Women in low- and middle-income nations are often highly willing to use vaginal rings, which they tend to find easy to use, aidsmap reports.


This is according to a systematic review of 47 studies of various forms of vaginal rings among women in low- and middle-income nations conducted by Jennifer Griffin, PhD, MPH, of RTI International in Redlands, California, and colleagues.


A monthly vaginal ring infused with the antiretroviral dapivirine has reduced the risk of HIV acquisition by a moderate amount among women in clinical trials and is currently under regulatory review by the European Medicines Agency. Submissions for approval of the ring by the U.S. Food and Drug Administration and the South African Health Products Regulatory Authority are forthcoming.


The review included 14 randomized controlled trials and 33 observational studies published between 1970 and 2019. Participants were women at least 15 years old.


The rings studied were for contraception in 28 studies, HIV prevention in 10 studies, multipurpose prevention technologies in four studies, abnormal uterine bleeding in three studies, pelvic pain in one study and menopause symptom management in one study.


The proportion of women who found the vaginal rings acceptable to use ranged from 71% to 97%. In most of the observational studies, more than 90% of the women rated their ring as acceptable. The longer women used the rings, the more acceptable they found them.


In four randomized controlled trials of rings for HIV prevention and in another study of the NuvaRing, a hormonal contraceptive ring, 8% to 43% of the women reported concerns about their sexual partners not liking the ring. Between none and 12% of the users of the rings in these studies experienced expulsion of their ring due to sex, urination or defecation.


Sixty-four percent to 99% of the women in three of the HIV prevention trials and the NuvaRing trial told their partner they were using the ring. So did 41% of the participants in the IPM001 study of the dapivirine ring. On the other hand, 63% of the women who used vaginal rings in the TRIO study of three forms of multipurpose technologies for preventing HIV and pregnancy said they did not tell their partner they were using a ring.


Seventy-seven percent of participants in the recent observational studies of vaginal rings stuck with using the ring, compared with continuation rates of 31% to 66% in older studies.


The evidence strongly suggests that most women find [vaginal rings] acceptable and easy to use, despite reported cognitive/emotional burden, impacts on sexual intercourse and some issues with expulsions,” the study authors concluded.

“An experience effect was seen, with acceptability increasing over time as users gained experience with the method, and continuation was high across studies,“ they continued. ”Some women value features associated with the [vaginal ring], including low dosing frequency, positive menstrual bleeding patterns and the potential for multipurpose technologies. As such, the [vaginal ring] may play an important role in expanding sexual and reproductive health options for women.


To read the aidsmap article, click here.


To read the study, click here.