Higher number of steps is related to lower endogenous progesterone but not estradiol levels in women

OBJECTIVES

Sex steroid hormones are important not only for reproduction but also for many aspects of women's health, including the risk of breast cancer. Physical activity has been shown to influence sex hormone levels in women. This study aimed to investigate a relationship between the average daily number of steps and the sex hormone (estradiol and progesterone) levels in premenopausal women.

MATERIALS AND METHODS

Data were collected from 85 healthy, urban women of reproductive age who performed at least 180 minutes/week of moderate physical activity for two complete menstrual cycles. Physical activity was measured using wrist bands. Estradiol and progesterone concentrations were measured in daily-collected saliva samples in the second menstrual cycle.

RESULTS

There was a significant negative association between the average number of steps taken daily and salivary progesterone levels after adjusting for potential confounding factors (age, BMI). Women who took more than 10,000 steps a day had significantly lower progesterone levels compared to women who took less than 10,000 steps. The association between physical activity and estradiol levels was statistically insignificant.

DISCUSSION

Our results indicate that taking at least 10,000 steps a day reduces progesterone levels, but this intensity of physical activity may not be high enough to affect estradiol levels. Daily step tracking is a valuable element of health promotion, but currently recommended levels of physical activity may not be high enough for healthy premenopausal women to significantly reduce both sex hormone levels and thus their risk of postmenopausal breast cancer.

Social support during pregnancy and the risk of postpartum depression in Polish women: A prospective study

Social support has been proposed as an important determinant of women's physical and emotional well-being during pregnancy and after childbirth. Our study aimed to examine the association between the risk of postpartum depression (PPD) and perceived social support during pregnancy. A web-based prospective study survey was conducted among Polish women. The level of social support was measured with the Berlin Social Support Scales during pregnancy. Four weeks after the birth the risk of PPD was assessed using the Edinburgh Postpartum Depression Scale. Data from 932 mothers aged 19-43 (mean 30.95; SD 3.83) were analyzed using multinomial logistic regression. Higher perceived available support (emotional and instrumental), currently received support (emotional, instrumental and informational), satisfaction with the support, and sum of score were all associated with lower risk of PPD, after controlling for selected covariates (woman's age, socioeconomic status, parity status, place of residency, education, child's Apgar score, type of delivery, complications during birth, kin assisting the labor, breastfeeding). Our results suggest that the more social support the pregnant woman receives, the lower is her risk of PPD. Since humans evolved as cooperative breeders, they are inherently reliant on social support to raise children and such allomaternal help could improve maternal well-being.

Hormonal Underpinnings of the Variation in Sexual Desire, Arousal and Activity Throughout the Menstrual Cycle - A Multifaceted Approach

Although prior evidence supports women's mating behaviors and preferences being related to ovarian hormonal levels, there is conflicting evidence about exactly which hormones predict sexual function best, which specific psychosexual facets are affected and how between-individual and within-individual differences relate to this question. In this study levels of estradiol and progesterone were measured (once daily for 15 days for each participant) for 97 women, who attended two testing sessions, in times of the cycle varying in conception probability (based on the luteinizing hormone (LH) test result). Women completed surveys on their sexual desire, arousal, sexual activity frequency and initiation. There was a significant difference between peri-ovulatory and luteal values for all sexual function variables. Between-subject progesterone negatively predicted sexual activity frequency only. Within-subject estradiol positively and progesterone negatively predicted sexual desire. The findings provide support for hormonal underpinnings of sexual desire and sexual activity frequency fluctuations during the menstrual cycle. The findings did not yield support for hormonal influences on sexual arousal and initiation of sexual encounters. The main findings are consistent with the excitatory and inhibitory effects of estradiol and progesterone, respectively, on measures of women's sexual motivation.

The diverse joys of sex and relationships in straight, gay, and bisexual Polish men

OBJECTIVES

The purpose of this study was to describe sexual orientations, intimate relationships, sexual behaviours, and pleasure in self-identified straight, gay, and bisexual men.

METHODS

The analysis drew on a database obtained from a cross-sectional online study of the sexuality of Polish straight (SM; N = 1,079), gay (GM; N = 1,704) and bisexual (BM; N = 713) men. This data was utilised to compare men from these three groups across their sexual orientations, intimate relationships and sexual behaviours, including the most pleasurable sexual activities.

RESULTS

In general, the sexualities of GM and BM seem to be more diverse and less oriented to particular sexual activities. Sexual minority men (SMM) tended to be more often in open (nonexclusive) relationships, had more diverse sexual experiences, and enjoyed a greater variety of sexual activities. This particularly concerned BM.

CONCLUSIONS

Present analysis revealed patterns and significant differences in sexual orientations, intimate relationships, sexual behaviours, and pleasure of SM, GM and BM. The results, pointing to a greater diversity of sexual expression and preferences in SMM, may both trigger reshaping of some of the stereotypical beliefs, as well as positively influence educational (sexual education, specialized teaching) and clinical practice (more accurate assessment of patients' needs and problems).

HIV pre-exposure prophylaxis (PrEP) for transgender and nonbinary persons. Literature review and guidelines for professionals

Transgender and nonbinary (TG/NB) persons are listed as one of the key populations in the context of HIV, due to increased risk of HIV infection in this group. HIV prevention, which includes a variety of available methods, should therefore be included in the comprehensive health care for TG/NB persons. One such method is the pre-exposure prophylaxis (PrEP), whose high effectiveness in preventing HIV transmission has already been demonstrated in numerous studies conducted in the cisgender population. However, the available empirical data on its use in TG/NB persons are limited in many respects. This issue is also practically absent in the Polish literature; as a consequence, there are significant gaps in recommendations for professionals involved i n the prevention of HIV among TG/NB persons and professionals involved in the comprehensive health care for TG/NB persons. This article 1) outlines the issue of the use of PrEP among TG/NB persons, including the associated challenges for professionals (specialising in physical, as well as mental health); 2) demonstrates the possible applicability of PrEP in TG/NB populations based on available research findings; 3) summarises good practices in counselling and PrEP-related psychoeducational activities, as part of the comprehensive health care for TG/NB individuals.

Erectile Problems in Polish Straight, Bisexual, and Gay Men: Does Sexual Identity Really Matter?

Erectile dysfunction (ED) is one of the most common sexual health diagnoses in men. Previous studies demonstrated that ED can be even more prevalent among sexual minority men. This study investigated whether sexual identity is related to erectile function (EF) and explored variables possibly contributing to the differences between Polish straight and sexual minority men. The study sample included 1,246 gay, 838 straight, and 535 bisexual men who participated in an online survey. First, the psychometric qualities of the IIEF-2-EF scale used in the study were examined through confirmatory and exploratory factor analysis; a correction to account for potential bias in the questionnaire was also applied. Next, a series of univariate and multivariable models accounting for predictors possibly contributing to the observed differences between the groups of men were conducted. It was demonstrated that gay and bisexual men were more likely to show poorer EF. However, as demonstrated in the subgroup of men who were in relationships, sexual identity lost its significance when the unique characteristics of minority men's sexuality (i.e., less focus on insertive penetrative sex in gay men and more frequent relational non-exclusivity in bisexual men) were controlled for. Erectile problems in minority men may benefit from clinical consideration in the unique context of their sexuality.

Professional Help-Seeking in Men Experiencing Sexual Problems - The Role of Sexual Identity and Minority Stress

BACKGROUND

Only a minority of men experiencing sexual problems will seek professional help and the proportion of gay or bisexual men can be even lower.

AIM

To investigate if sexual identity and minority stress are related to professional help-seeking in Polish gay and bisexual men.

METHODS

Sexual identity was measured with the standard question: "Do you consider yourself to be heterosexual, gay, or bisexual?" Men who provided a complete set of answers to the study tools and replied "yes" to the question: "Have you ever had a problem with sexual functioning that lasted at least several months?" were included (Ntotal =644, Nstraight = 203, Ngay = 324, Nbi = 117). A simple question on help-seeking was: "Did you seek professional assistance then?" Other data were gathered with the use of a self-constructed questionnaire. Minority stress processes, that is, internalized homophobia, expectations of rejection, and identity concealment, were measured with the subscales of the Sexual Minority Stress Scale. Bivariate analyses and multivariate logistic regressions were performed to test the statistical significance of sexual identity and minority stress processes as predictors of professional help-seeking.

OUTCOMES

Contacting a specialist when experiencing a sexual problem.

RESULTS

A total of 84.5% of all men did not seek professional help. Gay identity (OR = 0.58, P = .045), as opposed to bisexual identity, was significantly related to reduced odds of consulting a specialist. Age (OR = 1.03, P = .005), number of doctor's visits per year (OR = 1.51, P < .001), and a psychiatric diagnosis (OR = 1.65, P = .043) were positively related to help-seeking behaviors. Identity concealment significantly decreased the likelihood of consulting a specialist (OR = 0.94, P = .017).

CLINICAL TRANSLATION

Specialists need to be aware that gay identity and identity concealment may prevent a proportion of men from seeking their help and thus should be publicly explicit about their inclusive and nonpathologizing approach to sexual diversity.

STRENGTHS AND LIMITATIONS

The major strengths of the study include the use of a relatively large sample size and data from the little recognized Polish context characterized by a predominantly hostile anti-LGBT social climate, and exploration of a neglected topic of substantial significance at the public and individual levels. The major limitations are the use of nonprobability sampling, cross-sectional self-report design, and a single question to capture the presence of sexual problems with no measurement of associated distress.

CONCLUSION

Gay men are at risk of avoiding help-seeking when experiencing sexual problems because of identity concealment. Grabski B., Kasparek K., Koziara K., et al. Professional Help-Seeking in Men Experiencing Sexual Problems - The Role of Sexual Identity and Minority Stress. J Sex Med 2022;19:1090-1097.

Health determinants in men of the Bear subculture compared with the MSM population. Literature review

A number of health problems are more common in the population of men who have sex with men (MSM) as compared with the general population. At the same time, research reveals that the MSM population is far from homogeneous, and that subcultural affiliation is one of the characteristics that should be taken into account in health analyses of this group. One of the subcultures among MSM that has received growing interest from researchers in recent years, is the Bear community. It originated in the USA and comprises men - mostly homosexual or bisexual - who are characterized by larger, massive or muscular figure, and by distinctive male phenotypic traits - especially body hair pattern, including facial hair. The most significant health determinants in this group include a higher prevalence of behaviors contributing to negative health outcomes as compared with other MSM, elevated BMI values, as well as exposure to multiple stigma - both sexual minority and weight stigma. Research to date has shown that these characteristics of Bears have significant implications for their mental and sexual health. The article aims to review the literature, and to discuss the practical and the clinical implications of the studies conducted thus far in this population. The summary gives practical recommendations regarding both the support for Bear men in clinical practice, and the design of adequate and effective health promotion interventions for members of this unique community.

Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men

BACKGROUND

Research on pathways linking stigma with health inequalities affecting sexual minority populations, focused predominantly on exploring the hypothalamic-pituitary-adrenocortical (HPA) dysregulation profiles associated with chronic stress. One of such profiles reflecting a state of increased susceptibility to disease, and not yet studied among sexual minority individuals, is impaired habituation to repeated stress of the same type. In this study we explored whether sexual identity modulates endocrine stress responses and stress responses habituation in healthy heterosexual and gay men. We also explored the associations between perceived sexual minority stigma and cortisol response to stress in the latter group.

METHODS

Gay (N = 49) and heterosexual (N = 40) men, aged 24.4 years, were confronted twice with the Trier Social Stress Test and provided 5 salivary cortisol samples for each of the two testing sessions. A multilevel mixed-effects approach was used to model the cortisol curve throughout the two-day procedure. Habituation to repeated stress was conceptualized as the decrease in the total cortisol levels as well as the change in the cortisol curvilinearity between the first and the second testing session.

RESULTS

Gay participants were characterized by significantly higher cortisol levels throughout both laboratory visits. Their cortisol levels were also predicted by perceived rejection from family due to minority sexual identity, and stigma-related vicarious trauma. Although neither group showed habituation defined as the decrease in cortisol level, the shape of the cortisol curve changed between both visits only in the heterosexual participants.

CONCLUSIONS

Increased cortisol levels observed in gay men are predicted by minority stressors. Combined with non-habituation, the upregulation of the HPA axis may constitute a physiological pathway linking stigma to adverse health outcomes.

Recommendations of the Polish Sexological Society on medical care in transgender adults - position statement of the expert panel

Attempts at unifying the diagnostic and therapeutic procedures for transgender individuals experiencing gender dysphoria were first undertaken in Poland in the 1980s. Since then, there has been a change in the perception of transgenderism, almost paradigmatic, expressed in subsequent editions of the diagnostic systems (DSM, ICD), which is also associated with the fundamental changes in the principles of conducting trans-specific healthcare. This triggered the need to formulate recommendations for specialists practicing in Poland, which would at least partly reflect the evolution of views and guidelines on clinical care in transgender adults seeking help due to gender dysphoria.

Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature

BACKGROUND

The subject of gay and lesbian sexual health seems to be highly understudied, at least partially due to general limitations inherent in the studies of sexuality as well as heteronormative bias and difficulties in reaching out to these populations.

AIM

To critically review the studies on gay and lesbian sexual health in order to identify the existing gaps and biases in the scope and general construction of the published research.

METHODS

The dataset comprised 556 peer-reviewed articles identified through Medline search. Key studies characteristics were extracted according to the codebook developed for this study and analyzed descriptively.

OUTCOMES

The outcomes included: research methodology, study design, sampling, research topic and diversity inclusion in studied populations.

RESULTS

The majority of the studies were quantitative (70.5%), cross-sectional (83.6%) and used convenience sampling (83.2%). Most papers focused on HIV/STI risk behaviors, vulnerabilities and risk navigation (26.3%). The least often found topic captured the sexual function of gay and lesbian participants in older age (0.5%). Over 68% of papers relied on male samples and studies on female-only samples comprised less than 13%. Most studies did not recruit a specific age group (77.7%) and included information about ethnicity of study participants (62%). Information about education (58.7%) or other indicators of socioeconomic status (52.8%) was less often reported.

CLINICAL TRANSLATION

The methodological limitations of prevailing study designs, sampling procedures and the composition of samples, as well as extensive areas of omission confine the clinical utility of existing research.

STRENGTHS & LIMITATIONS

This study offers critical insights into the most significant challenges associated with studies on gay and lesbian sexual health. Medline-only database search, the inclusion of English-written papers exclusively and limited scope (gay and lesbian sexuality only) of the review constitute the most significant limitations.

CONCLUSIONS

Gay and lesbian sexual health is an understudied field characterized by primary focus on HIV/STI and paucity of higher quality research including diverse subpopulations. Mijas M, Grabski B, Blukacz M, et al. Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature. J Sex Med 2021;XXX:XXX-XXX.

Disgust Sensitivity Among Women During the COVID-19 Outbreak

The emotion of disgust is suggested to be an adaptation that evolved to keep us away from sources of infection. Therefore, individuals from populations with greater pathogen stress should have a greater disgust sensitivity. However, current evidence for a positive relationship between disgust sensitivity and the intensity of infectious diseases in the environment is limited. We tested whether disgust and contamination sensitivity changed in response to the COVID-19 pandemic. Disgust was assessed in 984 women in 2017 (before pandemic) and 633 women in 2020 (during pandemic) by a set of photographs depicting sources of infection and Pathogen and Moral of Three-Domain Disgust Scale. Further, contamination sensitivity among participants in two waves was measured by Contamination Obsessions and Washing Compulsions Subscale of Padua Inventory. State anxiety was measured with the Polish adaptation of the State-Trait Anxiety Inventory (STAI) only during the second wave of data collection. Women from the COVID-19 pandemic group assessed the photographs depicting sources of infection as more disgusting, scoring higher on Padua Inventory, but lower on Moral Disgust Domain as compared to women from before the pandemic. In addition, anxiety levels during pandemic positively correlated with scores from Pathogen Disgust Domain, Padua Inventory, and the ratings of the photographs. The participants of the study scored higher in state anxiety than the norms determined for the Polish population. Summarizing, we present evidence for differences in individual levels of disgust sensitivity in relation to pathogen stress, supporting the idea that disgust evolved to serve as protection from pathogens.

Cardiovascular Disease Risk in Bears and Other Gay Men: A Descriptive Study from Poland

A risk of cardiovascular disease (CVD) is increased by multiple factors including psychosocial stress and health behaviors. Sexual minority men who identify as Bears form a subculture distinguished by characteristics associated with increased CVD risk such as elevated stress and high body weight. However, none of the previous studies comprehensively investigated CVD risk in this population. Our study compared Bears (N = 31) with other gay men (N = 105) across a wide range of CVD risk factors. Logistic regression and analysis of covariance (ANCOVA) models were performed to compare both groups concerning behavioral (e.g., physical activity), medical (e.g., self-reported hypertension), and psychosocial (e.g., depressiveness) CVD risk factors. Bears were characterized by older age and higher body mass index (BMI) than the control group. We also observed higher resilience, self-esteem, as well as greater prevalence of self-reported hypertension, diabetes, and hypercholesterolemia in Bears. None of these differences remained statistically significant after adjusting for age and, in the case of self-reported diagnosis of diabetes, both age and BMI. Our study demonstrates that Bears are characterized by increased CVD risk associated predominantly with older age and higher BMI. Health promotion interventions addressed to this community should be tailored to Bears' subcultural norms and should encourage a healthier lifestyle instead of weight loss.

The character of sexual function of women who have sex with women

This paper will discuss the character of sexual relationships between women, considering their social and cultural context. The problem is still little known also to experts dealing with mental and sexual health. This may have serious consequences for the process of correct diagnosis of sexuality-related issues reported by those women. The article focuses on selected factors that have an impact on the character of this group's sexual function. Those factors include sex, heteronormativity and homophobia, as well as social messages related to female sexuality and sexual relationships established by women. The authors take up and subject to critical examination also the issue of "lesbian bed death" and fusion in same-sex relationships established by women. Towards the end, there is a holistic model by Heather L. Armstrong and Elke D. Reissing that describes sexual problems of women who have sexual contact with other women. The authors consider the issues brought up herein to be significant from the clinical point of view. Acknowledgement thereof by professionals dealing with mental and sexual health may contribute to extensive reflection over sexual and relationship problems of women who have sex with women, as well as to providing more efficient help to this group.

[Stage models of homosexual identity formation. Implications for therapeutic practice]

The authors discuss stage models of gay and lesbian identity formation first proposed during the 1970s within affirmative approaches to homosexuality. The process of developing homosexual identity is characterized here with linearly ordered stages distinguished around major developmental events leading to new self-definition. Among many stage proposals the authors have chosen and presented two: by Vivienne Cass and Susan McCarn with Ruth Fassinger. The presented models were analysed in terms of their usefulness in therapeutic practice aimed at promoting the formation of gay identity, for which they have been originally designed. An important part of this discussion is evaluation of the accuracy of developmental process descriptions contained in stage models.

[Mental health of homosexual and bisexual people--role of minority stress]

The results of the researches show that the prevalence of emotional problems among homosexual persons is higher in comparison with the general population. However, homosexual orientation should not be treated as a reason for that, which is stressed by the greatest associations of mental health, basing on research. The question of the causes of increased prevalence of mental disorders among members of the sexual minorities remains without a clear answer. The theory of minority stress seems to be a very interesting explanation. It integrates a variety of risk factors, which may influence the stress level. In the article we try to explain this concept, hoping that it will be useful in understanding the situation of homosexual people.

[Mental health of homosexual and bisexual people--review of research and presentation of phenomenon]

The issues of mental health and psychological well-being of sexual minorities have become one of the ponderable scientific questions in recent years. Not only do they attract the attention of psychiatrists, psychologists or sexologists, but also of public health professionals. It is because psychiatric disorders in sexual minorities are not only the source of individual suffering and dysfunction, but also a big and so far unappreciated social problem. The research results in this field were mostly unreliable in the past, because they were based on the false paradigm, assuming that homosexuality unquestionably belongs in the realms of psychopathology. This became a major selection bias in which researchers tried to draw conclusion upon the mental status of the hole population of homosexual people only from studies of clinical populations. New studies analyse the mental status of this relatively big social group implementing data from epidemiological population-based studies, which allows the more realistic assessment of the problem. In this work we presented new data indicating the elevated risk of psychiatric disorders within the sexual minorities. The problem was discussed in the context of living in the reluctant and hostile environment (minority stress exposure).