RESUMEN
The "reconstruction of the hymen"consists in a surgical suture of the seam of a hymen that has been fissured due to vaginal intercourse or other causes. This intervention aims at triggering bleeding on the occasion of the next intercourse, a phenomenon often required as proof of virginity within certain traditions. Valid data regarding this ethically and medically controversial and predominantly tabooissue is scarce. In an effort to further explore this practice, we have collected information about hymenorrhaphy from the databases of two anonymous, medical, online counselling services provided by the University Hospital Zürich, and explicitly for teenagers by the Children's Hospital Zürich. We found a sample of 22 questions from women seeking advice, and the results vividly illustrate the psycho-social dilemma these women face, prompting us to suggest that further ethical discussion, collection of empirical data and broad public education on issues related to sexuality are necessary.
Asunto(s)
Himen/cirugía , Procedimientos de Cirugía Plástica , Adolescente , Adulto , Coito , Consejo , Ética , Femenino , Hospitales Pediátricos , Hospitales Universitarios , Humanos , Sistemas en Línea , Guías de Práctica Clínica como Asunto , Religión , Suiza , TabúRESUMEN
OBJECTIVE: The University Hospital of Zürich has been providing an anonymous online consultation service since 1999. In January 2008 a service fee of CHF 20.- was introduced. The present investigation evaluated the impact of the service fee on the use of the medical online consulting service. METHODOLOGY: All 8269 requests between January 2007 and December 2008 were analysed using the following criteria: number, complexity and subjects (ICD-10) of the requests, personal statements of the users and evaluation of the online answers. RESULTS: The number of requests decreased by 69 % (6298 vs.1971) and the age of the users rose from 36 +/- 16 to 40 +/- 17 years. The text length of the requests increased (characters: 677 +/- 463 vs. 801 +/- 539), as did the length of the answers (characters: 1397 +/- 3224 vs. 2391 +/- 4327). In 2008 the assistance of specialists at the University Hospital Zürich were called upon more frequently (11.1 % vs. 15.9 %). Regarding the assessments of the quality of the answers, there were differences in the range of positive evaluations ("good": 38 % vs. 41 %, "excellent" 43 % vs. 36 %). DISCUSSION: The introduction of a new service fee resulted in a decrease in requests. At the same time, a greater number of older people used the service, and they asked questions that are more complex. Apparently, persons that probably have more medical problems have greater appreciation for the opportunity to ask questions and, in comparison to younger persons, are more willing to pay for the service. The continued positive evaluation given to the medical answers shows that an Internet service involving a fee can also be a useful supplement to the conventional physician/patient relationship.
Asunto(s)
Consejo/economía , Honorarios y Precios , Hospitales Universitarios/economía , Internet/economía , Educación del Paciente como Asunto/economía , Consulta Remota/economía , Adulto , Factores de Edad , Comportamiento del Consumidor/economía , Consejo/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Internet/estadística & datos numéricos , Persona de Mediana Edad , Relaciones Médico-Paciente , Consulta Remota/estadística & datos numéricos , Suiza , Revisión de Utilización de Recursos/estadística & datos numéricos , Adulto JovenRESUMEN
Since August 1999 free medical Internet consultations are offered by the University Hospital Zurich. Overall 13,984 inquiries have been answered until December 2003. As of today an average of about 10 questions has been received per day. The users are predominantly between 20 and 50 years old and most of them show normal characteristics in terms of weight and size. The incoming questions refer to a wide variety of medical subjects and 53% of them have been asked by women. Frequently asked questions refer to topics like HIV, nutrition, vaccination as well as contraceptive methods. Intimate questions concerning e.g. sexual dysfunction disorder as well as changes on male genitals are also overrepresented. Therefore medical Internet consultation is characterised by low thresholds and is particularly well suited for the consultation of intimate and sensitive topics.