Objective To investigate the impact of childbirth on the sexual health of primiparous women and idenDesign Setting Population Methods Quantitative analysis of obstetric and survey data.Main outcome measures tify factors associated with dyspareunia.Cross-sectional study using obstetric records, and postal survey six months after delivery.Department of Obstetrics and Gynaecology, St George's Hospital, London.All primiparous women (n = 796) delivered of a live birth in a six month period.Self reported sexual behaviour and sexual problems (e.g. vaginal dryness, painful penetration, pain during sexual intercourse, pain on orgasm, vaginal tightness, vaginal looseness, bleedinghrritation after sex, and loss of sexual desire); consultation for postnatal sexual problems.Of the 484 respondents (61% response rate), 89% had resumed sexual activity within six months of the birth. Sexual morbidity increased significantly after the birth: in the first three months after delivery 83% of women experienced sexual problems, declining to 64% at six months, although not reaching pre-pregnancy levels of 38% . Dyspareunia in the first three months after delivery was, after adjustment, significantly associated with vaginal deliveries (P = 0.01) and previous experience of dyspareunia (P = 0.03). At six months the association with type of delivery was not significant (P = 0.4); only experience of dyspareunia before pregnancy (P < 0.0001) and current breastfeeding were significant (P = 0-0006). Only 15% of women who had a postnatal sexual problem reported discussing it with a health professional.Conclusions Sexual health problems were very common after childbirth, suggesting potentially high levels of unmet need.Results

There is considerable concern about rates of drug-related mortality in the United Kingdom. Studies have suggested that recently released offenders are a group at high risk of dying from drug-related causes. To obtain more information about the extent and nature of drug-related mortality among newly released prisoners in England and Wales, the Home Office commissioned the Office for National Statistics to undertake a research project in collaboration with the National Addiction Centre (Singleton et al., 2003). The Singleton et al. study for the first time provided an empirical estimation of drug-related mortality risk among sentenced prisoners in the early phase of release from prison in England and Wales in 1999. To examine the trend in drug-related deaths over a longer period, the Home Office commissioned a replication, with some revision, of the Singleton et al. study, extended to cover prisoners released in two further years, 1998 and 2000.

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A pilot study was carried out investigating women's sexual health in the postnatal period. Postal questionnaires were sent to a cohort of 158 primiparous women approximately 7 months after delivery. Women who had resumed sexual intercourse were asked a detailed set of questions about problems experienced, sexual practices, frequency of intercourse, satisfaction with sex life, and consultation for postnatal sexual problems. All women were asked about the information they received on postnatal health prior to the birth and any information or help and advice they received from health professionals on the subject after the birth. Ninety-eight women (62%) responded. Women experienced significant levels of morbidity in the postnatal period; 3 months after delivery 58% experienced dyspareunia, 39% experienced vaginal dryness, and 44% suffered loss of sexual desire. These figures had reduced to 26, 22, and 35%, respectively, by the time of answering the questionnaire (approximately 8 to 9 months after delivery). Compared to before pregnancy, there was a decrease in frequency and satisfaction with sexual intercourse, although sexual practices changed little. Of the 67 women who reported a postnatal sexual problem, only 19% discussed this with a health professional. Conversations with health professionals in routine postnatal health contacts were mainly about contraception, and only rarely discussed problems with intercourse.

Analyses of longitudinal data from the Health and Lifestyles Surveys (HALS) were carried out in order to examine the household changes of older people. Respondents who were interviewed at both the first HALS survey in 1984/85 (HALS1) and the second survey 7 years later (HALS2) and were aged 60 or over in HALS1 were selected (1156). Changes in household composition between the two surveys were examined and the relationship of these changes to socio-demographic factors and to both cross-sectional and longitudinal health factors investigated. Results of the analysis showed there was great diversity of experience and a considerable amount of change in what is often considered a fairly stable and homogeneous section of the population. Almost one-third of respondents changed household type, the majority changing to live alone and only a small proportion changing to live in households with their child/children or with others. Household changes were associated with poor and declining health (both physical and mental) and the rate of change was found to increase with age. In the case of ill health the first source of practical support and care is generally from within the household. Where this is not available it is sought from the wider community or the state. An increase in the proportion of the population aged over 60 and in the numbers of the oldest people, coupled with a rate of household change that increases with age, means that demand on health and community services can only be expected to increase.

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