Sexual and Reproductive Health Care in Young Women with Cystic Fibrosis
The Journal of Cystic Fibrosis has published recent study results on research into the sexual and reproductive health care in young women with cystic fibrosis.
This study compared the sexual and reproductive health (SRH) care of those with CF to the general U.S. population. Both groups of women were aged 15 to 24 years.
The women with CF were connected with five CF centers in diverse areas of the country. The other group, a nationally representative sample, were women who participated in the U.S. National Survey of Family Growth (NSFG.)
The National Center for Health Statistics conducts the NSFG survey relating to the Centers for Disease Control and Protection (CDC).
The NSFG survey differed in one respect from the written one completed by the women with CF. The latter survey was conducted by personal interview with privacy given for responders to write out their answers to the “more personal” questions.
A total of 188 women with CF completed the survey. The NSFG group numbered 1997. The survey was a seven-pronged assessment addressing the various components of female sexual care.
Pap test
The Pap test (or Pap smear) looks for cancers or pre-cancerous cells in the cervix in the lower part of the uterus. Precancerous cells may include the presence of human papillomavirus (HPV) infection. This virus is sexually transmitted and can lead to cancer. It is recommended that women between the ages of 21 and 29 have Pap tests every 3 years. Those between 30 and 64 should have both a Pap test and a human papillomavirus (HPV) test every 5 years. A woman age 65 or older may speak with her doctor about stopping Pap and HPV testing.
Most health insurance plans must cover Pap tests or cervical cancer screening at no cost to you.
Pelvic exam
Around age 20, pelvic exams become a normal part of a woman’s medical care. They include the painless examination of the vagina and cervix with the use of a medical device referred to as a speculum.
To identify any signs of tumors, the medical provider presses onto the patient’s stomach while holding a few fingers in the vagina and then in the rectum. This procedure is an important part of the exam as it can help uncover elusive ovarian cancer.
HPV vaccination
Since the human papillomavirus (HPV) is a sexually transmitted infection which can lead to cancer, vaccination is crucial. The vaccine protects against most cancers caused by HPV.
Since the HPV vaccine also produces a higher immune response in preteens than in older adolescents, it’s best to give it early.
The vaccine is given to preteen girls and boys at age 11 or 12, before they’re exposed to the virus, in a series of 3 injections over a period of several months.
Most health insurance plans cover the cost of HPV vaccines. If the family doesn’t have health insurance, or their plan does not cover the injections, The Vaccines for Children Program (VFC) may be able to help.
The vaccine is also available through Planned Parenthood, most Safety Net Health Centers, the local medical clinic, or physician’s office.
Contraceptive counseling
According to the physician-authored website, Up to Date, “the goals of contraceptive counseling are to discuss a reproductive life plan and reduce unintended pregnancy. According to the CDC, the best way to reduce the risk of unintended pregnancy among women who are sexually active is “to use effective birth control correctly and consistently.” Among reversible methods of birth control, intrauterine contraception and the contraceptive implant are considered highly successful over a span of years.
The effectiveness of the contraceptive shot, pills, patch and ring, and barrier and fertility awareness-based methods, relies on proper and repeated use— so these methods have a lower success-rate.
Planned Parenthood, County Health Departments, local medical clinics, Safety Net Health Centers and some private Ob-Gyns are excellent resources for counseling on the availability and use of contraceptives.
Many insurance plans will pay for most of, if not all, the cost for birth control pills.
Seeking contraception
According to the Guttmacher Institute’s 2016 statistics on family planning, about 62% of all women of child-bearing age use some form of contraceptive.
Reflected in the Institute’s statistics for 2014, there were 38 million women requiring contraceptive care. Of these women, 20 million were eligible for publicly funded services and supplies due to low-incomes. Also, 4.7 million women receiving services were under aged 20.
Millions of women receive publicly funded contraceptive services from clinics or from private doctors serving Medicaid enrollees.
Teenagers represented 15% of contraceptive clients served by Safety Net Health Centers in 2014; nearly one million women under aged 20 were served by these centers.
Additional publicly funded centers include Title X family planning program centers devoted solely to family planning, Planned Parenthood, and State Health Department clinics.
Centers with a reproductive health focus were shown to offer a larger choice of onsite contraceptive options and were more probable to offer same-day insertion of IUD’s, as compared with generic primary care centers.
(The Guttmacher Institute is “a leading research and policy organization committed to advancing sexual and reproductive health and rights in the United States and globally”).
STI testing/counseling
Sexually transmitted infections continue to be a leading health care concern in the U.S. Approximately 19 million new cases are diagnosed each year.
Counseling at-risk is a recommendation of the CDC. Education of patients should stress ways to reduce the risk of infection and to choose an infection-free partner for an “exclusive” relationship.
STI testing seeks for any sexually transmitted infections, including chlamydia, gonorrhea, syphilis, herpes, HPV, Hepatitis C, and HIV.
Not all insurance companies will pay for STI preventive screening, testing and treatment. If you see a general physician, you will probably be billed at least for a co-pay.
In visiting an STI clinic, on the other hand, services will sometimes be free of charge. But, if payment is required, it would more likely be a sliding scale fee.
Also, the specialty clinic would offer a wider range of testing options, with service by clinicians who specialize in and are up to date with treatment options for these infections.
Most free STI clinics are run by County Health Departments. Local public-funded clinics or teaching hospitals may also offer low-cost STI clinics. In addition, Planned Parenthood offers low-cost STI testing and treatment.
Pregnancy testing
Low-cost at-home pregnancy kits can be purchased at many different stores. However, test results will be inaccurate if you take the test too soon after your missed period, if the kit is outdated, and/or you don’t correctly follow the instructions.
The urine tested will show a positive result if the presence of the pregnancy hormone human chorionic gonadotropin(hCG)is detected.
However, an appointment with a medical practitioner will need to be made for confirmation of test results and to set up necessary pre-natal care.
Research outcomes and conclusions
Regarding the outcome of this research study on sexual and reproductive health care:
- Women with CF had lower lifetime rates of ever obtaining a Pap smear or pelvic exam but showed similar rates of HPV vaccination compared to the NSFG respondents.
- Thirty-seven percent of women with CF reported seeking contraception and <10% reported contraceptive counseling, STI testing/counseling, or pregnancy testing in their lifetime.
- In contrast, during the last 12 months, 41% of NSFG respondents reported seeking contraception, 24% received contraceptive counseling, 22% STI testing/counseling, and 23% pregnancy testing.
- A minority of women with CF received or discussed SRH care in the CF setting, although 66% wanted to discuss SRH with their CF team.
Conclusions of the study
Young women with CF report low rates of SRH care utilization and desire SRH discussions in the CF setting. Interventions should target improved SRH care delivery and encourage patient-provider communication around SRH in the CF care setting.
Additional information
Virtually all Safety Net Health Centers continue to provide pregnancy testing. Most also offer HIV testing, the testing and treatment for other STIs, and HPV vaccinations.
Safety Net has provided injectables (e.g., Depo Provera). 90% of their centers supply condoms, and 80% have offered emergency contraceptive pills.
Points for discussion
Planned Parenthood has been a mainstay in the provision of U.S. sexual and reproductive services in the U.S. for over a century. However, in today’s political climate, there have been indications they may lose federal funding.
Two leading pro-life groups have stepped up to stress there are adequate health centers-eligible for federal assistance-should Congress eliminate its government funding of Planned Parenthood.
References
http://www.cysticfibrosisjournal.com/article/S1569-1993(17)30872-X/fulltext
https://www.plannedparenthood.org/learn/health-and-wellness/well-woman-visit/what-pelvic-exam
https://www.cdc.gov/reproductivehealth/contraception/qfp.htm
https://www.uptodate.com/contents/contraceptive-counseling-and-selection
https://www.plannedparenthood.org/get-care/our-services
https://www.guttmacher.org/fact-sheet/publicly-funded-family-planning-services-united-states
http://www.medscape.com/viewarticle/746451
http://www.webmd.com/baby/home-pregnancy-tests#1
https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216627/
