Labor pain: a comparison of parturients in a Dutch and an American teaching hospital.

Women giving birth in two university hospitals, one in the Netherlands and the other in the United States, were surveyed postpartum regarding expectations of pain in labor and availability of medication for its relief, perceptions of the painfulness of labor, and use of analgesia and anesthesia. American women expected labor to be more painful, anticipated that they would receive medication for it, and did receive such medication in significantly greater proportions compared with Dutch parturients. These findings point to fundamental, culturally determined differences between these two societies with respect to women's views of the painfulness of childbirth.

Women regretting their sterilization.

PIP: This study compares 2 groups of sterilized women: 1) a group of 118 sterilized women who requested reversal between 1978 and 1984 at the Radboud University Hospital in the Netherlands and 2) 116 matched controls, who did not request reversal. The reason for the request for reversal in 89 cases (75%) was a new partner and in 26 cases (22%) the wish for more children with the same partner. Women who regret being sterilized usually do so soon after the procedure. The mean length of time between sterilization and request for reversal was 3.8 years, measured from the date the patient presented for reversal. In 20% of the patients, the sterilization took place in combination with another gynecologic or obstetric procedure, such as abortion, prolapse operation, cesarean section, or an operation for ectopic pregnancy. This combination, although clearly arranged to save the patient another anesthesia, bears the risk of making the sterilization not a well-considered and free choice. 27 of the patients reported that their relationship at the time of sterilization was already poor; some of the women said they had kept silent about their marital problems fearing that otherwise they would not be sterilized. Another alarming discovery was that 12 of the patients were sterilized after their divorce under the age of 30 years. The reason for requesting a reversal of sterilization was a divorce and a new partner in 3/4 of the cases.^ieng

[Regret after sterilization in women]. / Spijt na sterilisatie bij de vrouw.

PIP: Feelings of regret seem to occur frequently after sterilization, but are mostly short-lived. Women in a test group who asked for reversal did so, on the average, after 3.8 years. This is a major operation and should be discussed thoroughly and, if possible, avoided, to keep requests from increasing. 118 patients who asked for reversal were compared with 116 control patients matched by sterilization date. The reversal group was sterilized at a much younger age, and over 8 times as many had other gynecological procedures at the same time as the control group. The reversal group altered their marital status after sterilization at a higher rate than the control group; both groups had the same number of children at the time of sterilization. Out of the control group, only 1 patient out of 88 reported guilt feelings to the family doctor after a child died. 1/5 of the reversal patients were operated on at the time of other gynecological or obstetrical surgery: 12 abortions, 6 prolapse operations, 4 cesarean sections, and 2 operations due to extrauterine pregnancy. These occurred in only 3 women in the control group. This combination of sterilization and gynecological problems should be avoided, with patients following their doctors' advice. However, patients should have more time to think things over and should not be pressured into sterilization, especially since sterilization can be performed in a clinic under local anesthesia. Reversal should not be encouraged.^ieng

[Experiences of patients with a hydraulic erection prosthesis]. / Ervaringen van patiënten met de hydraulische erectieprothese.

To evaluate the psychological effect of implantation of an inflatable hydraulic penile prosthesis, a follow-up investigation was carried out among 25 patients who between November 1985 and March 1989 received such a prosthesis in the department of Urology at St. Radboud Hospital, and among their partners. The methods consisted of written questionnaires and personal interviews. The mean time between implantation and evaluation was 20 months. Implantation did not improve sexual or general partner relationship. However, the great majority of patients (84%) and their partners (75%) would decide again to have the prosthesis implanted. Some elements of dissatisfaction (concerning the limited length of the erect penis, difficult coital position, and failing ejaculation) were found, that draw attention to the necessity of improving information and psychosexual counselling.

[Experiences with intracavernous auto-injection for the treatment of erection disorders]. / Ervaringen met intracaverneuze auto-injectie ter behandeling van erectiestoornissen.

We report on our experience with autoinjection therapy in 72 patients with erectile dysfunction. We analysed factors that have an impact on the outcome of autoinjection therapy, and we focused on psychological, sexological and relational issues. In 53 (74%) patients an organic aetiological factor was found. Although with the aid of injection 82% of the men were able to achieve an erection adequate for penetration, only 39% continued treatment beyond one year. Lowest drop-out rates were encountered among patients with diabetes mellitus and men without organic aetiology (50% and 53% respectively). The most important reason for discontinuation was lack of acceptance of autoinjection therapy by the partner. Other reasons were prolonged erection, haematomas, ineffectiveness and fear of self-injection. Although autoinjection provides a safe and effective long-term method for the treatment of erectile dysfunction, the drop-out rate is strikingly high. Apparently, the acceptance of the partner is the most important determinant of the result of autoinjection therapy. Therefore, the partner should be involved in the counselling and treatment from the beginning.