Tami S. Rowen

The Impact of Sexual Orientation on Sexuality and Sexual Practices in North American Medical Students

INTRODUCTION There has been limited investigation of the sexuality and sexual dysfunction in non-heterosexual subjects by the sexual medicine community. Additional research in these populations is needed. AIMS To investigate and compare sexuality and sexual function in students of varying sexual orientations. METHODS An internet-based survey on sexuality was administered to medical students in North American between the months of February and July of 2008. MAIN OUTCOME MEASURES All subjects provided information on their ethnodemographic characteristics, sexual orientation, and sexual history. Subjects also completed a series of widely-utilized instruments for the assessment of human sexuality (International Index of Erectile Function [IIEF], Female Sexual Function Index [FSFI], Premature Ejaculation Diagnostic Tool [PEDT], Index of Sex Life [ISL]). RESULTS There were 2,276 completed responses to the question on sexual orientation. 13.2% of male respondents and 4.7% of female respondents reported a homosexual orientation; 2.5% of male and 5.7% of female respondents reported a bisexual orientation. Many heterosexual males and females reported same-sex sexual experiences (4% and 10%, respectively). Opposite-sex experiences were very common in the male and female homosexual population (37% and 44%, respectively). The prevalence of premature ejaculation (PEDT > 8) was similar among heterosexual and homosexual men (16% and 17%, P = 0.7, respectively). Erectile dysfunction (IIEF-EF < 26) was more common in homosexual men relative to heterosexual men (24% vs. 12%, P = 0.02). High risk for female sexual dysfunction (FSFI < 26.55) was more common in heterosexual and bisexual women compared with lesbians (51%, 45%, and 29%, respectively, P = 0.005). CONCLUSION In this survey of highly educated young professionals, numerous similarities and some important differences in sexuality and sexual function were noted based on sexual orientation. It is unclear whether the dissimilarities represent differing relative prevalence of sexual problems or discrepancies in patterns of sex behavior and interpretation of the survey questions.

An Internet Survey of Demographic and Health Factors Associated with Risk of Sexual Dysfunction in Women Who Have Sex with Women

INTRODUCTION There has been scant attention to predictors of sexual dysfunction in women who have sex with women (WSW). AIM To investigate the associations of high risk for sexual dysfunction in an Internet cohort of WSW. MAIN OUTCOME MEASURE A modified version of the Female Sexual Function Index (FSFI) was used to quantify each subjects sexual function. METHODS Women who have sex with women were invited to participate in an Internet-based survey by invitations posted on e-mail listservs and on social media sites catering to WSW. Ethnodemographic, health status, and sexual/relationship data were collected. RESULTS The study was completed by 2,433 adult women. Of these, 1,566 participants had complete data on the FSFI and comprised the study cohort; 388 (24.8%) met the FSFI criteria for high risk of female sexual dysfunction (HRFSD). On multivariable analysis, the following variables were found to be independently associated with the HRFSD; moderate or severe subjective bother regarding sexual function (OR 4.8, 95% CI 3.0-7.9 and 13.7, 95% CI 7.5-25.1, respectively), overactive bladder (OAB) (OR 2.1, 95% CI 1.0-4.5), having a nonfemale or no partner (OR 2.3, 95% CI 1.1-4.7 and 3.2, 95% CI 2.0-5.2, respectively). A history of pregnancy was associated with lower odds of HRFSD (OR 0.567, 95% CI 0.37-0.87). Mean FSFI domain scores for all domains except desire were negatively impacted by partner factors and OAB. CONCLUSIONS A single-item question on sexual bother is strongly predictive of potentially distressing sexual problems in the WSW. A number of health and social factors are associated with risk of sexual problems in the WSW. Assessment of sexual well-being in the WSW is a priority for practicing healthcare providers.

New hope: community-based misoprostol use to prevent postpartum haemorrhage.

The wide gap in maternal mortality ratios worldwide indicates major inequities in the levels of risk women face during pregnancy. Two priority strategies have emerged among safe motherhood advocates: increasing the quality of emergency obstetric care facilities and deploying skilled birth attendants. The training of traditional birth attendants, a strategy employed in the 1970s and 1980s, is no longer considered a best practice. However, inadequate access to emergency obstetric care and skilled birth attendants means women living in remote areas continue to die in large numbers from preventable maternal causes. This paper outlines an intervention to address the leading direct cause of maternal mortality, postpartum haemorrhage. The potential for saving maternal lives might increase if community-based birth attendants, women themselves, or other community members could be trained to use misoprostol to prevent postpartum haemorrhage. The growing body of evidence regarding the safety and efficacy of misoprostol for this indication raises the question: if achievement of the fifth Millennium Development Goal is truly a priority, why can policy makers and womens health advocates not see that misoprostol distribution at the community level might have life-saving benefits that outweigh risks?

A qualitative assessment of Ugandan women's perceptions and knowledge of contraception

To determine Ugandan womens perceptions and knowledge of contraception.

Pubic Hair Grooming Prevalence and Motivation Among Women in the United States

Importance Pubic hair grooming is an increasingly prevalent trend. Several studies have sought to characterize its prevalence, associated demographics, and motivations. Objective To characterize current pubic hair grooming practices in the United States. Design, Setting, and Participants In this cross-sectional study, a nationally representative survey was conducted in January 2013 of noninstitutionalized adults aged 18 to 65 years residing in the United States via the GfK Group (formerly Knowledge Networks) panel members. Data analysis was performed from November to December 2015. Interventions A questionnaire examining pubic hair grooming habits. Main Outcomes and Measures Demographic characteristics and motivations associated with pubic hair grooming. Results A total of 3372 women were surveyed. Fifty-six women did not answer the grooming question; consequently, 3316 women were included in the analysis. Of these women, 2778 (83.8%) reported pubic hair grooming and 538 (16.2%) reported never grooming. On multivariate regression, several factors associated with grooming were found. When compared with younger women (aged 18-24 years), women aged 45 through 55 years (odds ratio [OR], 0.05; 95% CI, 0.01-0.49; P = .01) and those older than 55 years (OR, 0.04; 95% CI, 0.00-0.34; P = .003) were significantly less likely to groom. Women with some college (OR, 3.36; 95% CI, 1.65-6.84; P = .001) or a bachelors degree (OR, 2.39; 95% CI, 1.17-4.88; P = .02) were more likely to have groomed. Race was also significantly associated with grooming, with all groups reporting less grooming when compared with white women. No association was found between grooming and income, relationship status, or geographic location. Conclusions and Relevance This study provides a nationally representative assessment of contemporary female pubic hair grooming habits. Demographic differences in grooming were found, which may reflect cultural variations in preference related to pubic hair. Health care professionals and those who provide grooming services can use this information to better counsel patients and understand grooming practices.

Sexual Health Care for People with Physical Disabilities

BACKGROUND People with physical disabilities make up a large and heterogeneous population, many with specific sexual health needs that differ from the general population. METHODS To conduct a review of current definitions and statuses relating to the sexual well-being of people with physical disabilities. Medical, social, and behavioral literature was searched and included to address the specific sexual health needs and disparities in this population. RESULTS People with physical disabilities encompass a broad population, including those with concomitant mental and cognitive impairments. People with physical disabilities have significant sexual and reproductive health disparities when compared with the general population and higher rates of sexual distress. There are specific sexual health concerns for men and women with physical disabilities and approach to their care needs to be interdisciplinary. CONCLUSIONS Sexual health needs for people with physical disabilities should be a priority for healthcare providers. Continued education is essential to ensure disparities and health needs are addressed and treated.

Use of barrier protection for sexual activity among women who have sex with women

To assess the frequency and associations of barrier protection use during sexual activity in a population of women who have sex with women (WSW).

The Sexual Impact of Infertility Among Women Seeking Fertility Care

Introduction Infertility affects approximately 6.7 million women in the United States. Couples with infertility have significantly more anxiety, depression, and stress. This is compounded by the fact that almost 40% of couples undergoing assisted reproduction technology still cannot conceive, which can have an ongoing effect on quality of life, marital adjustment, and sexual impact. Aim To assess the sexual impact of infertility in women undergoing fertility treatment. Methods This study is a cross-sectional analysis of women in infertile couples seeking treatment at academic or private infertility clinics. Basic demographic information was collected. Respondents were surveyed regarding sexual impact and perception of their infertility etiology. Multivariate regression analyses were used to identify factors independently associated with increased sexual impact. Main Outcome Measure Sexual impact of perceived fertility diagnosis. Results In total, 809 women met the inclusion criteria, of whom 437 (54%) agreed to participate and 382 completed the sexual impact items. Most of the infertility was female factor only (58.8%), whereas 30.4% of infertility was a combination of male and female factors, 7.3% was male factor only, and 3.5% was unexplained infertility. In bivariate and multivariate analyses, women who perceived they had female factor only infertility reported greater sexual impact compared with woman with male factor infertility (P = .01). Respondents who were younger than 40 years experienced a significantly higher sexual impact than respondents older than 40 years (P < .01). When stratified by primary and secondary infertility, respondents with primary infertility overall reported higher sexual impact scores. Conclusion In women seeking fertility treatment, younger age and female factor infertility were associated with increased sexual impact and thus these women are potentially at higher risk of sexual dysfunction. Providers should consider the role young age and an infertility diagnosis plays in a women’s sexual well-being.

Urinary Incontinence and Associated Female Sexual Dysfunction

INTRODUCTION Urinary incontinence (UI) and sexual dysfunction are common conditions often undiagnosed and untreated in women and are associated with decreased quality of life. AIM To evaluate the relation between UI and female sexual dysfunction (FSD), considering incontinence type and the psychosocial and physiologic aspects of sexual function. METHODS PubMed search of terms related to UI and FSD from 1979 to 2016 generated 603 published references, of which 26 were included. Nine additional studies came from bibliographic review. MAIN OUTCOME MEASURE Rates and types of sexual dysfunction. RESULTS In cross-sectional and case-control studies, UI was associated with increased rates and severity of FSD. Coital UI occurred in 24% to 66% of women with UI. Impaired body image, fear of coital UI, avoidance of sex, and complete abstinence were more common in women with UI. Deficits in desire, lubrication, satisfaction, and increased pain were found across numerous studies. Mixed UI was associated with more FSD than urgency UI and stress UI. Multiple studies suggest urgent UI is more bothersome than stress UI. Coital UI was associated with a urodynamic diagnosis other than genuine stress incontinence in 25% to 50%. Leakage at penetration was associated with stress UI; leakage at orgasm was associated more often with detrusor overactivity. CONCLUSION Womens UI is associated with increased rates of sexual dysfunction, suggesting concurrent screening is warranted. Clarifying timing of coital leakage would facilitate targeted treatment. Standardization of FSD measurements could better elucidate the relation between UI and FSD. Duralde ER, Rowen TS. Urinary Incontinence and Associated Female Sexual Dysfunction. Sex Med Rev 2017;5:470-485.

Alternative Sexualities: Implications for the Urologist

Urologists routinely deal with sensitive issues of urinary function as well as sexuality in daily practice. Even experienced urologists may encounter patients who engage in sexual practices that are novel, unknown, or perhaps disturbing to the provider. This primer will serve as an introduction to sexual practices and lifestyle choices that may be foreign to many practicing urologists. It is by no means an exhaustive description of alternative sexualities, but will hopefully serve as a useful introduction to the topic and will enhance the ability of providers to care for, or appropriately refer, patients whose sexual practices and lifestyles may differ from their own.