Sex Differences in Health Conditions Associated with Sexual Assault in a Large Hospital Population.

Introduction: Sexual assault is an urgent public health concern with both immediate and long-lasting health consequences, affecting 44% of women and 25% of men during their lifetimes. Large studies are needed to understand the unique healthcare needs of this patient population. Methods: We mined clinical notes to identify patients with a history of sexual assault in the electronic health record (EHR) at Vanderbilt University Medical Center (VUMC), a large university hospital in the Southeastern USA, from 1989 to 2021 (N = 3,376,424). Using a phenome-wide case-control study, we identified diagnoses co-occurring with disclosures of sexual assault. We performed interaction tests to examine whether sex modified any of these associations. Association analyses were restricted to a subset of patients receiving regular care at VUMC (N = 833,185). Results: The phenotyping approach identified 14,496 individuals (0.43%) across the VUMC-EHR with documentation of sexual assault and achieved a positive predictive value of 93.0% (95% confidence interval = 85.6-97.0%), determined by manual patient chart review. Out of 1,703 clinical diagnoses tested across all subgroup analyses, 465 were associated with sexual assault. Sex-by-trauma interaction analysis revealed 55 sex-differential associations and demonstrated increased odds of psychiatric diagnoses in male survivors. Discussion: This case-control study identified associations between disclosures of sexual assault and hundreds of health conditions, many of which demonstrated sex-differential effects. The findings of this study suggest that patients who have experienced sexual assault are at risk for developing wide-ranging medical and psychiatric comorbidities and that male survivors may be particularly vulnerable to developing mental illness.

Circumcision Stories: Enhancing our Understanding of Parental Perspectives in a Context of Controversy.

This commentary examines twelve stories in which parents recount how they (and often their co-parent) decided whether or not to circumcise their newborn sons. Several debated whether this should be their decision to make. The stories offer an intimate glimpse into people's efforts to do the best for children in a context of incomplete and changing information and intense public controversy. The commentary explores the diverse meanings and contradictory commonsense beliefs that surround foreskin removal in the United States today. Considering these parents' reflections-and their silences-can help us appreciate the real-life consequences of debates about the ethics of male circumcision.

(Im)perishable Pleasure, (In)destructible Desire: Sexual Themes in U.S. and English News Coverage of Male Circumcision and Female Genital Cutting.

Under what conditions do sexual pleasure and desire get addressed in news coverage of sexual health issues like female genital cutting (FGC) and male circumcision (MC)? In this study we employed an embodied ethnosexuality approach to analyze sexual themes in 1,902 items published from 1985 to 2009 in 13 U.S. and 8 English newspapers and news magazines. Journalists' discussions of sexual pleasure, desire, control, problems, and practices differed in quantity and quality depending on the practice and nation to which they pertained. News coverage in both nations presented FGC as impeding female sexual pleasure, desire, and activity in ways that reinforce (hetero)sexist understandings of sexuality. The English press depicted MC as diminishing male sexuality, whereas U.S. papers showed it as enhancing male sexuality. These patterns are influenced by, and serve to reinforce, cultural norms of embodiment and ethnosexual boundaries based on gender, race, and nationality. They may, in turn, shape public understandings of FGC and MC as social problems.

Embodiment without bodies? Analysis of embodiment in US-based pro-breastfeeding and anti-male circumcision movements.

This article uses the cases of pro-breastfeeding and anti-circumcision activism to complicate the prevailing conceptualisation of embodiment in research on embodied health movements (EHMs). Whereas most EHM activists draw on their own bodily experiences, in the breastfeeding and circumcision movements, embodiment by proxy is common. Activists use embodiment as a strategy but draw on physical sensations that they imagine for other people's bodies, rather than on those they experience themselves. Pro-breastfeeding activists, who seldom disclose whether they were themselves breastfed, target mothers, encouraging them to breastfeed rather than to formula feed their children in order to reduce their child's risk of disease. Anti-circumcision activists, only some of whom are circumcised men, urge parents to leave their sons' penises intact in order to avoid illness and disfigurement and to preserve the sons' rights to make their own informed decisions as adults. In both movements activists use embodiment as a persuasive strategy even though they themselves do not necessarily embody the risks of the negative health outcomes with which they are concerned. Future research on EHMs should reconceptualise EHMs to include embodiment by proxy and examine whether this important phenomenon systematically affects movement strategies and outcomes.

Toward a social science of sexual satisfaction: commentary on "virginity lost, satisfaction gained? Physiological and psychological sexual satisfaction at heterosexual debut".

Higgins, Trussell, Moore, and Davidson (2010) expand our understanding of sexual satisfaction by showing that first vaginal sex is more likely to be psychologically than physically satisfying and by revealing differences between women and men and similarities between African Americans and Whites. Their analyses highlight the need for further theory-building, explicating the dynamics of change over time, integrating qualitative and quantitative approaches, and articulating implications for public policy. These are crucial steps toward developing a social science of sexual satisfaction. More research that focuses on positive aspects of sexuality, such as satisfaction, should be encouraged.

On remedicalisation: male circumcision in the United States and Great Britain.

This paper compares the histories of male circumcision in the United States and Great Britain to explicate the theoretically important, yet inadequately specified, processes of demedicalisation and remedicalisation. Circumcision became medicalised to a similar extent, through similar processes, in both countries before World War II. However, by the 1960s, circumcision was almost completely demedicalised in Britain and almost universal in the US, where it became partially demedicalised after the 1970s. Medical professionals and insurance/healthcare systems drove demedicalisation in both countries; in the US, grassroots activists also played a critical role, while medical community 'holdovers' and parents resisted demedicalisation. Recent research linking circumcision to HIV prevention and deaths following religious circumcision are differentially likely to produce remedicalisation in the two nations, given differences in circumcision prevalence, HIV epidemiology, insurance/health systems, activism opportunities, and status of religious groups. Research on (de/re)medicalisation should theorise the life cycle of medicalisation, explore comparative cases, and attend more closely to medical holdovers from previous eras, prevalence and duration of medicalised practices, and barriers to promoting non-medical interpretations.

Influencing health debates through letters to the editor: the case of male circumcision.

In this article I use the case of male circumcision (MC) to examine how grassroots activists, medical professionals, other stakeholders, and ordinary people employ letters to the editor (LTEs) to influence public health debates. I also show how journalistic practices affect the use of LTEs. Seventy LTEs about MC from U.S. newspapers between 1985 and 2006 are analyzed using qualitative methods. Pro-MC, anti-MC, and neutral LTE writers supported their stances on similar grounds, described adversaries as biased, and stressed medical and scientific authority. Yet only MC advocates and neutralists trivialized MC and declined to justify their stances, suggesting distinctive dynamics for LTEs about widely accepted practices. The prevalence of debated practices and activists' efforts to piggyback on related issues also affect LTE content. Editors chose LTEs to address readers' critiques, enact news values like balance and controversy, and showcase writers with strong claims to legitimacy, thereby mediating public health debates.

How motivation influences breastfeeding duration among low-income women.

In-depth interviews were conducted with 44 low-income breastfeeding women to explore the incentives and disincentives to breastfeeding experienced within 6 months postpartum. Using an individual net benefit maximization (INBM) framework based on economic theory, we assessed women's motivations, incentives, and disincentives for breastfeeding. Based on the framework and their experience breastfeeding, women fell into 3 groups: intrinsically motivated, extrinsically motivated, and successfully experienced with both intrinsic and extrinsic motivation. Successfully experienced women were most likely to breastfeed to 6 months. Intrinsically motivated women valued breastfeeding but often required information and instruction to reach breastfeeding goals. Extrinsically motivated women were least likely to continue breastfeeding even with support and instruction. Providers can screen women to determine their experience and motivation then tailor interventions accordingly. Intrinsically motivated women may need support and instruction, extrinsically motivated women may benefit from motivational interviewing, and successfully experienced women may need only minimal breastfeeding counseling.

Physical women, emotional men: gender and sexual satisfaction in midlife.

In late midlife, heterosexual women report markedly lower levels of sexual satisfaction than heterosexual men. This article explored the social factors contributing to this difference, using data from 1,035 sexually-active heterosexual adults, aged 40-59 years, who participated in the National Health and Social Life Survey (NHSLS). Conducted in 1992, NHSLS interviewed a nationally representative random sample of U.S. adults about diverse aspects of sexual life (Laumann et al., 1994, The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press). Contrary to gender stereotypes, women's emotional satisfaction was closely associated with bodily sexual practices, whereas men's physical pleasure was linked to relational factors. Lower levels of sexual satisfaction at older ages appeared to stem from differences between the Baby Boom and older generations rather than from aging per se.

Sex, drugs, and politics: the HPV vaccine for cervical cancer.

HPV is the most common sexually transmitted infection in the world. While most strains are relatively harmless, some increase a woman's risk of developing cervical cancer. This article explores the intimate, contested relationships among etiologies of cervical cancer, development and use of the new HPV vaccine, and contested notions of sexuality. We particularly focus on shifts in US health care and sexual politics, where the vaccine has animated longstanding concerns about vaccination (e.g. parental rights, cost, specialisation) and young women's bodies and behaviour. We conclude that vaccines are a distinctive kind of pharmaceutical, invoking notions of contagion and containment, and that politics shape every aspect of the pharmaceutical life course.