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Background: Sexual history training during undergraduate education is essential for preparing future doctors to handle patients' sexual health concerns. The purpose of this study was to assess the attitudes and perceptions of final-year medical students in Malaysia toward sexual history taking and the training they receive from their medical schools. Methods: The study used a cross-sectional survey of 379 final-year medical students from three medical schools in Malaysia. Students were asked to rate their attitudes and perceptions regarding training on taking sexual histories using a newly developed questionnaire with good internal consistency (Cronbach's alpha = 0.73). Ethics approval was obtained from the relevant medical schools, and the statistical analysis was conducted using SPSS, Version 20.0. Results: The mean age of participants was 23.58 ± 0.65 SD. Participants reported high interest in sexual health and felt it was important for doctors to know how to take a sexual history (95%). Among the participants, only half felt comfortable in taking sexual histories from patients. The participants identified cultural and religious differences between the doctor and the patient as a potential barrier for discussing sexual health. Participants were aware of their own practice and ability, as well as their limitations, in taking sexual histories. Less than half (46%) felt that the training they received adequately prepared them to take sexual histories. Conclusions: This study identified gaps in sexual health training among medical schools in Malaysia. The delivery of sexual health education program should incorporate confidence building and to make students feel comfortable to take sexual histories from patients. The barrier caused by differences in culture or religion between a doctor and a patient may be overcome through cross cultural and cultural competency training. This is important for multi-faith, multi cultural societies such as Malaysia and other similar countries. [ABSTRACT FROM AUTHOR]

Nurses working in sexual health and primary care are at the forefront of providing patients with contraception and sexual health advice, and face many dilemmas. Using Johns' (1995) reflective framework, this article examines a consultation that took place at an integrated contraception and sexual health clinic: the case was unusual and provided an opportunity to examine various aspects of sexual health. The reflection enabled the exploration of a complex consultation that covered contraception, sexuality, abstinence and potential issues such as sexual dysfunction. The scenario highlighted barriers to assessing sexual health, as well as the importance of gaining a grasp of the situation - from taking a history well to not being afraid of asking difficult questions. [ABSTRACT FROM AUTHOR]

This article examines how the essentialist/constructionist and gay/queer divides have been structured by a division between closed and open notions, and it then argues that these gay and queer notions also interrelate. It argues that unhistoricist queer theory has recently drawn attention to this closed/open interrelationship by inadvertently raising (a) doubts about the irreducible openness of queer; (b) questions about its fundamentalism; and (c) reservations about its ability to handle the re-emerging issues of consonances between sexual concepts across history and the importance, usages, and allure of sexual identities. I argue that these concerns are well grounded, and that queer theory may thus have reached its expiration date. [ABSTRACT FROM AUTHOR]

Self-disclosure of problematic behavioral history and the timeliness of full disclosure were explored as indicators of treatment responsivity and possible predictors of sexual recidivism. Specifically, this study evaluated the relationships among the variables of expeditious full disclosure of sexual history (measured via polygraph testing), treatment completion status, and sexual recidivism within a sample of 192 convicted sex offenders on probation/parole. The study compared a group of non-expeditious disclosers with expeditious disclosers across several variables (i.e., risk score/level, age of full disclosure, presence of sexual deviance, psychopathy, and denial). The independent variable of expeditious disclosure was defined as having disclosed sexually deviant behavioral history sufficient to produce a “no significant reaction” result on a sexual history polygraph examination (within 12 months of treatment program intake). A 5-year sexual recidivism follow-up period was utilized. Univariate analyses revealed that though expeditious disclosure was positively correlated with treatment completion, it was not a statistically significant factor in predicting sexual recidivism. The study provides emerging evidence that polygraph-facilitated full disclosure of sexual history is related treatment outcome and that it is worthy of additional study with larger samples in regard to any relationship with sexual recidivism. [ABSTRACT FROM AUTHOR]

Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the most reported diseases in the United States, and emergency departments (ED) serve a population presenting with increased infection risk. However, identifying patients for whom sexually transmitted infection (STI) screening is appropriate requires accurate sexual history reporting. Study Objectives To examine the consistency with which ED patients answer general and specific sexual activity questions, and how responses relate to perceived STI risk. Methods Urban ED patients aged 15–34 years completed a sexual history survey containing sexual activity and perceived infection risk questions and provided urine and pharyngeal specimens for CT/GC analysis. Results Participants included 192 males and 301 females with a mean age of 25.2 years and were 65.7% white and 33.3% black. Thirty-eight (7.7%) were infected with CT or GC. In patients denying sexual activity in the past year (general question), 40.7% of such males and 45.0% of females also reported some form of specific sexual activity (activity misclassification). Among self-identified heterosexuals, 7.2% males and 7.5% females reported some form of homosexual activity (orientation misclassification; OM). OM individuals were more likely to perceive themselves at risk of infection both orally (odds ratio 2.92, confidence interval 1.12-7.63) and genitally (odds ratio 3.36, confidence interval 1.55-7.30). Conclusions Given that reported sexual activity and age are the only criteria for routine female screening, and that homosexual activity is one of the few screening criteria for males, our results show that a substantial proportion of ED patients eligible for screening may not be identified by reliance upon general sexual history questions. [ABSTRACT FROM AUTHOR]

The intersection between a woman's body weight and sexual history and the victim blaming attitudes of future health care providers was investigated. University undergraduate students (N=91) enrolled in programs associated with the provision of health care read 1 of 4 patient files of a woman reporting a rape as well as 2 distracter files. Results showed that, for overweight rape victims/survivors, study participants' antifat attitudes were correlated with victim blaming attitudes. Male participants held the attacker significantly less responsible than did female participants if the victim/survivor had several previous sexual partners. Findings suggest that body weight should be considered as a contributing factor in attitudes toward rape victims/survivors, and the gender of the health care provider can be a factor in the post-assault treatment of overweight rape victims/survivors. [ABSTRACT FROM AUTHOR]

Sexually transmitted infections (STIs) in Vietnam have been increasing. Control of STIs among female sex workers (FSWs) is important in controlling the epidemic. Effective STI control requires that physicians are skilful in taking sexual history for FSW patients. Three hundred and seventy-one physicians responded to a survey conducted in three provinces in Vietnam. The respondents were asked whether they asked FSW patients about their sexual history and information asked during sexual history taking. The respondents were also asked about their barriers for taking sexual history. Over one-fourth (27%) respondents always, over half (54%) respondents sometimes and 19% respondents never obtained a sexual history from FSW patients. Multivariable analysis revealed that factors associated with always taking a sexual history were being doctor, training in STIs and working at provincial level facilities. Physician’s discomfort was found to be inversely associated with training on communication with patients, seeing 15 or fewer patients a week, working at provincial level facilities. Issues in sexual history taking among FSW patients in general practice in Vietnam were identified. These issues can help STI control for FSW patients and need due attention in order to improve STI management in Vietnam. [ABSTRACT FROM AUTHOR]

Because mating entails both costs and potential benefits to both sexes, males and females should be under selection to make optimal choices from among available potential mates. For example, in some cases, individuals may benefit by using information on potential mates' previous sexual histories to make mate choices. In such cases, the form and direction of these benefits may vary both between the sexes and based on the sexual history of the choosing individuals themselves. We investigated the effects of recent previous sexual history on the mate choice and mating behavior of both males and females of the crayfish Orconectes limosus. In one experiment, we found that opposite-sex dyads comprising crayfish that had both mated 7-8 d previously with other conspecifics were significantly less likely to mate than dyads in which at least one crayfish was unmated. In a second experiment, we found that, when presented with a choice of tethered (but free to move) opposite-sex conspecifics, only virgin females discriminated between males based on sexual history, showing a preference for virgin males over recently mated males. Mated females, mated males, and virgin males showed no preferences based on the sexual histories of potential mates. We discuss the implications of these inferences in the context of what was previously known about mating behavior and potential sperm limitation in crustaceans and other taxa. [ABSTRACT FROM AUTHOR]

Introduction Masturbation is a common sexual activity among people of all ages throughout life. It has been traditionally prohibited and judged as immoral and sinful by several religions. Although it is no longer perceived as a negative behavior, masturbation is often omitted in the diagnostic inquiry of patients with sexual problems. Aims The aims of this study are to increase the awareness of clinicians to the importance of including questions regarding masturbatory habits in the process of sexual history taking, to analyze cases of male sexual dysfunction ( SD) associated with unusual masturbatory practices, and to propose a practical tool for clinicians to diagnose and manage such problems. Methods A clinical study of four cases that include a range of unusual masturbatory practices by young males who applied for sex therapy is described. An intervention plan involving specific questions in case history taking was devised. It was based on detailed understanding of each patient's masturbatory practice and its manifestation in his SD. Main Outcome Measures Effects of identifying and altering masturbatory practices on sexual function. Results The four men described unusual and awkward masturbatory practices, each of which was associated with different kinds of SD. The unlearning of the masturbatory practices contributed notably to improvement of their sexual function. Conclusions The four cases in this study indicate that the detailed questioning of masturbatory habits is crucial for a thorough assessment and adequate treatment of sexual problems in men. We propose specific questions on masturbatory behavior as well as a diagnostic and therapeutic flowchart for physicians and sex therapists to address those problems. Bronner G and Ben-Zion IZ. Unusual masturbatory practice as an etiological factor in the diagnosis and treatment of sexual dysfunction in young men. J Sex Med 2014;11:1798-1806. [ABSTRACT FROM AUTHOR]

In England, chlamydia positivity in young men occurs at a slightly older age group (20–24 years) than positivity among young women (16–20 years) but total rates of infection among the population aged under 25 years are similar. Where there is variation, explanations often focus on individual sexual risk behaviours. We aimed to explore the extent to which variations in chlamydia positivity could be explained by reasons for attendance and sexual behaviour at a sexual health clinic in a high-prevalence area of England. Data routinely collected during clinic appointments were extracted retrospectively from the medical records of 952 clinic users (634 women) aged 16 to 24. We tested for associations with chlamydia positivity using the Chi square statistic and multiple logistic regression for men and women separately; 19.5% of men tested positive (95% CI: 15.1–23.8) compared to 11.5% of women (95% CI: 9.0–14.0). Reporting a partner with symptoms or a sexually transmitted infection diagnosis was significantly associated with a positive diagnosis (Men OR: 3.14, 95% CI: 1.5–6.25; Women OR: 3.78, 95% CI: 1.83–7.83). All other reasons for attendance and all sexual behaviour variables were not significantly associated with a positive diagnosis. Differences in chlamydia positivity between men and women attending this service cannot be explained by individual sexual behaviours found to be associated with higher risk of infection in national studies. Our findings question the utility of individual behavioural data routinely collected during clinic appointments for predicting risk of sexually transmitted infections in high-prevalence areas. [ABSTRACT FROM PUBLISHER]

Existing evidence suggests that offenders tend not to specialize in sexual offending in general but that there is some specialization in particular types of sexual offending. This study examined the sexual histories and reoffending of a large, national data set of offenders convicted of a sexual offense and managed in England and Wales by the National Offender Management Service (N = 14,804). The study found that specialization in sexual offending compared to nonsexual offending was most evident for offenders with convictions for accessing indecent images. We also found considerable evidence of specialization within sexual offending, most notably for noncontact offenders, especially again indecent images offenders. Crossover between sexual offense types was very rare for those with contact adult offenses and for noncontact offenders although those with child contact offenses sometimes crossed over to indecent images reoffending. If specialization within sexual offending exists, the use of single risk assessment instruments to predict all types of sexual recidivism may be less effective than previously assumed. A comparison of different prediction models indicated that some items presently used in one-size-fits-all risk tools to predict any sexual reoffending only effectively predict certain subtypes of sexual offending. Statistically there appear to be some potential benefits to creating specialist risk predictors for different subtypes of offending, but further work is needed to justify the implementation demands that would be caused by abandoning one-size-fits-all tools. [ABSTRACT FROM AUTHOR]

The article provides information on the 2013 British national guidelines for consultations requiring sexual history taking, which is primarily designed for use in the British Genitourinary Medicine (GUM)/Sexual Health settings, as well as sexually transmitted infection (STI) assessments. It mentions that the new version include an additional expanded section on integrated STI/contraception services and a new section covering outreach services and expanded sections on electronic patient records.

Introduction Sexual health is an integral part of overall health across the lifespan. In order to address sexual health issues, such as sexually transmitted infections ( STIs) and sexual functioning, the sexual history of adult patients should be incorporated as a routine part of the medical history throughout life. Physicians and health-care professionals cite many barriers to attending to and assessing the sexual health needs of older adult patients, underscoring the importance of additional research to improve sexual history taking among older patients. Aim The purpose of this article is to explore the content and context of physician-patient sexual health discussions during periodic health exams ( PHEs) with adults aged 50-80 years. Methods Patients completed a pre-visit telephone survey and attended a scheduled PHE with their permission to audio-record the exam. Transcribed audio recordings of 483 PHEs were analyzed according to the principles of qualitative content analysis. Main Outcome Measures Frequency of sexual history taking components as observed in transcripts of PHEs. Physician characteristics were obtained from health system records and patient characteristics were obtained from the pre-visit survey. Results Analyses revealed that approximately one-half of the PHEs included some discussion about sexual health, with the majority of those conversations initiated by physicians. A two-level logistic regression model revealed that patient-physician gender concordance, race discordance, and increasing physician age were significantly associated with sexual health discussions. Conclusion Interventions should focus on increasing physician self-efficacy for assessing sexual health in gender discordant and race/ethnicity concordant patient interactions. Interventions for older adults should increase education about sexual health and sexual risk behaviors, as well as empower individuals to seek information from their health-care providers. Ports KA, Barnack-Tavlaris JL, Syme ML, Perera RA, and Lafata JE. Sexual health discussions with older adult patients during periodic health exams. J Sex Med 2014;11:901-908. [ABSTRACT FROM AUTHOR]

QUESTIONS UNDER STUDY/PRINCIPLES: Little is known concerning patients’ expectations regarding sexual history taking by doctors: to ascertain expectations and actual experience of talking about sexuality among male patients attending outpatient clinics, and their sexual behaviour. METHODS: Patients consecutively recruited from two outpatient clinics in Lausanne, Switzerland were provided with an anonymous self-administered questionnaire. Survey topics were: patients’ expectations concerning sexual history taking, patients’ lifetime experience of sexual history taking, and patients’ sexual behaviour. RESULTS: The response rate was 53.0% (N = 1452). Among respondents, 90.9% would like their physician to ask them questions regarding their sexual history in order to receive advice on prevention (60.0% yes, 30.9% rather yes). Fifteen percent would be embarrassed or rather embarrassed if asked such questions. Nevertheless, 76.2% of these individuals would like their physician to do so. Despite these wishes, only 40.5% reported ever having a discussion “on their sexual life in general” with a doctor. Only one patient out of four to five was asked about previous sexually transmitted infections (STIs), the number of sexual partners and their sexual orientation. No feature of their sexual life distinguishes those who had discussed sexual issues with a doctor from those who had not, except a history of previous consultation for health problems related to sexuality. Conversely, being embarrassed about conducting this discussion was significantly associated with lack of discussion regarding sexuality. CONCLUSIONS: This study highlights the gap existing in the field of STI prevention in terms of doctors’ advice and patients’ wishes.

Abstract Introduction This workshop contains tools to review basic medical encounter communications skills as applied to sexual history taking, and to introduce the advanced skills of both handling of emotional silence (“the potential empathic opportunity”) and communicating during intimate examination and procedures. The workshop consists of a series of five skits that serve as a springboard for facilitated discussion. The skits may either be acted by a faculty member serving as the physician and either a second faculty member or student acting as the patient, or shown in the provided video files. Methods The five skits depict sequential portions of a single office visit for “Ruby,” a patient known to this physician who presents with a “yeast infection” and a significant hidden agenda. The facilitator will show the scenes (or act them out) one at a time, following each scene with the questions: “What did the doctor do right/well? What did s/he do wrong/incorrectly?“ Built into each scene are examples of highly effective communications techniques and major communications errors. Other portions of the scenes provoke mixed reactions from observers/students. The facilitator guide contains instructions for leading the introduction of the workshop as well as scene-by-scene guides to facilitate discussion, and questions regarding the various communication skills depicted. Results This workshop has been used with every block of third-year students on the core obstetrics and gynecology clerkship at the University of Miami Miller School of Medicine for more than 4 years. Blocks number 10–27 students though the average number of students is around 20. Student ratings have been consistently “excellent” among 90% or more of respondents. It has also been presented to OB/GYN residents and family practice residents. Discussion Responses to specific skills depicted in the skits may vary, depending on how they are acted, providing a rich variety of discussion if the facilitator chooses to act in real time rather than use the videos. A student can be trained within 15 minutes to play the role of the patient. It is important to emphasize that she maintain the silence required in scene III to exploit the teaching points of the potential empathic opportunity, as novice actors have difficulty maintaining this silence.

Introduction Good history-taking skills are the first step towards achieving a correct diagnosis of sexual dysfunction ( SD). However, studies show most general practitioners ( GPs) do not take the initiative to ask the patient about SD, and when diagnosing a condition, they tend to give preference to their own criteria over clinical guidelines. Aim The aim of this study is to characterize GPs' attitudes towards taking sexual history, identifying its frequency and focus, and to describe GPs' diagnostics and therapeutic approaches including the use of clinical guidelines, exploring patients' and doctor-related differences. Methods Cross-sectional study using confidential self-administrated questionnaires applied to GPs working in primary healthcare units in the Lisbon region. Main Outcome Measures Data concerning GPs' consultation of guidelines, active exploration of SD in male and in female patients, and focus on sexual history taking was collected. Results Of the 50 participants (73.5% response rate), 15.5% actively ask their patients about SD. The main reasons for asking patients about their sexuality are diabetes (84.0%), prescription of medication with adverse effects on sexuality (78.0%), and family planning (72.0%), the latter being a significantly more frequent reason for GPs with 20 or less years of practice. Routine sexual history taking (22.0%) appears as one of the least mentioned motives. The percentage of appointments with active exploration of SD was positively associated with guidelines' consultation, as well as considering the specialty as a good source of information and having longer appointments when SD is mentioned. However, 76.0% report not having consulted any guidelines in the previous year. Lack of time (31.6%) and low accessibility (25.0%) were referred to as the main reasons for not consulting guidelines. Conclusions Routine sexual history taking and consultation of guidelines about SD are not yet a generalized practice in primary care. Data should be interpreted with caution as they are self-reported. Further objective measurement such as direct observation or clinical files consultation should be implemented. Ribeiro S, Alarcão V, Simões R, Miranda FL, Carreira M, and Galvão-Teles A. General practitioners' procedures for sexual history taking and treating sexual dysfunction in primary care. J Sex Med 2014;11:386-393. [ABSTRACT FROM AUTHOR]

Background: The premature ejaculation diagnostic tool (PEDT) is a brief, multidimensional validated instrument devised for diagnosing premature ejaculation (PE). However, there is insufficient evidence regarding its ability to differentiate subgroups of PE. We assessed the ability of the PEDT to differentiate four subgroups of PE (lifelong, acquired, variable and subjective PE). Methods: An internet-based survey was conducted with a populationbased sample of males aged 20-59 years. Participants were asked to complete a questionnaire requesting detailed medical and sexual histories. The questionnaire including questions from the PEDT and from the Medical Outcome Study Shortform 36-Item Health Survey (SF-36). Using the PEDT, PE was defined as a cutoff score of ⩾11. Results: In this study, 443 subjects (mean age 39.3±10.1 years) were included. PEDT-PE prevalence was 14.6%. The proportions of PE subgroups and their mean PEDT scores were: lifelong PE, 2.9% and 15.5; acquired PE, 7.0% and 11.2; variable PE, 7.4% and 10.4; subjective PE, 3.2% and 9.0. PEDT scores were significantly higher in the lifelong PE group than in other the subgroups of PE (P < 0.001). The subjective PE group had the lowest PEDT score, and their physical and mental component scores for the SF-36 were similar to those of non-PE subjects. Conclusions: This population-based cross-sectional survey has demonstrated that the PEDT is not appropriate for research into four subgroups of PE when used in an general male population study, unless the PEDT is combined with an additional questionnaire with specific questions on the four PE subgroups. [ABSTRACT FROM AUTHOR]

Objective: To assess both the acceptance and the discontinuation rates from dapoxetine, the first oral pharmacological agent indicated for the treatment of premature ejaculation (PE). Methods: One hundred twenty consecutive potent patients (mean age 40.3 years; range 18-63 years) seeking medical treatment for lifelong PE were enrolled in a prospective phase II study. Moreover, they were assessed regarding detailed medical and sexual history, intravaginal ejaculatory latency time (IELT), International Index of Erectile Function (IIEF), and complete physical examination. The patients received a dapoxetine prescription (30 mg on demand) and unresponded cases received increased dose (60 mg after 3 months). The patients were evaluated at 1, 3, 6, and 12 months, and requested to complete a multiple-choice global assessment questionnaire regarding specific reasons for eventual therapy discontinuation. Results: Twenty-four of the patients (20%) decided not to start dapoxetine. Fear of using a “drug” was the most frequently reported reason for treatment nonacceptance (50%) and the cost of treatment was the reason for 25% of the patients. Ninety-six patients (80%) started the therapy. Twenty-six percent dropped out after 1 month, 42.7% dropped out after 3 months, 18.7% dropped out at 6 months, 2% dropped out at 12 months, and 10.4% are continuing the therapy after 1 year. The main reasons were effect below expectations 24.4%, costs 22.1%, side effects 19.8%, loss of interest in sex 19.8%, and no efficacy 13.9%. Conclusion: Twenty percent of lifelong PE patients seeking medical treatment for early ejaculation freely decided not to start treatment with dapoxetine, and roughly 90% of the patients who started therapy discontinued after 1 year. [ABSTRACT FROM AUTHOR]

Purpose: The incidence of penile cancer is four times higher in Paraguay than in the United States or Europe. There are no adequate scientific explanations for this geographical variation. The goal of this study was to evaluate the interplay among risk factors, morphology of the primary tumor, and HPV status. Methods: Information on socioeconomic status, education level, habits, and sexual history was obtained in 103 Paraguayan patients with penile cancer. All patients were then treated by surgery, and specimens were evaluated histopathologically. Results: Patients usually dwelled in rural/suburban areas (82%), lived in poverty (75%), had a low education level (91%), and were heavy smokers (76%). Phimosis (57%), moderate/poor hygienic habits (90%), and history of sexually transmitted diseases (74%) were frequently found. Patients with >10 lifetime female partners had an odds ratio of 3.8 (95% CI 1.1, 12.6; P-trend = .03) for presenting HPV-positive tumors when compared to patients with <6 partners. However, this trend was not significant when the number of sexual partners was adjusted for age of first coitus and antecedents of sexually transmitted diseases. HPV-related tumors (found in 36% of the samples) were characterized by a warty and/or basaloid morphology and high histological grade in most cases. Conclusions: In our series, patients with penile cancer presented a distinctive epidemiologic and pathologic profile. These data might help explaining the geographical differences in incidence and aid in the design of strategies for cancer control in Paraguay. [ABSTRACT FROM AUTHOR]

The article discusses the case of a patient presented with relatively nonspecific symptoms including pain and fever and who was found to have striking findings on physical examination that were suggestive of mononeuritis multiplex. It highlights the diagnostic approach to neuropathy which includes evaluation of the tempo, distribution and type of symptoms. The authors say the symptoms pointed to a vasculitic cause and that peripheral neuropathy is the presenting symptom of systemic vasculitis.

Introduction Because available definitions of premature ejaculation ( PE) were unable to encompass the various forms of PE, Waldinger et al. proposed a new classification that distinguished four PE syndromes. However, few studies have examined the prevalence rates of these four PE syndromes. Aims The study aims to analyze the prevalence of and factors associated with four PE syndromes in outpatients who complained of ejaculating prematurely. Methods Between December 2009 and December 2011, outpatients who complained of PE completed a detailed verbal questionnaire regarding their demographic data and medical and sexual history. Each patient was classified as having one of four PE subtypes: lifelong PE ( LPE), acquired PE ( APE), natural variable PE ( NVPE), or premature-like ejaculatory dysfunction ( PLED). Main Outcome Measures Based on the new classification scheme, PE was classified into four subtypes. The anxiety/depression status of patients was assessed by the Zung self-rating anxiety/depression scales, and erectile function was assessed by the International Index of Erectile Function-5 instrument. Results This study included 1,988 male outpatients who complained of PE, with mean ages and body mass index ( BMI) scores of 35.52 ± 10.38 years and 25.34 ± 4.51 kg/m2, respectively. Prevalence rates of PE syndromes were 35.66% for LPE, 28.07% for APE, 12.73% for NVPE, and 23.54% for PLED. Patients with APE had the highest mean ages and BMI scores, and they more frequently reported several comorbidities, including sexual desire disorder, hypertension, diabetes mellitus, chronic prostatitis, and erectile dysfunction. The PLED group had a lower mean frequency of sexual intercourse than other groups and higher rates of anxiety and depression. Conclusion The prevalence of LPE was higher than that of other PE subtypes in an outpatient setting. Several comorbidities were more common in patients with APE and PLED. In particular, a lower frequency of intercourse and higher frequencies of anxiety and depression were found in patients with PLED. [ABSTRACT FROM AUTHOR]

Abstract: An evolutionary history of human female infidelity and consequent sperm competition may have caused the evolution of male counter-adaptations. The infidelity-detection hypothesis for oral sex proposes that men perform oral sex to gather information about their partner’s recent sexual history. We tested this hypothesis with data secured from 231 men in committed, sexual, heterosexual relationships. We found support for two derivative predictions: men at a greater recurrent risk of sperm competition expressed greater interest in, and spent more time performing, oral sex on their partner, even after controlling statistically for relationship length, relationship satisfaction, and sexual intercourse duration. The discussion addresses limitations of this research and highlights directions for future research, including distinguishing empirically the infidelity-detection hypothesis from alternative hypotheses for oral sex. [Copyright &y& Elsevier]

The incidence and reinfection rates of Mycoplasma genitalium among young Australian women were estimated as 1.3 (95% confidence interval [CI], .8–2.3) and 0.8 (95% CI, .1–.9) per 100 person-years, respectively. Azithromycin treatment failure was 9.4% (95% CI, 2.0–25.0).Background. Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that is potentially associated with reproductive tract sequelae in women. This study aimed to estimate MG incidence and treatment failure and provide estimates of organism load in infection.Methods. 1110 women aged 16–25 years were recruited from primary care clinics in Australia. Women were tested for MG at baseline, 6 months, and 12 months, and MG organism load was measured by quantitative polymerase chain reaction (PCR). MG-positive cases were screened for MG 23S ribosomal RNA (rRNA) gene point mutations shown to confer azithromycin resistance using high-resolution melt following PCR.Results. MG incidence rate was 1.3 per 100 person-years (n = 14; 95% confidence interval [CI], .8–2.3); women reporting 3 or more sex partners in the last 12 months had an increased rate of incident infection (rate ratio [RR], 5.1; 95% CI, 1.3–19.6]). There were 3 cases of MG reinfection (0.8 per 100 person-years [95% CI, .1–.9]. Organism load was higher for prevalent than incident infection (P = .04). There were 3 cases of treatment failure (9.4% [95% CI, 2.0–25.0]); organism load was higher in cases with treatment failure than in successfully treated cases (P < .01). An MG 23S rRNA mutation was detected in 5 cases (3 cases of treatment failure and 2 successfully treated).Conclusions. Although MG incidence was relatively low, testing should be recommended for women considered to be at increased risk based on sexual history. Our results also suggest that organism load might be important in azithromycin treatment failure. [ABSTRACT FROM PUBLISHER]

ABSTRACT Introduction. While there is evidence of increased professional and public awareness of sexual problems, both male and female sexual dysfunctions remain underdiagnosed and undertreated by health care professionals around the world. Health care professionals (HCPs) are typically reluctant, disinterested, or unskilled in sexual problem management and regrettably are often disinclined to inquire about sexual issues. HCPs in all countries receive variable, nonstandardized, or inadequate training in sexual history taking and its treatment. Aim. This article presents a standard operating procedure (SOP) for taking a sexual history from men or women with sexual problems or performance concerns. Methods. Review of relevant evidence-based literature identified through a PubMed search, integrated with expert opinion. Results. Guidelines for taking a sexual history are presented along with the relevant domains, opening and follow-up questions. Conclusions. The SOP presented in this article offers HCPs a brief, structured, and uniform method for obtaining a sexual history from men or women seeking health care services. Sexual history taking should be based on three basic principles, which serve as the foundation for managing sexual problems in men and women. These include the following: (i) a patient-centered approach; (ii) evidenced-based diagnostic and treatment recommendations; and (iii) use of a unified management approach for men and women. Sexual history taking should always be conducted in a culturally sensitive manner, taking account of the individual's background and lifestyle, status of the partner relationship, and the clinician's comfort and experience with the topic. Sexual inquiry should be incorporated into all new patient encounters, when possible, if only to ask one or two broad questions such as the following: 'Are you sexually active? Do you have any sexual concerns or problems you would like to discuss?' Sexual history taking is a cornerstone of sexual medicine clinical practice. All patients should be provided an opportunity for frank and open discussion of sexual issues or concerns, conducted in an atmosphere of sensitivity and respect. Althof SE, Rosen RC, Perelman MA, and Rubio-Aurioles E. Standard operating procedures for taking a sexual history. J Sex Med **;**:**-**. [ABSTRACT FROM AUTHOR]

Objective In the UK community pharmacies have become involved in providing chlamydia testing and treatment ( CT& T) to young people. Our objective was to ascertain among pharmacy staff their self-reported competencies and training needs prior to implementation of a pharmacy-based CT& T service. Methods Self-complete questionnaires were posted to 166 community pharmacies in Lothian, Scotland. Questions included socio-demographic information and four-point Likert-type scale items addressing self-judged competencies and training needs for the provision of a CT& T service. Each competency item was transformed to a binary variable 'insufficiently competent' (comprising responses of 'not at all' or 'somewhat'), and each training need item to a binary variable 'substantial training need' (responses of 'full' or 'top-up' training needed). Results Forty-one per cent of the 235 respondents were pharmacists, 32% technicians and 26% counter assistants. In respect of 'insufficient' competency, more than half of all staff responses were thus categorised for four competencies regarding offering and giving instructions for screening (60% to 83%), knowing the signs/symptoms of chlamydia (60%), raising the issue of sexual health (58%) and responding to a request for sexual health information (53%). 'Substantial training need' was identified for the majority of respondents, for all but two items, highest rates being for the four inter-communicative competencies: giving guidance on use of the kit, offering test to men, or to women, and advising regarding screening (71% to 83%). For pharmacist-only competencies the highest rates of substantial training need were for clarity regarding medico-legal aspects (Fraser guidelines), criteria for referral, and ability to take a sexual history and to review staff competencies for CT& T service (74% to 83%). Conclusions Insufficient competency with respect to specifics of service procedure was not surprising, given that no training had yet been given and pharmacists and their support staff had not had any practical experience in the provision of the CT& T service. Substantial training need is particularly indicated for inter-communicative aspects specific to sexual health. [ABSTRACT FROM AUTHOR]

Summary: Introduction: This audit compared the management of epididymo-orchitis within our institution against the 2010 guidelines issued by the British Association of Sexual Health and HIV. Methods: A Retrospective casenote analysis was performed on all patients diagnosed with epididymo-orchitis between August 2004 and August 2009. Patients were identified using Hospital Episode Statistics (HES) data. Data analysed included patient''s age, investigations performed, treatment given, and patient follow-up. Results: In total, 232 patients were identified (mean age 41 years, range 1–96). A mid-stream urine was performed in 105 (45%) patients, 12 (5%) had a urethral swab and 82 (35%) had an ultrasound scan. Twenty patients were surgically explored to exclude torsion. The mean length of stay was 1 night (range 0–9). Antibiotics were prescribed in 94% of patients. Sexual history and advice to attend a genito-urinary clinic was documented in 16% and 4% of cases respectively. Referral for follow-up in the urology outpatient clinic occurred for 24% of patients. Conclusions: The management of epididymo-orchitis in patients referred for secondary care review is an area for significant improvement in clinical practice. Implementation and dissemination of clear local guidelines are essential to ensure appropriate patient management and minimise unnecessary in-patient admissions and outpatient follow-up. [Copyright &y& Elsevier]

Modern legal regimes have narrowed the scope of the sexual history evidence that is admissible for purposes of proving or refuting claims of consent in cases of sexual assault. Yet, under most modern regimes, similar-sexual-history evidence is still admissible. The article critically analyses the epistemic foundations of these regimes by laying down two arguments. The main argument is that, in the vast majority of cases, similar sexual history is simply irrelevant to questions of consent. First, a simple statistical analysis demonstrates that, in the class of complainants on sexual assault, similar-sexual-history evidence is not indicative of consent. Bayesian insights are then introduced in order to reinforce the analysis and refine it by identifying one narrow exception. Next, it is demonstrated that, in light of the proposed analysis, current evidential regimes can only make sense under some highly controversial normative or factual assumptions. The secondary argument contends that some of the modern evidential regimes reflect the idea that claims of power inequalities between men and women should be at the heart of sexual assault law, rather than claims of consent or lack of it. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. Sexuality is a key aspect of women's physical and psychological health. Research shows both patients and physicians face barriers to communication about sexuality. Given their expertise and training in addressing conditions of the female genital tract across the female life course, obstetrician/gynecologists (ob/gyns) are well positioned among all physicians to address sexuality issues with female patients. New practice guidelines for management of female sexual dysfunction and the importance of female sexual behavior and function to virtually all aspects of ob/gyn care, and to women's health more broadly, warrant up-to-date information regarding ob/gyns' sexual-history-taking routine. Aims. To determine ob/gyns' practices of communication with patients about sexuality, and to examine the individual and practice-level correlates of such communication. Method. A population-based sample of 1,154 practicing U.S. ob/gyns (53% male; mean age 48 years) was surveyed regarding their practices of communication with patients about sex. Main Outcome Measures. Self-reported frequency measures of ob/gyns' communication practices with patients including whether or not ob/gyns discuss patients' sexual activities, sexual orientation, satisfaction with sexual life, pleasure with sexual activity, and sexual problems or dysfunction, as well as whether or not one ever expresses disapproval of or disagreement with patients' sexual practices. Multivariable analysis was used to correlate physicians' personal and practice characteristics with these communication practices. Results. Survey response rate was 65.6%. Sixty-three percent of ob/gyns reported routinely assessing patients' sexual activities; 40% routinely asked about sexual problems. Fewer asked about sexual satisfaction (28.5%), sexual orientation/identity (27.7%), or pleasure with sexual activity (13.8%). A quarter of ob/gyns reported they had expressed disapproval of patients' sexual practices. Ob/gyns practicing predominately gynecology were significantly more likely than other ob/gyns to routinely ask about each of the five outcomes investigated. Conclusion. The majority of U.S. ob/gyns report routinely asking patients about their sexual activities, but most other areas of patients' sexuality are not routinely discussed. Sobecki JN, Curlin FA, Rasinski KA, and Lindau ST. What we don't talk about when we don't talk about sex: Results of a national survey of U.S. obstetrician/gynecologists. J Sex Med 2012;9:1285-1294. [ABSTRACT FROM AUTHOR]

Early development can have long-term effects on physiology and behavior. While severe disturbances predictably lead to dysfunction, recent work in humans and animals has led to a growing appreciation for the more subtle ways in which early conditions can modulate behavioral tendencies later in life. Life history theory predicts that early cues signaling a stressful or suboptimal environment might lead an organism to adopt a strategy favoring short-term gains and early reproduction. Fifty college men reported their birth weight, completed the Attention-Deficit/Hyperactivity Disorder (ADHD) Self-Report Scale, and answered a series of questions about their sexual history and attitudes towards short-term sexual encounters. Lower birth weights were associated with higher scores on the ADHD scale (r = -.352; p ≤ .05) and more favorable attitudes towards casual sex (r = -.456; p ≤ 0.001). There was a significant interaction between birth weight and casual sex favorability in predicting number of sexual partners (F1,46 = 4.994; p ≤ .05). This suggests that, although men who are smaller at birth may otherwise be at a disadvantage in reproductive terms, they may offset their reduced fitness by being more willing to engage in casual sex. [ABSTRACT FROM AUTHOR]

The article presents information on the concept of relevance that is used in the reforms of sexual history with respect to the rules of criminal evidence. The focus of relevant evidence is towards creating a balance between defendants, witnesses and the victims during the criminal trial process. Information on permitting of the judicial discretion towards the conviction of the guilty is also presented.

Sexual dysfunction is defined as a disturbance in one or more aspects of the sexual response cycle or as pain associated with sexual intercourse. Sexual dysfunction is common both in men and women although its prevalance changes with age. Considering its relation with other diseases and medical treatments, ethical and legal aspects, primary care phsycians should know the technique of taking sexual history, be able to do differential diagnosis and to give counselling to sexual dysfunctions or problems related to misbeliefs or lack of education and refer to the specialist appropriately. This review, aimes to outline main terms related to sexual dysfunctions and general approach in primary health care. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To identify the sexual history-taking practices of nurse practitioners (NPs) for patients 50 and older. Data Sources: The study involved a random sample of 500 American Academy of Nurse Practitioners (AANP) members. A mailed questionnaire was adapted from the Knowledge of HIV and HIV-Risk Screening tools and reflected the assumptions of Pender''s Health Belief Model. Conclusion: Only 2% of respondents indicated they always conduct a sexual history with their patients age 50 and older, while 23.4% never or seldom do such an assessment. The main barriers to taking sexual histories were identified as lack of time, interruptions, and limited communication skills. Implications for Practice: The findings support the need for NPs to be more conscientious about completing a sexual history with their older patients. [Copyright &y& Elsevier]

Introduction. Although approximately 40% of women report female sexual problems—and particularly sexual desire disorders, there are numerous practical, professional, and personal barriers to their diagnosis and management by treating clinicians. Aim. To identify practice patterns, perceptions, and barriers to the diagnosis and management of female sexual problems among U.S. practicing primary care physicians (PCPs) and obstetrician/gynecologists (OB/GYNs). Methods. A random sample of practicing U.S. PCPs and OB/GYNs were sent a case-vignette survey by e-mail and fax. Response to the survey was considered consent. A regression model was analyzed to assess predictors of confidence. Main Outcome Measure. Frequency and variability in diagnostic tests ordered and treatment recommendations provided for a patient with diminished sexual desire. Percent of physicians who reported they were confident in treating hypoactive sexual desire disorder (HSDD) and percent who reported significant barriers to initiating a dialogue about sexual health with female patients. Results. A total of 505 responses were analyzed (8.8% response rate). Of respondents, 21% of OB/GYNs and 38% of PCPs stated they were not at all confident in treating HSDD. The majority of physicians would order a thyroid panel (PCP = 63%, OB/GYN = 53%) to assess a patient's diminished desire and recommended counseling and stress management to treat a patient with sexual complaints (PCP = 48%, OB/GYN = 54%). Regression results identified time constraints, the perceived lack of effective therapies, perceptions regarding patient-physician gender discordance, years in practice, number of patients seen per week, and perceptions regarding continuing medical education and practice experience as significant and independent predictors of confidence in treating HSDD patients. Conclusions. Discussion of sexual health is difficult, but there are independent predictors of confidence in treating patients with decreased desire. Abdolrasulnia M, Shewchuk RM, Roepke N, Granstaff US, Dean J, Foster JA, Goldstein AT, and Casebeer L. Management of female sexual problems: Perceived barriers, practice patterns, and confidence among primary care physicians and gynecologists. J Sex Med 2010;7:2499–2508. [ABSTRACT FROM AUTHOR]

Collection of sensitive data with the use of video-enhanced, computer-assisted, self-administered interviews (V-CASI) has the potential to reduce interview bias and improve the validity of the study. The purpose of this study was to compare responses to sensitive questions elicited by V-CASI and by face-to-face interview (FTFI) methods. Women attending a New Orleans, Louisiana, public family planning or sexually transmitted disease clinic from July 1995 to July 1996, diagnosed with a Chlamydia trachomatis infection responded to eight close-ended behavioral questions (four socially undesirable, two socially desirable, and two neutral behaviors) using both FTFI and V-CASI techniques in a randomized crossover design. Of the 280 women included, the mean age was 23 years, 95 percent were African American, and 71 percent felt comfortable using computers. While kappa scores indicated good-to-excellent agreement between interview techniques, women tended to admit to socially undesirable behaviors more often on V-CASI compared with FTFI. Thirty percent of the women gave a discrepant response between V-CASI and FTFI toward social desirability. Women who reported a socially undesirable behavior in V-CASI (i.e., more than two sex partners and infrequent condom usage) were more likely to have a discrepant response. Utilization of the same logistic regression model to predict condom use yielded different results when data from V-CASI were used compared with data from FTFI. The V-CASI technique can reduce social desirability bias and improve validity in research requiring information on sensitive sexual behaviors. Am J Epidemiol 1999; 149:950–4. [ABSTRACT FROM PUBLISHER]

Introduction. Male sexual dysfunction is a common medical condition, which is addressed mainly from a biomedical perspective by Swiss general practitioners (GPs) and urologists as the results of part I of our study showed. A psychosocial orientation in sexual history taking (SHT) leads to a truly patient-centered approach and is crucial for improving therapy decisions related to sexual dysfunction. Aim. To analyze to what extent Swiss GPs and urologists have a psychosocial orientation in SHT, and what therapeutic options they focus on when confronted with male sexual dysfunction. Methods. A semistructured interview was developed and used in face-to-face encounters with 25 GPs and 25 urologists. Main Outcome Measures. Content and frequency of interview responses. Results. The GPs and urologists differed significantly from each other in 5 out of 22 psychosocial factors. Summarizing these psychosocial factors in four domains showed a difference between the GPs and urologists in only one domain. Both groups focus on an open conversation as their approach in SHT. No GP and only a minority of urologists based their diagnosis on criteria of the International Classification of Diseases (10th edition) (ICD-10) or Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV). The GPs and urologists differed significantly from each other in 4 out of 16 combinations resulting from the given therapeutic options and form of sexual dysfunction. The urologists focus more strongly on medication as a therapeutic option. Conclusions. The results of part II additionally justify establishing guidelines and training resources related to SHT in Switzerland. Swiss physicians should be encouraged to apply a more psychosocial orientation in SHT. This will contribute to a better patient-centered approach with positive consequences on physicians’ therapeutic decisions. Optimizing the approach in SHT and the choice of therapeutic options may better facilitate real sexual satisfaction for the patient and ultimately result in fewer health insurance costs. Platano G, Margraf J, Alder J, and Bitzer J. Psychosocial factors and therapeutic approaches in the context of sexual history taking in men: A study conducted among Swiss general practitioners and urologists. J Sex Med 2008;5:2533–2556. [ABSTRACT FROM AUTHOR]

UK government policy over the last decade has emphasised the role of general practice in delivering sexual health care. In four primary care trusts (PCTs) in the West Midlands, a continuing education programme (Sexual Health in Practice - 'SHIP') supports sexual healthcare provision in general practice. SHIP focuses primarily on improving sexual history taking and risk assessment skills amongst GPs and practice nurses through short courses, resources and ongoing contact and support. This paper reports the progress and impact of the SHIP scheme over a fiveyear period (2001/2-2005/6). Data are drawn from participant feedback on courses (response rate 92%; n=1054) and pre- and post-course questionnaires exploring change in knowledge/practice after a subset of two courses (post-course mean response rate 64%; n=311). Findings highlight that SHIP has reached most practices in the Birmingham/Solihull area, and its courses have been well received. Participants endorsed SHIP's training approach and its relevance to practice, and provided some indication of learning gains and impact on practice. There is potential for continuing education programmes like SHIP to support the delivery of the current sexual health agenda. [ABSTRACT FROM AUTHOR]

Introduction. General practitioners (GPs) and urologists are the first medical contacts for men with sexual dysfunction. Previous studies have shown that many GPs hesitate to address sexual issues and little is known about the sexological skills of urologists. Aim. To analyze sexual history taking (SHT) by Swiss GPs and urologists, in terms of active exploration, focus, and competence in discussing and treating sexual dysfunction. Methods. A semi-structured interview was developed and used in face-to-face encounters with 25 GPs and 25 urologists. Main Outcome Measures. Content and frequency of interview responses. Results. Urologists reported a significantly higher frequency of actively asking male patients about sexual dysfunction (22.80% vs. 10.42%, P = 0.01). GPs and urologists avoided actively asking certain patient groups about sexual dysfunction (e.g., “immigrants,”“macho men”). GPs reported a significantly lower percentage of male patients who spontaneously address sexual problems (6.35% vs. 18.40%, P < 0.001). Both physician groups emphasized erectile dysfunction in SHT. Eight percent of GPs and 28% of urologists considered their competence in discussing sexual dysfunction as very good. No GP and 20% of urologists considered their competence in treating sexual dysfunction as very good. Urologists reported having significantly greater competence in discussing ( P = 0.02) and treating ( P < 0.001) sexual dysfunction than the GPs. Competence in discussing correlated positively with competence in treating sexual dysfunction for GPs ( P = 0.01) and urologists ( P < 0.001). The majority of GPs (92%) and urologists (76%) reported a need for continuing education in sexual issues. Conclusions. Our results justify establishing guidelines for SHT in Switzerland to better meet the sexual health needs of male patients. Physicians should be encouraged to routinely inquire about sexual issues, overcome their discomfort with the subject, and regard male sexuality as more than erectile function. A clear need exists for relevant continuing education for Swiss GPs and urologists. Platano G, Margraf J, Alder J, and Bitzer J. Frequency and focus of sexual history taking in male patients—A pilot study conducted among Swiss general practitioners and urologists. J Sex Med 2008;5:47–59. [ABSTRACT FROM AUTHOR]

Objectives. We estimated the prevalence of same-sex experience among women and compared women reporting sex with women and men and women reporting sex exclusively with women with women reporting sex exclusively with men, in terms of sociodemographics and sexual, reproductive, and general health risk behaviors and outcomes. Methods. We used a British probability survey (n = 6399 women, aged 16 to 44 years) conducted from 1999 to 2001 with face-to-face interviewing and computer-assisted self-interviewing. Results. We found that 4.9% of the women reported same-sex partner(s) ever; 2.8% reported sex with women in the past 5 years (n = 178); 85.0% of these women also reported male partner(s) in this time. Compared with women who reported sex exclusively with men, women who reported sex with women and men reported significantly greater male partner numbers, unsafe sex, smoking, alcohol consumption, and intravenous drug use and had an increased likelihood of induced abortion and sexually transmitted infection diagnoses (age-adjusted odds ratios=3.07 and 4.41, respectively). Conclusions, For women, a history of sex with women may be a marker for increased risk of adverse sexual, reproductive, and general health outcomes compared with women who reported sex exclusively with men. A nonjudgmental review of female patients' sexual history should help practitioners discuss risks that women may face. (Am J Public Health. 2007;97:1126-1133. doi:10.2105/AJPH.2006.086439) [ABSTRACT FROM AUTHOR]

This article reviews previous research on the methodology used in collecting data on the sexual behavior of urban low-income, Afro-American and Hispanic youth. Results of this review indicate that data on sexual behavior in these populations can be collected in face-to-face interviews, and clinical language can be used to ask questions about intercourse. However, anal intercourse may be a sensitive topic for both males and females in these populations, and oral intercourse is a sensitive topic for females. Finally, particular care must be taken in interviews with Hispanic women because of their greater sensitivity about topics involving sexuality and menstruation. Interviewers and respondents were matched on gender and ethnicity. In addition to more general research procedures, interviewers were trained to: (1) apprise respondents of the right to refuse questions, (2) handle materials in order to maintain the respondents' anonymity, (3) create a setting for the interview which maintains the respondent's confidentiality and minimizes stress or discomfort, (4) manage silence, verbal and nonverbal responses, and (5) collect sexual history and answer requests for contraceptive information. Study data and interviewer impressions suggest that problems associated with sexuality research are not so very different from those encountered in other research areas.

The author interviewed 60 women with somatization disorder and 31 women with primary affective disorders who were matched for race, age at interview, and level of education to obtain their childhood sexual development histories. The two groups of women reported similar sexual experiences at similar ages, except that significantly more women with somatization disorder had been molested as children. [ABSTRACT FROM AUTHOR]

The population of women who sell or exchange sex or intimate sexual services for material goods or services, also called "sex work," often is unrecognized in the typical obstetric and gynecologic practice. The prevalence of this behavior among adult women is difficult to quantify because of its frequent omission from the routine sexual history by women and clinicians. Data on the prevalence of sex work in the United States are largely lacking. The American College of Obstetricians and Gynecologists supports increasing awareness about the health risks, preventive care needs, and limited health care services for female sex workers. [ABSTRACT FROM AUTHOR]

The article offers information on a study which deals with positive impact of efficient sexual history in improving both clinician and patient experience. It mentions that determination of sexual history will be useful in all clinical encounters with adolescent patients, helping ensure clinicians can acquire essential information from sexual history for appropriate care.