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

Neither subtotal nor total abdominal hysterectomy adversely affects pelvic organ function at 12 months. Subtotal abdominal hysterectomy results in more rapid recovery and fewer short-term complications but infrequently causes cyclical bleeding or cervical prolapse.

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Pre-eclampsia is a principal cause of maternal morbidity and mortality, affecting 5-10% of first pregnancies worldwide. Manifestations include increased blood pressure, proteinuria, coagulopathy and peripheral and cerebral oedema. Although the aetiology and pathogenesis remain to be elucidated, the placenta is undoubtedly involved, as termination of pregnancy eradicates the disease. Here we have cloned a complementary DNA from human placental messenger RNA encoding a precursor protein of 121 amino acids which gives rise to a mature peptide identical to the neuropeptide neurokinin B (NKB) of other mammalian species. In female rats, concentrations of NKB several-fold above that of an animal 20 days into pregnancy caused substantial pressor activity. In human pregnancy, the expression of NKB was confined to the outer syncytiotrophoblast of the placenta, significant concentrations of NKB could be detected in plasma as early as week 9, and plasma concentrations of NKB were grossly elevated in pregnancy-induced hypertension and pre-eclampsia. We conclude that elevated levels of NKB in early pregnancy may be an indicator of hypertension and pre-eclampsia, and that treatment with certain neurokinin receptor antagonists may be useful in alleviating the symptoms.

We report four human tachykinins, endokinins A, B, C, and D (EKA-D), encoded from a single tachykinin precursor 4 gene that generates four mRNAs (␣, ␤, ␥, and ␦). Tachykinin 4 gene expression was detected primarily in adrenal gland and in the placenta, where, like neurokinin B, significant amounts of EKB-like immunoreactivity were detected. EKA͞B 10-mers displayed equivalent affinity for the three tachykinin receptors as substance P (SP), whereas a 32-mer N-terminal extended form of EKB was significantly more potent than EKA͞B or SP. EKC͞D, which possess a previously uncharacterized tachykinin motif, FQGLL-NH2, displayed low potency. EKA͞B displayed identical hemodynamic effects to SP in rats, causing short-lived falls in mean arterial blood pressure associated with tachycardia, mesenteric vasoconstriction, and marked hindquarter vasodilatation. Thus, EKA͞B could be the endocrine͞paracrine agonists at peripheral SP receptors and there may be as yet an unidentified receptor(s) for EKC͞D.

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UAE and myomectomy both result in significant and equal improvements in QoL. UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention.