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For the opponents of the sexual reform movement, he was the father of all evil; for the proponents of the decriminalization of same-sex desire, he paved the way for objective research. With the term "Urning", he gave homosexuals an anthropological dignity. The Hanoverian lawyer Karl Heinrich Ulrichs (1825–1895) was notorious during his lifetime and at times esteemed after his death, but it was not until the 1990s that he became the secret hero of sexual emancipation and sexual history/historiography. Streets and squares were named after him, but his life's work was also often instrumentalized. [ABSTRACT FROM AUTHOR]

The sexual double standard (SDS) suggests that society holds gendered standards for appropriate sexual behaviors and histories. Typically, people judge women with more sexual partners harshly, especially when those partners originate from non-committed/casual relationships. The current research (n = 853) utilized a vignette design to investigate how one's number of sexual partners, and what type of relationships those partners came from (long/short-term, exclusive/non-exclusive), impacted evaluations of them and intentions to interact with them, including desire to date and engage in sexual intercourse with the target individuals. Results did not indicate the presence of the SDS, however, those with higher numbers of sexual partners, or those described as being involved in short-term/casual relationships in the past rather than long-term/committed relationships, were evaluated less favorably, and participants reported less desire to engage sexually or romantically with them. Some evidence for the Reverse-SDS emerged such that target men were evaluated more negatively and desired less than women despite having engaged in the same sexual behavior. [ABSTRACT FROM AUTHOR]

Yorgos Lanthimos's The Favourite (Ireland/UK/US, 2018) centers Queen Anne's torturous relationship with two women administrators, seeming to promise clarity about the monarch's sexual history. Instead, the film obliquely addresses British state history while the camera's gaze focuses on the queen's fictional rabbits. Gradually, these animals overwhelm the film's narrative, turning the cinematic image into an undulating, grey morass. This essay meditates on why The Favourite endlessly reproduces the rabbits' image and expands on how searching for lesbians in the past on film can mystify historical meaning. This article argues The Favourite constitutes an anti-heritage film, a film that uses heritage film's own generic dictates to unwrite history. Bringing together the film's reception, Queen Anne's historiography, and theories of sexual/cinematic reproduction, this essay outlines how rabbit proliferation at the site of lesbian desire subverts the heritage film's impulse to render the past into historical narrative. The film deploys visual copies of woman and rabbit that enliven residual anxieties about ungovernable feminine sexuality. In doing so, it marks the limits of the archive and encourages finding present life from outside the images proposed by national history. [ABSTRACT FROM AUTHOR]

Despite the importance of sexual well-being in overall health, health providers do not communicate with their patients about sexual health sufficiently and highlight their discomfort with the topic as one key barrier. This study tested the effectiveness of a brief reflective sexual health workshop as an online intervention to increase comfort in sexual health communication. Participants were students enrolled on an undergraduate medical programme at a private university in Malaysia who were randomly allocated to a workshop that focused either on sexual health communication (intervention, n = 48) or on cultural competence in communication training (active control, n = 50). While the workshops varied in their focus, both followed identical structures and tasks. Multilevel modelling analyses revealed that both workshops increased subjective (self-reported) comfort and observed comfort through more direct verbal mentions of sex during history-taking. However, the sexual health workshop was more effective than the cultural competence workshop in reducing verbal avoidance behaviours and in promoting awareness of the value of effective communication about sex. Our Findings highlight the value of conducting brief reflective workshops that focus on comfort in communication to supplement other aspects of the medical school curriculum. [ABSTRACT FROM AUTHOR]

The article focuses on the intersection between South Asia's post-colonial landscape and its geography and time. It explores the impact of historical value on the understanding of South Asia's sexual history, which has remained literal, and calls for theoretical indirection in queer/area studies to move past the crude literalism of a queer identity that demands recognition.

Introduction: Doctors experience barriers in consultations that compromise engaging with patients on sensitive topics and impede history taking for sexual dysfunction. Aim: The aim of the study was to identify barriers to and facilitators of sexual history taking that primary care doctors experience during consultations involving patients with chronic illnesses. Methods: This qualitative study formed part of a grounded theory study and represents individual interviews with 20 primary care doctors working in the rural North West Province, South Africa. The doctors were interviewed on the barriers and facilitators of sexual history taking they experienced during 151 recorded consultations with patients at risk of sexual dysfunction. Interviews were transcribed and line-by-line verbatim coding was done. A thematic analysis was performed using MaxQDA 2018 software for qualitative research. The study complied with COREQ requirements. Outcome: Doctors’ reflections on sexual history taking. Results: Three themes identifying barriers to sexual history taking emerged, namely personal and health system limitations, presuppositions and assumptions, and socio-cultural barriers. The fourth theme that emerged was the patient-doctor relationship as a facilitator of sexual history taking. Doctors experienced personal limitations such as a lack of training and not thinking about taking a history for sexual dysfunction. Consultations were compromised by too many competing priorities and socio-cultural differences between doctors and patients. The doctors believed that the patients had to take the responsibility to initiate the discussion on sexual challenges. Competencies mentioned that could improve the patient-doctor relationship to promote sexual history taking, include rapport building and cultural sensitivity. Clinical implications: Doctors do not provide holistic patient care at primary health care settings if they do not screen for sexual dysfunction. Strength and limitations: The strength in this study is that recall bias was limited as interviews took place in a real-world setting, which was the context of clinical care. As this is a qualitative study, results will apply to primary care in rural settings in South Africa. Conclusion: Doctors need a socio-cognitive paradigm shift in terms of knowledge and awareness of sexual dysfunction in patients with chronic illness.Pretorius D, Mlambo MG, Couper ID. “We Are Not Truly Friendly Faces”: Primary Health Care Doctors’ Reflections on Sexual History Taking in North West Province. Sex Med 2022;10:100565.

Background: Sexual history is rarely taken in routine consultations and research reported on common barriers that doctors experience, such as gender, age and cultural differences. This article focuses on how patients and doctors view sexual history taking during a consultation and their perspectives on barriers to and facilitators of sexual history taking. Aim: This study aimed to explore doctors’ and patients’ perspectives on sexual history taking during routine primary care consultations with patients at risk of sexual dysfunction. Setting: The research was conducted in primary care facilities in the Dr Kenneth Kaunda Health District, North West province. Methods: This was part of grounded theory research, involving 151 adult patients living with hypertension and diabetes and 21 doctors they consulted. Following recording of routine consultations, open-ended questions on the demographic questionnaire and brief interactions with patients and doctors were documented and analysed using open inductive coding. The code matrix and relations browsers in MaxQDA software were used. Results: There was a disconnect between patients and doctors regarding their expectations on initiating the discussion on sexual challenges and relational and clinical priorities in the consultation. Patients wanted a doctor who listens. Doctors wanted patients to tell them about sexual dysfunction. Other minor barriers included gender, age and cultural differences and time constraints. Conclusion: A disconnect between patients and doctors caused by the doctors’ perceived clinical priorities and screening expectations inhibited sexual history taking in a routine consultation in primary care.

Background: Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction. Aim: This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations. Setting: The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas. Methods: One-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data. Results: Twenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time. Conclusion: Consultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care.

ABSTRACT: Background: Sexual history taking for risk behavior contributes to improving health outcomes in primary care. Giving the high numbers of people living with AIDS, every patient in South Africa should be offered an HIV test, which implies that a comprehensive sexual history must be taken. Aim: To describe the optimal consultation process, as well as associated factors and skills required to improve disclosure of sexual health issues during a clinical encounter with a doctor in primary health care settings in North West province, South Africa. Methods: This qualitative study, based on grounded theory, involved the video-recording of 151 consultations of adult patients living primarily with hypertension and diabetes. This article reports on the 5 consultations where some form of sexual history taking was observed. Patient consultations were analyzed thematically, which entailed open coding, followed by focused and verbatim coding using MaxQDA 2018 software. Confirmability was ensured by 2 generalist doctors, a public health specialist and the study supervisors. Main Outcome Measure: Sexual history was not taken and patients living with sexual dysfunction were missed. If patients understand how disease and medication contribute to their sexual wellbeing, this may change their perceptions of the illness and adherence patterns. Results: Sexual history was taken in 5 (3%) out of 151 consultations. Three themes emerged from these 5 consultations. In the patient-doctor relationship theme, patients experienced paternalism and a lack of warmth and respect. The consultation context theme included the seating arrangements, ineffective use of time, and privacy challenges due to interruptions and translators. Theme 3, consultation content, dealt with poor coverage of the components of the sexual health history. Conclusion: Overall, sexual dysfunction in patients was totally overlooked and risk for HIV was not explored, which had a negative effect on patients’ quality of life and long-term health outcomes. The study provided detailed information on the complexity of sexual history taking during a routine consultation and is relevant to primary health care in a rural setting. Pretorius D, Couper I, Mlambo M. Sexual History Taking: Perspectives on Doctor-Patient Interactions During Routine Consultations in Rural Primary Care in South Africa. Sex Med 2021;9:100389.

The article focuses on the importance of laboratory and point-of-care testing for sexually transmitted infections (STIs) as part of a comprehensive testing strategy, emphasizing the need for sensitive diagnostics and targeted therapy. Topics include prevention strategies, diagnostic recommendations based on sexual history, and the use of nucleic acid amplification techniques (NAT) for syndromic testing, alongside an overview of available test kits.

Aim: Cancellation of university classes during the coronavirus disease 2019 pandemic challenges teaching inperson sexual history–taking skills to medical, physician assistant, and nursing students. We used commercial online electronic services for medical students to learn sexual history–taking skills. Methods: A total of 174 medical students viewed a lecture on sexual history taking and the PLISSIT model (Permission, Limited Information, Specific Suggestion, Intensive Therapy) and were then randomized into dyads. They arranged a time to meet online on Zoom with their partner, chose a simple sexual history case-history (male or female) from a small selection, and recorded the 5- to 6-minute sexual history within a 1-week time frame. Each student played a “provider” or “patient” and then switched roles with a new case. One of the course tutors, all sexual health practitioners, downloaded 10 videos randomly assigned to them asynchronously and viewed and commented on the interaction of each “provider” along with comments on what to improve in the sexual history. 2 weeks later after the remainder of the lectures in the course, a second, more complex set of 8 cases were provided, so students could move at their comfort pace and choose 1. Main Outcome Measure: Students were required to make 1 online post and 1 comment on another student's post for each case, on the experience, and associated issues arising, positive or negative. All comments were downloaded and analyzed by theme. Results: Major themes included developing comfort in using sexual language, using simpler sexual terms suitable for patients, feeling confidence and mastery, excitement using technology developing clinical skills, surprise watching their performances and body language, observation of how they appeared to the “patient,” organizing sexual histories and incorporating PLISSIT model, ability to ask about context and relationships, and seeing the exercise as building on existing clinical skills training. Some expressed anxiety and nervousness, which by the second case had largely or completely dissipated. Conclusion: A readily replicable, secure, cheap cloud-based model to integrate sexual history training asynchronously was provided, with tutors’ comments, and student skills development, and performance evaluated.Ross MW, Newstrom N, Coleman E. Teaching Sexual History Taking in Health Care Using Online Technology: A PLISSIT-Plus Zoom Approach During the Coronavirus Disease 2019 Shutdown. Sex Med 2021;9:100290

Background: A good quality sex life and interest in sex are positively associated with health in middle-aged and later life. For effective diagnosis of sexual health problems, an appropriate discussion about sexual health issues including a sexual history is advised. The sexual health care delivery and management during consultations by primary care physicians is relatively unexplored, especially for older patients. This paper aims to explore primary health care physicians' (PCPs) attitudes to sexual health care and management of middle-aged and older patients in Trinidad and Tobago. Methods: In-depth, semi-structured interviews were conducted with 35 PCPs in Trinidad and Tobago. Topics examined included physician-patient relations, sexual health care management challenges, communication and sexual history taking practices, and training needs of PCPs. The framework analysis method was adopted for analysis. Results: Most doctors stated that they were not comfortable with conducting a sexual history with their older patients, and they rarely discussed or initiated talking about sexual health with them. Barriers included time constraints, inappropriate environmental conditions for privacy, inadequate professional referral services, insufficient medical training in sexual function in middle and old age, reluctant patient behavior, conflicting personal beliefs on sexuality, and socio-cultural factors. Conclusion: PCPs may be reluctant to raise sexual health-related issues with their older patients, and these older patients may not initiate this discussion because of discomfort and embarrassment. Consequently, physicians' inability to effectively communicate with these patients could result in missed opportunities for interventions and patients' concerns may remain unheard and their sexual problems untreated.

Background: Our understanding of healthcare professionals' competence level in both their sexual history taking practices and their attitudes in addressing sexual health concerns of patients in middle and old age is lacking. This research aimed to assess primary care physicians' (PCPs) knowledge, attitudes, and sexual healthcare practices toward patients who are ≥45 years in Trinidad and Tobago. Materials and Methods: A self-reported survey instrument assessing clinical sexual health knowledge, attitudes, and practices was administered nationwide to all registered PCPs (n = 155) in the public healthcare service. Descriptive and inferential statistical analyses were conducted using STATA. Results: PCPs, who were foreign medical graduates, middle-aged, male, and worked in urban centers, had improved odds of discussing sexual health with middle-aged and older patients. PCPs with any training in sexual health communication or sexual history taking were three times more likely to initiate a sexual health discussion or take a sexual history. Over 90% of physicians reported taking a sexual history only if the discussion was patient initiated and over 50% of PCPs indicated they will not ask these older patients about their sexual orientation, sexual partners, sexual abuse, or violence. Conclusions: Even though PCPs reported having a positive willing attitude toward offering sexual health care to these patients, they had a low level of knowledge of sexual function in later life and inconsistent sexual history taking practices. There is a great need for training physicians' on sexual health communication and history taking and on sexual function in older adults.

Women's multiorgasmic capacity has long been mentioned in the human sexuality literature. However, due in part to the conceptual vagueness surrounding this phenomenon, few empirical studies have focused on this topic, and our scientific knowledge is currently limited. This exploratory research is mainly aimed at providing a much-needed assessment of the profiles of women reporting multiorgasmic experiences. For this study, 419 sexually diverse women ages 18 through 69 who identified as multiorgasmic completed an online survey assessing variables pertaining to sociodemographic background, context and characteristics of a recent/typical multiorgasmic experience, relationships between multiple orgasm and sexual/nonsexual aspects of life, and sexual and orgasmic history. Data reduction analyses using principal component analysis pointed out that 15 variables of interest were distributed across six components, accounting for a large proportion of the sample's variance. A k-means cluster analysis further revealed that four distinct groups of women could be parsed out. These four groups could be differentiated by three sets of variables—sexual motivation, sexual history, and multiple orgasm characteristics—suggesting that female multiple orgasm is not a unitary phenomenon. This research provides to date the most comprehensive picture of female multiple orgasm and helps refine our conceptual understanding. [ABSTRACT FROM AUTHOR]

The past several decades have witnessed a shift toward victim interests being considered and incorporated within adversarial systems of justice. More recently, some jurisdictions have somewhat contentiously considered granting sex offences complainants' legal representation at trial. In Australia, the Royal Commission into Institutional Responses to Child Abuse (2017), the Royal Commission into Family Violence (2016) and the Victorian Law Reform Commission (2016) considered the potential role of legal counsel for complainants in the criminal trial process. While contrasting quite significantly with the traditional adversarial framework—which sees crime as contested between state and accused—legal representation for complainants is not unprecedented, and victims may already retain counsel for limited matters. Despite broader use of victim legal representation in the United States, Ireland and Scotland, and as recently considered by the Sir John Gillen Review in Northern Ireland, legal representation for sex offences complainants is only just developing in Australia. Notwithstanding recent reference to legal representation for complainants where sexual history or reputational evidence may be adduced, there exists no sufficient guidance as to how such representation may be integrated in the Australian criminal trial context. This article explores the implications of introducing such counsel in Australia, including the possible role of non-legal victim advocates. [ABSTRACT FROM AUTHOR]

Condom effectiveness can be reduced by a number of problems and errors that take place during use. The purpose of the present study was to translate and adapt the Condom Use Errors and Problems Survey (CUES) into Spanish and to use it for testing the prevalence of these issues in a sample of young Colombian adults. A total of 775 people (414 women and 361 men) between 18 and 26 years of age participated in the study. Participants completed the following questionnaires online: Condom Use Errors and Problems Survey, Sexual Opinion Survey, Sexual Assertiveness Scale, Multidimensional Condom Attitudes Scale, a sociodemographic and sexual history questionnaire, plus two questions concerning condom-associated erectile problems. Results showed significant differences in the prevalence of condom use errors/problems associated with gender, sexual orientation, and whether the participant had a stable sexual partner. The occurrence of problems/errors ranged from 9.4% to 69.5%. Except for certain specific practices, observations were similar to those of studies performed in North America. Results indicate that the present linguistic adaptation of the CUES for its use in Colombian Spanish-speaking populations is an effective instrument to assess problems and errors associated with the use of male condoms. [ABSTRACT FROM AUTHOR]

Scholars of sexuality have known for many years that sexual identity claims do not map neatly on to sexual histories. However, many studies continue to use currently claimed sexual identities as the basis for data collection and analysis, which can erase this complexity, particularly in relation to bisexuality. This article identifies four methodological techniques that help to operationalise theoretical sensitivity around the complex relationship between identities and histories. It does so by bringing together life course perspectives and two mixed methods datasets from older people with bisexual histories. Combining life course perspectives with these unusual datasets makes evident the particular way in which moment-in-time perspectives oversimplify sexuality and privilege monosexual identities. A life course approach thus helps to explain a long-standing puzzle in the study of sexuality: the relative under-claiming of bisexual identities compared to the prevalence of bisexual behaviours. Furthermore, it offers methodological tools that facilitate richer theorisations of sexuality more widely. [ABSTRACT FROM AUTHOR]

Background: Proactive recommendations for human papillomavirus (HPV) vaccines in Japan have been suspended for 5 years because of safety concerns. While no scientific evidence exists to substantiate these concerns, one reason given for not reinstating recommendations is the lack of reliable vaccine effectiveness (VE) data in a Japanese population. This study reports the VE of the bivalent HPV vaccine in Japanese women aged 20-22 years.Methods: During cervical screening between 2014 and 2016, women had Papanicolaou smears and HPV tests performed and provided data about their sexual history. Estimates of VE for vaccine-targeted HPV type 16 (HPV16) and 18 and cross-protection against other types were calculated.Results: Overall, 2197 women were tested, and 1814 were included in the analysis. Of these, 1355 (74.6%) were vaccinated, and 1295 (95.5%) completed the 3-dose schedule. In women sexually naive at vaccination, the pooled VEs against HPV16 and 18 and for HPV31, 45, and 52 were 95.5% (P < .01) and 71.9% (P < .01), respectively. When adjusted for number of sex partners and birth year, pooled VEs were 93.9% (P = .01) and 67.7% (P = .01) for HPV16 and 18 and HPV31, 45, and 52, respectively.Conclusions: The bivalent HPV vaccine is highly effective against HPV16 and 18. Furthermore, significant cross-protection against HPV31, 45, and 52 was demonstrated and sustained up to 6 years after vaccination. These findings should reassure politicians about the VE of bivalent HPV vaccine in a Japanese population. [ABSTRACT FROM AUTHOR]

Purpose: Following radiation therapy (RT), women with gynecologic malignancies report high rates of sexual dysfunction, but little is known regarding sexual health communication between these patients and health-care providers. This study assessed these patients' beliefs/attitudes toward providers' sexual history taking.Methods: Surveys were administered to women who presented for follow-up care for gynecologic cancers in an academic radiation oncology department. The surveys assessed patient sexual health beliefs and inquiry preferences. Sexual functioning was assessed using the Female Sexual Function Index (FSFI). Ordered logistic regressions were performed to assess for correlations between survey responses, FSFI, and demographic characteristics.Results: Seventy-five subjects participated. Most (89.8%) had FSFI scores indicating sexual dysfunction. Most patients agreed that sexual function is an important component of overall health (78.7%) and that providers should inquire regularly (62.8%). Few (12.0%) reported embarrassment around provider discussions. Most (62.7%) preferred discussion with female providers, especially married patients (p = 0.03). Half (53.4%) agreed that sexual problems are an unavoidable part of aging, a view that was more common as education level decreased (p = 0.01). Most (62.7%) patients agreed that providers should regularly ask about their sexual history, with patients having significant differences in education level. Patients with low FSFI scores were less likely to report inquiry from their OB/Gyn (p = 0.03).Conclusions: Gynecologic cancer radiotherapy patients want to discuss sexual health, but report suboptimal provider inquiry. Patient views and experiences varied based on marital status, education level, and FSFI score. This work highlights the need for improved sexual health communication between cancer patients and providers. [ABSTRACT FROM AUTHOR]

Background: A good quality sex life and interest in sex are positively associated with health in middle-aged and later life. For effective diagnosis of sexual health problems, an appropriate discussion about sexual health issues including a sexual history is advised. The sexual health care delivery and management during consultations by primary care physicians is relatively unexplored, especially for older patients. This paper aims to explore primary health care physicians' (PCPs) attitudes to sexual health care and management of middle-aged and older patients in Trinidad and Tobago. Methods: In-depth, semi-structured interviews were conducted with 35 PCPs in Trinidad and Tobago. Topics examined included physician-patient relations, sexual health care management challenges, communication and sexual history taking practices, and training needs of PCPs. The framework analysis method was adopted for analysis. Results: Most doctors stated that they were not comfortable with conducting a sexual history with their older patients, and they rarely discussed or initiated talking about sexual health with them. Barriers included time constraints, inappropriate environmental conditions for privacy, inadequate professional referral services, insufficient medical training in sexual function in middle and old age, reluctant patient behavior, conflicting personal beliefs on sexuality, and socio-cultural factors. Conclusion: PCPs may be reluctant to raise sexual health-related issues with their older patients, and these older patients may not initiate this discussion because of discomfort and embarrassment. Consequently, physicians' inability to effectively communicate with these patients could result in missed opportunities for interventions and patients' concerns may remain unheard and their sexual problems untreated. [ABSTRACT FROM AUTHOR]

Background: Our understanding of healthcare professionals' competence level in both their sexual history taking practices and their attitudes in addressing sexual health concerns of patients in middle and old age is lacking. This research aimed to assess primary care physicians' (PCPs) knowledge, attitudes, and sexual healthcare practices toward patients who are ≥45 years in Trinidad and Tobago. Materials and Methods: A self-reported survey instrument assessing clinical sexual health knowledge, attitudes, and practices was administered nationwide to all registered PCPs (n = 155) in the public healthcare service. Descriptive and inferential statistical analyses were conducted using STATA. Results: PCPs, who were foreign medical graduates, middle-aged, male, and worked in urban centers, had improved odds of discussing sexual health with middle-aged and older patients. PCPs with any training in sexual health communication or sexual history taking were three times more likely to initiate a sexual health discussion or take a sexual history. Over 90% of physicians reported taking a sexual history only if the discussion was patient initiated and over 50% of PCPs indicated they will not ask these older patients about their sexual orientation, sexual partners, sexual abuse, or violence. Conclusions: Even though PCPs reported having a positive willing attitude toward offering sexual health care to these patients, they had a low level of knowledge of sexual function in later life and inconsistent sexual history taking practices. There is a great need for training physicians' on sexual health communication and history taking and on sexual function in older adults. [ABSTRACT FROM AUTHOR]

In this article, the author highlights German psychiatrist Albert Moll's understanding and changing judgment of homosexuality vacillated between three explanatory frameworks like gender inversion, sexual object choice, and age disparity. It mentions Moll's eventual marginalization in sexology and sexual history.

This article challenges the currently accepted wisdom that ‘previous sexual history evidence is never relevant’. It sketches and defends a conception of ‘relevance’, and uses that conception to analyse the plurality of issues to which previous sexual history evidence may theoretically be relevant. It highlights that evidence of the complainant’s prior sexual relationship with the accused (‘relationship evidence’) does not necessarily rely on legally forbidden propensity reasoning to support relevance. The article then examines the current legal framework in England and Wales and argues that the ‘ECHR gloss’, applied in R v A(2), should never have been required, and has been used in situations, such as R v Evans, where it was likely never intended to. In the current drive to reform s. 41, it is submitted that any such reforms must acknowledge the differences between relationship evidence and other sexual history evidence. [ABSTRACT FROM AUTHOR]

Purpose: To explore the acceptability of advance provision of emergency contraceptive pills (ECPs) to young men seeking health care.Methods: For this exploratory study in a clinic setting, we approached young men aged 16-35 to participate in a survey eliciting socio-demographics, sexual and contraceptive history, and knowledge about ECPs. We offered young men advance provision of ECPs and compared characteristics of 126 young men who did and did not accept the ECPs.Results: Most (76%) of the participants accepted advance provision and left with an ECP pack, with even higher proportions among males whose sexual histories were suggestive of increased risk of involvement in an unintended pregnancy.Conclusions: This study holds promise to inform scale up of advance provision of ECPs among young men. [ABSTRACT FROM AUTHOR]

Objective: We developed a curriculum to increase internal medicine interns' proficiency in sexual history taking and sexually transmitted illness (STI) counseling.Methods: The 4-h curriculum included didactics and interactive components, and was evaluated with matched pre- and post-surveys.Results: Twenty-one interns completed the curriculum. Mean knowledge score improved from 59% to 76% from pre- to post-curriculum (P = 0.004). Median comfort score (Likert scale 1-5) with obtaining a sexual history improved from 3.8 [IQR 3.0, 4.0] to 3.8 [IQR 3.6, 4.6] and 3.8 [IQR 3.6, 4.0] to 4.1 [IQR 3.9, 4.8] for male (P = 0.05) and female patients (P = 0.007), respectively. Median frequency score for obtaining a sexual history improved from 2.9 [IQR 2.7, 3.0] to 3.1 [IQR 2.8, 3.4] and 3.2 [IQR 2.8, 3.7] to 3.4 [IQR 3.2, 4.0] for male (P = 0.16) and female patients (P = 0.008), respectively. Pre- and post- curriculum, interns reported significantly higher comfort and frequency in obtaining sexual histories from female vs. male patients. Post- curriculum, interns reported significantly higher comfort with positive STI counseling.Practice Implications: Our curriculum improved interns' knowledge and comfort in sexual history taking and STI counseling. Future interventions should address sex disparities in sexual history taking. [ABSTRACT FROM AUTHOR]

Context: In India, psychiatrist is an important point of helpseeking for sexual complaints. A detailed sexual history can go a long way in understanding sexual difficulties. In this background, there is inadequate information on the difficulties that psychiatry postgraduate trainees experience while taking a sexual history as part of a routine mental health evaluation. Aims: The aim was to study the difficulties experienced by postgraduate psychiatry trainees while taking sexual history as a part of routine mental health evaluation. Setting: This study was conducted in an Indian medical college general hospital psychiatry setting. Materials and Methods: This is a qualitative study using focus group discussions and in-depth interviews with postgraduate psychiatry trainees. Statistical Analysis: Content analysis was used to identify direct and latent themes. Results: Thematic saturation was achieved with 17 participants. Major themes of difficulties that emerged included trainee-related factors such as gender and sociocultural background of the trainee; patient-related factors such as age, gender, and sexual orientation; setting-related factors; and language-related difficulties. Conclusions: Specific and regular training in taking a sexual history is essential in addressing the difficulties faced by postgraduate psychiatry trainees in India. [ABSTRACT FROM AUTHOR]

This article examines how behaviorally bisexual Latino men negotiate, modify, and perform their gender within distinct social spheres. An analysis was made of 148 sexual histories of Latino men aged eighteen to sixty, from a cross-sectional, multiyear study in New York City. A familial sphere of gender norm negotiation was sharply contrasted with conformity to elements of dominant or hegemonic forms of masculinity performed on streets of neighborhoods of residence. Rather than a strict dichotomy, our participants revealed a spectrum of masculine representations that worked to manage the risk of nonheterosexual stigma. Participants adopted variable configurations of masculinity to reconcile the plurality of their sexual practices, distinct social spaces, and socially sanctioned gender norms. [ABSTRACT FROM AUTHOR]

Introduction This standardized-patient-based module prepares medical students to take inclusive, comprehensive sexual histories from patients of all sexual orientations and gender identities. Health disparities faced by lesbian, gay, bisexual, transgender, and queer (LGBTQ) people are at least partially the result of inadequate access to health care and insufficient provider training. This module incorporates implicit bias activities to emphasize the important role providers can play in mitigating these disparities through compassionate, competent care. Furthermore, two of the three included cases highlight the negative impact sexual dysfunction can have on emotional well-being. Methods Over 3 hours, students participate in a 30-minute large-group lecture and three 40-minute small-group standardized patient encounters with debrief. Prework consists of a short video on sexual history taking, assigned readings, and an implicit bias activity. These materials are included in this resource, along with lecture slides, facilitator guide, and standardized patient cases. Though the cases are adaptable to all levels of medical education, this module is designed for second-year and early third-year medical students. Results Qualitative student evaluations were positive, and postparticipation surveys revealed statistically significant improvement in comfort with their ability to take a sexual history in general, and take one from patients with a differing sexual orientation. Deployed in the second year of our Doctoring curriculum, this module continues to receive positive evaluations. Discussion Introducing these skills begins to address the curricular deficiencies seen across medical education and lays the foundation for a more competent health care workforce to address the needs of LGBTQ patients.

Identifying patients at-risk for HIV infection, such as men who have sex with men (MSM), is an important step in providing HIV testing and prevention interventions. It is unknown how primary care providers (PCPs) assess MSM status and related HIV-risk factors. We analyzed data from a panel-derived web-based survey for healthcare providers conducted in 2014 to describe how PCPs in the U.S. determined their patients' MSM status. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to describe PCP characteristics associated with systematically determining MSM status (i.e., PCP used "a patient-completed questionnaire" or "routine verbal review of sex history"). Among the 1008 PCPs, 56% determined MSM status by routine verbal review of sexual history; 41% by patient disclosure; 39% by questions driven by symptoms/history; 23% by using a patient-completed questionnaire, and 9% didn't determine MSM status. PCPs who systematically determined MSM status (n=665; 66%) were more likely to be female (aPR=1.16, CI=1.06-1.26), to be affiliated with a teaching hospital (aPR=1.15, CI=1.06-1.25), to routinely screen all patients aged 13-64 for HIV (aPR=1.29, CI=1.18-1.41), and to estimate that 6% or more of their male patients are MSM (aPR=1.14, CI=1.01-1.30). The majority of PCPs assessed MSM status and HIV risk factors through routine verbal reviews of sexual history. Implementing a systematic approach to identify MSM status and assess risk may allow PCPs to identify more patients needing frequent HIV testing and other preventive services, while mitigating socio-cultural barriers to obtaining such information. [ABSTRACT FROM AUTHOR]

Background: Although obtaining sexual history from patients is essential, the attitudes of physicians can become a barrier to sexual health care. Iranian-American physicians may face particular challenges because talking about sexuality is considered a taboo within their culture. Our study examined these physicians' attitudes when taking a sexual history from their patients.Methods: In 2013, a self-administrated questionnaire was sent to 1550 Iranian-American physicians in California, USA. Using factor analysis, the principal components approach with a Varimax rotation was used on a set of 12-item questions (five-point Likert scales) to detect latent factors that explain attitudes affecting sexual history taking. Scores are generated to determine physicians' attitudes towards sexual history taking.Results: In total, 354 questionnaires were returned (23% response rate). Three factors were identified as internally consistent (Cronbach's α=0.84 - 0.94): (1) attitude towards various patients; (2) female sexuality; and (3) age and marriage. Significant association were found between these three factors and some variables such as physicians' gender, country of medical graduation, religion, birthplace and age.Conclusions: Results revealed that cultural attitudes are important factors affecting physicians' involvement in sexual history taking. Additional studies from this population and other subpopulations of US physicians are needed. New strategies that reflect on physicians' attitude on sexual healthcare delivery is needed. If confirmed in other studies, our findings could have implications for the training of medical graduates globally. [ABSTRACT FROM AUTHOR]

Pityriasis rosea (PR) is an acute self-limited exanthem characterized by oval erythematous patches with scale and may be difficult to differentiate from secondary syphilis. A rapid plasma reagin (RPR) test can be used to rule in secondary syphilis with high sensitivity and specificity. A retrospective study was performed on patients at Weill Cornell Medicine, who were diagnosed with PR from 2000 to 2016 and also received RPR testing at the time of diagnosis. The objective was to assess the frequency of secondary syphilis when the initial clinical impression was PR. Only 2/142 patients (1.4%) had a reactive RPR test. Based on our results, we advocate that careful social and sexual histories be taken in all patients presenting with atypical PR and syphilis screening performed if risk factors are present. [ABSTRACT FROM AUTHOR]

Background. Despite the improvement in patient-physician communication techniques, sexuality and sexual health continue to be challenging areas for discussion during a clinical encounter. Most people are not prepared to discuss sexual matters openly as it can be perceived as negative or inappropriate. Consequently, an incomplete health assessment can result in delayed diagnosis or misdiagnosis. Case Report. We present a 33-year-old woman who developed recurrent left breast abscesses. She required multiple incision and drainage procedures in the operating room followed by antimicrobial therapy. Although she always had an initial improvement with this approach, she continued to have recurrences and development of new abscesses in other body areas. The polymicrobial nature of her recurrences prompted an extensive and costly workup to determine the nature of her condition. The cause was finally elucidated when a thorough sexual history was obtained. Poor hygiene practices during her sexual encounters were considered the cause of her recurrent abscesses. After medical therapy and modification of her sexual practices, she has not developed new recurrences for more than two years. Conclusion. Discussions on sexuality and sexual health are important parts of any clinical encounter, yet frequently forgotten or avoided. Becoming aware of their importance would avoid delayed diagnosis or misdiagnosis. [ABSTRACT FROM AUTHOR]

Abstract Introduction This student-driven curriculum intervention, implemented with first-year medical students, was guided by the Association of American Medical Colleges’ standards for medical education on health care for sexual and gender minorities. Its goals are to describe the spectrum of sexual orientation and gender identity and sensitively and effectively elicit relevant information from patients about their sexual orientation and gender identity through inclusive sexual history taking. Methods Developed through student-faculty collaboration, this three-part module includes a 14-minute e-lecture on taking an inclusive sexual history, a 35-minute formative standardized patient encounter in which students take a sexual history and receive feedback, and a 20-minute facilitated group debrief on the standardized patient activity. Results Students completed a postmodule evaluation anonymously; the majority of respondents (92%) agreed that they felt more prepared to take a sexual history inclusive of sexual and gender minority patients. Most were more comfortable discussing sexual orientation (91%) and gender identity (83%) with patients after the module. Content analysis revealed an improved confidence in creating a safe space for sexual and gender minority patients and an increased awareness of biases about sexual and gender minority patients. Discussion This curriculum serves as an early foundation for students to understand sexual and gender minority identities and develop confidence in their inclusive sexual history taking skills before they provide care for patients. In addition, the student-driven curriculum development process used can serve as a template for students at other institutions hoping to collaborate with faculty to develop comprehensive sexual and gender minority curricula.

Social science research on the relationship between space and sex work, specifically among women in street-based settings, demonstrates the spatialized nature of risk and how different forms of civic and legal governance contribute to their socio-economic marginalization. However, these studies rarely consider the women’s spatial practices and gendered subjectivities beyond the sex trade, which is problematic because sex work is not their singular life activity or the only impetus for their spatial movements through the urban landscape. Using social mapping and interview data from 33 women in sex work in London, Ontario, this article explores how our participants navigate the spaces where they work and live alongside those regarding health care, social services, violence and places they avoid. Findings reveal that the women traverse diverse spaces as they access health services, especially for crisis issues that necessitate travel to hospitals located beyond the inner city. The spaces used to access social services and those they avoid (i.e. to not be emotionally triggered or under police surveillance) overlap significantly, which presents unique challenges for our participants who depend upon these services for their socio-economic survival. The theoretical contributions these data make to the feminist geography literature on gender and space are discussed, particularly with respect to the issues of nomadic subjectivity and the relationality between city spaces and marginalized bodies. [ABSTRACT FROM AUTHOR]

Introduction A detailed sexual history is the cornerstone for all sexual problem assessments and sexual dysfunction diagnoses. Diagnostic evaluation is based on an in-depth sexual history, including sexual and gender identity and orientation, sexual activity and function, current level of sexual function, overall health and comorbidities, partner relationship and interpersonal factors, and the role of cultural and personal expectations and attitudes. Aim To propose key steps in the diagnostic evaluation of sexual dysfunctions, with special focus on the use of symptom scales and questionnaires. Methods Critical assessment of the current literature by the International Consultation on Sexual Medicine committee. Main Outcome Measures A revised algorithm for the management of sexual dysfunctions, level of evidence, and recommendation for scales and questionnaires. Results The International Consultation on Sexual Medicine proposes an updated algorithm for diagnostic evaluation of sexual dysfunction in men and women, with specific recommendations for sexual history taking and diagnostic evaluation. Standardized scales, checklists, and validated questionnaires are additional adjuncts that should be used routinely in sexual problem evaluation. Scales developed for specific patient groups are included. Results of this evaluation are presented with recommendations for clinical and research uses. Conclusion Defined principles, an algorithm and a range of scales may provide coherent and evidence based management for sexual dysfunctions. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Female sexual dysfunction is highly prevalent and it has a major effect on quality of life. However, responding to this healthcare need is challenging for physicians due to limited time, insecurities about how and what to ask, and lack of knowledge of therapy options. In Germany, additional barriers such as poor training during residency, lack of sexual therapists, and limited options for continuing education result in an under-diagnosis and under-treatment of female sexual dysfunction. This study aims to better understand the perspectives of German obstetricians and gynaecologists (OB/GYNs) in terms of diagnosing and treating patients with female sexual dysfunction.Methods: In November 2014 all Bavarian-based OB/GYNs working in outpatient care were sent a 23-item questionnaire by mail. A reminder was sent 4 weeks later. A non-response survey was also performed.Results: Out of 1291 distributed questionnaires, 235 were completed and returned (18%). The greatest challenges to OB/GYNs caring for women with sexual dysfunction were: (1) long waiting times for referrals; (2) too little time with patients; and (3) insufficient training during residency. Only one out of five OB/GYNs brought up the topic of sexual function routinely; initiating a conversation about sexual function was significantly associated with perceived communication skills (P=0.001) and perceived medical competence (P=0.008).Conclusions: There are several barriers to diagnosing and treating female sexual dysfunction in a German outpatient setting. Further surveys of patients, psychologists, therapists and health insurance providers are needed to provide more perspectives on this particular health issue. [ABSTRACT FROM AUTHOR]

The article discusses guidelines for contraception for adolescents. Topics covered include the need for paediatricians to provide access to comprehensive sexual health information to all adolescents, the role of counselling in discussing the importance of dual contraception to protect adolescents from sexually transmitted infections (STIs), and the need for paediatricians to practice taking a sexual history. Also mentioned is the revised guidance from the American Academy of Pediatrics (AAP).

The article presents the findings of a survey of patients to know their quantitative opinions about their clinical scribes in primary care. Topics discussed include iterative development of questionnaire which includes gender wise sexual history, relation between patients and physicians, and chart on patient comfort.

Florida has some of the highest reported sexually transmitted disease (STD) rates in the country. STDs are a particular problem for minorities, women, and adolescents. Sexual history elicitation is a tool available to clinicians to assess patients' sexual risk behaviors and to counsel, test, and treat STDs. Nurses play an important role in caring for patients' sexual health problems, including unwanted pregnancies and STDs. We examined the sexual history-taking practices among advanced registered nurse practitioners (ARNPs) in Florida. We mailed an anonymous pencil-andpaper survey to measure sexual history-taking practices to a stratified random sample of 795 ARNPs. We analyzed the data with SPSS. Overall, 185 ARNPs completed the survey (23% response rate). We found that sexual history-taking practices varied. Approximately 71% of Florida ARNPs reported taking sexual histories. Targeted interventions are needed to increase sexual history-taking practices. [ABSTRACT FROM AUTHOR]

An estimated one million sexually transmitted diseases (STDs) are reported annually in the United States. Florida has some of the highest HIV and STD rates in the country. STDs are a particular problem for minorities, women, and adolescents. Sexual history elicitation is a tool available to clinicians to assess patients' sexual risk behaviors and to counsel, test, and treat STDs. Previous barriers to sexual history elicitation include subject matter, patient-physician communications, provider training, and physician perceptions. This pilot study was designed to test a survey questionnaire that measures primary care provider (PCP) sexual elicitation practices. PCPs included obstetricians and gynecologists, family practitioners, internal medicine physicians, pediatricians, nurse practitioners, and physician assistants in Leon County Florida. Between January 2010 and March 2010 a convenience sample of 50 PCPs in Florida were administered a pencil-and-paper survey. The survey instrument was constructed and tested to measure PCP sexual elicitation practices. The survey instrument was found to be an internally consistent and reliable assessment tool for sexual history elicitation. These preliminary pilot study findings warrant a larger study. [ABSTRACT FROM AUTHOR]

Introduction Women with lichen sclerosus ( LS) may experience (superficial) dyspareunia or the inability to have vaginal intercourse due to painful fissures and narrowing of the vaginal introitus. A surgical procedure may contribute to the relief of these sexual pain problems. It is unknown what motives women have to undergo surgery in order to regain the ability to have sexual intercourse. Such knowledge can offer important insights that are indispensable when discussing the option of vulvar surgery with patients with LS and might prevent potential patient dissatisfaction. This study's purpose is to examine why women with LS decide to undergo vulvar surgery in order to restore intercourse. Methods Nineteen women with anogenital LS participated in audiotaped qualitative individual interviews, in which their motives for undergoing vulvar surgery to restore intercourse were explored retrospectively. Interview data were analyzed using the constant comparative method. Results Three main motives for wanting to undergo surgery in order to restore intercourse were found. These were the desire to be a 'normal' woman, the desire to sexually satisfy the male partner, and the desire to regain the experience of intimacy and sexual enjoyment. Another reason for surgery was to reduce daily life LS symptoms. The sexual pain complaints prevented the women from living up to their norms about heterosexuality and gender roles. Being unable to have intercourse led women to feel inadequate as a woman and as a sexual partner. Conclusions Women with LS may opt for surgery to restore their identity as a 'normal' woman and sexual partner, to regain the experience of coital intimacy, and to be less bothered by LS symptoms in daily life. The present findings point to the importance of a thorough couple-based sexual history in which women's motives for and expectations of vulvar surgery will be explored in order to facilitate a good decision and to increase treatment satisfaction. Brauer M, van Lunsen R, Burger M, and Laan E. Motives for vulvar surgery of women with lichen sclerosus. J Sex Med 2015;12:2462-2473. [ABSTRACT FROM AUTHOR]

Connell’s concept of hegemonic masculinities has been invaluable for prevention efforts that seek to promote a shift in hegemonic male norms driving the HIV epidemic. However, inadequate attention has been given to the internal processes of hegemony, which limits the comprehension of how to engage men in HIV prevention efforts. A narrative approach, which privileges the diversity in men’s lived experiences, could address such concerns. Fifty sexual history interviews were conducted with men sampled from three age categories: (eighteen to twenty-four, twenty-five to fifty-four and fifty-five plus), a range of cultural and racial backgrounds, and in urban and rural sites across five provinces in South Africa. For the purpose of this article, narrative analysis was conducted on three cases that provide a platform for understanding how men both conform to and resist gender norms that influence their sexual and reproductive health. Implications of the narratives for gender transformative HIV prevention efforts are discussed. [ABSTRACT FROM AUTHOR]