Penetrative Vaginal Intercourse Research Articles

Outcomes of penile inversion vaginoplasty and robotic-assisted peritoneal flap vaginoplasty in obese and nonobese patients.

To explore the impact of body mass index (BMI) on the outcomes of gender-affirming vaginoplasty. A cohort consisting of all gender-affirming vaginoplasties in our practice between September 27th, 2018, and September 1st, 2022 were identified, and data were retrospectively collected. Patients were classified as obese if their BMI was ≥30 kg/m2 at the time of surgery and nonobese if their BMI was <30 kg/m2 . Complications were assigned a Clavien-Dindo grade and grouped as Grade ≥2 versus Grade ≤1. Patient-reported functional outcomes of intact erogenous sensation, tactile sensation, ability to achieve penetrative vaginal intercourse, and cosmetic satisfaction were assessed. A total of 58 patients with a mean follow-up time of 6.9 months were included. Seventeen patients (mean BMI = 36.8 kg/m2 ) were classified as obese and 41 patients (mean BMI = 25.1 kg/m2 ) were classified as nonobese. No significant differences in outcomes were identified in the obese versus nonobese groups in terms of the incidence of complications. Patient-reported functional outcomes did not differ significantly between thetwo groups. Similar results can be achieved with gender-affirming vaginoplasty in obese patients when compared to their nonobese counterparts. Eligibility for this procedure should not be restricted based on BMI alone.

Gender-affirming vaginoplasty: Technical considerations in patients with genital skin deficiency.

Gender dysphoria affects over 1 million American adults.Vaginoplasty is a critical step in gender affirmation, and many patients have insufficient genital skin for full-depth penile inversion vaginoplasty (PIV). We reviewed the literature for technical considerations addressing this and present our data supporting the use of peritoneal flaps (Davydov technique). A comprehensive review of modern literature was conducted. Second, we present a retrospective case review of our experience with PIV, including data from procedures utilizing peritoneal flaps. We identified 20 original articles, including retrospective and prospective case and cohort studies. Approaches included the application of local soft tissue grafts and flaps, peritoneal flaps, and intestinal segments. Between June 2018 and February 2021, 47 patients at our institution, underwent PIV for the treatment of gender dysphoria. Nineteen of those patients underwent robotic-assisted peritoneal flap procedure in addition to PIV. In this cohort, the mean follow-up was 200.6 ± 124.8 days. Mean neovaginal depth was 13.1 ± 3.0 cm intra-operatively and 11.0 cm at the last follow-up. Twenty-six percent of complications were Clavien Grade 1 or 2; others included wound dehiscence (30.4%), perianal and urethral fistula (13.0%), and neovaginal stenosis (8.7%). The majority of patients reported satisfactory results in terms of sexual function with intact tactile and erogenous sensation. Almost half were able to have penetrative vaginal intercourse at the last follow-up. We did not aim to perform statistical calculations to compare the outcomes of PIV with and without robotic-assisted peritoneal flap augmentation, as the groups were not constructed in that manner. However, it is evident that anatomical and functional results as well as the distribution of postoperative complications seem similar. Vaginoplasty is indicated in a growing population of patients with a wide range of medical histories and anatomic variations. Genitourinary reconstructive surgeons must have several methods to achieve full-depth vaginoplasty in cases of inadequate genital skin. Peritoneal flaps serve as a versatile, safe, and functionally advantageous solution.

Colpocleisis techniques: an open-and-shut case for advanced pelvic organ prolapse

The purpose of this video is to demonstrate several advanced surgical techniques to improve efficiency and optimize the clinical success of the colpocleisis procedure. Pelvic organ prolapse is a common condition that affects up to 40% of the postmenopausal female population. For women with advanced pelvic organ prolapse, multiple medical comorbidities, and who no longer desire penetrative vaginal intercourse, an obliterative approach is preferred due to decreased anesthetic needs and operative time, and 95% long-term efficacy. The umbrella term of “colpocleisis” encompasses LeFort Colpocleisis, a uterine sparing procedure, colpocleisis with hysterectomy, and post-hysterectomy vaginal vault colpocleisis. Typically levator myorrhaphy and perineorrhaphy are also included to reinforce the repair. This video demonstrates several advanced surgical techniques to streamline the colpocleisis procedure. These methods include using electrosurgery to mark out the epithelium, the push-spread technique for superficial dissection, and demonstrating methods to create the lateral tunnels during LeFort colpocleisis with and without the use of a urinary catheter. Retraction with Allis clamps and rubber bands on hemostat clamps are utilized to improve visualization. Approximation of the anterior and posterior vaginal muscularis is also performed to obliterate the vaginal canal. Attention must be paid not to proceed past the level of the urethrovesical junction to avoid angulation of the urethra. An anatomic model is used to demonstrate the suture placement during levator myorrhaphy to facilitate an adequate purchase of the levator ani muscles. Ultimately the goal of colpocleisis is a vaginal opening that is one centimeter in width and three centimeters in depth. These skills enable the surgeon to maximize efficiency and surgical outcomes of obliterative procedures for advanced stage pelvic organ prolapse.

Mullerian agenesis coexisting with gonadal dysgenesis in a lady with 46, XX karyotype: A rare case report

Mullerian agenesis also known as Mayer-Rokitansky-Kauster-Hauser (MRKH) syndrome is a congenital disorder associated with aplasia of the upper part of vagina, cervix in a female with normal karyotype (46, XX) and well developed secondary sexual characteristics. This was a rare case of combined Mullerian agenesis and gonadal dysgenesis in an eighteen-year-old Nigerian lady who presented with primary amenorrhoea and poorly developed secondary sexual features. She had no history of cyclical abdominal pain, and attempts at penetrative vaginal intercourse. Physical examination revealed a phenotypical female with height and weight of 155cm and 42 kg respectively. Hormone profile revealed markedly elevated Luteinizing Hormone (LH) and Follicle stimulating Hormone (FSH); and raised testosterone, normal prolactin and thyroid function test. Magnetic resonance imaging revealed an absent uterus, tubes and ovaries. Chromosomal studies revealed normal female karyotype 46, XX. Intravenous urography, ultrasonography and skeletal survey showed no associated renal and skeletal abnormalities. Hormone replacement therapy with estrogen was instituted for development and maturation of secondary sexual characteristics followed by serial vaginal dilatation to enhance sexual activities. Patient is on follow up and doing well. MRKH syndrome is a rare case and can coexist with gonadal dysgenesis. This knowledge would be helpful to clinicians in the diagnosis and management of primary amenorrhoea.

A Sexual and Gender Minority Inclusive Tool to Identify and Reduce Psychological Distress Related to Vaginal Brachytherapy Treatment

Evidence has shown treatments for gynecologic cancers can pose a significant impact to quality of life (QoL) and psychosocial functioning for cancer patients and cancer survivors, with very limited understanding of the impact of such treatments on the lesbian, gay, bisexual, transgender and queer/questioning community, also referred to as sexual and gender minorities (SGM), a diverse and medically underserved population. Specifically, intracavitary vaginal brachytherapy (ICVBT) for endometrial cancers can cause a negative impact on QoL and can even result in PTSD after treatment. Thus, better understanding a patient's unique identity and chosen sexual preferences, as well as assessing underlying anxiety, psychosocial issues, and/or prior non-consensual sexual encounter(s) can potentially alleviate distress during and after this sensitive treatment. Here, we present an innovative, SGM-inclusive assessment tool to identify potential risk factors for physical and/or psychosocial distress that may occur in patients undergoing ICVBT.We combined two previously published, validated tools to assess for urinary, bowel, and sexual symptoms in patients undergoing ICVBT. Next, as part of the ongoing LGBTQ initiative at our academic comprehensive cancer center, our department's LGBTQ Task Force, which is composed of volunteer patients, physicians, nurses, physicists, dosimetrists, and support staff reviewed the questionnaire and provided critical feedback for inclusivity. We subsequently had the questionnaire reviewed for health literacy by our Patient Education Liaisons.The task force recommended inclusion of sexual orientation and gender identity (SOGI) demographic questions to the survey, and adjustment of previous questions for improved inclusivity of SGM-identifying patients, especially those who identify as transgender, gender non-binary, and/or who choose to not engage in penetrative vaginal intercourse. Additionally, it was recommended to include a question that screens for a history of non-consensual sexual encounters to reduce triggering past trauma. The task force felt these items were important for the practitioner to discuss with their patient prior to the procedure, with the goal to reduce acute anxiety and possibly prevent acute and long-term negative physical and/or emotional outcomes.Our ICVBT survey tool is designed to screen for "at-risk" patients, and provide a pathway for open dialogue between patients and physicians to potentially reduce undue harm during this important, yet sensitive treatment. To the best of our knowledge, this is the first such ICVBT survey tool to assess for a history of sexual trauma, and include SOGI and gender-inclusive questions. This adaptation has allowed our team to approach patients in a sensitive manner inclusive of their identity and prior experiences. Preliminary data is being collected and will be presented at the conference.

Botulinum toxin A (Botox) injection into muscles of pelvic floor as a treatment for persistent pelvic pain secondary to pelvic floor muscular spasm: A pilot study.

Persistent pelvic pain (PPP) remains an important cause of morbidity. Pelvic floor muscle spasm is an important contributor to PPP. The study's primary aim was to assess if botulinum toxin (BoNT) injection to pelvic floor muscles altered pain scores or quality of life (QoL) at six, 12 and 26weeks. Secondary aims included investigating the impact of BoNT on opiate usage, examining the role of pain catastrophising, and assessing for complications. A single-centre prospective cohort study enrolled 21 patients with PPP who had failed physiotherapy techniques. Each participant underwent BoNT injection to muscles of the pelvic floor and pudendal nerve block. Questionnaires and digital vaginal examinations were conducted at baseline, six, 12 and 26weeks. Pain score quantification used visual analogue scales (VAS) and numerical rating scales (NRS). Other outcome assessments included The World Health Organization Quality of Life instrument (WHOQoL-BREF), Pain Catastrophising Scale (PCS), and modified Australian Pelvic Floor Questionnaire (APFQ). ACTRN12620000067976. Following BoNT injection, median VAS scores decreased for all domains at six and 12weeks, with VAS for dyspareunia significant at sixweeks (P=0.026). Scores returned to baseline by 26weeks. Opiate usage was significantly less following BoNT injection, with a percentage reduction of 23.8% (95% CI -48.3 to 0.7, P=0.06). Sexual function improved significantly (P<0.01), and at six months, four previously apareunic participants reported successful penetrative vaginal intercourse. Health-related QoL and PCS demonstrated sustained improvement (P=0.02-0.05). NRS for muscle tenderness decreased for all assessed muscle groups (P<0.001). BoNT requires further assessment as a treatment modality for select women with PPP.

Low Dose, High Frequency Movement Based Dilator Therapy for Dyspareunia: Retrospective Analysis of 26 Cases.

IntroductionWhile two-thirds of women will experience dyspareunia and vaginal dilators are often used to treat dyspareunia, outside of a single case report, no study has investigated the potential of low-dose, high frequency movement-based dilator therapy for dyspareunia in premenopausal female patients.AimTo determine the utility of low-dose, high frequency movement-based dilator use for dyspareunia in premenopausal female patients.MethodsRetrospective study of women presenting to outpatient hospital-based pelvic floor physical therapy office in a tertiary care center. All adult premenopausal female patients who were referred to pelvic floor physical therapy for dyspareunia and completed movement-based dilator therapy (MBDT) and met study criteria (n = 26) were included for analysis.Main Outcome MeasurePatient change in pain level status using Numeric Pain Rating Scale with intercourse was compared between initial evaluation and time of discharge from pelvic floor physical therapy.ResultsAmong the 26 women who met criteria for this study, the average pain score decreased from 8.3 (SD 2.2) before treatment to 1.3 (SD 2.0) after treatment and was statistically significant (P< .001). Complete resolution of dyspareunia was reported in 58% of patients. Patients completed between 2 and 6 total pelvic floor physical therapy visits (average 3.7, SD1.5), over 0–44 weeks (mean 9.6 weeks, SD 8.3).ConclusionLow-dose, high frequency, movement-based dilator therapy significantly reduced or resolved the experience of pain with penetrative vaginal intercourse with dyspareunia. Future prospective studies with larger samples and the inclusion of sexual functional status should be considered to explore the full potential of this modality in treatment of premenopausal patients with dyspareunia. Miles K, Miles S. Low Dose, High Frequency Movement Based Dilator Treatment for Dyspareunia: Retrospective Analysis of 26 Cases. Sex Med 2021;9:100344.

CERVICAL SMEAR ABNORMALITIES IN HIV INFECTED WOMEN ATTENDING A RURAL HOSPITAL ART CENTER IN TAMILNADU

INTRODUCTION: Cervical cancers are the most common form of cancer encountered in Indian women. Studies from India had reported HIV positive women are 10-11 times more prone for cervical carcinomas than HIV negative women with a recent rise in incidence observed. India started a free antiretroviral therapy (ART) program in 2004 with services extended to rural General Hospitals. Cancer cervix can be diagnosed at a preinvasive stage with repeatative papanicolaou smear (cytological screening) and can be readily preventable. AIM: Our aim is to determine the prevalence of PAP smear abnormalities among HIV infected women from rural areas coming for ART initiation and the relationship between immunological status and smear abnormalities. METHODS: As per the Indian National ART program all HIV positive women of reproductive age should undergo PAP smear examination before initiation of ART. All consenting women &gt;18 years of age with history of penetrative vaginal intercourse undergo PAP smear examination. In this observational cohort from 25th June 2011 to 15th January 2012 conducted in Melur ART centre and the cytological reports and the patient clinical and immunological status data was analyzed by using SPSS 17 version. RESULTS: 102 PAP smears were obtained and classified according to Bethesda classification. Five patients (4.90%) were abnormal. Squamous cell carcinoma was observed in 1 (0.98%) patient with a CD4 count of 580 cells/mm3. High squamous intraepithelial lesions were observed in 2 patients (1.96%) with CD4 counts of 208 &amp; 633 cells/mm3 respectively. Low squamous intraepithelial lesion were observed in 2 patients (1.96%) with CD4 counts of 50 and 385 respectively cells/mm3. Immunological status (CD4 count) correlated with grade of the initial lesion (p=0.10). All the patients with PAP smear abnormalities were referred to Madurai Medical College Hospital for further treatment and follow-up. CONCLUSION: In our observational study increasing cytological abnormalities in the HIV Infected women were noted. Accordingly, all ART centre and HIV treatment programs should institute comprehensive reproductive health care services for this high-risk groups, including routine Papanicolaou smear screening

V07-06 PROSTATO-NEOVAGINAL FISTULA REPAIR IN A PATIENT WITH PRIOR TRANSURETHRAL RESECTION OF THE PROSTATE

You have accessJournal of UrologyLower-Tract Reconstruction II: ED/Infertility & Transgender Surgery (V07)1 Apr 2020V07-06 PROSTATO-NEOVAGINAL FISTULA REPAIR IN A PATIENT WITH PRIOR TRANSURETHRAL RESECTION OF THE PROSTATE Rebecca Sager*, Daniela Kaefer, Natasha Ginzburg, and Dmitriy Nikolavsky Rebecca Sager*Rebecca Sager* More articles by this author , Daniela KaeferDaniela Kaefer More articles by this author , Natasha GinzburgNatasha Ginzburg More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000897.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vaginoplasties for gender affirmation are becoming increasingly common and are reported to carry a risk of serious urological complications such as urethro-neovaginal fistulae. Our objective was to demonstrate a technique for repair of prostatic urethro-neovaginal fistula in a transgender female with prior transurethral resection of the prostate (TURP). METHODS: A 65-year-old transgender female presented with a complaint of severe incontinence and was diagnosed with a prostato-neovaginal fistula. She had undergone TURP for symptomatic benign prostatic hyperplasia (BPH) prior to penile inversion vaginoplasty at another institution. Following vaginoplasty, she had severe incontinence of urine after the initial vaginal packing removal. Cystoscopy and vaginoscopy identified fistulae from the urethra, just proximal to the verumontanum, to the neovagina. The options for repair were considered ensuring that the neovagina remained patent. Surgical technique: The urethra was dissected laterally away from neovagina, and the prostatic and membranous urethral plate was incised dorsally. An Asopa-type dorsal inlay urethroplasty with buccal mucosa graft was performed. The lateral urethral edges were rotated ventrally, approximated and the adjacent tissue flaps were brought over in layers to cover ventral urethral anastomosis. A 16 French urethral catheter and vaginal packing were left in place at the conclusion of the case. Patient was followed with imaging, cystoscopy and questionnaires. RESULTS: Voiding cystourethrogram was performed 3 weeks post-operatively with no evidence of fistula. On follow up visits at 4- and 8-months patient reported no recurrent incontinence, no difficulty with vaginal dilations or penetrative vaginal intercourse. Cystoscopy and pelvic exam at the 8-months follow-up demonstrated no evidence of fistula or stricture and no stress incontinence with cough or Valsalva. CONCLUSIONS: Surgical treatment of BPH by TURP prior to gender affirmation surgery in transgender female patients may lead to complicated fistulae in a setting of incompetent bladder neck. The close proximity of the neovaginal dissection to a thinned prostate capsule and external sphincter may predispose this group of patients to fistula formation and incontinence. Traditional interposition flaps such as gracilis could create significant bulk compromising the neovaginal space. Asopa-type urethroplasty with dorsal inlay of buccal mucosa graft and ventral urethral closure can be used for a novel application in repair of complex prostato-neovaginal fistula. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e644-e645 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca Sager* More articles by this author Daniela Kaefer More articles by this author Natasha Ginzburg More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of Genital Fistula in Women with Meyer-Rokitansky-Kuster-Hauser Syndrome

Aims: The study sought to document our experience with management of genital fistula and related symptoms in women with MRKH syndrome.&#x0D; Methods: This is a retrospective review of women with MRKH syndrome who were treated for genital fistula and related conditions from January 2012 to July 2018. Our Microsoft Access database and operation register were used to locate the folders from which data was extracted. Follow up information was obtained by telephone interview. Data was analysed with SPSS version 17.&#x0D; Results: The mean age at presentation of the six patients was 21.2 years (SD 4.5). Mean follow-up period was 27.3 months (SD 24.1). One patient presented with infertility; the remaining five presented with genital fistula (two iatrogenic, two gishiri cuts and one sexual trauma). Three fistulae were vesicovaginal and two rectovaginal. All fistulae were successfully repaired. All patients were offered sigmoid neo-vagina as one-stage or two-stage procedure for concerns about penetrative vaginal intercourse. To date, two patients are sexually active during follow-up, and have a pleasing and satisfactory penetrative neo-vaginal sexual experience.&#x0D; Conclusion: Women and girls with MRKH syndrome present with genital fistula from iatrogenic, harmful cultural practice and sexual trauma. Regardless of presenting complaints of women with MRKH syndrome, they also had concerns regarding penetrative vaginal intercourse. Depending on the mode of presentation, one- stage or two-stage surgical repair was possible and sigmoid neo-vaginal surgery provided a satisfactory penetrative neo-vaginal sexual outcome.

Sexual activity among Nigerian women following successful obstetric fistula repair.

To evaluate post-operative sexual activity among women who have undergone obstetric fistula repair. The present descriptive cross-sectional study recruited married women who had undergone successful obstetric fistula repair who were attending reunion activities at Bingham University Teaching Hospital, Jos, Nigeria, between March 13 and March 15, 2014. Participants were interviewed regarding penetrative vaginal intercourse after surgery, and any changes in sexual desire, arousal, orgasm, sexual satisfaction, and the presence of coital pain compared with before they experienced obstetric fistula. There were 102 patients who participated in interviews; 23 (22.5%) reported not being able to engage in penetrative vaginal intercourse and 12 (52%) of these patients ascribed this to a "tight" or "narrow" vagina. Compared with the pre-fistula period, 63 (61.7%) patients reported reduced sexual desire, 57 (55.9%) reported lack of or inadequate lubrication during intercourse, 12 (11.8%) reported anorgasmia, and 60 (58.8%) reported reduced attainment of orgasm. Dyspareunia was reported by 48 (47.1%) patients; 43 (90%) experienced superficial or deep dyspareunia, and 5 (10%) experienced both. A lack of and lower sexual satisfaction were reported by 20 (19.6%) and 40 (39.2%) patients, respectively. Following obstetric fistula repair, many women experienced difficulty engaging in penetrative vaginal intercourse and reported sexual dysfunction. Management of sexual dysfunction should be part of fistula rehabilitation programs.

Sexual Function in Adult Life Following Passerini-Glazel Feminizing Genitoplasty in Patients with Congenital Adrenal Hyperplasia

We assessed external genitalia sensitivity and sexual function in adults with congenital adrenal hyperplasia who had undergone Passerini-Glazel feminizing genitoplasty as children, and compared them to a control group of healthy counterparts. Inclusion criteria were congenital adrenal hyperplasia, Passerini-Glazel feminizing genitoplasty, adult age and penetrative vaginal intercourse. Thermal and vibratory sensitivity of the clitoris, vagina and labia minora were analyzed using the Genito Sensory Analyzer (Medoc Ltd., Minnetonka, Minnesota). Psychosexual outcome was assessed with the Beck Depression Inventory, Zung Self-Rating Anxiety Scale, Female Sexual Distress Scale and Female Sexual Function Index. Matched analyses were performed to compare outcomes in patients to controls (healthy medical students). All statistical tests were performed using SPSS®, version 18.0 RESULTS: A total of 12 patients (10%) entered the study. Thermal and vibratory clitoral sensitivity was significantly decreased in all patients compared to healthy controls (p <0.01). There was no difference in thermal or vibratory vaginal sensitivity between patients and controls. On the Female Sexual Distress Scale 11 patients (91.6%) and 11 controls (91.6%) described a stable satisfactory relationship. All patients reported active sexual desire, good arousal, adequate lubrication and orgasm. No significant difference in Female Sexual Function Index global score or single domain scores was observed between patients and controls. Although clitoral sensitivity in sexually active patients with congenital adrenal hyperplasia treated with Passerini-Glazel feminizing genitoplasty is significantly reduced compared to controls, sexual function in those patients is not statistically or clinically significantly different from their healthy counterparts. Finally, 1-stage Passerini-Glazel feminizing genitoplasty seems to allow normal adult sexual function.

Sexual knowledge, attitudes and activity of men conscripted into the military

BackgroundMilitary conscripts may experience a change in their attitude towards sex at times when sexual urges are at their peak during their physical growth. This study examines the experience, understanding, knowledge and attitudes regarding sexual activity of the military conscripts.MethodsData was obtained from a cross-sectional survey of 1127 young adult military conscripts, and were evaluated in Southern Taiwan from January to July 2009, their demographic data, sexual knowledge, attitudes and activities were assessed.ResultsNearly 43% of the participants had performed penetrative vaginal intercourse at least once; 34% of the participants performed heterosexual oral sex at least once; almost 7% of participants had had homosexual intercourse, and 7.5% of participants had experienced homosexual oral sex in the past year. The mean sexual knowledge score based on 30 questions was 23.2 ± 4.0. The higher the educational level of the participants, the greater sexual knowledge they had obtained.ConclusionThis study found that 43% of unmarried young recruits had experienced premarital sexual activity. However, their sexual knowledge was insufficient and should be strengthened by sex education from an earlier age. College aged and adult learners also have sex education needs, especially with regard to integrating sexuality and life, being able to relate responsibly as sexual beings to others, the use of contraception, and about sexually transmitted disease.KeywordsYoung recruits, Sexual behavior, Sexual knowledge, Sex education

Air Embolism During Sexual Intercourse in the Puerperium

Air embolism is a rare but well-recognized cause of sudden death during pregnancy or in the puerperium. Many of the cases described in the medical literature are associated with sexual activities, in particular following air insufflation during orogenital sex. This case report describes the sudden death from air embolism of a young woman during consensual penetrative vaginal intercourse with her male partner 12 days into the puerperium.

T10-P-11 Sexual education and correct information about sexual physiologic functioning

Every woman and every man has the right to live sexual pleasure therefore sexual education should be scientific and correct. Sexologists should give teen-agers some important advices to let them approach sexuality without anxiety respecting themselves and the partner. The orgasm is a normal physiological function of all male and female human beings. Female orgasm is caused by female erectile organs. The female vagina has little sensitivity and distinguishing clitoral from vaginal orgasm is not correct: it has no scientific basis. Male and female orgasm should be a normal phase of the sexual response cycle. That is possible with a correct sexual stimulation, also after the menopause. The male erection is equivalent to the vasocongestion (erection) of the female erectile organs which causes lubrication of the vagina. To define as “complete sexual intercourse” the case in which the orgasm happens in both partners with or without a penetrative vaginal intercourse. To teach boys and girls that during the first sexual experience it is not obligatory to have a vaginal intercourse but it is important to give and to receive pleasure caressing and touching the partner. Sexual virginity doesn’t have to be identified anymore by the hymen and first penetration. Boys and girls should be taught that the size of the male penis is not important to give the partner an orgasm. The contemporary stimulation of the clitoris during vaginal intercourse facilitates the female orgasm. Sexologists should give correct and scientific sexual education to help people having a satisfactory sexual life.

Identification of HIV-1 specific T lymphocyte responses in highly exposed persistently seronegative Chinese

Studies of highly exposed persistently seronegative (HEPS) individuals may provide valuable information on mechanisms of protection and on vaccine design. Cellular immune responses play a critical role in containing human immunodeficiency virus. However, the cellular immune responses in HEPS individuals have not been thoroughly assessed at the entire viral genome level. Ten HEPS Chinese with a history of frequent penetrative vaginal intercourse (mean frequency, at least once a week), with some unprotected sexual contact occurring in the weeks or days immediately before enrollment, 25 HIV-1 seropositive individuals, 10 HIV-1-seronegative healthy individuals with low-risk sexual behavior and no history suggestive of exposure to HIV-1 infection were enrolled. HIV-1-specific T cell responses were comprehensively analyzed by an interferon-gamma Elispot assay against 770 overlapping peptides spanning all HIV-1 proteins. HIV-1-specific T-cell responses of interferon-gamma secretion were identified in 3 (30%) out of 10 HEPS individuals; the specific cytotoxic T lymphocytes were targeted at Pol (2/10), Env (2/10), and Tat (1/10). HIV-1-specific T-cell responses of interferon-gamma secretion were identified in 20 (80%) out of 25 seropositive intravenous drug users (IDUs), revealing that all HIV-1 proteins and protein subunits could serve as targets for HIV-1-specific CD8(+) T cell responses with 85% recognizing Gag, 80% recognizing Nef, 75% recognizing Pol, 60% recognizing Env, 55% recognizing Vpu, 45% recognizing Vpr, 20% recognizing Vif, 20% recognizing Tat and 15% recognizing Rev in these seropositive individuals. None of the seronegative healthy individuals gave the positive T-cell responses. About 30% of HEPS Chinese mounted HIV-1 specific T cell immune responses. Cell-mediated immunity against HIV-1 may be developed through non-productive infections.

Condom effectiveness in reducing heterosexual HIV transmission.

The amount of protection that condoms provide for HIV and other sexually transmitted diseases is unknown. Cohort studies of sexually active HIV serodiscordant couples with follow-up of the seronegative partner, provide a situation in which a seronegative partner has known exposure to the disease and disease incidence can be estimated. When some individuals use condoms and some do not, namely some individuals use condoms 100% of the time and some never use (0%) condoms, condom effectiveness can be estimated by comparing the two incidence rates. Condom effectiveness is the proportionate reduction in disease due to the use of condoms. The objective of this review is to estimate condom effectiveness in reducing heterosexual transmission of HIV. Studies were located using electronic databases (AIDSLINE, CINAHL, Embase, and MEDLINE) and handsearched reference lists. For inclusion, studies had to have: (1) data concerning sexually active HIV serodiscordant heterosexual couples, (2) a longitudinal study design, (3) HIV status determined by serology, and (4) contain condom usage information on a cohort of always (100%) or never (0%) condom users. Studies identified through the above search strategy that met the inclusion criteria were reviewed for inclusion in the analysis. Sample sizes, number of seroconversions, and the person-years of disease-free exposure time were recorded for each cohort. If available, the direction of transmission in the cohort (male-to-female, female-to-male), date of study enrollment, source of infection in the index case, and the presence of STDs was recorded. Duplicate reports on the same cohort and studies with incomplete or nonsepecific information were excluded. HIV incidence was estimated from the cohorts of "always" users and for the cohorts of "never" users. Effectiveness was estimated from these two incidence estimates. Of the 4709 references that were initially identified, 14 were included in the final analysis. There were 13 cohorts of "always" users that yielded an homogeneous HIV incidence estimate of 1.14 [95% C.I.:.56, 2.04] per 100 person-years. There were 10 cohorts of "never" users that appeared to be heterogeneous. The studies with the longest follow-up time, consisting mainly of studies of partners of hemophiliac and transfusion patients, yielded an HIV incidence estimate of 5.75 [95% C.I.: 3.16, 9.66] per 100 person-years. Overall effectiveness, the proportionate reduction in HIV seroconversion with condom use, is approximately 80%. This review indicates that consistent use of condoms results in 80% reduction in HIV incidence. Consistent use is defined as using a condom for all acts of penetrative vaginal intercourse. Because the studies used in this review did not report on the "correctness" of use, namely whether condoms were used correctly and perfectly for each and every act of intercourse, effectiveness and not efficacy is estimated. Also, this estimate refers in general to the male condom and not specifically to the latex condom, since studies also tended not to specify the type of condom that was used. Thus, condom effectiveness is similar to, although lower than, that for contraception.

Uso del profiláctico entre la juventud en sus relaciones de coito vaginal

ObjectiveTo describe young people's use of condoms in penetrative vaginal intercourse, and to identify the factors associated with this use. MethodThe information was collected using a self-administered questionnaire put in 1,000 people between 14 and 24 years of age resident in the region of Andalusia (Spain). The results of the sample were representative and the trust interval was 95%. A bivariante analysis was carried out and hierarchical logistic regression equations were adjusted to verify associations between the dependent variable «use of the condom in the vaginal intercourse» and the variables proposed from PRECEDE model (predisposing, enabling, and reinforcing). The adjustment of the model was of a 38%, according to the Nagelkerke's statistic. ResultsOf the people surveyed, 750 had affective and/or sexual relations with physical contact, and 63% of these had vaginal intercourse (47% of all surveyed). Of those, people that only had vaginal intercourse once (12% of all surveyed), 83% (10,3% of all surveyed) used a condom, whereas, people that had sex more than once (34% of all surveyed), 49% always used a condom (16,9% of all surveyed). The variables associated with always using a condom were: intention of «safe» behaviour with their regular partner and low frequency of practice. The variables associated with never using a condom were: living emancipated, having an external locus of control (thinking that becoming infected depends upon external factors), low number of zones of the body identified as pleasure-sensitive, thinking that a condom is not necessary if one trusts his or her partner, intention of «unsafe» behaviour with their regular partner, and not talking with the partner about preventive methods before having sex. DiscussionThe most associated factors with using or not a condom in vaginal intercourse are predisposing (attitudes, values and believes) that are related with the kind of sexual partner. Interventions (based on the young active participation) are suggested to make them perceived the compatibility between the trust with the partner and the use of condom, and put in doubt the «false safety» given by a partner perceived as habitual.