Qualitative study exploring the experiences of sexual dysfunction in premenopausal women with type 1 diabetes.

AIMS: To explore the sexual experiences and interactions of women with type 1 diabetes to explicate an understanding of the impact of diabetes on women's sexual function. The study was conducted as part of a wider project to develop a patient-reported outcome measure to assess sexual dysfunction (SD) in premenopausal women with type 1 diabetes. METHODS: A qualitative study using face-to-face and virtual semi-structured interviews was conducted with premenopausal women with type 1 diabetes who have had some difficulties related to sexual functioning. Participants were recruited from two National Health Services (NHS) sites in the UK and from social media platforms. The data were analysed to generate themes using Framework Analysis approach. RESULTS: Eighteen women, aged 22-49, were interviewed (NHS sites n = 13; online n = 5). Five themes related to women experiences of SD were identified, these were; initiation of sexual activity, sexual confidence, sexual enjoyment, sexual engagement and sexual desire. CONCLUSIONS: SD in women with type 1 diabetes is a complex phenomenon impacting their experiences and quality of life. SD is related to multiple interacting biopsychosocial factors related to diabetes, including blood glucose levels, diabetes treatments, technologies and complications. A targeted measure of SD for women with type 1 diabetes specifically would allow for these factors to be assessed routinely in clinical care.

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.

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.

Overactive bladder negatively affects erectile function and promotes premature ejaculation: findings from large representative population-level study.

PURPOSE: The effect of overactive bladder (OAB) on sexual health has been evaluated extensively for women but much less for men. Therefore, the aim of this study was to evaluate the relationship between OAB and men's sexual activity and the effect of OAB on erectile dysfunction (ED) and premature ejaculation (PE) in a large representative cohort of men at the population level. METHODS: This study was based on computer-assisted web interviews that used validated questionnaires. The most recent census and the sample size estimation calculations were employed to produce a population-representative pool. RESULTS: The study included 3001 men, representative of the population in terms of age and place of residence. The frequency of sexual intercourse was higher for respondents without OAB symptoms compared with persons who had OAB (p = 0.001), but there was no association between OAB symptoms and number of sexual partners (p = 0.754). Regression models did not confirm the effect of OAB on sexual activity (odds ratio 0.993, CI 0.974-1.013, p = 0.511). Both ED and PE were more prevalent in respondents with OAB symptoms compared with persons who lacked those symptoms (p < 0.001). Importantly, the effect of OAB on ED or PE was independent of age, comorbidities, and lifestyle habits (regression coefficients of 0.13 and 0.158 for ED and PE, respectively). CONCLUSION: Overactive bladder did not significantly affect men's sexual activity, but it significantly correlated with ED and PE. Our results suggest a need in daily clinical practice to screen for OAB symptoms for persons who report ED or PE.

Alpha-blockers: the magic pill for endourology-The great delusion.

PURPOSE: The present paper takes a different and more critical look at the role of alpha-blockers, sometimes nicknamed as "magical pills", in particular for stone disease and medical expulsive therapy (MET). METHODS: A non-systematic narrative review was performed, synthesizing pertinent information from selected articles, and critically evaluating their conclusions. Sometimes different views on alpha-blockers were laid bare, including curiosities or other entertaining nuances suitable to the present topic, but always maintaining sharp objectivity and the foremost scientific rigor. RESULTS AND CONCLUSIONS: Alpha-blockers seem to be a panacea, being used to treat a wide variety of non-urological diseases and conditions. Urological applications include erectile dysfunction to benign prostatic hyperplasia, from incontinence to urinary retention, or even to facilitate urinary stone passage along the urinary tract. Due to its versatility, alpha-blockers appear to be the Swiss army knife of urological medications. However, the efficacy of alpha-blockers for MET, pain management, or facilitating upper tract access is very disappointing, bringing no, or in some instances, only marginal benefits. Their treatment results are far from being significant or impressive let alone magical. Regular sexual intercourse is an effective alternative to alpha-blockers, providing faster ureteral stone expulsion rates and reducing the need for pain medication. Most of the research supporting alpha-blockers has been based on single-center, underpowered, low-quality studies. These low-quality studies biased several subsequent meta-analyses, contaminating them with their low-quality data, enhancing and prolonging this delusion. These results emphasize the need for large, multi-centric, unbiased, randomized, double-blinded, placebo-controlled trials to prevent future year-long delusions that may afflict any medical field.

From Gatekeeper to Facilitator: Balancing Between Sexual Rights and Protection From Harm in Dementia Adults.

OBJECTIVE: The assessment of sexual consent capacity has been a challenge due to its dynamic nature, influenced by factors such as time, environment, individuals involved, and the nature of activities. Particularly in people living with dementia, the complexity is intensified with the interplay of the disease's impact, residential care setting, and legal constraints. This amplifies the dilemma faced by practitioners-whether to prioritize protection or encourage and support sexual expression. This article aims to provide a sensible approach to uphold the sexual autonomy of people living with dementia while mitigating the potential risks of them being involved as either perpetrators or victims. METHODS: In this narrative review, a literature search spanning from 1990 to 2023 was carried out on PubMed. Relevant articles on people living with dementia and topics related to sexuality were scrutinized. RESULTS: 41 relevant articles identified themes related to the impact of cognitive impairment on sexuality, challenges in residential care facilities, sexual consent capacity assessment models, and ethical frameworks regarding sexual rights and law. CONCLUSION: Discussions highlight the often neglected influence of prolonged suppression of sexual expression and the benefits of actualization of sexual autonomy, especially in people living with dementia, whose sense of identity is fading. It scrutinizes the limitations of existing sexual consent capacity evaluation models, emphasizing ethical concerns, practical challenges, and the need for a more balanced approach. Proposed strategies advocate for a shift from a gatekeeper to a facilitator role, offering principles for setting educational programs and policies to mitigate obstacles, supporting sexual rights, and safeguarding vulnerable groups.

Patient Reported Sexual Adaptation Following Prostate Cancer Treatment: An Analysis of Related Variables and Sexual Outcomes Associated with Sexual Adaptation Styles.

Sexual concerns after prostate cancer (PCa) treatment are high. Flexible coping is a crucial element to maintaining sexual activity after PCa and improves adaptation outcomes. We aimed to identify potential sexual adaptation styles reported by men following PCa treatment, and to assess relationships among associated variables and outcomes. Individuals (n = 223) with PCa treatment history (e.g., radical prostatectomy [n = 165, 74.0%], external beam radiation [n = 83, 37.2%], hormone/androgen deprivation therapy [n = 83, 37.2%]), completed an online survey assessing sexual variables and processes of sexual adaptation. Using a combination of inductive and deductive coding, open-ended responses were thematically analyzed and grouped into sexual adaptation styles. Factors potentially associated with sexual adaptation styles (e.g., age, perceived partner involvement, co-morbidities, relationship duration, time since PCa treatment, desire for physical affection, depression, relationship adjustment) were tested using multinomial logistic regression. Outcomes of sexual well-being (sexual distress, sexual bother, sexual satisfaction) and relationship adjustment were compared against each sexual adaptation style using a multivariate analysis of variance. Sexual activity status and satisfaction with the adaptation process was assessed across the sexual adaptation styles using a chi-square analysis and post-hoc tests. Two distinct categories were identified: those who had Adapted (n = 185) and those who had Not Adapted (n = 38). Four sexual adaptation styles emerged in the adapted category: Relationship Renegotiation (n = 53) and Sexual Renegotiation (n = 47), which were couples-focused styles, and Acceptance/Resignation (n = 34) and Masturbation/Erection (n = 48), which were individual-focused styles. Participants who could not be categorized as one style, but rather met several, were identified as Mixed (n = 3). Higher rates of depression, lower relationship adjustment, lack of sexual activity, and greater dissatisfaction with the adaptation process were observed for Not Adapted participants. Participants engaged in any type of adaptation style fared better than those who had Not Adapted. Couples-focused styles tended to emphasize renegotiation, including a changed perspective on the expression of the relationship. Perceived direct engagement of the partner facilitated adaptation and emphasized engagement with flexible coping, either through redefining priorities or ways of being sexual. Individual-focused styles emphasized pre-cancer erectile function, and either aimed to return to capacity for penetrative sexual activity or accepted its inaccessibility and largely an abandonment of partnered sexual activity.

Long-term sexual function after mid-urethral slings for stress urinary incontinence in women.

INTRODUCTION: There has been increasing concern about potential negative impact of mid-urethral slings (MUS) on sexual life. Our aim was to study sexual activity 10-20 years after MUS surgery and changes in impact of incontinence on sexual life over time and to compare subjective cure, pain, satisfaction, and incontinence between sexually active and inactive women 10-20 years after MUS. MATERIAL AND METHODS: Historical cohort study using the Norwegian Female Incontinence Registry to identify women who underwent MUS between 2001-2006 and 2011-2012. They answered validated questionnaires about sexual activity, incontinence, pain, and satisfaction with MUS. We assessed changes in urinary incontinence during intercourse and compared symptoms and satisfaction between sexually active and inactive women. The study was registered in Clinical Trials (NCT04912830). RESULTS: In total, 1210/1903 (64%) responded. Of women responding to questions about sexual activity, 63% (735/1166) were sexually active. 31.3% experienced negative impact of incontinence on sexual life preoperatively, decreasing to 5.9% at 10-20 years follow-up. A higher proportion of sexually inactive vs sexually active women had urinary incontinence (63.5% vs. 47.5%, aOR 1.60 [1.18-2.17]). In a subanalysis, only urgency and mixed urinary incontinence remained significant. A higher proportion of sexually inactive were dissatisfied with MUS (30.1% vs. 12.9%, aOR 2.53 [1.82-3.51]). Persistent pain after MUS was similar for sexually inactive and active women (4.0% vs. 3.2%, aOR 1.10 [0.55-2.19]). Furthermore, 3.4% of sexually inactive had persistent pain after MUS and stated pain as a reason for not being sexually active, whereas 1.7% of sexually active women had persistent pain after MUS and pain during intercourse. CONCLUSIONS: Negative impact of incontinence on sexual life was less prevalent at 10-20 years follow-up after sling surgery compared to preoperative assessment. A higher proportion of sexually inactive had urgency and mixed urinary incontinence and were dissatisfied with MUS. Only 3%-4% of sexually active and inactive women had persistent pain after MUS and this was not associated with sexual activity. This indicates that incontinence has a greater negative impact on sexual activity than persisting pain after MUS at long-term follow-up.

A longitudinal study of sexual activity and influencing factors in breast cancer patients during treatment in the Southwest of China: a trajectory analysis model.

PURPOSE: The aim of this study was to describe the longitudinal developmental trajectories and its influencing factors of sexual activity in patients with breast cancer during treatment. METHODS: A prospective longitudinal study was conducted, including 225 newly diagnosed breast cancer patients in A tumor specialty three-class hospital in Southwest China. We measured sexual activity at the time of admission and diagnosis (T0) and one month (T1), three months (T2), six months (T3), and nine months (T4) after diagnosis. A trajectory analysis model (GBTM) was used to explore the changes in sexual activity in breast cancer patients. Multivariate binary logistic regression analysis was used to analyse the factors that affected the classification of sexual activity trajectories. RESULTS: The ratio of sexual activity abruptly declined from 100% at baseline to 39.1% at T1. The percentage of sexual activity was improved, from 51.4% at T2 to 63.1% at T4. The optimal model was a 2-group trajectory of sexual activity in breast cancer patients,36.6% in the "low activity group" and 63.4% in the "high activity group." The multivariate binary logistic regression analysis revealed statistically significant and positive correlations between sexual activity and age (ß = 0.085, OR = 1.089, 95%CI 1.035 ∼ 1.145, P = 0.001),libido(ß = 0.774, OR = 2.168, 95%CI 1.337 ∼ 3.515, P = 0.002), vaginal lubrication(ß = 1.254, OR = 33.503, 95%CI 2.000 ∼ 6.137, P<0.001). CONCLUSIONS: Breast cancer patients exhibited varying levels of sexual activity during treatment; higher age was associated with increased sexual activity, which can contribute to the recovery of sexual function. Therefore, it is crucial to provide appropriate guidance on sexual health for younger patients.

Primary Headache Associated with Sexual Activity: A Review of the Literature.

PURPOSE OF REVIEW: This review summarizes the evolution in diagnosis, evaluation, and treatment of primary headache associated with sexual activity (PHASA). RECENT FINDINGS: Despite increased access to patient information and advances in imaging, the pathophysiology of PHASA remains not fully understood. There are many secondary headaches that may present with headache during sexual activity, and a thorough workup is indicated to rule out potentially life-threatening etiologies. Many recent case series discuss the efficacy of known treatments of PHASA, as well as suggest other potential therapies for this condition including the newer CGRP-targeted therapies. Headaches during sexual activity can be worrisome events which necessitate urgent evaluation, particularly when presenting with sudden-onset and severe "thunderclap" headaches. A thorough workup including imaging should be conducted to rule out etiologies such as subarachnoid hemorrhage, reversible cerebral vasoconstrictive syndrome (RCVS), vasospasm, and dissection. PHASA is commonly comorbid with migraine, tension-type headache, exertional headache, and hypertension. PHASA can present as a dull headache that progresses with sexual excitement, or an explosive headache at or around orgasm. Pain is primarily occipital, diffuse, and bilateral. The headaches are discrete, recurrent events with bouts that typically self-resolve, but may also relapse and remit or continue chronically in some patients. PHASA can be treated preemptively with indomethacin and triptans administered prior to sexual activity, or treated prophylactically with beta-blockers, topiramate, and calcium channel blockers. CGRP-targeted therapies may provide relief in PHASA based on a few case reports, but there are no randomized controlled trials looking at specific efficacy for these therapies.

Factors associated with voluntary HIV counseling and testing among young students engaging in casual sexual activity: a cross-sectional study from Eastern China.

OBJECTIVES: To investigate the factors associated with voluntary HIV counseling and testing (VCT) among young students engaging in casual sexual activity and to establish a scientific rationale for developing targeted intervention strategies for preventing HIV/AIDS in this population. METHODS: Stratified cluster sampling was used to conduct a survey using questionnaires to collect demographic and behavioral information for statistical analysis. RESULTS: Data from 611 young students, who reported engaging in casual sexual activity, were included in the statistical analysis. Among these, 68 (11.13%) students underwent the VCT. Among young students who engaged in casual sexual activity, those who were non-Zhejiang residents (adjusted odds ratio [aOR]: 2.11; 95% Confidence Interval [CI]: 1.17-3.80), those who had received AIDS-themed lectures or health education courses from the school in the past year (aOR = 3.96, 95% CI = 1.49-10.50), those who had received HIV risk self-assessment conducted by the school in the past year (aOR = 2.31, 95% CI = 1.17-4.59), and those who had engaged in commercial sex activity in the past year (aOR = 1.98, 95% CI = 1.07-3.66) were more inclined to have undergone VCT. Male students (aOR = 0.37, 95% CI = 0.18-0.77) and those who used condoms consistently during casual sexual activity (aOR = 0.45, 95% CI = 0.21-0.97) were less likely to undergo VCT. CONCLUSION: Casual sexual activity was relatively prevalent among young students, posing a potential risk for HIV transmission. These findings will be instrumental in the development more effective HIV prevention and control strategies for young students. Additionally, it highlights the necessity of promoting and popularizing VCT among young students without Zhejiang province residency, who are involved in commercial sexual activity, and/or those who lacking HIV education. Moreover, additional research and implementation of refined HIV behavioral interventions specifically tailored to young students are necessary to enhance their awareness and knowledge of HIV prevention.

Development, implementation, and evaluation of the effectiveness of an intervention program to improve the sexual competence of young adult women about to get married: a protocol study.

BACKGROUND: Having competence in initiating sexual interactions is one of the challenges of sexual health in any society. Given that the social, cultural, and religious background of some societies can prevent the acquisition of sexual competence in young women, this study will be done to design, implement, and determine the effectiveness of an intervention program to improve the sexual competence of young women on the eve of marriage. METHODS: The current research is a mixed-method study in a qualitative-quantitative sequence. In the first phase, a qualitative study will be conducted to explore the needs of sexual competence in young adult women about to get married and ways to improve it. Then, after the literature review and combining it with the results of the qualitative study, a draft of the intervention program will be developed. After reviewing the content of the program and validating it in the panel of experts, the final program will be developed. In the second phase, the effect of the program to promote the sexual competence of adult women about to get married will be determined in a quantitative study with a two-group quasi-experimental method. DISCUSSION: Providing a comprehensive and practical intervention program to promote sexual competence based on cultural, social, and religious background can help to improve the quality of sexual interactions of young women about to get married, reduce harm caused by lack of sexual competence, and ensure women's sexual health.

Preparing young people to start safe and satisfactory sexual behaviors and as a result to acquire sexual competence can play an important role in ensuring their sexual health. But in some countries, talking about sexual issues is a cultural and religious taboo. Given that Lack of sexual competence is associated with negative consequences, the present study aims to design, implement, and determine the effectiveness of a program to promote sexual competence in young adult women who are about to get married. In the first phase, to identify the needs of acquiring sexual competence and to explore the strategies for improving sexual competence, a qualitative study will be conducted with a content analysis approach. Individual interviews will be conducted with women aged 18 to 25 about to get married, the teachers of pre-marriage classes, midwives, gynecologists, reproductive health specialists, psychiatrists, and psychologists who work in the field of sexual health. Based on the findings of this phase and after reviewing the literature, an intervention program to improve sexual competence in young adult women will be designed and prepared. After the experts approve the intervention program, in the second phase, a quantitative study will be conducted to determine the effect of the intervention program on improving the sexual competence of young adult women about to get married.

School Connectedness and Risk for Sexual Intercourse and Nonconsensual Sex in Adolescence.

The CDC reports that 30% of high school students have engaged in sexual intercourse. Evidence suggests biological, personal, peer, societal, and family variables affect when a child will initiate sex. The school environment plays an important role in a child's development. Evidence suggests that greater attachment to the school community can modify sexual risk-taking activity in adolescents. Future of Families and Child Wellbeing Study (FFCWS) comprises a cohort of approximately 4,700 families of children born in the U.S. between 1998-2000, over-sampled for non-marital births in large U.S. cities. Adolescents (N = 3,444 of 4,663 eligible) completed the wave six teen survey at approximately age 15. School connectedness was self-reported with four items measuring inclusiveness, closeness, happiness, and safety felt by the adolescent in their school environment. Sexual intercourse and nonconsensual sex were self-reported by the adolescent. Hierarchical regression analyses were conducted examining sexual intercourse, nonconsensual sex, risk factors, and school connectedness. In this sample of adolescents (48% female, 49% Black, 25% Hispanic, ages 14-19), school connectedness appears to reduce boys' risk of nonconsensual sex (OR = 0.29, p < 0.01), and reduce girls' risk of engaging in sexual intercourse (OR = 0.55, p < 0.01). Findings suggest gender differences in the association between school connectedness and sexual practices in adolescents. School connectedness may confer protection for boys' risk of nonconsensual sex, and for girls' risk of engaging in sexual intercourse. Further exploration of the relationship between school connectedness may allow for recommendations into preventative measures for teenage sexual behaviors.

Safe Sex After Total Hip Arthroplasty: Using Computed Tomography-Based Robotics to Evaluate "At-Risk" Sexual Positions.

BACKGROUND: Total hip arthroplasty (THA) can improve sexual satisfaction, but fear of dislocation can lead to sexual difficulties following this procedure. Previous kinematic research identified 4 sexual positions in women and 2 in men that were considered at risk for impingement. This study aimed to validate these findings using current robotic THA simulations. METHODS: The 3-dimensional renderings from 12 patients who received computed tomography (CT)-based robotic THA were used to assess for prosthetic and/or bony impingement among 12 popular sexual positions. There were 9 cup orientations tested for each position (a combination of anteversion [0 °, 15 °, and 30 °] and inclination [40 °, 45 °, and 60 °]). The at-risk positions were tested again using the unique hip positions and cup orientations where previous geometric modeling data found impingement to occur. RESULTS: Using mean hip positions, impingement occurred in at least 1 patient in 1 of the 12 positions for women (position 5) and 5 of the 12 positions for men (positions 1, 5, 8, 10, and 11). Among the at-risk positions, impingement occurred in none of the 2 at-risk women positions (0 of 17 cup orientations) and in both at-risk men positions (9 of 9 cup orientations for position 8 and 1 of 1 for position 11). CONCLUSION: Recreating popular and at-risk sexual positions following THA with a CT-based robotics system yielded results that were inconsistent with previous geometric modeling data. Resolving these discrepancies is crucial for surgeons to provide accurate postoperative patient education. The CT-based robotic systems may provide necessary input to feasibly individualize such recommendations, but current limitations in CT-based robotics require continued attention and innovation.

The Effects of Sexual Education on Sexual Function and Sexual Quality of Life of Women Who Underwent Total Hip Arthroplasty: A Randomized Controlled Trial.

BACKGROUND: This study aimed to determine the effect of sexual education on sexual function and quality of activity after Total Hip Arthroplasty (THA). METHOD: There were 31 patients who underwent THA who were randomly assigned to the education (n = 15) and the control (n = 16) groups in this randomized controlled trial. A sexual education session and an educational handout were provided to the study group after THA prior to discharge. Patients were evaluated four times throughout the study: preoperatively, at 1, 3, and 6 months after surgery. The data was collected by using the sociodemographic and medical data form, the Index of Female Sexual Function (IFSF), the Sexual Quality of Life Questionnaire-Female (SQoL-F) questionnaire, the Visual Analog Scale (VAS) of the Fear of Sexual Activity, and the VAS of Satisfaction with Sexual Activity scales. RESULTS: The mean sexual activity satisfaction score of the education group was higher in the second (95% Cl [confidence interval] [0.67 to 3.08]) and third follow-up (95% Cl [0.19 to 3.03]) (P < 0.05). Over time, the mean satisfaction scores of both groups increased (P < 0.05). The mean VAS fear of sexual activity scores at the first (95% CIs [-2.81 to -0.48]), second (95% CI [-4.71 to -2.80]), and third (95% CI [-3.80 to -1.55]) follow-ups of the education group were significantly lower. Over time, the mean fear scores of both groups decreased (P < 0.05). The education group had higher mean SQoL-F scores at the first (95% CI [4.90 to 33.11], second (95% CI [7.62 to 34.31]), and third (95% CIs [5.23 to 35.79) follow-ups (P < 0.05). For mean SQoL-F score, the difference between groups (F = 6.64), the change over time in both groups (F = 29.16), and the change over time between groups (F = 13.74) were statistically significant (P < 0.05). For the mean IFSF score, it was found that the change over time was significantly different for both groups (F = 69.64, P < 0.05). CONCLUSION: Sexual education after THA may improve satisfaction with sexual activity and quality of life.

'Feeling Ready': A Feminist Poststructural Analysis of Postpartum Sexual Health.

There exists a lack of literature surrounding how postpartum individuals define feeling 'ready' to resume sexual activities after childbirth. Many factors may influence feelings of desire or readiness for sexual activities, such as breastfeeding. Therefore, it is important to understand why and how postpartum individuals understand and make meaning of their experiences surrounding postpartum sexual activities, as well as how those experiences are influenced or negotiated through relations of power. This study was guided by feminist poststructuralism and discourse analysis. Eleven participants who were between 1 and 6 months postpartum and living in Nova Scotia, Canada, were interviewed using semi-structured interviews. Participants challenged certain discourses surrounding sexual activities postpartum, including the social discourse that positions sexual activities as a requirement within romantic relationships and the discourse that positions health care providers as the authority on postpartum sexual health. 'Feeling ready' centered on four main issues: (1) navigating physical recovery; (2) personal knowing and emotional readiness; (3) the 6-week check; and (4) redefining intimacy. This article describes one branch of the findings within the overall study. Choosing to resume sexual activities postpartum, or feeling ready to do so, is individual, fluid, and complex. This research has important implications for practice and policy, specifically as it pertains to postpartum care.

Sport and sexual recovery after total hip arthroplasty in young adults: a retrospective cohort study.

INTRODUCTION: Total Hip Arthroplasty (THA) is the main treatment for end-stage degenerative hip arthrosis in the elderly, while became increasingly performed as treatment of secondary arthrosis in younger patients, a population at high functional requests in terms of resumption of physical activity and resumption of sexual activity. This study evaluates the physical, sports recovery and the sexual quality of life in young patients undergoing primary THA. MATERIALS AND METHODS: Patients undergoing primary THA aged between 18 and 45, operated in a 10 year timeframe, were selected. Demographic, clinical, and radiological data were collected. The Harris Hip Score (HHS) was assessed before and after the surgery. The UCLA Activity Score was collected, sport participation in pre and post-operative period was acquired. The quality of sexual activity (SQoL) before and after surgery was analysed through a qualitative questionnaire. Collected data were also compared on the surgical approach, namely Direct Anterior (DAA), Postero-Lateral (PL) and Direct lateral (DL). RESULTS: The population consisted of 242 THA implanted in 232 patients, including 143 males and 89 females, with an average age of 37.4. The mean follow-up period was 51.0 months, with a minimum of 2.9 months and a maximum of 122.6 months. Postoperatively, the average HHS was 90.29 ± 0.9 points, compared to 62.43 ± 1.34 points preoperatively (p < 0.001). The UCLA Activity Score in the postoperative period was 7.17 ± 0.17 matching to intermediate impact sport activity. The 64% of patients reported an improvement in SQoL after-surgery, 73% of which being females that show a significant improvement in SQoL compared to males (p = 0.046). By surgical approach comparison, DAA patients demonstrated better UCLA Activity Score (p = 0.037) and Return to sport (p = 0.027) compared to PL and DL. CONCLUSION: Primary THA surgery in young adults can improve the level of physical activity and promote the involvement of subjects in moderate impact sports. Patients showed a better quality of sexual life compared to the preoperative period, an effect more evident in female patients.

Initiatory rites, sexual activity, and early pregnancies of adolescent girls in the savannah region of Togo: Views of canton chiefs, priests and initiates.

Teenage pregnancy and marriage are major concerns in many schools in Togo, due to the large number of cases recorded each year by the Ministry of Primary, Secondary, Technical Education, and Handicrafts. The aim of this article is to describe the rites associated with early pregnancy and the perceptions held by the populations of Gando in the Savannah region. The study was based on documentary research and interviews with several actors, including initiating priests, canton chiefs, and young initiates. The results show that the rites: Okpenkpen, Tkonte, Ignogues have a link with early pregnancy, and the populations perceive them relatively well.

Les grossesses et mariages chez les adolescentes constituent une vive préoccupation dans beaucoup d'établissements scolaires au Togo en raison du nombre important de cas recensés chaque année par le Ministère des enseignements primaire, secondaire, technique et de l'artisanat. L'objectif de cet article est de décrire les rites ayant un lien avec les grossesses précoces et les perceptions qu'ont les populations de Gando dans la région des Savanes. Pour y parvenir, la méthodologie utilisée est basée sur la recherche documentaire et les entretiens avec plusieurs acteurs, entre autres, les prêtres initiateurs, les chefs de cantons et les jeunes initiés. Les résultats montrent que les rites : Okpenkpen, Tkonte, Ignogues ont un lien avec les grossesses précoces et les populations les perçoivent relativement bien.

Extradyadic stress as a barrier to sexual activity in couples? A dyadic response surface analysis.

Sexuality is integral to most romantic relationships. Through stress spillover, however, factors such as individually experienced stress outside of the relationship (i.e., extradyadic stress) can negatively impact sexuality. In this study, we explored how a possible (mis)matching of both partners' levels of extradyadic stress is related to sexual activity and tested for gender differences. Analyzing 316 mixed-gender couples from Switzerland, we employed Dyadic Response Surface Analysis to assess how extradyadic stress is associated with sexual activity. Our results showed that extradyadic stress was positively linked to sexual activity for women (in general) and men (in the case of matching stress levels). As this result was surprising, we conducted additional exploratory analyses and split the measure of sexual activity into (1) exchange of affection and (2) eroticism (petting, oral sex, and intercourse) and controlled for age. Results from this second set of analyses showed that for women, matching stress levels were associated with higher exchange of affection, whereas men's exchange of affection was higher if men reported higher stress levels than women. Notably, after accounting for age, the link between stress and eroticism dissipated. Our findings suggest that exchange of affection may serve as a coping mechanism for stress, with gender influencing this dynamic. However, future research investigating stress and sexual activity should consider additional factors such as age, relationship satisfaction, stressor type, and stress severity.

Clinical Features, Antiviral Treatment, and Patient Outcomes: A Systematic Review and Comparative Analysis of the Previous and the 2022 Mpox Outbreaks.

BACKGROUND: This study aims to comparatively analyze clinical features, treatment, and patient outcomes between the previous and the 2022 mpox (monkeypox) outbreaks. METHODS: Five bibliographic databases were searched for studies reporting clinical features, management, and patient outcomes of mpox. Systematic review and meta-analysis were performed. RESULTS: In total, 73 studies were included in the systematic review, of which 33 studies were subjected to meta-analysis. Previous outbreaks substantially affected children, whereas the 2022 outbreak primarily affected male adults, of which 94.66% (95% confidence interval [CI], 88.03-98.95) were men who have sex with men. Furthermore, 72.47% (95% CI, 51.04-89.71) reported high-risk sexual activity and the overall human immunodeficiency virus (HIV) prevalence was 37.65% (95% CI, 30.09-45.50). Skin lesions remain the typical symptom; however, their anatomic distribution differed. Systemic manifestations were common, but rectal pain was unique to the 2022 outbreak. The estimated overall fatality during past outbreaks in Africa was 4.61% (95% CI, 2.39%-7.35%), whereas 6.34% (95% CI, 3.35%-10.10%) of patients from the 2022 outbreak required hospitalization. Antiviral treatment, in particular tecovirimat, has been prescribed for a subset of patients, but the efficacy remains inconclusive. CONCLUSIONS: These findings are important for better understanding the disease and guiding adequate response to mpox outbreaks.