Sex differences in the association between (sexual) abuse and lower urinary tract symptoms.

OBJECTIVES: To study the possible association between (sexual) abuse and lower urinary tract symptoms (LUTS) in men and women. To study the differences in this association between men and women, and between the timing of the abuse. SUBJECTS AND METHODS: A Dutch observational population-based cross-sectional study was used, based on self-administered questionnaires. Respondents were included if they had answered all questions about abuse and LUTS. Logistic regression was used to analyse the data. RESULTS: Included were 558 men and 790 women, of whom 29% and 37%, respectively, reported a history of one of more types of abuse. Abuse was significantly associated with LUTS in both men (odds ratio [OR] 1.7; 1.2-2.5) and women (OR 1.4; 1.1-2.1). This association, testing by two-way interaction, was significantly stronger in men. No association was found between childhood abuse or adulthood abuse and LUTS, in men or women. The association of sexual abuse with LUTS was significant in both men (2.7; 1.4-5.2) and in women (1.5; 1.1-2.2), and this association (testing by two-way interaction) was significantly much stronger in men. CONCLUSION: In men more than in women, a history of any type of abuse is associated with LUTS, regardless of whether the abuse occurred during childhood or adulthood. In both sexes, a history of sexual abuse is also associated with experiencing LUTS, with a much stronger association in men than in women. Patients, in particular male patients, presenting with LUTS should therefore be asked about sexual abuse in the past.

Perspectives of Dutch women on premenstrual disorder. A qualitative study exploring women's experiences.

BACKGROUND: Women presenting with Premenstrual Disorder (PMD) to general practitioners (GPs) experience problems with their biopsychosocial functioning. PMD is a disorder consisting of physical and/or mood-based symptoms cyclically occurring with a significant impairment of daily life. Little is known about the symptoms and coping strategies of women with PMD and their experiences with their GPs. OBJECTIVES: This present study aimed to improve understanding of the perspectives of women with PMD, their coping strategies and their expectations of the GP. DESIGN: Qualitative study with semi-structured interviews. SETTING: In 2017, Dutch women with symptoms of premenstrual disorder were recruited through local newspapers in the town of Nijmegen and the North-Holland region and via social media. After checking the inclusion and exclusion criteria, we interviewed 20 women (between 27 and 49 years of age). The interviews took place at a location of the interviewees' preference. RESULTS: PMD symptoms can strongly influence the quality of women's lives. Three themes emerged from our analysis: feelings of having two separate female identities, PMD as a life-controlling condition and different coping strategies. Most women used an active coping strategy. Women with PMD need recognition from their GPs and knowledge of proper treatment. CONCLUSION: PMD symptoms can have a high impact on daily life. Women with PMD expressed their need for acknowledgement and a personalised approach from their GP. Greater awareness and knowledge among GPs may be helpful in this.

The usefulness of uroflowmetry and ultrasound bladder scanning as diagnostic tools in primary care for new male patients with lower urinary tract symptoms; a cluster randomized controlled trial.

BACKGROUND: Uroflowmetry and ultrasound scanning of the post-void residual volume are diagnostic instruments in specialist urological care of men referred with lower urinary tract symptoms (LUTS). We hypothesized that implementing uroflowmetry and post-void ultrasound bladder scanning in primary care for men with LUTS will reduce the number of referrals to urologists. OBJECTIVE: To assess the effect on referrals to urologists for new male patients over 50 years of age with LUTS when performing uroflowmetry and post-void ultrasound bladder scanning in primary care. METHODS: A cluster randomized controlled trial was conducted among Dutch general practitioners (GPs). The GPs enrolled male patients with the first-time presentation of LUTS, these were randomized to primary-care treatment with or without uroflowmetry and post-void bladder scanning. Primary outcome: percentage of patients referred to urologists within 3 and 12 months. Secondary outcomes: changes in the International Prostate Symptom Score (IPSS) and the IPSS-Quality of Life, patient satisfaction and urologic medication usage after 12 months. RESULTS: Four GPs were randomly assigned to the intervention group (132 patients) and seven to the control group (212 patients). The percentage of patients referred to urologists did not differ significantly between the intervention group vs the control group: within 3 months 19.7% versus 10.4% (OR 1.9, 95% CI 0.8 to 5.0), and within 12 months 28.8% versus 21.2% (OR 1.5, 95% CI 0.9 to 2.5). CONCLUSIONS: Performing uroflowmetry and ultrasound bladder scanning in primary care as additional diagnostic tools do not reduce the number of referrals to urologists. We do not recommend using these diagnostic tools in general practice in the diagnostic work-up of these patients.

Exploring the views of successful applicants for medical school about gender medicine using a gender-sensitive video assignment.

BACKGROUND: Sex and gender influence health and disease outcomes, therefore, doctors should be able to deliver gender-sensitive care. To train gender-sensitive doctors, relevant sex and gender differences have to be included in medical education. In order to develop appealing, relevant, and effective education for undergraduate medical students, education should be tailored to students' level and anticipated on their ideas and assumptions. Therefore, we wanted to answer the following research questions: 1. What do aspiring medical students want to learn about gender medicine?; 2. How would they like to learn about gender medicine?; and 3. What are their ideas and assumptions about sex and gender differences in health and disease? METHODS: We performed an explorative thematic document analysis of educational assignments made by successful applicants (n = 50) during the selection procedure of their entry into medical school. To test aspirants' capacity for self-directed learning, students were asked to formulate their own study plan after they watched a video that resembled a future practical experience (a consultation with a patient). As the content of this video was gender-sensitive, the assignments of the successful applicants gave us the unique opportunity to examine aspiring medical students' views about gender medicine. RESULTS: Aspiring medical students were eager to start their training to become gender-sensitive doctors. They believed in better care for all patients and thought doctors should obtain gender competences during their medical training. Students preferred to start with acquiring basic biomedical knowledge about differences between men and women and continue their training by developing gender-sensitive communication skills in (simulated) practical settings. Students differed in their interpretation of the gender-sensitive video, some generalized potential differences to all men and all women. Teachers were considered as important role models in learning about gender medicine. CONCLUSIONS: We advise medical schools to teach gender medicine from the beginning of medical school, by focusing on sex differences first and adding gender related themes later on in the curriculum. As students may interpret gender-sensitive information differently, structurally embedding reflection on gender medicine with gender competent teachers is necessary.

Why do men suffering from LUTS seek primary medical care? A qualitative study.

RATIONALE, AIMS AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common problems among men, but only a small proportion actually visit their general practitioner (GP). This study aims to gain insight into the reasons why men visit a doctor, and their expectations. METHODS: We opted to perform a qualitative study with semi-structured interviews among men aged over 50 years who consulted their GP because of suffering from LUTS. All interviews were fully transcribed and coded and analysed by two researchers using ATLAS.ti. RESULTS: We interviewed 18 men between the ages of 52 and 80. Frequently mentioned reasons for seeking help can be grouped under three main themes: a wish for reassurance about not having prostate cancer, the nuisance of symptoms such as nycturia and being triggered by public information about LUTS. Most participants lacked an understanding of the cause and prognosis of their symptoms. CONCLUSION: The main reasons to seek primary medical care are the need for reassurance and the nuisance of symptoms, especially nycturia. Overall, the patients show remarkably poor knowledge about their symptoms.