Self-report versus interview data of women's subjective theories of illness: concordance and predictive validity in a psychosomatic-gynecological liaison service

Between-method comparisons of patient data from standardized self-report instruments and corresponding patient interview data frequently have poor agreement. We investigated the concordance and predictive validity of self-report measures and expert-rated interview data of women's subjective theories of illness in a psychosomatic-gynecological consultation liaison service. 31 patients completed two questionnaires (KKG, PATEF) on subjective theories of illness and were interviewed with a semistructured instrument on the same topic at the time of the initial appointment and after 1.5 years. External criteria for assessing the predictive validity of questionnaire versus interview data were: follow-up participation and psychotherapy utilization during the follow-up interval. Questionnaire and interview rating data were only modestly associated. Rater concordance on the interview data was low. Neither the initial-assessment interview nor the questionnaire data had predictive validity for patients' participation in the follow-up. None of the interview rating data but a portion of the questionnaire data, had predictive validity for patients' utilization of psychotherapy during the follow-up interval. The cognitive conceptualization of subjective theories of illness may fail in patients with psychosomatic disorders, due to their very mode of experience. A wider approach that includes assessment of nonverbal communication and countertransference might be useful.     

Hyperemesis gravidarum and patient satisfaction: A path model of patients' perceptions of the patient-physician relationship

Objective.?To examine the relationship between patients' perceptions of the patient-physician relationship and patients' satisfaction with the overall medical care received from their physicians in the treatment of hyperemesis gravidarum (HG).

Methods.?This study investigated patients' beliefs and their views of their physicians' beliefs about the causal explanation of HG, the seriousness of the illness, and the impact of the illness upon patients' daily lives. Also examined were the extent to which patients' beliefs were congruent with their perception of their physicians' beliefs, and patients' ratings of the humanistic characteristics of physicians they deemed important. Ninety-six respondents who had experienced at least one hospitalization from January 1993 through April 1997 responded to interview questions focusing on their HG illness experience. Using both quantitative and qualitative methodological approaches, a path model of patient perception factors associated with patient satisfaction was tested.

Results.?Perceived shared beliefs about the etiology of HG for a particular patient's illness were more important direct contributing factors of satisfaction than were the specific causal explanations. The length of the patient-physician relationship provided important indirect effects on patient satisfaction; three key mediating variables were patients' perceptions about physician humanism and perceived agreement about the cause and impact of HG. Pertinent qualitative findings are provided as additional sources of information to supplement the quantitative results.

Conclusion.?Knowledge of the patient-physician relationship factors that influence HG women's satisfaction can be used to enhance service delivery and may ultimately improve perinatal outcomes.     

The relationship between maternal visiting patterns and the development of premature infants

The objective of the current study was to evaluate the predictive validity of mothers' early interactions whit their premature infants in the Neonatal Intensive Care Unit (NICU) for the later development of these infants. The subjects were 35 premature infants born in the Kaplan Hospital, Israel, between 1976 and 1979, and who were discharged with no medical complications of limiting conditions. The infants were divided into two groups on the basis of the mothers' visiting patterns during the postnatal hospitalization. Group 1 comprised 21 mothers whose average visiting rate was 4.10 (SD 1.31), and group 2 consisted of 14 mothers with a mean visiting rate of 1.71 (SD 1.31).

Maternal behavior was assessed with two measures, i.e., a mothers' self-report questionnaire and an evaluation of the mother's behavior based on observations of the hospital nurses and other medical staff. These obsevations yielded data on the number of visits, the quality of the mother's contact with the infant, and feeding behavior. Measures of infant development included: 1) weight gain, 2) health condition, 3) psychomotor development and 4) psychosocial development. Measures 3 and 4 were based on Gesell and Armatruda's Development Diagnosis.

Mothers responded to the self-report questionnaire, and the medical staff was instructed to observe and record mothers' visiting patterns and behavior in the NICU. The infants were followed and evaluated for one or two years after discharge from the hospital.

From the findings it may be concluded that maternal behavior towards the infants while they were in the hospital, was significantly related tot higher weight gains and better general health ratings as well as psychomotor and psychosocial development at age one to two years. Gender-based differential treatment of premature infants in the NICU was also observed, girls being visited more frequently by their mothers than boys were.     

A Questionnaire for the Evaluation of Quality of Life after Penile Prosthesis Implant: Quality of Life and Sexuality with Penile Prosthesis (QoLSPP)

IntroductionPenile prosthesis implantation is considered to be a satisfactory treatment for erectile dysfunction. Previous studies have assessed mainly prosthesis function and perioperative complications and have measured satisfaction only with regard to sexual performance. Very little, if anything, has been reported on the most relevant question: To what extent does the implant affect the patient's life?AimTo develop and validate the pathology‐specific Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire, which evaluates patients' quality of life after penile prosthesis implantation.MethodsSixty‐nine patients aged 32–82 years who received a three‐component hydraulic prosthesis between 1997 and 2009 participated in the study; 47 participated in the retest of the instrument. The QoLSPP questionnaire was developed to examine general and sexual quality of life in four domains: functional, personal, relational, and social. All psychometric properties of the QoLSPP were validated. Internal validity was assessed by means of exploratory factor analysis. Cronbach's alpha was used to evaluate the internal consistency of the items within each factor. Paired‐sample t‐tests were used to investigate metric stability. Independent‐samples t‐tests and nonparametric tests were used to evaluate the sensitivity.Main Outcome MeasuresThe main outcome measure for the questionnaire was quality of life as biological and psychosocial–relational well‐being. Main outcome measures for validation were internal validity, metric stability, and sensitivity of the QoLSPP.ResultsThe QoLSPP met the psychometric requirements of internal validity and reliability. Metric stability and sensitivity were tested and confirmed. Respondents reported high satisfaction levels in all quality of life domains. All domains were significantly and positively correlated; the functional domain was most predictive of overall quality of life. More than half of respondents perceived their partners to be very satisfied.ConclusionsProsthesis implantation was correlated with high quality of life in recipients and high perceived quality of couple relationships; partner satisfaction affected patients' quality of life, self‐image, relation to the outside world, and satisfaction with implant function. Caraceni E and Utizi L. A questionnaire for the evaluation of quality of life after penile prosthesis implant: Quality of Life and Sexuality with Penile Prosthesis (QoLSPP). To what extent does the implant affect the patient's life? J Sex Med 2014;11:1005–1012.     

The triage-function of a psychosomatic liaison-service for gynecological patients

The psychosomatic psychotherapeutic consultation liaison (CL)-service for gynecological patients at the Vienna University has been evaluated. Research interest focused on success and failure of the initial interview, conceptualized for a specific clientele. The interview has a triage function for treatment planning. By the type of treatment that was applied, patients were divided into three groups: Group A, patients with one single contact with the unit; Group B, patients who were referred to external psychotherapy; Group C, patients who were treated with short-term psychoanalytic psychotherapy as offered by the service unit. The drop-outs figured as Group D. The questionnaires completed by the patients at the first consultation and 6 months after their final contact with the clinic covered socio-demographic data, ego functions; the motivation for psychotherapy, a complaints list and finally, at the second contact only, an individual retrospective judgement concerning personal consequences of the consultation. Patients needs in CL-seruices call for quick decisions, which therapeutic measure would be most adequate. An experienced clinician's decision is based on several circumstances: individual feeling of suffering therapy-motivation and ego-strength, as well as social and demographic facts. Comparing groups with different therapeutic recommendations showed that the psychometric tests discriminated well between these four groups and thus the validity of the clinical recommendation has been confirmed.     

Do Patients Lie? An Open Interview vs. a Blind Questionnaire on Sexuality

IntroductionPostmenopausal women are often hesitant to discuss their sexual attitudes and experiences surrounding sexuality with her doctors. Sociocultural, ethnic, and medical background may affect the attitude towards menopause and the expectations regarding sexuality in these women.AimTo describe communication about sex between patients and doctors and its relation to extrinsic limiting factors.MethodsA total of 2,332 women between 45 and 64 years old were involved in this cross-sectional survey. The study used an ad hoc questionnaire covering the demographic and reproductive variables as well as the data related to sexual activity. The Cervantes questionnaire was administered to determine the impact of sexuality on health-related quality of life.Main OutcomesPatients' responses to anonymous questionnaires or direct interviews.ResultsThe percentage of women who recognized having occasional or unconventional partners was twofold higher in the anonymous questionnaire than in the clinical interview. In the medical interview only 15.2% of women recognized that sexuality was not very important compared with more than 40% in the anonymous questionnaire (P < 0.001). The highest concordance between the anonymous questionnaire and the clinical interview was in women who referred to not having any sexual relationship at all (88.07%) whereas in the other conditions concordance was significantly lower (P < 0.001).ConclusionSelf-reported data on sexuality diverge from those derived from a direct interview. The proportion of women with low interest in sexuality was higher in the blind questionnaires. Castelo-Branco C, Palacios S, Ferrer-Barriendos J, Alberich X, and The Cervantes Study Group. Do patients lie? An open interview vs. a blind questionnaire on sexuality.     

Assessment of the Psychometric Properties of the Short‐Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) following Surgical Placement of Prolift+M: A Transvaginal Partially Absorbable Mesh System for the Treatment of Pelvic Organ Prolapse

IntroductionImpairment of sexual function is a significant problem among women suffering from pelvic organ prolapse (POP). Because anatomical measures of POP do not always correspond with patients' subjective reports of their condition, patient‐reported outcome measures may provide additional valuable information regarding the experiences of women who have undergone surgery. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) is a validated, widely used condition‐specific questionnaire focused on sexual function among patients with POP or urinary incontinence.AimThis study aims to report sexual function outcomes as measured by PISQ‐12 and to evaluate the psychometric characteristics of the questionnaire following surgical mesh implant for the treatment of POP.Main Outcome MeasuresThe PISQ‐12 was used to measure sexual function, while a set of other measures, namely, Pelvic Organ Prolapse Quantification, Patient Global Impression of Change, Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Surgical Satisfaction Questionnaire, was used for validation.MethodsData for the study were collected from a prospective multicenter, single‐arm study of surgical POP repair via the transvaginal placement of a partially absorbable mesh system. For baseline, month 3, and month 12 following POP surgery, several psychometric properties of the PISQ‐12 were evaluated, including internal consistency (Cronbach's alpha), concurrent validity, discriminant validity, and responsiveness.ResultsAs measured by the PISQ‐12 questionnaire, statistically significant improvements were observed in the composite summary score as well as all three subscale scores at 1 year. The PISQ‐12 generally demonstrated good psychometric properties including internal consistency reliability, validity, and responsiveness. The PISQ‐12 items had good distributional properties at baseline, with substantial ceiling effects at follow‐up visits reflecting improvements experienced by the patients.ConclusionThe PISQ‐12 is a valid measure of sexual function in studies involving patients with POP. Roy S, Mohandas A, Coyne K, Gelhorn H, Gauld J, Sikirica V, and Milani AL. Assessment of the psychometric properties of the short‐form prolapse/urinary incontinence sexual questionnaire (PISQ‐12) following surgical placement of prolift+M: A transvaginal partially absorbable mesh system for the treatment of pelvic organ prolapse. J Sex Med 12;9:1190–1199.     

The Hyperemesis Beliefs Scale (HBS): a new instrument for assessing beliefs about severe nausea and vomiting in pregnancy

Objective. The purpose of this research was to validate the Hyperemesis Beliefs Scale (HBS), a new instrument for assessing patient perception factors of hyperemesis gravidarum (HG) that influence reported patient satisfaction with medical care.

Methods. Patients' beliefs and their perception of their physicians' beliefs about the causal explanations of HG, seriousness of the illness, and the impact of the illness upon patients' daily lives were determined using a newly developed hyperemesis beliefs scale (HBS) in a sample of 96 women. Exploratory factor analyses of the patient and physician versions of the HBS were performed separately using principal factor analysis extraction and oblique rotation in SPSS.

Results. Exploratory factor analyses of patient and physician versions of the HBS demonstrated broad support for the hypothesized factor structure. However, two key differences appeared in the two versions of the HBS. First, the patient items exhibited two causal factors (general and personal), whereas the physician items showed only a single causal factor. Second, in the patient version, items assessing the impact of HG on the babies' health loaded separately from the rest of the items in the HBS, whereas the analyses of the corresponding physician items indicated that the baby items loaded well on the degree of seriousness factor.

Conclusion. This scale may be of value in facilitating further research on HG illness representations, patient–physician relationship and patient satisfaction. Specifically, the HBS design provides data to show whether patient–physician agreement on particular measures is associated with better patient satisfaction outcomes.     

The Ability of Men to Assess their Suitability to Take a Phosphodiesterase Type 5 Inhibitor: An Assessment of the Comprehension of Patient Information Materials

IntroductionErectile dysfunction is a treatable condition that affects a large proportion of men. Most men do not seek medical help for their ED because of embarrassment or social stigma that may lead some men to self-treat.AimTo evaluate men's ability to self-assess their suitability for 50 mg sildenafil use after reviewing patient information materials.Main Outcome MeasuresPatient rating of patient information materials, self-assessment of suitability for sildenafil use, and clinician assessment of sildenafil suitability.MethodsMen in the UK were recruited through newspaper, radio, and internet advertisements. Eligible men reviewed the 50 mg sildenafil patient information materials (packaging materials and patient information leaflet) at the in-person visit and then completed a survey to rate the materials and self-assess their suitability for sildenafil use. A clinician, blinded to the participant's ED status and self-assessed sildenafil suitability, then conducted a one-on-one interview to assess the participant's ED status and suitability for sildenafil treatment. The primary analysis was the concordance of self-assessed suitability versus clinician-assessed suitability.ResultsThe initial study phase included 113 generally healthy men, mean age 40.2 ± 13.1 years. The second phase included 70 men with comorbid prostate or cardiac conditions, mean age 60.7 ± 7.8 years. The 183 men rated the patient information materials as easy to understand; few participants reported problems understanding the materials, and many participants learned new information. The concordance rate between clinician-assessed suitability and self-assessed suitability was 73.9% (95% confidence interval [CI] = 66.7–81.2%). When accounting for men who would not take sildenafil even though they were suitable or would seek additional information from a healthcare professional prior to using sildenafil, the concordance rate was 90.1% (95% CI = 85.8–94.4%).ConclusionThe results of this UK study suggest that men are capable of using written sildenafil patient education materials to accurately assess their suitability for treatment with 50 mg sildenafil. Symonds T, Dean J, Coyne KS, Margolis MK, Hackett G, Edwards D, Marfatia A, and Schnetzler G. The ability of men to assess their suitability to take a PDE5 inhibitor: An assessment of the comprehension of patient information materials.     

The effectiveness of the interview for predicting the presence of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS), a leading cause of female infertility, occurs in approximately 4% of women of reproductive age. Multifamily studies have established that PCOS has strong inherited traits. Although diagnosis of PCOS in the relatives of affected women can readily be made by clinical and biochemical evaluations, these methods are costly and laborious. The aim of this investigation was to determine whether clinically evident PCOS could be detected by a written questionnaire, which is a significantly less expensive means of detection than direct determination. A questionnaire about the history of possible androgenic symptoms of PCOS was presented to patients and their first-degree female relatives, who were also evaluated by physical and laboratory examinations. The sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) for the detection of PCOS by interview were calculated. The NPV of the proband interview was significantly lower for sisters than for mothers (82% vs. 100%, respectively; p?<?0.05). When the family member completed the written questionnaire directly, the specificity and NPV of self-reporting were equally high (>90%) for both mothers and sisters. Thus direct interviewing of PCOS patients or their mothers and sisters reliably predicts affected status, but patient interview alone will not predict PCOS in almost 50% of the affected sisters.     

Validity of adolescent and young adult self-report of Papanicolaou smear results

OBJECTIVE: To assess the validity of adolescent and young adult report of Papanicolaou smear results and to determine sociodemographic, cognitive, and behavioral factors associated with incorrect reporting. METHODS: We conducted a cross-sectional study of 477 female subjects aged 12 to 24 years who attended an adolescent clinic and had a previous Papanicolaou smear. Subjects completed a self-administered survey assessing self-report of Papanicolaou smear results, knowledge about Papanicolaou smears and human papillomavirus (HPV), attitudes about Papanicolaou screening and follow-up, and risk behaviors. The sensitivity, specificity, positive predictive value, and negative predictive value of self-reported results were calculated using the cytology report as the standard. Variables significantly associated with incorrect reporting were entered into logistic regression models controlling for age and race to determine independent predictors for incorrect reporting. RESULTS: Of the 477 participants, 128 (27%) had abnormal cytology reports and 66 (14%) had incorrect self-reports. Sensitivity of self-report was 0.79, specificity 0.89, positive predictive value 0.72, negative predictive value 0.92, and kappa (kappa) 0.66. The adjusted odds ratios (OR) and 95% confidence intervals (CI) of the variables comprising a logistic regression model predicting incorrect reporting were an HPV knowledge source of zero (OR 2.4, CI 1.0, 5.8), low perceived communication with the provider (OR 2.1, CI 1.1, 4.0), and no contraception at last intercourse (OR 5.5, CI 2.7, 11.0). CONCLUSION: The validity of adolescent and young adult self-reported Papanicolaou smear result is high, except among those who lack knowledge of HPV, perceive poor communication with the provider, and use contraception inconsistently.     

Motives for having or not having Children: A Comparison between Questionnaire and Interview Methods

This study addresses validity issues in a questionnaire constructed with the aim of exploring a private and emotionally loaded topic, namely motives for having or not having children. Themes extracted by factor analysis of data from a reference population of men and women in the fertile ages were used to structure conversational interviews with a smaller sample of women and men of the same age. Of 30 persons invited, 24 agreed to participate in the interview and they completed the questionnaire before the interview. Factor scores were estimated from data obtained by means of the written questionnaire with closed questions, and the scores were compared with results from the structured interview with open questions. Thus, the questionnaire and the factor analysis were validated and a conclusion could be drawn that this method was able to provide important informatory facts even in an area where emotional factors are predominant. The findings also supported the idea that it is important to supplement questionnaire results with validity studies. The combination of the two methods in this study was fruitful and highlighted important new areas that need further research.     

Reliability and Validity of the Functional Pelvic Pain Scale: A New Measure of Pelvic Pain Severity

This study presents reliability and validity data from a small sample of pelvic pain clinic patients on a self-report rating scale, termed the Functional Pelvic Pain Scale (FPPS), designed to measure pelvic pain intensity as it relates to functions of daily living (bladder and bowel function, intercourse, walking, running, lifting, working, and sleeping).Study design: in a preliminary study, the FPPS was completed by 24 patients from a pelvic pain clinic, and 27 female medical students not having a complaint of pelvic pain. In a subsequent study of reliability and validity, 20 women attending the pelvic pain clinic completed the FPPS during their visit, and completed Daily Pain Records (DPRS) for every day of their next menstrual cycle, as well as a second FPPS at the end of their cycle.Results: preliminary results demonstrate that the FPPS shows discriminant validity between women without a complaint of pelvic pain and those with pelvic pan (p< 0.0001). Results in the second study demonstrate that the FPPS has satisfactory levels of test-retest reliability (r= 0.8048 p= 0.004) and construct validity. Functional pelvic pain scale scores showed statistically significant correlations with the highest monthly activity impairment (r= 0.5433 p= 0.007) and the average uterine pain intensity (r= 0.4436 p= 0.025).Conclusion: the FPPS is a sensitive and reliable measure of pelvic pain intensity through, time, demonstrating evidence of validity. The FPPS shows promise as a method for evaluation of pelvic pain severity. Its predictive value in research and clinical practice has yet to be determined.     

The Subjective Sexual Arousal Scale for Men (SSASM): preliminary development and psychometric validation of a multidimensional measure of subjective male sexual arousal

IntroductionSexual arousal is a multifaceted process that involves both mental and physical components. No instrument has been developed and validated to assess subjective aspects of male sexual arousal.AimTo develop and psychometrically validate a self‐administered scale for assessing subjective male sexual arousal.MethodsUsing recommendations of the Food and Drug Administration (FDA) guidance on patient‐reported outcome instruments, important aspects of male sexual arousal were identified via qualitative research (focus groups and interviews) of U.S. men with erectile dysfunction (ED) and healthy controls. After a preliminary questionnaire was developed by a panel of experts, a quantitative study of men with ED and controls was conducted to psychometrically validate the Subjective Sexual Arousal Scale for Men (SSASM).Main Outcome MeasuresTo develop a male sexual arousal scale and determine its factor structure, reliability, and construct validity.ResultsFive aspects of male sexual arousal were identified from the qualitative focus groups and cognitive interviews. Men's preferred language for describing sexual arousal and preferred response formats were incorporated into the questions. Factor analysis of data from the quantitative study of 304 men aged 21 to 70 years identified five domains with eigenvalues >1: sexual performance (six items), mental satisfaction (five items), sexual assertiveness (three items), partner communication (three items), and partner relationship (three items). The five domains had a high degree of internal consistency (Cronbach's alpha values 0.88–0.94). Test–retest reliability over a 2‐ to 4‐week period was high–moderately high (r values 0.75–0.88) for the five domain scores. Correlations between SSASM domain scores and standardized scale scores for social desirability, general health, life satisfaction, and sexual function demonstrated the construct validity of the scale.ConclusionsPreliminary validation data suggest that the 20‐item SSASM scale may be useful as a multidimensional, reliable, self‐administered instrument for assessing subjective sexual arousal in men of different ages. Althof SE, Perelman MA, and Rosen RC. The Subjective Sexual Arousal Scale for Men (SSASM): Preliminary development and psychometric validation of a multidimensional measure of subjective male sexual arousal. J Sex Med 2011;8:2255–2268.     

A questionnaire to assess women's perception of respectful maternity care (WP-RMC): Development and psychometric properties

ObjectiveTo develop and assess the psychometric properties of Women's Perspection-Respectful Maternity Care (WP-RMC) Questionnaire.DesignAn exploratory sequential mixed method study was carried out from March to August 2018 in Tehran, Iran. The questionaire items were generated from the literature review and qualitatatve study. The revised items of questionnaire were assessed for validity via testing for face, content and construct validity and relibility.SettingPublic and semi-public hospitals, and public primary health care centers.ParticipantsPostpartum women who had a low risk pregnancy, normal vaginal childbirth and gave birth to a healthy baby with normal birth weight.FindingsThe WP-RMC has 19 items that loaded in three factors: Providing comfort, Participatory care and Mistreatment. Exploratory factor analysis jointly accounted for 53.05% of observed variance. The CVI was 0.97 and the CVR in all items was more than 0.79. Cronbach's alpha for all items was 0.91 and ICC was 0.9.Key conclusions'The WP-RMCquestionnaire is a valid and reliable tool to measure women's experiences of Respectful Maternity Care. This questionnaire could assess subjective features of quality of childbirth care. It can be used in maternity services trying to evaluate and improve women's care experiences during labour and childbirth. The use of the translation of WP-RMC questionnaire in other countries is recommended.     

Patients' satisfaction with laparoscopic myomectomy

Background. Laparoscopic myomectomy offers a uterus-conserving alternative to hysterectomy for patients suffering from symptomatic myomas. The following study aimed to examine clinically relevant aspects of perceived satisfaction following laparoscopic myomectomy.

Method. 191 women completed a 17-item questionnaire on retrospective satisfaction with their choice for the operation and with the surgical outcome (e.g., “all myomas were removed”, “termination of discomfort”). A comparison was performed using questionnaire data, patients' demographical data and surgical records (e.g., duration of surgery).

Results. Women who trusted in their decision for the surgical procedure revealed better surgical outcome and greater satisfaction with the treatment process than those who were insecure with their choice. Age did not influence the patients' perceived satisfaction. In anticipation of the surgical outcome, patients placed stronger emphasis on tissue preservation than on their wish for a child or on the termination of discomfort.

Conclusions. The high overall level of satisfaction and positive outcome in various age groups contradicts current recommendations against laparoscopic myomectomy for women over 40 years of age.     

CASE REPORT: Postorgasm Illness Syndrome—A Spectrum of Illnesses

IntroductionWe describe two men with marked symptoms following orgasm. In each case, the symptoms were consistent with those found in postorgasm illness syndrome (POIS).AimFurther elucidation of the cause of the patients' symptoms.MethodsBoth cases were investigated for causes of POIS with biochemical, hormonal, neurological, autonomic, cardiological, and psychological workup.ResultsExtensive investigation did not reveal a major organic cause for these patients' symptoms. Detailed history revealed likely differing etiologies in each case. In one case, the symptom picture suggested cytokine release, and, in fact, the patient subjectively improved by 80% on taking nonsteroidal anti-inflammatory drugs just prior to and for a day or two after orgasm. The other case appeared to have an ethnic/cultural etiology that was associated with the “Dhat” syndrome.ConclusionThe apparent differing etiologies/clinical associations of these cases highlight the need for careful history, examination, and investigations in patients presenting with POIS. We recommend that each case needs individual consideration and investigation, and treatment needs to be tailored to the likely cause. It seems likely that POIS represents a spectrum of syndromes of differing etiologies. Further research into the neurobiochemical sequelae of orgasm will be useful in understanding the pathological processes in these cases. Ashby J, and Goldmeier D. Postorgasm illness syndrome—A spectrum of illnesses.     

Predictors of hysterectomy: an Australian study

OBJECTIVE: We evaluated the relative importance of predictors of hysterectomy. STUDY DESIGN: A questionnaire survey of an Australia-wide sample of adult female twins was conducted; self-report data were validated against reports from treating physicians. RESULTS: A total of 3096 women (94%) and 366 physicians (87%) responded. The sensitivity of patient report of hysterectomy was 98.2%. Best predictors of hysterectomy were endometriosis (odds ratio 4.85, 95% confidence interval 3.17-7.43), medical consultation for menorrhagia (odds ratio 3.55, 95% confidence interval 2.47-5.12), joint effects of fibroids with medical consultation for chronic or persisting pelvic pain (odds ratio 3.34, 95% confidence interval 1. 42 to 7.87), having smoked >40 cigarettes per day (odds ratio 3.24, 95% confidence interval 1.10-9.55), joint effects of fibroids with consultation for menstrual problems (odds ratio 2.61, 95% confidence interval 1.36-5.01), and tubal ligation (odds ratio 1.77, 95% confidence interval 1.31-2.39). Less-important predictors were age and higher education level (protective). CONCLUSION: Consulting a physician about pelvic pain and menstrual problems, especially heavy bleeding, are recognized steps toward hysterectomy. Of particular interest for future genetic analyses are the high odds of hysterectomy for women with endometriosis, fibroids, or menorrhagia.     

Vaginal flap for rectovaginal fistulae in Crohn's disease

ObjectivesTo evaluate efficacy and functional results (sexual activity) of vaginal flap for rectovaginal fistula in Crohn's disease.Patients and methodsFrom May 2004 to March 2008, we proposed a vaginal flap in patients who had a rectovaginal fistula in Crohn's disease and for which rectal flap was technically impossible. Monitoring included a clinical examination at 1 month and every 3 months for 1 year, Perianal Disease Activity Index for sexual activity evaluation. Every year and in April 2009 the nursing team during a telephone interview filled a standardized questionnaire.ResultsWe treated 5 patients. At 6 months, 4 of 5 patients were healed. At 7 months, 1 patient presented a new flare up of CD with reopening of the fistula. The other 3 patients were still healed at a median follow-up of 30.66 months (15 to 59). One patient presented dyspareunia during 3 months.Discussion and conclusionVaginal flap is an effective technique that entails neither prolonged dyspareunia nor fecal incontinence. Stoma is not systematic.