Sexual counseling for female sexual interest/arousal disorders: a randomized controlled trial based on the "good enough sex" model.

BACKGROUND: Female sexual interest/arousal disorder (FSIAD) is the most common female sexual disorder with adverse effects on women's health and interpersonal relationships. AIM: This survey evaluated the effects of sexual counseling based on the "good enough sex" (GES) model on the sexual health variables of women with FSIAD. METHODS: A randomized clinical trial with a 1:1 allocation ratio was conducted among 80 women with FSIAD in Iran in 2021. Eligible participants were randomly assigned to group A (women) and group B (couples). Women attended 4 weekly online group sexual counseling sessions based on the GES model, each lasting 120 minutes. In group B, husbands participated in sessions 2 and 3. OUTCOMES: Women's sexual health parameters-including sexual desire, sexual satisfaction, sexual function, sexual distress, sexual communication, frequency of sexual intercourse, and dysfunctional beliefs-were evaluated before and 3 months after counseling. The significance threshold considered P < .007 due to Bonferroni correction. RESULTS: After the intervention, all sexual parameters except sexual dysfunctional beliefs showed significant improvement (P < .001) in both groups. During the follow-up period, the average scores for all sexual variables were slightly higher in group B vs group A. The between-group difference was significant only for frequency of sexual intercourse (P < .01). CLINICAL IMPLICATIONS: This study reaffirms the impact of the GES model as biopsychosocial therapy in managing female sexual problems. Considering men's reluctance to accompany their wives to sex clinics, counseling for women alone can play a significant role in solving sexual problems, especially in the case of FSIAD. Online sexual consultation offers cost and time savings, provides a secure space for discussing sensitive topics, and facilitates group program coordination. It ensures universal access to counseling, thereby addressing gender incompatibility issues. It is a powerful, interactive, and acceptable alternative to in-person visits, providing convenience and confidentiality for clients seeking sexual health support. STRENGTHS AND LIMITATIONS: The following were among the survey strengths: conducting a randomized controlled trial on women with FSIAD by applying an appropriate model and scales, involving spouses, and evaluating online group sexual counseling. However, the results of this study may not be generalizable to women without partners. CONCLUSION: The GES model, emphasizing intimacy and sexual dialogue, reduces unrealistic sexual expectations and improves women's sexual desire and overall health. Our results showed that instead of insisting on the physical presence of husbands in counseling sessions, clinicians should emphasize their emotional support and companionship during the treatment process.

The Effect of Mindfulness-Based Sexual Counseling on Sexual Distress, Attitude Toward Sexuality, and Body Image Concerns in Pregnant Women: A Randomized Controlled Trial.

INTRODUCTION: Sexual distress during pregnancy can cause a negative attitude toward sexuality during pregnancy, and this can be seen especially in conjunction with body image concerns. This study was conducted to determine the effects of mindfulness-based sexual counseling (MBSC) on sexual distress, attitudes toward sexuality, and body image concerns in pregnant women. METHODS: A randomized controlled trial was conducted in a sample of women who experienced sexual distress presenting to a Healthy Living Center in eastern Turkey. Women (N = 134) were randomly assigned to receive a 4-week, 8-session counseling program based on mindfulness (experimental group; n = 67) or treatment as usual (control group; n = 67). The primary outcome of the study, sexual distress, was assessed using the Female Sexual Distress Scale-Revised. Secondary outcomes included attitude toward sexuality, assessed using the Attitude Scale toward Sexuality during Pregnancy, and body image concerns, using the Body Image Concerns during Pregnancy Scale. Outcomes were compared postintervention, correcting for baseline using analysis of covariance. The study was registered with ClinicalTrials.gov (NCT04900194). RESULTS: Mean scores for sexual distress (7.69 vs 17.36; P < .001) and body image concerns (57.76 vs 73.88; P < .001) decreased significantly in the mindfulness group compared with the control group. Similarly, mean scores for attitudes toward sexuality significantly improved in the mindfulness group compared with the control group (133.52 vs 105.78; P < .05). DISCUSSION: MBSC is a promising strategy to help women experiencing sexual distress during pregnancy to reduce their levels of sexual distress, raise their positive attitudes toward sexuality, and lower their body image concerns. Larger clinical trials of MBSC are recommended to support introduction of MBSC into clinical practice.

The Effect of Sex Counseling Based on (Permission, Limited Information, Specific Suggestions, Intensive Therapy) Model on Sexual Satisfaction in Women with Cyclic Mastalgia: A Randomized Controlled Clinical Trial.

BACKGROUND: More than half of the population of women suffer from cyclic mastalgia which can interfere with women's sexual function and affect their sexual satisfaction. The current study was conducted to determine the effect of sexual counseling on sexual satisfaction in women with cyclic mastalgia. MATERIALS AND METHODS: This randomized controlled trial study was performed on 81 women with cyclic mastalgia. The subjects were randomly divided into two groups of intervention (n = 40) and control (n = 41). Intervention was performed as Permission, Limited information, Specific suggestions, Intensive therapy (PLISSIT) sex counseling in four sessions for a maximum of 90 min in the intervention group. The demographic checklist and Index of Sexual Satisfaction (ISS) were used for data collection. Follow-up was performed 1 and 3 months after the intervention. The obtained data were analyzed using repeated-measures test. RESULTS: The intervention and control groups were in good balance in terms of demographic characteristics and sexual satisfaction scores prior to the intervention and no statistically significant differences were observed. There was a statistically significant increase in the mean (SD) score of female sexual satisfaction in the intervention group: 93 (12.52), 101.15 (7.70),101.37 (5.31), (F (1,39) = 27.4, p < 0.001). We also observed a decrease in the mean (SD) score of sexual satisfaction in the control group: 93.39 (13.12), 90.68 (8.41), 90.85 (6.57), (F (1,40) = 11.9, p < 0.001) 1 and 3 months following the intervention. CONCLUSIONS: This study revealed that individual counseling by PLISSIT sex counseling could lead to improvement in sexual satisfaction index in women with cyclic breast pain.

Comparing the Effectiveness of Sexual Counseling Based on PLISSITand BETTER Models on Sexual Selfdisclosure in Women with Sexual Problems after Childbirth: A Randomized Trial.

BACKGROUND: Sexual self-disclosure is one of the factors that affect sexual satisfaction. The aim of this study was to assess the efficacy of individual therapy using the Bring up, Explain, Tell, Timing, Educate, and Record (BETTER model) in comparison to individual therapy using the Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT model) in terms of increasing sexual self-disclosure in women with sexual problems after childbirth. MATERIALS AND METHODS: This randomized trial was conducted in 2017 in Mashhad, Iran. 80 women with sexual problems within 4 weeks to 6 months after childbirth were randomized into two equal groups and received the interventions in 2 sessions of 60-90 minutes. The research instruments included a demographic questionnaire, the Female Sexual Function Index (FSFI) and Hulbert sexual self-disclosure index. Changes in mean (SD) scores of sexual self-disclosures between groups were assessed before and 4 weeks after the intervention and the results (mean changes) were compared between groups. The data analysis was conducted using independent t-test, paired t-test, Chi-square, analysis of covariance (ANOVA), and Mann-Whitney U test in SPSS (p < 0.05). RESULTS: In the PLISSIT group, the mean (SD) sexual self-disclosure score at baseline was 43.80 (9.50) and after 4 weeks was 51.60 (8.30). In the BETTER group, at baseline and after 4 weeks the mean (SD) sexual self-disclosure score was, respectively, 44.10 (10.30) and 55.60 (8.20) (Z = -2.5, p = 0.013). CONCLUSIONS: The findings confirm the effectiveness of the BETTER counseling model in increasing sexual self-disclosure after childbirth.

The effect of sexual counseling on depression, anxiety, stress, sexual knowledge and sexual quality of life in men who have undergone invasive coronary interventions: An RCT.

BACKGROUND: Sexual dysfunctions are common in men with ischemic heart disease, especially in men undergoing therapeutic interventions. OBJECTIVE: This study intended to assess the effect of counseling on depression, anxiety, stress, sexual knowledge and sexual quality of life in men after invasive coronary interventions in the post catheterization department of Kashan Shahid Beheshti Hospital during 2018. MATERIALS AND METHODS: The study population consisted of 54 male participants who had undergone an invasive coronary intervention. The intervention group received counseling and the control group underwent the standard ward routine. Data were collected using the depression anxiety stress scales, Abraham's sexual quality of life, and the Yi-Hung Sexual Knowledge questionnaires before discharge and also two months later. RESULTS: Within two months, the intervention group's mean score of sexual knowledge significantly increased, compared with the control group, from 12.37 to 14.81 (p ≤ 0.001). The intervention group's mean score of sexual quality of life also significantly increased, compared with the control group, from 48.2 to 60.7 (p ≤ 0.001). Moreover, the mean anxiety score changed in the intervention group from 11.18 to 5.25, again a significant difference compared with the control group (p = 0.01). But, the differences in the depression and stress scores were not significant. CONCLUSION: Our findings suggest that sexual counseling may improve sexual knowledge, sexual quality of life and anxiety in men following invasive coronary intervention, but might not reduce their stress or depression. Further studies are needed to confirm these findings.

Effectiveness of cognitive-behavioral therapy on sexual function and sexual self-efficacy in pregnant women: An RCT.

BACKGROUND: Cognitive-behavioral therapy (CBT) is one of the ways to improve an undesirable sexual function. OBJECTIVE: The purpose of this study was to investigate the effect of CBT on the sexual function and sexual self-efficacy of pregnant women. MATERIALS AND METHODS: In this randomized clinical trial, 36 pregnant women referred to five healthcare centers in Ahvaz, Iran, from December 2016 to January 2017 were enrolled through stratified random sampling in two groups. The case group received counseling based on cognitive behavioral therapy for eight consecutive weeks and the control group received the routine training provided by healthcare staff. Two and four weeks after the end of sessions, both groups completed the Female Sexual Function Index and self-efficacy questionnaires again. RESULTS: The mean of sexual function and self-efficacy scores in pregnant women in the case and control groups before the intervention did not show a significant difference (p = 0.56). The mean of sexual function and self-efficacy scores of pregnant women in the case and control groups was statistically significant two and four weeks, respectively, after the intervention (p ≤ 0.0001). CONCLUSION: The results of this study showed that counseling based on CBT in comparison with the routine training during pregnancy improves the sexual performance and self-efficacy of pregnant women.

The Effect of Counseling Based on Sexual Self-Concept via Social Networks on Smartphone in Infertile Women: A Randomized Controlled Trial.

BACKGROUND: Infertility can affect the physical, mental and emotional aspects of a person's life. This study aimed to investigate the effect of sexual counseling via social networks on Smartphone in sexual self-concept of infertile women. METHODS: In a randomized controlled trial, 80 eligible infertile women referred to the fertility centers of Alborz University of Medical Sciences from April to July 2018. They were randomly assigned into intervention) sexual counseling with routine infertility counseling) and control groups )routine infertility counseling(. Eight counseling sessions via social networks were held for both groups. The Snell's sexual self-concept questionnaire was completed by participants before and after the intervention. The data were analyzed using SPSS 19 with a significance level of P<0.05. RESULTS: The mean age of women was 30.76±0.72 years and the most infertility duration was more than 36 months. The results of a repeated measure showed that there were significant differences in positive self-concept domain between the two groups during the time by comparing the means (120.4±17.9 versus 105.1±16.8). We also found an increasing trend of the scores in positive sexual self-concept domain (110.6±18.42, 120.1±18.7, 120.4±17.9) (P<0.001) and a decrease in negative sexual self-concept domain (24.3±7.87, 20.2±7.77, 19.65±6.97) (P<0.001) in intervention group. In the situational self-concept, there were no difference between the two groups during the time (P=0.06). CONCLUSION: The results obtained in the present study showed that counseling through social networks was effective in improving the sexual self-concept in infertile women, thus ameliorating the couples' sexual relations. Trial Registration Number: IRCT20160503027728N9.

Instrumentos de avaliação da sexualidade em homens e mulheres após a lesão medular: uma revisão sistemática / Assessment instruments of sexuality in men and women after spinal cord injury: a systematic review

A disponibilidade de instrumentos para avaliação da saúde sexual é muito importante para uma boa prática clínica, pois permite que os profissionais da área da saúde avaliem e intervenham de forma eficaz, atingindo os melhores padrões de avaliação e intervenção, e assim, melhorem a vida sexual dessa população. Objetivo: Revisar sistematicamente os instrumentos de avaliação da sexualidade em homens e mulheres após a lesão medular disponíveis na literatura, em relação ao seu uso e propriedades de medida. Método: Trata-se de uma revisão sistemática da literatura das bases de dados Pubmed, Lilacs, Scielo e Cinahl, de todos os estudos até maio de 2019, em que a estratégia de busca consistiu na utilização das palavras-chave: sexuality, spinal cord injury, evaluation, assessment e questionnaires. Os artigos identificados pela estratégia de busca inicial foram avaliados conforme critérios de inclusão pré-estabelecidos. Os desfechos foram mecanismos sexuais (excitação, ejaculação, ereção e orgasmo), desejo, satisfação, frequência sexual, ajuste, educação sexual e relação com o parceiro. Os dados foram organizados em tabelas foram apresentados através de uma análise descritiva dos resultados dos estudos incluídos. Resultados: Dezoito estudos atenderam aos critérios de elegibilidade e foram incluídos. Foram encontrados sete instrumentos validados para avaliação da sexualidade em indivíduos com lesão medular, nove genéricos e doze instrumentos para avaliação de fatores possivelmente relacionados a sexualidade. Dois avaliaram as propriedades de medida, sendo que em ambos foram adequadas. Conclusão: Esta revisão identificou um total de 28 instrumentos que foram utilizados na avaliação da sexualidade em indivíduos com lesão medular, entretanto, apenas sete desses instrumentos foram validados.

The availability of tools for sexual health assessment is very important for good clinical practice as it enables health professionals to evaluate and intervene effectively, achieving the best standards of assessment and intervention, and thus improving sex life of this population. Objective: To systematically review the instruments for assessing sexuality in men and women after spinal cord injury available in the literature regarding their use and measurement properties. Methods: This is a systematic literature review of the Pubmed, Lilacs, Scielo and Cinahl databases from all studies up to May 2019, in which the search strategy consisted of using the keywords: sexuality, spinal cord injury, evaluation, assessment and questionnaires. The articles identified by the initial search strategy were evaluated according to the pre-established inclusion criteria. Outcomes were sexual mechanisms (arousal, ejaculation, erection and orgasm), desire, satisfaction, sexual frequency, adjustment, sex education and relationship with the partner. Data were organized into tables were presented through a descriptive analysis of the results of the included studies. Results: Eighteen studies met the eligibility criteria and were included. We found seven validated instruments for assessing sexuality in individuals with spinal cord injury, nine generic and twelve instruments for assessing factors possibly related to sexuality. Two evaluated the measurement properties, and both were adequate. Conclusion: This review identified a total of 28 instruments that were used to assess sexuality in individuals with spinal cord injury, however, only seven of these instruments were validated.

Strengths and weaknesses of rapid Hiv test implementation in a specialized center in Brazil / Fortalezas y fragilidades en la implantación de la prueba rápida para VIH en un centro especializado en Brasil

RESUMEN Objetivo Analizar cómo los profesionales y usuarios de un servicio de salud evalúan el asesoramiento y las implementaciones de pruebas rápidas de VIH, que comenzaron en 2010, destacando aspectos positivos, barreras y limitaciones, e investigando los posibles sentidos y significados asignados a las EST/VIH/SIDA. Método Es una investigación cualitativa, exploratoria y descriptiva. Se realizaron entrevistas semi dirigidas con 27 usuarios de servicios y 15 profesionales de la salud, analizadas con el análisis temático. El estudio se realizó en uno de los primeros Centros de Asesoramiento y Pruebas (CTC) a implementar pruebas rápidas de VIH para todos los usuarios, en Porto Alegre, Brasil. Resultados Aspectos positivos de la implementación de pruebas rápidas de VIH: disminución del tiempo de espera de los resultados, mejor resolución de asistencia, expansión de las horas de servicio, pruebas pre y post personalizadas, y competencia en el enfoque de atención realizada por profesionales de la salud durante el asesoramiento. Limitaciones: creencias sobre la eficacia de la prueba rápida de VIH, la estructura física, la mala publicidad de la prueba rápida y poca capacidad de asistencia. Hay algunas oposiciones a la tecnología, debido a la creencia de que las pruebas rápidas pueden no ser efectivas. Conclusiones La integración de las perspectivas de los profesionales y usuarios de atención médica para esta política beneficiará las futuras implementaciones de pruebas rápidas en otros Centros de asesoramiento e incrementar el acceso a los servicios de salud.(AU)

ABSTRACT Objective To analyze how health professionals and health service users assess counseling on Rapid HIV test, as well as its implementation, which started in Brazil in 2010, focusing on positive aspects, barriers, and limitations, and analyzing possible meanings that are given to STD and HIV/AIDS. Method Qualitative, exploratory, and descriptive research. Semi-structured interviews were administered to 27 service users and 14 health care professionals; a thematic analysis of the interviews was performed. The study was carried out in one of the first Counseling and Testing Centers (CTC) designed to implement Rapid HIV tests in Porto Alegre, Brazil. Results Positive aspects of Rapid HIV testing implementation included a reduced waiting time for obtaining the test results, better assistance provision, an increase in the number of service hours, personalized pre- and post-tests, and better prepared health care professionals regarding health care during counseling. Limitations included beliefs about the effectiveness of Rapid HIV testing, physical structure, bad publicity on this technology, and poor health care capacity. Likewise, there are some who oppose this type of test, since they believe rapid tests may not be effective. Conclusions Integrating the perspectives of health care professionals and users on this policy will favor future rapid test implementations in other CTCs, and increase health care access possibilities.(AU)

Satisfacción de necesidades de anticoncepción en mujeres positivas al VIH: efecto sobre la eliminación de la transmisión vertical del virus / Meeting contraceptive needs of HIV-positive women: effect on elimination of vertical transmission of HIV

RESUMEN Cerca de 38% de embarazos no planeados se dan por necesidades insatisfechas en anticoncepción. En las mujeres positivas al VIH, las cifras se triplican, un fenómeno explicado por determinantes sociales como la pobreza, el acceso a los servicios de salud, la violencia y el desplazamiento forzoso, todos ellos elementos propios de la vida de estas mujeres. Los embarazos no planeados representan una carga psicológica vinculada con el temor de transmitir la infección a sus hijos, la orfandad y el asumir los riesgos durante el embarazo, a lo cual se añaden las consecuencias familiares y sociales que se manifiestan en baja asistencia al control prenatal, descuido de la salud y aumento de la posibilidad de transmisión vertical. El asesoramiento en anticoncepción diferencial e integrado a los servicios de atención y control del VIH es básico para lograr la eliminación de la transmisión vertical del VIH a corto y medio plazo. Reconocer que estas mujeres tienen características diferentes a las de la población general, como expresan su vida reproductiva, sus deseos e intenciones sobre la maternidad y que los embarazos no planeados representan una carga psicológica, social y económica adicional a la de las demás mujeres permitiría que el asesoramiento en anticoncepción se proporcionara en los programas de atención y seguimiento del VIH, en el mismo lugar y momento, con personal capacitado, capaz de comprender y atender sus necesidades reproductivas dentro de un marco de derechos, logrando que los sistemas de salud, basados en la responsabilidad que tienen con la sociedad, fueran capaces de ofrecer un asesoramiento en reproducción de calidad y dirigido a satisfacer las necesidades específicas de estas mujeres.

ABSTRACT Nearly 38% of unplanned pregnancies occur because of unmet contraceptive needs. In HIV-positive women, these figures triple, a phenomenon explained by social determinants such as poverty, access to health services, violence, and forced displacement, all of which are frequent elements in the lives of these women. Unplanned pregnancies represent a psychological burden related to women’s fear of transmitting the infection to their children, orphanhood, and assuming risks during pregnancy, in addition to family and social consequences that are expressed in lack of prenatal care, neglect of their health, and an increased likelihood of vertical transmission. Technical assistance for differentiated contraception counseling integrated into HIV care and control services is basic to achieving short- and medium-term elimination of vertical transmission of HIV. These women’s characteristics are different from those of the general population, as expressed in their reproductive lives, desires, and intentions regarding motherhood; and their unplanned pregnancies represent a greater psychological, social, and economic burden than that of other women. Recognizing this would allow contraception counseling to be provided by HIV care and follow-up programs, in the same place and time, with trained personnel, capable of understanding and meeting their reproductive needs within a rights-based framework, ensuring that health systems, based on the responsibility they have to society, would be capable of offering quality reproductive care counseling, aimed at meeting the specific needs of HIV-positive women.

Comportamientos sexuales en mayores de 18 años con diagnóstico VIH/SIDA en tres ciudades de Colombia 2011 / Comportamentos sexuais em mais de 18 anos com diagnóstico de HIV / AIDS em três cidades na Colômbia 2011 / Sexual behaviors in over 18 years old with a diagnosis of HIV/AIDS in three cities of Colombia 2011

Objetivo: Describir los comportamientos sexuales en personas VIH positivas en tres ciudades de Colombia antes y después de conocer el diagnóstico e identificar cambios en estos comportamientos. Metodología: Estudio descriptivo, de corte trasversal, en el que participaron 85 individuos de tres ciudades colombianas, entrevistados durante el año 2011. Se cumplió con los parámetros éticos para investigaciones con personas. Para el análisis estadístico se utilizó el software SPSS 18.0. Resultados: Se encontraron diferencias significativas al comparar el comportamiento sexual antes y después de conocer el diagnóstico VIH positivo. el 23% de los entrevistados manifestó no haber iniciado actividades sexuales después del diagnóstico, el 62.5% empezó a usar el condón en todas sus relaciones sexuales. Las relaciones sexuales con personas VIH positivo aumentaron a un 35.4%. Las infecciones de transmisión sexual disminuyeron a un 12.3%. El consumo de alcohol previo al inicio de relaciones sexuales disminuyó a un 31.8%. Conclusiones: Se encontraron cambios en los comportamientos de riesgo de las personas después de recibir el diagnóstico; sin embargo, dichas modificaciones no son suficientes por tratarse de la trasmisión de una infección mortal y de elevados costos socioeconómicos.

Objective: To describe sexual behaviors of HIV positive patients in three cities of Colombia, before and after learning diagnosis and to identify changes. Methodology: Quantitative, descriptive, cross-sectional study, with participation of 85 individuals from three cities of Colombia who were interviewed during 2011. Ethical standards for research involving individuals were met during the study. The SPSS software version 18.0 was used for statistical analysis. Results: Significant differences were found when comparing their sexual behavior before and after knowing HIV positive diagnosis, 23.0% of respondents said that they had not resumed sexual activity, 62.5% of the patients began to use the condom in all sexual relations. Sex with HIV-positive people increased a 35.4%. Sexually transmitted infections were reduced to a 12.3%. The consumption of alcohol prior to the onset of sexual intercourse decreased to 31.8%. Conclusions: Changes were found regarding risky behaviors of people after knowing the diagnosis; however, such modifications are not enough regarding the transmission of a deadly infection and with high social and economic costs.

Objetivo: Descrever o comportamento sexual em pessoas HIV-positivas em três cidades na Colômbia antes e depois de conhecer o diagnóstico e identificar mudanças no esses comportamentos. Metodologia: Estudo descritivo de transversal, em que 85 indivíduos participaram em três cidades colombianas, entrevistado em 2011. Eles se conheceram os padrões éticos para a investigação com as pessoas. Para análise estatística foi utilizado SPSS 18.0 software. Resultados: Diferenças significativas na comparação entre o comportamento sexual foram encontrados antes e depois de aprender sobre o diagnóstico de HIV positivo. 23% dos entrevistados disseram que a atividade sexual não ter iniciado após o diagnóstico, 62,5% começaram a usar preservativos em todas as relações sexuais. Sexo com pessoas HIV positivas aumentou para 35,4%. infecções sexualmente transmissíveis diminuiu para 12,3%. O consumo de álcool antes do início do sexo diminuiu para 31,8%. Conclusões: foram encontradas alterações nos comportamentos de risco de pessoas depois de receber o diagnóstico; No entanto, estas alterações não são suficientes, porque é a transmissão de uma infecção fatal e custos socioeconómicos elevados.

Sexual Problems among Japanese Women: Data from an Online Helpline.

INTRODUCTION: Sexual problems have been more prevalent among East Asian women than those from other areas of the world. However, Japanese women seldom tend to consult their treating physicians as such intimate problems are socially awkward topics to share and may be considered shameful. Presently, there is little data in the literature regarding women's sexual problems in Japan. AIMS: We aimed (i) to investigate the types of sexual problems that were reported among Japanese women who had sought online consultations; and (ii) to examine whether factors such as age and family structure (marital status and presence of children) increased the likelihood of sexual problems. METHODS: An online helpline received a total of 316 messages from Japanese women related to sexual problems over a 3-year period. We evaluated 276 respondents, who provided demographic information such as age and family structure as well as their response to an open-ended question regarding their sexual problems. MAIN OUTCOME MEASURES: Main outcome measures were the types of sexual problems reported by Japanese women. RESULTS: The majority of respondents were in their 30s (53.6%). Sexual aversion accounted for 42.4% of the complaints, partners' sexual issues for 18.5%, and pain during sex for 16.7%. Family structure significantly correlated with sexual problems (P < 0.001). Women with sexual aversion were more likely to be younger (P = 0.003) and have children (P < 0.001). Women whose partners had sexual issues were more likely to be married (P < 0.001) and have no children (P < 0.001). Women who reported pain during sex were more likely to have no children (P = 0.006). CONCLUSION: Sexual aversion was the most common sexual problem among Japanese women who sought help via the online helpline. Family structure was related to sexual problems. More detailed assessments of family structure may be important in better identifying the triggering causes of the reported sexual problems. Ozaki Y, Nagao K, Saigo R, Tai T, Tanaka N, Kobayashi H, Nakajima K, and Takahashi Y. Sexual problems among Japanese women: Data from an online helpline. Sex Med 2015;3:289-295.

Addressing sexual dysfunction in colorectal cancer survivorship care.

Despite the high prevalence of sexual dysfunction in survivors of colorectal cancer, studies have shown that patients and providers rarely discuss how these symptoms may be influencing overall quality of life. The type and severity of symptoms of sexual dysfunction can vary greatly depending on the type of colorectal cancer and treatment, and assessment of sexual dysfunction is key to understanding how patients may be affected by these symptoms. Although patients would like to discuss these issues with their provider, they are often reluctant to ask questions about sexual functioning during appointments. Likewise, health care providers may hesitate to address sexual dysfunction due to time limitations or lack of knowledge regarding treatment of sexual problems. Health care providers can facilitate discussion of sexual dysfunction by (I) assessing sexual functioning throughout treatment; (II) initiating discussions about symptoms of sexual dysfunction at each appointment; and (III) maintaining adequate referral resources for treatment of sexual dysfunction.

Combination of psychological intervention and phosphodiesterase-5 inhibitors for erectile dysfunction: a narrative review and meta-analysis.

INTRODUCTION: Erectile dysfunction (ED) is an increasing health problem that demands effective treatment. There is evidence that phosphodiesterase-5 inhibitors (PDE5-Is) and psychological intervention (PI) are effective treatment options; however, little is known about their comparative efficacy and the efficacy of combined treatments. AIM: The aim of this systematic review and meta-analysis is to evaluate the comparative efficacy of PI, PDE5-Is, and their combination in the treatment of ED. MAIN OUTCOME MEASURES: Primary outcome was ED symptoms, and secondary outcome was sexual satisfaction of the patient. METHODS: A systematic literature search was conducted in order to identify relevant articles published between 1998 and 2012. We included randomized controlled trials and controlled trials comparing PI with PDE5-I treatment or one of them against a combination of both. RESULTS: Eight studies with a total number of 562 patients were included in the meta-analysis. The results of the included studies are inconclusive, though they show a trend towards a larger effect of combined treatment compared with PI or PDE5-I treatment alone. The meta-analysis found that, overall, combined treatment was more efficacious for ED symptoms than PDE5-I treatment or PI alone. Combined treatment was more efficacious than PDE5-I use alone on sexual satisfaction. No differences were found between PDE5-Is and PI as stand-alone treatments. None of the moderators (treatment duration, methodological quality, or researcher allegiance) altered the effects. CONCLUSIONS: The combination of PI and PDE5-Is is a promising strategy for a favorable outcome in ED and can be considered as a first-choice option for ED patients. Stronger RCTs are required to confirm this initial finding.

La edad de la mujer como factor de riesgo de mortalidad materna, fetal, neonatal e infantil / Women age as a risk factor for maternal, fetal, neonatal and infant mortality

Background: Adolescent pregnancy and advanced maternal age are associated with increased risk for maternal, perinatal and infant death. However, the maternal age with the lowest reproductive risk has not been established. Aim: To determine the range of maternal age with the lowest reproductive risk. Material and Methods: A population-based study (2005-2010) was performed analyzing raw data from vital statistics yearbooks of the National Institute of Statistics of Chile. The association of maternal, fetal, neonatal and infant mortality with maternal age was analyzed. The latter was stratified in quinquenniums, between ages 10 and 54 years. Maternal, fetal, neonatal and infant mortality rates were calculated for each quinquennium. The lowest rate was selected as a control group for risk analysis, which was estimated according to Odds Ratio with 95% confidence intervals. Results: Women of 20-29, 25-34 and under 30 years, had the lowest rate of fetal, neonatal/infant and maternal death, respectively. Women aged 45-49 years had the higher rate of maternal, fetal, neonatal and infant mortality. The risk of fetal, neonatal and infant mortality doubled from 40-44 years onwards, and maternal mortality from the age of 30-34 years. Conclusions: Our results suggest that the maternal age range with the lesser general reproductive risk is between 20-29 years. This finding should be considered in future studies of reproductive risk and for an appropriate counseling about conception.

Psychiatric patients' return for HIV/STI test results in mental health centers / Devolução dos resultados de exames sorológicos de HIV/IST entre pacientes psiquiátricos nos serviços de saúde mental / Devolución de los resultados de exámenes serológicos de VIH/ITS entre pacientes psiquiátricos en los servicios de salud mental

OBJECTIVE: To assess individual and/or health service factors associated with patients returning for results of HIV or sexually transmitted infection (STI) tests in mental health centers. METHODS: Cross-sectional national multicenter study among 2,080 patients randomly selected from 26 Brazilian mental health centers in 2007. Multilevel logistic regression was used to assess the effect of individual (level 1) and mental health service characteristics (level 2) on receipt of test results. RESULTS: The rate of returning HIV/STI test results was 79.6 percent. Among health service characteristics examined, only condom distribution was associated with receiving HIV/STI test results, whereas several individual characteristics were independently associated including living in the same city where treatment centers are; being single; not having heard of AIDS; and not having been previously HIV tested. CONCLUSIONS: It is urgent to expand HIV/STI testing in health services which provide care for patients with potentially increased vulnerability to these conditions, and to promote better integration between mental health and health services.

OBJETIVO: Analisar fatores associados ao recebimento de resultados de exames sorológicos para HIV e outras infecções sexualmente transmissíveis (IST) entre pacientes psiquiátricos. MÉTODOS: Estudo de corte transversal multicêntrico nacional de 2.080 participantes selecionados aleatoriamente dentre 26 instituições de saúde mental brasileiras em 2007. O efeito do indivíduo (nível 1) e dos serviços de saúde mental (nível 2) no recebimento dos resultados dos exames foi avaliado utilizando-se regressão logística multinível. RESULTADOS: A proporção de retorno dos resultados de exames HIV/IST foi de 79,6 por cento. Entre as características individuais, houve associação do desfecho com: viver na mesma cidade onde se encontravam os serviços, ser solteiro, não ter ouvido falar sobre aids e não ter sido previamente testado para HIV. Entre as características dos serviços de saúde, apenas distribuição de preservativos esteve associada ao recebimento dos resultados de exames. CONCLUSÕES: É urgente promover melhor integração entre os serviços de saúde, além de expandir a oferta de exame anti-HIV e outras IST, em especial em serviços de atenção a pacientes psiquiátricos potencialmente mais vulneráveis a essas condições.

OBJETIVO: Analizar factores asociados a la recepción de resultados de exámenes serológicos para VIH y otras infecciones de transmisión sexual (ITS) entre pacientes psiquiátricos. MÉTODOS: Estudio de corte transversal multicéntrico nacional de 2.080 participantes seleccionados aleatoriamente entre 26 instituciones brasileñas de salud mental en 2007. El efecto del individuo (nivel 1) y de los servicios de salud mental (nivel 2) en la recepción de los resultados de los exámenes fue evaluado utilizándose regresión logística multinivel. RESULTADOS: La proporción de retorno de los resultados de exámenes VIH/ITS fue 79,6 por ciento. Entre las características individuales, hubo asociación del desenlace con: vivir en la misma ciudad donde se encontraban los servicios, ser soltero, no haber escuchado hablar sobre el sida, y no haber sido previamente evaluado para VIH. Entre las características de los servicios de salud, sólo la distribución de preservativos estuvo asociada a la recepción de los resultados de los exámenes. CONCLUSIONES: El retorno de los resultados de exámenes indicó que es urgente promover una mejor integración entre los servicios de salud, así como expandir la oferta de examen anti-VIH y otras ITS, en especial en servicios de atención a pacientes psiquiátricos potencialmente más vulnerables a estas condiciones.

Gravidez na adolescência: um desafio à promoção da saúde integral do adolescente / Teenage pregnancy: a challenge for comprehensive health promotion among adolescents

Para a promoção da saúde integral do adolescente, o PET-Saúde desenvolve ações integradas na comunidade do bairro São Marcos, região nordeste de Belo Horizonte, Minas Gerais. O trabalho tem por objetivo conhecer a importância da gravidez na adolescência como um problema de saúde na área de abrangência. Em um estudo observacional retrospectivo, foi realizado um levantamento do número de adolescentes entre as grávidas da área de abrangência da Unidade de Saúde São Marcos. Foram utilizadas informações do Sistema Datasus, do Ministério da Saúde, registradas entre junho de 2009 e maio de 2010. As complicações gestacionais, abortamentos e partos prematuros registrados no Sinasc/Datasus, do Ministério da Saúde, foram levantadas no ano de 2009. A prevalência de adolescentes entre as grávidas foi de 22,1%. Entre os 33 registros, 45,4% tinham 18 ou 19 anos de idade. Não houve associação entre prematuridade e gravidez na adolescência (p = 0,29) ou entre abortamentos registrados e adolescência (p = 1,0). Conclui-se que a prevalência de gestação em adolescentes na área de abrangência é preocupante, confirmando a necessidade de uma abordagem específica na prevenção de sua ocorrência nessa população.

In order to promote comprehensive health among adolescents, the Educational Program for Health Work (PET-Saúde) conducts integrated activities in the São Marcos neighborhood in northeast Belo Horizonte, Minas Gerais State, Brazil. The current study focuses on the relevance of teenage pregnancy as a health problem in the program's coverage area. A retrospective observational study was conducted to determine the number of pregnant teenagers in the coverage area of the São Marcos Health Unit. Information was used from the Ministry of Health database (Datasus), recorded from June 2009 to May 2010. Complications of pregnancy, miscarriages, and premature deliveries recorded in Sinasc/Datasus (Ministry of Health) were tabulated for the year 2009. Among the pregnant women in the database, 22.1% were adolescents. Of the 33 records, 45.4% were 18 or 19 years of age. There was no statistical association between teenage pregnancy and prematurity (p = 0.29) or miscarriage (p = 1.0). In conclusion, the high teenage pregnancy rate in the coverage area is worrisome, confirming the need for a specific approach to its prevention in this population.

Prevalence of Erectile Dysfunction and Utilization of Sexual Counseling in Community Family Medicine Clinics / 가정의학회지

BACKGROUND: Sexual dysfunction such as erectile dysfunction (ED) may be a hidden agenda, but, it should be dealt with by family physicians in primary care. We investigated the prevalence of ED and utilization of sexual consultation practice among community family physicians. METHODS: We analyzed the subjects who were males aged over 30 and married who visited 10 community family clinics around Seoul, Korea and completed questionnaires related to erectile function and utilization of sexual consultation service from May 9 to 28 2009. ED was designated if the 5-item version of international index of erectile dysfunction (IIEF-5) scores were less than 17. RESULTS: The average age of the responders was 45.6 years. The prevalence of ED was 43.3% and increased according to age, chronic disease, low educational history and low family income. Almost all of the mild ED patients answered that they needed sexual consultation. But, half of them had no plan to have a sexual consultation. Odds ratios (ORs) with 95% confidence intervals (CIs) for having a sexual consultation or not according to variables were calculated with logistic regression. More severe ED (OR = 0.875; 95% CI, 0.827 to 0.926), existence of chronic disease (OR = 1.828; 95% CI, 1.026 to 3.260), inferior education (OR = 0.395; 95% CI, 0.196 to 0.796), and lower income (OR = 0.326; 95% CI, 0.124 to 0.857) were the factors which influenced to have a sexual consultation with a family physician. CONCLUSION: The prevalence of ED in family clinic was over 40%, but the utilization of sexual consultations was under 50%. We need to develop intervention strategies for more sexual counseling practice according to educational history, family incomes and status of ED in community family medicine clinics.

Aconselhamento em HIV/aids: uma prática educativa / Counseling on HIV/aids: an educational practice / Asesoramiento en HIV/SIDA: una practica educativa

Neste estudo, o objetivo foi discutir o aconselhamento em HIV/aids na perspectiva da prática educativa, à luz da problematização e da educação para a autonomia. Verificou-se nos estudos sobre o tema a tendência ao autoritarismo e o despreparo dos profissionais tanto no campo da abordagem de temas como sexualidade e doenças sexualmente transmissíveis, como também no campo teórico-metodológico para a ação educativa.

The objective of this study was to discuss counseling in HIV/Aids from the point of view of educational practice in the light of problem raising and education for autonomy. it was found that studies on this theme showed a tendency to authoritarianism and a lack of preparation of workers both in dealing with issues, such as sexuality and sexually transmissible diseases, as well as in the theory and methodology for education.

Este estudio ha buscado discutir el asesoramiento en VIH / Sida desde la perspectiva de la práctica educativa, a la luz de la problematización y de la educación para la autonomía. en los estudios se ha observado la tendencia al autoritarismo y la falta de preparación de los profesionales tanto para enfocar temas como la sexualidad y enfermedades sexualmente transmisibles como en el campo teórico-metodológico para la acción educativa.