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Alarcon-Rodriguez R, García-Álvarez R, Fadul-Calderon R, Romero-Del Rey R, Requena-Mullor M, Read Tejada M, Garcia-Gonzalez J. The relationship between female orgasmic disorder, attention-deficit/hyperactivity disorder, and depression in Dominican women. J Sex Med 2024; 21:614-619. [PMID: 38628064 DOI: 10.1093/jsxmed/qdae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/03/2024] [Accepted: 03/24/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Female orgasmic disorder is listed in the DSM-5 and is defined as the persistent or recurrent inability to have an orgasm. Many depressed women may experience sexual dysfunction, including female orgasmic disorder. AIM The study sought to analyze the relationship between depressive disorders and attention-deficit/hyperactivity disorder (ADHD) and their influence on the development of female orgasmic disorder. METHODS A total of 221 Dominican women participated in this case-control study. The case group consisted of 107 women diagnosed with female orgasmic disorder, while the control group consisted of 114 women without any sexual dysfunction. OUTCOMES The diagnosis of ADHD was obtained from the participants' medical records, previously conducted using the DSM-5-TR criteria. The Beck Depression Inventory II was used to assess the severity of depressive symptoms in both groups. RESULTS There was a significant relationship between female orgasmic disorder and ADHD and depression. The results of multiple logistic regression indicated that the highest risk of female orgasmic disorder was observed in women with ADHD (odds ratio [OR], 4.91; 95% confidence interval [CI], 2.46-9.20; P < .001), women with severe depression (OR, 2.50; 95% CI, 1.08-6.96; P = .04), and women who had sexual intercourse that focused on penetration (OR, 2.02; 95% CI, 1.03-3.98; P = .04). CLINICAL IMPLICATIONS These findings may have important implications for the prevention and treatment of sexual disorders in women. STRENGTHS AND LIMITATIONS This design selected all diagnosed cases of female orgasmic disorder and did not select a specific subgroup. However, some limitations must be considered. This study was conducted in a single clinic, although it should be noted that it is the main clinic for the treatment of sexual dysfunction in the country. A further limitation could be that this type of study design does not allow for statements about causality to be made. CONCLUSION There is an increased risk of female orgasmic disorder in women with ADHD, with severe depression, and who engage in penetrative sex.
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Affiliation(s)
- Raquel Alarcon-Rodriguez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Carr. Sacramento, s/n, 04120, Almería, Spain
- Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Carr. Sacramento, s/n, 04120, Almeria, Spain
| | - Rafael García-Álvarez
- Human Sexuality Institute, Faculty of Health Sciences, Autonomous University of Santo Domingo, Arístides Fiallo Cabral Street Santo, 10105, Santo Domingo, Dominican Republic
| | - Rosario Fadul-Calderon
- Human Sexuality Institute, Faculty of Health Sciences, Autonomous University of Santo Domingo, Arístides Fiallo Cabral Street Santo, 10105, Santo Domingo, Dominican Republic
| | - Raúl Romero-Del Rey
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Carr. Sacramento, s/n, 04120, Almería, Spain
- Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Carr. Sacramento, s/n, 04120, Almeria, Spain
| | - Mar Requena-Mullor
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Carr. Sacramento, s/n, 04120, Almería, Spain
- Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Carr. Sacramento, s/n, 04120, Almeria, Spain
| | - Madelyn Read Tejada
- Human Sexuality Institute, Faculty of Health Sciences, Autonomous University of Santo Domingo, Arístides Fiallo Cabral Street Santo, 10105, Santo Domingo, Dominican Republic
| | - Jessica Garcia-Gonzalez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Carr. Sacramento, s/n, 04120, Almería, Spain
- Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Carr. Sacramento, s/n, 04120, Almeria, Spain
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Vencill JA, Kirsch JL, McPherson K, Sprankle E, Patten CA, Campana K, Brockman T, Bronars C, Hughes C, Gastineau D, Ehlers SL. Prospective Association of Psychological Distress and Sexual Quality of Life Among Hematopoietic Stem Cell Transplant Survivors. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10013-9. [PMID: 38615280 DOI: 10.1007/s10880-024-10013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/15/2024]
Abstract
Sexual health concerns are one of the most common late effects facing hematopoietic stem cell transplant (HSCT) survivors. The current study tested whether self-reported depression and anxiety symptoms before transplant were associated with embedded items assessing two specific areas of sexual health-sexual interest and sexual satisfaction-one year post-HSCT. Of the 158 study participants, 41% were diagnosed with a plasma cell disorder (n = 60) and most received autologous transplantation (n = 128; 81%). At post-HSCT, 21% of participants reported they were not at all satisfied with their sex life, and 22% were not at all interested in sex. Greater pre-HSCT depressive symptomology was significantly predictive of lower sexual interest (β = -.27, p < .001) and satisfaction (β = -.39, p < .001) at post-HSCT. Similarly, greater pre-HSCT trait anxiety was significantly predictive of lower sexual interest (β = -.19, p = .02) whereas higher levels of state and trait anxiety were both predictive of lower satisfaction (β = -.22, p = .02 and β = -.29, p = .001, respectively). Participant sex significantly moderated the relationship between state anxiety and sexual satisfaction (b = -.05, t = -2.03, p = .04). Additional research examining the factors that contribute to sexual health post-HCST is needed to inform and implement clinical interventions to address these commonly overlooked survivorship concerns.
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Affiliation(s)
- Jennifer A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, 200, 1st Street SW, Rochester, MN, 55905, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Janae L Kirsch
- Department of Psychiatry & Psychology, Mayo Clinic, 200, 1st Street SW, Rochester, MN, 55905, USA
| | - Keagan McPherson
- Department of Psychiatry & Psychology, Mayo Clinic, 200, 1st Street SW, Rochester, MN, 55905, USA
- Minnesota State University, Mankato, MN, USA
| | | | - Christi A Patten
- Department of Psychiatry & Psychology, Mayo Clinic, 200, 1st Street SW, Rochester, MN, 55905, USA
| | | | - Tabetha Brockman
- Department of Psychiatry & Psychology, Mayo Clinic, 200, 1st Street SW, Rochester, MN, 55905, USA
| | - Carrie Bronars
- Department of Psychiatry & Psychology, Mayo Clinic, 200, 1st Street SW, Rochester, MN, 55905, USA
| | - Christine Hughes
- Department of Psychiatry & Psychology, Mayo Clinic, 200, 1st Street SW, Rochester, MN, 55905, USA
| | - Dennis Gastineau
- Department of Psychiatry & Psychology, Mayo Clinic, 200, 1st Street SW, Rochester, MN, 55905, USA
| | - Shawna L Ehlers
- Department of Psychiatry & Psychology, Mayo Clinic, 200, 1st Street SW, Rochester, MN, 55905, USA.
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Zhang JY, Jabs F, Brown NB, Milani S, Brotto LA. The Impact of Loosening COVID-19 Restrictions and Live-in Partner Status on Sexual and Mental Health in a Canadian Sample. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:139-151. [PMID: 38596767 PMCID: PMC10903576 DOI: 10.1080/19317611.2022.2163446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/22/2022] [Accepted: 12/21/2022] [Indexed: 04/11/2024]
Abstract
Objectives We examined changes in frequency of sexual behaviors, dyadic sexual desire, relationship satisfaction, and COVID-19 stress in Canadians across the pandemic, considering partner status. Methods Participants completed online questionnaires. Results Participants with live-in partners and single participants decreased in dyadic sexual behaviors. In August-September 2020, participants with live-in partners engaged in more dyadic sexual behaviors than single participants. In November 2021, all partnered participants engaged in more dyadic sexual behaviors than single participants. Decreases in COVID-19 stress were observed. Conclusions Findings suggest that despite decreases in COVID-19 stress, there may be long-lasting pandemic impacts on sexual behaviors.
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Affiliation(s)
- Jia Yu Zhang
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Faith Jabs
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Natalie B. Brown
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Sonia Milani
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Lori A. Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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Hossini RNS, Norouzi E, Yousefi M, Masrour FF, Ahmadi A. Aerobic Exercise and Resistance Training to Improve Sexual Health and Emotional Problems of Obese Women. TRENDS IN PSYCHOLOGY 2022. [DOI: 10.1007/s43076-022-00151-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 08/28/2024]
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Brown E, Lo Monaco S, O’Donoghue B, Nolan H, Hughes E, Graham M, Simmons M, Gray R. Improving the Sexual Health of Young People (under 25) in High-Risk Populations: A Systematic Review of Behavioural and Psychosocial Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179063. [PMID: 34501652 PMCID: PMC8430747 DOI: 10.3390/ijerph18179063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Background: Ensuring young people experience good sexual health is a key public health concern, yet some vulnerable groups of young people remain at higher risk of poor sexual health. These individuals require additional support to achieve good sexual health but the best way to provide this remains needs to be better understood. Methods: We searched for randomised controlled trials of behavioural and psychosocial interventions aimed at promoting sexual health in high-risk young populations. Outcomes of interest were indicators of sexual health (e.g., condom use, attitudes to contraception, knowledge of risk). Participants were under 25 years old and in one of the following high-risk groups: alcohol and other drug use; ethnic minority; homeless; justice-involved; LGBTQI+; mental ill-health; or out-of-home care. Results: Twenty-eight papers from 26 trials met our inclusion criteria, with all but one conducted in North America. Condom use was the most frequently reported outcome measure along with knowledge and attitudes towards sexual health but considerable differences in measures used made comparisons across studies difficult. Change in knowledge and attitudes did not consistently result in long-term change in behaviours. Conclusions: There remains a dearth of research undertaken outside of North America across all high-risk groups of young people. Future interventions should address sexual health more broadly than just the absence of negative biological outcomes, with LGBTQI+, homeless and mental ill-health populations targeted for such work. An international consensus on outcome measures would support the research field going forward, making future meta-analyses possible.
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Affiliation(s)
- Ellie Brown
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
- Correspondence: ; Tel.: +61-3-9966-9100
| | - Samantha Lo Monaco
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Brian O’Donoghue
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Hayley Nolan
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Elizabeth Hughes
- School of Healthcare University of Leeds, Woodhouse, Leeds LS2 9JT, UK;
| | - Melissa Graham
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; (M.G.); (R.G.)
| | - Magenta Simmons
- Orygen, 35 Poplar Road, Parkville, VIC 3052, Australia; (S.L.M.); (B.O.); (H.N.); (M.S.)
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
| | - Richard Gray
- College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; (M.G.); (R.G.)
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Tanton C, McDonagh L, Cabecinha M, Clifton S, Geary R, Rait G, Saunders J, Cassell J, Bonell C, Mitchell KR, Mercer CH. How does the sexual, physical and mental health of young adults not in education, employment or training (NEET) compare to workers and students? BMC Public Health 2021; 21:412. [PMID: 33637055 PMCID: PMC7908525 DOI: 10.1186/s12889-021-10229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Syndemic theory highlights the potential for health problems to interact synergistically, compounding impact. Young adults not in education, employment or training (NEET) are more likely to experience disadvantage and poorer general health outcomes. However, there is little research on their sexual health, or the extent to which this clusters with mental and physical health outcomes. Methods Analysis of data from 16 to 24 year olds (1729 men, 2140 women) interviewed 2010–12 for Britain’s third National Survey of Sexual Attitudes and Lifestyles. Natsal-3 is a national probability sample survey using computer-assisted personal interviewing with computer-assisted self-interviewing. Participants were classified as workers, students or NEET. We used multivariable logistic regression to examine associations between being NEET (relative to worker or student) and risk behaviours and outcomes in physical, sexual and mental health domains. We then examined how risk behaviours and poor health outcomes cluster within and across domains. Results 15% men and 20% women were NEET; 36% men and 32% women were workers; and 49% men and 48% women were students. Young people who were NEET were more likely to report smoking and drug use (men) than other young people. There were few differences in sexual health, although NEETs were more likely to report condomless sex, and NEET women, unplanned pregnancy (past year). Risk behaviours clustered more within and across domains for NEET men. Among NEET women, poor health outcomes clustered across mental, physical and sexual health domains. Conclusions Harmful health behaviours (men) and poor health outcomes (women) clustered more in those who are NEET. This points to a possible syndemic effect of NEET status on general ill health, especially for women. Our paper is novel in highlighting that elevated risk pertains to sexual as well as mental and physical health. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10229-6.
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Affiliation(s)
- Clare Tanton
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Lorraine McDonagh
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Soazig Clifton
- Institute for Global Health, University College London, London, UK
| | - Rebecca Geary
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, UK
| | - John Saunders
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, UK
| | - Jackie Cassell
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, UK.,Department of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| | - Chris Bonell
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Kirstin R Mitchell
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Catherine H Mercer
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, UK
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8
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Evaluating co-occurrence of depression and sexual dysfunction and related factors among Iranian rural women: A population-based study. Biomedicine (Taipei) 2020; 10:33-39. [PMID: 33854911 PMCID: PMC7608841 DOI: 10.37796/2211-8039.1003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/14/2019] [Indexed: 02/06/2023] Open
Abstract
Background and objectives Sexual dysfunction and mood disorders have a high prevalence rate and their co-occurrence has been reported in previous studies. This study aimed to determine the prevalence of co-occurrence of sexual dysfunction and depression and related factors in women. Materials and methods This descriptive-analytical study was carried out on 826 married rural women aged 15-49 years in Sari, Iran in 2018, selected by random sampling. The participants filled the demographic and fertility questionnaires, as well as Beck's Depression Inventory and Female Sexual Function Index (FSFI). Results In this study, 18% of the participants experienced the co-occurrence of depression and sexual dysfunction. In addition, results of the multiple logistic regression showed that forced marriage (OR = 0.31, CI 95%: 0.15 to 0.64, P < 0.001), a one-level increase in the education of the spouse (OR = 0.76, CI 95%: 0.59 to 0.98, P < 0.041), lack of history of depression (OR = 0.36, CI 95%: 0.20 to 0.66, P < 0.001) and lack of vaginal infection (OR = 0.41, CI 95%: 0.27 to 0.62, P < 0.001) were considered as factors contributing to a decline in the co-occurrence of depression and sexual dysfunction. On the other hand, not having a private bedroom (OR = 1.63, CI 95%: 1.09 to 2.43, P < 0.017), no vehicle (OR = 1.52, CI 95%: 1.02 to 2.27, P < 0.038), a history of sychiatric diseases (OR = 2.09, CI 95%: 1.2.0 to 3.65, P < 0.009), lack of chronic diseases (OR = 2.11, CI 95%: 1.03 to 4.31, P = 0.039) and lack of use of antidepressants (OR = 2.03, CI 95%: 2.03 to 1.03, P < 0.039) increased the co-occurrence of depression and sexual dysfunction. Conclusion According to the results of the study, about one-fifth of the married rural women experienced the co-occurrence of depression and sexual dysfunction. If healthcare providers detect one of the disorders of depression or sexual dysfunction in a patient, it is suggested that the person be assessed in terms of the other disorder and the proper treatment be applied. Furthermore, the healthcare personnel must pay attention to factors related to the co-occurrence of these disorders in addition to providing a treatment program.
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Parkes A, Waltenberger M, Mercer C, Johnson A, Wellings K, Mitchell K. Latent class analysis of sexual health markers among men and women participating in a British probability sample survey. BMC Public Health 2020; 20:14. [PMID: 31914970 PMCID: PMC6950902 DOI: 10.1186/s12889-019-7959-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite known associations between different aspects of sexual health, it is not clear how patterning of adverse sexual health varies across the general population. A better understanding should contribute towards more effective problem identification, prevention and treatment. We sought to identify different clusters of sexual health markers in a general population, along with their socio-demographic, health and lifestyle correlates. METHODS Data came from men (N = 5113) and women (N = 7019) aged 16-74 who reported partnered sexual activity in the past year in Britain's third National Survey of Sexual Attitudes and Lifestyles, undertaken in 2010-2012. Latent class analysis used 18 self-reported variables relating to adverse sexual health outcomes (STI and unplanned pregnancy, non-volitional sex, and sexual function problems). Correlates included socio-demographics, early debut, alcohol/drug use, depression, and satisfaction/distress with sex life. RESULTS Four classes were found for men (labelled Good Sexual Health 83%, Wary Risk-takers 4%, Unwary Risk-takers 4%, Sexual Function Problems 9%); six for women (Good Sexual Health 52%, Wary Risk-takers 2%, Unwary Risk-takers 7%, Low Interest 29%, Sexual Function Problems 7%, Highly Vulnerable 2%). Regardless of gender, Unwary Risk-takers reported lower STI/HIV risk perception and more condomless sex than Wary Risk-takers, but both were more likely to report STI diagnosis than Good Sexual Health classes. Highly Vulnerable women reported abortion, STIs and functional problems, and more sexual coercion than other women. Distinct socio-demographic profiles differentiated higher-risk classes from Good Sexual Health classes, with depression, alcohol/drug use, and early sexual debut widely-shared correlates of higher-risk classes. Females in higher-risk classes, and men with functional problems, evaluated their sex lives more negatively than those with Good Sexual Health. CONCLUSIONS A greater prevalence and diversity of poor sexual health appears to exist among women than men in Britain, with more consistent effects on women's subjective sexual well-being. Shared health and lifestyle characteristics of higher-risk groups suggest widespread benefits of upstream interventions. Several groups could benefit from tailored interventions: men and women who underestimate their STI/HIV risk exposure, women distressed by low interest in sex, and women experiencing multiple adverse outcomes. Distinctive socio-demographic profiles should assist with identification and targeting.
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Affiliation(s)
- Alison Parkes
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200 Renfield St, Glasgow, UK.
| | - Michael Waltenberger
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200 Renfield St, Glasgow, UK
| | - Catherine Mercer
- UCL Institute for Global Health, University College London, Mortimer Market Centre, Off Capper Street, London, UK
| | - Anne Johnson
- UCL Institute for Global Health, University College London, Mortimer Market Centre, Off Capper Street, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, UK
| | - Kirstin Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200 Renfield St, Glasgow, UK
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10
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Kelley EL, Cannell MB, Gass M, Sealy-Jefferson S, Woods NF, Bird CE, Stefanick ML, Weitlauf JC. Is Interpersonal Abuse Associated with Sexual (Dis)satisfaction among Postmenopausal Women? Womens Health Issues 2019; 29:299-307. [PMID: 31277914 PMCID: PMC6668717 DOI: 10.1016/j.whi.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate associations between past-year verbal and/or physical abuse (VA/PA) and sexual (dis)satisfaction, that is, global or frequency-related (dis)satisfactions with sexual activity, among postmenopausal women in the Women's Health Initiative. PROCEDURES A cross-sectional analysis of archival data was performed from the subset of 83,329 Women's Health Initiative participants (clinical trial and/or observational study components) who reported sexual activity in the year before baseline. Associations between VA/PA and global frequency (dis)satisfactions were modeled using logistic regression. MAIN FINDINGS Most participants reported sexual satisfaction (global, 77%; frequency related, 66%). Disappointment with sexual frequency, specifically a desire for more frequent sex, was the most common dissatisfaction expressed. Past-year VA/PA exposure was reported by 9,410 participants (11%). In regression models adjusted for sociodemographic, health and health risk, and menopausal symptom variables, VA/PA was associated with higher rates of global (35% VA/PA exposed vs. 22% non-exposed; adjusted odds ratio, 1.66; 95% confidence interval, 1.53-1.80) and frequency-related dissatisfactions (50% of VA/PA exposed vs. 32% of non-exposed; adjusted odds ratio, 1.73; 95% confidence interval, 1.57-1.90). CONCLUSIONS Sexual satisfaction was common, but not universally reported by study participants. Sexual dissatisfactions were overrepresented in VA/PA-exposed participants and associated with a desire for more frequent sexual activity. Opportunities for postmenopausal women to receive clinician-led education about safe and healthy ways to increase sexual activity are needed. Further research on this topic, particularly efforts to characterize safety concerns as well as modifiable barriers to satisfying sexual activity among postmenopausal women with recent VA/PA, would ensure that these interventions are evidence based.
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Affiliation(s)
- Erika L Kelley
- Department of Reproductive Biology, Case Western Reserve University, Cleveland, Ohio; University Hospitals Cleveland Medical Center, MacDonald Women's Hospital, Cleveland, Ohio
| | - M Brad Cannell
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health - Dallas Campus, Dallas, Texas
| | | | | | - Nancy F Woods
- University of Washington School of Nursing, Seattle, Washington
| | - Chloe E Bird
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, California
| | - Marcia L Stefanick
- Department of Medicine (Stanford Prevention Research Center), Stanford University School of Medicine, Stanford, California; Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
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11
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Health status, sexual activity and satisfaction among older people in Britain: A mixed methods study. PLoS One 2019; 14:e0213835. [PMID: 30917152 PMCID: PMC6436725 DOI: 10.1371/journal.pone.0213835] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 03/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Men and women are increasingly likely to stay sexually active into later life, but research shows that sexual activity and satisfaction decrease with increasing age. Ill health and medical treatments may affect sexual activity but there is little research on why some older people with a health problem affecting their sexual activity are satisfied with their sex life, and others are not. METHODS A mixed method study integrating data and analyses from the third British National Survey of Sexual Attitudes and Lifestyles (n = 3343 aged 55-74 years) and from follow-up in-depth interviews with 23 survey participants who reported having a health condition or taking medication affecting their sex life. RESULTS Overall, 26.9% of men and 17.1% of women aged 55-74 reported having a health condition that affected their sex life. Among this group, women were less likely than men to be sexually active in the previous 6 months (54.3% vs 62.0%) but just as likely to be satisfied with their sex life (41.9% vs 42.1%). In follow-up interviews, participants sometimes struggled to tease out the effects of ill health from those of advancing age. Where effects of ill health were identified, they tended to operate through the inclination and capacity to be sexually active, the practical possibilities for doing so and the limits placed on forms of sexual expression. In close relationships partners worked to establish compensatory mechanisms, but in less close relationships ill health provided an excuse to stop sex or deterred attempts to resolve difficulties. Most fundamentally, ill health may influence whether individuals have a partner with whom to have sex. CONCLUSION The data show complex interactions between health, lifestyle and relationship factors that affect sexual activity/satisfaction. When dealing with sexual problems in older people, practitioners need to take account of individual lifestyle, needs and preferences.
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Coyle RM, Lampe FC, Miltz AR, Sewell J, Anderson J, Apea V, Collins S, Dhairyawan R, Johnson AM, Lascar M, Mann S, O'Connell R, Sherr L, Speakman A, Tang A, Phillips AN, Rodger A. Associations of depression and anxiety symptoms with sexual behaviour in women and heterosexual men attending sexual health clinics: a cross-sectional study. Sex Transm Infect 2019; 95:254-261. [PMID: 30814165 PMCID: PMC6585278 DOI: 10.1136/sextrans-2018-053689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/30/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To assess the association of symptoms of depression and anxiety with sexual risk behaviour and history, among women and heterosexual men attending genitourinary medicine (GUM) clinics. Methods Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) was a cross-sectional, self-administered questionnaire study recruited from 20 GUM clinics in England, 2013–2014. This analysis included women and heterosexual men. The prevalence of depression and anxiety symptoms was assessed. Modified Poisson regression was used to produce adjusted prevalence ratios (aPR) for the association of t demographic, socioeconomic and lifestyle factors with depression and anxiety, adjusted for gender, age, ethnicity, education level and study region. Among individuals reporting sex in the past 3 months, associations of depression and anxiety with sexual risk behaviour and history were assessed separately by gender, adjusted for age, ethnicity, study region, education and relationship status. Results Questionnaires were completed by 676 women and 470 heterosexual men. Depression symptoms were reported by 100 (14.8%) women and 33 men (7.0%). Anxiety symptoms were reported by 79 women (11.7%) and 21 men (4.5%). Among women reporting recent sex, those with depression symptoms were more likely to report condomless sex with a non-regular partner, aPR 1.38 (1.07–1.77) and recent condomless sex with two or more partners, 1.80 (1.25–2.59). Women with anxiety symptoms more likely to report recent condomless sex with two or more partners, 1.68 (1.13–2.50), low self-efficacy for condom use, 1.54 (1.02–2.31) and STI diagnosis in the last year 1.51 (1.04–2.20). Among heterosexual men reporting recent sex, depression and anxiety symptoms were associated with low self-efficacy with condom use, 2.32 (1.29–4.19) for depression and 2.23 (1.26–3.94) for anxiety, but not with measures of condomless sex. Discussion The associations between psychological symptoms and sexual risk behaviours highlight the importance of holistic assessment of need by both general and sexual health clinicians. We highlight the challenge in delivering holistic care associated with fragmentation of sexual health services.
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Affiliation(s)
- Rachel Margaret Coyle
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Fiona C Lampe
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Ada Rose Miltz
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Janey Sewell
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | | | - Rageshri Dhairyawan
- Outpatients East, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Anne M Johnson
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Monica Lascar
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Sue Mann
- Camberwell Sexual Health Centre, King's College Hospital, London, UK
| | | | - Lorraine Sherr
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Andrew Speakman
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Alan Tang
- Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - Andrew N Phillips
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
| | - Alison Rodger
- Institute for Global Health, University College London, Royal Free Hospital, London, UK
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Donnelly DW, Kearney T, McCaughan E, Downing A, Weller D, Glaser AW, Gavin A. Treatment for erectile dysfunction among older men in Northern Ireland. Int J Clin Pract 2019; 73:e13259. [PMID: 30222241 DOI: 10.1111/ijcp.13259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/14/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Erectile dysfunction is common among older men; however, diagnosis and treatment compared to reported prevalence is low. We aim to identify the degree to which older men are offered treatment for the condition and determine the level of unmet need within Northern Ireland (NI). METHODOLOGY Analysis of data collected using a cross-sectional survey was conducted for men aged ≥60 years with data weighted to the NI population by age and deprivation. Respondents answered questions on sociodemographic factors, health-related characteristics, ability to function sexually, level of sexual interest and activity, and any treatment offered to improve erections in the last 3 years. Results are presented as proportions reporting treatment receipt, with differences by respondent characteristics assessed using chi-square tests and multivariable logistic regression. RESULTS Among 2597 respondents, 46.5% reported erectile dysfunction. One quarter (25.8%) recalled being offered either medication, devices, or specialised services to improve erections. The offer of treatment was associated with younger age, being separated or divorced, higher number of long-term conditions, and greater interest in sex. Of men reporting erectile dysfunction and offered medication, 28.8% found them helpful and currently use them. CONCLUSIONS As a result of not being offered treatment or not finding treatment useful, 93% of men reporting erectile dysfunction have no help with the condition. This is a likely consequence of treatment availability through the NHS in NI, but also suggests that healthcare professionals need to engage more proactively with older men, discussing sexual health routinely and following up those treated for the condition.
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Affiliation(s)
- David W Donnelly
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Eilis McCaughan
- Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Amy Downing
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - David Weller
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Adam W Glaser
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
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Basson R, Gilks T. Women's sexual dysfunction associated with psychiatric disorders and their treatment. WOMEN'S HEALTH (LONDON, ENGLAND) 2018; 14:1745506518762664. [PMID: 29649948 PMCID: PMC5900810 DOI: 10.1177/1745506518762664] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/08/2017] [Accepted: 01/28/2018] [Indexed: 12/13/2022]
Abstract
Impairment of mental health is the most important risk factor for female sexual dysfunction. Women living with psychiatric illness, despite their frequent sexual difficulties, consider sexuality to be an important aspect of their quality of life. Antidepressant and antipsychotic medication, the neurobiology and symptoms of the illness, past trauma, difficulties in establishing relationships and stigmatization can all contribute to sexual dysfunction. Low sexual desire is strongly linked to depression. Lack of subjective arousal and pleasure are linked to trait anxiety: the sensations of physical sexual arousal may lead to fear rather than to pleasure. The most common type of sexual pain is 10 times more common in women with previous diagnoses of anxiety disorder. Clinicians often do not routinely inquire about their patients' sexual concerns, particularly in the context of psychotic illness but careful assessment, diagnosis and explanation of their situation is necessary and in keeping with patients' wishes. Evidence-based pharmacological and non-pharmacological interventions are available but poorly researched in the context of psychotic illness.
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Affiliation(s)
| | - Thea Gilks
- The University of British Columbia, Vancouver, BC, Canada
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Laxhman N, Greenberg L, Priebe S. Satisfaction with sex life among patients with schizophrenia. Schizophr Res 2017; 190:63-67. [PMID: 28270338 DOI: 10.1016/j.schres.2017.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/26/2017] [Accepted: 03/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Whilst subjective quality of life has been extensively studied in patients with schizophrenia, little is known specifically about their satisfaction with their sex lives. Aim To assess the level of satisfaction with sex lives of patients with schizophrenia and explore patient characteristics associated with lower satisfaction. METHOD Data of five independent samples of patients with schizophrenia or related disorders (ICD-10 F20-29) were analysed. Quality of life including satisfaction with sex life was assessed on the Manchester Short Assessment of Quality of Life. RESULTS Across all patients (N=1404), satisfaction with sex life was significantly lower than satisfaction with any other life domain, and in each sample mean scores were below the middle scale point, indicating explicit dissatisfaction. Lower satisfaction was associated with male gender, being unmarried and more affective symptoms. CONCLUSION Patients with schizophrenia experience their sex life as an area of particular dissatisfaction. Future research should identify context and reasons for this dissatisfaction.
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Affiliation(s)
- Neelam Laxhman
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Newham Centre for Mental Health, E13 8SP London, UK.
| | - Lauren Greenberg
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London E1 2AB, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Newham Centre for Mental Health, E13 8SP London, UK
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Paquette R, Tanton C, Burns F, Prah P, Shahmanesh M, Field N, Macdowall W, Gravningen K, Sonnenberg P, Mercer CH. Illicit drug use and its association with key sexual risk behaviours and outcomes: Findings from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). PLoS One 2017; 12:e0177922. [PMID: 28542366 PMCID: PMC5436851 DOI: 10.1371/journal.pone.0177922] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/05/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We explore the hypothesis that using illicit drugs other than, or in addition to, cannabis is associated with sexual risk behaviour and sexual health outcomes in the British population. METHODS We analysed data, separately by gender, reported by sexually-active participants (those reporting > = 1 partners/past year) aged 16-44 years (3,395 men, 4,980 women) in Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability survey undertaken 2010-12 involving computer-assisted personal-interview and computer-assisted self-interview. Analyses accounted for the stratification, clustering and weighting of the data. Multivariable logistic regression was used to calculate adjusted odds ratios. RESULTS Use of illicit drugs other than, or in addition to, cannabis in the past year was reported by 11.5% (95%CI:10.4%-12.8%) of men and 5.5% (4.8%-6.3%) of women. Use of these types of drugs was more common among those <35 years, those who reported poor general and/or sexual health behaviours, e.g. binge drinking > = weekly (age-adjusted ORs, aAORs, 10.91 (6.27-18.97) men; 9.95 (6.11-16.19) women); having > = 2 condomless partners in the past year (aAOR:5.50 (3.61-8.39) men; 5.24 (3.07-8.94) women). Participants reporting illicit drug use were more likely (than those who did not) to report sexual health clinic attendance (ORs after adjusting for age, sexual identity and partner numbers: 1.79 (1.28-2.51) men; 1.99 (1.34-2.95) women), chlamydia testing (1.42 (1.06-1.92) men; 1.94 (1.40-2.70) women), unplanned pregnancy (2.93 (1.39-6.17) women), and among men only, sexually transmitted infection diagnoses (3.10 (1.63-5.89)). CONCLUSIONS In Britain, those reporting recent illicit drug use were more likely to report other markers of poor general and sexual health. They were also more likely to attend sexual health clinics so these should be considered appropriate settings to implement holistic interventions to maximise health gain.
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Affiliation(s)
- Rachelle Paquette
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Clare Tanton
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Fiona Burns
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Philip Prah
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Maryam Shahmanesh
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Nigel Field
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Wendy Macdowall
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kirsten Gravningen
- Research Department of Infection and Population Health, University College London, London, United Kingdom
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Catherine H. Mercer
- Research Department of Infection and Population Health, University College London, London, United Kingdom
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Cumulative Adverse Childhood Experiences and Sexual Satisfaction in Sex Therapy Patients: What Role for Symptom Complexity? J Sex Med 2017; 14:444-454. [DOI: 10.1016/j.jsxm.2017.01.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/07/2017] [Accepted: 01/11/2017] [Indexed: 12/14/2022]
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Mercer CH, Prah P, Field N, Tanton C, Macdowall W, Clifton S, Hughes G, Nardone A, Wellings K, Johnson AM, Sonnenberg P. The health and well-being of men who have sex with men (MSM) in Britain: Evidence from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMC Public Health 2016; 16:525. [PMID: 27386950 PMCID: PMC4936006 DOI: 10.1186/s12889-016-3149-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background To date, research on men who have sex with men (MSM) has largely focused on their sexual health needs and on men recruited from gay-orientated venues. National probability survey data provide a rare opportunity to examine the broader sociodemographic, behavioural, and health profiles of MSM, defined as men who reported ≥1 male sexual partner(s) in the past 5 years, and thus regardless of their sexual identity, in comparison to men reporting sex exclusively with women (MSEW) during this time, and also the extent that health inequalities cluster. Methods Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability sample survey, interviewed 15,162 people aged 16–74 years (6,293 men) during 2010–2012 using computer-assisted personal-interviewing with a computer-assisted self-interview. We used multivariable regression to compare MSM relative to MSEW in their reporting of variables, individually and collectively, corresponding to three domains: physical, mental, and sexual health. Results Among all men, 2.6 % (n = 190) were defined as MSM, of whom 52.5 % (95 % CI: 43.6 %–61.2 %) identified as gay. MSM were as likely as MSEW (n = 5,069) to perceive their health was ‘bad’/’very bad’, despite MSM being more likely to report a long-standing illness/disability/infirmity (adjusted odds ratio, AOR: 1.46, 95 % CI:1.02–2.09), treatment for depression/past year (2.75, 1.69–4.47), and substance use (e.g., recreational drug use/past year: 3.46, 2.22–5.40). MSM were more likely to report harmful sexual health behaviours, e.g., condomless sex with ≥2 partners/past year (3.52, 2.13–5.83), and poor sexual health outcomes, including STI diagnosis/es (5.67, 2.67–12.04), poorer sexual function (2.28, 1.57–3.33), both past year, and ever-experience of attempted non-volitional sex (6.51, 4.22–10.06). MSM were also more likely than MSEW to report poor health behaviours and outcomes both within and across the three health domains considered. Of all MSM, 8.4 % had experienced poor health outcomes in all three domains – physical, mental, and sexual health - in contrast to 1.5 % of all MSEW. Conclusions MSM are disproportionately affected by a broad range of harmful health behaviours and poor health outcomes. Although often observed for a minority of MSM, many health inequalities were seen in combination such that policies and practices aimed at improving the health and well-being of MSM require a holistic approach, regardless of clinical specialty.
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Affiliation(s)
- Catherine H Mercer
- Research Department of Infection and Population Health, University College London, 3rd floor Mortimer Market Centre, London, UK.
| | - Philip Prah
- Research Department of Infection and Population Health, University College London, 3rd floor Mortimer Market Centre, London, UK
| | - Nigel Field
- Research Department of Infection and Population Health, University College London, 3rd floor Mortimer Market Centre, London, UK
| | - Clare Tanton
- Research Department of Infection and Population Health, University College London, 3rd floor Mortimer Market Centre, London, UK
| | - Wendy Macdowall
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Tavistock Place, London, UK
| | - Soazig Clifton
- Research Department of Infection and Population Health, University College London, 3rd floor Mortimer Market Centre, London, UK
| | | | | | - Kaye Wellings
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, Tavistock Place, London, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, 3rd floor Mortimer Market Centre, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, 3rd floor Mortimer Market Centre, London, UK
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