Relationship between sexual orientation and psychotic experiences in the general population in England.

BACKGROUND: Non-heterosexual individuals are at high risk for a variety of factors associated with the emergence of psychotic experiences (PEs) (e.g. common mental disorders, substance use, and stress). However, there is a scarcity of data on the association between sexual orientation and PEs. Therefore, the aim of this study was to examine the sexual orientation-PE relationship, and to identify potential mediators in this relationship. METHODS: This study used nationally representative cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey. Sexual orientation was dichotomized into heterosexual and non-heterosexual. Past 12-month PE was assessed with the Psychosis Screening Questionnaire. Regression and mediation analyses were conducted to analyze the association between sexual orientation and PEs, and to identify potential mediators involved in this relationship. RESULTS: The final sample consisted of 7275 individuals aged ⩾16 years. The prevalence of non-heterosexual orientation and any PE was 7.1% and 5.5%, respectively. After adjusting for sex, age, and ethnicity, non-heterosexual orientation was positively associated with any PE (odds ratio 1.99, 95% confidence interval 1.34-2.93). The strongest mediators involved in this relationship were borderline personality disorder (BPD) traits (mediated percentage = 33.5%), loneliness (29.1%), and stressful life events (25.4%). CONCLUSIONS: These findings suggest that there is a positive relationship between sexual orientation and PEs in the general population in England, and that underlying mechanisms may involve BPD traits, loneliness, and stressful life events. Future studies with a longitudinal design are warranted to shed more light on how these factors are implicated in the association between sexual orientation and PEs.

Sexual minority status, social adversity and risk for psychotic disorders-results from the GROUP study.

BACKGROUND: Lesbian, bisexual, or gay individuals (LBGs) have an increased risk for mental health problems compared to heterosexuals, but this association has sparsely been investigated for psychotic disorders. The aim of this study was: (1) to examine whether LBG sexual orientation is more prevalent in individuals with a non-affective psychotic disorder (NAPD) than in people without a psychotic disorder; and if so, (2) to explore possible mediating pathways. METHODS: Sexual orientation was assessed in the 6-year follow-up assessment of the Dutch Genetic Risk and Outcome of Psychosis study (GROUP), a case-control study with 1547 participants (582 patients with psychotic disorder, 604 siblings, and 361 controls). Binary logistic regression analyses were used to calculate the risk of patients with a psychotic disorder being LBG, compared to siblings and controls. Perceived discrimination, history of bullying, childhood trauma (CT), and sexual identity disclosure were investigated as potential mediating variables. RESULTS: The proportion of individuals with LBG orientation was 6.8% in patients (n = 40), 4.3% in siblings (n = 26), and 2.5% in controls (n = 10). The age- and gender-adjusted odds ratio of LBG for patients was 1.57 (95% CI 1.08-2.27; p = 0.019), compared to siblings and controls. Discrimination, bullying, and CT all partially mediated this association. CONCLUSIONS: Adverse social experiences related to sexual minority status may increase the risk for NAPD. Sexual identity, behavior, and difficulties need more attention in everyday clinical practice.

Assessment of an onco-sexology support and follow-up program in cervical or vaginal cancer patients undergoing brachytherapy.

PURPOSE: Women's sexual health and wellbeing with cervical or vaginal cancer may be largely affected by complications from external beam radiotherapy (EBRT) and utero-vaginal brachytherapy (BT), of which vaginal stenosis is the main complication. The objective of this study was to assess the impact of support by a nurse sexologist on sexuality, vaginal side-effects, and the quality of clinical follow-up in patients treated with brachytherapy for cervical or vaginal cancer. METHODS: We performed a retrospective study of the sexuality of women treated for cervical or vaginal cancer. Data from patients with cervical or vaginal cancer who underwent brachytherapy between 2013 and 2017 were collected at Institut Universitaire de Cancer de Toulouse-Oncopôle (IUCT-Oncopôle). Patients were divided into two groups: group A (intervention group) received support from a nurse sexologist and group B (control group) did not. The chi-square test and a logistic multivariate model were used for data analysis. RESULTS: A total of 156 patients were included in this study, including 57.7% who were followed by a nurse sexologist. We observed low compliance in using vaginal dilators after brachytherapy and/or radiotherapy over time regardless of the group, and patients' sexual activity was inadequately addressed. Information regarding the resumption of sexuality 2 months after treatment was missing in 1.1% of patients in group A and in 36.4% of patients in group B. Multivariate analysis showed that patients in group A had a lower risk of developing vaginal stenosis with OR crude = 0.5 (95% CI = 0.25-0.92) and OR adj. = 0.5 (95% CI = 0.26-1.09) compared with those in group B. CONCLUSION: This retrospective study highlights the lack of information collected by physicians during follow-up concerning the sexuality of patients with cervical or vaginal cancer treated by EBRT and BT. The support offered by nurse sexologists in improving patients' sexual activity and reducing their physical side-effects such as vaginal stenosis is likely to be beneficial. A prospective study is currently being conducted to validate the present findings.

Sexual Orientation and Functional Limitations: Cross-sectional Analyses From the Adult Psychiatric Morbidity Survey.

OBJECTIVE: To assess the association between sexual orientation and functional limitations in a large representative sample of the English population. DESIGN: Cross-sectional. SETTING: Data were from the 2007 Adult Psychiatric Morbidity Survey. PARTICIPANTS: A total of 7403 adults aged 16-95 years (51.4% female; mean age, 46.3±18.6y) were included in the present study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sexual orientation was assessed using 2 items adapted from the Kinsey scale and was dichotomized into heterosexual and sexual minority orientation. Functional limitations were assessed using 7 activities of daily living (ADL) and instrumental activities of daily living (IADL). Functional limitations were defined as at least 1 difficulty in 1 of 7 ADL and IADL. Adjusted logistic regression analyses were conducted to investigate the association between sexual orientation (independent variable) and functional limitations (dependent variable). RESULTS: The level of sexual minority orientation and prevalence of functional limitations in the sample was 7.1% and 32.9%, respectively. After adjusting for several potential confounders, sexual minority orientation was positively and significantly associated with functional limitations (odds ratio, 1.51; 95% confidence interval, 1.18-1.95; reference group: heterosexual orientation). CONCLUSIONS: Based on the findings of this study, interventions aiming to prevent against and/or manage/reduce functional limitations in sexual minorities are needed. More research is also warranted to better understand mediators (eg, obesity, cognitive complaints, psychiatric disorders) involved in the sexual orientation-functional limitation relationship.

Associations among sexuality-related factors, recent two-week morbidity and annual hospitalization in female migrant workers: a cross-sectional study in southern China.

To explore the influence of sexuality-related factors on recent two-week morbidity and annual hospitalization in female migrant workers, 880 Chinese rural-to-urban female migrant workers aged 16-57 years were studied. Clustered logistic regression analyses revealed that women who never or seldom experienced lubrication difficulties had a lower risk of recent two-week morbidity (adjusted odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.17-0.60, P< 0.001; adjusted OR = 0.35, 95% CI = 0.18-0.69, P= 0.003) than those who always experienced lubrication difficulties; women who never felt a lack of sexual interest had a significantly lower risk of annual hospitalization (adjusted OR = 0.40, 95% CI = 0.20-0.79, P= 0.009) than those who always or seldom lacked sexual interest, and women who never felt sexual satisfaction had a higher risk of annual hospitalization (adjusted OR = 3.08, 95% CI = 1.75-5.42, P< 0.001) than those who always or seldom experienced sexual satisfaction. The independent contributions of sexuality-related factors to the risk of recent two-week morbidity and annual hospitalization were 5.8% and 29.5%, respectively. This study suggests that sexuality may have a modest influence on recent two-week morbidity and a dominant impact on annual hospitalization.

Does Sexual Orientation Complicate the Relationship Between Marital Status and Gender With Self-rated Health and Cardiovascular Disease?

A substantial body of work has demonstrated the importance of marital status for health, yet the vast majority of this work has studied heterosexual marriages and relationships. To understand the role of marital status in shaping health among heterosexual, lesbian, gay, and bisexual men and women, we examine data from a probability-based sample of adults living in 40 U.S. states for selected years between 2011-2015. We test two physical health outcomes-poor-to-fair self-rated health and cardiovascular disease-and present predicted probabilities and pairwise comparisons from logistic regression models before and after adjustment for demographic characteristics, socioeconomic status, health behaviors, and depression. Overall, findings reveal some important similarities and differences in the relationships between marital status and health by sexual orientation and gender. First, the health benefits of marriage extend to sexual minority adults, relative to adults who are either formerly or never married. Among heterosexual adults, adjusted models also highlight the healthy status of never-married adults. Second, the health benefits associated with intimate relationships appear less dependent on legal marriage among sexual minorities than among heterosexual adults. Third, we document a persistent health disadvantage for bisexual adults compared with heterosexual adults, particularly among women who are formerly married, indicating some elevated health vulnerability among selected sexual minority women. Fourth, associations between sexual orientation and health are more similar across marital status groups for men than women. Altogether, these findings add much needed nuance to our understanding of the association between marital status and health in an era of increasing diversity in adult relationships.

A longitudinal birth cohort study of early life conditions, psychosocial factors, and emerging adolescent sexual orientation.

This study tested whether previously reported associations between early life factors and later adolescent sexual orientation could be replicated in another prospective birth cohort, the UK Millennium Cohort Study (MCS). We used data on 9,795 youth from the MCS. Emerging sexual orientation was assessed using measures of sexual attraction to males and females in separate items at 14 years. Factors including birthweight, breastfeeding, sibling composition, parental ages, maternal psychopathology, parent-child relationship, and contextual risks were separated into three developmental periods: prenatal (n = 5 factors), before 7 years (n = 6 factors), and after 7 years (n = 5 factors). We controlled for handedness as a putative marker of prenatal androgen exposure and the possibility of mischievous responding statistically. Girls with greater maternal psychological distress since age 7 and greater pubertal body mass index were more likely to be nonheterosexual but the effect sizes were very small. Among boys there were no significant associations between any early life conditions and later sexual orientation. However, focusing on effect sizes rather than significance levels, there were small associations between preterm birth and nonheterosexuality. The results offer further evidence that psychosocial influences in the development of adolescent sexual orientation are weak or non-existent.

The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use.

BACKGROUND: The college years represent a period of increased vulnerability for a wide range of mental health (MH) challenges. The onset of common psychiatric conditions occurs during this period of development. Increases in depression, anxiety, and suicidality among U.S. college students have been observed. This study identified prevalence and correlates of MH diagnoses and suicidality in a recent sample of U.S. college students. METHODS: The Spring 2015 American College Health Association-National College Health Assessment (ACHA-NCHA) survey assessed MH diagnoses and suicidality from U.S. undergraduate students (n = 67,308) across 108 institutions. RESULTS: Stress was strongly associated with a greater likelihood of suicide attempts and MH diagnoses, even among students reporting 1-2 stressful events (OR [odds ratio] range 1.6-2.6, CI [confidence interval] = 1.2-3.2). Bisexual students were more likely to report MH diagnoses and suicidality, compared to heterosexual and gay/lesbian students (OR range 1.5-3.9, CI = 1.8-4.3), with over half engaging in suicidal ideation and self-harm, and over a quarter reporting suicide attempts. Transgender students reported a higher rate of MH diagnoses and suicidality relative to females (OR range 1.9-2.4, CI = 1.1-3.4). Racial/ethnic minority students were generally less likely to report MH diagnoses relative to Whites, although the likelihood for suicidality was mixed. CONCLUSIONS: The high rate of multiple stress exposures among the U.S. college population and the high impacts of stress on MH and suicidality point to an urgent need for service utilization strategies, especially among racial/ethnic, sexual, or gender minorities. Campuses must consider student experiences to mitigate stress during this developmental period.

Prevalence and possible predictors of sexual dysfunction and self-reported needs related to the sexual life of advanced cancer patients.

Background: Sexual dysfunction and problems are common late effects after treatment of cancer. However, little is known about the prevalence and risk factors for sexual dysfunction in patients with advanced cancer. The aim of this study was to investigate the prevalence and predictors of sexual problems and needs in a large sample of Danish patients with advanced cancer. Methodology: The data derived from a representative cross-sectional study of patients with advanced cancer. Patients who had been in contact with 1 of 54 hospital departments were invited to fill out a questionnaire on symptoms and problems. Five items asked about sexuality. Ordinal logistic regression was used to identify variables associated with sexual functioning in explorative analyses. Results: A total of 1,447 patients completed the questionnaire and of those, 961 patients (66%) completed the sexuality items. More than half of the patients (60%) had not been sexually active within the previous month, despite a high prevalence of desire for sexual intimacy (62%). More than half of the patients (57%) experienced that their physical condition or treatment had impaired their sex life. Of those, 52% experienced an unmet need for help with sexual problems from the health care system. Older patients were less likely to report sexual problems than younger patients. Having prostate or gynecologic cancer was associated with the feeling that one's sexual life was negatively influenced. Conclusion: Sexual problems are common among patients with advanced cancer and should be addressed by the health care system.

Satisfaction and Health Within Four Sexual Identity Relationship Options.

Using a sample of 1,782 same-sex attracted (SSA) and lesbian, gay, and bisexual (LGB) identified participants, this study examined similarities and differences among those who are (a) single and celibate (SC); (b) single and not celibate (SNC); (c) in a heterosexual, mixed-orientation relationship (MOR); and (d) in a same-sex relationship (SSR). To reduce bias and increase generalizability, an ideologically diverse research team was formed. Participants in SSRs reported higher levels of some amount of satisfaction with their status (95%) compared to those in MORs (80%), those who are SC (42%) and those who are SNC (40%). The SSR group had the least depression and anxiety and the most life satisfaction and physical health, followed by the MOR group, followed by the two single groups. Results from a stepwise regression predicting satisfaction from important aspects of life and relationships identified that meeting needs for connection, intimacy, and mutual understanding was the strongest predictor of satisfaction across all options. Other significant variables included participant-defined authentic sexual expression, resolving conflicts with religion, and reducing depression and anxiety. Results may inform SSA/LGB individuals who are questioning which option fits best for them and help guide therapists who work with these individuals.

Association between comorbidities and female sexual dysfunction: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

INTRODUCTION AND HYPOTHESIS: Although medical comorbidities are widely recognized to be associated with erectile dysfunction, less research has been done on their association with female sexual dysfunction (FSD). The purpose of this study was to assess whether FSD is associated with comorbidities; we hypothesized that there is an association. METHODS: This is a secondary analysis of the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a prospective stratified probability sample of individuals aged 16-74. We assessed for association between sexual function scores and heart attack, heart disease, hypertension, stroke, diabetes, chronic lung disease, depression, other mental health condition, other neurologic conditions, and incontinence, as well as menopause and smoking status. Correlation between comorbidities and specific domains of sexual function was also assessed. RESULTS: A total of 6777 women, with an average age of 35.4 (14.1), responded to the survey and reported sexual activity in the past year. There was an association between sexual function score and age, menopause, hysterectomy, heart disease, hypertension, diabetes, obesity, smoking, depression, other mental health condition, stroke, other neurological condition, and homosexual attraction (p < 0.05). On multivariate analysis, age, sexual attraction, smoking status, depression, and other mental health conditions remained significantly correlated with sexual function (p < 0.05). Comorbidities were found to be correlated with specific domains. CONCLUSIONS: Comorbidities were associated with FSD and specific comorbidities associated with dysfunction in specific domains. Urogynecologists and urologists must assess for comorbidities, as women presenting with sexual dysfunction may provide an opportunity for early diagnosis of life-threatening conditions.

Are sociodemographic, lifestyle, and psychosocial characteristics associated with sexual orientation group differences in mental health disparities? Results from a national population-based study.

PURPOSE: Sexual minority mental health disparities are well documented. However, distinct sexual minority subgroups are often collapsed into a single "lesbian, gay, or bisexual" (LGB) analytic group. While limited research has shown sexual minority subgroup differences in mental health, little is known about the factors underlying these differences. This study examines whether sociodemographic, lifestyle, and psychosocial characteristics are associated with sexual orientation subgroup differences in mental health. METHODS: Using the National Epidemiologic Survey on Alcohol and Related Conditions, Wave III, differences in various mental health measures, and sociodemographic, lifestyle, and psychosocial characteristics were assessed across three sexual minority subgroups [lesbians/gay men, bisexuals, and heterosexuals reporting same-sex attractions or behaviors ("heterosexual-identified sexual minorities, HSM")] and heterosexuals reporting only opposite-sex attractions and behaviors ("heterosexuals"). Sequential linear regressions evaluated the degrees to which different factors attenuated mental health (SF-12) disparities between heterosexuals and sexual minority subgroups. Analyses were sex-stratified. RESULTS: Several sociodemographic, lifestyle, and psychosocial characteristic differences existed between sexual orientation groups. Further, all sexual minority subgroups had lower SF-12 scores than heterosexuals, except lesbian women. Sociodemographic factors attenuated the disparity for bisexual men. Sociodemographic, lifestyle, plus psychosocial factors attenuated the disparity for HSM men. However, sociodemographic, lifestyle, and psychosocial factors partially, but did not fully, attenuate the disparity for gay men, bisexual women, or HSM women. CONCLUSIONS: Different factors are associated with mental health disparities for sexual minority subgroups. To maximize health intervention efforts, additional research is needed to uncover the specific mechanisms contributing to health disparities across diverse sexual minority populations.

What do pediatric surgeons think about sexual issues in dealing with patients with anorectal malformations? The ARM-Net consortium members' opinion.

PURPOSE: Since pediatric surgeons aim to follow their patients with anorectal malformations (ARM) into adulthood the aim of this study was to investigate how pediatric surgeons deal with sexual issues related to ARM. METHODS: In 2018, a questionnaire was developed by the working group "Follow-up and sexuality" of the ARM-Net consortium and sent to all consortium-linked pediatric surgeons from 31 European pediatric surgical centers. Obtained data were statistically analyzed. RESULTS: Twenty-eight of 37 pediatric surgeons (18 males/10 females) answered the questionnaire. The majority of pediatric surgeons (82%) think they should talk about sexual issues with their patient. More than 50% of pediatric surgeons do not feel at all or only moderately confident discussing the topic of sexuality. Most pediatric surgeons require more support (96%) and wish to be trained in sexuality and sexual issues (78%) to feel confident towards their ARM-patients/parents. For optimal care, sexual issues with ARM-patients should be managed by a multidisciplinary team. CONCLUSIONS: Pediatric surgeons feel that sexuality is an important issue for their ARM-patients, which they are primarily responsible of but should be managed in concert with a multidisciplinary team. A training in sexuality is wished to feel more confident about this specific issue.

Sexual activity and life satisfaction in older adults.

AIM: Based on the concept of successful ageing and research reports on the benefits of maintaining sexual activity in mid- to late life, the purpose of the current study was to examine the relationship between global life satisfaction and sexual satisfaction in adults older than 60 years. The study also analyzed the relationship between various forms of sexual activity (genital and non-genital) and both types of satisfaction. METHODS: Thirty-three men and 50 women (N =83) were interviewed by using two structuralized questionnaires. Global life satisfaction was measured with Diener's Satisfaction with Life Scale, whereas sexual satisfaction and preferences regarding various intimate behaviours (i.e. kissing, cuddling, touching partner's intimate body parts, penetration, and masturbation) were assessed with a questionnaire devised for the purpose of the study. Statistical analyses were conducted to verify the relationships among the variables, group differences, and the statistical significance of sexual satisfaction as a predictor of global life satisfaction. RESULTS: Most of the interviewed subjects have had engaged in sexual activity in the last 1-6 months before the study (60%). Participants declared that they mostly engage in subtle forms of sexual activity rather than having intercourse. The level of sexual activity of older adults was positively associated with both sexual and global life satisfaction, but different forms of intimacy had a different impact on satisfaction. Gender was not correlated with the level of sexual and global life satisfaction. CONCLUSIONS: Sexual satisfaction was a good predictor of global life satisfaction in older adults in our study. The participants appeared less concerned with the frequency of their intimate activities and more with engaging in the type of behaviour they were able to enjoy, which shows that they were adapting to the ageing process and potential health issues.

Substance Use Among Lesbian, Gay, Bisexual, and Questioning Adolescents in the United States, 2015.

OBJECTIVES: To provide current national estimates of lesbian, gay, bisexual, and questioning (LGBQ) adolescents' (grades 9-12) substance use risks. METHODS: The 2015 national Youth Risk Behavior Survey included questions for 19 substance use outcomes covering 15 substances. LGBQ adolescents' substance use was described and their risk relative to heterosexual adolescents was estimated after controlling for sociodemographic confounders. RESULTS: In controlled analyses, we found that LGBQ adolescents were 1.12 (95% confidence interval [CI] = 1.06, 1.19) times as likely as heterosexual adolescents to report any lifetime and 1.27 (95% CI = 1.14, 1.41) times as likely to report past 30-day substance use. LGBQ adolescents were at significantly greater risk for all but 1 studied substance, including alcohol, cigarettes, cigars, cocaine, ecstasy, electronic vapor usage ("vaping"), hallucinogens, heroin, inhalants, marijuana, methamphetamine, prescription drugs (without physician direction), steroids, and synthetic marijuana. CONCLUSIONS: LGBQ adolescents are at substantially greater risk for substance use. Public Health Implications. Policymakers should invest in prevention and early intervention resources to address substance use risks among LGBQ adolescents.

The Rectal Cancer Female Sexuality Score: Development and Validation of a Scoring System for Female Sexual Function After Rectal Cancer Surgery.

BACKGROUND: Sexual dysfunction and impaired quality of life is a potential side effect to rectal cancer treatment. OBJECTIVE: The objective of this study was to develop and validate a simple scoring system intended to evaluate sexual function in women treated for rectal cancer. DESIGN: This is a population-based cross-sectional study. SETTINGS: Female patients diagnosed with rectal cancer between 2001 and 2014 were identified by using the Danish Colorectal Cancer Group's database. Participants filled in the validated Sexual Function Vaginal Changes questionnaire. Women declared to be sexually active at follow-up were randomly assigned to 2 groups: one for development and one for validation. Logistic regression analyses identified items for the score, and multivariate analysis established a weighted-score value allocated to each item, adding up to the total score. The validity of the score was tested in the validation group. PATIENTS: Female patients with rectal cancer above the age of 18 who underwent abdominoperineal resection, Hartmann procedure, or total/partial mesorectal excision were selected. MAIN OUTCOME MEASURES: The primary outcome measured was the quality of life that was negatively affected because of sexual problems. RESULTS: A total of 466 sexually active women responded. The score includes 7 items with a range of 0 to 29 points. Score ≥9 indicates sexual dysfunction. The score has a sensitivity/specificity of 76%/75% detecting patients bothered by sexual dysfunction with a negative impact on quality of life. LIMITATIONS: This study was limited by the large amount of nonresponders. CONCLUSIONS: Living up to our demands for a short and easy-to-use validated tool, we have developed the Rectal Cancer Female Sexuality score. It captures, with high sensitivity, the essential problems of female sexuality seen from the perspective of a surviving rectal cancer patient. See Video Abstract at http://links.lww.com/DCR/A576.

Differences in Orgasm Frequency Among Gay, Lesbian, Bisexual, and Heterosexual Men and Women in a U.S. National Sample.

There is a notable gap between heterosexual men and women in frequency of orgasm during sex. Little is known, however, about sexual orientation differences in orgasm frequency. We examined how over 30 different traits or behaviors were associated with frequency of orgasm when sexually intimate during the past month. We analyzed a large US sample of adults (N = 52,588) who identified as heterosexual men (n = 26,032), gay men (n = 452), bisexual men (n = 550), lesbian women (n = 340), bisexual women (n = 1112), and heterosexual women (n = 24,102). Heterosexual men were most likely to say they usually-always orgasmed when sexually intimate (95%), followed by gay men (89%), bisexual men (88%), lesbian women (86%), bisexual women (66%), and heterosexual women (65%). Compared to women who orgasmed less frequently, women who orgasmed more frequently were more likely to: receive more oral sex, have longer duration of last sex, be more satisfied with their relationship, ask for what they want in bed, praise their partner for something they did in bed, call/email to tease about doing something sexual, wear sexy lingerie, try new sexual positions, anal stimulation, act out fantasies, incorporate sexy talk, and express love during sex. Women were more likely to orgasm if their last sexual encounter included deep kissing, manual genital stimulation, and/or oral sex in addition to vaginal intercourse. We consider sociocultural and evolutionary explanations for these orgasm gaps. The results suggest a variety of behaviors couples can try to increase orgasm frequency.

Health and well being of lesbian, gay, bisexual, transgender and intersex people aged 50 years and over.

Objectives The aim of the present study was to examine the health and well being of older lesbian, gay, bisexual, transgender and intersex (LGBTI) people, the health issues that concern them, the services they use and challenges accessing services. Methods This study comprised a survey of the health and well being of 312 LGBTI people aged 50 years and over in New South Wales. The survey included the Short-Form 12 (SF-12) measure of health-related quality of life, the Kessler 10 (K10) measure of psychological distress, and the three-item Loneliness Scale. Results Higher levels of psychological distress, lower mental health and greater loneliness were found among this sample than is typically found in the general population. Mental health was lower among carers and those not in a relationship, while psychological distress was greater among those living alone and those experiencing higher rates of loneliness. The most commonly accessed health service was a general practitioner (GP), with most respondents reporting that they were open about their sexuality to their GP and that they had a regular GP. Some reported difficulties accessing health services because of their gender or sexual diversity. Conclusions Although many older LGBTI people are well, both physically and mentally, they do appear to face increased risk of certain health issues compared with the general population. What is known about the topic? Overseas research indicates that older LGBTI people may be at greater risk of certain physical and mental health conditions than the general population. What does this paper add? This paper provides Australian data, using well-validated instruments, on the health and well being of older LGBTI people. It provides evidence of the health issues that older LGBTI people are most concerned about and the barriers they face in accessing services. What are the implications for practitioners? It is important for health practitioners to be aware that older LGBTI people appear to be at increased risk of certain physical and mental health issues, such as loneliness and psychological distress. Providing opportunities for clients to identify their gender or sexual diversity may assist in monitoring risk factors and enable referral to promote healthy aging.

Lesbian and bisexual women's likelihood of becoming pregnant: a systematic review and meta-analysis.

BACKGROUND: Few data exist regarding pregnancy in lesbian and bisexual (LB) women. OBJECTIVES: To determine the likelihood of LB women becoming pregnant, naturally or assisted, in comparison with heterosexual women SEARCH STRATEGY: Systematic review of papers published 1 January 2000 to 23 June 2015. SELECTION CRITERIA: Studies contained details of pregnancy rates among LB women compared with heterosexual women. No restriction on study design. DATA COLLECTION AND ANALYSIS: Inclusion decisions, data extraction and quality assessment were conducted in duplicate. Meta-analyses were carried out, with subgroups as appropriate. MAIN RESULTS: Of 6859 papers identified, 104 full-text articles were requested, 30 papers (28 studies) were included. The odds ratio (OR) of ever being pregnant was 0.19 (95% CI 0.18-0.21) in lesbian women and 1.22 (95% CI 1.15-1.29) in bisexual women compared with heterosexual women. In the general population, the odds ratio for pregnancy was nine-fold lower among lesbian women and over two-fold lower among bisexual women (0.12 [95% CI 0.12-0.13] and 0.50 [95% CI 0.45-0.55], respectively). Odds ratios for pregnancy were higher for both LB adolescents (1.37 [95% CI 1.18-1.59] and 1.98 [95% CI 1.85, 2.13], respectively). There were inconsistent results regarding abortion rates. Lower rates of previous pregnancies were found in lesbian women undergoing artificial insemination (OR 0.17 [95% CI 0.11-0.26]) but there were higher assisted reproduction success rates compared with heterosexual women (OR 1.56 [95% CI 1.24-1.96]). CONCLUSIONS: Heterosexuality must not be assumed in adolescents, as LB adolescents are at greater risk of unwanted pregnancies and terminations. Clinicians should provide appropriate information to all women, without assumptions about LB patients' desire for, or rejection of, fertility and childbearing. TWEETABLE ABSTRACT: Review of likelihood of LB women becoming pregnant: LB teenagers at greater risk of unwanted pregnancies.

Criminalizing Sex Work Clients and Rushed Negotiations among Sex Workers Who Use Drugs in a Canadian Setting.

Previous research indicates that criminalization of sex work is associated with harms among sex workers. In 2013, the Vancouver Police Department changed their sex work policy to no longer target sex workers while continuing to target clients and third parties in an effort to increase the safety of sex workers (similar to "end-demand sex work" approaches being adopted in a number of countries globally). We sought to investigate the trends and correlates of rushing negotiations with clients due to police presence among 359 sex workers who use drugs in Vancouver before and after the guideline change. Data were derived from three prospective cohort studies of people who use drugs in Vancouver between 2008 and 2014. We used sex-stratified multivariable generalized estimating equation models. The crude percentages of sex workers who use drugs reporting rushing client negotiations changed from 8.9% before the guideline change to 14.8% after the guideline change among 259 women, and from 8.6 to 7.1% among 100 men. In multivariable analyses, there was a significant increase in reports of rushing client negotiation after the guideline change among women (p = 0.04). Other variables that were independently associated with increased odds of rushing client negotiation included experiencing client-perpetrated violence (among both men and women) and non-heterosexual orientation (among women) (all p < 0.05). These findings indicate that despite the policing guideline change, rushed client negotiation due to police presence appeared to have increased among our sample of female sex workers who use drugs. It was also associated with client-perpetrated violence and other markers of vulnerability. These findings lend further evidence that criminalizing the purchase of sexual services does not protect the health and safety of sex workers.