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BASIC SCIENCE & CLINICAL RESEARCH IN MALE & F E M
T H E
J O U R N A L
M A LE & FEMALE SEXUAL FUNCTION & DYSFUNCTION
Proceedings from the 20TH WORLD CONGRESS OF SEXUAL health
glasgow, united kingdom, june 12–16 2011
O F
AL
E
SEX
IN
Sexual
Medicine
UAL FUNCTION & DYSFUNCTION • BASIC SCIENCE & CLINICAL RESE A R C
H
Official Journal of
The International Society for Sexual Medicine
Asia Pacific Society for Sexual Medicine (APSSM)
European Society for Sexual Medicine (ESSM)
Latin American Society for Sexual Medicine (SLAMS)
Sexual Medicine Society of North America (SMSNA)
International Society for the Study of Women’s Sexual Health (ISSWSH)
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5/20/2011 2:06:43 PM
The Journal of Sexual Medicine
36 Old Mill Lane
Plymouth, MA 02360, USA
Tel: (+1) 617-417-6269 Fax: (+1) 508-747-9603
E-mail: [email protected] Website: http://jsm.issm.info
Editor-in-Chief
Irwin Goldstein, MD
Director, Sexual Medicine
Alvarado Hospital
University of California
San Diego, CA, USA
Editorial Assistant
Sue W. Goldstein, AB
San Diego Sexual Medicine
San Diego, CA, USA
Managing Editor
Jason Roberts, PhD
Plymouth, MA, USA
Assistant Managing Editor
Donna Schena
Plymouth, MA, USA
Associate Editors
Stanley E. Althof, PhD
University of Miami Miller School of Medicine
West Palm Beach, FL, USA
Brian Annex, MD
University of Virginia
Charlottesville, VA, USA
Johannes Bitzer, MD
University Hospital Basel
Basel, Switzerland
Meredith L. Chivers, PhD, CPsychp
Queen’s University
Kingston, ON, Canada
Giovanni Corona, MD, PhD
University of Florence
Florence, Italy
John Dean, MD
St Peter’s Andrology Centre
London, UK
Michael E. DiSanto, PhD
Albert Einstein College of Medicine
Bronx, NY, USA
Ian Eardley, MA, Mchir
Leeds University
Leeds, UK
Annamaria Giraldi, MD, PhD
Rigshospitalet
Copenhagen, Denmark
François Giuliano, MD, PhD
Paris-Ile de France Ouest Medical University
Le Kremlin Bicêtre, France
Andrew T. Goldstein, MD
George Washington University
Baltimore, MD, USA
Wayne Hellstrom, MD
Tulane University
New Orleans, LA, USA
Luca Incrocci, MD, PhD
Erasmus MC-Daniel den Hoed Cancer Center
Rotterdam, The Netherlands
Lior Lowenstein, MD
Technion Israel Institute of Technology
Haifa, Israel
Mario Maggi, MD
University of Florence
Florence, Italy
Marita McCabe, PhD
Deakin University
Burwood, Australia
Chris McMahon, MD, FACSHP
Australian Centre for Sexual Health
Sydney, Australia
Pedro Nobre, PhD
Universidade de Aveiro
Senhora da Hora, Portugal
James Pfaus, PhD
Concordia University
Montreal, QC, Canada
Caroline Pukall, PhD
Queen’s University
Kingston, ON, Canada
Talli Yehuda Rosenbaum, MSc., BS PT
Inner Stability, Ltd
Bet Shemesh, Israel
Eusebio Rubio-Aurioles, MD, PhD
Asociacion Mexicana para la Salud Sexual A. C
Mexico City, Mexico
Ira Sharlip, MD
University of California
San Francisco, CA, USA
Vin Tangpricha, MD, PhD
Emory University
Atlanta, GA, USA
Marcel Waldinger, MD, PhD
Utrecht University
Utrecht, The Netherlands
102_jsm_v8_is3_Editorial Board.indd 2
Kevan Wylie, MD, DSM
University of Sheffield
Sheffield, UK
Statistical Consultant
Christian J. Nelson, PhD
New York, NY, USA
Reviews Editors
Arthur Burnett, MD
Johns Hopkins
Baltimore, MD, USA
Lorraine Dennerstein, MBBS, PhD, DPM, FRANZCP
University of Melbourne
Melbourne, Australia
JSM Online Associate Editor
Mohit Khera, MD, MBA
Baylor College of Medicine
Houston, TX, USA
Culley Carson, MD
Chapel Hill, NC, USA
Mohammed Cassimjee, MMed
Pietermantzburg, South Africa
Beatrice Cuzin, MD
Lyon, France
Susan R. Davis, MBBS, FRACP, PhD
Melbourne, Australia
Leonard Derogatis, PhD
Lutherville, MD, USA
Amr El-Meliegy, MD
Cairo, Egypt
Geraldo Faria, MD
Rio Claro, Brazil
David Goldmeier, MD, FRCP
London, UK
JSM Highlights Associate Editor
John Mulhall, MD
Memorial Sloan Kettering Cancer Center
New York, NY, USA
Alexander Greenstein, MD
Tel Aviv, Israel
JSM Highlights Editorial Board
Education
Dimitrios Hatzichristou, MD
Thessaloniki, Greece
Han Hanafy, MD
Harrisburg, IL, USA
CME
Sharon Parish, MD
Bronx, NY, USA
Gerald Brock, MD
London, ON, Canada
Classic Citations
Sidney Glina, MD
Sao Paolo, Brazil
Controversies
Emmanuele A. Jannini, MD
L’Aquila, Italy
Laboratory Forum
Michael Adams, PhD
Kingston, ON, Canada
Surgical Techniques
Lara Burrows, MD
Washington, DC, USA
Serigne M. Gueye, MD
Dakar, Senegal
Konstantinos Hatzimouratidis, MD
Thessaloniki, Greece
Richard D. Hayes, PhD
London, UK
Graham Jackson, MD
London, UK
Erick Janssen, PhD
Bloomington, IN, USA
Philip Kell, MD
London, UK
Muammer Kendirci, MD
Istanbul, Turkey
Ellen Laan, PhD
Amsterdam, The Netherlands
Marita McCabe, PhD
Burwood, Australia
Marta Meana, PhD
Las Vegas, NV, USA
Osama K.Z. Shaeer, MD
Cairo, Egypt
Drogo K. Montague, MD
Cleveland, OH, USA
Survey of Literature
Noel Kim, PhD (chair)
San Diego, CA, USA
Kwangsung Park, MD, PhD
Gwangju, Korea
Lori Brotto, PhD
Vancouver, BC, Canada
Anita Clayton, MD
Charlottesville, VA, USA
Lesley Marson, PhD
Chapel Hill, NC, USA
Martin Miner, MD
Providence, RI, USA
Rachel Pauls, MD
Cincinnati, OH, USA
Hartmut Porst, MD
Hamburg, Germany
Lauri Romanzi, MD
New York, NY, USA
JSM Patient Highlights
Alan Shindel, MD
Sacramento, CA, USA
Christina Damsted Petersen, MD, PhD
Copenhagen, Denmark
Michael Perelman, PhD
New York, NY, USA
Elke Reissing, PhD
Ottawa, ON, Canada
J.C. Jorge Rivera, PhD
San Juan, Puerto Rico
Miguel A. Rivero, MD
Buenos Aires, Argentina
Andrea Salonia, MD
Milan, Italy
Isbelia Segnini, MSc
Caracas, Venezuela
James Simon, MD, CCD, NCMP, FACOG
Washington, DC, USA
Ulf Simonsen, MD, PhD
Aarhus, Denmark
Contributors
History
Dirk Schultheiss, MD
Gießen, Germany
Moniek ter Kuile, PhD
Leiden, The Netherlands
Industry Liaison
Hossein Sadeghi-Nejad, MD
New Brunswick, NJ, USA
Frederick Wu, MD
Manchester, UK
Editorial Board
Carmito Abdo, MD, PhD
São Paulo, Brazil
Monica Andersen, PhD
São Paulo, Brazil
Javier Angulo, PhD
Madrid, Spain
Tarek Anis, MD
Cairo, Egypt
Edgardo Becher, MD, PhD
Buenos Aires, Argentina
Kevin Billups, MD
Minneapolis, MN, USA
Yitchak M. Binik, PhD
Montreal, QC, Canada
Trinity Bivalacqua, MD, PhD
Baltimore, MD, USA
Linda Vignozzi, MD, PhD
Florence, Italy
Zhong Cheng Xin, MD
Peking, China
Michael Zitzmann, MD, PhD
Muenster, Germany
Ethics Committee
Eli Coleman, PhD
Joel Kaufman, MD (Chair)
Alison Labbate
Alvaro Morales, MD
Beverly Whipple, PhD, RN
International Advisory Board
P. Ganesan Adaikan, PhD, DSc
Jacques Buvat, MD
Sidney Glina, MD
Ron Lewis, MD
Vaclav Michal, MD
Former ISSM Editors
Gorm Wagner, MD, PhD
William Furlow, MD
Arnold Melman, MD
5/20/2011 2:06:57 PM
INTERNATIONAL SOCIETY FOR SEXUAL MEDICINE (ISSM)
President: Edgardo Becher (Argentina)
European Society for Sexual Medicine
President Elect: Chris McMahon (Australia)
President: Hartmut Porst (Germany)
Past President: John Dean (UK)
Past President: Ian Eardley (UK)
Secretary General: Wayne Hellstrom (USA)
Secretary General: Antonio Jens Sonksen (Denmark)
Treasurer: Luca Incrocci (The Netherlands)
Treasurer: David Ralph (UK)
Member Ex Officio: Ira Sharlip (USA)
Members at Large: Carla Sofia Costa (Portugal)
Members at Large: Tarek Anis (Egypt)
Natalio Cruz Navarro (Spain)
Arthur Burnett (USA)
Beatrice Cuzin (France)
Annamaria Giraldi (Denmark)
Petter Hedlund (Sweden)
Hui-Men Tan (Malaysia)
Fabrizio Palumbo (Italy)
Luis Otavio Torres (Brazil)
Yacov Reisman (The Netherlands)
Asia Pacific Society for Sexual Medicine
Mustafa F. Usta (Turkey)
President: Doddy M. Soebadi (Indonesia)
President Elect: Tai Young Ahn (Korea)
Past President: Han-Sun Chiang (Taiwan)
Latin American Society for Sexual Medicine
Secretary General: Nam Cheol Park (Korea)
President: Geraldo Faria (Brazil)
Deputy Secretary General: Carolyn Earle (Australia)
Vice President: Osvaldo Nestor Mazza (Argentina)
Treasurer: Hui-Meng Tan (Malaysia)
Secretary General: Adrián Momesso (Argentina)
Deputy Treasurer: Kavirach Tantiwongse (Thailand)
Treasurer: Joao Afif Abdo (Brazil)
Members at Large: Arif S. Adijomoelya (Indonesia)
Members at Large: Ernesto Grasso (Argentina)
Srilatha Balasubramaniam (Singapore)
Celso Gromatzky (Brazil)
Kew Kim Chew (Australia)
Isbelia Segnini (Venezuela)
Carolyn Earle (Australia)
Juan Fernando Uribe (Colombia)
Ju-Ton Hsieh (Taiwan)
Je-Jong Kim (Korea)
Sudhakar Krishnamurti (India)
Sexual Medicine Society of North America
Peter H. C. Lim (Singapore)
President: John Mulhall (USA)
Ji Hong Liu (China)
President Elect: Arthur Burnett (USA)
Wah Yun Low (Malaysia)
Past President: Ronald W. Lewis (USA)
Lasantha Malavige (Sri Lanka)
Secretary General: Gerald B. Brock (Canada)
Tanjore Rangaswami Murali (India)
Treasurer: Run Wang (USA)
Nansalmaa Naidan (Mongolia)
Members at Large: Stanley Althof (USA)
Koichi Nagao (Japan)
Robert C. Dean (USA)
Nhu Thanh Nguyen (Vietnam)
Jason Greenfield (USA)
Jong-Kwan Park (Korea)
Martin Miner (USA)
Shavakhabov Shavkat Shonasyrovich (Uzbekistan)
Khurram Mutahir Siddiqui (Pakistan)
Akmal Taher (Indonesia)
International Society for the Study of Women’s
Po-chor Tam (Hong Kong)
Sexual Health (ISSWSH)
Hui-Meng Tan (Malaysia)
President: Alan Altman (USA)
Anupan Tantiwong (Thailand)
President Elect: Andrew T. Goldstein (USA)
Akira Tsujimura (Japan)
First President Elect: Sharon Parish (USA)
Chii-Jye Wang (Taiwan)
Past President: Sheryl A. Kingsberg (USA)
Zhong Cheng Xin (China)
Secretary: Irwin Goldstein (USA)
ISSM Publications Committee
Treasurer: James A. Simon (USA)
Chair: Ronald W. Lewis (USA)
Members at Large: Johannes Bitzer (Switzerland)
Co-chair: Ian Eardley (UK)
André T. Guay (USA)
Tarek Anis (Egypt)
Crista Johnson (USA)
Sidney Glina (Brazil)
Susan Kellogg-Spadt (USA)
Larry Levine (USA)
Michael Krychman (USA)
Mario Maggi (Italy)
James Pfaus (Canada)
Sharon Parish (USA)
Andrea Salonia (Italy)
Ira Sharlip (USA)
Kevan R. Wylie (UK)
103_jsm_v8_is3_committees.indd 3
5/20/2011 2:06:07 PM
The Journal of Sexual Medicine
Official Journal of the International Society for Sexual Medicine
Volume 8, supplement 3
impact factor: 4.884
june 2011
Proceedings from the 20th World Congress of Sexual Health
Glasgow, United Kingdom, June 12–16 2011
79
WORLD ASSOCIATION FOR SEXUAL HEALTH
80
MESSAGE FROM ROSEMARY COATES WAS PRESIDENT
Rosemary Coates
81
MESSAGE FROM KEVAN WYLIE: CONGRESS PRESIDENT
Kevan Wylie
82
SCIENTIFIC RESEARCH AT THE WORLD ASSOCIATION FOR SEXUAL HEALTH
Alain Giami, Pierre Assalian, Roy Levin, Kevan Wylie
84
PROCEEDINGS FROM THE 20TH WORLD CONGRESS OF SEXUAL HEALTH
GLASGOW, UNITED KINGDOM, JUNE 12–16 2011
104_jsm_v8_is3_Content.indd 4
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The Journal of Sexual Medicine, (ISSN 1743-6095 [Print]; ISSN 1743-6109 [Online]), is published monthly on behalf of the
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105_jsm_v8_is3_prelim.indd 5
5/20/2011 2:07:27 PM
79
World Association for Sexual Health
President: Rosemary Coates, Australia
Local Scientific Committee
Vice-President: Kevan Wylie, UK
Secretary-Treasurer: Pierre Assalian, Canada
Past-President: Eusebio Rubio-Aurioles, Mexico
Executive Coordinator: Esther Corona, Mexico
Track leaders:
Track 1: David Goldmeier
Track 2: Geoff Hackett
Track 3: Roger Ingham
Track 4: Cynthia Graham
Track 5: Kaye Wellings
Track 6: Gill Greer
Track 7: John Dean
WAS Executive Committee
Associate Secretaries
Jaqueline, Brendler, Brazil, Ganesan Adaikan, Singapore, Sara Nasserzadeh, USA, Woet Gianotten, The
Netherlands
Presidents of the Regional Federations
Uwemedimo Uko Esiet, AFSHR, Antonio Casaubon,
FLASSES, Chiara Simonelli, EFS, Arif Adimoelja,
AOFS
Advisory Committee
WAS Scientific Committee
President: Alain Giami, France
Members: Ganesan Adaikan, Singapore, Yuko Higashi,
Japan, Charlotta Lofgren-Martenson, Sweden, Pedro
Nobre, Portugal
Members of the Advisory Committee:
Mariela Castro Espín, Cuba, Cristina Fridman, Argentina, Emil Man-Lun Ng, Hong Kong, Aminta Parra
Colmenarez, Venezuela, Luis Perelman, Mexico,
Nadine Terrein-Roccatti, Mexico, Matt Tilley,
Australia
Ex-Officio Members
President of the 20th WAS World Congress of Sexual
Health, Kevan Wylie
President of the XIX W AS World Congress of Sexual
Health, Lars-Gosta Dahlof
Past Presidents of WAS: Romano Forleo, Italy (1978–
1979), Fernando Bianco, Venezuela (1986–1989),
Alan Wabrek, USA (1989–1993), Rubén HernándezSerrano, Venezuela (1993–1997), Eli Coleman, USA
(1997–2001), Marc Ganem, France (2001–2005)
Local Organising Committee
President of the 20th WAS World Congress of
Sexual Health: Kevan Wylie
Executive Chair of the Local Scientific Committee:
Roy Levin
Executive Administrator: Kim Monk
Executive Chairs: Debbie Davies-South, Manolee
Shankar
Members:
Margaret Bellamy, David Clegg, Mary Clegg, Joan
Davies, Sandip Deshpande, Julie Fitter, Susan Maxwell,
Caren Shepherd, Anita Taylor, Rose Whiteley
Members:
Peter Aggleton, Sris Allen, Sandip Deshpande, Wallace
Dinsmore, James Drife, David Edwards, Paul Flowers,
Ruth Hallam-Jones, Mark Hayter, Sharron Hinchcliffe,
Jacob Jacobson, Erick Janssen, Mike Kirby, Abas Kokab,
Dennis Lin, Karen Lorimer, Sue Maxwell, Marita
McCabe, Ali Mears, Sara Nasserzadeh, George O’Neil,
David Ralph, Juliet Richters, Jane Ridley, Hossein
Sadeghi-Nejad, Abhijeeth Sheety, Ashok Singh, John
Studd, Alexsandar Stulhofer, Alireza Tabatabaie, Anita
Taylor, Leonore Tiefer, Sathya Vishwanath, Matthew
Waites
International Scientific Committee
Chair:
Pierre Assalian, Canada
Members:
Saïd Abdel Azim, Egypt, Ganesan Aidekan, Singapore,
Carlos Berganza, Guatemala, Fernando Bianco, Venezuela, Jules Black, Australia, Walter Bockting, USA,
Mireille Bonierbale, France, Juan Jose Borras Valls,
Spain, Jacqueline Brendler, Brazil, Gila Bronner, Israel,
Jacques Buvat, France, Francisco Cabello Santa Maria,
Spain, Mariela Castro Espin, Cuba, Radhika Chandiramani, India, Barbara Clarke, Canada, Rosemary Coates,
Australia, Eli Coleman, USA, Stephen Conley, USA,
Esther Corona, Mexico, Frederique Courtois, Canada,
John De Lamater, USA, John Dean, UK, Joseph Di
Norcia, USA, Marianne Doherty, Canada, Uwen Esiet,
Nigeria, William Fisher, Canada, Andres Flores Colombino, Uruguay, Christina Fridman, Argentina, Claudia
Garcia-Moreno, Switzerland, Hussein Ghanem, Egypt,
Irwin Goldstein, USA, Ruben Hernandez Serrano,
Venezuela, Yuko Higashi, Japan, Janet Hyde, USA, Eno
Ikpe, Nigeria, Patricia Kock, USA, Osmo Kontula,
Finland, Charlotta Lofgren-Martenson, Sweden, Rafael
Mazin, Paho, Chris McMahon, Australia, Moshe Mock,
Israel, Sara Nasserzadeh, Iran, M.L. Ng, Hong Kong,
Pedro Nobre, Portugal, Antonio Palha Pacheco, Portugal, Aminta Parra, Venezuela, Luis Perelman, Mexico,
Michael A. Perelman, USA, Robert Porto, France,
Margaret Redelman, Australia, Oswaldo Rodrigues,
Brazil, Eusebio Rubio Aurioles, Mexico, Chiara Simonelli, Italy, Mehmet Sungur, Turkey, Nadine TerreinRoccatti, Mexico, Matt Tilley, Australia, Marcel
Waldinger, The Netherlands, Beverley Whipple, USA,
Sahika Yuksel, Turkey
J Sex Med 2011;8(suppl 3):79
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80
Message from Rosemary Coates WAS President
The World Association for Sexual Health (WAS) is a
multi-disciplinary organization dedicated to the promotion of sexual rights and sexual health. Our membership
comprises a variety of professional societies, educational
institutions and non-government organizations. With
156 member societies and 63 individual members the
total number of people throughout the world with
whom we have contact is in the tens of thousands. Such
networking ensures that all aspects of sexology are well
represented.
A unique aspect of the biennial World Congresses is
that we draw together behaviourists, educators, clinicians, researchers, field workers and other service
providers. Over the past three Congresses we have
endeavoured to identify topics and invite speakers from
different disciplines to share their perspective on that
topic. As sexology is a holistic science, this is designed
to encourage furthering knowledge across the disciplines, thus benefitting practitioners, clients and society.
The Abstracts presented here are representative of
the variety of perspectives from which sexual rights and
sexual health are approached. There are papers cover-
ing issues of rights, ethics, the physiology and pathophysiology of human sexual function, behaviour, values
and attitudes. Sexuality education from early childhood
to adulthood and sexology for professional specialists is
also included; as are medical treatments and surgical
interventions, therapies and counselling theories and
strategies.
There are many notable names amongst the presenters. There are also presenters who represent the younger
generation of sexologists. They come from all parts of
the world and the tapestry of expertise, experience and
cultural perspectives enriches our understanding of
human sexuality. We encourage a collegial exchange of
views and information to promote a more holistic
approach to sexual health through all professions.
Video presentations of many of the authors represented here may be accessed through SexologyVisual.
com.
WAS President 2009–2013
J Sex Med 2011;8(suppl 3):80
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81
Message from Kevan Wylie: Congress President
Sexual health is a state of physical, emotional, mental and
social well-being in relation to sexuality; it is not merely
the absence of disease, dysfunction or infirmity. Sexual health
requires a positive and respectful approach to sexuality and
sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained
and maintained, the sexual rights of all persons must be
respected, protected and fulfilled. This definition has
served us well over the last decade and the World
Association for Sexual Health (WAS) offers its biannual
congress to facilitate clinicians, scientists, educators,
advocates and all of those with a legitimate interest in
human sexuality to meet and share their opinions and
findings. It is the wide diversity of interest in the field
as well as within the discipline which offers such variety
and opportunity to the delegates at our meetings especially at this time when we are consolidating our understanding of the field of sexual health whether this be
sexology, sexual medicine or sex education and training
to name only a few. This congress will hopefully offer
the chance to progress with our legend of forging
the future of our professions by allowing respectful
recognition that previous boundaries can sometimes
be relaxed to allow us to merge with confluent benefit
to all.
The invitation to preside over one of the world’s
most important congresses in our specialty is a great
honour and one which with the support and contribution from my colleagues at both the Sheffield Society
for the Study of Sexuality and Relationships (SSSSR)
and at the WAS will hopefully remain in your memories
in the years ahead. The major contributors to the
meeting have been three fold. First, from our carefully
selected plenary speakers who have travelled from
around the world to provide an insight into an aspect
of sexual health from different perspectives. Secondly,
from the many groups and teams who have proposed
and developed symposia across a wide range of fields.
Our third group, the largest group, is from individuals
who have submitted over 800 abstracts from around the
globe. Thank you to our scientific committees led by
Roy Levin, Alain Giami and Pierre Assalian and supported by our seven UK based track leaders with their
members who have all worked endlessly to ensure we
try to get the best mix and input across our sessions and
symposiums from both experienced scientists and contributors and those who are starting out or developing
their career. Yet, the congress cannot be a success
without the interaction of the delegates and each and
every one of you (including all of the Sassenachs) are
very welcome here in Scotland and the opportunity for
discussion and expression is warmly encouraged
throughout the congress. We are particularly pleased to
offer space to meet and interact with each of our 30
plenary speakers in dedicated 30 minutes sessions in
order to “meet the expert”.
This whole meeting could not have taken place
without the input from my colleagues at SSSSR. The
society is very much regional in origin but whose aim
is to further the opportunities for its members to join
the family of sexologists and sexual health workers globally. I want to extend my personal thanks to Roy Levin
who has chaired the local scientific committee and to
my colleagues Debbie Davies-South, Manolee Shankar,
Julie Fitter and Kim Monk who have all worked extraordinarily hard and over and above their daytime jobs to
ensure the scientific and social programme is the best
we can deliver in these times of austerity here in the city
known as that “dear green place” Glasgu. Take some
time to explore beyond the city centre and you will
discover one of the most beautiful countries in the
world before returning home in anticipation of our next
meeting in Rio de Janeiro when I hope that we shall all
have the chance to meet once again.
Kevan Wylie. Congress President
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What kind of science is presented at the 20th World
Congress of Sexual Health held in Glasgow between
June 13th and 16th 2011? More precisely, what kind of
“sexual science” or “sexology” is presented to illustrate
and give evidence to sexual health issues around the
world? In order to understand the originality of this
congress, it is important to recall a little bit of the
history of sexology, sexual health and sex research.
Sexual science and sexology have a long history, which
started at the end of the 19th century in Western
Europe. This sexual science was embedded in the postVictorian morality based on the legitimacy of sexual
activity as long as it was limited to reproduction and
located in marriage (Bland & Doan, 1999; Weeks,
1981). But at the same time, sexology started to consider the importance of sexual activity for well-being
and to incarnate sexual optimism, particularly with the
works of Havelock Ellis (Robinson, 1976). This process
culminated in the early sixties with the diffusion of the
hormonal contraception and the works of Masters &
Johnson about the human sexual response cycle. The
occurrence of these events allowed many historians to
talk about a process of sexual revolution (Escoffier,
2003). Sexual health started to be defined in the early
seventies in the context of a collaboration between the
WHO and some groups of professional sexologists
from Europe and the USA, until it became fully recognized in 2003 and included in the Sexual and Reproductive Health program of the WHO (Giami, 2002).
We should not forget the onset of the HIV-Aids epidemics in 1981, which continues to threaten the life
of millions people. Sexual health is the contemporary
response to these problems but it goes much beyond
the domain of disease and dysfunction and their treatment and the works presented in this conference reflect
the range of issues and practices that are involved in
this field.
Sexual health is a complex field of activities and practices including education, psychological and psychosocial approaches, therapy, medicine, public health,
sexological research, basic life sciences, behavioral sciences, social and anthropological sciences and ethics. It
is even more complex since the WAS establishes a
central link between sexual health and sexual rights,
which opens the way to a whole range of activities
related to advocacy, promotion and defense of human
rights when these are threatened.
In order to attract researchers, health professionals,
educators, social workers, and activists to present their
work at the Congress, the WAS Scientific Committee
(Alain Giami, Ganesan Adaikan, Yuko Higashi, Charlotta Löfgren-Mårtenson and Pedro Nobre) have organized the scientific field of sexual health and sexual
rights into seven tracks which represent the disciplines
involved in sexual health and sexual rights.
• Track 1: Bio-medical research (basic, physiological,
pharmacological). David Goldmeier;
• Track 2: Clinical approaches (medical, psychological
and sexological). Geoff Hackett;
• Track 3: Sexuality Education. Roger Ingham;
• Track 4: Social, Behavioural & Historical research
(non clinical). Cynthia Graham;
• Track 5: Public Health / Epidemiology / Public Policies. Kaye Wellings;
• Track 6: Sexual Health & Sexual Rights actions and
advocacy. Gill Greer;
• Track 7: Ethics, principles, practices and issues. John
Dean.
This construction of the scientific field of sexual health
and sexual rights facilitated the distribution and repartition of abstracts to the members of the Local Scientific
Committee led by Roy Levin (Sheffield, UK) and the
International Scientific Committee led by Pierre
Assalian (Montréal, Canada) to review and evaluate
carefully the abstracts, which were submitted electronically. The abstracts are presented in this volume following this distribution by track (Oral presentations and
Poster presentations) so that the reader can have a better
understanding of the consistency of the various fields.
This special supplement of the Journal of Sexual
Medicine offers 861 abstracts to be presented as plenary,
special symposia, oral presentation, narrated posters
and posters at the 20th Congress of the World Association for Sexual Health. Beyond the multi-disciplinarity
represented by more than a hundred faculty who
reviewed the abstracts, the selection of the papers
reflects the world wide compass and the originality of
research and practices which occur under the banner of
the link between sexual health and sexual rights.
What is striking in this volume is the diversity of
topics that are presented. Of course, as it could be
expected, one can find a very large number of abstracts
about female and male sexual disorders and their treatment, which form the core of sexological practice and
research. These can take place more often inside heterosexual relationship. But one can find an important
set of abstracts about gay and lesbian sexualities and the
problems encountered by these individuals (stigmatization, sexual problems and gender issues). One can also
find some papers about HIV prevention, reproductive
health issues such as contraception and abortion, sexual
abuse and sexual violence. Sexual education addressed
to various groups and using different approaches has
also an important presence. Health professionals who
are the major actors involved in the sexological and
sexual health practice are also approached through the
analysis of their psycho-social attitudes towards sexuality, their difficulties in communicating around sexual
issues and their training (or absence of training !).
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Besides these quite common aspects of sexuality and
sexual health, one can find groups and populations less
frequently studied in the field of sexology and sexual
health which deserve some attention: papers about
people with disabilities (intellectual and/or physical),
prisoners, transgender and transsexual individuals are
the source of some studies. Groups and individuals of
various age ranges such as children, adolescents, adults
and older people are treated with equal attention
regarding a positive approach of sexuality and sometimes the protection against discrimination and denial
of the right to sex. Educational and health promotions,
HIV prevention, interventions in unusual settings such
as theatres, night-clubs and discotheques, are presented
also. Sexual health professionals are not afraid to go in
the settings where problems may occur. Some papers
discuss the topic of male circumcision in the new context
of its use as an HIV prevention method. Whereas this
approach has been selected by the WHO and UNAIDS
as a new prevention device, some papers show that it
remains a controversial and problematic issue to be
discussed. Last but not least, the abstracts reflect also
the diversity of methodological approaches ranging
between quantitative using statistical methods, through
qualitative working with discourse analyses, some casestudies. More topics are developed in this special issue,
which give an idea of the diversity of fields and the
creativity of health professionals, social and behavioral
professionals, researchers and volunteers. All these indi-
viduals—professionals or non-professionals are dedicated to a positive vision a of sexuality and sexual health
and have tried to present and validate their work to the
community of those engaged in the recognition of
sexual health as a positive view of sexuality which needs
to be enhanced and protected.
Alain Giami,1 Pierre Assalian,2 Roy Levin,3
Kevan Wylie4
1
Inserm, CESP Centre for research in Epidemiology
and Population Health, U1018, Gender, Sexual and
reproductive health, F-94276, Le Kremlin Bicetre,
France; 2Dept. of Psychiatry, McGill University,
Montreal, Canada; 3Sexual Physiology Laboratory,
Porterbrook Clinic, Sheffield, United Kingdom;
4
Porterbrook Clinic, Sheffield, United Kingdom
References
Bland L., Doan L. (Eds.). (1999). Sexology in Culture. Labelling bodies
and desires. Cambridge: Polity Press.
Escoffier J. (2003). Sexual Revolution. New York: Thunder’s Mouth
Press.
Giami A. (2002). Sexual health: the emergence, development, and
diversity of a concept. Annu Rev Sex Res, 13, 1–35.
Robinson P. (1976). The modernization of sex. New York: Harper &
Row.
Weeks J. (1981). Sex, Politics and society : The regulation of sexuality since
1800. London: Longman.
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Proceedings from the 20th WORLD CONGRESS OF
SEXUAL health
glasgow, united kingdom, june 12–16 2011
GOLD MEDALIST
3
1
THE NEUROANATOMY OF SEX AND LOVE
SEDUCTION IS A NECESSARY COMPONENT
OF SEX IN LONG STAYING RELATIONSHIPS
A. Vansteenwegen
Cath.Univ.Leuven, Pellenberg, Belgium
Partners are different in most aspects of their sexuality. In the fallingin-love-period sex goes straightforwardly. But in a long staying living
together relationship these differences come about. They cannot be
solved by negotiation because large parts of human sexuality ‘happen’
to us. One ‘feels’ a desire for sex. One ‘gets’ aroused. One ‘gets’ an
erection, a vaginal lubrication, an orgasm. One ‘becomes’ satisfied. We
cannot negotiate about these aspects because we are not in control over
them.
How do couples then cope with their sexual differences? Seduction
is a way to manage these differences between the partners. Satisfying
sex is only possible if these differences are taken seriously. Sex in a long
staying relationship is a result of a seduction wherein the sexual differences between both partners are solved. Sex has essentially to do
with seducing and being seduced. Seduction is kind, tender, suggestive
and not demanding.
2
HIV AND SEXUAL HEALTH: A MESSAGE
FROM JAPAN
C. Ikegami
PLACE Tokyo, Tokyo, Japan
Fifteen years of data shows a continued increase in men infected with
HIV in Japan. Ninety percent of people living with HIV/AIDS
(PLWHA) are male, with seventy percent of these cases attributed to
homosexual contact. Meanwhile, numbers of infected females has flatlined at less than 10 percent. These factors may provide an explanation:
heterosexual couples use condoms to prevent pregnancy (which also
prevents infection), and men who have sex with men (MSM) have only
recently become a focus of HIV prevention programs. However,
PLACE Tokyo has been developing and spreading a message aimed at
everyone that goes beyond differences in gender and sexual
orientation.
First, “Sex feels better when you feel safe about sex.”
Second, “Love won’t protect your sexual health.”
Third, “If you make a mistake, it’s not the end of your life.”
The basic message is to think positively about sex, not be
deceived by love, and accept those who are infected. It is the same
for everyone, but the interpretation changes drastically depending
on the viewer. Moreover, care and prevention are a pair; research
shows that environments rife with discrimination against PLWHA
indicate that prevention efforts are not progressing. Therefore,
with PLWHA, we have been developing and implementing Living
Together, a plan that joins care and prevention efforts. Through
this, cooperation between administration, treatment, and NGOs
is becoming possible and public health policy has shifted towards
respect for human rights. But problems remain, so we continue our
efforts.
R. Cavalcanti
Cesex, Salvador, Brazil
Where does love live? Is it in the heart or the head? This question was
posed by Shakespeare in the Merchant of Venice. In homage to the
sexologists and neuropsychologists let’s remove sexuality of the heart
and put it in the head. But in which part of the head? For Franz Joseph
Gall the centers of the love were in the occipital region. Today the
neuropsychologists demonstrate that the left hemisphere is the logical
side and in the right the creative. Thus, the love as a dreamer must be
in the right side and sexuality that is more concrete must be in the left
side. Studies of the neurotransmitters, more specifically the dopaminérgic system, it is possible to observe that love and sexuality live in
the mesolimbic system, that it is related with the system of reward,
desire and pleasure. Using Functional Magnetic Resonance Imaging,
Bartels and Zeki of the University of London have shown that certain
regions of the limbic system are illuminated when the person is falling
in love. I say that there is the light of the romantic love. But it is
impossible not to also consider the cerebral chemistry of the love, the
role of pheromones, and the function of the neurohormones. But
leaving the brain for a moment, couldn’t the capacity for love depend
on the genetic configuration of individuals. Observations in the United
States, with mice of the Microtus type, found that with Microtus
ochrogaster they have a monogamous behavior while with Microtus
montanus the animals are promiscuous. Everything is related with the
receptors for vasopressin. The unfaithful males have few receptors and
the faithful males have many more. Genetic manipulation can transform unfaithful mice into monogamous ones and also make faithful
mice become promiscuous. The fidelity or infidelity depends on the
size of the microsatellite of the DNA. I was very apprehensive when I
saw that our microsatellite of DNA has the same size of the microsatellite of the unfaithful mice! It was strengthened by studies carried out
at the Karolinska Institute where they found evidence that the infidelity of the human being depends on allele 334, gen that manages the
vasopressin. I believe that it is better to say that love is in the head,
not as Shakespeare said: in the heart or the head?
4
RECONCILING RELIGIONS WITH
SEXUAL JUSTICE
W.R. Stayton1,2
Community Health and Preventive Medicine, Morehouse School of
Medicine, Smyrna, GA, 2Center for Education, Widener University, Chester,
PA, USA
1
All of us are sexual human beings from conception to death. Humans
are also spiritual being in that one often looks for meaning to life and
experience outside of oneself, including sexual questions. Who am I
sexually? What does it mean to be sexual? What is my sexuality all
about? Why do I feel this way sexually? What is the meaning of my
sexual experience? Almost all of us are also born into some type of
religious community. What does one’s religious upbringing or community teach about sexuality? Seldom are sexuality, spirituality and
religion in harmony with one another. Spirituality may or may not be
a part of one’s vocabulary and may or may not be considered religious.
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Sexual science is often suspicious of religion; religionists often do not
trust sexual science, especially in regards to sexual justice issues as
outlined in the WAS Declaration on Universal Sexual Rights. One’s
search for meaning about their sexuality is often not helped by their
religious teachings and community.
My career, as an ordained clergy, psychologist, and sexologist has
been to reconcile religious belief systems with current scientific knowledge about sexuality and sexual justice issues. This presentation will
emphasize the importance of religious systems in promoting sexual
health and responsible sexual behavior with the need for sexual science
to bring understanding about sexual behavior and sexual justice to
enlighten those religious systems. Universal sexual rights and universal
moral values are more deeply connected than are the world religions
and the field of sexology.
5
THE LIFE WORK OF A SEXUAL HEALTH
EDUCATOR AND RESEARCHER
B. Whipple
Rutgers University, Voorhees, NJ, USA
Dr. Whipple will review the past, present and future of her interdisciplinary research concerning women’s sexual health. She will discuss
how she became interested in sexuality education for health professionals and how that led to conducting sexuality research. She will
include her re-discovering and naming of the Grafenberg spot (G spot)
and the phenomenon of female ejaculation. The adaptive significance
of the G spot will be discussed, that is the strong pain blocking effect
produced by anterior vaginal wall stimulation as well as during labor
and childbirth. The variety of female sexual responses will be reviewed
that have been documented in her human physiology laboratory from
vaginal, cervical and imagery-induced orgasm to studies concerning
orgasms in women with complete spinal cord injury. The various
sensory pathways that are involved in female sexual responses, including fMRI of the brain studies during orgasm will be discussed. Future
directions of her research program will be presented.
7
MINDFULNESS APPLICATIONS TO WOMEN’S
SEXUAL DYSFUNCTION
L. Brotto
Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC,
Canada
Introduction: Mindfulness is the practice of intentionally being fully
aware of one’s thoughts, emotions and physical sensations in a nonjudgmental way. Although mindfulness is rooted in Eastern spiritual
practices, it is rapidly being embraced in Western approaches to both
physical and mental health care.
Method: The empirical literature testing mindfulness for sexual problems is limited to two non-controlled studies and one qualitative study
in non-distressed couples. Among the latter, a mindfulness-based
intervention significantly enhanced relationship satisfaction and
reduced distress (Carlson, Carlson, Gil, & Baucom, 2004). In the two
non-controlled studies, a 3-session mindfulness-based group therapy
significantly improved several indices of sexual function and reduced
sexual distress in women with iatrogenic sexual desire and arousal difficulties (Brotto, Basson, & Luria, 2008) and in women with sexual
arousal disorder associated with gynecologic cancer (Brotto, Heiman,
et al., 2008). The goal of this presentation is to discuss the findings
from four controlled trials evaluating a mindfulness-based cognitive
behavioral sex therapy in diverse samples of women.
Results: To be presented.
Discussion: Among different samples of women with
(1) Provoked Vestibulodynia,
(2) sexual dysfuntion associated with gynaecologic cancer,
(3) iatrogenic hypoactive sexual desire disorder, and
(4) sexual distress associated with a history of childhood sexual abuse,
a 4-session mindfulness-based cognitive behavioral intervention
significantly improved several indices of sexual function and significantly reduced distress compared to a wait-list control group.
These studies provide further support for the utility of incorporating
mindfulness into an array of complex sexual symptom presentations.
PLENARY SPEAKERS
8
6
EFFECTIVE SEX-ED: CONFESSIONS BY
A BELIEVER
CULTURAL ASPECTS OF SEXUALITY
P. Aggleton
School of Education & Social Work, Brighton, UK
Over the past three decades, there has been a veritable explosion of
work in the field of sexuality. From a relatively limited field, dominated
primarily by medicine, sexology and psychiatry, sexuality has expanded
across a wide range of social sciences. Many factors have influenced
what has taken place. Disciplines such as history, anthropology, sociology, and psychology have sought to find new ways of understanding a
world in which sex and sexuality are highly visible. Growing attention
towards sexuality has been triggered by a set of increasingly visible
social movements (e.g. the women’s movement, the LGBT movement). Finally, concern for population and development, sexual and
reproductive health, HIV/AIDS, has provided new legitimacy for work
on sex, sexuality, and health. Using contemporary examples, this paper
reflects on the nature and consequences of some of these changes, and
focuses on three recurrent sets of concerns: the search for meaning(s),
the importance of sexual culture(s), and the vitality of social structure
as a factor constraining and facilitating sexuality in individuals, communities and societies.
I. Vanwesenbeeck1,2
Rutgers WPF, 2Utrecht University, Utrecht, The Netherlands
1
Evidence in support of effectiveness of (school-based) sexuality education is increasing, yet remaining modest. Proof of the effects of sexuality education on biomarkers such as HIV-incidence is notably hard to
come by. This paper discusses the many reasons why this is the case.
Reasons pertain to, for instance, characteristics of the educational
programmes or the way they are taught, to the principal nature of
learning, to (‘golden standard’) research-methodological issues, to the
choice of outcome measures employed, or to the multi-determinedness
of sexual health. Considering all constraints and limitations, it is almost
a wonder that any effects are ever empirically shown at all. However,
in light of the general argument on the necessity of sexuality education,
such evidence is secondary. Believing in the beneficiality of sex-ed is
good sense and legitimate in itself. The same is true for the conviction
that young people everywhere are desperate for information about sex
and have a right to be educated, or for the notion that adequate sexuality education is a conditio sine qua non of sexual health and crucial in
light of global development goals. In calling for particular types of
evidence, sex-ed’s broader objectives are narrowed down, and its many
merits put out of sight. Not surprisingly then, the call for ‘evidence’
is often strategically entered into the political and moral wars over
sexuality education. In this keynote I take the opportunity to reflect
on sex-ed’s rationale, on the promises and challenges it (presently)
holds, and on directions for future sex-ed research.
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9
SEXUAL PERVERSION? CULTURAL AND
MEDICAL VIEWS THROUGHOUT HISTORY
J. Peakman
History, Birkbeck, University of London, London, UK
This paper will explore cultural and medical views on sexual health in
the past with a focus on sexual perversion. It takes as its subject matter
the dynamics of sex and power, the labelling of certain sexual acts as
perverted, and its effect.
So what is sexual perversion? Indeed, is there any such thing? The
term ‘sexual perversion’ when applied to an act immediately implies a
moral judgement. A ‘perverted’ act is one which is against the norm,
breaking away from the acceptable. The labels used to define these
acts are usually ‘normal’ or ‘abnormal’. Universally, both historically
and today, heterosexuality is defined as the definitive line of
‘normality.’
In this paper, I challenge the concepts of ‘normal’ and ‘abnormal’ as
a dividing line for sexual activities through an examination of sexual
activities in history—oral and anal sex, homosexuality, bestiality, S&M,
self-mutilation. I will raise the question of how power is brought to
bear on the decision-making process when applying these labels—or
indeed any laws in deciding what is acceptable or unacceptable in
sexual interaction. I will see how understanding the past may bring us
to a more equal resolution to accepting sexual difference now, and in
the future—a must for good sexual health.
10
SEXUAL RIGHTS, PARENTS AND
YOUNG PEOPLE
G. Greer
IPPF, London, UK
Investment in young people’s health and education is critical for their
wellbeing, resilience and development. The recognition that young
people are also human rights holders and sexual beings, entitled to
enjoy their sexuality, is a more contentious concept.
In some countries, parents’ desire to protect their children from
unplanned pregnancy, STIs and exploitation makes it difficult to accept
young people’s desire for meaningful relationships, their need for
information and confidential services, and thus deny them rights linked
to their sexuality. The outcomes are often negative, shrouding sexuality
in fear and guilt. Conversely, in other areas young people may be
denied their human rights in other ways as parents seek to impose
harmful traditional practices, or forced early marriage.
The role of parents and caregivers is central to young people’s
development. Laws and policies further shape the context for creating
the desired enabling, caring and respectful environment.IPPF’s Declaration of Sexual Rights considers these issues, based on human rights
entitlements and the realities of young people’s lives in the 21st
century. Likewise, community based programmes to discourage
parents from arranging early marriages and removing girls from
school, can be effective and life changing, as IPPF’s recent Girls
Decide initiative demonstrates.This paper will examine a number of
these issues, and explores how a paradigm of rights and respect
between parents and young people can contribute to richer relationships, more positive attitudes towards sexuality for both parents and
young people, and the achievement of young people’s potential and
resilience.
86
been linked to cardiovascular disease, Alzheimer’s disease, all cause
mortality and premature death.
Late onset hypogonadism looks set to be an increasingly common
problem with our ageing population. As men get older, testosterone
levels fall and resistance to its action increases, partly due to rising sex
hormone binding globulin (SHBG) levels. This age-related drop in
testosterone is made worse by co-morbidities and the drugs used to
treat them, particularly the metabolic syndrome and diabetes. In
primary care, it would seem appropriate for doctors to consider testing
testosterone levels in all at-risk men over the age of 40 years. Advice
on the benefits of exercise, weight loss, stopping smoking, moderating
alcohol consumption and the optimisation of CVD risk factors should
be the initial approach.
Treatment of those patients with signs and symptoms suggestive of
testosterone deficiency supported by biochemical evidence, may lead
to significant improvements. There should be a discussion of the benefits and risks of treatment and a commitment to long-term follow up,
to monitor for prostate disease, polycythaemia and the presence of
sleep apnoea.
Currently endocrinologists are seeing an increased number of referrals, and urologist’s workloads are likely to increase as more GP’s refer
patients for prostate biopsies.
Long-term hard outcomes and the resultant cost effectiveness is not
been established for testosterone therapy and this is an important area
for future research.
12
THE SOCIAL ORGANIZATION OF SEXUALITY
J. Weeks
Faculty of Arts and Human Sciences, London South Bank University,
London, UK
Sexuality is a profoundly social experience, and sexual activities are best
seen as complex, intricately interconnected social practices. Since the
1950s we have witnessed a great transition in the social organization
of sexuality. The impact has been uneven both in the west, the epicentre of the transition, and in the rest of the world, but the impact has
been profound. Amongst the key elements are the following:
• A democratisation and informalization of personal relations, accentuated both by globalization and cybersex, breaking the connections
between sex and reproduction, sexuality and marriage, marriage and
parenting, marriage and heterosexuality, and heterosexuality and
parenting.
• The development of a new sense of sexual agency, especially on the
part of women, but also among hitherto unorthodox, marginalized
and minoritized sexual subjects, most famously LGBTQ identified
peoples.
• A reordering of the boundaries between what were traditionally seen
as public and private activities, leading to the withdrawal of formal
regulation from some activities (such as homosexuality) and the
emergence of new forms of international regulation (for example,
of sexual abuse, human trafficking and child pornography).
• A heightened sense of risk, dramatized by the HIV/AIDS pandemic,
but at root shaped by the breakdown of traditional patterns of life.
This feeds into wider social conflicts, especially contemporary
fundamentalisms.
Understanding these cross currents, and their cultural and political
impact, is crucial to the ways we respond to questions of sexuality and
health, and develop a sense of our needs and common humanity.
11
13
TESTOSTERONE IS A MUST!
INTIMACY, DESIRE AND THE
“DIFFICULT COUPLE”
M. Kirby
Faculty of Health & Human Sciences, Hertfordshire, UK
Testosterone deficiency can significantly reduce quality life through
the symptoms it causes. In addition to its association with the metabolic syndrome and type 2 diabetes, testosterone deficiency has also
D. Schnarch
Crucible Institute, Evergreen, CO, USA
Sexual desire problems are widespread and therapists often find they
are among the hardest sexual difficulties to treat. Couples with severe
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relationship or personal problems often fair particularly poorly. When
therapists approach desire problems as something is going wrong, it
makes difficult couples more difficult. This presentation offers a paradigm-changing view of human sexual desire, explaining why normal
healthy couples have problems with sexual desire, intimacy and emotional gridlock-and nothing is going wrong. The non-pathological
Crucible Approach integrates sex and marital therapy, self-differentiation, brain science, and interpersonal neurobiology, allowing clients
to create desire, passion, personal growth, and better relationships
simultaneously (Schnarch, 2009, 1991).
Difficult couples do best when confronted with broadly-based
tightly integrated “isomorphic” treatment used by a well-differentiated
therapist. Differentiation is the ability to maintain our own sense of
self in important relationships with others. Our urge to develop and
maintain a self is one of the primary drives of human sexual desire. Sex
is part of the natural differentiation-driven people-growing processes
of emotionally committed relationships. Approaches that harness these
powerful dynamics can help the widest range of severely distressed,
dysfunctional, and poorly differentiated couples with desire and intimacy problems. However, the ultimate limiting factor in treating difficult couples is the therapist’s personal differentiation.
Schnarch, D.M. (2009). Intimacy & Desire: Awaken the passion in your
relationship. (New York: Beaufort Books).
Schnarch, D.M. (1991). Constructing the Sexual Crucible: An integration
of sex and marital therapy. (New York: WW Norton)
14
PHOSPHODIESTERASE-5 INHIBITORS IN
MEN WITH HIV
W. Dinsmore, E. Mccarty
Dept Genitourinary Med, Royal Victoria Hospital, Belfast, UK
Recent reports of PDE5 inhibitors as recreational drugs have raised
concerns about of health risks: primarily with drugs of abuse e.g.
ketamine and amyl nitrate increasing the risk of dangerous drug interactions . There is also an association between the use of PDE-5 inhibitors and high risk sexual behaviour. Prescribing PDE-5 inhibitors to
those with HIV infection is an area of controversy as there may be
potential for transmission of infection.
Aim: The study aims to determine the use of PDE5 within a cohort
of HIV positive men..
Results: 50 patients were prescribed PDE-5 inhibitors at HIV clinic
during the study period. The median age was 46 years (range 27–64).
20% were heterosexual and 80% were MSM. 46% were in a monogamous relationship, 42% were single and 12% described being in an
open relationship. 27 (54%) patients accepted an STI screen. Of these,
5 were diagnosed with early syphilis, 1 with late syphilis, 2 with urethral chlamydia and 2 with urethral gonorrhoea. Advice on the use of
recreational drugs and “poppers” was documented in only 28% and
16% respectively. Discussion regarding safe sex and information on
post-exposure prophylaxis (PEPSE) was documented in 80%.
Conclusions: PDE-5 inhibitors in HIV infected men is controversial.
It may however be argued that condom use is impaired by inability to
achieve and sustain an erection.Caution should be exercised in those
on ritonavir-based antiretroviral regimes and avoidance in those using
particular recreational drugs.
15
STEM CELL RESEARCH IN ED
T.F. Lue
Urology, Uninversity of California, San Francisco, San Francisco, CA, USA
Stem cells hold great promise for regenerative medicine because of
their ability to self-renew and to differentiate into various cell types.
Although embryonic stem cells (BSC) have greater differentiation
potential than adult stem cells, many hurdles regarding ethical concerns and governmental restrictions limit its progress to clinical application. Bone marrow stem cells (BMSC) are the best-studied adult
stem cells (ASC) and have the potential to treat a wide variety of dis-
eases, including erectile dysfunction (ED). Adipose tissue derived stem
cells (ADSC) are virtually identical to bone marrow stem cells in differentiation and therapeutic potential. These cells can be harvested in
larger quantities, and have the associated benefit of reducing obesity.
Therefore, ADSC appear to be a better choice for future clinical
applications. We have shown that ADSC could restore the erectile
function in rat models of ED from nerve injury (Albersen et al, 2010)
, diabetes (Garcia et al, 2010) and hyperlipidemia (Huang et al, 2010).
We also noted that mesenchymal stem cells exist in bone marrow and
in vessel wall of small blood vessels throughout the body. We and
others have recently propose that they should be named “vascular stem
cells” (Lin et al, 2008, 2010). They are likely the precursors of endothelial cells and pericytes and are thus important in vascular health and
diseases. Better understanding of the biology of these cells may be the
key to prevention and reversal of various types of ED.
16
SEXUAL PROBLEMS AND PELVIC FLOOR
HYPERACTIVITY IN WOMEN
E.T. Laan
Sexology and Psychosomatic OBGYN, Academic Medical Center, University
of Amsterdam, Amsterdam, The Netherlands
Pelvic floor hyperactivity is associated with complaints on all three
‘outlets’ of the pelvic floor: obstructive or frequent micturation, IBSlike complaints, and dyspareunia. We propose two possible etiological
pathways for pelvic floor hyperactivity: (1) primary pelvic floor hyperactivity (trauma, neglect, toilettraining, ‘overtraining’, psychological
‘make-up’), and (2) secondary pelvic floor hyperactivity (after sexarche)
associated with repeated painful ‘unaroused intercourse’.
In this talk I will present a questionnaire that we developed to
measure symptoms associated with pelvic floor hyperactivity. It’s 7
scales were found to reliably discriminate between women with and
without a hyperactive pelvic floor as assessed by a gynaecologist using
ICS guidelines. Women with dyspareunia and vaginismus were found
to have more symptoms associated with pelvic floor hyperactivity than
women without sexual problems. In addition, I will present work with
a vaginal probe that we developed that measures genital arousal
(vaginal pulse amplitude), sensibility of the vaginal wall and pelvic floor
EMG simultaneously. In a first study this probe was found to be a very
sensitive measure of pelvic floor muscle tone in asymptomatic women.
The probe will enable us to study whether (chronic) pelvic floor hyperactivity is directly related to reduced vaginal blood flow, and to directly
assess the relationship between pelvic floor EMG, pelvic floor symptoms and sexual complaints.
17
COMMON SEXUAL COMPLAINTS IN
CONSERVATIVE SOCIETIES:
UNCONSUMMATED MARRIAGES &
SMALL PENIS
H. Ghanem
Andrology, Sexology & STDs, Cairo University, Cairo, Egypt
Objectives: To highlight 2 sexual complaints that are prevalent in
conservative societies of the Middle East. These include Honeymoon
Erectile Dysfunction (ED) and Body Dysmorphic Disorder (Penis).
The high prevalence is probably related to cultural myths and lack of
sexuality education.
Methods: We review the etiologies and management for unconsummated marriage.
We also review the literature and evaluate the evidence about what
the normal penile size is, what patients complaining of a small penis
usually suffer from, benefits versus complications of surgery, penile
stretching/traction devices, and patient education and counseling
versus surgery.
Results: Six to 17% of patients presenting to sexual dysfunction clinics
in Egypt and Saudi Arabia complain of unconsummated marriages.
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Most cases are diagnosed to be mainly psychogenic in origin (performance anxiety or Vaginismus), and are managed through a combination of psychosexual therapy, sex education and short-term use of
PDE-5 inhibitors.
Research from Egypt shows large numbers of patients presenting
with concerns regarding penile size. We propose a practical approach
for evaluating and counseling patients complaining of a small sized
penis. Based on the current status of evidence, surgery is still considered experimental.
Conclusion: The prevalence rates of these 2 disorders remain alarmingly high and warrant serious public awareness and sex education
programs in the Middle East and in countries with Immigrant populations from the Middle East.
18
MALE GENITAL MODIFICATION—AN
HISTORICAL AND CONTEMPORARY REVIEW
K. Browne
HIV Prevention in Rural Development Enclaves, ADB & PNG NDOH,
Port Moresby, Papua New Guinea
The modification of the ‘natural’ body has been occurring ever since
concepts and perceptions of self and other shifted to an understanding
of attraction and competition for mates became established in early
homo sapien cultures. Hair removal through cutting and shaving, face
and body painting, tattoing, neck, lip and ear lobe elongation, foot
binding, ear and nose piercing, corsetry, body building, and dieting,
have a well documented history across diverse cultural contexts.
Genital modification may not have as long a documented history or
acknowledgement in popular culture, but, the types of modifications
listed above are also performed on the genitals of women and men.
This paper will attempt to review the complexity of male genital
modifications and compare western European modifications with
those occurring historically and currently in the developing country
non-Western context. The paper will explore the rationale behind
modifications and discuss the benefits and harms associated with
their use.
19
THE SEXUAL TIPPING POINT®: A MIND/
BODY MODEL FOR THE PAST, PRESENT
& FUTURE
M.A. Perelman
Psychiatry, Urology & Reproductive Medicine, NY Weill Cornell Medical
Center, New York, NY, USA
The Sexual Tipping Point (STP) Model® arose from approximately
two decades of collaboration with Kaplan, at NY Weill Cornell
Medical Center. Kaplan (1995) described a “psychosomatic” dualcontrol model of sexual motivation emphasizing “inhibition/excitation” processes. Yet, by 2000, worldwide media seemed exclusively
focused on the “robust” efficacy of sexual pharmaceuticals. It seemed
critical to advance a model that would help professionals and the public
alike, understand that sex is always both “mental and physical”. STP
was intended to easily describe the mind/body concept (underlying all
psychophysiological phenomena): “mental” factors can “turn you on”
as well as “turn you off”; the same is true of the “physical” factors.
Although explained in earlier presentations, STP gained a larger audience with the JSM (2005) publication of “The Sexual Tipping Point”
abstract, that described this etiological model for sexual function and
dysfunction. The STP model complemented the early seminal work
of Bancroft and later Jansen, Graham, & Sanders who provided erudite
articulation of “dual-control” theory, psychometrics, and comprehensive research. However, STP remains a very convenient heuristic
device when advocating for sexual counseling to be integrated with
current and future “translational” medical advances, in-order to
provide a combination treatment having the best benefit/risk for
patients with sexual disorders.
88
References:
Bancroft J, Graham CA, Janssen E, Sanders SA. The dual control
model: current status and future directions. J Sex Research.
2009;46(2–3):12–42.
Kaplan, HS. The Evaluation Of Sexual Disorders, Brunner/Mazel,
1995, NYC.
Perelman MA. “The Sexual Tipping Point®: A Mind/Body Model
For Sexual Medicine.” J Sexual Medicine, 2009;6(3):629–32.
20
CRIMINAL RESPONSIBILITY AND
THE PARAPHILIAS
S. Hucker
Psychiatry, University of Toronto, Toronto, ON, Canada
In most jurisdictions assessments of criminal responsibility by mental
health professionals requires a consideration of whether the accused
has a mental disorder and whether that mental disorder resulted in
impairment of the accused’s ability to perceive the world correctly and
rationally and whether it impaired the ability to control their
behaviour.
A brief overview of the typical legal tests of criminal responsibility
will be given as well as some examples of the ways in which individuals
with paraphilias have attempted to argue in court that their disorder
rendered them not criminally responsible. Those cases of paraphilia
which are successful do not usually succeed in claiming that the paraphilia itself impaired their legal responsibility but rather some other
co-existing mental disorder.
21
SEXUAL RIGHTS FROM A
YOUTH PERSPECTIVE
A. Singh
Adolescents & Young People, International Planned Parenthood Federation,
South Asia Regional Office, New Delhi, India
Introduction: What do Sexual Rights mean to young people around
the world in different situations and cultures? The paper attempts to
explore—through practical examples and voices from the ground—the
implications of Sexual Rights on the lives of adolescents and young
people, while detailing the history of Sexual Rights in the International
Planned Parenthood Federation (IPPF).
Objective: To increase understanding of what Sexual Rights for young
people means in practice
Background and aims: IPPF has long supported the Sexual Rights of
young people. In 1996 young IPPF volunteers developed a poster on
their Sexual Rights while in 1998 they wrote the Youth Manifesto.
Once the IPPF Declaration on Sexual Rights was adopted, they developed a guide that enables other young people understand what Sexual
Rights means for them. This practical application will be highlighted
for programme and service providers.
Methods: The paper will take practical examples around providing
sexual and reproductive health services to young people and study
some of the dilemmas that service providers may face. Case studies will
also be used to examine the notion of ‘parental rights’.
Conclusion: These dilemmas refer especially to the evolving capacity
of the child (as mentioned in the Convention on the Rights of the
Child) and its relation to the need for protecting children and young
people versus the need to enable autonomous decision making among
children and young people.
References: Exclaim! Young people’s guide to Sexual Rights (2010)
Sexual Rights: An IPPF Declaration (2008)
Voice! IPPF/Youth Manifesto (2000)
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WHO SUPPORT TO COUNTRIES IN
IMPROVING SEXUAL HEALTH
G.L. Lazdane
Sexual and Reproductive Health Programme, WHO Regional Office for
Europe, Copenhagen, Denmark
WHA in 2004 adopted the WHO Global Reproductive Health (RH)
Strategy that includes “promoting sexual health (SH)” as one of its core
aspects. To assist Member States in evaluating progress towards the
attainment of international RH goals a framework for implementing
the Strategy was published in which detailed actions and process and
outcome indicators are suggested for implementation at programme
levels (http://www.who.int/reproductivehealth/publications/general/
RHR_06.3/en/index.html). In 2010 WHO launched a holistic, multisectoral and interdisciplinary approach to planning and services delivery for sexual health entitled “Developing sexual health programmes:
A framework for action” (http://www.who.int/reproductivehealth/
publications/sexual_health/rhr_hrp_10_22/en/index.html). A detailed
explanation of possible SH interventions covers the following areas:
laws, policies and human rights; education; society and culture; economics; and health systems. The WHO Regional Office for Europe in
collaboration with the Ministry of Health, Social Policy and Equity of
Spain, the IPPF EN and BzGA, a WHO collaborating centre in
Cologne, carried out an analysis of the SH of adolescents, older people,
migrant populations, people living with HIV and people with disabilities, that was discussed during a meeting of national counterparts
from more than 30 countries and international partners working in
the area of SH. “Standards for sexuality education in Europe: A framework for policy makers, educational and health authorities and specialists” was presented and the standards have already been adapted and
adopted by several countries of the WHO European Region. Further
possible assistance from WHO to improve sexual health will be based
on the requests of its Member States and the governing bodies of
WHO.
23
“HOMOSEXUALITIES” AND “HOMOPHOBIAS”
IN LATIN AMERICA: BALANCE AND
PERSPECTIVES
J. Barrientos Delgado
Psychology School, Universidad Catolica del Norte, Antofagasta, Chile
Latin American countries are highly patriarchal and are characterized
by a machismo culture of male dominance and a rigid characterization
of masculinity. Different studies have shown that significant changes
are taking place in sexual and gender values in Latin American countries, but attitudes towards the LGTB population have changed more
slowly. This presentation formulates a synthesis of the uses and concepts of “homosexuality” and “homophobia” in Latin America, particularly in the last three decades, and demonstrates that the stigma
and discrimination towards LGTB populations persist in the region.
The presentation shows the evolution of attitudes towards gay men
and lesbians in different Latin American countries, using data from
various sources (World Values Survey, Gay Pride studies and specific
studies in each country). In addition, it provides a synthetic analysis of
the legal framework existing in the countries of the region in relation
to LGTB population, showing the problems in different areas (for
example: same sex-unions, same-sex marriage and anti-discrimination
laws).
Next, it makes a critical review of social research regarding “homosexualities” in the region (and the roles that the LGBT movement,
social sciences, universities and sexologists have played in it). It also
describes the use of research tools to establish public policies related
to sexual diversity on a regional basis. Only in the 80s, when HIV/
AIDS appeared in the region, was this theme considered a legitimate
line of scientific research. LGTB organizations helped supply effort
and resources to this task. The public policies didn’t do anything,
except help to HIV-related problems. Only in the last few years have
some countries like Brazil and Argentina made important changes to
improve the social situation of the LGTB population (anti-discrimination laws and efforts to fight towards discrimination, and same-sex
marriage in Argentina) This presentation also deals with the main
regional advancements and retrogressions concerning homophobia
and its effects on the LGBT population, particularly those referring
to quality of life and welfare.
Finally it analyzes the main challenges of the next few years and it
analyzes the social, cultural, and political conditions of the region that
may or may not influence the amount of respect for differences and
the role of sexology and sexologists in this area.
24
THE MIND AND THE GENITALS
M.P. McCabe
Psychology, Deakin University, Burwood, VIC, Australia
Research has clearly indicated that biological, psychological, social and
cultural factors impact on sexual response. This paper will examine the
contribution of psychological factors to the development of sexual
response in both men and women. Both long term and current psychological factors will be considered, as well as differences in the
responses of men and women to the factors. I will also discuss the
extent to which it is possible to link particular psychological variables
to particular problems in the response cycle, or whether the factors
have a more general association with sexual dysfunction. Examples of
variables that will be discussed are sex-specific variables (e.g., sex guilt
or shame, sexual anxiety, and performance anxiety), mood variables
(e.g., depression, anxiety, stress) and responses to the relationship (e.g.,
relationship satisfaction, conflict, communication). The way in which
psychological variables can enhance or impede sexual functioning will
be discussed.
25
NEEDS OF ‘MOST-AT-RISK POPULATIONS’
(MARP) INCLUDING SEXUAL MINORITIES
VERSUS POLITICS OF PROTECTION
S.I. Khan
Social and Behavioral Sciences Unit, Public Health Sciences Division,
ICDDR,B, Dhaka, Bangladesh
Background: Under the trademark of targeted HIV interventions,
social and sexual needs of MARP including sexual and gendered
minorities are quietly buried. Studies mostly measure behavioral risks
and explore ‘superficial’ reasons for not practicing safer behaviors
resulting in questionable outcome of HIV interventions.
Methods: Data of this article came from various studies conducted in
Bangladesh since early 1990s. This article has described diverse crisis
encountered by MARP inclduing gendered and sexual minorities, and
argued that unless structural interventions are implemented, HIV prevention goal remains unachieved.
Findings: Since early 1990s, millions of dollars are spent for purchasing condoms/lubricants and safer injection equipments but little has
been spent to improve water and sanitation of brothels; millions are
spent for operating drop-in-centers and STI treatment, but limited has
been done to strengthen health systems to be inclusive. Any diverse
form of gender and sexualities challenging bi-genderism or heteronormativity are condemned by political and religious leaders, whereas
significant funds already have been spent in the name of advocacy
meetings. Economic, social and sexual well-being of sexual minorities
are entrapped into politics of STI/HIV transmission.
Conclusion: In the context of multi-dimensional social and structural
crisis, ‘wrapping’ genitals with condoms/lubricants has no meaning to
vulnerable people. Multi-million dollars’ interventions in a low HIV
setting cannot be confined to condom promotion. Individual risk
reduction model must be accompanied with community and social
development initiatives with multi-sectoral involvement. We should
not forget that ‘genital safety’ has no meaning if life of the vulnerable
people remains unsafe.
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28
BETTING ON FUTURES FOR SEX RESEARCH
SEXUAL POLITICS AND THE “SCIENCE OF
SEX”: COMMON THREADS, FRACTURES AND
POTENTIALLY VIRTUOUS LIAISONS IN THE
21ST CENTURY
J.R. Heiman
The Kinsey Institute, Indiana University, Bloomington, IN, USA
Research on sexuality has the ambivalent advantage of needing and
benefiting from the best of many areas of scholarly expertise. Yet sex
research efforts are usually remarkably limited in the degree to which
researchers work with others from diverse disciplines and specialties,
or at least draw from the theories, methods and data generated from,
for example, biology, psychology, neuroscience, economics, social sciences, medicine, information technology and humanities. There are
good reasons for staying within one’s intellectual identity but the field
is not developing at a pace that justifies this as the main strategy of
inquiry. The present talk critically considers the value and cost of collaborating beyond area boundaries and proposes that the most impactful sex research, with the greatest promise of deeper knowledge over
the next decade will be incited by allied areas of expertise. These areas
will pursue a fresh look at theory, method, measurement, data analyses,
and participant qualities which include more refined sensitively to
environmental contexts. A topical case study is that of decision making,
particularly the combination of risk, emotion and rational decision
making. This is an area well-researched from a variety of frameworks
in economics and increasingly psychology and neuroscience, and has
applicability to a wide range of behaviors that have sexual health outcomes. There is now a science of risky behavior. This work has
not gone entirely unnoticed by sex researchers. Selected samples of
recent promising work will be discussed with an eye toward future
potentials.
27
SEXUALITY, OBESITY & GENDER
N. Bajos1,2
Inserm, CESP Centre for research in Epidemiology and Population Health,
U1018, Gender, sexual and reproductive health, F-94276, Le Kremlin
Bicetre, France, 2Université Paris Sud 11, UMRS 1018, F-94807, Villejuif,
France
1
Objectives: To analyse the association between body mass index
(BMI) and sexual activity, sexual satisfaction, unintended pregnancies,
and abortions in obese people and to discuss the implications for public
health practices, taking into account the respondents’ and their partners’ BMI.
Design and Setting: Random probability survey of sexual behaviours.
National population based survey of 12,364 men and women aged
18–69 living in France in 2006.
Results: Obese women were less likely than normal weight women to
report having a sexual partner in the past 12 months. Obese men were
less likely than normal weight men to report more than one sexual
partner in the same period and more likely to report erectile dysfunction. Sexual dysfunction was not associated with BMI among women.
Obese women aged under 30 were less likely to seek healthcare services
for contraception or to use oral contraceptives. They were also more
likely to report an unintended pregnancy.
Conclusion: There is a link between BMI and sexual behaviour and
adverse sexual health outcomes, with obese women less likely to access
contraceptive healthcare services and having more unplanned pregnancies. Prevention of unintended pregnancies among these women is
a major reproductive health challenge. Healthcare professionals need
to be aware of sensitivities related to weight and gender in the provision of sexual health services.
S. Sonia Correa
Sexuality Policy Watch, ABIA, Rio de Janeiro, Brazil
In the last five decades, clear gains have been achieved in societies,
both South and North of the Equator, in regard to the social acceptance of sexual plurality, agency and enjoyment. Political struggles
have also occurred resulting in the enlargement of rights in relation
to sexuality in various national contexts, but also at the level of international norms. Nonetheless, laws, cultural norms and religious prescriptions still persist, almost everywhere, which restrict the ability of
persons to express and experience their sexuality without shame or be
subjected to violation or coercion. The realms of gender and sexuality
have become battlegrounds, as dogmatic religious forces and other
conservative voices systematically invest discourses and resources to
contain the transformations that are underway.
This landscape has similarities with the European scenario of the
late 19th century that witnessed the birth of the science of sex, as
exemplified by current struggles against sodomy laws, dogmatic
religious revivals and the recourse to science as a way to contest
existing orders. But the two eras also differ in many aspects. Contemporary sexual politics is not exclusively European. It is global and
traversed by postcolonial tensions. Bodies and voices engaged in these
battles are much more diverse and much precaution is required
when resorting to scientific arguments in seeking to propel sexual
freedoms.
This paper will examine this complex scenario and explore the possibilities to reconnect a “science of sex” and sexual politics within a
perspective capable of keeping pace with the transformation of existing
sexual orders.
29
GOOD CATHOLIC SEX
J. O’Brien
Catholics for Choice, Washington, DC, USA
Contraception, abortion, masturbation, sex outside of marriage, gay
rights and sexuality education . . . for centuries the hierarchy of the
Catholic church has denounced all things sexual. The question is still
pertinent: why does the Catholic hierarchy still have a problem with
sex? Irishman Jon O’Brien, a longtime reproductive health activist and
leader of Catholics for Choice takes you on a biblical, theological,
political and hysterical journey to try and understand the mindset of
the bishops. The mindset that not only tries to inculcate guilt into
Catholics but attempts to influence the public policy agenda on everything from opposing condoms to prevent the spread of HIV to a
woman’s right to abortion to comprehensive sexuality education.
30
ETHICAL WORK OF REGULATORY
AGENCIES
J.L. Fourcroy
Urology, Uniformed services University Health Sciences, Bethesda, MD,
USA
“The first step in the evolution of ethics is a sense of solidarity with
other human beings” (Schweitzer). Change came with the Nuremberg
Code (1947) including informed consent, need for scientific merit.
right of patient to withdraw, and understanding the benefit balance.
To sign an informed consent one must have the ability the to give
consent, understand the circumstances and the information given
(1964 World Medical Association and the Declaration of Helsinki). D
r Jay Katz was important in addressing the complex issues of medical
ethics and the interaction of ethics, law, medicine and psychology
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laying the foundation for clinical and regulatory research. The purpose
of biomedical research involving human subjects must be to improve
diagnostic, therapeutic and prophylactic procedures and understanding of the etiology and pathogenesis of disease. Progress is based on
research, which ultimately involves human subjects. On July 12, 1974,
the U.S .National Research Act (Pub. L. 93–348, created the National
Commission for the Protection of Human Subjects of Biomedical and
Behavioral Research. This Belmont Report attempts to summarize the
basic ethical principles identified in the course of its deliberations.
The basic principles are respect for persons, beneficence, and justice.
The voluntary consent of the human subject is essential. In clinical
research, the safety of research subjects is important. The charge is to
minimize the likelihood of harms. Human subject protection includes
Health Organizations worldwide. Ensuring Ethical Promotion of
Pharmaceutical Products is essential worldwide.
30B
SURVEYS OF SEXUALITY AND
SEXUAL PRACTICE
Juliet Richters
School of Public Health and Community Medicine, University of New South
Wales Sydney, Australia
Large-scale sex surveys are sexy—from a media point of view. Journalists love to cite figures on how many people say they have seen a porno
in the past year (and if they were alone at the time), how often the
average person has sex, how many gay people there really are, and so
on. At the same time, journalists also attack or make fun of the published results, claiming that “no one tells the truth in those things
anyway”.
Survey teams bring together epidemiologists, psychologists, sociologists and demographers. All approach the task of designing the survey
questions and analysing the answers in different ways. People from
different disciplines make different assumptions and draw on different
conceptual frameworks. The multidisciplinary team approach naturally creates tensions, if often productive ones. Even in this multidisciplinary team framework, however, one important perspective is often
missing: linguistics. An interview or written questionnaire is, after all,
a discursive interaction in which the question-setter and the respondent try to understand each other.
This is especially true in crafting text for computer-assisted telephone interviews. What do terms like “sexual contact” or “sexual
partner” mean to an ordinary person responding? Does it match with
what a sex researcher means? How do you word questions about specific sexual practices so that they are simple enough for uneducated
respondents to understand but at the same time are appropriately
formal so as not to sound sleazy?
There are also political pressures on any sex survey. Lobby groups
from rights activists to religious groups engaged in anti-rights activism,
not to mention governments and pharmaceutical companies, all have
uses for the results of sex surveys. How do science teams negotiate
their way through these competing pressures?
We know more about these issues than the journalists think. In fact
these questions can all be answered more or less successfully. With care
we can indeed ensure that most of the time people tell the truth, or at
least the truth as they understand it.
Juliet Richters is part of the team that conceived and ran Australia’s
first large-scale national sex survey of 19,307 men and women interviewed by telephone in 2001–2002. The same team is conducting the
2012 survey. She also has experience in surveys of gay men and lesbians, college students and prisoners, and in-depth interpretive research
on sexuality.
SYMPOSIA
31
HOW CAN A SMALL NATIONAL SOCIETY
INFLUENCE SEXUAL HEALTH?
D. Edwards
White House Surgery, Chipping Norton, Chipping Norton, UK
Introduction: This symposium will give a flavour of what a small
national society (British Society for Sexual Medicine BSSM) can offer
concerning the important topic of male and female sexual
dysfunction.
Background and Aims: It will illustrate how its diverse membership
(which includes medical practitioners of many specialisms, nursing
specialists and psycho-sexual therapists) can be a strength or weakness.
Issues concerning organisation of such a group from an administrative,
funding aspect and running a national conference will be discussed.
There will be separate presentations demonstrating what the society
has actually achieved recently. This will include the BSSM androgen
guidelines for both men and women which have recently been updated.
Guidelines on the use of vacuum erection devices on patients with Ca
Prostate is another example of how locally written articles can be useful
to health care professionals. The important role of psycho sexual
therapists and how they fit into the BSSM will be presented.
32
LOW FREE TESTOSTERONE, ERECTILE
DYSFUNCTION AND THE FREQUENCY OF
THE ERECTIONS IN 1,706 MEN
R. Runciman1, M. Bartholo1, A. Wood2, D. Steward1, D. Davies-South1,
T. Bennett1, K. Wylie1
1
Porterbrook Clinic, University of Sheffield, 2North Trent Rotational
Training Scheme in Old Age Psychiatry, Beighton Hospital, Sheffield, UK
Objective: To corroborate the association of low testosterone
(LT), erectile dysfunction (ED) and age with frequency of
erections.
Method: Patient records of 1,706 men at the Porterbrook Clinic and
the Royal Hallamshire Hospital with erectile dysfunction were analysed for correlation between LT levels and erection frequency over
three age groups: 18–49, 50–64 and 64+ years. Frequency of erections
was noted by patients as occurring ‘every day’, ‘2–3 times a week’, ‘once
a week’ or ‘less than once a week’ in a variety of situations. Free testosterone was low <8 nmol/L (LT), borderline 8.1–12 nmol/L and
normal 12.1+ nmol/L (NT).
Results: A clear association was noted between LT and age; 10.9%
aged 65+, 8.6% aged 50–64 & 6.9% aged 18–49. Erections occurring
‘everyday’ on waking were more prevalent within NT men; 4.8% in
the youngest age group (18–49) (27.8% in NT men), 10.9% (20.0%
in NT men) aged 50–64 and 5.1% (11.4% in NT men) aged 65+.
Similarly, erections occurring ‘2–3 times a week’ on masturbation happened more frequently in NT than LT men; with 7.1% (46.5% in NT
men) aged 18–49, 43.8 % (45.2% in NT men) aged 50–64 and 17.9%
(33.1% in NT men) aged 65+. Furthermore, erections occurring ‘2–3
times a week’ during oral sex were more prevalent in NT men; 7.1%
(24.6% in NT men) aged 18–49, 1.6 % (19.2% in NT men) aged
50–64 and 5.1% (6.6% in NT men) aged 65+.
Conclusions: A correlation exists between ED, LT, age and the frequency of erections.
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SYPOSIUM: RELIGION AND SEXUAL HEALTH
MULTIPLE MEANINGS OF ORGASMS
P. Weerakoon
Graduate Program in Sexual Health, University of Sydney, Sydney, NSW,
Australia
Syposium:
(i) Some Biblical Principles for Sexuality
(ii) Sexuality and Hinduism
(iii) Sexual Health, Sexual Ethics and Islam
Aims: To explore how sexual health and sexual ethics are represented
in major world religions and how these are relevant to the 21st century.
A panel of experts will present an overview of sexuality, sexual heath
and sexual ethics from the perspective of Christianity, Judaism, Hinduism and Islam. Each presenter will then be allowed short ‘speech bytes’
on hot topics in sexual health including issues such as abortion, same
sex marriage/adoption, sex education, gender roles, prostitution/sex
trade, pornography.
34
THE MEDIA: SEXUAL HEALTH SAINT
OR SINNER
S. Quilliam1, P. Hall2, M. Barker3, R. Findlay4, S. Nasserzadeh5,
Y. Ohlrichs6
1
Self-employed, Cambridge, 2Relate, London, 3Social Sciences, Open
University, Milton Keynes, 4Family Planning Association, London, UK,
5
Pfizer, New York, NY, USA, 6Rutgers Nisso Group, Utrecht, The
Netherlands
Over the past decade in particular, the public media—radio, television,
print, the internet as well as social networking such as Twitter and
Facebook—has been blamed for many of the problems in our sexualised society. Banner headlines, celebrity shock stories, pornography
of all kinds—none of these are helpful to the cause of sexual health,
sex education and a mature view of sexuality.
But is there another side to the story? For the media also communicate positive, helpful sexual messages, provides accurate sex education, and offers confidential routes by which those with sexual problems
can be supported.
This symposium presents a wide range of evidence and viewpoints
from all sides of the media and sexology communities worldwide, to
give delegates a comprehensive appreciation of the dangers but also
the benefits of the media. This will not be a formal debate, but a
round table of current practice that informs the audience, allows them
the opportunity to interact, question and challenge—and also
resources them to work with the media to present sexual issues
effectively.
35
ORGASMS ACROSS CULTURES
S. Nasserzadeh
Private Practice, New York, NY, USA
Cultural differences in understandings of orgasm.
Different cultures with their particular views about gender role
within a relationship might have diverse views on Orgasm, how it
should feel, what it represents and who is entitled to it. This brief talk
will be an overview of the subject with a couple of case reports to shed
some light on the topic.
Take home messages:
• Orgasm could send different messages men and women in the
context of a particular culture
• Presenting problems about orgasm could be worded differently by
different clients based on their cultural values and linguistic abilities
(both in English and in their native language)
• The concept of mutual pleasure is a core concept to be discussed
when discussing orgasmic abilities
M. Barker
Psychology in Social Sciences, The Open University, Milton Keynes, UK
Diagnoses and therapy with people who are struggling with orgasms
tends to assume that orgasms are a positive experience which adults
should be having during sex. This brief presentation considers the
multiple possible meanings of orgasm for people, both between different people and within the same person at different times. Drawing on
Peggy Kleinplatz’ ideas that bodies which struggle to have certain
kinds of sex may carry a message, it highlights the importance of
understanding what orgasms—and their lack—mean to clients before
working with them to make any changes.
Take home messages:
• Orgasms mean different things to different people at different times
• Understanding the individual meaning of orgasm is vital to therapy
• Bodies that do not orgasm in expected ways may be carrying a message
• Opening up the possibilities for orgasmic, and non-orgasmic, experiences can be valuable
37
BESIDES ORGASM: BROADENING THE PATH
OF SEXUAL INTIMACY
A. Iantaffi
Division of Epidemiology and Community Health, University of Minnesota
School of Public Health, Minneapolis, MN, USA
Many people who seek sex therapy see orgasm as an essential goal to
be achieved. Yet, this can often become an obstacle to interventions
that challenge clients to broaden their definition of sex. It can also
hinder people’s search for intimacy, which often seems to be a motivating factor when seeking therapeutic help in relation to sexual issues.
This seems to be a central issue in particular when working with
individuals and couples working within an heteronormative paradigm.
Drawing on queer theory and insights from research carried out with
people who identify as queer, polyamorous, asexual and/or BDSM
practitioners, this brief presentation will highlight how many people
and communities have found several alternative paths to intimacy
besides orgasm and how using those insights and experiences in both
therapy and research could benefit the broader community.
Take home messages:
• Orgasm can become a hindrance to therapeutic improvement for
some clients.
• Heteronormative discourses have traditionally considered orgasm as
the privileged path to sexual intimacy.
• Many people within non-mainstream communities have created
other ways in which sexual intimacy can be obtained and valued.
• Recognizing broader concepts and experiences of sexual intimacy in
both clinical and research contexts can be beneficial.
38
WORKING WITH ORGASMS
BIOPSYCHOSOCIALLY
T. Barnes
Private Practice, London, UK
Sexual motivation, arousal, response and satisfaction need to be understood in a biopsychosocial context which factors in cultural and personal meaning, not only function. Two conceptual models will be
presented which assist the clinician in assessing and understanding the
key sexual and relationship issues as experienced by the individual and/
or couple.
Take home messages:
• Sexual difficulties and disorders may be identified and understood
in terms of a “sexual circuit” which encompasses sexual motivation,
arousal and response systems.
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• Clinical assessment of sexual problems should address predisposing,
precipitating and maintaining factors within a biological, psychological; emotional, relational and cultural framework.
• Sexual problems in the woman may be a functional and protective
mechanism in response to sexual disorders experienced by her
partner, or to relationship and/or sexual conflict.
• Choice of therapeutic options should be informed by their efficacy,
sustainability, tolerability and acceptability, as well as availability and
cost.
39
BETWEEN GLOBALISATION AND NATIONAL
CULTURE: THE TRANSFORMATIONS OF
SEXOLOGY INTO SEXUAL MEDICINE IN
EUROPE AND LATIN AMERICA
A. Giami1, J.A. Russo2
Inserm, CESP Centre for research in Epidemiology and Population Health,
U1018, Gender, sexual and reproductive health, F-94276, Le Kremlin
Bicetre, France, 2IMS/CLAM, Universidade do Estado do Rio de Janeiro,
Rio de Janeiro, Brazil
1
Objectives: Sexology is a field of knowledge, science and professional
practice that has been developed since the beginning of the XXth
century in various regions such as Europe, USA and Latin America.
Beyond this global development, national and cultural versions of
sexology have been developed in each of these countries. The presentation will include a comparative approach between six Latin American
countries and seven European countries.
Methods: Social-historical analysis of professional and scientific publications, contextualization in the larger cultural and political context,
ethnographic studies including participation in congresses and conferences, interviews with key informants and field professionals, were
carried in the six Latin American countries. On the other side, a multicentric survey was carried in seven European countries.
Results: The results offer a comprehensive overview of the field,
where sexology, sexual health, sexual rights and sexual medicine appear
in complex interaction, showing different configuration in each
country and above that in each region. The political context, the social
organization of medicine, psychology and other health disciplines, the
development of psychoanalysis, the importance of religion influence
the national construction of sexology nationally and give to each
country a specific profile.
40
CLINICAL SEXOLOGY IN CONTEMPORARY
BRAZIL: THE PROFESSIONAL DISPUTE
AMONG DIVERGENT MEDICAL VIEWS ON
GENDER AND SEXUALITY
J.A. Russo1, F. Rohden2
Institute of Social Medicine, State University of Rio de Janeiro, Rio de
Janeiro, 2Social Anthropology, Federal University of Rio Grande do Sul,
Porto Alegre, Brazil
1
This paper is based on an extensive investigation of the Brazilian sexological field. The research team interviewed twenty four leading brazilian sexologists, participated in several congresses and seminars, and
examined the most relevant publications in the sexological area. The
discussion will focus on the dispute between the two medical specialties
that dominate brazilian sexological field: gynecology and urology. We
intend to show how the original profession of the sexologist is related
not only to the way sexuality and gender are conceived, but also to the
way sexology itself is defined and practiced. We believe that the divergences and tensions between professional views and practices point to
the complexity of contemporary medicalization of sexuality and gender.
41
PROFESSIONALS IN CHILE OR THE
DIFFICULTY OF BEING CALLED
SEXOLOGISTS: WHO ARE THEY?
WHAT DO THEY DO?
J. Barrientos
Psychology School, Universidad Catolica del Norte, Antofagasta, Chile
The aim of this paper is to describe the professional group of sexologists in Chile. Findings show that 53 Chilean professionals define
themselves as such. Eleven of these professionals were interviewed.
Most of them have trained themselves by practicing in the field, not
in academic or specialized institutions. They call themselves specialists
but not sexologists: their practice is very similar to classical sexual
therapy, but it is not defined as such. They participate in the mass
media to educate, reeducate, demythologize, indicate, and recommend; however, they feel mutually suspicious of their motivations.
They have modeled a kind of intimate conversation in the mass media,
from educational formats first, then self-help formats, and the development of the so-called docu-reality lately.
42
THE EVOLUTION OF SEXOLOGY IN
NORDIC COUNTRIES
O. Kontula
Population Research Institute, Helsinki, Finland
Nordic countries are an encouraging example how collaboration
between neighboring countries can improve sexology. An important
agency for this evolution has been the Nordic Association for Clinical
Sexology (NACS) that was founded soon after the World Congress of
Sexology in 1978 in Rome. The first NACS conference was organized
already in 1979. It was decided that NACS will be mainly an umbrella
organization with the main task to invite people from the national
organizations to an Annual Conference. First Statutes were drafted for
NACS in 1980.
First members of NACS Board were Preben Hertoft, Thore Langfeldt and PO Lundberg. The first Nordic multidisciplinary sexological
journal was called in 1983 Nordisk Sexology. In 1994 NACS meeting
was organized in Copenhagen in co-operation with the second
Meeting of the European Federation of Sexology (EFS). Since 1998
Scandinavian Journal of Sexology was published for four years.
In last years of the 1990s NACS applied economical support from
the Nordic Council. It created in collaboration with Sweden, Norway,
Denmark, and Finland an educational program for sexual counselors
and clinical sexologists. This consensus was accepted as a common
Nordic program in six Nordic countries in the NACS meeting of 1999.
In 2000 common requirements and criteria for authorization was
accepted in the NACS meeting. First Nordic sexologists were authorized in 2002. Today there is a possibility to become authorized in
addition to Sexological Counselling and Clinical Sexology also in
Sexual Education and Sexual Health Promotion, and in Sexual Science.
43
THE STATE OF THE ART OF CBT FOR MEN’S
SEXUAL DYSFUNCTION
P.J. Nobre
Departamento de Educação, Universidade de Aveiro, Aveiro, Portugal
Despite the emergence of some therapeutic proposals, sex therapy
continues largely missing the potential positive effects of the cognitive
theory principles. In addition, there is a lack of research on treatment
outcome for sexual dysfunction. Empirically supported psychological
treatments for sexual dysfunction are scarce and mostly based on Master’s and Johnson sensate focus techniques, systematic desensitization
or specific behavioural procedures (masturbation training, squeeze,
etc.). Surprisingly, no randomized control trial studies have been
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published so far testing the efficacy of cognitive behaviour interventions for Erectile Dysfunction. CBT has been successfully used for a
variety of psychological problems and are by far the most listed empirical supported psychological treatment. Most significantly, CBT has
proved to yield more durable benefits than different pharmacological
interventions for depression (DeRubeis & Crits-Christoph, 1998;
Hollon et al., 2005), panic disorder (Craske et al., 1991), and bulimia
nervosa (Shapiro et al., 2007). The author will present a RCT project
testing the efficacy of a Cognitive-behavioural intervention for Erectile Dysfunction in comparison to oral medication (PDE5 Inhibitors)
and a waiting list control group.
44
MINDFULNESS-BASED CBT AND WOMEN’S
SEXUAL DYSFUNCTION: APPLICATIONS FOR
LOW DESIRE, SEXUAL DISTRESS, AND
PROVOKED VESTIBULODYNIA
L.A. Brotto
Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC,
Canada
Mindfulness is the practice of intentionally being fully aware of one’s
thoughts, emotions and physical sensations in a nonjudgmental way.
Although mindfulness is rooted in Eastern spiritual practices, it is
rapidly being embraced in Western approaches to both physical and
mental health care.
The empirical literature testing mindfulness for sexual problems is
limited to two non-controlled studies and one qualitative study in
non-distressed couples. The author co-developed a 3-session mindfulness-based CBT and tested it in two non-controlled studies. It was
found to significantly improve several indices of sexual function and
reduce sexual distress in women with iatrogenic sexual desire and
arousal difficulties (Brotto, Basson, & Luria, 2008) and in women with
sexual arousal disorder associated with gynecologic cancer (Brotto,
Heiman, et al., 2008). The goal of this presentation is to discuss the
findings from four controlled trials evaluating a mindfulness-based
cognitive behavioral sex therapy in diverse samples of women.
Results: Mindfulness-based interventions led to significantly improved
measures of sexual response, reduced sexual distress, reduced catastrophizing, and improved indices of mood, anxiety, and quality of life in
our diverse samples.
Discussion: Among different samples of women with sexual dysfunction, a 2- or 4-session mindfulness-based cognitive behavioral intervention significantly improved several indices of sexual function and
significantly reduced distress compared to a wait-list control group.
These studies provide further support for the utility of incorporating
mindfulness into an array of complex sexual symptom presentations.
45
SEX THERAPY FOR SEXUAL PAIN: DOES IT
MAKE SENSE?
Y.M. Binik
Dept. of Psychology, McGill University Health Center, Montreal, QC,
Canada
The so-called “sexual pain” disorders, vaginismus and dyspareunia,
have been treated quite differently in the past. Women suffering from
vaginismus were typically treated via a Masters & Johnson progressive
dilatation method. Until recently, this type of treatment was considered a sex therapy success story. On the other hand, women suffering
from dyspareunia, were rarely treated via sex therapy but were typically
either referred for medical intervention or for treatment of a presumed
underlying psychosocial cause for their pain (e.g. abuse, couple dysfunction, depression etc). Unfortunately, both of these treatment
approaches were based on theory, tradition or the prevailing influence
of important clinicians rather than on data. Recent randomized controlled trials have suggested that the Masters and Johnson treatment
for vaginismus is not as successful as had been thought. On the other
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hand, recent RCTs for the treatment of dyspareunia have suggested
the CBT type treatments combining pain management and sex therapy
are very useful. The future of sex therapy in the treatment of dyspareunia and vaginismus will be discussed.
46
ADDRESSING THE DISTURBED, LIKE
RIPPLES IN WATER. NETWORKING FOR
CHILDREN WHO TRANSE
E.E.P. Benestad1,2
1
Health and Sports, University of Agder, Kristiansand, 2Grimstad MPATInstitute, Grimstad, Norway
“Children who transe” , is a group to deserve attention from professional health workers. Since a majority of children who trans grow up
to be either lesbians, gays and/or transepeople, they are at risk for
suicide and other grave psychological consequences.
When brought to professional attention, children who transe will
often be taken to centralized specialists within the health care systems.
This goes especially for the somatic boys, since they evoke much more
anxiety than the somatic girls.
Centralized offers can but to a minor degree meet these children’s
special challenges, since those are to be found in their immediate and
extended networks.
The clinical work and experience described in this presentation has
been collected over a period of 10–15 years. The focus of the work has
been all those around the children who are or might be disturbed by
them. Like ripples in water, the children’s different networks are being
schooled into a better and more nuanced understanding of sex, gender
and gendered expressions.
This networking has proved to be very effective in relieving the
tensions and anxieties in the extended networks of children who transe.
47
TRYING TO THINK PSYCHODYNAMICALLY ABOUT A SERVICE FOR
TRANSGENDER PEOPLE
P. Valerio
Neuroscience, Naples University Federico II, Naples, Italy
Gender is a core aspect of human experience and crosses biological,
psychological, social, cultural, and religious categories. It is difficult to
convey the depth of feeling of bodily wrongness that many trans people
live with. Mental health professionals may be perceived as gate keepers
who hold the key to their salvation or who are denying them their only
chance of rescue. Feelings are intense and there is often an urgent
desire for action that will bring relief. In such circumstances, maintaining a rational frame-work for thinking can become very difficult.
This paper describes practices and structures in the working of a
gender identity clinic that are founded on psychoanalytic work. We
aim to understand the subjective experience of patients with gender
problems, and how this pain is transmitted and experienced by others,
rather than attempting to look for the aetiology of the clinical phenomena. The clinic aims to offer the containing environment that may
have been absent developmentally, in an attempt to reflect, contain and
modulate anxiety and to assist patients towards a reasoned decision
about their future. I will address two main issues, the importance of
the assessment process in fostering thought and reflection, and transference and counter-transference issues that are commonly encountered. This will be prefaced by brief consideration of the role of a
psychoanalytically-informed mental health professional in a gender
identity clinic and will conclude by considering the implications for
the development and provision of services.
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48
50
TRANSGENDER IDENTITIES AND
PRACTICES: PRELIMINARY RESULTS OF
A NATIONAL MULTI-CENTRIC SURVEY
IN FRANCE
TRAPS OF A HEALTH-BASED APPROACH TO
THE TRANSGENDER PHENOMENON IN
JAPAN
A. Giami, E. Beaubatie
Inserm, CESP Centre for research in Epidemiology and Population Health,
U1018, Gender, sexual and reproductive health, F-94276, Le Kremlin
Bicetre, France
Objective: A multicentric national survey concerning “trans” identities and practices was carried out in France in 2009–2010. Trans
individuals were recruited through Public Hospital Clinics (19%),
Private practice health professionals (30%) and Transgender NGO’s
(37%). 381 “trans” individuals completed a self-administered questionnaire and mailed it back to the research team anonymously. The
questionnaire included socio-demographic items, questions on transgender health and sexuality for a total of 117 questions.
Results: 26% reported that they were female at birth and 73% male
at birth. The questionnaire included an open-ended question about
“self-defined gender identity”. About 200 different responses were
given and categorized via content analysis. Among those assigned as
male at birth: 52% defined themselves as “women”, 22% as “transwomen” and 13% as “trans”. Among those assigned as female at birth:
50% defined themselves as “men”, 23% as “transmen” and 12% as
“trans”. The various options expressed by the respondents in their own
words appear to be more associated with their various modes of transition (hormonal treatment, sex reassignment surgery, other surgery,
etc.) than their assigned gender at birth. The presentation will sketch
the social and psychological correlates of the various gender identity
profiles found in this study.
Conclusion: This survey allows one to describe the wide spectrum of
subjective expressions of gender variance among “trans” individuals
living in France. It appears that it is more accurate to refer to these
individuals in terms of their self-defined gender identity rather than
in terms of their assigned gender at birth.
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FROM TRANSSEXUALISM TO
TRANSGENDERISM . . . CHANGING HEALTH
PRACTITIONERS’ CULTURE
D. Medico
Agnodice Foundation, Lausanne, Switzerland
Mental health practitioners in Switzerland were used to handle
«trans» people as individuals suffering from a gender identity problems, and access to appropriate care was rare. Their use of the term
«transsexualism» reflects their medical view of gender diversity which
is somehow a “pathologising” and binary model (Hirschauer, 1998).
Their approach of gender diversity expression could be associated to
«theoretical mistreatment» (Sironi, 2005). This model is now openly
challenged by the trans community, and more and more, by health
practitioners themselves. In the traditional model of «gender identity
problems», practitioners were constraining themselves to a gatekeeping role in the medical transition process or in reorientation therapies.
At the same time, many transgender issues were not taken into account
except for transitioning.
As an alternative, the Agnodice foundation implements a pioneering
model of multidisciplinary participative care for transgender clients.
This session will present the work we are currently doing in Switzerland, along with transpeople and practitioners (private and public),
building a network and putting ethical concerns into action. Our work
is focused on transgender health issues, transparent and participative
actions, education of practitioners, medical staff and social workers, an
internet platform, a network of mental health and other professionals,
supervisions and the development of empowering therapies for transgender clients. We implement a transition from a medical view -transsexualism- to a social and citizencentered view of gender variety
-transgenderism.
Y. Higashi
Department of Humanities and Social Sciences, Osaka Prefecture University,
Sakai, Japan
Despite numerous historical examples of the roles and acceptance of
gender-crossing within Japanese culture from as early as the 4th
Century, modernization has come with a stigmatization of the transgender phenomenon and homosexuality outside of the confines of
show business. However, with the official recognition of the legitimacy
of Sex Reassignment Surgery (SRS) as a treatment for Gender Identity
Disorder (GID) given by the ethics committee of a private university
in 1996, followed by the enactment of “Law Concerning Special Cases
in Handling Gender Status for People with GID” (Law No.111; July
16, 2003), the situation surrounding trans-people changed dramatically and GID has become a medical issue. This health-based approach
has been successful to the extent that society has developed a tolerance
to discuss at least the needs of people diagnosed with GID who fit in
the traditional gender dichotomy. It is hoped that this development is
just an initial step for Japanese society to move forward to embrace
more diverse trans-people and meet their needs as well. Unfortunately,
little evidence can be found to suggest further changes or advances,
and members of the younger generation may connect with the medical
establishment before they encounter diverse trans-/sexual minority
communities and explore different options and possibilities. In this
presentation, key historical events related to the transgender phenomena are reviewed leading to a discussion of the impact of the medical
conceptualization of GID on the current status and issues surrounding
trans-people who fight for sexual rights in Japan.
51
SEXUALITY IN THE PALLIATIVE CARE
PHASE OF LIFE: THE PATIENT AND
THEIR PARTNER
M. Redelman
Sydney Men’s Health, Bondi Junction, NSW, Australia
The Palliative Care Phase of the life cycle is often a sad difficult time
when the ending of life for one of the partners is nearing. It is a
complex time of ‘saying goodbye’ while at the same time ‘clinging to
life’ and the ‘relationship and love’ one has with the other. These
intertwining needs are often difficult to manage and our patients and
their partners may benefit from professional assistance.
‘Sexuality’ may be especially important at this time as it is ‘sexuality’
rather than ‘sex’ that defines the meaningful relationships people have
with themselves and significant others. And when sexuality is lost or
changed, important avenues of expression and communication may
also be lost.
Research shows that many patients/partners value sexuality throughout their life and want health professionals to assist them in making
the best of their sexual potential in this phase of living. Research shows
that health professionals acknowledge the importance of sexuality for
their patients but have difficulties acting on their beliefs and especially
when illness, aging and dying are involved.
Sexuality, as defined by the patient, needs to be given a place in
holistic management. It is also important to remember that there are
two individuals in the sexual relationship. Maybe the surviving partner
also needs assistance.
For patients who mourne the loss of their sexuality, having a health
professional raise the issue is a weight off their shoulders.
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52
SEXUALITY AND INTIMACY AFTER BREAST
CANCER IN JAPANESE CULTURAL AND
CLINICAL CONTEXT
M. Takahashi
Department of Public Health, Dokkyo Medical University, Tochigi, Japan
Breast cancer is a major cause of morbidity and mortality in Japan,
with the age-adjusted incidence rate of the disease being the highest
among cancers afflicting Japanese women since 1994. This presentation discusses the prevalence of sexual dysfunction experienced by
Japanese BC survivors and its correlative factors. It also discusses the
meaning of sexual relationship for Japanese couples based on the
survey results that revealed survivors’ perceived deterioration of sexual
relationship after BC does not necessarily lead to their perceived deterioration of the couple’s overall relationship. Support activities by
Japanese healthcare providers in clinical and community settings will
also be introduced.
53
INCORPORATING THE TOPICS OF
INTIMACY & SEXUALITY INTO CANCER
SUPPORT SERVICES
D. Brandenburg
Cancer/Health Psychology, Cancer Psychology Department, Queen Elizabeth
Hospital, Birmingham, UK
Breast cancer rates have increased by more than 50% in the last 25
years, making breast cancer the most common cancer type in the UK
at the present time and the second most common across the globe. As
screening and treatments have improved, cancer has moved from being
seen as a mostly fatal disease towards a recognition of it being a chronic
illness, with more than ¾ of breast cancer patients surviving their
diagnosis by more than 10 years.
In this context, a gradual shift has taken place towards increasing
consideration of the longer term consequences of cancer treatments.
Amongst these, the sexual side effects of cancer treatments are amongst
the longest lasting if left untreated. Approximately 50% of women
recovering from breast cancer are reporting sexual difficulties as a
direct consequence of their cancer treatments. These staggering
numbers pose a difficult challenge to an already overstreched NHS
and other health care systems world-wide in the midst of an economic
crisis.
This presentation will explore the specific needs, issues and
wishes of the breast cancer population and provide an overview of
current service provision models, their advantages and disadvantages.
Clinical results and reflections from a sexual rehabilitation service for
cancer patients are discussed. Real service models at the present time
rely on the willingness of individual practitioners to look beyond
their own specialism and promote true MDT working often across
traditional boundaries of disciplines, location and individual
organisation.
54
VAGINISMUS—THE FORGOTTEN PARTNER
M. Redelman
Sydney Mens Health, Bondi Junction, NSW, Australia
How does the male partner cope when the female partner has severe
penetration anxiety resulting in impenetrable spasm of the pelvic floor
muscles? Very little attention has been given to the male partner and
the few studies that exist are small.
Although it is the woman who experiences the vaginismus, the
problem is a relational one experienced by 2 individuals. Single women
not interested in sexual relationships rarely present for help.
This presentation will consider the effects on the male partner—the
non-presenting patient. Relevant factors may be the personality characteristics of the man, cultural expectations of male /female roles and
96
behaviours around sex, sex education, knowledge and personal
experiences.
There may be differences in response between Western and Eastern
cultures especially when considering personal choice/dating scenario
marriages versus arranged marriages where the couple has not spent
time together and where both may be virgins.
Most men worry that their penis is too small, but what if it is too
big? What is the incidence of sexual difficulties in men whose partners
have vaginismus? And which comes first?
What are the anxieties faced by the male in this situation and what
are his unmet needs? And what is the impact on the relationship and
procreation aspirations?
And finally, the non-presenting patient can be an ally or an enemy,
and it is better to have a accomplice than a saboteur.
55
‘LET’S GO DOWN UNDER . . . . AN
EXPLORATION OF TREATING VAGINISMUS’
K. McAllister
Sandyford Centre for Reproductive Health, Glasgow, UK
Botulinum toxin is a powerful neurotoxin which causes flaccid paralysis. It has been used as a therapeutic agent for over 20 years and now
plays a role in many specialties. The first report of its use in vaginismus
was in 1997. Since then, several studies have shown its potential beneficial effect, although none have been large enough to provide evidence that it should be incorporated as a standard treatment modality.
The purpose of this talk is to provide an overview of Botulinum toxin
and share my experience in its use.
56
COUPLES SEX THERAPY IN FEMALE
ANORGASMIA CASES
E. Lenzi, R. Giommi
Istituto internationale di sessuologia, Istituto ricerca e formazione s.r.l.,
Florence, Italy
The intervention model of the Florence International Institute of
Sexology, in the sex therapy couples, devotes significant attention to
the relational and socially learned causes. For the evaluation of
these areas our operational procedures, in the psychotherapy of sexual
dysfunction, provides a working protocol consisting of specific
instruments.
The aim of our study was to determine, in the diagnostic phase of
sex therapy for couples female anorgasmia, the similarities among
female patients, the perception of the body in sexuality with their
partners and the similarities between the partners in the way of
relationship.
To evaluate the variables related to the sphere of bodily perception,
patients were asked to fill the perception of self pleasure discomfort
item. To assess how the relationship of partners in the couple works,
we used the sexual genogram.
The results will be presented and discussed.
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THERAPIST IN VIVO EXPOSURE; THE BODYMIND CONNECTION IN THE THERAPY OF
LIFELONG VAGINISMUS
R. Bernorio
Associazione Italiana Sessuologia Psicologia Applicata, Milan, Italy
Vaginismus is commonly described as a persistent difficulty in allowing
vaginal entry of a penis or other object, despite the woman’s expressed
wish to do so. Lifelong vaginismus occurs when a woman has never
been able to have intercourse starting from first sexual experiences.
The aim of this study was to investigate the effectiveness of in vivo
exposure therapy for women with lifelong vaginismus. This kind of
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therapeutic approach, starts from the hypothesis that working directly
with the woman’s body can lead to change quickly the catastrophics
beliefs related to penetration through the activation of corrective emotional experiences and the construction of a correct genital map representation in the brain cortex. The author presents data from 97
therapies for lifelong vaginismus composed by two steps. In the first
step the female participant performed vaginal penetration exercises on
herself in the presence and with the direct help of a male therapist. In
the second step the couple performed at home vaginal penetration
exercises on themselves. Therapist in vivo exposure appears to be an
effective and quick treatment for lifelong vaginismus.
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LEGAL AND ETHICAL ISSUES IN SOCIAL &
HEALTH SERVICES TO YOUNG PEOPLE
WITH INTELLECTUAL DISABILITIES WHO
WANT TO BE PART OF THE “SEXUAL
SCENE”
P. Zachariassen
Department for Neurohabilitation, Oslo University Hospital, Oslo, Norway
Background: Since 1999 Norwegian law has regulated the use of force
in caring for people with ID. The governing principles in these regulations are that force should never be exercised where alternatives, not
involving the use of force, may be optional—and force should never
be used, unless actual and considerable damage to the individual or
his/her physical or social surroundings is a likely outcome of not intervening. These legal principles also apply to restrictions that service
providers may put on an individual’s access to the Internet or using
his/her mobile phone in establishing social contacts, which could be
potentially harmful—i.e. lead to physical or psychological abuse.
This places service providers in an ethically challenging position:
they may observe that an individual puts him-/herself in a potentially
dangerous situation—yet the actual danger might not be so concrete
or imminent that interventions are warranted. The rights of the individual to make its own choices regarding intimate relationships is held
up against the responsibility of service providers to protect him/her
against exploitation, STD’s and unwanted pregnancies.
Method and discussion: Clinical cases will be presented to illustrate
and discuss these legal and ethical issues. Some general points to be
considered in such cases will be listed, and implications for clinical
practice will be discussed. It will be argued that focusing on legal and
ethical issues is important—not only in securing the rights of the
individual, but also in guiding the clinician when considering intervention strategies.
literature study shows that it involves major challenges in meeting this
requirement as it may be a contradiction between being a person with
intellectual disability and cope as a parent. Children have their own
rights described in the UN Convention of 1986.
Findings and discussion: The results of the study show that children
of people with intellectual disabilities are often neglected and that they
come under child welfare supervision.
Recommendations: The conclusion recommends a two-part model
that deals with the prevention of pregnancy and how various venues
can work together to provide parents with intellectual disabilities and
their children the best possible assistance. The recommended assistance includes sexual education programs and behavioral training
programs.
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THE RIGHT TO SEXUAL HEALTH: A PILOT
STUDY ON SEX EDUCATION AND YOUNG
PEOPLE WITH INTELLECTUAL
DISABILITIES
L. Löfgren-Mårtenson
Faculty of Health and Society, Malmö University, Malmö, Sweden
Background: In Sweden sex education has been compulsory since
1955. However, access to this still seems to be insufficient in special
schools. Worries about unwanted pregnancies, sexual abuse and sexual
risk situations make the surrounding unsecure about what, how and
who are most supposed to deal with the subject. Also, a heteronormative norm in sex education makes young gay people with ID to be an
invisible group. In addition, stereotyped gender norms where girls are
supposed to be oriented towards love and relationships and boys
towards sexuality make it harder for young people with ID to find a
more nuanced way to act.
Purpose and research questions: The study aim to strengthen the
sexual health among young people with ID, and to develop knowledge
from their own experiences that can help teachers in special school to
supply sufficient sex education. Which experiences of sex education do
young people with ID in the age of 16–21 have? Are there any similarities or differences between boys and girls? In what way, and by whom,
should sex education be supplied? What themes do the young people
with ID think is of importance?
Methods: Qualitative research interviews with young females and
males with ID in the age of 16–21 years.
The use of the study: The results from the study intend to be used
to develop an adequate pedagogic model together with the young
people with ID for sex education at special schools.
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INTELLECTUAL DISABILITIES AND
SEXUALITY: PEOPLE WITH INTELLECTUAL
DISABILITIES AND THE PARENTING ROLE.
A LITERATURE STUDY
ONLINE SEXUAL EDUCATION:
INTERNATIONAL EXPERIENCES AND
EXPECTATIONS
W. Fjeld
Habilitation Team, Habilitation Team, Sykehuset Innlandet HF, Division
Habilitation and Rehabilitation, Ottestad, Norway
Background: This literature study deals with references in the book
“Parents with Intellectual Disabilities. Past, Present and Futures”,
published in 2010. The book is written after a conference in 2006,
where IASSID (International Association for the Scientific Study of
Intellectual Disabilities) established a group of professionals called
SIRG (Special Interest Research Group) on the subject people with
intellectual disabilities as parents. SIRG uses references to the UN
Standard Rules (UN Convention on the Rights of Persons with Disabilities), which highlights the right to marry and have children. The
individual countries have to “eliminate the discrimination of people
with disabilities in all areas related to marriage, family, parenthood
and relationships with other people” (Article 23) “. . . and shall
provide assistance to persons with disabilities who have children.” The
E. Haeberle
Archive for Sexology, Berlin, Germany
The present and future role of “open access” e-learning courses
A “live” demonstration of the multilingual “open access” curriculum
in sexual health available at the Archive for Sexology. It combines
several unique features and, so far, has no competition in the
internet:
— each of its 6 courses (6 semesters) can be studied both at the Bachelor’s and the Master’s level.
The choice is up to the teachers or students depending on whether
they concentrate on the body of course itself or, in addition, follow up
every internal and external link and read the entire recommended
literature (also online at the Archive).
— the curriculum also provides links to current scientifc news about
sexual health in general and specific journalistic news reports about
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various topics covered in the individual courses. Thus, the Archve
combines the advantages of an electronic textbook with those of a
constantly updated news desk. This unique combination is designed
to stimulate discussions and to emphasize the practical relevance
of each subject studied.
Finally, additional current possibilities and likely future developments
in e-learning will be discussed.
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ONLINE SEXUAL EDUCATION:
INTERNATIONAL EXPERIENCES AND
EXPECTATIONS
M.L. Ng
HKU Family Institute, Hong Kong, China
International cooperation in online sexual health education
In 2006, by the joint effort of sexologists in China, Taiwan and Hong
Kong, the online sexual health curriculum of the Archive for Sexology
was successfully translated into Chinese (simplified and traditional)
and adopted as a “Multilingual open-access online curriculum in sexual
health” (MOOCSH) and made available to all Chinese communities
all over the world. Teaching departments in many universities or institutes in China, Taiwan, Hong Kong and Macau have since made use
of MOOCSH to assist in their undergraduate or professional training
curricula in sexual health and related topics. It has been used as:
1. standard reading material
2. reference material
3. a source of discussion topics for class or internet debates
4. a source of topics for class or internet tutorials
5. a reliable source for the Chinese-English translation of sexology
terms
6. a source for topics in student projects or study reports.
In these curricula which included MOOCSH as reading or reference
materials, all students reported that it was the first and most frequently
read material during their study period, more than the notes their
teachers developed and gave to them. The reasons were convenience,
comprehensiveness, multilingualism and simplicity. Our experience
shows that although MOOCSH is only a web-based open-access
course on basic sex education, it is a precious aid to professional sex
health training programs which for practical reasons have to rely or
web-based learning more and more.
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ONLINE SEXUAL EDUCATION:
INTERNATIONAL EXPERIENCES AND
EXPECTATIONS
A. Palha
University of Porto, Porto, Portugal
Translating a curriculum in sexual health—Problems and rewards
Our university team has, by now, translated half of the courses constituting the online curriculum in sexual health of the Archive for Sexology. Our intention is to provide a unique and important free educational
resource not only for Portugal, but also for Brazil and other Portuguese-speaking countries. We will discuss our methods used in recruiting volunteer translators, the translation work itself, the difficulties
involved in the translation, and our experiences with it up to this point.
We will also describe the potential role of this curriculum in Portuguese general sexual health education. Finally, we will present an
outlook on the future of e-learning in our and other Portuguese
universities.
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ONLINE SEXUAL EDUCATION:
INTERNATIONAL EXPERIENCES AND
EXPECTATIONS
A. Hakobyan
Yerevan State Medical University, Yerevan, Armenia
Translating a curriculum in sexual health—Expectations in Armenia
Due to a lack of comparable materials in our own country, our university in Yerevan has decided to translate the sexual health curriculum of
the Archive for Sexology into Armenian . Since this translation, like
the English original, will be freely accessible, it will benefit not only
our own students, but the general public as well. The presentation will
discuss the present sexual health needs in Armenia, the difficulties
involved in our translation, and the role it may play in our educational
system.
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PHILOSOPHICAL SEXUAL ETHICS
T. Paalanen1,2
1
Center of Excellence in Sexual Health Education, 2Nordic Network for
Sexual Ethics, JAMK University of Applied Ethics, Jyväskylä, Finland
Sexual ethics is a branch of applied ethics that concentrates on sexual
behaviour and relationships. It can be either theoretical or applied,
while theoretical approach aims to find universal principles and
methods of solving ethical problems, and applied approach deals with
individual cases, professional ethics or sexual politics.
Basic questions of sexual ethics are
1) what kinds of sexual acts are morally acceptable, and
2) what are justified grounds for banning certain acts?
Answering these questions should be based on a philosophically sound
system of sexual ethics, which consist of coherent definitions, principles and methods that can be used to assess the ethical status of any
sexual act.
The system must be general enough to adapt to differing situations
and circumstances, hence it must be derived from ethical theory concerning human interaction in general. My research is based on John
Stuart Mill’s ethical liberalism, which argues that there is only one
plausible moral principle: no one has the right to intervene into individual’s affairs if they are not harmful to others.
In this framework sexual activities are seen as morally neutral, therefore ethical evaluation doesn’t depend on the question, whether an act
is sexual or not. Instead, it is based on assessing whether the act causes
harm or violates someone’s rights. This position leads consistently to
appreciating human autonomy, freedom, rights and sexual diversity.
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NORDIC SYMPOSIUM IN SEXUAL ETHICS:
SEX WORK—AN ETHICAL AND HUMAN
RIGHTS PERSPECTIVE
S.A. Boasdottir
Faculty of Theology and Religious studies, Iceland’s University, Reykjavík,
Iceland
The predominant attitude toward sex work worldwide is that it is
immoral and exploitative of women. As a result it is most often both
morally condemned and stigmatized. Sex work, however, is not a single
phenomenon but rather a most complicated issue which can only be
understood in its social and historical context.
The aim of my paper is to investigate the question of sex work from
an ethical and a human right perspective. I will depart from a Nordic
context, more specifically from recent prostitution legislations pointing out the main moral arguments that occur in those. I critically
discuss the Nordic moral argumentation, arguing that it is impossible
to view sex work in isolation from the social and economic situation
of the sex workers in society generally. Criminalization of the client,
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which is the way chosen by some of the Nordic countries, does not
apply as the solution to all moral problems connected to sex work. It
is even important to listen to human rights approaches to sex work
which draw attention to the relationship between criminalizing sex
work and human rights violations that result from these laws and
policies.
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IS THERE A FUTURE FOR CHRISTIAN
SEXUAL ETHICS?
T. Vilponen
University of Helsinki, Helsinki, Finland
During its lifespan the church has struggled with questions concerning
right and wrong. Sexuality has always been a fundamental part of its
ethical teaching in theory and in practice. For centuries the church has
told people what is permitted and prohibited in their sexual life. The
Reformation in the 16th century brought a radical change: Martin
Luther divided earthly and spiritual regime and stated that ethics
belongs to earthly matters.
In Lutheran theology morality is considered to be the responsibility
of an individual person. Thus moral decisions can be made using
human reason without referring to religious dogma. Also sexual appetite belongs to the earthly regime and is one of the natural functions
like eating.
However, Lutheran church, along with the majority of Christian
churches, still insists that sexuality issues should be addressed according to religious conventions. Because of this churches have major
problems in dealing with homosexuality and non-marital relationships,
for example. In these issues their attachment to “Christian sexual
ethics” seems to promote inequality and even support hate-speech.
In Protestant tradition religious dogmas are seen as unchanging, but
ethics is subject to temporal and cultural changes. However, abovementioned issues often contradict this and evoke arguments based on
scripture and divine world-order. The value of such religious
approaches in ethical research and discussion are very questionable and
it must be asked if there is any future for them at all? Surely loving
one’s neighbor is valuable, but its message is not convincing unless it
is verified in practice.
68
PREMATURE EJACULATION AND ERECTILE
DYSFUNCTION: A COMPARISON OF THE
TWO MOST FREQUENT MALE SEXUAL
DYSFUNCTIONS
G.P. Adaikan1, D.J. Linton2
1
Department of OBGYN, National University Health System, Singapore,
Singapore, 2Department of Anaesthesia, Pharmacology and Therapeutics,
University of British Columbia, Vancouver, BC, Canada
Premature ejaculation (PE) is the most common male sexual dysfunction, ranging in prevalence from 20% to 30% through all ages of men
and appears to be heritable. Erectile dysfunction (ED) is highly correlated to advanced age and may be acquired. Like ED, PE can be
organic or psychogenic in origin. However, the neuro-physiology and
the mechanism of primary PE is fundamentally different.
Ejaculation latency and tumescence depend on different physiological signalling pathways. Parasympathetic transmission (both cholinergic and nitrergic) predominates in the erectile process. Sympathetic
transmission is active during ejaculation but is also antierectile. The
role of serotonin in modulating ejaculation is complex but it is clear
that increased serotonin levels centrally can prevent/delay ejaculation.
Selective serotonin reuptake inhibitors (SSRIs) are used to treat PE,
including dapoxetine, an SSRI specifically approved for the treatment
of PE. Treatment of ED depends on enhancing proerectile signalling
through the nitrergic pathway by inhibition of the breakdown of
cGMP—a secondary transmitter involved in nitrergic transmission—
by PDE-5.
Both PE and ED place a strain on relationships, and have the potential to produce anxiety, depression and a negative impact on the male’s
self esteem. Severe forms of both conditions lead to unconsummated
marriages which are very common in Asian settings and yet men with
PE are much less likely to seek treatment than men with ED. However,
increasing awareness of both conditions as well as the availability of
effective therapies holds great promise for future treatment.
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IMPACT OF METABOLIC SYNDROME ON
SEXUAL FUNCTIONING
B. Srilatha, P.G. Adaikan
Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore, Singapore
Metabolic syndrome has been identified as an important organic risk
factor for sexual dysfunction. In males, obesity per se increased the
overall risk of erectile dysfunction by 30–90% compared to normal
individuals. Similarly, women with co-morbidities of metabolic syndrome had higher incidence of arousal and desire disorders. As the
prevalence of hypertension, hyperlipidemia and atherosclerosis
increases disproportionately with obesity, genital arteriosclerosis has
been identified in almost 50% of the elderly individuals. Animal studies
have confirmed that atherosclerosis precipitated sexual dysfunction
through morphological and cellular changes; pathophysiological alterations in endothelium-dependent and endothelium-independent vasoreactivity and smooth muscle/collagen ratio have been shown to result
from long-term exposure to high-cholesterol diets. In our studies,
dietary induction of hypercholesterolemia resulted in histological
manifestations of early atherosclerosis and anti-erectile changes to
neurotransmitter-mediated cavernosal responses in rabbits. Similarly,
experimental hypertriglyceridemia compromised erectile function
with direct detrimental effects on sexual behavior and intracavernous
pressure response to nerve electrical stimulation in rats.
Holistically, sexual health and function are important determinants
of quality of life. Hence, appropriate interventions to maintain body
weight and lipids within the normal limits can have significant impacts
on the management outcome and long-term prognosis; where possible
adequate treatment should also be initiated. Lifestyle changes to incorporate regular physical activity and balanced diet are effective and safe
ways to handle the modifiable risk factors in all population groups.
Recently, there is evidence to show that early management of the comorbid factors of metabolic syndrome is likely to correct and/or
reverse the ongoing pathology in both genders.
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PSYCHO-SOCIAL AND SEXUAL CONCERNS
IN HYPOGONADAL MEN
W.-Y. Low1, S.F. Tong2, H.M. Tan3, V. Lee4, C.J. Ng5
1
Medical Education & Health Research Development Unit, University of
Malaya, 2Department of Family Medicine, Universiti Kebangsaan Malaysia,
3
Department of Urology, Sime Darby Medical Center, 4Department of
Family Medicine, International Medical University, 5Department of
Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
Objective: To examine psychosocial and sexual concerns of hypogonadal men.
Methods: Men aged ³ 40 years in the Klang Valley, Malaysia participated in the a community-based Subang Aging Male (SAM) study. The
participants completed questionnaires on demography, DASS-21,
IIEF-5 and Quality of Life scale (SF-12). Hypogonadism is defined as
total testosterone <11 nmol/L. Erectile dysfunction (ED) is defined as
IIEF score <22. DASS-21 measures depression, anxiety and stress,
scores range from 0–42 for each index—high score suggests worse
psychological morbidity.
Results: 1007 men participated (response rate 53.6%), mean age 56.6
± 8.3 years. Prevalence of hypogonadism was 15.3% (n = 154). No
difference in socio-demographic characteristics between men with and
without hypogonadism. About 65% of hypogonadal men who had
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sexual activity in the past 4 weeks, (n = 753) had ED; 35.8% mild ED,
21.1% moderate ED, 4.6% moderate-severe ED, and 3.7% severe
ED. Using DASS-21, among the hypogonadal men, 10.5% had moderate depression, 3.9% had severe/extreme depression; 14.3% had
moderate anxiety and 9.7% had severe/extreme anxiety; 3.9% had
moderate stress, 2.6% had severe/extreme stress. No significant differences in the prevalence of ED, depression, anxiety and stress
between hypogonal and non-hypogonadal men. Hypogonadal men
had significantly lower scores in SF-12 compared to non-hypogonadal
men: physical functioning, general health, vitality and bodily pain and
their physical composite score were also lower. Mental composite
scores were similar in both groups.
Conclusion: Hypogonadal men showed lower quality of life related
to physical health but not psychological health or erectile function as
compared to non-hypogonadal men.
seems to enhance interest in sexual activity. Progesterone’s function is
to a large degree unclear. Other hormones like thyroid hormones,
adrenal hormones etc. can modulate sexual behavior by their general
effects on mood, activity level etc.
Conclusion: Hormones have an indirect modulating effect on sexual
behavior and function with a large intraindividual variablity which is
probably due to the impact of cognitive processes.
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Research suggests that sexual problems are more common in women
than in men. More specifically, many studies find women to be less
motivated for sexual activity, and to have greater difficulty in becoming
sexually aroused. Also, sexual pain problems seem more prevalent in
women than in men. It is unclear to what extent these differences in
prevalence represent individual vulnerabilities on the part of women,
perhaps related to factors associated with reproductive success, or
whether these differences are related to the challenges inherent in
having sex with an individual from a different sex.
In this talk, anatomical factors are forwarded as one of the often
neglected determinants of sexual problems in heterosexual couples.
Anatomical differences between men and women make women more
vulnerable than men to developing sexual problems. Many women
don’t know what excites them or when they have reached ‘normal’ or
high arousal. Unfortunately, unlike men, women have the capacity to
‘compromise their genitals’, driven by the mistaken belief that sex is
equivalent to intercourse. This ‘capacity’ is hypothesized to be one of
the determinants of the difficulties that heterosexual couples encounter
in their bedrooms. Therefore, the author will argue that sexual arousal
is not merely a ‘bonus’ but a necessary requirement for pain free and
pleasurable sex.
SCIENCE BEHIND GENITAL SEXUAL
AROUSAL RESPONSES
L.C. Lau, P.G. Adaikan
National University of Singapore, Singapore, Singapore
Sexual arousal responses following sexual stimulation are complex neurovascular processes that are regulated by both central and peripheral
mechanisms. In male, genital sexual arousal is manifested by penile
erection while in female it is characterized by engorgement and swelling of genital tissues, an increase in tactile sensitivity and production
of lubrication mucus and fluid transudate from the cervix, periurethral
glands and vagina.
Current knowledge based upon immunohistochemistry, organ bath
studies and animal models indicates that these haemodynamic events
are intricately modulated by adrenergic, cholinergic and nitrergic pathways, neurotransmitters, neuropeptides, and endocrine milieu. The sex
steroid hormones are critical in maintaining the structural integrity of
the genital tissues, contractility of vascular and non-vascular smooth
muscle and vaginal lubrication in the case of female. Aquaporins, the
water channel proteins that regulate the transport of vaginal fluid transudate are also estrogen dependent. Vascular insufficiency, disruption
of neural pathway and imbalances in endocrine milieu are thus likely
contributing factors for genital sexual arousal disorder.
A few effective treatment options are available for male erectile
dysfunction. However, to date, there is no approved pharmacotherapy
for the treatment of female genital arousal disorder. Research is
ongoing seeking novel efficacious peripherally acting agents. Recent
observations suggest that chloride channels and P2Y2 receptors may
be potential alternative target for development of new therapy for
restoring genital sexual arousal responses in older women and menopausal women.
72
SEXUAL ASPECTS OF HORMONES AND THE
FEMALE BODY
J. Bitzer
Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland
Introduction: In the animal kingdom certain hormones are signals to
the body (brain and other parts) to behave “sexually”. They are linked
to what we call instinctive behavior, which seems to be inborn with
very little learning to it. The question arises to what degree this “sexual
function” of hormones is also present in human women.
Methods: Review of the literature.
Results: Ovarian hormones direct the menstrual cycle and are essential for reproduction. They do not seem to be directly linked to sexual
behavior and function which seems to be strongly influenced by cognitive processes like thinking, imagining, learning etc. Observational and
interventional studies with ovarian hormones indicate that the effects
of hormones seem to be more indirect and permissive rather than
“causal”. Oestrogens help maintain structural integrity, receptivity for
sensual stimuli and seem to be linked to “attractivity”. Testosterone
73
INTEGRATING PSYCHOLOGY INTO THE
SEXUAL ANATOMY AND PHYSIOLOGY
E.T. Laan
Sexology and Psychosomatic OBGYN, Academic Medical Center, University
of Amsterdam, Amsterdam, The Netherlands
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SEXUAL ASPECTS OF THE PHYSICAL
IMPAIRED FEMALE BODY
W. Gianotten
Rehabilitation Sexology, Centre for Physical Rehabilitation De Trappenberg,
Huizen, The Netherlands
Objective: The disturbances in female sexuality and intimacy cover
a wide range, with some groups receiving much professional attention,
whereas other groups seem nearly forgotten.
Frequently overlooked are the women with a physical impaired body
due to stroke, traumatic brain injury, spinal cord lesion, multiple sclerosis or a neuromuscular disease. That group. apparently less sexy,
attracts far less attention from the sexual health professionals, in spite
of extensive impact on their sexual function, sexual identity and sexual
relationship.
This presentation aims to diminish the fear to deal with this group.
Method: Review of the scarce literature and additions from clinical
practice in the physical rehabilitation setting.
Results: Next to the direct damage to sexual function, physical
impaired women have to deal with various other determinants influencing sexual health. Examples are the visibility of the impairment (less
visible ailments being more disturbing), reaction of the partner, sexual
abuse (found more in physically impaired women), the sexual education received (usually insufficient) and the attention for sexuality and
intimacy paid by the medical and educational professionals (usually
absent or insufficient).
Nevertheless the majority of these women have normal sexual desire
and they want a normal sexual life.
Conclusions: Listening to this group, it is clear that sexuality is not
only for the healthy. Sexual health professionals should be aware of the
needs of this group of women, and develop strategies to include them
in their care.
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SEXUAL ASPECTS OF THE FEMALE BODY
M. Wasserman
Sexual Health Center, Cape Town, South Africa
Sexual Aspects of the Bruised, Battered and Infected Female Body
Introduction: About 17 million women over the age of 15 years are
infected with HIV worldwide. In Sub- Saharan Africa young women
are three times more likely to be infected than men. The disease is
spread by a complex interplay of sexual behaviour and biological
factors that affect the probability of HIV transmission. Gender based
violence (GBV) is the most significant reason for women’s greater
vulnerability to HIV. Partial explanation is women’s inability to negotiate terms and conditions of sex plus high levels of sexual and domestic
violence. Focus on sexual aspects of these women are sorely neglected.
Methods: Literature review.
Results: Within this contest of violence, shame and silence, the sexual
aspects of women are seldom raised by the healh care provider or the
women. Despite female HIV infection being associated with sexual
dysfunction scant attention is given to this aspect. Microcosmic factors
including peer pressure, sensation seeking, behavioral intention,
condom use at first sexual intercourse and sexual victimization + macrocosmic factors including subordinate position of women , impoverishment, wars, rapid urbanization and decline of social services need
prioritized attention in the treatment of the sexual aspects of infected
women.
Conclusion: Sub Saharan women between the ages of 15–25 are most
vulnerable to HIV/AIDS/STI’s. The intersectionality of GBV/ impoverishment,/biological vulnerability/alcohol lead to this dual epidemic
on women: HIV/AIDS/STI and GBV. Management includes clear
microcosmic and macrocosmic interventions which require the participation of civil society and government.
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SEX AND NORMALITY: A HISTORICAL VIEW
F. Attwood
Sheffield Hallam University, Sheffield, UK
As a lecturer whose teaching frequently focuses on issues of sexuality,
I often find that students’ understandings of sex are underpinned by
very strong, though usually unarticulated feelings about what is
normal; ‘normal’ being most commonly related to an idea of ‘sexual
health’ which in turn depends on a view of ‘sickness’ as deviance. These
understandings draw less on an evidence-based approach to sexuality
and health and much more on a commonsense acceptance of customs
and taboos, usually supported by very strong and visceral feelings of
disgust or desire. In this presentation I consider a range of accounts
of sexual normality and their social implications (Rubin, 1984; Warner,
1993; Ozimek, 2010). I discuss how a historical view of sexual practices
and discourses illuminates these accounts and how it can contribute to
the interrogation of normality. Finally, I ask what more we can do to
lay bare the mechanics by which a normality of sexual health is constructed, and how we can deal with the evidence that its interrogation
is so troublesome.
77
WHAT IS (NORMAL) SEX?: DEFINITIONS
FROM DSM, SEX THERAPY AND
ALTERNATIVE SEXUAL COMMUNITIES
M. Barker
Open University, Milton Keynes, UK
Working as a sex therapist for the past five years I have been struck
that the unifying feature of virtually all the clients I have worked with
is the intense desire to be ‘normal’. Indeed, having ‘normal’ sex is
frequently privileged over sex being in any way pleasurable or fulfilling.
This presentation examines the cultural context of understandings of
normal sex today, drawing on mainstream media and popular discourse. It then considers psychiatric and psychological definitions of
functional and dysfunctional, normal and abnormal sex, which underlie
and reinforce popular understandings. Finally, the presentation turns
to alternative definitions of sex which are emerging in various sexual
communities (notably amongst those in bisexual communities, slash
writers, kink communities and asexual groups) in order to extend and
re-evaluate our standard definitions of sex. It is suggested that an
expanded understanding of sex as something multiple and constantly
in process may be a more beneficial starting point for therapy.
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RETHINKING ‘NORMALITY’ IN RELATION
TO YOUNG PEOPLE, SEXUAL HEALTH AND
POPULAR CULTURE
C. Bale1, C. Smith2
1
University of Sheffield, Sheffield, 2University of Sunderland, Sunderland,
UK
Discussions about young people, sex and popular culture often start
from positions of concern regarding the possible promotion of ‘at risk’
behaviours leading to pregnancy, abortion and sexually transmitted
infections. Thus official discourses are often couched in terms of protecting young people from ‘sexualisation’, ‘pornographication’ and
sexual ‘predators’—concerns which frame young people as continually
at risk, but often fail to recognise young peoples’ own interests in
negotiating the complexities of sexuality, being sexy and having sex and
their relationship/s with popular culture. This paper explores the
framing of sexual health in relation to young people, examining how
particular concerns are legitimised and made plausible by recourse to
fears of increasing sexual exploitation. We look at the ways in which
young peoples’ voices are drowned out by adult concerns, how young
people define and consume sexualised media/culture and suggest
implications for future research and practice.
79
AM I NORMAL? PUBLIC ANXIETIES AND
UNDERSTANDINGS OF SEX AND
RELATIONSHIPS
P. Boynton
University College London, London, UK
In this talk I draw upon my dual roles of sex researcher and media advice
giver. Using examples from questions asked by the public of researchers
and advice columns I will focus on how concepts of ‘normal’ sex are
understood by the public and reinterpreted by the media. In particular
I will focus on what is seen as ‘good’ sex, anxieties people report over
sexual response and ‘performance’ and how unhelpful messaging around
sex and relationships can often fuel people’s concerns over normality, in
turn causing anxiety, stress and relationship problems. From this I will
suggest ways we can address, subvert and reinvent concepts of ‘normality’ in both research and mediated advice giving in order to empower
people and expand their views of sexual possibilities.
80
TRAINING PROGRAMS FOR SEXOLOGISTS
IN EUROPE
O. Kontula
Population Research Institute, Helsinki, Finland
Some important improvements took place in sexological education in
many European countries already in the 1970s. The second important
wave in this progression was realized in the 1990s when training for
sexologists was activated in many countries.
An inventory of training in sexology in Europe in the 2000s was
conducted in 2007 and this data collection continued till 2010. By that
date information was available from 25 countries.
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Based on the admission criteria the following models in training in
sexology were created:
1. A medical model,
2. A clinical model, integrating medical and psychological approaches,
3. Separated education in clinical sexology and human sexology,
4. Sex therapy model, and 5. Human sexuality model including its
common Nordic model.
The most common model in European training for sexologists is that
run by a national association or by an institute; which extends up to
two years, where contact education takes place during the week-ends,
and where there is a final exam. Those who complete this all will
receive a certificate from the organisers of the education. There is a
need for training programs in sexology to build and adopt some
common standards and requirements in Europe. For the future of
sexology in Europe a common certificate in sexology would be highly
recommendable.
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MASTER IN HUMAN SEXUALITY STUDIES.
50 YEARS EXPERIENCE WITH TRAINING
SEXOLOGISTS
P. Enzlin1,2
Insitute for Family and Sexuality Studies, Catholic University Leuven—
Faculty of Medicine—Department of Public Health, 2Context—Center for
Relation, Family and Sex Therapy, UPC KU Leuven, Campus Sint-Rafaël,
Leuven, Belgium
1
In this presentation the history (overarching 50 years), theoretical
background (sexuality is a multidimensional phenomenon so education
about sexuality should be multi-disciplinary too), aims (a scientific
introduction to the field of sexology), content (the courses currently
being given in the 2 year master program) and limitations (financial,
recognition of the diploma in the work field) of our two year master
program will be presented and discussed.
82
TRAINING PROGRAMMES IN SEXOLOGY IN
THE UK. 35 YEARS ON—THE EVOLUTION
OF THE INTEGRATED, BIOPSYCHOSOCIAL
APPROACH (SEXOLOGY TRAINING
SYMPOSIUM CONTRIBUTION)
J. Fitter
Porterbrook Clinic, Sheffield Health and Social Care NHS Foundation
Trust, Sheffield, UK
Porterbrook clinic in Sheffield, is one of the only remaining institutions offering training programmes in sexual and relationship psychotherapy in the UK. The MSc/Post Graduate Diploma programme is
approved by the College of Sexual and Relationship Therapists (previously the British Association of Sexual and Relationship Therapists),
and is validated by Sheffield Hallam University. The evolution of the
training programme over more than 35 years will be discussed in the
context of other training programmes that have been, and are currently, offered in the UK.
Alongside other training providers of this type of clinical and academic training, the Porterbrook Clinic programme grew out of what
was initially a pilot interest speciality of a few clinicians. It has evolved
today into a biopsychosocial model of training and clinical interventions. It integrates MIST, systemic and medical approaches to the
assessment and treatment of individuals and couples with sexual and
relationship difficulties.
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83
TEACHING SEXOLOGY IN ITALY
R. Rossi
Istituto Sessuologia Clinica, Rome, Italy
Sexology, as a distinct science, is a complex meeting point for many
disciplines, approaches and professionals of different fields. This multidisciplinary approach draws its basic assumptions from a psychosomatic/somatopsychic perspective towards sexuality itself. The
specialized training of the operators who deal with these issues is
fundamental to the understanding and resolution of the sexual disease.
The teaching of sexology in Italy has historically been the prerogative of private institutions, which for over thirty years, have entrusted
their training courses to psychologists and medical doctors working
under various titles in the field of sexology. It is only during the last
years that Italian universities have offered courses in sexology and
master’s degrees in clinical sexology in departments of medicine and
psychology.
The Italian Federation of Scientific Sexology, bringing together the
most important Italian organizations, through the work of the Training
Commission has led to the definition of a set of educational criteria
for the qualification of Expert in Sex Education, Sexual Counsellor and
Clinical Sexologist, identifying the basic topics and specific experiences
essential to each. In addition, the Federation has worked on a Code of
Ethics for professionals in the field of sexology.
84
HEALTH-CARE PROVIDERS AND
HOMOSEXUALITY IN LEBANON:
A PROBLEMATIC APPROACH
F. El-Kak1, R. Yasmine2
Health Promotion and Community Health Department, 2Epidemiology and
Population Health Department, American University of Beirut, Beirut,
Lebanon
1
Background: Lebanon has an increasingly open LGBT community
which demands acceptance and equality within Lebanese society.
Methods: A convenient sample of 72 doctors was selected via a physicians’ network from different specialties: obstetrics/gynecology (OBGYN), family medicine and internal medicine. These doctors practice
in urban and semi-urban locations. This was a cross-sectional study
and the survey used was written in both English and Arabic. Data
collection took place between July and August 2009. Data analysis was
conducted using SPSS by chi-square or Fisher’s exact test as appropriate and significance was defined as p < 0.05.
Results: In assessing their attitudes, physicians were asked how they
would define homosexuality, most of which said that homosexuality as
a disease requiring medical assistance (42 participants; 60.0%) or psychological counseling (51 participants; 72.9%). A minority of physicians had a more positive view, seeing homosexuality as an acceptable
behavior (9 participants, 12.9%), a personal preference (20 participants, 28.6%) or a natural orientation (11 participants, 15.7%). Participants had more the option of having more than one definition of
homosexuality which is why the percentages do not add up to 100%.
Interestingly, physicians practicing in semi-urban (75.9%) areas were
more likely to perceive homosexuality as “a disease that needs medical
assistance” than those practicing in urban areas (48.8%) (p = 0.023).
Conclusion: This construct of homosexuality causes profound health
inequalities and obstructed access to health-care for the LGBT community in Lebanon. This discriminatory approach poses a real problem
in achieving sexual health and sexual rights.
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85
This Symposium consists of several presentations from various countries in the Middle East to give the audience an overall knowledge of
the sexual health education, therapy and research status in the region.
The audience would be introduced to this new Committee at the
World Association for Sexual Health and be invited to join depending
on their areas of interest.
For each of these age groups we looked at their testosterone levels
and categorised those into Low, Borderline and Normal.
We then looked for each age group, at the comparative levels of
psychiatric illness and whether these varied with testosterone levels of
Low, Borderline or Normal.
Results: In our youngest age-group of 18–49 year-olds, 26.9% of
those with low testosterone had a psychiatric disorder compared with
only 14.6% who had a normal testosterone. In the middle age group
of 50–64 year-olds, 17.5% of those with low testosterone had a psychiatric disorder compared with 14.7% who had a normal testosterone.
In the older age patients 13.2% of those with low testosterone had a
psychiatric disorder compared with only 7.4% who had a normal
testosterone.
Conclusion: Within our service, data appeared to indicate some association between Low Testosterone and Psychiatric Disorder, particularly in younger men.
Take home message: There may be an association between low
testosterone and psychiatric disorder, in patients with erectile
dysfunction.
86
88
BARRIERS TO SEEKING AND RECEIVING
HELP FOR SEXUAL CONCERNS IN MID AND
LATER LIFE
CURRENT GUIDELINES ON TESTOSTERONE
REPLACEMENT IN MEN AND WOMEN
A PRESENTATION BY THE MIDDLE
EASTERN SEXUAL HEALTH COMMITTEE
(MESHC)
S. Nasserzadeh1, A. El-Tarahony2, M. Sungur3, E.A. Attallah4,
F. El-Kak5, Q. Beig6
1
Consultant, New York, NY, USA, 2Dubai-Springs 5, Dubai, United Arab
Emirates, 3Psychiatry Dept of Marmara University Hospital, Istanbul,
Turkey, Turkey, 4MOH, Kingdom of Bahrain, Bahrain, 5American
University of Beirut, Riad El-Solh, Lebanon, 6World Population Foundation,
Pakistan, Pakistan
S. Hinchliff
School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
Object of study: The sexual health needs of people at mid and
later life tend to get overlooked at both a political and professional
level. This presentation will explore the reasons why, by looking at
barriers to seeking and receiving help for sexual concerns and
difficulties.
Method: Evidence from a range of sources, including a literature
review of twenty-five articles on medical help-seeking and doctorpatient interactions, was examined.
Results: Patients reported a number of barriers to seeking help for
sexual concerns including thinking that sexual changes were ‘normal
with ageing’ and assuming that their doctor would think that sex was
not important to them ‘at their age’. Health care professional (HCP)
barriers to providing sexual health care related to limited knowledge
of mid and later life sexuality issues, as well as inadequate training at
medical school. Doctors tended not to take a proactive approach to
sexual health with ‘older’ patients, but patients were more likely to
seek help if their doctor had asked about sexual function during a
previous consultation.
Conclusion: The implications for sexual well-being if the doctor does
not ask and the patient does not tell are clear. Providing education
about sexuality for doctors and other HCPs is crucial if we are to meet
the needs of ‘older’ patients in useful and effective ways.
87
FINDINGS FROM ORIGINAL RESEARCH,
CONDUCTED IN SHEFFIELD, ON THE
ASSOCIATION BETWEEN TESTOSTERONE
LEVELS AND PSYCHIATRIC FACTORS
A.K. Wood1, R. Runciman2, Y. Abassi3, K. Wylie1
1
Poterbrook Clinic, Sheffield Health and Social Care NHS Foundation Trust,
2
Sheffield University, 3Sheffield Health and Social Care NHS Foundation
Trust, Sheffield, UK
Objective: To Explore the Association between Low Testosterone
Levels and Psychiatric Illness in Patients presenting, in Sheffield, with
Erectile Dysfunction.
Method: During a Service Evaluation Study, data was reviewed from
the MED database, in Sheffield.
1638 patient records, for whom testosterone values were recorded,
were reviewed.
They were divided into three age categories, 18–49,50–64 and 65+.
K. Wylie
Porterbrook Clinic, Sheffield, UK
The British Society for Sexual Medicine, along with several other
organisations, have issued new guidelines for the management of testosterone deficiency and the treatment of sexual disorders in men and
women. These are the first guidelines developed by UK organisations
on the subject of the diagnosis and treatment of sexual disorders in
women. There remains a lack of awareness and a reluctance from clinicians and patients to discuss sexual symptoms. These guidelines result
from a thorough review of the published research on the symptoms,
diagnosis and treatments of testosterone deficiency and sexual disorders in men and women and present a number of recommendations
summarised below.
Women should be routinely asked if they have any sexual concerns
at consultations at contraceptive and sexual health clinics and at cervical screening, postnatal and menopausal assessments. This especially
applies to women at higher risk, such as those who have premature
surgical menopause, vaginal dryness, depression or a history of sexual
abuse. Likewise, there are many opportunities to ask men about any
sexual problems. Assessment may be undertaken over several consultations and should cover sexual and medical history and may involve use
of validated questionnaires to assess female sexual function. Care
should be taken to rule out pre-existing medical conditions such as
diabetes, which may affect sexual function. Treatment should be based
upon clinical symptoms and individually tailored. All patients diagnosed should be offered the opportunity to attend psychosexual and/
or couples counselling or sex therapy. Additionally, patients may be
offered a number of pharmaceutical options.
89
STRIVING FOR IDEALS: THE INTERSECTION
OF SEXUAL AND ROMANTIC DOMAINS
E.S. Byers
Psychology, University of New Brunswick, Fredericton, NB, Canada
Symposium overview: This international symposium includes four
papers examining the sexual and romantic relationships of adolescents
and adults. The first paper, presented by Lucia O’Sullivan, Ph.D.,
examines the contributions of dating and sexual experience to Canadian adolescents’ perceptions of the quality of their current relationship. The second paper, presented by Deanne Simms, examines
cognitive and behavioural components of the sexual script for sexual
initiations among dating couples in Canada. The third paper, by Patricia Pascoal, investigates the personal definitions of sexual satisfaction
of Portuguese individuals living with a partner. The final paper, pre-
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sented Pablo Santos-Iglesias, examines the contributions of various
forms of verbal and nonverbal sexual communication to the sexual
satisfaction of dating couples in Spain.
90
THE ROLE OF VERBAL AND NONVERBAL
COMMUNICATION IN COUPLES’ SEXUAL
SATISFACTION
P. Santos-Iglesias1, S.E. Byers2
University of Granada, Granada, Spain, 2University of New Brunswick,
Fredericton, NB, Canada
1
Sexual satisfaction is determined by sexual communication, however
only the role of sexual self-disclosure has been tested. Other forms of
sexual communication such as sexual assertiveness or nonverbal sexual
communication have never been tested before. The aim of the present
study is to analyze the extent to which sexual satisfaction in couples is
individually and uniquely related to various forms of sexual communication, such as verbal and nonverbal communication and sexual and
nonsexual self-discolsure. And also to test whether there is an instrumental pathway between each of these forms of sexual communication
and sexual satisfaction in both male and female partners. One hundred
couples will be surveyed online from both a Canadian and a Spanish
university to collect data on sexual and nonsexual self-disclosure,
verbal and nonverbal sexual communication, as well as sexual satisfaction according to the instrumental pathway. Results will provide evidence for the contribution of different forms of sexual communication
over and above sexual self-disclosure to couples’ sexual satisfaction and
how these forms contribute to the components of the instrumental
pathway. Also they will allow to compare Canadian and Spanish
samples and to analyze cross-cultural differences. Results will also
provide valuable information for therapeutical interventions.
91
TURNING SEXY THOUGHTS INTO SEXY
BEHAVIOURS: HETEROSEXUAL DATERS’
SEXUAL INITIATION BEHAVIOURS
D.C. Simms, S. Byers
Psychology, University of New Brunswick, Fredericton, NB, Canada
Introduction: Sexual initiation behaviours contribute to sexual satisfaction in long-term couples (Byers & Heinlein, 1989). To explore this
relationship in short-term daters, the current study used the Theory
of Planned Behaviour (Ajzen, 1992) to investigate daters’ sexual initiation behaviors, and their association with sexual satisfaction.
Method: Participants were 151 young adults (75% female; M = 20.9
years) in heterosexual dating relationships. All completed an online
survey.
Results: Compared to women, men initiated more frequently, had
stronger sexual initiation intentions, and perceived more positive social
norms regarding initiation. However, the men and women did not
differ in their attitudes towards initiating or perceptions of their competence to initiate. Finally, more frequent sexual initiations were associated with greater sexual satisfaction for both men and women.
Discussion: While cognitive aspects of the initiation script are egalitarian, initiation behaviors are guided by gender-discrepant sociosexual
norms. Additionally, initiation behaviors are associated with sexual
satisfaction within dating relationships.
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92
DEFINITION OF SEXUAL SATISFACTION,
A QUALITATIVE ANALYSIS OF ON-LINE
RESPONDENTS IN COHABITATION: THE
ROLE OF GENDER, SEXUAL ORIENTATION,
RELIGION AND SEXUAL PROBLEMS
P. Pascoal1, I. Narciso1, N.M. Pereira2
1
Faculdade de Psicologia, Universidade de Lisboa, Lisboa, 2Departamento de
Ciências da Saúde, Universidade Lusofona de Ciências e Tecnologias, Lisbon,
Portugal
Objective: Definitions of sexual satisfaction have been derived from
theory or research-driven conceptual definitions, but little is known
about how people in relationships conceptualize sexual satisfaction for
themselves, using their own words. Our goal was to assess differences
in personal definitions of sexual satisfaction associated with gender,
sexual orientation, and the presence of sexual problems.
Method: Participants were 973 individuals (59% women and 41%
men) living with a partner who completed an on-line survey.
Results: Thematic analysis using NVivo indicated that two major
themes: one related to pleasure and one related to relationship and
intimacy. It also identified some subthemes. There were some differences in definitions based on whether individuals identified as male or
female, were in a mixed-sex or same-sex relationship, and had or had
not sexual problems.
Discussion: The results are used to highlight the strength and problems associated with existing definitions and measures of sexual
satisfaction.
93
SYMPOSIUM TITLE: GID AND BRAIN
FUNCTION: INTRODUCTION AND
OVERVIEW OF CURRENT RESEARCH IN GID
G. Knudson
Department of Sexual Medicine, University of British Columbia, Vanouver,
BC, Canada
Research in the field of gender dysphoria is lacking overall. This review
paper will briefly introduce the concepts associated with gender dysphoria and gender identity disorder. The main body of the paper will
provide commentary on the strengths and limitations of the prior
research in the field. Finally, emerging research in the field will be
highlighted including several ongoing research collaborations.
94
GENDER IDENTITY DISORDER &
BRAIN FUNCTION. PSYCHIATRIC
CHARACTERISTICS OF GID PERSONS:
A MULTI-CENTERED TRANSVERSAL
STUDY IN FOUR EUROPEAN COUNTRIES
G. De Cuypere1, E. Elaut1, M.C.S. Paap2, B.P.C. Kreukels3,
P.T. Cohen-Kettenis3, I.R. Haraldsen2, H. Richter-Appelt4, G. Heylens1
1
Dept. of Sexology and Gender Problems, University Hospital Ghent, Ghent,
Belgium, 2Dept of Neuropsychiatry and Psychosomatic Medicine, Oslo
University Hospital, Oslo, Norway, 3Dept of Medical Psychology, VU
University Medical Center, Amsterdam, The Netherlands, 4Institute of Sex
Research and Forensic Psychiatry, University Hospital Hamburg-Eppendorf,
Hamburg, Germany
Objective: To investigate whether adult patients fulfilling GID criteria
show more Axis I an II disorders compared to non-gender dysphoric
persons.
Methods: Applicants (n = 389) in 4 European gender teams (European
Network on the Investigation of Gender Incongruence) were consecutively included. The patients with a GID diagnose were interviewed
by means of MINI+ and SCID II within the first 6 months after
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application, before hormonal treatment. They were also evaluated by
the GAF-score. Due to drop-outs, ongoing data collection and analysis
288 patients were interviewed for Axis I and 205 patients for an Axis
II diagnosis (DSM-IV-TR).
Results:
Axis I: Compared to a normal population 75 % of the applicants have
an Axis I diagnosis (affective symptoms current and/or lifetime in app.
50 %, anxiety disorders in 32%, substance related problems in 16%).
There are no differences in age nor degree of gender dysphoria
between patients with or without an associated Axis I diagnosis. MtF’s
and FtM’s are equally affected. Regarding Axis I there are significant
differences between 4 countries.
Axis II: An overall prevalence of 17, 2% is found (Cluster A: 5,9%,
cluster B: 6,3% and Cluster C: 9,3%).
Applicants with a personality disorder are younger compared to
those without, but have the same degree of genderdysphoria. There
are no differences between MtF’s and FtM’s except for borderline
personality disorder which occurs more in FtM’s.
The GAF score is comparable in MtF’s and FtM’s.
Conclusion: GID-patients have more affective symptoms than the
general population.
This paper present a Summary of this and a strategy for coming
back to this important track.
So many issues are present
95
The Urologists and Medical Sexologist share common interests in the
medical field. Thus, from a genital perspective, these fields of medicine
rather complement each other much a-like urology and nephrology
do when the kidney is assessed. In females, Urologist focuses their
exams to the genital organs, the pelvic floor and its relationship with
thebladder. Incontinence is one of the most common complains in
women, and onethat portends a tremendous effect in sexual activity.
Its etiology is quiterich in causes. Urologists have shifted increased
attention and research to female sexual dysfunction. We confidently
predict that this area will growth in the field of Urology and Medical
Sexology will be pivotal for such event. For males, the similitudes are
blunt. Men with erectile dysfunction have benefitted from research and
have witnessed first hand thetremendous change in public perception
and quality of life in the era of the PDE5 inhibitors. Of interest
thought, was the initial transition when thesedrugs came to the medical
field, and in the United States, direct marketingtailored to patients,
whom were advice to discuss with their doctor, these new options.
Much experience has been gained in penile implants and their role for
men with ED. Of interest, outcomes research hasestablished that
penile implant surgery as one with the lowest rates of procedure regret
(<5%). Notwithstanding, the urologists clear focus on ED surgical fix,
increasing research with stem cells may change the spectrum in the
near future. It will not happen without strong collaboration between
Urologists and Medical Sexologists.
DIAGNOSTIC MANUAL FOR SEXOLOGICAL
DISEASES. DMSD-III. FLASSES. WAMS. IAMS
F.J. Bianco
Medical Sexology, CIPPSV. Postgraduated Center, Caracas, Venezuela
The work in this Classification started back in 1985.
The methodology has as initial point:
The Definition and Conceptualization of the field of Sexology.
After that the physiological mechanisms of Sex (Gender) and Sexual
Function was carry out, it allow to make an approximation to the
physiopathology and the study of their clinical manifestation in term
of Symptoms and Signs.
Sexological Syndromes are them conformed.
This methodology allows us to make the current Classification of
the different Syndromes (Disorders) that are present in Clinical
Sexology.
The present Classification has been endorsed by Latin American
Federation of Sexological and Educational Societies-FLASSES, by the
World Association for Medical Sexology-WAMS, and by the International Academy of Medical Sexology-IAMS.
96
THE PSYCHIATRIST AND SEXUAL MEDICINE
PRACTICE
R.J. Hernandez1,2
1
Psychiatry, UCV, 2Medical Sexology, UTES, Caracas, Venezuela
Despite the beginning of Sexology ,following the German School
(Kraft-Ebing, Moll,Marcuse,Block and Hirschfeld) , Psychiatrists are
afraid of SEX and SEXUAL HEALTH.
We saw untill Ellis, Kinsey and Masters and Johnson ( l966), a
complete stage of oscurantism and ignorance, even rejection by
Psychiatry.
Few reason may explain this:
1. Lack of recognition
2. Stigmas
3. Lack of Research.and Academic studies
4. Abscence of Posgraduate Courses and Full Training
5. Defficiency of themes in Curricula for Medical Students and Psychiatry trainnees
Founding of a WPA Section Psychiatry and Human Sexuality ocurred
in WCP Hamburg in l999.
Since then we have been pushing for spaces in WPA, APA, and Local
Societies, presenting a 8 hours Course on Human Sexuality Issues, and
several Symposia.
1. Effect of antidepressants and antipsychotics in Human Sexual
response.
2. Adequate treatment of Sex Offenders and Paraphilias.
3. Co-morbid or dual pathologies with sexual issues and Psychiatry.
4. Importance of knowledge of new aspects in Sexology.
5. Couples and Marital Therapy and sexual issues.
This is a way to come back, and to do research and comparative studies
regaining prestige and recognition of our field.
We must do it.
97
THE UROLOGIST AND THE MEDICAL
SEXOLOGIST
F.J. Bianco Jr
Urology and Robotic Surgery, Columbia University Division of Urology at
Mount Sinai Center Miami, Coral Gables, FL, USA
98
SEXUAL HEALTH PUBLIC HEALTH
A.J. Wabrek
Dean Office, International American University College of Medicine, Cove
Avon, CT, USA
How should the Public Health Model be applied so it really contributes to improved sexual health for all?
Public Health recognizes three levels of prevention—Primary, Secondary and Tertiary.
Primary prevention involves prevention of the disease or injury
itself.
Fluoride
Immunization
s Education to Avoid Smoking and Substance Abuse
s
s
Secondary prevention blocks the progression of an injury or disease
from an impairment to a disability.
An impairment has already occurred, but disability may be prevented
through early intervention.
s Use of the Papanicolaou smear to look for early cellular changes that
are thought to be precursors of cancer is a good example of secondary prevention.
s
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s
Treatment of certain streptococcal infections with penicillin can
prevent the occasional development of rheumatic fever and serious
heart disease.
Tertiary prevention blocks or retards the progression of a disability.
• The early detection and effective management of diabetes can
prevent some of the complications associated with the disease, or at
least slow their rate of progression
Public
Health
Sexual
Health
Primary
Prevention
Fluoride
Secondary Prevention
Screening Tests
Tertiary
Prevention
Slows/Decreases Disability
106
3.67g; T, n = 20, 55.55 ± 4.49g, p = 0.002. Ovaries: C, n = 20, 0.69 ±
0.04g; T, n = 20, 0.55 ± 4.49, p = 0.004. The number of immunoreactive GnRH neurones was also significantly (p = 0.04) reduced in the
T animals. Although the weights of the pituitary glands was not altered
by treatment in either sex the cellular populations were altered. Specifically, GnRH agonist treatment altered the proportion of gonadotrophs expressing oestrogen receptor alpha (ERa) in a sex specific
manner. Thus, the percentage of gonadotrophs co-localising ERa was
lower in the treated females (p = 0.001) but did not differ in the males.
Further, the percentage of ERa immunoreactive pituitary cells was
reduced by GnRH agonist treatment in both sexes (p = 0.001). In
summary, long term treatment with a GnRH agonist affects all levels
of the reproductive axis and provides us with an excellent animal model
to explore other physiological, behavioural and cognitive processes
that might be altered by such long term exposure.
101
Look at the sexual difficulties/dysfunction and think about how they
can be prevented using the Public Health Model
SYMPOSIUM: WORKING WITH SPECIAL
POPULATIONS, PART ONE OF THREE—
“CHALLENGES TO RECOVERY FOR
SEVERELY WOUNDED VETERANS OF WAR”
99
W. Stayton
Morehouse School of Medicine, Atlanta, GA, USA
EARLY ONSET GID AND ITS EFFECTS ON
HIPPOCAMPUS MEASURED BY
NEUROPSYCHOLOGICAL TESTS AND MRI
I. Haraldsen
Neuropsychiatry, Oslo University Hospital–Rikshospitalet, Oslo, Norway
Patients with early onset Gender Identity Disorder (GID) are treated
chronically with a GnRH receptor agonist to delay puberty, however
the effects of such treatment on physiology, behaviour and cognition
are unclear. Especially focus has been directed recently on age development modulated by GnRH. Therefore, we explored GID children/
adolescence under the age of 18 with regard to their neuropsychological (cognitive testing) and morphological brain function (MRI) before
starting GnRHR blockage treatment.
Results and discussion: Astonishingly we found highly significant
differences between GID and controls in cognitive function showing
reduced verbalization and executive function abilities by at the same
time significantly atrophic hippocampus and cerebellum tissue in GID
patients. Whether these effects will be reversible by treatment, or
whether they could be correlated to psychological functioning in those
kids has to be shown by our group over time.
Nevertheless in summary, before staring long-term treatment with
a GnRH agonist, effects on cognitive function and brain morphology
should be carefully explored before long term exposure and because
of the recent increasing literature on those functions in other study
populations.
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GNRH RECEPTOR BLOCKAGE ALTERS THE
ACTIVITY OF THE REPRODUCTIVE AXIS IN
MALE AND FEMALE SHEEP
J.E. Robinson, N.P. Evans
Institute of Biodiversity, Animal Health and Comparative Medicine,
University of Gllasgow, Glasgow, UK
Patients with early onset GID are treated chronically with a GnRH
receptor agonist to delay puberty, however the effects of such treatment on physiology, behaviour and cognition are unclear. To explore
these an animal model of GID was established using sheep given
monthly implants of the GnRH agonist goserelin acetate (Zoladex;
3.6mg) from immediately prior to puberty (male; 8 weeks: female; 28
weeks) until they were euthanized at 11 months of age. GnRH treatment (T) did not alter body weight, however it reduced the weights
of the gonads compared to controls (C). Testes: C, n = 21, 76.01 ±
This presentation will report on sexual issues encountered by the
severely wounded veterans returning from the wars in Afghanistan and
Iraq, including those with PTSD and Traumatic Brain Injury through
the “Road to Recovery” program. For four years, a group of sexuality
professionals have met with individuals, couples, and families to help
them to discover their challenging sexual potential. This presentation
will be a report on the challenges to their religious, spiritual, physical,
relational, and emotional life on that “Road to Recovery.”
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SYMPOSIUM: WORKING WITH SPECIAL
POPULATIONS, PART TWO OF THREE—
“THE USE OF SEX COACHING IN THE
TREATMENT OF PRE-ORGASMIC WOMEN”
P. Britton
Sex Coach U, Beverly Hills, CA, USA
Sex Coaching is an effective methodology for working with pre-orgasmic women. Sex Coaching offers women a unique opportunity to reach
orgasm, by using observational body-based sex coaching methodologies; psycho-educational techniques such as cognitive restructuring/
reframing; guided imagery for overcoming sexual trauma, guilt or
fears; body-based self-help activities to assist women in moving past
deeply held body shame; and step by step orgasm training such as
pelvic muscle contraction or PC exercises, fantasy enhancement, inclusion of vibrators, lubricants and breathing techniques. Dr. Britton,
trained by renowned orgasm-directed coaching expert Betty Dodson,
will talk about the 9 steps to orgasm, along with case examples of
effective treatment methods for helping women to reach their orgasmic potential.
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SYMPOSIUM: WORKING WITH SPECIAL
POPULATIONS, PART THREE OF THREE—
“CONSIDERATIONS FOR TREATING
POLYAMOROUS CLIENTS”
P.M. Sugg1,2
1
P. Michele Sugg, MSW, LCSW, CST, Branford, CT, 2Alexander Foundation
for Women’s Health, Berkeley, CA, USA
Polyamory, or honest non-monogamy, is now an acceptable relationship choice for many. Traditional monogamy-based treatment models
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are a poor fit with polyamorous relationships. How might clinicians
best address the often complicated nature of polyamorous relationships? What is polyamory? How does a therapist approach work with
a polyamorous client? Common misconceptions and assumptions
about polyamorous relationships will be covered. Case studies will be
provided, as well as helpful resources in working with polyamorous
clients.
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SYMPOSIUM: “WORKING WITH SPECIAL
POPULATIONS”
S. Pillai-Friedman
Council for Relationships Couple and Family Therapy Program, Thomas
Jefferson University, Penn Valley, PA, USA
Dr. Sabitha Pillai-Friedman moderates this fascinating three-part symposium which challenges our thinking and explores effective therapeutic strategies with special populations. The expert speakers include: Dr.
William Stayton on “Challenges to Recovery for Severely Wounded
Veterans of War,” Dr. Patti Britton, “The Use of Sex Coaching in the
Treatment of Pre-Orgasmic Women,” and P. Michele Sugg, MSW,
“Considerations for Treating Polyamorous Clients.”
In this three-part symposium, a better understanding will be developed in finding one’s sexual potential from from youth to old age,
including those severely wounded and traumatized by war. Women
will discover a rapid, reliable and direct approach for experiencing
orgasmic fulfillment through sex coaching methodologies. Sexuality
professionals will become knowledgeable about polyamory and treatment approaches in order to effectively work with the polyamorous
client.
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QUALITATIVE KNOWLEDGE FROM
PSYCHOTHERAPEUTIC PRACTICE AS A
BASIC FOUNDATION FOR TREATMENT OF
SEXUAL PROBLEMS
E. Almås
Faculty for Health and Sports, University of Agder, Grimstad, Norway
Evidence based treatment has become a mantra for therapists, resulting in strong focus on treatment methods and techniques. Research
on treatment of sexual problems is convincing, showing that sex
therapy ad modus Masters and Johnson is among the very best
approaches to treatment of sexual problems. There are, however,
important factors that may not be addressed in efficacy studies, as
research criteria requires randomization and control groups, requirements that are difficult to obtain in most clinical settings. There are
no doubt important experiences in development of good treatment
that are acquired in clinical settings even if ordinary research criteria
cannot be met Other qualities of therapy may be in focus. In a therapeutic setting, therapeutic methods and techniques are important
tools, but they are continuously bent and adapted to new situations,
and not used as strict manuals, as is necessary in research settings.
In clinical practice, there is a continuous development of therapeutic
methods. The clinician must have a sharp eye for the individual needs
and resources of the clients. Each clinician has his or her individual
therapeutic training that may include different theories and approaches,
skills and ability to adapt particular methods into a general therapeutic
context.
In this symposium we have asked experienced clinicians to tell how
they approach sexological problems, what is their training, theory, and
use of therapeutic techniques? This is the necessary “other side of the
coin”—where evidence concerning treatment methods is the one side
that is most often looked at.
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A CHARACTER ANALYTIC APPROACH TO
WORKING WITH DESIRE PROBLEMS
S. Schaller
Institute for Clinical Sexology and Therapy, Engstrand, Norway
Treating sexual desire problems is often a time demanding, complicated and difficult process, in particular if the lack of desire is caused
mostly by the great bulk of what we call relational factors. Very often
the outcome of therapy does not correspond with the initial request
of the client(s).
Traditional sexological treatment of desire problems, often grounded
on variations of CBT, may sometimes increase symptoms or consolidate the condition.
Working with desire as connected to the brains motivational system,
it may often be necessary to focus on the deeper aspects of motivation
and aversion.
To understand some common factors in desire problems, like anxiety
and depression, I build on Wilhelm Reich’s theory of how we, due to
traumas in childhood, inhibit our vitality and life energy thru developing more or less chronic muscular tensions, and how this influences
and puts restrictions on our experience of desire and therefore also on
sexual desire.
I will present character analytic approach as it is developed in
Norway after Reich’s influence in the late 1930’s in Oslo. With a case
I will illustrate some character analytic and body oriented ways of
working with the clients sexuality, that in my experience, targets the
deeper aspects of motivation and sexual desire.
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AVOIDING THE DOWNSIDES OF THE
“GOLDEN STANDARD”
A. Lindskog
Private clinic at Villa frisk, Greåker, Norway
The golden standard for therapeutic research is randomized independent control groups. This type of clinical research has shown that it
gives the most reliable results, but it has its downsides. The biggest
downside is the time-delay for introduction of a new method. One
example is that the first thoughts of cognitive therapy were formulated
by Beck in the 1960s. Today 2011, after more than 50 years, it is finally
coming to broad use in Norway! How do we shorten this time-delay
between ideas and clinical praxis so clients can benefit from new ideas
much earlier? Is it ethical to apply the golden standard resulting in 50
year delays? Another downside is the high cost of the long term studies.
What are our responsibilities as clinicians in this context? The golden
standard demands group samples from diagnostic groups. At the same
time most clinical therapists agree that choosing treatment method
form diagnostic groups is less effective than trying to adapt therapy
after the individual client. This problem is closely related to the fact
that clinically, the origin of a symptom often is more important to the
most effective solution than the symptom category. Behind a symptom
like impotence there can be extremely different origins and an
increased understanding here helps the therapist to choose the most
efficient treatment. Based on experience from Neuro-linguistic programming (NLP) the lecturer will show how you can avoid or reduce
these downsides. And at the same time maintain an ethical, safe and
high clinical standard.
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WORKING INTERACTIVELY USING A
SYSTEMIC SEX THERAPY MODEL FOR
COMMON SEXUAL PROBLEMS WITHIN A
MODERN HEALTH SEVICE SETTING
SEXUALITY EDUCATION IN SCHOOLS AND
FAITH BASED SETTINGS
B.-A. Hutchin
Porterbrook Clinic, Sheffield, UK
Working interactively using a systemic sex therapy model for common
sexual problems within a modern health sevice setting.
I shall be covering the ideas put forward in the article of the same
name which was published in Sexologies 2010. In doing so I shall
highlight how we have developed our systemic approach within the
clinic over the last two years. I will explain how this process has been
a part of the training course for first and second year trainees. In doing
so I will explain how we have used the systemic approach with regard
to couples presenting with both sexual and relationship problems. The
exchange of ideas with the audience will be encouraged and
appreciated.
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CLINICAL SEXOLOGY: AN INTEGRATED
APPROACH BETWEEN THE
PSYCHOSOMATIC AND THE
SOMATOPSYCHIC
A. Fabrizi
Institute of Clinical Sexology, Rome, Italy
The training of the sexologist, a figure often not officially recognized
in spite of growing client demand, is still a critical issue.
During the past three decades integration of sexology in international research between specialists, models and intervention techniques has increased markedly, both in clinical practice and
contributions.
This paper describes the Italian situation through the 20-year experience of Rome’s Clinical Sexology Institute in training doctors and
psychologists interested in acquiring the specific competencies
required to work in the sexology field.
The clinical experience of the ICS team, for a long time available
only to patients in private clinics but today extended to patients in a
public hospital, serves as natural basis for transmitting flexible theoretical and technical knowledge, as required by the integrated approach.
The context in which the clinical practice is carried out, also underlines
the limits and resources of the integrated approach, a modality which
takes ideally into consideration and puts on the same level of importance body, mind and relationship.
110
SEXUALITY EDUCATION IN THE ACADEMY:
AN UPDATE ON UNDERGRADUATE AND
GRADUATE INSTRUCTION IN THE UNITED
STATES
B. Crane
Widener University, Chester, PA, USA
This presentation will provide an update regarding sexuality instruction in the United States at the undergraduate, graduate, and postgraduate levels, based on a survey of faculty who are members of
AASECT, SSSS and SSTAR. Human Sexuality courses are offered at
the undergraduate level in a variety of disciplines such as Health, Psychology, Sociology, Nursing, and Public Health. At the graduate level,
students typically study sexuality as a concentration in another disciplinary degree program, however a few programs offer Masters and
Doctoral degrees in Human Sexuality. Perceptions of faculty regarding
current issues related to the provision of sexuality instruction will be
addressed as well as their observations about trends in the field.
D. Haffner
Religious Institute, Westport, PA, USA
Debra Haffner will examine the current status of sexuality education
in schools, community organizations, and faith based organizations in
the United States. Her paper will present an overview of how the new
federal teenage pregnancy prevention program and the curtailing of
the federal abstinence-only-until-marriage program may affect sexuality education in communities in 2011, as well as identify trends and
challenges in programs at the local level. She will provide information
from an online survey for 100 experienced sexuality educators and
trainers on the challenges they face as well as an update on how faith
communities are embracing sexuality education in the 21st century.
She will also offer reflections on how the Internet is changing young
people’s needs for sexuality information and how it can be used to
respond to obstacles faced by more traditional programs.
112
SEXUALITY COUNSELING: WHO BECOMES A
COUNSELOR AND WHY?
T.Y. Rosenbaum
Inner Stability, Ltd., Bet Shemesh, Israel
The field of sexuality and sexual health involves a variety of disciplines.
Outdated models of sexual health care have implied that medical practitioners address only physiological aspects of sexual health while sex
therapists address the psyche. Newer more integrated approaches recognize that practitioners involved in sexual health require basic counseling skills in order to evaluate and treat their clients with empathy
and respect, and provide permission, limited information, and specific
suggestions in accordance with the PLISSIT model. This presentation
will address the necessity of the sexuality counseling field and highlight
trends in certification over the last several years. In addition, examples
will be provided as to how sexuality counseling is integrated in to
sexual health practice.
113
WHAT IS NEW IN SEX THERAPY? PROPOSED
CHANGES IN THE DSM V AND THE
EXPANSION OF THE PLISSIT TREATMENT
MODEL
S. Pillai-Friedman1,2
1
Institute for Sex Therapy, Council for Relationships, 2Couple and Family
Therapy, Thomas Jefferson University, Philadelphia, PA, USA
Dr. Pillai-Friedman will examine the proposed changes in DSM V
related to the diagnosis of certain sexual dysfunctions. She will also
explore how sex therapists are increasingly expanding the PLISSIT
model by using alternative therapies such as EMDR, hypnosis, guided
imagery and tantra to treat sexual dysfunction. She will examine each
of these alternative therapies and their clinical implications. She will
present findings from an online survey of AASECT certified sex therapists on their use of alternative therapies.
114
SYMPOSIUM: COST, COST-EFFECTIVENESS
AND SCALE-UP OF SEXUALITY EDUCATION
J. Herat
Section on Education and HIV & AIDS, UNESCO, Paris, France
This symposium will focus on presentation of the results and discussion of a ground-breaking study into the cost and cost-effectiveness of
sexuality education (SE) in six countries, commissioned by UNESCO
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in 2010. Why an economic analysis? Policy-makers all over the world,
involved in decisions on school-based sexuality education (SE) programmes, are facing three important economic questions: what are the
costs of developing the programmes, what are the costs of implementing and scaling up the programmes, and do the programmes provide
value for money?
The study fills a critical gap in the evidence base for sexuality education, and demonstrates that, when planned and implemented carefully,
comprehensive sexuality education rolled out through schools is a
cost-effective way of mitigating poor health outcomes for young
people. Costs of implementing programmes vary greatly and are influenced by a number of factors such as whether the programme is intraor extra-curricula, the scale of the programme (including numbers of
teachers trained per learner), and finally, whether a programme is
developed from scratch or adapted from an existing model. The evidence presented is relevant not only to the SE programmes under
scrutiny but conveys important lessons for other countries that are
planning, or considering, the roll-out of sexuality education.
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COST AND COST-EFFECTIVENESS ANALYSIS
OF SCHOOL-BASED SEXUALITY EDUCATION
IN SIX COUNTRIES
E. Ketting
Nijmegen International Center for Health Systems Research and Education
(NICHE), Radboud University Nijmegen Medical Center, Nijmegen, The
Netherlands
This presentation will examine the way that key cost drivers that have
an impact on the cost and cost-effectiveness of school-based sexuality
education and the implications for scaling up the programme in different scenarios. The study, commissioned by UNESCO, looks at the
cost of sexuality education (SE) programmes in four developing countries (Nigeria, Kenya, India and Indonesia), one country in transition
(Estonia), and one developed country (The Netherlands). The costeffectiveness is analysed Kenya and Estonia.
The SE programmes studied vary widely in terms of their scope
(abstinence-only vs. comprehensive), position in the school curriculum
(mandatory vs. optional, and integrated vs. stand-alone), duration
(from a few months to several years), their age (from just starting to
20 years old), and several other characteristics. The cost per student
reached is highly dependent on the developmental stage of programmes. Because teacher salaries are the most important cost component, the cost per student highly depends on the programme
duration, class size, and teacher salary level. Other important cost
components are operational, teaching materials, M&E, and advocacy,
which may be costly in a context of low acceptance of SE. Through
scaling-up and increased coverage the cost per student reached can be
reduced significantly.
116
COMPREHENSIVE SEXUALITY EDUCATION
IN LATIN AMERICA. AN INVESTMENT IN
SOCIAL AND PERSONAL WELL-BEING
E. Corona
World Association for Sexual Health, Mexico City, Mexico
Looking at one region, Latin America, where sexuality education has
a long history and is present in most countries of the region. This
presentation will analyse some of the supporting factors at the policy
and political level that have enabled scale-up of sexuality education
programmes such as the Ministerial Declaration “Educating to
Prevent”. By understanding the political influences and the advocacy
undertaken to ensure roll out of sexuality education, conclusions can
be drawn about the different kinds of investments required, economic
and political, to enable school-based programmes to be taken to scale.
The presentation will also highlight examples of widespread teacher
training programmes, curriculum development and implementation in
different countries in the region. It will also discuss the need to consider the contribution of comprehensive sexuality education in the
exercise of human rights and personal and social well-being.
117
NATIONALLY ROLLED OUT SCHOOL-BASED
SEXUALITY EDUCATION PROGRAMME AND
DECREASING RATES OF STI, HIV AND
UNWANTED TEENAGE PREGNANCIES—
THE CASE OF ESTONIA
K. Haldre
West Tallinn Central Hospital Women’s Clinic, Tallinn, Estonia
This presentation highlights a compelling example of how a nationwide school-based sexuality education programme combined with the
availability of youth-friendly sexual and reproductive health services,
has led to dramatic improvements in reproductive health indicators
among young people over the past two decades in the country.
Major socio-economic changes took place in Estonia immediately
after the country regained its independence from Soviet occupation in
1991, including the creation of democratic political institutions,
changes from a planned to a market economy, health care reforms and
changes in the school curricula. In 1996 new school curricula were
introduced including sexuality education lessons, which were integrated in a compulsory subject called Human and Civil Studies
(renamed as Human Studies in 2002). The Human Studies curriculum
is based on the principle of social skills education. Part of the curriculum deals with building general attitudes and skills, and the other part
is explicitly sexuality related. Simultaneously, youth counselling services addressing reproductive and sexual health matters were set up
resulting in 20 counselling centres offering individual counselling and
health education for schoolchildren by 2010.
Teenage fertility rates and abortion rates started to decrease immediately after sexuality education, contraceptives and youth-friendly
services became available. The abortion rate among 15–19 year-olds
declined by 61% and the teenage fertility rate by 59% between 1992–
2009. The annual number of registered new HIV cases among
15–19-year-olds declined from 560 in 2001 to just 25 in 2009, a 95%
drop.
118
FROM OYSTERS TO STEAK: HEATING UP
MEN’S SEXUAL PLEASURE AND
PERFORMANCE WITH APHRODISIAC FOODS
L. De Villers1,2
1
Graduate School of Education and Psychology, Pepperdine University, Los
Angeles, 2Aphrodite Media, Marina del Rey, CA, USA
Contemporary body-mind approaches in psychology and medicine
offer support for the long-standing belief that aphrodisiac foods can
stir passion. Two online Aphrodisiac Food Surveys (nearly 2500
respondents) further elucidate
1) current beliefs about the effectiveness of aphrodisiac foods;
2) knowledge about the reputation of specific aphrodisiac foods,
3) personal preference for specific aphrodisiac foods; and
4) key features of memorable aphrodisiac meals shared with a partner.
This presentation highlights male responses, with emphasis on statistically significant gender differences, as revealed by chi square analyses
of the data. Specific strategies are offered to clinicians to assist them
in encouraging male clients to regularly enjoy aphrodisiac meals with
their partners to boost their sexual pleasure, performance and longterm sexual health.
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BEYOND WALTER MITTY: PSYCHOTHERAPY
AS SOCIAL BOND SUBSTITUTE FOR
MIDDLE-AGED DIVORCED MEN
K. Resnick Anderson
Center for Sexual Health/Psychiatry, Summa Health System, Akron, OH,
USA
Considerable research suggests that men are at greater risk of suicide
following divorce than women. Newer research suggests that the incidence of suicide among middle aged men, in general, has increased.
This puts middle-aged divorced men in a vulnerable category. This
paper will highlight the therapeutic journeys of three men who were
oblivious to the depths of their wives’ contempt toward them; and
found themselves facing an unwanted divorce. Each man experienced
suicidal ideation regarding of the loss of his marriage. As a result of
psychotherapy, each man “discovered” the benefits of psychological
intimacy and is now in a more emotionally and sexually satisfying
relationship. The author will share clinical observations regarding
“trends” among men age 45–60 from her hospital-based sex therapy
practice. These observations include complacency among middle-aged
men regarding their wives’ marital/sexual satisfaction, an untapped
capacity to engage in psychological intimacy, and a post-therapy climb
in self esteem/sexual confidence.
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THE IMPACT OF PROSTATE CANCER ON
MEN’S SEXUAL WELL-BEING
E.S. Byers1, C. Letts2, K. Tamlyn3
Psychology, University of New Brunswick, 2Operational Stress Injury Clinic,
3
Nursing, University of New Brunswick, Fredericton, NB, Canada
1
Objective: Past research has not provided a comprehensive picture of
men’s sexual well-being following treatment for prostate cancer.
Therefore, we assessed the impact of prostate cancer and its treatment
on a broad range of aspects of men’s relational and sexual well-being
including expressions of affection, relationship quality, self-concept,
sexual desire, erections, orgasmic consistency and sexual satisfaction.
Methods: Interviews were conducted with 19 men who were 1 to 5
years post-treatment and ranged in age from 49 to 74 years. Transcripts were analyzed using the framework methodology.
Results: Some but not all aspects of men’s sexual well-being were
affected by treatment; there was considerable variability between men
in the specific aspects that were affected as well as their emotional
impact. Following treatment, most (but not all) of the men reported
no change in the amount and type of affection expressed, the quality
of their romantic relationship, their self-concept as a man, or their
sexual desire. In contrast, nearly all of the men described negative
changes that were distressing to them in erections, orgasmic consistency, and sexual satisfaction. Further, most of the men had stopped
engaging in any sexual activity with their partner because of erection
difficulties, although one third of them continued to masturbate. Five
themes emerged with respect to factors that either contributed to or
buffered the emotional impact of changes in sexual well-being.
Conclusions: These results are discussed with respect to the importance of facilitating sexual communication between partners and
between patients and health care providers.
121
THE SEXUAL SELF: A MEASURE OF
MEANINGS, APPLICATIONS, AND FUTURE
DEVELOPMENT
A.L. Cotten
Psychology, Self-Employed, Durham, NC, USA
This presentation reports on a Scale of “The Meaning of My Sexual
Self ”. Using the techniques of Osgood, C. E., Succi, G. J., &
110
Tannenbaum, P. H. (1961) for semantic dimensions, bipolar adjectives
were determined. Developmemt was a continuation from previous
dissertation research which included 125 college students who
responded to 18 bipolar choices, 9 of which measured the 2 dimensisons of meaning: Evaluation, potency, activity.
For reliability and validity, a second sample ages 17–87, divded
into 3 age groups, showed that the 3 dimensions had principal
component analysis and accounted for 45% of the variation with
essentially equal coefficients. With reliability and validity established
and easy scoring (based on 9 of the 18 items in the bipolar scale),
it is hoped that it will h ave multiple uses as in hospitals, educational
institutions. and community programs. It could be especially useful
for prescreening for such traumatic events as cancer diagnosis.
Neither age gender,nor marital status were significant; however,
sexual experience and religiosity were significant. Further tests will tap
other variables such as masculinity and femininity for usage and
validity.
122
A NEW APPROACH FOR SEXUALITY
EDUCATION IN THE EUROPEAN REGION:
‘STANDARDS FOR SEXUALITY EDUCATION
IN EUROPE’
C. Winkelmann
WHO Collaboration Centre for Sexual and Reproductive Health, Federal
Centre for Health Education, Cologne, Germany
The “Standards for Sexuality Education in Europe” were developed
by a group of 20 experts from nine European countries under the
guidance of the Federal Centre for Health Education (BZgA) in
Cologne, Germany and the WHO Regional Office for Europe. The
Standards are an important instrument to overcome huge differences
in quality and scope of sexuality education in the European region. In
many countries sexuality education concentrates solely on the communication of biological facts, neglecting social and psychological
aspects as well as skills. This one-sided orientation and the poor quality
have negative consequences for young people: many countries are
recording substantial numbers of sexually transmitted infections,
teenage pregnancies and sexual violence.
The Standards are based on a positive interpretation of sexuality,
which they consider to be a part of physical and mental health, and on
the acknowledgement of sexual rights. Topics as HIV/AIDS, unintended pregnancies and sexual violence are embedded in all-embracing
education that focuses on the self-determination of the individual and
people’s responsibility for themselves and others. Furthermore the
‘Standards’ are based on the assumption that holistic sexuality education needs to start at birth, continue through childhood and adolescence into adulthood. The new guidelines not only indicate what
information should be given but also which specific skills children and
young people should acquire, and which attitudes should be promoted
at specific age periods.
123
IT’S ALL ONE CURRICULUM: GUIDELINES
AND ACTIVITIES FOR A UNIFIED APPROACH
TO SEXUALITY, GENDER, HIV, AND HUMAN
RIGHTS EDUCATION
D. Braeken
Youth Operational Division, International Planned Parenthood Federation,
London, UK
This presentation will introduce participants to this exciting new
resource for developing or revising their curricula. (Developed by an
international working group, this two-book set responds to the Millennium Development Goals and conforms with guidelines and priorities established by UNESCO, WHO and UNAIDS). The resource
contributed to the development of the ‘Standards for sexuality education for Europe’.
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The resource package is based on research and data suggesting that
young people who develop a belief in gender equality have better
sexual health outcomes (including with regard to rates of unintended
pregnancy, STIs, and HIV); develop critical thinking skills valuable to
their academic achievement and to their capacity for meaningful citizenship; and are better positioned to contribute to democratic and
prosperous societies. The evidence base for what makes sexuality education effective, comprehensive and rights-based will be presented. For
example, conservative views about gender and unequal power in intimate relationships are associated with earlier sexual initiation, more
sexual partners, more frequent sexual intercourse, lower rates of
condom and contraceptive use, and higher incidence of HIV. Yet a
review of some widely used sexuality education programmes found too
little attention to gender. Gender issues most commonly addressed
were male behaviour and coercion, but few took into account larger
issues of discrimination on the basis of gender or sexual orientation.
Moreover, sharing a shortcoming with many sexuality education programmes, consideration of gender norms tended to focus on individual
behaviour, not addressing the social and cultural barriers that young
people face. IAOC addresess these issues.
124
NEW APPROACHES IN SEXUALITY
EDUCATION—INCLUDING A SPECIAL
FOCUS ON THE ROLE OF EUROPE
J. Herat
Section on Education and HIV & AIDS, UNESCO, Paris, France
International Technical Guidance on Sexuality Education: from framework to action
The International Technical Guidance on Sexuality Education (International Technical Guidance on Sexuality Education, 2009, 2 volumes),
developed by UNESCO together with UNAIDS Cosponsors particularly UNFPA, WHO, UNICEF and the UNAIDS Secretariat, can be
instrumental in strengthening sexuality education (SE) in educational
institutions. While the ITGSE establishes norms and standards for
quality SE and provides a solid framework, support has been required
in many countries for the implementation of the Guidance. For
UNESCO, support has focussed on the four major steps for moving
from framework to action: advocacy & building stakeholder engagement; planning for implementation including policy, curriculum and
teacher training; partnerships and resource mobilisation; and, monitoring and evaluation of sexuality education. With a focus on building
on existing approaches such as Life Skills education, UNESCO has
begun working in a range of countries to engage with this Guidance,
to develop evidence on the cost-effectiveness of sexuality education
and to support countries in the different stages of implementation as
is appropriate. As each country and its approach to sexuality education
is diverse, so is the response to analyse and strengthen this important
component must be diverse—there is not a standard approach to
implementing this global framework. This presentation will offer some
perspectives on supporting national level engagement with sexuality
education in countries from different regions around the world highlighting critical steps in advocacy, planning, partnership and
monitoring.
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NEW APPROACHES IN SEXUALITY
EDUCATION IN FINLAND
D. Apter
Väestöliitto, Helsinki, Finland
The experience from Finland reflects the interconnectedness of
school-based sexuality education and the availability of sexual health
services in response to the needs of the population. Sexuality education
became obligatory in schools in 1970. In 2004 a new subject ‘health
education’ was introduced in most schools, and has been obligatory
since 2006. Health education in Finland includes theoretical, social,
emotional, functional and ethical skills along with information acquisition skills. Health competence involves the ability to assume responsibility for the promotion of one’s own health and that of other people.
From age 7–12 health education is integrated into environmental and
natural studies. At age 13–15 a total of 114 lessons over 3 years are
taught as an independent ‘health education’ subject. Sexuality education is a part of this, with a mean of 20 lessons, and includes human
relations, sexuality, behaviour, values and norms. Students’ knowledge
of this field is assessed as for any other topic.
After the introduction of the new curriculum, self reported use of
contraception among adolescents increased, the percentage who
started to have intercourse by the age 15 decreased (STAKES annual
school health surveys), and the rate of abortions among 15–19-year
olds again gradually decreased, from 16.3 in 2002 to 12.7 in 2008.
Having a clearly stated national curriculum thus supported the
improvement of sexual health indicators. After introduction of the
national curriculum specific teacher training also ensued.
Education and comprehensive sexual health services are needed and
the political will to provide both.
126
THE DUTCH APPROACH—STARTING AS
YOUNG AS POSSIBLE
S. van der Doef
International Programmes, RutgersWPF, Utrecht, The Netherlands
Although many people believe differently, the Netherlands do not have
a long history of mandatory school-based sexuality education. Only
since the 1990ies sexuality education became part of the curriculum of
secondary schools. But sexuality education in the Netherlands is in
another way rather unique: many schools introduced sexuality education voluntarily long before it became mandatory. Dutch teachers
perceive adolescents as persons who can take their own decisions even
concerning sexuality if they are equipped with the right information
and skills. In the Netherlands it is also widely believed that sexuality
education should start at a very early age. It is acknowledged that
young children are sexual beings too, although their sexuality is not
developed at the same level as in adolescence or in adulthood. Sexuality
education for young children should therefore be age- and developmentally appropriate, but can consist of the same topics as sexuality
education for adolescents. In this presentation some examples of sexuality education in the Netherlands will be presented, as well as examples of the Dutch approach in Asian and Africa.
127
TACKLING SEXUAL HEALTH INEQUALITIES
IN GLASGOW: THE STORY OF SANDYFORD—
DEVELOPING ACCESSIBLE SEXUAL HEALTH
SERVICES IN THE WEST OF SCOTLAND
R. Ilett1,2
1
Glasgow Centre for Population Health, NHS Greater Glasgow and Clyde,
2
Medicine, University of Glasgow, Glasgow, UK
This presentation will discuss the largest integrated sexual health
service in Scotland, the Sandyford Initiative in Greater Glasgow and
Clyde. This service pre-empted the first sexual health strategy for
Scotland in integrating family planning and genitourinary medicine in
2000, and the presentation details local conditions that informed the
development, much of which are linked to previous multi-agency
working concerning inequalities and health.The presentation, by one
of the original founders now a public health academic, reviews this
merger between family planning, GUM and a women’s health service,
drawing on direct experience, and internal and external documentary
evidence including a recent independent evaluation. It will describe
how integrating understandings of health and social inequalities into
planning and delivery of the service was seen as critical.It aims to map
progress against the original aims to discover how successful Sandyford
has been in embedding an inequalities sensitive approach—both as part
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of mainstream services, and through expanding the reach of specialist
services including for MSM, male survivors of childhood sexual abuse
and women involved in prostitution.The presentation concludes that
Sandyford has maintained a high level of understanding about inequalities, and has reached a wider range of service users than before integration, yet the current economic climate may prove increasingly
challenging in ensuring that the ethos continues to remain central.
Take home messages :1. Integrating sexual health services requires
careful planning2. A shared vision is critical3. Mainstreaming inequalities requires multi-disciplinary ownership4. Community engagement
underpins sexual health improvement
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SUPPORTING VULNERABLE ADULTS
ATTENDING SEXUAL HEALTH SERVICES—
THE SANDYFORD APPROACH
T.M. Groom
Sandyford, NHS GG&C, Glasgow, UK
Introduction: Sandyford is an integrated Community Sexual and
Reproductive Health Service serving Greater Glasgow & Clyde; and
has deveolped its services overtime, to support clients who may face
barriers to addressing or recognising their sexual health needs.
Aims: To raise awareness of the challenges faced by excluded and
vulnerable groups.
To demonstrate the need for developing specific ,client-centred,
holistic services.
To highlight the difficulties in providing such services; including the
importance of multiagency working and when to breach
confidentiality.
Case presentations will be used to highlight the above and lead
discussion.
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TACKLING SEXUAL HEALTH INEQUALITIES
IN GLASGOW: WORKING WITH MEN
INVOLVED IN PROSTITUTION
J. Heng
Open Road Service, NHS Greater Glasgow & Clyde, Glasgow, UK
Aim: To highlight the opportunities and challenges faced when
working with men involved in prostitution.
Description:
• Understand prostitution as a form of commercial sexual exploitation
• Discuss culture of “sex work” as a perceived form of sexual expression
within LGBT communities and contrast with project’s experience
• Explore issue of prostitution as a form of questioning sexuality and
contrast with project’s experience
• Outline the challenges within the implementation of partnership
working in a policy vacuum.
Results: Men involved in on-street prostitution are highly likely to
view this experience as a survival behaviour, while the life experience
of men involved in off-street prostitution is less well understood.
There has been a lack of clear strategic direction up until this point in
time which the Open Road Project is working to fulfill. Conversations
exploring the utility and scope of dovetailing responses to men and
women involved in prostitution are in their early stages.
Conclusions: A significant population of men involved in prostitution
exists within the Greater Glasgow & Clyde area. Identification of this
hidden population and service provision to offer support is achievable
and has an impact when backed with the appropriate strategic drivers.
Joint work across agencies/directorates is required to achieve a consistent approach with a shared understanding of the life experiences and
complexities therein.
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130
THE WORLD PROFESSIONAL ASSOCIATION
FOR TRANSGENDER HEALTH: MISSION AND
VISION: WPATH: DAY-TO-DAY
G. Knudson
Department of Sexual Medicine, University of British Columbia, Vancouver,
BC, Canada
The World Professional Association for Transgender Health
(WPATH) is a professional organization located at the University of
Minnesota in Minneaoplis/St.Paul. This paper will illustrate the dayto-day operations of the organization as well as the services it provides.
Highlights of WPATH’s biennial symposium at the Emory Conference Centre in Atlanta, September 2011 will also be featured.
131
WORLD PROFESSIONAL ASSOCIATION FOR
TRANSGENDER HEALTH: MISSION AND
VISION. RESPONSE OF WPATH TO THE
PROPOSED DSM 5 CRITERIA FOR GENDER
INCONGRUENCE AND TRANSVESTIC
DISORDER
G. De Cuypere1, G. Knudson2, W. Bockting3
Dept of Sexology and Genderproblems, University Hospital Ghent, Ghent,
Belgium, 2Dept of Sexual Medicine, University of British Columbia,
Vancouver, BC, Canada, 3Dept of Family Medicine and Community Health,
University of Minnesota Medical School, Minneapolis, MN, USA
1
WPATH is recognized as the leading authority in the field of transgender health and is therefore in an excellent position to give input on
the DSM 5 section on gender identity diosrders. To streamline the
ideas of the membership a consensus-building process was organized
to arrive at recommendations for removal or reform of the DSM 5
diagnoses starting in January 2009. This process culminated in a faceto-face meeting during the WPATH’s Biennial Oslo symposium in
June 2009. Although no consensus was reached on whether or not the
diagnoses should be retained, a consensus was reached that if the
diagnostic category related to gender dysphoria and transvestism
remained in the DSM 5, the diagnoses should be distress based.
Meanwhile the DSM 5 Work Group on Sexual and Gender Identity
Disorders of the American Psychiatric Association published the proposed changes for the diagnosis and the revised criteria on their
website. On behalf of the Board Members of WPATH, the authors
formulated a response to the proposed DSM5 criteria for Gender
Incongruence and Transvestic Disorder, based on the recommendations from the consensus statement for revision of these DSM diagnoses. This response contains agreements as well as points of critique
and focuses on name, diagnostic criteria, exclusion criteria, specifiers
and location of the diagnoses within DSM.
132
CONTRACEPTION AND WOMEN’S HEALTH
G. Lazdane
Division of Non-Communicable Diseases and Health Promotion, WHO
Regional Office for Europe, Copenhagen, Denmark
According to WHO “health is a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity”.
The 1948 Universal Declaration of Human Rights mentioned health
as part of the right to an adequate standard of living. The right to
health was again recognized as a human right in the 1966 International
Covenant on Economic, Social and Cultural Rights. Every woman has
the right to a responsible, satisfying and safe sex life, the right to
reproduce and the freedom to decide if, when and how often to do so,
the right to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of her choice, and
the right of access to appropriate health care services.
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Contraception gives women this freedom of choice and so directly
influences their health and quality of life. However, health systems in
many countries fail to meet women’s needs and only in 2006 did the
United Nations summit recognize importance of monitoring of the
unmet need for family planning and contraceptive prevalence (indicators of the Millennium Development Goal 5B) and affirm that further
development is impossible without “universal access to reproductive
health”.
According to the recent Demographic Health Surveys in countries
of the WHO European Region the difference of current use of modern
contraception between the lowest and highest wealth quintile groups
is around 15%. Links with social determinants of women’s health and
contraceptive prevalence will be presented.
133
THE IMPACT OF CONTRACEPTIVE
METHODS ON FEMALE SEXUAL FUNCTION
J. Bitzer
Gyn. Sozialmedizin und Psychosomatik, Universitätsspital Basel, Basel,
Switzerland
Introduction: Contraception aims at the separation of sexuality and
reproduction. Thus each family consultation deals indirectly with
sexuality. In usual practice the consultation is however focused on the
technical aspects of contraception assuming that the sexual experience
and sexual function of the patients are either their private matter or
somehow normally functioning anyway or a minor problem. Statistics
showing the high prevalence of sexual dysfunctions in women of the
reproductive age group indicate that this assumption is wrong. It seems
therefore necessary that the family planning professional takes a more
active role in the care for the sexual health of their patients.
Methods: Regular case discussions and supervision by two trained
sexologist elaborating a basic teaching program for family health professionals to provide sexual health care
Results: The professional for contraception needs some special
knowledge, understanding, communicative skills and technical
competences.
a) Knowledge about the types of sexual dysfunctions women may
experience during different phases of their reproductive life
b) Understanding of the complex interplay between biological, psychological, relationship and sociocultural factors contributing to
sexual problems including the possible impact of various contraceptive methods
c) Communicative skills to address sexual issues with patients in an
open, non-judgemental, structured way
d) Technical competences to establish a biopsychosocial diagnosis of
the sexual problem(s), provide basic counselling and treatment and
refer to other specialists if necessary.
method is related to a certain profile, intercourse related as the
condom, daily intake as the pill, need of doctor intervention such as
IUD insertion, and various contraceptive efficacy. Each contraceptive
user has her health risks, complaints and findings, as well as wishes and
values. Listening is an essential part of counselling. To the context part
belongs, sociocultural background, life phase, and relationship. Is it a
new relationship or longstanding, do partners frequently change, or
no present relationship. For a steady couple having intercourse once
a year, the emergency contraception progestin might be a good choice.
But if intercourse occurs more frequently, the contraceptive efficacy
of this preparation will be very low, and another choice is
recommended.
Sexuality education provides a good basis for individual counselling.
Particularly for young people, the organized education in schools is
essential.
135
SEXUALITY AND HINDUISM
A. Shetty
Sexual and Relationship Psychotherapy, Porterbrook Clinic/Sheffield Hallam
University, Sheffield, UK
Self-realisation as the predominant preoccupation of Hindu life will
be considered first. The four spiritual and normative goals of ‘dharma’
(righteousness), ‘artha’ (material prosperity), ‘kama’ (sensual pleasure)
and ‘moksha’ (liberation) will be discussed. The diversity of schools of
thought in relation to sexuality in Hinduism will be highlighted
through discussion of ‘Charvaka’ (hedonistic), ‘Tantra’ (ritual worship)
and ‘Advaita’ (non-duality) philosophies.
Sexual codes in the oldest surviving literature, the Vedas, the epics
Ramayana and Mahabharatha, the oldest surviving erotic text Kamasutra as well as erotic temple sculptures of Khajuraho and Ajanta will
be explored. The role of the ‘third gender’ in mythology and society
will be discussed.
The presentation will conclude by highlighting the paradox of contemporary Hindu society in its reluctance to talk about sexuality.
Take home messages:
1. Erotic pleasure is a legitimate pursuit in Hindu life as a means to
self-realisation
2. All pursuits are guided by the over-arching principle of ‘dharma’
(righteousness)
3. Eroticism in all its manifestations was celebrated in ancient
India
4. Modern Hindu society is rediscovering its erotic past
136
SEXUALITY AND ISLAM
The training program will be presented.
A. Tabatabaie
University of Cambridge, Cambridge, UK
134
Sexuality is inextricably intertwined with religious rules in Islam.
Sexual interests and motivations are presented in Muslim teachings as
a natural and necessary part of human existence and acquiring knowledge in sexual matters has been valued. Apart from some Muslims who
have adopted a more liberal interpretation of Islam, the dominant
Islamic discourse of sexuality focuses on sexual duality. It emphasises
the difference, complementarity and unity of the sexes and refers to
sexual activity as both recreative and procreative.
In understanding issues concerning sexuality within Muslim communities, the concept of modesty is particularly important. Modesty
has been considered to contribute to restrictions in public discourse
on sexuality. As a result of cultural sexual taboos, strongly overlaid onto
local understandings of Islam, talking about sexual issues is a difficult
task for most Muslims. Emphasising on the positive attitude towards
sexuality in Islamic teachings and encouraging constructive communication about sexual health issues, while acknowledging
and respecting cultural and religious sensitivities, are important
strategies in achieving better sexual health outcomes in Muslim
communities.
IMPACT OF SEXUAL FUNCTION ON
CONTRACEPTIVE CHOICES: COUNSELLING
AND SEXUALITY EDUCATION
D. Apter
The Sexual Health Clinic, Family Federation of Finland, Helsinki, Finland
Many factors influencing the choice of contraceptive methods are
related to sexual life situation and couple relation.
Age reflects changes in relationships. When starting to have intercourse, condom is the most common method of contraception, with
the added benefit of protection against STI. In Finland, up to the age
of 16, condom is the most used method. When the relationship gets
more stable, there is a switch to hormonal contraception. From 18 to
30, the pill is the most used method. Median age of delivery is 30.
After that, IUD is the most used method.
For counselling, contraceptive choices may be divided into method
related factors, woman’s profile related factors, and context. Each
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114
Take home messages:
139
— Islam has a positive attitude towards sexuality, values sexual activity
and believes sexual union gives a foretaste of the joys of paradise.
— There is a distinction between an ‘Islamic value’ and a ‘cultural
value, practised by Muslims’. Barriers to promoting sexual health
in Muslim communities are mostly cultural rather than religious.
— Facilitating a constructive dialogue on sexual issues, as encouraged
and valued by Islam, is an important strategy to achieve better
sexual health outcomes.
SUBJECTIVE SEXUAL EXPERIENCES AT
MOST RECENT SEXUAL EVENT AMONG
AMERICAN ADOLESCENTS
137
SYMPOSIUM: SOME BIBLICAL PRINCIPLES
FOR SEXUALITY
K. Weerakoon
Presbyterian Church of New South Wales, Sydney, NSW, Australia
Aims: To explore how sexual health and sexual ethics are represented
in the Bible and how these are relevant to the 21st century.
God created humans as physical and relational beings. Sexuality is
a good, healthy element of that created physical relatedness, with three
functions: relational bonding; mutual pleasure; and procreation. The
biblical pattern for sexual expression which best accords with these
functions is heterosexual monogamy.
Because of our active rejection of God (“sin”), sexual activity is—like
the rest of life—broken and imperfect. Jesus Christ, in repairing our
broken relationship with God through his death and resurrection,
affirms the goodness of sexuality—he is the bridegroom, the church is
his bride—and demonstrates the pattern for healthy sexual behaviour:
giving ourselves completely for the good of the other.
Enacting our sexuality for the good of others requires contentment
with our sexual partner, and self-control over our desires. We look
forward to our sexuality being fulfilled and transcended in heaven.
138
A SHORT-TERM PROSPECTIVE STUDY OF
FEMALE SEXUAL SUBJECTIVITY, AGE,
SEXUAL BEHAVIOR AND ROMANTIC STATUS
M.J. Zimmer-Gembeck1, W. Ducat1, M.-A. Boislard P.2
1
School of Psychology, Griffith University, Gold Coast, 2School of Psychology,
Griffith University, Labrador, QLD, Australia
Sexual self-perceptions are important aspects of sexuality, which can
undergo significant change during adolescence and early adulthood.
The purpose of the current longitudinal study was to describe these
changes among girls (N = 251; ages 16 to 25) over one year, and to
examine associations of sexual self-perceptions (sexual subjectivity) with
age, and sexual and romantic experience. Body-esteem, perceptions of
entitlement to desire and pleasure, efficacy, and self-reflection were
investigated as the five dimensions of sexual subjectivity. Perception of
entitlement to desire and pleasure increased over 1-year and all sexual
subjectivity elements were found to be higher among girls who had
more sexual experience and/or had steady romantic partners during
the study. Sexual subjectivity increased most for girls who began the
study with the least sociosexual experience and self-reflection increased
most for girls who had first coitus after the start of the study. Overall,
girls who had sexual intercourse the earliest (before age 16) had the
highest sexual subjectivity, but subjectivity increased the most among
girls without coital experience or who had more recent first coitus.
Sexual body-esteem showed the most stability and had minimal associations with sociosexual experiences. These results will be discussed
with regards to their clinical and theoretical applications.
D. Fortenberry
School of Medicine, Indiana University, Indianapolis, IN, USA
This paper summarizes the subjective sexual experiences associated
with the most recent partnered sexual event: sexual arousal, pleasure,
orgasm, erectile (males) or lubrication (females) difficulties, and sexual
intercourse pain.
Data were obtained from a population-based cross-sectional survey
of 5,865 adolescents and adults in the U.S. A total of 2,172 parents (or
legal guardians) reviewed a description of the study, including the
study instrument, and 62% (n = 1,347) subsequently consented to
allow their child to be invited via e-mail to participate. Of 1,347 adolescents contacted via e-mail, 831 responded, with 99.0% (n = 820)
consenting to participate. Of these, 242 (29.5%; 114 males and 128
females) reported at least one partnered sexual behavior in the past
year and are the focus of subsequent analyses.
Sexual behaviors were assessed by items describing a range of partnered sexual behaviors. Six sexual behaviors were specifically addressed:
frottage; given oral sex; received oral sex; penile-vaginal intercourse;
receptive anal intercourse; insertive anal intercourse. Subjective sexual
experience of the most recent sexual event assessed Sexual arousal,
Sexual pleasure, Orgasm, and Partner Orgasm. Participants who reported
penile-vaginal intercourse were asked about erectile or lubrication
difficulties, and pain.
Major findings were relatively high levels of arousal, pleasure
and orgasm across a variety of behaviors, lack of interference
with sexual pleasure or orgasm by condoms, and small but important
levels of erectile/lubrication difficulties and pain with penile-vaginal
intercourse. The data provide a basis for understanding sexual
aspects of adolescents’ sexual encounters from a sexual health
perspective.
140
THE INFLUENCE OF GENDER AND SEXUAL
ATTRACTIONS ON YOUTH’S DATING GOALS
M.-A. Boislard P.1, M. Kelly2, M.J. Zimmer-Gembeck2
School of Psychology, Griffith University, Labrador, 2School of Psychology,
Griffith University, Gold Coast, QLD, Australia
1
Emerging literature on dating goals suggest that young people have
different reasons to “date” and that their dating goals orient both their
behaviors and their satisfaction attainment. Four dating goals have
received previous empirical support among late adolescents and
emerging adults: intimacy, identity, social status and sexuality, with
identity being the most salient domain and having important implications for satisfaction. However, up to now, very little research has
examined how dating goals may differ according to sexual attractions
and gender. This study investigates differences in dating goals and in
goal-oriented behaviors among a diverse sample of same-sex and
other-sex attracted youth (N = 208 Australian youth; 91% Caucasian;
66% females; 43% same-sex attracted; Mage = 23.5 years, SD = 4.1).
Contrary to popular belief, males did not report higher levels of sex
dating goals than females and females reported higher levels of identity dating goals than males, F(1, 204) = 3.88, p < .05. There were no
differences between same-sex and other-sex attracted youth in dating
goals. Furthermore, although none of the interactions between gender
and attractions were significant to predict dating goals, an interesting
interaction effect of gender and attraction was found for affiliative
behavior, F(1, 204) = 16.72, p < .01, with same-sex attracted males and
other-sex attracted females significantly higher on preference for
affiliation than other-sex attracted males and same-sex attracted
females. A main effect of gender was also found, F(1, 204) = 7.72,
p < .01, indicating that preference for affiliation was higher among
females. Clinical implications and future directions for research are
discussed.
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141
SEX AND THE INTERNET: KEY FINDINGS
FROM THE MEN’S INTERNET STUDIES
(MINTS)
B.R.S. Rosser
Division of Epidemiology & Community Health, University of Minnesota
School of Public Health, Minneapolis, MN, USA
The Men’s INTernet Studies (MINTS I-III) is a series of NIH-funded
studies to research and develop Internet-based HIV prevention programs for Men who use the Internet to seek Sex with Men (MISM) in
the US. Key study questions include: Can we recruit high-risk men
into research studies? How does seeking sex online change risk behavior? Can we retain men in online sexual health programs so they
complete the program? Can we build Internet- programs that can
change MISM’s risk behavior?
MINTS-I (2001–2004; N = 1,026 Latino MISM) was one of the first
to evaluate men’s risk behavior in online vs offline liaisons. MINTS-II
(2005–2009) conducted a needs assessment (N = 2,716 MISM of all
race/ethnicities), developed and tested in a randomized controlled
trial, a highly interactive Internet-based sexual health promotion intervention based in persuasive computing (N = 550 MISM). MINTS-III
(2010–2014) is focused on long-term behavioral risk reduction. A video
will showcase the intervention. MSM are early adopters of new technology. MISM appear a large virtual community, estimated at between
2.5–6.2 million men in the USA. MISM report twice the number of
unprotected anal sex male partners in online liaisons to offline, but also
twice the number of partners overall. Less than half have attended
offline HIV prevention programs and only 29% use the CDC site for
HIV information. MISM want comprehensive sexual health information not condom use promotion. Highly explicit sexual content is
universally (97%) acceptable.
MINTS-II is the first trial to demonstrate promising sexual risk
reduction and acceptable retention through Internet-based education
among MISM.
142
ONLINE VIRTUAL FANTASIZING ABOUT
UNPROTECTED ANAL SEX AMONG MSM:
UNDERSTANDING AND MITIGATING
EFFECTS ON REAL-LIFE SEXUAL
RISK-TAKING
P.C.G. Adam
National Centre in HIV Social Research, University of New South Wales,
Sydney, NSW, Australia
Aims: Research shows that seeking sexual partners online is associated
with risk-taking among men who have sex with men (MSM). This
study explores the social and psychological mechanisms through which
online chatting exerts an influence on risk (reduction) practices in real
life and aims to identify and test self-regulation strategies to support
men in managing their online sex seeking and their sexual practices in
real life with partners met online.
Methods: An online survey of MSM in France enrolled 2,058 MSM
who completed assessments of UAI with partners met online, responses
to erotic chats about UAI, intentions to use condoms, attitudes regarding UAI, sexual risk-taking with casual partners, use of alcohol and
drugs with sex, and biographical characteristics.
Results: While intentions to use condoms with casual partners were
high, one third (32.1%) of respondents reported UAI with partners
met online. Responding positively to online chats about UAI was
significantly associated with sexual risk-taking with partners met
online, over and above motivational, behavioural and biographical
control variables.
Conclusions: Findings suggest that while most MSM do not go online
with the intention to take risk, some may engage in unprotected sex
after exchanging online fantasies about unprotected sex. This speaks
critically to the idea that online fantasizing has no consequences in real
life, and underscores the importance of HIV prevention that addresses
the dynamics of online chatting. Evidence from an online RCT will
be presented that supports the efficacy of self-regulation support strategies to mitigate sexual risk-taking with partners met online.
143
PREPARING FOR THE ‘HEAT OF THE
MOMENT’: EFFICACY OF A SELFREGULATION APPROACH IN ONLINE
PREVENTION FOR HIGHLY SEXUALLY
ACTIVE GAY MEN
J. de Wit
National Centre in HIV Social Research, University of New South Wales,
Sydney, NSW, Australia
Aims: Factors that currently shape sexual risk-taking in men who have
sex with men (MSM) remain poorly understood. Informed by a conceptual perspective underscoring the importance of unpremeditated
risk-taking, we assessed the role of behavioural willingness to engage
in unprotected sex with casual partners and tested an online intervention to promote planning for safer sex.
Methods: Online cohort studies among MSM in the Netherlands
(N = 400) and France (N = 5,240) assessed willingness to engage in
unprotected sex with casual partners in 22 situations. An online RCT
was then conducted among 1,700 French MSM who were randomly
assigned to a self-regulation intervention to support planning for safer
sex, a comparison intervention or a control condition.
Results: Willingness to take risk predicted unprotected at sex six and
12 months follow-up (explained variance 35–39%), controlling for
condom use and bareback intentions, and past risk and protective
behaviours. Willingness varied across situations, and willingness to
engage in unprotected sex in sexually adventurous situations was particularly influential in explaining unprotected sex. The e-intervention
had strong, significant effects on indicators of sexual self-regulation
and risk-taking, while the comparison intervention was not effective.
Most importantly, at 6 months follow-up the e-intervention reduced
sexual risk-taking by 30% among sexually adventurous men who previously experienced unplanned sexual risk-taking.
Conclusions: Much of the sexual risk-taking with casual partners
among MSM is unplanned. The strong and theoretically sound effects
of a brief intervention to promote advance planning for safer sex
illustrate the potential of the self-regulation perspective for innovative
online sexual health promotion.
144
SYMPOSIUM: PROVISION OF SERVICES FOR
VICTIMS OF SEXUAL ASSAULT: A MULTI
AGENCY PERSPECTIVE
C. Lipetz1, S. Mogg2, J. Stamp3
Community Gynaecology and Sexual Health, Aneurin Bevan Health Board,
Torfaen, 2Onyx Unit, Heddlu Gwent Police, Gwent, 3New Pathways,
Merthyr Tydfil, UK
1
The principles and structure of a Sexual Assault Referral Centre
A Sexual Assault Referral Centre (SARC) provides a safe discrete venue
for victims of rape and sexual assault who need forensic examination
and access to specialist police personnel if requested. The role of the
Crisis Worker and the Independent Sexual Violence Advocate (ISVA)
will be discussed. The process and rationale for the three stage model
of SARC services will be outlined and the benefits of therapeutic
intervention for victims, and for multi-agency partners delivering
SARC services, will be highlighted.
The structure of a victim focussed sexual assault investigation
The decision to report rape or sexual assault is courageous and challenging. When a victim does come forward it is imperative that their
needs are put first and that the subsequent investigation is focussed on
what matters to the victim as well as the need to secure evidence. The
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criminal process is important, but getting support and being believed
is as important. Sexual Offence Liaison Officers provide specialist
support for the victim and work closely with the Sexual Assault Referral Centre and the Forensic Medical Examiners. The role of the
forensic medical examiner
Forensic medicine is practised by a variety of doctors including
generalists and gynaecologists. Examination of victims of sexual assault
requires particular training and sensitivity. The role of the doctor
includes collecting evidence, immediate medical care and advising on
aftercare such as infection, emergency contraception, prophylaxis for
HIV. Education, training and service provision outside metropolitan
areas will be discussed.
SPECIAL SESSION
145
HISTORICAL, CULTURAL, AND
SOCIOLOGICAL PERSPECTIVES ON
TRANSGENDER HUMAN RIGHTS ACTIVISM
(WITHIN THE WHO SESSION ON (TRANS)
GENDER IDENTITY DISORDER, HUMAN
RIGHTS AND HEALTH)
S. Stryker
Gender Studies Department, Indiana University, Bloomington, IN, USA
This presentation offers a theoretical framework for understanding the
relationship between transgender human rights activism and other
forms of social justice activism. It first challenges the notion that
transgender activism is pertinent only to a tiny minority of transgendered individuals, and offers instead an account of gender as a disciplinary social apparatus that enables life for those rendered “normal”
while diminishing life for those who cannot or will not normalized. As
such, transgender activism provides a point of departure for critiquing
operations of power within which we are all enmeshed in various ways.
The presentation then briefly surveys the rise of a transgender rights
movement in the United States, the global dissemination of “transgender” as a category in public health and NGO/Philanthropic contexts,
the emergence of international and regional human rights standards
such as those promulgated in the Yogyakarta Principles, or through
the work of TGEU (Transgender Europe), or GATE (Global Advocates for Transgender Equality). It will point out several forms of
complexity that add to the difficulty of pursuing this work, as well as
to the excitement. These include the challenges of working across
incommensurable cultural and linguistic conceptions of the relationship between sex/gender/identity/embodiment, the range of national
healthcare systems and legal frameworks that impinge upon medicaljuridical gender-change processes and procedures, and geopolitical and
economic power imbalances between the Global North and the Global
South. It ends by asking whether “the human” and “rights” are the
best framework for expanding the possibilities of life for individuals
designated as “transgendered.”
146
GENDER IDENTITY AND THE ICD-11:
FINDING THE RIGHT BALANCE (WITHIN
THE WHO SYMPOSIUM ON (TRANS)GENDER
IDENTITY DISORDER, HUMAN RIGHTS AND
HEALTH)
G.M. Reed
Department of Mental Health and Substance Abuse (MSD/MER), World
Health Organization, Geneva, Switzerland
Health classifications are a core constitutional responsibility of WHO,
governed by international treaty with WHO’s 193 member countries.
The International Classification of Disease and Related Health Problems (ICD) is WHO’s most important classification, but has now been
without a major revision 20 years, the longest period in its history.
116
There is no question that the perspectives underlying areas of the
current classification characterized by major advances in scientific
understanding and changes in social attitudes over the past two decades
are seriously outdated, and no question that two such areas are sexual
health and issues related to gender identity. Two reasons for representing specific health conditions that may be linked-though not universally so-to transgender identity are:
1) As a basis for defining the obligations of WHO member states to
provide free or subsidized health care to their populations; and
2) As a basis for guidelines of care and standards of practice. WHO is
not invested in maintaining a conceptualization of transgenderlinked health conditions as mental disorders, and has specifically
highlighted changes in social understanding and the reduction
of stigmatization as legitimate reasons for changing the
classification.
A variety of conceptualizations of health entities that may be related
to transgender identity have been discussed, but none is entirely satisfactory and many are pathological. An alternative proposal that meets
scientific, health care, and human rights requirements has not been
offered. WHO has appointed a Working Group charged with making
recommendations in this area for the new classification.
147
THE RIGHT TO GENDER IDENTITY: LEGAL
PERSPECTIVES FROM EUROPE AND LATIN
AMERICA (WITHIN THE WHO SYMPOSIUM
ON (TRANS)GENDER IDENTITY DISORDER,
HUMAN RIGHTS AND HEALTH)
J. Westeson
Swedish Foundation for Human Rights, Stockholm, Sweden
This presentation explores legal approaches to gender identity and
gender expression in Europe and Latin America. In particular, the
presentation will highlight the tension between a focus on the right to
health services and treatment and the problems that a medicalization of
non-conforming gender expressions imply from a human rights perspective. By examining laws and cases from the two regions-including court
jurisprudence and legislation from Germany, Spain, Kazakhstan,
Colombia and Peru, as well as from the European Court of Human
Rights-this paper will address the following questions: How can the
law protect the rights of transgendered individuals, and what difference does a human rights perspective make? Is the ‘right to health’
perspective a fruitful way to address gender identity issues at all? If so,
how can the right to health and treatment for transgendered individuals be promoted through the law while also protecting their selfdetermination and right to dignity? For example, the European Court
of Human Rights suggests that transgendered individuals should be
entitled to state funding for gender reassignment, relying on the definition of ‘Gender Identity Disorder’ in ICD-10 and DSM-IV.
However, the same Court has also recognized the freedom to define
oneself as male or female as one of the most basic aspects of selfdetermination. Differing perspectives on this issue partly contradict
one other and may result in different logical conclusions with different
human rights implications.
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TAKING CARE OF HUMAN RIGHTS: PLACING
TRANS* HEALTHCARE IN A FRAMEWORK OF
HUMAN RIGHTS (WHO SYMPOSIUM ON
(TRANS)GENDER IDENTITY DISORDER,
HUMAN RIGHTS AND HEALTH)
J. Eisfeld
GATE—Global Action for Trans* Equality, New York, NY, USA
Trans* activists have called for a ‘depathologization’ of trans* identities, and an introduction of a human rights framework into medical
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practice. But how does this work? Departing from the human right to
the highest attainable standard of health, trans* individuals need access
to healthcare on the basis of autonomy and informed consent. Departing from the experiences of Callen-Lorde Community Health Center,
which has worked on the basis of informed consent (rather than a
mental health diagnosis) for the treatment of trans* individuals, as well
as the model of best practices introduced by the ‘Stop Trans Pathologization Campaign’, the presntation will lay out alternative healthcare
solutions for trans* individuals.
149
EROTIC INTELLIGENCE: THE PARADOX OF
INTIMACY AND SEXUALITY
E. Perel1,2
Psychiatry, New York University Medical Center, 2International Trauma
Studies Program, New York, NY, USA
1
Why does great sex so often fade for couples who claim to love each other as
much as ever? Why doesn’t good intimacy guarantee good sex? Can we want
what we already have? Why does the transition to parenthood so often spell
erotic disaster.
Based on her international best-seller, Mating in Captivity: Unlocking
Erotic Intelligence, Esther Perel probes the intricacies of love and desirehow they relate and how they conflict. Her bold, new take on intimacy
and sex, grapples with the obstacles and anxieties that arise when our
quest for secure love conflicts with our pursuit of passion?
Perel will address four central themes: paradox of intimacy and sexuality and how social forces inhibit erotic expression; how our emotional
history-“how we were loved” shapes our erotic blueprints and, in turn,
expresses itself in the physicality of sex- “how we make love”; the
language of the body; and the role of fantasy/imagination. We will
tackle eroticism as a quality of aliveness and vitality in relationships
extending far beyond mere sexuality, and consider how the need for
secure attachment and closeness can co-exist with the quest for individuality and freedom.
ORAL PRESENTATION
TRACK 1
150
PREMATURE EJACULATION IN MEN WITH
LOWER SPINAL CORD LESION
F. Courtois1,2,3, K. Charvier4, N. Morel Journel5, J.-G. Vézina6, I. Côté7,
M. Boulet7, S. Carrier8, G. Jacquemin9, C. Fournier9
1
Sexologie, Université du Québec à Montréal, 2Psychologie, Institut de
Réadaptation Gingras Lindsay de Montréal, Montreal, 3Clinique Externe,
Institut de Réadaptation en Déficience Physique de Québec, Quebec, QC,
Canada, 4Médecine Physique et Réadaptation, 5Urologie, Hospices Civils de
Lyon, Lyon, France, 6Urologie, 7Médecine Physique et Réadaptation, Institut
de Réadaptation en Déficience Physique de Québec, Québec, QC, 8Urologie,
Institut de Réadaptation de Montréal, Montréal, YT, 9Médecine Physique et
Réadaptation, Institut de Réadaptation de Montréal, Montréal, QC, Canada
Spinal cord injuries impair ejaculation. Yet, lower sacral lesions appear
to trigger premature ejaculation rather than anejaculation.
Objective: Analyse retrospective data from men with conus terminalis
lesions who consulted our center from 1992 to 2010.
Materials and methods: 34 men with conus terminalis lesions varying
from L5-S1 to S3-S4.
Results: Patients showed a loss of anal sensation in 6%, diminished
sensations in 79%, paresthesic sensations in 12% and normal in 3%.
Anal reflex was absent in 30%, diminished in 60% and normal in 10%.
Bulbocavernosus and bulboanal reflexes were absent in 38%, diminished in 41% and normal in 21%. Of the 34 patients, 91% reported
ejaculation, but 83% complained of premature ejaculation (eg, upon
mere sexual thought or desire) which appeared after the injury. 72%
also described the ejaculation as dribbling, and although the lesion was
incomplete in most cases, 78% reported no or little sensations upon
ejaculation and 15% painful sensations (eg. electric discharge upon
ejaculation). Only 7% reported climax.
Conclusion: Men with lower conus terminalis lesions appear to
develop premature ejaculation as a result of injury. Given the impaired
perineal innervation, most patients describe the ejaculation as dribbling and lacking sexual sensations. These findings are in marked
contrast with men with higher thoracic or cervical lesions, who generally lose ejaculation (with natural stimulation) but when triggered (with
vibrostimulation) appears to be propulsive and accompanied with
sexual autonomic sensations including climax. The results are discussed in relation to our current knowledge on the neurophysiology
of ejaculation.
151
THE NEUROBIOLOGY OF SEXUAL
ORIENTATION—THE GAY BRAIN
J. Goldstein
San Francisco Clinical Research Center, San Francisco, CA, USA
Homosexuality is a constantly debated issue as to whether it is determined at birth or a choice (nature vs. nurture). The works of the
Kinsey Reports and Dr. Evelyn Hooker published in the 1950s resulted
in the removal of homosexuality from the DSM4 in 1973. Since then,
it has been mentioned as an illness only in the context of being a putative exacerbating factor in anxiety states. Recent studies reveal a clear
cut neurobiology to sexual orientation.
Neurobiologist Simon LeVay conducted a study of brain tissue
samples from 41 human autopsies performed at several hospitals in
New York and California. He found a significant size difference of the
interstitial nuclei of the anterior hypothalamus between homosexual
and heterosexual men.
In addition, Dr. Ivanka Savic-Berglund and Dr. Per Lindström of
the Karolinska Institute, Stockholm, performed fMRI and PET measurements of cerebral blood flow. Using volumetric studies, they found
significant cerebral size differences between homosexual and heterosexual subjects; the brains of homosexual men resembled heterosexual
women and homosexual women resembled heterosexual men. Pheromonal studies also have added to the scientific knowledge of sexuality.
Sex-atypical connections were found among homosexual participants.
Amygdala connectivity differences were found to be statistically significant and provided evidence towards sexual dimorphism between
heterosexual and homosexual subjects. Extensive controls were performed during testing to exclude analytical variability.
A totally evidence-based medicine presentation will provide current
data regarding homosexuality showing differences, or similarities,
between the brains of homosexuals and heterosexuals.
152
STUDY OF THE PHARMACOLOGICAL
EFFECTS OF EUCALYPTUS GRANDIS ‘DRY
SEX’ TRADITIONAL MEDICINE USED IN
ZAMBIA
M.R. Mbikusita-Lewanika, S.L. Hart
Pharmacology & Therapeutics, King’s College, London, UK
Introduction: There has been some interest in the “dry sex” practice
in Central and Southern Africa, especially with regard to its possible
role in HIV transmission. Despite this interest, there has been little
scientific investigation of the practice. Hence the need for an ethnopharmacological study of the traditional compounds used in “dry sex”.
The traditional preparation evaluated in this study is made from Eucalyptus grandis and is normally administered locally, intra-vaginally, to
reduce vaginal secretions and to constrict the vaginal muscles.
Method: Samples of the traditionally-prepared “dry sex” medicine
were obtained from Zambia. The methods used to prepare the water
extracts from the traditional compound were as close as possible to
those used in the traditional preparation and administration of the “dry
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sex” medicine. The extracts were added to isolated guinea pig ileum
(GPI) and rat uterus, which were mounted in organ baths filled with
Krebs solution.
Results: 0.25–1.25mg/ml of the extract inhibited the GPI twitch and
caused an increase in the GPI tone. Both effects were dose-dependent
and irreversible. 0.25–4mg/ml of the extract also produced a dosedependent increase in uterine tone, as well as a reduction in the
spontaneous activity of the muscle.
Discussion: Although the pharmacological activity evaluated in this
study does not necessarily represent the in vivo effects of the “dry sex”
preparation, there was some correlation between the normal use of the
compound and the in vitro effects described in this study.
153
EFFECT OF ANACYCLUS PYRETHRUM
ON SEXUAL AND REPRODUCTIVE
DYSFUNCTION IN HYPERGLYCEMIC
MALE RATS
V. Sharma, V.K. Dixit
Department of Pharmaceutical Sciences, Dr.H.S.Gour University, Sagar,
India
Diabetes is considered as a major cause of sexual and erectile dysfunction in human population. Reproductive dysfunction is also consequence of diabetes. Anacyclus pyrethrum is considered as a sexual tonic
in Ayurvedic system of medicine with potent antioxidant and adaptogenic properties. The ethanolic extract of the herb was evaluated for
its effectiveness against streptozotocin induced hyperglycemic stress
and subsequent sexual dysfunction due to hyperglycemia in male rats.
Five groups with eight male rats in each group were used for the
present study and the study was carried out for 28 days. The body and
organ weights of the animals were recorded. Behavioral analysis of rats
was undertaken to observe the effect on mount, ejaculation and intromission (latencies and frequencies). Blood glucose and serum testosterone levels were determined after 28 days of treatment with Anacyclus
pyrethrum at 50,100 and 150 mg/Kg doses. This deleterious effect of
sustained hyperglycemia and associated stress was significantly ameliorated in animals treated with ethanolic extract of Anacyclus pyrethrum.
The Anacyclus pyrethrum treatment was helpful in ameliorating the
damage of sustained hyperglycemia evidenced in the principle parameters viz. male sexual behavior, sperm count, penile erection index and
seminal fructose content. Antioxidant and anabolic activities of the
extract under investigation could be a major attribute in preserving
the sexual functions in hyperglycemic male rats. The study validates
the use of Anacyclus pyrethrum in traditional medicine for curing diabetes induced sexual dysfunction and compromised sexual potency.
ORAL PRESENTATION
TRACK 2
154
SCREENING PROTOCOLS FOR GENDER
BASED VIOLENCE IN FAMILY PLANNING &
REPRODUCTIVE HEALTH CENTERS:
MULTICENTRIC SERVICE DELIVERY
INITIATIVE REPORT FROM INDIA
K. Apte1, V. Koliwad2, S. Natrajan3
1
Programme Implementation, 2CEO, FPA India,
Mumbai, India
3
President, FPAI,
Gender Based Violence (GBV), is widespread. In India, according to
NFHS—III, over 40% of married women face abuse at home. The
reported incidence of sexual violence in India is 10%, ranging from 22
% in West Bengal to 2 % in Meghalaya.
There is now increasing evidence linking physical and sexual violence and also in linking the negative health outcomes to violence.
118
FPA India, a national NGO working on sexual and Reproductive
Health issues in India in 17 states has initiated a screening for GBV
at its 10 centers for all women seeking reproductive health services.
SO far over 2500 women have been screened for GBV.
Findings:
1. A strong link exists between unwanted pregnancies; STIs and other
reproductive health outcomes and sexual violence.
2. Often women do not volunteer history of sexual or physical violence
with their healthcare providers.
3. Typically women suffering from violence are unable to continue
using a family planning method; unable to follow health recommendations; fail to return for follow-up visits.
4. Women feel ashamed and responsible for the violence they encounter; thus they are unable to share it with anyone.
Conclusions: The health sector has a vital role in preventing violence,
helping to identify abuse early, providing victims with the necessary
treatment, and appropriate referrals.
The services should include care and support and also necessary
treatment. The services would be provided as per need of the victims—
direct intervention, counseling or referral.
155
RISK OF VENOUS THROMBOEMBOLISM
(VTE) IN ESTROGEN-TREATED MALE-TOFEMALE TRANSSEXUALS. A REVIEW OF
LITERATURE AND OBSERVATIONS FROM 9
EUROPEAN CENTERS FOR GENDER
DYSPHORIA
H. Asscheman1, G. T’Sjoen2, A. Lemaire3, M.C. Merigiolla4, A. Mueller5,
J. Buffat6, A. Kuhn7, C. Dhejne8, N. Morel-Journel9, L.J. Gooren10
1
HAJAP, Amsterdam, The Netherlands, 2Endocrinology, University Hospital
Ghent, Ghent, Belgium, 3Endocrinology, Lille, France, 4Gyneacology,
Universiy of Bologna, Bologna, Italy, 5Gynaecology, University Hospital
Erlangen, Erlangen, Germany, 6Psychiatrist, Geneva, 7Frauenklinik,
University Hospital Bern, Bern, Switzerland, 8Psychiatry, Karolinska
University, Stockholm, Sweden, 9Urology, Université de Lyon-Sud, Lyon,
France, 10AndroConsult, ChangMai, Thailand
Objective: To evaluate the risk of venous thrombosis/embolism
(VTE) in male-to-female transsexuals treated with estrogens in the
literature and 9 European centers.
Main outcomes: Number and incidence of VTE/10,000 user-years
and prescribed hormones.
Results: Published incidence of VTE varied from 0 to 148/10,000
user-years, highest with ethinyl estradiol (EE) 0.1 mg/day. Observational data with estimated numbers of treated patients showed an
incidence of VTE 4.8–35.5/10,000 user-years. Four out of 21 VTE’s
occurred on OC containing EE + cyproterone acetate (CPA) though
standard estrogen prescription is 17-estradiol transdermal or oral
2–4 mg/day with CPA. Four cases of VTE with oral estradiol, one on
Premarin and five on transdermal estrogen (currently most prescribed
E2), were reported.
One surgical center reported a low but significant incidence of
postoperative VTE with LMWH and stopping of hormones. One
center did not stop hormones before operation and observed no postoperative VTE in >100 operated patients with only LMWH prophylaxis. No VTE was observed in the other centers which all stopped
hormones and used LMWH.
Conclusion: The incidence of VTE in estrogen-treated MtF has
much decreased in recent years, probably due lower estrogen dose and
avoiding EE. However, the risk of VTE appears still increased compared to women (3/10,000), even to estrogen-using women (OC and
HRT). Postoperative VTE incidence is low but significant, even in
subjects who stopped estrogen before surgery. Peri-operative prophylaxis with LMWH is mandatory. Stopping estrogens before surgery
seems prudent but we have insufficient data to recommend it.
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156
“ABUSED ABUSER” HYPOTHESIS IN
UNDERSTANDING THE AETIOLOGY OF
PAEDOPHILIA
M. Beisert
Social Science, Adam Mickiewicz University, Poznan, Poland
Introduction and objectives: Paedophilia is a complex issue of not
clearly defined aetiology. One of the well-known explanation is the
abused abuser hypothesis. It suggests that sexual abuse in childhood
may lead to the cycle of abuse: having been the victim of abuse as a
child is seen as an important factor related to later sexual offending.
The author presents the research grounded in three paradigms: biological, psychodynamic and behavioral-cognitive.
Methods: The abused abuser hypothesis has brought about the
assumptions that were verified in the presented study. There were
some standard measures used (questionnaires: TCI—Cloningers,
RSQ—Hazan i Shaver) and some constructed specially for the
conducted research (semi-structured interview, CSA Inventory)
The sample consisted of 248 child molesters—diagnosed pedophiles
(exclusive or non-exclusive), sentenced and jailed. Data was collected
during two years (2008–2009) by the highly qualified body of
researchers.
Results: A large proportion of child molesters (48%) has been sexually
abused as a child. There were no significant differences (considering
biological, familial and psychological variables) between abused
abusers and non-abused abusers.Nevertheless, having been the victim
in childhood affects indirectly and substantially the men’s early sexual
development and distorts his sexual preferences and their individual
expression.
Conclusions: The author presents the innovatory interpretation
of the abused abuser hypothesis. Although it is limited, but it contributes a lot to the understanding of a such complex issue as
paedophilia.
157
DOES FEMALE GENITAL MUTILATION/
CUTTING (FGM/C) AFFECT WOMEN’S
SEXUAL FUNCTIONING? RESULTS FROM A
SYSTEMATIC REVIEW AND META-ANALYSIS
R.C. Berg, E. Denison, A. Fretheim
Department of Health Promotion and International Health, Norwegian
Knowledge Centre for the Health Services, Oslo, Norway
FGM/C refers to a traditional practice involving the partial or total
removal of the female external genitalia or other injury to the female
genital organs for cultural or other non-therapeutic reasons. Estimates
suggest 100–130 million girls/women are currently living with various
health consequences from FGM/C.
We conducted a systematic review investigating the sexual consequences of FGM/C. We searched 13 electronic databases. Crossreferencing, handsearching organizations’ websites, and contacting
experts yielded additional records. Two reviewers independently
appraised 5,233 records and 36 full-text papers for inclusion and methodological quality.
15 comparative studies (7 countries, 12,671 participants), of variable
methodological quality, met the eligibility criteria. The studies
reported in total 65 outcomes for sexual consequences of FGM/C, the
majority of which were statistically associated with FGM/C status at
study level. Altogether meta-analyses were acceptable for seven outcomes: pain during intercourse, satisfaction, desire, initiation of sex,
orgasm, reporting clitoris as the most sensitive area of the body,
reporting the breasts as the most sensitive areas of the body. Compared
to women without FGM/C, women who had been subjected to
FGM/C were more likely to report pain during intercourse (RR = 1.52,
95%CI = 1.15, 2.0), no sexual desire (RR = 2.15, 95%CI = 1.37, 3.36),
and less sexual satisfaction (St.mean diff = -0.34, 95%CI = -0.56,
-0.13). Statistical tests for heterogeneity precluded additional consideration of outcomes.
Although a causal link cannot be established based on the current
evidence, results show that women with FGM/C are more likely to
experience increased pain during intercourse and reduction in sexual
satisfaction and desire.
158
VAGINISMUS: RELATIONSHIP WITH
GENERAL AND SEX-RELATED MORAL
STANDARDS
C. Borg1, P. de Jong1, W. Weijmar Schultz2
Department of Clinical Psychology and Experimental Psychopathology,
University of Groningen, 2Department of Gynaecology and Obstetrics,
University Medical Centre Groningen (UMCG), Groningen, The
Netherlands
1
Relatively strong adherence to conservative values and/or relatively
strict sex-related moral standards logically restricts the sexual repertoire and will lower the threshold for experiencing negative emotions
in a sexual context. In turn, this may generate withdrawal and avoidance behavior, which is at the nucleus of vaginismus.
The aim of our study was to examine whether indeed strong adherence to conservative morals and/or strict sexual standards may be
involved in vaginismus. We used two two self report measures; the Schwartz
Value Survey (SVS) to investigate the individual’s value pattern and the
Sexual Disgust Questionnaire (SDQ) to index the willingness to
perform certain sexual activities as an indirect measure of sex-related
moral standards. The SVS and SDQ were completed by three groups:
women diagnosed with vaginismus (N = 24), a group of women diagnosed with dyspareunia (N = 24), and a healthy control group of
women without sexual complaints (N = 32).
In this study it was found that specifically, the vaginismus group
showed relatively low scores on liberal values together with comparatively high scores on conservative values. Additionally, the vaginismus
group was more restricted in their readiness to perform particular sexrelated behaviors than the control group. The dyspareunia group, on
both the SVS and the SDQ, placed between the vaginismus and the
control group, but not significantly different than either of the groups.
The findings are consistent with the view that low liberal and high
conservative values, along with restricted sexual standards, are involved
in the development/maintenance of vaginismus.
Reference: Borg., C. , de Jong. J. P., Weijmar Schultz. W. (2011)—
Vaginismus and Dyspareunia: Relationship with General and
Sex Related Moral Standards. The Journal of Sexual Medicine;
8:223–231.
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LAPAROSCOPIC SACROCOLPOPEXY: LONG
TERM FUNCTIONAL AND ANATOMICAL
OUTCOMES
B.D. Deval1,2
1
75006, 2Geoffroy St Hilaire Clinic, Paris, France
Introduction: Assessment of the 4 year outcome of laparoscopic
sacrocolpopexy.
Methods: A total of 64 women taking part in a prospective longitudinal study of prolapse who had a laparoscopic sacrocolpopexy between
February 2004 and December 2010 was undertaken. Women attended
a research clinic where they completed validated quality-of-life questionnaires and were examined at 6 months, 1 year and 5 years. Pelvic
organ support was assessed objectively using the pelvic organ prolapse
quantification scale (POP-Q). Functional outcomes were assessed
using the International Consultation on Incontinence questionnaire
for vaginal symptoms (ICIQ-VS), both preoperatively and at 6–56
months postoperatively.
Results: At a mean follow up of 36.5 months with a mean age of 62
years (range, 49–78 years) were studied. At follow-up in clinic, all
women had good vault support (mean point C, -8.9; range, 10 to -8).
Stress urinary incontinence resolved in the majority of women without
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concomitant continence surgery. Bowel symptoms were uncommon,
but of those reporting postoperative bowel symptoms, approximately
half of them had no symptoms prior to surgery. No new onset dyspareunia was reported in those women sexually active at 4 years.
Conclusions: Our results confirm previous findings that laparoscopic
sacrocolpopexy is a safe and efficacious surgical treatment for female
genital prolapsed in long term. It provides excellent apical support and
good functional outcome with overall improvement in sexual
function.
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PREVALENCE AND RISK FACTORS FOR
SEXUAL DYSFUNCTION AND DISTRESS IN
PREMENOPAUSAL UNCOMPLICATED
WOMEN WITH TYPE 1 DIABETES
K. Dimitropoulos1, A. Bargiota2, O. Mouzas3, G. Koukoulis2, M. Melekos1,
V. Tzortzis1
1
Department of Urology, 2Department of Endocrine Disorders, 3Department
of Psychiatry, University of Thessaly, Larissa, Greece
Objective: Women with type 1 diabetes mellitus (DM-1) are in higher
risk for female sexual dysfunction (FSD). The aim of the present study
was to investigate the prevalence and determinants of FSD and sexual
distress (SeD) in a group of premenopausal, uncomplicated DM-1
women.
Materials and methods: The sexual function, distress and general
health of 44 DM-1 patients and 47 healthy women (CG) were evaluated with the Female Sexual Function Index (FSFI), the Female Sexual
Distress Scale (FSDS) and the General Health Questionnaire-28
(GHQ-28). A structured interview and laboratory tests were performed to all women. Non parametric tests were used in statistical
analysis.
Results: The prevalence of FSD was 25% in DM-1 patients and 8.5%
in CG. The combination of FSD and SeD was present in 15.91% of
DM-1 women versus 2.13% of the non-patients. Diabetic women had
significantly worse FSDS, desire, arousal, satisfaction and total FSFI
scores compared to the controls. In the diabetics, a positive correlation
was found between FSD and impaired general health, social dysfunction, anxiety, depression, high weight and BMI and number of children. SeD was positively correlated with low quality of life (physical
symptoms, depression, anxiety and social dysfunction) and low educational level. No other correlation was found.
Conclusions: Our study shows that FSD and SeD are common in
premenopausal, uncomplicated DM-1 patients. Desire, arousal and
satisfaction are the sexual domains affected. Psychosomatic and contextual factors seem to be the major predictors for FSD and SeD.
161
THE CHARMS STUDY: PATIENTS’ VIEWS
ABOUT DISCUSSING SEXUAL ISSUES
FOLLOWING CORONARY HEART DISEASE
S. Doherty1, M. Byrne1, A. Murphy2, H.M. McGee3
1
Psychology, 2General Practice, National University of Ireland NUI Galway,
Galway, 3Psychology, Royal College of Surgeons in Ireland (RCSI), Dublin,
Ireland
Purpose: The aim of this study is to document levels of sexual functioning, extent and causal attributions of sexual problems and the
cardiac patient’s experience of discussing sexual matters within the
healthcare system.
Method: Questionnaires have been administered over the telephone
to 200 male and female patients who have met the selection criteria of
completing cardiac rehabilitation within the previous two years but not
within the previous two months. Data collection is ongoing and we
aim to have a patient sample size of 500 by March 2011. The questionnaire includes five sections: (a) demographic information, (b) general
health, (c) sexual activity, (d) sexual problems and (e) sexual problems
and heart condition.
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Results: Early indications would suggest that males predominately
over the age of sixty years of age have lower levels of sexual activity
following a cardiac event than younger patients with coronary disease,
citing problems such as erectile dysfunction and fear of resuming
sexual activity. According to patients, sex information following a coronary event is not readily available from healthcare providers. Many
patients have expressed a need for an individual counselling programme to be provided as part of the cardiac rehabilitation
programme.
Conclusion: This research provides valuable information about the
personal experiences of patients in Ireland with coronary heart disease,
examining the impact on sexual and interpersonal relationships, their
wellbeing and their general quality of life. It will also specifically
contribute to the development of practice guidelines on sexual assessment and counselling for patients with coronary heart disease in
Ireland.
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ASSESSMENT OF DEPENDENCE BETWEEN
HEART RATE RECOVERY AND IIEF-5 TEST
SCORES IN PATIENTS WITH ISCHEMIC
HEART DISEASE AND ERECTILE
DYSFUNCTION SUBJECTED TO CARDIAC
REHABILITATION
D. Kalka1,2, Z.A. Domagala3, W. Marciniak4, P. Koleda1, A. Grychowski5,
M. Pilot5, R. Poreba6, A. Popielewicz—Kautz4, J. Wojcieszczyk2,7,
W. Pilecki1
1
Pathophysiology, Wroclaw Medical University, 2‘Creator’—Centre of
Cardiac Rehabilitation, 3Normal Anatomy, Wroclaw Medical University,
Wroclaw, 4Cardiology, Ostrobramska Medical Centre Magodent, Warszawa,
5
Center of Cardiac Rehabilitation, Glucholazy, 6Internal Diseases and
Hypertension, Wroclaw Medical University, 7University School of Physical
Education, Wroclaw, Poland
The process of erection in men and heart rate recovery (HRR) are
related to the parasympathetic system activity. The goal of the study
was to conduct an analysis of the dependence between the change of
HRR and the change of IIEF-5 test scores in a population of patients
with ischemic heart disease (IHD) and erectile dysfunction (ED) subjected to a six-month cardiac rehabilitation (CR).
The analysis has been conducted on 98 patients, at the mean age of
62.35 ± 8.88 (IIEF-5 score ≤21), subjected to a six-month cardiac
rehabilitation. Training sessions were five times a week—two days of
general rehabilitation exercises and three days of cycle ergometer
training. Each training session lasted 45 minutes.
The patients filled in an IIEF-5 questionnaire twice, at the interval
of six months, and were subjected to the treadmill exercise test twice.
HRR-60 was calculated as the difference between heart rate at peak
exercise and heart rate at the 60th second of recovery during the physical test.
The modification of the intensity of HRR and the change of scores
in the IIEF-5 test caused by a six-month cardiac rehabilitation cycle
in the population of patients with IHD and ED are correlated by a
statistically significant Pearson’s correlation coefficient r = 0.706 (p <
0.01).
Conclusions:
1. Modification of heart rate recovery and erectile dysfunction intensity caused by a six-month cardiac rehabilitation cycle are positively
correlated in patients with IHD and ED.
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163
EFFECTS OF ANDROGEN SENSITIVITY, FREE
TESTOSTERONE AND MOOD ON THE
SEXUAL DESIRE IN CONTRACEPTIVE USERS
E. Elaut1, A. Buysse2, P. De Sutter3, G. De Cuypere1, J. Gerris3,
E. Deschepper4, G. T’Sjoen1
1
Department of Sexology and Gender Problems, Ghent University Hospital,
2
Department of Clinical-Experimental and Health Psychology, Ghent
University, 3Department of Reproductive Medicine, 4Department of Medical
Statistics, Ghent University Hospital, Ghent, Belgium
Objective: This study set out to test whether sexual desire levels in
contraceptive users are influenced by genetic variation in the androgen
receptor (AR) gene, serum androgen levels and psychosexual and relational variables.
Method: Fifty-five couples were randomly assigned to three conditions in which women all used three products [Progestin Only Pill
(POP), Combined Oral Contraceptive (COC), and Vaginal Ring
(VR)], each product during three months and in a differing sequence.
Monthly, both partners filled out questionnaires on psychosexual and
relationship variables. Serum androgen levels and a genetic marker of
androgen sensitivity (AR CAG repeat polymorphism) were assessed in
female participants.
Results: Mixed models pointed to an effect of CAG repeats on solitary
sexual desire (desire to behave sexually by oneself): women with longer
CAG polymorphisms reported stronger solitary sexual desire (p =
.008). Women with a better baseline sexual functioning also presented
with a stronger solitary sexual desire throughout the study (p = .028);
while a more positive mood was marginally associated with a higher
dyadic sexual desire (desire to behave sexually with a partner) (p =
.051). Effects of FT-levels on solitary or dyadic sexual desire could not
be established (p = .777 and p = .153).
Conclusions: It appears not only intrapersonal processes such
as mood are important factors to consider in the debate on contraception and sexual desire. While no overt effects of serum androgen
levels could be established, a subgroup of women very sensitive
to androgenic effects reported a clearly different level of sexual
desire.
164
PSYCHOSEXUAL COUNSELING IN HIV
DISCORDANT COUPLES
S. Eleuteri1, C. Silvaggi1, C. Simonelli2
Institute of Clinical Sexology, 2‘Sapienza’, University of Rome, Rome, Italy
1
Introduction: HIV is frequently transmitted in the context of partners
in a committed relationship, with a rate of transmission among discordant couples 5 to 17 times higher than incidence rate among HIV
concordant negative couples.
Objective: The aim of this contribution is to review the literature
in order to investigate the role that couple psychosexual counseling
may have as an HIV prevention strategy and as a tool to enhance
the relational and psychological wellbeing of serodiscordant
couples.
Methods: The paper provides a theoretical contribution to HIV prevention interventions. The Authors have consulted the main scientific
search engines such as Medline and PsychInfo, taking into account
recent publications from 2000 to 2010.
Results: Literature analysis underlines the efficacy of couple psychosexual counseling in HIV prevention. As knowledge is not sufficient
to stop risky behaviour, couple counseling should address the dynamic
and interactional forces within dyads that contribute to sexual risks
(such as gender roles, communication styles and quality of
relationship).
Conclusions: There is a growing consensus that HIV prevention
should address couples as a unit of behavior change. This kind of
intervention represents an effective HIV prevention strategy but it
could also be an optimal tool to enhance the relational and psychological wellbeing of serodiscordant couples.
References: Burton J, Darbes LA, Operario D (2010). CoupleFocused Behavioral Interventions for Prevention of HIV: Systematic
Review of the State of Evidence. AIDS Behav, 14:1–10. Harman JJ,
Amico KR. (2009) The relationship-oriented information-motivation-behavioral skills model: a multilevel structural equation model
among dyads. AIDS Behav, 13:173–184.
165
WHY CONTINUE TO HAVE VAGINAL
INTERCOURSE DESPITE PAIN? REASONS
AND ASSOCIATED FACTORS AMONG YOUNG
SWEDISH WOMEN
E. Elmerstig1,2, B. Wijma2, K. Swahnberg2
1
Faculty of Health and Society, Malmö University, Malmö, 2Division of
Gender and Medicine, Department of Clinical and Experimental Medicine,
Faculty of Health Sciences, Linkoping University, Linkoping, Sweden
Introduction and objectives: Pain during vaginal intercourse (VIC)
is a frequent complaint among young Swedish women, of whom a
considerable proportion continues to have VIC despite pain. In the
present study we therefore examined the prevalence of women who
despite pain continue to have VIC, omit telling the partner, and feign
enjoyment; as well as the reasons for such behaviour.
Methods: A sample of 1566 Swedish female high school students (aged
18–22 years) completed a questionnaire concerning body and
sexuality.
Results: Forty-seven percent (207/576) of those women who reported
pain during VIC continued to have VIC despite pain. The most
common reasons were that they did not want to destroy sex for or
hurt their partner by interrupting VIC. Feigning enjoyment and
omit telling the partner about their pain were reported by 22%
and 33% respectively. Continuing to have VIC despite pain was
associated with feelings of being inferior to partner during sex, dissatisfaction with their own sex lives and feigning enjoyment while
having pain.
Conclusion: Pain during VIC is reported by every third young
Swedish woman and almost half of those still continue to have VIC.
The major reason given is noteworthy—prioritizing the partner’s
enjoyment before their own—and demonstrates that young women
who continue to have VIC despite pain take a subordinated position
in sexual interactions.
166
HETEROSEXUAL MALES WHO ACTIVELY
EMBRACE FEMINISM AND RESIST
HOMOPHOBIA: HOW DO THEY GET THAT
WAY? REPORT ON A QUALITATIVE STUDY
OF COLLEGE AGE U.S. MALES
R. Heasley1, M. Wolfe2, R. Smith1
Sociology, Indiana University of Pennsylvania, Indiana, 2Human Sexuality,
Widener University, Chester, PA, USA
1
To reduce violence and discrimination by males toward women and
gay, lesbian, bisexual or transgender people, it is critical to understand
the process through which heterosexual males who self-report as
highly accepting gay/lesbian/bi/trans people, and actively embrace
feminist values come to hold these values and beliefs. By understanding
the processes through which straight males choose not to adopt homophobic and misogynist qualities, it is possible to develop more effective
prevention and intervention processes for raising boys and working
with males in educational and therapeutic settings. This paper presents
the results of in-depth interviews conducted with heterosexual males
ages 19–30 who self-report as resisting homophobia and embracing
feminism. Interviewers gathered information on family background,
relationship history, sensitivity toward sexism, the effects of homophobia on the GLBT population, as well as sexism and homophobia on
heterosexual males. Emergent themes include:
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(1) Importance of family relationships including:
(a) Strong/feminist mother/sister,
(b) Nurturing/feminist/non-homophobic father,
(c) Negative exposure to homophobic/sexist father.
(2) Exposure
to
non-homophobic/non-sexist
environments,
including:
(a) university classes reflecting similar values/beliefs,
(b) Exposure to strong GLBT and feminist populations.
(3) Personal experience in romantic and friendship relationships,
including
(a)Female friends/girlfriends who have experienced abuse/acts of
discrimination,
(b) girlfriends identifying as feminists,
(b)Forming friendships with GLBT individuals,
(c)Negative exposure to straight males who overtly express
homophobic and misogynistic qualities.
Clinical/educational implications: Importance of: Increasing exposure
to GLBT populations and women’s issues; exposing males to women’s
leadership; affirming mothers to espouse feminist values and fathers
who are nurturing/non-homophobic.
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CLINICAL EVALUATION OF A NEW
BIBLIOTHERAPY FOR PREMATURE
EJACULATION
P. Kempeneers1,2,3, R. Andrianne1,3, S. Bauwens3, S. Blairy1, I. Georis3,
J.F. Pairoux3,4
1
University of Liege, Liege, 2Alexians’ Hospital, Henri-Chapelle, 3BibliothEP,
Liege, 4CHS, Lierneux, Belgium
Premature ejaculation (PE) is quite common. Although effective treatments do exist, only few affected people consult a practitioner in order
to overcome their problem. On the other hand, studies have shown
that reading didactical documents about their PE problem might be
useful to men. Such approach is called “bibliotherapy”. The aim of the
present study was to improve the bibliotherapy approach on the basis
of up to date knowledge and techniques. The expected benefits were:
(1) an efficient manual shorter than previous ones, (2) therapeutic
principles easier to assimilate and (3) a method thereby made accessible
to a large public which usually does not consult for this type of sexual
problem. A short bibliotherapy named Practical Guide of PE [in
French] was tested among 421 PE subjects. Self-reported anxiety,
sexual satisfaction, ejaculatory latency time, feeling of control and
distress were measured: (1) at baseline, (2) at 4–8 months and (3) at
10–14 months after reading the bibliotherapy. A control condition was
composed by 67 subjects left on a waiting-list for two months after
baseline. Significant improvements were found for all the parameters
after the bibliotherapy. They were associated with an adjustment of
sexual cognitions. The response to treatment seemed better when the
severity of PE was moderate, but did not seem related to variables such
as age, educational level and personality traits.
Conclusion: Its cost/benefit ratio makes the Practical Guide an ideal
first line therapeutic tool. Its large diffusion might be useful in order
to improve sexual health in populations.
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168
AN EXPLORATORY STUDY TO IDENTIFY
OBSTACLES AND ENABLERS TO
COMMUNICATION ABOUT ERECTILE
DYSFUNCTION FOLLOWING
CARDIAC TRAUMA
G. Kiemle1,2, J. Deakin-Denman3
Clinical Psychology (D. Clin. Psychol. Programme), University of Liverpool,
Liverpool, 2Psychological Therapies, Royal Bolton Hospital, Greater
Manchester West Mental Health NHS Foundation Trust, Bolton, 3Psychology
Services for Adults with a Learning Disability, Lincolnshire Partnership
NHS Foundation Trust, St. George’s Hospital, Lincoln, UK
1
Introduction: Previous literature demonstrates a lack of qualitative
research into communication between healthcare professionals and
patients about issues of sexuality, in the area of cardiovascular
disorders.
Aims: To explore changes in sexual functioning following serious heart
trauma and resultant psychological effects; as well as barriers and
enablers to communicating about sexual difficulties between patients
and professionals.
Design: Non-experimental qualitative design using semi-structured
interviews, and analysed using IPA aided by the computer software
Atlas.ti.
Participants and methods: In total, seven cardiac patients (A) and six
cardiac nursing professionals (B) took part in the study. Interview
schedule (A) focused on ‘Experience of heart problems’, ‘Psychological
experience of heart problems’, ‘Relationships’, ‘Sexual Relationship’,
and ‘Communication’. Interview schedule (B) focused on ‘Experience
in Cardiac rehabilitation’, ‘Experience of Sexual Difficulties in Patients’
and ‘Communicating about Sexual Difficulties’. Interpretative phenomenological analysis (IPA) was used to analyse data and identify key
themes for both groups.
Results: Over-arching themes demonstrating psychological effects
experienced by patients were ‘Importance of Sex’, ‘Lack of Understanding’ and ‘Psychological Input’. Barriers to communication identified by both groups included ‘Culture and Diversity’, ‘Embarrassment’,
‘Self-Worth’ and ‘Professional Issues’. Enablers to communication
identified by both groups were ‘Information’, ‘Training and Education’
and ‘Professional Issues’.
Conclusion: The study highlighted that ease of patient-professional
communication was vital for effective treatment and well-being of
patients. It stressed the need for focused sensitive information for
patient awareness, as well as education for professionals in sexual
dysfunction and its association with cardiac trauma, and training in
communication skills regarding sexual issues.
169
CAN SIMVASTATIN IMPROVE ERECTILE
FUNCTION AND QUALITY OF LIFE IN MEN
WITH ERECTILE DYSFUNCTION?
RATIONALE AND DESIGN OF THE ERECTILE
DYSFUNCTION AND STATINS TRIAL
[ISRCTN66772971]
D. Trivedi1, M. Kirby1, F. Norman1, I. Przybytniak1, S. Ali2, D. Wellsted3
1
Centre for Research in Primary and Community Care, University of
Hertfordshire, Hatfield, 2Department of Health Sciences, University of York,
York, 3Centre for Lifespan and Chronic Illness Research, University of
Hertfordshire, Hatfield, UK
Objective: To describe the rationale and design of the Erectile Dysfunction and Statins (EDS) trial evaluating the effectiveness of simvastatin on erectile function and quality of life (QoL) in men with
erectile dysfunction.
Patients and methods:
• Erectile Dysfunction (ED) is a common sexual health problem in
men over forty years with a major impact on their, and their partners’ QoL. Treatment is expensive and restricted.
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• The study is a randomised, double blind, placebo controlled trial,
to test the hypotheses that statins improve endothelial function,
reduce cholesterol, and may improve erectile function. Study subjects include men aged forty years and over, not receiving lipid
lowering or anti-hypertensive medication, with no other CVD risk
factors.
• Eligible men with untreated ED are randomised to 40 mg simvastatin or placebo once daily for six months. Data is collected at
baseline, mid trial (3 months) and a final follow-up visit (6 months).
• The main outcome is erectile function measured by IIEF-5. Secondary outcomes include sexual health related QoL and endothelial
function.
Results:
• Ten general practices have been recruited.
• 173 men have been randomised for 90% power
• To date there have been no serious unexpected adverse events.
• Study findings will be available in September 2011.
Conclusions:
• If simvastatin improves erectile function it would provide an inexpensive treatment for ED suitable for most men and reduce the risk
of future cardiovascular disease.
170
TRAUMA RELIEF: AN INTEGRATED
APPROACH FOR WORKING WITH SEXUALLY
ABUSED CLIENTS
A. Lindskog
Villa Frisk, Greåker, Norway
Introduction: Sexually traumatized patients often have problems with
flashbacks, nightmares and avoidance. This workshop teaches an integrated method for trauma relief, combining knowledge from NLP,
psycho dynamic therapy, cognitive therapy and modern trauma
research. The method is based on the human memory storing system,
which functions in the same way in all human beings. This means that
the method easily can be used cross-culturally and for all gender
combinations. I presented the basis of this workshop at WAS 2009 and
got very good feedback. It is now updated and I hope I will get a chance
to present this new version at WAS 2011.
Action: The workshop consists of the theoretical background, a practical introduction with case studies, a training session and finally a group
discussion.
Outcome: The goal of the workshop is that the participants shall be
able to use the method and independently give sexually abused patients
trauma relief.
Discussions and recommendations: The method yields its best
results when integrated in a therapeutic context but it is also possible
to use it as a single intervention with good results. This means that
the method can be recommended for education of “bare foot psychologists” in humanitarian aid projects.
References:
The lecturer will refer to works of: Richard Bandler, Aaron T. Beck,
Bob G. Bodenhamer, John Grinder, L. Michael Hall, Tad James, D.
Min, Bessel van der Kolk and Wyatt Woodsmall.
171
DYSPAREUNIA AND CHRONIC PELVIC PAIN
IN THE POST-PARTUM IN A POPULATION
AFFECTED BY SERONEGATIVE
SPONDYLOARTHRITIS: A RETROSPECTIVE
CASE-CONTROL STUDY
A.P. Londero1, A. Gasparetto1, S. Salvador2, S. Bertozzi3, V. D’Aietti1,
T. Grassi1, L. Driul1, D. Marchesoni1
1
Clinic of Obstetrics and Gynecology, AOU “S. M. della Misericordia”,
2
Frauenklinik, Josephs-Hospital, 3Department of Surgery, AOU “S. M.
della Misericordia”, Udine, Italy
Introduction: The complement cascade and its ability to activate
inflammation and mast-cells are part of the seronegative spondyloarthritis pathophysiology. At the same time, mast cells seem to play an
important role in sexual pain disorders and chronic pelvic pain. Therefore, the aim of this study is to find out any correlation between
seronegative spondyloarthritis dyspareunia and chronic pelvic pain in
the post-partum.
Methods: We selected a cohort of 64 women affected by seronegative
spondyloarthritis who delivered in our Clinic between 2004 and 2009,
and a random control cohort of 120 women. We collected personal,
clinical and obstetric data, and asked them about pelviperineal painful
symptoms, persistent after the 6th month post-partum.
Results: The mean maternal age at delivery of women affected by
seronegative spondyloarthritis is 32.62 years (±4.24), and that of controls 33.35 years (±5.36). The mean age at delivery of women affected
by chronic pelvic pain is 38.05 weeks (±2.38), and that of controls 38.48
weeks (±2.35). Women affected by seronegative spondyloarthritis
present a lower quality of life score based on the Euro-quol 5D (p <
0.05), and a lower prevalence of dyspareunia and chronic pelvic pain,
but a significantly higher Mc Gill pain questionnaire score focusing
on chronic pelvic pain.
Conclusions: Seronegative spondyloarthritis seems not to be correlated to post-partum chronic pelvic pain and dyspareunia, but may
exacerbate the painful symptomatology in women already affected by
pelvic pain or dyspareunia.
172
‘THE PIE OF DESIRE’ AN INTERVENTION IN
COLLABORATIVE SYSTEMIC PSYCHOSEXUAL
THERAPY
D. Markovic
School of Psychotherapy and Counselling Psychology, Regent’s College,
London, UK
A recorded 4 minutes extract from a clinical session with a couple
presenting sexual desire discrepancy illustrates a particular therapeutic
technique spontaneously developed in the session.
The technique, subsequently named ‘The Pie of Desire’ consists of
drawing with the clients’ guidance a chart representing the sexual
desire and its components. Therapeutic work is based on an integration between systemic therapy and psychosexual therapy approaches
that the author has been practicing and developing over many years.
The recorded excerpt illustrates some aspects of this integrated
approach and in particular: co-construction of therapy sessions, use of
therapeutic active exploratory curiosity in facilitating clients’ self
reflection, the complexity and multifaceted nature of sexual desire and
the social construction of reality.
The technique helpfully engaged the clients with a different perspective and enabled them to appreciate the multidimensional disposition of sexual desire which has positively contributed to successful
therapeutic outcomes.
The presented technique illustrates the importance of appreciating
clients’ expertise in psychosexual therapy and of encouraging their
sense of ownership of the definition of sex and sexual desire. It is
proposed as an example of the kind of therapeutic interventions that
could be applied in psychosexual therapy to broaden and enrich the
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existing repertoire of techniques. The relevance of such technique has
resonance at the wider levels of therapeutic action and therapeutic
relationship and relate to issues of power, knowledge, expertise, ethics
and the clients’ sexual and therapeutic rights.
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THE CONSEQUENCES ON QUALITY OF LIFE
AND SEXUALITY IN CHRONIC FEMALE
SCHIZOPHRENIC PATIENTS
I. Miclutia1, C. Popescu2, R. Macrea1
Psychiatry, University of Medicine & Pharmacy Cluj-Napoca, 2Psychiatry,
Emergency County Hospital Cluj, Cluj-Napoca, Romania
1
Introduction: The concept of quality of life covers various objective
and subjective domains (among the latest are wellbeing, social adjustment, sexual satisfaction), being an indicator of outcome. The intensity
of sexual, although present already at the onset, dysfunctions increases
following long-term antipsychotic treatment.
Objectives: The examination of various aspects of sexuality in chronic
female schizophrenic patients and the evaluation of quality of life.
Methods: 50 female patients suffering from chronic schizophrenia
were selected and treated with conventional and atypical antipsychotics. These patients were compared to 50 matched controls. Assessment
tools: PANSS, UKU sexual side effects component, GAF, female
SDBQ, WHOQOL-BREF.
Results: The patients displayed a range of characteristics in the field
of sexual experience. These include hyposexuality and dissatisfaction
with their sexual life. Many had also experienced sexual abuse, and few
used contraception, thus indicating a high level of sexual conservatism.
The evolution of schizophrenia affected their professional and marital
status, as well as their general level of functioning and their quality of
life.
It was found that even novel antipsychotics are responsible for sexual
side effects comparable to those produced by conventional
antipsychotics.
Conclusion: This direct investigation of sexuality in this particular
group, could, in combination with the management of information,
symptoms, and side effects, lead to long term acceptance of—and
adherence to—antipsychotic medication by sexually active persons suffering from schizophrenia. The overall quality of life of these individuals, as well as their general functioning, could thus be improved.
174
LIFE SATISFACTION AND BODY IMAGE OF
TRANSSEXUALS AFTER SEX REASSIGNMENT
SURGERY
N.A. Papadopulos, Research Group for Studies of Quality of Life after
Plastic, Reconstructive, Aesthetic, and Hand Surgery
Dept. of Plastic Surgery and Hand Surgery, University Hospital rechts der
Isar, Munich Technical University, Munich, Germany
Objective: More and more registration of life satisfaction is used to
evaluate different medical treatments. So far there are only few objective surveys on life satisfaction of transsexuals (TS). Transsexualism is
defined as a disorder in gender identity. Treatment options contain
psychotherapy and operative sex reassignment, the only possibility for
improvement of quality of life (QoL). Therefore, aim of the present
study was to investigate for the first time the QoL and body image of
transsexuals in comparison to normal population.
Patients and methods: 40 patients took part in this cross section study
(24 male-to-female and 16 female-to-male). A demographic questionnaire, a self developed questionnaire, the Life Satisfaction Module
(FLZM), the Munich version of the Body Dysmorphic Disorder Examination-Self Report, and the “Frankfurter Korperkonzeptskalen” questionnaire were used.
Results: 85–95% of TS were “very satisfied” or “satisfied” with the
result of their gender transformation respectively their gender identity.
The TS were significantly unsatisfied (p > 0.001) in the overall score
124
of the FLZM module “general life satisfaction” as the normal control
population. In the overall score of the FLZM module “health related
life satisfaction” no differences were seen. Finally, after the operative
transformation TS have a significantly better satisfaction with their
bodies, in contrast to normal control population.
Conclusion: These data show a discrepancy between subjective satisfaction with the new gender identity and the current life situation and
identify problems with life satisfaction. Therefore, an accompanying
psychotherapy and the advancement of surgical techniques could possibly improve quality of life of these patients.
175
SUBJECTIVE OUTCOME MEASURES OF
EXTRACORPOREAL SHOCK WAVE THERAPY
FOR PEYRONIE’S DISEASE
F. Rizvi, S. Alkhayal, G. John, M. Fletcher
Urology, Brighton and Sussex University Hospitals NHS Trust, Brighton,
UK
Objectives: To assess the efficacy and safety of Extracorporeal Shock
Wave Therapy (ESWT) in the management of patients with Peyronie’s disease (PD). The subjective results in patients with PD treated
with ESWT, over a 2-year period, were evaluated.
Patients and methods: 52 patients with PD were sent a questionnaire
to evaluate their subjective symptoms before and after treatment. Pain,
change in deformity, the ability to achieve satisfactory sexual intercourse, overall patient satisfaction and IIEF-5 scores were assessed.
Results: 41 patients responded to the questionnaire with a mean age
of 57 years (range 32–78 years) and disease duration of 22.7 months
(range 12–60 months). The mean number of sessions received was 4
(range 3–6) and follow-up of 9 months (range 1–24 months). 16 out
of 26 patients (62%) reported significant improvement in pain on
erection, P < 0.001. 27 (66%) patients reported improvement in penile
curvature and 56% of patients who were unable to achieve satisfactory
intercourse, were successful after treatment. The IIEF-5 score
increased in 23 patients (56%) with a mean improvement of 5.2 points,
P < 0.001. Only two patients reported minor bruising at the site of
therapy. 26 (63%) patients were satisfied with the outcome and treated
conservatively. The number of treatment sessions significantly correlated with overall satisfaction, P = 0.005.
Conclusion: ESWT remains a safe and effective treatment to alleviate
symptoms in patients with PD. Two thirds of patients were satisfied
with the outcome which was a significant improvement of subjective
symptoms of the disease.
176
DOES PELVIC FLOOR MUSCLE TRAINING
DURING PREGNANCY HAVE AN INFLUENCE
ON SEXUAL LIFE AFTER DELIVERY?
B. Schei1, S. Mørkved2,3, K. Bø4
Department of Public Health/Department of Obstetrics and Gynecology,
Faculty of Medicine, 2Department of Public Health, NTNU, 3Clinical
Research, St. Olavs Hospital, Trondheim, 4Department of Sports Medicine,
Norwegian School of Sport Sciences, Oslo, Norway
1
Background: The influence of pelvic floor muscle training during
pregnancy on sexual function after delivery has been sparsely studied.
The aim of this study was to compare sexual function after childbirth
in two groups; one group following an intensive pelvic floor muscle
training program between 20 and 36 weeks of pregnancy and one
control group.
Methods: The present study was a six year follow up study of a single
blind, randomized controlled trial, 1998–2000 [i] in which 301 women
were randomly allocated to a training group or to a control group.
Information regarding sexual function was registered on a postal
questionnaire.
Results: Two hundred and eighty of the women in the trial were
located. They received a postal questionnaire six years after, and 188
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women (63%) answered and returned the questionnaire. A significantly higher percentage of the women in the intervention group
(36%) reported improved satisfaction with sexual life / sexual function
after delivery compared to that of women in the control group (18%)
(p = 0.006).
Conclusion: More women in the training group reported perceived
improved sexual life after childbirth. [i] Mørkved S, Bø K, Schei B,
Salvesen KÅ. Pelvic floor muscle training during pregnancy to prevent
urinary incontinence—a single blind randomized controlled trial.
Obstetrics & Gynecology 2003;101:313–319.
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PROMOTING QUALITY COUPLE SEX:
GROWTH & SATISFACTION WITH
“GOOD-ENOUGH SEX”
J. Slowinski1, M.E. Metz2
1
Pennsylvania Hospital, Philadelphia, PA, 2Relationship & Sexual Therapy
Services, Meta Associates, St. Paul, MN, USA
This presentation addresses how to grow a vital, highly satisfying,
lifelong sexual and emotionally intimate relationship. The idyllic
pursuit of “great” sex is the source of extensive personal dissatisfaction,
sex dysfunction, and relationship distress—a poignant irony when this
pursuit becomes the cause of disappointment and dysfunctional sex.
The “Good-Enough Sex” (GES) model (Metz & McCarthy, 2007), is
a common sense yet comprehensive, biopsychosocial perspective that
challenges simplistic notions and encourages couples of all ages to
pursue positive, realistic meaning in their intimate lives. Models drive
clinical practice and research design, incorporating assumptions of
individual and couple sexual health and satisfaction, sex dysfunction
and health, and determine one’s approach to research design, clinical
formulation, treatment goals and objectives, clinical interventions, as
well as sex education objectives and social policy.The Good-Enough
Sex (GES) approach for couple sexual satisfaction is built from (1)
enduring features of the 40 years of classical sex therapy; (2) current
clinical observations and outcome experience, and (3) inferences drawn
from multiple biopsychosocial research studies of individual and
couple sexual function and satisfaction such as Kleinplatz’s “optimal
sexuality” (2008) studies.The ultimate purpose of medical and psychological sexuality therapies should be the personal self-worth and the
mutual relationship and sexual satisfaction of the couple. This presentation will describe 12 core features of the GES model (e.g., variability,
flexibility, playfulness, real-life focus) and several clinical tools (e.g., 3
arousal styles, regular sex as an “intimacy blender”) for couple
satisfaction.
178
LIBIGEL® (TESTOSTERONE GEL) SAFETY
STUDY ENTERS FOURTH YEAR WITH A
CONTINUED LOW RATE OF
CARDIOVASCULAR AND BREAST CANCER
EVENTS
M.C. Snabes1, S. Berry2, J. Zborowski1, W.B. White3
1
BioSante Pharmaceuticals, Inc., Lincolnshire, IL, 2Berry Consultants,
College Station, TX, 3University of Connecticut School of Medicine,
Farmington, CT, USA
Objective: To obtain FDA approval for LibiGel (testosterone gel)
cardiovascular (CV) and breast safety is being established in an ongoing
long-term study now entering its fourth year.
Design: This is a randomized, placebo-controlled, CV events-driven,
adaptive design, multi-center study. Postmenopausal women with
HSDD and at least two CV risk factors are receiving either 300 mcg/d
testosterone or identical placebo gel. The primary safety outcomes are
the effect of treatment on the incidence of an adjudicated CV event
composite and on the rate of breast cancer.
Results: To date over 2,822 post-menopausal women have been
enrolled at a mean age of 59.0 years. Those enrolled have a mean
duration of participation of 12 months. More than 87% of subjects
continue in the study. The overall rate of adjudicated CV events is
0.50% and the breast cancer rate is 0.29%. The Data Monitoring
Committee (DMC) has completed four reviews of all unblinded safety
data to date, and each time the DMC recommended that the study
continue as per protocol, without change.
Conclusions: This is the largest and longest controlled study of testosterone treatment in women. The DMC recommendations to continue the study unchanged suggests there is no significant negative
treatment effect of testosterone. Assuming continued positive safety
outcomes, demonstration of efficacy in the Phase III efficacy clinical
trials, and a successful regulatory review of the LibiGel new drug
application (NDA), LibiGel could be the first FDA approved therapeutic treatment of HSDD in postmenopausal women.
179
PREDICTING SEXUAL DESIRE IN IRANIAN
WOMEN: ROLE OF SEX GUILT, MARITAL
SATISFACTION, AGE AND MARITAL
DURATION
N. Teimourpour, N. Moshtagh Bidokhti, A. Pourshahbaz
University of Social Welfare and Rehabilitation, Tehran, Iran
Objective: The aim of this study was to determine the association of
sex guilt, marital satisfaction, age and marital duration with sexual
desire in Iranian women and role of each of these variables in predicting sexual desire.
Methods: The data presented here were obtained from a total of 192
married Iranian women (with age range of 18–40) who were selected
via a multi-cluster sampling method from three universities in Tehran.
The subjects’ socio-demographic data, sex guilt (Mosher Revised SexGuilt Inventory), marital satisfaction(ENRICH marital satisfaction
questionnaire) and sexual desire (Hurlbert Index of Sexual Desire)
were gathered.
Results: Pearson correlation coefficient and Stepwise regression analysis methods were used to analyse the data. Findings showed there are
significant relationships (p < 0.01)between sexual desire and sex guilt
(r = -0.44), marital satisfaction (r = 0.51), age (r = -0.55) and marital
duration (r = -0.34). Also Age, marital satisfaction and sex guilt were
able to predict 39.2 percent of the variance of sexual desire in women.
Conclusions: Women who have higher levels of sex guilt, lower levels
of marital satisfaction,who are older and have been married for a
longer period, have lower levels of sexual desire. Also 39.2 percent of
the variations of sexual desire can be predicted and explained by sex
guilt, marital satisfaction and age in Iranian women.
180
ENDOMETRIOSIS AND QUALITY OF SEXUAL
LIFE: WHAT DO WE KNOW?
F. Tripodi1, C. Silvaggi1, V. Cosmi1, G. Gambino1, L. Pierleoni1,
C. Simonelli2
1
Institute of Clinical Sexology, 2‘Sapienza’, University of Rome, Rome, Italy
Objective: To summarize current knowledge on sexual function and
dysfunction in patients with endometriosis, and to present an overview
of empirical literature on the experience of the disease.
Methods: Review of articles on this subject published in the Medline
(PubMed) database, selected according to their scientific relevance.
Results: Endometriosis, one of the most common causes of CPP, is
associated with symptoms of pelvic pain, deep dyspareunia, and infertility. These symptoms, as well as the “uncertainty” that surrounds
such diagnosis, disease course and the future, have a great impact on
women’s quality of life and on couple’s relationship. With respect to
sexuality, the main findings highlighted by studies are that the experience of pain is a significant factor in reducing or curtailing sexual
activity, the orgasm is less satisfying, women feel less relaxed and fulfilled after sex and report lowering of self-esteem, negative effects on
relationship with partners, although with some differences between
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younger and older women. Generally, no formal pain management
follows diagnosis or is included in the treatment of endometriosis.
Conclusion: The way in which the pain of endometriosis is interpreted and managed by women and health professionals makes a difference in the side effects on the patient’s quality of life; therefore pain
management and sexuality in endometriosis should be addressed routinely. A multidisciplinary approach is recommended. Both medical
and surgical treatments are effective and choice of treatment must be
individualized. Moreover, the use of the psychotherapy improves the
management of chronic pain.
181
TESTOSTERONE BUCCAL SYSTEM
(STRIANT): COMPARISON WITH OTHER
ROUTES OF ADMINISTRATION IN
HYPOGONDAL MALES
M.G. Wyllie1, W.W. Dinsmore2
1
Clin Dev, Plethora Solutions Plc, London, 2Dept of GU Medicine, Royal
Victoria, Belfast, UK
Objectives: It has been hypothesised that buccal administration of
testosterone (T), by preventing first-pass catabolism by the liver, may
be a viable alternative to gels, patches and injectables. This abstract
compares the pharmacokinetic/clinical pharmacological profiles of
several routes of administration.
Design and methods: Two studies were undertaken. In both Striant
(30 mg testosterone buccal system) was administered twice daily (at
circa 08.00 and 22.00). In one 14-day, open label study in 26 hypogonadal males at 4 sites a comparison was made with Androgel (5 g
containing 50 mg T), daily. In the second in 67 patients at 5 sites the
comparison was with Androderm (5 mg) and /or Andropatch (5 mg)
for 7 days.
Results: In the first, starting from similar baselines, Striant and
Androgel produced equivalent increases in T levels (Cavg (0–24) 4.8 and
4.4 ng/ml, respectively). The percentage of patients achieving
Cavg (0–24) within the normal range were 92% and 83% for the buccal
and gel formulations respectively, with 84% (buccal) and 75% (gel)
remaining within the normal physiological range over any 24 hr
period. In contrast, differences were observed between Striant and
patch delivery. In particular, the T Cavg (0–24) achieved for Striant was
much higher (5.4+/-1.7 ng/ml) than that for patches (3.5+/-1.6 ng/
ml) a difference which was reflected in the percentage of patients
achieving physiological levels (97% and 56% respectively for buccal
and patch delivery systems).
Conclusions: Based on pharmacokinetic and/or clinical pharmacology
parameters, Striant has an equivalent profile to T gel and a profile
superior to that obtained using patch technology.
ORAL PRESENTATION
TRACK 3
182
THE SEXUNZIPPED WEBSITE FOR SEXUAL
WELLBEING FOR YOUNG PEOPLE: EARLY
RESULTS OF A PILOT ONLINE RCT
J. Bailey1, O. McCarthy1, K. Carswell1, E. Murray1, G. Rait1, G. Hart2,
I. Nazareth1, C. Free3, R. French3, F. Stevenson1
1
University College London, 2UCL Centre for Sexual Health and HIV
Research, University College London, 3London School of Hygiene & Tropical
Medicine, London, UK
Background: The Sexunzipped website is an interactive, tailored
website which features material about safer sex, relationships and
sexual pleasure. Interactive activities encourage self-reflection, selfconfidence and communication skills. We are currently conducting a
pilot online randomised controlled trial, and present early results from
126
this. Online trials may recruit large numbers but often have large losses
to follow-up, and we will also report on the success of strategies to
retain participants.
Objectives: Pilot trial results: patterns of website use; retention at 3
months; sexual health outcomes (knowledge, safer sex self-efficacy,
intention, sexual behaviour, sexual wellbeing, genital Chlamydia
prevalence)
Method: Pilot RCT to compare the interactive intervention website
to an information-only control website. Recruitment, randomisation
and self-reported sexual health outcome measurement at baseline and
3 months are all conducted entirely online. 50% of participants are
asked to return a postal urine sample for genital Chlamydia testing at
3 months, with a £10 voucher offered for complete outcome data.
Results: We have so far recruited 1341 people aged 16 to 20 from
across the UK, with 3 month outcome data being collected between
February and June 2011. We will present data on retention, commenting on the feasibility of online sexual health outcome measurement
and postal urine sampling. We will also report on changes in sexual
health outcomes including genital Chlamydia prevalence.
Conclusions: A Facebook advert has been a highly efficient way of
recruiting young people to this online trial. Results will show whether
strategies for retention (email prompts and an incentive) were sufficiently successful.
183
THE INTERNET AS A SOURCE OF
INFORMATION ABOUT SEXUALITY
K. Daneback1, S.-A. Mansson2, M.W. Ross3, C.M. Markham3
University of Gothenburg, Gothenburg, 2Malmö University, Malmö,
Sweden, 3University of Texas, Houston, TX, USA
1
To use the internet for sex educational purposes and for sex information have been recognized by prior research as benefits of the technological development and important areas to investigate, but few
empirical studies has been conducted so far. The purpose of this study
was to identify those who use the internet to seek information about
sexual issues and to examine the reasons for using the internet for this
purpose. A total of 1,913 respondents completed an online questionnaire about internet sexuality and 1,614 reported to use the internet
for sexual purposes. More than half of the 1,598 respondents who
answered the question claimed to use the internet to seek information
about sexual issues. The results showed that men and women of all
ages used the internet for this purpose suggesting that the need for
sexual education persists even in the adult years. The reasons to seek
information were primarily to get knowledge about the body, about
how to have sex, and out of curiosity. Knowing who seeks information
about sexuality on the internet and the reasons why may be helpful in
identifying the needs of different groups of individuals as well as tailoring the information provided, both online and offline.
184
INTEGRATING GENDER AND RIGHTS
PERSPECTIVES INTO SEXUALITY
EDUCATION IN LATIN AMERICA AND THE
CARIBBEAN
J. Dietrich1, M. Billowitz2, J. Clyde2
1
Organizational Learning and Evaluation, 2Universal Access, IPPF/WHR,
New York, NY, USA
Objective: Through Member Associations in 40 countries, International Planned Parenthood Federation/Western Hemisphere Region
(IPPF/WHR) is implementing a regional strategy to increase access
to comprehensive sexuality education that promotes gender equity and
awareness of rights in Latin America and the Caribbean.
Background: International support for the integration of gender and
rights perspectives into sexuality education continues to grow. In Latin
America and the Caribbean, these principles are supported by the 2008
declaration “Prevent with Education” signed by ministers of health
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127
and education from 30 countries pledging to ensure the wellbeing of
young people. While strides have been made, improving access to
comprehensive sexuality education in the region faces many
challenges.
Method: The regional strategy includes dissemination of “It’s All One
Curriculum,” guidelines developed by IPPF/WHR and other members
of the International Sexuality and HIV Curriculum Working Group
to provide educators and policymakers with the tools needed to create
curricula that take a unified approach to sexuality, HIV, gender, and
human rights. The guidelines serve as a platform from which to engage
Member Associations in intensive reviews of their sexuality education
curricula. These reviews are being conducted with Associations individually and in groups that allow experienced program staff to share
and critique their curricula from a gender and rights perspective. A
standardized tool developed to assess these aspects of curricula is being
rolled out region-wide to identify future areas of focus.
Conclusion: Technical assistance to incorporate gender and rights
perspectives into sexuality education programs can benefit even longstanding providers.
185
PREVENTING TEENAGE PREGNANCY: THE
FIRST INTERACTIVE EXHIBIT ABOUT
TEENAGE PREGNANCY AND STD/AIDS IN A
BRAZILIAN SCIENCE MUSEUM
1
2
2
from the rigorous evaluations of three sexual health initiatives: SHARE
(a cluster randomised trial (CRT) of teacher-delivered sex education),
RIPPLE (CRT of peer-delivered school sex education) and Healthy
Respect Phase 2 (a quasi-experimental study of a multi-component
Scottish national sexual health demonstration project encompassing
youth friendly sexual health drop-ins, social marketing, branding, a
parenting component and SHARE).
Results: Compared with conventional sex education all three interventions improved practical sexual health knowledge, had modest
(mostly positive) impact on attitudes and quality of relationships, and
the pupils and teachers preferred the new interventions. However, all
three studies had disappointing self-reported sexual behaviour outcomes (sexual experience, number of partners, contraceptive use, pregnancy and terminations). None had an impact on objective NHS
recorded pregnancies or terminations. Meanwhile, there is a growing
body of evidence that generic parenting interventions in the early years
(e.g. the Family Nurse Partnership) and generic interventions that aim
to change both parenting and school culture (e.g. SEATTLE project)
can have a positive impact on sexual risk behaviours.
Conclusions: We appear to have reached the limits of what can be
achieved by specific school-based sex education in terms of changing
sexual risk behaviours. However, there seems to be scope to develop
and evaluate more generic programmes aimed at changing parenting
and school culture to improve sexual health.
187
2
C.M. Guastaferro , M.H.B. Vilela , L.A. Bragante , T.P.D.M. Petric ,
A.A. Meira2, J.H.C. Iglesias2
1
Educacional, 2Projetos, Instituto Kaplan—Centro de Estudos da Sexualidade
Humana, São Paulo, Brazil
The last epidemiologic data of Brazil’s AIDS national programme
points to a growing rate of AIDS among girls between 13 and 19 years
old, to 2.7 per 100 thousand people, while the index among male
teenagers decreased to 1.9. “Instituto Kaplan”, in partnership with
“Catavento Cultural e Educacional”, has developed a breakthrough
work in sexual education: a permanently open prevention exhibit for
teenagers.
Using the “Vale Sonhar” educational project, which motivates the
youngsters to adopt prevention, and the psychodrama methodology,
the exhibit has the objective of leading the teenagers to prevent STI
and AIDS during an interactive game for groups from 10 to 20 people.
It is 30-minute long, and it is divided in three phases. During phase
one, called “The Dream”, the teenagers are motivated to think about
their professional future. In phase 2, “The Maze”, the room changes
and the teenagers find themselves in a maze facing 18 risks or prevention situations, this happens during a party. In the last phase, “The
Voyage”, the teenagers, with the aid of a video, board in a trip to the
future. The session finishes with all the group members sharing their
experience.
In 22 months of activity, 16,834 teenagers between 13 and 19 years
old went thru the exhibit. Statistics show that 28% of them made
choices that led them to pregnancy (in the game) and 37% made
choices that led to STI/AIDS infection. This data confirms the importance of preventive actions for teenagers and the benefits of new
innovative approach.
186
THE LIMITS OF SCHOOL-BASED SEX
EDUCATION: LESSONS FROM RIGOROUS
EVALUATIONS IN THE UK
M. Henderson1, D. Wight1, L. Elliott2, C. Nixon1
1
Social and Public Health Sciences Unit, MRC, Glasgow, 2Centre for
Integrated Healthcare Research and School of Nursing, Midwifery, and
Social Care, Edinburgh Napier University, Edinburgh, UK
Background and aims: The UK has among the highest teenage
pregnancy and STI rates in Western Europe and strategies to reduce
these outcomes have a high priority. This paper seeks to draw lessons
SEX AND MOVIES: A TOOL FOR
SEXUALITY EDUCATION
R.J. Hernandez1,2, A.P. Parra3, G.E. Hernandez4
Psychiatry, Universidad Central de Venezuela UCV, 2Sexual Education and
Therapy Unit UTES, UTES, 3Medical Education, Universidad Central de
Venezuela UCV, Caracas, Venezuela, 4Film Production, Humo Films,
Miami, FL, USA
1
Cinema is perhaps the most important mass media communication
which change paradigms in 90 minutes average.
The case of Rain Man is classical in autism studies.
Sex has been one of the most important topics since the beginning
of movies.
We conducted a survey between medical students at UCV in 5th
year of the currricula and well trained sexologists in Latin America.
The results are so interesting that deserves research and a good
discussion in workshops as a tool for sexuality education.
To work with producers and directors must be encouranged to
change quickly stereotypes,myths and false beliefs.
We present 2 CD clippings with sex scenes, that change attitudes as
an example.
Ref:
1. Psychiatry and Cinema. Gabbard and Gabbard. APP. Washington,
USA (1999)
2. The Healing Movie Book.Kalm M. Duke Univ. USA (2004)
3. Movies and Mental Illness.Wedding et al. Hogrefe. USA (2005)
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SEXUAL EDUCATION AND ‘SEXUAL
ADDICTION’
B.G. Hughes
Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
Aim: This research investigates the role of sexual education in relation
to the concept of ‘sexual addiction’ from the perspective of the selfidentified sexual addict and treatment provider.
Method: Adopting a qualitative approach, data collection includes:
pilot study, focus groups, questionnaires and individual interviews
involving 81 adult participants consisting of 38 treatment providers
who work with this phenomenon in clinical practice and 43 selfidentified sexual addicts. Interpretative Phenomenological Analysis
(IPA) method is used for data analysis.
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Results: 41.9 % of sexual addicts report dissatisfaction with their
sexual education and state that defective sexual education was a causal
factor to their sexual addiction. Addicts state that better sexual education may have prevented them from engaging in high-risk sexual
behavior which can be a contributory factor to HIV, and other sexually
transmitted infections. All participants report on a range of educational
interventions that have proven helpful and unhelpful in the on-going
recovery from and management of sexual behavior.
In addition, treatment providers report that inadequate sexual education for clinicians may inhibit the recognition, assessment, diagnosis
and treatment of sexual addiction.
Conclusions: Improved sexual education can help identify the predisposing factors and the presenting behaviors. As a result of comprehensive sexual education, prevention strategies and therapeutic
interventions can be developed. These strategies are expected to lessen
the development of sexual addiction, minimize the negative impact on
individuals and society and ensure that every individual is enabled to
pursue a fulfilling sexual life, which is central to sexual health.
189
DOES A SEXUAL HEALTH EDUCATION
PROGRAMME WORK IN POSTPARTUM
WOMEN’S SEXUAL SELF-EFFICACY AND
SEXUAL RESUMPTION?
J.T. Lee
School of Nursing, Chang Gung University, Tao-Yuan, Taiwan R.O.C.
Objectives: To evaluate the effectiveness of a refined theory-based
Postpartum Sexual Health Education Program to enhance postpartum
women’s sexual self-efficacy and sexual resumption.
Methods: Experimental group A received our intervention program
(10–15 minutes of interactive individualized health education and an
interactive, self-help pamphlet); experimental B group received only
the pamphlet; and the control group received routine postpartum
sexual education. Only experimental group A received health education via strategies that matched participants’ learning preparedness, as
determined by the Transtheoretical Model. Data were collected at
baseline, 3 days, 2 months, and 3 months postpartum.
Results: Women who received the theory-based postpartum sexual
health education program had significantly greater sexual self-efficacy,
and tended to resume their sexual life earlier than women in the
routine teaching and interactive pamphlet-only groups.
Conclusion: A theory-based Postpartum Sexual Health Education
program enhanced postpartum women’s sexual self-efficacy, and return
to sexual activity.Practice implications: Our findings suggest that the
transtheoretical model can be translated into practice, and support its
use to enhance the sexual health of postpartum women.
190
INTEGRATING SEXOLOGY EDUCATION
INTO PSYCHIATRY RESIDENCY TRAINING:
PERSPECTIVES FROM THE USA
D.K. Lin, E. Kleinbart, D. Roane, M.-A. Handler, A. Buchanan
Department of Psychiatry and Behavioral Sciences, Beth Israel Medical
Center, New York, NY, USA
Objective: The oral podium presentation will focus on how sexology
and psychosexual medicine education can be integrated into psychiatry
residency training.
Design and method: The Psychosexual Medicine Program currently
being implemented at Beth Israel Medical Center, Department of
Psychiatry and Behavioral Sciences in New York City, USA will be
described.
Results: Psychiatry residents (registrars) from Beth Israel Medical
Center will discuss their experiences learning sexology under the Psychosexual Medicine Program.
Conclusion: An argument will be made why it is important to teach
sexology in psychiatry residency training and how psychiatrists are
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uniquely positioned to be good sexologists. It will be recommended
that sexology education become an integrated part of psychiatry residency training everywhere in the USA, in Europe, and the world.
191
CARTOONS (CARICATURES) FROM GERMAN
PUBLICATIONS IS ILLUSTRATED HUMOR
FOR SEX-ED
W. Loosch
Sex-ed, DGG, Berlin, Germany
Anyone concerned with sex education can deal with it in a variety of
ways. There are the very dry, scientifically-based depictions of biological processes, the morally influenced appraisal of sexual behaviour
often accompanied by feelings of fear and impending punishment, the
references to sexual behaviour and/or behaviour within a partnership
as seen from a social-ethical point of view, but also the brutal confrontation with pornographic depictions.
Studies have already been carried out in the past with regard to all
these different aspects and proposals have been worked out for improving sex-education as an integral part of the development of an individual’s personality. The aspect my paper deals with is illustrated
humor by means of which, quite tongue in cheek, gaps in knowledge,
a lack of social-emotional skills and, above all, linguistic deficits within
the framework of the different meanings of sexuality in interpersonal
experience and behavior are addressed. At the same time, they are to
be the basis for cheerful and uninhibited discussions in which solutions
can be worked out either by identifying with and/or by taking a deliberate critical distance to the subject matter. Cartoons (caricatures) from
German publications will be used as examples thereof.
192
HIV PREVENTION FOR RURAL YOUTH IN
NIGERIA: EVALUATION RESULTS OF
SCHOOL- AND COMMUNITY-BASED
PROGRAMMING
E. Maticka-Tyndale1, A. Onokheroya2, HP4RY Team
1
Sociology, Anthropology & Criminology, University of Windsor, Windsor,
ON, Canada, 2Centre for Population and Environmental Development,
Benin City, Nigeria
HIV Prevention for Rural Youth (HP4RY), Nigeria is a CanadaNigeria collaboration funded under the Global Health Research Initiative (Canada) to develop research-informed programming to reduce
the vulnerability to HIV infection of youth living in rural communities. This paper presents results of impact evaluation of school- and
community-based programmes delivered in Junior Secondary Schools
and their communities on student knowledge, attitudes, motivations
and behaviours 6 and 18 months after programme initiation.
Thirty schools in Edo State, Nigeria, were selected and assigned to
research arms (school program, school and community, control) using
proportional geographic random sampling. Questionnaires were completed pre-programme (2009) and 6 (2010) and 18 (2011) months after
programme initiation by a longitudinal sample of nearly 1000 students.
A subset participated in focus group discussions as well. Teachers and
community mobilizers were trained in programme delivery in August
2009 with programmes initiated in September 2009.
Analysis of data at 6 mos post initiation showed statistically significant gains in intervention as against control schools in student
knowledge, attitudes supportive of greater gender equity in sexual
matters, motivation to delay sexual initiation and use condoms, and
delays in sexual initiation for some subgroups of youth. Certain gains
were greater among youth in the school and community programme
group than in the school-only group. This presentation will include
analysis of both the 6 and 18 month data and will highlight specific
areas of success as well as challenges faced in using school- and
community-based programming to counteract youth vulnerability to
HIV.
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193
SEXUALITY EDUCATION AT RURAL
SCHOOLS IN SOUTH AFRICA:
LEARNERS’ PERSPECTIVES
J. Mcgogo, N. Phasha
Further Teacher Education, University of South Africa, Pretoria, South
Africa
The introduction of sexuality education in schools marked South
Africa’s commitment towards the attainment of one of the millennium
goals adopted at the Jomtien Conference in 1990 namely, gender
equality in primary and secondary schools by 2015. As a historically
tabooed subject especially in most African communities, it then
becomes imperative to understand how well the subject is being
covered and taught in rural schools (Grades 8–12). The paper will
present the findings of an on-going doctoral qualitative study pursued
at University of South Africa. Data were obtained by means of focus
interviews, which were further followed up with individual learners/
students in at three rural schools located along the borders of South
Africa and Mozambique. The findings revealed learners’ frustrations
with regard to the manner in which the learning content is handled.
In particular they alluded to
(a) the inadequacy of the topics covered;
(b) irrelevant learning content which does not equip them with
current challenges, and
(c) teachers’ unpreparedness to handle the learning content.
We conclude by suggesting a vigorous overhaul of the current curriculum on sexuality education and intensive training for teachers.
194
EFFICACY OF SEXUAL EDUCATION ON
SEXUAL KNOWLEDGE IN IRANIAN WOMEN
K. Mirzaii1, F. Rakhshani2, Z. Behzad3
Shahroud University of Medical Science, Shahroud, 2Zahedan University
Medical Science, Zahedan, 3Shahroud Health Service Center, Shahroud,
Iran
1
Introduction: Sexual satisfaction is one of the important factors of life
fulfillment. Sex education has important effect on sex satisfaction.
Aim: The aim of this study was to determine efficacy sexual education
on increasing knowledge and attitude of young women about the
sexual reproductive system and it function in sexual respond.
Method: Sexual education about the physiology and sexual respond
was educated to 40 Iranian young women in health service centre.
Questionnaires were ere distributed before and after the intervention
included the sexual reproductive system and sexual respond during the
sexual relationship.
Results: Analysis data suggested t here was significant difference about
knowledge of sexual reproductive system and sexual respond before
and after the intervention.
Conclusion: The findings suggest that sexual education has an impact
on sexual knowledge and might increase the sexual satisfaction greater
emphasis on premarital counseling and education might be one way
to help people achieve that goal.
195
Background: It’s made in cooperation between Swedish Association
for Sexuality Education (RFSU) and Swedish Educational Broadcasting Company (UR). To both organisations teachers had expressed a
need for new educational material. The film is based on teenagers’
questions.
Methods: The film is explicit and shows a sexual encounter between
a girl and a boy, and something is going on between two girls. Its
content is factual knowledge about sexual organs, masturbation,
vaginal corona, on mutuality, and the concept of ‘good feeling’—everyone should have a good feeling before, under and after sex. LGBTissues and gender aspects are integrated in the film. ‘Sex on the Map’
wants to broaden the view on what sex is and not focus just on penetrative sex.
In addition a textbook for teachers on sexuality education has been
published.
Result: The film was first shown on public service TV in January 2011.
It got 500 000 viewers. It’s already used in schools. The media response
has been positive. All the big newspapers has reported about it as well
as bloggers. The film can be watched at RFSU’s and UR’s web sites.
The film is distributed to school media centres all over Sweden.
The response from students has been very good as an ‘informative,
instructive film with a sense of humour’. Some negative responses have
occurred from right wing extremists and conservative Christian media.
196
FROM THE VIRTUAL WORLD TO THE REAL
WORLD: ON-LINE RELATIONSHIPS BY
YOUNG PEOPLE IN LIMA PERÚ
X. Salazar, M. Girón, S. Eddy, C. Cáceres
Public Health, Cayetano Heredia University, Lima, Peru
Using the Internet to know people is common among youth. On-line
dating is understood by users as funniest as dating “off-line”. We
conducted a study whose objectives were: to describe the characteristics of Internet as a way of establishing contact among young people
and assess the ways in which these contacts result in sexual contacts.
The population was young men and women between 18 and 25 from
Lima, using social networking sites on the web. We use Virtual Ethnography, 40 on-line and 10 face to face in depht interviews.
Results: Using the Internet to interact with others has had in recent
years a rapid diffusion.The perception is that it is a tool without limits
for these purpose.Contacts are available without having to invest time
and energy looking for them face to face.Young heterosexual men
make contacts mostly with women, but for specific interests they build
relationships with their peers. With regard to gay youth, they seek to
establish contacts with a wide range of same sex persons. Women show
more caution in establishing contacts. Most on-line contacts aspire to
become face to face contacts, whose outcome can have several
alternatives:disappointment, friendship and/or sex. In general, they are
ephemeral relationships, in which the illusion and the circumstantial
“chemistry” are predominant. The study indicates that the possibility
of a sexual encounter is implied in the contacts made on-line and these
encounters involve risks by being casual and occasional. Virtual relationships pose new challenges in young people’s sex education.
197
COMMUNICATION STRATEGIES FOR
CONDOM USE AMONG STUDENTS IN
REPUBLIC OF MACEDONIA
‘SEX ON THE MAP’—AN ANIMATED
EDUCATIONAL FILM ABOUT SEXUALITY
FOR TEENAGERS
1
Objective: To make an animated film, ‘Sex on the Map’, to be used in
sexuality education.
Aim: To support teachers’ sexuality education.
The research explores different communication strategies for condom
use negotiations among students in Macedonia, as a part of the safe
sex communication. Examining condom use negotiation strategies, the
research tends to categorize them based on whether they are verbal or
nonverbal and direct or indirect.
H.L. Olsson1, A. Birgersson Dahlberg2
1
RFSU, Swedish Association for Sexuality Education, 2Swedish Educational
Broadcasting Company, UR, Stockholm, Sweden
B. Sazdanovska1,2
Komaja Society for Development of the Art of Living, Skopje, 2SEE
University, Tetovo, FYR Macedonia
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There was realized survey among 234 students from South East
European University, private university in Tetovo, Republic of Macedonia. We gathered information regarding participants’ demographic
characteristics, as well as information about their condom negotiation
strategies, using adapted condom negotiation scale by A. Lam.
The study confirms that students use different communication strategies and those factors, such as the demographic characteristics; the
goal of the safe sex communication; the relationship status; and the
previous parent-child safe sex communication, influence on the choice
of the particular strategy.
All four main types are considered effective at attaining goals. While
many women used nonverbal direct strategies, the majority of men
utilize verbal strategies, to get their partners to use condoms. Students
from Macedonian ethnic group use more direct strategies, while students from the Albanian ethnic group prefer indirect communication
strategies.
The research stresses the need of including effective communication
skills, which young people can use in the initiation and maintain of the
discussion for condom use with their partners, in the sexuality education curriculum. Although the study focuses on the negotiation of
condom use, but it does not advocate these strategies for all dimensions
of intimate relationships.
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EMPOWERING YOUTH FROM
PHOTOGRAPHY AND STORY
DEVELOPMENT TECHNIQUE FOR
AWARENESS RAISING YOUTH SEXUAL
REPRODUCTIVE HEALTH HIV/AIDS STD’S
AND STI’S ISSUE
S. Sohail1,2
1
Media and Communication, Chanan Development Association (CDA),
2
Media and Communication, Youth Peer Education Network (Y-PEER),
Lahore, Pakistan
Background: A country where sexual harassment is considered as fun
activity, where there are negligible women rights where no proper
attention is given to sexual health and reproductive health, talking
about HIV/AIDS STD’s and STI’s is a huge problem for youth. In
Pakistan the religious dogmas prevent youth from getting education
on sexual health, reproductive health and HIV/AIDS.
Methods: The project aims at empowering young women through
accurate information and capacity building. The activities of the projects are trained some 40 people from all the provinces of Pakistan on
digital photography and story development skills and use photographs
and stories to share their thoughts and concerns over their own sexual
and reproductive rights and to learn about those from their peers.
Results: Young people need an enabling and encouraging environment in which there concerns are listed to their need provide for and
the rights respected. Developing countries have to deal with the harsh
realities of poverty isolation and lack of support many have to focus
on survival rather than education at a time when their bodies and mind
is developing, they face violence, and sexual abuse or coping with sexually transmitted infections.
Conclusion: Pakistan need to be able to make informed choices and
have a right to responsible in fulfilling experiences when it come to
sex and relationships must have access to youth friendly services and
information, comprehensive sex education either in schools or colleges
and especially out of school youth.
130
199
INTENSIFIED VIOLENCE: A CONTENT
ANALYSIS ON POPULAR PORNOGRAPHY
C. Sun
McGhee, New York University, New York, NY, USA
The objective of this study is to understand the content of popular
pornographic videos and its comparison to studies conducted a decade
ago.
We randomly selected 304 scenes from best-selling and most-rented
pornographic movies for heterosexual audiences (Adult Video News,
2006) and found that about 90% of them depict verbal or physical
aggression, a significant increase over the high of 30% found in studies
of the 1980s and 1990s (Barron & Kimmel, 2000; Duncan, 1991).
The increase in aggression is not only in quantity but also in type.
Two recent phenomena exemplify the “up the ante” approach. One is
“gagging” (found in 22.5% of scenes), which occurs when the penis is
inserted so far down the woman’s throat that it triggers her gag reflex.
A second phenomenon is an increase in sexual acts that may not cause
pain but are arguably degrading. One is ejaculation on a woman’s face
or in her mouth (found in 60% of scenes). Another was ATM, or “assto-mouth” (found in 41% of scenes), which depicts women performing
fellatio immediately after the penis has been inserted into an anus.
Perpetrators of aggression were usually male, and targets of aggression
were overwhelmingly female; further, the women tended to show pleasure or respond neutrally to the aggression.
ORAL PRESENTATION
TRACK 4
200
SOURCES OF REGRET AND POINTS OF
PRIDE: YOUNG WOMEN’S REFLECTIONS ON
ADOLESCENT SEXUALITY
L.Y. Bay-Cheng
School of Social Work, University at Buffalo, Buffalo, NY, USA
Introduction: There is considerable scrutiny in the U.S. of young
women’s sexuality, which is believed to be full of inter- and intrapersonal pitfalls. The current study probes young women’s reflections on
their adolescent sexual experiences in order to learn whether young
women perceive such threats and exhibit any associated ill-effects.
Method: Forty female undergraduates at an American university were
interviewed about their sexual histories. After reporting on past experiences, participants were asked if they had any sexual regrets and if they
were proud of any aspects of their sexuality.
Findings: 60% of participants described sexual regrets; however, only
four participants expressed deep-seated remorse stemming from past
experiences. The remaining participants regretted specific incidents
or circumstances but these did not detract from their otherwise positive assessments of themselves or their sexualities. On a similarly
positive note, all but one participant identified some point of sexual
pride or satisfaction. Although 20% of participants took pride in their
adherence to conventional gender norms regarding female sexuality,
the remaining 80% described resisting dominant norms and
instead following their own personal values and beliefs. They also
perceived themselves as sexually self-aware, assertive, skilled, and
knowledgeable.
Conclusion: For most participants, sexual regrets were compartmentalized and did not interfere with their pride and confidence in their
sexualities. These results counter the monolithic characterization of
young American women as beset by sexual anxiety, passivity, and vulnerability. Instead, the sexual outlook for young women, at least those
with socioeconomic privilege, may not be as bleak as commonly
believed.
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“I DON’T WANT MY DAUGHTER TO PASS
THROUGH ALL THE PAIN AND SUFFERING I
HAD”: A SYSTEMATIC REVIEW OF REASONS
FOR AND AGAINST FGM/C
R.C. Berg, E. Denison, A. Fretheim
Department of Health Promotion and International Health, Norwegian
Knowledge Centre for the Health Services, Oslo, Norway
Female genital mutilation/cutting (FGM/C) refers to a traditional
practice involving the partial or total removal of the female external
genitalia or other injury to the female genital organs for cultural or
other non-therapeutic reasons.
We conducted a systematic review to delineate the underlying forces
perpetuating and halting FGM/C. Factors were identified by members
of communities practicing FGM/C residing in a Western country. In
the diaspora people may more readily reflect upon home cultural
models. We searched 13 electronic databases, literature lists, organizations’ websites, and contacted experts. Two reviewers independently
appraised 5,998 records and 112 full-text papers for inclusion and
methodological quality. An integrative evidence approach was used:
data from cross-sectional survey studies were combined with data from
qualitative views studies. The accumulation of the analyses and our
conclusions were summed in a conceptual model.
20 studies (14 qualitative, 5 quantitative, 1 mixed-methods), of variable methodological quality, met the eligibility criteria. The 2,440
participants included revealed six key factors perpetuating FGM/C:
cultural tradition, sexual morals, marriageability, religion, health benefits, and male sexual enjoyment. There were four key factors perceived as halting FGM/C: health consequences, it is not a religious
requirement, it is illegal, and the host society discourse rejects FGM/C.
Results show that FGM/C is a socially entrenched practice, which
derives from a complex belief set, in which reasons are at once ideological, material, and spiritual. Important factors exist at multiple
levels: intrapersonal (e.g. health consequences), interpersonal (e.g.
sexual enjoyment), meso (e.g. cultural tradition), and macro level (e.g.
religion, legislation).
202
A JOHANNESBURG MUSLIM COMMUNITY’S
PERCEPTIONS OF SAME-SEX
RELATIONSHIPS: AN EXPLORATION
E. Bonthuys1, N. Erlank2
1
Law, University of the Witwatersrand, 2History, University of Johannesburg,
Johannesburg, South Africa
Newspaper reports of the persecution of gay men in Iran, Afghanistan,
Saudi Arabia and other Muslim societies creates or supports a perception a Muslim that communities are particularly conservative and
intolerant when it comes to same-sex sexual behaviour and gender
relations in general. This paper reflects the findings of a small-scale
pilot study of community perceptions towards same-sex relationships
in a predominantly Muslim suburb of Johannesburg, the largest city
in South Africa. We conducted qualitative interviews with three groups
of respondents: first, Muslim community members of Indian origin;
second, a small sample of Muslim religious experts and third a small
group of gay Muslim men. Community attitudes towards same-sex
relationships were less uncompromising than expected. Although all
respondents agreed that same-sex relationships were forbidden by
Islam, many were prepared to continue friendships, to socialize and to
maintain family ties with gay and lesbian people. Others expressed
strong disapproval, but in practice their behavior towards gay men and
lesbians were moderated by a strong desire not to know about sexual
transgressions. Even where people were known to have same-sex relationships, community members did not confront them directly or
publically challenge them, but attempted to maintain harmonious
social relations. Gay respondents experienced extreme family pressure
to marry, but once married, they often conducted sexual relationships
with other men without facing public enquiry into their sexual practices. These community attitudes reflect from certain pan-Islamic
standards which allow for discreet flouting of sexual norms.
202A
SEXUAL HEALTH AS FUNDAMENTAL TO
PROMOTING HUMAN DEVELOPMENT
E. Coleman
Program in Human Sexuality, Minneapolis, MN, USA
While sexual rights have been promoted and accepted as fundamental
to sexual health, the World Association for Sexual Health has gone
further in making the argument that sexual rights are fundamental to
achieving the UN Millennium Development Goals of human development. This presentation will describe how sexual rights are basic
human rights that are necessary conditions to promote overall human
development.
202B
SEXUAL RIGHTS IN THE PROMOTION OF
SEXUAL HEALTH: THE IMPACT OF A
REVOLUTIONARY VISION
E. Rubio-Aurioles
Clinical Reseacrh, Asociacion Mexicana para la Salud Sexual, A.C., Mexico
City, Mexico
Back in 1995, during the organization efforts for the XIII World
Association for Sexology (WAS) World Congress that was held in
Valencia, Spain, the idea put forward by the Juan Jose Borras and Maria
Perez Conchillo, congress hosts and Ruben Hernandez Serrano, then
President of WAS to dedicate the Congress to the links between
human sexuality and human rights resulted in the Valencia Declaration
of Sexual Rights that two years latter was the basis for the WAS Declaration of Sexual Rights.
Five years later, the WAS and the Pan-American Health Organization (PAHO) produced a definition of sexual health that included the
fulfillment of sexual rights as a condition for sexual health to be
attained and maintained by individuals, communities and societies.
The World Health Organization produced a working definition for
sexual health that also included the fulfillment of sexual rights as a
condition for sexual health.
This presentation will honor the value of a visionary idea -explicitly
recognizing sexual rights-, for the promotion of sexual health.
Although the definition of what constitutes sexually healthy behaviors
or characteristics is highly dependable on the specific cultural milieu
of the one who attempts the definition, pointing to sexual rights as the
absolute minimum standard of what is desirable and therefore healthy
has moved the concept of sexual health form a concept relative to
culture to a concept relative to human dignity.
202C
742
HUMAN SEXUAL RIGHTS, IN MEMORIAM
JUAN JOSE BORRAS VALLS
R.J. Hernandez-Serrano, FLASSES, SVSM
Psychiatry, Universidad Central Venezuela, Caracas, Venezuela
WAS founded in Rome in l978, (3rd WCS) after Paris 1974 and
Montreal 1976, is the umbrella organization for Sexology and Sexual
Health.
We developed in WCS IN VALENCIA, SPAIN 1997, a Declaration
of Human Sexual Rights, that was adopted unanimously in 1999 at the
General Assembly in WCS 1999, Hong Kong China.
JUAN JOSE BORRAS VALLS was one of the main leaders that
conducted the WCS, and with almost 2000 people in the Palace of
Music, developed with other leaders the VALENCIA DECLARATION OF HUMAN SEXUAL RIGHTS.
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This was a paradigmatic change of Route in our field. www.
worldsexualhealth.org contains this DECLARATION in many languages. After this, Amnecy, Montreal, Antigua PAHO, Geneva WHO
and many events including the WORLD SEXUAL HEALTH DAY
successfully followed this way and got recognition in the whole globe,
making SEXOLOGY a scientific discipline. This is one of the WAS
tracks and perhaps the banner and flag of honor. We will discuss the
impact, achievements, goals and new objectives for the inmediate future.
We have a lot to do, and this is just the beginning, specially for
women and children not only in developing countries but anywhere.
Th world today despite the progress in technology is going backwards
in human relations, violence, spirit poverty, and a severe social and
economic crisis.
We have a role on this.
Young people are waiting.
203
GENDER DIFFERENCES IN PATTERNS OF
SEXUAL VICTIMIZATION AMONG YOUNG
PEOPLE IN THE NETHERLANDS
J.B.F. de Wit1,2, L. Kuyper3, D. Smolenski4
1
National Centre in HIV Social Research, University of New South Wales,
Sydney, NSW, Australia, 2Social and Organizational Psychology, Utrecht
University, 3Rutgers WPF, Utrecht, The Netherlands, 4Division of
Epidemiology & Community Health, University of Minnesota School of
Public Health, Minneapolis, MN, USA
Background: Recent studies, looking beyond men as perpetrators and
women as victims, show alarming rates of sexual victimization among
men. The aim of this study was to assess similarities and differences in
types and patterns of coercive sexual experiences of young women and
men.
Methods: In a survey of a sizeable and diverse sample of sexually
experienced young people in The Netherlands (N = 1350; 15–25
years), coercive sexual experiences were assessed with an adapted
version of the Sexual Experiences Survey (Koss et al., 2007). Patterns
of sexual victimization were examined with latent class analyses (LCA).
Results: Experience with any form of sexual coercion was high
(women: 84%; men: 66%). Young women and men differed in their
experience of some types of sexual coercion (e.g., verbal manipulation),
but not others (e.g., abuse of being intoxicated). Among women and
men, one pattern of sexual victimization was to have no or hardly any
experience with sexual coercion. A second shared pattern reflected
experience with some, opportunistic, types of sexual coercion (e.g.,
abuse of intoxication). The third pattern, unique to women, reflected
a high risk of a range of types of sexual coercion.
Conclusion: This study confirms a concerning prevalence of coercive
sexual experiences among young people in The Netherlands (de Graaf
et al., 2005). Findings also show substantial gender similarities in
experiences of sexual coercion. Nevertheless, at least for some women,
a pattern of experience with a range of types of sexual coercion suggests
a more general vulnerability not found for men.
204
CONDOM-RELATED NEEDS AND CONDOM
FAILURE AMONG AFRICAN PEOPLE IN
ENGLAND: FINDINGS FROM BASS LINE 2008–
09, A COMMUNITY-BASED HIV PREVENTION
NEEDS ASSESSEMENT
C. Dodds1, F. Hickson1, J. Owuor2, P. Weatherburn1, D. Reid1,
G. Hammond1, K. Jessup1
1
Sigma Research, Dept of Social & Environmental Health Research, London
School of Hygiene & Tropical Medicine, London, 2University of Huddersfield,
Huddersfield, UK
132
Methods: The survey recruited African people living in England to
complete an online or booklet version of an HIV prevention needs
assessment. More than 105 collaborating community agencies used
recruitment to the survey as an engagement tool to maximise HIV
prevention activities. 2580 valid returns were included in the
analysis.
Results: Some questions focused on condom use and experience of
condom failure. One quarter of respondents who had intercourse in
the past year had not used condoms. Among those who had used
condoms sometimes or always in the past year, one third (30%) experienced condom slippage or breakage in that period. All condom-users
were also asked if they had engaged in a number of behaviours in the
past year that can be associated with condom failure. The most
common of these (reported by 60% of respondents) was use of a
condom for more than thirty minutes. Also, for almost all failurerelated behaviours, there was a significant relationship with reported
experience of failure.
Conclusions: High levels of condom failure may be detracting from
their use. Interventions to increase the use of condoms should include
elements to ensure minimum condom failure such as ensuring correct
usage, as well as good fit and feel achieved by condoms of different
types and sizes. Identifying and addressing the characteristics of those
who most often experience failure will help to increase successful
condom use in future.
205
A GENDERED ANALYSIS OF POSITIVE
SEXUAL HEALTH OUTCOMES AMONG
HETEROSEXUAL CANADIAN ADOLESCENTS
M. Doull1, I. Gaboury2
School of Population and Public Health, University of British Columbia,
Vancouver, BC, 2Department of Community Health Sciences, University of
Calgary, Calgary, AB, Canada
1
Background: Research on adolescent sexual health is generally
focused on negative outcomes and effects. However, sexual health is
defined as a positive state that includes more than simply the absence
of disease. Calls to shift the focus of sexual health research to include
positively oriented outcomes and extend our understanding beyond
negative behavioural outcomes are increasing. This paper responds to
those calls by examining, from a gendered perspective, whether a
sample of adolescents experience positive sexual health outcomes
within their heterosexual relationships.
Methods: Male (n = 75) and female (n = 254) adolescents who selfidentified as heterosexual and were 14 to 20 years old from two sites
in Ottawa, Canada participated. Participants completed a self-administered written survey. Descriptive statistics are reported for all variables where appropriate. Continuous variables normally distributed
were compared by gender with a Student’s t-test; a non-parametric
approach (Mann-Whitney) is used otherwise. Dichotomous variables
were compared using a chi-square or Fisher’s exact test.
Results: Score for males and females differed for many of the positive
sexual health outcomes. Males scored higher on the measure of sexual
self-efficacy (p = 0.011). Young women reported a statistically significantly higher score for sexual communication and health protective
communication as compared to males (0.048, p = 0.009; respectively).
Median scores on the sexual satisfaction scale were equal for males and
females (p = 0.370).
Conclusions: This study highlights the presence of positive
sexual health outcomes within adolescent relationships and the importance of considering gender when interpreting these results. Findings
point to intervention opportunities to promote adolescent sexual
health.
Background: Bass Line 2008–09 was a community-based research
project commissioned by England’s National African HIV Prevention
Programme.
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206
SEXUAL DECISION MAKING IN SCOTTISH
ADOLESCENTS WITH A HISTORY OF
OFFENDING BEHAVIOUR; AN EXPLORATORY
STUDY
B. Duncan1, J. Williams1, C. Johnman2
1
Psychology, Glasgow Caledonian University, 2Public Health and Health
Policy, University of Glasgow, Glasgow, UK
Background/aims: Adolescents with antisocial behavioural problems
are at increased risk of adverse sexual health outcomes (e.g. STIs).
Factors associated with increased risk include those known to contribute to delinquency. However, few studies have addressed this group’s
own understanding of their sexual decision-making. The aim of this
study was to explore understandings of sexual health and sexual risk
among young people with antisocial behavioural problems, in order to
identify salient psychosocial factors in sexual decision-making in this
population.
Participants: Thirty self-identified heterosexual adolescents (15
females / 15 males), aged between 16 and 18 years (mean = 16), with
a history of persistent offending behaviour.
Method: Qualitative data was gathered via individual semi-structured
interviews and analysed using Interpretive Phenomenological Analysis.
Analysis was carried out separately for males and females and results
compared across the data set.
Results: High rates of sexual risk-taking were reported. Sexual decision-making was heavily influenced by the socio-cultural context
(including understandings of gender-approriate behaviour). The comparative nature of the analysis offered valuable insights into how differences and similarities between sexes in the same population operated
to
a) produce and reinforce sexual risk behaviour and
b) mitigate against positive sexual health.
Further, the data offered tentative evidence of the manner in which
factors specific to this population (social exclusion and delinquency)
may interact with gender-related attitudes and norms of sexual conduct
to increase risk.
Conclusion: This study provides important insights into the psychosocial factors which underpin sexual decision-making in this vulnerable
population, which have implications for policy and practice.
207
RECEPTIVITY TO SEXUAL INVITATIONS
FROM STRANGERS OF THE OPPOSITE
GENDER
Conclusion: Correcting for relationship status the study found that
men will agree to sexual invitations from complete strangers of the
opposite gender more readily than women thus supporting the primary
conclusion from Clark and Hatfield (1989). Further, the study underline the importance of attractiveness for women and relationship status
for both men and women in short term mating.
208
SEXUAL COMMUNICATION AND
SEROADAPTATION PRACTICES AMONG HIVNEGATIVE MSM AGED 40 AND OLDER IN
SOUTH FLORIDA, UNITED STATES
R.J. Jacobs, R.L. Ownby
Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort
Lauderdale, FL, USA
Background: The incidence of HIV infection among older men who
have sex with men (MSM) in the U.S. is increasing, yet little is known
about their sexual decision-making processes. The purpose of this
analysis was to evaluate the impact of communication on self-reported
unprotected sexual behavior in MSM aged 40 and older.
Methods: We recruited a community-based sample of 802 selfidentified MSM aged 40+ in South Florida, U. S. from community
venues (e.g., bars, gyms) to complete an anonymous questionnaire.
Using data from a subset of 420 self-identified sexually active HIVnegative MSM aged 40 to 81 years (M = 55.5 years; SD = 10.7), we
report on sexual behaviors and communication among this group. This
study used a cross sectional research design. The data were analyzed
using logistic regression.
Results: Sixty-eight percent of respondents reported multiple sex
partners in the past 6 months (median = 3). Analyses showed that not
using condoms if the partner said he was HIV-negative (odds ratio
[OR] = 0.66; 95% confidence interval [CI]: 0.5, 0.9) was associated
with higher risk for unprotected receptive anal intercourse. Not using
a condom if the partner said he was HIV-negative (OR = 0.61; 95%
CI: 0.4, 0.8) was associated with higher risk for unprotected insertive
anal intercourse (UIAI). Assuming partners are HIV-positive (OR =
1.5; 95% CI: 1.1, 2.1) was associated with less risk for UIAI.
Discussion: Many MSM aged 40 and older are sexually active and
may engage in sexual risk behaviors. Communication about HIVserostatus while employing sexual seroadaptation strategies may influence protective decision-making in older HIV-negative MSM.
209
G.M. Hald1, H. Høgh-Olesen2
Department of Public Health, University of Copenhagen, Copenhagen,
2
Department of Psychology, University of Aarhus, Aarhus, Denmark
PEER NORMS, SELF-EFFICACY, STIGMA,
SOCIAL SUPPORT, RECREATIONAL DRUG
USE, AND AGE AS PREDICTORS OF HIGHRISK SEXUAL BEHAVIOR AMONG GAY MEN
Objective: To investigate the primary conclusion from Clark and
Hatfield’s often cited field experiment “Consent to Sex with a Stranger”
that men agree to sexual invitations from moderately attractive strangers of the opposite gender more readily than women do. In addition,
to investigate if rates of consent are influenced by a subject’s age,
relationship status, rating of confederate attractiveness, and type of
sexual invitation.
Methods: 173 men and 216 women were approached by a number of
moderately attractive confederates of the opposite gender. After a
standard introduction, subjects were asked one of the following three
questions: “Would you go on a date with me tonight or during the
week/weekend?”, “Would you come to my place tonight or during the
week/weekend?”, or “Would you go to bed with me tonight or during
the week/weekend?”
Results: Significantly more men than women consented to a sexual
invitation. For female subjects’ higher ratings of confederate attractiveness were found to significantly increase the odds of consenting to
a sexual invitation. Relationship status was found to be a significant
and strong moderating variable of consent for both men and women.
This presentation will discuss and compare the results of two largescale studies examining the predictive value of peer norms, self-efficacy, stigma, social support, age, and recreational drug use on high-risk
sexual behavior that enables HIV transmission among gay men. One
study (n = 576) was conducted in the Southeast United States and the
second study (n = 542) was conducted in the New York City Metro
area. Each study utilized a face-to-face anonymous survey research
method. In this sample, 42% of the men reported engaging in unprotected anal receptive intercourse in the past six months. Only 24% of
the sample population believed they were at risk for HIV infection.
The HIV prevalence rate of this sample of men was 13% and of this
population, 51% reported engaging in unprotected anal intercourse.
In a bivariate analysis, all aforementioned factors were statistically
significant in men who reported engaging in unprotected anal intercourse. A discriminant function analysis revealed predictors of highrisk sexual behavior included:
1
L. Kooyman
Department of Counseling and Educational Leadership, Montclair State
University, Montclair, NJ, USA
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(1) low self-efficacy with regard to being able to use a condom, disclose HIV status, and negotiate safer sex;
(2) low outcome expectancy with regard to successfully using a
condom, disclosing HIV status, and negotiating safer sex in the
actual sexual encounter; and,
(3) low peer norms (believing that safer sex was not the norm with
one’s friends).
These findings indicate that HIV primary and secondary counseling
for this population needs to focus on self-efficacy, outcome expectancy,
changing peer norms for safer sex, and perceived risk. Racial and
regional differences will be discussed.
210
MOTIVES FOR SEX AND SEXUAL COERCION:
DIRECT AND INDIRECT PATHWAYS
L. Kuyper1,2, J. de Wit1
1
Utrecht University, 2Rutgers WPF, Utrecht, The Netherlands
Aims: Previous research has shown that motives for sex play an important role in explaining sexual health behaviors like condom use or birth
control. The aim of the current study was to examine the explanatory
power of sexual motives in the field of sexual victimization and perpetration. Sexual motives could be either directly related to coercive
experiences or behaviors, or they could be related through their association with other behavioral risk factors (e.g., having a higher number
of sexual partners or having casual partners).
Methods: Data were obtained from the 1 year follow-up study of a
survey of sexual coercion among young people in the Netherlands (N
= 1250; 15–25 years).
Results: Logistic regression analysis confirmed the relationship
between motives for sex and sexual coercion. Experiencing any form
of sexual victimization was related to having sex to please one’s partner
or one’s peers. Having sex because of intimacy motives reduced the
odds of experiencing sexual victimization. This latter motive was also
related to lower levels of perpetration of sexual coercion. Having sex
for coping or enhancement motives increased the odds of perpetrating
coercive sexual behaviors. Entering sexual behavior characteristics
(number of partners, casual partners) did not attenuate the association
between motives and victimization. However, the relationship between
intimacy motives and the perpetration of sexual coercion was no longer
significant.
Conclusion: Sexual motives may play an important direct and indirect
role in sexual coercion among young people. This underscores the
importance of addressing motives for sex as part of prevention
programs.
211
BARRIERS TO ACCESSING SEXUAL
HEALTHCARE AMONG SUBSTANCEMISUSING WOMEN
N. Lambert1,2, H. Patel3, L. Bogen-Johnston1, A. Glasper4,
E. Chamberlain5, D. Mc Bride6
1
Centre for Nursing and Midwifery Research, University of Brighton,
Brighton & Hove, 2Research & Development, Sussex Partnership NHS
Foundation Trust, Brighton and Hove, 3Department of Genito-Urinary
Medicine, 4Substance Misuse Service, Hastings & Rother Primary Care
Trust, Hastings, 5c/o Centre for Nursing and Midwifery Research, University
of Brighton, Brighton & Hove, 6NHS Hastings and Rother and NHS East
Sussex Downs and Weald, Hastings, UK
Background: Injecting drug users (IDUs) and sex workers are target
populations for sexual healthcare. Existing evidence suggests substance-misusing women (SMW) experience high rates of sexually
transmitted infections (STIs), unwanted pregnancy and sex work, and
low rates of cervical screening and condom use; yet their sexual healthcare access issues are poorly understood.
Aim: To investigate barriers and enablers of sexual healthcare access
among SMW.
134
Methods: SMW who completed a questionnaire about sexual health
risks and services were invited to participate in an interview about
sexual healthcare access. Recruitment and data collection took place
in a substance-misuse service and homeless centre.
Results: Personal hygiene difficulties sometimes prevented attendance
for cervical screening and STI testing. Transport and telephone costs
deterred heavy drug users from accessing many services. Emotional
barriers predominated- lack of self-regard, and fear of STI testing and
cervical screening procedures and of results. Many women disclosed
sexual assault. Social support helped women attend services but was
often absent. Amenorrhoea, infrequent sexual activity and pregnancy
desires (usually undisclosed to professionals) led to inconsistent use of
contraception. Delayed access to antenatal or abortion services was
associated with a desire to ‘keep’ the baby as long as possible where
previous children had been removed from parental care. Perceived
assumptions about promiscuity of SMW deterred women from discussing their sexual health with general practitioners.
Conclusions: This population experience specific pragmatic, emotional and stigma-related barriers to sexual healthcare access. Enhanced
interventions providing emotional and pragmatic support to engage
with services are needed.
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EXAMINING THE SEXUAL HEALTH
OUTCOMES OF ABSTINENCE PLEDGES
A.M. Landor, L.G. Simons
Child and Family Development, University of Georgia, Athens, GA, USA
The last decade has sparked a heated debate about the impact of
abstinence pledges on sexual health outcomes, but a limited number
of studies have explored the effect of pledges and religiosity on sexual
behavior. This paper aims to
(1) examine the moderating role of religiosity,
(2) explore the different dimensions of religiosity (e.g., commitment
to religious beliefs/values and participation in religious activities),
and
(3) investigate the impact of pledges on a wide range of outcomes such
as virginity status, number of intercourse partners, and number of
oral sex partners.
Study data were obtained from a volunteer sample of 1512 college
students. Three hierarchical regression analyses were conducted to test
the effects of religious commitment, religious participation, pledge
signing, and their interactions on sexual health outcomes. Results
showed that signing an abstinence pledge does deter premarital sex
and reduces the number of intercourse partners for males and females
only to the extent that the individual reports high levels of religious
commitment. However, signing a pledge did not- in and of its selfreduce the number of oral sex partners. It was only when the pledge
was combined with high levels of religious commitment that findings
showed a decrease. Interestingly, although pledgers experience later
sexual initiation, a majority of them eventually engage in premarital
sex with multiple intercourse and oral sex partners. To this end, reduction in risky sexual behavior appears to have an effect on sexual outcomes only when pledges are combined with high levels of religious
commitment.
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WHAT DID YOU DO IF YOU FEEL SOMETHING’S
WRONG DOWN THERE? HEALTH-SEEKING
BEHAVIOURS OF FEMALE SEX WORKERS IN
HONG KONG
K.C.K. Lee
School of Public Health and Primary Care, Chinese University of Hong
Kong, Hong Kong, Hong Kong S.A.R.
Background: Female sex workers (FSW) are at higher risk of acquiring sexually transmitted infections (STI) and transmitting to more
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individuals if they are infected. Prompt diagnosis and appropriate
treatment of STI is essential for effective prevention.
Aim and methods: A community-based survey of FSWs was conducted to assess their health-seeking behaviours for recent genital
growth, abnormal vaginal discharge, or ulcers (last 6 months) and
recent access to HIV/STI testing services (last 1 year). Pre-survey
focus groups and mapping was done to categorize types and enumerate
distribution of FSWs in the territory. Multi-staged stratified cluster
sampling was used to sample 1000 FSWs of 5 different types: onewoman brothels, karaoke night clubs, bars, massage brothels and street
sex workers.
Results: Among 986 participants, 32% reported having any one of the
symptoms in prior 6 months. Majority reported self-medication (36%
for genital growth, 41% for vaginal discharge, 48% for genital ulcers),
seeking treatment at private clinics (30%, 29%, 14%) or just wait and
observe (18%, 11%, 15%) for their symptoms. Overall, less than 10%
sought treatment at local public STI service. The pattern is similar
across types of FSWs. Forty percent reported recent attendance at
public STI clinics (24%) or NGOs (20%) for HIV/STI testing in last
year.
Conclusion: Less than half of FSWs would seek doctor advice
for their genital symptoms and self-medication is common. Further
efforts are necessary to understand the factors contributing to this
phenomenon and to improve STI diagnosis and treatment among
them.
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SEXUAL FLUIDITY—A GROWING
PHENOMENON AMONG YOUNG PEOPLE
S.-A. Månsson
Malmö University, Malmö, Sweden
Background and aim of study: Sexual fluidity means situationdependent flexibility in a person’s sexual responsiveness making it
possible to experience sexual desires for either men or women regardless of their overall sexual orientation. Prior research has provided
support for the notion of gender differences arguing that women are
more fluid than men. The aim of our study was to test this notion on
a sample of men and women ages 18–65 living in Sweden.
Methods: A web questionnaire comprising 85 questions was administered in the Swedish language on three web sites and one Swedish
university. For comparative reasons four questions were taken from an
instrument used in the major population-based sex survey, Sex in
Sweden 1996. These were questions about love, sexual attraction, fantasies and actions. The scale for each of these questions was inspired
by Kinsey’s hetero-homo scale. A total of 1,913 respondents completed
the questionnaire, and the final sample comprised 66 percent women
and 34 percent men.
Results: The data supports the notion that women are more fluid than
men, especially women in the younger age groups. For example more
than 50 percent of the female respondents answered that they have
sexual fantasies about a person of the same sex; a dramatic rise if
compared to 16 percent in the 1996 Sex in Sweden study. Also the men
are more fluid than they were in 1996 but to a much lesser extent than
the women. The presentation aims at discussing these generational
differences in sexual fluidity.
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SEXUAL DESIRE AND SEXUAL AROUSAL: DO
MEN AND WOMEN MAKE A DISTINCTION?
diagnosis, it is important to know how ordinary people understand
these terms in the context of daily life.
Research question: How do men and women define sexual desire and
sexual arousal? Can they make a distinction?
Methods: 32 semi-structured interviews were conducted with men
and women (aged 23 to 78), purposively sampled to represent a spectrum of sexual function experience. Respondents were recruited from:
a UK General Practice (GP) practice waiting room (n = 11); GP diabetes and depression patient lists (n = 13); and a UK sexual problems
clinic (n = 8). Data were analysed using Grounded Theory
principles.
Results: Participants used three criteria to distinguish between desire
and arousal: temporal sequencing; mind/body engagement; and goal
orientation. Many participants saw desire as occurring before arousal;
viewed desire as mind (thinking about having sex) and arousal as body
(signs and sensations); and saw arousal as a response to a person or
stimulus but desire as sometimes motivational and sometimes freefloating (unattached to a person or act). However, a significant minority of respondents reversed these distinctions or found it difficult to
differentiate desire and arousal clearly.
Conclusion: Our findings highlight the lack of universal understanding of these concepts. Clinical definitions may often be at odds with
those of lay people. This has ramifications for clinical diagnosis.
216
MSM’S EXPERIENCE OF USING THE
INTERNET TO SEEK SEXUAL PARTNERS—
RESULTS FROM A QUANTITATIVE STUDY
N. Nodin1, A. Carballo-Diéguez2, I.P. Leal1
Instituto Superior de Psicologia Aplicada, Lisbon, Portugal, 2HIV Center
for Clinical and Behavioral Studies, NYSPI and Columbia University, New
York, NY, USA
1
Many people use the Internet to seek relationships and sex. For these,
the Internet offers an easy way to meet others with common interests.
This is even more so among sexual minorities, such as men who have
sex with men (MSM), for whom the Internet allows access to similar
others without the risk of social discrimination associated with homosexual self-identification. We set out to find out the reasons for seeking
partners online, the efficiency of this process, and which are the factors
associated with it.
Design and method: This was a quantitative and exploratory study.
An anonymous online questionnaire was designed based on a previous
qualitative phase of the research. It included a wide range of questions
about MSM’s experiences of using the Internet to meet sexual partners.
It was online for about 5 months and extensively publicized, mainly
online.
Results: 317 MSM, mean age 30.8 (sd = 9.4; 18~62), completed the
questionnaire. 73.2% had an university level education; 96.8% identified as white; 49.5% were in a relationship, most of which (83.4%)
with a man; 78.2% self-identified as gay, the remaining as bisexual. On
average these men had had 9.2 sexual partners over the previous year,
of which 7.1 were met online. Main reasons for using the Internet for
that purpose were not feeling comfortable in bars or clubs; need for
an alternative to beats; by accident; and need to find easy sex. These
results allow a greater insight into the reality of online sexual pursuit,
motivations and contexts for MSM.
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K. Mitchell1, C. Graham2, K. Wellings1
1
Social and Environmental Health Research, London School of Hygiene
and Tropical Medicine, 2Department of Psychology, Brunel University,
London, UK
A LONGITUDINAL ANALYSIS OF
PREDICTORS OF MALE AND FEMALE
ADOLESCENTS’ TRANSITIONS TO
INTIMATE SEXUAL BEHAVIOR
Introduction: Disorders of desire and arousal are classified separately
in the current DSM, despite evidence of co-morbidity. There have
been calls to combine desire and arousal into one disorder in the
upcoming DSM-5. Given the uncertainty surrounding definition and
Introduction: Pre-intercourse sexual activities can be pivotal in
helping shape adolescents’ sexual development yet are rarely incorpo-
L.F. O’Sullivan, S. Ronis
Psychology, University of New Brunswick, Fredericton, NB, Canada
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rated into studies of sexual development. Understanding transitions in
general may inform effective education and intervention efforts to help
ensure healthy sexual outcomes for youth. This study assessed which
variables best predict sexual transitions among male and female
adolescents.
Method: Three hundred students from Canadian high schools
(grades 9–11) completed on-line assessments at baseline and one year
later. Participants were predominately female (65%); 14.8 years (range
= 13–16). At Time 1, 235 participants (78.3%) reported no sexual
experience (“abstinent” group; i.e., no oral sex or intercourse). At Time
2, 34 participants (14.5%; 10 boys, 24 girls; “transition” group)
reported having engaged in more intimate sexual behavior than in
Time 1. Among the transition group, 3 boys and 10 girls reported
abstinence at Time 1 and oral sex experience by Time 2; 4 boys and 4
girls reported oral sex experience at Time 1 and intercourse by Time
2; and 3 boys and 10 girls reported abstinence at Time 1 and intercourse experience by Time 2.
Results: For boys, lower self-esteem at time 1was a significant predictor of transition to more intimate sex by Time 2, as were more restrictive parental sexual values. However, higher alcohol use and higher
self-esteem were significant predictors of girls’ transitions to more
intimate sex by time 2.
Discussion: Differential psychosocial profiles emerged for boys and
girls who advanced in sexual experience, suggesting the need for differential health approaches.
218
‘HOOKING UP’ IN CONTEXT: THINKING
ABOUT CASUAL SEX AND ALIENATION
R. Plante
Sociology, Ithaca College, Ithaca, NY, USA
Introduction: This is a paper about ‘hook up’ (“casual”) sex and
relationships, utilizing data from quantitative and qualitative studies of
United States’ college students’ sexual behavior and relationships. Cultural critics and observers in the U.S. have argued that hooking up is
bad for women because, they argue, it threatens future intimacy.
Others argue that youth no longer date and will lack the skills deemed
necessary for long-term intimate relationships.
Aims: To explore and answer key questions: Is hooking up an alienated
or alienating experience? Is it a rejection of dominant, hegemonic U.S.
values about individuality, intimacy, love, and sex? We wish to explore
how ‘casual’ sex is understood, experienced, and made consequential
in social and personal sexual development.
Background and aims: We focus on ‘hook up’ encounters involving
heterosexually active men and women, but we also address same-sex
hook ups; special attention to how race and ethnicity might affect
behavior and attitudes.
Methods: Face-to-face, semi-structured interviews (n = 108) and
online, anonymous surveys (n = 13,500) with U.S. college students.
Purposive interview sampling; non-random, unrepresentative quantitative study.
Result: We find that heterosexual gender differences color
respondents’ sexual and emotional experiences. We note that samesex hook ups differ from opposite-sex hook ups, and we see that
African-American, Latin-American, and multiracial respondents’ attitudes and experiences differ from their Caucasian/European-American
peers.
Conclusions: We argue that hook up sex may represent the failure of
several contemporary beliefs about sex and relationships: trust, connection, the rhetoric of intimacy, and traditional romanticism.
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219
SEXUALITY AND PERSONHOOD AMONG
FEMALE COLORECTAL CANCER SURVIVORS
WITH OSTOMIES
M. Ramirez1, C. McMullen2, M. Grant3, A. Altschuler4, M. Hornbrook2,
R. Krouse5
1
University of the Sciences, Philadelphia, PA, 2Kaiser Center for Health
Research, Portland, OR, 3City of Hope, Duarte, 4Kaiser Permanente
Division of Research, Oakland, CA, 5Southern Arizona Veterans Affairs
Health Care System, Tucson, AZ, USA
Background: As more people survive colorectal cancer (CRC),
greater attention is being given to the correlates of long-term survivorship and quality of life (qol). A notable amount of research has examined male sexual functioning and qol in this patient population, with
much less understood about how this surgery affects female
sexuality.
Objective: To describe the particular challenges that female CRC
survivors with ostomies face, and discuss the various adaptations that
helped them cope with their radically transformed bodies.
Methods: In-depth interviews were conducted with 30 female colorectal cancer survivors with intestinal stomas from Northern California
and Oregon.
Results: Most participants were White Non-Hispanic (N = 22),
however, other racial/ethnic groups were represented. Surviving CRC
with an ostomy assaults core notions of full-adult personhood including sexual participation. For some women, altered sexual participation,
particularly the inability to have intercourse, adversely affected their
qol. Other women did not find their altered sexual participation to be
particularly problematic. Participants provided various narrative reappraisals that gave their illness meaning and functioned to normalize
their condition.
Discussion: Women who have survived CRC treatment ranges from
no sexual difficulties (with minor modifications to sexual repertoire) to
complete interference with vaginal intercourse. Early assessment of
this population post treatment may reveal vaginal changes that may
aid in identifying testable interventions to improve sexual health.
However, the authors also contend that heteronormative assumptions
about sexual functioning interferes with empirically based, meaning
centered definitions of sexuality and personhood. Moreover, biomedical/clinical discourses of normative sexual functioning are likely too
narrow.
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PILOT-TEST AND VALIDATION OF A SET OF
INDICATORS OF SEXUAL HEALTH AMONG
YOUNG PEOPLE IN CANADA
L. Smylie1, M. Doherty2, B. Clarke1, T. Yovetich1, J. Otis3, J. Gahagan4,
G. Smith5, A. McKay6, M. Numer4
1
Sexual Health & STI Section, Public Health Agency of Canada, Ottawa,
ON, 2University of Alberta, Edmonton, AB, 3Université du Québec à
Montréal, Montreal, QC, 4Dalhousie University, Halifax, NS, 5Options for
Sexual Health, Vancouver, BC, 6Sex Information and Education Council of
Canada, Toronto, ON, Canada
Introduction and objectives: Canada only collects national data on
rates of positive tests of the three reportable sexually transmitted infections (STIs)—chlamydia, gonorrhea, and infectious syphilis- and rates
of pregnancy. The Public Health Agency of Canada lead a team of
Canadian sexual health researchers in developing, pilot-testing and
validating a comprehensive set of indicators of sexual health among
young people, aged 16 to 24 years, in Canada. This presentation will
highlight the results of the validation phase of this pilot study.
Method: A survey was administered to a purposive sample of 1185
participants between the ages of 16 and 24 years. The survey was
administered using computer-assisted self-interviewing technology, in
both English and French languages. Data was analyzed for content
validity, construct validity, criterion validity, test-retest reliability and
inter-rater reliability.
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Results: The set of indicators demonstrated good content validity,
construct validity, criterion validity, test-retest reliability and interrater reliability. Seven scales representing protection use self-efficacy,
STI/HIV testing self-efficacy, sexual limit setting, sexual assertiveness,
sexual functioning self-efficacy, partner violence victimization and
sexual coercion were supported by the analyses.
Conclusions & implications: This is the first attempt in Canada to
create a comprehensive set of indicators of sexual health. This set of
validated indicators can be used to collect national level data on the
sexual health of young people in Canada, in order to inform effective
policies and sexual health promotion programs.
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PREMARITAL SEX AMONG YOUNG ADULTS
IN GREATER JAKARTA
I.D. Utomo, T. Hull, P.F. McDonald, A. Reimondos
Australian Demographic and Social Research Institute, Australian National
University, Canberra, ACT, Australia
The paper is based on a statistical sample of 3006 young adults aged
20–34 years in Jakarta, Bekasi and Tanggerang, the 2010 Greater
Jakarta Transition to Adulthood Survey. This study, the first comprehensive survey of transition to adulthood conducted in Indonesia,
is funded by the Australian Research Council, WHO and the National
University of Singapore. Questions relating to sexuality and risk taking
behaviours were asked using a self administered questionnaire to insure
confidentiality. The objectives of this paper are to examine selfreported sexual orientation and responses to questions on sexual
behaviours among young people. Preliminary results show that 11 per
cent of never married respondents and around 10 per cent of evermarried respondents reported they had sexual relationships before
marriage. Among the never married, only 5 percent of females reported
experience of sexual intercourse, compared to 16 percent of males. The
authors speculate that reported premarital sex incidence among
respondents is understated. In an attempt to overcome this shortfall
indirect calculations are made by comparing date of marriage and date
of first birth to estimate apparent frequency of premarital conception
among those who have been married. Reports of self masturbation and
oral sex were significantly more common among males than females,
though almost equal numbers of male and female respondents reported
masturbation with a partner.Understanding of sexual orientation and
sexual behaviours among single and married young people is useful for
policy and planning so that young people can have access to reproductive health services and treatment.
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EXPLORATION OF THE SEXUAL HEALTH
CONTENT OF MASS MEDIA IN NIGERIA
O. Wusu, Behavioural Aspects of Sexual Health
Demography and Social Statistics, Covenant University, Ota, Nigeria
Objective: Sexual health content of Nigerian media landscape is
largely obscured. This study sought to address this need. The main
objective was to examine the frequency of scientifically classified sexual
health content of mass media in the country.
Material and methods: Data were gathered from stratified randomly
selected sample of the media in the country. Two print media (5724
pages were combed), two radio stations (211 programmes was listened
to) and TV stations (352 programmes were viewed) each were selected
in the two strata of mass media. Data on the nature and frequency of
sexual health content were elicited from selected media. Analysis
employed descriptive tools.
Result: The sexual health content of the media was classified into
three descriptive categories-sex education, contraception and sex provoking. Analysis indicated that sex education content occurred 10
times in printA, twice in printB and contraception was nil in the two
while sex provoking contents occurred 23 and 16 times in printA and
printB respectively. RadioA & B recorded sex education content 19
times; contraceptive use occurred twice and sex provoking 10 times.
TVA & B recorded sex education 16 times, contraceptive use 13 times
while sex provoking content occurred 22 times within the study period.
Conclusion: Sex provoking content is more predominant in Nigerian
mass media. Sex education had second y high frequency in both print
and electronic media. Information on contraception which is crucial
to the health of sexually active individuals is poorly represented in the
media in the country.
223
‘FEELS RIGHT UNTIL I GET CAUGHT’:
SEXTING AND INFIDELITY IN CYBERSPACE
D. Wysocki1, C.D. Childers2
Department of Sociology, University of Nebraska at Kearney, Kearney, NE,
2
Department of Sociology, Washburn University, Topeka, KS, USA
1
This exploratory project investigated the behaviors of sexting and
infidelity on the internet. The researchers placed a survey on a web
site called AshleyMadison.com which was created for married people
who want to find sexual partners outside their marriage. After receiving
IRB approval, the survey was placed on Qualtrics, then a link was
placed on the log out page of AshleyMadison.com, so respondents who
wanted to participate could be taken directly to the survey from the
web site. During the time the survey was online, it was accessed 8,801
times, with 8,678 people actually beginning the survey. However, we
had to eliminate 3,365 surveys because the respondents answered only
the questions about sexual behaviour and did not complete any of the
demographic questions. We refined it further which left us with 5,187
as a final sample size. Using both descriptive statistics and binary
logistic regression analysis, the researchers found that the respondents
use the internet to find real-life partners, both for dating and for sex
hookups, but many are anxious about being caught. Females are more
likely than males to engage in sexting behaviors, and to cheat both
online and in real life while in a serious real-life relationship. Older
males, however, are the most likely than younger males to cheat in real
life. The results suggest that as technology changes, the ways that
people find sexual partners also changes.
ORAL PRESENTATION
TRACK 5
224
UNDERSTANDING HIV-RELATED SEXUAL
RISK BEHAVIOUR AND HIV PREVENTION
CHALLENGES IN SCOTTISH GAY MEN
P. Flowers1, C. Knussen1, L. McDaid2
1
Psychology, Glasgow Caledonian University, 2Social and Public Health
Sciences Unit, MRC/CSO, Glasgow, UK
Objective: To illustrate trends in the HIV risk-related behaviour of
Scottish gay and bisexual men and explore the potential role of changing sexual cultures in shaping sexual conduct.
Methods: Data from ten cross-sectional anonymous, self-report
surveys in commercial gay venues in both Glasgow and Edinburgh (N
= 11,204) are supplemented with in-depth qualitative interviews with
gay and bisexual men conducted between 1996–2005.
Results: Across the survey period profound changes in a range of
sexual health behaviours are observed. In terms of HIV testing, in
1996, 28.4% of men reported having had a test in the previous year,
by 2011 this had risen to 57.1%. In terms of basic measures of HIV
risk related behaviour, levels of unprotected anal intercourse (UAI)
have also changed dramatically, from 8.3 % in 1996 reporting UAI
with more than two partners, to 15.5% in 2010. The analysis of qualitative data illustrates the complexity and centrality of sexual identity
and sexual cultures in shaping sexual conduct.
Discussion: HIV-related risk behaviours have changed dramatically
over the last 15 years in Scotland and elsewhere. We explore potential
explanatory frameworks to contextualise these changes, namely
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increasingly sophisticated means of managing HIV risk amongst some
populations of gay men, the impact of ART and the use of medical
technologies in managing HIV risks and the rise of new sexual identities and sub-cultures within gay men’s sexual cultures.
225
SEXUAL BEHAVIOUR AND HIV PREVALENCE
OVER THE LIFE COURSE IN RURAL MALAWI
E. Freeman1, P.A. Anglewicz2
1
London School of Economics, London, UK, 2Department of International
Health & Development, Tulane University, School of Public Health, New
Orleans, LA, USA
Objective: This paper compares HIV prevalence and sexual behaviour
of individuals aged 15–49 with those aged 50 years+ and 65 years+,
and examines patterns of HIV risk and sexual behaviour over the life
course in rural Malawi.
Methods: We use data from the 2010 wave of the Malawi Longitudinal Study of Families and Health (MLSFH), a longitudinal panel
survey collecting demographic, socioeconomic and health data in three
regions of rural Malawi. Data were collected from around 4000 adults
aged 15 and over.
Results: HIV infection remains a risk at older ages in rural Malawi.
HIV prevalence at age 50 and older was 7.7% among men and 4.2%
among women. Our data suggest that HIV infection in this population
is likely to be sexually transmitted. Sexual activity does not diminish
after age 49: 45% of women and 72% of men reported having sex in
the past year. Numbers of men and women’s recent extramarital partners were not significantly different after age 50 from those reported
before age 50. Our data also suggest that women may be less aware of
their husband’s extramarital partners at older ages.
Conclusion: We demonstrate that questions about sexuality and HIV
testing can be offered to older adults in Africa without the risk of high
non-response bias. This, coupled with our findings of considerable
levels of HIV infection and sexual activity among older Malawians,
suggests that individuals aged beyond 49 should and can be included
in HIV/AIDS research and prevention efforts in sub-Saharan Africa.
226
MALE CIRCUMCISION AND SEXUAL
FUNCTION IN MEN AND WOMEN:
A SURVEY-BASED, CROSS-SECTIONAL
STUDY IN DENMARK
M. Frisch1, M. Lindholm1, M. Grønbæk2
1
Department of Epidemiology Research, Statens Serum Institut, Copenhagen
S, 2National Institute of Public Health, Copenhagen Ø, Denmark
Background: One third of the world’s men are circumcised, but little
is known about possible sexual consequences of male circumcision. In
Denmark (~5% circumcised), we examined associations of circumcision with a range of sexual measures in both sexes.
Methods: Participants in a national health survey in 2005 (n = 5552)
provided information about their own (men) or their spouse’s (women)
circumcision status and details about their sexual lives. Logistic regression-derived odds ratios adjusted for potential confounders (ORadj)
measured associations of circumcision status with sexual experiences
and current difficulties with sexual desire, sexual needs fulfilment, and
sexual functioning.
Results: Age at first intercourse, partner number, perceived importance of a good sex life, and current sexual activity differed little
between circumcised and uncircumcised men or between women with
circumcised and uncircumcised spouses. However, circumcised men
were more likely to report frequent orgasm difficulties (11% vs 4%,
ORadj = 3.26; 95%CI:1.42–7.47), and women reporting a circumcised
spouse were more likely to report incomplete sexual needs fulfilment
(38% vs 28%, ORadj = 2.09;1.05–4.16) and frequent sexual function
difficulties overall (31% vs 22%, ORadj = 3.26; 1.15–9.27), notably
orgasm difficulties (19% vs 14%, ORadj = 2.66; 1.07–6.66) and dyspa-
138
reunia (12% vs 3%, ORadj = 8.45; 3.01–23.74). Findings were stable in
several robustness analyses, including one restricted to non-Jews and
non-Moslems.
Conclusions: Circumcision was associated with frequent orgasm difficulties in Danish men and with frequent sexual difficulties in their
spouses, notably orgasm difficulties, dyspareunia, and a sense of
incomplete sexual needs fulfilment. Thorough examination of these
matters in areas where male circumcision is more common is
warranted.
227
PHARMACY ACCESS TO THE EMERGENCY
CONTRACEPTIVE PILL (ECP) IN AUSTRALIA:
POLICY IMPLICATIONS OF THE FINDINGS
FROM TWO NATIONAL STUDIES
M.K. Hobbs1, S.Y. Hussainy2, A.J. Taft1, K. Stewart2, L.H. Amir1,
J.M. Shelley3, A.M. Smith4, C.B. Chapman2
1
Mother & Child Health Research, La Trobe University, 2Department of
Pharmacy Practice, Monash University, 3School of Health and Social
Development, Deakin University, 4Australian Research Centre in Sex,
Health and Society, La Trobe University, Melbourne, VIC, Australia
Aim: To examine the major policy issues from findings of national
surveys about over-the-counter (OTC) provision of the ECP in
Australia.
Methods: Computer-assisted telephone interviews with a random
sample of 632 Australian women aged 16–35 years, and a mail survey
of a random sample of 427 community pharmacists nationally in
2008/2009.
Results: Fewer than half the women surveyed were aware that the
ECP was available OTC. Most had high awareness of the ECP, but
limited knowledge in relation to its use. About a third of the women
erroneously thought the ECP was an abortion pill, over 60% that the
ECP could damage future fertility, and a significant number confused
it with RU-486. Fewer than half the women felt it was the pharmacist’s
role to give advice about regular contraception and STIs when a
woman was obtaining the ECP. Only one woman had purchased the
ECP for future use.
Most pharmacists believed that public awareness of the OTC
availability of the ECP is high, and that it is their role to provide
advice to women on regular contraception. Many felt the ECP should
not be supplied in certain circumstances, such as for future or repeat
use.
Conclusions: Public education campaigns and publicity through the
media about the safety, time-frame for use, OTC availability and the
difference between the ECP and medical abortion are needed. For
pharmacists, there is a need for a standardised national protocol or the
abolition of protocols altogether, and revised training on the provision
of the ECP.
228
HEALTH AND WELL-BEING OF
TRANSGENDER AND TRANSSEXUAL
WESTERN AUSTRALIANS: PRIORITIES FOR
PUBLIC HEALTH
Z. Hyde1,2, G. Brown1
Western Australian Centre for Health Promotion Research, Curtin
University of Technology, Bentley, 2School of Medicine and Pharmacology,
University of Western Australia, Crawley, WA, Australia
1
Background: Transgender and transsexual (trans) people are highly
stigmatised populations. However, little is known about the general
health status of these groups.
Methods: Between October 2006 and February 2007, 50 self-identified trans individuals living in Western Australia were recruited via a
range of purposive sampling strategies, and completed an anonymous
questionnaire exploring a range of health issues. Responses were compared against national surveillance data.
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Results: One in five participants were smokers (22%, n = 11), and
trans women were twice as likely to smoke as women in the general
population. One in three participants (30%, n = 15) had used an illicit
drug in the past six months. Cytological screening was utilised by 38%
of those in whom it was indicated, compared with 61% in the general
population. Mammograms were also poorly utilised, with 29% of trans
women aged 50–69 screened, compared with 56% of women generally.
In the past year, 32% (n = 16) were diagnosed with depression and
24% (n = 12) had been diagnosed with an anxiety disorder. The majority of participants had sought medical assistance to transition, but
difficulties were commonly reported. The most frequently cited problems were an inability to afford medical services, a lack of services in
the state, and encountering clinicians who lacked the knowledge to
provide appropriate care.
Conclusions: High rates of substance use and low uptake of cytological and breast-screening services suggest mainstream health promotion
messages are not reaching trans people or are not perceived as relevant.
Health services must develop programs relevant to and inclusive of
trans individuals.
229
FEMALE SEXUAL DYSFUNCTION DUE TO
DIABETES MELLITUS: STUDY AMONG
MUSLIM WOMEN IN MALAYSIA
S. Kamaralzaman1, S.B. Budin2, M. Yau3, H. Sidi4, J. Mohamed2
1
Occupational Therapy Programme, 2Department of Biomedical Sciences,
Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia, 3School of Public
Health, Tropical Medicine and Rehabilitation Sciences, James Cook
University, Townsville, QLD, Australia, 4Department of Psychiatry,
Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Sexual dysfunction is a known complication of diabetes mellitus in
both men and women.
The aims of this study: 1. to determine the prevalence of sexual
dysfunction 2. to identify the types of sexual dysfunction experienced
by Muslim women with type 2 diabetes mellitus in Malaysia.
Methods: This sequential mix-method study was conducted on
married Muslim women with type 2 diabetes mellitus, who received
treatment from three community clinics in Selangor, Malaysia. Female
sexual function was assessed using Malay version of Female Sexual
Function Index. Later, a few women were selected and interviewed
using semi structured questions to obtain their opinion regarding their
sexual function.
Results: Eighty-one women participated in this study which found
that sexual dysfunction was present among 27.2% women. Sexual dissatisfaction was the commonest symptom among these women and was
observed in 48.1% of women followed by poor libido (45.7%). Sexual
arousal disorder was observed in 25.9%, 23.5% complained of lack of
lubrication, and 21.0% had vaginal discomfort. Orgasmic dysfunction
was found in only 12.3% of these women. Semi structured interview
revealed that women seek religious guidance, reading materials in
magazines and traditional medicine to cope with sexual problems. All
women expressed the importance of sexual health as they consider it
as a religious obligation.
Conclusion: Sexual problems are frequently experience by Muslim
women with diabetes mellitus. Further investigation is necessary to
determine the associated factors including sociocultural and religious
influences.
230
VALIDATING SALIVARY TESTOSTERONE
COLLECTION AND MEASUREMENT IN A
LARGE RANDOM PROBABILITY SURVEY:
NATSAL 2011
W. Macdowall, Natsal 2011 Hormone Module Working Group
Department of Social and Environmental Health Research, London School
of Hygiene & Tropical Medicine, London, UK
Introduction: The development of novel techniques for measuring
testosterone in saliva has increased interest in exploring the relationship between androgens and sexual behaviour. However, salivary testosterone measurements have not yet gained acceptance because of
uncertainties over the accuracy of assays and the lack of proper validation of salivary against standard serum measurements.
Objectives: To validate a salivary assay for testosterone and to pilot
saliva sample self-collection procedures in a large population-based
survey.
Methods: Four dedicated studies were conducted to explore: assay
performance; stability of salivary testosterone; the correlations between
salivary testosterone and serum testosterone and individual variations
in testosterone. Saliva and blood samples were collected in tandem in
all four of the separate validation studies and were stored, transported
and analysed under standardised conditions. The self collection of
early morning saliva samples by participants and the laboratory and
data management procedures were tested in the pilot and dress
rehearsal for Natsal 2011.
Results: Results will be presented on assay performance, sample stability, temporal variations in salivary testosterone and on the correlation between testosterone in saliva and serum in men and women.
Results will also be presented on the up-take of saliva testing in the
pilot and dress rehearsal.
Conclusion: Measurement by mass spectrometry on a single saliva
sample collected before 10am in the morning can provide an accurate
assessment of tissue exposure to testosterone in both men and women
and early morning saliva collection can be operationalised within a
large population based survey such as Natsal 2011.
231
REPEAT INDUCED ABORTION—A MATTER
OF INDIVIDUAL BEHAVIOUR OR SOCIETAL
FACTORS? A CROSS SECTIONAL STUDY
AMONG WOMEN AND MEN IN SWEDEN
M. Makenzius1,2, T. Tyden3, E. Darj2, M. Larsson2
Sexuality and Reproductive Health, Swedish National Institute of Public
Health, Östersund, 2Women’s and Children’s Health, 3Public Health and
Caring Sciences, Uppsala University, Uppsala, Sweden
1
Background: Almost 40% of all induced abortions in Sweden are
repeat induced abortions; however, there is limited knowledge about
risk factors.
Objective: Investigate risk factors among women and men with repeat
abortion.
Methods: A Swedish cross-sectional study; 590 men (range 16–63 yrs);
798 women (range 14–49 yrs) involved in an abortion during 2009. A
questionnaire was used and a regression model examined risk factors
associated with repeat abortion (SPSS 17.0).
Results: One-third had been involved in at least one previous abortion.
Risk factors for repeat abortion among women; previous children (OR
2.57), lack of emotional support (OR 2.09), unemployment or sick leave
(OR 1.65), tobacco use (OR 1.56), and low educational level (OR 1.5).
Risk factors among men; age range 25–29 years (OR 3.72), victimised of
violence or abuse over the past year (OR 2.62), unemployment or sick
leave (OR 2.58), and previous children (OR 2.00). Some considered that
economic support and work opportunities might have enabled them to
continue the pregnancy. Increased sex and relationship education
(SRE), easy/free access to high-quality contraceptives and counselling,
were suggested interventions for preventing unintended pregnancies.
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Conclusions: A large proportion of abortion seeking women (35%)
and the involved male partner (32%) have experienced previous abortion and they appear more socio-economic disadvantaged than those
who experienced their first abortion. This vulnerability may hinder the
motivation and ability to practise safe sex. When applying these findings to public health work, welfare systems designed to narrow the gap
between different socio-economic groups become important, such as
increased work opportunity, SRE, subsidised contraceptives, and easy
access to counselling with follow-up visits.
232
REASONS WOMEN USE ‘DRY SEX’
TRADITIONAL MEDICINES IN ZAMBIA
M.R. Mbikusita-Lewanika, S.L. Hart
Pharmacology & Therapeutics, King’s College, London, UK
Introduction: There has been some concern in Central and Southern
Africa about the ‘dry sex’ practice prevalent in parts of that region,
especially in relation to the HIV epidemic which has disproportionately affected women. There have however been few, if any, studies
investigating the socio-cultural determinants of the practice. This
study looks specifically at the main reasons women use these medicines
and some of the beliefs that encourage the practice.
Method: A cross-sectional study involving 812 Zambian women, was
undertaken in Lusaka, the capital city of Zambia. Quantitative and
qualitative data was obtained through self-administered questionnaires, interviews, in-depth interviews and focus group discussions.
The quantitative data was analysed using SPSS, and the qualitative data
was used to complement and clarify the quantitative data.
Results and discussion: The main reasons women used the ‘dry sex’
traditional medicines (DSTM) included: for the man’s pleasure, fear
of rejection, to increase body temperature and because of social pressure or societal expectations. Respondents who were less traditional
were more likely to view DSTM use as practice perpetuated for the
benefit of men, and because of societal pressure. In contrast, the more
traditional respondents were more likely to view DSTM use as a social
and physiological necessity for women. Indeed, apart from the direct
reasons for DSTM use, one-third to two-thirds of the respondents
held ethnopharmacological, ethnobiological and socio-cultural perceptions and beliefs which encouraged DSTM use.
These findings are of importance in health promotion strategies,
especially in view of the HIV epidemic in the sub-Saharan region.
233
LATENT PROFILES OF PORNOGRAPHIC
VIEWING PREFERENCES AND SEXUAL
BEHAVIOR PRACTICES AMONG MEN WHO
HAVE SEX WITH MEN (MSM)
D. Smolenski, D.J. Erickson, A. Iantaffi, M.J. Wilkerson, J. Grey,
S.B.R. Rosser
School of Public Health, Division of Epidemiology and Community Health,
University of Minnesota, Minneapolis, MN, USA
Background: Sexually explicit media (SEM) is widely used among
MSM, however little is known about how to define and measure
MSM’s exposure to SEM. The primary aim of this investigation was
to determine how MSM grouped together based on their SEM viewing
preferences and recent behavioral practices.
Methods: We conducted a 7-day, test-retest study of 200 MSM
using an Internet-based recruitment approach. Eligible participants
reported sex with another man within the last 5 years, were at least 18
years old, and lived in the US. We asked respondents about viewing
and performance frequency of 23 diverse sexual acts in the last 3
months. We used latent class analysis to extract homogeneous groups
based on response patterns to each set of items (i.e., viewing and
behavior).
Results: Preliminary results indicate that there are four distinct profiles of viewing preferences:
140
(a) broad mainstream and fetish acts (26%),
(b) mainstream and limited fetish acts (22%, e.g., leather and spanking
only),
(c) mainstream sex acts (33%), and
(d) solo actor/masturbation (19%).
In terms of behavioral patterns, we observed only three profiles:
(a) broad mainstream and fetish acts (13%),
(b) limited mainstream acts (73%, e.g., masturbation, rimming, anal
sex), and
(c) broader mainstream (14%, includes three-ways and toy use).
Conclusions: We identified reliable patterns of SEM viewing and
sexual behavior among MSM. This classification will allow for
improved study of the effect of SEM on sexual risk behavior.
234
INTIMATE PARTNER SEXUAL VIOLENCE
AND ITS RELATIONSHIP TO HIV SEXUAL
RISK BEHAVIOUR AMONG MEN WHO HAVE
MULTIPLE FEMALE SEXUAL PARTNERS IN
CAPE TOWN, SOUTH AFRICA
L. Townsend1, C. Mathews1,2, Y. Zembe1
1
Health Systems Research Unit, Medical Research Council, 2Public Health
and Family Medicine, University of Cape Town, Cape Town, South Africa
Objective: To describe the changes over time in the perpetration of
intimate partner sexual violence (IPSV), and the association between
IPSV and sexual and other risk behaviours among adult men who have
multiple female sexual partners.
Method: Men from a peri-urban community outside of Cape Town,
South Africa were recruited in 2006 and again in 2010 into HIV
behavioural and biological surveillance studies employing Respondent
Driven Sampling. Eligible men were ≥18 years, and had at least two
female sexual partners in the 3 months prior to the survey.
Results: IPSV perpetrated in the last year was reported by more men
in 2010 (31.76%) than in 2006 (25.54%). Inconsistent condom use in
the last 3 months, reporting a symptom of a sexually transmitted infection (STI), engaging in transactional sex (TS) characterised by
exchange of money or goods, and consuming greater than 5 alcoholic
drinks on most occasions in the last 3 months were significantly more
common among men who reported perpetration of IPSV in 2006 and
2010. IPSV was more common among men who had more than 10
sexual partners in the last 3 months in 2006, and among men who were
unmarried in 2010.
Conclusion: Men in these serial, cross-sectional studies perpetrated
high levels of IPSV, and also engaged in risky sexual behaviour that
increases the risk of HIV. HIV risk reduction interventions that
address non-condom use and knowledge of and treatment for STIs
should also incorporate strategies to reduce intimate partner sexual
violence, transactional sex and excessive alcohol consumption.
235
THE PREVALENCE OF SEXUAL READINESS
IN A UK POPULATION COHORT
A. Waylen1, J. Heron2, A. Ness1, N. Low3
Oral and Dental Sciences, 2School of Social and Community Medicine,
University of Bristol, Bristol, UK, 3Institute of Social and Preventive
Medicine, University of Berne, Berne, Switzerland
1
Background and aims: There is evidence that higher levels of sexual
readiness are protective against poor sexual health outcomes. The aim
of this study was to prospectively examine the development of sexual
readiness in a UK cohort of adolescents.
Methods: Data were collected from 5247 adolescents who participated
in the Avon Longitudinal Study of Parents and Children at 12+, 13+
and 15+ years of age. Prospective data were collected using computer
assisted structured interviews and self-report questionnaires from the
young person and parents where appropriate. Experience of oral sex
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and sexual intercourse was recorded at each time point. A measure of
sexual readiness was derived by aggregating items which assessed the
young person’s willingness to take part, perceived autonomy, contraceptive use and lack of regret at being involved in these behaviours
(unready = 0, ready = 4).
Results: At 12+, 13+ and 15+ years of age, 1%, 3% and 23% respectively of each age group reported having had either oral sex or sexual
intercourse. The proportion of young people who were unready (score
< = 1) was 9% (95%CI 2–16%) at 12+ years and 6% (3–10% and 5–7%
respectively) at both 13+ and 15+ years whereas 34% (22–45%), 41%
(34–48%) and 55% (52–58%) respectively reported readiness for
sexual involvement (score = 4). Girls were more likely than boys to
report sexual activity but they also reported lower levels of sexual
competence.
Conclusions: Reported sexual readiness increases with age but at all
ages a substantial proportion of young people report low levels of
sexual readiness.
236
WHERE NOW IN PROMOTING YOUNG
PEOPLE’S SEXUAL HEALTH IN RURAL
SUB-SAHARAN AFRICA?
D. Wight1, M. Plummer2,3, HALIRA Research Team, NIMR Mwanza
1
Social and Public Health Sciences Unit, Medica Research Council, 2Social
and Public Health Sciences Unit, Medical Research Council, Glasgow, UK,
3
Independent Consultant, Dar es Salaam, Tanzania
Objective: To learn from a process evaluation accompanying the trial
of a multi-component adolescent sexual health programme in Tanzania, in order to recommend future preventative interventions.
Methods: An RCT of the MEMA kwa Vijana programme was accompanied by a process evaluation and descriptive research involving:
participant observation for repeated 7 week periods in 8 villages; indepth interviews with 118 young people (many repeated); and 6 series
of group discussions. Findings from intervention research elsewhere
in Africa were reviewed.
Findings: Rigorous evaluations of preventative behavioural interventions in Africa show limited impact. Our process evaluation identified
key barriers to behavioural change, both economic (e.g. women’s
dependence on men, sex as an important economic resource for
women, poverty) and cultural (e.g. low status of youth, contradictory
sexual norms and secrecy, predatory masculine sexuality, ambivalence
about contraception, negative condom beliefs, poor understanding of
HIV/AIDS). It also identified potential facilitators of behavioural
change, including restrictive norms, the influence of education and
religion, parents’ concern for their children’s health, village conformity, and contact with people with AIDS.
Conclusions: Preventative interventions with the strongest evidence
of effectiveness (largely biomedical) should be widely implemented,
but additional approaches are necessary. Our findings suggest 6 goals
for prevention: intensified promotion of A,B,C, particularly mutual
monogamy; greater openness about young people’s sexual relationships; stronger relationships between couples; forms of masculinity not
focused on sexuality; schooling that boosts confidence and challenges
gender norms; and raised expectations for young women. We will
discuss appropriate interventions to meet these goals.
ORAL PRESENTATION
TRACK 6
237
MEN AND WOMEN WITH GENITAL
PIERCINGS
M. Armstrong1, C. Young2, L. hogan3, K. Rinard 4, T. Nelius5
Texas Tech University Health Sciences Center, Marble Falls, 2Student
Health Services, University of Texas @ Arlington, Burleson, 3School of
Nursing, 4School of Medicine, 5Department of Medicine, Texas Tech
University Health Sciences Center, Lubbock, TX, USA
1
Object of study: To provide evidence about men (MGP) and women
(WGP) with genital piercings, including health, medical, and pregnancy issues. Currently they obtain their medical advice from the
non-health sources which may put their health at risk.
Methods: As random samples are almost impossible in populations
with hidden variables, two cross-sectional studies were conducted
using web-based surveys.
Results: Descriptive quantitative and qualitative data were obtained
from 445 MGP and 240 WGP, internationally. Deliberate decisionmaking was present. Their genital piercing (GP) outcomes (improvement of personal and partner’s sexual pleasure), were related to their
motives for the GP (sexual expression, uniqueness, and aesthetics).
MGPs often chose a Frenum/Frenum Ladder piercing (36%) and/or
a Prince Albert (56%), with 25% experiencing urinary flow changes
with the latter piercing. WGPs had clitoral area or labia piercings; they
stressed that GP were a normal, meaningful part of their lives. WGP
(n = 25) reported 37 pregnancies since GP procurement; half were not
asked to remove their piercings for delivery with no subsequent complications. Some WGP have experienced depression (47%), abuse
(physical 18%; emotional, 27%; sexual, 14%), and forced sexual activity (35%); they cited taking control and using GP to “re-claim” their
bodies.
Conclusions: The “social reality” of the GP phenomenon is here.
Several unsubstantiated assumptions were challenged regarding the
amount of STDs, GP complications, and overall demographics. Clinician awareness of GP is important to educate and inform adequately,
give professional advice, and provide a realistic picture of structural
complications.
238
AFTER ABORTION: WOMEN’S EMOTIONS
E. Astbury-Ward1,2
1
Social Inclusion Research Unit, Glyndwr University, Wrexham,
2
Contraception & Sexual Health, Western Cheshire PCT, Chester, UK
Women’s emotions are inextricably linked with the abortion experience. Women describe a range of varied feelings after abortion. They
include positive emotions such as the realisation the abortion is over
and that it was the end of keeping secrets, women express how they
are looking forward to life again and that they felt empowered, more
in tune with themselves and looking forward to the future. They also
experience a range of negative emotions such as remembering with
regret, feeling a sense of emptiness and loss, feeling isolated and concerned about the future. Some felt angry and ashamed at what they
described as ‘as a loss of life’ some felt they had disappointed themselves and others. The overwhelming emotion is described as relief
and this did not change over time although women re-evaluated their
abortion experiences differently as a result of the passage of time and
intervening life’s experiences, some re-evaluated their abortion negatively and others re-evaluated their abortion positively.Women’s emotions varied in their response to abortion. The initial feeling of relief
was re-evaluated over time; most felt it was the right thing to do at
that moment and moved on with their lives. Time may have eroded
the details, but not the fact of abortion.
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241
LEARNING THE ART OF ASSESSING AND
IMPROVING SEXUAL AND REPRODUCTIVE
HEALTH AND RIGHTS OF YOUNG PEOPLE
IN CONSERVATIVE MUSLIM SOCIETY
PLEASURE AND ORGASM IN WOMEN WITH
FEMALE GENITAL MUTILATION/CUTTING
(FGM/C)
Q. Baig
World Population Foundation, Islamabad, Pakistan
In any society good sexual and reproductive Health (SRH) is dependent on the recognition and realization of respective SRH Rights.
However the absence of research on SRHR status of young people, it
is difficult to plan interventions to address issues related to SRH of
young people and to advocate for an enabling policy environment.
In conservative countries like Pakistan which is currently undergoing demographic transition with over 64% of its population is below
the age of 24 years, it is vital to design rights based interventions to
meet their SRH needs. With this background, World Population
Foundation (WPF), Pakistan conducted a pioneering research on
‘Status of SRH Rights of Young People in Pakistan’—2010. The
‘Sexual and Reproductive Health Rights Assessment Framework’—
SeHRAF developed during the research is used for assessing SRHR
status of young people.
The research findings manifest limited realization of young people’s
SRH Rights, extreme discrimination against marginalized communities and has disregarded the assumption that boys/girls are “too young”
to need SRHR information and services. Most infringed rights are
‘Right to Education and Information’ and ‘Right to Health Care’. It
highlights the urgent need for building capacity of the education and
healthcare systems and advocacy for SRHR-friendly services and policies in Pakistan.
The findings of the research have enabled WPF in improving its
Life Skills Based Education (sexuality education) programme for
formal and non-formal education systems, incorporating LSBE into
National Education and Youth Policies and strengthening advocacy for
integration of SRHR Education into national school curriculum.
240
TOWARDS A WAS YOUTH INITIATIVE
A. Castellanos Usigli1, E. Corona Vargas2
1
Asociación Mexicana para la Salud Sexual, A.C., 2World Association for
Sexual Health, Mexico City, Mexico
According to the UNFPA, more than 1.5 billion people today are
between the ages of 10 and 25. It is the largest generation of young
people in history.
Over the past decades, scientific research and numerous surveys have
continuously demonstrated the many sexual problems faced by young
people, which are related to their particular developmental characteristics. Hence, in its Millenium Declaration, the WAS (2008) recognizes
their great need for comprehensive sexuality education and sexual
health services.
But as well as youths are prone to be affected by many sexual issues,
they can also become powerful sexual health advocates, as their actions
have proved over the last years.
Thus, it is crucial for the concretization of the Millenium Declaration,
and for the institutional life of WAS, to start developing mechanisms
of youth participation within WAS itself, as youths can become a
driving force that would contribute to the consolidation of WAS as the
leading global organization devoted to sexual health.
The WAS Youth Initiative emerges in this context, with three
main strategies to undertake: the constitution of the WAS Youth Initiative Committee with youth members of the five WAS Federations;
the use of modern communication technologies, particularly, the creation of Internet sites that would spread all the Initiative activities;
and an International Consultation, “Youth’s Sexual Health in the
XXI Century”, in response to the new sexual health challenges and,
consequently, in a necessary effort to define, through a youth-adult
partnership, the WAS guidelines to develop future work targeting
youth.
L. Catania1, J. Abdulcadir2, O. Abdulcadir1, V. Puppo3
Research Center for Preventing and Curing Complications of FGM/C,
Health Promotion of Immigrant Woman-Department of Gynaecology,
Obstetrics, Perinatology, Human Reproduction, Azienda Ospedaliera
Careggi, Florence, Italy, 2Department of Obstetrics and Gynaecology,
University Hospitals of Geneva, Geneva, Switzerland, 3Centro Italiano di
Sessuologia (CIS), Bologna, Italy
1
Introduction: Female genital mutilation/cutting (FGM/C) violates
human rights. FGM/C women’s sexuality is not well known and often
it is neglected by sexologists. In mutilated/cut women, some fundamental structures for orgasm have not been excised.
Object: To describe and analyze the results of four investigations on
sexual functioning in different groups of women with FGM.
Method: Sample: 137 adult women affected by different types of
FGM/C; 58 mutilated young ladies living in the West; 57 infibulated
women; 15 infibulated women after the operation of defibulation.
Results: The group of 137 women, affected by different types of
FGM/C, reported orgasm in almost 86%, always 69.23%; 58 mutilated young women reported orgasm in 91.43%, always 8.57%; after
defibulation 14 out of 15 infibulated women reported orgasm; the
group of 57 infibulated women investigated with the FSFI questionnaire showed significant differences between group of study and an
equivalent group of control in desire, arousal, orgasm, and satisfaction
with mean scores higher in the group of mutilated women.
Conclusions: The operation of defibulation showed that in infibulated
women, some erectile structures fundamental for orgasm have not
been excised. Cultural influence can change the perception of pleasure,
as well as social acceptance. Every woman has the right to have sexual
health and to feel sexual pleasure for full psychophysical well-being.
In accordance with other research, the present study reports that
FGM/C women can have the possibility of reaching orgasms. In case
of sexual disfunctioning, women with FGM/C have the right to have
an appropriate sexual therapy.
242
FEMALE GENITAL ‘COSMETIC’ SURGERY
(FGCS): GENITAL IMAGE AND BODY IMAGE
PERCEPTIONS IN AUSTRALIAN WOMEN
F. D’Arcy-Tehan1, G. Sitharthan2
1
Graduate Program in Sexual Health, University of Aarhus Sydney,
2
Graduate Program in Sexual Health, University of Sydney, Sydney, NSW,
Australia
This Internet-based study investigated 783 Australian women’s experiences with and attitudes about female genital cosmetic surgery (FGCS).
This study also assessed the relationship between aspects of genital
image and body image, including appearance satisfaction and body and
genital image self-consciousness during sexual activity. The aim of this
study was to investigate women’s experience with and attitudes about
FGCS. This would be achieved by investigating how body image and
genital image may influence attitudes about FGCS among women who
are not currently undergoing these procedures.
Results: Figures indicate that in the bedroom many women
experience a high frequency of appearance-based distracting
thoughts about their body (53%) and their genitalia (75%). Results
also found that 47% of women would consider having some form of
FGCS in the future. This figure indicates a very high proportion of
women who are not satisfied with their genitalia would consider
surgery.
The research shows the importance of considering genital image as
well as body image in conceptualizing women’s sexuality. The research
demonstrates an association with cognitive distraction during sexual
activity due to physical self-consciousness of negative body image and
negative genital image perceptions. An important implication of the
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study is that women with poor genital image can potentially have
unnecessary and harmful surgery. Solutions other than surgery need
to be considered such as debunking myths; genital education about
diversity; and addressing negative cognitive distortions. Body image
programs also need to be expanded to include genital image awareness
to help girls and women deal with genital anxieties.
243
FACILITATED SEXUAL ACTIVITY FOR
PEOPLE WITH PHYSICAL DISABILITIES
P. Green1,2,3
Sexology, Curtin University, 2Secretary, Western Australian Sexology
Society (WASS), 3Sexuality Education & Counselling, Sexuality &
Relationship Therapy Centre, Perth, WA, Australia
1
The purpose of this research was to investigate the challenges People
with Physical Disabilities (PWPD) face in sexual expression and to
further establish how they can be aided in achieving sexual pleasure
via Facilitated Sexual Activity (FSA). Encapsulating a working definition of FSA for PWPD required exploration of the legalities and ethics
involved in such assistance, professionals and assistants duty of care
and rights, consumers rights, access and resources available to act on
their basic human right of sexual expression.
Information was gained through a modified Delphi research method
utilising a critical literature review, semi-structured interviews and
follow up surveys with experts in disability and sexuality to inform the
discussion of issues and strategies of FSA and how this could be
achieved for PWPD.
The results revealed a definitive lack of services and options available
for PWPD according to both the professional and personal experts in
this area. The data indicates that most PWPD want to express their
desires to an aide or therapist in hope that they may be assisted in
sexual activity such as social desires or creating a personal environment
to achieve pleasure or arranging paid sexual services.
This in-depth, small cohort and rich descriptive analysis research on
the phenomena of FSA showed PWPD are assisted in most aspects of
their humanity however rights to sexuality expression often need to be
negotiated. Service providers such as aides and therapists require more
education and understanding to be able to incorporate facilitation into
an everyday aspect of service provision.
244
MUBOBOBO: WOMEN HAVE NO SEXUAL
FANTASIES IN THEIR SLEEP
C. Gwandure
Psychology, University of the Witwatersrand, Johannesburg, South Africa
Mubobobo is a belief among traditional Shona people of Zimbabwe
that women cannot have nocturnal emission in their sleep. This study
explored traditional Shona women’s experiences of mubobobo from an
ethnopsychological perspective. Participants were three men who
were alleged to be the perpetrators of mubobobo and three women
who claimed to be the victims of mubobobo. The men and women in
this study were not related or involved in litigation relating to mubobobo. In fact, the presented cases in this study were isolated individual
experiences of mubobobo. In-depth interviews were held to assess the
views of participants who were embroiled in the mubobobo controversy
as perpetrators and victims. A thematic content analysis of the narratives of the participants was done to establish the reasonableness
of participants’ convictions about mubobobo in the context of
human sexuality. The findings of the study revealed that traditional
Shona women experienced nocturnal emission like any other women
in the world but due to cultural constraints they could not believe
the excitation of their reproductive system in their sleep as real and
a normal biological process. Furthermore, research on the sexuality
of traditional Shona women could have a special focus on women
empowerment in the context of sexual and reproductive health
education.
245
A DEMOGRAPHIC SURVEY TO IDENTIFY
ASPECTS OF LIFESTYLE, CONDITIONS AND
CHARACTERISTICS OF LONDON
SEX-WORKERS
C.J. Hollins Martin1, G. Munro2, A. Bonner3, C.R. Martin4
1
School of Health, Glasgow Caledonian University, Glasgow, 2Research
Manager, Salvation Army Research and Development Unit, London, 3Kent
Institute of Medicine and Health Sciences, University of Kent, Canterbury,
4
School of Health, Nursing and Midwifery, West of Scotland University,
Paisley, UK
Background: There is a dearth of reports on London sex-workers
lifestyles, conditions and characteristics of living.
Aim: To establish age, nationality, alcohol and drug use, physical and
mental health concerns and whether trafficked or optionally migrated
into sex-work.
Participants: London sex-workers.
Method: A demographic survey integrated 4 data collection
strategies:
(1) An initial mapping exercise of:
(a) welfare, social and health care services accessed by the target
group, and
(b) commercial sex sites,
(2) A telephone survey of premises housing sex-workers,
(3) A review of criminal justice data of sex-worker related arrests, and
(4) face-to-face interviews with sex-workers (n = 21).
Findings: Initial mapping identified 263 services accessed by sexworkers. From the commercial sites, 174 advertising sex-workers were
identified. 100% were of foreign origin. From the telephone survey,
71 premises housing 114 sex-workers were identified (25% British).
Criminal justice data provided information about nationalities of sexworkers and trafficking claims. Out of the 21 interviewees, 7 optionally
migrated and 14 were trafficked into sex-work.
Conclusions: Data evidences sub-cultures within London’s sexworker population. There are overt differences between sex-workers
who:
(1) work off-street,
(2) work on-street,
(3) migrate into the industry,
(4) are trafficked,
(5) have citizenship,
(6) are illegal immigrants,
(7) are adult and consenting,
(8) are minors (<16 years of age),
(9) are remunerated and unrestrained,
(10) held hostage,
(11) are tied to sex-work through drug addiction.
Implications: That support services (police, welfare, social and health
care workers) tailor care to meet individual needs of this population.
246
MIGRATION AND SEXUALITY: A FAITH
BASED ORGANIZATION RESPONSE TO
SEXUAL HEALTH, HIV AND MIGRATION IN
MEXICO
C. Infante1, R. Leyva1, F. Quintino2, N. Gómez3
1
Centre for Health Systems Research, National Institute of Public Health,
Cuernavaca, 2Health Promotion, University of the City of Mexico, Mexico
City, 3AIDS Programme, Sanitary Jurisdiction VII Tapachula, Tapachula,
Mexico
Issues: There is concern that migration is associated with HIV.
However, research highlights the vulnerability of migrants as result of
sexual violence, social and economic inequality. The Mexico-US
migration corridor is transited by 10 million people every year, 16%
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are Central American migrants. In Mexico, there is a network of
shelters “casas de migrantes” (CM) that provide humanitarian assistance to migrants. CM are related to the catholic church.
Description: The National Institute of Public Health has developed
with local AIDS programs and CM a comprehensive strategy on
migrant’s sexual health and human rights. It includes legal assistance,
promotion of condom use, access to HIV rapid tests, and ARVT in
the south and northern Mexican borders. This strategy has proven to
be successful: 40,000 migrants have received information on HIV and
human rights; 4,000 HIV rapid tests have been applied and 150,000
condoms distributed. 90% of migrants have learned something new
on sexual rights and recognize they have had an opportunity to reflect
on their risks and vulnerability.
Lessons learned: We present results of an effective strategy based on
the active collaboration between community faith based organizations,
governmental programs and academic institutions. This approach
allows the empowerment and capacity building of social organizations
providing them with political and social visibility.
Next steps: This strategy has received recognition from the Mexican
and Guatemalan Governments and international agencies, and has
been scaled in seven CM in Mexico. The strategy is currently being
adapted to the context of five frontiers in South America.
247
FEMALE GENITAL MUTILATION: WORKING
PSYCHOLOGICALLY WITH CIRCUMCISED
WOMEN
A. Jones
St Ann’s Sexual Health Service, Barnet, Enfield and Haringey NHS Trust,
London, UK
Female genital mutilation (FGM) is the term given to traditional
practices involving the intentional cutting or partial or total removal
of the external female genitalia (WHO, 1999). This two part study
used both qualitative and quantitative methods. Part one of the study
explored the views and experiences of FGM amongst women who had
undergone the practice. It also explored their views about what clinical
psychologists needed to know and do in order to provide appropriate
services. In this part of the study six participants were interviewed
using a semi-structured interview. The data was analysed using interpretative phenomenological analysis (IPA). Findings indicated that
participants felt that despite there being many reasons given for FGM
none of them justified the practice. Further findings suggested that
participants felt that clinical psychologists needed to; understand how
FGM is accounted for; acknowledge the different views towards the
practice; have knowledge of the many consequences of the procedure
and talk about FGM in a sensitive and non-judgemental manner.
Part two of the study explored the experiences, knowledge and training needs related to FGM amongst clinical psychologists. A survey was
completed by 74 clinical psychologists. The findings indicated that
there was minimal experience of working with FGM related difficulties
amongst participants. Knowledge about FGM and the consequences
of it were also limited. Furthermore, clinical psychologists had received
little training about FGM and many did not feel confident in working
with issues related to the practice. Implications for clinical practice and
recommendations for further research are suggested.
and taboos. Understanding cultural perceptions influencing these concerns will shape more effective health interventions attuned to local
models of sexual illness.
Design: Exploratory.
Methods: The ways in which male sexual attitudes shape and inform
sexual health concerns and health seeking behavior was studied among
39 Bangladeshi men (ages 17–29). 15 informal and formal health care
providers were also interviewed. Qualitative tools included: focus
group discussions, free-listing, ranking and in-depth interviews.
Results: Male sexual health concerns mostly lie outside the biomedical
lens, and are concerned with locally defined concepts of “masculinity’.
Most men worried about their penile anatomy, sexual performance
skills and semen loss. In particular, uncontrolled nocturnal emissions
was perceived as causing weakness, deemed harmful to health, was
linked with poverty, malnutrition, and ‘decreased male sexual power’.
Traditional health providers suggested local treatments ‘to cure’ the
problem, thereby reinforcing the belief that semen loss is a significant
male sexual health concern.
Conclusion: Anxieties over semen loss result from culture-bound
beliefs, which are concerned with semen and its relationship to health
via spiritual and physical means. Men who lose semen enter a ‘weakened state’, preventing them from both working and sexually pleasing
their partners. Traditional providers, pornography and friends were all
sources of inaccurate information. A ‘male-centered approach’ in
health services, sensitive and knowledgeable regarding local terminology, cultural perceptions and taboos will have an important impact on
the sexual health of Bangladeshi men.
249
CHILDREN’S SEXUAL HEALTH. A
DEVELOPMENTAL APPROACH TO SERIOUS
SEXUAL PROBLEMS AMONG ADOLESCENTS
AND ADULTS
T. Langfeldt
Institute for Clinical Sexology and Therapy, Oslo, Norway
Considering adult sexual behaviour as independent of what happens
during childhood has put children’s sexual health in the shade. Children’s sexual rights to develop their heterosexual and homosexual orientation into an identity without shame and anxiety and for instance
not become a sex offender have been given little or no attention in our
society. Problems related to attachment and the early development of
sexual identity need to be focused both clinical and scientifically.
This presentation will illuminate how recent studies can give an idea
about how childhood sexual development, attachment and sexual orientation plays an important role in forming and developing sexual
attraction and identity, and further implications for sex education and
therapy.
250
“EXPANDING ACCESS TO INFORMATION
AND SERVICE TO KEY POPULATION (IDU,
SW, MSM AND PLHIV)”
S. Natarajan1, K. Apte2, V. Koliwad3
FPA India, 2Programme Implemenation, FPA India,
Mumbai, India
1
248
SEXUAL HEALTH IS A REAL MAN’S ISSUE:
PERCEPTIONS OF SEXUAL HEALTH
CONCERNS AMONG YOUNG BANGLADESHI
MEN
D.G. Jones1,2
1
Canadian Mental Health Association, Ottawa, ON, Canada, 2BRAC
University, Dhaka, Bangladesh
Introduction: Male sexual health concerns are culturally specific and
require comprehensive health services sensitive to local terminology
144
3
CEO, FPAI,
Gender is a flowing concept. The gender identity is closely linked with
power and violence, although women are understood to be most violated upon, it is the third gender or Transgender who are the most
disempowered group across gender identities.
FPA India implemented a very unusual project on working with
sexual minorities like MSM and Transgender; the main goal being
empowering the key groups to fulfill and exercise their sexual and
reproductive rights. It was implemented at Chennai (TN); Kohima
(Nagaland); Kolkata (WB) and Mumbai from 2008- 2010.
The project has involved over 20,000 key populations, providing
SRH services to over 2300 KPs.
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Main learnings:
1. Transgender (TG) are most vulnerable and disempowered among
all KPs.
2. TGs suffer most brutal and severe sexual violence
3. The vulnerability of a TG to HIV, STI and other outcomes is
closely linked to their family support, self image and self esteem.
4. TG have different Sexual and reproductive health needs and it
additional clinical as well as attitudinal training for the doctor and
the whole clinic team to address their health needs.
The project has indeed made an impact on people’s life. One of the
income generation skills Beneficiary said that “I would have still engaged
in begging and sex work had it not been for the timely involvement with
FPAI work. Now I am earning and helping people like me to come out of
vulnerability.” He is working as a technician in one of the Nokia
showrooms.
251
RURAL COMMUNITIES COLLABORATIVE
YOUTH-FOCUSED HIV PREVENTION IN
EDO STATE, NIGERIA
F.I. Omorodion1, E. Akpede2, A.G. Onokerhoraye2, E. Maticka-Tyndale2,
U. Anucha2, N. Dlamini2, B. Arnold2, I. Luginaah2, K. Eghafona3,
F. Okoro2, U. Oni2, N. Essiet2, F. Okonofua2
1
University of Windsor, Windsor, ON, Canada, 2Center for Population,
Environment and Development, 3Centre for Population, Environment and
Development, Benin City, Nigeria
Objectives: This paper describes a community participatory research
using AIDS competent community (ACC) framework to deliver and
build AIDS competent communities. The authors will present longitudinal data from 10 communities, where community-based activities
were facilitated by young graduates serving in a one-year mandatory
service referred to as National Youth Service Corp (NYSC)
programme.
Methods: This paper uses two sets of data. First, we examine and
analyze field diaries, reports and observations using content analysis.
Second, we use pre and post survey data to examine the influence of
corpers’ activities in the ten communities and to segregate those
factors that account for the challenges and successes of the activities
in the communities. We also proffer explanations based on community
profiles on why some communities are showing significant changes in
some of the ACC components than other communities.
Results: Data show that building partnerships and working with a
mixed population of both adults and youth in undertaking HIV prevention activities are more likely to result in building solidarity
between youth and elders. This solidarity further empowers rural
youth to build youth friendly centers, abstain from sex, use condoms,
and to promote youth willingness to be and be tested for HIV virus.
In addition, power differentials based on gender and age are challenged
and navigated by youth, resulting in girls practicing secondary abstinence and accepting condom use.
Conclusion: Future HIV prevention programmes in rural Nigeria
needs to adopt a participatory approach that gives local people ownership and promotes sustainability.
252
FREEDOM OF SEXUAL ORIENTATION AS A
SEXUAL RIGHT IN NEED OF LEGAL
PROTECTION: A CUBAN STUDY
R.M. Pereira
CENESEX, Havana, Cuba
discrimination/violence. It identified: current factors which induce
harm to sexual- mental health- in need of legal proscription; historical
linkages of events pivotal in the making of homo-negativity as a universal legacy; the intersection of the use of the pedagogical effects of
the law in the promotion of mental/sexual health—rights; the expanding trend in the enactment of national and international law—that
proscribes discrimination based on sexual orientation, and acknowledges full “sexual citizenship”.
A major outcome was the making of a documentary film that exposes
part of the findings. It is aimed to be used as an educational- awareness
building tool in support of the work developed by CENESEX to
sensitize diverse sectors of Cuban society, de-construe all false learning
and prejudice towards diverse expressions of non-heterosexual conducts and images. It underlines the need of a Constitutional- legal
reform—to protect such sexual rights.
Homo-negativity and heterosexism are identified as existing harmful
cultural barriers, in current Cuban society, obstructive to the comprehensive development of the health promotion policy of the State
geared to ensure the “highest possible index of health of the
population”.
253
EXPLORING EXPERIENCES OF SEXUAL AND
GENDER BASED VIOLENCE AMONG MEN
WHO HAVE SEX WITH MEN-SEX WORKERS
IN MOMBASA, KENYA
M. Syengo1, J. Okal2, N. Kingola1, C. Khavetsa1, A. Gathumbi3,
H. Doyle4, M. Temmerman5, S. Lucthers5
1
Social Science Research, International Centre for Reproductive Health,
Mombasa, Kenya, 2HIV/AIDS Operations Research, Population Council,
3
Health and Rights, Open Society Initiative for East Africa, Nairobi, Kenya,
4
Sexual Health and Rights, Open Society Initiative, New York, NY, USA,
5
Ghent University, International Centre for Reproductive Health, Ghent,
Belgium
Background: Sexual and gender based violence (SGBV) targeted at
men who have sex with men—sex workers (MSM-SW) is a potential
risk factor for HIV infection. Little is being done with regards to
intervention centred on MSM-SW and law enforcing agencies. Examining strategies and interventions to reach law enforcers on SGBV in
the community is vital in scaling up prevention programs for MSM-SW.
Methodology: Two focus group discussions (FGD) were conducted
with MSM-SW in Mombasa, between June and July 2009, with seventeen men aged between 17 to 26 years. Participants of different ages,
sexual identities and workplaces were purposively recruited during a
cross-sectional survey examining relationship between sex workers and
law enforcers in Mombasa.
Results: Findings indicate that MSM-SW experience rampant abuse
and violence from police. All respondent cited gross violation of their
rights from the hands of law enforcers. Incidences of arbitrary police
arrest, physical force and detainment were common. Participants
reported being arrested on trumped up charges and bribing their way
to freedom. Cases of assault, homophobic rape and being robbed of
their belongings were reported, having unprotected multiple sex with
different officers was common. Verbal abuse was cited by many respondents, some alluded being called “mume malaya” male prostitute by
police officers. MSM-SW expressed fear and reluctance to seek legal
redress against their perpetrators of violence.
Conclusion: Homophobic rape and unprotected sexual episodes put
both police officers and MSM-SW at risk of HIV acquisitions. SGBV
prevention interventions need to increase focus on MSM-SW and law
enforcers.
The lack of Constitutional and legal regulation of the right to freedom
of sexual orientation is posited as a conditioning factor limiting the
existence of the right to sexual health, to the effective protection of
the rights to free development of personality, and individual liberty.
The outcomes evidenced stereotyping of homo- and/or bieroticism
amidst popular imagery in Cuban society, conducive to expressions of
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146
254
256
THE DESIRE AND MOTIVATION FOR
HOMOSEXUAL PARENTHOOD: COMPARING
NORTHERN AND SOUTHERN ITALY
BARRIERS TO THE DELIVERY OF SCHOOLLINKED SEXUAL HEALTH SERVICES IN THE
UK: THE INFLUENCE OF SOCIETAL AND
SCHOOL VIEWS ON YOUNG PEOPLE’S
SEXUAL HEALTH
E. Todaro, R. Rossi, C. Simonelli
Instituto Sessuologia Clinica, Rome, Italy
Objective: To compare the desire and motivations towards parenthood amongst a group of homosexual residents in northern and southern Italy and to evaluate possible differences made by different
socio-cultural contexts. In addition, the Reflection on reasons and the
Intensity of the Desire in both groups are investigated.
Method: The research involved 166 homosexuals (105 M; 61 F) aged
between 19–55 years (average 31 years; SD 8.4), 100 from northern
Italy and 66 from southern Italy. The participants filled out a questionnaire evaluating: socio demographic data, sexual orientation, Parenthood Motivation List (categories: Well-Being/Social Control/Happiness/
Identity/Parenthood/Continuity), Reflections on reasons for wanting a
child and the Intensity of the Desire. Statistics were performed using
SPSS (version 15.0).
Results: Preliminary results showed that, of 166 subjects, 67.5%
expressed a desire for parenthood (69% north, 65% south) and, among
these, 61.6% declared the intention to realize this desire in their lifetime. In both variables and for both groups, women and couples report
higher rates. Regarding motivations for parenthood, Happiness is the
most important category (average 6.47; range 0–9), opposed to Social
Control (average 3.21; range 0–9) considered the less relevant. The
Intensity of Desire is estimated higher in southern Italy (average 2.63;
range 1–3). A comparison with a previous research will be presented
on a group of homosexuals selected from central Italy.
Conclusions: The first results confirm the literature on homosexual
parenthood, highlighting the significant relevance of the socio-cultural
context in influencing the parenthood desire.
ORAL PRESENTATION
E. Formby1, J. Hirst1, J. Owen2, M. Hayter3
Centre for Education and Inclusion Research, Sheffield Hallam University,
2
SCHARR, 3School of Nursing and Midwifery, University of Sheffield,
Sheffield, UK
1
Recent UK policy has placed increasing emphasis on access to sexual
health services for young people (DfES 2007a, DfES 2007b). In this
context, this paper presents findings from a study on school-linked
sexual health services in the UK (Owen et al 2010). The project set
out to map the variety of current provision across England, Wales,
Scotland and Northern Ireland, via 51 telephone interviews with
service coordinators and 205 self-completion questionnaires with
school nurses. It also involved a systematic review of published evidence on the effectiveness of school-linked services.
Our findings highlighted the range of services available, from
minimal ad hoc school nurse provision to comprehensive, multiagency services. We also identified a number of barriers to the development and successful continuation of services, including funding issues,
unsupportive school leadership, and ambivalence to young people’s
sexual health in the wider social context, leading to specific problems
with local media and/or parental resistance. This—combined with
adherence to school ‘ethics’ or ‘principles’—could result in school
policies and practices physically preventing young people accessing
services, or restricting marketing to advertise services, often in direct
opposition to the work of health professionals. In addition, service
providers reported practical concerns related to rural locations and
public transport considerations. At a time when the coalition government’s approach to sexual health services is (as yet) unclear, these data
raise issues about the principle of equality of service access for young
people.
TRACK 7
257
255
ETHICAL DILEMMAS WITH SENSITIVE
TOPICS IN QUALITATIVE RESEARCH
ISLAMIC SEXUAL COUNSELING IN FAITH
BASED ORGANISATIONS (FBO:S)
A. Carlbom
Faculty of Health and Society, Malmo University, Malmo, Sweden
During the last decades Muslims in Europe have built their own institutions for counseling in family and sexual matters. The services are
provided by both web-sites and family counselors in, for example,
mosques and other Faith Based Organizations (FBO:s). This paper
takes a look at what kind of dilemmas this counseling regards as problematic for Muslims trying to cope with the social situation in Europe.
The discussion is grounded in a series of interviews with an imam and
family counselor in one the biggest mosques in Scandinavia. What
kind of dilemmas related to sexuality and Muslim social relations does
he confront in his everyday work? How does he deal with these problems in a social context characterized by conflicting values between
Muslim conservative ideals and Western liberal ideals in terms of sexuality and family relations? A preliminary conclusion is that Muslim
counselors are trying to maintain the boundaries stipulated by sharia
by a re-interpretation of what this law regards as lawful sexual and
social conduct.
B.G. Hughes
Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
Aim: This paper investigates the challenging ethical considerations
that arise when researching the issue of ‘sexual addiction’ among those
who self-identify as ‘sexual addicts’.
Methodology: Adopting a primarily phenomenological approach, a
literature review was undertaken and focus-groups involving ‘sexual
addicts’ and treatment providers were used to identify potential ethical
concerns.
Results: Specific ethical challenges regarding recruitment, rapport,
confidentiality and boundary management were identified. An ethical
framework was devised to address these concerns.
‘Sexual addicts’ are a vulnerable group, difficult to recruit and challenging to interview. In order to lessen their vulnerability the target
population was confined to adults, (18 years and older) who selfidentify as ‘sexual addicts’ and who are in a process of recovery.
In order to access the participant’s story it is essential to build up a
level of rapport to create trust. Occasionally this may lead to false
expectations regarding the researcher-participant relationship. The
use of clearly defined boundaries is vital.
Participant disclosure is the essence of phenomenological research.
During fieldwork, dilemmas regarding pornography, child abuse and
HIV status are disclosed. Guided by standard legal and ethical requirements the researcher acknowledges the limits to confidentiality and
acts accordingly.
Qualitative interviewing involves listening empathically to the participant’s story. This dynamic mirrors the relationship between the
client and therapist and can be potentially confusing for participants
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currently receiving therapy. Understanding and clarifying this role
distinction is required.
Conclusion: A rigorous ethical framework is necessary in undertaking
sensitive research concerning sexuality.
258
TO KEEP SECRETS OR NOT TO KEEP
SECRETS; THAT IS THE QUESTION!
ETHICAL CONSIDERATIONS IN SEX
THERAPY WITH COUPLES
H. Miletski
Private Practice of Sex Therapy, Bethesda, MD, USA
When working with couples, many Sex Therapists tend to see each
partner individually to obtain information about his/her sexual history
and to assess his/her motivation for sex therapy. During the course of
meeting individually with partners, secrets the other partner is unaware
of may be revealed. This situation can pose difficult ethical questions
for the sex therapist.
This presentation will address these ethical dilemmas, will outline
three options for dealling with such a situation, and explore the pros
and cons of each possible therapeutic option. Cases from the presenter’s own experience will be used as examples, and ideas on how to
avoid such ethical dilemas will be discussed as well.
When confronted with secret information divulged by one partner
of a couple, the sex therapist has three main options in managing this
situation:
(1) Let the couple know from the start that all information has to be
shared among the partners and thus no secrets will be kept between
partners.
(2) Decide which secrets to keep and which secrets should be shared,
and if they should be shared, urge the partner to disclose.
(3) Keep all secrets confidential.
Each of these options has its advantages and disadvantages, and they
will be discussed in the presentation.
The purpose of this presentation is to bring these ethical dilemas
and their intricacies to the forefront of our awareness, and hopefully
begin a discussion among colleagues about this very important ethical
issue.
259
CULTURAL DIVERSITY AND SENSITIVITY IN
SEX THERAPY
D.S. Ribner
Sex Therapy Training Program, School of Social Work, Bar-Ilan University,
Ramat Gan, Israel
I am the author of the chapter entitled “Cultural diversity and sensitivity in sex therapy” which will appear in the upcoming second edition
of New Directions in Sex Therapy, edited by Dr. Peggy J. Kleinplatz.
For the 2011 WAS conference, I am proposing a one hour workshop
to help sex therapists to achieve a more finely honed awareness of the
importance and place of cultural sensitivity in our clinical work.
The workshop will focus initially on four elements:
• Being aware of the existence of differences—the willingness to see
our clients and ourselves on cultural contexts.
• Having knowledge of the client’s culture—seeking accurate information and avoiding myths, stereotypes and generalizations.
• Distinguishing between culture and pathology in treatment—
understanding the subtleties of cultural determinants for sexual
behaviors which some may find unfamiliar or disturbing.
• Taking culture into account in therapy—sufficient familiarity with
cultural norms and expectations to choose acceptable, effective
interventions.
In addition, the workshop will look at the following issues: inclusive
language; the efficacy of ethnic matching (attempting to find a thera-
pist with similar ethnic background to that of the client); and acknowledging that both therapist and client can be the “other.”
Finally the workshop will offer specific guidelines for therapists
working with various ethnic groups and authority figures within those
groups.
260
DEVELOPMENT AND IMPLEMENTATION
OF GUIDELINES FOR STI AND STD
PREVENTION IN GERMANY
C. Winkelmann1, H. Langanke2
1
Federal Centre for Health Education, 2GSSG, Charitable Foundation
Sexuality and Health, Cologne, Germany
Background: The prevention of STI/STD is an important part in
promoting sexual health. Germany is well known for its advanced HIV
prevention which is being led by many different entities, e.g. federal
and state institutions, NGOs and many more. However, there has been
no consent about the underlying principles of STI prevention that
should be accepted to by everyone in the field.
Method: In December 2007, a task force was formed with more than
a dozen German experts from different fields and backgrounds bringing together physicians, social scientists and researchers from various
institutional backgrounds. This task force met nine times and communicated continuously through e-mails. It revised international literature incl. WHO and WAS publications and developed a tailor-made
draft for German Prevention Guidelines. The Guidelines were presented and discussed at German conferences.
Results: The work of the group culminated in six central guidelines.
They come together with explanations. In 2010, the Guidelines were
endorsed by the German STD Society. They were published by the
German Robert-Koch-Institute (Epi Bull No. 35) as well as by the
national magazine of pro familia (IPPF-member).
Conclusions/recommendations: The Guidelines are to be used in
trainings and workshops for prevention experts and should be a
common basis for prevention efforts. Thus they will contribute to the
improvement of sexual health for people living in Germany. The
Guidelines can easily be adapted to other countries, as they are not
perceived as static but as a dynamic framework for improving STI/
STD prevention and sexual health in general.
ORAL PRESENTATION
TRACK 8
261
DEPRESSION, ANXIETY, MARITAL
ADJUSTMENT AND SEXUAL DYSFUNCTION
IN TURKISH WOMEN HAVING PARTNERS
WITH AN İNFERTILITY DIAGNOSIS
E. Orhan1, F. Karadağ2, C. İncesu3, I. Akduman4
1
İ stanbul IVF and Women Health Center, 2Maltepe University, Faculty of
Medicine, 3Acıbadem University, Faculty of Medicine, 4Maltepe University,
Faculty of Science and Literature, Istanbul, Turkey
Objective: Infertility is a stressful life event and diminish the sexual
and marital function of couples as well as cause depression and
anxiety123. The aim of this study is to investigate the impact of partners’ diagnoses of infertility on sexual function, marital adjustment,
anxiety and depression levels of Turkish women.
Method: 56 women between the ages of 24–45 having partners with
an infertility diagnosis were included in this study. And the control
group was consisted of 48 married women having at least one living
child. Data of the research was obtained by using, FSFI, BDI, STAI
and EUO.
Results & conclusion: The sexual desire scores of the women with
infertile partners were found to be significantly higher than the scores
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of the women with fertile partners. While the rate of sexual dysfunction in the axis of lubrication and pain was higher in the experimental
group women in the control group had more sexual desire problems.
Higher sexual desire in the experimental group may be evaluated as an
artificial reflection of the conception desire of those women3. Surprisingly, the 94.5% of the women in the experimental group and all of
the women in the control group had at least a diagnose of sexual
dysfunction. The findings of this study indicate that the sexual dysfunction in Turkish women is common and higher than expected.
While the women of experimental group were feeling more depressed
and anxious, not surprisingly,the marital adjustment level of the
couples in the control group was higher.
262
VIEWS OF MEN TO THE VIOLENCE
AGAINST WOMEN IN TURKEY
A. Kiliç1, M. Seven2, A. Akyuz2, T. Yavan2
1
Gülhane Military Medical Academy, School of Medical, Denizli, 2Gülhane
Military Medical Academy, School of Medical, Ankara, Turkey
Purpose: The purpose of this study was to examine attitudes toward
violence against women in Turkısh men.
Methods: The descriptive study was carried out in 144 men in Turkey.
“Descriptive Information Questionnaire” was developed by the
authors and “The Scale for Attitude Towards violence aganist women
(ATVW)” were used to collect data.
Results: The mean age was 29.48 ± 4. 939 years and 81,7 % of the
particiants were single men. The mean of ATVW total score was 57.59
± 1.106. Forthy-four percent % all of all participating men had ATVW
score above cut-off point. The result reflects more traditional beliefs
and higher levels of acceptability for male violence aganist women.
Sixtyfour percent of the men believe that violence is acceptable in
certain situations. Thirty-one percent of men reported that it is also
acceptable to force their wives to have sex. Age of the participant is
found to have effect on their views to the violence aganist women. The
variables such as education level, employment status, experienced violence during childhood did not affect views of men to the violence
against women.
Conclusions: Violence such as sexual, emotional and verbal is common
and especially considered to be “normal” by men. Therefore, men have
an important role in stopping or resolving violence. They must be
involved in efforts to increase awareness among men about violence
against women. It is also important to carry out mass public education
campaigns and the possible involvement of men in ending violence
against women.
263
ANCIENT ROMAN SEXUALITY
K. McGrath1, L. Mayberry2
Kalamazoo College, Kalamazoo, MI, USA,
Technology, Perth, WA, Australia
1
2
Curtin University of
This presentation will provide an overview of sexuality, including
sexual morals, within the 1400 years of ancient Roman civilization.
The pervading cultural standards, including a strong emphasis on
dominance within a strict social hierarchy, were central to the Roman
ideals. The influences of this focus on socially dominant relationships,
especially in regards to sexual violence, will be explored. The role of
sexual penetration within this structure was seen as key, especially
when examining the Roman social norms regarding homosexuality.
The ideal conceptions of Roman men and women and the sexual
double standards, are also examined. Roman men were held to ideals
of strength, dominance, and austerity, but not necessarily sexual
restraint, whilst women were expected to be chaste and were often
treated as property. This is exemplified by an examination of marriage
and family customs. Finally, the infamia (‘the undesirable’) will be
discussed. The infamia were considered by Roman society to be
unclean and their presence presented a contrast to the sexual morals
of the time.
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264
AN EXPLORATORY STUDY OF WOMEN
INVOLVED IN PROSTITUTION AND THEIR
PSYCHOSOCIAL EXPERIENCES OF THE
IRISH HEALTH CARE SERVICE
L.-A. Sweeney1, M. Molcho2, S. Nic Gabhainn1
1
Health Promotion Research Centre, National University of Ireland Galway,
2
Health Promotion Research Centre, National University of Ireland NUI
Galway, Galway, Ireland
Ireland has no direct guidelines in place for Health professionals
addressing women’s holistic needs in respect to prostitution. Service
development is poorly distributed nationally to accommodate the
overall health needs of this target group. Ireland has progressed slowly
from a catholic corporatist state to a hybrid/neo liberal state, having a
direct impact on women involved in prostitution and those attempting
to provide services within the health service.
This study identifies barriers that prevent women in prostitution
from availing of health services. It examines the experiences of women
in prostitution and in addition explores the attitudes and policies of
agencies providing these services. A biographical narrative approach in
conjunction with a tailored voice- centered relational model of analyses
was used. A total of 15 women actively involved in prostitution in the
west of Ireland partook in in-depth interviews. They discussed; how
they are received by practitioners? Are their needs being met holistically? What are the gaps in the health system? The women conveyed
these experiences through life stories and accounts which gave a
broader understanding of their psychosocial experiences.
This qualitative study addresses the experiences of the women themselves in prostitution as users of the Irish health services, and considers
implications for and to inform the development of a holistic, multidisciplinary healthcare service for women engaged in prostitution. The
findings suggest a reevaluation of policies and laws directing relating
to prostitution and the sex industry and indeed gender issues which
impact on a patriarchal, biomedical practice approach to healthcare in
Ireland.
265
EROTICISM: THE PARADOX AND SEX
THERAPY
A. Tabatabaie, Z. Mofatteh
University of Cambridge, Cambridge, UK
Eroticism can be defined as the process through which sex becomes
meaningful. While eroticism is as old as human history, given the
privacy of erotic thoughts and feelings, added to the widely-extensive
taboos associated with sexuality, there is little written academically
regarding its significance in our sexual lives and its application in sex
therapy. The following review will thematically review the literature
in this regard. It will start by defining eroticism and briefly contextualising it in the historical, social and cultural context. It will then move
on to look at three major schools of thought in relation to eroticism
[1]. Firstly, ‘pathology-oriented’ approach which proposes a narrow
path for normal erotic development that hardly anyone fully attains it;
secondly, ‘neat-and-clean’ approach which proclaims what is required
for a satisfying sex life is the removal of inhibiting factors such as
anxiety, guilt or unrealistic expectations; finally, the ‘paradoxical’
approach which acknowledges and embraces the contradictory and
dual nature of erotic life. It recognises that anything that inhibits
arousal (e.g. anxiety or guilt) can, under different circumstances,
amplify it. Choosing the paradoxical approach as probably a more
realistic and comprehensive explanation for erotic feelings and urges,
the significance of this approach in sexual and relational functions, as
well as developing dysfunctions will be discussed. The final section of
the review will give some practical suggestions on how to utilise Eroticism and apply erotic principles in the context of sex therapy.
[1] M
orin, J. (1995). The erotic mind. New York: HarperCollins
Publishers.
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266
POSTER PRESENTATION
A TWO YEAR SURVEY OF AN E-MAIL AND
TELEPHONE ADVISORY SERVICE FOR MEN
WITH SEXUAL PROBLEMS
TRACK 1
J. Tomlinson1, L. Fernandes2, K. Wylie3
1
Department of Urology, Royal Hampshire County Hospital, Winchester,
2
Sheffield Hallam University, 3Porterbrook Clinic, Sheffield, UK
Introduction: Sexual problems are common in the community. The
under-reporting of such problems mandates alternative methods to
obtain a true perspective of the prevalence of sexual dysfunction.
Aim: To assess and investigate the concerns, age and nationality of
male users of an electronic and telephone helpline for 2009–10.
Methods: Detailed records were kept of all emails and telephone calls
to the helpline including administrative and clinical queries. Clinical
calls and some emails were answered by the administrator; the majority
of emails were answered by a physician. This presentation will deal
with the users who emailed for assistance with male sexual dysfunction
(n = 673).
Results: The helpline received 6142 calls over two years, including
administrative and media enquiries. Men accounted for 88% of the
callers regarding sexual dysfunction. Erectile dysfunction accounted
for 68% of the complaints by men using the e-mail service. Rapid
ejaculation, loss of sexual drive, genital problems and masturbation
worries were other concerns received. A large number of men from
the Indian sub-continent used the email service, mostly for rapid ejaculation and masturbation worries, many related to arranged marriages.
Significant correlations were identified between the types of sexual
dysfunction and the age and ethnicity of the men who presented with
them.
Conclusions: We confirmed that the commonest sexual complaints in
men were erectile dysfunction and loss of sex drive.
267
WORKING CREATIVELY IN SEX AND
RELATIONSHIP THERAPY
M. Williams
Faculty of Health and Social Care, Canterbury Christ Church University,
Medway, UK
The aim of the workshop is to enable participants to explore aspects
of how the creative arts can be used therapeutically when working with
couples that have sex and relationship problems.
There is a rapidly increasing recognition of the positive impact the
Creative Arts, Creativity and Art therapies have on people’s health.
The concept of creativity in sex and relationship therapy is not new;
Crowe and Ridley recognised the use of sculpting and role play in
2002. However, evidence on the outcome of creative arts in sex and
relationship therapy is limited although it has a strong and ever
increasing theoretical basis in diverse disciplines as attachment theory
and neuroscience.
This workshop will be experiential and will introduce the participant
to surprises, unlikely twists, and the possible potentials that working
with modelling Clay and Movement/Dance can have.
Explorations will include:
• How such non- verbal communication can offer relationship insights
to both the clients and the therapist.
• How such interventions can be used to enhance couple
communication.
• How reciprocity and balance can be experience from a different
dimension.
• Permission to have fun and use imaginative ways to solve
problems.
268
EFFECTS OF MOBILE PHONE RADIATION
ON SERUM TESTOSTERONE AND SPERM
CELL MORPHOLOGY IN WISTAR ALBINO
RATS
S.A. Meo1, A.M. Al-Drees2
1
Department of Physiology, College of Medicine, 2King Saud University,
Riyadh, Saudi Arabia
Objectives: The widespread use of mobile phones has been going
sky-high over the past decade. The aim was to investigate the effects
of Electromagnetic Field Radiation generated by mobile phones on
serum testosterone levels and sperm cell morphology in Wistar albino
rats.
Methods: A total of 34 male Albino Rats [Wistar Strain], 2 months of
age, weighing 150–160 gm were used for the experiment. Animals
were divided into three groups. The first group containing 6 rats was
assigned as a control group. The second group containing 14 rats was
exposed to mobile phone radiation for 30 min daily and third group
containing 14 rats was exposed to mobile phone radiation for 60 min
daily for the total period of three months. At the end of experimental
period, blood was collected and serum testosterone was analyzed and
morphological changes were observed under a light microscope.
Results: Exposure to mobile phone radiation for 60 minutes / day for
the total period of three months significantly decrease the serum testosterone level and causes hypospermatogenesis 18.75% and maturation arrest 18.75% in the testis of albino rats compared to their
matched control.
Conclusion: Long-term exposure to mobile phone leads to reduction
in serum testosterone levels and cause hypospermatogenesis and maturation arrest in the spermatozoa in the testis of Albino rats. Based on
this animal model study, such effects are also expected in humans,
therefore, it is suggested that unnecessary long term and / or excessive
use of mobile phones should be avoided.
269
THEORY OF THE PHYSIOLOGICAL VARIANT
APPLIED TO SEX (GENDER) AND SEXUAL
FUNCTION
F.J. Bianco, B. Baena, R. Cardenas, E. Pazmino, M. Guache, S. Guevara,
P. Correa
Medical Sexology, CIPPSV. Postgraduated Center, Caracas, Venezuela
The study of the Sex(Gender) Development Process and the Sexual
Function Process led us to formulated that human been are able to
vary which is a CONDITION meaning a natural characteristic that
allow to change, to be different; a second natural characteristic is the
CAPACITY OF DISCRIMINATION which allow the human being
to choose or develop an specific change, response or path of behavior.
When we apply The Theory of the Physiological Variant to the Sex
(Gender) Development we are able to understand the Determination
and Differentiation Phases and its results. At Sexual Function Process
the variety of characteristics of the stimulation Phase and the Response
Phase are explained in a very simple manner. The Time after being
recognize as a independent variable is understood in a operative way.
The date is supported by audiovisual diagr.
This workshop is suitable for therapists who work with couples. Participants should be prepared to wear loose clothing, model with clay
and have some fun. The workshop will last between 1.5–2 hours.
Maximum number of participants 20.
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ASSESSMENT OF SEXUAL FUNCTION OF
GYNECOLOGICAL PATIENTS
I. Briedite1, G. Ancane2, U. Teibe3
1
Riga East University Hospital, Department of Gynecology, 2Riga Stradins
University, Department of Psychosomatic Medicine and Psychotherapy,
3
Riga Stradins University, Department of Physics, Riga, Latvia
Introduction: Sexual dysfunction (SD) ranges from 19% to 50% of
the population. Health care providers, including gynecologists, are not
comfortable or competent to appropriately manage these women
patients.
Aim: To assess the sexual function of gynecological patients, to find
out role of gynecologist. Should SD be included in gynecologic
examination?
Method: Special patient inquiry form was created-36 questions. 300
women (18–50 years old) were recruited from Gynecology clinic to
participate in study. Data were processed using SPSS Statistics 17.0
program.
Results: Only 40% were ever asked about their sexual life by gynaecologist. Source of information about sexual function was books and
press (24.8%), followed by internet (23.8%), friends (15.8%) and gynaecologist (15.8%). 70% said they would like to talk about their sexual
life with gynaecologist. 58% had at least one sexual problem at their
lifetime, but only 17.2% of them did seek help; reasons: too embarrassed (35.7%), physician should ask first (21.4%), thought their physician could not help (17.8%). 78% of respondents had sexual relations
during last 4 weeks, most of them 1–2 (33.3%) and 3–4 (28.2%) times,
65.9% had constant partner. Based on FSFQ28 calculations, a significant number of borderline status and SD of the main domains
were found: desire 69.1%, arousal 76.8%, lubrication 69.1%, cognitive
84.7%, orgasm 59%, satisfaction 48.7%, pain 25.7%, partner
12.8%.
Conclusions: SD is a significant problem in gynaecological clinic. A
sexual history should be included in routine gynecological health
assessments, clinicians have an obligation to develop knowledge and
selfawareness to address the topic.
271
IN SEARCH OF MOLECULE FOR
TREATMENT OF MIX PME AND ED
SYNDROM
M.H. Burki1, M. Haq1, M.Z. Mukhtar2, S. Saqlain3
Psychiatry, Sexual Health Institute of Pakistan, Lahore, 2Addiction, AZM
Center, Sagodha, 3Pharmochology, Hijvari Univeristy, Lahore, Pakistan
1
Introduction: Treatment of psychogenic mix ED and PME is highly
problematical assignment. Two disorders have paradoxical relation.
Treatment of PME aggravates ED and vice versa. Thanks to knowledge of neurotransmitters and receptors it is possible to conceive
properties of an ideal drug acting both ways. A drug which is agonist
for 5HT2C and D2 can be effective for mix ED and PME syndrome.
There can be other alternative combination.
Method: Electronic search was made at various database websites to
find out medicines used for ED and PME using key words dopamine
and serotonin agonist, alpha blocker, alpha blocker and serotonin
agonist, opiod and dopamine agonist, alpha blocker and dopamine
agonist. This was followed by study of journals and books describing
neurochemical mechanism of erection and orgasm.
Results: Search did not reveal many studies dealing conjoint problem
of ED and PME. No single drug claimed effectiveness for mix ED and
PME syndrome. Theoretically codergocrine, phentolamine, prozacine,
MDMA, lasuride, trazodone and opium is worth consideration.
Discussion: Transition from PME to ED is not uncommon phenomenon. In most of cases major depression also supervene which contribute to erectile dysfunction. Combinations’ like adding apomorphine
or PDE5 to SSRI, s are being used. Work is needed to evaluate, efficacy of medicines with dual mode of action. Dose adjustments are
required when these drugs are to be used for sexual dysfunctions.
150
Conclusion: Prior to development of hybrid molecule for mix ED and
PME previously existing drugs effecting on sexual functions need to
be tested.
272
ANATOMY AND PHYSIOLOGY OF THE
VULVA: THE FEMALE ORGASM AND
WOMEN’S SEXUAL HEALTH
L. Catania1, V. Puppo2, J. Abdulcadir3, D. Abdulcadir4, O. Abdulcadir1,
G. Puppo5
1
Research Center for Preventing and Curing Complications of FGM/C,
Health Promotion of Immigrant Woman-Department of Gynaecology,
Obstetrics, Perinatology, Human Reproduction, Azienda Ospedaliera
Careggi, Florence, 2Centro Italiano di Sessuologia (CIS), Bologna, Italy,
3
Department of Obstetrics and Gynaecology, University Hospitals of Geneva,
Geneva, Switzerland, 4Resident in Radiodiagnostic Section. University of
Florence, Careggi Hospita, 5Faculty of Biological Sciences. University of
Florence, Florence, Italy
Introduction: Female sexual physiology was for the first time
described in Dickinson’s textbooks in 1949 and subsequently by
Masters and Johnson. The correct anatomy of the clitoris is described
in every human anatomy textbook.
Object: To better understand female orgasm and the changes of the
female erectile organs during the female sexual response.
Method: Review of the literature.
Results: The vulva is localized in the anterior perineal region, it is
formed by the labia majora and vestibule, with the erectile apparatus:
clitoris (glans, body, crura), vestibular bulbs and corpus spongiosum,
labia minora. The erectile structures are the same in females and in
males. The male erection is equivalent to the erection of the female
erectile organs. Grafenberg, in 1950, did not describe a “G-spot”, he
did not report an orgasm of intraurethral glands: this hypothetical area
named G-spot should not be defined with Grafenberg’s name. Physiologically the female sexual satisfaction is based on orgasm and
resolution.
Conclusions: Every woman has the right to feel sexual pleasure. The
female orgasm should be a normal phase of the sexual response cycle
and it’s possible with a correct sexual stimulation in all healthy women.
For women the clitoral stimulation is important to achieve orgasm.
Terms as clitoral/vaginal/uterine orgasm, G/A/C/U spot orgasm
should not be used by sexologists, mass-media and common people.
Clitoral bulbs, clitoral or clitoris-urethrovaginal complex, urethrovaginal space, periurethral glans, genitosensory component of the vagus
nerve, G-spot, terms used by some sexologists, are not accepted or
shared by the Human Anatomy academicians.
273
WIDE RANGE EFFECTS OF OXYTOCIN IN
SEXUAL FUNCTIONING
M.H. Khan1, M.Z. Mukhtar2, M.U. Haq1, S. Naiz3, J. Sujjat4
1
Sexology, Sexual Health Institute of Pakistan, 2Psychiatry, Remedies
International, Lahore, Pakistan, 3Psychiatry, Cumbriab Partnership, White
Seven, UK, 4Psychology, Azm Center, Sargodha, Pakistan
Introduction: Oxytocin exerts broad range of central and peripheral
effects. As a neurotransmitter it has effects on sexual function, intimacy, maternal bounding, feeding behavior, and social memory. It
plays vital role in both arousal and ejaculation. Despite its extensive
involvement in social and sexual aspects it represent under exploited
area in sexology.
Method: An electronic search was made, using different database websites.Key words used were oxytocin, erectile function, premature ejaculation oxytonic agonist and antagonist. It was followed by study of
pharmacological effects factor effecting its release and functioning.
Results: Search revealed that oxytocin has variable functions as neurotransmitter and hormone. Oxytonic receptors can be manipulated to
produce variable psychosexual effects. It plays more pronounced role
in females.
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Discussion: Oxytocin is generally known as love hormone. As it has
affects on social, sensual, and sexual aspects of love. It enhances human
social recognition, promotes intimacy and trust. Stimulation of oxytonic receptors in PVN of hypothalamus induces erection. It modulates androgen level by converting testosterone into dihydrotestosterone.
It improves contractility of seminiferious tubules, epididymis and prostate gland to aid sperm release. Finally role played in childbirth; maternal bounding and milk secretion make it cardinally important in
preservation of human specie. Certain social behaviors and manipulation of erogenous zone improve its secretion. MDMA improves and
SSRI, s decrease its secretion. Intranasal OT can be used for treatment
of anorgasmia and retarded ejaculation.
Conclusion: Oxytocin and its receptor has potential to be utilized in
number of sexual and reproductive disorders.
274
SEQUENTIAL ACTIVATION OF BRAIN
REGIONS RELATED TO ORGASM IN
WOMEN, USING FMRI
1,2
1
1
1
Methods: Surgical specimens were removed from vaginal wall of 18
pre (PG) and 12 postmenopausal (MG) women submitted to surgery
for genital prolapse grade I and II.
Samples of vaginal specimens were stained with ER-alpha and
VIP antibody for immunohistochemstry analysis. Additionally, FSH,
estradiol, prolactin, fasting glucose, and serum TSH levels were
evaluated.
Results: There was a significant difference in the ER-alpha score of
the vaginal wall between the two groups; the scores of the PG were
significantly greater than those of the MG (PG = 3.6 ± 2.2, and MG
= 1.4 ± 1.8, p = 0.01). There was evidence of the association between
VIP and the group (p = 0.02). The increasing age reduces the probability of VIP staining (OR 0.88; 95% CI 0.78–0.99).
Conclusion: VIP expression in the posterior vaginal wall decreases
with the advent of menopause. However, the age is the independent
predictor of the VIP staining on vaginal wall.
276
3
B.R. Komisaruk , N. Wise , E. Frangos , K. Allen , B. Whipple
1
Dept. Psychology, Rutgers University, 2Dept Radiology, Univ Medicine &
Dentistry, 3College of Nursing, Rutgers University, Newark, NJ, USA
It is likely that as orgasm develops over a period of minutes, the effect
of genital sensory activity gradually increases the level of excitation of
neural elements in the brain, reaching a peak of excitation and then
subsides. However, to our knowledge, the actual sequence of activation
of neural systems in the brain leading up to, during, and after orgasm,
is not known. In our most recent research using fMRI, we have developed a novel method of measuring 80 brain regions repetitively at
2-second intervals during the course of genital self-stimulation-elicited
orgasm, and plotted their intensity sequentially over time. Graphically,
we display the activity of all 80 brain regions (in group data from 9
women) as a single image, which demonstrates both differential patterns of activation of specific brain regions leading up to orgasm, then
simultaneity of activation of many of these brain regions at orgasm,
and then widespread regional subsidence of activation. We observed
widespread regional brain activation leading up to, and during, orgasm,
especially in the cortex. By contrast, brainstem and medial cortical
regions showed greater differentiation of activation. Some brain
regions showed relatively early onset of activation leading to orgasm,
e.g., amygdala, hippocampus, head of caudate, relative to brain regions
that showed later onset of activation, e.g., sensory cortex, thalamus,
and substantia nigra. Other brain regions showed an abrupt increase
in activity at orgasm, e.g., anterior cingulate cortex, inferior frontal
cortex, and cerebellum. Still other brain regions showed peak activation after the onset of orgasm, e.g., nucleus accumbens and hypothalamus. The differential, sequential, pattern of regional brain activation
provides insight into the neural process underlying this gradually
developing peak experience. Support: NIH 2R25 GM060826 and the
Rutgers University Research Fund (BRK).
275
VIP EXPRESSION IN VESSELS OF THE
VAGINAL WALL: RELATION TO THE
ESTROGEN STATUS
ADEQUACY OF THE PLISSIT MODEL FOR
THE APPROACH TO FEMALE SEXUAL
FUNCTION BY THE GYNECOLOGIST:
THE T.O.P. MODEL
L.A.S. Lara1, R.A. Ferriani2, S.R.B. Ferraresi2, A.P.M. Salata Romão2,
F.R.R. Junqueira2, A.R. Manganaro2, A.C.J.D.S. Rosa e Silva3
1
Sexual Medicine Service, Faculty of Medicine, São Paulo University,
2
Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil, 3Faculty of
Medicine of Ribeirão Preto, Ribeirão Preto, Bulgaria
Introduction: Providing care for sexuality is a fundamental aspect of
actions that intend to promote the health and well-being of an individual. Sexuality may be affected by pathological states in various
medical specialties, representing a possible demand of patients so that
they may feel that their health is restored. The discussion of sexuality
is still limited in doctors’ offices, mainly because the lack of models to
discuss this theme.
Objectives: To determine the effectiveness of a model for the approach
to sexual complaints by gynecologists based on the universally accepted
PLISSIT model.
Methods: Data regarding 57 patients whose sexual complaints were
considered by a gynecologist and a therapist were compiled using the
following model: Teaching sexual response (T), Orienting sexual
health, (O), Permitting and stimulating sexual pleasure (P) (T.O.P.
model).
T: At this level, the gynecologist explains in a concise and schematic
manner the physiology of the female sexual response focusing on the
three main phases: desire, excitement and orgasm.
O: Sexual education provides information about the concept and
healthy experience of sexuality.
(P): To permit and stimulate sexual pleasure based on the argument
that the effectiveness of sexual pleasure is important for the physical
and emotional well-being of a person.
Result: Overall, 52% of patients referred improvement of sexual
response after T.O.P. model application, 48% reported no change in
their sexual function.
Conclusion: Many sexual problems may be improved by an individual
if he/she receives information about the psychic and biological mechanism of sexual function.
L.A.S. Lara1, C.V.S. Macedo2, J.C. Rosa e Silva2, M.F. Silva de Sá2,
A.C.J.D.S. Rosa e Silva2
1
Sexual Medicine Service, Department of Gynecology and Obstetrics, 2Faculty
of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
Objective: Vasoactive intestinal peptide (VIP) is a neuropeptide that
has been shown to have elevated expression in regions which exert
control on urogenital functions. The estrogen, appear to have a modulatory role on VIP and its expression in various organs, however in the
vagina wall this effect has not been demonstrated. Thus, the aim of
this study is to evaluate the influence of estrogen status on VIP expression in vessels on the vaginal wall.
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279
THE INTERFERENCE OF SERUM
TESTOSTERONE LEVELS AND OBESITY IN
THE SEXUAL RESPONSE OF PATIENTS WITH
OVARIAN SYNDROME MICROPOLYCYSTIC
COMP-ANG1 RESTORES CORPUS
CAVERNOSAL ANGIOGENESIS IN A TYPE II
DIABETIC RAT MODEL
1
1
2
2
S.R.B. Ferraresi , L.A.S. Lara , R.M. Reis , A.C.J.D.S. Rosa e Silva
Sexual Medicine Service, Faculty of Medicine, São Paulo University,
2
Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
1
Introduction: Polycystic ovary syndrome (PCPOS) is the most
common endocrine disorder among women in reproductive age. Oligomenorrhea and hyperandrogenism are the symptoms in PCOS
according The Rotterdam Consense -2003. Obesity is commonly associated to PCOS leading to poorer quality of life and emotional disorders such as depression and anxiety Some studies have shown a role of
testosterone in sexual function and PCOS patients are characterized
by the presence of hyperandrogenism.
Objective: This study aims to assess if the hyperandrogenism state of
PCOS patients can interfere with female sexual function, independently of the presence of obesity.
Methods: We included 19 non-obese ovulatory patients, 16 obese
ovulatory patients, 24 obese PCOS patients and 24 non-obese PCOS
patients, all of them answered structured questionaire (FSFI and QSF);
also free testosterone and SHBG were measured.
Results: There was no difference on sexual function between the four
studied groups, neither in a global nor in a domain evaluation. There
was also no correlations between BMI, presence of PCOS and
hormone levels.
Conclusions: The PCOS related hyperandrogenism does not interfere on patients sexual function, independently of the presence of
obesity.
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OBSERVATION OF THE PRESSURE
SENSITIVITY OF THE EJACULATORY
ORGANS IN RABBITS WITH PROSTATITIS
S. Luo
Urology Department, West China Hospital, Sichuan University, Chengdu,
China
Aim: To observe the change of the pressure sensitivity of the ejaculatory organs in the rabbits with prostatitis and discuss the roles of
the visceral sensitivity of the ejaculatory organs in the occuring of the
premature ejaculation.
Methods: 16 male adult rabbits were paired into two groups (the
chronic prostatitis group and the healthy control group) by weight.
The rabbits in the chronic prostatitis group were injected with escherichia coli into the prostate grand and the controls were injected with
equal physiological saline. After 4 weeks, all the rabbits were anesthetized, The pressure sensitivity of the ejaculatory organs were evaluated
by injecting the saline solution slowly into the cavity that induced the
contraction reflection of the bulbocavernosus and the controlateral
seminal vesicle. The average pressure of the two group were
compared.
Results: The average pressure of the chronic prostatitis group was
evident lower than that of the healthy control group (22.5 ± 3.46 cm
H2O vs 28.06 ± 3.82 cm H2O, P = 0.005). Which showed that the
pressure sensitivity of the ejaculatory organs of the rabbits with chronic
prostatitis was higher than that of the healthy controls, lower pressure
could induce the ejaculation action.
Conclusions: Higher visceral sensitivity of the ejaculatory organs may
play important role in the occuring of the premature ejaculation in the
chronic prostatitis patients.
S.-O. Kim1, H.-S. Lee1, Z. Li1, K. Ahn2, G.Y. Koh3, K. Park1
Department of Urology, 2Department of Anatomy, Chonnam
National University Medical School, Sexual Medicine Research Center,
Chonnam National University, Gwangju, 3Department of Biological
Sciences, Korea Advanced Institute of Science and Technology, Daejeon,
Republic of Korea
1
Purposes: Otsuka Long-Evans Tokushima fatty (OLETF) rat is an
animal model of type II diabetes mellitus. Cartilage oligomeric matrix
protein (COMP)-angiopoietin 1 (Ang1) (COMP-Ang1) is a soluble
and stable form of Ang1 which plays as a critical angiogenic factor for
vascular maturation and angiogenesis. We hypothesized that intracavernosal injection of Comp-Ang1 might promote angiogenesis in a
diabetic rat model of erectile dysfunction.
Methods: Male OLETF rats (1 year old, n = 30) and control
Long-Evans Tokushima Otsuka (LETO) rats (n = 10) were included
in this study. OLETF rats were divided into three groups; vehicle-only
(n = 10), COMP-Ang1 10 ug treatment (n = 10), and COMP-Ang1
20 ug treatment (n = 10). COMP-Ang1 was injected into the corpus
cavernosum of the penis. After 4 weeks, expression of platelet-endothelial cell adhesion molecule-1 (PECAM-1) was determined by
immunoblotting and immunohistochemistry.
Results: There was decreased immunoreactivity of PECAM-1 in
OLETF rat group compared with LETO rat group. And increased
immunoreactivity of PECAM-1 was observed in COMP-Ang1 treatment group compared with vehicle-only group. Moreover, the expression of PECAM-1 on penile tissue was notably augmented with
Comp-Ang1 20 ug treatment group compared with COMP-Ang1
10 ug treatment group. On Western blot analysis, PECAM-1 protein
expression was significantly decreased in vehicle-only group compared
to control LETO rat (P < 0.05). However, this expression was restored
to the level of the control after intracavernosal injection of COMP
Ang-1.
Conclusions: The results suggest that application of COMP-Ang1
may enhance cavernous angiogenesis by reinforcing the endothelium
structurally.
280
MORPHOLOGICAL VASCULAR CHANGES IN
THE VAGINAL WALL AFTER MENOPAUSE
L.A.S. Lara1, J.C. Rosa e Silva2, M.F. Silva de Sá1, A.C.J.D.S. Rosa e
Silva3
1
Sexual Medicine Service, Department of Gynecology and Obstetrics, 2Faculty
of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil, 3Sexual Medicine
Service, Department of Gynecology and Obstetrics, Faculty of Medicine of
Ribeirão Preto, Ribeirão Preto, Bulgaria
After menopause, critically estrogen low levels result in modifications
in vaginal wall. The present study aims to determine whether there is
a change in the number of vessels of the lamina propria of the vaginal
wall after menopause. Six women who were18 to 40 years old with
FSH levels ≤ 12 mIU/ml (PG) and a menopausal group (MG) consisting of six women who were < 65 years old with FSH levels ≥40 mIU/
ml, who underwent a genital surgery were selected for this cross-sectional study. Slides were stained for estrogen receptor-alpha (ERalpha) immunohistochemistry. An endothelial cell marker CD3 was
used to label vessels which were identified by using a system for morphometry. The number of vessels was significantly higher in the PG
than in the MG both on the anterior wall (PG:1.055 ± 145.8vessels/
mm2 and MG:346.6 ± 209.9vessels/mm2, p < 0.0001) and on the posterior wall (PG:1064 ± 303.3vessels/mm2 and MG:348.6 ± 167.3vessels/
mm2, p = 0.0005). The ER-alpha score was significantly higher in the
PG than the score for the MG on both the anterior and posterior walls
(PG:6.0 ± 0.52 and MG 2.5 ± 0.89, p = 0.007; PG:5.8 ± 0.79 and
MG:2.7 ± 0.95, p = 0.03). There was a positive correlation between
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the ER-alpha score and the vessel concentration on the anterior (r =
0.6656, p = 0.018) and posterior (r = 0.6738, p = 0.016) vaginal walls.
Age was strongly negatively correlated with vessel concentration on
the vaginal walls, (respectively r = -0.9033, p < 0.0001, r = -0.7440,
p = 0.0055). Thus, postmenopausal women with genital prolapse have
a smaller number of vessels on the vaginal wall compared to normoestrogenic controls with the same pathological condition. Hypoestrogenism and advancing age are factors that are associated to these
changes.
281
LOW FREE TESTOSTERONE, ERECTILE
DYSFUNCTION AND ASSOCIATED
CO-MORBIDITIES IN 1,638 MEN
R. Runciman, M. Bartolo, A. Wood, Y. Abbasi, D. Steward,
D. Davies-South, T. Bennett, K. Wylie
Porterbrook Clinic, University of Sheffield, Sheffield, UK
Objective: To corroborate the association of low testosterone (LT),
erectile dysfunction (ED) and age with other co-morbidities.
Method: Patient records of 1,638 men at the Porterbrook Clinic and
the Royal Hallamshire Hospital with erectile dysfunction were analysed for correlation between LT levels and prevalence of common
diseases over three age groups: 18–49, 50–64 and 64+ years. Free
testosterone was low < 8 nmol/L (LT), borderline 8.1–12 nmol/L and
normal 12.1+ nmol/L (NT).
Results: A clear association was noted between LT and age; 11% aged
65+, 8.6% aged 50–64 & 7.1% aged 18–49. Current psychiatric disorders were most prevalent (26.8%) with LT in the youngest age group
(18–49) (14.6% in NT men), compared to 17.5% (14.7% in NT men)
aged 50–64 and 13.2% (7.4% in NT men) aged 65+. Cardiovascular
disease (CVD) was commoner in older age groups, but markedly different between LT and NT men; with 19.5% (11.7% in NT men) aged
18–49 having CVD, compared to 47.6 % (38.4% in NT men) aged
50–64 and 63.2% (48.5% in NT men) aged 65+. Prevalence of diabetes
showed a similar pattern; 19.5% (7.6% in NT men) aged 18–49 having
type II diabetes, compared to 15.9 % (11.3% in NT men) aged 50–64
and 34.2% (13.4% in NT men) aged 65+. Although the LT50–64
group doesn’t follow the LT pattern, there is a marked difference
compared to prevalence in the NT 50–64 group.
Conclusions: A correlation exists between ED, LT, age and co-morbidities of psychiatric disorders, cardiovascular disease and type II
diabetes.
282
EFFICACY OF FLIBANSERIN AS A POTENTIAL
TREATMENT FOR HYPOACTIVE SEXUAL
DESIRE DISORDER IN NORTH AMERICAN
PREMENOPAUSAL WOMEN: RESULTS OF
THE BEGONIA TRIAL
M. Katz1, L. Derogatis2, R. Ackerman3, P. Hedges4, L. Lesko5, M. Garcia5,
R. Pyke5, M. Sand5
1
Katz and Kade, Cincinnati, OH, 2Center for Sexual Medicine at Sheppard
Pratt, Baltimore, MD, 3Comprehensive Clinical Trials, LLC, West Palm
Beach, FL, 4Clinical Trials of Texas, Inc., San Antonio, TX, 5BoehringerIngelheim, Ridgefield, CT, USA
Objective: To assess the efficacy of 24 weeks’ treatment with flibanserin 100 mg qhs for generalized acquired Hypoactive Sexual Desire
Disorder (HSDD) in premenopausal women.
Design and methods: This was a randomized placebo-controlled
trial. Co-primary endpoints were change from baseline to study end
in the number of satisfying sexual events (SSE) and Female Sexual
Function Index (FSFI-d) desire domain. Secondary endpoints included:
Female Sexual Distress Scale-Revised (FSDS-R) total and FSDS-R
Item 13 scores.
Results: Mean (SD) baseline data were: SSE 2.6 (2.7) and FSFI-d 1.9
(0.7). The mean changes from baseline to study end in the efficacy
endpoints are given in the table below. Adverse events leading to
discontinuation were experienced by 3.7% of women receiving placebo
and 9.6% of women receiving flibanserin (most frequent term: somnolence, 0.4% vs 1.7%, respectively).
Conclusions: In premenopausal women with HSDD, flibanserin
100 mg qhs was associated with clinically meaningful and statistically
significant improvements in the number of SSE and sexual desire
(FSFI desire domain), and the secondary endpoints for distress associated with sexual dysfunction (FSDS-R total) and distress associated
with low sexual desire (FSDS-R Item 13) compared with placebo.
There were no significant safety concerns associated with the use of
flibanserin for 24 weeks.
Placebo (n = 525)
Flibanserin 100 mg qhs
(n = 505)
Difference from placebo
SSE
FSFI-d
FSDS-R
total
FSDS-R
Item 13
1.5
2.4
0.7
1.0
-6.1
-9.3
-0.7
-1.0
0.9**
0.3**
-3.2**
-0.3*
[Mean change from baseline to study end in efficacy].
**p < 0.0001 versus placebo, *p < 0.0002 versus placebo.
283
DO SHORTER RECALL PERIODS PROVIDE
BETTER ASSESSMENT OF DESIRE IN
WOMEN WITH HYPOACTIVE SEXUAL
DESIRE DISORDER?
M. Katz1, L. Derogatis2, R.C. Rosen3, W.A. Fisher4, M. Garcia5, L. Lesko5,
R. Pyke5, M. Sand5
1
Katz and Kade, Cincinnati, OH, 2Center for Sexual Medicine at Sheppard
Pratt, Baltimore, MD, 3New England Research Institutes, Watertown, MA,
USA, 4Dept of Psychology, University of Western Ontario, London, ON,
Canada, 5Boehringer-Ingelheim, Ridgefield, CT, USA
Objective: The most appropriate recall period for patient-reported
assessment of female sexual function has yet to be established. In clinical trials, diaries usually collect endpoint data with 1–7 day recall
periods; rating scales, which are commonly recommended by clinical
experts, typically use 28-day recall. In cognitive debriefing studies of
women with Hypoactive Sexual Desire Disorder (HSDD), over 90%
of subjects stated that 1 day of recall was irrelevant to their overall
state, and that a recall period from 7–28 days was more appropriate.
Therefore, we assessed sexual desire using the Female Sexual function
Index (FSFI) in a crossover design comparing recall for 7 vs. 28 days.
Methods: A subset of 175 premenopausal women with HSDD taking
part in a Phase IIIb RCT of flibanserin completed the (FSFI) at weeks
20 and 24, once with a standard 4-week recall period, and once with
1-week recall, in crossover fashion. Results were compared using intra
class correlation (ICC) coefficient, Cohen’s D and an ANOVA bioequivalence test (0.6 mean difference and 80%-125% within patient
ratio boundary).
Results:
n
175
Mean Difference (95% CI)
Cohen’s D
Ratio (95% CI)
ICC (95% CI)
-0.11 (-0.23, 0.01)*
0.20
0.90 (0.80, 1.01)
0.78 (0.72, 0.83)
[FSFI 7 day vs. FSFI 28 day recall]
*Mean (SD) for 7-day recall: 2.53 (1.19); for 28-day recall: 2.63 (1.14)
Conclusions: FSFI 7 and 28-day recall assessments were found to be
equivalent based on the low Cohen’s D, substantial ICC coefficient
and mean difference and ratio estimates were well within the prespecified boundaries.
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284
STUDIES OF SESAME PHYTOESTROGENIC
LIGNANS DERIVATIVES ON IMPROVING THE
FERTILITY POTENTIAL AND STORAGE
CAPACITY OF MALE SPRAGUE DAWLEY RATS
EPIDIDYMIS
154
Results show a small effect of sexual functioning on sexual attitudes.
Although the effect is small, it goes in the expected direction. No
definitive conclusions should be taken with the present data. Differences are observed between groups but it cannot be concluded that
there is a cause-consequence influence.
R.K. Shittu1, L.A.J. Shittu2, Sesame Research Group
1
Micribiology, Jireh International Foundation Laboratory, Abuja, 2Anatomy,
Benue State university, College of Medicine, Makurdi, Nigeria
POSTER PRESENTATION
Introduction: Increasing concern has been expressed about the potential effects of both synthetic and natural estrogenic endocrine disruptors (EEDs) on human reproductive health in our environment in the
last decade. However, little attention is paid to quantitative structural
changes of the epididymis.
Objective: to evaluate the effects of exposure to the phytoestrogens
found in aqueous extract of sesame radiatum leaves on epididymal
diameter; volume density of epithelium and lumen of the epididymal
tubules in male Sprague Dawley (SD) rats using un-biased stereological methods.
Methods: Fifteen adult male SD rats were randomly divided into three
groups (2 treated and 1 control groups respectively). In the treated
groups, a single daily dose of aqueous leaves extract of Sesamum radiatum (14.0 and 28.0 mg /kg bwt) was administered via gastric garvage
and equal volume of normal saline was administered in control group
for six weeks.Five microns (5 um) of uniformly random sections of
processed epididymal tissues were analyzed using an un-biased stereological study and SPSS analysis of data generated was carried out with
P < 0.05 considered statistically significant.
Results: The mean epididymal diameter and volume density of the
tubular lumen significantly (P < 0.05) increased by 65% and 71%
respectively with improved fertility in low dose sesame as compared
to the control group. Similar findings in high dose sesame were also
observed.
Conclusion: Sesame has a high fertility potential and storage capacity
for the epididymal spermatozoa in a dose related manner.
286
285
DIFFERENCES IN SEXUAL ATTITUDES IN
TERMS OF SEXUAL FUNCTIONING OR
SEXUAL DYSFUNCTIONING
P. Vallejo-Medina, N. Moyano, P. Santos-Iglesias, J.C. Sierra
Personality, Evaluation and Treatment Psychology, Universidad de Granada,
Granada, Spain
Attitudes toward sexual fantasies and erotophobia-erotophilia are two
of the most common construct assessing sexual attitudes. Normally it
is assumed that sexual attitudes are explaining different sexual functioning parameters like sexual desire, sexual arousal or sexual satisfaction. However, little research is focused in the opposite direction, that
is, when sexual functioning could modify the sexual attitudes. We
hypothesize that sexual bad functioning would eventually be detrimental to attitudes toward sexuality.
A total of 920 functional people and 920 dysfunctional people were
evaluated. Samples were not balanced in age (35.67 and 40.39 years
old) and sex (679 men and 1158 women). Not significant differences
were found in population size and educational level. All sample completed the Massachusetts General Hospital Sexual Functioning Questionnaire, the Sexual Opinion Survey and the Wilson’s Sex Fantasy
Questionnaire. Convenience sample was used.
We carried out different Ancovas controlling the age effect and
separately by men and women. Significant differences were found in
sexual desire, sexual arousal, orgasm, erection and overall satisfaction.
The sexual dysfunction group had lower scores in sexual attitudes
than non-dysfunction group. Effect size differences were ranging
from low to moderate. Sex differences were minimal. Attitudes
toward sexual fantasies normally explain more variance than
erotophobia-erotophilia.
TRACK 2
GIRLS BORN WITH GENITAL ANOMALIES:
ARE THEY RECEIVING OPTIMAL CARE FOR
THEIR SEXUAL AND REPRODUCTIVE LIFE?
K. Adler, S.R. Grover
Paediatric and Adolescent Gynaecology, Paediatrics, Royal Children’s
Hospital, Melbourne, VIC, Australia
Birth anomalies affecting the genitals includes urinary, bowel and/or
genital anomalies. At birth, the priorities for these children is correction of their urinary and bowel problems as these may have immediate
and potentially life-threatening consequences. In girls, genital anomalies often include absence of, or duplication of the reproductive tract
with potential obstruction of one or both sides. Correction of urinary
or rectal anomalies may also result in narrowing of the vagina or
introitus. Failure to identify these problems may result in acute presentation with menstrual outflow obstruction at puberty. Additionally,
failure to address related issues with the adolescent may have negative
consequences on her developing positive sexual relationships. Discussion regarding childbearing also needs to occur with the young woman.
At present, limited treatment pathways exist for young women with
genital anomalies at the Royal Children’s Hospital (RCH) in Melbourne, Australia or other paediatric centres internationally. This audit
reviews the experiences of 180 girls born with genital anomalies
including Congenital Adrenal Hyperplasia (CAH), cloacal anomalies,
bladder extrophy and ano-rectal malformations. The rate of timely
identification of reproductive tract anomalies, referral for appropriate
advice and support regarding menstruation (in view of potential difficulties with the vaginal opening), and the opportunity for discussion
regarding sexual activity were assessed.
Many girls with cloacal extrophy presented in adolescence with
obstructed genital tracts requiring major surgery; more recently, young
women with bladder extrophy are being referred appropriately; young
women with CAH tend to have optimal care—they represent the
group with established care protocols.
287
YOUR PLACE OR MINE: HOW
EVOLUTIONARY FORCES DRIVE FEMALE
SEXUAL BEHAVIOR
K. Anderson
Center for Sexual Health/Psychiatry, Summa Health System, Akron, OH,
USA
Nature has proven that the best way to minimize genetic mutations in
offspring is to mate with someone who displays signs of “genetic
fitness”. Because women are not yet able to directly assess a potential
partner’s DNA, they must do their best to interpret obvious indicators
of genetic health (such as symmetry, body shape, scent, etc.). Considerable research is being done to increase our understanding of how
evolutionary forces drive female sexuality. This paper will highlight
the latest research on “ovulatory shift hypothesis” from esteemed evolutionary psychologists, sociologists, and neurobiologists who are
studying female sexuality from an evolutionary perspective. The presenter will address topics such as when women are most likely to be
unfaithful; why different types of men are appealing at different phases
of a woman’s cycle; how women dress and conduct themselves at dif-
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Proceedings from the 20th World Congress of Sexual Health
ferent phases of their menstrual cycle; biologic explanations for
female-initiated sexual behavior; and much more. This timely overview will provide insight into the cutting-edge science being conducted
to enhance our knowledge of the evolutionary forces that are driving
women’s sexual behavior, erotic experience, and partner selection.
288
INFLATABLE LOVE: THE STORY OF ONE
MAN’S FETISH
K. Anderson
Center for Sexual Health/Psychiatry, Summa Health System, Akron, OH,
USA
This presentation will provide historical and current context to fetishism as it follows the development of one man’s fetish. Through edited
video of actual clinical interviews (produced by the author), the
patient, in his own words, describes the impact of his fetish on his
marriage, sexual functioning, and daily life. The author will discuss
biological and psychological theories on the origins of fetishism as a
backdrop to the actual clinical material. This rare glimpse into the
emotional life of a fetishist will provide attendees with an opportunity
to gain insight into this common, yet elusive paraphilia.
References:
Binet, A. (1887). Le fetishisme dans l’amour [Fetishism in Love]. Revue
Philosophie, 24:143–167.
Freud, S. Miscellaneous Papers: 1888–1938. Vol. 5 of Collected Papers, 5
vols. London: Hogarth and Institute of Psycho-Analysis, 1924–
1950, 198–204.
Freud, S. (1962) Three essays on the theory of sexuality, trans. James
Strachey. New York: Basic Books.
Money, J. (1990) Love Maps. New York: Prometheus Books.
Rose L. (1988). Freud and fetishism: Previously unpublished minutes
of the Vienna Psychoanalytic Society. Psychoanal Q., 57:147–166.
Scott, P. (2004). The Fetish Fact Book. London: Virgin Books.
289
THE EFFECT OF PELVIC FLOOR MUSCLE
TRAINING IN FEMALE SEXUAL
DYSFUNCTIONS
N. Andrade, V.P. Piassarolli, E. Hardy, N.O. Ferreira, M.J.D. Osis
State University of Campinas, Campinas, Brazil
Objective: The aim of this article was to evaluate the effect of pelvic
floor muscle training in female sexual dysfunctions.
Design and methods: The study was designed as a clinical trial from
February 2008 to May 2009. We evaluated 26 women with sexual
dysfunctions. The participants underwent pelvic floor muscle training
(PFMT) for 10 sessions. Treatment was evaluated by: pelvic floor
strength by vaginal palpation, sEMG amplitudes and a questionnaire
to determine sexual function—Female Sexual Function Index (FSFI).
These variables were compared before and after treatment with a p
value < 0.05 defined as significant. Clinical and epidemiological characteristics were described in absolute and relative frequencies, mean
and standard deviation values. Regarding comparisons among the
evaluations, Friedman’s non parametric, as well as Bonferroni and
Manova’s test were applied.
Results: There was a significant improvement in pelvic floor muscle
strength and in sEMG amplitudes of all contractions throughout the
treatment (p < 0.0001). The sexual function showed a significant
increase in all FSFI scores domains (p < 0.0001).
Conclusions: The PFMT can provide a beneficial effect on sexual
function. This physiotherapy approach can be successfully used in
female sexual dysfunctions treatment.
290
CULTURAL ADAPTATION AND PERSIAN
TRANSLATION ARIZONA SEXUAL
EXPERIENCE SCALE (ASEX)
M. Asadi1, M.M. Faiaznoori2
Sexual Medicine, Roozbeh Hospital/Tehran Medical University of Medical
Science, 2INCAS, Iranian National Center for Addiction Study/Tehran
University of Medical Science, Tehran, Iran
1
Objective: The purpose of the study was to translate Asex to Persian;
to adapt it for Iranian culture and to investigate the performance and
psychometric characteristics of the Persian version.
Method: The Asex was translated to Persian using an elaborated
methodology according to world health organization (WHO) guideline. In addition, understandability and feasibility, of the measure were
investigated in 207 male in Tehran. To evaluate the test—retest reliability of the questionnaire a random sample of 60 male were selected
and retested one week later.
Results: Few changes or few adaptations were made to bring about
cross—cultural comparability. The Asex questions were generally
understandable and acceptable for male in Tehran. The internal consistency of the scale was
a = 0/88 . . . . . . . . . . . .
The test—retest reliability was r = 0/97 (p < 0/001) . . . . . . . . . . . .
Conclusion: The Asex Persian version appears to be a good cross—
culturally equivalent of the original American version. Understandability, internal consistency, test—retest reliability and applicability of
the instrument was good.
291
POST ORGASMIC ILLNESS SYNDROME
‘POIS’: CASE REPORT
A. Attia
Dermatology & Andrology, Minoufiya University, Cairo, Egypt
Introduction: POIS is a newly described syndrome. The reported
cases worldwide are few. It presents by cognitive and/or flu-like manifestations that start within seconds of orgasm and may continue for
days after. It is of unknown etiology and no treatment till now.
Aim: To report a case of POIS in an Egyptian engineer and to draw
the attention for such cases which may be misdiagnosed.
Methods: This case documents POIS presentations, investigations
and trials of treatment.
Results: Apart from his POIS manifestations; he is sexually normal.
His general health is fair except; life-long atopic manifestations; bronchial asthma, allergic rhinitis and neuro-dermatitis. All laboratory
results; CBC, Blood Sugar, Total Testosterone, DHEA, T3, T4, TSH,
Cortisol, Prolactin and Prostatic Smear were normal; only elevated
ALT and AST due to fatty liver.
Trials of treatment by non-steroidal anti-inflammatory drugs, selective serotonin re-uptake inhibitor s and tramadol were ineffective.
Conclusion: Data on POIS are very few. Cases are mostly misdiagnosed. Much attention must be given to this syndrome from the clinicians, researchers, and the scientific meetings of the interested
societies.
Atopy in this patient may point to allergic reaction as a cause. Trials
of treatment by corticosteroids may be worthy. Further investigations
are mandatory.
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292
294
IMPACT OF BUPRENORPHINE
MAINTENANCE ON SEXUAL DYSFUNCTION
AMONG OPIOID DPENDENCE SUBJECTS
LOW FREE TESTOSTERONE, ERECTILE
DYSFUNCTION AND THE RIGIDITY OF THE
ERECTION IN 1,706 MEN
Y.P.S. Balhara1, S. Mathur2
1
Lady Hardinge Medical College and SMT. S.K. Hospital, 2Jamia Milia
Islamia, New Delhi, India
Introduction: The prevalence of sexual dysfunction (erectile dysfunction and PME) have been reported to be very high among those with
heroin dependence. In fact high rates of sexual dysfunction have been
reported to be high among those who are on Oral Substitution
Therapy with Buprenorphine. This is one the common reasons for
relapse among this patient population. The present study aims at
assessment of impact of OST (buprenorphine) on the erectile dysfunction among those with heroin dependence.
Materials and methodology: The study used a prospective design. It
included 50 heroin dependent subjects from a de-addiction centre.
Socio demographic profile was recorded using a semi-structured proforma. The sexual dysfunction was assessed using IIEF-15 (for erectile
dysfunction) and premature ejaculation severity index (for PME).
Results: The overall prevalence for sexual dysfunction was high at
66% for the heroin dependent subjects. The rate for PME was 40%
and for ED it was 25%. Initiation of OST with buprenorphine reduced
the rate of both PME (p < .005) and ED (<.05) significantly in the
study subjects. However, some of the subjects (5%) reported a new
onset ED while on buprenorphine therapy.
Conclusions: The rate of sexual dysfunction is high among heroin
dependent subjects. Use of OST with buprenorphine could be an
effective measure to reduce this. However, one should screen the
patients during the follow-up for new onset ED.
293
AN EDUCATION STRATEGY FOR EXPANDING
THE APPROACH TO SEXUALITY IN HEALTH
CARE FOR THE ELDERLY
M.N.D.S. Barros1,2, M.T. Araújo2, I.G.V.d. Souza2, C.M.D.S. Andrade2,
G.M.D.A. Alves2, E.M. Vieira1, Izadora Gomes Veiga de Souza
1
Social Medicine Department, Universidade de São Paulo, Ribeirão Preto,
2
Natural Sciences Department, Universidade Estadual do Sudoeste da
Bahia—UESB, Vitória da Conquista, Brazil
Introduction: Sexuality is still rarely addressed by health professionals
in assisting the elderly mainly during the medical graduation.
Objectives: To identify and understand the importance of the study
and discussion of the topic “Sexuality in old age” among medical
undergraduate students.
Methods: The technique of focus group discussion was used as a
strategy of training to comprehensive care for the elderly, including
the sexual dimension. Some students were invited to make the selection of elderly women for debate on sexuality based on the experiences
of the participants. A group consisted of six women between 60 and
80 years old were accessed at the Centre for the Elderly.
Results: Most women reported a sexual debut filled with myths and
misinformation. The doctor is the health professional most looked for
to talk about of sexuality. The knowledge of the universe of sexuality
of older people is of paramount importance in the formation of a
medical student. The technique allowed seeing this dimension of life
of an elderly separated from the condition of old age. Direct contact
with the elderly population allowed to realize that there is not an
embarrassment for the elderly talk about sexuality, instead, the opportunity is often well received.
Conclusion: The resistance of health professionals reflects, often, lack
of adequate preparation for dealing with the subject and experiences
and initiatives within the graduate course can contribute to a better
quality of comprehensive care for the elderly.
M. Bartolo1, R. Runciman1, A. Wood2, Y. Abbasi1, D. Steward1,
D. Davies-South1, T. Bennett1, K. Wylie1
1
Porterbrook Clinic, University of Sheffield, 2ST 4, North Trent Rotational
Training Scheme in Old Age Psychiatry, Beighton Hospital, Sheffield, UK
Objective: To corroborate the association of low testosterone (LT),
erectile dysfunction (ED) and age with the rigidity of erections.
Method: Patient records of 1,706 men at the Porterbrook Clinic and
the Royal Hallamshire Hospital with erectile dysfunction were analysed for correlation between LT levels and a rating of their erectile
rigidity over three age groups: 18–49, 50–64 and 64+ years. The rigidity of erections was rated by the patients as ‘full’, ‘partial’ or ‘absent’
in a variety of situations. Free testosterone was low < 8 nmol/L (LT),
borderline 8.1–12 nmol/L and normal 12.1+ nmol/L (NT).
Results: A clear association was noted between LT and age; 10.9%
aged 65+, 8.6% aged 50–64 & 6.9% aged 18–49. Erections rated
‘absent’ on waking were broadly more prevalent with older LT men;
38.1% in the youngest age group (18–49) (21.9% in NT men), compared to 43.8% (35.6% in NT men) aged 50–64 and 43.6% (45.5%
in NT men) aged 65+. In a similar pattern, erections were more frequently rated as ‘absent’ during foreplay in LT than NT men; with
16.7% (13.8% in NT men) aged 18–49 having CVD, compared to
28.1 % (21% in NT men) aged 50–64 and 30.8% (28.9% in NT men)
aged 65+. Spontaneous erections rated ‘absent’ were more prevalent
in LT men; 61.9% (55.3% in NT men) aged 18–49, compared to 79.7
% (69.4% in NT men) aged 50–64 and 74.4% (69.7% in NT men)
aged 65+.
Conclusions: A correlation exists between ED, LT, age and the rigidity of erections.
295
TESTOSTERONE-THERAPY IN FEMALE-TOMALE TRANSSEXUALS AND LONG-TIME
EFFECTS ON FERRITIN
A. Becerra1, G. Pérez-López1, M. Menacho2, N. Asenjo1, M.J. Lucio1, J.M.
Rodriguez-Molina3
1
Gender Unit, Dpt Endocrinology, Hospital Universitario Ramón y Cajal,
University of Alcalá, 2Dpt of Biochemistry, Hospital Universitario Ramón y
Cajal, 3Gender Unit, Dpt Endocrinology, Autonomous University, Madrid,
Spain
Moderately elevated body iron stores may be associated with insulin
resistance (IR). Elevated serum ferritin levels (Fer) independently predicted incident type 2 diabetes and cardiovascular disease in apparently
healthy men and women.
Aims: To analyze the association between Fer and IR markers in
female-to-male transsexuals (FMTs), and effects after 2-year of
testosterone-therapy.
Methods: 79 FMTs, aged 28.6+/-7.6 y (range 18–47) were studied.
Relations between Fer and several parameters of IR and components
of metabolic syndrome (waist circumference [WC], systolic [SBP] and
diastolic blood pressure [DBP], and serum levels of glucose [G], triglycerides [TG] and HDL-cholesterol [HDL]) by ATP-III criteria,
were basally analyzed.
Results: Baseline Fer was significantly correlationed with WC, G,
SBP, DBP, TG and HDL. After 2-year of testosterone-therapy in
FMTs decreased from 43.1+/-7.2 to 38.2+/-6.4 ng/ml (p = 0.001).
Conclusion: Fer is associated with IR markers and components of
metabolic syndrome. So, in FMTs, testosterone-therapy could increase
the cardiovascular risk, but on the contrary this long-time treatment
can decrease this risk due to the fall in Fer.
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FROM GENDER DYSPHORIA TO GENDER
EUPHORIA, AN ASSISTED JOURNEY
E.E.P. Benestad1,2
1
Health and Sports, University of Agder, Kristiansand, 2GRIMSTAD
MPAT-Institute, Grimstad, Norway
People of unusual gender talents have long been labelled “dysphoric”
or as “suffering from”. These labels may at best have worked as tickets
to systems where one could get the medical support needed on a path
to gender fulfilment.
Pathologisations create feelings of dysphoria and will thus contribute to its own justification. This is immoral.
In an ambience of transe-, inter-, no gender and/or genderqueer
positivity, the path to positive gender belonging will also be a path to
gender euphoria.
Positive gender belonging is to be perceived and affirmed as gender
by others, the same way one perceives and affirms oneself.
Ordinarily cultures offer two gender options. This does not reflect all
known gendered or non-gendered talents. In order to make it possible
for all to reach positive gender belonging, cultures must offer more than
two positive gender options. This author is comfortable with offering
seven genders, but several of these offers still carry labels of pathology.
The path to positive gender belonging involves processes both on
inner and outer arenas. The inner process concerns questions of who
one might be in the world of gender. An able gender therapist and
gender path assistant must have the capacity to know and convey positive images of all the seven options, for the client to be mirrored in an
optimal way.
Simultaneously the therapist/assistant must work with networks in
order for them to be able to perceive and affirm the individual as gender
the same way as the individual perceives her/him/hir/sinhir self.
297
METHODOLOGIES IN SEX THERAPY:
A SURVEY-BASED ANALYSIS OF
PSYCHOTHERAPY MODELS FOR MEN’S
SEXUAL DYSFUNCTIONS
M.D. Berry
Department of Psychology, University College London, London, UK
Sex therapy is a site of professional and scholarly debate. While few
practitioners would question the logical foundations of combination
therapy (treatments that integrate pharmacotherapy and psychotherapy), or the biopsychosocial paradigm, the future of psychotherapeutic
sex therapy is contested (see, for instance, the debate surrounding
Rowland’s 2007 article, “Will Medical Solutions to Sexual Problems
make Sexological Care and Science Obsolete?”). Additionally, numerous sex therapists have argued for increased empirical and validated
research on sex therapy methodologies.
This research project analyzes the psychotherapeutic models practitioners used in treating men’s sexual dysfunction. Through this
research, I hope to determine which techniques and practices sex
therapists use most commonly, and which methods they find most
effective. Additionally, I hope to uncover methodological differences
between practitioners with different professional specializations (i.e.
psychologists, psychiatrists, social care workers, etc.), and those who
adhere to different treatment paradigms (i.e. cognitive behaviour
therapy, dynamic psychotherapy, etc.).
This presentation reports on my research methodology and preliminary research findings. The project generates data through two surveys
of sex therapists:
therapy methods. Through this presentation I hope to gain feedback
on my research project, which is the basis for my PhD studies in
Psychology at University College London.
298
AN AFRICAN CONTRIBUTION TO THE
TREATMENT OF FEMALE ORGASMIC
DYSFUNCTION
N. Bizimana
African Sexual Institute (Private), Berlin, Germany
The sexual technique used to stimulate women appears to be one of
the important factors responsible for the occurrence of female orgasmic dysfunction. Penile vaginal penetration alone allows only 25 to
50% of women to reach orgasm.
As an alternative to penile vaginal penetration, for over 150 years
men in Central Africa have used the sexual technique called kunyaza
to trigger female orgasm. During the practice of this technique, with
his penis in the hand the man stimulates the clitoris and other erogenous zones in the vulval and vaginal areas by rhythmically striking
these with vertical, horizontal or circular movements. Kunyaza was
documented for the first time in 2005 in our German-language book
for the general public, also published in French and Chinese, and in
2010 in our scientific article.
In this presentation, we again describe this little-known sexual
technique, which has the reputation of strongly stimulating female
orgasm and expulsion by the woman of large quantities of liquid during
heterosexual encounters, and demonstrate one of its variants with a
filmclip. We also report the experiences of the readers of our books
and of those attending our lectures concerning female orgasms
and expulsion of liquid by the woman during the practice of kunyaza
and, in addition, the results of the chemical analysis of the ejected
liquid.
The data, which we are still in the process of collecting, are based
on semi-structured questionnaires.
299
FEMALE GENITAL PAIN: DISTRESS AND
TREATMENT SEEKING
K. Bond1, P. Weerakoon2, R. Shuttleworth2
1
Graduate Program in Sexual Health, Faculty of Health Sciences, University
of Sydney, Maidstone, VIC, 2Graduate Program in Sexual Health, Faculty
of Health Sciences, University of Sydney, Sydney, NSW, Australia
Aim: What is the impact of distress on treatment seeking for women
with genital pain?
Background: Almost 15% of women in a national Australian study
reported dyspareunia (Pitts et al. 2008). A compounding factor in the
detection and management of dyspareunia is distress. Higher levels of
distress lead women to seek treatment (Ferenidou et al. 2008) however
there is little research exploring reasons underlying distress and treatment seeking behaviours.
Methodology: Women with genital pain completed the Female
Sexual Distress Scale and two semi-structured, in-depth interviews.
The data from interviews with six women has been analysed using
thematic analysis. Additionally, a qualitative on-line questionnaire will
be developed and results will be used for triangulation.
Data analysis: Early themes emerging from the data:
1) a questionnaire, designed to gain a general quantitative overview of
techniques used in the field, and
2) verbal interviews, which seek more detailed data on sex therapists’
methodological insights.
• Participants experience an emotional rollercoaster when seeking
diagnosis and treatment, which affects treatment seeking.
• Distress levels are caused by a number of factors and women seek
treatment for different reasons.
• The meaning of distress and genital pain appears to be different for
those women experiencing generalized vulvodynia versus those with
vestibulodynia.
This project is intended as a foundation for further research-such as
observational studies, and clinical trials-on the efficacy of different sex
Conclusions: Distress is a common yet varied experience of women
with genital pain.
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158
Reference List: Ferenidou, F., V. Kapoteli, et al. (2008). “Presence of
a sexual problem may not affect women’s satisfaction from their
sexual function.” Journal of Sexual Medicine 5(3): 631–639.
Pitts, M. K., J. A. Ferris, et al. (2008). “Prevalence and correlates of
three types of pelvic pain in a nationally representative sample of
Australian women.[see comment].” Medical Journal of Australia
189(3): 138–143.
in children’s and dog toys in some European countries and concerns
about unregulated use have been documented.
I feel a moral obligation to educate my clients and colleagues on
how to choose safe, effective phthalate-free products to assist their
progress.
300
PDE5 INHIBITORS IN THE TREATMENT OF
ED: REASONS FOR DROPOUT AND
PREDICTOR FACTORS FOR COMPLIANCE
QUESTIONNAIRE: WHAT HELPS
HETEROSEXUAL FEMALE SEXUAL
AROUSAL?
J. Brendler
SBRASH + WAS + FLASSES, Porto Alegre, Brazil
Objective: To develop an auxiliary method to identify behavior/factors
that help female sexual arousal, during coitus, for clinical sexology
patients, which might be applied to the general population.
Methods: The questionnaire includes general items, such as age,
marital status, (professional and academic) occupation, education.
There are two specific items on sexuality; both list 36 behaviors/
factors that may help emotional and/or physical female sexual arousal.
There is an open-ended, “Other” item (for writing about other
factors), item 37. The listed items are about the woman’s, the man’s,
or the couple’s behavior. First, they choose up to 10 factors (among
the 36 options); then, the 5 most important factors that help sexual
arousal.
Results: Among the general population, it was the most spontaneously
answered questionnaire. In that population, the results found were
used in sexual education. Among clinical sexology female patients, the
questionnaire “mapped” their sexual preferences regarding behaviors/
factors that increase sexual arousal, smoothed the couple’s communication, and allowed for fantasy discovery, thus resulting in improvements
in the quality of their sexual life.
Conclusions: The questionnaire is useful as an auxiliary method to
identify behaviors/factors that help sexual arousal in both populations
studied. In clinical sexology, such identification may improve the sexual
life of the woman/couple.
301
THERAPEUTIC CONSIDERATIONS AND
CLINICAL APPLICATIONS OF ADULT
NOVELTY ITEMS
L. Carlyle1, M.-E. Allen2
ASSERT, Ripponlea, VIC, 2Sassy Vibes, Bogangar, NSW, Australia
1
I recommend sex toys therapeutically for a range of client difficulties
in my sex therapy practice.
The masturbation sleeve can help PE sufferer’s transition from
behavioural exercises to intercourse, assist DE clients to tune into
life-like sensations, and give inclined women a pleasuring alternative
to intercourse.
A penis ring allows blood to enter the penis while restricting outflow, helping ED clients maintain a firmer erection. It also enables
those with lifelong PE to stay hard for a few minutes after ejaculation,
effectively doubling erection time.
A vast range of vibrators can assist with arousal and orgasmic difficulties in both sexes. I have discovered sexy alternatives to dilators that
my Vaginismus clients appreciate. Vaginal balls have revolutionised
pelvic floor training, accelerating sexual response and amplifying
orgasms.
Finally, I believe a safe, long-lasting lubricant is an essential tool for
every couple.
China produces approximately 70 % of the world’s sex toys, most
from PVC softened with plasticizers called phthalates. Phthalates can
leach out, smell extremely unpleasant, fragment over time and are
porous, meaning they are not easily cleaned or completely disinfected.
It follows that this may cause genital irritation. Phthalates are banned
302
A. Carvalheira1, N.M. Pereira2, V. Forjaz1
University Institute of Applied Psychology, 2iSex—Association for the
Advanced Study of Human Sexuality, ULHT, Lisbon, Portugal
1
Introduction: The discontinuation rate for phosphodiesterase
type 5 inhibitors (PDE5-i) use among men with erectile
dysfunction (ED) appears to be high. Understanding the reasons for
discontinuing PDE5-i will be necessary to optimize the response to
treatment.
Aim: The main goal was to
(1) to analyze drop-out rate to PDE5-i; and
(2) to identify the reasons for discontinuation to PDE5-i.
Methods: 327 men (Mean age = 56; Min = 25, Max = 81) with clinical
diagnosis for ED who had been treated with a PDE5-i were interviewed. Quantitative and qualitative methodology was used. Participation rate was 71.8%.
Results: Of the 327 men, 45.3% were still using PDE5-i, 49% had
discontinued the drug (n = 160), and 5.8% freely decided not to start
treatment. Of the 160 men who had discontinued PDE5-i, 55.1%
discontinued during the first three months, and 9.4% at 12 month.
Qualitative analysis of reasons for discontinuation revealed:
(1) non-effectiveness;
(2) psychological factors solved (e.g. overcome emotional difficulties)
and not solved (e.g. anxiety);
(3) concerns and fears related to the use of PDE5-i;
(4) dysfunctional believes inherent to use; and
(5) relational/contextual factors.
Discussion: The half of subjects under treatment with PDE5-i discontinued medication. The higher dropout rate appears to occur at
first month. Mostly there is a combination of factors that lead to
dropout. Psychosocial and relational variables appear to be fundamental topics to be addressed during follow-up. Optimizing response to
PDE5-I requires combined treatment approaches.
Funding: This study was funded by a scientific grant from Pfizer
PECANZ.
303
FOLLOW-UP OF ED PATIENTS IN
TREATMENT WITH PDE5 INHIBITORS:
HOW DO MEN USE THE INHIBITOR?
A QUALITATIVE STUDY
A. Carvalheira1, N.M. Pereira2, V. Forjaz1
University Institute of Applied Psychology, 2iSex—Association for the
Advanced Study of Human Sexuality, ULHT, Lisbon, Portugal
1
Introduction: Phosphodiesterase type 5 (PDE5) inhibitors (sildenafil,
tadalafil, vardenafil) are currently the first line treatment option for
erectile dysfunction (ED).
Aim: The main goal was to analyse the patterns and frequency of use
of PDE5 inhibitors in the treatment of erectile dysfunction.
Methods: 327 men (Mean age = 56; SD = 11.4; Min = 25, Max = 81)
with clinical diagnosis for ED who had been treated with a PDE5-i
were interviewed by telephone concerning their ongoing treatment.
Participation rate was 75.8%. Quantitative and qualitative methodology was used. Self-report measures include history and current status
of PDE5-i use, and other treatments adopted for ED.
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Results: A total of 148 men were still using PDE5-i (45.3%). 87.2%
of these men are committed and 91.2% has a regular sexual partner.
10.8% prostate cancer; 12.5% are taking antidepressants. In this
sample of 148 men, 79.9% referred secondary effects. 73.6% do not
use the inhibitor in every single sexual intercourse. A content analysis
revealed several determinant factors for taking/not taking the
inhibitor:
(1) momentary support to ensure self-confidence;
(2) diverse emotional conditions;
(3) level of stress;
(4) Unwillingness to accept drug-dependent erection;
(5) concerns and fears of taking a drug;
(6) interpersonal related;
(7) unpleasant side effects.
Discussion: A great majority of men are not using the inhibitor in
every single sexual intercourse. Diverse variables determine different
patterns of use. Taking or not taking the inhibitor depends on a diversity of factors, mainly psychological, interpersonal, and related to the
inhibitor.
Funding: This study was funded by a scientific grant from Pfizer
PECANZ.
304
THE FAILURE OF A SUCCESSFUL MAN
(CLINICAL CASE)
C. Coelho, Z. Figueiredo
Outpatient Clinical Sexology, Hospital de Magalhães Lemos, Oporto,
Portugal
Objective: Realignment/redefinition of the sexual problem of a male
patient (not consummated marriage because of erectile dysfunction)
on the couple dynamic.
Meaning of the sexual problem on the individual life of the patient.
Design and method:
Male patient, age 27, academic degree, with highly successful professional track record, and living with his girlfriend for 4 years (not
consummated marriage), to whom the following interventions were
done:
• Psychological assessment:
s Minnesota Multiphasic Personality Inventory–2 (MMPI-2)
s Self-esteem and relationship questionnaire (SEAR)
s International Index of Erectile Function (IIEF)
• Sexual Therapy
• Couple Therapy
Results: The patient had narcissist personality traces and rigid global
functioning pattern, which was alleviating along the Psychotherapy
cycle.
We proceeded with a realignment of the sexual complaint on a
systemic dysfunctional dynamic (couple), with positive evolution.
The marriage was finally consummated.
Conclusions: On this situation of not consummated marriage, a sexual
therapy aimed to the treatment of the erectile dysfunction was not
sufficient. The initial complaint may be understood as a defence mechanism on a wider dysfunctional context, including the couple dynamics
and the fear of intimacy.
This case is a good example of the complexity that involves human
sexuality.
305
TRAINING AS A SEXOLOGIST IN SPAIN
M. Larrazabal1, M.-Á. Cueto2
1
Instituto Kaplan de Psicología y Sexología, Madrid, 2CEPTECO, León,
Spain
Sexology in Spain is not a university degree. The societies of Federación Española de Sociedades de Sexología -Spanish Federation of
Sexology Societies- (FESS) are the ones which carry out more masters
and training courses together with several Spanish universities, though
their curricula are not unified; they are mainly addressed to psychologists and doctors. FESS validate their courses, which guarantees
quality and good praxis.
Other sexology institutions also organize postgrade courses but they
do not unify the specific criteria of the professionals, they just include
this training within the limits of Health Knowledge for students whose
degrees are related to Health Sciences.
The new Law of Sexual Health and Reproductive Health and Voluntary Interruption of Pregnancy (2010) warrants, for the first time,
the effective use of sexuality and the promotion of sexual health, and
the right of women to decide about their motherhood. Such sexual
training tries to get to as many people as possible and it wants to:
• Promote a responsible sexual behaviour by educating people to
prevent sexual discrimination.
• Remove prejudices related to sexuality and minorities to know and
respect sexual identities and different sexual behaviours.
Our challenge is getting that sexual health is fully integrated in our
National Health Service, as well as being taught at schools and universities, which will help specialists improve their research in this area.
These aims would be more easily reached by creating an official title
of sexologist, which would make easier the attainment of an Official
College of Sexologists.
306
COGNITIVE DISTRACTION, EROTIC
THOUGHTS AND ORGASM IN WOMEN
M. Cuntim1, P. Nobre2
1
Psychology, Universidade de Trás-os-Montes e Alto Douro, Vila Real,
2
Universidade de Aveiro, Aveiro, Portugal
Introduction: Distraction or interference in the cognitive processing
of erotic stimulus plays an important role in the development of sexual
dysfunctions or difficulties (Geer & Fuhr, 1976).
Aim: The aim of this study was to evaluate cognitive distraction and
negative automatic thoughts presented during sexual activity and its
impact on female orgasm.
Methods: A total of 191 women from the general population answered
to a set of questionnaires assessing orgasm function, automatic
thoughts during sexual activity and cognitive distraction.
Main outcome measures: Orgasm was measured by the respective
domain of the Female Sexual Function Index (FSFI, Rosen at al., 2000),
automatic thoughts were measured by the Sexual Modes Questionnaire
(Nobre & Pinto-Gouveia, 2003), and cognitive distraction was measured by the Cognitive Distraction Scale (Dove & Weiderman, 2000).
Results: Findings indicated that lack of erotic thoughts during sexual
activity was the best predictor of women’s sexual difficulties. Sexual
abuse thoughts, failure and disengagement thoughts, partner’s lack of
affection, sexual passivity and control, and lack of erotic thoughts were
significantly higher in women with orgasm difficulties compared to
sexually healthy women.
Conclusions: Overall, the results showed that cognitive distraction
from erotic thoughts is strongly associated with orgasmic difficulties
suggesting the importance of treatment techniques aimed at focusing
attention on sexual cues.
307
FROM THE MEDICAL SEXOLOGY TO
SEXOLOGICAL MEDICINE (PROSPECTS OF
THE DEVELOPMENT OF SEXOLOGICAL
CARE IN RUSSIA)
B. Alekseyev1, L.-G. Dahlöf 2
St Petersburg Medical Academy of Postgraduate Studies, St Petersburg,
Russia, 2Psychology, University of Gothenburg, Gothenburg, Sweden
1
Since the 1970ies there exists in Russia a separate medical specialty—
medical sexology and the profession of medical sexologist. Medical
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sexology is conceptualized as an interdisciplinary field of medicine
(G.S. Vasilchenko) with a specific methodological approach how to
help sexological patients. Medical sexology requires a comprehensive
knowledge and experience of traditional diagnostic and medical
methods of related disciplines modifying them conformably to the
specificity of sexual disorders and supplementing with those novel in
principle developed within the framework of medical sexology. Today,
a continously growing knowledge of how sexual disorders develop
together with more complicated technologies for examination and
treatment of patients, the different specialists involved in solving the
problems of a sexological patient are required to speak not only about
medical sexology, but also of sexological medicine. Here two important
problems become evident. The first is to find an optimal algorithm for
the specialists’ interaction. The second is the need of a common basis
of knowledge in medical sexology among these specialists.The sexologist must represent a key figure at the first level of providing sexual
health care to the patients. The sexologist is trained to work with a
system approach to the sexual disorder evaluation reaching an accurate
diagnosis. The second problem is how to secure a continuous service
to the patients with sexual disorders. In Russia the preconditions for
realizing training programs generating basic knowledge in sexology—
the Saint Petersburg Medical Academy of Postgraduate Studies
(MAPS) has a complete system of departments for it.
308
PRIAPISM MAY ANOUNCE A SERIOUS
DISEASE
O. Dahmani
Nephrology, CH Louis Jaillon, Saint Claude, France
Priapism is a persistent painful erection that usually lasts for more than
two hours. It’s a disorder of penile detumescence, not associated with
sexual thoughts or sexual activity. Priapism is originating from ischemic and non-ischemic mechanisms having medical and surgical
sources. We described here a surgical cause of priapism unmasking by
clinical and biological markers of acute renal failure.
Case report: a 50 year old nonsmoking male presented to the emergency department with history of one week duration of vague abdominal pain and left flank heaviness. Physical examination is unremarkable
apart of mild edema left lower limb and priapism. Laboratory tests
disclose picture of acute inflammatory syndrome with normal procalcitonine level, mild renal impairment with hyponatremia, normocalcemia and potassium level = 5 mmol/l. The remaining parameters
were normal and urine biochemistry was in favor of organic renal
process. Renal ultrasound showed pyelocaliceal dilation and conserved
cortex dimension. Despites symptomatic measure, the clinical condition rapidly deteriorated mandating further investigations including
TDM of the abdomen and pelvis to rule out retroperitoneal fibrosis.
Unfortunately, the picture emerged as an aortocaval fistula as a source
of both priapism and acute renal failure.
Discussion: The case illustrated here a surgical causality of priapism
coexisting along with clinical and biological markers of acute renal
failure. Despites active interventional measures including renal
replacement therapy and surgery,he was declared unrecoverable post
operatively, due to massive hemorrhage.
Conclusion: Priapism may announce a serious disease such as an
aortocaval fistula induced simultaneously acute renal failure.
309
THE INTRAVAGINAL EJACULATION
LATENCY TIME (IELT) IS NOT A VALID
MEASURE TO DETERMINE THE
ORGANICITY OF PREMATURE EJACULATION
F. de Carufel
Unité de Sexologie Fonctionnelle, Hôpital de Waterloo, Braine l’Alleud,
Belgium
The only cause of ejaculation is sexual excitement which, when it
reaches a sufficient intensity (threshold), triggers the ejaculatory reflex.
160
There is no organic condition that provokes instant ejaculation like a
cold can make a man sneeze, for example. If pathologies or genetic
factors precipitate the onset of ejaculation, they do it in conjunction
with excitement by accelerating its ascent or by lowering the ejaculatory reflex threshold. This synergy, if it exists, doesn’t take place only
when the penis is inserted inside the vagina. It happens as soon as
excitement begins which usually occurs at the start of foreplay. Consequently, it’s not the duration of excitement during intercourse (or
IELT) but the total length of excitement that can indicate if there is
any organic condition that hastens ejaculation. If the total period of
excitement is always short and ejaculation takes place quickly no matter
what type of stimulation is received (visual, manual, oral, vaginal) and
which control technique is applied, it can be hypothesised that organic
factors are involved. However, if it is only the excitement period during
intercourse (IELT) which is brief and if this period is preceded by an
excitement period during foreplay, it cannot be asserted that this short
period of excitement during intercourse (IELT) is due to organic
factors but to an inadequate management of excitement. This observation reinstates sexological treatments based on learning which were
discarded on the premise of the evidence-based medicine false assumption that lifelong premature ejaculation is a neurobiological aberrant
phenomenon.
310
A RESEARCH FOR PENILE ERECTION
STATE VIBROTACTILE THRESHOLD
MEASUREMENT IN THE DIAGNOSIS OF
PRIMARY PREMATURE EJACULATION
M. Deng
Institute for Oriental-Western Human Sexuality, New York, NY, USA
Objective: To evaluate the value of penile vibrotactile threshold in the
diagnosis of primary premature ejaculation under erection by comparing the changes of penile vibrotactile thresholds before and after erection and observing the differences of penile vibrotactile thresholds
between normal potent man and patients with premature ejaculation
under erection.
Methods: The penile vibrotactile thresholds of 68 patients with
primary premature ejaculation and 60 normal potent male volunteers
were detected. Vibrotactile thresholds before and after erection were
recorded at the index finger, glans penis, penile shaft and scrotum
using a biothesiometer.
Results: The vibrotactile threshold values of glans penis and penile
shaft were significantly lower under erection than those under unerection (P < 0.01). The values of glans penis and penile shaft in patients
with premature ejaculation were significantly lower than those in
normal potent men under erection (P < 0.01).
Conclusions: It is of diagnostic value to measure penile vibrotactile
threshold for primary premature ejaculation under erection.
311
AN ANALYSIS OF PSYCHOLOGICAL FACTORS
FOR 60 CASES OF ERECTILE DISORDER
M. Deng1, S. Lao2
1
Institute for Oriental-Western Human Sexuality, USA, New York, NY,
USA, 2Psychology Group, Guangxi Children Showplace, Nanning, China
Objective: Investigation and analysis to psychological risk factors of
patients of penis erectile disorder.
Methods: 60 patients of erectile disorder were researched with
Hawton Classification, and analyzed by Logistic model analysis.
Results: The incidence rates are lack of sexual intercourse, lack of
sexual education, sexual anxiety and sexual repression education, were
58 (96.7%), 56 (93.3%), 52 (86.7%) and 46 (76.6%) respectively. The
factors of lack of sexual intercourse, lack of sexual education, sexual
anxiety, sexual repression education, sexual hurt, fearing contraction
and life style were the most common psychological factors in patients
of erectile disorder by Logistic model analysis.
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Conclusions: Erectile disorder is closely related with the psychological factors, and the psychotherapy and behavior therapy must be
carried out in treatment of erectile disorder.
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CHLAMYDIA, YOUNG MEN, RISK BEHAVIOR
L.M. Diaz Gonzalez, A.M. Nilsson
Ungdomsmottagning Hisingen, Gothenburg, Sweden
Purpose: Making the youth clinic more accessible for young men, by
starting cooperation with secondary schools. Acquire knowledge about
study participants’experience and attitudes to sex, condoms and chlamydia in order to reduce the possible risk for STI.
Method: Classroom discussions with 18-year old men at high schools
in Gothenburg. Data was obtained through a survey and discussions
in the focus groups.
Results: A total of 88% (167) of the planned study groups participated,
of them 80% had experienced sexual intercourse. Most had had few
partners, while a small group had had many. Thirtyfive had tested for
chlamydia and 20% of them were chlamydia positiv. Young men who
had had sexual intercourse before the age of 15 had generally had more
sexual partners, more frequently used alcohol and drugs in conection
with sex and more often had sex against their will.
The discussions showed that the young men were prepared to
have alternative sex with a new partner if condoms were not on hand.
The young men reported that intoxication could increase sexual risk
behavior, such as sexually acting out, or by being persuaded into sexual
acts.
Conclusion: Co-operation with schools worked well. A risk group
consisting of those who made their debut before the age of 15 was
identified. One point worth noting is the high level of chlamydia, a
marker of sexual risk-taking. Contact with the youth centers should
make it easier for young men to go there for chlamydia testing and to
get condoms.
313
SATISFACTION FROM COUPLE’S SEXUAL
PERFORMANCE AS A PREDICTOR OF
SEXUAL DYSFUNCTION AND DISTRESS IN
PREMENOPAUSAL UNCOMPLICATED TYPE 1
DIABETIC WOMEN
K. Dimitropoulos1, A. Bargiota2, G. Koukoulis2, M. Melekos1,
V. Tzortzis1
1
Department of Urology, 2Department of Endocrine Disorders, University of
Thessaly, Larissa, Greece
Objective: The purpose of the present study was to examine whether
the degree of satisfaction from the couple’s sexual performance can be
a determinant for female sexual dysfunction (FSD) and distress (SeD)
in a group of premenopausal, uncomplicated type-1 diabetes mellitus
(DM-1) women.
Materials and methods: 47 DM-1 women were asked to select in a
4-point Likert scale the degree of satisfaction from their own and their
partner’s sexual performance. The Female Sexual Function Index
(FSFI) and the Female Sexual Distress Scale (FSDS) were used to
evaluate the sexual function and distress. Dichotomization and non
parametric tests were used in the statistical analysis.
Results: The prevalence of FSD in the DM-1 women was 25%;
15.91% of the diabetics had combined FSD and SeD. The dissatisfaction from the woman’s own sexual performance was positively correlated with FSD. DM-1 women unsatisfied from their own sexual
performance had worse FSDS, desire, orgasm, satisfaction and total
FSFI scores compared to those who reported satisfaction. The dissatisfaction from partner’s sexual performance was positively correlated
with FSD and with the combination of FSD and SeD. The diabetics
who reported no satisfaction from their partner’s sexual performance
had worse FSDS, lubrication, orgasm, satisfaction and total FSFI
scores compared to the satisfied ones.
Conclusions: Couple’s sexual performance can be a determinant for
FSD and SeD in premenopausal, uncomplicated DM-1 women,. Since
FSD is common in these women, physicians should ask their patients
whether they are satisfied from their or their partner’s sexual
performance.
314
SEXUALITY, EMOTIONS AND SYMPTOM
FORMATION IN PSYCHOSOMATIC
GYNECOLOGY. DIAGNOSTIC AND
THERAPEUTIC ASPECTS
W. Dmoch
Faculty of Medicine, Heinrich-Heine-University, Duesseldorf, Germany
The new classifications of diseases (ICD IV, DSM III) have tried to
eliminate theory from their manuals and to remain strictly descriptive
in their system. So they speak e. g. of “somatization disorders” without
expressing which pathogenetic ways lead to the symptoms being classified. According to the early psychoanalytical theory of symptom
formation psychosomatic symptoms were considered mainly to derive
from anxiety and defence of anxiety. Following this theory it proved
to be difficult to deal with various kinds of symptoms which frequently
are seen in gynecology and obstetrics as e.g. chronic pelvic pain, vulvar
itching and pain (vulvodynia), functional vaginal discharge, certain
bladder-related pain and various sexual dysfunctions.
Though actual interpersonal situations and underlying unconscious
conflicts triggering symptom formation could be identified, therapy of
women with above mentioned symptoms proved to be difficult in daily
gynecological practice. Following a suggestion of Felix Deutsch (1955)
who insisted on regarding the emotional phenomena during the diagnostic and therapeutic interviews and considering the affective phenomena shown by the patients it became possible to treat these
problematic patients successfully and to confirm how affects other than
anxiety contribute to symptom formation. The paper describes how
this theoretical concept was implemented into the therapy of formerly
untreatable patients with functional sexual and psychosomatic disorders in gynecology and obstetrics.
315
UNCONSUMMATED MARRIAGE AND MAYERROKITANSKY-KÜSTER-HAUSER SYNDROME
S. Dogan1, E. Erbek2
1
Psychiatry, NKU, Tekirdag, 2Zeynep Kamil Training Hospital, Istanbul,
Turkey
Introduction: While statistics regarding the prevalence of unconsummated marriage aren’t documented, it has been estimated that 1% of
all couples presenting to infertility clinics had not consummated their
marriage (have never had sexual intercourse).
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome occurs in
approximately one female in every 4,000 to 5,000. The syndrome was
first described by Mayer in 1829 and Rokitansky [in 1838 as including
agenesis of the uterus and vagina due to abnormal development of the
müllerian ducts; Rokitansky reported uterine and vaginal agenesis, and
Mayer described various vaginal duplications. In 1910, Küster recognized urologic associations, such as renal ectopy or agenesis, along with
skeletal deformities. In 1961, Hauser distinguished MRKH from testicular feminization.
Case: A 37-year-old man presented to our sex therapy clinic with complaints of erectile dysfunction and unconsummated marriage (have
never had sexual intercourse). He has been married for 6 years and
without children. Although the patient’s wife (30-year-old) was a normally developed woman, she was suffering from vaginismus. Initial
gynecological examination was limited to visuel inspection and gentle
exploration of vulvar opening. The first urology consultation showed
that no abnormalty in male partner. After starting conventional sex
thrapy in both partners, we had faced that female partner was not getting
better during vaginal dilation exercises (with the patient’s own fingers).
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The second OB-GYN consultation revealed that female partner had
have MRKH syndrome. The vagina was well cornified and had adequate
depth but ended in a blind pouch without a palpable cervix.
316
AGE, PHYSICAL FITNESS, ERECTILE
DYSFUNCTION INTENSITY AND CARDIAC
REHABILITATION IN MEN WITH ISCHAEMIC
HEART DISEASE AND ERECTILE DISORDERS
D. Kalka1, Z.A. Domagala2, W. Marciniak3, P. Koleda1, A. Grychowski4,
T. Szawrowicz-Pelka1, M. Poreba1, J. Wojcieszczyk5, M. Mical1,
W. Pilecki1
1
Pathophysiology, 2Normal Anatomy, Wroclaw Medical University, Wroclaw,
3
Cardiology, Ostrobramska Medical Centre Magodent, Warszawa, 4Center
of Cardiac Rehabilitation, Glucholazy, 5University School of Physical
Education, Wroclaw, Poland
Age is related to progressive decrease of physical capacity and increase
of the frequency of erectile dysfunction (ED) in men with ischemic
heart disease(IHD). The goal of the study was to analyse the influence
of a six-month controlled cardiac rehabilitation (CR) on physical
capacity and ED intensity in the population of patients with IHD and
ED, depending on their age.
The analysis has been conducted on 98 patients, at the mean age of
62.35 ± 8.88 (IIEF-5 ≤21 score.) The study group has been divided
into 3 subgroups [first–26 patients, under 55 years old; second–33
patients, 56–65 years old; third–39 patients, over 66 years]. Training
sessions were five times a week—two days of general rehabilitation
exercises and three days of cycle ergometer training. Each training
session lasted 45 minutes.
The patients filled in an IIEF-5 questionnaire twice, at the interval
of six months, and were subjected to the treadmill cardiac stress test
twice.
A comparative analysis of the change of physical capacity between
the analysed subgroups, which was respectively 2.02 ± 1.16, 1.95 ± 0.76
and 2.00 ± 0.86 for the groups from the youngest to the oldest (MET),
and of the intensity of ED, respectively 2.54 ± 1.03, 1.91 ± 1.61 and
1.26 ± 1.27, showed no statistically significant differences between the
values reflecting increase of physical capacity and significantly different
between the subgroups values showing decrease of ED intensity.
Conclusions:
1. Positive modification of ED, unlike improvement of physical capacity was related to the patients’ age and decreased along with its
increase.
317
EVALUATION OF THE INFLUENCE OF A SIXMONTH CARDIAC REHABILITATION CYCLE
ON PHYSICAL CAPACITY AND ERECTILE
DYSFUNCTION INTENSITY IN MEN WITH
ISCHEMIC HEART DISEASE
D. Kalka1,2, Z.A. Domagala3, W. Marciniak4, P. Koleda1, A. Grychowski5,
M. Pilot5, R. Poreba6, L. Rusiecki1, T. Sebzda1, W. Pilecki1
1
Pathophysiology, Wroclaw Medical University, 2‘Creator’—Center of
Cardiac Rehabilitation, 3Normal Anatomy, Wroclaw Medical University,
Wroclaw, 4Cardiology, Ostrobramska Medical Centre Magodent, Warszawa,
5
Center of Cardiac Rehabilitation, Glucholazy, 6Internal Diseases and
Hypertension, Wroclaw Medical University, Wroclaw, Poland
Physical activity, being the key element of cardiac rehabilitation (CR),
has a beneficial effect on erectile dysfunction in men. The aim of the
study was to analyse the influence of a six-month CR on physical
capacity and the IIEF-5 test scores in the population with ischemic
heart disease (IHD) and erectile dysfunction (ED).
The analysis has been conducted on 129 patients with IHD and ED.
The study group consisted of 98 patients who were subjected to CR,
and the control group comprised 31 patients. Training sessions were
162
five days a week—two days of general rehabilitation exercises and three
days of cycle ergometer training.
All patients filled in an IIEF-5 questionnaire twice, at the interval
of six months, and were subjected to the treadmill test twice.
As a result of CR, in the study group there was a statistically significant increase in the value of metabolic equivalent scores (6.91 ± 1.88
vs. 9.07 ± 2.45) and a significant increase in the IIEF5 test scores (11.88
± 6.2 vs. 13.69 ± 7.07), which was not observed in the control group.
The analysis of dependence between the values of change in physical
capacity and change in the IIEF-5 questionnaire scores showed in the
group of patients subjected to CR a correlation described by a statistically insignificant Pearson’s correlation coefficient r = 0.108 (p =
0.289).
Conclusions:
1. CR cycle led to a significant positive modification of erectile dysfunction intensity and an improvement of physical capacity of
patients with IHD.
2. No statistically significant dependence between the analysed effects
of CR was shown.
318
PERSONAL EXPERIENCES OF SEXUALITY
AFTER AN ACQUIRED BRAIN INJURY:
AN INTERVIEW STUDY
A.-S. Ek
Department of Rehabilitation Medicine, Skåne University Hospital, Lund,
Sweden
Introduction: What happens to sexuality when a person suddenly
acquires a brain injury as a result of severe illness or an accident? A
review of earlier studies shows that sexuality is affected among persons
who have acquired a brain injury. In primary rehabilitation when the
main focus is on independency in daily living the aspect of sexuality
can be overlooked.
Objective: The aim of this study was to illuminate the personal perspective of sexual changes among individuals who had acquired a brain
injury.
Methods: In the current study 9 men and women were interviewed
more than one year after an acquired brain injury. The individuals
were between 25 and 64 years, and had previously participated in a
primary rehabilitation program in a University Hospital in the south
of Sweden.
Results: Changes in sexuality were seen in relation to common consequences of brain injury such as fatigue and cognitive difficulties like
concentration. Changes also appeared in relation to the ability to
achieve erection, lubrication and orgasm. There were also modifications at the interpersonal level for example new roles in the relationship. The changes were managed in different ways but the coping
strategies used were not always efficient for the individual.
Conclusions: Sexuality can be seen as a vital part of the rehabilitation
process and therefore rehabilitation programs ought to include aspects
of sexuality also from the perspective of the partners.
319
EFFICACY AND SAFETY OF INTERNET USE
IN PRESCRIBING ERECTILE DYSFUNCTION
TREATMENTS
A. El Kharoubi
E-med Medical Services, London, UK
The aim of this study was to determinate the efficacy and safety of
online prescribing for patients who apply to internet pharmacies to get
E.D. treatment.
Patients and methodology: The initial patient questionnaire was the
same in all E-med coordinated websites. Those consultations that were
approved and paid for were sent an additional questionnaire with their
final email confirming drug delivery and time. All websites have to
fulfill all GMC criteria that fits with their “Good Medical Practice
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Guidelines 2008”. They also have to be MHRA compliant on the
advertising of medicines. All patients participate in this study were
approved for ED treatment after completing the initial questionnaire
which addressed many questions, including age, weight, height, full
details of their medical history e.g cardiovascular diseases, history of
any surgery, allergy to any medication, chronic diseases and permanent
medications. All patients that participated in our study were invited to
complete the additional questionnaire containing twelve supplementary questions. These pertained to their experience of using the internet for ED consultation and treatment as well as their partners views.
Results and discussion: Our research on the treatment of erectile
dysfunction (ED) has focused on medical interventions, in particular
oral medications. The current study examined the effectiveness of
internet-based clinics for this condition. In total, 509 men who were
approved to use ED treatments completed the second questionnaire.
The results demonstrated that men who used the internet based clinics
showed improved erectile functioning and sexual relationship satisfaction and quality.
320
DISORDERS OF SEXUAL DEVELOPMENT
AND GENDER IDENTITY: GUIDELINES FOR
PSYCHO-MEDICAL MANAGEMENT
A. Fabrizi, G. Gambino, E. Napoli
Institute of Clinical Sexology, Rome, Roma, Italy
The term “Disorders of Sex Development” (DSDs) indicates a series
of clinical conditions in which chromosome, gonadal and/or phenotypical sex development is atypical.
Sex assignment to newborns with ambiguous genitalia may raise
important bio-ethical issues in physicians, surgeons and parents and
may often influence the structuring of sex identity and gender
identification.
In 2006 the Intersex Society of North America (ISNA) proposed
new guidelines for the treatment of DSDs. Differently from previously
recommended procedures, the ISNA is in favour of delaying medical
and surgical interventions on genitalia until adulthood. Furthermore,
the ISNA underlines that such interventions should be performed only
in the case of real and imminent threats to the physical health of the
individual and provided there are definite evidence-based or predictive
indices.
The present work reviews the scientific literature on the topic in
order to describe how positions on medical sex-assignment have
changed over time, to analyze gender identity development in such
clinical conditions and to highlight the main factors necessary for an
adequate psycho-medical management of DSDs.
321
ASSESSMENT OF SEXUAL SATISFACTION IN
WOMEN WITH FIBROMYALGIA
M. Favero, M. Morgado
Instituto Superior da Maia, Porto, Portugal
Introduction: Fibromyalgia is a rheumatic syndrome whose cause is
unknown and it’s characterized by chronic pain and described in literature as one of the main causes of incapacity as it causes severe damage
to the patient’s life quality. It prevails between 0,66% and 4,4% of the
population, being more frequent among women (80%–90%).
Objectives: Evaluate the sexual satisfaction of women with fibromyalgia, aiming to understand the impact of fibromyalgia in sexual satisfaction of women.
Methodology: A sample of 120 women was gathered, of which 51 had
been diagnosed with fibromyalgia—clinic group—and 69 without
fibromyalgia—control group. The following evaluation instruments
were used: social demographic information questionnaire for sample
characterization; Self esteem and relationship questionnaire (SEAR);
Fibromyalgia impact questionnaire (FIQ); Dyadic adjustment scale
(DAS); Dysfunctional sex beliefs questionnaire (DSBQ); Female sexual
function index (FSFI).
Results: Results reveal that the bigger is the impact of fibromyalgia,
the bigger are the number of symptoms and depression degree, and
smaller is the degree of dyadic adjustment and sexual functioning.
Conclusion: Although, for the general population, sexual satisfaction
is influenced by factors such as the depression degree, the degree of
dyadic adjustment, the level of dysfunctional sex beliefs and sexual
functioning, for most women with fibromyalgia a low sexual satisfaction was found due to the low dyadic adjustment and a larger number
of dysfunctional sex beliefs. The obtained data reflects the negative
impact of fibromyalgia in sexual satisfaction, showing the need for
further studying and therapeutic interventions.
322
SEXUAL HEALTH CONCERNS AMONG
BREAST AND PROSTATE CANCER
SURVIVORS
S. Foley1, S. Crowley2, D. Wittmann3, N. Janz4, C. Jagielski2, R. Dunn2,
J. Griggs5, J. Wei3, J. Montie3, L. Northouse6
1
Graduate School of Social Work, 2Comprehensive Cancer Center, 3Urology,
4
Public Health, 5Oncology, 6Nursing, University of Michigan, Ann Arbor,
MI, USA
Introduction: It is unclear how much information patients receive
regarding sexual health concerns after cancer treatment, and if such
concerns persist over time.
Methods: This pilot study surveyed breast and prostate cancer survivors regarding their specific sexual health concerns. Study participants
completed a 12-item measure developed for the project by a multidisciplinary team of experts and FACT-G. Participants were stratified by
early (<2 years post-treatment) and late (>2 years post-treatment)
survivors.
Results: 114 survivors (58 breast, 56 prostate) were enrolled, with
median age of 52 for breast (range 29–86 years) and 64 for prostate
survivors (range 46–76 years). The number of sexual concerns reported
by survivors was negatively correlated with QOL (r = -0.21, p = 0.02).
Breast and prostate survivors had a similar number of concerns overall
(median breast = 3.5, prostate = 4.0), but their sexual concerns varied
by survivorship phase. Breast cancer survivors in later survivorship had
twice as many sexual concerns as those in the early phase despite nearidentical QOL. The opposite pattern was found for prostate cancer
survivors. Prostate cancer survivors were most concerned with their
ability to satisfy their partner (57%), while breast cancer survivors were
most concerned with changes in the way their body works sexually
(46%).
Conclusions: The sexual concerns for breast and prostate cancer
survivors vary by phase of survivorship and type of cancer.
Outcome (median)
Number of concerns:
Breast Early: 3.1
Breast Late: 5.6
Prostate Early: 4.5
Prostate Late: 3.3
FACT-G:
Breast Early: 86.5
Breast Late: 86.1
Prostate Early: 92.2
Prostate Late: 89.3
323
QUESTIONNAIRE EVALUATION OF
RELATIONSHIP DIFFICULITES IN PATIENTS
WITH SEXUAL PROBLEMS
L. Frodsham1, C. Domoney2
1
Obstetrics and Gynaecology, Maidstone Hospital, Maidstone, 2Obstetrics and
Gynaecology, Chelsea and Westminster Hospital, London, UK
Objectives: Psychosexual Medicine (PSM) has proven anecdotal
efficacy but, to date, there is no validated evidence in the published
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press of benefit to patients. Brief psychotherapeutic techniques
for sexual dysfunction are used and compared to questionnaire evaluation of relationships. In this study, patients referred with sexual
dysfunction were seen in a dedicated PSM clinic by two trained
doctors.
Methods: GRISS questionnaires were sent to all new referrals
prior to attendance (n = 72). Analysis was performed anonymously so
as not to skew the doctor-patient relationship or bias comparison
between the questionnaire and evaluation of sexual dysfunction at
consultation.
Results: 51 new patients completed questionnaires prior to review in
clinic. The completion rate was 71% (or 84% excluding 15% nonattenders). Questionnaires were well received and the majority of
patients commented that it helped them to focus on their problem
prior to clinic review. There were 49 female patients and 2 male referrals. On questionnaire analysis, 39 patients exhibited evidence of infrequency of sexual contact, 19 non-communication, 7 dissatisfaction, 24
avoidance, 19 non-sensuality, 25 vaginismus and 13 anorgasmia. The
2 men had erectile dysfunction and avoidance behaviour respectively.
However communication issues were identified in 79% (n = 41)
patients during the clinic consultation.
Conclusions: Fewer patients exhibit communication difficulties in
their relationships from questionnaire responses compared to the high
prevalence of communicative disorder elicited during the consultation.
Poor recognition of this may be the underlying cause of psychosexual
dysfunction and failure to acknowledge it a cause of treatment failure.
324
COMPARISON OF TWO DIFFERENT DOSES
OF BOTULINUM TOXIN A IN THE
TREATMENT OF SEVERE VAGINISMUS
(500 VS. 250U DYSPORT)
S. Ghazizadeh
Ob/ Gyn, Tehran University of Medical Sciences, Tehran, Iran
Objective: To compare the efficacy of 500Units vs. 250 U botulinum
toxin A (BTA) to treat severe vaginismus.
Method: 51 women with severe vaginismus who had not responded
to conventional treatments recruited from Feb. 2007 to Feb.2008.
Nine were excluded for not meeting inclusion criteria, 42 were randomly divided. The first group (n = 21) received 500 U. BTA, the
second group (n = 21) received 250 U. Patients filled out a sexual
questionnaire and had a pelvic exam before the procedure and one
month later. The gynecologists who evaluated the pelvic resistance
before and after the procedure and the subjects were blinded to the
dose. Main outcomes were improvement of sexual dysfunction and
relief of pelvic resistance.
Result: Sexual dysfunction improved after injection of 500 U. BTA (P
value < 0.0001), Pelvic exam showed significant relaxation in both
groups but more pronounced in the first group (P value < 0.0001).
Libido remained unchanged. Fear from intercourse was 68.3% before
the injection; it was relieved significantly in the first group (P value <
0.0001). Orgasm showed great improvement in the first group (P value
< 0.02).
Conclusion: BTA in dose of 500 Units is more effective than 250 U.
to treat severe vaginismus.
164
outpatients with sexual disorders, to evaluate the possible correlation
between sexual functioning and dysregulation of emotions.
Methods: 73 patients with sexual disorders and 73 healthy control
subjects were administered FSFI (Female Sexual Functioning Index)
to evaluate sexual functioning, TAS-20 (Toronto Alexithymia Scale) to
measure alexithymia and a socio-demographic questionnaire ad hoc
constructed.
Results: The results suggest a negative, moderate but significant correlation between FSFI and TAS-20 total scores (r = -.25; p < 0.01),
indicating that low levels of sexual functioning could be connected
with high levels of alexithymia. Then, the clinical group was divided
into five subgroups based on the different sexual disorders, but data
indicate that the distribution of alexithymia in each subgroup is not
significantly different (c2 = 1.264; p = 0.996). However, we found that
sexual pain disorders had the highest mean scores of TAS-20, respectively 49.4 for dyspareunia and 47.42 for vaginismus.
Conclusions: In conclusion, we can assume that our results highlight
a positive alexithymia trend in female sexual dysfunctions, especially
in sexual pain disorders. On the other hand, comparing these data with
them of male ones, we confirm alexithymia is a wider problem in men
in general as well as in the particular area of sexual dysfunctions.
326
SEXUAL SELF-SCHEMAS AND SEXUAL
FUNCTIONING IN WOMEN: DIFFERENCES
BETWEEN WOMEN WITH AND WITHOUT
SEXUAL DIFFICULTIES
D. Gonçalves1, P. Nobre2
Universidade de Trás-os-Montes e Alto Douro, Vila Real, 2Universidade de
Aveiro, Aveiro, Portugal
1
Object of study: The role of sexual self-schemas and cognitive
schemas activated during sexual events in women’s sexual functioning
was studied.
Method: A total of 245 women from the community, aged over 18
years, filled in a set of questionnaires assessing: female sexual functioning, sexual self-schemas and cognitive schemas activation in sexual
context. This sample was divided into two groups: Control Group (n
= 162) and Sexual Difficulties Group (n = 42).
Results: Results showed that Sexual Difficulties Group presented
mean ratings significantly higher in cognitive schemas activated in
sexual context and significantly lower in sexual self-schemas, compared
to the Control Group. However, cognitive schemas activated in sexual
context showed highest statistical significance and it was the Incompetence factor that presented the greatest effect factor on the differentiation between the two groups. Furthermore, according to our
hypothesis, cognitive schemas activation in sexual context showed
higher predictive power of female sexual functioning, compared to the
sexual self-schemas, although both presented significant predictive
power.
Conclusions: Therefore, the fact of cognitive schemas activated in
sexual context have had a higher significance in differentiation between
women with and without sexual difficulties and in prediction of female
sexual function assumes greater importance in clinical practice,
working as additional empirical support for utilization of cognitive
techniques for female sexual problems treatment and for utilization of
theoretical assumptions of cognitive theory for their comprehension.
325
ALEXITHYMIA AND SEXUAL FUNCTIONING:
A CLINICAL STUDY ON FEMALE PATIENTS
WITH SEXUAL DISORDERS
327
MULTIPLE COMORBIDITY IN A CASE OF
COMPULSIVE SEXUAL BEHAVIOR
M. Giuliani1, A. Fabrizi1, R. Rossi1, F. Tripodi1, I. Di Pomponio2,
S. Eleuteri1, C. Simonelli2
1
Institute of Clinical Sexology, 2‘Sapienza’, University of Rome, Rome, Italy
1
Objective: In previous researches, high or/and moderate alexithymia
levels were found in males with sexual dysfunctions. The aim of the
present study is to investigate prevalence of alexithymia in female
Introduction: People with clinically excessive sexual thoughts or
behaviors have been categorized as suffering from a compulsive,
impulsive or addictive sexual disorder (1). Some have described com-
J. Güler1, E. Kaymak1, E.E. Yilmazer2, A. Yenel1, M. Bilici1
Erenkoy Egitim Arastirma Hastanesi, Istanbul, 2Aliaga Devlet Hastanesi,
Izmir, Turkey
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pulsive sexual symptoms and addressed their relationship to obsessivecompulsive disorder (2). Others have emphasized the role of impulsivity
and the spectrum of impulse control disorders, in conceptualizing such
symptoms (3).
We have limited data on what makes a person vulnerable to loss
of sexual control. Raviv (7) found that 32 self-identified ‘sex addicts’
had higher mean scores on SCL-90-R scales for anxiety, depression,
obsessive-compulsiveness and interpersonal sensitivity than 38
controls.
Case: The patient is 56 year old, male, married for 25 years, with three
children. He didn’t complete primary school. He sought psychiatric
evaluation because his marital problems. They began two years ago,
after he abused a 15 year old girl. He reported having a troubled childhood with emotionally distant and verbally abusive parents. He was
sexually abused from two year old boy friend and his four year old
brother. He spend more then %50 his time with sexual fantasies, and
because of this he can not working. He meet the criteria proposed for
hypersexual disorder in DSM-V. He also meet the criteria of double
depression, obsessive compulsive disorder, enuresis nocturna and premature ejaculation.
Summary: Psychiatric comorbidity is the rule and not the exception
for persons with compulsive sexual behavior (8). The data of our case
is concordant with data of Black and colleagues (2), Kafka and Prentky
(9), and Raymond and colleagues (10).
328
ERECTILE DYSFUNCTION AND METABOLIC
SYNDROME
S.V. Hakobyan
Sexology, Yerevan State Medical University, Yerevan, Armenia
Aim: To determine the relationship between metabolic syndrome
(MS) and erectile dysfunction (ED) and to see which risk factors correlated the best with ED.
Methods: Seventy-nine cardiology clinic outpatients with coronary
artery disease (CAD) and lipid metabolism disorder were recruited.
They were categorized as having MS, hypertension (blood pressure
greater than 130/85 mmHg) and dyslipidemia. ED was classified based
on International Index of Erectile Function scores. Patients were
grouped into quartiles based on body mass index (BMI).
Results: The mean age of the patients was 56.6 years. ED was diagnosed in 59 (74.7 %) of the 79 patients. In the 38 patients with MS,
all had ED. ED was not significantly correlated with cholesterol levels,
but was found often in patients who had both hypercholesterolemia
and HT (P < 0.01). Nineteen(76 %) of the 25 patients who had dyslipidemia had ED. However, ED was not significantly correlated with
dyslipidemia (P > 0.05). Tweenty-two of the 23 patients who had BMI
greater than 30 had ED, which was significantly more prevalent than
that in those who had normal BMI (P < 0.01). ED was seen in 38 of
53 smoker patients. Although ED was more prevalent in cigarette
smokers, it was not significantly different from non-smokers (P > 0.5).
Conclusion: ED is present in a high percentage of patients with MS.
Among multiple risk factors for ED, MS correlates the most highly.
The next most important risk group is the patients with hypertension
+hypercholestrolemia and obesity (BMI > 30).
329
MANAGEMENT OF COMMON SEXUAL
DYSFUNCTION BY NON-SPECIALISTS: A
QUESTIONNAIRE SURVEY OF SPECIALIST
PRACTITIONERS’ OPINION
C. Hall, J. Craik, L. Melvin
Clinical Effectiveness Unit, Faculty of Sexual and Reproductive Health,
Glasgow, UK
Background: Sexual dysfunction is common in the UK. Of the men
and women reporting problems in NATSAL 2000, few seek help
and those that do commonly consult GPs. However GPs cite lack of
training, education and knowledge as barriers to managing sexual
dysfunction.
Objective: To survey opinion and local practices of specialists (defined
as practitioners that receive referrals and provide training in sexual
dysfunction) on clinical management, focusing on the patient pathway
and consultation with non-specialist practitioners.
Methods: Organisations with a membership that includes sexual dysfunction specialists were approached to provide a link to an online
survey to members. Potential participants were asked to only complete
the survey if they are specialists (defined above). Each organisation
provided the number of members forwarded the survey link. Questions
included demographics and qualifications of responder, and opinions
on history taking, examination, investigations, referral and training,
including free text responses.
Results: The following organisations participated.
Organisation
British Association of Sex and Relationship
Therapists
Royal Society of Medicine Special interest Group
British Association of Behavioural Cognitive
Psychotherapy
Sheffield Society for the Study of Sexuality and
Relationships and Leeds Sexuality Group
TOTALS
Number of members
emailed survey link
740
425
1058
179
2402
[Participating organisation]
Key findings will be reported when survey completed in January 2011.
Conclusion: To be completed (see above). The results of this survey
may inform the development of clinical guidance and training for
non-specialists in the management of sexual dysfunction.
330
WORKING WITH PATIENTS WHO
EXPERIENCE SEXUAL DIFFICULTIES AND
CHRONIC DISEASE
R. Hallam-Jones1, C. Sheppard2
1
Independent, Independent Psychotherapy Practitioner, 2Porterbrook Clinic,
Hallam University, Sheffield, UK
This patient population is propably the largest and least addressed
group and often few staff are trained and resourced to meet their
assessment and treatment needs.
The value of adequate, well tried patient material to aid their asking
for and receiving help is explored, and material for resourcing this
difficlty is suggested.
331
FREQUENCY AND CORRELATES OF SEXUAL
DYSFUNCTION AMONG WOMEN
ATTENDING OUTPATIENT
GYNECOLOGICAL CLINICS
A. Hamidi Madani, S.N. Tavakoli Lahijani, A. Farzan
Urology Research Center, Guilan University of Medical Sciences, Rasht, Iran
Objectives: Female sexual dysfunction is a high-frequent multifactorial problem and may have a major effect on the quality of life. This
study investigated the frequency of female sexual dysfunction and its
correlated factors in a group of women attending outpatient gynecological clinics.
Methods: A total of 300 married women attending 4 gynecological
outpatient clinics in Rasht, Iran were assessed. Sexual function was
assessed by FSFI questionnaire. Demographic characteristics, obstetric
and surgical history, some medical conditions and BMI, life style variants, knowledge about sexuality, and help-seeking behavior were
assessed by a self-created questionnaire.
Results: 76.67% of all women in this study reported sexual dysfunction in at least one domain. The total frequency of FSD according the
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166
low total FSFI score was 18.3%. The most frequent dysfunction was
desire disorders (63.7%). The frequency of other sexual disorders was
as pain disorders (35.7%), arousal disorders (34.7%), orgasmic disorders (16%), lubrication disorders (10.7%), and satisfaction disorders
(10.7%). Age (p < 0.0001), number of deliveries (p = 0.001), number
of children (p = 0.001), number of abortions (p = 0.042), menopause
(p = 0.0001), mode of delivery (p = 0.033), episiotomy (p = 0.035),
anemia (p = 0.028), psychiatric disease (p = 0.0001), psychotropic
medication use (p = 0.04), poor sexual knowledge (p = 0.048), husband’s age (p = 0.001) showed a significant statistical correlation with
low total FSFI score. Women who thought they had a sexual problem
were 15.3% of all subjects, of which 67.4% have had no professional
consultation about it.
Conclusion: Female sexual dysfunction was high frequent in women
attending gynecological clinics. Thus, physicians should be trained and
prepared to address this issue.
Results: The counsellor had 216 consultations with 69 new consultations and 147 follow-ups (New : FU ratio 1:2.1). The two doctors
carried out 152 consultations with a New : FU ratio was 1:1.7, with 89
patients identified, average age 40. The service is seeing 41 patients a
month, and has a growing waiting list. The audit clearly demonstrates
that psychosexual therapy is possible within a gynaecological outpatients setting. The brief interpretative psychodynamic therapy taught
by the IPM is ideal for use in this context. Duration of therapy is short.
55% patients had only one appointment, 83% were discharged by the
second appointment and 93% by the end of the third. 56% of these
89 patients were referred from the traditional catchment area of our
hospital. 10% were referred from within London but out of area, and
34% from outside of London.
Conclusion: There is a need for psychosexual services within gynaecology clinics and this can be provided without lengthy or time consuming follow up as is frequently perceived from specialist provision.
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334
SOMATOCOGNITIVE THERAPY IMPROVES
THE SELF-REPORTED PAIN LEVELS AND
RESPIRATION AND MOVEMENT PATTERNS
IN WOMEN WITH VESTIBULODYNIA
THE LEVONORGESTREL INTRAUTERINE
SYSTEM (MIRENA) FOR MENSTRUAL
CONTROL IN ADOLESCENTS WITH
MENTAL DISABILITIES
G.K. Haugstad1, E. Hakonsen1, T.S. Haugstad2
1
Oslo University College, Oslo, 2Sunnaas Rehabilitation Hospital, Nesodden,
Norway
Background: Somatocognitive therapy (SCT) has been developed as
a hybrid of physiotherapy and cognitive psychotherapy. It is a short
term body oriented therapy, where the goal is to achieve new body
awareness related to the activities of daily living and replace dysfunctional cognitive schema. In therapy the working alliance between
therapist and patient is of paramount importance. This study investigated whether short term SCT improves pain level, motor patterns
and self reported quality of life in patients with vestibulodynia (VD).
Methods: 10 women with VD were recruited to an Out Patient
Department, motor patterns assessed with the Standardized Mensendieck Test (SMT, assessing posture, movement, gait, sitting posture
and respiration), VAS score of pain and SF-36 assessing quality of life.
The patients received 12 sessions of SCT, with similar assessment after
therapy. Two patients were interviewed before and after treatment.
Results: The women averaged 24 years, pain duration 2.1 years. All
women were educated to a bachelor level or above. After therapy, VAS
scores were reduced on average 66 %, and for motor function assessed
with SMT, gait scores improved by 56 % and respiration by 88%, (see
also fig. 1). The women expressed less pain and more pleasure during
sex after therapy.
Conclusions: Somatocognitive therapy is a new approach that appears
to be very promising in the management of chronic gynaecological
pain. Short term outpatient treatment significantly reduces pain experience and improves motor function and patients express more pleasure during sexual function.
A. Huneeus, A. Schilling, O. Carrasco
Department of Obstetrics and Gynecology, Clinica Alemana, Santiago, Chile
Background: In girls with mental disabilities, just dealing with normal
menstruation is a complicated issue that can challenge hygiene and
psychological stability. We report experience with the levonorgestrel
intrauterine system (LNG IUS) for their menstrual control.
Cases: 4 patients 13 to 15 years old with mental disabilities were
referred for menstrual management. Developmental Delay; 3 cases,
Autism; 1 case. All caregivers desired to put them in amenorrhea, and
in one case, there were also concerns with contraceptive needs. One
family requested hysterectomy. Oral contraceptives had interactions
with other medications in three. The procedure was reviewed in
Clínica Alemana’s IRB. Two girls were unable to give consent and the
decision to treatment was given with caregiver consent on basis of their
best interest.
All but one participant required a day-case admission for a
brief general anesthetic. 3 hours before procedure all were given
400 mcg. of oral Misoprostol. After fitting, the correct localization of
the LNG IUS was confirmed by pelvic scan. The one participant that
did not require anesthesia was competent and not sexually active and
had it fitted uneventfully using local lidocaine gel in hymen and
introitus.
Outcome: The LNG IUD provided a scant bleeding pattern to all
patients after a very low risk intervention to fit it in. This resulted in
improved quality of life for these young women and their caregivers.
The additional contraceptive protection is an added bonus where vulnerability is a long term concern. There were no adverse events.
335
333
UP, UP AND AWAY—AN AUDIT OF AN
EXPANDING PSYCHOSEXUAL SERVICE
WITHIN A GYNAECOLOGY CLINIC
A. Hawkins1, C. Domoney2
1
Chelsea and Westminster Hospital, 2Obstetrics and Gynaecology, Chelsea
and Westminster Hospital, London, UK
Introduction: Over the last 3 years there has been an increase in
referrals to a teaching hospital gynaecology clinic of patients with
sexual difficulties.
Methods: The service consists of two gynaecologists who are Members
of the Institute of Psychosexual Medicine (IPM) and a BASRT trained
therapist. All patients seen under the lead clinician for a nine month
period were identified and the main clinical focus of the encounter was
ascribed from the consultation letter.
TWO PERSPECTIVES ON PROFESSIONAL
PSYCHOTHERAPEUTIC HELP FOR LGB
CLIENTS—DO THERAPISTS AND LGB
PEOPLE IN POLAND SHARE THE SAME
EXPECTATIONS?
G. Iniewicz1, B. Grabski2
1
Institute of Psychology, Jagiellonian University, 2Department of Psychiatry,
Collegium Medicum Jagiellonin University, Krakow, Poland
We would like to present the results of a study aiming at establishing
basic differences in the hierarchy of the expected therapeutic goals by
working with LGB clients between the subgroups of Polish LGB
people and Polish mental health professionals. The study design consists of a self-constructed semi-structured questionnaire to the
members of both groups. This was carried out by using the most
popular gay website and a mailing list of mental health professionals.
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The results will be discussed in the context of the minority stress
hypothesis and the continuously polarized views on homosexuality
(normal versus pathological variant of sexual development) in Polish
society.
336
EVALUATION OF SEXUAL FUNCTIONS AND
PATTERNS OF PATIENTS WHO UNDERWENT
PENILE AUGMENTATION SURGERY
S.-Y. Jang
LJ Genitourinary Surgery Institute, Seoul, Republic of Korea
Introduction: The number of men who wish to have penile augmentation surgery is increasing recently. We aimed to evaluate the sexual
pattern and function of people who had penile augmentation.
Methods: From 2004 to 2009, we studied 2900 patients who had
penile augmentation surgery using bovine collagen dermis or cadaveric
dermis. We had preoperative consultations for sexual history, medical
history and individual sexual life. And we asked the screening question
to patients “Do you have erectile problems?” The patients who
answered “Yes” or “unsure” completed the International Index of
Erectile Function (IIEF-5) for further evaluation of erectile function.
Results: Among 2900 patients studied, 1566 patients (54%) are
married and 1334 patients (46%) are unmarried. The frequency of
sexual intercourse is 1~2/week in 1798 pts (62%), 3~4/week in 348 pts
(12%), 5~6/week in 71 pts (2.45%), every day in 59 pts (2.05%) and
no intercourse in 624 pts (21.5%). According to preoperative time
survey, patients who answered “No” to the question about erectile
dysfunction were 1305 pts (45%), “yes” 1276 pts (44%) and “unsure”
319 pts (11%). Of 1595 patients who answer “Yes” or “unsure”, IIEF
scores above 45 is 622 pts (39%), score 30~45 is 415 pts(26%) and
below 30 is 558 pts (35%).
Conclusion: The patients who had performed by penile augmentation
surgery have variable sexual patterns and erectile functions. On the
basis of these results, we need to consider individual differences of
sexual patterns and erectile functions in the operative time and postoperative management.
337
CONSIDERATION FOR HISTOLOGIC
CHANGE AND SURGICAL RESULT IN PENILE
ENHANCEMENT SURGERY USING
ALLOGENIC DERMAL GRAFT
S.-Y. Jang
LJ Genitourinary Surgery Institute, Seoul, Republic of Korea
Introduction: Many kinds of materials including auto dermal fat graft,
bovine collagen graft and human cadaveric dermis (acellular allogenic
dermis) are used in penile girth enhancement. Among them, cadaveric
dermis is widely used in penile augmentation surgery because this
material is safe and convenient for performing surgery. This study is
to report the result of our surgical experiences using acellular allogenic
dermal graft.
Methods: We have performed 1400 penile augmentation surgeries
using acellular allogenic dermal graft. Pre-pubic minimal incision was
done and dissection using fingers and scissors was performed. Acellular
allogenic dermal graft (3~6 mm thickness) was fixed on the bucks’
fascia of the penile shaft with absorbable suture material. After dissecting fundi-form ligament, we closed transversely the pre-pubic dead
space with PDS 2.0. Subcutaneous tissue and skin were closed with
absorbable suture.
Results: Our follow-up period was from 2 weeks to 48 months
(average period was 4.6 months). We examined 12 patients by tissue
biopsy and could see histological well proliferated vessels. There was
no abnormal histological finding. Postoperative complications were
wound infection (17 cases), skin necrosis (2 cases) and graft failure (1
case) due to infection. But all complications were fixed with secondary
closure or conservative treatment.
Conclusion: In our experience, acellular allogenic dermal graft in
penile augmentation surgery was a very safe, effective material and
showed excellent histological findings.
338
TRENDS IN SEXUAL BEHAVIOUR AMONG
POLISH WOMEN BORN BETWEEN 1975
AND 1995
G.E. Jarząbek-Bielecka1, M. Durda2, M. Kaczmarek2
1
Division of Developmental Gynecology and Sexology, Department of
Perinatology and Gynecology, Karol Marcinkowski University of Medical
Sciences, 2Department of Human Biological Development, Faculty of Biology,
Adam Mickiewicz University, Poznan, Poland
The main objective of the study was to investigate changes in sexual
behaviour among Polish women born between 1975 and 1995. Sexual
initiation is a very important problem in adolescent gynecology.
Two hundred women, born in Wielkopolska voivodship were asked
to complete screening questionnaire. It was a self-reported inquiry
about the age at sexual iniciation, contraceptive use at first, preferred
forms of sexual activity and contraceptive use. Statistical evaluation was
based on the chi-square test and ANCOVA models.
The findings revealed the average age for sexual iniciation has
lowered significantly across subsequent cohorts of young women (F =
9.11, p).
The age, which Polish women start sexual activity has lowered
significantly across two consecutive decades among Polish women.
Early debut of sexual activity is believed to bring serious consequences,
including unintended pregnancy, emotional stress and STDs. The
right age to start having sex remains the topical issue both among
anthropologists and in public health.
339
CHRONOLOGICAL AGE AND PUBERTAL
DEVELOPMENT-EVALUATION FOR PURPOSE
OF CHILD-PORNOGRAPHIC MATERIALS
G.E. Jarząbek-Bielecka1, D. Lorkiewicz-Muszyńska2, M. Łabęcka2
Division of Developmental Gynecology and Sexology, Department of
Perinatology and Gynecology, Karol Marcinkowski University of Medical
Sciences, 2Department of Forensic Medicine, University of Medical Sciences,
Poznan, Poland
1
Sexual abuse of children comprises a broad range of sexual acts involving minors. These include touching with sexual intent, sexual intercourse and showing of pornographic material or sexual organs. The
problem of child pornography has increased highly in the past few
years. Experts from different disciplines are asked to rate such materials and verify the age of the victims represented in pornographic
material. It is a very difficult and often inaccurate analysis. There are
differences in age limit in each country’s legislation defining child
pornography, for example: below 18 years of age for the legislation in
the case of Italian, Franch, Canadian and American legislations, USA;
below16 in the case of Belgium, Switzerland, the Netherlands, Great
Britain; 14-in Germany, Austria. In Poland it is below 15 years of age.
Objective: The purpose of this study was to examine the relationship
between chronological age and pubertal development in children.
Methods: The study included 423 females, ranging in age from 13 to
18. Pubic hair and breast development were rated according to
TANNER. Axillary hairs were rated. Measurements (body height,
weight) were determined by standard anthropometrical methods. Body
mass index (BMI) was calculated.
Results: Using a test based on the Chi-square analysis a correlation
between chronological age and analyzed features of pubertal development was demonstrated.
Conclusions: We concluded that there is an association between
pubertal development and chronological age in children. It is possible
to establish only developmental age, not chronological age of the
victims, represented in pornographic material.
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340
FEMALE SEXUAL DESIRE: THE ROLE OF
PSYCHOSOCIAL FACTORS ON
SPONTANEOUS VERSUS RESPONSIVE
DESIRE
L. Junot Rocha1, P. Nobre2
1
Universidade de Trás-os-Montes e Alto Douro/Universidade de Aveiro, Vila
Real e Aveiro, 2Unidade Laboratorial Investigação Sexualidade Humana—
Universidade Aveiro, Aveiro, Portugal
Aim: Evaluate the role of psychosocial variables in women with difficulties in spontaneous versus responsive sexual desire: sexual beliefs,
psychopathology, sexual functioning, dyadic adjustment and automatic
thoughts during sexual activity.
Methods: A total of 107 women participated in the study, 34 women
in the Control Group (without sexual problems), 43 in the Low Spontaneous Desire Group and 30 women in the Low Global Desire Group
(Low Spontaneous and responsive Sexual Desire). The participants
answered to different questionnaires: Sexual Dysfunction Inventory
(Sbroco, 1992), Brief Symptom Inventory (Derogatis, 1982), Female
Sexual Function Index (Rosen et al., 2000), Dyadic Adjustment Scale
(Spanier, 1976), Sexual Modes Questionnaire (Nobre & Pinto-Gouveia,
2003) and Sexual Dysfunctional Beliefs Questionnaire (Nobre & PintoGouveia, 2003).
Results: Women in the Low Global Desire Group exhibit significantly
lower rates of dyadic adjustment and higher sexual dysfuntional beliefs
regarding the body, age and sexual conservatism, lower levels of sexual
functioning and higher frequency of negative automatic thoughts
during sexual activity compared to the Control and the Low Desire
Spontaneous Group. Additionally, women in the Low Global Desire
Group showed significantly higher levels of psychopathology, namely
depression, paranoid ideation, anxiety, and hostility when compared to
the Control Group.
Conclusions: These results suggest that women with low spontaneous
sexual desire but without difficulties in responsive sexual desire are
closer to women without sexual problems than to women with low
global sexual desire, supporting the DSM-V proposal for the exclusion
of this first group of women from the Sexual Interest / Arousal
disorder.
341
PROVIDING LEVEL 2 SEXUAL HEALTH
SERVICES IN A RURAL GP SETTING: A CASE
STUDY EXAMPLE FROM ENGLAND
R. Kane, Z. Davy, N. Siriwardena
University of Lincoln, Lincoln, UK
Introduction: In 2009 a level 2 (enhanced level of care) pilot service
was set up in a rural GP practice in England with the aim of meeting
the requirements of the local community and providing a clinical
learning environment for clinicians.
Objective: To present the results of its evaluation.
Aim: The aims of the evaluation were: assess the extent to which the
clinic is achieving its two key aims conduct a cost-benefit analysis of
clinic activity to date.
Methods: A range of data collection methods were used including the
use of existing data where possible. Key sources included routinely
collected clinical data, content analysis of policy documents, analysis
cost data, participant observation, a survey of users and in-depth interviews with users and providers.
Results: This evaluation has provided good evidence that the clinic is
providing a valued service to the local population, illustrating a successful approach to the provision of sensitive services in a rural setting.
Conclusion: The study identified a high quality safe and effective
service resulting in positive patient experience. The service approach
is holistic, flexible, non-judgemental, patient centred and confidential.
The clinic provides a good training environment, with the opportunity
for the nurses and GpswSI to work alongside the GU consultant.
Patients needing level 3 services benefit by the involvement of the GU
168
consultant as their care can be managed at the clinic thus removing
the need to refer to a GUM clinic.
The evaluation also revealed areas for improvement and made recommendations for future delivery.
342
CLINICAL RESULTS OF PENILE
AUGMENTATION SURGERY BY INJECTABLE
MICRONIZED HUMAN DERMAL TISSUES
J.Y. Kim, P.B.M. Kim, P.S.J. Kim
Philip & Paul Medical Institute / Manomedi Clinics, Seoul, Republic of
Korea
Introduction & objectives: Penile augmentation surgery with tissue
grafts through incision so far has been performed with; however, there
might be adverse effects such as a wound problem, a scar, prolonged
recovery time. Another augmentation method is the injection of chemical filler or fat but there is the disadvantage of histological instability,
migration and a high reabsorption rate. We are to introduce new
methods using acellular human dermal tissue with injection.
Material & methods: The surgery was done for men with a small
penis complex. Under the local anesthesia, according to the size of the
penis and the augmentation size the patient desired, about 3–6 cc of
dried acellular particulate dermal matrix combined with 1.5–1.8 cc of
lidocaine and 0.3 cc of gentamicin per 1 cc of the tissue were injected.
Results: Retrospective investigation was done for this study with 121
cases from December 2007 to December 2009. 4 cc of acellular
micronized dermal tissues on average were used and the average
surgery time was 20 minutes. 2 cases of local skin necrosis were
reported but it was treated through the conservatory treatment. There
was little migrartion of the injected tissues.
Conclusions: This surgical method does not require an incision and
resulting in short operation and rapid recovery time. There are few
side effects. Therefore, for the men who experienced difficulty with
penile augmentation surgery with the preexisting techniques, for
example, those who had physical health problems, or were of an older
age, or were on special medications, this surgical method could be
recommended.
343
CLINICAL RESULTS OF PENILE
REAUGMENTATION USING XENOGRAGFT
J.Y. Kim, P.B.M. Kim, P.S.J. Kim
Philip & Paul Medical Institute, Seoul, Republic of Korea
Introduction and objective: Since the 1990s when penile augmentation surgery using autologous dermal-fat and fat injection were introduced, surgical techniques utilizing diverse kinds of augmentation
materials have been conducted, such as allografts, xenografts, and
chemical fillers. However, in some cases when the patient has a higher
expectation or when shape improvement is required, secondary reaugmentation may be necessary.
Methods: The reaugmentation surgery was conducted by using
xenogrfts. For the xenogenic(bovine) implant, type I collagen was used.
It Through a transverse incision at the distal penis, girth enhancement
was performed. After separating the existing grafted area from the
Buck’s fascia. Then, the prepared graft was anchored and sutured to
the Buck’s fascia.
Results: Retrospective analysis was conducted on procedures performed between July 2005 and July 2009. This study included 67
patients with the following first augmentation surgery in the past:
autologous dermal fat graft (43.3 %); silicon injection (26.9 %); xenograft (13.4 %); autologous fat graft (7.5 %); allograft (4.5 %); hyaluronic acid injection (3.0 %); restorative scaffold (poly lactic-co-glycolic
acid) insertion (1.5 %). The diameter of the penis had increased by 5.6
± 1.2 mm. Active treatment was required in 2 cases (3 %): removal of
the graft because of infection.
Conclusions: Penile reaugmentation surgery with xenogenic type I
collagen has the advantages of being a simple surgical procedure and
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fewer complications. For the patient group that received penile augmentation surgery with diverse materials in the past, The use of xenogenic type I collagen in this procedure also demonstrated a effective
profile.
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CLINICAL EVAULATION OF THE LIFELONG
PREMATURE EJACULATION THAT
EJACULATES LESS THAN ONE-MINUTE
INTRAVAGINAL EJACULATION
LATENCY TIME
J.Y. Kim, P.B.M. Kim, P.S.J. Kim
Philip & Paul Medical Institute, Seoul, Republic of Korea
Purpose: This study aims to analyze sexual activity patterns and the
results of clinical laboratory studies of the patients with lifelong premature ejaculation of less than 1 minute IELT.
Method: The subjects were those who ejaculated within 1 minute, did
not have any other disease history, and no other sexual dysfunction. In
this study, their sexual activity patterns were researched, penile sensitivity test, blood test, and prostatitis test were conducted.
Results: The number of subjects were 122. The threshold of biothesiometry was 5.1 ± 1.6 and 32(26.2%) of them showed less than 4
threshold level. All were normal in the prostatitis test . Their thyroid
hormone levels were T3 1.1 ± 0.3 ng/ml, and T4 8.3 ± 1.7 mg/dl,
respectively. 6(4.9%) of them showed hypothyroidism while 3(2.5%)
of them showed hyperthyroidism. The level of total testosterone and
free testosterone was 514 ± 193 ng/dl and 12.6 ± 5.2 pg/ml, respectively. 4(3.3%) of them had increased level of testosterone. Their
leptine level was 3.9 ± 3.9 ng/mL and 75.5% of the subjects showed
prolongation of the ejaculatory latency after using anesthetic cream.
As for the question about the reason of their premature ejaculation,
54.5% responded that it was due to penile hypersensitivity.
Conclusion: In case of consulting the patients with lifelong premature
ejaculation of less than 1minute IELT, it may be considered to take
thyroid function test, testosterone hormone test and biothesiometry
as a selective test. As for treatment, along with the generally-used drug
therapy such as SSRIs and behavioral therapy, it is recommended to
use penile sensitivity approach.
Conclusion: Though the patients group was small in number, this
study was meaningful for reference in treating patients with very
severe premature ejaculation. Not only the neurobiological access
using SSRIs drug, but also the method to decrease penile sensitivity
can be considered for treating the patients with severe premature
ejaculation.
346
SEXUAL AROUSAL AND STROOP EFFECT:
DIFFERENCES BETWEEN MEN WITH AND
WITHOUT SEXUAL DYSFUNCTION WHEN
EXPOSED TO EROTICA
P.N. Laja, P.J. Nobre
Departamento de Ciências da Educação, Universidade de Aveiro, Aveiro,
Portugal
This study aims to evaluate sexual arousal and response to a modified
stroop test in men with and without sexual dysfunction when exposed
to erotica. A total of 40 men (20 with sexual dysfunction and 20 sexually healthy) will participate in this experimental study. Participants
will be exposed to three sexually explicit films while being assessed for
genital arousal (using indium gallium gauges), heart rate, and skin
conductance. After each film, participants will answer to a list of likert
scales assessing: subjective sexual arousal, affect (PANAS), cognitive
schemas (QCSASC), and automatic thoughts (SMQ). Between films 2
and 3 a feedback manipulation will be given to all participants. The
experimenter will enter the room and will give a neutral feedback
information related to a bogus technical problem involving the experiment. After the neutral feedback, both groups will answer to PANAS
and QCSASQ before watching a third film. At the end of the third
film participants will be asked to perform a modified stroop test, with
three sets of words: positive, negative and neutral. These words will
include general topics as well as topics related to sexual performance/
expectancy. We expect to find lower levels of sexual response to the
films in the clinical group. We also expect to find an increase on negative schemas in the clinical group, after the neutral feedback is given
and a decrease on sexual response to the third film. Additionally, we
expect to find a stroop effect for the negative set of words in the clinical
group.
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CLINICAL EVALUATION OF THE PATIENTS
WITH EJACULATION THAT ALWAYS OCCURS
PRIOR TO OR WITHIN 10 SECONDS OF
VAGINAL PENETRATION
LEGAL, SOCIAL AND PSYCHOLOGICAL
ASPECTS USING THE CONCEPT OF
“PAEDOPHILIA”
J.Y. Kim, P.B.M. Kim, P.S.J. Kim
Philip & Paul Medical Institute, Seoul, Republic of Korea
Purpose: Few clinical researches has been done on lifelong premature
ejaculation that ejaculates before or immediate after the insertion. This
study reports clinical characteristics of the patients who have severe
lifelong premature ejaculation.
Method: The subjects were those who repeated ejaculation before or
immediate after (less than 10 seconds) the insertion. Their sexual
behavioral patterns were researched, penile sensitivity test, blood test,
and prostatitis test.
Results: The study was conducted on 39 patients. The threshold of
biothesiometry was 4.75 ± 1.2 and 14(36.8%) of them showed less then
4. In the prostatitis test, they were all turned out to be negative. The
average PSA was 0.93 ng/ml. Their thyroid hormone levels were T3
1.2 ± 0.2 ng/ml, and T4 8.2 ± 1.3 mg/dl. 1(2.6%) showed hypothyroidism while 1(2.6%) showed hyperthyroidism. The total testosterone
and free testosterone were 489 ± 132 ng/dl and 12.7 ± 4.7 pg/ml.
1(2.6%) of them showed increase in testosterone. The leptine was 3.1
± 1.98 ng/mL. 73.7% of the patient responded that they had prolongation of the ejaculatory latency after applying anesthetic cream. On the
question asking “What do you think of the reason of your premature
ejaculation?”, 55% responded to penile hypersensitivity.
T. Langfeldt
Institute for Clinical Sexology and Therapy, Oslo, Norway
In the last three decades the concept of paedophilia has become a
dehumanized and confusing concept although it still is a diagnosis in
the DSM IV. Paedophilia as a sexual orientation has no root in scientific research but in a social movement for acceptance that also took
place in England in the nineteen seventies. The social and moral panic
concerning paedophilia as presented in the media is a serious challenge
for therapists and scientists. Clinical experience and empirical research
seems to indicate a change in the understanding of men and women
who sexual abuse children. This presentation is a contribution to a
more scientific understanding with implications for therapy, but can
science compete with media.
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348
350
SELF-PERCEPTION OF SEXUAL LIFE AMONG
WOMEN AFTER GYNECOLOGIC CANCER
TREATMENT: WHAT SHOULD
ONCOLOGISTS ATTEMPT FOR?
THE IMPACT OF PHYSICAL EXERCISE AND
PELVIC FLOOR MUSCLE TRAINING ON
SEXUAL FUNCTION AND MOOD IN
POSTMENOPAUSAL WOMEN
L.A.S. Lara1, J.M. Andrade2
Sexual Medicine Service, Department of Gynecology and Obstetrics, 2Faculty
of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
1
The return to sexual intercourse after gynecologic cancer treatment
often requires the assistance of a professional with sexual therapy
qualification.
Objective: To determine the impact of the diagnosis and treatment of
gynecological cancer on the sexuality and to learn about their selfevaluation regarding the quality of their sex life after treatment of
gynecological cancer.
Method: This study was based on the survey of the medical records
of gynecologic cancer survivor sexually active women with a stable
relationship with sexual complaints who received sexual guidance and
sexual therapy.
Results: The mean age of the women studied was 48.3 ± 8.2 years.
They reported feeling of insecurity and inhibition regarding the initiation of sexual relations and insecurity about the feelings of their partners toward them. Sixteen of them underwent surgical treatment
associated with chemotherapy and/or radiotherapy, and 14 underwent
surgery only. After cancer, the women experienced a significant worsening of the quality of their sex life (p < 0.01). The frequency of sexual
relations (SR) was significantly reduced after treatment (SR before: 2.7
± 2.6 per week versus 1.2 ± 1.4 per week after p = 0.006).
Conclusion: Indeed these women experienced a significant worsening
of the quality of their sexual life, which was confirmed by objective
data showing that, in addition to the occurrence of a significant reduction of the number of sexual relations, there was a significant proportion of women who admitted that the quality of their sex life had
worsened.
349
MARITAL INFERTILITY MAY INTERFERE
WITH SEXUALITY, ESPECIALLY IN MEN
S.R.B. Ferraresi1, L.A.S. Lara2, A.C.J.D.S. Rosa e Silva1
Faculty of Medicine of Ribeirão Preto, 2Sexual Medicine Service, Department
od Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, Ribeirão
Preto, Brazil
1
Introduction: In recent years, changes in society have witnessed the
increased inclusion of women in the job market, as well as new methods
for family planning. Such changes have resulted in an increase in the
average age at which couples begin to have families. This has led to
an increased demand for assisted reproductive therapy as an alternative
to infertility treatment.
Objective: To evaluate the sexuality of infertile couples
Method: To this literature review the studies selected for inclusion
used sexual functioning self-report assessments or quality of life questionnaires that included sexual satisfaction. The studies were separated
by gender. All of these articles have, as a central element, the assessment of sexual health in the presence of infertility.
Results: Despite the large number of articles on the topic, there are
limited studies that confirm the impact of infertility on sexual functioning. In general, the papers presented do not have a control group and
use subjective evaluations that are based on qualitative studies, which
hinder more definitive conclusions.
Conclusion: Infertility may represent an anxiogenic factor, and
thus adversely affect both women and specially men undergoing
assisted reproductive treatment. To better address and prevent the
effects of infertility treatment on sexual functioning in these couples
after treatment, greater support by the professionals involved is
needed.
L.A.S. Lara1, M.L. Montenegro2, M.M. Franco1, D.C.C.A. Abreu1,
A.C.J.D.S. Rosa e Silva1, C.H.J. Ferreira1
1
Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil, 2Faculty of
Medicine of Ribeirão Preto, Ribeirão Preto, Bulgaria
Introduction: It is unknown whether physical exercise has a positive
effect on sexual function of continent women after menopause.
Aims: To assess sexual function and mood of postmenopausal women
underwent to a physical exercise protocol (PEP).
Methods: Thirty-two sedentary women with a maximum of five years
post menopause with FSH ≥ 40 mIU/ml were selected for this longitudinal study. They possessed the ability to contract the pelvic floor
muscles (PFM), which was assessed by vaginal bimanual palpation.
The muscle strength was graded according to the Oxford Modified
Grading Scale (OMGS). A protocol of physical exercise (PEP) was
conduct twice a week for three months, and at home three times a
week. They completed both the Sexual Quotient-Female Version
(SQ-F) and the Anxiety and Depression Hospitalar Scale (ADH)
before and after the PEP.
Results: There was a significant increase in the second OMGS score
in relation to the first OMGS score (OMGS score 1 = 2.59 ± 1.24,
OMGS score 2 = 3.40 ± 1.32, p < 0.0001). There was a significant
decrease in the number of women suffering from anxiety after treatment (p < 0.01).
Conclusion: Although the implementation of the protocol of physical
exercise was effective for controlling anxiety and improving pelvic
floor muscular strength in sedentary and continent of urine menopausal women, it did not provide a positive impact on the their sexual
function. Possibly, others uncontrolled variables such as long-term
relationship and menopause status have affected our results. This suggests the need of a randomized controlled trial to confirm the results
of the present study.
351
BETWEEN THE POLES OF PATHOLOGICAL
SEXUAL SADISTIC ABUSE AND NONPATHOLOGICAL KINKY BDSM
J. Lemmer1,2,3
Academy for Sexology, 2CSHP—Council for Sexual Health Practitioners,
Pretoria, South Africa, 3Member, SSSS, Allentown, PA, USA
1
Non-pathological kinky BDSM can easily be confused with pathological sexual sadism and vice versa. The consequences of this confusion
proved to be devastating to society if not urgently clinically addressed.
Many innocent people suffered severely in the past because of this
confusion, many vulnerable women, men and children became victims
of sexual abuse and dangerous pathological sexual criminals got away—
all because of this confusion. A clear (although not absolute) clinical
distinction is long overdue.
The pathological sexual sadist is vaguely diagnosed in DSM IV TR
and it does not reflect the valuable research of Fromm, Dietz, Hazelwood and others in this regard. On the other hand a lot of research
was done on non-pathological kinky BDSM in recent years by Gabriele Hoff, Charles Moser, David Stein, Gary Switch, William Henkin
and others.
An in-depth analysis of the sexual sadist as “the great white shark of
sexual crimes” (Hazelwood 1990) is illustrated with a recent case study
in South Africa (2010) with clinical reports from various psychologists
as well as forensic criminologists.
An equal important in-depth analysis of the SSC (Safe Sane Consensual) and the RACK (Risk-Aware Consensual Kink) principles in
BDSM is also given.
Appreciating and researching both sides of the spectrum result in
a sexological praxis theory on pathological sexual sadism and non-
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pathological kinky BDSM aimed at more reliable clinical diagnoses which are
scientifically grounded and empirically observed. (Lemmer 2010)
Conclusion: The results demonstrate that explanatory variables can
interact to affect sexual function throughout pregnancy.
352
354
SEXUAL FUNCTION IN SCHIZOPHRENIA
WILL A SEXOLOGIST IN IMPROVE SEXUAL
FUNCTION AFTER PROSTATE CANCER
SURGERY?—A PROSPECTIVE
INTERVENTIONAL STUDY
D. Lin1,2, M.-A. Handler1, A. Buchanan1, S. Wu1, M. Cabrera1,
E. Urbina1, C. Snyder1
1
Department of Psychiatry and Behavioral Sciences, Beth Israel Medical
Center, 2Department of Psychiatry and Behavioral Sciences, Albert Einstein
College of Medicine, New York, NY, USA
Objective: This study surveys patients with schizophrenia or schizoaffective disorder, to understand the relationship between sexual function and treatment with antipsychotic medication. The study compares
patients on single versus multiple antipsychotics as well differences
between first and second generation agents.
Design and methods: Patients diagnosed with schizophrenia or
schizoaffective disorder at Beth Israel Medical Center are eligible.
Once patients are evaluated to ensure they meet enrollment criteria and
are consented, they are administered the Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS),
and either the International Index of Erectile Function for men, or the
Female Sexual Function Index for women. Inclusion criteria include
age 18–65, able to participate in a structured interview, fulfill DSM-IV
criteria for Schizophrenia or Schizoaffective disorder, and on stable
doses of one or more antipsychotic medications for at least six weeks.
Exclusion Criteria include patients taking Selective Serotonin Reuptake Inhibitors (SSRIs), and inability to provide informed consent.
Results: Presently, data suggests sexual function is impaired secondary
to antipsychotic use. However, because the number of completed
surveys is limited, further extrapolation of data is pending further
enrollment. A projected number of 30 participants is expected by
spring 2011.
Conclusions: Preliminary results are limited due to difficulties with
enrollment and further data is needed to draw clear conclusions. Barriers encountered include concommitant SSRI use, patient non compliance with appointment, lack of financial incentives for enrollment,
and patient reluctance to discuss sexuality.
C. Ljunggren, D. Musa, S. Samuelsson, I. Helen, E. Jacobsson, P. Stroberg
Dept of Urology, Lansjukhuset Ryhov, Jonkoping, Sweden
Objective: To evaluate if a clinical sexologist improves the outcome
of sexual rehabilitation after prostate cancer (PC) surgery
M and M:
In 2008: 25 sexually active men (49-68 yrs;) hade surgery due to PC,
12 patients had bilateral nerve sparing (BLNS), 9 had unilateral nerve
sparing (ULNS) and 4 had non nerve sparing (NonNS) surgery. All
were enrolled in a penile rehabilitation (PR) program The patients
received A) no treatment, B) oral PDE-inhibitors, C) Intrauretral
prostaglandin-E1 (pGE1), D) Intracavernousal pGE1, or any combination of B, C and D. Followed up at 1, 3, 6, 9, months with adjustments of therapy according to function. Outcome evaluated at 12 mths.
In 2009: a sexual medicine rehabilitation (PSM) program started with
a clinical sexologist (CLS) who evaluated the patient and partner prior
to surgery, followed them at 1, 3, 6, months (+extra visits PRN) and
instituted cooping/ intervention therapy when needed. Thirty-seven
potent and sexually active men (49-67 yrs) who had a dVP due PC
were enrolled, 21 had BLNS, 10 had ULNS and 6 had NonNS
surgery. Outcome at 12 mths.
Results:
CG: At 12 months 61% were sexually active with penetrating sexual
activity (PSA) regardless if nerve sparing or NonNS procedure.
SG: At 12 months all 37 had been able to perform PSA and 89% were
sexually active with PSA regardless of nerve sparing or NonNS procedure, 14 patients hade additional CLS visits, 9 with short-term
cognitive behavior therapy.
Conclusion: A clinical sexologist in a sexual rehabilitation program
appears to improve the outcome of sexual function after dVP regardless of procedure.
353
DETERMINANTS OF SEXUAL FUNCTION IN
EARLY, MIDDLE, AND LATE PREGNANCY
S.R. Chang1, K.H. Chen2, H.H. Lin3
1
School of Nursing, National Taiwan University, Taipei, 2Chung Tai
University of Medicine and Technology, Taichung, 3Department of Obstetrics
and Gynecology, National Taiwan University, Taipei, Taiwan R.O.C.
Aim: The purpose of this study was to examined the determinants of
sexual function during early, mid-, and late pregnancy.
Methods: A cross-sectional investigation was performed in 663 pregnant women who completed the Taiwanese version of the Female
Sexual Function Index, the Body Image Scale for Pregnant Women,
obstetric history and a demographic questionnaire. Stepwise multiple
regression analyses were used to test several explanatory variables for
sexual function during three trimesters.
Results: During early pregnancy, reported discomfort during pregnancy negatively affected sexual function (-1.90, p = 0.0009). Interestingly, having experienced infertility and having a college education had
a combined negative effect on sexual function (-0.21, p = 0.0047).
During mid-pregnancy, women who were employed full-time reported
higher scores for sexual function (5.27, p = 0.0023) than those without
full-time work. A higher body image score had a stronger negative
effect on sexual function for women with full-time work (-0.05, p =
0.0322). Infertility experience had a negative effect on sexual function
(-2.16, p < 0.0001). During late-pregnancy, gestational age had a negative effect on sexual function (-0.66, p = 0.0036). Having utilized
assisted reproduction also had a negative effect on sexual function,
but only among women belonging to the HoLou ethnic group (-0.21,
p = 0.0102).
355
VULNERABILITY FACTORS ON WOMEN’S
SEXUAL FUNCTIONING: RELIGION, SEXUAL
DYSFUNCTIONAL BELIEFS AND GUILT
M. Lopes1, P. Nobre2
Universidade de Trás-os-Montes e Alto Douro, Vila Real, 2Universidade de
Aveiro, Aveiro, Portugal
1
Aim: The aim of this study was to assess the role of religion, sexual
dysfunctional beliefs and guilt, on women sexual functioning.
Methods: A total of 199 women from the general population participated in the study and answered the following auto-reply questionnaires: Introductory Questionnaire, Francis Scale of Attitude Towards
Christianity (FSAC; Francis & Stubbs, 1987), Positive and Negative
Affect Schedule—Expanded Form (PANAS-X; Watson & Clark,
1994), Female Sexual Function Index (FSFI; Rosen et al., 2000), and
Sexual Dysfunctional Beliefs Questionnaire (QCSD; Nobre, PintoGouveia, & Gomes, 2003).
Results: The results suggest that religiosity level doesn’t present any
significant relationship with women sexual functioning, neither with
conservative sexual beliefs, beliefs on sexual desire and pleasure as sin,
and guilt (guilt-trait and guilt-state). Women with dysfunctional sexual
beliefs had more difficulty in sexual functioning and experienced more
guilt during sexual activity. Of the variables studied, the conservative
sexual beliefs were the only significant predictor of sexual functioning.
Women with guilt proneness (guilt-trait) experienced more guilt emotions during sexual activity (guilt-state), and also presented more difficulties in sexual functioning.
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Conclusions: The results of this study support the importance of the
role of cognitive-emotional factors, such as sexual dysfunctional beliefs
and guilt, on women sexual functioning.
356
MYOMAS AND SEXUAL FUNCTION
J. López-Olmos
Centro de Especialidades Monteolivete, Valencia, Spain
Objective: To study the sexual function of women with myomas in
prospective form during one year, in no sexual desire , no arousal , no
orgasm and dyspareunia, and pelvic pain , comparing with controls.
Design and method: During the 2009 year, in the consult of the
author, we retake 172 women with myomas of 3–5 cm in the major
diameter, and 80 women with myomas of >5 cm in the major diameter.
We compared both groups with control groups age-paired. Also, we
compared the two myomas groups between. With personal interview
we questioned the sexual facts.
Results: We indicate the significant statistical differences more importants. In the group of myomas 3-5 cm, there were statistical differences
in medical antecedents, p < 0,001; in no sexual desire, p < 0,01;
in vaginal dryness, p < 0,05; in subserosal myomas, p < 0,001, and in
equal size of myoma at one year, p < 0,001. In the group of myomas
of >5 cm, there were statistical differences in no sexual relations, p =
0,02; in intramural myomas, p < 0,001; in increase size of myoma at
one year, p < 0,001, and in pain, p = 0,02. No significant differences
were found in the sexual parameters (sexual desire, arousal, orgasm,
and dyspareunia, nor in vaginal dryness) between each group and their
controls.
357
VAGINAL INFECTIONS AND CELLULAR
CERVICAL LESIONS (III). CHARACTERISTICS
OF SEXUALITY
J. López-Olmos
Centro de Especialidades Monteolivete, Valencia, Spain
Objective: To study the characteristics of sexuality in a series of
patients: 399 with vaginal infections and 32 with cervical cellular
lesions, diagnosed by cervicovaginal cytology, during 1 year.
Materials and methods: We performed personal interview to ask
about sexual intercourse or not, and their causes; sexual desire, arousal,
orgasm, dyspareunia, vaginal dryness, coitus frequency, contraceptive
methods, anal coitus and simultaneous multiple sexual partners. We
compared with a control group of 252 women without vaginal infections nor cervical lesions.
Results: The women of the infections and lesions group are younger,
mean 34 years, and there is more nulligravides (33,25 %), p < 0,001.
In 60,23 %, they don’t used contraceptive methods. The most used
were the pill in 14,31 % and the condom in 12,23 %. In 70 cases (16,27
%), they don’t have intercourse because didn’t have a sexual partner at
this moment. The coitus frequency was one time a week in 20 %.
The characteristics of the sexuality :
—
—
—
—
—
—
no sexual desire in 45,15 %
no arousal in 32,5 %
no orgasm in 21,94 %
dyspareunia in 43,88 %, greater than control group, p < 0.001.
They practised anal intercourse in 15,83 %
They had simultaneous multiple sexual partners in 2,5 %.
358
GENDER IDENTITY DISORDER AND DSM V
L.M. Lothstein
The Institute of Living, Hartford, CT, USA
The object of the study is a review of the research on Gender Identity
Disorder (GID) and the presentation of research findings that under-
172
scores the implicit and explicit dangers of the diagnosis, especially for
children and other vulnerable populations. The methods employed in
this study are both qualitative and quantitative. Research to date suggests that male crossdressing in childhood may be a biomarker of later
homosexual development. It may also be a prolonged developmental
stage or a product of family dynamics that have not been addressed.
Crossdressing many also serve, in both sexes to respond to issues of self
destabilization and reparative self functioning involving symptom activation versus disorder characteristics. A unique case of a father-son
“transsexual” solution is presented to highlight all of these difficulties.
The diagnosis of GID in childhood is particularly pernicious and
should not be included in DSM V since the behavioral presentation
may reflect the final common pathway of many interacting motives
including a biomarker for later homosexuality in males (40% of male
homosexuals report crossdressing during their childhoods) and influenced by the politics of the status quo in a binary gender model. The
introduction of a “disorder concept” into the diagnostic mix can alter
developmental trajectories and do harm to a child’s normative development. Moreover, research in the neurosciences is only now beginning
to highlight the bio- psycho social links between brain neurocircuitry
and behavioral outcomes related to transgenderism (reported to be
occurring at the rate of 1/250 births in the USA).
359
THE ORGASMIC WOMAN—A TRAINING
PROGRAM FOR SEXUAL WELLBEING:
RESULTS FROM THE FOLLOW UP STUDY
F. Makaja Milicevic, A. Sartorius, Y. Zehnder
Komaja Foundation, Gersau, Switzerland
“The Orgasmic Woman” is an intensive three month self-training
program for healthy women who would like to enjoy their sexuality
more and enhance their sexual well-being. It consists of techniques
from the cognitive-behavioural and hypno-therapeutic fields and from
Komaja’s tantric training. The follow up study involved 43 women who
did daily exercises and regularly filled out a diary on the process. The
participants had a contact person as a supervisor whom they could
contact when necessary. There was also a control group.
The effectiveness of the training has been measured (with pretraining and post-training comparisons) and the training was evaluated
by using the FSFI (Female Sexual Function Index), a validated 19 item
multi-dimensional self-report instrument which is extraordinarily
useful to determine responses to sexual training programs. We also
evaluated the diary entries and a final questionnaire with 52 partially
open questions.
The training was significantly successful in improving sexual satisfaction and sexual arousal (p < 0.05*), which are some of the key
dimensions of female sexual function and the central focus of our
training.
Overall, pilot and follow up studies (n = 78) showed a significant
effectiveness in improvement of sexual satisfaction. Additionally,
women without tantric schooling from both studies (n = 42) showed a
significant effectiveness in improvement of sexual arousal (p < 0.05*).
The participants found the training very helpful for their sexual
wellbeing. Especially women without tantric schooling had great
benefit from the program. The program gives a clear evidence for a
very valuable therapeutical effect.
360
ERECTILE DYSFUNCTION IN MEN WITH
HIGH CARDIOVASCULAR RISK AND
METABOLIC DISORDERS
M. Mamedov, G. Sharvadze, E. Poddubskaya, A. Kontsevaya
Risk Factors Correction, National Research Center for Preventive Medicine,
Moscow, Russia
Objective: To evaluate the frequency of androgen deficiency and erectile dysfunction (ED) in men with metabolic syndrome and high cardiovascular risk on SCORE.
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Methods: The study included 300 men aged 30-59 with metabolic
syndrome (IDF criteria, 2005) and high cardiovascular risk on SCORE
(>5%). All participants were measured HDL cholesterol, LDL cholesterol, triglycerides and fasting glucose as well as waist circumference
and BP. Androgen deficiency was diagnosed if level of total testosterone was decreased (<12 nmol/l) and/or level of free testosterone was
decreased (<0,255 nmol/l ) and if symptoms of hypogonadism were
present. ED was evaluated by IIEF (<21 points).
Results: Androgen deficiency was diagnosed in 17% (n = 52) of men
with metabolic syndrome and high cardiovascular risk, but ED—in
60,7% (n = 182). In all cases androgen deficiency was combined with
ED of different degrees (18% mild, 33,7% mild-moderate and 9%
moderate). Hypogonadism was diagnosed in 28,6% of patients with
ED and high cardiovascular risk. Among men with ED (including the
subgroup with hypogonadism). The patients with ED in 22,6% had 3
component, 29,4%—4 component and 8,7% of men had all 5 components of metabolic syndrome.
Conclusion: Every second man with metabolic syndrome and high
cardiovascular risk has ED, one third—hypohonadism. Most of men
with ED had mild to moderate ED, the treatment include risk factors
correction and using of inhibitors of phosphodiesterase 5.
361
FEMALE SEXUALITY AND TOTAL HIP
REPLACEMENT
C. Matzaroglou1, K. Assimakopoulos2, P. Megas1, C. Georgiou1,
E. Panagiotopoulos1
1
Department of Orthopaedics, 2Department of Psychiatry, University of
Patras, Patras, Greece
Introduction/Objectives: The purpose of this paper is the evaluation
of female sexual functions, in patients with total hip replacement in
comparison with healthy subjects.
Patients and methods: A total of 46 patients with sexual activity were
included in the study after total hip replacement and examined with
FSFI index (Female Sexual Function Index). A total of 39 healthy
subjects used as control group normalized in age, marital status and
socioeconomic parameters. The SPSS 11.0 used as statistical package.
Results: Preoperatively, 42/46(91,30%) of female patients attributed
significant sexual difficulties related to their hip disease. Significant
difference was observed six months after surgery. The FSFI index does
not differ from the healthy control groupafter one year.
Conclusion: Compared with the healthy age- marital statud and
socieconomic matched controls, female patients with total hip replacement have a normal sexual life six months after the total hip replacement. Necessary training is required for balance, gait, and activities of
daily living, and do not forget the proper sexual counselling that is
necessary in postoperative care. Therefore, a booklet is neccesary for
postoperative patients and their sexual partners.
References:
1. Laffosse JM, Tricoire JL, Chiron P, Puget J. Sexual function before
and after primary total hip arthroplasty. Joint Bone Spine. 2008
Mar;75(2):189–94.
2. Dahm DL, Jacofsky D, Lewallen DG. Surgeons rarely discuss
sexual activity with patients after THA: a survey of members of the
American Association of Hip and Knee Surgeons. Clin Orthop
Relat Res. 2004 Nov;(428):237–40.
362
SEXUALITY OF BRAZILIAN WOMEN AFTER
BREAST CANCER
D. Barsotti Santos1, A. Giami2, M.A. dos Santos3, V. Monteiro Cesnik3,
E. Meloni Vieira4
1
Programa Interunidades de Doutoramento em Enfermagem da EE/EERP,
Universidade de Sao Paulo EERP-USP, Ribeirão Preto, Brazil, 2Equipe
Genre, Santé Sexuelle et Reproductive, Institut National de la Santé et de
la Recherche Medicale INSERM—CESP U 1018, Le Kremlin-Bicêtre,
France, 3Departamento de Psicologia e Educação, Universidade de Sao Paulo,
Faculdade de Filosofia Ciências e Letras de Ribeirão Preto FFCLRP-USP,
4
Departamento de Medicina Social, Universidade de São Paulo, Faculdade
de Medicina de Ribeirao Preto FMRP-USP, Ribeirao Preto, Brazil
Introduction: After breast cancer women go through a period of
reflections and questions about their lives before and after the disease.
Most of the sexuality and breast cancer’s studies emphasise the negative
consequences that the treatments bring to women’s sexual functioning
but pay less attention to the subjective dimensions of sexuality.
Objective: The objective of this qualitative study is to understand the
repercussions that diagnostic and treatment bring to the sexuality of
women after breast cancer and identify the psychosocial aspects of
sexual life (subjective and relational) and sexual satisfaction of the
periods before, during and after breast cancer treatment.
Methods: In depth interviews were collected among 14 women with
one year of diagnosis for breast cancer, enrolled in a rehabilitation
program. These narratives were categorized and analysed following
the sexual scripts theory (Gagnon).
Results: Four main categories (Relationships, Sexual life, Sexual communication, Representations of sexuality) were identified. There are
variations about sex life: some women reported better sexual life after
breast cancer; others reported that their sexual life remained the same,
while a similar proportion of women reported worse sexual life. These
different representations give us some clues that the breast cancer and
its treatments bring other subjective and relational repercussions to
sexuality beyond sexual functioning modifications.
Conclusion: Women sexual experience is not entirely dependent of
sexual function and it is important to take into account subjective and
relational aspects to consider the evolution of women sexuality after
breast cancer.
363
REINTERPRETING AND UTILISING
FORENSIC SEXOLOGY
G.J. Merriman1,2,3
Director/Senior Therapist: Sexuality & Relationship Therapy Centre,
Inglewood, 2Head, Department of Sexology, Curtin University, 3President:
Australian Institute of Sexology, Perth, WA, Australia
1
The term Forensic Sexology has been used in literature for over three
decades, yet rarely has there been clarification of the term or work
within this specialised field. Often the term is associated with criminal
investigation, legal and psychological work as specialised practitioners
in these fields often deal with assessment and legal aspects of sexuality—often sex offending. Yet Forensic Sexology is far more than this.
Contemporary use of the word ‘forensic’ refers to the application of
scientific principles and practices in the establishment of understanding and facts. While investigative TV shows (CSI, SVU, NCIS, etc)
have highlighted the work of analytic and forensic skills in dealing with
sex crimes, the area of forensic sexology is often only associated with
sexual crimes against a person or animal, or being outside the ‘normative behaviour’ expected in a society; eg certain sexual expression.
Forensic Sexology is anything related to laws and sexuality, sexual
rights, investigative aspects of sexual behaviours and the analysis of
sexual behaviour within the context it occurs. It is the establishment
of evidence that is presented to a decision making forum for decision
and action.
This presentation will provide greater clarity of this growing area
by presenting new frontiers of sexology that need to be from a Forensic
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base to provide the best evidence for action from different professional
groups. This includes issues of female genital mutilation, vaginal
drying practices, sex offending, age of consent for sexual activity, mandatory role of sexuality education and many others.
364
TRIAGE SYSTEMS APPROACHES TOWARD
SEXUAL HEALTH
A.H. Mirhaghi Saatchi
School of Nursing, Neishabour University of Medical Sciences, Neishabour,
Iran
Background & aim: Triage systems have applied different approaches
to triaging patients complaining of sexual problems. Pros & Cons for
these approaches need to be identified. Aim is to analysis management
of patients during various triage systems.
Methods: Critical review includes five triage systems, Emergency
Severity Index (ESI), Australasian Triage Scale (ATS), Canadian triage
and Acuity Scale (CTAS), Manchester Triage System (MTS) and 5-tier
Triage protocol. These systems have been analyzed via meta-synthesis
in terms of evidence-based criteria, inclusiveness, specific application
and practicability.
Results: General physiologic signs & symptoms were the gold standard for determining acuity in patients that have been applied by all
triage systems. Conscious level, air way, respiratory status and circulation assessment were identified as major criteria in decision-making.
MTS has encountered STDs inclusively. 5-tier Triage protocol and
CTAS has explained Sexual Assault considerations. There is no data
corresponding to sexual problems in ESI and ATS.
Conclusion: Although MTS showed the most comprehensiveness
characteristics to prioritizing patients with sexual problems but
resources necessary for evidence-based practice to support nursing
decisions in triaging patients with sexual problems need fundamentally
to be developed.
365
ADJUVANT TESTOSTERONE GEL
POTENTIATES SILDENAFIL CITRATE
EFFICACY IN ANDROPAUSE MEN
N.K. Mohanty, P. Vasudeva, R.P. Arora
Urology, V.M. Medical College & Safdarjang Hospital, New Delhi, India
Objective: To assess, whether addition of neo adjuvant testosterone
gel therapy followed by Sildenafil citrate achieves adequate potency in
men with andropause having subnormal serum testosterone.
Material & method: 100 men between 58-72 years of age with low
serum testosterone level and erectile dysfunction were enrolled for
the study. 50% of patient received 5gm of 1% testosterone gel daily
for 4 weeks followed by Sildenafil citrate 100mg weekly for next
12 weeks, while the other group received Sildenafil citrate weekly for
16 weeks.
Result: 43 men (84.3%) receiving testosterone therapy for 4 weeks
followed by Sildenafil citrate achieved potency as compared to 15 men
(30%) only receiving Sildenafil citrate.
Conclusion: Our result supports the use of testosterone gel initially
followed by Sildenafil citrate to achieve satisfactory potency in men
with low serum testosterone level having erectile dysfunction as compared to Sildenafil citrate therapy alone.
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366
EVALUATION OF EFFECT OF
PHOTOSELECTIVE VAPORIZATION OF
PROSTATE ON SEXUAL FUNCTION IN A
PROSPECTIVE STUDY: A SINGLE CENTRE
EXPERIENCE
N.K. Mohanty, A. Kumar, P. Vasudeva
Urology, V.M. Medical College & Safdarjang Hospital, New Delhi, India
Aim: To assess short term effect of PVP (Photo selective vaporization)
of prostate on erectile function in patient presenting with benign
hypertrophy of prostate (BHP) with lower urinary tract symptoms
(LUTS).
Material & method: 150 consecutive male patients with LUTS due
to BHP scheduled for PVP were included in our study. Patients with
cancer prostate, active urinary tract symptoms, neurogenic bladder or
stricture urethra were excluded from our study.
A written consent of all 150 patients were taken and their erectile
function using international index for erectile function score-5 (IIEF5) was done before PVP. There were grouped accordingly into Group
A having IIEF ≥ 19 and Group B with IIEF < 19. All 150 patient
underwent PVP of prostate using 80watt Greenlight laser.
Follow up done at 3rd, 6th, 12th month by ultrasound of KUB,
uroflow rate, kidney function test, urine culture and IIEF score.
Result: IIEF score in Group A after six months & one year was in the
range of 19.2 ± 5.9 while in Group B it ranged from 12.1 ± 1.8. In
both the groups IIEF score did not decrease after PVP for BHP.
Conclusion: Our study clearly reveals that PVP for BHP do not alter
IIEF score & is unlike TURP. However, a more prospective with
longer number of patients with longer follow up is desired.
367
SEXUALITY IN PREGNANCY: THE ROLE OF
MATERNAL BODY IMAGE
S. Nakić, H. Soljačić Vraneš
Department of Obstetrics and Gynecology, Sisters of Mercy University
Hospital, Zagreb, Croatia
Background: Sexual behaviour changes throughout the pregnancy.
Mainly the sexual desire and activity decrease toward the end of pregnancy which may be associated with different fears for foetal health.
Even though woman’s body goes through remarkable changes during
pregnancy, sexuality regarding body image did not get much attention
in the literature.
Object: We investigated the role of maternal body image in sexual
satisfaction and frequency of sexual activity.
Methods: One hundred and sixty-two pregnant women in third trimester were asked to complete a self-administered and structured
questionnaire anonymously. Modified version of Body Areas Satisfaction Scale, Body Image Self-Consciousness, perceived quality of
marital relationship, general information questionnaire, and sexual
behaviour questionnaire were administered. Statistic analysis was performed using descriptive statistics, Pearson correlation test and regression analysis.
Results: Most women reported that they had sexual intercourse
during last month (60.5%) and were satisfied with their sexual activity
in pregnancy (61.1%). Of those women who did not have intercourse,
39% had some obstetrical complications and most of them had fears
that intercourse would harm the foetus.
Significant predictors of intercourse frequency were sexual satisfaction, fears for foetal health and gestational age. On the other hand,
satisfaction with intimate relationship was determined by body satisfaction, intimacy and communication with partner, and frequency of
sexual intercourse.
Conclusion: Body dissatisfaction is predictor of low sexual satisfaction
or low satisfaction with intimate relationship, but not of intercourse
frequency. Different aspects of marital relationship are also relevant
for sexuality.
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368
370
TREATMENT OF SSRIS-INDUCED SEXUAL
DYSFUNCTION WITH SAFFRON IN WOMEN:
A DOUBLE-BLIND AND RANDOMIZED TRIAL
SOCIOSEXUAL ORIENTATION IN RELATION
WITH SEXUAL RISK BEHAVIOUR AND
ATTITUDES TOWARD CONDOM USE IN
LATE ADOLESCENCE
A.A. Nasehi
Iran Helal Institue of Applied Science and Technology, Tehran, Iran
Background: SSRIs sexual dysfunction is a common and significant
cause of patient distress and noncompliance with treatment. A number
of adjunctive pharmacologic strategies have been employed previously
Hence in this study the effect of saffron on reduction of this side effect
was evaluated.
Methods and materials: This study was conducted as a double blind
randomized clinical trial among 34 with women with and sexual dysfunction. For 4 weeks one group received cap Saffron 30 mg day plus
fluoxetine the second group received placebo plus fluoxetine and sexual
function was then assessed by FSFI questionnaire.
Results: There was no statistically significant difference between
groups at baseline but there were significant differences over the
four-week period for total FSFI, arousal, lubrication and orgasm
subscales.
Conclusion: It may be concluded that saffron is able to reduce sexual
dysfunction due to SSRI.
369
A PRACTICAL APPROACH IN THE
EVALUATION & TREATMENT OF SEXUAL
DYSFUNCTIONS IN CLINICAL SETUP
M. Nawal
Sexual Dysfunctions Clinic & Research Centre Pvt. Ltd., Indore, India
Objective: To establish an easy & practical way for evaluation & treatment of sexual dysfunctions in clinical setup. The patients were evaluated to know etiology & determine the line of treatment. The
treatment was aimed at restoration of normal sexual function.
Aim: The aim of study “restoration of normal sexual function” was
achieved by various methods including sex therapy—counseling & use
of different medicines.
Material & methods: During February 2007 to January 2009, total
3147 patients reported with sexual dysfunctions. Out of which 2982
agreed for treatment. Ages of patients were between 18–68 years. A
detailed history of sexual dysfunction was taken, with reference to
onset, specific situation, nocturnal & early morning erections, libido,
and ejaculation. In every case a detailed including sexual, personal,
medical (Hypertension, Cardiac disease, Diabetes etc) social, and
family history was taken. Complete medical & genital examinations,
lab investigations (according to need) were done.
Results & observation: Out of 2982 patients, in 2803 (94%) etiology
was established & accordingly treatment was advised. In 1878 (67%)
lab investigations performed . Out of all the patients treated, 2466
(88%) responded well & showed good improvement. In 26% of cases
cause was psychogenic & situational while in 41% cause was organic
& in 33% cause was psychogenic & organic.
Conclusion: A detailed sexual & other history, thorough exa­
minations & investigations establishes the diagnosis in majority of
cases. Sex therapy, correct sex knowledge, proper medication as &
when needed, plays a great role to restore the sexual function back
to normal.
M. Nekic, I. Tucak Junakovic
Department of Psychology, University of Zadar, Zadar, Croatia
Introduction: Sociosexuality refers to a person´s willingness to engage
in sexual activity with a variety of partners outside of a romantic relationship. Persons who are “restricted” in sociosexual orientation are
prone to monogamy, and to heavy emotional investment in long-term
relationships. “Unrestricted” tend toward promiscuity, are quick
to have sex, and experience lower levels of romantic relationship
closeness.
Aim: The purpose of this study was to investigate adolescents’ perception of their own sexual risk behaviour and its relation with sociosexuality and attitudes toward condom use.
Method: Participants: 354 college students (206 females and 148
males).
Measures: Attitudes toward condom use were assessed with Attitudes
toward Condom Use Scale, the Sociosexual Orientation Inventory, and
sexual risk behaviour was assessed with numerous questions about
students’ past and present sexual experience.
Results: 10% of sexually active students always use condoms, 14%
never, and the others occasionally. 49% had experience engaging in
sex under alcohol and 11% of them had sexual intercourse under influence of drugs (e.g. marihuana). Students who are unrestricted in sociosexual orientation have more sexual partners (r = ,45, p < 0,01), rank
higher possibility of getting STD (r = ,38, p < 0,01) and become sexually active early (r = -,33, p < 0,01). “Restricted” students more often
use condoms (r = ,44, p < 0,01) and other contraceptives such as pills
(r = ,36, p < 0,01). Those students also have more positive attitudes
toward using condoms in comparison with “unrestricted”.
Conclusion: Students with “unrestricted” sociosexuality are more
prone to sexual risk behaviour and negative attitudes toward condom
use in comparison with “restricted” students.
371
NEW APPROACH TO PREMATURE
EJACULATION TREATMENT
A.E. Hakobyan1, N.R. Nersisyan1, R.E. Azatyan1, A. Azizian2,3,
A.D. Grigoryan1
1
Department of Sexology, Yerevan State Medical University, Yerevan,
Armenia, 2Department of Mental Health, Coalinga State Hospital,
Coalinga, 3Department of Psychology, University of Southern California, Los
Angeles, CA, USA
Background: Over the past 10 years paradigm shift in the management of premature ejaculation (PE) has occurred involving replacement of the previous psychosexual cognitive behavioral therapy model
of treatment by an integrated treatment approach combining agents
such as selective serotonin reuptake inhibitor drugs (SSRIs) and cognitive behavioral therapy techniques.
Preliminary results from our lab, however, indicate that in many
cases, these treatments are ineffective. We suppose that there are some
inflammatory changes in prostate and related sex organs that produce
pathological irritation to Central Nervous System (CNS) and decreases
ejaculatory threshold by changing neuropeptide synthesis.
Purpose of current study is to evaluate the efficacy of two different
therapy methodology of PE.
Methods: Eighty married men with DSM IV diagnosis of (PE) consented to participate in a randomized controlled trial. Patients were
evaluated using the Index of Premature Ejaculation (IPE) questionnaire and were randomly assigned into two groups:
A) psychosexual therapy plus SSRI and
B) psychosexual therapy plus SSRI plus therapeutic intervention targeted on prostate and nerve conduction.
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Data were collected at two time points: Pre-treatment (<1 week
before treatment) and post-treatment (>8 weeks after treatment).
Results: A repeated-measure ANOVA with group as a betweensubject factor and IPE subscales as a within-subject factor showed
significant treatment differences. Relative to patients in Group A,
patients in Group B demonstrated greater improvement in Sexual
Satisfaction, Control, and Distress.
Conclusion: These findings suggest that PE is somato-neuropsychological condition. That is why local intervention on sexual organs
required for effective treatment of PE.
372
PERSONALITY PATTERNS AND CLINICAL
SYNDROMES IN PATIENTS DIAGNOSED
WITH VAGINISMUS
A.E. Hakobyan1, R.E. Azatyan1, N.R. Nersisyan1, A. Azizian2,3
1
Department of Sexology, Yerevan State Medical University, Yerevan,
Armenia, 2Department of Mental Health, Coalinga State Hospital,
Coalinga, 3Department of Psychology, University of Southern California, Los
Angeles, CA, USA
Background: The presence of anxiety disorders is often implicated in
the etiology of vaginismus. The co-occurrence and effect of personality disorders; however, are less clear.
Aim: The purpose of this study was to examine the relation between
clinical syndromes and personality patterns in patients diagnosed with
vaginismus.
Materials and methods: Twelve patients that met DSM IV TR criteria for diagnosis of vaginismus were assessed with the Millon Clinical
Multiaxial Inventory (MCMI-II). Patients were Armenian women from
city and rural areas, ranged in age from 22 to 39 years (mean = 30 years),
and had at least some college level education.
Results: The test results were consistent with the presence of a generalized anxiety disorder with one of the following three personality
patterns: dependent, avoidant, or narcissistic. The predominant symptoms of generalized anxiety disorder included feeling worn out and
tense, insomnia, and sweating. Furthermore, patients had significant
elevation on the passive-aggressive scale and endorsed items that were
suggestive of seeking and resenting the help of others.
Conclusion: The findings suggest the co-occurrence of distinct personality patterns with generalized anxiety disorder in patients with
vaginismus. Inclusion of personality patterns in treatment planning can
enable physicians to identify patients that might need adjunctive pharmacological or cognitive-behavioral therapies.
373
POSSIBLE EFFECTS OF HYPOTHYROIDISM
ON INFERTILITY AND ERECTILE
DYSFUNCTION
M.R. Nikoobakht1, M. Aloosh2, N. Nikoobakht3, A. Mehrsay4, F. Biniaz5
1
Urology Research Center, Sina Hospital, Tehran University of Medical
Sciences, 2Research Development Center, Sina Hospital, Tehran University
of Medical Sciences, 3Urology Research Center, Tehran University of Medical
Sciences, 4Tehran University of Medical Sciences, 5Radiology Department,
Tehran University of Medical Sciences, Tehran, Iran
Introduction: Hypothyroidism in adults is associated with disturbances in the sex hormones metabolism and sexual functions as well
as infertility. The aim of the current study was to evaluate these disturbances in male hypothyroid patients in comparison to normal
subjects.
Aims: Our hypothesis was that hypothyroid state has an adverse effect
on the erectile function and sperm parameters in male subjects.
Methods: Ninety cases composed of 24 hypothyroid patients and 66
normal individuals were included in the study. The inclusion criteria
of the cases were age between 20-70 year, not being investigated or
treated for sexual dysfunction before the onset of thyroid symptoms
and the marriage duration >1 year. Cases with diabetes mellitus,
176
cardiovascular disease or urological diseases were excluded. Serum
hormonal levels measurement (TSH, T4, T3, LH, FSH, prolactin and
testosterone) and semen analysis were done in all subjects. Erectile
dysfunction was evaluated using International Index of Erectile Function (IIEF) questionnaire, as well.
Results: The mean IIEF score of the hypothyroid group was 11.7,
95% CI (9.70-13.79) that is significantly lower than normal group,
21.8, 95% CI (20.02-21.60). Furthermore, significant differences
between serum concentrations of prolactin and seminal parameters
including count, motility and morphology were found (p < 0.001).
Conclusions: Our results show that hypothyroid state has a possible
adverse effect on the sperm parameters and erectile dysfunction.
Patients with seminal abnormalities especially sperm morphology and
erectile dysfunction problem may benefit from thyroid hormone
evaluation.
374
PATTERNS OF MEN’S SEXUAL RESPONSE
J. Carvalho, A.L. Vieira, P. Nobre
Universidade de Aveiro, Aveiro, Portugal
Strong debate has been brought out around the upcoming editions of
the DSM and ICD regarding new criteria for sexual dysfunction.
Although criteria for male sexual dysfunction have been supported by
traditional models of sexual response (Kaplan, 1979; Masters &
Johnson, 1966), recent data suggest that male sexual functioning could
be conceptualized differently, offering new directions for diagnostic
and assessment tools. The aim of this study was to test, through structural equation modeling, four conceptual alternative models of male
sexual response using samples of men with and without sexual difficulties. A total of 1558 men from the Portuguese population participated
in the study and answered to a modified version of the International
Index of Erectile Function (IIEF; Rosen et al., 1997). Findings supported a two-factor solution as the best model for male sexual response
in the sample of men with sexual difficulties:
1) a general sexual function factor (including sexual desire, erectile
function, and orgasmic function); and
2) premature ejaculation; and a three-factor solution for men without
sexual difficulties:
1) sexual desire,
2) erectile and orgasmic function (which merged into a single
dimension), and
3) premature ejaculation.
Discriminant validity between factors was strongly supported, suggesting that these dimensions measure distinct phenomena in both
samples. Results suggest that the A6 criterion could be excluded from
the new Sexual Interest/Arousal Disorder, and that ejaculatory control
could be conceptualized as a different phenomenon in relation to the
current orgasmic disorders.
375
PATTERNS OF WOMEN’S SEXUAL RESPONSE
J. Carvalho, A.L. Vieira, P. Nobre
Universidade de Aveiro, Aveiro, Portugal
For the last three decades male and female sexual responses have been
conceptualized as similar, based on separated and sequential phases as
proposed by Masters and Johnson (1966) and Kaplan’s (1979) models.
Recently, there is a growing debate around the need to reconceptualize
female sexual response and the classification of sexual dysfunction in
women in view of the upcoming editions of the DSM and ICD. The
aim of this study was to test, using SEM, four conceptual alternative
models (theoretically grounded) about female sexual function using a
clinical and a non-clinical sample. A total of 1993 women from the
Portuguese population participated in the study and answered to the
Female Sexual Function Index (FSFI; Rosen et al., 2000).
Findings suggested a four-factor solution as the model that best fits
the data:
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1) desire/arousal;
2) lubrication;
3) orgasm;
4) pain/vaginismus).
Discriminant validity between factors was strongly supported, suggesting that these dimensions measure four distinct phenomena. Model fit
to the data significantly decreased in both samples, as models began
to successively consider greater levels of overlap among phases of
sexual function, towards a single-factor solution.
Results partially support the new classification now in discussion for
DSM-V, suggesting the overlap between desire and subjective arousal,
as well as between pain and vaginismus. However, results contradict
the new proposal indicating the relative independency of lubrication
which emerged as a single construct.
The aim of this study was to explore various types of penis enlargement and implant, the extent and the reasons of the practice, health
consequences and treatment seeking behavior. We used qualitative
method, including in-depth interview among men, their partners,
medical and non-medical profession, as well as observation. The
first author is a medical doctor stationed in Jayapura and has been
documenting cases of penis enlargement and implant in his clinic.
Results indicated that the practice is carried out in unhygienic condition. The practice was usually started in teenage years either by traditional healer, with a help from a friend or self. Almost all men who
had penis enlargement or implant visited the doctor when they experienced severe inflammation, infection, penile tissue damage or other
medical complication that hindered their reproductive function and
made them more susceptible to HIV/AIDS and other STD
infection.
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378
VALIDATION OF THE PORTUGUESE
VERSION OF THE INTERNATIONAL INDEX
OF ERECTILE FUNCTION (IIEF-15)
TRAIT-AFFECT AND SEXUAL FUNCTIONING
IN WOMEN: THE MEDIATIONAL ROLE OF
PSYCHOPATHOLOGY
A.L. Quinta Gomes, P.J. Nobre
Unidade Laboratorial Investigação Sexualidade Humana—Universidade
Aveiro, Aveiro, Portugal
C. Oliveira1, P. Nobre2
1
Universidade de Trás-os-Montes e Alto Douro, Vila Real, 2Universidade de
Aveiro, Aveiro, Portugal
Objective: The objective of the present study was to determine
the psychometric properties of the Portuguese version of the
IIEF.
Methods: A total of 1363 Portuguese men participated in this study
(a clinical sample of 37 men and a community sample of 1326 men).
All participants completed a questionnaire regarding demographic
information and sexual functioning (IIEF-15).
Results: Principal component analysis using varimax rotation indicated a two-factor structure explaining 54.97% of the total variance:
one factor encompassing erection and orgasmic function domains of
the original IIEF and a second factor corresponding to sexual desire,
intercourse, and overall satisfaction. High internal consistency (Cronbach’s alpha = .89 for Erection and Orgasm Subscale, and .84 for
Desire and Sexual Satisfaction Subscale) and high test-retest reliability
(r = .75 for Erection and Orgasm, and r = .82 for Desire and Sexual
Satisfaction) were found for both subscales. Discriminant validity confirmed the ability of both subscales to differentiate men with erectile
dysfunction from matched controls.
Conclusions: Results suggested that the Portuguese version of the
IIEF has adequate psychometric properties and its use is recommended
for clinical and research purposes.
Aim: The aim of this study was to examine the mediation role of
psychopathology between trait-affect and sexual functioning.
Methods: A total of 242 women participated in the study: a control
sample of 188 women without sexual problems, a sub-clinical sample
with 37 women with low levels of sexual functioning and a clinical
sample of 17 women with sexual dysfunction. Participants answered
the Positive and Negative Affect Schedule—Expanded Form (PANASX), the Brief Symptom Inventory (BSI), the Beck Depression Inventory (BDI) and the Female Sexual Function Index (FSFI).
Results: Women with sexual problems (clinical groups) presented
lower levels of positive trait-affect when compared with woman
without sexual problems (control group). Mediation analysis indicated
that depression mediated 39% of the total effect of positive trait-affect
and 85% of the total effect of negative trait- affect on sexual functioning. The anxiety mediated 59% of the total effect of negative traitaffect on sexual functioning.
Conclusions: Overall, results showed the important role played by
emotional factors on sexual functioning. They also drew attention to
the importance of including treatment strategies aimed at working
with emotional states into sex therapy protocols.
377
CULTURAL PRACTICES AND BELIEFS OF
PENIS ENLARGEMENT AND IMPLANT IN
PAPUA, INDONESIA
A. Oktavian1, W. Diarsvitri2,3
1
Health, National Institute of Health Research and Development for
Biomedicine, Jayapura, 2Community Health, Faculty of Medicine, Hang
Tuah University, Surabaya, Indonesia, 3Australian Demographic and Social
Research Institute, The Australian National University, Canberra, ACT,
Australia
Papua Province has the highest prevalence of HIV/AIDS in Indonesia
and in 2009, 94.4% cases were transmitted through heterosexual
intercourse. High risk sexual behaviors, including multiple sex partners, early initiation of sexual activity, penis enlargement and implant,
have been widely practiced among Papuan men. These practices have
been passed from generation to generation through sexual culture
and beliefs without understanding the health consequences that it
might cause. The uses of ‘wrapping leaves’, such as Dendrocnide
stimulans and Eurycoma longifolia, dried leech oil, tree sap or silicon
injection, as well as implanting a metal or plastic subcutaneously
to enhance the erect phallus are commonly found among Papuan
men.
379
PSYCHOSOCIAL DETERMINANTS OF
SEXUAL PAIN IN PORTUGUESE WOMEN: AN
EXPLORATORY STUDY
C. Oliveira1, P. Nobre2, S. Vilarinho3
1
Universidade de Trás-os-Montes e Alto Douro, Vila Real, 2Universidade de
Aveiro, Aveiro, 3Universidade de Coimbra, Coimbra, Portugal
Aims and objectives: The aim of this study is to examine the role of
cognitive, affective, dyadic, and organic dimensions in determining
sexual pain. Specifically, we intend to examine how these different
dimensions discriminate women with sexual pain disorders from
women with other pain disorders, other sexual problems and women
with none of these problems. Finally we intend to understand how
these dimensions act as vulnerability factors on sexual pain.
Methods: A total of 250 women will participate in the study: a control
sample of 50 women without sexual and pain problems, 50 women
with sexual pain, 50 women with sexual difficulties, and 50 women with
other pain disorders. Participants will answer to a set of questionnaires
examining several variables, such as sociodemographic and medical
history, psychopathology, sexual functioning and satisfaction, pain,
affect, emotional expression and control, self-esteem, sexual selfesteem, cognitive schemas, sexual beliefs, cognitive distraction, mindful
facets, and dyadic adjustment.
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Conclusions: We expect to promote a general comprehension of the
psychosocial profile of women who suffer from sexual pain. We also
expect to contribute to the debate regarding the nature and classification of sexual pain disorders.
380
RELATIONSHIP SATISFACTION AND SEXUAL
FUNCTIONING IN MEN AND WOMEN:
THE MEDIATING ROLE OF AUTOMATIC
THOUGHTS
1
2
M. Pacheco , P. Nobre
1
Universidade de Trás-os-Montes e Alto Douro, Vila Real, 2Departamento
de Educação, Universidade de Aveiro, Aveiro, Portugal
The main objective of this study was to investigate the potential mediating role of negative automatic thoughts during sexual activity on the
relationship between dyadic adjustment and sexual functioning in men
and women. A total of 394 participants (200 men and 194 women)
from the general population completed the following measures:
Dyadic Adjustment Scale (Spanier, 1976), Sexual Modes Questionnaire
(Nobre & Pinto-Gouveia, 2003), International Index of Erectile Function (Rosen et al., 1997), and Female Sexual Function Index (Rosen et
al., 2000). Overall, findings indicated that negative automatic thoughts
during sexual activity mediate the impact of dyadic adjustment on
sexual functioning in both men and women. Specifically, negative
thoughts toward sex, age related thoughts, and failure anticipation
thoughts partially mediate the relationship between dyadic adjustment
and male sexual functioning. In women, this relationship is partially
mediated by failure/disengagement thoughts, lack of erotic thoughts,
sexual abuse thoughts, and partner’s lack of affection. Findings may
represent implications regarding intervention strategies used by professionals in the field of couple therapy that work with subjects with
relational and sexual problems simultaneously, providing opportunities
for the enrichment of their treatment plans. In the field of sex therapy,
this research indicate that it is important to address the content of
cognitive distraction during sex and replace dysfunctional automatic
thoughts by functional thoughts predominantly focused on erotic
stimuli, in order to provide protective factors to individuals with low
dyadic adjustment against sexual dysfunction.
381
THE IMPACT OF GENITAL WARTS ON
QUALITY OF LIFE USING GENERIC AND
SPECIFIC QUESTIONNAIRES
A. Paradisi1, A. Artese2, R. Capizzi2, D. Abeni1, S. Tabolli1
1
Health Services Research Unit, IDI-IRCCS, 2Dermatology, Catholic
University of the Sacred Heart, Rome, Italy
Background: Genital warts (GW), also called condylomata acuminata,
are one of the most common sexually transmitted disease, affecting the
1% of the sexually active population worldwide. Very few studies
investigated the impact of GW on the quality of life (QoL). The aim
of this study was to validate the Italian version of a specific anogenital
condylomata acuminata questionnaire (CECA) and assess the impact
of GW on QoL.
Methods: Generic health status questionnaire (SF_36), dermatological specific questionnaire (Skindex_29) and a disease specific questionnaire (CECA) were used. Moreover general health questionnaire
(GHQ_12) for minor psychiatric non psychotic diseases was utilized.
Results: A total of 118 patients with GW (age 35.6 ± 10.5 years, 102
males) were enrolled. High prevalence of GHQ cases (38%) was identified. The SF_36 mental component score (MCS) was particularly low
(39.3 ± 11). The Skindex_29 social functioning score was very high
(25.6 ± 17.7), compared to other common skin diseases (psoriasis,
dermatitis, alopecia, nevi, mycosis). Patients with larger extension of
the lesions (OR = 6.9; 95%CI, 2.1–23.05), or judged as “severe” by
physicians (OR = 4; 95%CI, 1.2–13.8), or reporting a lower QoL in
MCS (OR = 3.9; 95%CI, 1.2–12.9) and in total Skindex_29 score (OR
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= 9; 95%CI, 2.4-33.3) had the higher risk of developing anxiety and
depression. CECA showed a good correlation with SF_36 MCS,
GHQ, and emotional and social functioning Skindex_29 scores.
Conclusions: CECA confirmed to be a very useful toll in assessing
QoL of patients with GW. The burden of the disease is very high,
particularly on the mental status; QoL is poor and prevention is
mandatory.
382
EXPLORATORY STUDY OF SELF
PERCEPTION OF SEXUAL DISORDERS,
INTIMACY AND SEXUAL AND
RELATIONSHIP SATISFACTION IN A SAMPLE
OF PORTUGUESE LGB PEOPLE
P. Pascoal1, M.J. Almeida2
Faculty of Psychology, Lisbon University,
Portuguese NGO), Lisbon, Portugal
1
2
ILGA Portugal (LGBT
Objective: To describe the existence of sexual problems in a sample
of LGB people and to compare sexual satisfaction in a sample of LGB
people living and not living with their partners.
Design and method: On an on-line survey, people filled in a
General Questionnaire on sociodemographic data, general health
questionnaire, sexual orientation and sexual disorders. For the purpose
of this study we analyzed the results of 170 LGB participants, 70 of
which are in a relationship. The instruments used were the Global
Measure of Relationship Satisfaction (Lawrance & Byers, 1998); Inclusion
of Other in Self, a graphic measure highly correlated with intimacy
(Aron , Aron & Smollan, 1992); Global Measure of Sexual Satisfaction
(Lawrance & Byers, 1998). Nonparametric statistical procedures were
used.
Results: The most prevalent sexual disorder was sexual dissatisfaction
(26%) and low sexual desire (19%). There were no differences on
sexual and relationship satisfaction between people living and not
living with their partners, but inclusion of other in self is higher on
those cohabitating. Differences across gender will be addressed.
Conclusion and discussion: Both most prevalent disorders found are
relationship related disorders. There is no difference in sexual or
relationship satisfaction between people who are and are not cohabitating, however intimacy is higher in people living together, which seems
to indicate that sexual and relationship satisfaction are stable across
different relational structures and cohabitation is associated with more
specific relational dimensions such as intimacy. Results will be discussed at the light of the state of the art.
383
THE MEDIATOR ROLE OF DEPRESSED
MOOD IN THE RELATIONSHIP BETWEEN
TRAIT-AFFECT AND MALE SEXUAL
FUNCTIONING
M. Peixoto, P. Nobre
Educação e Psicologia, Universidade de Trás-os-Montes e Alto Douro,
Felgueiras, Portugal
Introduction: The relationship between trait-affect, depressed mood,
and sexual functioning has been studied, however the nature of that
relation is not yet well establish.
Aim: The aim of the present study is to investigate the mediator role
that depressed mood plays in the relation between trait-affect and
sexual functioning in men.
Methods: A total of 205 men from the general population participated
in the study and answered to a set of questionnaires assessing traitaffect, depressed mood and sexual functioning.
Main outcome measures: Trait-affect was measured by the Positive
Affect—Negative Affect Scale-Expanded Version (PANAS-X),
depressed mood was assessed by the Beck Depression Inventory (BDI),
and male sexual function was measured by the International Index of
Erectile Function (IIEF).
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179
Results: Regression analysis showed that negative trait-affect and
depressed mood were significant predictors of sexual functioning.
Moreover, mediation analyses indicated that depressed mood was a
partial mediator of the relation between negative trait-affect and sexual
functioning in men.
Conclusions: Findings support the role of negative trait-affect and
depressed mood on male sexual functioning.
384
A CLINICAL AUDIT OF MALE TO FEMALE
(MTF) TRANSGENDER PATIENTS
ATTENDING TAYLOR SQUARE PRIVATE
CLINIC IN SYDNEY, AUSTRALIA, AIMING TO
IMPROVE QUALITY OF CARE
C. Pell1, I. Prone2, E. Vlahakis3
Clinician, 2Clinical Trials Coordinator, 3Co Director, Taylor Square Private
Clinic, Sydney, NSW, Australia
1
Background:
characterised.
Methods:
Australian
transgender
patients
are
not
well
• Clinic database search identified patients.
• A database was created containing Birthdate; Birthplace;
Medicare eligibility; MTF/FTM; Occupation; Sex work; IVDU;
Attendence dates; Hormone therapy; Surgery; Medical conditions;
Referrals.
Results:
• 133 MTF attended since 2004. MTF attendance ranged from once
to 29.2 years, mean 5.2 years; 81 attended in 2010.
• Age range 21.4 to 79.6, mean 42.9 years. Of 119 MTF; 55 were
Australian, 25 Thai, 21 Asian, 10 UK/Europe, six Pacific, 2 Americas. All except one are eligible for Medicare.
• Of 103 with employment information, 83 are employed. Of 74
MTF, ten had been sexworkers, five worked currently. There are no
current and ten ex IVDU of 100 with data.
• At last visit 125 MTF were on oestrogen. Delivery for oestrogen
was oral (71), implants (32), injectables (11) and transdermal (8).
Seventy also took other gender transforming medication.
Methods:
• Clinic database (created in 2004) identified patients.
• A database was created containing Birthdate; Birthplace; Medicare
eligibility; MTF/FTM; Occupation; Sex work; IVDU; Attendance
dates; Hormone therapy; Surgery; Medical conditions; Referrals.
Results:
• Fifteen FTM attended since 2004. One is a biological male who
became a transgender female, now reverting to male. Attendance
length ranged from once to 11.9 years, with a mean of 4.3 years.
Thirteen attended in 2010.
• Age range is 21.5 to 56.9, mean of 34.4 years. Twelve FTM were
Australian, one from England, Malaysia and Hong Kong. All are
eligible for Medicare.
• Of eleven with employment information, ten are employed. None
of ten with data recorded have ever been sexworkers. There is one
current and one ex IVDU of the 13 with data.
• All FTM except one were on testosterone therapy. Three had
undergone mastectomy and one had also had a hysterectomy.
• Six were co-managed with an endocrinologist; six saw a psychiatrist
for medico-legal reasons and one for treatment of anxiety. Seven
had other medical conditions.
Conclusion: We see fewer FTM than expected; many are co-managed
with other practitioners. Most are employed and are not IVDU or
sexworkers. Most are Australian born. None have HIV. Despite 30
years of service, the maximum attendance is 11.9 years. Exploration of
why our service is utilised less by FTM than MTF is warranted.
386
COMPARISON OF MALE TO FEMALE (MTF)
AND FEMALE TO MALE (FTM)
TRANSGENDER PATIENTS ATTENDING
TAYLOR SQUARE PRIVATE CLINIC (TSPC)
SYDNEY, AUSTRALIA; CLINICAL AUDIT
RESULTS
C. Pell1, I. Prone2, E. Vlahakis3
Clinician, 2Clinical Trials Coordinator, 3Co Director, Taylor Square Private
Clinic, Sydney, NSW, Australia
1
67 MTF had undergone surgery, 44 had undergone full surgical
reassignment.
Background: Australian transgender patients are not well characterised. TSPC has provided care to transgender people since 1980.
Methods:
• 45 MTF were co-managed with endocrinologists, 41 referred to
psychiatrists, 17 to surgeons.
• There were 78 with other medical conditions, most commonly
mental health diagnoses (40). Six had HIV infection.
• Clinic database (created in 2004) identified patients.
• A database was created containing Birthdate; Birthplace; Medicare
eligibility; MTF/FTM; Occupation; Sex work; IVDU; Attendance
dates; Hormone therapy; Surgery; Medical conditions; Referrals.
Conclusion: Our MTF patients are diverse, in age and culturally.
Most (80.5%) are employed, only five as sexworkers. Ninety percent
have never been IVDU. Most (97%) have used hormones and more
than half (50.3%) have had some surgery. Many are co-managed. High
rates of mental health disorders and HIV are present. Recording of
demographic information could be improved.
Results: There were 133 MTF and 15 FTM attending.
MTF were older (42.9 vs 34.4 years) and had attended longer (4.3
vs 5.2 years).
MTF were less likely to be Australian born (46% vs 80%).
Nearly all patients were Medicare eligible.
MTF were less likely to be employed (80.5% vs 90.9%), overall
employment was high.
Sex work was low, at 13.5% in MTF and none in FTM.
IVDU was similar; 10% in MTF and 15% in FTM.
Hormone therapies were common, in MTF 97.0% vs 93.3% in
FTM; surgery was more common in MTF (50.3% vs 20%).
Co-management was 67.6% in MTF vs 80% in FTM.
Mental health problems were more common in MTF than FTM
(30% vs 6.7%), as was HIV (4.5% in MTF).
Conclusion: The ratio of 9 MTF:1 FTM is similar to the one published Australian paper, unlike 3:1 found elsewhere. There are differences between groups including overall numbers, sexwork, use of
surgery and comorbid conditions. The numerical imbalance between
the groups and the incomplete data sets necessitate caution with comparisons. This audit provides a baseline from which to improve care.
Future improvements will include recording data thoroughly and
exploring reasons for less service utilisation by FTM.
385
A CLINICAL AUDIT OF FEMALE TO MALE
(FTM) TRANSGENDER PATIENTS
ATTENDING TAYLOR SQUARE PRIVATE
CLINIC (TSPC) IN SYDNEY, AUSTRALIA,
AIMING TO IMPROVE QUALITY OF CARE
C. Pell1, I. Prone2, E. Vlahakis3
Clinician, 2Clinical Trials Coordinator, 3Co Director, Taylor Square Private
Clinic, Sydney, NSW, Australia
1
Background: Australian transgender patients are not well characterised. TSPC has provided care for transgender people since 1980.
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387
389
SSASM: PRELIMINARY DEVELOPMENT AND
PSYCHOMETRIC VALIDATION OF A
MULTIDIMENSIONAL MEASURE OF
SUBJECTIVE MALE SEXUAL AROUSAL
THE PORNOGRAPHY QUESTIONNAIRE (PQ).
PILOT SUDY BASED ON ITALIAN
POPULATION SAMPLE
1
2
3
M.A. Perelman , S.E. Althof , R.C. Rosen
1
Psychiatry, Urology & Reproductive Medicine, NY Weill Cornell Medical
Center, New York, NY, 2Psychiatry, Case Western Reserve University School
of Medicine, Cleveland, OH, 3New England Research Institutes, Watertown,
MA, USA
Introduction: Sexual arousal is a multifaceted process that involves
both mental and physical components. No instrument has been developed and validated to assess subjective aspects of male sexual arousal.
Aim: To develop and psychometrically validate a self-administered
scale for assessing subjective male sexual arousal.
Methods: Using recommendations of the USA, FDA guidance on
PRO instruments, important aspects of male sexual arousal were identified via qualitative research of US men with erectile dysfunction (ED)
and healthy controls. After a preliminary questionnaire was developed
by a panel of experts, a quantitative study of men with ED and controls
was conducted to psychometrically validate the Subjective Sexual
Arousal Scale for Men (SSASM).
Results: Five aspects of arousal were identified from the qualitative
focus groups and cognitive interviews. Men’s preferred language for
describing arousal and response formats were incorporated into the
questions. Factor analysis of data from the quantitative study of 304
men aged 21-70 years identified 5 domains with eigenvalues >1: sexual
performance, mental satisfaction, sexual assertiveness, partner communication, and partner relationship. The 5 domains had a high
degree of internal consistency (Cronbach’s alpha values 0.88–0.94).
Test-retest reliability over a 2-4-week period was high-moderately
high (r values 0.75–0.88) for the 5 domain scores. Correlations between
SSASM domain scores and standardized scores for social desirability,
general health, life satisfaction, and sexual function demonstrated the
construct validity of the scale.
Conclusion: Preliminary validation data suggest that the 20-item
SSASM scale may be useful as a self-administered instrument for
assessing subjective sexual arousal in men.
388
F. Quattrini1, C. Borgia2, L. De Rosa2, M.G. Mollica2
1
University of l’Aquila, L’Aquila, 2Instituto Italiano di Sessuologia Scientifica,
Roma, Italy
Introduction and objective: The Pornography Questionnaire (PQ)
is a new assessment tool created by the Authors to collect useful information about the social perception of phenomenon in Italian Sample.
The PQ is aimed to evaluate the most common stereotypes Italians
have when they think at or use pornography. This pilot study has two
different purposes. The first is to analyse the PQ reliability, the second
is to understanding why most people using pornography from early
adolescence have different stereotypes left on it.
Method: The PQ is composed of 3 modular forms:
1) anamnestic area,
2) use of pornography area (fruition & function),
3) preconceptions and stereotypes on pornography area.
In particular, this later form is composed of 8 sub-area. Except for
anamnestic area, PQ is composed of 51 five-points likert scale items.
The questions are formulated to focus on the typical use of pornograpihic material in every phase of the life and on the preconceptions and existing typical stereotypes on the phenomen pornography.
The sample (216 subjects) is composed of 97 males (45%) and 119
females (55%). As is regards to sexual orientation, the sample is composed of 83% heterosexuals, 12% homosexuals and 6 % bisexuals. The
average age is 32 (range 18–71).
Results: Pornography is largely used in each life´s phase as a form of
entertainment (28%) and a need of outlet (30%). For 36% of subjects
the world pornography is connected by mafia and for 27% pornography is produced only by men for men.
390
REVIEW OF A SPECIALIST SERVICE FOR
GENITAL DERMATOSES (GD) IN A
GENITOURINARY MEDICINE; (GUM)
SETTING
REACTIONS AND CHARACTER TRAITS IN
WOMEN WITH FEMALE ORGASMIC
DISORDER
R. Rani1, E. Gilmour2
Genitourinary Medicine & Sexual Health, NHS Tameside & Glossop,
Manchester, 2Dermatology, Tameside General Hospital, Ashton-under-Lyne,
UK
Purpose: The purpose of the study is to examine the levels of neurotic
reactions and specific character traits in a sample of women with the
diagnosis of Female Orgasmic Disorder.
Material and methods: The study involves 27 women, predominantly
of young age (78%) and good educational level-secondary school.
Most women are married (85%). The investigation is carried out in an
outpatient unit of clinical sexology. The diagnostic criteria of DSM-IV
are applied. Two psychological tests are used: the Neurotic-depressive
questionnaire of T. Tashev and the Drawing test of E. Wartegg.
Results: Inhibited orgasm is experienced as a falure in the intimate
life by 78% of the women.
Almost half of the investigated women have troubles at home and
at work.
Expressed neurotism is found in 81.5% of the investigated subjects.
The character profile is non-specific. The most typical traits are
deficit of contacts (67%), lack of aggressivness (81.5%), emotional
tenderness and sensitivity (90%).
Only 1/3 of the women express a global self rating “I am satisfied
with myself ”.
Conclusion: Female Orgasmic Disorder has a serious impact on the
neurotic reactions. There seems to be no specific character profile for
this disorder. Further investigation of larger samples may be helpful.
Background: Cases with genital skin conditions often present to the
GUM clinic. to meet their needs a apecialist service was set up jointly
by GUM & dermatology consultants in a GUM setting. This is a three
monthly multidisciplinary clinic.
A reveiw of the outcome of this service is presented.
Methods: Retrospectve case note reveiw.
Results: Out of 201 cases, 117(58%) were men & 173(81%) were over
25 years. All cases had chronic symptoms. Presenting symptoms
included pruritus, rashes, blisters, irritation, lumps and painful cracking. Most cases had consulted their general practionors (GPs) or other
health care professionals with these symptoms previously.
53% of the cases had self-referred themselves to our service. 37%
were referred by their GPs.
Main diagnosis: Dermatitis/eczema- 51(25%) cases, Lichen sclerosus- 45(22%), Psoriasis-17(8%), Zoon’s balanitis- 17(8%), Lichen
Plannus- 11(5%), Vulvodynia-6(3%), VIN- 5(2%) and lichen simplex5(2%). One cases had Mucosal Pemphigoid.
23 cases were treated for concurrent sexually transmitted infections.
Following consultation in the specialist clinic, most cases (77%)
were discharged with their care plans. 34 (18%) cases were referred to
other specialists and 11(5%) were followed up.
Conclusions: The specialist service for “Genital Dermatoses” assissts
in the management of cases with chronic symptoms in genital skin and
reduces re-visits.
S. Popov, V. Vlahova-Nikolova
Psychiatry, University of Medicine, Plovdiv, Bulgaria
1
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Proceedings from the 20th World Congress of Sexual Health
Eczema/dermatitis and Lichen sclerosus were the most common
conditions.
Demography of cases who attended GUM clinic with genital dermatoses was different compared to those who attended with STIs. This
cohort, had more men for whom there are no specific services like
“Vulva clinics” in England.
391
INSIDE WEST LONDON MENTAL HEALTH
TRUST GENDER IDENTITY CLINIC
(CHARING CROSS)
C. Richards, P. Lenihan, GIC Clinicians
Gender Identity Clinic, West London Mental Health NHS Trust, London,
UK
West London Mental Health Trust GIC (Charing Cross) is a national
Gender Identity Clinic where the majority of trans people in the UK
seeking NHS health care services for specifically trans issues that
cannot be dealt with in a general setting will be referred. The service
incorporates psychiatric and psychological assessment and treatment,
endocrine assessment and treatment, and speech and language assessment and treatment. We also have a national clinical doctoral placement training programme for postgraduate counselling psychologists,
counsellors and psychotherapists. The service has close links with
surgical services providing gender reassignment surgery.
Each stage of the GIC care pathway will be discussed, the diversity
of GIC services today will be outlined and myths about the GIC will
be deconstructed. Patients’ actual experience of the GIC will be
reviewed. The results of a patient experience tracker (PET) and a two
site patient satisfaction study will be examined. New GIC research and
service development (resulting from service user feedback and engagement) will be presented.
392
PSYCHOGENIC COITAL CEPHALGIA IN
AGING MALES
I. Roja1, Z. Roja1,2
Riga East Clinical University Hospital, 2Latvian University, Riga, Latvia
1
Introduction: Psychogenic coital cephalgia (PCC) in aging males is a
headache related to sexual activity with muscle tension, anxiety after
psychotraumatic events. Research achievements in European countries
for patients with PCC show positive results of combined treatment:
medication therapy (MT) and cognitive hypnotherapy (CH).
Aim of the study was to investigate the benefits of the CH and MT
in the combined 4 weeks treatment course for working ageing males
with PCC.
Material and methods: During 2010 year 14 aging males aged 51-63
was consulted with PCC. A group (males = 10) 4 weeks received
combined treatment: CH twice a week, and MT—anxiolytic Arketis—
20 mg once a day. Control or B group (males = 4) received 4 weeks
only MT. A stage of anxiety and intensity of pain was measured by
Rosenberg Self-esteem Scale and Visual Analogue Scale.
Results: Analysis of headache and anxiety manifestation, according to
the Rosenberg Self-esteem Scale, Visual Analogue Scale, showed such
results: at the conclusion of the complex therapy course there was
significant headache and anxiety reduction in 8 A group’s patients
(80%). Only 2 males of B group (50%) after 4 weeks therapy had
improvement of health state.
Conclusion: Combined 4 weeks treatment—cognitive hypnotherapy
and anxiolytic is just an optional short-term treatment for aging males
suffering from psychogenic related coital cephalgia.
393
DE-EPITHELIALIZATION LABIAPLASTY:
OUR EXPERIENCE
T.M. Roth
Bladder Control Center, Central Maine Medical Center, Lewiston, ME,
USA
Objective: Describe the surgical procedure, results, complications and
determine whether patients are satisfied with surgical reductions of the
labia minora in cases of hypertrophy (4cm or greater) resulting in some
functional impairment.
Methods: Records of 25 patients who underwent surgical reduction
of the labia minor during a 6 year period were reviewed. Age 22–55
(median 26). Surgery was requested for discomfort in clothing (80%),
discomfort with physical activity (40%), introital dyspareunia (36%).
None of the surgery was specifically requested for aesthetic concerns.
Anatomy was assessed 8 weeks postoperatively. Patient satisfaction was
assessed via questionnaire administered by the surgeon at time of
follow-up.
Results: No intraoperative or postoperative complications were
noted. 90% were satisfied with the aesthetic result, 100% were satisfied
with the functional/anatomic result (the primary indication for
surgery). All patients would have undergone the procedure again.
Conclusions: De-epithelialization labiaplasty is a uncomplicated surgical procedure with a high degree of patient satisfaction and resultant
improvement in functional outcomes.
394
ARDEN: A MODEL TO ENHANCE SEXUALITY
DISCOURSE FOR CLINICIANS IN NON-SEX
THERAPY PRACTICE
A. Rothenberg
The Center for Counseling and Sexual Health, Winter Park, FL, USA
Clinicians, who are not practicing sexologists, sometimes exhibit difficulty in communication related to topics of sex, sexuality and sexual
behavior. The research described in this paper examines how practitioners can employ methods to better communicate about sexuality in
psychotherapy/non-sex therapy settings. Qualitative methodologies
were used to understand various communication challenges faced by
practitioners and clients. Data is presented as case histories in the
context of sexological consultations. Clinical interviews demonstrate a
need for better communication. This paper looks at the obstacles faced
by both clients and therapists when initiating dialogue related to sexual
issues in a non-sex therapy setting. Methodology used to reduce anxiety
and the stigma that is often associated with sexuality is addressed as well
as the impact of sexual misinformation on successful client outcomes.
This paper explores the need to establish effective dialogue relating to
sexuality and proposes a new model, ARDEN, to address client and
therapist concerns related to sexuality discourse.
395
SEXUAL FUNCTION AND DYSFUNCTION IN
OLDER WOMEN: THE IMPLICATIONS FOR
OLD AGE PSYCHIATRY. A REVIEW OF
RECENT LITERATURE
R. Runciman1, A. Wood2, K. Wylie1
Porterbrook Clinic, University of Sheffield, 2ST 4, North Trent Rotational
Training Scheme in Old Age Psychiatry, Beighton Hospital, Sheffield, UK
1
Aims: In Old Age Psychiatry, patients’ illnesses as well as their treatments can have a considerable impact on their sexual functioning.
This review aims to examine this topic in the context of Old Age
Psychiatry.
Method: A review of recent literature was carried out through
‘Healthcare Databases.
Advanced Search’ via Athens, on the NHS Health Information
Resources Website.
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We accessed “MEDLINE” and “PsycINFO” databases.
Results: Mental health problems in old age adversely affect women’s
sexual lives. In particular, depression and its treatment can diminish
sexual functioning. Dementia can be very challenging within a close
sexual relationship. Antipsychotic treatments can impair functioning.
Increasing numbers of patients are developing also diabetes.
Comments: Prominent amongst drugs which adversely affect female
sexual functioning are SSRIs.
Recent literature suggests that Old Age Psychiatrists should enquire
about this common side-effect in older women patients.
Dementia complicates sexual lives but help is available.
We would suggest that Old Age Psychiatrists should be aware of
available treatments for female sexual dysfunction, from psychosexual
therapy to clitoral vacuum pumps. Then they can offer hope and
appropriately direct patients for further specialist advice.
396
THE IMPACT OF ED ON WOMEN AND
THEIR PARTNERS: QUALITATIVE ACCOUNTS
FROM COUPLE SAMPLES
D. Rutherford
Urology, NHS Ayrshire and Arran, Ayr, UK
Aim: The current research was designed to gain insight into ED from
a couple’s perspective.
Methods: Men with ED* were interviewed following GP referral and
their partners were recruited via invitation to participate in semistructured interviews. Recurring themes were identified from interviews with men and these data were compared and found to be in
concordance with feedback from the literature. Interviews with women
were taped and transcribed. Data were coded using grounded theory
and categories were refined by identifying similar theoretical concepts.
Interviews with women continued until the data had no impact on the
theoretical relevance of the study (15 interviews). Emergent theory was
tested by theoretical sampling.
Results: Women expressed that ED consumed their partners. Men
focussed on restoration of erectile function and these data were verified
by men. Women encouraged their partners to seek help but men
avoided help due to embarrassment. Women felt isolated and struggled
to make sense of their partner’s perspective. Men communicated that
the sexual act was of optimum importance in terms of defining the
relationship. Women were concerned that ED was a symptom of an
underlying condition.
Conclusions: Women were disappointed that ED had such a devastating influence on the relationship and were upset at their partner’s
reaction to ED. Feedback from interviews suggested that feelings of
hurt might prevail regardless of treatment outcomes. Men expressed
that restoration of erectile function would solve all of theirs and their
partner’s problems.
* ED = < 11 measured by the International Index of Erectile
Function.
397
SEXUAL DEPENDENCE IN SUBSTANCE USE
S. Saddichha, V. Benegal
Psychiatry, NIMHANS, Bangalore, India
Background: Substance dependence is an established problem around
the world. However, behavioral addictions like sexual dependence are
relatively emerging fields of study.
Aim: To study the prevalence of sexual dependence in patients with
alcohol dependence and compare it with a general population.
Methods: Fifty consecutively seen patients with alcohol dependence
were administered a semi-structured questionnaire modified from the
Mini International Neuropsychiatric Inventory to include behavioral
addiction. Fifty controls from the general population were also
recruited and administered the same questionnaire and the two groups
compared. Results and conclusion: As this is an ongoing study, the final
results are due.
182
398
PREVALENCENCE AND CORRELATES OF
ORGASMIC FUNCTION, INTERCOURSE
SATISFACTION, SEXUAL DESIRE AND
OVERALL SATISFACTION IN MEN ON
HEMODIALYSIS: A MULTINATIONAL CROSSSECTIONAL STUDY
V. Saglimbene1, M. Vecchio1, G. De Berardis1, M. Ruospo1,
M. Sciancalepore1, G.F. Strippoli1,2
1
Mario Negri Sud Consortium, S. Maria Imbaro, 2Diaverum, Bari, Italy
Although sexual dysfunctions in men include orgasmic problems,
intercourse dissatisfaction, sexual desire and overall satisfaction abnormalities, only erectile problems have been generally studied. In this
cross-sectional study, we have evaluated the remaining aspects of sexual
dysfunction in men receiving hemodialysis.
Patients were identified in 27 hemodialysis clinics selected randomly
within a collaborative network. All domains of sexual dysfunction were
assessed anonymously with the International Index of Erectile Function (IIEF-15) questionnaire. Multivariate logistic regression was used
to determine correlates of the different domains of sexual dysfunction
and data are presented as adjusted odds ratio (AOR) and 95% confidence intervals (CI) .
Overall, 1056 (60%) of 1611 eligible men responded. Of these, 773
(73%) men reported orgasmic dysfunction, 927 (88%) sexual desire
dysfunction, 957 (91%) intercourse dissatisfaction and 790 (75%)
overall dissatisfaction. Results on key correlates of these adverse
sexuality outcomes identified by multivariate analyses are reported in
Table 1.
Table 1.
Characteristic
Age (years)
Married
Depression
Hypertension
Use of
erythropoietin
Orgasmic
function
1.07
0.55
1.92
—
0.55
Sexual desire
(1.05–1.08) 1.06(1.05–1.08)
(0.40–0.77) —
(1.45–2.54) 1.55 (1.16–2.07)
0.69 (0.38–0.93)
(0.35–0.85) 0.72 (0.45–1.13)
Intercourse
satisfaction
Overall
satisfaction
1.07
0.43
1.90
0.59
0.58
1.05
0.71
2.01
0.47
0.71
(1.05–1.08)
(0.31–0.62)
(1.42–2.55)
(0.38–0.91)
(0.37–0.92)
(1.03–1.06)
(0.51–0.99)
(1.52–2.68)
(0.31–0.73)
(0.45–1.11)
In conclusion, dysfunctions of various aspects of sexuality are highly
prevalent in hemodialysis patients. Potentially modifiable risk factors
that warrant cautious consideration include hypotension and
depression.
399
SEXUAL DYSFUNCTION AFTER
ENDOVASCULAR REPAIR OF AN
INFRARENAL ABDOMINAL AORTIC
ANEURYSM
E.M. San Norberto, Á. Revilla, V. Gutiérrez, C. Vaquero
Valladolid University Hospital, Valladolid, Spain
Introduction: Open surgery (OS) of an abdominal aortic aneurysm
(AAA) is associated with deterioration in sexual function. There
appears to be lower incidence of erectile dysfunction with endovascular
repair (EVAR).
Objectives: To analyze the incidence of post-operative sexual dysfunction in AAA patients treated using OS or EVAR.
Material and methods: Prospective study carried out from
January 2008 until June 2009 using the IIEF test (International
Index Erectile Function) to measure pre- and post-surgical sexual
dysfunction. 182 patients treated, 112 patients included in the
study, of which 47 (42.0%) treated using OS and 65 (58.0%) using
EVAR.
Results: The mean age was 70 years (64.3 OS vs. 74.7 EVAR, P =
0.032). The prevalence of pre-surgical impotence was high in both
groups and was significantly higher in those treated using EVAR
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183
(40.5% OS vs. 66.2% EVAR, P = 0.017). Sexual dysfunction appeared
in 5 patients (22.7%) after EVAR and in 10 (35.7%) after OS (P >
0.05). Both internal iliacs were occluded in 3 (13.6%) patients in the
EVAR group and occluded in one artery in 10 (45%) patients. The
unilateral occlusion of the hypogastric artery had no effect on impotency (P > 0.05). All the bilateral occlusions suffered erectile dysfunction. The dysfunction was more severe in the EVAR group, both
before and after surgery.
Conclusions: The incidence of pre-operative sexual dysfunction in
AAA patients is high. Treatment using EVAR does not give any significant protection against impotency occurring. The bilateral occlusion of the hypogastric arteries is a cause of sexual dysfunction,
although unilateral occlusion is a significant risk factor.
400
A PHASE IV PROSPECTIVE EVALUATION OF
THE SAFETY AND EFFICACY OF EXTENDED
RELEASE TESTOSTERONE PELLETS FOR
TREATMENT OF MALE HYPOGONADISM
M. Sand1, B. Moclair2, M. Hemani1, J. Kaminetsky2
Urology, New York University, 2Urology, University Urology, New York,
NY, USA
1
Introduction: Extended-release testosterone pellets can provide
therapeutic levels of testosterone over several months; additional
data are needed to establish the safety and efficacy of testosterone
pellets.
Methods: A phase IV, single center, open-label extension study
designed to assess the safety and efficacy of subcutaneous insertion of
6 to 12 testosterone 75 mg pellets (450 mg to 900 mg) during a single
implantation procedure in hypogonadal men who had previously been
treated with topical and/or injectable testosterone.
Main outcome measures: Safety was determined based on adverse
events reported by the study subjects, as well as changes from baseline
to study end in physical examinations, and laboratory tests. Efficacy
was determined based on results of serum laboratory tests, complete
physical exams, and implantation site evaluations. Secondary objectives
assessed patient preference of testosterone pellets versus prior testosterone treatments.
Results: Mean testosterone significantly increased and LH levels significantly decreased from pre-implantation values at Weeks 1, 4, and
12, and had returned to pre-implantation levels by Week 24. PSA levels
remained unchanged for the duration of the study. Improvements in
several symptoms of hypogonadism were determined with multiple
questionnaires. Implanted testosterone pellets were generally well tolerated with 90% of the study participants preferring Testopel to their
previous therapy.
Conclusion: Implanted testosterone pellets can normalize testosterone and LH levels and improve symptoms for at least 3 months and
up to 6 months in men with hypogonadism, and should be considered
as a therapeutic option for hypogonadal men.
401
A PHASE IV PROSPECTIVE EVALUATION OF
EXTENDED RELEASE TESTOSTERONE
PELLETS: DOSE—RESPONSE PATTERNS AND
THE EFFECT OF INCREASING BMI
1
2
1
2
M. Sand , B. Moclair , M. Hemani , J. Kaminetsky
Urology, New York University, 2Urology, University Urology, New York,
NY, USA
1
Introduction: Previous studies have shown that extended release testosterone pellets can provide therapeutic levels of testosterone over
several months. This study was conducted to provide reliable dosage
guidelines for the hypogonadal patient.
Methods: A phase IV, single center study to assess insertion of 6 to
12 testosterone 75 mg pellets in hypogonadal men who had previously
been treated with topical and/or injectable testosterone.
Outcome measures: Testosterone was measured at baseline, 7 days,
4 weeks, 12 weeks and 24 weeks after administration. The doseresponse curves were examined for patients receiving 8, 10 and 12
pellets. Additionally, the effect of increasing BMI on the dose-response
curves was also examined.
Results: Mean testosterone peaked at day 7 and remained therapeutic
at week 4 with increasing peak T levels correlating with number of
pellets administered. The mean rise of serum T per pellet at day 7 was
calculated to be 57, 58, and 60 ng/dl/pellet for administration of 8, 10
and 12 pellets, respectively. Interestingly, BMI was not found to have
an effect on the change in serum T per pellet. Mean increase in T per
pellet at day 7 was calculated to be 63, 58 and 64 ng/dl/pellet in
patients with BMIs of <25, 25-30 and >30, respectively.
Conclusion: Serum T increased approximately 60 ng/dL per pellet
from baseline by week 4. Additionally, BMI was not observed to impact
the dose-response curves. The average rise of T of 60 ng/dL per pellet
can be used a guideline for initial pellet implantation.
402
AGOMELATINE: ANTIDEPRESSANT
WITHOUT IMPAIRMENT OF SEXUAL
RESPONSE
A.A. Sapetti
Sexual Dysfunctions, Centro MEDICO Sexologico, CABA, Argentina
Introduction: Sexual dysfunctions due to the use of antidepressants
are common and can lead to non-compliance of the drug or treatment
dropout. Patients medicated with different antidepressants query by
decreased libido delay orgasm (both sexes), erectile dysfunction or less
vaginal lubrication and may worsen in patients with previous stories
of sexual dysfunctions. Agomelatine by their different pharmacological
action (agonist melatonergic receptors MT1 and MT2 with antagonist
properties of 5-HT2C receptors; has no affinity for a adrenergic,
b-adrenergic receptors, histaminergic, cholinergic, dopamine) not
produce side effects in the sexual area as reported different clinical
papers.
Objectives: To assess tolerance and side effects of Agomelatine in the
stages of sexual response (desire, arousal, orgasm) of men and women
depressive. Assess satisfaction and effectiveness, side effects in other
areas.
Material and methods: Open study, naturalistic, observational,
n = 28, men and women with depression, sexually active, 21 to 75 years,
evaluated in 5 visits: admission, on 15, 30, 60, 90. Assessment scales
were used (MADRS, ASEX, IIEF-6, CGI, Visual analogue
scales—EVA-).
Preliminary results: There has been a favorable response, depressive
symptoms with 25 and 50 mg of Agomelatine, low incidence of side
effects and without sexual dysfunctions in both sexes.
Conclusions: Agomelatine is an effective antidepressant without
causing undesirable effects in sexual response which it would be a first
choice in patients who have an alteration of some of the stages of the
response.
1. Goodwin GM: “Efficacy and safety of agomelatine: a randomized,
double-blind, placebo-controlled study”. Int J Neuropsychopharm.
2004;7(suppl 1): Abstract P02.174.
403
GREATER BODY AWARENESS AND SEXUAL
ENJOYMENT THROUGH THE EROTIC
POWER TRAINING: RESULTS FROM THE
TRAINING PROGRAM “THE ORGASMIC
WOMAN”
A. Sartorius, F. Makaja Milicevic, Y. Zehnder
Komaja Foundation, Gersau, Switzerland
“The Orgasmic Woman” is a three month self-training program
for women who would like to enjoy their sexuality more and enhance
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their sexual wellbeing. It consists of techniques from the cognitivebehavioural field and from Komaja’s tantra training. The follow up
study was significantly successful in improving sexual satisfaction and
sexual arousal (p < 0.05*), measured by the “Female Sexual Function
Index questionnaire”.
One of the aims of the training was to improve body awareness and
sexual enjoyment. Parallel to the main exercises, the women were
doing three exercises from the so-called “Erotic Power Training”.
Vajroli Mudra is an exercise for strengthening the pelvic floor
muscle. Through it women can increase sensual pleasure for themselves and also for their partner. 87% of the women reported that this
exercise helped to give them a greater sexual enjoyment.
Tribanda is the exercise involving the pulling up of the vital powers
from the perineum upwards to the chest what gives greater sexual
pleasure. 70% of the participants answered that it helped them to bring
more vitality into the chest.
The Taboo Exercise (massage of the anal muscles) was a challenge
for the women. At the beginning, they had negative emotions (like
fear, disgust . . .) in relation to the exercise, but by the end of the
training these changed into positive ones, such as self confidence,
courage etc. Also, 60% of the women reported that they included the
anal area more in their sexual activities.
In general, this training contributed to a greater sexual enjoyment.
184
history, physical examination along with special laboratory investigation in the form of hormonal study was carried out. Out of 153 subjects
enrolled for the study, nearly 15-20 are on the brink of divorce as the
money lost on bourses even claimed their physical intimacy. A majority
of them are under 35 years of age, some married for just one or two
years. 68 patients had severe erectile disturbance and loss of desire,
and their pooled testosterone levels were less than 250 ng/dl. 75 subjects had suffered great financial loss on stock market because of the
sharp dip in the sensex.
406
ASSOCIATION BETWEEN SEXUAL
FUNCTION AND ETHNODEMOGRAPHIC/
HEALTH FACTORS IN A POPULATION OF
WOMEN WHO HAVE SEX WITH WOMEN
A.W. Shindel1, T.S. Rowen2, T.-C. Lin3, C.-S. Li3, P.A. Robertson2,
B.N. Breyer4
1
Urology, University of California, Sacramento, 2Obstetrics and Gynecology,
University of California, San Francisco, 3Biostatistics, University of
California, Davis, 4Urology, University of California, San Francisco, CA,
USA
Treating sexual desire problems is often a time demanding, complicated and difficult process, in particular if the lack of desire is caused
mostly by the great bulk of what we call relational factors. Very often
the out come of therapy does not correspond with the initial request
of the client(s).
Traditional sexological treatment of desire problems, that are often
grounded on variations of CBT, may sometimes increase symptoms or
consolidate the condition.
Working with desire as connected to the brains motivational system,
it may often be necessary to focus on the deeper aspects of motivation
and aversion.
To understand some common factors in desire problems, like anxiety
and depression, I build on Wilhelm Reich´s theory of how we, due to
traumas in childhood, inhibit our vitality and life energy thru developing more or less chronic muscular tensions, and how this influences
and puts restrictions on our experience of desire and therefor also on
sexual desire.
I will present character analytic approach as it is developed in
Norway after Reich´s influence in the late 1930´s in Oslo. With a case
I will illustrate some character analytic and body oriented ways of
working with the clients sexuality, that in my experience, target the
deeper aspects of motivation and sexual desire.
Introduction: Health and social factors associated with sexual dysfunction in women who have sex with women (WSW) have not been
extensively studied.
Methods: WSW were invited to participate in an internet-based
survey via social networking sites catering to this population. Data
were collected on ethnodemographics, health status, and sexual/relationship status. A modified version of the Female Sexual Function
Index (FSFI) was used to quantify each subject’s sexual function. An
FSFI-total score of 26.55 was used to divide the subject pool into high
risk of female sexual dysfunction (HRFSD, FSFI < 26.55) or low risk
of female sexual dysfunction (FSFI > 26.55). The Wald Chi-squared
test was used to study the association between HRFSD and exposure
variables. Logistic regression was utilized for multivariate analysis.
Significance was set at p < 0.05.
Results: 1,566 women had complete data; of these, 388 met criteria
for HRFSD. There was a markedly significant association between
bother regarding sexual function and HRFSD (p < 0.0001). There was
a significant association between HRFSD and increased age, hypercholesterolemia, depression, history of yeast infection, postmenopausal status, history of gynecological surgery, symptoms of
overactive bladder, never having been pregnant, bisexual orientation,
having a non-female partner, and lower sex frequency. On multivariate
analysis bother regarding sexual function, never having been pregnant,
having a non-female partner, and overactive bladder symptoms
remained significantly associated with HRFSD.
Conclusions: The modified FSFI strongly predicts sexual bother in
this population of WSW. Some aspects of gynecological history and
urologic health are significant associations of sexual function in this
cohort.
405
407
NO TIME FOR SEX DURING A BULL RUN,
NO MOOD FOR IT DURING A CRASH. . .
SEXUALITY AND HOSPICE: THE SEXUAL
EXPRESSION FACING THE PROSPECT
OF DEATH
404
A CHARACTER ANALYTIC APPROACH TO
WORKING WITH DESIRE PROBLEMS
S. Schaller
Norwegian Institute of Clincal Sexology and Therapy, Oslo, Norway
P.K. Shah1, A.P. Shah2
Sexual Medicines & Infertility, Sannidhya Institute & Research Centre,
Gujarat Research & Medical Institute, SAL Hospital, Ahmedabad, Gujarat,
India, 2Gynaecologist & Infertility Specialist, Women’s Health, a Division of
Sannidhya Institute & Research Centre, Gujarat Research & Medical
Institute, SAL Hospital, Ahmedabad, India
1
This study was conducted at Sannidhya Institute & Research centre,
Ahmedabad, India over a period of one year between January 2009 and
December 2009. Total 153 subjects were enrolled, who had come to
the centre with complain of sexual dysfunctions. These subjects were
asked to fill up a questionairre prepared specially with emphasis on
their investment in stock market since last two years. Detailed clinical
R. Silva
Psychology and Education, Universidade Católica de Brasília, Brasília, Brazil
The aim of this research is to study the repercussion of cancer on
marriage relationship and the couple’s sexual life in patients under
palliative care. We present a study of case whose sample was formed
by a couple. They live in the “Distrito Federal” and one of spouses has
been hospitalized at the “Hospital de Apoio de Brasilia (HAB)”. The
study privileged the qualitative analysis. We used the clinical method
and the data had been interpreted according the family systemic
approach as well as theoretical studies of human sexuality. The instruments were semi structured guided interview, family genogram and
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Proceedings from the 20th World Congress of Sexual Health
bonding technique. The study showed the following results: the infidelity of spouses before the disease, emphasis on physical attributes of
their wives when they were younger, the difficulty and the possibility
of talking about sexuality, lack of formal sex education, the role of
religion in the system’ homeostasis and the disease as a metaphor for
suffering. The method was appropriate to accomplish the previously
outlined objectives and for better comprehension of the phenomenon
under study. We were concluded that there is restructuring family and
marriage while it is evident the spouses are closest with to the arising
and development of disease. In addition, sociocultural and religious
issues permeate attitudes and sexual behaviors that lead to the need for
change and adaptation in the marital relationship as a whole. SILVA,
Rosenilda Moura da; RIBEIRO, Maria Alexina. Sexualidade e câncer:
vivência de casais no estágio avançado da doença. Curitiba: Juruá,
2009. 146p.
408
RHEUMATIC DISEASE AND SEXUAL
FUNCTION
C. Silvaggi1, F. Tripodi1, C. Simonelli2
Institute of Clinical Sexology, 2Sapienza, University of Rome, Rome, Italy
1
Objective: RD may affect all aspects of life including sexual functioning. The reasons are multi-factorial and comprise both disease-related
and treatment-related factors. The aim of this work is to collect results
of previous research and to highlight the implications for sexological
treatment. The authors will comment results in the light of their own
clinical experience.
Methods: Detailed review of the current available literature.
Results: Physical factors (pain, fatigue, stiffness, functional impairment, drug treatment), emotional problems (depression, anxiety, negative body image), and couple’s problems related to disease stress, as
well as contextual aspects due to complications in employment, family
and social areas, contribute to a less active and less satisfactory sex life.
The percentage of patients with RD who experience sexual problems
ranges from 10 to 80% in different studies and varies from one disease
to another. The most common disorders are low desire, dyspareunia
and erectile dysfunction.
Conclusion: Sexuality is an often underestimated and neglected area
of quality of life in patients with RD. Sexual functioning can be much
improved by adequate counselling and intervention. An integrative
approach is recommended.
409
“WHEN SEXUALITY DOES NOT INVOLVE
SEX”: A CASE REPORT OF MISHANDLED
CONGENITAL ADRENAL HYPERPLASIA (CAH)
M.T. Silveira1, C.C.P. Silva1, F. Knobloch2, C.E. Kater1
1
Medicine, Federal University of São Paulo, 2Psychologic, Catholic University
of São Paulo (PUC/SP), SP, Brazil
Introduction: CAH due to 21-hydroxylase deficiency (21OHD) is a
common cause of DSD, resulting in external ambiguous genitalia in
the female. Failure to diagnose and treat early prompts excess adrenal
androgens to accelerate growth velocity and develop premature male
sex characteristics, including, male behavior, temperament and sexual
orientation, a gender-identity disorder in the female.
Objective: To discuss the conundrum of DSD based on a mishandled
case report.
Case report: JB is a 62yo 46, XX DSD patient, registered and reared
as a girl in a rural area in Brazil. CAH was diagnosed only at 10y, and
treatment began in a reference center. At 17y, subtotal adrenalectomy
was performed due to poor compliance, but gender dysphoria was
already evident. Replacement therapy was interrupted several times.
At 59y, after living as a male in different cities, decided to apply for a
legitimate male ID, and 4 years later, JB unexpectedly requested for a
genital sex-reassignment surgery. Although male-sex oriented, he has
never had any sexual experience. This request was reasoned, in his own
words, as: “When I die, I’m afraid they will know who I am!”
Conclusion: A belated request for a sex corrective surgery poses the
intriguing contrast of sexuality in the social context disconnected from
sexual activity. Recent developments make possible the emergence of
sexuality issues that were seldom discussed before. However, one must
consider the psychological risks involved in face of body changes after
years of living with a DSD.
410
WITHOUT FDA-APPROVED TESTOSTERONE
TO TREAT WOMEN WITH HYPOACTIVE
SEXUAL DESIRE DISORDER U.S. PROVIDERS
RELY ON OFF-LABEL PRESCRIBING
M.C. Snabes, W. Milling, S.M. Simes
BioSante Pharmaceuticals, Inc., Lincolnshire, IL, USA
Introduction: To date, there is no FDA approved product for the
treatment of Hypoactive Sexual Desire Disorder (HSDD) in women
although testosterone continues to be prescribed, off-label. LibiGel
(testosterone gel) is in late-stage clinical development in the US.
Methods: An independent market survey (Campbell Alliance) of more
than 100 U.S. physicians who treat postmenopausal women was performed in 2010 to assess HSDD treatment patterns. One-on-one
interviews and internet surveys were used. IMS prescription tracking
identified the number of branded testosterone prescriptions written
for women.
Results:
• Physicians report a 3.4 out of 7 level of satisfaction with current
HSDD treatment options (1 = low, 7 = high satisfaction)
• Over 90% of physicians managing menopausal women prescribe
testosterone or estrogen/androgen combinations
s 45% of those reporting prescribe branded testosterone approved
for men
s 65% prescribe compounded testosterone (40% in 2008)
• Based on IMS prescription data and survey results, it is estimated
that over four million testosterone prescriptions are being written
off-label yearly for women in the US to treat sexual dysfunction;
• Physicians surveyed would switch 96% of their off-label prescribing
to an approved HSDD product.
Conclusion: In the absence of approved therapies, the majority of
physicians who treat HSDD patients appear to be using compounded
formulations in addition to off-label prescribing of testosterone. Demonstration of LibiGel efficacy and long-term safety in its clinical development program will meet the demand for the first safe and effective
treatment of HSDD in postmenopausal women.
411
SEXUAL MYTHS AND THEIR IMPORTANCE
IN MODERN SEXUALITY
T. Strepet1,2, A. Triuzzi1,2, R. Bochicchio1,2, A. Di Marco1,2, E. Troiano1,2,
D. Trotta1,2
1
ISA, Instituto Italiano Sessoanalisi, 2ACTS, Association for Clinics and
Therapy in Sexology, Salerno, Italy
Sex and sexuality in ancient time, had often a place and an importance
unknown in later cultures and civilizations. In classical world, sexuality
is represented by several figures and characters. The four figures of
Eros, Priapus, Pan and Dionysus cover different aspects of human
sexuality. Eros the god of love, with his childish aspect and behavior,
his wings and arrows, well describes the force and strength and the
unreliability and capriciousness of human love. Priapus, represented
with an enormous and fully erect phallus, tells us of the eternal human
aspiration and desire, to live genitality and sexuality, with unlimited
power and capacity and testifies man’s unwillingness to sexuality die.
Pan, with his animal feet and horns, his impulsiveness and sexual
obsession, is the god of aggressiveness and luxury. He tells us about
the dark side of human sexuality and its relation with hidden needs
and desires, which, even if largely shared by most, are usually not
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186
openly discussed with others. Dionysus is the god of passion and
irrationality. Great explorer and traveler and always accompanied by
faithful followers and ecstatic Maenads, Dionysus illustrates the power
of sexuality, its potentiality to go beyond sexual physicity and rational
boundaries and its capacity to penetrate our inner world, where the
basic and opposite forces of good and bad intermingle and fight.
Western sexual myths have a lot to say to modern sexology. They
tell us about our sexual roots and give us to possibility to confront our
sexuality with that of our ancestors.
414
412
The personality and hormonal correlates of mate poaching (attempting to steal another person’s partner away) and of the target of the
seducer (the mate poached) were examined in a sample 154 undergraduate university students (91 females; 63 males). Thirteen variables
were modeled into two regression equations to predict and profile
mate poachers and the mate poached. Findings revealed that
FEAR OF WOMEN: WORDS AND PICTURES
IN EVERYDAY LIFE AND PATIENTS’
IMAGINARY
T. Strepet1,2, A. Di Marco1,2, E. Arduino1,2, R. Bochicchio1,2, A. Triuzzi1,2,
D. Trotta1,2
1
ISA, Instituto Italiano Sessoanalisi, 2ACTS, Association for Clinics and
Therapy in Sexology, Salerno, Italy
Fear of femininity is an abnormal, irrational and persistent fear of
women. Sufferers experience undue anxiety even though they realize
they face no threat. Fear of women is termed “gynephobia,” a word
derived from the Greek “gyne” (woman) and “phobos” (fear). The
male fear of the feminine is not a well known phenomenon even if it
has been discussed since the naissance of psychoanalysis. Today it is a
topic in modern approach to sexuality like in sexoanalysis. Fear of
women can be present in men who otherwise claim an interest for
women. It can be cause of sexual problems and incapacity to penetrate
as well to establish or maintain an intimate relationship with the other
sex. It is possible to trace in many cultures as well in many sayings and
in narrative stories of men with intimacy disturbances a basic fear of
women.
Often the male fear of the feminine relates to internal and external
triggers. Among them: experiencing vulnerability and uncertainty;
considering women to strong and competent or angry and aggressive
or like their mothers.
413
EROTICA AND ART
T. Strepetova1,2, A. Triuzzi1,2, R. Bochicchio1,2, E. Fattorusso1,2,
E. Troiano1,2, E. Arduino1,2, D. Trotta1,2
1
ISA, Instituto Italiano Sessoanalisi, 2ACTS, Association for Clinics and
Therapy in Sexology, Salerno, Italy
Sexuality is essential for everyone. It permeates and shakes every aspect
of people’s life and the life of man and woman as an artist. Erotic art
covers any artistic work that is intended to evoke arousal or that depicts
scenes of love-making. It includes paintings, sculptures photographs,
music, writing and movies. Artists express in art themselves, their
inspirations, their needs, their being sexual people. Their art is proof
of their sexuality. Many artists have produced sexual works, directly or
indirectly. Examples of erotic art are present in many well known
artists. And their works attract lots of people because of their sexual
content. Sometimes we wonder and interrogate ourselves on the
meaning of some, at first sight, eccentric art works. Anyway from the
artist’s work we can understand much of the sexuality of men and
women in general, of every culture and every time. The artist is able
to leave, unlike the common man, a tangible sign—just in his artistic
opera—of the emotions that sexuality leads within him, in the own
language of sexuality (i.e. the language of the images and the imaginary). A lot of it can be understood from sexuality observing works of
art. And sexologists have a lot to learn and to say in this field. This
works takes into account different artistic productions and the fundamental issues that sexuality refers to: identity, relationship with the
other, aggressiveness, power, life and death.
INDIVIDUAL DIFFERENCES IN MATE
POACHING: AN EXAMINATION OF
HORMONAL, DISPOSITIONAL, AND
BEHAVIORAL MATE-VALUE TRAITS
S. Sunderani1, S. Arnocky1, T. Vaillancourt1,2
1
Psychology Neuroscience and Behaviour, McMaster University, Hamilton,
2
Faculty of Education, University of Ottawa, Ottawa, ON, Canada
(1) male mate poachers were better looking and had higher cortisol
levels, lower levels of testosterone, and reported being higher on
cold affect, self-esteem, and criminal tendencies, and
(2) female mate poachers and targets of mate poachers reported being
more physically attractive, as did male targets of mate poachers.
Sex differences in the context of mate poaching attraction as well as
the characteristics of those who are successful in their attempts to lure
away another person’s romantic partner are discussed.
415
ERECTILE DYSFUNCTION ASSOCIATED
WITH CARDIOVASCULAR RISK FACTORS
P.L. Tarraga1,2, A. Celada3, A. Galvez4, J. Solera5, M. Lopez3, E. Arjona3,
Salud Sexual Albacete
1
Medicina, Universidad de Castilla la Mancha, 2Medicina, Universidad
Catolica del Norte Castilla la Mancha, 3Health Center, SESCAM,
4
Anatomia, Universidad Catolica del Norte Castilla la Mancha, 5Medicina,
Universdad Castilla la Mancha, Albacete, Spain
Objectives: 1—To determine the prevalence of ED in patients with
cardiovascular risk factors (CRF).
Method: Study observational, descriptive and analytical,
cross-sectional.
Analysis of anthropometric variables, social and risk factors cardiovasculary lasrelacionadascon erectile dysfunction.
Results: The blood pressure was found to have no significant relationship with respect to the dependent variable and body mass index. As
toxic habits, consumption of cigarettes or alcohol seem to influence
the presence of ED.
Found a significant relationship with the atherogenic index and
variable recoded into low and high atherogenic risk (p < 0.04). The
glycemic profile was obtained with an average blood glucose of
126 mg/dl.
In the presence of diabetes disease, hypertension and dyslipidemia
was not found significant relationship with respect to the presence of
ED for each disease, but it can be noted that the association of these
diseases is a statistically significant relationship increase cardiovascular
risk, as measured by Framingham. The calculated coronary risk as
measured by Framinghan showed a statistically significant result in the
same way that the excess risk (difference between coronary risk and
average risk assigned to each age) for the presence of ED.
The drugs used to treat diseases of RCV show a close to statistical
significance (p < 0.07).
Conclusions: The high prevalence of erectile dysfunction in patients
with high cardiovascular risk. With greater control of cardiovascular
risk factors improved erectile dysfunction.
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416
418
SEXUAL BEHAVIOR AND SEXUAL
DYSFUNCTIONS IN “NON-HETEROSEXUAL”
WOMEN IN GEORGIA
THE RELATIONSHIP OF SEX GUILT, AGE
AND MARITAL DURATION WITH SEXUAL
DESIRE AMONG IRANIAN WOMEN
M. Tchavtchanidze1, E. Aghdgomelashvili2
Diagnostic-Treatment Amalgamation ‘League’,
Supporting Group, Tbilisi, Georgia
1
2
Women’s Initiatives
Background: Physicians in Georgia receive little formal training on
sexuality and sexual disorders of general population not to mention
“non-heterosexual” group.
Objective: The aim of the study was to assess the patterns of sexual
behavior and the prevalence of sexual disorders in a community sample
of “non-heterosexual” women of the “Women’s Initiative Supporting
Group” in Tbilisi, Georgia.
Methods: Medical and sexual history taking by face-to-face interview
conducted by sexologist.
All subjects provided information on their demographic characteristics, gender identity, sexual orientation, sexual behavior, general
health and sexual history, patterns of sexual partnership and sexual
concerns.
Results: Confusion over gender identity or sexual orientation, internalized homophobia, “mixed—orientation” sexual practices and sexual
problems are easily disclosed through the special interview technique.
Frequency and patterns of each parameter are presented in the study.
The analysis of interviews estimates the prevalence of sexual disorders
like hypoactive sexual desire, anorgasmia or vaginismus among the
group.
Conclusion: Face to face interview has turned out to be a comprehensive tool for gathering complete information and analyzing clients’
sexual function.
Study shows that the common reason why “non-heterosexual”
women delay and escape visiting sexologist is the impact of the widespread opinion that sexologist would treat their “wrong” tendencies.
However, they willingly speak about their sexual preferences and easily
overcome homophobic barriers when physician provides an open and
permissive contact. Thus, interviewing is indeed a valuable method in
enlightening sexual concerns among “non-heterosexual” women.
417
THE RELATIONSHIP BETWEEN SEX GUILT,
AGE AND MARITAL DURATION WITH
MARITAL SATISFACTION AMONG IRANIAN
WOMEN
N. Teimourpour, N. Moshtagh Bodokhti, A. Pourshahbaz
University of Social Welfare and Rehabilitation, Tehran, Iran
Objective: Among a representative sample of married women in the
Iranian capital, Tehran, we aimed to determine the association of selfreported marital satisfaction with self-reported sex guilt , age and
marital duration.
Methods: The data presented here were obtained from a total of 192
married Iranian women who were selected via a multi-cluster sampling
method from University of Social Welfare and Rehabilitation, Tarbiat
Modarres University and Islamic Azad University. The subjects’
sociodemographic data, marital satisfaction (ENRICH Marital Satisfaction Questionnaire), sex guilt (Mosher Revised Sex- Guilt Inventory) were gathered.
Results: Pearson correlation coefficient and regression analysis
methods were used to analyze the data. Findings showed that there is
a significant reverse relationship between sex guilt and marital satisfaction (r = -0.452, p < 0.01). Also there were significant reverse relationships between marital satisfaction and age (r = -0.5, p < 0.01) and
marital duration (r = -0.381, p < 0.01). Age and sex guilt were able to
predict 30.9 percent of the variance of marital satisfaction.
Conclusion: Higher scores in sex guilt was associated with lower
scores of marital satisfaction. Also age and marital duration were
inversely related to marital satisfaction.
N. Teimourpour, N. Moshtagh Bidokhti, A. Pourshahbaz
University of Social Welfare and Rehabilitation, Tehran, Iran
Objective: Among a representative sample of married women in the
Iranian capital, Tehran, we aimed to determine the association of sex
guilt, age and marital duration with sexual desire.
Methods: The data presented here were obtained from a total of 192
married Iranian women (with age range of 18-40) who were selected
via a multi-cluster sampling method from three universities in Tehran.
The subjects’ socio-demographic data, sex guilt (Mosher Revised SexGuilt Inventory) and sexual desire (Hurlbert Index of Sexual Desire)
were gathered.
Results: Pearson correlation coefficient and Stepwise regression analysis methods were used to analyse the data. Findings showed there are
significant negative relationships between sexual desire and sex guilt
(r = -0.442, p < 0.01), age (r = -0.553, p < 0.01) and marital duration
(r = -0.349, p < 0.01). Also Age and sex guilt were able to predict
34.8 percent of the variance of sexual desire in women.
Conclusions: Women who have higher levels of sex guilt, are older
and have been married longer, have lower levels of sexual desire and
visa versa.
419
AN EVALUATION OF THE GENESIS
WORKSHOP FOR NEWLY DIAGNOSED HIV
POSITIVE PEOPLE
P.J.M. Tilley1,2, G. Brown2,3, C. Martinez4
1
Department of Sexology, 2Curtin Health Innovation Research Institute,
3
Department of Health Promotion, Curtin University, 4Western Australian
AIDS Council, Perth, WA, Australia
With the continual improvements in HIV/AIDS treatments and management, the life expectancy for people diagnosed with HIV in
Western countries has improved dramatically (Wong & Ussher, 2008).
Despite this, receiving an HIV diagnosis is still reported as a difficult
life adjustment, often associated with fears for the future; increased
experiences of depression, anxiety and stress (although not always
meeting clinical markers); and the potential complications that come
with being diagnosed with a still potentially terminal disease. In
response to this the Western Australian AIDS Council (WAAC) has
continued to provide a workshop called “Genesis” for newly diagnosed
HIV positive people.
The current pilot study sampled 10 Genesis participants with the
purpose of investigating whether the newly developed questionnaire—
known as the Genesis Questionnaire—was an acceptable tool of measurement to the participants; and to investigate if the anecdotal positive
psychosocial outcomes of attending Genesis could be measured and
used to facilitate progression of the workshop.
It was concluded that the Genesis Workshop could potentially
provide a positive psychosocial experience for people living with HIV/
AIDS, however due to the small number of participants the findings
are preliminary. It was also concluded that although the Genesis Questionnaire shows potential to be a useful measurement tool, it is in need
of further review before it is an acceptable measurement tool for
people living with HIV/AIDS.
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420
SEXUAL (DYS)FUNCTION AND THE
QUALITY OF SEXUAL LIFE IN PATIENTS
WITH COLORECTAL CANCER:
A SYSTEMATIC REVIEW
M.J. Traa1, J. de Vries1,2, J.A. Roukema1,3, B.L. den Oudsten1,4
Center of Research on Psychology in Somatic Diseases, Tilburg University,
2
Department of Medical Psychology, 3Department of Surgery, 4Department
of Education and Research, St. Elisabeth Hospital, Tilburg, The Netherlands
1
Background: The objective of this systematic review was to
determine
(i) the prevalence of sexual (dys)function in patients with colorectal
cancer,
(ii) treatment-related and sociodemographic aspects in relation to
sexual (dys)function and the quality of sexual life.
Recommendations for future studies are provided.
Patients and methods: A systematic search was conducted for the
period 1990 to July 2010 that used the databases PubMed, PsychINFO,
the Cochrane Library, EMBASE, and OVID Medline.
Results: In total, 82 studies were included. The mean quality score
was 7.2. The percentage of preoperatively potent men that experienced
sexual dysfunction postoperatively varied from 5% to 88%. Approximately half of the women reported sexual dysfunction. Preoperative
radiotherapy, a stoma, complications during or after surgery, and a
higher age predicted more sexual dysfunction with a strong level of
evidence. Type of surgery, and a lower tumor location predicted more
sexual dysfunction with a moderate level of evidence. Insufficient evidence existed for predictors of the quality of sexual life. Current studies
mainly focused on biological aspects of sexual (dys)function. Furthermore, existing studies suffered from methodological shortcomings
such as a cross-sectional design, a small sample size, and the use of
non-standardized measurements.
Conclusion: In future research sexuality should be investigated prospectively from a biopsychosocial model. In this biopsychosocial model
the subjective evaluation of sexual (dys)function, hence the quality of
sexual life, and psychological factors associated with or predictive of
sexual (dys)function and the quality of sexual life should be taken into
account.
421
SEXUAL FUNCTIONING IN SURVIVORS
WITH COLON OR RECTAL CANCER
COMPARED WITH THE GENERAL
POPULATION: A POPULATION-BASED STUDY
M.J. Traa1, B.L. den Oudsten1,2, M.S.Y. Thong1,3, L.V. van de
Poll-Franse1,3
1
Center of Research on Psychology in Somatic Diseases, Tilburg University,
2
Department of Education and Research, St. Elisabeth Hospital, Tilburg,
3
Comprehensive Cancer Center South, Eindhoven, The Netherlands
Background: The aim was to compare sexual functioning (SF) in
colon cancer survivors, rectal cancer survivors, and the general population and to describe the correlates of SF in survivors.
Methods: Survivors diagnosed between 1998 and 2007 completed the
sexuality subscales of the EORTC QLQ-CR38. Outcomes were compared with the general population.
Results: For both sexes, SF was lower for rectal cancer survivors (n =
457) compared to the general population (n = 1731). No differences
were found between colon cancer survivors (n = 902) and the general
population. Sexual enjoyment (SE) for men was similar across groups,
while women with colon or rectal cancer reported lower scores compared to the general population. Lower erectile functioning was
reported for rectal cancer survivors compared to colon cancer survivors
and the general population. Female SF was lower for survivors with
colon or rectal cancer compared to the general population. Factors
associated with lower SF were higher age, being a woman, fewer years
188
since diagnosis, not having a partner, middle or high educational level,
rectal cancer, and having Diabetes. Lower SE was associated with
higher age and being a woman. Worse male SF was associated with
higher age, smoking and having a stoma. No significant associations
were found for female SF.
Conclusion: Compared to the general population rectal cancer survivors reported lower SF, SE (only women), erectile functioning, and
female SF. Only female colon cancer survivors reported lower SE and
female SF compared to the general population. Prospective research
is warranted in order to identify predictors of sexuality scores.
422
EVALUATION OF SEXUALITY AND
RELATIONSHIP IN WOMEN SUFFERING
FROM ENDOMETRIOSIS
F. Tripodi1, C. Silvaggi1, A. Fabrizi1, G. Gambino1, I. Di Pomponio2,
R. Rotunno1, C. Simonelli2
1
Institute of Clinical Sexology, 2Sapienza, University of Rome, Rome, Italy
Objective: This study evaluates the quality of sex life and relationship
in an Italian sample of women affected by endometriosis, verifying if
this desease as a negative impact on both areas.
Methods: 60 participants who had been diagnosed with endometriosis
were recruited at the Endometriosis and Chronic Pelvic Pain Outpatient Clinic at the Policlinico Umberto I of Rome and on the forum
of Italian Association of Endometriosis internet site from September
2009 to March 2010. The controls were 60 healthy women who
accepted to participate in the research, matched for age and relational
status. An ad hoc questionnaire and the McCoy Female Sexuality Questionnaire (MFSQ) were administered to participants.
Results: In both groups more than 70% of women reported engaging
in sexual activity during the previous 4 weeks. No statistically significant differences were observed between groups in sexual intercourse
frequency. As expected, the clinic group scored significantly lower in
the Sexuality scale than the healthy women (F = 4.981; p < .05), but
not in the Relationship scale. Sexuality is more impaired by pain frequency during sexual intercourse. Nevertheless, data showed that
women affected by endometriosis seem not to lose sexual interest and
orgasmic satisfaction.
Conclusion: The quality of relationship with the partner seems not
to be damaged by endometriosis. Women with endometriosis experience pain in different ways, more or less intensely and these pains can
be part of functional disorders, in which case a global assessment must
be carried out, taking into account many aspects, including emotional
ones.
423
SEXUAL FANTASIES AND SEXUAL PROBLEMS
D. Trotta1,2, T. Strepet1,2, A. Di Marco1,2, E. Arduino1,2
ISA, Instituto Italiano Sessoanalisi, 2ACTS, Association for Clinics and
Sexuality, Salerno, Italy
1
The importance of sexual fantasies in human sexuality, in the physiology as well as in the sexual pathology, is often under evaluated. Anyway,
the erotic and sexual imaginary, is a pillar of male and female sexuality
and has a central role in every man and woman’s sexual life.
Typical fantasies. Sexual fantasies are present in most men and
women. Most typical male fantasies are centered on identity affirmation and consolidation, sexual domination, woman detachment, phallic
aggressiveness. Most common female fantasies regard sexual power
and erotic fascination, exhibitionism and sex without direct involvement and consequent sense of guilt. Submission fantasies, competitive
as well as degradation fantasies are also common in men and women.
Importance of sexual imaginary. The study of erotic imaginary is
important to understand sexual health and to treat sexual limits and
sexual pathology; especially in structured and complex cases which are
often difficult to understand. Systematic observation of sexual and
erotic imaginary helps go beyond the gaps left empty by otherwise
meaningless behavior. This is the case when only objective and observ-
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Proceedings from the 20th World Congress of Sexual Health
able behavior is considered. The analysis of sexual fantasies and dreams
is a very useful tool, when used on its own or with other therapeutic
aids, like medicaments and behavioral -cognitive therapy. Sexual fantasies and sexual dysfunctions and desire disorders. Sexual fantasies of
dysfunctional persons are presented and the relationship between
sexual imaginary and disturbed sexual behavior and unpleasant feelings
is discusses.
tion = .66, Refusal = .74 and STD-P = .79). The correlations between
the CSFQ-14 and safe sex ratio are consistent with the SAS. The drug
dependent subsample obtains a significantly lower score in Initiation
and STD-P in comparison with the normative sample.
The adaptation of the SAS in drug dependent men provides sufficient guarantees for a reliable and valid use in both clinical practice
and research.
424
426
PSYCHOSEXUAL PROBLEMS IN MALES:
BEYOND THE PERFORMANCE ANXIETY
A PROPOSAL FOR TESTING THE EFFICACY
OF MINDFULNESS-BASED THERAPY AND
COGNITIVE-BEHAVIORAL THERAPY FOR
WOMEN WITH HYPOACTIVE SEXUAL
DESIRE DISORDER AND SEXUAL AROUSAL
DISORDER
D. Trotta1,2, T. Strepet1,2, A. Di Marco1,2, L. Cleffi1
1
ISA, Instituto Italiano Sessoanalisi, 2ACTS, Association for Clinics and
Sexuality, Salerno, Italy
Sexual problems could be found in the majority of people with psychiatric problems. Sexual disturbances can be also found in people with
psychological problems. However most people suffering from sexual
problems -and with no biological origin- is not affected by psychiatric
or psychological disturbances. Psychosexual causes of sexual problems
are many. The most common and known among them are the superficial causes, like superficial anxieties (i.e. anticipatory negative anxiety
and performance anxiety), cognitive behavioral factors or cultural
factors. The less common and known are the deep causes. In some
cases, specific sexual aspects connected to the identity, to the relationship one individual has with the other man or woman, and to the sexual
dynamic, are the basis of sexual disturbances.
Clinical disturbances: Various clinical cases have been taken into
consideration. They regard men, in good health conditions, suffering
from single or multiple disturbances. The disturbances range from
inability to penetrate to sexual anhedonia, ejaculation difficulties,
desire disorders and scarce or absent interest in vaginal penetration.
Clinical cases: This work focuses on these topics. Healthy men with
pure sexual symptoms, both single and multiples will be taken into
account. The case of a man with delayed ejaculation and pleasure
disturbance will be shown. Another case regards a man with inability
to penetrate. Furthermore a man with sexual trauma dating back to
his childhood is described. Authentic drawings made by the patient are
also shown.
425
HOW TO ADAPT AND VALIDATE A SEXUAL
QUESTIONNAIRE FOR SPECIAL
POPULATION: AN EXAMPLE OF THE SEXUAL
ASSERTIVENESS SCALE ON DRUG
DEPENDENT MEN
P. Vallejo-Medina, J.C. Sierra
Personality, Evaluation and Treatment Psychology, Universidad de Granada,
Granada, Spain
The Sexual Assertiveness is related with the initiation of the sexual
activity, with the refusal of unwanted sex and with the negotiation of
STD-P prevention methods. The Sexual Assertiveness Scale (SAS)
evaluates these three dimensions (Initiation, Refusal and STD-P) with
18 items. The Spanish SAS adaptation showed proper psychometric
properties.
A total of 326 drug dependent men and 322 normative men took
part on this study. No significant differences were found in age and
education level between these two groups. The SAS, the Changes in
Sexual Functioning Questionnaire (CSFQ-14) and the Substance
Abuse Questionnaire (SAQ) were used. The clinical sample was
obtained by cluster sampling and normative one was obtained by
convenience sampling.
The factorial invariance shows a strong factorial equivalence
between both samples. The Differential Item Functioning (DIF) analysis indicates DIF problems in items 1 and 14. The effect size of the
DIF is high and moderate respectively. In general psychometric properties are good, the internal consistency reliability is adequate (Initia-
S. Vilarinho1,2, P. Nobre1, J. Heiman3
Universidade de Aveiro, Aveiro, 2Universidade de Coimbra, Coimbra,
Portugal, 3The Kinsey Institute, Indiana University, Bloomington, IN, USA
1
The aim of this research is to test the efficacy of a Mindfulness-Based
Intervention (MBI) for women with sexual desire and arousal problems, as compared to a Cognitive-Behavioral Intervention (CBI), and
no treatment. Furthermore, the mechanisms involved in therapeutic
change will be examined.
A total of 60 premenopausal women with a DSM diagnosis of sexual
dysfunction due to psychogenic causes will participate in the study.
Participants will be randomly assigned to one of the three treatment
conditions:
1) MBI;
2) CBI;
3) no treatment.
Participants will be assessed before therapy, after sixth therapeutic
session, at the end of treatment and after the 6-month follow up
period.
Before therapy, assessment will address medical factors, relationship
factors, and psychopathology.
Also before therapy and during all the subsequent evaluation sessions, women will be assessed regarding sexual beliefs, thoughts, affect
during sexual activity, cognitive distraction, sexual functioning and
satisfaction.
Before and at the end of treatment, participants’ response to sexual
explicit material will be assessed with subjective measures (self-report),
physiological measures (photoplethysmograph) and brain imaging
(fMRI).
We expect to find a significant improvement on sexual functioning
in both groups when compared to no treatment. Higher levels of sexual
desire, arousal and satisfaction are anticipated in the group receiving
Mindfulness training.
Positive treatment outcome is expected to be related with changes
in attentional focus, automatic thoughts, sexual beliefs, affect, awareness of inner experience, physiological and subjective arousal, and
activation in neural circuits related to attention.
427
EXAMINING THE RELATIONSHIP BETWEEN
PSYCHOTROPIC MEDICATION USE AND
TESTING POSITIVE FOR CHLAMYDIA AND
GONORRHEA AMONG DETAINED
ADOLESCENTS
D. Voisin
School of Social Service Administration, University of Chicago, USA,
Chicago, IL, USA
Objective: We examined whether psychotropic medication (PTM)
use was related to testing positive for Chlamydia and Gonorrhea
among detained adolescents.
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Methods: A convenience sample of 547 detained adolescents ages
14-18 years were recruited from eight youth detention centers in
Georgia. Using A-CASI technology, data was collected on demographic factors, use of PTM, and sexual risk behaviors. Chlamydia and
Gonorrhea diagnoses were assessed by laboratory testing.
Results: Thirteen percent (13.1%) of adolescents not using PTMs
tested positive for STIs compared to only 4.9% of those reporting
PTM use. PTM users had a 62% smaller odds ratio for testing positive
for Chlamydia or Gonorrhea.
Conclusion: Findings suggest that screening and providing treating
for the unmet mental health needs of detained youth represents an
important priority area. Especially, given that such treatment is related
to lower rates of STIs.
428
QUALITY OF LIFE AND SEXUAL HEALTH
AFTER SEX REASSIGNMENT SURGERY IN
FEMALE-TO-MALE TRANSSEXUALS
K. Wierckx1, E. Van Caenegem1, S. Weyers2, P. Hoebeke3, S. Monstrey4,
G. De Cuypere5, E. Elaut5, G. T’Sjoen1
1
Endocrinology, 2Gynaecology, 3Urology, 4Plastic Surgery, 5Sexology and
Gender Problems, University Hospital Ghent, Ghent, Belgium
Context: Although sexual health after genital surgery is an important
outcome factor for many transsexual persons, little attention has been
attributed to this subject.
Objective: To provide data on quality of life and sexual health after
sex reassignment surgery (SRS) in female-to-male transsexual persons.
Design: A single center cross-sectional study in 50 female-to-male
transsexual persons (mean age 37 years) after longstanding testosterone therapy and on average 8 years after SRS. Ninety-two percent of
the participants underwent phalloplasty.
Mean outcome measures: Self-reported physical and mental
health using the Dutch version of the SF-36 Health survey; sexual
functioning before and after SRS using a newly constructed specific
questionnaire.
Results: Compared with a Dutch reference population of community
dwelling men, female-to-male transsexuals scored well on selfperceived physical and mental health. The majority had been sexually
active before hormone treatment. More than a quarter expressed to
have been frequently vaginally penetrated before starting hormone
therapy, whereas we found a tendency towards less vaginal involvement
during hormone therapy and before SRS. Most participants reported
increase in frequency of masturbation, sexual arousal and ability to
achieve orgasm after SRS. Almost all participants were able to achieve
orgasm during masturbation and sexual intercourse and the majority
reported a change in orgasmic feelings toward a more powerful and
shorter orgasm. Surgical satisfaction was high, despite a relatively high
complication rate.
Conclusion: Results of the current study indicate female-to-male
transsexual persons have generally a good quality of life and experience
satisfactory sexual function after SRS.
429
SEXUAL DESIRE IN FEMALE-TO-MALE
TRANSSEXUAL PERSONS
K. Wierckx1, F. Van De Peer1, D. Dedecker1, E. Van Caenegem1, E. Elaut2,
G. T’Sjoen1
1
Endocrinology, 2Sexology and Gender Problems, University Hospital Ghent,
Ghent, Belgium
190
Inventory). Also, participants were asked additional questions on
current and past sexual desire, frequency of masturbation and sexual
intercourse in the past month. Serum levels of testosterone and SHBG
were measured on fasting morning serum samples. Data from our
previous study on sexual desire in 62 male-to-female transsexual
persons using the same validated questionnaire was used as reference
population.
Results: In retrospect, the majority of the participants (73,9%)
reported an increase in sexual desire after cross sex hormone treatment
and SRS. No associations between levels of testosterone and scores of
solitary and dyadic sexual desire were found. Solitary sexual desire
scores were significantly correlated with frequency of masturbation (r
= 0,835; P = 0,0001), whereas frequency of sexual intercourse with a
partner was not correlated with dyadic nor solitary sexual desire.
Female-to-male transsexual persons scored significantly higher on
sexual desire scores than male-to-female transsexual persons (P =
0,0001).
Conclusion: Most female-to-male transsexual persons report on a
marked increase of sexual desire after testosterone treatment and SRS.
No associations between levels of testosterone and measures of sexual
desire were found. Sexual desire is significantly higher compared to
male- to-female transsexual persons.
430
STRIANT: PHARMACOKINETICS,
TOLERABILITY AND SAFETY IN
HYPOGONDAL MALES
M.G. Wyllie1, W.W. Dinsmore2
1
Clin Dev, Plethora Solutions Plc, London, 2Dept of GU Medicine, Royal
Victoria, Belfast, UK
Objectives: Buccal administration of testosterone (T) may offer a
viable alternative to gels, patches and injectables. We summarise here
the key features of the clinical database on Striant (the sustainedrelease, muco-adhesive, 30mg buccal tablet).
Design and methods: Data are from 6 clinical trials of up to 12 weeks
duration in 225 patients and volunteers. Striant 30mg was applied
twice daily.
Results: T levels are achieved within 4 hrs, reaching Cmax after about
12hrs with steady state after two doses. In 5 efficacy studies, consistent
efficacy was observed (Cavg(0-24) 4.78-5.43ng/ml). The T to DHT ratio
remained unaltered. Between 87 and 97% of patients achieve a
Cavg(0-24) within the normal range. The only side effect with greater
than 2% incidence was “application site irritation” (3.9%) with 1–1.3%
noting peculiar or bitter taste. Compliance was excellent with only
3.5% of patients discontinuing during the phase III programme.
Conclusions: As venous drainage from the oral cavity flows directly
to the superior vena cava, transbuccal delivery of T should circumvent
hepatic first-pass catabolism and represent a viable alternative route of
administration. In reality, clinical trials with Striant a sustained-release
muco-adhesive buccal tablet demonstrate that T levels can be consistently and rapidly restored to the normal physiological range in hypogonadal males. The formulation is well tolerated and has demonstrated
a high level of acceptability by patients. In addition Striant therapy
maintains the normal T to DHT ratio which could be an important
factor in co-morbid prostatic disease. Overall, Striant represents
an important addition to the therapeutic armamentarium for
hypogonadism.
Objective: The current study aims to describe sexual desire in femaleto-male transsexuals post SRS (sex reassignment surgery) using a validated questionnaire. The association between serum androgen levels
and the intensity and frequency of sexual desire are examined. The
data are compared to those of male-to-female transsexual persons.
Design: Cross sectional study.
Methods: Female-to-male transsexual persons, post SRS, (n = 48)
completed a questionnaire measuring sexual desire (Sexual Desire
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431
POSTER PRESENTATION
TESTOSTERONE BUCCAL SYSTEM
(STRIANT) DELIVERS PHYSIOLOGICAL
TESTOSTERONE LEVELS IN
HYPOGONDAL MALES
TRACK 3
M. Wyllie1, W.W. Dinsmore2
1
Clin Dev, Plethora Solutions Plc, London, 2Dept of GU Medicine, Royal
Victoria, Belfast, UK
Objectives: Due to hepatic catabolism, oral testosterone (T) replacement is ineffective in the treatment of hypogonadism. As venous drainage from the oral cavity flows directly to the superior vena cava,
transbuccal delivery of T should circumvent hepatic first-pass catabolism and represent an alternative route of administration. The data
presented examine this hypothesis.
Design and methods: Striant, the sustained and controlled-release T
buccal system (TBS), containing 30 mg was applied twice daily (at
approx 08.00 and 22.00) to hypogonadal males and hormonal levels
were measured by standard technology.
Results: In the first open-label, multicenter study in 82 hypogonadal
males, Striant was given twice daily for 12 weeks. Of these, 86.2% had
mean serum concentrations (Cavg(0-24)) values within the normal range
(5.4+/-1.7ng/ml), compared to 1.5+/-0.9ng/ml at baseline. At 12
weeks, the percentage of time over the 24hr sampling period that total
concentrations were within the normal range was 76%. In a second
study in 29 hypogonadal males, quantitatively and qualitatively similar
results were observed. A Cavg90-24) of 5.5+/-1.7ng/ml, from a baseline
of 1.2+/-0.7ng/ml, was observed after 7 days of twice-daily Striant
administration. Over 92 % of patients achieved T within the normal
range and the mean percentage of time over the 24hr sampling period
that T concentrations remained within the physiological range was
84%. In neither study was the ratio of T to DHT altered.
Conclusions: In an attempt to achieve and maintain physiological T
levels in hypogonadal males, buccal administration appears to offer a
viable alternative to gels, patches and injectables.
432
GYNECOLOGICAL AND SEXUAL
COMPLICATIONS IN WOMEN WITH
BLEEDING DISORDERS
D. Wysocki
Department of Sociology, University of Nebraska at Kearney, Kearney, NE,
USA
Women with bleeding disorders are typically undiagnosed, misdiagnosed, and/or receive surgery or hormone therapy for what actually
is a coagulation problem. While the literature on bleeding disorders
in women is increasing, much of the research leaves out information
about the quality of life complications specific to women who have
some type of coagulapathy. The study utilized a ‘snowball’ technique
to gather women who have some type of bleeding disorder and who
were willing to take part in this project which began in 1996. Women
were contacted at hemophilia conferences, through various Internet
bulletin boards such as Hemophilia Support, from advertisements
about my project in magazines specifically for the hemophilia community and in hemophilia chapter newsletters around the country,
my Internet web page, and through ‘word of mouth.’ The average
age of menarche of the women in this study was 12.5 (SD ± 1.5)
which they described as unusually long, frequent, heavy. The bleeding
worsened over time. About half of the women had undergone from
1 to 15 dilation and curettage. Of the women in this sample, 37.9%
had already undergone a hysterectomy for bleeding complications.
Furthermore, over half of the women in this study reported some
type complication during sexual intercourse. Complications included
pain, bleeding/bruising, or “ripping” of the vagina. When women
tried to talk with their doctors about this problem, they were told it
was “in their head,” or “they should find a smaller man” rather than
treating the problem.
433
NEED OF COMPREHENSIVE SEXUALITY
EDUCATION: EVIDENCE FROM NEPAL
R. Adhikari
Population and Geography Department, Mahendra Ratna Campus,
Kathmandu, Nepal
Objectives: To explore the sexual behavior, knowledge towards
the essential fact of HIV transmission and their perception on
need of sexuality education in school/college among college
students.
Methods: Structured self-administered questionnaires were administered to 1137 college students (573 males and 564 females) in Kathmandu Valley in 2006. Bivariate and multivariate analysis, separately
for male and female, were used for the analysis.
Results: A substantial proportions of college students indulge in risky
sexual behavior. Substance abuse, multiple sex partners, sex with commercial sex workers and inconsistence use of condom with both regular
and non regular partners are common among the males than the
females.
On the other hand, misconception about modes of HIV transmission is very high among students. Only less than two-thirds had correct
knowledge about all five modes of HIV transmission (UNGASS indicator). Females were less likely (Odds Ratio = 0.61) to have correct
knowledge about it than males. Furthermore, those who were highly
exposed to media, and who have studied reproductive health education
in school/college were more likely to have correct knowledge about
HIV transmission than their counterparts.
An overwhelming majority of the students mentioned that sexuality
education is necessary for youth before having sexual intercourse.
Notably, almost all students (87%) have demanded sexuality education
in school/college level.
Conclusions: College students are exposed to health hazards due to
their risky sexual behavior; hence sexuality education including comprehensive knowledge about HIV issues should be provided in school/
college. It could benefit even out-of-school youths, because their partners often are students.
434
BEST PRACTICES IN POSITIVE PREVENTION
INITIATIVE ON HIV/AIDS AMONG PEERS IN
COMMUNITIES ENUGU WEST SENATORIAL
ZONE OF ENUGU STATE
O.P. Aginam
Biochemistry, Global Health Awareness Research Foundation (GHARF),
Enugu, Nigeria
It is alarming that the ignored and overlooked areas for HIV/AIDS
education are the most devastating areas with HIV/AIDS epidemic.
There has been a poor response to HIV/AIDS epidemic. In many
grassroots communities due to peer knowledge on sexuality and reproductive issues. These factors has effect them in decision making and
recognizing their right which in turn has predispose them to various
SRH health problems including STIs, unwanted pregnancy, unsafe
abortion among others people has resolved together information from
media, peers internet for information on SRH issues which in most
cases is incorrect.
Methodology: The project which utilizes peer education has trained
30 peer facilitators (PF) of students, teachers, out of school youth,
people living with HIV and AIDS (PLWHAS), religious leaders,
Okada riders from these communities. The trainings were basically on
SRH issues and life building skills.
The follows series of advocacy, sensitization, training and step down
training.
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The trained paired peer facilitators using manual provided to conducts peer education session with their peers on abstinence, being
faithful to an uninfected partner and other prevention.
Result the guiding outcome has been recorded in which a total of
two hundred and forty nine (249) were reached through abstinence
and eight hundred and sixty nine (869) were reached through being
faithful and other prevention respectively.
Lesson learnt: Paring the peer facilitators for a minimum of 3 contact
of education session per 3 hours. This has increased the number of
house hold reached and facilitated on improved knowledge and positive behaviour.
435
APPRENTICESHIP EDUCATION—NEW
ROUTE TO STUDY SEXUAL COUNSELLING
IN FINLAND
R.E. Ala-Luhtala
Continuing Education, Center of Excellence in Sexual Health Education,
JAMK University of Applied Siences, Jyväskylä, Finland
The Finnish policy about promotion of sexual and reproductive health
given by Ministry of Social Affairs and Health includes a guideline for
integrating sexual counselling into standard health services all around
the country. According to the policy there should be at least 1–3 sexual
counsellors in every health center depending on the size of the center
and even more counsellors available in major hospitals and hospital
districts.
To meet the demands of the policy, JAMK University of Applied
Science coordinates a new type of supplementary education program
for employees in health and social work. The program is based on
apprenticeship education system that uses two-pronged learning
model:
1) basic knowledge in sexology and theoretical subjects are covered in
university level educational institutions, and
2) practical skills are developed in a workplace under a supervisor who
has competence in sexual counselling.
The apprenticeship education (30 ECTS) has four themes:
1) ethics, professionalism and developing competence,
2) knowledge base of sexual health and sexology
3) methods of sexual counselling and work-oriented development
project.
The core competence of the education is based on the requirements
of sexology and sexual health promotion as defined by the Nordic
Association for Clinical Sexology (NACS): Sexology I: Basics of
sexology.
The students show their skill level with performance-based exams
which evaluate their knowledge of sexual councelling defined by the
predetermined aims. The performance can be for example a portfolio,
a developmental task of sexual councelling, a simulated client situation
and a group exam.
436
ATTITUDES AND BELIEFS OF TURKISH
NURSING STUDENTS REGARDING GIVING
SEXUAL COUNSELING TO PATIENTS
H. Ayhan1, E. Iyigun1, S. Tastan1, H. Coskun2
1
Gulhane Military Medical Academy, School of Nursing, Ankara, 2Canakkale
Military Hospital, Canakkale, Turkey
The attitudes and beliefs of individuals with regard to special topics
may affect their behaviors, thus making it important to know their
attitudes regarding sexuality in the education of health staff. The aim
of this study was to determine the barriers and their possible causes
that affect Turkish nursing students when evaluating sexual problems
occurring in patients due to illnesses or their treatments and when
giving sexual counseling accordingly.
192
Material and method: This study was planned and applied as a
descriptive study. It was executed at a military nursing school in Turkey
between May and June of 2009. The study sample was composed of
125 volunteer nursing students. To collect data, a data collection form
and the Sexual Attitudes and Beliefs Survey was used.
Results: Most of nursing students had gathered information regarding
sexual life changes due to illnesses or treatments in patients. Most of
nursing students stated that the gender and age of the patient had an
influence when providing sexual counseling. When barriers regarding
giving counseling by the nursing students were examined that these
barriers were being uncomfortable in providing sexual counseling to
patients, not allowing time for patients to discuss their sexual problems
and the beliefs that sexuality is a very special topic to discuss with the
patients.
Conclusion: The barriers mentioned above result in deficiencies for
the nursing students in obtaining a professional attitude. For these
reasons that providing more education on sexual counseling, including
theoretical and practical aspects, in the nursing student curriculum is
important.
437
FEMALE INITIATION RITUALS AND
SEXUALITY IN NORTHEN MOZAMBIQUE
B. Bagnol
Anthropology, The Witwatersrand University, Johannesburg, South Africa
In Northern Mozambique most of the girls and boys are initiated when
they are between 6 and 14 years of age and in the last few decade the
age of initiation has been decreasing mainly due to the influence of
Islam. The paper brings evidence on the role of female initiation rituals
in the construction of girls’ sexuality.
A total of 19 individual interviews and 26 focus groups discussion
were carried out in December 2009 and 2010 in the provinces of Cabo
Delgado and Niassa with men and women of different age groups to
grasp the evolution of the practices. Participation in several phases of
three initiation rituals allowed registering the messages transmitted.
Although female initiation rituals present variations according to the
region, the linguistic group and the religious orientation, young initiated are prepared to engage in sexual intercourse after the rituals. They
are familiarized with penetration, movements during coitus, cleaning
of the penis and the vagina after sexual intercourse, massaging of their
partner, avoiding sexual contact during menstruation and caring of
menstrual fluids. They are also recommended to always accept having
sexual intercourse at their partner’ request. Girls are portrayed as the
one provoking men who cannot resist. In exchange of their sexual
favour they are taught that they should receive money in cash or in
kind.
While significant transformations are registered including the
reduction of the duration of initiation, the rituals represent a fundamental element in the construction of female sexual identity defining
the onset of sexual debut.
438
THE EDUCATION AND SEXUAL HEALTH
NEEDS OF ADOLESCENTS IN PAKISTAN
Q. Baig
Country Office, World Population Foundation, Islamabad, Pakistan
Talking about Sexuality is complex in conservative society like Pakistan, which is sixth most populous country with about 35 percent of
the population is of adolescents with evidence of risky behaviors. A
pioneering study by the World Population Foundation on the ‘Status
of Sexual and Reproductive Health and Rights of Young People in
Pakistan (2009-10)’ revealed that the most infringed Rights are the
‘Right to Information and Education’ and ‘Right to Healthcare’. WPF
believes that this is the time to challenge and change perceptions.
Accordingly, WPF developed SRHR Education Curriculum for adolescents in formal and religious schools in consultation with stakeholders that informs and promotes healthy behaviors and creates demand
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Proceedings from the 20th World Congress of Sexual Health
for SRHR friendly youth services. To address the needs WPF has
engaged health providers to ensure non-judgmental SRHR friendly
services to youth. The session will reflect on WPF’s unique approach/
model, challenges and lessons learned in this revealing journey.
439
CLEARING UP! THE SEXUAL WELLBEING
DEVELOPMENT PROJECT 2010–2012
S. Ruuhilahti, K. Bildjuschkin
Municipal Health Care and Social Services Department, Turku, Finland
Clearing Up! The Sexual Wellbeing Development Project 2010-2012
has been funded by a national health promotion grant. The Turku
Municipal Health Care and Social Services Health Promotion Unit is
responsible for carrying out the project.
The Clearing Up! is targeted at promoting sexual wellbeing of
young persons during their vocational training. Sexual education may
occupy a minor position in vocational training even if the young
student would benefit from support to his or her own sexual maturation and development especially during this phase of life.
Project provides continuation training to Vocational Institution
staff. The training process emphasizes supervision of work. The adults
develop their abilities to bring up sexuality related issues in discussions
with their students in everyday contexts or in teaching their subjects
and when the students broach this theme. Central concerns in the
process are the staff’s individual reflection on sexual and gender issues,
encouragement to a mutual, open dialogue as well as listening, and
responding, to the needs and hopes of young persons.
Targets:
Teachers’ own capacities and individual reflection on sexuality and
gender are strengthened.
Young, vocational students’ expectations and needs regarding sex
education are clarified and information, skills and support are
provided.
Strengthening the young person’s development toward his or her
individual and comfortable sexual and gender identity.
Promotion of skills to enhance one’s sexual health and wellbeing
among both the students and the teachers.
Strengthening of emotional skills to prevent non-violence and
promote equality.
Promotion of sexual rights.
Using LGBT health disparities as the rationale, educational sessions
identifying LGBT health care disparities and interview skills trainings
were developed. Guided by key informant interviews, lectures and
workshops have been presented in primary care residency training, and
will be offered at each affiliated Primary Care Network Clinic. Other
efforts to change atmosphere include staff education about respectful
interaction with sexual minorities, public identification of LGBTfriendly providers, and seeking designation as an LGBT-friendly
health system through Human Rights Campaign’s Healthcare Equality
Index. Provider education rollout will be completed prior to adding
SO/GI to the EHR.
441
ACTION RESEARCH IN CURRICULUM
DESIGN ON BODY IMAGE OF NURSING
INSTITUTE STUDENTS
L.H. Chen1, Y.C. Lin2
Lecturer, Department of Nursing, 2Lecturer, Center of General Education,
Chang Gung Institute of Technology, Taoyuan, Taiwan R.O.C.
1
The study intended to explore the body images of female nursing
students in Taiwan. 48 students were recruited to join the research.
Researchers investigated their level of body image satisfaction by
serving them a standardized instrumentation which was developed by
researchers. The important findings are:
1) more than half of the participants were not satisfied with their
breast size.
2) over 60% of those students perceived themselves intermediate satisfied or satisfied in their body images.
The unsatisfied body parts contribute to “breast size”, “thigh”, “buttocks”, “body height”, and “eye size”.
3) The most-used methods they choose to promote their appearance
were exercises (70.8%) and dietary management (64.6%).
Some participants (14.6%) will have weight control medication and
some (12.5%) choose to accept plastic surgeries.
Based on the study outcome, a curriculum will be design to promote
students’ body images. The suggestions will be given to teens, their
parents, and health promotion units in school.
440
442
INCLUSION OF SEXUAL ORIENTATION AND
GENDER IDENTITY IN ELECTRONIC
HEALTH RECORDS
MOTHER-ADOLESCENT COMMUNICATION
ABOUT SEX IN TAIWAN: BELIEFS AND
STYLES
1
1
Development of electronic health records (EHR) provides an opportunity to influence health care delivery within systems, potentially
reducing health care disparities by supplementing specific information
for the encounter. Recognizing disparities experienced by minority
populations, a Task Force was convened at University of California,
Davis Health System (UCDHS) to incorporate self-defined ethnic
identity and preferred language into EHR. To reduce LGBT health
care disparities, inclusion of sexual orientation and gender identity
(SO/GI) in the EHR was explored by a second Task Force.
Initial responses to inclusion of SO/GI in the EHR were swift
and negative. Objections were raised that clinicians lacked skills
needed for gathering such sensitive information, and that seeking
this information would be uncomfortable. Educating clinicians on
LGBT issues became the Task Force’s charge, working to: identify
the rationale for discussion of SO/GI in the clinician-patient
encounter; develop education to address clinician needs; identify strategies for successful local incorporation of education; and roll out
education.
The aim of the current study was to understand mothers’ beliefs and
ways of communication about sex with their adolescent children in
Taiwan. One-on-one in-depth interviews were conducted to 18 Taiwanese mothers in 2006. Interviewer was the first author. Interviews
were tape-recorded and were written down verbatim.
Based on the Grounded Theory, there derived four types of mothers’
beliefs about adolescent sexuality:
E.J. Callahan1, H. Ton2, R. Weiss3, D. Latimore4
Associate Dean for Academic Personnel, 2Psychiatry, 3Family and
Community Medicine, 4Internal Medicine, University of California, Davis
School of Medicine, Sacramento, CA, USA
C.-C. Cheng1, E.H.-W. Yen2
Public Health, Fu-Jen Catholic University, New Taipei City, 2Health
Promotion and Health Education, National Taiwan Normal University,
Taipei City, Taiwan R.O.C.
1. Innocence which believed that adolescents knew nothing about sex.
2. Denial which believed that adolescent sex were uncontrollable.
3. Limited Trust which believed that adolescents were curious about
sex yet their abilities to make decision were not mature enough, and
4. Fully Trust which gave adolescent full autonomy to make
decision.
There also found three styles of the roles mothers believed they played
in sex communication with their children: Protection, Guidance, and
Informing Only. Finally, depending on the topics of communication,
there found two dimensions of sex communication: the level of open-
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ness and the level of sensitivity. Most of the topics mothers talked to
their children were with low sensitivity (such as asking girls out), and
they talked about them openly.
Cultural aspects of sex and parental roles on parent-child communication were discussed. The applications of family sex communication
education were recommended.
443
COLLEGE STUDENTS’ SEXUAL HEALTH
KNOWLEDGE, SEXUAL ATTITUDE AND
SEXUAL-RELATED BEHAVIOR IN MAINLAND
CHINA
L.X. Chi, S. Winter
Faculty of Education, University of Hong Kong, Hong Kong, China
Sexual health knowledge scale, sexual attitude scale and sexual-related
behavior questionnaire were used to explore 381 college students’
sexual health knowledge, sexual attitude and sexual-related behavior in
Anhui Province in China. The results revealed that college students
were quite lack of sexual health knowledge; attitude towards sexuality
trended neutral and slight open; sexual-related behavior was active and
showed significant differences in gender and discipline. Positively significant correlations existed among sexual health knowledge, sexual
attitude and sexual-related behavior; condom use, permissiveness,
communion and instrumentality could well predict sexual-related
behavior. It suggested that the targeted sexuality education should be
developed for college students.
444
SEXUAL HEALTH KNOWLEDGE AND
SEXUAL-RELATED BEHAVIOR IN CHINESE
COLLEGE STUDENTS: IMPLICATION FOR
SEXUALITY EDUCATION IN MAINLAND
CHINA
L.X. Chi
Faculty of Education, University of Hong Kong, Hong Kong, China
This study investigated sexual health knowledge and sexual-related
behavior of college students in China by using sexual health knowledge
scale and sexual-related behavior questionnaire. The results revealed
that Chinese college students were both quite lack of sexual health
knowledge; female college students had significantly lower sexual
health knowledge level than male college students. Sexual-related
behaviors were active and showed diversity trends; boys had significantly more sexual activities than girls. It suggested that Chinese
college students need sexuality education, especially sexual health
knowledge education for female students, sexual health behavior education for male students. Besides, sexual and gender diversity, gender
education, sexuality and law education should also be concerned.
445
THE VALUE OF TEACHING POST GRADUATE
STUDENT DOCTORS A BASIC SEXOLOGY
MODULE
R. Hallam-Jones1, M. Clegg2
1
Independent, Independent Psychotherapy Practitioner, 2Hallam University,
Sheffield, UK
The value of teaching post graduate student doctors a basic sexology
module has rarely been explored for relevance to medical practice.
This poster will reveal the doctors views of relevance of the module,
obtained from a recent survey. Its finding will be explored and will
help to address the practise needs of these and other health
professionals.
194
446
ON-LINE TEACHER TRAINING IN
SEXUALITY EDUCATION IN LATIN AMERICA.
COMMONALITIES AND DIFFERENCES IN
THREE EXPERIENCES
A. Corona
Universidad Pedagógica Nacional, Mexico City, Mexico
All through-out Latin America official educational systems as well as
non-governmental organizations have developed different types of
sexual health, sexuality education and gender training programmes for
teachers. However, all these programmes require the presence of
students, thereby limiting their scope. To counteract this limitation,
many institutions are resorting to programmes that use current
technologies.
Among the different modalities offered by technology, some of the
most often used are virtual learning environments (platforms) and this
is the media chosen by many educational institutions to train teachers
in sexuality education.
This presentation aims at analysing and comparing three different
for education and/or health professionals in Colombia, Mexico and
Uruguay in order to be able to share the most successful experiences
and the best practices in this field.
The analyzed programmes come from three different perspectives.
An academic university experience in Mexico, a platform managed by
a Sexual and Reproductive Health NGO in Colombia and a course for
Primary School teachers in Uruguay.
These programmes offer some very innovative experiences in teacher
training that manage to work across distances and may be a viable
alternative to reach the large number of teachers that are demanded
by the scaling sexuality education programmes in Latin America.
447
TEACHER TRAINING IN SEXUALITY
EDUCATION IN LATIN AMERICA AND THE
CARIBBEAN. FIVE CASE STUDIES
E. Corona Vargas1, M.C. Arango Restrepo2
1
Mexican Association for Sexual Health, 2Independent Consultant, Mexico,
Mexico
All sexuality education programmes in Latin America agree that one
of the cornerstones for the achievement of the objectives they propose
is the training of those teachers that implement the programmes.
Under the auspices of UNESCO, a comparative study was carried
out in five countries in the Region to examine at what levels, training
occurs, its scope and how effective it is in addressing the goals of
national programmes in the selected countries and reaching the goals
set up by the Ministerial Declaration (2008).
Conclusions:
1. Although comprehensive sexuality education as a concept is now a
common feature of the reviewed programmes, the training that
implementing teachers have received do not allow for a comprehensive delivery of the subject.
2. The importance of training is recognized but appropriate programmes are not always available or wide enough in scope.
3. In some cases, training programmes do not correspond to the
curricula being used.
4 Basic Teacher Training Colleges have avoided engaging in sexuality
education contentes in their programmes.
5. Oftentimes so called “training” activities do not meet the necessary
criteria to be considered adequate for this purpose.
6. The role of civil society in teacher training has been crucial to
develop the field.
Based on this results recommendations are offered to Education Ministries, NGOs, International Organizations and other stakeholders.
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448
450
WIDENER UNIVERSITY’S GRADUATE
PROGRAMS IN HUMAN SEXUALITY:
A 35 YEAR SUCCESS STORY AND EXAMPLE
FOR ADVANCED TRAINING IN SEXUALITY
EDUCATION, SEX THERAPY, AND RESEARCH
ADOLESCENTS AND SOAP OPERAS: THEIR
UNDERSTANDING ABOUT ADOLESCENT
PREGNANCY
B. Crane1, W. Stayton1,2
Human Sexuality Education, Widener University, Chester, PA, 2Sacher
Health Leadership Center, Morehouse School of Medicine, Atlanta, GA,
USA
1
Few academic programs exist internationally offering training in sexology at the Masters and Doctoral levels. Graduate programs at Widener
University in Philadelphia, Pennsylvania have an applied scholarship
focus, providing a Master’s degree in Human Sexuality with an Education or Clinical focus, as well as a research-oriented doctoral degree
in Human Sexuality. Learning outcomes are aligned with AASECT
requirements for certification. Beginning at the University of Pennsylvania 35 years ago, the program has grown during its 12 years at
Widener, now enrolling over 200 students, Students commute from
across the United States and Canada to attend weekend classes, while
others are in residence pursuing dual degree programs in Social Work
or Clinical Psychology, along with sexuality studies. Presenters will
cover the curriculum and the rationale for affective education teaching
methods. “Take away messages” will include how aspects of this successful program might be replicated to advance access to training
internationally.
449
YOUTH’S PERCEPTIONS OF THE USE OF
REVERSE DISCOURSE IN ONLINE
SEXUALITY EDUCATION
W. Davis, J. Shoveller
UBC, Vancouver, BC, Canada
Introduction: In an effort to be relevant to youth culture, sexuality
education media often employ the use of reverse discourse—the
acknowledgement and rejection of shame associated with stigmatized
terms. By unapologetically using phrases such as ‘hook-up’ and ‘fuckbuddy’ in healthy sexuality promotion materials, this technique is
thought to destigmatize ‘risky’ behaviours and resonate with youth.
This study investigated the use of reverse discourse in web-based
media promoting healthy sexuality.
Methods: A sample of English-language, online sexual health
resources (n = 15) were qualitatively assessed. These sites were
reviewed by 20 Canadian youth (ages 15-24) during semi-structured,
in-depth interviews to examine the impact of the reverse discourse on
perceived saliency (e.g., relevance of information) and credibility (e.g.,
validity of information). Youth were asked to examine textual (e.g.,
clinical versus colloquial language) and visual (e.g., medicalized versus
sexualized images) enactments of reverse discourse.
Results: For many youth, risqué depictions of sexual health information corresponded with lower perceived appeal, quality, and trust of
the websites. The juxtaposition of colloquial portrayals of youth sexual
behaviour with dominant sexual health ‘risk’ discourse served to both
re-stigmatize youth sexual health behavior as inherently ‘risky’, and
lower youth’s perceptions of website credibility.
Conclusions: While many online sexual health promotion programs
utilize reverse discourse, this technique may not be acceptable for all
youth. In order to avoid inadvertently exacerbating existing barriers
for youth, socio-technical considerations must be attended to in the
development of web-based resources promoting healthy sexuality.
G.M.D. de Carvalho
Teachers, University of Santa Catarina State, Florianópolis, Brazil
This study aimed to construct a diagnostic of the adolescent understanding of some sexuality issues; adolescents from the eighth grade of
one Public School. The central question, data were drawn from oral
and written reports regarding the theme: the adolescent pregnancy.
The strategy to motivate debate was the practice of workshops with
audiovisual material made of scenes from Rede Globo Television soap
operas related to the research’s subject. It has showed the television
and soap operas importance in the sexual education process. The above
has resulted into a diagnostic construction regarding the way of perception and thinking of adolescents about this chosen theme, checking
which aspects of the sexual education history are preponderant to their
way of thinking. The qualitative research, of dialectic character, was
made by action-research, because the researcher already works at classrooms with adolescents. The evaluation of oral and written reports was
done according to the analysis of contents, emphasizing three categories named:
a) the usual still give the rules of how adolescents are still the same as
“our parents”
b) soap operas as a rich pedagogical way for a rich work about
sexuality
c) the hope expressed by contradiction.
Those categories evidence the importance of the pedagogical use of
the media of communication in the youths sexual education; education
that has been revealed too conservative, but with lines of hope to a
new look at the sexuality.
References: NUNES, Desvendando a sexualidade, 2002 and FREIRE,
Paulo. Pedagogia da Autonomia, 2007.
451
EMANCIPATORY INTENTIONAL SEXUAL
EDUCATION: URGENT NEED IN TEACHERS’
FORMATION COURSES
S.M.M. de Melo1, G.R. Pereira2
1
Departamento de Pedagogia-FAED, UDESC-Universidade do Estado de
Santa Catarina, Florianopolis, Brazil, 2Departamento de Educação,
Universidade de Aveiro, Aveiro, Portugal
With the aim of performing studies to identify the importance of a
proposal of an intentional sexual education in an emancipatory
approache in the higher education curricula, more specifically in the
Pedagogy courses, some data was collected by questionnaire of open
questions with a sample of 300 students from all stages of this degree
in three universities, two Brazilian and one Portuguese. The work is
part of a research post-doctoral research that makes a comparison
between Portugal and Brazil to subsidize the development of intentional actions of specific training in sex education for future teachers.
Using qualitative methodology, results showed that the students claim
that intentional sexual education is of paramount importance within
the curriculum, since the access to sexual and reproductive rights of
all people, is essential for these students to take more responsible
pedagogical decisions, initially through an understanding of their own
sexuality, in spaces where they can express their feelings and emotions
without fear and false beliefs. The action of developed training during
the study proved the need to steadily expand the awareness of intentional spaces for reflection and debate on the issue of sex education in
the perspective of human emancipation.
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452
KNOWLEDGE OF HIV/AIDS AND
REPRODUCTIVE HEALTH AND SELFREPORTED SEXUAL BEHAVIORS AMONG
SENIOR HIGH SCHOOL STUDENTS IN
PAPUA AND WEST PAPUA PROVINCES,
INDONESIA
W. Diarsvitri1,2, I. Dwisetyani2
1
Community Medicine, Hang Tuah University, Surabaya, Indonesia,
2
Australia Demographic and Social Research Institute, The Australian
National University, Canberra, ACT, Australia
Papua and West Papua Provinces have the highest prevalence of HIV/
AIDS among all provinces in Indonesia. In 2009, 94.4% HIV/AIDS
cases in Papua province were transmitted through heterosexual intercourse and HIV/AIDS cases among 15–19 years age group were in the
fourth rank. A study in 2007 revealed 46.9% Junior High School
students had misconception on HIV/AIDS transmission and prevention. Previous studies also found high-risk sexual behaviors in some
Papuan cultures, including multiple sex partners and early initiation of
sexual activity. These features motivated Diarsvitri, to carry out the
2009 Reducing the Risk of HIV/AIDS: Intervention Trial for Young
Papuans Study.
Sixteen Senior High Schools were randomly selected and agreed to
participate to either receive the reproductive health education program
or act as a control group. Students of Year 11 from the selected schools
(N = 1082) took a pre-test and two months later, a post-assessment test.
The aim of this study was to analyze the association between knowledge of 25 HIV/AIDS and reproductive health questions on the pretest and the self-reported sexual behaviors before the intervention. We
also used qualitative method to explore perspectives and experiences
on sexuality.
Results showed more than 50% of students had limited knowledge
on HIV testing, safe sex and STDs prevention. Although female students had better knowledge test and demonstrated less sexual intercourse experiences (28.5% compared to 46.5% of males), they carried
a more unfavorable condition related to the impact of premarital sex,
including pregnancy and unsafe abortion.
453
THE IMPORTANCE OF REPRODUCTIVE
HEALTH AND HIV/AIDS EDUCATION
PROGRAM FOR YOUNG PEOPLE IN PAPUA
AND WEST PAPUA PROVINCES, INDONESIA
1,2
2
196
better attitude (95% CI: 0.092–0.272) and 0.18 points for better behavior intention (95% CI: 0.105–0.332) after adjusting for age, gender,
previous sexual experience, ethnicity and pre test mean score.
Thus, the reproductive health and HIV/AIDS education proved to
be effective in changing knowledge, attitudes and behavior intention
of students and it is important to include it in the school curricula.
454
PEDIATRICIAN, TAKE CARE OF
ADOLESCENT: PSYCHOLOGICAL AND
SEXOLOGICAL TRAINING OF FAMILY
PEDIATRICIANS
V. Duretto1, S. Gambotto2, G. Barbero1, R. Colombo3
1
ASST, 2Fimp, Turin, 3FIMP, Vercelli, Italy
Introduction: Adolescents are interested in existential and ideological
issues which involve their choices in terms of identity and sexuality.
From predominantly diadic relationships with the same sex, they go
through the experience of being part of a group and move to the first
affective experiences with the other sex.
Objective: Pediatricians need to receive psycho-sexological training
in order to better hold the affective and relational factors expressed by
the adolescents.
Material and methods: The method foresees the integration of
medical, psychological, anthropological, sociological and pedagogical
knowledge, applied by psycho-sexologists in different ways and with
different goals.
Training courses with frontal lessons were used on predetermined
topics and training sessions with clinical case discussions, submission
of tests directly completed by participants. Each psycho-sexological
training takes about five hours.
Results: During 2008-10, 4 training courses for 120 pediatricians were
organised by 2 pediatricians and 2 psycho-sexologists in the provinces
of Turin and Vercelli (Italy).
Conclusions: To give family pediatricians the necessary tools to safeguard the psycho-sexual health of adolescents and recognise their
sexual habits, in order to guide them to make the right relational and
affective choices, while maintaining the relationship with adults within
the process of individuation and separation.
Pediatricians who have received a psycho-sexological training will
not only look at the anatomo-physiological aspects of sexual development, but also take account of the intimacy which expresses the adolescent’s sexuality.
455
W. Diarsvitri , I. Dwisetyani
1
Dept. of Community Medicine, Faculty of Medicine, Hang Tuah University,
Surabaya, Indonesia, 2Australia Demographic and Social Research Institute,
The Australian National University, Canberra, ACT, Australia
A QUALITY EVALUATION OF TRAINING
PROGRAMME ON CLINICAL SEXOLOGY IN
CHRONIC RENAL INSUFFICIENCY PATIENTS
Papua and West Papua Provinces have the highest prevalence of HIV/
AIDS in Indonesia. In 2009, 94.4% HIV/AIDS cases in Papua province were transmitted through heterosexual intercourse and the cases
among 15–19 years age group were in the fourth rank. A study in 2007
revealed 46.9% Junior High School students had misconception on
HIV/AIDS transmission and prevention. These features motivated the
first author, to carry out the 2009 Reducing the Risk of HIV/AIDS:
Intervention Trial for Young Papuans Study.
The aim of this study was to evaluate the effectiveness of the reproductive health and HIV/AIDS education program in changing young
people’s knowledge, attitudes and behavior intention associated with
HIV/AIDS and sexuality. Sixteen Senior High Schools were randomly
selected and agreed to participate to either receive the program or act
as a control group. Students of Year 11 from the selected schools (N
= 1082) took a pre-test and two months later, a post-assessment test.
Changes in knowledge, attitude and behavior intention between the
two groups were compared using a mixed model.
Findings showed that the intervention was associated with 0.11
points of better knowledge (95% CI: 0.083–0.117), 0.13 points for
Introduction: Chronic Renal Insufficiency negatively impacts on
patients’ affective and relational experiences, thus compromising their
quality of life. The training programme aims at providing a correct
sexological background to health professionals in order to prevent the
onset of pathological relationships in CRI patients. The course focuses
on counselling and active-selective listening tools to deal with any
sexual issue that may be brought up and ensure a comprehensive care
of patients.
Material and methods: 67 members of the dialysis staff participated
in the course and gave a qualitative evaluation by answering a series of
questions. The Sternberg triangle test and a body perception test on
“sensitive body zones” were submitted and completed. Besides frontal
lessons, the didactical method included interactive discussions after
slide presentations, movies or readings. Didactic brochures were
provided.
Results: 84% of the staff felt better informed on how to deal with
sexual issues in dialysis patients. 86% appreciated the course design
V. Duretto, F. Giacchino, G. Reinero, B. Bellis
Nephrology and Dialysis Unit, Civil Hospital, Ivrea, Italy
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and didactical method. 82% found the course useful and relevant for
their profession. 69% found the duration of the course appropriate (12
hours). 31% felt the need for more sessions.
Conclusions: Gaining awareness of one’s own behaviours and rigidities often greatly improves relationships with patients, ensuring a
better quality of life for patients and a better professional life for
caregivers.
456
PROGRAM EVALUATION “SEX EDUCATION
FOR CHILDREN—SEC”
M. Favero, P. Ferreira
Instituto Superior da Maia, Porto, Portugal
Introduction: The evaluation of sex education programs in Portugal
for the first cycle, hasn’t been subject of research. As such, it remains
the need to get started in this branch.
Objectives: We intend to evaluate a sex education program for the
students of third grade, which was prepared according to directions of
the law n. º 60/2009 in Portugal.
Method: The SEC program consists of five sessions, totaling six
hours. For the evaluation of the program we have used a qualitative
methodology based on interviews before and after application on a
sample of two groups of students between 8 and 9 years old: 16 students were in the experimental group (participants of the ESC) and 11
in the control group. The interviews were analyzed using content
analysis.
Results: Before implementing the program, both groups had some
knowledge in the area of sexuality. On the other hand, had misconceptions and numerous gender stereotypes. After the SEC application, we
found an increase in knowledge in the experimental group, compared
with the control group, but in both groups persisted gender
stereotypes.
Conclusion: Our results indicate that the sex education law is unable
to meet the specific needs of this age group by not to stressing the
importance of working in the sex education programs for the first
cycle, the gender stereotypes and therefore, gender inequalities.
458
A MULTIDISCIPLINARY APPROACH TO
POSTGRADUATE TRAINING IN SEX
THERAPY, SEXUALITY COUNSELING AND
SEXUALITY EDUCATION: LOCAL AND
DISTANCE LEARNING MODELS FOR
HEALTH CARE PROVIDERS
S. Foley, S. Sinks
Graduate School of Social Work, University of Michigan, Ann Arbor, MI,
USA
Objective: Addressing sexual health concerns of patients has been an
emerging concept for several decades. However, there have been very
few training opportunities that would prepare health and mental health
care providers for such a responsibility. The authors propose a postgraduate interdisciplinary model for health professionals in social
work, medicine, nursing and psychology who seek specialized , focused
training in sexual health.
Methods: An 18 month model which includes both residential and
distance learning was developed based on the extant literature on
sexual health education and sex therapy, and in consultation with the
American Association of Sexuality Educators, Counselors, and Therapists (AASECT). Program faculty are exclusively AASECT certified
sex therapists and educators.
Results: The first cohort of 29 completed the program in 2010. A
second cohort is in training. Enrollment for the 3rd cohort is in process
and includes international applicants. As the first cohort began training,
71% of participants in the first cohort reported having ‘no’ or ‘average’
knowledge of sexual health and treatment of sexual problems and 61%
of participants reported having ‘above average’ or ‘very great’ comfort
in discussing what they knew about sexual health. At conclusion of the
training program, 15% of the cohort reported ‘average’ knowledge and
85% reported ‘above average’ or ‘very great’ knowledge of sexual health
and treatment of sexual problems and 96% reported ‘above average’ or
‘very great’ comfort in discussing what they knew.
459
A MULTIDISCIPLINARY APPROACH TO
POSTGRADUATE TRAINING IN SEX
THERAPY, SEXUALITY COUNSELING AND
SEXUALITY EDUCATION: LOCAL AND
DISTANCE LEARNING MODELS FOR
HEALTH CARE PROVIDERS
S. Foley, S. Sinks
Graduate School of Social Work, University of Michigan, Ann Arbor, MI,
USA
Objective: Addressing sexual health concerns of patients has been an
emerging concept for several decades. However, there have been very
few training opportunities that would prepare health and mental health
care providers for such a responsibility. The authors propose a postgraduate interdisciplinary model for health professionals in social
work, medicine, nursing and psychology who seek specialized , focused
training in sexual health.
Methods: An 18 month model which includes both residential and
distance learning was developed based on the extant literature on
sexual health education and sex therapy, and in consultation with the
American Association of Sexuality Educators, Counselors, and Therapists (AASECT). Program faculty are exclusively AASECT certified
sex therapists and educators.
Results: The first cohort of 29 completed the program in 2010. A
second cohort is in training. Enrollment for the 3rd cohort is in process
and includes international applicants. As the first cohort began training, 71% of participants in the first cohort reported having ‘no’ or
‘average’ knowledge of sexual health and treatment of sexual problems
and 61% of participants reported having ‘above average’ or ‘very great’
comfort in discussing what they knew about sexual health. At conclusion of the training program, 15% of the cohort reported ‘average’
knowledge and 85% reported ‘above average’ or ‘very great’ knowledge of sexual health and treatment of sexual problems and 96%
reported ‘above average’ or ‘very great’ comfort in discussing what
they knew.
460
IDENTIFYING PREDICTORS OF VARIABILITY
IN SEXUAL HEALTH KNOWLEDGE,
ATTITUDES AND PRACTICES AMONG UK
YOUTH FOR MAIN SOURCES OF SEX
EDUCATION
M. Fontes1, P. Roach2
Research and Evaluation Unit, Durex Network, Brasília, Brazil, 2Durex
Network, London, UK
1
Objectives: According to the NIH system, the UK has one of the
highest rates of unwanted pregnancy in Europe. The main objective
is to explore predictors of sexual health knowledge, attitudes, and
practices (KAP) among youngsters in the UK.
Methods: Study is based on a Web-based survey carried out between
December 2009 and March 2010 (n = 689) among youngsters between
the ages of 15 and 20 in the UK. Descriptive and a robust multiple
linear regression models were used and a 41-item KAP Scale (Conbrach’s alpha > 0.7).
Results: Among sexually active, use of condoms at last sex was 55.9%.
Controlling for socio-demographic characteristics and clustering of
the data, predictors identified for higher levels of sexual health KAP
are: parents as main source of sex education, females, and lower
numbers of sexual partners.
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Conclusions: Areas that merit further attention: a) need for parents
to engage in sex education of their children; b) re-emphasizes the
importance of creating targeted opportunities for young males to participate in reproductive health programs; and c) importance to ensure
that youth with multiple sexual partners are using appropriate
protection.
Table 1 (UK)
Sexual Health KAP
Scale (UK)
Coef
Robust
Std. Err
t
P>t
[95% Conf.
Interval]
Actual Age
Male
No. Sexual partners
Parents
Health professional
Teachers
0.010
-3.756
0.193
3.566
2.220
1.307
0.270
0.746
0.096
1.340
1.228
0.880
0.040
-5.040
2.010
2.660
1.810
1.490
0.970
0.000
0.046
0.008
0.072
0.138
-0.521;
-5.224;
0.004;
0.929;
-0.197;
-0.424;
0.542
-2.289
0.382
6.203
4.637
3.039
198
The objective of this presentation is to recognize the impact and
influence that “fuzzy” personal, social, and professional boundaries
that exist around sexuality, intimacy, and touch translates to persons
with intellectual disabilities. And, how these same “fuzzy” boundaries
are viewed by criminal justice professionals.
Case reports will be used to illustrate the importance of providing
comprehensive sex education across the life span utilizing non-traditional formats, including developing sexual safety plans.
This is an interactive presentation, including lecture, DVD clips,
and discussion.
The goal/result of this presentation is to:
1) increase sex education for persons with disabilities;
2) build awareness to the impact the lack of sex education plays in the
criminal justice system; and
3) enhance the skill base of sex educators working with individuals
with intellectual and developmental disabilities.
461
463
FLAGSYSTEM. TALKING WITH CHILDREN
AND YOUNG PEOPLE ABOUT SEX AND
UNACCEPTABLE SXUAL BEHAVIOUR
“SEXUALITY AND PREVENTION OF HIV /
AIDS” CAOJ—CENTER FOR COUNSELING
AND GUIDANCE OF CHILDREN AND
TEENAGERS (LISBON)
E. Frans
Sensoa, Gent, Belgium
The flagsystem aims to be a preventive working tool which can offer
a framework and a guide to anyone thats works with children and
young people. The objective is to make sexuality, desires and boundaries, criteria and gradtions of unacceptable seual behaviour a subject of
discussion. In this way the methods aims to make a contribution to
preventing sexual unacceptable behaviour amongst and towoards children and young people.
The method consist of a normatieve list based on literature of sexual
development of children and young people. In this list sexual behaviour
is ordered referring to age or developmental stage, and to the scale of
acceptability of the behavior; green flag is acceptable sexual behaviour,
yellow flag is mildly unacceptable, red flag is seriously unacceptable,
and black flag us severely unacceptable sexual behaviour.
The 6 criteria that are used to asses the color of the flag are
1. Mutual Consent
2. Voluntarity
3. Equality
4. age or development
5 context
6. Selfrespect
We have 3 years of experience in working with the method, and the
evaluations are very positive. The flag system fills up the gap of the
classical sexuality education towards sexualisation and the need for
more and better resilience programmes.
462
BOUNDARY FLUIDITY: SEX EDUCATION,
DISABILITIES AND THE CRIMINAL JUSTICE
SYSTEM
B.L. Frantz
Institute on Disabilities, Temple University, Philadelphia, PA, USA
At any time, anyone can become a crime victim, defendant, or witness
of a crime. However, individuals with disabilities are at increased
vulnerability for becoming a victim of sexual violence or charged
with a sexual offense. When criminal against individuals with intellectual and developmental disabilities are reported there is a
lower rate of prosecution and conviction as the criminal justice system
does not perceive persons with disabilities that are victims of crime
to be believable and or credible. Conversely, when an individual with
an intellectual disability is charged with a criminal act they are perceived by the same criminal justice system to be believable and
credible.
F.M. Frazão de Aguiar, F. Póvoa, G. Fonseca, G. Bettencourt, I. Chagas,
J.M. Heitor, V. Gonçalves
Adminitration, Portuguesa Foundation ‘The Community Against AIDS’,
Lisbon, Portugal
In the field of Health Education for Sexuality and Prevention, is now
considered that peer education is more effective than that which is
performed by educational agents with different status, because young
people, when properly trained exert positive influence on the formation of others.
In the teaching / learning process using the peer education, the
activities organized by CAOJ and targeting adolescents who attend the
7th, 8th and 9th grade, are first directed by young volunteers and in a
second stage by students in classes where there was intervention, which
assume the role of peer educators.
The main objectives of the project are: develop the concept of
human sexuality based on interpersonal relationships,
b) promote the strengthening of the personal and social skills;
c) encourage the prevention of risk behaviors
d) explore themes related to human sexuality and prevention.
The intervention is developed over 3 academic years. In 1st and 2nd
years, training takes place in the discipline of Education for Health,
being held 8-10 sessions of 90 minutes. In the 3rd year, the school set
the number of sessions and selects the group in which that intervention
occurs.
We use active and participatory methodologies such as group
dynamics, debates, work groups, and theater.
In 2009/2010, the CAOJ developed its intervention in 15 schools,
21 classes, involving 60 volunteers and 380 students.
Qualitative data, based on the perceptions of teachers, the feedback
was very positive, highlighting the impact of the intervention on the
increasing knowledge and the improving interpersonal skills.
464
EROTISM AND PLEASURE AS SEXUAL
EDUCATION
S. Gonzalez-Serratos
Psychology, Universidad Nacional Autónoma de México, México, Mexico
Pleasure and joy are full of sensuality that this give us knowledge plane
of body and emotional knowledge, as well vital energy for a more rich
live in sensations that brings us to a personal development towards
emotional and sexual health that integrates ourselves. Historically this
has being prohibited to experiment them.
Erotism as an expresion is also joy but it has a strong influence from
the religious point of view, and because that it’s forbidden and
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repressed. Human sexual behavior have more social connotations that
merely biological, that means that if erotism pleasure and joy impregnate, and enlighten our sexual behavior, these are things that we have
to cultivate with new conceptual approaches and learnings, more in
the acceptance of the great diversity and different expressions of joy
pleasure and sexual erotism. In this work we follow the guide of pleasures joys and erotism as human sexual expressions along the span life
with the possibility of new learning about them.
465
SEXUALITY AND INTIMACY IN LATER LIFE:
DO UNDERGRADUATE NURSES APPLY
THEIR CLASSROOM LEARNING IN
PRACTICE?
R. Gutteridge
School of Health & Wellbeing, University of Wolverhampton, Wolverhampton,
UK
This paper explores the theory-practice gap using the results of a self
-evaluation exercise by 216 undergraduate nurses. At the end of a
classroom based session about sexual and intimacy needs in older
people, learners were asked anonymously to identify one practical
application which they would integrate into practice with older people.
Following their associated clinical placement, an anonymous follow up
postal questionnaire was sent. This was adapted from the Report and
Respond method proposed by Stronach and Maclure (1997). The
questionnaire enquired about actual application into practice. Although
response rates were low (25 learners, 11.5% responded), these respondents identified transfer in intellectual, cognitive, practical and transferable domains of learning, including increased confidence and
empathy with older people. Respondents also provided qualitative
detail about their experiences of cultural and organisational barriers to
integrating their learning in practice. The findings are discussed in
relation to methodological limitations and potential improvements in
the design of future learning experiences
Reference:
Stronach I., Maclure M., (1997). Educational Research Undone The
Postmodern Embrace, Buckingham, Open University Press.
466
YOUNG PEOPLE’S VIEWS ON THE
APPROPRIATE TIMING OF FIRST SEXUAL
INTERCOURSE: A QUALITATIVE STUDY
Z.C. Hawes, K. Wellings
Department of Social and Environmental Health Research, London School
of Hygiene & Tropical Medicine, London, UK
Background and aims: The appropriateness of young people’s sexual
activity has recently been framed in terms of readiness to have sex.
This approach regards the timing of first sexual intercourse as appropriate according to personally defined, individually applied criteria,
contrasting with previous emphases on externally defined, universally
applied criteria such as marriage or age. The strength of the readiness
approach lies in its recognition of the variation that exists between
individuals. Its weakness is a lack of clarity over what being ready to
have sex might mean in practical terms. There is no data on the perspectives of young people on the appropriate timing of first sexual
intercourse. This study addresses this gap.
Methods: Thirty depth interviews were conducted with 16-17 year
olds living in southwest London. Young people of both sexes, from a
variety of ethnic backgrounds and with various levels of sexual experience were included.
Results: The majority of young people rejected marriage as a marker
for the appropriate timing of first sex. Those who did value marriage
often upheld it as an ideal rather than a realistic target. Age was broadly
perceived as a relevant marker, although an exclusive focus on age was
rejected. Young people conceptualised readiness not only in relation
to themselves but also in relation to their partner and the wider social
world.
Conclusions: The young people endorsed an individualised approach
to sexual readiness. These results will be useful to policy makers and
sex educators in ensuring that sex education is relevant and holistic.
467
SEXUALITY AND THE PERSON WITH
DISABILITY—AN AWARENESS WORKSHOP
R. Heruti1, R. Kamin2
Rehabilitation and Sexual Clinic, Reuth Medical Center, Tel Aviv,
2
Psychiatry, Beer Sheva Mental Health Center, Beer Sheva, Israel
1
Synopsis and learning objectives: Disability produces problems that
affect sexual function and behavior. Thus, sexuality is an integral part
of the rehabilitation process that is too often neglected. The main
reason is feeling of unease on the side of the care giver, because of
societal attitudes as well as lack of systematic knowledge. Despite the
importance of sexual health, little attention is paid into sexual education of care-givers.
The aim of this workshop is to increase the awareness of professionals to their own attitudes and the barriers of sexuality they wish to
overcome, and to provide medical and psycho-sexual knowledge
regarding sexuality of persons with disability. We intend to bring into
the light sexual concerns presented by patients and to provide with
guide to better care in the field of sexuality and disability. The number
of participants is limited to 25 vacancies because of the intimate nature
of the workshop. The level of the workshop is basic and intermediate.
468
YOUTH SEXUALITY IN GERMANY REPEAT
SURVEY OF 14 TO 17-YEAR-OLDS CURRENT
FOCUS: MIGRATION
A. Hessling
Department of Sex Education and Family Planning, Federal Centre for
Health Education, Cologne, Germany
Objectives: For 30 years now the Federal Centre for Health Education in Germany has been analysing the attitudes and behaviour of
young people concerning sex education, sexuality, and contraception.
The current Youth Sexuality Survey is the seventh of its kind, carried
out in 2009/10.The results show significant changes in contraceptive
behaviour over recent years. We will discuss the reasons for these
changes.
Design & methods: The present study is a replica study of six previous representative investigations (1980,1994,1996,1998,2001 and
2005). The Study based on 3543 girls and boys with German and
foreign citizenship (face-to-face interviews). The methods for selecting
candidates was the quota method.
Results: The proportion of girls who did not use contraception for
the first sexual intercourse also halved since 1980. Now the number of
German girls and boys who did not use contraception have been going
down under 10%. Condoms are the first choice of contraception
methods. 7 to 10 girls and 6 to 10 boys state that they received information from their parents about contraception. More than 80% of the
girls and boys have learned about different contraception methods at
school in sex education classes which are obligatory in Germany.
Conclusion: Most of the parents and teachers offer a helpful information about contraception in Germany. Condom use is a clear and open
dicussed message in Germany since 15 years. The open communication results in responsible contraception behaviour among young
people, which explains why Germany has one of the lowest rates of
teenage pregnancies in Europe.
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200
469
471
A CASE FOR PLEASURE IN SEX AND
RELATIONSHIPS EDUCATION (SRE) FOR
YOUNG PEOPLE
SEXUALITY EDUCATION FOR THE VERY
YOUNG: SRH INFORMATION NEEDS OF
10–14 YEAR OLDS IN INDIA
J. Hirst
Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, UK
Pleasure and desire were highlighted as omissions in constructions and
discourses of female sexuality by feminist works more than twenty
years ago (Fine 1988). Though enduring norms can operate to maintain passive notions of female sexuality and silence on pleasure, particularly in school cultures and education on sexuality and sexual
health, recent research has begun to challenge this impasse. Quantitative and qualitative studies reveal the numerous constraints on females
in actively declaring desires for, and experience of pleasure in sexual
practice, but some display resistance in order to meet their aspirations
for enjoyable sexual experiences. Though there is less research on
young men, there are indications that motivations for enjoyable and
safe sexual relations are not dissimilar from young women. This paper
will deploy research on young people to offer a rationale for Sex and
Relationship Education (SRE) based on pleasure and sex-positive
notions of sexual health. It will be argued that sex positive SRE can
challenge heteronormative and gendered constructs of sexual identity
and practices, contribute to developing sexual competence, resisting
coercion, avoiding regret and supporting safer and more egalitarian
relationships.
470
THE COMMUNICATION OF THE SEXUALITY
AMONG ONCOLOGIST NURSES IN BRAZIL
L.C.U. Junqueira1, E.M. Vieira2, M.N.S. Barros2, M.A. Santos1
1
Psychology and Education, 2Social Medicine, University of São Paulo,
Ribeirão Preto, Brazil
Introduction: The discovery of a mammary nodule provokes an
intense emotional reaction facing the possibility of multiple losses
associates to the body image, the feeling of femininity and the affective-sexual relationship. There is a growing literature regarding the
impact of the breast cancer on woman’s sexuality, however few of them
are on the communication of health care professionals (HCP), in
particular the nurses. The objective of the study was to investigate the
way the sexuality is communicated in the context of health care offered
by the oncologist nurses.
Method: This is a qualitative study, descriptive exploratory in which
participated 28 nurses through in-depth interviews. The material was
submitted to the thematic analysis of content, with the intention to
emerge the units of meaning allowed the formation of thematic
categories.
Results: There are variations in the speech from nurses in:
1) No communication;
2) evasive speeches and negation of the sexuality in the care;
3) communication in a stratified way evidencing the biomedical model
and
4) communication is welcome and integrated including family
members.
Conclusion: As potential contribution, we expect that this study can
bring to the light new knowledge concerning the interface of the sexuality and care in oncology, in order to contemplate the questions of
the sexuality in the production of the health care and improve qualification of oncologist nurses and other HCPs.
V. Koliwad1, K. Apte2, S. Natrajan3
FPA India, 2Program Implementation, FPA India, 3President, FPAI,
Mumbai, India
1
Adolescence has special needs. The adolescent face reproductive
and sexual health challenges. Like unwanted pregnancies, sexually
transmitted infections (STIs) including HIV/AIDS and nonconsensual sex.
Most of these consequences can be prevented, provided young
people have adequate information on sexual and reproductive health.
However, access to comprehensive sexuality education is a very controversial and challenging issue.
FPA India conducted a national level survey of the school going
young adolescent boys and girls among age 10–14 years to understand
their information needs. The survey was conducted in 40 locations
across 17 states involving 503 schools. It was a free choice questionnaire where children could frame their questions. Later, all questions
were complied and categorized as “Most commonly asked questions”
and also “Most unusual questions”.
Findings:
1. Over 60% young boys wanted to know on puberty related changes
and had questions related to size and shape of genital organs, breast
development, and homosexuality
2. 78% young girls wanted to know about conception and menstrual
changes, reasons of being attracted to opposite sex and also on
gender discrimination
3. 64% Boys and girls wanted to know about various contraceptive
methods
4. Around 8% indicated any need for information on moral values &
on personality development
Conclusions:
1. The information needs of very young adolescents are as in-depth
as that of 15–19 year old
2. Parent and teachers do not have very clear understanding of what
young people want to know.
3. Adolescent have a right to comprehensive sexuality education
designed for their needs.
472
COMMUNICATION ABOUT REPRODUCTIVE
HEALTH WITH ADOLESCENT BOYS
H. Konecna, A. Kubickova
Faculty of Health and Social Studies, University of South Bohemia, Ceske
Budejovice, Czech Republic
Objectives: Promotion of primary prevention of reproductive health
for men is not virtually done in the Czech Republic. Adolescents often
do not realize the value of reproduction health. However, they constitute the age group most frequently endangered by incidence of testicular cancer and showing risk behavior for STI transfer.
Design and methods: The pilot quantitative analysis of attitudes of
adolescents to prevention of reproductive health helped us to get
insight into an unexplored area. A short survey with 5 questions was
filled in by 391 boys aged 15–19, studying at secondary schools.
Results: The respondents state most frequently not to talk to anybody
about that topic; reproductive health is perceived as a very intimate
topic. Information is exchanged most frequently among friends. The
topic of reproductive health is not so important in partner communication at that age, but girls—friends can suggest to boys that they should
care for their health. Physicians were appreciated the least, although
the information should be transferred preferably by health care
workers.
Conclusion: Boys wish and need information in the period of adolescence, but they still do not want to speak about it; they are rather
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passive recipients of information. It can be expected that it will take
long time to motivate men to take positive approach to reproductive
health. Success can be produced by school-based programs, highquality information in the media and education of professionals.
Supported by MZCR 16/10/PDD and GACR P407/10/0822
473
THE MARITAL ADJUSTMENT AND SUPPORT
NEEDS OF ADULTS WITH INTELLECTUAL
DISABILITIES IN TAIWAN
C.J. Lin
Special Education Teacher Center, Taipei Physical Education College, Taipei,
Taiwan R.O.C.
Background: People with Disabilities Rights Protection Act was
amended in 2007 in Taiwan. Article 50 of the Act, a new regulation,
requires the local authorities provide marital and reproductive health
counseling and services according to the results of need assessment.
This article will come into force, five years since the date of promulgation, in 2012. It is the first time for people with disabilities to have
such counseling and services. Not only the local authorities, but the
agencies and staff are also thinking how and what to support the new
‘needs’. Adults with ID and their parents begin to think the intimate
and family life as well. However, there is rare study here to listen to
their voices on marriage and family life.
Aims: The purpose of the study is to explore the marital adjustment
and support needs of adults with intellectual disabilities.
Methods: The method of deep interview and focus group interview
are conducted. The former interviewed 4 pair of couples, including 7
adults with ID and 1 without disabilities, to collect qualitative data of
marital adjustment and support needs. The later interviewed 8 staffs
and 8 decision-makers, via two focus groups, to realize their perspectives and supporting practices for married adults with ID.
Results: Four moving but laborious marital stories of couples with ID
are depicted. Some findings of their support needs are proposed.
474
THE SITUATION OF SEXUALITY
EDUCATION FOR PARENTS WITH THE
MENTALLY RETARDED CHILDREN
Y.C. Lin
Graduate School of Human Sexuality, Shu-Te University, Kaohsiung,
Taiwan R.O.C.
Regarding there are a few researches in sexuality education of parents
with the mentally retarded children in Taiwan, and comparing to
normal family, parents with the mentally retarded children face more
challenge in being negative labeled and children’s problems. Therefore, this research tried to understand their situation from sexual
knowledge, attitudes and communication behavior and plan to construct an effective intervention on sexuality education in the future.
There are some findings from 29 parents’ interviews as follow:
1. Parents lack for sexual knowledge. They think their children have
no sexual needs (myths of asexuality) and abilities and condition to
breed (myths of procreation). They think it is unnecessary for
mentally retarded people’s marriage (myths of marriage and raise).
They are also worried about their daughters would be attacked by
and their sons would attack others sexually (myths of sexual attack).
2. Parents’ sexual attitude is negative. They totally exclude their children from sexual behavior, and do not give their children sexuality
education actively in order to avoid encouraging their children’s
interests in sex. If they have to implement sexuality education to
their children, it must because they have no choice in some situations. They are worried and consider themselves disability to be
sexuality educators.
3. In sexual communication behavior, most of parents lack for subjects
and frequencies in communication because they are sensitive and
anxious to sex issues and feel uncomfortable in communication
usually.
475
LEARNING ARENA SEXUALITY: EDUCATIONAL
CHALLENGE-ACADEMIC RESPONSIBILITY—
THE GERMAN RECOMMENDATIONS
W. Loosch
Sex-ed, DGG, Berlin, Germany
Recommendations regarding sex education in the schools of the
Federal Republic of Germany—valid as a framework/ guideline for all
the German states.
Following a decision made by the Permanent Conference of the
State Secretaries of Education and Culture on March 10, 1968.
Although the recommendations which were decided upon in 1968
by the Standing Conference of the State Secretaries of Education and
Cultural Affairs of the Federal Republic of Germany (KMK) were
revoked in the year 2002, they will nevertheless be dealt with here in
detail because they are the basis for all further developments with
regard to sex education in schools. All regulations of the Federal States
(Länder) are based on the recommendations of the KMK dating from
the year 1968 and will thus be used as a point of reference and for the
purpose of comparing the documentation of the Federal States
(Länder).
Due to the fact that the KMK thereafter passed no more resolutions
concerning sex education and the guidelines of the individual states
(Länder)go far beyond that with regard to content, these recommendations are more or less of historical interest.
They were composed of three parts: tasks, implementation (basics,
teaching objectives, contribution of individual subjects) and helps for
teachers (basic and advanced training/education).
476
SOURCES OF INFORMATION AND
ATTITUDES ABOUT LOVE AND SEXUALITY
AMONG YOUNG PEOPLE FROM 3
DEVELOPING COUNTRIES
C. Lopez-del Burgo1, A. Osorio2, M. Ruiz-Canela3, M. Calatrava1,
S. Carlos1, J. de Irala1
1
Preventive Medicine and Public Health, 2Education, 3Biomedical
Humanities, University of Navarra, Pamplona, Spain
Background: Adequate knowledge is essential for youth to make
informed decisions concerning their sexuality. Knowledge and attitudes about love and sexuality depend on the sources of information
available to teens. Currently, information conveyed to youth is more
biological than emotional.
Objectives: We attempted to determine the sources of information
about love and sexuality that youth in three developing countries have.
Methods: An anonymous questionnaire was administered to representative samples of students in public and private schools in the Philippines, El Salvador and Peru.
Results: A total of 8,495 students, aged 14–18, participated in the
study. Students reported that their friends were their main source of
information about love and sexuality (46.7% of males and 56.3% of
females), although they valued their parents opinions more than those
of their friends. The majority of participants reported that they would
like to know more about how to better manage their feelings and
emotions (83.2%), what “falling in love” means (82.2%) or the difference between desire, sexual attraction and love (80.1%), rather than
biological considerations such as contraception (67%) or physical
changes in boys and girls (59.4%).
Conclusions: Parents are still not the main source of information
about love and sexuality in spite of being more valued than their friends
by their children. Youth also express a greater need for information
about emotional aspects of sexuality rather than strictly biological
ones.
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477
EXTERNAL PRESSURE IN SEXUAL DEBUT
AMONG ADOLESCENTS FROM 3
DEVELOPING COUNTRIES
C. Lopez-del Burgo1, A. Osorio2, S. Carlos1, M. Ruiz-Canela3,
M. Calatrava1, J. de Irala1
1
Preventive Medicine and Public Health, 2Education, 3Biomedical
Humanities, University of Navarra, Pamplona, Spain
Background: Early sexual initiation is sometimes influenced by external pressures, lowering the control of youth over their sexuality. This
can lead to negative consequences, such as riskier sex or regret.
Objective: To explore if reasons for sexual debut among youth from
3 developing countries include external pressures.
Methods: A multi-stage sampling of clusters representative of schools
in the Philippines, El Salvador and Peru was conducted. Students, aged
14-18, responded to an anonymous questionnaire.
Results: Out of 8495 participants, 1776 (21%) stated having had
sexual relationships. Among those, 31.3% of girls and 38.8% of boys
indicated at least one circumstance implying external pressure for
sexual debut: “Most of my friends had sex” (18.1% boys, 7% girls, p
< 0.001), “I wanted to be more popular” (12.3% boys, 3.5% girls, p <
0.001), “I was afraid to lose him/her” (16.7% boys, 17.7% girls, p =
0.59), “I did not know how to say no to a person who insisted” (17.4%
boys, 16% girls, p = 0.46). In univariate analysis, there were no differences between those who reported external pressure and those who
did not with respect to age, religiosity, socioeconomic status, public/
private school and academic grades. Reporting external pressure was
higher among boys, those attending coeducational schools and those
reporting that friends are their main source of information about
sexuality.
Conclusions: One third of sexually active youth reported that their
sexual debut was motivated by external pressure. Empowering boys
and girls to identify and avoid situations of pressure could help them
to make better informed decisions concerning sexuality.
478
RELATIONSHIPS AMONG ADOLESCENTS’
SEXUAL SELF-CONCEPT, SEXUAL SELFEFFICACY, AND SEXUAL RISK BEHAVIOUR IN
TAIWAN
J.-H. Lou1, R.-H. Li2, H.-Y. Yu3, S.-H. Chen4
MSN Students, National Taipei University of Nursing and Health Sciences,
Taipei, and Center for General Education, Hsin Sheng College of Medicine
Care and Management, Taoyuan, 2Department of Psychology, Chung Shan
Medical University, Taichung, 3Department of Nursing, Jen-Teh Junior
College of Medicine, Nursing, and Management, Miaoli, 4Department of
Service Business Management, Hsin Sheng College of Medicine Care and
Management, Taoyuan, Taiwan R.O.C.
202
(c) The relationship between overall self-concept and overall selfefficacy was statistically significant, and so did the relationship
between overall self-efficacy and overall sexual risk behaviour.
(d) The predicting power of sexual self-concept and sexual selfefficacy towards sexual risk behaviour was not satisfactory as the
overall R2 was 0.24 only.
Conclusion: The study suggests sexual health empowerment course
should be emphasized in educational institutes to enhance adolescents’
knowledge on sexual self-concept and sexual self-efficacy, and to
further promote their sexual well being and safe sex practice.
479
THE ROLE OF GENERAL ASSISTANTS IN
SUPPORTING SEXUALLY ABUSED LEARNERS
WITH INTELLECTUAL DISABILITIES
N. Maseko
Further Teacher Education, University of South Africa, Pretoria, South
Africa
The new education policy of South Africa recognizes that all learners,
irrespective of their challenges can learn if they are provided with
adequate and appropriate support which responds to their diverse ways
of learning. The White Paper 6 in particular embraces the roles of a
wide range of support structures including professional and non-professional teaching staff such as class assistants (DoE, 2001). Whilst the
roles of professional support staff are clearly known and spelled out in
most of the documents, the situation is otherwise with regard to the
roles of non-professional staff such as class assistants, also known as
general assistants, teacher assistants, class aids Para-educators/professionals. Without clear roles, educators may come to view class assistants as fully responsible for learners with disabilities. Conversely,
educators may perceive themselves as primary holders of the responsibilities for education of children. For that, Riggs (2001) warned that
the roles of class assistants should be made explicit and be driven by
clear guidelines. According to Giangreco and Doyle (2007) class assistant should provide support, meet needs of specific learners and/or
program needs within the school. These include responsibilities such
as: assisting learners with physical and mobility challenges by lifting,
positioning, exercising and transferring from or to transportation. The
aim of the study is to investigate the way class assistants are currently
involved in supporting learners who are sexually abused in order to
suggest guidelines on how to give support to these learners. A Qualitative case study research design will be used for this study.
1
Introduction and objectives: Adolescents are normally considered to
be sexually active and expose themselves to crisis of infecting sexual
transmitted diseases (STDs) and unplanned pregnancy while trying
sexual risk behaviour frequently as the occurrence of change on their
body, mind, and hormone. The study mainly aimed to explore the
relationships among sexual self-concept, sexual self-efficacy and sexual
risk behaviour.
Methods: A description analysis, a cross-sectional design, and a structured questionnaire were used to collect data from a medicine college
in central Taiwan. A total of 300 questionnaires were issued, with 265
valid copies replied, yielding a response rate of 88.3%.
Results: The findings of this study revealed that
(a) the negative sexual affect of self-concept scored highest; the
personal efficacy of self-concept scored higher than behavioural
skills.
(b) There was no difference among sexual self-concept, sexual selfefficacy, and sexual risk behaviour in respect to gender, have/have
no boyfriend or girlfriend, and with/without sexual experience.
480
THE EFFECT OF SEX EDUCATION ON
FAMILY HEALTH ON TEHRAN MEDICAL
UNIVERSITY STUDENTS
M. Mashhadian1, M. Lamyian2, M. Asghari Jafar Abady3
1
Department of Midwifery, Maybod Branch, Islamic Azad University,
Maybod, 2Department of Midwifery, Tarbiat Modares University, Tehran,
3
Department of Biostatistic, Tabriz Medical University, Tabriz, Iran
Background and aim: In today society, human life, in all life dimentions have been changed. marriage married life, sexual behavior, also,
have been changed. sex education can provide opportunity to learn
about sex awareness and sex roles. Sex education helps youth to clarify
their values, avoid risky behaviors and improve negotiation skills.
Research goals are the study of sex education effect on prevention of
sexual problems, health behavior, sex appropriate behavior, mental
health, family health, and gender identity.
Material & method: In this research method was experimental and
research design was post-test with one group. Statistical sample were
92(36 female, 56 male)university student. The sampling method was
stratified. To collect data a questionnaire was used the questionnaire
consists of 20 items with Likert type five-scale response option (with
a score rang of one to five). The questionnaire face and content validity
were established using a panel of experts. A Cronbach s aloha reliability
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of 0.84 was obtained of questionnaire in a pilot study with 30
students.
Results: In the present study to analyze data t-test have been used.
Six hypotheses were tested.
The result showed that
1) Sex education have effect on health behavior (t = 13.006, p < 0.0001)
2) Sex education have effect on sex appropriate behavior (t = 10.017,
p < 0.0001)
3) Sex education have effect on mental health and prevention of sexual
problems (t = 12.555, p < 0.0001)
4) Sex education have effect on effect on family health (t = 9.720, p <
0.0001)
5) Sex education have effect on effect on appropriate gender identity
(t = 0.556, p > 0.000)
6) Sex education have effect on effect on sex education is different
between male and female students (t = 0.556, p > 0.000)
Conclusion: The results of this research is consistent with other
studies. For example Gibson ans Mitchell (1999), Cooney (1991), Bee
(1998), Berrynan et al. (2002), Franken (2002), Jaff (1998), Schickedanz et al (2001).
481
STRIPPING BACK THE VENEER: A
QUALITATIVE STUDY OF UNDERGRADUATE
STUDENTS’ LEARNING EXPERIENCE IN
SEXOLOGY
L. Mayberry
Department of Sexology, Curtin University, Perth, WA, Australia
This qualitative research responded to significant issues related to the
problematic nature of in sexuality in Australian society. The study
provided insights into how higher education students extended their
understanding of sexuality. It emerged from the considerable body of
anecdotal evidence that has been gathered over thirty years in the
award winning1 sexuality education program at Curtin University. The
research provided unique insights into sexuality education an adult
learning environment, using ethnographic methods to reveal ways in
which undergraduate students perceived and interpreted new knowledge acquired from formal studies in sexology.
This presentation will focus on the early messages students brought
to the sexology class. How did the experiences and perceptions about
sexuality from childhood impact on the present? Sub themes that
emerged included: knowledge and attitudes absorbed from parents; the
role of religion; and the impact of sexual abuse.
The study also illuminated how the content and learning strategies
influenced participant perceptions of their own sexuality. The rich
body of information that emerged from this study provided much
needed information about the processes and learning outcomes for
students at this level, making a significant contribution to an important
issue that has thus far received scant attention in the literature on sexuality education at tertiary level.
1
In 2007 the Department of Sexology team at Curtin University was the
first tertiary institution to receive the Award for Innovation and Excellence
in Sexuality Education from the World Association for Sexual Health (WAS).
482
SYSTEMATIC DESIGN OF SEXUAL HEALTH
CURRICULUM FOR IRAN’S HIGHER
EDUCATION (A NEW VIEW POINT)
K. Mazdai, education-curriculum
Payam Noor, Sirjan, Iran
The current research is conducted to design the infrastructure of
sexual health curriculum in Iran university education on the basis of
recent researches and studies in realm of sexual issues, hygiene and
psyche health education through descriptive method. The most
updated factors and models have been used to codify the document in
curriculum planning. This article is based on survey study and due to
the indisputable role of education in developing countries, efforts have
been made to present the new model for the development of sexual
health in Iran and finally, presentation of main characteristic of the
developing model, submit the method of operation in the form of
preparing Iran sexual health education textbook to be used effectively
for the learners. Being in compliance with international models though
it is fully localized for all in our country, is the important characteristic
of the presented model. This typology offers the wide range of proposals for psychiatrists, educational psychology, curriculum planners,
health educators and educational policymakers in order to set the
modern educational strategies for high education development. Also
the result of the model and current ideas will make the leading framework to move Iranian society towards the sexual care and hygiene
development.
483
PRACTITIONER IMPACT UPON SOCIETAL
UNDERSTANDINGS OF CHILD SEXUAL
ABUSE: EVIDENCE BASED POLICY, PUBLIC
CRIMINOLOGY AND MEDIA DISCUSSIONS
K. Mccartan
Department of Health and Applied Social Sciences, University of the West of
England, Bristol, UK
This research will discuss findings from qualitative research conducted
with a broad group of criminological orientated professional’s (practitioners, media representatives and academics) about the media’s coverage of paedophilia, its impact upon the public and the realities of
‘Public Criminology’. The findings suggest that professional’s believe
that the media misrepresents and does not report paedophilia responsibly, which has resulted in a poor public understanding and moral
panic. However, the participants believe that professionals are also
responsible for the current misperceptions around paedophilia through
their discussions of it and media engagement surrounding paedophilia
in modern society. Hence, raising the question of whether the current
‘Public Criminology’ around paedophilia is effective in educating the
public? This paper will end with a discussion on how ‘Public Criminology’ focused on a paedophilia could be made more contemporary,
more media orientated and more public friendly possibly resulting in
a better societal understanding of paedophilia.
484
GAPS IN AFRICAN ADOLESCENTS’ RECEIPT
OF SCHOOL-BASED SEX EDUCATION
A.M. Moore1, S. Singh1, E. Zulu2, A. Munthali3
Research, Guttmacher Institute, New York, NY, USA, 2AFIDEP, Nairobi,
Kenya, 3Centre for Social Research, Zomba, Malawi
1
School provides an excellent forum for reaching a large number of
adolescents in a structured setting, particularly given that in subSaharan Africa today, adolescents are increasingly receiving more years
of education than previous generations. As official data on sexuality
education in sub-Saharan Africa is largely unavailable, national surveys
of adolescents provide valuable evidence on the extent and timing of
receipt of sex education at school, and help identify sub-groups who are
disproportionately lacking in receipt of sex education. Using four
nationally representative surveys conducted in 2003–2004 with 12–19
year olds in Burkina Faso, Ghana, Malawi and Uganda, we examine
who got sex education in schools; when is it taught relative to first sex;
and whether receipt of sex education predicts possessing in-depth of
knowledge about HIV prevention. Our results show that approximately
half of all adolescents were being exposed to sex education in schools.
Urban schools were more likely to teach sex education than rural
schools and males were more likely to report exposure as compared to
females. Most young people get sex education after age 15 but nevertheless before first sex. Exposure to sex education had mixed effects on
detailed knowledge of HIV/AIDS. In Ghana and Uganda, it had a posi-
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tive effect for females but no difference for males, while in Malawi and
Burkina Faso, it had a negative effect. These results highlight the need
to focus on reaching youth in rural areas, girls, and on the quality of sex
education being taught, especially on the subject of HIV.
485
MOVING FROM PAPER TO PRACTICE:
AN EXAMINATION OF TEACHERS’
IMPLEMENTATION OF RELATIONSHIPS AND
SEXUALITY EDUCATION (RSE) IN IRISH
POST-PRIMARY SCHOOLS
C. Murphy, S. Nic Gabhainn
Health Promotion, NUI Galway, Galway, Ireland
It is argued that school-based sex education is the most effective way
to target adolescent populations. In Ireland, Relationships and Sexuality Education (RSE) is implemented within the Social Personal and
Health Education (SPHE) programme in post-primary schools. RSE
is a teacher-delivered programme which requires teachers to act as
facilitators. This shift from traditional ‘chalk and talk’ teaching
methods is difficult and poses challenges to effective implementation
of sex education. Recent reports have highlighted this challenge
regarding the implementation of RSE, as well as other factors, such as
the need for improved teacher training.
This paper will critically examine the in-service training provided
to RSE teachers and explore how this training translates into practice.
A model of school-based implementation was derived from a review
of the literature. A mixed method (MM) approach was then employed
to examine components of the model as they relate to RSE. These
methods included self-report forms, lesson plans, attendance lists and
questionnaires.
The findings highlight several issues relating to the tension between
fidelity of implementation and programme adaptation. Fidelity of
implementation refers to programme delivery as prescribed by the
programme developer, while programme adaptation describes modifications made to a programme to suit the context or audience. Key
elements highlighted by this tension include teacher, programme and
organisational characteristics. The delicate nature of sex education and
the non-examinable status of RSE were some contributory barriers to
the effective implementation at school-level.
204
control groups 12.65+_3.61 [P < 0.05] highlighting the efficacy of the
performed education. Categorization of scores based on participants’
sex revealed that school girls tended to score significantly higher in
both pretest and post test than boys with P < 0.05 and P < 0.01
respectively.
Conclusion: Results indicate that peer education is very effective in
promotion of knowledge and attitude of high school students about
HIV/AIDS/STIs. Therefore implementation of this method is
strongly recommended at national level in order to increase awareness
of youth and reduce the incidence of HIV/AIDS/STIs in this age
group.
487
GENDER-SENSITIVE STRATEGIES FOR
ADDRESSING SEXUAL VIOLENCE IN
SPECIAL SCHOOLS FOR LEARNERS WITH
MILD INTELLECTUAL DISABILITIES IN
SOUTH AFRICA
D. Nyokangi
Further Teacher Education, University of South Africa, Pretoria, South
Africa
This paper reports on an aspect of the on-going doctoral study which
focuses on the experiences of sexual violence amongst learners with
intellectual disability at selected special schools in South Africa. Special
attention will be on participants’ views with regard to strategies for
addressing the problem at schools catering for learners with intellectual disability. The strategies include: (a) single-gender sessions which
will challenge issues like coercive sex and gender stereotypes; (b)
addressing negative cultural norms associated with violent behaviours
of masculinity in boys, (c) an gender sensitive school environment that
promotes and respect the rights of female learners; (d) empowering
girls with protective skills and a platform to report sexually violent
behaviours; (e) relevant and responsive sexuality education programs.
It was further recommended that teacher training equip teachers with
knowledge and skills to handle reported incidents.
The study followed a qualitative approach, and collected data by
means of in-depth interviews conducted with 18 participants. School
documents (incident report books) were also analysed.
488
486
PEER EDUCATION IS VERY EFFECTIVE IN
PROMOTION OF KNOWLEDGE AND
ATTITUDE OF HIGH SCHOOL STUDENTS
ABOUT HIV/AIDS/STIS IN BAHAWALPUR,
PAKISTAN
M. Nasir
Social Help & Research Organization (SHRO), Bahawalpur, Pakistan
Objective: High risk behaviors such as drug abuse and unprotected
sexual contact are frequently observed in these age groups. Hence
promotion of adolescent’s knowledge/attitude regarding prevention of
HIV/AIDS/STIs is very crucial for reduction of its incidence. Peer
education is considered one of the most effective educational methods
in order to increase knowledge/attitude of a target population. Study
purpose is to determine the efficacy of peer education on knowledge/
attitude of students toward HIV/AIDS/STIs.
Methods: Study conducted from September-February 2011, 1425
participants (755 males, 670 females) were recruited using cluster
random sampling. Subjects were divided randomly to five groups, in
each group 285 male & female. A standard questionnaire was designed
and knowledge/attitude of students were assessed as a pretest. Post test
evaluation was performed in after five months period of education by
educated peers for the two case groups.
Results: After five months level of knowledge/attitude of participants
in case groups 15.46+_3.42 was remarkably higher compared to
PERCEPTIONS OF SEXUAL PRACTICES AND
REPRODUCTIVE HEALTH PROBLEMS
AMONG THE ELDERLY IN IBADAN, NIGERIA
K.O. Odor, I.O. Olaseha
Health Promotion and Education, Faculty of Public Health, College of
Medicine, University of Ibadan, Ibadan, Nigeria
Most studies on sexual behaviour in Nigeria focus on young people
and adults, limited attention is paid to elderly people. Hence there is
dearth of information about elderly persons’ reproductive health challenges and involvement in risky sexual activities. This study therefore
examined the perceptions of sexual practices and reproductive health
problems among the elderly in Nigeria.
The study was cross sectional in design, 400 elderly persons aged
65 years and above were selected using a three-stage sampling technique. Both qualitative and quantitative methods of data collection
were adopted for the study. The FGDs were recorded and analysed
using the thematic approach, while the data from the questionnaires
were analysed using descriptive and Chi-square tests.
Slightly more than half, (50.5%) were males. A total of 25% of the
participants had extramarital-sex since they attained 65 years old.
Among this subgroup, very few (6.8%) used condom. Low level of
condom-use was attributed to the belief that condom is unnecessary
(34.5%) and perception (50%) that condom is not meant for elderly.
Moreover, majority (68.8%) believed that sex with virgin could boost
immunity against STIs/HIV. Whereas, early ejaculation/erectile dysfunction (31.3%) and inadequate vaginal lubrication (10.3%) were the
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reported main sexual problems of males and females respectively.
However, FGD participants were unanimous in their opinion that
sexual dysfunction was due to ageing.
Majority of the elderly were involved in risky sexual practices.
Therefore, health education intervention programmes such as training
on safe sex practices and counselling services are needed to address the
problem.
489
WHAT A DIFFERENCE A YEAR MAKES: IRISH
YOUNG PEOPLE’S PERCEPTIONS OF THE
FACTORS INFLUENCING CONDOM USE
AMONG THEIR PEERS
S. O’Higgins1, S. Nic Gabhainn2
1
Health Promotion Research Centre, National University of Ireland NUI
Galway, 2Health Promotion Research Centre, NUI Galway, Galway, Ireland
were deemed beyond the scope of the RSE programme. For the most
part the teaching methods proposed by the students were considered
to be acceptable, except where additional expenditure would be
required. This study showed that it is possible to involve stakeholders
in the development of curricula to ensure sex education meets the
needs of those for whom it is designed and those who deliver it.
491
INTEGRATING REPRODUCTIVE HEALTH
EDUCATION AMONG YOUNG PEOPLE IN
NIGERIA USING SPORTS AS A TOOL
C. Okonkwo
Management, Youth Network on HIV/AIDS, Population & Development in
Nigeria (Nynetha), Awka, Nigeria
Aim and methodology: The aim of the study was to explore the
young people’s perspectives on the factors affecting condom use. Two
data sets were generated; one from younger participants, modal age 16
years, (ranging from 15-18 years), the other from older students,
modal age19 years.
Results: Participants identified the multi-dimensional factors that
influence Irish condom use. Both groups demonstrated how proximal
and distal determinants effect positive sexual health. The issues identifed by both groups of participants included: male resistance to
condom use, females asking for them to be used, misconceptions of
how risky unsafe sex was (related to being uninformed and uneducated), and young women being pressurised to have penetrative sex
without condoms. Both groups placed drink and drugs high on the lists
of the reasons why condoms were not used. Although only one year
separated some of the two groups there were differences in attitudes
based on their own or their peers´ experience, particularly in statements related to relationship effects on sexual practice.
Conclusion: It was clear that a couple of years in the life of an adolescent effect attitudes and behaviours in terms of sexual health and
relationships. This supports the value of continuous sex education
being initiated before sexual activity. Underpinned by the value of
giving time and space to open and honest discussions of all forms of
sexual intimacy and so challenge hegemonic normative sexual
behaviours.
Background: Clear understanding of the situation of young people
and their need is required to design and successfully implement interventions to stem tide of vulnerability among them. Young people have
different needs and problems from adults; thus they have to be treated
and their needs addressed differently. However, sports especially football, passion of many young people in Nigeria is the most effective way
to do so. This project since 2008 uses YIRHEA Street Football (YSF)
a reproductive health package to create a fun open environment where
young people can comfortably explore sensitive issues.
Methodology: This project which uses special football competition
(Monkey Post) was made up of a team 4 with 2 players as reserves. It
targeted young people within ages of 15-19 years. 8 teams made up of
48 young people were selected and registered. Participants were
enrolled in a compulsory 3-day workshop tagged YIRHEA Street
football (YSF) Institute. YSF Institute provided participants with
information on HIV/AIDS and basic reproductive health education
including life skills.
Result: YSF Institute was compulsory for competing in the soccer
competition; attrition was insignificant during the workshop that benefited 450 young people. This program was reported at young people
favorite TV and radio sports programs including 7 National Dailies in
Nigeria. It built the capacity of young people, provided them with
resource materials, condoms and discovered new talents.
Conclusion: There is need for donor agencies and programmers to
explore this avenue so that they can reach more young people as it is
cost effective.
490
492
IRISH RELATIONSHIPS AND SEXUALITY
EDUCATION TEACHERS’ REACTIONS TO
POST-PRIMARY SCHOOLS STUDENTS’ IDEAS
FOR EFFECTIVE SEX EDUCATION
CONTRACEPTIVE PREVALENCE AMONGST
MARRIED WOMEN IN BAYELSA STATE OF
NIGERIA
S. O’Higgins, S. Nic Gabhainn
Health Promotion Research Centre, National University of Ireland NUI
Galway, Galway, Ireland
Aim and methodology: This paper is drawn from a study which
facilitated young Irish people, through a participatory research methodology, to generate, collate and present their views on effective sex
education without adult filtering or censure. The young people presented their views within ‘Webs’. Relationships and Sexuality Education (RSE) teachers were then asked what teachers would need in order
to incorporate the students’ suggestions on content and proposed
methods into sex education classes in Irish post-primary schools.
Results: The data presented in 58 webs created by 404 school students
(15-18 years) were presented to 26 teachers during two workshops.
The teachers added two layers of further detail to students’ ‘Webs’ in
order to present teachers’ views.
Conclusions: In general teachers responded positively to the issues
raised in the ‘Webs’, and stated a need for more training as well as
whole school support in order to deliver some of the learning outcomes identified. They reported that other learning outcomes would
best be delivered by outside facilitators but a further set of outcomes
G.S. Oladipo, P.A. Akande, I.G. Osogba
Human Anatomy, University of Port Harcourt, Port Harcourt, Nigeria
Objective: A research on the contraceptive prevalence amongst
married women residing in Bayelsa State of Nigeria was carried out.
Its principal objectives was to carryout a random estimate of contraceptive prevalence amongst married women in Bayelsa State, and to
determine the contraceptive prevalence, types of contraceptive used
and factors affecting the latter amongst women in Bayelsa State.
Methodology: A sample random method was employed where only
four hundred and ninety eight (498) women within the age range of
15–45 years of age were interviewed. Out of the five hundred (500)
questionnaire only four hundred and ninety eight (498) were retrieved
and used in this study.
Results: The highest contraceptive prevalence were between age
range of (21–30) (75, 15.7%) highest users based on educational level
are Tertiary 142 (28.5%) occupation was business women 99 (19.9%)
based on children 1–2 surviving children 104 (28.7%). From the result
of the research carried out, contraceptive prevalence rate amongst
married women in Bayelsa is low when compared to world wide figure,
though higher than the national figure in Nigeria. Education of eligible women on the use of contraceptive should be encouraged.
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206
493
495
INVOLVING PARENTS INTO SEXUALITY
EDUCATION OF YOUTH IN PAKISTAN
SELF-KNOWLEDGE AND CHANGE IN
EDUCATORS WOMEN OF THE
CONECUITLANI NET
K. Qayyum
Institutional Strengthening, Rutgers WPF, Islamabad, Pakistan
Sexuality education (SE) in a conservative society like Pakistan is
understood to be associated with various socio-political challenges. An
evaluation study conducted by RutgersWPF on SRHR-education
found that overall impact of SE interventions remains limited without
parental involvement. This study also highlights the burning issues of
harassment and gender roles for girls and boys respectively. To bridge
the communication gap between youth and their parents story telling
approach was used. In the pilot phase, two stories were developed, one
on gender role for boys and the other on harassment for girls. The
stories were shared with 23 girls and 28 boys, age 14–16, previously
exposed to SE curriculum, of 4 selected schools in urban and semi
urban areas of Karachi out of 270 schools of SE intervention. The
main characters of the story were taken from the SE curriculum and
students were asked to reflect on their comfort in sharing the story
with their parents and the importance of addressing the issue highlighted in the story with parents. Though the work is still in progress,
the first phase of pilot study shows that students approved the themes
and were comfortable in sharing the stories with their parents. Minor
editions and language modifications suggested by some students were
incorporated in the final draft along with some pictorials. The final
draft will be pre tested with students and their parents to encourage
communication and build confidence between children and their
parents.
O. Reyes-Nicolat
Psychology, National Autonomus University of Mexico, México, Mexico
In 2008 through in agreement beetwen Faculty of Psychology of the
Universidad Nacional Autónoma de México, and The Reecounter
Therapy Fundation of Valencia, Spain, lided by Fina Sanz, that has
created the Reecounter Therapy, to give to the comunity women
educators of the Conecuitlani Net, that atend Preeschool children
from 3 to 6 years old, a workshop of selveknowledge for the change.
The objetive was to give them tools so that they can incluide gender
equity, the good treatment and peace relationships, and for that, it was
applied the selveknowledge workshop for the change. This presentation report the experience with 13 of them that through 12 sessions of
3 hours each, once a week, in which they do exercises that lead them
to contact with themselves and the other participants through the
selveperception using drowings, expressions with the hands of positive
and negative emotions , full breath, rooting the body, open the senses,
global and genital erotism, the concept of afective family and care. All
sessions began with reflections and metioning the objetives for each
session, a round was open to leasen the experiences of everyone in the
group. Than it was given the homework exercises and the session was
closed with that. Than, it was done the care exercises that consisted in
eating and shearing food that was prepared by the group. Results was
that comunity women educators improved their relationships with
their pupils and their families and also their selveimage was improved
in order to achive selve empowerment.
494
SEXUAL BEHAVIORS, KNOWLEDGE AND
ATTITUDES IN A NATIONAL SAMPLE OF
PORTUGUESE SCHOOL STUDENTS
L. Ramiro, M. Reis, G. Tomé, I. Camacho, M. Ferreira, M.G. Matos
Project Social Adventure, Faculty of Human Kinetics / CMDT / IHMT /
FCT, Lisbon, Portugal
Aims: Sex education is becoming a regular practice in Portuguese
schools. The aim of this research was to deepen knowledge of sexual
behavior in Portuguese adolescents, including knowledge and attitudes
about HIV/AIDS, and assessing whether they changed from past
surveys and how significant sex education may have been in that
process.
Methods: Data were collected through a self-administered questionnaire from the Portuguese sample of the Health Behavior in Schoolaged Children (HBSC), a collaborative WHO study. The study
provides national representative data of students attending 6th, 8th and
10th grades. The 2010 sample is constituted by 5050 participants
(52.3% female and 47.7% male), with an average age of 14 years old.
A subset of participants attending 8th and 10th grades was constituted
in order to study sexual behavior.
Results: Results showed that, in general, adolescents have good
knowledge about HIV and aren’t intolerant towards HIV infected
people. The findings also show that 78.2% of adolescents aren’t sexually active. Considering those who are sexually active, 82.5% referred
having used condom during last sexual intercourse. Comparing with
past results, this showed a decrease in the number of teenagers who
reported having had sexual intercourse and an increase in the number
of those having used condom.
Conclusions: Sex education may have been responsible for the positive evolution in adolescents’ sexual risk behaviors, in their level of
information and positive attitudes. Nevertheless, there’s still a long way
to go since there are still adolescents that get involved in risk
behaviors.
496
SAFER SEX AND CONDOM USAGE IN NORTH
AMERICAN MEDICAL STUDENTS
T. Rowen1, J.F. Smith2, B. Breyer2, A.W. Shindle3
Obstetric and Gynecology, 2Urology, University of California, San Francisco,
3
Urology, University of California, Davis, Sacramento, CA, USA
1
Introduction: Previous studies indicate that sexual beliefs and mores
of students in medical professions may influence their capacity to care
for patients’ sexuality and safer sex issues. Students represent a large
sample of reproductive age individuals. In this study we examined
condom usage patterns in North American medical students.
Methods: North American medical students were contacted via online
medical student social and information networks and invited to participate in an internet based survey assessing ethnodemographic
factors, sexual history, use of contraceptive and barrier methods.
Descriptive statistics and logistic regression were utilized to analyze
responses.
Results: Among 2,269 complete responses, condoms were utilized by
1,011 respondents (50% of men and 40% of women). Overall, men
were more likely than women to report using condoms (OR 1.47 95%
CI 1.24-1.74), which was consistent across all racial groups. On multivariate analysis, condoms usage was associated with being Hispanic,
younger than 35, unmarried, having more recent sexual partners, and
not reporting erectile dysfunction. There was no association between
comfort in discussing sex or opinion of sexual health training in
medical school and condom use. Medical students had overall higher
rates of condom usage than age matched peers from the US
population.
Conclusions: There are significant ethnodemographic differences in
condom usage even in this highly educated population. There are also
differences between the general US population and medical students.
The personal safer sex choices of medical students may influence their
ability to accurately convey information about safer sex to their
patients.
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497
SURVEY RESULTS—WHAT SEXUAL
EDUCATION RESOURCES DO HEALTH
EDUCATORS PERCEIVE THEY NEED IN
ORDER TO FEEL CONFIDENT IN
DELIVERING THIS ROLE TO PATIENTS
H.-J.A. Ruth1, A. Tabatabaie2
Independent Practitioner, Sheffield, 2Cambridge, Cambridge, UK
1
A piloted survey questionnaire was used to collect the current situations, patient groupings, and previous training of sexual educators and
compare it with there confidence in delivering this help in differing
sexualiy related topics.
The results show that despite qualifications and experience many
educatirs still lack confidence at talking to patients in areas concerned
with sexual intimacy. This is seen as often linked to cultural and religious concerns.
498
FIZZING; EMPOWERING, SUPPORTING AND
ENABLING SEXUALITY EDUCATION
J. Kilpiä, S. Ruuhilahti
Nektariary, Helsinki, Finland
Fizzing is a method in sexuality education for young people by way of
participatory reflection, questioning, and sharing of their own thoughts
about sexuality, human life, and the world we live in today. Fizzing´s
vision is that a human being is unique and immeasurable with at least
physical, psychic and spiritual dimensions overlapping in relations with
other human beings.
Each session is a unique reflection of its participants. The particular
themes and approaches for each process are selected and specifically
tailoredfocusing on the issues raised and identified by the young
themselves.
Foundation of the process are Rendezvous; meaningfulness of every
moment, connection with oneself and others, coexisting side by side,
Martin Buber’s thought “I become me through you” and Presence;
open dialogue, presence instead of teaching, lingering flow of thoughts
and feelings without a premeditated intention in the atmosphere of
pedagogic love.
Fizzing creates stories because stories create reality. They uphold
and pull down structures, enable discussion about values and virtues.
Stories are inspired by young people´s environments and built in rendezvous, and thereby shape the concept of a human.
To build, create, share, experience and gain understanding from
somewhere beyond words, Fizzing makes art. It presents an opportunity to create reality instead of merely adapting to it passively.
One important tool in education is Humour. It is an attitude to life,
wisdom and phenomena which by way of distancing allows space and
a way for increased understanding and an equal and empowering field
of rendezvous enabling greater spontaneous sharing.
499
INFANT SEXUALITY IN A PRE-SCHOOL
EDUCATION
V.G. Schindhelm
Education, Universidade Federal Fluminense, Rio de Janeiro, Brazil
A pre-school education research makes us think about the process of
educating children aiming to: (a) get to know about the infant sexuality
and how it can happen at school; (b) understand what the educators
really know about the children’s sexuality; (c) how teachers deal with
the sexual experiences that the children daily live at school; (d) understand how sexual education can contribute for the improvement of
education practices and changes in the school ethos. Sexuality is a
social, historical and political construction related to power and rules.
Searching for the answers for these disturbing questions we reach to:
(1) qualitative research with participative observation; (2) collecting
information, free observation registers, children and educators narration; (3) bibliography analisys; (d) semi-structured individual interviews with educators; (4) narrative content analysis. The preliminary
conclusion was based on the everyday information as: (a) educators
have different interpretations about the behaviour related to sexuality;
(b) educators don’t like to talk about sexuality because they think
children are asexual; (c) educators carry their own sexual secrets and
sufferings; (d) educators know nothing about children’s sexual life and
their culture values. This unfinished research may contribute to think
about education comprehending sexuality, in order to rearrange the
students and educators’ personal values and the consciousness of the
individual capacity to encourage institutional movements that are able
to transform social groups which they live in, recognizing the link with
the society and the engagement with a new social arrangement.
500
INTERACTIVE THEATRE FOR SEXUALITY
AND REPRODUCTIVE HEALTH EDUCATION
TO LEARN AND PRACTICE (IT-HELP)
M. Shahzad
Networking & Partnership, Chanan Development Association (CDA),
Lahore, Pakistan
Issues: Pakistan has the largest demographic dividend of youth, i.e.
63 % population below the age of 29 (out of 170 million), but unfortunately majority of the youth are unaware about sexual and reproductive health and rights and lacks in access to sexuality education and
services due to socio-cultural norms which leads to harmful sex practices, increase rate of STI/RTI including HIV/AIDS and creating
myths and misconceptions in their minds.
Description: Chanan Development Association, a youth lead NGO,
launched an innovative program on self-help basis with titled “Interactive Theatre for Sexuality and reproductive Health Education to Learn
and Practice (IT-HELP)”. The project aimed at Equipping young
activist with the skill of Interactive Theatre to reduce the stigma
realated to their sexuality. for this
1. 22 Youth Groups formulated,
2. 200 performances staged
3. 40,000 young people approached to promote informed choices
among marginalized segment of the society, i.e. youth, women,
Madrisah students and MSM.
Lessons learned: Young people posses a great ability to challenge
societal norms and bringing change in their own and other peers
attitude, knowledge and practices. Through capacity building on innovative/interactive skills, youth activists can play an active role in combating stigma related to sexuality, can promote health, safer sex
practices to engage marginalized communities, generate dialogue even
on sensitive issues like sexuality/SRHR.
Next steps: Involving young activists and employing arts based
approaches should have to be ensured in every awareness raising
program for reaching marginalized groups and initiating dialogues in
very rigid and backwards communities.
501
PEER-EDUCATION IN HIV-INFECTION
PREVENTION: AN ITALIAN ACTIONRESEARCH PROJECT
C. Silvaggi1, F.M. Tripodi1, V. Cosmi1, L. Pierleoni1, C. Simonelli2
Institut of Clinical Sexology, 2Sapienza, University of Rome, Rome, Italy
1
Objective: This work presents both a descriptive survey on HIV-risk
behavior in adolescents and an evaluation of peer-education effectiveness in developing knowledge and positive attitudes with regards to
sexual health.
Methods: This three-phase study involved 1,773 students (850 M and
923 F) aged from 14 to 20 yrs (mean age 15.92) divided into an experi-
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mental (EG) and a control group (CG). The following instruments
were used for pre-test, post-test and follow-up: an ad hoc questionnaire
evaluating socio-demographic data, knowledge about HIV infection,
risk perception, risk behaviors and their correlates; a scale of selfefficacy. Peer educators were trained to deliver three 1-h classroom
sessions of HIV prevention to students of EG.
Results: Participants displayed a good level of information regarding
biological aspects of HIV. By contrast, they showed social stereotypes
and poor knowledge concerning the reliability of diagnosis tests,
vaccine, and transmission modes. At pre-test, systematic use of
condoms was declared by a quite low percentage of sexually active
participants and motivated by unwanted pregnancies prevention rather
than STDs (about 1/2 in vaginal sex; 1/3 in anal sex and 1/10 in oral
sex). Variance analysis (MANOVA) revealed significant post-test differences between EG and CG regarding transmission of knowledge [F
(1, 417) = 18.8; p = 0.001], risk behaviors [F (1, 32) = 4.1; p = .045],
HIV- infection preventive behaviors [F (1, 429) = 10.1; p = 0.002].
Conclusion: The data showed that students in the intervention group
(EG) improved both their HIV-knowledge and preventive behaviors,
although changes of the latter do not appear stable over time.
502
KNOWLEDGE OF HIV/AIDS AND RISK
BEHAVIOUR AMONG ADOLESCENTS:
A LONGITUDINAL ANALYSIS
1
1
2
2
3
C. Silvaggi , G. Torre , F. Tripodi , R. Rossi , C. Simonelli
1
Institute of Clinical Sexology, Rome, 2Institute of Clinical Sexology , Rome,
3
Sapienza, University of Rome, Rome, Italy
Objective: Sexual risk taking among adolescents represents a significant health problem. Many sources of HIV information (radio and
television) have become increasingly accessible over time; nevertheless,
risk behaviour in adolescents does not appear to have decreased.
During a ten-year period, the authors studied changes in adolescents’
knowledge about AIDS infection and syndrome and its relation to their
attitudes and risk behaviours.
Methods: 5,624 adolescents (M = 2,809; F = 2,815), belonging to ten
different high schools in Rome (Italy), with age ranging 14–21 (average
= 16.60; SD = 1.39) were recruited from 2000 to 2010. Participants
were asked to complete an ad hoc questionnaire investigating: sociodemographic data, sexual behaviours, risk perception, personal beliefs
and stereotypes regarding AIDS/HIV.
Results: Data showed a negative trend over time regarding knowledge
about AIDS/HIV and perception of personal risk of acquiring the
virus. Moreover, results highlighted some misinformation about
modes of HIV transmission: a relevant rate of adolescents considered
blood donation as a risky practice and this erroneous belief increased
over time (30% in 2000 vs 57% in 2010).
The risk of contracting STDs increases with the first sexual intercourse that is characterized by the highest use of natural methods of
birth control. Despite the increase in the use of condom and in the
perception of this being the only device for the prevention of STDs,
participants reported a decreasing condom use in oral and anal intercourse over time.
Conclusions: Accessibility to information, is not enough to ensure a
radical change in risk behaviours. Different strategies in prevention
programs should be considered.
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503
PROVIDING SEXUALITY EDUCATION
INCLUDING HIV/AIDS PREVENTION
AMONG RURAL WOMEN OF DISTRICT
LAHORE THROUGH INTERACTIVE
THEATRE
S. Sohail1,2
1
Media and Communication, Chanan Development Association (CDA),
2
Media and Communication, Youth Peer Education Network (Y-PEER),
Lahore, Pakistan
Background: In Pakistani society women sexuality and HIV/AIDs
both considered as taboo and a big stigma which creates an environment of frustration and repression, hindering women from accessing
the available information and healthcare services regarding sexual and
reproductive health information, Lack of information and services
increase the vulnerability of community women, high risk sexual
behaviors, unintended pregnancies, teenage pregnancies, unsafe abortions, family planning methods and HIV and AIDs including STIs,
STDs.
Methods: The project aims at empowering community women give
them accurate information through interactive theatre and capacity
building. The activities of the projects are
1. Conducting research in District Lahore to find out the knowledge,
Attitude, and Perception of women about sexuality and HIV/AIDS
2. Educating 1000 community women of District Lahore about sexuality rights, family planning including STIs, STDs and HIV/AIDS,
mode of Transmission and Prevention
3. Enabling community women to establish “Sexuality Education
Clubs” in their areas for replicating the information among other
women of their communities and to enable them to fight the stigma
and discrimination related to sexuality and HIV/AIDS in Islamic
society.
Results:
1. 1000 community women of “Lahore” got accurate education about
sexuality rights and HIV/AIDS
2. 15 Sexuality Education Clubs established and start functioning efficiently, 700 young women volunteered to be part of these Clubs
Conclusion: Need to give Sexuality education to community women
as they have no source to get accurate information about their sexuality
health and rights which creates their vulnerabilities to HIV/AIDs.
504
COMPARING PROFESSIONAL NURSES AND
ADVANCED PRACTICE NURSES
PERCEPTIONS OF CONFIDENCE AND
COMFORT IN DISCUSSING ISSUES OF SEX
AND SEXUALITY WITH PATIENTS
S.W. Stark, M.A. Troiano
School of Nursing and Health Studies, Monmouth University, West Long
Branch, NJ, USA
Registered professional nurses are well versed about methods to
address sensitive issues with patients and are knowledgeable about how
disease and treatment can affect patients’ sexual health and wellbeing.
However, while professional nurses believe that issues of sexual health
and sexuality are not too sensitive to discuss, they often express discomfort and lack of confidence in initiating discussions with patients
when issues of sexual health and sexuality should be addressed. Lack
of time, education, and ability to cope with patients’ sexual health
issues are often identified as barriers. For this study, Magnan’s (2005)
Sexual Beliefs and Attitudes Survey was used to measure professional
nurses perceived discomfort levels in discussing sexual health and sexuality issues with patients. Two focus groups were developed and perceived barriers to discussing sexual health and sexuality issues with
patients were identified. One group was comprised of professional
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Proceedings from the 20th World Congress of Sexual Health
registered nurses and the other group was comprised of advanced
practice nurses. Open forum lectures addressing the identified barriers
were presented and methods for discussing sexual health, sexuality and
conducting comprehensive sexual health histories were included. The
open forum format encouraged discussion of patient situations
encountered by nurses and advanced practice nurses. Conclusions of
this study were that there were few differences between professional
and advanced practice nurses’ perceived barriers to addressing sexual
health and sexuality issues with patients. There is a need in all levels
of nursing education to include a focus on methods to discuss sexual
health and sexuality issues with patients.
505
PARENTAL MANAGEMENT OF YOUNG
CHILDREN’S SEXUAL EDUCATION AND
INQUISITIVE QUESTIONING
N. Stone, R. Ingham
Centre for Sexual Health Research, University of Southampton, Southampton,
UK
Introduction: “Where do babies come from?”. “Why do boys have
willies?”. “What does gay mean?”. Probably all parents have faced such
‘innocent’ questions from young children on issues relating to sex and
reproduction. Similarly, nearly all parents have found these questions
challenging to answer. There has hitherto been very little research
interest in this area of communication, possibly because it is, by its
very nature, seen to be intrusive and unduly inquisitive. However,
there are strong indications that the impact of early styles of communication can be immense in terms of sexual development, safety and
outcomes.
Aim: The aim of this study was to explore parents’ experiences, fears,
concerns and justifications regarding early childhood sexual socialisation and development, their personal experiences of initiating sexuality
communication, reacting and responding to their child’s emerging
sexuality and sexual curiosity, and their understanding of the impact
their actions and reactions may have on their children both now and
in the future.
Method: Five focus groups discussions were held in South Central
England with parents of 4-7 year olds drawn from a range of socioeconomic backgrounds.
Results: Thematic analysis of the focus group transcripts revealed
parents to be educating their children (sometimes unknowingly) about
sex and relationships related issues; however, a number of barriers to
communication were clearly evident, including the need to protect
childhood ‘innocence’, the prevention of confusion and misunderstanding, suitable timing and age appropriateness of explanations,
discomfort with terminology and being unprepared for impromptu
questioning.
506
EMBEDDED AGGRESSION IN
PORNOGRAPHIC DESIRE: LISTENING TO
THE AUDIENCE
C. Sun
McGhee, NYU, New York, NY, USA
This research project used qualitative method to investigate the role
pornography plays in shaping sexual desires and relationships.
I interviewed 20 heterosexual men and found the following patterns
among men who regularly watch pornography:
(a) the earlier a man started watching pornography in his life, the more
likely it was that he would continue using pornography as a masturbatory aid;
(b) pornography and masturbation are always linked, and these men
no longer masturbate without pornography;
(c) the sexual acts that they desire closely resemble pornography:
threesomes, anal sex, group sex, sex in public spaces, ejaculation
on/in a woman’s face/mouth, etc.
Some respondents explicitly stated that they got these ideas from
pornography; and
(d) they either have performed or desired to perform certain aggressive acts on a woman: pulling hair, spanking, choking, manhandling/rough sex, and gagging.
I also interviewed 20 women about their pornography use. Compared
to their male counterparts, they viewed a lower quantity of pornography and less frequently. They were also more selective about the type
of pornography that they watch, and generally avoided pornography
that mistreats women. Nonetheless, there were also female viewers of
pornography who said that they liked “rough sex” or “being manhandled” and that they looked to pornography for ideas to incorporate
into their own sexual acts and scenarios.
Many respondents said that pornography is their primary source of
information about sex and the research results strikingly reflect that
what these porn users learned.
507
THE PRICE OF PLEASURE: PORNOGRAPHY,
SEXUALITY, AND RELATIONSHIPS
C. Sun
McGhee, New York University, New York City, NY, USA
The Price of Pleasure: Pornography, Sexuality, and Relationships (2010,
60 min) is a documentary film that investigates pornography as both
a genre of representation and as a distinct form of industrial
practice.
Once relegated to the margins of society, pornography has emerged
as one of the most visible and profitable sectors of the cultural industries, assuming an unprecedented role in the mainstream of our
popular culture. The Price of Pleasure tackles the complexity behind this
seeming paradox, placing the voices of critics, producers, and performers alongside the observations of men and women as they candidly
discuss the role that pornography has played in shaping their sexual
imaginations and relationships. By investigating the production,
content, and consumption of pornography, the film moves beyond the
liberal versus conservative debates so common in the culture to paint
a nuanced portrait of how pleasure and pain, commerce and power,
liberty and responsibility have become intertwined in the most intimate area of our lives. As a whole, the film argues that pornography
should be understood as the product of three dominant and interlinked
systems of oppression in U.S. society: patriarchy, white supremacy, and
capitalism on both macro and micro levels. On the macro level, the
racist and sexist mainstream pornographic materials rely on these
oppressive systems in order to achieve mass production and consumption. On the micro level, the audiences internalize the systems’ values
so as to find those sexist images and problematic racial dynamics sexually arousing.
508
LONGITUDINAL CHANGES OF THE SEXUAL
HEALTH CARE EDUCATION AMONG THE
NURSING STUDENTS IN TAIWAN
S.-C. Sung1,2, Y.-C. Lin2
Chang Gung Institute of Technology, Taoyuan,
Kaohsiung, Taiwan R.O.C.
1
2
Shu-Te University,
Purpose: The nursing curriculum in Taiwan has neglected to include
sexual health care. This study was to evaluate the longitudinal changes
of a sexual health care education for nursing students in Taiwan.
Methods: This study was conducted using a single pre-post test group
design for 95 senior nursing students from Department of Nursing,
Chang Gung Institute of Technology, Taiwan. The students received
a 12-week sexual health care education, including sessions of biopsycho-social aspects of sexuality, sexuality throughout the life cycle,
sexual harassment in the medial environment, sexual arousal and
response, nursing assessment, sexual dysfunctions, atypical sexual
variations and gender identity, sexuality and impaired systematic
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function, sexuality and reproductive cycle, sexuality and mutilating
surgery, sexuality and mental illness, and sexuality and sex victim. The
longitudinal changes from the study baseline to the follow-ups at the
13th and 18th weeks were estimated using the hierarchical linear models
for the repeated measures of knowledge of sexual health care, attitude
to sexual health care, and self- efficacy for sexual health care.
Results: The sexual health care education had significantly positive
changes on the students’ knowledge of sexual health care (B = 0.23, P
< 0.001), attitude to sexual health care (B = 0.36, P < 0.01), and selfefficacy for sexual health care (B = 1.24, P < 0.001).
Conclusions: The sexual health care education had positive changes
in improving nursing students’ knowledge, attitude, and self-efficacy
for sexual health care. Nursing students will become more knowledgeable, comfortable, and confidence when talking with patients about
sexuality, which is necessary for the comprehensive care in nursing
practice.
210
Marriage Consultation Center. A questionnaire of 31 questions was
developed and filled by all the study participants. 83.3% of females and
39.3% of males were younger than 24 years.
Results: The average knowledge score of males were 12 ± 3 compared
to 10 ± 3 properly-answered questions out of 31. The highest knowledge level was among participants with college education (15 ± 1 vs.
11 ± 2, respectively). In age group below 19 years, females’ knowledge
was higher than that in males (9 ± 1 vs. 7 ± 2.5, respectively); however,
in other age groups, males had higher knowledge. Most of the subjects
had obtained their knowledge from unreliable sources (70.3% females
vs. 64.7% of males). 44.3% of women and 15% of men had moderate
to severe phobia in sexual relationship.
Discussion: We found that Iranian newly married couples have very
limited knowledge on safe, responsible and enjoyable sexual relationship; and their knowledge is mainly obtained through unreliable ways.
This alarms us to pay more attention to educate Iranian young men
and women regarding sexual relationship.
509
A GLOBAL PERSPECTIVE ON SCHOOLBASED SEX EDUCATION AND MUSLIMS:
CHALLENGES AND OPPORTUNITIES
A. Tabatabaie, Z. Mofatteh
University of Cambridge, Cambridge, UK
The crucial need for reform in school-based sex education (SBSE) has
been triggered by various social changes during the past decades.
Studies across the globe have revealed that culturally sensitive and
properly designed SBSE programmes can reduce the risk of HIV and
other STIs and unintended pregnancy. However, teaching about sexuality in schools has been a matter of controversy and debate among
Muslim communities across the globe for a long time. There is a lack
in our knowledge regarding how to employ a practical approach in
developing and implementing islamically tailored SBSE programmes.
In this review, I will look thematically at the literature to explore this
issue. It will start by defining sex education and its potential contributions to raising the level of sexual health around the world, as well as
different approaches and dilemmas associated with it. Addressing the
dilemmas, the importance of values in developing and delivering sex
education programmes will be highlighted, as well as religious values.
Focusing on the Muslim community, Islam as a value system will be
looked at and the ways by which different interpretations of Islam
interact with issues of sexuality and sex education, including problematic and challenging areas, will be discussed. The final section of the
review will refine the argument in favour of utilising Islam as a framework for developing Islamically acceptable sex education programmes
and will present practical solutions on how to approach a reform in
order to provide young Muslims with better sexual health outcomes
around the Globe.
510
LEVEL OF KNOWLEDGE OF NEWLY
MARRIED COUPLES REFERING TO
MARRIAGE CONSULTATION CENTER IN
TEHRAN: SAFE, RESPONSIBLE, ENJOYABLE
SEXUAL RELATIONSHIP
S. Parsay1, M. Zahedie1, S. Taheri2
1
Shahid Beheshti University of Medical Sciences, 2Dr Taheri Medical
Research Group, Tehran, Iran
Introduction: Marriage is the most basic, essential and sacred relationship which in its correct definition consists of dynamic physical
and psychological communication between couples. Legally, all Iranian
prospective couples should attend Marriage Consultation Center
before marriage. In this study, we aimed to evaluate current knowledge
of safe, responsible, enjoyable sexual relation among Iranian prospective couples.
Methods and material: A cross sectional study was conducted on 150
randomly selected couples (300 subjects) who were referred to Tehran’s
511
THE CURTIN ALLY PROGRAM FOSTERS A
UNIVERSITY CULTURE WHICH IS
INCLUSIVE OF SEXUAL AND GENDER
DIVERSITY
P.J.M. Tilley
Department of Sexology, Curtin University, Perth, WA, Australia
Discrimination against GLBTI people may lead to feelings of inadequacy, guilt and depression, and further isolation from social structures, including school/university, family and work. It is well
documented that many GLBTI people use drugs & alcohol to cope
with the difficulties they face e.g. coming out; hiding sexual orientation
or gender identity; entering gay & lesbian social or commercial scene,
thus creating both individual and public health concerns. Additioanlly,
suicide rates amongst people who either identify as homosexual or are
same sex attracted (SSA) is 2-7 times higher than amongst heterosexuals (Cochran & Mays, 2000). Hillier and colleagues (2005) found that
it is important to assist young people to understand homophobia and
discrimination as it can help facilitate them reframing the negative
messages about sexual differences.
Curtin University implemented the Curtin Ally Program in 2006
with the aim of fostering a University culture which is inclusive of
sexual and gender diversity. It is designed to provide a campus based
sexuality and gender sensitivity training to both staff and students,
in-part meeting the WAS Universal Declaration of Sexual Rights. The
Curtin Ally Program offers training which assists participants to
explore the issues and their impacts on Curtin staff and students who
are GLBTI.
This presentation aims to showcase the Curtin Ally Program with
the hope that other service delivery agencies might adopt this model
in their health programs (academic or community based). It is also
hoped that this presentation will increase the awareness of the experiences of GLBTI teritary studnets.
512
‘SEX—IN YOUR WAY ’. A BOOKLET ABOUT
SEXUALITY FOR TEENAGERS
P. Ullholm
Swedish Association for Sexuality Education, Stockholm, Sweden
Objective: To make a booklet about sexuality, describing different
ways of having sex.
Background and aims: There is a demand from youth clinics, parents,
teachers and teenagers for a shorter material about sexuality for teenagers. The aim with the booklet is to make teenagers (age 14–16) more
knowledgeable and confident, and to improve their self-efficacy as
sexual beings with themselves and/or with a (potential) partner/s. The
aim is also to broaden the view on what sex could be and avoid the
focus on penetrative sex as ‘real sex’.
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Method: Sex is not simply something one do or feel, it’s also about
knowledge. The booklet is written with a non-normative perspective,
i.e. it’s addressing hetero-, bi-, homosexual and transgender persons
without using the terms sexual orientation or transgender. In an open
way the booklet describes different emotions and ways of having sex.
One can read about fondling, sex with oneself (masturbation), being
together with other/s, sensitive parts etc.
It also has a rights perspective and talks about the right to one’s own
body and sexuality, mutuality, and norms. Everyone has the right to
say yes and no. Everyone should have the freedom to choose, to be
oneself and to enjoy.
Illustrated with cartoon-like pictures.
Results: The booklet will be released in March 2011. Consequently
we don’t have any results to show yet. Though, at the time for the
conference we will. As we already know there is a demand, we are
confident it will get attention and be used.
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ARE CHILDREN LEARNING ENOUGH HIV/
AIDS KNOWLEDGE FROM INDONESIAN
SCHOOL TEXTBOOKS?
I.D. Utomo1, P.F. McDonald1, T. Hull1, W. Diarsvitri1, I. Rosyida2
1
Australian Demographic and Social Research Institute, Australian National
University, Canberra, ACT, Australia, 2Centre for Women Studies, Islamic
State University, Jakara, Indonesia
When HIV/AIDS was first identified in Indonesia in 1987, it was
considered to be a disease related to foreigners and to homosexuality
or commercial sex workers and their clients. Media coverage on HIV/
AIDS was minimal and stigmatising. The government did not think
that HIV/AIDS could enter the general population to the extent that
it has today. Though currently Indonesia has a low prevalence of HIV
infection of 0.1% among adults aged 15–49 years old, the number of
AIDS cases continues to rise. HIV/AIDS has infected the general
population of housewives, pregnant women and their babies and not
just among those with high risk sexual behaviours and intravenous drug
users. Informal education and campaigns on HIV/AIDS started in the
mid 1990s initiated by NGOs. Recently the Indonesian Government
decided to include HIV/AIDS education in formal school curricula
starting from primary schools. This paper assesses the content of
primary and secondary school text books that reflect the new curricula.
Three hundred books were reviewed using a Reproductive Health
Analysis Module developed by the authors to evaluate the depth of
information given in Biology, Science, Sport and Health Education,
Social Sciences and Islamic Religion text books. The assessment
covered information given, anatomical accuracy, gender depictions,
and the social and religious values applied to HIV/AIDS. The results
show that HIV/AIDS is covered mainly in a chapter attached to Sport
and Health Education textbooks. The information provided is conservative in nature and in some cases does not deliver safe sex messages
that would benefit students.
514
LEARNING PROFESSIONAL
COMPETENCES—SEXUAL COUNSELLING
AND THERAPY TRAINING IN JAMK
UNIVERSITY OF APPLIED SCIENCES IN
2000–2007
S.M. Valkama
Continuing Education, Center of Exellence in Sexual Health Education,
JAMK University of Applied Sciences, Jyväskylä, Finland
The objective was to study how adult students developed their professional competences in Sexual Counselling and Therapy training programmes based on NACS education and authorisation guidelines. The
aim of the study was to find out how the professionals describe their
sexological counselling and therapy competencies had changed after
their studies.
Professionals were asked about client relationships: ability to build
relationships, skills connected with studying and clarifying them, and
management of the client relationship process. The study utilized the
Internet-based Digium Survey and Research System. The professionals who participated the training in 2000–2007 were sent a semistructured questionnaire (N = 109) by email. The reply rate was 56%.
The respondents felt that their most impressive skills in building
relationship were respect and confidentiality for the client. Skills connected with studying and clarifying client relationships had improved
in all demanding areas. The greatest improvements were in focusing
matters, setting questions and managing confrontation. About half of
the respondents reported having extremely good skills in concluding
cooperation agreements. Slightly over 50% of the respondents felt that
their skills connected with the progress of the client relationship
process were extremely good after training in all the skill areas:
working on issues to be solved, setting goals and planning the work.
In conclusion, results show that the Nordic Programme and its
implementation in JAMK provide the participants with good competences and skills for working as sexual counsellors and therapists.
515
FEMALE SEXUAL PRECOCITY: A CURRENT
AND FUTURE PURSUIT
R. Vandyk, A. Tilbrook
Department of Physiology, Monash University, Victoria, VIC, Australia
We present a theoretical and experimental study that proposes an
alternative to a hyper-vigilant mentality that may restrict sexual play
behaviour in female humans, from childhood through to post-pubescence. Our theoretical commentary is based on a thorough review of
recent and classic literature, and informed by our experimental work
conducted with a sheep model of female sexual behavior. Sexual confidence in a female human emerging from her adolescent years is an
oxymoron; a combination of restriction and coercion by the society
she finds herself in is a recipe for confusion. Childhood carers, real
and virtual environments, and internal cognisance; influencing the
sexual and reproductive choices of the mothers of the future. We
review the Hensel model of Sexual Esteem, Openness and declined
Sexual Anxiety (Hensel et al., Journal of Adolescence 2010,
doi:10.1016/j.adolesecence.2010.09.005). We propose an extension
that uses a concept of an internal hologram as the conscious and subconscious self-representation of sexual and gender presence in the
social environment. We also present current animal research that
shows how stress inhibits sexual motivation; females who have distressful and displeasurable experiences have a propensity to cease sexual
encounters and suppress their sexual behaviour. We contend that
rather than a latent period of sexual development during childhood,
there are critical periods of exploration which, when effected, produce
a confident adolescent, in turn producing a confident, sexually precocious woman.
516
THE ART OF SEXUAL SCIENCE: GROMMETS,
GIRLY-GIRLS, AND GRANDPAS. . . AND
EVERYTHING IN BETWEEN
R. Vandyk, A. Tilbrook
Department of Physiology, Monash University, Clayton, VIC, Australia
A theatrical lecture on the novelty of the science of human sexuality:
educational, but rollicking good fun. . . ‘sex ed’ like never before. Pilot
lecture to be held in rural Victoria, Australia in early May 2011.
Targeted audience: Secondary school students, medical and community health professionals, parents, general public, art & science
community groups.
• Visually amazing and involving
• concise anatomical illustrations
• digital animations
• short films
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• skits
• slideshows
The content: covers the emotive involvement of the sexual human
from the neuroendocrine perspective in theatre, words, and pictures;
reviews the physiological basis of heterosexual reproductive sexuality
with concise anatomical illustrations and animations, with the neuropsychological involvement that extends to all human bonding across
the lifespan, regardless of sexual preference. The aim is to present a
non-hallowed view of sexual involvement, using an evolutionary psychology background as a basis for re-examining the standard sexual
premise, especially in its applications in rural and country areas.
517
REPRESENTATIONS OF WOMEN SEXUALITY
AMONG NURSES IN BRAZIL
E.M. Vieira1, L.C. Junqueira2, M.N. Santos Barros3, M.A. dos Santos2,
A. Giami4, Health and Gender
1
Social Medicine, Medical School of Ribeirão Preto University of São Paulo,
2
Psychology, Faculdade Filosofia Ciências e Letras de Ribeirão Preto-USP,
3
Nurse School of Ribeirão Preto, University of São Paulo, Ribeirão Preto,
Brazil, 4CESP Centre for Research in Epidemiology and Population Health,
U1018, Inserm, Paris, France
Introduction: The development of new treatments has improved survival and quality of life among cancer patients. As an important aspect
of life nurses are demanded to answer questions and provide orientation on sexual life of patients.
Objectives: To understand the representations of sexuality among
nurses working with women surviving breast cancer after diagnosis and
during treatment assuming that their representations will affect communication with the patient.
Methods: A qualitative study using an in-depth guideline to interview
28 nurses living and working in the Southeast of Brazil. The narratives
were submitted to a content analysis and categories of representations
were identified.
Results: Several representations of sexuality were found in the nurses’
discourses: Sexuality as:
1) dangerous and risky for diseases;
2) a basic human need for health and well being;
3) a prerogative of youth linked to reproduction and associating sexual
intercourse in mature age with displeasure;
4) an expression of an idealized pattern of beauty being connected to
body image and self-esteem;
5) linked to the idea that love and sex must be experienced together
being sex a complement of love;
6) sexual fantasy and erotization of patients including the manipulation of patient’s body and their reactions as expression of
sexuality.
Conclusions: The wide range of nurse’s representations about sexuality probably interferes in their practice and communication. Understanding nurses’ representations on sexuality provides knowledge to
redesign nurses’ qualification training. Nurse´s training should include
orientation on cancer patient sexuality.
518
MOTHERS’ TALK ABOUT SEXUAL HEALTH
WITH THEIR DAUGHTERS: THE
INFLUENCE OF SOCIAL AND CULTURAL
FACTORS IN FORTALEZA, BRAZIL
N.F. Vieira, P.N.C. Pinheiro, F.D.A. Gubert, A.G.M. Costa,
A.K.L. Martins, S.M. Barbosa, F.J.L. Sampaio Filho, M.M.C. Freitas,
M.D.F.B. Nóbrega, K.E.C. Bezerra, G.V. Arcanjo
Nursing Department, Federal University of Ceara, Fortaleza, Brazil
Introduction: Sexual health life is an important aspect for the adolescent development. The family must promote communication among
its members, especially for adolescent girls. Traditionally, mothers
212
have the responsibility to talk with their daughters about sex and sexuality in order to prevent an unwanted pregnancy and STD/HIV.
Objectives: To uncover, based on the mothers’ experience, their talks
to their daughters about sex, sexuality and prevention.
Methodology: Fifteen women age between 32–43 years old who participate of the Family Health Unit, in Fortaleza, Ceará, Brazil. Data
collection and analysis based on Transcultural Theory. Interviews and
focus group were used. This research was approved by the Ethics
Committee of Federal University of Ceara.
Results: Social and cultural factors influence mothers in the way they
talk about this sensitive theme, such as, limited knowledge, fear, emotions and shame. Also any talk about prevention is focused on pregnancy prevention. Regarding the DST/HIV, there are little discussion
about it as an argument for prevention, and it pointed out a perspective
of risk to life and it did not mention anything about signs and
symptoms.
Conclusion: There is need for the community nurse to consider social
and cultural factors in the family health care, improving knowledge
and communication skills for mothers hence sexual health promotion
for adolescent girls.
519
APPLICATION OF THE PARENT
ADOLESCENT COMMUNICATION SCALE
WITH BRAZILIAN FEMALE ADOLESCENTS
TO PROMOTE SEXUAL HEALTH
N.F.C. Vieira1, F.D.A. Gubert1, P.N.D.C. Pinheiro1, P.C.D. Almeida2,
M.O.B. Oriá1, A.G.N. Ferreira1, C.C. Maia1, M.E.M. Brito1,
L.B. Ximenes1
1
Nursing Departament, Federal University of Ceara, 2Curso de Medicina,
State University of Ceara, Fortaleza, Brazil
Introduction: The proposal of Parent Adolescent Communication
Scale (PACS) is to assess adolescent girls’ frequency of communication
related to sex, condom use, pregnancy, STD and HIV with their
parents.
Objective: To apply the PACS as technology to enhance health education programme for female adolescents.
Methodology: Firstly, the study consisted of translationadaptationvalidation of the PACS to Brazil because it was used originally in the
United States of America. Secondly, it was applied to 313 female
adolescents aged 14 to 18 years old, who have already sexual intercourse. Of these, 171 adolescents are of government schools and 142
are of private schools.
Results: Girls of government schools heard about sexuality by television and friends, while girls of the private schools got some information from their parents and internet. Girls cited the mother as a main
source of information more than their father. In a government schools,
the teacher was appointed as source of information about STDHIV.
On the other hand, in private schools that information were obtained
through the Internet and family. In both types of schools, the scale
showed that the more consistent condom use is associated with greater
parental communication among parent and daughters.
Conclusion: PACS is a useful instrument to use with adolescents
because its data show in what extend the parent communication may
contribute to adolescent health behaviour.
520
VALE SONHAR PROJECT
M.H. Vilela, L.A. Bragante, S.L. Vasques, M.C. Romualdo,
C.M. Guastaferro
Educacional, Instituto Kaplan—Centro de Estudos da Sexualidade Humana,
São Paulo, Brazil
Vale Sonhar Project has the objective of assessing a methodology to
reduce the number of teenage pregnancy and its potential reapplicability for schools in Brazil by means of teachers’ training for use VALE
SONHAR GAME, created by Kaplan Institute specifically for prevention workshops.
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The project was performed in all public middle schools of 3 States
in Brazil, Alagoas (178 schools), Espírito Santo (282) and São Paulo
(3.578). The methodology consists in applying 3 workshops, which
strategy is to motivate young boys and girls to perform safe sex through
the perception of the pregnancy impacts in their professional life
projects, and by gaining knowledge of reproduction, risky sexual practices and contraceptive methods. In order to evaluate its effectiveness,
a pregnancy poll was applied to the students before and one year after
the workshops had begun.
Results: In Alagoas, the workshops were performed in 60% (105) of
the schools involved, in Espirito Santo 127 (47%) and in São Paulo
42% (1.486), benefiting respectively 42.841 students, 35.132 and
182.944 in 2 years of project. The pregnancy rate reduction was of
50% in AL, 31% in ES and 14% in SP.
The impact of pregnancy on the life project was a determining factor
in the motivation of young boys and girls to learn the content and an
incentive for prevention. This result, associated to the success of the
reapplicability has turned Vale Sonhar Project into a public policy
of the Education Departments of the States of Alagoas and São
Paulo.
521
PROFESSIONAL COMPETENCE ASSESSMENT
AMONG STUDENTS PARTICIPATING
CONTINUING EDUCATION MODULE FOR
ADOLESCENTS SEXUAL HEALTH
PROMOTION
R. Vilkko, A. Nikula, A. Liinamo
Faculty of Health Care and Nursing, Helsinki Metropolia University of
Applied Sciences, Helsinki, Finland
Young people’s sexual health promotion and developing professionals’
sexual health promotion competence are the main priorities of the
National Action Programme for Sexual and Reproductive Health Promotion 2007–2011. As a part of Metropolia University of Applied
Sciences’ project ‘Sexual Health Promotion in School and Student
Health Care Services’ an educational module (10 credits) for professionals from primary health care services has been created.
The module was planned based on the scientific knowledge and
evidence of adolescent’s sexual health promotion including five competence areas: biological, psychological, social and cultural aspect of
sexual development, health and medical science base, methods for
sexual health promotion. The educational module is conducted
between October 2010 and February 2011. Pre-test of professionals
competence self-assessment (Visual Analogues Scale VAS) was done
before starting the continuing educational module. Respectively, posttest will be conducted after the education in February 2011.
Results of the pre-test revealled, that professionals experienced the
highest competence in the area of health and medical sciences. The
lowest competence area was in social and cultural aspect of sexuality
and sexual health. Final results will be presented in the presentation.
Educational module will be modified based on the final results of
the evaluation.
522
SEXOLOGY AND SEXUAL EDUCATION:
WAY OR CROSSING ROAD
F.J.J. Viola
Universidad Nacional de Tucumán, San miguel de Tucumán, Argentina
In Argentina, was approved in 2006 a Comprehensive Sexual Education. This law, incorporate sex education as an educational right of all.
This generated the need to train teachers for the task. In this context,
the National University of Tucumán offered training on the subjectoriented teachers (divided into three stages, with four modules each).
At the beginning of the first stage and the second was performed a
specific question about expectations of the same (Stage I) and the
usefulness of the first stage (top of the second stage).
After analyzing the responses follows some skills necessary to take
into account in teacher training in sex education. With these data re
made the crossing with the idea of sexology as a profession.
According to our analysis, we found the following conclusions:
a—The idea of sex education raised in the law (Viola, 2010), recovered
by the teachers, an idea associated with sexual health in an integral
sense.
b—sexology as a field of study does not provide per se, skills for sex
education but it acquires a complementary elements.
c—sexuality as a field of study required, as opposed to sex as a
phenomenon of study, a cultural nomad (Viola, 2011).
This strengthens the idea that the sex-ology should be distinguished
from sexua-logy (Viola, 2003.2010).
523
A NEED AND IMPORTANCE OF FAMILY LIFE
EDUCATION FOR ADOLSCENTS IN INDIA:
SPECIAL REFERENCE TO EAG STATES
A.N. Wankhede
Research, ICRW, Mumbai, India
Adolescent is a vital phase of life. It is one of the most apprehensive
stages in which they try to adjust to the various physical, emotional
and psychological changes. Though there has been a growing medium
of information and education from various sources specifically from
media and peer groups with an increasing emphasis on safe maternal
and reproductive health of women through the national program, the
access to quality information on each of these aspects of family life
education is questionable.
Objectives: To understand the need and importance of family life
education among adolescent girls.
Data and methods: The analysis is been conducted with the help of
District Level Household survey-3. The data from EAG states (70,530
unmarried women) from DLHS-3 were analyses by using various
statistical analyses for adolescent girls and women aged 15 to 24 years.
Results: The awareness of family life education (FLE) which consists
of knowledge about bodies, growing up, male-female relationship and
sexual matters is primilary very low among young adolescent girls
(15–17 years) and among those who have less than 10 years of schooling. The awareness increases with the increase in the standard of living
and is highest among the richest.
The interaction between the awareness and importance of FLE and
the outcome variables like discussion around contraceptives, knowledge about reproduction knowledge about RTI/STI symptoms and
knowledge about mode of HIV transmission among all the groups is
quite low across various socio-economic groups.
524
THE IMPORTANCE OF ENTERTAINMENT
FOR SEXUALITY EDUCATION
A. McKee, A.-F. Watson
Creative Industries Faculty, Queensland University of Technology, Brisbane,
QLD, Australia
Previous research into sexuality education has primarily focussed on
formal schooling as the principal site of learning for young people.
This discounts the fact that the sexuality information young people
want to know more about—addressing emotional and pleasurable
aspects of the practice—is provided from informal sources such as
peers, the internet, and entertainment media. The difficulties associated with presenting emotional and pleasurable information in formal
school settings calls for more creative methods of delivery. Working
collaboratively with producers of entertainment media to deliver sexuality education allows for these messages to be presented in ways that
are relevant to young people’s own experiences and interests.
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527
EFFECTS OF THE EDUCATIONAL
INTERVENTION TO THE NURSES ABOUT
SEXUALITY OF THE PATIENTS WITH
GYNECOLOGIC CANCER
SEXUAL SAFETY AMONG US BLACK
WOMEN: WHAT ARE WE MISSING?
K. Yamasaki1, M. Niitani2, M. Miyashita2
The Nursing Department, Tottori University Hospital, Yonago-City,
2
Hiroshima University, Hiroshima-City, Japan
1
Purpose: The purpose of this study was to assess the effects of the
educational intervention on nurses’ knowledge and consciousness
about sexuality of gynecologic cancer patients and nurses’ embarrassment into talking about sexuality.
Method: This study was designed as a pre-post anonymous questionnaire survey. After signing consent form, a ninety-minute intervention
was conducted to nurses. The contents of this intervention were a
lecture, role playing and discussion about sexuality of the gynecologic
cancer patients. Participants were asked to complete a questionnaire
before and after the intervention. The outcome measures were knowledge, consciousness and embarrassment. The knowledge was assessed
from the total number of correct answers to 10 questions. The
consciousness and the embarrassment were assessed from a single
Likert-type scale, ranged from 1 = “not at all” to 4 = “very much”,
independently.
Results: Twenty three nurses participated in this study. The mean
knowledge score significantly increased after the intervention from
7.65 ± 1.43 to 8.60 ± 1.11 (p = 0.004). The consciousness score and
embarrassment score were unchanged. After the intervention, all of
the participants reported that it was my role to deal with patients’
sexuality. In the discussions, participants mentioned about the necessity of acquiring of the knowledge and resources, enhancing of communication skills, and changing their attitude for sexuality problems.
Discussion: This study suggested that the educational intervention
could enhance nurses’ knowledge of sexuality of gynecologic cancer
patients. It is necessary to develop and repeat the intervention in order
to change nurses’ consciousness and embarrassment.
POSTER PRESENTATION
TRACK 4
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FREQUENCY OF CROSS-DRESSING AND
TRANSGENDER RELATED THOUGHTS
AND ASSOCIATIONS TO SEXUAL AND
MENTAL DISTRESS
K. Alanko, M. Ålgars, P. Santtila, N.K. Sandnabba
Psychology, Åbo Akademi University, Turku, Finland
Frequency of cross-dressing and transgender related thoughts were
measured in a large population based sample of Finnish twins. Participants consisted of 3261 twins aged 33–43. Participants completed
anonymous posted questionnaires. Items pertaining to transgender
thoughts were: Have you felt that you really are a woman (for men:
for women: felt you are a man), have you ever wanted to have a
woman’s/man’s body, have you considered having a so called sex reassignment surgery? Responses ranged from less than one percent to
approximately 11 % for feelings of really being a man for female
participants. Associations between the items and felt sexual distress and
depressive and anxious symptoms were also studied. Results and possible confounding factors will be discussed.
K. Alexander
School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
Introduction: Sexual safety research about US Black women often
focuses on sexual risk behaviors relating to HIV/AIDS, STIs, unintended pregnancies and condom use negotiations. However, sexual
safety is broader than sexual activity and includes emotional dimensions of intimacy which are influenced by culture, social determinants,
and personal values. Exclusive focus on risk behaviors limits our
knowledge about ways women seek to maintain sexual safety.
Aims: This presentation aims to:
1) explore cultural influences, conceptualizations and social determinants of sexual safety and
2) recommend culturally-congruent theoretical models to promote
sexual safety among Black women.
Methods: Sexual safety intervention studies focusing on adult Black
women in peer-reviewed publications between 2000 and 2010 were
critically analyzed. Strengths and limitations of current theoretical and
conceptual approaches to sexual safety guided the investigation.
Results: While numerous sexual safety intervention studies aimed to
decrease risks for HIV/AIDS, STIs, and/or unintended pregnancies,
few were rooted in theories acknowledging the emotionality of sexual
activity. Most studies focused on promoting condom and contraceptive
use, endorsed limiting numbers of sexual partnerships and encouraged
women to refuse unprotected sex. Few studies included broader emotional aspects of sexual activity such as love, trust, intimacy, and desire.
Conclusions: Research aimed at improving the sexual safety of Black
women neglects the love, trust, intimacy, and desire associated with
sexual activity. This gap in the literature can be filled by targeting
research to focus on emotions, socially determined definitions of sexual
safety, and holistic theoretical models as foundations for interventions
that promote sexual safety.
528
STATE OF KNOWLEDGE ABOUT HUMAN
SEXUALITY, SEXUAL HEALTH AND
REPRODUCTIVE HEALTH
A. Aparicio Aguilar1,2, S. Rodríguez Jiménez1, A. Medina Urrea2
1
Escuela Nacional de Enfermería y Obstetricia, 2Grupo de Ingeniería
Lingüística, Instituto de Ingeniería, Universidad Nacional Autónoma de
México (UNAM), Mexico City, Mexico
Objective: To assess state of knowledge about Human Sexuality,
Sexual Health and Reproductive Health, relevant for building a textual
corpus for compiling specialized dictionaries.
Methodology: We’re dealing with a bibliometric, descriptive,
cross-sectional and retrospective study, conducted in online indexed
scientific journals (2001–2010). Our dependent variable was Scientific
Productivity. The research was conducted on SCIELO database.
Subject areas were selected to delimit the research field, from which
descriptors were derived. From these areas we obtained our independent variables: the state of knowledge about Human Sexuality, Sexual
Health and Reproductive Health. Our sample comprises 150 publications. Each document was characterized by type of publication or
study, date, country, main author’s profession, subject area and productivity descriptors. Productivity was analyzed using SPSS 19.
Results: Countries reporting major productivity: Mexico (60.7%),
Cuba (9.3%), Spain (8.0%). Most productive journals: Salud pública de
México (30.0%), Perinatología y reproducción humana (8.0%), La ventana.
Estudios de género (6.0%). Subject areas: Sexual Health (58.7%), Reproductive Health (26%), Human Sexuality (15.3%). Highest productivity: physicians (40%), sociologists (16.0%), psychologists (14.7%)
nurses (6.0%). Types of publication or study: quantitative (46.0%),
qualitative (14.0%), mixed studies (4.7%), review papers (35.3%).
Most papers on Human Sexuality and Sexual and Reproductive Health
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dealt with Pregnancy, Delivery and Puerperium, STDs, Gender,
Sexual Health Promotion and Sexual Violence.
530
AGGRESSION PREDICTS LONG-TERM
DATING SUCCESS AMONG ADOLESCENTS
S. Arnocky1, T. Vaillancourt1,2
1
Psychology, Neuroscience & Behaviour, McMaster University, Hamilton,
2
Faculty of Education and School of Psychology, University of Ottawa,
Ottawa, ON, Canada
[Subjects Areas and Descriptors]
Conclusions: The researched problem is active in the multidisciplinary scientific productivity of the last decade. It’s expected to
broaden this study with five databases selecting accurate material for
the corpus.
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MALE PENILE/URETHRAL “PLAY” OR
“SOUNDING”
M. Armstrong1, C. Young2, T. Nelius3, L. hogan4, K. Rinard3
1
Texas Tech University Health Sciences Center, Marble Falls, 2Student
Health Services, University of Texas @ Arlington, burleson, 3School of
Medicine, 4School of Nursing, Texas Tech University Health Sciences Center,
Lubbock, TX, USA
Object of study: To provide quantitative and qualitative evidence
about men who inserted foreign liquids and objects into their penis
and/or urethra, an activity they call urethral “play” and “sounding.”
Method: From a larger, cross-sectional study (N = 445), two questions
inquired if they had penile tattoos and/or inserted other materials such
as fluids and foreign material into their penis or urethra.
Results: The medical literature has been robust about four types of
unusual genitourinary tract activities since 1755. The different published practices include embedding (a) foreign objects and/or (b)
liquids subcutaneously into penile tissue, as well as inserting (c) liquids
and/or (d) foreign objects into the urethra. This international subsample responded affirmatively (n = 85/24%) and many provided comments. Two respondents embedded metal balls into their penis, one,
at age 13 injected water for penis enlargement; 11 inserted liquids into
the urethra, and 63 reported insertion of 32 different objects, frequently urethral sounds or “sounding” (n = 33/52%) were mentioned.
Major motivational themes focused on sexual stimulation and experimentation. Penile tattoos (n = 14) were also reported, mainly for
aesthetics. Few complications or STDs were reported.
Conclusions: This contemporary data challenges some basic demographic assumptions and adds further evidence about these practices
including a wider distribution of men using penile or urethral “play”,
and their descriptive actions of “sounding.” Clinician awareness of
these practices and devices are important to obtain accurate health
histories, manage any genitourinary tract complications, and provide
applicable patient education.
Introduction: About a third of adolescents report bullying others
(Craig & Harel, 2004). The ubiquity of early aggression has prompted
researchers to study the evolutionary origins of aggression in childhood and adolescence. We tested the hypothesis that perpetration of
aggression promotes mating success and status over time.
Method: Students in grades 6 through 9 (N = 315) nominated same
sex class-mates on whether or not they engaged in six aggressive
behaviors: rumor spreading, arguing with others, threatening others,
calling others names, hitting, and dominating someone by excluding
them from the group. Students also reported on the popularity and
physical attractiveness of opposite sex peers. Dating status (measured
at Time 1 and 2) involved students each reporting being in a relationship with the other (reciprocated nominations).
Results: Controlling for dating status at Time 1, girls who spread
rumours (B = 0.66) hit (B = 1.06) and called names (B = 0.77), were
more likely to have obtained a dating partner at follow-up whereas
girls who started arguments were less likely to obtain a partner (B =
-3.91). For boys, aggression did not directly predict obtaining a dating
partner. However, popularity did predict dating at follow-up (B = 0.36)
which was predicted by dominating others by exclusion (B = 0.53).
Conclusion: Findings provided support for our hypotheses that
aggression can directly and indirectly promote the acquisition of
mates. Findings are discussed in light of evolutionary theory.
531
SEXUAL DEVELOPMENT AMONG DUTCH
YOUTH: THE ROLE OF PSYCHOLOGICAL
AND PHYSICAL FACTORS (RESEARCH
PROPOSAL)
L. Baams1, G. Overbeek1, J. Dubas1, D. van de Bongardt2, M. van Aken1
1
Developmental Psychology, 2Department of Pedagogical and Educational
Sciences, Utrecht University, Utrecht, The Netherlands
Introduction: There is a lack of research on the influence of psychological and physical factors on adolescent sexuality. Although personality and pubertal development are suggested to influence sexual
development, this has mostly been studied in cross-sectional research,
while focusing on single outcome measures (condom use, or age at first
intercourse).
Objective: With a longitudinal study we will investigate how personality and pubertal development determine normative and non-normative
trajectories of sexual development, including all aspects of sexual
development (cognitive, emotional, and behavioural). This abstract
proposes the presentation of the research plan of one of four subprojects of a large study on adolescent sexuality in the Netherlands, which
will be conducted between 2010 and 2014.
Methods: Five age cohorts (N = 800, 11–15 years old), will be asked
to fill out online questionnaires four times every six months (measures
include: e.g. personality, pubertal development, attitudes about sex,
sexual behaviour, sexual identity).
Purpose: We will examine whether psychological and physical factors
predict normative and non-normative sexual development (e.g. precocious, unsafe sexual behaviour, negative emotions, stronger peer influences on relational and sexual development). With latent growth
modelling we will examine the sexual development trajectories, and we
expect personality prototypes to influence these trajectories. Subsamples will be asked to participate in focus groups, to determine
whether personality characteristics influence the process of peer mediation in groups composed of different personality types. Furthermore,
we will also examine how pubertal development affects sexual
development.
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532
GENDER NONCONFORMING SEXUAL
MINORITIES WITH A LOWER LEVEL OF
PSYCHOLOGICAL WELL-BEING: WHAT
ROLE DOES STIGMATIZATION PLAY?
L. Baams, T. Beek, H. Hille, F.C. Zevenbergen
Psychological Methods, University of Amsterdam, Amsterdam, The
Netherlands
Introduction: Gender nonconforming sexual minorities often
encounter negative experiences of stigmatization and discrimination,
and experience lower levels of well-being (Sandfort et al., 2007; Skidmore et al., 2006). However, it is unknown whether the experience of
stigmatization mediates the relation between gender nonconformity
and well-being.
Aim: The current study investigates the relation between gender
nonconformity and psychological well-being, and whether this
link is mediated by experienced stigmatization of one’s sexual
orientation.
Material and methods: Via several LGBT-directed community websites, 142 participants aged 16–24 years old filled out online questionnaires (e.g. same sex attraction, gender nonconformity, experienced
stigmatization, and psychological well-being).
Conclusion: Confirming our hypothesis, gender nonconformity is
related to lower levels of psychological well-being among sexual
minorities, and this relation is mediated by the experience of stigmatization. The present study replicates findings among Latino gay and
bisexual males (Sandfort, et al., 2007), and concludes that among
gender nonconforming young sexual minorities, stigmatization has a
negative impact on well-being. Despite some caveats on the assessment
of stigmatization, the current study emphasizes the need for greater
acceptance of gender-queer and sexual minority individuals, and
stresses the need for further research of the discussed relations.
References: Skidmore, W. C., Linsenmeier, J. A. W., & Bailey, J. M.
(2006). Gender nonconformity and psychological distress in lesbians
and gay men. Archives of Sexual Behavior, 35, 685–697.
Sandfort, T. G. M., Melendez, R. M., & Diaz, R. M. (2007). Gender
nonconformity, homophobia, and mental distress in Latino gay and
bisexual men. Journal of Sex Research, 44, 181–189.
533
VAGINAL PRACTICES IN TETE PROVINCE,
MOZAMBIQUE: QUALITATIVE AND
QUANTITATIVE RESEARCH
B. Bagnol1,2, E. Mariano2,3, I. François2, M. Chersich4,5, F. Mbofana6,
A. Martin Hilber7
1
Anthropology, The Witwatersrand, Johannesburg, South Africa,
2
International Centre of Reproductive Health Mozambique (ICRH),
3
Faculdade de Letras e Ciencias Sociais, Department of of Archaeology and
Anthropology, Universidade Eduardo Mondlane, Maputo, Mozambique,
4
Centre for Health Policy, School of Public Health, The Witwatersrand
University, Johannesburg, South Africa, 5International Centre of
Reproductive Health, Department of Obstetrics and Gynaecology Ghent
University, Ghent, Belgium, 6Regional Centre for Health and Development
(CRDS), Maputo, Mozambique, 7Institute of Social and Preventive
Medicine, University of Bern, Bern, Switzerland
The paper presents both quantitative and qualitative data of the WHO
Multi-country Study on Gender, Sexuality and Vaginal Practices
carried out in Tete province, Mozambique. In 2005, 103 men and
women were interviewed individually or in focus group discussions. In
2007, a questionnaire was applied to 919 women. A large variety of
interventions were identified and 65% of the women were involved in
three or more practices in addition to daily washing. More than 80%
of the women reported having ever used at least three different practices in their lifetime (excluding washing). Elongation of the vaginal
labia minora (98.6%) and intravaginal cleansing 92.2% were universal.
Insertion of substances in the vagina was practiced by 71.5%. Less than
216
half (47.6%) reported ingestion of substances to affect the vagina while
a fourth (24.7%) stated they had performed cutting or incision at least
once in their lifetime. Application of substances in the vagina (16.3%)
or genitalia including steaming (14.6%) were less popular. Notions
such as ‘closed/open’, ‘dry/damp’, ‘hot/cold’, ‘heavy/light’, ‘life/death’,
‘wealth/poverty’ and ‘sweet/not sweet’ are extremely important in
order to understand and explain practices connected to sexuality,
reproduction and woman’s identity. These notions and practices
impact on sexual health risk as they influence people’s preferences for
having sex with or without a condom or adoption of microbicide.
Messages and interventions should take into account this situation. As
other research indicate that women reporting any vaginal practice have
a higher rate of HIV acquisition than those reporting none, these
practices need special attention.
534
THWARTED SEXUAL AGENCY: NARRATIVES
FROM ADOLESCENT GIRLS IN THE U.S.
CHILD WELFARE SYSTEM
L.Y. Bay-Cheng, N.M. Fava
School of Social Work, University at Buffalo, Buffalo, NY, USA
Introduction: Rates of youth pregnancy, STIs, and sexual coercion
are high among American adolescent girls, particularly those in the
child welfare system. Presently, many interventions focus on bolstering
girls’ sexual assertiveness in order to reduce these negative sexual
outcomes. These efforts presuppose that girls lack the agency to advocate for their sexual interests. We conducted in-depth interviews with
adolescent girls in residential treatment to assess if and how they
exhibit sexual agency.
Method: Nine girls (aged 16–17) completed sexual history interviews.
All had been removed from the care of their families and lived at a
residential treatment facility.
Findings: Participants shared many stories of how their attempts to
exert influence in sexual relationships (e.g., determining what behaviors to engage in, requesting condom use) were often thwarted by their
male partners’ refusals or threats. In some cases, participants’ negotiation strategies backfired and resulted in unwanted experiences. Three
participants had success in asserting their sexual interests in some
respects yet were still subject to negative sexual outcomes. Only one
participant had avoided any unwanted sexual experiences.
Conclusions: These data belie the characterization of adolescent
girls as devoid of sexual agency; instead, participants exhibited
agency but were overridden by male partners. Inadequate social and
material resources also undermined their leverage in sexual negotiations. Participants’ narratives expose gender and socioeconomic
inequality, not a lack of agency, as primary barriers to girls’ sexual
well-being. Results indicate that girls’ sexual health may be better
served by addressing social inequality, not girls’ supposed personal
deficiencies.
535
YOUTH SEXUALITY AND HIV/AIDS RISK:
AN ANTHROPOLOGICAL STUDY IN
URBAN CONTEXT
M.G. Brak-Lamy
Anthropology, Faculty of Social and Human Sciences/New University of
Lisbon, Lisbon, Portugal
Background: This study refers to the analysis of the risky sexual
behaviours of Portuguese and Cape Verde young girls and boys (15–30
years old) living in slums in Lisbon’ s metropolitan region.This
research aims to:
a) compare and evaluate the risky sexual behaviours of the young
Portuguese and Cape Verde girls and boys.
b) Compare and evaluate the knowledges and the beliefs of the young
Portuguese and Cape Verde girls and boys related to HIV/AIDS;
the access to the health services and their taking of HIV test.
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Method: This is a qualitative and exploratory methodology based in
in-depth semi-structured interviews (160 interviews were carried out).
Results: Approximately more than half of the girls and almost all the
boys were at high risk for HIV. The girls became at risk because of
their sexual partners behaviour (infidelity and i irregular use of
condom), HIV risk was highest among girls and boys who held strong
beliefs about barriers to condom use, have multiple sexual partners and
reported weak behavioural intentions to reduce risk.
Conclusions: Although the personal behaviour is determinant for the
HIV/AIDS vulnerability, the decisions are not taken based only in an
individual decision but also in a community level. In this process
should contribute many institutions in simultaneous: Schools, Public
Health Services, Youth Associations, Associations of Immigrants and
Parents Associations. Local meanings of beliefs and gender roles
related to sexual behaviour experienced by youths of different ethnic
groups, as well as their impact in the prevention of HIV/AIDS, should
be considered.
sex with men creating internalized homonegativity (IH) in those who
may describe themselves as bisexual or gay. IH has been shown to be
related to a number of other factors, including shame and insecure
attachment styles (Brown & Trevethan, 2010). The current study was
designed to consider IH in relation to culture, sexuality, and religiosity.
It involved an online survey of men who have sex with men in Malaysia
(n = 234) and Australia (n = 124) exploring variables of shame, self
esteem, avoidant and anxious attachment styles, religiosity, and IH.
Less than half of these men reported always protecting themselves and
their partners by using condoms when they have sex. Malaysian
respondents reported higher levels of IH, shame, religiosity and insecure attachment styles, and self esteem. Multivariate analysis reduced
these differences to anxious attachment style, shame and self esteem
when taking age into consideration. There were also differences in
religion on variables of anxious attachment style, shame, self esteem
and IH. IH was predicted by shame, avoidant attachment style and by
religiosity. These findings are discussed in relation to implications for
sexual health.
536
INITIAL SEDUCTION: WOMEN SAY WHAT
THEY PREFER. PRELIMINARY RESULTS
J. Brendler
SBRASH + WAS + FLASSES, Porto Alegre, Brazil
Objective: To find out the male characteristics and initial seduction
strategies preferred by Brazilian women.
Methods: Four out of 9 seduction-specific questionnaire items were
examined:
1—which male stranger has the most chance of success in
courtship?;
2—what is the best first dating invitation?;
3—what is the best way to make this first invitation?;
4—what behaviors by the man increase the chance of developing a
relationship?
Results: An interesting, charming, intelligent man, who is goodhumored and nice to talk to is more successful at courtship. Women
would rather have first an invitation to talk, to go out without a predetermined place or activity, to dine out, to dine and dance. Except by
a personal invitation, if he is “almost her boyfriend”, the way the invitation is made doesn’t matter, whether through written language or the
telephone (40,70 %); still, 28,76 % prefer a phone call. The chance of
a relationship increases when the man calls her as he promised in the
first date (22,80 %), is gentle, such as opening the car door or lending
her his coat (if it gets cold) (20,19 %), brings her flowers or some treat
(15,84 %).
Conclusions: Women value non-physical aspects in men. They are
traditional regarding the way the invitation is made, only accept
written language (by celullar phone or internet) if he is “almost boyfriend”; in the initial seduction phase, they prefer a phone call. A
relationship may develop if he calls again and is gentle.
537
MEN WHO HAVE SEX WITH MEN:
FACTORS RELATED TO INTERNALIZED
HOMONEGATIVITY, CULTURE,
AND RELIGION
J. Brown1, W.Y. Low2, R. Tal3
Psychology, Macquarie University, Sydney, NSW, Australia, 2Faculty of
Medicine, University of Aarhus Malaya, 3PT Foundation, Kuala Lumpur,
Malaysia
1
The enormous impact of AIDS around the world is substantially influenced by factors often related to regional attitudes, values, and behaviour. A recent study in Malaysia demonstrated that men who have sex
with men have the lowest rates of condom usage (Low, Siti, Wong, &
Tan, 2009). Societies often convey attitudes of homophobia or homonegativity that influence beliefs that may impact on males who have
538
DIGGING IN MY SECRET GARDEN:
EROTOPHOBIA, THE “HIDDEN OBSERVER,”
AND REPORTED SEXUAL FANTASIES
C. Burris1, S. Mathes2
Psychology, St. Jerome’s University, Waterloo, 2Reaching Our Outdoor
Friends (ROOF), Kitchener, ON, Canada
1
Erotophobia—a broad-based, affectively negative response to erotic
stimuli—has been linked to a decreased willingness to disclose intimate
information such as the occurrence, frequency, and details of one’s
sexual fantasies. Previous research has not established whether this link
reflects veridically impoverished experience or inhibition-driven
reporting bias, however. Thus, in the present study, 90 undergraduate
participants (49 women, 37 men, 4 not indicated) completed an erotophobia measure on-line and, in a separate session, were randomly
assigned to either a standard disclosure or “hidden observer” (HO, or
the ostensible part of them that knows their deepest secrets but will
only reveal them if questioned directly) disclosure condition, at which
point they were asked to submit a narrative of their favourite sexual
fantasy. Compared to the standard disclosure condition, HO virtually
eliminated reluctance to disclose fantasies, and the resulting fantasies
were more explicit, even among erotophobic individuals; HO also
allowed the latter to admit that bringing sexual fantasies “on-line”
serves an affective compensation function. The utility of the “hidden
observer” technique as a disinhibitory tool that can bypass self-censoring in the reporting of sexual attitudes and experiences therefore
deserves additional investigation.
539
WHY DO SOME INCARCERATED MALE
YOUNG OFFENDERS REPORT HIGH
CONTRACEPTIVE USE AND OTHERS LOW
USE OR NONE?
K. Buston, D. Wight
Social and Public Health Sciences Unit, Medical Research Council, Glasgow,
UK
Objectives: Relatively little is known about young men’s, compared
to young women’s, contraceptive attitudes and behaviour. This presentation compares the accounts of those young men incarcerated in a
Young Offender Institution who report high contraceptive use with
those who report low or no contraceptive use, in order to explore
factors which may explain frequency of use.
Methods: Sixty seven men, aged 16–21 years, were asked how often
they had used contraception when having sex. In-depth interviews
were conducted with 40 of these men, exploring their contraceptive
attitudes and behaviour.
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Results: Twenty of those surveyed reported using contraception on
every or most occasion(s) of intercourse; 30 reported using contraception never or not very often. Factors which distinguished these two
groups included: the strength of fear of pregnancy and/or STIs; the
extent to which individuals had thought about contraception and
linked it with the prevention of unwanted outcomes following intercourse; views as to which partner should be responsible for contraceptive use; and the extent to which extraneous factors such as alcohol
use, ‘heat of the moment’ and not having a condom to hand had
occurred as barriers to contraceptive use.
Conclusions: By focusing on men who report using contraception on
all or most occasions of intercourse we can better understand the
processes which may be involved in encouraging young men to use
contraception, including those around risk aversity. Such understanding may inform health promotion initiatives in this area, particularly
amongst marginalised young men.
540
PURCHASING SEX—DESCRIBING THE LIVED
EXPERIENCES OF MEN WHO BUY SEX IN
AUSTRALIA THROUGH CLIENT NARRATIVE
H. Caldwell1, P. Birch2, Z. Hossian1
University of Sydney, 2University of New South Wales, Sydney, NSW,
Australia
1
The current study examines the lived experiences of buying sex
within the context of clients daily lives and social situations. Using
narratives of the experiences of purchasing sexual services, and an
interpretive phenomenological analysis, this study investigates how
clients conceptualise their experiences and choices including perceived
risks, benefits and the effect on self-confidence/esteem. This presentation will provide historical background into the Australian sex industry
demonstrating the influences which underpin how social mores,
mythologies and stereotypes have emerged and continue to influence
debate.
Client demographics, the prevalence and motivations of buying sex
are essentially similar globally; however each country or region has
different regulatory policies, cultural and social factors and local economies which have varying dependence on sex industry income. In
Australia, there has been a growing trend towards legalisation or
decriminalisation of the sex industry which reflects changing moral
attitudes to sex work, recognition of the need to provide sex workers
with access to services and growing support for harm minimisation
approaches.
An online approach to data collection resulted in 137 responses,
which allowed for in-depth analysis of 25 narratives of men’s accounts
providing empirical evidence-based research about accessing commercial sexual services in Australia. This presentation discusses client
motivations including; his perceived risks and benefits, the effect on
his self-confidence, worth and esteem and his experiences of stereotyping, internalised stigma, and his own attitudes and perception of disclosure within the current Australian social context.
541
THE MISSING DISCOURSE OF MALE DESIRE?
SEXUAL THEMES IN U.S. AND BRITISH
NEWS COVERAGE OF MALE CIRCUMCISION
AND FEMALE GENITAL CUTTING
L. Carpenter, H.H. Kettrey
Sociology, Vanderbilt University, Nashville, TN, USA
Object: Scholars have documented a “missing discourse of female
desire” in U.S. and British popular culture, privileging male sexual
pleasure and neglecting its female counterpart. One rare case where
this pattern is reversed, news coverage of female genital cutting (FGC)
and male circumcision (MC)—two genital surgeries typically performed on children with parental consent—illuminates the social construction of gendered sexuality and its relationship to activism around
218
sexual health. This paper analyzes sexual themes in U.S. and British
print news coverage of FGC and MC from 1985–2009.
Methods: Data come from interviews with 18 U.S. and British journalists and activists and 671 U.S. and 849 British non-editorial news
items published in 20 newspapers and 4 news magazines. Data were
analyzed using enumerative and interpretive methods, following
grounded theory precepts.
Results: Ten sexuality-related themes—controls sexuality, stops/does
not stop/causes sexual pleasure, stops/causes masturbation, causes/
stops sexual problems, causes partner pleasure, and stops rape—
appeared with different frequencies and in qualitatively distinctive
ways depending on which practice they pertained to. Though rare,
references to desire and pleasure were more prevalent in coverage of
FGC, especially in U.S. sources. Journalists routinely presented FGC
as impeding female pleasure but rarely mentioned MC’s relationship
to pleasure.
Conclusions: These patterns can be traced to journalistic practices;
cultural understandings of gendered and raced sexuality; and the intersections of gender, race, nationality, and sexuality in popular and journalistic imaginations. Although not “missing,” female desire is
constructed in ways that reinforce (hetero)sexist understandings of
gendered sexuality.
542
SEXUAL IDENTITY & RECOVERY AFTER
DOMESTIC VIOLENCE
S. Cavilli, R. Coates, G. Merriman, B. Maycock
Public Health, Curtin University, Perth, WA, Australia
Introduction: For women in Australia, sexual assault, domestic and
family violence are some of the most pervasive human rights violations.
According to the Australian Bureau of Statistics (2005) nearly one in
five Australian women has experienced violence by a current or previous intimate partner.
Research on intimate partner abuse and violence (IPV) has focused
on factors related to a woman’s decision to leave or stay and the processes involved in arriving at that decision. However, studies on IPV
have seldom ventured beyond the point of physical separation and little
is known about the experience of women who have permanently left
their abusive partners. The oppressive nature of the abusive relationship leads to restricted personal growth as survival was prioritised over
self-development. Consequently, the post-separation period affords
opportunities for redirection of energy and intention and extrication
from false beliefs of their characteristics and identity.
Objective: The aim of this research is to establish theory that predicates the construction of a woman’s sexual self identity, personal
strength and sexual agency after the permanent physical separation
from an abusive relationship.
Design: This qualitative, grounded theory research will utilise explorative interviews with women, who are permanently separated from an
IPV relationship, as the main source of data. The resultant framework
will prove greater depth in understanding women’s process of leaving
and recovery from IPV and what has assisted them regaining their
psychological,emotional and sexual equilibrium.
543
HOMOPHOBIA: A MATTER OF HEALTH
S. Corrêa Junior1, F. Cecchetto2
1
ENSP, Fundação Oswaldo Cruz/FIOCRUZ, 2IOC, FIOCRUZ, Rio de
Janeiro, Brazil
Homophobia should be inclued in the context of health is justified by
the brief quantitative analysis of the material produced. It is noticed
that there are few studies in the area of public health that try to understand the violence against homosexuals. The objective of this study is
to understand some clues of the “state of the art” of “homophobia” in
the portal Scielo. This research is a bibliographic features, where a
brief investigation was conducted in three major Virtual Health
Library (VHL) on 16/08/2010, considering the word homophobia as
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a descriptor. The choice of the following VHL was due to the
visibility of them in Brazil, as well as the possibility of free access to
abstracts. As a result 19 items were found in the Scielo base, 24 in
LILACS database and one article in IBECS. It can be seen therefore,
the need to address the theme as a public health issue and demands
greater attention from researchers in violence and health. It was done
a brief reading of abstracts of the scientific articles found in Scielo
portal. This web site was choiced because of the easy access data, the
visibility of that area of public health. Although the number of articles
published in the source studied is still incipient to address the issue of
homophobia, the theme was diversified in the reviewed articles, but it
does not mean that it is satisfactory. This research could show that
public health must pay more attention about the violence against
homosexuals.
544
PRESIDENT OBAMA’S NATIONAL HIV/AIDS
STRATEGY FOR THE UNITED STATES:
CHANGE WE CAN BELIEVE IN OR MORE OF
THE SAME?
W.W. Darrow, Broward Coalition to Eliminate Disparities in HIV Disease
Robert Stempel College of Public Health and Social Work, Florida
International University, Miami, FL, USA
Introduction: In July 2010, the White House released President
Obama’s long-awaited National HIV/AIDS Strategy and accompanying Federal Implementation Plan. Our purpose was to assess the plan
and its chances for success.
The good: President Obama and his advisors are to be commended
for clearly enunciating three admirable goals, identifying eleven bold
action steps, and recommending “efficiency,” “innovation,” and a collaborative “public health approach to sexual health.” “To successfully
address HIV,” they write, “we need more and better community-level
approaches. . . .”
The bad: The Enhanced Comprehensive HIV Prevention Plan developed by federal officials contains 14 required interventions. All are
biomedical. Most are directed at the behaviors of individuals (often
classified as “HIV positive” or “highest risk”). None is empowering,
culturally competent, or directed at the fundamental causes of HIV
disease.
The ugly: Among the 30 “HIV prevention and risk reduction tools
for HIV-negative and HIV-positive individuals” offered by federal
officials are these “community” interventions: access to condoms,
syringe services, social marketing, availability of post-exposure prophylaxis, and reducing community viral load. Missing are the four
community-level interventions critical to our success in reducing disparities in HIV disease in Broward County: professional and peer
educational outreach to residents and businesses serving vulnerable
populations, strategic communications, organizational capacity building, and public health infrastructure development.
Conclusion: There is an obvious disconnect between the Obama
administration’s national strategy and the 14 interventions mandated
for federal support. Formative research conducted in collaboration
with communities at greatest risk should determine which interventions are most likely to eliminate local endemics.
545
REPRODUCTIVE BEHAVIOUR OF YOUNG
WOMEN AND ITS ASSOCIATION WITH THE
FINANCIAL AND ECONOMIC SITUATION IN
THE REPUBLIC OF KAZAKHSTAN
G. Dauletova, L.L. Karp, T. Potapchyuk
Public Health, Astana Medical University, Astana, Kazakhstan
Objective: The aim of the present study was to characterize the main
features of reproductive behaviour of young married women residing
in Astana, while taking into account the influence of the economic
conditions on the demographic ideals.
Data & methods: We developed a questionnaire that was used to
survey young married women, aged 18–29 years (350 respondents).
Results: Regarding the influence of economic factors on the demographic ideals, we found that the index of poverty depth in Astana
decreased since 0.9 in 2003 to 0.3 in 2009. The index of keenness
poverty decreased since 0.3 to 0.0 in the same time period. The average
monthly financial expenditure of households per capita increased by a
factor of 2.3.
According to the survey results, 37.6% respondents noted that they
would prefer not to work but to keep the house. They also indicated
that they believe that unemployment leads to the worsening of economic status of the family.
The following reasons that inhibit having a second child (for the
family with one child) were provided: financial difficulties (35.8%),
unsatisfactory living conditions (28.5), family interrelations (15.8), etc.
More than a half (53.1%) of young women believed that the best
conditions for education, formations and maintenance of children are
available in two-child-family.
The most frequent reasons for abortions in young families were
absence of the registered marriage (25.3%) and also material difficulties in a family.
Conclusions: The obtained data allow addressing only some of the
issues related to reproductive behaviour of young women.
546
IS EQUITY POWERFUL? QUESTIONING
YOUNG HETEROSEXUAL ADOLESCENTS
ABOUT POWER, SEXUAL RELATIONSHIPS
AND EQUITY
M. Doull
School of Population and Public Health, University of British Columbia,
Vancouver, BC, Canada
Introduction: Research in sexual health has outlined the negative
effects of power inequities on outcomes. While the evidence base on
the influence of power inequities continues to grow there has been
limited consideration of the concept of equity and how equity is understood in relation to power within sexual relationships.
Methods: Interviews with heterosexual youth (males, n = 13; females,
n = 22) were conducted at a sexual health clinic in Ottawa, Canada.
Interviews focused on issues of power, sexual health and relationships.
Interviews were tape recorded and transcribed. Each transcript was
coded line by line using codes to label each new idea represented.
Concepts and themes were then developed through an iterative process.
Results: Some participants were puzzled by questions about the exercise of power in their relationships. These participants described relationships that were characterized by equity. The presence of equity
eliminated the need to have or to use power and equity itself was not
seen as powerful. Power, either having it or using it, was seen as
negative.
Conclusions: Equity is generally not defined as a lack of power but
rather as a situation in which the distribution of power is equal, fair
or just. Power is variously defined as either something possessed,
expressed, or resisted. The young people here described equity as a
resistance to power. These results challenge ideas about traditional
notions of dominance/submission within relationships and raise questions about whether equity is the manifestation of equal power relations or whether it is needs to reconceptualised as distinct from power.
547
CURRENT RISK FACTORS FOR HIV
SEROCONVERSION AMONG GAY MEN
I. Down1,2, J. Bradley1, G. Prestage1,2
National Centre in HIV Epidemiology and Clinical Research, University of
New South Wales, Sydney, NSW, 2Australian Research Centre in Sex,
Health and Society, La Trobe University, Melbourne, VIC, Australia
1
The HIV Seroconversion Study (SCS) is a study of recently seroconverted people in Australia. We describe the characteristics of gay men
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in this sample and how the circumstances of the event that led to their
seroconversion compare to those of a recent occasion of unprotected
anal intercourse with casual partners (UAIC) among gay men in the
PASH (Pleasure and Sexual Health) Study.
116 men in SCS described a UAIC event that they believe led to
their HIV infection, 343 HIV-negative men in PASH described a
recent UAIC event. Demographically, and in terms of their sexual
practice, the two samples are remarkably similar.
The contexts in which the sexual risk event occurred were broadly
similar but differed on these key aspects: in SCS it was more likely to
have occurred in the context of group sex (41.7% versus 15.4%), men
in SCS study appear to have been less likely to have been told the HIV
status of their partner than those in PASH (43.1% versus 72.3%), men
in SCS were more likely to engage in UAI with partners they believed
to be HIV-positive (25.9% versus 3.8%) and the men in SCS were
more likely to have been the receptive partner (83.6% versus 63.0%).
The men in SCS appear less likely to employ strategies that might
minimise their risk of acquiring HIV in the context of UAI than were
the men in PASH. Clearer guidelines for non condom-based riskreduction may help some men protect themselves, and their partners,
from possible HIV infection.
548
UNCOMMITTED AFFECTIVE-SEXUAL
RELATIONSHIP THROUGHOUT THE LIFE
CYCLE AND ITS RELATION TO
ATTACHMENT PATTERNS
M. Favero, F. Ferreira
Instituto Superior da Maia, Porto, Portugal
Introduction: In Portugal, few studies have been dedicated to examine
the interaction between attachment patterns and emotional relationships without commitment.
Objectives: Analyze if secure attachment relationships of men and
women of different sexual orientations are associated to certain characteristics and involvement in casual sexual relationships.
Methodology: We have gathered a sample of 215 subjects, with ages
between 20 and 55 years old and used the following assessment instruments: Questionnaire CTR-R, (Fávero, Andrade & Pereira, 2005) and
the Adult Attachment Scale—EVA (M.C. Canavarro, 1995; Portuguese version of the Adult Attachment Scale-R: Collins & Read, 1990).
Results: Data from a previous study (conducted with a sample of 150
individuals) indicate that the more individuals approach the pattern of
a secure attachment, the more they report related experiences of being
involved in stable relationships and, secondly, more insecure individuals (without differences between avoidant and anxious attachment
styles) reported increased involvement in casual sex without commitment. Other data, such as the use of contraceptive methods in the
affective-sexual relationships without commitment, timing of the initiation of coital sexual relations, sexual victimization, stalking, among
others, are related to the attachment pattern.
Conclusion: The way sexuality is experienced differs from subject to
subject, being the pattern of attachment an influencing factor. The
study has not yet been completed and its final results will be presented,
but the preliminary study points to the existence of a significant relation between involvement in sexual relations without emotional commitment and patterns of attachment.
549
THE REPRESENTATIONS OF HUMAN
SEXUALITY IN CHILDREN OF THE XXI
CENTURY
M. Favero, P. Ferreira
Instituto Superior da Maia, Porto, Portugal
Introduction: Sex education is carried out by various information
agents, as such, is necessary to start to reflect on the impact of their
messages on the perception that children will build on sexuality.
220
Objective: To describe the representations that students in the third
grade, built on various topics of sexuality.
Method: We conducted two group interviews, and then analyzed
through a content analysis. The sample consisted of 26 students,
divided into two groups, with ages between 8 to 9 years old.
Results: Students have a limited view about the concept of sexuality.
Also there is a lack of knowledge about the teaching of sex education
sessions, that express thoughts, at times, removed from reality, and
also showed some unrealistic ideas about human reproduction. Moreover, their construction of sexuality is impregnated with gender
stereotypes.
Conclusions: This research sheds light on the permanence of the
traditional notion of gender roles that society constructs and transmits.
We considered relevant the involvement of the school environment in
the implementation of sessions structured to promoting a free and
responsible sexuality, allowing to deconstruct these beliefs. The representations concerning gender roles possibly reflect the attitude of
significant adults from children.
550
BEING ELDERLY IN PORTUGAL:
REPRESENTATIONS AND EXPERIENCES OF
OLD AGE, SEXUALITY AND EMOTIONAL
AND CASUAL RELATIONSHIPS
M. Favero, P. Cunha
Instituto Superior da Maia, Porto, Portugal
Introduction: The growing aging population in modern societies
leads to new needs in the field of scientific research on human aging.
There is insufficient available qualitative research on aspects of sexuality at the stage of old age.
Objective: We intend to analyze and understand the experiences and
social representations of elders committed in a care center on the
phenomenon of old age and its sexuality in relational and social aspects.
Methodology: We conducted semi-structured interviews with three
elderly men and three elderly women committed in a care center
approaching seven distinct themes. The data collected was analyzed
using content analysis.
Results: The results show the heterogeneity of human aging, being
the social representation of aging and sexuality are different and influenced by several factors, but described as a reductionist and genital
view. Casual relationships were present in youth and in old age of the
interviewed, but with distinct features of today. The difference between
genders is present in the discourse of the elderly, prevailing male
domination.
Conclusion: Over the years affective relations have been changing its
values, depreciating virginity, respect and commitment. It is believed
that sex education and the training of health workers in health will be
the most effective strategies to eliminate some of the myths and stereotypes by providing useful information for the reduction of sexual
risk behaviors and improving sexual satisfaction in the elderly.
551
KNOWLEDGE AND ATTITUDES ABOUT HIV/
AIDS AMONG ADOLESCENTS IN YOUTH
DETENTION CENTERS OF GALICIA (SPAIN)
M.L. Fernández, J.M. Failde Garrido, Y. Rodríguez
M.V. Carrera Fernandez, A. Alonso Alvarez, M. Dapía Conde
University of Vigo (Spain), Ourense, Spain
Castro,
The sample consisted of 134 subjects of adolescents (76.1% men and
23.9% women) with a mean age located in the 16.17 years (range (13
to 20 years). The Spanish were 79.1% and 20.9% foreigners. Their
participation was anonymous and voluntary . In the study were administered a questionnaire on knowledge, attitudes (affective component)
related to HIV / AIDS and Sexual Practices. The level of knowledge
was low, standing at an average rate of success of 51.91% for global
understanding and a 60.48% for VIH transmission routes; no statisti-
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cally significant differences by gender, except in protection methods
scale (F = 4.25, p < 0.042). Also there is a positive evaluation toward
monogamy, of indifference towards people with AIDS and moderately
prejudiced against homosexuals, drug users and promiscuity. Significant differences by gender in the assessment of monogamous men (F
= 10.34, p < 0.002), virgin girls (F = 11.25, p < 0.001), promiscuous
men (f = 11.22, p < 0.001), young people going to brothels (F = 6.72,
p < 0.011) and sex (F = 12.13, p < 0.001). 85.8% reported having had
intercourse at least once in their life, being the average age of first sex
at 13.89 years (Sx = 1.75). In the past 6 months to remain sexually
active reported the 90.40% (an average of 2.52 partners). The percentage of consistent condom use in vaginal intercourse stood at 39.1%.
Furthermore, 42.6% reported felt regret for not taking proper precautions with their regular partner and 38.3% with a casual partner.
552
SEXUAL HEALTH AND CARE IN A GROUP OF
MALE-TO-FEMALE TRANSGENDER SEX
WORKERS IN BARCELONA, SPAIN
P. Fernández Dávila, A. Morales
Research Unit, Stop Sida, Barcelona, Spain
Introduction: In Spain there are very few studies about risk and sexual
vulnerability among male-to-female transgender sex workers
(MTFSWs).
Objectives: To analyze the meanings of the experience of being transgender, sex work, unprotected sex and sexual health in MTFSWs.
Methodology: A qualitative study was carried out with 45 MTFSWs
(aged 19–62): 25 in individual interviews and 20 in three discussion
groups.
Results: 67% of the participants were from Latin America. Different
forms of self-definition were observed (female, transsexual, transvestite, and person). All have experienced some form of rejection and
discrimination for being transsexual. Sex work maintains and reinforces their sense of female identity (being desired by men) and represents for them the only means of livelihood while many have not
sought other work options because they anticipate the denial of access
to formal jobs and because some of them are in an irregular situation
in Spain. Most use condoms with clients, except those who are HIVpositive who do not use them especially if the client offers more money.
Among the HIV-positive MTFSWs there are some difficulties in
understanding certain aspects of the disease (reading of the analysis,
treatment). It is with casual sexual partners and stable partner that
condom use is inconsistent among some MTFSWs. Health care and
the relationship with the GP are positively valued.
Conclusions: MTFSWs are a highly vulnerable group, especially
immigrants. Health services in Barcelona can be a major means of
providing information on sexual health and HIV/STIs prevention
messages to MTFSWs.
553
COPING WITH CONFLICTS AND DATING
ISSUES DURING ADOLESCENCE: A
SYSTEMIC PERSPECTIVE ON INTIMACY
M. Fernet, M. Hébert, H. Manseau, M. Blais
Sexologie, Université du Québec à Montréal, Montréal, QC, Canada
Introduction: First romantic relationships represent a developmental
challenge for adolescents (Collins, Welsh, & Furman, 2009). Youth
face conflicts and dating issues that may lead to coercive
interactions.
Methods: Using a mixed method strategy (Creswell, 2003), this study
targets 40 heterosexual couples aged 14 to 20. Each partner completed
adapted coping strategy measures related to conflict in dating relationships (Self-Report Coping Style (SRCS): Causey & Dubow, 1992),
conflicts (Adolescent Couples’ Issues Checklist (ACIC): Welsh et al.,
2001), intimacy (Personal Assessment of Intimacy in Relationships
Modified (PAIR-M): Schaefer & Olsen, 1981) and dating violence
(Violence faite aux filles dans le contexte des fréquentations à
l’adolescence (VIFFA): Lavoie & Vézina, 2001) and participated in a
semi-structured interview.
Results: Thirty-eight percent of youth reported sustaining some form
of physical/sexual/psychological victimization. Concerning conflicts
and dating issues, frequency of different types of coping strategies was
not found to differ in adolescents reporting sustaining victimization in
their romantic relationships. Overall, Pearson’s correlations showed
that coping strategy type was related to the frequency of conflicts
which differed according to gender. For males, conflict frequency (r =
.40), sexual intimacy (r = -.35) and negative intimacy (r = .42) were
associated with avoidance coping strategies. For females, conflict frequency (r = -.38) and sexual intimacy (r = .34) were related to approach
coping strategies. Positive intimacy (r = .34) was related to approach
coping while conflict frequency (r = .27) and negative intimacy (r =
.27) were correlated with avoidance coping strategies.
Conclusion: From a systemic perspective, these results highlight the
contribution of intimacy in the understanding of adolescent’s romantic
relationships and conflict resolution.
554
ONLINE SEXUAL GROOMING: A CROSSCULTURAL PERSPECTIVE ON ONLINE
CHILD GROOMING VICTIMIZATION
F.A. Ferreira, P.M. Martins, R.A. Gonçalves
School of Psychology, Minho University, Braga, Portugal
Introduction: New technologies, particularly the Internet, are valuable educational, entertaining and connection resources but they also
create a new and mostly unregulated environment that exposes children to a multiplicity of risks: violence, bullying, misinformation and
sexual predators, amongst others. In fact, the unmonitored interface
between children and adults has led to a growing concern about the
Internet’s role as a tool for adults wishing to sexual exploit and abuse
young people.
Objective: This research intends to examine the prevalence and scale
of online child sexual grooming, how it takes place and the core characteristics (behaviors, frequency, and duration) of the online grooming
victimization.
Methodology: We have developed a questionnaire (Online Victimization Assessment) that was applied to a representative sample of youngsters from ten to eighteen years old, from Portugal, Spain and the
United Kingdom (that are classified at a medium-high level of access
to new technologies and exposure to online risks).
Results: A preliminary analysis of the questionnaire application to
6000 youngsters (which is still in the application stage to enlarge our
sample) allow us to understand that the online grooming phenomenon
isn’t one of the most present risks in the three realities analyzed.
Conclusions: Preliminary results, allow us to comprehend that,
although online grooming (when compared to cyberbullying, cyberstalking, amongst others) doesn’t constitute one of the most frequent
risk to which our youngsters are exposed, its impact can be classified
as one of the most severe on their lives.
555
A REVIEW OF 20 YEARS OF PROGRAMMATIC
APPROACHES TARGETING YOUNG PEOPLE
LIVING WITH HIV: HOW CAN EVIDENCE
INFORM “PREVENTION FOR POSITIVES”
YOUTH SERVICES TODAY?
S.J. Fielden1,2
Sexology, University of Quebec in Montreal, Montreal, QC, 2School of
Population and Public Health, University of British Columbia, Vancouver,
BC, Canada
1
Background: Effective sexual health and prevention programs are
important for youth living with HIV. This study examined literature
concerning risk-reduction programs for youth post-HIV infection in
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resource-rich countries, casting a critical gaze at the current evidence
provided by peer-reviewed sources.
Methods: Methods included a systematic narrative synthesis of the
available literature. Searches involved keywords and seven healthrelated electronic databases to locate articles (1990–2010) including
key terms related to intervention, programs, and/or services targeting
HIV-positive youth. Content analysis was used to group data.
Results: Preliminary analysis located 46 articles describing 27 unique
youth programs involving young people who were HIV-positive. In
this review, we categorize authors’ accounts of various prevention
program barriers and program facilitators. Facilitators or “core elements” to successful programs are related to service structure, delivery,
and providers such as: providing for basic needs and stability; using a
developmental framework; comprehensive care environments including case management; adult and youth partnerships; extensive formative research; youth involvement in program planning and as peers/
staff; family and partner involvement; youth-oriented services tailored
to the population; and having approachable friendly staff. We identify
gaps in the literature that make it difficult to draw conclusions about
core elements necessary for successful delivery of effective programs
to this population of young people.
Conclusions: Given that the current evidence base is missing pertinent details to enable the comparability of various sexual health programs and other intervention components, the review concludes with
recommending rethinking the “evidence” necessary to inform realworld