Patients with vulval symptoms are met frequently in gynaecological practice. The complaint is often long-standing and distressing and frequently induces a feeling of despair in both patient and doctor. The diagnosis and management of vulval dermatoses require such a multidisciplinary approach and the importance of this has been amply demonstrated by the evolution of combined clinics. Vulval disease in many societies can be the subject of unnecessary and exaggerated shame and embarrassment, hence their frequency and importance have been underestimated.
Female ; Genitalia ; Humans ; Shame ; Skin ; Skin Diseases

The study was designed to determine the effectiveness of perineal ultrasonography compared with chain cystourethrography(CUG) in genuine stress urinary incontinence and to evaluate the diagnostic significance of perineal ultrasonography in 30 women with genuine stress urinary incontinence. The distinctive characteristic of perineal ultrasonography is simple, noninvasive, free of radiation exposure, comfortable, and not shameful out-patient procedure. We measured the posterior urethrovesical angle(PLRVA) at rest and during strain, and calculated the difference between the two angles. The mean value of PUVA at resting state were 134.7' in perineal ultrasonography group and 135.5' in chain CUG group(p=0.8235). During strain state, PLRVA was 146.2' in perineal ultrasonography group and 147.4' in chain CUG groupt=0.8341) The difference between PUVAs at rest and during strain was 12.1' in perineal ultrasonography group and 12.0' in chain CUG group(p=0.9022). The percentage of patients' subjective satisfaction with perineal ultrasonography was 96%, however the percentage of discomfort in chain CUG was 96%. In conclusion, perineal ultrasonography is a very comfortable and useful diagnostic method in genuine stress urinary incontinence, to replace chain CUG.
Female ; Humans ; Outpatients ; Shame ; Ultrasonography* ; Urinary Incontinence*

The reconstruction of nipple and areola after breast mound reconstruction is fundamental in achieving final outcome. A variety of methods have been applied to make natural nipple and areola. The purpose of this study is to compare the operative methods and experience between FTSG and micropigmentation. Nipple-areolar complex was reconstructed after free TRAM flap for 33 breasts from May 1995 to August 2001. 20 patients underwent micropigmentation(Permark (R)) for areola and 13 patients underwent FTSG. Full thickness skin was obtained from inguinal area for FTSG method. Micropigmentation for areola was done 2 months after nipple reconstruction. There was no specific complication reported after areola reconstruction, but some differences in outcomes were noted between the two methods of areola reconstruction. First of all, there was an advantage in time saving for FTSG method due to simultaneous reconstruction of nipple and areola. However, FTSG has several disadvantages such as longer operation time, sometimes prominent scar formation of the inguinal and circumareolar region, feeling of shame due to location of the donor site, the lightening of the areolar color with time, and finally the color difference between the nipple and areola. Micropigmentation has advantages with simple procedure, short operation time, no donor site scar, no shameful feelings for dressing, no color change of areola with time, and easier color selection for the areola and nipple. It has disadvantages of double operation due to separate nipple and areola reconstruction, need for additional instruments, and experience in selection of well matched paste. FTSG from the inguinal region often had been used to produce the similar color of areola and was thought to be the standard method. However, we thought that areolar reconstruction utilizing micropigmentation is much better than FTSG in terms of cosmesis and convenience for operation.
Bandages ; Breast ; Cicatrix ; Humans ; Nipples ; Shame ; Skin ; Tissue Donors

PURPOSE: Breast volume is one of the crucial measurements in preoperative planning and postoperative evaluation of the results in mammoplasty. There are several methods suggested by different authors, but there is still no commonly accepted standard methods for measuring breast volume. To help the surgeons to base their estimation on an objective evaluation, we developed a simple method using Polyethylene bag and plaster molding. METHODS: After Polyethylene bags were put in suitable size on both breasts of the patient in upright position, silk plaster was molded on the surface evenly. Then molds can be obtained after marking boundaries of breasts with a pen. Breast volume measurement can be done by filling water in the molds and measuring it. Moreover, postoperative design for natural skin brassier was possible using the molds. RESULTS: This method was applied to 2 patients for reduction mammoplasty and the breast volume measurement was simple, hygienic and accurate, done within 10 minutes. CONCLUSION: This method using Polyethylene bag and plaster molding has several advantages. 1.It is comparatively accurate regardless of the size and shape of patient's breasts in upright position. 2.Measurement time is short and inconvenience and shame of patients can be reduced by making molds after putting on Polyethylene bags. 3.It is relatively economical and uses easily available hygienic materials . 4.The postoperative shape and volume of breasts can be predicted by using molds preoperatively.
Breast* ; Female ; Fungi* ; Humans ; Mammaplasty ; Polyethylene* ; Shame ; Silk ; Skin ; Water

PURPOSE: To investigate perceptions of erectile dysfunction(ED) treatment of patients visiting a university hospital in the era of multiple oral agents. MATERIALS AND METHODS: Using a questionnaire, this study was conducted on 103 new outpatients(average age 45.5 years) with ED who visited a university hospital between January 2004 and March 2005. RESULTS: The patients with ages in the 50's, 60's and 70's were 33%, 33%, and 6.8%, respectively. Forty percent indicated that they had discussed their ED with their wives. Prior to visiting the general hospital, only 19% of the patents had visited physicians to seek ED treatment, while 29% had taken oriental or folk medicines, and 26% had used exercise to enhance their potency. The remaining 24% had not attempted any management. Among 71 patients who had experience with phosphodiesterase type 5 inhibitors(PDE5I), 30% had obtained them without prescriptions, and 57% were not aware of the fact that proper sexual stimulation is required for effective drug action. The majority of the patients(83%) had felt embarrassment when they had presented their prescriptions to pharmacists. Fifty five percent of wives were not aware! of their husbands took the PDE5I. Among those wives who were aware, 62% felt favorably toward the treatment. CONCLUSIONS: Aging patients with ED are changing their attitude positively toward seeking treatment. However, their understanding of sexual health and ED treatment is still considerably low, suggesting a need for more active and continuous education. A sense of shame for having ED was still high. Thus, changing men's perception that their sexual problems are not shameful but a medical condition to be solved through discussion with their wives and doctors, is needed to lead to a healthy sexual culture.
Aging ; Education ; Erectile Dysfunction* ; Hospitals, General ; Humans ; Male ; Pharmacists ; Prescriptions ; Surveys and Questionnaires ; Reproductive Health ; Shame ; Spouses

Radiologic chain cystourethrography for stress urinary incontinence (SUI) has several disadvantages including the risk of excessive radiation, the time required for the test, and the discomfort of the patients. Nowadays it is widely accepted that transrectal ultrasonography for evaluating bladder and urethra provides similar information about SUI comparing with the conventional radiographic examination. We evaluated the effectiveness of transrectal ultrasonography in the diagnosis of SUI in 30 women with SUI and in normal 20 women as a control. The results of evaluation were as follows: 1. Mean age was 52.9 in SUI group and 48.5 in control group, and mean parity was 2.8 in SUI group and 3 In control group. 2. According to the symptom grading by Stamey, 8 patients (27%) were Grade I and 22 (73%) were Grade II. 3. The mean value of posterior urethrovesical angle (PUVA) at resting state was 139 +/- 14.7 degrees in control group and 145 +/- 15.2 degrees in SUI group (p>0.05). 4. The mean value of PUVA at strain state was 146 +/- 7.9 degrees in control group and 169 +/- 12.1 degrees in SUI group (p<0.05). 5, Bladder neck descent was 7.3 +/- 2.7 mm (mean+/-SD.) in control group and 13.7+/-6.2 mm in SUI group (p<0.05). 6. Diagnostic criteria of SUI in transrectal ultrasonography are more than 149.5 degrees in PUVA at strain state, and more than 9.1 millimeter in bladder neck descent. 7. Sensitivity and specificity of transrectal ultrasonography in the diagnosis of SUI were 86% and 80% in PUVA at strain state, 80% and 80% in bladder neck descent, respectively. 8. There was significant change of transrectal ultrasonographic finding in pre and post-bladder neck suspension (p<0.05). In conclusion, transrectal ultrasonography is simple, non-invasive, not shameful, and free of radiation, so might be a useful diagnostic method in female SUI.
Diagnosis ; Female* ; Humans ; Neck ; Parity ; Sensitivity and Specificity ; Shame ; Ultrasonography* ; Urethra ; Urinary Bladder ; Urinary Incontinence*

OBJECT: Social stigma and prejudice against schizophrenia hinder the prevention of the disease, early treatment and social rehabilitation. This stigma and the negative viewpoint against schizophrenia are enhanced by the mass media. This study investigated newspaper articles on psychosis, which strongly influence the public recognition of the illness. METHOD: The newspaper articles of Dong-A Ilbo and Chosun Ilbo from March 1998 to February 2000 were reviewed through a news-searching program in Chollian. The search words, which were regarded as psychotic illness, were Schizophrenia, Psychosis, Mental illness, and Mental derangement. A total of 326 articles were classified by category and analyzed quantitatively and qualitatively. The viewpoint of articles on psychosis consisted of these: (1) negative (direct or indirect) (2) neutral or positive (3) no specific viewpoint. RESULT: Of the 326 articles, the number with a negative description was 228 (69.9%), the number with a neutral or positive description was 43 (13.2%), and the number with no specific viewpoint was 55 (16.9%). The most frequent negative theme was psychotic patients are dangerous or violent or may commit a crime (n=118). Other negative themes were these: psychotic patients are bizarre or grotesque (n=27), psychotic patients can't function in society well(n=18), psychosis is incurable and families should bear great burden(n=16), psychosis is shameful (n=13) and psychotic patients should be institutionalized(n=6). There were also prejudices against the cause of the illness(n=18), the description of psychosis in degrading terms(n=22) and the negative description of psychiatric hospitalization(n=18) with the words such as institutionalization, imprisonment and put into etc. In the articles using the terms mental derangement or psychosis compared with mental illness, schizophrenia and in the articles describing psychotic patient compared with illness itself, the frequency of negative articles was high. Within each type of article, news, politics and culture articles more frequently had a negative description, while health articles less frequently had a negative description and most frequently had a neutral or positive description. CONCLUSION: There should be a program for monitoring newspapers for appropriate in-formation on psychosis. It might reduce social stigma and consequently help rehabilitation of psychotic patients. Also there should be endeavors to monitor other mass media and to develop a public education campaign through the mass media.
Crime ; Education ; Humans ; Institutionalization ; Mass Media ; Periodicals ; Politics ; Prejudice ; Psychotic Disorders* ; Rehabilitation ; Schizophrenia ; Shame ; Social Stigma

OBJECTIVES: Kleptomania is a disabling disorder, which results in intense personal shame, as well as familial, social, and legal problems. Despite its serious results, kleptomania remains poorly understood by the general public, clinicians, and the patients themselves. This study aimed to review the clinical characteristics, comorbidity, neurobiology, and treatment options of patients with kleptomania. METHODS: Domestic and international databases were searched using the keywords of "kleptomania" and "shoplifting". The search included articles published until May, 2010. RESULTS: The searches identified 252 articles. After excluding those which were overlapping in content or outside the scope of this study, a total of 65 articles remained for inclusion in this review. In general, the onset of kleptomania occurs in late adolescence or early adulthood, and the disorder is more common among women. Lifetime psychiatric comorbidity is frequent. Patients with kleptomania experience a significant decline in social and occupational functioning. Evidence suggests that kleptomania responds well to both pharmacological and psychosocial interventions. CONCLUSION: There is a need for mental health professionals to recognize and treat patients with kleptomania. More research into the etiology and treatment of this disorder, including studies involving double-blind, placebo-controlled trials, is required.
Adolescent ; Comorbidity ; Female ; Humans ; Disruptive, Impulse Control, and Conduct Disorders ; Mental Health ; Neurobiology ; Shame

This study adopts the phenomenological approach in order to explore the experience of urinary felt by the small island women and to find the meaning and structure of their experience, for the further understanding of them. This study succeeded in detecting five topics and three basic structure from eight participants, and followings are the comprehensive statement of them. The five topics include neglect of care after childbirth, unavoidable life in the tidal flat, shame which cannot be expressed even to their husbands, endless anxiety toward the expected future, and sad(dilemmatic) lived experience. The basic structure is that small island women who have urinary incontinence are apt to regard their disease as a natural destiny of women who fail to get adequate care after childbirth, and something to be endured to live in the seashore. They think of urinary incontinence as something so shameful that they cannot reveal it even to their husband and family. They believe that it even changes their personality since they must always stay alert in order to cope with the situation; for example, when it takes place unexpectedly, like too often to go to toilet, to change the underwears, to wake up in the middle of the night to go to toilet, to try not to laugh loudly, or to have showers. In addition, they accept it as a natural process of aging and incurable disease, and they consider themselves already ruined on the way of becoming uglier. They show dilemmatic abandonment: give it up unwillingly but at the same time think it is natural for others too. The unique experience of small island women with urinary incontinence implied in those statement are inseparable with the specific conditions for survival in the island. Unlike other diseases, it is considered the result of traditionally poor care after childbirth. However this misunderstanding that it is a natural phenomena for all the women who experience childbirth and aging and thereby incurable leads to an undesirable attitude toward urinary incontinence. According to the analysis, environmental conditions specific for small islands make the women there have distinct and unique experience concerned with urinary incontinence. Consequently, the future nursing plan for urinary incontinence in the small island area must be made and enforced with the consideration of these specific phenomenological meanings. Modern Korean nursing has basically been centered to hospital or urban areas. Besides, nursing intervention has long depended upon the research of western countries. This research, however, shows how greatly the regional and cultural characteristics influence the understanding of a certain disease, and is expected to make more specific and in-depth nursing approach enable for those who have urinary incontinence in small islands.
Aging ; Anxiety ; Cultural Characteristics ; Female ; Humans ; Islands ; Nursing ; Parturition ; Shame ; Spouses ; Urinary Incontinence*

OBJECTIVE: To see whether anodal direct current (DC) polarization of the inferior parietal cortex (IPC) and the primary sensorimotor area (SM1) in corticobasal degeneration (CBD) patients leads to improvement of praxia and finger motion. METHOD: Twelve patients with CBD were enrolled. This single blind crossover study had three arms, anodal DC to IPC, anodal DC to SM1, and shame polarization on occipital area. DC was delivered for 40 minute at 2 mA with 25 cm2 sponge electrodes. Before and 20 min after the start of polarization, we performed the test of oral and limb apraxia (TOLA), finger tapping frequency, and grooved pegboard test. RESULTS: The total score of TOLA was increased 5.4+/-2.3% after anodal DC to IPC. The scores of limb apraxia and picture gesture subtests of TOLA, not of oral apraxia subtest, increased significantly after anodal DC to IPC compared to sham DC polarization (p<0.05). In anodal DC to SM1 group, the finger tapping frequency increased 15.5+/-14.1%, which was significantly greater than in sham group (p<0.05). CONCLUSION: These results showed beneficial effects of anodal DC polarization on apraxia and hand function in CBD patients. In addition, these effects for apraxia and hand movement were dependent on their stimulation sites of brain.
Apraxias* ; Arm ; Brain* ; Cross-Over Studies ; Electrodes ; Extremities ; Fingers ; Gestures ; Hand* ; Humans ; Porifera ; Rabeprazole ; Shame