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1.
BMC Med Educ ; 21(1): 37, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419437

RESUMO

BACKGROUND: Sexual health is generally considered an integral part of medical and allied healthcare professional training. However, many medical schools do not offer this as a mandatory curriculum, or minimize it. Sexual health as an academic area was introduced in the 1970s, but there have been few cohort evaluations of its impact. This was limited by the availability of few psychometric scales for evaluation. We evaluated the full, mandatory, sexual health course in year 1 medicine at a large state university in the Midwest US, including the course with lectures; panels and tutorials; a video app to give students feedback on their sexual history taking skills; and a 3-station sexual history OSCE at the end of the course. RESULTS: Seventy-four medical students (43% of the course cohort) volunteered, for an incentive, to complete evaluation materials pre- and post-course. We used the Sexual Health Education for Professionals Scale (SHEPS), designed and with appropriate psychometric standardization for such evaluation. The SHEPS data covers 7-point Likert scale ratings of 37 patient situations, asking first how well the student could communicate with such a patient, and on the second part how much knowledge they have to care for such a patient. The third subscale examines personal sexual attitudes and beliefs. Data indicated that the matched pretest-posttest ratings for skills and knowledge were all statistically significant and with very large effect sizes. Few of the attitude subscale items were significant and if so, had small effect sizes. Sexual attitudes and beliefs may be well-formed before entry into medical school, and sexual health teaching and learning has minimal effect on sexual attitudes in this US sample. However, using the 3 sexuality OSCE cases scores as outcomes, two of the 26 attitude-belief items predicted > 24% of the variance. CONCLUSIONS: The sexual health course produced major changes in Communications with patients sexual health skills and Knowledge of sexual health, but little change in personal Attitudes about sexuality. These data suggest that personal attitude change is not essential for teaching US medical students to learn about sexual health and sexual function and dysfunction, and comfortably take a comprehensive sexual history.

2.
Sex Med Rev ; 9(1): 36-56, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32800563

RESUMO

INTRODUCTION: The 2 most well-known classification systems that include sexual medicine diagnoses are the International Classification of Diseases and Statistics (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM). Sexual medicine experts from international societies representing an array of disciplines have revised and redefined female sexual dysfunctions (FSDs) to reflect current scientific evidence and the state of the art. AIM: To summarize the evidence and interactive and chronological process by which sexual medicine societies' consensus groups developed the current nomenclature, classifications, and definitions for FSDs. METHODS: We review the contributions and collaborations of the Fourth International Consultation in Sexual Medicine (ICSM), the International Society for the Study of Women's Sexual Health (ISSWSH), and the World Association of Sexual Health in conjunction with the World Health Organization. MAIN OUTCOME MEASURES: The ICSM and ISSWSH diagnostic systems are contrasted with the DSM classification. We discuss innovations and strengths; relevant evidence regarding epidemiology, etiology, and risk factors; and key differences. We describe how sexual medicine expertise informed FSD codes in the ICD-11 classification. RESULTS: ICSM and ISSWSH published evidence-based guidelines on the definitions, nomenclature, and diagnostic criteria for FSD that diverge from the DSM psychiatric compendia. These definitions and nomenclature recommend the separation of female sexual desire and arousal disorders, elaborate on subtypes of arousal problems, broaden the scope of sexual pain definitions, and provide a greater understanding of etiologies and risk factors for FSDs. CONCLUSIONS: These collaborations among sexual medicine experts and their role in the ICD-11 development process provide confidence that the ICD-11 Sexual Dysfunction codes are based on current scientific evidence for diagnosing and coding FSDs in clinical settings worldwide, can serve as endpoints in clinical trials, and will provide specificity for treatment outcomes for FSD therapies. Parish SJ, Cottler-Casanova S, Clayton AH, et al. The Evolution of the Female Sexual Disorder/Dysfunction Definitions, Nomenclature, and Classifications: A Review of DSM, ICSM, ISSWSH, and ICD. Sex Med 2021;9:36-56.

3.
Int J Transgend Health ; 21(2): 125-137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33015664

RESUMO

Background: High quality data pertaining to the size of the transgender and gender diverse (TGD) population are scant, however, several recently published studies may provide more reliable contemporary estimates. Aims: To summarize the estimated number and proportion of TGD individuals overall and across age groups, based on most accurate data. Methods: This systematic review focused on recent studies (published from 2009 through 2019) that utilized sound methodology in assessing the proportion of TGD people in the general population. Publications were included if they used clear definitions of TGD status, and calculated proportions based on a well-defined sampling frame. Nineteen eligible publications represented two broad categories of studies: those that used data from large health care systems; and those that identified TGD individuals from population surveys. Results: Among health system-based studies, TGD persons were identified using relevant diagnostic codes or clinical notes. The proportions of individuals with a TGD-relevant diagnosis or other recorded evidence ranged between 17 and 33 per 100,000 enrollees. In population surveys TGD status was ascertained based on self-report with either narrow or broad definitions. The survey-based estimates were orders of magnitude higher and consistent across studies using similar definitions. When the surveys specifically inquired about 'transgender' identity, the estimates ranged from 0.3% to 0.5% among adults, and from 1.2% to 2.7% among children and adolescents. When the definition was expanded to include broader manifestations of 'gender diversity', the corresponding proportions increased to 0.5-4.5% among adults and 2.5-8.4% among children and adolescents. Upward temporal trends in the proportion of TGD people were consistently observed. Conclusions: Current data indicate that people who self-identify as TGD represent a sizable and increasing proportion of the general population. This proportion may differ, depending on inclusion criteria, age, and geographic location, but well-conducted studies of similar type and design tend to produce comparable results.

4.
J Sex Med ; 17(9): 1751-1760, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32653392

RESUMO

BACKGROUND: A number of studies have found that hypersexuality is associated with a high propensity for sexual excitation. In comparison, less is known about the relationship between hypersexuality and sexual arousal at the state level. Also, previous research has revealed a relationship between hypersexuality and negative mood. However, the possibility that sexual response might not be as negatively impacted by negative mood in hypersexual individuals has, as yet, not been tested. AIM: The purpose of this study was to investigate sexual responsivity and the effects of negative mood on sexual arousal in hypersexual men who have sex with men (MSM). METHODS: A total of 211 MSM were assigned to a hypersexuality (N = 81) or a control (N = 130) group using an interview patterned with a semi-structured Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders format. Participants filled out questionnaires and were shown neutral, sexual, and anxiety- and sadness-inducing films. OUTCOMES: Changes in penile circumference and self-reported sexual arousal were the primary outcomes analyzed in this study. RESULTS: Controlling for age and HIV status, no differences were found in genital response between hypersexual and non-hypersexual men. Also, the 2 groups did not differ in subjective sexual arousal. Moreover, no effects of negative mood were found. Time series clustering analyses revealed 3 groups-low responders and slow and fast high responders. Sexual excitation, but not sexual compulsivity or pornography use, predicted cluster membership. CLINICAL TRANSLATION: Hypersexual MSM may benefit more from an exploration of motivational and behavioral, as compared to psychophysiological, mechanisms underlying possible links between (negative) mood and sexual behavior. STRENGTHS & LIMITATIONS: Strengths of the study include its sample size, making it one of the larger psychophysiological sex studies; the use of clinical interviews for group assignment; the inclusion of genital response measures; and the application of time series clustering to examine differences among participants. Limitations include possible sample heterogeneity and the reliance on researcher-selected stimuli. CONCLUSION: Given the lack of any effects of negative mood on sexual response in hypersexual MSM, future studies could explore in more depth possible motivational and behavioral effects, including, for example, the impact of negative mood on the tendency to seek out sex as a form of distraction or for validation or emotional support. Janssen E, Prause N, Romine RS, et al. Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM). J Sex Med 2020;17:1751-1760.


Assuntos
Transtornos Parafílicos , Minorias Sexuais e de Gênero , Homossexualidade Masculina , Humanos , Masculino , Comportamento Sexual
5.
Health Soc Care Community ; 28(3): 1082-1089, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31917883

RESUMO

Research has identified discrimination and a lack of knowledgeable providers as major barriers for transgender and gender diverse (TGD) individuals seeking care, which contributes to greater stress and significant health disparities affecting this population. However, research involving TGD youth is limited. The aim of this study, therefore, was to describe TGD adolescents' experiences, concerns and needs in healthcare settings, including their feedback on themes previously identified by healthcare providers (i.e. discomfort with gender-related topics, reasons for not asking patients about gender and previous training regarding gender diversity). The authors conducted semi-structured interviews with 12 TGD-identified adolescents aged 14-17, living in Minnesota, USA in 2017-2018. Inductive thematic analysis was used to summarise participant comments into themes and subthemes. Two main themes were directly relevant to concerns and needs of TGD youth in healthcare settings and their views on healthcare providers' concerns: (a) asking about gender and pronouns and (b) training for healthcare providers. Findings suggest the need for revisions to clinic materials, infrastructure and protocols. Adding training to all general medical and nursing education to increase knowledge, comfort and competence around gender identity would further improve care and ultimately reduce healthcare disparities affecting TGD youth.

6.
LGBT Health ; 7(1): 15-27, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31880493

RESUMO

Purpose: We describe the development of a measure of internalized transphobia, defined as discomfort with one's transgender identity as a result of internalizing society's normative gender expectations. Methods: An item pool was created based on responses from a small clinical sample (N = 12) to an open-ended questionnaire. Expert judges reviewed the items, resulting in a 60-item instrument for empirical testing. We conducted exploratory factor analysis (EFA) by using a community sample of 430 transgender individuals (aged 18-72, mean [M] = 37.4, standard deviation [SD] = 12.0), and confirmatory factor analysis (CFA) by using an online sample of 903 transgender individuals (aged 18-66, M = 31.6, SD = 11.1). Construct validity was examined by using correlations with instruments assessing related constructs administered to the online sample. Results: EFA resulted in a 52-item instrument with four subscales: Pride, Passing, Alienation, and Shame. CFA, after removal of half of the items, retained the four-factor structure. The final 26-item scale showed excellent internal consistency (0.90) and test-retest reliability (0.93). The factors showed a pattern of association with crossgender identity, gender ideology, outness, felt stigma, self-esteem, and psychological distress consistent with moderate-to-good construct validity. Conclusion: Internalized transphobia can be conceptualized as four inter-related dimensions: pride in transgender identity (reverse scored), investment in passing as a cisgender person, alienation from other transgender people, and shame. The Transgender Identity Survey reliably assesses this construct, useful in research to understand the impact of minority stress on transgender people's health. It can also be used in clinical practice to assess internalized transphobia at intake and follow-up.

7.
Sex Addict Compulsivity ; 26(1-2): 24-41, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31772491

RESUMO

The association between positive and negative affect and sexual behavior in 39 MSM with and without hypersexuality (HS) was explored using ecological momentary assessment. Participants reported their current positive and negative affect three times per day and their sexual behavior each morning and evening. The relationship between affect and sexual behavior differed between men with or without HS. In those with HS, the timing of and interactions between experienced affect differentially predicted types of sexual behavior, indicating differing mechanisms driving partnered sexual behavior and masturbation. These findings lend support to conceptualizing HS behavior as a coping strategy for affective arousal.

8.
J LGBT Youth ; 16(3): 235-254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156739

RESUMO

This study examines the intersection of sexual and gender identities among adolescents, including the prevalence of these groups and rates of emotional distress and bullying victimization. Data come from a large population-based sample; two measures of sexual orientation and gender identity create eight identity groups. Youth who report identifying both as lesbian, gay, bisexual, or queer/questioning (LGBQ) and as transgender/gender diverse (TGD) had significantly higher levels of two measures of emotional distress and four measures of bullying victimization than those who report only identifying as LGBQ non-TGD or straight TGD. Implications for research and practice are discussed.

9.
Endocrinol Metab Clin North Am ; 48(2): 303-321, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31027541

RESUMO

Accurate estimates of the number and proportion of transgender and gender nonconforming people in a population are necessary for developing data-based policy and for planning and funding of health care delivery and research. The wide range of estimates reported in the literature is attributable primarily to differences in definitions. Other sources of variability include diverse cultural and geographic settings and important secular trends. The transgender and gender nonconforming population is undergoing rapid changes in size and demographic characteristics. More accurate and precise estimates will be available when population censuses collect data on sex assigned at birth and gender identity.


Assuntos
Disforia de Gênero/epidemiologia , Cirurgia de Readequação Sexual/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Transexualidade/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Criança , Europa (Continente)/epidemiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Taiwan/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
10.
J Pediatr Health Care ; 33(4): 379-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30827755

RESUMO

INTRODUCTION: Nurses and physicians receive minimal training about providing competent care to transgender and gender-diverse (TGD) patients, and training specific to TGD youth is particularly lacking. This qualitative study examined health care providers' experiences and attitudes about working with TGD youth to identify specific training needs. METHOD: Semistructured interviews were conducted with 14 nurses and physicians who work with adolescents. Thematic analysis was used to characterize participants' responses. RESULTS: Five themes summarized participants' responses to interview questions: Training Regarding Gender Diversity, Discomfort With Gender-Related Topics, Reasons for Not Asking About Gender, Talking About Gender With Patients, and Need for Resources. DISCUSSION: Findings highlight multiple opportunities to improve provider education and care experiences of TGD youth. Specific training is needed to help providers manage discomfort with gender-related topics and simultaneously develop their knowledge of and skills for discussing gender issues.

11.
J Rural Health ; 35(2): 270-281, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29940070

RESUMO

PURPOSE: Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations. METHODS: Data come from a statewide school-based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments. FINDINGS: Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students. CONCLUSIONS: Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population.


Assuntos
Vítimas de Crime/psicologia , Fatores de Proteção , Angústia Psicológica , Características de Residência/estatística & dados numéricos , Pessoas Transgênero/psicologia , Adolescente , Análise de Variância , Vítimas de Crime/estatística & dados numéricos , Feminino , Mapeamento Geográfico , Humanos , Masculino , Pessoas Transgênero/estatística & dados numéricos
12.
J Gambl Stud ; 35(1): 79-92, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30343416

RESUMO

Most gambling research utilizes general youth samples and focuses on binary gender categories; few studies examine and compare gambling behaviors between transgender and gender diverse (TGD) youth and their cisgender peers. The current study used population-based data from the 2016 Minnesota Student Survey to compare the prevalence of gambling behaviors and problem gambling among TGD versus cisgender adolescents, in addition to examining differences by birth-assigned sex. The analytic sample consisted of 80,929 students (including, n = 2168 [2.7%] TGD) in 9th and 11th grades. Chi-square tests and Cohen's d effect sizes were used for all comparisons. TGD youth reported greater involvement in most gambling behaviors and problem gambling compared to cisgender youth. In comparisons by birth-assigned sex, TGD youth assigned male at birth were particularly at risk for gambling involvement and problem gambling. TGD youth assigned female at birth also reported higher rates of problem gambling than both cisgender youth assigned male and female at birth. Results suggest that examining rates of gambling behavior and problem gambling as well as identifying disparities in vulnerable youth populations is crucial in order to develop culturally responsive and gender inclusive prevention, intervention, and outreach programs.


Assuntos
Comportamento do Adolescente/psicologia , Comportamento Aditivo/psicologia , Jogo de Azar/psicologia , Identidade de Gênero , Pessoas Transgênero/psicologia , Adolescente , Feminino , Humanos , Masculino , Grupo Associado , Estudantes/estatística & dados numéricos , Inquéritos e Questionários
14.
Am J Prev Med ; 55(6): 787-794, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30344037

RESUMO

INTRODUCTION: Important mental and physical health disparities exist for transgender and gender diverse youth compared with cisgender youth (i.e., those whose birth-assigned sex and gender identity align), yet little is known about factors that protect transgender and gender diverse youth from health problems. The objective of this paper is to identify modifiable protective factors in the lives of transgender and gender diverse adolescents, with the goal of informing efforts to eliminate disparities in depression, suicidality, and substance use in this population. METHODS: Secondary data analysis of the 2016 Minnesota Student Survey examined associations between eight protective factors (connectedness to parents, adult relatives, friends, adults in the community, and teachers; youth development opportunities; and feeling safe in the community and at school) and depression, suicidality, and substance use (alcohol, binge drinking, marijuana, nicotine) among 2,168 adolescents who identified as transgender, genderqueer, genderfluid, or questioning their gender. Logistic regressions assessed the role of each protective factor separately and simultaneously. RESULTS: Each protective factor was associated with lower odds of emotional distress and substance use. When protective factors were examined simultaneously, parent connectedness was protective for all measures. Feeling safe at school and connected to adults in one's community protected against depression and suicidality; teacher connectedness buffered risk of substance use. CONCLUSIONS: Given that transgender and gender diverse youth report lower levels of connectedness and safety, bolstering an explicitly transgender and gender diverse-friendly network of caring parents, safe and supportive schools, and connections to adults in the community may support efforts to eliminate disparities in depression, suicidality, and substance use.


Assuntos
Fatores de Proteção , Estresse Psicológico/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Pessoas Transgênero , Adolescente , Feminino , Humanos , Masculino , Minnesota , Ideação Suicida , Inquéritos e Questionários
16.
LGBT Health ; 5(5): 312-319, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29920146

RESUMO

PURPOSE: As measures of birth-assigned sex, gender identity, and perceived gender presentation are increasingly included in large-scale research studies, data analysis approaches incorporating such measures are needed. Large samples capable of demonstrating variation within the transgender and gender diverse (TGD) community can inform intervention efforts to improve health equity. A population-based sample of TGD youth was used to examine associations between perceived gender presentation, bullying victimization, and emotional distress using two data analysis approaches. METHODS: This secondary data analysis of the Minnesota Student Survey included 2168 9th and 11th graders who identified as "transgender, genderqueer, genderfluid, or unsure about their gender identity." Youth reported their biological sex, how others perceived their gender presentation, experiences of four forms of bullying victimization, and four measures of emotional distress. Logistic regression and multifactor analysis of variance (ANOVA) were used to compare and contrast two analysis approaches. RESULTS: Logistic regressions indicated that TGD youth perceived as more gender incongruent had higher odds of bullying victimization and emotional distress relative to those perceived as very congruent with their biological sex. Multifactor ANOVAs demonstrated more variable patterns and allowed for comparisons of each perceived presentation group with all other groups, reflecting nuances that exist within TGD youth. CONCLUSION: Researchers should adopt data analysis strategies that allow for comparisons of all perceived gender presentation categories rather than assigning a reference group. Those working with TGD youth should be particularly attuned to youth perceived as gender incongruent as they may be more likely to experience bullying victimization and emotional distress.


Assuntos
Bullying/estatística & dados numéricos , Vítimas de Crime/estatística & dados numéricos , Disforia de Gênero/psicologia , Estresse Psicológico/epidemiologia , Pessoas Transgênero/psicologia , Adolescente , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Minnesota/epidemiologia , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Pessoas Transgênero/estatística & dados numéricos
17.
Transgend Health ; 3(1): 57-70, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29756044

RESUMO

Regardless of their area of specialization, adult psychiatrists are likely to encounter gender-variant patients; however, medical school curricula and psychiatric residency training programs devote little attention to their care. This article aims to assist adult psychiatrists who are not gender specialists in the delivery of respectful, clinically competent, and culturally attuned care to gender-variant patients, including those who identify as transgender or transsexual or meet criteria for the diagnosis of Gender Dysphoria (GD) as defined by The Diagnostic and Statistical Manual of Mental Disorders (5th edition). The article will also be helpful for other mental health professionals. The following areas are addressed: evolution of diagnostic nosology, epidemiology, gender development, and mental health assessment, differential diagnosis, treatment, and referral for gender-affirming somatic treatments of adults with GD.

18.
Arch Sex Behav ; 47(4): 987-998, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29497915

RESUMO

This article describes the gender identity, gender expression, and sexual orientation of male spirit mediums in Myanmar. Our analysis is based on ethnographic work, field observation, and 10 semi-structured interviews. These observations were conducted from 2010 to 2015, mostly in Mandalay, with some fieldwork in Yangon and Bagan. The focus of this investigation was specifically on achout (gender variant individuals) who were spirit mediums (nat kadaw). Semi-structured interviews explored the ways that participants understood their gender identity, gender expression, and sexuality in relation to their work as spirit mediums and broader social life. Myanmar remains quite a homophobic and transphobic culture but is undergoing rapid economic and social change. Therefore, it provides an interesting context to study how safe spaces are produced for sexual/gender minorities amidst broader social change. We find that, through the animistic belief structure, there is a growing space for gender nonconforming people, gender variant, and same-sex-oriented individuals (achout) to neutralize their stigmatized status and attain a level of respect and economic advantage. Their ability to become nat kadaw (mediums of spirits) mitigates or trumps their stigmatized status.


Assuntos
Identidade de Gênero , Comportamento Sexual , Espiritualismo , Adolescente , Adulto , Idoso , Cultura , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Mianmar , Minorias Sexuais e de Gênero , Estigma Social , Adulto Jovem
19.
Pediatrics ; 141(3)2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29437861

RESUMO

BACKGROUND: Transgender and gender nonconforming (TGNC) adolescents have difficulty accessing and receiving health care compared with cisgender youth, yet research is limited by a reliance on small and nonrepresentative samples. This study's purpose was to examine mental and physical health characteristics and care utilization between youth who are TGNC and cisgender and across perceived gender expressions within the TGNC sample. METHODS: Data came from the 2016 Minnesota Student Survey, which consisted of 80 929 students in ninth and 11th grade (n = 2168 TGNC, 2.7%). Students self-reported gender identity, perceived gender expression, 4 health status measures, and 3 care utilization measures. Chi-squares and multiple analysis of covariance tests (controlling for demographic covariates) were used to compare groups. RESULTS: We found that students who are TGNC reported significantly poorer health, lower rates of preventive health checkups, and more nurse office visits than cisgender youth. For example, 62.1% of youth who are TGNC reported their general health as poor, fair, or good versus very good or excellent, compared with 33.1% of cisgender youth (χ2 = 763.7, P < .001). Among the TGNC sample, those whose gender presentation was perceived as very congruent with their birth-assigned sex were less likely to report poorer health and long-term mental health problems compared with those with other gender presentations. CONCLUSIONS: Health care utilization differs between TGNC versus cisgender youth and across gender presentations within TGNC youth. With our results, we suggest that health care providers should screen for health risks and identify barriers to care for TGNC youth while promoting and bolstering wellness within this community.


Assuntos
Identidade de Gênero , Indicadores Básicos de Saúde , Saúde Mental , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pessoas Transgênero/psicologia , Adolescente , Feminino , Pesquisas sobre Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Masculino , Minnesota
20.
JAMA Netw Open ; 1(7): e184468, 2018 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-30646355

RESUMO

Importance: The veracity, nomenclature, and conceptualizations of sex addiction, out-of-control sexual behavior, hypersexual behavior, and impulsive or compulsive sexual behavior are widely debated. Despite such variation in conceptualization, all models concur on the prominent feature: failing to control one's sexual feelings and behaviors in a way that causes substantial distress and/or impairment in functioning. However, the prevalence of the issue in the United States is unknown. Objective: To assess the prevalence of distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors among a nationally representative sample in the United States. Design, Setting, and Participants: This survey study used National Survey of Sexual Health and Behavior data to assess the prevalence of distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors and determined how prevalence varied across sociodemographic variables. Participants between the ages of 18 and 50 years were randomly sampled from all 50 US states in November 2016. Main Outcomes and Measures: Distress and impairment associated with difficulty controlling sexual feelings, urges, and behavior were measured using the Compulsive Sexual Behavior Inventory-13. A score of 35 or higher on a scale of 0 to 65 indicated clinically relevant levels of distress and/or impairment. Results: Of 2325 adults (1174 [50.5%] female; mean [SD] age, 34.0 [9.3] years), 201 [8.6%] met the clinical screen cut point of a score of 35 or higher on the Compulsive Sexual Behavior Inventory. Gender differences were smaller than previously theorized, with 10.3% of men and 7.0% of women endorsing clinically relevant levels of distress and/or impairment associated with difficulty controlling sexual feelings, urges, and behavior. Conclusions and Relevance: The high prevalence of this prominent feature associated with compulsive sexual behavior disorder has important implications for health care professionals and society. Health care professionals should be alert to the high number of people who are distressed about their sexual behavior, carefully assess the nature of the problem within its sociocultural context, and find appropriate treatments for both men and women.


Assuntos
Comportamento Compulsivo/psicologia , Comportamento Impulsivo , Transtornos Parafílicos/complicações , Autocontrole , Comportamento Sexual/psicologia , Disfunções Sexuais Psicogênicas/complicações , Estresse Psicológico/etiologia , Adolescente , Adulto , Comportamento Aditivo/psicologia , Emoções , Feminino , Inquéritos Epidemiológicos , Humanos , Relações Interpessoais , Libido , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Saúde Sexual , Estresse Psicológico/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
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