Perspectives on Sexual and Reproductive Health最新文献

Background: Evidence suggests that symptoms of endometriosis related to sexual dysfunction can disrupt intimate and sexual partnerships. The goal of this study was to understand the association between quality of life and sexual functioning and all its components among women with endometriosis.

Methods: We developed an anonymous online survey, which received responses from 1586 French women with endometriosis. We performed multivariable logistic regression to highlight the association between the Female Sexual Functioning Index (FSFI) and its dimensions with quality of life. Interaction analyses allowed subgroup investigation. Adjusted covariables were age, body mass index (BMI), tobacco, education, children, number of symptoms and menopause. We performed logworth analyses to assess the order of the strength relationships between all the components of FSFI.

Results: We found that FSFI was mainly associated with quality of life (OR = 1.02 [1.01-1.04], p = 0.002). We observed only two interactions between FSFI and BMI (p = 0.015) and education (p < 0.001). When considering educational subgroups, FSFI level was mainly associated with quality of life among those with a moderate educational level (OR = 1.07 [1.04-1.10], p < 0.001) and when considering BMI subgroups, FSFI level was mainly associated with quality of life among those with a moderate BMI (OR = 1.05 [1.02-1.08], p = 0.002). We did not observe an association between sexual functioning and quality of life among obese and low educational level women. Dyspareunia appeared to be the main component of sexual dysfunction among women with endometriosis (FDR logworth = 9.1, p < 0.001).

Conclusion: This study underscores the importance of professionals who treat patients with endometriosis addressing sexual dysfunction to ensure their quality of life.

Background: Sexual health is crucial for well-being, yet research often overlooks middle-aged and older adults, as well as those with disabilities. This study explores the sexual health of disabled middle-aged and older adults in Britain.

Objective: We aim to explain sexual behaviors and outcomes among disabled adults aged 45-74 in Britain.

Methods: We conducted a secondary quantitative analysis using data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a British population-representative survey. The study did not focus on a specific type of disability but rather included people who consider themselves to have a long-standing illness that limits their activity. The analysis incorporated variables on sexual behaviors and outcomes: bivariate analyses and multiple logistic regressions stratified by sex compared behaviors and outcomes by disability status.

Results: Of 7082 participants included, 1906 were classified as being with limiting disability status. Adjusting for sociodemographic differences, compared to nondisabled individuals, those with limiting disability status adults were less likely to engage in sex in the last 4 weeks (aOR: 0.60, CI: 0.51-0.71) or be in a steady relationship (aOR: 0.69, CI: 0.59-0.80) and were more likely to report poorer sexual health outcomes, including having experienced coerced sex attempts (aOR:1.83, CI:1.48-2.27), had coerced sex (aOR: 1.64, CI:1.33-2.01), had their sex life affected by health in the last year (aOR: 5.08, CI:4.27-6.05), and sought help for their sex lives (aOR:1.73, CI:1.38-2.17).

Conclusions: Middle-aged and older disabled adults in Britain are less likely to be sexually active, yet more likely to experience negative sexual health outcomes. The increased health-seeking behaviors and their vulnerability highlight the necessity for tailored sexual health services, extending into middle age and older adulthood.

Background: Coined the Contraceptive Paradox, unwanted pregnancies and abortions remain stable in most West-European countries despite the wide availability of highly effective contraception. Demographic and contextual reasons for ineffective (or no) contraceptive use in couples with no desire for a child have been described, yet data on women's concerns are scarce.

Objective: This study evaluates a broad range of individual factors potentially determining insufficient/less or ineffective contraceptive use.

Methods: N = 399 women post abortion in Vienna, Austria answered a questionnaire assessing demographics, use of contraception, fertility perception, desire to avoid a pregnancy, influence of family and friends, and attitudes toward hormones, the pharma industry, and naturalness. We used multivariate ordinal logistic regression (OLR), reporting Odds Ratios (OR) to identify factors determining contraceptive use (none vs. moderately effective vs. highly effective contraception). Additionally, decision trees served as a basis for hypothesis generation.

Results: Hormone skepticism (OR when compared with no skepticism ranged from 0.07 for very large to 0.20 for low skepticism), a moderate desire to avoid a pregnancy (1.43), older age (0.98), being unemployed (1.93) and being single (OR = 2.63 for unstable relationship and 1.73 for stable relationship when compared with no relationship, respectively), were all associated with using no contraception. Decision trees suggested perceiving oneself and the partner as fertile and knowing that hormone-free contraception was important for friends and family as additional factors.

Conclusions: Our findings may assist clinicians in better understanding women's attitudes and misconceptions. However, further research is needed to address potential dilemmas in women's contraceptive decision-making processes.

Context: Healthcare providers play a vital role in promoting comprehensive, sex-positive sexual health care. In the United States (US), patient-provider communication frameworks for sexual health predominantly rely on collecting the sexual health history. The most notable framework, the US Centers for Disease Control and Prevention's 5 Ps framework, emphasizes how an individual's current and past behaviors can predict a client's susceptibility to poor sexual health outcomes. However, this behavior centric approach has the capacity to introduce bias, stigma, and shame, potentially hindering effective communication and preventative care. The National Coalition for Sexual Health's 6 Ps framework introduced "Plus" to include sexual satisfaction as an integral part of sexual health communication.

Methods: Building on these existing frameworks, we developed an expanded model designed to reorient providers toward a paradigm that fosters more inclusive and affirming sexual health discussions, improves patient-provider communication and connection, and acknowledges the broader social and structural determinants that shape sexual well-being and vulnerability to human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs).

Results: We propose an expanded 8 Ps sexual health history that introduces "Proximity," which refers to the influence of one's living and sexual environment, and "Perspectives," highlighting how personal beliefs fundamentally shape behaviors.

Conclusion: Fortifying the sexual health discussions between providers and patients with non-behavioral context, such as geographical determinants of health and understanding of sexual health in general, that increase vulnerability to HIV and other STIs can begin to address the limitations in the prior frameworks.

Introduction: Population estimates of the prevalence of intimate partner violence (IPV) victimization and perpetration are limited for sexual minorities in mid-adulthood.

Methods: We examined IPV prevalence estimates, and associations between sexual orientation and self-reported physical and sexual IPV experiences among 10,812 respondents ages 33-43 years who were in a current relationship and participated in Wave V of the National Longitudinal Study of Adolescent to Adult Health, a population-based US study. We conducted sex-stratified logistic regressions to model associations between sexual orientation and IPV, adjusted for age, race/ethnicity, highest educational attainment, and household income as percent of federal poverty level.

Results: Ninety one percent of men and 80% of women self-identified as heterosexual. Prevalence ratios indicated greater victimization and perpetration among male and female sexual minorities compared to heterosexuals. In adjusted regression models, sexual minority men had higher odds of physical perpetration (AOR = 1.8) than heterosexuals. Among women, sexual minorities had higher odds of physical and sexual victimization (AORs = 1.8 and 1.8, respectively) than heterosexual females, and higher odds of physical perpetration (AOR = 1.9).

Conclusions: Even into mid-adulthood, sexually minoritized groups have a disproportionate likelihood of experiencing both IPV perpetration and victimization compared to heterosexual peers. More work is needed to understand and address sources of these disparities.

Objective: This study analyzed young adults' understanding of and thoughts about permanent contraception amidst increased demand for sterilization in this population following changes in abortion and contraception access in the United States (US).

Methods: Undergraduate students at a northeastern US university (N = 53) completed an online questionnaire assessing opinions about sterilization and factors they believed physicians should consider before performing sterilization. Quantitative analysis explored whether attitudes toward vasectomy versus tubal ligation differed by capacity to become pregnant. We used inductive thematic analysis to interpret qualitative data.

Results: There were no differences in attitudes toward sterilization methods by capacity to become pregnant. However, participants estimated posttubal ligation regret would be significantly more prevalent than postvasectomy regret. Key qualitative themes included patient-centered care, regret, and sociocultural influences.

Conclusions: This study revealed young adults value bodily autonomy in reproductive choices, regardless of permanence or potential regret, factors some providers weigh heavily. Whether interest in sterilization among this population increases or remains static, it is important for healthcare providers to be aware of these attitudes when handling requests from younger adults.

Introduction: Over the last decade at the University Hospital of Nancy in Lorraine, France, we have observed an increasing number of people under 35 years old who receive consultation for gender incongruence, from an average of 7 new patients per year in 2002-2013 to an average of 27 per year in 2014-2017.

Methods: We conducted a mixed-methods study, including a retrospective quantitative analysis of medical records of youths who sought care for gender incongruence from 2004 to 2020, and a qualitative analysis of in-depth interviews with 11 patients identified through the medical records.

Results: The study included 235 participants (135 assigned female at birth, 100 assigned male at birth). Transgender men were younger than transgender women: mean age 20 (1.6, standard deviation, [SD]) years vs. 22.7 (4.3 SD) years; p = 0.01 at first referral. We observed no difference in age at the initiation of gender-affirming hormonal treatments. More than half of our participants chronologically situated their first questioning about their gender identity in the prepubertal period. Their life experiences revealed a lack of transgender representation in society, discomfort with the treatments offered, difficulties in becoming aware of and disclosing their gender identity, and the importance of peer/community support.

Conclusion: The present study provides insights into the growing population of transgender and gender nonconforming people receiving care in the University Hospital of Nancy which has coincided with the evolution of the national legal framework. Our results identify several priorities for transgender youth who are receiving gender-affirming care. Further research outside hospital networks appears warranted.

Aim: This paper describes the social support women aged 25-35 years living in Victoria, Australia draw on during the reproductive decision-making process specific to the type of support they seek and their satisfaction with that support.

Methods: We conducted a cross-sectional study that collected data through an online questionnaire administered via Qualtrics. This included both closed- and open-ended questions, exploring women's experiences of receiving social support for reproductive decision-making, the types of support they sought, and their satisfaction with the support received. Using convenience sampling, we recruited 234 women aged 25-35 years.

Results: The women highlighted a myriad of factors that influenced their experiences of seeking and receiving support (or not), both positively and negatively. These included individual or micro-level factors (e.g., interpersonal relationships); contextual factors (e.g., issue and/or time-dependent); and macro/societal level factors (e.g., social attitudes and norms). The type of support depends on the reproductive decision, with women employing strategies to enhance their satisfaction with support.

Conclusion: These findings are important to inform and advocate for future public health and social policy to support women's decision-making and overall health and wellbeing related to their reproductive autonomy.

Objective: To analyze how shifts in population composition and variations in the behavior of different sociodemographic groups have changed abortion practices in Spain between 2011 and 2021.

Methods: We used data from the Voluntary Terminations of Pregnancies register and Spanish Population and Housing Censuses to examine abortion rates and demographic characteristics of women aged 12-52. We used Poisson regression models and the Oaxaca-Blinder decomposition technique to estimate the contributions of shifts in population structure and variations in behaviors to changes in abortion rates.

Results: We found that 40% of the decline was due to changes in sociodemographic characteristics. Specifically, the relative reduction in the number of younger women in the population and the increase in women's education levels significantly contributed to the decline in abortion rates, while the influx of immigrant women offset some of this reduction. The reduction not explained by these factors was attributed to behavioral changes, with significant reductions in the likelihood of undertaking an abortion also occurring among women under 35, immigrants from non-high-income countries, and lower-educated women.

Conclusions: The study highlights the importance of including changes in the sociodemographic composition of populations in analyses of shifts in abortion rates. It also shows that behavioral changes are not uniform, and that the primary driver of change in abortion rates in Spain is the reduction in abortion rates among the subgroups that had the highest initial rates, leading to a gradual flattening of the differences between women of different ages, education levels, and migratory backgrounds.

Introduction: Sexual and reproductive health (SRH) is a critical component of overall well-being, yet individuals with substance use disorder (SUD) often face significant barriers to accessing SRH services-and vice versa. SRH settings offer important opportunities to identify and address SUD needs through screening and referral, whereas SUD treatment settings can serve as key access points for SRH care. The Link Study was developed as a cross-training intervention to strengthen collaboration and care coordination between SRH and SUD providers.

Methods: We designed a curriculum covering core elements of SRH and SUD care, emphasizing person-centered practices, trauma-informed approaches, and evidence-based screening and referral tools. Thirty-five providers from three SRH and SUD site pairs participated. Evaluation included pre- and post-training knowledge surveys, site-level screening and referral data, and provider focus groups. We used confidence intervals to assess changes in quantitative outcomes and conducted thematic analysis of qualitative data.

Results: Providers demonstrated consistent increases in self-reported knowledge across key domains. Two of the three SRH and SUD sites showed statistically significant improvements in screening practices. Although referral rates did not change significantly, sites reported meaningful updates to workflows, tools, and policies to support integration. All sites sustained cross-sector provider relationships for at least 6 months post-training.

Discussion: The Link Study showed promising gains in provider knowledge, improvements in screening practices, and lasting collaboration across SRH and SUD service sectors. Findings highlight the potential of cross-disciplinary training and technical assistance to build integrated care pathways and strengthen community-based health systems.