Polish mental and sexual health specialists working with transgender and gender diverse persons - who are they and what is their background? / Polscy specjalisci i specjalistki w dziedzinie zdrowia psychicznego i seksualnego pracujacy z osobami transplciowymi i róznorodnymi plciowo ­ kim sa i jakie maja przygotowanie?

OBJECTIVES: This study aimed to present the demographic and professional characteristics of Polish mental and sexual health specialists (MSHS) and their experience in clinical work with transgender and gender diverse (TGD) people. METHODS: This cross-sectional study was conducted using the LimeSurvey platform. A total of 239 MSHS with a diverse professional background, at different stages of their careers, with experience of working with TGD patients, completed the survey. Participants were asked to provide demographic (e.g., gender and sexual identity) and professional (e.g., knowledge of leading standards and guidelines of care) data. Descriptive statistics were used. RESULTS: The mean age of participants was 39.5 years (SD 7.92) and the majority were assigned female at birth (73.2%). The sample was composed predominantly of psychotherapists (70%), then psychologists (53%), medical doctors (31%) and certified sexologists (5.9%). The majority (72%) practised in large cities (>500,000); 68.6% reported female gender identity, 24.7% a male identity and 6.3% were TGD; 63.2% were heterosexual, 12.1% homosexual, 12.6% bisexual, and 12.1% reported other sexual identity. Both the significance of religion and religious practice were significantly decreased compared to general Polish population. Most participants declared that they either do not know the basic guidelines of care for TGD people at all or know them very little. The majority of MSHS rated their professional training as insufficient. CONCLUSIONS: People providing clinical services to TGD patients are a professionally diverse group. There is an urgent need to expand and intensify professional training directed at MSHS on topics related to the health care dedicated to TGD people.

Higher number of steps is related to lower endogenous progesterone but not estradiol levels in women.

OBJECTIVES: Sex steroid hormones are important not only for reproduction but also for many aspects of women's health, including the risk of breast cancer. Physical activity has been shown to influence sex hormone levels in women. This study aimed to investigate a relationship between the average daily number of steps and the sex hormone (estradiol and progesterone) levels in premenopausal women. MATERIALS AND METHODS: Data were collected from 85 healthy, urban women of reproductive age who performed at least 180 minutes/week of moderate physical activity for two complete menstrual cycles. Physical activity was measured using wrist bands. Estradiol and progesterone concentrations were measured in daily-collected saliva samples in the second menstrual cycle. RESULTS: There was a significant negative association between the average number of steps taken daily and salivary progesterone levels after adjusting for potential confounding factors (age, BMI). Women who took more than 10,000 steps a day had significantly lower progesterone levels compared to women who took less than 10,000 steps. The association between physical activity and estradiol levels was statistically insignificant. DISCUSSION: Our results indicate that taking at least 10,000 steps a day reduces progesterone levels, but this intensity of physical activity may not be high enough to affect estradiol levels. Daily step tracking is a valuable element of health promotion, but currently recommended levels of physical activity may not be high enough for healthy premenopausal women to significantly reduce both sex hormone levels and thus their risk of postmenopausal breast cancer.

Social support during pregnancy and the risk of postpartum depression in Polish women: A prospective study.

Social support has been proposed as an important determinant of women's physical and emotional well-being during pregnancy and after childbirth. Our study aimed to examine the association between the risk of postpartum depression (PPD) and perceived social support during pregnancy. A web-based prospective study survey was conducted among Polish women. The level of social support was measured with the Berlin Social Support Scales during pregnancy. Four weeks after the birth the risk of PPD was assessed using the Edinburgh Postpartum Depression Scale. Data from 932 mothers aged 19-43 (mean 30.95; SD 3.83) were analyzed using multinomial logistic regression. Higher perceived available support (emotional and instrumental), currently received support (emotional, instrumental and informational), satisfaction with the support, and sum of score were all associated with lower risk of PPD, after controlling for selected covariates (woman's age, socioeconomic status, parity status, place of residency, education, child's Apgar score, type of delivery, complications during birth, kin assisting the labor, breastfeeding). Our results suggest that the more social support the pregnant woman receives, the lower is her risk of PPD. Since humans evolved as cooperative breeders, they are inherently reliant on social support to raise children and such allomaternal help could improve maternal well-being.

Psychometric assessment of the Polish Translation of the Transgender Positive Identity Measure (T-PIM). / Ocena psychometryczna polskiego tlumaczenia kwestionariusza Transgender Positive Identity Measure (T-PIM).

OBJECTIVES: Research conducted in transgender and gender diverse individuals focused mainly on the challenges and health disparities affecting this population. One reason for this situation is the lack of questionnaires capturing positive aspects and experiences related to being a transgender person. The Transgender Positive Identity Measure (T-PIM) is one of a very few measures designed to explore such experiences. The aim of the study was to investigate the structure, reliability and validity of the Polish translation of the T-PIM questionnaire. METHODS: A group of 89 transgender and gender diverse participants completed an online survey including the T-PIM questionnaire, resilience measurement scale (SPP-25) and depression (CESD-R) measures. Hierarchical item clustering method (ICLUST), Horn's parallel analysis and Velicer's minimum average partial test (MAP) were employed to investigate the structure of the questionnaire. RESULTS: The analyses showed that the Polish translation of the T-PIM questionnaire was characterized by a 5-factor structure consistent with the original publication (Authenticity, Intimacy, Community, Social Justice, Insights). Cronbach's alpha and Guttman's lambda-6 reliability coefficients reached satisfactory levels for all five factors and for the whole questionnaire. CONCLUSIONS: The Polish translation of the T-PIM questionnaire is characterized by satisfying psychometric properties and can be used in studies on transgender and gender diverse communities.

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

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

Hormonal Underpinnings of the Variation in Sexual Desire, Arousal and Activity Throughout the Menstrual Cycle - A Multifaceted Approach.

Although prior evidence supports women's mating behaviors and preferences being related to ovarian hormonal levels, there is conflicting evidence about exactly which hormones predict sexual function best, which specific psychosexual facets are affected and how between-individual and within-individual differences relate to this question. In this study levels of estradiol and progesterone were measured (once daily for 15 days for each participant) for 97 women, who attended two testing sessions, in times of the cycle varying in conception probability (based on the luteinizing hormone (LH) test result). Women completed surveys on their sexual desire, arousal, sexual activity frequency and initiation. There was a significant difference between peri-ovulatory and luteal values for all sexual function variables. Between-subject progesterone negatively predicted sexual activity frequency only. Within-subject estradiol positively and progesterone negatively predicted sexual desire. The findings provide support for hormonal underpinnings of sexual desire and sexual activity frequency fluctuations during the menstrual cycle. The findings did not yield support for hormonal influences on sexual arousal and initiation of sexual encounters. The main findings are consistent with the excitatory and inhibitory effects of estradiol and progesterone, respectively, on measures of women's sexual motivation.

Health determinants in men of the Bear subculture compared with the MSM population. Literature review. / Uwarunkowania zdrowia w grupie mezczyzn nalezacych do subkultury Bears na tle populacji MSM. Przeglad pismiennictwa.

A number of health problems are more common in the population of men who have sex with men (MSM) as compared with the general population. At the same time, research reveals that the MSM population is far from homogeneous, and that subcultural affiliation is one of the characteristics that should be taken into account in health analyses of this group. One of the subcultures among MSM that has received growing interest from researchers in recent years, is the Bear community. It originated in the USA and comprises men - mostly homosexual or bisexual - who are characterized by larger, massive or muscular figure, and by distinctive male phenotypic traits - especially body hair pattern, including facial hair. The most significant health determinants in this group include a higher prevalence of behaviors contributing to negative health outcomes as compared with other MSM, elevated BMI values, as well as exposure to multiple stigma - both sexual minority and weight stigma. Research to date has shown that these characteristics of Bears have significant implications for their mental and sexual health. The article aims to review the literature, and to discuss the practical and the clinical implications of the studies conducted thus far in this population. The summary gives practical recommendations regarding both the support for Bear men in clinical practice, and the design of adequate and effective health promotion interventions for members of this unique community.

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

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

HIV pre-exposure prophylaxis (PrEP) for transgender and nonbinary persons. Literature review and guidelines for professionals. / Profilaktyka przedekspozycyjna HIV (PrEP) dla osób transplciowych i niebinarnych. Przeglad pismiennictwa i wskazówki dla praktyków.

Transgender and nonbinary (TG/NB) persons are listed as one of the key populations in the context of HIV, due to increased risk of HIV infection in this group. HIV prevention, which includes a variety of available methods, should therefore be included in the comprehensive health care for TG/NB persons. One such method is the pre-exposure prophylaxis (PrEP), whose high effectiveness in preventing HIV transmission has already been demonstrated in numerous studies conducted in the cisgender population. However, the available empirical data on its use in TG/NB persons are limited in many respects. This issue is also practically absent in the Polish literature; as a consequence, there are significant gaps in recommendations for professionals involved i n the prevention of HIV among TG/NB persons and professionals involved in the comprehensive health care for TG/NB persons. This article 1) outlines the issue of the use of PrEP among TG/NB persons, including the associated challenges for professionals (specialising in physical, as well as mental health); 2) demonstrates the possible applicability of PrEP in TG/NB populations based on available research findings; 3) summarises good practices in counselling and PrEP-related psychoeducational activities, as part of the comprehensive health care for TG/NB individuals.

It gets better with age: Resilience, stigma, and mental health among lesbian, gay, bisexual, transgender and queer persons from Poland.

Lesbian, gay, bisexual, transgender, and queer populations are disproportionately affected by chronic stress associated with stigma which contributes to health adversities including depression. Negative impact of stigma on health can be alleviated by factors such as resilience. Little is known however on how exposure to stigma, protective factors and mental health change with age among gender and sexually diverse persons. Our study aimed at investigating this issue. Our sample consisted of (i) 245 sexually diverse cisgender women, (ii) 175 sexually diverse cisgender men, and (iii) 98 transgender and gender diverse persons. We collected data through a web-based survey. Linear regression models were performed to investigate the interactions of age and each group of participants for resilience, stigma exposure, and mental health indicators (depression and self-esteem). We hypothesized that resilience and mental health indicators will be positively associated with age in all distinguished groups despite the continued exposure to minority stress. The analysis yielded no significant relationships between stigma exposure and age among study participants. However, we observed significant interaction effects of distinguished groups of participants and age in case of self-esteem, depression, and resilience. Self-esteem and resilience were related positively, and depression was negatively associated with age in all study groups. Additionally, we observed that sexually diverse cisgender men demonstrated significantly increased resilience, reduced depression and higher self-esteem compared to other groups. Although the exposure to stigma did not decrease with age, resilience and self-esteem increased, suggesting that LGBTQ persons manage to thrive despite adversities.

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

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

Recommendations of the Polish Sexological Society on medical care in transgender adults - position statement of the expert panel. / Zalecenia Polskiego Towarzystwa Seksuologicznego dotyczace opieki nad zdrowiem doroslych osób transplciowych ­ stanowisko panelu ekspertów.

Attempts at unifying the diagnostic and therapeutic procedures for transgender individuals experiencing gender dysphoria were first undertaken in Poland in the 1980s. Since then, there has been a change in the perception of transgenderism, almost paradigmatic, expressed in subsequent editions of the diagnostic systems (DSM, ICD), which is also associated with the fundamental changes in the principles of conducting trans-specific healthcare. This triggered the need to formulate recommendations for specialists practicing in Poland, which would at least partly reflect the evolution of views and guidelines on clinical care in transgender adults seeking help due to gender dysphoria.

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

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

Exploring Health and Transition-Related Needs in Polish Transgender and Non-Binary Individuals.

BACKGROUND: Gender diverse individuals constitute a substantial yet still understudied population. Particularly little is known about gender non-binary people whose health needs have only recently gained attention from clinicians. AIM: To investigate needs for gender-affirming interventions, selected health indicators and determinants in Polish gender non-binary individuals as compared to transgender men and transgender women. METHODS: We analyzed a subset of data from an online study on health in members of the Polish LGBTQ community. The sample consisted of 53 persons who self-identified as non-binary and 45 transgender men and transgender women. The uptake and the desire for gender-affirming medical interventions as well as selected health indicators were compared in non-binary and transgender persons. Additionally, regression models were conducted for depression, self-esteem and somatic symptoms severity as dependent variables, age as a covariate, and perceived stigma exposure, resilience and discomfort associated with current gender expression as predictors. OUTCOMES: Outcomes such as desire for gender-affirming medical interventions and legal gender reassignment, symptoms of depression, resilience, physical symptoms severity, and perceived stigma exposure were captured in self-reported questionnaires. RESULTS: Compared to the transgender men and transgender women, the non-binary participants of the study significantly less often pursued or desired gender-affirming medical interventions and legal gender reassignment. The non-binary participants also felt significantly more discomfort with their current gender expression. They were also characterized by increased expectations of rejection, vicarious trauma associated with being an LGBTQ person, and by decreased resilience compared to the transgender men and transgender women. Non-binary identity and individual resilience predicted higher self-esteem and decreased depression in the sample. The severity of physical symptoms was predicted by perceived stigma exposure (positively) and by resilience (negatively). CLINICAL IMPLICATIONS: Polish non-binary individuals may constitute a vulnerable population in terms of greater perceived exposure to stigma and decreased individual resilience. Both transgender and non-binary individuals seek gender-affirming interventions and legal gender reassignment; the latter group, however, does so significantly less often. STRENGTHS & LIMITATIONS: We analyzed the data from a unique and understudied Polish population. By exploring the diversity within the transgender and non-binary community, we add to the ongoing discussion on transgender and non-binary health. The major limitations of the study are convenience sampling, cross-sectional design, and limited sample size. CONCLUSION: Non-binary individuals constitute a distinct population in terms of psychosocial and health-related characteristics. Clinicians should be aware of their needs and the challenges they face in association with living in a predominantly gender binary-oriented society. Koziara K, Mijas M. Wycisk J, et al. Exploring Health and Transition-Related Needs in Polish Transgender and Non-Binary Individuals. J Sex Med 2021;18:1110-1121.

Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature.

BACKGROUND: The subject of gay and lesbian sexual health seems to be highly understudied, at least partially due to general limitations inherent in the studies of sexuality as well as heteronormative bias and difficulties in reaching out to these populations. AIM: To critically review the studies on gay and lesbian sexual health in order to identify the existing gaps and biases in the scope and general construction of the published research. METHODS: The dataset comprised 556 peer-reviewed articles identified through Medline search. Key studies characteristics were extracted according to the codebook developed for this study and analyzed descriptively. OUTCOMES: The outcomes included: research methodology, study design, sampling, research topic and diversity inclusion in studied populations. RESULTS: The majority of the studies were quantitative (70.5%), cross-sectional (83.6%) and used convenience sampling (83.2%). Most papers focused on HIV/STI risk behaviors, vulnerabilities and risk navigation (26.3%). The least often found topic captured the sexual function of gay and lesbian participants in older age (0.5%). Over 68% of papers relied on male samples and studies on female-only samples comprised less than 13%. Most studies did not recruit a specific age group (77.7%) and included information about ethnicity of study participants (62%). Information about education (58.7%) or other indicators of socioeconomic status (52.8%) was less often reported. CLINICAL TRANSLATION: The methodological limitations of prevailing study designs, sampling procedures and the composition of samples, as well as extensive areas of omission confine the clinical utility of existing research. STRENGTHS & LIMITATIONS: This study offers critical insights into the most significant challenges associated with studies on gay and lesbian sexual health. Medline-only database search, the inclusion of English-written papers exclusively and limited scope (gay and lesbian sexuality only) of the review constitute the most significant limitations. CONCLUSIONS: Gay and lesbian sexual health is an understudied field characterized by primary focus on HIV/STI and paucity of higher quality research including diverse subpopulations. Mijas M, Grabski B, Blukacz M, et al. Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature. J Sex Med 2021;XXX:XXX-XXX.

Disgust Sensitivity Among Women During the COVID-19 Outbreak.

The emotion of disgust is suggested to be an adaptation that evolved to keep us away from sources of infection. Therefore, individuals from populations with greater pathogen stress should have a greater disgust sensitivity. However, current evidence for a positive relationship between disgust sensitivity and the intensity of infectious diseases in the environment is limited. We tested whether disgust and contamination sensitivity changed in response to the COVID-19 pandemic. Disgust was assessed in 984 women in 2017 (before pandemic) and 633 women in 2020 (during pandemic) by a set of photographs depicting sources of infection and Pathogen and Moral of Three-Domain Disgust Scale. Further, contamination sensitivity among participants in two waves was measured by Contamination Obsessions and Washing Compulsions Subscale of Padua Inventory. State anxiety was measured with the Polish adaptation of the State-Trait Anxiety Inventory (STAI) only during the second wave of data collection. Women from the COVID-19 pandemic group assessed the photographs depicting sources of infection as more disgusting, scoring higher on Padua Inventory, but lower on Moral Disgust Domain as compared to women from before the pandemic. In addition, anxiety levels during pandemic positively correlated with scores from Pathogen Disgust Domain, Padua Inventory, and the ratings of the photographs. The participants of the study scored higher in state anxiety than the norms determined for the Polish population. Summarizing, we present evidence for differences in individual levels of disgust sensitivity in relation to pathogen stress, supporting the idea that disgust evolved to serve as protection from pathogens.

Cardiovascular Disease Risk in Bears and Other Gay Men: A Descriptive Study from Poland.

A risk of cardiovascular disease (CVD) is increased by multiple factors including psychosocial stress and health behaviors. Sexual minority men who identify as Bears form a subculture distinguished by characteristics associated with increased CVD risk such as elevated stress and high body weight. However, none of the previous studies comprehensively investigated CVD risk in this population. Our study compared Bears (N = 31) with other gay men (N = 105) across a wide range of CVD risk factors. Logistic regression and analysis of covariance (ANCOVA) models were performed to compare both groups concerning behavioral (e.g., physical activity), medical (e.g., self-reported hypertension), and psychosocial (e.g., depressiveness) CVD risk factors. Bears were characterized by older age and higher body mass index (BMI) than the control group. We also observed higher resilience, self-esteem, as well as greater prevalence of self-reported hypertension, diabetes, and hypercholesterolemia in Bears. None of these differences remained statistically significant after adjusting for age and, in the case of self-reported diagnosis of diabetes, both age and BMI. Our study demonstrates that Bears are characterized by increased CVD risk associated predominantly with older age and higher BMI. Health promotion interventions addressed to this community should be tailored to Bears' subcultural norms and should encourage a healthier lifestyle instead of weight loss.

Chubby, Hairy and Fearless. Subcultural Identities and Predictors of Self-Esteem in a Sample of Polish Members of Bear Community.

Bear subculture exists within a larger gay community, which has been recognized by public health experts as disproportionately burdened with stigma and related health adversities. Bears are distinguished by a particular body look-body hirsuteness and heavy-set physique. Previous research documented the various health risks, and the exposure to both sexual minority and weight stigma, of this population. In this study we focused on the determinants of self-esteem in Bears. We explored the significance of such predictors as: perceived sexual minority and weight stigma, age, resilience, and physique as reflected by the BMI. Our sample consisted of 60 men from the Polish Bear community (i.e., Bears, Cubs, Otters, Wolves). Linear regression models were performed for the entire sample (N = 60) and for Bear-identified men (N = 31). Perceived sexual minority stigma negatively, and resilience positively, predicted self-esteem. In the case of Bear-identified men, age, perceived exposure to weight discrimination, and BMI were also significant predictors of self-esteem. Higher BMI in the case of Bear-identified men predicted higher self-esteem. Our results suggest that although Bear-identified men are characterized by their similarities to other gay men, subcultural identities create unique social contexts that are important for health and health interventions in this population.

Polish adaptation of the Daily Heterosexist Experiences Questionnaire. / Polska adaptacja Kwestionariusza Codziennych Doswiadczen Heteroseksizmu.

OBJECTIVES: The aim of the conducted research was to prepare the Polish adaptation of the Daily Heterosexist Experiences Questionnaire (DHEQ) by Kimberly Balsam et al. (2013) and to verify psychometric characteristics of the Polish adaptation. This original tool manages to address the experiences of prejudice and discrimination affecting LGBT (lesbian, gay, bisexual and transgender) people. METHODS: Data from 197 Polish LGBT participants were collected online. Mean age of participants was 31 years (M = 31.93; SD = 8.37). Nearly 17% (N = 33) of participants were transgender,alittleover19% (N = 38) described themselves as non-heterosexual women, while the remainder of the sample (N = 127; 64%) were self-described as homosexual, bisexual or pansexual men. The questionnaires included the Polish adaptation of the DHEQ and a control tool designed for the needs of this study. RESULTS: The highest scores were found on factor describing experiences of 'Vicarious trauma', showing that learning about abuse and discrimination of other members of LGBT community is an important stressor for LGBTpeople. Other important stressors were 'Isolation' and 'Vigilance' describing feelings of loneliness and effort made in order to conceal LGBT identity. Of all the groups, the transgender people were the most exposed to heterosexism. CONCLUSIONS: The Polish adaptation of the DHEQ is characterized by good psychometric properties. The majority of the factors distinguished in the DHEQ are applicable to Polish cultural context.

DSM-5 paraphilic disorders criteria in the light of autoerotic asphyxiophilia and non-sexual form of oxygen restriction. / Kryteria zaburzen parafilnych w DSM-5 wobec asfiksji autoerotycznej i pozaseksualnej formy ograniczania doplywu tlenu.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published in 2013 has proved to be particularly interesting in the field of sexuality. It introduced a number of significant changes in the definition of sexual norms, among them a widely discussed distinction between paraphilias and paraphilic disorders. The key criterion separating the abnormal sexual interests from the disordered ones is clinically significant distress resulting directly from sexual behavior and/or the risk of suffering or harm to another person as a result of one's sexual behavior. In the case of masochism - which addresses the phenomenon of suffering quite particularly - this distinction is troublesome. Using the example of autoerotic asphyxia - a behavior from the masochism spectrum - the authors critically examine the proposed DSM-5 method of defining the standards of sexual behavior. Interesting in this regard has been a comparison between autoerotic asphyxia and free diving - a nonsexual activity which, although also associated with possible loss of life by reduction of oxygen, has not been pathologized.