Who is the gate keeper for treatment in a fertility clinic in Germany? -baseline results of a prospective cohort study (PinK study).

BACKGROUND: It is estimated that 5-15% of all couples in industrialised nations are infertile. A perceived unfulfilled desire for a child or self-identification as infertile can lead to psychological strain and social isolation. About 53.000 women underwent assisted reproduction treatments in Germany in 2014. Little is known about the first medical consultation and patient needs prior to the first visit in a fertility clinic in Germany. The baseline survey of the prospective cohort study on couples undergoing fertility treatment in Germany (PinK Study) provides first results on this topic for Germany. METHODS: The baseline survey was conducted between 2012 and 2013. Self-administered questionnaires were handed out to patients of six fertility clinics at the beginning of treatment by clinic staff. At a participation rate of 31.0%, we were able to analyse data on 323 women and 242 men. RESULTS: 92.6% of the women had their initial medical consultation on their unfulfilled desire for a child with a gynaecologist. After the urologist (44.2%), the general practitioner (12.0%) was the second most approached initial contact person for men. 36.4% of all men had no medical consultation on the unfulfilled desire for a child before visiting a fertility clinic. 46.9% of the respondents expressed the wish that the conversation about infertility should be initiated by a physician. Prior to their first visit to a fertility clinic, 11.2% of the men and 24.8% of the women were informed by a physician that infertility treatment can cause emotional strain. CONCLUSION: While almost all women consult a gynaecologist prior to the first visit in a fertility centre, one out of three men do not consult any physician at that stage. For the remaining group of men, urologists and general practitioners are the most important contact persons. Gender-specific health care needs are evident. In order to close the health care gap for men in Germany, more opportunities for discreet access to consultation should be offered. Due to its low threshold and family-oriented approach, general practice could make an important contribution to this effect.

[Children and adolescents with sexual behaviour problems in residential and partially residential welfare services]. / Kinder und Jugendliche mit problematischem sexuellen Verhalten in (teil-)stationären Hilfen zur Erziehung.

The article considers how sexual behaviour problems in children and adolescents can be defined and investigates the degree to which the system of child welfare in Germany is confronted with clients demonstrating different kinds of problematic sexual behaviour. For the first time, the magnitude of this problem can be estimated by a secondary analysis of data from EVAS ("Evaluation System for Child and Adolescent Welfare Services"), a questionnaire-based evaluation system which supports youth care providers in their quality management. Data on more than 5,000 children and adolescents provided by a questionnaire completed at the point of admission to support services, as defined by paragraphs 32 or 34 SGB VIII (German Child Welfare legislation), is analysed. Information is provided on; prevalence of sexual behaviour problems and disorders of sexual behaviour; comorbidity; resources; psychosocial pressures; reasons for admission; and previous experience of child welfare systems. Clients with non-sexual symptoms function as a control group.