End‐of‐Life Care and Barriers for Female Inmates

The number of female inmates is growing, and their average age is increasing. As a result, end‐of‐life care is situated in a highly restrictive environment with a focus on security rather than comfort. We describe the need for and potential barriers to humane care and provide care strategies that can be useful in a complex organizational system. Frontline workers such as nurses who understand the balance between care and control must promote change in the women's prison system.     

One‐Year Efficacy and Safety Study of a 1.62% Testosterone Gel in Hypogonadal Men: Results of a 182‐Day Open‐Label Extension of a 6‐Month Double‐Blind Study

IntroductionA new formulation of testosterone gel (1.62% testosterone gel) with increased viscosity and reduced volume of application has been shown to be safe and efficacious after 182 days of use in a phase 3, double‐blind study in adult hypogonadal males.AimThe objective of this study was to evaluate the efficacy and safety of the 1.62% testosterone gel after daily application to the skin in a 182‐day (6‐month) open‐label extension of the initial 182‐day double‐blind study.MethodsOne hundred and sixty‐three subjects, aged 26 to 77 years, continued on active (Continuing Active subjects) 1.62% testosterone gel for the remainder of the study (364 days total). In 28 subjects who had previously received placebo (Formerly Placebo subjects), the dose was titrated to normal levels of serum total testosterone (300–1,000 ng/dL). Dose adjustments for both groups were allowed at specific visits to maintain serum testosterone within a normal range.Main Outcome MeasureThe main outcome measure was the percentage of subjects with serum total testosterone average concentrations (C_av) within the normal range at day 364.ResultsOn day 364, 77.9% (95% confidence interval: 70.0, 84.6) of the Continuing Active subjects and 87.0% (66.4, 97.2) of the Formerly Placebo subjects had C_av values within the eugonadal range. The 1.62% testosterone gel was safe and well tolerated in this study.ConclusionTreatment with 1.62% testosterone gel for up to 1 year (182 days for the Formerly Placebo subjects, 364 days for the Continuing Active subjects) was safe and efficacious, resulting in >77% of treated subjects achieving normal serum testosterone levels at final visit. Kaufman JM, Miller MG, Fitzpatrick S, McWhirter C, and Brennan JJ. One‐year efficacy and safety study of a 1.62% testosterone gel in hypogonadal men: Results of a 182‐day open‐label extension of a 6‐month double‐blind study. J Sex Med 12;9:1149–1161.     

Pilot Study on Quality of Life and Sexual Function in Men‐Who‐Have‐Sex‐with‐Men Treated for Prostate Cancer

IntroductionThere is limited data on post‐treatment quality of life (QoL) for men‐who‐have‐sex‐with‐men (MSM) with prostate cancer (PCa). QoL in MSM may not be reflected by assessment tools designed for the heterosexual population.AimsOur goals were to evaluate post‐treatment QoL in PCa patients who are MSM, and to investigate the utility of current QoL assessment tool.MethodsPCa patients treated with surgery and/or radiation were recruited from the local MSM community. Each participant completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire, Male Sexual Health Questionnaire (MSHQ), and a questionnaire focused on insertive and receptive roles of anal intercourse.Main Outcome MeasuresResponse scores were calculated based on questionnaire design and compared by treatment modality.ResultsSeven participants treated with surgery (mean age 58) and eight participants treated with radiation (mean age 67) were recruited. No participant in the surgical group received androgen deprivation therapy (ADT) while two in radiation group were treated with ADT.The sample size of this study did not permit formal statistical analysis, although potential differences in Urinary and Bowel Domains from EPIC and Ejaculation Scale from MSHQ were observed. More participants from the radiation group seemed to be able to maintain both insertive and receptive anal intercourse roles after treatment compared to participants who received surgery.ConclusionsWhile the two validated assessment tools suggested similar QoL scores including sexual function for both surgical and radiation groups, post‐treatment sexual function related to anal intercourse may be better in the radiation group, as compared to the surgical group. Larger studies in PCa patients from MSM community are warranted to verify these data. Lee TK, Breau RH, and Eapen L. Pilot study on quality of life and sexual function in men‐who‐have‐sex‐with‐men treated for prostate cancer. J Sex Med 2013;10:2094–2100.     

Development of a Neonatal End‐of‐Life Care Education Program for NICU Nurses in Japan

We developed the first end‐of‐life care education program for neonatal intensive care unit (NICU) nurses in Japan. It focused on ethical decision making, care of dying neonates, bereavement, and cultural communication. The program improved nurses’ knowledge, F(2.16, 62.5) = 260.6, p < .001, and understanding, F(2.05, 59.4) = 29.1, p < .001, and significantly reduced weaknesses in neonatal end‐of‐life care. It was considered well designed and may provide further mentoring support for NICU nurses.     

Subcutaneous Mastectomy in Female‐to‐Male Transsexuals: A Retrospective Cohort‐Analysis of 202 Patients

IntroductionSubcutaneous mastectomy is the first surgical procedure to be completed by female to male transsexuals after appropriate mental health and endocrine therapy. Objectives of subcutaneous mastectomy in this group are to masculinize the chest by the removal of breast tissue and skin excess, reduction and proper positioning of the nipple‐areola complex, obliteration of the infra‐mammary fold, and ideally with a minimal of chest wall scars. In this study, the largest series of subcutaneous mastectomies in female‐to‐male transsexuals to date is presented.AimsOur aim was to determine relations between surgical technique, risk factors, complications, reoperations and secondary corrections in female‐to‐male transsexuals.MethodsWe performed a retrospective survey study on 404 mastectomies in 202 female‐to‐male transsexuals during the period of 2000–2011.Main Outcome MeasuresPrimary outcomes for this study were complication rate, acute reoperations, secondary corrections, surgical time, and length of hospital stay in relation to the surgical technique used.ResultsThe average age of these patients at time of the intervention was 31 years (±10) with an average BMI of 25 kg/m² (±4). The chosen technique depended strongly on breast volume, which, in turn, was strongly related to BMI and age. The number of acute reoperations and secondary corrections depended on the surgical technique. The total rate of acute complications was 5.0%. This percentage was highest in surgeries without skin resection (10.5%). To improve overall aesthetic results, the following secondary corrections were performed: nipple and/or areola corrections (8.9%), scar revisions (12.6%), and chest contouring (17.8%).ConclusionThis study shows a correlation between the surgical technique, complication rate, and length of hospital stay. In general, the larger the breast, the larger the scars that remain after the operation. On the other hand, the smaller the scars resulting from the operation, the higher the risk of hematoma. Cregten‐Escobar P, Bouman MB, Buncamper ME, and Mullender MG. Subcutaneous mastectomy in female‐to‐male transsexuals: A retrospective cohort‐analysis of 202 patients. J Sex Med 2012;9:3148–3153.     

Effect of Intracavernous Administration of Angiopoietin‐4 on Erectile Function in the Streptozotocin‐Induced Diabetic Mouse

IntroductionErectile dysfunction (ED) is a highly prevalent complication of diabetes, and the severity of endothelial dysfunction is one of the most important factors in reduced responsiveness to oral phosphodiesterase type 5 inhibitors.AimTo study the effects of human angiopoietin‐4 (Ang‐4) protein on erectile function in diabetic mice.MethodsDiabetes was induced by intraperitoneal injection of streptozotocin into 8‐week‐old C57BL/6J male mice. At 8 weeks after the induction of diabetes, the animals were divided into four groups: control nondiabetic mice and diabetic mice receiving two successive intracavernous injections of phosphate buffered saline (days ?3 and 0), a single intracavernous injection of Ang‐4 protein (day 0), or two successive intracavernous injections of Ang‐4 protein (days ?3 and 0).Main Outcome MeasuresOne week after treatment, we measured erectile function by electrical stimulation of the cavernous nerve. The penis was harvested and stained with hydroethidine or antibodies to Ang‐4, platelet/endothelial cell adhesion molecule‐1, and phosphorylated endothelial nitric oxide synthase (eNOS). We also determined the differential expression of Ang‐4 in cavernous tissue in the control and diabetic mice. The effect of Ang‐4 protein on the phosphorylation of Tie‐2, Akt, and eNOS was determined in human umbilical vein endothelial cells (HUVECs) by Western blot.ResultsThe cavernous expression of Ang‐4 was downregulated in diabetic mice; Ang‐4 was mainly expressed in endothelial cells. Local delivery of Ang‐4 protein significantly increased cavernous endothelial content, induced eNOS phosphorylation, and decreased the generation of superoxide anion and apoptosis in diabetic mice. Ang‐4 protein strongly increased the phosphorylation of Tie‐2, Akt, and eNOS in HUVECs. Repeated intracavernous injections of Ang‐4 induced significant restoration of erectile function in diabetic mice (87% of control values), whereas a single intracavernous injection of Ang‐4 protein elicited modest improvement.ConclusionsCavernous endothelial regeneration by use of Ang‐4 protein may have potential for the treatment of vascular disease‐induced ED, such as diabetic ED. Kwon M‐H, Ryu J‐K, Kim WJ, Jin H‐R, Song K‐M, Kwon K‐D, Batbold D, Yin GN, Koh GY, and Suh J‐K. Effect of intracavernous administration of angiopoietin‐4 on erectile function in the streptozotocin‐induced diabetic mouse. J Sex Med 2013;10:2912–2927.     

Emotional Responses of Mothers of Late‐Preterm and Term Infants

ObjectiveTo compare the emotional responses of mothers of late‐preterm infants (34 0/7 to 36 6/7 weeks gestation) with those of mothers of full‐term infants.DesignA mixed method comparative study.SettingA southeastern tertiary academic medical center postpartum unit.ParticipantsSixty mothers: 29 mothers of late‐preterm infants and 31 mothers of full‐term infants.MethodsMeasures of maternal emotional distress (four standardized measures of anxiety, postpartum depression, posttraumatic stress symptoms, and worry about infant health) and open‐ended semistructured maternal interviews were conducted in the hospital following birth and by phone at one month postpartum.ResultsMothers of late‐preterm infants experienced significantly greater emotional distress immediately following delivery, and their distress levels continued to be higher at one month postpartum on each of the standardized measures. Mothers of late‐preterm infants also discussed the altered trajectories in their birth and postpartum experiences and feeling unprepared for these unexpected events as a source of ongoing emotional distress.ConclusionMothers of late‐preterm infants have greater emotional distress than mothers of term infants for at least one month after delivery. Our findings suggest that it may not be a single event that leads to different distress levels in mothers of late‐preterm and full‐term infants but rather the interaction of multiple alterations in the labor and delivery process and the poorer‐than‐expected infant health outcomes. In the future, researchers need to examine how and when mothers’ emotional responses change over time and how their responses relate to parenting and infant health and development.     

Long‐Term Evaluation of Donor‐Site Morbidity after Radial Forearm Flap Phalloplasty for Transsexual Men

IntroductionPhalloplasty using the radial forearm flap is currently the most frequently used technique to create the neophallus in transsexual men (formerly described as female‐to‐male transsexual persons). Although it is considered the gold standard, its main disadvantage is the eventual donor‐site morbidity in a young, healthy patient population.AimThe study aims to examine the long‐term effects of radial forearm flap phalloplasty in transsexual men and to evaluate aesthetic outcome, scar acceptance, bone health, and daily functioning.Main Outcome MeasuresScars were evaluated with the patient and observer scar assessment scale, the Vancouver Scar Scale, and self‐reported satisfaction. Bone health was assessed using dual X‐ray absorptiometry and peripheral quantitative computed tomography, and daily functioning using a physical activity questionnaire (Baecke). These measurements were compared with 44 age‐matched control women.MethodsThis is a cross‐sectional study of 44 transsexual, a median of 7 years after radial forearm flap phalloplasty, recruited from the Center for Sexology and Gender Problems at the Ghent University Hospital, Belgium.ResultsWe observed no functional limitations on daily life activities, a pain‐free and rather aesthetic scar, and unaffected bone health a median of 7 years after radial foreram flap phalloplasty. Over 75% of transsexual men were either satisfied or neutral with the appearance of the scar.ConclusionsTranssexual men, despite scarring the forearm, consider the radial forearm flap phalloplasty as worthwhile.     

Therapeutic Effect of Adipose‐Derived Stem Cells and BDNF‐immobilized PLGA Membrane in a Rat Model of Cavernous Nerve Injury

IntroductionCavernous nerve injury is the main reason for post‐prostatectomy erectile dysfunction (ED). Stem cell and neuroprotection therapy are promising therapeutic strategy for ED.AimTo evaluate the therapeutic efficacy of adipose‐derived stem cells (ADSCs) and brain‐derived neurotrophic factor (BDNF) immobilized Poly‐Lactic‐Co‐Glycolic (PLGA) membrane on the cavernous nerve in a rat model of post‐prostatectomy ED.MethodsRats were randomly divided into five groups: normal group, bilateral cavernous nerve crush injury (BCNI) group, ADSC (BCNI group with ADSCs on cavernous nerve) group, BDNF‐membrane (BCNI group with BDNF/PLGA membrane on cavernous nerve) group, and ADSC/BDNF‐membrane (BCNI group with ADSCs covered with BDNF/PLGA membrane on cavernous nerve) group. BDNF was controlled‐released for a period of 4 weeks in a BDNF/PLGA porous membrane system.Main Outcome MeasuresFour weeks after the operation, erectile function was assessed by detecting the ratio of intra‐cavernous pressure (ICP)/mean arterial pressure (MAP). Smooth muscle and collagen content were determined by Masson's trichrome staining. Neuronal nitric oxide synthase (nNOS) expression in the dorsal penile nerve was detected by immunostaining. Phospho‐endothelial nitric oxide synthase (eNOS) protein expression and cyclic guanosine monophosphate (cGMP) level of the corpus cavernosum were quantified by Western blotting and cGMP assay, respectively.ResultsIn the ADSC/BDNF‐membrane group, erectile function was significantly elevated, compared with the BCNI and other treated groups. ADSC/BDNF‐membrane treatment significantly increased smooth muscle/collagen ratio, nNOS content, phospho‐eNOS protein expression, and cGMP level, compared with the BCNI and other treated groups.ConclusionsADSCs with BDNF‐membrane on the cavernous nerve can improve erectile function in a rat model of post‐prostatectomy ED, which may be used as a novel therapy for post‐prostatectomy ED. Piao S, Kim IG, Lee JY, Hong SH, Kim SW, Hwang T‐K., Heang S, Lee JH, Ra JC, and Lee JY. Therapeutic effect of adipose‐derived stem cells and BDNF‐immobilized PLGA membrane in a rat model of cavernous nerve injury. J Sex Med 2012;9:1968–1979.     

Sexual Function in the Late Postmenopause: A Decade of Follow‐Up in a Population‐Based Cohort of Australian Women

IntroductionThere is a paucity of longitudinal studies assessing sexual function of women in the late postmenopause.AimThis study aims to describe sexual function of women in the late postmenopause and to investigate change from early postmenopause.MethodsCross‐sectional analysis of 2012/13 and longitudinal analysis from 2002/04 of the population based, Australian cohort of the Women's Healthy Ageing Project, applying validated instruments: Short Personal Experience Questionnaire (SPEQ), Female Sexual Distress Scale (FSDS), Hospital Anxiety and Depression Scale, Geriatric Depression Scale, and California Verbal Learning Test.Main Outcome MeasuresSexual activity, SPEQ, and FSDS.ResultsTwo hundred thirty women responded (follow‐up rate 53%), mean age was 70 years (range 64–77), 49.8% were sexually active. FSDS scores showed more distress for sexually active women (8.3 vs. 3.2, P < 0.001). For 23 (23%) sexually active and for five (7%) inactive women, the diagnosis of female sexual dysfunction could be made. After adjustment, available partner (odds ratio [OR] 4.31, P < 0.001), no history of depression (OR 0.49, P = 0.036), moderate compared with no alcohol consumption (OR 2.43, P = 0.019), and better cognitive function score (OR1.09, P = 0.050) were significantly predictive for sexual activity. Compared with early postmenopause, 18% more women had ceased sexual activity. For women maintaining their sexual activity through to late postmenopause (n = 82), SPEQ and FSDS scores had not changed significantly, but frequency of sexual activity had decreased (P = 0.003) and partner difficulties had increased (P = 0.043). [Correction added on 10 July 2014, after first online publication: Mean age of respondents was added.]ConclusionsIn late postmenopause, half of the women were sexually active. Most important predictors were partner availability and no history of depression. However, being sexually active or having a partner were associated with higher levels of sexual distress. Compared with early postmenopause, sexual function scores had declined overall but were stable for women maintaining sexual activity. Further research into causes of sexual distress and reasons for sexual inactivity at this reproductive stage is warranted. Lonnèe‐Hoffmann RAM, Dennerstein L, Lehert P, and Szoeke C. Sexual function in the late postmenopause: A decade of follow‐up in a population‐based cohort of Australian women. J Sex Med 2014;11:2029–2038.     

The effect of post‐natal symptoms of post‐traumatic stress and depression on the couple's relationship and parent–baby bond

Objectives: Research has shown that between 1 and 3% of women may suffer from post‐traumatic stress disorder (PTSD) following childbirth. However, the potential effect of childbirth on fathers, and the implications of post‐natal symptoms of PTSD for family relationships, have received little attention. The current study therefore examined the potential effects of PTSD symptoms on the couple's relationship and parent–baby bond.

Design: Internet‐based questionnaire study.

Methods: One hundred and fifty‐two parents (126 women and 26 men) completed questionnaire measures of PTSD, depression, quality of the couple's relationship, and the parent–baby bond.

Results: Symptoms of PTSD and depression were significantly correlated with the couples' relationship and parent–baby bond. Structural equation modelling found the model that best fitted the data was one where PTSD symptoms had a direct effect on the parent–baby bond, but the effect of PTSD on the couples' relationship was mediated by depression.

Conclusions: The results indicate the importance of examining the psychological reactions of men and women after birth; and suggest that symptoms of PTSD have an effect on the parent–baby bond. However, methodological considerations mean further research is needed to replicate and extend this study before firm conclusions can be drawn.     

The Distribution of Weight‐Related Risks Among Low‐Income Women During the First Postpartum Year

ObjectiveTo describe the distribution of weight‐related risks (weight retention and overweight/obese status) during the first postpartum year and determine if risk distributions differ by race/ethnicity, time, age, or parity.DesignSecondary analysis of a longitudinal data set from 1‐ to 3‐days to 12‐months postpartum.SettingInitial recruitment was from a community hospital.ParticipantsTwo hundred and forty‐seven (White, African American, or Hispanic) low‐income women.ResultsAt 1‐ to 3‐days postpartum weight‐related risks were distributed as follows: 6.1% no risk, 17.0% significant postpartum weight retention, 12.1% overweight/obese, and 64.8% both weight‐related risks; at 12 months, the distribution was 32.4%, 8.9%, 16.6%, and 42.1%, respectively. Distributions differed by race/ethnicity at 6‐months (χ²=16.1, p=.013) and 12‐months postpartum (χ²=19.7, p=.003). Having both weight‐related risks (vs. not) at 12 months was 3.1 (odds ratio [OR]) times more likely (95% confidence interval [CI], 1.6, 6.2) for African American and 2.4 (OR) times more likely (95% CI[1.3, 4.6]) for Hispanic than White women. Having two risks decreased significantly only between 1 to 3 days and 6 weeks (p=.000). Maternal parity, but not age, was associated with weight‐related risk distributions on four of five time points.ConclusionDespite changes in the weight‐related risk distributions from 1‐ to 3‐days to 6‐weeks postpartum, the proportion of African American and Hispanic women with weight‐related risk (especially having two weight‐related risks) remains high at 12‐months postpartum.     

An Oral Formulation of Angiotensin‐(1‐7) Reverses Corpus Cavernosum Damages Induced by Hypercholesterolemia

IntroductionThe renin angiotensin system plays a crucial role in erectile function. It has been shown that elevated angiotensin‐II levels contribute to the development of erectile dysfunction (ED). Oppositely, angiotensin‐(1‐7) (Ang‐[1‐7]) mediates penile erection by activation of receptor Mas. Recently, we have developed a formulation based on Ang‐(1‐7) inclusion in cyclodextrin (CyD) [Ang‐(1‐7)‐CyD], which allows for the oral administration of Ang‐(1‐7).AimIn the present study, we evaluated the effects of chronic treatment with Ang‐(1‐7)‐CyD on penile fibrosis, oxidative stress, and endothelial function in hypercholesterolemic mice.MethodsApolipoprotein(Apo)E^?/? mice fed a Western‐type diet for 11 weeks received Ang‐(1‐7)‐CyD or vehicle during the final 3 weeks. Collagen content and reactive oxygen species (ROS) production within the corpus cavernosum were evaluated by Sirius red and dihydroethidium staining, respectively. Protein expression of neuronal nitric oxide synthase (nNOS) and endothelial nitric oxide synthase (eNOS), nicotinamide adenine dinucleotide phosphate (NADPH) subunits (p67‐phox and p22‐phox), and AT1 and Mas receptors in the penis was assessed by Western blotting. Nitric oxide (NO) production was measured by Griess assay in the mice serum. Cavernosal strips were mounted in an isometric organ bath to evaluate the endothelial function.Main Outcome MeasuresThe effect of Ang‐(1‐7)‐CyD treatment on penile fibrosis, oxidative stress, and endothelial function in hypercholesterolemia‐induced ED.ResultsAng‐(1‐7)‐CyD treatment reduced collagen content in the corpus cavernosum of ApoE^?/? mice. This effect was associated with an attenuation of ROS production and a diminished expression of NADPH. Furthermore, Ang‐(1‐7)‐CyD treatment augmented the expression of nNOS and eNOS in the penis and elevated vascular NO production. Importantly, these effects were accompanied by an improvement in cavernosal endothelial function.ConclusionLong‐term treatment with Ang‐(1‐7)‐CyD reduces penile fibrosis associated with attenuation of oxidative stress. Additionally, cavernosal endothelial function in hypercholesterolemic mice was markedly improved. These results suggest that Ang‐(1‐7)‐CyD might have significant therapeutic benefits for the treatment of erectile dysfunction. Fraga‐Silva RA, Costa‐Fraga FP, Savergnini SQ, De Sousa FB, Montecucco F, da Silva D, Sinisterra RD, Mach F, Stergiopulos N, da Silva RF, and Santos RAS. An oral formulation of angiotensin‐(1–7) reverses corpus cavernosum damages induced by hypercholesterolemia. J Sex Med 2013;10:2430–2442.     

Conjectures Concerning Cross‐Sex Hormone Treatment of Aging Transsexual Persons

IntroductionGuidelines for cross‐sex hormone treatment of transsexual people are now in place. However, little attention has been paid to the issue of treatment suitability for older people. Does existing treatment need to be adapted as subjects age, and does it make a difference if treatment is only started when the subject is already older?AimTo assess the necessity of adapting cross‐sex hormone administration for elderly transsexual people.Main Outcome MeasuresRisks/benefits of continued use of cross‐sex hormones with regard to bone health, cardiovascular risks, and malignancies.MethodsDue to lack of data on the subject population, sex hormone treatment of other conditions in older non‐transsexual people has been taken as the best available analogy to determine the extent to which these might be applicable to comparable transsexual persons. Findings in transsexual people receiving cross‐sex hormone treatment sometimes modified the above approach of applying guidelines for the elderly to the aging transsexual population.ResultsTestosterone administration to female‐to‐male transsexual persons (FtoM) carries little risk with regard to cardiovascular disease and cancer. For those with high hematocrit or cardiac insufficiency the dose can be reduced. Administration of estrogens to male‐to‐female transsexual persons (MtoF), particularly when combined with progestins, does significantly increase the risk of developing cardiovascular disease (almost a twofold incidence compared with the general population). This may require dose adjustment or changing from oral to safer transdermal estrogens. Tumors of the breasts, prostate and pituitary may occur. In FtoM, breast cancer can occur even after breast ablation. Older subjects can commence cross‐sex hormone treatment without disproportionate risks.ConclusionCross‐sex hormones may be continued into old age but monitoring for cardiovascular disease and malignancies, both of the old and new sex, is recommended. MtoF will have more health complications in old age than FtoM requiring adaptations of treatment. Gooren L and Lips P. Conjectures concerning cross‐sex hormone treatment of aging transsexual persons. J Sex Med 2014;11:2012–2019.     

A Longitudinal Survey of Childbirth‐Related Fear and Associated Factors

ObjectiveTo investigate the prevalence of childbirth‐related fear from pregnancy to one year after childbirth and to identify factors associated with being cured of childbirth‐related fear.DesignA longitudinal regional survey.SettingThree hospitals in a northern part of Sweden.ParticipantsSix hundred ninety‐seven (697) women who completed four questionnaires.MethodsData were collected by questionnaires in mid and late pregnancy and at 2 months and one year after birth. Childbirth related fear was measured 3 times.ResultsThere was a statistically significant increase in childbirth fear from 12.4% in mid‐pregnancy to 15.1% one year after childbirth (p < .001). Women who were cured of childbirth fear reported a better birth experience and would prefer a vaginal birth in a subsequent pregnancy. These women were also more likely to experience a feeling of control during birth and were more satisfied with information about the progress of labor, but there was no difference in prenatal counseling or having an elective cesarean between the groups.ConclusionWomen with prenatal fear of childbirth may be cured of this fear by having a better birth experience. If women feel in control of their bodies and are well informed about the progress of labor, the chances of being cured will increase. Prenatal counseling or having an elective cesarean birth does not seem to be a solution for relieving childbirth fear.