Teenage partners' communication about sexual risk and condom use: the importance of parent-teenager discussions.

CONTEXT: Teenagers' communication with their partners about sex and their use of condoms may be influenced by the discussions teenagers have with their parents about sex. However, little is known about the process of parent-teenager communication on this topic. Understanding both what parents discuss with their children and how they discuss it may lead to a greater understanding of teenagers' sexual behavior. METHODS: Interviews were conducted with 372 sexually active black and Hispanic youth aged 14-17 from Alabama, New York and Puerto Rico. Regression analyses were used to examine parent-teenager discussions about sexuality and about sexual risk, and parental communication skills as predictors of teenagers' discussions about sexual risk with a partner and teenagers' condom use. RESULTS: Parent-teenager discussions about sexuality and sexual risk were associated with an increased likelihood of teenager-partner discussions about sexual risk and of teenagers' condom use, but only if parents were open, skilled and comfortable in having those discussions. Teenagers' communication with their partner about sexual risk also was associated with greater condom use, but the relationship between parent-teenager communication and teenagers' condom use was independent of this association. CONCLUSIONS: The influence on teenagers of parent-teenager discussions about sexuality and sexual risk depends on both what parents say and how they say it. Programs that foster parent-teenager communication about sexuality and sexual risk must emphasize both of these aspects.     

Sex and the Quality of Life in Denmark

From a representative sample of 2460 Danish citizens, ages 18 to 88, anonymous answers were obtained to a 317-item quality-of-life (QL) questionnaire, which included five questions on sexuality. Among the respondents in the sample, 1.2% reported they were bisexual and 0.9% homosexual. Although sexual problems were found in all age groups, lack of a suitable sex partner and inability to achieve orgasm were more common among the young and erectile dysfunction more common among the old. Most frequent problems among the women were reduced sexual desire (11.2%) and the lack of a suitable sex partner (4.9%), and among the men, the lack of a suitable sexpartner (7.3%)and erectile dysfunction (5.4%). The QL of persons with sexual problems was from 1.2 to 19.1% lower than the population mean (as expressed in terms of this mean). The intermediate sized covariation between sexual problems and the QL suggests that such problems can be symptoms of a reduced QL rather than medical problems to be tackled through medical intervention or sex therapy proper. Implications for a quality-of-life-sensitive clinical practice are discussed.     

Helping parents with sex education

Health visitors, school nurses and other community nurses are sometimes asked for advice by parents and carers on the emerging sexuality of their children. Parents often lack knowledge about sexual development and are confused about whether to talk to their children about sex. They may have been brought up in a family where sex was not mentioned. They are worried that they do not have the skills or the knowledge to help their children. They do not know whether to leave it all to the school or not allow their children to have any information. All the evidence shows that children who have had their questions answered and who know about sex and relationships start sexual activity later, use contraception more reliably and are less likely to cause or have an unwanted pregnancy. Sex education should be part of the ordinary information and moral guidance that parents normally give and should start as early as possible. The type of advice to give to parents and carers is split into age ranges that they might find helpful. Examples of language and the level of information required are given. A list of resources for further guidance is included.     

Teenage sexual behaviour: attitudes towards and declared sexual activity

Although the teenage pregnancy rates in the UK are falling in the 16 to 19 year old range, they are still rising in the 13 to 15 year olds. Overall, they remain one of the highest within Western Europe. Teenagers continue to present a challenge to the health services due to the increase in their sexual risk taking behaviour, the earlier age at which they are starting sexual activity and a reluctance to utilise services available to them. In an attempt to develop current services and make them more 'user friendly', a sexual health needs assessment was carried out on teenagers, part of which looked at their attitudes towards risk taking sexual behaviour and their declared sexual behaviour. A quantitative survey, using a questionnaire in schools, was answered by 1500 pupils aged between 13 and 18 years old, and showed that the majority of teenagers had declared some form of sexual contact with a partner with a degree of sexual activity increasing with age. Twenty per cent of 13 year olds reported that they had already had either full or oral sexual intercourse with a partner. Feeling peer pressure, not knowing the facts about sexual risk taking and a declared intent that would increase the likelihood of putting themselves or others at risk sexually were significantly more likely in the younger teenage boys surveyed. This study confirms that there remain many different factors involved in teenagers' decision-making processes, about their developing attitudes towards sex and their resultant behaviour. Despite a lack of maturity, such opinions and attitudes are bringing about definite views and sexual behaviour patterns in teenagers as young as 12 or 13 years old who are becoming fully sexually active. In particular teenage boys are becoming fully sexually active at a younger age than the girls and are taking risks in doing so. They are being influenced by peer pressure, condoning promiscuity and are declaring the intent to practice unsafe sexual intercourse. Their level of maturity would appear to be inadequate for them to comprehend the implications and consequences of their actions. This study has shown a need for developing adequate education and provision of sexual health services for teenagers, particularly for teenage boys, and that this may go some way in helping to address the imbalances found.     

Ageing, sexuality and enhancement among Yoruba people in south western Nigeria

Sexual health across the life course is influenced by biological and psychosocial factors. The paper explores sexuality and associated practices among older Yoruba people with a view to identifying the implications of cultural beliefs and practices for sexual health in later life. A total of 64 vignette-based in-depth interviews and 12 focus-group discussions were held with older adults (50-75 years) in two Yoruba communities in south western Nigeria. Findings portray sexuality as an important aspect of old age, with sexual intercourse being construed as having physical and spiritual consequences. This same perspective also emerged as participants' attributed factors affecting sexual desire in old age to religious beliefs, poverty, ill health and the non-availability of a partner. Gender differences were dominant on sexual desire and pleasure in old age. Participants' views on causes of sexual dysfunction identified biological, psychosocial and spiritual factors. Sexual decline in old age was considered redeemable with the support of biomedical and traditional medicines. However, only traditional medicine was considered beneficial in addressing sexual dysfunctions that had spiritual dimensions.     

Vaginal Dryness Problems Among Southeastern Women Aged 40–65 Years in Turkey

The aim of this study was to investigate vaginal dryness (VD) problems among 40–65 year old married women in Southeastern Turkey and its effect on their sexuality and health. A cross-sectional study was conducted with 281 women aged 40–65 via face-to-face interview. The results of the study showed that participating women feel that they lose their sexual functions as a result of VD problems. Reported sexually related problems were as follows: decreased sexual desire was identified in 14 % of women, sexual coercion by her partner in 20.6 %, trouble receiving sexual pleasure in 54.4 %. The incidence of VD was found to be 47 %. About 8.9 % of the women stated that their partners complain about the dryness all the time, 73.6 % of the women did not take any action to improve dryness in order to facilitate sexual intercourse. Statistically significant relationships were found between a woman’s having VD and violence from her partner, sexual coercion by her partner, and decrease in sexual desire and sexual pleasure (p < 0.05). It is recommended that women who are in menopause or during transition stages be routinely assessed for VD and sexuality by nurses or physicians in a professional atmosphere in order to help relieve discomfort.     

A National Study of Lesbian,Gay, Bisexual (LGB), and Non-LGB Youth Sexual Behavior Online and In-Person

Online and in-person sexual behaviors of cisgender lesbian, gay, queer, bisexual, heterosexual, questioning, unsure, and youth of other sexual identities were examined using data from the Teen Health and Technology study. Data were collected online between August 2010 and January 2011 from 5,078 youth 13–18 years old. Results suggested that, depending on sexual identity, between 4–35 % of youth had sexual conversations and 2–24 % shared sexual photos with someone online in the past year. Among the 22 % of youth who had oral, vaginal, and/or anal sex, between 5–30 % met one of their two most recent sexual partners online. Inconsistent condom use was associated with increased odds of meeting one’s most recent partner online for heterosexual adolescent men. For gay and queer adolescent men, having an older partner, a partner with a lifetime history of sexually transmitted infections (STI), and concurrent sex partners were each significantly associated with increased odds of having met one’s most recent sex partner online. None of the examined characteristics significantly predicted meeting one’s most recent sexual partner online versus in-person for heterosexual; bisexual; or gay, lesbian, and queer women. The Internet is not replacing in-person exploration and expression of one’s sexuality and meeting sexual partners online appears to be uncommon in adolescence across sexual identities. Healthy sexuality programming that acknowledges some youth are meeting partners online is warranted, but this should not be a main focal point. Instead, inclusive STI prevention programming that provides skills to reduce risk when engaging in all types of sex is critical.     

Communicating with older adults about sexual issues: How are these issues handled by physicians with and without training in human sexuality?

Although sexuality is an important part of health and emotional well-being throughout the entire life cycle, including during old age, little is known about how physicians discuss or approach the topic of sexuality during later life. The present study examined the perspectives of two groups of physicians toward discussing sexuality with older patients: 17 physicians who did not have any training in human sexuality and 21 physicians who were certified as sex therapists. The interviews underwent thematic content analysis to identify and code major themes and patterns. Qualitative analysis of the interviews yielded three main themes: (a) discourse between physicians and older adults regarding sexuality, (b) diagnosing sexual dysfunction among older adults, and (c) treating sexual dysfunction among older adults. Physicians who were not trained in sex therapy did not regularly ask their older patients about sexual functioning and/or problems with sex, tended to diagnose sexual problems from a medical perspective, and offered medication as the main treatment for sexual problems. Physicians trained as sex therapists felt more comfortable discussing sex-related issues with their older patients and diagnosed sexual problems from a medical, social, dyadic and psychological perspective. Although they offered their older patients a greater variety of medication-oriented interventions than those without training in sexuality, they did not rush into such interventions and instead emphasised the importance of the psychological and relational aspects of sex. The present study highlights the importance of human sexuality training for physicians and points out the effects of such training on the discourse, diagnosis and treatment of sexual concerns in later life.     

Is there a place for sexuality in the holistic care of patients in the palliative care phase of life?

Being diagnosed with a life-limiting condition is a traumatic event. The journey to the moment of death is usually only done once--so it is a time of fears and uncertainty. Sexuality is particularly vulnerable at this time. It may be difficult for both patient and partner to deal with the changes in sexuality without professional assistance. It is "sexuality" rather than "sex" that defines the meaningful relationships people have with themselves and significant others. When sexuality is lost or changed, important benefits may be lost. Studies show that many patients do value sexuality and want assistance in making the best of their sexual potential during the palliative care phase. Health professionals regularly acknowledge the importance of sexuality for their patients but have difficulties acting on their beliefs. Sexuality, within the patient's functional ability and desire for it, must be acknowledged and included in holistic management. It is the health professional's responsibility to raise this issue.     

In pursuit of intimacy: disability stigma,womanhood and intimate partnerships in South Africa

Notions of womanhood inculcate naturalised ideologies of femininity, sexuality, motherhood and caregiving. The paper asks how disability stigma intersects with womanhood to characterise intimate partnerships in South Africa. In-depth interviews with 30 women with a range of disabilities were conducted in informal settlements in Cape Town. Findings suggest that disability stigma may hamper attainment of normative womanhood and sexual relationships for women with disabilities in South Africa. Limited opportunities to meet potential partners, hegemonic gender expectations and restricted sexual and physical contact shape their intimate partnerships. However, women with disabilities also challenge ableist constructs of normalcy and discredit negative images of disabled womanhood. Because of this, theoretical models of intimate partner violence should consider the influence of disability on constructions of sexuality and norms in intimate partnerships. Building on women with disabilities’ stigma-avoidance strategies will help facilitate better relationship outcomes. Social norms interventions with broader society, communities, women with disabilities and their partners, family and carers can help destabilise assumptions that women with disabilities are unable to have long-lasting and fulfilling sexual and intimate partnerships. Moreover, accessible and relevant sexuality education and information on relationships, intimate partner violence, maternal and sexual and reproductive health care can ensure healthy and safe intimate partnerships for women with disabilities.     

The sexual ethics of HIV testing and the rights and responsibilities of partners

The discourse of much of the international AIDS community champions the rights of individuals in low-income countries to "just say no" to routine HIV testing in health-care settings and, if tested and found positive, not to inform their sexual partner(s) if such disclosure could result in substantial personal harm. This study contends that the right of individuals to refuse testing ignores the right of their sexual partners--male or female, regular or casual--to be informed of the health risks to which they may be exposed on entering or continuing a sexual relationship or engaging in particular sexual acts. If, as the UN has declared, all persons have the right to decide freely and responsibly on matters relating to their sexuality, including their sexual and reproductive health, free from coercion, discrimination, and violence, then all persons have the right and the responsibility to know their own and their partner's serostatus and to protect themselves and their partner(s) from sexually transmitted infections (STIs). Support by AIDS activists for policies of routine STI/HIV testing, counseling, and disclosure between both partners in a sexual relationship would help to promote an ethic of equal rights and shared responsibility for sexual behavior and its consequences.     

Talking about sex to oncologists and about cancer to sexologists

More than 50% of all cancer sufferers suffer from sexual problems. This can be a major issue for them, but is one which is often not dealt with appropriately. Both patients and professionals are reluctant to bring up the topic. The patients are embarrassed, and feel it may be seen as trivial compared to survival. Professionals may also be embarrassed, and may be unsure how to deal with sexual issues should they be discussed. Professionals may also have biased and judgmental attitudes to sex and sexuality, particularly in relation to age and sexual orientation, which interferes with their patient care. Research has shown that patients wish their doctors to discuss sexuality with them, and if mentioned at an early stage in the cancer journey, then the sexual outcomes may be better. There are also practical barriers to open discussion of sex with these patients, such as lack of time and opportunity in relation to the overwhelming issues that have to be faced in relation to the cancer. Sexual counselors with no clinical background would also benefit from some knowledge of cancer and its treatments in order to understand the physical impact of the disease. Improved professional education and increased awareness of sexual issues and modes of treatment coupled with the provision of early information to the patients should greatly improve patient care.     

Partner Support and Communication for Pre-exposure Prophylaxis (PrEP) Use Among Male Couples

Between one to two-thirds of HIV infections among gay, bisexual, and other men who have sex with men are from primary partners, and there has been increased research attention focused on strategies to increase PrEP adoption among male couples. While there is evidence that partner support is a strong correlate of pre-exposure prophylaxis (PrEP) adoption, there has been a lack of attention on PrEP communication dynamics among male couples. In this paper, we build upon this literature through analysis of dyadic data from a large cross-sectional survey of 543 concordant sero-negative and serodiscordant male couples to examine individual and relationship factors associated with reports of partner communication around PrEP, comfort in discussing PrEP, and perceived partner-level support for PrEP use. PrEP use was relatively low (16.2%), and although 87.5% of men reported their partners would support their PrEP use, only 26.3% had talked to their partner recently about PrEP. PrEP communication and perceived support for PrEP were significantly negatively associated with PrEP stigma and stigma based on sexuality (i.e., internalized homophobia and enacted external stigma based on sexuality), while men with sexual agreements were more comfortable talking about PrEP with their partner. There is a need to adapt current interventions, or develop new dyadic interventions, that provide opportunities for male couples to talk and learn about PrEP together, as a potential pathway to engage them toward PrEP use.

     

Older Chinese men and women's experiences and understanding of sexuality

This study explored the meaning of sexuality for older Chinese people from diverse backgrounds and the role of traditional Chinese cultural values in shaping sexual expression. A total of 20 Hong Chinese elders were interviewed. Most reported a rigid definition of sexual behaviour, confining it to heterosexual sexual intercourse. Kissing, hugging and caressing were not considered 'sexual', and same-sex relationships were virtually absent from respondents' conceptions of sexuality. Traditional patriarchal values in relation to sexuality prevailed. Men and women attached different meanings to sexuality. Neither believed that sex was enjoyable for women or that women needed sex in the same way as men. Female participants saw sex as part of their responsibility to procreate and to fulfill their husband's needs. Male participants considered sex to be important for fulfilling their physical drives. The lack of an appropriate partner due to widowhood, the partner's physical condition or a poor spousal relationship apparently accounted for the low levels of sexual activity reported by informants.     

The Sexuality of Adults with Intellectual Disability in Poland

Sexuality is one of the most important aspects of human life that relates to sex, one's identification, sexual role, sexual preferences, eroticism, pleasure and intimacy. It fulfils such functions as procreative, hedonistic and relationship-building as well as constitutes an integral part of human's personality. The sexuality of people with intellectual disability is a special case - both from medical, pedagogical, psychological and ethical point of view. Little available research shows that it may become a significant factor that modifies their psychological and sexual functioning. The basic poll involved altogether 133 people with mild intellectual disability. The work was carried out in 11 schools and special institutions of three provinces in Poland: kujawsko - pomorskie, wielkopolskie and dolno?l?skie (provinces of Kujavy and Pomerania, Great Poland and Lower Silesia) The respondents qualified to take part in the poll constituted a very uniform group - homogenous as regards their age of 18-25 as well as IQ level that was average for the people with higher degree of intellectual disability (HDID). Their age was of importance as in that life period one can observe the formation of first partner relationships with the clear aim of establishing a family. It is accompanied by a quick development of sexual desire and taking up various forms of sexual activity. People with intellectual disability don't form a homogenous group as regards their psychological and sexual development. In this group, one can observe both different forms of clinical mental handicap which definitely affects the whole process of sexual development. The sexual development is delayed by an average period of 3 years. The people with intellectual disability take up mostly autoerotic behaviour whereas partner relationships wthin that group are more seldom. The phenomenon of sexuality of people with higher degree of intellectual disability is an issue that needs further constant analysis. The research has also made it possible to detect what kind of sexual behaviour people with intellectual disability undertake and the value of sexuality for such people. The article deals also with some important dilemmas connected with sexual education and what factors trigger off incorrect sexual reaction including their lack in the above mentioned group.     

Integrating medication, realistic expectations, and therapeutic interventions in the treatment of male sexual dysfunction

Male sexuality in adolescence and early adulthood is characterized by autonomous, predictable erections. As males age, however, their arousal becomes less predictable and more dependent on partner interaction. This transition can produce anxiety. Many males view this change as a medical dysfunction requiring pharmacologic treatment or specialist intervention. New medical interventions, including Viagra, have been developed promising to return males to their automatic erections. A medical approach, however, fails to address the multidimensional nature of male sexuality and reinforces sex as intercourse performance. This article outlines a biopsychosocial approach to the assessment, treatment, and relapse prevention of male sexual dysfunction.     

Sexual Regret in College Students

A questionnaire study was conducted to assess the relationship between sexual regret and sexual behaviors and demographic factors among 348 college-aged students prior to attending an educational program about sexual health issues. Analyses conducted on the portion of the sample who were sexually active (n = 270) indicated that the majority (71.9%, n = 194) has regretted their decision to engage in sexual activity at least once. The most cited reasons for regret by students included their sexual decision making as inconsistent with their morals (37%), an acknowledgment that alcohol influenced their decision (31.7%), the realization they did not want the same thing as their partner (27.9%), the lack of condom use (25.5%), feeling pressure by their partner (23.0%), and their desire to wait until marriage to have sex (15.4%). The only significant sex difference was that women reported regret due to feeling pressured by a partner more often than men. Multiple and logistic regression analyses indicated that the only significant predictor of regret regarding one's sexual decisions was the number of sexual partners. These results demonstrate the need for sexual educators to incorporate sexual regret into their curricula as the phenomenon of regret is more common than pregnancy and sexually transmitted diseases, the usual focus of sexuality education.     

Older Chinese men and women's experiences and understanding of sexuality

This study explored the meaning of sexuality for older Chinese people from diverse backgrounds and the role of traditional Chinese cultural values in shaping sexual expression. A total of 20 Hong Chinese elders were interviewed. Most reported a rigid definition of sexual behaviour, confining it to heterosexual sexual intercourse. Kissing, hugging and caressing were not considered ‘sexual’, and same-sex relationships were virtually absent from respondents' conceptions of sexuality. Traditional patriarchal values in relation to sexuality prevailed. Men and women attached different meanings to sexuality. Neither believed that sex was enjoyable for women or that women needed sex in the same way as men. Female participants saw sex as part of their responsibility to procreate and to fulfill their husband's needs. Male participants considered sex to be important for fulfilling their physical drives. The lack of an appropriate partner due to widowhood, the partner's physical condition or a poor spousal relationship apparently accounted for the low levels of sexual activity reported by informants.     

上海市妊娠少女性与避孕知识及行为的调查

目的:研究妊娠少女性的避孕知识及行为,探索改变少女风险性行为及预防少女妊娠的方法。方法:采用自填式问卷的方法对2004年1～6月在上海市国际和平妇幼保健院要求终止妊娠的少女(10～19岁)进行性和避孕知识及行为调查。结果:调查对象平均年龄为(17.57±1.21)岁,20.0%来自中学,36.5%来自中专和职校,10.5%来自大学,其他33.0%来自社会无业和从业人员。性和避孕知识的主要来源是传媒、网络、同伴和男友。超过50%的少女妊娠超过12周不得不住院引产或成为少女妈妈;81.7%是第1次怀孕,其余18.3%已有1次以上的人工流产史,下生殖道感染率高达67%。少女对使用避孕措施的态度可以部分影响少女的避孕行为(P<0.01),紧急避孕知识的掌握也可以部分影响少女的避孕行为(P<0.05)(如与男朋友讨论使用避孕措施)。结论:少女人群早年开始性生活、多次流产、多性伴和高生殖道感染率等生殖健康的问题已逐渐凸现。全国范围内预防艾滋病的宣传已经深入到青少年人群,但学校性教育滞后的问题仍然存在。要改善少女人群的生殖健康问题,关键是改变少女的风险性行为,但仅向青少年人群提供知识尚不能达到最终改变行为的目的,还有很多影响因素,如:青少年人群对性和避孕的态度、个人的技能以及社会、社区的环境和氛围等。因此最终的方法应该?