Previous Sexual Activity Research Articles

A Brief Intervention to Reduce Adolescent Sexual Risk Behaviors: Feasibility and Impact

Many adolescents with high-risk sexual behaviors only receive health care episodically in the emergency department (ED). ED visits offer an opportunity to deliver brief interventions to improve health, but no proven ED-based brief intervention to reduce sexual risk behaviors exists. The study objectives were to 1) assess feasibility of a novel intervention using National Research Council criteria (effectiveness, efficiency, and satisfaction), and 2) examine impact on attitudes and behaviors. In this cross-sectional pilot study, sexually active patients aged 14-19 years presenting to a Midwestern ED were recruited to receive an intervention to reduce sexual risk behaviors. The intervention, based on motivational interviewing (MI), included agenda setting, exploration of behaviors, decisional balance exercise, tailored feedback, and referral to the hospital-affiliated Adolescent Clinic. Individually-tailored sessions offered provision of condoms, prescriptions for emergency contraception, and/or testing for sexually transmitted infections (STI). Participants completed a survey and intervention at baseline, an immediate post-intervention survey at Time 1, and a three-month phone follow-up survey at Time 2. Surveys assessed sexual behaviors, attitudes and self-efficacy regarding condoms and birth control. Additional questions included: demographics (baseline), satisfaction, and fidelity measures (Time 1). Feasibility criteria were: 1) Subject rated interventionist fidelity to MI principles (Likert scale 1 = strongly agree to 4 = strongly disagree), 2) Session duration (minutes), and 3) Subject satisfaction (Likert scale 1 = not at all to 5 = very). Sixty-six subjects (96% of approached) completed the screening with 24 (37%) qualifying for enrollment by reporting previous sexual activity. Of those, 20 (83%) participated (mean age 16.2 years; 60% female). Subjects somewhat or strongly agreed that the interventionist: 1) “was easy to talk to” (90%), 2) “was concerned about me” (78%), 3) “understood me” (89%), 4) “treated me like an equal” (89%), and 5) “did not push me into something I wasn't ready for” (80%). The mean duration was 15.7 minutes. All subjects were fairly (20%) or very (80%) satisfied. One subject tested positive for Chlamydia trachomatis and received treatment at Adolescent Clinic. When offered, most (59%) accepted condoms and 71% accepted a prescription for emergency contraception. Five subjects kept appointments at Adolescent Clinic where additional services were provided: STI testing (n = 2), birth control prescribed/administered (n = 2), provision of condoms (n=1), and influenza vaccination (n = 1). Fifteen subjects (75%) were reached for 3-month follow-up. Among those reporting sex since enrollment (n = 6), 67% reported continued condom use at most recent sex. There were positive trends in attitudes towards condoms and birth control self-efficacy. This ED-based intervention was delivered with high fidelity and relative rapidity, and resulted in high satisfaction among these sexually active adolescents. A considerable proportion received health services essential for optimal sexual health. Studies to assess efficacy appear warranted.

Sexual Health Behaviors, Preferences for Care, and Use of Health Services Among Adolescents in Pediatric Emergency Departments

The objective of this study was to describe sexual health behaviors, as well as prior use of and preferences for sexual health services among adolescents in the pediatric emergency department (ED). In this cross-sectional study, subjects aged 14 to 19 years who presented to an urban or suburban ED from a single Midwestern hospital system completed a written survey. The survey included questions on previous sexual activity, high-risk behaviors (first sex before age 15 years, no condom at last sex, substance use at last sex, >3 partners in past 3 months, and >4 lifetime partners), and sexual health service use and preferences. Comparisons of responses between subgroups were analyzed using χ2 test. Multiple logistic regression was used to identify factors associated with high-risk behaviors. Care preferences were scored using a 4-point Likert scale; mean scores were ranked. Subjects included 306 adolescents (85% of approached). The mean age was 15.5 years. Almost half (45%) reported previous sexual activity, and of those, 63% reported 1 or more high-risk behaviors (most commonly first sex before age 15 years [43%] and no condom at last sex [29%]). Almost all wanted to prevent pregnancy, but only one third received birth control counseling before sexual debut, and 14% reported no contraception at last sex. Younger age was associated with 1 or more high-risk behaviors (odds ratio, 3.7; confidence interval, 1.39-9.84). Preferences for care included caring, knowledgeable providers, and low/no cost. Because of high prevalence of high-risk behaviors among adolescents presenting in the ED, strategies should be developed to link these patients to comprehensive sexual health care.

Topical Anesthetic (Lidocaine-Prilocaine) Cream Application Before Speculum Examination in Postmenopausal Women

Study ObjectiveTo evaluate the effectiveness of lidocaine–prilocaine (EMLA 5%) cream application to genital mucosa for reducing pain or discomfort associated with speculum examination in postmenopausal women. DesignA randomized controlled study (Canadian Task Force classification I). SettingA university hospital. PatientsOne-hundred thirty-four postmenopausal women. InterventionsThe subjects were randomized to an EMLA cream group, a lubricant gel group, or a control group. General data was collected, including age, body weight, gravidity, parity, smoking habits, history of diabetes mellitus, previous gynecologic operations, dyspareunia, sexual activity, and duration of menopause. All patients were asked to score pain at 3 time points (insertion, dilation, and extraction of speculum) during the procedure using a visual analog scale. Pain intensity during speculum examination was compared between the groups. Measurements and Main ResultsThere was no statistically significant difference between the EMLA cream, the lubricant gel, and the control groups in terms of age, weight, gravidity, parity, dyspareunia, duration of menopause, sexual activity, smoking habit, diabetes mellitus, previous vaginal and other gynecological procedures, vaginal length, and serum follicle-stimulating hormone and estradiol levels (p > .05). The pain scores obtained during all phases of speculum application were significantly lower in the EMLA group than in both the lubricant gel and the control groups (p < .001). Comparing the gel and the control groups, a lower pain score was observed in the former, except for the second phase of the examination (p < .001). ConclusionTopical application of EMLA 5% cream on genital mucosa of postmenopausal women before vaginal examination significantly reduces pain associated with speculum application.

Anogenital Human Papillomavirus in Sexually Abused and Nonabused Children: A Multicenter Study

To characterize the epidemiology of genital human papillomavirus (HPV) infection in children without previous consensual sexual activity, comparing HPV prevalence by certainty of child sexual abuse (CSA). Patients presenting for evaluation of CSA in 8 sites in Atlanta, Houston, Harrisburg, and New York City were recruited along with patients presenting for unrelated health visits. CSA certainty was classified as definite, probable, possible, or no evidence following published guidelines and the results of history, physical examination, and laboratory tests. Urine and swabs of external genitalia were tested for HPV using L1 consensus polymerase chain reaction. The study included 576 participants (89.9% female) aged 6 months to 13 years (mean: 7.9); 534 of whom were evaluated for CSA and 42 for unrelated reasons. Of those evaluated for CSA, 14 had genital warts. One or more HPV types were detected in 11.8% (61 of 517) of participants with adequate samples. HPV detection was more likely among abused participants (definite, probable, or possible) than among participants without evidence of CSA (13.7% and 1.3%, respectively; P < .0001) and increased with certainty of abuse (8.4%, 15.6%, and 14.5% in participants with possible, probable, and definite CSA, respectively; P < .0001). Participants aged 10 years or older had a higher prevalence of HPV (20.6%) than others (5.6%) (P < .0001). CSA, anogenital warts, and age were independently associated with HPV detection. HPV detection was associated with CSA and increased with CSA certainty. In this population, genital HPV seemed to behave as a sexually transmitted infection.

High-risk hpv infection in sexually active and non active young women

Abstract To determine the prevalence of high-risk HPV infection before first vaginal intercourse and after initiation of sexual activity in 14-22 years old girls, to find which HPV types occur most commonly. During the gynecologic exam cervical swabs were collected. Specimens were tested using Hybrid Capture 2 DNA test. In positive samples digene HPV genotyping test was performed. Subjects included 264 women, of whom 169 (64.0%) reported previous sexual activity and 95 (36.0%) had not yet had vaginal intercourse. There were 43 cases (16.3%) of high risk HPV, with 39 cases in those reporting sexual activity and 4 in virgins. Single strain HPV infection was detected in 62.8%, two strains in 23.2%, and three strains in 14.0% of subjects. HPV-16 was the most common type (20.9%), next more prevalent types were 18, 56, 31, 33 and 59. HPV-16 or HPV-18 were detected in 39.5% of the subjects. Not a single case was identified containing both types. The prevalence of high-risk HPV is common in sexually active young Lithuanian women. HPV were found in a small percentage of girls who had never had vaginal intercourse. The prevalence of types 16 and 18 among Lithuanian women was higher than in international data.

Actinomicosis pélvica en una paciente sin relaciones sexuales previas

The presence of an abdominal mass may be symptomatic or it could be found in a routine physical examination. Before this is diagnosed some further tests should be done for the differential diagnosis of the mass, whether it is of gynaecological origin and if the pathology is benign or malignant. The mass may be accompanied by acute or chronic pain. Pelvic actinomycosis is a rare cause of such signs and it is usually associated with the use of an intrauterine device. Here we present a case of chronic abdominal pain with cyst of ovary in a 20-year-old patient without previous sexual activity.

Epidemiology of Genital Chlamydia trachomatis Infection Among Young Women in Costa Rica

To investigate Chlamydia trachomatis (Ct) epidemiology among 5829 women 18 to 25 years old, in Costa Rica. Data are from a community-based human papillomavirus 16/18 vaccine trial. Before randomization, eligible women who reported previous sexual activity were interviewed and tested for Ct DNA by Hybrid Capture 2 and polymerase chain reaction-based genotyping. Multivariate models were developed. Overall prevalence was 14.2% (95% confidence interval, 13.3-15.1). Among Ct genotypes, serovar E was the most common (4.3%), followed by serovar F (3.0%), serovar D/Da (2.9%), and serovar I/Ia (2.1%).Ct increased with lifetime sexual partners of the women, and among women with 1 lifetime partner, with sexual partners of the partner. Current intrauterine device users had an increase in Ct detection [odds ratio (OR) 1.6, 1.1-2.5] but hormonal contraceptives or condom users did not. Miscarriages were associated with a reduction in Ct detection (OR 0.7, 0.5-1.0) while current regular smoking increased it (OR 1.7, 1.2-2.5). Vaginal discharge, reactive changes, ASCUS or LSIL and moderate to severe inflammation in the cytology were significantly more common among Ct positive women (P <0.001). Gonorrhea prevalence was 0.8%, and it was, as other STIs, highly correlated with Ct detection. This is a high-prevalence population where we confirmed the strong link between Ct and sexual behavior of women and their partners. The establishment of a screening program in the age group included in this study should be considered. More studies are needed in developing countries to further investigate the role of intrauterine devices and the lack of protection by condoms, in addition to the interplay between Ct and other STIs, ectopy, inflammation, and epithelial abnormalities.

Associação entre idade ao início da atividade sexual e subseqüente infecção por papilomavírus humano: resultados de um programa de rastreamento brasileiro

PuRPOse : to investigate women’s age at their first sexual intercourse and its correlation with their present age, human papillomavirus (HPV) infection and cytological abnormalities at Pap smear. MethOds : women from the general population were invited to be screened for cervical cancer and pre-malignant lesions. After answering a behavior questionnaire, they were submitted to screening with cervical cytology and high-risk HPV testing with Hybrid Capture 2 (HC2). This report is part of the Latin American Screening (LAMS) study, that comprises centers from Brazil and Argentina, and the data presented herein refer to the Brazilian women evaluated at the cities of Porto Alegre, Sao Paulo and Campinas. Results : from 8,649 women that answered the questionnaire, 8,641 reported previous sexual activity and were included in this analysis. The mean age at the interview was 38.1±11.0 years and the mean age at the first sexual intercourse was

Sexual and reproductive health of female inmates in Brazil

To describe the sociodemographic profile and health problems of inmates in a women's prison. A descriptive study was conducted from March to September 1997 in a women's prison in the state of Espírito Santo, Brazil. All inmates were invited to participate in the study. A total of 121 women aged more than 18 years were interviewed. A structured questionnaire was used to collect data on sociodemographics, clinical and criminal past history. Following the interview, subjects underwent clinical and gynecological examination. Of 121 women included in the study, the mean age was 30.2 years (SD 8.98) and the mean of schooling was 4.8 years (SD 3.50). All participants reported previous sexual activity, the mean age of the first sexual intercourse was 15.2 years (SD 2.55) ranging from 9 to 27 years. Previous STDs were reported by 28%; 12 (9.9%) were pregnant at the time. Teenage pregnancy was often reported. Most women reported no use of either any contraceptive methods or condoms. Tubal ligation was seen in 19.8% and abnormal Pap smear in 26.9%. Knowledge about health problems inside the prison system can contribute to promoting and increasing social rehabilitation. However, effective results could be seen only with collaboration between public health authorities and the prison system.

Prevalence of sexually transmitted infections and mental health needs of female child and adolescent survivors of rape and sexual assault attending a specialist clinic

Objectives: To determine the prevalence of sexually transmitted infections (STIs) and the mental health needs of female child and adolescent survivors of rape and sexual assault who were referred to...

Dermoid tumor with ovarian torsion masking as appendicitis

A previously healthy 24 year-old female presented to the emergency department with 2 days of severe crampy and sharp lower abdominal pain associated with anorexia, nausea, malaise, non-bloody emesis, and some non-bloody loose stools. She denied previous sexual activity and reported normal menstrual pattern with no current vaginal discharge or bleeding. She denied any fevers or chills or other systemic symptoms. She had no past medical history and took no medications. Her vital signs were normal with an oral temperature of 37.1°C. She was a well-developed, thin female in moderate distress holding her lower abdomen, preferring to stay still in bed. The physical examination was unremarkable except for the abdomen, which was soft and flat with normal bowel sounds. She had localized rebound tenderness and voluntary guarding of the right lower quadrant. A urine pregnancy test was negative, and the white blood count was 15,000/mL.

Central inhibition of sexual response in the male: a theoretical perspective

A theoretical model for central inhibition of sexual response is proposed, postulating individual variability in the propensity for such inhibition. Whereas such inhibition is typically adaptive, individuals with high propensity may be vulnerable to sexual dysfunction, and those with low propensity to high risk sexual behavior. Evidence of the existence and localization of such inhibitory mechanisms from both the animal and human literature is reviewed. Evidence of central neurotransmitters with sexual inhibitory effects is substantial, though in most cases the inhibition is not specific to sexual response or behavior. Recent studies have identified centers in the brain stem and lateral hypothalamus which appear to have specific inhibitory effects on sexual response. A variety of adaptive mechanisms involving inhibition of sexual response are considered, some involving perception of threat, others occurring more directly as consequences of previous sexual activity. These different adaptive functions may well involve different inhibitory mechanisms. This theoretical model opens a new agenda for experimental research into adaptive sexual behavior, both human and animal.

Judicial Discretion and Fundamental Justice: Sexual Assault in the Supreme Court of Canada

On August 22, 1991 the Supreme Court of Canada delivered its judgment in R. v. Seaboyer.1 At issue was the constitutionality of Criminal Code provisions limiting a defendant's ability to introduce evidence about a complainant's previous sexual activity or reputation in trials for sexual assault. Writing for a seven-justice majority, Justice Beverly McLachlin declared that the prohibition against the admission of sexual activity evidence infringed the right to a fair trial guaranteed under sections 11(d) and 7 of the Charter of Rights and Freedoms. According to Justice McLachlin, the impugned provision failed the test of constitutionality because, with only limited exceptions, it categorically prohibited defendants from introducing potentially exculpatory evidence. In her judgment, defendants could not make full answer and defense to sexual assault charges unless judges retained significant discretion to admit such evidence. Seaboyer was the first in a series of judgments that broadened the rights of sexual assault defendants, contrary to the policy preferences and constitutional arguments advanced by the Canadian federal government and the Canadian feminist movement.2 One interpretation of these judgments is that they reflect judicial hostility toward women's rights generally and feminist legal analysis in particular. Support for this interpretation can be found in a 1989 study of equality rights litigation by the Canadian Advisory Council of the Status of Women, books by Michael Mandel and Allan Hutchinson, and recent judgments in which the Court has divided along gender lines.3 There is, however, significant evidence to suggest that this

Attitudes of Female College Students Toward Over-the-Counter Availability of Oral Contraceptives

Study ObjectiveTo determine female college students’ beliefs about oral contraceptive pill (OCP) ava]ability and use, and to examine significant factors associated with these beliefs. DesignCross-sectional survey. SettingUrban women's liberal arts college. ParticipantsTwo hundred ninety female undergraduates who completed surveys. InterventionAn anonymous survey was placed in all undergraduate mailboxes. Surveys were returned to a locked collection box in the mailroom. Within 4 weeks after distribution, 290 surveys were completed. Main Outcome MeasuresSexual and contraceptive practices and students’ beliefs regarding whether OCPs should be made available without prescription. ResultsThe respondents’ average age was 20.9±3.3 years; 84% reported previous sexual intercourse with the mean age of first intercourse at 16.6±2.2 years. Seventy-five percent of the sexually active women reported use of OCPs and 52% had used OCPs at their last intercourse. Sixty-five percent of all respondents felt OCPs should not be available without prescription. The two most commonly cited reasons for not wanting acps to be available over the counter (OTC) were that (1) side effects might occur that a health care provider could have prevented (59%), and (2) people would not go to their providers for regular check ups (56%). The most commonly cited reason for believing that OCPs should be available OTC was that there would be fewer unwanted pregnancies (74%). Race, previous OCP use, previous sexual activity, and perceived risk of pregnancy were not significant predictors of believing OCPs should be available OTC. Having had a previous pregnancy was a significant predictor of believing OCPs should be available OTC (p = 0.047). Those who believed OCPs should be available only with a prescription were willing to pay more for OCPs (p = 0.033). Logistic regression controlling for race revealed that both younger age (p = 0.03) and previous pregnancy (p – 0.002) were independent predictors of believing OCPs should be available OTC. ConclusionsThe majority of our sample believe that OCPs should remain as a prescription medication. Previous pregnancy and younger age are important factors in determining beliefs regarding OCP availability. Further studies in a more diverse population are needed to explore the relationship between age, previous pregnancy, and desire for contraceptive availability without prescription.

Design and methods of a population-based natural history study of cervical neoplasia in a rural province of Costa Rica: the Guanacaste Project.

This paper reports on the enrollment phase of a population-based natural history study of cervical neoplasia in Guanacaste, a rural province of Costa Rica with consistently high rates of invasive cervical cancer. The main goals of the study are to investigate the role of human papillomavirus (HPV) infection and its co-factors in the etiology of high-grade cervical neoplasia, and to evaluate new cervical cancer screening technologies. To begin, a random sample of censal segments was selected and enumeration of all resident women 18 years of age and over was conducted with the aid of outreach workers of the Costa Rican Ministry of Health. Of the 10738 women who were eligible to participate, 10049 (93.6%) were interviewed after giving written informed consent. After the interview on cervical cancer risk factors was administered, a pelvic examination was performed on those women who reported previous sexual activity. The pelvic examination included a vaginal pH determination and collection of cervical cells for cytologic diagnosis using three different techniques. Additional cervical cells were collected for determination of the presence and amount of DNA from 16 different types of HPV, and two photographic images of the cervix were taken and interpreted offsite by an expert colposcopist. Finally, blood samples were collected for immunologic and micronutrient assays. Women with any abnormal cytologic diagnosis or a positive Cervigram, as well as a sample of the whole group, were referred for colposcopy, and biopsies were taken when lesions were observed. The enrollment screening will serve as the basis for a prevalent case-control study, and the members of the cohort free from serious disease will be followed actively, at intervals of no more than a year, to study the natural history of HPV infection and the origins of high-grade squamous intraepithelial lesions (HSIL). Details of the field operation are outlined, with particular reference to the realization of this kind of study in developing countries. Descriptive data on the prevalence of disease and exposure to various risk factors are also presented.

Nonconsensual Sexual Experiences in Precollege Women: Prevalence and Risk Factors

The authors of this study examined the prevalence of nonconsensual sexual experiences in dating situations among a sample of 330 incoming female college students. Results indicated that 38.5% of women reported experiencing at least one form of sexual victimization in dating, ranging from unwanted sexual contact to rape. Victimization was related to history of childhood sexual abuse as well as previous consensual sexual activity. Discussion focuses on the need for education and prevention programs during the secondary school years and counseling assistance for college‐age victims.

A Theory of the Causes of Courtship Rape: Part 2

A theory is proposed that there may be as many as five varieties of courtship rape. Each type is described as arising at a different stage of a romantic relationship in terms of both the length of the relationship and previous sexual activity. Beginning date rape occurs during a couple's first few dates. Early date rape occurs after several dates but before the couple has established sexual ground rules. Relational rape occurs after the couple's sexual ground rules have been established. The remaining two forms of rape occur after a couple has or had an active sexual relationship, and they are distinguished by the presence or absence of battering. When this form occurs without physical abuse, it may be essentially the same as relational rape. Suggestions and hypotheses for testing this model are provided.

Sexually Transmitted Diseases and Rape: The Experience of a Sexual Assault Centre

Epidemiological data and rates of sexually transmitted diseases (STDs) are presented from a group of 90 women screened following rape. Forty-eight (53%) women knew their assailant. In 6 cases multiple assailants were involved. In 21 (23%) rapes weapons were used. Of 47 women examined within 48 hours of rape, 17 (36%) had evidence of genital trauma. Anal injury was common (8 of 11, 73%) in those reporting anal intercourse. Anal assault (17 of 90, 19%) and oral assault (16 of 90, 18%) commonly accompanied rape. STDs were diagnosed in 13 (14.4%) women, 3 having mixed infections. Neisseria gonorrhoeae was isolated in 2 women, Chlamydia trachomatis in 7, Trichomonas vaginalis in 6, genital warts in 2 and Pediculosis pubis in 2 women. Five of 16 cervical cytology results showed abnormalities, 2 were suggestive of CIN. Eleven of 13 women with an STD (84.6%) had been sexually active within the 3 months prior to the rape. Previous sexual activity may be the most relevant factor determining those most at risk of harbouring an STD.

Knowledge, Attitudes And Behavior Related To Sexuality In Adolescents With Chronic Disability

This study explored the level of knowledge, attitudes and activity related to sexuality in a group of adolescents and young adults with myelomeningocele, a group of matched controls and a group of adolescents with cystic fibrosis. Slightly more than half of the study sample were female, the mean age was 17.2 years, and their backgrounds were mainly middle-class. 28 per cent of the myelodysplastic group reported previous sexual activity, compared with 60 per cent of the control group and 43 per cent of the group with cystic fibrosis. Most of the disabled adolescents expressed a desire to marry and have children, but fewer than 20 per cent had sought information regarding their sexual or reproductive function from their physician. Among those sexually active, 60 per cent of the controls and 67 per cent of those with cystic fibrosis had used contraception, compared with 16 per cent of the myelodysplastic group. The authors conclude that sex education and screening for contraceptive need is indicated for adolescents with chronic disabilities.

Microflora of the urethra in adolescent boys: Relationships to sexual activity and nongonococcal urethritis

Urethral cultures were obtained from 90 adolescent youth, 16 of whom denied previous sexual activity. Among the sexually active boys was a group of 32 with clinically significant pyuria, consistent with the diagnosis of urethritis, on a first-part urinalysis (FPU) specimen. To relate differences in urethral microflora to sexual activity, 42 sexually active patients with a negative FPU were compared with the never sexually active group. The profile of anaerobic, but not aerobic, bacteria isolated from the urethra was related to the presence or absence of previous sexual activity. Mycoplasma species and Ureaplasma urealyticum were isolated from sexually active patients only, and may be markers of sexual activity in adolescent boys. Of the 32 patients with FPU evidence of urethritis, 22 (69%) had cultures positive for Chlamydia trachomatis, and an additional three (9%) had cultures positive for Neisseria gonorrhoeae. The findings in sexually active patients with a positive FPU were otherwise similar to those of sexually active patients without evidence of urethritis. C. trachomatis appears to be the most important agent of urethritis among adolescent boys with a positive FPU.