Adverse childhood experiences, sexual risk-taking and non-consensual sexual experiences in a nationally representative study of 15-29-year-old Danes.

BACKGROUND: Adverse childhood experiences (ACEs) have been linked with risky health-related behaviors and poor health. OBJECTIVE: This study aimed to investigate associations of ACEs with a broad panel of sexual risk-taking behaviors and non-consensual sexual experiences among young people in Denmark. PARTICIPANTS AND SETTING: Baseline questionnaire data from 15 to 29-year-old participants in the nationally representative cohort study Project SEXUS were used in combination with data from Danish national registers to include a total of 13,132 individuals. METHODS: In logistic regression analyses, confounder-adjusted odds ratios (aORs) with 95 % confidence intervals (CIs) were obtained for associations of five ACE categories (Household challenges, Loss or threat of loss, Material deprivation, Abuse, and Neglect) and a cumulative ACE score with measures of sexual risk-taking and non-consensual sexual experiences. RESULTS: Statistically significant associations were observed between ACEs and multiple sexual risk-taking behaviors and non-consensual sexual experiences with particularly increased odds among individuals with a history of Abuse, Neglect, or an ACE score of 3 or more. Specifically, Abuse was associated with having received payment for sex (women: aOR 5.38; 95 % CI 2.73-10.61; men: aOR 2.11; 95 % CI 1.22-3.64), with having paid for sex (men: aOR 1.88; 95 % CI 1.41-2.51), and with having been the victim of a sexual assault after age 18 years (women: aOR 3.33; 95 % CI 2.36-4.68). CONCLUSIONS: In this Danish study, multiple measures of sexual risk-taking and non-consensual sexual experiences were markedly more common among young people with ACEs than in those without ACEs. This knowledge should be considered in future initiatives to promote sexual health among young people.

Sexuality among young Danes treated for mental health problems: Baseline findings in a nationwide cohort study.

Mental health problems are common among adolescents and young adults (AYA), but although sexuality plays a central role in the transition from adolescence to adulthood, associations between such problems and sexuality have only been sparsely researched in AYA. The aim of this study was to investigate the association between mental health problems and various outcomes related to body and sexuality, romantic relationships, sexual functioning, and sexual risk behaviors among AYA. We used questionnaire data from 8696 Danish AYA aged 15-24 years who participated in the nationwide cohort study Project SEXUS at baseline in 2017-2018. Logistic regression analyses yielded demographically weighted, age-adjusted odds ratios for associations between mental health problems and sexual outcomes. Female AYA treated for mental health problems reported more active sex lives than other women. Treatment for mental health problems was associated with statistically significantly increased odds ratios for several sexual dysfunctions, and treated AYA significantly more often reported sexual debut before age 15 years, high sex partner numbers, sexual victimization, unsafe sex, sexually transmitted infections, induced abortions, discontentment with the appearance of body and genitalia, gender non-conformity, same-sex sexual experience, and non-heterosexual identity. Compared to healthy peers, AYA treated for mental health problems constitute a vulnerable group at increased risk of sexual adversities. Healthcare professionals should acknowledge these possible sexual challenges and offer relevant counselling to reduce the risk of adverse sexual outcomes in this group.

Associations between recalled childhood gender nonconformity and adult sexual dysfunction in Denmark: baseline assessment in the Project SEXUS cohort study.

BACKGROUND: Sexual dysfunctions may negatively affect an individual's self-perceived womanhood or manhood, but whether gender nonconformity in childhood or adolescence can influence adult sexual functioning has not been examined so far. AIM: To explore the possible link between recalled childhood gender nonconformity and sexual dysfunctions in adulthood in a large sample. METHODS: We analyzed baseline questionnaire data from Project SEXUS, a nationally representative cohort study on sexual health among 15- to 89-year-old Danish citizens. Our sample included sexually active participants aged ≥18 years who were queried about gender nonconformity in childhood or adolescence (N = 21 390). To capture sexual dysfunctions, we assessed (1) difficulties with lubrication, orgasm, vaginal cramps precluding sexual intercourse, and/or genital pain during partnered sexual activity in women and (2) difficulties with erection, premature ejaculation, orgasm, and/or genital pain during partnered sexual activity in men. Furthermore, we assessed whether such difficulties were perceived as problematic. The 6-item Female Sexual Function Index and the 5-item International Index of Erectile Function served as standardized measures. Polytomous logistic regression analyses yielded demographically weighted adjusted odds ratios (aORs) with 95% CIs for associations between childhood gender nonconformity and sexual dysfunctions, controlling for age, sociodemographics, health-related factors, and other potential confounders. OUTCOMES: Sexual difficulties and dysfunctions, as well as scores on the Female Sexual Function Index and International Index of Erectile Function. RESULTS: Age-adjusted odds ratios indicated that sexual dysfunctions were significantly more common among childhood gender-nonconforming than conforming participants. After controlling for additional potential confounders, most sexual dysfunctions-notably, vaginal cramps in women (aOR, 2.12; 95% CI, 1.25-3.60) and genital pain dysfunction in men (aOR, 2.99; 95% CI, 1.79-4.99)-remained significantly increased among childhood gender-nonconforming respondents. CLINICAL IMPLICATIONS: Findings suggest that self-perceived gender nonconformity in childhood or adolescence may negatively affect sexual functioning in adult life. If confirmed by future studies, they may warrant a clinical emphasis on such issues in sexologic treatment and care. STRENGTHS AND LIMITATIONS: Our study is the first to report associations between childhood gender nonconformity and adult sexual dysfunction, building on data from a large-scale, nationally representative cohort study. The retrospective assessment of childhood gender nonconformity via one item might have neglected significant dimensions of this construct. CONCLUSION: The present study is the first to show that individuals who recall being gender nonconforming in childhood or adolescence may be at a greater risk of experiencing sexual dysfunctions, particularly sexual pain disorders, as adults.

Sexuality Among Young Danes Treated for Long-Lasting or Severe Physical Disease: Baseline Findings in a Nationwide Cohort Study.

PURPOSE: Sexual ramifications of physical disease are well-documented in adult populations, but are scarcely investigated among adolescents and young adults (AYA). This study compared measures of sexuality and sexual health among 8,696 15-year-old to 24-year-old Danes with and without a history of treatment for long-lasting or severe physical disease. METHODS: Using baseline data from Project SEXUS, a nationally representative cohort study on sexual health in the Danish population, differences in various domains of sexual behaviors and sexual health between AYA who have and AYA who have not been treated for long-lasting or severe physical disease were investigated. Logistic regression analyses yielded demographically weighted age-adjusted odds ratios (ORs) for associations between physical diseases and sexual outcomes. RESULTS: AYA treated for long-lasting or severe physical disease resembled their healthy peers on fundamental aspects of sexual interest, activity and satisfaction. However, significantly increased odds ratios of various sexual difficulties and dysfunctions, early sexual debut, high sex partner numbers, discontentment with body or genital appearance, gender nonconformity, nonheterosexuality, and exposure to sexual assaults were observed, overall or within specific disease categories. DISCUSSION: The overall similarity in sexual profiles between AYA treated for physical disease and healthy peers indicates that clinicians should routinely address questions related to sexuality and relationships when encountering AYA with chronic health conditions. Moreover, the observed excess of certain adversities, including sexual assaults, among physically ill AYA highlights the need for preventive measures and counseling services specifically targeted at AYA afflicted by physical disease.

Adverse childhood experiences and mental health problems in a nationally representative study of heterosexual, homosexual and bisexual Danes.

Non-heterosexual persons more often report adverse childhood experiences (ACEs) than heterosexuals, and they generally bear a greater burden of mental health challenges. However, population-based data on this topic are scarce. In a nationally representative study within the Project SEXUS, one of the world's largest cohort studies on sexual health, we used data from 57,479 individuals in Denmark to explore the interplay between ACEs and mental health problems among self-identified heterosexual, homosexual and bisexual persons, and among self-identified heterosexuals with or without same-sex sexual experience. Compared to heterosexuals, non-heterosexual persons were more likely to report most of the studied ACEs, with odds ratios (ORs) for the ACE category "abuse" ranging from 1.38 to 1.75 for homosexual women, from 1.76 to 2.65 for homosexual men, from 2.52 to 3.64 for bisexual women, and from 1.58 to 6.07 for bisexual men. Furthermore, non-heterosexual persons had consistently and statistically significantly higher odds for mental health problems (ORs: 1.50 to 4.63). Combinations of ACEs with a non-heterosexual identity resulted in markedly elevated odds for mental health problems, particularly among bisexual individuals. This included high odds for suicidal thoughts/attempts among bisexual persons with a history of "neglect" (women: OR=12.82; men: OR=35.24) and "abuse" (women: OR=11.81; men: OR=11.65). Among self-identified heterosexuals, combinations of ACEs with same-sex sexual experience were associated with consistently elevated odds for mental health problems (ORs: 2.22 to 12.04). The greater burden of ACEs among self-identified homosexuals and, most notably, bisexuals may account for part of their excess risk of mental health problems. These findings emphasize the public health importance of preventive measures to minimize the burden of ACEs and avert their harmful long-term effects. Moreover, they highlight the need to safeguard the welfare of children and adolescents with non-conforming expressions of sexuality.

Sexual Inactivity and Dysfunction in Denmark: A Project SEXUS Study.

Sexual dysfunctions are common experiences that often impact negatively on the health and well-being of affected individuals. We used baseline questionnaire data from 62,675 Danes aged 15-89 years, who participated in the cohort study Project SEXUS 2017-2018, to yield nationally representative estimates of the prevalence of sexual inactivity and dysfunction and to identify their sociodemographic correlates. Overall, we found that 23.0% of sexually experienced men and 28.8% of sexually experienced women had not been sexually active with another person within the last year. Sexual inactivity with another person was associated with both young and old age, single status, less favorable socioeconomic conditions, underweight and obesity, indicators of poor health, no use of alcohol, and physical inactivity. Among sexually active respondents, 18.0% of men had experienced any dysfunction within the last year, including erectile dysfunction (7.4%), premature ejaculation dysfunction (10.0%), orgasmic dysfunction (4.0%), and/or genital pain dysfunction (0.7%). Among women, 20.4% had experienced any dysfunction within the last year, including lubrication dysfunction (9.1%), orgasmic dysfunction (12.2%), genital pain dysfunction (5.0%), and/or vaginal cramp dysfunction (vaginismus) (0.8%). Additionally, 3.4% of men and 9.9% of women with a spouse/partner had experienced hypoactive sexual desire disorder within the last four weeks. Using the 5-item International Index of Erectile Function (IIEF-5) and the 6-item Female Sexual Function Index (FSFI-6) among respondents with a spouse/partner who had attempted sexual intercourse within the last four weeks, we found that 3.8% of men had experienced moderate or severe erectile dysfunction (IIEF-5 score ≤ 11) and 20.8% of women had experienced any sexual dysfunction (FSFI-6 score ≤ 19) during that period. Single status, difficulties paying bills and, among men, unemployment were positively associated with sexual dysfunction. In conclusion, we document several sociodemographic disparities in the prevalence of sexual inactivity and dysfunction in Denmark. In particular, both sexual inactivity and dysfunction were more common among singles and those reporting financial difficulties.

Educational disparities in perinatal health in Denmark in the first decade of the 21st century: a register-based cohort study.

OBJECTIVE: To investigate socioeconomic differences in six perinatal health outcomes in Denmark in the first decade of the 21st century. DESIGN: A population-based cohort study. SETTING: Danish national registries. PARTICIPANTS: A total of 646 829 live born children and 3076 stillborn children (≥22+0 weeks of gestation) born in Denmark from 2000 to 2009. We excluded children with implausible relations between birth weight and gestational age (n=644), children without information on maternal country of origin (n=138) and implausible values of maternal year of birth (n=36). MAIN OUTCOME MEASURES: We investigated the following perinatal health outcomes: stillbirth, neonatal and postneonatal mortality, small-for-gestational age, preterm birth grated into moderate preterm, very preterm and extremely preterm, and congenital anomalies registered in the first year of life. RESULTS: Maternal educational level was inversely associated with all adverse perinatal outcomes. For all examined outcomes, the risk association displayed a clear gradient across the educational levels. The associations remained after adjustment for maternal age, maternal country of origin and maternal year of birth. Compared with mothers with vocational education, mothers with more than 15 years of education had an adjusted risk ratio for stillbirth of 0.64(95% CI 0.56 to 0.72). The corresponding adjusted risk ratios for neonatal mortality, postneonatal mortality, congenital anomalies, moderate preterm birth and small-for-gestational age were, respectively, 0.79(95% CI 0.67 to 0.93), 0.57(95% CI 0.42 to 0.78), 0.87(95% CI 0.83 to 0.91), 0.80(95% CI 0.77 to 0.83) and 0.83(95% CI 0.81 to 0.85). CONCLUSION: Substantial educational inequalities in perinatal health were still present in Denmark in the first decade of the 21st century.