Jean-Jacques Amy

A 10-year follow-up after Kegel pelvic floor muscle exercises for genuine stress incontinence.

Objective To determine the outcome 10 years after an individual course of pelvic floor muscle (PFM) exercises for genuine stress incontinence.

C‐reactive protein in preterm labour; association with outcome of tocolysis and placental histology

Tocolytics were administered in 66 consecutive women in uncomplicated preterm labour with intact fetal membranes (53 singleton and 13 twin pregnancies). C‐reactive protein (CRP), a marker of infection, was determined daily and used retrospectively to investigate the role of subclinical infection in preterm labour and to predict the efficacy of tocolysis and the development of a clinical perinatal infection. CRP was also determined in 66 women in uncomplicated labour at term (53 singleton and 13 twin pregnancies). The placenta was examined for histological evidence of infection in all patients who were delivered bcfore 36 weeks (n=21) and in all women in the control group (n=66). Elevated CRP levels were more often found in patients who were refractory to tocolysis, suggesting an underlying infectious morbidity. Placental infection was found in 62% of the preterm delivery group and in 12% of the control group. There was an association between elevated CRP levels and histological evidence of placental infection. However, confounding factors such as urinary tract infections limit the usefulness of the CRP test. Because CRP cannot predict clinical perinatal infection accurately, its clinical relevance is very limited.

Congenital toxoplasmosis: a prospective survey in Brussels

A prospective survey of antenatal patients was made at a hospital in Brussels over the period 1979–1982 to assess the incidence of congenital toxoplasmosis. Of 2986 patients assessed, 1403 (47%) had no toxoplasma antibodies and were at risk. The susceptible population was assessed every 6 weeks and 20 of these women (1.4%) seroconverted during pregnancy. Ten of the seroconverters had a therapeutic abortion; of the remaining 10 two gave birth to congenitally infected infants. Of the 1583 (53%) patients with a positive serology for toxoplasmosis initially, 17 (1.1%) had high antibody litres indicating that the infection could have taken place early in pregnancy. Nine infants born to these women were followed at our hospital and two of them were affected.

Certificates of virginity and reconstruction of the hymen

Virginity in women has traditionally been associated with the integrity of the hymen, the incomplete membrane occluding the lower end of the vagina. The hymen is often ruptured during the first coitus, which may cause bleeding of varying intensity. In certain communities, the bed-sheet, now soiled with blood, is shown as proof that the first sexual intercourse has taken place and that the bride was indeed a virgin up to that point. Thus, the sullied sheet constitutes evidence that the ‘honour’ of the woman and that of her family remain intact. Literature data concerning the frequency of bleeding at defloration are amazingly scarce. Olga Loeber conducted a retrospective survey among women of diverse ethnic origin and with different cultural and religious background aborted at one centre in The Netherlands. Somewhat less than half of these women reported that they had not bled during their first coitus! The Jewish, Christian and Muslim faiths all attach considerable importance to premarital virginity, particularly that of women. Yet, the social valorization of virginity dates back to a much earlier time than the imposition of chastity upon unmarried women in Muslim communities. Neither the Koran nor Hadiths state that virginity is a precondition to marriage. Patriarchal societies aim to control the sexuality of women in order to regulate lines of descent and transfer. Islam has only translated a social into a religious norm. It is worth remembering that until the 1960s, moral and behavioural norms kept even European atheists from engaging in premarital sex. These constraints have only been gradually lifted in the last 50 years as a result of the liberalization of sexuality and the improved social status of women.

Sexual Functioning in Women Using Levonorgestrel‐Releasing Intrauterine Systems as Compared to Copper Intrauterine Devices

INTRODUCTION There has been little research published on the impact of intrauterine contraceptive (IUC) methods on sexual functioning. AIMS This study aimed: (i) to assess different aspects of sexual functioning, including the prevalence of sexual dysfunction in women using a levonorgestrel intrauterine system (LNG-IUS); (ii) to compare this prevalence with that among copper-releasing intrauterine device (Cu-IUD) users; and (iii) to identify the relationship between psychological variables and sexual functioning in women using one of the aforementioned IUCs. METHODS In a multicenter cross-sectional study, 845 women with an IUC were invited to fill out a questionnaire. The latter was returned by 402 (48%) of them: 353 women were LNG-IUS users (88%) and 49 were Cu-IUD users (12%). The questions asked pertained to depression, well-being, marital relation quality, and sexual functioning. MAIN OUTCOME MEASURES Sexual functioning was measured with the short sexual functioning scale. RESULTS One-third of LNG-IUS users (33%) reported a sexual dysfunction. Of those, 20% reported an increased sexual desire, 25% a decreased sexual desire, 5% arousal problems, and 8% orgasm problems. Women using a LNG-IUS did not differ significantly in distribution, type, or prevalence (32.9% vs. 36.7%) of sexual dysfunction, nor in depressive symptoms (Beck Depression Inventory score; 4.7 vs. 3.9; P = 0.33), general well-being (WHO-5 well-being scale score; 16.8 vs. 17.7; P = 0.170), or partner relationship quality (Dyadic Adjustment Scale score; 107 vs. 108; P = 0.74) compared to Cu-IUD users. Overall, the perceived influence of IUCs on sexual functioning was in the lower range and did not differentiate LNG-IUS greatly from Cu-IUD-users. CONCLUSION Women using a LNG-IUS do not differ from those wearing a Cu-IUD with regard to psychological and sexual functioning. The perceived impact of IUD use on sexuality should not be overestimated.

Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism.

The controversy around the combined hormonal contraceptives (CHCs) of the so-called third (containing gestodene or desogestrel) and fourth generation (containing drospirenone, DRSP) has reached a highly emotional political dimension in which all those who are professionally responsible for womens health are involved: the national health authorities, the pharmaceutical companies, the professional organisations, the prescribers, the media and the public (i.e. the current or potential users of CHCs). The – initially scientific – controversy has now led to a public health dispute that culminated in the decision of the French authorities to withdraw the combination containing ethinylestradiol (EE) and cyproterone acetate (CPA) from the market. The potential impact of this measure, namely the loss of confidence in all CHCs, could be quite serious. Several registry-based studies published in the British Medical Journal , particularly the one based on the Danish Registry, indicated that there is an increased risk of venous thromboembolism (VTE) associated with the intake of third- and fourth-generation combined oral contraceptives (COCs) compared to preparations containing the progestogen levonorgestrel (LNG).1–,5 The relative risk (RR) was around 2, and the absolute attributable risk was estimated to be (dependent on the background prevalence rate) between 2 to 8 per 10 000 users per year.6 A very recent systematic review and meta-analysis of the possible link between treatment with CHCs and VTE concluded that, in this regard, (1) CHCs containing LNG or norgestimate were the safest, (2) those containing desogestrel, DRSP or CPA were associated with a significantly higher risk than CHCs containing LNG, and (3) the augmented risk of VTE found for pills containing gestodene compared to COCs with LNG appeared to be smaller than in earlier studies.7 These results contrast with those of published prospective cohort studies, sponsored by Bayer HealthCare, at the request of …

Pregnancy during adolescence: A major social problem

Adolescents tend to behave impulsively and may show a low capacity for abstraction and planning ahead of time. This also applies to their sexual behaviour. Worrying parents, and all others providing advice and guidance, must take this profile into account and have regard for the youngsters’ innate desire of autonomy. The median age at which adolescents in Europe start having sexual intercourse is presently 15–16 years, but notable differences exist between countries. The following factors have been found to increase the risk for early sexual activity:

The shortest lecture on fertility control

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Female sterilisation is becoming less popular

This article discusses the advantages and disadvantages of female versus male sterilization. Male sterilization is a simple procedure that prohibits the sperm from reaching the genital tract. On the other hand female sterilization is a more complex procedure. There are a variety of ways to sterilize a woman all of which result in the inability of the egg to come in contact with sperm. Despite its complexity female sterilization has always been more popular due to a social norm dictating that contraception is a female issue. Recently though the preference towards female sterilization has been declining due to changing societal norms surrounding the appropriate age of reproduction and an effort to reduce the need for in vitro fertilization.

Preserving the reproductive potential of transgender and intersex people

Abstract Background: The bodies of some transgender and intersex people have been mutilated and their minds subjected to immense distress. Their gender has often been determined by others. Loss of fertility used to be considered an inevitable consequence of treatment. Objective: To review the issue of preserving the reproductive potential of transgender and intersex people. Methods: A narrative review based on a wide-ranging search of the literature in multiple disciplines. Results: Major technological advances have facilitated reproduction for transgender and intersex people in the last few years. A majority of trans-adults believe that fertility preservation should be offered to them. Deferment of surgery for intersex people is often best practice; gonadectomy in infancy closes off fertility options and determines a gender they may later regret. Conclusions: Transgender and intersex people should be able to consent to or decline treatment, especially radical surgery, themselves. Preservation of reproductive potential and sexual function must be given a high priority. Treatment by multidisciplinary teams can provide a strong emphasis on mental health and well-being. Detailed information about options, an absence of any coercion and enough time are all needed in order to make complex, life-changing decisions.