Astrid Ditte Højgaard

Retrograde ejaculation and sexual dysfunction in men with diabetes mellitus: a prospective, controlled study

Retrograde ejaculation (RE) and erectile dysfunction may be caused by diabetes mellitus (DM), but the prevalence of RE among DM patients is unknown. A prospective, blinded case–control study comparing men with DM with matched controls according to RE and erectile dysfunction was performed. Twenty‐seven men with DM matched the inclusion criteria and agreed to participate in the study, and of these 26 delivered an ejaculate. We were able to recruit 18 matching controls, and of these 16 delivered an ejaculate.

Reproductive patterns and fertility wishes among HIV-infected patients: survey from six outpatient clinics in Denmark

OBJECTIVES Reproductive patterns among HIV patients in Denmark have not previously been described. We aimed to uncover the fertility wishes among Danish HIV-infected persons. METHODS A cross-sectional questionnaire survey was done at six outpatient HIV clinics in Denmark. A total of 409 (56%) HIV patients returned the questionnaire; 323 had completed the questionnaire, although they had not all responded to all of the questions. RESULTS Among HIV-infected individuals, 49% (137/280) had their own biological children. Fifteen percent (43/280) desired (additional) children and 15% (43/280) were undecided. Female gender, birth outside Europe, young age, completed high school education, heterosexuality, present partner, and non-disclosure were associated with a desire for children in the univariate analysis. In the multivariate analysis only young age, heterosexual orientation, and non-disclosure were significant. Thirty-seven percent (93/250) felt that HIV infection was a hindrance to having more children. The most common reasons indicated were fear of HIV transmission to the child (24%, 59/244) and to the partner (16%, 40/244). CONCLUSIONS Many HIV-infected patients have children and a substantial proportion of HIV-infected patients desire (additional) children, although there is a high degree of fear of HIV transmission to their partner or child. This highlights the need for care providers to improve the services provided to HIV-infected patients who desire to have children.

Predictive value of serum human chorionic gonadotropin ratio, progesterone and inhibin A for expectant management of early pregnancies of unknown location

OBJECTIVE To evaluate serum human chorionic gonadotropin (hCG) ratio, progesterone and inhibin A as single parameters and in combination for the prediction of spontaneous resolution of pregnancies of unknown location (PUL). STUDY DESIGN Prospective observational study of 105 consecutive patients with a diagnosis of PUL. Serum levels of hCG, progesterone and inhibin A were determined at the first visit and after 2 days. Patients were followed clinically until a final diagnosis of spontaneously resolving PUL, viable or non-viable intrauterine pregnancy, or ectopic pregnancy with need of laparoscopic intervention had been reached. Different combinations of hCG ratio (hCG at 48 h/hCG at 0 h), s-progesterone and s-inhibin A were investigated to find the best predictor for successful expectant management. RESULTS The final pregnancy outcomes were: 52 spontaneously resolving PUL (49.5%), 37 viable intrauterine pregnancies (35.2%), 8 non-viable intrauterine pregnancies (7.6%), 7 ectopic pregnancies (6.7%), and one molar pregnancy (1.0%). An hCG ratio<0.80 predicted spontaneously resolving PUL with positive and negative predictive values (PPV and NPV), sensitivity, and specificity of 0.98, 0.78, 0.72, and 0.99, respectively. In patients with hCG ratio ≥ 0.80, a combination of s-progesterone < 20 nmol/l and s-inhibin A < 30 pg/ml predicted spontaneously resolving PUL with PPV, NPV, sensitivity and specificity of 0.92, 0.96, 0.85, and 0.98 respectively. CONCLUSION Our results suggest that patients with PUL and hCG ratio < 0.80 display a high probability of spontaneously resolving PUL with minimum need of follow-up. In cases of hCG ratio ≥ 0.80, a combination of s-progesterone < 20 nmol/l and s-inhibin A < 30 pg/ml, may be a reliable predictor of spontaneously resolving PUL. The safety of this approach should be tested in large prospective studies.

Development of a sexual dysfunction scale for women with inflammatory bowel disease

Background Women with inflammatory bowel disease (IBD) may have decreased sexual function. To understand how common this condition is in our female patients, we developed a new IBD-specific Female Sexual Dysfunction Scale (the IBD-FSDS). Methods We performed a prospective cross-sectional study of 454 female IBD patients ≥18 years of age attending 1 of 3 IBD clinics in the United States or Denmark. We gathered information on sexual function via a de novo 23-item scale. General sexual functioning was measured with the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). Medical history and sociodemographic data were collected via chart review. Exploratory factor analyses (EFAs) of the English language version of IBD-FSDS assessed unidimensionality, factor structure, reliability, criterion validity, and construct validity. Results EFAs suggested retaining 15-items creating a unidimensional scale with strong internal consistency reliability (α = 0.93). Validity of the English language IBD-FSDS was measured using Spearmans coefficient, demonstrating significant criterion validity with the FSDS-R (P < 0.05) and the FSFI (P < 0.05) and significant construct validity with the composite for cases of active IBD (P < 0.05) and PHQ-9 (P < 0.05). Sexual dysfunction in women with IBD was significantly associated with depression (P = 0.042), active IBD (P = 0.002), and no history of surgery (P = 0.044). Conclusions We have developed and validated an IBD-specific scale to assess the psychosexual impact of IBD in women. This novel screening questionnaire may help health care providers recognize factors contributing to impaired sexual function in their female patients.

Homosexual Men and Women, Cancer, and the Health Care System

Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality. It is not merely the absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled. That goes for heterosexuals as well as for people with a different sexual orientation.