203_SexualHealth_2223_MyStudies.pptx

sexual health what is sexual health? T3 - L7 health a state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity sexual health a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the abs...

sexual health what is sexual health? T3 - L7 health a state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity sexual health a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence 1 thinking / writing exercise Why is the concept of “sexual health” preferable to “reproductive health”? 2 Why is “sexual health” preferable to “reproductive health”? 20,037 respondents in Australian Study of Health & Relationships: sexual identity 96.5% heterosexual 1.7% bisexual 1.6% homosexual 0.1% other sexual experience 87.5% exclusively heterosexual 9.4% heterosexual and homosexual 0.6% exclusively homosexual 2.4% none (Richters et al., 2014) resist and question heteronormativity statistical norm ≠ moral norm (102 symposium) 3 should we refer to STDs? or STIs? or RTIs? much medical research focuses on disease (HIV and other STIs) sexual dysfunction (+ unplanned pregnancy) less attention is given to non-disease / dysfunction but it is important to consider sexual well-being in more broad terms sexual satisfaction sexual difficulties sexual coercion sexually transmitted infections 4 sexual satisfaction 87% of men and 79% of women agree that “An active sex life is important for your sense of well-being” (de Visser et al., 2014) overall relationship satisfaction is strongly related to sexual satisfaction in national surveys, satisfaction with emotional aspects of relationships is significantly related to greater physical satisfaction and more frequent sex (Badcock et al., 2014) 5 ideal frequency men have higher ideal frequency but large male/female overlap actual frequency (in relationship) actual frequency is similar for men and women ... and lower than ideal for both ideal and actual frequency of sex match for only 15% of men and 26% of women - most men and women want more mean frequency in relationships is 1.5 / week 6 sexual difficulties men* women* lacked interest in sex 25% 55% orgasm too quickly 24% 12% unable to orgasm 6% 29% anxious about ability to perform 16% 17% sex not pleasurable 6% 27% pain during intercourse 2% 20% vaginal dryness . 24% unable to keep erection 10% . low function also related to greater age * depression poor physical health lower relationship satisfaction inability to talk about sex with partners (Field et al., 2013; Mercer et al., 2005; Mitchell et al., 2013; Richters et al., 2003, 2022) 7 sexual coercion around 5% of men and 20% of women have ever been sexually coerced = forced or frightened into unwanted sexual activity sexual coercion has potentially long-lasting effects on - psychological well-being e.g., higher prevalence of depression and anxiety - physical well-being e.g., lower well-being, greater cigarette/drug/alcohol use - sexual well-being e.g., more STIs, more negative attitudes any sexual coercion has these detrimental effects (de Visser et al., 2007) few people seek or get professional support (de Visser et al., 2014) + 16% of women and 10% of men report ever having had a sexual experience when they did not want to because they were too drunk or high at the time (Carter et al., 2021) 8 knowledge check What is included in a biopsychosocial definition of ‘sexual health’? pleasurable sexual experiences freedom from discrimination and violence freedom from coercion absence of dysfunction absence of disease 9 sexual health across the lifespan sexual health concerns vary over time youth – avoiding unintended pregnancy - avoiding STIs - treating STIs to protect reproductive health adulthood - optimising reproductive health - optimising sexual satisfaction older age - optimising sexual function - limiting impact of physical health on sexual health ? less lifespan variation in sexual health needs of homosexual people age and/or cohort effects - society more sexualised - sexual health more valued 10 prevalence of sexual difficulties varies with age - but not simply more problems with age (Richters et al., 2003) * sexual function is not simply physical = also related to - relationship satisfaction - ability to discuss sex with partner (de Visser et al., 2017; Mitchell et al., 2013) 11 initial experiences affect subsequent sexual wellbeing population-based sample of 2784 British people aged 17-to 24 in NatSaL (Palmer et al., 2017) classified as sexually competent at first intercourse if all of the following: - it happened at the ‘right time’ - both partners were ‘equally willing’ - autonomy of decision to have sex - contraceptive protection for whole sample, lack of competence at first intercourse was independently associated with - testing positive for human papillomavirus (HPV) at interview - low sexual function* in the past year among women only, lack of competence was also independently associated with - reporting ever being diagnosed with an STI - unplanned pregnancy in the past year - ever experienced nonvolitional sex 12 promoting preventive behaviour major focus in sexual health is prevention absence of vaccines, cures or effective treatment increases importance of behaviour high and increasing rates of STIs, particularly among young people condom use but only and 90% of men and women have ever used condoms 23% used one last time they had vaginal sex 15% said the condom was put on late need to promote condom use and correct condom use (de Visser et al., 2003) 13 what affects condom use? The IMB Model - the key to effective safe sexual promotion weighted average correlations with condom use (Albarracín et al., 2001; ; Sheeran et al., 1999) knowledge r = .06 condom attitudes r = .32 susceptibility r = .06 subjective norms r = .26 severity r = .02 self-efficacy = .24 intentions to use r = .43 r communication re: condom use r = .46 14 interventions that enhance skills are the most effective - but few focus on developing skills (Whiting et al. 2019) heterosexual condom use is influenced most by concerns about pregnancy - dual use of hormonal contraception and condom is uncommon (de Visser, 2007; Ott et al., 2002) - it is unclear how best to promote dual use (Lopez et al., 2014) post-coital contraception (morning-after pill) = greater STI risk? ... so need to balance prescribing hormonal contraception with the need also to encourage condom use to protect against STIs also need to consider non-rational influences - e.g. romantic narrative (e.g., Kirkman et al., 1998) 15 PEP and PrEP anti-retroviral drugs can prevent sexual transmission of HIV : - post-exposure prophylaxis (PEP) immediately after high-risk events - pre-exposure prophylaxis (PrEP) (Krakower et al., 2015; Traeger et al., 2018) medical practitioners tend to know that PrEP is effective, and are aware of guidance for use, but ... - it tends to be under-prescribed ... often because of lack of familiarity with processes - few provide appropriate pre-use counselling (Babiarz et al., 2023) - need to balance prescribing PrEP with encouraging condom use to prevent other STIs 16 knowledge check If you wanted to have the biggest influence on condom use, but could only focus on one variable, what should you try to change? attitudes toward condoms capacity to negotiate condom use perceived norms for condom use perceived severity of STI infection perceived susceptibility to STIs 17 promoting screening and testing diagnoses are not decreasing for many STIs artefact? - more sensitive tests - more people getting tested real increase - more young people sexually active - inconsistent condom use - lack of concern about HIV affects STI concern - belief that STIs are not serious 18 National Chlamydia Screening Programme (NCSP) opportunistic screening of under-25s - i.e. at places other than GUM clinics purpose of screening? - collect data - treat people - notify partners - raise awareness testing via urine sample or self-collected vulvo-vaginal swabs (all men, 70% of women) (30% of women) how many people have undiagnosed chlamydia? 19 (Ratna et al., 2021) 20 HPV vaccination prevalence of Human Papilloma Virus was 20-40% of 20-24yo women ... so, introduction of HPV vaccination 84% of eligible women have had 2-dose vaccination prevalence of HPV16 and HPV18 is now 6% (PHE, 2020; Sonnenberg et al., 2014) what about older people? 21 references Ayers S & de Visser RO. Psychology for Medicine & Health Care (3 e). London: Sage, 2021. Albarracin D, et al. Theories of reasoned action and planned behavior as models of condom use ... Psych Bull 2001; 127: 142-61 Babiarz J, et al. Insufficient PrEParation: an assessment of primary care prescribing habits and use of pre-exposure prophylaxis in patients at risk of HIV acquisition ... Sex Trans Inf. doi: 10.1136/sextrans-2022-055551 Badcock PB, et al. Characteristics of heterosexual regular relationships among a representative sample of adults ... Sexual Health 2014; 11: 427-38 Carter A, et al. Unwanted sex due to intoxication among Australians aged 16-69 years. J Sex Res 2021; 58: 74-85 de Visser R. Why do heterosexual young adults who use reliable contraception also use condoms? ... Br J Health Psych 2007; 12, 305-313. de Visser RO, et al. Attitudes toward sex and relationships ... Sex Health 2014; 11: 397-405. de Visser RO, et al. Experiences of sexual coercion in a representative sample of adults ... Sex Health 2014; 11: 472-80. de Visser RO, et al. Safer sex and condom use: findings from the Second Australian Study of Health and Relationships. Sexual Health, 11: 495-504. de Visser RO, et al. Sexual difficulties: prevalence, impact, and help-seeking ... European Society for Sexual Medicine Conference, Nice, February 2017. de Visser R & Smith A. Which intention? Whose intention? Condom use and theories of individual decision making. Psych Health Med 1999; 9: 193-204 Kirkman M, et al. Adolescent sex and the romantic narrative: Why some young heterosexuals use condoms to prevent pregnancy but not disease. Psychol Health Med 1998; 3: 355-70 Krakower DS, et al. Antiretrovirals for primary HIV prevention: The current status of pre- and post-exposure prophylaxis. Curr HIV/AIDS Rep 2015; 12: 127–138 Lopez LM, et al.. Behavioral interventions for improving dual-method contraceptive use. Cochrane Database Syst Rev 2014;(3):CD010915 Mercer C., et al. Who reports sexual function problems? ... Sex Transm Infect 2005; 81: 394-9 Ott M, et al. The trade-off between hormonal contraceptives and condoms ... Perspect Sex Reprod Health 2002; 34: 6–14 Palmer MJ, et al. Is "sexual competence" at first heterosexual intercourse associated with subsequent sexual health status? J Sex Res 2017; 54: 91-104Public Health England. Human papillomavirus (HPV) vaccination coverage in adolescent females and males in England: 2019 to 2020. Health Protection Report Vol.14 No.19 Ratna N, et al. Sexually Transmitted Infections and Screening for Chlamydia in England. London: PHE Richters J, et al. Sex in Australia: sexual difficulties ... Aust NZ J Public Health 2003; 27: 164-170 Richters J, et al. Sex in Australia: sexual and emotional satisfaction in regular relationships ... Aust NZ J Public Health 2003; 27: 171-179 Richters J, et al. Sexual identity, sexual attraction and sexual experience ... Sexual Health 2014; 11: 451-60 Richters J, et al. Sexual difficulties, problems, and help-seeking in a national representative sample ... Arch Sex Behav Sheeran P, et al. Psychosocial correlates of condom use ... Psychol Bull 1999; 125: 90-132 Traeger MW, et al. Effects of pre-exposure prophylaxis for the prevention of human immunodeficiency virus infection ... Clin Infect Dis 2018; 67: 676-86. Wellings K, et al. Sexual behaviour in Britain: early heterosexual experience. Lancet 2001; 358: 1843-50 Whiting W, et al. Behavioral interventions to increase condom use among college students in the United States: A systematic review. Health Educ Behav 2019; 46: 877-88