The contribution of interagency collaboration to the promotion of young people's sexual health.
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This paper employs a case study approach in order to examine the contribution of interagency working to the delivery of education and services in the difficult field of young people's sexual health. It reports on a collaborative UK initiative involving teachers, community health practitioners, health promotion staff, and youth and community workers. The provision included school-based sex education, drop-in advice and information facilities, 'detached' street work, and a young person's clinic. A qualitative study was completed involving detailed interviews with 25 staff from the different agencies involved. The findings suggest that interagency collaboration can enhance the work of each organization, and can achieve a comprehensive response to young people's sexual health needs by making positive use of the distinctive roles, skills, knowledge and approaches of the different agencies. The potential that such a collaboration will have a significant impact on young people's sexual health is discussed. (+info)
Planning with PRA: HIV and STD in a Nepalese mountain community.
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The application of Participatory Rural Appraisal methods (PRA) to the topic of sexual health enabled us to explore key factors concerning local people's perceptions regarding HIV/AIDS and STDs and to plan collectively to address the emerging issues. Conducting the process in a gender sensitive way enabled people to feel safe enough to express their own opinions, and having gained confidence in their peer groups, to share ideas later with the whole community in a joint planning exercise. Nevertheless one group was identified as difficult to reach and whose needs could not be met in a group for reasons of confidentiality. While the methodology itself clearly has great potential in planning around specific health issues, there are, nevertheless, limitations. Although the approach and the tools used are simple and accessible, the skills needed to analyze the information are more complex and demanding. The training given did not manage to equip facilitators adequately with these analytical skills and in the future will be more experience based and geared towards developing analysis and the ability to formulate questions. In addition, since the project is not permanently resident in the area, intensive support within the District is necessary to increase the chances of sustainability. (+info)
Sexual functioning among stroke patients and their spouses.
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BACKGROUND AND PURPOSE: The aim of this study was to assess effects of stroke on sexual functioning of stroke patients and their spouses and to study the associations of clinical and psychosocial factors with poststroke changes in sexual functions. METHODS: One hundred ninety-two stroke patients and 94 spouses participating in stroke adjustment courses sponsored by the Finnish Stroke and Aphasia Federation completed a self-administered questionnaire concerning their prestroke and poststroke sexual functions and habits. The main outcome measures were (1) libido, (2) coital frequency, (3) sexual arousal, including erectile and orgastic ability and vaginal lubrication, and (4) sexual satisfaction. RESULTS: A majority of the stroke patients reported a marked decline in all the measured sexual functions, ie, libido, coital frequency, erectile and orgastic ability, and vaginal lubrication, as well as in their sexual satisfaction. The most important explanatory factors for these changes were the general attitude toward sexuality (odds ratio [OR] range, 7.4 to 21.9; logistic regression analysis), fear of impotence (OR, 6.1), inability to discuss sexuality (OR range, 6.8 to 18.5), unwillingness to participate in sexual activity (OR range, 3.1 to 5. 4), and the degree of functional disability (OR range, 3.2 to 5.0). The spouses also reported a significant decline in their libido, sexual activity, and sexual satisfaction as a consequence of stroke. CONCLUSIONS: Sexual dysfunction and dissatisfaction with sexual life are common in both male and female stroke patients and in their spouses. Psychological and social factors seem to exert a strong impact on sexual functioning and the quality of sexual life after stroke. (+info)
Prevalence of HIV-1 among attenders at sexually transmitted disease clinics: analyses according to country of birth.
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OBJECTIVES: To determine the importance of world region of birth as a risk factor for HIV-1 infection, the likelihood of having an HIV-1 infection diagnosed and the likelihood of having another coexisting acute sexually transmitted infection (STI) among attenders at genitourinary medicine clinics. SUBJECTS: Specimens from attenders having routine syphilis serology at 15 sexually transmitted disease clinics in England, Wales, and Northern Ireland participating in the unliked anonymous seroprevalence monitoring programme from 1994 to 1996. METHODS: Limited data were collected with specimens that were irreversibly unlinked from the source patients before testing for antibodies to HIV-1. Numbers of specimens, the prevalence of HIV-1, the proportions of infections clinically diagnosed, and the presence of coexisting acute STIs were analysed according to world region of birth, sexual orientation, and injecting drug use. RESULTS: Between 1994 and 1996, 173,075 specimens were collected; 16.9% were from people born outside the United Kingdom. Risk of being HIV-1 positive was significantly higher overall for both men and women born abroad, but this was not the case for those born in south Asia (India, Pakistan, and Bangladesh). Homosexual and bisexual males born abroad were almost twice as likely to be HIV infected as their counterparts born in the United Kingdom. However, homosexual and bisexual men born in the United Kingdom accounted for almost three quarters of the 1174 HIV-1 positive specimens detected. Among 158,728 non-drug injecting heterosexuals the highest prevalence was observed in specimens from those men (4.0%) and women (5.8%) born in sub-Saharan Africa. The 6991 heterosexual men and women born in other European countries were also more likely to provide HIV-1 positive specimens than UK born heterosexuals. However, 39% of the HIV-1 positive specimens in heterosexuals come from clinic attenders born in the United Kingdom. Heterosexual males were generally less likely to have their infection diagnosed than females. There were 182 attendances (mostly from London clinics) non-drug injecting heterosexual men and women who were infected with both HIV-1 and an acute sexually transmitted infection; only 12% of whom had had their HIV-1 infection diagnosed. CONCLUSION: Among most people attending genitourinary medicine clinics, being born abroad is associated with an increased likelihood for HIV-1 infection. HIV-1 infected heterosexuals, of whom 46% are people from sub-Saharan Africa, are unlikely to have their infection clinically diagnosed and thus are unable to obtain appropriate treatment. The presence of HIV-1 infected heterosexual men and women with acute STI represents a potential source of heterosexual HIV transmission both for those born in the United Kingdom and born abroad. (+info)
Physical fitness, aging, and sexuality.
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Sexuality is a major quality-of-life issue, even into advanced age. Although relatively few studies have addressed sexuality, most studies have emphasized the decline in both sexual performance and satisfaction with aging. In an effort to assess possible positive modifiers of the decline, we included questions concerning sexuality in a multipurpose 90-item questionnaire submitted to members of the Fifty Plus Fitness Association based in Stanford, California. This group is unique in its commitment to a very active lifestyle and has served as a cohort for many prior studies related to fitness and medical outcomes. Sixty-seven percent of the membership returned the mail questionnaire, and 59% of these respondents replied to the sexually relevant items. The results indicated a high level of sexual activity and satisfaction in both older men and women of the Fifty Plus Fitness Association members. Further, sexual satisfaction seemed to correlate with the degree of fitness. We conclude that physical fitness and high levels of sexual activity are mutually supportive elements of successful aging. (+info)
Vaginal changes and sexuality in women with a history of cervical cancer.
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BACKGROUND: In women with cervical cancer, treatment causes changes in vaginal anatomy and function. The effect of these changes on sexual function and the extent, if any, to which they distress women are not known. METHODS: In 1996 and 1997, we attempted to contact 332 women with a history of early-stage cervical cancer (age range, 26 to 80 years) who had been treated in 1991 and 1992 at the seven departments of gynecological oncology in Sweden and 489 women without a history of cancer (controls) to ask them to answer an anonymous questionnaire about vaginal changes and sexual function. RESULTS: We received completed questionnaires from 256 of the women with a history of cervical cancer and 350 of the controls. A total of 167 of 247 women with a history of cancer (68 percent) and 236 of 330 controls (72 percent) reported that they had regular vaginal intercourse. Twenty-six percent of the women who had cancer and 11 percent of the controls reported insufficient vaginal lubrication for sexual intercourse, 26 percent of the women who had cancer and 3 percent of the controls reported a short vagina, and 23 percent of the women who had cancer and 4 percent of the controls reported an insufficiently elastic vagina. Twenty-six percent of the women who had cancer reported moderate or much distress due to vaginal changes, as compared with 8 percent of the women in the control group. Dyspareunia was also more common among the women who had cervical cancer. The frequency of orgasms and orgasmic pleasure was similar in the two groups. Among the women who had cervical cancer, the type of treatment received had little if any effect on the prevalence of specific vaginal changes. CONCLUSIONS: Women who have been treated for cervical cancer have persistent vaginal changes that compromise sexual activity and result in considerable distress. (+info)
Psychosocial experiences in women facing fertility problems--a comparative survey.
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In a survey involving 281 patients awaiting assisted reproduction treatment at five centres in three countries, and 289 population controls, we investigated whether the patients had experienced more negative emotional feelings and negative emotional impact during periods when they were attempting to conceive as compared with the controls, and whether there was any difference in their well-being at the time of consultation. The study was performed in the context of currently divergent views as to the burden of fertility problems. The survey was carried out using questionnaires of the self-administration type. Women with fertility problems did in fact consistently report a higher prevalence of negative emotions than the controls with reference to the periods during which they had been trying to conceive. Patients reported more changes in interpartner relationships (either negative or positive). Sexuality was negatively affected among the patients. At the time of consultation, the patients had less favourable scores than the controls on scales for depressed mood, memory/concentration, anxiety and fears, as well as for self-perceived attractiveness. One in four (24.9%) of the patients had scores indicating depressive disorders as compared with only 6.8% of the controls. Current well-being was even more markedly affected in patients with previous unsuccessful in-vitro fertilization (IVF) experience. The 'infertility' life event was perceived as severe by both patients and controls. Both prior to consultation and during diagnosis and treatment, women with fertility problems had a higher prevalence of reported negative psycho-emotional experiences than women without fertility problems. (+info)
Dehydroepiandrosterone replacement in women with adrenal insufficiency.
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BACKGROUND: The physiologic role of dehydroepiandrosterone in humans is still unclear. Adrenal insufficiency leads to a deficiency of dehydroepiandrosterone; we therefore, investigated the effects of dehydroepiandrosterone replacement, in patients with adrenal insufficiency. METHODS: In a double-blind study, 24 women with adrenal insufficiency received in random order 50 mg of dehydroepiandrosterone orally each morning for four months and placebo daily for four months, with a one-month washout period. We measured serum steroid hormones, insulin-like growth factor I, lipids, and sex hormone-binding globulin, and we evaluated well-being and sexuality with the use of validated psychological questionnaires and visual-analogue scales, respectively. The women were assessed before treatment, after one and four months of treatment with dehydroepiandrosterone, after one and four months of placebo, and one month after the end of the second treatment period. RESULTS: Treatment with dehydroepiandrosterone raised the initially low serum concentrations of dehydroepiandrosterone, dehydroepiandrosterone sulfate, androstenedione, and testosterone into the normal range; serum concentrations of sex hormone-binding globulin, total cholesterol, and high-density lipoprotein cholesterol decreased significantly. Dehydroepiandrosterone significantly improved overall well-being as well as scores for depression and anxiety. For the global severity index, the mean (+/-SD) change from base line was -0.18+/-0.29 after four months of dehydroepiandrosterone therapy, as compared with 0.03+/-0.29 after four months of placebo (P=0.02). As compared with placebo, dehydroepiandrosterone significantly increased the frequency of sexual thoughts (P=0.006), sexual interest (P=0.002), and satisfaction with both mental and physical aspects of sexuality (P=0.009 and P=0.02, respectively). CONCLUSIONS: Dehydroepiandrosterone improves well-being and sexuality in women with adrenal insufficiency. (+info)