Sexual Health Screening Research Articles

Analysis of the significance of a male sexual wellbeing (mswb) clinic in an area of high diversity in east london, uk.

To analyse the socio-demography of the clinic attendees, associated comorbidities, investigations and final diagnosis. A sample of 100 attendees were selected using simple random sampling out of a total of 270 patients between 2015-2017. The socio-demographic details, associated comorbidities, relevant examination, investigations including hormonal assessments and treatment methods were extracted from the electronic records. 270 patients visited the MSWB with a total of 539 visits during this period. The mean age was 40.37. More than half of the patients were of South Asian ethnic background. 75% of the clients experienced Erectile Dysfunction (ED). Rapid ejaculation (RE) was reported in 22% of the sample. 86% of the sample had a full sexual health screening within a year. 13% were PLWH who were on ARVs. 66% of the ED patients had any form of other underlying medical condition. Baseline hormonal assessments were carried out in 57% of the sample and 96% of them suffered from ED. 57% of patients were diagnosed with ED and 23 of them suffered from psychogenic related ED. Lifelong and acquired RE was diagnosed in 5 & 13 patients respectively. 7 patients were diagnosed with a mixture of ED & RE. Orgasmic and anorgasmic ejaculation was diagnosed in each one patient. 2 Peronei's and 1 Hypogonadism were diagnosed and referred to the specialist service. Different modes of treatment were given including PDE5 inhibitors, vasodilators in the form of urethral stick and cream for the ED patients. 59% of the attendees were referred to our psychosexual service. It reveals the importance of having MSWB service for a diverse population. The clinical assessments and further investigations lead to newer diagnoses and further management. No conflicts of Interest

Automated Sexual History and Self-Collection of Extragenital Chlamydia and Gonorrhea Improve Detection of Bacterial Sexually Transmitted Infections in People with HIV.

With consistently rising rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) since 2014, the need for increased screening, testing, and treatment of bacterial sexually transmitted infections (STIs) in people at risk is clear. In this study, people with HIV were asked to complete a comprehensive audio computer-assisted self-interview sexual history at routine clinic-based laboratory visits every 3-6 months. The sexual health screening resulted in an automated summary of recommended bacterial STI tests. Self-collection of recommended extragenital CT/GC specimens was implemented to decrease the need for a provider to collect the specimen(s) and to give more control to the client. In total, extragenital CT/GC testing returned a 7.3% (n = 11) test positivity for CT and/or GC, with the highest test positivity of 14% (n = 7) among rectal swabs and 4% (n = 4) for pharyngeal swabs. Urogenital testing for combined CT/GC returned a 4.8% (n = 11) test positivity. All participants with extragenital CT/GC who underwent simultaneous urine testing returned discordant laboratory results, with urine collected at the same clinic visit resulting as negative. In addition, 7 of 11 (63.6%) of the positive extragenital GC/CT cases were asymptomatic. Therefore, extragenital site-specific testing was essential in appropriately diagnosing and treating CT and GC among participants. When extragenital STI testing was recommended, participants needing extragenital CT/GC specimens primarily chose self-collection after a brief demonstration. Error rates between self- versus provider-collected samples did not differ, and participants provided positive feedback on the intervention and self-collection process in satisfaction surveys taken at the end of each visit.

Sexual History Documentation and Screening in Adolescent Females with Suicidal Ideation in the Emergency Department.

Adolescents with mental illness often seek care in the emergency department (ED) and are more likely to engage in risky behaviors such as substance abuse and unprotected sex, increasing their risk of sexually transmitted infections (STI), unintended pregnancy, and non-consensual sex. This was a retrospective study of 312 females, aged 13–17 years, presenting to the pediatric ED with the chief complaint of suicidal ideation from February to May 2018. Electronic medical records were reviewed for demographics, psychiatric history, sexual history, and testing for pregnancy or STI. The primary outcome was the documentation of the presence or absence of prior sexual activity. Secondary outcomes included documented aspects of sexual history and pregnancy or STI testing performed in the ED. Of the 312 eligible patients, 144 (46.2%) had a documented sexual history, and of those 50 (34.7%) reported being sexually active. Sexual history documentation was not associated with patient age, race, ethnicity, insurance, or the gender of the ED provider. A history of anxiety and a recent suicide attempt were associated with a lack of sexual history documentation (p = 0.03). Of the sexually active patients, 28 (56%) had documentation of contraception use. Pregnancy testing was performed in 67.3% of all patients and 80% of sexually active patients. Only 10 patients had STI testing in the ED, with most testing occurring in those with sexual history documentation (p = 0.007). In conclusion, more than half of females with suicidal ideation in our ED had no documentation of sexual history, and when documentation was completed, it was often missing important elements, including screening for pregnancy, STI, non-consensual sex, and contraception use. Since the ED visit provides an important opportunity to address the reproductive health needs of this high-risk population, further work is needed to determine ways to improve provider documentation and sexual health screening.

Integration of an Inclusive Health Care Curriculum for Sexual Health and Gender Minorities

Context Research suggests that athletic training students lack knowledge and experience providing care to transgender patients. Additionally, research has identified a lack of comfort with sexual health screening in peer health professions. Objective To assess how a curriculum, including a standardized patient (SP) encounter, influenced attitudes and skills in working with sexual health and gender minorities. Design Prospective observational study. Setting Simulation lab. Patients or Other Participants Twenty cisgender postbaccalaureate professional athletic training students (females = 16, males = 4; age = 23 ± 2 years). Intervention(s) The intervention included a focused curriculum on transgender health care and sexual health. In a culminating SP encounter, one group (n = 10) interacted with a cisgender woman and the second group (n = 10) with a transgender woman. Main Outcome Measure(s) The students completed a postintervention survey. Instruments included the Attitudes Towards Transgender Patients tool, which is divided into 3 subscales: clinician education, transgender sport participation, and clinician comfort; and the the Sexual Health Knowledge and Attitudes and Sexual History–Taking instruments, which evaluated the effectiveness of the sexual health curriculum on knowledge, attitudes, and comfort. The investigator and SP actor evaluated the SP encounters. Data were analyzed using descriptive statistics, nonparametric Mann-Whitney U, and 1-way analyses of variance. Results We identified a significant difference between those completing a transgender SP encounter (mean = 5.30 ± 2.11) and those completing the cisgender SP encounter (mean = 3.50 ± 0.97) on the clinician education subscale (P = .035). There were no differences between groups on the transgender sport participation (P = .70) and clinician comfort (P = .32) subscales. On the SP actor evaluation, we found no significant differences (P = .08). Conclusions The curriculum and SP encounter influenced knowledge, attitudes, and comfort when working with gender minorities and screening for sexual health.

Can we talk about sex? Feasibility of universal sexual health screening for BRCA1/2 patients.

211 Background: Patients with BRCA1/2 pathogenic variants have an elevated risk for several malignancies including breast and ovarian cancer. Recommended risk-reducing treatments and surgeries can cause sexual dysfunction. Yet, sexual health is often under-addressed among this population. The goal of this initiative was to assess the feasibility and acceptability of implementing universal sexual health screening among BRCA1/2 patients in the outpatient setting. Methods: From 1/2022-6/2022, all patients with BRCA1/2 pathogenic variants in an outpatient Gynecologic Oncology clinic were asked to complete a sexual health symptom questionnaire at their visit. The self-administered screener was distributed by a medical assistant in the waiting room and included a validated single-item screener to assess for sexual dysfunction and questions regarding prior provider discussions about sexual health and how patients wanted to receive information on the topic. The screener was positive if a patient reported at least one symptom related to sexual dysfunction. Results: Thirty-six patients were given the sexual health screening and 100% completed it. The median age was 41 years (range 27-72) and 28 (78%) identified as White and 32 (89%) as non-Hispanic. Fourteen (39%) patients screened positive for sexual dysfunction and 25 (69%) reported never having previously discussed the topic of sexual health with a provider. Among the 14 patients that screened positive for sexual dysfunction, 6 (43%) preferred written educational resources about sexual health and 5 (36%) wanted a follow-up in-person visit. Vaginal dryness, lack of interest, and difficulty with orgasm were the most common patient concerns. Conclusions: Implementing a universal sexual dysfunction screening tool for patients with BRCA1/2 pathogenic variants in the outpatient setting is feasible and acceptable, with 100% participation. Further, over one third of patients screened positive for sexual dysfunction, the majority of whom had never discussed their symptoms with a provider. Future efforts are needed to evaluate scalable strategies to assess and improve sexual health among patients with hereditary cancer syndromes.

Examination of Identity Negotiation, Sexual Health Behavior, and Healthcare-Seeking Behavior of Transgender Sex Workers in India

The current study, which expects to fill in the gap in research on transgender sex workers in India, examines the sexual identity negotiation, risk perception and condom compliance, sexual health screening and testing behavior, contextual barriers to healthcare seeking, and barriers to community mobilization among this population. The study was conducted in the red-light districts of Kolkata and rural subdivisions of West Bengal, and Eastern India. Transgender sex workers comprise 15% of the sex workers’ populace in India, yet they are an understudied and underserved group in the commercial sex sector. It is anticipated that the study will help to formulate future programmatic interventions that can cater more effectively to the health needs of Indian transgender commercial sex workers, contribute to the HIV/STI risk reduction among this group, and reduce barriers to attaining health.

An exploration of women's sexual and reproductive health following traumatic brain injury.

To develop a gendered understanding of sexual and reproductive health for Australian women following traumatic brain injury. The intersection of socialised normative expectations of sexuality and sexual health, and being a woman with a disability, can lead to inequity and a misconception that a woman with a disability is asexual. An equal weighting concurrent mixed methods design. Twenty women participated in conversational interviews and 49 women completed an online survey. Equal priority was given to both qualitative and quantitative data which were collected concurrently. A separate analysis of data was performed and was later merged. This paper follows the Good Reporting of a Mixed Methods Study guidelines for reporting mixed methods research. Women reported changes in menstruation, reproduction, and sexual activity. Results identified that following traumatic brain injury, routine reproductive, and sexual health screening were neglected. Women revealed a personal reticence to discuss sexual health in a holistic sense and appeared more comfortable discussing reproductive health rather than sex for pleasure. Additionally, they perceived there was a reticence by clinicians to discuss sexual health as part of their rehabilitation. Shifting the focus to be on women's health through periodic comprehensive health assessments is essential to the delivery of holistic health care. These results can inform the provision of sexual health, sexual safety, and sexual assertiveness education and training for women and girls within a rehabilitation framework and would be a way of addressing what women in this study identified as an unmet need. Reproductive and sexual health are important elements of routine comprehensive health screening for women. Nurses are well positioned to begin discussions regarding sexual agency, sexual, and reproductive health to ensure person-centred care.

Engaging hard-to-reach men-who-have-sex-with-men with sexual health screening: Qualitative interviews in an Australian sex-on-premises-venue and sexual health service.

Compared with the general population in Australia, men-who-have-sex-with-men (MSM) have higher rates of HIV and sexually transmissible infections (STIs). Despite widespread advice to test regularly, a minority of these men remain "hard to reach." We undertook qualitative interviews with a group of such men in Sydney to better understand their views and experiences in relation to sexual health screening. We conducted semi-structured interviews with men engaging with HIV/STI screening services at a sex-on-premises-venue and the local Sexual Health Service in Greater Western Sydney. We analyzed these data for content and themes. Sexual behaviors and identities were diverse, often discordant and compartmentalized from everyday lives. Overall, reported HIV/STI knowledge was poor and men did not see themselves at risk of HIV/STIs regardless of sexual behavior. Men took calculated risks and balanced with pleasure and escapism. Reasons for avoidance of testing included fear, unwillingness to disclose behavior, privacy concerns, and perceived low risk. Men viewed sexual health care as distinct from general health care. Service delivery preferences varied by service venue. Participants highlighted convenience, confidentiality, and trust as critical factors for a testing service. A variety of testing options are needed to engage hard-to-reach MSM. Opportunities to enhance testing may include expanding health messaging, demystifying testing, and delinking sexual identity from sexual behavior and risk, thus promoting advantages of testing and establishing testing as standard of care.

“O” No: A Reddit Analysis of Orgasmic Dysfunction

ABSTRACT Introduction Orgasmic dysfunction includes reduced orgasmic intensity, decreased orgasm frequency and inability to achieve orgasm. Issues with orgasming are often multi-factorial in origin and can cause significant distress to patients. Objective We aimed to evaluate the experience of women with orgasmic dysfunction on Reddit, an anonymous forum-based platform that allows users to interact with a global audience. Methods The subreddit “TwoXChromosomes” was queried using the Reddit Application Programming Interface (API) for posts using the keywords “orgasm” and “climax”. Posts that were deleted, archived or unrelated to themes of orgasm were excluded. Threads were qualitatively analyzed using the grounded theory approach. Five independent researchers read and coded each thread identifying dominant themes and emergent concepts. Results Qualitative analysis of 108 threads and approximately 6,300 comments resulted in 5 major categories: psychological aspect of orgasms, difficulty orgasming with partners, partners’ response to orgasmic dysfunction, types of orgasms, and treatments for orgasmic dysfunction. Preliminary themes included (1) the presence of an emotional component or history of trauma resulting in orgasmic difficulty, (2) difficulty orgasming with a partner regardless of ability to orgasm during masturbation, and mixed partner responses to orgasmic dysfunction, with approximately half of posters reporting a supportive sexual partner who was interested in their sexual satisfaction while the remainder of posters reported partner dissatisfaction. (3) variety of stimulation required to orgasm, (4) the definition of a “normal orgasm and (5) self-motivated treatment for orgasmic dysfunction, including clitoral stimulation devices and masturbation techniques, with few posters discussing their orgasmic dysfunction with health care providers. Conclusions Overall, Reddit provides a medium for individuals with orgasmic dysfunction to discuss their experiences. Posts addressed users’ inability to orgasm, the interplay with their mental health and relationships, types of stimulation and treatments. Interestingly, very few posts discussed seeking out medical care for orgasmic dysfunction, potentially suggesting that women do not classify their orgasmic dysfunction as a health issue. The obvious prevalence of orgasmic dysfunction with little discussion surrounding healthcare reveals a large gap in sexual health counseling, indicating the need for expanded sexual health screening and detailed clinician-patient counseling. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Sprout (Raliegh, NC), Absorption Pharmaceuticals, Urovant Sciences, Inc.

Do Ask, Do Tell: Understanding Disclosure of Sexuality and Implications Among MSM Active Duty Service Members.

Men who have sex with men (MSM) account for over half of new diagnoses of human immunodeficiency virus (HIV) every year in the United States, with over one-third of this population being unaware of their HIV status. The U.S. Military requires biannual HIV testing for all service members. Although this may be an appropriate recommendation for the military at large, current health protection agencies suggest more frequent testing for those at increased risk of HIV transmission, such as those in the MSM community. However, more frequent testing for those at higher risk relies heavily on the preliminary step of patient disclosure of sexual practices to health care providers. An exploratory cross-sectional study was conducted in order to gain a better understanding of the relationship between sexual health variables and the disclosure of sexual identity to health care providers by MSM service members. A convenience sample of MSM currently serving in the U.S. military services (N = 354) was used to collect demographic data, sexual health and history, and opinions concerning medical treatment and HIV. Analyses of the data were conducted using univariate analysis and multivariate regression. Men of color were more likely to report a higher degree of sexual identification transparency with their health care providers, which deviates from the civilian population. Pre-exposure prophylaxis (PrEP) uptake was increased among individuals who were more transparent with their health care providers. Findings from this study indicate that feeling more comfortable sharing one's sexual identification with a health care provider results in increased engagement with HIV prevention measures. Potential implications for the Military Health System are the advancement of preventive sexual health screening procedures and the development and revision of policies that promote positive outcomes for gender and sexual minorities.

Acceptability and Feasibility of Peer-to-Peer Text Messaging Among Adolescents to Increase Clinic Visits and Sexually Transmitted Infection Testing: Interrupted Times-Series Analysis

BackgroundAdolescents are disproportionately affected by sexually transmitted infections (STIs), including HIV. Many youths with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the health care system for other reasons.ObjectiveWe examined intervention completion and changes in the number of new patients, the number of STI or HIV tests, and the sexual risk profile of patients over time to determine the feasibility and acceptability of a peer-driven text messaging strategy to connect youth to STI and HIV services.MethodsThe intervention enlisted consecutive patients at an adolescent medicine clinic to send a text message to 5 peers they believed were sexually active and lived in the clinic’s service area. The intervention was evaluated using an interrupted time-series design in which baseline clinic service levels were documented during a 35-week lead-in period, followed by a 20-week intervention implementation period, and a 16-week period of continued clinic observation. Clinic and patient data were obtained through chart abstraction from intake forms that occurred during the entire study period. Analyses conducted in 2015 used a generalized linear mixed model.ResultsOf the 153 patients approached to participate, 100 agreed to send SMS text messages. Most (n=55, 55%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results, and reported risk behavior increased post intervention, although this was not statistically significant, likely because of the small sample size.ConclusionsGiven low youth uptake of health care services, and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss those not connected to school or community programs. The peer-based text messaging strategy showed promise for both increasing the number of youths accessing health services and finding youths engaging in sexual risk behaviors and most in need of sexual health screening and services.

Integrating testing for sexually transmissible infections into routine primary care for Aboriginal young people: a strengths‐based qualitative analysis

ObjectivesThis paper examines factors that enabled successful integration of testing for sexually transmissible infections into routine care in Aboriginal Community Controlled Health Services. MethodsThis paper reports analysis of qualitative interview data recorded with 19 purposively sampled key informants in New South Wales, Australia, representing six Aboriginal Community Controlled Health Services and five government health bodies supporting those services. The analysis explicitly adopted a strengths‐based approach. ResultsParticipants reported a strong belief that routine screening overcomes shame and increases engagement with sexual health screening. Incorporating sexual health screening into general medical consultations increases the capture of asymptomatic cases. The Medicare Benefits Schedule 715 Adult Health Check was highlighted as an ideal lever for effective integration into routine care. ConclusionIntegration of testing for sexually transmissible infections into routine care is widely perceived as best practice by senior stakeholders in Aboriginal healthcare in NSW. Findings support continued work to optimise the MBS 715 as a lever to increase testing. Implications for public healthIdentifying accessible strategies to increase testing for sexually transmissible infections in Aboriginal Community Controlled Health Services can reduce disparities in notifications affecting Aboriginal young people.

Sexual Health Problems and Their Association with Psychological Distress: Investigating the Role of Dyadic Coping Behaviors among Young Adult Breast Cancer Survivors and Partners

ABSTRACT Introduction Cancer-related sexual health problems are among the most prevalent and distressing consequences of breast cancer. Representative studies have shown almost one-half of adult U.S. women reporting sexual dysfunction; among female young adult breast cancer survivors (YABCS) this figure approaches an estimated 75%. When untreated, sexual problems can persist throughout survivorship and negatively affect physical and psychological health. Despite the prevalence of sexual health concerns among this population and the negative impact on intimate relationships, the extant literature has marginally considered the role of interpersonal factors. Objective The present work utilized a dyadic perspective assessing emotional distress, satisfaction with sexual relationship, sexual functioning, and relationship satisfaction among YABCS and their partners in the first-year post-diagnosis. Using the Systemic-Transactional Model of Dyadic Coping theoretical framework, it was additionally assessed whether dyadic coping behaviors moderated the relationship between sexual health and distress. Methods YABCS (n=83) and partners (n=40) from an NCI-designated cancer center completed a cross-sectional survey. Validated questionnaires of psychological distress (PHQ-9), relationship functioning (DAS-7), satisfaction with sexual relationship (GMSEX), sexual function (IIEF, FSFI), and dyadic coping [Dyadic Coping Inventory, (DCI)] were administered. Descriptive statistics and independent sample t-tests were used to assess mean differences between survivors and partners’ measures. In addition, the moderating role of dyadic coping on the relationship between sexual health measures and psychological distress was assessed using the PROCESS macro. Results In the present sample, more than one-half of YABCS scored above the cut-off for clinically significant sexual dysfunction (51.6%), compared to 20% of the partners. Both patients and partners reported elevated scores for relationship satisfaction, positive dyadic coping behaviors and low distress. Significant differences were detected in satisfaction with sexual relationship and stress communication, with YABCS reporting lower satisfaction (p<.05), higher self- reported stress communication (p<.01) and male partners rating higher women's engagement in stress communication behaviors (p<.05). Common dyadic coping moderated the relationship between sexual functioning subscales and distress in male partners, with higher distress for those reporting low levels of shared coping behaviors. Similarly, stress communication by the partner moderated the relationship between desire and distress. Among YABCS partner-reported dyadic coping behaviors moderated the relationship between vaginal lubrication and distress, with lower rates of distress for YABCS reporting elevated partner stress communication. Conclusions Despite elevated relationship satisfaction, a substantial subgroup of YABCS and partners experience impaired sexual functioning. Our study provides emerging evidence about the role of interpersonal factors on the relationship between sexual health and distress among YABCS and partners. Specifically, the study reveals that perceived partner stress communication and common dyadic coping behaviors could be clinical intervention targets. Additional research is needed to confirm these findings in larger dyadic samples, including cancer types that are not sex-based. Healthcare providers serving YABCS and their partners should utilize standardized sexual health tools and screening protocols to identify and address survivor, partner, and couple-based factors that can alleviate the impact of sexual health problems on psychological well-being during cancer survivorship. Disclosure No

The sexual and reproductive health of female psychiatric inpatients: An area needing more attention?

Trauma-informed care and physical (including sexual and reproductive) health screening is standard in Western Australian mental health settings. We sought to determine the rates of reported sexual trauma and domestic violence (DV), the rates of sexual and reproductive health screening, and associations between sexual trauma and reproductive health screening in a sample of women of child-bearing age (WOCBA), that is, 18-49years, admitted to an inpatient psychiatric unit (IPU). A retrospective study on 12months of admissions to an outer metropolitan IPU (2017-2018), using descriptive analysis. Review of 160 admissions demonstrated high rates of reported sexual trauma (49.4%) and DV (38.8%). Rates of screening for pregnancy (56.9%) and sexually-transmitted infection risk (18.8%) were low. 5 out of 25 (20.0%) patients prescribed a mood stabiliser had documented discussions regarding reproductive risks of their medication. An overall lack of effect (p > .6) was found between sexual trauma history and reproductive health screening. WOCBA admitted to an IPU are vulnerable to having experienced sexual trauma and DV, with low rates of documented reproductive health screening despite existing clinical guidelines.

Sexual Health Screening for Gynecologic and Breast Cancer Survivors: A Review and Critical Analysis of Validated Screening Tools.

IntroductionStudies have shown that the sexual health concerns of gynecologic and breast cancer survivors are not adequately being addressed by clinicians.AimTo provide a comprehensive narrative review of validated sexual health screening tools and aid clinicians in choosing a screening tool that will allow them to best address their patients' sexual health concernsMethodsA review of PubMed and Google Scholar databases was conducted, using search terms “sexual health”, “screening”, “tools”, “cancer”, and “survivors” to identify sexual health screening tools meeting the following inclusion criteria: 1) published in a peer-reviewed journal, 2) were written in English, 3) included breast and/or gynecological cancer patient population, 4) included self-reported measure of sexual health and function, and 5) underwent psychometric validation.Main Outcome MeasureCriteria used to evaluate identified screening tools included ability to assess desire, arousal, satisfaction, orgasm, dyspareunia, solo sexual expression, relationship with partner, body image, distress over changes in sexual function, and support systems. Pre and post- treatment comparisons, differentiation between lack of sexual desire and inability, heterosexual bias, diversity in patient population, and ease of scoring were also evaluated.ResultsBased upon the inclusion criteria, the following 10 sexual health screening tools were identified and reviewed: Female Sexual Function Index, European Organization for Research and Treatment of Cancer Quality of Life Questionnaires for both Cervical and Endometrial Cancer, Sexual Adjustment and Body Image Scale, Sexual Adjustment and Body Image Scale- Gynecologic Cancer, Sexual Function and Vaginal Changes Questionnaire, Gynaecologic Leiden Questionnaire, Information on Sexual Health: Your Needs after Cancer, Sexual Satisfaction Questionnaire, and Sexual Activity Questionnaire. Most tools assessed satisfaction (n=10), desire (n=9), and dyspareunia (n=8). Fewer addressed objective arousal (n=7), body image/femininity (n=7), partner relationship (n=7), orgasm (n=5), pre/post treatment considerations (n=5), distress (n=4), and solo-sexual expression (n=2). Heterosexual bias (n=3) and failure to differentiate between lack of desire and inability (n=2) were encountered.ConclusionUnderstanding the strengths and limitations of sexual health screening tools can help clinicians more effectively address cancer survivors' sexual health concerns, which is essential in providing comprehensive care and improving quality of life. Screening tools have room for improvement, such as eliminating heterosexual bias and including cancer and treatment-specific questions. Clinicians can use this guide to select the most appropriate screening tool for their patients and begin bridging the gap in sexual healthcare.Tounkel I, Nalubola S, Schulz A, et al. Sexual Health Screening for Gynecologic and Breast Cancer Survivors: A Review and Critical Analysis of Validated Screening Tools. Sex Med 2022;10:100498.

Athena Speciality Certificate Examination case for male genital dermatology.

A 42-year-old uncircumcised male presents in clinic with a seven year history of progressive difficulty in retracting his foreskin, accompanied by soreness, itching and variable redness around the head of his penis (Figure 1). He mentions occasional splits in the skin at this site, and, on direct questioning, avoidance of sexual activity on account of pain. He had taken it upon himself to obtain a full sexual health screen which was reported as negative.

1050 An Audit of the Management of Acute Epididymo-orchitis

Abstract Aim To evaluate the management of patients referred to our Surgical Assessment Unit presenting with acute epididymo-orchitis. Concordance with local antibiotic guidance, the use of ultrasound scanning, and microbiological testing were all assessed over a one-year period. Method All adult patients presenting with acute epididymo-orchitis in 2019 were identified retrospectively using ICD-10 codes and the choice of antibiotic used was compared to our own local guidance. The use of ultrasound scanning was recorded and whether this led to a change in diagnosis or management. Use of microbiological investigations including urine microscopy & culture and sexual health screening were assessed. Results After exclusion criteria were applied 64 cases were identified with an average age of 55 (16-88). Concordance with local antibiotic guidance was low with 3/64 patients receiving antibiotics in-line with local guidance. This was predominantly due to the frequent use of Ciprofloxacin (49/64) which is not advised locally, however is in-keeping with guidance from organisations such as EAU/BASHH. Ultrasound was used acutely in 46/64 patients with 28/46 showing evidence of epididymo-orchitis, 15/46 were normal and 1/46 confirmed an abscess which required surgical drainage. All normal scans were still treated with antibiotics based on clinical findings. 25/64 had a urine sample sent for MC&S and uptake of sexual health screening was low. Conclusions Urologists should be aware of differences between local prescribing policy and broader guidance from relevant organisations. Epididymo-orchitis remains a clinical diagnosis and ultrasound should be reserved acutely for diagnostic uncertainty, unwell patients, or failure to improve.

A changing demographic - Ten years of HIV care.

We aimed to benchmark the quality of care and describe characteristics of patients newly attending the HIV clinic at differing time points over the past 10years, against the Infectious Disease Society of America HIV/AIDS performance measures. We performed a retrospective analysis of records for patients newly attending the HIV clinic in 2011, 2016 and 2018. There was an increase in male attendees in 2018 and 2016 compared to 2011 (88%, 88% vs. 59% p < .001), viral suppression rates were 97%, 83% and 99% (p < .001), respectively. We observed an increase in patients of South American origin over time. Acquisition risk changed, with increased proportion of MSM (24% in 2011 vs 78% in 2018, p < .001), lower rates of heterosexual (20% in 2018 vs 48% in 2011, p < .001) and IDU transmission (1.5% in 2018 vs 24% in 2011, p < .001). There were lower rates of Chlamydia trachomatis and Neisseria gonorrhoeae testing in 2018 (72%, p < .001), compared to 2016 (84%) and 2011 (83%). Hepatitis B virus vaccination and pneumococcal vaccine rates are declining (p < .001). We demonstrate the changes in both ethnicity and risk of acquisition over time, high rates of antiretroviral therapy prescription and viral suppression, and highlight the importance of health prevention with sexual health screening and vaccination in this population.

Vaginal symptoms in women who are affected by gynecologic cancer.

Pelvic floor disorders are common among gynecologic cancer survivors. With improvements in survivorship, quality of life conditions in these women need greater attention and care. This review focuses specifically on vulvovaginal symptoms, which are common and have a negative impact on sexual health and quality of life in women affected by gynecologic cancer. We review publications on treatment-specific sexual health outcomes, screening and treatment of vulvovaginal symptoms and sexual pain, and surgical management options. Recent evidence regarding the safety of concomitant prolapse repair at the time of surgery for gynecologic malignancies and CO2 laser therapy is discussed and areas needing further research and innovation are highlighted. Pelvic floor disorders, including vaginal and sexual health concerns, are common in women affected by gynecologic cancer due to both common risk factors and as a side effects of cancer treatment. Gynecologists play a critical role in screening, treatment, and collaboration with other specialists to provide comprehensive care for these women throughout their lifetime.

Sociodemographic Characteristics, HIV-Related Risk Behaviors and HIV Prevalence of Vulnerable Men in Tehran, Iran.

Sexual minorities, such as men who have sex with men (MSM), are disproportionately impacted by HIV/AIDS compared to heterosexual men. The increased prevalence of HIV/AIDs among this group of individuals is associated with increased participation in HIV-related risk behavior, such as multiple sexual partnerships and injection drug use. However, very little is known about the prevalence of HIV and the risk behaviors related to HIV infection among MSM in Iran. This absence of data is due to the increased discrimination and stigmatization MSM, and other vulnerable populations face in Iran. This study was conducted to identify HIV-related risks, HIV prevalence and sociodemographic characteristics of the MSM population in Iran. A cross-sectional study was conducted among MSM attending the Sexual Health Clinic at Imam Khomeini Hospital in 2018. A sexual health screening questionnaire was used to aid in identifying HIV-related risk behaviors. HIV status was determined using an HIV rapid test and confirmed by an ELISA. One hundred MSM enrolled in this study, out of which 41% were 18-25 years old. The majorities were single; almost one-third had a diploma degree. Only a fifth were employed, and about a quarter (25%) reported substance abuse. Among eighty-three people (83%) reported having sex during the past three months, and only 27 (27.3%) of participants always used condoms for sex. Among 80 participants tested for HIV, two positive results were detected (2.5%). Data collected through a sexual health questionnaire indicated that the prevalence of HIV is increased among MSM in Iran. This finding sheds light on the urgent need for the implementation of social programs providing counseling and healthcare to vulnerable populations in Iran.