More than just bad sex: sexual dysfunction and distress in patients with endometriosis

Objectives

The aim of the current study was to evaluate the prevalence and the impact of sexual dysfunction, sexual distress and interpersonal relationships in patients with endometriosis.

Study design

A questionnaire-based multicentre cohort study was conducted in eight tertiary referral centres in Austria and Germany. One hundred and twenty-five patients with histologically proven endometriosis and dyspareunia were included. The Female Sexual Function Index and the Female Sexual Distress Scale were used to screen women's sexuality. Additionally, we evaluated psychological parameters and pain intensity during/after sexual intercourse via a self-administered questionnaire.

Results

Female sexual distress and sexual dysfunction were observed in 97/125 and 40/125 patients. Statistically significant correlations were found between sexual dysfunction and pain intensity during/after sexual intercourse (p < 0.01/p < 0.01), a lower number of episodes of sexual intercourse per month (p < 0.01), greater feelings of guilt towards the partner (p < 0.01) and fewer feelings of feminity (p < 0.01). Thirty-eight out of 125 women agreed that the primary motivation for sexual intercourse was to conceive and nearly half of women (46%) included stated that satisfying the partner acted as primary motivation for sexual contact.

Conclusion

Overall, our findings demonstrate that dyspareunia as a common complaint in patients with endometriosis causes a severe impairment of sexual function, relationship and psychological wellbeing.     

Coerced sexual debut and lifetime abortion attempts among women in Rakai, Uganda

Objective

To assess whether reported coercion at sexual debut is associated with a greater lifetime risk of attempting an abortion among women in Rakai, Uganda.

Methods

Analysis of data from sexually experienced, ever-pregnant women in a longitudinal, population-based, open cohort study in 56 rural communities in Rakai, Uganda (n = 4784). For univariate analysis, the t test was used for continuous variables and the Pearson χ² or Fisher exact tests for categorical variables. Multivariate logistic regression was used to control for potential confounding.

Results

Twenty percent of women reported coercion at sexual debut. Compared with women who reported consensual sexual debut, the adjusted odds ratio (OR) of subsequent abortion attempts among coerced women was 1.57 (95% CI, 1.11-2.20).

Conclusion

There is a need to protect women from sexual coercion, implement policies for prevention of violence, and provide comprehensive reproductive health care, including prevention of unwanted pregnancy and unsafe abortions.     

The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation

Objective

Prophylactic salpingo-oophorectomy is recommended to women who carry a BRCA1 or BRCA2 mutation to reduce the risks of breast, ovarian and fallopian tube cancer. We measured the impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual functioning in women with a BRCA mutation.

Methods

Women who underwent prophylactic salpingo-oophorectomy between October 1, 2002 and June 26, 2008 for a known BRCA1 or BRCA2 mutation were invited to participate. Participants completed questionnaires before prophylactic surgery and again one year after surgery. Measures of sexual functioning and menopausal symptoms before and after surgery were compared. Satisfaction with the decision to undergo prophylactic salpingo-oophorectomy was evaluated.

Results

114 women who underwent prophylactic surgery completed questionnaires before and one year after surgery. Subjects who were premenopausal at the time of surgery (n = 75) experienced a significant worsening of vasomotor symptoms (hot flashes, night sweats and sweating) and a decline in sexual functioning (desire, pleasure, discomfort and habit). The increase in vasomotor symptoms and the decline in sexual functioning were mitigated by HRT, but symptoms did not return to pre-surgical levels. HRT decreased vaginal dryness and dyspareunia; however, the decrease in sexual pleasure was not alleviated by HRT. Satisfaction with the decision to undergo prophylactic salpingo-oophorectomy remained high regardless of increased vasomotor symptoms and decreased sexual function.

Conclusions

Women who undergo prophylactic salpingo-oophorectomy prior to menopause experience an increase in vasomotor symptoms and a decrease in sexual functioning. These symptoms are improved by HRT, but not to pre-surgical levels.     

Miomas y función sexual. Estudio prospectivo de un año

Objective

To prospectively study sexual function in women with myomas over a 1-year period. Absence of sexual desire, absence of arousal, anorgasmia, dyspareunia and pelvic pain were compared in women with myomas versus controls.

Design and method

A total of 172 women with myomas (largest diameter: 3-5 cm) and 80 women (largest diameter > 5 cm) were examined in the author's consulting rooms in 2009. Both groups were compared with control groups paired by age. The two myoma groups were also compared between each other. Sexual data were gathered through personal interviews.

Results

The most statistically significant differences were the following: in the group of women with myomas measuring 3-5 cm, differences were found in medical history (P < .001), absence of sexual desire (P < .01), vaginal dryness (P < .05), subserosal myomas (P < .001) and in equal size of the myoma at 1 year (P < 0,001); in the group of myomas measuring > 5 cm, differences were found in the absence of sexual relations (P = .02), intramural myomas (P < .001), increased size of the myoma at 1 year (P < .001), and in pain (P = .02). No significant differences were found in sexual parameters (sexual desire, arousal, orgasm, dyspareunia, and vaginal dryness) between each group or their controls.

Conclusions

1) In women with myomas measuring 3-5 cm, statistically significant differences were found in the absence of sexual desire (P < .01) and in vaginal dryness (P < .05). 2) In myomas measuring > 5 cm, statistically significant differences were found in the absence of sexual intercourse (P = .02), in increased size of the myoma at 1 year (P < .001) and in chronic pelvic pain (P = .02).     

Posttraumatic stress disorder, depression, and hopelessness in women who are victims of sexual violence

Objective

To evaluate posttraumatic stress disorder (PTSD), depression, and hopelessness in women 1 and 6 months after they experienced sexual violence.

Methods

This prospective study, in which the clinician-administered PTSD scale, the Beck depression inventory, and the Beck hopelessness scale were used, included 67 women at 1 month and 52 women at 6 months after they experienced sexual violence.

Results

Overall, 77.6% of the women were ≤ 24 years of age, and 52% were adolescents; 15% had a history of drug abuse, and 13.5% had a history of previous sexual violence. The aggressor was unknown in 76% of cases, and there was more than 1 aggressor in 9% of cases. In the first month, 43% of the women had moderate or very severe PTSD; 52.2% had moderate or severe depression; and 22.4% had moderate or severe hopelessness, which decreased to 21%, 20% and 10%, respectively, at 6 months. In the first month, severity of PTSD was associated with moderate or severe depression, and at 6 months severity of PTSD was associated with multiple aggressors and previous psychiatric disorders. All scores decreased in the sixth month.

Conclusion

Severe mental health disorders were still present 6 months after women had experienced sexual violence.     

Simple posterior vestibuloplasty for central introital dyspareunia

The aim of this study is the evaluation of a simple surgical widening plasty of the posterior vestibulum for central introital dyspareunia. This study takes place in gynecological infectious diseases clinic in secondary and tertiary care centers. The subjects are one hundred forty-five consecutive patients with introital pain during or when attempting sexual intercourse. One-digit examination of the posterior hymenal rim of the vulva elicits the specific pain and clinical examination reveals nothing abnormal or only focal redness on the central posterior vestibulum. This condition should be clearly differentiated from the focal-provoked vestibulodynia, although mixed forms are frequent. A questionnaire was composed to assess the level of pain experienced during intercourse and of satisfaction of their sexual life in general at 1 to 3?years after the intervention. After a mean of 3?years, 90% of the patients were very satisfied with the improvement of the sexual health due to the intervention. Eighty percent had less pain during intercourse. The proportion of patients forced to interrupt sexual intercourse because of pain dropped from 64% to 26% (p?<?0.0001). The number of women only having infrequent intercourse (once a month or less) decreased more than fourfold and the mean number of occasions that sexual intercourse took place increased by 27% after the intervention. Simple surgical widening plasty of the posterior vestibulum without excision of tissue led to a significant improvement of the sex life of at least 80% of a group of women with primary and secondary central introital dyspareunia of any cause. Correct and specific diagnosis is crucial prior to any intervention.     

Resumption of sexual activity and regular menses after childbirth among women infected with HIV in Malawi

Objective

To determine the factors associated with resumption of sexual activity and regular menses after childbirth among women infected with HIV-1.

Methods

Information on sociodemographic, behavioral, and clinical factors was obtained from 2 HIV perinatal studies (NVAZ and PEPI trials) conducted in Malawi, 2000-2009. Factors associated with resumption of sexual activity and menses were analyzed using Cox proportional hazard models.

Results

A total of 1838 women from the NVAZ study and 2982 women from the PEPI study were included in the analysis. Resumption of sexual activity was primarily associated with sociodemographic factors (e.g. in the PEPI study, marital status [adjusted hazard ratio (aHR) 0.56, P < 0.001], use of contraceptive method [aHR 8.0, P < 0.001], and breastfeeding [aHR 0.52, P < 0.001]), whereas resumption of regular menses in the PEPI study was primarily associated with biological factors (e.g. plasma viral load [aHR 0.89, P < 0.006], and breastfeeding [aHR 0.23, P < 0.001).

Conclusion

HIV-infected women need adequate counseling to take into account their HIV infection status before resuming sexual activity after childbirth.     

Assessment of sexual dysfunction and determination of its risk factors in the Republic of Korea

Objective

To assess sexual function among women via self-evaluation of female sexual dysfunction (FSD) and to determine risk factors for FSD among Korean women.

Methods

A preliminary questionnaire-based study in Ansan, Korea, enrolled 935 women between January and December 2010. Participants completed the Female Sexual Function Index and a self-administered survey. Participants were divided into 2 groups: in the recognized group (RG), women were aware of their sexual problems; in the unrecognized group (URG), women were not.

Results

The prevalence of FSD was 46.1% (n = 431). The prevalence of recognized FSD was 21.5% (n = 201), whereas that of unrecognized FSD was 24.6% (n = 230) Younger women showed a significantly more positive attitude toward sex compared with older individuals (P < 0.001). Sexual desire, sexual arousal, dyspareunia, lubrication, and sexual satisfaction were factors of sexual dysfunction in the RG. In the URG, sexual arousal, sexual desire, orgasm, dyspareunia, and sexual satisfaction were identified as significant factors.

Conclusion

Women in the RG had positive attitudes toward sex, whereas those in the URG had negative attitudes. Women who were unsatisfied with their sexual life did not express a need for treatment. The sociocultural background of Korean women should be considered in the diagnosis and treatment of FSD.     

Infecciones vaginales y lesiones celulares cervicales (III). Características de la sexualidad

Objective

To study the characteristics of sexuality in a series of patients: 399 with vaginal infections and 32 with cervical cell lesions, diagnosed by cervicovaginal cytology during a 1-year period.

Material and methods

We performed personal interviews to inquire about the presence or absence of sexual intercourse and the reasons, sexual desire, arousal, orgasm, dyspareunia, vaginal dryness, the frequency of coitus, contraceptive methods, anal coitus and simultaneous multiple sexual partners. The 399 patients were compared with a control group of 252 women without vaginal infections or cervical lesions.

Results

The group with infections and lesions were younger, with a mean age of 34 years, and there were more nulligravidas (33.25%), p < 0.001. A total of 60.23% used no contraceptive method. The most commonly used methods were the pill in 14.31% and the condom in 12.23%. Seventy patients (16.27%) were not having intercourse due to lack of a sexual partner. The frequency of coitus was once a week in 20%.The characteristics of sexuality were as follows: 45.15% had no sexual desire, 32.5% experienced no arousal, 21.94% had no orgasm, and 43.88% had dyspareunia. These percentages were higher than in the control group (p < 0.001). Anal intercourse was practiced by 15.83% and 2.5% had simultaneous multiple sexual partners.The following significant differences were found according to infection types: absence of sexual desire was greater in bacterial vaginosis (p < 0.05), lack of arousal was greater in Gardnerella vaginalis (p < 0.01), and dyspareunia was greater in Candidas (p < 0.001), bacterial vaginosis (p < 0.001), in women with a history of human papilloma virus (HPV) (p < 0.01) and in Trichomonas vaginalis (p < 0.05). Anal intercourse was more frequent in women with HPV (p < 0.01) and those with cervical lesions (p < 0.05).

Conclusions

Women with vaginal infections and cervical cell lesions were younger, with fewer pregnancies despite low use of contraception, had low coital frequency and more dyspareunia. These women practiced anal coitus and more frequently had simultaneous multiple sexual partners.Individuals are responsible for their sexuality and sexual health. Concern for sexually-transmitted diseases, HIV and cervical cancer should be universal.     

Prevalence and characteristics of female sexual dysfunction in a sample of women from Upper Egypt

Objective

To study the prevalence and associated risk factors for female sexual dysfunction (FSD) in Upper Egypt.

Methods

Married women attending the outpatient clinic of Sohag University Hospital between February 2008 and March 2009 were recruited. Through direct interviews, each woman completed a questionnaire that included questions on sexual dysfunction.

Results

From 648 recruited patients, 47 declined to participate in the study. Of the 601 remaining participants, 462 women (76.9%) reported 1 or more sexual problems. Low sexual desire was the most common sexual problem (66.4%). Patients with FSD were significantly more likely to be older than 40 years, have sexual intercourse fewer than 3 times a week, have been married for 10 years or more, have 5 children or more, be circumcised, have a husband aged 40 years or more, and be postmenopausal. Age of the women maintained a statistically significant positive relationship with FSD in the regression model (odds ratio 1.39; 95% CI, 1.26-1.53).

Conclusions

There was a high prevalence of FSD in this sample of women from Upper Egypt. The prevalence of sexual problems increased with increasing age of the women.     

Sexuality and psychological wellbeing in women with polycystic ovary syndrome compared with healthy controls

Objectives

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting women of fertile age. The aim was to study whether PCOS has an effect on sexual functioning.

Study design

Women meeting the Rotterdam criteria for PCOS (n = 49), and 49 age-matched controls identified from the population registry, were recruited. Sexual functioning was assessed by means of (i) an in-person, structured interview covering various aspects of sexuality, and (ii) the nine-item McCoy questionnaire of female sexual satisfaction. Participants also completed the Psychological General Well-Being Index.

Results

Almost half the women with PCOS reported that the disorder had a great impact on their sex life. Despite having the same number of partners and about the same frequency of sexual intercourse, women with PCOS were generally less satisfied with their sex lives compared to the population-based controls. Within the group of women with PCOS, high body mass index had only a minor effect on sexual functioning, while the total serum level of testosterone correlated positively to sexual satisfaction. PCOS women scored numerically lower than controls on the McCoy total score, but this difference was not statistically significant.

Conclusion

Women with PCOS reported decreased satisfaction with their sex life. Sexual function should be taken into account in treatment trials of PCOS, which traditionally target only symptoms related to insulin resistance, overweight, and hirsutism.     

Evaluation of the incision angle of mediolateral episiotomy at 60 degrees

Objective

To study the angle of mediolateral episiotomy at the time of cut, after primary repair, and 6 months postpartum; and the incidence and severity of perineal pain and anal incontinence 6 months after delivery.

Methods

The study group comprised 60 consecutively recruited primiparous women who required episiotomy during delivery assisted by 2 obstetricians. The incision angle of episiotomy (defined as 60°) was measured before cutting, after primary repair, and after 6 months. At follow-up, perineal pain was evaluated by a verbal rating score; anal incontinence was assessed by St Mark's score.

Results

The angles differed significantly among the incision (60°), repair (45°), and 6-month (48°) measurements (P < 0.001). There was a poor correlation between the suture angle and the angle measured at 6 months postpartum. No severe perineal tear was diagnosed in the cohort. At 6 months postpartum, only 1 woman reported mild symptoms of de novo anal incontinence, whereas 7 women reported perineal pain related to episiotomy.

Conclusion

An incision angle of mediolateral episiotomy of 60° resulted in a low incidence of anal sphincter tearing, anal incontinence and perineal pain. A randomized controlled trial is needed to assess the outcome when different angles of episiotomy are used.     

Effects of vaginal discharge on female sexual function

Objective

To assess the effects of vaginal discharge on female sexual dysfunction (FSD) by using the Female Sexual Function Index (FSFI).

Methods

In a study at a university hospital in Canakkale, Turkey, women affected by vaginal discharge and age-matched healthy control women were recruited between January and December 2012. Women were grouped in accordance with their vaginal discharge complaints and each participant completed the FSFI questionnaire.

Results

A total of 114 women were included in the study. Women in the first group (n = 58) had no vaginal discharge or had physiologic vaginal discharge, those in the second group (n = 29) had abnormal vaginal discharge with itching, and those in the third group (n = 27) had abnormal vaginal discharge without itching. Compared with the first group, women in the second and third groups had higher FSFI scores for desire, arousal, orgasm, and pain, in addition to higher overall FSFI scores. Women with genital malodor had significantly higher FSFI scores than patients without genital malodor (23.83 ± 5.07 vs 21.15 ± 4.78; P = 0.008).

Conclusion

Women with abnormal vaginal discharges were found to have better FSFI scores for some domains. This finding may be attributed to the adverse effects of sexual intercourse on vaginal infections.     

Collagen-coated polypropylene mesh in vaginal prolapse surgery: an observational study

Objective

To determine the incidence and factors associated with the development of bowel, urinary and sexual symptoms following obstetric anal sphincter injury (OASIS).

Study design

A prospective cohort study involving 435 women who sustained OASIS, over a five-year period, in a large UK teaching hospital. Details of bowel, urinary and sexual function were documented using a structured questionnaire. The outcome measures included the incidence of symptoms following OASIS and factors which modify the risk of developing symptoms.

Results

The majority (96%) of women were faecally continent three months after primary OASIS repair. Nevertheless, 34.2% reported faecal urgency, 25% suffered poor flatal control, and nearly 30% reported pain and bleeding on defaecation. Sixteen percent of women reported stress urinary incontinence, 15% experienced urgency and 20% reported urinary frequency. Fifty-seven percent of women had resumed intercourse but 32% of those women reported dyspareunia. Women who developed faecal symptoms were significantly more likely to develop urinary symptoms. Advancing maternal age and the use of forceps, in particular rotational forceps, significantly increase the risk of developing faecal and urinary symptoms.

Conclusions

Obstetric anal sphincter injuries continue to be responsible for significant morbidity, with approximately 30% of women reporting faecal, urinary or sexual symptoms, three months postpartum. This large prospective UK study provides up-to-date information relating to factors which increase the likelihood of such symptoms occurring. These data are useful for counselling and targeting more intensive follow up to women at higher risk of developing symptoms.     

Post-coital vaginal douching is risky for non-regression of low-grade squamous intraepithelial lesion of the cervix

Background

Vaginal douching is a common practice worldwide. Its effect on the natural history of the early lesion of human papillomavirus (HPV) infection, low-grade squamous intraepithelial lesion (LSIL), is unknown.

Methods

In a prospective nation-wide cohort (n = 1332), epidemiological variables including habit of vaginal douching after intercourse and outcomes of LSIL were studied. Colposcopy-confirmed LSIL women (n = 295) were followed every 3 months. Parameters of HPV infection, sexual behavior, personal hygiene and environmental exposures were compared with the follow-up outcomes.

Results

There was a 15% chance of HSIL co-existing with the LSIL cytology result. Eight percent of colposcopy-confirmed LSIL were found with HSIL in 1 year. With a follow-up of up to 36 months, 83% LSIL regressed, 11% progressed and 6% persisted. The mean time (95% CIs) to regression and progression were 5.2 (4.7-5.8) and 8.0 (5.8-10.3) months, respectively. Risk factors of the non-regression of LSIL included HPV prevalence on enrollment, habit of vaginal douching after intercourse with a hygiene product and non-regular Pap screening, with odd ratio of 4.4 (1.9-10.3), 3.14 (1.04-9.49) and 2.12 (1.24-3.62), respectively. HPV prevalence and vaginal douching also conferred a slower regression of LSIL (8.0 vs. 4.1 months, P < .001 and 8.0 vs. 5.6 months, P = 0.02, respectively).

Conclusion

The study disclosed a transient but warning nature of cytological LSIL. Practicing of vaginal douching after intercourse, especially with hygiene products, is associated with non-regression of LSIL.     

Does urinary incontinence subtype affect sexual function?

Objective

Urinary incontinence (UI) may affect a woman's physical and psychological well-being in different aspects. The aim of this study was to compare the effects of urinary stress incontinence (USI), detrusor overactivity (DO) and mixed urinary incontinence (MUI) on sexual function.

Study design

One-hundred and seventy urinary incontinent, sexually active women were included in this cross-sectional study. After urodynamic evaluation, participants were divided into three subgroups as USI (n = 61), DO (n = 55) and MUI (n = 54). Patients were matched according to age, parity and body mass index (BMI), rendering the sample size to 41 patients in each group. Turkish version short form of the Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire (PISQ-12) was filled out by each of the participants. Totally, 52 patients were excluded from the study (47 could not be matched and 5 incomplete questionnaire). Demographic characteristics of the participants, total and three domain scores of PISQ-12 were compared among three UI subgroups.

Results

The study group was consisted of 38 (32.2%) DO, 41 (34.7%) USI and 39 (33.1%) MUI patients. Demographic characteristics of the patients were similar in three subgroups. Patients with a diagnosis of MUI had significantly lower mean PISQ-12 scores than the ones with USI and DO whereas patients with USI had lower mean PISQ-12 scores than patients with DO.

Conclusion

Although urinary stress incontinence effects sexual function more than detrusor overactivity in terms of PISQ-12 scores, mixed urinary incontinence has the greatest impact on sexual function when compared with urinary stress incontinence and detrusor overactivity.     

Prevalence and incidence of diagnosed endometriosis and risk of endometriosis in patients with endometriosis-related symptoms: findings from a statutory health insurance-based cohort in Germany

Objective

The objectives were: (a) to determine the administrative prevalence and incidence of endometriosis and (b) to assess the risk of endometriosis associated with endometriosis-related symptoms.

Study design

The study is based on inpatient and outpatient data from a statutory health insurance fund in Germany. For prevalence and incidence definition 62,323 women aged 15-54 continuously insured in 2007 were identified. The prevalence and incidence of endometriosis in 2007 were calculated standardized to the age distribution in Germany. In a further prospective cohort study based within the health insurance sample 2095 patients with endometriosis-related symptoms and 8380 age-matched asymptomatic controls were identified. Endometriosis follow-up was from 2004 to 2008. Cox proportional hazard regression was used to examine the risk of endometriosis associated with endometriosis-related symptoms, such as pelvic pain, dysmenorrhoea, dyspareunia, menorrhagia, post-coital bleeding, inter-menstrual pain and ovarian cysts. Relative risks (RR) and 95% confidence intervals (CI) were calculated.

Results

Standardized prevalence and incidence rates were 8.1 and 3.5 per 1000 women, respectively. The highest prevalence was observed in women aged 35-44 with 12.8 per 1000 women. Median follow-up was 4.5 years. Risk of endometriosis associated with endometriosis-related symptomatology was RR (95% CI) = 4.95 (3.67-6.68); 4.5% of all symptomatic women were diagnosed with endometriosis in a median follow-up of 4.5 years. The highest risk was observed in women aged 35-44 [RR (95% CI) = 6.29 (4.00-9.90)] with 7.6% of all symptomatic women receiving a diagnosis of endometriosis during the follow-up.

Conclusion

Prevalence estimates based on population-based administrative data were lower than described in the literature. Risk of endometriosis was increased in women with endometriosis-related symptoms. However, those symptoms were of limited predictive value for endometriosis as only a small proportion of symptomatic patients were diagnosed with endometriosis in the follow-up.     

Audit on the management of complainants of sexual assault at an emergency department

Objective

Proper medical management should be offered to rape complainants, including systematic investigation for sexual transmitted diseases, prophylactic antibiotics, a pregnancy test, emergency contraception, and psychological and medical follow up. We conducted an audit on the medical management of complainants of sexual assault in a public university hospital with a high referral of rape complainants.

Study design

Retrospective study of rape complainants, based on medical records (n = 356) including women admitted at the emergency department between January 1, 2002 and December 31, 2007.

Results

Most complainants were Caucasian (median age: 25 years, range: 15-79 years). About 82% of the assaults were committed by one assailant only, and almost two-thirds of the rapes were characterized by vaginal penetration. In 8% of the patients, no blood sample to screen for sexually transmitted disease had been taken and in 38% of the patients, no cervical smear for C. trachomatis had been done. Prophylactic antibiotics were provided to 40% of the patients. Eighty percent of the complainants who were not using contraception received an emergency contraceptive treatment. Respectively, 10%, 16% and 11% of the complainants were seen at a gynecological, infectious diseases or psychological support follow-up visit.

Conclusion

Only about 20% of the complainants received optimal care. Different steps were taken to improve the medical management, including a specific computerized checklist and involvement of a social nurse for the follow up. These steps aim at reducing psycho-affective and medical morbidity of rape complainants.     

Vaginal length and incidence of dyspareunia after total abdominal versus vaginal hysterectomy

Objective

To evaluate the vaginal length and incidence of dyspareunia after total abdominal hysterectomy compared to vaginal hysterectomy.

Study design

This is a prospective observational study. Sixty-six patients were invited to participate in the study who were already planned to undergo abdominal or vaginal hysterectomy for different benign indications in the OB/GYN department, Sohag University Hospital, during the period from March 2007 till April 2009. Patients were classified into two groups. Thirty-six patients who were planned to undergo total abdominal hysterectomy (TAH) represented the first group, and 30 patients who were planned to undergo vaginal hysterectomy (VH) represented the second group. Vaginal length was obtained just before the operation and three times postoperatively. Pre- and post-operative dyspareunia was reported.

Results

The mean pre-operative and post-operative vaginal lengths in the TAH group were nearly the same (10.5 ± 2.1 cm vs. 10.2 ± 1.8 cm) without statistically significant difference. In the VH group, there was a statistically significant difference between pre- and post-operative vaginal length (10.1 ± 1.9 cm vs. 8.4 ± 1.6 cm). In the TAH group, 2 patients (5%) reported a newly developed post-operative dyspareunia. In VH group, 6 patients (20%) developed dyspareunia after surgery.

Conclusion

Postoperative dyspareunia is more common after vaginal hysterectomy compared to abdominal hysterectomy. This may be attributed to postoperative shortening of the vagina secondary to excessive trimming of the vaginal walls especially if VH was done for utero-vaginal prolapse.     

Sexual behavior and knowledge of sexually transmitted infections among university students in Sao Paulo, Brazil

Objective

To investigate the sexual behavior and knowledge about sexually transmitted infections (STIs) among undergraduate students in Sao Paulo, Brazil.

Methods

Self-reported questionnaires were used.

Results

Most of the 447 students in the study were single (97.3%), in their first year of university (87.7%), and the mean ages were 20.4 years (males) and 19.8 years (females). Vaginal intercourse was practiced by 69.7% of males and 48.4% of females, oral sex by 64.5% of males and 43.7% of females, and anal sex by 18.4% of males and 14.1% of females. Use of a condom during vaginal sex was practiced by 80.4% of males and 74.8% of females and during anal sex by 47.8% of males and 30.0% of females. Knowledge of transmission of STIs was greater than 90% for HIV, syphilis, genital herpes, and gonorrhea; 63%-76% for HPV and genital warts; 30%-34% for Trichomonas and only 16% for Chlamydia. Only 25%-34% knew that HIV was transmitted by breastfeeding; 56%-60% knew that HIV was transmitted by anal sex.

Conclusion

Many students engage in high-risk sexual behavior with multiple partners and use condoms inconsistently. Knowledge of the acquisition and modes of sexual and vertical transmission of HIV are strikingly deficient.