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This chapter provides an overview of theory and research around sexual health among LGBTIQ populations. The first section of this chapter focuses on sexual intimacy and on specific environments (e.g., gay saunas, dating apps) as means for facilitating sexual encounters, as well as the experiences of sex for trans people who have undergone gender-affirming surgery and those of people born with intersex variations. The rest of the chapter focuses on sexual health in gay and bisexual men (and other mean-who-have-sex-with-men), including the use of pre-exposure prophylaxis in the prevention of HIV, sexual health in lesbian and bisexual women (and other women-who-have-sex-with-women), including engagement in cervical screening, and sexual health in trans people, including the impacts of body dysmorphia and cisgenderism on engagement with healthcare professionals.
People with intellectual disability are as likely to experience menstrual cycle-related mental problems as the general population; however, there may be problems in recognition and communication. Exploration of these health problems and potential treatments associated with menstrual cycle, from puberty through to menopause, are discussed.
Edited by
Laurie J. Mckenzie, University of Texas MD Anderson Cancer Center, Houston,Denise R. Nebgen, University of Texas MD Anderson Cancer Center, Houston
Cervical cancer is the most common gynecologic malignancy worldwide and the third most common in the United States. While incidence and mortality rates have decreased significantly with improved access to screening and prevention methods in the United States, cervical cancer remains a significant cause of cancer morbidity and mortality in resource-limited countries. Human papillomavirus (HPV) infection is the cause of almost all cervical cancer and is associated with 99.7% of cervical cancer. Additional risk factors associated with HPV include early onset of sexual activity, multiple sexual partners, history of sexually transmitted infections, increased parity, and immunosuppression. Non-HPV-related risk factors include cigarette smoking, oral contraceptive use, and low socioeconomic status. Squamous cell carcinoma is the most common histologic subtype of cervical cancer, comprising around 70% of cases, and adenocarcinoma is the second most common histologic subtype, comprising approximately 25% of cases. Cervical cancer is staged clinically, and stage is the most important prognostic factor. Early-stage disease can generally be treated surgically with a hysterectomy. Fertility-sparing surgical options include cold knife conization and radical trachelectomy in select cases. Adjuvant therapy with chemotherapy, radiation, or chemoradiation may be required for early-stage disease with specific risk factors. Advanced-stage disease is primarily treated with chemoradiation. Using FIGO 2018 staging, five-year survival rates were 92−97% for stage IA tumors and 76−92% for stage IB tumors. Lymph node involvement is associated with worse prognosis with five-year survival rates near 40−60%. Routine screening with cervical cytology is recommended starting in young adulthood to identify and treat females with high-grade dysplasia. Routine HPV vaccination is recommended to protect against development of cervical cancer from persistent high-risk HPV infection.
Sexual health campaigns to tackle the rise in sexually transmitted infections in England are at the core of sexual health charities' and grassroots organizations' work. Some of them collaborated with the author's translation students to produce inclusive translations of their sexual health content (website and multimedia content). The role of translation and localization within multicultural contexts can be seen as 'social activism' promoting sexual health and community engagement, with a view to providing wider healthcare access and information using inclusive language. This Element presents students' approaches to sexual health translation, using language as a vessel for change and striking a balance between clients' expectations, translation industry best practices, and socio-educational needs. The data analysis of the students' experiences will make the case for wider embedding of queer pedagogy approaches into the translation curriculum.
Women and gender-diverse people with early psychosis are at risk for suboptimal sexual health outcomes, yet little research has explored their sexual health experiences.
Aims
This study explored sexual health experiences and related priorities among women and gender-diverse people with early psychosis, to identify opportunities for improvements in sexual health and well-being.
Method
Semi-structured individual qualitative interviews explored how patient participants (n = 19, aged 18–31 years, cisgender and transgender women and non-binary individuals) receiving clinical care from early psychosis programmes in Ontario, Canada, experienced their sexual health, including sexual function and behaviour. Thematic analysis was conducted, with triangulation from interviews/focus groups with clinicians (n = 36) who provide sexual and mental healthcare for this population.
Results
Three key themes were identified based on patient interviews: theme 1 was the impact of psychotic illness and its treatments on sexual function and activity, including variable changes in sex drive, attitudes and behaviours during acute psychosis, vulnerability to trauma and medications; theme 2 related to intimacy and sexual relationships in the context of psychosis, with bidirectional effects between relationships and mental health; and theme 3 comprised autonomy, identity and intersectional considerations, including gender, sexuality, culture and religion, which interplay with psychosis and sexual health. Clinicians raised each of these priority areas, but emphasised risk prevention relative to patients’ more holistic view of their sexual health and well-being.
Conclusions
Women and non-binary people with early psychosis have wide-ranging sexual health priorities, affecting many facets of their lives. Clinical care should incorporate this knowledge to optimise sexual health and well-being in this population.
Though BDSM interest (bondage & discipline, dominance & submission and sadism & masochism) has proven to be quite prevalent (46.8% in recent research), there is still significant stigma surrounding it, both in general society and among mental health practitioners.
Objectives
This research explores the biological mechanisms associated with a BDSM interaction in the hope to strengthen the argument that it does not belong in the psychiatric field.
Methods
The present study collected data on peripheral hormone levels, pain thresholds and pain cognitions before and after a BDSM interaction and compared these results to a control group.
Results
show that submissives have increased cortisol and endocannabinoid levels due to the BDSM interaction and that these increases are linked. Dominants showed a significant increase in endocannabinoids associated with power play but not with pain play. BDSM practitioners have a higher pain threshold overall and a BSDM interaction will result in a temporary elevation of pain thresholds for submissives. Additionally, pain thresholds in dominants will be dependent upon their fear of pain and tendency to catastrophize pain and submissives will experience less fear of pain than the control group
Conclusions
Even though this is one of the first studies of its kind, several biological processes can be associated with BDSM interactions, strengthening the hypothesis of BDSM as a healthy form of intimacy and promoting its distinction from paraphilias as they are described in the DSM or ICD classifications.
This quality improvement project was a collaboration between an adult, inpatient female psychiatric intensive care unit (PICU) in South London and the Sexual and Reproductive Health Rights, Inclusion and Empowerment (SHRINE) programme. SHRINE is a London-based programme delivering SRH care to any individual with serious mental illness, substance misuse and/or learning disability.
Objectives
The primary aim of this quality improvement project was to assess patients’ sexual and reproductive (SRH) needs, and the acceptability of providing SRH assessments in a female PICU setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and SHRINE interventions in the PICU.
Methods
A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought.
Results
30% of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. 42% of women were assessed, representing a 3.5-fold increase in uptake. 21% of women initiated SRH interventions of which 14% had all their SRH needs met.
Conclusions
Results identified SRH needs for PICU admissions are greater than realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient’s individual risk profile considered. Providing a nurse-led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients.
The COVID-19 pandemic has dramatically affected ones well-being. ICU healthcare providers are particularly concerned by this impact which includes physical, mental and socioeconomic repercussions. Others health dimensions could be deeply affected but not well explored such as the psycho-sexual status.
Objectives
The aim of this study was to assess sexual health status among ICU healthcare providers.
Methods
This was a cross-sectional study enrolling Tunisian ICU healthcare providers and conducted between July and September 2021. Data collection was based on a self-administrated questionnaire. To assess sexuality, Arabic validated versions of the IIEF-15 and the FSFI was used for male and female respectively. The Fear of COVID-19 Scale and the Rosenberg Self-esteem questionnaire were also used.
Results
Twenty ICU workers (13 physicians and 7 nurses) were enrolled. The mean age was 28.2 years and the sex ratio was 2.3. All participants were involved in COVID-19 crisis management and 80 % reported an increase in their workload. The mean Rosenberg scale was 27 suggesting a low self-esteem. The mean Covid19 Fear Scale was 26 ± 2. For the IIEF-15 the mean score was 17 ± 3 (moderate erectyl dysfunction) and the most damaged dimension was the intercourse satisfaction. For the FSFI scale, the mean was 23 ± 5 witch (a low sexual dysfunction). A high sexual desire with a lack in the satisfaction dimension was reported in 90% of cases. Only 4 participants have consulted a sexologist.
Conclusions
COVID-19 has a serious sexual impact in ICU healthcare providers justifying urgent psychological interventions.
Maintaining sexuality is important to the well-being of women, particularly after menopause and benefits of sexual satisfaction in terms of emotional well-being and quality of life have been well demonstrated.
Objectives
This study aims to assess the sexual health behaviors in Tunisian women during and after menopause and the awareness of Tunisian partners about the role of the quality of their sexuality regarding their physical and psychological wellbeing.
Methods
We comprehensively review the scientific literature using Pubmed database to state Tunisian literature regarding sexual behaviors and function in women during and after menopause. Interviews with twenty Tunisian women after menopause about sexual health have been conducted.
Results
Our bibliographic research revealed a poor literature with only two papers responding to our inquiry but among a specific female population investigated after experiencing breast cancer “Female sexuality in premenopausal patients with breast cancer on endocrine therapy and sexuality after breast cancer: cultural specificities of Tunisian population”. Interrogated women reported a poor sexual satisfaction as well as sexual difficulties in the partner or with him. In fact, there is an important wrong understanding of the female anatomy and physiology by both partners, for the female sexual satisfaction. There is also many wrong cultural ideas about menopause and sexuality.
Conclusions
Currently, sexuality in Tunisian women during and after menopause is influenced by ageing, by previous sexual function and experiences, the male domination in partner’s sexual practices and the sexual functioning in the partner. In general, there is an unfavorable body image and disturbed sexual health.
Inequities in HIV pre-exposure prophylaxis (PrEP) use persist in the United States. Although scientific advancement in delivery options and social acceptance of PrEP has occurred in the past decade, gaps remain in ensuring that this sexual health program is available to all. Components of what a national PrEP program for all would look like are discussed.
Having a mental disorder is associated with increased vulnerability to the transmission of the Human Immunodeficiency Virus (HIV) and the prevalence of HIV is higher in people with a severe mental disorder. People with psychiatric comorbidities such as bipolar affective disorder and depressive disorder, post-traumatic stress disorder (physical or sexual abuse) and/or psychoactive substance use have a higher risk of HIV infection.
Objectives
This work is intended to expose the importance of integrating mental health care with the care of HIV patients.
Methods
The authors conducted a non-systematic review of the literature, conducting research through Pubmed and Medscape using the keywords ‘Preexposure prophylaxis’, ‘HIV’, ‘Mental health problems’.
Results
Several factors may contribute to the high comorbidity between HIV and Mental Disorders, including socio-demographic factors, weak social and environmental structures, as well as internalized stigma, social and experienced discrimination. Mental health problems may interfere with the care needed for prevention, including regular HIV testing and/or adherence to Preexposure Prophylaxis (PrEP); and influence access to and adherence to antiretroviral treatment.
Conclusions
This compelling evidence makes the necessary contribution of integrating mental health into an assessment and continuous treatment of the HIV patient, on the other hand, the assessment and treatment of mental disorders should address sexual health.
Unplanned pregnancies are a significant risk factor in perinatal mental health. They also have the potential to result in adverse health impacts for mother, baby and children into later in life. Women from disadvantaged backgrounds are less likely to access contraception. Women are more likely to on board health advice during pregnancy and post partum period due to high level of surveillance by health professionals.
Objectives
Our aim was for 90% of patients on Coombe Wood Mother and Baby Unit (MBU) to feel supported to make an informed decision about their contraception by October 2020.
Methods
A questionnaire was completed by fifteen inpatients at the Mother and Baby Unit over a 4 month period (April- August 2020) to assess areas around their pregnancy and contraceptives of choice. Contraceptive training was provided by a Sexual Health Specialist to staff across multiple disciplinaries on Coombe Wood MBU. Sexual Health discussion groups were delivered by doctors to inpatients on a monthly basis. A post-intervention questionnaire was given to patients.
Results
•53% of patients reported unplanned pregnancies. •40% of women felt lacking confidence in choosing the right contraceptive •The most frequent question asked during the sexual health groups was regarding hormonal contraceptives impacting on mental health. •By September 100% of patients felt they were able to make an informed decision about their contraception on discharge.
Conclusions
Facilitating women to make informed decisions regarding their contraception empowers them to gain autonomy, reduces the risks of physical and mental illness, improves the quality of life for mothers and babies.
Definitions of health in different branches of medicine are one of the key paradigms in medical sciences. Nowadays, there are two distinct definitions of sexual health and mental health. The definition of sexual health, as well as sexual rights, was proposed by the World Health Organization (WHO, 2006), and the definition of mental health was published in World Psychiatry (Galderisi et al, 2015).
Objectives
The analysis and comparison of these two definitions: mental health and sexual health are two main objectives of this study.
Methods
The analysis was carried out in three areas: logic, philosophical aspects (values) and the impact of other disciplines.
Results
The definition of sexual health reveals a eudaimonistic approach, whereas the definition of mental health is based on a holistic paradigm. Regarding the main principles in the definition of sexual heath, one can identify the following values: well-being, pleasure, safety, sexual rights – compared to harmony, empathy, coping skills, universal values in the definition of mental health. Sexual rights are a constitutive part of sexual health. There is no comparative element in the definition of mental health (e.g. the rights of mentally disabled persons).
Conclusions
These two definitions can have different effects on the prophylaxis and therapy of patients. It all depends on the specific context of care (sexology or psychiatry). Sometimes universal values matter and sometimes not. This is contradictory. Consistency is needed between definitions and practices.
The multiple realities around the sexual and reproductive health of Ghanaian adolescents are explored in this paper. Female and male adolescents (aged 10–19 years, N=298) participated in 40 focus group discussions in 20 communities. A comparative inductive approach has been used to present, analyse and document the sexual and reproductive realities of adolescents in their communities. The findings reveal commonalities as well as differences in the realities among participants. Common realities, regardless of age and sex, were teenage pregnancy and abortion, sexual violence (defilement, rape and coercive sex) and parental neglect. These aside, there were divergent realities for older adolescent girls in particular, e.g. lack of access to contraceptives and understanding of the fertility cycle, and the influences and pressures of social media and varied notions about sexual harassment between female and male adolescents. The findings, overall, underscore the complexity and nuanced lives of adolescents in traversing the sexual and reproductive maturation processes. These events unfold in communities where adolescents are ‘required’ to be silent and ‘play’ innocent regardless of their daily struggles, compounded by limited opportunities to learn and unlearn embedded norms about sexual and reproductive functioning. Some implications for sexual health promotion programmes are outlined.
This chapter focuses on women’s sexual and reproductive health across their lifecourse. It begins with an overview of how sexual and reproductive health has been defined historically and today. Next, it describes the leading causes of morbidity and mortality related to sexual and reproductive health globally and then turns to some specific health outcomes that primarily or exclusively impact girls and younger women, and women during their childbearing ages, as well as peri- and post-menopausal women. The chapter highlights some of the ways gender adversely impacts girls’ and women’s sexual and reproductive health and rights as well as how gendered opportunities limit women’s access to sexual and reproductive health care and services. The chapter concludes with a summary and recommendations for future research and programs.
Sexual dysfunction is a common side effect of external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT) to treat prostate cancer. Men are likely to experience erectile dysfunction, low libido, ejaculatory problems and penile shortening. This qualitative study explored men’s perceptions of sexual dysfunction, including factors such as self-perception, relationships and information and support needs.
Methods:
Semi-structured interviews were carried out with n = 8 men living 18–30 months after EBRT ± ADT. The interviews were transcribed and thematic analysis was carried out.
Results:
All men experienced sexual dysfunction following treatment. The main themes arising were: (i) priorities—sexual issues were not a priority when making treatment decisions, (ii) information and support—men described a lack of information and support about sexual dysfunction and (iii) impact—sexual dysfunction impacted on their self-perception and relationships.
Findings:
Men undergoing EBRT/ADT for prostate cancer may be affected by post-treatment changes in sexual function in a range of ways. This study suggests that they would benefit from early and wide-ranging information and support on sexual dysfunction, even if they do not consider it as a priority. Candid discussions about self-perception and relationships, as well as physical changes, may equip them to cope with post-treatment changes.
Primary care physicians are in a position to recognize sexuality as a core component of health. Data examining the sexual behaviours of Canadians over the age of 50 and the role of primary care in this domain is lacking. A cross-sectional survey was administered to patients over the age of 50, which assessed the importance of sexual activity, problems, and preferences in discussing sexual health with their primary care providers. A total of 39 per cent of patients indicated ongoing sexual activity and 52% of male participants reported current sexual activity compared with 25 per cent of females (p < 0.01). More males reported sexual activity as important than did females (69% vs. 45%, p < 0.01). Participants identifying sexual health concerns discussed physical dysfunctions more than emotional, social, or global health concerns (p < 0.01). More male participants discussed sexual health concerns with their family physician than did females (p < 0.01). The results of our study indicate that many individuals over the age of 50 continue to be sexually active, and that physical and non-physical concerns directly impact participation in sexual activity.
The aim of this study was to explore the role and activities of the school nursing service in sexual health within a large inner London borough.
Background
School nurses (SNs) are specialist community public health nurses working with the school age population to promote their health and well-being and therefore are arguably in a prime position to promote the sexual health of children and young people. This is particularly pertinent in inner city boroughs where the rates of sexually transmitted infections and under-18 conceptions are a significant problem.
Methods
Following a review of the literature, a mixed methods study was undertaken which included an audit of documentary data to identify the referrals received in relation to sexual health and also included questionnaire surveys of school staff and SNs on their views of the role of the SN in sexual health.
Findings
SNs and school staff identified that SNs have a role in sexual health, which was reflected in the referrals received during the audit of documentary data. There appeared to be inconsistencies across the service and evidence suggested that the school nursing service may be underutilised in comparison to the number of students who require sexual health support. The current service appears to be predominantly reactive, particularly for males and those less than 12 years old. However, both SNs and school staff would like to see a more preventative approach; including greater sexual health promotion, condom distribution and school health clinics.