A survey of ocular complaints in postmenopausal women.

Aging patients often complain about chronic ocular irritation, which is commonly related to dryness of the eyes. To determine the effect of hormone replacement therapy (HRT) on ocular complaints and tear production, we compared these parameters in postmenopausal women who were taking or not taking HRT. A questionnaire was administered to determine the number of ophthalmic complaints of 79 women who were postmenopausal at least 1 year (mean, 22 +/- 13.5 years) and were not using any ophthalmic drops or medication known to contribute to dry eyes. A Schirmer test with anesthesia was performed on each subject to quantify tear production. We found that the number of ophthalmic complaints of women taking HRT was statistically fewer (P = 0.015) than women not taking HRT. Women taking HRT for 5 years or longer had statistically fewer complaints and greater tear production, as measured by the Schirmer test, than women taking HRT for 5 years or less. The study concluded that women taking HRT have significantly fewer ocular complaints than women not taking HRT. HRT may help alleviate symptoms related to ocular dryness in postmenopausal women.

Effectiveness of hysterectomy.

OBJECTIVE: To measure the effectiveness of hysterectomy in relieving adverse symptoms and to identify factors associated with lack of symptom relief. METHODS: In a 2-year prospective study, data were collected before and at 3, 6, 12, 18, and 24 months after hysterectomy in 1,299 women who had hysterectomies for benign conditions at 28 hospitals across Maryland. Effectiveness was measured in terms of relief of symptoms such as problematic vaginal bleeding, pelvic pain, and urinary incontinence. Psychologic function and quality of life before and after surgery also were assessed. RESULTS: Symptom severity, depression, and anxiety levels decreased significantly after hysterectomy and quality of life improved, particularly in the area of social function. However, 8% of women had at least as many symptoms at problematic-severe levels 1 and 2 years after hysterectomy as before. In multiple logistic regression, several presurgical patient characteristics predicted lack of symptom relief, including therapy for emotional or psychologic problems, depression, and household income of $35,000 or less. Bilateral oophorectomy predicted lack of symptom relief at 24 months but not at 12 months after hysterectomy. CONCLUSION: Significant improvements were seen after hysterectomy for all three aspects of health status (symptoms, psychologic function, and quality of life), which persisted or continued to improve throughout the 2 years of follow-up. However, hysterectomy did not relieve symptoms for some women, particularly those who had low incomes or were in therapy at the time of hysterectomy.

Hysterectomy and sexual functioning.

CONTEXT: Women considering hysterectomy often are concerned about its potential effects on their sexual functioning but the effects of hysterectomy on sexual functioning remain unclear. OBJECTIVE: To examine changes in sexual functioning after hysterectomy. DESIGN AND SETTING: A 2-year prospective study (Maryland Women's Health Study) of hysterectomy, which included measures of sexual functioning prior to hysterectomy and at 6, 12, 18, and 24 months after hysterectomy, performed during 1992 and 1993. PATIENTS: Of 1299 women interviewed prior to hysterectomy, 1101 (84.8%) completed the study and provided information about their sexual functioning. Most were between the ages of 35 and 49 years, white, married or living with a partner, and high school graduates. MAIN OUTCOME MEASURES: Frequency of sexual relations, dyspareunia, orgasm, vaginal dryness, and sexual desire. RESULTS: The percentage of women who engaged in sexual relations increased significantly from 70.5% before hysterectomy to 77.6% and 76.7% at 12 and 24 months after hysterectomy. The rate of frequent dyspareunia dropped significantly from 18.6% before hysterectomy to 4.3 % and 3.6% at 12 and 24 months after hysterectomy. The rates of not experiencing orgasms dropped significantly from 7.6% before hysterectomy to 5.2% and 4.9% at 12 and 24 months after hysterectomy. Low libido rates also decreased significantly from 10.4% before hysterectomy to 6.3% and 6.2% at 12 and 24 months after hysterectomy. The distribution of women not reporting vaginal dryness in the past month improved significantly from 37.3% before hysterectomy to 46.8% and 46.7% at 12 and 24 months after hysterectomy. Prehysterectomy depression was associated with experiencing dyspareunia, vaginal dryness, low libido, and not experiencing orgasms after hysterectomy. CONCLUSIONS: Sexual functioning improved overall after hysterectomy. The frequency of sexual activity increased and problems with sexual functioning decreased.

Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function.

OBJECTIVES/HYPOTHESIS: To evaluate the impact of a pelvic fracture on a woman's physical, sexual, and reproductive functioning. DESIGN: Retrospective review. SETTING: Level one trauma center. PATIENTS: Two groups of female multitrauma patients: those with pelvic fractures (subjects) and those with extremity fractures but no pelvic fracture (controls). MAIN OUTCOME MEASUREMENTS: Of the 302 women eligible for participation in this study, 255 (80%; 123 subjects, 118 controls) were interviewed by blinded professional interviewers regarding genitourinary symptoms, sexual function, and reproductive history. RESULTS: Urinary complaints occurred significantly more frequently in subjects than in controls (21 versus 7%, respectively; p = 0.003), in subjects with residual pelvic fracture displacement > or = 5 mm than in those without displacement (33 versus 14%, respectively; p = 0.018), and in subjects with residual lateral (60%) or vertical (67%) displacement than in those with medially displaced fractures (21.4%) (p = 0.04). Although both groups reported increased rates of cesarean section, this increase was statistically significant only in the subject group: 14.5% preinjury versus 48% postinjury (p < 0.0001). Adjusting for previous cesarean sections, cesarean section was significantly more frequent in subjects with fractures initially displaced > or = 5 mm (80%) than in those with fractures initially displaced < 5 mm (15%) (p = 0.02). There was no difference in the incidence of miscarriage or infertility between the groups. Problems with physiologic arousal or orgasm were rare. Pain during sex (dyspareunia) was more common in subjects with fractures displaced > or = 5 mm than in those with nondisplaced fractures (43 versus 25%, respectively; p = 0.04). CONCLUSIONS: We found that pelvic trauma negatively affected the genitourinary and reproductive function of female patients. The increased rate of cesarean section in women after pelvic trauma may be multifactorial in origin and warrants further investigation.

Cost-Effectiveness of Laparoscopic-Assisted Vaginal Hysterectomy

This study enrolled nearly 1300 women having hysterectomy for benign indications at 28 hospitals during 1992 and 1993. Of these procedures, 816 were performed abdominally, 311 vaginally, and 154 were laparoscopic-assisted vaginal hysterectomies (LAVH). On average, LAVH was more expensive ($4294) than abdominal ($2753) and vaginal ($2312) hysterectomies, primarily due to higher operating room and surgical supply costs. Women who had LAVH were younger, had higher incomes, were more educated, more likely to be treated at nonteaching and smaller hospitals, and had lower comorbidity scores than those in the other two groups. After adjusting for these differences, LAVH was not significantly different from vaginal hysterectomy in terms of operative and postoperative complications, readmissions, postoperative days of pain, days in bed, days of feeling tired, days before resuming full activities, and days before going back to work full time. Compared with abdominal hysterectomy the vaginal groups combined had significantly fewer days of pain, days of feeling tired, and days back to work full time. By 6 months after surgery the three groups were quite similar in terms of patient satisfaction and other outcome measures.

Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis.

OBJECTIVE: To investigate racial differences in the presence of leiomyomas, condition severity, associated symptoms and age at diagnosis between black and white hysterectomy patients. STUDY DESIGN: This study included 409 black women and 836 white women aged 18 or older who underwent hysterectomy for noncancerous conditions at 28 hospitals in Maryland. Patients were interviewed shortly before surgery, and hospital records were abstracted after discharge. RESULTS: Overall, 89% of the black women and 59% of the white women were found to have leiomyomas. Among those with a confirmed presurgical diagnosis of leiomyomas, the average age at diagnosis was 37.5 years for black women and 41.6 for white women, and the average age at hysterectomy was 41.7 for black women and 44.6 for white women. The average uterine weight for black women with leiomyomas was 420.8 g and for white women was 319.1 g. Black women were more likely to have seven or more leiomyomas (57%) in comparison to white women (36%). Black women with leiomyomas were more likely to be anemic (56%) than white women (38%) and more likely to report having very severe or severe pelvic pain (59%) than white women (41%). CONCLUSION: Black women having hysterectomy had larger and more numerous leiomyomas, and the leiomyomas were more symptomatic than in white women despite a younger age at diagnosis and hysterectomy.

Hysterectomy and race.

OBJECTIVE: To investigate black-white differences in factors related to hysterectomy. METHODS: Discharge summary data were analyzed for 53,159 hysterectomies that occurred in Maryland from 1986-1991. RESULTS: The average annual age-adjusted hysterectomy rate was higher for black women (49.5 per 10,000) than for white women (41.2 per 10,000). For 65.4% of the hysterectomies in black women, the principal diagnosis was uterine fibroids, compared to 28.5% for white women. Logistic regression was used to measure the effect of race on complications, length of stay, and mortality after adjustment for a variety of factors including age, comorbidities, diagnosis, route (abdominal, vaginal, or subtotal), hospital characteristics, and source of payment. In comparison to white women, black women having hysterectomy were found to have an increased risk of one or more complications of surgical or medical care (odds ratio 1.4, 95% confidence interval [CI] 1.3-1.5), a length of stay of more than 10 days (odds ratio 2.7, 95% CI 2.5-3.1), and in-hospital mortality (odds ratio 3.1, 95% CI 2.0-4.8). CONCLUSIONS: In a study of more than 53,000 hysterectomies, black women were more than twice as likely to have a diagnosis of uterine fibroids as white women, were more likely to have complications, had a longer hospitalization, and had more than three times the in-hospital mortality rate.

The socioeconomic correlates of hysterectomies in the United States.

The purpose of this study was to examine the relationship between incidence of prior hysterectomy and education, income, and race. Data concerning previous hysterectomy and socioeconomic information were collected from 12,465 women 18 years or older as part of the Behavioral Risk Factor Surveillance System conducted in 16 states in 1988. The results indicate that women with less education and lower incomes were more likely to have had a hysterectomy. Race was not related to hysterectomy rate.

Ovarian pregnancy diagnosed after a failed midtrimester therapeutic abortion. A case report.

Ovarian pregnancy is a rare phenomenon. Its presentation often is difficult to distinguish from that of tubal ectopic pregnancy and hemorrhagic ovarian cyst. A patient had an ovarian pregnancy diagnosed following failed midtrimester therapeutic abortion in a suspected bicornuate uterus. Despite vaginal prostaglandin suppositories and intraamniotic instillation of urea and prostaglandin, neither the abortion process nor rupture of the ovarian pregnancy ensued. This is the first reported case of this most unusual presentation of ovarian pregnancy.

Toluidine blue in the corroboration of rape in the adult victim.

Objective physical evidence to corroborate a claim of rape is frequently absent. Genital lacerations are considered evidence that rape has occurred. In this study, toluidine blue dye, a nuclear stain, was used to detect vaginal lacerations. The detection of vaginal lacerations in reported rape victims increased from one in 24 to 14 in 24 with toluidine application. Toluidine blue increases the detection of perineal lacerations in adult rape victims and the presence of lacerations is supportive of the documentation of rape.

Toluidine blue in the detection of perineal lacerations in pediatric and adolescent sexual abuse victims.

Posterior fourchette lacerations are suggestive of sexual assault, and toluidine blue dye has increased the detection of these lacerations in adult rape victims. This study investigated the use of toluidine blue dye in the pediatric (0 to 10 years) and adolescent (11 to 18 years) patients to detect posterior fourchette lacerations in sexually abused and control populations. Application of toluidine blue dye increased the detection rate of posterior fourchette lacerations from 4% (1/25) to 28% (7/25) (P less than .05, Fisher exact test) in adolescent sexually abused patients and from 16.5% (4/24) to 33% (8/24) (P = .318, Fisher exact test) in pediatric sexually abused patients. Posterior fourchette lacerations occurred with the same frequency in sexually abused adolescents and sexually active controls adolescents. In the pediatric aged population, 33% of the sexually abused group had lacerations detected, whereas none of the control patients had lacerations. The presence of posterior fourchette lacerations in the pediatric aged patient is strongly suggestive of sexual abuse. Toluidine blue increases the detection of posterior fourchette lacerations in children and adolescents (P less than .001, Fisher exact test). The application of toluidine blue dye to highlight posterior fourchette lacerations is an important addition to tools already used in the evaluation of the sexually abused patient.

Change in obstetrician advice following a two-year community educational program on alcohol use and pregnancy.

A professional education program about the risks of drinking during pregnancy was conducted from 1979 to 1981 in King County, Washington. Advice of obstetricians to patients was measured both before and after the program. There was a significant increase in the proportion of obstetricians asking about current alcohol use of patients and in the proportion routinely recommending that alcohol be limited during pregnancy. When asked by their patients about the possible effects of alcohol on the fetus, obstetricians were more likely to mention fetal alcohol syndrome as a specific risk after the educational program. Patients of these obstetricians also reported similar, although somewhat more conservative attitudes. While no control group without access to the educational program was available, sources of information about drinking and pregnancy cited by obstetricians indicated that the program was influential in the change that occurred in the 2-year period.

Incest and pelvic pain: the social worker as part of a research team.

This article suggests the valuable role a social worker can play as a researcher on a multidisciplinary team. In a study conducted by a gynecologist, a social worker, a psychiatrist, and a psychologist, women experiencing chronic pelvic pain were found to be profoundly affected by factors other than organic disease, such as traumatic early childhoods, psychopathology, and incest in a significant number of cases.

Psychosexual functioning in symptomatic and asymptomatic women with and without signs of vaginitis.

Women with symptoms of vaginitis, but no microbial etiology for their condition (the experimental group) were compared to women with symptoms and abnormal findings on examination, women with no symptoms and abnormal findings on examination, and women with no symptoms and normal findings on examination. Comparison was on a variety of measures of personality, marital satisfaction, and sexual function. All women were found to have normal personality structure as measured by the Minnesota Multiphasic Personality Inventory (MMPI). However, the experimental group differed from the others in their objective sexual function, subjective level of enjoyment, and the extent to which they were affected by their vaginal symptoms.

Prevention of Fetal Alcohol Syndrome: a model program.

This article describes a new 3-yr demonstration program, funded by NIAAA, to intervene in female alcohol abuse during pregnancy and to prevent fetal alcohol syndrome.