Premenstrual dysphoric disorder--review of actual findings about mental disorders related to menstrual cycle and possibilities of their therapy.

It is known that mood disorders in women explicitly relates to estrogen production. Except for these findings phenomenon as Premenstrual Syndrome and Premenstrual Dysphoric Disorder, directly connected to menstrual cycle in women, is widely discussed. Premenstrual dysphoric disorder (PMDD) is a set of subjectively unpleasant mental and somatic symptoms. It appears in luteal phase of ovarian cycle. During menstruation it remits and disappears up to one week from its termination. DSM IV classified PMDD into the category of "Other specific depressive disorders" and further revision DSM IV-TR classifies PMDD as a separate strictly defined psychiatric diagnosis. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) does not include any specific category as PMDD or similar. The closest category F38.8 does not represent the core of the phenomenon because it relates only to general depressive symptomatology and does not give specific diagnostic criteria to menstrual cycle related mood disorders (Grady-Weliky, 2003). In the presented article, possible effectivity of PMDD treatment with the focus to antidepressants of SSRI type (Serotonin selective reuptake inhibitors) is discussed. In spite of interesting and significant findings, the treatment of PMDD and accordingly PMS is above all multidisciplinary question and it must be treated like that.

[Recommendations for the treatment of tobacco dependence]. / Doporucení pro lécbu závislosti na tabáku.

This first Czech version of guidelines formulated by the working group of mentioned medical associations is based on current literature and international guidelines. They are aimed mainly on clinical medicine and on incorporation of this treatment into the health care system according to WHO recommendations. They should serve to the treatment of tobacco dependence at any level: during any contact with the smoking patient (short intervention), in specialised centres or for the health care providers or health system itself.

[Sexual satisfaction and sociological factors]. / Sexuelle Zufriedenheit von Frauen und soziologische Faktoren.

Using the interview method, three sexologists examined over a period of 36 years the sexual development and life of 2425 gynecological patients who were sent to Frant. Lázne (Franzensbad) for post-treatment of conditions following gynecological inflammations or surgery. They had all been married at least one year and when interviewed were 20-40 years old. After their division into individual decades of birth between 1911 and 1970 it was ascertained that the percentage of coitally orgastic women continuously increased from 31% to 80%. This was accompanied by a distinct increase of coital activity. On the basis of results of new sociological studies the authors try to explain the increase of sexual satisfaction mainly through changes in the course of sexual life of women. These were caused through changes of social milieu not only after the second world war but also in the course of the whole twentieth century. The authors are of the opinion that the sexual satisfaction in women will remain due to biological differences always somewhat lower than in men.

[Sexual development in adolescent girls]. / Sexuální vývoj dospívajících dívek.

The authors investigated by interviews in Frantiskovy Lázne the sexual development and sex life in 614 Czech girls aged 16 to 18 years. It was revealed that the sexual development in 311 girls, where in the course of the year before convalescent treatment in Frantiskovy Lázne appendectomy was performed and in 89 probands who were operated twice or more frequently, was highly significantly retarded as compared with 163 probands who had no surgery so far. Comparison of the findings in 426 girls from complete and emotionally balanced families and 140 probands of divorced parents did not reveal a significant difference in their sexual development.

[Fertility in patients treated for malignant tumors before puberty]. / Plodnost pacientu lécených pred pubertou pro maligní nádorová onemocnení.

35 patients with malignant tumours were examined. In 4 of them comprehensive therapy was initiated in the course of the first five years of life. In the remaining 31 cases the first symptoms of the disease appeared between the ages of 9 to 16 years. In the entire group spermiogenic function was insufficient in about 65% of the afflicted. Subnormal values of plasma testosterone were found only in 9%.

Changes in the premarital and marital sexual life of Czechoslovak women born between 1911 and 1970.

Using the interview method, three sexologists examined, over a period of 36 years, the sexual development and life of 2,425 gynecological patients who were sent to Franzensbad for after-treatment of conditions following gynecological inflammations or surgery. They had all been married at least 1 year and when interviewed were 20-40 years old. The average age at the time of the first coitus dropped from 20.75 among the women born in the decade 1911-1920 to 17.8 among those born between 1961 and 1970. As far as premarital sexual life is concerned, the number of young women with numerous coital partners before marriage has continuously increased since 1931. About 50% of young brides today had premarital sexual contacts with 1-3 partners. Over the decades between 1921 and 1970, the number of women with 4-10 premarital coital partners has increased from 1% to 12%. Among women born in the decade 1961-1970, there has been a distinct increase in those who achieve coital orgasm only rarely to 26%. This is the highest percentage of this type of insufficient sexual reactivity since 1911. This unfavorable change in sexual life of young married women is discussed in the context of negative social environmental factors in Czechoslovakia today. The study concludes with the opinion that frequency of coital orgasm in women is a sensitive indicator of social environmental influences in a given society.

Sexual life of women with the Stein-Leventhal syndrome.

The course of sexual socialization of 50 women suffering from the Stein-Leventhal Syndrome (SLS), on which the wedge resection of the ovaries was carried out, as examined using the HTDW (heterosexual development of women) questionnaire, did not differ from that of 50 normal women of the same age. Sexual life of SLS patients was examined using an interview and the SAW (sexual activity of women), SFW (sexual function of women), and SAI (sexual arousability inventory) questionnaires. Comparison with the findings in the control group showed that the average score in all the three questionnaires was within normal limits for both groups; the differences between the groups were not statistically significant. Among 45 SLS patients who had sexual experience before the surgery, 42 stated that no pronounced changes occurred in their sexual lives after resection of the ovaries. The average value of testosterone in the whole group (0.52 ng/ml plasma) was within normal limits. The level of the male sexual hormone tended to be higher in the subgroup of 19 patients with low orgastic capacity than in the subgroup of 31 orgastic SLS patients. The differences in the average scores of neurotic symptoms in the N5 questionnaire between the SLS patients and the control group were not significant. On the basis of the above findings, it is concluded that SLS patients, after wedge resection of the ovaries, are not more sexually arousable, more active, or more orgastic than medically healthy women.

[Sex life following hysterectomy]. / Das Geschlechtsleben nach der Hysterektomie.

The authors report on the results of an inquiry via questionnaires on the sexual activities of 164 hysterectomised women before and after surgery. 47.5 per cent of the women stated that their sexual activities had deteriorated after the operation, whereas 13% reported an improvement. There was a significant increase in the number of women with "deteriorated" sex life after simultaneous bilateral ovarectomy (p less than 0.01). The most frequent negative sequels were a decrease in sexual appetency (42.7%) and coital activity (30.5%). Sex life deterioration became evident in 43% of the women already during the first year following the operation, further deterioration being less marked (in one to three years in 52%, and after more than 3 years after the operation in 58% of the patients). The opinion has been voiced that the time a few months before and after hysterectomy is the most critical phase in respect of mental condition and sexual activities. This critical phase can be overcome only with the close co-operation between the doctor on the one hand and the married couple on the other; both partners to the marriage must be equally amenable to counselling and advice.

Sexual life of women with the Küstner-Rokitansky syndrome.

The sexual development and sex life of 12 women with the Küstner-Rokitansky syndrome, in whom the developmental anomaly (vaginal agenesis) was corrected through surgery, were examined through structured interviews and by means of questionnaires. The comparison group was 22 women who had regular menses and a functional sex life. All differences between the groups were statistically nonsignificant. Only in one questionnaire was there a slight trend toward retarded heterosexual development in the patient sample.