SEARCHLIGHT
Navigating the Global Medical Network
Of Sexual Health Issues for Sexual Health Matters
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You are welcome to this column in Sexual Health Matters that will regularly
navigate the medical world to flag recent development in Sexual Health issues.
There will be opportunity to take part in regular problem based searchlight
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Paternal age is an important risk factor for subfertility
Maternal age of Ž 35 years is a well known risk factor for subfertility
but paternal age has rarely been studied and therefore this study is timely.
A lage retrospective, population based sample involving 6188 European women
from 4 countries including Denmark, Italy, Spain, and Germany aged 25 to 44
years were selected randomly from Census registers in 1991 through to 1993 in
a French study 1.
Risk of infertility was significantly higher among couples composed of a woman
aged 35 to 39 years when paternal age was Ž 40 years than when paternal
age was 40 years, with an adjusted odds ratio of 2.21 (95% CI, 1.13, 4.33)
for delay in pregnancy onset (failure to conceive within 12 months) and of 3.02
(95% CI, 1.56, 5.85) for difficulties in having a baby (failure to conceive
within 12 months or pregnancy not resulting in a live birth).
It was concluded that like maternal age (Ž35), paternal (Ž40) age
should be considered to be a risk factor for subfertility.
1Rochebrochard E and Thonneau P. American Journal of Obstetrics and Gynaecology Vol 189, issue4, October 2003, Pages 901-905.
Viagra is not effective in oestrogenised postmenopausal women.
The effect of sildenafil on sexual arousal and orgasmic functioning in 34 Canadian
oestrogenised postmenopausal women with acquired genital female sexual arousal
disorder and impaired orgasm were studied1 including the concordance between
a detailed historical assessment of genital response in real life, with laboratory
vaginal photoplethysmographic assessment of genital vasocongestion.
In a 4 stage study design, session one consisted of a semi-structured clinical
interview to assess real life sexual arousal. Session two employed vaginal pulse
amplitude and self-report questionnaire assessment of erotica-induced sexual
arousal. Sessions three and four were a randomised, double-blind, placebo-controlled
crossover administration of sildenafil (50mg) or placebo on orgasm latency,
intensity, perception of genital congestion and subjective arousal to erotica
plus clitoral vibrostimulation.
The main outcome measures were orgasm latency and intensity during drug sessions;
subjective and psychophysiological sexual arousal during photoplethysmography
session.
The data suggest that oestrogenised postmenopausal women with genital female
sexual arousal disorder and orgasmic impairment based only on clinical assessment
do not benefit from sildenafil. However, the photoplethysmograph had predictive
value––those women showing low vaginal pulse amplitude response
benefited from sildenafil compared with women with a higher response. Thus,
oestrogenised women diagnosed with acquired genital female sexual arousal disorder
may be a heterogeneous group and the photoplethysmograph might be useful in
their further characterisation.
1 Tasson R and Brotto L. Sexual psychophysiology and effects of sildenafil
citrate in oestrogenised women with acquired genital arousal disorder and impaired
orgasm: a randomised controlled trial. British Journal of Obstetrics and Gynaecology:
Volume 110, Issue 11 , November 2003, Pages 1014-1024.
How common is drug error in obstetric anaesthesia?
Drug errors are important cause of morbidity and mortality in Hospitals. It
has been estimated that the incidence of anaesthetic drug errors is approximately
1 per 133 anaesthetics. The Labour ward is an unpredictably busy area with anaesthetic
services often called upon urgently (for regional intrapartum pain relief and
obstetric surgical intervention analgesia and anaesthesia), a combination with
significant potential for drug errors.
Yentis and Randall1 published their post survey study in International Journal
of Anaesthesia; the aim was to determine the types of obstetric anaesthetic
drug errors that are occurring in the UK and any preventative measures that
are in place.
The result showed that of the 179 out of 240 (75%) who responded, 70 (39%) knew
of at least one drug error in their unit during the last year, with 28 of them
(40%) experiencing more than one.
Of the most recent errors, giving the wrong drug (most commonly thiopental instead
of antibiotics or vice versa [14 cases]), or suxamethonium instead of Syntocinon
[8 cases] or other drugs [4 cases]) was the most common error, occurring in
27 units (15%).
Errors involving epidural/spinal analgesia/anaesthesia (including drugs intended
for these routes but given via other routes) occurred in 20 cases. Only 36 respondents
(20%) described protocols for checking anaesthetic drugs. Methods described
for reducing drug errors were use of coloured labels (20%) or pre-filled labelled
syringes (6%), limiting the range of drugs available (6%) and keeping drugs
in separate trays once drawn up (6%).
These results confirmed that few anaesthetists check drugs with another person,
though whether through lack of motivation, time or staff is unclear. The capacity
for human error is not confined to non-medical personnel, and perhaps it is
time to consider a double-checking and signing procedure for doctors too. These
findings support the Audit Commissions recommendation that a proper reporting
and monitoring system be established for drug errors.
1Yentis SM and Randall K. Drug errors in obstetric anaesthesia: a national survey International Journal of Obstetric Anaesthesia (2003) 12, 246–249.
Sexual behaviour and condom practices in post-reproductive and divorced women
A recent population based study of 1,178 unmarried women in the USA by Upchurch
et al 1 examined the sociodemographic correlates of the number of recent sexual
partners and condom.
The results showed that Asian Americans, foreign born, and older women are less
likely to be sexually active and those more educated and previously married
women are more likely to be sexually active. Among the sexually active (n =
909), Hispanic women and older women are less likely to have multiple partners,
and younger and previously married women more are more likely. African-American
women and younger women are more likely to use condoms; older and previously
married women are less likely.
This study indicates that women-centred primary and secondary prevention efforts
may benefit from targeting women not previously considered, such as women of
post-reproductive age and divorced women.
1 Upchurch D,, Kusunoki Y, Simon P, and Doty MM, Sexual behavior and condom
practices among Los Angeles women. Women's Health Issues Volume 13, Issue 1
, January-February 2003, Pages 8-15 2002;187:521-7
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