Factors affecting female sexual well-being: a 5-year follow-up of a randomised clinical trial on post-abortion contraception

INTRODUCTION

Sexual well-being is associated with general well-being. Several factors, such as overweight, infertility, anxiety and sex hormones, also play a role, but the effects of hormonal contraception remain a point of debate. We characterised the factors associated with sexual well-being in fertile-aged women following induced abortion.

METHODS

A 5-year follow-up of a nested, longitudinal, cohort study examining the effects of routine provision of intrauterine contraception as part of abortion care. Sexual well-being, anxiety and quality of life were assessed annually using validated questionnaires (McCoy Female Sexuality Questionnaire, State-Trait Anxiety Inventory and EuroQoL), along with data on general and reproductive health, and relationship status. Of the 742 women participating in the trial, 290 (39%) provided sufficient follow-up data and were included in this study.

RESULTS

Based on trajectories of McCoy scores across the 5-year follow-up, two groups were identified: those with stable and higher (n=223, 76.9%) and those with declining sexual well-being (n=67, 23.1%). Women in the group of declining sexual well-being had significantly higher levels of anxiety and lower quality of life at all time points. They also had chronic diseases more often and were less happy in their relationships. No differences were found in method of contraception when classified as hormonal versus non-hormonal, or long-acting versus short-acting reversible contraception.

CONCLUSIONS

Lower anxiety and higher quality of life are associated with stable and higher sexual well-being. Method of contraception or relationship status are not associated with sexual well-being during long-term follow-up in fertile-aged women.

Health-related Quality of Life after Laparoscopic Hysterectomy following Enhanced Recovery after Surgery Protocol or a Conventional Recovery Protocol

STUDY OBJECTIVE

To compare the health-related quality of life (HRQoL) and psychologic distress after laparoscopic hysterectomy (LH) following enhanced recovery after surgery (ERAS) and conventional recovery protocols.

DESIGN

A secondary analysis of a single-center randomized controlled trial.

SETTING

University hospital.

PATIENTS

Women assigned to LH were randomly divided into 2 groups: intervention (ERAS protocol) group (IG) (n = 60) and control (conventional protocol) group (CG) (n = 60).

INTERVENTIONS

Women in the intervention group (IG) were treated according to the ERAS protocol.

MEASUREMENTS AND MAIN RESULTS

The primary outcome was a change in HRQoL assessed by the 15D questionnaire and a change in psychologic distress assessed by the General Health Questionnaire-12 at baseline before surgery and 1 month later. One month after surgery, the HRQoL was clinically and statistically better compared with baseline but with no difference between the groups. When following the ERAS protocol, the improvement in HRQoL was clinically greater, the difference in the dimension of sleeping was statistically better (p <.05), and the dimensions of discomfort and symptoms (+0.028), depression (+0.282), distress (+0.018), and vitality (+0.040) were clinically better than when following the conventional recovery protocol. No differences were found in the psychologic distress scores either preoperatively or 1 month after surgery (24 in IG vs 25 in CG [p = .85] and 9 in IG vs 12 in CG [p = .47], respectively).

CONCLUSION

The HRQoL improved after LH with no significant difference between the ERAS and conventional recovery protocols. However, clinically, the change in HRQoL was greater, and the dimensions of sleeping, discomfort and symptoms, depression, distress, and vitality were better when following ERAS. Psychologic distress was equal in both groups. ERAS seems to have a positive impact on recovery after LH.

Pregnancy and delivery after mid-urethral sling operation

Introduction and hypotheses

There is no consensus regarding pregnancy after mid-urethral sling (MUS) operation, and some clinicians recommend postponing the MUS operation if a woman considers further pregnancies or routinely suggest cesarean section as the delivery method after MUS operations. Our primary aim was to assess the risk for stress urinary incontinence (SUI) re-procedure after delivery in women with a MUS operation prior to pregnancy. We also analyzed SUI re-visits and MUS-related complications during pregnancy and postpartum.

Methods

We conducted a register-based case-control study of women with a MUS operation in Finland during 1996–2016. We identified 94 cases with a subsequent pregnancy and 330 controls without subsequent pregnancies matched by age, operation type and year.

Results

The median follow-up time was 10.7 years (IQR 7.1–13.7). The number of SUI re-procedures did not differ between the cases (n = 3, 3.2%) and controls (n = 17, 5.2%; OR 0.6, 95% CI 0.2–2.1). There was no significant difference in re-visits for stress or mixed urinary incontinence between the cases (n = 23, 24.5%) and controls (n = 86, 26.1%; OR 0.9, 95% CI 0.5–1.6), but 35% of the re-visits in the case group occurred already before the delivery after MUS. The rate of vaginal delivery was lower after MUS operation (57%) than in deliveries before MUS (91%, P < 0.001).

Conclusions

Pregnancy after MUS did not increase the odds for SUI re-procedure or re-visit. Considering on our results, future pregnancy does not need to be viewed as an absolute contraindication for MUS operation.

Electronic supplementary material

The online version of this article (10.1007/s00192-020-04497-w) contains supplementary material, which is available to authorized users.

Transumbilical versus lateral transabdominal removal of benign adnexal masses in laparoscopic surgery-A randomized trial

OBJECTIVE

In laparoscopic adnexal surgery the conventional method of removing a mass from the abdominal cavity in Finland is through a 10-mm-wide lateral abdominal port. The larger the lateral trocar, the greater the risk of pain, complications and delayed recovery. Here, we assumed that adnexal mass removal through a 10-mm umbilical port together with 5-mm side trocars would decrease the postoperative need of analgesics when compared with removal through a 10-mm lateral abdominal port.

STUDY DESIGN

Women scheduled for laparoscopic surgery of a benign adnexal mass were invited to participate. The participants were randomized into two groups: removal via the transumbilical (TU) (n=21) or lateral transabdominal (TA) (n=21) route. General anesthesia and use of local anesthetics were standardized. The amount of postoperative opioid (oxycodone) and visual analog scale (VAS) scores for pain were the primary outcome measures. Secondary outcome measures were nausea/vomiting (VAS evaluation), time to discharge, peri- and postoperative complications, surgeons' opinions of the alternative methods and patients' satisfaction, evaluated via a questionnaire sent six months postoperatively.

RESULTS

There were no significant differences in the use of opioids or median pain-VAS scores between the groups during the first 24h postoperatively. However, in the TU group the amount of women with very low pain-VAS scores (0-1) during the whole 12-h follow-up time was significantly greater than in the TA group (4 vs. 0 women p=0.04). The amounts of nausea and vomiting, and median times to discharge were similar in both groups. There were no major complications.

CONCLUSIONS

Both transumbilical and transabdominal routes of abdominal mass removal during laparoscopy were feasible and safe. However, the transumbilical route resulted in more women with very low pain-VAS scores.

Immediate adverse events after second trimester medical termination of pregnancy: results of a nationwide registry study

BACKGROUND Increasing gestational age is associated with an increased risk of complications in studies assessing surgical termination of pregnancy (TOP). Medical TOP is widely used during the second trimester and little is known about the frequency of complications. This epidemiological study was undertaken to assess the frequency of adverse events following the second trimester medical TOP and to compare it with that after first trimester medical TOP. METHODS This register-based cohort study covered 18 248 women who underwent medical TOP in Finland between 1 January 2003 and 31 December 2006. The women were identified from the Abortion Registry. Adverse events related to medical TOP within 6 weeks were obtained from the Hospital Discharge Registry. RESULTS When compared with first trimester medical TOP, second trimester medical TOP increased the risk of surgical evacuation [Adj. odds ratio (OR) 7.8; 95% confidence interval (CI) 6.8-8.9], especially immediately after fetal expulsion (Adj. OR 15.2; 95% CI 12.8-18.0). The risk of infection was also elevated (Adj. OR 2.1; 95% CI 1.5-2.9). Within the second trimester, increased length of gestation did not influence the risk of surgical evacuation or infection after medical TOP. CONCLUSIONS Medical TOP during the second trimester is generally safe. Surgical evacuation of the uterus is avoided in about two-thirds of cases, though it is much more common than after first trimester medical TOP. The risks of surgical evacuation and infection do not increase with gestational weeks in the second trimester TOP.

Young age and termination of pregnancy during the second trimester are risk factors for repeat second-trimester abortion

OBJECTIVE

The objective of the study was to characterize women undergoing a termination of pregnancy (TOP) during the second trimester and to evaluate the risk factors and timing of repeat TOP.

STUDY DESIGN

This nationwide retrospective cohort study investigated 41,750 women who underwent TOP during the first (n = 39,850) or second (n = 1900) trimester in Finland in 2000-2005. The follow-up time was until repeat TOP or until Dec. 31, 2006.

RESULTS

TOP during the second trimester increases the risk of repeat TOP (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.3-1.6), repeat second-trimester TOP (HR, 3.8; 95% CI, 2.9-5.1), and repeat TOP after 16 weeks of gestation (HR, 5.0; 95% CI, 3.3-7.7). The other risk factor for these is young age (HR, 7.0, 95% CI, 5.3-9.3; and HR, 12.5; 95% CI, 3.1-50.4 for age <20 years).

CONCLUSION

Second-trimester TOP and young age are risk factors for repeat second-trimester TOP. Special focus on these women might be effective in decreasing repeat abortions.