Sexual Outcomes Research Articles

Anterior obturator artery perforator (aOAP) flap: A last-resort treatment option for sexual dysfunction in lichen sclerosus et atrophicus

IntroductionLichen sclerosus et atrophicus is an inflammatory, scarring dermatosis of the female anogenital area and may lead to pain and sexual dysfunction. In select cases which are refractory to conservative therapy, surgery may provide significant symptom improvement. The objective of this study was to expand the range of surgical treatment options for these patients by presenting the operative outcomes of a specialised reconstructive method using the anterior obturator artery perforator (aOAP) flap. MethodsA retrospective cohort study was conducted on sexual outcomes following the excision of affected vulvovestibular tissue by skinning vulvectomy and subsequent single-stage reconstruction using the aOAP flap. Additional procedures, such as the Omega-Domed (OD) flap, scar surgery and clitoral re-exposure, were performed when indicated. ResultsBetween 2014 and 2022, a total of 61 patients were surgically treated and retrospectively included in this study. Vulvectomy and subsequent reconstruction with bilateral aOAP flaps were performed in 53 (87%) cases. There was a significant reduction in the prevalence of dyspareunia and inability to have sexual intercourse at the 1-year follow-up compared to baseline (p < 0.001). There were several minor, reversible complications that required secondary intervention. ConclusionsThe outcomes of this study indicate a substantial improvement in sexual function, evidenced by a significant reduction in dyspareunia and an increased ability to engage in sexual intercourse. Altered tissue quality in patients with lichen sclerosus et atrophicus and long-term cortisone application may predispose this patient population to a higher risk of minor post-operative complications. Clinical Trial Registration NumberDRKS00033261

Differences in shared decision-making and prostate cancer screening by sexual orientation and race/ethnicity.

10525 Background: There are well-documented disparities among racial and sexual minorities in prostate cancer screening uptake and shared-decision making (SDM) conversations. However, it is unclear how racial/ethnic identity and sexual orientation interact to affect prostate-specific antigen (PSA) testing uptake. Methods: Data came from the 2018-2022 Behavioral Risk Factor Surveillance Survey (BRFSS). Outcomes were survey responses to questions about engagement in SDM and PSA testing uptake. The sample included 88,365 heterosexual (HS) men and 2,562 sexual minority (SM) men ages 55 to 69. Data were stratified by race/ethnicity and survey-weighted logistic regression models analyzed the association between sexual orientation and outcomes. Models controlled for age, relationship status, education, household income, insurance status, having a usual source of care, and region. Results: White SM men were more likely to have discussed disadvantages of PSA testing with their healthcare provider [odds ratio (OR)=1.407; p&lt;0.001] and to have undergone PSA testing [OR=1.320; p&lt;0.001] compared to White HS men. Asian SM men were more likely to have had discussions about PSA testing [OR=4.470; p&lt;0.05]; to have discussed advantages [OR=4.596; p&lt;0.05]; to have been recommended PSA testing [OR=4.836; p&lt;0.05] and to have undergone PSA testing [OR=4.401; p&lt;0.001] compared to Asian HS men. Black SM men were more likely to undergo screening because of an issue or a reason besides routine screening [OR=1.073, p&lt;0.05] compared with Black HS men. Hispanic SM men were more likely to have undergone screening as part of a routine checkup [OR=4.2, p&lt;0.001] compared with Hispanic HS men. There were no sexual orientation differences in PSA screening or SDM among American Indian or Native Alaskans. Conclusions: Differences in PSA testing uptake and SDM by sexual orientation vary by race/ethnicity. Further research is needed to study the factors affecting PSA testing uptake and SDM among sexual minority men of different racial/ethnic groups. [Table: see text]

Recovery of Social Continence and Sexual Function in Men With High-risk Prostate Cancer After Radical Prostatectomy: Results From a Statewide Collaborative

OBJECTIVESTo examine post-operative urinary and sexual functional outcomes for men with high-risk prostate cancer (HRPCa) who underwent radical prostatectomy (RP) within the Michigan Urological Surgery Improvement Collaborative (MUSIC). METHODSWe identified patients who underwent RP for HRPCa in MUSIC between 2014-2023. HRPCa was defined according to American Urological Association criteria. Patients completed Expanded Prostate Cancer Index Composite (EPIC-26) pre-RP and 3-, 6-, 12-, and 24-months postoperatively. Primary outcomes included social continence, defined as 0-1 pads used daily; and recovery of sexual function, defined as the ability to achieve erections firm enough for intercourse. Multivariable and bivariate analyses were performed to identify factors associated with recovery of social continence and sexual function. RESULTS1323 patients were included in the post-RP urinary continence analysis and 422 men in the sexual function analysis. 58% and 86% of patients achieved social continence at 3- and 12-months post-RP, respectively. Continence recovery was associated with higher baseline EPIC-26 urinary continence scores (OR 1.10, per 5 points, 95% CI 1.06-1.15, p<0.001), and negatively associated with increasing age (OR 0.78 per 5-year increase, 95% CI 0.71-0.85 p<0.001). 15% of patients had recovery of sexual function at 12-months post-RP. On bivariate analysis, recovery of sexual function was associated with nerve-sparing at time of RP, lower pre-operative PSA, and not receiving post-RP ADT/RT. CONCLUSIONSRP for HRPCa has acceptable rates of postoperative social continence. However, post-RP recovery of sexual function remains a challenge. This information has important implications for pre-operative counseling and post-operative follow-up for patients with HRPCa.

Sexual health outcomes in sexual minority vs. heterosexual men after prostate radiotherapy.

Sexual health outcomes in sexual minority vs. heterosexual men after prostate radiotherapy.

Sexual lives and reproductive health outcomes among persons with disabilities: a mixed-methods study in two districts of Ghana

IntroductionPeople with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana.MethodsA sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis.ResultsMost PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes.ConclusionThe study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs.

My Body, My Choice: An Adapted Sexual Health Intervention for Youth with Histories of Commercial Sexual Exploitation

Youth with commercial sexual exploitation (CSE) histories experience high rates of unplanned pregnancies and sexually transmitted infections, with few interventions targeting their needs. We therefore piloted an evidence-based sexual health education intervention tailored for CSE-impacted youth, My Body, My Choice (MBMC). MBMC was implemented in two rounds between March and October 2021 with a total of 37 youth who completed a baseline questionnaire, engaged in a 13 to 16-hour online course over two to three weeks, and then assessed the course’s likability and feasibility via a post-course evaluation survey. To measure sexual health knowledge retention and attitudes, follow-up questionnaires were administered at baseline, 1-month, and 3-months post-course. Descriptive and bivariate analyses examined demographic characteristics and differences between timepoints. Most participants identified as female (92%), and Latinx (57%) or Black (27%). Overall, youth had an improved understanding of sexual health concepts over time, with significantly increased knowledge regarding birth control methods such as IUDs and condoms. Youth expressed high rates of satisfaction with MBMC, with 93% seeking continued course access. Findings underscore the utility and acceptability of MBMC and may inform future interventions to reduce health disparities and improve sexual health outcomes among youth with CSE histories.

Intersectionality analysis of young people’s experiences and perceptions of discrimination in primary health centers in Ebonyi State, Southeast Nigeria

Background Young people (aged 10 to 24 years) in sub-Saharan Africa bear a huge and disproportionate burden of poor sexual and reproductive health (SRH) outcomes due to inequalities and discrimination in accessing sexual and reproductive health services (SRHS). This study assessed the experiences and perceptions of discrimination among young people seeking SRH services in Primary Health Centers (PHCs) using an intersectionality lens.Methods A cross-sectional mixed-methods study was undertaken in six local government areas (LGAs) in Ebonyi State, southeast Nigeria. The LGAs comprise both urban and rural locations. The study population for the quantitative survey consisted of 1025 randomly selected young boys and girls aged 15–24 years. Eleven focus group discussions (FGDs) were conducted with the young people. Descriptive and inferential analyses were performed for quantitative data, while thematic analysis was performed for the qualitative data, using NVivo.Results A total of 16.68% participants in the survey reported that young girls/women were treated badly/unfairly compared to young boys/men when seeking SRH services in PHCs; 15.22% reported that young clients get treated badly/unfairly from adults; and 12.49% reported that young clients with poor economic status were treated unfairly. Respondents also reported that young clients with disability (12.12%), and those who are poorly educated or uneducated (10.63%) are treated badly by healthcare providers when they access SRH services. Young people in urban areas were about 7 times more likely to believe that girls/young women are treated badly than boys/young men when seeking SRH services in PHCs compared to those who live in rural areas (p < 0.001). Among the young girls/women, residing in urban areas, being poor and in school increased the likelihood of getting treated badly/unfairly when receiving SRH services by 4 times (p < 0.001). The qualitative results revealed that health workers were generally harsh to young people seeking SRH services and the level of harshness or unfriendliness of the health workers varied depending on the young person’s social identity.ConclusionThere are varieties of intersecting factors that contribute to the discrimination of young clients in PHCs. This underscores the urgent need to prioritize intersectional perspectives in the design and implementation of interventions that will improve access and use of SRH services by young people.

Investigating the Impact of Reproductive Coercion and Intimate Partner Violence on Psychological and Sexual Wellbeing.

Emerging research suggests that reproductive coercion and abuse (RCA), like intimate partner violence (IPV), is associated with poorer mental and sexual health outcomes, including greater symptoms of post-traumatic stress disorder (PTSD) and depression and poorer markers of physical and sexual health such as sexually transmitted infections, unplanned pregnancies and lowered sexual agency. Although victims/survivors of RCA report long-lasting impacts on future relationships, including fear and anxiety, little is known about impacts of RCA on anxiety and general wellbeing, nor emotional and mental components of sexual health that comprise a person's sexual self-concept. With community samples of participants in Australia, we conducted two studies to explore the impact of RCA and IPV on psychological (study 1) and sexual (study 2) health outcomes. Study 1 (n = 368) found that experiencing IPV and RCA both significantly and uniquely contributed to poorer mental health outcomes. After controlling for age and IPV, RCA significantly predicted symptoms of depression, anxiety, stress, PTSD, and reduced satisfaction with life. Study 2 (n = 329) found that IPV and RCA differentially predicted various components of sexual health. IPV predicted decreased sexual satisfaction and increased sexual anxiety, depression, and fear of sexual encounters. After controlling for age and IPV, RCA significantly and uniquely predicted lower levels of sexual assertiveness and increased sexual depression and fear of sexual encounters, but not sexual satisfaction or anxiety. We conclude that RCA is associated with significant psychological distress and a negative sexual self-concept that may impact future relationships. Screening for both IPV and RCA across settings is warranted.

The impact of pharmacotherapy on sexual function in female patients being treated for idiopathic overactive bladder: a systematic review

BackgroundOveractive bladder (OAB) is a condition defined by urgency with or without incontinence which disproportionately affects female patients and has a negative impact on sexual enjoyment and avoidance behaviour. Pharmacotherapy can be considered one of the main options for treating OAB. This research set out to determine the impact of pharmacotherapy on sexual function in females with OAB.MethodsThis research used the robust methodology of a systematic review. The clinical question was formulated using the PICO (population, intervention, control, and outcomes) format to include females being treated with pharmacotherapy (anticholinergics or beta-3 adrenergic agonists) for idiopathic OAB with the use of a validated questionnaire assessing self-reported sexual function at baseline and post-treatment. The review incorporated the MEDLINE, PubMed and EMBASE databases. The AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) appraisal tool was used to guide the review process. Two reviewers worked independently in screening abstracts, deciding on the inclusion of full-texts, data extraction and risk of bias assessment.ResultsIn female patients with OAB, pharmacotherapy does seem to offer at least partial improvement in self-reported sexual function outcomes after 12 weeks of therapy. Still, the value of this finding is limited by an overall poor quality of evidence. Patients with a higher degree of bother at baseline stand to benefit the most from treatment when an improvement within this health-related quality of life domain is sought.ConclusionThis research should form the basis for a well-conducted randomized controlled study to accurately assess sexual function improvements in females being treated with pharmacotherapy for OAB.

Targeted microwave ablation for prostate cancer (FOSTINE1b): a prospective 'ablate-and-resect' study.

To assess histopathological outcomes, as well as feasibility and safety of targeted microwave ablation (TMA) via the Trinity® system (KOELIS, La Tronche, France). Prospective, single-institution, interventional Phase IIa study with an 'ablate-and-resect' design. In all, 11 patients diagnosed with localised prostate cancer (PCa) underwent TMA via the Trinity system under conscious sedation in an outpatient setting using a single transrectal TATO® 18-G antenna with different treatment regimens. Magnetic resonance imaging (MRI) and robot-assisted radical prostatectomy (RARP) were conducted at 7 days and 1 month after TMA, respectively. Nine patients received RARP, and two patients chose to withdraw their consent following TMA. These men chose an active surveillance protocol upon confirmation of a low-risk prostate cancer diagnosis. Functional outcomes and adverse events were evaluated at baseline and follow-up visits using validated questionnaires. Prostate volumetry and confirmation of necrosis were carried out through MRI and whole-mount histopathological examination. The TMA was successfully executed, and all patients were discharged on the same day. No severe adverse events (Common Terminology Criteria for Adverse Events Grade ≥3) were reported at the 7-day and 1-month follow-up visits. Additionally, no declines were observed in urinary, sexual and ejaculation functional outcomes. T1-weighted MRI revealed clear and well-defined ablation zones. The RARP was executed without difficulty, particularly during the dissection of the posterior plane. As a result, no intraoperative complications were encountered. Histopathological assessment on surgical specimens confirmed the absence of viable cells, indicating complete necrosis of the ablative zone if a power intensity >10 W was used during TMA. Ablation zone volumetry revealed no notable distinctions between the three-dimensional segmentation of the virtual ablation zone at TMA (median volume: 2 mL) and MRI (median volume: 1.923 mL). Conversely, a significant reduction was noted in the surgical specimen (median volume: 0.221 mL). Targeted microwave ablation via the Trinity system for localised PCa treatment proves to be a secure and feasible procedure, with complete necrosis evidence within the ablation zone on surgical specimens.

The relationship between social support and erectile dysfunction in middle-aged and older males.

Erectile dysfunction (ED) is a prevalent condition that affects middle-aged and older men, impacting their sexual health and overall wellbeing. We aimed to investigate the relationship between social support and ED among this specific population. Data were collected from the National Health and Nutrition Examination Survey. Social support was assessed through various dimensions, including emotional support, material support, and network support. Multivariate logistic regression was performed to examine the association between social support and ED, and a propensity-score-matched (PSM) analysis was further conducted. Among 1938 middle-aged and older males in the United States, 49.9% had a history of ED. ED was more prevalent in older individuals and those with comorbidities such as hypertension, prostate disease, higher serum creatinine level, and mental problems. Males with lower social support scores had a higher weighted rate of ED (P < 0.001). After adjusting for multiple variables in logistic regression analysis, a higher social support score was associated with a 19% lower likelihood of ED (weighted odds ratio [OR] 0.81, 95% confidence interval [CI] 0.66-0.98, P = 0.032). The association remained consistent after propensity score matching (OR 0.80, 95% CI 0.66-0.98, P = 0.028). Social support appears to be associated with a reduced risk of ED in middle-aged and older men. Further research is needed to better understand this relationship and explore interventions that enhance social support, potentially leading to improved sexual health outcomes.

Perioperative, Oncological, and Functional Outcomes Between Robot-Assisted Laparoscopic Prostatectomy and Open Radical Retropubic Prostatectomy: A Randomized Clinical Trial.

Limited high-quality studies have compared robot-assisted laparoscopic prostatectomy (RALP) vs open retropubic radical prostatectomy. We sought to compare their postoperative outcomes in a randomized setting. In a single center, 354 men with newly diagnosed prostate cancer were assessed for eligibility; 342 were randomized (1:1). The primary outcome was 90-day complication rates. Functional outcomes and quality of life were assessed over 18 months, and oncological outcomes, biochemical recurrence-free survival, and additional treatment over 36 months. From 2014 to 18, 327 patients underwent surgery (retropubic radical prostatectomy = 156, RALP = 171). Complications occurred in 27 (17.3%) vs 19 (11.1%; P = .107). Patients undergoing RALP experienced lower median bleeding (250.0 vs 719.5 mL; P < .001) and shorter hospitalization time. Urinary EPIC (Expanded Prostate Cancer Index Composite) median scores were better for RALP over 18 months, with higher continence rate at 3 months (80.5% vs 64.7%; P = .002), 6 months (90.1% vs 81.6%; P = .036) and 18 months (95.4% vs 78.8%; P < .001). Sexual EPIC and Sexual Health Inventory for Men median scores were higher with RALP up to 12 months, while the potency rate was superior at 3 months (23.9% vs 5.3%; P = .001) and 6 months (30.6% vs 6.9%; P < .001). Quality of life over the 18 months and oncological outcomes over 36 months were not significantly different between arms. Complications at 90 days were similar. RALP showed superior sexual outcomes at 1 year, improved urinary outcomes at 18 months, and comparable oncological outcomes at 36 months. Prospective Analysis of Robot-Assisted Surgery; NCT02292914. https://clinicaltrials.gov/ct2/show/NCT02292914?cond=NCT02292914&draw=2&rank=1.

A Novel Surgical Approach (Freya Technique) in Vulvar Labiaplasty: Inspired by the Fibonacci Sequence

Background: In this study, we aimed to introduce a new technique of labiaplasty and to evaluate the effect of this novel technique on female genital self-images, and sexual outcomes and to assess the feasibility of this novel technique. Methods: We conducted a single-center, retrospective study in 59 women who underwent labiaplasty and vaginoplasty (29 Freya approach technique, 30 classic technique) from 2020 to 2022. Both groups evaluated before (within 7 days) and after (1 month after) surgery with Female Sexual Function Index (FSFI) and Female Genital Self-Image Scale (FGSIS) questionnaires and all the patients received postoperative care and follow-up assessments for complications 7 days and 1 month after surgery. Results: The Freya approach technique was associated with a shorter operation time (p &lt; 0.05) and significantly lower postoperative Visual Analogue Scale (VAS) scores (p &lt; 0.001). Both techniques increased FSFI scores (p &lt; 0.001) and total FGSIS scores (p &lt; 0.001). With the exception of a few cases of wound dehiscence that necessitated surgical correction (n = 1), wound healing occurred without complications. The outcomes were deemed highly satisfactory both aesthetically and functionally (p &lt; 0.001). Conclusions: Freya approach technique is a simple and safe technique. It is effective in improving genital appearance and sexual satisfaction. Although this novel approach has similar satisfaction rates with other surgical techniques, it could be useful to reduce surgery time and postoperative pain.

A review of published studies on virtual reality in sexuality research.

Virtual reality (VR) technology contributes to greater approach of methodological safety to make ecological validity more feasible and a growing interest in sexuality behaviors. The aim of this study was to show VR in the sexuality area by a comprehensive review of outcomes, offer a synthesis of the studies, and make a methodological quality assessment of finding results. A secondary goal was to investigate the effect of immersion on diverse sexual responses outcomes. We designed a review based on a systematic review strategy describing types of studies, participants, data collection and outcomes; searched in 4 electronic databases (PubMed, EMBASE, PsycINFO, and SciELO), and made a full-text screening process. The study found 18 articles that met research criteria synthesized within 3 outcome groups: erection measures, level of immersion, and biomarker studies. Synthesis shows a lack of methodological aspects that impair results, such as description of methods from bias protection, randomization, or concealment. The literature still needs to improve its methodology, even though it already shows relevant data for intervention in sexual dysfunction, forensic psychiatry, sexual attraction, orientation, and use of pornography. Current methodological issues need better design to highlight relevant issues in sexuality with stronger quality of design, opening boundaries to new diagnostic or interventional technologies to sexual health.

Developing an Inclusive Model of Young Heterosexual and Sexual Minority Women’s Sexual Decision-Making

ABSTRACT Efforts to improve sexual health outcomes among young cisgender women require in-depth understanding of how women with diverse sexual identities make decisions about their sexual health. We conducted semi-structured interviews with 31 young cisgender women with diverse sexual identities and histories (age range 18–29 (M = 23.32); 81% White; 29% bisexual, 26% heterosexual, 16% lesbian, 13% queer, 10% pansexual, 3% gay, 3% demisexual) about their decision-making surrounding sexual risk reduction. By conducting thematic analysis, we found that, regardless of partner sex or gender, women adapted sexual health strategies based on how much commitment, trust, and communication existed in their relationships. Because heteronormative structural influences limited access to information and safer sex options, women had to rely on trust and communication more with other women and partners with vaginas, compared to men and partners with penises. Women did not consider safer sex strategies with partners with vaginas (e.g. hand washing) risk-reduction techniques; instead, they considered them general hygiene or a way to take care of a partner. We propose that an inclusive model of young women’s sexual decision-making should: (a) highlight the influence of relationships; (b) frame prevention in terms of overall health instead of pregnancy and STIs; and (c) acknowledge that structural factors, such as heteronormativity and sex-negativity, constrain women’s decisions.

Provision of sexual health education in secondary schools: A multidisciplinary lens of stakeholders in southern highlands, Tanzania

IntroductionSchool-based sexual health education reduces risky sexual outcomes for in-school adolescents such as unintended premarital pregnancies, unsafe abortions, increased risk of contracting sexually transmitted infections (STIs) including HIV and AIDS, early parenthood, a massive dropout from schools and untimely deaths. Despite the teaching of sexual health education in secondary schools, adolescents in Iringa Region are being exposed to increasing risks of sexual behaviours such as premarital sex, multiple sexual partners, and unprotected sex. This study examines stakeholders’ attitudes and beliefs toward providing sexual health education in secondary schools in Iringa Region, Tanzania. MethodsA qualitative approach under cross-sectional design was used. A purposive sampling technique was applied in selecting the Districts and participants for the study while simple random was used in the selection of schools. The participants were purposively selected depending on their position and knowledge of the subject matter. This study had 50 participants in total, 36 of them were teachers (6 from each school) who participated in focus group discussions (FGDs). After that, in-depth interviews with 14 participants were also conducted including 6 headmasters/mistresses, 6 healthcare professionals and 2 District secondary education officers. All FGDs and in-depth interviews used standardized questions to elicit information. The collected data were audio-recorded through tape recorders, transcribed, and translated into English. An initial coding matrix was developed and refined throughout the coding process. Transcripts were coded and analyzed using the content analysis approach. ResultsFindings from this study revealed all stakeholders having positive attitudes toward the provision of sexual health education in secondary schools. Results also revealed participants in favour of adolescents being taught several topics except for homosexuality. Findings on the appropriate age to start learning sexual health education revealed participants having trouble in fixing the right age, however, they said, at least 5 through 10 years before a child initiates sexual activity. ConclusionThe study concludes that stakeholders in the study areas have a positive attitude towards the provision of sexual health education in secondary schools and want students to be taught a wide range of topics before they initiate sexual activity. It is recommended that age-appropriate comprehensive sexuality education be given to teenagers to provide them with the knowledge they need to make informed decisions about their sexuality. This requires concerted efforts from the school, government and community involvement in the provision of sexual health education to in-school adolescents.

Empowering youth through sexuality and leadership education: Approaches and outcomes

Empowering youth through sexuality and leadership education is crucial for their holistic development and well-being. This paper provides an overview of approaches and outcomes related to empowering youth in these areas. Effective approaches to empowering youth through sexuality and leadership education include comprehensive sexuality education (CSE), youth-friendly services, peer education, and leadership training. CSE equips young people with accurate, age-appropriate information about sexuality, relationships, and reproductive health, enabling them to make informed decisions. Youth-friendly services provide confidential, nonjudgmental health services tailored to young people's needs. Peer education involves young people teaching their peers about sexual and reproductive health, encouraging open dialogue. Leadership training fosters skills such as communication, decision-making, and advocacy, empowering youth to become leaders in their communities. Empowering youth through sexuality and leadership education leads to various positive outcomes. It improves sexual and reproductive health outcomes, including reduced rates of unintended pregnancies, sexually transmitted infections (STIs), and HIV/AIDS. It also promotes gender equality and empowerment, as young people learn about their rights and how to challenge harmful gender norms. Additionally, sexuality and leadership education enhance young people's self-esteem, communication skills, and ability to make informed decisions, preparing them for future leadership roles. Empowering youth through sexuality and leadership education is essential for their development and well-being. By providing comprehensive education and support, we can help young people navigate challenges, make healthy choices, and become empowered leaders in their communities.

Do different sources of sexuality education contribute differently to sexual health and well-being outcomes? Examining sexuality education in Spain and Portugal

Sexuality education (SE) can be acquired through different sources. In a cross-sectional online study with Spanish and Portuguese participants ( N = 595), we examined differences between formal traditional sources (i.e., mandatory SE received in schools), formal modern sources (e.g., SE received in courses), informal traditional sources (e.g., talks with friends and family), and informal modern sources (e.g., pornography and online content) and their contribution to sexual health and well-being outcomes. Results showed that sexual and reproductive health were among the most addressed topics across all sources. Nearly all participants received SE from informal sources, whereas more than two-thirds received SE from formal traditional sources. Results of a linear regression model showed that participants who perceived more influence from formal traditional sources reported using condoms more often, were more focused on disease prevention, and enacted more sexual health communication, but were also less sex-positive. Participants who perceived more influence from both types of informal sources attributed more importance to SE topics but reported having condomless sex more frequently and were more focused on pleasure promotion. Still, participants who perceived more influence from informal traditional sources also endorsed more internal/external consent, were more sexually satisfied, were more sex-positive, and enacted more sexual health practices. Lastly, participants who perceived more influence from informal modern sources were also more likely to have been diagnosed with a sexually transmitted infection. Only a small proportion of participants received SE from formal modern sources and had to be excluded from this analysis. Some differences between Spain and Portugal are discussed. Taken together, our findings highlight the need to consider different sources for a more comprehensive and inclusive SE, in articulation with sociocultural and political contexts.

Esengo ya Bosembo ("Joy of Equity"): Development of an Advocacy Video to Reduce Stigma and to Promote Sexual and Reproductive Health and Rights of Women Sex Professionals in Pointe-Noire, Congo Republic.

Sex workers experience elevated risks of sexual and gender-based violence (SGBV) from intimate partners, clients, and community members that harms health and human rights. While SGBV contributes to poorer sexual and reproductive health (SRH) outcomes among sex workers, including elevated human immunodeficiency virus (HIV) vulnerabilities, stigma targeting sex workers reduces SRH service access and uptake. The Congo Republic is an exemplar context to address stigma toward sex workers. Sex workers' HIV prevalence (8.1%) in Congo Republic is double the national prevalence, yet research indicates that nearly one-fifth (17.2%) of sex workers in Congo Republic avoid health care because of stigma and discrimination. This Resources, Frameworks, & Perspectives article describes the process of developing Esengo ya Bosembo ("Joy of Equity"), a culturally tailored advocacy video that aims to reduce health care and community stigma toward women sex professionals (e.g., sex workers) in Pointe-Noire, Congo Republic. This knowledge translation product stems from a participatory mapping intervention with sex professionals in Pointe-Noire that revealed the need for sensitization tools and activities to reduce sex work stigma among health care providers and community members. The video incorporates three overarching key messages: (1) sex professionals are human beings with equal rights to dignity, protection, and health services; (2) elevated risks of SGBV and stigma targeting sex workers reduce SRH service access and uptake; and (3) participatory mapping is a potential way to empower sex professionals to share their experiences and recommendations for change. This article details how health promotion practitioners and sex professionals may use the video to advocate for change.

Minimally invasive surgical therapies for benign prostatic hyperplasia in the geriatric population: A systematic review.

Geriatric patients, prone to adverse events (AEs) and low compliance with drugs, may benefit from minimally invasive surgical therapies (MISTs) for managing benign prostatic hyperplasia (BPH). We evaluated the efficacy, safety, and procedural characteristics of MISTs in geriatric patients with BPH. PubMed/MEDLINE database was systematically searched for relevant articles through October 1, 2023. Eligible studies focused on geriatric patients (≥65 years) with BPH who were treated with MISTs and evaluated follow-up surgical, micturition, and/or sexual outcomes. Studies were included if there was separate reporting for age subgroups ≥65 years, or if the mean age minus standard deviation was ≥65 years, or if the first quartile was ≥65 years. Out of 292 screened studies, 32 (N = 3972 patients) met inclusion criteria and assessed prostatic artery embolization (PAE), Rezum, GreenLight, holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP), diode laser enucleation of the prostate (DiLEP), and Aquablation. Except for Rezum, all MISTs required a planned overnight stay. While PAE and Rezum could be performed under local anesthesia, the other MISTs needed general or spinal anesthesia. Postoperative catheterization duration was longest for PAE (median 14 days) and Rezum (21 days) and shortest for GreenLight (1.9 days). At 12 months postoperatively, all MISTs exhibited significant percent changes in International Prostate Symptom Score (median -69.9%) and quality of life (median -72.5%). Clavien-Dindo Grade 1 AEs ranged widely, with PAE (5.8%-36.8%), Rezum (0%-62.1%), and GreenLight (0%-67.6%) having the largest range, and HoLEP (0%-9.5%), ThuLEP (2%-6.9%), and DiLEP (5%-17.5%) having the smallest. PAE, Rezum, DiLEP, and Aquablation reported no significant changes in the International Index of Erectile Function. Although all the MISTs reviewed in this study effectively treat BPH in geriatric patients, differences in procedural characteristics and safety profiles across MISTs were considerable. Physicians should use shared decision-making processes, considering risks and patient characteristics, when choosing a suitable treatment option for their patients.