Sexual health intervention for couples with difficulty in sexual abstinence

Purpose@#Nurses in the forefront of reproductive health services face the challenge of motivating clients to adapt fertility awareness-based methods, or making them continue with the method due to concerns about handling sexual abstinence. To assist nurses and other reproductive health providers, a sexual health intervention was developed. Thus, this study aimed to determine the effectiveness of the sexual health intervention called Kalabit-kalabit (sexual desire), Irap (abstinence), and Sanggang-dikit (shared behavioral plan) (KIS) on the sexual scripts, motivation, and behavior of couples with difficulty in sexual abstinence in natural family planning. Specifically, it aimed to identify the sexual scripts on pagkatao (personhood), pagkalalaki (manhood), pagiging lalaki (masculinity), pagkababae (womanhood), pagiging babae (femininity), pagtatalik (sexual intercourse), and pagpipigil (abstinence), as well as the sexual motivation and behavior of couples with difficulty in abstinence before and after KIS.@*Methods@#Embedded multiple-case study with purposive sampling using the replication logic was used to satisfy the inquiry. Four couples qualified using the assumption that difficulty with abstinence is caused by illogical sexual scripts, and inappropriate sexual motivation and behavior of either one or both spouses as a template to determine KIS’s effectiveness. Pattern matching, cross-case synthesis, and logic model were used for analytic generalization. Prior to the conduct of the study, the research protocol underwent scrutiny by the Independent Ethics Committee of De La Salle Medical and Health Sciences Institute.@*Result@#KIS was found to be effective in (a) decoding and denouncing illogical sexual scripts and inappropriate sexual motivation and behavior, (b) reframing them to logical sexual scripts and appropriate sexual motivation and behavior, and (c) sharing mutual behavioral plans if accompanied with openness and full acceptance of self and spouse coupled with conviction, cooperation, commitment, and determination.@*Conclusions@#Decoding, challenging, reframing, and sharing mutual behavioral plans facilitate couples' competence in achieving sexual abstinence with ease.

A enfermagem e as condutas sexuais de jovens no contexto das Infecções Sexualmente Transmissíveis / Nursing and sexual conduct of young people in the context of Sexually Transmitted Infections

Este estudo teve como objetivo geral analisar as condutas sexuais dos jovens universitários e a prevenção de Infecções Sexualmente Transmissíveis (IST). E como objetivos específicos: conhecer a percepção dos jovens universitários acerca da sexualidade; descrever as condutas sexuais dos jovens universitários; e discutir os roteiros sexuais dos jovens na perspectiva da prevenção de IST. Trata-se de um estudo descritivo com abordagem qualitativa, integrado ao projeto "Sexualidade e vulnerabilidade dos jovens em tempos de Infecções Sexualmente Transmissíveis". O cenário da pesquisa foi uma instituição de ensino superior privada, situada no município do Rio de Janeiro. Os participantes do estudo foram os jovens universitários, de ambos os sexos, com idades entre 18 e 29 anos, regularmente matriculados na respectiva instituição. Os dados foram coletados através da técnica de grupo focal. Os principais tópicos de discussão foram aqueles relacionados aos aspectos sociais, à sexualidade, condutas sexuais/gênero e prevenção de IST. Para análise dos dados, foi empregada a técnica de análise do conteúdo na modalidade temático-categorial, sendo operacionalizada com auxílio do software Nvivo 9.0. Da análise, emergiram três categorias: compreensão dos jovens universitários acerca da sexualidade, gênero e orientação sexual; relacionamentos, iniciação sexual e o diálogo com as crenças religiosas na perspectiva dos jovens universitários; uso do preservativo nos roteiros sexuais dos jovens universitários: motivações e estímulos. Os resultados demonstram que o cenário cultural e a organização das relações entre os gêneros exercem forte influência na elaboração das condutas sexuais da população investigada. As relações de namoro e a confiança nos parceiros tornam os jovens vulneráveis às IST, uma vez que, na concepção dos participantes, este tipo de roteirização dispensa o uso do preservativo. Nos encontros com os universitários, foram verbalizadas roteirizações, sendo percebido que as mulheres apresentam maior dificuldade em negociar a utilização do preservativo com seus parceiros, e que as relações sem o uso deste recurso nem sempre são consentidas por elas. Conclui-se que é necessário repensar os direitos sexuais, as políticas de saúde e os programas disponíveis para a população jovem no enfrentamento das IST para a superação das iniquidades de gênero. É relevante que os serviços e profissionais de saúde, sobretudo os enfermeiros, considerem a universidade como um espaço privilegiado para a educação permanente e a discussão destas temáticas junto à população jovem.

This study had as general objective 'to analyze the sexual behavior of university students and the prevention of Sexually Transmitted Infections (STI)'. And as specific objectives: to comprehend the perception of university students about sexuality; to describe the sexual behavior of university students; and to discuss the sexual scripts of young people in regard to preventing STIs. This is a descriptive study with a qualitative approach, integrated to the project "Sexuality and Vulnerability of young people in times of Sexually Transmitted Infections". The research took place in a private higher education institution, located in the city of Rio de Janeiro. The study participants were university students of both sexes, aged between 18 and 29 years, regularly enrolled in the respective institution. Data were collected through the focal group technique. The main topics of discussion were those related to social aspects, sexuality, sexual/gender behavior and STI prevention. For the data analysis, the technique of Content Analysis was employed in the thematic-categorial modality, being operationalized using Nvivo 9.0 software. From the analysis emerged three categories: understanding of university students about sexuality, gender and sexual orientation; relationships, sexual initiation and dialogue with religious beliefs in the perspective of university students; use of condoms in the sexual scripts of university students: motivations and triggers. The results show that the cultural scene and the organization of gender relations exert a strong influence in the elaboration of the sexual behavior of this population. Dating relationships and trust in partners make young people vulnerable to STIs, since in the perspective of the participants, this type of scripting does not require the use of condoms. In the meetings with the university students, scriptures were verbalized and it was noticed that women show greater difficulty in negotiating condom use with their partners, and that sexual relations without the use of this resource are not always consented to by them. It is concluded that it is necessary to rethink the sexual rights, the health policies and the programs available to the young population in fighting against STIs to overcome gender inequities. It is relevant that health services and professionals, especially nurses, consider the university as a privileged space for ongoing education and discussion of these issues among the young population.

Adolescentes em situação de acolhimento institucional: vulnerabilidade às Infecções Sexualmente Transmissíveis (IST) / Adolescents in residential care situation: vulnerability to Sexually Transmitted Infections (STI)

O objeto deste estudo foi a vulnerabilidade às IST de adolescentes do sexo feminino em situação de acolhimento institucional. Os principais problemas de saúde dos adolescentes vêm das atividades sexuais; entre eles as IST. Estas, quando não identificadas e tratadas, podem trazer consequências severas que prejudicam a saúde sexual e reprodutiva das adolescentes; como infertilidade, doenças inflamatórias pélvicas, câncer de colo uterino, abortamento espontâneo, prematuridade, disfunção sexual, e nos casos mais graves pode levar a morte. As adolescentes em situação de acolhimento, devido às situações de desagregação familiar, autoestima baixa, relações sexuais desprotegidas, exposição à violência, comercialização das relações sexuais para sobrevivência, uso de drogas lícitas e ilícitas, ficam em situação de vulnerabilidade, dentre elas a vulnerabilidade à saúde sexual. Embora, seja possível identificar inúmeras conquistas nas ações à saúde para as adolescentes, principalmente a saúde sexual e reprodutiva, as abordagens educativas ainda têm uma finalidade corretiva das condutas sexuais e não incorporaram os contextos socioculturais, ou seja, os roteiros sexuais que guiam as adolescentes em situação de acolhimento institucional. Todas essas constatações levaram a reflexão da necessidade em aprofundar a concepção de vulnerabilidade para a saúde sexual das adolescentes em situação de acolhimento. O estudo desta vulnerabilidade proporciona a compreensão das formas pelas quais as adolescentes e suas coletividades se expõem ou favorecem a um determinado contexto vulnerável. Para tal, traçou-se como objetivo: analisar as dimensões de vulnerabilidade às IST em adolescentes em situação de acolhimento institucional, considerando as condutas sexuais. Foi realizada uma pesquisa qualitativa de caráter descritivo-exploratório que utilizou como referencial teórico-metodológico Daniel Bertaux. Foram entrevistadas 10 adolescentes que se encontravam em instituições de acolhimento, na Zona Norte e na Zona Sul da cidade do Rio de Janeiro. Os dados produzidos foram interpretados a partir de uma análise temática. Deste processo emergiu uma categoria analítica: Roteiros Sexual e a vulnerabilidade às IST de adolescentes em situação de acolhimento institucional; com duas subcategorias: Sexualidade das adolescentes em situação de acolhimento institucional; Saúde sexual de adolescentes em situação de acolhimento institucional. Na primeira subcategoria identificaram-se as características de seus relacionamentos interpessoais, as percepções quanto a perda da virgindade e ao seu corpo e experiências homoafetivos. Na segunda subcategoria emergiram narrativas da vivência de violência sexual e prostituição, questões de gênero (dificuldade de negociação), o uso de métodos contraceptivos para a prevenção de futuras gestações, os conhecimentos limitados quanto à exposição às IST e os cuidados necessários para se protegerem das mesmas. A pesquisa considerou que conhecer os roteiros sexuais e as dimensões de vulnerabilidade de adolescentes em situação de acolhimento às IST revelou que são questões fundamentais a serem incorporadas na assistência a essas adolescentes, tendo em vista a prevenção das IST e promoção da saúde sexual e o empoderamento dessas jovens.

The object of this study was the vulnerability to STI female adolescents in residential care situation. The main health problems of adolescents have sexual activity; including STI. These, if not identified and treated, can bring severe consequences that impair sexual and reproductive health of adolescents; as infertility, pelvic inflammatory disease, cervical cancer, miscarriage, premature birth, sexual dysfunction, and in severe cases can lead to death. The teens in foster situation, due to family breakdown situations, low self-esteem, unprotected sex, exposure to violence, trading of sex for survival, use of legal and illegal drugs, are in vulnerable situations, among them vulnerability to sexual health. Although, it is possible to identify numerous achievements in health actions for adolescents, especially sexual and reproductive health, educational approaches still have a corrective purpose of sexual conduct and not incorporated socio-cultural contexts, ie the sexual scripts that guide teens in residential care situation. All these findings led to reflection on the need to deepen the concept of vulnerability to sexual health of adolescents in situation of welcome. The study of the vulnerability provides an understanding of the ways in which adolescents and their communities are exposed or vulnerable favor a particular context. To do this, it drew up the following objectives: to analyze the STI vulnerability dimensions in adolescents in residential care situation, considering the sexual conduct. A qualitative study of descriptive exploratory character used as theoretical and methodological Daniel Bertaux reference was made. They interviewed 10 adolescents who were in institutions, in the north and south of the city of Rio de Janeiro. The data produced were interpreted from a thematic analysis. This process emerged an analytical category: Sexual Scripts and vulnerability to STI adolescents in residential care situation; with two subcategories: Sexuality of adolescents in residential care situation; Sexual health of adolescents in residential care situation. In the first category, we identified the characteristics of their interpersonal relationships, perceptions as loss of virginity and his body and homosexual experiences. In the second subcategory emerged narratives of experience of sexual violence and prostitution, gender issues (difficulty of trading), the use of contraception to prevent future pregnancies, limited knowledge on exposure to STI and care needed to protect themselves from same. The survey found that knowing the sexual scripts and adolescent vulnerability dimensions in the host state to STI revealed that are fundamental issues to be incorporated in the care of these adolescents, with a view to prevention of STI and sexual health promotion and empowerment these young people.

Debates feministas sobre pornografia heteronormativa: estéticas e ideologias da sexualização / Feminist debates on heteronormative pornography: aesthetics and ideologies of sexualization

Este artigo re-visita o debate feminista sobre pornografias heteronormativas e analisa a sua produção de discursos polarizados, em particular os que recorreram às ciências psicológicas como forma de legitimar as suas posições. Partindo da localização da indústria pornô nas mecânicas do capitalismo contemporâneo, propomos repensar os significados da pornografia para lá da psicologia social tradicional e do feminismo norte-americano mais conservador. O papel preponderante que a pornografia hoje assume nas indústrias do sexo é indissociável da proliferação tecnológica da mídia e da crescente sexualização dos seus mercados. Neste artigo - uma análise de textos e discursos - situamos a pornografia numa fenomenologia mais ampla e reflexiva, cruzando uma abordagem feminista-construcionista com a psicologia social crítica. (AU)

This paper revisits the feminist debate on heteronormative pornography and analyzes its production of polarized discourses, particularly those that have explored psychological sciences to legitimize their positions. Locating the porn industry within the mechanics of contemporary capitalism, we propose to rethink the meanings of pornography beyond the strict boundaries of the traditional social psychology and the conservative North American feminism. The paramount role played by pornography in the sex industries is nowadays inseparable from the technological proliferation of the media and the increasing sexualization of its markets. In this article - an analysis of texts and discourses - we situate pornography in a broader and more reflexive phenomenology, crossing a constructionist-feminist approach with critical social psychology. (AU)

Amor e conjugalidade na contemporaneidade: uma revisão de literatura / Amor y conyugalidad en la contemporaneidad: una revisión literaria / Contemporary love and conjugality: a literature review

O presente artigo se propõe a realizar uma revisão bibliográfica sobre a temática do amor e da conjugalidade no mundo contemporâneo trazendo contribuições de autores como Bozon, Gagnon e outros. O amor tem sido uma temática de discussão diversificada das ciências humanas e sociais e principalmente da Psicologia. A perspectiva adotada neste trabalho apresenta as contribuições da sociologia da sexualidade em uma revisão que traz o amor como uma perspectiva de interação social vivenciada como sentimento amoroso. Esta análise centra-se principalmente na teoria dos roteiros sexuais, compreendendo o amor como uma prática social, mas vivenciada como sentimento. Esta forma híbrida constitui uma das principais características do amor na contemporaneidade.

The purpose of this article is to provide a bibliographic review about the theme of love and conjugality in the contemporary world including contributions from authors such as Bozon, Gagnon and others. The theme of love has been discussed not only in human and social science but particularly in psychology. The perspective adopted in this work presents contribution from the sociology of human sexuality. Its revision demonstrates love as a social interaction perspective experienced as a loving sentiment. The analysis focuses basically on the sexual scripts theory, which understands love as a social practice although lived as a feeling. This hybrid form consists in one of the main characteristics of contemporary love.

La propuesta del presente artículo es realizar una revisión bibliográfica sobre el tema del amor y la conyugalidad en el mundo contemporáneo, trayendo contribuciones de autores como Bozon, Gagnon entre otros. El amor ha sido un tema de discusión de las ciencias humanas, sociales y principalmente de la psicología. La perspectiva adoptada en este trabajo trae contribuciones de la sociología de la sexualidad. Esta revisión coloca el amor como una perspectiva de interacción social vivenciada como sentimiento amoroso. Este análisis se centra principalmente en la teoría de los scripts sexuales, comprendiendo el amor como una práctica social vivenciada como sentimiento. Esta forma hibrida constituye una de las principales características del amor en la contemporaneidad.

Reconocimiento y uso de tácticas de coerción sexual en hombres y mujeres en el contexto de relaciones heterosexuales: Un estudio en estudiantes universitarios / Recognition and use of sexual coercion tactics in men and women in the context of heterosexual relations a study of university students

Violence is a problem gone through by people in one way or another because of the great amount of manifestations in which it is presented. Sexual violence constitutes one of those ways. At the present time, sexual violence is considered a high-priority problem of public health and of human rights; this type of violence is presented in a continuum that goes from groping to forced sexual relationships. Most of the people associate sexual violence with its extreme form which is rape, but, what does it happen with that type of violence where subtlety or persuasions are involved in order to obtain a sexual relationship? This kind of violence is denominated sexual coercion, and it is defined as the use of any type of physical or emotional pressure used by a person to impose on another one acts of sexual order in the context of a heterosexual encounter of mutual agreement to go out together, to get to know themselves, or to have a romantic or erotic relationship, or a more formal relationship such as the courtship. Sexual coercion is a phenomenon mainly studied in heterosexual and student populations and by means of the theory of sexual scripts is one of the forms adopted by it that have been theoretically tackled with. Sexual scripts are all those structural blocks of knowledge information processing where concepts, categories and relationships based on social experience are gathered and which indicate how heterosexual sexual relationships are to be. The vast majority of the studies on sexual coercion have provided enough evidence on the fact that men are the main perpetrators and women are mostly the injured victims. In developing countries, such as Mexico, several studies show that young men frequently feel with the right, precisely for the fact of being men, to have sexual relationships with young women. For this reason, it is understandable that young women's sexual activity is mostly stigmatized, what can contribute to the acceptance of sexual coercion within the intimate couple relationships as a more <> behavior and socially accepted. For this reason, although men can in some moment be sexually constrained and women can exert coercion, the meaning of the fact can be different and, besides, behaviors that are carried out to obtain the wanted sexual behavior themselves also differ between men and women. Tactics constitutes a clear example on the difference between men and women in the act of coercion. Some international studies have identified, in general terms, two types of sexual coercion tactics: indirect and the direct ones. The indirect tactics are strategies in which the person hides his/her sexual purpose. The direct tactics are strategies where the person openly uses physical or psychological force to compel the other one to get involved in certain sexual activity. In Mexico there are not studies about sexual coercion in non formal relationships of heterosexual couples. Because of the above-mentioned, the present work objectives were to know the frequency and type of sexual coercion tactics in men and women university students. Methods and material Three hundred and twenty students were interviewed, 49.7% of them were men and 50.3% women, and the average individual age was of 21 years. The sample was a non random one and the study was of exploratory type. A questionnaire ad hoc of open questions was elaborated, which made inquiries on the tactics used by men and women to press people of another sex to have a sexual relationship. Personal experiences of sexual coercion were also investigated. The application of the instrument was carried out in a group way and its length was around 45 minutes. Open questions were analyzed through the search of thematic units and categories. The contents analysis was used and later transformed into cases count in order to make the corresponding statistical analysis. Result About the experience of sexual coercion, 33.4% of the total sample mentioned that he/she had been victim of sexual coercion. Women (56.1 %) reported being mainly victims of sexual coercion contrary to the men (43.9%), when carrying out an X² statistics there were not significant differences, in statistical terms, between men and women. Nine point four percent of the total sample mentioned that he/she had exerted sexual coercion toward his/her couple. Men (83.3%) reported to have mainly exerted sexual coercion toward their couple contrary to women (16.7%). When carrying out an X² statistics a significant difference, in statistical terms, between men and women was found [X²=16.21, (gl =320/1) p = .000]. Regarding the frequency of the different tactics used by men, men and women reported that the indirect tactics are the most used by men to press women to have sexual relationships. Among the indirect tactics there were found the blackmail, the <>, the verbal deceits, etc. On the other hand, the direct tactics such as threats of physical violence, use of physical violence, insistent petting, etc., were less used by men. Regarding sexual coercion tactics used by women, men and women who participated in the sample, mentioned that direct tactics are more used by women to press a man to have sexual relationships. Within this kind of tactics there were found sexual advances using the body, use of physical violence, use of verbal violence, etc. With respect to the indirect tactics, there were verbal deceits, blackmail, psychological threats, among others. Discussion This research is barely an exploratory study, non representative, but we consider that it makes a contribution of descriptive type to the understanding of sexual coercion in heterosexual relationships when considering both men as women. As it is observed in the results about the experience of sexual coercion, in general terms, such as it is shown in other studies, women were the main victims of sexual coercion, although some men reported being victims, there were no significant difference. Besides, as in other studies, men were those who mostly reported to exert sexual coercion contrary to women, being differences significant in statistical terms. Regarding the tactics used by men in order to coerce their couple, men and women who participated in the sample recognized the indirect tactics as the most used ones, which is in agreement with the outcomes found in other studies. What makes these results interesting is the fact that women recognize in a more open and significant way, that the way a man exerts coercion to a woman is by means of an indirect tactics. These results are much related with the sexual scripts where the man has to gain a sexual access to the woman. With regard to sexual coercion tactics used by women, the direct ones are outstanding, that is to say, those in which woman openly uses the physical, psychological or economic force to press a man to have sexual relationships. The studies about domestic violence state, on the whole, that violence is more exerted by men toward women than the opposite case. Nevertheless, there are also studies about domestic violence which state that women are as aggressive as men. These studies have been questioned and at the moment the debate persists about the findings, because although women use physical violence, it is important to wonder about the intensity of the blow or if the physical violence is rather a defensive answer. The results of this study show the relevance of knowing more about this phenomenon, since many of the subjects in this study are not able to identify any event of sexual coercion in their relationship, reason for which it will be necessary to search what is happening in Mexico on this matter and to even go into the topic of youth's relationships, in particular, the heterosexual ones and the scripts that regulate this relationship, in order to be able of creating better prevention programs guided to eliminate domestic violence to obtain a better mental, sexual and reproductive health.

La violencia es un problema que nos afecta a todas las personas de una u otra manera por la gran cantidad de manifestaciones en las que se presenta. Una de esas formas es la violencia sexual. En la actualidad ésta es considerada un problema prioritario de salud pública y de derechos humanos y se presenta en un continuo que va desde el manoseo hasta las relaciones sexuales forzadas. Una de las formas de este tipo de violencia es la coerción sexual que se define como el uso de cualquier tipo de presión física o emocional que es utilizada por una persona para imponer actos de orden sexual sobre otra en el contexto de un encuentro heterosexual de mutuo acuerdo para salir juntas, para conocerse o sostener una relación romántica o erótica, o en una relación más formal como el noviazgo. La coerción sexual ha sido abordada teóricamente a través de la teoría de los guiones sexuales o scripts. Aunque hombres y mujeres pueden sufrir este tipo de violencia, la gran mayoría de los estudios sobre coerción sexual han evidenciado que los hombres son los principales perpetradores y las mujeres, las víctimas. Un claro ejemplo sobre la diferencia entre hombres y mujeres en la forma de coercionar son las tácticas. Por lo anterior, el presente trabajo tiene como objetivos conocer la frecuencia y tipo de tácticas de coerción sexual en hombres y mujeres universitarios. Material y métodos Se entrevistaron a 320 estudiantes, un 49.7% de los sujetos fueron hombres y 50.3% mujeres, la media de edad fue de 21 años. La muestra fue no probabilística y el estudio fue de tipo exploratorio. Se elaboró un cuestionario ad hoc de preguntas abiertas, las cuales indagan sobre las tácticas utilizadas por hombres y mujeres para presionar a personas de otro sexo a tener una relación sexual; también se indagó sobre las experiencias personales de coerción sexual. La aplicación del instrumento se realizó de manera grupal con una duración aproximada de 45 minutos. Las preguntas abiertas fueron analizadas a través de la búsqueda de unidades temáticas y categorías. Se utilizó el análisis de contenido y después se transformó en conteo de casos para hacer el análisis estadístico correspondiente. Resultados Sobre la experiencia de coerción sexual, un 33.4% de la muestra total menciona que ha sido víctima de ella. Un 9.4% de la muestra total menciona que ha ejercido coerción sexual hacia su pareja; al realizar una X² se encontró una diferencia estadísticamente significativa entre hombres y mujeres [X² =16.21, (gl = 320/1) p = .000]. En cuanto a la frecuencia de las diferentes tácticas utilizadas por los hombres, los y las participantes reportan que las tácticas indirectas son más utilizadas por éstos, mientras que las mujeres utilizan más las tácticas directas. Discusión: Como se observa en los resultados, en general, al igual que en otros estudios, las mujeres son las principales víctimas de coerción sexual y los hombres quienes la ejercen. Los resultados de este estudio evidencian la importancia de conocer más sobre este fenómeno ya que muchos de los sujetos en este estudio no fueron capaces de identificar algún evento de coerción sexual en su relación, por lo que habrá que profundizar mucho más en el tema de las relaciones de pareja de los jóvenes, en particular en la heterosexualidad, y los guiones que la norman, para poder crear cada vez mejores programas de prevención encaminados a eliminar la violencia en las relaciones de pareja y para obtener una mejor salud mental, sexual y reproductiva.