No change in adolescents' neglect on contraceptive use over two decades.

PURPOSE: The sexual activity and contraceptive use is evaluated over 21 years amongst Danish adolescents in ninth grade. METHODS: A repeated, cross-sectional questionnaire study in the municipality of Viborg, comparing the results of four consecutive surveys between 1986 and 2007. RESULTS: In 2007, 40% of the pupils had sexual debut at an average age of 15.3 ± 1.5 years. At sexual debut condoms were used in 77% of the adolescents and the contraceptive pill in 15%. At their latest coitus 34% used any contraceptive pill as 27% of pupils changed from use of condom to the pill. Practical experience with condoms was found in 90% of both sexes at sexual debut. Fourteen percent of the adolescents used no contraception at all at debut in 2007, which is similar to 1986, 1993, and 2000. Eighteen percent of the pupils used no contraception at all at their last intercourse in 2007 and 2000. CONCLUSION: Knowledge about and use of condoms is substantial amongst adolescents already at sexual debut. A shift is confirmed from condoms at first coitus to more frequent use of the pill later on. A considerable number of pupils (10-20%) are neither protected against sexually transmitted infections nor pregnancy at first or later intercourse.

Gender-specific knowledge on sex.

PURPOSE: A study of what sources of knowledge on sex education, reproductive physiology and abortion was sought by adolescents at school. METHODS: A cross-sectional questionnaire study of 9th grade pupils in the municipality of Viborg, Denmark in 2007 compared with similar studies performed in 1986, 1993 and 2000. RESULTS: A total of 394 of 398 questionnaires were answered in 2007. The age of the pupils was 15.3 ± 1.5 years. In 2007, the limits for legal abortion were known by 64% of the pupils. The boys, who had had sexual debut, answered the question most correctly and the girls with no prior sexual experience the least correctly. The legal aspects of abortion in a 16-year-old girl were known by 58% of the pupils. The school was the most important source of information for the pupil without sexual debut. The adolescents who had sex indicated more use all other sources of information than those without debut. Half of the girls indicated they used magazines as a source of information, whilst only 40% of the boys mentioned pornography and magazines. The contents of girls' choice of magazines suggest that the use of written pornography as substantial source of information on sexual education. Friends/peers play a major role in sexual knowledge for both genders. CONCLUSION: In 2007, school and friends/peers still play a large role in the sexual education of the 9th grade pupils, but screen-based and magazine media whose content include substantial pornographic material share the third place.

[Long-term follow-up after endometrial ablation. A questionnaire study on bleedings, hormone treatment and surgery]. / Langtidsopfølgning efter endometrieresektion. En spørgeskemaundersøgelse om blødninger, hormonbehandling og operationer.

INTRODUCTION: Long-term follow-up 11 years after endometrial ablation. MATERIAL AND METHODS: A questionnaire on menstruation, hormone treatment, and surgery was conducted among women who had 420 endometrial ablations during the 1990-96 period; the results were analysed in conjunction with register data on cancer, surgery and obstetric history. RESULTS: A total of 82% of the questionnaires were answered. In all, 26% of the women who received hormone treatment after ablation subsequently had a hysterectomy compared with 34% of the women who received no hormone treatment after ablation (p = 0,28; chi(2)-test). Hysterectomy was associated with occurrence of meno-/metrorrhagia. However, the number of women who were hysterectomised was distributed evenly throughout the duration of hormone treatment. The time of hormone treatment according to the ablation was not associated with the distribution of meno/metrorrhagia or whether the women subsequently had a hysterectomy. We observed three women with incidental endometrial cancer at follow-up, here of one in a polyp, and the expected number was 6,8 cases. CONCLUSION: Endometrial ablation is a good treatment for menorrhagia, but in 40% of cases it is followed by further gynaecological surgery. Hormone treatment was not found to have any effect on the course of events. No additional cases of incidental cancer were noted at follow-up.

[Vaginal rupture as a late complication of hysterectomy]. / Vaginaltopruptur som senkomplikation ved hysterektomi.

We report a patient with intracoital vaginal rupture two months after a hysterectomy. The case was managed successfully by simple suturing of the vaginal vault.

[Knowledge of contraception, pregnancy, and sexuality in ninth grade pupils in the municipality of Viborg during a 21-year-period]. / Viden om praevention, graviditet og seksualitet gennem 21 år hos 9. klasser i Viborg.

INTRODUCTION: A study of the sources of and the changes in the knowledge about contraception, pregnancy, and sexuality during a 21-year-period. MATERIAL AND METHODS: A questionnaire was handed out on the same day in all ninth grade classes in the Municipality of Viborg without prior notice to teachers or pupils. The results were compared with similar studies performed in 1986, 1993, and 2000. RESULTS: In all 394 of 398 questionnaires were answered. The answers revealed that forty-three percent knew at which time in the cycle pregnancy can occur; boys with sexual debut scored lowest. The time limits for legal abortion were known by 64%, the girls had a higher level of knowledge on this item than the boys. The abortion limits for 16-year-old girls were known by 58%, but here the boys, who had made sexual debut, scored highest and the girls with no prior sexual experience scored lowest. The sources of knowledge changed over the years; screen-based media (TV, internet) now cover more than 30% of both gender's sources, and magazines/pornography comprise more than 50% of girls' and 30% of boys' sources of knowledge. The school's and friends' share in sexual education remained constant, while books and parents as knowledge sources show a downward trend. CONCLUSION: School and friends still play a substantial role in the sexual education of ninth grade pupils, but screen-based media and magazines are now the third-most important source of information and their importance have increased considerably over the past seven years. Knowledge of time limits for abortion, early pregnancy signs and cycle has not changed except for slight gender differences.

[Sexual activity and use of contraception in ninth grade pupils during the last 21 years]. / Seksuel aktivitet og praeventionsvaner hos unge gennem 21 år.

INTRODUCTION: The study surveys sexual activity, use of contraception at sexual debut and changes in sexual habits during a 21-year period. MATERIAL AND METHODS: A questionnaire was handed out on the same day in all ninth grade classes in the Municipality of Viborg. Neither teachers nor pupils were given prior notice. The results were compared with similar studies performed in 1986, 1993 and 2000. RESULTS: A total of 394 of 398 questionnaires were answered and returned. In both genders, 40% had had debuted sexually. The frequency among the boys had increased in comparison with the previous 21 years. The amount of sexual debuts before the legal age of consent at 15 years was 18%, which is similar to previous years. In both genders an increased proportion had experienced coitus within the last week. Condoms were used by 76% and the pill by 15% at sexual debut. Subsequently, 27% shifted from condom use to pill use alone or in combination with a condom at the latest coitus; thus, 34% used the pill at their latest coitus. Practical experience with condoms was found in 90% of both genders among those who had debuted sexually, while 56% of the boys and 68% of the girls indicated that they had experience with the pill. CONCLUSION: Knowledge of and use of condoms are widespread among adolescents already at sexual debut. A shift from the use of condoms to more frequent use of the pill occurs from debut to later coitus. A considerable amount of adolescents (10-20%) still do not protect themselves against sexually transmitted diseases and pregnancies at debut or later coitus.

[Sex education and knowledge of venerial disease among public school 9th graders]. / Seksualundervisning og viden om kønssygdomme hos 9. klasses elever.

INTRODUCTION: A study on knowledge of venereal diseases, opinions on sexual matters, and satisfaction with sex education at school. MATERIAL AND METHODS: A questionnaire was handed out on the same day in all ninth grade classes in the municipality of Viborg without prior notification of teachers and pupils. RESULTS: A total of 394 of 398 questionnaires were answered and returned. Only 36% were fully satisfied with the sex education imparted at school, while 70% of the teenagers were satisfied with the quantity. Satisfaction was similar between genders, but more marked among those without sexual debut as 66% were satisfied, while just 47% of those with sexual debut thought sex education was satisfactory (p < 0.006). Knowledge of venereal disease like hiv/aids, chlamydia and herpes simplex was high (> 80% of pupils). A total of 58% of boys and 76% of girls identified chlamydia as the most common venereal disease (p < 0.0001, girls vs. boys), while 26% of the boys and 27% of the girls answered AIDS/HIV (p < 0.75). Finally, 13% of boys and 6% of girls wrote "don't know" or did not answer the question. Having had sexual debut increased knowledge of chlamydia's status as the most common venereal disease to 85% among girls (p < 0.03). Knowledge of the symptoms and risks of chlamydia is rather limited. The girls were more aware of the fact that it may cause sterility (p < 0.001, girls vs. boys) and that it occurs symptomless (p< 0.02). The respondents' guess as to how many of the girls and boys had experienced sexual debut was not associated with gender but with own sexual debut. Those with no sexual debut guessed better than the pupils with sexual debut, as 77% of boys and 81% of girls with no sexual debut guessed correctly. CONCLUSION: The sex education curriculum should be differentiated with regard to sexual debut or not in order to increase satisfaction with teaching and increase the school's contribution to improve sexual knowledge and behaviour.

[Analysis of need for sick leave after hysterectomy]. / Vurdering af rekreationsbehovet efter hysterektomi.

INTRODUCTION: The recommended sick leave after hysterectomy varies among operating wards and depends on many non-medical issues. The recommendation is rarely validated scientifically and is often without any connection to the women's actual handling of the leave if this is not recorded as part of a project. We analysed the postoperative period for a group of hysterectomised women who kept a diary over eight weeks. MATERIALS AND METHODS: Between July 2005 and June 2006 all hysterectomised women entered the diary project if they fulfilled the following criteria: the operation was indicated by meno-metrorrhagia, dysplasia, pressure symptoms or pain, she was under 60, she was Danish-speaking and in full-time work which was to be recommenced after operation. Women were excluded if they were operated for descended uterus, if a major re-operation was performed or, unexpectedly, endometriosis or malignancy was found. Our ward's recommendation on sick leave was four weeks for vaginal hysterectomy and six weeks for abdominal hysterectomy, but with emphasis on the necessary individualization of sick leave. Once a week, the women answered eight questions on their well-being and activities in the diary and returned the diary. RESULTS: In total, 71 women entered the study, 27 with vaginal hysterectomy and 44 with abdominal hysterectomy. After one week, none of the women suffered from nausea or discomfort, while 20% were still complaining of pain. Less than half of the women had commenced work one week after the recommended sick leave. At that time, two thirds had recommenced their former leisure activities but less than half of the women's sex lives were as before the operation. CONCLUSION: The majority of women extend their sick leave beyond the recommended period on their own initiative, despite the ward's long recommended period of sick leave. It is questionable whether the actual period of sick leave can be cut by shortening the recommended sick leave.

[Umbilical cord constriction caused by amniotic band]. / Navlesnorsafsnøring forårsaget af amnionbånd.

We present a fatal case of umbilical cord constriction caused by an amniotic band, which occurs in one of 100,000-150,000 births. Prelabour diagnosis is possible by ultrasonography and MRI, and surgical removal by fetoscopy is the only theoretically possible therapy.

[Vaginal vault fluid collection after hysterectomy. Frequency and clinical significance]. / Vaginaltopansamling efter hysterektomi. Hyppighed og klinisk betydning.

INTRODUCTION: Our aim was to investigate the prevalence of sonographically detectable vault fluid collection after hysterectomy and its relation to post-operative morbidity. MATERIALS AND METHODS: We studied a group of 103 women below 60 years of age who had undergone abdominal or vaginal hysterectomy for benign causes apart from uterovaginal prolapse. A transvaginal ultrasound examination was carried out 24 to 72 hours after surgery. A telephone follow-up and a record review were done six to eight weeks later to determine the morbidity rate. RESULTS: Of the 103 women scanned, 39 (38%) had sonographically detected vaginal vault fluid collection. A haemoglobin concentration drop was observed in a significant number of patients (33% vs. 13%) who had fluid collection in the immediate post-operative period. At follow-up, a significant increase in the complaints of post-operative pain (15% vs. 42%) and re-presentation (32% vs. 55%) was seen in the fluid collection group. The increased risk of re-presentation was not accompanied by an increased risk of needing additional treatment. CONCLUSION: Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Vaginal ultrasound examination should not be performed routinely after hysterectomy.

[Ultrasonically verified vesicouterine fistula]. / Ultralydverificeret vesikouterin fistel.

We report a case of a vesicouterine fistula occurring after a Caesarean section. There was a noticeable delay in recognizing the fistula, which was, however, clearly visible on a vaginal ultrasound scanning. When urinary incontinence is developed after gynaecologic or obstetric surgery, a fistula must be suspected.

The short-term prevalence of de novo urinary symptoms after different modes of hysterectomy.

The aim of this study was to determine the short-term prevalence of de novo urinary symptoms after hysterectomy indicated by meno/metrorrhagia or dysmenorrhea/dyspareunia. The study group consisted of 451 women who had had a hysterectomy for reasons of meno/metrorrhagia or dysmenorrhea/dyspareunia. Fifty-three (12%) had a supracervical, 151 (33%) a total abdominal and 247 (55%) a vaginal hysterectomy. As a non-gynecologic background population we enrolled 110 women who had had their gallbladder removed laparoscopically. All women received a postal questionnaire 9-45 months after their operation. Specific questions were asked about their voiding habits, comprising significant stress incontinence, bothersome stress incontinence, significant urge incontinence, bothersome urge incontinence, pollakisuria, nocturia, use of pads, and the feeling of having a hygiene problem. To evaluate de novo symptoms or de novo cure, the women assessed the symptoms before as well as after the operation. Results showed that abdominal hysterectomy lasted longer, had heavier blood loss and required longer hospitalization than did vaginal or supracervical hysterectomy. Women scheduled for a supracervical hysterectomy had preoperatively more significant and bothersome urge incontinence, and postoperatively more significant urge, urgency, and feeling of having a hygienic problem than did women having a vaginal hysterectomy, a total abdominal hysterectomy or a laparoscopic cholecystectomy. When assessing de novo symptoms, supracervical hysterectomy was associated with more urgency and the feeling of having a hygienic problem. Some women experienced de novo cure, but these were almost exclusively in the study group and rarely in the control group. It was concluded that supracervical hysterectomy is related to more urinary symptoms than vaginal or total abdominal hysterectomy. De novo symptoms as well as de novo cure are common, which is why urinary symptoms after hysterectomy must be evaluated over time.

[Recurrent Paget's disease of the vulva in a skin graft]. / Recidiv af morbus Paget i hudtransplantat på vulva.

Paget's disease of the vulva is rare, but has a high rate of recurrence, even in skin grafts as our case shows. The histogenesis of such a recurrence has not yet been satisfactorily elucidated. We therefore recommend careful and long-term follow-up.

[Retained fetal bones in uterus]. / Retinerede føtale knoglerester i uterus.

We report a case of menorrhagia caused by retained fetal bones after a missed abortion in the second trimester. By hysteroscopy several bone fragments were removed. The patient got pregnant two months later.

[Long-memory of labor pain]. / Langtidshukommelse for fødesmerte.

BACKGROUND: The aim of the study was to investigate the stability of labour pain recall 14-21 months after delivery, and to relate it to events during labour. MATERIAL AND METHODS: One hundred and fifteen primipara completed a visual analogue scale (VAS) on the second day after delivery, and a similar VAS 14-21 months later. Women who were delivered before completing 37 gestational weeks, had a multiple pregnancy, needed epidural analgesia, or whose infant was transferred to the neonatal care unit were excluded. Data were analysed by three different methods to minimise bias. By method 1, the proportion of VAS 2 > VAS 1 was calculated. By method 2, the accuracy of recall was defined from the equation -1 < or = VAS 2--VAS 1 < or = 1. By method 3, the VAS used was regarded as an unlimited scale, but with all observations shortened to the interval, 0 to 10 cm. Pain scores were related to obstetrical data: instrument delivery, fetal weight, duration of second stage of labour, use of pethidine and use of pudendal analgesia. RESULTS: Thirteen of 20 women (65%) who had received pethidine during labour reported a higher VAS 2 than VAS 1, compared to 27 of 95 (28%) women who had not received pethidine (p = 0.003). According to method 2, 35% of the pethidine-treated women overestimated labour pain on recall, compared to 13% in the non-pethidine-treated group (p < 0.05). According to method 3, women who were not treated with pethidine showed a decrease of 0.81 cm on the recalled VAS, compared to an increase of 1.13 cm in the pethidine-treated group (p < 0.01). None of the other investigated events during labour were related to pain recall. DISCUSSION: In general, labour pain recall fades over time or tends to be stable, but to a significantly higher number of women receiving pethidine, pain seems to intensify on recall. If further investigations show that this is an effect of pethidine itself, opioids should be used with caution during labour.

Premenopausal metrorrhagia as a symptom of sarcoidosis.

Sarcoidosis rarely affects the female genitalia. We report a 36-year-old woman who had a hysterectomy for metrorrhagia. Histologic examination showed sarcoid granulomas in the endometrium and myometrium. Subsequent examinations revealed pulmonary sarcoidosis as well.