Christian W. Wallwiener

Prevalence of Sexual Dysfunction and Impact of Contraception in Female German Medical Students

INTRODUCTION Female sexual dysfunction (FSD) is a very common disorder, with an estimated prevalence of having at least one sexual dysfunction of about 40%. AIM To investigate the prevalence and types of FSD and the relationship between hormonal contraception (HC) and FSD in female German medical students. MAIN OUTCOME MEASURES Female Sexual Function Index (FSFI) with additional questions on contraception, sexual activity, and other factors that may influence sexual function. METHODS An online questionnaire based on the FSFI was completed by students from six medical schools. Obtained data were screened for inconsistencies by programmed algorithms. RESULTS A total of 1,219 completed questionnaires were received, and 1,086 were included in the analyses after screening. The mean total FSFI score was 28.6 +/- 4.5. 32.4% of women were at risk for FSD according to FSFI definitions. Based on domain scores, 8.7% for were at risk for FSD concerning orgasm, 5.8% for desire, 2.6% for satisfaction, 1.2% for lubrication, 1.1% for pain and 1.0% for arousal. The method of contraception and smoking were factors with significant effect on the total FSFI score whereby hormonal contraception was associated with lower total FSFI scores and lower desire and arousal scores than no contraception and non-hormonal contraception only. Other variables such as stress, pregnancy, smoking, relationship and wish for children had an important impact on sexual function as expected according to earlier studies. CONCLUSIONS The prevalence of students at high risk for FSD was consistent with the literature although domain subscores differed from samples previously described. The contraception method has a significant effect on the sexual functioning score and women using contraception, especially hormonal contraception, had lower sexual functioning scores. Stress and relationship among other variables were found to be associated with sexual function and may thus provide insight into the etiology of sexual disorders.

Impact of electronic messaging on the patient-physician interaction:

Patients are interested in secure electronic communication with their health-care providers, but physicians have been slow to adopt the technique into their practice. We have therefore reviewed the literature on secure patient messaging. Relevant studies were identified by Medline search which produced 1065 publications. Of these, 71 relevant articles were read independently by two reviewers. Currently available messaging systems allow for asynchronous communication, physician reimbursement and automated supporting functions such as triaging of patient messages and integration of messaging into medical records. The review showed that patients are satisfied with the use of secure physician messaging systems and find such services to be convenient, time-saving and useful. Physicians do not report adverse effects from their use. Legal concerns with electronic messaging include compliance with privacy standards. The economic benefits of secure messaging systems are most immediately apparent for larger health-care groups and hospitals, although smaller practices will also benefit in the long run. Secure patient-physician messaging is a convenient and useful addition to the health-care infrastructure. It can be expected that the identification of secure providers, integration with reimbursement systems and initial uptake by larger health-care organizations will speed up the adoption into routine health care.

A direct comparison of seprafilm, adept, intercoat, and spraygel for adhesion prophylaxis.

BACKGROUND Commercially available agents for adhesion prophylaxis are legion but there is a lack of direct comparisons between them. Here we compare four of the most commonly used adhesion barriers against a control group in a clinically relevant rat model. MATERIAL AND METHODS Standardized lesions were created in Wistar rats using electrocautery and suturing. Subsequently, the experimental lesions were treated with Seprafilm (n = 30), Adept (n = 30), Intercoat (n = 30), Spraygel (n = 30), or no barrier (n = 30). The resulting adhesions were examined 14 d postoperatively. RESULTS The mean area covered by adhesion was 77% in the control group, 46% in animals treated with Seprafilm, 54% in animals treated with Adept, 55% in animals treated with Intercoat, and 68% in animals treated with Spraygel. The adhesion-free incidence was 20% (n = 6) of lesions treated with Seprafilm, 20% (n = 6) of lesions treated with Intercoat, 3% of lesions treated with Spraygel (n = 1), and 0% of lesions treated with Adept or the control group. CONCLUSIONS There were statistically significant differences between the barriers with regards to the area covered by adhesions and the adhesion-free incidence. In spite of this, a significant adhesion burden remains with all of the tested barriers.

Current Strategies and Future Perspectives for Intraperitoneal Adhesion Prevention

IntroductionThe formation of peritoneal adhesions still is a relevant clinical problem after abdominal surgery. Until today, the most important clinical strategies for adhesion prevention are accurate surgical technique and the physical separation of traumatized serosal areas. Despite a variety of barriers which are available in clinical use, the optimal material has not yet been found.DiscussionMesothelial cells play a crucial physiological role in frictionless gliding of the serosa and the maintenance of an antiadhesive surface. The formation of postoperative adhesions results from a cascade of events and is regulated by various cellular and humoral factors. Therefore, optimization or functionalization of barrier materials by developments interacting with this cascade on a structural or pharmacological level could give an innovative input for future strategies in peritoneal adhesion prevention. For this purpose, the proper understanding of the formal pathogenesis of adhesion formation is essential. Based on the physiology of the serosa and the pathophysiology of adhesion formation, the available barriers in current clinical practice as well as new innovations are discussed in the present review.

Thermal Conduction, Compression, and Electrical Current–An Evaluation of Major Parameters of Electrosurgical Vessel Sealing in a Porcine In Vitro Model

Bipolar vessel sealing is pivotal in laparoscopic hemostasis. However, major coaptive desiccation parameters have yet to be investigated in detail. The current investigation aims to study the impact of compressive pressure, thermal conduction, and electrical current effects on seal quality in a randomized, controlled experimental trial in an in vitro porcine model of vessel sealing. A total of 106 porcine vessels were sealed with either bipolar current or thermal conduction. Compressive pressure on the sealing site and maximum temperature were varied and monitored. Additionally, the longitudinal vessel tension was measured. The burst pressure of the resulting seal was determined as an indicator of seal quality. In bipolar coaptation, seal quality depends on the compressive pressure applied to the coagulation site in both arteries and veins. The optimal pressure interval was around 270 mN/mm2 for arteries and 200 mN/mm2 for veins. Deviation from these optimal pressures towards low and high extremes led to significantly fewer successful seals. We also found that both maximum coaptation temperature and vessel shrinking correlated with the seal quality. This correlation was reciprocal in arteries and veins. Thermal conduction alone was less successful than sealing by bipolar current. Therefore, compressive pressure during coaptation determines the seal quality. Upper and lower pressure boundaries for safe coaptation exist for both arteries and veins. Vessel sealing by thermal conduction without electrical current effects is possible but represents a less effective method for coaptation. These findings have implications for the rational design of new electrosurgical instruments.

Effects of sex hormones in oral contraceptives on the female sexual function score: a study in German female medical students

BACKGROUND The survey was conducted to compare the influence of sex hormones in oral contraceptives (OCs) on female sexual function. METHODS One thousand eighty-six female German medical students completed an online-based questionnaire incorporating the Female Sexual Function Index (FSFI). Oral contraceptives used were classified into those containing androgenic or antiandrogenic progestins and by ethinylestradiol (EE) dosage (20 mcg, 30 mcg and >30 mcg). Female Sexual Function Index scores in women using OCs were compared to those in nonusers. RESULTS Seven hundred fifty-two of 1086 participating women used OCs. No statistically significant differences in FSFI scores were found among women using OCs containing androgenic or antiandrogenic progestins, nor were any seen between different EE dosages. In general, OC users had lower FSFI scores than nonusers. CONCLUSION Female Sexual Function Index scores were negatively influenced by the use of OCs. However, the impact of an androgenic or antiandrogenic progestin content or different dosages of EE as modulating factors of female sexual function seems negligible.

The extent of adhesion induction through electrocoagulation and suturing in an experimental rat study

OBJECTIVE To investigate the effect of three types of peritoneal trauma occurring during surgery (high-frequency bipolar current, suturing, and mechanical damage) on postoperative adhesion formation in a rodent animal model. DESIGN Randomized, controlled experimental trial in an in vitro animal model. SETTING Laboratory facilities of a university department of obstetrics and gynecology. ANIMAL(S) Thirty-five female Wistar rats. INTERVENTION(S) Bilateral experimental lesions were created on the abdominal wall in every animal. The effect of minimal electrocoagulation was examined by creating lesions (n = 14) through sweeps of a bipolar forceps with a duration of 1 second and standardized pressure. For extensive electrocoagulation standardized lesions (n = 14) were created using sweeps of a duration of 3 seconds and three times more pressure. For mechanical trauma, standardized lesions (n = 14) were created by denuding the peritoneum mechanically. To study the additive effect of suturing, experimental lesions were created by suturing plus minimal electrocoagulation (n = 14) or mechanical denuding (n = 14). MAIN OUTCOME MEASURE(S) Adhesion incidence, quantity, and quality of the resulting adhesions were scored 14 days postoperatively. Adhesions were studied histopathologically. RESULT(S) Mechanical denuding of the peritoneum did not result in adhesion formation. After minimal electrocoagulation, mean adhesion quantity of the traumatized area averaged 0%. This contrasted with extensive electrocoagulation, where there was 50% adhesion. Additional suturing increased mean adhesion quantity to 73% and 64% for superficial electrocoagulation and mechanical denuding, respectively. CONCLUSION(S) We conclude that superficial trauma limited mostly to the parietal peritoneum may be a negligible factor in adhesion formation in this model. This appears to be irrespective of the mode of trauma. However, additional trauma to the underlying tissues, either by deeper electrocoagulation or suturing, leads to significantly increased adhesion formation. These data also show that there is a spectrum of electrocoagulation trauma at the lower end of which there is little adhesion formation.

Adhesion prophylaxis using a copolymer with rationally designed material properties

BACKGROUND Physical barriers are the only licensed adjuncts for adhesion prophylaxis in the United States and Europe. Here, we investigate D,L-polylactide-epsilon-caprolactonetrimethylenecarbonate (PCT copolymer), which is a rationally designed biomaterial, as an adhesion barrier. METHODS PCT copolymer membranes were produced by polymerization of the monomers, dissolution in organic solvents, and subsequently processing them by means of modified phase inversion and freeze drying. In vitro cytotoxicity was assayed by fibroblast culture. In vivo adhesion prophylaxis was studied in a rat model that involved standardized traumatization by electrocautery and suturing. The quantity and quality of the resulting adhesions were scored 14 days postoperatively. Complete autopsy was performed in each animal, and the implantation sites were examined histologically. The suitability for human laparoscopic application was investigated in a patient admitted for routine myomectomy. RESULTS The PCT copolymer had no effect on the proliferation of cultured cells in vitro. The in vivo model showed that the quantity of adhesions that cover the traumatized areas was significantly less in animals treated with PCT copolymer membrane (32%) than in untreated animals (78%) (P < .01). Adhesions of both dense and filmy quality were affected. In the animals, autopsy and histologic examination of the relevant tissues revealed no indication of adverse reactions to the PCT copolymer. Human laparoscopic application was successful. CONCLUSION The PCT copolymer membrane is biocompatible with the abdominal cavity and decreased adhesions in the animal model. It is also suitable for human laparoscopic application. Therefore, the PCT copolymer represents a candidate for additional clinical evaluation.

Laparoscopically Assisted Neovaginoplasty in Vaginal Agenesis: A Long-Term Outcome Study in 240 Patients

STUDY OBJECTIVE To assess the long-term outcome of an optimized minimally invasive neovaginoplasty technique in vaginal agenesis. DESIGN Combined retrospective and prospective study. SETTING University hospital. PARTICIPANTS 240 patients with congenital vaginal agenesis. INTERVENTIONS Patients with an indication for neovagina creation underwent laparoscopically assisted neovaginoplasty involving vaginoabdominal blunt perforation and intracorporeal traction using tension threads and an abdominally positioned extracorporeal traction device. MAIN OUTCOME MEASURES Long-term anatomic success, functional success compared with similar-aged controls, long-term complications, and incidence of human papilloma virus (HPV) infections. RESULTS During median follow-up for 16 (range 11-141) months, mean functional neovaginal length remained stable at 9.5 cm in all patients, including those who had no sexual intercourse and had stopped wearing the vaginal dummy. Median dummy wearing time was 8.6 months. Time to epithelialization depended on the time of onset and frequency of sexual intercourse. At long-term follow-up, median total Female Sexual Function Index score was 30.0, comparable with similar-aged controls. No common long-term complications occurred. Four patients required cauterization of granulation tissue. 7/240 (2.9%) patients were HPV-positive with low- to high-grade squamous intraepithelial lesions, 3 patients reverting to HPV-negative status at long-term follow-up. CONCLUSIONS Our technique creates a neovagina of adequate size and secretory capacity for normal coitus, requiring no prolonged dilation postoperatively, even in the absence of sexual intercourse. The procedure is fast, effective and minimally traumatic, has a very low long-term complication rate and provides very satisfactory long-term functional results.

An Improved Model for the Induction of Experimental Adhesions

ABSTRACT Background: The creation of ischemic buttons from parietal peritoneal tissue using a ligature is among the most established models for adhesion induction. However this model is plagued by slipping of ligatures and subsequent obliteration of the buttons when the animals mobilize postoperatively. Here we describe an improved model that involves creating the buttons with a backstitch ligature and compare it to the traditional model. Methods: A total of 160 ischemic buttons were created in 20 adult Wistar rats. Ischemic buttons in the control group (n == 80) were created using the traditional technique whereas ischemic buttons in the investigative group (n == 80) were created using the novel technique with a backstitch ligature. The resulting adhesions and the frequency of slipped ligatures were analyzed on postoperative day 10. Results: Slipping of the ligature with obliteration of the button occurred in 18.8%% (n == 15/80) of buttons in the control group and in 3.8%% (n == 3/80) of buttons in the investigative group (p < .01). Adhesions formed to 69.2%% (n == 45/65) of the remaining buttons in the control group and to 62.3%% (n == 48/77) of the remaining buttons in the investigative group (p == .38). Conclusion: There was no statistically significant difference in adhesion quantity between the models. However, the novel technique significantly reduced postoperative slipping of the ligatures with obliteration of buttons. As a result, a greater number of intact buttons are available for data collection. Furthermore slipped sutures, which act as foreign bodies in uncontrollable locations, no longer confound adhesion formation to the remaining buttons.