the threat of a criminal ban following the elimination of federal abortion rights protection. METHODS:We recruited 21 OB-GYNs from diverse practice settings in virtual interviews between September and December of 2023. Interviews explored experiences providing pregnancy care and facilitating abortion under institutional policies both before and following threatened enforcement of a state criminal abortion law. Investigators coded and analyzed data using a combined inductive-deductive approach. RESULTS:We identified three themes regarding how Wisconsin OB-GYNs facilitated abortion under a statewide ban. First, physicians faced legal fog and lack of institutional guidance, leading to highly varied referral practices. Second, the lack of robust referral pathways had negative impacts for both physicians and patients. Third, many physicians were left to patch together their own abortion referral systems, leading to unique physician burdens. CONCLUSIONS:While abortion services were unavailable, Wisconsin's systems to facilitate abortion for patients were inadequate or absent, leaving OB-GYNs with informal and unconventional means to help patients access care within-and across-state lines. In settings where abortion is banned or severely restricted, referrals may rely heavily on healthcare institutional-level referral pathways and patient navigation systems. In such settings, institutions should help facilitate timely abortion access for patients and ease burdens on physicians by establishing and supporting robust referral systems and patient-centered navigation services.
INTRODUCTION:Digital technologies have reshaped relationships and sexual practices, both in terms of sexual well-being and through the emergence of cyberharassment. However, evidence remains limited, however, on how these practices vary by gender, generation, sexual orientation, and social position. This article aims to describe the frequency of online sexual experiences and their correlates in a large national sample. METHODS:The study draws on CSF-2023, a cross-sectional survey of sexuality in France. The sample comprises 15,906 individuals aged 18-59 who reported information on their online practices. We analyze the frequency of these experiences and their associations with gender, generation, sexual orientation, and educational level, using univariate and multivariate analyses. RESULTS:Men reported online sexual experiences more often than women (58% vs. 46%). Sending intimate images was reported by 21% of women and 25% of men, and receiving them by 28% and 33% respectively. These practices were more frequent among younger respondents and among people who had same-sex partners, with older generations having taken them up later in life. A marked gender contrast emerged for negative experiences: while they affected 19% of women and 17% of men aged 18-59, the gap widened sharply among 18-29-year-olds (33% of women vs. 25% of men). Single women and people in poor health were more exposed; among men, risk was highest for those who had same-sex partners and a low level of education. CONCLUSION:Digital practices can be positive, but they can also lead to harmful exposure with deleterious effects, which particularly affect young women. There is a need to develop lifelong education about these new forms of intimate exchange, together with support measures for people confronted with these new forms of sexual violence.
PURPOSE:The United States Supreme Court case Dobbs v. Jackson Women's Health Organization overruled federal protections for abortion in 2022. Young adult Black women (YABW) are expected to be among those most impacted directly by abortion restrictions and indirectly by effects on broader sexual and reproductive health access. This study assessed the extent to which this population anticipates negative impacts of the ruling. METHODS:A nationwide convenience sample of 500 YABW 18-22 years participated in an online sexual and reproductive health survey in November-December 2023. Participants rated the extent to which they anticipated negative impacts of Dobbs on five domains: their sex life and decisions related to prescription contraception, emergency contraception, sexually transmitted infection testing, and abortion. We used multivariable analyses including ordinal logistic regression to examine participant characteristics associated with anticipated negative impacts. RESULTS:Half of participants (51%-59%) anticipated at least some negative impact of the Dobbs ruling across the five domains, and 19% reported high levels of anticipated negative impact. Greater odds of a high anticipated impact score were associated with awareness of the Supreme Court decision prior to participation (aOR = 2.00, 95% CI [1.09-3.83]) and medical mistrust (aOR = 1.71, 95% CI [1.22-2.40]). DISCUSSION:These findings can inform the development of targeted support for YABW in the post-Dobbs landscape, which may include education on reproductive care options that remain legally available and culturally responsive care that fosters patient trust in the health care system within the current policy environment.
OBJECTIVE:While most people in the United States obtain abortion care in outpatient settings, such facilities may limit care for some individuals because of a variety of conditions. The situations when abortion care cannot be obtained in the outpatient setting have not been evaluated, leaving a deficit in understanding the need for hospital-based abortion care. METHODS:We obtained outpatient abortion facility care protocols from the Society of Family Planning #We Count project, which, in January 2024, invited participating organizations with outpatient physical facilities to share their protocols for determining when patients were unable to be cared for in their facility(ies). Using summative content analysis, we identified health conditions for which a patient could be deemed ineligible, organizing individual conditions thematically and, as appropriate, by organ system. RESULTS:We analyzed 20 unique protocols. Protocols delineated ineligibility for temporary conditions (e.g., fever), conditions specific to current pregnancy (e.g., placenta previa), conditions related to the patient's reproductive history or conditions (e.g., history of uterine surgery), and chronic conditions (e.g., hypertension). Protocols varied in quantity of limiting conditions (range: two to 26 conditions) and most frequently included limits to outpatient care for heart disease (15 [75%]), bleeding conditions (15 [75%]), seizure disorders (15 [75%]), hypertension (13 [65%]), anemia (12 [60%]), and asthma (11 [55%]). The definitions for a given condition as a limit for care frequently varied between protocols. CONCLUSIONS:US outpatient abortion clinics commonly define limitations to outpatient care, but the specific limiting conditions and their criteria vary substantially across protocols.
BACKGROUND:Many people living along the Appalachian mountain region, which spread down the eastern side of the United States, experience limited access to abortion care and report high levels of distrust in health care providers. Therefore, Appalachians are likely to have a unique lens through which to view the use of self-managed abortion. The purpose of this study is to better understand Appalachians' perceptions of self-managed abortions. METHODS:Data was collected via an online survey. Participants were recruited by trusted community partners and boosted ads on social media. Inclusion criteria included pregnancy-capacity, 18+ years old, living in an Appalachian county, and having a history of either considering or attempting self-managed abortion. Open-ended responses were coded using deductive thematic analysis guided by our theoretical framework. RESULTS:Participants [N = 159] representing every Appalachian state responded to the survey. Three themes were identified: (1) self-managed abortion is often a decision made in the absence of choice but can be empowering within these constraints, (2) anticipating failure: the expectation of failure and health complications for those using self-managed abortion, and (3) connection with others is critical to having a more positive self-managed abortion experience. CONCLUSIONS:These findings reveal that self-managed abortion is often pursued not out of preference but due to barriers such as cost, legal restrictions, stigma, or lack of access to clinical care. Improving access to accurate information, emotional support, and follow-up care could greatly enhance confidence in the safety of abortion and improve the well-being of those seeking abortion care in Appalachia.
INTRODUCTION:Abortion scholars treat the timing of care as an important measure of access. Despite the legacy of medical mistreatment of Black people, few studies have explored the racialized relationship between medical trust and when abortion care is obtained. We examined how differences in healthcare provider trust impact the timing of receiving abortion care. METHODS:In 2020-2021, we invited people seeking abortion care in West Virginia, Kentucky, and Ohio to complete an electronic survey. We assessed the prevalence of general healthcare provider trust and abortion provider trust and examined associations among race, trust, and timing of obtaining abortion care. RESULTS:Respondents who reported that they did not trust the last healthcare provider they saw for an issue other than the abortion (8% of respondents) were more likely to have a second trimester abortion (odds ratio (OR): 1.74, 95% confidence interval (CI): 1.00-3.06). This association was stronger for Black respondents (OR: 2.63, 95% CI: 1.27-5.47). Not trusting the abortion provider was uncommon (1% of respondents) and was not significantly associated with the timing of obtaining abortion care (OR: 1.24, 95% CI: 0.28-5.42). CONCLUSIONS:Not trusting the last healthcare provider was associated with receiving abortion care later than those who did trust their last provider. More research is needed to fully understand the nuanced relationship between race, trust, and delays in abortion care.
