Ignorance is not bliss when it comes to sexuality. Psychosexual problems lead to shame, fumbling, needless fears, low-self esteem and even subfertility. The demands for help appears to be increasing; as the general population become more aware of its presence and the treatment options available through the mass media and better health education. Sex therapy has traditionally been the realm of the psychiatrist but with the gynaecologist as the first contact for most women, the number of women seeking advice directly from their doctors will only increase with time. A total of 243 new cases of sexual dysfunction were treated at the sexual problem clinic in Kandang Kerbau Hospital between January 1994 and November 1996; majority of which were self-referrals (48.5%). The patient pool consisted of more males than females although the clinical setting is in an obstetrics and gynaecology teaching institute. Vaginismus and erectile problems constituted the main complaints. Erectile problems are more common in the patients above 40 years old (p < 0.001). We report here our experience of such a sexual problem clinic and hope to provide insight into this area of medicine from the perspective of a practising gynaecologist.
Between November 1994 to May 1996, there was a total of eight ureteric injuries out of 2495 major gynaecologic operations and one ureteric injury out of 4146 caesarean sections at the Kandang Kerbau Hospital, giving the incidence to be 0.3% and 0.02% respectively. Antecedent operations were four abdominal hysterectomies, two Werthiem's hysterectomies, one laparoscopic-assisted vaginal hysterectomy and one caesarean section. All operations were performed by qualified specialists. Three patients had previous abdominal operations and five patients had procedures complicated by dense adhesions. Only one injury was detected intraoperatively and the rest presented with uretero-vaginal fistula. One presented with immediate postoperative anuria. The average time interval for diagnosis ranged between one day and twenty-three days (average 10.7 days). The commonest damage was transection of the ureter. Double J stents were used in all repairs with two cases requiring reimplantation with psoas hitch, and two cases of ureteroneocystostomies and one case of primary reanastomosis. There were no mortality in our series.