Professional Help-Seeking in Men Experiencing Sexual Problems - The Role of Sexual Identity and Minority Stress.

BACKGROUND: Only a minority of men experiencing sexual problems will seek professional help and the proportion of gay or bisexual men can be even lower. AIM: To investigate if sexual identity and minority stress are related to professional help-seeking in Polish gay and bisexual men. METHODS: Sexual identity was measured with the standard question: "Do you consider yourself to be heterosexual, gay, or bisexual?" Men who provided a complete set of answers to the study tools and replied "yes" to the question: "Have you ever had a problem with sexual functioning that lasted at least several months?" were included (Ntotal =644, Nstraight = 203, Ngay = 324, Nbi = 117). A simple question on help-seeking was: "Did you seek professional assistance then?" Other data were gathered with the use of a self-constructed questionnaire. Minority stress processes, that is, internalized homophobia, expectations of rejection, and identity concealment, were measured with the subscales of the Sexual Minority Stress Scale. Bivariate analyses and multivariate logistic regressions were performed to test the statistical significance of sexual identity and minority stress processes as predictors of professional help-seeking. OUTCOMES: Contacting a specialist when experiencing a sexual problem. RESULTS: A total of 84.5% of all men did not seek professional help. Gay identity (OR = 0.58, P = .045), as opposed to bisexual identity, was significantly related to reduced odds of consulting a specialist. Age (OR = 1.03, P = .005), number of doctor's visits per year (OR = 1.51, P < .001), and a psychiatric diagnosis (OR = 1.65, P = .043) were positively related to help-seeking behaviors. Identity concealment significantly decreased the likelihood of consulting a specialist (OR = 0.94, P = .017). CLINICAL TRANSLATION: Specialists need to be aware that gay identity and identity concealment may prevent a proportion of men from seeking their help and thus should be publicly explicit about their inclusive and nonpathologizing approach to sexual diversity. STRENGTHS AND LIMITATIONS: The major strengths of the study include the use of a relatively large sample size and data from the little recognized Polish context characterized by a predominantly hostile anti-LGBT social climate, and exploration of a neglected topic of substantial significance at the public and individual levels. The major limitations are the use of nonprobability sampling, cross-sectional self-report design, and a single question to capture the presence of sexual problems with no measurement of associated distress. CONCLUSION: Gay men are at risk of avoiding help-seeking when experiencing sexual problems because of identity concealment. Grabski B., Kasparek K., Koziara K., et al. Professional Help-Seeking in Men Experiencing Sexual Problems - The Role of Sexual Identity and Minority Stress. J Sex Med 2022;19:1090-1097.

Sexual Anal Pain in Gay and Bisexual Men: In Search of Explanatory Factors.

BACKGROUND: Sexual anal pain-or anodyspareunia-in gay and bisexual men is a scientifically and clinically neglected topic. More understanding of its origins and correlates is needed. AIM: To search for correlates of painful anal intercourse with the inclusion of minority stress processes. METHODS: The analysis is based on data collected in an Internet study on the sexuality of Polish gay, bisexual, and straight men. Multiple ordinal regression analysis was used to search for the correlates of painful receptive anal intercourse in a group of 1,443 nonheterosexual men who declared practicing this type of intercourse within the last 12 months. The investigated correlates included demographics, sexual patterns and experiences, experiencing minority stress, sexual problems, and mental and physical health. To assess the level of minority stress, we used the Sexual Minority Stress Scale based on Ilan Meyer's Minority Stress Model, with its subscales relating to internalized homophobia, expectation of rejection, concealment, and sexual minority negative events. Sexual problems were measured with single-item questions adapted from the National Health and Social Life Survey. Data on the remaining correlates were obtained using a survey that we developed. MAIN OUTCOME MEASURES: The intensity of pain during receptive anal sexual intercourse as rated on a 5-point Likert scale was a dependent variable. RESULTS: Age (odds ratio [OR]: 0.97; P < .001), performance anxiety (OR: 1.94; P < .001), and internalized homophobia (OR: 1.04; P < .001) were the only statistically significant predictors of the intensity of pain during receptive anal sexual intercourse. CLINICAL IMPLICATIONS: Clinicians addressing sexual anal pain should consider performance anxiety, internalized homophobia, and younger age as possible operating factors. STRENGTHS & LIMITATIONS: The major strengths of the study include the provision of additional data on this neglected topic derived from a large sample of participants from the little recognized Central European cultural context and the major limitations are the nonrepresentative sampling, retrospective data collection, cross-sectional design, Internet methodology, and lack of information on the clinical relevance of experienced pain, that is, distress or help-seeking, as well as its recurrent or persistent character. CONCLUSION: Painful sexual anal activity requires further investigation. Grabski B, Kasparek K. Sexual Anal Pain in Gay and Bisexual Men: In Search of Explanatory Factors. J Sex Med 2020;17:716-730.

Sexual Quality of Life in Homosexual and Bisexual Men: The Relative Role of Minority Stress.

BACKGROUND: Minority stress is an important risk factor for sexual problems in gay and bisexual men. It remains unclear whether and to what extent this stress is associated with the sexual quality of life in these groups. AIM: To investigate the significance of minority stress as a factor explaining the sexual quality of life in gay and bisexual men. METHODS: The analysis is based on data collected in an Internet study on the sexuality of Polish gay, bisexual, and straight men. Multiple regression analysis was used to investigate the importance of minority stress in explaining the sexual quality of life in a group of 1,486 non-heterosexual men in the context of other predictors, including demographics, the level of current sexual function, sexual patterns and experiences, and mental and physical health. We used the Sexual Minority Stress Scale based on Ilan Meyer's Minority Stress Model, with its subscales relating to internalized homophobia, expectation of rejection, concealment, and sexual minority negative events. The level of sexual functioning was evaluated using 2 scales, the International Index of Erectile Functioning and the Premature Ejaculation Diagnostic Tool. Data on the remaining predictors were obtained using a survey that we developed. MAIN OUTCOME MEASURES: The men's sexual quality of life as rated on the Sexual Quality of Life Scale for Men was a dependent variable. RESULTS: Internalized homophobia (ß = -0.28; P < .001) and sexual minority negative events (ß = -0.09; P < .001) were statistically significant predictors of sexual quality of life in non-heterosexual men. Internalized homophobia (ß = -0.28; P < .001) and erectile function (ß = 0.29, P < .001) turned out to be the strongest predictors. Sexual orientation (gay vs bisexual) and its interactions with individual processes of minority stress were statistically nonsignificant. CLINICAL IMPLICATIONS: To evaluate and improve the sexual quality of life of non-heterosexual men, it is necessary to consider not only their sexual function, but also the minority stress they experience, particularly internalized homophobia. STRENGTHS & LIMITATIONS: The major strengths of the study include a large sample size, a comprehensive assessment of minority stress, and the previously understudied Central European cultural context. The major limitations are the nonrepresentative sampling, retrospective data collection, and cross-sectional design. CONCLUSION: Internalized homophobia predicts poorer sexual quality of life in gay and bisexual men in Poland. Grabski B, Kasparek K, Müldner-Nieckowski L, et al. Sexual Quality of Life in Homosexual and Bisexual Men: The Relative Role of Minority Stress. J Sex Med 2019;16:860-871.

Is sexual identity associated with the risk of premature ejaculation? / Czy tozsamosc seksualna zwiazana jest z ryzykiem diagnozy wytrysku przedwczesnego?

OBJECTIVES: Some studies suggest that homosexual identity, compared to heterosexual, may be associated with a reduced risk of premature ejaculation (PE). The aim of this study was to test this relationship and to investigate possible underlaying mechanisms. METHODS: The present study drew on a database obtained from a cross-sectional online study of the sexuality of Polish heterosexual (HM; N = 1,121), gay (GM; N = 1,789) and bisexual (BM; N = 743) men. The dependent variable was the PE diagnosis based on the PEDT questionnaire. The explanatory variables were characteristics of sexual and partnership patterns, health and minority stress among GM and BM. Statistical one- and multifactor analyses were performed. RESULTS: Homosexual identity proved to be an independent negative predictor of PE diagnosis. The preference for insertive penetration activity (including vaginal), performance anxiety and financial difficulties increased the risk of PE, while the experience of insertive and receptive forms of oral and anal sex but not vaginal sex, a higher level of education, better general sexual functioning and regular physical activity reduced such risk. The predictive meaning of homosexual identity has not been present in multifactor models for group of men in relationships. CONCLUSIONS: Homosexual identity is associated with a lower risk of PE diagnosis. This may be due to the differences in sexualities of GM and HM, as well as other psychosocial factors.

Erectile Problems in Polish Straight, Bisexual, and Gay Men: Does Sexual Identity Really Matter?

Erectile dysfunction (ED) is one of the most common sexual health diagnoses in men. Previous studies demonstrated that ED can be even more prevalent among sexual minority men. This study investigated whether sexual identity is related to erectile function (EF) and explored variables possibly contributing to the differences between Polish straight and sexual minority men. The study sample included 1,246 gay, 838 straight, and 535 bisexual men who participated in an online survey. First, the psychometric qualities of the IIEF-2-EF scale used in the study were examined through confirmatory and exploratory factor analysis; a correction to account for potential bias in the questionnaire was also applied. Next, a series of univariate and multivariable models accounting for predictors possibly contributing to the observed differences between the groups of men were conducted. It was demonstrated that gay and bisexual men were more likely to show poorer EF. However, as demonstrated in the subgroup of men who were in relationships, sexual identity lost its significance when the unique characteristics of minority men's sexuality (i.e., less focus on insertive penetrative sex in gay men and more frequent relational non-exclusivity in bisexual men) were controlled for. Erectile problems in minority men may benefit from clinical consideration in the unique context of their sexuality.

Characteristics and expectations of patients seeking help for gender dysphoria in one of the sexological outpatient clinics in Poland. / Charakterystyka i oczekiwania pacjentów szukajacych pomocy z powodu dysforii plciowej w jednej z poradni seksuologicznych w Polsce.

OBJECTIVES: The aim of the study was to present the characteristics of the convenience sample of the transgender people who registered in one of the sexological outpatient clinics, with particular emphasis on the needs of those seeking assistance. The division into persons with binary and non-binary identities was included. METHODS: A statistical analysis of the data obtained from the medical records of a group of 49 patients, including 35 patients declaring binary identity and 14 patients declaring non-binary identity, was conducted. The data included, among others, the reported gender identity, the process of its emergence and the range of expectations towards the outpatient clinic (hormone therapy, qualification for gender confirmation procedures, support in obtaining legal recognition of gender reassignment, assistance in the coming-out process, treatment of co-occurring psychiatric problems or psychological assistance). RESULTS: The results indicate a great diversity of the examined group in terms of the declared gender identity. In the group of non-binary persons, a different than in binary persons course of the emergence and consolidation of gender identity is noticeable. The expectations reported in terms of hormone therapy, surgical treatment, legal recognition, assistance in the coming-out process and mental health indicate that there are differences and heterogeneous needs in the study group. The results indicate that expectations for hormone therapy, gender confirmation surgeries and legal recognition are more common in binary patients. CONCLUSIONS: Despite the frequent perception of transgender people as a homogeneous group with similar experiences and expectations, the results indicate considerable diversity in the given range.

Gender confirmation hormonal treatment use in young Polish transgender binary and non-binary persons.

INTRODUCTION: Gender confirmation hormonal treatment (GCHT) is a cornerstone of medical treatments for persistent gender dysphoria, which is expected and required by many transgender binary and non-binary individuals. Many protocols have been published, and the qualification process is guided by the World Professional Association for Transgender Health Standards of Care. The standards and other documents such as the Endocrine Society Clinical Practice Guideline provide gender confirmation hormonal care also for minors. However, the issue of starting these treatments in younger populations is still marked by controversy. This preliminary study aimed to inquire into GCHT (medications used, timing of its initiation, its tolerance, and sources of information on the treatment) in a convenience sample of young Polish transgender binary and non-binary persons. MATERIAL AND METHODS: A total of 166 adult transgender participants answered our online questionnaire between November 2020 and December 2021. The population was divided into 2 groups: assigned male at birth (AMB, n = 37) and assigned female at birth (AFB, n = 126). Subsequently, division into binary and non-binary was applied to these groups. RESULTS: Most patients (91.9% AMB and 92.2% AFB) did not use gender confirmation medical treatments before the age of 18 years. The most common medication used for GCHT before the age of 18 was cyproterone acetate for AMB and testosterone for AFB. When asked about their opinion on the timing (age) of initiating GCHT, 73.1% of the AMB and 59.2% of the AFB participants shared the view that it had been initiated much too late. By far the most common source of information on GCHT and gender confirmation surgery (GCS) was the Internet (92.2%). CONCLUSIONS: These treatments (including pubertal blocking) seem to be rarely commenced in Poland before the age of 18 years. In adults, treatment consists mostly of either testosterone or oestradiol, and cyproterone acetate and, more seldom, spironolactone are used as antiandrogens in persons assigned male at birth. In turn, gonadotropin-releasing hormone agonists are barely used at all. Specialists need to be more aware that withholding treatment in minors with gender dysphoria is not a health-neutral option. Gonadotropin-releasing hormone agonists should also be more often considered as an alternative to cyproterone acetate in the context of long-term safety.

The diverse joys of sex and relationships in straight, gay, and bisexual Polish men. / Róznorodnosc relacyjna i przyjemnosc seksualna wsród polskich mezczyzn heteroseksualnych, homoseksualnych i biseksualnych.

OBJECTIVES: The purpose of this study was to describe sexual orientations, intimate relationships, sexual behaviours, and pleasure in self-identified straight, gay, and bisexual men. METHODS: The analysis drew on a database obtained from a cross-sectional online study of the sexuality of Polish straight (SM; N = 1,079), gay (GM; N = 1,704) and bisexual (BM; N = 713) men. This data was utilised to compare men from these three groups across their sexual orientations, intimate relationships and sexual behaviours, including the most pleasurable sexual activities. RESULTS: In general, the sexualities of GM and BM seem to be more diverse and less oriented to particular sexual activities. Sexual minority men (SMM) tended to be more often in open (nonexclusive) relationships, had more diverse sexual experiences, and enjoyed a greater variety of sexual activities. This particularly concerned BM. CONCLUSIONS: Present analysis revealed patterns and significant differences in sexual orientations, intimate relationships, sexual behaviours, and pleasure of SM, GM and BM. The results, pointing to a greater diversity of sexual expression and preferences in SMM, may both trigger reshaping of some of the stereotypical beliefs, as well as positively influence educational (sexual education, specialized teaching) and clinical practice (more accurate assessment of patients' needs and problems).

Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men.

BACKGROUND: Research on pathways linking stigma with health inequalities affecting sexual minority populations, focused predominantly on exploring the hypothalamic-pituitary-adrenocortical (HPA) dysregulation profiles associated with chronic stress. One of such profiles reflecting a state of increased susceptibility to disease, and not yet studied among sexual minority individuals, is impaired habituation to repeated stress of the same type. In this study we explored whether sexual identity modulates endocrine stress responses and stress responses habituation in healthy heterosexual and gay men. We also explored the associations between perceived sexual minority stigma and cortisol response to stress in the latter group. METHODS: Gay (N = 49) and heterosexual (N = 40) men, aged 24.4 years, were confronted twice with the Trier Social Stress Test and provided 5 salivary cortisol samples for each of the two testing sessions. A multilevel mixed-effects approach was used to model the cortisol curve throughout the two-day procedure. Habituation to repeated stress was conceptualized as the decrease in the total cortisol levels as well as the change in the cortisol curvilinearity between the first and the second testing session. RESULTS: Gay participants were characterized by significantly higher cortisol levels throughout both laboratory visits. Their cortisol levels were also predicted by perceived rejection from family due to minority sexual identity, and stigma-related vicarious trauma. Although neither group showed habituation defined as the decrease in cortisol level, the shape of the cortisol curve changed between both visits only in the heterosexual participants. CONCLUSIONS: Increased cortisol levels observed in gay men are predicted by minority stressors. Combined with non-habituation, the upregulation of the HPA axis may constitute a physiological pathway linking stigma to adverse health outcomes.

Encountering an Exhibitionist: The Female Victim's Perspective.

Although exhibitionism is thought to be one of the most common sexual offenses, relatively little is known about its victims. The present study aimed to explore the correlates of encountering an exhibitionist, the course of exhibitionist acts, and their impact on the victim. An online survey was completed by 1,075 women, 58.7% of whom had encountered an exhibitionist. Previous victimization had the strongest impact on the probability of encountering an exhibitionist; victims' habits had no impact. The most frequent type of place where the incidents occurred was green spaces. Most exhibitionists touched their genitals and a third of them talked to the victim. The perpetrators usually did not chase their victims, but those who did were more aggressive. The emotions most frequently reported by the victims as accompanying the incident were surprise, disgust and fear. Taking action to avoid further incidents was reported by 29.0% of the respondents. Few incidents were reported to the authorities (7.0%). The results suggest that the impact of encountering an exhibitionist is in some ways similar to other types of sexual victimization.

High or very high recidivism risk? The possibilities of recidivism risk assessment under the Polish SVP law (the Act of 22 November 2013). / Wysokie czy bardzo wysokie ryzyko recydywy? Mozliwosci oceny kategorii ryzyka recydywy sprawców na potrzeby Ustawy z 22.11.2013.

The paper presents an analysis of possibilities of performing recidivism risk assessment under the Act of 22 November 2013 on the treatment of people with mental disorders posing a threat to life, health or sexual freedom of others. The Act allows, among others, the post-penitentiary isolation of persons posing a threat. The risk assessment at "very high" level is one of the key elements taken into account in adjudication of this procedure.The first part presents basic information on the recidivism risk assessment procedure: types of risk factors and different approaches to recidivism risk assessment. Then, three main limitations related to the assessment under the Act were discussed. These are: (1) the problem of the scope of the predicted events, (2) the problem of differentiation between the upper sub-categories of recidivism risk, (3) the problem of the lack of full Polish adaptations of recidivism risk assessment instruments. In consequence of these limitations, the risk assessment under the Act has lower precision. The problem of the lack of Polish adaptations can be solved with validation of the appropriate instruments. However, the other two challenges result directly from the provisions of the Act and cannot be faced with its current form. Therefore main conclusion of the paper focuses on the need to take into account the discussed limitations by experts, officials participating in the proceedings and the institutions issuing decisions. Risk assessment should be based on the measurement of all types of recidivism risk factors, including primarily static and then stable dynamic ones.

Sexual problems in homo- and bisexual men - the context of the issue. / Problemy seksualne u mezczyzn homo- i biseksualnych ­ omówienie kontekstu zagadnienia.

The aim of the paper is to present a specific context for the occurrence of sexual problems, i.e., sexual dysfunction in the population of homo - and bisexual men. Sexual problems and revealing them are usually a big challenge for men. In case of homo - and bisexual men additional psychological and social factors may contribute to the occurrence of these problems, as well as make experiencing them more painful, but also impede looking for and receiving an adequate help. These factors are connected to the specific features of gay men sexuality, such as: lack of obvious sexual scripts for homosexual men, full reversibility of all sexual roles and positions in contacts between two men or no fear of unwanted pregnancy, but also with the unique psychosocial context such as: minority stress and internalized homophobia. Clinicians - psychiatrists, sexologists and psychologists - should be aware of their existence to deliver a more effective professional and culturally competent care, which is free of prejudice, based on deepened reflection and void of automatic transference of experiences with work with heterosexual men.

Sexual dysfunctions in non-heterosexual men - literature review. / Dysfunkcje seksualne mezczyzn nieheteroseksualnych ­ analiza i krytyka pismiennictwa.

The paper aims to present results and discuss methodology of research conducted so far on sexual dysfunction in non-heterosexual men, as well as to form suggestions for future research and clinical practice. The present paper is a continuation of our earlier paper, which discussed the specific context of the issue connected with the characteristics of gay sexual orientation and the social situation those men face. There is little research on dysfunctions and sexual problems in non-heterosexual men, and none has been conducted in Poland. The research that has been done is characterized by inconsistent methodology that is far from perfect, and varied results which cannot be compared. There are still many unanswered questions in the field. The issues connected with research that require attention include the choice of samples and their representativeness, and the accuracy of the methods used for identifying sexual dysfunctions. It is also still not clear whether sexual problems occur more often in non-heterosexual than heterosexual men, how non-heterosexual men deal with those problems, and how the problems influence their functioning. Another issue that requires a deeper understanding is the connections between sexual dysfunctions in this group and various aspects of the so-called minority stress, such as internalized homophobia and experiencing discrimination, psychoactive substance abuse, HIV infection, and the sexual and partnership lifestyle.

Polish project of a Sex Offenders Registry - a mental health professionals' perspective. / Polski projekt rejestru sprawców przestepstw na tle seksualnym - perspektywa specjalistów ds. zdrowia psychicznego.

The paper discusses the governmental draft of the Act on counteracting threats of sexual offences. It assumes the creation of the Registry of Sex Offenders in a version with a limited access and a version available to the public. The registry is supplemented with a publically available map of sexual crime threats, which includes the places of sexual offences and the places of residence of offenders. Criticising the proposed solutions, the authors point out the lack of integration with other interventions conducted in Poland against sex offenders, noncompliance with the recommendations of the most important expert circles in the field, as well as the research results showing the lack of effectiveness of the planned measures to reduce sexual offences. Anumber of negative consequences of making the sex offenders'data available to the public was also highlighted in the form of a clear deterioration of social rehabilitation prognoses, additional stigmatisation, as well as social exclusion of the offenders themselves and the victims of sexual violence. The summary emphasises the need to counteract the problem of sexual offences in a systematic way and the need to diversify the interventions undertaken against the offenders, depending on the level of risk of sexual recidivism.