Intravaginal Practices among a Cohort of Rural Malawian Women

Background:

Intravaginal practices (IVP) are highly prevalent and commonly performed in many countries for a variety of purposes related to genital health, hygiene and sexual pleasure. However, IVP may also have harmful side effects, including associations with bacterial vaginosis and HIV.

Methods:

The prevalence and motivations for IVP among 650 women participating in the baseline survey of a community-based cohort study on sexual and reproductive health in rural Lilongwe District, Malawi, were characterised. Key variables included the type and frequency of IVP, and motivations for engaging in IVP.

Results:

Most women (95%) had engaged in IVP in the past 30 days: 88% reported internal vaginal cleansing with water only, 87% reported cleansing with soap and water, and 84% reported inserting cotton, cloth or tissue. A majority (60%) reported at least three practices. Very frequent engagement in at least one type of IVP was also common; among those who inserted cotton, cloth or tissue, 43% did so more than once a day; among those who cleansed internally with soap and water, 51% did so more than once a day. Women reported many reasons for using IVP. The most commonly reported reasons were to remove odours (91%), to remove extra moisture (58%), to prevent disease (49%), to relieve symptoms of disease (41%) and to improve sex for a partner (40%).

Conclusion:

IVP are highly prevalent and frequently performed among these rural Malawian women. Future research should investigate the associations between IVP and sexually transmissible infection prevalence.

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By:  Allahna Esber A D, Abigail Norris Turner B, Gladson Mopiwa C and Alison H. Norris A B 

A Division of Epidemiology, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA. B Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, 410 W. 10th Columbus, OH 43210, USA. C Child Legacy International, Umoyo wa Thanzi Research, P.O.Box 1927, Lilongwe, Malawi. D Corresponding author. Email: esber.8@osu.edu 

Sex Health. 2016 Apr 14. doi: 10.1071/SH15139.

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An Initial Typology of Contexts of Dyadic Sexual Encounters Between Men & Associations with Sexual Risk & Pleasure

Background:

Although many within-subjects comparisons conducted on samples of men who have sex with men have sought to understand the association between specific situational characteristics (e.g. drug use or location of sex) and sexual risk behaviour, none have considered the 'clustering' of patterns of situational characteristics. An initial typology of sexual encounters is derived and the relationship of this typology to condomless anal intercourse (CAI) and pleasure is tested.

Methods:

Data from a longitudinal survey of men who have sex with men living in England were used. Multilevel latent class analyses were estimated to determine an optimal class solution on the situational characteristics, and then pseudo-imputation was used to estimate the association between class and both CAI and pleasure.

Results:

A three-class solution fit the data best, with a scaled relative entropy of 92.4%. Classes were characterised as featuring: regular steady partners in private locations with low drug use

• Class 1, casual partners with increased probability of sex occurring in a sex-on-premises venue 
• Class 2, and high levels of polydrug use together with increased probability of casual partners
• Class 3. Encounters were different both in pairwise comparisons and overall on probability of CAI. 

They were different overall but not necessarily pairwise on pleasure.

Conclusions:

These initial findings demonstrate the possibility of understanding sexual encounters in terms of the contexts, or classes, within which they occur. This may have implications for tailoring HIV prevention to specific encounter types. Future research should seek to extend encounter-level typologies to specific drug use variables.

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By:  G. J. Melendez-Torres A D, Ford Hickson B, David Reid B, Peter Weatherburn B andChris Bonell C 

A Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry. B Sigma Research, London School of Hygiene and Tropical Medicine. C Department of Social Science, UCL Institute of Education, University College London D Corresponding author. Email: G.Melendez-Torres@warwick.ac.uk 

Sex Health. 2016 Mar 9. doi: 10.1071/SH15218

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Psychosexual Correlates of Sexual Double Standard Endorsement in Adolescent Sexuality

Endorsement and enactment of the (hetero)sexual double standard (SDS), prescribing sexual modesty for girls and sexual prowess for boys, has been shown to be negatively related to sexual and mental health. To be able to challenge the SDS, more insight is needed into the conditions that shape gendered sexual attitudes. 

A survey was conducted among 465 heterosexual adolescents (aged 16–20 years), examining the relationship between a number of relevant demographic and psychosexual variables and SDS endorsement. SDS endorsement was assessed using a newly developed instrument, the Scale for the Assessment of Sexual Standards Among Youth (SASSY). Gender (being male) and religiousness were significantly associated with increased SDS endorsement. 

For both boys and girls, increased feelings of entitlement to self-induced sexual pleasure (e.g., masturbation) were significantly associated with reduced SDS endorsement, whereas higher gender investment was significantly associated with increased SDS endorsement. Furthermore, increased feelings of entitlement to partner-induced sexual pleasure and more frequent talking about sexuality with peers were associated with increased SDS endorsement among boys but not among girls. 

We conclude that future research should explore peer influence processes through peer communication about sex, gender investment, and feelings of entitlement to both self and partner-induced sexual pleasure.

Scale for the Assessment of Sexual Standards Among Youth (SASSY) Items and Factor Loadings

Item #	Item Content	Factor Loadings
1	Once a boy is sexually aroused, a girl cannot really refuse sex anymore.	.626
2	Girls like boys who take the lead in sex.	.404
3	I think that a girl who takes the initiative in sex is pushy.	.617
4	I think it is more appropriate for a boy than for a girl to date different people at the same time.	.508
5	Girls should act in a more reserved way concerning sex than boys.	.618
6	I think it is more appropriate for a boy than for a girl to have sex without love.	.456
7	A boy should be more knowledgeable about sex than a girl.	.650
8	I think sex is less important for girls than for boys.	.712
9	I think it is normal for boys to take the dominant role in sex.	.506
10	I think sexually explicit talk is more acceptable for a boy than for a girl.	.562
11	Sometimes a boy should apply some pressure to a girl to get what he wants sexually.	.582
12	It is more important for a girl to keep her virginity until marriage than it is for a boy.	.531
13	Boys are more entitled to sexual pleasure than girls.	.640
14	It is not becoming for a girl to have unusual sexual desires.	.536
15	Sex is more important for boys than for girls.	.548
16	It is more important for a girl to look attractive than it is for a boy.	.449
17	Boys and girls want completely different things in sex.	.413
18	I think cheating is to be expected more from boys than from girls.	.533
19	I think it is important for a boy to act as if he is sexually active, even if it is not true.	.641
20	I think it is more appropriate for a boy than for a girl to masturbate frequently.	.434

Note. The instrument was administered in the Dutch language. For international readability the table provides the English translation. Dutch item wording is available upon request.

Below:  Interaction between participant sex and talking about sex with peers (separated by low and high frequency of talk) depicted based on standardized values.

Below:  Interaction between participant sex and feelings of entitlement to partner-induced sexual pleasure (separated by low and high entitlement) depicted based on standardized values

Full article at:   http://goo.gl/lCG0t8

By:  Peggy M. J. Emmerink, a , * Ine Vanwesenbeeck, a , b Regina J. J. M. van den Eijnden, a and Tom F. M. ter Bogt a

aDepartment of Interdisciplinary Social Sciences, Utrecht University, Utrecht, Netherlands

bRutgers, Expert Centre for Sexual and Reproductive Health and Rights, Utrecht, Netherlands

Correspondence should be addressed to Peggy M. J. Emmerink, Department of Interdisciplinary Social Sciences, Utrecht University, Martinus J. Langeveldbuilding, Room H2.09, Heidelberglaan 1, Utrecht 3584 CS, the Netherlands.

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Defining Pleasure: A Focus Group Study of Solitary and Partnered Sexual Pleasure in Queer and Heterosexual Women

Solitary and partnered sexuality are typically depicted as fundamentally similar, but empirical evidence suggests they differ in important ways. 

We investigated how women's definitions of sexual pleasure overlapped and diverged when considering solitary versus partnered sexuality. Based on an interdisciplinary literature, we explored whether solitary pleasure would be characterized by eroticism (e.g., genital pleasure, orgasm) and partnered pleasure by nurturance (e.g., closeness). 

Via focus groups with a sexually diverse sample of women aged 18-64 (N = 73), we found that women defined solitary and partnered pleasure in both convergent and divergent ways that supported expectations. Autonomy was central to definitions of solitary pleasure, whereas trust, giving pleasure, and closeness were important elements of partnered pleasure. Both solitary and partnered pleasure involved exploration for self-discovery or for growing a partnered relationship. 

Definitions of pleasure were largely similar across age and sexual identity; however, relative to queer women, heterosexual women (especially younger heterosexual women) expressed greater ambivalence toward solitary masturbation and partnered orgasm. 

Results have implications for women's sexual well-being across multiple sexual identities and ages, and for understanding solitary and partnered sexuality as overlapping but distinct constructs.

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By:  Goldey KL1,2, Posh AR1, Bell SN3, van Anders SM4.

• 1Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
• 2Department of Psychology and Behavioral Neuroscience, St. Edward's University, Austin, TX, USA.
• 3Departments of Psychology and Women's Studies, University of Michigan, Ann Arbor, MI, USA.
• 4Departments of Psychology and Women's Studies, Programs in Neuroscience and Reproductive Sciences, Science, Technology, and Society Program, Biosocial Methods Collaborative, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA. smva@umich.edu. 
• Arch Sex Behav. 2016 Mar 23.

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Measures of Attitudes Toward and Communication about Condom Use: Their Relationships with Sexual Risk Behavior among Young Black Men Who Have Sex With Men

OBJECTIVE:

The aim of this study was to construct and test measures of psychosocial mediators that could be used in intervention studies seeking to promote safer sex behavior among young black men who have sex with men (YBMSM).

METHODS:

A total of 400 YBMSM, ages 18 to 29 years, were recruited from a clinic for sexually transmitted infection in the southern United States. All men had engaged in penile-anal sex with a man as a "top" in the past 6 months. The men completed an audio-computer-assisted self-interview and provided specimens used for nucleic acid amplification testing to detect Chlamydia and gonorrhea. Four measures were constructed and tested for criterion validity (Safer Sex Communication, Condom Turn-Offs, Condom Pleasure Scale, and a single item assessing frequency of condom use discussions before sexual arousal).

RESULTS:

With the exception of Safer Sex Communication, all of the measures showed criterion validity for both unprotected anal insertive and unprotected anal receptive sex. With the exception of the Condom Turn-Offs, the 3 other measures were supported by criterion validity for oral sex. Both the Condom Turn-Offs and Condom Pleasure Scale were significantly related to whether or not the men reported multiple partners as a top, but only the Condom Pleasure Scale was associated with reports of multiple partners as a "bottom." Only the Condom Turn-Offs Scale was positively associated with having been diagnosed with either Chlamydia or gonorrhea.

CONCLUSION:

Findings provide 3 brief scales and a single item that can be used in intervention studies targeting YBMSM. Perceptions about condoms being a turnoff and about condoms enhancing pleasure showed strong association with sexual risk behaviors.

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By:  Crosby RA1, Graham CA, Yarber WL, Sanders SA, Milhausen RR, Mena L.

• 1From the *College of Public Health, University of Kentucky (http://www.uky.edu/publichealth/), Lexington, KY; †The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, ‡Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN; §Department of Psychology, University of Southampton, UK; ¶Department of Gender Studies, Indiana University, Bloomington, IN, **Department of Applied Health Science, Indiana University, Bloomington, IN; ††Department of Family Relations and Applied Nutrition, University of Guelph, Ontario, Canada; and ***University of Mississippi Medical Center, Jackson, MS.
• Sex Transm Dis. 2016 Feb;43(2):94-8. doi: 10.1097/OLQ.0000000000000392.

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Triggering the Decision to Undergo Medical Male Circumcision: A Qualitative Study of Adult Men in Botswana

In 2007, the World Health Organization endorsed voluntary medical male circumcision (VMMC) as part of comprehensive HIV-prevention strategies. A major challenge facing VMMC programs in sub-Saharan Africa remains demand creation; there is urgent need for data on key elements needed to trigger the decision among eligible men to seek VMMC. 

Using qualitative methods, we sought to better understand the circumcision decision-making process in Botswana related to VMMC. From July to November 2013, we conducted 27 focus group discussions in four purposively selected communities in Botswana with men (stratified by circumcision status and age), women (stratified by age) and community leaders. All discussions were facilitated by a trained same-sex interviewer, audio recorded, transcribed and translated to English, and analyzed for key themes using an inductive content analytic approach. 

Improved hygiene was frequently cited as a major benefit of circumcision and many participants believed that cleanliness was directly responsible for the protective effect of VMMC on HIV infection. While protection against HIV was frequently noted as a benefit of VMMC, the data indicate that increased sexual pleasure and perceived attractiveness, not fear of HIV infection, was an underlying reason why men sought VMMC. 

Data from this qualitative study suggest that more immediate benefits of VMMC, such as improved hygiene and sexual pleasure, play a larger role in the circumcision decision compared with protection from potential HIV infection. 

These findings have immediate implications for targeted demand creation and mobilization activities for increasing uptake of VMMC among adult men in Botswana.

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By:  Wirth KE1,2,3, Semo BW1,4, Ntsuape C5, Ramabu NM1, Otlhomile B1, Plank RM3,6,7, Barnhart S4, Ledikwe JH1,4.

• 1 Botswana International Training and Education Center for Health (I-TECH) , Gaborone , Botswana.
• 2 Department of Epidemiology , Harvard T. H. Chan School of Public Health , Boston , Massachusetts , USA.
• 3 Department of Immunology and Infectious Diseases , Harvard T. H. Chan School of Public Health , Boston , Massachusetts , USA.
• 4 Department of Global Health , University of Washington , Seattle , Washington , USA.
• 5 Department of HIV/AIDS Prevention and Care , Botswana Ministry of Health , Gaborone , Botswana.
• 6 Division of Infectious Diseases , Brigham and Women's Hospital , Boston , Massachusetts , USA.
• 7 Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education , Gaborone , Botswana.
• AIDS Care. 2016 Jan 11:1-6.  

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Female Sexual Subjectivity and Verbal Consent to Receiving Oral Sex

Women are less likely than men are to report receiving oral sex from their partners. Elements of sexual subjectivity may have implications for women's communication of consent to specific sexual acts. 

Sexually active women (n = 237) between 18 and 71 years of age (M = 28.85 years) completed an online survey measuring sociodemographic variables, entitlement to pleasure from partner, self-efficacy in achieving sexual pleasure, and consent communication at last receptive oral sex event. Participants were predominantly White (84.8%, n = 201) and in exclusive or monogamous sexual relationships (54.9%, n = 130). The authors used a 4-step test of mediation to determine whether self-efficacy in achieving sexual pleasure mediated the relation between entitlement to pleasure from partner and verbal consent communication. 

Self-efficacy emerged as a significant predictor of verbal consent communication (p <.01) in the fourth step, while entitlement to pleasure dropped out of the model (p >.05), indicating full mediation. Therefore, entitlement to pleasure predicted verbal consent to oral sex as a function of self-efficacy in achieving sexual pleasure. Sex-positive educational interventions may improve disparities between men and women in receiving oral sex from their partners. 

Results of this study offer insight into the ways in which culture-level forces affect interpersonal and intraindividual sexual health behaviors.

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By:  Sonya Satinsky^a* & Kristen N. Jozkowski^b

^a Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, USA

^b Department of Health, Human Performance & Recreation, University of Arkansas, Fayetteville, Arkansas, USA

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"I provide the pleasure, I control it": Sexual Pleasure & "Bottom" Identity Constructs amongst Gay Youth in a Stepping Stones Workshop

This paper explores the meanings attached to gay sexuality through the self-labelling practices of a group of young gay-identified students in focus group and individual interviews in Johannesburg, South Africa. These meanings include constructs of the dynamics surrounding safe sex negotiation and risk related to "top-bottom" subject positioning as well as the erotics of power and desire that are imbued in these practices and positioning. 

Using performativity theory as a theoretical tool of analysis, I argue that constructs of "top-bottom" subjectivities can be seen to meet certain erotic needs for LGBTI youth, including reasons related to physical safety for LGBTI people living in dangerous spaces. The performance of "bottom" identities in sexual intimacy and behaviour is further deployed in the expression and performance of power that the participants construct as erotic. 

The implications for sexual health intervention include understanding the gendered performance influences of sexual behaviour including safe sex, exploring creative ways that practices of sexual health can be engaged with this population group in a way that accommodates the erotic pleasure interfaced with sexual identity identifications and performances of "bottom" identities.

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By:   Kiguwa P¹.

¹Senior Lecturer, Department of Psychology, University of the Witwatersrand, South Africa. Electronic address: Peace.Kiguwa@wits.ac.za.

Reprod Health Matters. 2015 Nov;23(46):117-26. doi: 10.1016/j.rhm.2015.11.016. Epub 2015 Dec 17. 

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"Sex Is Sweet": Women from Low-Income Contexts in Uganda Talk About Sexual Desire and Pleasure

In many patriarchal societies in Africa, heterosexuality is privileged as the single legitimate form of sexual interaction; other sexualities are marginalised because they are perceived as un-African, abnormal, sinful and are repressed. Female sexuality too is subordinated and controlled with it being reduced to women's conventional mothering roles that are conflated with their reproductive capacities. However, there is evidence that women in heterosexual relations have the opportunity to assert themselves and to define pleasurable sex. 

Drawing on in-depth interviews and focus group discussions with married women in heterosexual unions the article examines the extent to which women from low-income contexts in Uganda express their sexual agency. 

The findings show that within heterosexual relations, these women are able to express their sexual desires freely and negotiate diverse options for pleasurable sexual experiences. The evidence indicates the need for acknowledging variations within heterosexual experiences and the possibility of positive heterosexual relationships that resist hegemonic masculinity and subordinated femininity.

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By:   Muhanguzi FK1.

• 1Senior Lecturer, School of Women and Gender Studies, Makerere University, P.O. Box 7062, Kampala, UGANDA. Electronic address: floramuha@yahoo.com. 

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Female-Driven Multiple Concurrent Sexual Partnership Systems in a Rural Part of a Southern Tanzanian Province

Background

Multiple concurrent sexual relationships are one of the major challenges to HIV prevention in Tanzania. This study aims to explore sexual behaviour patterns including the practice of multiple concurrent sexual partnerships in a rural Tanzanian setting.

Methods

This qualitative study used focus group discussions and in-depth interviews with men and women from the community as well as ethnographic participant observations. The data was collected during 16 months of fieldwork in 2007, 2008, and 2009. The focus group discussions and in-depth interviews were transcribed verbatim and translated into English. The data was analysed through the process of latent content analysis. An open coding coding process was applied to create categories and assign themes.

Findings

Mafiga matatu was an expression used in this society to describe women’s multiple concurrent sexual partners, usually three partners, which was described as a way to ensure social and financial security for their families as well as to achieve sexual pleasure. Adolescent initiation ceremonies initiated and conducted by grand mothers taught young women why and how to engage successfully in multiple concurrent sexual relationships. Some men expressed support for their female partners to behave according to mafiga matatu, while other men were hesitant around this behaviour. Our findings indicate that having multiple concurrent sexual partners is common and a normative behaviour in this setting. Economical factors and sexual pleasure were identified as drivers and viewed as legitimate reason for women to have multiple concurrent sexual partnerships.

Conclusions

Structural changes improving women’s financial opportunities and increasing gender equality will be important to enable women to not depend on multiple concurrent sexual partnerships for financial security. Future research should explore how normative sexual behaviour changes as these structural changes take place.

Below:  Description of the mafiga matatu system of a married woman, from 29 to 32 years of age. The figure illustrates the structure of mafiga matatu, a wife balancing on top of the husband or steady partner and two lovers.

Full article at:   http://goo.gl/UvxOvx

By:   

Abela Mpobela Agnarson, Susanne Strömdahl, Anna Ekéus Thorson

Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

Francis Levira, Honorati Masanja

Ifakara Health Institute, Dar es Salaam, Tanzania

 

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Costs of Pleasure & the Benefits of Pain: Self-Perceived Genital Sensation, Anatomy & Sexual Dysfunction

Background: Research has highlighted the complex association between female sexual dysfunction (FSD) and distress regarding sexual activity, with decreased physical pleasure being an important mediator. The current study aims to elucidate the association between pleasurable and painful genital sensitivity and FSD, and to further investigate whether FSD may be distressing because it prevents the experience of sexual pleasure, induces pain or both. 

Methods: Sexually active women (n = 256; median, 22 years; range, 18-49 years) completed web-based questionnaires, including the Self-Assessment of Genital Anatomy and Sexual Function, the Female Sexual Function Index and the Female Sexual Distress Scale.

Results: Women reported their clitoris to be more sensitive than their vagina in terms of having more pleasurable responses (P < 0.001), but not more painful responses (P = 0.49). In women with FSD (n = 36), impaired self-perceived genital sensation was found: they reported significantly less sexual pleasure and orgasm intensity, and more orgasm effort and discomfort within the clitoral and vaginal area than women without FSD (n = 220) (P-value < 0.05). The odds of having FSD were significantly greater in women with perceived increased discomfort in the vaginal area during stimulation (odds ratio = 5.59, P = 0.009, 95% confidence interval: 1.53-20.39), but not in the clitoral area. 

Conclusions: The data provide evidence of the relevance of self-perceived genital sensitivity to sexual pleasure and overall sexual experience. Enhancing the pleasurableness of genital sensations, especially during partnered sex, could decrease the likelihood of experiencing pain and concomitant FSD.

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By:  Nina Callens ^A, Guy Bronselaer ^B, Petra De Sutter ^C, Griet De Cuypere ^D, Guy T’Sjoen^D E, Piet Hoebeke ^B and Martine Cools ^A F 

^A Department of Pediatrics, Division of Pediatric Endocrinology, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000 Ghent, Belgium. 
^B Department of Urology, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000 Ghent, Belgium. 
^C Department of Obstetrics and Gynecology, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000 Ghent, Belgium. 
^D Department of Sexology and Gender Problems, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000 Ghent, Belgium. 
^E Department of Endocrinology, University Hospital Ghent and Ghent University, De Pintelaan 185, 9000 Ghent, Belgium. 
^F Corresponding author. Email: martine.cools@ugent.be 

 

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