[Health Council of the Netherlands' report on contraception in intellectually disabled people]. / Gezondheidsraadadvies over anticonceptie voor mensen met een verstandelijke handicap.

Recently the Health Council of the Netherlands published a comprehensive report which incorporates juridical, ethical, medical and social aspects directing the judgement and decision-making regarding contraception in people with an intellectual disability. Although professional responsibility is in the hands of medical practitioners, medical guidelines to manage consent issues and to indicate contraception in this population are missing. There are no ethical and legal grounds for enforcing contraception and it comes down to professional accountability in trying to prevent irresponsible parenthood by a convincing dialogue. People with intellectual disabilities are intellectually, physically, socially and economically prone to be vulnerable parents, who need assistance in making deliberate choices to have children and in raising them. There is an urgent need for advanced sexual education and a comprehensive social discussion on contraception for this population. Physicians for intellectually disabled people embrace the committee's recommendations to stimulate public debate, enhance research, develop guidelines and build professional networks to call on.

[Transsexualism and schizophrenic psychosis. Problems preparing expert opinion on transsexualism]. / Transsexualismus und schizophrene Psychose. Probleme bei der gutachterlichen Beurteilung nach dem Transsexuellengesetz.

We report on two schizophrenics with transsexual beliefs to illustrate the problems in nosological classification of these patients and the difficulties in preparing expertises on changing the first name or on the legal changing of sex status according to the German Transsexuals Act (TSG). We should differentiate between rare cases of true comorbidity of schizophrenia and transsexualism, and other patients in whom the transsexual wish presents as a symptom of psychosis. Before approving any legal changes or even sex reassignment surgery, the transsexual wish should have remained unchanged under otherwise successful antipsychotic treatment. Moreover, the patients must be able to translate into reality the desired sexual role in their social environment.

Female and male sterilization and refertilization in Sweden.

In Sweden, approximately 1,500 men and 7,000 women are sterilized yearly. The frequency varies considerably between regions. The reasons for these differences are not fully known. More women than men are sterilized in Sweden, but a higher proportion of sterilized men undergo refertilization. The object of the study was to analyze counselling routines prior to sterilization, presterilization waiting time, the number of refertilizations performed, the attitudes of the operating departments towards refertilization, and the possible relation between frequency of refertilization and incidence of sterilization. A questionnaire was mailed to all units performing refertilizations and/or sterilizations of mean and women in Sweden (n = 161). The response was 93%. Counselling routines and waiting times before sterilization varied, which influenced the operation's availability. The frequency of refertilizations varied considerably between counties from 0.5 to 5.4 per 100,000 inhabitants. There was no correlation between frequency of sterilizations and refertilizations. The rate of refertilization appears to be determined mostly by the local attitudes of the health authority. The Swedish sterilization law has had a heterogeneous impact in the country.