Child sexual abuse

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.     

The impact of mental health, sexual desire and sexual importance on the sexual behaviour of women with HIV

HIV infection is increasing among women in the US, particularly among racial minority groups. The hypothesized theoretical model considered the extent to which indicators of depression, sexual desire and sexual importance would predict whether sexual behaviour would occur for a sample of 96 women with HIV. The results of this study supported previous findings that depression significantly decreases the chances that sexual behaviour will occur, while sexual desire and sexual importance moderately increased the chance occurrence of this variable. The results of this study suggested that the mental health of women with HIV significantly affects whether they engage in sexual behaviour. HIV-prevention and intervention models need to be more inclusive of those factors that are most salient in the sexual relationships of women. Moreover, additional research is needed to examine the importance of maintaining sexual behaviour for women with HIV.     

Lesbians' sexual history with men: implications for taking a sexual history

BACKGROUND: Health care providers may not solicit a comprehensive sexual history from lesbian patients because of provider assumptions that lesbians have not been sexually active with men. We performed this study to assess whether women who identify themselves as lesbians have a history of sexual activities with men that have implications for receipt of preventive health screening. OBJECTIVE: To convey the importance for health care providers to know their patients' sexual history when making appropriate recommendations for preventive health care. METHODS: A survey was printed in a national news magazine aimed at homosexual men, lesbians, and bisexual men and women. The sample included 6935 self-identified lesbians from all 50 US states. The outcomes we measured were respondents' number of lifetime male sexual partners and partners during the past year, their lifetime history of specific sexual activities (e.g., vaginal intercourse, anal intercourse), their lifetime condom use, and their lifetime history of sexually transmitted diseases. RESULTS: Of respondents, 77.3% had 1 or more lifetime male sexual partners, 70.5% had a lifetime history of vaginal intercourse, 17.2% had a lifetime history of anal intercourse, and 17.2% had a lifetime history of a sexually transmitted disease. Exactly 5.7% reported having had a male sexual partner during the past year. CONCLUSION: These findings reinforce the need for providers to know their patients' sexual history regardless of their reported sexual orientation, especially with regard to recommendations for Papanicolaou smears and screening for sexually transmitted diseases.     

Medications and sexual function

There seems to be a reluctance to self-report sexual dysfunction during clinical interviews. The rate of reported sexual dysfunction increases when information is sought aggressively in the clinical interview. The relationship to a specific therapeutic agent, however, can be clouded by the patient's perception and coexisting morbidity. Most of the data relating sexual dysfunction to specific drugs are anecdotal. The strongest proof of a casual effect is improvement in sexual function after withdrawal of the medication. Most of the adverse sexual effects of commonly used medications can be predicted from a simplified understanding of the human sexual response and physiologic mediators. Alternative therapeutic agents can be substituted by understanding these physiologic mechanisms and a careful clinical interview. Although polypharmacy is a problem for older persons, in some cases sildenafil can be used to correct drug-induced impotence.     

Challenges in sexual medicine

The sexual medicine field has been in mode of revolution until recently. Like all other fields of biomedical research, the economic situation around the world has had a negative impact on the field's momentum-research funding bodies, regulatory bodies and pharmaceutical companies seem to have placed sexual medicine in their low-priority list. But this is not the only challenge the field is facing. The successful development of phosphodiesterase type 5 (PDE5) inhibitors for treatment of erectile dysfunction (ED) means that research in this area seems to have slowed. However, there remain several unmet medical needs within sexual medicine such as premature ejaculation, severe ED and hypoactive sexual desire disorder, which await novel therapeutic approaches. Despite these challenges, research into finding and developing such therapies is likely to continue in the sexual medicine field, in an effort to improve the lives of our patients, who wait for effective therapies.     

Ovaries in sexual precocity

BACKGROUND AND OBJECTIVE Ovarian Uh8SOnOgra-phy may be helpful in distinguishing the various types of precocious puberty, and the ovarian appearances Increasingly influence choice of therapy In these girls. We examined retrospectively the ovarian volume and prevalence of polycystic ovarian appearance at ultrasound in girls with sexual precocity. DESIGN Ultrasound examinations were obtained from girls who presented with sexual precocity. If there were several scans from the same Individual, the latest was analysed. PATIENTS The girls were divided Into groups: untreated central precoclous puberty (n= 25), central precocious puberty treated with GnRH analogue (n= 18) or with GnRH analogue and recombinant human OH (n= 11), girls who had stopped treatment with GnRH analogue and GH (n= 12), premature thelarche and thelarche variant (n= 15) and premature adrenarche (n= 14). MEASUREMENTS Ovarian volume was calculated and the ovaries were assessed for polycystic appearance using standard criteria. Ovarian volume standard deviation (SD) scores were calculated using means and standard deviations derived from a control population and compared using analysis of variance. Differences from control data were assessed using Student's t-test. RESULTS Ovarian volume SD scores for all the groups studied were greater than those for control subjects. Girls who had stopped treatment with GnRH analogue and GH had mean ovarian volume of 6.98 mi and ovarian volume SD score (+1·72) greater than that of girls having treatment with GnRH analogue alone (+1·24). Polycystic appearance ovaries were found in 83% of scans in girls who had stopped treatment with GnRH analogue and GH. The ovarian volume SD score of girls with premature adrenarche was less than that of girls with untreated central precoclous puberty. CONCLUSIONS Girls with central precocious puberty had large ovaries which did not return to a volume appropriate for age. Girls treated with GnRH analogue and GH developed very large ovaries when they stopped treatment, and had an Increased prevalence of ovaries with a polycystic appearance. Central precocious puberty, or some aspect of Its treatment, results In an Increased prevalence of polycystic ovarian appearance.     

Alcohol and sexual behaviour

Alcohol, the oldest drug known to the human race, is widely perceived to affect sexual behaviour. The general public, scientific, medical and judicial establishments share and express interest in the potential effects of alcohol on the sexual behaviour of individuals. The understanding of the current state of medical knowledge, regarding the effect of alcohol on sexual behaviour, is of particular interest for the development of sexually transmitted diseases control strategies, and may be called upon for investigating alleged assault and rape. The perceived effects are influenced by historical, mythological, cultural, religious, physiological, pharmacological, expectancy, personal and legislative factors. The potential effects are investigated through surveys, global/situational association studies and placebo-controlled experiments. This article provides a review of literature and a summary of the current state of knowledge regarding the correlation between alcohol and sexual behaviour.