Sexual dysfunction in men who abuse illicit drugs: a preliminary report

IntroductionDespite being seen as aphrodisiacs, illicit drugs are reported to have detrimental effects on male sexual function but most studies have been based on small case numbers with ambiguous results.AimsTo assess the impact of illicit drugs abuse on male sexual function.Main Outcome MeasuresInternational Index of Erectile Function (IIEF) and global assessment questions.MethodsIllicit drug abusers in a Drug Abstention and Treatment Center were recruited to complete the questionnaires and their data were compared with an age-matched control.ResultsThe abusers (N = 701, mean age 33.8 years) had a lower mean IIEF score in each domain than that of the controls (N = 196, mean age 35.4 years). Heroin, amphetamine, and MDMA (“Ecstasy”) were the leading drugs used. Erectile dysfunction (ED) was reported in 36.4% of the abusers and the odds ratio of having ED (compared with the controls) in mono-users of heroin, amphetamine, and MDMA was 4.8 (P < 0.05), 3.2 (P < 0.05), and 1.4 (P > 0.05), respectively. Of the abusers, 38.6% reported to have decreased sexual desire with illicit drug use, more often seen in the heroin mono-users (46.7%), and 18.4% reported to have enhanced sexual desire, more often seen in the amphetamine mono-users (22.6%). Mean IIEF sexual desire domain score of the abusers was lower than that of the control, even for those who reported to have enhanced sexual desire. Increased and decreased ejaculation latency affected by illicit drugs was reported in 49.9 and 14.3%, respectively, of the abusers, showing no significant difference among the mono-users of three different drugs.ConclusionsIllicit drug male abusers were prone to have ED, decreased sexual desire, and increased ejaculation latency. ED and decreased sexual desire were most commonly seen in heroin, followed by amphetamine and MDMA mono-users, while increased ejaculation latency occurred commonly in all of the abusers. Jiann B-P. Sexual dysfunction in men who abuse illicit drugs: A preliminary report. J Sex Med **;**:**–**.     

Amphetamine abuse in pregnancy: the impact on obstetric outcome

Objective To determine whether pregnant women with amphetamine abuse developed more obstetric complications than non-drug abuser pregnant women. Materials and methods A retrospective case control study was undertaken. Pregnant women with amphetamine abuse who delivered between January 2002 and December 2003 were compared to control pregnant women. Results Pregnant women who abused amphetamine were more likely to develop anemia, preterm delivery, thick meconium stained amniotic fluid, and delivered small for gestational age neonates. However, cephalopelvic disproportion was less frequently found in the amphetamine abuse group. Conclusion Pregnant women who abuse amphetamine experience more obstetric complications than the non-drug abuser. This information may be useful to medical personnel who are caregivers of these pregnant women to provide adequate perinatal care.     

Vulvar and genital trauma in pediatric and adolescent gynecology

PURPOSE OF REVIEW: This review will look critically at recent research articles that pertain to children and adolescents who present with genital injuries. RECENT FINDINGS: Many recently published articles have noted that the history as given by the child or adolescent is the most important factor in determining the etiology of genital injuries as abuse or accidental. The history is more important than any documented or lack of documented findings on physical examination. Distinguishing whether the injury was accidental or caused by abuse is of significance to the family and the injured child or adolescent. Genital examinations of victims of documented abuse are often normal. Examinations of pregnant adolescents may appear normal, the only evidence that intercourse has taken place being pregnancy. Documented accidental genital injuries are described; unfortunately such injuries can easily be confused with sexual abuse. Photographic documentation of injuries by colposcopic photography has allowed a new level of peer review, improving the understanding of what are normal and non-specific findings, many of which were considered to be abnormal in the past. The psychological impact of living in a violent, war-torn culture, or surviving a traumatic genital injury are reviewed. New ideas on the management of genital trauma are also reported. SUMMARY: Increasingly, victims of sexual abuse are found to have normal examinations, and the victim's history becomes the most important determining factor. Peer review has led to a better understanding of the wide variations in the normal genital examination. Psychological support for these victims is important in the management of genital injuries.     

Estimation of neonatal exposure after accidental ingestion of lufenuron in a breastfeeding mother.

A case of accidental anti-flea preparation (lufenuron) ingestion by a breastfeeding mother is reported. An estimation of infant exposure level was calculated based on the highest level measured. The breastfed infant was exposed to an average lufenuron dose of 0.032 mg/kg/day, which is only 3% of a reported acute overdose. No adverse effects were reported during 7 months of follow-up. Breastfeeding should be considered cautiously after consultation with a regional poison center in cases of accidental ingestion of this drug by a breastfeeding mother. The infant should be monitored for potential adverse effects.     

Screening for Substance Abuse in Women's Health: A Public Health Imperative

Alcohol and drug use is a significant public health problem with particular implications for the health and safety of women. Women who abuse these substances are more likely to have untreated depression and anxiety and are at higher risk for intimate partner violence, homelessness, incarceration, infectious disease, and unplanned pregnancy. Substance abuse during pregnancy places both mother and fetus at risk for adverse perinatal outcomes. Data regarding the prevalence of substance abuse in women are conflicting and difficult to interpret. On the clinical level, strong arguments exist against routine urine drug testing and in favor of the use of validated instruments to screen women for drug and alcohol use both in primary women's health care and during pregnancy. A number of sex‐specific screening tools are available for clinicians, some of which have also been validated for use during pregnancy. Given the risks associated with untreated substance abuse and dependence in women, the integration of drug and alcohol screening into daily clinical practice is imperative. This article reviews screening tools available to providers in both the prenatal and primary women's health care settings and addresses some of the challenges raised when women screen positive for drug and alcohol abuse.     

Drug fever induced by carboplatin-based regimens: Higher incidence in a women's hospital

ObjectivePrevious studies have reported low incidence of carboplatin-related drug fever in early cancer treatment cycles. This study describes and analyzes relatively higher incidence rate of carboplatin-related drug fever associated with gynecologic cancer chemotherapy in order to allay anxiety in patients and avoid unnecessary interventions.Materials and methodsAll gynecologic cancer cases treated with carboplatin in a women's hospital in 2017 and 2018 were retrospectively reviewed and analyzed. Data for patients who experienced carboplatin-induced drug fever and those who received the same treatment but did not experience drug fever were compared for statistical significance. Risk factors for drug fever were identified by logistic regression analysis.ResultsIn total, 318 females with a mean age of 52 years were included in the analysis. Drug fever was observed in 25 patients (7.86%) in 45 cycles of total 1605 carboplatin-containing infusions. Fever occurred at a median of the third (range: 1–7) cycle, starting at 10.62 h (range: 1.18–50.35 h) after carboplatin infusion, and was generally controlled within 3 days. After chemotherapy rechallenge, the mean frequency of drug fever was 2 times per patient (range: 1–4 times). There were 35/45 drug fever incidents (77.78%) that were classified as grade II; in 15/45 cases (33.33%), antibiotic treatment was immediately initiated to prevent infection. Younger age was found to be a risk factor for drug fever following carboplatin treatment (odds ratio = 0.126, 95% confidence interval: 0.025–0.628; p < 0.05).ConclusionsThe retrospective analysis demonstrated that carboplatin-induced drug fever, which occurred on post treatment 3 days, was a type of delayed hypersensitivity reaction with an incidence rate of 7.86% in gynecologic cancer. Younger age was identified as a risk factor. Drug fever is generally tolerated by patients, who insist on chemotherapy. Knowledge of carboplatin-induced drug fever may help physicians reach timely recognition for appropriate interventions.     

The outcome of pregnancy associated with amphetamine use.

Thirty cases of pregnancy associated with maternal amphetamine use were studied retrospectively fifteen out of the 30 women used amphetamines alone and the other 15 used other drugs in addition to amphetamines. Women who simultaneously used opiates were excluded from this analysis. Women were cared for in a multidisciplinary setting and all delivered in one hospital. With support all women were encouraged to discontinue drug use. There were 2 perinatal deaths, 1 from each group (amphetamines alone or amphetamines plus others). The mean birth weight were 2878 and 2959 grams respectively and gestational age 38.23 and 37.47 weeks respectively. If the whole group was divided into women who ceased amphetamine use and continued use in pregnancy, there was no marked difference between outcome in these 2 subgroups, however, the 2 perinatal deaths both occurred in women who continued amphetamine use. The risk of prematurity was 28.6% and low birth weight 25%, rates which were not reduced by an alteration in drug use.     

Childhood sexual abuse (CSA) experiences: an underestimated factor in perinatal care

BACKGROUND: Childhood sexual abuse can have several negative consequences on pregnancy, birth, and the early neonatal period. However, most obstetricians are not aware if their patients have a history of childhood sexual abuse. We therefore investigated childhood sexual abuse experiences in 226 women three to eight months after delivery of a healthy child. METHODS: 415 women were approached to answer a self-administered questionnaire including obstetrical questions and questions focusing on abuse experiences. 320 women agreed to participate, 226 (69.1% of the women fulfilling inclusion criteria) of which returned a completed questionnaire. Sexual abuse was explored using a modified version of a questionnaire developed by Wyatt. The complete questionnaire was designed in cooperation with the German "Frauennotruf", a society providing care for victims of sexual abuse. RESULTS: The prevalence of childhood sexual abuse was a minimum of 11.5% and a maximum of 14.6% if women who were not sure about such experiences during their childhood were included. Another 1.3% of the women had experienced sexual abuse as an adult. Lifetime sexual abuse prevalence was 12.8% and 15.9%, respectively. Of the women with an experience of childhood sexual abuse, 42.3% mentioned an ongoing abuse situation for at least six months. CONCLUSIONS: As approximately every 9th woman presenting for obstetrical care has experienced childhood sexual abuse, and as those experiences may have a negative impact on fetal and maternal well-being, adequate counseling models should be offered to victims of sexual abuse.     

Inhibition of lactation by cyclofenil and bromocriptine

Summary. In a double blind controlled study of the inhibition of lactation 13 women received 300 mg of cyclofenil and 11 women 2.5 mg of bromocriptine twice daily for 14 days. Lactation was effectively inhibited by both drugs, but with bromocriptine there was a significantly higher frequency of relapse. The plasma concentration of prolactin, which decreased rapidly with bromocriptine, returned to the pretreatment level the day after drug treatment stopped, but with cyclofenil it remained low. Plasma oestradiol followed a similar pattern. Plasma FSH increased more rapidly with bromocriptine than with cyclofenil. There was no significant difference between the treatment groups at any stage for haematology, coagulation or liver function tests. The more sustained effect of cyclofenil on prolactin secretion with a reduced frequency of relapse, and the lower oestradiol level, which might indicate a reduced risk of thromboembolism, suggest that this drug has some advantage over bromocriptine in the inhibition of postpartum lactation.     

Inhibition of lactation by cyclofenil and bromocriptine

In a double blind controlled study of the inhibition of lactation 13 women received 300 mg of cyclofenil and 11 women 2.5 mg of bromocriptine twice daily for 14 days. Lactation was effectively inhibited by both drugs, but with bromocriptine there was a significantly higher frequency of relapse. The plasma concentration of prolactin, which decreased rapidly with bromocriptine, returned to the pretreatment level the day after drug treatment stopped, but with cyclofenil it remained low. Plasma oestradiol followed a similar pattern. Plasma FSH increased more rapidly with bromocriptine than with cyclofenil. There was no significant difference between the treatment groups at any stage for haematology, coagulation or liver function tests. The more sustained effect of cyclofenil on prolactin secretion with a reduced frequency of relapse, and the lower oestradiol level, which might indicate a reduced risk of thromboembolism, suggest that this drug has some advantage over bromocriptine in the inhibition of postpartum lactation.     

The independent and combined effects of physical and sexual abuse on health. Results Of a national survey

Background: Although physical and sexual abuse have been linked to health risk behaviors as well as mental health problems, it is unclear whether those young women who have experienced both physical and sexual abuse are at greatest risk. To examine the independent associations between physical, sexual, and/or both types of abuse and health status, mental health, and health risk behaviors among a national school-aged sample of girls. We hypothesized that the magnitude of risk would be highest for those reporting both types of abuse compared to those reporting neither or one type of abuse. Methods: In 1997, 3,015 girls in grades 5 through 12 participated in the Commonwealth Fund Adolescent Health Survey and responded to both questions inquiring about physical and sexual abuse. This sample was derives from a nationally representative cross-section of 265 public, private, and parochial schools with an oversampling of 32 urban schools to obtain ethnic diversity. Data were analyzed using chi-square and binary or multinomial logistic regression stratified by type of abuse (none, physical abuse, sexual abuse, or both). Results: About 8% (n = 246) of girls reported a past history of only physical abuse, 5% (n = 140) reported only sexual abuse, and 5% (n = 160) reported experiencing both physical and sexual abuse. Logistic regression controlling for demographic characteristics (grade level, ethnicity, family structure, and socioeconomic status) found those who reported both types of abuse as compared to those who did not report any abuse were significantly more likely to experience moderate-to-severe depressive symptoms (OR = 5.1), moderate to high life stress (OR = 3.3), history of bingeing and purging behavior (OR = 4.4), regular smoking (OR = 5.9) regular drinking (3.8), illicit drug use in the past 30 days (RR = 3.5) and fair to poor health status (OR = 1.9). In contrast, lowered adjusted odds ratios (1.8-2. 5) were seen for those reporting one type of abuse as compared to no abuse across most health outcomes.Conclusions: Those experiencing any type of abuse are at risk; however, those adolescent females who report both physical and sexual victimization are at much greater risk.     

The prevalence of emotional abuse in gynaecology patients and its association with gynaecological symptoms

AIM: To determine the lifetime prevalence of emotional abuse in a population of women attending a gynaecology outpatient clinic and also to investigate whether women who reported emotional abuse were more likely to complain of certain gynaecological symptoms. SETTING: A gynaecology outpatient clinic in a North of England Hospital. METHODS: Anonymous confidential questionnaire given to women. RESULTS: Nine hundred and twenty consecutive women were included, 825 questionnaires were returned (90% response rate). The prevalence of emotional abuse was 24% (198/825). Emotional abuse is four times less common in women over 50 years old. Of the fifteen presenting symptoms reported by the women, referral for termination of pregnancy, cervical smear abnormality, worry about cancer and urinary incontinence were significantly more common in the group who reported emotional abuse. The women with emotional abuse also had significantly more consultations; however, the duration of their symptoms was not significantly different. CONCLUSION: The prevalence of emotional abuse in a group of women attending the gynaecology outpatient clinic in a North of England Hospital was 24%. Women who are subjected to emotional abuse tend to have more consultations and are more likely to complain of certain symptoms.     

Screening of substance misuse during early pregnancy in Blyth: an anonymous unlinked study.

Substance abuse during pregnancy is rising and often remains undiagnosed. This harms both the mother and the baby. We conducted an anonymous unlinked study in Blyth valley, Northumberland, to determine the prevalence of substance abuse and alcohol use during pregnancy. Urine toxicology screening was performed on 150 women who attended antenatal clinic for booking. Seven commonly misused substances (amphetamine, benzodiazepine, barbiturates, cannabinoids, cocaine, methadone and opiates) and alcohol were tested in the urine. A total of 16 (10.7%) women were found positive and all 16 of them had denied use of any substance. Amphetamine was the most common among the substances misused. A total of 12 out of the 16 were from social classes 4 and 5. None of the positive women was nulliparous. Because of the difficulty in identifying substance misuse in pregnant women, consideration should be given to the implementation of routine substance screening at the booking antenatal visit in general population with a high incidence of substance misuse.     

The Role of the Doran Building in Puerperal Fever in Canada

The Doran Building at the Kingston General Hospital, opened in 1894, represents an early Canadian initiative to apply the principles of sanitation, antisepsis, and asepsis to prevent puerperal fever in a freestanding lying-in hospital. This initiative was a response to maternal mortality during the 17th and 18th centuries, when approximately half of maternal deaths were due to puerperal fever. During the 250 years leading up to 1890, an understanding of the clinical nature of puerperal fever, its cause, mode of spread, and means of prevention had gradually developed. Despite this progress, puerperal fever remained a major cause of maternal mortality in the latter part of the 19th century.The Doran Building is a compact example of a pavilion hospital, built as a freestanding facility for women and children, with its own staff. Kenneth Fenwick, who was Professor of Obstetrics and Gynaecology at Queen’s University and a vigorous advocate of sanitation, antisepsis, and asepsis, established the principles of patient care in the Doran Building during the period 1894 to 1928. His goal was the prevention of maternal mortality due to puerperal fever.During this period, there was a modest increase in the number of deliveries each year to a total of 3111 by 1928. There were 26 direct and indirect maternal deaths, representing a maternal mortality rate of 8.25 per 1000 live births. Puerperal fever accounted for the deaths of three women: one who had delivered in hospital and two who had delivered in the community and had been admitted following delivery. The application of the principles of isolation, sanitation, antisepsis, and asepsis limited the mortality in hospital due to puerperal fever in a manner consistent with the best hospitals elsewhere at that time.     

The Impact of Illicit Use of Amphetamine on Male Sexual Functions

IntroductionData concerning the impact of amphetamine on male sexual functions are limited, although amphetamine has been used as an aphrodisiac.AimsThis cross‐sectional study was to assess the impact of illicit use of amphetamine on male sexual functions.MethodsMale illicit drug users in a Drug Abstention and Treatment Center were recruited to complete a self‐administered questionnaire, and data were compared with age‐matched controls.Main Outcome MeasuresThe International Index of Erectile Function (IIEF) and global assessment questions were used to assess sexual functions.ResultsOf 1,159 amphetamine mono‐illicit drug users, the mean age was 31.9 ± 7.5 (18–57) years, and mean duration of drug use was 30.7 ± 52.2 (median 9, range 0.1–252) months. Half of them reported that drug use had no impact on their sexual functions. The other half reported drug impacts as reduced erectile rigidity and sexual life satisfaction, enhanced orgasmic intensity, and prolonged ejaculation latency time more often than the opposite effects, while they reported enhanced or reduced effect equally on sexual desire. Dosing frequency of amphetamine was associated with its impact on sexual functions, but duration of its use had little association with that. Compared with 211 age‐matched controls, the amphetamine mono‐illicit drug users had lower IIEF scores in the domains of erectile function, orgasmic function, and overall satisfaction, but there are no significant differences in intercourse satisfaction and sexual desire scores. The prevalence of erectile dysfunction (ED) was significantly higher in the drug users than in the controls (29.3% vs. 11.9%). The odds ratio of ED for amphetamine use was 2.1 (95% confidence interval 1.2–3.6) after adjustment for other risk factors.ConclusionsThe impact of illicit use of amphetamine on male sexual functions varied among users, and their ED prevalence was higher than the controls. Chou N‐H, Huang Y‐J, and Jiann B‐P. The impact of illicit use of amphetamine on male sexual functions. J Sex Med 2015;12:1694–1702.     

The diagnosis and treatment of syphilis in women

Syphilis is a sexually transmitted diseage with a known cause and an effective cure. Unfortunately, during the past decade syphilis has resurfaced as a major public health problem. This resurgence of cases has paralleled the rise of crack cocaine abuse and the attendant risky sexual behaviors associated with drug-seeking. Syphilis, as a leading cause of genital ulcer disease, enhances human immunodeficiency virus transmissibility. Syphilis has returned to damage our most vulnerable patients, the developing fetus and newborn. The eradication of this disease awaits the solution of the stubborn social problems of ignorance, poverty, drug abuse, and prostitution.     

Therapist responses to recovered and never-forgotten memories of child sex abuse. A national survey of licensed psychologists

The credibility of recovered memories of child sexual abuse following a long period of repression remains controversial in the mental health field. Some have argued that recovered memories are the work of overzealous therapists who implant such material. To learn more about the steps clinicians follow when they encounter such reports, a questionnaire was mailed to 300 female and 300 male licensed psychologists randomly selected from the 1994 American Psychological Association Membership Register. The survey included 1 of 4 versions of a vignette in which a 14-year-old girl suddenly remembers (or always remembered and just decided to disclose) sexual abuse that occurred at age 2 or 8 years. Survey forms were returned by 49% (144 females and 140 males). Only 1 therapist reached a firm conclusion about the validity of the abuse report based on the vignette alone; the rest indicated a need for further information, disputing claims that therapists respond to allegations of abuse with reflexive certainty. Reports were more likely to be believed when the age at abuse was 8 years rather than 2 years, by younger therapists (45 years and under), and by women who were nonpsychoanalytically oriented. Whether the abuse memory had been repressed did not significantly affect beliefs about its likely occurrence. Respondents also were given a list of 12 possible responses to an abuse disclosure and asked to check those they were most likely to follow. The most commonly cited responses were: discuss the allegations further in the next session (80%), consult with other clinicians (52%), file a child abuse report (40%), consult with an attorney about legal responsibilities (36%), schedule a session with all family members (30%), and schedule psychological testing (28%). The finding that less than 50% of therapists would file a mandated report of suspected child abuse indicates a need for states to more clearly define the criteria for filing such reports.     

Effects of nafarelin on bone density

The effects of the gonadotropin-releasing hormone analog nafarelin on bone metabolism during treatment of premenopausal women for endometriosis were evaluated in two studies, both of which involved 6 months of medication followed by 6 months without medication. With low doses of nafarelin (200 micrograms/day), bone mineral measurements remained constant, whereas with high doses of the drug (400 micrograms/day) bone mineral levels decreased significantly. Within 6 months after treatment was stopped, however, bone mineral measurements returned to normal levels. Both dosages of nafarelin resulted in significant increases in bone resorption, but these determinations also returned to pretreatment values after drug therapy was stopped. In the second study, patients treated with nafarelin, 400 micrograms/day, and norethindrone, 1.2 mg/day, did not lose significant amounts of bone mineral during the treatment period.     

The effects of drug abuse on pregnancy

PURPOSE OF REVIEW: The present article is an update on the effects of drug abuse on pregnancy outcome. RECENT FINDINGS: Substance abuse in pregnancy is on the increase worldwide. Simultaneously, there is great variability in prevalence rates in different countries, regions of countries and in different ethnic groups. In the United States nearly 90% of drug-abusing women are of reproductive age. Substances most commonly abused in pregnancy include cocaine, amphetamines, opioids, marijuana, ethanol, tobacco, caffeine, and toluene-based solvents. Polysubstance abuse is very common. SUMMARY: Substance abuse in pregnancy is associated with significant maternal and fetal morbidity. Risk factors suggesting substance abuse in pregnancy include lack of prenatal care, history of premature labor, and cigarette smoking. In the United States the American College of Obstetricians and Gynecologists has made multiple recommendations regarding management of parturients with drug abuse during pregnancy. Women who acknowledge use of illicit substance during pregnancy should be counseled and offered necessary treatment. The American College of Obstetricians and Gynecologists also acknowledged that some states consider intrauterine fetal drug exposure to be a form of child neglect or abuse under the law.     

Walter Reed,MD

Walter Reed, son of a Methodist minister, was born in 1851. His father sent each of his five sons to the University of Virginia, but in order to preserve family finances, Walter completed his education quickly. He remains the University of Virginia School of Medicine's youngest graduate, receiving his degree at age 18. He pursued further training in New York, but found civilian medicine disillusioning. At age 24, he passed the Army Medical Corps entrance examination and subsequently spent 14 years as an Army surgeon on the American frontier. He treated soldiers, prospectors, and Indians for little, if any, payment. Yearning to become part of the scientific revolution, Reed returned to academia, auditing pathology and bacteriology courses at Johns Hopkins University. He learned the principles of the scientific method and made important contacts during that period of training. The Surgeon General then called him to aid in the definition and resolution of the epidemics of infectious diseases affecting American troops. He presided over the investigative board that refuted the water-borne theory of typhoid fever and identified files, feces, and fomites as the source of this dreaded illness. After his success with this epidemic, he was sent to Cuba to tackle the problem of yellow fever. In approximately 6 months, he was able to disprove a bacterial cause of the illness, establish the mosquito as the likely source, and conduct a controlled trial to successfully confer illness throughthat vector. This information facilitated elimination of a horrific tropical pest. At 51, just one and a half years after his landmark work with yellow fever, he fell victim to appendicitis and died.