RESUMO
BACKGROUND: The objectives were firstly to assess acrosome reaction (AR) status of spermatozoa following uterine flushing, secondly to measure levonorgestrel (LNG) levels in serum and in uterine flushing fluid and finally to measure endometrial glycodelin-A expression after administration of LNG as a form of emergency contraception (EC). METHODS: Forty-eight experiments were conducted on 15 regularly menstruating women. Four groups were formed based on different intercourse to treatment interval and treatment to recovery of spermatozoa and the biopsies. RESULTS: Twenty-four and forty-eight hours after treatment, there were 14.5 +/- 3.9 x 10(6) and 17.3 +/- 6.8 x 10(6) sperm recovered from the uterus, respectively. There were no differences between the AR rate and the endometrial glycodelin-A staining intensity in an LNG or placebo treated cycles. The LNG in uterine flushing medium represented 1.38% of the values observed in serum 24 h after the LNG intake. CONCLUSIONS: Twenty-four and forty-eight hours after administration of EC, neither the proportion of AR sperm, nor the glycodelin-A level was influenced by 1.5 mg of LNG. LNG did not impair the cervical mucus either because viable spermatozoa were found in the genital tract 36-60 h after coitus and 24-48 h after LNG intake. The mechanism of action of LNG as EC remains unknown.
Assuntos
Reação Acrossômica/fisiologia , Anticoncepção Pós-Coito , Anticoncepcionais Sintéticos Pós-Coito/administração & dosagem , Endométrio/metabolismo , Glicoproteínas/biossíntese , Levanogestrel/administração & dosagem , Proteínas da Gravidez/biossíntese , Adulto , Método Duplo-Cego , Endométrio/efeitos dos fármacos , Feminino , Glicodelina , Humanos , Levanogestrel/sangue , MasculinoRESUMO
BACKGROUND: ACIDFORM is a microbicidal and contraceptive candidate with strong buffering capacity. METHODS: This was a Phase I blinded, randomized and crossover clinical study on two products, ACIDFORM and a commercial nonoxynol-9 (N-9) product (2%), evaluating their vaginal safety in 20 couples aged between 19 and 45 years. The women had regular menses, underwent previous tubal ligation, were not breast-feeding, had no vaginal sign and symptom and were in a stable partnership; both partners had no previous STI. Colposcopy, vaginal microbiology, inflammation markers and subject complaints were studied after coitus. Women were randomly assigned sequentially to receive ACIDFORM 0-30 min (0-30 min before intercourse), ACIDFORM 8-10 h (8-10 h before intercourse) or N-9 0-30 min after a control cycle. RESULTS: Mild/moderate vulvar irritation was observed in five postcoital test colposcopies, burning and pruritus were reported in six treated cycles and non-irritation-related symptoms were found in five cycles with different treatments. No difference in vaginal pH, Nugent scores, H2O2-producing lactobacillus or leukocytes and interleukin 6 in the cervicovaginal lavage was found between the treatment and control cycles. CONCLUSIONS: ACIDFORM appears to be safe for clinical use once a day. There is a potential spermicidal-microbicidal role for ACIDFORM as a vaginal flora helper or as a vehicle for products, except N-9.
Assuntos
Nonoxinol/efeitos adversos , Espermicidas/efeitos adversos , Vagina/efeitos dos fármacos , Adulto , Anti-Infecciosos Locais/efeitos adversos , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Vagina/microbiologiaRESUMO
ACIDFORM is a gel already shown to be safe in vaginal use during six consecutive days through colposcopic observation. A randomized, blinded, crossover study was carried out to compare the spermicidal effect of ACIDFORM to that of a commercial 2% nonoxynol-9 (N-9) product. Twenty sexually active, sterilized women, aged 19-45 years, with regular cycles, normal gynecological exam, no previous sexually transmitted infection (STI) and stable partner willing to undergo four postcoital tests (PCTs) at midcycle during four different menstrual cycles, were enrolled in the study. Known allergy to N-9 or ACIDFORM, oligospermic partner, chronic diseases, use of hormones, previous treatment for STI or presence of STI at screening tests were criteria for exclusion. ACIDFORM or N-9 product administered 0-30 min precoitus or ACIDFORM given 8-10 h precoitus significantly reduced the mean number of progressively motile sperm compared to control cycles (0.19, 0.07, 0.75 vs. 17.94, respectively, p<.05, Wilcoxon test). All treated cycles had five or fewer progressively motile sperm in midcycle cervical mucus, confirming in vivo the spermicidal effect of ACIDFORM previously observed in vitro and in animal models.
Assuntos
Anticoncepcionais Pós-Coito/administração & dosagem , Géis/administração & dosagem , Nonoxinol/administração & dosagem , Espermicidas/administração & dosagem , Cremes, Espumas e Géis Vaginais/administração & dosagem , Administração Intravaginal , Adulto , Soluções Tampão , Coito , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Ciclo Menstrual , Pessoa de Meia-Idade , Motilidade dos Espermatozoides/efeitos dos fármacos , Resultado do Tratamento , Esfregaço VaginalRESUMO
O Brasil tem uma alta prevalência de laqueadura tubária. Alguns setores da sociedade acreditam que essa alta prevalência estaria indicando um controle da natalidade dissimulado, que visa diminuir a fecundidade nas camadas mais pobres da populaçäo. O objetivo deste trabalho é contribuir para a compreensäo das possíveis diferenças sócio-econômicas quanto à prática da laqueadura. Parra este fim, analisamos uma base de dados com 1.335 mulheres com idade de 15 a 49 anos, obtida entre mulheres de nível sócio-econômico médio-baixo ou baixo, em duas regiöes do Estado de Säo Paulo, no ano de 1991. Os resultados mostraram uma aparentemente maior prevalência de laqueadura entre as mulheres com menor nível educacional e também entre as que moravam em habitaçäo de boa qualidade. Entretanto, ao controlar por idade, essas associaçöes desapareceram, sugerindo que se deviam apenas a menor escolaridade e maiores recursos das mulheres de maior idade, sendo este último o fator mais fortemente associado à prevalência de laqueadura. Discute-se a complexidade das relaçöes entre nível sócio-econômico e ligadura tubária, incluindo a diferença sócio-econômica na prevalência de cesárea, intimamente ligada à esterilizaçäo feminina.