Vaginal health in copper intrauterine device users and non-users

Objective: To compare the cervicovaginal flora, vaginal symptoms, infections and pH between copper intrauterine device (IUD) users and non-IUD, non-hormonal usersMaterials and Methods: A cross-sectional study was conducted from August 2010 to March 2011 at Ramathibodi Hospital. Ninety-two women at the age of 18-45 yr of whom 46 were copper IUD users while other 46 were nonusers. Each woman was evaluated clinically with direct observation of vaginal secretions, wet mount examination, Whiff test, vaginal pH testing and cervicovaginal culture. The outcomes included prevalence of aerobic and anaerobic bacteria colonization, bacterial vaginosis, vaginal candidiasis, trichomoniasis, vaginal symptoms and vaginal pH.Results: There was no difference in prevalence of aerobic (50% VS 54.3%; p=0.67) and anaerobic (82.6%VS 76.1%; p=0.44) colonization between two groups. Vaginal symptoms, candidiasis and trichomoniasis were not significantly different. Prevalence of bacterial vaginosis was significantly higher among IUD users than non-IUD users. (28.3% VS 10.9%; p=0.03). The mean vaginal pH was significantly higher in IUD group (5.3±0.6 VS 4.8±0.8; p<0.05).Conclusion: Copper intrauterine device altered vaginal pH and bacterial vaginosis was more common among IUD users

Postpartum Use of Long-Acting Reversible Contraception in Primiparous Women: Ramathibodi Hospital’s Experiences

Objective: To determine desire and initiation of long-acting reversible contraception (LARC) of primiparous women in the postpartum period. Material and Method:A prospective cohort study was conducted at Faculty of Medicine Ramathibodi Hospital, Bangkok, from July 2012 to December 2012. Postpartum women, who were primiparous, aged greater than or equal to 20 years and willing to participate were recruited into this study. Prior to discharge, a structured interview questionnaire was used to determine initial postpartum contraception desires. After discharge, data was collected at 8–12 weeks postpartum using telephone calls to determine postpartum contraception utilization and reasons.Results:Five hundred and two out of 547 women had a documented postpartum visit at 8-12 weeks, giving an overall response rate of 91.8%. Amongst the 197 women (36.0%), who desired LARC prior to discharge, 161 (32.1%) utilized LARC within 8-12 weeks postpartum and the most common reason was no effect on breast-feeding. Injectable was the most common method of LARC used (55.9%). Simultaneous factor associated with desire for LARC prior to discharge and LARC utilization at 8-12 weeks postpartum was occupation. Compared to government officers, employees and housewives, business owners were more likely to desire and utilize LARC.Conclusions: LARC is highly desired and utilized at 8-12 weeks postpartum in primiparous women. Occupation was a predictor of LARC desire and utilization. The most common reason of LARC utilization at 8-12 weeks was no effect on breast-feeding

Efficacy of Topical Ethyl Chloride Spray versus Subcutaneous 1% Lidocaine Injection in Reducing Pain from One Rod System Implant Insertion

Objectives: To compare the efficacy of topical ethyl chloride spray and subcutaneous 1% lidocaine injection in reducing pain from one rod system implant insertion.Materials and Methods: Eighty-four women undergoing one rod implant insertion during February 2014 to December 2015 were enrolled and randomly allocated to ethyl chloride spray and 1% lidocaine injection groups. After skin was sterilized, the assigned anesthetic method was administered before insertion of one rod implant according to the standard pro-cedure. Pain during anesthetic administration, implant insertion, 20 min after insertion, and overall pain were evaluated, using a 100-mm visual analogue scale (VAS). Patient and doctor satisfaction were measured using a five-point Likert scale.Results: All basis clinical characteristics between two groups did not differ. There was no significant difference in VAS during and 20 min after implant insertion between 2 anesthetic groups (p > 0.05). Median VAS during anesthetic administration and overall pain in ethyl chloride spray group (1.50 and 1.60) were significant lower than lidocaine injection group (3.75 and 2.75) (p < 0.01). Patient and doctor satisfaction scores were significant higher in ethyl chloride spray group (p < 0.05).Conclusion: Ethyl chloride spray can be used as anesthetic option for one rod system implant insertion. It provides comparable analgesic effect to lidocaine injection but with less pain from anesthetic administration

Mobile Application Based Pelvic Floor Muscle Training for Treatment of Stress Urinary Incontinence: An Assessor-Blind, Randomized, Controlled Trial

A first-line treatment for stress urinary incontinence (SUI) is pelvic floor muscle training (PFMT) for at least three months. The key problem is that patients do not understand the importance of these exercises and their effectiveness. Mobile health apps offer new possibilities to increase treatment adherence. This study compared a reduction in SUI, exercise adherence, and quality of life in PFMT with animation vs. standard instruction. A prospective, single-blind, randomized control trial was collected. SUI patients were randomized into the application or control groups confirmed using a one-hour pad test. In the intervention group, the PFMT application was applied via mobile phone (PFMT with animations, recording system, and reminder system). The standard exercise protocol was similar in both groups. Additional follow-up was conducted at 4, 8, and 12 weeks. A total of 51 participants were randomized to the application (n = 26) and control groups (n = 25), respectively. At the 12-week follow-up, there was no significant difference between the two groups in terms of SUI cure rate, SUI severity by pad test, and daily SUI episodes from the bladder diary (p-value of 0.695, 0.472, and 0.338, respectively). The mean PFME adherence in the application group was higher than the control group at 8 weeks (66.3 ± 13.6 vs. 52.7 ± 16.6, p = 0.002) and 12 weeks (59.1 ± 13.9 vs. 37.8 ± 11.0, p = 0.001). The application group reported no difference from the conventional PFMT group in terms of improvements in SUI cure rate, symptom severity, and quality of life effects at 12-week follow-up. However, the improvement evaluated by the mean difference in SUI episodes and quality of life effects (ICIQ-UI SF) reported a better outcome in the mobile app group. The PFMT application has been proven to be an effective tool that improves PFMT adherence