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Background: Over half of adolescents are sexually active by age 18 years and represent half of sexually transmitted infections (STI). These individuals often do not obtain routine medical care, so discussing contraception at each visit becomes imperative. Our study objectives were to determine the frequency of visits before contraception was discussed/initiated, and to assess factors affecting primary care contraception provision., Methods: A retrospective chart review (January 2009-June 2019) was conducted for preventive, follow-up, and sick visits; Title X confidential visits were excluded. Questions were asked about method at start and end of the visit. Nonparametric median tests for continuous variables and chi-squared tests for categorical variables assessed for differences for patient age, race, gender, insurance type, visit type, and provider gender. The institutional review board approved the study as exempt., Results: Patients (n = 12,619; median = 15 years; 58% female) were seen in primary care clinic. Providers asked about contraception for 82% of visits, and averaged 3 visits before contraception was discussed. For patients asked about contraception, 60% were using a contraceptive method, 15% left the visit on a new method (24.9% long-acting reversible contraception [LARC]). For patients not using contraception, 39.9% left the visit on a method. Patients asked about contraception were female, older, Hispanic, had public insurance, and were seen by female providers (P < .001). Follow-up/sick visits represented <20% of patients asked about contraception., Conclusions: Multiple visits occur before contraception is discussed in adolescent primary care, and factors including age, race, and gender affect these discussions. Strategies to increase contraception discussions at all visits is essential, as adolescents do not always present for yearly visits., (Copyright © 2020 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Background: Cervicitis is widespread, but no studies have examined cervicitis in accordance with established guidelines for diagnosis and treatment. Study objectives were to describe adherence to Centers for Disease Control and Prevention guidelines for diagnosis and treatment of cervicitis within an adolescent population and to compare factors associated with adherence to guidelines in a primary care setting and the Emergency Department., Methods: Data were collected as part of a retrospective chart review of evaluation, diagnosis, and treatment of STI in adolescent women in an outpatient setting. Participant charts were eligible for review if they were 12-21 years of age and were given an ICD-9 and chart diagnosis of cervicitis. Two primary outcome variables: meeting cervicitis guidelines and correct treatment among those meeting cervicitis guidelines (no/yes) were utilized; the study controlled for age, race, venue, past infection with chlamydia or gonorrhea., Results: Subjects (n = 365) were examined for the primary outcome variables and 75.1% (274/365) met at least one criterion for cervicitis. Of these, 166 (60.9%: 166/274) subjects were found to meet criteria for cervicitis alone, versus subjects meeting criteria for both cervicitis and pelvic inflammatory disease (PID) (39.4%: 108/274). The majority, 89.3%, (326/365) were treated for both chlamydia and gonorrhea, but only 64.7% (211/326) were treated correctly for both infections., Conclusions: Our findings suggest that knowledge deficits exist in diagnosis and treatment of cervicitis in adolescent patients and in differentiating between cervicitis and PID. Educational tools, simulated patient exercises, and order sets may be warranted for quality improvement to allow for improved care of this at risk sexually active population., (Copyright © 2011 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Study Objective: The study sought to expand the minimal understanding of the prevalence of gynecological symptoms, such as vulvovaginal pain, pelvic cramps, and vaginal discharge, and the prevalence of the relationship of symptom duration to event-level sexual behaviors., Design: Data were daily diaries collected from an ongoing, longitudinal cohort with the three symptom variables, Main Outcome Measures: Symptom duration was calculated, and event-level sexual behaviors were included., Results: It was reported with relative frequency that single symptoms had positive and negative effects, whereas multiple symptoms and long duration of symptoms decreased the likelihood of all noncoital sexual behaviors., Conclusions: Gynecological symptoms influence the likelihood of sexual behaviors, suggesting a complex relationship between the occurrences., (Copyright 2010 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

Study Objective: Contraceptive withdrawal, or coitus interruptus, is a widespread method in adolescents, but factors affecting usage have not been longitudinally investigated. Study objectives were to examine usage numbers of withdrawal among a group of sexually active adolescent females and to investigate the influence of personal, partner, and family factors on usage patterns., Design/setting/participants: Subjects (N=387; 14 to 17 years at enrollment; 92% African American) were recruited from primary care adolescent health clinics in areas with high rates of pregnancy and sexually transmitted infection. As part of a larger longitudinal study, subjects contributed face-to-face quarterly and annual questionnaires assessing contraceptive behavior, recent sexual behaviors, as well as partner- and family-based attitudes/beliefs. INTERVENTIONS, MAIN OUTCOME MEASURES: The outcome variable was: withdrawal use during the previous 12 weeks (no/yes); predictor variables included 19 individual, family and partner variables. All models additionally controlled for any current hormonal use (no/yes; any method), current condom use (no/yes) and past withdrawal use (past 30 days; no/yes). Logistic regression, with GEE estimation to adjust for repeated within-subject observations, was performed in SUDAAN, 9.0., Results: Subjects supplied 1632 quarterly interviews; withdrawal was mentioned in about 25% of the interviews (392/1632). Controlling for primary contraceptive method, withdrawal was mentioned in 13.2% (51/307) of interviews with hormonal methods, in 32.4% (255/787) of the interviews with condoms and in 4.7% (78/1632) of interviews with no method. Current hormonal use was associated with a decreased likelihood of also using withdrawal (OR=0.34), whereas past withdrawal use increased the likelihood of current withdrawal by about 4-fold (OR=4.18). Condom use was not associated with withdrawal use. Current withdrawal use was more likely with a more diverse sexual repertoire (OR=1.65), more sexual partners in the past 3 months (OR=1.46), higher sexual control (OR=1.15), lower perceived STI risk (OR=0.46), higher sexual self-efficacy (OR=1.24), lower sexual coercion (OR=0.56) higher condom negativity (OR=1.16), living with a boyfriend (OR=2.17) and lower family sexual health support (OR=0.88)., Conclusion: Contraceptive withdrawal in adolescents should not be considered 'rare.' Careful clinical consideration of usage within the context of other contraceptive behaviors, sexual behaviors/attitudes, and relationship issues could better inform effective contraceptive counseling efforts.