"Sex without fear": exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England.

Gay, bisexual, and other men who have sex with men (GBMSM) experience a high prevalence of psychosocial health problems, such as harmful substance use and depression, as well as being disproportionately affected by HIV. HIV Pre-Exposure Prophylaxis (PrEP) may provide psychosocial benefits beyond its intended purpose of reducing HIV infection. We explore the psychosocial impact of oral PrEP use on gay men in England using qualitative data from the PROUD study. From February 2014 to January 2016, semi-structured in-depth interviews were conducted with 40 gay men and one trans woman. Participants were purposively recruited based on trial arm allocation, adherence, and sexual risk behaviours. By removing HIV risk from sex, PrEP improves users' wellbeing by reducing HIV-related anxiety and internalised stigma and increasing HIV prevention self-efficacy, sexual pleasure, and intimacy. In turn, these psychological changes may influence behaviour in the form of greater sexual freedom, reduced harmful drug use, and more protective sexual health behaviours. However, PrEP may create internal conflict for some gay men, due to its disruption of social norms around condom use and its perceived influence on their sexual behaviour leading to reduced condom self-efficacy. These findings provide a baseline of PrEP's psychosocial impact amongst some of the first PrEP users in England and supports calls to consider the psychosocial impact of PrEP in prescribing guidelines.

Anxiety in Attachment and Sexual Relationships in Adolescence: A Moderated Mediation Model.

Adolescence is characterized by several transformations, such as identity construction, progressive estrangement from parents, relational interest in peers, and body changes that also involve sexuality issues. In this process, attachment patterns play a fundamental role in relationships, and when these are dysfunctional, they can result in internalizing and externalizing problems. Often, females show their relational difficulties through internalizing expressions and males through externalizing expressions. Additionally, given the sexual progress involved in this life moment, psychological symptomatology may influence adolescents' perception of sex and performance. Our purpose is to study the mediating role of internalizing and externalizing symptomatology in the relationship between attachment patterns and sexual and psychological dimensions. In addition, we investigated the moderating effect of the sex assigned at birth on this mediation model. n = 493 adolescents (38.3% males; Mage = 16.51; SD = 1.17) participated in the study. The results show a significant mediation effect of internalizing symptomatology on the relationship between attachment and sexual anxiety. Additionally, this effect is moderated significantly by assigned-at-birth sex. These results confirm that in adolescence, attachment patterns can influence adolescents' perception of sex. The connection between these two psychological dimensions is influenced by symptomatologic expression. Further investigations are needed.

Sexual Anxiety Mediates Dyadic Associations Between Body Satisfaction and Sexual Quality in Mixed-Sex Couples.

Body satisfaction predicts sexual quality among women and men; however, mechanisms of the association are largely unknown. We hypothesized that sexual anxiety would mediate average associations over 1 year between individuals' body satisfaction and their own and their partner's sexual quality, which is comprised of their sexual satisfaction and dissatisfaction, in 123 mixed-sex cohabiting couples. Results of Actor-Partner Interdependence Models extended to Mediation (APIMeM) and tested via multilevel modelling partially supported the hypotheses. Specifically, individuals' body satisfaction indirectly predicted their own and their partner's sexual satisfaction through individuals' sexual anxiety, and indirectly predicted their own, but not their partner's sexual dissatisfaction through individuals' sexual anxiety. Thus, when individuals are relatively less satisfied with their bodies, they may experience anxiety during sexual encounters, which then interferes with their own and their partner's sexual quality.

Is My Sex Life Ok? The Mediating Role of Sexual Anxiety in the Association between Childhood Sexual Abuse and Sexual Coercion against Women.

Empirical studies suggest that childhood sexual abuse is associated with sexual revictimization by a male romantic partner in female survivors. Yet, the potential mechanisms underlying this association remain understudied. Past studies indicated that women childhood sexual abuse survivors report more sexual anxiety, which in turn was linked to an increased risk of sustaining sexual coercion. The current study, conducted with a sample of 448 adult women from the community, aimed to examine sexual anxiety as a potential mechanism in the association between childhood sexual abuse and sexual coercion sustained by women in heterosexual romantic relationships. Results from path analyses confirmed the indirect effect of sexual anxiety in the relationship between childhood sexual abuse and sexual coercion victimization. Findings indicated that childhood sexual abuse is associated with higher levels of sexual anxiety, which in turn, was linked to a higher frequency of sexual coercion experiences perpetrated by the romantic partner. This study contributes to a better understanding of the determinants of sexual violence against women and provides an empirical basis to better inform prevention initiatives and guide future interventions.

The Unanticipated Benefits of PrEP for Young Black Gay, Bisexual, and Other Men Who Have Sex with Men.

Pre-exposure prophylaxis (PrEP) is effective at reducing new HIV infections among adherent users. However, there are potential benefits of PrEP beyond HIV prevention that remain understudied, particularly among young Black gay, bisexual, and other men who have sex with men (MSM). In 2018, we conducted six focus groups (n = 36) in four midwestern cities: Milwaukee, WI; Minneapolis, MN; Detroit, MI; and Kansas City, MO with current and former PrEP users who identified as Black MSM. The focus groups covered medical care and provider experiences, patterns of PrEP use and adherence, relationships while on PrEP, and PrEP stigma. Results revealed four unanticipated benefits of PrEP for young Black MSM: (1) improved engagement in medical care, (2) reduced sexual and HIV anxiety, (3) increased sexual comfort and freedom, and (4) positive sexual relationships with people living with HIV. Findings from this study fill a gap in our understanding of the potential benefits of PrEP beyond HIV prevention. Public health campaigns and messaging around PrEP should incorporate such benefits to reach young Black MSM who may be motivated by benefits beyond HIV prevention.

Emotional numbing symptoms partially mediate the association between exposure to potentially morally injurious experiences and sexual anxiety for male service members.

Service members (SMs) returning from deployment are at risk of a range of sexual problems, some of which are thought to be related to psychological issues that may arise during deployment or combat. The current study sought to examine whether exposure to potentially morally injurious events (PMIEs) was associated with sexual anxiety (SA) above and beyond combat exposure and whether any such association was mediated by post-traumatic stress disorder (PTSD) symptom clusters. These questions were tested using data from self-report surveys collected from 221 partnered male Army (Active Duty, National Guard, or Reserve) SMs at three separate time points. Findings showed that exposure to PMIEs was significantly related to greater SA, with transgressions by self and perceived betrayal demonstrating unique associations when controlling for all factors of PMIEs. Moreover, total exposure to PMIEs was associated with SA above and beyond general combat exposure. PTSD symptoms partially mediated the association between exposure to PMIEs and SA, with emotional numbing accounting for significant unique indirect effects after controlling for other PTSD symptom clusters. The findings suggest that exposure to PMIEs is associated with SA, even when accounting for either combat exposure or PTSD symptoms, emphasizing the importance of this issue in understanding post-deployment problems in sexual intimacy.

Internalized Homophobia and Drug Use in a National Cohort of Gay and Bisexual Men: Examining Depression, Sexual Anxiety, and Gay Community Attachment as Mediating Factors.

The minority stress process of internalized homophobia (IH) has been associated with a range of adverse health outcomes among gay and bisexual men (GBM). However, evidence is mixed regarding the effect of IH on drug use, suggesting the potential role of multiple mediated pathways. Researchers have linked depression, sexual anxiety, and gay community attachment with IH. Depression, sexual anxiety, and gay community attachment have also been linked with drug use and drug-related problems suggesting potential mediating roles. A U.S. national sample of 1071 HIV-negative GBM completed at-home surveys, including measures of sociodemographic characteristics, IH, depression, sexual anxiety, gay community attachment, and drug use and associated problems. Adjusting for sociodemographic characteristics, depression mediated the association between IH and recent drug use. IH was positively associated with depression, and depression was positively associated with recent drug use. Gay community attachment partially mediated drug-related problems. IH had a positive direct association with drug-related problems and a negative direct association with gay community attachment. Gay community attachment had a positive association with drug-related problems. IH was positively associated with sexual anxiety, but sexual anxiety was not associated with either drug outcome. Efforts to reduce IH among HIV-negative GBM are likely to have a positive impact on mental health problems, as well as reduce risk for drug use and drug-related problems. Gay communities could provide the social support necessary for reducing IH; however, emphasis on community level interventions that address factors that increase risk for drug-related problems remains important.

Diagnosis and Management of Pearly Penile Papules.

Pearly penile papules (PPP) are common, benign lesions that appear on the corona of the glans penis during adolescence or early adulthood. Despite their benign nature, PPP are known to cause significant distress because of their resemblance to sexually transmitted infections such as condyloma acuminata. PPP can be clinically distinguished based on their uniform, dome-shaped papules that orient in one to two rows around the glans penis. There is no association between PPP and sexually transmitted infections, and treatment is generally reserved for patients with excessive concern. Physicians should be aware of this distinction in order to adequately reassure anxious patients. For patients who still desire treatment after counseling, cryotherapy and laser therapy represent two reliable treatment options with low rates of recurrence.

Thoughts about Sexual Difficulties and Related Anxiety among a Predominantly Female Sample of Adolescents.

This qualitative data analysis examined adolescents' thoughts and feelings about difficulties that can emerge during sexual experiences. The sample consisted of 53 sexually experienced, ethnically diverse, predominantly female, non-pregnant adolescents participating in a web-based sexual health intervention. As part of a message board discussion, adolescents described anxiety-enhancing attitudes and beliefs (e.g., men should be skilled sexually, women should express satisfaction even if they do not feel it). Several adolescents advocated for condom use despite potential difficulties when attempting to use them. Health professionals should equip adolescents with skills to communicate with partners about sexual difficulties and cope with related anxiety.

Genital image, sexual anxiety, and erectile dysfunction among young male military personnel.

INTRODUCTION: More than a third of young military personnel report experiencing some level of erectile dysfunction (ED). Preoccupation with body image, particularly genitals, is a distraction that can influence sexual anxiety (SA) and sexual functioning problems (SFPs), particularly ED. AIMS: This study assessed the relationships between male genital self-image (MGSI), SA, and ED in a sample of male military personnel age 40 or younger. METHODS: Data were from a larger study on SFPs in military populations. This sample consisted of 367 male military personnel age 40 or younger. Hierarchical regression analyses and process modeling using mediation analysis were performed to examine the effects of MGSI on ED with SA as an intermediate variable. We predicted that SA would mediate the relationship between MGSI and ED. MAIN OUTCOME MEASURES: ED severity was assessed with the International Index of Erectile Function. MGSI was assessed using the MGSI Scale. SA was assessed with the SA subscale of the Sexual Needs Scale. RESULTS: As hypothesized, greater satisfaction with MGSI was predictive of significantly lower SA (F[8, 352] = 4.07, P = 0.001) and lower ED (F[8, 352] = 13.20, P = 0.001). Lower levels of SA were predictive of lower levels of ED (F[8, 354] = 21.35, P < 0.001). Additionally, results also revealed a significant indirect effect of MGSI on ED through SA (b = -0.07, standard error = 0.03, confidence interval = [-0.14,-0.02], P < 0.05), indicating mediation of MGSI on ED via SA. CONCLUSIONS: This study underscores the complex etiologic basis of SFPs, particularly ED, and highlights the importance of considering psychologic contributors to ED, such as SA and MGSI. Strategies aimed at reducing SA may be useful in improving ED in young military populations and are worth considering as complements to strategies that improve SFPs.