Deconstructing "Sexual Deviance": Identifying and Empirically Examining Assumptions about "Deviant" Sexual Fantasy in the DSM.

We identify and examine three assumptions underpinning "sexual deviance" in the Diagnostic and Statistical Manual (DSM) of Mental Disorders: (1) the "sexual deviant" - often, "the male sex offender" - prefers "deviant," and has limited (if any) "non-deviant," sexual fantasies; (2) this differentiates them from the non-sexual-/non-offending "norm"; (3) preferred fantasies are "deviant" or "non-deviant." Adult volunteers (N = 279; equal numbers of sexual offending [SO], non-sexual offending [NSO] and non-offending [NO] men) provided anonymous descriptions of their favorite sexual thought and responses to a revised Wilson Sex Fantasy Questionnaire during a wider computerized survey of 6,289 men from prison and the community. Latent class analysis identified five types of favorite sexual thought; vaginal/oral sex with 1+ woman was commonest for SO men and the WSFQ findings supported this - challenging the first assumption. Both SO and NO men were over-represented for thought types considered "deviant" by the DSM - tempering the second assumption - although SO men were over-represented for thoughts involving children specifically. All thought types were multidimensional; none included solely elements considered "deviant" by the DSM - contesting the third assumption. Notions of the "sexual deviant" as "different"/"other" may underpin these assumptions, potentially negatively impacting research, therapy and understanding sexual crime.

Are UK Policies and Practices for Regulated Donor Insemination Forcing Women to Find Unregulated Sperm Donors Online? A Perspective on the Available Evidence.

In recent years, there has been an increase in women obtaining donor sperm via unregulated websites and social media. In this article, we bring together the disparate evidence in this emerging field to consider whether restrictive UK policies and practices for regulated clinical donor insemination (DI) are a potential explanation for the growing use of the currently unregulated, online route to donor insemination. To this end, we examine the nature of the National Institute for Health and Care Excellence (NICE) guidelines, recent data provided by the Human Fertilisation and Embryology Authority (HFEA), and prior research on who uses online sperm donation and their reasons for doing so. In addition, we highlight why this issue is important by outlining some of the benefits and drawbacks of the unregulated route. We argue that, whilst there are many factors driving the unregulated route to DI, restrictive UK policies and practices for regulated DI might be one of these. We conclude that turning our attention to structural barriers, such as regulated DI policies and practices, is necessary to produce more definitive evidence of this potential issue, and that adopting a Reproductive Justice framework could lead to more equitable provision of regulated DI services.

Systematic Review of Factors Affecting Transition Readiness Skills in Patients with Inflammatory Bowel Disease.

BACKGROUND AND AIMS: The incidence of inflammatory bowel disease [IBD] diagnosed before adulthood is increasing worldwide. Transition from paediatric to adult health care requires certain skills. The aim of this study was to identify factors affecting these skills. METHODS: This review was registered on the PROSPERO database [CRD42019152272]. Inclusion criteria were: 1] studies of factors affecting transition readiness skills in patients with IBD; 2] written in English; 3] published since 1999. MEDLINE, CINAHL, and PsychINFO databases were searched between 1999 and 2019. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. RESULTS: Searches identified 822 papers. Sixteen papers were included. Age was positively associated with skills including disease knowledge and performing self-management behaviours [14 studies]. Improvement often occurs at 18; however, skill deficiency may still remain. Increased self-efficacy [confidence] was associated with greater disease knowledge and performing self-management behaviours [three studies]. Self-efficacy was positively correlated with transition duration [two studies] and health-related quality of life [r = 0.57, p <0.001] [one study], negatively correlated with depression [r = -0.57, p <0.001] and anxiety [r = -0.23, p = 0.03] [one study], and was associated with higher education level [two studies] and a family history of IBD [one study]. Females had higher self-management scores [three studies], and greater health care satisfaction was significantly associated with higher knowledge [one study]. Greater transition communication improved knowledge, self-management, and overall transition readiness [two studies]. CONCLUSIONS: Potentially modifiable factors have been identified that could be supported in the transitioning IBD population, to improve transition readiness. Identification of those with non-modifiable characteristics associated with poor readiness may aid targeted support.

Making and Communicating Decisions About Sexual Consent During Drug-Involved Sex: A Thematic Synthesis.

Sexual consent is a central component in the primary prevention of sexual violence. There is growing evidence of the impact that alcohol consumption has on sexual consent. However, there has been no review examining sexual consent in the context of other drug-taking. Published literature was sought using searches of: PsycINFO, PsycARTICLES, Scopus, Web of Science, CINAHL, MEDLINE and Open Dissertations. Unpublished literature, such as unpublished government or charity reports, were identified through Google search engine. All 21 eligible studies employed qualitative or mixed methods; therefore, a thematic synthesis was deemed an appropriate method of analysis. Three themes were constructed: "Drug-taking changes sexual norms", "Drug-taking diminishes the capacity to make sexual decisions" and "Drug-taking reduces verbal and non-verbal ability to communicate consent". The findings demonstrated that prevailing models of sexual consent may not account for circumstances relevant to drug-involved sex, such as how drug-taking impacts freedom and capacity to consent to sex. We propose the use of the medical model of capacity to consent as a broader framework through which capacity to consent to sex in drug-taking contexts can be assessed. The importance of both the social and situational context for sexual decision-making following drug-taking is discussed.

Men Presenting With Sexual Thoughts of Children or Coercion: Flights of Fancy or Plans for Crime?

INTRODUCTION: There is limited evaluation of clinical and theoretical claims that sexual thoughts of children and coercing others facilitate sexual offending. The nature of these thoughts (what they contain) also is unknown. AIM: To examine the relation between child or coercive sexual thoughts and sexual offending and to determine the nature of these thoughts and any differences among sexual offending (SO), non-sexual offending (NSO), and non-offending (NO) men. METHODS: In a cross-sectional computerized survey, anonymous qualitative and quantitative self-reported sexual thought and experience data were collected from 279 adult volunteers composing equal numbers of SO, NSO, and NO men recruited from a medium-security UK prison and a community sample of 6,081 men. MAIN OUTCOME MEASURES: Computerized Interview for Sexual Thoughts and Computerized Inventory of Sexual Experiences. RESULTS: Three analytical approaches found child sexual thoughts were related to sexual offending; sexual thoughts with coercive themes were not. Latent class analyses identified three types of child sexual thought (primarily differentiated by interpersonal context: the reporting of own emotions, emotions of others, or both) and four types of sexual thoughts of coercing others (chiefly discriminated by the other person's response: no emotional states reported, consent, non-consent, or mixed). Type of child sexual thought and participant group were not significantly related. Type of coercive sexual thought and group were marginally related; the consensual type was more common for the NO group and the non-consensual type was more common for the SO group than expected statistically. CONCLUSION: Child sexual thoughts are a risk factor for sexual offending and should be assessed by clinicians. In general, sexual thoughts with coercive themes are not a risk factor, although thought type could be important (ie, thoughts in which the other person expresses an enduring lack of consent). Exploring the dynamic risk factors associated with each type of child and coercive thought could lead to more targeted treatment.