Sexual dysfunction among middle aged women

stay geriatric patients. They last as long as more expensive silicone coated or pure silicone catheters, are more comfortable because they are softer, and are contraindicated only in patients allergic to latex. This view was also shared by Dr Belfield himself a couple of years ago,' and supports the view that a catheter is changed according to patients' needs and not by manufacturer's specification. Other workers have confirmed that there is no difference in the time between catheter changes with different types despite the apparently smoother surface of the Silastic catheters supposedly minimising encrustation.23 Indeed, scanning electronmicroscopy of the surface structure of different catheter materials has shown that the surface of unused siliconised latex is rough.4 Some patients are probably "encrustation formers" whatever catheter material is chosen. Alternative methods, such as high fluid intake and acidifying the urine with high dose ascorbic acid, are more effective at reducing blockage. Our second comment concerns the treatment of "infection." We certainly agree that the addition of antibacterial substances into drainage bags is ineffective in preventing bacteriuria. There are, however, good studies reporting that bladder washouts are also ineffective and probably harmful by further disrupting the already damaged bladder epithelium, thus predisposing the patient to further infection.56 Finally, we think that there should have been some comment about local care and about the effect on sex lives. A twice daily local soapy wash to the area, including the first six inches of catheter, and counselling on methods of sexual intercourse are minimum requirements for all patients.