Lauri Rauramo

Supra Vaginal Uterine Amputation VS. Hysterectomy: Effects on libido and orgasm

Postoperative symptoms of hysterectomy have received relatively little attention. In the present study, the first author has personally interviewed and examined 105 abdominal hysterectomy patients and 107 patients with supravaginal uterine amputation preoperatively and 6 weeks, 6 months and 12 months postoperatively. Participation in the follow-up study was 99.5% (211/212) at one year. This paper deals with the effects of the two operations on libido and the frequency of orgasms. In the statistical analysis, McNemars test of symmetry and the Fisher exact test were used. Weak or absent libido was reported preoperatively by 28.0% of hysterectomy patients and by 26.4% of amputation patients. One year postoperatively the corresponding figures were 35.4% and 31.4%. No statistical changes were observed between the two groups or within either group. In the frequency of orgasms a highly significant (p less than 0.001) reduction from the situation before operation to one year postoperatively was detected after hysterectomy. In the supravaginal amputation group no statistically significant decrease was detected. Preoperatively the two groups were alike; one year postoperatively the difference was almost significant (p less than 0.05). The reductions in orgasms after hysterectomy as compared with supravaginal amputation appears to result from the greater radicality of the former; at hysterectomy, the autonomous innervation of the proximal vagina and cervix is damaged more than in supravaginal amputation, the anatomy of the vagina is altered and scar tissue forms in the vagina. It is probable that these changes and subconscious psychological reactions due to total removal of the uterus explain why supravaginal uterine amputation gives better results than hysterectomy.

Effect of bilateral oophorectomy and peroral estradiol valerate therapy on serum lipids.

The effect of bilateral oophorectomy upon serum lipids was studied in 25 women, whose average age was 48 years. One month after castration the triglyceride level was significantly (p<0.01) higher than before the operation. Six months later the triglyceride level had fallen slightly and the difference from the preoperative level was no longer significant. Castration did not have any significant effect on serum cholesterol and phospholipids during the seven‐month follow‐up period. The effect of peroral estradiol valerate was studied in the same way in 25 women, whose average age was 49 years. Estradiol valerate therapy (2 mg per day) was started one month after castration. After 6 months of treatment the serum phospholipids had increased slightly (p<0.05), but there was no significant effect on the cholesterol and triglyceride levels.

SERUM OESTRIOL, OESTRONE AND OESTRADIOL CONCENTRATIONS DURING ORAL OESTRIOL SUCCINATE TREATMENT IN OVARIECTOMIZED WOMEN

Serum oestriol, oestrone and 17 beta-oestradiol concentrations during oral oestriol succinate treatment were investigated in ovariectomized women. Either a single dose of 8 mg or two doses of 4 mg were given daily. With the second divided dosage the serum oestriol levels remained uniform. The oestriol concentrations were clearly higher than in the beginning or in the middle of the normal menstrual cycle in the fertile woman. With both treatment schemes the ratio E3/(E2 + E1) was clearly higher than before treatment and during the normal menstrual cycle. Oestriol succinate treatment lowered the ratio E1/(E2 + E3), which was rather similar to the one during normal menstrual cycle.

The first abortion ‐ and the last? A study of the personality factors underlying repeated failure of contraception

The causes leading to a second abortion were outlined in a psychological study comparing 30 women expecting a second abortion with 29 women who had successfully prevented conception after a first abortion. It was found that both groups improved their contraceptive practices after the first abortion. However, while the latter group continued with their improved practices, the former group went back to the earlier inefficient or non‐existent contraceptive behavior. The inability to improve contraception in the long run was not related to differences in educational level or knowledge about contraceptive techniques but to the developmental level of personality structures. The women expecting their second abortion rated lower in control of impulsivity, emotional balance, realism, self‐esteem and stability of life as well as capacity for more integrated personal relationships. The differences in personality development and consequently in the capacity for long‐term contraception were found to be due to growth conditions in childhood.

Serum oestrone, oestradiol and oestriol concentrations in castrated women during intramuscular oestradiolvalerate and oestradiolbenzoate-oestradiolphenylpropionate therapy

Serum oestrone, oestradiol and oestriol concentrations were studied during intramuscular Primogyn Depot (10 mg of oestradiolvalerate) and Dimenformon prolongatum (2.5 mg of oestradiolbenzoate + 10 mg of oestradiolphenylpropionate) treatments. The serum oestrone concentrations were markedly elevated in both therapeutic groups 24 h after the injection. After the Primogyn Depot injection the serum oestrone concentration 10 days after the injection was still significantly higher than the pretreatment level. The serum oestradiol concentrations of both groups were markedly elevated 24 h after the injections and were significantly higher than the pretreatment concentration 10 days later. The oestriol values were low during both treatments.

Cervical Bacterial Flora in Women Fitted with A Copper-Releasing Intra-Uterine Contraceptive Device (IUD)

Abstract. A bacterial culture was taken from the cervix in 85 sexually active women before, and 3 and 6 months after, insertion of either a copper‐releasing or an inert intra‐uterine contraceptive device (IUD). Sixty had a Copper‐T (TCu‐200) and 25 a Lippes loop D. Although in more than a quarter of the patients the bacterial flora increased slightly in diversity and abundance after IUD insertion, there was no difference in effect between the TCu‐200 and Lippes loop D.

Effect of Estrogen Therapy on Climacteric Symptoms and Tissue Changes

Abstract. Estrogen substitution for 50 castrated women consisted of estriol succinate and for another 50 women of estradiol valerate. The daily dose in both groups was 2 mg, given for six months starting one month after castration. The patients generally developed strong vegetative symptoms after oophorectomy. Five patients failed to respond to estriol succinate and one to estradiol valerate. The effect of estrogen therapy on the vaginal smear and the skin was also studied in these six cases. An estrogen effect, though often fairly weak, in the vaginal smear was observed. Total urinary estrogens were high in all the cases after three and six months of estrogen therapy. The epidermis was significantly thickened after three months of estrogen except in one case. There was generally no significant difference between the 3‐month and 6‐month skin specimens. Ostensibly ineffective estrogen subsitution may thus play a role in the prevention of postmenopausal degenerative changes. The effect of estrogen therapy on the vegetative symptoms alone should not be regarded as the yardstick of its efficacy.

Serum Estrone, Estradiol and Estriol Concentrations During Oral Hormone Therapy After Oophorectomy

Serum estrone, estradiol and estriol concentrations during estradiolvalerate‐norgestrel therapy for women who have undergone oophorectomy were studied. The patients in one group received 1 mg of estradiolvalerate in the morning and 2 mg of estriolsuccinate in the evening. The estrone and estradiol concentrations of the first and fifth day were at roughly the same level and the treatment caused no estrogen cumulation. The estriol concentrations on the fifth day were distinctly higher than on the first, owing to the conversion of estrone and estradiol into estriol. The other group of women were placed on a regimen of 2 mg of estradiolvalerate plus 0.5 mg of norgestrel in the morning and 2 mg of estriolsuccinate in the evening. Here again, the estrone and estradiol concentrations on the first and fifth days were similar.

Glucuronide Formation in Parturients

Glucuronation during pregnancy was studied by means of salicylamide tolerance tests. One hour after oral administration of salicylamide to parturients the blood contents of free salicylamide and salicylamideglucuronide are considerably lower than in similarly tested nonpregnant women. At hour 4 from administration, both groups have similar blood concentrations of these substances. The inhibition of glucuronide formation or disturbances in resorption during pregnancy may be involved. The clinical reliability e.g. of determinations of urine steroids during pregnancy is discussed in the light of the alterations in glucuronation caused by pregnancy.

Über die chemische Bestimmung des E‐Vitamins im Serum und den E‐Vitamingehalt des Serums bei Frauen: Vorläufige Mitteilung

In den letzten Jahren sind fur das E-Vitamin zahlreiche verschiedene chemische Bestimmungsverfahren dargestellt worden. Ohne in diesem Zusammenhang diese Verfahren im Einzelnen naher zu betrachten, mochte ich nur erwahnen, dass die meisten von diesen Methoden auf den reduzierenden Eigenschaften der TOCOpherole beruhen, und dass bei allen die zu untersuchende Losung vor der colorimetrischen Bestimmung von reaktionsstorenden Stoffen gereinigt werden muss. Bei den neuesten Gewebsuntersuchungen ist allgemein als Grundlage das Ferrichlorid-DipyridylVerfahren von Emmerie und Engel (1938) benutzt worden Q3. und H. v. EULER, 1941; GLAVIND, 1942; D’OLIVEIJRA, 1942; COUPERUS, 1943). Da diese Methode aus den Resultaten zu schliessen verhaltnismassig praktisch wirkte, wahlte ich sie anfangs, als ich daran ging, ein Mikroverfahren zur Bestimmung des E-Vitamins zu entwickeln zu versuchen, zur Grundlage fur meine Versuche.