Sexual History Research Articles

Doxycycline as Post-Exposure Prophylaxis: Awareness, Beliefs, and Interest Among Patients with and at Risk for HIV.

Recent studies have demonstrated the efficacy of doxycycline as post-exposure prophylaxis (doxy-PEP) for sexually transmitted infection (STI) prevention, but little is known regarding patient beliefs and interest in doxy-PEP. We conducted a cross-sectional survey of adults (≥ 19 years) receiving care for HIV treatment (PWH) or prevention (pre-exposure prophylaxis, PrEP) between May-October 2023. The 32-question survey was organized into three parts: doxy-PEP awareness/beliefs/interest/concerns, sexual history, and demographics. Fishers Exact and Wilcoxon rank sum tests were used to compare responses between groups. Multivariate logistic regression identified predictive factors for doxy-PEP interest and concern(s). 166 participants completed the survey. Mean age was 43 years, 83% were male, 22% Black, and 13% Hispanic. Forty-one participants (25%) were on PrEP. Most respondents (75%) were unaware of doxy-PEP. Factors associated with doxy-PEP interest were respondents prescribed PrEP (aOR 2.67; 95% CI, 1.15-6.21) and belief of high risk for STI (aOR, 4.50; 95% CI, 2.24-9.07). Higher doxy-PEP concerns were associated with age ≤40 years (aOR, 3.10; 95% CI, 1.47-6.52), > high school education (aOR, 3.47; 95% CI, 1.64-7.33), and belief of high risk for STI (aOR, 2.58; 95% CI, 1.21-5.50). In this single-site cohort survey study, most respondents were unaware of doxy-PEP but expressed interest and low levels of overall concern. Clinicians should offer doxy-PEP access to all patients at high risk for STIs or requesting the treatment after shared decision-making discussions.

Sexual Trauma, Polygenic Scores, and Mental Health Diagnoses and Outcomes

Leveraging real-world clinical biobanks to investigate the associations between genetic and environmental risk factors for mental illness may help direct clinical screening efforts and evaluate the portability of polygenic scores across environmental contexts. To examine the associations between sexual trauma, polygenic liability to mental health outcomes, and clinical diagnoses of schizophrenia, bipolar disorder, and major depressive disorder in a clinical biobank setting. This genetic association study was conducted using clinical and genotyping data from 96 002 participants across hospital-linked biobanks located at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee (including 58 262 individuals with high genetic similarity to the 1000 Genomes Project [1KG] Northern European from Utah reference population [1KG-EU-clustered] and 11 047 with high genetic similarity to the 1KG African-ancestry reference population of Yoruba in Ibadan, Nigeria [1KG-YRI-clustered]), and Mass General Brigham (MGB), Boston, Massachusetts (26 693 individuals with high genetic similarity to the combined European-ancestry superpopulation [1KG-EU-clustered]). Clinical data analyzed included diagnostic billing codes and clinical notes spanning from 1976 to 2023. Data analysis was performed from 2022 to 2024. Clinically documented sexual trauma disclosures and polygenic scores for schizophrenia, bipolar disorder, and major depressive disorder. Diagnoses of schizophrenia, bipolar disorder, and major depressive disorder, determined by aggregating related diagnostic billing codes, were the dependent variables in logistic regression models including sexual trauma disclosure status, polygenic scores, and their interactions as the independent variables. Across the VUMC and MGB biobanks, 96 002 individuals were included in analyses (VUMC 1KG-EU-clustered: 33 011 [56.7%] female; median [range] age, 56.8 [10.0 to >89] years; MGB 1KG-EU-clustered: 14 647 [54.9%] female; median [range] age, 58.0 [10.0 to >89] years; VUMC 1KG-YRI-clustered: 6961 [63.0%] female; median [range] age, 44.6 [10.1 to >89] years). Sexual trauma history was associated with all mental health conditions across institutions (ORs ranged from 8.83 [95% CI, 5.50-14.18] for schizophrenia in the VUMC 1KG-YRI-clustered cohort to 17.65 [95% CI, 12.77-24.40] for schizophrenia in the VUMC 1KG-EU-clustered cohort). Sexual trauma history and polygenic scores jointly explained 3.8% to 8.8% of mental health phenotypic variance. Schizophrenia and bipolar disorder polygenic scores had greater associations with mental health outcomes in individuals with no documented disclosures of sexual trauma (schizophrenia interaction: OR, 0.70 [95% CI, 0.56-0.88]; bipolar disorder interaction: OR, 0.83 [95% CI, 0.74-0.94]). Sexual trauma and mental health polygenic scores, while correlated with one another, were independent and joint risk factors for severe mental illness in a large, diverse hospital biobank population. Furthermore, associations of schizophrenia and bipolar disorder polygenic scores with respective diagnoses were greater in those without disclosures, suggesting that genetic predisposition to mental illness as measured by polygenic scores may be less impactful in the presence of this severe environmental risk factor.

Special Needs in Substance Use Treatment for Women Who Use Drugs: Social and Mental Health Factors

Women who receive substance use treatment have a particular classification of sensitivity to European drugs and drug use (according to the EMCDDA). The average level of women’s treatment is lower than men’s across Europe, while women’s abandonment is higher than men’s. The purpose of this study was to examine the factors associated with problems for women who use drugs, analyzing several psychological and social factors (gender, substance use, mental health, source of economic support, legal status, and abuse). Methodology: This was a quantitative study. Data on 2179 people receiving rehabilitation treatment were obtained from the EuropASI survey. The dependent variables in this study were (1) a patient’s known history of addiction and mental illness; (2) primary drug use; (3) drug use in their lifetime and the past month; (4) mood in their lifetime and the past month, physical condition, and sexual abuse history; (5) mental illness in their lifetime and the past month (including suicide attempts); (6) legal status in their lifetime and the past month; (7) and source of income in the past month and (8) and the number of patients. The factor of gender was taken as a dichotomous variable (male–female). The confidence interval used was 95%. Results: In summary, we found that women had consumed more alcohol, used more drugs, and suffered more from depression, anxiety, and suicidal ideation than men, both during their lifetimes and in the past month. In addition, women were more likely than men to be stigmatized for prostitution because their financial support came mainly from colleagues, friends, and family, as well as from prostitution. Finally, women had experienced more violence (emotional, physical, and sexual) during their lifetimes and in the last month than men. Conclusion: There appears to be a need to develop a comprehensive treatment network for addictive behaviors from a multifactorial perspective, including harm reduction, psychosocial support, and recovery programs; furthermore, targeting specific groups with special needs, such as women, especially those with mental health problems, women with alcoholism, and abused women, it also seems important to develop adaptive recovery programs within addictive behavior treatment networks.

Breaking the silence: Do I tell my child about their sexual abuse history? Longitudinal analysis of parental decision-making regarding disclosure of preverbal sexual abuse by parents to their child: A qualitative study

BackgroundThe Amsterdam Sexual Abuse Case (ASAC) presented parents with a dilemma about disclosing preverbal sexual abuse to their child. Advising parents was challenging due to limited knowledge about the consequences of preverbal child sexual abuse (CSA) and the rarity of children having no conscious awareness of their experience. To enhance recommendations and knowledge, we explored parents' experiences over the years. ObjectiveThis unique qualitative study introduced “parental disclosure”, where non-offending parents disclose CSA to their child, and investigated the decision-making process spanning a decade after the ASAC discovery. MethodsLongitudinal qualitative data were collected through yearly interviews. Participants and settingIn total, 41 parents participated for 47 children. An additional in-depth interview was conducted with 20 parents in 2015. ResultsQuantitative data highlighted that over 10 years, parents of more than half of the children disclosed the preverbal CSA. Our analyses revealed that parental disclosure decisions entail dilemmas and unfold as a gradual process. Factors influencing decision-making included fear of stigma, child's emotional readiness, perceived benefits and risks, parental beliefs, values, and CSA circumstances. ConclusionThis study underscores the complex nature of parental disclosure and shows that it is an ongoing process rather than a singular event. Parents' choices evolved based on changing circumstances and new information. Outcomes enrich the understanding of parental disclosure decision-making, highlighting the need for tailored support services to aid parents navigating the aftermath of preverbal CSA. Parental disclosure is highly individualized and calls for evidence-based interventions and policies.

Spatial distribution and factors associated with HIV testing among adolescent girls and young women in Sierra Leone

BackgroundSierra Leone faces a significant challenge in addressing HIV/AIDS, particularly among adolescent girls and young women. This age group is considered highly vulnerable due to biological factors and social inequalities. Understanding the prevalence of HIV testing in this demographic is crucial for designing effective prevention and treatment strategies. This study investigated the spatial distribution of HIV testing and its associated factors among adolescent girls and young women in Sierra Leone.MethodsData from the 2019 Sierra Leone Demographic and Health Survey was used for the study. The sample comprised 6,062 adolescent girls and young women between the ages of 15 and 24. Spatial autocorrelation and Moran’s I statistic were employed to analyze the spatial distribution of HIV testing. An analysis utilising mixed-effect multilevel binary logistic regression was performed to determine the factors associated with HIV testing. The findings were presented as adjusted odds ratios (aOR) and a 95% confidence interval (CI).ResultsThe national prevalence of HIV testing among adolescents and young women in Sierra Leone was 42.1% [40.3,43.9]. Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts were found to be statistically significant hotspot for HIV testing. Whereas, Karene, Falaba, Bo, kenema, and some parts of Pujuhun were statistically cold spot districts. Adolescent girls and young women aged 20–24 [aOR = 1.63, 95% CI = 1.29, 2.07] had higher odds of HIV testing than those aged 15–19. Those with secondary/higher education [aOR = 1.87, 95% CI = 1.40, 2.51] had higher odds of HIV testing than those with no education. The odds of HIV testing was higher among adolescent girls and young women who use the Internet [aOR = 1.75, 95% CI = 1.32, 2.33] than those who did not use internet. Adolescent girls and young women with one [aOR = 16.56, 95% CI = 12.31, 22.29] and two or more parity [aOR = 16.37, 95% CI = 10.86, 24.68] had higher odds of HIV testing than those with no parity. The likelihood of HIV testing was higher among adolescent girls and young women who had sex below 18 [aOR = 4.54, 95% CI = 3.25, 6.34] and those who had sex at 18+ [aOR = 5.70, 95% CI = 3.84, 8.45] compared to those who had never had sex. Adolescent girls and young women who visited health facilities in the past 12 months [aOR = 1.82, 95% CI = 1.46, 2.26] had higher odds of HIV testing than those who did not.ConclusionDespite some positive trends, HIV testing rates among adolescent girls and young women in Sierra Leone remain moderate. Spatial autocorrelation analysis consistently revealed hotspots and cold spots for HIV testing, with Kailahun, Kambia, Tonkolil, some parts of the Western rural area, and Bonthe districts remaining persistent hotspots. Age, education, internet use, sexual history, parity, and healthcare access are significant factors influencing testing behaviour. To improve testing rates, the government and policymakers should prioritize educational campaigns, expand internet access, integrate HIV testing into routine healthcare, and address stigma associated with HIV.

Sexual Victimization History and Emotion Regulation in Daily Life: A Role for Stress Sensitization.

Relative to other types of traumatic experiences, a lifetime history of sexual violence (SV) has been linked with more persistent and severe mental health outcomes, but the reasons for this discrepancy have not been clearly established. Stress sensitization, or the amplification of responses to daily stressors as a function of trauma history, offers one possible explanation. Using ecological momentary assessment, the current study tested stress sensitization effects in daily life for individuals with a history of SV, focusing on emotion regulation as an outcome. Smartphone surveys were delivered four times per day over a 2-week period to assess relationships between prior SV exposure, daily stressors, and emotion regulation in an undergraduate sample (N = 122). As expected, individuals with lifetime exposure to SV evidenced increased emotion dysregulation and maladaptive emotion regulation in response to daily stressors relative to nonexposed peers, even after accounting for cumulative trauma. However, the SV and non-SV groups did not differ significantly on state adaptive emotion regulation. Instead, experiencing daily stressors was associated with increased adaptive emotion regulation for individuals in both groups. Broadly, results suggest that SV is uniquely associated with increased sensitivity to daily stressors, manifested as emotion dysregulation and use of maladaptive emotion regulation strategies to regulate emotions. These findings are consistent with emerging research on the neurobiology of trauma and with an emphasis on emotion regulation skills in leading interventions for SV-exposed individuals. Stress sensitization warrants additional attention as a factor linking SV and mental health problems.

A new identity: Enhancing life skills and work-readiness for those with a sexual offending history

The purpose of this research was to examine the experiences of individuals, with a sexual offending history, who have engaged with a community-based life skills and work-readiness programme. With a view to understand the impact of such programmes on their rehabilitation and to inform a growing body of research around the approaches needed for promoting rehabilitation within this group. Semi-structured interviews were conducted with four participants about their experiences of accessing a community-based charity and three themes were identified using Interpretive Phenomenological Analysis: “a place to belong without fear or judgement;” “creating an identity away from offending;” and “space and time to realise own potential.” These findings were discussed in relation to the Good Lives Model; previously identified protective factors for people with a history of sexual offending; and desistance research. The research offers a number of recommendations for practice which can be used by organisations to help them develop an inclusive and meaningful approach to supporting individuals with a history of sexual offending.

Increasing Screening for Sexually Transmitted Infections Among Adolescents and Young Adults Diagnosed With Sickle Cell Disease: A Quality Improvement Project

BackgroundSexually transmitted infections affect 20 million adolescents and young adults in the United States annually. Local ProblemIn a pediatric outpatient sickle cell disease clinic, in southeastern, US, 16% (43/272) of patients aged 16-24 had a documented sexual health history and 12% (4/77) completed STI screenings. The clinic's aim was to increase sexual health assessment, STI screenings, diagnosis, and treatment. Methods/InterventionUsing process redesign, a standardized sexual health and STI screening process at routine visits was implemented to increase completion of sexual health histories and STI screening. ResultsSexual health history collection rates increased from 16% (43/272) pre- to 92% (107/116) post-intervention. The rate of STI testing offered increased from 12% (5/43) pre- to 100% (116/116) post-intervention. The STI testing rates increased 22.5 % from 40% (2/5) pre- to 49% (20/41) post-intervention. ConclusionsEvidence-based standardized interventions can successfully be used to assist in sexual health documentation and STI screening.

Reclaiming Desire and Defying Conventions: An Analysis of Female Sexuality in Mrs Dalloway and the God of Small Things

The paper offers a detailed analysis of the complexities of female sexuality in Mrs Dalloway and The God of Small Things from a feminist perspective. It investigates how female protagonists overcome and defy societal norms and expectations concerning their sexual desires. The obstacles of conventional sexual norms align with the ‘repressive hypothesis’, coined by Michele Foucault in The History of Sexuality which posits that the modern discourse on sexuality is characterized by repression. This theory is used to depict how societal repression shapes and is shaped by the narratives of Clarissa and Ammu. The paper is qualitative and uses close textual analysis as an analytical tool. For the study, primary data were collected from textbooks, and secondary sources including various books, websites, articles, and journals were used to gather secondary data. The clear finding is that Clarissa has a sexual desire for Sally which is not accepted by post world war British society and Ammu, being a divorcee and upper-class woman, reclaims her sexual agency and attempts to fulfill her sexual desire by making a romantic relationship with Velutha which is prohibited in the post-colonial Indian society. Through the blending of sexual desires with more general societal issues like race, class, and cultural identities, both novels deconstructed conventional depictions of female sexuality. Thus, the study contributes to the ongoing conversation on the role of women’s sexual desires and their place in a postmodern world where autonomy, self-expression, and the deconstruction of conventional norms are of paramount importance.

«Non-conforming Pleasures»: Representations of Homosexuality in Casanova’s Histoire de Ma Vie

Giacomo Casanova’s Histoire de Ma Vie offers an interesting perspective for exploring same-sex eroticism in the eighteenth century. Despite its reputation as a classic focused on heterosexual adventures, the Memoirs reveal references to sodomy and eroticism between same-sex individuals. This article aims to identify and place in the historical context traces of this theme within the literary source. It documents biases and captures shifts in sensibilities through Casanova’s firsthand account, delving into male homoeroticism, lesbian encounters, and the evolution of Casanova’s attitude towards male sodomy at a time when terms like «homosexuality» had yet to be defined. The challenge of anachronism is addressed by acknowledging that the absence of a specific terminology in earlier periods does not negate the existence of same-sex love and intimacy. Examining the representations of same-sex eroticism in Casanova’s Histoire provides insights into the historical contextualization of male subjectivity, the understanding of emotions, and the physiological-moral discourse regarding the body-mind connection, during a pivotal turning point in the history of emotions and sexuality.

Phenomenal Eros: For a History of Sensuality

Forty years of scholarship in the history of sexuality and gender studies have delivered a considerable amount of knowledge, framed by an encompassing premise: power is paramount. A preferred object of this kind of attention are the erotic cultures of ancient Greece and Rome. The focus on power leads contemporary scholars to adopt binary thinking, namely the attribution to ancient writers and thinkers of dichotomies such as domination versus subjection, or activity versus passivity. This is a fixist view that obliterates the dialectic of desire and, therefore, its fundamental mobility. Desire aims at the other person’s desire; roles are exchanged; age and social status can play in surprising ways; hyperactivity can become subjugation. It is time for a change. It is time to look at what mattered for the Ancients themselves: the subjective experience of sensations, bodies and situations; the felicitous, ironic, or tragic reversals of intersubjective games. More importantly: the quest for pleasure, rather than the use of pleasures. The Greeks thought the sexual experience as sensuality. And sensuality inflects what they thought about gender. In poetry, narrations and philosophy, concrete details draw our attention to the felt phenomena of lived bodies – in the plural. When we look for the logic of gender, we discover that bodies can be compared, not as totalities, but as bundles of multiple discreet qualities, ready to be combined and recombined, allotted and exchanged. Qualities can be bits and pieces of anatomy, manners and garments; but also fragments of experience, moments of sensory awareness. The logic of the concrete meets the phenomenal body. For the body is a challenge, to be taken up – as a cinematic life, frame after frame. Sensations can be shared across the boundaries of female and male, which are adjectives, not substances. A granular, corpuscular, pointilliste redistribution of traits, distinctive – or not. Sensuality is queer. Like Plato’s pharmacy, erotic materialism can deliver us, beautifully, cathartically, refreshingly from the modern strictures of binary thinking. This is what the Greeks have to tell us. Let us listen!

Birth Order and Family Size of UK Biobank Subjects Identified as Asexual, Bisexual, Heterosexual, or Homosexual According to Self-Reported Sexual Histories.

This study used a recently developed statistical technique to investigate the relations between various elements of a subject's family background and the odds of that subject reporting a sexual history indicative of a minority sexual orientation. The subjects were 78,983 men and 92,150 women who completed relevant questionnaire items in the UK Biobank, a large-scale biomedical database of volunteers aged 40-69 years. The men were divided into three sexual minority groups-homosexual, bisexual, and asexual-and a comparison group of heterosexual men. The same was done for the women. The analytic procedure consisted of logistic regressions specifically designed to disentangle the effects of birth order and family size. The results showed that older brothers increased the odds of homosexuality in both men and women, and that older sisters increased the odds in men. In contrast, neither older brothers or older sisters affected the odds of bisexuality or asexuality in men or in women. These results suggest that birth order effects may be specific to homosexuality and not common to all minority orientations. The only family size finding was the negative association between family size and the odds of asexuality in both men and women. The outcomes of this study indicate that the maternal immune hypothesis, which was advanced to explain the relation between older brothers and homosexuality in later-born males, might have to be abandoned or else expanded to explain the findings concerning females. A few such modifications are considered.

Qualitative Insights Into Healthcare Professionals’ Perceived Barriers in Providing Equitable and Patient-Centered Care to Members of the LGBTQI+ Community in Greece

LGBTQI+ individuals often face health disparities, with encumbered outcomes. We investigated the perspectives of a wide range of Greek health professionals using a battery of questionnaires examining LGBTQI+ health-related knowledge, attitudes, and clinical preparedness, while exploring the potential challenges they face when providing care for LGBTQI+ patients via qualitative analysis of their free text answers. In total, 220 health professionals participated, including physicians, nurses, dentists, physiotherapists, social workers, nutritionists, medical laboratory professionals, pharmacists, radiographers, and health promotion specialists. Four main themes were revealed concerning the barriers to providing equitable and patient-centered care to LGBTQI+ individuals: (1) Inadequate knowledge (1a. Distinctive health issues of the LGBTQI+ community, 1b. Community-related terminology), (2) Insufficient communication skills (2a. General approach of LGBTQI+ patients, 2b. Addressing LGBTQI+ individuals, 2c. Managing critical attitudes of colleagues/third parties), (3) Personal perceptions (3a. Attitudes toward the LGBTQI+ community, 3b. Perceptions on the necessity of sexual health history), and (4) Ambiguous bureaucratic procedures. Self-identification, contact with community members in personal life, as well as LGBTQI+ patients’ openness during the encounter were reportedly enabling inclusive care. Most participants (83.2%) expressed willingness for further training on LGBTQI+ health issues. Going forward, study participants identified this field, in conjunction with communication skills, as important areas of focus for training health providers and empowering them to provide equitable, patient-centered, high-quality care to the LGBTQI+ community.

Awareness of HPV and HPV vaccine among college students in China.

Cervical cancer is the fourth most common cancer among women, HPV vaccine can reduce the incidence of cervical cancer by approximately 70%. Sexual behavior is a direct risk factor for HPV infection, and sexually active college students, therefore, receive attention for HPV vaccination. This study aimed to investigate the awareness of HPV and its vaccine among college students in Zhengzhou, and to explore the factors influencing their awareness of HPV vaccine, to understand college students' willingness to receive the vaccine. The findings of this study will lay a foundation for cervical cancer prevention. Using a multistage random sampling method, 650 college students from four universities in Zhengzhou were selected. A self-administered questionnaire on the awareness of HPV and its vaccine, and willingness to receive HPV vaccination was carried out. Logistic regression was used to analyze the factors influencing students' awareness of the HPV vaccine. 58.0% of college students had heard of HPV, and 72.8% of college students had heard of HPV vaccine. Logistic regression showed that gender, major, grade, mean monthly consumption level, sexual history, and mother cervical cancer screening participation significantly influenced the awareness of HPV vaccine (p < 0.05). Only 27(4.2%) college students had received the HPV vaccine. 63.2% of college students expressed their willingness to get vaccinated. The awareness of HPV and its vaccine among college students in Zhengzhou needs improvement. Although the vaccination rate is low, most college students are willing to be vaccinated. Diverse health education programs should be conducted for different groups to improve awareness of cervical cancer prevention and promote vaccination.

Human papillomavirus (HPV) vaccination in a privately funded program in Ghana: A qualitative case study

ABSTRACT HPV vaccination is one of the safest and most effective interventions against HPV-related cancers. From 2013 to 2018, HPV vaccination was piloted in Ghana in preparation for a national program. Yet, at the time of this study, there was no publicly funded HPV vaccination program in Ghana. We explored an existing privately funded HPV vaccination program in Ghana to identify challenges and gaps and to gather insights to inform vaccination practice and national policy. This study used a qualitative case study research design. We conducted semi-structured interviews on experiences, barriers, and challenges in HPV vaccination at the Greater-Accra Regional Hospital between October 1 and November 26, 2023. Participants (N = 16) included HPV vaccinators (n = 8) and program/policy leaders (n = 8). Our thematic analysis focused on HPV vaccination processes, practice challenges, and policy interests. Four main themes emerged from our analyses. Our findings revealed many challenges faced by the HPV vaccination program. These include a lack of guiding policy/framework for the HPV vaccination program, an emphasis on sexual history, cervical screening, and HPV DNA test in determining vaccination eligibility by vaccinators, and a lack of formal provider and recipient HPV education programs. Although many vaccinators advocated for a universal HPV program, some policy/program leaders were reluctant to prioritize HPV vaccination advocacy due to their focus on acute health concerns. A vaccination program without a policy can be limited in quality and efficiency, as there will be no accountability and sustainability measures. We recommend the need to develop standardized guidelines to support evidence-based HPV vaccination practice.

Group Comparisons of the Sexual Interests and Behaviors of Assigned Males and Their Association with Genital Ablation Fantasies.

We describe here the sexual histories and characteristics of 338 individuals with interests in castration (orchiectomy) and, more broadly, genital ablation (i.e., orchiectomy, penectomy, and/or nullification), recruited from the Eunuch Archive. We compared four groups: those who only fantasize about castration (Fantasy, n = 66), those who wish to be castrated in the future (Aspiring, n = 166), and those who have been castrated (Eunuchs) both with (n = 42) or without (n = 64) androgen replacement therapy (ART). In our sample, 35.6-53.8% had sexual fantasies of castrating someone, 83.3-90.8% had fantasies of being castrated, 20.6-33.3% had fantasies of removing someone's penis, and 45.3-61.9% had fantasies of having a penectomy. The four groups had similar arousal by high-risk sex behaviors, anal sex play, attraction to people under 18, common sex behaviors, and fetishistic behaviors. Fantasy of being castrated by someone was associated with elevated high-risk sexual behaviors and attraction to individuals aged 18 to 49 after controlling for age, groups, and sexual attraction. In addition, after adjusting for age, groups, and sexual attraction, fantasy of castrating someone was associated with more attraction to individuals under the age of 18 and being aroused by interaction with a stranger, whereas fantasy of cutting off someone's penis was associated with less tendency for common sexual behaviors and digital sex communication. Fantasy of being penectomized was associated with high risk and fetishistic sexual behaviors. These results support screening for high-risk behaviors in individuals who endorse an interest in genital ablation, with treatments focused on harm reduction.

Sexual health and wellbeing and the menopause: An EMAS clinical guide

IntroductionSexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care. AimTo provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond. Materials and methodsReview of the literature and consensus of expert opinion. Results and conclusionThe assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond.

Overcoming “the Penetration Model”: Rethinking Sexuality with Foucault, Shusterman, and Contemporary Feminism

In the present contribution, dealing with the intellectual legacy of Michel Foucault forty years after his death, I offer an analysis of some possible relations between certain aspects of Foucault’s project of a history of sexuality, Richard Shusterman’s somaesthetic investigation of the experience of lovemaking, and some recent attempts to critically rethink sexuality in the context of feminist scholarship. My approach towards Foucault’s thinking in this contribution is not philological or attentively reconstructive but rather selective and interpretive. In the first section, I briefly examine Foucault’s general view of sexuality as a “limit-experience”; then, in the second section, I specifically focus my attention on his (critical) analysis of “the penetration model”—an expression coined by Foucault in the context of his inquiry into Greco-Latin sexual culture. In the third section, I take into examination the important influence of Foucault’s aesthetics of existence on Shusterman’s somaesthetics and, in particular, on his book Ars Erotica. Finally, in the fourth section, I make reference—without any ambition of completeness or systematicity—to the question of the relation between Foucault’s thinking and contemporary feminism, focusing my attention on some recent proposals for a critical rethinking of sexuality by feminist scholars such as Bini Adamczak, Ilka Quindeau, Amia Srinivasan, Tamara Tenenbaum, and bell hooks.

Exploring the relationship between earthquake exposure and severity of erectile dysfunction in southern part of Türkiye.

This study aimed to explore the impact of psychological stress on erectile dysfunction (ED) in male patients following the Gaziantep-Kahramanmaras earthquake. The investigation aimed to establish correlations between earthquake-induced stress and changes in sexual function using International Index of Erectile Function (IIEF), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scores. A retrospective analysis was conducted on male ED patients from a Gaziantep urology clinic post-earthquake (March to August 2023). Patients with deteriorated erectile function post-earthquake (group 1) and those with pre-existing ED experiencing worsened symptoms post-earthquake (group 2) were included. Data collected encompassed sexual histories, IIEF scores, laboratory tests, and PHQ-9/GAD-7 evaluations. Patients were also evaluated mild and mild to moderate ED, moderate and severe ED according to IIEF erectile function. Seventy-six patients were evaluated (24 in group 1 and 52 in group 2). Significant reductions in total IIEF scores (58 to 40 in group 1 and 49 to 33 in group 2) were observed post-earthquake in both groups (p<0.001). PHQ-9/GAD-7 scores was 11.12±3.79/9.34±3.11 in mild and mild to moderate ED and 13.17±3.05/12.14±3.17 in moderate and severe ED (p=0.011, p<0.001, respectively). Negative correlations existed between PHQ-9/GAD-7 scores and IIEF erectile function (p<0.05) and total IIEF (p<0.05). This research suggests a plausible connection between the Gaziantep-Kahramanmaras earthquake and heightened ED cases. Psychological stress post-earthquake may contribute to worsened ED symptoms. Further investigations are warranted to comprehensively understand the interplay between natural disasters and sexual dysfunction, essential for optimizing patient care in challenging situations.

Adherence to CDC Guidelines for mpox Evaluation: Practice Patterns Across an Academic Medical System During the 2022 Epidemic.

Patients with suspected mpox presented to different venues for evaluation during the 2022 outbreak. We hypothesized that practice patterns may differ across venue of care. We conducted an observational study of patients undergoing mpox testing between 1 June 2022 and 15 December 2022. We assessed concomitant sexually transmitted infection (STI) testing, sexual history, and anogenital examination and a composite outcome of all 3, stratified by site. Venue of care was defined as ED (emergency department or urgent care), ID (infectious disease clinic), or PCP (primary care or other outpatient clinic). Of 276 patients included, more than half (62.7%) were evaluated in the ED. Sexual history, anogenital examination, and STI testing were documented as performed at a higher rate in ID clinic compared to ED or PCP settings. STIs were diagnosed in 20.4% of patients diagnosed with mpox; syphilis was the most common STI among patients diagnosed with mpox (17.5%). Patients evaluated in an ID clinic had higher odds ratio of completing all 3 measures (adjusted odds ratio, 3.6 [95% confidence interval, 1.4-9.3]) compared to PCP setting adjusted for age, gender, and men who have sex with men status. Cisgender men who have sex with men, transgender males, and transgender females had higher odds ratio of completing all 3 measures compared to cisgender females (adjusted odds ratio, 4.0 [95% confidence interval, 1.9-8.4]) adjusted for age and venue of care. Care varied across clinical sites. ID clinics performed a more thorough evaluation than other venues. Rates of STI coinfection were high. Syphilis was the most common STI. Efforts to standardize care are important to ensure optimal outcomes for patients.