Effects of sexual counseling on sexual function and sexual quality of life of women with permanent intestinal ostomy.

BACKGROUND: Patients with an intestinal ostomy may experience significant sexual dysfunction that may have adverse impacts on quality of life. Appropriate sexual health counseling can be beneficial for these patients. AIM: This study was conducted to determine the effect of sexual counseling on the sexual function and sexual quality of life of women with a permanent intestinal ostomy. METHODS: For this experimental study, 60 female patients with a permanent intestinal ostomy were selected through convenience sampling and then randomly assigned to either the intervention or control groups. Patients in the intervention group received four 90-minute individual counseling sessions based on the PLISSIT (permission [P], limited information [LI], specific suggestions [SS], and intensive therapy [IT] model over a period of 4 weeks). The control group underwent routine training. Data were collected by use of a demographic information questionnaire, the Female Sexual Function Index, and the Sexual Quality of Life Female questionnaire. Both groups completed the questionnaires before and after the intervention. OUTCOMES: Study outcomes were the resulting data for the Female Sexual Function Index and the Sexual Quality of Life Female questionnaire. RESULTS: The results revealed a significant increase in the mean score of sexual function in the intervention group after counseling (P = .001). No significant difference was observed in the mean score of sexual quality of life between the 2 groups before the intervention (P > .05). In contrast, a significant increase was noted in the intervention group's sexual quality of life after the intervention (P = .001). CLINICAL IMPLICATIONS: The results indicate a need to sexual counseling interventions directed toward sexual function and sexual quality of life in women with permanent intestinal ostomy. STRENGTHS AND LIMITATIONS: Study strengths include utilization of the PLISSIT model for sexual counseling as an invaluable roadmap for healthcare professionals, systematically addressing patient needs within a tailored framework, and prescribing appropriate strategies over 4 distinct phases. Limitations include the use of convenience sampling and no follow-up duration. CONCLUSIONS: This study demonstrated the efficacy of counseling in enhancing sexual well-being of women with permanent intestinal ostomy.

Adapting the Client Priority Rating Scale to better fit the sexual health counselling setting: a quality improvement study.

BACKGROUND: When demand for counselling in community-based clinics exceeds capacity, waiting lists are typically formed. Determining allocation priority solely on wait time can overlook client risk factors that can elevate priority. We undertook to rigorously adapt the only existing validated counselling triage tool, to better fit the sexual health setting. METHODS: Sexual health counsellors were surveyed about aspects of client presentations that flagged increased priority. The revised Client Priority Rating Scale (CPRS-R) was created through systematic analysis and decision making, informed by survey results and literature review. Four expert sexual health counsellors independently rated the priority of 14 hypothetical clinical vignettes using the CPRS and CPRS-R. RESULTS: Criterion (concurrent), content and face validity are evidenced in the revised scale. Average interrater agreement was higher on the CPRS-R (28%) than the CPRS (11%); however, this difference was marginal (P =0.06). According to Gwet's Agreement Coefficient (AC) and Krippendorff's Alpha, both the CPRS and the CPRS-R demonstrate comparable interrater reliability, substantial and moderate, respectively. Kendall's W indicates the CPRS yielded higher reliability. However, the difference is not substantial. CONCLUSIONS: The CPRS-R is a triage tool designed for the sexual health counselling setting. This tool has demonstrated criterion, content and face validity, as well as moderate to substantial inter-rater reliability. It can be used in sexual health settings to inform assessments about client priority, along with clinical judgement and peer consultation.

Get2PrEP: An Electronic Medical Record Laboratory Comment Increased Safe Sex Counseling But Not Preexposure Prophylaxis Services at a Large Urban Academic Medical Center in Northern Manhattan.

BACKGROUND: HIV preexposure prophylaxis (PrEP) remains underutilized despite its efficacy and potential population impact. Achieving PrEP's full potential depends on providers who are knowledgeable and comfortable prescribing it to individuals at risk of acquiring HIV. Previous educational interventions targeting provider-related uptake barriers have had limited success. We designed and tested an electronic medical record (EMR) interpretative comment to improve the delivery of PrEP. METHODS: An EMR comment provided information on PrEP eligibility and referral resources to providers delivering positive chlamydia and gonorrhea results. Positive test results for bacterial sexually transmitted infections before intervention (January 1, 2019-August 23, 2019) and after intervention (August 24, 2019-December 31, 2019) were identified. A retrospective chart review was conducted to ascertain provider documentation of PrEP discussions or provision, HIV prevention discussions, and HIV screening. Pretest-posttest analysis was performed to compare the provision of PrEP and HIV prevention services. RESULTS: We reviewed 856 preintervention encounters spanning 8 months and 461 postencounters spanning 4 months. Patient demographics were comparable. We observed an increase in provider documentation of safe sex and condom counseling (odds ratios [ORs], 1.2 [95% confidence interval {CI}, 1.07-1.18] and 1.11 [95% CI, 1.05-1.17], respectively), and the absence of any HIV prevention discussion decreased (OR, 0.85; 95% CI, 0.80-0.90), but not HIV screening or PrEP documentation. CONCLUSIONS: We demonstrated that an EMR laboratory comment had a modest effect on increasing risk reduction counseling, although not HIV screening or PrEP prescriptions. Future strategies to encourage provider delivery of sexual health services may benefit from more targeted strategies that combine behavioral and information technology approaches.

Sexual Counseling with the PLISSIT Model: A Systematic Review.

A systematic review was conducted to use recent and relevant literature resources in examining the sexual counseling with the PLISSIT model. Electronic literature search was conducted on Medline, Science Direct, Google Scholar, and PubMed between January 1, 2011, and March 1, 2021. 14 studies were included in the systematic review. The mostly used study design was randomized controlled trial. It was determined that PLISSIT model on sexual counseling is an effective, simple, useful, and cost-effective counseling method.

Educational Programs and Sexual Counselling for Postmenopausal Sexual Dysfunction: A Systematic Review and Meta-Analysis.

BACKGROUND: Female sexual dysfunction has a high prevalence in women in the postmenopausal period. Not only factors like comorbidities and chronic illnesses are responsible for this high prevalence, but also psychological and interpersonal factors play a significant role. Sexual counselling educational programs have shown positive sexual behavioral changes and they should be considered the first line approach to female sexual dysfunction in this group of women. AIM: To review the evidence of the efficacy of sexual counselling educational programs for sexual dysfunction in postmenopausal women. METHODS: A systematic search was performed in February 2021 from electronic databases (MEDLINE, CENTRAL, and Scopus), unpublished studies, ongoing clinical trials, conference abstracts and journal archives, dissertations and theses, gray literature and free search on the Google Scholar search engine. Studies that evaluate the effectiveness of sexual educational programs in postmenopausal women were selected. Study selection and data extraction were performed by 2 independent researchers. Extracted data included author identification, publication date, geographic location, study population and sample size, type of intervention, sexual function evaluation tool and outcome. Studies that evaluate sexual function by using the Female Sexual Function Index (FSFI) were included in the meta-analysis, calculating the mean difference. OUTCOMES: Improvement of sexual function in postmenopausal women. RESULTS: We included 8 studies in the systematic review, 6 randomized and 2 nonrandomized controlled trials, with a total sample size of 619 women, aged between 39 and 75 years old, all in menopause for less than 5 years. The studies described sexual education programs, with 4-10 sessions, 45-60 minutes each, including themes like sexual anatomy, physiological sexual response, menopause, methods of stimulation, and common sexual myths. Five studies also included cognitive-behavior therapy and 3 studies assessed mindfulness techniques. Six studies evaluated the effectiveness of sexual educational programs using FSFI. The results showed that sexual counselling educational programs had statistically significant effects on enhancing the total FSFI score (mean difference = +7.14, 95% confidence interval = 3.70-10.6, P < .0001) in comparison to routine care. Results were also significant in all evaluated sex domains: pain, arousal, lubrication, desire, orgasm and satisfaction (P < .05). CONCLUSION: Our meta-analysis shows that sexual counselling educational programs are effective in improving sexual dysfunction in postmenopausal women when compared to routine care. These are simple approaches, easily administered with minimal resources that help prevent the psychological and social consequences of sexual dysfunction at this age. IMS Silva, MP Pinto, D Gonçalves. Educational Programs and Sexual Counselling for Postmenopausal Sexual Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:54-63.

Practice Facilitation Improves Adolescent Reproductive Health Preventive Services in Primary Care.

OBJECTIVES: Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well positioned to provide these services but often face barriers. With this project, we aimed to build quality improvement (QI) capacity within pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventive services. METHODS: In 2016, an accountable care organization overseeing health care delivery for low-income children in the Midwestern United States used practice facilitation, a proven approach to improve health care quality, to support pediatric practices in implementing reproductive health QI projects. Interested practices pursued projects aimed at providing (1) sexual risk reduction and contraceptive counseling (reproductive health assessments [RHAs]) or (2) etonogestrel implants. QI specialists helped practices build key driver diagrams and implement interventions. Outcome measures included the proportion of well-care visits with RHAs completed and number of etonogestrel insertions performed monthly. RESULTS: Between November 1, 2016, and December 31, 2019, 6 practices serving >7000 adolescents pursued QI projects. Among practices focused on RHAs, the proportion of well-care visits with completed RHAs per month increased from 0% to 65.8% (P < .001) within 18 months. Among practices focused on etonogestrel implant insertions, overall insertions per month increased from 0 to 8.5 (P < .001). CONCLUSIONS: Practice facilitation is an effective way to increase adherence to national guidelines for adolescent reproductive health preventive services within primary care practices. Success was driven by practice-specific customization of interventions and ongoing, hands-on support.

Effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda: A randomised controlled trial.

BACKGROUND: The unmet need for contraceptives among refugee adolescents is high globally, leaving girls vulnerable to unintended pregnancies. Lack of knowledge and fear of side effects are the most reported reasons for non-use of contraceptives amongst refugee adolescents. Peer counselling, the use of trained adolescents to offer contraceptive counselling to fellow peers, has showed effectiveness in increasing use of contraceptives in non-refugee adolescent resarch. OBJECTIVE: To determine the effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda. METHODS: A randomised controlled trial carried out in Palabek refugee settlement in northern Uganda, May to July 2019. Adolescents were included if they were sexually active or in any form of union, wanted to delay child bearing, and were not using any contraceptives. A total of 588 consenting adolescents were randomised to either peer counselling or routine counselling, the standard of care. RESULTS: Adolescents who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling (PR: 1·24, 95% CI: 1·03 to 1·50, p = 0·023). Adolescents whose partners had attained up to tertiary education were more likely to accept a method than those whose partners had secondary or less education (PR: 1·45, 95% CI: 1·02 to 2·06, p = 0·037). In both groups, the most frequently accepted methods were the injectable and implant, with the commonest reasons for non-acceptance of contraception being fear of side effects and partner prohibition. CONCLUSION: Our data indicates that peer counselling has a positive effect on same day acceptance of modern contraceptives and should therefore be considered in future efforts to prevent adolescent pregnancies in refugee settings. Future peer counselling interventions should focus on how to effectively address adolescents' fear of side effects and partner prohibition, as these factors continue to impede decision making for contraceptive uptake.

Patient Reported Sexual Function Outcomes in Male Patients Following Open Radical Cystoprostatectomy and Urinary Diversion.

OBJECTIVE: To report sexual health outcomes in male patients undergoing open radical cystoprostatectomy using a validated questionnaire. MATERIALS AND METHODS: Beginning in 2017, male patients were asked to complete a validated questionnaire during scheduled post-cystectomy clinic visits that assessed sexual function using the 5 item International Index of Erectile Function (IIEF-5) and supplemental questions which evaluated libido, orgasm, partner interest, and adequacy of pre-operative counselling. Baseline data and functional outcomes were compared and multivariable analysis performed. RESULTS: A total of 134 patients who met inclusion criteria completed the questionnaire. Pre-operative IIEF-5 was available in 78 patients with a median score of 16 (IQR:5-23). In those patients, median age at cystectomy was 68.9 years (IQR:60.2-72.4) and median duration of follow-up was 17.3 months (IQR:6.3-28.7). Median IIEF-5 score at time of survey completion was 1 (IQR:1-11). Increasing age, shorter follow-up duration, insufficient counselling, and absence of partner interest were predictive of lower scores. Younger age, pre-operative erectile function, and neurovascular preservation were predictive of a higher IIEF-5 score on univariate and multivariate analysis. Median libido score was 2 "low" (IQR:1-3) and ability to orgasm was reported by 34 (43.6%) patients. Neurovascular preservation (OR:3.03 95% CI:1.10-8.26, P = .03) and sufficient preoperative counselling (OR:3.078 95% CI:1.17-8.098, P = .02) were associated with preserved ability to orgasm. Libido was influenced by partner interest (OR 11.7, 95% CI:3.793-6.14, P <.0001). CONCLUSION: Sexual dysfunction after radical cystoprostatectomy is prevalent with many contributing factors. As such, establishing appropriate expectations and goals during preoperative counseling, performing neurovascular preservation when appropriate, and readily identifying and treating dysfunction in follow-up may improve sexual recovery.

What Women Want: Radical Cystectomy and Perioperative Sexual Function Educational Needs.

OBJECTIVE: To assess the extent and adequacy of pre-operative sexual function (SF) counseling in females undergoing radical cystectomy (RC) and develop educational material to improve identified deficits. METHODS: A 10-question survey was electronically delivered to all females who underwent RC at a single institution between 2015 and 2020. 23 of 145 patients responded (15.9%). In addition, women on the Bladder Cancer Advocacy Network (BCAN) patient discussion board were also queried. The primary outcome was the development of a patient educational handout based on patient perception of pre-operative SF counseling and self-reported changes in post-operative SF. RESULTS: 22 women, 84% of whom were sexually active, met the inclusion criteria. More than half (12/22, 54.5%) reported receiving no pre-operative counseling regarding possible SF changes while another 27.3% (6/22) received some counseling but desired more. Most women rated vaginal preservation as moderate to very important (17/22, 77.3%) and nearly all women noted at least one change in SF, most commonly dyspareunia (13/22, 59.1%). Most also desired more information regarding female sexual health. Separately, the BCAN discussion board was queried regarding patient preference for modality of pre-operative counseling. 77.8% (14/18) preferred a discussion with provider and 13/18 (72.2%) also wanted a written handout. CONCLUSIONS: Sexual dysfunction is prevalent following RC in women and many desire more pre-operative counseling, regardless of disease stage or receipt of chemotherapy. These findings supported our development of interventions to improve pre-operative education as well as strategies to address post-operative SF changes, such as dyspareunia.

Online Compared to Face-to-Face Sexual Intimacy Enhancement Training Program Counseling with Cognitive-Behavioral Approach on Sexual Intimacy in Pregnant Women.

Studies have shown sexual intimacy enhancement-training with cognitive-behavioral can affect women's sexual intimacy. Interventional study to compare online and face-to-face sexual enhancement-training with cognitive-behavioral approach on sexual intimacy was conducted on 48 pregnant women with sexual intimacy scores < 75 who were randomly divided online (n = 25) and face-to-face (n = 23). Six 90-minute session sexual intimacy enhancement-training were conducted. Data were collected Botlani's sexual intimacy questionnaire (primary outcome) and counseling satisfaction scale (secondary outcome) measured baseline and after 6 and 10 weeks. In each group sexual intimacy in 10th week increased significantly compared to baseline (65.88 ± 5.51 vs 87.36 ± 8.39, p < 0.001) and (67.39 ± 5.26 vs 83.70 ± 5.61, p < 0.001) respectively. There was no significant difference between two groups in sexual intimacy scores in 6th (82.32 ± 9.25 vs 79.87 ± 6.35, p = 0.29) and 10th weeks (87.36 ± 8.39 vs 83.70 ± 5.61, p = 0.08) but totally intervention caused significant increase in sexual intimacy in 10th week compared to baseline (p = 0.04). Satisfaction from intervention was significantly different in 6th (65.72 ± 2.57 vs 61.21 ± 7.17, p = 0.021) and 10th weeks (68.92 ± 2.79 vs 64.26 ± 5.15, p = 0.001). Intervention improved sexual intimacy in pregnant women via both online and face-to-face counseling, with more sexual intimacy and satisfaction in online group, could be useful in COVID-19 pandemic.

Office-Based Screening for Sexually Transmitted Infections in Adolescents.

Almost 1 in 4 adolescents have a sexually transmitted infection (STI). These infections are preventable through safe sexual practices and routine screening. Pediatricians are the first line of clinical care for adolescents and are well positioned to offer sexual and reproductive health care counseling and services to their patients; yet, there is a paucity of sexual health screening provided at routine health supervision visits. This article addresses the epidemiology of STIs in adolescents, reviews the evidence of current clinical practice, presents recommended STI screening from government and medical agencies, and offers strategies to address barriers to providing care for adolescents and for sexual health screening in primary care.

Sexual norms and the intention to use healthcare services related to female genital cutting: A qualitative study among Somali and Sudanese women in Norway.

BACKGROUND: Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway. METHODS: We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants. FINDINGS: We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants' intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal- sexual partner scenarios. Participants with negative attitudes towards the use of almost all of the FGC-related healthcare services were influenced by a set of norms pertaining to virginity and passive sexual behavior. In contrast, participants with positive attitudes towards the use of all of these same services were influenced by another set of norms pertaining to sexual and gender equality. On the other hand, participants with positive attitudes towards the use of services that can help to improve their marital sexual lives, yet negative towards the use of premarital services were influenced by a third set of norms that combined norms from the two aforementioned sets of norms. CONCLUSION: The intention to use FGC-related healthcare services varies between and within the different ethnic groups. Moreover, the same girl or woman can have different attitudes towards the use of the different FGC-related healthcare services or even towards the same services at the different stages of her life. These insights could prove valuable for Norwegian and other policy-makers and healthcare professionals during the planning and/or delivery of FGC-related healthcare services.

Single women and motherhood: right now or maybe later?

Purpose: The decision to have a child might be postponed by the lack of partner, and elective egg freezing (EEF) can afford single women more time to find a suitable companion to reach the desired family structure. Alternatively, some women decide to have a child on their own thorough in vitro fertilization (IVF) or intrauterine insemination (IUI) with donor sperm. This study investigates the motivations and personal characteristics of single women undergoing IVF/IUI or EEF.Materials and methods: This is a cross-sectional study including 281 heterosexual single women who underwent either IVF/IUI with donor sperm for solo motherhood (208) or EEF (73) in 2015 at a large fertility center. An anonymous electronic survey was sent after starting the treatment.Results: The most common reason for not having fulfilled the motherhood desire was lack of partner (72.4% IVF/IUI and 65.9% EEF). We found that women undergoing IVF/IUI report a longer motherhood desire, >10 years (71.3% vs. 54.3%), live closer to their families (75.5% vs. 56.5%), and perceive a stronger family support than women undergoing EEF (85.4% vs. 68.8%). Finally, 100% of EEF obviously knew about the possibility of IVF/IUI with donor sperm, while 59.9% of IVF/IUI knew about EEF.Conclusion: Our results underscore the relevance of family ties in the decision to undergo IVF/IUI as single women. Moreover, these women might not be fully informed about social freezing as an option to postpone motherhood. Health professionals should be aware of these differences when counseling single women on fertility choices.

A systematic review and meta-analysis of couple-based intervention on sexuality and the quality of life of cancer patients and their partners.

PURPOSE: To synthesize the characteristics and effects of couple-based intervention on sexuality and the quality of life (QOL) of cancer patients and their intimate partners and its implications for future research and practice. METHODS: A systematic review and meta-analysis of randomized and non-randomized controlled studies of interventions was conducted in nine English databases and two Chinese databases, with identification of related studies published in English and Chinese. The quality of the studies was assessed using the tools of the Effective Public Health Practice Project. RESULTS: A total of 33 articles were identified for systematic review and 23 articles were identified for meta-analysis. For patients, the effect size was 0.42 (Hedges's g, 95% CI = 0.05-0.78, p = 0.03) for physical health. For partners, the effect size was 0.52 (Hedges's g, 95% CI = 0.06-0.98, p = 0.03) for sexual relationships. However, moderate to high heterogeneity was reported. Effects on sexual function, sexual self-concept, and mental health for couples were not significant. CONCLUSION: Couple-based interventions had small to medium-sized effects on physical health for cancer patients. Partners could derive medium effects for improvement in sexual relationships from couple-based intervention. Future research should pay more attention to sexual self-concept in cancer patients and target types of cancer that are more likely to compromise sexuality and QOL. PROSPERO REGISTRATION: The systematic review and meta-analysis has been registered in PROSPERO with registration number: CRD42019119047.

Anejaculation: Relevance to Sexual Enjoyment in Men and Women.

INTRODUCTION: Ejaculation and orgasm are important components of sexual response in men. Our understanding of both phenomena is limited. Anejaculation can be a source of substantial distress, even when procreation (ostensibly the only purpose of ejaculation itself) is not a priority. AIM: To present an opinion on male perceptions of ejaculation disorders (specifically anejaculation) based on a variety of data sources, including peer-reviewed literature. METHODS: A non-systematic review of literature on anejaculation and other impairments of ejaculatory and orgasmic response was conducted. Relevant articles were critically analyzed and reported MAIN OUTCOME MEASURE: An opinion is presented, based on existing data sources, on how and why ejaculation is deemed important to men and their sexual partners. RESULTS: The peer-reviewed literature on disorders of ejaculation is scant; existing reports oftentimes do not adequately distinguish between orgasm and ejaculation in assessment. Men's perceptions of ejaculation quality appear to be positively associated with satisfaction with sexual response, particularly regarding orgasm. Based on very limited data, female sexual partners of men appear to often (but not always) value the orgasmic experience of their partner; only a minority prioritize actual ejaculation. There is evidence that disorders of ejaculation may be particularly troublesome for men who have sex with men. CLINICAL IMPLICATIONS: The influence of medical conditions and treatments on ejaculation should be considered in the clinical context. Psychological adaptations and interventions may be of value in some cases. STRENGTHS & LIMITATIONS: Data on the clinical relevance of anejaculation outside the context of concomitant orgasmic dysfunction are sparse. Men's experience of orgasm is at least partially associated with ejaculation-specific variables; whether this association is mediated by psychological, physical, or a combination of factors remains unclear. CONCLUSIONS: Ejaculation, orgasm, and sexual satisfaction are closely intertwined but distinct phenomena. Shindel AW. Anejaculation: Relevance to Sexual Enjoyment in Men and Women. J Sex Med 2019;16:1324-1327.

Sexual health counselling targeting girls and young women with female genital cutting in Sweden: mind-body dualism affecting social and health care professionals' perspectives.

Female genital mutilation (FGM), also referred to as female genital cutting (FGC), has become the subject of an intense debate exposing tensions between varying cultural values about bodies and sexuality. These issues are brought to the fore in settings where professionals provide sexual counselling to young circumcised women and girls in Western, multicultural societies. This article is based on interviews and focus group discussions with professionals in social and healthcare services. The aim of this study was to examine how professionals reflect upon and talk about sexuality and the promotion of sexual wellbeing in young circumcised women and girls. Policy documents guide their obligations, yet they are also influenced by culture-specific notions about bodies and sexuality and what can be called "the FGM standard tale". The study found that professionals showed great commitment to helping the girls and young women in the best possible way. Their basic starting point, however, was characterised by a reductionist focus on the genitalia's role in sexuality, thus neglecting other important dimensions in lived sexuality. In some cases, such an attitude may negatively affect an individual's body image and sexual self-esteem. Future policy making in the field of sexual health among girls and young women with FGC would benefit from taking a broader holistic approach to sexuality. Professionals need to find ways of working that promote sexual wellbeing in girls, and must avoid messages that evoke body shame or feelings of loss of sexual capacity among those affected by FGC.

PLISSIT model: sexual counseling for breast cancer survivors.

OBJECTIVE: Reporting the experience of use of the PLISSIT model as tool for the nursing care of breast cancer survivors with sexual dysfunction. METHOD: case study developed from January to August 2017, in the outpatient mastology clinic and sexuality service of a maternity in Fortaleza, Ceará, Brazil, with 15 breast cancer survivors. RESULTS: sexual counseling sessions were conducted using the PLISSIT model to address sexual issues, highlighting the particularities of women who experience survival after the treatment of breast cancer. FINAL CONSIDERATIONS: the model used in the practice of nursing care is customary and allows identifying issues experienced by women, as it has easy availability and practicality for use by nursing professionals, helping to address sexual matters with greater tranquility.

The 'Pleasure&Pregnancy' web-based interactive educational programme versus expectant management in the treatment of unexplained subfertility: protocol for a randomised controlled trial.

INTRODUCTION: Many subfertile couples are diagnosed with (relatively) unexplained subfertility and a good prognosis. National professional guidelines (eg, the Netherlands and UK) advise 'expectant management (EM)' for 6-12 months, in which no interaction with healthcare staff is offered. Underpowered studies indicate that face-to-face sex-counselling increases the ongoing pregnancy rates of these couples. In patients with other conditions, web-based interactive educational programmes have the same effect on sexual functioning as face-to-face sex counselling. The 'Pleasure&Pregnancy randomised controlled trial (RCT)' will examine in couples with unexplained subfertility and a good prognosis whether a new web-based interactive educational programme results in a higher chance of naturally conceiving an ongoing pregnancy within 6 months as compared with EM. METHODS AND ANALYSIS: A multicentre RCT with cost-effectiveness analysis will include heterosexual couples diagnosed with (relatively) unexplained subfertility and a good prognosis in Dutch and Belgian secondary or tertiary fertility clinics. Couples will be randomised between 6 months of EM and 6 months of the Pleasure&Pregnancy-programme. This new web-based interactive educational programme includes eight progressive modules of information (on the biology of conception and pleasurable sex) and sensate focus, couple communication and mindfulness exercises. Couples are offered interaction with their coaches via email and can take part in three moderated chat sessions with peers. The primary outcome of this RCT is the probability of naturally conceiving an ongoing pregnancy within 6 months after randomisation. Secondary outcomes include time-to-pregnancy, live birth rate, costs, sexual functioning and personal and relational well-being. Analysis will be according to intention to treat. ETHICS AND DISSEMINATION: This study has been approved by the Medical Ethical Committees of the Academic Medical Centre (the Netherlands) and the Leuven University Hospital (Belgium). The findings of this RCT will be disseminated through presentations at international scientific meetings and peer-reviewed publications. TRAIL REGISTRATION NUMBER: NTR5709; Pre-results.

Pre-Exposure Prophylaxis Counseling in a Community Sexual Health Clinic for Men Who Have Sex with Men in Lisbon, Portugal.

INTRODUCTION: Pre-exposure prophylaxis is defined as the use of antiretroviral drugs to prevent HIV acquisition in uninfected individuals. Recognizing the increasing use of informal pre-exposure prophylaxis in Portugal, CheckpointLX, a community clinic targeted to men who have sex with men in Lisbon, Portugal, began offering counselling and follow-up services prior to formal introduction. This study aims to characterize pre-exposure prophylaxis users attending CheckpointLX before formal pre-exposure prophylaxis introduction in Portugal, and those who were referred to pre-exposure prophylaxis in the National Health Service following formal approval of pre-exposure prophylaxis. MATERIAL AND METHODS: Data was collected by peer counsellors between May 2015 and September 2018 and inserted in a database. Medical care followed the European AIDS Clinical Society recommendations for pre-exposure prophylaxis eligibility, initiation and follow-up. For formal pre-exposure prophylaxis, the General-Directorate for Health's Pre-exposure Prophylaxis guidelines checklist was used. RESULTS: Until the end of May 2018, CheckpointLX had a total of 90 appointments for wild pre-exposure prophylaxis, of which 64 (71%) were first time visits. As for the 380 service users referred to the National Health Service, most were Portuguese (n = 318, 84%), and the mean age was 31 (8.9) years old. Condomless sex in the last six months with partners of unknown HIV status was the most common eligibility criteria (n = 59, 83%). DISCUSSION: Pre-exposure prophylaxis delivery should be complemented with effective information on the importance of immunization and education on safer practices of drug administration, in the scope of broader preventive sexual health care. CONCLUSION: Much remains to be done in Portugal to ensure that pre-exposure prophylaxis is available to those who need it the most. Offering pre-exposure prophylaxis at community clinics could be a first step.

Introdução: A profilaxia pré-exposição pode ser definida como o uso de medicamentos anti-retrovirais para prevenir a aquisição do VIH em indivíduos não infectados. Reconhecendo o uso crescente da profilaxia pré-exposição informal em Portugal, o CheckpointLX, uma clínica comunitária destinada a homens que têm sexo com homens em Lisboa, Portugal, começou a oferecer aconselhamento e serviços de acompanhamento antes da introdução formal. Este estudo pretende caracterizar os utilizadores da profilaxia pré-exposição que frequentam o CheckpointLX antes da introdução formal da profilaxia pré-exposição em Portugal, e aqueles que foram encaminhados para a profilaxia pré-exposição no Serviço Nacional de Saúde após a aprovação formal da profilaxia pré-exposição. Material e Métodos: Os dados foram colhidos por pares entre maio de 2015 e setembro de 2018 e inseridos numa base de dados. Os cuidados médicos seguiram as recomendações da European AIDS Clinical Society para elegibilidade, iniciação e acompanhamento da profilaxia pré-exposição. Para a profilaxia pré-exposição formal, foi utilizada a lista de verificação da Norma de Profilaxia Pré-exposição da Direção-Geral da Saúde. Resultados: Até ao final de maio de 2018, o CheckpointLX fez um total de 90 consultas para o wild pre-exposure prophylaxis, das quais 64 (71%) foram primeiras consultas. Quanto aos 380 utilizadores referenciados ao Serviço Nacional de Saúde, a maioria era de nacionalidade portuguesa (n = 318, 84%) e a idade média era de 31 (8,9) anos. Sexo sem preservativo nos últimos seis meses com parceiros com estatuto VIH desconhecido foi o critério de elegibilidade mais reportado (n = 59, 83%). Discussão: A dispensa da profilaxia pré-exposição deve ser complementada com informações eficazes sobre a importância da imunização e da educação em práticas mais seguras de administração de medicamentos, no âmbito de cuidados de saúde sexual preventivos mais amplos. Conclusão: Ainda há muito a ser feito em Portugal para garantir que a profilaxia pré-exposição esteja disponível para aqueles que mais dela precisam. Oferecer profilaxia pré-exposição em clínicas comunitárias pode ser um primeiro passo.

When Healthcare Providers do not Ask, Patients Rarely Tell: The Importance of Sexual Counselling in Multiple Sclerosis.

Multiple sclerosis (MS) is a relatively frequent inflammatory autoimmune illness of the central nervous system affecting about 2.5 million people around the world, and represents the most common cause of neurological disability among young adults. Indeed, the disease can affect sensory-motor, autonomic and cognitive function potentially leading to a high prevalence of sexual dysfunction (SD). Thus, the identification of barriers to help seeking for sexual concerns in patients with MS is an important, although still overlooked, issue. Aim of this overview is to briefly investigate the role of sexual counselling in managing SD in individuals with MS, highlighting the importance for the clinicians to get more knowledge about; the pathophysiology, assessment and treatment of MS-related SD.