Sexual function after using tension-free vaginal tape for the surgical treatment of genuine stress incontinence.

OBJECTIVE: To determine whether the use of the tension-free vaginal polypropylene tape (TVT) procedure for the treatment of genuine stress incontinence (GSI) affects sexual activity. PATIENTS AND METHODS: Sixty-seven women treated by insertion of a TVT between September 1998 and March 2001 for GSI were sent questionnaires 6-36 months after surgery to determine any urinary symptoms, sexual activity, patient satisfaction and the use of hormone-replacement therapy. RESULTS: The questionnaire was returned by 57 patients (87%); 43 (76%) reported being sexually active and 14 (25%) were not. Of the former, 31 (72%) reported no change in sexual function after surgery and only two reported an improvement; six (14%) reported that sexual function was worse and four did not reply to the questions. The patients reporting that sexual function was worse cited loss of libido as the main reason. No patients complained of dyspareunia. CONCLUSIONS: There was no significant change in sexual function or activity after the TVT procedure and patients can thus be reassured that this operation will not affect their sex life.

Jordanian women's attitudes towards cervical screening and cervical cancer.

This paper looks at Jordanian women's attitudes towards cervical screening and cervical cancer. The sample consisted of 600 women attending gynaecology clinics at King Hussein Medical Centre, Amman, Jordan. Seventy-five per cent of women had never had a smear before; however, the majority agreed that it is important; 34.5% of women did not know the significance of a positive cervical smear; 77% of women were not aware of causes of cervical cancer. Finally, when asked who would they like to take their cervical smear test, a clear preference was stated for a female doctor or a female nurse. These findings provide a useful background for developing strategies to increase the uptake of cervical smears among Jordanian women. It also emphasises the need to educate and promote awareness of women to risk factors for cervical cancer and to the need for screening programmes.

Women's satisfaction with medical termination.

One hundred women aged between 14 and 43 completed a questionnaire regarding their experience and satisfaction with medical termination of pregnancy at Bedford Hospital. A visual analogue score from 0-10 was used. Age, occupation, marital status, parity, previous terminations and awareness of the medical method were recorded. Additional comments were also invited. Overall satisfaction with the method was good, with a mean score of 8.19 and women were very appreciative of the care given by nursing staff. Counselling and choice of method offered scored less well and need improvement. Eighty five per cent of this sample had already had a previous termination of pregnancy, with 30 per cent having had two or more, indicating a need for improved contraceptive counselling both before and after the termination.

PIP: Women's satisfaction with medical abortion was assessed in a survey of 100 women 14-43 years of age (mean age, 24.6 years) who undergone this procedure at Bedford Hospital (UK). 45 women had not heard of medical abortion before presentation to the hospital. 30 women stated they were not given a choice between medical and surgical abortion. 85 women had already had at least 1 prior pregnancy termination and 30 reported 2 or more prior procedures. Women were given 200 mg of oral mifepristone and returned to the gynecology ward 48 hours later for a 1 mg gemeprost vaginal pessary. A satisfaction questionnaire was distributed before discharge. Women used a visual analogue scale with scores from 0 to 10 to assess staff helpfulness, the appropriateness of the information they received, and overall satisfaction. The amount of bleeding was deemed heavy by 51 women and acceptable by another 42 women. 70 women did not require pain killers. The mean score for overall satisfaction was 8.19 out of a possible 10. When women with a previous surgical abortion were asked to compare it with the medical procedure, the mean value was 7.63, favoring the medical option. Satisfaction with the staff and the informational leaflet was high. The greatest dissatisfaction centered around the adequacy of the counseling women received. The high rate of repeat abortion indicates a need for improved contraceptive counseling before and after pregnancy termination.