Research in brief: How prevalent is rough sex? Results from a national online sample of adults in Germany.

BACKGROUND: Rough sex refers to consensual sexual activities that incorporate playful aggression, such as hair pulling, spanking, or choking. It is relevant in the context of sexual health as it can enhance sexual arousal, pleasure, and intimacy among consenting partners. However, it can also be associated with consent violations, discomfort, and injuries ranging from mild to severe or even fatal. The prevalence of rough sex in Germany is widely unknown. Our study aims to establish, for the first time, the overall age-related and gender-related prevalence rates of active and passive rough sex involvement among adults in Germany. METHODS: A national online sample of 1101 adults from Germany, aged 18-69 years (50% men, 49% women, 1% gender-diverse individuals) gave informed consent and reported on their lifetime engagement in rough sex in active and passive roles. We recruited participants through a professional panel provider for a multi-themed sexual health survey. Data analysis was conducted using R, with 95% confidence intervals of prevalence rates computed to answer the research questions. RESULTS: Lifetime prevalence of rough sex involvement was 29%. Adults below the age of 40 reported higher rates of involvement (up to 43%) than people over 40 (up to 26%). Men reported predominantly active role involvement and women reported primarily passive role involvement. DISCUSSION: Results show that rough sex is common. Sexual health professionals, educators, and researchers should be prepared to guide current and aspiring practitioners of rough sex, helping them understand potential benefits, risks, and age- and gender-related differences.

Web-Based Initiatives to Prevent Sexual Offense Perpetration: A Systematic Review.

PURPOSE OF REVIEW: Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of this systematic review is to give an overview of the literature on web-based initiatives aimed at sexual offense perpetration prevention published during the last 10 years (2013-2023) and to report data on the efficacy as well as issues of the discussed initiatives. RECENT FINDINGS: We included 18 empirical studies discussing web-based perpetration prevention initiatives, of which six are randomized controlled trials. Among the articles, four cover programs focusing on prevention of sexual reoffending and 14 discuss programs aimed at preventing initial sexual offenses. Evaluations and observations of web-based initiatives aimed at preventing sexual offense perpetration show overall promising results and are well-appreciated. However, evaluation studies are scarce and more randomized controlled trials replicating this effect are warranted.

Living without Partnered Sex in Germany. Results From the First Representative, Population-based German Health and Sexuality Survey (GeSiD).

Broader insights into the life situations of sexually inactive adults in Germany are widely unexplored. Within the nationally-representative survey GeSiD (German Health and Sexuality Survey), undertaken 2018-2019, data of 4,758 participants with lifetime interpersonal sexual experience aged 18-75 years (men: n = 2234; women: n = 2524) were analyzed in regards to partnered sexual inactivity in the past 12 months (PSI; no genital-involving sexual contact with another person). Overall, advanced age, being single and impaired health conditions were associated with PSI. Data showed gender-specific associations with PSI, such as less alcohol, smoking and drug use in women. PSI was associated with lower general life satisfaction throughout different age groups.

Who feels affected by "out of control" sexual behavior? Prevalence and correlates of indicators for ICD-11 Compulsive Sexual Behavior Disorder in the German Health and Sexuality Survey (GeSiD).

Background and aims: The purpose of this study was to examine the prevalence and correlates of indicators consistent with Compulsive Sexual Behavior Disorder (CSBD)-defined and operationalized according to the ICD-11 guidelines-in a large (n = 4,633; 50.5% male; 49,5% female) probability-based German national sample. Methods: Participants were asked if they had ever experienced "intense and recurring sexual impulses or sexual urges that I had difficulty controlling and resulted in sexual behavior" over a period of several months. Those who reported this experience were queried about the associated distress. Results: Overall, 4.9% of men [95% CI = 3.9-6.1] and 3.0% of women [95% CI = 2.3-3.9] reported experiences consistent with ICD-11 diagnostic requirements for lifetime diagnosis. In the 12 months preceding the study, 3.2% of men [95% CI = 2.4-4.2] and 1.8% of women [95% CI = 1.2-2.5] reported experiences consistent with CSBD requirements. Compared to controls and participants who reported elements of compulsive sexuality but without accompanying distress, strict religious upbringing was most prevalent in the CSBD group. The CSBD group was more likely to view sexual practices like men having sex with men as unacceptable and to report the belief that pornography has negative impacts on their sex life and life in general. Compared to the other two groups, the CSBD group was significantly more likely to have received psychiatric treatment for depression or another mental health problem during the past 12 months. Discussion and conclusions: The current study provides novel and important insights into the prevalence and characteristics of CSBD in the general population.

Factors associated with non-use of condoms among heterosexually-active single people in Germany: Results from the first representative, population-based German health and sexuality survey (GeSiD).

Background: Against the backdrop of rising STI incidence among the heterosexual population, sexually active single people are at particularly high STI transmission risk. Gaining insight into circumstances related to condoms non-use in this population is therefore important for developing effective health interventions. Methods: The nationally-representative survey, GeSiD (German Health and Sexuality Survey) undertaken 2018-2019, interviewed 4,955 people aged 18-75 years. A total of 343 heterosexually-active single participants answered a question about condom use at last sex. Data on sociodemographic characteristics, sexual behaviours and circumstances of last sex were analysed to identify independently associated factors. Results: Condom non-use at last sex was reported more commonly by participants aged >35 years than by younger participants (48.5 vs 33.7%, respectively) and more likely among longer relationships (adjusted odds ratio [AOR]: 2.43) or early loving relationships (AOR: 3.59) than in one-night-stands. It was also associated with not discussing using condoms before sex (AOR: 6.50) and with reporting non-use of condoms at sexual debut (AOR: 4.75). Conclusions: Non-use of condoms is a common STI risk behaviour among heterosexually-active single people in Germany and so needs promoting from sexual debut throughout the life course, regardless of relationship type and age, but particularly among middle-aged and older people.

Interdisciplinary, internet-based trans health care (i²TransHealth): study protocol for a randomised controlled trial.

INTRODUCTION: Living in an area with no or deficient structures for trans health care is disadvantageous for trans people. By providing an internet-based health care programme, i²TransHealth aims at reducing structural disadvantages for trans people living in areas lacking specialised care. The e-health intervention consists of video consultations and a 1:1 chat with a study therapist. Additionally, the i²TransHealth network cooperates with physicians, who especially offer crisis intervention close to the participants' place of residence. The aim of this study is to evaluate the (cost-)effectiveness of the internet-based health care programme for trans people compared with a control (waiting) group. The following research questions will be examined with a sample of 163 trans people: Does a 4-month treatment with the i²TransHealth internet-based health care programme improve patient-reported health-outcomes? Is i²TransHealth cost-effective compared with standard care from a societal or health care payers' perspective? Does the participation in and support by i²TransHealth lead to an increase of trans-related expertise in the physician network? METHODS AND ANALYSIS: In a randomised controlled trial, the outcomes of an internet-based health care programme for trans people will be investigated. In the intervention group, participants are invited to use i²TransHealth for 4 months. Participants allocated to the control group will be able to start with their transition-related care after 4 months of study participation. The primary outcome measure is defined as the reduction of psychosomatic symptoms, as assessed by the Brief Symptom Inventory-18, 4 months after using the i²TransHealth programme. Participants in both groups will undergo an assessment at baseline and 4 months after using i²TransHealth. ETHICS AND DISSEMINATION: Positive ethical approval was obtained from the Hamburg Medical Association (PV7131). The results will be disseminated to service users and their families via media, to health care professionals via professional training and meetings and to researchers via conferences and publications. TRIAL REGISTRATION NUMBER: NCT04290286. PROTOCOL VERSION: 22 December 2021 (V.1.0).

Barriers to Accessing Health Care in Rural Regions by Transgender, Non-Binary, and Gender Diverse People: A Case-Based Scoping Review.

Research shows an overrepresentation of trans people in vulnerable socioeconomic situations, primarily due to experiences of discrimination. At the same time, rural or suburban living areas often lack specialized trans-related health care, which a majority of trans people rely on to some extent. Taken together, the lack of both socioeconomic resources and access to trans-related health care can exacerbate health-related distress and impairment for trans people. We illustrate this problem using case vignettes of trans people from rural and suburban areas in (Northern) Germany. They are currently participating in an e-health intervention and randomized controlled trial (RCT) called i2TransHealth, whose case vignettes provided the impetus for the scoping review. The scoping review analyzes the impact of place of residence and its intersection with barriers to accessing trans-related health care. PubMed and Web of Science Data bases were searched for relevant studies using a search strategy related to trans people and remote, rural, or suburban residences. 33 studies were selected after full-text screening and supplemented via reference list checks and study team expertise by 12 articles addressing the living conditions of remotely living trans people and describing requirements for trans-related health care. The literature on trans people living remotely reveals intersections of trans mental health with age, race, gender expression, geographic location, community size, socioeconomic status, discrimination experiences, and attitudes towards health care providers. Several structural health care barriers are identified. The role of health care professionals (HCPs) for remotely living trans people is discussed. There is no need assuming that rural life for trans people is inevitably worse for health and well-being than urban life. Nevertheless, some clear barriers and health disparities exist for trans people in remote settings. Empowering trans groups and diversity-sensitive education of remote communities in private and institutional settings are needed for respectful inclusion of trans people. Facilitating access to trans-related health care, such as through video-based e-health programs with HCPs, can improve both the health and socioeconomic situation of trans people.

[Non-consensual forwarding of personal erotic photos at schools : A survey of school principals in Schleswig-Holstein on sexual border violations using digital media]. / Zur nichtkonsensuellen Weiterleitung persönlicher erotischer Fotos an Schulen : Eine Befragung von Schulleitungen in Schleswig-Holstein zu sexuellen Grenzverletzungen mittels digitaler Medien.

BACKGROUND: The Internet and digital media entail both risks and opportunities for children and young people. One risk is posed by cases in which personal erotic photos of schoolchildren are forwarded against their will. For the children and adolescents concerned, the psychosocial consequences can be serious. OBJECTIVE: The aim of this study is to investigate the prevalence and consequences of non-consensual forwarding of personal erotic photos among children and adolescents at schools in the German state of Schleswig-Holstein. METHODS: From 25 April to 7 June 2019, principals of secondary schools were surveyed via an online brief questionnaire about both the incidence of non-consensual forwarding of erotic photos at their respective schools, as well as actions taken, consequences for the students depicted, and consequences for those who sent the photos. Information from 74 school administrators was included in the data analysis. RESULTS: In more than two-thirds of the schools, school principals were aware of at least one case of non-consensual forwarding of personal erotic photos. Measures taken were mostly informing the parents of all involved and a "guided exchange" between the involved students. The consequences for the affected students were reported to be social withdrawal, psychological suffering, school performance problems, and experiences with cyberbullying. In eight cases, affected students left the school. DISCUSSION: Non-consensual forwarding of personal erotic photos in schools is a problem of considerable magnitude. Up-to-date specific prevention measures are urgently needed.

[Lifetime prevalences of nonconsensual sexual intercourse and touch and associations with health-related factors : Results from the German Health and Sexuality Survey (GeSiD)]. / Lebenszeitprävalenz des Erlebens von Sex und sexueller Berührung gegen den eigenen Willen sowie Zusammenhänge mit gesundheitsbezogenen Faktoren : Ergebnisse aus der Studie Gesundheit und Sexualität in Deutschland (GeSiD).

BACKGROUND: In the last decade, the negative effects of sexual violence on health have again become a focus of health policies worldwide. So far, representative population data on lifetime prevalence for different age groups and specific links to health-related factors for Germany are lacking. OBJECTIVES: The study aimed to assess 1) the lifetime prevalence of self-reported nonconsensual sexual intercourse and sexual touch in childhood and across the lifespan and 2) associations with health-related factors. MATERIALS AND METHODS: Using a two-step stratified, randomized sample of residents' registration offices, 4955 persons aged 18 to 75 years were interviewed within the scope of the nationwide scientific survey on health and sexuality in Germany (GeSiD). The associations between experiences of sexual violence and socio-demographic and health-related factors were age-adjusted and stratified for gender using logistic regression. RESULTS: For women, the lifetime prevalence of (attempted/completed) nonconsensual intercourse was 14.9% and in the form of (attempted/completed) nonconsensual sexual touching was 40.8%; for men the prevalences were 3.1% and 13.2%, respectively. Regarding forced experiences in childhood, the prevalence of sex was 2.1% and of sexual touching was 7.5%. For both genders, the prevalence of nonconsensual intercourse was significantly higher in the case of low quality of life, poor health condition, a chronic illness or disability, or treatment for depression or for another mental disorder. CONCLUSIONS: The results illustrate the strong links between sexual violence and mental and somatic health. This points to the urgency to routinely explore experiences of sexual aggression.

Single and Multiple Orgasm Experience Among Women in Heterosexual Partnerships. Results of the German Health and Sexuality Survey (GeSiD).

BACKGROUND: Orgasm occurrence plays an important role in general sexual satisfaction for women. Until now, only few studies have focused on examining a broad spectrum of sexuality- and relationship-specific factors associated with orgasm in heterosexual women currently in a long-term relationship or on differences between the overall experience of orgasm and multiple orgasms. AIM: The present study aims to understand how various sexuality- and relationship-associated factors are related to experiencing partnered orgasm among heterosexual women having stable relationships in Germany. Moreover, the study aims to differentiate between the overall experience of orgasm and the experience of multiple orgasms and shed light on their impact on general sexual satisfaction. METHODS: Within the nationwide representative survey GeSiD (German Health and Sexuality Survey), n = 1,641 sexually active women aged between 18 and 75 years in heterosexual relationships reported their experience of orgasm during the latest sexual encounter. Data on the type of sexual practices, frequency of sexual activity and of masturbation, relationship satisfaction, feelings of love, closeness, and general sexual satisfaction were analyzed. OUTCOMES: The overall experience of orgasm, the experience of multiple orgasms, and associations between experiencing orgasm and sexual satisfaction. RESULTS: Frequency of sexual activity, relationship satisfaction, feelings of love and closeness were moderately to strongly positively correlated with each other and each showed positive associations with the likelihood of orgasm. Greater number of sexual practices and frequency of sexual activity were associated with an increased likelihood of experiencing multiple orgasms, which in turn was correlated with higher sexual satisfaction. CLINICAL IMPLICATIONS: In clinical and therapeutic work with women who have difficulty achieving orgasm, central issues should be the perceived relationship quality as well as regular sexual activity with the partner. STRENGTHS & LIMITATIONS: The present population-representative study is the first in Germany to identify significant factors associated with the experience of orgasm among heterosexual women in relationships. Further studies ought to include the frequency of orgasms in partnered sex over a longer period of time as well as the experience of orgasm during masturbation. CONCLUSION: The experience of orgasm for women is related to a variety of complex interpersonal mechanisms and to be associated with sexual satisfaction. Cerwenka S, Dekker A, Pietras L, et al. Single and Multiple Orgasm Experience Among Women in Heterosexual Partnerships. Results of the German Health and Sexuality Survey (GeSiD). J Sex Med 2021;18:2028-2038.

[The German health and sexuality survey (GeSiD)-a brief introduction to the study]. / Die GeSiD-Studie "Gesundheit und Sexualität in Deutschland" ­ eine kurze Einführung.

Until 2020, there was no representative sex survey for Germany with published data. The GeSiD study "Health and Sexuality in Germany" is the first nationwide, representative sex survey. The aim of this paper is to provide a brief introduction to the German health and sexuality (GeSiD) survey.A total of 4955 persons (2336 men, 2619 women) aged 18-75 years were interviewed between 2018 and 2019. The computer-assisted face-to-face interviews had an extensive self-completion section and asked about a wide range of sexual behaviour and sexual health topics. Data on sexual identity, relationships, sexual behaviour, and sexual health were assessed. Data show, among other things, that only a minority of respondents had ever talked to a healthcare provider about HIV/AIDS or other sexually transmitted infections (STIs).Data show a clear need for education, information dissemination, and training in the area of sexual health.

[How good is the knowledge about sexually transmitted infections in Germany? : Results of the first nationwide representative German health and sexuality survey (GeSiD)]. / Wie gut ist das Wissen über sexuell übertragbare Infektionen in Deutschland? : Ergebnisse der ersten bundesweiten repräsentativen Befragung zu Gesundheit und Sexualität (GeSiD).

BACKGROUND: Sexually transmitted infections (STIs) are a relevant risk factor for the sexual health of individuals and the population. Therefore, the level of awareness and knowledge about STIs in different population groups is of particular interest for specific prevention work. OBJECTIVES: The aim of this study was to analyze the awareness of and knowledge about nine STIs in the German population. To do so, the study examined correlations with sociodemographic variables, sexuality-related characteristics, and subjective satisfaction with the level of information. METHODS: The GeSiD study "German Health and Sexuality Survey" collected representative quantitative data from 4955 persons via face-to-face interviews on the state of knowledge about STIs. As a selection procedure, a two-step random sample was collected. Firstly, 200 sample points (municipalities) were initially selected proportionally across Germany. Secondly, a random sample of addresses was drawn from the respective residents' registration offices. The participation rate was 30.2%; the average age was 46.3 years. RESULTS: Knowledge about HIV/AIDS was widespread in all age groups, but other STIs were significantly less known. Older people and respondents with a low level of education were particularly poorly informed. Local social disadvantage and a family history of migration were also negatively correlated with knowledge about STIs. A higher number of sexual partners is related to a better level of knowledge. In addition, persons who do not describe their sexual orientation as heterosexual as well as those with a history of STIs were well informed. CONCLUSION: Heterosexual adults in Germany are insufficiently informed about the risks of STIs. Therefore, target-group-specific efforts are needed to improve knowledge about STIs in order to reduce sexual risk behavior and improve the utilization of prevention programs among socially disadvantaged groups.

Methodology of the German National Sex Survey - GeSiD (German Health and Sexuality Survey).

The German Health and Sexuality Survey (GeSiD) was carried out in 2018/2019 to provide up-to-date measures of sexual behavior, sexual attitudes and sexual lifestyles of the adult population. We describe the methods used in GeSiD which surveyed the general population in Germany aged 18-75 years (with oversampling of younger adults aged 18-35 years). This article focuses on study design, recruitment, and response rate and discusses the strategies implemented to enhance the response rate compared to the pilot study. Overall, 4.955 interviews were completed with a response rate of 30.2%. The data were weighted by age, gender, education, nationality, and region to reduce possible bias. Compared to the German 2018 census, the weighted sample provides good representativeness for selected respondent characteristics. The computer-assisted interviews consisted of a combination of face-to-face and self-completion components. They covered a broad perspective on sexual health, which included topics such as online sexual activities, pleasure, sexual dysfunction, and sexual violence. Reliable data on sexual and reproductive health in Germany are urgently needed for evidence-based prevention and health promotion work, to inform sexual health policy and for cross-national comparisons of the development of sexual behavior in Europe.

VR Porn as "Empathy Machine"? Perception of Self and Others in Virtual Reality Pornography.

The usage of virtual reality (VR) pornography has risen in recent years. Anecdotal evidence suggests that the steep increase may be driven by an essential difference compared to traditional pornography, namely strong feelings of intimacy and the illusion of interaction with the porn actors. The present study is the first to systematically address this topic in an experimental design. Fifty healthy male participants watched two pornographic films on consecutive days in the laboratory, randomly one in VR and one traditional two-dimensional (2D) film. The perception of 2D and VR pornography was assessed using several self-report measures. Furthermore, the role of the social neuropeptide oxytocin in facilitating intimacy and interaction was studied. In the VR condition, participants felt more desired, more flirted with, more looked into the eyes. They were also more likely to feel connected with the actors and more likely to feel the urge to interact with them. Interestingly, saliva levels of oxytocin were related to the perceived eye-contact with the virtual persons indicating a role for the social neuropeptide in the perception of increased intimacy and interaction in VR. Thus, VR pornography seems to be a powerful tool to elicit the illusion of intimate sexual experiences.

Health, Sexual Activity, and Sexual Satisfaction.

BACKGROUND: Physical and mental health disorders can markedly affect sexual activity and sexual satisfaction. Until now, there has been a lack of representative data from the German population that could serve as a basis for demonstrating specific links between sexuality and health. METHODS: In the German Health and Sexuality Survey (GeSiD), 4955 men and women in a two-step stratified random sample drawn from local resident registration offices across Germany were surveyed by questionnaire. The response rate was 30.2%. The questions involved, among other things, the respondents' selfassessment of sexual activity and sexual satisfaction, general health status, and any chronic illnesses or disabilities. RESULTS: The percentage of respondents who reported having been sexually active with one partner in the past four weeks was highest among men aged 36 to 45 and women aged 26 to 35. In male respondents, the likelyhood of having been sexually active in the past four weeks decreased from 79.1% to 59.0% and 30.1%, respec - tively, if they described their own health status as fair or bad compared with those in very good health. In female respondents the decrease was from 72.5 % to 48.0 % and 32.4%, respectively. A comparable association was found with self-reported chronic illnesses and disabilities that were perceived as impairing sexuality. Sexual satisfaction was present to a similar extent in all age groups. CONCLUSION: Self-reported physical and mental illnesses are often associated with marked impairment of sexuality. Even illnesses without any immediately evident relation to sexuality often affect aspects of sexual health. It is, therefore, advisable for physicians to address their patients' sexuality routinely in everyday clinical practice.

Estimating the Prevalence of Sexual Dysfunction Using the New ICD-11 Guidelines.

BACKGROUND: The 11th edition of the International Statistical Classification of Diseases (ICD-11) is due to come into force in 2022. The goal of the present partial evaluation of the GeSiD study findings is to provide the first ever estimate of the prevalence of different types of sexual dysfunction in Germany as defined by the diagnostic guidelines that are soon to take effect. METHODS: The representative GeSiD study was carried out in 4955 men and women who belonged to a doubly stratified random sample of data from residence registration offices across Germany. The participation rate was 30.2%. Various types of sexual dysfunction were ascertained for the first time by means of a screening instrument based on the new ICD-11 guidelines. RESULTS: The reported prevalence of one or more sexual problems, including mild distress, in the previous 12 months was 33.4% in men (95% confidence interval [31.0; 35.9]) and 45.7% in women [43.0; 48.4]. Some 80.4% of men and 72.1% of women stated that they had had at least one sexual contact in the past year. Sexual dysfunction causing marked distress, as per the ICD-11 guidelines, was reported by 13.3% [11.6; 15.1] of the sexually active men (most commonly, erectile dysfunction in 6.6% and early ejaculation in 4.5%), and by 17.5% [15.6; 19.6] of the sexually active women (most commonly, hypoactive sexual desire in 6.9% and orgasmic dysfunction in 5.8%). Orgasmic dysfunction was approximately twice as common in women as delayed ejaculation was in men. The prevalence of erectile dysfunction increased with age, while that of early ejaculation decreased. Women felt particularly impaired by pain associated with sexual activity. CONCLUSION: The findings of this study indicate the importance of sexual dysfunction as an obstacle to sexual health. The study provides the first prevalence estimates for the new ICD-11 guidelines and simultaneously offers a screening instrument for sexual dysfunction that can be used economically in routine practice.

[Heterosexual Practices in Different Generations - Findings of a Pilot Study for "GeSiD Gesundheit und Sexualität in Deutschland (Health and Sexuality in Germany)"]. / Heterosexuelle Praktiken in unterschiedlichen Generationen ­ Ergebnisse einer Pilotstudie zu "GeSiD Gesundheit und Sexualität in Deutschland".

OBJECTIVES: There is a lack of broad representative data in Germany in order to analyze the lifetime experiences of heterosexual adults with different sexual practices. Differences between generations were investigated with regard to whether specific sexual experiences were more common in the generation aged from 18 to 30 years (the Digital Natives) than in the older generations, particularly referring to the generation of the 61- to 75-year-olds, whose sexual socialization was not yet embedded into the presence of new media. For young adults it was analyzed to what extent diversifications of the sexual repertoire can be depicted. METHODS: In a pilot-study (2) for GeSiD - Gesundheit und Sexualität in Deutschland (Health and Sexuality in Germany) - in 2017, a representative survey was carried out on 1155 persons aged from 18 to 75 years. Data from heterosexual men and women regarding lifetime experiences with different sexual practices and sexuality-related experiences were analyzed. RESULTS: In the generation of the 18 to 30 year olds, experiences with oral practices and the use of a dildo/vibrator were more common in women as well as sadomasochistic/BDSM-practices in both women and men compared with older generations. While in women there were hardly any differences between the 18 to 25 year olds and the 26 to 30 year olds, a higher percentage of young men revealed having not made a variety of sexual experiences. Oral practices, active anal stimulation and sexual role play were reported slightly more often by 26 to 30 year old men than by older ones. In the generation of the 61 to 75 year olds, experiences with oral and manual practices were reported less commonly by women as well as anal practices and the use of a dildo/vibrator by women and men in comparison with younger generations. DISCUSSION: The ongoing process of digital revolution at the end of the 20th century induced a fundamental societal change, which is also reflected in different ranges of sexual experiences in the generations. CONCLUSION: The results allow first insights into heterosexual practices among different generations in Germany that may provide valuable clues for the steering of information and education campaigns as well as a psychoeducational basis for couple and sex therapy work.

Sexual Interest in Children Among Women in Two Nonclinical and Nonrepresentative Online Samples.

INTRODUCTION: Regarding women, little research is available about the prevalence of sexual interest in children (SIC), especially in nonclinical samples. AIM: The present study aimed to investigate the extent to which adult women from 2 nonclinical and nonrepresentative samples indicate sexual interest in prepubescent and/or pubescent children. METHODS: Participants took part in an online survey either via general websites or via websites directed toward individuals with a SIC. MAIN OUTCOME MEASURES: The self-report survey included questions about the use of online abuse material including children and teenagers as well as about sexual fantasies involving prepubescent and pubescent children. Both measures were included as main outcome measures. RESULTS: Results showed that few women reported having used online abuse material including children (total sample: n = 7 [0.8%], general websites: n = 3 [0.4%], SIC websites: n = 4 [9.5%]) or teenagers (total sample: n = 44 [5.0%], general websites: n = 37 [4.4%], SIC websites: n = 7 [16.7%]). Results further revealed that some women reported sexual fantasies involving prepubescent (total sample: n = 98 [7.0%], general websites: n = 92 [6.8%], SIC websites: n = 6 [11.1%]) or pubescent children (total sample: n = 136 [9.6%], general websites: n = 129 [9.5%], SIC websites: n = 7 [13.0%]). CONCLUSIONS: The samples included are nonrepresentative and therefore not generalizable to the female population. Nevertheless, they strongly suggest that SIC is a phenomenon also found in women. We therefore recommend professionals in the field of sexual medicine to increase their attention and engagement for women with SIC. Based on the present results, the development of preventive treatment services specifically tailored to women with a SIC has to be strongly encouraged in the near future. Tozdan S, Dekker A, Neutze J, et al. Sexual Interest in Children Among Women in Two Nonclinical and Nonrepresentative Online Samples. Sex Med 2020;8:251-264.

The Needs of LGBTI People Regarding Health Care Structures, Prevention Measures and Diagnostic and Treatment Procedures: A Qualitative Study in a German Metropolis.

(1) Background: Studies indicate that lesbian, gay, bisexual, transgender and intersex (LGBTI) people constantly face challenges and disadvantages in the health care system that prevent them from getting the best possible patient-centered care. However, the present study is the first to focus on LGBTI-related health in a major German metropolis. It aimed to investigate health care structures, prevention measures and diagnostic as well as treatment procedures that LGBTI individuals need in order to receive appropriate patient-centered health care and health promotion. (2) Methods: Following a participatory approach, five expert interviews with LGBTI people with multiplier function, i.e., people who have a key role in a certain social milieu which makes them able to acquire and spread information in and about this milieu, and three focus groups with LGBTI people and/or health professionals were conducted. Qualitative data were analyzed according to the principles of content analysis. (3) Results: The specific needs of LGBTI individuals must be recognized as a matter of course in terms of depathologization, sensitization, inclusion, and awareness. Such an attitude requires both basic knowledge about LGBTI-related health issues, and specific expertise about sufficient health care services for each of the minorities in the context of sex, sexual orientation and gender identity. (4) Conclusions: For an appropriate approach to LGBTI-centered health care and health promotion, health professionals will need to adopt a better understanding of specific soft and hard skills.