By R. Javier. Wilkes University. 2018.

To avoid the unpredictably variable analgesia and potential for toxicity discount aygestin 5mg with mastercard, a simpler approach is to use morphine buy generic aygestin 5mg. Consider supplemental steroids at times of stress if patient has received long-term or frequent bursts of steroid therapy proven aygestin 5 mg. Prolonged weakness may occur when corticosteroids are used concurrently with non-depolarizing neuromuscular blocking agents. Fast onset and short duration of action with single doses, duration of action prolonged with continued use. Epinephrine (Racemic) Post-extubation stridor/croup: Use 1:1000 epinephrine(racemic 2. Higher doses may be required if administered through a ventilator due to loss of drug in the circuit. Consider supplemental steroids at times of stress if patient has received long-term or frequent bursts of steroid therapy. Prolonged weakness may occur when corticosteroids are used concurrently with non-depolarizing neuromuscular blocking agents. With continuous infusions measure blood glucose q1h initially, adjust dose as required based on blood glucose measurements. Higher doses may be required if administered through a ventilator due to loss of drug in the circuit. Give in water or juice, do mix with fruit juices with high potassium content such as orange juice. Consider supplemental steroids at times of stress if patient has received long-term or frequent bursts of steroid therapy. Prolonged weakness may occur when corticosteroids are used concurrently with non-depolarizing neuromuscular blocking agents. Extrapyramidal reactions occur more commonly in children and may be treated with diphenhydramine. Use with caution in non-ventilated patients due to potential for respiratory depression. To prevent withdrawal, avoid abrupt cessation following high doses or long duration of therapy (> 5 days). Improving the treatment of pain at McMaster Children’s Hospital Morphine is the preferred oral opiate for the treatment of acute pain Morphine has important effectiveness and safety advantages and is preferred over codeine (which historically had been the most commonly used oral opiate at McMaster Children’s Hospital). Codeine is a weak opiate analgesic with minimal intrinsic analgesic activity; it must first be metabolized to morphine which provides most of the analgesic effect. Up to 10% of the population does not effectively metabolize codeine to morphine, resulting in poor pain control. To avoid the unpredictably variable analgesia and potential for toxicity, a simpler approach is to use morphine. Hydromorphone or oxycodone are alternatives for patients who cannot tolerate morphine because of adverse effects. An oral solution is available for doses other than 10 and 20 mg but is very unpalatable and should be given via feeding tube. Hold feeds before and after enteral administration as continuous feeds and formula may decrease bioavailability of oral products. Significantly increased free fraction in patients with hypoalbuminemia may result in underestimation of effective drug concentration and difficulty in interpretation of drug levels and toxicity may occur at “therapeutic” serum levels. Consider supplemental steroids at times of stress if patient has received long-term or frequent bursts of steroid therapy. Prolonged weakness may occur when corticosteroids are used concurrently with non- depolarizing neuromuscular blocking agents. Higher doses may be required if administered through a ventilator due to loss of drug in the circuit. Titrate dose to effect and/or adverse effects (tachycardia, tremor and hypokalemia). For most patients metered dose inhalers with a spacer device are the preferred method of drug delivery. Some patients, particularly those receiving opiates may require higher doses and/or more frequent administration. Use lower doses if there is no significant bleeding and patient will require warfarin in the future. They were developed taking into consideration services provided at different levels within the health system and resources available. These guidelines are intended to standardize care at both tertiary and secondary levels of service delivery across different socio- economic stratifcations of our society. The clinical conditions included in this manual were selected based on facility reports of high volume and high risk conditions treated in each specialty area. The guidelines were developed through extensive consultative work sessions, which included health experts and clinicians from different specialties. The work group brought together current evidence-based knowledge in an effort to provide the highest quality of healthcare to the public. It is my strong hope that the use of these guidelines will greatly contribute to improved diagnosis, management and treatment of patients. And, it is my sincere expectation that service providers will adhere to these guidelines/protocols. The Ministry of Health is grateful for the efforts of all those who contributed in various ways to the development, review and validation of the National Clinical Treatment Guidelines. We would like to thank our colleagues from district, referral and university teaching hospitals, and specialized departments within the Ministry of Health, our partners and private health practitioners. We also thank the Rwanda Professional Societies in their relevant areas of specialty for their contribution and technical review, which enriched the content of this document. Finally, we wish to express thanks to all those who contribute to improving the quality of health care of the Rwanda population. Weak / absent breathing Circulation Cold Hands with any of: Immediate transfer to emergency area: 1. Classifcation of pain severity - Self-reporting: use of number or faces scale - Observational: based on behaviors (crying, shaking, etc. Acute Gastroenteritis Defnition: Gastroenteritis is an infammation of the stomach and intestines that causes diarrhea, vomiting, nausea and other symptoms of digestive upset. Causes - Viral gastroenteritis: Rotaviruses are the most likely cause of infec- tious diarrhea in children under the age of 5 - Bacterial gastroenteritis : Campylobacter, Salmonella or E. Persistent Diarrhea Defnition: Persistent diarrhea is a diarrhea, with or without blood, which begins acutely and lasts for 14 days or longer. Bloody Diarrhea Defnition: Frequent (>3/day) passage of blood and/or mucus in the stool Causes - Amoebic dysentery is the most common serious cause in children - Bacterial infections (e. Peptic Ulcer Disease Defnition: Tis refers to ulceration of gastric or duodenal mucosa that tends to be chronic and/or recurrent Causes - Helicobacter pylori (H. Te symptoms associated with peptic ulcers are not sensitive or specifc and the diferential diagnosis is broad.

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If you’re having trouble doing this buy aygestin 5mg with amex, use carbohydrate choices or servings: eat enough soft foods or drink enough liquids to take the place of the fruits and breads you usually eat order aygestin 5mg fast delivery. Try to drink at least 1/ cup (4 ounces) to 3/ cup 2 4 (6 ounces) every half-hour to hour buy aygestin 5mg without a prescription, even if you have to do this in small sips. Having trouble breathing, feeling more sleepy than usual, or not thinking clearly can be danger signs. You should call your health care provider or go to an emergency You may need to call your room if any of the doctor daily when you’re sick. Many days will go smoothly, but some days will hold surprises, such as extra activity or delays that throw your schedule off. Plan ahead for these times by always keeping a treatment for low blood glucose with you (see page 26 for some choices). If you have any signs that your Stay in charge of your diabetes—no matter what your day holds—by planning ahead. At Work and School Talk with your health care team about the type of activity you do at work or at school. From time to time, you and your health care team may need to make changes in your activity, medicine, or eating. Many people take supplies for checking their glucose Talk with your health care to school or work so they provider about balancing can check if at regular your daily activities and break times. Even the types of food and supplies you can buy on your trip may not be the same as those you get at home. Before you travel, work with your health care provider to plan your timing for medicine, food, and activity. Plan ahead for trips: ■ Keep snacks with you that could be used to prevent—or treat—low blood glucose. Keep medicines in the original pharmacy container with the printed label that clearly identifes the medicine. If you’re traveling in a different time zone, you may need to change your timing of food, medicine, and activity. It’s also a good idea to get your doctor to write a prescription for you to get insulin or supplies if needed. Your diabetes educator or other health care provider may be able to help you think of ways to deal with these problems. In support groups, people who have just found out they have diabetes can learn from people who have lived with it for a long time. They can also talk about how they take care of their health, how they prepare food, and how they get physical activity. Ask your health care team about support groups for people with diabetes and their families and friends. If there is not a support group in your area, you may want to call a diabetes organization (see the list on pages 127–129) It can help to talk with other people who about start- have problems like your own. Research shows that keeping your blood glucose level closer to normal can prevent or delay the onset of diabetic eye disease. Signs of Diabetic Eye Disease Since diabetic eye disease may be developing even when your sight is good, regular dilated eye exams are important for fnding problems early. If your blood pressure is higher than 130/80, ask your health care provider how to keep your blood pressure at a healthy level. Ask your health care provider to help you fnd an eye doctor who cares for people Get a complete eye exam each year. If you haven’t already had a complete eye exam, you should have one now if any of these conditions apply to you: ■ You’ve had type 1 diabetes for 5 or more years. Discuss Your Physical Activity Plan If you have diabetic eye disease, talk with your health care provider about the kind Think of a way to remind of physical activity that is yourself to get an eye best for you. An operation called a vitrectomy may help those who have lost their sight from bleeding in the back of the eye. If your sight is poor, an eye doctor who is an expert in low vision may be able to give you glasses or other devices that can help you use your limited vision more fully. You may want to ask your health care provider about support groups and job training for people with poor vision. A recent study shows that controlling your blood glucose can prevent or delay the onset of kidney disease. When the kidneys fail, a person has to have his or her blood fltered through a machine (a treatment called dialysis) several times a week or has to get a kidney transplant. If the tests show microalbumin in the urine or if your Work with your health care kidney function isn’t provider to prevent or treat normal, you’ll need to kidney problems. Protecting Your Kidneys Keep Your Blood Glucose Under Control High blood glucose can damage your kidneys as time goes by. Know the Effects of Some Medicines and X-Ray Dyes If you have kidney disease, ask your health care provider about the possible effects that some medicines and X-ray dyes can have on your kidneys. You’re more likely to have heart and blood vessel problems if you smoke cigarettes, have high blood pressure, or have too much cholesterol or other fats in your blood. Talk with your health care team about what you can do to lower your risk for heart and blood vessel problems. Signs of Heart and Blood Vessel Problems If you feel dizzy, have sudden loss of sight, slur your speech, or feel numb or weak in one arm or leg, you may be having serious heart and blood vessel  problems. Danger signs of circulation problems to the heart include chest pain or pressure, shortness of breath, swollen ankles, or irregular heartbeats. Signs of circulation problems to your legs are pain or cramping in your buttocks, thighs, or calves during physical activity. Preventing and Controlling Heart and Blood Vessel Problems Eat Right and Get Physical Activity Choose a healthy diet, low in salt. See pages 14–18 to read more about If you’re overweight, talk with healthy choices for food your dietitian about how to safely lose weight. When you have diabetes and also use tobacco, the risk of heart and blood vessel problems is even greater. One of the best choices you can make for your health is to never start smoking—or if you smoke, to quit. If your cholesterol is higher than 200 mg/dL on two or more checks, you can do several things to lower it. You can work with your health care team to improve your blood glucose control, you can lose weight (if you’re overweight), and you can cut down on foods that are high in fat and cholesterol. Some Signs of Diabetic Nerve Damage Some signs of diabetic nerve damage are pain, burning, tingling, or loss of feeling in the feet and hands. It can cause you to sweat abnormally, make it hard for you to tell when your blood glucose is low, and make you feel light-headed when you stand up.

Seven surveys had been social insurance buy aygestin 5mg with mastercard, and labour programmes cheap 5 mg aygestin otc, and with particular completed generic 5 mg aygestin, in Ghana, Kenya, Myanmar, the Philippines, attention to the needs of low-income populations. Data on adoption of new tools, while others indicate a need for social coverage levels are not easy to obtain, but coverage in many 5 assistance and other forms of social protection. However, increasing such pooled funding alone is patients, for example by providing food, cash, vouchers, or not sufcient; the funds must then be directed to priority other economic or psycho-social support. Both publications services and populations through the mechanisms used to also signaled the need to explore more efcient, systematic pay providers. Philippine Institute for Development patient must be an active PhilHealth member, meaning Studies; 2015. Revised guidelines for the PhilHealth outpatient anti- that the person is registered, with qualifying contributions. Typically, fnancing and 1960s, when the availability of efective treatments coin- systems that include these mechanisms involve a distinct cided with rapid social and economic development. Poor and vulnerable groups include transfers to individuals and households based on socio-economic criteria and may include children, the elderly, poor people with disabilities, and those facing food insecurity; disabled refers to persons having a disability regardless of socio-economic status. However, the latest value and recent trends in article/pii/S0277953609002111, accessed 2 August 2017) this indicator are shown in the country profles in Annex 2. Out of pocket expenditure is any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. Social Social Social • Social protection: Percentage of population covered Nutrition protection Nutrition protection Nutrition protection by social protection and labour programmes. Not in poverty Not in poverty Not in poverty • Not in poverty: Percentage of population living above the international poverty line. Field evaluations are expected The pipeline also includes three commercial technologies to start in 2018. Performance data for with higher throughput and potentially a lower unit cost these tests remain limited, and to date only the Epistem (per sample tested). Platforms being developed by Becton Dickinson and Roche, which are expected to be ready for feld evaluation studies in 2018. This was particularly the case for commercial transport products improved the performance of smear-negative, culture-positive specimens (e. However, the increased sensitivity has been ofset by a decrease in Critical concentrations for culture-based drug-susceptibility specifcity, possibly due to the well-described limitations of testing the reference standard (culture) used as the comparator for both versions of the Xpert cartridge. The main outcomes were changes to the critical concentrations for Products for transportation of samples the fuoroquinolones and the establishment of interim critical concentrations for bedaquiline and delamanid. Products for transportation the performance of centralized high-throughput testing of samples that improve the recovery and detection of platforms, the use of molecular sequencing as a reference M. The second step is evaluation of the clinical validity of the assays, based on testing of the platforms in two or 1 World Health Organization. These to isoniazid, injectable agents and fuoroquinolones as an 17 drugs are described in more detail in Section 8. Consensus meeting report: development of a 1 The use of molecular line probe assays for the detection of resistance to target product profle and framework for evaluation for a test of progression second-line anti-tuberculosis drugs. A The use of delamanid in addition to an optimized back- single ascending dose study will be completed in late 2017. The trial is being implemented in Peru and South Africa and is Pretomanid scheduled for completion in late 2017. Federation; positive results in terms of safety, efcacy and tolerability were reported in a press release in March 2017. The other trial arms, which included the clinical development of sutezolid in combination with various combinations of 10 mg/kg or 20 mg/kg of rifampicin, other drugs. A cure rate of 87% has been Evaluation of a standardized treatment regimen of anti-tuberculosis drugs reported for the frst 15 patients. It is intended as a in health research, and multisectoral therapeutic vaccine, to be used in conjunction with a short collaboration. It was designed as a advocates and public–private partnerships prophylactic boost vaccine for infants, adolescents and adults. Research priorities network will be used to share knowledge and to facilitate that were identifed included obtaining collaboration among research institutions, public health a better understanding of the impact of practitioners, international organizations and civil society. Digital health innovations will need to be evaluated in a variety of geographic, social and economic contexts and in specifc subpopulations to generate the evidence needed to inform global guidance, as well as adaptation and use at country level. Such evaluation and application will involve both the health sector and the feld of information and communication technology. Following review and follow-up with countries, the data used for the main part of this report were those data available on 14 August 2017. The number of countries and territories that had reported data by 14 August 2017 is shown in Table A1. Funded domestically Funded internationally Unfunded d Includes patients diagnosed before 2016 and patients who were not laboratory-confrmed. Funded domestically Funded internationally Unfunded Data for all countries and years can be downloaded from www. Funded domestically Funded internationally Unfunded Data for all countries and years can be downloaded from www. Funded domestically Funded internationally Unfunded Data for all countries and years can be downloaded from www. For details about the methods used to produce these estimates see the technical appendix at http://www. Estimates are shown rounded to three signifcant fgures unless the displayed value is under 100, in which case it is shown rounded to two signifcant fgures. This includes Aruba, Curaçao, Puerto Rico and Sint Maarten, which are Associate Members of the Pan American Health Organization, plus the territories of Anguilla, Bermuda, Bonaire, Saint Eustatius and Saba, British Virgin Islands, Cayman Islands, Montserrat and Turks and Caicos Islands. European Union/ European Economic Area countries Notifcation and treatment outcome data for European Union and European Economic Area countries are provisional. France Data from France include data from 5 overseas departments (French Guiana, Guadeloupe, Martinique, Mayotte and Réunion) and exclude French territories of the Pacifc. The fndings and conclusions in this document are those of the author(s) who are responsible for its contents; the fndings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an offcial position of the Department of Veterans Affairs. What will be the health impacts of using either of two available directly acting antivirals combined with pegylated interferon and ribavirin (triple therapy)? Average Annual Net Increase in Cost by Treatment Strategy and Uptake Rate over the 5 Years of the Analysis Relative to Standard Therapy. We used analysis of observational data and decision analysis to answer these questions over a 5 year time horizon, all in comparison to health outcomes and costs if standard two-drug treatment were continued without adoption of either of the new technologies. Importantly, these results are appropriate for short-term budgeting and planning considerations but are not appropriate for formal cost-effectiveness analyses as they do not represent the full costs and benefts experienced over a life time. Of those who initiated boceprevir, 89% continued to 8 weeks, 81% to 12 weeks, 76% to 16 weeks, and 29% to 32 weeks. Key Question #2: What will be the health impacts of using either of two available directly acting antivirals combined with pegylated interferon and ribavirin (triple therapy)?

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Is the principle to the conventional effcacy of either procedure obturator approach aygestin 5 mg sale, and are affected by concomitant surgery? At this stage no long and demonstrable problem 5 mg aygestin overnight delivery, term comparative data regarding evidence suggests that abdominal effcacy are available generic aygestin 5 mg amex. Stem cells hysterectomy performed at the injected para – urethrally remain time of a Burch colposuspension an interesting possibility, but are has no adverse effect on the still, at this stage, experimental. While The Future the retropubic approach is still popular, the obturator approach Recently the “mini – sling” has many probable advantages to products have become available, recommend this technique, and consisting of shorter lengths of make it the treatment of choice. While the ersatz knock – offs may be slightly cheaper (since no development costs were involved), the originators have the advantage of published clinical trials proving good outcomes. The problem however is that neurological pathology can often be a cause 55 of these dysfunctions and various Most conditions of the central neurological conditions can cause nervous system can produce the overactive bladder symptoms, full range of bladder symptoms, impaired detrusor contractility varying sometimes from one stage and incontinence. Brain tumours These conditions can cause high • Cerebral Palsy pressures within the bladder • Parkinsons disease of above 40cmH20 without the • Shy-Drager Syndrome urethral sphincter opening. This • Multiple sclerosis causes severe back pressure and • Spinal cord injuries – suprasacral upper urinary tract damage. It is however important • Skeletal abnormalities of the in the patient with atypical or spine (disc problems, ankylosing mixed urinary symptoms to be spondylitis) on the lookout for more subtle • Peripheral nerve damage neurological changes before (radical surgery, diabetes instituting treatment, especially mellitus) surgical treatment. Neurological disorders often Table 11: Other Causes Of overwhelm the average clinician, Voiding Dysfunction who probably slept through neurology lectures at university. Until Infammatory recently, however, the correlation • Severe vulvo vaginitis (genital between history, clinical fndings herpes, severe vulvo-vaginal and special investigations has candidiasis) shown poor correlation in women • Urethritis and cystitis and been more extensively and better defned in men. Pharmacological • General anaesthesia The following urinary symptoms • Regional anaesthesia are however important in making • Analgesics (Morphine) the diagnosis of suspected voiding • Anti depressants abnormalities. Be aware however • Anti cholinergics that different studies have linked these symptoms differently to Detrusor Muscle Abnormalities confrmed voiding disorders • Detrusor myopathy • Over distention • Hesitancy • Straining to void Psychogenic • Feeling of incomplete emptying • Terminal dribble Post Partum Voiding Diffculty • Post micturition dribble • Splitting and spraying of urine Idiopathic • Changing position to void Surgical The above urinary symptoms • Will be discussed later in this may also be associated with chapter overactive bladder symptoms and incontinence. Further important questions in the history would be careful questioning about the usage 57 of medications, recent pelvic or for infection and haematuria abdominal surgery, neurological • Post micturition residual symptoms and symptoms of utero- volume. Ultrasound scanning Abdominal and pelvic examinations should concentrate is less invasive and causes less discomfort than urinary on detecting local lesions and anomalies, which might cause catheterisation. It is important to remember however that the urinary obstruction, such as pelvi- accuracy of this measurement abdominal tumours, utero-vaginal depends on the time since the prolapse, vulvo-vaginitis, urethritis last passage of urine until the and evidence of pelvic foor spasm or relaxation. In diffcult cases, with mixed • Urofowmetry is an excellent non invasive screening test urinary symptoms, or where for voiding dysfunction. A symptoms have had sudden onset, careful neurological examination fow rate of less than 15ml per including inspecting the lumbar second would be considered to be abnormal. This fow spine, assessing sensory and motor function in the pelvic area rate however also needs to be and checking peripheral refexes compared to the voided volume are all important features of the and the Liverpool Nomogram, examination. If the Special Investigations diagnosis of voiding dysfunction has been made, uro-dynamic • Mid stream urine examination 58 studies are important for practitioners taking care of this confrmation of this diagnosis particular patient, changes in and to assess whether the medication, which might be voiding dysfunction is associated causing the problem should be with poor detrusor contractions considered as well as attention to or obstruction, associated with the psychological and psychiatric high bladder pressures of more health of the individual. This has Treatment Of Voiding proven to be a very useful and safe method of emptying the Disorders bladder without continuous (Excluding Voiding Diffculty catheterisation. This can be done After Incontinence Surgery) at 2-4 hourly intervals and can be performed by the patient The treatment of voiding themselves if they have the disorders obviously is dependant necessary motor co-ordination on the underlying cause. In spinal injuries underlying cause is obstructive, below C7, most patients can such as in pelvic swellings, utero- manage this themselves. Clean vaginal prolapse, constipation or catheterisation as opposed foreign bodies, these problems to sterile catheterisation is should obviously be attended to. These patients need careful surveillance for urinary tract The two major issues concerning infection, stone formation and post operative urinary retention regular cystoscopy to exclude are: the development of bladder 1. The reported incidence of post • History of age, menopausal operative voiding diffculty and status and previous surgical retention of urine varies greatly history should be taken into in the literature and is frequently account. Comparative studies between • Urofowmetry of less than 15ml/ colpo-suspension and tension free second. The those suggestive of outfow reported incidence of voiding obstruction and poor detrusor dysfunction following mid urethral activity for whatever cause. Attention should be procedures such as Burch colpo- given to the above predisposing suspension, Marshall Marchetti factors. In the care of a trained Krantz procedures, slings and uro-gynaecologist after careful needle suspensions have varied assessment, these factors do not between 5 and 22%. Furthermore, 61 in cases where voiding diffculty days before tissue ingrowth has might be anticipated, it might taken place. This can be done be worthwhile teaching clean, as a simple surgical procedure intermittent self catheterisation with local anaesthesia. The more formal surgical procedure treatment of pain and either cutting or removing a constipation are important. Post operative voiding diffculty • Other forms of surgical release with high residual volumes include transvaginal and and urinary retention might retropubic urethrolysis. The methods of releasing post surgical management of the problem obstruction can be found in the related to the surgical procedure Textbook of Female Urology itself, particularly with the use of and Uro-gynaecology, Volume mid urethral tape, is according 2 Chapter 68 by Huckabay and to whether the diagnosis is made Nitti, Editors Cardozo and Staskin, in the immediate post operative Publishers Informa Healthcare, period or much later 2006 • Early post operative voiding The early and late release of mid diffculty, particularly with the urethral tapes is very successful presence of a mid urethral tape, in the management of voiding which persists beyond the time diffculties and interestingly, up when the reversible causes to more than 60% of patients will have disappeared, is usually remain continent despite cutting treated early in the frst 7-10 or removing the tape, however in 62 some of these patients, overactive Recommended bladder symptoms might persist. Female Urology, tape for obstruction, one should Uro-Gynaecology and Voiding replace it immediately with a Dysfunction. It would seem however of Female Urology and Uro- appropriate to adopt a wait and Gynaecology Second Edition see policy in view of the fact that Informa Healthcare 2006. With the easy reviews and original articles access to changing tension and on the topics discussed in this removing and cutting mid urethral chapter. The fnal category Sexuality and urinary incontinence included other sexual pain are often considered to be disorders not associated with coitus taboos in the minds of many (Table1). At present, there is no consensus The focus of this chapter will be regarding the defnition of normal directed towards the impact of sexual function. However, women with urge urinary Finally, sociocultural infuences, incontinence leaked more often such as cultural and religious Table I. Categories of sexual dysfunction Low sexual desire Diffculty with Diffculty with Sexual pain Arousal orgasm disorder Hypoactive sexual Female arousal Dyspareunia desire disorder disorder Vaginismus Sexual aversion Other non-sex causes 65 beliefs have an important impact • Societal taboos on sexual function. The fear • Medication of leaking urine and a concern • Alcohol / Substances about odour also induce a sense • Hormonal loss of anxiety. The general menopause is known to be questionnaire is insensitive signifcantly associated with a to a condition such as urinary decrease in libido, sexual activity incontinence, whereas a condition and responsiveness. It is essential that a not report feeling too embarrassed women’s sexual function causes to complete the questionnaire. Admittedly, this after treatment intervention which was a small study but it certainly could be conservative or surgical. For some patients, simple advice Treatment of Urinary such as emptying the bladder incontinence and prior to intercourse or a change in Female sexual position are effective in reducing dysfunction coital urinary incontinence. In most studies looking at the Women with overactive bladder outcomes of treatment for urinary fnd the symptoms particularly incontinence, objective measures more bothersome compared to of continence outcomes are usually those patients complaining of the primary aims and sexual stress urinary incontinence since function is usually assessed as a urinary leakage is not the only secondary outcome.