Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey

BackgroundProbability-based surveys of college students typically assess sexual behaviors such as oral, vaginal, and anal sex. Little is known about the broader range of sexual behaviors in which students engage.AimsIn a random sample survey of undergraduate students, we aimed to: (1) describe how recently participants had engaged in solo and partnered sexual behaviors, (2) examine how frequently participants enacted certain rough sex sexual behaviors (e.g., light spanking, hard spanking, choking, slapping, and others), (3) assess participants’ frequency of experiencing certain rough sex behaviors, (4) describe participants’ frequency of threesome/group sex, (5) assess the characteristics of participants’ experiences with choking during sex; and (6) examine choking and face slapping in regard to consent.MethodsA confidential, online cross-sectional survey of 4,989 randomly sampled undergraduate students at a large U.S. university.OutcomesParticipants reported having engaged in a broad range of solo and partnered sexual activities, including rough sex behaviors.ResultsThe most prevalent general sexual behaviors were solo masturbation (88.6%), oral sex (79.4% received, 78.4% performed), penile-vaginal intercourse (73.5%), and partnered masturbation (71.1%). Anal intercourse was the least prevalent of these behaviors (16.8% received, 25.3% performed). Among those with any partnered sexual experience, 43.0% had choked a partner, 47.3% had been choked, 59.1% had been lightly spanked and 12.1% had been slapped on the face during sex.Clinical translationCollege health clinicians and educators need to be aware of the diverse and evolving range of solo and partnered sexual behaviors reported by students. In addition to counseling students about pregnancy and sexually transmitted infection risk, clinicians might assess patients’ engagement in diverse sexual behaviors, such as choking/strangulation during sex, given the risk for serious outcomes including death.Strengths and limitationsStrengths of our research include the large sample size, use of random sampling, high response rate for college populations, broad range of behaviors assessed, and novel data on choking during sex. Among our limitations, we did not assess to what extent the experiences were wanted, pleasurable, or appealing to participants. Except for in relation to choking and slapping, we also did not assess issues of consent.ConclusionParticipants reported engaging in diverse sexual behaviors, some of which have important clinical implications, are understudied, and warrant further research.Herbenick D, Patterson C, Beckmeyer J, et al. Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey. J Sex Med 2021;18:1024–1041.     

The Impact of the COVID-19 Pandemic on Sexual Health in Cis Women Living in Germany

BackgroundPreliminary research shows a substantial impact of the COVID-19 pandemic on women's sexual health, whereby empirical work on sexual well-being of minoritized sexual identities is still rare.AimThe objective of this study was to explore sexual health in heterosexual, lesbian and bisexual cis women during the first wave of COVID-19 pandemic in Germany.MethodsAn anonymous nationwide online survey was conducted among cis women during the first nationwide lockdown in Germany from April 20th to July 20th, 2020. The questionnaire was distributed via e-mail, online chats and social-media platforms.OutcomesDemographic variables and self-report measures from the Sexual Behavior Questionnaire (SBQ-G) "before the pandemic" and "since the pandemic" were collected.ResultsA total of 1,368 cis women participants were included: heterosexual women (n = 844), lesbian women (n = 293), bisexual women (n = 231). Results indicate overall decrease in frequency of sexual contacts and masturbation during the COVID-19 pandemic. Regarding differences before and during the pandemic lesbian women showed significant changes in sexual arousal whereas heterosexual women showed significant changes in all dimensions except capability to enjoy sexual intercourse. The data of bisexual women showed significant changes in almost all dimensions except for frequency of sexual intercourse and sexual arousal. Results of the multiple regression analysis revealed that being younger than 36 years-old, and being in a relationship as well as being heterosexual (compared with being lesbian) is positively associated with general satisfaction with sexual life during the pandemic.Clinical ImplicationsThe findings suggest that during a pandemic sexual and mental health care for (cis) women should be provided and address the specific needs of sexual minority groups.Strengths & LimitationsThis is the first study to describe sexual behavior in heterosexual, lesbian and bisexual women during the COVID-19 pandemic in Germany. Limitations, however, include the fact that the data described were obtained at only one time point so there is a possibility of recall bias, and that the results cannot be generalized because of the underrepresentation of women over age 46.ConclusionThis study examined the impact of the COVID-19 pandemic and resulting social constraints on the sexual health of particular groups of lesbian and bisexual women, which may improve preparedness for future public health and policy crises.Batz F, Lermer E, Hatzler L, et al. The Impact of the COVID-19 Pandemic on Sexual Health in Cis Women Living in Germany. J Sex Med 2022;19:907–922.     

Impact of the COVID-19 Pandemic on the Psychosexual Functions of Healthcare Workers

BackgroundA novel infection, COVID-19, emerged in China and soon became a global pandemic. Pandemic conditions have resulted in stress in the workplace and led to anxiety among healthcare workers (HCWs), having negative impacts on different aspects of their lives, including their sexual function.AimTo evaluate the changes in the anxiety status of HCWs during the COVID-19 pandemic and the impact of anxiety on their sexual functions.MethodsThis is a longitudinal study based on an online survey conducted from April 2020 to February 2021 in hospitals designated as pandemic healthcare centers. An online survey link was sent to HCWs that provided consent for participation in the study. The anxiety status of the participants was assessed using the State Anxiety Inventory, and sexual function was evaluated using the International Index of Erectile Function–15 for men and Female Sexual Function Index for women.OutcomesScores obtained at the beginning of the pandemic were compared with those obtained at 6 months into the pandemic to determine the changes in the anxiety levels and sexual functions of the HCWs.ResultsA total of 399 HCWs participated in the survey, and the median age was 32 (20–60) years. Compared to the beginning of the pandemic, there was a significant increase in the State Anxiety Inventory score of the female and male HCWs at the sixth month of the pandemic. Among the women, the mean total Female Sexual Function Index score was 23.55 ± 8.69 at the beginning of the pandemic and 21.42 ± 8.91 at the sixth month, and there was a significant decrease in all parameters except pain. Among the men, the International Index of Erectile Function–15 total score was 62.75 ± 12.51 at the beginning of the pandemic and 55.1 ± 12.87 at the sixth month, indicating a significant decrease in all parameters.Clinical implicationsConsidering that the pandemic will continue for a long time, more psychological support should be provided, and interventions should be made to protect the mental health of HCWs.Strengths & LimitationsThe strength of the study is that it had a fairly high number of participants across several institutions. However, being conducted in one country and the sample not being randomly selected and being based on voluntariness can be considered as limitations.ConclusionOur results show that the COVID-19 pandemic has led to an increase in the anxiety levels of both female and male HCWs, and this situation has negatively affected their sexual functions.Eroglu U, Balci M, Coser S, et al, Impact of the COVID-19 Pandemic on the Psychosexual Functions of Healthcare Workers. J Sex Med 2022;19:182–187.     

Diverse Sexual Behaviors and Pornography Use: Findings From a Nationally Representative Probability Survey of Americans Aged 18 to 60 Years

BackgroundConvenience sample data indicate that substantial portions of adults have engaged in sexual behaviors sometimes described as rough; little is known about these behaviors at the population level.AimTo describe, in a U.S. probability sample of Americans aged 18 to 60 years, (i) the prevalence of diverse sexual behaviors, described here as dominant and target behaviors; (ii) the age at first pornography exposure as well as prevalence, range, and frequency of pornography use; (iii) the association between past year pornography use frequency and dominant/target sexual behaviors; and (iv) associations between lifetime range of pornography use and dominant/target sexual behaviors.MethodsA confidential cross-sectional online survey was used in this study.OutcomesLifetime engagement in dominant behaviors (eg, spanking, choking, name calling, performing aggressive fellatio, facial ejaculation, penile-anal penetration without first asking/discussing) and lifetime engagement in target behaviors (eg, being spanked, being choked, being called names during sex, having their face ejaculated on, receiving aggressive fellatio, or receiving penile-anal penetration without having discussed) were assessed; lifetime pornography use, age at first porn exposure, past-year frequency of porn viewing, and lifetime range of pornography were also assessed.ResultsWomen as well as men who have sex with men were more likely to report target sexual behaviors: having been choked (21.4% women), having one's face ejaculated on (32.3% women, 52.7% men who have sex with men), and aggressive fellatio (34.0% women). Lifetime pornography use was reported by most respondents. After adjusting for age, age at first porn exposure, and current relationship status, the associations between pornography use and sexual behaviors was statistically significant.Clinical ImplicationsClinicians need to be aware of recent potential shifts in sexual behaviors, particularly those such as choking that may lead to harm.Strengths & LimitationsStrengths include U.S. probability sampling to provide population level estimates and the use of Internet-based data collection on sensitive topics. We were limited by a lack of detail and context related to understanding the diverse sexual behaviors assessed.ConclusionClinicians, educators, and researchers have unique and important roles to play in continued understanding of these sexual behaviors in the contemporary United States.Herbenick D, Fu T-C, Wright P, et al. Diverse Sexual Behaviors and Pornography Use: Findings From a Nationally Representative Probability Survey of Americans Aged 14 to 60 Years. J Sex Med 2020;17:623–633.     

Impact of Protocol Adjustments Due to the COVID-19 Pandemic on Infertility Treatment Outcomes

As a result of the COVID-19 pandemic, our centre made adjustments that reduced the number of patient visits, ultrasound scans, laboratory investigations, and face-to face instructions. The objective of this study was to evaluate whether these changes had any effect on the pregnancy rate for patients undergoing infertility treatment. The primary outcome was clinical pregnancy rates from intrauterine insemination and frozen embryo transfer.Clinical pregnancy rates were not statistically different between patients who underwent either procedure before and after the protocols were put in place. It is reassuring to know our pandemic protocol adjustments did not have a negative impact on infertility treatment outcomes.     

Comparison of Correlated Comorbidities in Male and Female Sexual Dysfunction: Findings From the Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Background

Many of the same mechanisms involved in the sexual arousal-response system in men exist in women and can be affected by underlying general medical conditions.

A Contrast of Mothering Behaviors in Women From Korea and the United States

In both the United States and Korea, culture heavily influences a mother's behavior toward her infant. Differences between these two cultures are explored, based on the author's experiences and work in both environments. This comparison includes a number of points of departure. The American culture encourages autonomous and independent behaviors from infants, whereas in the Korean culture, mothers tend to view infants as passive and dependent. American mothering is individually fashioned and relies on the expertise of health care providers. Conversely, the Korean culture is highly ritualistic, so mothering is molded more by societal rules than by individual design, and professional advice is less sought for guidance than is folklore information. American mothers tend to rear their infants in a nuclear family setting, whereas Korean mothers rear their infants in a extended family or at least in a highly social environment. Implications for American nurses who provide perinatal care for Korean immigrant women are discussed.     

Psoriasis and Sexual Behavior in Men: Examination of the National Health and Nutrition Examination Survey (NHANES) in the United States

IntroductionEpidemiologic data on sexual behavior in psoriasis patients are lacking.AimWe aim to examine and compare the sexual behaviors between men with and without psoriasis in the United States.MethodsWe analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006 and 2009 to 2010. Responses from male participants to the dermatology and sexual behavior questionnaires of the NHANES were collated and analyzed.Main Outcome MeasuresOutcome measures included sexual orientation, age of first sexual encounter, number of oral and non‐oral sexual partners, and frequency of unprotected sex.ResultsAmong 6,444 U.S. men that responded to the psoriasis question, 170 (2.6%) reported a physician‐given diagnosis of psoriasis. Heterosexual men accounted for 95.5% and nonheterosexual men 4.5% of the overall study population. On multivariate analysis, psoriasis was not associated with differences in sexual orientation (odds ratio 1.78, 95% confidence interval [CI] 0.75–4.15). Heterosexual men with psoriasis experienced first sexual encounter at an earlier age than those without psoriasis (weighted difference −0.9 years, P = 0.002). Heterosexual men with psoriasis had significantly fewer female oral sexual partners compared with heterosexual men without psoriasis on multivariate analysis (lifetime partner number: rate ratio [RR] 0.65, 95% CI 0.45–0.95; past‐year partner number: RR 0.64, 95% CI 0.42–0.97). No significant differences existed between heterosexual men with and without psoriasis regarding frequency of unprotected sex (RR 0.96, 95% CI 0.85–1.09). Among nonheterosexual men with and without psoriasis, no significant differences existed in age first had sex, number of sexual partners, or frequency of unprotected sex.ConclusionHeterosexual men with psoriasis have significantly fewer lifetime female oral sexual partners compared with those without psoriasis. Dermatologists and other healthcare providers need to examine the genital region routinely and initiate appropriate therapy to improve patients' sexual health. Armstrong AW, Harskamp CT, and Schupp CW. Psoriasis and sexual behavior in men: Examination of the National Health and Nutrition Examination Survey (NHANES) in the United States. J Sex Med 2014;11:394–400.     

Impact of the COVID-19 Pandemic on Access to Fertility Care: A Retrospective Study at a University-Affiliated Fertility Practice

ObjectiveTo elucidate the impact of the COVID-19 pandemic on access to fertility services.MethodsA retrospective quality improvement study was conducted at a university-affiliated fertility practice in southwestern Ontario. Annual procedural volumes for intrauterine and donor inseminations (IUI/DI), in vitro fertilization and intracytoplasmic sperm injections (IVF/ICSI), and frozen embryo transfers (FET) during the COVID-19–affected year were compared with mean annual volumes from the 2 preceding years. In addition, volumes for the same procedures were compared between the first quarter of 2021 and mean first quarter volumes from 2018 to 2019. Piecewise linear regressions were conducted to evaluate whether any changes in monthly procedural volume were attributable to the COVID-19 pandemic.ResultsIn 2020, our fertility practice attained the mean annual volumes of 89.7% for IUI/DI, 69.0% for IVF/ICSI, and 60.6% for FET. In contrast, in 2021, we performed mean first quarter volumes of 130.1% for IUI/DI, 164.3% for IVF/ICSI, and 126.8% for FET. The slopes of the pre- and post–COVID-19 segments of the piecewise linear regressions were significantly different for IUI/DI (P < 0.001) and IVF/ICSI (P = 0.001), but not for FET (P = 0.133).ConclusionThe COVID-19 pandemic resulted in decreased annual volumes of medically assisted reproductive procedures at a university-affiliated fertility practice in southwestern Ontario. Impact on monthly procedural volume was confirmed for IUI/DI and IVF/ICSI by linear regression. Local adaptations helped compensate and exceed expected volumes in 2021. As a result, the COVID-19 pandemic resulted in a short-lived limitation in access to fertility care.     

Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in the United Kingdom

BackgroundOn 23rd March 2020, the UK government released self-isolation/social distancing guidance to reduce the risk of transmission of SARS-CoV-2. The influence such guidance has on sexual activity is not known.AimTo investigate levels and correlates of sexual activity during COVID-19 self-isolation/social distancing in a sample of the UK public.MethodsThis paper presents preplanned interim analyses of data from a cross-sectional epidemiological study, administered through an online survey.OutcomesSexual activity was measured using the following question: “On average after self-isolating how many times have you engaged in sexual activity weekly?” Demographic and clinical data were collected, including sex, age, marital status, employment, annual household income, region, current smoking status, current alcohol consumption, number of chronic physical conditions, number of chronic psychiatric conditions, any physical symptom experienced during self-isolation, and number of days of self-isolation/social distancing. The association between several factors (independent variables) and sexual activity (dependent variable) was studied using a multivariable logistic regression model.Results868 individuals were included in this study. There were 63.1% of women, and 21.8% of adults who were aged between 25 and 34 years. During self-isolation/social distancing, 39.9% of the population reported engaging in sexual activity at least once per week. Variables significantly associated with sexual activity (dependent variable) were being male, a younger age, being married or in a domestic partnership, consuming alcohol, and a higher number of days of self-isolation/social distancing.Clinical ImplicationsIn this sample of 868 UK adults self-isolating owing to the COVID-19 pandemic, the prevalence of sexual activity was lower than 40%. Those reporting particularly low levels of sexual activity included females, older adults, those not married, and those who abstain from alcohol consumption.Strength and LimitationsThis is the first study to investigate sexual activity during the UK COVID-19 self-isolation/social distancing. Participants were asked to self-report their sexual activity potentially introducing self-reporting bias into the findings. Second, analyses were cross-sectional and thus it is not possible to determine trajectories of sexual activity during the current pandemic.ConclusionInterventions to promote health and well-being during the COVID-19 pandemic should consider positive sexual health messages in mitigating the detrimental health consequences in relation to self-isolation/social distancing and should target those with the lowest levels of sexual activity.Jacob L, Smith L, Butler L, et al. Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in the United Kingdom. J Sex Med 2020;17:1229–1236.     

Impact of the COVID-19 Pandemic on Delivery of Gynecology and Obstetrics Services at a Maximum Care University Hospital in Germany

Introduction The COVID-19 pandemic has been the cause of drastic measures within the national health system. This led us to analyze the clinical and economic performance indicators for gynecology and obstetrics services at the University Hospital of Marburg, which is one of the regional maximum care university hospitals. Therefore, we evaluated the impact of the pandemic on monthly inpatient and outpatient case numbers and the associated ICD and DRG codes, in order to identify any shortcomings in the care provided. Methods and Materials The study is based on a retrospective analysis of data relating to inpatient and outpatient cases that received treatment from 2016 to 2020. We used QlikView, the hospital’s internal performance monitoring program, to evaluate the data from 9487 cases from the gynecology department and 19597 cases from the obstetrics department. Results In line with the nationwide dynamics of the pandemic, we observed a 6% drop in the number of inpatient gynecology cases, while the volume of obstetrics cases rose by 11% in 2020. Overall, the impact on outpatient services was less severe. We also observed a location-specific drop in the number of C50 “malignant neoplasm of breast” cases by 7.4%, and a 14% drop in the number of C56 “malignant neoplasm of ovary” cases. A return to the level of service delivered in the previous year was achieved in three months for outpatient services, and in five months for inpatient services. Conclusion The negative effects of the COVID-19 pandemic primarily affected the gynecology clinic. An increase in obstetrics cases was achieved due to public trust in the safety of the university hospital care, and the service offered of allowing prospective fathers to take part in the birthing process following a rapid test. The return to a pre-pandemic level of service continues to be sluggish, while the outpatient sector, which was less affected in the first place, is showing a more rapid recovery. The location-specific decrease in C50 and C56 diagnoses is concerning, and needs to be assessed from an epidemiological perspective. The impact of the pandemic on case numbers is also reflected in the financial performance indicators. Schlüsselwörter: COVID-19, Pandemie, Versorgungsforschung, Maximalversorger, Universitätsklinikum     

Pubic Hair Removal and Sexual Behavior: Findings from a Prospective Daily Diary Study of Sexually Active Women in the United States

IntroductionPubic hair removal is prevalent among women in the United States. However, most studies related to pubic hair removal are based on cross‐sectional surveys and retrospective recall.AimThe purpose of this research was to, in a prospective event‐level daily diary study, assess demographic, affective, relational, situational, and behavioral factors related to women's pubic hair removal.MethodData collection occurred as part of a 5‐week prospective, Internet‐based daily diary study.Main Outcome MeasuresAge; Affective predictors (positive mood, negative mood, feeling interested in sex, feeling in love); Relational predictors (partner support, partner negativity, partner type, partner gender); Situational predictors (any vaginal symptoms, use of any vaginal hygiene products; having applied any creams to the genitals); Behavioral variables (penile–vaginal sex, penile–anal sex, had finger inserted into vagina, had clitoris stimulated with fingers, inserted toy into vagina, used vibrator on clitoris, inserted finger into anus, inserted toy into anus, duration of penetration, intensity of penetration).ResultsA total of 2,453 women ages 18 to 68 (mean age 32.69) completed the study, contributing 49,287 total diaries (mean per person 24.5; standard deviation 10.3, median 30); 15.2% of all days (N = 7,362) involved pubic hair waxing or shaving, with the vast majority of hair removal days involving shaving (N = 7,302; 99%). Pubic hair removal was significantly associated with younger age, a greater interest in sex, vaginal fingering, finger–clitoral stimulation, having a casual sex partner, using vaginal hygiene products, and applying cream to the genitals. Hair removal was marginally associated with longer duration of vaginal penetration.ConclusionsThese findings provide greater insight into the factors associated with women's pubic hair removal and their sexual experiences on a day‐to‐day level. Clinical and educational implications are discussed. Herbenick D, Hensel D, Smith NK, Schick V, Reece M, Sanders SA, and Fortenberry JD. Pubic hair removal and sexual behavior: Findings from a prospective daily diary study of sexually active women in the United States. J Sex Med 2013;10:678–685.