BackgroundThe Dutch Human Papillomavirus (HPV) catch-up vaccination program in 2009 appeared less successful than expected. We aimed to identify the most important determinants of refusing the vaccination.MethodsTwo thousand parents of girls born in 1996 targeted for HPV vaccination received an invitation letter to participate in a questionnaire study. Two study groups were defined: the first group consisted of parents of girls who had accepted the vaccine and already received the first dose of HPV vaccination. The second group consisted of parents whose daughters were not vaccinated. The questionnaire consisted of a broad spectrum of possible determinants that were revealed after literature search and discussions with the stakeholders.ResultsFour hundred sixty nine questionnaires (24%) were returned, 307 (31%) from those who accepted and 162 (16%) from those who declined the vaccine. The decision not to accept the vaccine was largely determined by: (i) perception that the information provided by the government about the vaccine was limited or biased (OR 13.27); (ii) limited trust, that the government would stop the vaccination program if there were serious side effects (OR 9.95); (iii) lack of knowledge about the effectiveness of the vaccine (OR 7.67); (iv) concerns about the side effects of the vaccine (OR 4.94); (v) lack of conviction that HPV can be extremely harmful (OR 3.78); (vi) perception that the government is strongly influenced by vaccine producers (OR 3.54); and (vii) religious convictions (OR 2.18).ConclusionsThis study revealed several determinants for HPV vaccination uptake after implementation of the HPV vaccine for adolescent girls. These determinants should be taken into consideration in order to successfully implement HPV vaccination into National Immunization Programs.

Background After the diagnosis and treatment of disease, a major barrier to research on psychosexual functioning is the lack of a consistent estimate for the prevalence of female sexual dysfunction in the general population. Aim To clarify the prevalence of age-related female sexual functioning in the general population. Methods A sample was compiled by random selection of women from the general population in the northern part of the Netherlands and was categorized by age. Women completed the Female Sexual Function Index (FSFI), personal medical items and daily activities, the Body Image Scale, the SF-36 Health Survey, the Hospital Anxiety and Depression Scale, and the Multidimensional Fatigue Inventory. Participants' representativeness was assessed by comparing their characteristics with data from the Dutch Central Agency for Statistics and the Dutch Health Monitor. General health, fatigue, and well-being were compared with national or international data. Outcomes Age-related total and domain scores of the FSFI. Results We evaluated female sexual functioning of 521 sexually active women. For women 20 to 80 years old, sexual functioning showed wide variance and was poor in 28% of all sexually active women, with FSFI scores being below the defined clinical cutoff (FSFI score < 26.55). Although sexual activity and functioning significantly decreased with increasing age, sexual satisfaction decreased only non-significantly. Clinical Implications This study provides valuable age-specific ranges for female sexual functioning in the general population and can inform upcoming clinical studies. Strengths and Limitations This is the largest study on female sexual function in a representative Dutch population using internationally validated tools and described by age categories, providing valuable information that can help in the understanding of how female sexual function changes with age. The FSFI has been criticized for not assessing personal distress related to sexual problems, so the lack of the Female Sexual Distress Scale in our study is an unfortunate shortcoming. The high rate of sexual inactivity (31%) resulted in fewer women being available to evaluate sexual functioning, but this could reflect the actual level of sexual (in)activity among women in a general population. Conclusion FSFI total and domain scores showed wide variation across all age categories, but overall, one in four sexually active women scored below the diagnostic cutoff score. Sexual activity and functioning also decreased with age, whereas sexual satisfaction decreased only slightly.

Introduction Physicians are increasingly presented with women requesting a labia minora reduction procedure. Aim To assess the influencing factor of personal predisposition in general practitioners, gynecologists, and plastic surgeons to labia minora appearance in relation to their willingness to refer for, or perform, a surgical labia minora reduction. Methods Cross-sectional self-administered questionnaire survey. Between May 2009 and August 2009, 210 physicians were surveyed. Primary care: general practitioners working in the north of the Netherlands. Secondary care: gynecologists and plastic surgeons working in five hospitals in the north of the Netherlands. Main Outcome Measures A five-point Likert scale appraisal of four pictures showing a vulva, each displaying different sizes of labia minora, indicating a physician's personal predisposition, manifesting as willingness to refer for, or perform, a labia minora reduction. Results A total of 164/210 (78.1%) physicians completed the questionnaire, consisting of 80 general practitioners, 41 gynecologists, and 43 plastic surgeons (96 males, 68 females). Ninety percent of all physicians believe, to a certain extent, that a vulva with very small labia minora represents society's ideal (2–5 on the Likert scale). More plastic surgeons regarded the picture with the largest labia minora as distasteful and unnatural, compared with general practitioners and gynecologists (P < 0.01), and regarded such a woman as a candidate for a labia minora reduction procedure (P < 0.001). Irrespective of the woman's labia minora size and the absence of physical complaints, plastic surgeons were significantly more open to performing a labia minora reduction procedure than gynecologists (P < 0.001). Male physicians were more inclined to opt for a surgical reduction procedure than their female colleagues (P < 0.01). Conclusions The personal predisposition of physicians (taking account of their specific gender and specialty) concerning labia minora size and appearance influences their clinical decision making regarding a labia minora reduction procedure. Heightened awareness of one's personal predisposition vis-à-vis referral and willingness to operate is needed.