Cycles of shame: menstrual shame, body shame, and sexual decision-making

Experience of menstruation with the use of reusable menstrual products: a qualitative study among menstruators in Israel

Menstruation is an embodied experience that influences menstruators' perceptions of the self and body. The stigma surrounding menstruation and its negative representation in popular culture has consequences for women's sexual and reproductive health. In this study, semi-structured interviews were conducted with forty 18-50 year old participants who used reusable menstrual products to examine their experience of menstruation and how their use of these products shaped their self-body image. Data were analysed using thematic analysis. Participants commonly reported physical, medical and emotional improvement in menstrual experience and improved acceptance of the menstrual body alongside changes in feeling towards menstrual products and related issues. The participants described menstruation, menstrual blood, and the menstrual body more positively than before, reported a high comfort level with and in their bodies, and rejected common representations of menstruation. Findings suggest that using reusable menstrual products can contribute to body appreciation. Given these benefits, further research is needed to assess how knowledge of alternative menstrual products can stimulate positive views about the menstruating body and contribute to menstrual health.

Patterns of Sexual Risk Behaviors and Sexuality-Related Risk Factors among Young Adults in Germany: Implications for Prevention and Therapy

Sexual risk behavior (SRB) includes behavioral (sex without contraception, sexualized substance use, sex work, sexual partner violence, other sexual activities that harm oneself or others) and affective subtypes (sexuality-related feelings of shame/guilt, relationship impairments) and leads to psychosocial and health-related consequences. Young adults comprise a vulnerable group regarding the development of SRB. The study aimed to identify SRB patterns among young adults and their relation to sexuality-related risk factors. A cross-sectional online survey measured behavioral and affective aspects of SRB with nine items. Latent class analysis was conducted to identify patterns of SRB. Gender, sexual orientation, age of first intercourse, number of sexual partners, hypersexuality, and sexual dysfunction were captured as risk factors via multinomial logistic regression. Within this convenience sample (n = 609; nfemale = 365; nmale = 245; Mage = 23.1 years), the SRB patterns unremarkable (67%; low values in all SRB subtypes), shame-ridden (17%; high values in sexual feelings of shame/guilt) and risky sexual behavior (16%; high values in all subtypes of SRB, especially sexualized drug use) were identified. The shame-ridden and risky patterns were strongly associated with higher hypersexuality values, the risky pattern moreover with being non-heterosexual, of younger age at first sexual experience, and a higher number of sexual partners. Male and sexual minority participants demonstrated SRB more often than females and heterosexuals. Within prevention and treatment of SRB, it seems beneficial to address sexuality-related feelings of shame/guilt and addictive patterns (concerning sexual behaviors/substances) via gender- and diversity-sensitive measurements.

Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls' health and education outcomes

BACKGROUND

Menstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these impacts have not been quantified, curtailing investment. The Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study aims to describe menstrual health and its trajectories across adolescence, and quantify the relationships between menstrual health and girls' health and education in Khulna, Bangladesh.

METHODS AND ANALYSIS

AMEHC is a prospective longitudinal cohort of 2016 adolescent girls recruited at the commencement of class 6 (secondary school, mean age=12) across 101 schools selected through a proportional random sampling approach. Each year, the cohort will be asked to complete a survey capturing (1) girls' menstrual health and experiences, (2) support for menstrual health, and (3) health and education outcomes. Survey questions were refined through qualitative research, cognitive interviews and pilot survey in the year preceding the cohort. Girls' guardians will be surveyed at baseline and wave 2 to capture their perspectives and household demographics. Annual assessments will capture schools' water, sanitation and hygiene, and support for menstruation and collect data on participants' education, including school attendance and performance (in maths, literacy). Cohort enrolment and baseline survey commenced in February 2023. Follow-up waves are scheduled for 2024, 2025 and 2026, with plans for extension. A nested subcohort will follow 406 post-menarche girls at 2-month intervals throughout 2023 (May, August, October) to describe changes across menstrual periods. This protocol outlines a priori hypotheses regarding the impacts of menstrual health to be tested through the cohort.

ETHICS AND DISSEMINATION

AMEHC has ethical approval from the Alfred Hospital Ethics Committee (369/22) and BRAC James P Grant School of Public Health Institutional Review Board (IRB-06 July 22-024). Study materials and outputs will be available open access through peer-reviewed publication and study web pages.

Associations Between Negative Body Image and Sexual Health Practices in Emerging Adults from Malaysia

Past findings on the association between negative body image and sexual health behaviors have been mixed and mostly derived from Western samples. The aim of the current study was to examine associations between indices of negative body image and sexual health practices that reduce the risk of disease transmission in emerging adults, and whether these associations are moderated by gender. Using an online survey, a convenience sample of 584 Malaysian adults aged 18-30 years (230 men, 354 women) completed measures of satisfaction with overall appearance, body size dissatisfaction, weight satisfaction, height satisfaction, and genital image evaluation. They also reported if they ever had partnered sex, condomless sex, and been screened for human immunodeficiency virus (HIV), as well as their lifetime number of penetrative sex partners. Hierarchical logistic and ordinal regression analyses indicated that more positive genital image evaluation, but not the other body image indices, was significantly associated with having had partnered sex and fewer lifetime penetrative sex partners. None of the body image indices were significantly associated with condomless sex. All associations were consistent across men and women. For HIV testing, a significant interaction between genital image evaluation and gender emerged. However, this was reduced to non-significance after controlling for the number of penetrative sex partners. Overall, our findings underline the importance of promoting improved genital image in interventions aimed at increasing positive sexual health behaviors.

[Premenstrual dysphoric disorder (PMDD): Drug and psychotherapeutique management, a literature review]

INTRODUCTION

Premenstrual Dysphoric Disorder (PMDD) was first recognised in July 2013 in the DSM-5 after a long journey to identify its existence. It was not until 1983 that the US National Institute of Mental Health determined research criteria for the study of PMS. In 1994, the term "premenstrual dysphoric disorder" (PMDD) replaced this term in the 4th edition of the Diagnostic System Manual (DSM). It was listed in the section "Mood Disorder Not Otherwise Specified" and remained under consideration until the DSM-5, in which it appeared in the depressive disorders section. The legitimisation of the psychiatric diagnosis as well as the determination of clear symptomatology criteria in 2013 opened up possibilities for management, development of clinical, pathophysiological, therapeutic and psychotherapeutic studies. This disabling disorder can affect personal, social, family and professional life. In 2019, the ICD-11 in turn introduced the diagnosis of premenstrual dysphoric disorder, which solidifies the recognition of the disorder.

OBJECTIVE

(I) to review the existing treatments, both medicinal and psychotherapeutic, and (II) to review their effectiveness. At the end of this work we will formulate recommendations for the management of these patients.

METHODOLOGY

A bibliographic search was carried out from 7 June 2021 to 7 July2021 on the databases (bases de données) Psychinfo APA, Scopus, PubMed, as well as the bases de données of the Cochrane organisation and the recommendation documents of the Haute Autorité de la santé. After an initial selection based on keywords, the full text of all articles were read to arrive at the final selection of 32 articles.

RESULTS

Antidepressants and Cognitive Behavioural Therapies (CBT) appear to be the most commonly recommended treatments for PMDD. Other research shows the effectiveness of oral contraceptives including drospirenone. Selective serotonin reuptake inhibitors (SSRIs) were identified as an effective treatment for PMDD. These data are consistent with the current etiological hypothesis of PMDD which has a negative impact of natural hormonal fluctuations on certain neurotransmitters. CBT showed positive results in reducing the functional impact of PMDD.

DISCUSSION

Selective serotonin reuptake inhibitor (SSRI) antidepressants were reported to be first-line treatments for PMDD (sertraline 50-150 mg/d, fluoxetine 10-20 mg/d, escitalopram 10-20 mg/d, paroxetine 12.5-25 mg/d). Drospirenone (EE 3 mg and EE 20 mg/d 24 days of hormonal pills, 4 days inactive) appears to have been a first or second line treatment depending on the articles. Current results clearly point to the effectiveness of CBT in helping to reduce: functional impairment, depressed mood, feelings of hopelessness, anxiety, mood swings, sensitivity, irritability, insomnia, conflict with others, impact of premenstrual symptoms on daily life, intensity of symptoms experienced, and symptom handicap. CBTs could also become a first-line treatment if there were to be more evidence of their effectiveness. In the future, it would seem useful to offer a psychotherapeutic treatment that can be reproduced and to multiply research with a high level of scientific comparability in order to clarify the place of CBT in the management of PMDD. Research on the etiopathology of the disorder and the optimal drug regimen is still ongoing. There is a need to develop appropriate psychotherapeutic techniques to support and accompany these patients.

CONCLUSION

In order to better evaluate treatments for PMDD, there is a need to homogenise studies on the subject at several levels: design, treatment doses, psychotherapeutic techniques, and evaluation measures. At present, some studies include both premenstrual syndrome (PMS) and PMDD patients. PMS and PMDD do not include the same symptoms, nor the same severity and potentially the same aetiology in the patients studied. In order to propose rigorous research that evaluates the effectiveness of treatments for PMDD and to properly support people with both these disorders, it seems essential to distinguish the two conditions. The role of the health practitioner is to be able to identify PMDD by differentiating it from other clinically related disorders. The patient must then be accompanied to make a choice of treatment adapted to her symptoms, their severity, her history, her plans for procreation, contraindications and her preferences. In 2021, the French National Authority for Health did not offer any guidelines or recommendations for the management of premenstrual dysphoric disorder. There is a need to develop research in France.

Menstrual attitudes in adult women: A cross-sectional study on the association with menstruation factors, contraceptive use, genital self-image, and sexual openness

BACKGROUND

Menstruation is a central part of the everyday life of most women, and menstrual attitudes may impact health and well-being.

OBJECTIVES

This article aimed to map menstrual attitudes among adult women and examine factors associated with these attitudes, such as aspects of menarche and current menstruation, and rarely studied factors, such as genital self-image and sexual openness.

STUDY DESIGN

A cross-sectional online survey.

METHOD

A sample of 1470 women, aged 18-50 years, were recruited through social media sites. The Menstrual Self-Evaluation Scale was used to measure three different attitudes: menstruation as natural, shameful, and bothersome. Multiple linear regression analysis was used to investigate the relationship between each attitude and factors related to menarche and current menstruation, contraceptive use, genital self-image (assessed by Female Genital Self-Image Scale), and sexual openness (Personal Comfort with Sexuality Scale). Sociodemographic variables were included into the models as covariates.

RESULTS

Agreeing with the attitude of menstruation as something natural was predicted primarily by positive emotions at menarche, experiencing less menstrual pain, using no or nonhormonal contraception, and having a positive genital self-image. Perceiving menstruation as bothersome was predicted by a lower educational level, experiencing stronger menstrual pain, having more perimenstrual psychological symptoms, and using hormonal contraceptives. Menstruation as something shameful was chiefly predicted by lower sexual openness and a negative genital self-image.

CONCLUSION

Many women held attitudes about menstruation as both something natural and bothersome. Menarche and current menstruation experiences, and contraceptive method, played central roles in shaping attitudes toward menstruation as natural and bothersome. Viewing menstruation as shameful stood out from other attitudes by indicating a triad of self-objectified shame that includes menstruation, sexuality, and genital self-image. Further research into the relationships between menstruation, contraceptive use, sexuality, and body image is needed to enhance our understanding of women's menstrual health.

Menstruation in the USA

Purpose of review

Menstruation touches all spheres of human society, including psychology, education, business, policy, race, and religion. This narrative review aims to describe the relationship menstruation holds with these spaces.

Recent findings

First, menstruation plays many roles in psychology - premenstrual syndrome affects psychological wellbeing and in turn, psychological stress impacts menstruation. Functional hypothalamic amenorrhea can result when stress hormones inhibit the Hypothalamus-Pituitary-Ovarian axis. Furthermore, menstruation has many implications for all aged individuals, especially adolescents and those who are menopausal. These implications underscore the importance of proper education surrounding menstruation, which can be achieved via social media, school systems, family, and clinicians. However, menstrual health education is highly variable depending on the state and family that someone is raised in. Additionally, menstruation can pose a financial burden as menstrual products can be expensive and access to these products is limited for those who are homeless, incarcerated, and low-income. Recent public policy measures in various states have aimed to achieve "menstrual equity," by requiring public schools to supply free menstrual products in bathrooms. Furthermore, racial disparities exist with menstrual disorders. Uterine fibroids occur more frequently in Black menstruators compared to White menstruators, and Black women experience worse outcomes overall with fibroids and endometriosis management. Finally, analysis of religion and its relationship to menstruation underscores the immense stigma and "impurity" associated with menstruation.

Summary

Overall, this review highlights the universality of menstruation in society. As a "fifth vital sign", there is significant room for improvement in terms of education, research, and cultural acceptance of menstruation. Future research should explore interventions to reduce these gaps.

Attitudes toward Help-Seeking for Sexual Problems among College Women

Prior research has indicated that 65-70% of college age women have experienced at least one sexual problem. Sexual problems are associated with higher rates of depression, anxiety, and relationship distress; however, few college age women seek professional help for sexual difficulties. The present study used the Theory of Planned Behavior to explore how adherence to traditional feminine norms and self-stigma are associated with intention to seek professional psychological help for a sexual difficulty. Results of structural equation modeling analysis demonstrated approximate fit in a sample of 259 college women. The structural model indicated that self-stigma and stronger endorsement of specific feminine gender norms (i.e., romantic relationship, sexual fidelity, sweet and nice) were found to be associated with less intention to seek help for a sexual problem. We discuss future research directions and implications for clinical services.

Optimizing menstrual health and hygiene management in the U.S.: A mixed-methods study of the barriers and the role of healthcare professionals

OBJECTIVE

Menstrual health (MH) practices have been understudied in the U.S. This study aimed to assess patient and medical staff views of MH.

METHODS

The mixed-methods approach included medical staff and patient surveys, and patient interviews on MH experiences. Quantitative survey data generated descriptive statistics. Thematic content analysis (TCA) evaluated qualitative interviews. Convergent Parallel Triangulation Analysis (CPTA) evaluated both datasets in tandem.

RESULTS

The medical staff survey's response rate was 72% (54 participants/75 invited staff). Only 7% (4/54) of staff consistently asked patients about menstrual products (MP), while 54% (29/54) were concerned about patients affording MP. The patient survey's response rate was 90% (186/207); 22% (40/186) of respondents showed MH insecurity, which was associated with annual income <$30,000 (p < 0.01); 45% (85/186) missed commitments during menses; 53% (98/186) never discussed MP with healthcare providers. To reach thematic saturation 10/17 invited patients were interviewed. Five themes were identified through TCA: menstruation as a social barrier; menstrual education comes from a variety of sources; MP choice is a balance of comfort, cost, and convenience; patients value relationships with their providers; adolescence is the window for establishing MH. Three threads were identified through CPTA: MH insecurity is common; MH screening and education are limited; menstruation impacts patients' ability to engage in daily activities.

CONCLUSION

A holistic approach toward MH is needed; education and screening are inconsistent. Comprehensive MH can enhance a patient's understanding of and capacity to advocate for their health. These findings are specific to this population and may not be generalizable.

Sexual Modesty in Sexual Expression and Experience: A Scoping Review, 2000 - 2021

Sexual modesty is the social, cultural, interpersonal, and psychological systems - defined by the tenets of Script Theory - that regulate individuals' sexual expression and experience at the social, legal, and interpersonal boundaries of acceptable/not-acceptable, private/public, and personal/social. Almost all aspects of sexual expression and experience are touched by the pervasive modesty standards for sexual communication, sexual display, sexual relations, and sexual behaviors. Sexual modesty influences an array of sexual and reproductive health outcomes. Many aspects of sexual modesty are enforced by legal as well as social, cultural, and religious proscriptions, including social shaming and ostracism as well as corporal and capital punishments. The purpose of this paper is to summarize a diverse literature related to sexual modesty from the years 2000 to 2021 in order to clarify its role in sexual health and sexual wellbeing and to identify directions for new research.

Menstrual Health and Hygiene among Adolescents in the United States

STUDY OBJECTIVE

Menstrual health in adolescents has been understudied in the United States. We aimed to assess patient and provider perspectives surrounding menstrual health management and screening.

DESIGN

Our mixed-methods approach consisted of provider surveys, patient surveys, and patient interviews.

SETTING

Participants were recruited from a pediatric gynecology practice or an adolescent medicine clinic at an urban tertiary academic center.

PARTICIPANTS

Providers were pediatrics faculty or residents. Patients aged 13-24 years were eligible.

INTERVENTION

Participants completed an anonymous survey or semi-structured interview about their experiences with menstrual health.

MAIN OUTCOME MEASURES

Descriptive statistics and thematic content analysis were used for quantitative and qualitative data, respectively. Convergent parallel analysis elucidated key findings in both data sets.

RESULTS

The provider survey response rate was 65% (69/106); 15% (9/69) of providers consistently asked patients about menstrual products, whereas 44% (27/68) were concerned patients could not afford products. The patient survey response rate was 85% (101/119); 19% (19/101) of respondents reported menstrual hygiene insecurity, 55% (55/101) missed commitments during menses, and 45% (45/101) discussed menstrual products with providers. Fifteen patients were invited for qualitative interviews; 10 were conducted, and thematic saturation occurred. Interviews highlighted the importance of comprehensive early menstrual health education and providers' role in menstrual management.

CONCLUSION

Adolescence is a crucial point of entry into health care. Because taboos surrounding menstruation could limit access to health care, menstrual health education must be emphasized. Menstrual health education is provided piecemeal by parents, schools, and providers. Current practice should be reevaluated to consider comprehensive educational approaches in which health care leads.

The Relationship between the Sexual Double Standard and Women's Sexual Health and Comfort

The current research explores the relationship between Sexual Double Standard (SDS) endorsement and women's sexual health and attitudes. Women (n = 705) completed an SDS endorsement scale, and then answered a variety of questions in three main categories of outcome variables: sexual comfort, sexual reputation, and sexual health. Results suggest that women's SDS endorsement was not related to women's sexual comfort. Further, SDS endorsement was slightly positively related to how concerned women were about their sexual reputation. Regarding sexual health, SDS endorsement was related to a shorter timespan since women's last OBGYN screening, and unrelated to women's discomfort discussing birth control with their OBGYN. Results suggest there is much more to explore in targeted studies on the relationship of SDS endorsement to women's perceptions of their sexual reputations and their interactions with OBGYNs with respect to the SDS. Previous and related research is discussed, along with implications of the current research.

Impact of the Menstrual Cycle Phases on the Movement Patterns of Sub-Elite Women Soccer Players during Competitive Matches

The purpose of this study was to evaluate the influence of the menstrual cycle phases on the movement patterns of sub-elite women soccer players during competitive matches over three consecutive seasons. Individual movement data were analyzed and compared in eight players from the second French League at the early follicular (EF), late follicular (LF) and mid-luteal (ML) phases of their menstrual cycle, determined by the calendar method. The movement patterns, expressed as meters per minute, were recorded during competitive matches using devices placed on the player’s ankle. Our results showed significantly lower distances covered at moderate and high velocity in the EF phase than in the LF and ML phases (Cohen’s d effect size = 1.03 and 0.79, respectively). The total distance covered during matches and the number of sprints also were reduced during EF compared with LF (d = 0.78 and 0.7, respectively). Overall, the total distance and distance covered at low velocity were significantly lower during the second half-time of the matches (d = 1.51), but no menstrual cycle phase × game period interaction was noted. In conclusion, our study suggests that EF may impact the movement pattern of sub-elite women soccer players during competitive matches, without any modulation of this effect by the playing time. Despite the low sample size, these results can be useful for coaches and support staff to modulate training loads and player rotation during soccer games.

The Role of Objectification in College Women's Substance Misuse and Sexual Risk

Sexism and objectification present major challenges for mental and physical health among women. Scholars have called for research to identify mechanisms that underlie these associations as well as to delineate factors to target in prevention and intervention efforts. This study aimed to build on central tenets of objectification theory through its examination of sexist experiences in relation to body surveillance, body shame, depressive symptoms, and the health risk behaviors of substance use (i.e., alcohol and drug misuse) and sexual risk (i.e., condom use and number of sexual partners) among a large sample of college student women. We also examined whether body surveillance, body shame, and depressive symptoms would mediate theorized pathways extended to substance use and sexual risk. A sample of 505 full-time college student women ages 18-26 completed an online survey that assessed their health and behaviors. We used structural equation modeling to test mediation hypotheses. Results largely supported hypotheses, extended objectification theory to sexual risk, and expanded upon past research on objectification in relation to substance use. Notably, results of this study provided a more nuanced knowledge of how objectification may lead to increases in sexual risk when assessed by number of sexual partners (but not condom use). Further research is warranted to understand potential explanatory pathways between sexism, objectification, and sexual risk. Findings can inform prevention and intervention efforts to target body surveillance, body shame, and depressive symptoms to attempt to reduce the burden of sexist experiences on women's health.

"Pretty hurts": Acceptance of hegemonic feminine beauty ideals and reduced sexual well-being among Black women

Although women are expected to idealize and achieve hegemonic feminine beauty standards such as being slender and lighter skinned, few studies have examined how women's investment in achieving these restrictive feminine appearance ideals may influence their sexual attitudes and behaviors. Even less is known about Black women. We surveyed 640 Black college women to test hypotheses that endorsement of hegemonic beauty ideals would be positively associated with four dimensions of negative sexual affect (sexual guilt, shame, emotional distancing, and self-consciousness) and negatively associated with two dimensions of sexual agency (sexual assertiveness and satisfaction). Correlation and regression analyses showed that hegemonic beauty ideal acceptance was linked with greater sexual guilt, shame, emotional distancing, and sexual self-consciousness in addition to lower levels of sexual assertiveness and satisfaction. Findings highlight how endorsing restrictive, hegemonic standards of beauty is associated with Black women's reduced sexual affect and sexual agency.

Acceptability and safety of the menstrual cups among Iranian women: a cross-sectional study

Background

Menstrual cup is one of the menstrual management products that is available throughout the world and can be effective in improving women's quality of life by empowering women in menstrual management. Although menstrual cups have recently entered the Iranian market, the use of this product is limited among women. The aim of this study was to determine the acceptability and safety of menstrual cups among Iranian women.

Methods

This is a cross-sectional study conducted in 2020. Iranian women between the ages of 18 and 50 with regular menstrual periods who used the menstrual cup at least for three months were included. Participants were selected through continuous sampling, and they completed a web-based questionnaire including a demographic characteristics form as well as checklists on acceptability and safety through a link sent electronically via social media.

Results

The mean score of the overall satisfaction with the cup was 6.54 ± 0.76, and the leakage had the lowest mean score among the satisfaction items (5.25 ± 1.63). About 83% of participants reported experiencing menstrual cup leakage. Among the reported health risks, the highest mean score was for vaginal pain during removal (23.9%). Most participants (83.9%) were familiar with the cup via social networks and 98.6% recommended this product to other women.

Conclusions

The high level of acceptability and safety of the menstrual cup showed that this product is a suitable alternative for menstrual management in Iranian women. The results of the study help healthcare providers to learn more about the potential advantages and disadvantages of using cup and create trust in the menstrual cup use based on the results of local evidence-based research.

Seeking synergies: understanding the evidence that links menstrual health and sexual and reproductive health and rights

Global efforts to improve menstrual health and sexual and reproductive health and rights (SRHR) are fundamentally intertwined and share similar goals for improving health and well-being and increasing gender equality. Historically, however, the two fields have operated independently and missed opportunities to build upon their biological and sociocultural linkages. Biological touchpoints connecting the two fields include genital tract infections, menstrual disorders, contraception, and menopause. From a sociocultural perspective, intersections occur in relation to the experience of puberty and menarche, gender norms and equity, education, gender-based violence, and transactional sex. We describe evidence linking menstrual health and SRHR and offer recommendations for integration that could strengthen the impact of both fields.

Period poverty and mental health implications among college-aged women in the United States

Background

The purpose of this study is to examine the frequency of “period poverty,” or not being able to afford sanitary products, among university students, and associations with poor mental health.

Methods

An online survey was conducted with a nationally-drawn sample (N = 471) of college-attending women to assess the association between period poverty and depression. Period poverty was measured via two questions designed for this study; depression was measured with the standard PHQ-9. Multivariable logistic regression was utilized for analysis.

Results

Among our sample, 14.2% of women had experienced period poverty ever in the past-year; an additional 10% experienced it every month. Compared to those who had never experienced period poverty, adjusted analysis revealed that women with monthly past-year period poverty were the most likely to report moderate/severe depression (AOR = 2.34, 95% CI 1.09–4.99), followed by those who had experienced it ever in the past year (AOR = 1.83, 95% CI, 0.99–3.38).

Conclusion

Many young women cannot afford menstrual health products to meet their monthly needs, and this may impact their mental well-being. Improved access to affordable menstrual products is needed to support these young women.

Internalized Body Stigma as a Barrier to Accessing Preventative Healthcare for Young Women

Internalizing stigma toward the body can have negative implications for women's sexual health. In the current study, we examined how young women's internalized stigma toward their body shape, genitals, and menstrual periods are associated with their use of preventative healthcare services for sexual health. Additionally, we tested two mechanisms that may mediate the relationship between internalized body stigma and preventative care: self-objectification (in the form of a loss of autonomy) and comfort communicating with a healthcare provider. We collected and analyzed survey data from 685 undergraduate women. We tested a serial mediation model, such that the internalization of body stigma predicted greater self-objectification, greater self-objectification predicted less comfort communicating with a provider, and discomfort communicating with a provider predicted lower receipt of preventative care. Results partially supported the proposed serial mediation model, such that internalizing stigma towards body shape, genitals, and menstrual periods was associated with discomfort communicating via greater self-objectification. Internalized stigma toward genitals and menstrual periods were significant predictors of preventative care use, even when accounting for self-objectification and communication. Findings suggest that interventions to address genital and menstrual stigma could be especially beneficial for enabling young women to seek preventative care.

The relationship between gender role and attitude toward menstruation with female sexual function: A cross-sectional study

Background

Although female sexual function can be affected by many psychological, interpersonal, and sociocultural factors, limited studies have focused on the relationships between this construct with some concepts such as women's attitudes toward menstruation and perception from their gender role.

Objective

To investigate the association between gender roles and attitude toward menstruation with sexual function among Iranian reproductive women.

Materials and Methods

An observational cross-sectional study was carried out on a group of 164 Iranian women referred to the health centers of Torbat Heydariyeh, between August and December 2018. All eligible women filled the female sexual function index (FSFI), Bem Sex Role Inventory, and Menstrual Attitude Questionnaire.

Results

The result showed that the total FSFI score was significantly higher in masculine and androgynous gender role groups than women with undifferentiated gender role (p = 0.014, and p = 0.012, respectively). Nevertheless, androgynous women had better sexual arousal than undifferentiated women (p = 0.013). Significant reverse correlations were observed between the perception of menstruation as a debilitating, bothersome, and predictable event with a total score of FSFI and all subscales except lubrication (p = 0.001). In contrast, there was a positive relationship between denial of any effects of menstruation with total FSFI and all its sub-scores except lubrication (p = 0.001).

Conclusion

This study highlighted the role of masculinity and androgyny gender role stereotypes and menstrual attitude in the sexual function of heterosexual women. Future studies are needed to explain how these psychological contexts contribute to different aspects of women's sexuality.

The experience of embodiment scale: Development and psychometric evaluation

The construct of embodiment captures a broad range of experiences of living in the body. The present program of research involved developing and evaluating a fully structured measure of the experience of embodiment construct, the Experience of Embodiment Scale (EES), via four independent samples of women. Study 1 (N = 92) provided initial support for the internal consistency and convergent validity of the EES. Study 2 (N = 412) involved factor analyses of the EES, leading to the emergence of 6 factors, reflecting different aspects of the experience of embodiment. Further, this study supported the internal consistency of the EES and its subscales, as well as its construct and discriminant validity. As expected, the EES correlated with measures of body- and self-esteem, body connection, sexual assertiveness, among other measures, and did not correlate with the Perfectionism Personal Standards Scale. Study 3 (N = 348) confirmed the factor structure of the scale from Study 2. Study 4 (N = 76) demonstrated that EES scores were stable over a 3-week period. The EES can be used by researchers and clinicians interested in capturing individuals' range of experiences of living in their bodies, both positive and negative.

Which contraceptive side effects matter most? Evidence from current and past users of injectables and implants in Western Kenya

Objectives

The objectives were to assess experiences of menstrual bleeding and nonbleeding side effects among current and past users of injectables and implants and the associations between side effects and method evaluations by women — satisfaction, perceived suitability, the likelihood of future use and intended duration of use.

Study design

We used data on past and current users of injectables and implants from a survey of 1866 married or cohabiting women who participated in the third round of a 2-year prospective longitudinal study conducted in Homa Bay County, Western Kenya. Descriptive and bivariate analysis with χ² tests was used to assess statistically significant associations between experience of bleeding/nonbleeding side effects and method-specific attitudes.

Results

Self-reported method-related bleeding problems were high among current and past users of injectables (range 69%–79%) and implants (range 55%–60%) and much more common than nonbleeding side effects. For both methods, experience of either bleeding or nonbleeding side effects reduces positive evaluations, but the conjunction of both types had particularly pronounced consequences. Heavy bleeding was more strongly related to method evaluation (satisfaction and the likelihood of future use; p < .001) among past users than other forms of menstrual bleeding disorders. Even among current users, about one third regarded bleeding side effects as very serious. Care-seeking from a healthcare provider for management of contraceptive-related side effects was low among current users (less than 40%) and modest among past users (range 53%–63%).

Conclusions

The results underscore the need to strengthen programs on counseling and information on contraceptive side effects including menstrual bleeding disturbances to improve method satisfaction and reduce discontinuation.

Implication

The experience of contraceptive-related menstrual bleeding and nonbleeding side effects reduces positive evaluation of the method and deters past users from future use of the method.

Who is at risk? Gendered psychological correlates in Italian students’ sexual risk profiles

Recent research has shown that sexual risk behaviours are rising substantially among Italian youth, but this evidence is still undervalued in public discussion. Adopting a multidimensional perspective for sexual risk and addressing gender differences, the present study investigates if and how some individuals’ psychological characteristics—namely body satisfaction, self-esteem and body sensation-seeking—are associated with unsafe and risky sexual behaviours of Italian emerging adults. We exploited the survey SELFY—Sexual and Emotional LiFe of Youths—conducted in 2017 in Italy. Several key points may be highlighted from our study. First, we identify two clusters characterized by high sexual risk-taking behaviours, which include one third of our sample, a non-negligible proportion. Second, we prove that women are generally less inclined to adopt risk-taking behaviours in sexual life. Third, our findings show that body satisfaction, self-esteem and sensation seeking are differently linked to sexual risk taking among women and men. Body satisfaction is associated with a higher probability of adopting risky and promiscuous sexual behaviours among men, while the relationship is not significant among women. Sensation seeking shows a certain relevance in defining sexual risk profiles, especially for men. Overall, our research suggests that body image and self-worth could be relevant areas of intervention for sexual health programs targeting emerging Italian adults. Notably, communication and education strategies on these issues should be differentiated for women and men.

Becoming an object: A review of self-objectification in girls

Objectification theory (Fredrickson & Roberts, 1997) provides a framework for understanding how cultural pressure on women's appearance (i.e., sexual objectification) impacts their psychological and physical well-being. Although objectification theory proposes that objectification processes commence with the onset of puberty, much of the existing research on self-objectification has been conducted with adult women. Thus, less is known about how self-objectification operates with younger girls and adolescent girls. In this paper, we provide a comprehensive review of self-objectification research on girls under the age of 18 including the prevalence, predictors, and outcomes of self-objectification as well as protective factors (n = 66 studies). In addition, we discuss how development is relevant to objectification theory and self-objectification. Finally, we call for a program of research that addresses methodological and conceptual concerns in existing research, fills gaps in the research literature, and pays further attention to developmental processes in self-objectification. An especially notable pattern we identified is that self-objectification is strongly related to age, such that older girls experience higher levels of self-objectification compared to younger girls. The aim of this paper is to provoke deeper considerations of development and the inclusion of girls in future research on self-objectification.

"I Thought I Was Dying:" (Un)Supportive Communication Surrounding Early Menstruation Experiences

Menstruation is a salient, and sometimes scary, communication topic for young women. The present study reports on the early communication experiences about menstruation from 165 women using open-ended survey data. Through the framework of supportive communication, findings reveal that a discrepancy occurs between the health and practical information and needs to which young people who menstruate desire access, and their social and emotional needs. The present study indicates an inadequacy of both aspects of menstruation communication from important others in childhood and adolescence. Themes of boundary management, impersonal, silence, and accidents also characterize early communication experiences about menstruation. Our participants identified a desire for conversations that normalize menstruation as typical and acceptable, validate period pain and prescribe management tactics, and describe the existence of feminine hygiene products other than pads and tampons. Limitations and directions for future research are discussed.

Predicting Sexual Victimization Among College Students in Chile and Turkey: A Cross-Cultural Analysis

To address the shortage of cross-cultural research on vulnerability factors of sexual victimization, this two-wave longitudinal study examined predictors of sexual victimization among female and male college students in Chile (N = 1098) and Turkey (N = 885). These two countries were selected based on theoretical considerations regarding religiosity and gender inequality. A path model was tested that conceptualized participants' risky scripts for consensual sex, risky sexual behavior, sexual self-esteem, refusal assertiveness, and religiosity at T1 as predictors of sexual victimization in the following 12 months, as assessed at T2, mediated through past experiences of sexual victimization. As predicted, more risky sexual scripts were linked to more risky sexual behavior and lower refusal assertiveness, indirectly increasing the odds of sexual victimization in both countries. Lower sexual self-esteem predicted a higher probability of sexual victimization through lower refusal assertiveness as well as through more risky sexual behavior in both the Chilean and Turkish samples. Higher religiosity in Chile, a Christian country, and Turkey, a Muslim country, indirectly predicted a lower vulnerability to sexual victimization through less risky sexual scripts and less risky sexual behavior. In the Turkish sample only, higher religiosity predicted a higher vulnerability to sexual victimization through lower sexual self-esteem. The findings show that risky sexual scripts played a central role in the prediction of sexual victimization in both cultures, which has implications for prevention efforts.

"The state of mind tells me it's dirty": menstrual shame amongst women using a vaginal ring in Sub Saharan Africa

Socio-cultural beliefs and practices surrounding menses influence women's sexual and reproductive health behaviors and decision-making. We analyzed menstrual experiences within the context of the MTN-020/ASPIRE clinical trial during which women were asked to use a monthly vaginal ring for HIV prevention. The qualitative component of the trial was conducted during February 2013-June 2015, included interviews and focus group discussions with 214 women aged 18-42, in Malawi, Zimbabwe, Uganda, and South Africa. Emotions of shame, embarrassment and disgust relating to menses emerged. Menstruation was referred to using euphemistic terms or language about dirtiness. Women were uncomfortable touching their own menstrual blood when removing vaginal rings and felt embarrassed about study staff seeing blood on returned rings. Despite reassurances, women felt ashamed performing study procedures while menstruating, leading to missed study visits. Women's aversion to menstrual blood was linked to narratives about avoiding sex during menses and beliefs about its potential harms. Women associated men's disgust pertaining to menstrual blood with men's willingness to use condoms for sex only during menses, highlighting another way through which socio-cultural beliefs and practices around menstruation affect HIV protective behaviours. These findings provide novel insight into menstrual shame among women in these four countries.

Predictors of Sexual Aggression Perpetration Among Male and Female College Students: Cross-Cultural Evidence From Chile and Turkey

This two-wave longitudinal study examined risky sexual scripts and sexual behavior regarding consensual sexual interactions, sexual self-esteem, initiation assertiveness, and religiosity as predictors of sexual aggression perpetration in a cross-cultural comparison of college students in Chile and Turkey. As predicted, risky sexual scripts were linked to higher odds of perpetration through more risky sexual behavior cross-sectionally in both the Chilean and the Turkish sample and indirectly predicted perpetration 12 months later. High sexual self-esteem increased the likelihood of perpetration via higher initiation assertiveness in the Turkish sample only. High religiosity reduced the odds of perpetration through less risky sexual scripts and less risky sexual behavior in both samples. In addition, high religiosity increased the probability of perpetration through lower sexual self-esteem in the Turkish sample. Implications of these findings and the role of cultural factors contributing to the differential functioning of religiosity and sexual self-esteem are discussed.

Understanding menstruation: Influence of gender and ideological factors. A study of young people's social representations

This research investigates social representations of menstruation. It analyses firstly how young Spanish people understand menstruation in their everyday lives. And secondly, it explores how gender and ideological factors (liberal vs. conservative; feminist vs. non-feminist) impact on the meaning of menstruation and its implications for acceptance of this process. A free association exercise elicited by the word “menstruation” was answered by 250 people and the content was examined by lexical analysis. The results divided social representations of menstruation into two levels: firstly, a traditionalist level that is clearly linked to a negative stigmatized discourse about menstruation; and, secondly, a progressive level where two different discourses emerge, one representing liberal men and the other representing feminist women. The results show that only the feminist conception of menstruation provides an empowered and emotionally positive representation. The concept of menstruation is concluded to emerge from various sources of information, values and social conventions that are somewhat removed from its scientific meaning. The representation of menstruation is therefore understood to be situated within a social, ideological and emotional context. Accordingly, health education campaigns should frame their discourse about menstruation within a feminist perspective as their point of departure, thereby increasing their effectiveness.

Relationship Quality and Perceived Partner's Body Appreciation Is Related to Women's Own Body Appreciation and Sexual Functioning

Research on body appreciation is limited, especially when examining its relationship to sexual functioning. The aim of this study was to explore the relationship between body appreciation and sexual functioning, while measuring perceived partner's body appreciation and general relationship quality. A sample of 244 women aged 18 to 30 completed measures of sexual functioning, relationship quality, and body image online. General relationship quality and perceived partner's appreciation of one's body predicted levels of sexual functioning. Levels of body appreciation did not predict sexual functioning over and above general relationship quality and perceived partner's appreciation of one's body. This study is the first to demonstrate the significance of general relationship quality and perceived partner's body appreciation in relation to levels of body appreciation and sexual functioning. The findings highlight the importance of understanding body appreciation and its role in buffering the harmful impacts of viewing idealized images within the media.

Understanding the emotion of shame in transgender individuals - some insight from Kafka

Both clinical literature and biographical accounts suggest that many transgender individuals experience shame or have experienced shame at some point in their life for reasons related to their gender identity. In clinical psychology, at least until the 1960s, shame has not received much attention; focus was on guilt and shame was regarded mainly as a 'by-product' of guilt. From the 1960s shame has been identified as an emotion not necessarily related to guilt and with unique features, and has been studied in connection with a number of situations, such as domestic abuse, trauma, illness, and sexual orientation. However shame has been studied less in connection with gender variance. Shame has however intrigued philosophers, writers and artists for a very long time. Yet, the importance of the contribution of various disciplines to the understanding of the experience of shame in vulnerable individuals has been overlooked. This paper attempts to explore the meaning of shame for transgender individuals, by making reference not only to clinical studies, but also to artworks and literary novels. Franz Kafka, named "the poet of shame" is particularly salient to the analysis of shame, and some of his works will enable us to shed light on the complexities of the experience of shame in transgender individuals which may defy clinical observation.

Menstrual restriction prevalence and association with intimate partner violence among Nepali women

INTRODUCTION

Emerging research has linked women's sanitation and menstrual hygiene experiences with increased vulnerability to violence outside the home. Few studies, however, have investigated the relationship between menstruation and violence perpetrated by family members. This type of violence may be linked specifically to restrictions placed on women during menstruation, which are common in some regions of Nepal owing to shared power differentials that disfavour women, and societal norms that stigmatise menstruation.

OBJECTIVE

To record the prevalence of menstrual restrictions experienced by married women and examine potential associations between intimate partner violence (IPV) in the past year and menstrual restrictions imposed by husbands and/or in-laws among women in three districts of Nepal: Nawalparasi, Kapilvastu and Chitwan.

METHODS

Baseline data from a larger randomised control trial aiming to reduce IPV in three districts of the Terai region of Nepal (n=1800) were used to assess the prevalence of menstrual restrictions and the association with IPV.

RESULTS

Nearlythree out of four women (72.3%) reported experiencing high menstrual restriction, or two or more types of menstrual restriction. When controlling for demographic variables and IPV, no type of IPV was associated with high menstrual restrictions.

CONCLUSION

The experience of menstrual restriction was widespread in this sample of women in Nepal. Future research should seek to identify how best to capture menstrual stigma and deviations around such norms. The global health and development community should prioritise integration with existing water and sanitation programmes to reduce stigma and ensure the well-being of menstruating women and girls.

TRIAL REGISTRATION NUMBER

NCT02942433.

Associations Between Positive Body Image, Sexual Liberalism, and Unconventional Sexual Practices in U.S. Adults

While studies have documented robust relationships between body image and sexual health outcomes, few studies have looked beyond sexual functioning in women. Here, we hypothesized that more positive body image would be associated with greater sexual liberalism and more positive attitudes toward unconventional sexual practices. An online sample of 151 women and 164 men from the U.S. completed measures of sexual liberalism, attitudes toward unconventional sexual practices, and indices of positive body image (i.e., body appreciation, body acceptance by others, body image flexibility, and body pride), and provided their demographic details. Regression analyses indicated that, once the effects of sexual orientation, relationship status, age, and body mass index had been accounted for, higher body appreciation was significantly associated with greater sexual liberalism in women and men. Furthermore, higher body appreciation and body image flexibility were significantly associated with more positive attitudes toward unconventional sexual practices in women and men. These results may have implications for scholars working from a sex-positive perspective, particularly in terms of understanding the role body image plays in sexual attitudes and behaviors.

A systematic review on identifying risk factors associated with early sexual debut and coerced sex among adolescents and young people in communities

AIMS AND OBJECTIVES

To review literature on identifying the risk factors associated with early sexual coerced debut with the aim to facilitate the healthcare workers' planning of relevant health services to improve intervention strategies for delaying of early coerced sexual debut or forced sexual debut (CSD/FSD) in the communities.

BACKGROUND

Identifying the risk factors associated with coercion at first sex is crucial for developing appropriate sexual and reproductive health information and health promotion in response. However, current knowledge about the risk factors associated with coercion, sexual debut (SD) and delayed SD among young people is limited. Health information programmes are important during adolescence, when young people are developing their values and beliefs about sexual activity and sexual norms. However, little is known about those risk factors on initiation of early sexual debut to plan relevant interventions that can delay SD and prevent CSD/FSD in this population.

DESIGN

A systematic review.

METHODS

An extensive literature search using MEDLINE (PubMed), Nursing Journals (PubMed), Web of Science, PsychINFO and CINAHL.

RESULTS

The search generated 39 published studies that met our inclusion and exclusion criteria. Thirty-two articles passed the quality appraisal and were selected. This review identified six domains of risk factors, categorised as: (1) the individual domain, (2) the family domain, (3) the partner/peer domain, (4) the school domain, (5) the community domain and (6) the cultural domain. These factors highlight the influences on sexual decision-making among adolescents and young people and the timing of their first sexual intercourse.

CONCLUSION

It is important to use the outcome of this review's categorisation of identified risk factors to facilitate the healthcare workers and plan relevant sexual and reproductive health programmes more accessible to adolescents, especially young females and their parents. There is a need to evaluate the impact of these programmes that can delay SD and prevent CSD/FSD in this population.

RELEVANCE TO CLINICAL PRACTICE

The results of this study could provide guidance on the planning of effective interventions for delaying of early CSD/FSD in the communities.

Negotiating Discourses of Shame, Secrecy, and Silence: Migrant and Refugee Women's Experiences of Sexual Embodiment

In Australia and Canada, the sexual health needs of migrant and refugee women have been of increasing concern, because of their underutilization of sexual health services and higher rate of sexual health problems. Previous research on migrant women's sexual health has focused on their higher risk of difficulties, or barriers to service use, rather than their construction or understanding of sexuality and sexual health, which may influence service use and outcomes. Further, few studies of migrant and refugee women pay attention to the overlapping role of culture, gender, class, and ethnicity in women's understanding of sexual health. This qualitative study used an intersectional framework to explore experiences and constructions of sexual embodiment among 169 migrant and refugee women recently resettled in Sydney, Australia and Vancouver, Canada, from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, India, and South America, utilizing a combination of individual interviews and focus groups. Across all of the cultural groups, participants described a discourse of shame, associated with silence and secrecy, as the dominant cultural and religious construction of women's sexual embodiment. This was evident in constructions of menarche and menstruation, the embodied experience that signifies the transformation of a girl into a sexual woman; constructions of sexuality, including sexual knowledge and communication, premarital virginity, sexual pain, desire, and consent; and absence of agency in fertility control and sexual health. Women were not passive in relation to a discourse of sexual shame; a number demonstrated active resistance and negotiation in order to achieve a degree of sexual agency, yet also maintain cultural and religious identity. Identifying migrant and refugee women's experiences and constructions of sexual embodiment are essential for understanding sexual subjectivity, and provision of culturally safe sexual health information in order to improve well-being and facilitate sexual agency.

Negotiating Discourses of Shame, Secrecy, and Silence: Migrant and Refugee Women's Experiences of Sexual Embodiment

In Australia and Canada, the sexual health needs of migrant and refugee women have been of increasing concern, because of their underutilization of sexual health services and higher rate of sexual health problems. Previous research on migrant women's sexual health has focused on their higher risk of difficulties, or barriers to service use, rather than their construction or understanding of sexuality and sexual health, which may influence service use and outcomes. Further, few studies of migrant and refugee women pay attention to the overlapping role of culture, gender, class, and ethnicity in women's understanding of sexual health. This qualitative study used an intersectional framework to explore experiences and constructions of sexual embodiment among 169 migrant and refugee women recently resettled in Sydney, Australia and Vancouver, Canada, from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, India, and South America, utilizing a combination of individual interviews and focus groups. Across all of the cultural groups, participants described a discourse of shame, associated with silence and secrecy, as the dominant cultural and religious construction of women's sexual embodiment. This was evident in constructions of menarche and menstruation, the embodied experience that signifies the transformation of a girl into a sexual woman; constructions of sexuality, including sexual knowledge and communication, premarital virginity, sexual pain, desire, and consent; and absence of agency in fertility control and sexual health. Women were not passive in relation to a discourse of sexual shame; a number demonstrated active resistance and negotiation in order to achieve a degree of sexual agency, yet also maintain cultural and religious identity. Identifying migrant and refugee women's experiences and constructions of sexual embodiment are essential for understanding sexual subjectivity, and provision of culturally safe sexual health information in order to improve well-being and facilitate sexual agency.

Experiences and Constructions of Menarche and Menstruation Among Migrant and Refugee Women

Experiences and constructions of menarche and menstruation are shaped by the sociocultural environment in which women are embedded. We explored experiences and constructions of menarche and menstruation among migrant and refugee women resettled in Sydney, Australia, and Vancouver, Canada. Seventy-eight semistructured individual interviews and 15 focus groups comprised of 82 participants were undertaken with women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and varying South American countries. We analyzed the data using thematic decomposition, identifying the overall theme "cycles of shame" and two core themes. In "becoming a woman," participants constructed menarche as a marker of womanhood, closely linked to marriage and childbearing. In "the unspeakable," women conveyed negative constructions of menstruation, positioning it as shameful, something to be concealed, and polluting. Identifying migrant and refugee women's experiences and constructions of menarche and menstruation is essential for culturally safe medical practice, health promotion, and health education.

The Dual Role of Media Internalization in Adolescent Sexual Behavior

Sexualizing media content is prevalent in various media types. Sexualizing media messages and portrayals emphasize unattainable body and appearance ideals as the primary components of sexual desirability. The internalization of these ideals is positively related to self-objectification and sexual body consciousness. In turn, self-objectification and sexual body consciousness affect adolescents' sexual behavior, albeit in opposing directions. While objectifying self-perceptions are linked to higher levels of sexual behavior, body consciousness during physical intimacy is linked to lower levels of sexual behavior. Based on this knowledge, the present three-wave panel study of 824 Belgian, predominant heterosexual adolescents (M _age = 15.33; SD = 1.45) proposes a dual-pathway model that investigates two different pathways through which the internalization of media ideals may impact adolescents' sexual behavior. An inhibitory pathway links media internalization to lower levels of sexual behavior through sexual body consciousness, and a supportive pathway links media internalization to higher levels of sexual behavior through self-objectification. Structural equation analyses supported the proposed dual-pathway, showing that the impact of media internalization on adolescents' sexual behavior proceeds through an inhibitory pathway and a supportive pathway. Regarding the supportive pathway, media internalization (W1) positively predicted sexual behavior (W3), through valuing appearance over competence (W2). Regarding the inhibitory pathway, media internalization (W1) positively predicted body surveillance, which, in turn, positively predicted sexual body consciousness (all W2). Sexual body consciousness (W2) is negatively related to sexual behavior (W3). From a sexual developmental perspective, these findings emphasize the importance of guiding adolescents in interpreting and processing sexualizing media messages.

Toward a Relational Understanding of Objectification, Body Image, and Preventive Sexual Health

There is a wealth of empirical support for objectification theory. Researchers have suggested an extension to the theory that includes risky sexual behaviors as a consequence of body shame. However, there are no known studies that place the association between body image and sexual behavior in the context of the interpersonal sexual relationship. The current study was grounded in objectification theory and relational cultural theory and sought to better understand how negative self-objectification, body appreciation, relationship quality, and preventive sexual health behaviors are related. An online survey was conducted with 399 emerging adult women in the Midwest, and the proposed model was tested using structural equation modeling (SEM). The results suggest that, among this sample, negative self-objectification was indirectly related to preventive sexual health behaviors through body appreciation alone and through both body appreciation and relationship quality. Implications for clinical practice and future research are discussed.

"I Liked Girls and I Thought They Were Pretty": Initial Memories of Same-Sex Attraction in Young Lesbian and Bisexual Women

There is little research on what is meant by the concept of "feeling attracted" and even less about what same-sex attraction looks and feels like for individuals. Without insight into the phenomenon of same-sex attraction, researchers risk misunderstanding the role of sexual attraction in sexual identity development and risk mis-categorizing individuals in research designs that compare LGBTQ and heterosexual samples. The current study draws from semi-structured interviews (n = 30) with young lesbian-, bisexual-, and queer-identified women (ages 18-24) about their initial memories of same-sex attraction. Two questions were pursued using qualitative analytic strategies. We examined the age that participants remembered first experiencing same-sex attraction using content analysis. Two age groups emerged as distinct: those with experiences of same-sex attraction in childhood and those with initial attractions in later adolescence. We also examined key elements in participants' descriptions of early same-sex attraction using thematic analysis. The role of embodied feelings, relationships with other young women, and social environments including media images emerged as central to initial experiences of attraction. Findings highlight how early experiences of same-sex attraction produced different types of interpretations within individuals and, in turn, these interpretations informed how participants did or did not take up LGBTQ identity labels. These findings may help guide the development of more refined measurement tools for researchers hoping to sample sexual minorities and can contribute to developing more effective supports for individuals who experience same-sex attraction but may not adopt LGBTQ identity labels and, as a result, are routinely missed in outreach efforts.

Eating behaviours in adolescent girls: the role of body shame and body dissatisfaction

PURPOSE

Numerous studies are conducted to investigate factors influencing eating and weight-related problems, given the alarming prevalence of such behaviours among adolescents. The relationship between shame, especially body shame, and eating disorders has received increased attention in recent years. The current study contributes to this field by exploring body shame as a potential mediator of the relationship between body dissatisfaction and eating behaviours among adolescent girls, while controlling for age and body mass index (BMI).

METHODS

The participants, 187 adolescent girls from three secondary schools in Zagreb, completed self-report measures of demographic, eating behaviours, body satisfaction and body shame.

RESULTS

Body shame and body dissatisfaction explained statistically significant amount of eating behaviours variance, while controlling for age and BMI. Further, body shame partially mediated the relationship between body dissatisfaction and eating behaviours.

CONCLUSIONS

This study provides further evidence of the experience of body shame among adolescent girls and suggests that this shame is associated with disordered eating behaviours. Future longitudinal research designed to specifically explore body shame and other potentially shared risk factors is needed, and would enhance our understanding of eating disorder aetiology.

A Swiss Longitudinal Study of the Prevalence of, and Overlap Between, Sexual Problems in Men and Women Aged 20 to 50 Years Old

The aim of this study was to obtain data on the development and course of sexual problems and their interrelationships by investigating a representative sample of men and women over a period of 30 years. A representative sample of 299 women selected from the complete electoral register and 292 men selected from screening lists for military service in Zurich, Switzerland, answered questions about their sexuality as part of a series of seven interviews between ages 20 (1979) and 50 (2008). Of the initial sample of 591 participants, 43% (57% of them male) were lost to follow-up. Interviews were conducted using the Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology (SPIKE), a semistructured interview. Sexual problems were identified on the basis of the study participants' self-appraisal. One-year prevalence rates, lifetime risks, and overlap of functional, emotional, and sexual desire problems in men and women were evaluated. The findings confirmed higher lifetime risks in women than in men for any sexual problem (females 67.0%; males 46.0%) and for functional (39.3%; 22.1%), emotional (35.7%; 15.9%), and sexual desire problems (51.6%; 33.3%). While in general men's sexual problems increased with age, no such association was observed in women. The overlap of all three problems (functional, emotional, and sexual desire) was reported by 16.9% of women but only 5.0% of men. Although there are commonalities, the type but also the development and, in particular, the overlap of sexual problems in women and men are markedly different.