Margo Mullinax

Sexual satisfaction and sexual health among university students in the United States.

Despite the World Health Organizations definition of sexual health as a state of well-being, virtually no public health research has examined sexual well-being outcomes, including sexual satisfaction. Emerging evidence suggests that sexual well-being indicators are associated with more classic measures of healthy sexual behaviors. We surveyed 2168 university students in the United States and asked them to rate their physiological and psychological satisfaction with their current sexual lives. Many respondents reported that they were either satisfied (approximately half) or very satisfied (approximately one third). In multivariate analyses, significant (P < .05) correlates of both physiological and psychological satisfaction included sexual guilt, sexual self-comfort, self-esteem (especially among men), relationship status, and sexual frequency. To enhance sexual well-being, public health practitioners should work to improve sexual self-comfort, alleviate sexual guilt, and promote longer term relationships.

Community understandings of and responses to gender equality and empowerment in Rakai, Uganda

Abstract Womens rights and gender empowerment programmes are now part of the international agenda for improving global public health, the benefits of which are well documented. However, the public health community has, yet, to address how people define and understand gender equality and how they enact the process of empowerment in their lives. This study uses safe homes and respect for everyone (SHARE), an anti-violence intervention in rural Rakai, Uganda, as a case study to investigate perceptions of gender equality. Investigators analysed 12 focus groups of adult women and men to explore how macro-level concepts of gender equality are being processed on an interpersonal level and the effects on health outcomes. Respondents generally agreed that women lack basic rights. However, they also expressed widespread disagreement about the meanings of gender equality, and reported difficulties integrating the concepts of gender equality into their interpersonal relationships. Community members reported that equality, with the resulting shift in gender norms, could expose women to adverse consequences such as violence, infidelity and abandonment with increased sexual health risks, and potential adverse effects on education. Efforts to increase womens rights must occur in conjunction with community-based work on understandings of gender equality.

How Condom Discontinuation Occurs: Interviews With Emerging Adult Women.

We have almost no data on how and when couples stop using condoms. This qualitative study investigated the process of condom discontinuation. From November 2013 to April 2014, a total of 25 women living in a college town in the Midwest, ages 18 to 25, participated in semistructured interviews centered around three domains: partner interactions, contraceptive use, and sexually transmitted infection (STI) prevention. Analysis followed a critical qualitative research orientation. Participants described actively seeking the best options to prevent pregnancy, perceiving condom discontinuation in favor of hormonal methods as a smart decision, and reported wanting to discontinue using condoms due to physical discomfort. Oftentimes, nonverbal communication around contextual instances of condom unavailability paved the way for discontinuation. Participants indicated the decision to stop using condoms was neither deliberate nor planned. Condom discontinuation rarely occurred at one point in time; instead, it was preceded by a period of occasional use. Even after participants described themselves as not using condoms, sporadic condom use was normal (typically related to fertility cycles). This study provides a more detailed understanding of how and why emerging adults negotiate condom discontinuation, thereby enhancing our ability to design effective condom continuation messages. Attention should be paid to helping emerging adults think more concretely about condom discontinuation.

Screening for Sexually Transmitted Infections (STIs) Among a Heterogeneous Group of WSW(M)

ABSTRACT Objectives: This study explored predictors of STI screening among a heterogeneous group of women who have sex with women and men. Methods: Following bivariate analyses, a multivariate logistic regression model was conducted to assess the relationship between testing and sociodemographic, relationship characteristics. Results: The majority of participants reported not receiving STI screening in the past year. Gender expression, and not sexual orientation, was a significant predictor of screening. For each increase in masculinity, participants had lower odds of receiving an STI test. Conclusions: More research is needed to understand how gender expression of WSW(M) relates to preventative health behaviors.

Establishment of safety paradigms and trust in emerging adult relationships

Abstract There is a critical need to understand the interplay between relationship trust and public health outcomes. The purpose of this study was to develop an understanding of emerging adult women’s processes of establishing trust in sexual relationships. Twenty-five women aged 18–24 years participated in semi-structured interviews. Throughout the interviews, women compared and contrasted experiences in which they felt comfortable engaging in sexual intercourse with a partner versus times in which they did not feel comfortable. Analysis was based on a critical qualitative research orientation. When asked to speak to instances when they felt comfortable having sex, most women spoke about relationship trust. Many participants conceptualised trust based on past experiences with bad relationships or sexual violence. Based on their previous experiences of feeling unsafe or undervalued, emotional and physical security became prioritised in relationship development. Trust was developed through friendship, communication over time, and through shared life experiences. This research is among the first to qualitatively investigate trust formation and other impersonal dynamics related to sexual health decision-making. Insights from this study should be translated into future action by public health practitioners to promote healthy sexual relationships and communication about sexual health topics as a form of trust building.

Prevention of Sexually Transmitted Infections Among Adolescents

Sexually transmitted infections (STIs), including HIV infection, can have a profound impact on adolescent sexual and reproductive health. While adolescents are a quarter of the sexually active population, they represent nearly half of all new STI cases globally. STIs have considerable impact on the morbidity and mortality for infected individual, but also their partners and children. A complex interplay of biological, behavioral, sociocultural, and ecological factors put young people at risk of STIs. This chapter discusses the global spread of STIs among adolescents, the pathogens, symptoms, and health consequences of select STIs, social and behavioral determinants of STIs, and we describe key public health approaches aimed at reducing the burden of STIs among adolescents.

HIV-Risk Behaviors of Men Who Perpetrate Intimate Partner Violence in Rakai, Uganda

Little is known about men who perpetrate IPV in communities also at risk for HIV infection. Using data from the Rakai Community Cohort Study (RCCS), five survey rounds were used (n = 21,157, observation from n = 10,618 men) to examine HIV risk and prevention behaviors among men who reported acts of violence against their wife/primary partner in the past 12 months. Overall, 10.4% men reported perpetrating physical violence and 17.3% perpetrating verbal violence, 3.1% reported sexual violence, 3.1% used violence to have sex with their wife/partner, and 1.1% used verbal coercion. Factors associated with IPV were: age 20-24 years, lower socio-economic status, being married, no male circumcision, drinking alcohol before sex, no consistent condom use, multiple sex partners in the past 12 months, multiple partners ever, and working in a bar. Protective HIV behaviors predicted fewer reports of perpetration and HIV-risk behaviors predicted more reports of perpetrating IPV.

Women's Experiences With Feelings and Attractions for Someone Outside their Primary Relationship

The purpose of this article is to explore womens experiences with attractions and feelings for people outside their primary romantic relationship. In an anonymous Internet-based survey, 160 women answered open-ended questions about crushes. Women had varied experiences with, and diverse strategies for, managing crushes. The majority of women reported the crush did not impact their primary relationship; participants also reported that these crushes improved their desire for their partner. The majority of women in this sample did not communicate with their partners about their crushes. This research can be used by therapists and counselors working with patients experiencing these feelings.

Adolescent Sexual Health and Sexuality Education

The sexual health needs of adolescents have been a central focus of the public health community. Adolescence is a unique time of physical and psychological growth and, for many, a time when sexual and romantic exploration begins. Increasingly, attention is being focused on protective aspects of adolescent sexual health and the recognition that adolescents have sexual rights. The right to sexuality information has become the foundational rationale for sexuality education. The main cornerstone of sexuality education is, arguably, formal school-based sexual education (SBSE) that is important because of the ability to reach numerous adolescents and young adults. It involves teaching youth information, skills, and attitudes related to their sexual health and sexual rights. SBSE has evolved over the past decade, and two main curriculum types have been developed: comprehensive sexuality education programs (CSE) and abstinence-until-marriage (AUM) curriculums. CSE is an age-appropriate, culturally relevant approach to teaching about sex and relationships by providing scientifically accurate, realistic, nonjudgmental information. Overall, SBSE has been proven effective in positively influencing sexual health-related behaviors, and researchers have identified key characteristics across effective programs. Still, providing sexuality education into schools is often controversial. To address issues of concern, the public health community has worked to create a supportive environment for SBSE. In addition to SBSE, there are other channels of sexuality education designed to reach vulnerable youth and youth disconnected from formal systems like the educational system.