Could precolposcopy information and counseling reduce women's anxiety and improve knowledge and compliance to follow-up?

OBJECTIVE: To investigate the effects of precolposcopy counseling on women's anxiety, knowledge about colposcopy and compliance to follow-up. METHODS: Two hundred and twenty women referred for colposcopy for the first time were recruited. They attended precolposcopy sessions in which written and video information were given and subsequently were randomized to have either further explanation and discussion with an experienced colposcopic nurse (study group) or no further discussion (control group). Each subject completed a Chinese version of the state-anxiety questionnaire (STAI) and a knowledge questionnaire before and immediately after the precolposcopy sessions and also before the colposcopy examination. Women's concern and opinion on the programme were also assessed. Follow-up data was compared with those who did not attend the precolposcopy sessions. RESULTS: Women's knowledge about colposcopy significantly improved after the precolposcopy sessions. The improvement was more significant in the study group than in the control group immediately after the sessions (P = 0.003). The difference between the groups in knowledge scores remained statistically significant before colposcopic examination (P = 0.015) but the difference diminished between these two assessment points. There was no statistically significant difference between the two groups in the anxiety scores at all assessment points. Women who attended the precolposcopy sessions had a significantly higher attendance rates and better compliance to follow-up than those who did not attend the sessions. CONCLUSION: Precolposcopy session with explanation and discussion improves women's knowledge about colposcopy, but has negligible effects on women's anxiety before colposcopy. Provision of written and video information at the precolposcopy sessions can improve compliance to follow-up after colposcopy.     

Epidemiology of male and female reproductive disorders and impact on fertility regulation and population growth

The National Institute of Child Health and Human Development has conducted a series of vision workshops to set an ambitious but tenable broad agenda, transcending traditional organizational and disciplinary boundaries. This presentation sets forth a vision regarding how the aspects of a woman's reproductive lifespan are interrelated, likely starting from childhood all the way to the later reproductive years. As a woman propagates, this circular interaction is then transmitted to the next generation. We need an understanding of the clinical processes, the time course, the natural history, and disruptors of these processes. With that understanding, we can then bring tools to bear to assess these issues, whether these tools are epidemiology, demography, social science, molecular biology, proteomics, genomics, or epigenomics. Our future research agenda should investigate how reproduction affects health and how health affects reproduction.     

Gender‐Specificity of Solitary and Dyadic Sexual Desire among Gynephilic and Androphilic Women and Men

IntroductionIncentive motivation theory proposes that sexual desire emerges from sexual arousal, and is triggered by sexually competent stimuli. Research demonstrates gender and sexual orientation differences in the features that contribute to the competency of sexual stimuli. Men's and gynephilic women's genital arousal tends to be gender‐specific with preferred gender eliciting significantly greater genital arousal than nonpreferred gender. In contrast, stimuli depicting preferred and nonpreferred gender elicit similar degrees of genital arousal among androphilic women, termed a gender‐nonspecific pattern. Given these differences in the features that elicit a sexual response, and that sexual desire is proposed to emerge from sexual arousal, the question remains as to whether sexual desire would emerge only through exposure to preferred stimuli or whether patterns of responsive desire would parallel those observed for genital arousal.AimThe study aims to examine patterns of dyadic and solitary sexual desire in response to stimuli differing in incentive value.MethodsThirty androphilic women, 21 gynephilic women, 21 gynephilic men, and 16 androphilic men participated in a sexual psychophysiological session. Participants viewed sexual stimuli that varied the gender of the actors and the intensity of sexual activities depicted.Main Outcome MeasuresParticipants reported their degree of desire for sex with a partner (dyadic desire) and desire to masturbate (solitary desire), before and after each film.ResultsMen and gynephilic women exhibited gender‐specific patterns of sexual desire. Androphilic women's dyadic desire showed significantly less differentiation between genders, and their solitary desire did not differentiate at all. No gender difference was observed for either type of desire. All groups reported greater desire as stimulus intensity increased.ConclusionsGender‐nonspecific sexual response is not limited to the sexual arousal patterns of androphilic women, but extends to include responsive sexual desire. Men and gynephilic women, however, show gender‐specific responsive sexual desire that parallels their sexual arousal patterns. Dawson SJ and Chivers ML. Gender specificity of solitary and dyadic sexual desire among gynephilic and androphilic women and men. J Sex Med 2014;11:980–994.     

Birth place preferences and women’s expectations and experiences regarding duration and pain of labor

Introduction: We know a great deal about how childbirth is affected by setting; we know less about how the experience of birth is shaped by the attitudes women bring with them to the birthing room. In order to better understand how women frame childbirth, we examined the relationship between birth place preference and expectations and experiences regarding duration of labor and labor pain in healthy nulliparous women.

Methods: A prospective cohort study (2007–2011) of 454 women who preferred a home birth (n?=?179), a midwife-led hospital birth (n?=?133) or an obstetrician-led hospital birth (n?=?142) in the Netherlands. Data were collected using three questionnaires (before 20 weeks gestation, 32 weeks gestation and 6 weeks postpartum) and medical records. Analyses were performed according to the initial preferred place of birth.

Results: Women who preferred a home birth were significantly less likely to be worried about the duration of labor (OR 0.5, 95%CI 0.2–0.9) and were less likely to expect difficulties with coping with pain (OR 0.4, 95%CI 0.2–0.8) compared with women who preferred an obstetrician-led birth. We found no significant differences in postpartum accounts of duration of labor. When compared to women who preferred an obstetrician-led birth, women who preferred a home birth were significantly less likely to experience labor pain as unpleasant (OR 0.3, 95%CI 0.1–0.7). Women who preferred a midwife-led birth – either home or hospital – were more likely to report that it was not possible to make their own choices regarding pain relief compared to women who preferred obstetrician-led care (OR 4.3, 95%CI 1.9–9.8 resp. 3.4, 95%CI 1.5–7.7). Compared to women who preferred a midwife-led hospital birth, women who preferred a home birth had an increased likelihood of being dissatisfied about the management of pain relief (OR 2.5, 95%CI 1.1–6.0).

Discussion: Our findings suggest a more natural orientation toward birth with the acceptance of labor pain as part of giving birth in women with a preference for a home birth. Knowledge about women’s expectations and experiences will help caregivers to prepare women for childbirth and will equip them to advise women on birth settings that fit their cognitive frame.     

Anti-TNFα therapy and its implication in gynecology and obstetrics

Anti-TNFα treatments have modified the medical care, the course and the quality of life of the patients with autoimmune rheumatic, cutaneous or bowel inflammatory diseases. On the other hand, these treatments may have potential severe side effects during pregnancy (congenital malformations, fetal infections). Actually, many pregnancies have been reported during anti-TNFα exposures, with good maternal and neonatal outcomes. The introduction or the discontinuation of these treatments will always have to be discussed with the specialist of the chronic disease and, ideally, during a preconceptional counselling. In gynecology, anti-TNFα drugs may offer a new safe and effective approach to treating patients with recurrent miscarriages or unexplained or failed in vitro fertilization cycles. On the other hand, these treatments significantly increase the risk for serious infections or viral reactivations and may promote gynaecological malignancies. An adapted gynaecological survey is necessary.     

Atrial and ventricular septal defects – epidemiology and spontaneous closure

Objective.?To present data on the epidemiology and spontaneous closure for septal defects (secundum atrial septal defect (ASD) and/or ventricular septal defect (VSD)).

Methods.?Data from the EUROCAT Registry of Congenital Malformations for Funen County, Denmark were analyzed. All infants born from 1986 to 1998, diagnosed with a secundum ASD and/or a VSD as the only cardiac malformation, were included.

Results.?There were 78 infants with an ASD, 195 with a VSD, and 19 had both an ASD and a VSD. The overall prevalence of septal defects was 4.1 per 1000 livebirths. Among the VSDs 45% were perimembranous and 55% were muscular defects. Associated non-cardiac malformations, syndromes, or karyotype anomalies were present in 54 cases (19% of total) but with a significantly lower proportion among cases with muscular VSDs (7%, p < 0.05). Eighty-one percent of the cases had an isolated cardiac malformation. Five of 61 cases (8%) with isolated ASD were closed surgically before five years of age and 43 (70%) closed spontaneously within the first five years of life. Of the 65 cases with isolated perimembranous VSDs, 13 were closed surgically (20%) and 13 closed spontaneously (20%). Of the 99 cases with isolated muscular VSDs no defects were closed by surgery and 64 (65%) closed spontaneously. The rate of spontaneous closure for perimembranous and muscular VSDs were significantly different (p < 0.0001).

Conclusions.?Secundum ASD has a high rate of spontaneous closure. Perimembranous and muscular VSDs seem to be two different diseases with different epidemiology and natural history.     

Pregnancy-induced hypertonia and preeclampsia – risk factors and prediction possibilities

Summary Pregnancy-induced hypertension and preeclampsia account for nearly 25 % of perinatal morbidity and mortality and are a leading cause of maternal death in developed countries. Consequently, early detection of women with a higher risk is helpful for intensified prenatal care. Since therapeutic options exist in some cases, screening for risk factors is required. Risk factors include parity, medical history, and family history. Laboratory tests of haemostasis and the detection of autoimmune disease complete adequate screening. More than 100 methods have been tested for the prediction of preeclampsia in the second trimester. Results obtained by Doppler ultrasound appear to be more reliable than most clinical parameters. However, no test presently available can really serve as a useful early marker of developing preeclampsia. More specific methods detecting endothelial dysfunction and platelet activation are being developed and might provide improved prediction.      

Lactoferrin and neonatology – role in neonatal sepsis and necrotizing enterocolitis: present,past and future

Neonatal sepsis and necrotizing enterocolitis (NEC) are two most important neonatal problems in nursery which constitute the bulk of neonatal mortality and morbidity. Inflammatory mediators secondary to sepsis and NEC increases morbidity, by affecting various system of body like lung, brain and eye, thus causing long term implications. Lactoferrin (LF) is a component of breast milk and multiple actions that includes antimicrobial, antiviral, anti-fungal and anti-cancer and various other actions. Few studies have been completed and a number of them are in progress for evaluation of efficacy and safety of LF in the prevention of neonatal sepsis and NEC in field of neonatology. In future, LF prophylaxis and therapy may have a significant impact in improving clinical outcomes of vulnerable preterm neonates. This review analyse the role of lactoferrin in prevention of neonatal sepsis and NEC, with emphasis on mechanism of action, recent studies and current studies going on around the globe.     

Women’s Health and Obstetrics and Gynaecology: Their Relationship and Suggestions for a Practical Integration

The specialty of obstetrics and gynaecology has assumed itself to be the likely leader in women’s health. However, over the past fifteen years, women’s health has emerged as a broad-based, multidisciplinary, social/academic movement in which medicine is viewed as only one contributor. Nonetheless, reproductive medicine ranks high on the priority list of women’s health concerns, and this specialty is being asked to make changes on the basis of women’s health principles. Neither the specific changes nor the means by which to achieve them has been delineated. One approach to this dilemma rests with determining which women’s health issues are salient to the actual practice of obstetrics and gynaecology, and translating them for use by obstetrician/gynaecologists. Experience with this approach at the University of Ottawa suggests seven principles which are proposed as an example of the practical integration of women’s health and obstetrics and gynaecology.     

Aetiology,diagnosis and therapyof sexually transmitted and allied infections—reflections on novel observations and current trends

The present communication highlights aspects on the aetiology, diagnosis and therapy of sexually transmitted infections (STIs) and some allied infections in which sexual transmission is regarded as possible. The aetiology of many genital infections is still unknown or rather, an aetiological relationship between a given agent and a clinical manifestation is in some infections still debated. The paper will discuss some shortcomings in the current surveillance systems for STIs, if these systems exist at all. Thus, the paper considers their value in estimating the extent of the problem on a general population basis. It also focuses on the discrepancy between the current high prevalence of diagnosed cases of some STIs, such as of genital chlamydia infections, and the relatively low number of complications and sequelae presently seen, in contrast to the comparatively high prevalence more commonly reported in the past. Recent discoveries of novel aetiological agents of STIs, including mycoplasmas, may explain a lack of recovery from infections, due to the common use of antibiotic drugs to which these agents have a natural resistance. The observation of a synergistic effect of a commonly used anti-inflammatory drug, which may overcome antifungal resistance in vulvovaginal candidiasis, will also be reviewed. Furthermore, other reflections concern some of the classic STIs, e.g. lymphogranuloma verenerium, syphilis, gonorrhoea, herpes and condyloma.     

Ageing and ART: a waste of time and money?

In many societies, more and more young women are delaying childbearing until the fourth decade of life. It is well known that fertility is remarkably reduced with increasing age of women in both natural conceptions and assisted reproductive technology (ART). In this chapter, the effect of ageing on the pregnancy rate in ART, and the options available to improve the reproductive outcomes in women of advanced age will be presented after understanding the mechanism of reproductive ageing and the effects of ageing on the reproductive outcomes in normal women. It is important to identify the predictive factors associated with a better treatment outcome.     

Big brothers and little sisters? Sex selection and birth order

Should you be allowed to choose the sex of your child? Even before the advent of modern reproductive technologies, people have expressed interest in producing a child of a specific sex, trying everything from herbal treatments to sexual positions that have been claimed to produce a male or female child. Modern technologies such as flow cytometry make this a realistic possibility but what might the consequences be? In India and China, a preference for male offspring has led (via abortion) to a significant sex-ratio imbalance in those populations. Do other countries express strong preferences for male or female offspring? This article will address the possible birth order implications. Will we live in a world of first-born boys and second-born girls?     

Vulvodynia and proctodynia treated with topical baclofen 5 % and palmitoylethanolamide

Background

The prevalence of idiopathic vulvodynia and proctodynia is high. Pain management with anti-depressants and anti-epileptics may induce undesirable side effects. Therefore, topical baclofen cream and palmitoylethanolamide might be new therapeutic options.

Case

A 33-year-old woman with intractable chronic vulvar and anal pain had to abstain from sexual intercourse and could neither cycle nor sit for more than 5 min. The patient did not respond to standard treatments. We prescribed a combination of topical baclofen 5 % and palmitoylethanolamide 400 mg, three times daily. After 3 months her symptoms decreased more than 50 % and sexual intercourse was possible again without pain.

Conclusion

Topical baclofen and palmitoylethanolamide can be a viable treatment option in chronic vulvodynia and proctodynia.     

Patient safety culture in obstetrics and gynecology and neonatology units: the nurses’ and the midwives’ opinion

Background: Patients treated in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology are especially vulnerable. Large multidisciplinary teams of physicians, multiple invasive and noninvasive diagnostic and therapeutic procedures, and the use of advanced technologies increase the probability of adverse events. The evaluation of knowledge about patient safety culture among nurses and midwives working in such units and the identification of critical areas at a health care institution would reduce the number of adverse events and improve patient safety. The aim of the study was to evaluate the opinion of nurses and midwives working in clinical departments that provide services in the fields of obstetrics, gynecology, and neonatology about patient safety culture and to explore potential predictors for the overall perception of safety.

Methods: We used the Hospital Survey on Patient Safety Culture (HSOPSC) to evaluate nurses’ and midwives’ opinion about patient safety issues. The overall response rate in the survey was 100% (n?=?233).

Results: The analysis of the dimensions of safety on the unit level showed that the respondents’ most positive evaluations were in the Organizational Learning – Continuous Improvement (73.2%) and Feedback and Communication about Error (66.8%) dimensions, and the most negative evaluations in the Non-punitive Response to Error (33.5%) and Staffing (44.6%) dimensions. On the hospital level, the evaluation of the safety dimensions ranged between 41.4 and 56.8%. The percentage of positive responses in the outcome dimensions Frequency of Events Reported was 82.4%. We found a significant association between the outcome dimension Frequency of Events Reported and the Hospital Management Support for Patient Safety and Feedback and Communication about Error Dimensions.

Conclusions: On the hospital level, the critical domains in health care facilities that provide services in the fields of obstetrics, gynecology, and neonatology were Teamwork Across Hospital Units, and on the unit level – Communication Openness, Teamwork Within Units, Non-punitive Response to Error, and Staffing. The remaining domains were seen as having a potential for improvement.