What advances may the future bring to the diagnosis, treatment, and care of male sexual and reproductive health?

Over the past 40 years, since the publication of the original WHO Laboratory Manual for the Examination and Processing of Human Semen, the laboratory methods used to evaluate semen markedly changed and benefited from improved precision and accuracy, as well as the development of new tests and improved, standardized methodologies. Herein, we present the impact of the changes put forth in the sixth edition together with our views of evolving technologies that may change the methods used for the routine semen analysis, up-and-coming areas for the development of new procedures, and diagnostic approaches that will help to extend the often-descriptive interpretations of several commonly performed semen tests that promise to provide etiologies for the abnormal semen parameters observed. As we look toward the publication of the seventh edition of the manual in approximately 10 years, we describe potential advances that could markedly impact the field of andrology in the future.

Consultoría integral en salud sexual y reproductiva: Guía operativa para equipos de salud: Marzo 2021 / Comprehensive consulting in sexual and reproductive health: Operational guide for health teams: March 2021

Guía basada en el trabajo de la becaria María Pía Elissetche, que fue dirigido por la Lic. Graciela Giorgetti. El trabajo de campo de la beca "Consejerías integrales en salud sexual y salud reproductiva: articulación e integración intersectorial para garantizar derechos" fue realizado durante 2019-2020 en los centros de salud del primer nivel de CABA y tuvo como finalidad conocer la articulación intersectorial entre Salud y Educación con foco en las consejerías integrales en salud sexual y reproductiva en escuelas medias. Este documento está dirigido a los/as profesionales de los equipos de salud que trabajan en el primer nivel de atención de la Ciudad de Buenos Aires y propone el fortalecimiento y la creación de consejerías integrales en salud sexual y reproductiva en las escuelas medias, como un modo de ampliar la promoción y prevención en salud sexual integral y de fomentar la autonomía en la toma de decisiones de los/as adolescentes. (AU)

Changes in contraceptive and sexual behaviours among unmarried young people in Nigeria: Evidence from nationally representative surveys.

CONTEXT: Nigeria is a high-burden country in terms of young people's health. Understanding changes in young people's sexual and reproductive health (SRH) behaviours and the associated factors is important for framing appropriate interventions. OBJECTIVE: This study assessed changes in SRH behaviours of unmarried young people aged 15-24 and associated factors over a ten-year period in Nigeria. DATA AND METHOD: We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours. RESULTS: Over four-fifths of unmarried young people (15-24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20-24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves. CONCLUSION: Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH.

Estratégias e ações utilizadas pelo enfermeiro frente à sexualidade do paciente renal crônico: revisão integrativa da literatura / Strategies and actions used by nurses against chronic renal patient sexuality: integrative review of the literature / Estrategias y acciones utilizadas por enfermeras contra la sexualidad crónica del paciente renal: revisión integrativa

Objetivo: identificar na literatura as estratégias e ações utilizadas pelo enfermeiro na promoção da sexualidade de pacientes com Doença Renal Crônica. Método: revisão integrativa, com abordagem qualitativa e coleta de dados nas bases Literatura Latino-Americana e do Caribe em Ciências da Saúde, no Banco de Dados em Enfermagem e no Medical Literature Analysis and Retrieval System Online, utilizando os seguintes descritores: "Sexualidade" and "Doença Renal Crônica" and Enfermagem or Enfermeiro". A busca resultou em 232 produções, sendo 12 selecionadas para análise. Resultados: as estratégias e ações utilizadas pelo enfermeiro estão relacionadas ao cuidado e à utilização do processo de enfermagem. Conclusão: A atuação do enfermeiro contribui para a promoção da assistência integral ao paciente renal crônico, em todas as dimensões do cuidado, abrangendo a sexualidade. Ao aplicar o processo de enfermagem é possível traçar um plano de cuidado conforme sua realidade e auxiliar para uma melhor qualidade de vida

Objective: to identify in the literature the strategies and actions used by nurses in promoting the sexuality of patients with Chronic Kidney Disease. Method: integrative review, with a qualitative approach and data collection from the Latin American and Caribbean Health Sciences Database, the Nursing Database and the Medical Literature Analysis and Retrieval System Online, using the following descriptors: "Sexuality" and "Chronic Kidney Disease" and Nursing or Nurse ". The search resulted in 232 productions, 12 of which were selected for analysis. Results: the strategies and actions used by nurses are related to care and utilization of the nursing process. Conclusion: the role of nurses contributes to the promotion of comprehensive care for chronic renal patients, in all dimensions of care, including sexuality. By applying the nursing process it is possible to draw a care plan according to your reality and help for a better quality of life

Objetivo: identificar en la literatura las estrategias y acciones utilizadas por las enfermeras para promover la sexualidad de pacientes con enfermedad renal crónica. Metodo: revisión integradora con un enfoque cualitativo y recopilación de datos de la Base de datos de ciencias de la salud de América Latina y el Caribe, la Base de datos de enfermería y el Sistema de análisis y recuperación de literatura médica en línea, utilizando los siguientes descriptores: "Sexualidad" y "Enfermedad renal crónica" y Enfermería o Enfermera ". La búsqueda resultó en 232 producciones, 12 de las cuales fueron seleccionadas para su análisis. Resultados:las estrategias y acciones utilizadas por las enfermeras están relacionadas con la atención y la utilización del proceso de enfermería. Conclusión: el papel de las enfermeras contribuye a la promoción de la atención integral para pacientes renales crónicos, en todas las dimensiones de la atención, incluida la sexualidad. Al aplicar el proceso de enfermería, es posible elaborar un plan de atención de acuerdo con su realidad y ayudar a una mejor calidad de vida

Salud sexual y reproductiva en mujeres víctimas del conflicto armado / Sexual and reproductive health in women victims of the armed conflict

RESUMEN Objetivo Mostrar las principales afecciones en salud sexual y reproductiva en mujeres víctimas del conflicto y posconflicto armado. Metodología Se hizo una revisión sistemática exploratoria de la literatura nacional e internacional, en idiomas inglés, español y portugués, entre los años 2000 al 2019, en PubMED, EMBASE, Google Scholar, LILACS, IBECS, SciELO; y consulta a informantes clave. Resultados Se encontró en el ámbito internacional que la principal afectación identificada se refirió a violencia sexual. Se encontraron factores de riesgo que la perpetúan, como el entorno familiar, acceso a educación, pobre infraestructura de servicios de salud entre otros. Otras afectaciones importantes derivaron en un aumento en la tasa de embarazos y matrimonios. En Colombia el panorama fue similar: las zonas con mayor afección por conflicto tienen más tasa de fecundidad, pobre acceso a atención obstétrica y pobre conocimiento de las ITS. Conclusión Se debe asegurar el acceso a servicios de salud sexual en el conflicto para prevención de enfermedades y asegurar el derecho a la salud sexual y reproductiva.(AU)

ABSTRACT Objetive Show the main conditions in sexual and reproductive health in women victims of the conflicts and armed post-conflicts. Methodology An scoping systematic review was conducted, about literature in English, Spanish, and Portuguese languages, between 2000 to the present, in PubMED, EMBASE, Google Scholar, LILACS, IBECS, SciELO and was consulted key informants. Results It was found in the international ambit, the main affectation identified referred to sexual violence, risk factors were found that perpetuate it, such as the family environment, access to education, poor infrastructure of health services among others. Other important effects derive from an increase in the rate of pregnancies and marriages. In Colombia the situation is similar: the areas with the greatest impact due to conflict have a higher fertility rate, poor access to obstetric care, and poor knowledge of STIs. Conclusion Access to sexual health services in the conflict, for disease prevention, and the right to sexual and reproductive health must be ensured.(AU)

Young adults' sexual health in the digital age: Perspectives of care providers.

OBJECTIVES: This study examined care providers' views on young people's sexual health in the digital age. Young people have high rates of sexually transmitted infections (STIs), indicating sexual risk-taking behaviours. Adolescents transitioning to adulthood may be particularly at risk due to increased sexual behaviour and exposure to risk factors for unsafe sex, such as less parental monitoring. These risks may be accentuated in the digital age, where the availability of dating apps and pornography have potentially influenced young people's sexual behaviours. Care providers give a unique insight into sexual health in the digital age as they are able to identify changes over time. STUDY DESIGN: Qualitative semi-structured interviews were conducted with general practitioners, nurses, counsellors and university residential college staff (N = 15, six female) who work with young people aged 17 and 18. Interviews took 20-40 min, and were recorded and transcribed verbatim. Transcripts were coded by the primary researcher and an independent coder using thematic analysis. RESULTS: We identified four themes depicting predictors for sexual risk-taking among young people: media influence on norms (influence on sexual behaviours, relationships and appearance), transition to adulthood (independence, social opportunity), communication difficulties (gender and sexuality differences, greater fear of pregnancy than STIs), and impulsive behaviour (disinhibition, substance use). CONCLUSION: Findings highlight targets for prevention of sexual risk-taking among adolescents, such as addressing changing norms depicted in media. Further, the complex interplay of contextual and individual factors highlights the need for more comprehensive theory and holistic approaches to STI prevention.

Using Systematic Anomalous Case Analysis to Examine Sexual and Reproductive Health Outcomes in the Philippines.

The Philippines is characterized by sustained economic growth and political stability, yet sexual and reproductive health indicators have stalled or even worsened in recent decades. We employed an innovative, mixed-methods approach-Systematic Anomalous Case Analysis-to gain insights into these worsening trends by examining sexual and reproductive decision-making among a cohort of young adults in Metro Cebu, Philippines. We first analyzed longitudinal data (1998-2009) to predict reproductive outcomes (i.e., age of first sex, number of living children) among participants in the Cebu Longitudinal Health and Nutrition Survey to identify cases (predicted and anomalous) with whom we subsequently conducted qualitative, in-depth interviews in 2013-14 (n = 48). Analysis of the qualitative data revealed unique social and contextual factors that shaped patterns of sexual and contraceptive decision-making across three, distinct reproductive life stages: (1) at first sex, (2) after the birth of first child, and (3) after the birth of several children. However, gendered roles and expectations exerted strong influences on sexual and reproductive outcomes across these life stages. Finally, we identified two constructs from our qualitative analysis-sexual fluidity and sexual agency-that deserve further examination and integration into theoretical and empirical models of sexual and reproductive decision-making.

Emerging Issues in Male Adolescent Sexual and Reproductive Health Care.

Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.

A Triadic Intervention for Adolescent Sexual Health: A Randomized Clinical Trial.

OBJECTIVES: In this study, we evaluate the efficacy of Families Talking Together (FTT), a triadic intervention to reduce adolescent sexual risk behavior. METHODS: Adolescents aged 11 to 14 and their female caregivers were recruited from a pediatric clinic; 900 families were enrolled; 84 declined. Families were randomly assigned to FTT or 1 of 2 control conditions. The FTT triadic intervention consisted of a 45-minute face-to-face session for mothers, health care provider endorsement of intervention content, printed materials for families, and a booster call for mothers. The primary outcomes were ever having had vaginal intercourse, sexual debut within the past 12 months, and condom use at last sexual intercourse. Assessments occurred at baseline, 3 months post baseline, and 12 months post baseline. RESULTS: Of enrolled families, 73.4% identified as Hispanic, 20.4% as African American, and 6.2% as mixed race. Mean maternal age was 38.8 years, and mean adolescent grade was seventh grade. At the 12-month follow-up, 5.2% of adolescents in the experimental group reported having had sexual intercourse, compared with 18% of adolescents in the control groups (P < .05). In the experimental group, 4.7% of adolescents reported sexual debut within the past 12 months, compared with 14.7% of adolescents in the control group (P < .05). In the experimental group, 74.2% of sexually active adolescents indicated using a condom at last sexual intercourse, compared with 49.1% of adolescents in the control group (P < .05). CONCLUSIONS: This research suggests that the FTT triadic intervention is efficacious in delaying sexual debut and reducing sexual risk behavior among adolescents.

Impact of Endourological procedures with or without double-J stent on sexual function: a systematic review and meta-analysis.

BACKGROUND: Endourological procedures are widely used to treat benign urinary disorders and the double-J stent is routinely used. However, its potential impact on sexual function remains unclear. Therefore, we performed a quantitative systematic review to determine the relationship between endourological procedures with or without double-J stent and post-operative sexual function. METHODS: We conducted a search of PubMed, EMBASE, Web of Science, and Cochrane Library databases up to December 2018 for studies that compared sexual function before and after endourological procedures. The quality of the included studies was evaluated using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I). We performed subgroup analyses to explore heterogeneity. A random effects model was used to combine the results. RESULTS: Five prospective studies involving 485 sexually active participants were identified. Pooled results showed that, in patients without a double-J stent, the change in sexual function after endourological procedures was not significant in men (mean difference [MD]: - 0.61, 95% confidence interval [CI]: - 1.43 to 0.22, p = 0.148) or women (MD: 0.53, 95% CI: - 0.52 to 1.57, p = 0.322). However, in patients with indwelling double-J stent, sexual function scores significantly declined after the procedure in both men (MD: -4.25, 95% CI: - 6.20 to - 2.30, p < 0.001) and women (MD: -7.17, 95% CI: - 7.88 to - 6.47, p < 0.001). CONCLUSIONS: Our meta-analysis suggests that indwelling double-J stent after endourological procedures could be a crucial factor causing temporary sexual dysfunction post-operatively. Our results may be used to provide evidence-based advice to patients.

The State of Adolescent Sexual and Reproductive Health.

In the 25 years since the 1994 International Conference on Population and Development, significant progress has been made in adolescent sexual and reproductive health and rights (ASRHR). Trend analysis of key ASRHR indicators at global, national, and subnational levels indicates that adolescent girls today are more likely to marry later, delay their first sexual experience, and delay their first childbirth, compared with 25 years ago; they are also more likely to use contraceptives. Despite overall progress, however, unequal progress in many ASRHR outcomes is evident both within and between countries, and in some locations, the state of adolescents' lives has worsened. Population growth in countries with some of the worst shortfalls in ASRHR mean that declining rates, of child marriage, for example, coexist with higher absolute numbers of girls affected, compared with 25 years ago. Emerging trends that warrant closer attention include increasing rates of ovarian and breast cancer among adolescent girls and sharp increases in the proportion of adolescents who are overweight or obese, which has long-term health implications.

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development.

Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH-adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day.

A Package of Sexual and Reproductive Health and Rights Interventions-What Does It Mean for Adolescents?

This article analyzes the relevance of the comprehensive definition of sexual and reproductive health and rights (SRHR) to adolescents and identifies adolescent-specific implications for the implementation of an essential package of SRHR interventions. The delivery of a comprehensive approach to SRHR targeting adolescents is underpinned by five principles-equity, quality, accountability, multisectorality, and meaningful engagement. All SRHR interventions included in the package are relevant to adolescents, given the diversity of adolescents' SRHR needs and considering their specific attributes, circumstances, and experiences. Ensuring that this package is available, accessible, and acceptable to adolescents requires an approach that looks at adolescents as being biologically and socially distinct from other age groups and acknowledges that they face some specific barriers when accessing SRHR services. This article provides cross-cutting strategies for the implementation of a comprehensive approach to SRHR for adolescents and specific considerations in delivering each intervention in the package of essential SRHR interventions. To further implement the International Conference on Population and Development Programme of Action, a prerequisite for achieving the Sustainable Development Goals, SRHR interventions must be adolescent responsive, delivered through multiple platforms, leveraging multisectoral collaboration, and strengthening accountability and participation.

Forward, Together: A Collaborative Path to Comprehensive Adolescent Sexual and Reproductive Health and Rights in Our Time.

The 1994 International Conference on Population and Development established a basis for the advancement of adolescent sexual and reproductive health and rights (ASRHR) that endures today. Twenty-five years later, our vision for the future warrants reflection based on a clear understanding of the opportunities and challenges before us. Inclusion of adolescents on global, regional, and national agendas; increased investment in ASRHR policies and programs; renewed commitments to universal health coverage; increased school enrollment; and advances in technology are all critical opportunities we can and must leverage to catalyze progress for adolescents. At the same time, a range of significant challenges remain, have newly emerged, or can be seen on the horizon, including persistent denial of adolescent sexuality; entrenched gender inequality; resistance to meaningfully engaging adolescents and young people in political and programmatic processes; weak systems, integration, and multisectoral coordination; changes in population dynamics; humanitarian and climate crises; and changes in family and community structures. To achieve as much progress toward our vision for ASRHR as possible, the global ASRHR community must take strategic and specific steps in the next 10 years within five areas for action: (1) mobilize and make full use of political and social support for ASRHR policies and programs; (2) increase and make effective use of external and domestic funding for ASRHR; (3) develop, communicate, apply, and monitor enabling and protective laws and policies for ASRHR; (4) use and improve available ASRHR data and evidence to strengthen advocacy, policies, and programs; and (5) manage the implementation of ASRHR strategies at scale with quality and equity.

Adolescent sexual initiation and pregnancy: what more can be learned through further analysis of the demographic and health surveys in the Philippines?

BACKGROUND: Adolescent pregnancy poses risks to the life of a young mother and her baby, and can affect their health, educational and future employment outcomes. In many low- and middle-income countries like the Philippines, the Demographic and Health Surveys (DHS) Program is among the most reliable and easily accessible sources of demographic and health data for researchers, development workers, and policymakers. Data on adolescent sexual and reproductive health (SRH) are often limited, but in the absence of other sources, there is room to make the most of the adolescent health data gathered by the DHS. The aim of this study is to explore what more can be learned about adolescent sexual initiation and pregnancy through the further analysis of demographic and health data, using DHS data from the Philippines as an example. METHODS: This study conducted trend analysis of DHS data over three survey rounds (2003, 2008 and 2013) to explore the context of adolescent sexual initiation and pregnancy over time. Bivariate and multivariate logistic regression were then used to study associations between adolescent pregnancy experience and selected demographic, socioeconomic and SRH variables using data from the 2013 DHS. RESULTS: This study found that between 2003 and 2013, proportions of Filipino young women experiencing adolescent sexual initiation and adolescent pregnancy have increased. Multivariate logistic regression affirmed the protective effect of education and belonging to higher wealth quintiles on the risk of adolescent pregnancy. Ever use of contraception was positively associated with adolescent pregnancy but is likely indicative of use after a prior pregnancy, and/or other factors relating to improper/inconsistent contraceptive use. CONCLUSIONS: In the absence of reliable, easily accessible data on adolescent SRH, the DHS data can provide important insights about adolescent reproductive transitions such as sexual initiation and first pregnancy. However, there are limited variables in the datasets that could proxy for other important social determinants which prior studies have linked to adolescent SRH outcomes. There remains a need for timely and targeted collection of quantitative and qualitative data on adolescent SRH that can guide programming and policy intended to foster positive health outcomes during this crucial transition period to adulthood.

Leading by Example: Web-Based Sexual Health Influencers Among Men Who Have Sex With Men Have Higher HIV and Syphilis Testing Rates in China.

BACKGROUND: The spread of healthy behaviors through social networks may be accelerated by influential individuals. Previous studies have used lay health influencers to prevent sexually transmitted infections (STIs) among internet-using men who have sex with men (MSM). However, there is a lack of understanding of the characteristics of this key subset of MSM. OBJECTIVE: This study aimed to examine sociodemographic characteristics, HIV and syphilis testing, and sexual behaviors of Web-based MSM sexual health influencers (SHIs) in China, defined as individuals with relatively stronger influence on spreading HIV and STI information online. METHODS: A Web-based survey of MSM was conducted in August 2017 as a final follow-up of a randomized controlled trial promoting HIV testing in 8 Chinese cities. Men were recruited through a gay social networking mobile phone app and were included if they were born biologically male, aged 16 years and above, ever had sex with another man, and HIV negative or with unknown HIV status. Information regarding sociodemographic characteristics, sexual behaviors, and HIV and syphilis testing was obtained. We assessed men's Web-based sexual health influence using a standardized 6-item opinion leadership scale focused on HIV and STI information. Influencers were defined as those whose mean score ranked within the top 13% (a higher score means greater influence). We used multivariable linear and logistic regression models to measure Web-based sexual health influence's association with HIV and syphilis testing, controlling for intervention trial effects, age, education, income, and marital status. RESULTS: Overall, 1031 men completed the survey. Most men were younger than 30 years (819/1031, 79.43%) and had at least college education (667/1031, 64.69%). Influencers were more likely to get tested for HIV (73/132, 55.3% vs 337/899, 37.5%; P<.001) and syphilis (35/132, 26.5% vs 137/899, 15.2%; P=.001) in the last 3 months compared with noninfluencers. There were no significant differences in condomless sex with male partners (26/132, 19.7% vs 203/899, 22.6%; P=.46), mean number of male sex partners (1.32 vs 1.11; P=.16) in the last 3 months, and mainly meeting male sex partners online in the last 12 months (97/132, 73.5% vs 669/899, 74.4%; P=.82) between influencers and noninfluencers. Regression analyses showed that influencers had higher odds of HIV testing (adjusted odds ratio, AOR 2.16, 95% CI 1.48-3.17) and syphilis testing (AOR 1.99, 95% CI 1.28-3.10) in the last 3 months. CONCLUSIONS: We identified Web-based SHIs who might be more likely to help promote healthy HIV and syphilis testing behaviors through MSM populations. Leveraging existing influencers may help improve HIV and syphilis testing among their networks.