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Teens face health and safety risks exploring sex online

Online sexual experiences can predict whether they become victims of sexual assault one year later.

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Teens spend hours every day on internet-connected devices, where limitless opportunities to explore sexuality online. These opportunities don’t come without big risks, though. A researcher from Michigan State University found that online sexual experiences can predict whether they become victims of sexual assault one year later.

The findings, published in the Journal of Youth and Adolescence and funded by the National Institutes of Health, are part of a study that is the first of its kind to investigate online sexual experiences using a person-centered approach, which identifies specific patterns of behaviors in sub-groups of people rather than general observations across a large group. This approach allowed researchers to track the girls’ online experiences – and subsequent offline experiences – more intricately than prior studies.

“It makes sense that engaging in risky behavior online would translate to offline risks,” said Megan Maas, research author and MSU assistant professor of human development and family studies at MSU. “But we were able to identify specific online behavioral patterns that correlated with susceptibility to different offline outcomes – which was never captured from conventional approaches before.”

Maas and colleagues assessed data from 296 girls between 14- and 17-years-old, who self-reported their online and offline sexual experiences over five years. Additionally, the girls would visit a lab each year for a trauma interview to measure experiences such as sexual abuse, assault or violence that may go undetected in a survey.

“By assessing the teens’ online sexual experiences using the person-centered approach, we were able to group the teens into four classes of experience patterns, which predicted sexual health and victimization outcomes one year later,” Maas said.

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The four classes were:

  • Online inclusive: These teens have a high probability of having several online sexual experiences, including looking at internet porn, chatting with strangers about sex, sending nude photos and posing provocatively on social media. This class often has strangers posting sexy comments on their social media accounts, requesting nude photos and soliciting them for sex.
  • Seekers: These teens purposefully seek out internet porn, chat with others about sex and post sexy photos on social media, but purposefully do not have a sexy profile picture and do not receive a lot of online attention from others.
  • Attractors: This class of teens gets attention from others online, though they’re not explicitly looking for it. They had a sexy social media profile, had people requesting nude photos, received comments about how sexy they are and have strangers solicit them for offline sex.
  • Online abstinent: This group had little probability in having online sexual experiences.

The goal was to pinpoint online patterns of sexual experiences related to three offline outcomes one year later: HIV risk, sexual assault and intimate partner violence, Maas said.

They discovered that attractors were more likely to be sexually assaulted than the seekers; online inclusive were likely to be sexually assaulted or engage in risky sex, especially if they’d experienced prior sexual abuse or assault; whereas, the seekers were more likely to have a physically violent romantic partner, especially if they’d experienced prior sexual abuse or assault.

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Maas explained that her findings demonstrate how critical it is for teens to receive education to understand how online sexual experiences may shape their offline experiences. Specifically, she hopes that schools and families will educate youth on sexual health and consent as well as healthy relationships, as their online experiences could have serious consequences.

“Rather than trying to tackle the impossible – like eliminating teens’ exposure to porn or ability to sext – we can and should educate them about these realities and risks and offer alternatives for learning about and expressing sexuality,” Maas said.

Maas hopes that her findings will inspire parents to proactively talk to their kids about risks they face online, as well as to establish rules early in their lives that can prevent girls’ from putting too much emphasis on their sexy social media presence.

“The best strategy for parents to follow is to limit time and space for internet usage,” Maas said. “Establish a time limit they can be on a device, and don’t allow screens in bedrooms. There are apps for parents that can help control screen time – and plenty of ways to involve their kids in activities that don’t rely on the internet at all.”

Next, Maas plans to explore why these online experiences predict offline risk and victimization. For instance, if teen girls feel obligated to engage in unwanted sexual activity if they have already sent a nude photo, or if boys feel entitled to sex from girls with sexy social media profiles. She hopes this follow-up study will clarify these findings to provide more specific guidance for sexual health and internet safety programming without attributing blame to survivors.

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Health & Wellness

Study finds most young women unhappy, stressed about their sex lives

Half of young women experience sexually-related personal distress, with one in five women having at least one female sexual dysfunction (FSD), new research by Monash University shows.

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Half of young women experience sexually-related personal distress, with one in five women having at least one female sexual dysfunction (FSD), new research by Monash University shows.

A study conducted in Australia by the Women’s Health Research Program at Monash University has reported, for the first time, an overall picture of the sexual wellbeing of Australian women between the ages of 18 and 39. The findings have been published today (Monday 24 February 2020) in the international journal, Fertility and Sterility.

Results showed 50.2 per cent of young Australian women experienced some form of sexually-related personal distress. This relates to the degree of feeling guilty, embarrassed, stressed or unhappy about their sex lives.

A concerning 29.6 per cent of women experienced sexually-related personal distress without dysfunction, and 20.6 per cent had at least one FSD.

The most common FSD was low sexual self-image, which caused distress for 11 per cent of study participants. Arousal, desire, orgasm and responsiveness dysfunction affected 9 per cent, 8 per cent, 7.9 per cent and 3.4 per cent of the study cohort respectively.

Sexual self-image dysfunction was associated with being overweight, obese, living together with partner, not married, married and breastfeeding.

Taking psychotropic medication (such as antidepressants), reported by 20 per cent of surveyed women, had the most pervasive impact on sexual function. The use of the combined oral contraceptive pill was not associated with any sexual dysfunction.

“Sexual wellbeing is recognised as a fundamental human right. It is of great concern that one in five young women have an apparent sexual dysfunction and half of all women within this age group experience sexually-related personal distress,” senior author and Professor of Women’s Health at Monash University, Susan Davis, said.

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“This is a wake-up call to the community and signals the importance of health professionals being open and adequately prepared to discuss young women’s sexual health concerns.”

The Grollo-Ruzzene Foundation Younger Women’s Health Study, funded by Grollo Ruzzene Foundation, recruited 6986 women aged 18-39 years, living in Victoria, New South Wales and Queensland, to take part in the study.

All women completed a questionnaire that assessed their sexual wellbeing in terms of desire, arousal, responsiveness, orgasm, and self-image. Participants also evaluated whether they had sexually-associated personal distress and provided extensive demographic information.

Almost one-third of participants described themselves as single, 47 per cent had a body mass index within the normal range, and nearly 70 per cent had reported being sexually active in the 30 days preceding the study.

Women who habitually monitored their appearance, and for whom appearance determined their level of physical self-worth, reported being less sexually assertive and more self-conscious during intimacy, and experienced lower sexual satisfaction.

Professor Davis said if untreated, sexually-related personal distress and FSD could impact relationships and overall quality of life as women aged.

“The high prevalence of sexually-related personal distress signals the importance of health professionals, particularly those working in the fields of gynaecology and fertility, being adequately prepared to routinely ask young women about any sexual health concerns, and to have an appropriate management or referral pathway in place,” Professor Davis said.

The study, titled ‘The prevalence of sexual dysfunctions and sexually-related distress in young women: a cross-sectional survey’, was authored by: Ms Jia Zheng, Dr Marina Skiba, Professor Robin Bell, Dr Rakibul Islam and Professor Susan Davis from Monash University’s School of Public Health and Preventive Medicine.

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Health & Wellness

Half of trans youth avoid disclosing gender identity to a health care provider

The most common reasons cited for withholding gender identity were feeling uncomfortable and not knowing how to bring it up, with only 25% saying they preferred to be the ones to broach the topic.

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Researchers at UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh surveyed patients in a local clinic providing gender-affirming care to transgender youth and found that a surprisingly high number of them intentionally avoided disclosing their gender identity to doctors outside the clinic.

The paper was published in the Journal of Adolescent Health.

“The provider-patient power dynamic is a real one,” said lead author Gina Sequeira, M.D., M.S., adolescent medicine fellow at UPMC Children’s Hospital. “It’s important for us as providers to open the door and ask young people in a respectful and open way if they would like to talk about their identity.”

When providers know that a young patient is transgender, they’re in a better position to ensure access to services, from medical transition to mental health, Sequeira said.

During the summer and fall of 2018, she analyzed survey responses from 153 transgender youth ages 12-26 years old. Two-thirds identified as male, one-fifth as female and another fifth as nonbinary.

While 78% of the participants reported disclosing their gender identity to a health care provider outside the clinic at least once, 47% reported intentionally avoiding disclosure, even in situations where they thought it might be important for their health.

The most common reasons cited for withholding gender identity were feeling uncomfortable and not knowing how to bring it up, with only 25% saying they preferred to be the ones to broach the topic.

Instead, participants suggested multiple ways clinics can create spaces to help young patients feel more comfortable disclosing their gender identities, including transgender-friendly materials in the waiting room, forms that include a checkbox for gender identity and educating staff about using a patient’s preferred name and pronouns.

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It’s important to note that the gender clinic where participants were recruited requires parent or guardian consent for treatment of minors — a group that makes up half of the total study sample — meaning these youth are “out” at home and often have at least one supportive caregiver in their lives.

Given that sampling bias, Sequeira was surprised to see so many participants avoiding disclosure.

“I suspect if we looked in a non-clinical sample, that number would be much higher,” Sequeira said. “Our patients have already overcome many barriers.”

Sequeira is expanding the study to sample a larger, more general population of transgender youth through social media.

Additional authors on the study include Kristin Ray, M.D., M.S., of Pitt; Elizabeth Miller, M.D., Ph.D., of Pitt and UPMC Children’s Hospital; and Robert Coulter, Ph.D., M.P.H., of the Pitt Graduate School of Public Health.

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Health & Wellness

Young men unaware of risks of HPV infection and need for HPV vaccination

The US Food and Drug Administration has expanded the use of HPV vaccine to people between the ages of 27 to 45. Originally, it was prescribed for those between the ages of 9 to 26.

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Young sexual minority men – including those who are gay, bisexual, queer or straight-identified men who have sex with men – do not fully understand their risk for human papillomavirus (HPV) due to a lack of information from health care providers, according to Rutgers researchers.

A Rutgers study published in the Journal of Community Health, examined what young sexual minority men – a high-risk and high-need population – know about HPV and the HPV vaccine and how health care providers communicate information about the virus and vaccine.

In the US alone, about 79 million Americans are infected with HPV, with about 14 million becoming newly infected each year, according to the Centers for Disease Control and Prevention (CDC). As a sexually transmitted infection, HPV can lead to several types of cancer, including anal and penile cancer, and is particularly concerning for sexual minority men due to the high prevalence of HIV and smoking in this community and the low HPV vaccination rates overall among men.

“Particularly in light of the decades-long focus on gay men’s health care as HIV care, there is a missed opportunity for HPV prevention in the community,” said study co-author Caleb LoSchiavo, a doctoral student at the Rutgers School of Public Health.

The researchers, who are members of the Rutgers School of Public Heath’s Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), analyzed interviews with sexual minority men in their early 20s in New York City and determined they knew little about HPV infection — including transmission, signs, symptoms and cancer risk — and vaccination.

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They also found that the men did not prioritize HPV vaccination due to the incorrect perception that HPV is an issue that exclusively or primarily affected women.

“Everyone who is sexually active – regardless of gender, sexual orientation, partners’ genders, relationship or marital status – should talk to their doctor about receiving the HPV vaccine to prevent a future generation who may develop HPV-related cancers, such as cervical, oral and anal cancer, as we have seen emerging in Baby Boomers and Gen-Xer s,” said Perry N. Halkitis, Rutgers School of Public Health dean, CHIBPS director, and PI of the study.

The US Food and Drug Administration has expanded the use of HPV vaccine to people between the ages of 27 to 45. Originally, it was prescribed for those between the ages of 9 to 26.

In the study, researchers found that health care providers rarely discuss HPV and the HPV vaccine with patients who are young sexual minority men, and when they do, their communication is often inadequate in conveying potential risks of HPV and benefits of vaccination.

“Clinicians have a direct role in expanding the availability of LGBTQ-competent healthcare,” said lead author Jessica Jaiswal, an assistant professor at the University of Alabama, and CHIBPS affiliate. “By learning about sexual minority men’s diverse health needs and routinely offering the HPV vaccine, we can move toward a health promotion model and not only a disease prevention model.”

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Health & Wellness

Gay and bisexual men have higher rate of skin cancer

Rates of skin cancer were higher among gay and bisexual men compared to heterosexual men, but lower among bisexual women than heterosexual women.

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In the largest study of skin cancer rates among gay, lesbian or bisexual individuals, investigators from Brigham and Women’s Hospital report important differences in skin cancer prevalence among sexual minorities. Rates of skin cancer were higher among gay and bisexual men compared to heterosexual men, but lower among bisexual women than heterosexual women.

These findings, which were possible because of the sexual orientation and gender identity (SOGI) module built into a national system of surveys, have implications for patient education and community outreach initiatives focused on reducing skin cancer risk. They also have implications for the design of future nationwide surveys. Results are published in JAMA Dermatology.

“It’s absolutely critical that we ask about sexual orientation and gender identity in national health surveys; if we never ask the question, we’d never know that these differences exist,” said corresponding author Arash Mostaghimi, MD, MPA, MPH, director of the Dermatology Inpatient Service at the Brigham. “This information helps inform the nation about how to allocate health resources and how to train providers and leaders. When we look at disparities, it may be uncomfortable, but we need to continue to ask these questions to see if we’re getting better or worse at addressing them. Historically, this kind of health variation was hidden, but we now recognize that it’s clinically meaningful.”

Mostaghimi and colleagues leveraged data from the Behavioral Risk Factor Surveillance System (BRFSS), using data collected from annual questionnaires from 2014 to 2018. The Centers for Disease Control (CDC) uses the BRFSS to collect information about risk factors and behaviors among adults. About 450,000 adults are interviewed by telephone by the BRFSS each year. Beginning in 2014, the BRFSS began using the SOGI module to include questions about sexual orientation and gender identity. This module was administered in 37 states.

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Mostaghimi and colleagues compared skin cancer rates among heterosexual men to rates in gay or bisexual men and compared rates among heterosexual women to lesbian or bisexual women. Rates of skin cancer were 8.1 percent among gay men and 8.4 percent among bisexual men, statistically higher than the rate of 6.7 percent among heterosexual men. Skin cancer rates were 5.9 percent among lesbian women and 6.6 percent among heterosexual women, which was not a statistically significant difference. However, the rate of 4.7 percent among bisexual women was statistically significantly lower than heterosexual women.

The authors note that the data are based on self-reported skin cancer diagnoses, which have not been confirmed by a physician. The SOGI module was also only implemented in 37 states, so may not be generalizable to all states.

The BRFSS survey did not collect information about risk factors for skin cancer, such as UV exposure, Fitzpatrick skin type (a measure of skin color and susceptibility to sun burn), HIV status and more. However, smaller studies have reported higher usage of indoor tanning beds among sexual minority men, a known risk factor for skin cancer.

The CDC recently considered stopping implementation of the SOGI module for future BRFSS surveys, a move Mostaghimi feels would hinder efforts to support this population.

“This is the first time we’ve been able to look nationally at data about skin cancer rates among sexual minorities. Eliminating SOGI would prevent us from better studying this vulnerable population over time to see how rates may change from year to year,” said Mostaghimi. “As a next step, we want to connect with sexual minority communities to help identify the cause of these differences in skin cancer rates. This is work that will need to be done thoughtfully but may help not just sexual minorities but everyone.”

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Health & Wellness

10+ lifetime sexual partners linked to heightened cancer risk

Those who reported a higher tally of sexual partners were also more likely to smoke, drink frequently, and do more vigorous physical activity on a weekly basis.

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A history of 10 or more lifetime sexual partners is linked to a heightened risk of being diagnosed with cancer, reveals research published online in the journal BMJ Sexual & Reproductive Health.

And among women, a higher number of sexual partners is also linked to heightened odds of reporting a limiting long term condition, the findings indicate.

Few studies have looked at the potential impact of the number of sexual partners on wider health outcomes.

To try and plug this knowledge gap, the researchers drew on information gathered for the English Longitudinal Study of Ageing (ELSA), a nationally representative tracking study of older adults (50+) living in England.

In 2012-13, participants were asked how many sexual partners they had had. Complete data were provided by 5722 of the 7079 people who responded to this question: 2537 men and 3185 women. Responses were categorised as 0-1; 2-4; 5-9; and 10 or more sexual partners.

Participants were also asked to rate their own health and report any long standing condition or infirmity which impinged on routine activity in any way.

Other relevant information obtained included: age; ethnicity; marital status; household income other than a pension; lifestyle (smoking, drinking, physical activity); and presence of depressive symptoms.

The average age of participants was 64, and almost three out of four were married. Some 28.5% of men said they had had 0-1 sexual partners to date; 29% said they had had 2-4; one in five (20%) reported 5-9; while 22% reported 10 or more.

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The equivalent figures for women were: just under 41%; 35.5%; just under 16%; and just under 8%.

In both sexes, a higher number of sexual partners was associated with younger age, single status, and being in the highest or lowest brackets of household wealth.

Those who reported a higher tally of sexual partners were also more likely to smoke, drink frequently, and do more vigorous physical activity on a weekly basis.

When all the data were analysed, a statistically significant association emerged between the number of lifetime sexual partners and risk of a cancer diagnosis among both sexes.

Compared with women who reported 0-1 sexual partners, those who said they had had 10 or more, were 91% more likely to have been diagnosed with cancer.

Among the men, those who reported 2-4 lifetime sexual partners were 57% more likely to have been diagnosed with cancer than were those who reported 0-1. And those who reported 10 or more, were 69% more likely to have been diagnosed with the disease.

While the number of sexual partners was not associated with reported long standing conditions among the men, it was among the women.

Women who reported 5-9 or 10+ lifetime sexual partners were 64% more likely to have a limiting chronic condition than those who said they had had 0-1.

This is an observational study, and as such, can’t establish cause. Nevertheless, the findings chime with those of previous studies, implicating sexually transmitted infections in the development of several types of cancer and hepatitis, suggest the researchers.

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They didn’t obtain information on the specific types of cancer participants reported, but speculate: “…the heightened risk of cancer might be driven by those types known to be associated with [sexually transmitted infections].”

And they suggest that enquiring about the number of sexual partners might complement existing cancer screening programmes by helping to identify those at risk, if further research can establish a causal association between the number of sexual partners and subsequent ill health.

But an explanation for the gender difference in long term condition risk remains “elusive,” they write, especially given that men tend to have more lifetime sexual partners than women, while women are more likely than men to see a doctor when they feel ill, so potentially limiting the associated consequences for their long term health.

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Health & Wellness

Visual disturbances in Viagra users

In a new study, Viagra patients suffered numerous visual disturbances, including abnormally dilated pupils, blurred vision, light sensitivity, and color vision disturbances, which included intensely blue colored vision with red/green color blindness.

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Sildenafil is commonly used to treat erectile dysfunction and is generally regarded as safe with limited side effects. However, a recent study in Frontiers in Neurology has highlighted the risk of persistent visual side-effects, such as light sensitivity and color vision impairment, in men who have taken the highest recommended dose of Viagra. While these effects appear to be rare, the research suggests that first-time Viagra users should start with a lower dose before increasing it, if necessary.

Erectile dysfunction can have significant psychological consequences for men who are affected by it, and it can make fulfilling sexual relationships more difficult to achieve. Sildenafil, more commonly known by its trade name Viagra, became available in 1998 as a treatment for erectile dysfunction. It soon became the fastest selling drug in history, demonstrating the phenomenal demand for treatments that enhance sexual performance.

Originally developed as a treatment for high blood pressure, the drug dilates blood vessels and relaxes smooth muscle in the penis, making it easier to achieve and maintain an erection. The effects of the drug normally last 3-5 hours and although side-effects such as headache and blurred vision occasionally occur, they usually disappear relatively quickly.

However, Dr. Cüneyt Karaarslan of the Dünyagöz Adana hospital in Turkey, noticed a pattern in 17 male patients who attended the hospital. In the new study, Karaarslan reports that the patients suffered numerous visual disturbances, including abnormally dilated pupils, blurred vision, light sensitivity, and color vision disturbances, which included intensely blue colored vision with red/green color blindness.

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All 17 patients had taken sildenafil for the first time, and all took the highest recommended dose of 100 mg. None of the men had been prescribed the medication. The visual side-effects began once the drug took effect, and were still present when the men arrived at the clinic 24-48 hours later.

The doctors in the clinic conducted various eye tests and monitored the patients over time to see how their symptoms developed. Fortunately, in all 17 patients the symptoms had cleared up by 21 days later, but this was doubtless a difficult experience for the men involved.

“Many men use non-prescription performance enhancing drugs to help with sexual anxiety and erectile dysfunction,” said Karaarslan. “For the vast majority of men, any side-effects will be temporary and mild. However, I wanted to highlight that persistent eye and vision problems may be encountered for a small number of users.”

So, why were these men susceptible to such long-lived side-effects? It may be possible that a small subsection of the population does not break sildenafil down and eliminate it from the body efficiently, leading to very high concentrations in the blood compared with most users.

These men also took the highest recommended dose of sildenafil on their first time taking the drug. Starting with a lower dose may have meant less severe side-effects. In addition, taking the drug under medical supervision would likely have meant that the men would not have used such a high dose on their first time.

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So, if you are struggling with erectile dysfunction, should you be worried about trying Viagra? In short, no. Such persistent side-effects appear to be very rare. However, it is always best practice to consult your physician first, it may be best not to start at the highest dose, and in case you are particularly sensitive, consider first using the drug under medical supervision.

“Although these drugs, when used under the control of physicians and at the recommended doses, provide very important sexual and mental support, uncontrolled and inappropriate doses should not be used or repeated,” said Karaarslan.

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