Combined estrogen-progestin oral contraceptives and female sexuality: an updated review

INTRODUCTION

Sexual side effects of combined oral contraceptives (COCs) have not been fully understood, but increasing evidence prompts broader risk/benefit evaluation and merits inclusion in counseling on contraceptive options.

OBJECTIVES

The study sought to explore the impact of combined estrogens-progestin oral contraceptives on components of female sexuality, including sexual desire, anatomic genitourinary changes, lubrication, orgasm, provoked vestibulodynia, well-being, body image, partner preference, and relationship stability.

METHODS

A literature review was performed between April 2023 and January 2024 exploring the association between combined oral contraceptive pills and sexual health.

RESULTS

Although COCs decrease free testosterone, it is unclear if COCs affect sexual function, including desire. Antiandrogenic COCs do seem to have a negative effect on sexual arousal, lubrication, and orgasm. Provoked vestibulodynia may be related to early onset of COC use, low-estrogen pills, and antiandrogenic progestins. Emotional and sexual side effects are strong predictors of COC discontinuation. Longitudinal data indicate that using COCs when meeting and selecting a partner has implications on sexual satisfaction and relationship length. Analysis of data is complicated by various doses and forms of estrogen and progestin in COCs, which have changed over time.

CONCLUSION

Lack of randomized placebo-controlled studies and heterogenicity in study design hampers generalized statements about the effects of COCs on sexual function. Despite these challenges, consideration of sexual dysfunction when presenting and prescribing hormonal contraception is essential for informed consent, shared decision making, and ensuring reliable contraceptive choices.

'And she shall be called woman, because she was taken out of man': androcentrism and the creation of knowledge-driven ignorance

In this paper, I critically analyse biomedical clinical studies and literature reviews regarding the physiological phenomenon known as female ejaculation to demonstrate a process by which androcentric bias, which positions the male body as the scientific 'standard human', produces what I term as knowledge-driven ignorance. I show how even though knowledge about female ejaculation has expanded, its biomedical ontological status remains vague and controversial. The production of ignorance in this case does not result from active erasure or concealment, but rather from unintentional disregard, and is a by-product of knowledge-creation itself. As such, it is not only the narration of the scientific story that has the power to abject and exclude certain bodies from culture, but also what is untold and unknown.

"Sewed girl" pronounced "virgin": hymenoplasty and the shift in rhetoric of virginity in Iran

In late 2018, Ayatollah Makarem Shirazi posted a fatwa approving hymenoplasty for women who had lost their virginity before marriage, arguing that the medical procedure could restore a woman's virginity and therefore her honour. Hymenoplasty, which restores a woman's hymen to its 'virgin' state, is a highly controversial procedure in Iranian society because it strikes at the heart of the purist feminine ideal promoted by the Islamic Republic. For an ayatollah with a conservative reputation to sanction such a procedure seemed antithetical to his position in the regime. On closer inspection, however, it is possible to see his comment as a rhetorical attempt to assert control. Recent social changes, including an increase in the number of educated women and the emergence of new communication technologies, have challenged the rigidity of the old order as women take advantage of emerging freedoms of action and expression. Ayatollah Makarem's fatwa endorsing hymenoplasty can be read as a response to this perceived threat. This essay draws on Kenneth Burke's rhetorical theory to argue that Ayatollah's fatwa should be seen less as a tolerant recognition of social change and more as an attempt to maintain order. Fearing that women might begin to question and reject the entire moral order of the regime, he approves of hymenoplasty to prevent what Burke calls the 'weak in virtue' from falling into 'the strong in sin'.

The Prevalence of the Risk of Sexual Dysfunction in the First and Third Trimesters of Pregnancy in a Sample of Spanish Women

Sexuality is a central aspect for all human beings. Research into the prevalence of sexual dysfunction in pregnant Spanish women is scarce. The aim of this work is to examine the prevalence of risk of sexual dysfunctions in pregnant Spanish women and determine in which trimester the greatest difficulties in sexual response occur. The sample consisted of 180 pregnant Spanish women, with an average age of 32.03 years (SD = 4.93). The participants completed a questionnaire for socio-demographic data, as well as the female sexual function index, the state/trait depression inventory, and the dyadic adjustment scale. The results indicate that the percentage of women with a risk of sexual dysfunction was 65% in the first trimester and 81.11% in the third trimester. Likewise, the highest score on the depression questionnaire was in the third trimester, and the couple's relationship also improved in the third trimester. To improve women's sex lives during pregnancy, it is recommended to increase sexual education and information for both pregnant women and their partners.

Revealing the Connection Between Hemodialysis and Sexual Physiology in Women With End-Stage Renal Disease

INTRODUCTION

In the recent past, the procedure of hemodialysis has frequently been opted for patients with end-stage renal disease (ESRD) around the globe. In such patients, the concern of sexual dysfunction is highly prevalent, which causes psychological as well as social deterioration in these patients. Wretchedly, this issue has been ignored in developing countries like Pakistan because of social and cultural constraints.  Objectives: The aim was to measure and compare Female Sexual Functions of Dialysis (FSFI) scores among three comparative groups: healthy controls, pre-dialysis patients, and hemodialysis patients.

METHODS

A comparative cross-sectional study was carried out with 60 females aged 22-50 years in which 20 were healthy (controls) and 40 were patients with ESRD; of these 40, 20 were taking only oral medicines (pre-dialysis) and 20 were also receiving hemodialysis (hemodialysis). Married women who could read Urdu and were living with live spouses were included, and those with any psychological or psychiatric illness were excluded. Data was collected through a Likert-scaled questionnaire, Urdu translation of the FSFI questionnaire, and scores of each domain were analyzed. Single-tail one-way ANOVA was used to observe the significant difference among the three comparative groups.

RESULTS

A strong statistical difference was observed among the hemodialysis, pre-dialysis, and healthy control groups when these three study groups were compared for the mean scores of all related domains of FSFI questtionarie. In each female sexual domain, i.e. Desire, Arousal, Lubrication, Orgasm, Satisfaction, and Pain, the diseased groups (pre-dialysis and hemodialysis) showed lower sexual scores than the healthy group. The lowest scores were observed in the pre-dialysis group (16.4 ± 6.8) and the highest were noticed in the healthy group (29.9 ± 1.8); the hemodialysis group (23.3 ± 5.0) expressed a moderate pattern of scores in each sexual domain.

CONCLUSION

ESRD female patients who were receiving hemodialysis along with routine oral medications showed improved sexual physiology (with better FSFI scores) compared to those who were without hemodialysis.

Female sexual function after repair of uterovaginal prolapse

OBJECTIVE

To evaluate the impact of repair of uterovaginal prolapse using sacrospinous hysteropexy on female sexual function.

METHODS

A cross-sectional study was conducted at the Urogynecology Clinic of the Suez Canal University Hospital from May 2014 to April 2019. Twenty-seven women with a diagnosis of uterovaginal prolapse and wishing to preserve their uteri were recruited. Sacrospinous ligament fixation was done. Sexual symptoms were assessed using the female sexual function index (FSFI) questionnaire just before and 6 months after the operation.

RESULTS

The mean age of the participants was 36.5 ± 4 years. Sacrospinous hysteropexy only was performed for three women. Additional procedures included anterior colporrhaphy (12), posterior colporrhaphy (9), and perineorrhaphy (15). There was a significant improvement in pre- and postoperative patients' orgasm (3.1 ± [0.8] vs. 3.7 ± [1.1]; p value = 0.03) and satisfaction (3.4 ± [0.6] vs. 4.2 ± [0.8]; p value < 0.001) while there was worsening of pain (4.3 ± [1.5] vs. 3.2 ± [1.6]; p value = 0.017). There was insignificant improvement in the other three domains as well as total score of FSFI, with all patients having sexual dysfunction.

CONCLUSION

Sacrospinous hysteropexy was associated with significant improvement orgasm and satisfaction domains of FSFI and significant worsening of pain.

"Impossibility of its being deciphered": Anne Lister, her "crypt hand" diaries, and the contrast between voicing and silencing

In recent decades, it has become increasingly important to reevaluate certain literature and figures in history to discover what was being communicated in the midst of, and through, the silence of minority groups. My particular focus is on the tradition of white female silence and the ways in which Anne Lister and her diaries (as separate entities) contributed to conversations about silence by establishing other methods of communication despite restrictions placed on women's voices at the time. As the main focalizers in the creation and depiction of her societal and sexual identity, I discuss Lister's "crypt hand" diaries, her self-presentation, her inheritance of Shibden Hall, and the contrast they offer between voicing and silencing. Although I argue that through these focalizers Lister does present a certain level of voicing or speaking out, ultimately this is done by using various methods of silence such as coding and implication. I also offer particular analysis of Lister's conceptualization of her own sexuality compared with that of the women she sleeps with and how her inability to fathom their queer identities contributes to a narrative of oppressive patriarchal silence.

Sexually destroyed or empowered? Silencing female genital cutting in close relationships

Based on fieldwork among Kurdish-Norwegian migrants, this study explored how female genital cutting (FGC) was a silenced topic between mothers and daughters, and between men and women. The silence was often broken when FGC was discussed as a practice that needed to be rejected. The main reasons for rejecting FGC were to support women's rights and to recognise the negative ways in which FGC affected women's sexuality. This way of breaking the silence on FGC was particularly helpful to some husbands and wives in their discussion of how FGC might have affected their sexual relationships. Using theories of migrant women's sexual agency and embodiment, this study examined how the silencing of FGC in close relationships can be interpreted both as a sign of oppression and as a sign of empowerment. The analysis suggests that the stigmatisation that circumcised women can experience from condemnatory public discourse on FGC may sometimes lead to the negotiation of assertive female sexuality.

Sexuality in women with Mayer-Rokitansky-Küster-Hauser syndrome

OBJECTIVE

Evaluation of the quality of sexual life of women with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) after neovagina creation using dilation and surgical techniques.

METHODS

Literature search of articles published in the years 2000–2021 using the databases Web of Science, Google Scholar and PubMed by key words: Mayer-Rokitansky-Küster-Hauser syndrome, neovagina, female sexuality and Female Sexual Function Index. We used a standardized international Female Sexual Function Index and other quantitative and qualitative parameters of sexual satisfaction to assess sexual function and overall satisfaction in women with neovagina.

RESULTS

It is possible to develop functional neovagina in women with MRKHS by either conservative or surgical techniques. The choice of the method used depends on the experience and skill of the surgeon, on the technical possibilities and equipment of the department, and on the anatomical predispositions and preferences of the patient. Satisfaction with sexual life also depends on the psychosexual maturity and sexual demands of both partners as well as on regular vaginal rehabilitation and quality of long-term psychological support. The functional results of dilation and surgical methods are comparable according to objective criteria. They only differ in individual aspects which correspond to the overall personality traits as well as to the character and quality of cohabitation.

CONCLUSION

Women with MRKHS are primarily handicapped by coital insufficiency and inability to reproduce naturally. Creating a neovagina technically allows them to realize satisfactory coitus, but in most cases, they are still frustrated by the primary problem of „physical indisposition“ and complicated path to motherhood.

Breaking the Silences about Non-hetero Female Sexuality in Saghi Ghahraman's Poetry

Born in Iran, Saghi Ghahraman, an Iranian poet, lives in exile in Canada currently. Ghahraman founded Gilgamishaan Books, and founded and operated the Exiled Writers Club for two years. Zhe has been running the Iranian Queer Organization (IRQO) since 2008. In this paper analyzing hir non-phallocentric, multilayered, and non-linear poetry, I contend that Ghahraman rewrites androcentric history within the public sphere of cyberspace, pushing back against the attempts to mute queer sexuality and desire within Iranian culture. My main goal here is to illustrate that Ghahraman gives voice to the historically unthinkable and unspeakable issue of veiled Iranian women's bodies and voices breaking the deafening silences concerning the multiplicity of gender identities and sexualities. In this way, not only does Ghahraman assert hirself and hir desire, but zhe also liberates others who have been subjected to this historical silencing and suppression of their voices.

Peyronie's disease may negatively impact the sexual experience of a couple and female sexual function: a single center study

Background

Peyonie’s disease (PD) mostly affects males in the fifth decade of life, with a prevalence in the general population ranging between 0.5% and 20.3%. The pathology of PD is characterized by fibrosis of the tunic albuginea of the cavernous bodies of the penis, with the presence of pain in the erection and penile deformity. This is associated with decreased sexual function for both participants. The objective of the study was to investigate the influence of PD pathology on both male patients’ and their female partners’ sexual spheres, and analyze changes in sexual function and perception following penile correction surgery.

Methods

Prospective study, we included male patients with PD and their female partner sexually active. Patients underwent corporoplasty with multiple plications. The male and female sexuality was evaluated before surgery and three months after male treatment by the Female sexual Function Index (FSFI); International Index of Erectile Function (IIEF); Visual Analogical Scale (VAS).

Results

From January 2018 to November 2019 we included 35 couple. The female subjects before partner’s surgery presented dyspareunia, loss of sexual desire, inability to achieve orgasm, and sexual dissatisfaction. At three months after surgical treatment there was an improvement of sexual function in both male patients and female partners (desire P<0.0001, arousal P<0.0001, lubrification P<0.0001, orgasm P<0.0001, satisfaction P<0.0001, pain P<0.0001). As regarding male patients the pain decreased significantly (VAS score from 6 to 2.5), while there was no statistically significant improvement in erectile function (P=0.05).

Conclusions

Our findings suggest that a viable approach to treatment of PD patients that involves their partners could lead to better functional and psychological results.

Impact of bowel and stoma dysfunction on female sexuality after treatment for rectal cancer

AIM

The aim of this study was to measure the impact of bowel dysfunction and a poorly functioning stoma on the risk of sexual inactivity and sexual dysfunction in female patients.

METHOD

In a population-based cross-sectional study, Danish rectal cancer patients diagnosed between 2001 and 2014 were invited to answer a comprehensive questionnaire regarding cancer- and treatment-related late side effects after rectal cancer treatment. Bowel function was assessed using the Low Anterior Resection score and stoma function using the Colostomy Impact score. Female sexuality was measured by sexual activity, overall sexual dysfunction (the Rectal Cancer Female Sexuality score) and by different domains of sexual dysfunction (Sexual Vaginal Changes questionnaire).

RESULTS

Eight-hundred and thirteen female patients completed the questionnaire (response rate 49.2%). Major bowel dysfunction did not significantly increase the risk of sexual inactivity (OR 1.39, 95% CI 0.93-2.07) but clearly increased the risk of sexual dysfunction (OR 3.03, 95% CI 1.67-5.51). The most distinct problems were dyspareunia and inability to complete intercourse. On the contrary, poor stoma function increased the risk sexual inactivity (OR 2.26, 95% CI 1.16-4.40) but not the risk of sexual dysfunction (OR 0.74, 95% CI 0.27-1.99). The most distinct problem was dissatisfaction with own physical appearance.

CONCLUSIONS

Both bowel dysfunction and stoma dysfunction negatively, but differently, affect sexuality. After restorative surgery, bowel dysfunction was primarily associated with sexual dysfunction while poor stoma function after abdominoperineal excision was associated with sexual inactivity.

An experimental test of the ovulatory homolog model of female orgasm

The ovulatory homolog model of female orgasm posits that the neuro-endocrine mechanisms underlying female orgasm evolved from and are homologous to the mechanisms mediating copulation-induced ovulation in some mammals. This model predicts that pharmacological agents that affect human orgasm, such as fluoxetine, should also affect ovulation in animals with copulation-induced ovulation, such as rabbits. We tested this prediction by treating rabbits with daily doses of fluoxetine for 2 wk and found that fluoxetine treatment reduces the number of ovulations postcopulation by 30%. In a second experiment we tested whether this result was mediated by an effect on the brain or via peripheral serotonin functions. We treated animals with fluoxetine and induced ovulation with a single injection of human chorionic gonadotropin. In this experiment ovulation rate was nominally reduced by only 8%, which is statistically not significant. We conclude that the effect of fluoxetine on copulation-induced ovulation rate supports the ovulatory homolog model of female orgasm, suggesting that female orgasm has very deep evolutionary roots among the early eutherian mammals.

Adjusting hormones and constructing desires: new materialisations of female sexuality in Brazil

This paper presents the findings from a study conducted in Brazil among doctors specialised in the treatment of sexual problems. Its focus is on medical treatments and approaches related to female sexuality. According to the accounts provided by professionals, the most common 'problem' they encountered among women was lack of sexual desire in the period around menopause. In line with current principles of sexual medicine, they concurred that this issue resulted from declining hormone production. This paper discusses how pharmaceutical treatments have facilitated the materialisation of female desire in terms of the presence or absence of testosterone, paradoxically the hormone most commonly associated with masculinity.

Psychobiological Factors of Sexual Functioning in Aging Women - Findings From the Women 40+ Healthy Aging Study

Background: A variety of biological and psychosocial factors are associated with women’s sexual health in midlife and older age. Evidence suggests a decline in sexual functioning in the context of aging and the menopausal transition, including changes in sexual desire, arousal, lubrication, orgasm, pain, and/or contentment. However, not all women in midlife and older age experience such a decline, and it remains unclear how the endocrine environment and psychosocial aspects contribute to the maintenance of healthy sexual functioning. Therefore, the aim of this study was to examine psychobiological predictors of sexual functioning in healthy middle-aged and elderly females.

Methods: A total of 93 healthy, sexually active women aged 40–73 years completed a battery of validated psychosocial questionnaires, including measures of sexual functioning (Female Sexual Function Index) and of protective psychological traits and interpersonal variables. The steroid hormones estrogen, testosterone, progesterone and dehydroepiandrosterone sulfate were determined in saliva samples, while follicle-stimulating hormone, luteinizing hormone and sex hormone-binding globulin were determined in dried blood spots. The findings were statistically adjusted for multiple testing.

Results: Age and postmenopausal status were negatively associated with overall sexual functioning, arousal, and lubrication. Regression analyses revealed that relationship satisfaction, emotional support, self-esteem, optimism, and life satisfaction each significantly predicted overall sexual functioning or specific aspects of sexual functioning, including arousal, contentment, orgasm, and pain (all p < 0.029). For desire and lubrication, no associations were found with the tested psychosocial factors. In terms of steroid hormones, testosterone was positively linked to orgasm (p = 0.012). In this sample, 79.6% reported to have healthy sexual functioning according to the questionnaires’ cutoff. Younger age (OR = 0.911, 95% CI 0.854–0.970, p = 0.004) and a higher level of emotional support (OR = 1.376, 95% CI 1.033–1.833, p = 0.029) were associated with the presence of healthy sexual functioning.

Discussion: Although aging and menopause negatively affected aspects of sexual functioning, the accompanying endocrine correlates were not predictive for sexual functioning in this healthy sample of middle-aged and older females. Instead, our findings suggest that sexual functioning is highly dependent on psychosocial aspects related to well-being. Accordingly, personality traits such as optimism, and interpersonal aspects such as emotional support and relationship satisfaction were identified as important predictors of sexual functioning.

Religious leaders' position toward female genital cutting and their perspectives on the relationship between the Islamic religion and this practice

This study aimed to understand the position of religious leaders toward female genital cutting (FGC) and their perspectives on the relationship between the Islamic religion and FGC. In-depth interviews were conducted with 29 religious leaders in Erbil governorate, Iraqi Kurdistan region from June 2016 to May 2017 using a semi-structured interview guide. Most interviewees supported the continuation of FGC or thought that it should be at least permissible. Religious requirement and reducing the sexual activity of girls and women were the primary reasons for supporting FGC. The religious leaders disagreed about whether Islam requires, encourages, permits, or discourages the practice. The religious leaders generally agreed that most of the Islamic religious scripts about FGC are weak, and no clear and strong hadiths encourage FGC. However, they believed that some hadiths suggest that Islam requires FGC and that no hadiths prohibit FGC. The absence of open opposition to FGC in a context in which legislation has banned this practice was notable. The position of many religious leaders toward FGC is potentially shaped by the cultural interest in feminine chastity and virginity. Religious leaders need to explore different Islamic law schools and consider the religious disagreement and medical evidence about FGC.

Female anatomy and hysterical duality

This article attempts to add another layer to our understanding of the phenomenon of hysterical duality. The author postulates that hysterical duality can be explained based on the dual-aspect model of feminine sexuality, which exhibits two initially contradictory paths: one derived from primary vaginal sensations and the other from clitoral pleasure. At first, these two paths create a fundamental split between representations of internal space, containment and motherhood and representations related to auto-eroticism and the effacement of the Other's presence and needs. The author argues that this manifest contradiction makes the attainment of integration in feminine development an intricate and protracted process, which involves an act of inversion. This inversion entails a post-Oedipal disavowal of primary vaginal sexuality, pending its rediscovery through the encounter with the Other. Hysteria is thus viewed as the result of a failure to perform this inversion and an inability to extract oneself from the position of a "Vaginal Girl", who defines herself through the desire of the other. This pathological course of development leaves the hysteric's sexuality in a split state and traps her in the duality of clitoral pleasure versus penetration, which unconsciously represents humiliation and exploitation.

Yoruba culture and the resilience of HIV-positive adolescent girls in Nigeria

Although there is a growing body of research exploring the influence of culture on the resilience of African youth, few studies have examined how culture constrains or enables resilience among HIV-positive adolescent girls from the perspective of the young women themselves. This paper reports on the findings from a qualitative study of five purposively selected girls living with HIV in Ibadan, Nigeria. By analysing data drawn mainly from interviews and observations, we explored how cultural influences promote or limit resilience in participants. Social-ecological resilience theory was used to document and interpret the findings. While some cultural values and perceptions enable resilience, others constrain participants' resilience trajectories. However, the girls were able to navigate through these constraints using their cultural identities and coping strategies, such as future dreams, emotional and physical resources linked to spirituality and networks of friends and families. Findings have implications for policymakers, researchers and programmers in strengthening the health and resilience of young people in the face of HIV.

Lifestyle Choices Can Augment Female Sexual Well-Being

Female sexual wellbeing is complex and it's an important part of a comprehensive approach to women's health. Unfortunately, this aspect of health often is not discussed during medical appointments which can be isolating for female patients. Low libido is the most common female sexual dysfunction. There are multiple causes of low libido that may be physical, cultural, emotional, medical psychological or due to her relationship with her partner. A healthy lifestyle is one way to help women overcome low libido and a few examples include exercise, mindfulness and yoga. Ultimately, these lifestyle approaches can enhance sexual satisfaction.

What Is Known and Unknown About the Association Between Endometriosis and Sexual Functioning: A Systematic Review of the Literature

It is well known that endometriosis is associated with an increase in the risk of deep dyspareunia, with potential negative effects on global female sexual functioning and couple relationship. The aims of this study were to review the literature on the impact of endometriosis on female sexual functioning and to suggest new avenues for future research and treatment strategies. An electronic database research was performed to identify all the studies on the relation between endometriosis and sexual functioning published in the period 2000 to 2016. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After the screening process, a total of 9 studies investigating the relation between endometriosis and female sexual functioning were considered. Overall, these studies indicated that around two thirds of women with endometriosis have some form of sexual dysfunction not limited to deep dyspareunia. These findings suggest that the global sexual impact of endometriosis requires further investigation, focusing not only on pain during intercourse but also on psychological and relational dimensions, including partner's sexual functioning. Because sexual functioning is a complex, multidimensional phenomenon, the ideal treatment for endometriosis-related sexual dysfunctions should be conducted by a multidisciplinary team composed of gynecologists, sexologists, and psychologists/psychotherapists.

Fifty Shades: ambivalence about birth control in an erotic bestseller and its cultural implications

The Fifty Shades trilogy by E.L. James has taken the world by storm and become a cultural phenomenon. The lack of contraceptive use in the erotic fiction, first pointed out by bloggers, is analysed in this article and compared to medical information. James may be praised for sexualising condom use. However, her protagonist makes poor choices in terms of hormonal contraception and is negligent about its use, resulting in an unintended pregnancy and resolved in marital bliss and motherhood. What is of more interest here than a possible message about contraceptive use, is the outcome that the fiction's negligence in birth control and responsibility affirms an ideology in which female sexuality and sexual experimentation can only be tolerated within the context of procreation and affirmation of motherhood. Subsequently, the cultural significance of the trilogy's popularity and its tension between sexual exploration, birth control and fertility is explored. In a globally popular fantasy published more than five decades after the introduction of the pill, the protagonist's lack of attention to reliable birth control leads to a telling dichotomy that combines adventurous exploration of female sexuality and affirmation of the nuclear family.

'Basically, it's sorcery for your vagina': unpacking Western representations of vaginal steaming

Vaginal steaming made global headlines in 2015 after its promotion by celebrity Gwyneth Paltrow. One of many female genital modification practices currently on offer in Anglo-Western nations - practices both heavily promoted and critiqued - vaginal steaming is claimed to offer benefits for fertility and overall reproductive, sexual or even general health and wellbeing. We analysed a selection of online accounts of vaginal steaming to determine the sociocultural assumptions and logics within such discourse, including ideas about women, women's bodies and women's engagement with such 'modificatory' practices. Ninety items were carefully selected from the main types of website discussing vaginal steaming: news/magazines; health/lifestyle; spa/service providers; and personal blogs. Data were analysed using thematic analysis, within a constructionist framework that saw us focus on the constructions and rationalities that underpin the explicit content of the texts. Within an overarching theme of 'the self-improving woman' we identified four themes: (1) the naturally deteriorating, dirty female body; (2) contemporary life as harmful; (3) physical optimisation and the enhancement of health; and (4) vaginal steaming for life optimisation. Online accounts of vaginal steaming appear both to fit within historico-contemporary constructions of women's bodies as deficient and disgusting, and contemporary neoliberal and healthist discourse around the constantly improving subject.

Impact of estrogen receptor α gene and oxytocin receptor gene polymorphisms on female sexuality

Over the past decades, research attention has increasingly been paid to the neurobiological component of sexual behavior. The aim of the present study was to investigate the correlation of estrogen receptor α (ERA) gene polymorphism (rs2234693-PvuII) (T→C substitution) and oxytocin receptor gene polymorphism (rs53576) (G→A substitution) with sexuality parameters of young, healthy women. One hundred thirty-three Greek heterosexual women, students in higher education institutions, 20-25 years of age, sexually active, with normal menstrual cycles (28-35 days), were recruited in the study. Exclusion criteria were chronic and/or major psychiatric diseases, use of oral contraceptive pills (OCs), polycystic ovary syndrome (PCOS), thyroid diseases as well as drugs that are implicated in hypothalamus-pituitary-gonadal axis. T allele (wildtype) of rs2234693 (PvuII) polymorphism of ERA gene was correlated with increased levels of arousal and lubrication, whereas A allele (polymorphic) of rs53576 (OXTR) polymorphism was correlated with increased arousal levels. The simultaneous presence of both T allele of rs2234693 (PvuII) and A allele of rs53576 (OXTR) polymorphisms (T + A group) was correlated with increased arousal, orgasm levels as well as female sexual function index full score. To our knowledge, this is the first study to investigate the interaction between ERA and OXTR with regard to sexual function in women. Female sexuality is a complex behavioral trait that encompasses both biological and psychological components. It seems that variability in female sexual response stems from genetic variability that characterizes endocrine, neurotransmitter and central nervous system influences.

Barriers to female sex addiction treatment in the UK

Background Over the last 20 years, behavioral addictions (e.g., addictions to gambling, playing video games, work, etc.) have become more accepted among both public and scientific communities. Addiction to sex is arguably a more controversial issue, but this does not take away from the fact that some individuals seek professional help for problematic excessive sex, irrespective of how the behavior is conceptualized. Empirical evidence suggests that among treatment seekers, men are more likely than women to seek help for sex addiction (SA). Methods Using the behavioral addiction literature and the authors' own expertise in researching female SA, this paper examines potential barriers to the treatment for female sex addicts. Results Four main types of barriers for female sex addicts not seeking treatment were identified. These comprised (a) individual barriers, (b) social barriers, (c) research barriers, and (d) treatment barriers. Conclusions Further research is needed to either confirm or disconfirm the identified barriers that female sex addicts face when seeking treatment, and if conformation is found, interested stakeholders should provide better awareness and/or see ways in which such barriers can be overcome to aid better uptake of SA services.

Black Women with Multiple Sex Partners: The Role of Sexual Agency

Motivations of low-income substance using heterosexual Black women in New York City for having multiple sexual partners are explored in this paper. Analysis of in-depth interviews with 50 study participants demonstrates that their relationships consisted of those who had: (1) a main sex partner and a secondary sex partner; or (2) two or more "casual" partners. Individual-level motivations for extra relational sex fell into four dominant themes: sexual pleasure, partner infidelity, sex exchange and past main partners. Using a Black feminist framework, we describe how participants displayed considerable autonomy by actively forming and withdrawing from sexual relationships with men. However, women described low rates of condom use with main partners and inconsistent use of condoms with more casual sexual partners. This contradiction becomes an important area for sexual health interventions. Women who had sexual relations with only one current mate in the past two years were recruited as a monogamous comparison group.

Self-reported sexually transmitted infections among female university students

AIM

To investigate the occurrence of self-reported sexually transmitted infections (STIs) and associated factors among female university students requesting contraceptive counselling.

MATERIAL AND METHODS

Cross-sectional study. Female university students (n = 353) completed a waiting-room questionnaire in connection with contraceptive counselling at a Student Health Centre in Uppsala, Sweden.

RESULTS

Ninety-three (26.3%) female students had experienced an STI. The three most frequently reported STIs were chlamydia trachomatis, condyloma, and genital herpes. The experience of an STI was significantly associated with the total number of sexual partners (OR 1.060, 95% CI 1.030-1.091, P < 0.001), being heterosexual (OR 4.640, 95% CI 1.321-16.290, P = 0.017), having experienced an abortion (OR 2.744, 95% CI 1.112-6.771, P = 0.028), not being HPV-vaccinated (OR 2.696, 95% CI 1.473-4.935, P = 0.001), and having had intercourse on first night without using a condom (OR 2.375, 95% CI 1.182-4.771, P = 0.015).

CONCLUSIONS

Contraceptive counselling should also include information about primary and secondary prevention of STI, such as the importance of correct use of a condom and STI testing, to prevent a further spread of STIs.

A model for lesbian, bisexual and queer-related influences on alcohol consumption and implications for policy and practice

Research consistently reports higher rates of problematic drinking among lesbian, bisexual and queer women than among heterosexual women, but relatively little research has identified underlying factors. Within this context, the aim of the present study was to qualitatively explore the sociocultural influences on alcohol consumption among lesbian, bisexual and queer women in Australia. An ethnographic study including in-depth interviews and 10 sessions of participant observation was conducted with 25 Australian lesbian, bisexual and queer women. Analysis of transcripts and fieldnotes focused on lesbian, bisexual and queer-related influences on alcohol consumption. Three lesbian, bisexual and queer-related factors were identified that influenced alcohol use: (1) coping, (2) connection and (3) intersections with lesbian, bisexual and queer identity. Most participants reported consuming alcohol to cope with discrimination or to connect with like-minded others. Alcohol use had positive influences for some women through facilitating social connection and wellbeing. Women with a high lesbian, bisexual and queer identity salience were more likely to seek lesbian, bisexual and queer community connection involving alcohol, to publicly identify as lesbian, bisexual and queer and to experience discrimination. National policies need to address underlying causes of discrimination against lesbian, bisexual and queer women. Alcohol policies and clinical interventions should acknowledge the impact of discrimination on higher alcohol consumption amongst lesbian, bisexual and queer women compared with heterosexual women, and should utilise health promotion messages regarding safe drinking that facilitate lesbian, bisexual and queer social connection.

Female sexuality

Sex is a motive force bringing a man and a woman into intimate contact. Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. Though generally, women are sexually active during adolescence, they reach their peak orgasmic frequency in their 30 s, and have a constant level of sexual capacity up to the age of 55 with little evidence that aging affects it in later life. Desire, arousal, and orgasm are the three principle stages of the sexual response cycle. Each stage is associated with unique physiological changes. Females are commonly affected by various disorders in relation to this sexual response cycle. The prevalence is generally as high as 35-40%. There are a wide range of etiological factors like age, relationship with a partner, psychiatric and medical disorders, psychotropic and other medication. Counseling to overcome stigma and enhance awareness on sexuality is an essential step in management. There are several effective psychological and pharmacological therapeutic approaches to treat female sexual disorders. This article is a review of female sexuality.

Overweight, obesity and female sexuality in perimenopause: a preliminary report

INTRODUCTION

The research was conducted among patients of the Department of Perinatology and Gynaecology of the Poznań University of Medical Sciences. Its aim was to investigate the influence of overweight and obesity on female sexuality during the perimenopausal period. Preliminary results of the research are presented in the thesis, which was as a matter of fact intended as a preliminary report. The examination of sexual functions of the patients was performed with the use of the Female Sexual Function Index (FSFI) form.

MATERIAL AND METHODS

Sixty-one women during the perimenopausal period filled out the survey, with the average age of these women being 51 years. Forty-two of the examined women had an appropriate body mass index (BMI), i.e. between 18.5 and 25, while for 19 of the women, the BMI was above normal. For statistical analysis and in order to assess the differences between the two above-mentioned groups of patients, the nonparametric Mann-Whitney test was applied. A statistically significant value was assumed at p < 0.05. The results of the conducted research indicated no such difference between the women with differing BMI for the specific domains of the FSFI test.

RESULTS

The results obtained show that research in the area needs to be continued.

CONCLUSIONS

All the hitherto existing scientific studies also seem to indicate that the influence of overweight and obesity on female sexuality during the perimenopause has not yet been unambiguously proven. Beyond any doubt, however, sexual disorders appear in women at this time of life and the factors which determine them can vary greatly. Given the character of the situation, women ought to be supported both by a team of specialists representing different branches of medicine as well as by their relatives. The whole situation also calls for more research of the important subject matter.

Late-in-life childbearing (kōrei shussan) in contemporary Japan

This paper draws on interviews with a group of 27 Japanese women who were classified as late-in-life-childbearing mothers, or kōrei shussan--women who had had their first delivery at 35 years of age or over. In making sense of the significance, symbolism and consequences of late-life motherhood, the paper utilises a symbolic interactionist perspective to shed light on the cultural, structural, interpersonal and intrapsychic dimensions underpinning the experiences of this group of mothers. The paper highlights the relevance of social interaction and everyday life that make pregnancy an 'obligation' for these women. Grounded in the Foucauldian notion of normalisation, the analysis suggests that the experience of late-in-life childbearing can be understood as the result of three forms of pressure: biological, homosocial and work. The late-in-life-childbearing mother largely stems from governmental economic neoliberalism imbued with traditional conservatism and the pervasive influence of the Assisted Reproduction Treatments industry.

Sensual, erotic, and sexual behaviors of women from the "kink" community

Unconventional sensual, erotic, and sexual behaviors (herein referred to as kink behaviors) investigated by academia are based largely on clinical and criminal cases, and most published, peer-reviewed, quantitative research on these behaviors is based almost exclusively on male participants. For this study, information was collected and analyzed from 1580 female participants recruited from the kink community, using a non-clinical and non-criminal sample. We explored and described the preferences and diversity of more than 126 sensual, erotic, and sexual behaviors found among these participants, along with recommendations for continued research. Gaining a better understanding of the breadth and depth of activities engaged in by female kink practitioners could benefit educators, counselors, therapists, medical doctors, and other professionals when interacting with members of the kink community.

[Symptomatology and treatment of persistent genital arousal disorder. Case report]

Persistent genital arousal disorder is a rare condition among women characterized by unwanted and intrusive sexual arousal that can persist for an extended period of time and unrelated to sexual desire or sexual stimuli. Since its first documentation in 2001, numerous studies have been dedicated to investigate its specifics. The persistent genital arousal occurs in the absence of sexual interest and fantasies and it causes excessive psychological suffering. Masturbation, spontaneous orgasm or sexual intercourse can offer only a temporary relief. Researches provide a limited insight into the characteristics of persistent genital arousal disorder. This paper presents a case and summarizes the scientific findings on prevalence, etiology and treatment perspectives.

Sexual dysfunction in diabetic women: prevalence and differences in type 1 and type 2 diabetes mellitus

BACKGROUND

The aim of this work was to evaluate the impact of diabetes on female sexuality and to highlight any differences between sexuality in the context of type 1 and type 2 diabetes mellitus (DM).

METHODS

The subjects selected were 49 women with type 1 DM, 24 women with type 2 DM, and 45 healthy women as controls. Each participant was given the nine-item Female Sexual Function Index questionnaire to complete. The metabolic profile was evaluated by body mass index and glycosylated hemoglobin assay.

RESULTS

The prevalence of sexual dysfunction (total score ≤30) was significantly higher in the type 1 DM group (25/49, 51%; 95% confidence interval [CI] 18-31) than in the control group (4/45, 9%; 95% CI 3-5; P=0.00006); there were no significant variations in the type 2 DM group (4/24, 17%; 95% CI 3-4) versus the control group (P=0.630, not statistically significant). The mean total score was significantly lower in the type 1 DM group (30.2±6.9) versus the control group (36.5±4.9; P=0.0003), but there was no significant difference between the type 2 DM group and the control group (P=0.773). With regard to specific questionnaire items, the mean values for arousal, lubrication, dyspareunia, and orgasm were significantly lower only in the type 1 DM group versus the control group. The mean values for desire were reduced in type 1 and type 2 DM groups versus control group.

CONCLUSION

Type 1 DM is associated with sexual dysfunction. This may be due to classic neurovascular complications or to the negative impact of the disease on psychosocial factors. Larger and ideally longitudinal studies are necessary to better understand the relationship between DM and sexual dysfunction.

Female same-sex sexuality from a dynamical systems perspective: sexual desire, motivation, and behavior

Fluidity in attractions and behaviors among same-sex attracted women has been well-documented, suggesting the appropriateness of dynamical systems modeling of these phenomena over time. As dynamical systems modeling offer an approach to explaining the patterns of complex phenomena, it may be apt for explaining variability in female same-sex sexuality. The present research is the first application of this analytical approach to such data. Dynamical systems modeling, and specifically generalized local linear approximation modeling, was used to fit daily diary data on same-sex attractions and behaviors over a 21 day period among a group of 33 sexual minority women characterized as lesbian, bisexual or "fluid" based on their identity histories. Daily measures of women's reported same-sex attractions were fit using a linear oscillator model and its parameters estimated the cyclicity in these attractions. Results supported the existence of a "core sexual orientation" for women in this sample, regardless of how they identified and despite a high degree of variability in daily same-sex attractions. Thus, modeling individual differences in the variability of attractions and behaviors of sexual minority women may be critical to furthering our understanding of female same-sex sexuality and human sexual orientation more broadly.

Oedipus in Brooklyn: reading Freud on women, watching Lena Dunham's girls

Through an examination of Freud's Lecture 33, "Femininity" (1933), and "Mourning and Melancholia" (1917), the author proposes a reading of Freud's description of the girl becoming a woman. Female development is retold as a melancholic narrative-one in which the girl's entrance into the positive Oedipus is founded on unconscious grievance and unmourned loss of the early relationship with her mother. Castration and penis envy are reconceived as melancholic markers-the manifest content of the subjectivity of refusal, loss, and imagined repair of the early maternal relationship. Lena Dunham's HBO television series Girls is analyzed as an illustration of these theoretical understandings.

Phases of female sexual response cycle among Malaysian women with infertility: a factor analysis study

INTRODUCTION

This cross-sectional study aimed to determine the construct of the phases of the female sexual response cycle (SRC) among women attending an infertility clinic in a Malaysian tertiary center.

METHODS

The sexual response phases were measured with a validated Malay version of the Female Sexual Function Index (FSFI). The correlation structure of the items of the SRC phases (i.e. desire, arousal, orgasm, satisfaction and pain) was determined using principal component analysis (PCA), with varimax rotation method. The number of factors obtained was decided using Kaiser's criteria.

RESULTS

A total of 150 married women with a mean age of 32 years participated in this study. Factor loadings using PCA with varimax rotation divided the sexual domains into three components. The first construct comprised sexual arousal, lubrication and pain (suggesting a mechanical component). The second construct were orgasm and sexual satisfaction (suggesting a physical achievement). Sexual desire, suggesting a psychological component, stood on its own as the third.

DISCUSSION

The findings suggest that three constructs could be identified and in favor of the Basson model (a non-linear concept of SRC) for Malaysian women's sexual functioning. Understanding this would help clinicians to strategize the treatment approach of sexual dysfunction in women with infertility.

Androgen replacement therapy in women

Female androgens are derived from either the adrenal and peripheral conversion of the adrenal sex steroid precursor, dehydroepiandrosterone, or from direct ovarian production. Adrenal insufficiency or bilateral oophorectomy (surgical menopause) result in severe androgen deficiency, which can be clinically associated with impaired libido, drive and energy. Physiological menopause does not necessarily lead to androgen deficiency. The previously suggested definition of female androgen deficiency syndrome, as the concurrent presence of low androgen levels and low libido, is not precise enough and may lead to overdiagnosis. Current replacement options include transdermal testosterone or oral dehydroepiandrosterone treatment, both of which have been shown to result in significant improvements, in particular in libido and mood, while long-term effects on body composition, cardiovascular and cancer risk are less documented. Owing to these concerns, androgen replacement should be reserved for women with severe androgen deficiency due to an established cause and matching clinical symptoms.

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Sexual stereotypes are beliefs that are generally accepted and are thought to define how men and women should express their sexuality. The objectives of this study were to identify how many heterosexual Puerto Rican men and women endorsed certain stereotypes about male and female sexuality and to explore the relationship between the endorsement of these sexual stereotypes and the attitudes towards condom use, as well as actual condom use during intercourse. We conducted a cross-sectional study in which we administered two scales, one about male sexuality and the other about female sexuality, to a group of 429 heterosexual participants. We found that men endorsed significantly more male and female sexual stereotypes than women and that these tended to have a more conservative view of female sexuality than what they had of male sexuality. Women, on the other hand, tended to view female and male sexuality in a less stereotypical way. We also found that the more men and women endorsed male and female sexual stereotypes, the worse the attitudes toward condom use. However, endorsement of male and/or female sexual stereotypes was not related to condom use. These findings contradict the literature that suggests that these sexual stereotypes result in high-risk sexual conduct, which has important implications for the development and implementation of prevention programs.

Effects of mindfulness training on body awareness to sexual stimuli: implications for female sexual dysfunction

OBJECTIVES

Treatments of female sexual dysfunction have been largely unsuccessful because they do not address the psychological factors that underlie female sexuality. Negative self-evaluative processes interfere with the ability to attend and register physiological changes (interoceptive awareness). This study explores the effect of mindfulness meditation training on interoceptive awareness and the three categories of known barriers to healthy sexual functioning: attention, self-judgment, and clinical symptoms.

METHODS

Forty-four college students (30 women) participated in either a 12-week course containing a "meditation laboratory" or an active control course with similar content or laboratory format. Interoceptive awareness was measured by reaction time in rating physiological response to sexual stimuli. Psychological barriers were assessed with self-reported measures of mindfulness and psychological well-being.

RESULTS

Women who participated in the meditation training became significantly faster at registering their physiological responses (interoceptive awareness) to sexual stimuli compared with active controls (F(1,28) = 5.45, p = .03, η(p)(2) = 0.15). Female meditators also improved their scores on attention (t = 4.42, df = 11, p = .001), self-judgment, (t = 3.1, df = 11, p = .01), and symptoms of anxiety (t = -3.17, df = 11, p = .009) and depression (t = -2.13, df = 11, p < .05). Improvements in interoceptive awareness were correlated with improvements in the psychological barriers to healthy sexual functioning (r = -0.44 for attention, r = -0.42 for self-judgment, and r = 0.49 for anxiety; all p < .05).

CONCLUSIONS

Mindfulness-based improvements in interoceptive awareness highlight the potential of mindfulness training as a treatment of female sexual dysfunction.