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HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels. [ABSTRACT FROM AUTHOR]

Objective Most studies on agreeing to unwanted sex have assessed sexual encounters between people who have had sex before. Thus, we examined instances of sexual compliance with a novel sexual partner. Participants: A probability sample of college students at a university in the Midwest United States (N = 7,112). Methods: Participants completed an online survey based on measures from the National Survey of Sexual Health and Behavior. Results: Only 2.5% (n = 179) agreed to unwanted sexual activity at their most recent sexual encounter. People who were sexually compliant with a novel sexual partner frequently did so due to their own alcohol intoxication. Further, sexual compliance with novel sexual partners was less frequently associated with affectionate sexual behaviors or orgasm. Conclusions: Our initial findings regarding the effect of sexual precedent on sexual compliance warrant further research on instances when people agree to sex they don't want with novel partners. [ABSTRACT FROM AUTHOR]

Purpose: To create an instrument to assess attitudes toward lesbian, gay, and bisexual (LGB) patients among random samples of athletic trainers in the United States. Methods: This was a cross-sectional study using semi-structured interviews, paper-based questionnaires, and an electronic questionnaire. Development included three phases: (1) exploratory interviews and questionnaire responses, (2) construct validity and item reduction, and (3) criterion validity. Results: Six athletic trainers completed semi-structured interviews to develop themes regarding LGB patients. Additionally, 39 students in professional and post-professional athletic training programs answered questionnaires designed to elicit statements regarding LGB patients. For item reduction, 3,000 athletic trainers were emailed a questionnaire (response rate = 17%). For validation, another sample of 3,000 athletic trainers was sent the instruments (response rate = 13%). Athletic trainer emails were obtained from the National Athletic Trainers' Association. The resultant instrument was the 15-item Attitudes Toward Lesbian, Gay, and Bisexual Patients (ATLGBP) (α =.830). There were significant correlations between the ATLGBP and subscales of the Lesbian, Gay, Bisexual–Knowledge and Attitude Scale for Heterosexuals (hate: r =.464; civil rights: r = −.683; religion: r =.532; internal: r = −.612; knowledge: r = −.430; P <.001). Conclusions: The ATLGBP assesses affective, cognitive, and behavioral expressions of LGB attitudes in settings common to clinicians. The ability to assess attitudes toward LGB patients enables clinicians to identify areas on which to focus training and education. [Athletic Training & Sports Health Care. 2021;13(4):e146–e152.] [ABSTRACT FROM AUTHOR]

To describe long-acting reversible contraceptive (LARC) users' knowledge, patient-provider interactions, and condom use associated with LARC use. Methods: Data are from the 2018 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14–49. Results: Of 1,451 sexually active women, 11.2% used intrauterine devices, and 3.1% used implants. Approximately 19-26% of LARC users reported inaccurately on LARC longevity, and 30% reported relying on their provider to indicate the timing of intrauterine device removal. Consistent condom use among LARC users was rare (6.1%). Conclusions: Our findings have implications for how clinicians educate patients on LARC and condom use. [ABSTRACT FROM AUTHOR]

We analyzed cross-sectional data collected from a U.S. nationally representative survey of individuals ages 14-24 years old on what sources of information from the past year they considered to be the most helpful about how to have sex (n = 600 adolescents ages 14-17 years old, and n = 666 young adults ages 18-24 years old). Among the 324 adolescents who indicated that they had been helped by at least one source of information, helpful information was most likely to have come from parents (31.0%) and friends (21.6%). Only 8.4% of adolescents said pornography was helpful. However, for those in the 18-24-year-old age group, pornography was the most commonly endorsed helpful source (24.5%), as compared to other possible options such as sexual partners, friends, media, and health care professionals. Multivariable regression analyses revealed that indicating that pornography was the most helpful source of information about how to have sex, compared to the other sources, was inversely associated with being female (OR = 0.32, p = .001), inversely associated with identifying as bisexual compared to heterosexual (OR = 0.15, p = .038), positively associated with being Black compared to being white non-Hispanic (OR = 4.26, p = .021), inversely associated with reporting a household income of either $25 K to $49,999 (OR = 0.31, p = .010) or $50 K to $74,999 (OR = 0.36, p = .019) compared to more than $75 K, and positively associated with having masturbated (OR = 13.20, p = .005). Subsequent research should investigate the role of pornography in both adolescent and adult sexual development, including why one-quarter of U.S. young adults say that pornography is a helpful source of information about how to have sex and what they think that they are learning from it. [ABSTRACT FROM AUTHOR]

Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective. [ABSTRACT FROM AUTHOR]

Using data from the 2014 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14+, we assessed the prevalence and correlates of kissing, cuddling, and massage during 1,493 individuals' most recent sexual event from the past year. Most respondents reported kissing (87%) and cuddling (70%); fewer (23%) reported massage. Each was significantly associated with age, education, and relationship structure. Respondents younger than 30 were significantly more likely to indicate they did not kiss because kissing would have been too intimate with their partner. Only cuddling was significantly associated with event-level emotional intimacy and sexual pleasure. [ABSTRACT FROM AUTHOR]

Research on sexual satisfaction tends to focus mostly on heterosexual women and women in monogamous relationships. Sexual satisfaction among sexual minority women and women who are nonmonogamous or not partnered is under-researched. Through an online survey, we gathered data from 334 cisgender sexual minority women in various relationship configurations and assessed sexual satisfaction in relation to individual and interpersonal factors. Sexual satisfaction was not related to sexual identity or gender of relationship, dating, or sexual partners. Although women without a partner reported lower sexual satisfaction compared to those with one partner and those with more than one partner (p <.001), satisfaction between monogamous and nonmonogamous women did not differ (p <.001). Less internalized homonegativity was associated with greater sexual satisfaction (p <.001). This study broadens our knowledge of the sexual lives and health of sexual minority and nonmonogamous women. Findings support reconceptualizing how we understand and measure sexual satisfaction and expanding samples in future research to include sexual minority women and women in nonmonogamous relationships. [ABSTRACT FROM AUTHOR]

Abstract Research demonstrates health disparities between gender-minority individuals and cisgender individuals. These disparities arise from multiple sources, including negative health care experiences. This study examines interactions between transgender and gender non-binary (TGGNB) individuals and their health care providers. We analyzed 119 participants' descriptions of positive and negative health care experiences, and what they wish providers knew about caring for TGGNB patients. Health care experiences went well when providers and staff used inclusive language, demonstrated their experience and education, and treated identity disclosure as routine. Negative interactions were characterized by misgendering, unfamiliarity with TGGNB people and health issues, and transphobic practices. Participants wished providers understood their health concerns, did not expect their patients to educate them, and created a welcoming clinical environment. Medical educators, administrators, and providers share responsibility for improving TGGNB patient experiences. Through a framework of cultural safety, we recommend several changes to ensure more equitable treatment in health care. [ABSTRACT FROM AUTHOR]

People in open and other consensually nonmonogamous partnerships have been historically underserved by researchers and providers. Many studies group such partnerships together with nonconsensual nonmonogamy (NCNM) under the banner of "concurrent sexual partnerships." Discrimination from service providers poses a substantial barrier to care. Responding to such concerns, this investigation explored sociodemographic correlates with open relationships and associations between relationship structure and sexual risk, HIV/STI testing, and relationship satisfaction in a nationally representative probability sample. Data were drawn from the 2012 National Survey of Sexual Health and Behavior (n = 2270). We used multinomial logistic regression to identify correlates with relationship structure, and linear and logistic regression to investigate associations between relationship structure and testing, condom use, and relationship satisfaction. Eighty-nine percent of participants reported monogamy, 4% reported open relationships, and 8% reported NCNM. Males, gay/lesbian individuals, bisexual individuals, and those who identified as "Other, Non-Hispanic" were more likely to report open relationships. Bisexual individuals and Black, Non-Hispanic participants were more likely to report NCNM; older participants were less likely to do so. Participants in open relationships reported more frequent condom use for anal intercourse and lower relationship satisfaction than monogamous participants. NCNM participants reported more HIV testing and lower satisfaction. Identities, experiences, and behaviors within open and other consensually nonmonogamous populations should be regarded as unique and diverse, rather than conflated with those common to other relationship structures. There is a need for greater awareness of diverse relationship structures among researchers and providers, and incorporation of related content into educational programming. [ABSTRACT FROM AUTHOR]

Although bisexual parents represent the largest proportion of lesbian, gay, and bisexual (LGB) parents, their lived experiences are rarely included in prior research. The intimate relationships of bisexual parents may be similar to or distinct from monosexual (i.e. sexually oriented to one sex/gender) individuals, and such relationships impact individuals’ health and well-being, as well as family dynamics. We conducted phone interviews with 33 self-identified bisexual parents who were at least 18 years old, with at least one child (genetic, adopted, foster, stepchildren, partners’ children) living in the United States. As with individuals of all sexual identities, participants’ relationship structures (e.g. monogamy, commitment, co-parenting with former partners, single, dating) were diverse. Most participants’ partners were supportive of their bisexuality. Former relationships were often significant in positive ways, including beneficial co-parenting, or in negative ways, including poor co-parenting and experiences of biphobia. Open communication, boundary negotiation, and counseling were all strategies that reportedly strengthened relationships. Many participants viewed relationships differently based on the gender of their partner(s), and biphobia impacted these perceptions. Participants expressed the desire for targeted resources and therapeutic approaches for bisexual parents, since their role as a parent was often a primary factor in how they organized their relationships. [ABSTRACT FROM PUBLISHER]

The study purpose was to assess, in a U.S. probability sample of women, experiences related to orgasm, sexual pleasure, and genital touching. In June 2015, 1,055 women ages 18 to 94 from the nationally representative GfK KnowledgePanel® completed a confidential, Internet-based survey. While 18.4% of women reported that intercourse alone was sufficient for orgasm, 36.6% reported clitoral stimulation was necessary for orgasm during intercourse, and an additional 36% indicated that, while clitoral stimulation was not needed, their orgasms feel better if their clitoris is stimulated during intercourse. Women reported diverse preferences for genital touch location, pressure, shape, and pattern. Clinical, therapeutic, and educational implications are discussed. [ABSTRACT FROM AUTHOR]

Bisexual parents constitute the largest proportion of “lesbian, gay and bisexual (LGB) parents” yet are largely absent from previous research. As parenting and sexual identity may be significant pieces of one's self-concept, examining bisexual parents’ experiences and sexual identity formation is important. This qualitative study used phone interviews with 33 self-identified bisexual parents in the United States with at least one child (including genetic, adopted, step, or foster). Participants were between ages 22 and 65 years, and the majority were non-Hispanic White. The authors thematically analyzed interview data using Dedoose. Participants described experiencing biphobia as a barrier to understanding their identity or coming out to others, including their children. Despite misconceptions about bisexuality, parents reported pride in their identity and more openness to and understanding of their children. Developing resources to navigate biphobia and identity disclosure in the context of parenting may build community and reduce stress. [ABSTRACT FROM PUBLISHER]

This study assessed the prevalence of sexual behaviors among a nationally representative sample of Latino men and women in the United States (US) (N = 432) including Spanish language data collection. Prior studies of sexual health among US Latinos have consisted of convenience samples, and focused mainly on assessing risk behaviors. We consider a broader range of sexual behaviors, subjective sexual experiences (e.g. pleasure and arousal), and STI testing behaviors. Analyses by language dominance and gender indicate a higher variability in sexual behaviors for English-dominant participants and a link between overall STI testing to regular medical examinations, especially women. Higher rates of pleasure, orgasms and arousal was reported by Spanish-dominant men and women, relative to the English-dominant group. Results represent a nuanced examination of internal differentiation among US Latinos and provides applicable data for reducing sexual health disparities in this population. [ABSTRACT FROM AUTHOR]

In 2015, we conducted a cross-sectional, Internet-based, U.S. nationally representative probability survey of 2,021 adults (975 men, 1,046 women) focused on a broad range of sexual behaviors. Individuals invited to participate were from the GfK KnowledgePanel®. The survey was titled the 2015 Sexual Exploration in America Study and survey completion took about 12 to 15 minutes. The survey was confidential and the researchers never had access to respondents’ identifiers. Respondents reported on demographic items, lifetime and recent sexual behaviors, and the appeal of 50+ sexual behaviors. Most (>80%) reported lifetime masturbation, vaginal sex, and oral sex. Lifetime anal sex was reported by 43% of men (insertive) and 37% of women (receptive). Common lifetime sexual behaviors included wearing sexy lingerie/underwear (75% women, 26% men), sending/receiving digital nude/semi-nude photos (54% women, 65% men), reading erotic stories (57% of participants), public sex (≥43%), role-playing (≥22%), tying/being tied up (≥20%), spanking (≥30%), and watching sexually explicit videos/DVDs (60% women, 82% men). Having engaged in threesomes (10% women, 18% men) and playful whipping (≥13%) were less common. Lifetime group sex, sex parties, taking a sexuality class/workshop, and going to BDSM parties were uncommon (each <8%). More Americans identified behaviors as “appealing” than had engaged in them. Romantic/affectionate behaviors were among those most commonly identified as appealing for both men and women. The appeal of particular behaviors was associated with greater odds that the individual had ever engaged in the behavior. This study contributes to our understanding of more diverse adult sexual behaviors than has previously been captured in U.S. nationally representative probability surveys. Implications for sexuality educators, clinicians, and individuals in the general population are discussed. [ABSTRACT FROM AUTHOR]

Although many self-identified bisexual individuals report having at least one child, bisexual parents’ unique experiences, including sexuality-related communication with their children, have been largely absent from the parenting literature. We conducted in-depth interviews via telephone (or digital telephony such as voice over Internet protocol) with 33 individuals who self-identified as bisexual were at least 18 years old, had at least one child (genetic, adopted, step, foster, guardian or partner’s child) and currently living in the USA. Nearly all participants encouraged their children to be tolerant of sexual and gender diversity. Sexual behaviours were primarily discussed in terms of protection from sexually transmitted infections and unintended pregnancy. Participants’ approaches to communication included non-verbal methods (e.g. role modelling) and pragmatic verbal discussion. Participants employed numerous strategies, including age-appropriate, child-driven and opportunistic discussions. Some parents did not discuss sexuality at all with their children. Many had not received training in childhood development or sexuality education. The participants’ experiences were often similar to previous research on parents of other sexual identities. However, due to the unique stigma associated with bisexuality, findings point to a need for developing and providing targeted resources for bisexual parents to assist in discussions about sexuality within the family context. [ABSTRACT FROM PUBLISHER]

As bisexual individuals in the United States (U.S.) face significant health disparities, researchers have posited that these differences may be fueled, at least in part, by negative attitudes, prejudice, stigma, and discrimination toward bisexual individuals from heterosexual and gay/lesbian individuals. Previous studies of individual and social attitudes toward bisexual men and women have been conducted almost exclusively with convenience samples, with limited generalizability to the broader U.S. population. Our study provides an assessment of attitudes toward bisexual men and women among a nationally representative probability sample of heterosexual, gay, lesbian, and other-identified adults in the U.S. Data were collected from the 2015 National Survey of Sexual Health and Behavior (NSSHB), via an online questionnaire with a probability sample of adults (18 years and over) from throughout the U.S. We included two modified 5-item versions of the Bisexualities: Indiana Attitudes Scale (BIAS), validated sub-scales that were developed to measure attitudes toward bisexual men and women. Data were analyzed using descriptive statistics, gamma regression, and paired t-tests. Gender, sexual identity, age, race/ethnicity, income, and educational attainment were all significantly associated with participants' attitudes toward bisexual individuals. In terms of responses to individual scale items, participants were most likely to “neither agree nor disagree” with all attitudinal statements. Across sexual identities, self-identified other participants reported the most positive attitudes, while heterosexual male participants reported the least positive attitudes. As in previous research on convenience samples, we found a wide range of demographic characteristics were related with attitudes toward bisexual individuals in our nationally-representative study of heterosexual, gay/lesbian, and other-identified adults in the U.S. In particular, gender emerged as a significant characteristic; female participants’ attitudes were more positive than male participants’ attitudes, and all participants’ attitudes were generally more positive toward bisexual women than bisexual men. While recent population data suggest a marked shift in more positive attitudes toward gay men and lesbian women in the general population of the U.S., the largest proportions of participants in our study reported a relative lack of agreement or disagreement with all affective-evaluative statements in the BIAS scales. Findings document the relative lack of positive attitudes toward bisexual individuals among the general population of adults in the U.S. and highlight the need for developing intervention approaches to promote more positive attitudes toward bisexual individuals, targeted toward not only heterosexual but also gay/lesbian individuals and communities. [ABSTRACT FROM AUTHOR]

Previous social and behavioral research on identity among bisexual men, when not subsumed within the category of men who have sex with men (MSM), has primarily focused on samples of self-identified bisexual men. Little is known about sexual self-identification among men who are behaviorally bisexual, regardless of sexual identity. Using qualitative data from 77 in-depth interviews with a diverse sample of behaviorally bisexual men (i.e., men who have had sex with at least one woman and at least one man in the past six months) from a large city in the Midwestern United States, we analyzed responses from a domain focusing on sexual self-identity and related issues. Overall, participants' sexual self-identification was exceptionally diverse. Three primary themes emerged: (1) a resistance to, or rejection of, using sexual self-identity labels; (2) concurrent use of multiple identity categories and the strategic deployment of multiple sexual identity labels; and (3) a variety of trajectories to current sexual self-identification. Based on our findings, we offer insights into the unique lived experiences of behaviorally bisexual men, as well as broader considerations for the study of men's sexuality. We also explore identity-related information useful for the design of HIV/STI prevention and other sexual health programs directed toward behaviorally bisexual men, which will ideally be variable and flexible in accordance with the wide range of diversity found in this population. [ABSTRACT FROM AUTHOR]

Unlabelled: Background There is a lack of research that examines event-level lubricant use and outcomes among gay and bisexual men, with the majority of current research addressing lubricant use within the context of sexual risk. Most studies examining sexual health among gay and bisexual men have relied on convenience sampling strategies for participant recruitment.Methods: Data were collected from the 2012 wave of the National Survey of Sexual Health and Behaviour (NSSHB), which involved the administration of an online questionnaire to a nationally representative probability sample of women and men in the United States aged 18 years and older, including an oversampling of self-identified gay and bisexual men and women. The findings from gay (n=307) and bisexual (n=25) participants who reported sexual behaviours with other male partners during their last sexual encounter are included in this paper. Post-stratification data weights were applied to the data to maximise the generalisability of the findings.Results: Men who reported lubricant use during their last sexual event with a male partner (n=163) were significantly more likely to be non-White, Hispanic and between 30 and 39 years old. Bisexual men had lower odds of using lubricant than gay-identified men. The majority of men reported using lubricant during anal intercourse, along with lower numbers with a range of other sexual behaviours.Conclusion: Public health promotion specialists should consider recommending continued lubricant use as a part of comprehensive sexual health promotion efforts for gay and bisexual men, including that it reduces pain and maximises pleasure. [ABSTRACT FROM AUTHOR]

Most previous studies of the sexual behaviors of men who have sex with men (MSM) living with HIV are based on samples recruited within relatively urban and suburban areas of the United States. Using an internet-based questionnaire, we assessed HIV-related stigma, loneliness, and event-level sexual behaviors in a sample of HIV positive MSM ( n = 100) residing within a largely rural area in the Midwestern United States. HIV-related stigma was correlated with loneliness ( r = 0.619, p < 0.01). Loneliness was negatively associated with condom usage with the most recent partner of unknown status ( p < 0.05). Namely, a 1-unit increase in the UCLA loneliness score was met with a 10% decrease in odds of condom usage. Further studies are warranted that explore loneliness, within the context of HIV-related stigma, among HIV-positive MSM residing in rural areas. More refined data will inform clinical and social service practice, as they provide much-needed information on sexual health outcomes and experiences of an often underserved and under studied population. [ABSTRACT FROM AUTHOR]

Introduction Few previous studies have examined lubricant use among gay and bisexual men outside the context of human immunodeficiency virus risk reduction associated with condom use during penile-anal intercourse and the potential use of lubricants to deliver rectal microbicides. The vast majority of studies examining lubricant use among gay and bisexual men have employed convenience sampling strategies for participant recruitment. Additionally, most studies have collapsed gay men and bisexual men into one category of 'gay and bisexual men.' Aims This study aimed to provide overall rates of lubricant use and related factors among a nationally representative sample of self-identified gay and bisexual men. Frequencies of lubricant use, reasons for using lubricant, and perceptions of lubricant use were examined separately for subsamples of both gay and bisexual men. Methods Data were from the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of women and men in the United States aged 18 and older, and we oversampled self-identified gay and bisexual men and women; the results from male participants are included in this article. Main Outcome Measures Measure included demographic characteristics, recent and lifetime commercial lubricant use, lubricant use during specific sexual behaviors, frequency of lubricant use, and reasons for lubricant use during sexual activity. Results Over 90% of both gay and bisexual male participants reported lifetime lubricant use. Use was most common during partnered sexual activities, particularly among men aged 25-29 years old. The most commonly reported reasons for lubricant use included to increase comfort during anal intercourse, curiosity, and to make sex more comfortable. Conclusions Most gay and bisexual men in the United States have used lubricant to enhance a wide range of sexual activities, including but not limited to anal intercourse. Findings from this study will be of utility to clinicians and other health practitioners who seek to understand and promote sexual health among gay and bisexual men and other traditionally underserved public health populations. Dodge B, Schick V, Herbenick D, Reece M, Sanders SA, and Fortenberry JD. Frequency, reasons for, and perceptions of lubricant use among a nationally representative sample of self-identified gay and bisexual men in the United States. J Sex Med 2014;11:2396-2405. [ABSTRACT FROM AUTHOR]

Research examining the sexual behaviors and experiences of behaviorally bisexual men is limited. Most studies focus primarily on highlighting sexual risk behaviors among groups of 'men who have sex with men (MSM)' or 'gay and bisexual men,' which may not be appropriate in terms of behaviorally bisexual men's sexual repertoires with both men and women. This study aimed to assess a broad range of sexual behaviors and associated experiences among bisexual men living in the midwestern United States. An interviewer-administered questionnaire containing items from the National Survey of Sexual Health and Behavior assessed lifetime and recent (i.e., past 6 months and last event) sexual behaviors and experiences with both male and female partners among a diverse sample of 75 behaviorally bisexual men. Responses were quantified and analyzed using descriptive and multivariate statistics. A wide range of sexual behaviors with partners of both genders was found. Vaginal intercourse and oral sex with both men and women were the most commonly reported behaviors. Subjective reports of pleasure, arousal, and sexual function during sexual activity were similar with both male and female sexual partners. Many participants reported using condoms during insertive sexual behaviors with male and female partners, but less during oral sex. Unprotected receptive anal sex was less commonly reported. Overall, participants reported a variety of sexual behaviors and experiences; however, unlike other populations, they shared these with partners of both genders. Results have implications for interventions targeting the sexual behaviors and associated issues among behaviorally bisexual men. [ABSTRACT FROM AUTHOR]

Limited research exists regarding community involvement and social support among behaviourally bisexual men. Previous studies suggest that bisexual men experience high levels of social stigma in both heterosexual and homosexual community settings. Research focusing on social support has demonstrated that individuals with limited access to similar individuals experience greater risk for negative health outcomes. Using a community-based research design, participants were recruited using multiple methods. Researchers conducted in-depth, semi-structured interviews with 75 men who reported having engaged in bisexual behaviour within the past six months. Interviews elucidated the experiences of behaviourally bisexual men in heterosexual and homosexual settings, as well as their perceptions of the existence of a bisexual community or bisexual spaces. All participants perceived a lack of a visible bisexual community and expressed difficulty with being comfortable, or a feeling of belonging, within a variety of heterosexual and homosexual community spaces. Findings suggest the need for interventions focused on community building among, as well as creating spaces specifically designed for, bisexual men in order to increase perceived social support and decrease isolation and possible negative health outcomes. [ABSTRACT FROM PUBLISHER]

Previous research suggests that bisexual men face unique health concerns in comparison to their exclusively homosexual and heterosexual counterparts. However, little is known about behaviorally bisexual men's experiences with health services, including ways of providing services that would be most appropriate to meet the health needs of this population. This study sought to understand preferences for health-related services among behaviorally bisexual men in the Midwestern United States. Using a community-based research approach, a diverse sample of 75 behaviorally bisexual men was recruited for in-depth interviews. Qualitative data were analyzed utilizing inductive coding through established team-based protocols to ensure reliability. Themes emerged involving the importance of privacy and trust when reaching, recruiting, and engaging behaviorally bisexual men in health services. Findings suggest that multifaceted approaches are needed, including those that provide relevant and confidential services while allowing for the development and ongoing maintenance of trust. [ABSTRACT FROM AUTHOR]

The midwestern United States has a high number of recent Latino migrants, but little information is available regarding their sexual behaviors. A total of 75 behaviorally bisexual men (25 Latino, 25 Black and 25 White) participated in an exploratory study on sexual health. The data presented in this article are restricted to the 25 self-identified Latino men. Qualitative in-depth interviews were conducted and optional self-administered sexual transmitted infection (STI) screening was provided. The measures used were taken from the National Survey of Sexual Health and Behavior (NSSHB), a probability study of the sexual behaviors of nearly 6,000 individuals, age 14 to 94, in the United States. In this sample of bisexual men, the most commonly reported sexual behaviors were masturbation, vaginal intercourse and receiving oral sex from male and female partners. The majority of the participants were the insertive partner during anal sex with male partners. Many of the participants reported alcohol use during their most recent sexual activity. A fair number reported not using condoms during their last sexual event. Pleasure, arousal, orgasm and erectile functioning were markedly similar despite partner gender. A small number of participants also engaged in sexual activities with transgender individuals. All of the Latino participants took part in optional self-collection for STI specimens. The results of the study provide rich insights into the sexual behavior and related factors, as well as potential risk behaviors, of bisexual Latino men that may be targeted for future sexual health promotion efforts. [ABSTRACT FROM AUTHOR]

Little public health research has explored male bisexuality and the wide range of behaviors experienced by bisexual men beyond disease transmission and other negative consequences. There is a general lack of information on diverse expressions of sexuality among diverse groups of bisexual men in the United States. Researchers collected data on a wide range of variables related to sexual behavior from a sample of 26,042 participants, recruited via a large social and sexual networking Website. Four distinct typologies of male bisexuality were constructed: self-identified bisexual, bisexual dating, bisexual with current sexual partners and bisexual by behavior. These categories were examined individually as well as compared and contrasted with one another. Demographic characteristics varied among men depending on bisexual categorization. Although participants that identified as bisexual within each typology often met criteria for other categories for other typologies, there was no absolute overlap between categories. The recency and frequency of sexual behaviors significantly varied based upon the participant's bisexual typology. Findings suggest that previous research on bisexual men's sexual behaviors and sexual risk behaviors may be misleading if bisexuality is restricted to a single typology. Further research should examine the potential subjective meanings and health implications of diverse typologies of male bisexuality, beyond sexual risk. Comprehensive and insightful research on aspects of life other than disease infection and transmission among bisexual men will help to ensure a more accurate understanding of male bisexuality in a comprehensive sexual health framework. [ABSTRACT FROM PUBLISHER]

ABSTRACT Introduction. Little is known about the prevalence of sexual behaviors among the black and Hispanic populations in the United States outside the context of sexual risk and disease transmission in 'high-risk' samples. Aim. This study sought to establish current rates of sexual behaviors, sexual health care practices (i.e., experiences with testing and diagnosis of sexually transmitted infections [STIs]), and condom use in a probability sample of black and Hispanic adult men and women in the United States. Main Outcome Measures. Sexual behaviors including solo masturbation, partnered masturbation, receiving oral sex and giving oral sex, vaginal intercourse, and anal intercourse were assessed. Self-reported rates of HIV and other STI testing, and self-reported history of STI diagnosis were examined. Also assessed were rates of condom use during most recent and past 10 vaginal intercourse events. Methods. Data from a probability sample of 1246 black and Hispanic adults were analyzed to explore sexual behaviors, condom use, and STI testing and diagnosis trends. Results. Masturbation, oral sex, and vaginal intercourse were prevalent among black and Hispanic men and women throughout the life course. Anal intercourse and same-gender sexual activities were less common. Self-reported rates of HIV testing were relatively high but varied by gender across age groups. Similarly, rates of testing for other STI were high and differed by gender across age groups. Overall rates of condom use among black and Hispanic men and women were relatively high and did not appear to be related to a variety of situational factors including location of sexual encounter, relationship status, other contraceptive use, and substance use during sexual activity. Conclusion. These data provide a foundation for understanding diverse sexual behaviors, sexual health-care practices, and condom use among the general population of black and Hispanic men and women in the United States. Dodge B, Reece M, Herbenick D, Schick V, Sanders SA, and Fortenberry JD. Sexual health among U.S. black and Hispanic men and women: a nationally representative study. J Sex Med 2010;7(suppl 5):330-345. [ABSTRACT FROM AUTHOR]

This nationally representative study documents that vibrator use among heterosexually identified men in the United States is common, with 43.8% reporting use of a vibrator at some point in their lives, with most vibrator use by heterosexual men occurring within the context of sexual interactions with a female partner. Approximately 94% of male vibrator users reported that they had used a vibrator during sexual play with a partner, and 82% reported that they had used a vibrator during sexual intercourse. These data support the work of therapists and educators who often make recommendations for the incorporation of vibrators into partnered relationships. [ABSTRACT FROM AUTHOR]

Promoting consistent and correct condom use remains a priority public health activity, although some HIV- and STI-related providers remain challenged by some men's resistance to condoms, which some claim do not fit properly or do not feel comfortable. Although these perceptions have been examined across multiple populations, they have not been documented among men living with HIV. During spring 2008, data were collected from 215 men living with HIV at HIV service organizations in the Midwestern and Southeastern United States. Participants completed the Condom Fit and Feel Scale and measures related to demographics and condom use during sexual interactions within the past 90 days. Men were primarily homosexual, African American, with a high school degree or higher, and unemployed. More than half of participants had used condoms for sexual intercourse within the previous 90 days. The majority of the men reported few problems with the fit and feel of condoms, with 63.1% reporting that condoms “fit my penis just fine,” and 80.9% reported being able consistently to find condoms that they perceived to be “sized appropriately for my penis.” Some men did report specific characteristics of condoms that challenged fit and feel, including 20.6% endorsing (always or often) that condoms feel too tight, 15.9% that condoms are too short, 17.8% or that condoms would not roll down far enough to cover their penis completely (15.6%). These data provide insights into mechanisms through which providers can help to increase men's access to the diverse range of condoms in the marketplace. [ABSTRACT FROM AUTHOR]

Condom-distribution programs have striven to make condoms more accessible to sexually active individuals, particularly adolescents and populations disproportionately affected by HIV and other STIs. Despite such programs, little is known about where condom-using men in the United States acquire their condoms. The purpose of this study was to document condom-access trends among a large sample of sexually active condom-using men in the United States. Data were collected from 1,832 men from all 50 U.S. states and the District of Columbia by using an Internet-based survey in which men provided details regarding the source of condoms that they had used within the past 30 days. Men reported acquiring their condoms from a variety of sources, including free condom-distribution programs (56.7%) and from venues where they had purchased condoms for themselves (75.7%). Bivariate analyses indicated that participants who reported using free condoms tended to be younger, self-identified as not heterosexual, or not currently in a monogamous relationship. Further, results indicated that those participants who accessed only free condoms did not differ from those who used only purchased condoms, indicating that perhaps efforts to make condoms more accessible through public health distribution campaigns are reaching a more general population of condom-using men than expected. Findings illustrate the importance of continuing free condom-distribution efforts but also suggest benefits of facilitating linkages between public health and a community's retail venues to increase access to the growing diversity of condoms in the marketplace. [ABSTRACT FROM AUTHOR]

In the United States, a debate exists as to whether abstinence-only or comprehensive sexuality education strategies are most beneficial for school-age youth. Despite abstinence being a fundamental component of comprehensive education, the two are often characterized as polar opposites. Few studies have examined overlaps between the approaches. The purpose of this study was to examine relationships between abstinence education and comprehensive topic instruction among sexuality education teachers. Data came from public school teachers (n = 199) in Florida. Abstinence instruction was measured using the Section 510 A-H guidelines. Comprehensive topic instruction was measured using the Sexuality Information and Education Council of the United States' guidelines. Logistic regression analyses measured relationships between abstinence and comprehensive topic instruction. Nearly one-half of teachers taught all eight A-H guidelines, and the majority taught most comprehensive sexuality education topics. The odds of teaching comprehensive sexuality education topics generally increased as teachers taught more of the federal government's abstinence guidelines. This suggests that abstinence instruction, a core element of comprehensive sexuality education, may increase alongside instruction on other comprehensive topics. We discuss the relevance our findings have for understanding the nature of both abstinence and comprehensive sexuality education. [ABSTRACT FROM AUTHOR]

Adolescents in the United States continue to face sexual health issues. While community-based organizations (CBOs) have a long history of addressing the sexual health needs of those they serve, little attention has been given to CBOs focused on adolescent populations and the role youth development professionals (YDPs) might play in the advancement of sexual health. The purpose of this study was to assess the potential of YDPs to provide sexuality information to youth by 1) determining the frequency and type of questions YDPs receive from youth on sexuality and 2) ascertaining the perceived comfort, confidence, skills, and knowledge of YDPs in answering questions from youth and characteristics that might be predictive of increased levels of perceived comfort, confidence, skills, and knowledge. Utilizing a community-based participatory research process that engaged the researchers with leaders, key stakeholders, and youth development professionals from community-based organizations throughout the state, data were collected from 169 YDP in Indiana. YDPs received questions from youth on a broad array of sexuality-related topics with personal skills and relationships being the most frequent topics. YDPs had high perceived levels of comfort, confidence, skills, and knowledge (CCSK) in addressing questions from youth about sexuality. Training, both formal classroom-type training and more informal practices such as advice-seeking from a professional, was the only factor predictive of higher levels of CCSK. Results indicate that YDPs might play an important role in providing sexuality information to youth. Communities interested in ameliorating disparities among youth might want to consider including CBOs and YDPs in an ecological approach to sexual health education. [ABSTRACT FROM AUTHOR]

Men's gender roles and norms may influence their sexual behaviors and sexual health care practices in numerous specific ways and contexts. Health professionals encourage men's performance of testicular self-exams (TSE), yet estimates of monthly TSE from convenience samples range from 2% to 10%. In this population-based study of 655 U.S. men aged 18 to 44 years, TSE prevalence during the past month was 40.3% and was predicted by geographic location, sexual behaviors, genital self-image, and having a physical exam within the past year. National TSE prevalence rates will be useful to those who work to reduce the morbidity and mortality associated with testicular cancer. [ABSTRACT FROM AUTHOR]

Little is known about women's use of vibrators within sexual partnerships. Data were collected from a population-based, cross-sectional survey of 2056 women aged 18-60 years in the United States. Partnered vibrator use was common among heterosexual-, lesbian-, and bisexual-identified women. Most vibrator users indicated comfort using them with a partner and vibrator use was related to positive sexual function as measured by the Female Sexual Function Index (FSFI). In addition, partner knowledge and perceived liking of vibrator use was a significant predictor of sexual satisfaction for heterosexual women (p < .01). Clinical and research implications are discussed. [ABSTRACT FROM AUTHOR]

Among men who have sex with men (MSM), sexual compulsivity has been associated with higher frequencies of sexual behaviors that may increase risk for transmission of HIV and other sexually transmitted infections (STI). In a Midwestern region where social and community resources for MSM are relatively diffuse, the patterns of partner-seeking and sexual behavior, and their relations to sexual compulsivity, may be different than findings from most other assessments of men in large urban areas. Using a community-based participatory approach (CBPR) and a cross-sectional survey, quantitative data were collected between November 2006 and January 2007 from 504 men related to sexual compulsivity, sexual partner-seeking, and sexual behavior. We sought to explore sexual behaviors in venues where men reported meeting sexual partners, based on their level of compulsivity. Venues that could be characterized as “sexualized” were better predictors of higher sexual compulsivity scores among men than those that are “social” in nature. Men who were higher in compulsivity reported patterns of saturating sexualized venues in order to find sexual partners. Given the unique patterns of sexual partner-seeking in this area, interventions to decrease sexual risk-taking should take into account that men who have a higher propensity for sexual compulsivity are visiting multiple venues, and prevention messages need to be tailored to be consistent across these contexts. In addition, these may need to be differentially designed based on the specific environment in which they are to be delivered. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine whether there were differences in sexual risk among behaviorally and self-identified bisexual men, men who reported having sex with both men and women without reporting a bisexual identity and men who self-identified as bisexual but reported only recent homosexual behavior over the past 6 months. Methods. Through a secondary data analysis, we conducted stepwise linear regression equation modeling to determine which factors were significant predictors of sexual risk among various subgroups of bisexual Latino men. Results. Having sex with women, regardless of sexual identity, increased the likelihood of insertive unprotected anal intercourse with men. Bisexual identity was not statistically associated with unprotected anal intercourse with men. Conclusions. Future studies should begin to examine differences within groups rather than focusing on group comparisons that yield limited insights into sexual risk predictors for homosexually and bisexually active men. Further research that explores risk and protective factors in the sexual lives of Latino bisexual men is also needed. (Am J Public Health. 2007;97:1102-1106. doi:10.2105/AJPH. 2005.078345) [ABSTRACT FROM AUTHOR]

Objectives: To assess differences in sexual health behaviors, outcomes, and potential sociocultural determinants among male college students in the United States and the Netherlands. Methods: Survey data were collected from random samples of students from both national cultures. Results: American men were more likely to report inadequate contraception, HIV/STD infection, and unintended pregnancy than were Dutch men. Religiosity and sexuality education were able to explain national differences in these sexual health outcomes. Conclusions: Findings suggest that sexuality education seems to decrease, rather than increase, sexual risk in heterosexually active male college students. [ABSTRACT FROM AUTHOR]

The principles of community-based participatory research were applied to an exploratory sexual health study that examined "cruising for sex" among men on a college campus. In the context of a study seeking a broad interpretation of the health implications of cruising, and when faced with methodological challenges, the researchers found these principles to provide invaluable guidance. A review of the research process is offered and the manner in which the principles of community-based participatory research were operationalized for this study is described. [ABSTRACT FROM AUTHOR]

An intense social and political debate continues in the United States regarding sexuality education. Included in the debate are those who favor comprehensive approaches, those who favor abstinence-only approaches, and those who favor no sexuality education. In this study, we showed that men who received school-based condom education were less likely to have been diagnosed with sexually transmitted infections (STIs) and were more likely to ever have been tested for sexually transmitted infections than were men without such education. School-based condom education is associated with less, rather than more, STI risk. [ABSTRACT FROM AUTHOR]

Background: Economic vulnerability, such as homelessness and unemployment, contributes to the HIV risk among racial minorities in the U.S., who are disproportionately infected. Yet, few economic-strengthening interventions have been adapted for HIV prevention in economically-vulnerable African-American young adults. Engaging Microenterprise for Resource Generation and Health Empowerment (EMERGE) is a feasibility randomized clinical trial of an HIV prevention microenterprise intervention with integrated text messages ("nudges") that are informed by behavioral economic principles. The trial aims to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors.Methods/design: In total, 40 young adults who are African-American, aged 18-24, live in Baltimore City, have experienced at least one episode of homelessness in the last 12 months, are unemployed or underemployed (fewer than 10 h per week), are not enrolled in school, own a cell phone with text messaging, and report at least one episode of unprotected or unsafe sex in the prior 12 months will be recruited from two community-based organizations providing residential supportive services to urban youth. Participants will undergo a 3-week run-in period and thereafter be randomly assigned to one of two groups with active interventions for 20 weeks. The first group ("comparison") will receive text messages with information on job openings. The second group ("experimental") will receive text messages with information on job openings plus information on HIV prevention and business educational sessions, a mentored apprenticeship, and a start-up grant, and business and HIV prevention text messages based on principles from behavioral economics. The two primary outcomes relate to the feasibility of conducting a larger trial. Secondary outcomes relate to employment, sexual risk behaviors, and HIV preventive practices. All participants will be assessed using an in-person questionnaire at pre-intervention (prior to randomization) and at 3 weeks post-intervention. To obtain repeated, longitudinal measures, participants will be assessed weekly using text message surveys from pre-intervention up to 3 weeks post-intervention.Discussion: This study will be one of the first U.S.-based feasibility randomized clinical trials of an HIV prevention microenterprise intervention for economically-vulnerable African-American young adults. The findings will inform whether and how to conduct a larger efficacy trial for HIV risk reduction in this population.Trial Registration: ClinicalTrials.gov, NCT03766165 . Registered on 4 December 2018. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the collaboration within the justice system to improve sexual health services for vulnerable women in the U.S. It states that justice-involved women are at high risk for these conditions due to individual risk behavior as well as other network-level risk factors. It examines how community-based participatory research principles (CBPR) were adapted and tailored for use in a court setting. It also cites the lessons learned as well as the implications for CBPR projects in a community court.

Although much research has examined correlates of pain during sex, far less research has examined why women have sex despite having pain and why they avoid telling their partner. The purpose of our study was to examine women's reports of painful sex, including location of pain, whether they told their partner, factors associated with not disclosing their pain, and their reasons for not disclosing. We used data from the 2018 National Survey of Sexual Health and Behavior, a probability-based online survey of 2,007 individuals ages 14 to 49 years. We limited our sample to adult women who reported a sexual experience that was painful in the past year (n = 382; 23.2%). The primary outcome in quantitative analyses was whether women told their partner they experienced pain during sex. Associations with social identities and sexual health were explored via logistic regression. Those who did not tell their partner about painful sex were asked why; their accounts were coded and analyzed qualitatively. Women were asked, "To what extent was this sexual experience physically painful for you?" Those who reported any pain were asked, "Did you tell your partner that you were in pain during sex?" and, if applicable, "Why didn't you tell your partner that you were in pain during sex?" Of those reporting pain during sex, most said it was "a little painful" (81.6%) and occurred at the vaginal entrance (31.5%), inside the vagina (34.4%), or at or around the cervix (17.4%). Overall, 51.0% (n = 193/382) told their partner about their pain. Adjusting for age and wantedness, women who reported little or no event-level sexual pleasure had nearly 3-fold greater odds of not telling a partner about painful sex (adjusted odds ratio = 3.24; 95% CI, 1.43–7.37). Normalizing painful sex, considering pain to be inconsequential, prioritizing the partner's enjoyment, and gendered interactional pressures were the predominant themes in women's narratives. Providers should ask about painful sex, if the woman continues intercourse despite pain, and how she feels about this as a means of assessing any sexual and social pressures. Strengths include the use of social theory in nationally representative survey research to examine how contextual factors influence sexual health, but experiences were largely limited to heterosexual interactions. Many women do not discuss painful sex with their partners, lack of pleasure is significantly more likely among this group, and gender norms and cultural scripts are critical to understanding why. Carter A, Ford JV, Luetke M, et al. "Fulfilling His Needs, Not Mine": Reasons for Not Talking About Painful Sex and Associations with Lack of Pleasure in a Nationally Representative Sample of Women in the United States. J Sex Med 2019; 16:1953–1965. [ABSTRACT FROM AUTHOR]

Although withdrawal use is routinely measured as part of contraceptive surveillance in the United States, its assessment may be prone to underreporting and measurement errors. Additionally, at the population level, little is known about subjective experiences of withdrawal. To measure respondents' frequency of and reasons for engaging in extra-vaginal ejaculation in the past year, and to compare contraceptive withdrawal vs extra-vaginal/anal ejaculation during the most recent sexual event. The 2018 National Survey of Sexual Health and Behavior is a U.S. nationally representative probability survey of adolescents and adults. This study was administered in February–March 2018 via GfK Research's KnowledgePanel. Respondents who reported consensual penile-vaginal intercourse in the past year were included in the analysis. Logistic regression was used to assess factors associated with finding extra-vaginal ejaculation sexy/arousing. Main outcomes were the frequency of and reasons for extra-vaginal ejaculation in the past year, as well as reported contraceptive withdrawal use and the location of ejaculation at the most recent penile-vaginal intercourse. In the past year, approximately 60% of respondents reported engaging in any extra-vaginal ejaculation; pregnancy prevention and sexual pleasure were given as common reasons. Those who were men, white, or aged 25–29 were more likely to find extra-vaginal ejaculation sexy or arousing; no gender differences were observed in their partner's perception of this act. Prevalence of selecting withdrawal on the contraceptive inventory was 12.2% (95% CI 10.6–14.0) at last sexual event, whereas extra-vaginal/anal ejaculation was reported by 20.8% (95% CI 18.7–23.0). This lack of concordance in differing measures was observed consistently across all age groups, and approximately 12% to 14% of individuals reported an ejaculation location that did not correspond to their withdrawal use. The results of this study have implications for how healthcare providers discuss withdrawal with their patients and counsel them on using extra-vaginal ejaculation as part of their contraceptive use or part of their sexual repertoire. This is the first nationally representative study to directly compare contraceptive withdrawal to extra-vaginal ejaculation. Limited data were collected at event level regarding motivations for extra-vaginal ejaculation, pregnancy attitudes, perceptions of condoms and sexually transmitted infection prevention, or exposure to erotic media, thus limiting further assessment of relationships between various factors and extra-vaginal/anal ejaculation. We found that reporting of withdrawal as a contraceptive method vs extra-vaginal/anal ejaculation was inconsistent and that extra-vaginal/anal ejaculation was commonly used for reasons other than pregnancy prevention; future research should use more precise measures of "withdrawal." Fu TC, Hensel DJ, Beckmeyer JJ, et al. Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior. J Sex Med 2019;16:1170–1177. [ABSTRACT FROM AUTHOR]

Objective. To examine knowledge of Zika transmission and risk perception and to assess variability by condom use in a probability sample of sexually-active adults in the United States. Methods. Data for this study came from the 2016 wave of the National Survey of Sexual Health and Behavior, a nationally representative probability sample of adults in the United States. Data were collected in November 2016 via a cross-sectional Internet-based survey administered to members of a Knowledge Panel, an address-based random sample service managed by GfK. A weighted subsample (n = 1 713) of sexually active adults, 18 - 50 years of age, was included in analyses. Results. More than 90% of men and women reported low or no perceived risk of Zika. Most participants identified mosquito bite as a route of transmission, while significantly fewer identified sexual intercourse (≈ 40%) and vertical (29% men, 41% women) transmission routes. Conclusion. Sexually-active adults in the United States, especially young men, lack awareness of sexual and vertical transmission of Zika Virus. Given the likely endemic nature of Zika, this low-risk perception is an important prevention challenge. Zika prevention messaging should address lesser known transmission routes, emphasize male education, and promote correct and consistent condom use. [ABSTRACT FROM AUTHOR]

Objectives Male condom use in conjunction with other contraceptives increases protection against pregnancy and sexually transmitted infections. However, few analyses contextualize dual method use within the sexual episode, include reports from men or explore gendered patterns in reporting. Study design We analyzed dual method use patterns using a nationally representative dataset of 18–44 years old in the US ( N =404 men, 416 women). Respondents indicated contraceptive methods used at last penile–vaginal intercourse, condom practices and relationship and sexual information about that particular partner. Results More than one-in-three penile–vaginal intercourse episodes (40%) involved male condom use: 28% condom only and 12% condom plus a highly effective method. Dual method reporting did not differ significantly by gender. Among dual method users, only 59% reported condom use during the entire intercourse episode, while 35% began intercourse without one and 6% removed the condom during intercourse. A greater proportion of men than women reported incorrect use of condoms (49% versus 35%), though this difference was not statistically significant. Only 50% of dual method users reported condom use in all of their last 10 intercourse episodes. Conclusions Many people classified as “dual users” in previous studies may not be using dual methods consistently or correctly. Researchers and practitioners should inquire how and how often condoms are used when assessing and addressing dual method use. Furthermore, though men have rarely been surveyed about dual method use, they can provide consistent contraceptive estimates and may be more likely to report condom practices such as late application or early removal. Implications statement Many US women and men reporting dual method use also reported late application and early removal of condoms, as well as multiple condom-less prior sexual acts with that partner. Clinicians may wish to inquire how and how often clients use condoms; they may also wish to provide condom instruction and/or tips on better integrating condoms into the sexual experience with one's partner. [ABSTRACT FROM AUTHOR]

Introduction Much scientific research focuses on assessing and understanding individuals' perceptions of sexual pleasure, enjoyment and satisfaction. Many existing measures of pleasure and satisfaction provide valuable information but are limited in their ability to assess event-level quality. Aims To develop a scale for measuring the event-level quality of a sexual experience that could be used regardless of the age, gender, sexual orientation, and relationship status of the individual and across sexual activity types. Methods Interviews about the measurement of sexual quality and pleasure were conducted with 15 experts in the field of sexual health and informed the development of an event-level scale to measure the quality of sexual experiences. Scale items were administered to a cross-sectional nationally representative probability survey of Americans ages 18 to 60. Main Outcome Measures Socio-demographic items; Quality of Sexual Experience ( QSE) scale items; event-level items related to overall sexual quality ('Quality item'), comparison to other sexual events ('Comparison item'), and orgasm ('Orgasm item'). Results QSE scores were significantly correlated with responses to the Quality Item ( r = 0.901, P < 0.001 for both women and men). Better experiences were associated with significantly higher QSE scores than were worse experiences; significant linear relationships were found for both women ( GLM F[4,1461] = 129.46, P < 0.001) and men ( GLM F[4,864] = 71.84, P < 0.001). QSE scores were significantly related to responses on the Orgasm Item for women [ F[3,1430] = 246.53, P < 0.001] and men [ F[3,858] = 117.24, P < 0.001]. Conclusions The QSE scale is a valid and reliable event-level measure of the quality of a sexual experience in both women and men with outstanding psychometric properties. Clinical and research implications are discussed. Sanders SA, Herbenick D, Reece M, Schick V, Mullinax M, Dodge B, and Fortenberry JD. The development and validation of a brief quality of sexual experience (QSE) scale: Results from a nationally representative sample of men and women in the United States. J Sex Med 2013;10:2409-2417. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. Although most Americans have used condoms and/or lubricant during sex, little is known about the context of sexual events that involve the use of such products outside of experimentally manipulated studies. Aims. To assess, in a nationally representative study of men and women in the United States ages 18-59, the characteristics of condom and lubricant use during participants' most recent sexual event and the relationship of their condom and lubricant use to event-level ratings of sexual quality. Methods. Data are from the National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of the U.S. adults. Main Outcome Measures. Sociodemographic items: event-level items related to sexual behavior, condom use, lubricant use, and participants' perceptions of their arousal, pleasure, ease of erection or lubrication, and pain associated with sex. Results. During their most recent sexual experience, 27.5% of men (N = 237) and 22.3% of women (N = 175) reported using a condom. More than twice as many women as men were unsure whether the condom was lubricated (26.6% vs. 11.4%) and the material it was made of (23.6% vs. 8.9%). Participants consistently rated sex to be arousing and pleasurable whether or not they used condoms or lubricant. No significant differences were found in regard to men's ratings of the ease of their erections based on condom and lubricant use. Conclusions. Although some have concerns about how condoms or lubricants may impact their enjoyment of sex, in a nationally representative sample of men and women ages 18-59, ratings of sex were largely quite high, with few differences based on condom and lubricant use. Women, more often than men, reported being unsure about the type of condom and lubricant used, which has implications for patient education. Herbenick D, Schick V, Reece M, Sanders SA, Smith N, Dodge B, and Fortenberry JD. Characteristics of condom and lubricant use among a nationally representative probability sample of adults ages 18-59 in the United States. J Sex Med **;**:**-**. [ABSTRACT FROM AUTHOR]

Over the past two decades, an expanding body of research has examined women's and men's genital self-image. Support for the reliability and validity of the 7-item Female Genital Self-Image Scale (FGSIS) has been found in a convenience sample of women. The purpose of this study was to assess the reliability and validity of the FGSIS, its model of fit, and its association with women's scores on the Female Sexual Function Index (FSFI) in a nationally representative probability sample of women in the United States ages 18 to 60. A second purpose was to assess the temporal stability of the scale in a subset of this sample. A nationally representative sample of 3,800 women ages 18 to 60 were invited to participate in a cross-sectional Internet-based survey; 2,056 (54.1%) participated. Demographic items (e.g., age, race/ethnicity, marital status, sexual orientation, geographic region), having had a gynecological examination in the past year, having performed a genital self-examination in the past month, frequency of masturbation in the past month, vibrator use in the past month, the FGSIS, and the FSFI. An abbreviated 4-item version of the scale, the FGSIS-4, was a better fit to the data than the original 7-item scale. Women's scores on the FGSIS-4 were significantly related to vibrator use, frequency of masturbation, having had a gynecological exam in the past year, having performed genital self examination in the past month, and all FSFI subscales. Most of the participants felt generally positively about their genitals and female genital self-image was significantly related to female sexual function, women's sexual behavior and their sexual and genital healthcare behaviors. In addition, the FGSIS-4 has evidence of reliability, validity, and temporal stability in a nationally representative probability sample of women in the United States. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. To provide a foundation for those who provide sexual health services and programs to men in the United States, the need for population-based data that describes men's sexual behaviors and their correlates remains. Aims. The purpose of this study was to, in a national probability survey of men ages 18-94 years, assess the occurrence and frequency of sexual behaviors and their associations with relationship status and health status. Methods. A national probability sample of 2,522 men aged 18 to 94 completed a cross-sectional survey about their sexual behaviors, relationship status, and health. Main Outcome Measures. Relationship status; health status; experience of solo masturbation, partnered masturbation, giving oral sex, receiving oral sex, vaginal intercourse and anal intercourse, in the past 90 days; frequency of solo masturbation, vaginal intercourse and anal intercourse in the past year. Results. Masturbation, oral intercourse, and vaginal intercourse are prevalent among men throughout most of their adult life, with both occurrence and frequency varying with age and as functions of relationship type and physical health status. Masturbation is prevalent and frequent across various stages of life and for both those with and without a relational partner, with fewer men with fair to poor health reporting recent masturbation. Patterns of giving oral sex to a female partner were similar to those for receiving oral sex. Vaginal intercourse in the past 90 days was more prevalent among men in their late 20s and 30s than in the other age groups, although being reported by approximately 50% of men in the sixth and seventh decades of life. Anal intercourse and sexual interactions with other men were less common than all other sexual behaviors. Conclusion. Contemporary men in the United States engage in diverse solo and partnered sexual activities; however, sexual behavior is less common and more infrequent among older age cohorts. Reece M, Herbenick D, Schick V, Sanders SA, Dodge B, and Fortenberry JD. Sexual behaviors, relationships, and perceived health among adult men in the United States: Results from a national probability sample. J Sex Med 2010;7(suppl 5):291-304. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. Past surveys of sexual behavior have demonstrated that female sexual behavior is influenced by medical and sociocultural changes. To be most attentive to women and their sexual lives, it is important to have an understanding of the continually evolving sexual behaviors of contemporary women in the United States. Aims. The purpose of this study, the National Survey of Sexual Health and Behavior (NSSHB), was to, in a national probability survey of women ages 18-92, assess the proportion of women in various age cohorts who had engaged in solo and partnered sexual activities in the past 90 days and to explore associations with participants' sexual behavior and their relationship and perceived health status. Past year frequencies of masturbation, vaginal intercourse, and anal intercourse were also assessed. Methods. A national probability sample of 2,523 women ages 18 to 92 completed a cross-sectional internet based survey about their sexual behavior. Main Outcome Measures. Relationship status; perceived health status; experience of solo masturbation, partnered masturbation, giving oral sex, receiving oral sex, vaginal intercourse, anal intercourse, in the past 90 days; frequency of solo masturbation, vaginal intercourse, and anal intercourse in the past year. Results. Recent solo masturbation, oral sex, and vaginal intercourse were prevalent among women, decreased with age, and varied in their associations with relationship and perceived health status. Recent anal sex and same-sex oral sex were uncommonly reported. Solo masturbation was most frequent among women ages 18 to 39, vaginal intercourse was most frequent among women ages 18 to 29 and anal sex was infrequently reported. Conclusion. Contemporary women in the United States engage in a diverse range of solo and partnered sexual activities, though sexual behavior is less common and more infrequent among older age cohorts. Herbenick D, Reece M, Schick V, Sanders SA, Dodge B, and Fortenberry JD. Sexual behaviors, relationships, and perceived health status among adult women in the United States: Results from a national probability sample. J Sex Med 2010;7(suppl 5):277-290. [ABSTRACT FROM AUTHOR]