Magnetic resonance imaging of sexual intercourse: initial experience

The objective of this study was to investigate sexual intercourse with magnetic resonance imaging (MRI). A volunteer couple (30 year-old male, 27-year-old female) with a normal sex life, had face-to-face sexual intercourse (reversed missionary position) under MRI. Static and dynamic T2-weighted sagittal sequencies were acquired on the midline before and during vaginal penetration. In this position, before penetration, the vagina was parallel to the pubococcygeal line and had normal anterior convexity. After penetration, accentuation of the vaginal convexity was observed, produced by the penile gland reaching the anterior cul-de-sac and contact with the anterior vaginal wall. The posterior bladder wall was pushed forward and upward, the uterus upward and backward. In this initial experience, we observed a preferential contact of the penis in erection with the anterior vaginal wall and the anterior cul-de-sac in the face-to-face sexual position. MRI allows a noninvasive assessment of sexual intercourse.     

Vaginal laceration and hemorrhagic shock during consensual sexual intercourse

Coital injury causing severe vaginal laceration is not uncommon during first coitus. However, hemorrhagic shock during consensual sexual intercourse is quite rare. In this report, there was one 30-year-old, 20-year-old one, and one 24 year-old women who suffered severe vaginal laceration and bleeding during the process of consensual coitarche. All subjects were transferred to the hospital in the condition of impending shock. We found that the lacerated sites were located at right posterior fornices in all cases. We postulate that these vulnerable sites of vaginal laceration may be due to the dextro-rotation characteristics of the uterus and the distensibility of the vagina in this area. The vaginal fornix can be extremely distended during sexual intercourse, making it vulnerable to laceration in this area. Besides, there was a disproportionate genital size in all three cases which may be a cause of vaginal laceration. It is critical that such patients receive a prompt diagnosis to provide efficient management. It needs only simple surgical skills to cure the injury if the vital signs are stable. However, those survivors may need further psychological consultation to prevent negative impact on their future sexual functioning.     

百合避孕囊房事后试验临床分析

[目的 ]　对女用屏障式器具百合避孕囊的临床安全性、有效性及男女双方感觉进行探讨。 [方法 ]　志愿参加的 2 13例育龄妇女为观察对象 ,于安全期使用本器同房后 6～ 12小时内来门诊检查 ,取出避孕囊后 ,分别于宫颈管、后穹隆、避孕囊囊腔内取样镜检 ,并作精液计量。 [结果 ]　 2 13人作了 2 6 8次房事后试验 ,避孕有效性为98.77%。对宫颈糜烂、阴道炎者一般无加重 ,少数人有好转。 95 %有负压感。男女均无异常感觉 ,甚至有加强性感作用。 [结论 ]　阴道形态学、子宫体位的个体差异对避孕囊的使用、有效性无明显差异 ;对男女性感有增强作用。     

Dyspareunia.

Dyspareunia--painful intercourse--is a common cause of sexual difficulty. The following paper discusses, for both males and females, the common causes of dyspareunia and in many instances the appropriate treatment. Painful intercourse for the male is related either to the prepuce, glans penis, penile shaft, testicles, or urethra and prostate gland, whereas painful intercourse for the female is related to the vaginal opening, clitoris, vagina, or uterus, tubes, and/or ovaries. Each of the above is discussed.     

Prolapse of appendices epiploicae due to vaginal vault [corrected] rupture

A 52-year-old woman, para 2, presented with pain in her lower abdomen and a bleeding vaginal swelling. The night before she had fallen on her buttocks at a dancing party. The medical history listed a vaginal hysterectomy with anterior and posterior repair. On physical examination a mildly bleeding, red lobulated tumour protruded through the vaginal orifice. On closer inspection appendices epiploicae were seen to be bulging through a 3 cm wide, but narrow rupture in the vaginal vault. The patient denied having had sexual activity or any specific trauma. As some appendices epiploicae showed signs of necrosis, repositioning and repair was performed by laparotomy. Evisceration through a vaginal wall defect is a very rare, but potentially life threatening situation. Predisposing factors are postmenopausal status, a history of uterus extirpation and vaginal prolapse. In premenopausal women it is most often associated with coitus or trauma. The vaginal wall defect can be closed from a vaginal approach but if there is any doubt about the viability ofthe viscera, a laparotomy should be carried out.     

AIDS and heterosexual anal intercourse

Heterosexual anal intercourse is rarely discussed in the scientific literature. Review of the literature suggests the silence is linked to ethnocentric discomfort about it among researchers and health care providers, coupled with the misconception that anal sex is a homosexual male practice, not heterosexual. Review of surveys of sexual practices suggest that heterosexual anal intercourse is far more common than generally realized, more than 10% of American women and their male consorts engaging in the act with some regularity. Sexually transmitted disease (STD) data, especially where only the rectum is infected with gonorrhea or other STD agents, buttresses survey data. Considerably more heterosexuals engage in the act than do homosexual and bisexual men, not all of whom participate in anal coitus. Anal intercourse carries an AIDS risk for women greater than that for vaginal coitus, just as receptive anal intercourse carries a very high risk for males. Infection with the AIDS virus is increasingly documented in women engaging in anal coitus with infected males, in America, Europe, and Latin America. Women in Western countries are less likely to continue HIV infectivity chains than are males engaging in same-gender anal intercourse.     

Sexual interest,activity, and satisfaction among male nursing home residents

Structured interviews were conducted with all male residents (n = 116) of a Veterans Affairs Nursing Home to gather information on sexual interest, preference, activity levels, satisfaction, and distress. We excluded males with severe cognitive impairment, leaving a sample of 61. Of these, 30 had partners. Sexual interest was significantly higher among those with partners (p = 0.014), although those without partners reported that their interest would have been higher if they had a sexual partner. Sexual preference was strongly in favor of vaginal intercourse, regardless of the presence or absence of a partner. Among those with partners, coitus was reported to occur at least monthly by 17%, and other forms of sexual activity (e.g., hugging, kissing) were practiced at least monthly by 73%. Sexual satisfaction was high, and distress with relative sexual inactivity was remarkably low. We found age, functional status, and intercourse frequency to correlate positively with sexual satisfaction, whereas marital status, cognitive function, libido, and frequency of kissing were positive correlates of sexual distress. Institutionalized elderly males remain sexually interested, especially in coitus, and may benefit from counseling and home visits when a partner is available.     

Distribution of a vaginal gel (Invisible Condom) before, during and after simulated sexual intercourse and its persistence when delivered by two different vaginal applicators: a magnetic resonance imaging study

OBJECTIVE: The objective of this study was to evaluate the vaginal distribution of a microbicidal gel (Invisible Condom) before, during and after simulated intercourse using an artificial phallus. The gel was delivered using either a new proprietary vaginal applicator (PVA), which has multiple lateral and apical holes, or a commercial applicator (CA), which has a single apical hole. The persistence of the gel was evaluated up to 24 h after its administration. STUDY DESIGN: Nine women (five women using the PVA and four women using the CA) applied the vaginal gel once, and pelvic images were taken immediately after application. An artificial phallus was inserted and the women had 30 vaginal thrusts, then another set of images was taken while the phallus was still inside the vagina. On exit of the phallus, one more set of images was taken. Images were subsequently taken at 30 min, 2 h, 6 h and 24 h after gel application. RESULTS: Immediately after gel application, the PVA distributed the gel throughout the vaginal/cervical mucosae, while the CA delivered the gel only to the cervical area. During simulated intercourse, the phallus further pushed the gel delivered with the CA into the fornix, whereas it spread the gel delivered with the PVA more evenly throughout the mucosal surface. After simulated intercourse, both applicators gave similar gel distributions between 30 min and 6 h after application. However, at 24 h, using the PVA, only 5% of the gel persisted in the vagina, compared to 40% of the gel using the CA. DISCUSSION AND CONCLUSION: Using the new PVA, the Invisible Condom covered the vaginal/cervical mucosae before and during simulated intercourse, offering immediate protection, whereas only the cervical mucosa was covered using the CA. Forty percent of the gel persisted mostly in the upper vaginal/cervical area at 24 h following its administration with the CA, while only 5% of the gel was left using the PVA. The new applicator, with its unique design, ensures an even and immediate coating lasting throughout the first 6 h and could prevent potential microbicide vaginal toxicity at 24 h.     

成年女性阴道异物滞留10年一例

报告1例28岁女性阴道异物滞留10年的病例。该患者自述10年前有被性侵史,未就医。2年前开始同房出现间断阴道出血,1年前出现腹痛、发热症状,盆腔磁共振成像提示阴道异物可能。本次入院后行宫腹腔镜联合手术,腹腔镜探查见盆腔脏器表面均被覆大量炎性粘连带,双侧输卵管僵硬、迂曲,未见阴道异物突入盆腔,宫腔镜探查示阴道中段大量炎性质硬息肉状赘生物,其间可见直径1 cm孔洞,宫腔镜探入后,可见右侧穹窿部一桶状质硬黑色异物,长约3 cm,直径约2 cm,此异物与穹窿及阴道壁广泛致密粘连,行宫腹腔镜联合阴道异物取出术+宫腔镜下阴道炎性赘生物切除术+阴道修补术,术后恢复良好。     

Sexual function during the puerperium

Of 328 women interviewed at a postnatal clinic, 166 (50.6%) had resumed sexual intercourse, the average interval after delivery being 5 weeks postpartum. Of the various social and clinical factors examined, resumption of coitus was related only to marital status, vaginal laceration, and continuing vaginal bleeding. Of the sexually active group, 89% were practicing effective contraception.     

Men pressured and forced into sexual experience

A predominantly heterosexual sample of 204 college men were asked to report incidents of pressured or forced sexual touch or intercourse since age 16. About 34% indicated they had received coercive sexual contact: 24% from women, 4% from men, and 6% from both sexes. Contact involved only sexual touching for 12% and intercourse for 22%. Sexual contact was pressured in 88% of the 81 reported incidents by tactics of persuasion, intoxication, threat of love withdrawal, and bribery. In 12% of the incidents, sexual contact was forced through physical restraint, physical intimidation, threat of harm, or harm. Contact was initiated by an acquaintance or intimate in 77% of incidents. The negative emotional impact of male contact was rated significantly higher than the impact of female contact. Men with and without coercion experience did not differ, however, for scale scores on sexual esteem, depression, and preoccupation. Interviews with 10 subjects revealed complex reactions to coercive male and female contact, including doubts about one's sexuality, resentment of unexpected or forceful contact, and fear of telling others about the event.     

Coitarche and orgastic capacity

In a group of 2,159 gynecological patients, aged 21 to 40, the age at the first sexual intercourse was ascertained and correlated with orgastic capacity during coitus in marital life. All had been married for at least 1 year. Of the examined females, 1,093 who reached orgasm mostly or always during sexual intercourse had their first coitus earlier than 394 women with rare and 165 women with no coital orgasm. The difference between orgastic women and examinees with rare orgasm was significant at the 0.01 level. The difference between females with adequate sexual reactivity and females with no coital orgasm was significant at the 0.001 level.     

The female condom: the African perspective

The female condom is a soft, pliable, prelubricated polyurethane pouch which is inserted into the vagina prior to having sexual intercourse. A flexible polyurethane ring encircles the condom's open end to prevent the entire pouch from entering the vagina during intercourse and to cover the vulva while allowing an entryway for the penis. A smaller flexible ring inside of the condom helps to position and hold the condom within the vagina. Studies have found the female condom to be as effective as male condoms or other female controlled barrier methods in preventing pregnancy. Moreover, the female condom is theoretically better than the male latex condom because of its lower leakage and slippage rates. A recent study in Thailand has shown that accessibility of the female condom can lead to a reduction in STIs among prostitutes, while Trussel et al. estimate that perfect use of the device may reduce the annual risk of acquiring HIV by more than 90% among women who have sexual intercourse twice weekly with an infected male. Women participants in several studies in Africa, however, have complained that the female condom is too long, and over-lubrication has been a reported problem in areas where dry sex is preferred. On the other hand, some users have found sexual intercourse using the female condom to convey the same level of physical sensitivity in the genital region as intercourse without using a barrier method. Evidence suggests that the female condom may be acceptable to men and women in certain types of sexual relationships, but unacceptable in others.     

Documented male-to-female transmission of HIV-1 after minimal vaginal exposure in the absence of other cofactors for infection

AIDS cases attributable to heterosexual vaginal intercourse constitute a growing proportion of new AIDS cases in the United States. Major cofactors that possibly increase the efficiency of heterosexual transmission of HIV-1 include genital ulcer disease, multiple sexual exposures, lack of male circumcision, and primary and advanced stages of HIV-1 disease. I report the case of a 33-year-old woman who was recently infected with HIV-1 after one to three nontraumatic episodes of vaginal intercourse with a healthy-appearing, HIV-1-infected, bisexual man. An investigation of her exposure history revealed the precise time frame during which infection occurred. The patient developed a primary HIV-1-infection syndrome and became seropositive for HIV-1 within eight weeks of her last sexual contact with the infected man. An epidemiological and laboratory evaluation of the index patient and her sexual partner identified only one risk factor for enhanced HIV-1 transmission: the patient's use of oral contraceptives. Her partner was immunologically intact, HIV-1 antigen negative, and circumcised. Both of the individuals were from Minnesota, as were their recent sexual partners. This case illustrates that HIV-1 infection by vaginal intercourse can occur in the absence of the major risk factors believed to increase the efficiency of transmission. Even in a low HIV-1 prevalence area like Minnesota, efforts to promote awareness of HIV-1 status, abstinence, non-penetrative sex, or barrier protection need to be expanded and the behaviors adopted by sexually active persons if HIV-1 transmission is to be minimized.     

Condom use among female commercial sex workers in Nevada's legal brothels.

OBJECTIVES. The purpose of this study was to evaluate condom use and the incidence of breakage and slippage during vaginal intercourse among female prostitutes in legal Nevada brothels, where use of condoms is required by law. METHODS. Forty-one licensed prostitutes in three brothels were enrolled in a prospective trial in August 1993. Used condoms were collected to verify reported breaks visually. Retrospective breakage and slippage rates were obtained in a standardized interview. RESULTS. Condoms were used for every act of vaginal intercourse with a brothel client during the study period, as well as in the previous year. In the prospective study phase, condoms were used in 353 acts of vaginal intercourse with clients. No condoms broke, and none fell off the penis during intercourse. Only twice (0.6%) did condoms completely fall off during withdrawal. Twelve times (3.4%) during intercourse and 15 times (4.3%) during withdrawal, condoms slipped down the penis but did not fall off. CONCLUSIONS. These findings, among the lowest breakage and slippage rates published, suggest that regular condom use may lead to condom mastery and the development of techniques to reduce the likelihood of breakage and slippage.     

Older male sexual partner as a marker for sexual risk-taking in adolescent females in Nova Scotia

PURPOSE: To examine age differences between Nova Scotia women aged 15-19 and their male sexual partners, and to determine if those adolescents with older partners were more likely to have engaged in sexual risk-taking behaviours. METHODS: A cross-sectional survey (response rate=91%) administered in May 2003 assessed the following sexual risk behaviours: (a) not using condom/hormonal contraception at last vaginal intercourse; (b) having unplanned vaginal intercourse while using alcohol or drugs; (c) having more than one partner in the previous year; (d) vaginal intercourse before age 15; and (e) ever having anal intercourse. Univariate analysis was carried out to determine associations of sexual risk behaviours with partner age difference. Logistic regression was then used to examine behaviours associated with partner age (p < 0.15) in univariate analysis. RESULTS: Of the young women surveyed, 520 (47.7%) had had vaginal intercourse in the previous year; 515 of these provided information on their last partner's age. Over 10% had partners four or more years older. In multivariate analysis, having a partner > or =4 years older was associated with not using a condom at last intercourse (OR 2.15; 95% Cl 1.10-4.20), having more than one partner in the previous year (OR 21.9; 95% Cl 1.13-4.28) and having unplanned vaginal intercourse while using alcohol or drugs (OR 2.66; 95% Cl 1.34-5.28). CONCLUSIONS: A significant number of female adolescents have older male sexual partners, and such relationships are markers for high-risk sexual behaviours. Partner age is an important consideration for health professionals providing sexual health advice to young women.     

Heterosexual Anal Intercourse: An Understudied, High-Risk Sexual Behavior

Differences between heterosexuals who have or have not engaged in anal intercourse were analyzed. Though anal intercourse is widely recognized as an activity that greatly increases the risks for HIV transmission, it has received little attention in heterosexual populations. A questionnaire was mailed to a random sample of university students, a population in which many people engage in vaginal intercourse with several partners each year. The three largest minorities were randomly oversampled in order that all four major ethnic/racial groups could be statistically evaluated for possible differences. Almost 23% of nonvirgin students had engaged in anal intercourse. Regression analysis indicated that people who had participated in anal intercourse were more likely than people without anal experience to have been younger at first vaginal intercourse, to be older when the data were collected, to have engaged in vaginal intercourse in the last three months before data collection, to be more erotophilic, to use less effective contraceptive methods, and to have used no condom at last coitus. Overall, people who engage in anal intercourse take more sexual risks when engaging in vaginal intercourse than do people without anal experience. No major ethnic/racial differences were detected. Sexologists have not explored anal sex in much detail, hence we have been weak in educating those 20 to 25% of young adults who are not reluctant or (inhibited about) exploring anal intercourse. As young adults use condoms less for anal than vaginal intercourse, they have not learned enough about the risk of anal sex.     

The prevalence of high-risk sexual behavior in male intravenous drug users with steady female partners.

A sample of 149 (70 White, 79 Black) male intravenous drug users with steady female sexual partners was interviewed in 1987, in treatment and street settings, about sexual practices during the previous five years. Eighty-three percent had multiple partners, 15 percent reported male sexual contact, 38 percent reported heterosexual anal intercourse, and 73 percent never used condoms. Thirty-seven White and 30 Black subjects reported bisexuality or heterosexual and intercourse or both.     

Sexual Timetables for Oral-Genital,Vaginal, and Anal Intercourse: Sociodemographic Comparisons in a Nationally Representative Sample of Adolescents

Objectives. We documented the prevalence and relative timing of oral-genital, vaginal, and anal intercourse during adolescence and examined whether these timetables varied by sociodemographic factors.Methods. We used data from almost 14 000 Wave IV respondents to the National Longitudinal Study of Adolescent Health to generate prevalence estimates for adolescents who reached age 18 years by 2001 and logistic and ordinary least squares regression to examine sociodemographic correlates of sexual patterns.Results. One in 5 adolescents did not engage in any of these sexual behaviors by age 18 years. More than two thirds reported vaginal or oral-genital sexual activity, but only about half experienced both. One in 10 reported anal intercourse experience. A third initiated 2 or more behaviors within a 1-year period. In longer timetables, vaginal intercourse was more often initiated first. Most sociodemographic characteristics examined were uniquely associated with prevalence and sexual timing.Conclusions. Diversity in patterns of sexual initiation occurring in the 1990s underscores the ongoing need for comprehensive and nuanced examinations of adolescent sexual trajectories and their implications for sexual health in more recent cohorts.Sexual behavior patterns have evolved significantly since the “first sexual revolution” of the 1920s.1 Fewer than 10% of individuals born early in the 20th century had sex by age 18 years, compared with more than 50% of persons born between 1968 and 1973.2 Of individuals 15 to 44 years old in 2002, 75% had had premarital vaginal intercourse by age 20 years3; almost 90% of individuals 18 to 27 years old in 2001 had had premarital vaginal intercourse.4Most adolescent sexuality research focuses exclusively on vaginal intercourse. Two cross-sectional US national surveys routinely measure vaginal intercourse in adolescent samples. Estimates from the Centers for Disease Control and Prevention’s 2009 Youth Risk Behavior Survey indicate that approximately 60% of male and 65% of female high-school seniors have had vaginal intercourse.5 Similarly, in the 2006 to 2008 National Survey of Family Growth (NSFG), 66% of men and 62% of women aged 18 and 19 years had had vaginal intercourse.6By contrast, estimates of adolescent oral-genital and anal intercourse experience vary widely, probably because most, except NSFG figures, are based on smaller community samples.7–10 During the 1980s and 1990s, estimates of adolescent oral-genital sexual activity ranged from 35% to 66%. In the 2006 to 2008 NSFG, 70% of men and 63% of women aged 18 to 19 reported oral-genital sexual activity.6 Community sample prevalence estimates of adolescent anal intercourse range from 20% to 32%.10 Recent NSFG data indicate that almost 17% of men and 15% of women aged 18 to 19 years have ever had anal intercourse.6 The Youth Risk Behavior Survey does not ask about oral-genital or anal intercourse.The order of initiating oral-genital and vaginal intercourse is of interest because initiating oral-genital sexual activity first, which carries lower risk of sexually transmitted diseases (STDs) than does vaginal or anal intercourse, could substitute for vaginal and anal intercourse, postpone their onset, or hasten the transition to coital or anal experience. Community sample estimates of initiating oral-genital intercourse first range from 14% to 50%.7–9,11,12 Some analyses indicate that “vaginal virgins” are less likely to have had oral-genital intercourse than are “vaginal nonvirgins,” implying that vaginal intercourse typically occurs first.10,13,14 However, about half of male and female respondents aged 15 to 24 reported that they had oral-genital before vaginal intercourse in the 2006 to 2008 NSFG data.6 The NSFG does not measure the amount of time separating oral-genital and vaginal initiation. There has been less investigation of anal intercourse, but given its low prevalence (10% of respondents aged 15–19 years in the 2006–2008 NSFG),6 if anal intercourse is initiated during adolescence, it will typically occur last.Timing of first sexual experience may have implications for the sexual sequence and pace that follow.14 There has been extensive research on the timing of first vaginal intercourse in particular. In the United States, the average age at first vaginal intercourse is about 17 years.15 Mean ages at initiation of oral-genital and anal intercourse have not been reported for current national data.Documenting variation and typicality in the order and timing of life experiences—including sexual experience—across cohorts is important because they may differentially affect physical and emotional health within and across historical time.16 For example, initiating intimate behaviors (e.g., vaginal intercourse) before less intimate ones (e.g., kissing) has been linked to inconsistent use of contraception.17 Findings suggest differential psychosocial implications of oral-genital and vaginal intercourse,18,19 which may make order of initiation important. Compared with adolescents with vaginal intercourse experience (with or without oral-genital sexual experience), adolescents who have had only oral-genital intercourse are less likely to feel guilty or used or to get into trouble with parents because of sexual activity. However, they are also less likely to experience sexual pleasure or to report feeling good about themselves.18 Early coitus is also linked to higher likelihood of sexual risk taking, including inconsistent condom use, more sexual partners, and, at least during adolescence, a higher likelihood of STDs.20–23 Heterosexual anal intercourse is also a marker for sexual risk taking.24In summary, despite potential implications for sexual health and general well-being, few studies have documented the typicality of sexual timetables for multiple behaviors, and much of the available information is based on relatively small and geographically limited samples. To date, only NSFG data from 2002 forward allow estimates of adolescent oral-genital and anal intercourse for a nationally representative sample. Although a valuable resource, NSFG data do not include ages at initiation of noncoital behavior, limiting opportunities to evaluate implications of sexual timing.The current study provided unique information about the timing (age at initiation) of oral-genital, vaginal, and anal intercourse and order of initiation for adolescents in grades 7 through 12 in the 1994 to 1995 school year. Documenting sexual timetables during adolescence provides a foundation for examining developmental implications of patterns and offers a point of reference to examine historical changes. We used data from the National Longitudinal Study of Adolescent Health (Add Health) to examine the

• prevalence of vaginal, oral-genital, and anal sexual experience during adolescence and whether prevalence varies by age cohort, biological sex, pubertal timing, race/ethnicity, family structure, and parent education;
• typicality of the earliest behavior (i.e., which is initiated first) across groups defined earlier;
• average timing (age) at initiation of oral-genital, vaginal, and anal intercourse and whether timing varies by groups defined earlier; and
• overlap in experience of oral-genital, vaginal, and anal intercourse during adolescence and whether overlap varies by biological sex.

     

Sexual intercourse and pregnancy

Coitus during pregnancy is a crucial factor in the health maintenance of pregnant women. Fifty‐two women were surveyed regarding the information they received concerning sexual intercourse during and following pregnancy. This study showed that, overall, health professionals were not providing information to pregnant women about sexual intercourse and pregnancy. The health professionals who provided sexual information to pregnant women were shown to be inadequate in their efforts. Nurses need to take a more active role in the education of women and their partners about coitus during pregnancy and postpartum.