PROBLEM Our knowledge of the innate host-defenses in the vagina, a site where these defenses are essential to protecting the host upper reproductive tract from invasion by pathogens, is as yet rudimentary. Specifically, little is known about the pattern-recognition component of vaginal innate immunity, the relationship of pattern-recognition molecules to known cytokine levels, and the role of gonadal hormones in their regulation. METHOD OF STUDY We measured levels of Surfactant Protein-A (SP-A), a prototypic innate pattern-recognition protein, in vaginal fluid (VF) and correlated them with levels of IL-1β and IL-8, two cytokines known to be present in VF. Assays were carried out on VF collected over three consecutive cycles from ten healthy naturally cycling women who were sampled at three specific time points in the menstrual cycle. The three time points were chosen to enable correlation with distinct hormonal states. RESULTS Both SP-A and cytokines levels were highest 5–6 days after menses (p < 0.05) and were significantly lower at ovulation and mid-luteal phase. CONCLUSION SP-A, like other host-defense molecules in the reproductive tract, appears to be regulated by gonadal hormones.
Introduction:The intrauterine device (IUD) is a long-acting and highly efficacious form of contraception that can also be used for menstrual suppression. Although IUD use is increasing, the type chosen, appeal, and satisfaction among individuals who are transgender and gender diverse and assigned female at birth (TGD-AFAB) is unknown. The purpose of this study is to evaluate IUD usage among TGD-AFAB individuals.Methods: TGD-AFAB individuals who had an IUD for a minimum of 6 months at the time of completing the survey or had one in the past completed an anonymous online survey. Descriptive statistics were used to analyze the data.Results: One hundred and five TGD-AFAB individuals completed the survey. Among participants who were sexually active, 88% reported they were in a relationship in which it was possible to get pregnant. There were 85 individuals who currently had an IUD: 62 (73%) chose a 52-mg levonorgestrel (LNG) IUD, 5 (6%) chose a lower-dose LNG IUD, 17 (20%) chose the copper IUD, and one chose an IUD unavailable in the United States. Menstrual suppression was the primary reason for choosing a 52-mg LNG IUD (58%). Most individuals who opted for a copper IUD did so to avoid hormonal contraception (71%). Participants reported experiencing IUD side effects; however, few desired removal. Among the 36 respondents who had an IUD in the past, the most frequent reasons for removal were expiration of the device (LNG IUDs) and undesired side effects (copper IUD). Approximately half of participants who had an IUD removed had it replaced with another IUD.Discussion: Pregnancy can occur among TGD-AFAB individuals even if they are on testosterone and amenorrheic. IUDs are well tolerated in this population, with few current users desiring removal for unwanted side effects. Clinicians should counsel TGD-AFAB individuals about the contraceptive and noncontraceptive benefits of IUDs and expected side effects.
INTRODUCTION: Although usage of the intrauterine device (IUD) is increasing, the prevalence among transgender and gender diverse individuals assigned female at birth is unknown. Our goal is to determine the reasons these individuals are choosing IUDs and if they are satisfied. METHODS: Transgender and gender diverse individuals assigned female at birth ages 18-64 participated in an online survey about their experiences with an IUD. RESULTS: 104 surveys were completed. The mean age was 26.2 (SD 4.8). 21 (20%) identified as transgender, and 83 (80%) identified as genderqueer or non-binary. 26 (25%) were bisexual, 8 (8%) gay/lesbian, 28 (27%) pansexual, and 32 (31%) queer. The majority (84%) was white and had a college education (59%). 88 (85%) were sexually active, and 77 (88%) were at risk for pregnancy. 84 (81%) currently have an IUD. 66 (79%) have a progestin and 17 (20%) a copper IUD. Most common influential factors in choosing a specific IUD were menstrual manipulation (66%), duration (67%), and to avoid side effects experienced with other contraceptive methods (49%). 36 (35%) had an IUD in the past. Of these, 20 (56%) did not choose another IUD. 6 (30%) disliked side effects, 3 (15%) initiated testosterone, 2 (10%) experienced expulsion, and 2 (10%) had a hysterectomy. 2 (10%) became pregnant with an IUD. 1 (5%) desired pregnancy. CONCLUSION: IUDs are an excellent form of contraception and menstrual manipulation for transgender and gender diverse individuals, with few desiring removal. Providers should not overlook counseling this population in regards to the benefits of an IUD.
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