Influence of the COVID-19 pandemic on births and induced abortions in Southern Sweden: a register-based study.

BACKGROUND: Pandemics are linked with declining birth rates, but little is known about how the COVID-19 pandemic has influenced childbearing decisions. We aimed to investigate the associations between the COVID-19 pandemic and reproductive decisions, specifically to identify potential changes in the frequency of deliveries and induced abortions in Skåne, Sweden. METHODS: Using the Skåne Healthcare Register, we identified women aged 15-45 years who had at least one pregnancy-related care visit registered between 1 January 2013 and 11 November 11 2021. Deliveries and induced abortions were identified, and changes in weekly delivery and abortion counts were assessed using an interrupted time series design. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated from a Poisson regression model. RESULTS: During the study period we identified 129 131 deliveries and 38 591 abortions. Compared with the counterfactual (exposed interval assuming COVID-19 had not occurred), pandemic exposure was associated with fewer deliveries (RR 0.93; 95% CI 0.89 to 0.98). For abortions, pandemic exposure appeared to be associated with fewer abortions (RR 0.95; 95% CI 0.90 to 1.00); however, age-related differences were found. Among women aged 25 years and over, pandemic exposure was more strongly associated with fewer abortions. Contrastingly, among women aged under 25 years, abortions appeared to increase. CONCLUSIONS: The COVID-19 pandemic seemed to have contributed to a decline in births in Southern Sweden. During the same period, abortions declined in women in the older age range, but contrastingly increased among younger women.

The relationship between dominant Western discourse and personal narratives of female genital cutting: exploring storytelling among Swedish-Somali girls and women.

Introduction: A dominant narrative, referred to as "the standard tale," prevails in popular representations about female genital cutting (FGC) that often contrast with how cut women traditionally narrate their FGC experience as meaningful in contexts where FGC is customary. However, scholarship has increasingly highlighted how global eradication campaigns and migration to countries where FGC is stigmatized provide women with new frames of understanding which may lead to a reformulation of previous experiences. This article subjects the storytelling itself to analysis and explores how participants narrate and make sense of their FGC experience in a post-migration setting where FGC is stigmatized. Methods: Semi-structured focus groups (9) and individual interviews (12) with Swedish-Somali girls and women (53) were conducted. Results: The article highlights how the participants navigate their storying in relation to "the standard tale" of FGC in their efforts to make sense of their experiences. Navigation was conducted both at an intrapersonal level through continuous identity work, and in relation to the social context in interpersonal encounters, i.e., with service providers and others, among whom the standard tale has become a truth. Discussion: The article places the analysis within broader discussions about anti-FGC work and considers the implications in relation to efforts to end FGC.

Barriers to and strategies for dealing with vaginal dilator therapy - Female pelvic cancer survivors' experiences: A qualitative study.

PURPOSE: Vaginal changes, a frequently reported late effect among women treated with pelvic radiotherapy, can result in sexual dysfunction and distress. Women are recommended vaginal dilator therapy after completed radiotherapy; however, low adoption has been recognized. This study aims to provide insight into women's difficulties with carrying out vaginal dilator therapy and their experiences of information. METHODS: Face-to-face, semi-structured interviews were undertaken with 12 pelvic cancer survivors in a selected sample of women with difficulties adopting the therapy. Interviews were audio-recorded, transcribed and analyzed using qualitative content analysis. RESULTS: One overarching theme, Being unprepared, emerged from three identified categories relating to Experience of received information, Experience of performing the therapy, and Motivation to perform the therapy. The women experienced the information as unrealistic and insufficient, and requested clearer and earlier information. Bleeding, pain, fear of cancer recurrence, and recalling memories from treatments were experienced. Women described intestinal symptoms, fatigue, and feeling that the therapy was self-harm as barriers to performing the therapy. They described creating routines, breathing exercises, relaxation, pre-warming the dilator and performing therapy together with their partner as helpful strategies. CONCLUSIONS: Careful discussion, early and clear communication, psychoeducation and supportive follow-up of vaginal changes should be integrated into cancer treatment and follow up. Healthcare professionals should be aware of potential difficulties with vaginal dilator therapy and identify women in need of extended support. Research is required to investigate interventions that suit the needs of female pelvic cancer survivors.

The pros and cons of fertility awareness and information: a generational, Swedish perspective.

Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.

Sexuality >1 year after brain injury rehabilitation: A cross-sectional study in Sweden.

PURPOSE: This study investigates whether Acquired Brain Injury (ABI) is associated with changes in sexual function and satisfaction and how such changes are experienced, focusing on invisible impairments after ABI. MATERIALS AND METHODS: A study-specific questionnaire was distributed in 2018-2019. The sample included individuals aged 20-90 years diagnosed with ABI due to subarachnoid hemorrhage (SAH), trauma, infection, or anoxia (ischemic stroke and intracerebral hemorrhage excluded), who participated in brain injury rehabilitation in Sweden, 2014-2016. Chi-square and Logistic regression analyses were used. RESULTS: The study consists of 250 participants (response rate was 40%). Among participants 78% (194/250) had resumed sexual life. Participants reporting sexual changes also experienced more consequences related to ABI. Those with decreased sexual desire (63%, 148/234) reported more ABI consequences, including decreased memory (86% vs 65%, p = 0.000), decreased concentration ability (82% vs 65%, p = 0.003), and increased tiredness (91% vs 70%, p = 0.000) compared to those with intact desire. Such consequences can be invisible to others. CONCLUSION: Visible impairments are known to impact sexual functions and satisfaction after ABI. Our results show how invisible impairments also have a great impact. From a biopsychosocial perspective, these results imply that individuals should receive sexual rehabilitation, irrespective of ABI impairment.

Changes in Intimacy and Sexuality During the COVID-19 Pandemic: A Qualitative Analysis of Data from a Survey on Partnered Individuals in Eight European Countries.

This qualitative study explores experiences of intimacy and sexuality during the first phase of the COVID-19 pandemic of 3357 participants from Croatia, the Czech Republic, the Netherlands, France, Germany, Portugal, Sweden, and Turkey. Data were collected through open-ended questions within a survey on sexuality during the pandemic. Based on a reflexive thematic analysis three themes occurred. The first theme No change was described by 41% when summarizing their sex life during the pandemic. The second theme Positive change was experienced by 25%, and the third theme Negative change by 21%. An overarching theme then emerged as: "Still the same trajectories, but the pandemic could be a catalyst for improved or worsened sex- life." For those intimate partnered individuals who already had problems with intimacy and sexuality before the COVID-19 pandemic it seemed to remain the same or deteriorated throughout the pandemic. For those with positive experiences of intimacy and sexuality before the COVID-19 pandemic it remained the same or improved throughout the pandemic. These findings are relevant for researchers and clinicians in developing preventive and supportive interventions in the context of crisis and social isolation.

Sexual health and wellbeing among female pelvic cancer survivors following individualized interventions in a nurse-led clinic.

PURPOSE: Treatment-induced sexual and intestinal dysfunctions coexist among women after pelvic radiotherapy. We aimed to explore if sexual health and wellbeing may be improved after radiotherapy following nurse-led interventions and if an association exists between improved intestinal health and sexual health. METHODS: A population-based cohort of women treated with pelvic radiotherapy underwent interventions at a nurse-led clinic at Sahlgrenska University Hospital, Sweden, from 2011 to 2017. Self-reported questionnaires were used, pre- and post-intervention, to compare self-reported changes in sexual health and wellbeing. A regression model was performed to explore the association between intestinal and wellbeing variables. RESULTS: Among the 260 female pelvic cancer survivors included in the study, more women reported increased than decreased satisfaction with overall sexual health post-intervention (26.0% vs. 15.3%, p = 0.035). They also reported significantly reduced superficial genital pain (25.8% vs. 13.1%, p ≤ 0.025), reduced deep genital pain (23.1% vs. 8.0%, p ≤ 0.001), increased QoL (42.7% vs. 22.4%, p < 0.001), and reduced levels of depression (43.1% vs. 28.0%, p = 0.003) or anxiety (45.9% vs. 24.4%, p < 0.001) post-intervention. We found a significant association between reduced urgency to defecate and improved satisfaction with overall sexual health (RR 3.12, CI 1.27-7.68, p = 0.004) and between reduced urgency to defecate with fecal leakage and reduced anxious mode (RR 1.56, CI 1.04-2.33, p = 0.021). CONCLUSION: Sexual health and wellbeing can be improved by interventions provided in a nurse-led clinic focusing on physical treatment-induced late effects. Further research to optimize treatment strategies in female pelvic cancer survivors is needed.

Perceived Changes in Sexual Interest and Distress About Discrepant Sexual Interest During the First Phase of COVID-19 Pandemic: A Multi-Country Assessment in Cohabiting Partnered Individuals.

Due to COVID-19 pandemic, different restrictive measures in terms of physical distancing and lockdowns have been introduced in most European countries, affecting all facets of social life. Currently, little is known about how partnered individuals perceive changes in their sexual life during this complex emergency. This study explored retrospectively assessed changes in sexual interest for one's partner and levels of distress related to perceived sexual interest discrepancy during the first phase of the pandemic in a large-scale online sample of partnered individuals (n = 4813; Mage = 38.5 years, SD = 10.74) recruited between May and July 2020 in seven European Union countries and Turkey. We also examined the possible role of approach/avoidance motives for sex in reported changes in sexual interest and associated distress. Most participants (53%) reported no change in their sexual interest during the pandemic, followed by those who reported an increase (28.5%). The pattern was similar across the eight countries. Distress about discrepant sexual interest, which was only weakly related to changes in sexual interest, was significantly associated with relationship quality and emotional closeness with a partner, coping with and worrying about the pandemic, and specific motivation for sex. In contrast to avoidant and relationship-focused approach motivation, ego-focused approach motivation was related to stable sexual interest during the pandemic. The current study contributes to the understanding of the link between sexual interest and complex emergencies. Considering that the COVID-19 pandemic continues, the reported experiences and perceptions are prone to change.

Fertility outcomes in women with pre-existing type 2 diabetes-a prospective cohort study.

OBJECTIVE: To study childbirth and the risk of miscarriage and infertility among women who have received a diagnosis of type 2 diabetes before the start of their reproductive journey. DESIGN: Register-based cohort study using the Skåne Healthcare Register SETTING: All healthcare visits for the whole population of the southernmost region in Sweden over the past 20 years PATIENT(S): All women who were aged 18-45 years between January 1, 1998 and December 31, 2019 and who received a clinical diagnosis of type 2 diabetes before their first childbirth, miscarriage, or infertility diagnosis (n = 230) were compared with a healthcare-seeking population of women without any type of diabetes, matched for calendar year and age (n = 179,434). INTERVENTION(S): None MAIN OUTCOME MEASURE(S): Childbirth, miscarriage, and infertility diagnosis RESULT(S): The birthrate was lower among women with type 2 diabetes (62.6% vs. 83.8%), and they were less likely to give birth (crude risk ratio [RR] = 0.73, 95% confidence interval [CI]: 0.66-0.81). They had a higher risk of experiencing a miscarriage (RR = 1.88, 95% CI: 1.50-2.36). The risk of infertility was increased (RR = 3.44, 95% CI: 2.88-4.10) as was the risk of having infertility and not giving birth (RR = 4.47, 95% CI: 3.44-5.82). All results remained the same after adjustment for polycystic ovary syndrome and obesity. CONCLUSION(S): Women with type 2 diabetes with onset before their reproductive journey were more often childless compared with women without diabetes and had a higher risk of experiencing both miscarriage and infertility. This patient group may be in need of targeted information regarding potential fertility issues as part of their clinical treatment.

Cohort profile: an observational longitudinal data collection of health aspects in a cohort of female cancer survivors with a history of pelvic radiotherapy-a population-based cohort in the western region of Sweden.

PURPOSE: The study 'Health among women after pelvic radiotherapy' was conducted in response to the need for more advanced and longitudinal data concerning long-term radiotherapy-induced late effects and chronic states among female cancer survivors. The objective of this paper is to detail the cohort profile and the study procedure in order to provide a sound basis for future analyses of the study cohort. PARTICIPANTS: Since 2011, and still currently ongoing, participants have been recruited from a population-based study cohort including all female patients with cancer, over 18 years of age, treated with pelvic radiotherapy with curative intent at Sahlgrenska University Hospital in Gothenburg, in the western region of Sweden, which covers 1.7 million of the Swedish population. The dataset presented here consists of baseline data provided by 605 female cancer survivors and 3-month follow-up data from 260 individuals with gynaecological, rectal or anal cancer, collected over a 6-year period. FINDINGS TO DATE: Data have been collected from 2011 onwards. To date, three studies have been published using the dataset reporting long-term radiation-induced intestinal syndromes and late adverse effects affecting sexuality, the urinary tract, the lymphatic system and physical activity. These projects include the evaluation of interventions developed by and provided in a nurse-led clinic. FUTURE PLANS: This large prospective cohort offers the possibility to study health outcomes in female pelvic cancer survivors undergoing a rehabilitation intervention in a nurse-led clinic, and to study associations between demographics, clinical aspects and long-term late effects. Analysis focusing on the effect of the interventions on sexual health aspects, preinterventions and postinterventions, is currently ongoing. The cohort will be expanded to comprise the entire data collection from 2011 to 2020, including baseline data and data from 3-month and 1-year follow-ups after interventions. The data will be used to study conditions and treatment-induced late effects preintervention and postintervention.

Preconditions to parenthood: changes over time and generations.

Reproductive decision-making and fertility patterns change with time and place, and are influenced by contemporary societal factors. In this paper, we have studied biosocial aspects of reproductive decision-making over time and generations in a Nordic setting. The aim was to explore intergenerational changes and influences on decision-making, especially regarding preconditions to first birth. Twenty-six focus group interviews were conducted in southern Sweden, including a total of 110 participants aged 17-90 years. The analysis of the interviews resulted in six themes: (i) 'Providing security - an intergenerational precondition'; (ii) 'A growing smorgasbord of choices and requirements'; (iii) 'Parenthood becoming a project'; (iv) 'Stretched out life stages'; (v) '(Im)possibilities to procreate'; and (vi) 'Intergenerational pronatalism'. Our findings reflect increasing expectations on what it means to be prepared for parenthood. Despite increasing awareness of the precariousness of romantic relationships, people still wish to build new families but try to be as prepared as possible for adverse events. The findings also show how increasing life expectancy and medical advancements have come to influence people's views on their reproductive timeline.

Sexual health and wellbeing after pelvic radiotherapy among women with and without a reported history of sexual abuse: important issues in cancer survivorship care.

AIMS: Sexual abuse is a women's health concern globally. Although experience of sexual abuse and cancer may constitute risk factors for sexual dysfunction and low wellbeing, the effects of sexual abuse have received little attention in oncology care. This study aims to explore sexual health and wellbeing in women after pelvic radiotherapy and to determine the relationship between sexual abuse and sexual dysfunction, and decreased wellbeing. METHODS: Using a study-specific questionnaire, data were collected during 2011-2017 from women with gynaecological, anal, or rectal cancer treated with curative pelvic radiotherapy in a population-based cohort and a referred patient group. Subgroup analyses of data from women with a reported history of sexual abuse were conducted, comparing socio-demographics, diagnosis, aspects of sexual health and wellbeing. RESULTS: In the total sample of 570 women, 11% reported a history of sexual abuse and among these women the most common diagnosis was cervical cancer. More women with than without a history of sexual abuse reported feeling depressed (19.4% vs. 9%, p = 0.007) or anxious (22.6% vs. 11.8%, p = 0.007) and suffering genital pain during sexual activity (52% vs. 25.1%, p = 0.011, RR 2.07, CI 1.24-3.16). In the total study cohort, genital pain during sexual activity was associated with vaginal shortness (68.5% vs. 31.4% p ≤ 0.001) and inelasticity (66.6% vs. 33.3%, p ≤ 0.001). CONCLUSIONS: Our findings suggest that a history of both sexual abuse and pelvic radiotherapy in women are associated with increased psychological distress and sexual impairment, challenging healthcare professionals to take action to prevent retraumatisation and provide appropriate interventions and support.

A wonderful experience or a frightening commitment? An exploration of men's reasons to (not) have children.

Research on reproductive decision-making mainly focuses on women's experiences and desire for children. Men included in this type of research usually represent one-half of a heterosexual couple and/or men who are involuntarily childless. Perspectives from a broader group of men are lacking. This study is based on the results of a baseline questionnaire answered by 191 men aged 20-50 years who attended two sexual health clinics in two major Swedish cities. The questionnaire included questions about sociodemographic background, reproductive history and fertility, but also two open-ended questions focusing on reasons for having or not having children. The results of these two questions were analysed by manifest content analysis and resulted in five categories: '(non-)ideal images', 'to pass something on', 'personal development and self-image', 'the relationship with the (potential) co-parent' and 'practical circumstances and prerequisites'. Reasons for having children were mainly based on ideal images of children, family and parenthood. Meanwhile, reasons for not having children usually concerned practical issues. The type of answer given was related to men's procreative intentions but not to background characteristics. In conclusion, men raised many different aspects for and against having children. Therefore, reproductive decision-making should not be considered a non-choice among men.

"We should be experts, but we're not": Sexual counselling at the antenatal care clinic.

OBJECTIVE: Several studies show that nurses don't meet patients' needs in addressing issues around sexuality and sexual health. However, little attention has been paid to midwives' views on sexual counselling. This study explores midwives' views and experiences on sexual counselling during antenatal care. STUDY DESIGN: Semi-structured interviews were conducted with nine midwives at seven different antenatal care clinics in southern Sweden. The interviews were analysed with qualitative content analysis, and script theory was used as a theoretical perspective. RESULTS: The result showed that the midwives considered sexuality important but hard to address. Lack of time, knowledge, and encouragement from the managerial level and/or lack of counselling tools were given as reasons for not bringing it up. In addition, midwives' insecurity turned out to be even greater with patients that deviated from the heterosexual norm or had another cultural background. CONCLUSION: There are cultural and interpersonal scripts in the workplace in which sexuality is not expected to be addressed. As long as these are in place, only education will not help to change issues in addressing patients' sexuality. Organizational and managerial support along with education and opportunities for reflection and dialogue regarding sexual issues might help midwives to approach sexuality and change the cultural and interpersonal scripts.

Being "Good in Bed"-Body Concerns, Self-Perceptions, and Gender Expectations Among Swedish Heterosexual Female and Male Senior High-School Students.

We investigated gender differences regarding body perceptions, self-perceptions, values and expectations in sexual situations, and factors associated with expectations, among Swedish heterosexual female and male high-school students. A total of 2,765 students (aged 18 to 22) completed questionnaires. Women reported lower satisfaction with themselves and their body appearance (p < 0.001), and felt more inferior to their partner (p < 0.001). Men felt more superior to their partner, and felt higher expectations (p < 0.001). Male sex, difficulty saying no to sex, dissatisfaction with the body, feeling inferior or superior to partner, and considering partner's satisfaction as more important, were all associated with feeling expectations during sex.

Masturbation Experiences of Swedish Senior High School Students: Gender Differences and Similarities.

Research about masturbation tends to be limited to the assessment of masturbation incidence and frequency. Consequently, little is known about what people experience connected to masturbation. This might be one reason why theoretical approaches that specifically address the persistent gender gap in masturbation frequency are lacking. The aim of the current study was to explore several aspects of masturbation in young men and women, and to examine possible associations with their social backgrounds and sexual histories. Data from 1,566 women and 1,452 men (ages 18 to 22) from 52 Swedish senior high schools were analyzed. Comparisons between men and women were made regarding incidence of and age at first masturbation, the use of objects (e.g., sex toys), fantasies, and sexual functioning during masturbation, as well as about their attitudes toward masturbation and sexual fantasies. Cluster analysis was carried out to identify similarities between and differences within the gender groups. While overall more men than women reported experience with several of the investigated aspects, cluster analyses revealed that a large proportion of men and women reported similar experiences and that fewer experiences are not necessarily associated with negative attitudes toward masturbation. Implications of these findings are discussed in consideration of particular social backgrounds.

Vulvar Pain-Associations Between First-Time Vaginal Intercourse, Tampon Insertion, and Later Experiences of Pain.

This study examines associations between the first experience of vaginal intercourse/tampon insertion and later experiences of vulvar pain. The study is based on questionnaire data from 1,259 Swedish female senior high-school students, aged 18 to 22 years old. Of these, 592 women reported present vulvar pain. Present vulvar pain was associated with first-time experiences of vaginal intercourse (pain, negative experience, against will) and with pain at tampon insertion. First-time experiences were also related to temporal aspects of present vulvar pain during vaginal intercourse (at the beginning, after a while during, and after). Implications of first-time experiences of vaginal intercourse for future symptoms of vulvar pain are discussed.

Sexual interaction or a solitary action: young Swedish men's ideal images of sexual situations in relationships and in one-night stands.

OBJECTIVE: It seems that traditional gender norms influence young women's and men's sexuality differently. However, little attention has been paid to ideal images of sexual situations. This study identifies young heterosexual men's ideal images of sexual situations and their expectations of themselves in sexual situations. STUDY DESIGN: The present study employs a qualitative design. Twelve Swedish men (aged 16-20) participated in individual in-depth qualitative interviews. The interviews were transcribed verbatim and analysed using the constant comparative method from grounded theory. RESULTS: Our study revealed that the young men's conceptions of normal sexual situations were divided into two parts: sexual situations in relationships, and sexual situations in one-night stands. Their ideal image, "a balanced state of emotional and physical pleasure", was influenced by the presence/absence of intimacy, the partner's response, and their own performance. The greatest opportunities to experience intimacy and the partner's response were found during sexual situations in relationships. In one-night stands, the men wanted to make a good impression by performing well, and behaved according to masculine stereotypes. CONCLUSION: Stereotyped masculinity norms regulate young heterosexual men's sexuality, particularly in one-night stands. Sexual health promotion should emphasize the presence of these masculinity norms, which probably involve costs in relation to young men's sexual wellbeing.

Prioritizing the partner's enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse.

The present study examines the prevalence of women who continue to have vaginal intercourse (VIC) despite pain, avoid telling the partner, and feign enjoyment. It also considers the reasons for this behavior. A sample of 1566 female senior high school students (aged 18-22 years) completed a questionnaire concerning their experiences and attitudes toward their body and sexuality. Forty-seven percent (270/576) of those women who reported pain during VIC continued to have VIC despite the pain. The most common reasons were that they did not want to spoil sex for or hurt the partner by interrupting VIC. Feigning enjoyment and not telling the partner about their pain were reported by 22 and 33%, respectively. Continuing to have VIC despite pain was associated with feelings of being inferior to the partner during sex, dissatisfaction with their own sex lives and feigning enjoyment while having pain. Pain during VIC is reported by every third young Swedish woman, and almost half of those still continue to have VIC. The major reason given is noteworthy - prioritizing the partner's enjoyment before their own - and indicates that young women who continue to have VIC despite pain take a subordinate position in sexual interactions.

"Sexual pleasure on equal terms": young women's ideal sexual situations.

OBJECTIVE: The aim of this study was to identify young women's ideal images of sexual situations and expectations on themselves in sexual situations. STUDY DESIGN: We conducted audio-taped qualitative individual interviews with 14 women aged 14 to 20 years, visiting two youth centers in Sweden. Data were analysed with constant comparative analysis, the basis of grounded theory methodology. RESULTS: The women's ideal sexual situations in heterosexual practice were characterized by sexual pleasure on equal terms, implying that no one dominates and both partners get pleasure. There were obstacles to reaching this ideal, such as influences from social norms and demands, and experiences of the partner's "own run". An incentive to reach the ideal sexual situation was the wish to experience the well of pleasure. CONCLUSIONS: Our research further accentuates the importance of finding ways to focus on the complexity of unequal gender norms in youth heterosexuality. A better understanding of these cognitions is essential and useful among professionals working with youths' sexual health.