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.

Differences in postload plasma glucose levels between 100-g and 75-g oral glucose tolerance tests in normal pregnant women: a potential role of early insulin secretion.

OBJECTIVE: To demonstrate a role of early insulin secretion on plasma glucose levels after different amounts of oral glucose loads in pregnant women. MATERIAL AND METHOD: Forty-one pregnant women with normal glucose tolerance according to the Carpenter and Coustan' s criteria and 25 non-pregnant women (control group) with normal glucose tolerance according to the World Health Organization criteria were enrolled. Each subject was randomly scheduled to perform both the 100-g and 75-g OGTT within a 1-week interval. Venous blood was drawn at fasting, 30-, 60-, 120-, and 180-minute intervals during both tests for determination of plasma glucose and serum insulin levels. RESULTS: The mean (+/- SE) ages of the pregnant and control groups were 33.3 +/- 0.9 and 31.8 +/- 1.4 years, respectively. The mean gestational age at the time of performing OGTT of the pregnant group was 28.7 +/- 0.6 weeks. In the non-pregnant group, the plasma glucose concentrations were not different between 75-g and 100-g OGTT whereas the serum insulin levels at the 30 and 180 minutes of the 100-g OGTT were significantly higher than those of the 75-g OGT. In the pregnant group, both plasma glucose and serum insulin concentrations at the 120 and 180 minutes of the 100-g OGTT were significantly higher than those of the 75-g OGT. CONCLUSION: The limited ability of early insulin secretion to increase when glucose load increased in the pregnant women could explain the high plasma glucose levels at 2 and 3 hours of 100-g OGTT compared to those of 75-g OGTT.

Clinical practice guideline for cesarean section due to cephalopelvic disproportion.

OBJECTIVES: To evaluate the effect of the Clinical Practice Guideline (CPG) for cesarean section due to Cephalopelvic Disproportion (CPD) on physician compliance, pregnancy outcomes and cesarean section rate. The study also wants to identify factors associated with physician non-compliance. MATERIAL AND METHOD: 455 medical records of women undergoing a cesarean section due to CPD from January 1, 2002 to December 31, 2003 were reviewed The CPG was implemented on January 1, 2003. The pregnant outcomes of women who delivered from January 1, 2002 to December 31, 2002 were used for comparison. The outcome measurements were physician compliance, pregnancy outcomes and cesarean section rates. Multivariate logistic regression analysis was used to identify factors associated with physician non-compliance. Independent variables included private care, parity, maternal height, Bishop score, maternal age and estimated fetal weight. RESULTS: The compliance rate was 83%. Physician compliance in private practice was lower than in non-private practice (76.6% VS 92.4%). Pregnancy outcomes were not different between the two periods. The cesarean section rates before and after implementation of the CPG were 8.4% and 8.5%, respectively. Private practice, poor Bishop score and estimated fetal weight < or = 3500 g were significant predictors of physician non-compliance. CONCLUSION: The compliance rate was high, but the cesarean section rate due to CPD did not significantly change within a one year period There was no adverse outcome. Physician non-compliance was more common in private practice. Poor Bishop score and high estimated fetal weight were significant predictors.