Human sexuality during pregnancy and the postpartum period.

Sexual problems and dysfunctions during pregnancy are often led by the anxiety of hurting the fetus. Males are also afraid of hurting a female and females are afraid of insufficient satisfaction of a male partner. Just 12-14% of couples deny sexual problems after the childbirth. The main postpartum risk factor for dyspareunia is the extent of a birth injury. Breastfeeding is linked to a low coital activity, low sexual desires and low sexual satisfaction of females and their partners. Breastfeeding females start with a sexual life later; more often suffer from dyspareunia and indicate a lower satisfaction with the sexual intercourse. Further, episiotomy is associated with a higher prevalence of a postpartum dyspareunia. Low interest of antenatal and postnatal care providers in the issues of sexuality is documented. Lack of relevant information is the common reason for avoiding this topic. 76% of pregnant females would recommend a discussion on sexuality during pregnancy as a topic in an antenatal clinic and almost a half of pregnant women evaluate the information received from health care providers as insufficient (Ref. 48). Full Text (Free, PDF) www.bmj.sk.

[Spermiologic parameters in Czech men from 1950 to 1984 (analysis of data from the archives of the Sexology Institute of the First Medical School of Charles University and the General Medical School Hospital in Prague]. / Spermiologické parametry ceských muzu v letech 1950-1984 (analýza materiálu z archivu Sexuologického ústavu 1. lékarské fakulty Univerzity Karlovy a Vseobecné fakultní nemocnice v Praze).

Reports maintaining that sperm concentration in male ejaculates had decreased markedly over the past decades captured mind-share all over the world. However, literary data diverge about such a lasting trend. Our objective has been to contribute to the ongoing debate by presenting results of our own research. We have studied semen analyses of 5,363 men who had been tested at an outpatient care unit of the Prague Institute of Sexology between 1950 and 1984. These semen analyses measured volume of the ejaculate, sperm concentration, sperm motility, and a share of sperms with morphological abnormalities. None of these values showed statistically significant deterioration among seven groups of patients, each spanning five years. Therefore, our data did not confirm the above-mentioned lasting trend in semen analysis values. Research teams from all over the world have recently attracted a lot of attention by reporting a no-table decrease over the past decades in sperm concentration in the male ejaculates. However, literary data diverge about such a lasting trend. Our objective has been to contribute to the ongoing debate by presenting results of our own research. We have analysed semen tests filed in the archives of the Institute of Sexology at the 1st Faculty of Medicine of Charles University. We have studied a set of 5,363 men who had undergone their first sperm analysis between 1950 and 1984. We have gathered our data from medical records, using a uniform pattern of investigation. The set was divided into seven five-year groups based on the year of the first analysis. Volume of the ejaculate: The groups showed the following average volume of the ejaculate: 3.9-3.8-3.8-3.8-3.8-3.7-3.7 (ml). Neither the distribution nor the mean value of this variable has changed much over time. Sperm concentration: The groups showed the following mean sperm concentration: 32.9-42.3-56.2-57.9-72.2-70.8-72.3 (million per ml). It is obvious from these results that the mean sperm concentration increased over time in our set. Sperm motility: The groups showed the following mean sperm motility: 34.7-46.4-53.3-57.7-59.6-58.5-58.2 (per cent). Sperm morphology: The share of ejaculates with a high percentage of morphologically abnormal sperm cells has not grown much. Our data did not confirm the hypothesis that sperm analysis results have been gradually worsening. We have not found deteriorating trends in any of the sperm quality measures in the five-year intervals between 1950 and 1984. Although our results cannot close the debate about purported deterioration of sperm analysis results, they seem to indicate that we should take reports of universal decrease in sperm concentration in the seminal fluid with a grain of salt.

Experiences with sexual aggression within the general population in the Czech Republic.

In a representative survey of the sexual behavior of the inhabitants of the Czech Republic (862 men and 825 women older than 15), questions were included concerning experience with sexually aggressive behavior: 11.6% of women reported this kind of experience (3.4% of them more than once). The average age at the time of rape was 21.2 years. Most of these experiences occurred within marriage or a stable partnership. In only a tenth of them the perpetrator was a stranger. Only 3.4% of the offenses were reported to police. Of Czech men, 4.8% replied positively to the question whether they had ever forced a woman to have sexual contact. The most common form of these enforced contacts was vaginal coitus.

[Factors affecting the attitude of the Czech population towards induced abortion]. / Faktory ovlivnující postoje ceské populace k umelému prerusení tehotenství.

Based on an anonymous questionnaire survey of a representative population group above 15 years of age in the Czech Republic (862 men and 857 women) the authors investigated also sociodemographic factors affecting attitudes of the Czech population to induced abortions. The findings suggest that attitudes of men and women to induced abortions do not differ essentially in any of the investigated criteria. The size of domicile does not affect the attitudes substantially. The most restrictive views are expressed by respondents of the oldest age group (above 60 years) and respondents of the youngest age group (15-17 years). The liberal attitude to induced abortions increases with the educational level. Religious belief has a marked effect on restrictive attitudes to abortions, nevertheless among catholic subjects only 7% male and female respondents expressed refused induced abortions unequivocally.

[Use of condoms among the population of the Czech Republic: results of a national study]. / Pouzívání kondomu u obyvatel Ceské republiky: výsledky národního výzkumu.

Based on an anonymous survey, using questionnaires, in a representative group of the population of the Czech Republic above 15 years of age (862 men and 857 women) the authors investigated the use of condoms at the onset of sex life and with a steady and casual sexual partner. From the results ensues that the use of condoms in our population is lower than in advanced western European countries and the USA. During the first intercourse it was used only by 19% men and 14% women, in particular those of younger age groups. In a steady partnership two thirds of the respondents have experience with a condom, however, only one fifth uses it regularly. The position is similar during intercourse also with casual sexual partners, though the respondents use it more frequently. However not even then one third of men and almost half the women do not use protection by condoms. The most important influence on the reported use of condoms is exerted by the factors of sex (men, probably to appear socially in the most favourable light report its more frequent use) and age (condoms are used more frequently by younger men and women). In the Czech population the effect of religion and education is not important in this respect.

[Contraceptive behavior in the population of the Czech Republic: results of a national survey]. / Kontracepcní chování obyvatel Ceské republiky: výsledky národního výzkumu.

Using an anonymous questionnaire the authors investigated in a representative group of the Czech population above 15 years of age (862 men and 857 women) the use of the main contraceptive methods. During the first intercourse more than half the respondents did not use any contraception, a condom was used only by 19% men and 14% women. In a steady partnership the most frequent method of contraception is coitus interruptus, whereby experience with hormonal contraception was reported by cca one third and with a condom by two thirds of respondents. Among younger men and women there are more users of hormonal contraception and condoms. Only 5% of the examined men and 4% of the women opposed any type of contraception, almost one quarter of respondents use only so-called "natural methods" and almost three quarters of the respondents consider them an essential part of sex life. The attitudes of atheists and junior and more educated women are more liberal.

[Contraceptive behavior in the population of the Czech Republic: results of a national survey]. / Kontracepcní chování obyvatel Ceské republiky: výsledky národního výzkumu.

Based on an anonymous survey by means of questionnaires in a representative sample of the population of the Czech Republic above the age of 15 years (862 men and 857 women) the use of different types of contraception was investigated at the onset of sexual life with a steady or casual partner, as well as attitudes to contraception. From the results ensues that during the first intercourse no contraception was used by more than half the respondents, a condom was used only by 19% men and 14% women, in particular younger men and women. In a steady partnership the most frequent method of contraception is coitus interruptus, whereby about one third have experience with hormonal contraception and two thirds of the respondents have experience with condoms. Among younger age groups of men and women there are more users of hormonal contraception and condoms. The position is similar in intercourse with casual partners. Only 5% men and 4% women oppose any contraception, almost one quarter are in favour of the so-called "natural" method and almost three quarters consider it necessary. The attitudes of atheists, younger and better educated women are more liberal.

[Homosexuality in the medical context]. / Homosexualita, medicínské souvislosti.

The author presents a review of contemporary views on homosexual orientation. He describes the development of attitudes of society and specialists and the gradual decriminalization and demedicinalization of homosexuality. Despite the modern trend of complete social acceptance of the homosexual minority it is important to deal with the peculiar features in social adaptation of these people. Homosexual men and women have their specific health problems: for instance quite understandable difficulties with the acceptance of their different sexual character. Homosexual men have a greater tendency of risky sexual behaviour which has epidemiological consequences in the incidence of sexually transmitted diseases and HIV/AIDS.

[Sexual attitudes of Czech Republic population: the results of the national survey]. / Sexualni postoje obyvatel Ceske Republiky: vysledky narodniho vyzkumu.

PIP: The sexual attitudes of 1719 (862 male, 857 female) respondents over 15 years of age were investigated by an anonymous survey who made up a representative sample of the population of the Czech Republic. The questionnaire contained a total of 35 questions. The findings showed objections, in principle, against premarital sexual intercourse and abortion (3.3% of men, 3.6% of women), while 57.5% of women and 59.7% of men stated that every woman has the right to decide whether to bear children. 3.0% of men and 4.4% of women were altogether against premarital sexual intercourse, while 50.3% of men and 69.4% of women deemed that it is allowed within the framework of a lasting relationship. 4.0% of men and 8.6% of women thought that pornography should be banned. 36% (22.7% of men, 46.4% of women) were against group sexual activity, while 53.7% of men and 47.7% of women deemed it acceptable but would refuse to take part in it. 24% (18.3% of men, 30.9% of women) were against extramarital intercourse, while 44.0% of men and 25.7% of women thought it was natural and normal. 28% (14.5% of men, 39.9% of women) were against casual sex, while 40.3% of men and 41.8% of women did not condemn it, but would not engage in it either. 7% (5.0% of men, 9.6% of women) were against masturbation and considered it harmful, while 65.5% of men and 58.4% of women thought it was a natural manifestation of human sexuality. 6% (6.1% of men, 5.7% of women) were against homosexual intercourse, while 33.4% of men and 41.0% of women thought it was a disease, which those afflicted could not help. 5% of men and 4.4% of women rejected contraceptive use.^ieng

[Sex behavior of women seeking hormonal contraception and women seeking induced abortion]. / Sexuální chování zadatelek o hormonální kontracepci a zadatelek o umelé prerusení tehotenství.

Using an anonymous questionnaire, the authors assessed the sexual and contraceptive behaviour of 130 applicants for induced abortions and 330 applicants for hormonal contraception. Between the two groups these main differences were found: applicants for abortion used less frequently effective contraception and used more frequently unreliable contraceptive methods. This difference was obvious during the first intercourse as well as during later life. The use of contraception in this group is more limited also as compared with the nationwide average. In the case-history of applicants for abortion previous abortions were more frequent, as well as prostitute behaviour and the prevalence of venereal diseases. As regards heterosexual behaviour the applicants for abortion and applicants for hormonal contraception did not differ substantially. According to the authors the differences between the examined groups depend more on personality traits than sexuological characteristics.

[Effect of treated genital cancer on sexual functions of the woman]. / Die Wirkung des behandelten Genitalkrebses auf die sexuellen Funktionen der Frau.

By means of a structured interview and four questionnaires (Heterosexual development of woman, Sexual activity of woman, Sexual function of woman and Questionnaire N5 which evaluates the presence and intensity of neurotic symptoms) the authors examined 163 women following treatment of a malignant tumor of the genitalia. The examination was made during balneological therapy in a spa. Their age varied between 20 and 63 years. The feeling of female inferiority was recorded roughly in every eighth proband. Deterioration of sexual function of varying extent affected every second patient. Changes in emotional relations between couples (partners) were more favourable than in sexual life. Emotional and sexual relations improvement was recorded in every fifth and eleventh woman compared with the state before the illness. Husbands or partners of the patients had great understanding and were very tolerant. In the author's opinion it is a pleasant surprise that one quarter of the patients perceived the associated stress only as medium or even small stress. A general change (deterioration) of sexual intercourse correlated directly with subjectively perceived stress. The investigation revealed also that women treated on account of malignant tumors of the genitalia on the territory of former Czechoslovakia have practically no contacts with specialists in sexual rehabilitation.

[Sexuality in women after treatment of malignant genital tumors]. / Sexualita zen po lécbe maligního tumoru rodidel.

Using a structured interview and four questionnaires (Heterosexual development of woman, Sexual activity of woman, Sexual function of woman and questionnaire N5 which is used to evaluate the prevalence and intensity of neurotic symptoms, the authors examined 163 women after treatment of a malignant tumour of the genitalia. The examination was made during balneological therapy in a spa. Their age varied between 20 and 63 years. The feeling of female inferiority was recorded roughly in every eighth proband. Deterioration of sexual function of varying extent affected every second patient. Changes in emotional relations between couples (partners) were more favourable than in sexual life. As regards emotional and sexual relations improvement was recorded in every fifth and 11th woman resp., as compared with the state before the illness. Husbands or partners of the patients had great understanding and were very tolerant. In the authors' opinion it is a pleasant surprise that one quarter of the patients perceived the associated stress only as medium or even small stress. A general change (deterioration) of sexual intercourse correlated directly with subjectively perceived stress. The investigation revealed also that women treated on account of malignant tumours of the genitals on the territory of former Czechoslovakia have practically no contacts with specialists in sexual rehabilitation.

Sexual abuse experiences of psychiatric patients.

By interviewing 200 male psychiatric patients and 150 female psychiatric patients, we found that 17.1% of the respondents had experienced sexual victimization during their childhood. Only 11% of a control group of 50 males and 50 females, who had never received psychiatric treatment, reported similar victimization. The incidence of intrafamilial sexual victimization was greater among females than males. The group that had suffered the most sexual victimization was that of female psychiatric patients diagnosed with neuroses. Sexual victimization linked to aggressive behaviour and threats of violence was more common in the case of male and female psychiatric patients than in the control groups. Only 4% of the sexual victimization cases were investigated by the police.

Correlation of asthenozoospermia with increased antisperm cell-mediated immunity in men from infertile couples.

To investigate whether cell-mediated immunity (CMI) against sperm and/or antisperm circulating antibodies are associated with poor semen quality, a leukocyte migration inhibition factor (LMIF) assay and an enzyme-linked immunosorbent assay (ELISA) were performed in groups of men from infertile couples, men from fertile couples and sperm donors. Twenty-five of 102 men (25%) revealed positive CMI against sperm and 10 (10%) had positive antisperm antibody titers in their sera. Fifteen of 28 asthenozoospermic men (53%) from infertile couples revealed positive antisperm CMI. The incidence of antisperm CMI was significantly increased (P < 0.05) in the infertile men with asthenozoospermia compared with the men from the other two groups (men from fertile couples and sperm donors). No significant differences between migration indices were seen when such a comparison was done for oligoasthenoterato- and teratozoospermics. The results indicate that increased antisperm CMI is associated with asthenozoospermia in a significant number of men from infertile couples. The importance of these findings is discussed.

[Masturbation in adolescents]. / Masturbacní chování dospívajících.

Examination of a group of 602 Czech girls and group of 192 Czech boys aged 16 to 18 years revealed that differences in the occurrence of masturbation are in our population markedly greater than in German or American university students. In the examined groups cca 90% boys and only 6% of the examined girls masturbated. There were also marked differences in the frequency of masturbation. In our population so far the consequences of sexual liberalization after social changes at the end of 1989 are not yet manifest. It can be, however, assumed that in our country liberalization will also lead to a diminution of differences in the occurrence and frequency of masturbation between the two sexes. The authors hold the view that an important part is played also by biological factors, in particular those of a hormonal character.

[Anti-sperm antibodies in women and men in infertile marriages]. / Antispermatozoální protilátky u zen a muzu z neplodných manzelství.

The authors examined the serum of 76 women and 33 men from infertile marriages for the presence of antispermatozoal antibodies. Seropositivity was revealed in 19 women (25%) and in 12 men (36%). In control groups of healthy men and women seropositivity was substantially less frequent. In women the difference was statistically significant, but not in men. The ELISA method which was applied for examination appears to be a useful tool for screening of immunological factors of infertility, in particular in couples who where infertile for prolonged periods and where no unequivocal cause of infertility was found. Only more detailed comprehensive examination can explain immunologically conditioned cases of infertility and lead to selection of an optimal therapeutic strategy.

[Surgical treatment of obstructive azoospermia]. / Chirurgická lécba obstrukcní azoospermie.

In 23 infertile men the diagnosis of azoospermia was established. Bilateral biopsy of the testes was made, in four patients primary deficiency of spermiogenesis was revealed, in another four patients the Sertoli cells only syndrome. In a group of 3 men with hypospermiogenesis revision revealed severe hypoplasia of the epididymis which in context with the bioptic finding did not give hope of successful surgery. In the group of four men with normal spermiogenesis revision revealed in one obliteration of the terminal portion of the d. deferens, treated by transurethral discision of the colliculus and in three its partial or total agenesis. In one of the three latter cases bilaterally artificial spermatoceles were implanted which function satisfactorily; in the aspirated contents, however, even after several months only non-motile sperm cells were found. In seven patients epididymovasoanastomosis was performed by the microscopic technique--five times unilateral and twice bilateral. In one patient a condition after bilateral vasectomy was involved which was resolved by vasovasoanastomosis. In three patients after epididymovasoanastomosis azoospermia persists. In another two patients the check-up spermiogram revealed a positive finding, the wife of one of the patients is pregnant at the moment. In one patient the result of the operation cannot be evaluated yet due to a short time interval after operation. One patient did not come for a check-up examination. The patient after vasovasoanastomosis has a positive spermiogram with 38 million sperm cells per ml. In one patient with a discision of the colliculus the spermiogram is negative. The cumulative index of patient anastomoses reported in the literature is approximately 45%, the percentage of pregnancies only 17-18%.