Effects of sexual counseling on sexual function and sexual quality of life of women with permanent intestinal ostomy.

BACKGROUND: Patients with an intestinal ostomy may experience significant sexual dysfunction that may have adverse impacts on quality of life. Appropriate sexual health counseling can be beneficial for these patients. AIM: This study was conducted to determine the effect of sexual counseling on the sexual function and sexual quality of life of women with a permanent intestinal ostomy. METHODS: For this experimental study, 60 female patients with a permanent intestinal ostomy were selected through convenience sampling and then randomly assigned to either the intervention or control groups. Patients in the intervention group received four 90-minute individual counseling sessions based on the PLISSIT (permission [P], limited information [LI], specific suggestions [SS], and intensive therapy [IT] model over a period of 4 weeks). The control group underwent routine training. Data were collected by use of a demographic information questionnaire, the Female Sexual Function Index, and the Sexual Quality of Life Female questionnaire. Both groups completed the questionnaires before and after the intervention. OUTCOMES: Study outcomes were the resulting data for the Female Sexual Function Index and the Sexual Quality of Life Female questionnaire. RESULTS: The results revealed a significant increase in the mean score of sexual function in the intervention group after counseling (P = .001). No significant difference was observed in the mean score of sexual quality of life between the 2 groups before the intervention (P > .05). In contrast, a significant increase was noted in the intervention group's sexual quality of life after the intervention (P = .001). CLINICAL IMPLICATIONS: The results indicate a need to sexual counseling interventions directed toward sexual function and sexual quality of life in women with permanent intestinal ostomy. STRENGTHS AND LIMITATIONS: Study strengths include utilization of the PLISSIT model for sexual counseling as an invaluable roadmap for healthcare professionals, systematically addressing patient needs within a tailored framework, and prescribing appropriate strategies over 4 distinct phases. Limitations include the use of convenience sampling and no follow-up duration. CONCLUSIONS: This study demonstrated the efficacy of counseling in enhancing sexual well-being of women with permanent intestinal ostomy.

Adapting the Client Priority Rating Scale to better fit the sexual health counselling setting: a quality improvement study.

BACKGROUND: When demand for counselling in community-based clinics exceeds capacity, waiting lists are typically formed. Determining allocation priority solely on wait time can overlook client risk factors that can elevate priority. We undertook to rigorously adapt the only existing validated counselling triage tool, to better fit the sexual health setting. METHODS: Sexual health counsellors were surveyed about aspects of client presentations that flagged increased priority. The revised Client Priority Rating Scale (CPRS-R) was created through systematic analysis and decision making, informed by survey results and literature review. Four expert sexual health counsellors independently rated the priority of 14 hypothetical clinical vignettes using the CPRS and CPRS-R. RESULTS: Criterion (concurrent), content and face validity are evidenced in the revised scale. Average interrater agreement was higher on the CPRS-R (28%) than the CPRS (11%); however, this difference was marginal (P =0.06). According to Gwet's Agreement Coefficient (AC) and Krippendorff's Alpha, both the CPRS and the CPRS-R demonstrate comparable interrater reliability, substantial and moderate, respectively. Kendall's W indicates the CPRS yielded higher reliability. However, the difference is not substantial. CONCLUSIONS: The CPRS-R is a triage tool designed for the sexual health counselling setting. This tool has demonstrated criterion, content and face validity, as well as moderate to substantial inter-rater reliability. It can be used in sexual health settings to inform assessments about client priority, along with clinical judgement and peer consultation.

Assessment of Jordanian Pharmacists’ Knowledge and Perception Regarding Sexual and Reproductive Health and their Practice in Providing Sexual Counseling to Patients

Objective: In this quantitative study, we intended to explore sexual/ reproductive counseling between Jordanian pharmacists by addressing pharmacists’ knowledge regarding sexual/ reproductive health and their perception and practice in providing counseling to patients. Method: This study adopted a survey methodology using a self-completed validated and administered unnamed survey. Participants were asked to fill-out the electronic survey after providing their electronic consent. Social media was utilized to extend the survey to facilitate contact multiple parts of pharmacists’ community. Results: In this study, 200 pharmacists agreed to participate in this study. Most of the pharmacists knew that depression (n= 182, 91%) and alcohol (n=171, 85.5%) were among the main factors that my decrease sexual performance. Also, only 38.5% of the pharmacists (n= 77) agreed that discussing sexual issues is the responsibility pf pharmacists, and only 55% of them (n= 110) felt comfortable discussing patients’ sexual matters as any medical issue. Moreover, more than two-third of the pharmacist (n= 146, 73%) reported that if they were consulted about sexual problem, they may explore patients’ problem. On the other side, only half of pharmacists (n= 102, 51%) revealed that they may discuss the side effects of prescribed drug if it might affect sexual performance. Conclusion: Education on sexuality/ reproduction is the key to help Jordanian pharmacists to advance patients’ sexual/ reproductive health. In general, research on sexual/ reproductive health in conservative societies is limited. Therefore, additional surveys that include the perspectives of both patients and pharmacists on sexuality/ reproduction to augment this normally ignored aspect of health are necessary. (AU)

Índice de satisfação do uso do DIU de cobre colocado no pós-parto imediato em pacientes do HSPM / Satisfaction index for the use of copper IUDs placed postpartum immediate response in HSPM patients

O objetivo do presente trabalho foi avaliar a taxa de satisfação do uso do DIU de cobre colocado no pós-parto imediato em puérperas no Hospital do Servidor Público Municipal na cidade de São Paulo. Foram selecionadas 103 pacientes que fizeram a inserção do DIU no pós-parto imediato nos anos de 2019 a 2021, independentemente do tipo de parto realizado ou paridade. Posteriormente, foram avaliados fatores como: grau de satisfação com o método inserido, controle de posicionamento adequado, aconselhamento sobre o método, razões e vantagens de sua utilização, eventos adversos obtidos, continuação do método e comportamento sexual. A avaliação de tais fatores foi feita por meio de um questionário com perguntas objetivas e subjetivas. De um total de 103 pacientes selecionadas no estudo, foi obtido contato com 44 mulheres. Destas, 28% classificaram o grau de satisfação com o DIU de cobre como muito satisfeita, 44,2% como satisfeita, 14% como um pouco satisfeita e 14% como não satisfeita. 88,4% indicariam o método para outras mulheres e não se arrependem de terem colocado. Quanto ao posicionamento do dispositivo, 38% não realizaram o acompanhamento e, das mulheres que acompanharam, 38% mantêm o DIU bem-posicionado e 24% mal posicionado. Em relação ao aconselhamento prévio, 66% das pacientes foram aconselhadas sobre o DIU no próprio momento do parto e 93,2% dessas afirmam terem tido todas suas dúvidas sanadas, inclusive relacionadas as IST. No momento da colocação, 56,8% já conheciam o método, seus riscos e benefícios. Quanto a permanência do método, 19 pacientes não persistiram com o método devido a fatores relacionados a aumento/alteração do fluxo menstrual (6 mulheres), expulsão espontânea do DIU (6 mulheres) ou mau posicionamento (7 mulheres). De modo geral, a grande maioria das pacientes entrevistadas permanecem com o método escolhido, possuem altas taxas de satisfação (72,2%), indicariam o uso para outras mulheres e não se arrependem da escolha do método. O pré-parto foi o momento em que a maioria foi aconselhada sobre o DIU pós-parto, mostrando que o assunto ainda é pouco abordado durante o pré-natal. O acompanhamento precoce deve ser encorajado para detectar expulsões e enfrentar possíveis problemas como mau posicionamento. Assim, o uso DIU de cobre no pós-parto imediato mostrou que houve satisfação por parte da paciente principalmente pela sua conveniência, pela contracepção no pós-parto e pelo tempo de uso. Palavras-chave: Contracepção. DIU. Período Pós-parto. Dispositivos Intrauterinos.

Violência sexual e aborto legal: possibilidades e desafios da atuação psicológica / Sexual offence and legal abortion: opportunities and challenges from psychological working / Violencia sexual y aborto legal: posibilidades y desafíos de la atención psicológica

A violência sexual e o aborto legal são temas tabus em nossa sociedade. No campo da saúde, a(o) psicóloga(o) atua em fases distintas, seja na avaliação psicológica do pedido pelo aborto legal, que culminará ou não em sua aquiescência; seja no momento posterior à solicitação, no atendimento em enfermarias ou ambulatorial. Partindo de relato de experiência, este artigo tem como objetivo refletir sobre as possibilidades e desafios da atuação psicológica no atendimento em saúde para pessoas em situação de gestação decorrente de violência sexual e que buscam pelo aborto legal. Para tanto, dividimos o artigo em três momentos. No primeiro deles, será possível encontrar dados conceituais, estatísticos e históricos sobre ambos os temas, trazendo recortes nacionais e internacionais. No segundo, trazemos apontamentos sobre o que chamamos de "eixos norteadores", ou seja, dialogamos com aspectos fundamentais para o trabalho nesta seara, sendo eles gênero, família, sexualidade e trauma. Por fim, no terceiro, aprofundamos a reflexão sobre o atendimento psicológico atrelado aos conceitos já discutidos, analisando de forma crítica principalmente um dos pontos mais espinhosos da atuação: a avaliação para aprovação (ou recusa) do pedido pelo aborto. Apoiamo-nos no referencial psicanalítico e defendemos que esta atuação psicológica é primordialmente uma oferta de cuidado, comprometido com as demandas das pessoas atendidas e com a promoção de saúde mental, e consideramos que o papel da psicologia é essencial para o reconhecimento do sofrimento e dos efeitos do abandono socioinstitucional na vida do público atendido.(AU)

Sexual abuse and legal abortion are taboo subjects in our society. On the health area, the psychologist works on different fields, such as psychological evaluation from the request of legal abortion, that will end or not on its approval, and also in a further moment, either the care on wards or ambulatorial treatment. Relying on a case report, this article aims to contemplate the possibilities and challenges from psychological work on healthcare to pregnant women from sexual violence and seek legal abortion. For this purpose, we divide this article in three moments. On the first, it will find definitions, statistics, and historical data about both issues, including national and international information. On the second, we bring notes called 'guiding pillar,' that is, we interact with fundamental aspects from this area, such as gender, family, sexuality, and trauma. On the third one, in-depth discussions we dwell on psychological care tied to the concepts previously addressed, critically analyzing one of the hardest moments of working in this area: the evaluation to approve (or refuse) the request for abortion. We lean over psychoanalytic thoughts and argue that this psychological work is primarily an offer of care, committed to the needs from those who seek us and to promoting good mental health and, also, we consider that psychology is essential to acknowledge the suffering and the effects of social and institutional neglect on the lives of the people seen.(AU)

La violencia sexual y el aborto son temas tabús en nuestra sociedad. En el campo de la salud, el(la) psicólogo(a) actúa en diferentes fases: en la evaluación psicológica de la solicitud del aborto legal, que culminará o no en su obtención, y/o en el momento posterior a la solicitud en la atención en enfermería o ambulatorio. Desde un reporte de experiencia, este artículo pretende reflexionar sobre las posibilidades y los desafíos de la Psicología en la atención en salud para personas en estado de embarazo producto de violencia sexual y que buscan un aborto legal. Para ello, este artículo está dividido en tres momentos. En el primer, presenta datos conceptuales, estadísticos e históricos sobre los dos temas, trayendo recortes nacionales e internacionales. En el segundo, comenta los llamados "ejes temáticos", es decir, se establece un diálogo con aspectos fundamentales para el trabajo en este ámbito, como género, familia, sexualidad y trauma. Por último, en el tercer, profundiza en la reflexión sobre la atención psicológica asociada a los conceptos discutidos, analizando de forma crítica uno de los puntos más espinosos de la actuación: la evaluación para la aprobación (o negativa) de la solicitud de aborto. Se utilizó el referencial psicoanalítico y se argumenta que esta atención psicológica es sobre todo una forma de cuidado, comprometida con las demandas de las personas atendidas y la promoción de la salud mental, y el papel de la Psicología es esencial para reconocer el sufrimiento y los efectos del abandono socioinstitucional en la vida del público atendido.(AU)

Comparison Between the Effect of the Information-Motivation-Behavioral (IMB) Model and Psychoeducational Counseling on Sexual Satisfaction and Contraception Method Used Under the Coercion of the Spouse in Iranian Women: A Randomized, Clinical Trial / Comparação entre o efeito do modelo Informação-Motivação-Comportamental (IMB) e o aconselhamento psicoeducacional sobre a satisfação sexual e o método contraceptivo usado sob coerção do cônjuge em mulheres iranianas: um ensaio clínico randomizado

Abstract Objective Women play an essential role in maintaining the family's health, and family planning is part of women's and families' health. The couple's mutual understanding of family planning methods is essential in selecting contraception. Acceptance of and satisfaction with different contraception methods can impact sexual satisfaction. The present study aimed to compare the effect of the information-motivation-behavioral (IMB) model and psychoeducational counseling on sexual satisfaction and contraception methods of women referring to health centers in Kerman. Methods This trial was conducted on 81 women aged 18 to 45, in Kerman health centers, from 2021 to 2022. Participants were randomly divided into 3 groups of 27 people (control, psychoeducational counseling, and IMB method). Three online counseling sessions were held for the psychoeducational group, and four were held for the IMB group. The control group received routine care. The IBM SPSS Statistics for Windows, version 22 (IBM Corp. Armonk, NY, USA) was used for data analysis using nonparametric Friedman and Kruskal-Wallis tests. Results The mean age of participants was 32.59 ± 7.04, and the majority of them had university degrees and were homemakers. The mean sexual satisfaction score significantly increased immediately after the intervention and 1 month later in the 2 interventional groups (p< 0.0). Changes in contraception methods after intervention were significant in the psychoeducational group (p= 0.0) Conclusion The results indicate the positive impact of psychological counseling on women's sexual satisfaction and contraception method. The IMB method also impacted men's sexual satisfaction but did not lead to any changes in the contraceptive method.

Resumo Objetivo A mulher desempenha um papel essencial na manutenção da saúde da família, e o planejamento familiar faz parte da saúde da mulher e da família. A compreensão mútua do casal sobre os métodos de planejamento familiar é essencial na seleção da contracepção. A aceitação e a satisfação com os diferentes métodos contraceptivos podem afetar a satisfação sexual. O presente estudo teve como objetivo comparar o efeito do modelo informação-motivação-comportamental (IMB) e aconselhamento psicoeducacional sobre a satisfação sexual e métodos contraceptivos de mulheres encaminhadas para centros de saúde em Kerman. Métodos Este estudo foi realizado em 81 mulheres de 18 a 45 anos, nos centros de saúde de Kerman, de 2021 a 2022. As participantes foram divididas aleatoriamente em 3 grupos de 27 pessoas (controle, aconselhamento psicoeducacional e método IMB). Foram realizadas três sessões de aconselhamento online para o grupo psicoeducativo e quatro para o grupo IMB. O grupo de controle recebeu cuidados de rotina. OIBM SPSS Statistics for Windows, versão 22 (IBM Corp. Armonk, NY, EUA) foi utilizado para a análise dos dados por meio dos testes não paramétricos de Friedman e Kruskal-Wallis. Resultados A média de idade das participantes foi de 32,59 ± 7,04, sendo que a maioria delas possuía nível superior e eram donas de casa. A pontuação média de satisfação sexual aumentou significativamente imediatamente após a intervenção e 1 mês depois nos 2 grupos de intervenção (p <0,0). As mudanças nos métodos contraceptivos após a intervenção foram significativas no grupo psicoeducativo (p = 0,0) Conclusão Os resultados indicam o impacto positivo do acompanhamento psicológico na satisfação sexual das mulheres e no método contraceptivo. O método IMB também impactou a satisfação sexual dos homens, mas não levou a nenhuma mudança no método contraceptivo.

Get2PrEP: An Electronic Medical Record Laboratory Comment Increased Safe Sex Counseling But Not Preexposure Prophylaxis Services at a Large Urban Academic Medical Center in Northern Manhattan.

BACKGROUND: HIV preexposure prophylaxis (PrEP) remains underutilized despite its efficacy and potential population impact. Achieving PrEP's full potential depends on providers who are knowledgeable and comfortable prescribing it to individuals at risk of acquiring HIV. Previous educational interventions targeting provider-related uptake barriers have had limited success. We designed and tested an electronic medical record (EMR) interpretative comment to improve the delivery of PrEP. METHODS: An EMR comment provided information on PrEP eligibility and referral resources to providers delivering positive chlamydia and gonorrhea results. Positive test results for bacterial sexually transmitted infections before intervention (January 1, 2019-August 23, 2019) and after intervention (August 24, 2019-December 31, 2019) were identified. A retrospective chart review was conducted to ascertain provider documentation of PrEP discussions or provision, HIV prevention discussions, and HIV screening. Pretest-posttest analysis was performed to compare the provision of PrEP and HIV prevention services. RESULTS: We reviewed 856 preintervention encounters spanning 8 months and 461 postencounters spanning 4 months. Patient demographics were comparable. We observed an increase in provider documentation of safe sex and condom counseling (odds ratios [ORs], 1.2 [95% confidence interval {CI}, 1.07-1.18] and 1.11 [95% CI, 1.05-1.17], respectively), and the absence of any HIV prevention discussion decreased (OR, 0.85; 95% CI, 0.80-0.90), but not HIV screening or PrEP documentation. CONCLUSIONS: We demonstrated that an EMR laboratory comment had a modest effect on increasing risk reduction counseling, although not HIV screening or PrEP prescriptions. Future strategies to encourage provider delivery of sexual health services may benefit from more targeted strategies that combine behavioral and information technology approaches.

Educational Programs and Sexual Counselling for Postmenopausal Sexual Dysfunction: A Systematic Review and Meta-Analysis.

BACKGROUND: Female sexual dysfunction has a high prevalence in women in the postmenopausal period. Not only factors like comorbidities and chronic illnesses are responsible for this high prevalence, but also psychological and interpersonal factors play a significant role. Sexual counselling educational programs have shown positive sexual behavioral changes and they should be considered the first line approach to female sexual dysfunction in this group of women. AIM: To review the evidence of the efficacy of sexual counselling educational programs for sexual dysfunction in postmenopausal women. METHODS: A systematic search was performed in February 2021 from electronic databases (MEDLINE, CENTRAL, and Scopus), unpublished studies, ongoing clinical trials, conference abstracts and journal archives, dissertations and theses, gray literature and free search on the Google Scholar search engine. Studies that evaluate the effectiveness of sexual educational programs in postmenopausal women were selected. Study selection and data extraction were performed by 2 independent researchers. Extracted data included author identification, publication date, geographic location, study population and sample size, type of intervention, sexual function evaluation tool and outcome. Studies that evaluate sexual function by using the Female Sexual Function Index (FSFI) were included in the meta-analysis, calculating the mean difference. OUTCOMES: Improvement of sexual function in postmenopausal women. RESULTS: We included 8 studies in the systematic review, 6 randomized and 2 nonrandomized controlled trials, with a total sample size of 619 women, aged between 39 and 75 years old, all in menopause for less than 5 years. The studies described sexual education programs, with 4-10 sessions, 45-60 minutes each, including themes like sexual anatomy, physiological sexual response, menopause, methods of stimulation, and common sexual myths. Five studies also included cognitive-behavior therapy and 3 studies assessed mindfulness techniques. Six studies evaluated the effectiveness of sexual educational programs using FSFI. The results showed that sexual counselling educational programs had statistically significant effects on enhancing the total FSFI score (mean difference = +7.14, 95% confidence interval = 3.70-10.6, P < .0001) in comparison to routine care. Results were also significant in all evaluated sex domains: pain, arousal, lubrication, desire, orgasm and satisfaction (P < .05). CONCLUSION: Our meta-analysis shows that sexual counselling educational programs are effective in improving sexual dysfunction in postmenopausal women when compared to routine care. These are simple approaches, easily administered with minimal resources that help prevent the psychological and social consequences of sexual dysfunction at this age. IMS Silva, MP Pinto, D Gonçalves. Educational Programs and Sexual Counselling for Postmenopausal Sexual Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:54-63.

Sexual Counseling with the PLISSIT Model: A Systematic Review.

A systematic review was conducted to use recent and relevant literature resources in examining the sexual counseling with the PLISSIT model. Electronic literature search was conducted on Medline, Science Direct, Google Scholar, and PubMed between January 1, 2011, and March 1, 2021. 14 studies were included in the systematic review. The mostly used study design was randomized controlled trial. It was determined that PLISSIT model on sexual counseling is an effective, simple, useful, and cost-effective counseling method.

Practice Facilitation Improves Adolescent Reproductive Health Preventive Services in Primary Care.

OBJECTIVES: Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well positioned to provide these services but often face barriers. With this project, we aimed to build quality improvement (QI) capacity within pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventive services. METHODS: In 2016, an accountable care organization overseeing health care delivery for low-income children in the Midwestern United States used practice facilitation, a proven approach to improve health care quality, to support pediatric practices in implementing reproductive health QI projects. Interested practices pursued projects aimed at providing (1) sexual risk reduction and contraceptive counseling (reproductive health assessments [RHAs]) or (2) etonogestrel implants. QI specialists helped practices build key driver diagrams and implement interventions. Outcome measures included the proportion of well-care visits with RHAs completed and number of etonogestrel insertions performed monthly. RESULTS: Between November 1, 2016, and December 31, 2019, 6 practices serving >7000 adolescents pursued QI projects. Among practices focused on RHAs, the proportion of well-care visits with completed RHAs per month increased from 0% to 65.8% (P < .001) within 18 months. Among practices focused on etonogestrel implant insertions, overall insertions per month increased from 0 to 8.5 (P < .001). CONCLUSIONS: Practice facilitation is an effective way to increase adherence to national guidelines for adolescent reproductive health preventive services within primary care practices. Success was driven by practice-specific customization of interventions and ongoing, hands-on support.

Trajectories towards affirmation: Gender identity in mental health services after the ICD-11 / Trayectorias hacia la afirmación: La identidad de género en los servicios de salud mental después del CIE-11

Depathologisation of gender diversity in the ICD-11 marks a shift in psychological services for transgender and gender nonconforming people. Even though the stipulated changes are only practically applicable ever since early 2022, a general move towards affirmative psychothera-peutic and counselling practice has been noticed ever since 2018. The present paper covers three main models of mental health care for genderminorities, namely the conversion therapy model, the transsexual gatekeeping model, and the affirmative model, in order to view them under a novel lens. Drawing on Science, Technology and Society Studies, the universalist pre-sumptions and rigid gender roles of the traditional models are brought under scrutiny. Moreo-ver, the itinerary reveals the need for situated narratives that encourage self-determination and renovate the therapeutic relationship as a means of self-exploration instead of an institu-tionalcontrol mechanism. Concluding, it is remarked that intersectional knowledge is crucial in compensating for micro-aggressive practices and dynamics historically promoted by psycholo-gists and other mental health providers. (AU)

La despatologización de la diversidad de género en el CIE-11 marca un giro para los servicios psicológicos para personas trans y no conformes al género. Aunque los cambios estipulados so-lo se incorporan prácticamente desde principios de 2022, se ha estado observando un movi-miento general hacia la práctica psicoterapéutica y de asesoramiento afirmativo desde 2018. El presente artículo realiza un recorrido por los tres modelos principales de atención de salud mental para minorías de género, concretamente el modelo de terapias de conversión, el mode-lo transexual de vigilancia, y el modelo afirmativo, con el fin de contemplarlos bajo una nueva perspectiva. Partiendo de los Estudios de Ciencia, Tecnologíay Sociedad, se examinan las pre-sunciones universalistas y los roles rígidos de los modelos tradicionales. Además, el recorrido revela la necesidad de narrativas situadas que incentiven la autodeterminación y renueven la relación terapéutica como eje de autoexploración en vez de mecanismo de control institucio-nal. Como conclusión, se remarca que el conocimiento interseccional es crucial para compen-sar las prácticas micro-agresivas y dinámicas que históricamente han promovido psicólogos y otros prestadores de servicios de salud mental. (AU)

Effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda: A randomised controlled trial.

BACKGROUND: The unmet need for contraceptives among refugee adolescents is high globally, leaving girls vulnerable to unintended pregnancies. Lack of knowledge and fear of side effects are the most reported reasons for non-use of contraceptives amongst refugee adolescents. Peer counselling, the use of trained adolescents to offer contraceptive counselling to fellow peers, has showed effectiveness in increasing use of contraceptives in non-refugee adolescent resarch. OBJECTIVE: To determine the effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda. METHODS: A randomised controlled trial carried out in Palabek refugee settlement in northern Uganda, May to July 2019. Adolescents were included if they were sexually active or in any form of union, wanted to delay child bearing, and were not using any contraceptives. A total of 588 consenting adolescents were randomised to either peer counselling or routine counselling, the standard of care. RESULTS: Adolescents who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling (PR: 1·24, 95% CI: 1·03 to 1·50, p = 0·023). Adolescents whose partners had attained up to tertiary education were more likely to accept a method than those whose partners had secondary or less education (PR: 1·45, 95% CI: 1·02 to 2·06, p = 0·037). In both groups, the most frequently accepted methods were the injectable and implant, with the commonest reasons for non-acceptance of contraception being fear of side effects and partner prohibition. CONCLUSION: Our data indicates that peer counselling has a positive effect on same day acceptance of modern contraceptives and should therefore be considered in future efforts to prevent adolescent pregnancies in refugee settings. Future peer counselling interventions should focus on how to effectively address adolescents' fear of side effects and partner prohibition, as these factors continue to impede decision making for contraceptive uptake.

Patient Reported Sexual Function Outcomes in Male Patients Following Open Radical Cystoprostatectomy and Urinary Diversion.

OBJECTIVE: To report sexual health outcomes in male patients undergoing open radical cystoprostatectomy using a validated questionnaire. MATERIALS AND METHODS: Beginning in 2017, male patients were asked to complete a validated questionnaire during scheduled post-cystectomy clinic visits that assessed sexual function using the 5 item International Index of Erectile Function (IIEF-5) and supplemental questions which evaluated libido, orgasm, partner interest, and adequacy of pre-operative counselling. Baseline data and functional outcomes were compared and multivariable analysis performed. RESULTS: A total of 134 patients who met inclusion criteria completed the questionnaire. Pre-operative IIEF-5 was available in 78 patients with a median score of 16 (IQR:5-23). In those patients, median age at cystectomy was 68.9 years (IQR:60.2-72.4) and median duration of follow-up was 17.3 months (IQR:6.3-28.7). Median IIEF-5 score at time of survey completion was 1 (IQR:1-11). Increasing age, shorter follow-up duration, insufficient counselling, and absence of partner interest were predictive of lower scores. Younger age, pre-operative erectile function, and neurovascular preservation were predictive of a higher IIEF-5 score on univariate and multivariate analysis. Median libido score was 2 "low" (IQR:1-3) and ability to orgasm was reported by 34 (43.6%) patients. Neurovascular preservation (OR:3.03 95% CI:1.10-8.26, P = .03) and sufficient preoperative counselling (OR:3.078 95% CI:1.17-8.098, P = .02) were associated with preserved ability to orgasm. Libido was influenced by partner interest (OR 11.7, 95% CI:3.793-6.14, P <.0001). CONCLUSION: Sexual dysfunction after radical cystoprostatectomy is prevalent with many contributing factors. As such, establishing appropriate expectations and goals during preoperative counseling, performing neurovascular preservation when appropriate, and readily identifying and treating dysfunction in follow-up may improve sexual recovery.

What Women Want: Radical Cystectomy and Perioperative Sexual Function Educational Needs.

OBJECTIVE: To assess the extent and adequacy of pre-operative sexual function (SF) counseling in females undergoing radical cystectomy (RC) and develop educational material to improve identified deficits. METHODS: A 10-question survey was electronically delivered to all females who underwent RC at a single institution between 2015 and 2020. 23 of 145 patients responded (15.9%). In addition, women on the Bladder Cancer Advocacy Network (BCAN) patient discussion board were also queried. The primary outcome was the development of a patient educational handout based on patient perception of pre-operative SF counseling and self-reported changes in post-operative SF. RESULTS: 22 women, 84% of whom were sexually active, met the inclusion criteria. More than half (12/22, 54.5%) reported receiving no pre-operative counseling regarding possible SF changes while another 27.3% (6/22) received some counseling but desired more. Most women rated vaginal preservation as moderate to very important (17/22, 77.3%) and nearly all women noted at least one change in SF, most commonly dyspareunia (13/22, 59.1%). Most also desired more information regarding female sexual health. Separately, the BCAN discussion board was queried regarding patient preference for modality of pre-operative counseling. 77.8% (14/18) preferred a discussion with provider and 13/18 (72.2%) also wanted a written handout. CONCLUSIONS: Sexual dysfunction is prevalent following RC in women and many desire more pre-operative counseling, regardless of disease stage or receipt of chemotherapy. These findings supported our development of interventions to improve pre-operative education as well as strategies to address post-operative SF changes, such as dyspareunia.

Online Compared to Face-to-Face Sexual Intimacy Enhancement Training Program Counseling with Cognitive-Behavioral Approach on Sexual Intimacy in Pregnant Women.

Studies have shown sexual intimacy enhancement-training with cognitive-behavioral can affect women's sexual intimacy. Interventional study to compare online and face-to-face sexual enhancement-training with cognitive-behavioral approach on sexual intimacy was conducted on 48 pregnant women with sexual intimacy scores < 75 who were randomly divided online (n = 25) and face-to-face (n = 23). Six 90-minute session sexual intimacy enhancement-training were conducted. Data were collected Botlani's sexual intimacy questionnaire (primary outcome) and counseling satisfaction scale (secondary outcome) measured baseline and after 6 and 10 weeks. In each group sexual intimacy in 10th week increased significantly compared to baseline (65.88 ± 5.51 vs 87.36 ± 8.39, p < 0.001) and (67.39 ± 5.26 vs 83.70 ± 5.61, p < 0.001) respectively. There was no significant difference between two groups in sexual intimacy scores in 6th (82.32 ± 9.25 vs 79.87 ± 6.35, p = 0.29) and 10th weeks (87.36 ± 8.39 vs 83.70 ± 5.61, p = 0.08) but totally intervention caused significant increase in sexual intimacy in 10th week compared to baseline (p = 0.04). Satisfaction from intervention was significantly different in 6th (65.72 ± 2.57 vs 61.21 ± 7.17, p = 0.021) and 10th weeks (68.92 ± 2.79 vs 64.26 ± 5.15, p = 0.001). Intervention improved sexual intimacy in pregnant women via both online and face-to-face counseling, with more sexual intimacy and satisfaction in online group, could be useful in COVID-19 pandemic.

Sexual norms and the intention to use healthcare services related to female genital cutting: A qualitative study among Somali and Sudanese women in Norway.

BACKGROUND: Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway. METHODS: We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants. FINDINGS: We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants' intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal- sexual partner scenarios. Participants with negative attitudes towards the use of almost all of the FGC-related healthcare services were influenced by a set of norms pertaining to virginity and passive sexual behavior. In contrast, participants with positive attitudes towards the use of all of these same services were influenced by another set of norms pertaining to sexual and gender equality. On the other hand, participants with positive attitudes towards the use of services that can help to improve their marital sexual lives, yet negative towards the use of premarital services were influenced by a third set of norms that combined norms from the two aforementioned sets of norms. CONCLUSION: The intention to use FGC-related healthcare services varies between and within the different ethnic groups. Moreover, the same girl or woman can have different attitudes towards the use of the different FGC-related healthcare services or even towards the same services at the different stages of her life. These insights could prove valuable for Norwegian and other policy-makers and healthcare professionals during the planning and/or delivery of FGC-related healthcare services.

Office-Based Screening for Sexually Transmitted Infections in Adolescents.

Almost 1 in 4 adolescents have a sexually transmitted infection (STI). These infections are preventable through safe sexual practices and routine screening. Pediatricians are the first line of clinical care for adolescents and are well positioned to offer sexual and reproductive health care counseling and services to their patients; yet, there is a paucity of sexual health screening provided at routine health supervision visits. This article addresses the epidemiology of STIs in adolescents, reviews the evidence of current clinical practice, presents recommended STI screening from government and medical agencies, and offers strategies to address barriers to providing care for adolescents and for sexual health screening in primary care.

Single women and motherhood: right now or maybe later?

Purpose: The decision to have a child might be postponed by the lack of partner, and elective egg freezing (EEF) can afford single women more time to find a suitable companion to reach the desired family structure. Alternatively, some women decide to have a child on their own thorough in vitro fertilization (IVF) or intrauterine insemination (IUI) with donor sperm. This study investigates the motivations and personal characteristics of single women undergoing IVF/IUI or EEF.Materials and methods: This is a cross-sectional study including 281 heterosexual single women who underwent either IVF/IUI with donor sperm for solo motherhood (208) or EEF (73) in 2015 at a large fertility center. An anonymous electronic survey was sent after starting the treatment.Results: The most common reason for not having fulfilled the motherhood desire was lack of partner (72.4% IVF/IUI and 65.9% EEF). We found that women undergoing IVF/IUI report a longer motherhood desire, >10 years (71.3% vs. 54.3%), live closer to their families (75.5% vs. 56.5%), and perceive a stronger family support than women undergoing EEF (85.4% vs. 68.8%). Finally, 100% of EEF obviously knew about the possibility of IVF/IUI with donor sperm, while 59.9% of IVF/IUI knew about EEF.Conclusion: Our results underscore the relevance of family ties in the decision to undergo IVF/IUI as single women. Moreover, these women might not be fully informed about social freezing as an option to postpone motherhood. Health professionals should be aware of these differences when counseling single women on fertility choices.

A systematic review and meta-analysis of couple-based intervention on sexuality and the quality of life of cancer patients and their partners.

PURPOSE: To synthesize the characteristics and effects of couple-based intervention on sexuality and the quality of life (QOL) of cancer patients and their intimate partners and its implications for future research and practice. METHODS: A systematic review and meta-analysis of randomized and non-randomized controlled studies of interventions was conducted in nine English databases and two Chinese databases, with identification of related studies published in English and Chinese. The quality of the studies was assessed using the tools of the Effective Public Health Practice Project. RESULTS: A total of 33 articles were identified for systematic review and 23 articles were identified for meta-analysis. For patients, the effect size was 0.42 (Hedges's g, 95% CI = 0.05-0.78, p = 0.03) for physical health. For partners, the effect size was 0.52 (Hedges's g, 95% CI = 0.06-0.98, p = 0.03) for sexual relationships. However, moderate to high heterogeneity was reported. Effects on sexual function, sexual self-concept, and mental health for couples were not significant. CONCLUSION: Couple-based interventions had small to medium-sized effects on physical health for cancer patients. Partners could derive medium effects for improvement in sexual relationships from couple-based intervention. Future research should pay more attention to sexual self-concept in cancer patients and target types of cancer that are more likely to compromise sexuality and QOL. PROSPERO REGISTRATION: The systematic review and meta-analysis has been registered in PROSPERO with registration number: CRD42019119047.