Vaginismus and subfertility: case reports on the association observed in clinical practice.

OBJECTIVE: To analyse the features of patients with vaginismus first presented to a gynaecologist for infertility before being referred for psychiatric evaluation and management. The case series aim to provide some insight on features and presentations of Asian women with vaginismus. Vaginismus is characterised by persistent or recurrent difficulties in vaginal penetration despite the woman's wish for coitus. Avoidance, phobia, anticipatory fear of pain and involuntary pelvic muscle contraction are the most common symptoms. METHOD: We report a series of cases of Malaysian women who had been suffering from vaginismus and 'infertility'. All the cases had never been attended to medically and there were long delays in seeking intervention. There was no history of traumatic sexual experience or any major psychiatric illness in these patients. Majority of the patients had prominent symptoms of anxiety. CONCLUSION: The cases illustrate that it is important to rule out the possibility of vaginismus among patients with infertility. The former have unique psychological features which require psychological interventions.

High-risk behaviours and concomitant medical illnesses among patients at methadone maintenance therapy clinic, hospital tengku ampuan afzan, malaysia.

BACKGROUND: High prevalence of high-risk behaviours and concurrent medical illnesses among opioid drug users would influence the outcome of Methadone Maintenance Programme. It would also require a special medical attention to contain these issues. OBJECTIVES: This study explored patients' characteristics and their high-risk behaviours in order to understand more about opioid dependent users in Malaysia. METHODS: A total of 172 patient case notes at Methadone Clinic Hospital Tengku Ampuan Afzan (HTAA) were retrieved for relevant data. RESULTS: Many of the patients were engaged in high-risk behaviours such as needle sharing, unsafe sex and criminal activities. A large number of the subjects had contracted blood-borne diseases such as HIV and hepatitis infections. CONCLUSIONS: Education on the issue of medical and psychosocial complications related to high risk behaviours is essential. Medical professionals dealing with this group have to pay attention and update their knowledge on the medical issue.