Women Reporting on Their Use of Pornography: A Qualitative Study Exploring Women's Perceived Precursors and Perceived Outcomes.

The aim of this study was to explore motivations women describe for using pornography. A qualitative online interview study was conducted with 30 women (Mean age 30.23, range 20-47; residing in the UK and in Greece; of varied sexual orientations and relationship status) about their pornography use, motivations for use, and preferences. Reflexive thematic analysis was used. Results were organized into four themes: Sexual Precursors, Non-sexual Precursors, Intended Outcomes, and Unintended Outcomes. The findings highlight that pornography use for women can have both positive and negative ramifications for women's sexual lives. Implications for clinical practice and education are discussed.

The impact of Chatbot-Assisted Self Assessment (CASA) on intentions for sexual health screening in people from minoritised ethnic groups at risk of sexually transmitted infections.

Background Sexually transmitted infections (STIs) present a significant global public health issue, with disparities in STI rates often observed across ethnic groups. The study investigates the impact of Chatbot-Assisted Self Assessment (CASA) on the intentions for sexual health screening within minoritised ethnic groups (MEGs) at risk of STIs as well as the subsequent use of a chatbot for booking STI screening. Methods A simulation within-subject design was utilised to evaluate the effect of CASA on intentions for STI/HIV screening, concern about STIs, and attitudes towards STI screening. Screening intentions served as the dependent variable, while demographic and behavioural factors related to STI/HIV risk were the independent variables. ANCOVA tests were conducted to measure the impact of CASA on these perceptions. Results Involving 548 participants (54% women, 66% black, average age=30years), the study found that CASA positively influenced screening intentions t (547)=-10.3, P t (544)=-4.96, P t (543)=-4.36, P Conclusion CASA increased motivations for STI screening intentions among ethnically diverse communities. The intervention's non-judgemental nature and the chatbot's ability to emulate sexual history-taking were critical in fostering an environment conducive to behavioural intention change. The study's high acceptability indicates the potential for broader application in digital health interventions. However, the limitation of not tracking actual post-intervention behaviour warrants further investigation into CASA's real-world efficacy.

Three-site screening for STIs in men who have sex with men using online self-testing in an English sexual health service.

OBJECTIVES: Among men who have sex with men (MSM) in the UK,Chlamydia trachomatis (CT) and Neisseria gonorrhoea (NG) infections commonly occur asymptomatically at extragenital sites. Therefore, MSM seeking sexual health services are offered three-site (oropharyngeal, rectal and urogenital) STI screening. To increase access to screening, some UK sexual health services enable asymptomatic service users to order free STI screening kits online for self-sampling at home. We sought to assess prevalence of overall and extragenital CT/NG infection among asymptomatic MSM who used online self-testing in Hampshire, UK. METHODS: We assessed prevalence of CT/NG infections from non-pooled samples among asymptomatic cisgender MSM using an administrative database with results from 5601 STI screening kits returned between 20 December 2016 and 31 January 2020. We compared number of diagnoses of extragenital infection with urogenital results of the same individuals to determine prevalence of infection that would have been missed with urine testing alone. RESULTS: Among 5051 valid CT and 5040 valid NG asymptomatic test results, overall prevalence was 5.9% (298/5051) and 4.5% (228/5040), respectively. Among MSM with asymptomatic CT, 71.8% (214/298) had extragenital infection only, χ2 (1, n=298)=56.71, p<0.001. Among those with asymptomatic NG, 89.9% (205/228) had extragenital infection only, χ2 (1, n=228)=145.281, p<0.001. CONCLUSIONS: Overall, most CT/NG infections among asymptomatic MSM who used online self-testing were extragenital. Given this and the likelihood of onward transmission from asymptomatic infection, it is recommended that three-site testing remain standard for MSM and free screening services be expanded in easily accessible ways.

Prevalence of Masturbation and Associated Factors Among Older Adults in Four European Countries.

Solitary sexual activity is a free, safe, and accessible way to experience sexual pleasure. Despite these advantages, research on masturbation in later life is highly understudied. Using data from a cross-sectional probability-based survey of 3816 European adults (mean age 67 years; range 60-75 years), we explored several sociodemographic, health, attitudinal, and sexual behavioral factors associated with reported masturbation frequency. Across all countries, between 41% and 65% of men and 27% and 40% of women reported any masturbation in the preceding month. Satisfaction with sexual activity and attitudes related to disapproval of sex without love were significant predictors of reported masturbation in almost all countries and in both genders. Age, education, self-perceived health, and depression were for the most part predictive of men's reported masturbation, but not women's. Generally, those believing sex is beneficial to older people were more likely to masturbate, while less permissive attitudes decreased the likelihood of reporting masturbation. To improve healthy sexual aging, misinformation about masturbation and sexual attitudes in older people need to be addressed.

Exploring structure/property relationships to health and environmental hazards of polymeric polyisocyanate prepolymer substances-2. Dermal sensitization potential in the mouse local lymph node assay.

The sensitization potencies of twenty custom-designed monomer-depleted polymeric polyisocyanate prepolymer substances and their associated toluene diisocyanate (TDI), methylene diphenyl diisocyanate (MDI), hexamethylene diisocyanate (HDI), and isophorone diisocyanate (IPDI) monomer precursors were investigated by means of the mouse Local Lymph Node Assay (LLNA). These polymeric prepolymers were designed to represent the structural features and physical-chemical properties exhibited by a broad range of commercial polymeric polyisocyanate prepolymers that are produced from the reaction of aromatic and aliphatic diisocyanate monomers with aliphatic polyether and polyester polyols. The normalization of LLNA responses to the applied (15-45-135 mM) concentrations showed that the skin sensitization potency of polymeric polyisocyanate prepolymers is at least 300 times less than that of the diisocyanate monomers from which they are derived. The sensitization potency of the prepolymers was shown to be mainly governed by their hydrophobicity (as expressed by the calculated octanol-water partition coefficient, log Kow) and surfactant properties. Neither hydrophilic (log Kow <0) nor very hydrophobic (log Kow >25) prepolymers stimulated lymphocyte proliferation beyond that of the dosing vehicle control. The findings of this investigation challenge the generally held assumption that all isocyanate (-N=C=O) bearing substances are potential skin (and respiratory) sensitizers. Further, these findings can guide the future development of isocyanate chemistries and associated polyurethane applications toward reduced exposure and health hazard potentials.

Women in Relationships and Their Pornography Use: A Systematic Review and Thematic Synthesis.

A systematic review and thematic synthesis were conducted on the motivations, purposes, and influence of pornography use among women who are in committed relationships. Pornography use was identified as having both positive and negative outcomes for women's sexual and relationship lives. Women watched pornography for diverse reasons: to feel sexually empowered, to enhance sexual arousal, and for masturbation purposes. Shared use of pornography with partners provided variety in sexual activities, could aid communication about sexual issues and helped improve intimacy. Pornography use can help some women feel sexually empowered, relaxed and better able to enjoy their sexual lives.

Emotional Intimacy and Distress About Sexual Difficulties in Partnered Older European Men and Women: A Network Analysis.

Although research in older individuals' sexual health is steadily increasing, the nature of, and predictors related to, their distress about changes in sexual function have not been well-studied. Using data from sexually active and partnered 1,047 Norwegian and Danish women and men aged 60-75 years, this study employed network analysis to explore the structure of older individuals' sexual distress and the role of emotional intimacy. Men's network of sexual distress facets was more densely interconnected than women's network. Higher emotional intimacy was associated with lower sexual distress levels across gender. The findings have implications for sexual health interventions targeting older people.

What Does Research Tell Us About Women's Experiences, Motives and Perceptions of Masturbation Within a Relationship Context?: A Systematic Review of Qualitative Studies.

This systematic review provides an overview of what qualitative research has revealed about partner-related factors around women's masturbation and explores how these factors relate to women's behavior, perceptions, and motives toward masturbation. Eleven studies were identified and secondary thematic analysis was used for synthesis. Women's perceptions often focus on the (potential) negative influences of masturbation on current or future relationships. Motivations some women reported for masturbating due to partner-related factors were diverse. Findings suggested that some women modify their masturbation behavior when in a relationship. The implications of these findings for sexual health educators and clinicians are discussed.

Prevalence and Predictors of Sexual Difficulties and Associated Distress Among Partnered, Sexually Active Older Women in Norway, Denmark, Belgium, and Portugal.

There has been little comparative, cross-cultural research on sexual difficulties and associated distress, and factors associated with these, among older women. Therefore, the aim of this study was to investigate prevalence rates of sexual difficulties, distress related to these difficulties, and associated sociodemographic, relational, and health factors, among sexually active older women (60-75 years) in committed relationships across four European countries (Norway, Denmark, Belgium, and Portugal). These data could inform us about what differentiates women who do and do not experience distressing sexual difficulties and facilitate the identification of older women who might benefit from clinical interventions as well as the development of new interventions. In total, 1057 women (357 Norwegian; 322 Danish; 237 Belgian; 141 Portuguese) completed a cross-sectional questionnaire assessing six sexual difficulties-vaginal dryness, orgasmic difficulties, lacking interest in sex, lacking enjoyment in sex, pain during sex, and no excitement/arousal during sex-and associated distress. We found a high prevalence of sexual difficulties lasting 3 months or longer in the past year (between 23.5 and 50.2%, depending on the specific difficulty). With the exception of vaginal dryness and pain during sex, however, the majority of women reporting sexual difficulties (50.0% to 86.1%, depending on the specific difficulty) reported no or mild distress. There were relatively few cross-country differences, either in the prevalence of sexual difficulties or related distress. Few sociodemographic or health variables were associated with distressing sexual difficulties, but higher sexual intimacy, higher emotional intimacy, and better mental health were associated with less distress about some sexual difficulties. The findings underline the importance of healthcare professionals asking older women about sexual function and especially associated distress, and suggest that careful attention to the psychological and relationship context of these sexual difficulties is needed, as these could be important targets in the treatment process.

Perceived barriers and facilitators to female condoms among UK based healthcare professionals.

OBJECTIVES: The female condom (FC) is an effective strategy against sexually transmitted infections (STIs) in susceptible women and men who have sex with men. FCs are the only female-initiated dual protection method that protects against both STIs and unintended pregnancy. As healthcare professionals (HCPs) are a key element in the promotion of contraceptive use, it is important to examine attitudes towards FCs among this group. Study participants: 15 male and female HCPs aged between 22 and 57 years recruited from sexual and reproductive health settings located in Brighton, London, and Glasgow. Sampling method: Purposive sampling with targeted advertisements (newsletters and bulletins). Study design: face-to-face and telephone interviews with sexual health HCPs. Main outcome measure: potential barriers and facilitators to FCs in the UK. Data were analysed thematically to identify common views and perspectives. RESULTS: FCs were thought to be unacceptable to most women due to stigma, design, negative visual appeal, insertion difficulties and lack of familiarity. The perceived unavailability and higher cost of FCs, in comparison to male condoms, are major barriers to their use. CONCLUSIONS: HCPs are reluctant to promote FCs, often due to the perceived social stigma surrounding FCs. Further education and promotion are needed to increase acceptability and correct usage. Future research needs to explore strategies to increase the acceptability of FCs among women, men who have sex with men and HCPs.

Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries.

BACKGROUND: Among older men, comparable cross-cultural investigations of sexual problems and associated distress that also include a multitude of relevant explanatory variables of these sexual problem and related distress are rare in the research literature. AIMS: To investigate prevalence rates of sexual problems and associated distress among older men across 4 European countries (Norway, Denmark, Belgium, and Portugal) and assess for associated mental and physical health-related factors. METHODS: Multinational cross-sectional questionnaire study using self-report measures. OUTCOMES: Prevalence rates of sexual problems and associated distress levels. RESULTS: We found a high prevalence of sexual problems persisting for months or longer across countries, but noted that many affected men experienced minimal or no distress related to these problems. We also found marked cross-cultural differences in reported distress about sexual problems, with southern European men (ie Portugal) reporting significantly more distress related to the majority of sexual problems investigated compared with northern European men (ie Denmark and Norway). Finally, we identified several relational, physical, and mental health problems associated with the reported number of sexual problems and the distress related to these problems. CLINICAL IMPLICATIONS: We suggest that healthcare professionals also target distress when considering sexual problems among older men and contextualize these considerations within a multifactorial approach to general health in which (other) mental and physical health factors relevant to these patients' sexual health and function are also jointly considered. STRENGTHS & LIMITATIONS: Strengths of this study include the large sample size, inclusion of participants from 4 European countries, assessment of distress associated with sexual problems, and similar research design and method of data collection across the 4 included countries. Limitations of the study include the cross-sectional design, which precludes causal conclusions; the low response rate in the Portuguese sample; the lack of homosexual participants; and the lack of comprehensive assessments of dyadic factors that may be of relevance to sexual problems and associated distress. CONCLUSION: This study identified a high prevalence of sexual problems persisting for 3 months or longer among older men across 4 European countries, but also found that many of the men with sexual problems experienced minimal or no distress related to these problems. G.M. Hald, C. Graham, A. Stulhofer, et al. Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries. J Sex Med 2019;16:1212-1225.

Relationship Quality and Perceived Partner's Body Appreciation Is Related to Women's Own Body Appreciation and Sexual Functioning.

Research on body appreciation is limited, especially when examining its relationship to sexual functioning. The aim of this study was to explore the relationship between body appreciation and sexual functioning, while measuring perceived partner's body appreciation and general relationship quality. A sample of 244 women aged 18 to 30 completed measures of sexual functioning, relationship quality, and body image online. General relationship quality and perceived partner's appreciation of one's body predicted levels of sexual functioning. Levels of body appreciation did not predict sexual functioning over and above general relationship quality and perceived partner's appreciation of one's body. This study is the first to demonstrate the significance of general relationship quality and perceived partner's body appreciation in relation to levels of body appreciation and sexual functioning. The findings highlight the importance of understanding body appreciation and its role in buffering the harmful impacts of viewing idealized images within the media.

Sexual Activity and Sexual Satisfaction Among Older Adults in Four European Countries.

The aim of this article was to describe partnered and non-partnered sexual activity and sexual satisfaction in older men and women from Norway, Denmark, Belgium, and Portugal, and to explore sociodemographic correlates of sexual activity and satisfaction. Data were collected in 2016 using postal, anonymous questionnaires in probability samples of the population aged 60-75 years recruited by phone registers in Norway (676 men, 594 women), Denmark (530 men, 515 women), Belgium (318 men, 672 women), and Portugal (236 men, 273 women). In men, the percentage of sexually active participants in the past year ranged from 83% in Portugal to 91% in Norway. In women, the percentage of sexually active participants during the last year ranged from 61% in Belgium to 78% in Denmark. Regarding frequency of sexual intercourse activity during the past month, men in Norway, Denmark, and Belgium (23-24%) most often reported 2-3 times per month, whereas most men in Portugal (29%) reported 1-3 times per week. Masturbation was most commonly reported among Norwegian men (65%) and women (40%), and least commonly in Portugal. Concerning sexual satisfaction, across all countries, 40-60% of participants reported that they were sexually satisfied. Portuguese men and Danish women reported being most sexually satisfied. Having a partner was the most important positive predictor of sexual activity and sexual satisfaction in all subgroups except Portuguese men. In conclusion, partnered sexual activity was more frequent in the south of Europe, and solitary sexual activity more frequent in Northern Europe.

Informing Adults With Back Pain About Placebo Effects: Randomized Controlled Evaluation of a New Website With Potential to Improve Informed Consent in Clinical Research.

BACKGROUND: Placebo effects and their underpinning mechanisms are increasingly well understood. However, this is poorly communicated to participants in placebo-controlled trials. For valid informed consent, participants should be informed about the potential benefits and risks of participating in placebo-controlled trials. Existing information leaflets often fail to describe the potential benefits and adverse effects associated with placebo allocation. This study tested the effects of a new website designed to inform patients about placebo effects (The Power of Placebos, PoP). PoP was designed using qualitative methods in combination with theory- and evidence-based approaches to ensure it was engaging, informative, and addressed patients' concerns. OBJECTIVE: This study aimed to test the effects of PoP, compared with a control website, on people's knowledge about placebo and the ability to make an informed choice about taking part in a placebo-controlled trial. METHODS: A total of 350 adults with back pain recruited from 26 general practices in Southern England participated in this Web-based study. Participants were randomly assigned to PoP (which presented scientifically accurate information about placebo effects in an engaging way) or a control website (based on existing information leaflets from UK trials). Participants self-completed Web-based pre- and postintervention questionnaire measures of knowledge about placebo effects and preintervention questionnaire measures of attitudes toward and intentions to participate in a placebo-controlled trial. The 2 primary outcomes were (1) knowledge and (2) informed choice to take part in a placebo-controlled trial (computed from knowledge, attitudes, and intentions). RESULTS: After viewing PoP, participants had significantly greater knowledge about placebos (mean 8.28 [SD 1.76]; n=158) than participants who viewed the control (mean 5.60 [SD 2.24]; n=174; F1,329=173.821; P<.001; η2=.346). Participants who viewed PoP were 3.16 times more likely than those who viewed the control to make an informed choice about placebos (χ21=36.5; P<.001). CONCLUSIONS: In a sample of adults with back pain, PoP increased knowledge and rates of informed choice about placebos compared with a control website. PoP could be used to improve knowledge about placebo effects in back pain. After essential further development and testing in clinical trial settings, it could support informed consent in placebo-controlled trials.

Evidence for behavioural interventions addressing condom use fit and feel issues to improve condom use: a systematic review.

Continuing high rates of sexually transmissible infections (STIs) in many countries highlight the need to identify effective behavioural interventions. Consistent and correct use of male condoms is a key strategy for the prevention of STIs. However, some men report problems with condom fit (e.g. the size and shape of the condom) and feel (e.g. tightness, irritation, sensitivity), which inhibits their use. We conducted a systematic review to identify existing interventions addressing condom use fit and feel problems. We searched electronic databases for peer-reviewed articles and searched reference lists of retrieved studies. Five studies met the inclusion criteria. These were generally small-scale pilot studies evaluating behavioural interventions to promote safer sex with men aged under 30 years, addressing, among other things, barriers to condom use relating to fit and feel. There were significant increases in the reported use of condoms, including condom use with no errors and problems. Improvements in some condom use mediators were reported, such as condom use self-efficacy, knowledge, intentions and condom use experience. There were mixed findings in terms of the ability of interventions to reduce STI acquisition. Behavioural interventions addressing condom fit and feel are promising in terms of effectiveness but require further evaluation.

Corrigendum to: Decision making over condom use during menses to avert sexually transmissible infections.

Background:The aim of this study was to test the hypothesis that receptive partners in penile-vaginal intercourse (PVI) who exercise independent decision making over condom use during menses do so to avert sexually transmissible infection (STI) transmission or acquisition. Methods: Data were collected through a partnership with Clue, the industry-leading female health app. A brief web-based questionnaire was developed, translated into 10 languages, and made accessible via a URL link sent to Clue users and posted on social media. Inclusion criteria were: age ≥14 years, not being currently pregnant and engaging in PVI and condom use during menses in the past 3 months. The analytical subsample comprised 12889 respondents residing in 146 countries. Results: Twenty per cent indicated independent decision making about condom use during menses. Independent decision making was associated with lower odds of reporting that condoms were used for contraception (adjusted odds ratio (aOR) 0.65; 99% confidence interval (CI) 0.57-0.73) and higher odds that they were used for the prevention of STIs (aOR 1.44; 99% CI 1.28-1.61). A third significant finding pertained to always using condoms during menses; this was less likely among those indicating independent (female only) decision making (aOR 0.69; 99% CI 0.62-0.78). Non-significant associations with another two outcomes were found: protecting the partner against menstrual blood and protecting themselves against semen. Conclusions: Findings from people in 146 countries strongly support the hypothesis that those exercising independent decision making over condom use during menses do so to avert STI transmission or acquisition. That only one-fifth of this global sample reported this type of independent decision making suggests that empowerment-oriented (structural-level) interventions may be advantageous for individuals who are the receptive partner in PVI that occurs during menses.

Decision making over condom use during menses to avert sexually transmissible infections.

Background The aim of this study was to test the hypothesis that receptive partners in penile-vaginal intercourse (PVI) who exercise independent decision making over condom use during menses do so to avert sexually transmissible infection (STI) transmission or acquisition. METHODS: Data were collected through a partnership with Clue, the industry-leading female health app. A brief web-based questionnaire was developed, translated into 10 languages, and made accessible via a URL link sent to Clue users and posted on social media. Inclusion criteria were: age ≥14 years, not being currently pregnant and engaging in PVI and condom use during menses in the past 3 months. The analytical subsample comprised 12889 respondents residing in 146 countries. RESULTS: Twenty per cent indicated independent decision making about condom use during menses. Independent decision making was associated with lower odds of reporting that condoms were used for contraception (adjusted odds ratio (aOR) 0.65; 99% confidence interval (CI) 0.57-0.73) and higher odds that they were used for the prevention of STIs (aOR 1.44; 99% CI 1.28-1.61). A third significant finding pertained to always using condoms during menses; this was less likely among those indicating independent (female only) decision making (aOR 0.69; 99% CI 0.62-0.78). Non-significant associations with another two outcomes were found: protecting the partner against menstrual blood and protecting themselves against semen. CONCLUSIONS: Findings from people in 146 countries strongly support the hypothesis that those exercising independent decision making over condom use during menses do so to avert STI transmission or acquisition. That only one-fifth of this global sample reported this type of independent decision making suggests that empowerment-oriented (structural-level) interventions may be advantageous for individuals who are the receptive partner in PVI that occurs during menses.

Evaluation of the Condom Barriers Scale for Young Black Men Who Have Sex With Men: Reliability and Validity of 3 Subscales.

BACKGROUND: Reliable and valid scale measures of barriers to condom use are not available for young black men who have sex with men (YBMSM). The purpose of this study was to evaluate the Condom Barriers Scales for application with YBMSM. METHODS: A clinic-based sample of 600 YBMSM completed a computer-assisted self-interview. The primary measure was a 14-item abbreviated version of the Condom Barriers Scale. Reliability and criterion validity were assessed. RESULTS: All 3 subscales were reliable: partner-related barriers (Cronbach α=0.73), sensation-related barriers (α=0.70), and motivation-related barriers (α =0.81). A complete absence of barriers was common: 47.0% (partner-related), 30.7% (sensation-related), and 46.5% (motivation-related). Dichotomized subscales were significantly associated with reporting any condomless insertive anal sex (all Ps < 0.001) and any condomless receptive anal sex (all Ps < 0.001). The subscales were significantly associated with these measures of condomless sex preserved at a continuous level (all Ps <0.001, except for sensation barriers associated with condomless receptive anal sex = 0.03). Further, the subscales were significantly associated with reporting any condom use problems (all Ps <0.001) and a measure of condomless oral sex (all Ps <0.001, except for partner-related barriers=0.31). Finally, the sensation-related barriers subscale was significantly associated with testing positive for Chlamydia and/or gonorrhea (P=0.049). CONCLUSIONS: The 3 identified subscales yielded adequate reliability and strong evidence of validity, thereby suggesting the utility of these brief measures for use in observational and experimental research with YBMSM.

Sexual Excitation and Sexual Inhibition as Predictors of Sexual Function in Women: A Cross-Sectional and Longitudinal Study.

To date, no longitudinal studies have evaluated the predictive value of the two factors of the dual control model-sexual excitation (SE) and sexual inhibition (SI)-for future sexual function. The aims of the present study were to investigate the associations between SE/SI and sexual function and estimate their predictive value for future sexual function in a sample of women. Overall, 2,214 women participated in a web-based survey that assessed SE, SI, and sexual function as well as symptoms of depression. The one- and two-year follow-up surveys included 396 and 382 participants, respectively. Correlational analyses and hierarchical regression analyses were conducted to analyze the relationships between predictor and outcome variables. Four factors of SE (Arousability, Partner Characteristics, Sexual Power Dynamics, and Setting) and two factors of SI (Concerns about Sexual Function and Arousal Contingency), as well as symptoms of depression and partnership status, were significant predictors of concurrent and future sexual function. Several subscales of SE and SI contributed to the prediction of future sexual function above and beyond prior sexual function levels. Our study provides the first supportive evidence for the assumptions of the dual control model that propensities for low SE and high SI influence future sexual function.