Sterilization of those with intellectual disability: Evolution from non-consensual interventions to strict safeguards.

Non-consensual sterilization is one of the characteristic historical abuses that took place mainly in the first half of the 20th century. People with intellectual disability (ID) were a prime target as part of the ideology of negative eugenics. In certain jurisdictions, laws were in force for several decades that permitted sterilization without the need for consent or with consent from third parties. The long-term adverse effects on those sterilized against their will have only more recently been recognized. In the latter half of the 20th century, human rights treaties were introduced and developed; they have, in the main, curbed sterilization abuses. Courts have developed more stringent criteria for making decisions on applications for sterilization, and nowadays there are mostly adequate safeguards in place to protect those with ID from non-consensual sterilization. The only exception should be the particular case in which, all medical and social factors having been taken into account, sterilization is overwhelmingly thought to be the right decision for the individual unable to give consent.

Legalised non-consensual sterilisation - eugenics put into practice before 1945, and the aftermath. Part 1: USA, Japan, Canada and Mexico.

In the late 19th century, eugenics, a pseudo-scientific doctrine based on an erroneous interpretation of the laws of heredity, swept across the industrialised world. Academics and other influential figures who promoted it convinced political stakeholders to enact laws authorising the sterilisation of people seen as 'social misfits'. The earliest sterilisation Act was enforced in Indiana, in 1907; most states in the USA followed suit and so did several countries, with dissimilar political regimes. The end of the Second World War saw the suspension of Nazi legislation in Germany, including that regulating coerced sterilisation. The year 1945 should have been the endpoint of these inhuman practices but, in the early post-war period, the existing sterilisation Acts were suspended solely in Germany and Austria. Only much later did certain countries concerned - not Japan so far - officially acknowledge the human rights violations committed, issue apologies and develop reparation schemes for the victims' benefit.

Legalised non-consensual sterilisation - eugenics put into practice before 1945, and the aftermath. Part 2: Europe.

This article deals with the nine European nations which legalised non-consensual sterilisation during the interwar years, thus completing the review, the first part of which was published in an earlier issue of this Journal. Like we did for North America, Japan and Mexico, countries concerned are addressed in chronological order, as practices in one of these influenced policies in others, involved later. For each, we assess the continuum of events up to the present time. The Swiss canton of Vaud was the first political entity in Europe to introduce a law on compulsory sterilisation of people with intellectual disability, in 1928. Vaud's sterilisation Act aimed at safeguarding against the abusive performance of these procedures. The purpose of the laws enforced later in eight other European countries (all five Nordic countries; Germany and, after its annexation by the latter, Austria; Estonia) was, on the contrary, to effect the sterilisation of large numbers of people considered a burden to society. Between 1933 and 1939, from 360,000 [corrected] to 400,000 residents (two-thirds of whom were women) were compulsorily sterilised in Nazi Germany. In Sweden, some 32,000 sterilisations carried out between 1935 and 1975 were involuntary. It might have been expected that after the Second World War ended and Nazi legislation was suspended in Germany and Austria, including that regulating coerced sterilisation, these inhuman practices would have been discontinued in all nations concerned; but this happened only decades later. More time still went by before the authorities in certain countries officially acknowledged the human rights violations committed, issued apologies and developed reparation schemes for the victims' benefit.

Non-consensual sterilization of women living with HIV.

Women living with HIV are stigmatized and discriminated against. They often wish to have children, but they are subjected to the practice of forced (involuntary) sterilization in at least 27 countries under the guise of protecting maternal health and preventing the birth of infected infants. Some women are not asked to give consent, or a third party consents on their behalf. Others are given insufficient information or fed misinformation. The circumstances under which such women have been asked to sign consent forms for sterilization include fear, coercion, intimidation, and undue influence. Courts have been clear that such practice is a breach of human rights, but, so far, it has not been formally declared in courts that such practice constitutes discrimination. More needs to be done in terms of education, sanctions against those who carry out this practice, and help for victims.

Preserving the reproductive potential of transgender and intersex people.

BACKGROUND: The bodies of some transgender and intersex people have been mutilated and their minds subjected to immense distress. Their gender has often been determined by others. Loss of fertility used to be considered an inevitable consequence of treatment. OBJECTIVE: To review the issue of preserving the reproductive potential of transgender and intersex people. METHODS: A narrative review based on a wide-ranging search of the literature in multiple disciplines. RESULTS: Major technological advances have facilitated reproduction for transgender and intersex people in the last few years. A majority of trans-adults believe that fertility preservation should be offered to them. Deferment of surgery for intersex people is often best practice; gonadectomy in infancy closes off fertility options and determines a gender they may later regret. CONCLUSIONS: Transgender and intersex people should be able to consent to or decline treatment, especially radical surgery, themselves. Preservation of reproductive potential and sexual function must be given a high priority. Treatment by multidisciplinary teams can provide a strong emphasis on mental health and well-being. Detailed information about options, an absence of any coercion and enough time are all needed in order to make complex, life-changing decisions.

The condom: A turbulent history.

BACKGROUND AND OBJECTIVES: The literature concerning the history of condoms is replete with errors. The paper Youssef published in 1993 is in our opinion the best. We update and expand the information. METHODS: To mention only established facts, we accessed primary sources, which are identified in the article. FINDINGS: The origin of the term 'condom' remains an enigma. Plausible hypotheses are that it is derived from either (i) the Latin 'condere' (to sheathe) or the corresponding noun 'condus' (receptacle); or (ii) the Venetian variant 'gondon' of the Italian word 'guantone' (glove). The earliest identified mention of a similar barrier method is in the legend of Minos and Pasiphae written (in the 2nd century AD) by Antoninus Liberalis. A penile sheath, made from animal gallbladder, was advocated in the 10th century by the Persian physician Al-Akhawayni. The earliest surviving condoms made of animal membranes date back to between 1642 and 1646. Such 'skin' condoms became increasingly popular for prevention of venereal disease, but as early as the 18th century their value as contraceptives was appreciated. Rubber condoms were available from 1855; since 1930, they are made of latex. We mention, in parallel, the most striking changes over time in sexual mores and behaviours, and illustrate these by referring to colourful figures such as, among others, Boswell, Mrs Philips, Casanova, Marguerite Gourdan, and Richard Carlile. CONCLUSION: Papers related to this topic often contain errors, which we identify. Condoms over time evolved from animal gut receptacles to reliable contraceptives protecting also against certain sexually transmitted infections, including HIV.

Sexual functioning in women using levonorgestrel-releasing intrauterine systems as compared to copper intrauterine devices.

INTRODUCTION: There has been little research published on the impact of intrauterine contraceptive (IUC) methods on sexual functioning. AIMS: This study aimed: (i) to assess different aspects of sexual functioning, including the prevalence of sexual dysfunction in women using a levonorgestrel intrauterine system (LNG-IUS); (ii) to compare this prevalence with that among copper-releasing intrauterine device (Cu-IUD) users; and (iii) to identify the relationship between psychological variables and sexual functioning in women using one of the aforementioned IUCs. METHODS: In a multicenter cross-sectional study, 845 women with an IUC were invited to fill out a questionnaire. The latter was returned by 402 (48%) of them: 353 women were LNG-IUS users (88%) and 49 were Cu-IUD users (12%). The questions asked pertained to depression, well-being, marital relation quality, and sexual functioning. MAIN OUTCOME MEASURES: Sexual functioning was measured with the short sexual functioning scale. RESULTS: One-third of LNG-IUS users (33%) reported a sexual dysfunction. Of those, 20% reported an increased sexual desire, 25% a decreased sexual desire, 5% arousal problems, and 8% orgasm problems. Women using a LNG-IUS did not differ significantly in distribution, type, or prevalence (32.9% vs. 36.7%) of sexual dysfunction, nor in depressive symptoms (Beck Depression Inventory score; 4.7 vs. 3.9; P = 0.33), general well-being (WHO-5 well-being scale score; 16.8 vs. 17.7; P = 0.170), or partner relationship quality (Dyadic Adjustment Scale score; 107 vs. 108; P = 0.74) compared to Cu-IUD users. Overall, the perceived influence of IUCs on sexual functioning was in the lower range and did not differentiate LNG-IUS greatly from Cu-IUD-users. CONCLUSION: Women using a LNG-IUS do not differ from those wearing a Cu-IUD with regard to psychological and sexual functioning. The perceived impact of IUD use on sexuality should not be overestimated.

The higher the educational level of the first-time mother, the lower the fetal and post-neonatal but not the neonatal mortality in Belgium (Flanders).

OBJECTIVE: To assess, in a homogenous population of primiparous women, how fetal and infant (=first year of life) mortality varied by the mothers' level of education. STUDY DESIGN: We conducted an observational study in Flanders (Northern Belgium) involving 170,948 primiparous women who delivered in Flanders during the period 1999-2006, and their 174,495 babies. We linked the maternal education (3 levels) with a series of obstetrical and perinatal events, with special emphasis on fetal and infant death. A logistic regression analysis was performed to adjust for confounders. RESULTS: The incidence of fetal (0.21% - high level of education; 0.35% - medium level; 0.84% - low level) and infant mortality (0.32%; 0.41%; 0.70%, respectively), followed an inverse maternal educational gradient: higher with a lower level of education. However, neonatal death (0-27 days) was independent of the educational level of the mother. The age of the woman at delivery, the use of assisted reproductive technology and the incidence of twin birth increased while the rates of preterm birth (7.7% - high level; 8.9% - medium level; 10% - low level) and low birth weight (7.2%; 9.5%; 11.8%, respectively) decreased with the mother's educational level. CONCLUSION: Perinatal and obstetrical outcome differ according to the level of the education of the mother, which is a determinant of the incidence of fetal and post-neonatal death but not of early and late neonatal death (0-27 days).