Male or female sterilization: a comparative study.

The study compares 709 males and 546 females recruited from a well-defined geographic area and sterilized during a 5-year period at the same hospital. Medical records were reviewed and questionnaires sent out. Widespread satisfaction with the sterilization was found. The sterilized women had experienced contraceptive side effects and failures more often than the men. Only 70% of the laparoscopic sterilizations could be carried out during a 1-day admission, 25% of the women complained about long-term sequelae, and there were 1% failures. The vasectomies were carried out on an outpatient basis, there were few postoperative symptoms, and 0.5% failures were recorded. Female sterilization was at least four times as expensive as vasectomy. It is concluded that vasectomy is generally to be preferred to female sterilization, and that the preoperative guidance should involve both man and wife.

PIP: 810 men and 594 women, sterilized at a hospital in Denmark between 1978-1982, were sent a questionnaire to determine their motivation, postoperative effects, and satisfaction. The men were vasectomized under local anesthesia on an outpatient basis. The women were sterilized either by laparoscopy, using the Falope Ring technic, or by minilaparotomy, using Pomeroy's method under general anesthesia, and either stayed overnight in hospital or were discharged on the evening of the surgery. The women tended to belong to a lower social class, 15% were unemployed, and 16% were single parents. The men tended as a group to be older. More women gave health reasons, contraceptive failure, fear of the pill's side effects, and marital problems as their reason for wanting sterilization. After sterilization, 21% of the women experienced menstrual changes and/or pelvic pain, and 8 women became pregnant. 2 of the men developed hematomas, and 4 caused pregnancies. 3% of men and 2% of women experienced a deterioration of their sex lives; 40% of men and 36% of women said their sex lives improved; and 57% of men and 62% of women said it was unchanged. 3% of men and 5% of women regretted the decision, and all felt that they had received insufficient information before surgery. The cost of a male sterilization is estimated at $60 and the cost of a female sterilization is estimated at $240. In view of the cost difference and the difference in the invasiveness of the procedure, more men should be motivated to be the sterilized partner.

Medical appraisal of allegations of torture and the involvement of doctors in torture.

Today, torture is used in more than 90 countries. In most of these countries, the authorities try to conceal the use of torture. Therefore torture methods which do not leave marks are more often selected. Consequently, appraisal of statements of torture is mostly based on interviews with ex-prisoners. The statement of torture is compared with the description of symptoms in the period following imprisonment and with the result of the clinical examination, which is often normal. In the evaluation of the validity of a statement reservations often have to be made for minor disagreements between the single elements of the examination, for example because of impaired concentration during the examination and loss of consciousness during the torture. Furthermore, the statement may be incomplete because of psychological inhibitions and imperfect interpretation. Assessment of allegations of medical involvement in torture is also based on information given by the ex-detainee. The presumed doctor's examination technique and the treatment carried out and prescribed by him, are compared with the context in which he acted. Only very rarely do torture victims have marks from e.g. injections or suturing which can be related to medical treatment in torture centres. The critical evaluation of data collected during in-depth interviews with torture victims is the core of documentation of torture and medical involvement in torture. The national medical associations share the responsibility of ensuring that their country's doctors comply with the ethical rules and do not in any way participate in or omit to report torture.

Sequelae to torture. A controlled study of torture victims living in exile.

Twenty-eight Turkish refugees living in Denmark were examined by the authors in the period 1984-85. Fourteen of the persons alleged having been tortured in Turkey during the period 1980-83. The remaining 14 persons reported that they had not been tortured and thus acted as controls. All the testimonies were found valid according to a method previously used by us. The most common forms of violence reported were blows and electrical torture. Blindfolding, solitary confinement and threats were also frequent. At the time of examination the main mental complaints were sleep disturbances with nightmares and impaired memory. Emotional lability and concentration disturbances were also frequent. Physically the torture victims suffered from headache, various cardio-pulmonary and muscular pains, dyspepsia and reading disturbances. All reported that they had been healthy before torture. The clinical examination revealed only a few signs related to torture, although examples of minimal scars, fractured or missing teeth, discrete neurological disorders and mental depression were found. The 14 controls had significantly fewer complaints, and almost no abnormalities were found during the clinical examination. The present study clearly demonstrates the traumatic effects of torture.

[Torsion of the gallbladder]. / Galdeblaeretorsion.

Torsion of the gall bladder is caused by abnormal placement of the gall bladder and is a surgical emergency. A case with a typical history is reported. Treatment is cholecystectomy. Correctly treated, the mortality is less than 3%.

[Carcinoma of the urachus]. / Urachuskarcinom.

The urachus is an embryological structure originating from the allantois and situated in Retzius' space. Neoplasms originating from the urachus are very rare. They become clinically manifest late in the course of the disease. Deformation of the apex of the bladder and supravesical calcifications are described as radiological findings but these are of limited diagnostic value and should be supplemented by ultrasonic scanning, computed tomography and possibly by magnetic resonance scanning which will provide information about the extent of the disease. The final diagnosis is based on the macroscopic findings and the macroscopic picture. Three cases representing various aspects of the disease are presented. Treatment consists of en bloc resection in the form of partial cystectomy and excision of the tissue in Retzius' space and the umbilicus. The results are, however, disappointing as the five-year survival rates in the majority of materials do not exceed 10%. Irradiation is of doubtful value and chemotherapy is scarcely of value in the treatment.

[Regret after female sterilization. Review of the literature with a description of groups at risk]. / Fortrydelse af kvindelig sterilisation. En litteraturgennemgang med beskrivelse af risikogrupper.

PIP: About 5% of the Danish women who are sterilized subsequently regret having undergone the procedure. In order to improve counselling for those women who apply for sterilization, the literature concerning women who have regretted their decision are described. Risk factors for regret include: young age at sterilization; puerperal sterilization and sterilization when the youngest child was under the age of 1 year; marital and/or personal crisis at the time of the procedure; low socioeconomic status (no further education, no work outside the home, etc.); sterilization performed under pressure from husband or physician; and short period of time from decision to become sterilized to the procedure itself. Based on the above, it is recommended that women belonging to the high risk groups be provided with high-level counselling and advice including information about alternative contraceptives prior to the sterilization. If necessary, more counselling sessions should be offered. (author's modified)^ieng

[Patient information prior to sterilization]. / Patientinformation forud for sterilisation.

The law in Denmark prescribes that the patient and the general practitioner to whom the patient directs his or her request for sterilization are obliged to confirm by their signatures that the patient has received information about sterilization, its risk and consequences. We asked 97 men and 96 women, if they had received this information prior to their sterilization. They were also asked about their knowledge about sterilization. 54% of the women and 35% of the men indicated that they had not received information. Only few of these wished further information by the hospital doctor. Knowledge about sterilization was good. It is concluded that the information to the patient prior to sterilization is far from optimal. The patients' signature confirming verbal information is not a sufficient safeguard. We recommend, among other things, that the patient should receive written information and that both the general practitioner and the hospital responsible for the operation should ensure that optimal information is received by the patient.

[Vasectomy in specialized surgical practice]. / Vasektomi i kirurgisk speciallaegepraksis.

In the county of Roskilde an exception was made from the Danish legislation concerning sterilization that vasectomy should be performed in hospitals only on account of the long waiting list for this intervention. Two surgical specialists were selected to perform the operation in their practices. 88% (176/199) elected to accept the offer. All of these sterilizations were carried out within a period of six months. A questionnaire investigation did not reveal any difference in satisfaction between conduct of the intervention by the practising specialist in surgery or in hospital. Justification of the requirement that this form of sterilization can only be undertaken in hospital is discussed.

PIP: The current Danish law on sterilization specifies that the procedure may be carried out only in a hospital. Because of the long waiting time at Roskilde county hospital, the Ministry of Health granted special permission for the procedure to be carried out for a limited time in the practice of a surgical specialist. Of the 308 men on the waiting list at the hospital, 167 elected sterilization at the office. 3 months after the procedure a questionnaire was sent to the men as well as to the 18 patients who had elected to be sterilized at the hospital. The questionnaire covered satisfaction with the procedure, pain during the procedure, pains on the first day following and pain or discomfort at present. There was no significant statistical difference between the replies of the 2 groups. In the hospital setting sterilization is usually performed by young residents in the ambulatory surgical ward. The results of this investigation indicate that there is no valid medical reason for the requirement that sterilization be performed in a hospital. Long waiting lists for sterilization at hospitals ensure that patients have sufficient time to consider the operation but it would be equally effective to include a mandatory waiting period in a revision of the law. The authors recommend that the present Danish sterilization law should be administered by the Ministry of Health rather than by the Ministry of Justice and that it should revised to provide sufficient waiting time.

[Defective sterility after vasectomy]. / Manglende sterilitet efter vasektomi.

PIP: A 32 year old man inpregnated 2 women 5-1/2--7-1/2 months after he had undergone a vasectomy. The patient was revasectomized; no sperm granulomata or third ductus deferens was found. 2-3 cm of the ductus deferens was resected instead of 1-1/2 cm as in the earlier operation, and metal clips were used on the bisected ends instead of catgut. The patient did not win a lawsuit he filed against the hospital. It is recommended that all vasectomy patinets be informed that sterility may not be effected until up to 3 months after the operation. Patients should also be encouraged to have regular control check-ups after the operation.^ieng