Sexual Health

Introduction. Validated questionnaires are used to assess postoperative continence, sexual function, and other quality-of-life issues after radical prostatectomy. The International Index of Erectile Function (IIEF) is one such well-tested inventory that is routinely used. However, some centers use the Sexual Health Inventory for Men (SHIM) or the IIEF-6 to record erectile function, and comparison between the three can be difficult. Aims. To define if there was a predictive correlation between IIEF (or IIEF-6) and SHIM, and to explore a strategy for the use of an abbreviated and rapid functional assessment of erectile function in patients.

Recherche sur la thérapie ; Méthodes de traitement ; Problèmes sexuels ; Effets du traitement ; Sexothérapie Résumé D'après une synthèse fondée sur 80 articles de recherche sélectionnés à partir du plus grand nombre de documents consacrés à l'effet des traitements non pharmacologiques des problèmes sexuels, les méthodes et techniques de traitement pour les problèmes sexuels les plus courants sont décrits ainsi que les effet des traitements abordés en rapport avec le problème spécifique. Les méthodes de traitement sont organisées selon différents groupes : thérapie psychodynamique, comportementale, cognitive, cognitivo-comportementale, éducative, de couple, de groupe, hypnose, sexothérapie et bibliothérapie. Les méthodes et techniques de traitement au sein de chaque groupe sont décrites et les études réalisées sur chaque groupe font l'objet d'une présentation et d'une discussion. Les résultats mettent en évidence un effet positif pour la plupart des approches, mais à des degrés divers. Les thérapies centrées sur le problème sexuel paraissent plus efficaces que les traitements indirects des problèmes sous-jacents comme l'anxiété ou les problèmes de communication. Le modèle PLISSIT est recommandé pour différencier les problèmes susceptibles d'être résolus au travers d'une simple thérapie éducative ou d'une bibliothérapie nécessitant une intervention minime du thérapeute, des problèmes nécessitant une assistance thérapeutique spécialisée. La recherche portant sur les thérapies qui s'attachent aux relations causales entre le problème cible et la méthode thérapeutique semble donner lieu à des schémas de recherche circulaires qui prennent en compte davantage de variables, comme les caractéristiques du thérapeute, les caractéristiques du client, le cadre du traitement et le contenu du traitement. Le modèle bio-psycho-social est recommandé en tant qu'approche pluridisciplinaire intégrative du traitement des problèmes sexuels.

Female genital mutilation (FGM) concerns an estimated half a million women in Europe. The studies based in countries where migrant women have settled highlight the need for more accurate information on FGM health consequences, in a European health care context. Excision and Handicap (ExH) is a multicentric survey based on caseecontrol methodology and conducted in France to assess the long-term consequences of FGM, sampling both FGM and non-FGM adult women. The interviews were conducted in 74 mother-and-child health centres and hospital departments providing gynaecological and family planning services in five French regions. The two groups were compared on health indicators (selfperceived health, illnesses, symptoms) and functioning indicators (daily, sexual and reproductive life) for cases (n ¼ 678) and controls (n ¼ 1706). Multivariate logistic models highlighted FGM-related health problems. Among women living in France, FGM was significantly associated with poor health indicators: gynaecological and urinary infections (OR ¼ 2.0), sleep disorders (OR ¼ 1.4), intense pain (OR ¼ 1.5), difficulties in daily life (OR ¼ 1.5) and in sexual life (OR ¼ 1.7) or tearing during childbirth (OR ¼ 1.6). Our results suggest that, even in a favourable healthcare context, FGM exposes women to long-term health problems, including in areas neglected in previous research. They confirm the need to establish recommendations to help physicians understand these women's needs.

Speculum 'self-insertion': a pilot study Aim. This paper reports phase II of a pilot study that aimed to determine whether self-insertion of a speculum by women undergoing a pap smear would be more comfortable and lead to an improvement in satisfaction and a decrease in anxiety associated with this procedure. Background. Research demonstrates that pelvic examinations are considered by most women to be unpleasant and are routinely associated with embarrassment, apprehension, fear and often some level of discomfort and/or pain. Design. The study used quantitative and qualitative data collection techniques. Phase I (described elsewhere) tested the newly developed Speculum Self-Insertion Satisfaction Questionnaire for content validity, internal consistency and clarity. Phase II pilot study tested the technique of speculum self-insertion. Women's general level of anxiety was measured using the State Trait Anxiety Inventory, both before and after they performed the self-insertion procedure. Women's satisfaction and acceptance of the procedure was measured using the Speculum Self-Insertion Satisfaction Questionnaire and explored through the use of qualitative research techniques. Participants. A total of 198 women attending family planning clinics in Perth, Western Australia, between September and December 2003 were invited to participate in the study. One hundred and thirty-three women agreed to self-insert their own speculum. Results. The study demonstrated that speculum self-insertion was acceptable to most women, especially younger women. Nearly 91% of women either agreed or strongly agreed that they were satisfied with the experience of self-insertion and would choose to self-insert the speculum again. This included the women who had not previously had a speculum examination. The quality of specimen collected was not detrimentally affected by speculum self-insertion.

Background: Encouraging Mexican men who have sex with men (MSM) to learn about and get tested for human immunodeficiency virus (HIV) is essential not only to initiate early treatment and reduce complications related to acquired immune deficiency syndrome (AIDS) but also to avoid new infections. HIV testing for MSM in Mexico remains a challenge, in part because of the stigma and discrimination they face in their daily lives and perceived discrimination in health care services. Thus, innovative approaches are needed to increase the uptake of health prevention services among this population. Games for health and gamification are now established approaches to achieving desired behavior change. Gamified interventions have been successfully deployed in various health domains, including HIV awareness, treatment, and prevention. The aim of this 2015 study was to develop a phone-based game and linked online platform with gamification elements to incentivize HIV and sexually transmitted infections (STI) testing, normalize asking partners about serostatus, and increase HIV and STI knowledge among young Mexican MSM. This paper describes its implementation process and feasibility assessment.

Methods: The study consisted of three phases. The first phase was the formative research, which consisted of 6 focus groups and rapid prototyping to determine the most effective and appropriate design for the intervention. The second phase consisted of piloting and implementing the intervention over five weeks among 62 MSM, aged between 18 and 35 years old. Lastly, we assessed the feasibility of the intervention over three dimensions: acceptability, demand, and implementation. We conducted ten semi-structured interviews with participants and used a mixed-methods approach, including qualitative and quantitative evaluation methods.

Results: Overall, the conceptual components of the intervention were perceived as acceptable, which leads us to believe that the formative phase captured our participants’ needs and perceptions. However, we underestimated the complexity of the technical challenges involved. Participants’ high standards and expectations of an interactive product based on their experience with industrially produced games impacted their patterns of use. Nevertheless, they perceived the platform as a good-quality information source. Gamification elements such as badges, points, and prizes were perceived as fun, exciting, and motivating, and 71% of participants engaged in at least one activity to earn points.

Conclusions: A game-based intervention, coupled with an online platform that incorporates gamification elements to motivate HIV and STI testing in young Mexican MSM is feasible. Successfully scaling such an intervention to a broader audience would require reducing the complexity of the intervention, working with a local technical partner to develop and implement a more efficient platform, improving the quality of the graphics, and a re-design of the point system.

In discussions about sexuality in relation to circumcision, one often finds a kind of lip service, where it is declared that sexuality is multifaceted and relies on all kinds of psychological and social dimensions. Yet few authors discuss, in depth, the implications of a sexual-pleasure research approach that moves beyond the state of the genitalia. We would like to discuss exactly this: Sexual pleasure cannot be reduced to a question of genital tissue – sexuality is a more complex phenomenon than that. It is obvious that current quantitative approaches to investigating sexuality after FGC are inadequate. Generally speaking, they place too much weight on that which has been done to a woman’s genital tissue. We call such assumptions the fallacy of genital determinism (Johnsdotter 2013).
Western understandings of sex rely heavily on ideas emanating from researchers that created the model of the Human Sexual Response Cycle (Masters and Johnson 1966), which has been criticized for its simplistic focus on genitals (and not on people). Physiological aspects are thus over-emphasized at the expense of psychological, social and cultural aspects of importance for outcome.
Sexual scripting theory, introduced by sociologists in the 1970s (e.g. Gagnon and Simon 1973), highlights the cultural and social dimensions of lived sexuality, demonstrates how sexuality is embedded in social and cultural contexts and how people learn how to enact their sexuality. In addition, anthropological research on sensations (e.g. Hinton et al. 2008) suggests that culturally based learning also takes place when it comes to how we perceive bodily sensations, whether we notice bodily signals or not, and how we interpret and give meaning to sensations. Based on these findings, we will discuss possible implications of current campaigning for immigrant women and girls, who have to deal with these public expectations about erased possibilities to feel sexual pleasure after genital cutting.
In summary, we suggest that research, preventive work and rehabilitation care better take into consideration that sexuality is a complex phenomenon, and we stress the need to avoid reductionist one-track approaches that may be more harmful than helpful.

References
Gagnon, J.H. and Simon, W. (1973). Sexual conduct. The social sources of human sexuality. London: Aldine.
Hinton, D. E., Howes, D. & Kirmayer, L.J. (2008). “Toward a medical anthropology of sensations: Definitions and research agenda.” Transcultural Psychiatry, 45(2),142–162.
Johnsdotter, S. (2013). “Discourses on sexual pleasure after genital modifications: The fallacy of genital determinism (a response to J. Steven Svoboda).” Global Discourse, DOI 10.1080/23269995.2013.805530 (e-pub ahead of print).
Masters, W. H. and Johnson, V. E. (1966). Human sexual response. Boston: Little, Brown.