Contraception最新文献

{"title":"A systematic comparison of implementation strategies at three U.S. clinic settings that expanded access to self-administered injectable contraception.","authors":"Jennifer Karlin, Tammy Bennett, Leah Michael, Sally Rafie, Elise D Berlan","doi":"10.1016/j.contraception.2025.110972","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110972","url":null,"abstract":"<p><strong>Objectives: </strong>To describe experiences and systematically compare three U.S. clinics that initiated or expanded access to DMPA-SC for self-administration during the COVID-19 pandemic.</p><p><strong>Study design: </strong>We used the Expert Recommendations for Implementing Change (ERIC) framework to systematically compare three case studies of implementation projects that expanded use of self-administered DMPA-SC in the United States during the COVID-19 pandemic.</p><p><strong>Results: </strong>All three settings used multiple implementation strategies and common strategies fell into five main categories including 1) increasing provider awareness about self-administration of DMPA-SC and continuing education for clinical staff, 2) providing patient education and counseling tailored to patients' needs, 3) supporting changes in clinic workflow, 4) addressing insurance coverage and payment, and 5) reducing barriers to filling prescriptions for self-administered DMPA-SC. Ongoing implementation challenges identified include mitigating additional payment barriers for DMPA-SC and increasing access points beyond physical clinical sites.</p><p><strong>Conclusion: </strong>The implementation strategies described in this study may be generalizable to other settings and help US-based clinics and health care providers meet current recommendations for ensuring access to self-administration of DMPA-SC.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110972"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative performance of ultra-thin and standard latex condoms: a randomized multi-centre trial.","authors":"Frederic Esclassan, Nina Tank, Alice Switonski, Markus Steiner, Sarah Hood, Unnop Jaisamrarn","doi":"10.1016/j.contraception.2025.110970","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110970","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the performance of a natural rubber latex (NRL) condom with thickness 42 µm, compared with two currently marketed alternatives.</p><p><strong>Study design: </strong>In this blinded, three-way crossover, multi-centre study, across four sites in Thailand, couples were randomised to receive one of three thicknesses of condom (42 µm, 55 µm, or 70 µm) at first visit. Couples received the remaining condoms at visits two and three respectively. Participants were given seven condoms at each visit and asked to use at least five condoms of each thickness and report any clinical failures (slippage or breakage during intercourse or withdrawal from the vagina). Participants recorded adverse events and clinical failures within two hours of use.</p><p><strong>Results: </strong>225 couples completed the study. Clinical failure rates were 1.37% (95% confidence intervals [CI] 0.78, 2.22) in the 42 µm group, 2.12% (95% CI 1.38, 3.11) in the 55 µm group and 1.68% (95% CI 1.03, 2.58) in the 70 µm group. The 42 µm condom was non-inferior compared with each of the reference condoms and had a similar safety profile.</p><p><strong>Conclusions: </strong>This ultra-thin, NRL condom of <50 µm has been clinically tested to current International Organization for Standardization (ISO) standards. The 42 µm condom was as effective as the 55 µm and 70 µm condoms, demonstrating that performance in terms of failure rate, slippage, or breakage was not altered by its thinness.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110970"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing digital sexual and reproductive health tools: challenges and recommendations post-Dobbs.","authors":"Lisa S Callegari, Elizabeth A Mosley, Sonya Borrero, Mehret Birru Talabi, Traci M Kazmerski, Greer Donley, Tamar Krishnamurti","doi":"10.1016/j.contraception.2025.110969","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110969","url":null,"abstract":"<p><p>Abysmal sexual and reproductive health (SRH) outcomes in the United States persist due to multiple factors, including diminishing SRH care access and inequities in care for socially or economically marginalized populations. Digital innovations have the potential to address gaps in SRH care as scalable, low-cost, patient-centered solutions that supplement the formal healthcare system. Our multidisciplinary team has developed a suite of patient-facing digital tools to help address suboptimal SRH care delivery for marginalized individuals capable of pregnancy, including those with chronic medical conditions. These tools-MyPath for reproductive preferences, prepregnancy health, and contraception; MyVoice for SRH needs of people with rheumatic/autoimmune disease or cystic fibrosis; MyDecision for tubal sterilization; and MyHealthyPregnancy for tailored pregnancy support-are guided by principles of community engagement, person-centeredness, and health equity. In the wake of the Dobbs v. Jackson Women's Health Organization 2022 Supreme Court decision overturning federal abortion protections, as well as the rapidly shifting policy landscape under the current administration, there are new considerations for use and implementation of digital SRH tools. In this commentary, we draw directly from lessons learned in our work to discuss emerging concerns related to data privacy and pregnancy criminalization, trust in healthcare providers and systems, and research. We then propose recommendations for researchers seeking to create, implement, and evaluate these tools with the goal of safeguarding reproductive autonomy and achieving health equity in this new policy context.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110969"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating FemTech App Regulation in Switzerland: Challenges and Opportunities from a Public Health Perspective.","authors":"Marie-Hélène Peter-Spiess, Dylan Hofmann","doi":"10.1016/j.contraception.2025.110975","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110975","url":null,"abstract":"<p><p>This article examines the Swiss legal framework governing FemTech applications (apps), particularly those dedicated to fertility tracking. It explores the challenges and opportunities associated with regulating these apps from a public health perspective, oriented towards the health of the collectivity rather than that of individuals alone. While these technologies hold great potential, they also raise various critical concerns. Against this background, this article considers ways to improve the current legal framework to better protect all stakeholders while promoting public health outcomes. By addressing the complex interplay between technological innovation and state responsibility, including the roles of governmental and regulatory bodies, this piece aims to explore ways to maximize the opportunities offered by FemTech while ensuring public well-being.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110975"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smooth Muscle Relaxants for Intrauterine Device Placement: A Systematic Review.","authors":"Emily M Snyder, Gopika Krishna, Lauren B Zapata, Antoinette T Nguyen, Maura K Whiteman, Kathryn M Curtis","doi":"10.1016/j.contraception.2025.110971","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110971","url":null,"abstract":"<p><strong>Objectives: </strong>To systematically review evidence on whether medications with smooth muscle relaxant properties improve patient and provider outcomes for intrauterine device (IUD) placement.</p><p><strong>Study design: </strong>We searched multiple databases through August 2022 for randomized clinical trials assessing smooth muscle relaxants for IUD placement. Primary outcomes were pain experienced with IUD placement, provider ease of placement, need for adjunctive placement measures, placement success, patient satisfaction with procedure, medication side effects occurring before clinic discharge, and adverse events occurring before clinic discharge. We extracted data from included articles, assessed risk of bias for each trial, narratively summarized results, and determined certainty of evidence for all outcomes.</p><p><strong>Results: </strong>Five trials met inclusion criteria; four trials had low risk of bias and one had moderate risk. Two trials of topical nitroprusside gel or nitroglycerin ointment found no differences in patient pain, provider ease of placement, patient satisfaction, placement success, side effects, or adverse events. One trial suggested that drotaverine plus mefenamic acid reduced patient pain but did not improve placement success. Two trials suggested that isonicotinic acid hydrazide reduced patient pain, improved provider ease of placement and patient satisfaction, reduced need for analgesia and for cervical dilation (in one trial) and did not increase side effects; neither trial reported improved placement success.</p><p><strong>Conclusions: </strong>Evidence on smooth muscle relaxants for IUD placement remains sparse with inconsistent findings across specific medications. Certainty of evidence for all outcomes was low for topical nitroprusside gel and nitroglycerin ointment, very low for drotaverine plus mefenamic acid, and mostly high for isonicotinic acid hydrazide.</p><p><strong>Implications: </strong>Before IUD placement, healthcare providers can counsel patients on the potential for pain during placement and options for pain management. However, more evidence is needed on specific smooth muscle relaxants to determine their effectiveness as an intervention for IUD placement.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110971"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abortion experiences of individuals with a history of trauma(s): A qualitative study.","authors":"Kristen Chalmers, Diana Marino-Nunez, Candice Norcott, Danielle Young, Julie Chor","doi":"10.1016/j.contraception.2025.110973","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110973","url":null,"abstract":"<p><strong>Objective: </strong>Individual trauma is highly prevalent among reproductive age individuals who can become pregnant. We sought to elicit perspectives of individuals with a history of trauma about their abortion experiences, trauma-activating factors in abortion care, and how to optimally incorporate trauma-responsive principles into abortion care.</p><p><strong>Study design: </strong>Patients with a self-identified history of three types of trauma (sexual assault, interpersonal violence, adverse childhood experience) were recruited from family planning clinics in the Chicago-area to participate in semi-structured phone interviews. Qualitative data was analyzed using ATLAS.ti.</p><p><strong>Results: </strong>Analysis of thirty interviews identified trauma-activating factors and trauma-responsive strategies throughout the abortion experience. Participants reported that, pre-abortion, restricted access and limited options activated trauma-related feelings of autonomy loss and a desire for unbiased information. During procedures, participants described how physical pain/discomfort and healthcare professional use of insensitive language worsened their experience. In contrast, use of neutral language, warnings prior to touch, proper draping, and checking-in and offering options helped mitigate effects of prior history of trauma(s). Post-procedurally, participants desired mental health support specifically addressing abortion-related stigma, though this resource was rarely available.</p><p><strong>Conclusions: </strong>Throughout abortion care, numerous opportunities exist to help mitigate or activate trauma responses among individuals with a history of trauma. These opportunities exist at the level of the individual provider as well as the level of the clinic, and must be considered to fully address the needs of individuals seeking abortion who have experienced prior trauma(s).</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110973"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provider confidence & willingness to insert & remove LARC methods in Kenyan public facilities.","authors":"Katherine Tumlinson, Stephanie Chung, Brooke W Bullington, Dickens Otieno Onyango, Leigh Senderowicz, Abigael Mwanyiro, Ben Wekesa, Brian Frizzelle, Ginger Golub, Claire W Rothschild, Emilia Goland","doi":"10.1016/j.contraception.2025.110956","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110956","url":null,"abstract":"<p><strong>Objective: </strong>Use of long-acting reversible contraception (LARC) in Kenya has grown over the last decade, yet emerging evidence points to challenges in LARC removal. The objective of this paper is to document provider training in LARC insertion/removal and to better understand provider experience, confidence, and willingness to both insert and remove LARC.</p><p><strong>Study design: </strong>In this paper we present a descriptive analysis of self-reported data from family planning providers working in all 137 public-sector healthcare facilities in Kisumu County (Western Kenya). We assess the frequency of public-sector provider training, experience, confidence, and willingness to insert and remove LARC, as well as the association between confidence and willingness to provide these services.</p><p><strong>Results: </strong>A substantial proportion of providers in our study lacked training in the insertion and removal of both implants and IUDs. Overall, providers reported that they were more experienced, confident, and willing to insert implants rather than remove them. A fifth of providers trained in IUD insertion were not confident in their ability to insert IUDs and nearly 10% were not willing to perform insertion. In contrast, 8% of providers trained in IUD insertion were not confident in their ability to remove IUDs and 6% were not willing to remove them. Provider confidence was significantly associated with willingness to insert/remove both implant and IUD. Less than two-thirds of facilities demonstrated stock of the implant (61%) or IUD (58%).</p><p><strong>Conclusion: </strong>Results raise important concerns about reproductive autonomy within the larger environment of family planning programs that heavily promote LARC use. Within Kisumu, public-sector providers require greater supplies and support to maintain confidence and ensure their willingness to engage in LARC insertion and removal in equal measure.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110956"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous electrical nerve stimulation (TENS) for pain control during first-trimester procedural abortion: a blinded randomized controlled trial.","authors":"Andrea Henkel, Erica P Cahill, Sonia Chavez, Jade M Shorter, Serena M Liu, Stephanie I Amaya, Simranvir Kaur, Kate A Shaw","doi":"10.1016/j.contraception.2025.110955","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110955","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) to manage pain during first-trimester procedural abortion for those not eligible for or otherwise forgoing sedation.</p><p><strong>Study design: </strong>This is a double-blinded, block-randomized superiority trial (IRB approved, NCT05320432) comparing TENS (placed posteriorly, T10-L1 and S2-S4) to sham for pain management during first-trimester procedural abortion. We enrolled pregnant people less than 12 weeks gestation, English- or Spanish-speaking at two outpatient clinics not receiving sedation. The primary outcome was self-reported pain by visual analog scale (VAS, 100 mm) with passage of largest cervical dilator. We planned to enroll 70 patients to detect a 15 mm difference in median pain score (80% power, α = 0.05).</p><p><strong>Results: </strong>Between January 2023 and March 2024, we enrolled 70 participants. Baseline demographics were balanced between groups: median (range) gestational duration 6 (5-11) weeks, 35.7% nulliparous. Median (range) reported pain with passage of largest dilator was 44mm (0-88) and 50mm (0-96) in the TENS and sham groups, respectively (p=0.56). We did not find a difference in median pain at any collected time point including placement of tenaculum, paracervical block, aspiration, or recovery. The active TENS group was more likely to say they would recommend this method of pain control to others (94mm vs 73mm, p=0.01). More participants receiving TENS unit correctly identified their group allocation (91.4% vs 63.6%, p<0.001).</p><p><strong>Conclusion: </strong>While we did not demonstrate a difference in pain scores during the procedure, TENS is a non-pharmacologic alternative that may improve patient experience during uterine aspiration.</p><p><strong>Implications: </strong>In a blinded randomized trial, the median pain scores reported during first-trimester procedure abortion did not differ between those receiving TENS or sham. However, those randomized to TENS were more likely to say they would recommend this method of pain control. For those with contraindications to IV sedation, improved experience may justify consideration of offering TENS during first-trimester abortion care.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110955"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First trimester suction aspiration without septum resection for trasverse vaginal septum: a case report.","authors":"Abraham Fessehaye Sium, Gebresilassie Andualem Asmare","doi":"10.1016/j.contraception.2025.110954","DOIUrl":"https://doi.org/10.1016/j.contraception.2025.110954","url":null,"abstract":"<p><p>A 27 years-old G2 Para1 patient with a known uterine didelphys presented at 11 weeks of gestation with 3 days of vaginal bleeding. Evaluation demosnstrated a fetal demise and a thin transverse vaginal septum with a central dimple. We successfully performed a mannual vacuum aspiration without septoplasty by dilating the dimple with vacuum cannulas.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110954"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating emergency contraception efficacy with levonorgestrel and copper intrauterine devices.","authors":"Susan E Nourse, Alexandra L Woodcock, Kathryn S Brown, Alexandra Gero, Lori M Gawron, David K Turok","doi":"10.1016/j.contraception.2025.110946","DOIUrl":"10.1016/j.contraception.2025.110946","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine observed vs expected pregnancy risk among levonorgestrel 52 mg and copper T380A intrauterine device (IUD) emergency contraception (EC) users.</p><p><strong>Study design: </strong>This is a secondary analysis of participants seeking EC randomly assigned to a levonorgestrel 52 mg or copper T380A IUD. Participants had at least one episode of unprotected intercourse (UPI) in the 5 days preceding enrollment and reported all episodes in the preceding 5 days. We report the proportion of pregnancies prevented of those expected at 1 month following IUD insertion using an established approach that assigns pregnancy risk by menstrual cycle day of intercourse. We calculated proportion of pregnancies prevented using both the day of most recent UPI and all reported UPIs within 5 days of presentation.</p><p><strong>Results: </strong>One pregnancy occurred among the 312 participants who received the levonorgestrel 52 mg IUD, with 137 (43.9%) reporting multiple episodes of UPI. No pregnancies occurred among the 318 participants who received the copper IUD, of whom 142 (44.6%) reported multiple episodes. In the levonorgestrel 52 mg IUD group, 14.8 pregnancies were expected using the most recent episode of UPI, and 22.0 pregnancies were expected using all episodes within 5 days of presentation. In the copper IUD group, we calculated 15.0 and 23.1 expected pregnancies, respectively. Levonorgestrel 52 mg IUDs prevented 93.2% to 95.7% of expected pregnancies, and copper IUDs prevented 100% of expected pregnancies.</p><p><strong>Conclusions: </strong>The results of this analysis provide additional data quantifying the pregnancy risk reduction for both the levonorgestrel 52 mg IUD and copper IUD in a realistic population of EC users.</p><p><strong>Implications: </strong>The levonorgestrel 52 mg IUD for emergency contraception prevented 93% to 96% of expected pregnancies using an established pregnancy risk method, while copper IUD users experienced 100% pregnancy prevention.</p>","PeriodicalId":93955,"journal":{"name":"Contraception","volume":" ","pages":"110946"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}