Contraception for Adolescents with Medically Complex Conditions.

Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have developed, published, and updated evidence-based guidelines to support medical providers in the provision of contraceptives to patients with specific medical conditions or characteristics. The goal of these guidelines is to provide recommendations on the safe use of contraceptives with the goal of removing unnecessary medical barriers to access and use of contraceptives, thus decreasing the number of unintended pregnancies. Many medical conditions increase a patient's risk of venous thromboembolism; a risk that may also be increased with specific contraceptives. Specific conditions that require more enhanced contraceptive counseling due to their frequency in adolescence and their association either with adverse events during pregnancy or with increased risk for specific contraceptives are detailed by the WHO and CDC and are summarized herein. Adolescents with morbid obesity, migraine headache, cardiac conditions, hypertension, diabetes mellitus, hyperlipidemia, systemic lupus erythematosus, sickle cell anemia, cystic fibrosis, inflammatory bowel disease, or seizure disorders would benefit from greater attention to the urgency of exploring highly effective contraceptive methods. Details of the considerations that should be used in providing contraceptive care to adolescents with each of these medical conditions, as per WHO and CDC guidelines, are provided in this review. The ultimate goal in contraceptive counseling is the balancing of risk and benefit to arrive at the best therapeutic option, maintaining patient preference as a priority, as that will enhance adherence and comfort with the contraceptive method. Each patient must be assessed for pregnancy risk and be allowed full risk reduction and education regarding contraceptive options.

Meeting the sexual and reproductive health needs of high-school students in South Africa: experiences from rural KwaZulu-Natal.

BACKGROUND: Adolescents in South Africa (SA) have a huge unmet need for sexual and reproductive health (SRH) services. Integrating such services into schools may overcome many of the current barriers to access. OBJECTIVES: We describe an SRH service model developed for high-school students and its implementation in 14 high schools in rural SA. METHODS: Following consultation with community and other key stakeholders about the demand for and acceptability of adolescent-targeted SRH services, a three-tier school-based model was developed that included: (i) in-school group SRH information and awareness sessions; (ii) in-school individual SRH counselling and customised HIV counselling and testing (CCT); and (iii) referrals to in-school fixed, in-school mobile or public sector primary SRH clinics. RESULTS: From October 2011 to June 2012, 70 consultative meetings were held. There was overwhelming support for the pilot founded on concerns about the high HIV prevalence and teenage pregnancy rates among adolescents in the community. SRH information was provided to 8 867 high-school students, 4 171 (47.0%) of whom accessed on-site CCT services for HIV. The gender-specific prevalence of HIV in these students was 3.3% (64/1 962) and 1.1% (24/2 209) for females and males, respectively. Two hundred and thirty-nine students (5.7%) were referred for clinical services at in-school fixed, in-school mobile or public sector primary SRH clinics. CONCLUSIONS: The SRH service provision pilot was acceptable in the community and seems feasible for scale-up. Further work is required to understand inter-school variability in uptake, identify additional service needs of students, and characterise SRH demand dynamics.

High levels of acceptability of couples-based HIV testing among MSM in South Africa.

The acceptability of couples-based voluntary HIV counseling and testing (CVCT) has not been previously investigated among men who have sex with men (MSM) in South Africa. Using online advertisements, data were collected from 486 MSM, who were 18 years of age or older with a current residence in South Africa and had at least one male sex partner in the previous 12 months. The analysis examined associations between individual characteristics and willingness to utilize CVCT services. The willingness to utilize CVCT services was compellingly high (89%) among this sample of mostly White/European African (89%) and HIV-negative (83%) men. MSM who reported higher numbers of completed school years were less likely to report willingness to use CVCT. Willingness did not vary significantly across other individual demographic or behavioral characteristics. Our results show an overwhelmingly high acceptance of CVCT services. Future studies should survey a more heterogeneous population of MSM, explore the complex nature of same-sex male relationships, and why respondents would or would not use these HIV testing services.

Factors affecting the willingness of counselors to integrate preconception care into sexually transmitted disease clinics.

BACKGROUND: The high rate of unintended pregnancy is an immediate barrier to providing preconception care (PCC). Failure to deliver additional PCC messages at sexually transmitted disease (STD) clinics might represent a major missed opportunity to target women at increased risk for unintended pregnancy for behaviors that also put them at risk for adverse pregnancy outcomes. METHODS: Using a survey questionnaire, we assessed perceptions of PCC and factors influencing the willingness of STD counselors to integrate PCC as an intervention service provided by the STD clinics of 140 STD counselors. We used a cross-sectional design and selected survey participants with a minimum of 2 years' experience in providing HIV pretest and posttest counseling and syphilis interviewing using a nonprobability, purposive sample. RESULTS: The level of occupational responsibility and the amount of time available seemed to affect counselor perceptions of the importance of PCC and whether it should be integrated as an intervention service provided by STD clinics. Findings suggested that, although most STD counselors reported that PCC was an important issue, there was significant variation in the perception of whether PCC should be delivered at STD clinics. CONCLUSION: STD counselors perceived PCC to be an important intervention service that can be delivered at STD clinics. Additional study is needed to identify factors that might affect full integration into the STD clinic setting.

Discussing sexuality with patients in a motor neurone disease clinic.

Sexual relationships remain an important aspect of life for people living with motor neurone disease. This article explores the use of the Extended-PLISSIT model when discussing relationships and sexual function with patients and their partners in a motor neurone disease clinic. The model provides a structured approach to assist discussions with patients as well as promoting reflection and exchange of knowledge in the multidisciplinary team. It is a useful model when addressing issues that are sometimes difficult to discuss.

Sexual assessment: research and clinical.

It has been well documented that most patients do not volunteer information about sexual problems, and that health care providers should incorporate at least a brief sexual assessment into routine health histories and medical evaluations. While not every nurse can be a sexual counselor, listening to concerns of patient and family, presenting factual information in a nonthreatening manner, managing noncomplex disease and treatment related symptoms, and providing appropriate referrals can be easily incorporated into routine care.

Sexuality in women with cancer.

There are gaps in the research regarding sexuality in women with cancer, making the interventions that are used more expert opinion rather than scientific evidence. There is a need for research about effective interventions, and there is a need to educate nurses to help change practice through communication about a topic that makes both the patient and the nurse uncomfortable.

The sexual impact of cancer and cancer treatments in men.

This article presents an overview of the literature on the impact cancer and associated therapies have on male sexuality, interventions to maintain or improve sexual function after cancer, and identification of gaps in health care providers' knowledge of this topic. Normal sexual activity depends on a complex inter-relationship among multiple systems, including psychologic, biochemical, neurologic, and physiologic. Furthermore, there are multiple factors associated with the diagnosis and treatment of cancer that have an impact on male sexuality, including the complex psychologic and symptom burden of the disease and treatments. There are an increasing number of pharmacologic and nonpharmacologic interventions to treat erectile function; however, success rates are variable and long-term compliance is generally low. Little study has been devoted to interventions that may improve compliance, such as counseling, or that focus on aspects of male sexuality other than erectile dysfunction.

Intimacy and multiple sclerosis.

Persons with multiple sclerosis require extensive management of the physiologic and psychologic sequelae of their chronic disease process. Sexual intimacy is affected by many of these disease effects, which impacts them in diverse ways. Many persons with multiple sclerosis do not discuss sexual intimacy with their health care provider because they assume it is an expected part of the disease and nothing can help, or they are too embarrassed to admit to problems at a very young age. Since this is a disease that usually occurs between 20 and 40 years of age, sexual intimacy is affected from many perspectives. Collaboration is essential in the plan of care between the client, family, and the health care provider.

Arthritis and sexuality.

More than 120 kinds of arthritis exist. This article focuses on the more common types of musculoskeletal disorders, which are osteoarthritis, rheumatoid arthritis, and osteoporosis. Because of the pain, fatigue, and joint stiffness associated with arthritis, physical intimacy may be difficult. These symptoms can be ameliorated during sexual activity by good communication between the partners, timing medication, and experimenting with different positions. Clients may need to be taught to be creative and to be willing to experiment. Learning the relaxation response, in addition to fantasizing and guided imagery, can enhance the sexual experience for people who have arthritis.

Sexuality in chronic lung disease.

Multiple factors converge to cause sexuality and intimacy problems in individuals who have chronic lung disease. It is imperative that clinicians include in their discussions with patients the ways they can maintain their sexual lives in the face of chronic lung diseases such as chronic obstructive pulmonary disease and lung cancer. Providing patients and their partners with information on ways to enhance their overall physical functioning, as well as discussing the many pharmacologic and nonpharmacologic methods available to maintain healthy sexual lives is critical to maintaining quality of life. It is apparent that more research is needed so that we can help these patients and their partners continue to have quality sexual relationships.

HIV, AIDS, and sexuality.

The purpose of this article is to outline information about people who live with HIV and AIDS and provide nurses with information on how to provide high-quality care for these patients related to sexuality and intimacy. This care is provided through a discussion of relationships, sexuality and sexual health, gender perceptions about sexuality, sexual needs and difficulties, and nursing assessment and intervention strategies.

Chronic illness care for lesbian, gay, & bisexual individuals.

Nurses provide care for lesbian, gay, and bisexual (LGB) patients on regular basis, whether they know it or not. Education of health care workers routinely has excluded discussion of patient sexuality, rendering LGB patients invisible or stigmatized, and has offered few tools to nurses to provide quality care for their LGB patients with chronic illnesses. This chapter provides basic information about LGB chronic health care to increase awareness and sensitivity about this marginalized patient population and focuses on providing specific information to help nurses care for these individuals.

Including sexuality in your nursing practice.

One would think that today's exposure of the topic of sexuality in the electronic and print media would elevate the medical professional's comfort level with communication regarding sexuality issues. However, writers continue to comment on clinician discomfort or lack of discussion with their patients about sexual concerns and anxieties. Many patients want to learn about the implications of their treatment and medications on their sexuality. Nurses who care for chronically ill patients may help foster a more positive self-esteem for the patient, and may influence patient-partner attitudes about worthiness, self-concept, and body image, by providing opportunities to talk about feelings and fears about how treatment may affect their sexuality.

Journey into the realm of requests for help presented to sexual medicine specialists: introducing male sexual distress.

INTRODUCTION: The recent availability of noninvasive pharmacological remedies for male sexual function triggered an exponential increase in the number of men requesting help in the sexuality area. AIM: The Italian Society of Andrology explored requests for help, not included in formerly established clinical categories of sexual medicine. METHODS: A central board of 67 andrologists identified new areas of requests for help, instrumental for a web-based questionnaire, forwarded to 912 members of the Italian Society of Andrology. Results were submitted to an independent consensus development panel. MAIN OUTCOME MEASURES: A questionnaire response rate of 30.8% was considered acceptable according to standard response rates of medical specialist samples. RESULTS: The Central Board interaction identified two new domains of requests for help: sexual distress and unconventional requests for pro-erectile medications. Web-based questionnaire results suggested that such domains account for 29% and 9% respectively of all requests for help already presented by male patients at sexual medicine clinics. The Independent Consensus Development Panel issued a final consensus document; herewith, the statement defining male sexual distress: A non-transitory condition and/or feeling of inadequacy such as to impair "sexual health" (WHO working definition). Inadequacy can originate both from physiological modifications of male sexual functions, and from diseases, dysfunctions, dysfunctional symptoms and dysmorphisms, both of andrological and non-andrological origin, which do not relate to "erectile dysfunction" (NIH Consensus Development Panel definition), but that might also induce erectile dysfunction. Sexual Distress can lead to a request for help which needs to be acknowledged. CONCLUSION: The Italian Society of Andrology identified two new areas of requests for help concerning male sexual issues: sexual distress and unconventional requests for pro-erectile medications. These domains, which do not represent new diseases, nonetheless induce the sufferers to seek help and, accordingly, need to be acknowledged.