Taking their wellbeing into their own hands: Self-educated and peer-recommended techniques used by women with breast cancer to improve sexual functioning during treatment and in survivorship.

OBJECTIVE: Coping with sexual dysfunction during and after breast cancer treatment is a persistent challenge for many women, even with clinician-offered standard sexual rehabilitative therapies (i.e., lubricants, counseling). This study sought to explore how women with breast cancer supplement clinician recommendations with self-discovered and peer-recommended techniques for improving sexual functioning and provide insight into how well they work. METHODS: Adult women with stage I-IV breast cancer were recruited to participate in a one-time online survey via Breastcancer.org. Thematic analysis identified emergent domains and themes focused on techniques for improving sexual function during and after treatment. Frequencies were calculated to quantify technique sources and perceived efficacy levels. RESULTS: Of 501 women responding to the survey, mean age was 53 years (range 30-79). Overall, 34.7% reported using a technique they discovered themselves or that was recommended by someone other than a clinician to improve sexual functioning. Four main themes regarding techniques included: 1) pain reduction, 2) intimacy and relationship enhancement, 3) desire and arousal enhancement, and 4) emotional coping. Most women discovered coping techniques without the help of clinicians, and 45.7% of women rated their techniques as moderately or more effective when used in addition to or instead of standard techniques offered by clinicians. CONCLUSIONS: Our study provides insight into how women with breast cancer successfully cope with sexual dysfunction symptoms during and after treatment. To fully understand and share patients' innovative techniques for coping with these symptoms, clinicians should foster open discussion about the potential for dysfuction and treatment for these symptoms, as well as avenues of peer-supported discussion to promote coping self-education and discovery.

Vaginal Squirting: Experiences, Discoveries, and Strategies in a U.S. Probability Sample of Women Ages 18-93.

Vaginal squirting is a phenomenon in which women expel fluid during the sexual response process, but it remains poorly understood in the extant literature. The study purpose was to use nationally representative data to investigate adult women's experiences with vaginal squirting. We assessed the prevalence of women who have ever squirted in their lifetime, the level of pleasure and concurrency of orgasm women reported during squirting, the ways in which women discovered squirting, and the challenges and/or concerns women experience with squirting. Forty percent of U.S. adult women (M = 47.6 years, SD = 16.8; Md = 24 years) had ever squirted in their lifetime (Md frequency = three to five times). Two thirds of women reported unintentional discovery of squirting, and most (75%) used specific techniques to promote build up and release of squirting versus squirting spontaneously. About 60% of participants reported squirting to be very or somewhat pleasurable, but only 20% "always" experienced squirting and orgasm together. Women reported different challenges with squirting, such as the time required to reach squirting or the experience being too emotionally intense. Our findings contribute to the growth of much needed, detailed literature on the ways in which women discover and enjoy squirting as part of their sexual lives. Knowledge of these techniques can enable women to better identify their own preferences, communicate about them with their partners, and advocate for their sexual pleasure.

Women's techniques for pleasure from anal touch: Results from a U.S. probability sample of women ages 18-93.

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to experience pleasure from anal touch. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified three previously unnamed, but distinct, anal touch techniques that many women find pleasurable and that expand the anal sexual repertoire beyond the more commonly studied anal intercourse behaviors: Anal Surfacing, Anal Shallowing, and Anal Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report-a cross-sectional, online, national probability survey of 3017 American women's (age 18-93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 40% of women find 'Anal Surfacing' pleasurable: sexual touch by a finger, penis, or sex toy on and around the anus. Approximately 35% of women have experienced pleasure using 'Anal Shallowing': penetrative touch by a finger, penis, or sex toy just inside the anal opening, no deeper than a fingertip/knuckle. Finally, 40% of women make other forms of sexual touch more pleasurable using 'Anal Pairing': touch on or inside the anus that happens at the same time as other kinds of sexual touch such as vaginal penetration or clitoral touching. These data provide techniques that women can and do use to explore the anus as a pleasurable region for touch-which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

"OMG, Yes!": Feasibility, Acceptability, and Preliminary Efficacy of an Online Intervention for Female Sexual Pleasure.

The purpose of this study was to evaluate the acceptability, feasibility, and preliminary efficacy of using an online educational resource that presents research-informed strategies for women's pleasure, OMGyes.com, as a resource to empower women to broaden the ways in which they understand, advocate for, and enjoy sexual pleasure. A cohort of 870 adult women was given access to OMGyes.com and asked to explore the resource over a four-week period and complete online pre/post questionnaires. Participants reported a high level of satisfaction with the relatability, usefulness, and functionality of OMGyes.com. We observed statistically significant, large effect size increases in participants' knowledge about their own pleasure preferences, their confidence and positivity about that knowledge, as well as how pleasurable their sexual experiences were during both masturbation and partner sex. Many participants reported that after using OMGyes.com they felt more motivated to explore their preferences and more confident to explain their preferences to their partners. Our data suggest that OMGyes.com may be useful for positively impacting how women think about sexual pleasure, how they understand their own specific preferences, how they advocate for what they enjoy with partners, and how they actually experience pleasure.

Women's techniques for making vaginal penetration more pleasurable: Results from a nationally representative study of adult women in the United States.

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to make vaginal penetration more pleasurable. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified four previously unnamed, but distinct, techniques women use to make vaginal penetration more pleasurable: Angling, Rocking, Shallowing and Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report-a cross-sectional, online, national probability survey of 3017 American women's (age 18-93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel®. Data suggest that 87.5% of women make vaginal penetration more pleasurable using 'Angling': rotating, raising, or lowering the pelvis/hips during penetration to adjust where inside the vagina the toy or penis rubs and what it feels like. Approximately 76% of women make vaginal penetration more pleasurable using 'Rocking': the base of a penis or sex toy rubbing against the clitoris constantly during penetration, by staying all the way inside the vagina rather than thrusting in and out. About 84% of women make vaginal penetration more pleasurable using 'Shallowing': penetrative touch just inside of the entrance of the vagina-not on the outside, but also not deep inside-with a fingertip, sex toy, penis tip, tongue, or lips. Finally, 69.7% of women orgasm more often or make vaginal penetration more pleasurable using 'Pairing': when a woman herself (Solo Pairing) or her partner (Partner Pairing) reaches down to stimulate her clitoris with a finger or sex toy at the same time as her vagina is being penetrated. These data provide techniques that are at women's disposal to make penetration more pleasurable-which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

Psychological well-being as part of the public health debate? Insight into dimensions, interventions, and policy.

BACKGROUND: Increasing evidence suggests that psychological well-being (PWB) is associated with lower disease and mortality risk, and may be enhanced with relatively low-cost interventions. Yet, dissemination of these interventions remains limited, in part because insufficient attention has been paid to distinct PWB dimensions, which may impact physical health outcomes differently. METHODS: This essay first reviews the empirical evidence regarding differential relationships between all-cause mortality and multiple dimensions of PWB (e.g., life purpose, mastery, positive affect, life satisfaction, optimism). Then, individual-level positive psychology interventions aimed at increasing PWB and tested in randomized-controlled trials are reviewed as these allow for easy implementation and potentially broad outreach to improve population well-being, in concert with efforts targeting other established social determinants of health. RESULTS: Several PWB dimensions relate to mortality, with varying strength of evidence. Many of positive psychology trials indicate small-to-moderate improvements in PWB; rigorous institution-level interventions are comparatively few, but preliminary results suggest benefits as well. Examples of existing health policies geared towards the improvement of population well-being are also presented. Future avenues of well-being epidemiological and intervention research, as well as policy implications, are discussed. CONCLUSIONS: Although research in the fields of behavioral and psychosomatic medicine, as well as health psychology have substantially contributed to the science of PWB, this body of work has been somewhat overlooked by the public health community. Yet, the growing interest in documenting well-being, in addition to examining its determinants and consequences at a population level may provoke a shift in perspective. To cultivate optimal well-being-mental, physical, social, and spiritual-consideration of a broader set of well-being measures, rigorous studies, and interventions that can be disseminated is critically needed.

Sexual Function among Women in Midlife: Findings from the Nurses' Health Study II.

BACKGROUND: Women's sexual well-being is an important determinant of overall health and quality of life across the life course. Yet the factors associated with women's levels of sexual activity and sexual function in midlife are little understood. This study sought to assess the prevalence of recent sexual activity and sexual dysfunction symptoms among middle-aged women and evaluate the associations of partner status, menopause, and health status factors with sexual dysfunction. METHODS: Participants of this cross-sectional study were 68,131 women who responded to the 2013 Nurses' Health Study II observational cohort questionnaire when they were age 48-68 years. Sexual activity and dysfunction symptoms were assessed with the Female Sexual Function Index. Age-adjusted multivariable regression models estimated risk ratios for the association of health-related factors with past month sexual dysfunction symptoms among women who were sexually active over the past month, overall and stratified by partner status. RESULTS: Of middle-aged women participants, 73% were sexually active (n = 49,701) and 50% of sexually active women reported symptoms of sexual dysfunction. Symptoms of sexual dysfunction were less common among unpartnered than partnered women (42% vs. 51%; p < .0001). A positive association between menopause and sexual dysfunction was greater for unpartnered women (risk ratio, 2.37, 2.99; p < .001) than partnered women (risk ratio, 1.89, 2.00; p < .001). CONCLUSIONS: Difficulty with sexual function is common among women in midlife, but less so than previously estimated. Regular monitoring of women's sexual function could enable clinicians to offer women timely, supportive interventions tailored by partner status and menopausal status.

Identifying distinct trajectories of change in young breast cancer survivors' sexual functioning.

OBJECTIVES: To identify and characterize distinct trajectories of change in young women's sexual functioning over the first 5 years following breast cancer diagnosis. METHODS: Group-based trajectory modeling was applied to the sexual functioning of 896 women diagnosed with stage I-IV breast cancer at age 40 or younger. The Cancer Rehabilitation Evaluation System was used to evaluate women's symptoms of sexual dysfunction annually for 5 years. RESULTS: Five distinct trajectories of sexual functioning were identified: one asymptomatic, one minimally symptomatic, two moderately symptomatic, and one severely symptomatic trajectory. Twelve percent of women were asymptomatic throughout follow-up. The plurality of women experienced stable mild symptoms (42%). Among those with moderate symptoms, some experienced improvement over time (22%) while others experienced deterioration (13%); 11% experienced stable severe symptoms that did not remit over time. Independent predictors of experiencing a symptomatic rather than asymptomatic trajectory (P < 0.05, two-sided) included diagnosis with stage 2 versus 1 disease, ER positive disease treated with oophorectomy or ovarian suppression, being partnered, having anxiety, poorer body image, and greater musculoskeletal pain. CONCLUSIONS: We identified distinct trajectories that describe the reported sexual symptoms in this cohort of young breast cancer survivors. The majority of women reported various degrees of sexual dysfunction that remained stable over the study period. There is, however, potential for improvement of moderate and severe symptoms of sexual dysfunction in early survivorship.

A Next Generation Assets-Based Public Health Intervention Development Model: The Public as Innovators.

In the public health field, the design of interventions has long been considered to be the province of public health experts. In this paper, I explore an important complement to the traditional model: the design, prototyping, and implementation of innovative public health interventions by the public (users) themselves. These user interventions can then be incorporated by public health experts, who in turn design, support, and implement improvements and diffusion strategies as appropriate for the broader community. The context and support for this proposed new public health intervention development model builds upon user innovation theory, which has only recently begun to be applied to research and practice in medicine and provides a completely novel approach in the field of public health. User innovation is an assets-based model in which end users of a product, process, or service are the locus of innovation and often more likely than producers to develop the first prototypes of new approaches to problems facing them. This occurs because users often possess essential context-specific information about their needs paired with the motivation that comes from directly benefiting from any solutions they create. Product producers in a wide range of fields have, in turn, learned to profit from the strengths of these user innovators by supporting their grass-roots, leading-edge designs and field experiments in various ways. I explore the promise of integrating user-designed and prototyped health interventions into a new assets-based public health intervention development model. In this exploration, a wide range of lead user methods and positive deviance studies provide examples for identification of user innovation in populations, community platforms, and healthcare programs. I also propose action-oriented and assets-based next steps for user-centered public health research and practice to implement this new model. This approach will enable us to call upon the strengths of the communities we serve as we develop new methods and approaches to more efficiently and effectively intervene on the varied complex health problems they face.

Pharmacists' perspectives on HIV testing in community pharmacies.

OBJECTIVE: To assess the feasibility, readiness, and acceptability of offering rapid human immunodeficiency virus (HIV) testing in community pharmacies. DESIGN: Qualitative study. SETTING: Community pharmacies in Indiana from May to September 2012. PARTICIPANTS: 17 licensed community pharmacists. INTERVENTION: Semistructured interviews among a convenience sample of community pharmacists. MAIN OUTCOME MEASURES: Community pharmacists' self-reported attitudes toward rapid HIV testing in community pharmacies, perceptions of peer acceptability, and opinions about readiness for implementation of the practice in community pharmacies. RESULTS: Participants accepted the idea of pharmacy-based HIV testing, describing it as accessible, convenient, and nonstigmatizing. Acceptability was closely linked to positive patient relationships and pharmacist comfort with consultation. Identified challenges to pharmacy-based HIV testing included staffing issues, uneasiness with delivering positive test results, lack of information needed to link patients to care, insufficient consulting space, and need for additional training. Participants indicated that peer beliefs about the acceptability of pharmacist-based HIV testing would vary but that more recently trained pharmacists likely would be more accepting of the practice. CONCLUSION: Most participants felt that offering HIV testing was a reasonable addition to the evolving role of the community pharmacist, pending resolution of personal and institutional barriers.

We can do more than just sell the test: pharmacist perspectives about over-the-counter rapid HIV tests.

Pharmacist attitudes about the over-the-counter (OTC) sale of HIV rapid tests in pharmacies were explored through interviews conducted among 17 licensed community pharmacists in a Midwestern, moderate HIV incidence state between May and September 2012. Participants recognized that OTC rapid HIV tests would increase the number of people aware of their HIV status. Concerns included linkage to care and results consultation for those who test HIV-positive. Point of sale was identified as an opportunity for consultation about the test and to establish a relationship for future discussion about results and linkage to care. Pharmacists could provide initial test consultation or information, and consultation about the test results in order to provide post diagnosis support and facilitate linkage to care.