Unconsummated marriage: a systematic review of etiological factors and clinical management.

BACKGROUND: Unconsummated marriage (UCM) is the inability of the heterosexual married couple to have penovaginal sexual intercourse. AIM: The study sought to systematically review current evidence regarding the etiological factors and clinical management of UCM. METHODS: A comprehensive bibliographic search on the MEDLINE, Scopus, Web of Science, and Cochrane Library databases was performed in June 2023. Studies were selected if they described married couples who never had sexual intercourse in case report or case series evaluating the related causes and/or management and reporting data with qualitative, quantitative, or mixed methods. The review was reported according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) statement and registered in PROSPERO with ID CRD42023433040. RESULTS: A total of 27 studies including 1638 males and 1587 females were selected. Eight (29.6%) articles were case reports involving a single couple and 19 (70.4%) studies were case series. Mean Murad score was 4.1 (range, 1-8) showing low-intermediate overall study quality. All articles had a level of evidence of 4. Most of studies were conducted in Egypt (n = 5 [18.4%]), Israel (n = 4 [14.9%]), and the United States (n = 4 [14.9%]). The mean age of males and females varied between 24.2 and 37.6 years and from 21 to 27.4 years, respectively. The reasons for the medical visit that led to the diagnosis of UCM were inability to consummate in 23 (85.2%) studies, inability to conceive in 1 (3.7%) article, and mixed in 3 (11.1%) articles. The mean duration of UCM varied from 7 days to 3.5 years. Eight studies involving both men and women showed that vaginismus (8.4%-81%) and erectile dysfunction (10.5%-61%) were the most common causes of UCM. Three articles reported that 16.6% to 26% of all UCM cases were due to both male and female factors. Sildenafil, tadalafil, intracavernosal injection, penile plication, female genital reconstructive surgery, vaginal dilators, lubricants, psychosexual therapy, and sex education were the various treatment modalities in 27 studies to achieve consummation rate of 66.6% to 100%. STRENGTHS & LIMITATIONS: A strength is that this is the first systematic review covering the entire spectrum of UCM. Limitations comprised the low quality of most of the included articles and the large percentage of UCM cases probably not published. CONCLUSION: Erectile dysfunction and vaginismus are the most reported causes of UCM; however, a strong psychological component certainly underlies a significant number of cases. A multidisciplinary approach based on strategic integration of sex education, medical therapy, psychosexual support, and surgical treatment would seem the most suitable option to manage couples with UCM.

A feasibility trial of online Acceptance and Commitment Therapy for women with provoked vestibulodynia.

OBJECTIVES: Acceptance and Commitment Therapy (ACT) is an established treatment for chronic pain. However, it is a form of treatment that have not yet been applied much in the treatment of persistent vulvar pain disorders. This study examines the feasibility and preliminary effects of online ACT for patients with provoked vestibulodynia. METHODS: Women diagnosed with provoked vestibulodynia were assigned randomly either to online ACT or to a waitlist control group. Feasibility was assessed in terms of recruitment potential, treatment credibility, completions rates, retention in trial, and data quality. Participants completed measures of pain with sexual activity, sexual functioning, emotional and relational adjustment, and potential treatment processes before and after treatment. RESULTS: Of the 111 women who were invited to participate in the study, 44 were included (39.6 % recruitment rate). Thirty seven participants (84.1 %) completed the pre-treatment assessment. Participants who received online ACT rated treatment credibility positively, and completed on average 4.31 (SD=1.60) of the six treatment modules. Of participants, 34 provided post treatment data, giving a trial retention rate of 77 %. Effects of online ACT, as compared to waitlist, were large for pain acceptance and quality of life, medium for anxiety and pain catastrophizing, and small for sexual satisfaction, pain with sexual activity, and relationship adjustment. CONCLUSIONS: With some adjustments to recruitment procedures, a full scale randomized controlled trial of online ACT for provoked vestibulodynia appears feasible.

The Indirect Effect of Avoidant Motives for Sex on the Pathways From Childhood Maltreatment to Risky Sex Behaviors.

Literature supports a strong link between engagement in risky sex and childhood maltreatment, with engagement in risky sexual behavior proposed as a manifestation of avoidant coping. Sex motives refer to underlying motivations for engaging in sex such as increased intimacy, or peer pressure. Limited research has examined the role of sex motives on the relationship between childhood maltreatment and risky sex. This study sought to examine this path between childhood maltreatment types and later engagement in risky sex through sex motivations that seek to avoid or reduce negative affect (i.e., sex to cope and sex to affirm self-esteem). A sample of sexually active undergraduate women (n = 551) completed a series of questionnaires on childhood maltreatment, risky sexual behavior, and motivations for sexual intercourse as part of a larger parent study on revictimization. Path analysis was conducted to examine differential indirect effects of childhood maltreatment on risky sex (i.e., sex with a stranger and hookup behaviors). Results suggested sex to cope with negative affect mediated the relationship between emotional abuse, sexual abuse, physical neglect, and hookup behavior. Only an indirect path between childhood emotional abuse and sex with a stranger was identified through sex to cope. Emotional abuse was the only maltreatment to predict sex to affirm, but sex to affirm did not predict risky sex outcomes. Findings provide support for differential pathways from various forms of childhood maltreatment, specifically sexual abuse, emotional abuse, and physical neglect, to increased risky sex as a manifestation of avoidant coping. Furthermore, results support the call for more inclusion of nonsexual forms of childhood maltreatment in studies of risky sex and avoidant coping as a potential intervention target for risky sexual behavior regardless of childhood maltreatment type.

Multidisciplinary approach to the treatment of sexual dysfunction in couples using a biopsychosocial model.

BACKGROUND: Given the complexity of the psychological and biological pathologies associated with sexual dysfunction, which affects at least a third of adult women and men worldwide, a multidisciplinary approach has been advocated. AIM: To assess sexual functioning, relationship satisfaction, and mood stability pre- and post- treatment at the Loyola University Sexual Wellness Program. METHODS: Couples attending the 6-week multidisciplinary Sexual Wellness Program provided consent and completed pre- and post- intervention assessments. Linear mixed effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency. OUTCOMES: All patients completed self-reported surveys: Dyadic Adjustment Scale, PROMIS Sexual Function and Satisfaction Measures Brief Profile (Patient-Reported Outcomes Measurement Information), and International Index of Erectile Function. RESULTS: There were 85 respondents: 42 men and 43 women. The mean age was 49.82 years (range, 25-77). The largest improvement was on the total Dyadic Adjustment Scale score, which increased by approximately 5.18 points (95% CI, 2.55-7.81). PROMIS scores for global satisfaction with sex life, erectile function, and interest in sexual activity significantly increased from baseline, while the vaginal discomfort score significantly declined. Overall the score for global satisfaction with sex life increased from baseline by approximately 5.57 points (95% CI, 3.03-8.10). On average, men reported a 4.33-point increase (95% CI, 0.04-8.62) in their International Index of Erectile Function score from baseline. CLINICAL IMPLICATIONS: A multidisciplinary treatment approach focused on the couple positively affects a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function. STRENGTHS AND LIMITATIONS: This study is one of the few to document the effects of a multidisciplinary treatment approach for both members of a heterosexual couple-male and female. Limitations include the narrow demographics and lack of a control group in our population. Furthermore, this was completed at 1 academic center. CONCLUSION: These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being.

The effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment: a randomized controlled study.

INTRODUCTION AND HYPOTHESIS: The purpose of this study is to determine the effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment. METHODS: A total of 34 women at the vaginismus treatment stage, including 17 in the experiment group and 17 in the control group, were included in the study with a randomized controlled design. In addition to the routine treatment protocol, women in the experiment group were provided with pelvic relaxation and sexual counseling based on the Information, Motivation, Behavior (IMB) model consisting of four sessions. The control group received the routine treatment protocol. The assessments were made at the 3rd week and 2nd month after coitus. The women filled out an Information Form, the validated Female Sexual Function Index (FSFI), and the Vaginal Penetration Cognition Questionnaire (VPCQ). RESULTS: The mean age of the women was 27.59±5.32, and their mean duration of marriage/relationship was 33.44±12.11 months. After the treatment statistically significant increases were observed in the total FSFI scores and the desire, arousal, and pain dimension scores of the experiment group in comparison with the control group (p<0.05). In the VPCQ total scores, there was a significant reduction in the experiment group in comparison with the control group and after the treatment in comparison with before the treatment (p<0.01). CONCLUSIONS: The sexual counseling based on the IMB model and pelvic relaxation interventions provided to the women who were receiving vaginismus treatment affected their sexual function positively. It may be recommended to conduct comparative studies with a broader sample and different models.

O Um e a função do sexo segundo a psicanálise / El Uno y la función del sexo según el psicoanálisis / The One and the function of sex according to psychoanalysis

RESUMO Segundo a ambiguidade constitutiva do Um que Lacan promove a partir da lógica e da matemática nos seminários O saber do psicanalista e ... ou pior, entre 1971 e 1972, o artigo busca fundamentar a teoria da sexuação desenvolvida nesse período e esclarecer que tal conceituação retoma a subversão freudiana do polimorfismo pulsional. Se a pulsão não tem qualquer determinação instintual quanto a seu objeto, constata-se que esse mesmo equívoco se deslinda como impossibilidade de proporção e relação sexual [rapport sexuel] para o ser falante, que se posiciona gramaticalmente na estrutura da linguagem a partir desse impasse. Nesse sentido, a bifididade do Um, entre conjunto e elemento, mesmidade e diferença, particularidade e universalidade, ex-sistência e relatividade, real e simbólico, reescreve a diferença (sexual) conforme a psicanálise. O sexo, portanto, é a própria ausência de qualquer referência que não seja a opacidade de princípio do significante, é a evasão fundamental do ser à verdade.

RESUMEN Basado en la ambigüedad constitutiva del Uno que Lacan promueve desde la lógica y de la matemática en los seminarios O saber do psicanalista e ...ou pior, entre 1971 y 1972, el artículo busca apoyar la teoría de la sexuación desarrollada en ese período y aclarar que tal conceptualización reanuda la subversión freudiana del polimorfismo de la pulsión. Si la pulsión no tiene ninguna determinación instintiva en cuanto a su objeto, parece que este mismo malentendido se revela como la imposibilidad de la proporción y la relación sexual [rapport sexuel] para el ser hablante, que se posiciona gramaticalmente en la estructura del lenguaje desde esta cuestión. Así, la bifidez del Uno, entre conjunto y elemento, igualdad y diferencia, particularidad y universalidad, ex-sistencia y relatividad, real y simbólico, reescribe la diferencia (sexual) según el psicoanálisis. El sexo, por lo tanto, es la ausencia misma de cualquier referencia que no sea la opacidad de principio del significante, es la evasión fundamental del ser de la verdad.

ABSTRACT Based on the constitutive ambiguity of the One that Lacan promotes from logic and mathematics in the seminaries O saber do psicanalista e ...ou pior, between 1971 and 1972, the article seeks to support the theory of sexuation developed in that period and clarify that such conceptualization resumes the Freudian subversion of the drive polymorphism. If the drive does not have any instinctual determination as to its object, it appears that this same misunderstanding is revealed as the impossibility of proportion and sexual relationship [rapport sexuel] for the speaking being, who grammatically positions themselves in the structure of language from this impasse. Thus, the bifidity of the One, between set and element, sameness and difference, particularity and universality, ex-sistence and relativity, real and symbolic, rewrites the (sexual) difference according to psychoanalysis. Sex, therefore, is the very absence of any reference other than the constitutive opacity of the signifier, it is the fundamental evasion of the being from the truth.

Women's experience and perspectives toward genital cosmetic surgery in Erbil city/Iraq: a qualitative study.

BACKGROUND: Nowadays, Female Genital Cosmetic Surgery is quite prevalent, resulting in a wide range of medical and cultural implications. The majority of women who undergo this operation suffer from anxiety, depression, and other emotional symptoms. The present study was carried out in order to explore women's perspective on and experience of genital cosmetic surgery given their special context and cultural aspects. METHODS: The qualitative study applying content analysis examined the experiences of nine women who received genital cosmetic surgery in Erbil, Kurdistan-Iraq, between 2021 and 2022. Each of the semi-in-depth face-to-face interviews lasted between 40 and 60 min and was conducted at the physician's clinics. RESULTS: Semi-structured interviews led to emergence of two main themes, namely "husband satisfaction" and "self-confidence". Interpreting the participants' stories resulted in some relevant subthemes and meaning units like "ugly appearance", "anxiety related to husband undesirable intercourse", and "dyspareunia". Finally, the related conclusions of each theme were explored. CONCLUSION: As suggested by the study findings, female genital cosmetic surgery improves the women's body image and sexual function and the couples' sexual satisfaction, especially that of husbands. Because of the people's sociocultural aspects in Kurdistan region, their awareness of female sexual needs and marital relationship needs to be raised.

Determination of Sexual Attitude, Sexual Self-Consciousness, and Sociocultural Status in Women With and Without Lifelong Vaginismus: A Case-Control Study.

Vaginismus is a sexual dysfunction occurring in females presented as a contraction of the muscles around the vagina as a reflex, causing the failure of vaginal penetration. Although many psychological, social, and cultural factors that may cause vaginismus have been suggested, its underlying mechanisms are not clear. The aim of this study was to determine the sexual attitude, sexual self-awareness, and sociocultural status of women with and without lifelong vaginismus. This is a case-control study. A total of 148 women were included in the study: 74 women with a lifelong vaginismus diagnosis and 74 women without a history of vaginismus/painful sexual activity controls. Data were collected using a structured questionnaire, the Sexual Self-Consciousness Scale, and the Hendrick Brief Sexual Attitudes Scale. Sexual shyness (OR = 0.854), sexual self-focus (OR = 0.888) and birth control (OR = 1.279), communion (OR = 1.198), and instrumentality (OR = 1.330; the sub-dimensions of the Sexual Attitude Scale) were associated with (χ2 = 96.130, p < .001) vaginismus at the rate of 63%. Those who did not receive sexual information; those who obtained information about sexuality from the social media; those who had negative thoughts about sexuality due to religious reasons; those who found the genitals and sexuality as disgusting; and those having more feelings of fear and pain are more likely to have vaginismus. Some socio-cultural factors may negatively affect women and cause vaginismus. Women with vaginismus had low sexual self-consciousness and negative attitudes toward sexuality. It may be incomplete to consider vaginismus only as a vaginal entry problem. Therefore, in the treatment of vaginismus, women's sexual attitude, sexual self-awareness, and sociocultural factors should be evaluated in a holistic manner.

The Effect of Female Orgasm Frequency on Female Mate Selection: A Test of Two Hypotheses.

Female orgasm has been a mystery that psychologists have been attempting to understand for decades. Many have contended that female orgasm is a functionless by-product of male orgasm, while others have argued that female orgasm may be an adaptation in its own right, offering several adaptationist accounts of female orgasm. In the current research, we tested predictions derived from two hypotheses regarding adaptive functions of female orgasm: female orgasm indicates partner mate value or female orgasm promotes long-term, pair bonding. 199 female undergraduates participated in an experiment where they imagined themselves as a member of a romantic relationship provided in a scenario. Within these scenarios, the relationships varied between either short- or long-term and the frequency that the female experienced orgasm during intercourse varied between never, occasionally, and almost always. Participants answered questions regarding relationship satisfaction and perceptions of the fictional relationship. A series of analysis of variance (ANOVAs) indicated that females assigned to conditions of experiencing more frequent orgasms reported greater relationship satisfaction, across both short- and long-term relationships. The relationship between female orgasm frequency and relationship satisfaction was fully mediated by the female's perceived love for her hypothetical partner but not by perceptions of her hypothetical partner's commitment. Taken together, this study provides preliminary support for the hypothesis that female orgasm evolved as a mate-selection tool for females and promotes long-term, pair bonding but does not provide support for the hypothesis that female orgasm evolved as an indicator of male value.

Sexuality in Assisted Reproductive Technology Couples.

BACKGROUND: Sexuality is a complex social and psychological phenomenon even more complicated in the setting of Assisted Reproductive Technology (ART). SUBJECTS AND METHODS: In total 192 participants entered the study (96 couples) in the process of ART. Participants filled up anonymous questionnaire while waiting routine procedure. At the time of questionnaire males and females were in separate rooms without knowledge about partners answers. RESULTS: The frequency of sexual intercourse was not related to the sociodemographic variables in women but was related to education level and work status. More educated men who were employed had more frequent sexual intercourses. Moreover, the frequency of the sexual intercourse was not related to the duration of the relationship nor the infertility treatment. The correlational analyses showed that the frequency of sexual masturbation was not related to the sociodemographic variables, except for place of living. Both women and men from more urban areas reported to engage in masturbation more often. The frequency of specific sexual activities did not differ between reports by women and men for vaginal, oral, anal, and foreplay activities. However, men reported engaging in masturbation more often than women. CONCLUSION: The frequency of sexual activities is similar in women and men for vaginal, oral, anal, and foreplay activities. However, men reported engaging in masturbation more often than women. ART could only slightly affect quality of sexual life. Both partners should be informed.

Early Resumption of Sexual Intercourse after First Childbirth and Unintended Pregnancy within Six Months.

OBJECTIVE: We aimed to evaluate factors associated with early resumption of sexual intercourse after first childbirth and assess whether early intercourse is associated with unprotected intercourse, subsequent pregnancy, and unintended pregnancy over 6 months. METHODS: This secondary analysis used data from the First Baby Study, a prospective study of women aged 18-35 years with singleton pregnancies who delivered at 76 hospitals in Pennsylvania. At 1 and 6 months postpartum, women were asked about intercourse and the use of birth control since childbirth. We compared women who resumed intercourse in the first month after childbirth (early resumption) with those who resumed intercourse later, via multivariable logistic regression models. RESULTS: In our cohort, 261 of 2,643 women (9.9%) reported first intercourse within the first postpartum month (7-31 days). Women who resumed intercourse early were less educated, younger, and less likely to breastfeed, have had a perineal laceration, or have had an episiotomy than those who resumed intercourse later. In addition, they were more likely to have unprotected intercourse in at least one of the first 6 months after first childbirth (adjusted odds ratio [aOR], 2.33; 95% confidence interval [CI], 1.76-3.09); to be pregnant by 6 months postpartum (aOR, 3.03; 95% CI, 1.48-6.20); and to report that pregnancy as unintended (aOR, 3.32; 95% CI, 1.50-7.36). CONCLUSIONS: Nearly 10% of women resumed intercourse in the first month after childbirth. Because early resumption of intercourse was associated with a greater likelihood of unprotected intercourse and unintended pregnancy within 6 months of first childbirth, clinicians should focus efforts on comprehensive family planning and contraception counseling beginning in the prenatal period.

As características desejadas em parceiros amorosos selecionados por meio da internet, intenções dos usuários e seus desdobramentos / Desired features of virtual partners, intentions of the users and their developments / Las características deseadas en parejas virtuales, intenciones de los usuarios y sus desarrollo

O presente estudo avaliou as características desejadas em um parceiro virtual quando há intenção de se casar ou ficar. Uma amostra de 210 estudantes universitários respondeu a um questionário com questões elaboradas pelos pesquisadores e a Escala de Atributos do Parceiro Ideal. Verificou-se qual a intenção amorosa dos sujeitos ao utilizarem os aplicativos, a quantidade de encontros concretizados e o tempo de acesso a eles. Os resultados mostraram que as características desejadas em um parceiro para ficar e em um para casar são diferentes, assim como as intenções amorosas entre os sexos e a quantidade de encontros que concretizaram. O tempo de acesso aos aplicativos foi semelhante e as mulheres consideraram que os homens criam mais expectativas sobre o desenvolvimento de um namoro por ferramentas virtuais. Concluiu-se que os homens são mais propensos ao envolvimento sexual casual.

The present study evaluated the desired characteristics in a virtual partner when one wanted to marry or date. A sample of 210 university students answered a questionnaire that contained questions elaborated by the researchers and the Scale of Attributes of the Ideal Partner. It was verified the subjects' loving intention in using the applications, the number of encounters made and the time of access to them. The results demonstrated that the characteristics desired in a partner to date and to marry are different, as well as the love intentions between the sexes and the amount of dates that have materialized. Access time to applications was similar and women considered that men created more expectations about developing relationship by virtual tools. It is concluded that men are more prone to casual sexual involvement.

El presente estudio evaluó las características deseadas en parejas virtuales cuando se anhelaba casarse o coquetear. Participaran 210 estudiantes universitarios que respondieron a un cuestionario presencialmente que contuvo cuestiones elaboradas por los investigadores y la Escala de Atributos de Pareja Ideal. Se verificó cuál fue la intención amorosa de los sujetos al utilizar las aplicaciones, la cantidad de encuentros concretizados y el tiempo de acceso a ellos. Los resultados demostraron que las características deseadas en parejas para coquetear y en un para casarse son diferentes, así como las intenciones amorosas entre los sexos y la cantidad de encuentros que concretaron. El tiempo de acceso a las aplicaciones fue similar y las mujeres consideraron que los hombres creen más expectativas sobre el desarrollo de un noviazgo por medios virtuales.Se concluye que los hombres son más propensos a la implicación sexual casual.

[Assessment of quality of sexual life in women after breast cancer treatment: about 100 cases]. / Evaluation de la sexualité chez des femmes atteintes d'un cancer du sein après traitement: à propos de 100 cas.

Breast cancer is the most common neoplastic disease in women. Several treatment strategies are used: chemotherapy, radiotherapy, surgery and hormone therapy. Each of these treatments may affect sexual health of patients in the short or long term. The purpose of our study is to assess the quality of sexual life in women after breast cancer treatment. We made a quantitative descriptive estimate of 100 sexual active patients followed up for non-metastatic breast cancer, met during their consultations with a gynaecologist at the Farhat Hached hospital in Sousse. Data collection was carried out using an information sheet and two validated scales: RSS (relation Ship and sexual) and BESAA (Body EsteemScale for adolescents and Adults) to assess the quality of sexual life and body image. The average age of patients was 53.8 years. About half of patients (48%) had impaired sexuality due to the disease. The frequency of intercourse, sexual desire and the ability to reach orgasm were decreased in 65. 45, and 54 patients, respectively. The overall score for the three body image dimensions was 49.4. Women aged between 35 and 39 years were significantly more afraid of sexual intercourse (p=0.002) and less of sexual frequency (p=0.004). Adequate and enhanced training focused on the management of women with cancer and their sexual problems and multidisciplinary approach can improve women's psychological status.

Factors associated with sexual intercourse initiation: a retrospective cohort of Lebanese adolescents in schools.

OBJECTIVES: Early sexual initiation is known to be associated with deleterious health outcomes. The objective of this study was to evaluate factors (bullying, weight status, smoking and alcohol consumption, peer influence, relations with parents) associated with the initiation of sexual intercourse among Lebanese adolescents in schools. METHODS: A retrospective cohort was formed using a convenient sampling of Lebanese students (n=1635) in private schools from Beirut and Mount Lebanon. RESULTS: Younger age of adolescents at first sexual intercourse was significantly associated with finding it very easy to talk about things that worry them with an older brother, having a best friend who drinks sometimes compared to no drinking, and a best friend who smokes sometimes or every day compared to not smoking. Moreover, older age at the first sexual relationship was significantly associated with female gender (HRa=0.25), as was older age at first time drinking alcohol, first time getting drunk, and smoking cigarettes. CONCLUSION: This study sheds light on some of the factors associated with age at first sexual intercourse in Lebanese adolescents.

Women's techniques for making vaginal penetration more pleasurable: Results from a nationally representative study of adult women in the United States.

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to make vaginal penetration more pleasurable. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified four previously unnamed, but distinct, techniques women use to make vaginal penetration more pleasurable: Angling, Rocking, Shallowing and Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report-a cross-sectional, online, national probability survey of 3017 American women's (age 18-93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 87.5% of women make vaginal penetration more pleasurable using 'Angling': rotating, raising, or lowering the pelvis/hips during penetration to adjust where inside the vagina the toy or penis rubs and what it feels like. Approximately 76% of women make vaginal penetration more pleasurable using 'Rocking': the base of a penis or sex toy rubbing against the clitoris constantly during penetration, by staying all the way inside the vagina rather than thrusting in and out. About 84% of women make vaginal penetration more pleasurable using 'Shallowing': penetrative touch just inside of the entrance of the vagina-not on the outside, but also not deep inside-with a fingertip, sex toy, penis tip, tongue, or lips. Finally, 69.7% of women orgasm more often or make vaginal penetration more pleasurable using 'Pairing': when a woman herself (Solo Pairing) or her partner (Partner Pairing) reaches down to stimulate her clitoris with a finger or sex toy at the same time as her vagina is being penetrated. These data provide techniques that are at women's disposal to make penetration more pleasurable-which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

Selective serotonin re-uptake inhibitors for premature ejaculation in adult men.

BACKGROUND: Premature ejaculation (PE) is a common problem among men that occurs when ejaculation happens sooner than a man or his partner would like during sex; it may cause unhappiness and relationship problems. Selective serotonin re-uptake inhibitors (SSRIs), which are most commonly used as antidepressants are being used to treat this condition. OBJECTIVES: To assess the effects of SSRIs in the treatment of PE in adult men. SEARCH METHODS: We performed a comprehensive search using multiple databases (the Cochrane Library, MEDLINE, Embase, Scopus, CINAHL), clinical trial registries, conference proceedings, and other sources of grey literature, up to 1 May 2020. We applied no restrictions on publication language or status. SELECTION CRITERIA: We included only randomized controlled clinical trials (parallel group and cross-over trials) in which men with PE  were administered SSRIs or placebo. We also considered 'no treatment' to be an eligible comparator but did not find any relevant studies. DATA COLLECTION AND ANALYSIS: Two review authors independently classified and abstracted data from the included studies. Primary outcomes were participant-perceived change with treatment, satisfaction with intercourse and study withdrawal due to adverse events. Secondary outcomes included self-perceived control over ejaculation, participant distress about PE, adverse events and intravaginal ejaculatory latency time (IELT). We performed statistical analyses using a random-effects model. We rated the certainty of evidence according to GRADE. MAIN RESULTS: We identified 31 studies in which 8254 participants were randomized to receiving either SSRIs or placebo. Primary outcomes: SSRI treatment probably improves self-perceived PE symptoms (defined as a rating of 'better' or 'much better') compared to placebo (risk ratio (RR) 1.92, 95% confidence interval (CI) 1.66 to 2.23; moderate-certainty evidence). Based on 220 participants per 1000 reporting improvement with placebo, this corresponds to 202 more men per 1000 (95% CI 145 more to 270 more) with improved symptoms with SSRIs.  SSRI treatment probably improves satisfaction with intercourse compared to placebo (defined as a rating of 'good' or 'very good'; RR 1.63, 95% CI 1.42 to 1.87; moderate-certainty evidence). Based on 278 participants per 1000 reporting improved satisfaction with placebo, this corresponds to 175 more (117 more to 242 more) per 1000 men with greater satisfaction with intercourse with SSRIs. SSRI treatment may increase treatment cessations due to adverse events compared to placebo (RR 3.80, 95% CI 2.61 to 5.51; low-certainty evidence). Based 11 study withdrawals per 1000 participants with placebo, this corresponds to 30 more men per 1000 (95% CI 17 more to 49 more) ceasing treatment due to adverse events with SSRIs.  Secondary outcomes: SSRI treatment likely improve participants' self-perceived control over ejaculation (defined as rating of 'good' or 'very good') compared to placebo (RR 2.29, 95% CI 1.72 to 3.05; moderate-certainty evidence). Assuming 132 per 1000 participants perceived at least good control, this corresponds to 170 more (95 more to 270 more) reporting at least good control with SSRIs.  SSRI probably lessens distress (defined as rating of 'a little bit' or 'not at all') about PE (RR 1.54, 95% CI 1.26 to 1.88; moderate-certainty evidence). Based on 353 per 1000 participants reporting low levels of distress, this corresponds to 191 more men (92 more to 311 more) per 1000 reporting low levels of distress with SSRIs.  SSRI treatment probably increases adverse events compared to placebo (RR 1.71, 95% CI 1.48 to 1.99; moderate-certainty evidence). Based on 243 adverse events per 1000 among men receiving placebo, this corresponds to 173 more (117 more to 241 more) men having an adverse event with SSRIs.  SSRI treatment may increase IELT compared to placebo (mean difference (MD) 3.09 minutes longer, 95% CI 1.94 longer to 4.25 longer; low-certainty evidence). AUTHORS' CONCLUSIONS: SSRI treatment for PE appears to substantially improve a number of outcomes of direct patient importance such as symptom improvement, satisfaction with intercourse and perceived control over ejaculation when compared to placebo. Undesirable effects are a small increase in treatment withdrawals due to adverse events as well as substantially increased adverse event rates. Issues affecting the certainty of evidence of outcomes were study limitations and imprecision.

Is It the Timing? Short-Term Mobility and Coital Frequency in Agbogbloshie, Ghana.

Short-term mobility is often associated with increased sexual risk behavior. Mobile individuals often have higher rates of sexual risk behavior compared to non-mobile individuals, but the reasons why are not clear. Using monthly retrospective panel data from 202 men and 282 women in Agbogbloshie, Ghana, we tested whether short-term mobility was associated with changes in coital frequency, and whether the association was due to the act of travel in the given month (e.g., enabling higher risk behavior), the reason for travel, or an individual's travel propensity at other times in the year. Overnight travel specifically to visit family or friends, or for education, health, or other reasons, was associated with increased coital frequency for men. However, men with higher travel propensities had lower overall coital frequency and the act of traveling enabled more sex only for the most frequent male travelers. Men who seldom traveled had much higher coital frequency, but the act of traveling was not associated with additional sex acts. For women, travel for education, health, or other reasons increased coital frequency. Occasional female travelers had slightly more sex acts compared to non-mobile women, and the act of traveling for these women was associated with slight increases in coital frequency, supporting the enabling hypothesis. Highly mobile women had fewer sex acts per month on average. Our findings suggest that mobility characteristics measured on a broad temporal scale, as well as the reason for mobility, are important to understand the relationship between short-term mobility and sexual behavior.

[Subjective orgasm experience in the context of solitary masturbation]. / Experiencia subjetiva del orgasmo en el contexto de la masturbación en solitario.

BACKGROUND AND OBJECTIVE: The subjective orgasm experience refers to the evaluation of sensations caused by orgasm from a psychological approach. The objective of this study was to examine the subjective orgasm experience in the context of solitary masturbation taking into account sex and age, as well as to compare this experience with perceived experience in the context of a sexual relations. MATERIAL AND METHODS: The sample was composed of 874 heterosexual adults from the general Spanish population (441 men [50.5%], 433 women [49.5%]). It was distributed into two age ranges: 18-34 and 50-93years. Participants completed a survey composed of a Background questionnaire and the Spanish version of the Orgasm Rating Scale. RESULTS: It was shown that sex (p<.001) and age (p<.001) influence subjective orgasm experience in the context of solitary masturbation. Women and young people showed greater intensity. Furthermore, significant differences in the subjective orgasm experience between the context of solitary masturbation and the context of a sexual relations were found. It was estimated as more intense in a sex-with-partner context. CONCLUSIONS: The subjective orgasm experience in the context of solitary masturbation is different to the one experienced in the context of a sexual relationship, being more intense in women and in young people.

Protection at First Sexual Intercourse Among Adolescent Girls and Young Women in Kenya.

Adolescent girls and young women (AGYW) are at high risk of HIV and other sexually transmitted infections (STIs), including at first sexual intercourse. The literature is scarce on factors influencing use of protective strategies at this critical time. We conducted 20 in-depth interviews and five focus group discussions with purposively sampled AGYW aged 16-20 years who reported first sex while enrolled in a larger cohort study and willing to participate. All AGYW were counseled on HIV prevention and had access to reproductive health information and services. Data collected were transcribed, translated and analyzed thematically. We identified two approaches to first sex. In one approach, the AGYW facilitated protection use, and those AGYW reported intention and preparation to initiate sexual activity and ability to request condom use, as well as their male partner's willingness to use and provide condoms. In another approach, AGYW experienced first sexual intercourse without agency (the feeling of control over actions and their consequences [Moore, 2016]) and described lack of prior intentions and planning, discomfort with discussions about sex and condom use, and desire to experience sexual pleasure as reported by peers. No AGYW mentioned parents/adults as playing any role as facilitators of protection use at first sex, highlighting the need for further research on the missing gap. The AGYW were trusting of verbal reports by male partners describing themselves as having never engaged in sex, HIV negative, and free of STIs. We found that some AGYW were empowered to plan, discuss, and request protection at first sex, and others did not take agency. First sex is a time of vulnerability where innovative strategies are needed to strengthen AGYW's agency and promote condom use and other HIV/STI prevention methods.

First Sexual Intercourse in the Irish Study of Sexual Health and Relationships: Current Functioning in Relation to Age at Time of Experience and Partner Age.

The Irish Study of Sexual Health and Relationships, based on a nationally representative sample of Republic of Ireland adults in 2004-2005, was used to examine adult adjustment in individuals who had their first sexual intercourse as a minor with an adult. Participants were classified into one of four groups based on their age at first intercourse and their partner's age: minors under 18 with peers; minors under 16 with adults; minors 16 to 17 with adults; and adults with adults. Adjustment (health, general relationships, satisfaction with most recent sexual partner, self-confidence, education and career achievement, and sexual problems) was compared across groups separately by gender. The vast majority of cases involved postpubertal heterosexual coitus. Overall, minors involved with adults were not significantly less well adjusted than adults involved with other adults on a majority of measures, effect size differences in adjustment were mostly small, and mean adjustment responses consistently indicated good rather than poor adjustment. Sex differences in first-intercourse characteristics and reasons for engaging reliably occurred for all age groups. In general, males compared to females were more willing, wanted more to lose their virginity, felt more ready for it, did it more often on the spur of the moment, and were less often involved in a relationship or in love when it occurred. Sex differences were greatest for boys versus girls under 16 with adults. Mediation and moderator analyses were also performed. Results were discussed in relation to competing perspectives on the effects of minor-adult sex.