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PubMed1993

Patterns of sexuality in a high-risk sample: results from a survey of new intakes at a county jail.

Described the sexual habits and behaviors in a sample of individuals thought to be at high risk for infection with the AIDS virus. The sample is drawn from new arrestees at a county jail in the San Francisco Bay Area. Results indicate that the individuals in this sample are very sexually active: The majority began their sexual activities at a young age; most are currently in a primary relationship; and a large proportion report having had two or more sexual partners in the last 12 months. Furthermore, for the most part, the patterns of sexual behavior reported by respondents did not differ on the basis of gender. Although it was true that men tended to initiate intercourse at an earlier age than women, men and women did not differ with respect to the numbers of sexual partners reported in the last year, frequency of vaginal intercourse, frequency of anal intercourse, or in the distribution of sexual risk-taking. Overall, women in this sample are very much like men in terms of their sexual behavior.

Adolescent↗
PubMed1993

Composite risk score for Kaposi's sarcoma based on a case-control and longitudinal study in the Multicenter AIDS Cohort Study (MACS) population.

The possibility that an agent in addition to human immunodeficiency virus type 1 may be involved in the etiology of Kaposi's sarcoma in acquired immunodeficiency syndrome (AIDS) patients was investigated between 1984 and 1992 in this nested case-control analysis from the Multicenter AIDS Cohort Study (MACS) of homosexual and bisexual men. A total of 316 cases of Kaposi's sarcoma were identified and compared with 510 participants with AIDS and no evidence of cancer. More of the Kaposi's sarcoma cases were from Los Angeles and used a higher number of recreational drugs. The Kaposi's sarcoma cases were also more active sexually. There was a dose-response relation between Kaposi's sarcoma and the number of sexual partners, with an odds ratio of 2 between the most and least sexually active subgroups. The odds ratio for Kaposi's sarcoma increased to 4.18 (95% confidence interval 1.29-14.1) in the presence of a history of five infections. Hepatitis and gonorrhea contributed the most to this relation. The various observed odds ratios did not change after multivariate adjustment for the other risk factors. A model was developed combining all predictive associations into a composite risk score ranging from one to 12 and based on history of infections, sexual activity, use of poppers/nitrites, and having had sexual partners from the West Coast of the United States. The subgroup with the highest scores, compared to the subgroup with the lowest score, had an odds ratio of 8.93 (95% confidence interval 3.21-30.44) for Kaposi's sarcoma. A longitudinal proportional hazards analysis among all 2,190 human immunodeficiency virus type 1-seroprevalent men at study entry, based on this risk score and CD4 cells at baseline, confirmed these findings. Identifying these specific subgroups that are at high and low risk for Kaposi's sarcoma will help future investigations to be more focused in their search for an additional etiologic factor for Kaposi's sarcoma in AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

HIV prevalence, attitudes and behaviour in clients of a confidential HIV testing and counselling centre in Uganda.

OBJECTIVE: To describe clients, operation and impact of an African public HIV testing and counselling centre. DESIGN AND SETTING: Analysis of samples from clients attending the AIDS Information Centre (AIC) in Kampala, Uganda in early 1991. SUBJECTS: HIV-1-positive and HIV-negative consecutive clients (250 of each), 86 consecutive couples, and 200 consecutive clients who were HIV-negative in 1990 and were attending for their repeat test. MAIN OUTCOME MEASURES: HIV seroprevalence rates, attitudes, behaviour and behaviour change. RESULTS: HIV-1 prevalence was 28% overall, 24% in men and 35% in women. Reasons for taking the HIV test were a planned marriage or a new relationship (27%; 84% in couples), to plan for the future (35%), distrust of sexual partner (14%) and illness or disease/death (not HIV-specific) of partner (20%). The majority of the reported intentions in response to a positive or a negative HIV test result were positive, demonstrating the ability to cope with this information. Of repeat clients, two (1%) had become HIV-1-positive. The majority of repeat clients reported one sexual partner only (67%) or sexual abstinence (25%). Compared with pre-test information from AIC clients attending for the first time, repeat clients reported casual sexual contacts less often (6 versus 25%) and, of those, the majority used condoms. CONCLUSIONS: Our study demonstrates the demand for and the feasibility of confidential HIV testing and counseling services in Uganda, and illustrates the value of these services in achieving behaviour changes. Such services should be considered an additional approach for the reduction of HIV transmission in Africa, especially in areas with high HIV seroprevalence rates.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Validation of a questionnaire for self-assessment of sexual function and vaginal changes after gynaecological cancer.

The Sexual function-Vaginal changes Questionnaire (SVQ), was developed to investigate sexual and vaginal problems in gynaecological cancer patients. The instrument consists of 20 core items, measuring sexual interest, lubrication, orgasm, dyspareunia, vaginal dimensions, intimacy, sexual problems of partner, sexual activity, sexual satisfaction, and body image. Seven additional items assessing current levels of sexual and vaginal problems compared to pre-diagnosis are intended to be used only once in longitudinal studies. The SVQ was validated in two ways: first, the comprehensibility of each item was investigated through combined quantitative and qualitative assessment of patient-observer agreement in 75 gynaecological cancer patients, second, multitrait analyses and principal component analyses were applied to responses from 257 patients with cervical cancer to investigate the scale properties. The level of agreement between the patients' and the observer's ratings was high (median overall agreement 0.84, range 0.46-1.00; median kappa: 0.80, range 0.52-1.00). From the 10 items applicable to all patients, three scales were hypothesized: intimacy, sexual interest and global sexual satisfaction. For sexually active respondents an additional two scales were hypothesized: vaginal changes and sexual functioning. The psychometric analyses confirmed these scales. The internal consistency of the scales ranged 0.76-0.83 (Cronbach's alpha). The study supports the validity and reliability of the SVQ.

Adult↗
PubMed1995

Risk of hepatitis B in adolescence and young adulthood.

In countries of low hepatitis B virus (HBV) endemicity, infection occurs mainly in adolescents and young adults (15-34 years old). The most important risk factors for infection are heterosexual activity, homosexual activity and intravenous drug use. In industrialized countries, therefore, HBV infection is classified among the major sexually transmitted infections, as more than 50% of infections are spread in this way. Transmission from mother to newborn and during infancy is of less importance, except in some countries of southern Europe and in some southern states of the USA. The highest concentrations of HBV are found in blood of infected individuals, but HBsAg is also present in semen and vaginal and cervical secretions, which forms the biological explanation for sexual transmission of the virus. In epidemiological studies, HBV is, in general, associated with indicators of sexual activity such as number of lifetime or recent sexual partners, years of sexual activity and a history or serological marker of other sexually transmitted infections. Providing immunity from infection before risk-taking behaviour is adopted should be the major control strategy for HBV infection. Just as for other sexually transmitted infections, this can be best achieved by universal vaccination of young adolescents or infants, or both groups.

Adolescent↗
PubMed2004

Behavioural risk factors for cervical cancer from a prospective study in Khon Kaen, Northeast Thailand.

Fifty seven cases of cancer of the cervix were identified within a cohort of 16,648 women enrolled in a cohort study of lifestyle and cancer in a rural population of Northeast Thailand. They were compared with 228 matched controls from the same cohort, with respect to demographic, behavioural and reproductive factors potentially associated with risk of the disease. Number of pregnancies and age at having first child were associated with the risk of cervical cancer, but in contrast to studies elsewhere, age at having first sexual intercourse, number of sexual partners and sexually-transmitted infections were not associated with risk. The lack of effect may be simply due to the small size of the study. But it is also likely that these aspects of female sexual behaviour are not very relevant in a relatively conservative rural population. These aspects may be investigated further in future, as new incident cancers are accrued into the cohort.

Adult↗
PubMed2006

The co-occurrence of substance use and high-risk behaviors.

Study findings suggest that alcohol and methamphetamine use heighten the risk for violence, multiple sexual partners, and unprotected sexual intercourse. Although the odds of engaging in risky behaviors increased dramatically with alcohol and methamphetamine use, the majority of subjects did not become involved in high risk behaviors even though they used alcohol and illicit drugs.

Adolescent↗
PubMed2004

Social chemosignals from breastfeeding women increase sexual motivation.

Human pheromones, a type of social chemosignal, modulate endocrine function by regulating the timing of ovulation. In animals, pheromones not only regulate ovulation but also female reproductive motivation and behavior. There is no extant evidence that humans produce social chemosignals that affect human sexual motivation or reproductive behavior as occurs in other mammals. Here, we demonstrate that natural compounds collected from lactating women and their breastfeeding infants increased the sexual motivation of other women, measured as sexual desire and fantasies. Moreover, the manifestation of increased sexual motivation was different in women with a regular sexual partner. Those with a partner experienced enhanced sexual desire, whereas those without one had more sexual fantasies. These results are consistent with previous pheromonal effects on endocrine function, and warrant further study of these social chemosignals as candidates for pheromonal processes, including their effects on other aspects of motivation and behavior.

Adolescent↗
PubMed2002

Adverse childhood experiences and risk of paternity in teen pregnancy.

OBJECTIVE: Few studies have investigated risk factors that predispose males to be involved in teen pregnancies. To provide new information on such factors, we examined the relationships of eight common adverse childhood experiences to a male's risk of impregnating a teenager. METHODS: We conducted a retrospective cohort study using questionnaire responses from 7399 men who visited a primary care clinic of a large health maintenance organization in California. Data included age of the youngest female ever impregnated; the man's own age at the time; his history of childhood emotional, physical, or sexual abuse; having a battered mother; parental separation or divorce; and having household members who were substance abusers, mentally ill, or criminals. Odds ratios (ORs) for the risk of involvement in a teen pregnancy were adjusted for age, race, and education. RESULTS: At least one adverse childhood experience was reported by 63% of participants, and 34% had at least two adverse childhood experiences; 19% of men had been involved in a teen pregnancy. Each adverse childhood experience was positively associated with impregnating a teenager, with ORs ranging from 1.2 (sexual abuse) to 1.8 (criminal in home). We found strong graded relationships (P <.001) between the number of adverse childhood experiences and the risk of involvement in a teen pregnancy for each of four birth cohorts during the last century. Compared with males with no adverse childhood experiences, a male with at least five adverse childhood experiences had an OR of 2.6 (95% confidence interval [CI] 2.0, 3.4) for impregnating a teenager. The magnitude of the ORs for the adverse childhood experiences was reduced 64-100% by adjustment for potential intermediate variables (age at first intercourse, number of sexual partners, having a sexually transmitted disease, and alcohol or drug abuse) that also exhibited a strong graded relationship to adverse childhood experiences. CONCLUSION: Adverse childhood experiences have an important relationship to male involvement in teen pregnancy. This relationship has persisted throughout four successive birth cohorts dating back to 1900-1929, suggesting that the effects of adverse childhood experiences transcend changing sexual mores and contraceptive methods. Efforts to prevent teen pregnancy will likely benefit from preventing adverse childhood experiences and their associated effects on male behaviors that might mediate the increased risk of teen pregnancy.

Adolescent↗
PubMed2003

Social regulation of reproduction in the female mound-builder mouse (Mus spicilegus).

Social environment influences the reproductive physiology and sexual behaviour of the female house mouse Mus musculus. An all-female environment tends to suppress the oestrous cycles, whereas the presence of a male induces and synchronises sexual receptivity. However, reproductive responses to social environment may differ among the various species of rodents. In mound-builder female mice, Mus spicilegus, periods of sexual receptivity are interrupted by periods where adult females display a vaginal closure. We investigated the influence of different social environments on the vaginal opening and oestrous state of adult female M. spicilegus. Result showed that when females were grouped their vaginas were generally closed but that vaginal opening occurred when they were isolated or housed with a sexual partner. Females became sexually receptive when housed with a male, but when isolated their cervical smears did not reach characteristics of the oestrus. In female M. spicilegus, male presence thus has a stimulating effect on oestrous induction. Furthermore, cohabitation with females has an inhibiting effect on vaginal opening.

Animals↗
PubMed1997

Childhood sexual abuse, adolescent sexual behaviors and sexual revictimization.

OBJECTIVE: The aims of this study were to examine the extent to which exposure to childhood sexual abuse (CSA) was associated with increased rates of sexual risk taking behaviors and sexual revictimization during adolescence. METHOD: A birth cohort of 520 New Zealand born young women was studied at regular intervals from birth to the age of 18. At age 18 retrospective reports of CSA were obtained from sample members. Over the course of the 18 year study information was gathered on: (a) childhood, family, and related circumstances; and (b) the young women's history of sexual experiences from 14 to 18 years. RESULTS: Young women reporting CSA, and particularly severe CSA involving intercourse, had significantly higher rates of early onset consensual sexual activity, teenage pregnancy, multiple sexual partners, unprotected intercourse, sexually transmitted disease, and sexual assault after the age of 16. Logistic regression analyses suggested that the associations between CSA and sexual outcomes in adolescence arose by two routes. First, exposure to CSA was associated with a series of childhood and family factors including social disadvantage, family instability, impaired parent child relationships, and parental adjustment difficulties that were also associated with increased sexual vulnerability in adolescence. Second, there appeared to be a causal chain relationship between CSA and sexual experiences in which CSA was associated with early onset sexual activity which, in turn, led to heightened risks of other adverse outcomes in adolescence. CONCLUSIONS: The findings of this study suggest that those exposed to CSA have greater sexual vulnerability during adolescence. This appears to arise because: (a) the childhood and family factors that are associated with CSA are also associated with increased sexual risks during adolescence; and (b) exposure to CSA may encourage early onset sexual activity which places those exposed to CSA at greater sexual risk over the period of adolescence.

Adolescent↗
PubMed2001

Improvement of sexual function in male patients after parathyroidectomy for secondary hyperparathyroidism.

BACKGROUND: Clinically, the severity of uremia is known to be inversely proportional to sexual desire and activity in patients with chronic renal failure. We studied sexual function and sex hormones in male patients with symptomatic hyperparathyroidism before and 3 months after parathyroidectomy. STUDY DESIGN: From October 1998 to December 2000, 20 male patients with symptomatic secondary hyperparathyroidism were enrolled in this study. They underwent total parathyridectomy and autotransplantation of 90 mg of tissue to the subcutaneous tissue of the forearm or thigh. They all had regular sexual partners and were sexually active. Preoperatively, hemoglobin, hematocrit, calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), prolactin, testosterone, leutenizing hormone (LH), and follicle stimulation hormone (FSH) were checked routinely. Three months after operation those data were checked again. Sexual function was evaluated with the International Index of Erectile Function (IIEF). Monthly frequency of attempted sexual intercourse, satisfaction of attempted intercourse, and enjoyment of intercourse were individually analyzed preoperatively and 3 months postoperatively. RESULTS: Hemoglobin, hematocrit, testosterone, and LH were noted to have not significantly changed 3 months after surgery. Serum levels of calcium, phosphorus, alkaline phosphatase, FSH, and iPTH were significantly reduced, as were the levels of prolactin. But preoperative and postoperative FSH levels were within normal limits, and 70% of the postoperative alkaline phosphatase levels were above normal. Sexual function increased significantly 3 months after parathyroidectomy, as did monthly frequency of attempted intercourse, satisfaction of attempted intercourse, and enjoyment of intercourse. CONCLUSIONS: Sexual function of male patients with symptomatic hyperparathyroidism can possibly be improved by parathyroidectomy and autotransplantation. Decreases in the levels of prolactin, calcium, phosphorus, and iPTH are also noticed after parathyroidectomy.

Adult↗
PubMed2001

Prevalence and correlates of sexual activity and HIV-related risk behavior among psychiatric outpatients.

This study investigates the prevalence and correlates of sexual activity and HIV-risk behavior among adults with a mental disorder. Demographic, psychiatric, sexual behavior, and substance-use data were available for 1,558 outpatients. During the past year, 69% were sexually active and 23% engaged in risky behavior. Risk markers included multiple sexual partners (19%), a sexually transmitted disease (4%), sex trading (3%), injection drug use (1%), and needle sharing (<1%). Being sexually active and being at risk for HIV infection were associated with alcohol and drug use, psychiatric diagnoses other than schizophrenia, and younger age. Married patients were more likely to be sexually active but less likely to engage in risk behavior. Screening for HIV risk in psychiatric settings can identify patients who may benefit from risk reduction programs.

Ambulatory Care↗
PubMedDate not supplied

Low relationship satisfaction and high partner involvement predict sexual problems of women with fibromyalgia.

To examine the predictive potential of relationship variables on sexual functioning in women with fibromyalgia, we instructed 63 women (age 21-54 years) to fill out several questionnaires. Low relationship satisfaction was the strongest and most-frequent predictor of problematic sexual functioning. In addition, more fatigue and--only after taking account of relationship satisfaction--more active engagement (i.e., involvement) of the spouse were associated with reduced sexual functioning and satisfaction. Our study suggests that for women with fibromyalgia, relationship satisfaction is good for sexual functioning. Although having an involved spouse is good for the relationship, it may be bad for sexual functioning.

Adult↗
PubMed1998

Are medical students ready to provide HIV-prevention counseling?

PURPOSE: To determine whether medical students were prepared to assess risk and counsel patients about prevention of HIV infection, and whether HIV-related experience produced better knowledge and counseling skills. METHOD: In 1995, students at four North Carolina medical schools interviewed a standardized patient portraying a young woman concerned about HIV infection. The standardized patient recorded whether students asked risk-behavior questions and provided risk-reduction advice. A 21-item questionnaire assessed the students' knowledge of HIV testing and prevention. Students indicated whether they had had experience in educational settings related to HIV or STDs. RESULTS: 415 students completed both the patient interview and the questionnaire. Many failed to ask the patient about several HIV-risk behaviors. Although nearly all (98%) inquired about condom use, fewer than two thirds asked about the patient's history of STDs, number of sexual partners, or specific sexual practices. Most students advised the patient to use condoms. The average score on the knowledge test was 79%; 70% of students confused anonymous with confidential testing, more than half overestimated the risk of HIV transmission from a needle stick, and nearly one in ten did not know how to use a condom. Educational exposures did not produce significantly better risk assessment, counseling information, or knowledge scores. CONCLUSION: A majority of experienced medical students did not assess several important risk factors of a patient concerned about HIV infection, and many would have provided incorrect information related to HIV testing and prevention of infection. Patient contact in traditional clinical settings did not influence prevention knowledge or behavior. More innovative methods are needed to train students in HIV-infection prevention and counseling.

Counseling↗
PubMed2005

Treatment of erectile dysfunction following therapy for clinically localized prostate cancer: patient reported use and outcomes from the Surveillance, Epidemiology, and End Results Prostate Cancer Outcomes Study.

PURPOSE: Erectile dysfunction (ED) persists for years following curative therapies for clinically localized prostate cancer. We report use and treatment outcomes in a 5-year interval in a population based cohort from the Surveillance, Epidemiology, and End Results Prostate Cancer Outcomes Study. MATERIALS AND METHODS: A sample of 1,977 men with localized prostate cancer who received external beam radiation therapy or radical prostatectomy in 1994 to 1995 were surveyed for 5 outcome measures of ED treatment, namely treatment, perceived helpfulness, erectile sufficiency, sexual activity frequency and erection maintenance. Subjects were surveyed 6, 12, 24 and 60 months after prostate cancer diagnosis. RESULTS: Overall 50.5% of men ever used ED treatment. The use of ED treatments increased during the study course. Subject age, regular sexual partner and baseline sexual activity were factors positively associated with ED treatments. While it was used uncommonly (1.9%), a penile prosthesis was perceived as the most helpful ED treatment (helped a lot in 52% of respondents). Sildenafil helped a lot in 12% of respondents. Erectile fullness, erection maintenance and sexual activity frequency were modestly improved in men using ED treatment compared with those in men not using ED treatment. CONCLUSIONS: Approximately half of the patients in this population based cohort of men used ED treatment during the 5 years following prostate cancer diagnosis. Men using ED treatments had modest improvement in sexual function compared with men that in who did not receive ED treatment at 60 months. More effective treatments for ED following local therapy for prostate cancer are needed.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed1991

Characterization of risk factors for Helicobacter pylori infection among men attending a sexually transmitted disease clinic: lack of evidence for sexual transmission.

The mechanism of transmission of Helicobacter pylori is unknown. To investigate the role of sexual behavior and demographic factors in the acquisition of H. pylori infection, we evaluated the seroprevalence of antibody to H. pylori in 370 men attending an urban sexually transmitted diseases clinic. Sera from the following three groups were analyzed by enzyme-linked immunosorbent assay for H. pylori-specific immunoglobulin G: 78 human immunodeficiency virus (HIV)-seropositive homosexual men, 102 HIV-seronegative homosexual men, and 190 HIV-seronegative heterosexual men. Overall, the seroprevalence of H. pylori was 100 of 370 men (27%), with rates of 18% in HIV-seropositive homosexual men and 20% in HIV-seronegative homosexual men versus 35% in heterosexual men (P less than 0.005, chi 2 test). By ethnic group, 21 (12%) of 181 Caucasian men, 40 (41%) of 97 black men, and 37 (43%) of 87 Hispanic men were seropositive (P less than 0.001, chi 2 test). Multivariate analysis revealed that race was associated with H. pylori seropositivity independent of HIV status, sexual preference, or age. There was no relationship between H. pylori seropositivity and the number of lifetime sexual partners or previous sexually transmitted diseases. Three HIV-seropositive men with H. pylori immunoglobulin G had essentially identical antibody titers over 8 to 16 months of follow-up. In conclusion, black and Hispanic men have significantly higher H. pylori seroprevalence rates than do Caucasian men, but neither sexual behavior nor HIV infection influences the presence or persistence of H. pylori antibody. Further evaluation of the factors associated with these ethnic differences may lead to a better understanding of H. pylori acquisition and transmission.

Adolescent↗
PubMed2004

Investigating ethnic differences in sexual health: focus groups with young people.

OBJECTIVES: To compare normative beliefs about sexual health in young men and women from black Caribbean, black African, and white ethnic groups in order to better understand ethnic inequalities in sexual health. METHODS: Focus group discussions with young people living in an area with known high prevalence of gonorrhoea and chlamydia. Groups were stratified by sex and self defined ethnicity. RESULTS: 22 male and 20 female 16-25 year olds of black Caribbean, black African, and white ethnicity took part in eight discussions. Participants from black ethnic groups were more aware of gonorrhoea than white participants but all ethnic groups regarded these as being less important than unplanned pregnancy or HIV/AIDS. Most participants believed that they would have obvious symptoms if they had a sexually transmitted infection and could determine the cleanliness of sexual partners by visual or behavioural cues. Black Caribbean women were alone in acknowledging the likelihood of their partners having concurrent sexual relationships. Some black Caribbean women described negative attitudes of staff in genitourinary medicine clinics who were from the same ethnic background. CONCLUSION: In this focus group study we identified ethnic differences in terminology, awareness of sexually transmitted infections, non-exclusive sexual relationships, and experience of sexual health services but gender had a greater influence on normative beliefs. The similarities in norms for all ethnic groups might reflect common social and cultural exposures. The low priority given to sexually transmitted infections by young people from all ethnic groups needs to be addressed if they are to be tackled successfully.

Adolescent↗