Pornography use, demographic and sexual health characteristics among university students: a gender-based comparative study of non-users, non-problematic users, and problematic users.

BACKGROUND: Limited gender-based research has compared sexual health among pornography users (PUs) and non-users, including non-problematic pornography users (non-PPUs) and problematic pornography users (PPUs), particularly in non-Western cultures. METHODS: A 2022 cross-sectional study involving 450 Iranian university students categorized participants as PUs or non-users based on 12 months of use. PUs were further classified as non-PPUs or PPUs using the 'Problematic Pornography Use Scale' cutoff point, with comparisons of demographic and sexual variables made between these groups. RESULTS: Pornography use was reported among 39.6% of students, including 51.7% of men and 33.6% of women. In general, 9.5% of participants were PPUs, including 17.4% of men and 5.6% of women. PUs were mainly men, had fewer children, shorter marriages, lower religiosity, and lower levels of education. Compared with non-users, PUs reported earlier sexual relationships, lower satisfaction with sex frequency and communication, and greater rates of extramarital relationships, masturbation, sexual desire, and sexual distress. PPUs reported more sexual desire, pornography use, masturbation, and extramarital affairs than non-PPUs. Similar patterns in demographics, sexual history, and health were observed in pornography use across genders. The regression indicated being male (OR: 2.42, 95% CI: 1.44-4.06), having lower education (OR: 0.89, 95% CI: 0.81-0.97), fewer children (OR: 0.64, 95% CI: 0.48-0.86), higher masturbation (OR: 1.31, 95% CI: 1.14-1.49), more extramarital relationship (OR: 1.69, 95% CI: 1.07-2.67), less religiosity (OR: 0.87, 95% CI: 0.82-0.93), more sexual excitement (OR: 0.79, 95% CI:0.62-1), and more sexual distress (OR: 1.20, 95% CI: 1.02-1.32) were associated with pornography use. Two-way ANOVA found no significant effects of gender or pornography use on sexual satisfaction. Women had worse sexual function regardless of usage. Pornography users, regardless of gender, experienced higher sexual distress.

Access to PrEP and other sexual health services for cisgender women in the United States: a review of state policy and Medicaid expansion.

Pre-exposure prophylaxis (PrEP) has the potential to prevent new HIV infections, but it is unclear how state policies governing sexual and reproductive health services (SRH) impact access for cisgender women. The objective of this review is to identify barriers to PrEP access for cisgender women in the United States. Using the CDC Atlas Program, 20 states with the highest HIV incidence among cisgender women were included in this analysis. Through a search conducted in May-July 2022 of CDC, PrEPWatch.org, and other State Department and Insurance websites, Medicaid expansion status, pharmacist PrEP prescribing laws, financial support programs, and Traditional Medicaid coverage of PrEP, HIV testing, and emergency contraception were reviewed. Of the included states, nearly half did not expand Medicaid at the state level. Emergency contraception and HIV testing was covered under Traditional Medicaid for almost all included states, but insurance stipulations and eligibility requirements remain. Although PrEP is covered under all Traditional Medicaid plans, six states require pre-authorization. Three states have HIV testing mandates, four allow pharmacists to prescribe PrEP and six have financial support programs to cover the cost of PrEP. Medicaid expansion, pre-authorization requirements for PrEP prescriptions and emergency contraception, and limitations on pharmacist prescribing abilities were identified as barriers to SRH access for cisgender women. Medicaid expansion should be prioritized as an approach to expanding access to HIV prevention services at the state level.

Obesity and sexual health trends among a large, national sample of men who have sex with men on Grindr in the USA.

Background A growing number of men who have sex with men (MSM) utilise Grindr for seeking relationships and immediate/casual sexual encounters. Grindr and other mobile applications can be a valuable source of information on sociological predictors of health. One topic that is under reported is the use of Grindr by MSM with obesity. We described differences in Grindr use between MSM with and without obesity, and to use Grindr information to reveal trends which may serve as potential predictors of health. Methods Data was collected from 3744 Grindr users (mean age [s.d.], 32.3 years [9.1]) from the largest 50 metropolitan centres in the USA between February and May 2018. Users were divided into two cohorts based on BMI: (1) MSM with obesity (BMI>30), n =253; and (2) MSM without obesity, n =3491. Profile characteristics were compared. Results When evaluating potential predictors for obesity, we found that black/African-American and older MSM were significantly more likely to have obesity. Further, we found that obesity among MSM was significantly inversely associated with the population percent lesbian, gay, bisexual, and transgender (LGBT) within a city. Additionally, we found that MSM with obesity were significantly more likely to indicate interest in immediate sexual encounters. Conclusions These results highlight important trends that may serve as predictors of health in urban settings. Furthermore, our results suggest that MSM with obesity may be more likely to engage in risky sexual behaviours. These findings may be useful in informing providers and healthcare officials on when and how to provide outreach to this unique population.

Time trends in positive gonorrhoea diagnoses at the Christchurch Sexual Health Service (2012-2022): a data audit study.

Background Gonorrhoea infections and antimicrobial resistance are rising in many countries, particularly among men who have sex with men, and an increasing proportion of infection is detected at extragenital sites. This study assessed trends in gonorrhoea diagnoses and antibiotic resistance at a sexual health service in New Zealand that followed national guidelines for specimen collection. Methods Routinely-collected data from Canterbury Health Laboratories of specimens taken at the Christchurch Sexual Health Service 2012-2022 were audited. Descriptive results included the number of patient testing events positive for gonorrhoea per year and site of infection (extragenital/urogenital). Annual test-positivity was calculated (number of positive patient testing events divided by total number of testing events) and the Cochran-Armitage Test for Trend was used to assess whether there was an association between test-positivity and year. Results Of 52,789 patient testing events, 1467 (2.8%) were positive for gonorrhoea (81% male). Half (49.3%) of people (57.9% of males, 12.2% of females) with a gonorrhoea infection had an extragenital infection in the absence of a urogenital infection. The number of extragenital infections increased at a faster rate than urogenital among males. Test-positivity increased from 1.3% in 2012 to 5.8% in 2022 (P Conclusions This study highlights the importance of extragenital sampling and maintaining bacterial culture methods for accurate diagnosis and treatment. The observation that gonorrhoea positivity rate and antimicrobial resistance rates are rising in New Zealand calls for urgent action.

Understanding Risk Factors for Oropharyngeal Gonorrhea Among Sex Workers Attending Sexual Health Clinics in 2 Australian Cities: Mixed Methods Study.

BACKGROUND: The risk factors for oropharyngeal gonorrhea have not been examined in sex workers despite the increasing prevalence of gonorrhea infection. OBJECTIVE: This study aims to determine the risk factors for oropharyngeal gonorrhea in female and gender-diverse sex workers (including cisgender and transgender women, nonbinary and gender fluid sex workers, and those with a different identity) and examine kissing, oral sex, and mouthwash practices with clients. METHODS: This mixed methods case-control study was conducted from 2018 to 2020 at 2 sexual health clinics in Melbourne, Victoria, and Sydney, New South Wales, Australia. We recruited 83 sex workers diagnosed with oropharyngeal gonorrhea (cases) and 581 sex workers without (controls). Semistructured interviews with 19 sex workers from Melbourne were conducted. RESULTS: In the case-control study, the median age of 664 sex workers was 30 (IQR 25-36) years. Almost 30% of sex workers (192/664, 28.9%) reported performing condomless fellatio on clients. Performing condomless fellatio with clients was the only behavior associated with oropharyngeal gonorrhea (adjusted odds ratio 3.6, 95% CI 1.7-7.6; P=.001). Most participants (521/664, 78.5%) used mouthwash frequently. In the qualitative study, almost all sex workers reported kissing clients due to demand and generally reported following clients' lead with regard to kissing style and duration. However, they used condoms for fellatio because they considered it a risky practice for contracting sexually transmitted infections, unlike cunnilingus without a dental dam. CONCLUSIONS: Our study shows that condomless fellatio is a risk factor for oropharyngeal gonorrhea among sex workers despite most sex workers using condoms with their clients for fellatio. Novel interventions, particularly targeting the oropharynx, will be required for oropharyngeal gonorrhea prevention.

A Machine Learning Model for Identifying Sexual Health Influencers to Promote the Secondary Distribution of HIV Self-Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men in China: Quasi-Experimental Study.

BACKGROUND: Sexual health influencers (SHIs) are individuals actively sharing sexual health information with their peers, and they play an important role in promoting HIV care services, including the secondary distribution of HIV self-testing (SD-HIVST). Previous studies used a 6-item empirical leadership scale to identify SHIs. However, this approach may be biased as it does not consider individuals' social networks. OBJECTIVE: This study used a quasi-experimental study design to evaluate how well a newly developed machine learning (ML) model identifies SHIs in promoting SD-HIVST compared to SHIs identified by a scale whose validity had been tested before. METHODS: We recruited participants from BlueD, the largest social networking app for gay men in China. Based on their responses to the baseline survey, the ML model and scale were used to identify SHIs, respectively. This study consisted of 2 rounds, differing in the upper limit of the number of HIVST kits and peer-referral links that SHIs could order and distribute (first round ≤5 and second round ≤10). Consented SHIs could order multiple HIV self-testing (HIVST) kits and generate personalized peer-referral links through a web-based platform managed by a partnered gay-friendly community-based organization. SHIs were encouraged to share additional kits and peer-referral links with their social contacts (defined as "alters"). SHIs would receive US $3 incentives when their corresponding alters uploaded valid photographic testing results to the same platform. Our primary outcomes included (1) the number of alters who conducted HIVST in each group and (2) the number of newly tested alters who conducted HIVST in each. We used negative binomial regression to examine group differences during the first round (February-June 2021), the second round (June-November 2021), and the combined first and second rounds, respectively. RESULTS: In January 2021, a total of 1828 men who have sex with men (MSM) completed the survey. Overall, 393 SHIs (scale=195 and ML model=198) agreed to participate in SD-HIVST. Among them, 229 SHIs (scale=116 and ML model=113) ordered HIVST on the web. Compared with the scale group, SHIs in the ML model group motivated more alters to conduct HIVST (mean difference [MD] 0.88, 95% CI 0.02-2.22; adjusted incidence risk ratio [aIRR] 1.77, 95% CI 1.07-2.95) when we combined the first and second rounds. Although the mean number of newly tested alters was slightly higher in the ML model group than in the scale group, the group difference was insignificant (MD 0.35, 95% CI -0.17 to -0.99; aIRR 1.49, 95% CI 0.74-3.02). CONCLUSIONS: Among Chinese MSM, SHIs identified by the ML model can motivate more individuals to conduct HIVST than those identified by the scale. Future research can focus on how to adapt the ML model to encourage newly tested individuals to conduct HIVST. TRIAL REGISTRATION: Chinese Clinical Trials Registry ChiCTR2000039632; https://www.chictr.org.cn/showprojEN.html?proj=63068. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-021-11817-2.

Sexual and Reproductive Health Among Cisgender Women With HIV Aged 18-44 Years.

INTRODUCTION: The sexual and reproductive health of cisgender women with HIV is essential for overall health and well-being. Nationally representative estimates of sexual and reproductive health outcomes among women with HIV were assessed in this study. METHODS: Data from the Centers for Disease Control and Prevention's Medical Monitoring Project-including data on sexual and reproductive health-were collected during June 2018-May 2021 through interviews and medical record abstraction among women with HIV and analyzed in 2023. Among women with HIV aged 18-44 years (n=855), weighted percentages were reported, and absolute differences were assessed between groups, highlighting differences ≥|5%| with CIs that did not cross the null. RESULTS: Overall, 86.4% of women with HIV reported receiving a cervical Pap smear in the past 3 years; 38.5% of sexually active women with HIV had documented gonorrhea, chlamydia, and syphilis testing in the past year; 88.9% of women with HIV who had vaginal sex used ≥1 form of contraception in the past year; and 53.4% had ≥1 pregnancy since their HIV diagnosis-of whom 81.5% had ≥1 unintended pregnancy, 24.6% had ≥1 miscarriage or stillbirth, and 9.8% had ≥1 induced abortion. Some sexual and reproductive health outcomes were worse among women with certain social determinants of health, including women with HIV living in households <100% of the federal poverty level compared with women with HIV in households ≥139% of the federal poverty level. CONCLUSIONS: Many women with HIV did not receive important sexual and reproductive health services, and many experienced unintended pregnancies, miscarriages/stillbirths, or induced abortions. Disparities in some sexual and reproductive health outcomes were observed by certain social determinants of health. Improving sexual and reproductive health outcomes and reducing disparities among women with HIV could be addressed through a multipronged approach that includes expansion of safety net programs that provide sexual and reproductive health service coverage.

Correlates of sexual and reproductive health service utilization among older adults in China: Findings from the sexual well-being (SWELL) study.

BACKGROUND: Sexual and reproductive health (SRH) is critical to the overall health of older adults. We assessed the utilization of SRH services and its correlates among older adults in China. METHODS: We recruited community-dwelling adults aged 50 and above in five Chinese cities between June 2020 and December 2022. In this study SRH services included reproductive health examination, cervical cancer screening, and sexual life counselling. Logistic regression was used to assess correlates of SRH services utilization. RESULTS: A total of 3001 older adults (1819 men and 1182 women) were enrolled. Among them, 11.4 % (343/3001) of participants received a reproductive health examination, 35.4 % (418/1182) of female participants received cervical cancer screening, and 30.1 % (401/1332) of sexually active participants sought help for their sexual lives. Older men with an annual income of USD 7500 or more (aOR = 3.21, 95%CI: 1.39-7.44), two or more chronic conditions (2.38, 1.39-4.08), and reproductive health problems (2.01, 1.18-3.43) were more likely to receive a urological examination. For older women, individuals who were younger (aged 50-59 years: 5.18, 2.84-9.43; aged 60-69 years: 2.67, 1.49-4.79), lived in an urban area (1.88, 1.31-2.71), were employed (1.73, 1.21-2.47), had two or more chronic conditions (2.04, 1.37-3.05), were sexually active (1.72, 1.15-2.58) and talked about sex (1.69, 1.21-2.36) were more likely to receive a gynecological examination. CONCLUSION: SRH services utilization among older adults was low, with urological examination among older men particularly low. SRH messages and services tailored for older adults are needed to enhance their utilization of SRH services.

Sexuality Among Young Danes Treated for Long-Lasting or Severe Physical Disease: Baseline Findings in a Nationwide Cohort Study.

PURPOSE: Sexual ramifications of physical disease are well-documented in adult populations, but are scarcely investigated among adolescents and young adults (AYA). This study compared measures of sexuality and sexual health among 8,696 15-year-old to 24-year-old Danes with and without a history of treatment for long-lasting or severe physical disease. METHODS: Using baseline data from Project SEXUS, a nationally representative cohort study on sexual health in the Danish population, differences in various domains of sexual behaviors and sexual health between AYA who have and AYA who have not been treated for long-lasting or severe physical disease were investigated. Logistic regression analyses yielded demographically weighted age-adjusted odds ratios (ORs) for associations between physical diseases and sexual outcomes. RESULTS: AYA treated for long-lasting or severe physical disease resembled their healthy peers on fundamental aspects of sexual interest, activity and satisfaction. However, significantly increased odds ratios of various sexual difficulties and dysfunctions, early sexual debut, high sex partner numbers, discontentment with body or genital appearance, gender nonconformity, nonheterosexuality, and exposure to sexual assaults were observed, overall or within specific disease categories. DISCUSSION: The overall similarity in sexual profiles between AYA treated for physical disease and healthy peers indicates that clinicians should routinely address questions related to sexuality and relationships when encountering AYA with chronic health conditions. Moreover, the observed excess of certain adversities, including sexual assaults, among physically ill AYA highlights the need for preventive measures and counseling services specifically targeted at AYA afflicted by physical disease.

Função sexual e sua associação com a sexualidade e a qualidade de vida de mulheres idosas / Función sexual y su asociación con la sexualidad y la calidad de vida en mujeres mayores / Sexual function and its association with sexuality and quality of life in older women

Resumo Objetivo analisar a função sexual e sua associação com a sexualidade e com a qualidade de vida de mulheres idosas. Método trata-se de um estudo transversal, do tipo web survey, desenvolvido com 166 mulheres idosas. Foram utilizados quatro instrumentos autoaplicáveis para a obtenção dos dados biosociodemográficos, da função sexual, sexualidade e qualidade de vida. A análise foi realizada com o teste de Mann-Whitney, correlação de Spearman e regressão linear, considerando um intervalo de confiança de 95%. Resultados a maior influência da função sexual foi observada na dimensão ato sexual da sexualidade (β=0,524; [IC95%=0,451-0,597]; p<0,001; R2=54,8%) e entre a faceta intimidade da qualidade de vida (β=0,501; [IC95%=0,380-0,622]; p<0,001; R2=29,0%). De modo geral, o modelo de regressão demonstrou que a função sexual permaneceu associada à sexualidade (β=0,888; [IC95%=0,749-1,028]; p<0,001; R2=49,1%) e à qualidade de vida das participantes (β=0,352; [IC95%=0,264-0,439]; p<0,001; R2=27,7%). Conclusão e implicações para a prática a função sexual está associada à sexualidade e à qualidade de vida das mulheres idosas, assumindo comportamento diretamente proporcional que, por sua vez, pode se tornar uma estratégia para agregar qualidade aos anos adicionais de vida dessa população.

Resumen Objetivo analizar la función sexual y su asociación con la sexualidad y la calidad de vida de mujeres mayores. Método se trata de un estudio transversal, del tipo web survey, desarrollado con 166 mujeres mayores. Se utilizaron cuatro instrumentos autoadministrados para obtener datos biosociodemográficos, función sexual, sexualidad y calidad de vida. El análisis se realizó mediante la prueba de Mann-Whitney, correlación de Spearman y regresión lineal, considerando un intervalo de confianza del 95%. Resultados la mayor influencia de la función sexual se observó en la dimensión acto sexual de la sexualidad (β = 0,524; [IC 95% = 0,451-0,597]; p <0,001; R2 = 54,8%) y entre la faceta intimidad de la calidad de vida (β = 0,501; [IC del 95% = 0,380-0,622]; p <0,001; R2 = 29,0%). En general, el modelo de regresión mostró que la función sexual permaneció asociada con la sexualidad (β = 0,888; [IC95% = 0,749-1,028]; p <0,001; R2 = 49,1%) y la calidad de vida de los participantes (β = 0,352; [IC95% = 0,264-0,439]; p <0,001; R2 = 27,7%). Conclusión e implicaciones para la práctica la función sexual está asociada a la sexualidad y calidad de vida de las mujeres mayores, asumiendo un comportamiento directamente proporcional que, a su vez, puede convertirse en una estrategia para agregar calidad a los años adicionales de vida de esta población.

Abstract Objective to analyze the sexual function and its association with the sexuality and quality of life of elderly women. Methods this is a cross-sectional web survey study developed with 166 elderly women. Four self-administered instruments were used to obtain biosociodemographic, sexual function, sexuality and quality of life data. The analysis was performed using the Mann-Whitney test, Spearman correlation and linear regression, considering a 95% confidence interval. Results the greatest influence of sexual function was observed in the sexual act dimension of sexuality (β=0.524; [95%CI=0.451-0.597]; p<0.001; R2=54.8%) and between the intimacy facet of quality of life (β =0.501; [95%CI=0.380-0.622]; p<0.001; R2=29.0%). In general, the regression model showed that sexual function remained associated with sexuality (β=0.888; [CI95%=0.749-1.028]; p<0.001; R2=49.1%) and the quality of life of the participants (β=0.352; [CI95%=0.264-0.439]; p<0.001; R2=27.7%). Conclusion and implications for the practice sexual function is associated with the sexuality and quality of life of older women, assuming a directly proportional behavior which, in turn, can become a strategy to add quality to the additional years of life of this population.

The sexual and reproductive health of women with mental illness: a primary care registry study.

The purpose of this study is to characterise the sexual and reproductive health risks associated with mental illness among women. This was a retrospective cohort study of 2,680,149 women aged 14 to 45 years in the Clinical Practice Research Datalink, a UK primary care register, linked to 1,702,211 pregnancies that ended between the 1st January 1990 and 31st December 2017. Mental illness was identified in primary care and categorised into the following: common mental illness (depression/anxiety); addiction (alcohol/drug misuse); serious mental illness (affective/non-affective psychosis); other mental illness (eating/personality disorders). Logistic regression estimated the association between mental illness and subsequent risk of recurrent miscarriage and termination. Cox proportional hazards estimated the association between mental illness and time to gynaecological diseases, sexually transmitted infections, reproductive cancers, cervical screen, contraception and emergency contraception. Models were adjusted for calendar year, year of birth, smoking status and ethnicity, region and index of socioeconomic status. Compared to women without mental illness, exposed women were more likely to experience recurrent miscarriage (adjOR = 1.50, 95%CI 1.41 to 1.60), termination (adjOR = 1.48, 95%CI 1.45 to 1.50), gynaecological diseases (adjHR = 1.39, 95%CI 1.37 to 1.40), sexually transmitted infections (adjHR = 1.47, 95%CI 1.43 to 1.51), reproductive cancers (adjHR = 1.10, 95%CI 1.02 to 1.19), contraception (adjHR = 1.28 95%CI 1.26 to 1.29) and emergency contraception (adjHR = 2.30, 95%CI 2.26 to 2.34), and less likely to attend for cervical screening (adjHR = 0.91, 95%CI 0.90 to 0.92). Currently, the sexual and reproductive health needs of women with mental illness are unmet representing significant health inequalities. Clinicians must create opportunities to engage with women in primary care and mental health services to address this gap.

Sexual Health in COPD: A Systematic Review and Meta-Analysis.

COPD has a profound impact on the lives of patients and their partners, but the influence on physical, psychological and social aspects of sexual health has not been reviewed systematically. Searches for studies of the impact of COPD on sexual health were conducted independently by two authors in the databases of PubMed, PsycINFO, Embases, CINAHL, Web of Science, Scopus and The Cochrane Library. English-language quantitative and qualitative studies assessing one or more aspects of sexual health in patients diagnosed with COPD were narratively reviewed and, when possible, subjected to meta-analytic evaluation. A total of 31 studies, including 4 qualitative, were included. Twelve studies assessing erectile dysfunction with the International Index of Erectile Function were subjected to meta-analysis. The pooled prevalence of erectile dysfunction was 74% (95% CI: 68-80%) in a total of 1187 patients with COPD, compared with 56% (37-73%) in 224 age-matched, non-COPD controls. The sexual health outcomes assessed in the remaining studies varied considerably, compromising the comparability of the results. None of the qualitative studies had sexual health as their primary focus. Compared with non-COPD individuals, erectile dysfunction appears to be more prevalent among patients with COPD, but more studies including non-COPD controls are needed to confirm this finding. In addition, the impact of COPD on other physical, psychological and social aspects of sexual health remains unclear due to the lack of comparable assessment methods and study designs.

Development of an international sexual and reproductive health survey instrument: results from a pilot WHO/HRP consultative Delphi process.

Population health surveys are rarely comprehensive in addressing sexual health, and population-representative surveys often lack standardised measures for collecting comparable data across countries. We present a sexual health survey instrument and implementation considerations for population-level sexual health research. The brief, comprehensive sexual health survey and consensus statement was developed via a multi-step process (an open call, a hackathon, and a modified Delphi process). The survey items, domains, entire instruments, and implementation considerations to develop a sexual health survey were solicited via a global crowdsourcing open call. The open call received 175 contributions from 49 countries. Following review of submissions from the open call, 18 finalists and eight facilitators with expertise in sexual health research, especially in low- and middle-income countries (LMICs), were invited to a 3-day hackathon to harmonise a survey instrument. Consensus was achieved through an iterative, modified Delphi process that included three rounds of online surveys. The entire process resulted in a 19-item consensus statement and a brief sexual health survey instrument. This is the first global consensus on a sexual and reproductive health survey instrument that can be used to generate cross-national comparative data in both high-income and LMICs. The inclusive process identified priority domains for improvement and can inform the design of sexual and reproductive health programs and contextually relevant data for comparable research across countries.

[Assessment of quality of sexual life in women after breast cancer treatment: about 100 cases]. / Evaluation de la sexualité chez des femmes atteintes d'un cancer du sein après traitement: à propos de 100 cas.

Breast cancer is the most common neoplastic disease in women. Several treatment strategies are used: chemotherapy, radiotherapy, surgery and hormone therapy. Each of these treatments may affect sexual health of patients in the short or long term. The purpose of our study is to assess the quality of sexual life in women after breast cancer treatment. We made a quantitative descriptive estimate of 100 sexual active patients followed up for non-metastatic breast cancer, met during their consultations with a gynaecologist at the Farhat Hached hospital in Sousse. Data collection was carried out using an information sheet and two validated scales: RSS (relation Ship and sexual) and BESAA (Body EsteemScale for adolescents and Adults) to assess the quality of sexual life and body image. The average age of patients was 53.8 years. About half of patients (48%) had impaired sexuality due to the disease. The frequency of intercourse, sexual desire and the ability to reach orgasm were decreased in 65. 45, and 54 patients, respectively. The overall score for the three body image dimensions was 49.4. Women aged between 35 and 39 years were significantly more afraid of sexual intercourse (p=0.002) and less of sexual frequency (p=0.004). Adequate and enhanced training focused on the management of women with cancer and their sexual problems and multidisciplinary approach can improve women's psychological status.

Menstrual pain and sexual health in mothers-A cross-sectional study in the Danish National Birth Cohort.

INTRODUCTION: Prevalence and consequences of menstrual pain have mainly been studied in younger women. We aimed to describe the prevalence of menstrual pain in mothers and its association with sexual problems. MATERIAL AND METHODS: A cross-sectional study using questionnaire data from the Maternal Follow Up (2013-2014) in the Danish National Birth Cohort (1996-2002). Of 82 569 eligible mothers, 43 639 (53%) completed the follow up. Of these, 24 000 women had a partner, and answered the questions on menstrual pain. Log binomial regression was used to calculate prevalence proportion ratios (PPR) with 95% CI for the association between menstrual pain and specific sexual problems. RESULTS: Menstrual pain was reported by 16 464 women (69%), and severe menstrual pain by 19%. Treatment had previously been requested by 19% of women with menstrual pain. The most common treatment was oral contraceptives, but for 18% of women seeking treatment, no treatment was given. Women with menstrual pain were more likely to report reduced sexual desire (PPR 1.22, 95% CI 1.15-1.29), vaginismus (PPR 1.31, 95% CI 0.96-1.78), and dyspareunia (PPR 1.63, 95% CI 1.47-1.81), in particular deep dyspareunia (PPR 1.92, 95% CI 1.67-2.20). CONCLUSIONS: A majority of Danish mothers in mid-life experienced menstrual pain, and these women more often reported reduced sexual desire, vaginismus, and deep dyspareunia. Few women sought and received treatment for menstrual pain. Healthcare practitioners should be aware that menstrual pain can affect parous women and co-occurs with sexual problems. Future studies should identify barriers to seeking and receiving adequate treatment for menstrual pain.

Impact of infertility duration on female sexual health.

BACKGROUND: Infertility, an important source of stress, could affect sexual life. Extensive studies suggest that the incidence of sexual dysfunction is highly prevalent in infertile women. As the duration of infertility increases, the level of stress is also likely to increase even further, and this could aggravate psychological pain and cause sexual dysfunction. However, the effect of infertility duration on sexual health is unclear. METHODS: We conducted a case-control study in which 715 patients participated between September 1,2020 and December 25, 2020. We included patients diagnosed with infertility (aged between 20 to 45), who were divided into four groups according to their infertility durations: ≤ 2 years (Group I, n = 262), > 2 years but ≤ 5 years (Group II, n = 282), > 5 years but ≤ 8 years (Group III, n = 97), and > 8 years (Group IV, n = 74). A questionnaire survey on female sexual functions and psychological depression was administered to participants, and their female sexual functions and depression status were measured using the Female Sexual Function Index (FSFI) and Patient Health Questionnaire (PHQ-9), respectively. RESULTS: As the number of years of infertility increased, the PHQ-9 score as well as the incidence of psychological depression increased significantly (p < 0.05), but the total score of FSFI and those of its six domains/sub-scales were not significantly different among the four groups. An analysis of the relevant factors affecting sexual functions, using the multivariable logistic regression model, revealed that when the infertility duration was greater than 8 years, there was a significant increase in the incidence of sexual dysfunction [adjusted odds ratios (AOR) = 5.158, 95% confidence interval (CI): 1.935-13.746, P = 0.001], arousal disorder (AOR = 2.955, 95% CI: 1.194-7.314, P = 0.019), coital pain (AOR = 3.811, 95% CI: 1.045-13.897, P = 0.043), and lubrication disorder (AOR = 5.077, 95% CI: 1.340-19.244, P = 0.017). CONCLUSIONS: An increasing infertility duration is a risk factor for the occurrence of sexual dysfunction. Hence, as the infertility duration increases, the incidence of female sexual dysfunction and psychological distress could also increase, especially when the infertility duration is more than 8 years.

What do young people in high-income countries want from STI testing services? A systematic review.

BACKGROUND: There are upward trends of STI rates among young people in most high-income countries. We reviewed the literature to provide a summary of information to support health services with the aim of increasing testing of STIs among young people living in high-income countries. METHODS: We conducted a systematic review (Prospero: CRD42020179720) using PubMed, Embase, PsychINFO and CINAHL. The search was performed on 10 January 2020 for studies between January 2000 and 10 January 2020. Two reviewers independently screened articles, and any discrepancies were resolved by a third reviewer. Studies were included if they were performed in high-income countries and contained data on both young people (<26 years) and STI testing preferences. Data regarding the characteristics of STI testing services that young people preferred was extracted. We categorised these characteristics using the framework of a social-ecological model. RESULTS: We identified 1440 studies, and 63 studies were included in the final review. We found 32 studies that addressed individual factors, 62 studies that addressed service factors and 17 studies that addressed societal factors. At an individual level, we identified eight attributes including the need for improved sexual health education. At a service level, 14 attributes were identified including preferences from different subgroups of young people (such as sexual and ethnic minorities) for the types of services. At a societal level, we identified two attributes including the need to address stigma associated with STIs. CONCLUSION: We provide an overview of the growing body of literature capturing the preferences of young people for STI testing services. To optimise the uptake of STI testing among young people, factors from all socioecological levels should be considered. In addition, understanding and accounting for distinct preferences from subgroups of young people could increase demand for STI testing services for those at greatest need.

Patient Satisfaction Increases with Nipple Reconstruction following Autologous Breast Reconstruction.

BACKGROUND: Nipple reconstruction has been linked to patient satisfaction; however, there is debate about the validity of these findings in autologous breast reconstruction patients. This study hypothesized that satisfaction would increase with nipple reconstruction following autologous breast reconstruction. METHODS: A comparison study was performed of autologous breast reconstruction patients. Patients completed a survey that included BREAST-Q and nipple satisfaction measures. A chart review identified reconstructive details. RESULTS: A total of 191 patients completed the survey (48 percent response rate), with an average age of 53.7 ± 10.0 years and follow-up time of 2.8 ± 1.5 years. Nipple-areola complex reconstruction was completed in 33 percent of patients (63 of 191). Nipple-areola complex tattoos were used most frequently [n = 37 (58 percent)], followed by local flaps [n = 10 (16 percent)], free nipple-areola complex grafts [n = 9 (14 percent)], and a combination of local flaps and tattoos [n = 7 (11 percent)]. In comparison to women who did not undergo nipple-areola complex reconstruction, women who underwent any type of nipple reconstruction had a statistically higher BREAST-Q score for Sexual Well-Being (60 ± 24 versus 50 ± 22; p = 0.01), Postoperative Satisfaction with Breasts (65 ± 11 versus 61 ± 12; p = 0.01), and Satisfaction with Surgeon (97 ± 6 versus 93 ± 16; p = 0.009). The average nipple satisfaction score was 74 ± 19. There were correlations between the nipple satisfaction score and BREAST-Q scores for Sexual Well-Being (r = 0.50; p < 0.001), Psychosocial Well-Being (r = 0.43; p < 0.001), and Postoperative Satisfaction with Breasts (r = 0.43; p < 0.001). CONCLUSION: Reconstruction of the nipple-areola complex is an important part of autologous breast reconstruction, resulting in increased sexual well-being and satisfaction with reconstructed breasts.

Female Sexual Function following Sling Surgery: A Prospective Parallel Cohort, Multi-Center Study of the Solyx™ Single Incision Sling System versus the Obtryx™ II Sling System.

PURPOSE: Limited data exist regarding sexual function after single incision sling (SIS) surgery. We compared sexual function 36 months postoperatively between patients undergoing SIS and transobturator sling (TMUS) for treatment of stress urinary incontinence. MATERIALS AND METHODS: Assessment of sexual function was a planned secondary objective of this prospective, multi-center study that enrolled women to Solyx SIS or Obtryx II TMUS. The primary study aim was to compare efficacy and safety using non-inferiority design at 36 months. Patient-reported outcomes of sexual function were assessed at baseline and 6, 12, 18, 24 and 36 months using Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Changes in sexual function were analyzed within and between groups. Outcomes for patients requiring surgical retreatment were determined. RESULTS: Baseline characteristics were balanced using propensity score stratification (N=141 SIS, N=140 TMUS). Groups were similar in age, body mass index and concomitant surgery performed. Average length of followup was 30 months. Baseline sexual activity was similar (123/141 SIS, 114/140 TMUS, p=0.18). Severity of urinary incontinence did not correlate with baseline sexual activity. Mean PISQ-12 scores increased significantly from baseline to 36 months for both groups, indicating better sexual function at each visit. There were no significant differences in PISQ-12 scores between groups except at 36 months, where the difference was small (-2.5, 95% CI [-4.7, 0.2]). Among patients undergoing surgical retreatment (9/281, 3%), improvement in sexual function was maintained. De novo dyspareunia was rare following both treatments (SIS 1/141, TMUS 0/140, p=1.00). CONCLUSIONS: Patients have significant improvement in sexual function after SIS and TMUS. De novo sexual pain is low after sling surgery.