Sexual functioning in postmenopausal women not taking hormone therapy in the Gynecological and Menopause Clinic, Songklanagarind Hospital measured by Female Sexual Function Index questionnaire.

OBJECTIVE: To study sexual functioning and attitudes towards sexuality in postmenopausal women. MATERIAL AND METHOD: A cross-sectional study was conducted among 219 healthy postmenopausal women with a uterus, aged 45-55 years, and not taking hormone therapy, who attended the gynecological and menopause clinic, Songklanagarind Hospital. The Female Sexual Function Index (FSFI) questionnaire was used as the instrument. RESULTS: The median age at enrollment and menopause age of women were 52 and 49, respectively. All the women had engaged in sexual intercourse. Sixty nine percent reported being sexually active once or twice in the previous four weeks, 27.9% three to four times and 3.1% more than four times. The mean total FSFI score was 20.4 while the proportion of women with female sexual dysfunction based on FSFI overall scores of 26.5 or less was 82.2%. Almost all the women displayed a positive attitude towards sexuality. Ninety six percent reported having sex in menopause as a natural normal part of life, 95% regarded having sex to make their partner happy whereas 77% regarded sex as a way to make themselves happy. CONCLUSION: Sexual dysfunction in postmenopausal women was rather high. However, they were still satisfied with their sexual relationship and had a positive attitude towards sexuality.

Effect of audit and feedback on the accuracy of diagnosis summary for gynecological conditions in Songklanagarind Hospital, Songkhla Province, Thailand.

OBJECTIVE: To assess the effect of an audit and feedback intervention on the accuracy of the diagnosis summary in the medical records of gynecologic patients in Songklanagarind Hospital. MATERIAL AND METHOD: An audit was conducted on the medical records of 468 gynecologic patients that visited between January 2006 and March 2007. They were divided into non-malignant and malignant conditions both before and after the planned intervention. RESULTS: The accuracy of the summary of the diagnosis for non-malignant conditions was better than malignant conditions. The correction to the principle diagnosis in medical records of patients with malignant conditions increased significantly from 16.7% to 42.9% (p < 0.001) after the audit and feedback. In medical records of non-malignant conditions, corrections to the principle diagnosis and any complications also significantly increased from 72.0% to 82.0% (p = 0.01) and 76.0% to 90.7% (p = 0.002), respectively. CONCLUSION: Audit and feedback is effective for improving the accuracy of the diagnosis summary for gynecological conditions but malignant conditions need more improvement strategies.

Positive predictive value of clinical diagnosis of endometriosis.

OBJECTIVE: To determine the positive predictive value of the combined symptoms of severe dysmenorrhea with the sign of tenderness and/or nodularity of the cul-de-sac and/or uterosacral ligament(s) in diagnosing endometriosis clinically. MATERIAL AND METHOD: In this prospective study, 116 patients with severe dysmenorrhea, after excluding urinary and gastrointestinal disease, underwent pelvic examination by the same investigator. Women having adnexal mass on pelvic examination were excluded Tenderness, and also nodularity, of the cul-de-sac, right and left uterosacral ligament were recorded separately. The laparoscopist did not know the findings of the pelvic examination. The diagnosis of endometriosis was made visually when lesions were typical and all other lesions were biopsied. RESULTS: The prevalence of endometriosis was 78.4%. Tenderness, nodularity, tenderness and nodularity, and also tenderness or nodularity of cul-de-sac and/or uterosacral ligament(s) were all statistically significantly associated with the presence of endometriosis (P = .048, .005, .004, and .004 respectively). The positive predictive values were 85.5%, 94.0%, 94.6% and 86.7%, respectively. CONCLUSION: The positive predictive value of severe dysmenorrhea with nodularity of the cul-de-sac and/or uterosacral ligament(s) was 94.0%.

Clinical diagnosis of hirsutism in Thai women.

OBJECTIVE: To determine the cutoff score for identifying hirsute, Thai women, by using modified Ferriman-Gallwey-Lorenzo (mF-G-L) method. MATERIAL AND METHOD: Hirsutism was defined as an amount of terminal hair in the androgen-sensitive skin areas that the women themselves would consider obviously abnormal, and their mF-G-L score was above 97.5 percentile of general population. The subjects were consecutive unselected premenopausal women who came to our hospital for their yearly Papanicolaou smear check up, without any complaint. Acne and oily skin were also assessed. RESULTS: Five hundred and thirty-one women underwent a physical exam. The women who had the total hair-growth score of 0, 1 and 2 by mF-G-L method accounted for 97.8% of all the subjects. All of the 11 subjects with a total score of 3 or more considered themselves to have excessive growth of hair. None of these 11 women had acne. CONCLUSION: The authors purposed that the cutoff score to diagnose Thai hirsutism may be 3 or more by mF-G-L method.