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  • Title: Nonbarrier contraceptives and vaginitis and vaginosis.
    Author: Roy S.
    Journal: Am J Obstet Gynecol; 1991 Oct; 165(4 Pt 2):1240-4. PubMed ID: 1951581.
    Abstract:
    Within the limitations of the available data, it has been reported that oral contraceptive use versus other contraceptive methods is associated with a greater or similar frequency of candidiasis, increased numbers of anaerobic microorganisms, an increased or similar frequency of chlamydia trachomatis, and a reduced frequency of bacterial vaginosis and trichomoniasis. The impact of contraceptive steroids on cellular and humoral immunologic factors may explain these observations. Intrauterine contraceptive device use is reported to be associated with an increased rate of bacterial vaginosis and anaerobic organism recovery from the vagina regardless of symptoms. Patients having a contraceptive vaginal ring were found to have the same number and types of vaginal organisms as oral contraceptive users. Levonorgestrel-releasing subdermal implant (Norplant, Wyeth-Ayerst, Philadelphia, Pa.) users have been reported to have approximately half the rate of vaginitis and vaginosis compared with that of Copper T-200 intrauterine device users. A literature review was conducted to determine the association between vaginitis/vaginosis and four forms of contraception--oral contraceptives (OCs), IUD, vaginal ring, and Norplant. This review failed to provide evidence of any direct associations between the occurrence of the various vaginitidies and these four contraceptive methods. In comparison with the other methods, OC use is associated with a greater or similar frequency of candidiasis, increased numbers of anaerobic microorganisms, an increased or similar frequency of Chlamydia trachomatis, and a reduced incidence of bacterial vaginosis and trichomoniasis. The frequency of candidiasis and C trachomatis is reduced in IUD users compared to OC users, while that of bacterial vaginosis appears to be slightly increased. The risk of infection of the upper genital tract is greatest immediately after IUD insertion. Contraceptive vaginal ring users have the same number and type of vaginal organisms as OC users. Finally, women who use the levonorgestrel-releasing subdermal implant have approximately half the rate of vaginitis and vaginosis as that identified in Copper T-200 IUD users. The prospective, randomized type of study adjusted for confounding factors such as age, parity, sexual activity, and smoking that is required to calculate the precise likelihood of the development of vaginitis and vaginosis by type of contraception used has never been conducted, however.
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