Coital frequency among married and cohabiting couples in the United States

Hormonal Contraception Use and Sexual Frequency across Young Women's Intimate Relationships

We examined whether hormonal contraception (HC) use predicts sexual frequency throughout and across young women's intimate relationships. From 2008-2012, the Relationships Dynamics and Social Life Study collected weekly surveys over 2.5 years, and included 893 women (aged 18-19 at baseline) who reported 2,547 intimate relationships across 32,736 weeks. Three-level logistic multilevel models assessed the weekly probability of sexual intercourse based on 1) weekly HC use (vs. nonuse) and 2) duration of HC use, both accounting for several relational and individual characteristics, including relationship duration. Women had more frequent sexual intercourse when they were using HC than when they were not (predicted probabilities .65 vs .41). The weekly probability of sexual intercourse increased sharply within the first month of HC initiation (by about 27 percentage points), remained high for several months, then began to slowly decline (yet remained above that of nonuse). When separated by method type, similar trajectories were found for the pill, ring, and IUD/implant; following the initial increase, steeper declines in intercourse frequency were found for the contraceptive injectable, eventually dropping below pre-initiation levels. Findings signify the immediate influence of reduced pregnancy fears in facilitating sexual intercourse among young women, which may decline as HC use continues long-term.

Changes in Frequency and Patterns of Marital Sexual Activity During COVID-19: Evidence From Longitudinal Data Prior to, During and After Lockdown in Singapore

BACKGROUND

The literature suggests that the pandemic has affected sexual activity and sexual desire around the world, potentially due to increased levels of stress, movement restrictions under lockdown conditions, and changes in relationship quality.

AIM

To investigate changes in frequency and patterns of marital sexual activity and the role of potential factors underlying these changes, during and after COVID-19 lockdown.

METHODS

This longitudinal study followed 409 heterosexual married female participants who completed a baseline survey in April-July 2018 and biweekly online surveys over the next 14 weeks; an online survey in May 2020 during the lockdown in Singapore; and an online survey in June 2020 after the lockdown was lifted. Participants were recruited in 2018 using street intercept and screened for inclusion and exclusion criteria. Logistic fixed-effects models were used to test for changes in frequency and patterns of marital sexual activity and assess underlying factors. Pseudo-design-based sample weights were applied.

OUTCOMES

The 2018 in-person baseline survey collected information on demographic characteristics and ideal frequency of marital sex, while follow-up online questionnaires in May-June 2020 included items on exact dates of marital sexual activity of previous weeks; stress and fatigue levels; both spouses' stay-at-home statuses during lockdown; and marital satisfaction.

RESULTS

409 heterosexual married women were included in this study. Compared to pre-pandemic levels, the proportion of participants not having marital sex within a week remained stable while weekly sexual frequency increased, with more evenly distributed sexual activity on weekdays and weekends. Stress, fatigue, and marital satisfaction levels predicted probability of non-activity and sexual frequency.

CLINICAL TRANSLATION

The increase in weekly sexual frequency has implications for sexual and reproductive health, including sexual satisfaction and prevalence of infertility and low birth weight associated with waiting time to pregnancy.

STRENGTHS & LIMITATIONS

The longitudinal nature of the dataset provides unique insights into differences in frequency of marital sexual activity during compared to before the pandemic. Unlike previous studies, detailed data on exact dates of sexual activity allow for detection of differences in sexual activity by day of the week. However, dates of sexual activity were recorded retrospectively and may contain recall errors. Data were collected only from wives and hence dates of marital sexual activities were not cross-validated with husbands.

CONCLUSION

Results point to more active and flexible marital sex lives during the pandemic, with effects that persisted after the lockdown ended. Tan PL. Changes in Frequency and Patterns of Marital Sexual Activity During COVID-19: Evidence From Longitudinal Data Prior to, During and After Lockdown in Singapore. J Sex Med 2022;19:188-200.

Relationship between socio-economic characteristics of older adults' women and family planning use in Botswana

Older adults (50 years and over) are still sexually active and therefore vulnerable to unplanned pregnancy, infection of STIs and HIV, yet there are no programmes in place to cater for their family planning needs. The objective of the study is to show how some socio-economic characteristics of older adults influence their family planning (FP) use. The study used a stratified random sampling design where four health districts (two urban and two rural) were purposively selected and the sample size of 444 older adult women allocated to the districts using proportional allocation to size. Snowball technique was used in identifying respondents. The multinomial logistic regression analysis reveals that while age, marital status, educational qualification, employment status, menopausal status, district and desire for another child jointly significantly predict FP use, only menopausal status and desire for another child individually significantly (p < 0.01) predict FP use. Older adult women who desired another child were significantly (p < 0.01) 7.5 times more likely to use family planning (FP) methods than those who do not want another child. The postmenopausal older adult women were less likely to use FP methods than those in their premenopausal state (OR = 0.13). Women with no schooling were less likely to use FP methods than those with degree/professional qualifications. Single and married women were less likely to use FP methods than the divorced/widowed/separated. The study recommends the promotion of education and training on FP use among the older adult women that will take into consideration their menopausal status and desire for another child. The training should be home-based.

Stress, Fatigue, and Sexual Spontaneity Among Married Couples in a High-Stress Society: Evidence from Sex Diary Data from Singapore

This paper investigates the associations between stress and fatigue and sexual spontaneity among heterosexual married couples in Singapore, a high-income society with high work performance expectations and long working hours. Data on self-reported menstrual dates, sexual activity within the marriage, and stress and fatigue levels were collected from 657 married women aged 25-34 years through biweekly online diaries over 14 weeks. Using a two-way fixed effects logistic model which controlled for time-invariant individual fixed effects and menstrual cycle fixed effects, the paper tests three hypotheses: (1) sexual activity is significantly lower on weekdays compared to weekends and public holidays, (2) sexual activity is significantly lower during periods when women reported higher stress and fatigue, and (3) stress and fatigue are more predictive of sexual activity during weekdays than during weekends. Frequencies of marital sexual intercourse during the diary keeping period were 3.69 and 2.55 per 30 days among women aged 25-29 and 30-34 years, respectively, much lower than ideal frequencies of 6.40 and 5.23. Consistent with all three hypotheses, there was a strong positive weekend effect and a weak but positive public holiday effect, and strong negative effects of both stress and fatigue, especially during weekdays. There was no evidence of compensatory sex on weekends to make up for hectic workweeks. Increased support for work-life balance can contribute to more spontaneous marital sex lives and may reduce underachievement of ideals for sexual intimacy and childbearing in Singapore.

Pelvic Floor and Sexual Dysfunction After Vaginal Birth With Episiotomy in Vietnamese Women

Introduction

Episiotomy has been the most common procedure in obstetrical practice; however, its benefits remain controversial, especially in case of postpartum pelvic floor disorder and sexual dysfunction.

Aim

The aim of this study was to evaluate early complications, pelvic floor, and sexual dysfunction after delivery with episiotomy and their associated factors.

Methods

158 healthy pregnant women at term (38 weeks 0 days to 41 weeks 6 days), aged above 18 years old, who vaginally delivered a singleton baby with cephalic presentation were recruited. The subjects were evaluated through 3 interviews at 1−3 days, 6 weeks, and 3 months after delivery, respectively.

Main Outcome Measure

The evaluations were accomplished primarily by administration of 2 validated questionnaires: the Pelvic Floor Distress Inventory Short-form 20 to evaluate symptoms of pelvic floor dysfunction, and the Female Sexual Function Index to evaluate effects on the women’s sexual life.

Results

Among early complications, pain while sitting (30.4%) was the most prominent trouble, other pelvic disorders, such as urinary incontinence (11.4%), urinary retention (10.8%), or flatus incontinence (8.9%), were also observed in a remarkable number of participants. Average Pelvic Floor Distress Inventory Short-form 20 score was 7.0 ± 10.2 after 3 months. At that time, the prevalence of sexual dysfunction was 40.7%. Trouble occurred commonly in the domains of desire (68.9%) and pain (58.5%). Associated factors of sexual dysfunction were maternal age over 30 years and parity. These factors, in combination with birth weight over 3,500 gram (g), were also associated factors of pelvic floor disorders.

Conclusion

Pelvic pain was the most popular postdelivery complication. Urinary and bowel dysfunction were self-limited complications. Despite being considered a simple technique, episiotomy and its repair must be performed rigorously in order to allow the best recovery of pelvic floor and sexual function.

Huy Quoc NV, Phuc An LS, Phuong LS, et al. Pelvic Floor and Sexual Dysfunction After Vaginal Birth With Episiotomy in Vietnamese Women. Sex Med 2019;7:514–521.

Sexual Activity and Weekly Contraceptive Discontinuation and Selection Among Young Adult Women in Michigan

Understanding young women's contraceptive and pregnancy prevention behaviors is important for helping women and their partners control if and when they have children. Prior research on associations between patterns of sexual activity and contraceptive behaviors is limited. We assessed the influence of recent sexual activity on discontinuation and selection of specific contraceptive methods. We used weekly data from the Relationship Dynamics and Social Life (RDSL) study, a longitudinal 2.5-year population-based project that sampled woman ages 18 and 19 (N = 1,003) in one Michigan county. We estimated logistic and multinomial regression models that accounted for clustering of weekly observations within partnerships and women. Weekly discontinuation of longer-acting methods declined with increasing sexual activity in the past month, as did discontinuation of shorter-acting hormonal methods. Sexual activity was associated with decreased selection of condoms relative to other methods. Future research into life events that lead to changes in the frequency of sexual activity may provide insight into times when women are at risk of contraceptive discontinuation. These findings underscore the importance of anticipatory guidance in contraceptive counseling so that when women change their contraceptive behavior they are equipped in advance with resources to make safe transitions between methods.

A comparison of sexual function in primiparous and multiparous women

Childbirth is one of the most important influencing factors for sexual function. Therefore, this study was conducted with the aim of comparing sexual function in primiparous and multiparous women. This cross-sectional analytical study was performed using systematic random sampling on 420 women in the postpartum period who referred to Bandar Abbas health Centres in 2018. The data were collected using an interview method which consisted of a Female Sexual Function Index questionnaire and a demographic questionnaire. The data analysis was performed using the SPSS Version 23 software. The results showed that sexual dysfunction was lower in multiparous women compared to primiparous women (p = .006). Low sexual activity in primiparous women can be due to less privacy and more time and energy loss. Several factors including housing situation, monthly income, episiotomy incision, and the education level of the couple were influential in the sexual function of the primiparous women (p < .05). Sexual function differs between primiparous and multiparous women in postpartum period and the number of deliveries can affect sexual performance.IMPACT STATEMENTWhat is already known on this subject? Sexual function in humans is affected by a complexity of interactions. Childbirth is among the most one of the important factors that influences sexual function. Pregnancy and childbirth affect all organs of the female body, especially the genital tract, and the resulting changes may cause problems in sexual intercourse. Negative childbirth experiences from previous deliveries can affect sexual performance.What do the results of this study add? Regarding the high prevalence of sexual problems during the postpartum period and the direct impact of this on spousal relationship, and also given the controversial data on the relationship between parity and sexual dysfunction, the present study was conducted to compare postpartum sexual function between primiparous and multiparous women.What are the implications of these findings for clinical practice and/or further research? The sexual and emotional intimacy of couples may be affected due to the changes in women's sexual function as the result of physiological and anatomical changes during pregnancy and postpartum. Therefore, to improve the quality of sexual relations, screening and counselling for sexual disorders should not be limited to pregnancy and postpartum periods, but should also be included in pre-pregnancy counselling centres.

Fearful-Avoidant Attachment: A Specific Impact on Sexuality?

In this study, we investigated sexual outcomes in individuals presenting fearful-avoidant attachment, that is, those who have both high avoidant and anxious attachment tendencies (reluctant to engage in a close relationship and a dire need to be loved by others). A community sample of men and women (N = 600; 25-45 years) completed self-reported questionnaires related to attachment, sexuality, and control variables. Results showed that fearful avoidance is predictive of (a) more sexual partners in individuals during their lifetime and (b) greater sexual compliance. These effects were true for women as well as for men.

Predictors of Sexual Intercourse Frequency Among Couples Trying to Conceive

BACKGROUND

Little is known about the predictors of sexual intercourse frequency (SIF) among couples trying to conceive despite the well-established link between SIF and fecundity.

AIM

To evaluate men's and women's demographic, occupational, and lifestyle predictors of SIF among couples.

METHODS

469 Couples without a history of infertility participating in the Longitudinal Investigation of Fertility and the Environment Study (2005-2009) were followed up for ≤1 year while trying to conceive. At enrollment, both partners were interviewed about demographic, occupational, lifestyle, and psychological characteristics using standardized questionnaires. Multivariable generalized linear mixed models with Poisson distribution were used to estimate the adjusted percent difference in SIF across exposure categories.

OUTCOMES

SIF was recorded in daily journals and summarized as average SIF/mo.

RESULTS

The median (interquartile range) SIF during follow-up was 6 (4-9) acts/mo. For every year increase in age for women and men, SIF decreased by -0.8% (95% CI -2.5 to 1.0%) and -1.7% (95% CI -3.1 to -0.3%). Women with high school education or less and those of non-white race had 34.4% and 16.0% higher SIF, respectively. A similar trend was seen for men's education and race. Only couples where both partners (but not just 1 partner) worked rotating shifts had -39.1% (95% CI -61.0 to -5.0%) lower SIF compared to couples where neither partner worked rotating shifts. Men's (but not women's) exercise was associated with 13.2% (95% CI 1.7-26.0%) higher SIF. Diagnosis of a mood or anxiety disorder in men (but not women) was associated with a 26.0% (95% CI -42.7 to -4.4%) lower SIF. Household income, smoking status, body mass index, night work, alcohol intake, and psychosocial stress were not associated with SIF.

CLINICAL TRANSLATION

Even among couples trying to conceive, there was substantial variation in SIF. Both partners' age, education, race, and rotating shift work as well as men's exercise and mental health play an important role in determining SIF.

CONCLUSIONS

As this was a secondary analysis of an existing study, we lacked information on many pertinent psychological and relationship quality variables and the hormonal status of participants, which could have affected SIF. The unique population-based couple design, however, captured both partners' demographics, occupational characteristics, and lifestyle behaviors in advance of their daily, prospective reporting of SIF, which was a major strength. Important predictors of SIF among couples attempting to conceive include men's exercise and mental health and both partners' age, education, race, and rotating shift work. Gaskins AJ, Sundaram R, Buck Louis GM, et al. Predictors of Sexual Intercourse Frequency Among Couples Trying to Conceive. J Sex Med 2018;15:519-528.

Estimating HPV DNA Deposition Between Sexual Partners Using HPV Concordance, Y Chromosome DNA Detection, and Self-reported Sexual Behaviors

Background

Detection of human papillomavirus (HPV) DNA in genital samples may not always represent true infections but may be depositions from infected sexual partners. We examined whether sexual risk factors and a biomarker (Y chromosome DNA) were associated with genital HPV partner concordance and estimated the fraction of HPV detections potentially attributable to partner deposition.

Methods

The HITCH study enrolled young women attending a university or college in Montréal, Canada, and their male partners, from 2005 to 2010. We tested baseline genital samples for Y chromosome DNA and HPV DNA using polymerase chain reaction.

Results

Type-specific HPV concordance was 42.4% in partnerships where at least one partner was HPV DNA positive. Y chromosome DNA predicted type-specific HPV concordance in univariate analyses, but in multivariable models the independent predictors of concordance were days since last vaginal sex (26.5% higher concordance 0-1 vs 8-14 days after last vaginal sex) and condom use (22.6% higher concordance in never vs always users). We estimated that 14.1% (95% confidence interval [CI], 6.3-21.9%) of HPV DNA detections in genital samples were attributable to vaginal sex in the past week.

Conclusions

A substantial proportion of HPV DNA detections may be depositions due to recent unprotected vaginal sex.

The case for investing in the male condom

When used correctly and consistently, the male condom offers triple protection from unintended pregnancy and the transmission of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). However, with health funding levels stagnant or falling, it is important to understand the cost and health impact associated with prevention technologies. This study is one of the first to attempt to quantify the cost and combined health impact of condom use, as a means to prevent unwanted pregnancy and to prevent transmission of STIs including HIV. This paper describes the analysis to make the case for investment in the male condom, including the cost, impact and cost-effectiveness by three scenarios (low in which 2015 condom use levels are maintained; medium in which condom use trends are used to predict condom use from 2016–2030; and high in which condom use is scaled up, as part of a package of contraceptives, to meet all unmet need for family planning by 2030 and to 90% for HIV and STI prevention by 2016) for 81 countries from 2015–2030. An annual gap between current and desired use of 10.9 billion condoms was identified (4.6 billion for family planning and 6.3 billion for HIV and STIs). Under a high scenario that completely reduces that gap between current and desired use of 10.9 billion condoms, we found that by 2030 countries could avert 240 million DALYs. The additional cost in the 81 countries through 2030 under the medium scenario is $1.9 billion, and $27.5 billion under the high scenario. Through 2030, the cost-effectiveness ratios are $304 per DALY averted for the medium and $115 per DALY averted for the high scenario. Under the three scenarios described above, our analysis demonstrates the cost-effectiveness of the male condom in preventing unintended pregnancy and HIV and STI new infections. Policy makers should increase budgets for condom programming to increase the health return on investment of scarce resources.

Does Sex Really Matter? Examining the Connections Between Spouses' Nonsexual Behaviors, Sexual Frequency, Sexual Satisfaction, and Marital Satisfaction

We examined the interplay between husbands' and wives' positive and negative nonsexual interpersonal behaviors, frequency of sexual intercourse, sexual satisfaction, and feelings of marital satisfaction. To do this, we conducted an in-depth face-to-face interview and completed a series of telephone diaries with 105 couples during their second, third, and fourteenth years of marriage. Consistent with the argument that women's sexual response is tied to intimacy (Basson, 2000), multilevel analyses revealed that husbands' positive interpersonal behaviors directed toward their wives-but not wives' positivity nor spouses' negative behaviors (regardless of gender)-predicted the frequency with which couples engaged in intercourse. The frequency of sexual intercourse and interpersonal negativity predicted both husbands' and wives' sexual satisfaction; wives' positive behaviors were also tied to husbands' sexual satisfaction. When spouses' interpersonal behaviors, frequency of sexual intercourse, and sexual satisfaction were considered in tandem, all but the frequency of sexual intercourse were associated with marital satisfaction. When it comes to feelings of marital satisfaction, therefore, a satisfying sex life and a warm interpersonal climate appear to matter more than does a greater frequency of sexual intercourse. Collectively, these findings shed much-needed light on the interplay between the nonsexual interpersonal climate of marriage and spouses' sexual relationships.

Prevalence and risk factors of sexual dysfunction in postpartum Australian women

INTRODUCTION

Female sexual dysfunction is highly prevalent and reportedly has adverse impacts on quality of life. Although it is prevalent after childbirth, women rarely seek advice or treatment from health care professionals.

AIM

The aim of this study was to assess the sexual functioning of Australian women during the first year after childbirth.

METHODS

Postpartum women who had given birth during the previous 12 months were invited to participate in this cross-sectional study. A multidimensional online questionnaire was designed for this study. This questionnaire included a background section, the Female Sexual Function Index, the Patient Health Questionnaire (PHQ-8), and the Relationship Assessment Scale. Responses from 325 women were analyzed.

RESULTS

Almost two-thirds of women (64.3%) reported that they had experienced sexual dysfunction during the first year after childbirth, and almost three-quarters reported they experienced sexual dissatisfaction (70.5 %). The most prevalent types of sexual dysfunction reported by the affected women were sexual desire disorder (81.2%), orgasmic problems (53.5%), and sexual arousal disorder (52.3%). The following were significant risk factors for sexual dysfunction: fortnightly or less frequent sexual activity, not being the initiator of sexual activity with a partner, late resumption of postnatal sexual activity (at 9 or more weeks), the first 5 months after childbirth, primiparity, depression, and relationship dissatisfaction.

CONCLUSION

Sexual satisfaction is important for maintaining quality of life for postpartum women. Health care providers and postpartum women need to be encouraged to include sexual problems in their discussions.

Do testosterone declines during the transition to marriage and fatherhood relate to men's sexual behavior? Evidence from the Philippines

Testosterone (T) is thought to help facilitate trade-offs between mating and parenting in humans. Across diverse cultural settings married men and fathers have lower T than other men and couples' sexual activity often declines during the first years of marriage and after having children. It is unknown whether these behavioral and hormonal changes are related. Here we use longitudinal data from a large study in the Philippines (n=433) to test this model. We show that among unmarried non-fathers at baseline (n=153; age: 21.5 ± 0.3 years) who became newly married new fathers by follow-up (4.5 years later), those who experienced less pronounced longitudinal declines in T reported more frequent intercourse with their partners at follow-up (p<0.01) compared to men with larger declines in T. Controlling for duration of marriage, findings were similar for men transitioning from unmarried to married (without children) (p<0.05). Men who remained unmarried and childless throughout the study period did not show similar T-sexual activity outcomes. Among newly married new fathers, subjects who had frequent intercourse both before and after the transition to married fatherhood had more modest declines in T compared to peers who had less frequent sex (p<0.001). Our findings are generally consistent with theoretical expectations and cross-species empirical observations regarding the role of T in male life history trade-offs, particularly in species with bi-parental care, and add to evidence that T and sexual activity have bidirectional relationships in human males.

Associations between affect, context, and sexual desire in depressed young women

We investigated associations of sexual desire with time of day, physical and social context, and positive and negative affect using momentary sampling in 44 depressed young women (mean age = 18). Analyses revealed that depressed young women experienced sexual desire when with their boyfriends and later in the evening. Sexual desire was also positively associated with positive affect. Sexual desire was not associated with negative affect or physical context. This research suggests that sexual desire is experienced by depressed young women in normative developmental social contexts. Our findings may help clinicians and sexual health educators in correcting the myth that depressed women do not have sexual desire.

Factors associated with abortion-seeking and obtaining a safe abortion in Ghana

Although Ghana's abortion law is fairly liberal, unsafe abortion and its consequences remain among the largest contributors to maternal mortality in the country. This study analyzes data from the 2007 Ghana Maternal Health Survey to identify the sociodemographic profiles of women who seek to induce abortion and those who are able to obtain safe abortion services. We hypothesize that women who have access to safe abortion will not be distributed randomly across different social groups in Ghana; rather, access will be influenced by social and economic factors. The results confirm this hypothesis and reveal that the women who are most vulnerable to unsafe abortions are younger, poorer, and lack partner support. The study concludes with policy recommendations for improving access to safe abortion for all subgroups of women, especially the most vulnerable.

Egalitarianism, Housework, and Sexual Frequency in Marriage

Changes in the nature of marriage have spurred a debate about the consequences of shifts to more egalitarian relationships, and media interest in the debate has crystallized around claims that men who participate in housework get more sex. However, little systematic or representative research supports the claim that women, in essence, exchange sex for men's participation in housework. Although research and theory support the expectation that egalitarian marriages are higher quality, other studies underscore the ongoing importance of traditional gender behavior and gender display in marriage. Using data from Wave II of the National Survey of Families and Households, this study investigates the links between men's participation in core (traditionally female) and non-core (traditionally male) household tasks and sexual frequency. Results show that both husbands and wives in couples with more traditional housework arrangements report higher sexual frequency, suggesting the importance of gender display rather than marital exchange for sex between heterosexual married partners.

Frequency of sexual activity with most recent male partner among young, Internet-using men who have sex with men in the United States

Sex frequency, defined here as the number of oral or anal sex acts with the most recent partner in the past year, is a potential driver of risk for sexually transmitted infections. However, few data on sex frequency have been reported for men who have sex with men (MSM). Data from an Internet survey of MSM were used to describe sex frequency with most recent main and casual male partners and to estimate factors associated with higher sex frequency. Among 5,193 MSM, higher sex frequency was associated with younger age, shorter relationship duration, and reporting a main (vs. casual) partner; and lower sex frequency with male partners was associated with heterosexual or bisexual (vs. homosexual) identity or Black race (vs. non-Hispanic White). Secondary analyses of estimates of sex frequency from 2 publicly available nationally representative datasets comprised of primarily heterosexual survey respondents (the 2008 General Social Survey and the 1992 National Health and Social Life Survey) were performed. Sex frequency among MSM respondents was similar to that reported by heterosexuals.

The partner-specific sexual liking and sexual wanting scale: psychometric properties

Inspired by research showing that wanting (one's motivation to engage in an activity) often diverges from liking (one's enjoyment of the activity), this article details the development and validation of a new measure to examine the distinction between sexual wanting and liking within a relationship: the partner-specific sexual liking and wanting (PSSLW) scale. In Study 1, participants (N = 1145; 63% female) completed items intended to measure PSSLW. Factor analysis supported a 15-item two-factor solution that explained 64.7% of the total variance. The partner-specific sexual liking (PSSL) subscale (Cronbach's α = .93) and the partner-specific sexual wanting (PSSW) subscale (Cronbach's α = .87) showed good internal validity. Test-retest reliability on a subsample (n = 30) was high (Pearson's r = .75). In Study 2, participants (N = 67; 71.6% female) completed the PSSLW scale and additional measures of satisfaction and desire. Both scales displayed satisfactory discriminant and convergent validity. In Study 3, participants (N = 2589; 45.3% female) completed the PSSLW scale and answered questions about sexual behavior within their relationships. The two subscales were distinctly correlated with measures of self-reported behavior. Moreover, confirmatory factor analysis (CFA) yielded a good-fit two-factor model, where the Comparative Fit Index (CFI) = .97, Tucker Lewis Index (TLI) = .96, and root mean square error of approximation (RMSEA) = .06. Data from these three studies suggested that PSSLW were distinct, measurable, and valid constructs that have the potential to enrich future studies of sexual experience and behavior within sexual partnerships.

Sex after stroke: a content analysis of printable educational materials available online

BACKGROUND

Providing written educational materials to stroke survivors is a key recommendation in many international stroke guidelines. Yet, sexual concerns are generally overlooked in current stroke rehabilitation and the content of educational materials on sexual concerns has not been analyzed nor evaluated in published stroke research.

AIM

The aim of this study was to identify, describe, and analyze printable educational materials on sexual concerns that are available online and easily shared with stroke survivors.

METHOD

Google search engine was used to locate printable educational materials from the Internet using a search term strategy of 35 phrases that were piloted for accuracy. The content of eligible materials was analyzed using NVivo software to produce both enumerative and thematic data.

RESULTS

Nine educational materials from reputable organizations were included with an average length of seven pages and 1445 words (total 61 pages, 13 000 words). The content of the materials was similar and covered three main content areas: problems experienced after stroke: 30% coverage suggested solutions: 32% coverage, and reassurance: 9% coverage. Content describing potential problems reflected published research, but solutions and reassurance were general, nonspecific, and often not supported by evidence.

CONCLUSIONS

Educational materials on sex after stroke may be helpful for health professionals, stroke survivors, and their partners, yet some messages appear to discourage recovery. Educators, health professionals, and organizations can use this analysis to evaluate their own educational resources and create resources that better address the sexual concerns of stroke survivors and their partners.

The developmental association of sexual self-concept with sexual behavior among adolescent women

Developing a sexual self-concept is an important developmental task of adolescence; however, little empirical evidence describes this development, nor how these changes are related to development in sexual behavior. Using longitudinal cohort data from adolescent women, we invoked latent growth curve analysis to: (1) examine reciprocal development in sexual self-concept (sexual openness, sexual esteem and sexual anxiety) over a four year time frame; (2) describe the relationship of these trajectories with changes in sexual behavior. We found significant transactional effects between these dimensions and behavior: sexual self-concept evolved during adolescence in a manner consistent with less reserve, less anxiety and greater personal comfort with sexuality and sexual behavior. Moreover, we found that sexual self-concept results from sexual behavior, as well as regulates future behavior.

The association of sexual interest and sexual behaviors among adolescent women: a daily diary perspective

Theoretical and empirical linkages of adult women's sexual interest and sexual behaviors are relatively well-established, but few data address similar issues in adolescent women. This paper reviews data from published reports of associations of adolescent women's sexual interest and various sexual behaviors. All of the papers reported data collected from a single longitudinal cohort of young women. The primary source of data collection was daily diaries, allowing close temporal pairing of sexual interest with sexual behaviors. Young women's sexual interest on a given day was consistently and independently associated with sexual activity on that day, whether the behavior was first lifetime coitus, coitus, fellatio, cunnilingus, anal intercourse, or coitus during menses. We also found no evidence of influence of hormonal contraceptives on young women's sexual interest. Taken together, these data demonstrate the relevance of sexual interest as a key factor in young women's sexuality and sexual behavior.

Sexual function in the postpartum period: effects of maternal depression and interpersonal psychotherapy treatment

Women's sexual functioning in the postpartum period is understudied given its potential impact on women's mental health and their relationships with their partners. The sexual functioning of women with postpartum depression (PPD) in particular is not well characterized. The goals of this study were to examine factors associated with the sexual functioning of postpartum women and to compare the long-term sexual functioning of depressed postpartum women treated with interpersonal psychotherapy with a group of postpartum women who had never been depressed. Depressed (120) and never depressed (56) postpartum women were enrolled. Self-report questionnaires and clinician-rated measures were completed at initial entry to study, immediately post-treatment, and at 6, 12, and 18 months post-treatment. Analyses revealed significant differences in sexual interest between depressed and never depressed postpartum women (t (171) = 11.82, p <0.001). Although sexual interest improved significantly following treatment for depression (t (104) = -3.18, p < 0.01), those women who fully recovered continued to experience less interest (F (2, 140) = 32.24, p < 0.0001) and less sexual satisfaction through 2 years postpartum than never depressed women. These findings suggest that differences in sexual functioning exist between depressed and never depressed postpartum women, even after depressed women are treated and have recovered from their depression. Clinicians should inquire about changes in sexual functioning when treating women with PPD.

Risk behaviors among adolescent girls in an HIV prevention trial

Adolescent girls remain vulnerable to HIV and other sexually transmitted infections. Understanding their sexual and substance use behaviors is essential to designing effective interventions to reduce their risk. In this study, baseline data were analyzed from 738 adolescent girls ages 15 to 19 years in Rochester, New York. Data on sexual behavior and substance use (lifetime, past 3 months, and most recent sexual experience) were collected. Nearly one half of recent vaginal (42%) and anal (45%) sex acts were not condom protected; 39% had a prior sexually transmitted infection (STI) and 12% were currently infected with an STI. Approximately one third (31%) of girls had more than one sex partner in the past 3 months. Girls with multiple partners reported that their recent sexual experiences were more likely to involve drug and alcohol use by themselves and partners. Adolescent girls, particularly those with multiple sexual partners, continue to report high-risk sexual behaviors and need focused risk-reduction interventions.

Pooled energy budget and human life history

Human life history contains a series of paradoxes not easily explained by classical life history theory. Although overall reproductive output is higher than in related primates, juvenile growth is slower and age-specific reproductive rates decline faster with age. A simple energetic model would predict that growth and reproductive rates should be positively correlated and that reproductive effort should not decelerate with age. The pattern of negative correlations in humans suggest the presence of trade-offs among peak reproductive rate, childhood growth, and reproductive rate at older ages. To address this puzzle, we propose a synthesis of reproductive ecology and behavioral ecology focused on intra- and inter-somatic energy transfers. This integration includes three concepts: the mother as final common pathway through which energy must pass to result in offspring; a distinction between direct and indirect reproductive effort, proposing the latter as a novel net energy allocation category relative to growth and direct reproductive effort; and a pooled energy budget representing the energetic contributions and withdrawals of all members of a breeding community. Individuals at all reproductive life stages are considered in light of their contributions to the pooled energy budget.

Vaginal dryness: a comparison of prevalence and interventions in 11 countries

INTRODUCTION

There is limited research comparing cross-cultural differences in women's experiences of vaginal dryness.

AIM

To examine international differences in the prevalence of vaginal dryness, the degree to which it is experienced as problematic or bothersome, the use of lubricants to alleviate it, and women's discussion of this problem with physicians.

MAIN OUTCOME MEASURES

Questionnaire measuring the level of vaginal dryness and degree to which it is perceived as bothersome.

METHODS

The Global Survey of Sexual Attitudes and Practices was administered to 6,725 women from 11 countries: UK, Germany, Japan, Australia, Canada, Spain, Italy, Mexico, Argentina, Brazil and Thailand.

RESULTS

Prevalence of self-reported vaginal dryness varied from a minimum of 5.8% in Italy to a maximum of 19.7% in Brazil. The proportion of women with self-reported vaginal dryness who found it very bothersome varied as well (e.g., 5.6% UK, 26.4% Germany). Pain during intercourse ranged from a reported low of 3.6% in Australia to 18.6% in Brazil. Older women (50-65 years) as compared with younger women (18-34 years) reported significantly more vaginal dryness in the UK, Australia, Canada, Italy, Spain, Argentina, and Thailand (P values <0.02). The majority of women under 50 attributed vaginal dryness to inadequate sexual arousal while women over 50 believed it was because of aging or menopause. Cross-culturally, women differed substantially in the likelihood of discussing their sexual life/concerns with a physician.

CONCLUSION

Women from different countries differ substantially in their experiences, concerns, and reports of vaginal dryness/sexual pain, as well as their familiarity with personal lubricants as a treatment. Researchers should assess the prevalence and degree of the bother of vaginal dryness in order to make international comparisons of the burden of this condition.

Preventing sexual transmission of HIV

The risk of human immunodeficiency virus (HIV) transmission during sexual activity is dependent on the infectivity of the HIV-positive individual and the susceptibility of the uninfected partner. HIV is most often transmitted during periods of high HIV load, but factors such as the type of sexual activity and the innate and genetic defenses of the uninfected partner exert a strong influence on the risk of transmission. Certain factors, such as coinfection with other sexually transmitted diseases or the presence of genital lesions in either sexual partner, amplify the risk of transmission that is predicted on the basis of sexual contact alone. In the absence of more-reliable options, such as a vaccine, factors that define HIV infectivity and susceptibility and factors that amplify the risk of HIV transmission, may serve as critical targets for containment of the HIV epidemic.

The relationship between HAART use and sexual activity among HIV-positive women of reproductive age in Brazil, South Africa, and Uganda

The purpose of this study was to determine whether current HAART use is associated with recent sexual intercourse among HIV-infected women (18-49 years) from Brazil, South Africa and Uganda. We conducted an analysis of survey data from a cross-sectional study, which enrolled 179 HIV-infected women receiving regular care from the Mbarara Hospital HIV Clinic in Uganda (n=85); the Perinatal HIV Research Unit in Soweto, South Africa (n=50); and the IPEC-Fiocruz cohort in Rio de Janeiro, Brazil (n=44). The primary outcome was sexual intercourse in the previous month. Secondary outcomes were protected sex and contraceptive use. We found that overall, 46% reported recent sexual intercourse. After adjusting for covariates, recent sexual intercourse was not associated with HAART use (AOR: 0.76; 95%CI: 0.34-1.72); however, it was significantly associated with being currently married, wanting to have more children and having higher HAART optimism. Among women reporting recent sexual intercourse (n=83), HAART users were significantly more likely to practice protected sex (crude OR: 3.64; 95%CI: 1.41-9.38) and non-significantly more likely to use contraceptive methods (crude OR: 2.15; 95%CI: 0.77-5.99). In summary, self-reported recent sexual intercourse is not more likely among women on HAART. Moreover, sexually active HAART users may be more likely to practice protected sex and use contraceptives.

Multipartnered fertility among American men

Using the 2002 (Cycle 6) National Survey of Family Growth (NSFG), which was the first NSFG to interview men, we document the prevalence and correlates of sequential parenthood with different partners (multipartnered fertility) among a representative sample of American men. Nearly 8% of American men aged 15–44 report having had children with more than one partner, with sharp differences by age, race/ethnicity, and income—over one-third of poor black men aged 35–44 report having had children with two or more mothers, and 16% report children with three or more mothers. Fathers of two or more children by multiple partners appear to be more disadvantaged than fathers with two or more children by the same partner. Multipartnered fertility is strongly related to prior birth characteristics; men not in a coresidential union at the preceding birth are more likely to have their next birth with a new partner, and controlling for prior-birth characteristics accounts for the elevated risk of Hispanics and blacks in baseline models. Results also suggest that multipartnered fertility is becoming more prevalent as younger cohorts transition to a new-partner birth more quickly and at a higher rate than older cohorts.

Sex and aging in the city: Singapore

A survey was carried out on 307 healthy men and 774 women, aged between 30 and 70 years to evaluate the determinants of sex life in the highly urbanized Singapore population. The results showed that significantly more women (28.8%) as compared to men (16.3%) were currently sexually inactive. The main reason for sexual inactivity for women was being divorced or widowed (37.9%) and for men, the loss of interest in sex (42.8%). Relationship problems and being stressed out in life were the next two most common reasons for both men and women. Coital frequency for men and women between the ages of 30 and 55 years averaged about five to six times monthly and was significantly reduced to about three times monthly in those above 55 years old. More men (25.7%) wanted to have more frequent sex than women (5.4%), but were unable to fulfill their desire and the primary reason was that they were too stressed out in life. Results from this study revealed that sex life is determined not only by physiological, but also cultural, social and lifestyle factors. In Singapore, life style factors accounted largely for sexual inactivity, and the inability to fulfill the desire for more frequent sex. The term 'lifestyle impotency' was coined to describe the group of men and women who were too stressed out in life to have sex. Therefore, there is a need to evolve a paradigm for the management of sexual dysfunctions by taking into account the underlying etiological factors which, as we have shown, may not be resolved by pharmaceutical interventions.

Sexual activity among older Thais: the influence of age, gender and health

This study examines sexual activity among the population aged 50 and over in Thailand in relation to age, gender and health status. It is the first study of older persons based on a large nationally representative survey in any non-Western or developing country. The results indicate substantial proportions of older married Thais remain sexually active, but at lower levels than found in Western countries. Sexual activity and desire decline steadily with age for both married men and women but at any given age both are lower for women. Overall, the sexual desire of husbands is a far more important determinant of marital sexual activity than that of wives. Poor health depresses activity and desire but does not account for the decline of either with age. For the majority of older married Thai men and women behavior and desires are concordant. Discordance levels for married women exceed those for men, however, and arise primarily from being active but lacking desire. Possible reasons for lower sexual activity relative to Western countries are considered. Implications for the quality of life of older persons and the AIDS epidemic are discussed together with methodological lessons for research on older age sexual behavior.

Frequency of marital intercourse among patients with psychiatric and psychosomatic disorders in Japan

This study investigated the frequency of marital intercourse in 951 patients with psychiatric and psychosomatic disorders and compared it to that in a normative sample. Only fourteen percent of the patient group had sexual intercourse more than once per week; thirty-nine percent were sexually inactive. The groups of patients with eating disorders, mood disorders, or any mental or behavioral disorders complicated by organic diseases such as cancer, ischemic heart disease, and other physical disorders had fewer mean coital frequencies than the controls, whereas the coital frequency of patients with anxiety disorders, somatoform disorders, sleep disorders, or psychosomatic disorders did not differ significantly from that of controls.

Interrelated family-building behaviors: Cohabitation, marriage, and nonmarital conception

Data from the National Longitudinal Study of the High School Class of 1972 are used to estimate a series of models of entry into marriage, entry into cohabitation, and nonmarital pregnancy. Our models account explicitly for the endogeneity of one outcome as a predictor of another by taking into account both heterogeneity across individuals due to unmeasured factors that may affect all these outcomes and the correlation in the unmeasured factors across processes. We find that these heterogeneity components are strongly and positively related across the outcomes. Women who are more likely to cohabit, marry, or become pregnant while unmarried are also more likely to do each of the others. Although black and white women differ in the likelihood of these behaviors, the interrelations of the behaviors are quite similar across groups.

The frequency of coitus during breastfeeding

BACKGROUND

New mothers and clinicians would benefit from an understanding of typical sexual behavior during breastfeeding. Unfortunately, little information is available about both the typical length of time to resumption of coitus and the frequency of sexual relations during breastfeeding. This paper describes the commencement and frequency of coitus among breastfeeding women in a variety of settings.

METHODS

The analysis draws on data from two separate research studies. The first was undertaken in three sites (Birmingham, United Kingdom; Montreal, Canada; Sydney, Australia), the purpose of which was to correlate natural observations of fertility with the underlying hormonal profile among breastfeeding women using the symptom-thermal method of natural family planning. The second was a clinical trial of the lactational amenorrhea method of family planning conducted in Manila, the Philippines.

RESULTS

Coital frequency reported by these populations of breastfeeding women appears to be lower than that reported in other studies for married women in general. As other research demonstrated, we found coital frequency and postpartum resumption of coitus to be associated with age, but not with the number of children in the household.

CONCLUSIONS

A better understanding of the level of sexual activity among breastfeeding women could inform and improve programs that offer postpartum support and counseling about family planning.