RESUMO
We undertook a prospective study of 300 postmenarcheal female subjects (median age, 18.0 years) to examine (1) the relation of tampon use, sports participation, prior gynecologic examination, and consensual sexual activity to hymenal anatomy, (2) the factors leading to choice of tampons by girls not sexually active, and (3) factors related to ease of gynecologic examination. The sample included 100 subjects in group 1, who denied sexual intercourse and used only pads for menses; 100 subjects in group 2, who denied sexual intercourse and had used tampons; and 100 subjects in group 3, who gave a history of sexual intercourse. Sexually active subjects (81%) were significantly more likely than tampon users and pad users to have "complete clefts" in the lower hymen between the 2 o'clock and 10 o'clock positions (p < 0.001); tampon users were not significantly different from pad users (11% vs 5%). In subjects who were not sexually active, the presence of these complete clefts was not related to participation in sports or to prior pelvic examination. Although median hymenal opening diameter differed in the three groups (1.2 cm for group 1 vs 1.5 cm for group 2 vs 2.5 cm for group 3; p < 0.0001), the ranges of measurements were wide. Tampon users were significantly more likely than pad users to have mothers and friends, but not sisters, who had a favorable attitude toward tampon use. The best predictors of tampon use in a multivariate model were a favorable maternal attitude (odds ratio (OR), 5.3; 95% confidence interval (CI), 2.4, 12.1) and friends' use of tampons (OR 7.9; 95% CI 3.5, 18.1). Only 26% of speculum examinations in pad users were rated as easy compared with 56% of examinations in tampon users and 81% in sexually active young women (p < 0.001). The best predictors of ease of speculum examination were sexual activity (OR 15.9; 95% CI 1.9, 135.3) and tampon use (OR 3.6; 95% CI 1.0, 12.7). This large sample should provide useful data for physicians who testify in sexual assault cases and gives new information on the predictors of tampon use and ease of gynecologic examination in young women.
Assuntos
Comportamento do Adolescente , Hímen/anatomia & histologia , Produtos de Higiene Menstrual , Comportamento Sexual , Adolescente , Adulto , Criança , Feminino , Humanos , Produtos de Higiene Menstrual/estatística & dados numéricos , Menstruação , Pelve , Exame Físico , Estudos ProspectivosRESUMO
Fourteen hirsute girls, ages 12 to 22 years (mean +/- SD: 17.2 +/- 2.6 years), in whom 21-hydroxylase deficiency was excluded by a 1-hour intravenous alpha 1-24 corticotropin test, were evaluated by a 4-day dexamethasone test and then treated with a bedtime dose of dexamethasone (0.5 mg in 10 patients, 0.25 mg in four) for 0.6 to 3.4 years (1.3 +/- 0.8 years). Hirsutism decreased in four patients, did not change in nine, and increased in one. Of the 10 patients with irregular menses, only three developed regular cycles while taking dexamethasone. During long-term dexamethasone therapy, serum levels of testosterone decreased from 102 +/- 22 to 72 +/- 27 ng/dL, free testosterone from 35 +/- 11 to 19 +/- 8 pg/mL, and dehydroepiandrosterone sulfate from 396 +/- 138 to 171 +/- 101 micrograms/dL. Although free testosterone decreased to less than 15 pg/mL in eight of 14 patients with the suppression test, only four patients had free testosterone levels less than 15 pg/mL during therapy. Two of the 14 patients have had no recurrence of hirsutism or increase in serum androgens after 28 and 29 months, respectively, after dexamethasone therapy was discontinued. Oral contraceptives were given to nine patients inadequately responsive to bedtime dexamethasone therapy. The mean percent decrease of testosterone and free testosterone levels during oral contraceptive therapy was significantly greater than during long-term treatment with dexamethasone, and hirsutism lessened in all. We conclude that a single bedtime dose of dexamethasone is satisfactory only in patients who maintain serum free testosterone values less than 15 pg/mL without side effects. For other patients, either another glucocorticoid or, in most cases, ovulation suppression should be prescribed for adolescents with progressive hirsutism and elevated androgen levels.