Male and female sexual function after surgical repair of female organ prolapse.

INTRODUCTION: Few data are available referring to male and female sexual function after prolapse repair of symptomatic pelvic organ. AIM: Primary aim of this study is to determine the male and female sexual function before and after surgery for pelvic organ prolapse. MAIN OUTCOME MEASURES: We used the Female Sexual Function Index (FSFI) questionnaire for female patients and for their male partners the Brief Male Sexual Inventory (BMSI) as measurement of sexual function. METHODS: We included sexually active heterosexual couples that were referred to the Department of Urogynaecology because of symptomatic cystocele, rectocele or vault descent. For cystoceles, anterior repair was performed, for rectoceles posterior repair, and for vault descent sacrospinous ligament fixation. FSFI and BMSI questionnaires were distributed before and after pelvic organ surgery and 4 months after. Female clinical examination assessing the degree of prolapse was performed before and 6 weeks after surgery. RESULTS: A full data set of 70 female questionnaires and 64 male questionnaires could be evaluated. Two cases of female de novo dyspareunia occurred. In women, FSFI scores improved significantly in the domains desire, arousal, lubrication, overall satisfaction, and particularly pain. Orgasm remained unchanged. In men, interest, sexual drive, and overall satisfaction improved significantly. Erection, ejaculatory function, and orgasm remained unchanged. Despite remaining unchanged, erection, strength of erection, ejaculation, and orgasm were not considered problems anymore compared to preoperative BMSI scores. CONCLUSION: Surgery for pelvic organ prolapse improves male and female sexual function in some domains but not in all.

Growth, thermal stability and structure of ultrathin Zn-layers on Pd(1 1 1).

Low-energy ion scattering with monolayer sensitivity was applied to investigate ultrathin films of zinc on Pd(1 1 1). Uptake curves taken at 150 K indicate the simultaneous growth of multilayers with negligible interlayer transport. Annealing experiments for two-monolayer films reveal a rapid decrease in the zinc content on the surface layer at temperatures above 300 K, forming a metastable state with a Pd:Zn surface ratio of approx. 1:1 in the temperature region between 400 and 550 K. This state is most easily explained as a slightly buckled p(2 × 1)-PdZn surface alloy, with Zn atoms located approx. 0.25 Å above their Pd counterparts.

Infant irritability: The impact of fetal alcohol exposure, maternal depressive symptoms, and low emotional support from the husband.

OBJECTIVES: The aim of this study was to investigate the impact of fetal alcohol exposure, maternal depressive symptoms, and low emotional support from the husband on infant irritability in the first one and a half years of life. Four models describing the interplay of these factors were assessed: A direct effect model, an interaction or threshold model, a mediational model and a transactional model. METHOD: A sample of initially 458 women was assessed in a prospective 3-wave study across the first 17 months after childbirth. Fetal alcohol exposure was questioned retrospectively six weeks after birth. Infant irritability was reported by the mothers and fathers. RESULTS: Support for the direct effect model and the interaction model could be found: Fetal alcohol exposure and low emotional support from the husband were associated with increased infant irritability at 5 months. The impact of fetal alcohol exposure was moderated by postnatal depressive symptoms. More irritability was reported if both risk factors, prenatal alcohol exposure and maternal depressive symptoms, were present. Infant irritability and maternal depressive symptoms were associated cross-sectionally. At the age of 17 months only a main effect of prenatal alcohol exposure on irritability could be found. CONCLUSION: Direct effects of fetal alcohol exposure, maternal depressive symptoms, and low emotional support from the husband on infant irritability as well as an interaction between fetal alcohol exposure and maternal depressive symptoms were revealed. The interaction can be understood in terms of a diathesis-stress model. However, no longitudinal associations between maternal depressive symptoms and infant irritability could be found.

A pilot study of Connexin 43 (Cx43) in human bladder tissue in patients with idiopathic detrusor overactivity.

OBJECTIVE: Aim of the study was to compare Connexin 43 (Cx43) in human bladder tissue of urodynamically proven idiopathic detrusor overactivity to those of urodynamically stable bladders. STUDY DESIGN: We compared bladder biopsies of patients with detrusor overactivity and those with stable bladder analysing Cx43 message by RNA extraction and PCR amplification. All patients had multichannel urodynamics prior to the biopsies. RESULTS: We investigated the bladder biopsies of 15 female patients with and 15 patients without detrusor overactivity. Cx43 could be detected in nine patients of the detrusor overactivity group and in eight patients of the control group which was not statistically significant. 42 cycles of PCR were necessary to demonstrate Cx43 presence in the positive specimen. The presence of Cx43 was not consistent in the samples from the bladder dome and the side walls meaning there were Cx43 positive results in the dome and negative ones in the side walls of the same patient and vice versa. CONCLUSION: In conclusion, Cx43 is present in human bladder tissue both of overactive bladders and those of controls. However, it is expressed in very small amounts and is not always detectable. The role of Cx43 for the origin of detrusor overactivity remains unclear.

The Diaper Change Play: Validation of a New Observational Assessment Tool for Early Triadic Family Interactions in the First Month Postpartum.

The quality of family relations, observed during mother-father-infant triadic interactions, has been shown to be an important contributor to child social and affective development, beyond the quality of dyadic mother-child, father-child, and marital relationships. Triadic interactions have been well described in families with 3 month olds and older children using the Lausanne Trilogue Play (LTP). Little is known about the development of mother-father-baby interactions in the very 1st weeks postpartum, mostly because no specific observational setting or particular instrument had been designed to cover this age yet. To fill this gap, we adapted the LTP to create a new observational setting, namely the Diaper Change Play (DCP). Interactions are assessed using the Family Alliance Assessment Scales for DCP (FAAS-DCP). We present the validation of the DCP and its coding system, the FAAS-DCP. The three validation studies presented here (44 mother-father-child-triads) involve a sample of parents with 3-week-old infants recruited in two maternity wards (n = 32 and n = 12) in Switzerland. Infants from both sites were all healthy according to their APGAR scores, weight at birth, and scores on the NICU Network Neurobehavioral Scale (NNNS), which was additionally conducted on the twelve infants recruited in one of the maternity ward. Results showed that the "FAAS - DCP" coding system has good psychometric properties, with a good internal consistency and a satisfying reliability among the three independent raters. Finally, the "FAAS-DCP" scores on the interactive dimensions are comparable to the similar dimensions in the FAAS-LTP. The results showed that there is no statistically significant difference on scores between the "FAAS-DCP" and the "FAAS," which is consistent with previous studies underlying stability in triadic interaction patterns from pregnancy to 18 months. These first results indicated that the DCP is a promising observational setting, able to assess the development of the early family triadic functioning. The DCP and the FAAS-DCP offer to both clinicians and researchers a way to improve the understanding of the establishment of early family functioning as well as to study the young infant's triangular capacity. Perspectives for future research will be discussed.

Acute stress reactions in the first 3 weeks postpartum: a study of 219 parturients.

OBJECTIVES: There is increasing research on posttraumatic stress (PS) 4-6 weeks and 3 months postpartum, but, there are no data on acute stress reactions (ASR) in the first 3 weeks postpartum, i.e. the potential precursors of PS. However, ASR may have long-term effects, e.g., on a subsequent pregnancy without having manifested as PS in the meantime. We propose: (i) to describe the patterns of ASR after childbirth, (ii) to explore differences between women with normal and traumatogenic ASR, and (iii) to provide data on the early detection of traumatogenic ASR 2 and 3 weeks postpartum. STUDY DESIGN: Intra-event variables (relationship with caregivers, overall birth experience, and dissociative experiences, as well as obstetric variables) were assessed 48-96 h. postpartum, as were ASR (by means of the Impact-of-Event Scale IES) in weeks 1, 2, and 3 postpartum. According to research on PS the upper 33%-range of ASR in weeks 2 and 3 was defined as 'traumatogenic'. RESULTS: Normal ASR in week 1 are at a level which in non-obstetric trauma-situations is considered as the upper range of low stress or lower range of medium distress. ASR decline constantly from week 1 to week 3. However, high ASR in week 1 do not drop faster than do low ones, thus indicating a prolonged stress reaction in women with high ASR in week 1. Low ASR (IES-scores <10) and high ASR (IES-scores >20) in week 1 are highly predictive for normal ASR, and traumatogenic ASR in weeks 2 and 3, respectively. Medium ASR (IES-scores 10-20) in week 1 are of uncertain predictive value for stress reactions in weeks 2 and 3 and have to be re-assessed at that time. CONCLUSIONS: Clinical screening for ASR appears to be helpful in detecting women with a compromised ability to process childbirth-related stress. The association between ASR and long-term development should be further explored.

Antenatal depressive symptoms and subjective birth experience in association with postpartum depressive symptoms and acute stress reaction in mothers and fathers: A longitudinal path analysis.

OBJECTIVES: Postpartum depressive symptoms (PDS) and acute stress reactions (ASR) after childbirth are frequently documented in mothers, but research is scarce in fathers. In a longitudinal path analysis, the interplay of depressive symptoms in pregnancy and the subjective childbirth experience of mothers and fathers are examined with regard to the development of PDS and ASR postpartum. STUDY DESIGN: One hundred eighty nine expectant couples were recruited between August 2006 and September 2009. They completed the Edinburgh Postnatal Depression Scale (EPDS) in the last trimester of pregnancy. In the first week postpartum, they answered the Salmon's Item List (subjective birth experience), and four weeks after birth the EPDS and the Impact of Event Scale - revised (IES-r). The data were evaluated in a longitudinal path analysis. RESULTS: Compared with fathers, mothers reported more depressive symptoms (pregnancy: p<0.001; postpartum: p<0.001), higher ASR (p<0.001), and lower 'positive birth experience' (p<0.001). The association between depressive symptoms in mothers and fathers was not significant during pregnancy (r=0.107, p>0.10), but moderately correlated four weeks after birth (r=0.387, p<0.001). Depressive symptoms during pregnancy and a negative subjective birth experience were independently predictive of PDS and ASR after childbirth in mothers and fathers controlling for age, mode of delivery, parity, epidural anaesthesia, infant gender and birth weight. Antenatal depressive symptoms were related to subjective childbirth experience only in fathers. CONCLUSION: Parental prenatal depressive symptoms and subjective birth experience are important predictors of postnatal psychological adjustment in mothers and fathers.

Post-traumatic symptoms after childbirth: what should we offer?

Most studies on post-traumatic stress symptoms after childbirth have focused on prevalence of and looked at etiological factors and predictors. While most authors agree that around 1.5% of the women develop post-traumatic stress disorder (PTSD) and significantly more present with post-traumatic stress symptoms, the studies still lack a proper diagnosis using diagnostic interviews to validate the enhanced stress scores found in questionnaires. Also, some relevant predicting factors such as pre-existing psychopathology and dissociation during labor have not been investigated so far. Mostly, however, research on counseling strategies for women with post-traumatic symptoms after childbirth has been neglected. While most women remain in a mother-child unit during the first days after birth, there is a unique opportunity to systematically assess birth experience in this setting and screen for women at risk for developing trauma symptoms. This article presents a multilevel counseling approach including postnatal counseling and counseling in a subsequent pregnancy.

How do obstetric variables influence the dimensions of the birth experience as assessed by Salmon's item list (SIL-Ger)?

OBJECTIVE: To analyse the effect of obstetric variables on four dimensions of the birth experience. DESIGN/PARTICIPANTS: The birth experience of 251 German-speaking women was assessed at 48-96 h postpartum by means of Salmon's item list--German-language version (SIL-Ger). METHOD/MAIN OUTCOME MEASURES: Statistical correlations and variances between four dimensions of the birth experience (fulfillment, emotional adaptation, negative emotional experience, physical discomfort) and common obstetric variables were calculated. The explained variance is assessed by a stepwise regression analysis. RESULTS: In general the variance explained by the investigated obstetric variables per se is low. The mode of delivery affects the dimension of negative emotional experience with a constant qualitative worsening in the order of spontaneous deliveries, instrumental deliveries, elective and unplanned caesarean sections. Epidurals are associated neither with positive nor with negative evaluative feelings. To assess the impact of duration, the subjective latent phase of labour has to be taken into consideration in addition to the duration of labour itself. Not only very long durations of labour, but also very short ones may induce negative evaluative feelings in the immediate postpartum. CONCLUSIONS: Further research on this question must include the aspect of the parturients' subjective perception of both obstetric procedures and the attending staff. Clinicians should be aware that epidurals and elective caesarean sections do not necessarily enhance positive evaluative feelings in the immediate postpartum.

Parental psychopathology, marital quality, and the transition to parenthood.

This study of 80 expectant first-time parents investigated the associations among marital quality, parental psychiatric disorders, and parents' capacity to form triadic relationships (Triadic Capacity). The results suggest that marital quality as well as maternal and paternal psychopathology affect child and family development as early as pregnancy, when parents prepare themselves to integrate the future child into their relational world.

Alloying and Structure of Ultrathin Gallium Films on the (111) and (110) Surfaces of Palladium.

Growth, thermal stability, and structure of ultrathin gallium films on Pd(111) and Pd(110) are investigated by low-energy ion scattering and low-energy electron diffraction. Common to both surface orientations are growth of disordered Ga films at coverages of a few monolayers (T = 150 K), onset of alloy formation at low temperatures (T ≈ 200 K), and formation of a metastable, mostly disordered 1:1 surface alloy at temperatures around 400-500 K. At higher temperatures a Ga surface fraction of ∼0.3 is slightly stabilized on Pd(111), which we suggest to be related to the formation of Pd2Ga bulk-like films. While on Pd(110) only a Pd-up/Ga-down buckled surface was observed, an inversion of buckling was observed on Pd(111) upon heating. Similarities and differences to the related Zn/Pd system are discussed.

Maternal mental health in the first 3-week postpartum: the impact of caregiver support and the subjective experience of childbirth - a longitudinal path model.

OBJECTIVE: Acute stress reactions (ASR) and postpartum depressive symptoms (PDS) are frequent after childbirth. The present study addresses the change and overlap of ASR and PDS from the 1- to 3-week postpartum and examines the interplay of caregiver support and subjective birth experience with regard to the development of ASR/PDS within a longitudinal path model. METHOD: A total of 219 mothers completed questionnaires about caregiver support and subjective birth experience (Salmon's Item List) at 48-6-h postpartum. ASR and PDS were measured for 1- and 3-week postpartum. The Impact of Event Scale (IES) was used to assess ASR, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PDS. RESULTS: ASR was frequent 1-week postpartum (44.7%) and declined till week 3 (24.8%, p <.001), while the prevalence of PDS was continuous (14.2% week 1; 12.6% week 3; p = .380). Favorable reports of caregiver support were related to better subjective childbirth experience, which was related to lower ASR and PDS (controlled for age, mode of delivery, parity, EDA and duration of childbirth). CONCLUSION: High quality of intrapartum care and positive birth experiences facilitate psychological adjustment in the first 3-week postpartum.

In situ XPS study of methanol reforming on PdGa near-surface intermetallic phases.

In situ X-ray photoelectron spectroscopy and low-energy ion scattering were used to study the preparation, (thermo)chemical and catalytic properties of 1:1 PdGa intermetallic near-surface phases. Deposition of several multilayers of Ga metal and subsequent annealing to 503-523 K led to the formation of a multi-layered 1:1 PdGa near-surface state without desorption of excess Ga to the gas phase. In general, the composition of the PdGa model system is much more variable than that of its PdZn counterpart, which results in gradual changes of the near-surface composition with increasing annealing or reaction temperature.In contrast to near-surface PdZn, in methanol steam reforming, no temperature region with pronounced CO(2) selectivity was observed, which is due to the inability of purely intermetallic PdGa to efficiently activate water. This allows to pinpoint the water-activating role of the intermetallic/support interface and/or of the oxide support in the related supported Pd(x)Ga/Ga(2)O(3) systems, which exhibit high CO(2) selectivity in a broad temperature range. In contrast, corresponding experiments starting on the purely bimetallic model surface in oxidative methanol reforming yielded high CO(2) selectivity already at low temperatures (∼460 K), which is due to efficient O(2) activation on PdGa. In situ detected partial and reversible oxidative Ga segregation on intermetallic PdGa is associated with total oxidation of intermediate C(1) oxygenates to CO(2).

Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful?

OBJECTIVE: To evaluate quality of life and pelvic organ and sexual function before and during pessary use in patients with symptomatic pelvic organ prolapse and to determine reasons which lead to cessation of pessary use. DESIGN: Prospective observational study. SETTING: Tertiary referral center. PATIENT(S): Patients with symptomatic stage II or more prolapse of the anterior, posterior, or apical vaginal wall with or without uterus were included in this study. INTERVENTION(S): We used the Female Sexual Function Index questionnaire and the Sheffield prolapse questionnaire. For quality of life we used the King's Health Questionnaire. MAIN OUTCOME MEASURE(S): Main outcome measures were quality of life and sexual and pelvic organ function. RESULT(S): A total of 73 women participated in this study; 31 were sexually active. Desire, lubrication, and sexual satisfaction showed statistically significant improvement, and orgasm remained unchanged. Statistically significant improvement in the feeling of bulge occurred during therapy, stool outlet problems were significantly improved, overactive bladder symptoms were significantly better, and pessaries did not significantly alter incontinence. CONCLUSION(S): Pessaries have been shown to be a viable noninvasive treatment for pelvic organ prolapse improving organ and sexual function as well as general wellbeing.

The net which made her wet: two unusual cases of stress incontinence.

This report describes two cases of urinary stress incontinence secondary to mesh repair of large abdominal hernias. Both patients had never experienced urinary incontinence before their hernia repair. In both cases, polypropylene nets were inserted to stabilise the abdominal wall. Immediately after the intervention, both patients became stress incontinent. Probably pressure transmission to the pelvic floor was increased due to stabilisation of the abdominal wall, which worked as a "windpipe" before surgery. After the insertion of suburethral tapes the incontinence resolved.

Postpartum depressive symptoms in the first 17 months after childbirth: the impact of an emotionally supportive partnership.

OBJECTIVES: This study investigates the impact on different postpartum depressive trajectories (i.e., "non depressive symptoms", "stable depressive symptoms", "deterioration" and "improvement") from 5-17 months after childbirth exerted by emotional support that mothers receive from their partners and emotional support they provide to their partners. METHODS: Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale 5 and 17 months after delivery in a sample of 293 mothers. Emotional support received from the partners was assessed among both mothers and partners. RESULTS: The initial level and the change in emotional support that mothers received from their partners were related to different trajectories of postpartum depressive symptoms. Mothers who were living in a partnership with low reciprocal emotional support showed a significantly higher risk of suffering from "stable depressive symptoms" than mothers who were living in a partnership with high reciprocal emotional support. CONCLUSIONS: An increased risk of persistent depressive symptoms beyond the early postpartum period was observed in mothers with poor reciprocal emotional support in the partnership. Further research is needed for a better understanding of the mothers persistent depressive symptoms after childbirth associated with reciprocity of emotional support in the partnership.

Quality of life 15 years after sex reassignment surgery for transsexualism.

OBJECTIVE: To evaluate quality of life and patients' satisfaction in transsexual patients (TS) after sex reassignment operation compared with healthy controls. DESIGN: A case-control study. SETTING: A tertiary referral center. PATIENT(S): Patients after sex reassignment operation were compared with a similar group of healthy controls in respect to quality of life and general satisfaction. INTERVENTION(S): For quality of life we used the King's Health Questionnaire, which was distributed to the patients and to the control group. Visual analogue scale was used for the determination of satisfaction. MAIN OUTCOME MEASURE(S): Main outcome measures were quality of life and satisfaction. RESULT(S): Fifty-five transsexuals participated in this study. Fifty-two were male-to-female and 3 female-to-male. Quality of life as determined by the King's Health Questionnaire was significantly lower in general health, personal, physical and role limitations. Patients' satisfaction was significantly lower compared with controls. Emotions, sleep, and incontinence impact as well as symptom severity is similar to controls. Overall satisfaction was statistically significant lower in TS compared with controls. CONCLUSION(S): Fifteen years after sex reassignment operation quality of life is lower in the domains general health, role limitation, physical limitation, and personal limitation.

Long-term results and patients' satisfaction after transurethral ethylene vinyl alcohol (Tegress) injections: a two-centre study.

Tegress is ethylene vinyl alcohol which is non-allergenic and permanent. The aim of the study was to evaluate efficacy, feasibility and safety of transurethral Tegress in women with urodynamic stress incontinence in a two-centre setting. Approximately 33 female patients with urodynamic stress incontinence were prospectively included in the study. Preoperatively, the patient's history, gynaecological examination and multichannel urodynamics were performed. On follow-up, the patient was asked to use a visual analogue scale to measure her contentness and underwent uroflowmetry and a cough test. Median follow up was 51 months. About 15 women considered themselves as completely continent, and 23 (69%) were either satisfied or very satisfied. Pad test was positive in 18 (54.5%) patients, and cough test was positive in 20 (60.6%). Patients' satisfaction did not correlate with objective dryness. Ethylene vinyl alcohol is a bulking agent with a success rate of approximately 45% after 51 months.