Women's Sexual Health Research Articles

Llegar a ser matrona en España. Parte I

The midwife's field of competence is related to women's sexual and reproductive health care from a holistic perspective, based on a salutogenic model and the promotion of physiology. It is a professional recognized by the World Health Organization and European health institutions for its impact on improving reproductive health and its contribution to the sustainability of health systems. The midwifery profession has traditionally been an independent profession from the nursing profession and continues to be so in other European countries. In Spain, since 1953, midwifery has been considered a nursing specialty, which was integrated into the Specialized Health Care Training model in 1992. Its legal framework is regulated by the regulations applicable to Specialized Health Training, the European regulations on competencies and training of midwives, their transposition into Spanish legislation and the training program for the specialty of midwifery.

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.

Sexual health and intimacy after cancer treatment in women of color: A systematic review.

Cancer diagnosis and treatment can significantly affect women's sexual health and intimacy, leading to diminished quality of life in survivorship. The perspectives and experiences of women of color (WOC) with cancer are critical to inform comprehensive, inclusive sexual wellbeing care in survivorship. The purpose of this systematic review is to summarize contemporary literature describing sexual wellbeing experiences of WOC treated for cancer. A comprehensive search of CINAHL, PubMed, Embase and PsycInfo and Scopus identified studies that addressed sex and intimacy of U.S. WOC treated for cancer published in the last 15years. The authors identified emergent themes from the literature through thematic content analysis. Eighteen studies (10 qualitative, 8 quantitative) met the inclusion criteria, all with breast or gynecologic cancer samples. Studies include African American (13), Asian American (3), and Latina (10) women, as well as Non-Hispanic Whites and 'other' race/ethnicity women. Overarching themes identified were: 1) impacts of treatment on sexual health and body image, 2) process of accepting and overcoming, 3) value of an engaged and supportive partner, and 4) current clinical practice and barriers to sexual health care. WOC experience changes in sex and intimacy after cancer treatment, and experiences of sexual function, sexual communication, and sexual healthcare are often shaped by sociocultural experiences. An understanding of WOC's sexual health and intimacy after cancer treatment can inform inclusive, culturally responsive sexual health interventions.

Design and psychometric properties of a questionnaire for assessing sexual and reproductive health needs of married adolescent women: an exploratory sequential mixed methods study

To date, there is no valid and reliable instrument to specifically evaluate married adolescent women's sexual and reproductive health (SRH) needs. Hence, the aim of this study was to develop and evaluate the psychometric properties of a questionnaire for assessing married adolescent women (MAW)'s SRH needs. The current exploratory sequential mixed method study was performed in two phases. In the first phase, a preliminary questionnaire was developed based on in-depth interviews with 34 MAW and four key informants as well as a comprehensive literature review. In the second phase, validity of the questionnaire was assessed using face, content, and construct validity and reliability of the questionnaire was assessed using internal consistency and test–retest reliability. Based on qualitative content analysis and literature review, 137 items were extracted. After several modifications of the generated items, a 108-item questionnaire was prepared for the psychometric process. After checking face and content validity, 85 items remained in the study. In the exploratory factor analysis, 11 items were removed and the remaining 74 items were categorised into nine factors. Cronbach's alpha coefficient and the intraclass correlation coefficient were found to be 0.878 and 0.99 for the whole scale, respectively. Impact Statement What is already known on this subject? Sexual and reproductive health (SRH) needs of married adolescent women (MAW) are different from those of married adult women or unmarried, sexually active adolescents. However, there are to date no valid and reliable instruments to specifically evaluate the SRH needs of this group of women. What do the results of this study add? The final version of questionnaire consists of 74 items in nine domains including need to improve MAW's sexual quality of life, promote MAW's SRH self-care, improve MAW's SRH self-efficacy, increase MAW's SRH knowledge, increase husband's involvement in MAW's SRH, improve the performance of health care providers, strengthen the family support to married adolescent women, improve family involvement in SRH education of MAW, and provide specific premarital counselling to MAW. What are the implications of these findings for clinical practice and/or future research? The 74-item questionnaire has acceptable validity and reliability. Therefore, it can be used by researchers and policymakers as an appropriate instrument for assessing MAW's SRH needs.

Intimate Partner Violence and Its Predictors among Pregnant Women in Eastern Ethiopia: Generalized Structural Equation Modeling.

Introduction Intimate partner violence (IPV) has a negative impact on women's physical, mental, sexual, and reproductive health. Identifying the determinant factors of IPV among pregnant women is of paramount importance to overcome its negative consequences thereby increasing the performance of women in all activities. Thus, this study applied a generalized structural equation model (GSEM) to determine the prevalence of intimate partner violence among pregnant women and its predictors in Eastern Ethiopia. Methods A community based cross-sectional study was conducted in Kersa Health and Demographic Surveillance System (KHDSS), Eastern Ethiopia. Data were collected form a sample of 1051 pregnant women using structured questionnaires. Descript findings were presented in percentage with 95% confidence interval. The generalized structural equation model was used to determine factors associated with each domain of IPV (physical, emotional, and social violence). Adjusted odds ratio (AOR) with a 95% CI were used to declare significant factors associated with intimate partner violence. Results The overall prevalence of IPV in the Eastern Ethiopia was 48.57% (95% CI: 45.45, 51.69). The highest intimate partner violence was observed in the sexual domain of IPV (31.6%, 95% CI: (28.8, 34.58)). In GSEM, being a farmer (AOR = 0.42, 95% CI: 0.19, 0.91) was significantly associated with psychological domain of IPV. Age (AOR = 0.97, 95% CI: 0.95, 0.99) and educational status (neither read nor write) (AOR = 2.50, 95% CI: 1.61, 3.89) were significantly associated with physical domain of IPV. Being in medium (AOR = 0.64, 95% CI: 0.46, 0.90) and rich (AOR = 0.53, 95% CI: 0.36, 0.78), wealth quintiles were significantly associated with sexual domain of IPV, whereas husband controlling behavior was significantly associated with all domains of IPV. Conclusions The magnitude of IPV among pregnant women was relatively high in Eastern Ethiopia. This finding pin a light to pay special consideration to pregnant women at each point of service delivery to alleviate consequence of IPV. Being a farmer, older ages and being in higher wealth quintiles were protective factor, whereas being uneducated increase the risk of IPV. Improving socioeconomic status and promoting legal rights of women is needed to alleviate the problem, and younger women require special attention.

Sexual Medicine Programs for Women Across the Life Span: Lessons Learned from a New Initiative in a US-Based Academic Medical Center

ABSTRACT Introduction In a self-report study of women presenting to a gynecological clinic, 9 out of 10 women reported a sexual health concern (Nusbaum 2003). These concerns are best addressed using a biopsychosocial approach to assessment, treatment and prevention drawing on medical, behavioral and psychological science. At an academic health center in the United States, The Women's Sexual Health Consultation Service was launched in 2019 to provide evaluation, education, treatment and prevention interventions using an integrated practice model. The interdepartmental program currently includes an Advanced Practice Nurse from the Department of Obstetrics and Gynecology as well as two clinical health psychologists from the Department of Psychiatry all with expertise in women's health and women's sexual medicine. Our interprofessional team collaborates closely with providers in women's primary care, medical, gynecologic and radiation oncology, urogynecology, colorectal surgery, among others. Objective Review lessons learned from interdepartmental program design, funding, implementation, and evaluation of the Women's Sexual Health Consultation Service in an academic health center, summarize the types of sexual health concerns among women who presented to the integrated service, and highlight recommendations to generalize and/or adjust the program model to other types of health settings. Methods Review the program implementation and evaluation process for the Women's Sexual Health Consultation Service, summarize the data on the women seen for care from April 23 2019 through June, 2021 (e.g., the number of unduplicated patients evaluated, their age, sexual health concerns, and treatment offered, etc), and outline program challenges and strategies to sustain and expand the initiative during and following the COVID-19 pandemic through virtual and in-person care. Results The Women's Sexual Health Consultation Service saw 198 women from April 23 2019 through June, 2021. Patients ranged in age from 21 to 72 (mean: 45 years). While most patients (33%) referred themselves to this program, other women were referred by obgyns, medical oncologists, women's primary care providers and gynecologic oncologists. Primary sexual health concerns included one or more of the following issues: pain (100), low desire (76), difficulty with orgasm (19), difficulty with arousal (12) and other (55). Additional findings will be presented on the types of treatment offered as well as patient and referring provider satisfaction with the new integrated sexual health consult service. Conclusions Our interdepartmental Women's Sexual Health Consultation Service implemented a highly successful program that integrates sexual medicine, behavioral health, health psychology and sexual therapy to ensure access to state-of-the-art interprofessional education and care for women across the life span in all their diversities. We were able to sustain and expand this program through telehealth and in-person visits during the COVID-19 pandemic, and anticipate further growth in patient referrals and treatment modalities moving forward. Providers across disciplines also routinely refer to and collaborate with the program. Several components of the model are generalizable or adjustable to other women's health settings. Disclosure No

Availability, Quality, and Implementability of Canadian Clinical Practice Guidelines for Female Sexual Dysfunction

ABSTRACT Introduction Sexual health problems are common among Canadian women, though they often go unaddressed and untreated in clinical settings. Clinical practice guidelines (CPGs) are systematically developed statements that facilitate structured, evidence-based guidance for specific clinical circumstances. Their potential benefits to patients and practitioners are dependent upon comprehensive guideline development processes that consolidate best available evidence, and guide successful implementation into practice. Little is known about the curation, availability, quality, and implementability of Canadian CPGs for women's sexual health problems and female sexual dysfunction (FSD). Objective i) To determine the availability of protocols guiding the curation of Canadian CPGs ii) To assess the availability, quality, and implementability of Canadian CPGs for women's sexual health concerns and FSD. Methods A systematic search for publicly available documents referencing Canadian CPG development processes was conducted. Websites associated with provincial and national health bodies, in addition to relevant professional medical organizations, and electronic databases PubMed and Google Scholar were searched. A separate search was conducted to retrieve Canadian CPGs specific to women's sexual health and FSD using similar methodology. FSD CPGs that met the criteria of including recommendations on FSD screening, management, and resources went on to subsequent analyses using the AGREE-II and AGREE-REX tools to assess CPG quality and implementability, respectively, and qualitative content analysis to identify the scope and thematic content of the CPGs. Results Two national guidelines for Canadian CPG development were identified. 3/13 Canadian provinces and territories had protocols outlining processes for general CPG development. National and provincial documents varied in their recommended methodologies for CPG curation and updating evidence suggesting a lack of standardization. Two Canadian CPGs specific to FSD and sexual concerns were identified: one from the Canadian Urological Association, and one from the Society of Obstetrics and Gynecology of Canada (SOGC). Only the SOGC guideline contained information regarding screening, management, and resources for FSD, and thus underwent subsequent analysis. The SOGC guideline scored highly with respect to the domains of Scope and Purpose (79%), and Clarity of Presentation (86%), though it did not sufficiently address the remaining AGREE-II domains, scoring lowest in Applicability (44%) and Editorial Independence (13%). AGREE-REX scoring was 58%, suggesting it was moderately implementable. Qualitative analysis revealed a focus on the importance of healthcare providers ensuring they have the necessary skills and knowledge to assess and manage sexual health problems, though the details of these skills and knowledge were not consistently defined. Conclusions There is a lack of standardization of the process of CPG curation in Canada and limited Canadian CPGs guiding best practices for screening and management of FSDs, and provision of additional resources. This study highlights the strengths and deficiencies in the current Canadian CPGs for FSD. Canadian CPG developers should consider FSD a topic of priority and continue to make attempts to curate comprehensive, evidence-based CPGs in this field that are implementable in all local Canadian contexts. The ISSWSH Process of Care for the Identification of Sexual Concerns and Problems in Women may serve as a valuable resource in improving Canadian-specific FSD CPGs. Disclosure No

Female Sexual Dysfunction Resources: Women and Healthcare Providers Need More Options

ABSTRACT Introduction Female sexual dysfunction (FSD) is an orphaned field due to numerous barriers faced by both providers and patients. Internet platforms, such as mobile applications, are potential tools to overcome these barriers and improve patient access to education and management options for FSD. Objective The purpose of this review is to identify existing applications addressing female sexual health and evaluate their educational content and services. Methods We searched the internet and Apple App Store for key words including: “sexual wellness app for women”, “female sexual health app”, “best sex apps for women”, “sexual health for women”, “sexual health”, “sexual wellness”. A panel of female pelvic medicine and reconstructive surgery experts reviewed the apps for quality of content, scientific basis of provided information, interactivity, usability and whether they would recommend it as a reference tool for patients. Results Of the 204 apps identified, 182 were excluded based on unrelated content (sex frequency trackers, ovulation trackers, sex games for couples, etc.). Two applications did not work and three were meant to be used with a vibrator. Total of 17 apps were analyzed and divided into five categories: educational (6), emotions and communication (2), relaxation and meditation (4), general sexual health (2), and social and fun (3). Among these 17 apps, eight required either a one-time payment ($4.99- 9.99) or annual subscription ($23-120) and two apps were advertisement driven. The apps from the educational category were reviewed in further details. All of the educational apps provided scientific information in collaboration with health experts, however only three offered interactive features. When assessed for usability, one app received good (70) and five received excellent (97.5) scores based on the System Usability Scale (SUS). The majority of the apps (5) provided information on pathology and treatments of orgasmic dysfunction, but only one app, created by a physician, provided information on all categories of female sexual dysfunctions. The reviewers identified only one app that they would recommend as a credible resource for patients to use. Conclusions Internet apps provide an ideal platform for women to learn about sexual health and female sexual dysfunction, which is rarely addressed by their healthcare providers. Apps may also serve as a valuable reference for providers. Our review of relevant apps available on the Apple App Store revealed only six with evidence-based information, and only one that would be recommended to patients by experts in the field. Clearly, there is a need for more accessible, educational resources addressing female sexual dysfunction for patients and providers. Disclosure No

Incarcerated Women: Need to Address Sexual Health

ABSTRACT Introduction Incarceration, which affects more than 200,000 women annually, has a multidimensional negative impact on these women's health and wellbeing, including their sexual health. Sexual satisfaction, defined as a subjective evaluation of a sexual relationship, depends on several sociocultural and biopsychological factors, including the individual's physical and mental health, their schooling, and the intimacy setting. These factors are exacerbated in correctional facilities. Most obvious, is the women's lack of a desirable settings for sexual intimacy. It is essential to maintain sexual function in prison as women continue to be sexual beings with sexual needs. Despite this need, there are few initiatives addressing sexual health in incarcerated women, which is known to impact general and mental health, family function, and recidivism. The NJ Commission on Women's Reentry (NJCWR) was legislated to address the health and wellness of both incarcerated and reentry women, including their sexual health. Objective To study incarcerated women's sexual health and the impact of incarceration. Methods A Literature review was conducted on sexual function in US correctional facilities by searching PubMed/Medline and Google Scholar. Relevant publications were sought using keyword combinations including, "sexual function," "sexual satisfaction," "conjugate visits," "incarcerated women," "mental health," "general health," and "US correctional facilities." Results Correctional facilities often enforce abstinence on incarcerated women and adopt deprivation as a measure to resolve sexual desires during incarceration. Additionally, limited knowledge is available about the quality of sexual experiences in the small number of facilities that provide conjugal visits. The available literature shows high levels of sexual dysfunction amongst incarcerated women that is significantly correlated with an increase in mental health issues, aggression, and recidivism. Data suggest that sexual deprivation is more significantly associated with mental health disorders than partner status and romantic relationships. Incarcerated individuals have expressed the lack of sexual contact as "sexual torture." Alternative methods sought may be coercive, less satisfactory, and/or riskier behaviors, possibly leading to transmission of sexual diseases. Only six states allow conjugal visits even though it is a suggested solution with primarily benefits including lower sexual offenses, rape, and disciplinary records in prison. However, many facilities that permit conjugal visits lack private space for the couple. Conclusions Determinants of sexual health include complex cognitive, emotional, and physiological processes. Sexual deprivation and dysfunction dehumanize incarcerated women and negatively affect sexual health, in addition to overall general health. Sexual function and satisfaction is a primarily understudied area in the carceral system, considering all of the barriers to sexual expression. It is imperative for more initiatives, such as those being carried out by the NJCWR, in order to effectively address the needs of incarcerated women, including their sexual health. Disclosure No

Surgical Outcomes of PGAD/GPD Patients with Sacral Radiculopathy Associated with Tarlov Cyst

ABSTRACT Introduction In 2012, Komisaruk and Lee introduced the concept that a bothersome women's sexual health issue associated with catastrophization and suicidal ideation, currently defined as Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD), could be mediated by sacral radiculopathy from Tarlov cysts in the cauda equina. To more safely and effectively manage PGAD/GPD patients in our facility with such suspected cauda equina pathology, a robust collaboration was developed in 2016 among specialists in sexual medicine, spine surgery and neurophysiology. A management algorithm was developed to select appropriate patients for surgical treatment. Objective The aim of this study is to review the treatment outcome of PGAD/GPD patients with sacral radiculopathy associated with Tarlov cysts in the cauda equina selected by our collaborative management algorithm. Methods Charts from 2015 to 2021 of PGAD/GPD patients presenting to our sexual medicine facility were reviewed. Patients who met the definition of PGAD/GPD in the broadest sense were included. They all experienced unwanted, unrelenting, distressing dysesthesia symptoms (e.g. arousal, pain and/or itching) in the genito-pelvic region lasting >3 months. The management algorithm was used to identify those PGAD/GPD patients with sacral radiculopathy from a surgically treatable sacral Tarlov cyst. The algorithm included: i) ruling out triggers in the end organ and pelvic/perineum regions; ii) performing neurogenital testing to identify patients with test results consistent with sacral radiculopathy; iii) reading sacral MRIs during regular collaborative meetings to identify patients with a surgically treatable sacral Tarlov cyst; and iv) performing a caudal block with an anesthetic agent to assess for temporary clinically significant PGAD/GPD symptom reduction. Those patients who met these selection criteria and underwent an imbricating Tarlov cyst procedure using minimally invasive spine surgery techniques were followed for at least 6 months. Results Ten patients (8 women, 2 men), mean age 40 years (range 19 - 66), met inclusion criteria. Patients were discharged the same day or the next morning post-operatively. There were no serious complications. Follow-up was > 6 months (range 6 - 16 months). A total of 7 (70%) patients reported post-operative clinical improvement on PGI-I at last follow up. Two patients reported “very much better”, three patients reported “much better” and two patients reported “little better”. Two patients had no improvement. One patient was much worse; it is believed that the PGI-I score of 6 reflects the worsening of the PGAD/GPD condition and not a specific result of the surgical procedure. Conclusions Cauda equina pathology from Tarlov cysts can cause distressing PGAD/GPD from sacral radiculopathy. Collaboration among sexual medicine, spine surgery and neurophysiology specialists enabled an effective management algorithm to identify and treat appropriate PGAD/GPD patients with sacral radiculopathy having a surgically treatable sacral Tarlov cyst. Imbricating the Tarlov cyst using minimally invasive spine surgery techniques is associated with a 70% clinical improvement in these select patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Elliquence and Lumenis

#Menopause: The Menopause Ontology Project

ABSTRACT Introduction Medical professionals and patients increasingly utilize social media to connect and share healthcare information. Twitter is a popular social media platform with 186 million users in 2020 alone. Twitter users employ hashtags-terms or phrases proceeded by the “#” symbol-to aggregate data about related subjects. Hashtag ontologies are groups of hashtags used to standardize terminology and facilitate easier communication. Objective To create a hashtag ontology specific to menopause. Methods This study analyzed tweets including the hashtag #menopause between November 2019 and November 2021 to identify co-occurring hashtags related to menopause. Tweets performed by the International Society for the Study of Women's Sexual Health, North American Menopause Society, International Menopause Society, and International Society of Sexual Medicine amongst others were included in analysis. To analyze hashtag utilization amongst all Twitter users, hashtags from the “Top” tweets Twitter search function from October 2021 were also analyzed. Co-occurring hashtags were recorded as well as the type of user who performed the tweet during the “Top” tweets analysis. The Society of Gynecologic Surgeons hashtag ontology was also reviewed as a cross reference and for completeness. Social media influencers and experts reviewed and edited the hashtag list. The hashtags were then grouped by subject and the ontology was finalized. Results We analyzed three-hundred eighty-two tweets with #menopause. Major societies produced 231 tweets and expert influencers produced 53 tweets. Using the “Top” tweets search function from October 2021, we identified 98 additional tweets. Of the users included in the “Top” tweets, 40% were patient advocates or advocacy groups; 38% were medical professionals, academics, societies, or journals; and 22% were general users. In total, 123 unique hashtags were identified. After social media influencer and expert review, 32 hashtags were included in the final ontology. The ontology was then grouped into the following categories based on subject matter: general, premature menopause, hormones, sexual function, and genital disorders. The finalized ontology appears in Table 1. Conclusions Social media is an important tool for medical professionals and patients. Our study is the first to develop a hashtag ontology specific to menopause. Adoption of a hashtag ontology with standardized terminology by medical professionals may facilitate easier communication with peers and patients. Disclosure No

College Women, Sex, and Drinking: Examining the Impact of Pre-sex Alcohol Consumption in Consensual Sexual Encounters

ABSTRACT Introduction College is a time of sexual exploration and experimentation for many emerging adults. Sex and alcohol use frequently co-occur on college campuses. Research and theory predict that alcohol catalyzes sexual responding and enjoyment, despite evidence linking alcohol with negative sexual outcomes. Because of this apparent paradox, research examining different facets of post-drinking sexuality continues to warrant attention. Objective The purpose of this study is to examine whether alcohol-involved sexual encounters differ from non-alcohol-involved ones in terms of sexual distress, sexual functioning, and sex-related consequences. Methods First- and second-year college women (N = 389) were enrolled in a longitudinal study on college women's alcohol use and sexual health. Inclusion criteria included having sex with a man and drinking alcohol in the 3 months prior to study enrollment. Study participation entailed the completion of a baseline survey and follow-up surveys at 6 and 12 weeks. At each timepoint, participants answered event-specific questions regarding their most recent sexual encounter. Participants who reported at least one sexual encounter over the course of the study (n = 351) were included in analyses. Participants completed measures of sexual distress and sexual consequences. Sexual functioning and satisfaction were measured using the Monash Female Sexual Satisfaction Questionnaire. Estimated blood alcohol concentration (e-BAC) at the time of the sexual encounter was also calculated. Results Across the study, participants reported 758 unique sexual encounters, ranging from 1-3 events per participant (M = 2.16, SD = .84). Alcohol was consumed in 429 (57%) of the sexual encounters reported. Most encounters took place with a partner with whom the participant had sex previously (83%) and with a boyfriend (62%). Encounters that were preceded by alcohol consumption were more likely to be with a new partner, X2(1, N=745) = 17.68, p < .001, or non-boyfriend, X2(1, N=737) = 57.98, p < .001. Most encounters (86%) included receptive vaginal or anal penetration. Among those who drank prior to the sexual encounter, e-BAC ranged from .00 to .27% (M = .06, SD = .06). Alcohol-involved sexual encounters led to fewer positive sexual consequences, t(692) = 2.54, p = .003 and with higher sexual distress, t(720) = .689, p = .012. There was a trend toward more negative sexual consequences (e.g. concern about STIs, unwanted pregnancy, worsened mood) following alcohol-involved encounters, t(660) = -1.37, p = .044, though this difference is not significant following Bonferroni correction (α = .013). There were no significant differences in overall sexual functioning. Conclusions Sex under the influence of alcohol is common among college women and is associated with more distress and fewer positive consequences than sober sexual encounters. Women who drink prior to sex may do so for a variety of reasons, including to enhance sexual pleasure or to cope with distress or anxiety around sex. Sexual health professionals are encouraged to query patients about their alcohol use, particularly in sexual contexts, and to provide psychoeducation and alternative strategies to enhance sexual experiences without alcohol. Disclosure No

Exploring the Role of Provider-Patient Communication in Women's Sexual Health and Pre-Exposure Prophylaxis Care in the Primary Care Settings in New York State of the United States.

Background: Women shoulder a disproportionate burden of HIV infection in the United States and worldwide. Pre-exposure prophylaxis (PrEP) is an effective tool for HIV prevention, but its use is suboptimal. Primary care providers (PCP) are considered the ideal PrEP caregivers, but they generally underperform in PrEP care implementation. Methods: From 2020 to 2022, we employed semi-structured in-depth interviews to collect information about barriers and facilitators in PrEP care and beliefs and opinions regarding sexual wellness among 18 PCP and 29 PrEP-eligible women. We employed content analysis and thematic analysis to explore the transcribed narrative data. Results: The current study was guided by the “Communication Pathways” Framework. We studied how communication functions affect PrEP care and women’s sexual wellness on the pathways. We identified several specific pathways between communication and PrEP care implementation in primary care settings, including patient knowledge, linkage to care, therapeutic alliance, and decision making on PrEP care. A paradox regarding who should initiate the discussion regarding sexual history and PrEP care was identified. Conclusions: Findings suggested that a navigation and assistance system for PrEP care in patients and providers is urgently needed. Future studies should facilitate PrEP discussion, engagement, and monitoring in primary care settings.

CEZAEVİNDE KALAN KADINLARIN ÜREME SAĞLIĞI/CİNSEL SAĞLIK DURUMLARI: SİSTEMATİK DERLEME

Bu sistematik derleme ile cezaevindeki kadınların cinsel sağlık ve üreme sağlığı sorunlarının araştırıldığı çalışmaların gözden geçirilmesi ve sağlık alanında yapılacak araştırmalara taban oluşturarak cezaevinde kalma sürecinin kadın cinsel sağlığı ve üreme sağlığına ilişkin verilerinin incelenmesi amaçlanmıştır. Çalışmada literatür taraması anahtar kelimeler “prison; health; woman; sexual”, “prison; health; woman; reproductive health ”, “cezaevi; kadın; üreme sağlığı” ve “cezaevi; kadın; cinsel sağlık” kullanılarak 2005-2021 yılları arasında yayımlanmış Pub-Med, Science Direct, Google Akademik ve Ulusal Tez Merkezi veri tabanındaki 12 çalışmaya odaklanılmıştır. Bu sistematik inceleme, meta birleştirme yaklaşımı ve meta-analiz için tercih edilen raporlama öğeleri olan PRISMA akış şeması adımları kullanılarak gerçekleştirilmiştir. Metodolojik çalışmayı değerlendirirken kontrol listesi tercih edilmiş ve en iyi kanıt sentez analizi yapılmıştır. Araştırmanın sonuçları değerlendirildiğinde cezaevi sürecinin kadınların cinsel sağlık ve üreme sağlıkları üzerinde birçok yönden olumsuz etkilerinin olduğu görülmektedir. Ayrıca bu alanda metodolojik olarak daha iyi tasarlanmış çalışmalara ihtiyaç olduğu ortaya çıkmıştır.

The Effect of the Transtheoretical Model-Based Healthy Youth Program on Sexual Health Knowledge and Behavior of College Women

College women are at more risk in terms of sexual behavior than male students. This study was carried out to determine the effect of the transtheoretical model-based Healthy Youth Program on college women's sexual health knowledge and behaviors. The sample of the study, which was conducted with a one-group pretest-posttest quasi-experimental design, consisted of 207 first-year college women. It was determined that the Healthy Youth Program was effective in improving the sexual health knowledge and behaviors of college women. It can be used as a guide in sexual health education in colleges.

PrEP-aring the General Gynecologist to Offer HIV Pre-exposure Prophylaxis.

It is estimated that 450,000 American women are at increased risk of infection with human immunodeficiency virus (HIV), and yet only 7% have a prescription for pre-exposure prophylaxis (PrEP). PrEP is a safe and effective method of HIV infection prevention via a daily use of an oral combination antiretroviral pill or longer-acting intramuscular injections. Gynecologists are experts in women's sexual health, and provide over half of annual preventative health visits, but are not yet routinely providing PrEP to patients, citing lack of knowledge as a major barrier. The authors aim to provide the general gynecologist with the skills to expertly provide PrEP to their patients to reduce HIV infection.

Sexual Health and Women Living With Spinal Cord Injury: The Unheard Voice.

Women's sexual health within the context of sexual function and psychosocial dimensions while living with a spinal cord injury (SCI) has rarely been discussed separately from men living with a SCI or from a collective with other chronic conditions. To date, over 64,000 women in the U.S. are currently living with SCI, with total numbers increasing each year, as well as the demographics shifting to include more diversity in race and incidences occurring later in life. On average, SCI tends to be acquired during the childbearing years (~30–50 years old), as well as when women experience other health concerns associated with aging, including perimenopause and menopause. Additionally, women's sexual health is often conceptualized from the position of the absence of disease and dysfunction. However, consistent with definitions furthered by the World Health Organization (WHO) and World Association of Sexual Health (WAS), we believe women's sexual health is multifaceted, moving beyond a focus on reproduction to also encompass sexual function and the psychosocial dimensions of sexual health both living with and without disabling conditions and diseases. Within this lens, we present prior research that has been conducted, conclusions from these studies, implications for practice, and recommendations for future research. Thus, the paper will expand the understanding of both sexual function and psychosocial dimensions for women living with SCI.

Sexual medicine programs for women across the life span: Lessons learned from a new initiative in a US-based academic medical center

ABSTRACT Introduction In a self-report study of women presenting to a gynecological clinic, 9 out of 10 women reported a sexual health concern (Nusbaum 2003). These concerns are best addressed using a biopsychosocial approach to assessment, treatment and prevention drawing on medical, behavioral and psychological science. At an academic health center in the United States, The Women's Sexual Health Consultation Service was launched in 2019 to provide evaluation, education, treatment and prevention interventions using an integrated practice model. The interdepartmental program currently includes an Advanced Practice Nurse from the Department of Obstetrics and Gynecology as well as two clinical health psychologists from the Department of Psychiatry all with expertise in women's health and women's sexual medicine. Our interprofessional team collaborates closely with providers in women's primary care, medical, gynecologic and radiation oncology, urogynecology, colorectal surgery, among others. Objective Review lessons learned from interdepartmental program design, funding, implementation, and evaluation of the Women's Sexual Health Consultation Service in an academic health center, summarize the types of sexual health concerns among women who presented to the integrated service, and highlight recommendations to generalize and/or adjust the program model to other types of health settings. Methods Review the program implementation and evaluation process for the Women's Sexual Health Consultation Service, summarize the data on the women seen for care from April 23 2019 through June, 2021 (e.g., the number of unduplicated patients evaluated, their age, sexual health concerns, and treatment offered, etc), and outline program challenges and strategies to sustain and expand the initiative during and following the COVID-19 pandemic through virtual and in-person care. Results The Women's Sexual Health Consultation Service saw 198 women from April 23 2019 through June, 2021. Patients ranged in age from 21 to 72 (mean: 45 years). While most patients (33%) referred themselves to this program, other women were referred by obgyns, medical oncologists, women's primary care providers and gynecologic oncologists. Primary sexual health concerns included one or more of the following issues: pain (100), low desire (76), difficulty with orgasm (19), difficulty with arousal (12) and other (55). Additional findings will be presented on the types of treatment offered as well as patient and referring provider satisfaction with the new integrated sexual health consult service. Conclusions Our interdepartmental Women's Sexual Health Consultation Service implemented a highly successful program that integrates sexual medicine, behavioral health, health psychology and sexual therapy to ensure access to state-of-the-art interprofessional education and care for women across the life span in all their diversities. We were able to sustain and expand this program through telehealth and in-person visits during the COVID-19 pandemic, and anticipate further growth in patient referrals and treatment modalities moving forward. Providers across disciplines also routinely refer to and collaborate with the program. Several components of the model are generalizable or adjustable to other women's health settings. Disclosure Work supported by industry: no.

Breast Cancer Patients’ Experience and Wishes Regarding Communication on Sexual Health: The BEROSE Study

BEROSE is a single-center observational study, which aimed to determine the proportion of women with breast cancer who received information on sexual health from health professionals throughout their whole care pathway. A total of 318 women with all stages of breast cancer (30% metastatic) and at different time interval from diagnosis (up to 7 years) participated to the survey. Sixty-five percent of women reported that they had not received any information about sexual health over the whole care. Increased awareness among the healthcare professionals and particularly the oncology community is needed to discuss sexual health in women with breast cancer.

Major revision version 11.0 of the European AIDS Clinical Society Guidelines 2021.

BackgroundThe European AIDS Clinical Society (EACS) Guidelines were revised in 2021 for the 17th time with updates on all aspects of HIV care.Key points of the Guidelines updateVersion 11.0 of the Guidelines recommend six first‐line treatment options for antiretroviral treatment (ART)‐naïve adults: tenofovir‐based backbone plus an unboosted integrase inhibitor or plus doravirine; abacavir/lamivudine plus dolutegravir; or dual therapy with lamivudine or emtricitabine plus dolutegravir. Recommendations on preferred and alternative first‐line combinations from birth to adolescence were included in the new paediatric section made with Penta. Long‐acting cabotegravir plus rilpivirine was included as a switch option and, along with fostemsavir, was added to all drug–drug interaction (DDI) tables. Four new DDI tables for anti‐tuberculosis drugs, anxiolytics, hormone replacement therapy and COVID‐19 therapies were introduced, as well as guidance on screening and management of anxiety disorders, transgender health, sexual health for women and menopause. The sections on frailty, obesity and cancer were expanded, and recommendations for the management of people with diabetes and cardiovascular disease risk were revised extensively. Treatment of recently acquired hepatitis C is recommended with ongoing risk behaviour to reduce transmission. Bulevirtide was included as a treatment option for the hepatitis Delta virus. Drug‐resistant tuberculosis guidance was adjusted in accordance with the 2020 World Health Organization recommendations. Finally, there is new guidance on COVID‐19 management with a focus on continuance of HIV care.ConclusionsIn 2021, the EACS Guidelines were updated extensively and broadened to include new sections. The recommendations are available as a free app, in interactive web format and as an online pdf.