Sexual Health and Women Living With Spinal Cord Injury: The Unheard Voice

Women's sexual health within the context of sexual function and psychosocial dimensions while living with a spinal cord injury (SCI) has rarely been discussed separately from men living with a SCI or from a collective with other chronic conditions. To date, over 64,000 women in the U.S. are currently living with SCI, with total numbers increasing each year, as well as the demographics shifting to include more diversity in race and incidences occurring later in life. On average, SCI tends to be acquired during the childbearing years (~30–50 years old), as well as when women experience other health concerns associated with aging, including perimenopause and menopause. Additionally, women's sexual health is often conceptualized from the position of the absence of disease and dysfunction. However, consistent with definitions furthered by the World Health Organization (WHO) and World Association of Sexual Health (WAS), we believe women's sexual health is multifaceted, moving beyond a focus on reproduction to also encompass sexual function and the psychosocial dimensions of sexual health both living with and without disabling conditions and diseases. Within this lens, we present prior research that has been conducted, conclusions from these studies, implications for practice, and recommendations for future research. Thus, the paper will expand the understanding of both sexual function and psychosocial dimensions for women living with SCI.

Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States

BACKGROUND

Compulsive sexual behavior (CSB) is a clinical syndrome that causes significant distress and impairment for many individuals in the United States. Gay men are thought to have a higher prevalence of CSB, and it is associated with many relevant health outcomes including HIV risk behavior.

AIM

To estimate the prevalence and examine demographic correlates of CSB among gay men in the United States.

METHODS

A U.S. national probability sample of 227 gay-identified men were collected as part of the 2015 National Survey of Sexual Health and Behavior (NSSHB).

OUTCOMES

Participants completed the Compulsive Sexual Behavior Inventory (CSBI-13) and demographic measures.

RESULTS

Eighteen participants (7.93%) scored above the CSBI-13 clinical cut point, indicating they would likely meet criteria for clinically significant compulsive sexual behavior. To assess demographic correlates of CSB, demographic variables were entered into a logistic regression. Results of the logistic regression indicated that participant age, education, and religious affiliation were significant predictors of CSB status. Individuals scoring above the cut point were younger on average (M = 39.17; SD = 14.84) than those scoring below the cut point (M = 47.52; SD = 14.62; P = .02). Odds of scoring above the cut point were about six times greater for religiously affiliated participants compared to non-religiously affiliated participants (P = .005), and four times greater for those who had attended college compared to those who had not (P = .03).

CLINICAL IMPLICATIONS

These results indicate the prevalence of CSB in gay men is more modest than previously estimated, and is similar to the general population prevalence estimated in a previous study. The strongest predictor of CSB in this sample was religious affiliation, which underscores the importance of evaluating the role of religiosity in the etiology and/or identification of this clinical syndrome.

STRENGTHS AND LIMITATIONS

These findings are strengthened by the national probability sampling methodology and the use of the empirically validated CSBI-13 cut point. However, this sample was also older and had higher income and educational attainment than the larger population of gay men in the U.S.

CONCLUSION

These results indicate gay men may have a CSB prevalence rate similar to the general population, which contradicts previous research suggesting they are at greater risk for CSB. Gleason N, Finotelli I, Miner MH, et al. Estimated Prevalence and Demographic Correlates of Compulsive Sexual Behavior Among Gay Men in the United States. J Sex Med 2021;18:1545-1554.

Development of an Instrument to Assess Athletic Trainers' Attitudes Toward Transgender Patients

CONTEXT

  The unique contexts in which athletic trainers (ATs) work require specific tools in order to understand their attitudes toward diverse patient populations, including sexual and gender minorities.

OBJECTIVE

  To develop and validate the Attitudes Toward Transgender Patients (ATTP) instrument for ATs.

DESIGN

  Cross-sectional study.

SETTING

  Semistructured interviews, paper-based questionnaire, and electronic questionnaire.

PATIENTS OR OTHER PARTICIPANTS

  Six ATs completed semistructured interviews to develop themes regarding transgender patients. Additionally, 39 students in professional and postprofessional athletic training programs answered questionnaires designed to elicit statements regarding transgender patients. For item reduction, a sample of 3000 ATs were e-mailed (response rate = 17%), and for validation, another sample of 3000 ATs were e-mailed (response rate = 13%). Athletic trainers' e-mail addresses were obtained from the National Athletic Trainers' Association.

DATA COLLECTION AND ANALYSIS

  The 3 phases were (1) exploratory interviews, (2) construct validity and item reduction, and (3) criterion validity. Items were created based on interviews and questionnaires. Principal axis factoring was used for item reduction, and Pearson correlations were used for validation.

RESULTS

  Thirty-six statements pertaining to transgender patients were developed from the interview and questionnaire data. After item reduction, 10 items remained to form the ATTP (α = .834). For validation, the ATTP and Transphobia Scale were significantly correlated ( r = .723; P < .001).

CONCLUSIONS

  The ability to assess attitudes toward transgender patients will allow clinicians to identify needed areas of focus for training and education. The ATTP assesses affective and cognitive attitudes and behavioral intentions toward transgender patients in common clinical settings.

Genital vibration for sexual function and enhancement: best practice recommendations for choosing and safely using a vibrator

Vibrators are an evidence-based treatment for a variety of sexual dysfunctions and sexual enhancement; however, the use of a genital vibrator lacks best practice recommendations. This aim of this article is to provide current, best practice recommendations regarding the use of vibratory stimulation for the treatment of sexual dysfunction and/or sexual or relationship enhancement. A multidisciplinary team of sexual health specialists collaborated to develop best practice recommendations based on a narrative literature review. Recommendations for the use of vibratory stimulation for the treatment of sexual dysfunction are provided, with special attention to counseling patients on choosing and safely using a vibrator. Further study is needed to determine the most effective methods to counsel patients on vibrator use and to provide evidence-based cleaning recommendations.

Genital vibration for sexual function and enhancement: a review of evidence

Vibration, as provided by a genital vibrator, is commonly regarded as a tool to enhance sexual pleasure and in modern day society falls under the category of a sex toy. However, the vibrator was not originally intended to be a toy, and its benefits reach far beyond that of a plaything. This article is a narrative review of the current evidence regarding the use of vibratory stimulation for the treatment of sexual dysfunction and/or sexual and relationship enhancement. The literature indicates that vibratory stimulation has evidence-based support for the treatment of erectile dysfunction, ejaculatory dysfunction and anorgasmia. Vibratory stimulation is positively correlated with increased sexual desire and overall sexual function. It has also shown benefit for sexual arousal difficulties and pelvic floor dysfunction. Though definitive evidence is lacking, genital vibration is a potential treatment for sexual dysfunction related to a wide variety of sexual health concerns in men and women.

Health and identity-related interactions between lesbian, bisexual, queer and pansexual women and their healthcare providers

Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women's experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the different barriers, stigma and health outcomes that exist between them. This paper presents factors influencing identity disclosure and describes the characteristics of interactions that sexual minority women have with their healthcare providers around sexual identity and health. Using a mixed-methods approach, both qualitative and quantitative data were gathered using an online survey. The sample included lesbian, bisexual, queer and pansexual women from across the USA. Qualitative and quantitative data were analysed concurrently, and qualitative themes were quantified and integrated into quantitative analyses. Identity disclosure, reasons for disclosing identity and characteristics of interactions with providers varied by identity, but often overlapped. Bisexual and pansexual participants were significantly less likely to disclose identity than lesbian participants. There were no significant differences related to age or ethnicity. Findings from this study have the potential to inform ethical medical practices and improve healthcare quality among sexual minority women.

Prevalence, frequency, and associations of masturbation with partnered sexual behaviors among US adolescents

OBJECTIVE

To assess masturbation prevalence, frequency, and associations with partnered sexual behaviors.

DESIGN

Cross-sectional survey.

SETTING

The United States of America.

PARTICIPANTS

Nationally representative samples of adolescents aged 14 to 17 years.

MAIN OUTCOME MEASURES

Solo masturbation, partnered sexual behaviors, and condom use.

RESULTS

Across age groups, more males (73.8%) reported masturbation than females (48.1%). Among males, masturbation occurrence increased with age: at age 14 years, 62.6% of males reported at least 1 prior occurrence, whereas 80% of 17-year-old males reported ever having masturbated. Recent masturbation also increased with age in males: 67.6% of 17-year-olds reported masturbation in the past month, compared with 42.9% of 14-year-olds. In females, prior masturbation increased with age (58% at age 17 years compared with 43.3% at age 14 years), but recent masturbation did not. Masturbation was associated with numerous partnered sexual behaviors in both males and females. In males, masturbation was associated with condom use, but in females it was not.

CONCLUSIONS

Sexual development is a dynamic process during adolescence, and masturbation is an enduring component of sexuality. Fundamental differences appear to exist between male and female sexual expression. Health care providers should recognize that many teens masturbate and discuss masturbation with patients because masturbation is integral to normal sexual development.

Beliefs about women's vibrator use: results from a nationally representative probability survey in the United States

Women's vibrator use is common in the United States, although little is known about beliefs about its use. Elicitation surveys and interviews informed the development of a 10-item scale, the Beliefs About Women's Vibrator Use Scale, which was administered to a nationally representative probability sample of adults ages 18 to 60 years. Most women and men held high positive and low negative beliefs about women's vibrator use. Women with positive beliefs reported higher Female Sexual Function Index scores related to arousal, lubrication, orgasm, satisfaction, and pain (indicating less pain).

Association of lubricant use with women's sexual pleasure, sexual satisfaction, and genital symptoms: a prospective daily diary study

INTRODUCTION

Although lubricant use is commonly recommended to women for solo and partnered sexual activities, little is known about women's use of lubricant or their relationship to sexual pleasure and satisfaction.

AIM

The aim of this study was to assess: (i) how adult women used lubricant during partnered and solo sexual activities; (ii) relations between women's reports of sexual pleasure and satisfaction and their use of a lubricant during a particular sexual event; and (iii) to what extent lubricant use was associated with subsequent genital symptoms.

METHODS

A total of 2,453 women completed a 5-week internet-based, double-blind prospective daily diary study in which they were assigned to use one of six water- or silicone-based lubricants.

MAIN OUTCOME MEASURES

Baseline data included demographics, contraceptive use, and sexual behavior during the 4 weeks prior to study enrollment. Daily diary data included reports of penile-vaginal sex, penile-anal sex, solo sex, lubricant use, lubricant application, ratings of sexual pleasure and satisfaction, and genital symptoms.

RESULTS

Water-based lubricants were associated with fewer genital symptoms compared with silicone-based lubricants. In addition, the use of a water-based or silicone-based lubricant was associated with higher ratings of sexual pleasure and satisfaction for solo sex and penile-vaginal sex. Water-based lubricant use was associated with higher ratings of sexual pleasure and satisfaction for penile-anal sex as compared with no lubricant use.

CONCLUSION

The water- and silicone-based lubricants used in this study were associated with significantly higher reports of sexual pleasure and satisfaction and rarely associated with genital symptoms.

Field collection of rectal samples for sexually transmitted infection diagnostics among men who have sex with men

Rectal sexually transmitted infections (STIs) are common in men at risk for urethral infections with these pathogens, particularly men who have sex with men (MSM). However, for those individuals not regularly seen by a clinician, screening for rectal STI is not currently a widespread option. Qualitative data and samples (i.e. self-obtained rectal specimens) were collected from 75 MSM in a variety of venues. Upon completion of the rectal self-sampling, each participant completed a brief interview regarding their overall experience with the process. Participants reported an overall high level of acceptability and comfort-level involved with self-sampling for rectal STI. Of the majority of men who agreed to provide a rectal self-sample, all reported that they would provide a sample again in the future. However, many men also appreciated the interaction with a health-care provider that a clinical setting offered. In conclusion, self-sampling is a feasible and acceptable option when offered to MSM in a range of community-based venues. Further research is needed to determine which combinations of STI testing and treatment methods (including self-sampling) are most appropriate for diverse groups of men.

Patterns of condom acquisition by condom-using men in the United States

Condom-distribution programs have striven to make condoms more accessible to sexually active individuals, particularly adolescents and populations disproportionately affected by HIV and other STIs. Despite such programs, little is known about where condom-using men in the United States acquire their condoms. The purpose of this study was to document condom-access trends among a large sample of sexually active condom-using men in the United States. Data were collected from 1,832 men from all 50 U.S. states and the District of Columbia by using an Internet-based survey in which men provided details regarding the source of condoms that they had used within the past 30 days. Men reported acquiring their condoms from a variety of sources, including free condom-distribution programs (56.7%) and from venues where they had purchased condoms for themselves (75.7%). Bivariate analyses indicated that participants who reported using free condoms tended to be younger, self-identified as not heterosexual, or not currently in a monogamous relationship. Further, results indicated that those participants who accessed only free condoms did not differ from those who used only purchased condoms, indicating that perhaps efforts to make condoms more accessible through public health distribution campaigns are reaching a more general population of condom-using men than expected. Findings illustrate the importance of continuing free condom-distribution efforts but also suggest benefits of facilitating linkages between public health and a community's retail venues to increase access to the growing diversity of condoms in the marketplace.

Inside the ordering room: characteristics of women's in-home sex toy parties, facilitators and sexual communication

BACKGROUND

Previous research suggests that adult bookstores are a unique way through which individuals may learn about sexuality or practice sexual communication. Recently, the woman-oriented in-home sex toy party industry has rapidly expanded in several countries. The purpose of this study was to document the characteristics of the parties, the women who run the parties ('facilitators') and facilitator-consumer communication about sexual health topics.

METHODS

Female facilitators for a large in-home sex toy party company in the USA were invited to participate in an anonymous, cross-sectional online survey.

RESULTS

A total of 1197 completed surveys were received. Most respondents were white (85.2%), heterosexual (91.6%), had at least some college education (76.3%) and were married (59.4%). Most parties were held in another woman's home (88.3%), lasted 1-2 h (72.2%) and had 10 or fewer women in attendance (65.1%). At their most recent party facilitated, most respondents were asked questions about increasing desire/arousal (75.3%), orgasm (57.8%), desire discrepancy (56.4%), erection and ejaculation (73.8%), and vaginal dryness and lubrication (64.5%). Respondents who encountered sexual health questions or disclosures by consumers (those that were more 'askable') scored significantly higher on the Sexual Opinion Survey, indicating greater erotophilia.

CONCLUSIONS

Results suggest that female in-home sex toy party facilitators have the potential to provide a diverse group of women with opportunities to access sexuality information, products and communication and that facilitators' 'askability' is related to erotophilia. Implications for sexual health professionals are discussed.

Women's vibrator use in sexual partnerships: results from a nationally representative survey in the United States

Little is known about women's use of vibrators within sexual partnerships. Data were collected from a population-based, cross-sectional survey of 2056 women aged 18-60 years in the United States. Partnered vibrator use was common among heterosexual-, lesbian-, and bisexual-identified women. Most vibrator users indicated comfort using them with a partner and vibrator use was related to positive sexual function as measured by the Female Sexual Function Index (FSFI). In addition, partner knowledge and perceived liking of vibrator use was a significant predictor of sexual satisfaction for heterosexual women (p < .01). Clinical and research implications are discussed.

Penile dimensions and men's perceptions of condom fit and feel

OBJECTIVES

Sexual health professionals continue to promote correct and consistent condom use among sexually active individuals yet research indicates that some men remain resistant to using condoms because of perceptions that they do not fit properly or feel comfortable. This study empirically assessed relations between men's penile dimensions and their perceptions of condom fit and feel.

METHODS

Data related to demographics, a bivariate calculation of erect penile length and circumference, and perceptions of condom fit and feel were analysed from 1661 adult men from 50 US states

RESULTS

While many men reported that condoms generally fit fine and feel comfortable, at clearly identifiable intersections of length and circumference relations between penile dimensions and perceptions of condom fit and feel existed, particularly for those men who felt that condoms were "too long" (p<0.004), "too short" (p<0.001), "too loose" (p<0.047) or "too tight" (p<0.001).

CONCLUSIONS

These analyses provide empirical insights into the relations between bivariate penile dimensions (the intersection of length and circumference) and men's perceptions of the positive and negative aspects of condom fit and feel. Those men with the most negative perceptions of condom fit and feel may benefit from an assessment of their condom-related concerns as a component of community and clinic based STI prevention interventions in order to help them select from the variety of condoms in the marketplace that they may find to be better fitting or more comfortable.