Sexual Activity Research Articles

6953 Bridging the Gender Gap: Sexually Dimorphic Brain Responses in Distressing Low Sexual Desire

Abstract Disclosure: J. Tsoutsouki: None. N. Ertl: None. E.G. Mills: None. M.B. Wall: None. L. Thurston: None. L. Yang: None. S. Suladze: None. T. Hunjan: None. M. Phylactou: None. B. Patel: None. J. Howard: None. A. Abbara: None. D. Golmeier: None. A.N. Comninos: None. W.S. Dhillo: None. Background: Distressing low sexual desire, termed Hypoactive Sexual Desire Disorder (HSDD), affects 10% of women and 8% of men. The established ‘top-down’ neurofunctional model of HSDD in women suggests that in response to erotic cues, excessive activation of higher-level cognitive brain regions (involved in introspection/self-monitoring) suppresses lower-level sexual brain centres, thereby impeding normal sexual function. By contrast, the neurodysfunction in men with HSDD remains to be fully characterised and crucially unlike in women, there are currently no licensed therapies. Herein, we report the first direct comparison of the neural bases of HSDD in women and men. Methods: 32 premenopausal women with HSDD [mean age±SD (y) 29.2±6.7] and 32 men with HSDD [age 37.9±8.6] underwent a task-based functional MRI (fMRI) measuring sexual brain activity during erotic versus control (exercise) videos. Participants completed psychometric questionnaires before and after the fMRI scan, providing functional relevance for the brain activity changes. Results: Women displayed significantly greater activation in higher-level cortical regions (e.g. inferior frontal gyrus, superior frontal gyrus) and lower-level limbic brain regions (e.g. amygdala, striatum, thalamus) in response to erotic videos, compared to the men. Lower activation in lower-limbic sexual regions in women correlated with more severe HSDD, which along with a hyperactivation in the inferior-frontal gyrus relative to the men, supports the ‘top-down’ mechanism underlying HSDD in women. By contrast, men exhibited lower activation in both higher-cortical and lower-limbic regions, but greater activation than the women in the visual cortex in response to erotic videos. Hence, a heightened sensitivity to visual erotic cues in men might not be effectively relayed to the limbic system. In women only, hypothalamic hyperactivation in response to erotic videos correlated with ‘increased heartbeat’ (r=0.5, P=0.001), and ‘tingling all over’ (r=0.6, P<0.001), while higher striatal activation correlated with feeling more ‘stimulated’ (r=0.4, P=0.001) and ‘genital tingling’ (r=0.6, P<0.001) on the psychometric questionnaires. Crucially, these findings were specific to erotic stimuli as no differences were identified in the control comparison (exercise>baseline contrast). Discussion: This is the first study to directly compare the neural bases of distressing low sexual desire in women and men. While supporting the ‘top-down’ mechanism of HSDD in women, it suggests a different neurodysfunctional process in men with HSDD, highlighting a potential functional disconnection between sensory/attention and sexual centres. Our findings have key clinical implications as they identify a sexual dimorphism in the neural bases of low sexual desire relevant to the escalating development of therapeutics for patients with HSDD. Presentation: 6/3/2024

6942 Should there be a consensus statement about managing Inguinal Hernia In females? A Case of Delayed Diagnosis in Complete Androgen Insensitivity Syndrome (CAIS)

Abstract Disclosure: S. Echetebu: None. Introduction: Androgen Insensitivity Syndrome is usually due to a missense mutation that encodes part of the androgen receptor. More than 50% of females with CAIS present with inguinal hernias (4:1 female to male ratio). Previous CAIS studies have estimated the incidence of CAIS to be 0.8% to 2.4% in girls with inguinal hernias. 90% of the girls with CAIS will undergo inguinal hernia repair during childhood. The prevalence of germ cell tumors is estimated as 0.8% therefore, post-pubertal gonadectomy is now the recommended therapy for individuals with CAIS. Clinical Case: We present a case of a 15-year-old patient with primary amenorrhea who underwent bilateral inguinal hernia repair at the age of 5 weeks and was raised as a female. Initial ultrasound imaging at the age of 14 years revealed an absent uterus and complex hemorrhagic cysts of the ovaries. Further laboratory results revealed 46 XY chromosomal analysis, confirming her diagnosis of CAIS. Her laboratory values are: FSH 6.0 mIU/ml (1.0 to 18.6), Prolactin 15.6 ng/mL (<25), 17OHProgesterone 49 ng/dl (<265), Estradiol 30 pg/ml (<47), LH 17 mIU/ml (0.4 -11.7), Anti Mullerian Hormone 368 ng/ml (<13), Testosterone 629 ng/dl (<55 ). Upon our review of her past medical records from a different hospital, the operation note reports that her gonads resembled testes. Gonads were relocated in the abdomen without follow-up or consultation with an endocrinologist. Upon receiving her new diagnosis, the patient experienced significant emotional distress. As a result, both the patient and her family received psychological counseling and were referred to a genetic counselor to assess any potential risks for her younger sister. There is currently no consensus on the management of females with inguinal hernias in the available literature. It is widely accepted to perform gonadectomy. Currently, researchers at NIH are conducting an observational study on the benefits of additional delays in gonadectomy. Although most surgeons are familiar with this condition, it would be beneficial for families and patients to have an early diagnosis and provide appropriate education regarding future sexual encounters and fertility concerns. Conclusion: We propose to initiate a consensus statement for pediatricians, surgeons, and endocrinologists to perform systematic genetic testing in females with inguinal hernia. Such testing may include either a buccal mucosal smear, karyotype, or skin biopsy in all females with inguinal hernias. If the family chooses to delay orchiectomy, it is recommended that during hernioplasty, the testes should be repositioned in a location that allows for easy monitoring using annual imaging. By adopting this methodology, we can increase awareness about the effects of diagnosis and foster discussions among healthcare professionals regarding suitable management options. Presentation: 6/3/2024

Viral genetics and transmission dynamics in the second wave of mpox outbreak in Portugal and forecasting public health scenarios

In 2023, a second wave of the global mpox epidemic, which is mainly affecting men who have sex with men (MSM), was observed in some countries. Herein, we benefited from a large viral sequence sampling (76/121; 63%) and vast epidemiological data to characterise the re-emergence and circulation of the Monkeypox virus (MPXV) in Portugal during 2023. We also modelled transmission and forecasted public health scenarios through a compartmental susceptible-exposed-infectious-recovered (SEIR) model. Our results suggest that the 2023 mpox wave in Portugal resulted from limited introduction(s) of MPXV belonging to C.1.1 sublineage, hypothetically from Asia, followed by sustained viral transmission and potential exportation to other countries. We estimated that the contribution of the MSM high sexual activity group to mpox transmission was 120 (95% CrI: 30-3553) times higher than that of the low sexual activity group. However, among the high sexual activity group, vaccinated individuals likely contributed approximately eight times less [0.123 (95% CrI: 0.068-0.208)] than the unvaccinated ones. Vaccination was also linked to potential reduced disease severity, with a Mpox Severity Score of 6.0 in the vaccinated group compared to 7.0 in unvaccinated individuals. Scenario analysis indicated that transmission is highly sensitive to sexual behaviour, projecting that a slight increase in the MSM sub-population with high sexual activity can trigger new mpox waves. This study strongly supports that continued vaccination, targeted awareness among risk groups and routine genomic epidemiology is needed to anticipate and respond to novel MPXV threats (e.g., global dissemination of clade I viruses).

Patterns of inconsistent condom use and risky sexual behaviors among female sex workers in Mozambique

BackgroundFemale sex workers (FSWs) in Mozambique face significant health risks, including high HIV prevalence, combination of factors, including inconsistent condom use, engagement in risky sexual behaviors, and various socio-ecological determinants of health. Understanding the determinants of these practices is crucial for developing targeted interventions.MethodsThis cross-sectional study analyzed data from the second round of Biobehavioral Survey (BBS) conducted from 2019 to 2020 in five urban areas to examine determinants of inconsistent condom use and risky sexual behaviors among FSWs. Modified Poisson regression models were used to assess the effect of various socio-demographic, economic, and behavioral factors on the outcomes, providing adjusted relative risk (aRR) with 95% confidence intervals (CI).ResultsAmong the 2,565 FSWs who reported inconsistent condom use, younger FSWs (15–24 years old, 29.1%), single (27.3%), with secondary or higher education (26.1%), nationals (25.9%), and residents of Tete City (30.5%) had a higher prevalence of inconsistent condom use. Initiating sex work < 18 years (31.0%), binge drinking (23.7%), and experiencing physical violence (29.0%) were significantly associated with this behavior. Among the 2,564 FSWs reporting risky sexual behaviors, a higher prevalence was observed in FSWs aged 15–24 (75.6%), those with secondary or higher education (75.8%), nationals (74.4%), and those residing in Quelimane (87.3%). Early sexual debut (< 15 years, 79.3%), initiating sex work before 18 years of age (77.7%), and illicit drug use (82.2%) were all associated with increased risky sexual practices. Inconsistent condom use among FSWs was significantly associated with residing in Tete (aRR = 2.4, 95% CI: 1.77–3.25), not being aware of female condom (aRR = 1.22, 95% CI: 1.03–1.45) and having experienced sexual a physical violence. Moreover, being married was significantly linked to risky sexual behavior among female sex workers (aRR = 1.27, 95% CI: 1.19–1.37), along with initiating sexual activity before age 15, having at least five years of sex work experience, engaging in binge drinking, and experiencing sexual and physical violence.ConclusionThe study highlights the complex set of factors as age, education, geographic location, years of sex work services, early sexual debut, and illicit drug use that influence sexual risks behavior among FSWs in Mozambique. Tailored interventions addressing not only sexual health education and services, but also economic empowerment and illicit drug use is imperative for mitigating these risks.

Chemsex and its impact on gay and bisexual men who have sex with men: Findings from an online survey in Belgium.

The study aimed to estimate the prevalence of sexualized drug use, or chemsex, in a wide group of gay, bisexual and other men who have sex with men (gbMSM) in Belgium. It examined which drugs gbMSM used before and during sex, the frequency with which they used it, whether they experienced non-consensual sex, and evaluated the impact of chemsex on the health and professional and social lives of respondents. We conducted an online survey among Belgian gbMSM. Five specific questions on chemsex were included in the survey. These questions assessed whether gbMSM engaged in chemsex. If they did, they were asked to provide information on which drugs they had used and how often. We asked whether their and their partners' boundaries had been respected and whether and how engaging in chemsex had affected a range of life domains. Of 836 respondents, 258 (30.9%) self-reported having had sex under the influence of substances ("chemsex") in the previous 6 months. Of these, 227 (88%) were considered chemsex users according to the definition used for the analysis. Poppers (73%), gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL; 69%) and cathinones (68%) were the most commonly reported substances. Almost half of respondents (45%) engaging in chemsex were high on drugs during at least half of their sexual encounters. Nearly 1 in 10 (9%) reported that boundaries had not been respected, suggesting non-consensual sexual activities. The 82 respondents experiencing negative impacts from their chemsex use reported that mental health (65%), physical health (40%) and sexual health (38%) were most impacted. Our findings provide a snapshot of the current chemsex situation in Belgium. The frequency of chemsex is concerning because several health, professional and social aspects are impacted. Almost 1 in 10 respondents using chemsex reported that chemsex impacted consent around sex, requiring additional efforts to eradicate these non-consensual sexual experiences. Therefore, larger scale research focusing on respected boundaries and consent during chemsex and the frequency of drug use for sex seems required. Additionally, sensitisation, as well as care and support programmes are critical.

Sexuality and Gender Issues in Autistic Youth: A Series of 6 Cases and a Literature Review

Autism Spectrum Disorder (ASD) involves challenges in social communication and repetitive behaviors, impacting daily functioning. Individuals with ASD face unique difficulties regarding sexuality, often experiencing mismatches between sexual development and social maturity, leading to potential inappropriate behaviors. Social competence deficits may limit their understanding of sexuality, increasing risks of offending or victimization. Gender differences in sexual behavior are evident, with males showing earlier and more frequent sexual activity, while females demonstrate greater flexibility in sexual orientation. This paper presents six clinical cases highlighting the diverse experiences of sexuality and gender identity in autistic individuals, offering insights into the complex interactions between ASD, gender, and sexual behavior.

Menopause and Sexual Life Amongst Older Men: A Review Study

Objectives: To determine factors affecting the quality of men’s sexual life during menopause and identify the existing challenges. Design: A review study. Setting(s): Older people living in public institutions and living in their own homes. Participants: Older adults over 60 years of age. Outcome measures: All factors affecting the quality of sexual life of postmenopausal men in old age have been investigated in three physical, psycho-emotional, and social domains. Results: In the physical field, factors such as age, general health, disease, exercise, impotence, erectile dysfunction, genital warts, surgery of total hip arthroplasty, surgery of prostate, cancer radiotherapy, alopecia, and disorder in ejaculation, urinary disorders, and physical rehabilitation were known factors affecting the quality of men’s sexual life. The impacts of factors such as sleep problems, stressors, self-image, depression, alcohol addiction, premature ejaculation, emotional divorce, marital satisfaction, and fear of sexual activity were confirmed in the psycho-emotional field of studies. In the social field, factors such as education, duration of the marriage, marital status, income, life partners, number of sexual relations with spouse, the presence of multiple sexual partners, body mass of spouse (female), sex education and health literacy, sexual awareness, and quality of life related to health were recognized to be effective. Conclusions: Promoting sexual awareness through educational programs, providing opportunities for frequent sexual relationships, and addressing physical, psychological, emotional, cognitive, and social factors, and andropause could contribute to a more desirable sexual life quality in men during andropause.

The relationship between body image and sexual satisfaction in women who have undergone hysterectomy.

This study aims to examine the relationship between body image and the level of sexual satisfaction in women who have undergone a hysterectomy. This descriptive study utilized a relational screening model. Conducted between June 2023 and March 2024, the study included a total of 300 sexually active women who had undergone a hysterectomy 6 months prior. Data were collected using a personal information form, the Golombok-Rust Sexual Satisfaction Scale, and the Body Image Scale through face-to-face interviews lasting approximately 20-30 min. The average age of the participating women was 44.4±10.55 years. Of the participants, 96.7% were married and 42.4% had entered menopause. The average score on the Body Image Scale was 81.2±3.8, and the average score on the Golombok-Rust Sexual Satisfaction Scale was 33.0±15.1. A positive significant relationship was found between body image and sexual satisfaction (p<0.05). There was also a statistically significant positive relationship between the total scores on the Body Image Scale and the Golombok-Rust Sexual Satisfaction Scale with age and frequency of sexual intercourse (p=0.049, p<0.001, p<0.001, p=0.047, and p=0.014). It was determined that as the age and frequency of sexual intercourse increased, the levels of body image and sexual satisfaction also increased. Our study found that women's self-image is negatively affected, and their level of sexual satisfaction decreases following a hysterectomy.

The effect of genital self-image on sexual satisfaction and stress in women after vaginal delivery.

Pregnancy, childbirth, and postpartum periods bring along biological, psychological, and social changes that could affect women's sexual health. The aim of this study was to evaluate the effect of genital self-image on sexual satisfaction and stress in women who had a vaginal delivery. This descriptive and cross-sectional study was conducted online between June and September 2023 by using snowball sampling and the data collection forms prepared in the GoogleDocs program. Women who had a normal vaginal delivery were included, were within 6 weeks to 1 year postpartum, were able to use at least one of the social media networks (e-mail, WhatsApp, Facebook, and Instagram), and volunteered to participate in the research. Data were collected through the Personal Information Form, the "Female Genital Self-Image Scale," the "Golombok-Rust Inventory of Sexual Satisfaction," and the "Female Sexual Distress Scale-Revised." The average age of the participating women was 30.54±5.83 years (n=235). The participants' mean scores were 18.94±2.92 for the Female Genital Self-Image Scale, 40.07±15.51 for the Golombok-Rust Inventory of Sexual Satisfaction, and 8.85±8.50 for the Female Sexual Distress Scale-Revised total. A statistically significant and negative relationship was found between Female Genital Self-Image Scale and Golombok-Rust Inventory of Sexual Satisfaction and Female Sexual Distress Scale-Revised total scores (r=-0.183, p<0.01; r=-0.387, p<0.01). Regression analysis (forward) was performed, and genital self-image was found to be the predictive factor affecting sexual satisfaction and stress. This study found that women had a medium level of genital self-image and sexual satisfaction and a low level of sexual distress.

Changes in sexual activity in young women during pregnancy

Objective: To conduct changes in sexual activity during pregnancy and its related factors in pregnant women. Methods: The present descriptive cross-sectional study was conducted in 2017 on pregnant women who referred to the women's clinic of Afzalipour Hospital in the southeast of Iran. Participants were included in the study through convenient sampling. The data collection tool was a researcher-made questionnaire consisting of two parts of personal social information of the couple and questions to measure the level of sexual activity and the attitude of the subjects during pregnancy compared to before pregnancy. Results: 201 Pregnant women were included. The average age of pregnant women was (27.3±6.1) years and their average gestational age was (24.7±11.8) years. More than 62% of women had decreased sexual activity. There was a significant relationship between the amount of changes in sexual activity and delivery time (P=0.013), abortion history (P=0.001) and premature birth history (P=0.002). Most pregnant women believed that sex during pregnancy caused damage to the fetus (67.7%). A decrease in the intensity of sexual desire was reported in 63% of pregnant women. More than 60% of the subjects did not consult with doctors and midwives with regards to sexual issues (63.5%). The most common reason for not consulting was not feeling the need (32%). Most women experienced back pain during (42.8%) and after (39.8%) intercourse. Conclusions: Changes in sex life during pregnancy are often caused by the lack of sexual knowledge and the increase in misconceptions among couples, which can affect the quality of relationships. The role of education is essential. Therefore, it is suggested that by including sexual counseling along with pregnancy care, wrong beliefs and information among women will be corrected.

Contraception Used by People Assigned Female at Birth With Spinal Cord Injury

ObjectivesThere is limited data on contraception used by people assigned female at birth with spinal cord injury (SCI). Pregnancy in people with SCI can be medically complex, therefore access to contraception to prevent unplanned pregnancies is imperative. This study aimed to assess the availability of contraception from health care providers (HCPs) to people with SCI and the contraception methods used. MethodsAn online international questionnaire was distributed. Demographic data and reproductive histories were recorded. Overall, 780 responses were received from participants in 33 different countries. Most participants lived in North America and self-identified as White. In total, 75% had a traumatic SCI. Most SCIs were at cervical and thoracic levels and American Spinal Injury Association-A and American Spinal Injury Association-B. Descriptive and χ2 statistics were used. ResultsThe recruitment rate was 85.4% and the completion rate was 73.8%. Overall, 93.6% of participants reported ever having been sexually active, while 60.7% reported sexual activity over the past year. Of people who were injured under the age of 50 years and who have been sexually active, 63.6% were offered birth control by an HCP. Condoms were used by 44.5% of participants, withdrawal by 20.1%, the combined oral contraceptive pill by 28.4% and intrauterine device by 20.1% of respondents. ConclusionsThis is the largest known study on SCI and contraception. Most people with SCI are sexually active. The withdrawal method and no contraception are used by many individuals, which may increase the risk of unplanned pregnancy. Increased use of highly effective contraception in this population may be achieved through HCP-initiated conversations about sexual health.

Mlambe economic and relationship-strengthening intervention for alcohol use decreases violence and improves relationship quality in couples living with HIV in Malawi

IntroductionA syndemic of unhealthy alcohol use, intimate partner violence (IPV), and economic insecurity threatens to derail progress towards UNAIDS 95-95-95 targets in sub-Saharan Africa. We developed a combined economic and relationship-strengthening intervention called Mlambe to reduce unhealthy alcohol use and increase adherence to antiretroviral therapy for couples in Malawi. This study evaluates the additional impact of Mlambe on IPV and relationship dynamics. MethodsIn a pilot randomized controlled trial, 78 married couples (156 individuals) living with HIV and reporting unhealthy alcohol use based on the AUDIT-C (at least one partner) were recruited from HIV care clinics in Zomba, Malawi. The intervention arm (39 couples) received a 10-month program consisting of incentivized savings accounts with financial literacy education, relationship education, and couples counseling sessions to build relationship skills. The control arm (39 couples) received enhanced usual care (EUC) with brief alcohol counseling. We used linear mixed-effects models to assess the effects of Mlambe on relationship quality (e.g., constructive communication, unity, sexual satisfaction) and IPV (physical, sexual, and emotional) by including fixed effects for treatment arm and a random effect for dyad, and tested whether effects on IPV and relationship quality differed by gender. ResultsAt 10- and 15-month follow-up visits, couples in the Mlambe arm showed greater increases in couple communication, unity, sexual satisfaction, intimacy, and trust (Cohen’s d ranged from 0.36 to 0.56; p<0.05) as compared to EUC. Couples in the Mlambe arm also showed significant decreases in physical and emotional IPV (Cohen’s d ranged from 0.33 to 0.49; p<0.05) as compared to EUC. Subsequent moderation analyses indicated that women reported significantly greater improvements in relationship quality than men, except for sexual satisfaction (p<0.05), and greater declines in physical IPV than men (p<0.05). ConclusionsMlambe resulted in significant improvements in relationship quality and decreased IPV in couples, particularly for women who as a group reported lower relationship quality at baseline. Economic and relationship-strengthening interventions have potential to disrupt harmful syndemics of violence, substance use, and poverty among couples living with HIV. Clinical Trial NumberNCT#04906616

Mpox outbreak among men who have sex with men in Kraków, Poland; June 2022-November 2022.

Mpox is a zoonotic disease caused by the mpox virus (MPXV). Sporadic cases reported before 2022 were almost universally linked to direct contact with animals or travel to endemic regions in Africa. However, in 2022, a significant shift occurred with human-to-human transmission, leading to a global outbreak in 117 countries. In Poland, 217 cases of mpox were reported. The aim of this study was to evaluate the epidemiology, clinical presentations, laboratory findings, and co-infections with sexually transmitted pathogens among patients with mpox. A retrospective analysis of all mpox cases diagnosed at the University Hospital in Kraków between June 2022 and November 2022 was performed. Forty-five patients aged 19-48 years (median age 34) were diagnosed with mpox. Most of them were male 44 (98%) and 42 (93%) identified themselves as men who have sex with men (MSM). Twenty-two (49%) of the patients had previously been diagnosed with HIV. During mpox diagnosis, new cases of sexually transmitted infections (STIs) were identified. Specifically, 4 patients (9%) were newly diagnosed with HIV, 5 with syphilis, 4 with Chlamydia trachomatis, 3 with Neisseria gonorrhoeae infection, and 2 with Ureaplasma urealyticum infection; among this group, 4 patients (33%) had more than one sexually transmitted co-infection. The mpox outbreak in Kraków in 2022 primarily affected MSM and was transmitted through sexual contact. Healthcare professionals should be aware of emerging STIs. Educational initiatives should emphasize the importance of vaccinations, safe sexual practices and regular testing.

Effects of doxycycline post-exposure prophylaxis for prevention of sexually transmitted infections on gonorrhoea prevalence and antimicrobial resistance among men who have sex with men in the USA: a modelling study

Doxycycline post-exposure prophylaxis (PEP) has been shown to be efficacious for the prevention of bacterial sexually transmitted infections, but resistance implications for Neisseria gonorrhoeae remain unknown. We aimed to use a mathematical model to investigate the anticipated impact of doxycycline PEP on the burden of gonorrhoea and antimicrobial resistance dynamics in men who have sex with men (MSM) in the USA. Using a deterministic compartmental model, characterising gonorrhoea transmission in a US MSM population comprising three sexual activity groups defined by annual partner turnover rates, we introduced doxycycline PEP at various uptake levels (10-90%) among those with high sexual activity. Infections were stratified by symptom status and resistance profile (ie, susceptible, ceftriaxone-resistant, tetracycline-resistant, or dual-resistant), with ceftriaxone the treatment for active infection. As resistance to tetracycline, not doxycycline, is monitored and reported nationally, we used this as a proxy for doxycycline PEP resistance. We compared the 20-year prevalence, incidence rates, and cumulative incidence of gonococcal infection, resistance dynamics (time to 5% prevalence of ceftriaxone resistance, 5% prevalence of dual resistance, and 84% prevalence of tetracycline resistance), and antibiotic consumption with baseline (ie, no doxycycline PEP). Uptake of doxycycline PEP resulted in substantial reductions in the prevalence and incidence of gonorrhoea, but accelerated the spread of tetracycline resistance. The maximum reduction in prevalence over 20years compared with no uptake ranged from 40·3% (IQR 15·3-83·4) with 10% doxycycline PEP uptake to 77·4% (68·4-84·9) with 90%uptake. Similarly, the maximum reduction in the incidence rate ranged from 38·6% (14·1-83·6) with 10% uptake to 77·6% (68·1-84·7) with 90% uptake. Cumulative gonococcal infections were reduced by a median of 14·5% (IQR8·4-21·6) with 10% uptake and up to 46·2% (26·5-59·9) with 90% uptake after 5years, and by 6·5% (3·4-13·0) with 10% uptake and 8·7% (4·3-36·2) with 90% uptake by 20years. In almost all scenarios explored, doxycycline PEP lost clinical effectiveness (defined as 84% prevalence of tetracycline resistance) within the 20-year period, but itslifespan ranged from a median of 12·1years (IQR 9·9-15·7) with 10% uptake to 1·6years (1·3-1·9) with 90%uptake. Doxycycline PEP implementation had minimal impact on extending the clinical lifespan of ceftriaxone monotherapy (5·0years [IQR 4·0-6·2]), with the median time to 5% prevalence of resistance ranging from 4·8years (3·9-6·0) for 90% uptake to 5·0years (4·1-6·2) for 10% uptake. Similarly, the median time to 5%prevalence of dual resistance to ceftriaxone and tetracycline ranged from 4·8years (3·9-6·0) for 90% uptake to 5·8years (4·8-7·4) for 10% uptake. Median decrease in ceftriaxone consumption for high doxycycline PEP uptake levels compared with baseline ranged from 41·7% (27·0-54·3) for 50% uptake to 50·2% (29·3-62·7) for 90% uptake at 5years, but dropped to 11·8% (6·9-32·0) for 50% uptake and 12·1% (7·0-41·6) for 90% uptake after 20years. Notwithstanding the clear benefits of doxycycline PEP for other sexually transmitted infections, for Ngonorrhoeae, model findings suggest that doxycycline PEP is an effective but impermanent solution for reducing infection burden, given eventual selection for resistant strains. This finding presents a challenge for policy makers considering strategies for doxycycline PEP implementation and oversight: the need to balance the clear, short-term clinical benefits with the risk of harm via antimicrobial resistance. US Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases.

Conceptions of Consensual versus Non-Consensual Sexual Activity among Young People from Colombia

Conceptions or ideas that couples hold about sexual consent could be a key factor in their communication, mutual respect, and the prevention of sexual violence. The multifaceted nature of sexual consent makes it a complex concept. The aim of the present study was to explore individuals’ ideas and understanding of sexual intercourse in two distinct contexts: consensual and non-consensual. We used a qualitative approach, adopting the methodology of thematic analysis. In total, 113 surveys obtained from the general population (76.1% women and 23.9% men aged 18 to 59 years) were studied. Two open-ended questions were asked about the general topic of sexual consent, where we distinguished sexual activity in which there is sexual consent vs. no consent. The phases of the thematic analysis approach were applied. For the consensual context, the following themes emerged: mutual reciprocity and respect; open, clear communication and agreements; and awareness and emotional well-being. For the non-consensual context, the following themes emerged: violence and sexual assault, absence and ambiguity of sexual consent, and lack of communication. All of these aspects should be considered in couples’ communication and sexual education to facilitate and improve sexual relationships and, in turn, prevent violence and sexual aggression.

Self-reported sexually transmitted infections and associated risk factors among female university students.

The spread of sexually transmitted infections (STIs) is an ongoing public health challenge, and awareness of risk factors is essential for designing effective preventive interventions. This study aimed to assess self-reported STI occurrences and identify risk factors and sexual behaviors associated with STIs among female university students. This is a cross-sectional, online questionnaire study, including 384 female university students seeking contraceptive counseling at a gynecology clinic in Uppsala, Sweden, and reporting having had sex. Associated risk factors and behaviors were assessed by comparing those who reported STIs and those who did not. The mean age of participants was 22.8 years. Seventy-eight (20%) had contracted at least one STI, with seven (9%) experiencing multiple infections. Seventy-three (94%) reported first-date sexual activity without a condom among STI experienced. Chlamydia trachomatis was the most common STI pathogen (68% of all infections), followed by Herpes simplex virus (18%) and Mycoplasma genitalium (13%). Behavioral factors associated with self-reported STIs were first-date sexual activity without a condom, not using condom at first intercourse, younger age at first intercourse, a higher number of sexual partners overall and in the last 12 months, experience of anal sex, dating app usage, and regretting sexual activity after substance use (P < 0.003 for all). Condom use was low among the respondents, and STIs were common regardless of the high level of education in this group. Contraceptive counseling needs to highlight the importance of condom use in addition to contraceptive efficacy. It is also essential to consider the specific risk factors and behaviors prevalent among young adults to reduce the spread of STIs.

Sexual Health and Quality of Life in Patients With Low-Risk Early-Stage Cervical Cancer: Results From GCIG/CCTG CX.5/SHAPE Trial Comparing Simple Versus Radical Hysterectomy.

Simple hysterectomy and pelvic node assessment (SHAPE) is a phase III randomized trial (ClinicalTrials.gov identifier: NCT01658930) reporting noninferiority of simple compared with radical hysterectomy for oncologic outcomes in low-risk cervical cancer. This study presents secondary outcomes of sexual health and quality of life (QOL) of the SHAPE trial. Participants were randomly assigned to receive either radical or simple hysterectomy. Sexual health was assessed up to 36 months postoperatively using the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised and QOL using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Cervical Cancer-Specific Module (QLQ-CX24) questionnaires. Among participants with at least one QOL measure, clinical and pathologic characteristics were balanced and with no differences in preoperative baseline scores for sexual health or QOL between groups. FSFI total score met the cutoff for dysfunction up to 6 months (P = .02) in the radical hysterectomy group. Group differences favored simple hysterectomy for FSFI subscales: desire and arousal at 3 months (P ≤ .001) and pain and lubrication up to 12 months (P ≤ .018). Both groups met the cutoff for sexual distress but was higher in radical hysterectomy at 3 months (P = .018). For QLQ-CX24, symptom experience was significantly better up to 24 months (P = .031) and body image better at 3, 24, and 36 months (P ≤ .01) for simple hysterectomy. Sexual-vaginal functioning was significantly better up to 24 months (P ≤ .022) and more sexual activity up to 36 months (P = .024) in the simple hysterectomy arm. Global health status was significantly higher at 36 months for simple hysterectomy (P = .025). Simple hysterectomy was associated with lower rates of sexual dysfunction than radical hysterectomy, with a lower proportion of women having sustained sexual-vaginal dysfunction. These results further support the benefit of surgical de-escalation for low-risk cervical cancer.

Is Degradation in the Eye of the Beholder (or the Researcher)?

When people raise concerns about pornography, they most often are focused on whether pornography increases violence toward women and/or whether it degrades women. While a substantial amount of cross-cultural data suggests that there is no direct link between adult consumption and violence, the question of whether pornography is inherently degrading to women lacks clear answers. As does the question of whether behaviors in pornography that are commonly labeled as degrading are perceived that way when they take place outside pornography. To answer this question about the inherent nature of degradation, we need a better definition and understanding of what particular behaviors people consider to be degrading and whether their perception of what is degrading is influenced by the circumstance or the people involved in a non-pornography setting. To examine this, 496 individuals (247 females, 249 males) were asked to indicate their perceptions of various sexual behaviors when engaged in by males and females toward male and female partners. Results suggest that while some particular sexual behaviors are broadly viewed as degrading (e.g., watersports), perceptions of degradation for other behaviors seem to be influenced by who is doing what to whom. In this sense, the perception of degradation exists in the eye of beholder and is often not defined by the particular sexual act. Future studies of degradation should take into account the context as well as the players involved.

Hybrid high and low molecular weight chains of hyaluronan for clitoral injection is an effective modality treatment for increasing female sexual satisfaction: an interventional, randomized-controlled parallel study.

Hormonal, behavioral, psychological, surgical, and pharmacopsychological treatment approaches contribute to female sexual dysfunction (FSD). Aim: The study is conducted to assess the effectiveness of hyaluronan high and low molecular weight hybrid cooperative complexes (hybrid H-HA/L-HA) in treating females with SD and to compare the female sexual function index (FSFI), dermatological life quality index (DLQI), and female genital self-image scale (FGSIS) before and after therapy. We divided the 60 female participants into two groups. Hybrid H-HA/L-HA was administered to form pili of 0.25cc around the clitoris in the direction of clock positions of 12, 3, 6, and 9. In Skene's gland; 0.25cc for each and 0.5cc into the corpus/body of the clitoris. Two treatments were held 30days apart.The same procedure was repeated on the control group, but with saline as a placebo. Women completed self-report questionnaires assessing sexual functioning using the FSFI, DLQI, and FGSIS before and after therapy. There was a significant (P= 634.152; P< .05) increase in the study group's weekly sexual interactions compared with the controls. The study group showed statistically significant amelioration in desire, arousal, lubrication, orgasm, satisfaction domains, overall score, and a decrease in pain following the first and second injection sessions (P= .014, .031, .003, .001, .011, .004, and .011, respectively). A comparison of the results between the two groups revealed significant improvement were found (P= .025).There were significant improvements in the domains of the FGSIS compared with the controls (P= .026). The study group showed a substantial improvement in satisfaction with the way their genital area looked, comfort level when allowing a sexual partner to view their genital area, belief that their genitals smell perfectly fine without being self-conscious about them, and overall score (P= .022, .031, .003, .001, and .004, respectively) (P< .05).The hybrid H-HA/L-HA sessions resulted in significantly greater positive perceptions and feelings, leisure activities, interpersonal interactions, and general assessments (P= .021, .021, and .020, respectively) (P< .05). Female individuals with SD experience sexual improvements after hybrid H-HA/L-HA injection. This is the first study focusing on female individuals with SD. We recommend conducting the study on a larger population and including their partners. Hybrid H-HA/L-HA injection for rejuvenating the clitoral injection appears to be a reliable and safe method for enhancing female genital self-image, sexuality, and quality of life.

A Randomized Controlled Trial of a Digital Intervention to Improve the Sexual Health of Adolescent and Young Adult Male Emergency Department Patients

PurposeTo assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve adolescent and young adult (AYA) male sexual health. MethodsWe conducted a pilot randomized controlled trial of sexually active male emergency department (ED) patients aged 14–21 years. Participants were randomized to the intervention (Dr. Eric, Emergency Room Interventions to improve Care) or usual care. Dr. Eric consists of an ED-based sexual health app followed by 3 months of interactive text messages. We assessed the feasibility, adoption, and fidelity among users. Condom use, defined as the number of sexual encounters with condoms divided by the total number of sexual encounters over the past 4 weeks, was the primary efficacy outcome. ResultsWe enrolled 119 patients; mean age was 17.9 years, 87% were Hispanic, and half used condoms at last intercourse. Dr. Eric demonstrated feasibility, with high rates of consent (86.2%) and follow-up (81.5%). Intervention participants found Dr. Eric acceptable, liking (86.2%) and recommending (87.9%) the program. 98% of intervention participants interacted with all five app modules; one-quarter opted out of text messaging. At 6-week follow-up, the intervention group more often used a condom compared to the control group [OR 3.57, 95% confidence interval (1.93, 6.60)], p < .001]; however, this significant difference did not sustain at 13 weeks. DiscussionDr. Eric was feasible to deliver and acceptable to male AYA patients. To our knowledge, Dr. Eric is the first intervention to demonstrate evidence of short-term efficacy for improving condom use among male AYA in the ED.