SEARCHLIGHT Navigating the Global Medical Network Of Sexual Health Issues for Sexual Health Matters

Mr Ibrahim Bolaji, MD, FRCPI, FRCOG. Consultant Obstetrician and Gynaecologist, Diana Princess of Wales Hospital, Grimsby, DN3 2BA
Honorary Senior Clinical lecturer, Section of Reproductive and Developmental Medicine, University of Sheffield.

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 medical exercises. The columnist welcomes regular feedback from readers through the feed back e-mail. Enjoy your reading.

Uterine artery embolisation and laparoscopic occlusion of uterine vessels for the treatment of fibroid uterus compared.
Hald et al1 from Norway evaluated the effects of laparoscopic occlusion of uterine arteries (n=24) in the treatment of symptomatic fibroids and compared with uterine arteries embolisation (n=22) in 46 premenopausal Norwegian women with mean age of 43 (Range 34-51). The laparascopic technique reduced picture blood assessment score after 6 months by 50% from an initial value of 345 (±288). Uterus volume was reduced by 37% (±18%), and the dominant fibroid was reduced by 36% (±31%). Postoperative pain and use of pain relief differed significantly, requiring more pain medication after embolization: Specific complications to the laparascopic technique were temporary damage to the obturator nerve in 3 patients. Bilateral Laparoscopic uterine artery occlusion is a promising new method for treating fibroid related symptoms, with less postoperative pain than embolization and comparable effects on symptoms.

Hald K, Langebrekke A, Kløw NE, Noreng HA, Berge A B and Istre. Laparoscopic occlusion of uterine vessels for the treatment of symptomatic fibroids: Initial experience and comparison to uterine artery embolization. American Journal of Obstetrics and Gynecology Volume 190, Issue 1, January 2004, Pages 37-43 

Trichonomiasis revisited
Trichomonas vaginalis was originally considered a commensal organism until the 1950s when the understanding of its role as a sexually transmitted infection (STI) began to evolve. Trichomoniasis has been associated with vaginitis, cervicitis, urethritis, pelvic inflammatory disease (PID), and adverse birth outcomes. Infection with T vaginalis could have an important role in transmission and acquisition of HIV. T vaginalis is site specific for the genitourinary tract and has been isolated from virtually all genitourinary structures. Asymptomatic disease is common in both men and women, thus screening for disease is important. Various sociodemographic factors have been correlated with presence of T vaginalis, and may be used to predict infection. This fascinating topic including epidemiology, diagnosis such as direct visualisation, nucleic acid ampilification and syndromic management of trichomaniasis was recently reviewed by Swygard et al 1 in STI journal.

H Swygard, A C Seña, M M Hobbs and M S Cohen. Trichomoniasis: clinical manifestations, diagnosis and management . Sex Transm Infect 2004;80:91-95

Pregnancy rate and pregnancy outcomes in Mirena IUS users
A Finn study 1 evaluated the pregnancy rate and the outcome of pregnancies with Levonorgestrel intrauterine (LNG IUS) system involving questionnaires from 17,360 users and analysis of their hospital records. One hundred and thirty two pregnancies were reported. Medical records were reviewed from 108 of these women. In 64 pregnancies, conception occurred with the LNG IUS in situ. Thirty-three pregnancies were ectopic. The 5-year cumulative pregnancy rate per 100 users was 0.5 and the 5-year Pearl rate was 0.11. Pregnancy with the LNG IUS in situ is rare. Ectopic pregnancies constitute 53% of all pregnancies. Typical pregnancy symptoms occur during pregnancies with the LNG IUS. The importance of counselling about the risk of pregnancy before insertion needs emphasis.

1. Backman T , Rauramo I, Huhtala S and Koskenvuo M. Pregnancy during the use of levonorgestrel intrauterine system. American Journal of Obstetrics and Gynaecology Volume 190, Issue 1 , January 2004, Pages 50-54

Total or subtotal hysterectomy – The Danish Hysterectomy Group?
The Danish hysterectomy group1 in a randomised, controlled, unblinded trial compared total abdominal hysterectomy (n=158) and subtotal abdominal hysterectomy (n=161) performed for benign uterine diseases. In a one-year follow up questionnaires with a response rate of 87%, the results were analysed by intention-to-treat analyses. The main outcome measures were: (1) Primary: urinary incontinence and (2) secondary: post-operative complications, quality of life, constipation, prolapse of the vaginal vault/cervical stump, satisfaction with sexual life, pelvic pain and vaginal bleeding. A significantly (P = 0.043) smaller proportion of women had urinary incontinence one year after total abdominal hysterectomy compared with subtotal abdominal hysterectomy [9% vs. 18% (OR 2.08, 95% CI 1.01–4.29)]. The lower proportion of incontinent women in the total abdominal hysterectomy group was a result of a higher proportion of symptom relief (total abdominal hysterectomy: 20/140, subtotal abdominal hysterectomy: 14/136) as well as a lower proportion of women with new symptoms (total abdominal hysterectomy: 3/140, subtotal abdominal hysterectomy: 10/137). Twenty-seven women (20%) from the subtotal abdominal hysterectomy group had vaginal bleeding and two of them had to have their cervix removed. No other clinically important differences were found between the two hysterectomy methods. The study concluded that a smaller proportion of women suffered from urinary incontinence after total abdominal hysterectomy than after subtotal abdominal hysterectomy one year post-operatively.

1. Helga Gimbel, Vibeke Zobbe, Birthe Margrethe Andersen, Thomas Filtenborg, Christian Gluud and Ann Tabor. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results BJOG: An International Journal of Obstetrics and Gynaecology. Volume 110, Issue 12 , December 2003, Pages 1088-1098. 

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