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 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Female genital mutilation (FGM) is often associated with African and Muslim women, but dealing with its aftermath is a public health concern in the United States. There are several different types of mutilation, which are demonstrated with drawings. FGM is primarily practiced and enforced by women and has cultural significance. FGM is practiced in the United States among some immigrant groups, and women who have immigrated here often need specialized medical care as a result of the mutilation. The most extreme form of FGM is called infibulation which involves removal of all outside genitalia and near closure of the vaginal opening. Infibulated women often must be cut to allow intercourse and childbirth, and are sometimes re-infibulated after delivery, often after each child. Women who have had FGM suffer from a number of serious health complications, including anemia, chronic pelvic infections, infertility, abscesses and keloids, sexual dysfunction, menstrual disorders, urinary problems, and complications in pregnancy and childbirth. The psychological consequences have not been well studied. FGM can cause vaginal lacerations during intercourse, and anal intercourse is common in affected couples. The lacerations and anal intercourse raise concerns about HIV transmission in these women and also from the practice of performing FGM on a group of girls with the same unsterile tools. FGM is being re-introduced in the United States by some immigrant communities, and health care providers need to be sensitive to the needs of affected women. Several issues related to the need for cultural sensitivity are discussed.
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PMID:Female genital mutilation: not just over there. 1136 40

This paper examines the association between traditional practices of female genital cutting (FGC) and adult women's reproductive morbidity in rural Gambia. In 1999, we conducted a cross-sectional community survey of 1348 women aged 15-54 years, to estimate the prevalence of reproductive morbidity on the basis of women's reports, a gynaecological examination and laboratory analysis of specimens. Descriptive statistics and logistic regression were used to compare the prevalence of each morbidity between cut and uncut women adjusting for possible confounders. A total of 1157 women consented to gynaecological examination and 58% had signs of genital cutting. There was a high level of agreement between reported circumcision status and that found on examination (97% agreement). The majority of operations consisted of clitoridectomy and excision of the labia minora (WHO classification type II) and were performed between the ages of 4 and 7 years. The practice of genital cutting was highly associated with ethnic group for two of the three main ethnic groups, making the effects of ethnic group and cutting difficult to distinguish. Women who had undergone FGC had a significantly higher prevalence of bacterial vaginosis (BV) [adjusted odds ratio (OR)=1.66; 95% confidence interval (CI) 1.25-2.18] and a substantially higher prevalence of herpes simplex virus 2 (HSV2) [adjusted OR=4.71; 95% CI 3.46-6.42]. The higher prevalence of HSV2 suggests that cut women may be at increased risk of HIV infection. Commonly cited negative consequences of FGC such as damage to the perineum or anus, vulval tumours (such as Bartholin's cysts and excessive keloid formation), painful sex, infertility, prolapse and other reproductive tract infections (RTIs) were not significantly more common in cut women. The relationship between FGC and long-term reproductive morbidity remains unclear, especially in settings where type II cutting predominates. Efforts to eradicate the practice should incorporate a human rights approach rather than rely solely on the damaging health consequences.
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PMID:The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey. 1155 30

Confidentiality is arguably the most frequent source of ethical dilemmas for counsellors of all types, but especially those working within or alongside multidisciplinary teams in clinical settings. Infertility counsellors fall within this category and are frequently faced with difficult decisions about what issues to treat as strictly confidential to the counselling relationship and when to disclose information to other members of the clinical team. This article examines the professional parameters within which infertility counsellors make these decisions under the Human Fertilisation and Embryology Authority (HFEA) Code of Practice. These parameters place considerable reliance on the professional judgement of the counsellor, which raises the issue of how best to conceptualize these dilemmas. The second part of this article examines how some counsellors working in a closely related field, namely HIV counselling, have ameliorated this dilemma by distinguishing ethical stances appropriate to different circumstances. The positive response of participants at the British Infertility Counselling Association Conference at the Tavistock Centre in London on 25 May 1999 suggests that this type of ethical framework would be useful for informing the ethical decision-making of these counsellors and developing a positive appreciation of ethical diversity of practice within the multidisciplinary team. The final sections of this article examine these potential applications.
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PMID:Issues of confidentiality in fertility counselling. 1184 88

Mycoplasma genitalium was first isolated from men with non-gonococcal urethritis (NGU) more than 20 years ago. Use of polymerase chain reaction technology has shown it to be a cause of acute NGU and probably chronic NGU, almost independently of Chlamydia trachomatis, but there is no substantial evidence that it causes acute or chronic prostatitis. In women, M. genitalium is not associated with bacterial vaginosis, but it is strongly associated with cervicitis and endometritis and serologically with salpingitis and tubal factor infertility. Further studies may show M. genitalium to be associated, perhaps causally, with epididymoorchitis, neonatal disease and reactive arthritis. Furthermore, its potential for enhancing HIV transmission needs to be explored. M. genitalium is susceptible to various broad-spectrum antibiotics, but M. genitalium-associated diseases are probably best treated with azithromycin.
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PMID:Mycoplasma genitalium -- an up-date. 1186 Jun 89

This article describes the nature and extent of sexually transmitted diseases (STDs) in South Africa, the spread of STDs, and recommended STD prevention and control approaches. Gonorrhea, chlamydia, syphilis, and chancroid are in the top 25 causes of healthy days of life lost in sub-Saharan Africa. In South Africa, an estimated 40% of women attending family planning clinics were diagnosed with an STD. 15% of women attending prenatal clinics in urban areas had latent syphilis. The World Bank estimates that over 3 million in South Africa, are infected with at least 1 STD/year. 1 in 10 sexually active persons in South Africa, may be infected with an STD every year. STDs cause morbidity, infertility, abortions, ectopic pregnancies, stillbirths, prematurity, and cervical cancer. The presence of a genital ulcer increases the risk of AIDS up to tenfold. The presence of a urethral or vaginal discharge increases the AIDS risk fivefold. An estimated 1200 HIV infections could be prevented over the next 10 years by curing or preventing 100 cases of syphilis. In 1995, 1 in 10 women who attended prenatal clinics was infected with HIV. The incidence of STDs among women are underestimates due to the greater chance that women are without STD symptoms or may be embarrassed to report symptoms. High rates of urbanization are linked to 9 factors that contribute to the spread of AIDS. STD prevention programs should create awareness, provide accessible and user-friendly services integrated within primary health care, provide simple and effective STD management, and detect/manage STD carriers.
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PMID:Urbanisation and the epidemic of sexually transmitted diseases in South Africa. 1217 2

A majority of the nations that took part in the 1994 International Conference on Population and Development in Cairo, Egypt, agreed to the Conference's Program of Action. The Cairo Program of Action stresses the rights of couples and individuals with respect to reproductive health care and family planning. The Roman Catholic Church has expressed its opposition to the Program by conducting a campaign of obstruction directed against the implementation of parts of the Cairo agenda--mainly and specifically those dealing with sexual and reproductive rights. The progressive reproductive health measures that church officials have opposed have included the broadening of sexuality education programs, the expansion of prevention programs on HIV/AIDS and other sexually transmitted diseases, and an end to discrimination against disabled persons with regard to reproductive rights and family formation. This pattern of consistent opposition is reflected in the encyclical Evangelium Vitae (The Gospel of Life) of the Pope. In it he condemns, among other things, contraception, and treatment of infertility.
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PMID:Barring the way. 1217 98

Reproductive health (RH) is defined as all health events related to reproduction in the life cycle. Its components include family planning, postabortion care, safe pregnancy and safe motherhood, reproductive tract infections, sexually transmitted diseases, HIV/AIDS, RH services for adolescents, maternal and infant nutrition, cancer of the reproductive tract, infertility, female genital mutilation, and gender-based violence. This paper presents a review of the prevailing RH situation in Bangladesh. Despite improvements in some aspects of health, the RH situation in Bangladesh still remains unsatisfactory. This situation is reflected in the unacceptably high rates of maternal and child mortality and morbidity in the country. Although significant success has been achieved in the decline of fertility and increase in contraceptive prevalence rate, the population growth rate is still high. Adolescent RH is also becoming an important issue. Added to the high rates of premarital and extramarital sex among male and female adolescents are concerns related to early marriage and teenage pregnancy. While the HIV/AIDS situation remains under control, there exists a potential threat of spreading the fatal disease rapidly. The government of Bangladesh has officially adopted the International Conference on Population and Development definition of RH and developed a comprehensive plan of action in light of the recommendations of the conference. The policies and programs of the government of Bangladesh addressing RH issues are discussed.
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PMID:A review of reproductive health situation in Bangladesh. 1217 57

Despite great improvements in preventing and treating sexually transmitted diseases (STDs) and reproductive tract infections (RTIs), including HIV/AIDS, infections have been increasing significantly throughout the world. The problem of STDs, RTIs, and HIV/AIDS among women aged 15-49 years is increasing at an alarming rate. Certain biological risk factors and cultural practices enhance the vulnerability of women of reproductive age. Among these biological risks are age, gender, blood transfusion during pregnancy and childbirth, and the development of asymptomatic STDs/RTIs. These are exacerbated by cultural practices like douching with pharmaceutical products, use of intravaginal substances, and the practice of anal sex. STDs, RTIs, and HIV/AIDS affect female reproductive health in certain ways: mother-to-child transmission, effects on pregnancy (spontaneous abortion, premature birth, stillbirth, low birth weight, ectopic pregnancy), infertility, cancer, and rise in AIDS-related mortality. On the other hand, society will experience an increase in orphans, destabilization of the family unit, and a reduction in family income. Considering the impact of these diseases on the reproductive health of women and the community, measures should be taken to prevent and control the epidemic. The paper discusses certain interventions and diagnostic and preventive strategies against STDs, RTIs, and HIV/AIDS.
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PMID:Sexually transmitted diseases (STD) / reproductive tract infections (RTI) including acquired immunodeficiency syndrome (AIDS) / human immunodeficiency virus (HIV) infections among the women of reproductive age group: a review. 1217 60

Sexually transmitted diseases (STDs) constitute an epidemic of tremendous magnitude, with an estimated 15 million persons in the United States acquiring a new STD each year. Effective clinical management of STDs is a strategic common element in efforts to prevent HIV infection and to improve reproductive and sexual health. Sexually transmitted diseases may result in severe, long-term, costly complications, including facilitation of HIV infection, tubal infertility, adverse outcomes of pregnancy, and cervical and other types of anogenital cancer. The publication of national guidelines for the management of STDs, by the U.S. Centers for Disease Control and Prevention (CDC), has been a key component of federal initiatives to improve the health of the U.S. population by preventing and controlling STDs and their sequelae. This paper presents new recommendations from the 2002 CDC Guidelines for the Treatment of Sexually Transmitted Diseases in the context of current disease trends and public health.
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PMID:U.S. Centers for Disease Control and Prevention guidelines for the treatment of sexually transmitted diseases: an opportunity to unify clinical and public health practice. 1218 16

This article provides a general discussion of a variety of different features of HIV infection and the not widely accepted concept of preconception counseling. The focus is on testing, counseling and counselors, infertility clinics, promotion of awareness, attitudes to HIV testing, education, parameters for counseling, the risk of coitus and the value of contraceptive usage in the presence of HIV, accurate and understandable information, attitudes of children, legal significance, and the effect of disaster on the family and relationships. The author is concerned with the need to provide testing facilities, and prepregnancy testing. The risk of HIV infection adds to the importance of planned pregnancy and counseling in family planning and selecting appropriate methods. Informed and responsible decisions require adequate consideration of all the issues and information currently available. Preconceptual counseling clinics tend to be small in number, but the health care professionals serving the population in need must be well educated in the knowledge of obstetrics and the behavior of HIV infection/AIDS. Infertility clinics are one potential source of contact with those at high risk of HIV. A national campaign to emphasize the need to seek advice on family planning for those at risk of HIV is necessary in countries where HIV is widespread. Preconception counseling is possible only after there is awareness of risk of HIV infection and the risks of pregnancy. Confounding policies for testing and counseling are attitudes of politicians and officials which may reflect the general welfare rather than individual welfare or public opinion and attitudes of pressure groups which may not reflect the general welfare. 2 issues are of concern: that risk by accurately assessed, and terms like safe sex avoided. The following understandable information needs to be provided; a woman's risk with an HIV positive husband, a woman's pregnancy risk, a father's risk with an HIV infected partner, the fetal risk (estimated at 30%), prognosis for an infected child, the effect on family of having an infected child, possible cures/effective treatment in the future, the effect of relationships and parents work/life, the possibility of an orphaned child or loss of a parent, adverse effects of factors on pregnancy, the relevance of any treatment, and children's welfare with harmful parent lifestyles. Counselors must be aware of the influence of race, religion, class, and the pressures in prostitution for unprotected sex. Legal issues may arise between parent and child, or in counselor negligence. Caring for a handicapped child and the nature of discrimination against those with AIDs must be approached openmindedly. An informed decision must be an available option.
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PMID:HIV and preconceptional counselling. 1228 44


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