Dyspareunia, signs of epithelial disruption, sexual abstinence, and HIV status in female sex workers in Nairobi: a cross-sectional study

BACKGROUND

Epithelial trauma is a risk factor of HIV infection in men who have sex with men (MSM) and female sex workers (FSWs). Painful intercourse may be indicative of epithelial tissue disruption. Previous studies on a cohort of Kenyan FSWs established an association between prolonged sexual abstinence and late HIV seroconversion. Our research objective was to establish whether there is a relationship between HIV serostatus and signs of epithelial disruption and between HIV serostatus and sexual abstinence behaviour.

METHODS

Participants were selected from a Nairobi health facility. A structured questionnaire was administered to 322 FSWs, who provided data on HIV status, sexual behaviour, abstinence intervals and the level of sexual dysfunction. Sexual dysfunction scores were created using parts of the Female Sexual Function Index (FSFI-19). Additional questions addressed epithelial trauma signs. Descriptive data analysis, bivariate and multivariate logistic regression were used to describe the study population and determine factors associated with living with HIV. Potential factors influencing sexual dysfunction were assessed by FSWs via self-rating.

RESULTS

36% of FSWs reported discomfort or pain during vaginal penetration half the time. 44% noticed genital bleeding half the time. Vaginal tenderness was experienced by 70.6% half the time during or after intercourse. Variables predictive of living with HIV on multivariate analysis included a medium and high score of discomfort or pain during and following vaginal penetration (medium: AOR 2.288, p-value 0.032, 95% CI 1.075-4.871; high: AOR 3.044, p-value 0.031, 95% CI 1.110-8.348). No significant association of HIV status with past abstinence durations as reported by participants could be established in the multivariate analysis. A majority of FSWs agreed that steady partnerships (81% agreement), regularity of intercourse (74%), foreplay (72%) and lubricants (65%) alleviated dyspareunia.

CONCLUSIONS

Recurrent exposure to blood during sex was highly prevalent in FSWs, as was sexual dysfunction. Complaint levels were associated with living with HIV, providing evidence that reducing sexual dysfunctions may prevent HIV transmission. Preventive initiatives may be created that address sexual dysfunction in key populations and general populations with a high HIV prevalence. Subjective assessments indicate that prevention may include the promotion of sexual intercourse regularity, foreplay, and lubricant use.

The GAy MEn Sex StudieS: Anodyspareunia Among Belgian Gay Men

Introduction

Anal intercourse is commonly associated with male homosexuality, but not all gay males engage in anal sex. Receptive anal intercourse can cause pain. Little is known about this sexual dysfunction.

Aim

This study aims to determine the 4-week incidence of anodyspareunia (AD) in a sample of Belgian men who have sex with men (MSM) population and to assess the relevance of possible predictors such as age, relationship, and sexual behavior.

Methods

An internet-based survey on sexual behavior and sexual dysfunctions, called GAy MEn Sex StudieS, was administered to the MSM aged 18 years or older, between April and December 2008. A part of the questionnaire was focusing on anal eroticism. The participants, who self-reported being human immunodeficiency virus-positive or not having anal intercourse, were excluded.

Main Outcome Measure

Female Sexual Function Index questions on pain domain adapted for anal intercourse.

Results

A total of 1,752 Belgian MSM completed the questionnaire. Of the 1,190 (68%) participants who reported engaging in receptive anal sex in the last 4 weeks, 59% indicated having some degree of anal pain during and after sexual intercourse. For 44%, the level of pain was acceptable. Mild AD was reported by 32%, 17% had mild to moderate AD, 4% had moderate AD, and 2% had severe AD. Independent predictors for the presence of AD were age, having a steady relationship, frequency of sex with their partner, number of sex partners, number of sex partners at the same time, and massaging the anal sphincter before anal sex. The prevalence and severity of AD among the MSM were lower among older participants, the MSM who more frequently had sex with their partner, and participants with a higher number of sex partners. Inadequate lubrication and lack of oral or digitoproctic stimulation prior to penetration were the most important factors predicting pain. Unsafe anal sex was performed by 28%.

Conclusion

One-third of the participants reported not engaging in receptive nor penetrative anal sex. The 59% of participating Belgian MSM, who had anal receptive intercourse, reported some degree of AD. These findings highlight the need for more education about anal eroticism for MSM, and more research into AD is needed. Vansintejan J, Vandevoorde J, and Devroey D. The GAy MEn Sex StudieS: Anodyspareunia among Belgian gay men. Sex Med 2013;1:87–94.