Sexual Trajectories of Lesbian, Gay, and Bisexual Adults in the Netherlands.

Studies on sexual trajectories of lesbian, gay, and bisexual (LGB) people generally focus on the first same-sex attraction and sexual experience, and their relation to self-identification and coming out as LGB. Relational and opposite-sex experiences are generally not taken into account. The aim of this study was to provide a more comprehensive overview of LGBs' sexual trajectories and to distinguish subsamples with different trajectories. A sample of same-sex attracted members of an online research panel (N = 3054) completed a sexual health questionnaire, including items about the timing of sexual and relational milestones. Results showed that the majority of gay men and lesbian women had same-sex sexual and relational experiences, whereas most bisexual men and women had had experiences with the opposite sex. Among gay men and lesbian women, two trajectories emerged, differing mainly on whether people had been sexually or romantically involved with opposite-sex partners, and on age of first same-sex attraction. Among those who were not exclusively attracted to the same sex, six patterns emerged, which differed especially with regard to the nature and comprehensiveness of their same-sex experiences. Within the exclusively same-sex attracted group, the trajectory with no heterosexual experiences related to higher levels of psychological adjustment. For non-exclusive sexually attracted people, trajectories including experience of same-sex relationships seem to be most beneficial. In conclusion, both relational and opposite-sex experiences proved to be important elements of LGB men and women's sexual trajectories.

Chlamydia screening and prophylactic treatment in termination of pregnancy clinics in the Netherlands and Great Britain: a qualitative study.

BACKGROUND: Women having a termination of pregnancy (TOP) have higher rates of Chlamydia trachomatis (CT) than the general population. In this study, we explored CT treatment and prevention in Dutch TOP clinics in comparison to that provided in Great Britain (GB). METHODS: A qualitative study including 14 semi-structured interviews with health care professionals (HCPs) in TOP clinics (the Netherlands: 9, GB: 5). Interviews were recorded, transcribed, and analysed by thematic content analysis. RESULTS: Prophylactic treatment with azithromycin is routinely prescribed after surgical TOP, but not after medical TOP ('abortion pill'). Sexually transmitted infections (STI) tests are offered to clients who are considered at high risk of having STI. Uptake varies according to health insurance coverage of STI testing. Some Dutch clinics are able to provide free testing for women under 25 years of age. Sexual health counselling is often limited to discussing birth control. The major difference between the Netherlands and GB is that GB TOP clinics more often offer free STI testing and prophylaxis to their clients. CONCLUSION: HCPs in Dutch TOP clinics consider STI testing an important part of their service, but financial barriers prevent testing on location. Dutch TOP clinics should offer STI tests to all women, and collaboration with public health services could improve STI testing and counselling for young people. Furthermore, clinics should treat all TOP clients with prophylactic azithromycin. This could prevent CT and other upper genital tract post-abortion infections.

Decision-making concerning unwanted pregnancy in general practice.

BACKGROUND: In the Netherlands, termination of pregnancy is legal under well-defined conditions. Before undergoing the procedure, women have to observe a 5-day 'reflection period'. The official start of this period has to be established by a medical doctor, most frequently the GP. OBJECTIVE: To provide insight into the elements of counselling by GPs regarding unwanted pregnancies and the relationship between GP-reported elements of counselling and whether women change their minds concerning their wish for pregnancy termination or vice versa. METHODS: Data were collected via the registration system of the NIVEL Primary Care Database Sentinel Practices from 2004 to 2010. Standardized registration forms were used to collect data on unwanted pregnancy consultations. The data were analysed by chi-square analyses and logistic regression methods. RESULTS: Most women who consulted their GPs for unwanted pregnancy opted for an abortion and did not change their minds. Approximately one in six patients were undecided. Of the women who had made up their minds, 8% altered their decision after consultation with their GP. Women with a higher gestational age and those who discussed alternatives with their GP were more likely to change their minds after consulting their GP. Women who were referred to an abortion clinic were less likely to change their minds. CONCLUSION: In the case of unwanted pregnancy, discussion of all options in a protocolized way by the GP may support patients in their decision-making. Additional training of GPs may enhance awareness of the possible benefits of abortion counselling for the patients.

Intention to use emergency contraceptive pills and the role of knowledge in a Dutch national sample.

OBJECTIVES: Emergency contraceptive pills (ECPs) are underused for preventing unintended pregnancy. Not all women are willing to use them even when at risk of conceiving. This paper examines whether increased knowledge about ECPs may increase the intention to use these products. METHODS: Factors associated with intention to use emergency contraception (EC) were assessed among 1310 women who participated in the nationally representative Sexual Health in the Netherlands 2009 Survey. Logistic regression models included demographics, prior use of ECPs, and ECP knowledge. RESULTS: Seventeen percent of the women did not intend to use EC after unprotected sexual intercourse and a further 27% were unsure whether they would use it. Intention is most strongly related to prior use and not having children. Only two of six knowledge items were related to intention in the multivariate analyses. Being aware that ECPs can be obtained without prescription upgrades intention, whereas knowing that a woman can still get pregnant after having taken the ECP has a negative impact on intention. CONCLUSIONS: Improving knowledge may contribute to intention to use EC, but its role will be modest. To understand the reasons behind ECP use it is essential to study the contribution of other factors, like attitudes and social norms.

Skipping the pill-free interval: data from a Dutch national sample.

INTRODUCTION: A monthly pill-free interval is unnecessary and many women prefer to have fewer bleeding episodes. METHODS: Eight hundred eighteen oral contraceptive pill (OCP) users reported frequency of skipping the pill-free interval in the online 2011 Sexual Health in the Netherlands Survey. Demographics of women who skipped pill-free intervals regularly were compared to those of women who rarely skipped intervals. RESULTS: 73% of the women have ever skipped pill-free intervals and 38% do so regularly. Women of Dutch or Western origin and non-religious women skip intervals more frequently, but differences are small. DISCUSSION: Skipping pill-free intervals is common, even when it is not actively promoted. IMPLICATIONS: Women who use OCPs can and do skip pill-free intervals, either with or without consulting a physician. If bleeding preferences were structurally discussed with patients, the number of women who skip intervals may increase even further.

Characteristics of women who have repeat abortions in the Netherlands.

OBJECTIVES: To explore the demographic characteristics of women having multiple abortions, in order to identify abortion clients who might be at increased risk of repeat abortion. METHODS: On the basis of the registration data of most Dutch abortion clinics, responsible for 64% of all such procedures, women who procured a first abortion were compared to those who had one or more previously. Results of bivariate analyses and a multivariate binary logistic regression analysis are presented. RESULTS: Of all abortions, 36% were repeat abortions. Women aged over 20 were more likely to have repeat abortions, as were migrants, particularly those with a Caribbean background (from Surinam or the Netherlands Antilles) and women who had children. Effect sizes of other factors were very small. Surprisingly, women who had repeat abortions more often used contraception in the preceding six months than women who had a first abortion, but also this effect size was small as well. A multivariate logistic regression analysis led to similar results. CONCLUSIONS: Abortion clients with a Caribbean background should be targeted for the prevention of more unwanted pregnancies. Not only should the use of reliable contraception be promoted, but also compliance and continuation.

Ethnicity, gender socialization, and children's attitudes towards gay men and lesbian women.

The aim of the present study was to assess whether children's attitudes towards gay men and lesbian women differ in relation to their ethnic backgrounds, and whether ethnic differences are a result of perceived differential gender socialization practices. Data were collected from children in eight Dutch elementary schools by means of a paper-and-pencil questionnaire administered in the classroom. All children (mean age 11.47; N = 229) lived in the Netherlands; 50.2% had non-Western and 49.8% Western ethnic backgrounds. Children with non-Western ethnic backgrounds reported more negative attitudes towards gays and lesbians. These children perceived more parental pressure to behave in accordance with their gender and showed more negative attitudes towards gender-nonconforming behaviour by peers. Hierarchical regression analyses revealed that cultural differences in attitudes towards gay men and lesbian women are partly mediated by differentially perceived parental pressure to behave in accordance with their gender.

Young Dutch people's experiences of trading sex: a qualitative study.

In recent years, the subject of transactional sex among young Dutch people has generated a heated social debate in the Netherlands. However, accurate data on this phenomenon are scarce. This article describes the findings of a qualitative study on young Dutch people's experiences of having sex in return for money or a material reward. Thirty in-depth interviews were conducted with young Dutch men and women aged 14 to 24. Participants came from diverse backgrounds in terms of gender, ethnicity, sexual orientation, and socioeconomic status. Experiences of trading sex differed in terms of the motivation to trade sex, the presence or absence of coercion, and the availability of other options for earning money. Participants' feelings about their experiences varied. For most participants, the sex itself was unpleasant and required considerable emotion management. Still, some felt adequately compensated by the reward or felt trading sex was preferable to other jobs. Gender played an important role, with feelings of disgust or shame reported especially by female participants, whereas male participants reported more positive experiences. Interactions involving coercion or financial dependence on trading sex generally had a negative emotional impact. Participants stressed the differences between their own experiences and professional prostitution.

Self-administration of C1-inhibitor concentrate in patients with hereditary or acquired angioedema caused by C1-inhibitor deficiency.

BACKGROUND: Administration of C1-inhibitor concentrate is effective for prophylaxis and treatment of severe angioedema attacks caused by C1-inhibitor deficiency. The concentrate should be administered intravenously and hence needs to be administered by health care professionals, which might cause considerable delay in treatment and inconvenience for patients. OBJECTIVE: The aim of this study was to investigate the feasibility, efficacy, and safety of on-demand and prophylactic self-administration of C1-inhibitor concentrate in patients with frequent attacks of angioedema. METHODS: Patients with hereditary or acquired C1-inhibitor deficiency who had very frequent angioedema attacks were trained to self-administer C1-inhibitor concentrate. The study consisted of 31 patients using on-demand treatment and 12 patients using prophylaxis with C1-inhibitor concentrate. Mean follow-up was 3.5 years. RESULTS: All patients were capable of self-administering the concentrate, with technical failure rates of self-injection being less than 2%. Times between the onset of the attack and the initiation of relief or complete resolution of symptoms in the on-demand group were significantly shortened (2.2 hours and 7.9 hours, respectively) compared with the situation before the start of self-administration. In the prophylaxis group self-administration of C1-inhibitor concentrate decreased the angioedema attack rate from 4.0 to 0.3 attacks per month. CONCLUSION: Intravenous self-administration of C1-inhibitor concentrate is a feasible and safe option and results in more rapid and more effective treatment or prevention of severe angioedema attacks in patients with C1-inhibitor deficiency. CLINICAL IMPLICATIONS: Self-administration of C1-inhibitor concentrate could be a valuable and convenient treatment modality to prevent or treat angioedema attacks in patients with C1-inhibitor deficiency.