Engage In or Refrain From? A Qualitative Exploration of Premarital Sexual Relations Among Female College Students in Tehran.

This study explored the factors that educated young Iranian women consider when they decide whether to have premarital sex. Using a purposive sampling method, 30 in-depth interviews were conducted with female college students in both government and private universities in Tehran in 2005-2006. The respondents included unmarried women who had experienced sexual relations, unmarried women who had abstained, and married women. Young women's considerations for premarital sex included (1) marriage meaning and motivations; (2) compliance with family values and expectations; (3) perceived gender and social norms of premarital sex; (4) importance of religiosity; and (5) sexual knowledge and self-efficacy. Marriage meaning and motivation seem to be the central pillar in the complex decision to engage in or refrain from premarital sex among female college students. These considerations have theoretical implications for understanding premarital relationships and sex in a conservative setting. Finally, some shifts are occurring in the meaning of marriage and sexual mores among educated young women in Iran; these changes are discussed.

Health Risks in Same-Sex Attracted Ugandan University Students: Evidence from Two Cross-Sectional Studies.

Widespread discrimination across much of sub-Saharan Africa against persons with same-sex sexuality, including recent attempts in Uganda to extend criminal sanctions against same-sex behavior, are likely to have profound effects on this group's health, health care access, and well-being. Yet knowledge of the prevalence of same-sex sexuality in this region is scarce. This study aimed to systematically examine prevalence of same-sex sexuality and related health risks in young Ugandan adults. We conducted two cross-sectional survey studies in south-western Uganda targeting student samples (n = 980, n = 1954) representing 80% and 72% of the entire undergraduate classes attending a university in 2005 and 2010, respectively. A questionnaire assessed items concerning same-sex sexuality (same-sex attraction/fantasies, same-sex sexual relations), mental health, substance use, experience of violence, risky sexual behavior, and sexual health counseling needs. Our findings showed that same-sex sexual attraction/fantasies and behavior were common among male and female students, with 10-25% reporting having sexual attraction/fantasies regarding persons of the same-sex, and 6-16% reporting same-sex sexual relations. Experiences of same-sex sexuality were associated with health risks, e.g. poor mental health (2010, AOR = 1.5; 95% CI: 1.0-2.3), sexual coercion (2010, AOR 2.9; CI: 1.9-4.6), and unmet sexual health counseling needs (2010, AOR 2.2; CI: 1.4-3.3). This first study of young adults in Uganda with same-sex sexuality found high levels of health needs but poor access to health care. Effective response is likely to require major shifts in current policy, efforts to reduce stigmatization, and reorientation of health services to better meet the needs of this vulnerable group of young people.

Being forced to become your own Doctor - Men who have Sex with Men's Experiences of Stigma in the Tanzanian Healthcare System.

OBJECTIVE: To acquire a deepened understanding of how stigma in healthcare affects health-seeking behaviours of same-sex practising men in Tanzania. METHODS: In-depth interviews with twelve men were conducted in Dar es Salaam, 2012. Data were interpreted through qualitative content analysis. RESULTS: Narratives revealed that men's healthcare perceptions were shaped by previous encounters, rumours in gay community, norms and legislation around homosexuality. Fears of exposure aggravated men's possibilities of giving full anamnesis and detached them from formal healthcare services. CONCLUSIONS: Stigma in healthcare might lead to severe public health problems due to perceived exclusion from the health system by sexual minorities.

Outcomes of using the internet for sexual purposes: fulfillment of sexual desires.

BACKGROUND: The purpose of the current study was to examine the characteristics of those who report fulfillment of sexual desires as a result of internet use for sexual purposes and which sexually related online activities contribute to the fulfillment of sexual desires. METHODS: Data were collected through a questionnaire posted on Swedish-language websites in 2009. The sample comprised 1614 respondents who reported using the internet for sexual purposes, 62% women and 38% men. RESULTS: The results showed that the majority of the respondents had their sexual desires fulfilled as a result of their sexually related activities on the internet; 21% to a great extent and 59% to a small extent, but 20% did not have their sexual desires fulfilled. Using a multinomial logistic regression analysis, respondents who had their sexual desires fulfilled to a small or great extent were each compared with those who did not have their sexual desires fulfilled at all. At the level of individual characteristics and sexual behaviours, those with no fulfillment of their sexual desires did not differ from those who had their sexual desires fulfilled, with the exceptions of age and masturbation. In comparison to fulfillment to a small extent, fulfillment of sexual desires to a great extent was predicted by a larger number of sexually related online activities that were based on interaction. CONCLUSION: The findings suggest that the internet may contribute to fulfillment of sexual desires among a large internet population, irrespective of sex or sexual identity.

Technological advancements and Internet sexuality: does private access to the Internet influence online sexual behavior?

The aim of this study was to investigate whether demographic characteristics and sexual behavior online and offline were associated with private, respectively, nonprivate access to the Internet in a Web sample of people who use the Internet for sexual purposes. A total of 1,913 respondents completed an online questionnaire about Internet sexuality, and 1,614 reported using the Internet for sexual purposes. The majority of these respondents reported having access to an Internet-connected computer no one else had access to (62 percent women and 70 percent men). The results showed that it is possible to differentiate between those who have access to an Internet-connected computer no one else has access to and those who have shared access to an Internet-connected computer. Not only did they differ in demographic characteristics, but also in the sexual activities they engaged in on the Internet. Different patterns were found for women and men. For example, men who had private access to Internet-connected computers were more likely than those who had shared access to seek information about sexual issues. Thus, having access to Internet computers no one else has access to may promote sexual knowledge and health for men. The results of this study along with the technological development implies that in future research, attention should be paid to where and how people access the Internet in relation to online behavior in general and online sexual behavior in particular.

Occupational health and safety among commercial sex workers.

The concept of occupational health and safety (OHS) for commercial sex workers has rarely been investigated, perhaps because of the often informal nature of the workplace, the associated stigma, and the frequently illegal nature of the activity. We reviewed the literature on health, occupational risks, and safety among commercial sex workers. Cultural and local variations and commonalities were identified. Dimensions of OHS that emerged included legal and policing risks, risks associated with particular business settings such as streets and brothels, violence from clients, mental health risks and protective factors, alcohol and drug use, repetitive strain injuries, sexually transmissible infections, risks associated with particular classes of clients, issues associated with male and transgender commercial sex workers, and issues of risk reduction that in many cases are associated with lack of agency or control, stigma, and legal barriers. We further discuss the impact and potential of OHS interventions for commercial sex workers. The OHS of commercial sex workers covers a range of domains, some potentially modifiable by OHS programs and workplace safety interventions targeted at this population. We argue that commercial sex work should be considered as an occupation overdue for interventions to reduce workplace risks and enhance worker safety.

Prevalence, severity, and correlates of problematic sexual Internet use in Swedish men and women.

The content and prevalence of problematic Internet sexual use was investigated in a sample of 1,913 Internet-recruited younger Swedish men and women. Five items as part of a larger Internet sexual use study addressed problems associated with it, control, dysphoria, feeling "addicted," and feeling the need for treatment. The resulting scale of Internet sexual problems indicated that 5% of women and 13% of men reported some problems, with 2% of women and 5% of men indicating serious problems across the five items. Of five predictors of problematic use, three were significant: religiosity, having negative experiences with Internet sexual use, and frequency of pornography viewing. The viewing and sharing of pornography was most closely associated with reported problems. Data also suggested that having some very specific pornographic content interests were associated with an increase in reported problems. While these data were limited by the non-random nature of the sample, they suggest that Internet sexual problems are measurable, are a subset of Internet addiction with sexual content, and affect a small but significant proportion of the Internet-using population.

Lust, love, and life: a qualitative study of Swedish adolescents' perceptions and experiences with pornography.

There is a widespread concern in Western society about the visibility of pornography in public places and on the Internet. What are the consequences for young men and women, and how do they think about gender, sexuality, and pornography? Data was collected, through 22 individual interviews and seven focus groups, from 51 participants (36 women and 37 men aged 14-20 years) in Sweden. The results indicated a process of both normalization and ambivalence. Pornography was used as a form of social intercourse, a source of information, and a stimulus for sexual arousal. Pornography consumption was more common among the young men than among the women. For both the young men and women, the pornographic script functioned as a frame of reference in relation to bodily ideals and sexual performances. Most of the participants had acquired the necessary skills of how to deal with the exposure to pornography in a sensible and reflective manner.

Use of pornography in a random sample of Norwegian heterosexual couples.

This study examined the use of pornography in couple relationships to enhance the sex-life. The study contained a representative sample of 398 heterosexual couples aged 22-67 years. Data collection was carried out by self-administered postal questionnaires. The majority (77%) of the couples did not report any kind of pornography use to enhance the sex-life. In 15% of the couples, both had used pornography; in 3% of the couples, only the female partner had used pornography; and, in 5% of the couples, only the male partner had used pornography for this purpose. Based on the results of a discriminant function analysis, it is suggested that couples where one or both used pornography had a more permissive erotic climate compared to the couples who did not use pornography. In couples where only one partner used pornography, we found more problems related to arousal (male) and negative (female) self-perception. These findings could be of importance for clinicians who work with couples.

Using the Internet to find offline sex partners.

We aimed to expand upon the demographic characteristics and gender differences among those who have met someone on the Internet who they later met offline and had sex with as well as any relationship with cybersex, sexually transmitted infections, and online sexual problems. We analyzed data collected through an online questionnaire in 2002 in Sweden including a total population of 1836 respondents of which 1458 used the Internet for sexual purposes. Of those, 35% men and 40% women reported to have met offline sex partners online. The majority reported an occurrence of one to two times, whereas 10% reported six or more times. The analysis suggested women aged 34-49 and 50-65 years, homo- and bisexual men, and singles more likely to have this experience. They were also more likely to have engaged in cybersex. No relationships were found with sexually transmitted infections or online sexual problems. The results suggest that using the Internet to find sex partners may be less hazardous for the general Internet users than pointed out by prior research about this behavior often focusing on specific sub groups of Internet users.

An Internet study of cybersex participants.

Cybersex is a subcategory of online sexual activities (OSA) and is defined as when two or more people are engaging in sexual talk while online for the purposes of sexual pleasure and may or may not include masturbation. Cybersex is a growing phenomenon with a significant impact on participants but very little research has been done on this subject to date. This study is the first to attempt to delineate characteristics of those who engage in cybersex. Data were collected through an online questionnaire in Swedish, administered through the Swedish web portal Passagen.se. Out of the total sample (N = 1828), almost a third, both men and women, reported to have engaged in cybersex. A logistic regression analysis showed that age, sex, and sexual orientation were important demographic variables to consider when investigating cybersex. A comparison of interval data showed those engaging in cybersex to have a higher likelihood of spending more time online for OSA and having more offline sex partners than those not engaging in cybersex.

Characteristics of men who have sex with men on the internet but identify as heterosexual, compared with heterosexually identified men who have sex with women.

We compared men who have sex with other men on the Internet with the remainder of the sample of men who reported only sex with women on the Internet, in a sample of 1,846 Swedish men recruited from a major Swedish portal. We report on the self-identified heterosexual men in the sample who reported engaging in cybersex in the past year, and for whom there was complete data on sexual identity and the gender of cybersexual partners. Of the 244 cases with full data, 76% were heterosexual in both identity and behavior, 16% were gay or bisexual in identity and reported both male and female cybersexual contacts on the Internet, and 8% indicated their sexual preference was heterosexual but also reported at least one male sexual partner on the Internet. Thus, 11% of self-identified heterosexual men had sex with other men online. Comparing the two groups, the men who had sex with men (MSM) who did not identify (MSM-NI) spent significantly more time per week online, although a similar amount of time on sexual pursuits, as the heterosexual men. The MSM-NI were significantly more likely to agree that their online sexuality had affected their sexuality in a positive way, to have bought sex from prostitutes, to agree that they do things online that they would not do offline, have cybersex more often, use a web-camera and microphone more often, flirt and visit contact sites more often, and agree more often that sexual thoughts and behaviors are causing problems, desire to have sex creates problems, and sometimes fail to meet commitments due to their sexual behavior. These data taken together suggest that MSM-NI online are not uncommon and are characterized by the extent of their cybersexual involvement that sometimes extends to other men. Such men may rationalize this cybersex with other men as not, or minimally, sexual in much the same way as Humphreys characterized MSMs in public restrooms.

Biases in internet sexual health samples: comparison of an internet sexuality survey and a national sexual health survey in Sweden.

The internet is becoming a favored technology for carrying out survey research, and particularly sexual health research. However, its utility is limited by unresolved sampling questions such as how biased internet samples may be. This paper addresses this issue through comparison of a 'gold standard' random selection population-based sexual survey (The Swedish Sexual Life Survey) with an internet-based survey in Sweden which used identical demographic, sexual and relationship questions, to ascertain the biases and degree of comparability between the recruitment methods. On the internet questionnaire, there were significant differences between males and females on all the measured indices. There were no significant differences in proportions of males and females, or nationality, between the two samples. However, the internet samples for both males and females were significantly more likely to be younger, originally from and currently living in a major city, better educated, and more likely to be students and less likely to be retired. Relationship variables were less likely to be significantly different between samples: there were no differences for males or females between the SSS and the internet samples on having been in a committed relationship, and how they met their present partner, nor for males in having discussed separation in the past year. However, there was a higher proportion of people attracted to the same sex, and higher numbers of sex partners (as well as a higher proportion of people reporting no sex) in the past year, in the internet sample. These data suggest that apart from the demographics of age, location, and education, currently being in a committed relationship, and the number of sex partners in the past year, internet samples are comparable for relationship characteristics and history with a national sexual life survey. Comparison of internet data with random survey data in other western countries should occur to determine if these patterns are replicated.

Characteristics of men and women who complete or exit from an on-line internet sexuality questionnaire: a study of instrument dropout biases.

This study compared respondents who completed an Internet sexuality questionnaire and those who dropped out before completion. The study was in Swedish and comprised 3,614 respondents over a 2-week period (53% males, 47% females). There were significant differences between males, of whom 51% dropped out before completion of the 175-item questionnaire, and females, of whom 43% dropped out. Dropout in both genders followed a curve of negative acceleration. The data suggest that dropout is likely to be significant and gender and demographically biased, and to occur significantly earlier for men than for women. Geography, education, sexual orientation, age, relationship status, living arrangements, and Internet connection speed were related to dropout for men, while only relationship status and living arrangements, which were in the opposite direction from men, were related to dropout in women.