Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey

Objectives The aim of the European REVIVE survey was to achieve a better understanding of vulvovaginal atrophy (VVA), a chronic and progressive condition after menopause. We investigated perceptions, experiences and needs in terms of sexual and vaginal health in a sample of European postmenopausal women.

Methods An online internet based survey was conducted in Italy, Germany, Spain and the UK with a total surveyed sample of 3768 postmenopausal women (age: 45–75 years).

Results The most common VVA symptom was vaginal dryness (70%). VVA has a significant impact on the ability to be intimate (62%), to enjoy sexual intercourse (72%) and to feel sexual spontaneity (66%). Postmenopausal women with VVA are sexually active (51%), but their sexual drive is reduced. Health-care professionals (HCPs) have discussed VVA with postmenopausal women (62%), but they initiated the conversation only in 10% of the cases. The most common treatments for VVA are over-the-counter, non-hormonal, local vaginal products. Thirty-two per cent of postmenopausal women were naïve to any kind of treatment, whereas discussion with the HCP was relevant to be on current treatment (60% of postmenopausal women that discussed VVA with a HCP vs. 23% who did not). The top reasons for poor compliance with vaginal treatments were: not bothersome enough symptoms (18%); vaginal changes not therapeutically reversed (18%); relief from VVA symptoms (17%). Approximately 45% were satisfied with treatment. The most frequent disliked aspects of treatment were the route of administration or the messiness. The fear of hormones was common in postmenopausal women using vaginal prescription products.

Conclusions The European REVIVE survey confirmed that VVA symptoms are frequent in postmenopausal women and demonstrates a significant impact on quality of life and sexual life. However, the condition is still under-diagnosed and under-treated, with a high rate of dissatisfaction for actual available treatments in the four European countries surveyed. The discussion of symptoms with HCPs seems the most critical factor for diagnosis and treatment of VVA.

Two good reasons: women's and men's perspectives on dual contraceptive use

In the US, continued high rates of unintended pregnancy, combined with increases in heterosexual transmission of HIV to women, have sharply magnified concern about the factors leading to or barring the use of contraceptive methods to protect concurrently against both risks. This paper reports on results of focus group research among African-American women participating in a longitudinal study and African-American men who are either partners of the women or are of similar socio-economic status as their partners. We found a high level of agreement between men and women on the issues and problems that both sexes face. People felt that regardless of a woman's use of other contraceptive methods, a condom should always be used for protection. This belief, however, differed markedly from actual practice. Although we attempted to discern the relative salience of concern about pregnancy versus STIs, we conclude that people may not separate these two concerns in their resolve to use two methods. Furthermore, they recognized the need for dual protection, but expected conflict with their partners from using condoms as a second method because of high levels of distrust regarding sexual fidelity. Thus people are caught in a bind: distrust further increases the sense of a need for dual methods, but using condoms exacerbates the problems people have with achieving trust in relationships.

Physical sexual and intimate relationship concerns among Indonesian cervical cancer survivors: A phenomenological study

Cervical cancer often leads to sexuality and intimacy concerns for the affected woman within a marital relationship.This study aimed to explore physical sexual concerns and their impact on the intimate partner relationships experienced by cervical cancer survivors. Using a descriptive phenomenological approach, data were collected through in-depth interviews with Indonesian women survivors of cervical cancer. Two themes and five sub-themes were constructed from the thematic analysis. The first theme was the physical sexual concerns following cervical cancer treatment, with the subthemes: red spotting and massive vaginal discharge after having sexual intercourse; narrower, smaller and less lubricated vagina; pain during sexual intercourse; feeling of shortened vagina as if it had been cut. The second theme of impact of sexual concerns on intimate partner had five subthemes of: looking for reasons to refuse sexual intercourse; prejudice towards the spouse; feeling forced to fulfil husband's sexual needs; accepting spouse's anger; willingness to let the spouse marry another woman. The findings provide nurses with a greater understanding on how women adapt to their altered sexuality and intimacy with their partner following cancer treatments.

Gender, relationship dynamics and South African girls' vulnerability to sexual risk

South African researchers have stressed the importance of gender and relationship dynamics underlying sexual risk, particularly among 15- to 19-year-olds. Nevertheless, we know little about these factors among young girls, who are especially at risk of HIV. The main objective in this study was to explore the ways that young girls aged 16 to 17 years give meaning to boys and boyfriends and the processes through which these relationship dynamics are shaped. In-depth interviews were conducted with a group of black girls in a working class context in Durban about their sexual relationships with boys. Dominant gender norms underlined the ways in which girls discussed these sexual relationships in relation to their lack of power and condom use. Factors such as their class, race and gender interacted with girls' vulnerability to risk of HIV. While girls were complicit in their subordination, particularly in relation to cheating boyfriends, many were critical of boys who displayed patterns of sexual domination. Efforts aimed at reducing sexual risk must work toward shifting dominant patterns of masculinity over femininity to broaden pathways of love, trust, loyalty and understanding.

"My mother told me that I should not": a qualitative study exploring the restrictions placed on adolescent girls living with HIV in Zambia

Introduction

Adolescent girls in sub‐Saharan Africa are disproportionately affected by HIV due to a range of social and structural factors. As they transition to adulthood, they are recipients of increasing blame for HIV infection and ‘improper’ sex, as well as increasing scrutiny, restrictions and surveillance. This study used a qualitative and participatory approach to explore the messaging and restrictions imposed on adolescent girls living with HIV in Zambia.

Methods

Thirty‐four in‐depth interviews and four participatory workshops were carried out with 24 adolescent girls aged 15 to 19 years old living with HIV in Lusaka, Zambia. Key themes explored included experiences living with HIV, finding out about HIV status, disclosure, experiences with antiretroviral treatment, and support needs. Data were organized, coded and analysed using a grounded theory approach to thematic analysis. This analysis uses data on participants’ experiences of living with HIV and their interactions with their parents, guardians and healthcare providers.

Results

Family and healthcare providers, partly in a quest to protect both the health of adolescent girls living with HIV and also to protect them from blaming discourse, imposed restrictions on their behaviour around three main topics: don't disclose your HIV status, don't have sex, and don't miss your medicines. These restrictions were often delivered using tactics of fear, and usually disconnected from other options. Participants responded to these messages in several ways, including internalizing the messages, changing their behaviour either to comply with or resist the restrictions, by remaining silent and anxious when restrictions were broken, and developing concerns around their own health and sexual and reproductive aspirations. Participants also sometimes experiencing stigma when restrictions could not be maintained.

Conclusions

Restrictive messages were delivered to adolescent girls living with HIV through the broader social discourses of stigma, religion, and global and local narratives about HIV. Programmes aiming to support adolescent girls living with HIV need to work together with parents and healthcare providers to reflect on the impact of sanctioning messages, and to encourage more enabling and empowering messaging for adolescent girls living with HIV.

Bowel function and quality of life following surgery for deep endometriosis

OBJECTIVE

To assess the influence of surgical approach, complications and patient characteristics and their postoperative functional outcomes on (sexual) quality of life (QoL) in patients with deep endometriosis (DE) with bowel involvement.

METHODS

Retrospective cohort study on patients surgically treated for DE in a Dutch tertiary referral hospital. Data are based on surgical records and questionnaires covering current postoperative bowel function and (sexual) QoL.

RESULTS

Postoperative functional score outcomes: constipation, fecal incontinence and Low Anterior Resection Syndrome (LARS) did not differ between patients treated with rectal shaving or segmental resection. Thirty percent of women treated with rectal shaving experienced LARS-like symptoms as well. Women who underwent segmental resection had a worse sexual QoL compared to patients managed by shaving. Patients who suffered from complications had a worse postoperative QoL. A higher postoperative constipation score was correlated with a significantly higher pain score and a lower overall and sexual QoL. LARS-score was correlated with a worsened sexual QoL.

CONCLUSION

Women who underwent surgery for deep endometriosis rated their overall QoL as lower when a complication occurred. Segmental resection resulted in a lower sexual QoL compared to shaving. We showed that a higher LARS-score correlates with a lower sexual QOL, and postoperative constipation with more pain and a lower overall and sexual QoL. Interestingly, after using the shaving technique one-third of the patients experienced LARS-like symptoms as well.

Qualitative evaluation of selected social factors that impact sexual risk-taking behaviour among African students in Kwazulu-Natal, South Africa

BACKGROUND

The incidence of HIV and AIDS continues to be a source of great concern within universities in South Africa. Furthermore, university students constitute an important community in the intervention against the HIV/AIDS epidemic. Students in the age group of 15-24 years are at a greater risk of HIV infection than any other group in the country; yet, little is known about why they continue to engage in risky sexual practices.

OBJECTIVES

This study was designed to explore the sexual behaviour of students in a metropolitan Durban University of Technology in KwaZulu-Natal to understand the social factors underlying their risk of HIV infection.

METHODS

This is a qualitative study that used cluster sampling where the population was stratified by campus and faculty. The study population was selected using a standard randomization technique. This was a part of a multi-phased research project aimed at providing a sero-prevalence baseline and an analysis of risk-taking behaviour at a Durban University of Technology in the eThekwini Metropolitan Municipality area.

RESULTS

The study highlights peer pressure among students as an influence in promoting high-risk sexual behaviour. Within this context, the findings revealed that university students lack the ability to negotiate risk-aware decisions especially regarding sexual relationships.

CONCLUSION

This study draws attention to the perspectives of African university students regarding their risk-taking sexual practices and selected factors which influence such behaviour. The findings are not exhaustive in exploring contextual antecedents that shape students' sexual practices. However, they provide an important basis in understanding key factors which expose students to HIV infections. The study provides insights into opportunities for further studies as well as preventative implications.

The Cape Town boyfriend and the Joburg boyfriend: women's sexual partnerships and social networks in Khayelitsha, Cape Town

In South Africa, young people's "multiple" or "concurrent" partnerships have been increasingly prominent in public health discourses - as drivers of HIV transmission. Multiple partnerships are typically framed in moralising, negative terms and depicted primarily as male-driven, within a broader framework of women's vulnerability and use of sex for survival and material gain. Based on ethnographic fieldwork with adolescents and young adults in Khayelitsha township near Cape Town, this article investigates young women's partnerships by exploring their complex interpersonal and social dynamics. We unpack women's multiple motivations for, and careful management strategies of, both sexual and social relationships in a broader context of socioeconomic exclusion, threats to health and wellbeing, social obligations and relationships of care. The meanings and practices associated with young people's relationships are more than the sum of individual sexual behaviours, rigid cultural scripts or simply a locus of "risk." The data presented here highlight some of the limitations of "prevention" approaches that do not take into account this nuanced and multilayered view of such relationships. The affective and empathetic dimensions of young peoples' relationships, as well as the socioeconomic contexts in which they occur should also be considered. Without accounting for this context, standard "prevention" approaches are less likely to succeed.

Can a restrictive law serve a protective purpose? The impact of age-restrictive laws on young people's access to sexual and reproductive health services

This article explores the purpose, function and impact of legal restrictions imposed on children's and young people's involvement in sexual activity and their access to sexual and reproductive health services. Whilst there is no consensus on the age at which it is appropriate or acceptable for children and young people to start having sex, the existence of a minimum legal age for sexual consent is almost universal across national jurisdictions, and many states have imposed legal rules that place restrictions on children's and young people's independent access to health services, including sexual health services. The article draws on evidence and analysis from a recent study conducted by the International Planned Parenthood Federation in collaboration with the Coram Children's Legal Centre, UK, which involved a global mapping of laws in relation to sexual and reproductive rights, and exploratory qualitative research in the UK, El Salvador and Senegal amongst young people and health care providers. The article critically examines the social and cultural basis for these rules, arguing that the legal concept of child protection is often founded on gendered ideas about the appropriate boundaries of childhood knowledge and behaviour. It concludes that laws which restrict children's access to services may function to place children and young people at risk: denying them the ability to access essential information, advice and treatment.

Hemophilia and sexual health: results from the HERO and B-HERO-S studies

Background

Sexual health plays a primary role in quality of life (QoL) for many people, including those with hemophilia; however, there is little information available about sexual relationships and satisfaction in patients with hemophilia.

Methods

To address this issue, the Hemophilia Experiences, Results and Opportunities (HERO) and the Bridging Hemophilia B Experiences, Results and Opportunities into Solutions (B-HERO-S) studies included questions from the Male Sexual Health Questionnaire (MSHQ).

Results

Although these data were not statistically analyzed for comparisons between the 3 populations (HERO, HERO US only, and B-HERO-S), in general, participants in the HERO survey appeared to be more satisfied with their sexual relationship than participants in the B-HERO-S survey. In addition, many patients, especially those outside the United States, reported that they had not discussed sexual health with their doctor or other members of the hemophilia treatment center team. While the topic of sexual health has been infrequently explored in men with hemophilia, this is the first time it has been investigated in women with hemophilia.

Conclusion

The results of these studies demonstrate that the impact of hemophilia extends to intimacy and suggest the need for large-scale studies in additional countries to explore further the factors associated with sexual health issues in people with hemophilia.

Adolescent mothers' sexual, contraceptive, and emotional relationship content with the fathers of their children following a first diagnosis of sexually transmitted infection

PURPOSE

A sexually transmitted infection (STI) diagnosis may profoundly change the meaning of adolescent women's relationships, particularly when the relationship involves a shared child. This study explored the sexual, contraceptive, and emotional characteristics of sexual partners with whom adolescent women had and did not have children in the 3 months after the first STI diagnosis.

METHODS

Adolescent women (n = 387; age: 14-17 years at enrollment) were tested quarterly for STI and completed partner-specific items on emotional and sexual relationship content. We used nonparametric statistics (SPSS/18.0) to compare these characteristics between partners with whom these adolescent women did (n = 20) or did not (n = 118) share a child.

RESULTS

Rates of condom use at last sex, overall condom use, and condom insistence were lower with sexual partners involving shared children as compared with childless sexual partners. Relationship status, commitment to partner, and using no method of contraception were more common in parous sexual relationships as compared with nulliparous sexual relationships after an STI.

CONCLUSIONS

After an STI, adolescent women have different sexual risk behaviors with the fathers of their children, even after a signal event such as a recent STI diagnosis. Tailored counseling may specifically address the challenges of STI prevention with partners who have the unique status of being the "father of the baby."

Symptoms, attitudes and treatment perceptions of vulvo-vaginal atrophy in UK postmenopausal women: Results from the REVIVE-EU study

OBJECTIVES

To describe the attitudes and perceptions of postmenopausal women from the United Kingdom regarding menopause, vulvo-vaginal atrophy and its therapeutic management.

STUDY DESIGN

Post hoc analysis of the United Kingdom population from the REVIVE-EU Study.

MAIN OUTCOME MEASURES

The survey contained questions about women's knowledge of menopause and vulvo-vaginal atrophy symptoms, impact on their life and sexual activities, communication with healthcare professionals and treatments.

RESULTS

The most frequent symptom of menopause was hot flushes (75%). Vulvo-vaginal atrophy symptoms had a significant impact on participants' ability to enjoy sexual intercourse (66%), spontaneity (62%) and ability to be intimate (61%); however, only 68% of women had been to their healthcare professional for advice. Half of the sample expected that doctors would initiate a discussion of menopausal symptoms and sexual health, but was in fact rare (5%). Only 27% were under current treatment without a clear therapy pattern, of which 43% used vaginal over-the-counter treatments, 28% prescription (Rx), and 13% both. Efficacy was the main limitation for over-the-counter treatments, while for Rx products were side effects and safety. Women highlighted the restoring of the natural condition of the vagina as the main goal for a treatment (35%). Many United Kingdom women did not feel the need to see any healthcare professional for their gynaecological symptoms. Overall satisfaction with treatment was only 44%.

CONCLUSIONS

Vulvo-vaginal atrophy remains underdiagnosed and undertreated in United Kingdom. There is a lack of coherent discussion about vulvo-vaginal atrophy symptoms with clinicians. Many United Kingdom healthcare professionals could improve proactive communication with patients about vulvo-vaginal atrophy.

Being dragged into adulthood? Young people's agency concerning sex, relationships and marriage in Malawi, Mozambique and Zambia

This study aimed to explore how young people exercise agency in rural Malawi, Mozambique and Zambia in relation to sex, relationships and marriage, to inform local programmes aiming to prevent teenage pregnancy and child marriage. In each country, focus group discussions with young people and parents, in-depth interviews with young people and a variety of other participants, and a household survey with young people (15-24 years) were conducted. We found that (child) marriage was often a response to teenage pregnancy, which was highly prevalent in all study areas. Young people's aspirations to enter adulthood were influenced by their life circumstances. Initiation ceremonies symbolised the transition to adulthood and gave social endorsement to young people to start engaging in (often unprotected) sexual activity. Given the uncertain socio-economic context, resource constraints led families to marry off their daughters; or girls themselves to marry early to relieve the burden on their families, but also to get pregnant as a 'next step' towards adulthood. Transactional sex was common. These intersecting cultural, social and economic contextual factors constrained young women's agency, more as compared to young men. However, young women did manoeuvre within contextual constraints to exercise a degree of agency.

Association between condom use and perspectives on contraceptive responsibility in different sexual relationships among sexually active college students in China: A cross-sectional study

China has increasing incidence of unplanned pregnancies among college students these years. Increasing students' sense of responsibility to protect sexual partners may help reduce the rate of unplanned pregnancies.A self-administered questionnaire was distributed to students from 3 colleges in Sichuan, China. Among them, 559 of male students and 267 of female students were included in this study. The questionnaire collected participants' characteristics, usage of condom, and investigated male and female students' perceptions of who should be responsible for contraception use.We found that relationship status was closely related to students perceiving responsibility for reproductive health and condom using. Male students who were in casual relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other male students (P < .001). Female students who were in steady relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other female students (P = .007). The multivariate analysis revealed condom use was associated with greater odds of sharing responsibility for contraceptive use in different types of sexual relationships.Improving students' attitudes toward responsibility for contraception may increase condom use among students at risk for unplanned pregnancies. Programs providing targeted health education and services may help reduce the rate of unplanned pregnancies among students in China.

Macro-regional variation in attitudes toward and experiences of vulvar and vaginal atrophy among Italian post-menopausal women: a post hoc analysis of REVIVE survey data

Italian participants in the European REVIVE survey reported that vaginal and vulvar atrophy (VVA) impaired various aspects of their lives, notably the ability to enjoy sex. The aim of the present study was to explore regional differences in knowledge, experiences, and treatment of VVA in the Italian REVIVE sample (n = 1000), which was analyzed according to region of residence. While many respondents were unfamiliar with the VVA condition, most could relate their VVA symptoms to the menopause. The rate of diagnosis of VVA was twice as high in Central Italy as in the North-East. For individual VVA symptoms, 25.4-41.6% of respondents judged that the symptom had worsened over time. There were no significant regional differences for symptoms in terms of reported rate, change in severity, impact on sexual activity, or health-care visits. Testosterone cream and OTC medication based on hyaluronic acid showed significant regional differences in lifetime rates of use. In Italy, there are modest regional differences in knowledge, diagnosis, and treatment of VVA, some of which may be explained by inter-regional differences in health care. Further efforts are needed to ensure that Italian women are properly informed about VVA and have access to appropriate health care and treatments.

Dangerous girls and cheating boys: Zulu-speaking disabled young peoples' constructs of heterosexual relationships in Kwazulu-Natal, South Africa

Across South Africa there is a growing body of work that explores gender dynamics in heterosexual relationships between young people aged 15-24 years. This is mainly influenced by the high prevalence of HIV and the incidence of intimate partner violence in this age group. Most studies to date have been based upon non-disabled young people, with limited focus on young disabled people. In an attempt to address this gap, this paper describes findings from a study conducted with 22 Zulu-speaking young people with visual and physical disabilities in KwaZulu-Natal. Throughout the findings, young disabled participants appeared to downplay their disability with respect to intimate relationships and accentuated the interweaving of complementary and contentious discourses of gender and cultural identity. Taking cognisance of the intersectionality of gender and cultural discourses, the paper extend constructs of disabled sexualities beyond an exclusive gaze on disability in the South African context.

The Empire of Affectivity: Qualitative Evidence of the Subjective Orgasm Experience

The subjective orgasm experience (SOE) refers to its perception and/or assessment from a psychological viewpoint. Few works have approached this construct from a qualitative perspective and have never taken a consolidated theoretical model as a reference. This study aims to provide qualitative validity evidence to the Multidimensional Model of Subjective Orgasmic Experience, derived from the Orgasm Rating Scale (ORS), to qualitatively address SOE in the contexts of sexual relationships and solitary masturbation, analyzing the terms self-generated by individuals and examining the coincidence with the semantic descriptions of orgasm proposed by the ORS. Four hundred Spanish adults aged 18 to 64 years participated. The Technique of Free Association of Words was applied, and prototypical, frequency, and similitude analyses were performed. A similar description was observed concerning the terms generated in both contexts, with a higher frequency and intensity in the context of sexual relationships. In the context of solitary masturbation, negative orgasmic descriptions were evoked. Participants were able to elicit the vast majority of ORS adjectives, with Affective being the most notable dimension, followed closely by Rewards, especially in masturbation. Most of the adjectives were evoked simultaneously with those of the Affective, with "pleasurable" standing out as the most predominant one. This work provides qualitative evidence to the SOE study, ratifying the semantic composition of the ORS and thus endorsing the Multidimensional Model of Subjective Orgasmic Experience as a good theoretical model from which to continue studying the subjective orgasmic experience.

'I'm in love with an older man': reasons for intergenerational sexual relationships among young women in South Africa

The literature on intergenerational sexual relationships in Africa focuses predominantly on economic motivations. This paper aims to identify the common reasons for older male sexual partners among young women in South Africa. Data for the study came from the Fourth South African National HIV, Behaviour and Health Survey 2012. A representative sample of 620 young women (15-24 years old) with older male sexual partners was extracted. A multiple logistic regression analysis was conducted to adjust for potential confounders. The authors found that more than a quarter of sexually active young women engaged in age-disparate relationships. The majority of the respondents did not see age as an important factor, while financial support ranked fourth in the list of reasons for having older partners. Women who were 20-24 years old (AOR 1.16, CI: 0.59287-1.87493), divorced, separated or widowed (AOR 1.38, CI: 0.65360-1.92105) and who were students or learners (AOR 1.85, CI: 0.41943-1.29402) were more likely to have an older partner for financial reasons. Thus, financial motivations are not the predominant reason for age-disparate relationships; instead, other reasons including age not being important and feeling secure were more cited. Not all young women in South Africa are seeking financial assistance from older sexual partners.

Negotiating HIV and pregnancy prevention and sexual pleasure amongst heterosexual men and women in South Africa

Heterosexual sex, foremost its gender-power dynamics, is embedded in and informed by the socio-historical context in which it occurs. While safer sexual communication skills are well documented as key to the success of sexual and reproductive health programming and education, communication skills about the positive aspects of sexuality such as sexual pleasure are often limited if not absent. Using data from in-depth qualitative interviews with men and women aged 26-39 from a diverse set of backgrounds in Cape Town, South Africa, this study examines the ways in which gender-power dynamics manifest in negotiations of HIV and pregnancy prevention and sexual pleasure in the intimate spaces of heterosex. Findings fall under three themes: 1) condom negotiation as a replacement for other aspects of sexual communication; 2) self-efficacy in negotiating prevention and negotiating one's own sexual pleasure; and 3) the integral role men play in heterosexual encounters in the facilitation of women's sexual autonomy and women's sexual pleasure. This study contributes to research not only examining the positive and more nuanced realities of heterosex in the South African context, but also argues for the need to integrate positive aspects of sexuality into sexual and reproductive health programming in general.

Danger and sexuality: exploring negotiations in romantic and sexual relationships among university students in Ghana

Gender inequalities and social mores normalise gender-based violence in many settings. The goal of this study was to gain a more in-depth understanding of romantic and sexual relationships, consent, and gender-based violence among university students in Ghana. We used focus group discussions to explore individual factors influencing romantic and sexual relationships among students enrolled at a university in the Central Region of the country to inform the development and tailoring of future interventions. During a series of four focus group discussions comprising students recruited via convenience and snowball sampling, participants were asked to reflect on the nature of their romantic and sexual relationships. Demographic data and experiences of gender-based violence were also collected. The focus groups discussions were recorded and transcribed verbatim and analysed thematically. Five themes were developed from the data: (1) traditional gender roles; (2) self-control; (3) relationship-based consent; (4) cheating; and (5) non-verbal communication. This study suggests negative health and social ramifications of violence will continue until there is a resolution of conflicting social norms that result in different expectations about how men and women can address their sexual needs. Future programming and interventions for gender-based violence prevention should reflect on their impact across all ecological levels.

Relationship impacts of the COVID-19 pandemic and lockdown restrictions on young women and men in Durban and Soweto, South Africa

To deepen our understanding of the impact of the COVID-19 pandemic on intimate and/or sexual relationships, we conducted a qualitative study among 26 South African women and men aged 21-30 years in Durban and Soweto between September 2020 and March 2021. Overall, 13 women and 12 men who had been in an intimate and/or sexual relationship since the start of the COVID-19 pandemic were asked about the impact of COVID-19 on their relationships with their current or most recent primary partners. Data were analysed using reflexive thematic analysis. The three most common impacts of the COVID-19 pandemic on relationships were on (i) communication and connection; (ii) strained relationships; and (iii) job and economic loss. Both women and men discussed how COVID-19-related lockdowns provided opportunities to foster better communication, connection and support to one another. However, too little or too much time together strained relationships. Finally, income loss among young men meant that some young women became the primary income earner, changing relationship power dynamics. Findings highlight the importance of young people's relationships and the need for action to support young people in building positive relationships in challenging times.

Relationship between Solitary Masturbation and Sexual Satisfaction: A Systematic Review

Masturbation is a healthy sexual behavior associated with different sexual functioning dimensions, which highlights sexual satisfaction as an important manifestation of sexual wellbeing. This review aims to systematically examine studies that have associated masturbation with sexual satisfaction, both in individuals with and without a partner. Following the PRISMA statement, searches were made in the APA PsycInfo, Medline, Scopus, and Web of Science databases. The search yielded 851 records, and twenty-two articles that examined the relation between solitary masturbation and sexual satisfaction were selected. In men, a negative relation between masturbation and sexual satisfaction was observed in 71.4% of the studies, 21.4% found no such relation, and 7.2% observed a positive association. In women, 40% reported no relation, 33.3% a negative relation, and 26.7% a positive one. The negative association between solitary masturbation and sexual satisfaction is consistent with the previously proposed compensatory role of masturbation, especially for men. In women, compared to men, the complementary role of masturbation in relation to sexual relationships is observed to a greater extent and is associated more closely with sexual health. The importance of including different parameters beyond the masturbation frequency in future studies to explore its relation with sexual satisfaction is emphasized. This systematic review is registered in PROSPERO (CRD42023416688).

Crossing the line: sexual boundary violations by physicians

In this edition of The Interface, we review the literature related to sexual boundary violations by physicians. This literature consists of data from both disciplinary boards/agencies and anonymous surveys of physicians. Our findings indicate that disciplinary actions far under-represent the actual prevalence of self-reported physician boundary violations of patients. However, both prevalence rates represent a very small minority of practitioners. According to these findings, most self-reported boundary violations entail male physicians who are predominantly in the areas of family medicine, psychiatry, and obstetrics/gynecology.

A comparative study of sexual behavior, dysfunction, satisfaction, relationship, and sexual quality of life amongst treatment-naïve and abstinent men (buprenorphine-maintained) with Opioid (heroin) dependence syndrome

BACKGROUND

Association between opioid use and sexual functioning is well-known. However, data evaluating the influence of treatment on different aspects of sexuality are lacking.

AIM

To compare sexual behavior, functioning, relationship, satisfaction, and sexual quality of life (sQoL) among treatment naïve patients (GROUP-I) with Opioid (heroin) dependence syndrome (ODS-H) with those maintained on buprenorphine (GROUP-II).

METHODS

Married adult males diagnosed with ODS-H, currently sexually active, and living with their partner were recruited. They were assessed for their sexual practices and high-risk sexual behavior (HRSB) through a semi-structured questionnaire and sexual functioning, relationships, satisfaction, and sQoL through structured questionnaires.

RESULTS

A total of 112 individuals (GROUP-I: 63; GROUP-II: 49) were recruited from the outpatient settings. Mean age and employment in GROUP-II were higher (p < 0.05) than in GROUP-I (37 vs 32 years; 94% vs 70%, respectively). Other sociodemographic variables and the age of onset of heroin use were comparable. The current practice of HRSB (e.g., engaging in casual partner sex, sex with commercial sex workers, and sex under intoxication) was higher in GROUP-I while almost no differences were seen in lifetime HRSB. The frequency of erectile dysfunction and premature ejaculation in the two groups were: 78% vs 39% (p < 0.001), and 30% vs 6% (p = 0.001), respectively. GROUP-II had significantly higher scores in all the scales (p < 0.05) as compared to GROUP-I, indicating better sexual satisfaction, quality of life, and sexual relationship.

CONCLUSION

Heroin use is associated with HRSB, poorer sexual functioning, overall satisfaction, and sQoL. Maintenance of Buprenorphine helps with improvement in all these parameters. Comprehensive management for substance use should target sexual problems as well.

Dissolution of transactional sex relationships during COVID-19: a qualitative study of Ugandan men's experiences during COVID-19 lockdowns

The COVID-19 pandemic and subsequent mitigation measures led to social disruption and negative economic shocks for a large proportion of Uganda's population. The social and economic consequences of COVID-19 on Ugandan men's sexual behaviours, including transactional sex relationships, are unclear. We conducted in-depth interviews between November 2021-February 2022 with 26 men in a high HIV prevalence region of Uganda. Data were analysed thematically to understand how sexual relationships, including transactional sex, were impacted by COVID-19. We found that COVID-19 mitigation measures had far-reaching social and economic impacts on most respondents, particularly those employed in the informal economy. Men described experiencing job loss, food insecurity and restricted mobility, which limited opportunities to provide for and meet with transactional sex partners. Inability to provide financial resources meant that men could not form new transactional sex relationships and men who could no longer provide for their existing transactional sex partners consistently reported relationship dissolution. Men who reported stable employment during the pandemic described few changes in transactional sex relationships. Similarly, men in non-transactional relationships did not report relationship dissolution despite decreased financial provision. Further research should assess the potential short- and long-term impacts of COVID-19 mitigation measures on transactional sex relationships.