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Endometriosis in the adolescent has, in recent years, been discovered to be a challenging problem in gynaecology. Although the pain may start at a young age, even before the onset of menstruation, the diagnosis by laparoscopy is almost always postponed for several years, by which time destructive lesions have affected the tubo-ovarian structures and severely compromised fecundability. Several factors may play a role, but one important reason for this disease progression is likely to be the delay in diagnosis. Therefore, transvaginal ultrasounds and transvaginal access with a less invasive needle endoscopy are recommended for exploration of the pelvis, diagnosis of endometriosis and treatment at an early stage before severe lesions develop. [ABSTRACT FROM AUTHOR]

The article focuses on the health dimension of sexual behavior. A background is provided on the focus given to efforts for the prevention and control of sexually-transmitted infections (STI). The concept of sexual and reproductive health is presented from the International Conference on Population and Development in Cairo in 1994 to the subsequent broadening of the concept. Variant sexual behaviours are discussed including the relationship between hetero- and homo-sexuality and its ethical aspects from the perspective of Christianity, Islam and Judaism.

The article discusses the findings of a study that examines the different factors that influence human sexual behavior. It references research conducted by the La Sapienza University Department of Obstetrics and Gynecology in Rome, Italy and explains key concepts of human sexuality derived from other scientific and religious literature. The study proposes that humans have attributed a wider meaning to sexuality beyond the norms of tradition, ethics, and religion. This article also highlights the social and ethical determinants of sexuality with discussions on conceptive sexuality, the impact of sexuality on health, and tolerance for variant sexual behavior.

Emergency contraception (EC), also known as 'the morning after pill', or post-coital contraception, is a modality of preventing the establishment of a pregnancy after unprotected intercourse. Both a hormonal and an intrauterine form are available. Modern hormonal EC, with low side effects, was first proposed by Yuzpe in 1974. More recently, a new regimen, consisting of levonorgestrel administered alone, was introduced and found in clinical trials to be more effective (if taken as early as possible), and associated with less side effects than the Yuzpe regimen, which it has gradually replaced. The WHO developed another regimen based on the use of the selective progesterone receptor modulator (antiprogestin) mifepristone and conducted trials with different dosages. Intrauterine EC was first proposed by Lippes in 1976. It has the advantage of being applicable for almost a week and the disadvantage of a greater complexity. In addition, this modality is solely interceptive, acting by preventing implantation. Pregnancy rates reported following EC using an intrauterine device with more than 300 mm2 of copper are consistently low (0.1-0.2%). [ABSTRACT FROM AUTHOR]

Objective To evaluate the reason for requesting emergency contraception (EC), previous use of contraceptive methods and provision route in a Family Planning Clinic in Italy. Methods Women requesting EC were interviewed, through a questionnaire containing questions on demographic characteristics, about their reasons for requesting EC, their prior contraceptive use, their reasons for not using an effective contraceptive method (or possible reasons for its failure) and specifically about the so-called ‘provision route’ (i.e. whether and where they had previously requested EC receiving a negative response). Results Almost 70% of all women requesting EC were aged between 18 and 25 years. Some 80% of all women were in a stable relationship with their partner, with fewer than 20% having had an occasional intercourse. The vast majority of women (83%) reported prior use of a modern contraceptive method, i.e. 64% with a condom, 27% for combined oral contraceptives and 1.1% for the intrauterine device (IUD). In addition, 15% of the women had used more than one method (oral pills and condoms). Concerning the reasons for requesting EC, condom breakage or slipping was the most frequently cited (64%), followed by totally unprotected intercourse (28%), failed withdrawal (5%) and forgetting one or more pill (only 1.1%). Conclusions More than one-third of the women interviewed had previously used an emergency contraceptive modality; although no one did so more than four times. Therefore, it can be inferred that—at least in the present series—EC had not been used as a routine contraceptive method. Finally, it seems clear that in Italy, even in large cities, information about the availability, proper usage and mechanism of action is lacking. This seems due to information being spread by word of mouth between peers and friends, with more formal communication channels lagging behind. [ABSTRACT FROM AUTHOR]

The term progestogen has been widely utilized to indicate the general class of agents that includes both progesterone and its synthetic analogs, whereas the term progestin refers only to synthetic progestational steroids. The development of progestins has been influenced in a major way by the search for orally active hormonal contraceptives, since it is likely that hormonal contraceptives will continue to utilize a progestin, the only possible alternative being represented by the utilization of antiprogestins. Synthetic progestogens in clinical use today belong to three main chemical families: progesterone derivatives (progesterone, retro-progesterone, 19-norprogesterone and 17α-hydroxyprogesterone); gonane and 19-nortestosterone derivatives (norethisterone, levonorgestrel, desogestrel, gestodene, norgestimate); a spironolactone derivative. Biological potency of progestogens varies depending on the end-point measured, usually ovulation inhibition and endometrial transformation; with both these tests, the most active compounds are all gonane derivatives, with a potency over a 100 times that of the natural hormone. When administered in adequate doses, a progestin inhibits fertility by inhibiting ovulation. This action is mainly exerted at the hypothalamic level where, physiologically, progesterone decreases the number of LH pulses. When progestogens are delivered directly to the uterine cavity, their action seems to be purely local. It has been amply proven that - even when administered in doses that do not constantly inhibit ovulation - a progestin can still remain effective as a contraceptive by acting at the level of the cervical mucus and, at least in part, of the endometrium. Progestogens utilized today differ largely in their pharmacokinetics. In general, after intake, these compounds are rapidly absorbed and distributed so that peak serum concentrations are reached between 1 and 4 h. Third-generation progestins (desogestrel, gestodene, norgestimate) have common characteristics: a higher affinity for progesterone receptors than their predecessors, a lower affinity for androgen receptors, a higher selectivity of action, a higher central inhibitory activity, a higher potency at the level of the endometrium, and an overall metabolic neutrality, in terms of effects on lipid and carbohydrate metabolism. In general, progestins can induce two types of adverse effects: changes in lipid metabolism and bleeding irregularities. Whereas the newer compounds seem to have overcome the first of these adverse effects, the second remains untouched: to this day, proper cycle control can only be achieved with combined hormonal contraceptives. [ABSTRACT FROM AUTHOR]

Over the last twenty years the international community—realizing that the tragedy of women dying during pregnancy and in childbirth could no longer be tolerated—launched a series of initiatives aimed at making safe motherhood a cornerstone of health services in all countries. Making pregnancy and delivery safe events is particularly complex, as it involves infrastructural and logistic, as well as technical, issues. Women die because they have no access to skilled personnel during pregnancy and at the time of delivery and because—if an emergency situation arises—they cannot reach a facility where emergency obstetric services are available. FIGO, the International Federation of Obstetrics and Gynecology—as the only global organization representing the Obstetricians of the world—decided some time ago that it could not limit its activities to proposing technical guidelines and debating scientific issues. It had to move into the field and, through its affiliated societies, help change the ability of the multitude of women in the developing world to obtain skilled attendance at birth. In 1997, plans were made to launch activities in five areas where maternal mortality was particularly high: Central America (Guatemala, Honduras, Nicaragua and El Salvador), Ethiopia, Mozambique, Pakistan, and Uganda. Five member societies from the developed world (the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Italian Society of Obstetrics and Gynecology, the Royal College of Obstetricians and Gynecologists of the United Kingdom; and the Swedish Society of Obstetrics and Gynecology) agreed to provide support to their counterparts in these five selected areas. The project is now in its final stage. Results are, by and large, positive, demonstrating that, by motivating health professionals in the field and for a relatively modest financial outlay, more efficient use of existing services could be made in a sustainable fashion to save lives. [Copyright &y& Elsevier]

The article reports on the application of condoms for the prevention of HIV and other sexually transmitted diseases. The effectiveness of properly used latex condoms has been recorded and confirmed that undamaged condoms served as a safe, physical barrier against HIV. However, the availability and accessibility of these contraceptives remained a problem in many parts of the world.

The article discusses the history of benign reproductive tract disorders, such as adenomyosis and endometriosis. Harvard University pathologists conducted a study in 1950s that detailed the different features of the neonatal endometrium and found that in most of the case the endometrium is in an indifferent or proliferative phase at birth.

The relatively short history of hormonal contraception has been marked by a series of 'pill scares', all of which-after creating panic among users- were proven to be unfounded in terms of public health impact. The latest pill scare, provoked by regulatory action in the United Kingdom and the Federal Republic of Germany in response to the publication of a series of articles indicating a doubling of risk of deep venous thrombosis in users of oral contraceptives containing third-generation progestins, seems finally settled: both the British and the German Drug Regulatory Authorities have now reverted their verdict. The damage unfortunately stays: hundreds of thousands of women have been compelled to abandon the pill of their choice, often deciding to drop contraception altogether, thereby exposing themselves to unwanted pregnancy and-in a number of cases -to pregnancy termination. This latest episode should be turned into something positive: we need to learn that, in the case of drugs in widespread use, before restrictive action is taken-and except for very rare and specific instances-the scientific community must carry out an exhaustive debate on the reality and importance of the observed effects. Although the public should, in each instance, be properly informed, it is only after this process has been completed that restrictive action should be taken. It is hoped that, after this last episode, all concerned have learned this simple principle and will accept being guided by it from now on. [ABSTRACT FROM PUBLISHER]

The history of endometriosis is reviewed in the light of today's clinical and pathological knowledge of this disease. Prior to Sampson's report in 1921, attention was focused on the enclosed type of endometriosis, sited deep in the pelvis and called adenomyosis externa. Sampson's first hypothesis, that rupture of an ovarian endometrioma caused superficial peritoneal endometriosis, was probably changed after this observation that the free, superficial peritoneal implants reacted like eutopic endometrium. These implants were recognized as implants from menstrual blood regurgitated into the pelvic cavity. Adenomyosis externa, ovarian endometrioma and peritoneal endometriosis then came to be regarded as the same disease. In the light of today's knowledge, it may be important to remember this progressive understanding in the nosology of what is now universally called pelvic endometriosis. [ABSTRACT FROM PUBLISHER]

Progestasert devices releasing 65 μg of [14C]progesterone daily were inserted in 10 women 3 months prior to elective hysterectomy. Following surgery, specimens were examined by light and electron microscopy and by autoradiography. In three uteri, removed during the early follicular phase, there was a clear contrast between the appearance of the superficial portion of the endometrium in the zone immediately adjacent to the device, when compared to areas away from the progestasert. This difference became more pronounced in four specimens obtained at mid-cycle and tended to diminish during the luteal phase: the number of glands was still lower than normal, but stromal decidual reaction was apparent throughout the functional layer of endometrium; in addition, in portions away from the device, glands showed the characteristics of a secretory phase. Progesterone and/or its metabolites were abundant in the superficial epithelium and in the portion of the glands adjacent to the surface; and also well distributed in the stroma and in the capillary walls. Historadiography however, clearly showed that progesterone barely penetrated the deeper portion of the endometrium. This picture does not substantially change during the entire cycle [ABSTRACT FROM PUBLISHER]

Progestasert devices releasing 65 micrograms of [14C]progesterone daily were inserted in 10 women 3 months prior to elective hysterectomy. Following surgery, specimens were examined by light and electron microscopy and by autoradiography. In three uteri, removed during the early follicular phase, there was a clear contrast between the appearance of the superficial portion of the endometrium in the zone immediately adjacent to the device, when compared to areas away from the progestasert. This difference became more pronounced in four specimens obtained at mid-cycle and tended to diminish during the luteal phase: the number of glands was still lower than normal, but stromal decidual reaction was apparent throughout the functional layer of endometrium; in addition, in portions away from the device, glands showed the characteristics of a secretory phase. Progesterone and/or its metabolites were abundant in the superficial epithelium and in the portion of the glands adjacent to the surface; and also well distributed in the stroma and in the capillary walls. Historadiography however, clearly showed that progesterone barely penetrated the deeper portion of the endometrium. This picture does not substantially change during the entire cycle. [ABSTRACT FROM AUTHOR]

Objective: Assessment of the capacity of Glycodelin A (GdA) to modulate the aggregation of cultured human umbilical vein endothelial cells. Methods: Highly purified Glycodelin A (GdA) from late first trimester amniotic fluid has been added to cultured cells and its biological activity has been observed with immunofluorescent staining of β-catenin molecules. Results: GdA induces translocation of β-catenin molecules promoting cell-to-cell adhesion and formation of adherents junctions through cytoskeletal reorganization. Conclusion: These data provide further mechanistic insight into the specificity of cell-to-cell adhesion, thus corroborating the role of GdA in promoting angiogenesis. [ABSTRACT FROM AUTHOR]

Abstract: FIGO's priority is to address the barriers of clinicians to respond to violence against women through the use of advocacy, training and services. [ABSTRACT FROM AUTHOR]

FIGO's priority is to address the barriers of clinicians to respond to violence against women through the use of advocacy, training and services. [ABSTRACT FROM AUTHOR]