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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Some efforts have been made to investigate sexual functioning in obstetric patients, and these are considered in 3 areas: pregnancy, the postpartum period, and the sequelae of episiotomy. Most research in the area of pregnancy suggests that sexual activity and libido decline steadily during pregnancy, but some studies such as that of Masters and Johnson (1966) report that sexual functioning varies during pregnancy. In this study, 101 North American women were interviewed in each trimester of pregnancy and again 3 months after delivery. In primiparous women there was, compared with preconception levels, a marked reduction of sexual activity and libido during the 1st and 3rd trimesters of pregnancy, but an increase during the 2nd trimester. Multiparous women showed a similar pattern. The finding of an improvement in sexual performance during the 2nd trimester has not been supported by subsequent research. Studies in which sexual functioning was assessed during pregnancy and retrospectively during the puerperium have reported a steady decline in libido and coital frequency throughout the 3 trimesters. Childbirth appears to be associated with diminished frequency and enjoyment of sexual intercourse for at least a year after delivery, but there is a gradual improvement in sexual functioning during this period. The level of sexual functioning before conception appears to determine sexual behavior in the year after delivery. Available findings cannot provide a basis for determining whether episiotomy is a specific cause of dyspareunia, but Beischer's (1967) findings suggest that there is little relation between the anatomical results of episiotomy and subsequent development of pain on intercourse. Sexual problems encountered in gynecology may be of 2 main types: those accompanying gynecological disorders and those arising from gynecological treatments. Research has focused mainly on sexual problems in 2 gynecological conditions--the menopause and infertility. In contrast to previous findings, recent studies have suggested that there is little sexual disturbance at the time of menopause. It seems likely that the loss of libido and orgasmic dysfunction are not specifically associated with the menopause, but vaginal dryness is not an uncommon feature of ovarian failure and may give rise to dyspareunia. Infertility is reported to be associated with a substantial prevalence of sexual dysfunction, some of which may be a direct cause of the failure to conceive. Certain sexual problems have no etiological relation to infertility but are nevertheless distressing to the patients involved. Sexual dysfunction has been studied in relation to surgical procedures and oral contraceptive use.
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PMID:Sexual problems in obstetrics and gynaecology. 668 51

This report presents the clinical responses of 39 women who underwent danazol treatment for conservative therapy of proven endometriosis. The patients were treated with 800 mg of danazol daily for a mean duration of 7.3 months and were clinically reevaluated at 16.9 months (mean) following the end of treatment. Complete subjective pain relief was noted in 38 patients (97%) within 6 weeks of the onset of danazol therapy. One patient noted only partial amelioration of pain. Recurrence of pain was noted in 38% of all patients at a mean of 6.9 months following therapy. More advanced disease was associated with an increased likelihood and rapidity of recurrence. Twenty-nine of the women were infertile. After treatment, nine conceived (33%). However, when patients with infertility potentially due to other causes also present were excluded, the corrected pregnancy rate was 56%. The side effects of danazol therapy were minimal and cleared rapidly following termination of the drug. These results compare favorably with other study populations where recurrence of disease and corrected pregnancy rates were specifically considered.
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PMID:Conservative treatment of endometriosis externa: the effects of danazol therapy. 687 13

We have carried out a prospective survey of 25 cases of male hypogonadism attending one hospital, and a retrospective study of 73 men attending other endocrine clinics in Manchester. In total, 47 had pituitary disorders, 15 isolated gonadotrophin deficiency (including 4 with Kallmann's syndrome), 10 testicular atrophy of unknown cause, 12 testicular damage, 10 with Klinefelter's syndrome, and 4 had miscellaneous disorders. Our survey emphasises the importance of adequate history and examination. Most patients presented with reduced libido, with marital problems in 62% of married men. Less common problems were facial flushing, osteoporosis and gross obesity. Several patients with pituitary disorders were asymptomatic, even in the presence of visual field defects. Klinefelter's syndrome, and testicular atrophy, may present with infertility or gynaecomastia rather than symptoms of androgen deficiency. On examination, the presence of gynaecomastia or obesity were of no help in differential diagnosis, whereas visual field defects clearly indicated a pituitary cause. Measurement of height/span was of little help. The precise diagnosis was usually established with basal plasma LH, FSH, testosterone and prolactin, with karyotype and pituitary radiology, and without more elaborate dynamic hormone tests. Testosterone esters given by intramuscular injection as "Sustanon 250" was the most commonly used replacement therapy. Improved libido usually resulted. Side-effect occurred in 10%, usually as muscle cramps, pain at the injection sites, acne, or excessive sex drive. One tragic case illustrates the potential dangers of androgen replacement therapy in an unrecognised psychopath, and where doubt exists a psychiatric opinion should be sought before starting therapy.
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PMID:Clinical aspects of androgen deficiency in men. 689 Jul 81

The definition, early history, and practical implications of family planning are discussed as well as the age groups affected by it, choice of contraceptive methods, and effect on abortion rate. The introduction of oral contraceptives in the 1960's revolutionalized sexual behavior, but had a detrimental effect on family life. In Finland, a new law was passed in 1972 to prevent unwanted pregnancies and to help plan family size by providing advice about contraceptive use. As early as the 1800's there were efforts to disseminate information about family planning, but programs began in earnest only in the 1960's and 1970's. Advice about family planning is especially important to underage groups, those wishing childspacing, women over 40 -- because of risk of birth defects -- and to women whose health is threatened by complications in pregnancy. In Finland about 16,000 abortions are performed per year (most of the decisions are attributable to social reasons), and worldwide 50,000,000 procedures take place annually. 1/10 of all marriages in Finland are childless because of infertility (50% of infertile persons are women, 40% men). The choice of contraceptives is important: condoms protect not only against unwanted pregnancy but also against venereal disease. About 13-14% of all women in Finland use the pill, which is better for young women than IUDs; however, the pill is not recommended for women over 35, nor for those who are overweight or who smoke. IUDs can cause pain or irregular menstruation, but these risks can be eliminated by proper examination before fitting. About 80% of IUd users are satisfied with the device. Recently, a hormonal IUD has been put on the market. The age of women bearing their 1st child has increased to 28-30 years because of modern contraceptives; and since fertility decreases after age 30-35, it is very likely that family size will be smaller in the future.
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PMID:[Family planning and contraception]. 691 67

1 out of 4-5 women develop uterine leiomyomata, the most common solid pelvic tumors in women. This paper assesses the reports of 4714 myomectomies and records of 59 personal cases. Townsend et al. suggested that leiomyomata are unicellular in origin. Estrogen, growth hormone, and progesterone may influence the growth of the tumors. In the performance of myomectomy, the 2 major technical concerns are the minimization of blood loss and the prevention of postoperative adhesions. Although most leiomyomata are asymptomatic and grow slowly, 20-50% of the tumors are estimated to produce symptoms, the severity of which depends upon the number, size, and location of the tumors. The symptoms include menorrhagia, infertility, fetal wastage, pelvic pain/pressure, polycythemia, ascites, impingement, and related complications (e.g., ulceration and infection, fever, pain, uterine inversion, sarcomatous change). Asymptomatic patients with uteri of less than 10-12 weeks' gestational size require no more than observation at 6-month intervals regardless of fertility status. For women with uteri of 10-12 weeks gestational size or longer, management will depend on the patient's desire for fertility. Women desirous of fertility should have a 6-12 month trial for conception. If tumor growth is rapid, myometomy may be performed earlier. Women not desirous of fertility (e.g., pre- and post-menopausal) should have total abdominal hysterectomy and bilateral salpingo-oophorectomy. For symptomatic patients desirous of fertility, myomectomy using the transabdominal approach or hysteroscopy should be performed. For symptomatic patients not desiring fertility, dilatation and curettage and hysterectomy should be performed. With regard to oral contraceptive use, no studies have yet demonstrated that women on oral pills are at increased risk for growth of these tumors. Low-dose contraceptives should not be contraindicated in patients with leiomyomata if they desire to use this form of contraceptive. With IUD users, the device should be discontinued if bleeding occurs.
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PMID:Uterine leiomyomata: etiology, symptomatology, and management. 702 95

The pathophysiology of endometriosis and its treatment are discussed. Endometriosis is a gynecological disorder characterized by the growth of the ectopic endometrium. The usual plaque looks like a small blood-filled cyst that is surrounded by a puckering scar. This tissue responds to fluctuating levels of hormones just as the normal endometrium does, and monthly bleeding of the cysts occurs followed by inflammation and scarring. Endometriosis may cause infertility, dyspareunia, dysmenorrhea, pelvic pain, and other menstrual problems. Therapy is chosen based on extent of disease, tolerance of side effects, and desire for pregnancy. Surgery is usually reserved for more extensive cases of the disease or if fertility is no longer desired. Induction of "pseudopregnancy" with estrogen-progesterone combinations has been used frequently; however, weight gain, initial exacerbation of pain, and the possibility of thromboembolism are limiting factors. Pseudomenopause, induced by danazol therapy, is an alternate method of treatment that causes a static endometrium. It offers rapid relief of symptoms to the majority of patients, and its most common side effects of weight gain and edema are reversible. Fertility rates after treatment are difficult to compare, but they appear to be similar for both hormonal therapies. Danazol has emerged as an effective alternative to the estrogen-progesterone combination treatment of endometriosis. Danazol may be prescribed before surgery to reduce lesions, following surgery to ablate any remaining lesions, or as the sole therapy for endometriosis.
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PMID:Pathophysiology and treatment of endometriosis. 703 70

Seminal vesiculograms were performed on 44 men being evaluated for chronic perineal pain consistent with seminal vesiculitis. The vesiculograms were performed prior to antibiotic instillation into the vas deferens. Vesiculograms were abnormal in 32 of the 44 patients (73%). The most common abnormality was the presence of multiple small diverticula producing a feathery appearance of the vas deferens (64%), a finding present in only 19 per cent of patients being evaluated for infertility and 20 per cent of normal patients. Asymmetry and incomplete filling of the seminal vesicles were less common abnormalities. Seventeen of these patients had seminal vesiculectomies for persistent or recurrent pain, and 15 have been followed long enough to assess the results. The histologic examination of the excised seminal vesicles was abnormal in only 3 patients (20%), despite radiographic abnormalities in 10 (67%) and improvement after surgery in 12 (80%). Seminal vesiculography may be useful to exclude anatomic abnormalities prior to instillation, but does not appear sufficiently specific to warrant use as the primary diagnostic examination for patients suspected of having seminal vesiculitis.
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PMID:Seminal vesiculography: limited value in vesiculitis. 714 21

Drs. Edelman and Bergers' report "Contraceptive practice and tuboovarian abscess (Am. J. Obstet. Gynecol. 138:541, 1980) may produce the impression in the medical profession that the IUD does not predispose to salpingitis, salpingo-oophoritis, and tubo-ovarian abscess, as published data and clinical experience would suggest. Also, the diagnostic criteria for diagnosing 'acute pelvic inflammatory disease' stated in the report, and published studies of Jacobson and Westrom and Chaparro et al question a diagnosis of pelvic inflammatory disease that is not confirmed endoscopically or by some direct visualization obtained surgically. 35% of patients who had laparoscopy by Jacobson and Westrom and who were suspected of having salpingitis, or pelvic inflammatory disease, and 54% of laparoscoped patients suspected by Chaparoo et.al. of having pelvic inflammatory disease were found not to have either salpingitis or pelvic inflammatory disease of gynecologic etiology. As pelvic inflammation may be caused by a variety of disorders, such as appendicitis, colitis, diverticulitis, and others, the term pelvic inflammatory disease is an imprecise diagnostic term. Edelman and Berger's results can also be questioned on the ground that numerous reports (e.g., Second Report on Intrauterine Contraceptive Devices, Food and Drug Administration, 1978; Population Reports, Series B, No. 3, May 1979, the Johns Hopkins University) indicate an increased incidence of salpingitis with its attendant pelvic crippling pain and infertility that is many times more common in IUD users than in nonIUD users. Available published data therefore strongly suggest that an IUD user is at far greater risk of developing inflammatory disease of infectious etiology in her reproductive tract with its attendant pain, morbidity, infertility, and even death than nonIUD users.
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PMID:Inflammatory disease with use of IUD. 727 Jun 16

Over the seven years from 1971 to 1977, 287 women with ectopic pregnancy were admitted to the Royal Women's Hospital, Melbourne (one in 142 deliveries). The most important aetiological factors found were chronic pelvic inflammatory disease (35%), previous infertility (15%), the presence of an intrauterine contraceptive device (14%), a previous ectopic pregnancy (9%), and increasing parity and age. Only 2% of ectopic pregnancies occurred in teenage girls. Amenorrhoea and vaginal bleeding were absent in 14% and 16% of patients respectively. The only consistent features were pain in the lower part of the abdomen and pelvic tenderness. There were no maternal deaths.
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PMID:Ectopic pregnancy: a seven-year survey. 733 75

This paper discusses issues relevant to psychiatrists working in a reproductive biology unit: 1. The couple's anxiety. 2. The question of whether psychological conflict can cause infertility. 3. Dealing with the outcome of the workup. 4. Donor insemination. The anxiety of couples applying for an infertility workup can usually be countered by supportive and educative measures. More problematic sources of anxiety that require psychiatric consultation are: 1) Fear that the workup may shatter a myth that explains the infertility, a myth reinforced by unconscious conflicts; 2) An untenable wish that having a child will repair problems in the marriage or in the sense of relief. The psychiatrist is often asked whether psychological conflicts can cause infertility. The most understandable manner in which they do is by their effect on sexual performance. Where there is no sexual performance problem, psychotherapy can be offered if one or both partners experiences psychological pain, but with the understanding that therapy cannot be expected to cure the infertility. Psychiatric consultation at the end of the workup is indicated 1) where irreversible infertility is discovered and mourning is excessive, 2) where a myth to explain the infertility has been shattered, 3) to reassess sexual performance and to deal with the uncertainty, where no physical cause has been discovered. Donor insemination (AID) is fraught with legal and ethical problems. There are no criteria for selecting donors or recipient families, and there is concern that AID may lead to genetic engineering. The psychological effects of AID are uncertain. A study at our clinic suggests that the pursuit of AID involves a two-stage process: first, dealing with the outcome of the infertility workup and second, confronting AID itself; and that the secrecy that surrounds AID obstructs resolution of conflict.
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PMID:Infertility. A psychiatrist's perspective. 743 96


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