Sexual Orientation and Cervical Cancer Screening Among Cisgender Women.

Importance: Lesbian, gay, and bisexual populations face barriers accessing health care in Chicago, Illinois. Objective: To describe the prevalence of up-to-date cervical cancer screening among lesbian, gay, and bisexual vs heterosexual cisgender women in Chicago. Design, Setting, and Participants: This retrospective, cross-sectional, population-based study of cisgender women residing in Chicago was completed from 2020 to 2022 using data from the Healthy Chicago Survey, which is conducted annually by the Chicago Department of Public Health. Participants included cisgender women aged 25 to 64 years with no history of hysterectomy. Respondents who self-identified as lesbian, gay, or bisexual or other than straight, lesbian, or bisexual were coded as lesbian, gay, or bisexual (LGB). Respondents who self-identified as straight were coded as heterosexual. Those who reported having a Papanicolaou test within the past 3 years were considered up-to-date with cervical cancer screening. Data analysis was performed from June to October 2023. Exposures: The primary exposure was sexual orientation. Covariates included age, income level, race, ethnicity, having a primary care practitioner (PCP), and insurance coverage. Main Outcomes and Measures: Prevalence ratios (PRs), log-based regression models, and interaction analysis were used to describe the association of sexual orientation with up-to-date screening. Results: The sample included 5167 cisgender women (447 LGB and 4720 heterosexual), aged 25 to 64 years, with no history of hysterectomy. Among LGB cisgender women, 318 (71.14%) reported previous cervical cancer screening compared with 3632 (76.95%) heterosexual cisgender women. The prevalence of up-to-date screening was 10% lower in the LGB group compared with the heterosexual group (PR, 0.90; 95% CI, 0.82-1.00). In regression analysis, having a PCP (PR, 1.43; 95% CI, 1.29-1.59) was associated with up-to-date screening. In interaction analysis, LGB cisgender women with a PCP were 93% more likely to be up-to-date compared with those without a PCP (PR, 1.93; 95% CI, 1.37-2.72). Conclusions and Relevance: In this cross-sectional study of cervical cancer screening rates between the heterosexual and LGB populations in Chicago, up-to-date cervical cancer screening was associated with having a PCP, regardless of sexual orientation, but this association was greater for LGB individuals. Although LGB populations were less likely to be screened, this disparity may be reduced with more consistent health care access and established care with PCPs.

Prevalence of precancerous lesions and other cervical abnormalities among internally displaced women in Benue State Nigeria.

Introduction: visual inspection is a low-cost screening strategy that can be used to prevent cervical cancer in women. These techniques can improve screening health outcomes for internally displaced women (IDW) who have poor sexual and reproductive health and rights' behaviors and outcomes. This study aimed to determine the prevalence of precancerous lesions and other clinical features using a visual inspection with acetic acid (VIA) technique during a cervical cancer screening campaign in two internally displaced people (IDP) camps in Benue State, Nigeria. Methods: this was a cross-sectional study of 166 IDW who voluntarily participated in the study during a VIA cervical cancer screening campaign in two IDP camps in Benue State, Nigeria the screening was done by a group of qualified and trained healthcare workers and data was collected using a structured, pretested questionnaire. Results: a total of 99(60%) of the women had a first sexual experience at 16 years, while 78(47%) had more than 5 full-term pregnancies. Although only 72(43.4%) of the women acknowledged having more than one sexual partner, over 70% of the women stated that their sexual partner had another sexual partner. The prevalence of precancerous lesions among women was 10.8%. Smoking(p=0.003), age at menarche (p≤ 0.001) and sexual behaviors (p=0.009, p=0.004) were factors that had a statistically significant relationship with the presence of a precancerous lesion among the IDW. The study also highlights the high rate (95%) of cervicitis among the women and the relatively high rate (5.4%) of leukoplakia. Conclusion: the majority of IDW had sociodemographic and lifestyle characteristics that predisposed them to developing cervical cancer More targeted interventions aimed at improving the sociodemographic and lifestyle characteristics of IDW are recommended. In addition, there is a need to create awareness about cervical cancer among IDW and make screening available in camp facilities for early detection and management.

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.

Inclusion of a Parental Component in a Sports-Based HIV Prevention Program for Dominican Youth.

BACKGROUND: Underprivileged youth in the Dominican Republic (DR) are at high risk of acquiring the human immunodeficiency virus (HIV). Protective parenting practices may inhibit sexual risk-taking. OBJECTIVE: We investigated whether parental involvement in a sports-based HIV prevention program increased self-efficacy to prevent HIV and safe sex behavior among Dominican youth. METHOD: The study had a quasi-experimental design with repeated measures. N = 90 participants between 13 and 24 years of age participated in the program through two different trainings, UNICA and A Ganar, both of which had an experimental (i.e., program with parental component) and a control (i.e., program without parental component) condition. RESULTS: Self-efficacy to prevent HIV significantly increased among participants in the experimental condition of UNICA. Self-efficacy for safe sex increased among sexually active participants in the experimental condition of A Ganar. Implications for Impact: These findings are important to meet the United Nations' Sustainable Development Goal of good health and wellbeing, as they suggest that parental involvement in sports-based HIV prevention programs can enhance their positive effects for increasing youth's self-efficacy to practice HIV-preventive behaviors. Randomized control trials and longitudinal studies are needed.

Comportamiento sexual de pacientes con infección por VIH según grupos de edad / Sexual behavior among patients with HIV according to age groups

Nuestro objetivo fue determinar la prevalencia y conductas de riesgo por grupos de edad entre pacientes con infección por VIH. Se realizó un estudio observacional analítico transversal de pacientes que acuden al servicio de Enfermedades Infecciosas a recibir tratamiento antirretroviral. Resultados: De 117 personas que ingresaron al estudio, se observó que el grupo etario de los jóvenes varones con infección por VIH señalaron una orientación homosexual (HSH) en 64,5% y una mayor tasa de haber sufrido abuso sexual (29%) respecto al resto. En adultos el uso de métodos anticonceptivos es 71,4% y superior al resto de grupos de edad, la concurrencia a lugares de riesgo (visita a trabajadoras sexuales de la calle) se encuentra mayoritariamente en el rango de 45 a 90 años. El rol homosexual activo de los hombres con VIH representa 66,7%. Los hallazgos enfatizan la necesidad de realizar más estudios que profundicen el tema del abuso sexual en adolescentes y adultos jóvenes, debido a la alta prevalencia encontrada en este estudio(AU)

Our objective was to determine the prevalence and risk behaviors by age groups in patients with HIV infection. A cross-sectional analytical observational study of patients attending the Infectious Diseases service to receive antiretroviral treatment was carried out.Results: Out of 117 people who entered the study, it was observed that the age group of young men with HIV infection indicated a homosexual orientation (MSM) 64.5%; and a higher rate of having suffered sexual abuse (29%) in comparison to the others. In adults, the use of contraceptive methods is 71.4%, and higher than the rest of the age groups, attendance at places of risk (visits to street sex workers) is mostly in the range of 45 to 90 years. The active homosexual role of men with HIV represents 66.7%. The findings emphasize the need for more studies that delve into the issue of sexual abuse in adolescents and young adults, due to the high prevalence found in this study(AU)

Conocimiento y conductas sexuales de las mujeres gestantes / Knowledge and sexual behaviors of pregnant women / Conhecimento e comportamentos sexuais de mulheres grávidas

Introducción: escasos son los estudios que investigan el conocimiento sexual y las conductas sexuales de las mujeres dentro de un periodo tan importante como lo es el embarazo. En esta etapa se producen una serie de cambios que repercuten en su vida y por lo tanto en su sexualidad, por tal motivo es que surge realizar este trabajo de investigación. Objetivo: evaluar el nivel de conocimiento y conducta sexual durante la gestación, en un grupo de gestantes que acuden al Centro de Atención Periférica Número 8 perteneciente a la Dirección General de Atención Periférica de la Dirección Nacional de Sanidad de la Fuerzas Armadas. Materiales y métodos: se realizó un análisis observacional, descriptivo y prospectivo de cohorte transversal de los datos obtenidos a través de entrevistas realizadas a embarazadas. Se entrevistan gestantes que cursan los tres trimestres de embarazo y concurren a sus controles obstétricos en el periodo comprendido entre el 22 de abril y 22 de julio de 2021 que cumplen con los criterios de inclusión y exclusión. Para alcanzar el objetivo se aplicó un cuestionario con respuestas cerradas que consta de 11 preguntas basadas en conocimientos y conductas sexuales en gestantes. Resultados: el 52% de nuestras pacientes gestantes encuestadas tienen más de 30 años, 52% cursa su primera gestación y 51% un embarazo no deseado, pero si aceptado. El 61% de ellas dicen que el estar embarazadas afectó su actividad sexual, 39% refiere que son más satisfactorias las relaciones sexuales en el segundo trimestre, 78% manifiesta que el mantener relaciones sexuales no adelanta el parto, el 83% expresa que la posición menos recomendada es boca arriba, el 9% no saben dónde se localiza el tapón mucoso y el 100% de las encuestadas no tuvo educación sobre sexualidad en los controles prenatales. Conclusiones: durante el embarazo se producen cambios anatómicos, psicológicos y emocionales que provocan cambios en la actividad sexual. La educación que tienen sobre sexualidad es nula por lo que es recomendable la implementación de programas formativos de educación sexual en gestantes y sus parejas para afrontar una salud sexual plena.

Introduction: there are few studies that investigate the sexual knowledge and sexual behaviors of women in such an important period as pregnancy. During this stage, a series of changes take place that have repercussions in their lives and therefore in their sexuality, which is the reason why this research work has been carried out. Objective: to evaluate the level of knowledge and sexual behavior during pregnancy in a group of pregnant women attending the Peripheral Care Center Number 8 belonging to the General Directorate of Peripheral Care of the National Health Directorate of the Armed Forces. Materials and methods: an observational, descriptive and prospective cross-sectional cohort analysis of the data obtained through interviews with pregnant women was carried out. Pregnant women in the three trimesters of pregnancy and attending their obstetric check-ups between April 22 and July 22, 2021 who met the inclusion and exclusion criteria were interviewed. To achieve the objective, a questionnaire with closed answers consisting of 11 questions based on knowledge and sexual behaviors in pregnant women was applied. Results: 52% of our pregnant patients surveyed were over 30 years of age, 52% were in their first pregnancy and 51% had an unwanted pregnancy, but accepted it. 61% of them said that the pregnancy was unwanted. Sixty-one percent of them say that being pregnant affected their sexual activity, 39% say that sexual relations are more satisfactory in the second trimester, 78% say that having sexual relations does not advance labor, 83% say that the least recommended position is on the back, 9% do not know where the mucus plug is located and 100% of the respondents had no education on sexuality in prenatal checkups. Conclusions: During pregnancy there are anatomical, psychological and emotional changes that cause changes in sexual activity. The education they have about sexuality is null, so it is advisable to implement sex education programs for pregnant women and their partners in order to achieve full sexual health.

Introdução: há poucos estudos que investiguem o conhecimento sexual e o comportamento sexual das mulheres durante um período tão importante como a gravidez. Nesta fase, ocorre uma série de mudanças que têm repercussões em suas vidas e, portanto, em sua sexualidade, razão pela qual este estudo de pesquisa foi realizado. Objetivo: avaliar o nível de conhecimento e comportamento sexual durante a gravidez em um grupo de mulheres grávidas que freqüentam o Centro de Atenção Periférica Número 8 pertencente à Direção Geral de Atenção Periférica da Direção Nacional de Saúde das Forças Armadas. Materiais e métodos: foi realizada uma análise observacional, descritiva e prospectiva de coorte transversal dos dados obtidos através de entrevistas com mulheres grávidas. Foram entrevistadas mulheres grávidas no terceiro trimestre de gestação e que compareceram aos check-ups obstétricos entre 22 de abril e 22 de julho de 2021, que preenchiam os critérios de inclusão e exclusão. Para alcançar o objetivo, foi aplicado um questionário com respostas fechadas que consiste em 11 perguntas baseadas em conhecimentos e comportamentos sexuais em mulheres grávidas. Resultados: 52% de nossas pacientes grávidas pesquisadas tinham mais de 30 anos de idade, 52% estavam grávidas pela primeira vez e 51% tiveram uma gravidez indesejada, mas aceitaram-na. 61% deles dizem que estar grávida afetou sua atividade sexual, 39% dizem que as relações sexuais são mais satisfatórias no segundo trimestre, 78% dizem que ter relações sexuais não antecipa o trabalho de parto, 83% dizem que a posição menos recomendada é na parte de trás, 9% não sabem onde o plugue de muco está localizado e 100% dos entrevistados não tiveram nenhuma educação sobre sexualidade nos check-ups pré-natais.

Sexualidade de adolescentes na unidade socioeducativa de internação: pulsões e interseções / Sexuality of adolescents in a socio-educational inpatient unit: drives and intersections / Sexualidad de adolescentes en una unidad de internación socioeducativa: impulsos e intersecciones

O artigo integra uma investigação documental em prontuários de adolescentes que cumprem medida socioeducativa de internação. Tem como objetivo explorar dados referentes à sexualidade e práticas sexuais, em interlocução com a interseccionalidade e a teoria das pulsões em Freud. As informações disponíveis nos prontuários indicam que a vida sexual ativa faz parte da realidade de muitos dos adolescentes. No entanto, oportunidades para abordar a sexualidade em sentido ampliado, que levem em conta as relações interseccionais de poder, parecem ser perdidas no cotidiano de uma unidade de internação. Ao restringir o corpo com a privação da liberdade de ir e vir, o sistema socioeducativo impacta o exercício da sexualidade de modo entrelaçado aos marcadores de gênero, classe e raça dos sujeitos adolescentes. (AU)

The article is part of a documentary investigation in medical records of adolescents who are serving a socio-educational measure of detention. It aims to explore data related to sexuality and sexual practices, in dialogue with intersectionality and the theory of drives in Freud. The information available in the medical records indicates that an active sexual life is part of the reality of many adolescents. However, opportunities to approach sexuality in a broader sense, which take into account intersectional power relations, seem to be lost in the daily life of a detention unit. By restricting the body by depriving the freedom to come and go, the socio-educational systemimpacts the exercise of sexuality in an intertwined way with the adolescent subjects' gender, class and race markers.(AU)

El artículo es parte de una investigacióndocumental en historias clínicas de adolescentes que se encuentran cumpliendo una medida socioeducativa de detención. Tiene como objetivo explorar datos relacionados con la sexualidad y las prácticas sexuales, en diálogo con la interseccionalidad y la teoría de los impulsos en Freud. La información disponible en las historias clínicas indica que una vida sexual activa es parte de la realidad de muchos adolescentes. Sin embargo, las oportunidades para abordar la sexualidad en un sentido más amplio, que toman en cuenta las relaciones de poder interseccionales, parecen perderse en la vida diaria de una unidad de detención. Al restringir el cuerpo al privar de la libertad de ir y venir, el sistema socioeducativo impacta el ejercicio de la sexualidad de manera entrelazada con los marcadores de género, clase y raza de los sujetos adolescentes. (AU)

Assessment of US Preventive Services Task Force Guideline-Concordant Cervical Cancer Screening Rates and Reasons for Underscreening by Age, Race and Ethnicity, Sexual Orientation, Rurality, and Insurance, 2005 to 2019.

Importance: Cervical cancer screening rates are suboptimal in the US. Population-based assessment of reasons for not receiving screening is needed, particularly among women from historically underserved demographic groups. Objective: To estimate changes in US Preventive Service Task Force guideline-concordant cervical cancer screening over time and assess the reasons women do not receive up-to-date screening by sociodemographic factors. Design, Setting, and Participants: This pooled population-based cross-sectional study used data from the US National Health Interview Survey from 2005 and 2019. A total of 20 557 women (weighted, 113.1 million women) aged 21 to 65 years without previous hysterectomy were included. Analyses were conducted from March 30 to August 19, 2021. Exposures: Sociodemographic factors, including age, race and ethnicity, sexual orientation, rurality of residence, and health insurance type. Main Outcomes and Measures: Primary outcomes were US Preventive Services Task Force guideline-concordant cervical cancer screening rates and self-reported primary reasons for not receiving up-to-date screening. For 2005, up-to-date screening was defined as screening every 3 years for women aged 21 to 65 years. For 2019, up-to-date screening was defined as screening every 3 years with a Papanicolaou test alone for women aged 21 to 29 years and screening every 3 years with a Papanicolaou test alone or every 5 years with high-risk human papillomavirus testing or cotesting for women aged 30 to 65 years. Population estimation included sampling weights. Results: Among 20 557 women (weighted, 113.1 million women) included in the study, most were aged 30 to 65 years (16 219 women; weighted, 86.3 million women [76.3%]) and had private insurance (13 571 women; weighted, 75.8 million women [67.0%]). With regard to race and ethnicity, 997 women (weighted, 6.9 million women [6.1%]) were Asian, 3821 women (weighted, 19.5 million women [17.2%]) were Hispanic, 2862 women (weighted, 14.8 million women [13.1%]) were non-Hispanic Black, 12 423 women (weighted, 69.0 million women [61.0%]) were non-Hispanic White, and 453 women (weighted, 3.0 million women [2.7%]) were of other races and/or ethnicities (including Alaska Native and American Indian [weighted, 955 000 women (0.8%)] and other single and multiple races or ethnicities [weighted, 2.0 million women (1.8%)]). In 2019, women aged 21 to 29 years had a significantly higher rate of overdue screening (29.1%) vs women aged 30 to 65 years (21.1%; P < .001). In both age groups, the proportion of women without up-to-date screening increased significantly from 2005 to 2019 (from 14.4% to 23.0%; P < .001). Significantly higher rates of overdue screening were found among those of Asian vs non-Hispanic White race and ethnicity (31.4% vs 20.1%; P = .01), those identifying as LGBQ+ (gender identity was not assessed because of a small sample) vs heterosexual (32.0% vs 22.2%; P < .001), those living in rural vs urban areas (26.2% vs 22.6%; P = .04), and those without insurance vs those with private insurance (41.7% vs 18.1%; P < .001). The most common reason for not receiving timely screening across all groups was lack of knowledge, ranging from 47.2% of women identifying as LGBQ+ to 64.4% of women with Hispanic ethnicity. Previous receipt of a human papillomavirus vaccine was not a primary reason for not having up-to-date screening (<1% of responses). From 2005 to 2019, among women aged 30 to 65 years, lack of access decreased significantly as a primary reason for not receiving screening (from 21.8% to 9.7%), whereas lack of knowledge (from 45.2% to 54.8%) and not receiving recommendations from health care professionals (from 5.9% to 12.0%) increased significantly. Conclusions and Relevance: This cross-sectional study found that cervical cancer screening that was concordant with US Preventive Services Task Force guidelines decreased in the US between 2005 and 2019, with lack of knowledge reported as the biggest barrier to receiving timely screening. Campaigns addressing patient knowledge and provider communication may help to improve screening rates, and cultural adaptation of interventions is needed to reduce existing disparities.

Functional Outcomes and Quality of Life After Transanal Total Mesorectal Excision for Rectal Cancer: A Prospective Observational Study.

BACKGROUND: Few studies have addressed the functional impact after transanal total mesorectal excision. OBJECTIVE: This study aimed to evaluate function and health-related quality of life among patients with rectal cancer treated with transanal total mesorectal excision. DESIGN: Consecutive patients treated between 2016 and 2018 were selected. Their function and quality of life were studied preoperatively and at 3 and 12 months after surgery. SETTING: This is a prospective case series. PATIENTS: Patients were eligible if they had primary anastomosis, their diverting stoma had been reversed, and they did not have anastomotic leakage. Forty-five patients were finally included. A total of 31 (68.8%) and 32 patients (71.1%) completed the 3- and 12-month surveys. INTERVENTIONS: Standard transanal total mesorectal excision was performed. MAIN OUTCOME MEASURES: The primary end point was functional and quality-of-life outcomes using validated questionnaires. Secondary end points included values obtained with endoanal ultrasounds, anorectal manometries, and rectal sensation testing. RESULTS: Wexner and Low Anterior Resection Syndrome scores significantly increased 3 months after surgery but returned to baseline values at 12 months. The rate of "major low anterior resection syndrome" at the end of follow-up was 25.0% (+11.7% compared with baseline, p = 0.314). Sexual and urinary functions remained stable throughout the study, although a meaningful clinical improvement was detected in male sexual interest. Among quality-of-life domains, all deteriorations returned to baseline values 12 months after surgery, except worsening of flatulence symptoms, and improvement in insomnia and constipation. At 12 months, an expected decrease in the mean width of the internal sphincter, the anal resting pressure, and the tenesmus threshold volume was found. LIMITATIONS: This study was limited by its small sample size, the absence of a comparative group, and significant missing data in female sexual difficulty and in ultrasounds and manometries at 3 months. CONCLUSIONS: Patients undergoing transanal total mesorectal excision report acceptable quality-of-life and functional outcomes 12 months after surgery. See Video Abstract at http://links.lww.com/DCR/B541. RESULTADOS FUNCIONALES Y CALIDAD DE VIDA DE LOS PACIENTES DESPUS DE LA ESCISIN MESORRECTAL TOTAL TRANSANAL PARA CNCER DE RECTO UN ESTUDIO PROSPECTIVO OBSERVACIONAL: ANTECEDENTES:Pocos estudios han abordado el impacto funcional después de la escisión mesorrectal total transanal.OBJETIVO:Evaluar la función y la calidad de vida relacionada con la salud en pacientes con cáncer de recto tratados con escisión mesorrectal total transanal.DISEÑO:Se seleccionaron pacientes consecutivos tratados entre 2016 y 2018. Se estudió su función y calidad de vida, en la etapa preoperatoria, a los tres y doce meses postoperatorios.METODO:Serie de casos prospectivos.PACIENTES:Los pacientes eran incluidos en presencia de anastomosis primaria, cierre del estoma de derivación y en ausencia de fuga anastomótica. Finalmente se incluyeron cuarenta y cinco pacientes. Un total de 31 (68,8%) y 32 pacientes (71,1%) completaron las encuestas de tres y doce meses, respectivamente.INTERVENCIONES:Escisión mesorrectal total transanal estándar.PRINCIPALES MEDIDAS DE RESULTADO:Los criterio de evaluación principal fueron los resultados funcionales y de calidad de vida mediante cuestionarios previamente validados. Los criterios de evaluación secundarios incluyeron los valores obtenidos con ecografía endoanal, manometría anorrectal y prueba de sensibilidad rectal.RESULTADOS:La escala de Wexner y el síndrome de resección anterior baja aumentaron significativamente tres meses después de la cirugía, pero volvieron a los valores iniciales a los doce meses. La tasa de "síndrome de resección anterior inferior grave" al final del seguimiento fue del 25,0% (+ 11,7% en comparación con el valor inicial, p = 0,314). La función sexual y urinaria se mantuvo estable durante todo el estudio, aunque se detectó una mejora clínica significativa en la libido masculina. Entre los criterios que evalúan la calidad de vida, todas las alteraciones en la misma volvieron a los valores iniciales, doce meses después de la cirugía, excepto el aumento de flatulencia, la mejoría del insomnio y el estreñimiento. A los doce meses, se encontró una disminución esperada en el grosor medio del esfínter interno, la presión anal en reposo y el volumen umbral para la presencia de tenesmo.LIMITACIONES:Tamaño de muestra limitado, ausencia de un grupo comparativo, falta significativa de datos para identificar la dificultad para la actividad sexual femenina y el efectuar ecografía y manometría a los tres meses.CONCLUSIONES:Los pacientes sometidos a escisión mesorrectal total transanal refieren una calidad de vida y resultados funcionales aceptables a los doce meses después de la cirugía. Consulte Video Resumen en http://links.lww.com/DCR/B541.

Sexual behaviours associated with incident high-risk anal human papillomavirus among gay and bisexual men.

OBJECTIVE: High-risk human papillomavirus (HRHPV) causes anal cancer, which disproportionately affects gay and bisexual men (GBM). We examined sexual behaviours associated with incident anal HRHPV in an observational cohort study of GBM in Sydney, Australia. METHODS: GBM aged 35 years and above were enrolled in the Study of the Prevention of Anal Cancer. Detailed information on sexual practices in the last 6 months, including receptive anal intercourse (RAI) and non-intercourse receptive anal practices, was collected. Anal human papillomavirus (HPV) testing was performed at the baseline and three annual follow-up visits. Risk factors for incident HRHPV were determined by Cox regression using the Wei-Lin-Weissfeld method. RESULTS: Between 2010 and 2015, 617 men were recruited and 525 who had valid HPV results at baseline and at least one follow-up visit were included in the analysis. The median age was 49 years (IQR 43-56) and 188 (35.8%) were HIV-positive. On univariable analysis, incident anal HRHPV was associated with being HIV-positive (p<0.001), having a higher number of recent RAI partners regardless of condom use (p<0.001 for both), preference for the receptive position during anal intercourse (p=0.014) and other non-intercourse receptive anal sexual practices, including rimming, fingering and receptive use of sex toys (p<0.05 for all). In multivariable analyses, being HIV-positive (HR 1.46, 95% CI 1.09 to 1.85, p=0.009) and reporting condom-protected RAI with a higher number of sexual partners (p<0.001) remained significantly associated with incident HRHPV. When stratified by recent RAI, non-intercourse receptive anal practices were not associated with incident HRHPV in men who reported no recent RAI. CONCLUSION: GBM living with HIV and those who reported RAI were at increased of incident anal HRHPV. Given the substantial risk of anal cancer and the difficulty in mitigating the risk of acquiring anal HRHPV, HPV vaccination should be considered among sexually active older GBM. TRIAL REGISTRATION NUMBER: ANZCTR365383.

Associação entre as vivências em sexualidade e características biosociodemográficas de pessoas idosas / Asociación entre experiencias en sexualidad y características biosociodemográficas de las personas mayores / Association between experiences in older adults' sexuality and biosociodemographic characteristics

RESUMO Objetivo analisar a associação entre as vivências em sexualidade e características biosociodemográficas de idosos. Método estudo transversal, desenvolvido com 3.740 idosos. Os participantes preencheram dois instrumentos para a obtenção das variáveis biosociodemográficas e sobre as vivências em sexualidade. Os dados foram analisados com os Testes de Mann-Whitney e Kruskal-Wallis, com intervalo de confiança de 95% para todas as análises. Resultados houve predominância de participantes do sexo masculino (62,6%) e que nunca receberam orientações sobre sexualidade pelos profissionais de saúde (77,6%). As melhores vivências em sexualidade foram observadas entre os participantes do sexo masculino (p=0,002), com idade entre 60 e 74 anos (p<0,001), autodeclarados pardos (p<0,001), adeptos às religiões de origens africanas (p<0,001), que possuem parceria fixa (p<0,001), que convivem com o cônjuge por tempo igual ou inferior a cinco anos (p<0,001), que não possuem filhos (p<0,001), e os homossexuais (p<0,001). Conclusão e implicações para a prática todas as variáveis biosociodemográficas se associaram significativamente com, pelo menos, uma dimensão da escala de sexualidade. Nesse sentido, os profissionais de saúde terão evidências científicas e atuais das variáveis que mais necessitam de atenção no cuidado ao idoso no que diz respeito à sua sexualidade.

RESUMEN Objetivo analizar la asociación entre experiencias en sexualidad características biosociodemográficas de los ancianos. Método estudio transversal, desarrollado con 3.740 personas mayores. Los participantes completaron dos instrumentos para obtener las variables biosociodemográficas y sobre experiencias en la sexualidad. Los datos se analizaron mediante las pruebas de Mann-Whitney y Kruskall-Wallis, con un intervalo de confianza del 95% para todos los análisis. Resultados predominó el sexo masculino (62,6%) y que nunca había recibido orientación sobre sexualidad por parte de profesionales de la salud (77,6%). Las mejores experiencias en sexualidad se observaron entre los participantes masculinos (p=0,002), edad entre 60 y 74 años (p<0,001), marrón autodeclarado (p<0,001), adherentes a religiones de origen africano (p<0,001), que tienen una pareja estable (p<0,001), que viven con su cónyuge durante cinco años o menos (p<0,001), que no tienen hijos (p<0,001) y homosexuales (p<0,001). Conclusión e implicaciones para la práctica todas las variables biosociodemográficas se asociaron significativamente con al menos una dimensión de la escala de sexualidad. En este sentido, los profesionales de la salud contarán con evidencia científica y actual de las variables que más necesitan atención en el cuidado de las personas mayores en cuanto a su sexualidad.

ABSTRACT Objective to analyze the association between experiences in older adults' sexuality and biosociodemographic characteristics. Method a cross-sectional study developed with 3,740 older adults. The participants filled out two instruments to obtain the biosociodemographic variables and on the experiences in sexuality. Data were analyzed using the Mann-Whitney and Kruskal-Wallis tests, with a 95% confidence interval for all analyses. Results there was a predominance of male participants (62.6%) who never received guidance on sexuality from health professionals (77.6%). The best experiences in sexuality were observed among male participants (p=0.002), aged between 60 and 74 years (p<0.001), self-declared brown (p<0.001), adherents to religions of African origins (p<0.001), who have a single partner (p<0.001), who live with their spouse for five years or less (p<0.001), who do not have children (p<0.001) and homosexuals (p<0.001). Conclusion and implications for practice all biosociodemographic variables were significantly associated with at least one dimension of the sexuality scale. In this sense, health professionals will have scientific and current evidence of the variables that most need attention in elder care with regard to their sexuality.

[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.

Pediatric oncology clinician communication about sexual health with adolescents and young adults: A report from the children's oncology group.

BACKGROUND: Sexual health (SH) is an important concern for adolescents and young adults (AYAs). This study determined current SH communication practices, barriers, and additional resources needed among pediatric oncology clinicians who treat AYAs. METHODS: A cross-sectional survey was developed by the Children's Oncology Group (COG) AYA Committee and sent to pediatric oncologists (n = 1,987; 85.9%) and advanced practice providers (APPs, n = 326; 14.1%) at 226 COG institutions. Responses were tabulated and compared using tests of proportion and trend. RESULTS: The sample comprised 602 respondents from 168 institutions and was proportionally representative (468 oncologists [77.7%], 76 APPs [12.6%], 58 unidentified [9.6%]; institutional and provider response rates 74.3% and 26.2%, respectively). Almost half of respondents (41.7%) reported no/small role in SH care. Medical topics were discussed most often, including contraception (67.2%), puberty (43.5%), and sexual activity (37.5%). Topics never/rarely discussed included gender identity (64.5%), sexual orientation (53.7%), and sexual function (50.3%). Frequently cited communication barriers included lack of time, low priority, perceived patient discomfort, and the presence of a parent/guardian. Respondents endorsed the need for further education/resources on sexual function (66.1%), gender identity/sexual orientation (59.5%), and body image (46.6%). Preferred education modalities included dissemination of published guidelines (64.7%), skills training modules (62.9%), and webinars (45.3%). By provider type, responses were similar overall but differed for perception of role, barriers identified, and resources desired. CONCLUSIONS: Many pediatric oncology clinicians play minimal roles in SH care of AYAs and most SH topics are rarely discussed. Provider-directed education/training interventions have potential for improving SH care of AYA cancer patients.

Prevalence of STIs, sexual practices and substance use among 2083 sexually active unmarried women in Lebanon.

Access to sexual and reproductive health in conservative communities and in the MENA region are particularly limited and, as such, increase women's vulnerability to unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STIs). The aim was to assess the prevalence of STIs, sexual practices, recreational drug-use and their possible associations among cisgender unmarried women residing in Lebanon. Data on demographics, sexual practices and substance-use were collected from 2083 unmarried cisgender women who voluntarily attended a sexual health clinic in Lebanon between 2015 and 2019. They tested for HIV, Hepatitis B, Hepatitis C and Syphilis through rapid testing. Other infections (genital warts, Neisseria gonorrhea/Chlamydia trachomatis) were screened for. Regression models were computed between variables. There were two cases of HIV, one of Hepatitis B and syphilis, and no cases of Hepatitis C. Genital warts were present in 15% and symptoms indicative of Neisseria gonorrhea/Chlamydia trachomatis in 14%. Inconsistent condom-use (81%) was significantly associated with number of partners (adj. OR: 0.4). Inconsistent condom-use discussion with partners (33%) was significantly associated with unemployment (adj OR: 1.7), recreational drug-use (adj. OR: 1.4), and number of partners (adj. ORs 3.7-4.4). Unwanted pregnancies (11%) were significantly associated with age (adj. ORs 0.1-0.37), recreational drug-use (adj. OR: 2), using intrauterine device (adj. OR:2.9) and natural birth control methods (adj. OR: 2.4). Recreational drug-use (33%) was significantly associated with age (adj ORs 1.9-2.2), and smoking status (adj. OR: 0.6). The results indicate an urgent need for: (1) Accessible, non-stigmatizing, and inclusive sexual health services dedicated to women's sexual health; (2) Comprehensive and non-stigmatizing sexual health education for all, but especially women, in order to promote safer sexual practices and effective decision making with regards to contraception and condom-use.

Variation in diet quality across sexual orientation in a cohort of U.S. women.

PURPOSE: Extensive prior research has shown that sexual minority women are more likely to have a number of cancer risk factors, thereby putting them at higher risk for cancer than heterosexual women. However, there has been little research evaluating the association between sexual orientation and diet quality. METHOD: Data come from participants (aged 24-54 years) enrolled in Nurses' Health Study 3, an ongoing, U.S.-based cohort study (N = 15,941). We measured diet using recommendations from the Dietary Approach to Stop Hypertension (DASH) and American Health Association (AHA) 2020 Strategic Impact Goals. RESULTS: We found limited evidence of differences across diet quality by sexual orientation. When examining predicted DASH scores, mostly heterosexual [predicted mean score (95% confidence interval), 24.0 (23.8, 24.3)] and lesbian [24.3 (23.8, 24.9)] women had healthier predicted DASH scores than the reference group of completely heterosexual women with no same-sex partners [23.6 (23.5, 23.7)]. Even though certain sexual minority women had overall healthier predict DASH scores, their consumption of certain food groups-low-fat dairy and fruit-was lower than completely heterosexual women with no same-sex partners. When measuring AHA scores, most sexual minority groups (completely heterosexual women with same-sex partners, mostly heterosexual women, and lesbian women) had higher diet quality compared to the reference group of completely heterosexual women with no same-sex partners. CONCLUSION: Sexual minority women, particularly mostly heterosexual women and lesbian women, had healthier diet quality than completely heterosexual women with no same-sex partners. These data suggest that cancer risk factors (e.g., smoking, drinking, and inactivity) other than diet would drive higher cancer rates among sexual minority compared to heterosexual women. Nonetheless, it is critical for all women to improve their diet quality since diet quality was poor among participants of all sexual orientations.

High-risk sexual behavior and HIV/STDs cascade of care in migrants: results from an Italian dedicated outpatient clinic.

INTRODUCTION: Ethnical segregation and migration influence sexual health. Differences in sexual networks and the risk of sexually transmitted diseases (STDs) between racial/ethnic minorities and the native population have been described in the literature. METHODOLOGY: We collected data on sexual behavior and physical examination. Basing on CDC 2015 guidelines on STDs, anamnesis, and clinical features, screening for HIV/STDs was proposed. RESULTS: We enrolled 209 migrants, the median age was 32.5 (26-40) years, and 146 (69.9%) were male. The most represented nationalities were Nigerian, Senegalese, and Somali, with 85 (40.7%), 68 (32.5%), and 16 (7.7%) people, respectively. Twenty-two (10.5%) patients referred perianal/genital lesions, 6 (2.9%) abdominal/pelvic discomfort, and 183 (87.6%) were asymptomatic. Almost all symptomatic patients accepted the tests. 52/183 (28.4%) asymptomatic subjects accepted the tests, and only 24/52(46.2%) performed them. Among symptomatic patients were 6 (24%) HBsAg positivities and one (4%) HCV infection. Four (16%) people had latent syphilis; in 12 (48%) people, HPV-related genital warts were present, 7 (28%) people had Molluscum contagiosum, and 6 (24%) women had pelvic inflammatory diseases. Among patients referring no symptoms, there were 10 (41.7%) HBsAg positivities, one (4.2%) HIV infection, four (16.7%) latent syphilis, one (4.2%) HPV-related genital infection, and one (4.2%) PID. Being Nigerian and having symptoms were associated with a more high acceptance of the STDs test. Having a high-risk behavior was significantly associated with the development of at least one STD. CONCLUSIONS: migrants have high-risk sexual behavior. Despite this, they have a low perception of HIV/STDs risk and healthcare needs. Particular attention should be given to improve access to HIV/STDs services that provide screening and treatment and increase the perception of healthcare needs.

Timing, number, and type of sexual partners associated with risk of oropharyngeal cancer.

BACKGROUND: Case-control studies from the early 2000s demonstrated that human papillomavirus-related oropharyngeal cancer (HPV-OPC) is a distinct entity associated with number of oral sex partners. Using contemporary data, we investigated novel risk factors (sexual debut behaviors, exposure intensity, and relationship dynamics) and serological markers on odds of HPV-OPC. METHODS: HPV-OPC patients and frequency-matched controls were enrolled in a multicenter study from 2013 to 2018. Participants completed a behavioral survey. Characteristics were compared using a chi-square test for categorical variables and a t test for continuous variables. Adjusted odds ratios (aOR) were calculated using logistic regression. RESULTS: A total of 163 HPV-OPC patients and 345 controls were included. Lifetime number of oral sex partners was associated with significantly increased odds of HPV-OPC (>10 partners: odds ratio [OR], 4.3 [95% CI, 2.8-6.7]). After adjustment for number of oral sex partners and smoking, younger age at first oral sex (<18 vs >20 years: aOR, 1.8 [95% CI, 1.1-3.2]) and oral sex intensity (>5 sex-years: aOR, 2.8 [95% CI, 1.1-7.5]) remained associated with significantly increased odds of HPV-OPC. Type of sexual partner such as older partners when a case was younger (OR, 1.7 [95% CI, 1.1-2.6]) or having a partner who had extramarital sex (OR, 1.6 [95% CI, 1.1-2.4]) was associated with HPV-OPC. Seropositivity for antibodies to HPV16 E6 (OR, 286 [95% CI, 122-670]) and any HPV16 E protein (E1, E2, E6, E7; OR, 163 [95% CI, 70-378]) was associated with increased odds of HPV-OPC. CONCLUSION: Number of oral sex partners remains a strong risk factor for HPV-OPC; however, timing and intensity of oral sex are novel independent risk factors. These behaviors suggest additional nuances of how and why some individuals develop HPV-OPC.

Preteen Behaviors and Sexual Orientation of High School Students Who Report Depressive Symptoms, United States, 2015-2017.

Unhealthy preteen behaviors are associated with adolescent depression. However, little is known about preteen factors among sexual minority young people, a group at increased risk for teen depression and suicide. We completed weighted multivariate logistic regression analyses on data from the national 2015 and 2017 Youth Risk Behavior Survey of 30 389 high school students in the United States. Preteen sex, cigarette smoking, and alcohol and marijuana use were significantly more prevalent among lesbian, gay, or bisexual (LGB) and questioning students who reported depressive symptoms than among their heterosexual peers (adjusted prevalence ratio [APR] range, 1.33-2.34; all significant at P < .05). The only exception was that marijuana use among questioning students was not significantly different from use among heterosexual peers (APR = 1.34; P = .11). Assessment of preteen sex and substance use-especially among LGB and questioning young people, who are more prone to depressive symptoms and more likely to initiate risky preteen behaviors than their heterosexual counterparts-will facilitate a life course approach to sexual minority mental health that should begin by early adolescence.

Prevalence of Oral Human Papillomavirus Infection by Number of Vaccine Doses Among US Adults.

The human papillomavirus (HPV) vaccine is effective at reducing the incidence of cervical cancer caused by HPV. Studies have shown that 1 dose of the HPV vaccine offers comparable protection against genital HPV infection as additional doses; however, it is unknown whether oral HPV prevalence also differs by number of vaccine doses. We examined differences in prevalence of oral HPV by number of doses using the National Health and Nutrition Examination Survey from 2009 to 2016. The prevalence of HPV 6, 11, 16, and 18 infections was statistically significantly lower in individuals who received 1 dose (0.3%, 95% confidence interval [CI] = 0.0% to 0.9%) or 2-3 doses (0.4%, 95% CI = 0.0% to 1.2%) compared with unvaccinated individuals (1.2%, 95% CI = 0.9% to 1.6%). Smokers, individuals who initiated oral sex at age 17 years or younger, and those with more than 2 oral sexual partners had higher rates of oral HPV infection. Ongoing prospective studies are essential to further evaluate the efficacy of a single-dose regimen for prevention of oral HPV.