Receptive Vaginal Intercourse Research Articles

(047) ORGASM ABILITY AND MAPPED EROGENOUS SENSATION DURING RECEPTIVE VAGINAL AND ANAL INTERCOURSE

Abstract Introduction Erogenous sensation zones (ESZs) elicit feelings of sexual arousal in response to touch. Prior research has generated whole-body erogenous sensation maps, but they do not differentiate between individual anatomical structures or assess for erogenous sensation of internal surfaces of the body, such as the vagina and anal canal. There is an even greater paucity of literature on the ability to orgasm from vaginal and anal receptive intercourse. Objective To describe detailed maps of erogenous sensation of the vagina and anal canal amongst cisgender women, and assess for ability to orgasm from receptive intercourse. Methods Respondents were recruited via Qualtrics and completed an anonymous, online questionnaire. They were instructed to indicate ESZs by selecting from predefined areas that bring them pleasure when touched during sex with a partner from anatomic illustrations of the vagina and anal canal. Respondents were also queried on their ability to orgasm from receptive vaginal and anal intercourse. All statistical analyses were completed using Qualtrics Stats iQ software, with p<0.05 indicating statistical significance. ESZ maps were generated based on the proportion of respondents selecting each anatomical structure as erogenous. Results A sample of 441 sexually active cisgender women completed the study survey (mean age 48.9±15.6y). Of the five ESZs of the vagina (Figure 1), the superficial anterior (selected by 48% respondents) and superficial posterior (33%) regions were the most frequently selected areas. The four ESZs of the anal canal further revealed greater erogeneity at the superficial anterior (18%) and superficial posterior (11%) walls (Figure 2). With respect to ability to orgasm from receptive intercourse, 35% of cisgender women reported being able to orgasm from vaginal penetration alone while 45% required simultaneous costimulation of another body part and 10% reported an inability to orgasm during receptive vaginal intercourse, regardless of costimulation (Figure 3a). Additionally, 19% of cisgender women reported an ability to orgasm from receptive anal intercourse alone, while 50% required costimulation and 31% reported an inability to orgasm during receptive anal intercourse, regardless of costimulation (Figure 3b). Conclusions Erogenous sensation of the vagina and anal canal is primarily localized to the superficial walls of both structures, with a greater preference for the superficial anterior zones. These findings support the proposed location of the “G-spot” existing proximal to Skene’s glands in the anterior portion of the vaginal canal. Results from this study further highlight the importance of costimulation in achieving orgasm during receptive vaginal and anal intercourse, with only a minority of respondents reporting an ability to orgasm from vaginal or anal penetration alone. Disclosure No.

(022) A NOVEL SURGICAL TECHNIQUE TO CREATE A NATURAL-APPEARING RECESSED VAGINAL INTROITUS WITH GENDER-AFFIRMING VULVOPLASTY (“SHALLOW-DEPTH VAGINOPLASTY”) UTILIZING A PEDICLED ADVANCEMENT FLAP

Abstract Introduction Feminizing genital gender-affirming surgery options include vaginoplasty with neovaginal canal creation (“full-depth vaginoplasty”), or vaginoplasty without creation of a neovaginal canal, referred to as “vulvoplasty” or “shallow-depth vaginoplasty”. If a transgender woman does not require a vaginal canal for sexual intercourse, shallow-depth vaginoplasty is an excellent option for women as it does not carry the additional requirements of lifelong dilation and douching and lower risk of complications as compared to the full-depth vaginoplasty procedure. As with either of these procedures, achieving “normal appearing” feminine anatomy is critical for patients. Currently, techniques for shallow-depth vaginoplasty have relied on the use of a separate full thickness skin graft utilizing a portion of scrotal skin to delineate Objective 1) To better understand decision-making factors when choosing to undergo shallow-depth vaginoplasty. 2) To describe a novel technique used to create a recessed vaginal introitus. 3) To evaluate patient perceptions of appearance as compared to cisgender vulvae. Methods Patients undergoing feminizing genital gender-affirming surgery between 04/2017-07/2022 were included in this study. Of the patients undergoing shallow-depth vaginoplasty, an anonymous electronic survey querying decision-making factors and overall post-operative satisfaction were undertaken. In addition, our novel technique is described. Results A total of 110 patients underwent feminizing genital gender-affirming surgery. Of these, 35 (32%) underwent shallow-depth vaginoplasty, whilst 75 (68%) underwent full-depth vaginoplasty. Priorities: Achieving an appearance which was “comparable to” cisgender vulvae was ranked second highest after “elimination of male genital anatomy” (Figure 1a). Technique: To achieve a recessed skin-lined introitus, gathering sutures were used to create a “dimple” from penile/scrotal skin, which is tethered to the tendon of the bulbospongiosus muscle, and the diffuse perineal body tissue behind the urethral bulb (Figure 1, b-d). Attractiveness: When comparing their vulva to cisgender women’s of similar age and weight, all 26 (100%) patients reported that their vulvas had “similar” or “somewhat similar” appearance to cisgender vulvae. 24/26 (92%) of patients found their vulvas to be either “similarly or more attractive”, and 2/26 (8%) found their vulvas to be “less attractive” as compared to cisgender vulvae. Conclusions Women option for shallow-depth vaginoplasty greatly consider the cosmetic appearance which must be indistinguishable from cisgender female anatomy, which appears to be offered by this surgical technique. In addition to this, this technique offers transgender women the opportunity to have external anatomy in line with their gender identity, and for women who are not interested in using a vaginal canal for sexual experiences (i.e. receptive vaginal intercourse), this option foregoes the added risks and commitment to lifelong dilation and douching which is required for women opting to undergo full-depth vaginoplasty. Disclosure No.

Shallow-depth vaginoplasty: preoperative goals, postoperative satisfaction, and why shallow-depth vaginoplasty should be offered as a standard feminizing genital gender-affirming surgery option.

Shallow-depth vaginoplasty (SDV), also referred to as vaginoplasty without creation of a vaginal canal, is an understudied alternative to full-depth vaginoplasty (FDV), or vaginoplasty with creation of a vaginal canal. SDV is associated with fewer short- and long-term risks and shorter recovery, and does not require a lifelong commitment to vaginal dilation and douching. To describe a surgical technique for SDV that creates a dimpled introitus, together with clinical outcomes, decision-making prioritization, and satisfaction data. We hypothesize that SDV patients prioritize comparable appearance and sexual function to FDV over shorter-term risk factors, and experience high satisfaction. We describe (1) a surgical technique for SDV; (2) the proportion of patients who underwent SDV vs. FDV, with SDV complication rates; and (3) the results of an anonymous, electronic questionnaire administered via Qualtrics that assessed SDV patient demographics, terminology preferences, prioritization of decision-guiding factors for choosing SDV over FDV, and postoperative satisfaction across various domains. A total of 110 patients underwent primary feminizing genital gender-affirming surgery at a single institution between April 2017 and July 2022: 35 (32%) of 110 underwent SDV and 75 (68%) underwent FDV. The 35 SDV patients were invited to answer the study questionnaire, of which 29 (83%) completed it (mean age 51.9 ± 16.7 years, mean body mass index 27.3 ± 5.3 kg/m2). All but one survey respondent met one or more of the following characteristics: (1) ≥40years of age, (2) exclusively feminine-identifying sexual partners, and/or (3) significant aversion to performing long-term vaginal dilation and douching. Ranking of 8 decision-guiding factors revealed prioritization of long-term over short-term outcomes. Postoperatively, patients reported high satisfaction across all 3 domains. When asked if they had to choose between SDV and FDV over again, 86% reported that they would choose SDV. While 14% would choose FDV, all but one reported new interest in receptive vaginal intercourse due to finding masculine-identifying partners post-SDV surgery. A total of 27% of SDV patients experienced complications that required additional surgeries; 82% of complications were related to urinary spraying. SDV is a lower-risk alternative to FDV and is associated with reduced postoperative maintenance and high postoperative satisfaction. This study describes the clinical outcomes of the largest documented cohort of patients to undergo SDV to date. Limitations include recall bias due to the retrospective survey and use of nonvalidated questions attributed to the paucity of validated gender-affirming surgery questionnaires. SDV's appeal to a large subset of patients (32% in this study), low complication rate, high satisfaction, and low decisional regret suggests that this surgical option should be offered to all patients seeking feminizing genital gender-affirming surgery.

The Association Between Heterosexual anal Intercourse and HIV Acquisition in Three Prospective Cohorts of Women.

The extent to which receptive anal intercourse (RAI) increases the HIV acquisition risk of women compared to receptive vaginal intercourse (RVI) is poorly understood. We evaluated RAI practice over time and its association with HIV incidence during three prospective HIV cohorts of women: RV217, MTN-003 (VOICE), and HVTN 907. At baseline, 16% (RV 217), 18% (VOICE) of women reported RAI in the past 3 months and 27% (HVTN 907) in the past 6 months, with RAI declining during follow-up by around 3-fold. HIV incidence in the three cohorts was positively associated with reporting RAI at baseline, albeit not always significantly. The adjusted hazard rate ratios for potential confounders (aHR) were 1.1 (95% Confidence interval: 0.8-1.5) for VOICE and 3.3 (1.6-6.8) for RV 217, whereas the ratio of cumulative HIV incidence by RAI practice was 1.9 (0.6-6.0) for HVTN 907. For VOICE, the estimated magnitude of association increased slightly when using a time-varying RAI exposure definition (aHR = 1.2; 0.9-1.6), and for women reporting RAI at every follow-up survey (aHR = 2.0 (1.3-3.1)), though not for women reporting higher RAI frequency (> 30% acts being RAI vs. no RAI in the past 3 months; aHR = 0.7 (0.4-1.1)). Findings indicated precise estimation of the RAI/HIV association, following multiple RVI/RAI exposures, is sensitive to RAI exposure definition, which remain imperfectly measured. Information on RAI practices, RAI/RVI frequency, and condom use should be more systematically and precisely recorded and reported in studies looking at sexual behaviors and HIV seroconversions; standardized measures would aid comparability across geographies and over time.

(034) Shallow-Depth Vaginoplasty: Patient Demographics, Preoperative Goals, and Postoperative Satisfaction

Abstract Introduction Shallow-depth vaginoplasty (SDV) is an excellent genital gender-affirming surgery (gGAS) option for patients who are not interested in the factors associated with full-depth vaginoplasty (FDV), which include the ability to engage in receptive vaginal intercourse (RVI), increased surgical risks, longer wound healing, and/or strict, lifelong postoperative maintenance requirements (i.e., regular vaginal dilation and douching). Despite the many compelling reasons for a patient to select SDV, this surgery is seldom offered and severely underrepresented in the medical literature. We define SDV as “vaginoplasty without a canal” or “vulvoplasty,” and FDV as “vaginoplasty with a canal.” Objective To (1) describe patient demographics; (2) understand which specific decision-guiding factors are most important for patients (ordered by priority) when selecting SDV over FDV; and (3) assess postoperative satisfaction across various domains, among the largest documented cohort of patients to undergo SDV to date. Methods A total of 119 patients underwent feminizing gGAS at our institution between April 2017 and April 2022, of which 44 (37%) underwent SDV and 75 (63%) FDV. All 44 SDV patients were emailed a link to an anonymous, electronic survey via Qualtrics®, which assessed preoperative priorities and postoperative satisfaction. Eight decision-guiding factors were identified via patient interviews and a comprehensive literature search. Results Thirty-one respondents (mean ± SD age and BMI: 51.2±15.8y and 27.2±5.5) completed the survey (response rate = 70.5%). Analysis of demographics and sexual history (Table 1) revealed a diverse range of backgrounds and preferences; however, all respondents met one or more of the following characteristics: (1) exclusively feminine-identifying sexual partner(s); (2) middle/older age; and/or (3) have not been sexually active in 4 years. While 66.7% of SDV patients reported they would engage in RVI if they had a vaginal canal, respondents with feminine-identifying partners were significantly less likely to express this interest (p*=0.0479). Interestingly, 71.4% of respondents who expressed an interest in engaging in RVI felt it was not sufficiently important to them to have to commit to long-term vaginal canal dilation. Ranking of the eight decision-guiding factors patients commonly consider revealed prioritization of long-term over short-term outcomes (Figure 1). Overall, patients reported high postoperative satisfaction across three domains (Figure 2). When asked if they “had to do it all over again,” all respondents indicated they would complete genital gender-affirming surgery again: 93.5% would select SDV and 6.5% FDV. Conclusions SDV was associated with high postoperative satisfaction and low decisional regret amongst the diverse cohort of patients we surveyed. This, combined with the fact that patients’ sexual practices are often not known to the provider, underscores why providers should always offer SDV as a standard option to all patients considering feminizing gGAS. Despite the diversity in patient backgrounds/identities, we identified three of the highest-priority long-term decision-guiding factors: elimination of male genital anatomy, preservation of erogenous sensation, and desire for normal appearance. Nevertheless, the variability in prioritization ratings reflects the highly individual nature of surgery decision-making, and highlights the need for thorough patient education that addresses the individual expectations of each patient who seeks femininizing gGAS. Disclosure No

Receptive anal sex contributes substantially to heterosexually acquired HIV infections among at‐risk women in twenty US cities: Results from a modelling analysis

Receptive anal intercourse (RAI) is more efficient than receptive vaginal intercourse (RVI) at transmitting HIV, but its contribution to heterosexually acquired HIV infections among at-risk women in the USA is unclear. We analysed sexual behaviour data from surveys of 9152 low-income heterosexual women living in 20 cities with high rates of HIV conducted in 2010 and 2013 as part of US National HIV Behavioral Surveillance. We estimated RAI prevalence (past-year RAI) and RAI fraction (fraction of all sex acts (RVI and RAI) at the last sexual episode that were RAI among those reporting past-year RAI) overall and by key demographic characteristics. These results and HIV incidence were used to calibrate a risk equation model to estimate the population attributable fraction of new HIV infections due to RAI (PAFRAI ) accounting for uncertainty in parameter assumptions. Receptive anal intercourse prevalence (overall: 32%, city range: 19%-60%) and RAI fraction (overall: 27%, city range: 18%-34%) were high overall and across cities, and positively associated with exchange sex. RAI accounted for an estimated 41% (uncertainty range: 18%-55%) of new infections overall (city range: 21%-57%). Variability in PAFRAI estimates was most influenced by uncertainty in the estimate of the per-act increased risk of RAI relative to RVI and the number of sex acts. Receptive anal intercourse may contribute disproportionately to new heterosexually acquired HIV infections among at-risk low-income women in the USA, meaning that tools to prevent HIV transmission during RAI are warranted. The number of RVI and RAI acts should also be collected to monitor heterosexually acquired HIV infections.

Increases in HIV Incidence Following Receptive Anal Intercourse Among Women: A Systematic Review and Meta-analysis

Receptive anal intercourse (RAI) carries a greater per-act risk of HIV acquisition than receptive vaginal intercourse (RVI) and may influence HIV epidemics driven by heterosexual sex. This systematic review explores the association between RAI and incident HIV among women, globally. We searched Embase and Medline through September 2018 for longitudinal studies reporting crude (cRR) or adjusted (aRR) relative risks of HIV acquisition by RAI practice among women. Of 27,563 articles identified, 17 eligible studies were included. We pooled independent study estimates using random-effects models. Women reporting RAI were more likely to acquire HIV than women not reporting RAI (pooled cRR = 1.56 95% CI 1.03–2.38, N = 18, I2 = 72%; pooled aRR = 2.23, 1.01–4.92, N = 5, I2 = 70%). In subgroup analyses the association was lower for women in Africa (pooled cRR = 1.16, N = 13, I2 = 21%) than outside Africa (pooled cRR = 4.10, N = 5, I2 = 79%) and for high-risk (pooled aRR = 1.69, N = 4, I2 = 63%) than general-risk women (pooled aRR = 8.50, N = 1). Interview method slightly influenced cRR estimates (p value = 0.04). In leave-one-out sensitivity analyses pooled estimates were generally robust to removing individual study estimates. Main limitations included poor exposure definition, incomplete adjustment for confounders, particularly condom use, and use of non-confidential interview methods. More and better data are needed to explain differences in risk by world region and risk population. Women require better counselling and greater choice in prevention modalities that are effective during RVI and RAI.

Receptive Anal Intercourse and HIV Infection

Objective: Inform the public that receptive anal intercourse (RAI) is a key transmission route of the human immunodeficiency virus (HIV) epidemic in the United States. Method: The role of receptive anal intercourse (RAI) in this epidemic will be examined using the following approach: 1) Risk comparison of HIV transmission via RAI to the other major routes of transmission. 2) HIV transmission risks of RAI using some of the present risk reduction techniques. 3) HIV infection via anal intercourse among male youth. 4) HIV infection via anal intercourse among women. Results: Of the major transmission routes of HIV, receptive anal intercourse has the highest transmission risk for acquiring HIV infection. RAI is 2 times the risk of needle-sharing during injection drug use (IDU) and 17 times the risk of receptive vaginal intercourse. The estimated per act probability of acquiring HIV from an infected source by the exposure route of RAI is high in most circumstances: 1) Condoms alone only partially reduce the high risk of RAI. With the addition of pre-exposure prophylaxis (PrEP), the risk is further reduced. 2) When one or both partners are infected with a sexually transmitted disease (STD), even with condom use, the risks are very high. With the addition of PrEP the risks are reduced, but RAI still carries significant risks. 3) With exposure to acute HIV (high viral load) the risks of RAI are very high and remain significant even with condom use and PrEP. Anal intercourse often begins in adolescence; both genders are at risk. Conclusion: Public knowledge of the high transmission risks of receptive anal intercourse may likely result in a downward trend of new HIV infections and contribute to ending the epidemic.

Heterosexual Anal Intercourse in the United States [6

INTRODUCTION:More than one-third of women in the U.S. have engaged in heterosexual anal intercourse (HAI). The risk of acquiring HIV per sexual act is estimated to be 18 times higher for receptive anal intercourse than receptive vaginal intercourse; HAI is also associated with lower rates of condom

Heterosexual Anal Intercourse among Teenagers in the United States

Heterosexual Anal Intercourse among Teenagers in the United States

BRIEF - SYNOPSIS OF THE CURRENT EVIDENCE ON THE RISK OF HIV TRANSMISSION.

Knowledge of the risk of HIV transmission has evolved over the past decade as evidence on the impact of biological and behavioural co-factors, such as viral load, has come to light. We undertook a comprehensive review of the evidence on the risk of HIV transmission. A search was conducted for literature published between January 2001 and May 2012. The search focused on systematic, meta-analytic, and narrative reviews. For topics where no reviews existed, primary research studies were included. The risk estimates for the sexual transmission of HIV, per sex act, ranged from 0.5% to 3.38% (with mid-range estimates of 1.4% to 1.69%) for receptive anal intercourse; 0.06% to 0.16% for insertive anal intercourse; 0.08% to 0.19% for receptive vaginal intercourse; and approximately 0.05% to 0.1% for insertive vaginal intercourse. For people who inject drugs, the risk of transmission from a contaminated needle, per injection, was estimated to be between 0.7% and 0.8%. A number of factors impact the risk, including viral load, the presence of other sexually transmitted infections (STIs), and male circumcision. Within each route of transmission, estimates of the risk of transmission varied widely, likely due to the role of behavioural and biological co-factors. Viral load appears to be an important predictor of transmission, regardless of the route of transmission. However, the evidence indicates that viral load is not the only determinant and that certain co-factors play a role in increasing (e.g., STIs) or decreasing (e.g., male circumcision) the risk of transmission.

Human Immunodeficiency Virus Prophylaxis for Sexual Assault Survivors

Adolescent sexual assault is unfortunately all too common. An analysis of the 2001 Youth Risk Behavior Survey revealed that 10.2% of women and 5.1% of men reported forced sexual intercourse at least once in their lifetimes. Recent National Criminal Victimization Survey results revealed that annually 1/10 of one percent of all individuals aged 12 or older had survived rape or sexual assault. The ratio of male/female survivors is 1:10 and 29% of victims are 12 to 17 years old. There is a general concern that survivors are at increased risk for acquiring human immunodeficiency virus (HIV) infection via the sexual assaults. Most reviews cite a case report by Murphy et al which describes HIV seroconversion related to rape. Epidemiological studies of consensual coitus have shown that the risk for heterosexual sexual transmission from 1 coital act ranges from 0.001 to 0.008.4 Estimates vary by the stage of the infected person (eg time since seroconversion: 15 months) and type of exposure (eg insertive anal intercourse receptive vaginal intercourse). (excerpt)