Rectosigmoid vaginoplasty in patients with vaginal agenesis: sexual and psychosocial outcomes.

BACKGROUND: The main goal in women with Mayer-Rokitansky-Küster-Hauser syndrome (vaginal agenesis) is creation of a neovagina that will satisfy the patient's desire. We evaluated sexual and psychosocial adjustment in patients who underwent rectosigmoid vaginoplasty because of vaginal agenesis. METHODS: A total of 36 women, aged 21 to 38 years (mean=26) who underwent rectosigmoid vaginoplasty from 1997 to 2006 were evaluated. Sexual and psychosocial appraisal included the Female Sexual Function Index (FSFI), Beck's Depression Inventory (BDI), and standardised questionnaires about postoperative satisfaction, social and sexual adjustment. RESULTS: Mean FSFI score was 28.9 (range=11.5-35.7) with a cut-off score of 26.55 for sexual dysfunction. Out of the 36 women, 10 (27, 8%) had sexual dysfunction. Mean BDI score was 7.55 (cut-off score=0-9 for non-depression). Twenty-eight women (77.8%) were without symptoms of depression, six women (BDI range=10-29) had moderate and two women had severe depression (BDI=42). There were a significant number of patients (P<0.01) with a high satisfaction score in FSFI and low BDI results. Thirty-two (88.9%) of the patients believed that surgery was done at the right time and the main postoperative support came from their family. Thirty-four (94.4%) of the patients reported satisfactory femininity, with a heterosexual orientation. Thirty patients (83. 3%) were very satisfied with the surgery, while 34 considered surgery as the best treatment. CONCLUSIONS: The sexual function and psychosocial status of these patients should be followed long-term to estimate their quality of life.

[Post-traumatic stress disorder and coping strategies in psychotraumatized refugees].

INTRODUCTION: In extreme life events basic assumptions are frequently reassessed and changed. Therefore, trauma requires re-education. Effective coping strategies enable individual to tolerate, minimize, accept or ignore what one cannot manage and to moderate the consequences of stressful, traumatic events. MATERIALS AND METHODS: The aim of this study was to evaluate coping strategies in refugees with post-traumatic stress disorder prior and after group cognitive-behavioural therapy. The sample included 70 refugees who experienced multiple stressors such as organized violence, ethnic conflicts, bombing, expelling from their homes and life in exile. Impact Event Scales-Revised, Ways of Coping-Revised, Scale of Cognitive Self-regulation and Scale of Coping Strategies were administered before and after six months of group cognitive-behavioural therapy. RESULTS: Post-traumatic stress disorder in refugees after therapy significantly decreased. Cognitive self-regulation was improved by moving locus of control from external to internal resources. Coping was qualitatively different, with a wider repertoire of adaptive strategies. DISCUSSION: Cognitive group work facilitates processes of grieving, working-through of traumatic material, increasing emotional awareness and developing creativity in coping. CONCLUSION: Our findings highlight the positive impact of cognitive-behavioural treatment on post-traumatic stress disorder and post-traumatic adjustment.

Pathways to psychiatric care in Eastern Europe.

BACKGROUND: There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. AIMS: To improve understanding of prior care-seeking and treatment of new patients seen at mental health services. METHOD: Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups. RESULTS: The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as 'gatekeeper' in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders. CONCLUSIONS: Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.