More comprehensive sex education reduced teen births: Quasi-experimental evidence.

Women in the United States are much more likely to become mothers as teens than those in other rich countries. Teen births are particularly likely to be reported as unintended, leading to debate over whether better information on sex and contraception might lead to reductions in teen births. We contribute to this debate by providing causal evidence at the population level. Our causal identification strategy exploits county-level variation in the timing and receipt of federal funding for more comprehensive sex education and data on age-specific teen birth rates at the county level constructed from birth certificate natality data covering all births in the United States. Our results show that federal funding for more comprehensive sex education reduced county-level teen birth rates by more than 3%. Our findings thus complement the mixed evidence to date from randomized control trials on teen pregnancies and births by providing population-level causal evidence that federal funding for more comprehensive sex education led to reductions in teen births.

Satisfaction with care, general health, and mental health among sexual and gender minority cancer survivors: Results of the OUT National Cancer Survey.

BACKGROUND: Few studies have attempted to characterize the cancer care experiences and outcomes of sexual and gender minority (SGM) patients with cancer, despite indications that this population experiences disparities across the cancer continuum. The current study used descriptive and exploratory methods to assess factors related to SGM cancer patients' satisfaction with cancer care and self-reported physical and mental health. METHODS: The authors designed a cross-sectional self-report online survey and recruited 3750 SGM cancer patient participants (mixed cancers; 85.6% White; 57% gay, 24% lesbian, 6.7% bisexual, and 6.2% transgender/gender nonbinary) using social media posts, partner organizations, and paid advertisements. They analyzed data using descriptive approaches and exploratory multivariate logistic regression models. RESULTS: Overall, 70.6% of participants reported feeling satisfied with the cancer care they received, 70% rated their physical health as very good or excellent, and 46% reported experiencing less than 5 days of poor mental health in the last month. In models including all participants, complete cases, and Black, Indigenous, and people of color (BIPOC), satisfaction with care was consistently associated with receiving treatment in an SGM welcoming environment. Physical health was consistently associated with having strong social support after cancer. Mental health was consistently associated with feeling safe disclosing SGM identities. CONCLUSIONS: SGM cancer patients treated in SGM-welcoming environments were over six times more likely to be satisfied with the care they received than those treated in nonwelcoming environments; this and other modifiable factors could be the target of further study and intervention.

An evaluation of sexual function and health-related quality of life following laparoscopic surgery in individuals living with endometriosis.

STUDY QUESTION: What is the relationship between sexual function, health-related quality of life (HRQoL), and laparoscopic surgery in individuals living with endometriosis? SUMMARY ANSWER: A higher number of laparoscopic surgeries is significantly associated with poorer HRQoL and greater levels of sexual dysfunction in individuals with endometriosis. WHAT IS KNOWN ALREADY: Prior research indicates that endometriosis is associated with lowered HRQoL and sexual function and that these outcomes are influenced by endometriosis-related symptom profiles, medical, and surgical management. A limited number of studies have examined changes in sexual function in individuals with endometriosis following laparoscopic surgery or following repeated surgeries. STUDY DESIGN, SIZE, DURATION: A cross-sectional community-based online survey was used to examine the relationships between sexual function, HRQoL, and laparoscopic surgery (n = 210). PARTICIPANTS/MATERIALS, SETTING, METHODS: Individuals with a self-reported diagnosis of endometriosis were recruited via online advertising through social media and gynaecology clinics. Endometriosis-specific data (e.g. diagnostic delay, symptom experience) was collected in addition to engagement with laparoscopic surgery, level of HRQoL (EuroQol-5 Dimension: EQ-5D-5L), and sexual function (Female Sexual Function Index: FSFI). Bivariate correlational analyses and hierarchical multiple regression were used to determine the associations between the variables of interest. MAIN RESULTS AND THE ROLE OF CHANCE: Individuals with endometriosis have substantially poorer HRQoL in comparison to Australian normative samples, with greater levels of endometriosis-related symptom burden, distress, and pain significantly associated with lower levels of HRQoL. The mean FSFI score was suggestive of clinically significant female sexual dysfunction, with the lowest level of function noted in the domain of sexual pain and the highest level of function noted in the sexual satisfaction domain. A greater number of laparoscopic surgeries was significantly associated with poorer overall HRQoL and greater levels of sexual dysfunction. LIMITATIONS, REASONS FOR CAUTION: The cross-sectional nature of the data precludes direct findings of causality and further longitudinal research is recommended. The information pertaining to engagement in laparoscopic surgery was self-report in nature and was not medically verified. WIDER IMPLICATIONS OF THE FINDINGS: The study's findings highlight the pervasive impact of endometriosis on all domains of living, emphasizing the need to extend treatment planning beyond that of physical pain management alone. Early referral for assessment and management of sexual wellbeing is recommended prior to, and post-surgical intervention, with a focus on maintaining post-surgical changes, potentially reducing the need for multiple surgeries. STUDY FUNDING, COMPETING INTEREST(S): The study was not associated with research funding. Author CN reports grant funding from the Australian Government and Medical Research Future Fund (MRFF) and was a previous employee of CSL Vifor (formerly Vifor Pharma Pty Ltd). TRIAL REGISTRATION NUMBER: N/A.

Receptiveness to monkeypox vaccines and public health communication strategies among gay, bisexual and other men who have sex with men in Singapore: cross-sectional quantitative and qualitative insights.

OBJECTIVES: Monkeypox (mpox) was declared as a global health emergency by the WHO, with most reported cases disproportionately involving gay, bisexual and other men who have sex with men (GBMSM). This study explored the willingness of Singaporean GBMSM to receive mpox vaccines and engage in changes to sexual behaviour, and analysed the factors influencing both decisions. METHODS: An online cross-sectional study was disseminated through community groups and Grindr from September to October 2022 among GBMSM in Singapore, where we surveyed respondents' demographics, stigma associated with mpox, perceived risks of sexually transmitted infections (STIs) and changes to sexual behaviours in response to mpox. Descriptive statistics and multivariable linear and logistics regression analyses, as well as thematic analysis of data, were also conducted. RESULTS: 237 GBMSM community members responded to the survey, with the majority being receptive to vaccine and 67.5% indicating changes to sexual behaviour in view of rising mpox infections. Predictors of vaccine receptivity among GBMSM included self-perceived mpox risk (adjusted OR (aOR)=0.44, 95% CI 0.07, 0.82) and self-perceived STI risk (aOR=0.39, 95% CI 0.03, 0.76). Predictors for changes to sexual behaviour included self-perceived mpox stigma (aOR=1.17, 95% CI 1.08, 1.27), self-perceived mpox risk (aOR=1.22, 95% CI 1.03,1.44), age (aOR=0.96, 95% CI 0.93, 1.00) and race (aOR=0.31, 95% CI 0.10, 0.93). In the thematic analysis, respondents raised concerns about vaccine effectiveness, side effects, cost and privacy. CONCLUSIONS: Our findings suggest that the rise in mpox infections have prompted changes to GBMSM's sexual practices. In general, GBMSM are willing to receive the mpox vaccine but are concerned about the physical and social consequences of uptake. These concerns should be addressed when vaccines are released.

The Society of General Internal Medicine's Recommendations to Improve LGBTQ + Health.

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ +) individuals experience bias in healthcare with 1 in 6 LGBTQ + adults avoiding healthcare due to anticipated discrimination and overall report poorer health status compared to heterosexual and cisgendered peers. The Society of General Internal Medicine (SGIM) is a leading organization representing academic physicians and recognizes that significant physical and mental health inequities exist among LGBTQ + communities. As such, SGIM sees its role in improving LGBTQ + patient health through structural change, starting at the national policy level all the way to encouraging change in individual provider bias and personal actions. SGIM endorses a series of recommendations for policy priorities, research and data collection standards, and institutional policy changes as well as community engagement and individual practices to reduce bias and improve the well-being and health of LGBTQ + patients.

Threats to social safety and neuro-inflammatory mechanisms underlying sexual orientation disparities in depression symptom severity: A prospective cohort study of young adults.

Sexual minority individuals have a markedly elevated risk of depression compared to heterosexuals. We examined early threats to social safety and chronically elevated inflammation as mechanisms contributing to this disparity in depression symptoms, and compared the relative strength of the co-occurrence between chronic inflammation and depression symptoms for sexual minorities versus heterosexuals. To do so, we analyzed data from a prospective cohort of sexual minority and heterosexual young adults (n = 595), recruited from a nationally representative sample, that included assessments of early threats to social safety in the form of adverse childhood interpersonal events, three biomarkers of inflammation (i.e., CRP, IL-6, TNF-α) measured at two time points, and depression symptoms over four years. In pre-registered analyses, we found that sexual minorities experienced more adverse childhood interpersonal events, were more likely to display chronically elevated inflammation, and reported more severe depression symptoms than heterosexuals. Adverse childhood interpersonal events and chronically elevated inflammation explained approximately 23 % of the total effect of the association between sexual orientation and depression symptom severity. Further, there was an increased coupling of chronically elevated inflammation and depression symptoms among sexual minorities compared to heterosexuals. These results provide novel longitudinal, population-based evidence for the role of chronically elevated inflammation in linking threats to social safety during childhood with depression symptom severity in young adulthood, consistent with the primary tenets of the social signal transduction theory of depression. Our study extends this theory to the population level by finding that members of a stigmatized population (i.e., sexual minorities) experience a greater risk of depression because of their greater exposure to adverse childhood interpersonal events and the subsequent link to chronic inflammation, highlighting potential biopsychosocial intervention targets.

The role of exogenous testosterone and social environment on the expression of sociosexuality and status-seeking behaviors in young Chilean men.

Testosterone plays an important role as a social hormone. Current evidence suggests that testosterone is positively related to sociosexuality increasing the psychological attitudes toward investing in short-term versus long-term mating and promotes status-seeking behaviors both by dominance and prestige. In addition, the social environment may play an important role in the expression of mating effort through changes in sociosexuality and status-seeking behaviors. However, the causal relationships among the mentioned variables are still debated. We employed a double-blind, placebo-controlled within-individual design, in order to test and integrate the proposed causal relationships between testosterone and social environment over short-term and long-term mating orientation and dominant and prestigious status-seeking behaviors in a sample of 95 young Chilean men. We did not find evidence that the administration of exogenous testosterone increased short-term or decreased long-term mating orientation as expected. Moreover, exogenous testosterone did not affect either aggressive or cooperative behavior failing to support the social status hypothesis. We also did not find any relationship between short or long-term mating orientation with status-seeking behaviors. Finally, we found support for the effect of social environment on sociosexual attitudes but not over status-seeking behaviors. Thus, men reported higher levels of short-term mating orientation in the presence of a woman compared to a man and no differences were found for long-term mating orientation. We argue that sociosexuality may be expressed flexibly, but contextual factors such as the presence of women seem more important than changes in testosterone levels.

Ovulatory cycle shifts in human motivational prioritisation of sex and food.

Previous research on the endogenous effects of ovarian hormones on motivational states in women has focused on sexual motivation. The Motivational Priority Shifts Hypothesis has a broader scope. It predicts a shift from somatic to reproductive motivation when fertile. In a highly powered preregistered online diary study across 40 days, we tested whether 390 women report such an ovulatory shift in sexual and eating motivation and behaviour. We compared 209 naturally cycling women to 181 women taking hormonal contraceptives (HC) to rule out non-ovulatory changes across the cycle as confounders. We found robust ovulatory decreases in food intake and increases in general sexual desire, in-pair sexual desire and initiation of dyadic sexual behaviour. Extra-pair sexual desire increased mid-cycle, but the effect did not differ significantly in HC women, questioning an ovulatory effect. Descriptively, solitary sexual desire and behaviour, dyadic sexual behaviour, appetite, and satiety showed expected mid-cycle changes that were diminished in HC women, but these failed to reach our strict preregistered significance level. Our results provide insight into current theoretical debates about ovulatory cycle shifts while calling for future research to determine motivational mechanisms behind ovulatory changes in food intake and considering romantic partners' motivational states to explain the occurrence of dyadic sexual behaviour.

Longitudinal changes in sexual desire and attraction among women who started using the Natural Cycles app.

Many women experience sexual side effects, such as decreased libido, when taking hormonal contraceptives (HCs). However, little is known about the extent to which libido recovers after discontinuing HCs, nor about the timeframe in which recovery is expected to occur. Given that HCs suppress the activities of multiple endogenous hormones that regulate both the ovulatory cycle and women's sexual function, resumption of cycles should predict libido recovery. Here, using a combination of repeated and retrospective measures, we examined changes in sexual desire and partner attraction (among partnered women) across a three-month period in a sample of Natural Cycles users (Survey 1: n = 1596; Survey 2: n = 550) who recently discontinued HCs. We also tested whether changes in these outcomes coincided with resumption of the ovulatory cycle and whether they were associated with additional factors related to HC use (e.g., duration of HC use) or relationship characteristics (e.g., relationship length). Results revealed that both sexual desire and partner attraction, on average, increased across three months after beginning to use Natural Cycles. While the prediction that changes in sexual desire would co-occur with cycle resumption was supported, there was also evidence that libido continued to increase even after cycles resumed. Together, these results offer new insights into relationships between HC discontinuation and women's sexual psychology and lay the groundwork for future research exploring the mechanisms underlying these effects.

Hormonal and cycle phase predictors of within-women shifts in self-perceived attractiveness: Tests of alternative functional models.

Prior research has produced mixed findings regarding whether women feel more attractive during the fertile phase of the menstrual cycle. Here, we analyzed cycle phase and hormonal predictors of women's self-perceived attractiveness (SPA) assessed within a daily diary study. Forty-three women indicated their SPA, sexual desire, and interest in their own partners or other potential mates each day across 1-2 menstrual cycles; saliva samples collected on corresponding days were assayed for estradiol, progesterone, and testosterone; and photos of the women taken at weekly intervals were rated for attractiveness. Contrary to some prior studies, we did not find a significant increase in SPA within the estimated fertile window (i.e., cycle days when conception is possible). However, within-cycle fluctuations in progesterone were significantly negatively associated with shifts in SPA, with a visible nadir in SPA in the mid-luteal phase. Women's sexual desire and SPA were positively associated, and the two variables fluctuated in very similar ways across the cycle. Third-party ratings of women's photos provided no evidence that women's SPA simply tracked actual changes in their visible attractiveness. Finally, for partnered women, changes in SPA correlated with shifts in attraction to own partners at least as strongly as it did with shifts in fantasy about extra-pair partners. Our findings provide preliminary evidence for the idea that SPA is a component of women's sexual motivation that may change in ways similar to other hormonally regulated shifts in motivational priorities. Additional large-scale studies are necessary to test replication of these preliminary findings.

Mode of delivery and subsequent self-perceived sexual life satisfaction: a population-based cohort study.

BACKGROUND: The potential association between mode of obstetrical delivery and subsequent sexual outcomes of the birthing parent remains uncertain and has not been well investigated from the perspective of positive sexual life satisfaction. OBJECTIVE: This study aimed to investigate if there was any association between mode of delivery and subsequent sexual life satisfaction of the birthing parent. A secondary aim was to assess the extent to which this association changed when stratified by time elapsed since delivery. STUDY DESIGN: The study matched participants in the Stockholm Public Health Cohort with deliveries recorded in the Swedish Medical Birth Register. Any deliveries recorded in the registry before the participation in the Stockholm Public Health Cohort were included (n=46,078). The length of time from delivery to outcome assessment varied from 1 month to 41 years (mean, 18 years [±10.8]). Mode of delivery was retrieved from the same registry, whereas self-perceived sexual life satisfaction was retrieved from the Stockholm Public Health Cohort Questionnaires where participants had assessed their sexual life satisfaction as 1 out of 5 mutually exclusive options. Multinomial logistic regression was used to test for any association between mode of delivery (cesarean, instrumental, and spontaneous vaginal delivery) and sexual life satisfaction, both overall and stratified by time elapsed since delivery. RESULTS: After adjusting for covariates, no statistically significant (P < .05) difference in subsequent sexual life satisfaction of the birthing parent between modes of delivery was identified. Adjusted odds ratios for assessing sexual life satisfaction as the lowest level ("very unsatisfactory") were 1.11 (95% confidence interval, 0.98-1.25) for cesarean delivery and 1.16 (95% confidence interval, 0.99-1.35) for instrumental delivery, compared with spontaneous vaginal delivery. The difference in covariate-adjusted prevalence of the lowest level of sexual life satisfaction among the different groups categorized by time since delivery was small: 4.0% (95% confidence interval, 2.4%-5.6%) for cesarean delivery as opposed to 2.8% (95% confidence interval, 2.1%-3.6%) for spontaneous vaginal delivery within 2 years since delivery. CONCLUSION: These findings do not support any impact of mode of delivery on the subsequent self-perceived sexual life satisfaction among birthing people, either overall or across different time periods since delivery.

Trajectories of Mental Distress Among US Women by Sexual Orientation and Racialized Group During the First Year of the COVID-19 Pandemic.

Objectives. To describe longitudinal trends in the prevalence of mental distress across the first year of the COVID-19 pandemic (April 2020‒April 2021) among US women at the intersection of sexual orientation and racialized group. Methods. Participants included 49 805 cisgender women and female-identified people from the COVID-19 Sub-Study, a cohort of US adults embedded within the Nurses' Health Studies 2 and 3 and the Growing Up Today Study. We fit generalized estimating equation Poisson models to estimate trends in depressive and anxiety symptoms by sexual orientation (gay or lesbian, bisexual, mostly heterosexual, completely heterosexual); subsequent models explored further differences by racialized group (Asian, Black, Latine, White, other or unlisted). Results. Relative to completely heterosexual peers, gay or lesbian, bisexual, and mostly heterosexual women had a higher prevalence of depressive and anxiety symptoms at each study wave and experienced widening inequities over time. Inequities were largest for sexual minority women of color, although confidence intervals were wide. Conclusions. The COVID-19 pandemic may have exacerbated already-glaring mental health inequities affecting sexual minority women, especially those belonging to marginalized racialized groups. Future research should investigate structural drivers of these patterns to inform policy-oriented interventions. (Am J Public Health. 2024;114(5):511-522. https://doi.org/10.2105/AJPH.2024.307601).

Psychosocial Syndemic Burden, Sexual Behaviors, and Engagement in HIV Prevention Care Among Sexual and Gender Minority Youths: United States, 2022.

Objectives. To examine linear and nonlinear associations between psychosocial syndemic factors and HIV risk and engagement in HIV prevention care among sexual and gender minority (SGM) youths. Methods. Between February and October 2022, we recruited 17 578 SGM youths aged 13 to 18 years in the United States for an online survey. We examined the relationship of syndemics (i.e., binge drinking, drug use, sexual victimization, and anti-lesbian, gay, bisexual, and transgender discrimination) with sexual behaviors (i.e., sexual initiation, condomless anal or vaginal sex, and number of sexual partners) and HIV prevention care (i.e., HIV testing, preexposure prophylaxis awareness and utilization) using regression. Results. Psychosocial syndemic burden (number of syndemic factors reported) was linearly and cubically associated with engagement in sexual behaviors. Psychosocial syndemic burden was linearly associated with higher HIV testing and preexposure prophylaxis awareness and cubically associated with higher preexposure prophylaxis utilization. Conclusions. Our findings are evidence of synergism across psychosocial syndemic factors regarding HIV risk and engagement in HIV prevention care among SGM youths in the United States. Public Health Implications. Multicomponent interventions may help reduce HIV risk and promote access to HIV prevention services among SGM individuals aged 13 to 18 years. (Am J Public Health. 2024;114(9):892-902. https://doi.org/10.2105/AJPH.2024.307753).

Pornography use, problematic pornography use, impulsivity, and sensation seeking: a meta-analysis.

BACKGROUND: While some individuals engage in recreational pornography use (PU), others may develop an uncontrolled pattern of use termed problematic pornography use (PPU). PPU is characterized by persistent, excessive, or compulsive engagement with pornographic content, despite distress and adverse consequences. Impulsivity has been identified as a factor associated with PU and PPU. AIM: The present meta-analysis aims to sum up the existing research on the relationship between impulsivity and PU/PPU and investigate whether age and gender could moderate this relationship. METHODS: A keyword-based systematic literature search was performed to identify articles that assessed PU/PPU and impulsivity. Extracted correlations were converted into Fisher's Z. Meta-regression analyses were also performed. Publication bias was assessed by Egger's regression intercept. OUTCOMES: Outcomes included general impulsivity and its dimensions (ie, negative and positive urgency, lack of premeditation and perseverance), sensation seeking, PU, and PPU. RESULTS: Meta-analytic results of the random effects model showed a significant positive correlation between impulsivity as total score and PU (n = 1504, k = 4, Fisher's Z = 0.21, P < .001) and PPU (n = 20174, k = 13, Fisher's Z = 0.17, P < .001). Significant and positive associations were also found between sensation seeking and PU (n = 11707, k = 11, Fisher's Z = 0.14, P < .001) and PPU (n = 20152, k = 9, Fisher's Z = 0.06, P < .001). Concerning the relationship between PPU and different dimensions of impulsivity, almost all the associations were significant and positive. The dimension of positive urgency and attentional and nonplanning impulsivity showed the strongest association. Age (ß = -0.50, Q = 101.26, df = 11, P < .001) and gender (female = 1; ß = -0.46, Q = 102.54, df = 12, P < .001) moderated the association between general impulsivity and PPU. No risk of publication bias emerged. CLINICAL IMPLICATIONS: Prevention programs of PPU should focus on impulsivity and certain key dimensions (eg, positive urgency, attentional and nonplanning impulsivity) and be tailored to individual impulsivity profiles, considering age and gender differences. STRENGTHS AND LIMITATIONS: The primary strength of this meta-analysis is that it considers various conceptualizations of impulsivity. However, the results are to be interpreted with caution since >30% of relevant studies had to be excluded because information could not be gathered from the study authors. CONCLUSION: These results suggest that general impulsivity is linked to PU and PPU and that specific dimensions of impulsivity (ie, attentional impulsivity, nonplanning impulsivity, and positive urgency) can serve as risk factors for PPU.

Genital self-image and sexual function in Iranian women from pregnancy to postpartum: a cohort study.

BACKGROUND: Genital self-image is among the factors affecting women's sexual function. AIM: The present study aimed to determine changes in the genital self-image and its relationship with women's sexual function in the third trimester of pregnancy and postpartum. METHODS: The participants of this prospective cohort study included 301 eligible pregnant women chosen through stratified random sampling with proportional allocation from comprehensive health centers in Gorgan, Iran. The Persian version of the 7-item Female Genital Self-Image Scale, the 6-item Female Sexual Function Index, and Depression Anxiety and Stress Scale 21 were filled in a self-report manner on 2 occasions: (1) 30 to 37 weeks of pregnancy and (2) 12 to 16 weeks (± 2 weeks) postpartum. Finally, the data were analyzed using SPSS 24 software. OUTCOMES: Outcomes included Female Genital Self-Image Scale and Female Sexual Function Index changes from pregnancy to postpartum according to the childbirth mode. RESULTS: The mean age of participants was 29.66 ± 5.27 years. These values for the genital self-image scores of women during pregnancy (19.18 ± 3.25) and postpartum (19.43 ± 3.57) were not significantly different (P = .30). Also, this difference was not statistically significant regarding the mode of delivery in 2 groups of women with vaginal birth (P = .62) and cesarean section (P = .14). The mean Female Sexual Function Index scores during pregnancy (15.15 ± 6.73) and postpartum (17.52 ± 6.46) were significantly different (P = .001). In addition, this difference was significant in women with vaginal birth (P = .004) and cesarean section (P = .001). CLINICAL IMPLICATIONS: Clinicians should inform women/couples about changes in female sexual function and address genital self-image as a factor involved in female sexual function during pregnancy and postpartum.Strengths and Limitations: Because the participants of this study were women in the third trimester of pregnancy, the obtained results may not be generalized to pregnant women in the first and second trimesters of pregnancy or even to different postpartum periods (ie, midterm and long term). CONCLUSION: The results showed that the female genital self-image is not significantly different during pregnancy and postpartum, or with the mode of delivery. However, the female sexual function score in postpartum is higher than in pregnancy, regardless of the mode of delivery.

Experiences of young women in the practice of squirting: a descriptive qualitative study.

BACKGROUND: While female ejaculation is viewed as a potential enhancer of women's sexual experiences and their relationships with their sexual partners, existing studies to date emphasize the need for further exploration of the squirting phenomenon. AIM: The study sought to explore experiences and perceptions about the phenomenon of squirting in young adult women. METHODS: A descriptive qualitative study was conducted. Semi-structured, in-depth interviews were conducted between December 2022 and March 2023. Seventeen young adult women who experienced squirting were recruited using a convenience and snowball sampling. ATLAS.ti v.9 software was used for a thematic analysis of the interview data. The study adhered to the recommendations for reporting qualitative research (Standards for Reporting Qualitative Research). OUTCOMES: The outcomes included (1) exploring factors influencing initial squirting experiences, (2) insights gained through squirting experiences, (3) communication as the cornerstone in sexual relationships, and (4) resources and sources for knowledge on the squirting phenomenon. RESULTS: After the analysis of the results, the following subthemes emerged: (1) first perceptions on squirting, (2) facilitating factors, (3) physical sensations and psychological aspects in squirting experience, (4) sources of information about squirting and (5) addressing squirting in comprehensive sex education. CLINICAL IMPLICATIONS: Frontline healthcare providers should undergo specific training to address anxiety related to squirting among certain individuals and enhance societal awareness while offering emotional support for diverse sexual response variations. STRENGTHS AND LIMITATIONS: Acknowledging limitations in our study of young women's experiences with squirting, a more diverse sample could provide alternative insights. Despite this, our findings contribute valuable knowledge, suggesting avenues for professional training to promote sexual and reproductive health in a more realistic and sensitive manner. CONCLUSION: This study explored the emotional and psychological effects of squirting on women's sexual experiences, ranging from heightened arousal to feelings of humiliation and embarrassment. It emphasized the importance of a partner's reaction in interpreting the event and the limited understanding of squirting, often influenced by pornography.

Sexual counseling for female sexual interest/arousal disorders: a randomized controlled trial based on the "good enough sex" model.

BACKGROUND: Female sexual interest/arousal disorder (FSIAD) is the most common female sexual disorder with adverse effects on women's health and interpersonal relationships. AIM: This survey evaluated the effects of sexual counseling based on the "good enough sex" (GES) model on the sexual health variables of women with FSIAD. METHODS: A randomized clinical trial with a 1:1 allocation ratio was conducted among 80 women with FSIAD in Iran in 2021. Eligible participants were randomly assigned to group A (women) and group B (couples). Women attended 4 weekly online group sexual counseling sessions based on the GES model, each lasting 120 minutes. In group B, husbands participated in sessions 2 and 3. OUTCOMES: Women's sexual health parameters-including sexual desire, sexual satisfaction, sexual function, sexual distress, sexual communication, frequency of sexual intercourse, and dysfunctional beliefs-were evaluated before and 3 months after counseling. The significance threshold considered P < .007 due to Bonferroni correction. RESULTS: After the intervention, all sexual parameters except sexual dysfunctional beliefs showed significant improvement (P < .001) in both groups. During the follow-up period, the average scores for all sexual variables were slightly higher in group B vs group A. The between-group difference was significant only for frequency of sexual intercourse (P < .01). CLINICAL IMPLICATIONS: This study reaffirms the impact of the GES model as biopsychosocial therapy in managing female sexual problems. Considering men's reluctance to accompany their wives to sex clinics, counseling for women alone can play a significant role in solving sexual problems, especially in the case of FSIAD. Online sexual consultation offers cost and time savings, provides a secure space for discussing sensitive topics, and facilitates group program coordination. It ensures universal access to counseling, thereby addressing gender incompatibility issues. It is a powerful, interactive, and acceptable alternative to in-person visits, providing convenience and confidentiality for clients seeking sexual health support. STRENGTHS AND LIMITATIONS: The following were among the survey strengths: conducting a randomized controlled trial on women with FSIAD by applying an appropriate model and scales, involving spouses, and evaluating online group sexual counseling. However, the results of this study may not be generalizable to women without partners. CONCLUSION: The GES model, emphasizing intimacy and sexual dialogue, reduces unrealistic sexual expectations and improves women's sexual desire and overall health. Our results showed that instead of insisting on the physical presence of husbands in counseling sessions, clinicians should emphasize their emotional support and companionship during the treatment process.

Early traumatic experiences are linked to hypersexual behavior and erectile dysfunction in men through the mediation of body uneasiness and general psychopathology.

BACKGROUND: Childhood traumatic experiences have been associated with hypersexuality and sexual dysfunctions. However, the mediators of the interactions between these variables should be clarified in men. AIM: This study aimed to investigate the interaction of early traumatic experiences, psychopathology, and sexuality with respect to erectile dysfunction (ED) and hypersexual behavior. The hypothesized model expected that traumatic experiences would be associated with hypersexual behavior and reduced sexual functioning through the mediation of body uneasiness and psychological distress. METHODS: The study was cross-sectional and observational. A total of 317 men were enrolled. Male patients with a primary complaint of ED and an indication for psychiatry referral represented the clinical sample (n = 116; mean ± SD age, 42.82 ± 16.89 years). Clinical classification was assessed with the Structured Interview on Erectile Dysfunction. The second sample (n = 201, 30.82 ± 11.94 years) was recruited from the general population. All participants were administered the following questionnaires: Brief Symptom Inventory, Childhood Trauma Questionnaire-Short Form, Hypersexual Behavior Inventory, Body Uneasiness Test-A, and 5-item International Index of Erectile Function. OUTCOMES: Psychopathology and sexual functioning were assessed by a dimensional approach, and a multivariate model was computed by structural equation model analysis. RESULTS: When compared with the sample from the general population, the clinical sample exhibited a higher prevalence of early traumatic experiences, as measured by scores on the Childhood Trauma Questionnaire-Short Form (45.08 ± 14.25 vs 39.03 ± 10.22, F = 17.63, P < .001), and a higher tendency to engage in hypersexual behaviors (34.63 ± 13.55 vs 30.79 ± 12.44, F = 6.97, P < .01). Structural equation model analysis showed excellent fit indices indicating that early traumatic experiences predicted hypersexual behaviors and ED through the exacerbating mediating effect of body uneasiness and psychopathology. CLINICAL IMPLICATIONS: Clinicians should not limit their attention to the behavioral level when assessing sexual dysfunction in men; rather, they should also consider the complex psychopathologic consequences of childhood trauma. Integrated treatments that address the potential presence of childhood trauma with its wider psychological correlates (eg, emotion dysregulation, body uneasiness) might improve treatment response. STRENGTHS AND LIMITATIONS: The study reports novel data on the relationship among childhood maltreatment, male sexuality, and psychopathologic mediators with a dimensional assessment. However, the assessment was cross-sectional, and causality was mainly derived from previous studies. CONCLUSION: The present study enriches the current literature, strengthening the hypothesis that childhood traumatic experiences significantly shape development and sexuality. Body uneasiness and psychopathology can both tax sexual functioning, as assessed by erectile functioning or hypersexuality.

Trajectories of sexual well-being and links with grief after a recent pregnancy loss: a dyadic longitudinal study.

BACKGROUND: Pregnancy loss affects 1 in 4 women and is linked with poorer overall health and relationship outcomes. Despite sexual well-being's importance to health, how sexual well-being changes across time after a pregnancy loss and what might predict such changes, like perinatal grief, have never been examined, leaving practitioners and couples without knowledge of what to expect. AIM: We aimed to examine (1) how sexual satisfaction, sexual desire, sexual distress, and perinatal grief change from 10 to 25 weeks postloss for both couple members; and (2) if perinatal grief levels at 10 weeks postloss predict sexual well-being trajectories. METHODS: Women and gender-diverse individuals who were pregnant when a pregnancy loss occurred (within the last 4 months) and men, women, and gender-diverse partners who were not pregnant (N = 132 couples) independently completed 4 monthly assessments of sexual well-being and perinatal grief. OUTCOMES: Outcomes included sexual satisfaction (Global Measure of Sexual Satisfaction), sexual desire (Sexual Desire Inventory), sexual distress (Sexual Distress Scale-Short Form), perinatal grief (Perinatal Grief Scale). RESULTS: Dyadic growth curve modeling indicated that, from 10 to 25 weeks postloss, both couple members' sexual satisfaction increased, and their sexual desire remained stable; sexual distress decreased for partners but remained stable for individuals who were pregnant; and both couple members' perinatal grief decreased. Perinatal grief levels at 10 weeks postloss did not predict sexual well-being trajectories over time. CLINICAL IMPLICATIONS: Given sexual well-being's dynamic nature, clinicians should regularly discuss sexuality with both couple members after pregnancy loss. During such discussions, clinicians could reassure couples about their sexual relationship's recovery by sharing that, on average, sexual satisfaction, sexual desire, and sexual distress tend to improve or stay the same (rather than worsen) from 10 to 25 weeks postloss. They can also share that perinatal grief tends to decrease during this time and is unrelated to trajectories of sexual satisfaction, sexual desire, and sexual distress. STRENGTHS AND LIMITATIONS: This is the first study, to our knowledge, to examine how sexual well-being changes across time after a pregnancy loss and perinatal grief's role in such changes. The results may not generalize broadly, as most couples were in mixed-gender/sex relationships, identified as White, and were relatively affluent. CONCLUSION: From 10 to 25 weeks postloss, both couple members tend to experience improvements in their overall sexual well-being and declines in their perinatal grief. Early perinatal grief levels and subsequent sexual well-being trajectories are seemingly unrelated.

Age-specific reference scores for the PISQ-12 on female sexual functioning in the Netherlands: a retrospective population-based survey.

BACKGROUND: Female sexual dysfunction is common in the general population, with age emerging as a significant determinant of sexual activity and functioning. AIM: To establish age-specific reference scores for the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in the general Dutch female population. METHODS: A retrospective, cross-sectional, questionnaire-based study was conducted in the Netherlands. The study population comprised 2518 Dutch-speaking women aged ≥18 years, representing a cross section of the general Dutch population. The PISQ-12 was used to assess sexual functioning in heterosexual women. The Groningen Defecation and Fecal Continence questionnaire was utilized to demonstrate demographic factors. OUTCOMES: We established age-specific reference scores for the PISQ-12 in the general Dutch population. RESULTS: Of the 2518 women, 1592 (63.2%) were sexually active and 926 (36.8%) were not. Further analysis focused on the sexually active group: we found a decrease in mean total PISQ scores, ranging from 38.34 among 18- to 34-year-olds to 36.98 among ≥65-year-olds. Older women scored lower in the behavior domain, specifically pertaining to sexual desire (P < .001) and sexual excitement (P < .001). They also had lower scores in the partner-related domain regarding partner problems of erection (P < .001) and orgasm perception (P < .001). With increasing age, negative emotional reaction scores were higher (P < .001). In the physical domain, we observed significantly different scores for pain during sexual intercourse (P < .001) and restrictions in sexual activity due to fear of urinary leakage (P < .001), with the lowest scores in the youngest group. CLINICAL IMPLICATIONS: These age-specific references scores of the PISQ-12 provide an overview of sexual functioning of a general population, which enables caregivers to assess and interpret patients' individual scores more accurately. STRENGTHS AND LIMITATIONS: We included only sexually active women in our subanalyses, potentially introducing selection bias for older women with better physical conditions. The study's strength lies in its extensive sample size, representing a cross section of the general Dutch population. Furthermore, the self-administered questionnaire approach helped minimize embarrassment and obtain realistic responses. CONCLUSION: Our study demonstrated age-specific PISQ-12 reference scores and highlighted associations between aging and diminishing scores of sexual desire, sexual excitement, erection problems, and orgasm perception, while women aged 18 to 34 years reported the lowest scores for pain during intercourse and limited sexual activity due to fear of urinary leakage.