Unprotected Intercourse and One-Night Stands: Impact of Sexual Excitation, Sexual Inhibition, and Atypical Sexual Arousal Patterns on Risky Sexual Behaviors in Women

INTRODUCTION

Associations among sexual excitation, sexual inhibition, atypical sexual arousal patterns, and risky sexual behaviors have been reported in studies involving men and women. To date, longitudinal studies have not evaluated the predictive value of these propensities for future sexual behaviors in women.

AIM

To investigate associations among sexual excitation, sexual inhibition, atypical sexual arousal patterns, and potentially risky sexual behaviors in women.

METHODS

Overall, 2,214 women (mean age = 30.65 years, standard deviation = 9.91 years) participated in a baseline Web-based survey. The 1- and 2-year follow-up surveys included 396 and 382 participants, respectively. Correlational analyses and multiple linear regression analyses were conducted to analyze the relations between predictor and outcome variables.

MAIN OUTCOME MEASURES

Number of partners, number of one-time sexual encounters, and number of partners with whom no condoms were used during the 12-month periods before each of the three data assessment points.

RESULTS

All five lower-order factors of sexual excitation showed positive correlations and all three lower-order factors of sexual inhibition showed negative correlations with outcomes at baseline and follow-up. Atypical sexual arousal patterns, the tendency to become aroused in unusual sexual situations, and the importance of relationship factors, such as trust, for sexual arousal were the strongest predictors for sexual behaviors at baseline. These variables also predicted the number of sexual partners and the number of one-night stands at follow-up.

CONCLUSION

The findings suggest that increased sexual arousal when experiencing negative mood might be a risk factor for potentially health-threatening sexual decisions and support the assumptions of the dual control model that sexual excitation is positively and sexual inhibition is negatively predictive of risky sexual behavior in women.

General Erectile Functioning among Young, Heterosexual Men Who Do and Do Not Report Condom-Associated Erection Problems (CAEP)

INTRODUCTION

Condom-associated erection problems (CAEP) are an underestimated factor related to inconsistent or incomplete male condom use. The underlying mechanisms of CAEP are not understood, and whether men who report these difficulties are also likely to experience erectile problems in situations when condoms are not used has not been studied.

AIM

The aim of the study was to investigate, in a sample of condom-using young, heterosexual men (aged 18-24 years), whether men who report CAEP are more likely to (i) have erection problems when not using condoms and (ii) meet criteria for erectile dysfunction.

METHODS

A total of 479 men recruited online completed the International Index of Erectile Function (IIEF-5) and answered questions about erection problems experienced when using and not using condoms during the last 90 days. Demographic, sexual experience, and health status variables were investigated as correlates.

MAIN OUTCOME MEASURES

Self-reported frequency of erection loss during condom application or during penile-vaginal intercourse (PVI) in the past 90 days and IIEF-5 scores.

RESULTS

Of the men, 38.4% were classified in the no CAEP group, 13.8% as having CAEP during condom application, 15.7% as having CAEP during PVI, and 32.2% as having CAEP during both condom application and PVI. Men reporting any form of CAEP were significantly more likely than men reporting no CAEP to also report erection difficulties during sexual activity when not using condoms. Men who reported CAEP during PVI only or during both application and PVI scored significantly lower on the IIEF-5 than men without CAEP.

CONCLUSION

The findings suggest that men who report CAEP are also more likely to experience more generalized erection difficulties. Clinicians should assess whether men using condoms experience CAEP and where appropriate, refer for psychosexual therapy or provide condom skills education.

Treatment of Female Sexual Pain Disorders: A Systematic Review

Sexual pain disorders affect women's sexual and reproductive health and are poorly understood. Although many treatments have been evaluated, there is no one "gold standard" treatment. The aim of this systematic review was to investigate what treatments for female sexual pain have been evaluated in clinical studies and their effectiveness. The search strategy resulted in 65 papers included in this review. The articles were divided into the following categories: medical treatments; surgical treatments; physical therapies; psychological therapies; comparative treatment studies; and miscellaneous and combined treatments. Topical and systemic medical treatments have generally been found to lead to improvements in, but not complete relief of, pain, and side effects are quite common. Surgical procedures have demonstrated very high success rates, although there has been variability in complete relief of pain after surgery, which suggests less invasive treatments should be considered first. Physical therapies and psychological therapies have been shown to be promising treatments, supporting a biopsychosocial approach to sexual pain disorders. Although most of the interventions described have been reported as effective, many women still experience pain. A multidisciplinary team with active patient involvement may be needed to optimize treatment outcome.

Influence of sexual arousability on partner communication mediators of condom use among African American female adolescents

Background Ample evidence shows that partner sexual communication is related to condom use. Although communication about safer sex may often occur when sexual arousal is high, no studies have examined arousability, one’s propensity for sexual arousal and partner sexual communication. The purpose of this study was to examine associations between sexual arousability and partner-related mediators of condom use among African American female adolescents, who have disproportionate risk for HIV and sexually transmissible infections (STIs). Methods: The study analysed self-reported baseline data from 701 African American females aged 14–20 years participating in a HIV/STI trial. Linear regression models examined associations between arousability and partner-related mediators of condom use (partner sexual communication self-efficacy, partner sexual communication frequency, sex refusal self-efficacy and condom use self-efficacy), controlling for age, impulsivity and relationship power. Results: Greater arousability was significantly associated with reduced levels of each partner communication outcome assessed (partner sexual communication self-efficacy, partner sexual communication frequency and sex refusal self-efficacy) but was not associated with condom use self-efficacy. Conclusions: Arousal and other positive aspects of sex have largely been ignored by HIV/STI prevention efforts, which primarily focus on individual behaviour. A population-level sexual health approach focusing on sexual wellbeing may reduce stigma, facilitate partner sexual communication and be more effective at reducing HIV/STI rates than traditional approaches.

Desire to father a child and condom use: a study of young black men at risk of sexually transmitted infections

To determine whether men's reported desire to father a child or their perception that someone wanted to have their child was associated with elevated rates of unprotected vaginal sex, we studied a sample of young Black men at high risk of sexually transmitted infection acquisition. Data were collected in clinics treating sexually transmitted infections in three southern U.S. cities. Men 15-23 years of age who identified as Black/African American and reported recent (past two months) penile-vaginal sex were eligible (N = 578). Logistic regression was used to examine whether desire to conceive a child (self and perception of partners' desire) predicted condom use, adjusting for age and whether they had previously impregnated someone. Their own level of desire to conceive a child was not significantly associated with unprotected vaginal sex or the proportion of times a condom was used. However, those who perceived higher level of someone wanting to conceive their child were 1.73 times more likely to report unprotected vaginal sex (P = .006) and 1.62 times more likely to report a lower proportion of times condoms were used (P = .019). Young Black men attending sexually transmitted infection clinics in the USA may forego condom use based on a perceived desire of their partners to become pregnant, putting themselves at risk for sexually transmitted infection acquisition and unplanned pregnancy. Findings provide initial support for the relevance of the idea that perceptions of women partners' desire to conceive may be a critical determinant of condomless sex.

Condom-Associated Erection Problems: A Study of High-Risk Young Black Males Residing in the Southern United States

Previous research indicates that young men may experience condom-associated erection loss and that these problems may lead to inconsistent or incomplete condom use. The primary aim of this study was to assess, using a retrospective recall period of 2 months, correlates of condom-associated erection problems among young Black men attending sexually transmitted infection (STI) clinics. Data were collected in clinics treating patients with STIs in three southern U.S. cities. Males 15 to 23 years of age who identified as Black/African American and reported recent (past 2 months) condom use were eligible. A total of 494 men participated. Nineteen percent reported that condom-associated erection problems during condom application occurred at least once, and 17.8% indicated erection difficulties occurred during sexual intercourse at least once in the past 2 months. Multivariate analyses identified that condom-associated erection problems were associated with reports of sex with more than one partner during the recall period, reported problems with condom fit and feel, lower motivation to use condoms, and attempts at condom application before having a full erection. Findings suggest that clinic interventions should address possible condom-associated erection problems among young Black men who are at risk of STIs. Encouraging men who may be vulnerable to erection loss when condoms are used to allow sufficient time for sexual arousal to build may be an effective strategy.

Condoms are more effective when applied by males: a study of young black males in the United States

PURPOSE

To determine, among a sample of young black male (YBM), whether female application of male condoms for penile-vaginal intercourse would be associated with higher or lower rates of breakage or slippage. A secondary aim was to investigate if higher rates of breakage or slippage were associated with increased odds of acquiring chlamydia and/or gonorrhea.

METHODS

A cross-sectional study of 412 YBM, aged 15 to 23 years, was conducted in three US cities located in the Southern United States.

RESULTS

Among YBM reporting frequent female application of condoms, 43.5% reported one or more instance of breakage or slippage, compared with those reporting less frequent female application (27.2%, P = .003). Among YBM reporting one or more event of breakage or slippage, 25.4% tested positive for chlamydia and/or gonorrhea. In contrast, among those not reporting breakage or slippage, 17.2% tested positive (P = .047).

CONCLUSIONS

Findings suggest that educational and behavioral interventions should seek to improve young women's skills relative to condom application and use. Further studies could also investigate whether intervention efforts should encourage some YBM to be responsible for their own condom application.

Body region dissatisfaction predicts attention to body regions on other women

The proliferation of "idealized" (i.e., very thin and attractive) women in the media has contributed to increasing rates of body dissatisfaction among women. However, it remains relatively unknown how women attend to these images: does dissatisfaction predict greater or lesser attention to these body regions on others? Fifty healthy women (mean age=21.8 years) viewed images of idealized and plus-size models; an eye-tracker recorded visual attention. Participants also completed measures of satisfaction for specific body regions, which were then used as predictors of visual attention to these regions on models. Consistent with an avoidance-type process, lower levels of satisfaction with the two regions of greatest reported concern (mid, lower torso) predicted less attention to these regions; greater satisfaction predicted more attention to these regions. While this visual attention bias may aid in preserving self-esteem when viewing idealized others, it may preclude the opportunity for comparisons that could improve self-esteem.

Arousability as a predictor of sexual risk behaviours in African-American adolescent women

This study examined the impact of sexual excitation (arousability) on sexual risk-taking behaviours in a community sample of African-American adolescent women. A sample of 701 African-American adolescent women completed measures examining their propensity for sexual arousal, impulsivity and sexual behaviour. Compared with women with a lower propensity for sexual arousability, women with a higher propensity reported a greater number of sexual partners, more inconsistent condom use, a greater likelihood of having engaged in sexual intercourse with 'risky' partners, and sex while high on alcohol or drugs. These results indicate that women who have a greater propensity to become sexually aroused in a variety of situations may be at a greater risk for contracting HIV or sexually transmissible infections relative to women with a lower propensity for arousal. This suggests that individual differences in the propensity to become sexually aroused should be considered when developing intervention approaches targeting young African-American women.

Young women's attitudes towards, and experiences of, long-acting reversible contraceptives

OBJECTIVES

To identify factors involved in women's decisions to choose particular contraceptive methods and more specifically, incentives and disincentives to use three long-acting reversible contraceptive (LARC) methods: injectables, implants, and intrauterine devices/systems (IUDs/IUSs).

METHODS

A total of 502 women aged 18 to 30 completed a cross-sectional online questionnaire.

RESULTS

The three most important factors in choosing a contraceptive method were: high efficacy at preventing pregnancy, protection against sexually transmitted infections, and non-interference with sexual intercourse. The most common incentives for LARC use were the high efficacy and long duration of action. Disincentives included the possibility of irregular bleeding and concerns about effects on fertility; fear of needles and pain was a particular disincentive for IUD/IUS use. Only 93 (18%) of the participants reported ever having used a LARC.

CONCLUSIONS

Reported disincentives to LARC use (e.g., concern about effects on future fertility) indicated that many young women hold inaccurate beliefs about these methods. The relatively high proportions of women who held neutral attitudes about LARCs (21-40%, depending on the method) highlight the importance of education and contraceptive counselling to improve knowledge about the advantages of these methods.

Assessment of quality of life and functional outcome in patients sustaining moderate and major trauma: a multicentre, prospective cohort study

BACKGROUND

Trauma care systems aim to reduce both death and disability, yet there is little data on post-trauma health status and functional outcome.

OBJECTIVES

To evaluate baseline, discharge, six month and 12 month post-trauma quality of life, functional outcome and predictors of quality of life in Hong Kong.

METHODS

Multicentre, prospective cohort study using data from the trauma registries of three regional trauma centres in Hong Kong. Trauma patients with an ISS≥9 and aged≥18 years were included. The main outcome measures were the physical component summary (PCS) score and mental component summary (MCS) scores of the Short-Form 36 (SF36) for health status, and the extended Glasgow Outcome Scale (GOSE) for functional outcome.

RESULTS

Between 1 January 2010 and 31 September 2010, 400 patients (mean age 53.3 years; range 18-106; 69.5% male) were recruited to the study. There were no statistically significant differences in baseline characteristics between responders (N=177) and surviving non-responders (N=163). However, there were significant differences between these groups and the group of patients who died (N=60). Only 16/400 (4%) cases reported a GOSE≥7. 62/400 (15.5%) responders reached the HK population norm for PCS. 125/400 (31%) responders reached the HK population norm for MCS. If non-responders had similar outcomes to responders, then the percentages for GOSE≥7 would rise from 4% to 8%, for PCS from 15.5% to 30%, and for MCS from 31% to 60%. Univariate analysis showed that 12-month poor quality of life was significantly associated with age>65 years (OR 4.77), male gender (OR 0.44), pre-injury health problems (OR 2.30), admission to ICU (OR 2.15), ISS score 26-40 (OR 3.72), baseline PCS (OR 0.89), one-month PCS (OR 0.89), one-month MCS (OR 0.97), 6-month PCS (OR 0.76) and 6-month MCS (OR 0.97).

CONCLUSION

For patients sustaining moderate or major trauma in Hong Kong at 12 months after injury<1 in 10 patients had an excellent recovery, ≤3 in 10 reached a physical health status score≥Hong Kong norm, although as many as 6 in 10 patients had a mental health status score which is≥Hong Kong norm.

Likelihood of Condom Use When Sexually Transmitted Diseases Are Suspected: Results From a Clinic Sample

OBJECTIVE

To determine the event-level associations between perceived risk of sexually transmitted disease (STD) acquisition/transmission and condom use during penile-vaginal intercourse (PVI) among STD clinic attendees.

METHOD

A convenience sample (N = 622) completed daily electronic assessments. Two questions were proxies of perceived risk: suspicion that the partner might currently have an STD and that "you" might currently have an STD. Participants reported whether condoms were used with PVI events in the past 24 hours. Generalized estimating equations determined the association between each of the perceived risk variables and event-level condom use.

RESULTS

For the model pertaining to suspicion of sex partner infection, there were 16,674 events of PVI, with condom use during 10,552 of these events. The effect of current suspicion was significant after adjusting for gender and whether participants identified as African American/Black (estimated odds ratio = 2.17, 95% confidence interval = 1.57-3.00, P = .0001). The model pertaining to suspicion of self-infection included 16,679 events of penile-vaginal sex, with condom use during 10,557 of these events. Again, the effect of current suspicion was significant after adjusting for gender and African American/Black race (estimated odds ratio = 2.05, 95% confidence interval = 1.43-2.40, P = .0001). Tests for interactions with gender and with race were nonsignificant (all Ps > .25).

CONCLUSION

Using an event-level research design, strong associations were found between perceptions of STD risk and condom use in a clinical population. Health care providers and other professionals may indirectly promote condom use by helping clinic patients realistically evaluate their risk of having sex with infected partners or of being a source of STD transmission to others.

Condom use errors and problems: a study of high-risk young Black men residing in three Southern US cities

The primary aim of this study was to assess self-reported frequencies of selected condom use errors and problems, using a retrospective recall period of 2 months, among young Black men attending sexually transmitted infection clinics. A secondary objective was to determine whether more errors/problems occurred among men reporting sex with multiple partners compared with those reporting one sexual partner. Data were collected in clinics treating patients with sexually transmitted infections in three Southern US cities. Men, 15–23 years of age who identified as Black/African American and reported recent (past 2 months) condom use were eligible (N = 475). Condom use errors and problems were common, with some of the most critical errors occurring for greater than one of every five young Black men, such as late application, early removal, slipping off during sex, and re-using condoms. For 8 (33.3%) of the 24 errors/problems assessed, young Black men reporting more than one sexual partner in the previous 2 months experienced more errors and problems than men reporting only one partner. The disease protective value of condoms may be sub-optimal in this population. A need exists to improve the quality of condom use among young Black men at risk of sexually transmitted infection acquisition or transmission. Intensified clinic-based intervention that helps young Black men improve the quality of their condom use behaviours is warranted.

Understanding problems with condom fit and feel: an important opportunity for improving clinic-based safer sex programs

The purpose of this study was to investigate gender differences and other demographic correlates of condom fit and feel problems among a diverse sample of adult condom users and to examine men's and women's perceptions and experiences with condom fit and feel problems. Participants were recruited from an electronic mailing list. The analytic sample (N = 949) included self-identified heterosexual men (n = 771) and women (n = 178) who reported using condoms for penile-vaginal or penile-anal intercourse in the past 3 months. Both quantitative and qualitative methods were applied. Of the sample, 38.3% reported experiencing at least one condom fit or feel problem. Problems with condom fit during sex did not differ significantly by gender (p = .73). Perceptions of specific condom use problems were organized into five themes: (1) decreased sensation, (2) lack of naturalness, (3) condom size complaints, (4) decreased pleasure, and (5) pain and discomfort. In this diverse sample, there was a high prevalence of condom fit and feel issues among women as well as men. These issues, mostly focused on loss of pleasure, represent a substantial public health problem and thus warrant attention in safer sex programs.

Being drunk and high during sex is not associated with condom use behaviours: a study of high-risk young Black males

Objective To assess the relationship between the frequency of being drunk and high during sex, and condom use errors and problems (CUEP) among a sample of high-risk young Black males recruited from the United States.

METHODS

Data were collected in clinics treating sexually transmissible infections in three cities in the southern United States. Males 15-23 years of age (n=697) who identified as African-American and reported recent (past 2 months) condom use were eligible. Measures of alcohol and drug use, as well as condom use behaviours were assessed by audio-computer assisted self-interview. Eighteen CUEP were included in this assessment.

RESULTS

Sixteen bivariate correlations were obtained. The magnitude of the coefficients was small, ranging from 0.01 to 0.13. Only three were significant. These were positive associations between the frequency of being drunk and the frequency of unprotected vaginal sex, as well as the frequency of the 18-item measure of CUEP. A significant correlation was also found between the frequency of being high during sex and the frequency of unprotected vaginal sex. Adjustments for age did not change the findings.

CONCLUSIONS

Interventions designed to promote safer sex behaviours among young Black males attending sexually transmissible infection clinics are no more likely to benefit patients through the inclusion of messages and training attempting to dissuade the use of alcohol and drugs before or during sex.

Condom use motivations and selected behaviours with new versus established sex partners

Objective To compare condom use motives and behaviours in the context of penile–vaginal intercourse (PVI) with new versus established sexual partners, using daily event-level data among a clinic-recruited sample. Methods: Participants (ages 15–65 years old) were recruited from five sexually transmissible infection (STI) clinics in three United States cities. They were provided with personal digital assistants and instructed to respond to daily questionnaire items regarding PVI events from the past 24 h. Generalised estimations equations were used to make inferences on age-adjusted estimated odds ratios, comparing events occurring with established versus new partners. Results: For males, pregnancy prevention was a more common motivation for condom use in new relationships (P < 0.001). Males with new sex partners were more likely to report condom use (P < 0.005) and also reported fewer errors or problems in condom use with new sex partners (P < 0.001). For females, pregnancy prevention (P = 0.03), STI acquisition (P < 0.001) and STI transmission (P = 0.005) were more likely to be motives for condom use with new versus established partners. Also, females with new sex partners were more likely to report condom use (P < 0.001) as well as using multiple condoms during a single event (P = 0.03). Conclusion: Event-level findings suggest that condom use motivations and behaviours vary depending on whether PVI occurs between established versus new sex partners. Condom use is more likely for PVI with new partners, but other condom-associated behaviours and motivations differ between females and males.

A novel, self-guided, home-based intervention to improve condom use among young men who have sex with men

OBJECTIVE

This pilot study tested the efficacy of a brief, novel, theory-driven, self-guided, home-based intervention designed to promote condom use among young men who have sex with men (YMSM).

PARTICIPANTS

Thirty YMSM were recruited from a large public US midwestern university during spring of 2012.

METHODS

The intervention was tested using a repeated measures design with the primary follow-up assessment occurring 6 weeks after enrollment.

RESULTS

Forty-five percent of men reported a reduced frequency of unprotected insertive penile-anal intercourse in the past 30 days compared with baseline (p = .01). Consistency of condom use improved (p = .013), as did motivation to use condoms correctly, condom use self-efficacy, and condom attitudes. All participants indicated that they were glad they participated, would recommend the program, and that overall, they had liked the program.

CONCLUSIONS

This pilot study supports an expanded trial of this intervention with MSM at high-risk of acquiring human immunodeficiency virus/sexually transmitted infections (HIV/STIs).

Anthropometric and physiological measurements in healthy children

1. Normal ranges for ultrasonic cardiac output monitor-derived cardiovascular indices are derived for Chinese children aged 1 to 12 years in Hong Kong. 2. A simple formula for calculating stroke volume is constructed, but the error varies from 8 to 40%. 3. Stroke volume index and, to a lesser extent, the cardiac index generally increase from ages 1 to 5 years, but plateau or fall slightly thereafter.

Prevalence and predictors of condom use in a national sample of Canadian university students

Young adult Canadians of university age are highly sexually active compared to other age groups and are at relatively high risk for sexually transmitted infections (STI). It is therefore important to comprehensively assess condom use in this age group. In this study, the prevalence and individual predictors of condom use at last penile vaginal intercourse (PVI) were assessed in a national sample of 653 Canadian university students (252 male, 401 female). Overall, less than half of students (47.2%) reported condom use at last PVI. Condom use was higher among men (55.4%) than women (42.3%). For both men and women, the most frequently cited main reason for having used a condom was birth control. In multivariate analyses, the strongest predictor of condom use at last PVI was a preference for condoms as a contraceptive method; specifically, men and women who stated condoms were their preferred method were 9 and 23 times, respectively, more likely to use condoms at last PVI than those who selected another method. Female students who reported that their most recent sexual encounter occurred with a more committed partner (e.g., committed dating versus a hook-up) had slightly lower odds of reporting condom use at last PVI. The results indicated that rates of condom use are low among Canadian university students and that many students are likely at high risk for STI. Interventions to raise awareness of STIs are needed on Canadian university campuses and educational programs should emphasize improving attitudes towards condoms in addition to developing sexual health knowledge and condom use skills.