"Make Sure You Wash Your Monkey": Multigenerational Vaginal Hygiene Messages from Black Women.

In the United States, the messages Black women receive about vaginal hygiene are often rooted in misogynoir. As a result, Black women across multiple generations may engage in extensive vaginal hygiene practices that are harmful to their health as a means of decreasing the potential for dehumanization or confirming racist stereotypes. The purpose of the current qualitative study is to explore the messages four generations of Black women (n = 12) received about genital hygiene and grooming and the sociocultural factors that influence these messages. Reflexive thematic analysis was used to analyze the semi-structured interview data. The following themes were identified: (1) a culture of silence, (2) knowledge acquisition, (3) pressure to maintain Black cleanliness standards, and (4) gendered racist messaging. Subthemes emerged within the knowledge acquisition theme, including learning through word-of-mouth, observation, deduction, trial and error, and direct messaging. Overall, themes and subthemes were consistent across generations; however, some differences were discussed. Participants highlighted the importance of intergenerational conversations in promoting safe vaginal hygiene practices. Recommendations for sexuality educators and healthcare professionals are discussed.

Correlates of Transactional Sex Among Black Men and Women Who Misuse Opioids.

The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t-tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed.

'Just be strong and keep going': the influence of Superwoman Schema on Black women's perceived expectations of coping with sexual pain.

Superwoman Schema, a conceptual framework that reflects Black women's ability to overcome gendered racism and stress, affects the way Black women choose to cope with health-related issues. The purpose of this study was to investigate how Black women perceive they should cope with sexual pain using the Superwoman Schema as an analytic and interpretative guide. Data were derived from participants who completed an individual interview on sexual pain and pleasure. Deductive thematic analysis was conducted. Results indicated whereas some Black women endorsed all five components of Superwoman Schema as coping strategies for sexual pain, other Black women resisted SWS completely. Additionally, one participant was an outlier and did not endorse or resist SWS. Implications for generational sexual health interventions for Black women are discussed.

The influence of pornography on heterosexual black men and women's genital self-image & grooming.

Pornography consumption may negatively impact Black men's and women's genital self-image. Poor genital self-image is linked to negative mental health outcomes and sexual dysfunction. Despite this, little work has examined genital self-image among Black men and women, a group whose genital self-image may be informed by racist-gendered stereotypes and perceived expectations for genital grooming. The purpose of this multigenerational qualitative study is to examine how pornography impacts genital self-image and grooming for Black heterosexual men and women. Semi-structured qualitative interviews were conducted with participants (n = 20) across four generational cohorts. An inductive content analysis resulted in three categories and four subcategories. All participants reported pornography consumption at some point in their lifetime. The degree of influence on their genital self-image and grooming was categorized in four ways: no influence, perceived influence, and direct influence, and resisting influence. There were four subcategories within the perceived and direct influence categories: pubic hair grooming & preferences, designer vaginas, penis size, and partnered expectations. Black men and women differed in their reported influence of porn on genital self-image and grooming. Implications of findings for pornography creators, sex educators, and sex partners are discussed.

Adverse Childhood Experiences and Psychological Correlates of Substance Use Disorders Among Black Sexual Minority Women.

This study examined the influence of adverse childhood experiences (ACEs) on Black sexual minority women's mental health and substance use disorders in adulthood. Secondary data analysis was conducted using N = 149 Black sexual minority women's reports from the Generations Study. Study variables included psychological distress, chronic strains, stressful life events, ACEs, and substance use disorders, including alcohol use disorder and drug use disorder. Quantitative data analysis consisted of descriptives and bivariate correlations. Participants' total ACE scores were positively significantly correlated with increased alcohol misuse, chronic life strains, and stressful life events. Exposure to household interpersonal violence and household mental illness during childhood were significantly correlated with alcohol misuse. Black sexual minority women with ACEs are at higher risk for mental health concerns throughout their lifespan and maladaptive coping strategies (e.g., substance use). Implications for counselors and therapists are provided.

Religion, Psychiatric Symptoms, and Gender Role Conflict Among Incarcerated Black Men.

Extant literature is mixed on the role of religiosity as a protective factor for mental health concerns and the effectiveness of faith-based prison programs on a reduction in recidivism. Religiosity and psychiatric symptoms are associated with gender role conflict, yet little is known about these relationships among Black incarcerated men. Undergirded by gender role conflict theory, this study aimed to investigate the relationship between religiosity, 30-day psychiatric symptoms, and three measures of gender role conflict: emotional restrictiveness, work-family conflict, and affectionate behavior towards men. In a sample of 206 Black men nearing community re-entry, our results indicated strong religious beliefs and psychiatric symptoms were associated with less emotional restrictiveness. Religious influence and psychiatric symptoms were positively associated with perceived work-family conflict. Further, strong religious beliefs moderated the association between psychiatric symptoms and work-family conflict. Implications for faith-based prison support programs as mechanisms for reducing recidivism among Black men are discussed.

Cultural Predictors of Self-Esteem Among Black Women With Criminal Justice Involvement and Herpes Simplex Virus.

Black women have disproportionately alarming HSV-2 infection rates yet receive little attention in sexual health literature. Using a strengths-based resilience framework, this study sought to determine culturally relevant protective predictors of self-esteem for Black women who are justice-involved and have HSV-2. The authors conducted secondary data analysis on data from the "Black Women in the Study of Epidemics (B-WISE) Project," a longitudinal prospective study investigating health disparities and health services utilization among Black women with justice involvement. At baseline, N = 151 Black women with HSV-2 who were incarcerated or on probation completed survey measures assessing self-esteem, ethnic identity affirmation and belonging, perceived social support, and John Henryism Active Coping. Hierarchical linear regression analyses revealed ethnic identity affirmation and belonging and John Henryism Active Coping were significant predictors of self-esteem at 6-month follow-up. Implications are provided for current health professionals.

'My partner will think I'm weak or overthinking my pain': how being superwoman inhibits Black women's sexual pain disclosure to their partners.

Black women experience persistent sexual pain that may often last longer than White women. Despite the value of sexual communication to alleviate sexual pain concerns, many women do not disclose sexual pain to their partners. Limited research explores barriers to disclosing sexual pain to partners among Black women. This study seeks to fill this gap. Relying on an integration of Sexual Script theory and Superwoman Schema, the study explored the barriers that premenopausal, cisgender Black women from the Southern USA perceived when disclosing sexual pain to their primary partners. We identified five common themes from women's open-ended responses to an online survey: (a) distressing emotions associated with disclosure; (b) limited knowledge and communication skills; (c) protecting partner's feelings and ego; (d) invading privacy; and (e) taking sole responsibility for managing sexual pain. Findings suggest a combination of intrapsychic, interpersonal and cultural factors influence Black women's perceived ability to have direct and open dyadic communication about sexual pain with their partners. Implications for Black women's sexual health and relationship outcomes are discussed.

"Anger, embarrassment, less than a woman": the emotional impact of Black women's sexual pain.

Limited research has examined the emotions Black women report when thinking about sexual pain. To fill this gap in the literature, we explored the types of emotions that emerged when N = 126 premenopausal Black women thought about pain during sex. Open-ended responses to the following research question were analyzed: "What feelings emerge when you think about sexual pain?" Structural tabular thematic analysis was used to find commonalities in participants' responses. Findings indicated five families, or categories, of emotions: self-judgment, anger/disgust, sadness, anxiety, and emotions felt somatically. Additionally, women's reports were predominantly within the feeling state and cognitive appraisal components of emotion. Implications for health providers and therapists are discussed.

From Sin to Sexual Self-Awareness: Black Women's Reflection on Lifetime Masturbation.

To date, there has been very little empirical research on Black women's masturbation practices and views on masturbation. This study fills the gap by exploring the messages Black women received about masturbation and self-pleasure and the sources of these messages using valence theory. Data were collected in 2021 from 242 Black women who participated in a survey during phase one of the triphasic Big Sex Study. Thematic analysis was used to analyze this short-form qualitative data. Results indicated a range of responses, with mixed messages reported more than negative, positive, and neutral messages. The three primary sources of messages were religion, family, and friends. There were several themes across the valence of messages including the development of positive messages, sexual self-awareness, masturbation as sin, health benefits and consequences, relationship difficulties, devaluation, and masturbation as dirty and gross. These results provide a basis for sexuality professionals to improve sociocultural knowledge about masturbation beliefs, practices, and message sources among Black women.

An Interpretative Phenomenological Analysis of Black Women's Meaning and Experiences of Sexual Anxiety.

Sexual anxiety can activate the stress response cycle during sex, compromising a woman's ability to experience sexual pleasure. Black women face additional cultural and contextual factors, such as hypersexualization, partner scarcity, and higher rates of sexual trauma that may increase the magnitude, frequency, and odds of experiencing sexual anxiety. However, limited research has explored this phenomenon among Black women. Thus, we sought to qualitatively explore how N = 25 premenopausal Black women living in the southern United States make meaning of experiences with sexual anxiety. We analyzed the interview data using an interpretive phenomenological approach. Three components of the phenomenon of sexual anxiety were gleaned: 1) causes of sexual anxiety, 2) characteristics of sexual anxiety, and 3) coping strategies. Each component included three to six elements of meaning making. For these Black women, causes of sexual anxiety included fears of sexual pain, partner unfamiliarity, previous traumas, mental health concerns, and intersecting socio-structural factors. Characteristics of sexual anxiety included mental, somatic, and emotional elements. Coping strategies included having a reassuring and supportive sex partner, supporting themselves with affirmations and mindfulness, attending therapy, and using substances. Through reflection about their perceived causes of, experienced characteristics of, and intentional coping with sexual anxiety, meanings were co-constructed through an intersectional frame. Implications for intersectionality-informed interventions and suggestions for mental health professionals and partners are discussed.

Social Health Care Determinants of Breastfeeding Black Women: A Multigenerational Study.

Background: Black women encounter many challenges to breastfeeding, including inequitable access to support and resources and medical racism. However, limited research investigates how Black women across generations interface with health care systems to initiate or continue breastfeeding and what factors facilitate or hinder their breastfeeding experiences. Objective: Using the social determinants of health (SDoH) theoretical framework, this study qualitatively explored how a multigenerational sample of Black mothers' interactions with health care systems facilitated or hindered their breastfeeding initiation and continuation. There were three areas of interest: (1) access and quality, (2) professional and personal support, and (3) literacy and resources. Materials and Methods: Four age cohorts and three breastfeeding length cohorts of Black mothers in Kentucky completed semi-structured interviews on their breastfeeding experiences. Responses to research questions (e.g., "What was your experience during the birthing process and how did it impact your decision to breastfeed?") informed by the SDoH were analyzed using thematic analysis. Results: Four themes emerged on how experiences within health care systems influence Black women's breastfeeding initiation and continuation: (1) health care access, (2) health care quality/bias, (3) health care-related support, and (4) health care resource use. Conclusions: Interpersonal and systemic barriers in health care related to access, quality, support, and resources hindered Black mother's breastfeeding across generations. Mothers across each age and breastfeeding cohorts emphasized a need for culturally tailored pro-breastfeeding health care systems to meet their breastfeeding needs.

"Why Would I Talk To Them About Sex?": Exploring Patient-Provider Communication Among Black Women Experiencing Sexual Pain.

Ineffective patient-provider communication poses a potential health risk to Black women if medical providers are not addressing their needs or concerns. Additionally, less than half of OBGYNs report asking their patients about sexual difficulties, which limits women's opportunities to disclose their experiences of sexual pain. The purpose of this qualitative study is to explore Black women's experiences of patient-provider communication about sexual pain (reoccurring unwanted genital pain). Specifically, we aimed to describe the pathway from sexual pain disclosure to treatment among N = 25 premenopausal Black women living in the southern United States who were experiencing sexual pain. Using constructivist grounded theory, open-ended responses to six interview questions related to healthcare experiences, treatment, and patient-provider communication were qualitatively analyzed and categorized to form a conceptual framework of patient-provider communication about sexual pain. Five key categories emerged related to Black women's experiences with their medical providers regarding sexual pain: (1) provider preferences, (2) healthcare experiences, (3) reasons for non-disclosure, (4) provider responses to sexual pain, and (5) treatment for sexual pain. Useful strategies to improve patient-provider communication are presented for both patients and providers.

"Can we get a Black rehabilitation center"? Factors impacting the treatment experiences of Black people who use opioids.

INTRODUCTION: With opioid overdose rates doubling in the state of Kentucky over the last year, the opioid crisis is having a deadly impact on the state. Among Black individuals in particular, overdose rates have increased by nearly a third. As such, we must examine ways to effectively intervene to reduce deaths among this underrepresented population. METHOD: The current study utilized a thematic analysis to examine factors influencing treatment perceptions and experiences among a sample of 39 Black adults with a recent history of opioid use. RESULTS: The primary themes highlighted in the study included "autonomous accessibility," "provider characteristics," and "relational support," which are aligned with Self-Determination Theory. CONCLUSIONS: We discuss how these themes relate to treatment initiation, engagement, and completion and discuss implications of this research in treatment for Black adults. Specifically, we discuss treatment considerations among Black adults who use prescription opioids such as ensuring autonomy and a collaborative approach to treatment, especially in mandated treatment, with strategies such as motivational interviewing. Further, we discuss the importance of nonjudgmental providers, gauging client preferences for racially, ethnically, and gender matched providers; and we assess support networks among clients and how these networks can be integrated or utilized in treatment planning.

Black sexual minority women's social well-being and psychological distress.

Black sexual minority women (SMW), the largest racial group among the sexual minority community, often report high psychological distress and decreased psychological health and social well-being. Strong, positive, social relationships positive within group identities, and support networks are a key component in coping with minority stressors and promoting overall well-being. This study explored the association between minority stressors, social support, and Black SMW's social well-being and psychological distress. Participants consisted of individuals identifying as Black (including biracial identities, n = 48) cisgender women (N = 149) who responded to the Generations Study's initial round of surveys collected in 2016-2017. Participants were between the ages of 18-60, with a mean of 29.3 years old. Descriptive and bivariate correlations were conducted for lesbian, gay, and bisexual (LGB) stigma, internalized homophobia, gender presentation, ethnic identity affiliation, LGB community connectedness, and social support. Multiple regression models were conducted to analyze correlates of social well-being and psychological distress, controlling for age and education level. LGB stigma and internalized homophobia were significant predictors of social well-being and psychological distress. Low internalized homophobia, distress, and stigma were associated with higher social well-being as were high connection to LGB and ethnic communities. Implications for therapy are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"White people stress me out all the time": Black students define racial trauma.

OBJECTIVE: Using a constructivist-interpretivist paradigm and a Black feminist qualitative framework, this study investigated how Black students at a predominantly White university in the southeast defined racial trauma. METHOD: A purposive sample of 26 participants (10 men and 16 women, aged 18-27) participated in a semistructured interview about their definitions of race-based stress and racial trauma. Data analysis consisted of a six-phase inductive, latent thematic analysis. Researcher reflexivity, interviews, observations, and research memos contributed to trustworthiness. RESULTS: Participants' understandings of race-based stress and racial trauma-informed two composite definitions of racial trauma. Participants conceptualized racial trauma and race-based stress as related and identified three salient components of racial trauma: (a) "Sticking with": temporal component, (b) "Suffering severely": intensity component, and (c) "Repeating regularly": frequency component. CONCLUSIONS: The findings of this study contribute to the existing literature by providing an academic and community definition of racial trauma grounded in the voices of Black collegians. These definitions of racial trauma may be used to inform future research, clinical services, and outreach. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Pursuing Pleasure Despite Pain: A Mixed-Methods Investigation of Black Women's Responses to Sexual Pain and Coping.

The current mixed-methods study is the first to explore Black women's (N = 153) cognitive (e.g., worry about being perceived as sexually unresponsive) and emotional (e.g., sadness) responses to sexual pain based on age and relationship status, and coping strategies. Findings indicated significant differences in younger and single Black women's cognitive and emotional responses to sexual pain compared to older and coupled Black women. Qualitative responses revealed Black women engage in several proactive coping strategies to mitigate their sexual pain, including non-penetrative activities, foreplay, tools for increasing arousal, making physical adjustments, and intimacy and sexual communication. Implications for sexual health providers are discussed.

Balancing the sexology scales: a content analysis of Black women's sexuality research.

Existing research adopting a sex positive and intersectional framework for investigating Black women's sexualities is scarce. We conducted a 46-year (1972-2018) content analysis of sexualities research focussed on Black women. It sought to examine which sexualities topics were published most; whether the publications aligned with sex-positive, neutral or negative discourse; what methodologies were used; and differences in how various identities were investigated among Black women. Using human coding, we applied an integrative approach to the content analysis. Results found 245 articles meeting criteria. Approximately one-third of articles within the analysis focussed on the topic of sexually transmitted infections (STIs), HIV and sexual risk behaviours among Black women. Only 6.5% of articles utilised a sex-positive discourse. Quantitative articles were the most published methodology, and publications disproportionately overlooked Black women's intersectional identities. Implications for future research and practice are discussed.