Radiotherapy in the management of cervical cancer in elderly patients.

PURPOSE: To report treatment results and complications experienced by elderly patients treated with curatively intended radiotherapy for cancer of the uterine cervix. PATIENTS AND METHODS: One hundred and fourteen elderly patients (median 75.5 years, range 70.0-85.9) consecutively referred for curative radiotherapy in the period 1987-1996 were prospectively followed with regard to tumour control and complications. The importance of age, stage (FIGO), tumour size, histology, tumour fixation, haemoglobin, concurrent disease, performance status (WHO) and type of radiotherapy were assessed using univariate and multivariate analyses. RESULTS: Treatment was completed as planned in 68%, delayed in 29% and stopped prematurely in 3%. The frequency of grade 3 late complications was 11% and the actuarial probability at 5 years was 20%. Overall 5-year survival according to FIGO was 61% (I), 34% (II) and 25% (III). Cox multivariate analysis identified tumour size as independent prognostic factor for tumour control, disease-free survival and overall survival. FIGO stage was predictive for late grade 2 complications. We were unable to identify significant factors with respect to grade 3 complications. Age was not a significant parameter for any of the investigated endpoints. CONCLUSION: Elderly patients in good performance status with advanced cancer of the uterine may tolerate radical radiotherapy with acceptable morbidity and reasonable survival. Radiotherapy may also be a good alternative in early stage disease for surgically unfit elderly patients.

Life after radiotherapy: the psychological and social effects experienced by women treated for advanced stages of cervical cancer.

PURPOSE: The aim of this study was to describe the psychological and social reactions of women with advanced stages of cancer of the cervix during and after radiotherapy. METHODS: A questionnaire about health-related quality of life was used, which consisted of the EORTC QLQ-C30 and additional specific questions. One-hundred eighteen patients filled out the questionnaire at the end of treatment and 1, 3, 6, 12, 18, and 24 months later. The scores from the disease-free patients were compared to those from 236 healthy controls. RESULTS: Many patients experience psychological and social consequences at the end of treatment and 1 to 3 months later. Patients continue to think about their illness and treatment throughout the 24-month study period, but find it increasingly hard to share their worries with others. Their score on overall quality of life never reaches that of the controls. CONCLUSION: Disease-free patients treated for cancer of the cervix with radiotherapy have psychological reactions. The interpretation of the results should take into consideration that the patients change their personal frame of reference over the course of time. Professionals should be aware of patients' needs to talk about their disease long after treatment. Patients should be informed about the risk of psychological reactions. The more information about possible symptoms they receive the better their ability to cope with them should they arise.

The patients' perspective on physical symptoms after radiotherapy for cervical cancer.

PURPOSE: The aim of this study was to describe the physical symptoms experienced by patients with advanced stages of cervical cancer during the first 2 years after radiotherapy. METHODS: A questionnaire about health-related quality of life was used. It consisted of the EORTC QLQ-C30 and additional specific questions. The patients were assessed at the end of treatment and 1, 3, 6, 12, 18, and 24 months later. The scores from the 118 patients were compared to those from 236 healthy controls. RESULTS: Most patients had acute physical symptoms at the end of treatment and up to 3 months later. Local symptoms such as frequent voiding and diarrhea may become chronic symptoms. CONCLUSION: Assessment of health-related quality of life includes information about milder side effects that is not usually included in physician scoring of morbidity. Information about possible side effects improves the patient's ability to cope with the symptoms should they occur.

[Post-partum stay at the maternity ward vs. ambulatory delivery--seen from the women's point of view]. / Barselsophold versus ambulant fødsel--set fra kvindernes synsvinkel.

The purpose of the present study was to examine the benefit of post-partum in-hospital maternity stay among primi- and multipara and to explore the attitude to post-partum in-hospital stay versus outpatient delivery in the future. The study design was a prospective survey with 335 participants. Independent of parity 95% of the women in confinement found it important/very important to be able to have the reassurance and safety of staying on the maternity ward and to be able to obtain help when needed. Concerning future births, 86% of the women in confinement wanted to stay in the hospital post-partum, while 12.5% would consider outpatient delivery, if the same midwife visited them daily at home during the first week. Among the women wanting a future outpatient delivery, there was an excess of women who did not feel that their need for peace and quiet had been fulfilled at the present post-partum in-hospital stay, and the women had needed more help in establishing nursing. Twice as many primi- as third/fourth para wanted a future out-patient delivery. In conclusion, if it were decided to do away with the post-partum maternity in-hospital stay for multiparae due to budget cuts, it would clearly be against the women's wishes. The in-hospital maternity stay was appreciated among all women irrespective of parity.

[Optimization of radiotherapy of cervical cancer. Introduction of an extern radiotherapy based on CT and low-dosage afterload technique at the Rikshospitalet]. / Optimering af strålebehandling af cervixcancer. Introduktion af ekstern strålebehandling baseret på CT og lav dosishastigheds afterloading-teknik på Rigshospitalet.

In September, 1987 remote controlled afterloaded caesium in treatment of carcinoma was introduced at the Department of Oncology, Copenhagen University Hospital. All patient data, treatment, complications and deaths were registered prospectively. This study describes treatment results of the first 178 consecutively treated patients. The four year survival rates for patients stage I, II and III were 70%, 68% and 43%, respectively. The stage I patients were all considered unfit for surgery due to age or other medical conditions. During the observation period 13 patients developed severe complications requiring surgery, and three of these patients died. It was concluded that treatment with afterloaded caesium for carcinoma of the cervix has reduced radiation of the medical personnel to an almost unmeasurable dose, that the treatment results were comparable to those of the larger centres in the world and that the new treatment technique suggests further improvement in the treatment of cervical carcinoma.

Early- and late-onset pelvic inflammatory disease among women with cervical Chlamydia trachomatis infection at the time of induced abortion--a follow-up study.

After termination of a double-blind, randomized study on erythromycin in the prevention of post-abortion infection, 34 women (14 treated with erythromycin, 20 not treated with erythromycin) harbouring Chlamydia trachomatis were followed up within 6 weeks and again 2 to 24 months after the abortion in order to detect an early- and late-onset pelvic inflammatory disease (PID). For statistical analysis survival analysis by Kaplan-Meir estimates and Mantel-Cox test were carried out. Untreated women with C. trachomatis infection at the time of abortion had a cumulative risk of 72% of developing early and/or late PID, if observed for 24 months. This cumulative risk was significantly reduced to 8% if the C. trachomatis infection was treated at the time of the abortion. Screening for and treatment of C. trachomatis is warranted, especially in women < or = 25 years old, to avoid early and late-onset PID after induced first trimester abortion.

Sexuality among gynecologic cancer patients--a cross-sectional study.

To establish the prevalence of sexual activity among gynecologic cancer patients and to estimate the extent of sexual problems, a cross-sectional study using questionnaires was used. All patients (pts) had gynecologic cancer treated with chemotherapy or radiation therapy and attended the gynecologic outpatient department at Rigshospitalet, Copenhagen from December 1, 1989 to January 31, 1990; 146/186 (78%) pts participated. The study describes the 107/146 (74%) pts who had a partner. Median ages for pts with endometrial, cervical, and ovarian cancers were 63, 55, and 52 years, respectively. The median time since diagnosis was 15 months (range, 0-311 months). Little or no desire for sexual relations was found among 74% of the patients and 42% of their partners, but 54% of the patients were sexually active, 79% of the patients < 55 years old, and 37% of the patients > 55 years old. Sexual activities were not related to diagnosis or stage of disease. Among the sexually active patients 40% experienced dyspareunia. Only 22% of all patients with a partner expressed dissatisfaction with their sexual life or lack thereof. Despite considerable decrease in sexual desire and frequent dyspareunia, many gynecologic cancer patients continue to be sexually active. Gynecologic cancer patients of all ages should be supplied with information on the possible sexual changes their disease may evoke, but they should also be reassured that many patients regain their sexual capacity and satisfaction.

[Genital Chlamydia trachomatis infection in abortion seekers. Strategy of examination and treatment in order to reduce the sequelae of the infection]. / Genital Chlamydia trachomatis infektion hos abortsøgende. Undersøgelses- og behandlingsstrategi for at mindske infektionssequelae.

Among women applying for termination of pregnancy, 5-17% are infected with Chlamydia trachomatis. The prevalence is higher among women under 20 years of age (12-30%), in nulliparae and when Neisseria gonorrhoeae are found simultaneously. If women applying for termination of pregnancy with Chlamydia infection are not treated, 10-60% will develop pelvic infection after abortion. Salpingitis caused by Chlamydia runs a milder clinical course than salpingitis caused by gonococci or other etiology but salpingitis due to Chlamydia is regarded as one of the most important causes of tubal infertility and extrauterine pregnancy. The symptoms may be discharge and dysuria or objective findings such as cervicitis and pathological findings in wet smears of the cervical secretion. The majority of women applying for termination of pregnancy with Chlamydia infection have no symptoms. Only few investigations have analysed Chlamydia infection in connection with sexual behaviour and association between Chlamydia infection and the number of sexual partners has been demonstrated. Direct immune fluorescent microscopic examination or enzyme immune examination of material from the cervix and urethra may be employed in women applying for termination of pregnancy on account of the rapid results. Tetracyclines and erythromycin may be employed for treatment of demonstrated Chlamydia infection. Completion of treatment prior to abortion is probably not necessary. The sexual partners should be treated.

[Presence of genital Chlamydia trachomatis in abortion seekers--correlates with young age and nulliparity but not with previous genital infection]. / Genital forekomst af Chlamydia trachomatis hos abortsøgende--korrelerer med ung alder og nulliparitet, men ikke tidligere underlivsbetoendelse.

Out of 432 women applying for termination of pregnancy, 7.9% (34/428) had cervical Chlamydia trachomatis and 0.7% (3/431) genital Neisseria gonorrhoeae. The prevalence of Chlamydia was 19.2% among the women applying for termination who were under 20 years and 12.8% among those aged 21-25 years. The finding of Chlamydia among nulliparae was 14.5%. Only 2.8% of the women with Chlamydia had previously had pelvic infections. Women with Chlamydia did not have significantly greater frequency of previous venereal diseases. It is concluded that women under the age of 25 years and nulliparae who apply for termination of pregnancy should be examined for Chlamydia and should be treated in connection with the intervention. Previous pelvic infections are observed significantly more rarely in women with Chlamydia applying for termination and thus do not constitute an indication for examination for Chlamydia. It is not yet elucidated whether women with previous venereal diseases should be examined for Chlamydia. On account of the low prevalence, there are no indications for performing routine smears in women applying for termination of pregnancy for gonococci but, on the other hand it appears relevant to examine women with Chlamydia for gonococci as double infections are frequently present.

A double-blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion.

OBJECTIVE: To assess the prophylactic use of erythromycin in prevention of post-abortal pelvic inflammation disease (PID) in first trimester abortion. DESIGN: Double-blind, randomized controlled trial. SETTING: Department of Surgery, County Hospital, Denmark. SUBJECTS: Four hundred and thirty two women who were to undergo induced abortion before 12 weeks gestation were randomized to be treated either with prophylactic erythromycin or a placebo. INTERVENTION: The women were randomized to receive a placebo or erythromycin, 500 mg twice a day for 7 1/2 days starting the evening before the abortion. All the women were investigated for Chlamydia trachomatis and Neisseria gonorrhoea before the abortion. MAIN OUTCOME MEASURES: Frequency of cervical C. trachomatis and N. gonorrhoea and frequency of PID after abortion. RESULTS: Fifty four women were excluded after randomization. The frequency of PID was 11% (20/189) in the erythromycin group and 16% (30/189) in the placebo group (P = 0.13, chi 2-test). The prevalence of C. trachomatis was 19% (15/78) in women less than or equal to 20 years of age, 13% (14/109) in women between 21 and 25 years and 2% (5/241) in women greater than or equal to 26 years of age. In women positive for C. trachomatis erythromycin prophylaxis significantly reduced the frequency of PID to 8% (1/13) compared with 43% (6/14) in the placebo group (P = 0.051, logistic regression analysis). Erythromycin had no effect on other potential high risk groups (first pregnancy, nulliparous, less than 20 years of age, and women with previous PID). CONCLUSION: Prophylactic erythromycin is not warranted for all women having an abortion. Cervical C. trachomatis is a risk factor for postabortal PID, and prophylaxis with erythromycin significantly reduces the frequency of PID. However, only a few women with PID had cervical C. trachomatis, and the prevention of post-abortal PID remains a major challenge requiring further studies.

Hormonal and menstrual changes after laparoscopic sterilization by Falope-rings or Filshie-clips.

OBJECTIVE: To evaluate the influence of laparoscopic sterilization by Falope-rings (Cabot Medical Corp., Langhorne, PA) or Filshie-clips (Femcare, Nottingham, United Kingdom) on menstrual pattern and ovulatory function. DESIGN: A prospective, nonrandomized study of women sterilized by Falope-rings (n = 6) or Filshie-clips (n = 5). Menstrual charts were kept. Serum follicle-stimulating hormone (FSH), estradiol (E2) and progesterone (P) were measured by means of radioimmunoassay in one cycle before and 3, 6, and 12 months after the sterilization. Blood samples were drawn on day -6, -2, 0, +6, +10 of the menstrual cycle, ovulation corresponding to day 0. The women sterilized by Filshie-clips had abdominal ultrasonography of the ovaries measuring the leading follicle on day -6, -2, 0, +6 of the menstrual cycle. PATIENTS: Twelve women, 25 to 38 years old, with regular menstrual cycles and no use of oral contraceptives or intrauterine contraceptive device at least 6 months before sterilization. One woman was excluded. RESULTS: After the sterilization, all women reported unchanged menstrual pattern. The follicular rise in E2 unchanged, and FSH levels fell accordingly. Progesterone levels were ovulatory, but the midluteal P peak 3 months poststerilization was significantly decreased. Serial abdominal ultrasonography in women sterilized by Filshie-clips confirmed ovulation in all cycles except in one woman, who had an unruptured follicle in one cycle before and in the sixth cycle after sterilization. CONCLUSION: Laparoscopic sterilization by Falope-rings or Filshie-clips does not seem to interfere with menstrual pattern or ovulatory function.

PIP: Physicians evaluated the effect of laparoscopic female sterilization by Falope-ring and the Filshie-clip technique on the menstrual pattern, the ovarian endocrine function, and the ovulatory function on 6 women at the Rigshospitalet in Copenhagen, Denmark and on 5 women at Gentofte County Hospital in Denmark. They followed these women from 1-2 months before sterilization and at 3,6, and 12 months after sterilization. The physicians took blood samples on day -6, -2, 0 (menstrual cycle), 6, 10 of the menstrual cycle to measure follicle stimulating hormone (FSH), estradiol, and progesterone. Ultrasonography measured the leading follicle of women sterilized by Filshie-clips on day -6, -2, 0, 6, 10 of the menstrual cycle. None of the 11 25-38 year old women used oral contraceptives or an IUD before the surgery. All experienced regular menstrual cycles. The sterilization did not cause any changes in menstruation. Moreover peak estradiol levels rose during the follicular phase and peak FSH levels decreased as normal. Overall peak progesterone levels stayed within normal limits of the ovulatory cycle, but it fell considerably 3 months after sterilization (p.05) and somewhat significantly 12 months after sterilization. Ultrasonography revealed that only 1 women sterilized by Filshie-clips experienced an unruptured follicle in the cycle before and the 6th cycle after sterilization. All other women sterilized by Filshie-clips experienced normal valuation. Based on these results, the researchers concluded that laparoscopic female sterilization by Falope-rings and the Filshie-clips do not affect the menstrual pattern or ovulatory function.

Postpartum symptoms. Episiotomy or tear at vaginal delivery.

The influence of episiotomy was evaluated in a quasi-randomized follow-up study. In 193 primiparas with spontaneous vaginal delivery, postpartum perineal pain and insufficiency symptoms and their duration were evaluated by means of a questionnaire, 15-24 months post partum. Information about the birth and any complications was obtained from the medical records. On comparing the 85 primiparas delivered by midwives who had a low episiotomy rate (mean 21%) versus the 61 primiparas delivered by midwives with a medium episiotomy rate (mean 34%) and the 41 delivered by midwives with a high episiotomy rate (mean 70%), no differences were found regarding postpartum perineal pain and insufficiency symptoms. Postpartum perineal pain symptoms were significantly correlated to the duration of the second stage of labor, irrespective of the episiotomy rate of the midwife in charge, or of the use of episiotomy.

Male or female sterilization: a comparative study.

The study compares 709 males and 546 females recruited from a well-defined geographic area and sterilized during a 5-year period at the same hospital. Medical records were reviewed and questionnaires sent out. Widespread satisfaction with the sterilization was found. The sterilized women had experienced contraceptive side effects and failures more often than the men. Only 70% of the laparoscopic sterilizations could be carried out during a 1-day admission, 25% of the women complained about long-term sequelae, and there were 1% failures. The vasectomies were carried out on an outpatient basis, there were few postoperative symptoms, and 0.5% failures were recorded. Female sterilization was at least four times as expensive as vasectomy. It is concluded that vasectomy is generally to be preferred to female sterilization, and that the preoperative guidance should involve both man and wife.

PIP: 810 men and 594 women, sterilized at a hospital in Denmark between 1978-1982, were sent a questionnaire to determine their motivation, postoperative effects, and satisfaction. The men were vasectomized under local anesthesia on an outpatient basis. The women were sterilized either by laparoscopy, using the Falope Ring technic, or by minilaparotomy, using Pomeroy's method under general anesthesia, and either stayed overnight in hospital or were discharged on the evening of the surgery. The women tended to belong to a lower social class, 15% were unemployed, and 16% were single parents. The men tended as a group to be older. More women gave health reasons, contraceptive failure, fear of the pill's side effects, and marital problems as their reason for wanting sterilization. After sterilization, 21% of the women experienced menstrual changes and/or pelvic pain, and 8 women became pregnant. 2 of the men developed hematomas, and 4 caused pregnancies. 3% of men and 2% of women experienced a deterioration of their sex lives; 40% of men and 36% of women said their sex lives improved; and 57% of men and 62% of women said it was unchanged. 3% of men and 5% of women regretted the decision, and all felt that they had received insufficient information before surgery. The cost of a male sterilization is estimated at $60 and the cost of a female sterilization is estimated at $240. In view of the cost difference and the difference in the invasiveness of the procedure, more men should be motivated to be the sterilized partner.

Regret among 547 Danish sterilized women.

To help identify potential regretters of female sterilization, the women sterilized at Frederiksborg County Hospital, Hørsholm, Denmark, from 1978 through 1982 were contacted by questionnaires, and their medical records were reviewed. Ninety-two per cent (547/594) responded. The median observation time was 50 months. Five per cent of the women (n = 28) regretted the sterilization. The risk of regretting the sterilization was significantly increased among women who at sterilization experienced marital disharmony (12.5% regretted), had a child less than one year old (14.7% regretted), had the sterilization performed in connection with another surgical procedure (16.1% regretted), were outside the social groupings (17.0% regretted), or had no paid work (10.0% regretted). No association between number of children at the time of sterilization, prior number of contraceptives used, abortion at sterilization, and later regret was found. Twenty-five per cent of the regretters had had psychiatric problems prior to the sterilization. The regretters were sterilized shortly after their request (median 1 month) compared to 3 months among non-regretters. The main reason for regret of sterilization was the desire for more children, independent of a change in marital status. Sequelae to the sterilization was a common complaint. Refertilization was requested by 1% of the sterilized women. The study suggests that the psychosocial situation should be carefully evaluated in women requesting sterilization. A time lag from request to the sterilization should be mandatory and a thorough pre-sterilization counseling including information about possible sequelae and alternative contraceptives should be given.

PIP: In Denmark, a study was conducted on women who had been sterilized. The purpose of the study was to discover the percentage of women who regretted the sterilization and the reasons concerning their regret. 594 who had been sterilized at the Freiksborg County Hospital were contacted and sent a 3-page questionnaire which included quetions on social background, reasons for the sterilization, and complications due to the sterilization including sexual problems. 547 women (92.1%) answered the questionnaire. The result of the study are as follows. 28 women (5.1%) were found to be regretters, while 519 of the women (94.9%) were satisfied. The risk of regretting sterilization was higher among women experiencing marital disharmony (12.5% regretted), had a child less than 1 year old (14.7% regretted), had the sterilization performed with another surgical procedure (16.1% regretted), were outside of the social groupings (17.0% regretted), or had no paid work (10.0% regretted). 25% of the regretters had psychiatric problems prior to the sterilization. There was no association found between the number of children, the type of contraceptive used prior to the sterilization, and later regret. The main reason given for regret was the desire for more children. 1% of the sterilized women requested refertilization. Conclusions drawn from the study are that physicians should recommend counselling to patients seeking sterilization.

[Sterilization and regret]. / Sterilisation og fortrydelse.

PIP: Since 1972, Danish law provides free access to sterilization for any resident 25 years old. It is not clear how this age was chosen but under previous rules when permission for sterilization was required by the Ministry of Justice after referral from the Mothers Aid Council, permission was seldom granted for anyone under 25. Some studies have found that 47% of the men referred for refertilization were under 30 years old at sterilization. Another study found that 61% of women refertilized were sterilized before 30 years of age. In these studies, all patients were reviewed who regretted having been sterilized and found that they formed an inhomogeneous group with a greater spread in age although primarily concentrated in the younger age group. Regret is 2-3 times more frequent among women and men sterilized before age 30. Raising the age for free sterilization to 30 years will produce only a small decrease in men and women who seek refertilization since sterilization before 30 years of age is undertaken only by a small group of men and women. The average age for sterilization for men and women rose in the years between 1977 and 1984. Sterilization of men and women between 25-30 in 1977 made up 12% and 23% respectively of all those sterilized. The percentage of 25-30 year old men and women in 1984 fell to 8 and 16% respectively of all those sterilized. No correlation was found between a waiting period before sterilization and regret.^ieng

[Regret after female sterilization. Review of the literature with a description of groups at risk]. / Fortrydelse af kvindelig sterilisation. En litteraturgennemgang med beskrivelse af risikogrupper.

PIP: About 5% of the Danish women who are sterilized subsequently regret having undergone the procedure. In order to improve counselling for those women who apply for sterilization, the literature concerning women who have regretted their decision are described. Risk factors for regret include: young age at sterilization; puerperal sterilization and sterilization when the youngest child was under the age of 1 year; marital and/or personal crisis at the time of the procedure; low socioeconomic status (no further education, no work outside the home, etc.); sterilization performed under pressure from husband or physician; and short period of time from decision to become sterilized to the procedure itself. Based on the above, it is recommended that women belonging to the high risk groups be provided with high-level counselling and advice including information about alternative contraceptives prior to the sterilization. If necessary, more counselling sessions should be offered. (author's modified)^ieng

Results of reversal of sterilization performed in Danish women 1978-1983.

To follow up the outcome of refertilization after female sterilization, the Danish women refertilized from 1978 through 1983 were contacted by questionnaires, and the operative reports from sterilization and refertilization were obtained. Ninety percent (132/147) responded. The median follow up time was 39 months (range 18-83). Forty-four percent of the women became pregnant, 26% gave live birth, 7% had a miscarriage only, and 11% had a tubal pregnancy. The results of reversal of sterilization by means of conventional surgery (n = 101) and microsurgery with microscope or magnifying glasses (n = 31) did not differ in terms of number of live births. Refertilization after sterilization by laparoscopic methods was more successful: 34% of these women gave live birth, whereas 19% gave live birth after reversal of sterilization performed by resection of the tubes. The predictive value of peroperative tubal patency for subsequent pregnancy was 32%, whereas the prediction of no pregnancy in cases of no patency was found to be 60% correct. Postoperative hysterosalpingography (HSG) showing tubal patency was of predictive value for later pregnancy in 45%, whereas no patency by HSG gave a correct prediction for no pregnancy in 94% of the cases. In order to improve the skill of the surgeons, and thus, apply the microsurgical technique to full advantage, it would seem necessary to concentrate reversal of female sterilization on a small number of departments especially interested in this technique.

Profile of Danish women undergoing reversal of sterilization, 1978-1983.

To help identify those women who might regret undergoing sterilization, the Danish women refertilized from 1978 to 1983 were contacted by mailed questionnaire. Eighty-three percent (120/144) responded. These women were younger at the time of sterilization than Danish women sterilized in the same period (mean age 29 years versus 34 years). Furthermore, they had more children at the time of sterilization and had their first and last child at a younger age than Danish women generally, in the same age group. Their social and educational status was lower than the background population and fewer were in gainful employment. At sterilization, most of the women were in an emotionally stressful situation (e.g., marital disharmony (78% of the married women), single parenthood (28%), unwanted pregnancy (27%], or had chronic health problems in the family. Alternative contraceptive methods had not been fully explored. Thirty-eight percent complained of late secondary effects attributable to the sterilization, but the main reason for wanting reversal of sterilization was a new partner (75%). The study suggests that the psycho-social situation and contraceptive alternatives should be carefully evaluated in women requesting sterilization, especially in those below the age of 30.

PIP: Danish women who had been refertilized over the 1977-1983 period, inclusive, were contacted in an effort to characterize their demographic, educational, and social status and to identify measurable traits for probable subsequent regret of sterilization that would be useful in presterilization counseling. Over the study period, 147 women were sterilized and subsequently refertilized. A questionnaire was sent to each woman. Verification of sterilization and refertilization and descriptions of operative methods were obtained from the hospitals. The 147 sterilizations were performed at 52 different hospitals and the refertilizations at 33 hospitals. Data on the background population -- all Danish women in the same age group as the refertilized women -- were obtained from information published by the Danish National Board of Health and the Danish National Bureau of Statistics. 3 women were excluded from the study. At the time of sterilization, 61% of the women who later had reversal of sterilization were below age 30, compared with 22% of all Danish women sterilized during the same period. The mean number of living children/refertilized woman was 2.4 at the time of sterilization; the mean number of living children for each woman in the Danish general population in the same age group was 1.8. The mean number of elective abortions prior to sterilization was 0.6, identical with the mean number among all Danish women in the same age group. The educational level of the refertilized women was much lower compared with Danish women in the same age group. 77 women (64%) had paid work, which was fewer than anticipated for the age group. 61 women (51%) had tried at most 2 different contraceptive methods, and only 17 (14%) complained of lack of information about alternative contraceptive methods. Satisfaction with the numer of children was the primary reason for sterilization, but 20 women (17%) were dissatisfied with the number of children at the time of sterilization. Their reasons for choosing sterilization varied, including medical grounds or severe marital problems. 41% of the women were pregnant at the time they requested sterilization, and most of the pregnancies ended in elective abortion. The average age at reversal was 32 years, and the average time span from sterilization to reversal was 37 months. On average, the women regretted the sterilization 22 months following the operation. 103 women (87%) had experienced a change in marital status at reversal of sterilization. 90 of the women stated that their new partner was the reason for the reversal. 6 women had had a child die, and 7 women lost custody of their children. 45 of the women (38%) reported late secondary effects of the sterilization, but only 6 women were refertilized because of these secondary effects (hormone imbalance and pelvic pains). 10 women thought they had lost their "womanhood" after sterilization.