What Do Danish Youth Want to Know About Sex? Twenty Years of Telephone Counseling on Sexual and Reproductive Issues

Young people's need for sexual counseling is well documented, and both website and hotline-based services have been established as means of health promotion in this field. Such measures, however, are rarely evaluated, so this article offers data from the world's presumably oldest sexuality helpline aimed at young people. With an observation time of two decades and a total of 42,325 questions asked, the study provides a unique glance into the sexual landscapes of Danish youth. It shows an overall male predominance among callers and reveals that the counseling themes change over time and differ between both age groups and genders. The article suggests that telephone counseling-although more resource demanding than online alternatives-provides a secure, anonymous, and dialogue-based arena for discussing delicate sexual issues and therefore may constitute a viable supplement to web-based media for young people with the need to talk rather than just chat.

Sexual rehabilitation of women with a spinal cord injury

STUDY DESIGN

Literature review and a qualitative study.

OBJECTIVE

This article reviews literature examining the sexual rehabilitation of women following spinal cord injury (SCI). It includes recommendations for improvements in initial clinical rehabilitation efforts and counselling services.

SETTING

United Kingdom, Denmark and Sweden.

METHODS

Articles concerning sexual rehabilitation following SCI from the last two decades have been reviewed and critiqued. Qualitative results from discussions with women with SCI in Denmark and Sweden are presented.

RESULTS

The literature focuses on the effect of neurological change on women's ability to achieve sexual arousal and orgasm. Urinary and bowel incontinence, spasticity, vaginal lubrication and autonomic dysreflexia are the physical consequences of SCI that appear to have most impact on sexual activity. More recent studies have acknowledged that psychosocial factors such as age and partnership status may also affect the successful sexual rehabilitation. Discussions with women with SCI in Denmark and Sweden on their reactions to information and counselling offered during rehabilitation revealed an overwhelming need for the exchange of information and experience with other women with SCI, and a desire for opportunities for counselling after initial rehabilitation.

CONCLUSION

Successful sexual rehabilitation of women with SCI demands a holistic approach that considers individual neurological, physical and psychosocial circumstances. Peer-counselling could make a significant contribution to the sexual rehabilitation of women with SCI.

Integrating medication, realistic expectations, and therapeutic interventions in the treatment of male sexual dysfunction

Male sexuality in adolescence and early adulthood is characterized by autonomous, predictable erections. As males age, however, their arousal becomes less predictable and more dependent on partner interaction. This transition can produce anxiety. Many males view this change as a medical dysfunction requiring pharmacologic treatment or specialist intervention. New medical interventions, including Viagra, have been developed promising to return males to their automatic erections. A medical approach, however, fails to address the multidimensional nature of male sexuality and reinforces sex as intercourse performance. This article outlines a biopsychosocial approach to the assessment, treatment, and relapse prevention of male sexual dysfunction.

Youth, sexuality and sex education messages in Indonesia: issues of desire and control

Since the 1994 International Conference on Population and Development, the need for sexuality education for youth has been articulated, and numerous activities in Indonesia, especially Java, have been directed at young people. However, many parents, teachers and religious leaders have considered it essential that such education should suppress youth sexuality. This article reflects upon current discourses on youth sexuality in Java as against the actual sexual behaviour of young people. Using examples from popular magazines and educational publications, and focus group discussions with young men and women in Surabaya, East Java, we argue that the dominant prohibitive discourse in Java denounces youth sexuality as unhealthy, reinforced through intimidation about the dangers of sex. In contrast, a discourse of competence and citizenship would more adequately reflect the actual sexual behaviour of youth, and raises new challenges for sexuality education. Information should be available to youth concerning different sexualities, respecting the spectrum of diversity. Popular youth media have an especially important role to play in this. The means to stay healthy and be responsible--contraceptives and condoms--should be available at sites where youth feel comfortable about accessing them. Meanwhile, young Indonesians are engaging in different forms of sexual relationships and finding their own sources of information, independent of government, religion and international organisations.

“Peer” Educator Initiatives for Adolescent Reproductive Health Projects in Indonesia

Since the ICPD in 1994, the Government of Indonesia has struggled with the challenge of providing sexual and reproductive health education to adolescents. Following an attempt at a family-centred approach, a pilot project was carried out in Central and East Java to train peer educators, coordinated by the National Family Planning Coordinating Board (BKKBN). A total of 80 peer educators (male/female teams) carried out small-group information sessions in ten different districts. Over 1,300 adolescents attended in all. Forty peer counsellors in 20 teams then carried out five outreach sessions each in their communities, attended by nearly 4,000 adults and adolescents. Educators chosen were older in age, knowledge level, authority and communication skills than adolescents, but were well accepted as mentors. Adolescents wanted to know how to deal with sexual relationships and feelings, unwanted pregnancy and STDs. With 42 million Indonesian adolescents needing information, the government cannot produce enough manuals to satisfy demand. New strategies are required to put information in the public domain, e.g. via the media. The approach described in this paper would probably be beyond the staffing and resource capacity of most districts in Indonesia. Nonetheless, it shows that there was great enthusiasm across a variety of communities for efforts to educate young people on protecting their reproductive health.

Innovations in adolescent reproductive and sexual health education in Santiago de Chile: effects of physician leadership and direct service

Reproductive and sexual health (RSH) education is a key component of most family planning programs around the world and is particularly important for adolescents, for whom parenthood is more likely to have difficult or dangerous health outcomes. A lack of comprehensive RSH education targeted at adolescents may augment the poor outcomes associated with early pregnancy by creating barriers to optimal care. This article discusses the creation of the Centro de Medicina Reproductiva y Desarrollo Integral de la Adolescencia clinic, a comprehensive adolescent reproductive health center in Santiago de Chile, and its RSH education programs. In particular, the role of the physician in originating and leading the RSH education efforts, the controversy associated with RSH education in Chile, and the effects of comprehensive RHS education on the local and regional adolescent populations are discussed.

[Sexuality of women living with HIV/AIDS in São Paulo]

The social and cultural setting which increases female vulnerability to HIV does not disappear when women living with HIV/AIDS discover that they are infected. Following diagnosis, new challenges arise in their emotional lives, an issue which has received little attention in the literature. This study interviewed 1068 women living with HIV/AIDS using a questionnaire consisting of both open and closed questions, aimed at describing aspects of their sexual and reproductive lives and how they perceive counseling at Reference Centers in two cities in the State of São Paulo, where they have access to free antiretroviral therapy. Of the women with stable sexual partners, 63% used condoms in all their sexual relations, or three times the national average; 43% of the partners were HIV-negative and 14% had unknown serological status; 73% of the women had children and 15% were considering becoming pregnant. Knowledge on mother-to-child transmission was less than expected, and the interviewees complained of limited space and receptiveness for discussing sexuality, especially with regard to their childbearing wishes. Counseling on sexuality should be a continuing process and requires interdisciplinary training for the professional team working in health care services, with an emphasis on sexual and reproductive rights.

A pilot study of AIDS education and counseling of high-risk adolescents in an office setting

Little is known about interventions in office practices aimed toward reducing behaviors that put adolescents at risk for human immunodeficiency virus (HIV) acquisition. We therefore targeted a pilot study of HIV education and counseling to high-risk adolescents. Ninety adolescent patients (mean age, 17.6 +/- 2.0 years) were interviewed in a hospital-based adolescent clinic by two physicians and randomized to two groups: 1) a standard care group that was interviewed about high-risk behaviors at 0 and 2 months; and 2) an intervention group that was similarly interviewed but was also given a detailed discussion about HIV risks and prevention. At follow-up (mean, 2.6 +/- 0.8 months), 25% of patients reported less sexual activity (standard care, 32%; intervention, 18%) toward a trend. The reduction in mean number of partners per month was 0.4 +/- 0.9, (p = 0.0001). Fifty-four percent of the patients reported that they used condoms more often than previously with no significant difference between the two groups. Use of condoms ("always use") increased in both groups significantly (p = 0.03 standard care, p = 0.02 intervention). Use of condoms at last intercourse increased in the intervention group (37% to 42%, p = 0.03). In the interval, there were no significant differences between the groups in the number of newly diagnosed sexually transmitted diseases or in the number of patients seeking HIV testing. The number of patients stating that they shared needles decreased from 3 to 0. Both the intervention and standard care groups reported a reduction in high-risk behaviors that was temporally related to the discussion of this subject in the clinic.(ABSTRACT TRUNCATED AT 250 WORDS)

Men's disclosure of HIV test results to male primary sex partners

We evaluated disclosure of human immunodeficiency virus (HIV) antibody status to a main sex partner and the impact on the relationship in men who have sex with men and who are enrolled in the Acquired Immunodeficiency Syndrome (AIDS) Community Demonstration Projects cohorts. Eighty-nine percent of both seronegative and seropositive men disclosed the results to their main sex partner. Seventy percent of the seronegative men and 82% of the seropositive men who did so reported that the relationship remained "as strong as ever" after 6 months. Most men who did not disclose their test results to their main partner reported being "single" after 6 months.

Sex therapy: the successes, the failures, the future

Sexual dissatisfaction or dysfunction occurs in one fifth to one third of the adult population. Although great advances have been made in the pharmacological treatment of impotence, psychological and relationship therapy remain the mainstay of the treatment of sexual problems within relationships.

Condom use in anal intercourse amongst people who identify as homosexual, heterosexual or bisexual

AIMS

to study condom use amongst those who practice anal intercourse.

METHODS

a sample of 814 clients attending anonymously for pretest counselling for HIV infection at the Burnett Clinic, Auckland, gave detailed information about their sexual behaviour.

RESULTS

insertive or receptive anal intercourse was reported in 39% of clients. This included 89% among homosexual men, 78% among bisexual men, 17% among heterosexual men and 21% among heterosexual women. In those practising anal intercourse concomitant condom use was reported by 71% of homosexual men, 53% of bisexual men, 16% of heterosexual men and 7% of heterosexual women. Those most likely to use condoms were homosexual men, prostitutes, those with multiple partners and those with an HIV infected partner. Those least likely to use condoms were heterosexual men or women.

CONCLUSIONS

whilst substantial changes in sexual practices appear to have been made in the homosexual community, heterosexuals practising anal intercourse have made few such changes. More explicit AIDS education may be necessary which acknowledges that anal intercourse is practised by heterosexuals and advises condom use accordingly.

Erectile dysfunction in Singapore men: presentation, diagnosis, treatment and results

Three hundred and thirteen new cases were seen in more than two years at the Sexual Dysfunction Clinic at the Division of Urology, Toa Payoh Hospital (TPH). Patients were assessed by history, clinical examination, psychological evaluation, hormonal and biochemical tests; special investigations such as monitoring of nocturnal penile tumescence, cavernosography, selective pudendal arteriography and tests of neurological function were performed where indicated. Two hundred and twenty-seven patients (72.5%) had impotence due to organic causes while 86 patients (27.5%) were found to have psychogenic impotence. Diabetes mellitus and vascular disease account for the large proportion of organic impotence (81%). Patients with psychogenic impotence responded fairly well to psychosexual therapy and drug treatment in certain cases. Forty-four patients underwent medical therapy which consisted mainly of pharmacologically induced penile erections by the use of papaverine, phentolamine or prostaglandin E-1; 21 patients (48%) who were on self-injection therapy became non-compliant subsequently. One hundred and fourteen andropausal patients with low testosterone levels received hormonal replacement. Thirty-one patients underwent surgery--stripping and ligation of the deep dorsal vein of the penis (13 patients), microsurgical arterial revascularisation (two patients) and penile prosthetic implantation (16 patients). Our success rates for the operations were 54%, 100% and 88% respectively.

Condom use in multi-ethnic neighborhoods of San Francisco: the population-based AMEN (AIDS in Multi-Ethnic Neighborhoods) Study

We examined the prevalence and correlates of condom use in a community-based sample of unmarried heterosexual and gay/bisexual Whites, Blacks, and Hispanics (aged 20 to 44 years) in San Francisco (n = 1229). Only 9% of heterosexual males reported always using condoms, and fewer of those with multiple sexual partners (6%) reported always using condoms compared with those in monogamous relationships (12%). Much higher proportions of gay/bisexual men reported always using condoms (48%). Racial differences in condom use were observed only among women. Sexual communication and the sexual enjoyment value of condoms were consistent correlates of condom use across gender and sexual orientation, while other condom-related beliefs were significant predictors of condom use only for men. In general, condom promotion programs should build sexual communication skills, teach people how to enhance enjoyment with condoms, and reduce psychological barriers to condom acquisition and use.

Discussing safer sex in HIV counselling: assessing three communication formats

Although it is acknowledged that counselling can be an important factor in behaviour change, we lack information on how HIV counselling works in practice. Research is reported based on transcriptions of audio-tapes of counselling drawn from seven hospital centres in England and the USA. It is shown that communication occurs in the context of three different formats. Certain formats and conversational strategies used by counsellors produce far greater patient participation. Such participation may hold out the prospect of greater behavioural change than simply listening to information and advice.

Group counseling at STD clinics to promote use of condoms

An intervention was developed to promote safer sex and condom use among patients seeking treatment for sexually transmitted disease (STD) at a public health STD clinic in Los Angeles, CA. The intervention consisted of a short group discussion on condom use, a presentation of a videotape portraying condom use as socially acceptable behavior, and a role-playing session concerning negotiating the use of a condom with one's sex partner. The study group was 551 persons who visited the clinic in 1988. Medical records of 426 (77 percent) were located and reviewed 7 to 9 months later. Among those, 220 had participated in the intervention and 206 were control subjects who had not participated in the intervention. The rates at which patients reacquired STD after treatment and after the intervention were compared between the intervention group and the control group. Men who participated in the intervention subsequently showed a lower rate of STD reinfection than those who did not. There was no evidence that the intervention reduced reinfection among women. The strongest predictor of reinfection was found to be a history of STD infection prior to the infection that was being treated at the time of the intervention. The results show that group interventions directed to STD patients can be effective in reducing STD reinfection among men.

Seasonal variation in adolescent conceptions, induced abortions, and late initiation of prenatal care

The monthly distribution of conceptions among adolescents and the proportion of adolescent pregnancies that are voluntarily terminated by induced abortion by month of conception are the objects of this study. Additionally, seasonal variations in the timing of initiation of prenatal care services by adolescents are investigated. Vital records files of single live births, fetal deaths, and induced terminations of pregnancy to residents in the State of South Carolina, 1979-86, were aggregated to estimate conceptions. There was a significant difference between adolescents and adults in the monthly distribution of conceptions. The peak month of adolescent conceptions coincided with the end of the school year. Pregnancies of adolescents occurring at this time further demonstrated later access of prenatal care services than conceptions occurring at other times of the year, most notably during the school term. These findings suggest that there is considerable opportunity for improving the availability of reproductive health care services for adolescents. The results specifically suggest the potential benefit of increasing adolescent pregnancy prevention efforts prior to high-risk events and increasing the availability of and access to health care and counseling services to adolescents during the school recess months of the summer.

Contraceptive management for female adolescents with mental retardation and handicapping disabilities

Adolescent girls with mental retardation and handicapping disabilities have a need for sexual counseling and contraceptive management. Societal attitudes have changed, allowing these patients to experience normal and satisfying sexuality. The reproductive health concerns of these patients are extensive. Contraceptive selection varies with regard to the mental and physical capabilities of individual patients. The use of barrier methods, intrauterine devices, oral contraceptives, intramuscular medroxyprogesterone acetate, and sterilization has been discussed thoroughly in the past. No formal studies have been performed to evaluate the use of subdermal levonorgestrel implants in patients with mental retardation and physical disabilities.

Attitudes toward nurses discussing sexual concerns with patients

Attitudes toward nurses discussing sexual concerns with clients were examined in 73 healthy subjects using Section A of the Sexual Adjustment Questionnaire. The variables of age, sex, race, occupation, educational level, marital status, importance of sexual activity, frequency of discussing sexual relationship with partner, and number of others with whom sexual concerns are discussed were examined to determine influence on subject's attitudes. Ninety-two per cent of subjects thought that nurses should discuss sexual concerns with clients. Weighted least squares analysis showed that only two variables (number of others with whom sexual concerns are discussed and race) were significant predictors of attitudes.

Sexual counselling in the neuroscience setting: theory and practical tips for nurses

Human sexuality and sexual function may be profoundly affected by a number of neurologic illnesses and injuries. While nurses have historically supported the value of the holistic approach to patient care, sexuality (as a routine component of the recovery process) has frequently been neglected. Nurses' discomfort with this topic must be addressed in order to maximize patients' adjustment to any sexual changes. The purpose of this presentation is to reduce some of the anxiety surrounding the topic of sexuality, by suggesting strategies which nurses may find useful in approaching the subject and approaches to initiating the discussion outlined. Finally, a theoretical framework for promoting sexual health will be presented and its congruence with popular nursing models briefly examined. "Sexual counselling should be directed as to supporting a client's ability to make choices in every aspect of his life, including use of sexual experience." Comarr & Vigue.

[The problem of the effectiveness of condoms against HIV infection]

In several countries the condom is recommended as the most important protection against HIV infection, although there is no proof that the condom is effective against sexually transmitted diseases (STD). Prior to the HIV epidemic the condom was used to prevent pregnancy and to decrease the risk of STD. To prevent a deadly infection such as that with HIV, safe ways of protection are mandatory. Recent studies on HIV prevention show the assumption that condoms provide reliable protection against HIV to be a dangerous illusion. In carefully planned studies the residual risk was 13% and 27% and more respectively.

Sexual counseling standards for the spinal cord-injured

Spinal cord injury is one of the most prevalent disabilities in the United States today. The disability invariably affects sexual functioning challenging the usual ways one thinks about sexuality. Rehabilitation and development of standards of care for sexual counseling in this population are essential. Outlined in this article are proposed standards of care for sexual counseling of the spinal cord-injured (SCI) client. Theoretical approaches, provision of counseling and nurse-client objectives which support development of these standards are identified. Also included is a discussion of the preparation and role of the nurse in providing sexual counseling.