Sexual Counseling Research Articles

Salud Sexual: La gran olvidada del ámbito educativo

Introduction: Sexual education is a priority in the psychosocial development of people and there is a significant deficit both in the school and the Institutes and Universities, in the informative-preventive field, as in sexual counseling and in the intervention of Clinical Sexology and / or Sexual Medicine that are taught, already as indispensable subjects in the Faculties of Medicine of Europe, USA, Canada and Latin America. In Spain we have more than a decade with a Master of Sexology that is taught at universities (Almeria, Health Sciences (UAL, Seville, Extremadura) Other University as Camilo Jose Cela, (at the INCISEX, the Institute of Sexological Sciences ) has been teaching sexology for more than 4 decades, and today sex education occupies spaces in many schools and in many families.The physical and emotional need to touch us, to give us pleasure and intimacy, accompanies us from birth to We die, to all people, sexuality is reworked throughout a life.Objective: To value sexual education in our area. Method: Analysis of rights and duties in education applied to the sexual field in our country. The OMS. defines Sexual Health in 1975. The W.A.S. in the XIII World Congress of Sexology, (29.06.1997 establishes the Universal Declaration of Sexual Rights or Declaration of Valencia) and updates them in 2014.Results: There has been an increase in Spanish legislation in the field of sex education, however, an important deficit is still detected that logically limits the formation and development of people. For a National Sexual Health Plan, and implementation of the March 2010 Law. Organic Law 2/2010, of arch 3, on sexual and reproductive health and the voluntary interruption of pregnancy. https://www.boe.es/buscar/pdf/2010/BOE-A-2010-3514- consolidado.pdfConclusions: Sexual education should be increased in schools, institutes and universities that facilitate the personal development of all people, from infancy to old age.

The 2018 Revision to the Process of Care Model for Management of Erectile Dysfunction

IntroductionErectile dysfunction (ED) is a common condition the treatment of which over the years has expanded from specialty care settings to various other clinical settings. A Process of Care Model was developed in 1999 to provide primary care physicians with guidance in the diagnosis and management of ED. AimThis update to the Process of Care Model aims to reflect current ED management practices, because the study of ED has changed since 1999. MethodsUpdates to the Process of Care Model were developed during a meeting of international experts from diverse disciplines. The updated model is data-driven, evidence-based, and relevant to a wide range of healthcare providers. Main Outcome MeasuresThis article summarizes the results of the expert meeting and focuses on ED management. The evaluation of ED is discussed in a separate article. ResultsThe updated model presents modification of risk factors and correction of comorbidities frequently associated with ED as critical parts of patient management. Patients should be encouraged to make positive lifestyle changes such as improving diet and increasing physical exercise. Lifestyle changes may be accompanied by the first-line medical therapies of sexual counseling and therapy, which takes into consideration patient sexual dynamics and pharmacotherapy with phosphodiesterase 5 inhibitors (PDE5Is). Clinical ImplicationsThe updated model provides guidance regarding risk factors associated with ED, their modification, sexual counseling, and PDE5I selection, dosing, and patient education. Strengths and LimitationsThis update leverages the extensive clinical expertise and experience of the authors to provide updated, comprehensive guidance for ED management. The model reflects the views and experiences of a limited number of contributors; however, these authors draw upon a diverse array of clinical specialties and are regarded as experts in their fields. Additionally, no meta-analyses were performed to further support the ED evaluation guidelines presented. ConclusionEffective management of ED may be achieved through a combination of patient risk factor modification and first-line therapy, taking into consideration any patient comorbidities known to be associated with ED. Treatment goals should be individualized to restore sexual satisfaction to the patient and/or couple and improve quality of life based on the patient’s expressed needs and desires.Mulhall JP, Giraldi A, Hackett G, et al. The 2018 Revision to the Process of Care Model for Management of Erectile Dysfunction. J Sex Med 2018;15:1434–1445.

"Free Testing and PrEP without Outing Myself to Parents:" Motivation to participate in oral and injectable PrEP clinical trials among adolescent men who have sex with men.

BackgroundAdolescent men who have sex with men (AMSM) account for disproportionately high numbers of new HIV diagnoses. Non-adherence to daily use limiting the effectiveness of oral PrEP (Truvada) has led to current trials with adult MSM testing Cabotegravir, a long-term injectable medication. Once comparative studies with young adult MSM have established relative safety and efficacy of these medications, there will be a need for such comparative trials involving adolescents. Trends in state laws and IRB protocol review indicate that many of these studies will permit youth to provide independent consent for participation. Understanding the motivations of AMSM to participate in HIV biomedical prevention studies is important to ensure their agreement is voluntary without misunderstanding and undue influence. This study examined AMSM attitudes toward participation in oral/injectable PrEP RCTs to inform protections of youth’s rights and welfare in future studies.MethodsWe administered to 198 ethnically diverse U.S. AMSM, 14–17 years, a web-based survey including demographic and sexual health questions, description of a year-long oral versus injectable PrEP RCT and 26 Likert-type and one open-ended item assessing motivations for and against participation including: perceived benefits and risks of PrEP; free HIV/STI testing and counseling; confidentiality concerns; random assignment; and benefit to others.ResultsSixty-two percent indicated they were likely to participate in the study. The majority endorsed daily HIV protection, free HIV/STI testing, sexual health counseling, not having to rely on partner’s condom use, and altruism as reasons to participate. Reasons against participation included medication side effects, concern taking the pill daily and clinic visits would reveal their sexual orientation and behaviors to parents. Over half erroneously assumed they would be assigned to the condition best for them and 39% indicated free access to services would lead them to participate even if they did not want to. Multiple regression indicated these factors accounted for 55% of the variance in participation choice. Nether age or ethnicity yielded significance.ConclusionsResults suggest future biomedical HIV prevention research will need to develop procedures to address AMSM’s confidentiality concerns, enhance youth’s understanding of random assignment, the continued importance of medication adherence and partner condom use during trial participation, and availability of alternative sexual health services to avoid the potentially undue influence of access to free sexual health services.

Salud sexual y reproductiva de los pacientes con esquizofrenia y trastorno afectivo bipolar

IntroductionPeople with schizophrenia and bipolar disorder (BD) have a high risk of unwanted pregnancies and abortions, due to their condition of vulnerability or hypersexuality (common in BD). This is associated with difficulty in planning their actions and lack of sex education and counselling by medical personnel, and can lead to adverse obstetric outcomes and inability to care adequately for their children. ObjectiveTo describe the characteristics in terms of sexual and reproductive health, and the use of contraception and counselling in psychiatric consultations, in a sample of patients with BD and schizophrenia in Medellin, Colombia. MethodsObservational cross-sectional study. We included the 160 participants from the clinical trial, “The effects of a multimodal intervention programme in patients with bipolar disorder and schizophrenia”, who were recruited from the mood and psychosis disorders group clinic at Hospital Universitario de San Vicente Fundación in Medellin. They were contacted by phone by a third-year psychiatry resident, who applied a survey about the characteristics of their sex life, contraception and reproduction. ResultsAlmost all of the patients with schizophrenia were single, had no undergraduate studies and were unemployed. No significant differences were found regarding the age of starting sexual relations when comparing by diagnosis and gender. Almost all patients with schizophrenia and almost half of the patients with BD reported not having an active sexual life. Almost all of those who admitted to having an active sexual life claimed to always use contraception; in the BD group, only 48.8% of single women admitted to using contraception and a little over half of men stated that they used a condom when having sex. A quarter of the pregnancies were unplanned.Although the majority of the patients stated that they had never received information about family planning in the consultations with their psychiatrist, 57.4% of the patients with BD and 78.8% of those who had schizophrenia, considered themselves to be well informed on the subject. ConclusionsPatients with mental illness have cognitive and behavioural alterations that affect their sexual and reproductive lives. Psychiatrists should therefore address this issue, to ensure education in areas such as contraception, family planning and sexually transmitted diseases and help safeguard the safety and quality of life of their patients.

The CHARMS pilot study: a multi-method assessment of the feasibility of a sexual counselling implementation intervention in cardiac rehabilitation in Ireland

BackgroundMany people living with cardiovascular disease (CVD) are affected by sexual problems associated with the condition. International guidelines recommend all patients with CVD should receive sexual counselling, yet this is rarely provided by health professionals. The current study piloted the Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention, a complex multi-level intervention designed to increase the implementation of sexual counselling guidelines in hospital-based cardiac rehabilitation (CR) in Ireland.MethodsThe CHARMS intervention, consisting of awareness training and skills development for staff, and education and support for patients, was implemented in two CR centres. Following a repeated measures design, quantitative and qualitative feasibility, fidelity, cost, and outcome data were collected from staff and patients at baseline (T1, pre-intervention), at 3 months post-baseline (T2, post-intervention), and at 6 months post-baseline (T3, post-intervention). Data were organised according to a 14-point reporting framework of methodological issues that should be examined in pilot and feasibility studies. To inform a future definitive trial, potential solutions to identified feasibility issues were generated using the ADePT process for decision-making after pilot and feasibility trials.ResultsMost elements of the study protocol were executed smoothly, and intervention implementation was successful. Patients’ (N = 42) responses to the intervention were positive. The reporting framework and the ADePT process facilitated the identification of two overarching feasibility problems, as well as solutions to be implemented in a definitive trial: (1) a high level of patient attrition in the pilot study, to be addressed through the use of financial incentives, reducing the length of the patient questionnaire, and providing a telephone survey option; and (2) negative staff perceptions, to be addressed through an augmented staff intervention, reframing ‘sexual counselling’ as ‘sexual education and support’ to fit with professional role perceptions, and reviewing all intervention terminology with a CR staff member to ensure acceptability.ConclusionsThis article reports the successful piloting of a novel sexual counselling implementation intervention in cardiac rehabilitation. The utilisation of an extended reporting framework and the ADePT process facilitated the identification of adaptations necessary to ensure the feasibility of a definitive trial, thereby maximising methodological transparency.

Women's sexual and reproductive health care needs assessment: an Iranian perspective.

Reproductive health problems are a leading cause of women's ill health and mortality worldwide. There is a need to investigate sexual and reproductive health care needs in different societies and cultural contexts. Despite the success in health care promotion in the Iranian health care system, women still need to receive sexual health care and appropriate HIV/AIDS services. However, studies on the sexual and reproductive health care needs of Iranian women are lacking. This study aimed to investigate the sexual and reproductive health care needs of women referred to health care centres in an urban area of the Islamic Republic of Iran. We carried out a cross-sectional study in 2013 on 514 women living in an urban area in the north of the Islamic Republic of Iran. Taking into consideration ethical principles, data were collected using the Sexual and Reproductive Health Care Needs Assessment Questionnaire. The findings showed a greater need for the provision of care by practitioners in the sexual history and activities domain (73%) compared with other domains. Also, the woman's age and the location where she sought treatment and care for sexually transmitted infections were predictors of sexual activities needs. Owing to the high prevalence of women's referral to health care centres seeking treatment of sexual disorders, there is a need for the provision of sexual counseling centres and services promoting women's reproductive health care.

647 An outcomes analysis of 47 penile prosthesis implantations after cistoprostatectomy for muscle-invasive bladder cancer: a multicentric study

To report the outcomes of a multicentric series of patients underwent a penile prosthesis (PP) implantation following radical cystoprostatectomy (RCP). A multicentric database, involving 4 tertiary referral centers, was created. From December 2004 to September 2017 65 patients underwent a PP implantation for a medically refractory ED following a RCP for bladder cancer. Clinical records were retrospectively reviewed. 47 patients, presenting comprehensive intraoperative and postoperative information were enrolled in the study. Patients were confined in 2 groups according to the type of urinary diversion: neobladder (A) or other diversions (B), including ileal conduit and ureterocutaneostomy. The intraoperative complications, the hospital stay, a postoperative haematoma scale and the postoperative complications were selected as variables for the surgical outcomes. 14 patients (29.8%) were enrolled in group A, whereas the remainders were in group B. A consistent percentage (65.9%) of patients were referred to an early postoperative sexual counseling, with a median time of 12 months after surgery. Most of the patients (65.9%) started pde-5 inhibitors as a first line treatment and less than half of the them (44.7%) used a second line attempt, intracavernous injections (ICI). Overall, the time elapsed between the RCP and the PP implant was long, with a median of 38 months. Nevertheless, the median implant length resulted to be satisfactory (19 cm) and the need of a reduced diameter cylinder (CXR®) was a rare event. Despite the previous pelvic surgery, most of the PP implanted were three-pieces. The spherical reservoir was the most used, compared to the low-profile (Conceal®). In most of the cases a safe placement of the reservoir in the extraperitoneal space through a second abdominal incision was the preferred surgeon’s choice. However, the ectopic high-submuscolar placement was used in up to 30% of cases in group A. Both intraoperative and postoperative complications resulted to be rare events. Finally, the multivariate statistical analysis did not show any independent predictive risk factor for postoperative complications.

662 Preserving sexual function after bone marrow transplant

To preserve sexual function after bone marrow transplant. Women with haematological cancers are frequently rendered menopausal by chemotherapy. Untreated this results in vasomotor symptoms insomnia, low mood, low libido and genito-urinary syndrome of menopause including dry vagina. In addition women who have allogenic bone marrow transplants are susceptible to Graft-Versus-Host-Disease (GVHD). When this affects the genital tract, sexual function can be difficult or impossible especially when vaginal stenosis occurs. The Menopause Symptoms after Cancer clinic at the Royal Women’s Hospital provides management of menopausal symptoms as well as gynaecological surveillance for women after cancer. A protocol has been developed for haematological cancer follow-up designed particularly for the early detection and treatment of GVHD. Many opportunities exist for the discussion of sexual issues during the consultations. This can aid detection and treatment of GVHD. Furthermore it can open up opportunities for improving quality of life with sex and relationship therapy via the Sexual Counselling Clinic (RWH).

The effectiveness of group counseling based on Bandura's self-efficacy theory on sexual function and sexual satisfaction in Iranian newlywed women: A randomized controlled trial

PurposeThis study was conducted to determine the effect of training based on Bandura's Self-Efficacy Theory on sexual function and sexual satisfaction in newlywed women. MethodsThis randomized controlled trial was conducted on 96 newlywed women presenting to health centers in Zanjan, Iran, in 2016. The participants were assigned to an intervention and a control group using randomized blocking. The intervention group received six 90-minute sessions of sexual counseling based on Bandura's self-efficacy theory held once every week over six weeks. The Female Sexual Function Index (FSFI) and the Sexual Satisfaction Questionnaire were completed by the participants before and eight weeks after the intervention. The ANCOVA and independent t-test were used for data analysis. ResultsThere were no statistically significant differences between the two groups in terms of sexual function (p = 0.169) and sexual satisfaction (p = 0.190) scores before the intervention. Eight weeks after the intervention and after adjusting for the baseline scores, the ANCOVA showed that the sexual function score was significantly higher in the intervention group than in the control group (mean difference = 1.8; 95% Confidence Interval = 0.2 to 3.4; p = 0.021); however, there were no statistically significant differences between the two groups in terms of sexual satisfaction (5.6; −0.1 to 11.4; p = 0.058). ConclusionThe results suggest the positive effects of sexual counseling on sexual function but not on sexual satisfaction, which may be due to the duration of the follow-ups and the limited number of the counseling sessions held.

The role of Ecstasy (MDMA) in managing intimacy and conflict in stable relationships

This paper discusses motivations for the use of MDMA among young adults in intimate relationships living in resource poor environments, where structural constraints limit potential for economic mobility and impact upon interpersonal relations. Drawing from in-depth interviews with men and women in intimate relationships with one or more partners, we report the range of motivations for MDMA use and their association with indicators of relationship quality, specifically trust and romantic exclusivity. Findings demonstrate that both men and women use MDMA primarily for the purpose of sexual enjoyment. However, men report the use of MDMA for sexual enjoyment more often, while women more frequently report the use of MDMA to compensate for psychological or physical displeasure, particularly in relationships characterised by distrust. We discuss how these motivations to use MDMA are shaped by gender norms and larger contextual and socio-economic factors and conclude with a call for more relational and sexual counselling opportunities for urban young adults to avoid MDMA use for self-medication.

Sexualidade durante todas as fases da gravidez: experiências de gestantes

Resumo Objetivo Explorar e compreender as experiências sexuais de gestantes durante a gravidez. Métodos O estudo foi realizado em dois centros de saúde no Distrito Sanitário de Almería, sul da Espanha. Os participantes incluíram gestantes que receberam atendimento pré-natal e/ou educação para maternidade. Os critérios de inclusão foram estar grávida, manter atividade sexual e concordar em participar do estudo. Os critérios de exclusão foram ter limitações na atividade sexual por prescrição médica. A amostra foi composta por 15 gestantes selecionadas por meio de amostra de conveniência, das quais cinco participaram de grupo focal (GF) e 10 de entrevistas em profundidade (EP). Os dados foram coletados entre os meses de junho e dezembro de 2016. Os participantes foram contatados pelo pesquisador principal e foi realizada uma consulta para conduzir o GF ou EP. Resultados Três categorias principais emergiram: Falsas crenças e uma abordagem holística da sexualidade durante a gravidez, que está relacionada ao conceito de sexualidade, falsas crenças e aconselhamento sexual limitado durante a gravidez. Limitações: Do medo no início à dificuldade física no final, referindo-se às flutuações no desejo sexual, bem como às mudanças físicas que limitam a atividade sexual. Adaptação às mudanças: práticas seguras e satisfação com a imagem corporal, que engloba preocupações com os riscos e a relação entre imagem corporal e autoestima. Conclusão A falta de aconselhamento sexual durante a gravidez leva à criação de falsas crenças, que, juntamente com mudanças físicas, preocupações com o risco e flutuações no desejo e interesse sexual, provocam uma diminuição na atividade sexual. Mas a sexualidade permanece um aspecto importante da gravidez, em relação ao qual os participantes devem adotar uma abordagem mais ampla e não limitada ao ato sexual, além de adotar práticas adaptadas às mudanças físicas e emocionais que ocorrem durante esse período.

25 - Physical and psychological factors that impact sexual functioning after electrocautery treatment for HGAIN in HIV positive MSM

Started working as an HIV counselor in 2001 and first performed HRA in 2011 in the Academic Medical Center in Amsterdam, the Netherlands. As an assignment during his extra study to become a sexual healthcare counselor, he performed the following study. The results have not been published. Although his study is small (n=6), he feels that the results are newsworthy for all healthcare providers visiting the IANS scientific meeting. Background A recent study showed negative impact of electrocautery treatment for anal HSIL on sexual functioning of HIV-positive MSM. Little is known about the physical and psychological factors that impact sexual functioning after electrocautery treatment. This study set out to identify what physical and psychological factors had an impact on sexual functioning of HIV-positive MSM that reported negative effects on their sexual functioning after electrocautery treatment. Methods In this qualitative survey six patients with known negative effects after electrocautery treatment, were interviewed using a semi-structured in-depth interview. Physical factors were analyzed as is. Psychological sexual factors were labeled and categorized using the grounded theory. Results Of six interviewed men, ages ranged from 27 to 66 years old, three participants were in a stable relationship with one partner, two were single and one had a sex buddy. HGAIN diagnose ranged from one to nine years. Four out of six patients reported physical factors that negatively impacted their sexual functioning of which blood loss, pain and loss of sensation were reported most. All patients reported psychological sexual factors that had a negative impact on their sexual functioning. These factors were categorized: on a personal level, within the relationship, with regard to feelings and action. The most dramatic result was showed that one out of six reported having ended his relationship and one was too afraid to start a new relationship. Conclusions This small study shows the impact of psychological factors on sexual functioning after electrocautery treatment. We advise that sexuality is discussed during HRA visits to allow healthcare providers to resolve misconceptions and provide sexual counseling or refer them to sexual counselor experts.

Risk Factors, Depression, and Drugs Influencing Sexual Activity in Individuals With and Without Stroke.

The aim of the study was to analyze factors affecting sexual activity in individuals with and without stroke, ages 40-59 years, in a national, cross-sectional, population-based sample derived from the National Health and Nutrition Examination Survey (NHANES). Descriptive, cross-sectional survey. Data were obtained from the NHANES (2011-2012) data set from individuals (N = 3,649) completing items related to cardiovascular risk factors, drugs, and sexual activity. Data were analyzed using chi-square, t tests, and logistic regression. Overall, number of drugs, smoking, and depression significantly predicted sexual activity. When comparing sexually active to not sexually active, those with stroke had significantly less sexual activity (t = 2.822, p = .005) and reduced sexual activity per week or month (χ = 16.275, p = .005, df = 4). Those taking angiotensin-converting enzyme inhibitors and statins had reduced sexual activity. Findings illustrate the importance of risk factor modification and nurses engaging in sexual assessment, education, and counseling to support sexual quality of life in younger individuals with stroke.

Sexual advice at a Federal University

Purpose: The incidence of Sexually Transmitted Infections (STIs), a serious health problem, remains very high in Brazil, especially for the Human Immunodeficiency Virus (HIV), which has mobilized governments and the scientific community to control them. Sex education should be the primary means of preventing STIs by adopting strategies tailored to each population. The objective was to analyze the profile of individuals who seek sexual counseling at the Federal University of Rio Grande do Norte (UFRN) in Natal, Rio Grande do Norte state. Methods: The study used a quantitative approach, descriptive longitudinal design, and data collection with proportional stratified sampling, totaling 98 self-reporting questionnaires. Results: Participants exhibited the following profile: the majority were single heterosexual young men with secondary schooling. Thirty participants reported having had only one sexual partner and 81 had never contracted any STIs. Conclusion: It is concluded that the subjects who seek sexual counseling practice safe sex and need to be encouraged to undergo HIV testing.

Telephone sexual counselling and current technologies: Are helplines still effective in the social media era?

Summary Helplines are common counselling services for men and women seeking advice for health, psychological and sexual problems. With the advent of the social media era, users have now more possibilities to search for information about sexual health than before. Comparing the recent data of a long-standing telephone counselling service on sexual health by the Institute of Clinical Sexology of Rome, we aimed to investigate the range of sexual concerns reported by users, to describe the differences, if any, between male and female callers, and the changes in contents and usage in the last years. The study included selected records of the calls received during the 8-year period between 2010 and 2017 (n = 1865). Users were more often men than women (respectively 1253 vs. 612), aged between 26 and 45 years, medium to high education, employed, and who had not sought any previous help for their sexual concerns. The most frequently reported reasons to call were “male sexual dysfunctions” and “relational problems”. Comparing with previous data, a decrease of requests about specific sexual dysfunctions and sexual general information is noted. Moreover, some gender peculiarities are reported, and the counsellor actions to the user request are analysed. Although the service registered a decrease of calls in after the social media spreading, in the last years a new increase of calls and a switch in requests’ contents has been showed. Telephone counselling is still an important and effective resource to elicit requests that otherwise might remain hidden; therefore, it can be a useful link between health-care system and callers.

Health sector involvement in the management of female genital mutilation/cutting in 30 countries

BackgroundFor the last decades, the international community has emphasised the importance of a multisectoral approach to tackle female genital mutilation (FGM/C). While considerable improvement concerning legislations and community involvement is reported, little is known about the involvement of the health sector.MethodA mixed methods approach was employed to map the involvement of the health sector in the management of FGM/C both in countries where FGM/C is a traditional practice (countries of origin), and countries where FGM/C is practiced mainly by migrant populations (countries of migration). Data was collected in 2016 using a pilot-tested questionnaire from 30 countries (11 countries of origin and 19 countries of migration). In 2017, interviews were conducted to check for data accuracy and to request relevant explanations. Qualitative data was used to elucidate the quantitative data.ResultsA total of 24 countries had a policy on FGM/C, of which 19 had assigned coordination bodies and 20 had partially or fully implemented the plans. Nevertheless, allocation of funding and incorporation of monitoring and evaluation systems was lacking in 11 and 13 of these countries respectively. The level of the health sectors’ involvement varied considerably across and within countries. Systematic training of healthcare providers (HCP) was more prevalent in countries of origin, whereas involvement of HCP in the prevention of FGM/C was more prevalent in countries of migration. Most countries reported to forbid HCP from conducting FGM/C on both minors and adults, but not consistently forbidding re-infibulation. Availability of healthcare services for girls and women with FGM/C related complications also varied between countries dependent on the type of services. Deinfibulation was available in almost all countries, while clitoral reconstruction and psychological and sexual counselling were available predominantly in countries of migration and then in less than half the countries. Finally, systematic recording of FGM/C in medical records was completely lacking in countries of origin and very limited in countries of migration.ConclusionSubstantial progress has been made in the involvement of the health sector in both the treatment and prevention of FGM/C. Still, there are several areas in need for improvement, particularly monitoring and evaluation.

Sexual Problems of Patients With Breast Cancer After Treatment: A Systematic Review.

Sexual health is a crucial part of quality of life in breast cancer survivors, regardless of their relationship status. However, previous studies have rarely used qualitative methods to explore the postoperative experiences and feelings of patients with breast cancer. The aim of this study was to examine the causes of changes in sexual relationships of breast cancer survivors, methods for adaptation to these changes, and healthcare interventions to facilitate the patients' return to a normal life. A survey was performed by using five electronic databases and electronic journals accessed through the Internet. The following keywords were used: "breast cancer," "sexual problem," "sexual dysfunction," and "qualitative." Seven articles were included in the literature review. Three main domains were explored, namely, reasons for sexual relationship changes; the way patients used to adapt to sexual life after the diagnosis of breast cancer; and intervention by healthcare workers. The results of this study can facilitate and encourage health professionals to identify, examine, and solve most of the patient's sexual problems by using the functional and medical framework of the healthcare system. One practical recommendation of this study is the incorporation of sexual counseling units into the national healthcare system. Counselors in these units can help breast cancer survivors solve problems and improve sexual satisfaction between couples.

Infusing Human Sexuality Content and Counseling in Counselor Education Curriculum

ABSTRACTHuman sexuality is a pervasive and universal part of being human and despite this, receives inadequate attention in counselor education curricula. Consequently, counselors may be ill-prepared to assist clients who present with sexuality issues. The authors provide support and recommendations for infusing sexuality content throughout counselor education programs.

Working in the Field of Complex Psychological Trauma: A Framework for Personal and Professional Growth, Training, and Supervision.

The aim of this article is to explore the positive and negative impacts of working therapeutically in complex psychological trauma (CPT), particularly the field of gender-based violence (GBV) and childhood sexual abuse (CSA), from the clinicians' perspective. The focus was on the prospect of positive gains and growth for therapists. Twenty-one clinicians (n = 21; counselors/psychotherapists and psychologists) from National Health Service (NHS) specialist trauma services, a community mental health team, and specialist sexual assault counseling organization participated. Interpretative phenomenological analysis (IPA) was utilized to conduct single one-off interviews and analysis. Six themes were identified: Called to the work; Connection, Separation, and Oneness; Into and out of the darkness; Chaos into meaning; Reparation not repetition; and Expansion and growth. The first "Therapist Led Framework of Growth in Trauma Work" is presented. Vicarious posttraumatic growth (VPTG) was a key finding, with CPT therapists experiencing a "challenge/benefit/change" growth process. Adoption of actively relational strategies to enhance clinicians' growth process through trauma work is being proposed. The benefits of conceptualizing both the positive and negative impacts of such work for supervision, training, shaping the formal curricula, service management, and continuing professional development (CPD) are being discussed. The need for good practice guidelines on self-care internationally is highlighted.

The Influence of Comorbidities, Risk Factors, and Medications on Sexual Activity in Individuals Aged 40 to 59 Years With and Without Cardiac Conditions: US National Health and Nutrition Examination Survey, 2011 to 2012.

Sexual activity is increasingly recognized as an important aspect of quality of life for many individuals with cardiovascular disease, although less is known about the factors contributing to sexual functioning in younger adults. This study examined factors influencing sexual activity in individuals aged 40 to 59 years, comparing those reporting a cardiac condition with those without a cardiac condition, in a national population-based sample. The data were derived from the 2011 to 2012 National Health and Nutrition Examination Survey, a publicly available data set with a noninstitutionalized nationally representative sample. The sample included individuals between the ages of 40 and 59 years (N = 1741) who completed relevant items related to cardiovascular disease, cardiovascular risk factors, comorbidities, cardiac symptoms, sexual activity, and medication use. Recommended weighting was applied, and the data were analyzed using χ and logistic regression. Overall, 94% of the sample reported sexual activity, although those with coronary artery disease, angina, and myocardial infarction engaged in significantly less sexual activity. Individuals who smoked; had a weight problem, depression, or lung problems; or experienced symptoms of shortness of breath or chest pain with exertion reported less sexual activity. Medications negatively affecting sexual function were central α agonists, potassium sparing diuretics, and antilipidemic agents. Predictors of less sexual activity were smoking, chest pain walking uphill, and weight problems. Unexpectedly more reported, sexual activity was predicted by one or more cardiac conditions. In men and women ages 40 to 59 years, certain cardiac conditions, risk factors, comorbidities, symptoms, and medications negatively affected sexual activity, illustrating the need for sexual assessment and counseling to support sexual quality of life.