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  • Title: [Contraception and sexuality].
    Author: Kahn-nathan J.
    Journal: Cah Sexol Clin; 1987; 13(77):58-63. PubMed ID: 12342527.
    Abstract:
    Earlier age at menarche, a longer reproductive life, and fewer desired births have been factors in the increasing importance of contraception in the life of women and couples. This work assesses the optimal contraceptive methods for different physiological phases of affective and sexual life and for various sexual problems. Contraception should prevent pregnancy, not promote sexually transmitted diseases and disorders of the genital tract, and preserve future fertility. The 1st gynecological consultation, even for very young girls, has 3 main objectives: detecting anomalies of the genital tract, ensuring that no physiological problems will arise in the 1st intercourse, and providing contraception if it will be needed in the relatively near future. The physician should speak directly to the young patient instead of to her mother. Hormonal contraception is preferred for adolescents with regular sexual activity, but for the majority who have episodic and irregular sexual relations other methods may be preferable. Condoms provide some protection against sexually transmitted diseases but require cooperation from the male partner. Vaginal sponges which can be left in place for 24 hours are easier to use than other vaginal methods. The "morning after" pill is available in case of unprotected coitus. The unplanned and unstable sexuality of adolescents is increasingly followed by a period of regular and continuous premarital sexual relations requiring reliable and continuous contraception. The pill remains the best choice for its efficacy, tolerance, and safety. Various formulations are available in case of contraindications to the classic combined pill. IUDs should be formally contraindicated because of the possibility of extrauterine pregnancy or salpingitis. Mechanical methods can be used for short periods but should not replace a more effective method on a permanent basis. The IUD may be a good choice for women who have completed their families. Oral contraceptives may be continued for premenopausal women without other cardiovascular risk factors. High dose progestins derived from 17 hydroxyprogesterone are recommended in case of luteal insufficiency. Premenopausal women whose sexual relations have become less frequent may prefer IUDs, local methods, or tubal ligation. Sexual difficulties of couples should be considered in selecting a method. Frigid women do not tolerate contraception well because fear of pregnancy is their excuse for avoiding sex. IUDs may be more satisfactory than pills in such cases because they do not require daily action. Pills may be the best choice in cases of premature ejaculation or impotence.
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