Abuse of women and children in a Philippine community.

This retrospective study describes the demographic profiles, types of injuries and characteristics of abusers of 1354 women and children survivors of domestic violence who sought medical care from the obstetrics and gynecology resident and attending staff in the Women and Children Protection Unit in Vicente Sotto Memorial Medical Center from 1 January 1997 to 31 December 1998. Thirty-nine percent of these patients were sexually abused; their peak age was 11-20 years. Almost 75% of sexual abusers were from outside of the household. The highest incidence of physical abuse occurred in ages 26-35 years. Seventy-five percent of this form of abuse was in the home and perpetrated by husbands and live-in partners. Our data add to the expanding literature demonstrating the existence of family violence throughout the world. The role of our Protection Unit in responding to the victims of family violence is in keeping with the responsibilities and the ethical obligations all obstetrician-gynecologists have to the safety, physical and psychological needs of the women they serve.     

Experience of sexual violence among sexually experienced Japanese teenage girls and influencing factors

Aim  The aim of the present study was to identify influencing facors for sexual violence in sexually experienced teenage girls. Methods  Eighty sexually experienced teenage girls aged between 14 and 19 attending obstetrics and gynecology clinics in suburban Tokyo were selected as subjects. After completing a simple questionnaire on sexual behavior and lifestyle the subjects were interviewed using a semistructured interview technique. Logistic regression analysis was used to identify factors associated with sexual violence. Results  Police and government statistics for rape, sexual and domestic violence in Japan are extremely low. However, the present study showed that 52.5% of subjects had been victims of sexual violence. Furthermore, of these, 69.0% had been forced to have sex with a partner and 64.3% had been raped by someone other than a partner. Factors influencing the risk of sexual violence were sexual behavior and attitudes towards sexuality and lifestyle. Having a sexually transmitted infection was not an influencing factor. Conclusions  It is important to identify teenage girls attending obstetrics and gynecology clinics at risk of sexual violence and to teach them about the risks of sexual behavior associated with imbalances of power. Furthermore, it is essential to support victims of sexual violence to protect them from the recurrence of such abuse.     

Dating Violence in Adolescence: Implications for Girls’ Sexual Health

Adolescents in the United States are too often involved in relationships characterized by coercion and violence. An emerging body of research suggests that dating violence is linked with other health risks in adolescent relationships, particularly sexual risk behavior. The confluence of risks conferred by dating violence and sexual risk behavior are particularly acute for adolescent girls. Adolescent gynecology providers need to understand the nature of dating violence in adolescence and the ways in which dating violence and sexual risk behavior are mutually influential. This article reviews the literature on the links between dating violence and sexual risk in adolescent girls’ relationships. The prevalence, risk factors, and consequences of dating violence in adolescence are discussed, followed by a review of the research linking dating violence and sexual risk, with a focus on common mechanisms underlying these relationship risk behaviors. The review concludes with implications for screening, prevention, intervention, and future directions for research.     

Racial/Ethnic Disparities in Female Sexual Health from Adolescence to Young Adulthood: How Adolescent Characteristics Matter?

Study ObjectiveTo describe sexual initiation patterns in female adolescents and examine their association with adolescent characteristics and racial disparities in adverse sexual health across adolescence into early adulthood.DesignA prospective, longitudinal, observational study from adolescence to adulthood.SettingNationally representative, the National Longitudinal Study of Adolescent to Adult Health data, in the range of 24-32 years old at final assessment.ParticipantsData from 43,577 US women from 1994 to 2008.Interventions and Main Outcome MeasuresAdolescent sex-related characteristics at the individual-, family-, and school peer-level were assessed, and multiple sex partners, sexually transmitted infections (STIs)/HIV, and intimate partner violence (IPV) were longitudinally tracked. The sexual initiation pattern and its longitudinal association with sexual health were analyzed using latent class analysis and mixed effects Poisson regression models.ResultsOf the 43,577 subjects, the sexual initiation patterns were determined as normative (n = 28,712, 65.9%), late (n = 10,799, 24.8%), and early but unempowered (n = 4,066, 9.3%). The highest rate of the early-unempowered group was shown in Hispanic individuals (1,054/7,307 = 14.4%); they were more likely to be depressed, unsatisfied with their bodies, receiving welfare, and have less educated/permissive parents to their sexual initiation than others. The late group had a higher body mass index and greater satisfaction with their bodies. The highest number of STIs/HIV and IPV victimization was shown in non-Hispanic Black (NHB) and Hispanic individuals, respectively. However, NHB females’ higher number of STIs/HIV was shown in the late/normative groups, not in the early-unempowered group. Among Hispanic females, adolescent sexual initiation patterns were not directly associated with their frequent IPV victimization.ConclusionNHB females' higher STI/HIV in late/normative groups and Hispanic females’ frequent IPV victimization regardless of their sexual initiation patterns might indicate that racial/ethnic disparities in female sexual health was not directly determined by adolescent risk behaviors.     

Effects of an Interprofessional Student-Led Sexual Education Program on Self-Efficacy and Attitudes About Sexual Violence in Youths in Juvenile Detention

Study ObjectiveWe aim to explore the impact of an interprofessional graduate student−led sexual education curriculum on sexual self-efficacy, perceived importance of sexual consent, and willingness to intervene against sexual violence in the high-risk population of detained youths.Design, Setting, and ParticipantsMedical, nursing, social work, and physician assistant students implemented a 3-session, comprehensive sexual health curriculum for detained youths (n = 253).Interventions and Main Outcome MeasuresThe curriculum from Son et al (2017) was adapted to include a more targeted curriculum on consent and safe relationships. Youths completed pre- and postintervention assessments that evaluated their sexual self-efficacy and violence-related beliefs and behaviors.ResultsDetained youths completing the curriculum showed statistically significant increases in the sexual self-efficacy (P < .001), view of the importance of consent (P < .001), and willingness to intervene (P = .0027). The subset of male individuals and adolescents aged 17-19 years achieved statistically significant improvement in each category; adolescents aged 12-14 years did not. Female participants showed statistically significant improvement in sexual self-efficacy scores only.ConclusionsThe curriculum addressing topics of consent and sexual violence was effective in improving detained youths’ belief in their ability to safely navigate a sexual encounter and their attitudes toward sexual assault. Additional research on gender- and age-specific programming and the long-term impact on sexual health risk behaviors is needed.     

Repeat Screening for Sexually Transmitted Infection in Adolescent Obstetric Patients

ObjectiveTo determine if repeat screening for sexually transmitted infection is appropriate for adolescent obstetric patients and to identify any risk factors associated with increased risk of contracting a sexually transmitted infection (STI) during pregnancy.MethodsWe conducted a retrospective review of the medical records of adolescent obstetric patients seen over a five-year period in the Young Prenatal Program at the Hospital for Sick Children (Toronto, Ontario).ResultsBetween January 2003 and December 2007, 201 patients with 211 pregnancies attended the Young Prenatal Program. Of the 211 pregnancies reviewed, all patients had screening at baseline for HIV, syphilis, hepatitis B, chlamydia, gonorrhea, and trichomonas; 173 patients were screened in the third trimester, two were tested at another point in the pregnancy because of symptoms, and 161 were screened at their postpartum visit. In 53 pregnancies, STI was diagnosed either during pregnancy or postpartum. Fourteen patients had multiple sexually transmitted infections for a total of 71 infections. Thirty-four infections were diagnosed at baseline, 15 in the third trimester, two because of symptoms, and seven were diagnosed postpartum.In patients who did not develop an STI during pregnancy, the previous use of contraception (excluding condoms), being in a relationship with the baby’s father, and living with their partner were identified as significant protective factors against STI. There was a trend towards significance for contracting an STI in patients with a history of abuse, in those with a higher than average number of sexual partners, and in those with a younger than average age of coitarche.ConclusionSexually transmitted infections were diagnosed in 25.1% of adolescent pregnancies (53/211) in our cohort. Of the 71 sexually transmitted infections diagnosed, 22.5% (16/71) were diagnosed on routine third trimester screening. Because of the high rates of STI and the small number of identified risk factors, routine repeat screening in the third trimester for chlamydia, gonorrhea, and trichomonas is warranted in pregnant adolescents.     

Prevalence and correlated factors of sexually transmitted diseases-chlamydia, Neisseria, cytomegalovirus--in female rape victims

IntroductionPrevalence of sexually transmitted infections (STIs) was not well known in female rape victims.AimTo assess the prevalence and correlated factors of STIs—especially Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and cytomegalovirus (CMV) in female rape victims presenting to a dedicated regional referral center in South Korea after settle down of intergrated service center for sexual abuse in study hospital.Main Outcome MeasuresPositive polymerase chain reaction (PCR) result for CT, NG, and CMV.MethodsA retrospective observational analysis was conducted from December 2008 to February 2010. All females, regardless of age and previous sexual history, who were victims of rape, and self presented or referred to the regional center for medical care and couselling were included. Relevant diagnostic tests for STIs—including PCR by cervical swab—were performed. Analysis for virgin (VIR) and nonvirgin (non‐VIR) groups was done separately to compare certain clinical characteristics.ResultsA total of 316 females were included. Overall STI prevalence was 32.91%; CT in a majority (28.85%) followed by NG (6.27%), CMV(1.37%). In VIR group, prevalence of STI was 26.67%; 20.00% in CT, 4.55% in GN, 2.33% in CMV. A small and non‐significant difference in STI was noted in VIR and non‐VIR groups (26.67% vs. 34.26%, respectively). STI prevalence was higher in young women 20 to 24 years of age and girls 15 to 19 years of age compared with other age groups. Age (odds ratio [OR]: 0.909, confidence interval [CI]: 0.851–0.971) and pyuria (OR: 3.454, CI: 1.567–7.614) were determined as significant correlated factors after multivariate regression analysis.ConclusionsPrevalence of CT and GN in female rape victims was introduced and it was higher than that in the general population. Even in the VIR group, it was high. CMV prevalence in the female genital tract was reported firstly. Jo S, Shin J, Song KJ, Kim JJ, Hwang KR, and Bhally H. Prevalence and correlated factors of sexually transmitted diseases—chlamydia, Neisseria, cytomegalovirus—in raped female victims. J Sex Med 2011;8:2317–2326.     

Multiple sexual partnership mediates the association between early sexual debut and sexually transmitted infection among adolescent and young adult males in Nigeria

Objectives To assess the relationship between early sexual debut, risky sexual behaviours and sexually transmitted infections (STIs) among young males.

Methods The study was cross-sectional analytical in design and involved 1278 Nigerian males aged 15–24 years. Logistic regression was used in assessing the statistical relationship between early sexual debut (<16 years) and self-reported STIs (history of at least one of three symptoms – painful urination, genital discharge, and genital ulcer/sore – within the past 12 months), with demographic factors, sexual behaviours and psychosocial measures controlled for.

Results The prevalence of self-reported symptoms was 4.2% for genital discharge, 4.1% for painful urination, and 2.0% for genital sore/ulcer. Overall, 6.8% had STI symptom(s). At bivariate analysis, early sexual debut (p = 0.021), multiple partners (p < 0.001), concurrent partners (p = 0.002), and sex with casual/commercial partners (p = 0.013) were associated with STIs. At multivariate analysis, early sexual debut (odds ratio [OR] = 2.12, 95% confidence interval [CI] = 1.17–3.84) remained significantly associated with STIs. Multiple sexual partnership (OR = 2.00, 95% CI = 1.13–3.52) was also significantly associated with STIs, and is a mediator of the association between early debut and STI.

Conclusions Multiple sexual partners and early sexual debut are associated with STIs among adolescent and young adult males.     

Female Adolescent Sexuality Revisited: 20 Years Later

Twenty years ago, adolescent sexual activity was considered unacceptable. Unwanted pregnancy was a major problem, and access to such medical services as abortion and birth control was uncommon without parental consent. Today, with confidential care easy access to youth clinics and more openness about sex have we solved the problems and can we move on to other issues? It is more likely that problems related to sexuality, pregnancy, birth control sexually transmitted diseases and violence will remain an important part of adolescent development, and will often be associated with other high risk behaviours.     

Case Series: Vaginal Rupture Injuries after Sexual Assault in Children and Adolescents

BackgroundVaginal rupture after sexual assault is a rare but life-threatening occurrence requiring prompt recognition and treatment. Herein, we describe four such cases in children. Our purposes are to increase clinicians' awareness of the physical trauma that a sexual abuse victim can suffer and increase recognition that these victims require immediate trauma services.CasesEach patient had obvious hymenal and vaginal lacerations with a vaginal apical rupture injury and secondary acute blood loss. None of the four victims sustained infectious sequelae.Summary and ConclusionProviders should have a low threshold for managing sexual abuse victims as trauma cases when they have obvious hymenal and vaginal lacerations and genital bleeding, proceeding expeditiously to examination using general anesthesia when appropriate.     

Prevalence Rates of Sexual Behaviors,Condom Use,and Contraception Among Australian Heterosexual Adolescents

BackgroundThe development of effective health promotion practices and education programs to reduce rates of sexually transmitted infections and unintended pregnancy requires accurate, up-to-date information about young people's sexual behaviors.AimsTo provide prevalence rates on sexual behaviors and condom and contraceptive use for Australian year 10–12 heterosexual students in a nationally representative sample.MethodsA nationally representative sample of 2,301 male and 2,055 female year 10 through 12 heterosexual students were recruited to an online survey about their lifetime sexual behaviors and condom and contraceptive use. Means and 95% confidence intervals of weighted data, based on the national census, were reported.OutcomesThe main outcomes of this study were prevalence of sexual behaviors by gender (excluding trans and gender diverse) and prevalence of contraception and condom use among sexually active students by gender.ResultsThe most common sexual behavior was masturbation (96.3% of male students, 78.9% of female students), and the least common behavior was anal or vaginal sex (43.7% of male students, 48.5% of female students). Of the sexually active students, condoms were used by 78.1% of male students and 77.5% of female students at first sexual experience and by 65.1% of male students and 56.8% of female students at their most recent sexual experience, whereas 91.6% of male students and 92.3% of female students used some form of contraception at most recent sexual experience.Clinical TranslationResults provide up-to-date information on the practices clinicians who are likely to encounter with heterosexual cisgender adolescent populations in Australia.Strengths & LimitaitonsThe study represents the largest representative cohort of adolescents in Australia to date. However, comparisons with previous representative studies were limited owing to differing samples by age and culture.ConclusionsCompared with earlier Australian studies, young heterosexual cisgender people today engage in slightly less oral and penetrative sexual behaviors, with the exception of more women receiving oral sex, and are generally consistent in condom and contraceptive use.Fisher CM, Kauer S, Mikolajczak G, et al. Prevalence Rates of Sexual Behaviors, Condom Use, and Contraception Among Australian Heterosexual Adolescents. J Sex Med 2020;17:2313–2321.     

Providing quality care to the sexual assault survivor: education and training for medical professionals

One in every six women in the United States will be the victim of an attempted or completed rape over the course of their lifetime.³ Health care providers trained in sexual assault examination procedures are not available in all clinical settings. CNMs/CMs have most of the requisite training to provide this service, and they are ideally poised to help women who report sexual abuse. We can assist persons who have been sexually assaulted by becoming educated in sexual assault care, attending specialty training as sexual assault examiners, joining SARTs, and serving as sexual assault response coordinators in our communities. Education about sexual assault care in midwifery programs can facilitate the ability of CNMs/CMs to provide physical assessments and forensic examinations to sexual assault victims.Once training has been obtained, it is essential to stay current about topics such as emergency contraception, STI treatments, and new methods of forensic evidence collection. Sexual assault examiners must have a knowledge of available referral sources and local resources where the person reporting these crimes may receive assistance as needed. Providing medical and forensic care for women who are victims of sexual violence should be considered a core practice within the midwifery scope of practice. CNMs/CMs need to be well prepared to care for sexual assault patients by receiving proper education and training. Specific instruction concerning care for victims of sexual and domestic violence, along with an introduction to serving as an expert witness, should be an integrated into midwifery education programs as part of the core curriculum.     

Differences in Perceived and Physiologic Genital Arousal Between Women With and Without Sexual Dysfunction

Background

Many sexual psychophysiologic studies have failed to find differences in physiologic genital arousal between women with and those without sexual dysfunction. However, differences in self-reported (ie, perceived) measures of genital responses between these 2 groups of women have been noted.

Sexting and Young Adolescents: Associations with Sexual Abuse and Intimate Partner Violence

Study ObjectiveTo explore whether sexting by young adolescent girls and boys is associated with adverse life experiences including exploitative or violent sexual relationships.Design and SettingCross-sectional, anonymous survey of a convenience sample of minor adolescents younger than age 18 years recruited while waiting for care in clinics affiliated with a children's hospital in a low-resource, high-poverty, urban community.ParticipantsFive hundred fifty-five adolescents aged 14-17 years, 63% girls and 37% boys.Main Outcome MeasuresWe measured sexting by asking, “Have you ever sent a sexually suggestive or naked picture of yourself to another person through text or e-mail?” The survey also measured risk behaviors, sexual abuse, intimate partner violence (IPV), and arrest and included a validated depression scale.ResultsMean age was 15.6 ± 1.1 years; 59% were Hispanic, 28% were black; 44% of girls and 46% of boys ever had sex; 24% of girls and 20% of boys ever sent a sext. More girls than boys reported sexual abuse (16% vs 3%; P < .01), IPV victimization (15% vs 7%; P < .01), and depression (33% vs 17%; P < .01). More boys than girls reported arrest (15% vs 7%; P < .01). Independent associations with sexting for girls were: ever had sex (odds ratio [OR], 4.59; 95% confidence interval [CI], 2.29-9.19; P < .001); sexual abuse (OR, 3.81; 95% CI, 1.80-8.05; P < .001); IPV victim (OR, 2.72; 95% CI, 1.11-6.62; P < .05), and for boys: ever had sex (OR, 4.26; 95% CI, 1.47-12.32; P < .01); sexual abuse (OR, 38.48; 95% CI, 1.48-999.46; P < .05); IPV perpetration (OR, 16.73; 95% CI, 1.64-170.75; 95% CI, P < .05), as well as cannabis use, older age, other race, and arrest.ConclusionFor young adolescents, sexting is independently associated with exploitative and abusive sexual relationships including sexual abuse and IPV with similarities and differences in predictors of sexting for girls and boys.     

Squamous Carcinoma of the Cervix in a 15-Year-Old with Congenital HIV: A Case Report

BackgroundHuman papillomavirus (HPV) is the most prevalent sexually transmitted infection (STI) worldwide. Immunocompetent hosts have intact defense mechanisms to prevent HPV infection, but immunocompromised patients are at higher risk for complications, including HPV-related cancers. Most of these cancers originate from high-risk HPV strains in sexually active patients.CaseHere we present a case of an immunocompromised adolescent who developed cervical cancer despite no prior sexual activity and only ever having had low-risk type HPV on biopsy.Summary and ConclusionsTo our knowledge, this is the first case report of a cervical cancer arising from a low-risk HPV strain in an immunocompromised, non?sexually active adolescent. This case highlights the importance of preventive and screening mechanisms in immunocompromised populations, as they are have a higher probability of HPV-related complications, even in the absence of traditional risk factors.     

Diagnosis of Trichomonas vaginalis in Female Children and Adolescents Evaluated for Possible Sexual Abuse: A Comparison of the InPouch TV Culture Method and Wet Mount Microscopy

Study ObjectiveTo compare the performance of wet mount microscopy and the InPouch TV culture method in diagnosing Trichomonas vaginalis in a cohort of female children and adolescents evaluated for possible sexual abuse.DesignA prospective study in which samples for both wet mount and InPouch TV were collected from the vaginal vault of each participant. The wet mount was examined microscopically for the presence of motile trichomonads, and the InPouch TV was analyzed in accordance with manufacturer specifications.SettingA regional, university-affiliated sexual abuse center in Nashville, TN.ParticipantsFemales (N = 271) aged 10 to 17 years (inclusive) who met screening criteria for sexually transmitted infection testing in accordance with Centers for Disease Control recommendations, and who exhibited evidence of at least partial hymenal estrogenization.Main Outcome MeasuresA Trichomonas vaginalis diagnosis either via detection of motile trichomonads on wet mount or a positive InPouch TV.ResultsThe median age of the 271 participants was 13.6 years, 88% (235/268) were genital Tanner stage 4 or 5, and 66% (173/263) were Caucasian. Trichomonas vaginalis was diagnosed by either wet mount or InPouch TV in 4% (12/274) of the possible sexually transmitted infection exposures. The sensitivity of wet mount was 8/12 = 0.67 (95% confidence interval [CI]: 0.39, 0.86) and specificity was 262/262 = 1.00 (95% CI: 0.99, 1.00). The false negative rate of wet mount was 4/12 = 0.33 (95% CI: 0.14, 0.61).ConclusionsA culture-based method such as InPouch TV should be considered for Trichomonas vaginalis diagnosis when evaluating children and adolescents in whom sexual abuse is a concern.     

Sexual abuse and reproductive health among unmarried young women seeking abortion in China.

OBJECTIVE: To investigate sexual violence and its impact on reproductive health in unmarried young women seeking abortion in China. METHODS: A total of 2002 participants were surveyed by questionnaire, gynecologic examination, and laboratory tests for sexually transmitted disease (STD). RESULTS: Overall, 14% of participants had experienced sexual violence and 43.4% were diagnosed with STD. Among victims of sexual abuse, 8.6% had their first sexual encounter when they were younger than 18 years; 42.7% had had 2 or more sexual partners; and 21.6% never used contraception. Multivariate analysis revealed that sexual abuse, multiple sexual partners, sexual activity before the age of 18 years, and not using contraception were important indicators of the presence of STD. CONCLUSION: The prevalence of sexual abuse is high in China; and among unmarried young women seeking abortion, those who experience sexual abuse are at significantly increased risk for STD.