Complications of laparoscopic sterilization. Comparison of 2 methods.

A retrospective study of 5346 cases of laparoscopic sterilization with special reference to early and late complications was undertaken. In the 6-year period from 1972 to 1978, 846 patients were sterilized by the elasticized silicone-ring technique and 4500 patients were sterilized by the electrocautery method. The electrocautery method was complicated by electrical burns in 13 cases (0.29%); 3 of these patients required bowel resections. Mechanical complications occurred in 1.6% of the Silastic-ring cases, but none of the patients required additional surgery. The Silastic-ring patients had greater postoperative abdominal pain than the electrocautery patients, but it usually abated within 48 hours. There were 15 cases of postoperative pelvic infection in the electrocautery group, and none in the Silastic-ring group. Bleeding from the mesosalpinx occurred in both groups and occurred more often with coincident suction D&C. Technical failure to perform the sterilization procedure was principally related to previous abdominal surgery. A substantial number of patients complained of menstrual irregularity and/or dysmenorrhea following these sterilization procedures. The majority of women reported unchanged or improved sexual relations. Improvement in sexual relations was reported by significantly more patients in the Silastic-ring group than in the electrocautery group.

PIP: 5346 cases of laparoscopic sterilization, using both electrocautery and Silastic-ring method, were studied from 1972-1978. Of the 4500 electrocautery method patients there were 13 cases of electrical burns, 3 of which required bowel resection. Of the 846 Silastic-ring method patients there were 14 cases of inadvertent ejection of a ring into the peritoneal cavity. In addition, 235 Silastic ring patients had postoperative abdominal pain severe enough to require analgesia stronger than aspirin and codeine compared to 399 of the electrocautery patients. 15 women in the electrocautery group experienced pelvic infections; there were no infections in the Silastic-ring group. Mesosalphinx bleeding occurred in both groups and most frequently with coincident suction D and C. There were cardiac complications curing the sterilizations; 6 bradycardia cases, 10 arrhythmia cases secondary to over-distention of the abdomen with carbon dioxide. Technical failure was related to previous abdominal surgery due to the presence of adhesions. 37.4% of 366 patients noted increased flow and/or duration of menses and 15% complained of menstral cramping. The majority of women reported unchanged or improved sexual relations; improved sexual relations were more significant among Silastic-ring patients.

Emotional reaction to sterilization.

Ninety-four patients sterilized by tubal occlusion were interviewed at the time of hospitalization for surgery and followed at scheduled intervals for a 2-year period. There were no serious problems, medical or psychologic, and all but 3 patients were pleased and satisfied at the end of 2 years. There were no technical failures. Psychosomatic symptoms do develop. They are more prominent and persist longer in the younger age group. Patients having these symptoms are those who had difficulty with contraceptive technics, have a limited understanding of the sterilization procedure, and continue to question its permanency. The need for preoperative evaluation and counseling is emphasized.

PIP: Psychologic and somatic aftereffects are reported for 94 patients sterilized by tubal occlusion at Rush Presbyterian St. Luke's Medical Center, Chicago, from July 1971 to December 1971. An initial interview was conducted at hospitalization, and follow-up interviews were scheduled for 6 weeks, 3 months, 1 year, and 2 years. 3 patients at 6 months and 7 patients at 1 year had health complaints; at 2 years there were none. 40% of the younger (under 26 years old) women had minor complaints at 1 year, and 18% had sought medical attention. By the second year 30% continued to have complaints, but none sought medical attention. Menorrhagia, memometrorrhagia, and dysmenorrhea were reported by 25% of the older group at some follow-up. Among the younger patients, 40% at 6 months, 60% at 1 year, and 65% at 2 years reported menstrual irregularities. At the 2-year follow-up the responses of 93% of the older patients and 77% of the younger patients indicated normal quality of sexual relations. 95% of the older and 75% of the younger group were completely satisfied with the sterilization. The physician must explain details of the procedure and its consequences.

Impairment of spermatogenesis and libido through antibodies to lutenizing hormone.

PIP: To histologically and biologically assess the impairment of testicular function after active immunization with LH, adult male rats (49) and rabbits (9) were actively immunized with bovine LH and then compared with saline-injected controls. When the measured antibody titer was high, the mating behavior of the males was altered. The males mated only 41.8% of the time when exposed to cycling females. The control group mated 90% of the time. Testicular weights were unchanged but the seminiferous tubules of the experimental group showed vacuolation in the Sertoli cells with some of the spermatids being multinucleated. Passive immunization of rats with anti-LH sera diminished mating capacity to a greater extent than active immunization. Immunization of rabbits led to a rapid decrease in libido. Uniform interruption of spermatogenesis was noted along with a loss of testicular weight of immunized rabbits. The probable mechanism of the LH inhibition of spermatogenesis is the interference with androgen production in the interstitial tissue.^ieng

Combination of 19-nortestosterone-hexyloxyphenylpropionate (Anadur) and depot-medroxyprogesterone-acetate (Clinovir) for male contraception.

Because monotherapy with 19-nortestosterone hexyloxyphenylpropionate (Anadur, Pharmacia Arzneimittel, Ratingen, Federal Republic of Germany) suggested improved results for male contraception compared with available testosterone esters, it was tested for induction of complete azoospermia when combined with depot-medroxyprogesterone acetate (DMPA, Clinovir, Upjohn GmbH, Heppenheim, Federal Republic of Germany). Twelve men were treated for 7 weeks with weekly intramuscular (IM) injections of 200 mg Anadur followed by 3-weekly IM injections of Anadur up to week 15. Clinovir (250 mg) IM was administered at the start of treatment and during weeks 6 and 12. Anadur and Clinovir suppressed serum gonadotropins. Although serum testosterone declined steeply, in general, libido and potency were not impaired. Sperm concentrations were reduced significantly after 3 weeks of treatment. Lowest sperm counts were seen during week 8 of follow-up, when only 2 volunteers showed measurable sperm counts of 2.1 and 3.0 X 10(6)/ml, with a declining tendency. After 43 weeks, sperm concentrations were still below pretreatment range in 2 men, but later returned to pretreatment values. Computerized sperm motion analysis revealed that motility parameters in the residual sperm were reduced. In vitro analysis excluded a direct effect of medroxyprogesterone acetate in seminal plasma on sperm motion. The data indicate that the combination of Anadur with Clinovir increases the rate of azoospermia in normal volunteers seen under Anadur monotherapy, although the goal of azoospermia in all participants was not quite achieved.

Acceptability of drugs for male fertility regulation: a prospectus and some preliminary data. World Health Organization Task Force on Psychosocial Research in Family Planning.

Hormonal substances for male fertility regulation administered orally or by injection are currently undergoing clinical evaluation. These trials, sponsored by the World Health Organization, provide unique opportunities for intensive study of the acceptability of such an approach to fertility regulation, and of these drugs in particular. The research employs repeated interviews over a 15-month period and is conducted by social scientists collaborating with biomedical scientists at each of seven sites (Bangkok, Hong Kong, London, Mexico City, Santiago, Seoul, and Toronto). The focus is upon gauging male user's evaluations of hormonal methods (several androgen/gestagen combinations as well as cyproterone acetate) relative to their evaluations of other male methods they know about or have experienced. Of particular importance is to determine whether the hormonal methods modify or interfere with sexual desire, feelings, and behavior. The research is also assessing specific ways in which various perceived properties of fertility regulating methods relate to their acceptability in different socio-cultural settings.

PIP: A 7-country WHO (World Health Organization) field trial on hormonal drugs for males administered either by daily pill or monthly injection, is being undertaken. The trials, being conducted in Hong Kong, Bangkok, London, Mexico City, Santiago, Seoul, and Toronto, provide an opportunity to assess acceptability and effects on sexuality of these new male contraceptives. The research uses repeated interviews over a 15-month period, conducted by social and biomedical scientists. The respondents are asked to compare their evaluation of the method with previously-used male or female methods and to indicate whether they feel the method modified or interfered with sexual desire, feelings, and/or performance. Methodology of the trials is explained. The hormones used, numbers of volunteers participating, and other factors important for each trial site are tabulated. Preliminary results are available from some of the trial sites The new method, either pill or injectable, was ranked highest as to acceptability, followed by vasectomy and condoms. Respondents favored self-administered, reversible methods. In fact, irreversibility was found to be the most negative feature of vasectomy, indicating that a reversible form of sterilization would be acceptable. Respondents in all trial sites favored 3-month injectables the most and permanent methods the least. Effectiveness and ease of use were important in a contraceptive.

A comprehensive review of the sequelae of male sterilization.

PIP: This study of the sequelae of vasectomy considers morphological and immunological changes, epidemiological studies, reversibility, and psychological aspects. The data on morphological changes after vasectomy are diverse and contradictory, as a wide range of experimental animals have been studied. The number of studies on men has been limited, but they suggest little histologic change in testicular morphology or spermatogenesis. Hormonal changes after vasectomy are difficult to assess because of the large fluctuations in semen levels of testosterone and gonadotropins. Most of the studies on this topic have been small and have lacked controls, with comparisons consisting of pre-post differences in the same subject group. The only prospective controlled study found no differences between vasectomized and control subjects on any of the hormones investigated. 2 large-scale studies have also produced conflicting results; 1 found no changes in hormone levels, and the other found that only follicle stimulating hormone levels did not change. It is apparent from the studies that any hormonal fluctuations after vasectomy remain within the normal range, and it has not been demonstrated that testicular endocrine function or the relationship of the pituitary to the testis are in any way adversely affected by vasectomy. It has been shown that after vasectomy 50-60% of men develop sperm agglutizating antibodies while 20-30% develop sperm immobilizing antibodies. The implications are 1) that if some of the antibodies are nonspecific or cross-reacting, the incidence of autoimmune disease may be increased in vasectomized men; and 2) the persistence of sperm antibodies may cause failure of reversal attempts despite anatomical patency. Studies of the incidence of atherosclerosis in vasectomized monkeys showed that they developed antisperm antibodies and much more extensive atherosclerosis than controls, causing concern because of the phylogenic closeness of monkeys to man. Epidemiologic studies as yet furnish insufficient evidence to extrapolate findings on postvasectomy atherosclerotic lesions in monkeys to man. There is no clinical evidence after several large studies to show that vasectomy is harmful to the circulatory system in man, but surveillance of men who have undergone vasectomy is indicated. Pregnancy rates after reversal attempts are not as high as success rates in terms of canalization and sperm appearance in the ejaculate, but it is not yet known what causes the difference. No adverse psychological effects of vasectomy have been demonstrated in developed countries, and the high incidence of regret and other psychological effects in developing countries may be due to a lack of truly voluntary consent.^ieng

Vasectomy: its effect upon marital stability.

PIP: 50 couples were studied as to whether vasectomy had any effect on marital stability, communication, and sexual satisfaction. The procedure of the study is described and all results are tabulated. Demographic data on the couples indicate a general trend toward the mid-20s in terms of couples making the decision in favor of vasectomy. The couples seemed to have a stable marital history and to have made the decision earlier in marriage than was previously the case. The average number of children among the couples was 2. An average increase in coital frequency resulted from the vasectomy. Improved stabilization of the marriage and improved sexual satisfaction also resulted. Little change was noted in marital communication, understanding, and affection as a result of the vasectomy.^ieng

Changes in sexual drives of patients on oral contraceptives.

PIP: 169 married and 42 single women attending the Family Planning Clinic at Wilford Hall U.S. Air Force Medical center were surveyed over a 4-month interval to study changes in sexual drives associated with oral contraceptives (OCs). 74.4% reported they were without side effects. The menstrual flow was decreased in 62% and increased in 4%. Duration of the menstrual cycle was decreased in 57% and unchanged in 41%. 34% indicated less dysmenorrhea while taking OCs. There were some differences between married and single women when questioned about their sexual drive. 68% of the married women and 71% of the single were without change in their libido. 21% of the married women felt that their libido diminished. 22% of single women experienced increased libido. 31% of the single women had a heightened sexual response while only 17% of the married women reported this. Sexual activity increased in 40% of the single women and 16% of the married women. Libido decreased as family size increased. There were only minor differences in changes among those who use different OCs. There was a progressive decrease in libido, sexual response, and sexual activity during the first 2-3 years of medication. After 5 years, however, sexual response was progressively heightened. Fear of pregnancy was uniformly lessened with OCs in 72-75% of all patients. Individuals may have changes in their sexual drives secondary to OCs. However, as many have increased as have decreased drive.^ieng

Promiscuity and pill: etiologic agents in the genesis of cervical malignancy.

PIP: An 800% increase in the number of "suspicious" Papanicolaou smears from young women have been reported since 1970. In cases diagnosed from tissue specimens as "surface dysplasia," the majority of patients gave histories of use of birth control pills and sexual promiscuity. Sexually active women have an increased incidence of cervical ectopy. In cervical ectopy the endocervical columnar cells are exposed to the acid vaginal content. Development of squamous metaplasia may result. An ideal contraceptive would be one contributing to the preservation of a healthy cervical epithelium without ectopy, and a healthy vaginal content as shown by the presence of Doderlein flora. These conditions would serve to prevent cervical malignancy.^ieng

[Neurohumoral influences of steroid hormones on sexual responsiveness in women (author's transl)]. / Uber neuro-humorale Einflüsse von Steroidhormonen auf die Sexualsphäre der Frau

An analysis has been carried out on the basis of endocrinological and psychosomatic studies of the influence of steroid hormones, acting via probable transmitter substances, on the sexual response in women. From a review in the literature it can be concluded that among other factors the endocrine state of the women determines her sexual response and behaviour. However, the present lack of specific psychological tests is pointed out, as well as the absence of relevant hormonal data to the sexual sphere, both normal and pathological.

PIP: Based on current literature on the subject, an analysis is made of the endocrinological and psychosomatic aspects of the influence of steroid hormones, which probably act through the action of transmitter substances, upon the sexual responsiveness of women. Endocrinological studies center on the role of androgens, estrogens, and progesterones, and the possible transmitter substances. The physiological basis of abnormal changes in the sexual responsiveness, such as frigidity, is the prime concern of such studies. Among other factors, it is concluded that the state of the endocrinal system does determine a woman's sexual responsiveness and behavior. The present lack of psychological tests is noted as relevant, however, as well as the absence of hormonal data relevant to the sexual sphere, both for normal and pathological states.

[Medical and social indications of sterilization]. / Indicazioni mediche e sociali alla sterilizzazione.

PIP: In 1977 there were about 80 million couples in the world who had chosen sexual sterilization as a permanent contraceptive method; it appears that the number will be 200 million in 1985. In many countries sterilization is still permitted only for medical reasons, for example in cases of serious cardiopathies or nephropathies, in severe hypotension syndromes, or in cases of tuberculosis in its evolutive stage. However, it is apparent from the published literature that only about 8% of sterilization procedures are performed for strictly medical reasons; about 80-90% are performed for purely contraceptive reasons, and in couples for which other methods did not work or were too risky. In most countries request for sterilization must be made by both partners, they must be over 35, have at least 3 children, and have a harmonious sexual and emotional relationship. Candidates for sterilization must be well informed of the difficulties of reversibility, and must have a mature and responsible personality. Otherwise, the danger of sexual and/or psychological side effects would be much increased.^ieng

[Principle complications and contraindications of the use of oral contraceptives]. / Considerazioni sulle principali complicanze e controindicazioni dell'uso dei contraccettivi orali.

PIP: The use of oral contraceptives should at all times be under physician's control. Most contraindications and complications from oral contraceptives are now a thing of the past, when higher doses were prescribed. However oral contraceptives are still responsible for many side effects and complications. Some of these are gastrointestinal problems; menstruation disorders, such as spotting or amenorrhea; decreased libido; increase in body weight; mastodynia; blood coagulation effects; lipid and carbohydrate metabolic effects; ophthalmological and dermatological problems; and, possibly, an increase in susceptibility to some infectious diseases. Patients with hypertension; with heart or hepatic diseases; with a history of family thrombolic accidents; with diabetes; or hyperthyroidism should utilize another form of contraception. Oral contraceptives are totally contraindicated for obese or emotionally depressed people, for pregnant or nursing mothers, for women with uterine or breast cancer, and for adolescents.^ieng

Psychological effects of abortion (a study of 1739 cases).

PIP: A 6-month prospective study was conducted among 1739 women who underwent therapeutic abortion at Kandang Kerbau Hospital in Singapore to ascertain the aftereffects of abortion. Results of the study indicate that induced abortion has no observable bad effects on the mental health of the patients. In fact, somatic and psychiatric complaints were reduced and sexual adjustment increased 6 months postoperative. Those who were also sterilized at the time of the abortion showed a slightly lower rate of somatic symptom reduction than the rest of the group.^ieng

Sexuality--the mature or childbearing years and the effect of gynecologic surgery.

PIP: Little is written about a woman's sexuality and the changes it may undergo when gynecologists assault the pelvis, the woman, and the individual with their armamentarium and surgery. This paper examines, to a limited degree, such sexual sequelae in women in the mature or childbearing phase of life. The data presented are derived from the history and physical examination of surgical patients seen in a private office gynecologic practice from the fall of 1972 to the fall of 1977. The attempt was made to include in all clinical histories a sexual history with at least as much depth as that acquired in the system review of a good history. Sexual histories were obtained from 79% of the patients over this period. Of the 986 patients from whom a sexual history was obtained, a 6 or more month follow-up was made in 69% or 671 patients. In this follow-up the same inquiry was made at intervals from 6 months up to 38 months. 187 students in a university and office complex in the relative area served as the control group and were asked the same questions as the surgical population by a research associate. Questions covered the following: whether orgasm was achieved; the manner in which orgasm was achieved; masturbation; the importance of sex; the variability of sexual appetite; faking orgasms; and preferences of sexual stimuation. The significant changes seen among women who had undergone a laparoscopy after the longterm evaluation were in faking orgasm and in seeking different outlets for sexual gratification. Faking orgasms decreased 60%. Preoperatively, all women reported that they had or did fake orgasms. 6 months postoperatively the women were more honest sexually and would not pretend. At this point women had no sexual stimulatory preference. The data illustrate that laparoscopic sterilization does not produce a radical change in women's sexual responses other than a release from pretending and greater sexual freedom in acting out what pleases them. The next procedure studied was hysterectomy. This procedure had great impact on the minds and emotions of these women. During the first 6 weeks after surgery, 80% of the women were devoid of sexual feelings and most expressed this as a fear of being hurt by just about anything. The 20% who were in touch with their sexual feelings varied from a few patients who masturbated to orgasm while still in the hospital to the remainder of patients who masturbated to orgasm by the 6th postoperative week. The postoperative prohibition against sexual relations was a stimulus to the libido of these women. At the 6th month period and later, there developed a stable plateau. 78% of the women stated that they were orgasmic compared with 76% in the preoperative history. The greatest change was noted among the women who had undergone colporrhaphy. 60% of the women were orgasmic after 6 or more months postoperatively compared with 76% preoperatively. They attributed this for the most part to failure to achieve pleasure through vaginal penetration, which had either been ancitipated or suggested.^ieng

Masculinity-femininity and the desire for sexual intercourse after vasectomy: a longitudinal study.

PIP: This research was concerned with the question of whether masculinity-femininity is related to postoperative changes in desire for intercourse among men who underwent vasectomy. Sexual desire was assumed at the outset to be a positive characteristic associated with masculinity among males with its expression being a means of reaffirming a sense of masculinity. The hypothesis was that masculinity would have a positive effect on changes in the desire for intercourse following vasectomy. Of the initial 176 couples who filled out questionnaires, 75 actively participated in follow-up and furnished data for this analysis. This group was compared to the group who did not furnish follow-up data and the 2 groups were found not to differ significantly with respect to masculinity, femininity, age or education. Masculinity was positively and significantly related to the postsurgical expression of increase in desire for sexual intercourse among vasectomized men. There is support then for the notion that response to vasectomy may sometimes involve compensation in those men who would likely perceive vasectomy as demasculinizing. 1 negative finding was that androgynous males do not alter their desire following vasectomy.^ieng

[Laparoscopic tubal sterilisation using Yoon's rings. The technique and psychological effects]. / Stérilisation tubaire coelioscopique par anneaux de Yoon. Aspect technique et incidence psychologique.

So long as certain contra-indications are observed it had been found that the application of Yoon's rings in the isthmial region of the fallopian tube is an efficient way of sterilising women. It is easy and devoid of major operative or post-operative complications. The authors report 245 cases that were treated in a University Hospital Centre. This technique had been particularly well received from the psychological aspect, as has been shown by an enquiry that we conducted between 6 and 48 months after the procedure in patients in this study.

PIP: 245 tubal sterilizations using Yoon rings were performed at a university hospital center in Liege between July 1977 and June 1980. Average age of patients was 36.3 years, 9.4% were nulliparas and 17.6% were primaparas. In 4 cases an abortion was performed simultaneously. Each patient requesting sterlization was referred to a psychologist or psychiatrist. A multiple choice questionnnaire was sent to each patient in 1981 to assess medium term psychological effects of the sterilization. Fewer than 20% of the sterilizations were performed for medical indications. The average duration of the operation was 35 minutes and the average hospital stay was 3.4 days. Problems with the laparoscope necessitated laparotomy in 3 patients. In 6 cases uterine perforation without hemorrhage occurred. Rupture of the tube occurred in 12 cases, in 1 of which hemorrhage occurred and laparotomy was required. Minor bleeding occurred in 8 cases, incorrect placement of a ring occurred in 3 cases, a ring fell into the abdominal cavity in 6 cases, and a 2nd ring was placed on the same tube in 18 cases. 28.9% of the patients complained of pain in the 1st 24 hours. 1 urinary infection with E. coli, and 2 cases of hemotoma on the abdominal walls occurred post-operatively. 1 pregnancy was recorded after 4922 cycles, giving a failure rate of .4% and a Pearl's index of .24/100 woman years. The failure was due to incorrect placement of the ring. 137 of 209 patients receiving questionnaires responded. 67.4% reported feeling more relaxed and 27.2% reported no change; 43.5% reported better sex life and 48.1% reported no change; 85.6% reported no fear of pregnancy; and 96.4% reported they would repeat the operation. Before the operation, 75.4% of the partners were in favor of it, 2.6% were opposed, and 14.4% had no opinion. At the questionnaire data, 79.3% declared themselves fully satisfied, 5.4% had regrets, and 15.3% had no opinion. The acceptance of this method of contraception on the psychological level appears to be good when adequate pre-operative counseling is provided and the patient is aware of the implications of the procedure.

[Preliminary trials of an oral chemical contraceptive for men]. / Premiers essais d'une contraception chimique par voie orale chez l'homme

PIP: R 2323 (13-ethyl, 17 alpha-ethyl, 18-hydroxy-gona-4,9,11-trien-3-one) was administered orally, 50, 75, or 100 mcg/week in 2 or 3 divided doses with or without 3 100 mg testosterone implants to arrest spermatogenesis, to 20 healthy men 25-35 years of age with at least 2 children. There were 3 dropouts, 1 for a high triglyceride level. 7 men became azoospermic within 2-3 months after the combined treatment and 8 after receiving 75 or 100 mg/week of R 2323 only. No abnormal sperm forms appeared. Side effects were weight gain of 2-8 kg chiefly with the combined schedule. Libido declined in 3, erective capacity decreased in 2, and coital frequency fell in 8. 1 case of gynecomastia appeared after 4 months. 1 man had a superficial thrombosis in the left arm at the site of a biopsy for polyadenopathy. Testosterone fell from 5 to .5 ng/ml and follicle stimulating hormone and luteinizing hormone from 5-1 mIU/ml in both groups. The only remarkable change in a biological parameter was an increase in transaminase, especially SGPT, 25-50%. Testosterone and gonadotropins returned to normal within 1 month after stopping steroids, and sperm counts within 3-4 months. The testosterone implants failed to prevent plasma testosterone levels from falling, and seemed to cause more side effects such as weight gain and loss of libido than did R 2323 alone.^ieng

[Male sterilization with vasectomy. The effect of the operation on sex life]. / Mandlig sterilisation med vasektomi. Indgrebets indflydelse på det seksuelle samliv.

PIP: 182 of 220 men, 25-54 years of age, who underwent vasectomy, filled out a questionnaire describing how the operation affected their sex life. Nearly all of the men were married and were regularly employed. 86% of those who returned the questionnaire had 2 or 3 children. 99% said that their wives agreed with their decision to undergo vasectomy. 80% chose vasectomy because their wives could not or did not want to use oral contraceptives or other methods, or because they wanted 100% effectiveness. 48 experienced short-term difficulties. 6% reported a decrease in libido or orgasm, and 1% reported a decrease in sexual intercourse after the operation. 86% would recommend the operation to others, 7% would not.^ieng

[Diagnostic investigation of clients seeking contraception in a general practive. Diagnostic probability for pronounced menstrual discomfort, sexual complaints and pathological gynecologic findings in a woman's age, marrital status, parity, employment, and social status]. / En diagnostisk undersøgelse af et antikonceptionsklientel fra almen praksis. Diagnostiske sandsynligheder for udtalte menstruationsgener, seksuelle klager og patologiske gynaekologiske fund vurderet ud fra kvindens alder, aegteskabelige stilling, paritet, beskaeftigelse og sociale status

PIP: 1983 women seeking contraception were surveyed about age, marital situation, menstrual irregularities, sexual problems, parity, occupation, and social status and were examined for pathological gynecological findings. These results were then correlated to determine relationships between them. 17% of the women had menstrual problems, 16% sexual problems, and 10% pathological gynecological findings. As age increased, menstrual problems decreased in frequency and sexual problems increased. Housewives and married women in general had fewer menstrual problems and more sexual problems than working women. Menstrual problems decreased as parity increased, while sexual problems and pathological gynecological findings increased as parity increased. Social status showed no relation to any of the other variables. When parity is given, none of the other parameters add significance to the findings.^ieng

[Psychosexual changes in contraception]. / Cambios psicosexuales con la anticoncepción

PIP: The participation of a psychologist in the family planning program is very important. The use of contraceptive methods may cause psychological problems for couples, but most problems can be eliminated by adequate information. Couples should be taught that contraceptive practices will not interfere with their relations, orgasm, or normal sexual life, but may even improve them. Ignorance and erroneous beliefs should be eliminated and couples should be informed of the nature, action, and possible side effects of all contraceptive methods.^ieng