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drop out (36% with SSRI and 39% with tricyclic antidepressants; p=0-34). Both studies quoted by Hale as showing an advantage of SSRIs over tricyclic antidepressants in long term compliance were placebo controlled, not including tricyclic antidepressants. In summary, there seems little evidence to support the routine first line use of SSRIs. The debate has now shifted to the issues of suicide by overdose and costs. This cannot be resolved by reference to the trial data and will be the subject of a further paper. SmithKline Beecham and Lilly Industries Ltd refer to data from unpublished studies, which therefore cannot be commented on. The burden of proof must lie with those who advocate the use of expensive new drugs on the basis of improved tolerability.

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This article describes a study on the psychological stress associated with vaginal examinations. The findings challenge current medical and midwifery working practices in the area of obstetrics and gynaecology.

The presentation outlines research conducted on 500 women by the author which demonstrated that genital medical procedures could be sufficiently stressful to induce Post-Traumatic Stress Disorder (PTSD).' This occurred in women who had been previously sexually traumatised and also in women who had had no apparent previous psychological stress. Factors which predisposed to the development of PTSD were shown to include: feelings of powerlessness and loss of control by the woman; lack of consent; lack of information; perceived lack of sympathy in the examiner; and the experience of physical pain. These factors are compared to the situation arising in sexual assault, sexual torture and circumcision. Preliminary findings of a comparative study of PTSD in circumcised men are described.