Vaginal hysterectomy in women with history of previous cesarean delivery

Objective: This study aimed to compare surgical outcomes with vaginal hysterectomy between women who have had ≥1 cesarean delivery and those who have not had a cesarean delivery. A secondary objective was to analyze the effect of previous vaginal birth on the complication rate of vaginal hysterectomy. Study Design: A retrospective analysis was performed on 221 women undergoing vaginal hysterectomy. Women were separated into those who had a history of previous cesarean deliveries (N = 35) and those who did not (N = 186). The groups were analyzed for the indications for surgery, perioperative hemoglobin loss, operative time, length of hospitalization, and complications. Trends in the complication rate for women in the previous cesarean group were also studied from the perspectives of numbers of previous cesarean deliveries and of vaginal delivery history. The 95% confidence intervals for the difference between proportions as well as P values for probability tests were calculated. P < .05 was considered significant. Results: Previous cesarean delivery experience did not affect hemoglobin change, hospital stay, or operative time among women undergoing vaginal hysterectomy. A total of 11.3% of women in the previous cesarean group had complications, versus 4.3% for the noncesarean group (P = .10, 95% confidence interval –3.8% to 18.0%). Complications did not increase with increasing number of previous cesarean deliveries (U = 1020.5, P = .28). Also, a trend toward fewer complications among patients with a history of cesarean delivery who had also had a vaginal delivery was demonstrated (U = 836, P = .05). Overall, women who were undergoing vaginal hysterectomy who had a history of ≥1 previous vaginal delivery had a complication rate of 3.2%, versus 17.6% for women who had not had a previous vaginal birth (P = .004, 95% confidence interval –27.5% to –1.3%). Conclusions: In this study women who had a history of previous cesarean delivery were not at higher risk for greater hemoglobin loss, longer hospital stay, more prolonged operative time, or significantly more perioperative complications when undergoing vaginal hysterectomy than were those women who had no history of previous cesarean delivery. Likewise, increasing the number of previous cesarean deliveries did not have an adverse impact on the complication rate. Previous vaginal delivery lowered the risk of complications from vaginal hysterectomy. (Am J Obstet Gynecol 1998;179:1473-8.)     

Assessment of first sexual intercourse in young women with a history of childhood sexual abuse

Women reporting childhood sexual abuse (CSA) that involved actual or attempted penetration may not identify this as their first sexual intercourse. Data were drawn from a population-based, prospective cohort study spanning adolescence to adulthood. CSA prior to age 16 and age of first sexual intercourse with a male were assessed retrospectively. More than half of women reporting CSA in the form of actual or penetrative abuse reported an age of first sexual intercourse at or beyond 16 years. Direct questioning about CSA is needed to accurately ascertain sexual history.     

Disorders in sexual desire and sexual arousal in women, a 2010 state of the art

In this contribution, female sexual desire and arousal disorders are viewed from the perspective of incentive motivation and information processing models of sexual response. The effects of hormones, somatic disease, and medication on sexual arousability are discussed, as well as the influence of psychological factors, such as stimulus meaning, mood and cognition, and relational context on female sexual desire and arousal. Specific topics to attend to during the anamnesis of sexual desire and arousal problems, and empirically evaluated psychological and pharmacological treatments for these problems are discussed.     

Psychophysiological and subjective sexual arousal to visual sexual stimuli in new women

Conflicting data exist regarding the sexual arousal patterns of post-operative male-to-female (MTF) women with Gender Identity Disorder. The purpose of this study was to examine objective and subjective aspects of the sexual arousal response using a vaginal photoplethysmograph. Fifteen MTF women viewed neutral and erotic audiovisual film segments while their blood flow patterns were monitored. Subjective measures of affect and sexual arousal were taken before and immediately after the films. There was a significant increase in self-reported subjective arousal, perceived genital arousal, perceived autonomic arousal, and positive affect; however, movement artefacts interfered with our assessment of the genital arousal response. MTF women reported both low levels of pain and low levels of awareness of the vaginal probe during testing. These data are discussed in the context of differences in pelvic musculature between natal and new women and have implications for future studies that aim to measure sexual arousal objectively in MTF women.     

Psychophysiological and subjective sexual arousal to visual sexual stimuli in new women

Conflicting data exist regarding the sexual arousal patterns of post-operative male-to-female (MTF) women with Gender Identity Disorder. The purpose of this study was to examine objective and subjective aspects of the sexual arousal response using a vaginal photoplethysmograph. Fifteen MTF women viewed neutral and erotic audiovisual film segments while their blood flow patterns were monitored. Subjective measures of affect and sexual arousal were taken before and immediately after the films. There was a significant increase in self-reported subjective arousal, perceived genital arousal, perceived autonomic arousal, and positive affect; however, movement artefacts interfered with our assessment of the genital arousal response. MTF women reported both low levels of pain and low levels of awareness of the vaginal probe during testing. These data are discussed in the context of differences in pelvic musculature between natal and new women and have implications for future studies that aim to measure sexual arousal objectively in MTF women.     

Thermography as a physiological measure of sexual arousal in both men and women

IntroductionCurrent physiological measures of sexual arousal are intrusive, hard to compare between genders, and quantitatively problematic.AimTo investigate thermal imaging technology as a means of solving these problems.MethodsTwenty‐eight healthy men and 30 healthy women viewed a neutral film clip, after which they were randomly assigned to view one of three other video conditions: (i) neutral (N = 19); (ii) humor (N = 19); and (iii) sexually explicit (N = 20).Main Outcome MeasuresGenital and thigh temperatures were continuously recorded using a TSA ImagIR camera. Subjective measures of sexual arousal, humor, and relaxation were assessed using Likert‐style questions prior to showing the baseline video and following each film.ResultsStatistical (Tukey HSD) post‐hoc comparisons (P < 0.05) demonstrated that both men and women viewing the sexually arousing video had significantly greater genital temperature (mean = 33.89°C, SD = 1.00) than those in the humor (mean = 32.09°C, SD = 0.93) or neutral (mean = 32.13°C, SD = 1.24) conditions. Men and women in the erotic condition did not differ from each other in time to peak genital temperature (men mean = 664.6 seconds, SD = 164.99; women mean = 743 seconds, SD = 137.87). Furthermore, genital temperature was significantly and highly correlated with subjective ratings of sexual arousal (range r = 0.51–0.68, P < 0.001). There were no significant differences in thigh temperature between groups.ConclusionThermal imaging is a promising technology for the assessment of physiological sexual arousal in both men and women. Kukkonen TM, Binik YM, Amsel R, and Carrier S. Thermography as a physiological measure of sexual arousal in both men and women. J Sex Med 2007;4:93–105.     

Factors affecting sexuality in older Australian women: sexual interest, sexual arousal, relationships and sexual distress in older Australian women.

OBJECTIVE: To investigate the sexual behavior, sexual relationships, sexual satisfaction, sexual dysfunction and sexual distress in a population of older urban Australian women. METHOD: In 2004, 474 women participating in the Longitudinal Assessment of Ageing in Women (LAW) Study completed a series of questionnaires about sexuality. They included the Short Personal Experiences Questionnaire (SPEQ), Relationship Assessment Scale (RAS), Female Sexual Distress Scale (FSDS), questions concerning past sexual abuse based on the Sex in Australia Study, and questions comparing present and past sexual interest and activity. RESULTS: The percentage of women with partners ranged from 83.3% in the 40 - 49-year age group to 46.4% women in the 70 - 79-year age group. The sexual ability of partners diminished markedly with age, with only 4.8% of the partners using medication to enable erections. Only 2.5% of women reported low relationship satisfaction. The incidence of sexual distress was also low, being reported by only 5.7% of women. Younger women and women with partners had higher levels of distress than older women. Indifference to sexual frequency rose from 26.7% in women aged 40 - 49 years to 72.3% in the 70 - 79-year age group. Past sexual abuse was recalled by 22.7% of women and 11.6% recalled multiple episodes of abuse. Women who recalled abuse had lower scores for satisfaction with sexual frequency. CONCLUSIONS: It appears from this study that there is a wide range of sexual experience amongst aging women, from never having had a sexual partner, to having solitary sex, to having a relationship with or without sex into the seventh decade. As women age, they experience a decrease in sexual activity, interest in sex, and distress about sex. This may be associated with the loss of intimate relationships as part of separation, divorce or bereavement. Decreased sexual activity with aging may be interpreted as a biological phenomenon (part of the aging process) or as sexual dysfunction, or it may be the result of adapting to changed circumstances.     

子宫全切术对妇女性生活影响的分析

目的 了解子宫切除术后的妇女性方面的情况。方法 问卷调查并分析１９７例行子宫切例术的妇女术后的性生活情况。结果 ５５．３％的妇女在术前为紧张心态,其中３２．１％担心今后的性生活。认为子宫很重要者占３９１％,要前,术后每月性生活次数及性生活满意程度比较无明显差异。４７．７％的妇女在术后有一些性方面的问题,心理方面因素占４６．８％,而仅有１２．２％的妇女进行过咨询。７３．１％的医生在术前对手术进行解释     

Female sexual arousal: a behavioral analysis

OBJECTIVE: This study was designed to assess female sexual arousal by using a combination of physiologic measures and self-reported level of arousal. DESIGN: Twenty subjects viewed a 23-minute sequence of randomly ordered relaxation and erotic tapes, both with and without auditory stimulus. The physiologic parameters of vaginal blood flow, galvanic skin resistance, respiration, pulse, and blood pressure, as well as self-reported level of arousal, were simultaneously recorded and correlated with video segments. SETTING: An academic teaching hospital. PATIENT(S): The 20 subjects (mean age +/- SD: 24.9 +/- 3.0 years) included Caucasian (10), Hispanic (2), Asian-American (4), and African-American (4) women. All women were screened for normal sexual function with the Female Sexual Function Index (FSFI) and with the Beck Anxiety Inventory and Beck Depression Inventory. INTERVENTION(S): Randomly ordered sequences of erotic and relaxation tapes with and without sound. MAIN OUTCOME MEASURE(S): Physiologic and behavioral data, as well as subjective arousal rating, were acquired. The resulting set of multichannel data was correlated with erotic segments and analyzed for sound vs. no sound and time to maximal physiologic arousal. RESULT(S): Four independent variables were found to have beta values that were significantly different from 0: respiration (mean = -0.239, SD = 0.177, range = -0.55-0.09, t = -6.04), VPP (mean = 0.158, SD = 0.37, range = -0.48-0.80, t = 1.91), rVPP (mean = 0.161, SD = 0.35, range = -0.537-0.686, t = 2.075), and erotic marker (mean = 0.582, SD = 0.191, range = 0.16-0.85, t = 13.6). Neither heart rate nor galvanic skin resistance beta values approached significance. Respiration period was correlated negatively with arousal rating, indicating that subjects breathed faster when aroused. Auditory stimuli during erotic segments did not increase subjective arousal, and for both subjective arousal rating as well as VPP measurement, maximal response occurred within 2 minutes. CONCLUSION(S): Simultaneous measurement of vaginal blood flow, respiration, pulse, and a variable accounting for the onset and offset of erotic video segments accounts for approximately 50% of the variance in predicting subjective female arousal. Regardless of the presence or absence of audio input, 2 minutes was the average minimum time required to reach maximal arousal in young, sexually functional women.