Sexual Events Research Articles

Parent Reactions to Sexual and Gender Identity Disclosure Events in the Deep South

Parental reactions to sexual and gender identity disclosures are known to be related to queer children and adolescents’ mental health and psychosocial adjustment. An improved understanding of how and why parents react how they do, in conjunction with their perceptions of how the coming out process unfolded can inform our understanding of how a young person’s coming out is experienced by parents in the broader context of the family. A clearer understanding is especially important for families located in historically sociopolitically conservative geographic areas because these parents might be at highest risk for a maladaptive reactions to coming out, subjected to homophobic legislation and cultural pressures, and because families from these areas are less represented in the literature. In the current qualitative study, semi-structured interviews were conducted with parents of queer children and adolescents living in the Deep South. Results illuminate a highly heterogenious experience and provide an initial roadmap, via the articulation of a conceptual model, to guide further research with families in this context.

Exploring police sexual misconduct: an examination of a decade of incidents in a metropolitan agency

PurposePolice misconduct is a grave matter undermining public trust in law enforcement and police professionalism. While research has specified major forms and causal theories of police misconduct, especially regarding corruption and excessive force, scientific attention to police sexual misconduct (PSM) has been more limited and is addressed here. The purpose of this paper is to address this issue.Design/methodology/approachThe current study was commissioned to examine PSM incidents (n = 50) between 2000 and 2009 in a large, metropolitan, police department in the USA. Data were extracted from agency internal affairs case files, personnel records and disciplinary histories for involved officers.FindingsAnalyses identified common factors and trends across officers, complainants and sexual misconduct events that were dichotomized per case substantiation and observed on a severity continuum from unobtrusive to criminal conduct.Originality/valueThough findings did not evidence a deviant subculture often implicated in the police literature, specific opportunities to reduce officer misconduct, including intensifying administrative sanctioning and other perceptual deterrence measures, were identified.

Efficacy and safety of adrenergic alpha-1 receptor antagonists in older adults: a systematic review and meta-analysis supporting the development of recommendations to reduce potentially inappropriate prescribing

BackgroundAdrenergic alpha-1 receptor antagonists (alpha-1 antagonists) are frequently used medications in the management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and in the management of therapy-resistant arterial hypertension, two conditions frequently found in older adults. This systematic review aims at presenting a complete overview of evidence over the benefits and risks of alpha-1 antagonist treatment in people ≥ 65 years, and at deriving recommendations for a safe application of alpha-1 antagonists in older adults from the evidence found.MethodsA comprehensive literature search was performed (last update March 25th 2022) including multiple databases (Medline/Pubmed, Embase, the Cochrane Library) and using the PICOS framework to define search terms. The selection of the studies was done by two independent reviewers in a two-step approach, followed by a systematic data extraction. Quality appraisal was performed for each study included using standardised appraisal tools. The studies retrieved and additional literature were used for the development of recommendations, which were rated for strength and quality according to the GRADE methodology.ResultsEighteen studies were included: 3 meta-analyses, 6 randomised controlled trials and 9 observational trials. Doxazosin in the management of arterial hypertension was associated with a higher risk of cardiovascular disease, particularly heart failure, than chlorthalidone. Regarding treatment of LUTS suggestive of BPH, alpha-1 antagonists appeared to be effective in the relief of urinary symptoms and improvement of quality of life. They seemed to be less effective in preventing disease progression. Analyses of the risk profile indicated an increase in vasodilation related adverse events and sexual adverse events for some agents. The risk of falls and fractures as well as the effects of long-term treatment remained unclear. All meta-analyses and 5 out of 6 interventional studies were downgraded in the quality appraisal. 7 out of 9 observational studies were of good quality.ConclusionsIt cannot be recommended to use doxazosin as first-line antihypertensive agent neither in older adults nor in younger patients. In the management of BPH alpha-1 antagonists promise to effectively relieve urinary symptoms with uncertainty regarding their efficacy in preventing long-term progression events.

Modelling differences in reproductive effort between iteroparous and semelparous reproductive strategies in Bromeliaceae

Abstract Quantifying reproductive effort (RE), the trade-off between devoting resources to reproduction versus individual growth, in plants presents a number of challenges. Of particular interest is comparing RE between reproductive strategies, such as those in Bromeliaceae: semelparous, where individuals undergo a one-time and subsequently lethal sexual reproductive event, versus iteroparous, where individuals reproduce sexually multiple times by producing clonal offshoots called pups. We introduce a dynamic model of vegetative and reproductive growth in long-lived Bromeliaceae rosettes accounting for the allocation of resources over developmental time. We compare multiple definitions of RE in semelparous and iteroparous Bromeliaceae at critical times during development and over the entire reproductive life of the individual. While others have posited that semelparous taxa exhibit higher RE than comparable iteroparous taxa, our results indicate that this will only occur in limited circumstances: when RE is calculated over the lifespan of a rosette started from seed, semelparous RE is greater when pup mass is accounted for as if it were purely vegetative; or when RE is calculated over the lifespan of the genetic individual, semelparous RE is greater when the ratio of vegetative to inflorescence mass in each pup is greater than that of the originating rosette started from seed.

Emotional Reactions to High-Risk Sex among Sexual Minority Men: Exploring Potential Opportunities for Just-In-Time Intervention

ABSTRACT Rates of HIV and other sexually transmitted infections (STIs) are high among sexual minority men (SMM). A large body of research has explored determinants of HIV/STI risk behavior, but few studies have explored emotional consequences of these events. Understanding the valence, timing, and strength of emotional reactions to sexual risk could inform use of specific behavior change techniques in interventions (such as anticipated regret) and identify new opportunities for intervention, including just-in-time interventions. We analyzed data from an ecological momentary assessment (EMA) study of 100 HIV-negative/unknown-status SMM to understand patterns of positive affect, negative affect, shame, and stress in the 24 hours after sex. Mixed-effects models showed that the probability of negative affect was higher in the hours following condomless anal sex (CAS) with high-risk partners during which SMM reported being under the influence of alcohol or drugs (A/D involved CAS), versus all other types of sex events (OR = 0.92, SE = 0.03, p = .017). The probability of shame was also higher after A/D-involved CAS, versus other sex events (OR = 1.14, SE = 0.07, p = .035). Findings suggest that the hours following A/D-involved CAS events may be an opportune time to intervene to help SMM avoid similarly aversive experiences in the future.

Parental guardianship and online sexual grooming of teenagers: A honeypot experiment

Although previous research has examined the association between the absence of guardianship and online sexual grooming victimization, no previous study has examined the impact of parental supervision on the progression of an online grooming event. To address this empirical gap, we designed three honeypot chat bots that simulated young female users on online chatrooms and deployed them on a list of 21 popular chatrooms commonly accessed by youth and online groomers from all around the world. The first chat bot was designed to convey an active guardianship style to a grooming suspect (treatment 1), the second chat bot was designed to convey a passive style of parental guardianship, and the third chat bot was designed to convey no guardianship (control group). The chat bots were deployed over a period of 2.5 months. Findings indicate that online unstructured socializing with peers in the absence of parental supervision increased online groomers’ likelihood to persist in an online sexual grooming event. In contrast, online groomers were less likely to continue their online grooming once believing their targets were communicating online in the presence of parental guardianship (both passive and active).

Transgressive Behavior in Dutch Youth Sport

The current article reports on the second large-scale prevalence study on transgressive behavior in sport in the Netherlands, and is a follow up of an earlier, comparable prevalence study in 2015. Using a dedicated and customized online questionnaire, approximately 4000 adults who met the inclusion criteria (18 to 50 years old and have played sports in an organized context during childhood in the Netherlands) were surveyed with respect to their experiences of childhood psychological, physical, and sexual transgressive behavior while playing sports. The survey showed that 71.7% experienced some form of transgressive behavior as a child, in which 48.6% of these events also made an impact (in other words, was significant at the time it took place). The degree of impact the event made is also related to the severity of the event. Severe emotional transgression events occurred in 22% of the youth athletes, severe physical assault events in 12.7%, and severe sexual assault events occurred in 6.9% of the youth athletes. Disabled athletes, and those competing at national and international levels, report more experiences of transgressive behavior in sport. The results are consistent with former research and indicate the need for structural attention to create a safe sports climate.

Flibanserin Improves Libido In Women with Breast Cancer

ABSTRACT Introduction Sexual dysfunction is reported during and after breast cancer treatment and causes a substantial distress on women. Breast cancer and its treatment can cause decreased libido and there are currently no FDA approved medications for the treatment of disease and/or medication induced hyposexual desire disorder (HSDD). This study evaluates the use of flibanserin in breast cancer patients on endocrine therapy who are experiencing decreased libido. Objective The primary endpoint of this study is to evaluate the feasibility of flibanserin for 24 weeks in women with breast cancer on endocrine therapy. Secondary endpoints include efficacy of flibanserin as measured by the number of satisfying sexual events (SSE) per month, change in desire, change in sexual function, QoL and distress from sexual function. These outcomes are measured using a pill diary and these validated instruments: Female Sexual Function Index (FSFI) both desire and total scores, Female Sexual Distress Scale (FSDS-R), and Patient-reported Outcomes Measurement Information System Sexual Function Instrument (PROMIS-SF). Methods Twenty women with stage 0-III ER+ breast cancer on endocrine therapy for at least three months were enrolled from both an academic center and an alliance community site on a prospective, longitudinal pilot IRB-approved trial to evaluate the feasibility and efficacy of flibanserin in women with breast cancer on endocrine therapy. All patients met criteria for the diagnosis of HSDD as defined by the DSM-IV and ISSWSH consensus paper. Patients took flibanserin 100mg po at bedtime for 24 weeks and were followed for 52 weeks. Patients were monitored closely with medical exams including vital signs and completed questionnaires at baseline, weeks 4, 8, 16, 24 and 52. Given the small sample size, descriptive, graphical, and nonparametric paired tests for pairwise comparisons of a measure were performed. Results This study met its pre-defined feasibility end point. We found more than 70% of the study patients were able to complete 24 weeks of flibanserin therapy and took greater than 80% of planned doses of flibanserin as documented in their medication diary. Three patients dropped out of the study within 14 days of starting the medication due to adverse side effects. Our study also found patients subjectively reported improved libido through PROs and SSEs. The baseline mean FSFI total score was 13.3 with a desire score of 1.96 and improved to a total score of 19.4 and desire score of 3.3 by 8 weeks on flibanserin. All study participants except one reported 0 sexually satisfying events per month at baseline and this increased to 2.2 per month after 8 weeks of treatment. Patient distress also decreased from 32 to 25 on the FSDS-R and 3.33 to 2.86 on the distress thermometer at 8 weeks. Conclusions It is feasible for women with breast cancer on endocrine therapy with HSDD to take flibanserin for 24 weeks. The majority of women reported efficacy from the medication with increased libido as measured by the FSFI, increased SSEs and decreased distress. Flibanserin improved patients’ overall sexual functioning. A larger randomized placebo-controlled study is still needed to further evaluate flibanserin in women with breast cancer. Disclosure Yes, this is sponsored by industry/sponsor: The study is funded by a research grant through Sprout Pharmaceuticals Inc Clarification Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Consulting and Advisory Boards for NanOlogy, Spectrum Pharmaceuticals Inc, Sermonix Pharmaceuticals LLC, Procter & Gamble and Paxman Coolers Limited

Patient reporting of sexual adverse events on an online platform for medication experiences.

For >300 drugs, sexual side effects are included in the drug information leaflet. As sexual adverse events (sAEs) may be more easily shared at online medication platforms, patient-reported drug experiences may add to the current knowledge on sAE experiences. This study evaluated patient reports from the online platform mijnmedicijn.nl for the frequency of sAE reporting, sex differences concerning sAEs and to assess drugs with disproportional sAE reporting. On the online platform, terms for sAEs as used by patients were collected with a poll. Subsequently, drug reports posted between 2008 and 2020 were searched for sAEs with the identified terms. From the retrieved reports, the sAE frequencies and complaints and reporting odds ratios (ROR) were calculated, stratified for sex and drug (class). sAE reporting was considered disproportional frequent if the lower 95% confidence interval bound of the ROR >2.0. For 189 drugs, sAEs were identified in 2408 reports (3.9%). Women posted 1383 reports (3.5% of all female reports) and men 1025 (4.7%). Almost half of the sAE reports addressed antidepressants: 586 reports of women (ROR 4.2; 95%CI 3.8-4.7) and 510 reports of men (ROR 7.5; 95%CI 6.6-8.5). Disproportional high numbers of sAE reports were found for 27 drugs, mostly antidepressants, hormonal contraceptives and drugs used in benign prostatic hyperplasia. Of these drugs with frequent sAEs, 7 had low sAE risks in their professional drug information. One in 25 drug reports on mijnmedicijn.nl included sAEs. The sAEs were reported frequently for antidepressants, contraceptives and drugs used in benign prostatic hyperplasia.

The Risks and Benefits of Being “Early to Bed": Toward a Broader Understanding of Age at Sexual Debut and Sexual Health in Adulthood

BackgroundA younger age at sexual intercourse has frequently been linked to adverse sexual health outcomes. Yet, little is known about its associations with healthy sexual function, and less still about the timing of pre-coital sexual debuts and adult sexual health. AimWe examined associations between an earlier sexual debut and subsequent sexual health, using broad operationalizations of each that capture pre-coital experiences and positive outcomes. Connections to sexual health risk and healthy sexual function were assessed through the lens of the dual-control model of sexual response. MethodsData on age at first sexual intercourse, first sexual contact, first sexual stimulation, and first orgasm, as well as sexual health risk and healthy sexual function were gathered from 3,139 adults. OutcomesAdverse sexual events (reproductive illness, infection, or injury affecting sexual activity; pregnancy termination and/or loss; non-volitional sex) and current sexual difficulties (Female [FSFI] and/or Male Sexual Function Index [MSFI] scores; Sexual Excitation and/or Sexual Inhibition Inventory for Women and Men [SESII-W/M] scores). ResultsWhen defined narrowly as first sexual intercourse, earlier sexual debut was associated with adverse sexual events, including non-volitional sex, pregnancy termination and/or loss, and reproductive illness, infection, or injury affecting sexual activity. However, it was also related to healthier sexual function, including less pain during vaginal penetration, better orgasmic functioning, and lower sexual inhibition. When sexual debut was broadened to include pre-coital experiences, earlier sexual contact, like earlier sexual intercourse, was associated with non-volitional sex. However, earlier sexual stimulation and orgasm were unrelated to adverse outcomes. Rather, these related to fewer sexual desire difficulties, and greater sexual excitation. Exploratory mediation analyses revealed later sexual intercourse and orgasm were connected to sexual difficulties through higher sexual inhibition and lower sexual excitation, respectively. Clinical ImplicationsWhen sexual functioning is impaired, delay of both coital and noncoital debuts may warrant assessment, and sexual excitation and inhibition may be targets for intervention. To facilitate healthy sexual development of young people, non-coital debuts with and without a partner may warrant inclusion in risk management and health promotion strategies, respectively. Strengths & LimitationsAlthough this research operationalized sexual debut and sexual health broadly, and examined associations between them, it is limited by its cross-sectional retrospective design and non-clinical convenience sample. ConclusionFrom a risk-based perspective, earlier sexual intercourse is adversely related to sexual health. Yet, it is also associated with healthy sexual function. Indeed, earlier sexual initiation may confer more benefits than risks when sexual debuts beyond intercourse are considered.Peragine DE, Skorska MN, Maxwell JA, et al. The Risks and Benefits of Being “Early to Bed”: Toward a Broader Understanding of Age at Sexual Debut and Sexual Health in Adulthood. J Sex Med 2022;19:1343–1358.

Mesotherapy With Dutasteride for Androgenetic Alopecia: A Retrospective Study in Real Clinical Practice.

5-alpha inhibitors are an effective treatment for androgenetic alopecia. Mesotherapy with dutasteride has been proposed as an effective method to improve hair loss and reducing systemic absorption. The main objective was to describe the safety profile of mesotherapy with dutasteride in real clinical practice in a large cohort of patients with androgenetic alopecia. A secondary aim was to describe the effectiveness of this treatment. A multicentric retrospective study was designed. Patients treated with at least 6 months of follow-up were included in the study. Side effects and response to the treatment were analyzed. A total of 541 patients were included. The commonest approach during the first year was to perform the treatment every 3 months. Response to the mesotherapy in monotherapy could be assessed in 86 patients (15.9%) after one year. Most of them presented clinical improvement, being a marked improvement in 33 patients (38.4%). Pain was the most frequent side effect of the treatment (246 patients, 45.5%). No serious or sexual adverse events were detected. Mesotherapy with dutasteride was effective in male and female hair loss in real clinical practice. Side effects related to the treatment were mild and self-limited. This therapy may be an effective option for select patients wishing to avoid oral treatment. J Drugs Dermatol. 2022;21(7):742-747. doi:10.36849/JDD.6610.

Switching to Non-daily Pre-exposure Prophylaxis Among Gay and Bisexual Men in Australia: Implications for Improving Knowledge, Safety, and Uptake

IntroductionPreexposure prophylaxis (PrEP) dosing options such as event-driven PrEP hold promise to increase PrEP uptake among gay, bisexual, and queer men (GBQM), but their impacts have not yet been realized and uptake by GBQM suitable for PrEP remains slow in countries where it is only considered an alternative option to daily PrEP.MethodsWe conducted semi-structured interviews between June 2020 and February 2021 with 40 GBQM in Australia to understand PrEP dosing behaviors, knowledge, and preferences.ResultsAll participants commenced PrEP daily; 35% had ever switched to non-daily PrEP, mostly taking it event-driven. GBQM who preferred non-daily PrEP had infrequent or predictable sex, were concerned about cost given infrequency of sex, and/or wanted to minimize unnecessary drug exposure. Accurate knowledge of event-driven PrEP was poor. However, reflecting concepts underpinning critical pedagogy, having accurate knowledge was supported by access to consistent messaging across clinical, social, community, and public settings. Several participants who switched to event-driven PrEP had condomless sex events in which they were unable to adhere to pills due to unanticipated sex.Conclusions and Policy ImplicationsImplementation of comprehensive and consistent education about correct dosing for event-driven PrEP across multiple settings is needed to ensure increased uptake and safe use. GBQM require messaging about non-condom based HIV prevention strategies when they cannot access daily or event-driven PrEP.

Sex-Specific Differences in Clinical Outcomes After Percutaneous Coronary Intervention: Insights from the TAILOR-PCI Trial.

BackgroundTAILOR‐PCI (Tailored Antiplatelet Initiation to Lessen Outcomes due to decreased Clopidogrel Response After Percutaneous Coronary Intervention) studied genotype‐guided selection of antiplatelet therapy after percutaneous coronary intervention versus conventional therapy with clopidogrel. The presence of CYP2C19 loss‐of‐function alleles in patients treated with clopidogrel may be associated with increased risk for ischemic events. We report a prespecified sex‐specific analysis of genotyping and associated cardiovascular outcomes from this study.Methods and ResultsAssociations between sex and major adverse cardiac events (MACE: cardiovascular death, myocardial infarction, stroke, stent thrombosis, and severe recurrent ischemia) and Bleeding Academic Research Consortium (BARC) bleeding at 12 months were analyzed using Cox proportional‐hazards models. Among 5276 randomized patients, loss‐of‐function carriers were observed in ≈36% of both sexes, and >80% of carriers were heterozygotes. At 12 months, after adjustment for baseline differences, risks of MACE (HR , 1.28 [0.97 to 1.68]; P=0.088) and BARC bleeding (hazard ratio [HR], 1.36 [0.91 to 2.05]; P=0.14) were comparable among women and men. There were no significant interactions between sex and treatment strategy for MACE interaction P value (Pint =0.59) or BARC bleeding (P int=0.47) nor for sex and genotype (MACE P int=0.15, and BARC bleeding P int=0.60).Conclusions CYP2C19 loss‐of‐function alleles were present in ≈1 in 3 women and men. Women had similar adjusted risks of MACE and bleeding as men following percutaneous coronary intervention. Genotype‐guided therapy did not significantly reduce the risk of MACE or bleeding relative to conventional therapy for both sexes.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT01742117.

Abstracts 8th PCNE working symposium ‘Navigating research on pharmaceutical care’. 11–12 February 2022, Lisbon, Portugal

Abstracts 8th PCNE working symposium ‘Navigating research on pharmaceutical care’. 11–12 February 2022, Lisbon, Portugal

The Influence of Surgeon Sex on Adverse Events Following Primary Total Hip Arthroplasty: A Register-Based Study of 11,993 Procedures and 200 Surgeons in Swedish Public Hospitals.

Stereotypes may prevail, but little is known about the influence that the sex of an orthopaedic surgeon may have on outcomes. In a recently published study, there were no differences in the rate of adverse events following total hip arthroplasties (THAs) performed by female or male orthopaedic surgeons. The objective of the present study was to investigate whether there was any difference in adverse events within 90 days following a primary THA performed by either a male or female surgeon in Sweden. A retrospective study was performed to evaluate primary THAs performed for osteoarthritis between 2008 and 2016 at 10 hospitals in western Sweden. Local hospital data were linked with the Swedish Hip Arthroplasty Register (SHAR) and with a regional patient register. Data collected from local hospitals and the SHAR included surgeon-related information (e.g., sex, annual volume, and level of training) and patient-related information (e.g., age, sex, and Elixhauser comorbidity index). Adverse events were retrieved from the regional patient register. The definition of adverse events followed the SHAR definition of adverse events. Mixed models were used to investigate the impact of surgeon sex on adverse events. A total of 11,993 primary THAs were performed by 200 surgeons, of whom 17.5% were women. The proportions of adverse events within 90 days were similar for female (6%) and male (7%) surgeons. No association was found between surgeon sex and adverse events (adjusted odds ratio, 0.72; 95% confidence interval, 0.52 to 1.00) when all surgeons (both attendings and residents) were included in the analysis. A sensitivity analysis that included attendings only yielded similar results (adjusted odds ratio, 0.88; 95% confidence interval, 0.60 to 1.29). Despite a small tendency toward lower rates of adverse events at 90 days after THAs performed by female surgeons, there was no significant association between surgeon sex and the risk of adverse events following THA. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort study

The association between cortisol secretion and mortality in patients with adrenal incidentalomas is controversial. We aimed to assess all-cause mortality, prevalence of comorbidities, and occurrence of cardiovascular events in uniformly stratified patients with adrenal incidentalomas and cortisol autonomy (defined as non-suppressible serum cortisol on dexamethasone suppression testing). We conducted an international, retrospective, cohort study (NAPACA Outcome) at 30 centres in 16 countries. Eligible patients were aged 18 years or older with an adrenal incidentaloma (diameter ≥1 cm) detected between Jan 1, 1996, and Dec 31, 2015, and availability of a 1 mg dexamethasone suppression test result from the time of the initial diagnosis. Patients with clinically apparent hormone excess, active malignancy, or follow-up of less than 36 months were excluded. Patients were stratified according to the 0800-0900 h serum cortisol values after an overnight 1 mg dexamethasone suppression test; less than 50 nmol/L was classed as non-functioning adenoma, 50-138 nmol/L as possible autonomous cortisol secretion, and greater than 138 nmol/L as autonomous cortisol secretion. The primary endpoint was all-cause mortality. Secondary endpoints were the prevalence of cardiometabolic comorbidities, cardiovascular events, and cause-specific mortality. The primary and secondary endpoints were assessed in all study participants. Of 4374 potentially eligible patients, 3656 (2089 [57·1%] with non-functioning adenoma, 1320 [36·1%] with possible autonomous cortisol secretion, and 247 [6·8%] with autonomous cortisol secretion) were included in the study cohort for mortality analysis (2350 [64·3%] women and 1306 [35·7%] men; median age 61 years [IQR 53-68]; median follow-up 7·0 years [IQR 4·7-10·2]). During follow-up, 352 (9·6%) patients died. All-cause mortality (adjusted for age, sex, comorbidities, and previous cardiovascular events) was significantly increased in patients with possible autonomous cortisol secretion (HR 1·52, 95% CI 1·19-1·94) and autonomous cortisol secretion (1·77, 1·20-2·62) compared with patients with non-functioning adenoma. In women younger than 65 years, autonomous cortisol secretion was associated with higher all-cause mortality than non-functioning adenoma (HR 4·39, 95% CI 1·93-9·96), although this was not observed in men. Cardiometabolic comorbidities were significantly less frequent with non-functioning adenoma than with possible autonomous cortisol secretion and autonomous cortisol secretion (hypertension occurred in 1186 [58·6%] of 2024 patients with non-functioning adenoma, 944 [74·0%] of 1275 with possible autonomous cortisol secretion, and 179 [75·2%] of 238 with autonomous cortisol secretion; dyslipidaemia occurred in 724 [36·2%] of 1999 patients, 547 [43·8%] of 1250, and 123 [51·9%] of 237; and any diabetes occurred in 365 [18·2%] of 2002, 288 [23·0%] of 1250, and 62 [26·7%] of 232; all p values <0·001). Cortisol autonomy is associated with increased all-cause mortality, particularly in women younger than 65 years. However, until results from randomised interventional trials are available, a conservative therapeutic approach seems to be justified in most patients with adrenal incidentaloma. Deutsche Forschungsgemeinschaft, Associazione Italiana per la Ricerca sul Cancro, Università di Torino.

The beneficial effect of short-term multimodal physiological therapy on female provoked vulvodynia: A pilot study

ABSTRACT Introduction Vulvodynia is a subset of the genito-pelvic/penetration disorder and is currently defined by chronic pain in the vulva area of at least 3-6 months duration. It affects 8-10% of women of all ages. According to 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of vulvodynia, it can be divided into provoked (e.g., insertional, contact), spontaneous or mixed type. Although the etiology remains an enigma, peripheral neurologic mechanism has recently been identified as a factor. Objective The aim of this trial was to evaluate the effectiveness of short-term physical therapy in women with vulvodynia. Methods Women with intolerable vulvodynia were included in the study from Jan to May 2021. Medical screen including cotton-tipped testing and pelvic examination were performed by one gynecologist. After informed consent obtained, women lied down with cross-legged receiving once treatment per 1-2 weeks until completely pain relief achieved. Treatment consisted of a multimodal approach including lidocaine gel 20mins, capsaicin gel 20mins and TENS (Transcutaneous electrical nerve stimulator) 30 mins. TENS was administered through skin probes via a dual channel NeuroTrac device. A set of double electrode patches were placed on the dermatome of unilateral side of pain: channel A constant 80Hz, and channel B burst of 9 pulses 150Hz, 175 µS pulse duration and the intensity at the maximal level that patient could tolerate. At the completion, all women were followed for 3-6 months to assess efficacy, satisfying sexual events (SSE) in 4weeks, adverse events and recurrence. Results Ten women were diagnosed with provoked (n=8) or spontaneous vulvodynia (n=2) (primary 60% and secondary 40%). The average age was 34.1 years (range= 25-50) with an average duration of vulvodynia of 50.0 months (range= 4-276). 50% of women reported tolerating intercourse sometimes, 40% never did, and one was virgin. 37.5% (n=3) underwent one treatment session, and 62.5% (n=5) two sessions to achieve completely pain relief. At the completion of one week, 100% of provoked type women reported moderate or high improvement on vulvodynia region. Those reported improvement in the frequency of SSE within 4 weeks after treatment completion (62.5% sometimes, 25% often and one didn't restart intercourse). However, both of spontaneous type women failed to treatment and were suggested a referral for nerve blocking. After 4.4-24.3 weeks follow-up, 25% of provoked group reported no recurrence, 62.5% mild recurrence, and 12.5% (n=1) moderate recurrence. Only minor adverse events occurred. 90% reported mild to moderate vulva irritation immediately after treatment, which were completely resolved after bath. Only one spontaneous type reported vulva swelling and moderate irritation for one week. 100% of participants were willing to receive treatment in the next time. Conclusions A short-term multimodal physiological therapy including lidocaine, capsaicin and TENS enabled women with provoked vulvodynia to achieve rapid pain relief, moderate or high improvement in sexual encounters and the efficacy is seemed to last long. The tolerability and safety were high. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Youren clinic).

Self-reported mental health in adolescents attending school and its association with later school dropout: A prospective 2.5-year follow-up study.

Mental health problems in young people are associated with educational outcomes. There are persistent difficulties in screening for these problems and mapping the trajectories of mental health in relation to academic and work outcomes. We investigated whether Strength and Difficulties Questionnaire (SDQ) scores in adolescents attending school were associated with school dropout in upper secondary school, both in adolescents with already recognised mental disorders and adolescents without known mental disorders. The data consisted of a questionnaire targeting 13,100 adolescents attending the final year of compulsory school combined with data derived from a national register. SDQ scores were divided into normal, borderline and abnormal scores. School dropout in upper secondary school was identified during a 2.5-years follow-up period. We stratified the data by recognised mental disorders. Logistic regression was performed to examine the association between SDQ scores and later school dropout with adjustment for parents' mental disorders, parents' educational level, sex, suicidal thoughts, school absence and negative childhood events. During follow-up, 18.5% of adolescents experienced school dropout. Adolescents with abnormally high SDQ scores and borderline SDQ scores had higher odds for school dropout than adolescents with SDQ scores in the normal range. The association remained in the adjusted analysis, although more covariates showed independent contributions in association with school dropout. Self-reported SDQ scores in adolescents attending school were associated with later school dropout irrespective of recognised mental disorders, indicating that markers such as the SDQ might contribute to the identification of vulnerable adolescent groups, although the findings of multifactorial contributions suggest we should consider more indicators in a risk assessment for school dropout.

Increased Risk for Sexual Violence Victimization on Drinking Days Involving Pregaming

ABSTRACT Alcohol consumption has been associated with increased risk for sexual violence victimization and perpetration. Pregaming, a popular activity among college students that involves heavy and quick drinking prior to going out for the night and often results in high blood alcohol levels (BALs), may convey increased risk for sexual violence – potentially due to greater likelihood of contact with intoxicated perpetrators and significantly impaired victim ability to consent or resist. Yet no published work has evaluated whether there is increased risk for victimization on drinking days that involve pregaming. Using a sample of 390 college student drinkers who completed a past 30-day Timeline Followback, we examined heavy drinking behavior, estimated BALs, and experience of sexual violence victimization during 1,899 drinking days, of which 30% involved pregaming. After controlling for demographics, we found that participants drank approximately two more drinks and reached significantly higher BALs on drinking days where they pregamed as compared to drinking days where they did not pregame. Nearly 6% of drinking days that included pregaming involved sexual violence victimization, compared to about 2% of drinking days where pregaming did not occur. Participants were at 2.71 times the odds of experiencing sexual violence, primarily unwelcomed comments and nonconsensual sexual touching, during drinking days with pregaming. This study represents a first step toward greater understanding of the sexual violence and pregaming link, but future research assessing perpetrator behavior and context-specific factors (e.g., amount consumed by victims and perpetrators, location of sexual violent events and peers present) are needed.

Sexual Activities and Changes in Condom Use in Group Sex Events Among Female Sex Workers in Melbourne, Australia.

BackgroundThere are few studies investigating group sex among female sex workers (FSWs). This study aimed to examine the typical number of group sex participants, sexual activities and condom use in group sex among FSWs attending a sexual health clinic in Melbourne, Australia.MethodsWe conducted a cross-sectional survey between May 1, 2019 and March 13, 2020 among FSWs in Melbourne. Participants were asked whether they had participated in group sex (sex involving more than two participants) within the past 3 months, the size of the most recent group sex event, sexual activities they engaged in and condom use. It is unknown whether this was a paid or unpaid event in our study.ResultsOf the 247 FSWs surveyed, the mean age was 28.9 years and 51.8% were born in Australia. More than a quarter (27.5%, n = 68) had had group sex in the past 3 months with the number of events ranging from 1 to 10 times. The median size of the group was 3 participants with one man and two women (including the FSW) being the most common combination. Kissing was the most common activity in group sex. Of 58 FSWs who had vaginal sex during group sex, 77.3% (51/58) reported their male partners always used condoms but 13.7% (7/51) of these did not change condoms between women.ConclusionThis study finds that group sex is common among FSWs. Although condoms are always used during group sex, one in six men did not change their condoms between partners, which may increase STI transmission between partners.