HIV infection and STI in the trans population: a critical review.

BACKGROUND: Based on the scarcity of existing data in France, the objective of this critical review of the literature is to assess the available data on HIV infection and STIs and their major risk factors among the transgender population around the world. METHODS: Papers published from 1986 to 2008 were selected in PubMed and Ovid using the following keywords in the title: "female-to-male", "male-to-female", "transsexualism", "Gender Identity Disorder", and the keywords "transsexualism", and "transgender". A second manual selection was carried out with the keywords "HIV", "AIDS", and "STI". A few non-indexed references were also included. Overall, 124 references were selected, most of them reporting studies in the United States. RESULTS: This review provides evidence of the difficulties related to establishing a consistent and consensual definition of the transgender population and its different subgroups and also to identifying its sociodemographic characteristics. It shows the diversity of risk factors and the risk for HIV infection and STIs, which endanger the different subgroups of this population to different degrees. Belonging to an ethnic minority, international migration, social instability, and participation in sex work are the major risk factors for this population. Taking into account that all transgender individuals are not exposed in the same proportions to HIV and STI risks, it is recommended that more social and epidemiological work be developed, which would more accurately consider all the characteristics of this population and the high-risk situations to which it is exposed.

[The sexuality of HIV-infected-adolescents: literature review and thinking on the unthinkables of sexuality]. / La sexualité des adolescents séropositifs : analyse de la littérature et réflexion sur les impensés de la sexualité

The objective of this review was to analyze the scientific literature on the sexuality of HIV-positive adolescents. The first point was to identify how sexuality is addressed and secondly the impact of HIV infection on HIV-positive adolescents. Fifty-four articles were selected for this review. The review demonstrates that sexuality is mainly considered under the angle of sexual and reproductive behavior and preventive practices (condom use and contraception), based on questionnaire studies. Some studies investigated the physiological impact of HIV and its treatment, especially in relation to puberty. On the other hand, the subjective experience of an HIV-positive status among adolescents was rarely studied. Overall, HIV has a negative impact on the sexual life of HIV-positive adolescents. The vast majority of them practice sexual abstinence, notably adolescents infected through mother-to-child contamination, for whom the access to sexuality seems to be delayed. Among those who are sexually active, nearly one-half continue having unprotected sex. The problems related to living with HIV induce a climate of anxiety and dissatisfaction that affects behaviors and sexual practices, and disrupts the quality of sexual life. Some results suggest that the type and mode of contamination has an effect on the general sexual experience of being an HIV-positive adolescent. More research should be developed to study the subjective experience of HIV-positive adolescent sexuality and its impact on sexual experience according to the type of contamination in this population.

Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: results of a French exploratory survey.

OBJECTIVE: The objective of this study was to assess the prevalence and associated factors of sexual activity, sexual problems or sexual satisfaction in French early-stage breast cancer survivors (BCS). METHODS: Eight hundred and fifty eligible, post-treatment (6 months-5 years) female patients, aged 18-70 years, randomly selected from a consultation list, were invited to fill in questionnaires exploring quality of life (EORTC QLQ-C30 and QLQ-BR23), body image scale, and sexuality (Sexual Activity Questionnaire-SAQ; Relationship and Sexuality Scale; French Sexual Behaviour Survey-CSF). RESULTS: Fifty-three percent of BCS agreed to participate. Participating women (n=378) were younger, more often premenopausal at diagnosis and with a more recent diagnosis than non-respondents. The prevalence of sexual problems was significantly higher in BCS compared with adjusted data from a French female representative sample (p<0.0001). In logistic regression, no sexual activity (R(2) =0.37) or sexual dissatisfaction (R(2) =0.28) were associated with the feeling of emotional separation in the couple or of partner's fear of sexual intercourse, lower emotional functioning, poorer body image, or co-morbidities. In sexually active women (71% of respondents), lower frequency of sexual activity (R(2) =0.26), lower sexual pleasure (R(2) =0.22), or higher sexual discomfort (R(2) =0.22) were associated with the feeling of emotional separation in the couple or of partner's fear of sexual intercourse, lower emotional functioning, age (>50 years), nausea, or insomnia (all Hosmer-Lemeshow tests: p=NS). CONCLUSIONS: Psychological factors including the perception of the couple relationship appeared prominent in BCS women's experience of sexual problems.

[The influence of technical products on sexual activity and gender relations: oral contraceptive, condom, oral treatments of sexual disorders]. / Les objets techniques de la sexualité et l'organisation des rapports de genre dans l'activité sexuelle: contraceptifs oraux, préservatifs et traitement des troubles sexuels.

Over the past fifty years, sexuality has been marked by an increasing interest in sexual and reproductive health. This progression can be seen in changes in legislation, in social norms, in sexual practices and in gender relations. It is also characterised by the introduction and use of various technical products, which have a direct impact on both sexual activity and its consequences: contraception, methods of sexually transmissible infections prevention and treatment for male impotence. Irrespective of their usefulness or their technical effectiveness, these different products are endowed with a symbolic identity that reflects dominant representations of sexuality and the sexual roles of men and women. An analysis of the way in which these products are used illustrates how they have contributed to the development of scenarios of sexual relations, by distributing specific roles to men and to women. Three models of sexuality associated with each product have been analysed: liberated sexuality, protected sexuality, and functional sexuality.

Sexology as a profession in the United Kingdom.

To identify clinicians working within the field of sexual and psychosexual medicine and to identify and quantify the diversity of problems seen by specialist physicians, nurses and therapists working in the UK and compare these with French clinicians, a prospective 89 item questionnaire was sent to 2352 practitioners in the UK. Eight hundred and fourteen completed questionnaires were returned detailing clinician practice and training and the presenting problems of patients in their clinical practice. The commonest presenting problem amongst men was erectile dysfunction (562/814) followed by emotional and relational problems. The commonest problem for women was loss or absence of sexual desire and was of a similar magnitude to that of erectile dysfunction in men. The substantial majority of clinicians working with patients and clients with sexual problems are non-physicians from a diverse professional training background which contrasts with a high number of physicians in France. The high incidence of emotional and relational problems in both men and women would suggest that clinical services require considerable psychotherapeutic consultation space within the service provision.

[The impact of infertility and its treatment on sexual life and marital relationships: review of the literature]. / L'impact de l'infertilité et de ses traitements sur la vie sexuelle et la relation de couple: revue de la littérature.

This paper reviews the literature on the psychosocial impact of infertility and its treatments by the ART on the marital sexuality, by paying special attention to the relationship between gender and the infertility experience. It is convenient to divide this literature into articles that explore the sexual life of the infertile couples on the one hand, and those focusing on the couple relationship - marital satisfaction and marital adjustment-, on the other hand. The literature on the infertile couples' sexuality and sexual satisfaction, mostly descriptive, presents infertility as a deleterious experience for both women and men even if the repercussion differ according to gender, with correlative dynamic effects within the couple. The contributions to the investigation of the couple relationship, mostly quantitative Anglo-Saxon studies, have produced equivocal or contradictory results concerning the satisfaction with the relationship, the closeness between the two partners so that it is difficult to assume a trend in this field. This situation is largely due to the problems of sampling. In this view, future research should perform its methodological apparatus to take into account the processual nature of the infertility experience, at both levels of couple history and its involvement in the ART process.

Sexual dysfunction in 156 ambulatory HIV-infected men receiving highly active antiretroviral therapy combinations with and without protease inhibitors.

We conducted a cross-sectional study of 156 ambulatory HIV-infected homosexual or bisexual men to assess and compare the prevalence and characteristics of sexual dysfunction according to treatment combinations (group A, protease inhibitor [PI] treatment; group B, no PI treatment; and C, PI treatment interrupted >1 month previously). The study was based on a self-administered 163-item questionnaire that included a French translation of the International Index of Erectile Function, five sections of the Derogatis Sexual Functioning Inventory, and open questions. Data analysis was performed using Mann-Whitney and Kruskal-Wallis H nonparametric tests (quantitative values) and chi2 tests (qualitative values) using SPSS software (SPSS, Chicago, IL, U.S.A.). One hundred fifty-six patients completed the study. The median age +/- SD of the patients was 40.5 +/- 7.7 years, and the median CD4+ cell count +/- SD was 415 +/- 236/mm3. One hundred eleven (71%) of 156 patients reported some degree of sexual dysfunction since the beginning of their treatment (65 [71%] of 91 group A patients; 15 [65%] of 23 group B patients; and 31 [74%] of 42 group C patients), with no significant difference among the groups. Of the 111 patients, 99 (89%) reported decrease or loss of libido, 76 (68%) reported orgasmic perturbation, 96 (86%) reported erectile dysfunction, and 65 (59%) reported ejaculation perturbation, with no significant difference among the three groups. There were no significant differences among the three groups regarding the International Index of Erectile Function and Derogatis Sexual Functioning Inventory scores. These data suggest that PI-based therapy does not seem to increase sexual dysfunction in this patient population.

Sterilisation and sexuality in the mentally handicapped.

This article analyses the historical and psychosocial background of the sterilisation of mentally handicapped individuals in France and investigates the relationship between their sexuality and their sterilisation. Sterilisation of the mentally handicapped has been used as a method for controlling their sexual activity. The processes and situations leading to the sterilisation of the mentally handicapped are described and discussed.

Coping with the sexuality of the disabled: a comparison of the physically disabled and the mentally retarded.

Taking as a starting point, papers on sexuality of disabled people and papers on attitudes and representations toward their sexuality, we have demonstrated that the coping of those people is directed by an ideology of rationalisation of sexuality. This ideology is expressed in different ways, with physically disabled and mentally retarded people. This fact makes clear the importance of the handicapped referent over the coping. Procreation is strongly supported for the physically disabled people (paraplegics). Mentally retarded people are strictly forbidden to procreate: this appears especially with the sterilisation of mentally retarded women.