1
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Jabs F, Brotto LA. Examining the Treatment Relevance of the Approach-Avoidance Motivation Model for Sexual Interest/Arousal Disorder in Women and Non-Binary Individuals. J Sex Res 2024; 61:562-573. [PMID: 36449295 DOI: 10.1080/00224499.2022.2148240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Up to 8% of cisgender women meet diagnostic criteria for Female Sexual Interest/Arousal Disorder (SIAD), a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, yet treatment research for SIAD remains scarce, particularly for transgender women and non-binary individuals. The treatment relevance of the Approach-Avoidance Motivation Model for SIAD was tested in a sample of cis- and transgender women, and non-binary individuals, who either met criteria for SIAD (n = 45) or reported no sexual concerns (n = 76). Participants completed an online writing exercise previously found to increase the salience of approach or avoidance sexual motivation, or a control writing task. At baseline, and 72 hours following the writing task, they completed measures of sexual motivation, sexual desire, and partnered sexual behaviors. Participants with SIAD in the approach condition significantly increased in approach sexual motivation immediately following the manipulation but these improvements were not maintained 72 hours later. Compared to baseline, participants who wrote about an approach-motivated sexual encounter experienced a decrease in sexual desire and partnered sexual behaviors, while participants who wrote about an avoidance-motivated sexual encounter had decreased motivation but increased partnered sexual behaviors 72 hours following the manipulation. Overall, findings did not show support for the relevance of the approach-avoidance motivation manipulation for SIAD. Future studies might explore novel ways of targeting sexual motivation to address sexual difficulties.
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Affiliation(s)
- Faith Jabs
- Department of Psychology, University of British Columbia
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia
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2
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Brotto LA, Walker L, Sears C, Woo S, Millman R, Zdaniuk B. A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors. J Sex Med 2024; 21:452-463. [PMID: 38465848 DOI: 10.1093/jsxmed/qdae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Sexual difficulties and vaginal pain are common following treatment for breast cancer. AIM The goal of this study was to evaluate an online mindfulness-based group sex therapy vs an online supportive sex education group therapy to address these sexual difficulties. METHODS Breast cancer survivors (n = 118) were randomized to 1 of the 2 arms; 116 provided informed consent and completed the time 1 assessment. Treatment included 8 weekly 2-hour online group sessions. Those randomized to the mindfulness group completed daily mindfulness exercises, and those in the comparison arm read and completed exercises pertaining to sex education. OUTCOMES Assessments were repeated at posttreatment and 6 months after the completion of the group. RESULTS There was a main effect of treatment on primary endpoints of sexual desire, sexual distress, and vaginal pain, with all outcomes showing significant improvements, with no differential impact by treatment arm. Secondary endpoints of interoceptive awareness, mindfulness, and rumination about sex also significantly improved with both treatments, with no group-by-time interaction. CONCLUSION Both mindfulness-based sex therapy and supportive sex education delivered in group format online are effective for improving many facets of sexual function, vaginal pain, rumination, mindfulness, and interoceptive awareness in breast cancer survivors. STRENGTHS AND LIMITATIONS We used a randomized methodology. Future studies should seek to diversify participants. CLINICAL IMPLICATIONS These findings highlight the need to offer similar treatments to more breast cancer survivors immediately after and in the years following cancer treatment as a means of improving survivorship quality of life.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Lauren Walker
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
- Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, T2N 1N4, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, T2N 4N2, Canada
| | - Carly Sears
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Shannon Woo
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Roanne Millman
- Private Practice, West Coast Centre for Sex Therapy , Vancouver, British Columbia, V6H 3H4, Canada
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, V5Z 1M9, Canada
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3
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Cole S, Brotto LA. Investigating trait mindfulness in women with a history of unwanted sexual contact. J Sex Marital Ther 2024:1-12. [PMID: 38685854 DOI: 10.1080/0092623x.2024.2343282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Unwanted sexual contact (USC) is common in women, and may contribute to sexual dysfunction via avoidance coping techniques. Mindfulness-based treatments, which directly challenge avoidance, have been shown to be effective in treating sexual dysfunction, however, it is not yet clear whether there are differences in trait mindfulness between women with and without a history of USC. We used data from four previous studies and compared trait mindfulness on the Five Facet Mindfulness Questionnaire (FFMQ) in women with and without a history of USC. There were no significant differences between the USC and no-USC groups on total FFMQ score, nor on most individual domain scores; however, significant group differences were found on observe and acting with awareness subscales. We speculate on the possible meaning of the USC group having higher observe scores and lower acting with awareness scores compared to the no-USC group.
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Affiliation(s)
- Sara Cole
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
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4
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Xue A, Makarenko B, Brotto LA. A Brief Online Mindfulness Intervention for Women's Sexual Desire: The BROWSE Study. J Sex Marital Ther 2024:1-20. [PMID: 38650453 DOI: 10.1080/0092623x.2024.2343286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
With growing interest in developing digital health tools for treating sexual dysfunction, this pilot study aimed to determine feasibility and gather preliminary efficacy data of a self-led online mindfulness intervention in comparison to an online psychoeducational intervention for women's low sexual desire in a community sample (N = 57). After a four-week intervention, participants showed overall improvements on sexual functioning, orgasm, sexual self-pleasure, sexual self-image, and sexual distress, in both treatment arms. Majority completed assigned homework and felt the intervention enhanced their sexual well-being. This study supports the feasibility of a self-led online mindfulness intervention that could help inform future programs.
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Affiliation(s)
- Adrianna Xue
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Brett Makarenko
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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5
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Blumenstock SM, Suschinsky K, Brotto LA, Chivers ML. Genital arousal and responsive desire among women with and without sexual interest/arousal disorder symptoms. J Sex Med 2024:qdae036. [PMID: 38582607 DOI: 10.1093/jsxmed/qdae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Models depicting sexual desire as responsive to sexual arousal may be particularly apt for women experiencing arousal or desire difficulties, and the degree to which arousal triggers desire may depend on the relationship context and desire target and timing-yet, these associations have not been directly tested among women with and without sexual interest/arousal disorder (SIAD). AIM To assess the role of SIAD status and relationship satisfaction in the associations between genital arousal and 4 types of responsive desire. METHODS One hundred women (n = 27 meeting diagnostic criteria for SIAD) in romantic relationships with men viewed a sexual film (pleasurable intimate depiction of oral sex and penile-vaginal intercourse) while their genital arousal was recorded via vaginal photoplethysmography (n = 63) or thermal imaging of the labia (n = 37). Partner and solitary desire was assessed immediately before and after the film (immediate desire) and 3 days later (delayed desire). OUTCOMES Outcomes consisted of genital response (z scored by method) and associations between genital response and responsive sexual desire. RESULTS The key difference between women with and without SIAD was not in their ability to experience genital arousal but in how their genital responses translated to responsive sexual desire. Women with SIAD actually exhibited greater genital arousal than unaffected women. Associations between genital arousal and desire were significant only for women with SIAD and depended on relationship satisfaction and desire type. For women with SIAD with low relationship satisfaction, higher arousal predicted lower immediate desire for a partner; for those with high relationship satisfaction, arousal was either positively related (vaginal photoplethysmography) or unrelated (thermal imaging of the labia) to immediate desire for a partner. Associations with other desire types were not significant. CLINICAL IMPLICATIONS Patterns of genital arousal and partner-specific responsive desire among women affected with SIAD were indicative of an avoidance model in response to heightened genital arousal, unless relationship satisfaction was high; attending to genital arousal sensations could be a means of triggering sexual desire for women with SIAD who are satisfied in their relationships. STRENGTHS AND LIMITATIONS This is one of the first sexual psychophysiologic studies to connect relationship factors to patterns of sexual response. The differing arousal assessment procedures and lack of official diagnosis may have attenuated results. The homogeneous sample and in-person session requirement limit generalizability. CONCLUSION When compared with unaffected women, women affected by SIAD may exhibit stronger arousal responses with sufficiently incentivized sexual stimuli, and the connection between their genital arousal and responsive desire for their partners may be stronger and more dependent on relationship context.
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Affiliation(s)
- Shari M Blumenstock
- Department of Psychology, Queen's University, Kingston K7L 3L3, Canada
- Kinsey Institute, Indiana University-Bloomington, Bloomington IN 47405, United States
| | - Kelly Suschinsky
- Royal Ottawa Mental Health Centre, University of Ottawa, Ottawa K1Z 7K4, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver V6T 2A1, Canada
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6
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Rebić N, Law MR, Brotto LA, Cragg JJ, De Vera MA. The Intersectional Impact of Cost-Related Non-Adherence and Depression: A Cross-Sectional Analysis of the Canadian Community Health Survey by Sex, Race, and Indigeneity. Community Ment Health J 2024; 60:515-524. [PMID: 37930467 DOI: 10.1007/s10597-023-01202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
We evaluated the relationship between cost-related non-adherence (CRNA) and depressive symptoms. Pooling data from the 2015, 2016, 2018, and 2019 annual Canadian Community Health Survey, we analyzed the relationship between CRNA and moderate to severe depressive symptoms, assessed by the Patient Health Questionnaire (PHQ-9). Among the sample, 4.9% experienced CRNA and 6.8% experienced moderate to severe depressive symptoms. Respondents who reported CRNA had 1.51 (95% confidence interval [CI], 1.51-1.52) greater odds of experiencing moderate to severe depressive symptoms. Stratified analysis by sex and race showed the association between CRNA and depressive symptoms was greatest among racialized males (aOR: 1.83, 95% CI: 1.81- 1.85). Stratified analysis by sex and Indigeneity showed this association was greatest for Indigenous males (aOR: 2.16, 95% CI: 2.10-2.22). Forgoing prescribed medications due to cost is associated with more severe depressive symptoms among Canadians, particularly racialized and Indigenous males.
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Affiliation(s)
- Nevena Rebić
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Michael R Law
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jacquelyn J Cragg
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 570-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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7
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Oveisi N, Cheng V, Taylor D, Bechthold H, Barnes M, Jansen N, McTaggart-Cowan H, Brotto LA, Peacock S, Hanley GE, Gill S, Rayar M, Srikanthan A, De Vera MA. Meaningful Patient Engagement in Adolescent and Young Adult (AYA) Cancer Research: A Framework for Qualitative Studies. Curr Oncol 2024; 31:1689-1700. [PMID: 38668031 PMCID: PMC11049004 DOI: 10.3390/curroncol31040128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 04/28/2024] Open
Abstract
Over the last two decades, patient engagement in cancer research has evolved significantly, especially in addressing the unique challenges faced by adolescent and young adult (AYA) cancer populations. This paper introduces a framework for meaningful engagement with AYA cancer patient research partners, drawing insights from the "FUTURE" Study, a qualitative study that utilizes focus groups to explore the impact of cancer diagnosis and treatment on the sexual and reproductive health of AYA cancer patients in Canada. The framework's development integrates insights from prior works and addresses challenges with patient engagement in research specific to AYA cancer populations. The framework is guided by overarching principles (safety, flexibility, and sensitivity) and includes considerations that apply across all phases of a research study (collaboration; iteration; communication; and equity, diversity, and inclusion) and tasks that apply to specific phases of a research study (developing, conducting, and translating the study). The proposed framework seeks to increase patient engagement in AYA cancer research beyond a supplementary aspect to an integral component for conducting research with impact on patients.
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Affiliation(s)
- Niki Oveisi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (N.O.); (V.C.)
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC V6T 1Z3, Canada
| | - Vicki Cheng
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (N.O.); (V.C.)
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC V6T 1Z3, Canada
| | | | | | - Mikaela Barnes
- Patient Research Partner
- Registered Physiotherapist, Pelvic Health Provider, Vancouver, BC, Canada
| | | | - Helen McTaggart-Cowan
- BC Cancer, Vancouver, BC V5Z 1M9, Canada; (H.M.-C.); (S.P.); (S.G.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Lori A. Brotto
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (L.A.B.); (G.E.H.); (M.R.)
| | - Stuart Peacock
- BC Cancer, Vancouver, BC V5Z 1M9, Canada; (H.M.-C.); (S.P.); (S.G.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Gillian E. Hanley
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (L.A.B.); (G.E.H.); (M.R.)
| | - Sharlene Gill
- BC Cancer, Vancouver, BC V5Z 1M9, Canada; (H.M.-C.); (S.P.); (S.G.)
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (L.A.B.); (G.E.H.); (M.R.)
| | - Meera Rayar
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (L.A.B.); (G.E.H.); (M.R.)
| | - Amirrtha Srikanthan
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada;
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8M5, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Mary A. De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (N.O.); (V.C.)
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
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8
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Chivers ML, Zdaniuk B, Lalumière M, Brotto LA. Effects of Group Mindfulness-Based Cognitive Therapy versus Supportive Sex Education on Sexual Concordance and Sexual Response Among Women with Sexual Interest/Arousal Disorder. J Sex Res 2024:1-15. [PMID: 38477943 DOI: 10.1080/00224499.2024.2319695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Low interest in sexual activity and impaired sexual response are among women's most frequent sexual concerns. Mindfulness-based treatments improve low sexual desire and arousal and associated distress. One theorized mechanism of change is the cultivation of increased mind-body awareness via greater concordance between psychological and physiological components of sexual response. We examined sexual psychophysiology data from 148 cisgender women randomized to receive mindfulness-based cognitive therapy (MCBT: n = 70) or supportive sex education (STEP: n = 78) over eight weekly group sessions. Women completed in-lab assessments of subjective, affective, and genital sexual responses to an erotic film pre- and post-treatment, and at 6- and 12-month follow-ups. Both groups showed positive changes in sexual and affective responses, but these were generally more pronounced for MBCT. MCBT increased sexual concordance to a greater degree, and gains in sexual concordance predicted improvements in sexual distress throughout treatment.
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Affiliation(s)
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynecology, University of British Columbia
| | | | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia
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9
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Mirlashari J, Brotto LA, Lyons J, Pederson A. The Wall of Silence: Perceived Barriers to Gender-Based Violence Disclosure among Women in the Perinatal Period. Can J Nurs Res 2024; 56:117-128. [PMID: 38086750 DOI: 10.1177/08445621231220810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
STUDY BACKGROUND Gender-based violence is a global concern. The perinatal period is a crucial time for early identification of the harmful impact of violence on the well-being of both mothers and infants. However, it has been observed that many women choose not to disclose their experiences to their healthcare providers. PURPOSE To gain insight into this issue, a study was conducted to explore the perspectives of both survivors and healthcare providers regarding the barriers to disclosure. METHODS Through the utilization of a thematic analysis approach, a total of 28 interviews were conducted, involving 12 survivors and 16 healthcare providers. RESULTS Data analysis revealed barriers to disclosure at the individual, community, and healthcare system levels. CONCLUSION Health-care providers have a pivotal role in creating an atmosphere where women are encouraged to break the silence and a paradigm shift in the health system approach towards GBV is necessary.
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Affiliation(s)
- Jila Mirlashari
- College of Nursing, Seattle University, Seattle, Washington State, USA
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, Women's Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Janet Lyons
- Department of Obstetrics and Gynecology, Women's Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Ann Pederson
- Women's Health Research Institute, University of British Columbia, Vancouver, Canada
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10
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Scheller M, de Sousa AA, Brotto LA, Little AC. The Role of Sexual and Romantic Attraction in Human Mate Preferences. J Sex Res 2024; 61:299-312. [PMID: 36795115 DOI: 10.1080/00224499.2023.2176811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Sex differences in mate preferences are ubiquitous, having been evidenced across generations and cultures. Their prevalence and persistence have compellingly placed them in the evolutionarily adaptive context of sexual selection. However, the psycho-biological mechanisms contributing to their generation and maintenance remain poorly understood. As such a mechanism, sexual attraction is assumed to guide interest, desire, and the affinity toward specific partner features. However, whether sexual attraction can indeed explain sex differences in partner preferences has not been explicitly tested. To better understand how sex and sexual attraction shape mate preferences in humans we assessed how partner preferences differed across the spectrum of sexual attraction in a sample of 479 individuals that identified as asexual, gray-sexual, demisexual or allosexual. We further tested whether romantic attraction predicted preference profiles better than sexual attraction. Our results show that sexual attraction accounts for highly replicable sex differences in mate preferences for high social status and financial prospects, conscientiousness, and intelligence; however, it does not account for the enhanced preference for physical attractiveness expressed by men, which persists even in individuals with low sexual attraction. Instead, sex differences in physical attractiveness preference are better explained by the degree of romantic attraction. Furthermore, effects of sexual attraction on sex differences in partner preferences were grounded in current rather than previous experiences of sexual attraction. Taken together, the results support the idea that contemporary sex differences in partner preferences are maintained by several psycho-biological mechanisms that evolved in conjunction, including not only sexual but also romantic attraction.
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Affiliation(s)
- Meike Scheller
- Department of Psychology, University of Bath
- Department of Psychology, Durham University
- School of Psychology, University of Aberdeen
| | | | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia
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11
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Liu YD, Noga H, Allaire C, Bedaiwy MA, Lee CE, Williams C, Booth A, Galea LA, Kaida A, Ogilvie GS, Brotto LA, Yong PJ. Mental health outcomes of endometriosis patients during the COVID-19 pandemic: Impact of pre-pandemic central nervous system sensitization. J Pain 2024:S1526-5900(24)00355-9. [PMID: 38246253 DOI: 10.1016/j.jpain.2024.01.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
To correlate pain-related phenotyping for central nervous system sensitization in endometriosis-associated pain with mental health outcomes during the COVID-19 pandemic, the prospective Endometriosis and Pelvic Pain Interdisciplinary Cohort (EPPIC, ClinicalTrials.gov #NCT02911090) was linked to the COVID-19 Rapid Evidence Study of a Provincial Population Based Cohort for Gender and Sex (RESPPONSE) dataset. The primary outcomes were depression (PHQ-9) and anxiety (GAD-7) scores during the pandemic. The explanatory variables of interest were the Central Sensitization Inventory (CSI) score (0-100) and endometriosis-associated chronic pain comorbidities/psychological variables before the pandemic. The explanatory and response variables were assessed for correlation, followed by multivariable regression analyses adjusting for PHQ-9 and GAD-7 scores pre-pandemic as well as age, BMI, and parity. A higher CSI score and a greater number of chronic pain comorbidities before the pandemic were both positively correlated with PHQ-9 and GAD-7 scores during the pandemic. These associations remained significant in adjusted analyses. Increasing the CSI score by 10 was associated with an increase in pandemic PHQ-9 by 0.74 points (p<0.0001) and GAD-7 by 0.73 points (p<0.0001) on average. Each additional comorbidity/variable was associated with an increase in pandemic PHQ-9 by an average of 0.63 points (p=0.0004) and GAD-7 by 0.53 points (p=0.0002). Endometriosis patients with a history of central sensitization before the pandemic had worse mental health outcomes during the COVID-19 pandemic. As a risk factor for mental health symptoms in the face of major stressors, clinical proxies for central sensitization can be used to identify endometriosis patients who may need additional support. PERSPECTIVE: This article adds to the growing literature of the clinical importance of central sensitization in endometriosis patients, who had more symptoms of depression and anxiety during the COVID-19 pandemic. Clinical features of central sensitization may help clinicians identify endometriosis patients needing additional support when facing major stressors.
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Affiliation(s)
- Yang Doris Liu
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, BC, Canada
| | - Heather Noga
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada
| | - Catherine Allaire
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Caroline E Lee
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Christina Williams
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Amy Booth
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Liisa Am Galea
- Women's Health Research Institute, Vancouver, BC, Canada; Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Angela Kaida
- Women's Health Research Institute, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Gina S Ogilvie
- Women's Health Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Lori A Brotto
- Women's Health Research Institute, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Paul J Yong
- University of British Columbia Endometriosis and Pelvic Pain Laboratory, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
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12
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MacLeod RGK, Parmar G, Zhang S, Noga H, Allaire C, Albert A, Flannigan R, Brotto LA, Orr NL, Wahl K, Yong PJ. Acceptability, reliability, and validity of a vaginal insert for the self-assessment of endometriosis-associated deep dyspareunia: a cross-sectional study. J Sex Med 2023; 21:44-53. [PMID: 38014766 DOI: 10.1093/jsxmed/qdad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Approximately half of people with endometriosis experience deep dyspareunia; however, there is no means of objective self-testing of endometriosis-associated deep dyspareunia. AIM The aim of this study was to assess the acceptability, test-retest reliability, and validity of a vaginal insert for a self-assessment of endometriosis-associated deep dyspareunia. METHODS Participants were recruited from a tertiary endometriosis center. Inclusion criteria were: 19 to 49 years of age, self-reported deep dyspareunia of ≥4 of 10, and surgically confirmed endometriosis. Participants completed 2 self-assessments using the vaginal insert to self-assess tenderness at the right and left pelvic floor, bladder, cervix-uterus, and posterior cul-de-sac (vaginal fornix). The participants recorded tenderness at each pelvic site and completed a questionnaire regarding the acceptability of the vaginal insert to assess deep dyspareunia. Test-retest reliability was assessed by correlating the tenderness scores between the 2 assessment dates. Over a 4-week period, the participants also recorded deep dyspareunia severity at each penetrative vaginal sex encounter. Validity was assessed by correlating vaginal insert tenderness to deep dyspareunia severity, and also to tenderness reported on a prior gynecologic pelvic examination. OUTCOMES The main outcome measures were the acceptability index score, tenderness (0-10) at each pelvic site, and prospective deep dyspareunia scores (0-10) over 4 weeks. RESULTS There were 19 participants (mean age 34 ± 7 years) who completed the study. The majority identified as female (94.7%), heterosexual (89.5%), and white (89.5%). The median acceptability index score was 0.72 (interquartile range, 0.66-0.81). For test-retest reliability, the intraclass correlation coefficients were 0.79 (P = .001) for the left pelvic floor, 0.82 (P < .001) for the right pelvic floor, 0.54 (P = .07) for the bladder, 0.89 (P < .001) for the cervix-uterus, and 0.77 (P = .003) for the cul-de-sac. The correlation between the highest self-assessed mean tenderness in each participant and self-reported deep dyspareunia over 4 weeks was r = 0.32, but correlations for each pelvic site varied significantly. Tenderness at each site on prior gynecologist pelvic exam was associated with higher self-assessed mean tenderness with the vaginal insert in each participant (effect sizes = 0.42-0.88). CLINICAL IMPLICATIONS The vaginal insert is acceptable and reliable for the objective self-assessment of endometriosis-associated deep dyspareunia, with initial evidence of validity. STRENGTHS AND LIMITATIONS A strength was the inclusion of participants who were avoiding sexual activity and a limitation was the small sample size. CONCLUSION Future studies with larger sample sizes are required to further establish the validity of the vaginal insert for the self-assessment of endometriosis-associated deep dyspareunia.
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Affiliation(s)
- Rebecca G K MacLeod
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Gurkiran Parmar
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Sandy Zhang
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Heather Noga
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
- British Columbia Women's Centre for Pelvic Pain and Endometriosis, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Ryan Flannigan
- Department of Urology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Natasha L Orr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Kate Wahl
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, V6Z 2K8, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- British Columbia Women's Centre for Pelvic Pain and Endometriosis, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
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13
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Stephenson KR, Latimer SRE, Zippan NL, Brotto LA. History of Sexual Assault as a Predictor of Response to a Self-Guided Online Program for Sexual Desire and Arousal Difficulties in Women. Arch Sex Behav 2023; 52:3379-3391. [PMID: 37697093 DOI: 10.1007/s10508-023-02685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023]
Abstract
Sexual Interest/Arousal Disorder (distressing, long-lasting impairments in sexual desire and/or arousal) is common in women, but few have access to efficacious psychotherapies, including cognitive-behavioral therapy (CBT) and mindfulness-based therapy (MBT). eSense, an online program meant to maximize treatment access, has been shown to be a feasible, satisfactory, and potentially efficacious intervention. However, subpopulations such as sexual assault survivors may find the program less usable or efficacious. The current study compared women with and without a history of sexual assault (SA) regarding their ability to use and benefit from eSense. Forty-four women (22 with a history of SA; M age = 34.20 years) used eSense (CBT or MBT) and completed validated self-report scales of sexual function, sexual distress, treatment satisfaction, and homework compliance. A history of SA did not predict differences in attrition or changes in clinical outcomes. Exploratory analyses suggested that women with a history of SA reported slightly higher difficulty completing homework assignments, but also slightly higher treatment satisfaction. These preliminary results suggest that eSense may be usable and helpful for women with a history of SA. We discuss ways to maximize the acceptability and efficacy of online programs for women with a history of SA.
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Affiliation(s)
- Kyle R Stephenson
- School of Psychology, Xavier University, 3800 Victory Parkway, Cincinnati, OH, 45207, USA.
| | | | - Natasha L Zippan
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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14
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Oveisi N, Cheng V, Brotto LA, Peacock S, McTaggart-Cowan H, Hanley G, Gill S, Rayar M, Srikanthan A, Ellis U, De Vera MA. Sexual health outcomes among adolescent and young adult cancer patients: a systematic review and meta-analysis. JNCI Cancer Spectr 2023; 7:pkad087. [PMID: 37878813 PMCID: PMC10674049 DOI: 10.1093/jncics/pkad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Sexual health outcomes (SHO), which entail the physical, emotional, mental, and social impacts, are an important consideration for adolescent and young adults (AYA, ages 15-39) affected by cancer. The objective of this systematic review and meta-analysis is to summarize the current literature and evaluate AYA cancer impact on SHO. METHODS EMBASE and MEDLINE were searched from January 1, 2000 to September 28, 2022 to identify epidemiologic studies that used an analytic observational design, included individuals with AYA cancer and non-cancer control participants, and evaluated SHO. Odds ratios and prevalence ratios were calculated; random effects models were used to obtain pooled measures where possible. RESULTS Of 2621 articles, 8 were included that investigated 23 SHO in 9038 AYA cancer patients. Based on the sexual response cycle, outcomes were categorized as those occurring among males (desire = 1, arousal = 1, orgasm = 4, other = 3) and females (desire = 2, arousal = 1, orgasm = 2, pain = 6, other = 3). It was feasible to conduct meta-analysis for 3 female SHO and 5 male SHO. There were associations between AYA cancer and 3 SHO: vaginal dryness (pooled odds ratio = 3.94; 95% confidence interval (CI) = 2.02 to 7.70), ejaculatory dysfunction (pooled odds ratio = 3.66; 95% CI = 2.20 to 6.08), and testosterone level (pooled mean difference = -2.56 nmol/liter; 95% CI = -3.46 to -1.66; P = .00001). CONCLUSION This study found increased ejaculatory dysfunction and reduced testosterone levels in male AYA cancer patients and increased vaginal dryness in female AYA cancer patients, highlighting the need for sexual health resources in this population.
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Affiliation(s)
- Niki Oveisi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Vicki Cheng
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
| | - Lori A Brotto
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stuart Peacock
- BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Helen McTaggart-Cowan
- BC Cancer, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Gillian Hanley
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sharlene Gill
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Meera Rayar
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amirrtha Srikanthan
- Faculty of Medicine University of Ottawa, Ottawa, ON, Canada
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ursula Ellis
- University of British Columbia Library, Vancouver, BC, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
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15
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Blumenstock SM, Suschinsky K, Brotto LA, Chivers ML. Sexual Desire Emerges from Subjective Sexual Arousal, but the Connection Depends on Desire Type and Relationship Satisfaction. J Sex Marital Ther 2023; 50:252-271. [PMID: 37882054 DOI: 10.1080/0092623x.2023.2272719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
According to models of responsive sexual desire, desire emerges from sexual arousal. This study examined how sexual desire type (dyadic-partner, dyadic-other, solitary) and relationship satisfaction affect the connection between subjective sexual arousal (SSA) and desire. Women (N = 100; 27% with sexual interest/arousal disorder symptoms) reported SSA while viewing a sexual film. Solitary and dyadic responsive sexual desire were assessed immediately before and following the film (immediate desire) and three days later (delayed desire). SSA predicted higher immediate solitary desire. SSA also predicted higher immediate dyadic desire, and this link was stronger for those with higher relationship satisfaction; for those with low relationship satisfaction, SSA was unrelated. For delayed desire, SSA predicted higher dyadic-partner desire, regardless of relationship satisfaction. SSA also predicted higher dyadic-other desire, yet this association was stronger for those with low relationship satisfaction; for those with high relationship satisfaction, SSA was unrelated to dyadic-other desire. Findings support the theoretical premise that desire emerges from arousal, but that this connection is dependent upon additional factors, specifically the target and timing of desire and participants' current relationship quality. Relationship satisfaction may affect the motivational value of sex with (and without) a current partner.
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Affiliation(s)
- Shari M Blumenstock
- Department of Psychology, Queen's University, Ontario, Canada
- Kinsey Institute, Indiana University-Bloomington, Bloomington, Indiana, USA
| | - Kelly Suschinsky
- Royal Ottawa Mental Health Centre, University of Ottawa, Ottawa, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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16
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Brown NB, Milani S, Jabs F, Kingstone A, Brotto LA. Exploring Women's State-Level Anxiety in Response to Virtual Reality Erotica. J Sex Marital Ther 2023; 50:137-151. [PMID: 37807833 DOI: 10.1080/0092623x.2023.2265924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Virtual Reality (VR)-based treatments for anxiety disorders are efficacious but there is a lack of research examining anxious responses to VR erotica, which could innovate treatments for sexual difficulties. We examined erotica features that elicited anxiety and sexual presence in women. Thirty-eight women viewed erotic videos from different modalities (2D, VR) and points of view (1st, 3rd person) and completed anxiety and sexual presence measures before and after each video. Women experienced greater anxiety for VR than 2D films and reported the most anxiety for VR 1st person films. Sexual presence was affected by modality and point of view.
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Affiliation(s)
- Natalie B Brown
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sonia Milani
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Faith Jabs
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Alan Kingstone
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Lori A Brotto
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada
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17
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Rebić N, Law MR, Cragg J, Brotto LA, Ellis U, Garg R, Park JY, De Vera MA. "What's Sex and Gender Got to Do With It?" A Scoping Review of Sex- and Gender-Based Analysis in Pharmacoepidemiologic Studies of Medication Adherence. Value Health 2023; 26:1413-1424. [PMID: 37068558 DOI: 10.1016/j.jval.2023.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/03/2023] [Accepted: 04/04/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Medication taking is a complex multidimensional behavior that may be impeded by a range of biological and psychosocial factors, including sex and gender. We aimed to synthesize how sex and gender have been reported and analyzed in pharmacoepidemiologic studies of medication. METHODS We searched for English-language peer-reviewed articles of observational studies (eg, cross-sectional, cohort, and case-control) that examined medication adherence among adults and included sex or gender in their reporting. RESULTS We included 937 studies among 530 537 287 participants published between the year 1979 and 2021. Most studies were cross-sectional (47%), lasted ≤ 1 year (35%), examined self-reported adherence (53%), did not assess specific adherence problem(s) (40%), and included medications for cardiovascular conditions (24%) or systemic infections (24%). A quarter of studies (25%) used sex and gender interchangeably, more than one third of studies (36%) that reported gender data likely collected data on sex, and < 1% of studies described sex and gender as distinct variables. Studies of cisgender participants more often reported that females/women experienced greater adherence problems often than males/men (31% vs 20%), particularly discontinuation and cost-related nonadherence. Only 21 studies (2%) reported on transgender individuals, and these predominantly examined antiretroviral medications for HIV. CONCLUSIONS Our review revealed substantial conflation of sex and gender in studies of medication adherence and a paucity of research among transgender individuals. Moreover, our synthesis showed sex/gender disparities in medication taking with studies reporting greater medication adherence problems among cisgender women and transgender participants than cisgender men.
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Affiliation(s)
- Nevena Rebić
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Centre of Canada, Vancouver, Canada
| | - Michael R Law
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacquelyn Cragg
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ursula Ellis
- Woodward Library, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ria Garg
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamie Y Park
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Centre of Canada, Vancouver, Canada; Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada.
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18
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Mirlashari J, Pederson A, Lyons J, Brotto LA. "Don't Turn a Blind Eye": An Instruction for Supporting Meaningful Conversations About Gender-Based Violence During Perinatal Care. Can J Nurs Res 2023; 55:354-364. [PMID: 37128631 DOI: 10.1177/08445621231171976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Evidence suggests that Gender-based violence (GBV) is prevalent throughout the perinatal period. Women during this time have frequent contact with healthcare providers (HCPs), and there are many opportunities that HCPs can identify GBV and support women by early intervention during routine prenatal care. However, evidence shows that HCPs are still hesitant to address this issue. This study was conducted to explore the experiences of Survivors and HCPs on how to manage a meaningful conversation about GBV with survivors during perinatal care. METHODS A thematic approach has been used in this qualitative study. RESULTS Twenty-eight semi-structured interviews were conducted with survivors and HCPs. Three main themes emerged from the data analysis, including: "Knock gently on the door to enter the client's private world", "Show interest in clients' stories that are beyond their physical problems" and "Gradually and cautiously cross the hidden borders." CONCLUSION HCPs play a pivotal role in identifying GBV and providing support for survivors, particularly during their perinatal period. However, initiating a conversation around this sensitive topic needs time, skill, and enough knowledge. Validating survivors' experiences, providing a private and safe atmosphere without judgment, and creating empathy could lead to more disclosure of GBV. To have a meaningful conversation, HCPs need to have a holistic approach toward care, show interest in clients' stories beyond their physical problems, and support clients who have shared sensitive information.
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Affiliation(s)
| | - Ann Pederson
- School of Population and Public health, University of Brithish Columbia, Women's Health Research institute. Vancouver, Canada
| | - Janet Lyons
- Medical Lead, High-Risk Obstetrics BCWH, Clinical Associate Professor, Division of General Gynecology & Obstetrics, University of British Columbia, BC Women's Hospital, Provincial Health Services Authority, Vancouver, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Executive Director of WHRI, Vancouver, Canada
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19
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Lavery BM, Nelson M, Firican D, Prestley N, Kumru R, Jabs F, O'Loughlin J, Brotto LA. #DebunkingDesire: Sexual Science, Social Media, and Strategy in the Pursuit of Knowledge Dissemination. J Sex Marital Ther 2023; 50:1-17. [PMID: 37566559 DOI: 10.1080/0092623x.2023.2243923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Approximately 1 in 3 women experience low sexual desire. Despite this being a common concern, many women never seek professional help for their difficulties and will instead turn to online resources for information. We sought to address this need for digitally-accessible, evidence-based information on low sexual desire by creating a social media Knowledge Translation (KT) campaign called #DebunkingDesire. Our team led a 10 month social media campaign where our primary outcomes for the campaign were impressions, reach, and engagement. We generated over 300,000 social media impressions; appeared on 11 different podcasts that were listened to/downloaded 154,700 times; hosted and participated in eight online events; and attracted website users from 110 different countries. Over the course of the campaign we compiled lessons learned on what worked for disseminating our key messages and the importance of creating community for this population. These findings point to the utility of using social media as part of KT campaigns in sexual health, and to the importance of collaborating with patient partners and considering social media ads and podcasts to meet reach goals.
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Affiliation(s)
- Brynn M Lavery
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Melissa Nelson
- Women's Health Research Institute, BC Women's Hospital and Health Care, Vancouver, Canada
| | | | - Nicole Prestley
- Women's Health Research Institute, BC Women's Hospital and Health Care, Vancouver, Canada
| | - Rayka Kumru
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Faith Jabs
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Julia O'Loughlin
- Department of Educational and Counselling Psychology, University of British Columbia, Vancouver, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Care, Vancouver, Canada
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20
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Merwin KE, Brotto LA. Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach. Arch Sex Behav 2023; 52:2249-2260. [PMID: 37253921 PMCID: PMC10228892 DOI: 10.1007/s10508-023-02617-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023]
Abstract
Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.
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Affiliation(s)
- Kathleen E Merwin
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Borderline Personality Disorder Treatment Program, Mental Health and Addictions Program, Nova Scotia Health Authority, Dartmouth, NS, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, Faculty of Medicine, UBC Sexual Health Research, University of British Columbia, 2775 Laurel Street, 6th Floor Gordon & Leslie Diamond Health Care Centre, Vancouver, BC, V5Z 1M9, Canada.
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21
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Thomas HN, Brotto LA, de Abril Cameron F, Yabes J, Thurston RC. A virtual, group-based mindfulness intervention for midlife and older women with low libido lowers sexual distress in a randomized controlled pilot study. J Sex Med 2023:qdad081. [PMID: 37353906 PMCID: PMC10390320 DOI: 10.1093/jsxmed/qdad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/22/2023] [Accepted: 05/03/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Distressing low libido is common among women and has significant negative impacts; mindfulness has shown promise to increase sexual desire in women with low libido, but existing interventions are not tailored to midlife and older women. AIM We adapted a mindfulness intervention to meet the needs of this population and conducted a pilot randomized controlled trial to assess feasibility and acceptability. METHODS Women aged ≥45 years with low libido were randomized to the mindfulness intervention or an education group that met over videoconferencing. The intervention included mindfulness instruction and practice, group discussion, and education on sexuality and aging. The education group included general information on menopause and health. OUTCOMES We defined feasibility by the number of screened women who enrolled and completed their group. We defined acceptability as satisfaction with the group and likelihood of recommending it to another woman with low libido. We assessed sexual function (Female Sexual Function Index) and sexual distress (Female Sexual Distress Scale-Revised) at 6 weeks postconclusion. RESULTS Of 81 women screened, 31 were randomized to mindfulness and 30 to education. Eighteen women in the intervention group and 23 in the control group attended at least 1 session. Time conflict was the main reason for nonattendance. Of the 41 women who started attending groups, 37 (90%) attended at least 5 sessions. In the mindfulness group, 73% of women were very or extremely satisfied. Women in the mindfulness group were more likely to recommend it to another person with low libido as compared with those in the education group (P = .031); 67% said that they would probably or definitely recommend it. There were no significant changes in sexual function in either group (mean Female Sexual Function Index score, 22.6 to 18.6 [P = .101] with mindfulness and 21.2 to 19.7 [P = .537] with education). Women in the mindfulness group had significant improvements in sexual distress (mean Female Sexual Distress Scale-Revised score, 27.1 to 19.7; P = .021) while women in the education group did not (19.0 to 15.8; P = .062). CLINICAL IMPLICATIONS Mindfulness may reduce sexual distress in older women with low libido. STRENGTHS AND LIMITATIONS This is the first trial testing mindfulness for midlife and older women with low libido. CONCLUSION A virtual mindfulness intervention for midlife and older women with low libido is feasible and acceptable and appears to improve sexual distress as compared with an education control; these findings provide data that can be used to design a larger clinical trial.
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Affiliation(s)
- Holly N Thomas
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15217, United States
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver V5Z 4M2, Canada
| | - Flor de Abril Cameron
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15217, United States
| | - Jonathan Yabes
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15217, United States
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15217, United States
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Bhanji A, Kaida A, Roche J, Kilpatrick E, Anam F, Nicholson V, Muchenje M, Brotto LA, Carter A. 'HIV made me fabulous': a qualitative analysis of embodied storytelling in film to address stigma, further understandings of U=U and advance gender equity. Sex Health 2023:SH23052. [PMID: 37344190 DOI: 10.1071/sh23052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Even with the Undetectable equals Untransmittable campaign (U=U) campaign, women living with HIV continue to experience intersecting forms of stigma. We explored how the somatic experiences of viewing a film about U=U and women could help individuals gain deeper understandings of HIV and alter learned prejudices. METHODS HIV Made Me Fabulous is a film that utilises embodied storytelling to tell the story of a trans woman living through social and historical traumas of HIV. Four online film screenings and focus group discussions took place between June 2020 and June 2021, with participants attending from Canada, Australia, South Africa, Kenya, Zimbabwe and India. Two sessions were held with women living with HIV (n=16) and two with HIV-negative individuals (n=12). Transcripts were analysed via thematic analysis using Lafrenière and Cox's framework to assess its impact. RESULTS Participants experienced strong, diverse emotional responses and sometimes physical effects from viewing the film. These somatic experiences furthered engagement with key messages in the film, including U=U, intersectional identities, and impacts of patriarchal systems. Women living with HIV commented on unique gendered risks experienced during disclosure, and the pressures of reaching an undetectable viral load. Women also commented how the film resulted in deeper reflection of their deservingness of pleasure. Regardless of HIV status, participants expressed motivation towards influencing change that included addressing biases and sharing U=U with others. CONCLUSIONS Embodied storytelling in film is an effective method to counter both intra- and inter-personal HIV-related stigma by provoking responses that enhance compassion for oneself and others.
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23
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Brotto LA, Zdaniuk B, Chivers ML, Jabs F, Grabovac AD, Lalumière ML. Mindfulness and Sex Education for Sexual Interest/Arousal Disorder: Mediators and Moderators of Treatment Outcome. J Sex Res 2023; 60:508-521. [PMID: 36178481 DOI: 10.1080/00224499.2022.2126815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Sexual Interest/Arousal Disorder (SIAD) is a common sexual dysfunction in women. Both mindfulness-based cognitive therapy (MBCT) plus psychoeducation and sex therapy, education, and support (STEP; which contains the same educational information as in the MBCT arm but also integrates supportive-expressive therapy), are effective. We tested mediators and moderators of improvements. Each treatment arm consisted of eight sessions delivered weekly, and participants completed measures online pre-treatment, immediately post-treatment, and at 6- and 12-month post-treatment. Depression, self-reported interoceptive awareness, self-compassion, self-criticism, and mindfulness were examined as mediators, and expectations for improvement as a moderator. Of 148 cisgender women who consented, 70 were randomized to the MBCT plus psychoeducation group (mean age 39.3 ± 13.2 yrs) and 78 to the STEP group (mean age 37.9 ± 12.2 yrs). Decreases in depression mediated decreases in sexual distress in the MBCT plus psychoeducation group only. Improvements in interoceptive awareness mediated changes in both sexual desire and arousal, and sexual distress, and to a greater degree after MBCT plus psychoeducation. Changes in self-compassion mediated changes in sexual desire and arousal only for the MBCT plus psychoeducation group and mediated changes in sexual distress in both groups. Reductions in self-criticism mediated improvements in sexual distress to a greater extent after MBCT plus psychoeducation. Changes in mindfulness predicted changes in desire and arousal, and distress only in the MBCT plus psychoeducation group. Expectations for improvement did not moderate any outcomes. The findings have implications for understanding common and potentially distinct pathways by which MBCT plus psychoeducation and supportive sex education improve symptoms of SIAD.
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynecology, University of British Columbia
| | | | - Faith Jabs
- Department of Obstetrics and Gynecology, University of British Columbia
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24
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Oveisi N, Khan Z, Brotto LA. A qualitative study of sexual health and function of females with pelvic cancer. Sex Med 2023; 11:qfac002. [PMID: 36910701 PMCID: PMC9978583 DOI: 10.1093/sexmed/qfac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/06/2022] [Accepted: 09/22/2022] [Indexed: 03/06/2023] Open
Abstract
Background Pelvic cancers are among the most common cancers, impacting millions of individuals worldwide annually. However, little is known about the impact of more rare pelvic cancers on the sexual health of females. Aim In this study we explored sexual health experiences of female pelvic cancer survivors (FPCS) and their healthcare providers (HCP) in order to identify the most salient impacts of pelvic cancer on sexual function. Methods In this qualitative study, semi-structured online interviews were conducted with 15 female patients with vulvar, vaginal, uterine, ovarian, endometrial, cervical, bladder, and/or colorectal cancers. Additionally, semi-structured online interviews were conducted with HCPs who treat pelvic cancers (n = 9). For data analysis, qualitative framework analysis was used. Outcomes We used the collected data and analysis of findings to establish recommendations including ways to improve sexual health and function in female survivors of pelvic cancer. Results Most FPCS experienced negative impacts on their sexual health and function through increased pain and dryness, bleeding due to atrophy, decreased libido, and psychosocial issues such as body dysmorphia. Females with the rarer vulvar and vaginal cancers faced additional challenges to their sexual health such as shortening of vaginal canals, high levels of neuropathy, lack of sexual activity with their partners, and suicidal ideation. FPCS had unmet sexual health needs, which can be attributed to lack of appropriate training by HCPs and lack of resources and availability of services. Although HCPs recognized the importance of providing sexual healthcare, they lacked confidence in their ability to facilitate a conversation on sexual health with their patients, and often avoided this topic. Clinical implications The sexual health outcomes of FPCS can be improved by providing targeted training for HCPs, developing standard resources for sexual health, and integrating tiers of support, including group interventions and counseling. Strengths and limitations The main strength of this study is that data were collected from HCPs as well as FPCS, thus providing a more in-depth overall picture of the current strengths and weaknesses of the resources for sexual health support available for this patient population. A limitation of this study is that the experiences of transgender men were not captured. Conclusions Sexual difficulties are very common in all FPCS, particularly survivors of vulvar and vaginal cancers. Improvement of sexual health outcomes is needed in this patient population, which can be achieved by providing more training for HCPs, developing robust resources for FPCS and their sexual health, and providing more opportunities for tiered support.
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Affiliation(s)
- Niki Oveisi
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada
| | - Zeba Khan
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, British Columbia, V5Z 1M9, Canada
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25
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Yang EC, Koenig NA, Gong M, Brotto LA, Barr AM, Lee T, Yong PJ, Geoffrion R. Cannabis use preferences in women with myofascial pelvic pain: A cross-sectional study. Eur J Obstet Gynecol Reprod Biol X 2023; 18:100192. [PMID: 37095765 PMCID: PMC10121619 DOI: 10.1016/j.eurox.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 03/02/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023] Open
Abstract
Objective Myofascial tenderness is present in most chronic pelvic pain conditions and causes significant distress to patients. Treatment is challenging and often not curative. Cannabis is often used for self-management of chronic pelvic pain. However, we do not know which concentrations and routes of administration are most acceptable to users. We aimed to investigate patterns and willingness of cannabis product use among both habitual users and non-users with myofascial pelvic pain (MPP), to inform therapeutic development. Study design We conducted a cross-sectional study of questionnaire responses from female patients with MPP from two tertiary pelvic pain centers. We aimed for a convenience sample of 100 responses with representation from both centers. Inclusion criteria were age over 18 with pelvic floor muscle tenderness on standard gynecologic examination. We collected information on demographics, pelvic pain history, cannabis use status, cannabis use preferences, validated opioid misuse risk assessment, and interest in using gynecologic cannabis products and used descriptive analyses. Results 77/135 (57 %) questionnaire respondents were cannabis users and 58 (43 %) were non-users. Most users consume cannabis daily, (48.1 %) orally (66.2 %) or by smoking (60.7 %), and rated cannabis as effective at relieving pelvic pain. 37/58 (63.8 %) non-cannabis users responded that they would be willing to use cannabis for pelvic pain. Lack of information and potential adverse effects were the most common reasons for unwillingness to use. Approximately 3 of 4 respondents were willing to try vaginal or vulvar application of cannabis products for pelvic pain. Conclusions This cross-sectional study describes cannabis use patterns in MPP patients. Topical vulvar and vaginal cannabis products are of strong interest to both cannabis users and non-users and warrant further research.
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Affiliation(s)
- Emily C. Yang
- University of British Columbia, Vancouver, BC, Canada
- Correspondence to: St. Paul’s Hospital, Department of Obstetrics and Gynecology, Suite 930, 1125 Howe Street, Vancouver, BC, Canada V6Z 2K8.
| | | | - Merry Gong
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Terry Lee
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC, Canada
| | - Paul J. Yong
- University of British Columbia, Vancouver, BC, Canada
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26
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Kemerer BM, Zdaniuk B, Higano CS, Bossio JA, Camara Bicalho Santos R, Flannigan R, Brotto LA. A randomized comparison of group mindfulness and group cognitive behavioral therapy vs control for couples after prostate cancer with sexual dysfunction. J Sex Med 2023; 20:346-366. [PMID: 36763954 DOI: 10.1093/jsxmed/qdac038] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/17/2022] [Accepted: 11/22/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sexual dysfunction is the most common and most distressing consequence of prostate cancer (PCa) treatment and has been shown to directly affect the sexual function and quality of life of survivors' partners. There are currently no established therapies to treat the emotional and psychological burden that sexual issues impose on the couple after PCa. AIM Our study examined the impact of 2 therapies-cognitive behavioral therapy (CBT) and mindfulness therapy-on sexual, relational, and psychological outcomes of PCa survivor and partner couples. METHODS PCa survivors (n = 68) who self-reported current sexual problems after PCa treatments and their partners were randomized to 4 consecutive weeks of couples' mindfulness therapy, couples' CBT, or no treatment (control). OUTCOMES Couples' sexual distress, survivors' sexual satisfaction, and couples' relationship satisfaction, quality of life, psychological symptoms (anxiety and depression), and trait mindfulness were measured at baseline, 6 weeks after treatment, and 6 months after treatment. RESULTS Sexual distress and sexual satisfaction were significantly improved 6 weeks after the CBT and mindfulness interventions as compared with the control group, but only sexual distress remained significantly improved at 6 months. Relationship satisfaction decreased and more so for partners than survivors. There were increases in domains of quality of life for survivors vs their partners 6 months after treatments and an overall increase in general quality of life for couples 6 weeks after mindfulness. There were no significant changes in psychological symptoms and trait mindfulness. Qualitative analysis showed that the mindfulness intervention led to greater personal impact on couple intimacy after the study had ended. CLINICAL IMPLICATIONS CBT and mindfulness can be effective treatments for helping couples adapt to and cope with changes to their sexual function after PCa treatments and could help improve the most common concern for PCa survivors-that is, couples' sexual intimacy-after cancer, if added to routine clinical care. STRENGTHS AND LIMITATIONS We used established standardized treatment manuals and highly sensitive statistical methodology and accounted for covariable factors and moderators of primary outcomes. Due to difficulty in recruitment, we had a smaller control group than treatment, reducing our power to detect between-group differences. Our sample was mostly White, heterosexual, and affluent, thereby limiting the generalizability. CONCLUSION This is the first randomized clinical trial to test and demonstrate benefits among PCa survivors and partners' sexual outcomes after CBT and mindfulness as compared with a nontreatment control group.
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Affiliation(s)
- Bibiana M Kemerer
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Celestia S Higano
- Prostate Cancer Supportive Care Program, Vancouver Coastal Health, Vancouver, BC, V5Z 1M9, Canada.,Department of Urologic Sciences, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Jennifer A Bossio
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON K7L 2V7, Canada.,Department of Urology, Queen's University, Kingston, ON K7L 2V7, Canada
| | | | - Ryan Flannigan
- Prostate Cancer Supportive Care Program, Vancouver Coastal Health, Vancouver, BC, V5Z 1M9, Canada.,Department of Urologic Sciences, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada.,Department of Urology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
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27
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Milani S, Zhang JY, Zdaniuk B, Bogaert A, Rieger G, Brotto LA. Examining Visual Attention Patterns among Asexual and Heterosexual Individuals. J Sex Res 2023; 60:271-281. [PMID: 35674497 DOI: 10.1080/00224499.2022.2078768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Asexuality has garnered much attention, and empirical data support its classification as a sexual orientation. Asexuality is defined as a lack of sexual attraction to others, with approximately 1% of the population falling in this category. As theoretical models situate attention as a central component of sexual response, the current study examined attentional processing of erotic stimuli in asexuals and heterosexuals. We hypothesized that heterosexual participants would have initial and controlled visual attention patterns favoring erotic images over non-erotic images. We predicted that asexual participants would have significantly smaller or non-existent differences in attention to erotic versus non-erotic images. Ninety-five adults completed an eye-tracking task viewing erotic and non-erotic images. Eye-tracking data showed no group differences in initial attention to erotic images. For controlled attention, there was a large effect size in the hypothesized direction. Heterosexual participants exhibited more and longer fixations on erotic images, whereas asexuals exhibited a more even distribution of attention across image types. Exploratory analysis of group differences in the association between visual attention and ratings of sexual attractiveness revealed a complex pattern of differences, with some indication of a stronger association between total fixation and sexual attraction for heterosexual participants. These findings suggest that differences in attention to sexual stimuli may represent key underlying differences between asexual and allosexual orientation. Findings also contribute to the larger literature on visual attention and attraction.
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Affiliation(s)
- Sonia Milani
- Department of Obstetrics and Gynaecology, University of British Columbia
| | - Jia Yu Zhang
- Department of Obstetrics and Gynaecology, University of British Columbia
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia
| | | | | | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia
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28
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Abstract
Human asexuality has been defined as a lack of sexual attraction to others, although its nature is not well understood. Asexual men's genital and subjective sexual arousal patterns were compared to sexual men's to better understand asexual men's sexual response patterns. Using a penile plethysmograph to measure genital arousal, 20 asexual, 27 heterosexual, and 22 gay cisgender men (M age = 28.28, SD = 9.41) viewed erotic films depicting sexual activity or masturbation, and a subsample engaged in sexual fantasy of their choosing. Questionnaires assessing sexual function and behavior were also completed. Asexual men scored lower on sexual desire and orgasmic function, higher on sexual aversion, and did not differ on overall sexual satisfaction. Compared with gay and heterosexual men, asexual men demonstrated lower genital and subjective sexual arousal to the erotic films but displayed similar sexual arousal when engaging in sexual fantasy. Asexual men's lower levels of sexual excitation rather than their higher levels of sexual inhibition were associated with lower responses to the erotic films. These findings suggest asexual men have preferred sexual stimuli that differ from sexual men and have a similar capacity for sexual arousal as sexual men. Collectively these findings add to a growing literature aiming to understand the nature of asexuality.
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Affiliation(s)
- Malvina N Skorska
- Child & Youth Psychiatry, Centre for Addiction and Mental Health, Brock University
| | | | | | - Lori A Brotto
- Department of Obstetrics & Gynaecology, University of British Columbia
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29
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Zhang JY, Jabs F, Brown NB, Milani S, Brotto LA. The Impact of Loosening COVID-19 Restrictions and Live-in Partner Status on Sexual and Mental Health in a Canadian Sample. Int J Sex Health 2023; 35:139-151. [PMID: 38596767 PMCID: PMC10903576 DOI: 10.1080/19317611.2022.2163446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/22/2022] [Accepted: 12/21/2022] [Indexed: 04/11/2024]
Abstract
Objectives We examined changes in frequency of sexual behaviors, dyadic sexual desire, relationship satisfaction, and COVID-19 stress in Canadians across the pandemic, considering partner status. Methods Participants completed online questionnaires. Results Participants with live-in partners and single participants decreased in dyadic sexual behaviors. In August-September 2020, participants with live-in partners engaged in more dyadic sexual behaviors than single participants. In November 2021, all partnered participants engaged in more dyadic sexual behaviors than single participants. Decreases in COVID-19 stress were observed. Conclusions Findings suggest that despite decreases in COVID-19 stress, there may be long-lasting pandemic impacts on sexual behaviors.
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Affiliation(s)
- Jia Yu Zhang
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Faith Jabs
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Natalie B. Brown
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Sonia Milani
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Lori A. Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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30
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Garcia de leon R, Baaske A, Albert AY, Booth A, Racey CS, Gordon S, Smith LW, Gottschlich A, Sadarangani M, Kaida A, Ogilvie GS, Brotto LA, Galea LA. Higher perceived stress during the COVID-19 pandemic increased menstrual dysregulation and menopause symptoms. Womens Health (Lond) 2023; 19:17455057231199051. [PMID: 37732492 PMCID: PMC10515540 DOI: 10.1177/17455057231199051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The increased stress the world experienced with the coronavirus disease (COVID-19) pandemic affected mental health, disproportionately affecting females. However, how perceived stress in the first year affected menstrual and menopausal symptoms has not yet been investigated. OBJECTIVES This study evaluates the effect that the first year of the COVID-19 pandemic had on female reproductive and mental health. METHODS Residents in British Columbia, Canada, were surveyed online as part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex. A subgroup of participants (n = 4171), who were assigned female sex at birth (age 25-69 years) and were surveyed within the first 6-12 months of the pandemic (August 2020-February 2021), prior to the widespread rollout of vaccines, was retrospectively asked if they noticed changes in their menstrual or menopausal symptoms, and completing validated measures of stress, depression and anxiety. DESIGN This is a population-based online retrospective survey. RESULTS We found that 27.8% reported menstrual cycle disturbances and 6.7% reported increased menopause symptoms. Those who scored higher on perceived stress, depression and anxiety scales were more likely to report reproductive cycle disturbances. Free-text responses revealed that reasons for disturbances were perceived to be related to the pandemic. CONCLUSION The COVID-19 pandemic has highlighted the need to research female-specific health issues, such as menstruation. Our data indicate that in the first year of the pandemic, almost one-third of the menstruating population reported disturbances in their cycle, which was related to percieved stress, depression and anxiety scores.
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Affiliation(s)
| | | | | | - Amy Booth
- Women’s Health Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - C. Sarai Racey
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Shanlea Gordon
- Women’s Health Research Institute, Vancouver, BC, Canada
| | | | - Anna Gottschlich
- Women’s Health Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Angela Kaida
- Women’s Health Research Institute, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Gina S. Ogilvie
- Women’s Health Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Lori A. Brotto
- Women’s Health Research Institute, Vancouver, BC, Canada
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, BC, Canada
| | - Liisa A.M. Galea
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
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31
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Sears C, Millman R, Brotto LA, Walker LM. Feasibility and Acceptability of a Group-Based Mindfulness Intervention for Sexual Interest/Arousal Disorder Following Breast Cancer Treatment. J Sex Marital Ther 2022; 49:533-549. [PMID: 36573823 DOI: 10.1080/0092623x.2022.2154296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
This study aimed to assess feasibility and preliminary efficacy of an 8-week Mindfulness-Based Cognitive Therapy (MBCT) group program to treat Sexual Interest/Arousal Disorder (SIAD) in women following breast cancer (BrCa) treatment. Thirty women participated, of whom 67% (n = 20) attended at least 6 of 8 group sessions. Feedback indicated the program was relevant and valuable; minor modifications were suggested to further address survivorship concerns. Results of pre-post questionnaires demonstrated significant improvements in sexual distress and sexual interest/desire, with large effect sizes. Results support the feasibility and preliminary efficacy of an 8-week MBCT program among women following breast cancer treatment.
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Affiliation(s)
- Carly Sears
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Roanne Millman
- West Coast Centre for Sex Therapy, Vancouver, British Columbia, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren M Walker
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Arnie Charbonneau Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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32
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Sharma B, Racey CS, Booth A, Albert A, Smith LW, Gottschlich A, Goldfarb DM, Murray MC, Galea LA, Kaida A, Brotto LA, Sadarangani M, Ogilvie GS. Characterizing intentions to receive the COVID-19 vaccine among the general population in British Columbia based on their future intentions towards the seasonal influenza vaccine. Vaccine X 2022; 12:100208. [PMID: 35996447 PMCID: PMC9387116 DOI: 10.1016/j.jvacx.2022.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction This study assessed the relationship between intention to receive a COVID-19 vaccine and intention to receive a seasonal influenza vaccine, as well as how intention to receive a COVID-19 vaccine has changed during the pandemic. Methods Residents of British Columbia aged 25–69 years were invited to complete an online cross-sectional survey from August 2020 - March 2021. Mixed-effects logistic regression models assessed the relationship between intention to receive a COVID-19 vaccine and intention to receive the seasonal influenza vaccine. A generalized additive mixed model was used to investigate changes in COVID-19 vaccine intention during the pandemic (August 2020–March 2021). The relationship between intention to receive a COVID-19 vaccine and retrospective overall perceived value of vaccines prior to and during the pandemic was also considered. Results Of 6,333 participants, 80.2 % of participants were ‘somewhat or very likely’ to receive a COVID-19 vaccine and 69 % of participants reported intending to receive a seasonal influenza vaccine. In multivariable modeling, intention to receive a COVID-19 vaccine was strongly associated with intention to receive a seasonal influenza vaccine (aOR = 4.25, 95 %CI 3.33–5.43). Intention to receive a COVID-19 vaccine increased over the study period (p < 0.0001), with the largest increase coinciding with the announcement of forthcoming approvals of COVID-19 vaccines in November 2020 (aOR = 1.45, 95 %CI 1.11–1.91). Conclusion Intention to receive the COVID-19 vaccine was associated seasonal influenza vaccine intention, which is an important relationship to measure for implementation and future planning of COVID-19 booster doses. We found an increase in the intention to receive a COVID-19 vaccine after public announcements of forthcoming vaccine approval, which highlights the importance of ongoing monitoring and reporting of vaccine uptake, and the potential impact of emerging vaccine safety and efficacy information may have on vaccine acceptance.
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Affiliation(s)
- Bhawna Sharma
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - C. Sarai Racey
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Amy Booth
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, British Columbia V6H 2N9, Canada
| | - Arianne Albert
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, British Columbia V6H 2N9, Canada
| | - Laurie W. Smith
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, British Columbia V6H 2N9, Canada
- Cancer Control Research, BC Cancer Agency, 675 W 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Anna Gottschlich
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, British Columbia V6H 2N9, Canada
| | - David M. Goldfarb
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
- Department of Pathology and Laboratory Medicine, BC Children’s and Women’s Health Centre, 4500 Oak Street, Vancouver, British Columbia V6H 3N1, Canada
| | - Melanie C.M. Murray
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, British Columbia V6H 2N9, Canada
| | - Liisa A.M. Galea
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, British Columbia V6H 2N9, Canada
- Department of Psychology, Djavad Mowifaghian Centre for Brain Health, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Angela Kaida
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, British Columbia V6H 2N9, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Lori A. Brotto
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, British Columbia V6H 2N9, Canada
| | - Manish Sadarangani
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
- BC Children’s Hospital Research Institute, 938 W 28th Avenue, Vancouver, British Columbia V5Z 4H4, Canada
- Vaccine Evaluation Centre, 950 W 28th Avenue, Vancouver, British Columbia V5Z 4H4, Canada
| | - Gina S. Ogilvie
- BC Centre for Disease Control, Provincial Health Services Authority, 655 West 12th Avenue, Vancouver, British Columbia, V5Z 4R4, Canada
- Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, British Columbia V6T 1Z4, Canada
- Women’s Health Research Institute, 4500 Oak Street, Vancouver, British Columbia V6H 2N9, Canada
- Corresponding author at: 4500 Oak Street, BC Women’s Hospital, Vancouver, BC.
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Mirlashari J, A. Brotto L, Lyons J, Pederson A. The Experiences of Women and Healthcare Providers in Assessing the History of Gender-Based Violence During Perinatal Care. Violence Against Women 2022; 28:3291-3310. [PMID: 35765236 PMCID: PMC9530537 DOI: 10.1177/10778012221077125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Despite its prevalence and consequences, perinatal healthcare providers' identification of gender-based violence (GBV) remains controversial in British Columbia. This study investigated women and healthcare providers' perspectives regarding their experiences with and views of inquiring about GBV during perinatal care. Twelve in-depth interviews were conducted with women with a history of GBV and 16 perinatal healthcare providers. Data were analyzed thematically. Three themes, including "barriers to disclosure," "healthcare providers hesitate to open Pandora's Box," and "how to ask in a culturally safe way," emerged from the data. Study participants support inquiry about GBV during perinatal healthcare.
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Affiliation(s)
- Jila Mirlashari
- Women's Health Research Institute, Department of OBGYN, University of British
Columbia, Vancouver, Canada
- School of Nursing and Midwifery, Tehran University of Medical
Sciences, Tehran, Iran
| | - Lori A. Brotto
- Women's Health Research Institute, Department of OBGYN, University of British
Columbia, Vancouver, Canada
| | - Janet Lyons
- Division of General Gynecology & Obstetrics, BC Women's
Hospital, Provincial Health Services Authority, Vancouver, Canada
| | - Ann Pederson
- School of Population and Public Health, BC Centre of Excellence for
Women's Health, Vancouver, Canada
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Chankasingh K, Booth A, Albert A, Kaida A, Smith LW, Racey CS, Gottschlich A, Murray MC, Sadarangani M, Ogilvie GS, Galea LA, Brotto LA. Coping during the COVID-19 pandemic: A mixed methods approach to understand how social factors influence coping ability. Heliyon 2022; 8:e10880. [PMID: 36247143 PMCID: PMC9536866 DOI: 10.1016/j.heliyon.2022.e10880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/12/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
The COVID-19 pandemic and public health protection measures aimed at mitigating the transmission of the virus have both resulted in tremendous physical and mental health impacts. The study at hand used a gender-based analysis and social determinants of health approach to investigate which communities had trouble coping during times of strict protection measures and symptoms and strategies employed during the COVID-19 pandemic. Participants were recruited from previously established cohorts as a part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE) study. Being a young adult, female, woman, gender diverse, low-income earner or LGBTQ/2S+ was significantly associated with not being able to cope during the first wave of the pandemic. The effects for females, women, and gender diverse were attenuated yet still significant when controlling for various covariates. Those who reported not coping were more likely to present maladaptive coping symptoms and strategies. Our findings demonstrate the need to support marginalized communities in coping with the current ongoing COVID-19 pandemic and build proactive support for future pandemics.
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Affiliation(s)
- Kyle Chankasingh
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Amy Booth
- Women's Health Research Institute, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada,Women's Health Research Institute, Vancouver, BC, Canada
| | - Laurie W. Smith
- Women's Health Research Institute, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - C. Sarai Racey
- Women's Health Research Institute, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Melanie C.M. Murray
- Women's Health Research Institute, Vancouver, BC, Canada,Division of Infectious Diseases, Department of Medicine, UBC; Oak Tree Clinic, BC Women's Hospital, Vancouver, BC, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Gina S. Ogilvie
- Women's Health Research Institute, Vancouver, BC, Canada,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Liisa A.M. Galea
- Women's Health Research Institute, Vancouver, BC, Canada,Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Lori A. Brotto
- Women's Health Research Institute, Vancouver, BC, Canada,Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada,Corresponding author.
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35
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Oveisi N, Khan Z, Brotto LA. Relationship of sexual quality of life and mental well-being in undergraduate women in a Canadian university. The Canadian Journal of Human Sexuality 2022. [DOI: 10.3138/cjhs.2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As young women transition from adolescence to adulthood, they begin to explore their sexual identities and sexual relationships. The current literature supports the relationship between sexual quality of life (QOL) and mental well-being. However, this relationship has not yet been replicated in undergraduate women. In order to address this gap, the authors assessed the correlation between sexual QOL and mental well-being among a sample of women undergraduate students in Canada. The study design was cross-sectional in nature, and demographic information was collected, along with the completion of validated measures of sexual QOL and mental well-being. A total of 157 individuals participated. After removing those who did not meet inclusion criteria and those with > 90% incomplete responses, 124 valid survey responses remained for analysis. A hierarchical multivariable linear regression was conducted while controlling for age, sexual orientation, exercise, history of nonconsensual sexual contact, household income, and self-perceived health status. Every one-unit increase in sexual QOL was associated with a 0.35 increase in mental well-being (95% CI 0.105–0.428, p = .002). A history of unwanted or nonconsensual sexual activity had a significant negative correlation with mental well-being ( p = .027). The authors’ findings suggest a significant relationship between sexual QOL and mental well-being. There is a strong opportunity for universities to bolster the support services available to students, with a required focus on women with a history of nonconsensual sexual contact.
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Affiliation(s)
- Niki Oveisi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zeba Khan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lori A. Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
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36
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Racey CS, Booth A, Albert A, Smith LW, Krajden M, Murray MCM, Côté HCF, Gottschlich A, Goldfarb DM, Sadarangani M, Galea LAM, Kaida A, Brotto LA, Ogilvie GS. Seropositivity of SARS-CoV-2 in an unvaccinated cohort in British Columbia, Canada: a cross-sectional survey with dried blood spot samples. BMJ Open 2022; 12:e062567. [PMID: 36038173 PMCID: PMC9438102 DOI: 10.1136/bmjopen-2022-062567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Gathering population-based data on prevalence of SARS-CoV-2 infection is vital to the public health response and planning. Current seroprevalence data in BC are limited with respect to considerations of how socioeconomic and demographic factors, such as age, sex, gender, income, identifying as a visibility minority and occupation, are related to SARS-CoV-2 antibody detection due to infection-acquired immunity. We aimed to estimate the SARS-CoV-2 seropositivity in a cohort of British Columbians, using at-home self-collected dried blood spot (DBS) samples. DESIGN This cross-sectional study included online surveys that collected sociodemographic and COVID-19 vaccine receipt information, and an at-home DBS collection kit. SETTING British Columbia (BC), Canada. PARTICIPANTS Eligible participants were aged 25-69 years and residents of BC. PRIMARY OUTCOME MEASURE SARS-CoV-2 anti-spike IgG antibody detection in unvaccinated individuals. Adjusted incidence rate ratios (aIRR) explored factors associated with seropositivity. RESULTS SARS-CoV-2 serology was performed on a total of 4048 unvaccinated participants 25-69 years of age who submitted DBS samples taken from November 2020 to June 2021. A total of 118 seropositive cases were identified, for an estimated overall seropositivity of 2.92% (95% CI 2.42% to 3.48%). Participants identifying as a visible minority had a higher seropositivity, 5.1% vs 2.6% (p=0.003), compared with non-visible minority participants. After adjustment by age and sex, identifying as a visible minority (aIRR=1.85, 95% CI 1.20 to 2.84) remained the only significant factor associated with SARS-CoV-2 antibody detection in this cohort of unvaccinated individuals. CONCLUSIONS SARS-CoV-2 seropositivity in the BC population due to infection-acquired immunity was low. Seropositivity indicated that among those unvaccinated, visible minority communities have been most impacted. Continued monitoring of SARS-CoV-2 serology due to both infection-acquired and vaccine-acquired immunity will be vital in public health planning and pandemic response.
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Affiliation(s)
- C Sarai Racey
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Amy Booth
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Arianne Albert
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Laurie W Smith
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Melanie C M Murray
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Hélène C F Côté
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
- Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Anna Gottschlich
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - David M Goldfarb
- Pathology and Laboratory Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Liisa A M Galea
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela Kaida
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lori A Brotto
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
- Department of Obstetrics & Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gina S Ogilvie
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Women's Hospital and Health Centre, Women's Health Research Institute, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
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37
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Kaida A, Brotto LA, Murray MCM, Côté HCF, Albert AY, Nicholson V, Gormley R, Gordon S, Booth A, Smith LW, Baaske A, Galea LAM, Sadarangani M, Ogilvie GS. Intention to Receive a COVID-19 Vaccine by HIV Status Among a Population-Based Sample of Women and Gender Diverse Individuals in British Columbia, Canada. AIDS Behav 2022; 26:2242-2255. [PMID: 35020094 PMCID: PMC8753016 DOI: 10.1007/s10461-022-03577-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 12/22/2022]
Abstract
COVID-19 vaccination is recommended for people living with HIV (PLWH), among whom social inequities and co-morbidities may drive risks of COVID-19 infection and outcome severity. Among a provincial (British Columbia) sample, we determined the prevalence of COVID-19 vaccine intention by HIV status and assessed socio-demographic, vaccine hesitancy, and psychological predictors of vaccine intention. Individuals (25-69 years) recruited from province-wide research cohorts and the general public completed an online survey examining COVID-19 impacts (August/2020-March/2021). In an analysis restricted to women and gender diverse participants (n = 5588), we compared intention to receive a recommended COVID-19 vaccine (Very likely/Likely vs Neutral/Unlikely/Very Unlikely) by self-reported HIV status. Logistic regression models assessed the independent effect of HIV status and other factors on COVID-19 vaccine intention. Of 5588 participants, 69 (1.2%) were living with HIV, of whom 79.7% were on antiretroviral therapy. In bivariate analyses, intention to vaccinate was significantly lower among PLWH compared to participants not living with HIV (65.2% vs 79.6%; OR 0.44; 95%CI 0.32-0.60). However, this association was not statistically significant after adjustment for ethnicity, income, education, and essential worker status (aOR 0.85; 95%CI 0.48-1.55). Among PLWH, those with greater vaccine confidence, positive attitudes towards the COVID-19 vaccine, and more strongly influenced by direct and indirect social norms to vaccinate had significantly higher odds of vaccine intention. Tailored messaging is needed to build vaccine confidence, address questions about vaccine benefits, and support informed vaccination decision-making to promote COVID-19 vaccine uptake among women and gender diverse people living with HIV.
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Affiliation(s)
- Angela Kaida
- Faculty of Health Sciences, Simon Fraser University (SFU), Burnaby, BC, Canada.
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada.
| | - Lori A Brotto
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada
- University of British Columbia (UBC), Vancouver, BC, Canada
| | - Melanie C M Murray
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada
- University of British Columbia (UBC), Vancouver, BC, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Hélène C F Côté
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada
- University of British Columbia (UBC), Vancouver, BC, Canada
| | | | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University (SFU), Burnaby, BC, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University (SFU), Burnaby, BC, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Shanlea Gordon
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada
| | - Amy Booth
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada
- University of British Columbia (UBC), Vancouver, BC, Canada
| | - Laurie W Smith
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Ally Baaske
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada
| | - Liisa A M Galea
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada
- University of British Columbia (UBC), Vancouver, BC, Canada
| | - Manish Sadarangani
- University of British Columbia (UBC), Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Gina S Ogilvie
- Women's Health Research Institute (WHRI), Vancouver, BC, Canada
- University of British Columbia (UBC), Vancouver, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
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38
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Baaske A, Brotto LA, Galea LAM, Albert AY, Smith L, Kaida A, Booth A, Gordon S, Sadarangani M, Racey CS, Gottschlich A, Ogilvie GS. Barriers to Accessing Contraception and Cervical and Breast Cancer Screening During the COVID-19 Pandemic. J Obstet Gynaecol Can 2022; 44:1076-1083. [PMID: 35738558 PMCID: PMC9212845 DOI: 10.1016/j.jogc.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 12/02/2022]
Abstract
Objective This study sought to examine how access to contraception and cervical and breast cancer screening in British Columbia, Canada, has been affected by the COVID-19 pandemic. Methods From August 2020 to March 2021, 3691 female residents of British Columbia (age 25–69 y) participated in this study. We used generalized estimating equations to analyze the proportion of females accessing contraception and the proportion having difficulty accessing contraception across the different phases of pandemic control measures, and logistic regression to analyze attendance at cervical and breast cancer screening. We added sociodemographic and biological variables individually into the models. Self-reported barriers to accessing contraception and attending screening were summarized. Results During phases with the highest pandemic controls, self-reported access to contraception was lower (OR 0.94; 95% CI 0.90–0.98; P = 0.005) and difficulty with access was higher (OR 2.74; 95% CI 1.54–4.88; P = 0.001). A higher proportion of adults aged 25–34 years reported difficulty accessing contraception than those aged 35–39 years (P < 0.0001), and participants identifying as Indigenous had higher odds of access difficulties (OR 5.56; 95% CI 2.44–12.50; P < 0.001). Of those who required screening during the COVID-19 pandemic, 62% and 54.5% did not attend at least one of their cervical or breast screening appointments, respectively. Those with a history of breast cancer had significantly higher odds of self-reporting having attended their mammogram appointment compared with those without a history of breast cancer (OR 5.62; 95% CI 2.69–13.72; P < 0.001). The most common barriers to screening were difficulty getting an appointment and appointments being considered non-urgent. Conclusions The COVID-19 pandemic has uniquely affected access to contraception and cancer screening participation for various subgroups. Self-reported data present potential avenues for mitigating barriers.
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Affiliation(s)
| | - Lori A Brotto
- Women's Health Research Institute, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.
| | - Liisa A M Galea
- Women's Health Research Institute, Vancouver, BC; Department of Psychology, University of British Columbia, Vancouver, BC
| | - Arianne Y Albert
- Women's Health Research Institute, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Laurie Smith
- Women's Health Research Institute, Vancouver, BC; Cancer Control Research, BC, Cancer, Vancouver, BC
| | - Angela Kaida
- Women's Health Research Institute, Vancouver, BC; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - Amy Booth
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | | | - Manish Sadarangani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC; Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, BC
| | - C Sarai Racey
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Anna Gottschlich
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Gina S Ogilvie
- Women's Health Research Institute, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
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Zhang SXJ, MacLeod RGK, Parmar G, Orr NL, Wahl KJ, Noga H, Albert A, Flannigan R, Brotto LA, Yong PJ. OHNUT VS WAITLIST CONTROL FOR THE SELF-MANAGEMENT OF ENDOMETRIOSIS-ASSOCIATED DEEP DYSPAREUNIA: A PILOT RANDOMIZED CONTROLLED TRIAL PROTOCOL (Preprint). JMIR Res Protoc 2022; 12:e39834. [PMID: 36972117 PMCID: PMC10131731 DOI: 10.2196/39834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Endometriosis-associated deep dyspareunia is associated with reduced sexual quality of life, lower self-esteem, and impaired sexual function. OBJECTIVE The primary objective is to assess the acceptability of a phallus length reducer (brand name: Ohnut [OhnutCo]), which is a buffer worn over the penis or a penetrating object to reduce endometriosis-associated deep dyspareunia, and the feasibility of a definitive randomized controlled trial (RCT). The secondary objective is to obtain estimates of the effectiveness of the buffer. An embedded substudy will explore the acceptability and the preliminary validity and reliability of a vaginal insert for the self-assessment of deep dyspareunia. METHODS Ours is an investigator-initiated, 2-arm RCT. We will recruit 40 patient participants with diagnosed endometriosis between the ages of 19 and 49 years, as well as their sexual partners. The participating couples will be randomized in a 1:1 ratio into the experimental arm or the waitlist control arm. The length of the study period will be 10 weeks, during which time all participants will record deep dyspareunia severity following each episode of sexual intercourse. In weeks 1 to 4, all patient participants will record deep dyspareunia severity at each sexual encounter. In weeks 5 to 10, participants in the experimental arm will use the buffer during vaginal penetration; participants in the waitlist control arm will continue engaging in vaginal penetration as usual. Participants will complete questionnaires for assessing measures of anxiety, depression, and sexual function at baseline, at 4 weeks, and at 10 weeks. In the substudy, patient participants will self-assess dyspareunia by using a vaginal insert on 2 occasions, at least 1 week apart. The primary outcomes-the acceptability and feasibility of the buffer-will be assessed with descriptive statistics, and the secondary outcome-phallus length reducer effectiveness-will be assessed by using an analysis of covariance-based approach. For the vaginal insert, we will assess acceptability, test-retest reliability, and convergent validity via correlation analyses comparing the use of the insert to clinical examination in terms of dyspareunia assessment outcomes. RESULTS Our pilot will provide initial data on the acceptability and effectiveness of the buffer and the feasibility of the study methodology. The results from our study are expected to be submitted for publication by the spring of 2023. As of September 2021, we have consented 31 couples into the study. CONCLUSIONS Our study will provide preliminary evidence for the self-assessment and management of endometriosis-associated deep dyspareunia. The findings will inform the decision to proceed to a definitive RCT. TRIAL REGISTRATION ClinicalTrials.gov NCT04370444; https://clinicaltrials.gov/ct2/show/NCT04370444. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39834.
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Affiliation(s)
- Sandy X J Zhang
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca G K MacLeod
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Gurkiran Parmar
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Natasha L Orr
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Kate J Wahl
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Heather Noga
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Ryan Flannigan
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Lori A Brotto
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
| | - Paul J Yong
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
- British Columbia Women's Centre for Pelvic Pain & Endometriosis, British Columbia Women's Hospital & Health Centre, Vancouver, BC, Canada
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40
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Brotto LA, Galea LAM. Gender inclusivity in women's health research. BJOG 2022; 129:1950-1952. [PMID: 35596700 DOI: 10.1111/1471-0528.17231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/27/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Liisa A M Galea
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
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Clephane K, O'Loughlin JI, Bodnar TS, Wilson MC, Stariha JT, Craig AN, Weinberg J, Brotto LA, Lorenz TK. Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples. J Sex Med 2022; 19:745-760. [PMID: 35296386 PMCID: PMC9064911 DOI: 10.1016/j.jsxm.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/29/2022] [Accepted: 02/04/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammation has been linked to a variety of mental and physical health outcomes that disproportionately impact women, and which can impair sexual function; thus, there is reason to expect a link between inflammation and women's sexual functioning. AIM To test the hypothesis that higher concentrations of C-reactive protein (CRP), a general biomarker of inflammation, would predict women's lower sexual desire. METHOD As 2 independent research teams, we conducted 3 separate studies (total n = 405) that assessed salivary CRP and various measurements of sexual desire in different women populations. OUTCOMES Female Sexual Function Index, Sexual Desire Inventory-2, Decreased Sexual Desire Screener, and Sexual Interest and Desire Inventory. RESULTS Regardless of the way sexual desire was measured (e.g., state vs trait; general desire vs. desire functioning) and the population sampled (i.e., healthy vs. clinically diagnosed with sexual dysfunction), all the studies revealed null results. CLINICAL IMPLICATIONS While exploratory, the convergence of these null results across studies and researchers suggests that if there is an association between inflammation and women's sexual desire, it is likely very subtle. STRENGTHS & LIMITATIONS Across 2 independent research teams, 3 unrelated studies, and various measurements of sexual desire, results were consistent. These points lend to the generalizability of the results. However, study designs were cross-sectional. CONCLUSIONS Future research may reveal (i) a non-linear threshold effect, such that inflammation does not begin to impact women's sexual desire until it is at a high level, (ii) inflammatory biomarkers other than CRP might be more sensitive in detecting associations between inflammation and desire, should they exist, or (iii) the mechanisms underlying sexual dysfunction may differ between sexes. Clephane K, et al. Lack of Evidence for a Relationship Between Salivary CRP and Women's Sexual Desire: An Investigation Across Clinical and Healthy Samples. J Sex Med 2022;19:745-760.
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Affiliation(s)
- Kirstin Clephane
- University of Nebraska - Lincoln, Center for Brain, Biology and Behavior, Lincoln, NE, USA; University of Nebraska - Lincoln, Psychology Department, Lincoln, NE, USA
| | - Julia I O'Loughlin
- University of British Columbia, Department of Educational and Counselling Psychology, and Special Education, Vancouver, British Columbia, CA, USA
| | - Tamara S Bodnar
- University of British Columbia, Department of Cellular and Physiological Sciences, Vancouver, British Columbia, CA, USA
| | - M Claire Wilson
- Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Jordan Tb Stariha
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, British Columbia, CA, USA
| | - Amber N Craig
- Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Milwaukee, WI, USA
| | - Joanne Weinberg
- University of British Columbia, Department of Cellular and Physiological Sciences, Vancouver, British Columbia, CA, USA
| | - Lori A Brotto
- University of British Columbia, Department of Obstetrics and Gynecology, Vancouver, British Columbia, CA, USA; University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, CA, USA
| | - Tierney K Lorenz
- University of Nebraska - Lincoln, Center for Brain, Biology and Behavior, Lincoln, NE, USA; University of Nebraska - Lincoln, Psychology Department, Lincoln, NE, USA.
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Pederson A, Mirlashari J, Lyons J, Brotto LA. How to Facilitate Disclosure of Violence while Delivering Perinatal Care: The Experience of Survivors and Healthcare Providers. J Fam Violence 2022; 38:571-583. [PMID: 35342223 PMCID: PMC8938212 DOI: 10.1007/s10896-022-00371-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
Gender-based Violence (GBV) during the perinatal period is a serious concern as it is associated with many adverse outcomes for both the mother and the baby. It is well known that violence is under-reported. Thus, official statistics (both police reports and survey data) underestimate the prevalence of violence in general and during the perinatal period specifically. In this study conducted in Canada, we sought to explore the barriers to and facilitators of women disclosing their experiences of GBV within healthcare services to safely facilitate more disclosure in the future and reduce the harms that arise from GBV. We used thematic analysis to analyze in-depth interviews with 16 healthcare providers (nurses, midwives and physicians) and 12 survivors of GBV. The data reflect three main themes: "raising awareness of gender-based violence", "creating a shift in the healthcare system's approach toward gender-based violence" and "providing support for survivors and care providers." Our findings suggest that the healthcare system should increase its investments in raising awareness regarding GBV, training healthcare providers to respond appropriately, and building trust between survivors and healthcare providers. Healthcare providers need to be aware of their role and responsibility regarding identifying GBV as well as how to support survivors who talk about violence. Expanding a relationship-based approach in the care system and providing support for both survivors and health care providers would likely lead to more disclosures.
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Affiliation(s)
- Ann Pederson
- Population Health School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jila Mirlashari
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Janet Lyons
- Division of General Gynecology & Obstetrics, University of British Columbia, BC Women’s Hospital, Provincial Health Services Authority (PHSA), Vancouver, Canada
| | - Lori A. Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
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43
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Carter A, Gormley B, Muchenje M, Zhu D, Patterson S, Kestler M, Hankins C, Logie CH, Brotto LA, Tharao W, Lee M, Li J, Ding E, de Pokomandy A, Loutfy M, Kaida A. Prevalence and correlates of sexual concerns and associated distress among women living with HIV in Canada. Womens Health (Lond Engl) 2022; 18:17455065221074877. [PMID: 35088623 PMCID: PMC8801632 DOI: 10.1177/17455065221074877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We assessed the prevalence and correlates of sexual concerns and associated distress among women living with HIV in Canada. Methods: We analyzed cross-sectional survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (2017–2018). Self-identified women living with HIV were asked about sexual concerns post-HIV diagnosis and associated distress (none, mild, moderate, severe). Five areas of concern were assessed, including difficulties related to sexual self-esteem, sexual function, relationships, and emotional and behavioral aspects of sex. Logistic regression analyses identified correlates of reporting any sexual concerns and severe distress about these concerns. Results: Of 906 participants (median age 48, Q1–Q3 = 41–55), 596 (65.8%) reported sexual concerns post-HIV diagnosis. We found a high prevalence of concerns related to relationships (43.3%), sexual self-esteem (49.4%), and emotional aspects of sex (45.4%), relative to sexual functioning (38.4%) and behavioral aspects (33.7%). Of those with sexual concerns, 36.7% reported severe distress. Reports of severe distress were the highest for relationship difficulties (32.5%), relative to other areas of concern (21.4%–22.8%). In adjusted analyses, women reporting sexual dissatisfaction and high HIV-related stigma had significantly higher odds of reporting sexual concerns. Conversely, those reporting higher resilience, better mental health, African, Caribbean, and Black identity, and sex as somewhat unimportant, not at all important, or neutral to their lives had lower adjusted odds. Factors associated with severe distress about sexual concerns included older age, body dissatisfaction, sexual dissatisfaction, and high HIV-related stigma, while better mental health and getting support from someone living with HIV were protective. While 84.4% of women had discussed with a provider how viral load impacts transmission risk, only 40.6% had conversations about sexual wellbeing. Conclusion: More attention to women’s sexual wellbeing within social and relational contexts is critical to ensure the sexual rights of women living with HIV are upheld.
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Affiliation(s)
- Allison Carter
- Kirby Institute, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, NSW, Australia
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Becky Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Marvelous Muchenje
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Denise Zhu
- Faculty of Science, The University of British Columbia, Vancouver, BC, Canada
| | - Sophie Patterson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Mary Kestler
- Division of Infectious Diseases, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Oak Tree Clinic, British Columbia Women’s Hospital and Healthcare Centre, Vancouver, BC, Canada
| | - Catherine Hankins
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
| | | | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jenny Li
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Erin Ding
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | | | - Mona Loutfy
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
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44
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Milani S, Jabs F, Brown NB, Zdaniuk B, Kingstone A, Brotto LA. Virtual Reality Erotica: Exploring General Presence, Sexual Presence, Sexual Arousal, and Sexual Desire in Women. Arch Sex Behav 2022; 51:565-576. [PMID: 34697691 DOI: 10.1007/s10508-021-02111-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 06/13/2023]
Abstract
Virtual reality (VR) media using a three-dimensional (3D) camera facilitates an immersive experience compared to traditional two-dimensional (2D) formats. In this novel study, we used high quality, women-centered erotica and examined whether stimulus modality (VR vs. 2D) and point of view (POV: first-person vs. third-person) impacted women's feelings of sexual presence (activation of sexual response induced by the perception of being present), sexual arousal, and sexual desire (dyadic and solitary). We also investigated the effects of stimulus modality on feelings of general presence (a sense of "being there"). Results from 38 women indicated that with medium to large effects, general presence, sexual presence, and sexual arousal were significantly higher for VR videos relative to 2D videos. Sexual presence was higher for first-person POV depending on the order of film exposure. A general trend toward increasing dyadic sexual desire over the course of the study was observed. No significant differences were observed for solitary sexual desire. These findings support the adaptability of VR media to sex research and show that it can induce feelings of sexual presence and presence more generally. That sexual arousal was positively impacted by VR erotica may have implications for addressing the limitations that accompany other stimulus modalities used to elicit sexual responses in women.
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Affiliation(s)
- Sonia Milani
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Faith Jabs
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Natalie B Brown
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Alan Kingstone
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, 6th Floor, Vancouver, BC, V5Z 1M9, Canada.
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45
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van Anders SM, Herbenick D, Brotto LA, Harris EA, Chadwick SB. The Heteronormativity Theory of Low Sexual Desire in Women Partnered with Men. Arch Sex Behav 2022; 51:391-415. [PMID: 34426898 PMCID: PMC8382213 DOI: 10.1007/s10508-021-02100-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 05/10/2023]
Abstract
Low sexual desire in women partnered with men is typically presumed to be a problem-one that exists in women and encourages a research agenda on causation and treatment targeting women. In this paper, we present a distinct way forward for research on low sexual desire in women partnered with men that attends to a more structural explanation: heteronormativity. A heteronormative worldview assumes that relationships and structures are heterosexual, gender (usually conflated with sex) is binary and complementary, and gender roles fit within narrow bounds including nurturant labor for women. We propose the heteronormativity theory of low sexual desire in women partnered with men, arguing that heteronormative gender inequities are contributing factors. We outline four hypotheses and their predictions related to: inequitable divisions of household labor, blurring of partner and mother roles, objectification of women, and gender norms surrounding sexual initiation. We discuss some mechanisms-social, physiological, and otherwise-for the heteronormativity theory, especially related to stress, objectification, and nurturance. We close by noting some limitations of our paper and the ways that the heteronormativity theory of low sexual desire in women partnered with men provides a rigorous, generative, and empirical way forward.
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Affiliation(s)
- Sari M van Anders
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON, K7L 3N6, Canada.
- Department of Gender Studies, Queen's University, Kingston, ON, Canada.
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
| | - Debby Herbenick
- School of Public Health, Indiana University, Bloomington, IN, USA
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Emily A Harris
- Department of Psychology, Queen's University, 62 Arch Street, Kingston, ON, K7L 3N6, Canada
| | - Sara B Chadwick
- Departments of Psychology and Women's and Gender Studies, University of Michigan, Ann Arbor, MI, USA
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46
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Brotto LA, Graham CA. Is Basson's Model of Sexual Response Relevant? Yes, and so are other validated models of sexual response: A commentary on Balon (2021). J Sex Marital Ther 2021; 48:13-16. [PMID: 34772329 DOI: 10.1080/0092623x.2021.1918301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Lori A Brotto
- University of British Columbia, Obstetrics and Gynaecology, Vancouver, British Columbia, Canada
| | - Cynthia A Graham
- University of Southampton, Psychology, Shackleton Bldg, Southampton, United Kingdom of Great Britain and Northern Ireland
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47
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Ronis ST, Byers ES, Brotto LA, Nichols S. Beyond the Label: Asexual Identity Among Individuals on the High-Functioning Autism Spectrum. Arch Sex Behav 2021; 50:3831-3842. [PMID: 34661809 DOI: 10.1007/s10508-021-01969-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 06/13/2023]
Abstract
Researchers have suggested that asexuality, which has been conceptualized traditionally as a persistent lack of sexual attraction to others, may be more common among individuals with autism spectrum disorder than in the neurotypical population. However, no studies to date have considered how these individuals understand and conceptualize their sexual identity. The aim of this study was to provide a more nuanced understanding of asexuality among individuals with high-functioning autism spectrum disorder (HF-ASD) than has been done in the past. Individuals with ASD, 21-72 years old (M = 34.04 years, SD = 10.53), were recruited from online communities that serve adults with ASD and Amazon's Mechanical Turk to complete an online survey of sexual and gender identity. Overall, 17 (5.1%) participants who met study criteria (N = 332) self-identified as asexual. However, 9 of the 17 people identifying as asexual expressed at least some sexual attraction to others. In addition, based on open-ended responses, some participants linked their asexual identity more with a lack of desire or perceived skill to engage in interpersonal relations than a lack of sexual attraction. Results suggest that researchers should be cautious in attributing higher rates of asexuality among individuals with ASD than in the general population to a narrow explanation and that both researchers and professionals working with individuals with ASD should consider multiple questions or approaches to accurately assess sexual identity.
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Affiliation(s)
- Scott T Ronis
- Department of Psychology, University of New Brunswick, 38 Dineen Drive, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada.
| | - E Sandra Byers
- Department of Psychology, University of New Brunswick, 38 Dineen Drive, Keirstead Hall, Fredericton, NB, E3B 5A3, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Shana Nichols
- ASPIRE Center for Learning and Development, Huntington, NY, USA
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48
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Siddhpuria S, Breau G, Lackie ME, Lavery BM, Ryan D, Shulman B, Kennedy AL, Brotto LA. Women’s Preferences and Design Recommendations for a Postpartum Depression Psychoeducation Intervention: A User Involvement Study (Preprint). JMIR Form Res 2021; 6:e33411. [PMID: 35737435 PMCID: PMC9264129 DOI: 10.2196/33411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/24/2022] [Accepted: 04/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Shailee Siddhpuria
- Department of Undergraduate Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Genevieve Breau
- School of Human Sciences, University of Greenwich, London, United Kingdom
| | - Madison E Lackie
- Department of Undergraduate Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brynn M Lavery
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deirdre Ryan
- Reproductive Mental Health Program, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Shulman
- Reproductive Mental Health Program, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea L Kennedy
- Reproductive Mental Health Program, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lori A Brotto
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
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Brotto LA, Zdaniuk B, Chivers ML, Jabs F, Grabovac A, Lalumière ML, Weinberg J, Schonert-Reichl KA, Basson R. A randomized trial comparing group mindfulness-based cognitive therapy with group supportive sex education and therapy for the treatment of female sexual interest/arousal disorder. J Consult Clin Psychol 2021; 89:626-639. [PMID: 34383535 DOI: 10.1037/ccp0000661] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Sexual interest/arousal disorder (SIAD) is the most prevalent sexual dysfunction in women. Our goal was to compare (a) group mindfulness-based cognitive therapy (MBCT) plus sex education with (b) group supportive sex education and therapy (STEP) for women with SIAD. Method: Eight-session treatments were delivered weekly and participants completed the measures of sexual desire and arousal, sexual distress, relationship satisfaction, rumination, and global impressions of change, at baseline, immediately posttreatment, and at 6- and 12-month posttreatment. Of 148 women who consented, 70 were randomized to MBCT (mean age 39.3 ± 13.2 years) and 78 were randomized to STEP (mean age 37.9 ± 12.2 years). Results: Sexual desire and arousal significantly improved at each time point relative to baseline, with large effect sizes (d = -1.29 to -1.60), and similarly for MBCT and STEP. Sexual distress also improved at each time point with large effect sizes (d = 0.83-1.17), and more so for MBCT relative to STEP. Relationship satisfaction significantly improved (d = -0.17 to -0.20), and rumination about sex improved significantly in both arms, with medium effect sizes (d = 0.42-0.69), with both outcomes responding more to MBCT. About half the participants across both treatments reported moderate or great improvements in global indicators of desire and overall sexuality. Conclusions: Results support the efficacy of both group MBCT and group supportive sex education for improving symptoms of SIAD with 12-month retention of improvements. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia
| | | | - Faith Jabs
- Department of Psychology, University of British Columbia
| | | | | | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia
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50
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Brotto LA, Jabs F, Brown N, Milani S, Zdaniuk B. Impact of COVID-19 Related Stress on Sexual Desire and Behavior in a Canadian Sample. Int J Sex Health 2021; 34:1-16. [PMID: 38595679 PMCID: PMC10903598 DOI: 10.1080/19317611.2021.1947932] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/31/2021] [Accepted: 06/19/2021] [Indexed: 04/11/2024]
Abstract
Objectives We evaluated various facets of sexual health in Canadians across phases of the COVID-19 pandemic. Methods Online questionnaires every four weeks from April-August 2020. Results Higher COVID-19 stress predicted higher baseline dyadic sexual desire, lower relationship satisfaction, higher desire for solitary sexual behavior, and higher likelihood of experiencing sexual coercion among people with a live-in romantic partner. Dyadic sexual desire and pandemic-related stress both decreased with time, whereas solitary sexual behavior decreased and dyadic sexual behavior increased among participants without a live-in romantic partner. Conclusions Our findings reveal differential impacts of COVID-19 related stress on sexual outcomes.
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Affiliation(s)
- Lori A. Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Faith Jabs
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Natalie Brown
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sonia Milani
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Bozena Zdaniuk
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
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