Predictors of duty sex frequency in women.

BACKGROUND: Duty Sex-the act of engaging in sex out of a sense of duty or obligation to a partner-is a commonly reported reason why women have sex, with studies indicating associations between Duty Sex and sexual dysfunction, as well as nonconsensual sexual experiences (NSEs). AIM: This study sought to examine the associations between Duty Sex frequency, sexual function, and NSEs using comprehensive, validated measures of sexual function and NSE histories in a large community sample of women. METHODS: Six hundred and fifty-eight women with (n = 293) and without (n = 365) NSE histories completed measures of sexual function and sexual motivations. RESULTS: Women with NSE histories reported more sexual pain, lower sexual satisfaction, and more frequent Duty Sex. The relation between NSE history and Duty Sex remained after controlling for the variance in sexual function. The type of NSE behavior, but not the timing of the first NSE nor the perceived impact of the experience, predicted Duty Sex frequency. CLINICAL IMPLICATIONS: Clinicians should consider sexual motivations, particularly Duty Sex, when treating women with NSE histories or who experience sexual dysfunction. STRENGTHS AND LIMITATIONS: To our knowledge, this was the first study to examine how NSEs relate to all domains of sexual function and sexual motives, revealing a link between NSEs, sexual function, and Duty Sex. However, we were unable to account for what percentage of sexual encounters are considered Duty Sex. Therefore, our measurement of Duty Sex lacks specificity, which may explain the relatively low variance accounted for by the models in our analyses. CONCLUSIONS: There are consequences of NSEs, including difficulties with communicating sexual boundaries and impairment of sexual function, that may contribute to the increased likelihood of engaging in Duty Sex.

"What Is Normal?": A Qualitative Exploration of Health Practitioners' Reports of Treating Patients Presenting with Unpleasant Sexual Experiences.

Sexual health, including sexual pleasure, is fundamental to holistic health and well-being, and is considered an area of priority health in Australia. Despite the importance of sexual functioning, women experience significant gaps in sexual well-being compared to men and often do not seek medical care or treatment. Health practitioners are central to the identification and treatment of sexual dysfunction, including fostering sexual well-being for patients. Despite this, minimal research has explored health practitioners' experiences in treating reports of unpleasant sex. This study aimed to explore health practitioners' experiences, responses, and confidence in treating patients presenting for unpleasant sexual experiences. An online, mixed-methods survey was completed by 96 participants. Thematic analysis identified 11 core themes. These themes included five patient centred themes (health risks, diverse sex acts, painful vaginal intercourse, relationship breakdown and violence, unwanted sex) and six health practitioner centred themes (communication and counselling, what is normal, ongoing care and follow up, emotional response, limited practical training, and highly prevalent). Participants described a complex sexual health landscape, with social contexts impacting women's sexual experiences and engagement in treatment. Additionally, health practitioners reported the need for a biopsychosocial approach to understanding and responding to unpleasant sexual experiences for patients, while simultaneously reporting limited education in this area. Findings reflect the need for health practitioners to be cognisant of matters related to sexual function, consent, coercion, client engagement, and treatment pathways, identifying a need for greater education and holistic approaches to sexual healthcare across medical settings.

"I Think You Covered the Three Levels of Drugs and Consent": Qualitatively Testing Different Operationalizations of an Alcohol and Other Drugs-Involved Sexual Violence.

Substance-involved rape is increasing among college students, particularly women (Koss et al., 2022). Addressing rape requires first measuring it accurately in surveys to understand its true scope and nature. We used cognitive interviews with 40 young adults to qualitatively test the construct validity of an alcohol- and other drugs (AOD)-involved rape item in the Sexual Experiences Survey by asking participants to comment on different operationalizations of this construct. Our findings revealed that different phrasings elicited different interpretations of the items by participants. Specifically, the results indicated that (1) respondents viewed the different operationalizations as a sequence of events with varying severity; (2) some participants focused on the intentionality and responsibility of the perpetrator as opposed to opportunistic perpetration; and (3) study participants consistently chose one of the operationalizations as describing "being roofied" (being drugged without consent). Participants also contributed additional scenarios not described in the questionnaire and shared their interpretations of the items. The results underscore the importance of refining survey language to properly measure AOD-involved rape and allow us to understand how to tailor appropriate questions for best comprehension. The findings indicate the benefit in including several items about AOD-involved rape in questionnaires such as the Sexual Experiences Survey, with each item addressing different scenarios of victim intoxication. The results could also have important implications for sexual violence prevention programs, which should discuss consent, intentions, and responsibility specifically in the context of AOD consumption.

Parental Sexual Socialization, Sexual Subjectivity, and Emotional Responses to Sexual Experiences among Adolescent Girls.

This study explored girls' sexual subjectivity as a pathway through which parental socialization influenced their emotions about past sexual experiences. A national online survey of 397 adolescent girls (Mage = 16.8 years) from diverse racial/ethnic backgrounds (33.0% Black, 25.7% Latina, 28.0% non-Hispanic White) assessed (1) parental messaging emphasizing relational, sex-positive, gendered sex role, abstinence-only, and sex-is-taboo discourses; (2) girls' sexual subjectivity including sexual body esteem, entitlement to sexual pleasure, and perceived sexual control; and (3) positive and negative emotional reactions to sexual experiences. Sexual subjectivity fully mediated the positive effect of relational messaging on positive emotional reactions and the negative effect on negative emotional reactions. Additionally, sexual subjectivity partially mediated the positive effect of gendered sex role messaging on negative emotional reactions. This study draws critical attention to placing the psychological aspects of girls' sense of their own sexuality and the emotional components of their sexual experience at the forefront of understanding the influence of parental sexual socialization on the sexual experiences of adolescent girls.

Sexual experiences and knowledge of people with moderate intellectual disability.

BACKGROUND: This study addresses the sexuality of people with moderate intellectual disabilities (PMID), a topic that has been little studied. Understanding romantic and sexual experiences is highly relevant for reducing stigma and prejudice related to their sexuality. Additionally, comprehending the level of sexual knowledge of PMID contributes to the development of preventive and sexual health education programmes tailored for this group. Our aim is to explore the sexual history (relationships, sexual behaviour, condom use and sexual abuse), sex education received and the level of sexual knowledge of PMID. METHOD: The total of 142 PMID completed questionnaires about sexual knowledge and experiences, and their support staff provided additional information. Data were analysed using chi-square test (χ2) and descriptive statistical analysis. RESULTS: Masturbation was the most common sexual behaviour (75.7%), especially among men (χ2 = 5.81, P < 0.05). Sexual intercourse was rare, and only 30.5% reported using condoms. Women reported a higher prevalence of self-reported sexual abuse (27.3% vs. 6% in men). The study also highlighted misconceptions about sexual intercourse risks and contraceptive methods. CONCLUSION: The results suggest that PMID need sexual education to ensure healthy sexual experiences and prevent risky behaviour.

A thin line between consent and abuse - Reflections on sexual experiences among Swedish young adults with intellectual disabilities.

Research shows that young adults with intellectual disabilities struggle to understand the social codes embedded in sexual situations. This may lead to an incomprehension of sexual consent, or when consenting to sex may lead to abuse. This qualitative study aimed to gain an in-depth understanding of sexual experiences and perceptions about sexual consent among Swedish young adults with intellectual disabilities. The data comprise 22 semi-structured interviews with young adults aged 18-35 with intellectual disabilities, thematically analyzed using sexual script theory as a theoretical framework. Four themes emerged from the analysis: Setting the sexual scene, Sexual self-awareness, Sexual communication and the necessity of clarification and Striving for a balance. The results show that the participants had a variety of sexual experiences and challenges associated with sexual consent, but also an agency that favors sexual situations. Further research is necessary to understand the complexities of sexual consent in this population.

Intimate Partner Sexual Violence, Gender, and Psychological Distress Among Northern Irish University Students.

While substantial prevalence rates of intimate partner sexual violence (IPSV) have been found among university students for decades in North America, there is a specific gap in published studies on this issue in the United Kingdom and Ireland. The present analysis used data from a larger survey study of students in one Northern Irish university. The analyses reported here were used to examine relationships among IPSV victims, gender (males and females only), unhealthy alcohol use, and psychological distress among university students (n = 654) since the age of 16 and during the previous year. The results of this study are consistent with previous research indicating that women (n = 248) experience IPSV more often than men (n = 37; 50% vs. 23%, respectively). Nonetheless, IPSV is experienced by both men and women with statistically significant associations with alcohol use, posttraumatic stress, depression, and generalized anxiety compared with those who did not report any IPSV experience.

Virtual Reality Erotica: Exploring General Presence, Sexual Presence, Sexual Arousal, and Sexual Desire in Women.

Virtual reality (VR) media using a three-dimensional (3D) camera facilitates an immersive experience compared to traditional two-dimensional (2D) formats. In this novel study, we used high quality, women-centered erotica and examined whether stimulus modality (VR vs. 2D) and point of view (POV: first-person vs. third-person) impacted women's feelings of sexual presence (activation of sexual response induced by the perception of being present), sexual arousal, and sexual desire (dyadic and solitary). We also investigated the effects of stimulus modality on feelings of general presence (a sense of "being there"). Results from 38 women indicated that with medium to large effects, general presence, sexual presence, and sexual arousal were significantly higher for VR videos relative to 2D videos. Sexual presence was higher for first-person POV depending on the order of film exposure. A general trend toward increasing dyadic sexual desire over the course of the study was observed. No significant differences were observed for solitary sexual desire. These findings support the adaptability of VR media to sex research and show that it can induce feelings of sexual presence and presence more generally. That sexual arousal was positively impacted by VR erotica may have implications for addressing the limitations that accompany other stimulus modalities used to elicit sexual responses in women.

Sexual Victimization in Adulthood and Associated Factors Among Men and Women: Cross-Sectional Evidence from Mainland China.

Limited empirical research addresses sexual victimization and related factors among the general adult population in China. To address this gap, we explored the association between sexual victimization in adulthood and associated factors (unwanted sexual experiences [USE] before age 18, binge drinking prior to sex, hooking up, violent pornography use, awareness and perceived behavioral control of consent, and sexual refusal assertiveness) among a convenience Chinese sample. A cross-sectional study was performed in September 2020 among 898 screened men and women from 29 provinces in mainland China. Overall, 52.5% of men and 57.9% of women experienced sexual victimization at least once in adulthood. Men and women differed in the severity of sexual victimization in adulthood, with the mean severity scores of women being significantly higher than those of men. Hierarchical ordinal logistic regression revealed that, after considering control variables, correlates of severity of sexual victimization in adulthood included gender (OR 3.17, 95% CI 2.30-4.40), severity of USE before age 18 (OR 2.28, 95% CI 1.92-2.73), binge drinking prior to sex (OR 2.52, 95% CI 1.83-3.49), hook-up history (OR 2.24, 95% CI 1.49-3.39), violent pornography use (OR 1.07, 95% CI 1.04-1.09), lack of perceived behavioral control of communicating consent (OR 1.04, 95% CI 1.01-1.07), and sexual refusal assertiveness (OR 0.92, 95% CI 0.89-0.95). These findings indicate that early adverse sexual experiences, potential risky sexual behaviors, violent pornography use, and beliefs about consent and refusal may play an important role in predicting sexual victimization among Chinese adults.

Behavioral, Neural, and Molecular Mechanisms of Conditioned Mate Preference: The Role of Opioids and First Experiences of Sexual Reward.

Although mechanisms of mate preference are thought to be relatively hard-wired, experience with appetitive and consummatory sexual reward has been shown to condition preferences for partner related cues and even objects that predict sexual reward. Here, we reviewed evidence from laboratory species and humans on sexually conditioned place, partner, and ejaculatory preferences in males and females, as well as the neurochemical, molecular, and epigenetic mechanisms putatively responsible. From a comprehensive review of the available data, we concluded that opioid transmission at µ opioid receptors forms the basis of sexual pleasure and reward, which then sensitizes dopamine, oxytocin, and vasopressin systems responsible for attention, arousal, and bonding, leading to cortical activation that creates awareness of attraction and desire. First experiences with sexual reward states follow a pattern of sexual imprinting, during which partner- and/or object-related cues become crystallized by conditioning into idiosyncratic "types" that are found sexually attractive and arousing. These mechanisms tie reward and reproduction together, blending proximate and ultimate causality in the maintenance of variability within a species.

The Relationship Between College Student Characteristics and Reporting Sexual Assault Experiences on Two Different Scales.

Though high rates of sexual assault are found on college campuses, prevalence rates between studies can vary considerable by gender, sexual orientation, and other student characteristics. Thus, it is unknown whether these are "true" differences for such characteristics or if there are methodological differences to consider. As such the current study examined whether student characteristics including gender, race, sexual orientation, sexual attraction, Greek affiliation, and relationship status are uniquely associated with reporting on two different sexual assault scales. Data were gathered from 783 college students in 2019-2020 at a large Midwestern university. Results revealed that the two different scales consistently provided different prevalence rates of sexual assault. Moreover, for each type of sexual assault (e.g., coercion, incapacitation, and physical force), there were also significant differences with students consistently reporting higher prevalence rates on one scale over the other. Finally, significant differences were found in prevalence rates across gender, sexual attraction, and Greek affiliated status.

Men's Sexual Experiences with the Dapivirine Vaginal Ring in Malawi, South Africa, Uganda and Zimbabwe.

The dapivirine vaginal ring has been well-tolerated and shown to prevent HIV in clinical trials. The ring is female initiated, yet endorsement for use is sought from male partners in many relationships. In clinical studies, participants have expressed worries about men detecting rings during vaginal sex, which introduces concerns about product use disclosure, sexual pleasure, penile harm, inter-partner dynamics, and ring removals. This study reports African men's firsthand sexual experiences with the ring. Qualitative data were captured through 11 focus group discussions and one in-depth interview with 54 male partners of ring-users at six research sites in Malawi, South Africa, Uganda and Zimbabwe. Following a semi-structured guide, and using demonstration rings, vulva and penis models, men were asked to discuss the ring's impact on sex and views on male engagement and ring use. Interviews were facilitated by local male social scientists, audio-recorded, translated into English, and analyzed thematically. 22 (41%) of the male partners reported feeling the ring during sex, often attributed to perceived incorrect insertion. Many men described the ring as "scratching" the tip of their penises, and sensations of "prodding" something that "blocked" the vagina and prohibited "full entry". In most cases, feelings dissipated with time or when sexual fluids increased. Less common descriptions included perceiving the vaginal texture, wetness and size as different, which increased pleasure for some, and decreased for others. Over half (59%) never noticed the ring; some attempting and failing to feel it during intercourse. A majority of men reported that the ring did not lead to changes in sexual positions, feelings, frequency or experience of sex, although some were initially afraid that the ring was a "magic snake" or "potion". Male partners expressed strong opinions that ring use was a shared prevention responsibility that men should be engaged in, especially for maintaining trust and open communication in relationships. The ring was noticed by many male partners, particularly during women's initial stages of ring use, although this led to few sexual problems or changes. Nevertheless, results suggest that risk of ring discovery should be discussed with women to mitigate any potential negative reactions or social harm. Strategies to increase male partner engagement will enhance support of this prevention method for women.

Sexual Satisfaction: Exploring the Role of Flow.

Sexual satisfaction plays an important role in relationship, mental, and even physical health. Activities that produce a state of flow create meaning in people's lives. Although people who report high levels of sexual satisfaction describe their sex lives as being very meaningful, there is little research on the relationship between sexual satisfaction and flow. This study sought to address this gap. One hundred participants who were in monogamous relationships completed an online survey consisting of two questionnaires-the New Sexual Satisfaction Scale and the Core Dispositional Flow State Scale. We used partial least square structural equation modeling approach to examine the association between flow and sexual satisfaction. We found that flow was a statistically significant positive predictor of both partner-focused and personal sexual satisfaction. Our results indicate that there are no statistically significant gender differences.

Gender, sexual experiences and sexual behavioural differences in Turkish university students.

This study was conducted to determine sexual experiences and gender differences in sexual behaviour in university students. In this cross-sectional and descriptive study conducted between 1st February and 12th November 2017. A total of 491 volunteer students were selected at a state university in the Mediterranean region of Turkey using a systematic sampling method. Questionnaires were distributed to the students in sealed envelopes and collected on completion. The data were collected using a socio-demographic form and a sexual experiences and sexual health behaviours form. A total of 414 students (78 males; 336 females) were included in this study. The prevalence of sexual intercourse among these was 4.3%, and total oral and anal sex experiences were 35% and 16.7%, respectively. A significantly higher number of female students of those who reported having sexual intercourse (n = 9; 50.0%), oral sex (n = 81; 55.9%) and anal sex (n = 60; 87.0%), also reported not telling anyone about his/her partner (77.2%), not talking about sex (82.4%) and not buying contraceptive products, even when necessary (78.3%). Hidden sexuality was seen to affect female students more often and this may lead to risky sexual behaviours, sexually transmitted diseases, an unhealthy sexual life with multiple partners and even unplanned, unwanted pregnancies.

Structured review of the use of the Arizona sexual experiences scale in clinical settings.

BACKGROUND: Approximately 40% of women and 30% of men describe sexual dysfunction, although recognition in medical settings is suboptimal, due to problems in reporting and eliciting concerns relating to sexual function and satisfaction. Screening questionnaires may help to support this aspect of clinical practice. The Arizona sexual experiences scale (ASEX) includes items that quantify sex drive, arousal, vaginal lubrication or penile erection, ability to reach orgasm, and satisfaction from orgasm. METHOD: We investigated the validity and other psychometric properties of the ASEX, and the findings from the populations in which it has been employed, by searching MEDLINE, EMBASE, and Google Scholar using the terms, Arizona sexual experiences scale, Arizona Sexual Experience Questionnaire, and ASEX. We eliminated duplications, letters, and papers not available in English, and grouped the remaining papers into the categories of psychometric, epidemiological, and outcome-based studies. RESULTS: After elimination of letters and duplicates, papers not in English, and preclinical and irrelevant studies, 104 papers were analyzed. The ASEX has excellent internal consistency, scale reliability and strong test-retest reliability. Analyses of variance reveal significant differences in total ASEX scores between patients and controls and between females and males. ASEX appears to be useful in a range of clinical situations including patients with primary sexual dysfunction, specific psychiatric disorders, specific physical illnesses, and treatment emergent sexual dysfunction. DISCUSSION: The ASEX appears to be a reliable instrument for identifying and quantifying sexual dysfunction across a range of populations in various clinical settings. Little is known about its utility in patients with anxiety disorders or relationships between ASEX scores and biological parameters.

First Postpubertal Same-Sex Sex in Kinsey's General and Prison Male Same-Sex Samples: Comparative Analysis and Testing Common Assumptions in Minor-Adult Contacts.

Kinsey's prison male same-sex sample (consisting of prisoners who were gay, bisexual, or had had extensive postpubertal same-sex sex regardless of sexual attractions) was compared with Kinsey's general (i.e., non-prison) same-sex sample (previously analyzed by Rind and Welter, 2016) in terms of reactions to and characteristics of first postpubertal same-sex sex, with a focus on minor-adult contacts. Prison participants had a minor-adult contact as their first postpubertal same-sex sex twice as often as general participants, and their experience involved penetration in three-quarters of cases compared to only half the time for general participants, and it was paid for (i.e., prostitution) three times as often. Despite these differences, reactions to these events by prison and general participants were the same, with combined results of 66% positive reactions (i.e., enjoyed it "much") versus 15% emotionally negative reactions (e.g., shock, disgust, guilt). Results added to those from a series of studies done since 2000 using male same-sex samples in showing that minor-adult same-sex sexual experiences in this population do not conform to the child sexual abuse (CSA) model of trauma and harm. Comparing prison and general participants also showed that the CSA-trauma-crime link often claimed (i.e., where minor-adult sex is said to produce trauma that leads to later criminal behavior) did not hold in the Kinsey same-sex samples, because trauma (the middle element) was mostly missing. This null result for the link alerts that trauma needs to be shown rather than assumed when considering this link. The positive reaction profile obtained was discussed in terms of cultural factors dominant in Kinsey's time.

Sexual Attraction, Sexual Identity, and Same-Sex Sexual Experiences of Adult Offspring in the U.S. National Longitudinal Lesbian Family Study.

The U.S. National Longitudinal Lesbian Family Study has followed offspring with sexual minority parents from conception into adulthood. It was initiated in 1986, and it has a 92% retention rate to date. In the current investigation, the 25-year-old offspring answered questions about sexual attraction, sexual identity, and sexual experiences; their responses were compared with those of same-age adults from a population-based survey. The analytic samples consisted of 76 offspring of lesbian parents and 76 demographically matched participants from the National Survey of Family Growth. All 152 respondents were 25 years old, 48.7% were female, 90.8% identified as White, 9.2% were people of color, and all had attended at least some college. Although most respondents in each sample identified as "heterosexual or straight," compared to their matched counterparts in the population-based survey, the female and male offspring of lesbian parents were significantly more to likely to report same-sex attraction, sexual minority identity, and same-sex experience. These findings suggest that adult offspring from planned lesbian families may be more likely than their peers to demonstrate diversity in sexual attraction, identity, and expression.

A qualitative investigation of expected versus actual initial sexual experiences before age 16.

INTRODUCTION: Individuals often develop expectations prior to their initial sexual experiences based on external messages from peers and the broader culture. According to sexual script theory (Simon & Gagnon, 1986), these expectations form schemas about how an initial sexual experience should occur. When reality deviates from these schemas, dissatisfaction can occur (McCormick, 1987). The current study examines the contrast between expectations and reported initial sexual experiences before age 16. METHODS: Forty young adult participants were recruited from four local Atlantic Canadian universities (77.5% women; M age = 20.20, SD = 1.31; 75% heterosexual; 77.5% Caucasian). Semi-structured qualitative interviews on participants' actual initial sexual experiences, expectations of initial sexual experiences, and perceived consequences of initial sexual experiences were conducted. Thematic analysis of the interviews was conducted using a grounded theory framework. RESULTS: Findings indicated that respondents' expectations were influenced by sources such as various media, peers, family, and religion. Initial sexual experiences reportedly met, surpassed, or failed to meet participants' expectations. The presence or absence of a discrepancy between expected and actual sexual experiences was perceived to shape subsequent sexual encounters. A theoretical model of development and adaptations of sexual experience expectations was developed in accordance with these results. CONCLUSIONS: Comparisons between expected and actual initial sexual experiences can be perceived by youth as having consequences on their personal and interpersonal well-being. Honest communication between parents, educators, and youth should therefore be prioritized in order to establish more realistic expectations of initial sexual experiences.

Lifetime Acts of Violence Assessment (LAVA) predictors of laboratory aggression.

While self-report data warrants interpretive caution in applied settings, these indices serve an important role in exploratory research. The Lifetime Assessment of Violent Acts (LAVA) inventory is a brief, reliable, face-valid questionnaire for estimating the frequency, triggers, and consequences (including injuries to others) of prior acts of aggression. The LAVA also identifies the situational contexts in which prior violence was triggered and provides a basis for risk classifications based on past reactive, intimate partner, alcohol-related, and/or weapon-related violence. Scores on the LAVA indices have been linked to a range of developmental and maladjustment indicators. Associations were found between lab-provoked (Taylor Aggression Paradigm) responding and both dimensional and risk classification scores in this sample (N = 92) of college men. Participants "competed" with a fictional opponent using electric shock as a retaliatory measure for perceived provocation. The total LAVA dimensional score predicted mean shock intensity ( d = .87), baseline responding ( d = 0.90), and past sexual aggression ( d = 1.01). Shock intensities in response to high provocation were predicted ( M d = 0.57) by all but one LAVA index. Participants who reported inflicting one or more injuries on another showed more intense escalations of aggression ( d = 0.46) in response to provocation than normative counterparts. Prior injuries to another ( RR = 2.71), reactive acts of aggression ( RR = 3.73), or intimate-partner violence ( RR = 4.19) elevated the risk of one or more prior acts of self-reported sexual aggression. The limitations and potential value of self-report data were discussed in regard to aggression research.

Sexual experiences and quality of life in Turkish women using methods of contraception.

The aim of this study was to examine the sexual experiences and quality of life in women using methods of contraception. The sample of this descriptive study consisted of 259 women. The data were collected by the Personal Information Form, the Arizona Sexual Experiences Scale (ASES) and the World Health Organisation Quality of Life Scale (WHOQOL-BREF). It was found that 35.1% of the women use condoms, 30.1% of them use the Intrauterine Device (IUD), 22.0% had problems using the method and 39% had the side effects while using the method. There was a statistically significant difference between the state of having problems using the methods and quality of life average scores and between the state of having side effects and sexual life and quality of life average scores (p < .05). Impact statement What is already known on this subject? Sexual problems are common health problems among women and can lead to loss of self-esteem in women, depression and emotional stress. What do the results of this study add? Women who experience problems using a contraception method have a lower quality of life. Sexual dysfunctions were higher among those who experienced side effects of the methods, quality of life scores were lower. What are the implications of these findings for clinical practice and/or further research? Health professionals should provide information and counselling about possible problems or side effects and ways to cope with these problems or side effects.