Sexual Health in the Netherlands: Main Results of a Population Survey Among Dutch Adults

ABSTRACT

In 2006, the Rutgers Nisso Groep conducted an extensive population survey to assess the epidemiology of sexual health in the Netherlands. The sample consists of a random selection of the adult population living in the Netherlands (N= 4147) who were approached through internet panels. The study assesses the prevalence of a broad range of sexual health issues, including sexual and relational satisfaction, experience of sexuality, sexual identity, paraphilia, excessive desire, sexual dysfunctions, contraception, abortion, infertility, testing for sexually transmitted infections and HIV, condom use, and sexual violence. The data show, among other findings, that a small half of the adult Dutch population was basically without sexual health-related problems or stress during the year preceding the study. The other half experienced problems to a varying extent in one or more areas. Overall, 24% of the women and 19% of the men have experienced a need for professional sexual health care during the previous year. For women and men alike, relational problems are the most common complaint. About half of those in need of one or another form of sexual health care actually received it. Young people and people with an ethnic minority background show an elevated need for sexual health care.     

Frequency and Types of Partner Violence Among Mexican American College Women

Objective and Participants: The authors studied the prevalence of partner violence, by type, among Mexican American college women aged 18 to 35 years (N = 149; response rate = 85%). Results: Twelve percent of women who reported a dating partner in the past year were physically or sexually assaulted, 12.1% were stalked, and 9.1% scored as psychologically abused. Among those experiencing partner violence, almost half experienced stalking and 89% reported psychological abuse. Few women (25%) who experienced physical violence believed violence was a problem in their relationship. Conclusions: Partner violence was prevalent in this population, and participants experienced many forms of violence. Because few women experiencing physical violence report that violence is a problem in their relationship, interventions must address perceptions of violence and its impact on women's mental and physical health in college populations.     

Feasibility and acceptability of using a web-based contraceptive support tool in a university health clinic

Abstract

Objective: To evaluate feasibility of integrating Bedsider.org, a web-based contraceptive decision support tool, at a university health clinic (UHC). Participants: Female students (ages 18–29) seeking contraceptive care at the UHC were enrolled in September 2015 (n?=?46). Methods: Providers recruited eligible patients during reproductive healthcare visits and introduced Bedsider. Surveys were administered immediately following the visit and a follow-up 2–4?weeks later. Electronic health records through 6?weeks post-enrollment were extracted. Results: Most patients had positive views toward Bedsider and appreciated receiving information during their UHC encounters. None were using long-acting reversible contraceptives (LARC) at enrollment. At follow-up, two patients self-reported IUD use. Among those recently sexually active, use of more effective contraceptive methods increased from 65% to 74%; 11% had initiated or were scheduled to receive a LARC. Conclusion: Bedsider can be feasibly integrated into UHC visits and may support women’s selection of more effective contraceptive methods, including LARCs.     

Sexual inactivity among men who have sex with men living with hiv in europe

Objectives: Most people living with HIV stay sexually active, but some remain inactive. This study investigated prevalence and correlates of sexual inactivity among European HIV-positive men who have sex with men (MSM). Methods: An anonymous sexual health questionnaire was distributed in 17 HIV outpatient clinics throughout Europe. Ninety-seven (11.6%) of 838 respondents reported absence of sexual activity. Results: Multivariable regression analysis identified older age, relationship status, and less satisfaction with general health and sexual desire as being associated with sexual inactivity. Conclusions: Prevalence of sexual inactivity has declined since the introduction of antiretroviral therapy to levels similar to those of HIV-negative MSM, suggesting a tendency toward normalization of HIV-positive MSM's sex lives.     

Men's Reproductive and Sexual Health

Abstract

A broad definition of men's reproductive and sexual health (MRSH) includes medical (pathophysiological) matters such as sexually transmitted infections (STIs), developmental anomalies, malignancy, trauma, and infertility. It also includes psychosocial concerns: sexuality, contraception, disease prophylaxis, developmental and lifecycle issues, tobacco and drug use, sexual identity and orientation, and partnership issues. College men, of whom a large majority are sexually active, have a range of MRSH needs, including some that are particular to their age and social environment. To reach men effectively requires approaches that are somewhat different from those used with women. Clinicians in college health services are in an excellent position to help young men recognize the importance of reproductive health and sexual responsibility. College health services therefore should offer men screening; clinical diagnosis and treatment for MRSH conditions; and information, education, and counseling services, in a manner designed to meet their unique needs.     

College Health Service and the Fast-Food Value System

Abstract

Objective: To estimate and compare the prevalence of overweight and obesity among self-identified lesbian, bisexual, and heterosexual college age women. Methods: A secondary analysis of the Spring 2006 National College Health Assessment was conducted with 31,500 female college students (aged 18 to 25 years) to compare body mass index (calculated from self-reported height and weight) among lesbian, bisexual and heterosexual college women. Results: Compared to heterosexuals female college students, lesbians and bisexual women were both significantly more likely to be overweight or obese. Lesbians were also less likely to be underweight compared to heterosexual college women. Conclusions: Self-identified lesbian and bisexual college women were more likely to be overweight or obese than their heterosexual counterparts. Health care professionals and educators should target these high-risk populations for obesity prevention programs. This study highlights the need for additional research examining the potential risk factors for overweight and obesity among young sexual minority women.     

Prevalence of Human Immunodeficiency Virus Testing and Associated Risk Factors in College Students

Abstract

Objective: This study documents the prevalence of human immunodeficiency virus (HIV) testing in a sample of college students and examines associated demographic and behavioral characteristics. Participants: College students aged 18 or older were randomly selected to participate in a health behavior survey at a southeastern university in September 2011. Methods: Only sexually active students were included (N = 905). Relationships between demographic and sexual behavior characteristics were explored using logistic regression and classification regression tree (p ≤.05). Results: Only 36.2% reported having been tested for HIV. Age was the most significant factor associated with testing. Factors associated with those least likely to be tested were race and anal sexual activity. Unsafe sexual behaviors were also associated with lower rates of HIV testing. Conclusions: Findings support the need for targeted HIV interventions on college campuses. Such interventions need to be tailored for at-risk students and take into consideration factors likely to contribute to HIV testing.     

Toward a generation free of tuberculosis: TB disease and infection in individuals of college age in the United States

Objectives: To assess the magnitude of active TB disease and latent TB infection (LTBI) in young adults of college age. Participants: Individuals who were aged 18–24 years in 2011 were used as a proxy for college students. Methods: Active TB cases reported to the 2011 US National TB Surveillance System (NTSS) were included. LTBI prevalence was calculated from the 2011–2012 National Health and Nutrition Examination Survey. The 2011 American Community Survey was used to calculate population denominators. Analyses were stratified by nativity. Results: Active TB disease incidence among persons aged 18–24 years was 2.82/100,000, 18.8/100,000 among foreign-born individuals and 0.9/100,000 among US-born individuals. In 2011, 878 TB cases were reported; 629 (71.6%) were foreign-born. LTBI prevalence among persons of 18–24 years was 2.5%: 8.7% and 1.3% among foreign-born and US-born, respectively. Conclusion: Active screening and treatment programs for foreign-born young adults could identify TB cases earlier and provide an opportunity for prevention efforts.     

What Do Men Want?

Abstract

Men play a key role in determining good sexual health outcomes for themselves and their sexual partners. However, many interventions and much of the programmatic focus and effort in reproductive and sexual health care delivery, are focused on women. This paper shows how international goals for development (the Millennium Development Goals), and international agreements on population and development (such as that agreed at the International Conference on Population and Development, Cairo,1994) cannot be met without the full and active involvement of men. We argue that achieving international goals and targets requires more than simply encouraging men to take more responsibility for their actions, it requires a detailed understanding of men's own concerns in the field of sexual health and a commitment to address those concerns to achieve better sexual health for all.

Using examples from south Asia, the paper explores the evidence surrounding the burden of men's sexual ill-health in the Region. We find that while public health programmes are (rightly) focused on controlling HIV (and sexually transmitted infections to some degree), evidence from population-based surveys of men across south Asia shows that men are most concerned with ‘psycho-sexual conditions’ including discharge syndromes, weakness, and erectile dysfunction. There is evidence that some of these conditions may be linked to higher rates of risk-taking and gender-based violence in some men. We further review patterns of care seeking for men reporting these and other sexual health problems.

We conclude that the challenges facing public health professionals are how to ensure that men receive interventions which are appropriate (and affordable and accessible and of high quality) for addressing their own sexual health concerns whilst also meeting wider public health goals of improving population levels of sexual and reproductive health.     

Body Size and Sexual Behavior in a Community-Based Sample of Women

ABSTRACT. Women's body size is closely related to their social and sexual experiences. Clinical research has found that women's lifetime sexual behaviors may vary based on body mass index (BMI). Objectives: This study examined the relationship between BMI and recent solo and partnered sexual repertoire in a community-based, non-clinical sample of women. Methods: Two hundred thirty-eight sexually active women completed an online survey measuring age, sexual relationship status, BMI, gender of sexual partners, and engagement in sexual behaviors in the previous 4 weeks. Logistic regression analyses were conducted to determine whether BMI predicted engagement in behaviors after controlling for age and sexual relationship variables. Results: Participant age ranged from 18 to 56 years (M = 30.4, SD = 7.8). Participants were predominantly in exclusive sexual relationships (62.9%, n = 146) with men (82.8%, n = 197). Mean BMI for the sample was 29.33 (SD = 9.28). Participation in self-masturbation, masturbating a partner, performing oral sex on a partner, receiving oral sex from a partner, and penile–vaginal intercourse were not predicted by BMI after controlling for age and partner variables. Conclusions: BMI did not impact sexual repertoire during the previous 4 weeks, with the exception of an increased odds ratio for penile–anal intercourse (OR = 1.06; 95% CI [1.02, 1.10]). Researchers and practitioners working with women should not assume limitations on women's sexual repertoires because of larger body size.     

Young and Sexual in Norway and Croatia: Revisiting the Scandinavian Versus Mediterranean Gendered Pattern of Sexual Initiation

ABSTRACT

This article describes and analyzes patterns of first sexual intercourse and contraception use from a bicultural perspective. Study results are based on a 2009–2010 large-scale national probability survey of young adults aged 18 to 24 years in Croatia (n = 1,005) and Norway (n = 871). The findings corroborated the persistence of the dual model of sexual initiation in Europe (Scandinavian vs. Mediterranean), in which Norwegian women and Croatian men reported coital debut at an earlier age than their gender counterparts. Age difference between partners and the prevalence of condom use at first coitus were similar in both countries, with differences in contraceptive choices emerging with time. Young Norwegian men and women switched from using condoms to hormonal contraception when having been coitally active for some time. Interestingly, “the pill” remains rather unpopular among young Croatian women. Controlling for selected variables, using a condom at most recent sexual intercourse was significantly associated with condom use at first intercourse in all groups except Norwegian men, as well as with years of coital activity (except among Croatian men). Additionally, the odds of a condom being used at most recent intercourse were significantly correlated with same-sex sexual experience (only among Norwegian men) and with reporting the most recent intercourse with a casual partner (only among Norwegian participants). Country-specific patterns of contraceptive use are discussed in the context of public health and prevention.     

Seventy-Five Years Old and Still Going Strong: Stability and Change in Sexual Interest and Sexual Enjoyment in Elderly Men and Women Across Europe

Abstract

Objective: The aim of this study was to test a conceptual model of retrospectively assessed change in sexual interest and sexual enjoyment in the past 10 years among coupled older adults in Norway, Denmark, Belgium and Portugal. To which degree do structural influences, personal characteristics, and interpersonal factors predict the dynamics of sexual interest and enjoyment in partnered persons? Methods: Data were collected as a cross-sectional postal survey, with national probability-based samples of the population aged 60-75 years recruited by phone registers in Norway (676 men and 594 women), Denmark (530 men and 515 women), Belgium ( 318 men and 672 women), and Portugal (236 men and 273 women). Results: Across countries, personal characteristics—primarily general health status—were the most important predictors of change in sexual interest and sexual enjoyment in men. Change in sexual interest and enjoyment among women (except for Portuguese women) was best predicted by interpersonal factors. Conclusions: Good health, an active sex life throughout the lifespan, direction of relationship, and feeling emotionally close to partner during sex are important factors in maintaining sexual interest and enjoyment among partnered older adults in Europe.     

Sexual Violence and the MDGs

ABSTRACT

Sexual violence is multi-faceted. Three (overlapping) categories can be distinguished: violence that is sexual in nature, gender-based violence, and sexuality-based violence. The latter refers to violence against persons because of their sexuality and/or their (presumed) sexual behavior. Being female, young, poor, and living in a sexually conservative culture and/or in conflict areas appear to be important risk factors for sexual violence. Sexual violence is widespread (one in five girls worldwide are sexually abused in childhood and up to three-quarters of women in some countries have been victimized by a partner), but prevalence figures around the globe are hard to compare. Both the individual and society suffer from sexual violence. The eradication of sexual violence is directly relevant to achieving the Millennium Development Goals (MDGs) related to infant and maternal health and mortality, and combating HIV/AIDS. And certainly no less important, it is very closely linked to the MDGs related to gender equality and the empowerment of women, poverty, and primary education for all. Campaigning against sexual violence against women has been presented as one of the ‘quick wins’ in progress towards achieving the MDGs by the UN Millennium Project. Many good practices have been employed in political-legal, awareness raising, prevention, and health care domains, but important setbacks are noteworthy as well. Priority number one for the World Association for Sexual Health now seems to be to adequately and strategically contribute to the continuous efforts to integrate sexual health into the Millennium Development framework.     

Development of Sexual Expectancies among Adolescents: Contributions by Parents,Peers and the Media

To expand the scant research on sexual expectancies development among non–sexually active adolescents, we examined the relationship between adolescents' exposure to four socializing agents—mother/female guardian, father/male guardian, peers, and television programs with high sexual content—and their endorsement of four sexual expectancies: social benefit, pleasure, social risk, and health risk. Data are from Waves 2 and 3 of a three-wave annual longitudinal study conducted among California adolescents, the majority of whom were not sexually active (N = 914, 84%). Structural equation models were conducted to examine cross-sectional and longitudinal associations between the socializing agents and the sexual expectancies. Cross-sectional results indicate associations between peer sexual communication and social benefit, pleasure, and social risk expectancies. A positive association was found between exposure to music videos and social benefit expectancies, and a negative association was found between exposure to music videos and health risk expectancies. Longitudinal results suggest that communication with peers positively predicted pleasure expectancies and negatively predicted social risk expectancies. No other socializing agents were associated with any sexual expectancies. An invariance test found that significant correlations were similar across the different age groups. Results suggest that efforts to support positive sexual decision making among non–sexually active adolescents should target peer sexual communication.     

Young Clients of Hotel-Based Sex Workers in Bangladesh: Vulnerability to HIV,Risk Perceptions,and Expressed Needs for Interventions

ABSTRACT

A qualitative study was conducted among key informants and 53 young clients (15 to 24 years of age) of commercial sex workers from nine hotels in Dhaka, Bangladesh. Respondents reported first sexual encounter before 18 years of age, and reasons for purchasing sex were to prove masculinity or to reduce wet dreams and masturbation, thought to be detrimental to health. Limited knowledge of HIV and sexually transmitted infections was linked to high-risk sexual practices. Condom use was related to perceptions of cleanliness, status, and trust in the sex worker.

A hotel-based, confidential intervention program promoting safe sex practices among clients of sex workers is warranted.     

The Who Concept of Sexual Health Applied to An Urban Poor Community in Mumbai,India

Objectives: The objectives of this study were to describe a scale that operationalizes the World Health Organization concept of sexual health and to assess factors associated with scale variation. Methods: Qualitative in-depth interviews (N = 39), sexual health interviews (N = 21), and survey data (N = 1,128) for this article are drawn from an Indo-U.S. project to reduce the incidence of HIV and sexually transmitted infections among poor urban married women (aged 18–49 years old) in Mumbai, India. Results: Lower sexual health status was significantly associated with gender inequity, marital violence, poorer marital relationships and physical health, and lower empowerment and social support. Conclusions: This work demonstrates the need to view sexual health in the broader context of community and family.     

The State of the Union: Sexual Health Disparities in a National Sample of US College Students

Abstract

Objective: To examine sexual health disparities between blacks and whites in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 44,165 nonmarried undergraduates (aged 18–24; M = 20.1) responding to the Spring 2007 American College Health Association–National College Health Assessment; 64% were female and 94.7% were white. Results: Whites reported more experience in oral and anal sex, were less likely to use condoms for oral, anal, and vaginal sex, and less likely to have been tested for HIV (human immunodeficiency virus) compared with blacks. However, blacks reported more sex partners, lower use of hormonal contraceptives, and higher rates of adverse sexual health outcomes, such as sexually transmitted infections (STIs) and unintended pregnancy. Sexual behaviors and outcomes also varied across gender. Conclusions: This study highlights a need to increase access to hormonal contraceptives and early STI screening/treatment among blacks, improve HIV testing among whites, and increase condom use promotion for all students.     

Quantifying the magnitude and potential influence of missing data in campus sexual assault surveys: A systematic review of surveys, 2010–2016

Objective: To understand how missing data may influence conclusions drawn from campus sexual assault surveys. Methods: We systematically reviewed 40 surveys from 2010–2016. We constructed a pseudo-population of the total population targeted across schools, creating records proportional to the respective response rate and reported sexual assault prevalence. We simulated the effects of 9 scenarios where the sexual assault prevalence among nonresponders differed from that of responders. Results: The surveys represented a total female undergraduate population of 317,387 with only 77,966 (24.6%) survey responses. Among responders, 20.4% reported experiences of sexual assault. However, prevalence of sexual assault could theoretically range from 5.0 to 80.4% under extreme assumptions about prevalence in nonresponders. Smaller, but still significant differences were observed with less extreme assumptions. Conclusions: Missing data are widespread in campus sexual assault surveys. Conclusions drawn from these incomplete data are highly sensitive to assumptions about the sexual assault prevalence among nonresponders.