Autoerotism,Homoerotism, and Foreplay in African Women Who Practice Labia Minora Elongation: a Review

ABSTRACT. Objectives: Labia minora elongation is a female genital modification in which some women in certain linguistic groups from Africa engage. One of the purposes is to enhance sexual pleasure for their male partners. Methods: The literature has been reviewed to describe how labia minora elongation serves for women to increase their sexual pleasure, both as an autoerotic method and in the context of homoerotic and heterosexual relationships. Results and Conclusions: This aspect deserves to be investigated, as there are narratives from some women practitioners of labial elongation that this practice might contribute to improve the sexual health of some of the women who engage in it.     

Measurement of the sexual health and wellbeing of women who have undergone female genital mutilation/Cutting: A scoping review

Objective: We conducted a scoping review to identify and assess instruments used to measure sexual health and wellbeing in women who have undergone female genital mutilation/cutting (FGM/C). Method: We retrieved and assessed 10 validated instruments using an 18-item checklist derived from the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Results: All instruments were developed and initially validated among literate, predominantly Caucasian participants in North America and Europe. Only 1 validation study was conducted among women living with FGM/C. Conclusion: Most instruments only measured sexual functioning. Findings underscore the need to validate instruments appropriate for use among FGM/C survivors.     

Medical Complications of Female Genital Mutilation

Abstract

More than 130 million women are subjected to genital mutilation. Despite increasing efforts to reduce the practice, there are many obstacles to eliminating this 2,000-year-old practice, which is based on strong cultural traditions. As college health clinicians provide care to more international students from countries where female genital mutilation is performed, increased awareness and knowledge of the procedure will enable clinicians to understand and manage its complications. We report a case of obstructive uropathy resulting in hydronephrosis secondary to female genital mutilation and review the medical literature regarding this and other complications of genital mutilation “surgery.”     

Changes in Sexual Distress,Depression and Sexual Function after Clitoral Reconstruction in Women with Female Genital Mutilation/Cutting

Abstract

Background: Female genital mutilation/cutting (FGM/C) links health complications and psychological distress. However, there is scarce literature on how women with FGM/C respond to treatment interventions. Objective: In this study, we aimed to assess changes in depression symptomatology, sexual function, and distress following clitoral reconstructive surgery combined with a psychoeducational intervention. Methods: The reconstructive surgery consisted of recovering the remaining clitoris and placing it externally and as close to the vagina as possible. FGM/C patients (n?=?27) received psychological support and sexual counseling upon undergoing the surgical intervention and were further assessed at 6-month follow-up. Moreover, they completed the Beck Depression Inventory and the Female Sexual Distress Scale Revised at these two time points. Patients’ sexual dysfunction was assessed according to DSM-5 criteria. Results: Statistically significant clinical changes after FGM/C were reported. Overall, patients presented reduced depression and sexual distress levels, and decreased female sexual interest/arousal disorder prevalence. Results also revealed that sexual distress improvements were more significant in Type I FGM/C patients. Conclusions: Significant improvements in sexual distress, psychopathology, and sexual function were observed in our sample following reconstructive surgery, suggesting that combined interventions are effective for treatment.     

Local Rites and Body Politics

The growing awareness of violence against women has resulted in endorsement of various international codes and conventions relating to physical, psychological and sexual violence. Female genital mutilation is one form of violence against women that has polarized people within and across national borders. Here, I explore its popular representation, consider how activism against genital mutilation has been confounded by sex and race and how activism to eradicate the practice is understood by immigrant women in Australia. In doing this, I draw on research conducted with women immigrants to Australia from north Africa (the Sahel areas) and the Middle East, from countries where female genital mutilation is most common. These women are often frustrated by what they see as contradictions in hospital policy and practice that arise in response to their requests to be reinfibulated after childbirth. I tease out the dilemmas that emerge when refusal is contrasted with other permissible practices of the body, such as hymen reconstruction, and given the commodification of bodies and related issues of age and agency, the individual and the community. The perceived discrepancies suggest to these African women that rights discourse is discriminatory, racist and informed by sensational portrayals of traditional practices. I question the ethics, values and rights that inform public discourse about sexual and reproductive rights, when women’s rights and values are so discrepant from our own ideals.     

Zambian Women in South Africa: Insights Into Health Experiences of Labia Elongation

Labia minora elongation consists in the manual stretching of the inner lips of the external genitalia. This practice is documented in east and southern Africa. The experiences of African women in the diaspora practicing elongation are not thoroughly understood. The purpose of this qualitative study was to explore the health harms and benefits associated with this practice of Zambian women who have migrated to Cape Town, South Africa. Twenty women and seventeen men participated in this study. Between December 2013 and May 2014, in-depth interviews and natural group discussions were conducted with the participants. The focus of this article is to report on the emic of the women related to notions of health, hygiene, and well-being. Labial elongation is perceived as a practice involving minor, short-term adverse effects that can be prevented by following some basic hygiene. Overall, personal and social value is placed on this practice because of its reported benefits for the sexual health of men and women, and for women's femininity and self-image. Further research is necessary on how female genital modifications influence Zambians’ sexual preferences to inform the development of culturally appropriate health promotion interventions.     

Sexual and reproductive health knowledge and information-seeking behavior among middle eastern female university students: a systematic review

Objectives: The objective of this study was to collate the level of sexual and reproductive health knowledge, awareness, attitudes, and behavior among female university students, in addition to identifying their sources of information in Middle Eastern and North African countries. Methods: A systematic review was conducted with a search in Medline, EMBASE, Web of Knowledge, PsycINFO, and CINAHL from inception to February 2013. Included were studies in any language describing sexual and reproductive health knowledge and attitudes among female university students. Results: Nine studies were included, and all were cross-sectional surveys. There was a general lack of knowledge of sexual and reproductive health. The highest knowledge levels reported were for HIV. Conclusions: There are deficiencies in sexual and reproductive health knowledge and behavior in Middle Eastern and North African countries. Studies are needed to evaluate how to provide culturally sensitive sexual and reproductive health information.     

Sexual Health Interventions for Black Women in the United States: A Systematic Review of Literature

Objective: The purpose of this systematic review was to identify and evaluate approaches used in sexual health interventions targeting Black women in the United States. Methods: We conducted a review of 15 sexual health intervention studies for Black women published between January 2000 and May 2017 in the United States. Results: Each intervention focused on HIV/sexually transmitted infection prevention, incorporated an asset and deficit-based approach, primarily used individual-level assets, and was effective in achieving the stated sexual health-related outcomes. Conclusions: Comprehensive sexual health interventions require further development and refinement to include more community and institutional-level assets to improve long-term sustainable change and empower Black women.     

Influence of Female Genital Cutting on Sexual Experience in Southern Ethiopia

Female genital cutting (FGC) is a persistent social norm in the Liben district of southern Ethiopia. This study explores whether the sexual experiences of married men and women differ by women's FGC status. Qualitative in-depth interviews were conducted with 28 women with different types of FGC (or no FGC) and 21 husbands. Compared to others, women with more severe FGC reported traumatic sexual experiences and decreased sexual desire. Nonetheless, participants largely endorsed FGC for daughters, revealing pressure to maintain the practice. Opportunities for change exist, as women and men recognized the sexual pleasure and healthy birth experiences of uncut women.     

Sexual Practices Among a Sample of Young Lesbian and Bisexual Women from Mexico: An Exploratory Study

Objective: To describe sexual practices in Mexican lesbian and bisexual women. Materials and method: An online survey was conducted with a nonprobabilistic sample of self-identified lesbian (n?=?768) and bisexual (n?=?371) women from the 32 states of Mexico. Results: Lesbians less frequently reported having had sex with a man than bisexual women. Preferred sexual practices with other women were external genital stimulation with fingers, internal genital stimulation with fingers, and oral genital stimulation. Most (～80%) participants did not use protection to prevent sexually transmitted infections. Conclusions: Our results can inform the design of promotion and prevention programs in sexual health aimed at sexual minority women.     

Sexual Health Education in OB-Gyn Residencies—The Program Directors’ Survey

Abstract

Objective: To evaluate U.S. obstetrics-gynecology (OB-Gyn) program Director appraisal of resident physician female sexual health training. Methods: An OB-Gyn resident sexual health curriculum survey was developed and sent to 237?U.S. OB-Gyn program directors. University/military programs were compared to community-based programs. Results: 115 OB-Gyn residency program directors responded (48.5% participation); 37.9% university/military and 43.2% community OB-Gyn Program Directors appraise the resident curriculum as “not well” preparing residents to manage sexual health therapies upon graduation. Topics not sufficiently covered include human sex trafficking, sexual health for women with disabilities, and cultural competency. Conclusions: This study identifies opportunities in OB-Gyn residency female sexual health education.     

UK Paramedics Confidence in Identifying Child Sexual Abuse: A Mixed-Methods Investigation

United Kingdom (UK) paramedics are in a prime position to identify children and young people who are victims or at risk of sexual abuse. Paramedics have access, by phone, or in person, to unprepared homes and communities which other health professionals such as social workers may not. Little research exists however, investigating UK paramedic confidence in identifying child sexual abuse. This mixed-method explanatory sequential investigation used the self-reported confidence levels of 276 UK paramedics to inform the design of seven semi-structured focus groups with 25 UK paramedics from a large ambulance service with operating models similar to all UK services. Multiple factors contribute to a lack of confidence in identifying child sexual abuse, child sexual exploitation, and female genital mutilation, including a perceived lack of exposure to sexual abuse, the perceived hidden nature of sexual abuse, and the lack of physical symptoms and examination. An overarching lack of knowledge is the most significant contributor to a lack of confidence which in turn perpetuates misinformation surrounding prevalence, location, and the signs and symptoms of sexual abuse. These findings suggest a lack of sufficient training and a need for further research evaluating the content of current training and its method of delivery.     

Can Botox Offer Help Women With Vaginismus? A Systematic Review and Meta-Analysis

Abstract

Objectives: Evaluating the effect of botox injections on the satisfactory penetrating in women with vaginismus. Methods: A comprehensive systematic search in the electronic databases carried out up to September 2018. All studies that used botox to treat vaginismus were included in this review. Results: Nine cohort studies were included in meta-analysis. Our results indicate that botox can be an option for effective treatment of patients with vaginismus (event rate = 0.855, 95% confidence interval = 0.764 to 0.915; p-value < 0.001). Conclusion: Botox injection can improve vaginismus. However, because of the lack of randomized clinical trials, this conclusion should be carefully interpreted.     

Knowledge Regarding Hymens and the Sex Education of Parents

The objective of this study was to ascertain beliefs and knowledge of pediatricians and parents regarding the hymen and to evaluate parental and pediatrician attitudes regarding sex education by pediatricians. Surveys were distributed anonymously to parents and pediatricians. Survey questions included knowledge of the female hymen and questions regarding attitudes toward sexual health education. There was a statistically significant difference in mean knowledge scores between pediatricians and parents regarding the hymen (3.7 versus 1.3; p < 0.0001). Almost two-thirds of pediatricians (63%) felt comfortable providing sexual health education directly to their patients, but only 41% felt comfortable educating parents. Pediatricians and parents demonstrate knowledge gaps about the hymen.     

Socially Sanctioned Violence Against Women: Female Genital Mutilation Is Its Most Brutal Form

A historic survey indicates that Female Genital Mutilation occurs not only in the Third World but has also been practiced in the Occident. Though the differences in the practices, scope, and extent of the genital mutilations performed in these two divergent cultures are great, the basic goal has been the same. In the prevalent patriarchal societies, men sought and seek to curb, at times even eradicate, women's sexuality. Psychoanalytic findings indicate that the motive for female genital mutilation is based on men's unconscious fear of women's sexuality. The minimal psychic consequences following the mutilation of female genitals are loss of trust, a prevailing lack of bodily well-being, post-traumatic shock and depression.     

Medical complications of female genital mutilation.

More than 130 million women are subjected to genital mutilation. Despite increasing efforts to reduce the practice, there are many obstacles to eliminating this 2,000-year-old practice, which is based on strong cultural traditions. As college health clinicians provide care to more international students from countries where female genital mutilation is performed, increased awareness and knowledge of the procedure will enable clinicians to understand and manage its complications. We report a case of obstructive uropathy resulting in hydronephrosis secondary to female genital mutilation and review the medical literature regarding this and other complications of genital mutilation "surgery."     

Internet Pornography use and Sexual Body Image in a Dutch Sample

Objectives: A commonly attributed cause of sexual body image dissatisfaction is pornography use. This relationship has received little verification. Methods: The relationship between sexual body image dissatisfaction and Internet pornography use was tested using a large-N sample of Dutch respondents. Results/Conclusion: Penis-size dissatisfaction is associated with pornography use. The relationship between pornography use and breast-size dissatisfaction is null. These results support prior speculation and self-reports about the relationship between pornography use and sexual body image among men. These results also support a prior null finding of the relationship between breast-size satisfaction for women and pornography use.     

THe Use of Hormone Therapy in the Male-to-Female Transgender Population: Issues for Consideration in Thailand

ABSTRACT

Objectives: Prejudice against transgender people is evident around the world with discrimination in many aspects of life, including access to health care. Even in Thailand, where male-to-female (MTF) transgender people are particularly visible and society is reputedly accepting, barriers to attaining appropriate health care still exist. The vast majority of MTF transgender people in Thailand are reported to be taking hormone therapy; however, most do not seek medical advice regarding these regimens, with the initiation and tailoring of medication often being guided by sympathetic peers instead. The objectives of this review are to consider hormone therapy in the context of the Thai population and provide recommendations regarding ways to improve practice and reduce health risks. Methods: The data analysis in this article represents a comprehensive literature review regarding hormone therapy for MTF transgender people including the guidelines for initiation, prescribing, and monitoring of hormone therapy, risks for serious adverse events and reported hormone use by the MTF transgender population in Thailand. Results: There is a notable lack of published research regarding hormone therapy in the transgender population. Guidelines, whilst relying considerably on expert opinion, do provide clear recommendations on the initiation, maintenance and monitoring of hormone therapy. Comparison of endocrine guidelines with reported practice in Thailand reveals significant opportunities for improvement in MTF transgender hormone therapy. Conclusions: The incautious use of hormone therapy may represent a considerable health risk behavior undoubtedly contributing to the morbidity and mortality in MTF transgender people. Although there is currently considerable focus on sexually transmitted infections in the MTF transgender population, a more comprehensive approach to health care is required, including education for transgender people and the health professionals who attend to them regarding appropriate hormone therapy.     

Gender-Specificity of Women's and Men's Self-Reported Attention to Sexual Stimuli

Men's sexual arousal is largely dependent on the actor's gender in a sexual stimulus (gender-specific), whereas for women, particularly androphilic women, arousal is less dependent on gender (gender-nonspecific). According to information-processing models of sexual response, sexual arousal requires that attention be directed toward sexual cues. We evaluated whether men's and women's self-reported attention to sexual stimuli of men or women were consistent with genital responses and self-reported arousal. We presented gynephilic men (n = 21) and women (n = 22) and androphilic men (n = 16) and women (n = 33) with audiovisual stimuli depicting men or women engaged in sexual activities. Genital responses were continuously recorded and, following each stimulus, participants reported the amount of attention paid to the video and feelings of sexual arousal. Self-reported attention was gender-specific for men and gender-nonspecific for women, and generally mirrored genital responses and self-reported arousal. Gender-specificity of genital responses significantly predicted gender-specificity of self-reported arousal; however, for men only, this effect was significantly mediated by gender-specificity of self-reported attention. Gender differences in gender-specificity of sexual arousal may be partially accounted for by differences in gender-specificity of self-reported attention, although attention may play a greater role in men's sexual arousal than women's.