Validation of the Sexual Activity Questionnaire in women with endometriosis.

STUDY QUESTION: Is the Sexual Activity Questionnaire (SAQ) a valid tool for patients treated for symptomatic endometriosis? SUMMARY ANSWER: For women having surgical treatment for endometriosis, we determined that the SAQ is a valid and responsive tool. WHAT IS KNOWN ALREADY: Endometriosis adversely affects sexual quality of life. Suitable validated sexual quality of life instruments for endometriosis are lacking both in clinical practice and for research. STUDY, DESIGN, SIZE, DURATION: A total of 367 women with proven endometriosis undergoing medical or surgical treatment were included in an observational study conducted between 1 January 2012 and 31 December 2014 in two French tertiary care centers. Both hospitals are reference centers for endometriosis treatment. Of these 367 women, 267 were sexually active and constituted the baseline population. PARTICPANTS/MATERIALS, SETTINGS, METHODS: Women >18 years old with histological or radiological proven endometriosis, consulting for painful symptoms of at least 3 months duration, infertility, or other symptoms (bleeding, cysts) were invited to complete self-administered questionnaires before (T0) and 12 months after treatment (T1). Tests of data quality included descriptive statistics of the data, missing data levels, floor and ceiling effects, structural validity and internal consistency.The construct validity was obtained by testing presupposed relationships between previously established SAQ scores and prespecified characteristics of the patients by comparing different subgroups of patients at T0. Sensitivity to change was subsequently calculated by comparing the SAQ score between T1 and T0 overall and for different subgroups of treatment. Effect sizes (to T1) were calculated according to Cohen's method. The minimally important difference was estimated by a step-wise triangulation approach (including anchor-based method). MAIN RESULTS AND THE ROLE OF CHANCE: In total, 267 sexually active patients (204 surgical and 63 medical treatment) completed the SAQ at T0 and 136 (50.9%) at T1. The SAQ score ranged from 2.0 to 28.0 (mean ± SD: 16.8 ± 5.7).The SAQ score was one-dimensional according to the scree plot with good internal consistency (Cronbach alpha = 0.78, 95% CI 0.74-0.81) and had good discriminative ability according to pain descriptors and quality of life in endometriosis. The SAQ was responsive in patients treated by surgery but the effect size was low (0.3, 95% CI (0.0-0.6), P = 0.01). The minimally important difference was determined at 2.2. LIMITATIONS, REASONS FOR CAUTION: The effect size for medical treatment was non-significant. Other effect sizes were low but statistically significant. This could be explained by lower libido due to progestin intake, which was used for both surgically and medically treated patients. WIDER IMPLICATIONS OF THE FINDINGS: The SAQ is easy to use, valid and effective in assessing sexual quality of life in patients with endometriosis. This patient-reported score could be used as a primary outcome for future clinical studies. The minimally important difference estimation will be useful for future research. We recommend using 2.2 for the minimally important difference of the SAQ. STUDY FUNDING/COMPETING INTEREST(S): This work was funded by the 'Direction à la Recherche Clinique et à l'Innovation' of Versailles, France and the 'Institut de Recherche en Santé de la Femme' (IRSF). The authors have no conflicts of interest to declare.

[Contribution of fetal middle cerebral artery peak systolic velocity in the management of non-immune hydrops]. / Apport de la mesure du pic des vitesses systoliques dans l'artère cérébrale moyenne pour la discussion étiologique des anasarques foetaux.

Hydrops fetalis is associated with a wide variety of fetal and maternal disorders. Among these disorders, cases with anemia may benefit from a specific treatment. The authors report on two cases of hydrops fetalis with increased middle cerebral artery peak systolic velocity and discussed the contribution of this finding in the management of fetuses with hydrops.

Flow cytometric analysis of androgen receptor expression in human prostate tumors and benign tissues.

Androgen receptor (AR) plays an important role in growth and hormonal therapy of human prostate tumors. Immunohistochemical analysis of AR expression, a nonquantitative technique, is currently used for screening of receptor expression in prostate tissues. The present report describes a laser flow cytometric method for monitoring AR expression in human cell lines and in archival formalin-fixed paraffin-embedded prostate tissues and tumors. Multiparametric flow analysis can be used for simultaneous detection of other cellular markers (e.g., DNA aneuploidy), and by gated analysis, AR expression in subpopulations of a tumor can be quantitatively determined.

Considerations on anatomical and psychic reality in relation to an intersexual patient.

On the basis of a clinical account of the analysis of an intersexual patient, the author discusses theories of sexual identity and psychosexuality in terms of the impact of bodily and other aspects of factual reality on psychic reality. She considers the extent to which a subject's fate is determined by anatomy and emphasises the importance of such factors as sexual assignment at birth. The fluctuations in Freud's views on female psychosexuality are examined in detail and it is pointed out that in his writings anatomy is always mediated by psychic reality. A critical review of later authors' theories of sex and gender then follows. Turning to her case history, the author describes the implications of her insistence, partly as a manifestation of countertransference disavowal, on seeing her patient as a woman despite the latter's self-presentation as a hermaphrodite. The significance of the patient's homosexuality is discussed and an account is given of her development in the analysis. Aspects of anatomy, bisexuality and identity are reviewed and the paper ends with a further consideration of the treatment of sex and gender in Freud and other authors leading to ideas on the role of the drives and the importance of the sexual element in identity.

Fine structure mapping and deletion analysis of the murine piebald locus.

piebald (s) is a recessive mutation that affects the development of two cell types of neural crest origin: the melanocytes, responsible for pigment synthesis in the skin, and enteric ganglia, which innervate the lower bowel. As a result, mice carrying piebald mutations exhibit white spotting in the coat and aganglionic megacolon. Previously the gene had been localized to the distal half of mouse chromosome 14. To determine its precise location relative to molecular markers, an intersubspecific backcross was generated. Two anchor loci of chromosome 14, slaty and hypogonadal, in addition to simple sequence length repeat markers, were used to localize s to a 2-cM interval defined by the markers D14Mit38 and D14Mit42. The molecular markers were also used to characterize nine induced s alleles. Three of these mutations exhibited no deletions or rearrangements of the flanking markers, whereas the other six had two or more of these markers deleted. The extent of the deletions was found to be consistent with the severity of the homozygous phenotype. The location of deletion breakpoints in the induced alleles, coupled with the recombination breakpoints in the backcross progeny, provide useful molecular landmarks to define the location of the piebald gene.

The wish for a sex change: a challenge to psychoanalysis?

This paper approaches different facets of male transsexualism from the point of view of different current psychoanalytic theories and the criticisms to which some of them give rise. On the basis of the author's observations, the determining psychological factor is stated to be the hatred of masculinity. The central thesis is that the clinical challenge made to psychoanalysis is an integral part of the pathology and that it highlights the working of this disorder, just as the 'reflection theories' of the manifest content of what the patients say represent in their objectifying reification a fundamental aspect of this disturbance. Based on two clinical vignettes, an attempt at reconstruction is proposed, in which the narcissistic aspects of this pathology are emphasized. Current theory tends to stress the concepts of deficit and developmental arrest, which are generally inconsistent with those of conflict and defence, but they are here linked organically together.