Female circumcision: the view from Sudan. Interview [with Ikhlas Nouh Osman

Female circumcision involves removing either all or part of the clitoris, labia minora, and/or labia majora. The practice is therefore increasingly being described as female genital mutilation. More than 90% of women in Sudan have undergone female genital mutilation. Pharonic circumcision is the most prevalent in Sudan. This form of mutilation involves the full removal of the clitoris and the labia. The two sides of the wound are then sewn together, leaving a small hole through which urine and menstrual blood may pass. Female genital mutilation occurs because women believe that the resultant narrow vaginal entrance will give pleasure to a future husband, due to tradition, uncircumcised women have great difficulty finding a spouse, and from the belief that the practice is mentioned in Islam. Koranic law is widely respected and followed in the Islamic areas of Sudan. Contrary to the belief of women that female circumcision keeps the vagina very clean, considerable health and psychological problems may result following the operation and throughout the woman's life. An activist against female genital mutilation describes her experience undergoing the operation, the trauma of first penile penetration with her husband, giving birth, and how women have their genital orifice restitched after delivery to the size before penetration. Nongovernmental organization efforts in Sudan against female circumcision are described.     

Japanese Women's Views on Penile Hygiene and Male Circumcision

ABSTRACT. Current campaigns to promote male circumcision to reduce the risk for HIV infection among heterosexual men do not seem to apply to Japan because the majority of men are uncircumcised and HIV/AIDS rates remain comparatively lower among industrialized countries. No official statistics on male circumcision exist; the surgery has never been mandatory for infants and it is rare among adults, who are largely circumcised at beauty salons. The procedure is largely commercialized as a cosmetic surgery to boost maleness and to “satisfy” the sexual desires of Japanese women. In this light, this article discusses the outcomes of semistructured interviews with 13 single Japanese women to explore their views on circumcision, penile hygiene, and sexuality. The analysis indicates a reluctance to talk about male circumcision among the participants due to ignorance, language availability, and gender matters. Intriguingly, the participants suggested that expressions related to the foreskin implied derogatory comments toward male's sexual performance and genital sizes.     

Erotosexuality in a Man Lacking Physiological Postnatal Androgen Exposure

Gender identity, gender role, erotosexual orientation, sexual functioning, and psychological functioning were assessed in a 20-1/2 year old man who had suffered a complete loss of testes at birth and who consequently lacked a physiological androgen surge postnatally. No sequela of this androgen deprivation were found.     

Women and health: female circumcision

Documented cases of female circumcision are reported for Malaysia, Indonesia, East and West Africa. Infibulation is reported for East and West Africa. A specific village listing is provided. Female circumcision as practised in African villages is designed to reduce sexual enjoyment. Those girls who refuse the operation are often ostracized. Sunna circumcision, the cutting of the prepuce of the clitoris, is performed with razor blades and knives by old women. In some areas cuts in the vagina are made to make childbearing easier. The result is the opposite. Moslems perform infibulation (fastening the labia majora together) to insure virginity and paternity. In Kenya defenders of the practise of clitoridectomy say its opposers are viewing the situation emotionally from a Western perspective. Changes are typically resisted by men, especially if they are perceived as being determined by outsiders.     

“I Feel Like More of a Man”: A Mixed Methods Study of Masculinity,Sexual Performance,and Circumcision for HIV Prevention

Ethnographic studies from numerous societies have documented the central role of male circumcision in conferring masculinity and preparing boys for adult male sexuality. Despite this link between masculinity, sexuality, and circumcision, there has been little research on these dynamics among men who have been circumcised for HIV prevention. We employed a mixed methods approach with data collected from recently circumcised men in the Dominican Republic (DR) to explore this link. We analyzed survey data collected six to 12 months post-circumcision (N = 293) as well as in-depth interviews conducted with a subsample of those men (n = 30). We found that 42% of men felt more masculine post-circumcision. In multivariate analysis, feeling more masculine was associated with greater concern about being perceived as masculine (OR = 1.70, 95% CI: 1.25–2.32), feeling more potent erections post-circumcision (OR = 2.25, 95% CI: 1.26–4.03), and reporting increased ability to satisfy their partners post-circumcision (OR = 2.30, 95% CI: 1.11–4.77). In qualitative interviews, these factors were all related to masculine norms of sexually satisfying one’s partner, and men’s experiences of circumcision were shaped by social norms of masculinity. This study highlights that circumcision is not simply a biomedical intervention and that circumcision programs need to incorporate considerations of masculine norms and male sexuality into their programming.     

Reviews

This essay responds to Winter, Thompson and Jeffreys’ critique of the UN approach to harmful traditional practices. By questioning why these authors address only a limited set of harmful practices in the West, in particular missing the problem of infant male circumcision, I argue their critique is less radical than it appears. Indeed, the article reproduces what I see as the most problematic and gendered assumptions in the UN’s approach: namely, the conceptualization of harmful practices solely in terms of women’s victimization and men’s benefit.     

Cervico‐motor reflex: Description of the reflex and role in sexual acts

A recently identified reflex, termed the “cervico‐motor reflex,” was studied in 15 healthy women (mean age 36.6 years). The response of levator ani (LA) and puborectalis (PR) muscles to electrical and mechanical stimulation of the cervix uteri (CU) was determined. One concentric needle electrode was inserted into the CU (stimulating), a second into the LA (recording), and a third into the PR (recording). The vaginal pressure was measured at rest and on cervical stimulation by balloon‐tipped catheters. Electrical stimulation of the CU led to a reduction in pressure in the upper portion of the vagina (p < .05) and an increase in pressure in the middle and lower portions (p < .001). Stimulation also caused an increase in the electromyographic (EMG) activity of the LA and PR muscles (p < .01). Mechanical stimulation induced the same effects but to a lesser degree. Stimulation of the anesthetized CU, LA, or PR did not evoke the response. The data suggested the presence of a reproducible reflex relationship between the CU and both the LA and PR. During the sexual act and penile buffeting of the CU, levator contraction “balloons” the upper vagina, which acts as a “receptacle” for the semen. Meanwhile, PR contraction narrows the lower vagina, which may effect an increase of penile erection and rigidity. The cervico‐motor reflex may be incorporated as an investigative tool in sexual act disorders.     

Is Hba1c level of diabetic patients associated with penile prosthesis implantation infections?

Background and objectives: Diabetes mellitus is an important risk factor for erectile dysfunction (ED). Penile prosthesis implantation surgery is the final solution for diabetic patients with ED, but infections thereof are still a serious risk factor. While some studies suggest that most infections associated with penile prosthesis implantation are associated to high glycated hemoglobin (HbA1c) levels, other research did support such relationship.

Materials and methods: The current study assessed retrospectively, the association between HbA1c level and penile prosthesis surgery infection. We retrieved and reviewed the records of 300 diabetic patients who had penile prosthesis surgery at our Institution (January 2012–November 2016). Patients’ mean age was 55.26?±?10.9 years (31% patients were <50 years of age), and mean HbA1c was 7.60?±?1.90%.

Results: Infection rate among diabetics was 0.67%. Prevalence of prosthesis infection among patients with HbA1c?≤?9% was 0.9%, compared with 0% among patients with HbA1c?>?9%. Prosthesis infection risk did not significantly increase with higher HbA1c levels, with no meaningful difference in the median or mean level of HbA1c in the infected and non-infected diabetic patients.

Conclusion: Findings do not support the use of HbA1c values among diabetic patients who are candidates for penile prosthesis implantation surgery in order to identify and exclude those who might be prone to increased risk of prosthesis infections. Future studies would benefit from larger sample sizes in order to support or refute our findings.     

The pattern of child sexual abuse in northern ireland

A team from the Departments of Child Psychiatry, Royal Belfast Hospital for Sick Children, and of Epidemiology and Public Health, Queens University Belfast, conducted a study in 1987 of the reported incidence of child sexual abuse in Northern Ireland. The incidence rate of established cases of child sexual abuse was 0.9 per 1000 children under the age of 17 years. Further analysis of all the cases of sexual abuse (suspected, alleged and established) and an estimation of the potential under-ascertainment indicated that the actual rate was between 0.9 per 1000 and 1.85 per 1000 children. Data obtained from a detailed structured questionnaire on each sexually abused child was analysed. The results are presented in relation to the child, age and sex; the abuse, type and duration; the abuser, sex, age and relationship to the child; and outcome factors, initial psychological sequelae, physical signs and symptoms, and social sequelae.     

Transformations in the medicalization of sex: HIV prevention between discipline and biopolitics

This article examines transformations in HIV prevention strategies from the 1980s to the present. Drawing on the concepts of medicalization (Conrad, 2007 ), discipline and biopolitics (Foucault, 1976/ 1988 ), and biomedicalization (Clarke, Fishman, Fosket, Mamo, & Shim, 2003 ), it explores the shift from behavioral to biomedical and surgical prevention techniques-a shift symbolic of a more general trend toward the biomedicalization of sexuality. It argues that, although biomedical and surgical approaches (chemoprevention and male circumcision) have certain benefits, their efficacy is limited and uncertain. They do not guarantee individual protection. The aim is no longer the modification of sexual behavior through disciplinary strategies aimed at the development of subjective and sexual awareness, but the modification of health behavior as a positive response to biomedical recommendations. Through the use of preventative or curative drugs, the same type of sexual awareness is seen as no longer required.     

“You see,one day they cut”: The evolution,expression, and consequences of resistance for women who oppose female genital cutting

ABSTRACT

It is estimated that more than 200 million women alive today have undergone female genital cutting (FGC). While emerging evidence shows that attitudes toward FGC may evolve for immigrants as they acculturate to the host country, scant empirical research explores how women come to oppose the practice. This qualitative study used grounded theory methods to explore the trajectory of resistance to FGC for seven women circumcised in childhood who sought asylum in the United States as adults to protect their daughters from the practice. Participants originated from Burkina Faso, Guinea, The Gambia, and Chad. Analysis revealed nine themes tracing the evolution of resistance to FGC and other gender role norms for participants: coercion, threat, and retribution narratives; traumatic memories of circumcision; growing awareness of the personal implications of circumcision; emergence of critical thinking; trangressive thoughts and acts; navigating the consequences of resistance; everyday reinforcement; negotiating resistance dilemmas; and making meaning of resistance. In contrast to previous studies linking opposition to FGC to post-settlement acculturation or pre-migration exposure to organized international human rights campaigns, findings of this study indicate that traumatic memories of the circumcision rite, combined with the capacity to reflect on “taken for granted” cultural practices and to employ critical thinking skills, may lead to resistance to FGC for some women. Furthermore, findings highlight that FGC, and opposition to it, has lasting consequences for women from societies where the practice is embraced, and these consequences persist after migration. Practice and policy recommendations are drawn from the analysis.     

Back to Stir It Up: Erectile Dysfunction in an Evolutionary,Developmental, and Clinical Perspective

In this review, we analyze erectile dysfunction (ED) in the context of sexual selection. We highlight that ED is a specific human male characteristic linked to the loss of the baculum or penile bone and results from a range of physical and psychological factors. We discuss evolutionary interpretations that consider dysfunctional penile erection as an honest signal of a low-quality male. We further emphasize the importance of considering psychosocial context and early attachment dynamics for understanding the etiology of some types of ED. Finally, we suggest that the integration of developmental factors for understanding the emergence of this sexual disorder is instrumental for the calibration of more effective therapies.     

"Circumcision", culture,and health-care provision in Tower Hamlets,London

Tower Hamlets (London, England) has a sizable Somali community whose members maintain close links with their families in Africa. The London Black Women's Health Action Project (LBWAP) was established in Tower Hamlets, in 1982, to address the health needs of Somali women, especially those related to female circumcision. The major focus in the UK has been on protecting girls from undergoing this practice, with little attention to the needs of women who have already been circumcised. Of 200 Somali women interviewed by LBWAP, 61% had been infibulated in their native country by people with no medical training. Among the long-term health consequences were dysmenorrhea, recurrent urinary problems, urethral damage, and painful intercourse. Although deinfibulation can be obtained, both health care professionals and circumcised women tend to be unaware of this service. LBWAP has proposed a study to assess the expressed health care needs of circumcised Somali women and match these desires with actual health care provision. To raise the consciousness of British health care professionals, parallels between female circumcision and the indiscriminate, unnecessary use of episiotomy are being made.     

Conformity and change: community effects on female genital cutting in Kenya

In this article, I analyze women's decisions to have their daughters circumcised based on data from 7,873 women in Kenya collected in the 1998 Kenya Demographic and Health Survey. I use multilevel models to assess the degree to which women s decisions are correlated with the decisions of other women in their community, in addition to studying the effects of socioeconomic characteristics measured at both the individual and community levels. I find some support for modernization theories, which argue that economic development leads to gradual erosion of the practice of female circumcision. However, more community-level variation is explained by the convention hypothesis, which proposes that the prevalence of female circumcision will decline rapidly once parents see that a critical mass of other parents have stopped circumcising their daughters. I also find substantial variation among different ethnic groups in the pace and onset of the decline of female genital cutting.     

A Summary of Selective Experimental Research on Psychosocial Interventions for Sexually Abused Children

This study was conducted to explore current trends in psychosocial interventions for sexually abused children through a review of recent research. Our comprehensive review is limited to published (quasi) experimental studies in the English language over a period of 2000–2013. It provides a detailed analysis of the final 18 articles that met our inclusion criteria, from the 670 potentially relevant articles that were identified. Reviewers analyzed candidate articles to determine whether they met inclusion or exclusion criteria. The retrieved studies reported positive results with respect to improvements in the negative psychosocial sequelae of child sexual abuse following the use of a diverse set of treatment strategies. Of the various interventions, cognitive behavioral therapy was shown to be the most promising type of intervention for sexually abused children. In this review, we discuss some of the implications of psychosocial interventions for victims of child sexual abuse, citing both the methodological and ethical issues that should be considered.     

Race,ethnicity, gender,and generational factors associated with the coming‐out process among gay,lesbian, and bisexual individuals

Age at coming out among gay/lesbian/bisexual (GLB) persons and sexual debut with same‐gendered partners has typically been investigated in samples that do not reflect the racial and ethnic diversity of these communities. Addressing this limitation, data were collected from a diverse sample of men and women attending large‐scale GLB community events in New York and Los Angeles in 2003 (N = 2,733). Compared to older cohorts, younger cohorts (18–24 year olds) of both men and women reported significantly earlier ages for sexual debut with same‐gendered partners, and earlier ages for coming out to themselves and to others. Also, women began the process at later ages than men, as they reported coming out to themselves and sexual debut with a same‐gender partner approximately two years later than men. There were no racial or ethnic differences in age out to self or others; however, people of color were less likely to be out to their parents. Service providers, sexuality educators, and researchers should attend to the diversity in experience of coming out among GLB populations as they relate to the individuals’ gender, age, and racial and ethnic backgrounds.     

Does writing reduce posttraumatic stress disorder symptoms?

To see if writing about their trauma lessened PTSD and related symptoms, 57 undergraduates, previously screened for traumatic experiences, wrote for 15 minutes on 4 days across 2 weeks about either their trauma or a trivial topic. They reported PTSD, impact, suicide ideas, dissociation, and depression pre-, post-, and at 6-week follow-up testing. Trauma and trivial writers were not different. Surprisingly, at follow-up everyone reported less severe PTSD symptoms, impact, and dissociation, and fewer health visits, but about the same suicidal ideation and depression. On PTSD symptoms and impact, the pattern of improvement was different: Those writing about trauma got worse at posttesting, but improved to better than their initial state by follow-up. Those writing about a trivial topic got better by posttesting, and held that position at follow-up. In this project, writing seemed to reduce PTSD symptoms regardless of whether it concerned the trauma or what they ate for lunch.     

Association of the modified frailty index with adverse outcomes after penile prosthesis implantation

Objectives: To investigate frailty as a predictor of surgical outcome in elderly patients undergoing penile prosthesis implantation.

Material and methods: A total of 54 elderly patients, above 60 years of age, underwent penile prosthesis implantation between 2012 and 2014. Their data were collected and retrospectively analyzed. A modified frailty index (mFI) was calculated for each patient based on 11 risk factors from the Canadian Study of Health and Aging Frailty Index. The 1-year adverse outcomes were correlated with mFI, patients’ and procedure’s risk factors.

Results: Mean age was 64.9?±?5.2 years. No mortality was reported in our patients, however, one-year adverse outcomes were encountered in 43 (79.6%) patients. Among all studied variables, the 1-year adverse outcomes was not significantly association with mFI, but with preoperative glycosylated hemoglobin A1c (HbA1c) (p?=?0.031) and associated Peyronie’s disease (PD) (p?=?0.000). HbA1c, dyslipidemia, hypertension, PD and duration of the procedure were predictive of infection complications (p?Conclusions: mFI is not a predictive of post-penile prosthesis implantation adverse outcomes in elderly patients with impotence. Degree of diabetic control and association with PD was associated with the 1-year adverse outcomes and infection complications.     

Aging and sexual health: getting to the problem

Erectile dysfunction (ED) is one of the most common disorders in male and is often associated with other age-related comorbidities. The aging process affects the structural organization and function of penile erectile components such as smooth muscle cell and vascular architecture. These modifications affect penile hemodynamics by impairing cavernosal smooth muscle cell relaxation, reducing penile elasticity, compliance and promoting fibrosis. This review aims to identify the mechanisms of ED in the penile aging process in experimental and clinical data. It also highlights areas that are in need of more research. The search strategies yielded total records screened from PubMed. Clarification of the molecular mechanisms that accompanies corpus cavernosum aging and aging-associated ED will aid new perspectives in the development of novel mechanism-based therapeutic approaches. Age is not a limiting factor for ED medical management, and it is never too late to treat. Hypogonadism should be managed regardless of age, and synergistic effects have been found during testosterone (T) replacement therapy when used along with oral phosphodiesterase-5 (PDE-5) inhibitors. Therefore, the clinical management of ED related to aging can be done by therapeutic interventions that include PDE-5 inhibitors, and other pharmacological treatments.