Acceptability of home-use of misoprostol in medical abortion

INTRODUCTION: Home-use of misoprostol would reduce the number of visits and improve access to medical abortion. We evaluated acceptance of home-use of misoprostol among women and their partners. MATERIALS AND METHODS: One hundred women with up to 49 days of amenorrhea were given mifepristone, followed by misoprostol taken at home. RESULTS: Women chose home-use of misoprostol because it felt more natural, private and allowed the presence of a partner/friend. Two women had a vacuum aspiration due to incomplete abortion. Five unscheduled visits occurred. Ninety-six women were satisfied with their choice of home-use. The male partners were generally satisfied with their partner's choice of home-use and felt that their presence and support had been valuable. DISCUSSION: Our study shows a high acceptability among women and their partners and confirms the safety and efficacy of home-use of misoprostol. Women should be offered this choice to allow more flexibility and privacy in their abortions.     

Introducing General Practice in Urban Greece: Focus on Morbidity Profile

Objectives: To investigate the needs of women and their partners during and after a miscarriage, and the extent that these were met by general practitioners.

Methods: A postal questionnaire was sent to women who had attended one of two acute hospitals in Leicester, UK for clinical investigation and treatment for miscarriage. The questionnaire was sent between three and six months after their attendance. They were also sent a questionnaire to be completed by their partners, if applicable.

Results: Of the 176 questionnaires sent out to women, 94 (53%) were returned. Additionally, 74 questionnaires were completed by male partners. Overall 57 women (65%) felt that all or most of their needs had been met by general practice, but 31 (35%) reported that none or only a few of their needs had been met. Equivalent figures for partners were 35 (60%) and 23 (40%). Aspects of care that were most frequently reported as not having been received before admission included home assessment, information and support. Findings after discharge were similar, when a significant minority wanted but did not receive a follow-up review by their general practitioners. None of the patient variables measured predicted satisfaction with care.

Conclusions: Miscarriage is a common event in general practice but has significant psychological sequelae. A greater understanding of perceived needs of women and their partners provides opportunities to improve care.     

Choice of female-controlled barrier methods among young women and their male sexual partners

CONTEXT: Little is known about the factors associated with the choice of female-controlled, over-the-counter barrier contraceptive methods among women and their male sexual partners. METHODS: Predictors of method choice were assessed following an educational presentation on contraceptive use and risk reduction among 510 sexually active females aged 15-30 who were recruited in the San Francisco Bay Area. In addition, the primary partners of 160 of these women participated in the survey RESULTS: Twenty-two percent of women who enrolled in the study alone, 25% of those who enrolled with their main partner and 18% of these male partners chose female-controlled, over-the-counter barrier methods alone. The strongest predictor of this choice was current use of a hormonal contraceptive both for women who participated in the study on their own (odds ratio, 2.1) and for those who enrolled their partner in the study (odds ratio, 6.3). Female-controlled methods were also chosen significantly more often by teenagers than by older women; for example, among those who enrolled with a male partner, the odds ratio for selection of a female-controlled barrier method by women younger than 18 was 6.0. Among women who enrolled without a partner, those who had had multiple partners in the previous six months and those who were current users of male condoms were less likely to choose female-controlled methods (odds ratios, 0.7 and 0.5, respectively). CONCLUSIONS: Although the majority of participants did not choose female-controlled, over-the-counter barrier methods without also choosing male condoms, such female-controlled methods appear to offer an acceptable alternative for prevention of sexually transmitted infections. They may be a particularly attractive option for individuals using hormonal contraceptives and for teenage women.     

Comparing knowledge and perceived risk related to the human papilloma virus among Australian women of diverse sexual orientations

Objectives : The study compared levels of awareness of human papilloma virus (HPV) as a sexually transmissible infection (STI) between women of different sexual orientations. It also examined self-reported risk factors for HPV infection, perceived level of personal risk, and willingness to have the HPV vaccine.
Methods : Recruitment occurred through community sampling and data was collected using a self-completion questionnaire.
Results : A convenience sample of 349 women completed the questionnaire in early 2007, 309 were sexually active; 47.6% had lifetime sexual partners of both genders, 26.9% had only male partners, and 25.5% had only female partners. Women with partners of both genders were more likely to have ever had a pap test but were also more likely to report an abnormal result (OR 3.19) than women with only male partners. Only 68% of the sample had heard of HPV and women with partners of both genders were significantly more likely to be aware than women with only male partners (OR 2.56). Forty-four per cent did not know how HPV was transmitted and less than half correctly identified HPV-associated clinical problems, with no differences according to gender of partners. The majority of women had risk factors for HPV, however, few felt personally at risk.
Conclusions : The very low personal risk perception for HPV, particularly among women who have female and male sexual partners, suggests the need for targeted education for this group regarding HPV transmission and prevention.
Implications : Health promotion regarding HPV should be broadened to specifically include information about HPV as an STI between women.     

Second-hand prostatism: effects of prostatic symptoms on spouses' quality of life, daily routines and family relationships.

OBJECTIVES: The aim of this study was to explore the impact of male prostatic symptoms on their partners' quality of life, daily routines and family relationships. METHODS: A structured telephone interview study was carried out on a random sample of 215 of the wives and partners of men aged 50 years or older drawn from those registered at four family medicine centres in Israel. They were asked about sleep disturbances, number of night-time wakings, and the effect on sexual relations, travel, entertainment, family and social relationships. RESULTS: The vast majority of women (86%) were affected by their partners' prostatism, with multiple consequences for their daily routines, quality of life and relationships. Sleep was the area of greatest concern, with 46% of women regularly waking due to their partners' urination disorder. The women reported other limitations: 37% noted problems with sexual functioning; 17% were unable to take long trips with partners; 10% could not visit places without toilets; while 8% were unable to go to the cinema or theatre. Women felt that their partners' prostatic symptoms were also to be blamed for upsetting family relationships (10%) and relationships with friends (16%). There was near total correspondence between women and their male partners regarding the effects of prostatic symptoms. CONCLUSIONS: Prostatism has an impact on men and women; strategies that consider the whole couple should be developed and utilized when considering treatment options.     

BOOK REVIEWS

This multimethod study explored challenges faced by women in close heterosexual relationships who decided to test for HIV, and their experiences with instituting safer sexual practices and partner testing. Eighty-one women who sought HIV counseling and testing and had a regular male sexual partner were interviewed on five occasions, and 18 of these women and 15 men later took part in one of four focus groups (women only, men only, or couples). Findings identified difficulty understanding the unpredictability of HIV transmission, gender differences in how partners interpret their susceptibility to HIV, and male resistance to safer sex and testing. We also identified a pervasive phenomenon of “testing by proxy”—the belief that if one partner tests negative for HIV after having unprotected intercourse, the untested partner's serostatus is deemed to be negative. This dangerous practice must be addressed in public health prevention efforts. Programs aiming to reduce heterosexual HIV risk for women must include their male partners and incorporate effective interpersonal communication skills.     

The assessment of sexual functions in women with male partners complaining of erectile dysfunction: does treatment of male sexual dysfunction improve female partner's sexual functions?

The aims of this prospective study were to compare sexual functioning between women with male partners who have erectile dysfunction (ED) and women without partners with ED and also to investigate the effect of the treatment of male ED on female partner's sexual function. The study included 87 women and their male partners. We divided the women into two groups: 38 women with male partners complaining of ED (ED group) and 49 women with male partners who have no ED (control group). Of the men with ED, 30 were treated with penile prosthesis implantation (n = 17) or oral sildenafil citrate (n = 13). We evaluated all the men with the International Index of Erectile Function (IIEF; Rosen, Cappelleri, Smith, Lipsky, & Pena, 1999), physical examination, and color penile Doppler ultrasound. We evaluated female sexual function with the Female Sexual Function Index (FSFI; Rosen et al., 2000) to assess sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. We compared female sexual function scores between the women of the male partners with and without ED and also compared before both groups and after the treatment of male partners in the ED group. Additionally, we compare the scores according to the type of treatment given to the male partners. Sexual arousal (p = 0.009), lubrication (p = 0.001), orgasm (p = 0.006), satisfaction (p = 0.000), pain (p = 0.039), and total score (p = 0.003) were highly significantly lower in the ED group than in the control group, although sexual desire did not differ between the two groups (p = 0.515). We investigated the effect of male ED on female sexual functions and found no statistically significant differences in the presence of organic type impotence, older age, and lower erection scores on the IIEF (p = 0.53, p = 0.15, and p = 0.1, respectively). After the treatment of male ED, we observed significant improvement in sexual arousal (p = 0.001), lubrication (p = 0.002), orgasm (p = 0.000), satisfaction (p = 0.000), and pain (p = 0.002) in the women. These findings suggest that female sexual function is affected by male erection status and may improve after the treatment of male sexual dysfunction.     

Sexual Orientation Disparities in Experiences of Male-Perpetrated Intimate Partner Violence: A Focus on the Preconception and Perinatal Period

IntroductionCompared with their heterosexual counterparts, sexual minority women (SMW), especially those with male partners, are at increased risk for intimate partner violence (IPV). IPV has been linked to a variety of adverse maternal, infant, and child health outcomes. However, to date, no research has examined SMW's experiences of IPV in the context of pregnancy. This study explored whether SMW were more likely than exclusively heterosexual women with only male sexual partners (WSM) to report a variety of forms of IPV perpetrated by their male partner before or during pregnancy.MethodsData are from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Our sample size ranged from 10,081 to 10,328 pregnancies, matched with their male pregnancy partner, reported by 3,828 to 3,873 women.ResultsLogistic regression results indicated that compared with heterosexual-WSM, mostly heterosexual women and heterosexual-women who have sex with women (WSW) were more likely to report any IPV, mostly heterosexual women were more likely to report an IPV-related injury, and heterosexual-WSW were more likely to report sexual assault.ConclusionsResults suggest that mostly heterosexual and heterosexual-WSW are at increased risk of experiencing multiple forms of IPV with their male pregnancy partners, highlighting the need for additional screening and prevention efforts to reduce IPV and its negative sequelae.     

Male engagement in women's microbicide use in Kenya: Navigating gender norms

The success of women's microbicide use for HIV/AIDS prevention may hinge on health programs' ability to engage men to support it. In this qualitative study in Kenya, most women did not or would not tell their partners prior to initiating use, and/or would use despite their objections. Men generally did not agree with this, yet male partners of trial participants who discovered that their partners were using microbicides without their knowledge did not seem concerned. Findings suggest that efforts to engage men in microbicide use should avoid “awakening” patriarchal gender norms, and support women to use microbicides without involving their partners.     

Interpersonal issues surrounding HIV counseling and testing, and the phenomenon of "testing by proxy"

This multimethod study explored challenges faced by women in close heterosexual relationships who decided to test for HIV, and their experiences with instituting safer sexual practices and partner testing. Eighty-one women who sought HIV counseling and testing and had a regular male sexual partner were interviewed on five occasions, and 18 of these women and 15 men later took part in one of four focus groups (women only, men only, or couples). Findings identified difficulty understanding the unpredictability of HIV transmission, gender differences in how partners interpret their susceptibility to HIV, and male resistance to safer sex and testing. We also identified a pervasive phenomenon of "testing by proxy"--the belief that if one partner tests negative for HIV after having unprotected intercourse, the untested partner's serostatus is deemed to be negative. This dangerous practice must be addressed in public health prevention efforts. Programs aiming to reduce heterosexual HIV risk for women must include their male partners and incorporate effective interpersonal communication skills.     

Men’s Controlling Behaviors and Women’s Experiences of Physical Violence in Malawi

In the feminist paradigm, intimate partner violence (IPV) among heterosexual couples is gender asymmetric and largely a tactic of male control. However, research on the relationship between men’s controlling behavior and physical violence against women is limited. This study examines whether having a controlling partner is associated with women’s reports of experiencing physical violence in Malawi. Bivariate and multivariate analyses were conducted using data from 8,385 women who completed the domestic violence module of the Malawi 2004 Demographic and Health Survey. About 18 % of women reported they had experienced moderately severe physical violence and 1 % experienced very severe violence in the past 12 months. A third of women reported their partners had ever been controlling. Results from multivariable ordinal logistic regression showed that women who had controlling partners were significantly more likely to report experiencing physical violence. Other factors significantly associated with women’s experience of physical violence included women who reported initiating physical violence against their partners, women’s work status, partners’ lower education level, and partners’ alcohol consumption. Women with controlling partners were at increased risk of experiencing physical violence in the past year. However, women who reported initiating physical violence in the past year were nearly four times more likely to experience partner violence in the same time period. Future research should attempt to elucidate these two important risk factors for IPV.     

Female control of sexuality: illusion or reality? Use of vaginal products in south west Uganda

This paper reports on a trial of vaginal products that were distributed and used by 131 women and 21 men in south west Uganda. It focuses specifically upon the issue of female control in heterosexual relationships and examines whether methods which are ostensibly under women's control, will in practice give women greater control of their sexual health. Participants were invited to select two from a range of vaginal products that included the female condom, contraceptive sponge, film, tablets, foam and gel, and use each for five weeks and their favourite product for a further three months. They were interviewed up to seven times over a five-month period. Although the women perceived that a major advantage of the products (with the exception of the female condom) was that they could be used secretly, less than 40% were using the products without their partner's knowledge after one week and this proportion declined over time with only 22% using the products secretly after ten weeks. In the main male partners were told as women felt it their duty to inform them. In general the women were very much more positive about the products than they were about the male condom, as were the men. A contributory factor to their popularity among women was the greater control they gave them. Even though, use of these products in practice often involved negotiation with male partners, the fact that use was contingent on women's action was empowering and increased somewhat their ability to control their sexual health.     

Female sexual response and the timing of partner orgasm

Although orgasm can be experienced in many ways with or without a partner, partner involvement continues to be a noted preference for many women. In order to examine the timing of partner orgasm in relationship to female sexual response, women who usually experience orgasm before, simultaneously, or after their male partner's first orgasm were examined in the context of their orgasmic behaviors, role of their partners in sexual interaction, and their level of sexual satisfaction. A survey research design, which utilized the responses of 709 adult women, indicated that those women who usually experienced orgasm after their male partners perceived less physiological and psychological sexual satisfaction. Furthermore, several other significant results were found regarding timing of partner orgasm. With the failure to reach orgasm through sexual intercourse being reported by women as a common sexual complaint, sex educators and therapists can use these findings to facilitate an increased awareness of timing factors influencing satisfying sexual relationships.     

Treatment outcome of secondary orgasmic dysfunction: A two- to six-year follow-up

Sixty-six women reporting secondary orgasmic dysfunction and their partners, who received one of five group treatment formats, were sent questionnaires 2–6 years later. Thirty-eight of the women and 38 of the male partners responded to the follow-up questionnaires. Women who were not divorced and who did not receive additional treatment after group treatment (n =28) showed consistent increases across time in their ability to experience orgasm during intercourse, improving from a mean coital orgasmic frequency of 9.5% before treatment to 36.9% at long-term follow-up. Sexual harmony and coital frequency showed similar increases following treatment but had returned to near baseline levels 2–6 years later. Divorced women and women who received additional treatment (n =10) demonstrated greater declines in sexual harmony over the follow-up period than did their untreated counterparts. The subjects reported generally favorable reactions to treatment and stressed the importance of a treatment focus on communication and relationship skills. Regression analyses suggested the predictive importance of variables associated with the male partner's functioning. The implications of the results for clinical practice and for future research are discussed. This study is part of an investigation funded by NIMH Grant #MH32241.     

Psychosocial Correlates of Unprotected Sex Without Disclosure of HIV-Positivity among African-American,Latino, and White Men Who Have Sex with Men and Women

African-American, Latino, and White men who have sex with men and women (MSMW) may be a bridge of HIV transmission from men to women. Very little research has directly compared culturally specific correlates of the likelihood of unprotected sex among MSMW. The present study examined psychosocial correlates of unprotected sex without disclosure of HIV status with male and female partners among 50 African American, 50 Latino, and 50 White HIV-positive MSMW recruited from AIDS service organizations in Los Angeles County. Multivariate logistic regressions were conducted to examine relationships of race/ethnicity and psychosocial variables (e.g., condom attitudes, self-efficacy for HIV disclosure, sexual identification) to unprotected sex without disclosure of HIV status, for male and female partners separately. For female partners, different effects emerged by race/ethnicity. Among African-Americans, less exclusively homosexual identification and low self-efficacy for disclosure of HIV status to female partners were associated with unprotected sex without disclosure; among Latinos, less exclusively homosexual identification and negative attitudes about condoms were significant. Participants who were more exclusively homosexually identified, who held less positive condom attitudes, and who had low self-efficacy for disclosure to female partners were more likely to have unprotected sex without disclosure of HIV status to male partners. Culturally tailored community-level interventions may help to raise awareness about HIV and bisexuality, and decrease HIV and sexual orientation stigma, thereby increasing African-American and Latino MSMW's comfort in communicating with their female partners about sexuality, HIV and condoms. Addressing norms for condom use and disclosure between male partners is recommended, especially for homosexually identified MSMW.     

Boyfriends and injecting: the role of intimate male partners in the life of women who inject drugs in Central Java

The international literature shows that HIV-risk behaviour for women mostly occurs in the context of intimate relationships. Power imbalances in the social, economic and cultural spheres put women at risk. This paper addresses the roles of male partners in women's engagement in drug-use behaviour and drug-related HIV-risk behaviour in Indonesia. Data were gathered through in-depth interviews with 19 women who had injected drugs in the previous month in three sites in central Java. Most of the women had male partners who also injected drugs. Results show that male partners play a significant role in the initiation of drug use, the provision of drugs, injecting behaviour and in the constitution of women injectors' social networks. These findings suggest the need to develop couple-based interventions and to facilitate women-only groups as part of HIV prevention.     

Sexual Risk Behaviors of HIV-Positive,HIV-Negative,and Serostatus-Unknown Black Men Who Have Sex with Men and Women

Black men who have sex with men and women (MSMW) are at high risk for HIV infection and transmission. This study compared the sexual risk behaviors of Black MSMW who self-reported being HIV-positive with those who reported being HIV-negative and those who did not know their HIV status. Respondent-driven sampling (RDS) was used to recruit 1,154 Black MSM in Philadelphia and New York who completed an audio computer-assisted self-interview (ACASI). Of these men, 212 had engaged in anal sex with male partners and vaginal or anal sex with female partners in the past 3 months. A quarter (23.6%; n = 50) of MSMW self-reported testing positive for HIV at their last test, 59.4% (n = 126) reported testing negative for HIV at their last test, and 17.0% (n = 36) reported never having an HIV test. Multivariate logistic regression analysis revealed that HIV-positive MSMW were much less likely than HIV-negative men and never-tested men to have engaged in unprotected intercourse with main male and main female partners perceived to be HIV-negative or of unknown serostatus. However, HIV-positive men were equally as likely as HIV-negative men to have unprotected intercourse with non-main male and non-main female partners perceived as HIV-negative or of unknown serostatus. Our findings indicate that some HIV-positive MSMW engage in unprotected sex that places female and male partners at risk for HIV infection. However, MSMW who have never taken an HIV test, or who have not been recently tested, may be a greater source of HIV transmission to their female and male partners.     

Violence and HIV Sexual Risk Behaviors Among Female Sex Partners of Male Drug Users

SUMMARY

Objective: Violence and HIV are emerging as interconnected public health hazards among drug users and their families. The purposes of this study are to (1) determine the prevalence of sexual and physical abuse of non-drug-using female sex partners of male drug users, and (2) ascertain the association between such violence and HIV-related risk behaviors. Methods: From 11/93 to 11/95, 208 female sex partners of injection drug or crack users in Collier County, FL, Tucson, AZ, and Portland, OR, were interviewed as part of a NIDA-funded HIV risk reduction project. Their mean age was 30 years (range 18–54); 21% were White, 6% African American, 7% Native American, and 63% Hispanic. Results: Of the 208 women, 28% reported being sexually molested and 20% raped before age 13; 41% reported being raped at least once in their lifetime. Forty-two percent of the women were physically assaulted by their sex partners; 36% had been threatened with assault by their sex partners. Those who were raped or threatened with assault were more likely to have multiple sex partners and engage in unprotected anal sex; there was a trend for women who had been physically assaulted to be more likely to engage in unprotected anal sex. Discussion: Rape, assault and the threat of assault are commonplace in the histories of female sex partners of male drug users. Experiences of violence and threats of violence are associated with heightened risk for the sexual transmission of HIV. Providers of HIV prevention need to understand the sequelae of violence, and design interventions which empower women to protect themselves from sexual transmission of HIV.     

Partnership Concurrency Status and Condom Use Among Women Diagnosed with Trichomonas vaginalis

INTRODUCTION AND BACKGROUND: Partner concurrency increases the risk of sexually transmitted infections (STIs) such as Trichomonas vaginalis. Women diagnosed with T. vaginalis have a 2- to 3-fold higher risk of acquiring the human immunodeficiency virus and developing the acquired immunodeficiency syndrome. GOALS: We sought to describe partnership concurrency (multiple sexual partners during the same time period) and condom use among women diagnosed with T. vaginalis, and to compare reports of concurrency between matched female and male dyads. METHODS: A baseline interview on partnership status and condom use was administered to women diagnosed with T. vaginalis at a public sexually transmitted infections (STI) clinic. A male partner substudy was also conducted. Seventy-three dyads were matched by unique identifier and female and male responses were compared. RESULTS: The participants were 319 African American women and 10 white women aged 15-40 years (N = 329). Almost three fourths (72.3%) had only 1 partner over a 3-month period, compared with more than one fourth (27.7%) with >/=2 partners. Regular condom use was low (16.4%), especially with regular partners (9.1%). In the matched substudy, men reported significantly higher rates of concurrency than women (47.3% vs. 23.0%; p 相似文献   

Do Adolescent Sexual and Reproductive Attitudes and Knowledge Predict Men and Women's Adult Sexual Partnerships?

PurposeAdolescence is a key stage for forming knowledge and attitudes about sex and reproduction that may have long-term implications for adult sexual behaviors. Gender differences in experiences and socialization processes may affect the links between adolescent characteristics and adult behaviors.MethodsBy following adolescent virgins aged 15 years and older from wave I through wave IV of the National Longitudinal Study of Adolescent to Adult Health (n = 4,152), we test whether adolescent boys' and girls' knowledge about, and attitudes toward, sex and reproduction influence the number of lifetime different-sex sexual partners and the likelihood of having concurrent sexual partners in adulthood, using negative binomial regression and logistic regression, respectively. Models are run separately by gender.ResultsMen and women who reported greater physical benefits of sex as adolescents reported more lifetime different-sex sexual partners and were more likely to have concurrent sexual partners in adulthood. For women, adolescent perceptions of more social costs to sex were linked to fewer lifetime sexual partners, whereas greater birth control confidence was linked to more sexual partners. Women who more strongly felt that avoiding sexually transmitted infections was a hassle during adolescence were less likely to have concurrent sexual partners as adults, and men who were more knowledgeable about condoms during adolescence were more likely to have concurrent sexual partners.ConclusionsAdolescent knowledge and attitudes about sex, contraception, and reproduction have implications for adult sexual behavior, but different aspects emerge as salient for men and women.