Stigma on the Streets, Dissatisfaction in the Sheets: Is Minority Stress Associated with Decreased Sexual Functioning Among Young Men Who Have Sex with Men?

INTRODUCTION: Sexual function and satisfaction are understudied aspects of adolescent and young adult sexual wellbeing, and even less is known about sexual minority youth who are vulnerable to unique lesbian, gay, bisexual, and transgender (LGBT)-related stigma. AIM: We aimed to describe sexual functioning (sexual interest, erectile function, orgasm satisfaction, global satisfaction with one's sex life, and anal discomfort) and examine its associations with demographics, sexual and relationship behavior, and minority stressors (internalized stigma, victimization, microaggressions, and perceived LGBT acceptance within residential neighborhood) among a cohort of young men who have sex with men (YMSM) aged 16-29. METHODS: Data for this cross-sectional analysis came from an ongoing longitudinal study of HIV and substance use among YMSM (analytic N = 678). We conducted univariate and bivariate analyses and multivariable linear regression, controlling for age, race/ethnicity, and sexual orientation as well as sexual and relationship characteristics that were significant at the bivariate level. MAIN OUTCOME MEASURE: We assessed sexual functioning in the previous 30 days using the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Measures Brief Profile for Males. RESULTS: YMSM in our sample reported high levels of sexual functioning that were significantly greater than an adult clinical reference population. However, 13.9% of the sample reported having any difficulty with erections, 6.9% reported having less than "good" satisfaction with orgasms, 20.0% reported being "somewhat" or less satisfied with their sex lives, and 9.1% reported experiencing problems during receptive anal sex at least "sometimes." Most associations between minority stressors and sexual functioning domains that were significant at the bivariate level attenuated to non-significance in multivariable analyses. Internalized stigma remained negatively associated with global satisfaction, whereas perceived neighborhood acceptance remained positively associated with orgasm satisfaction. Being sexually active was significantly associated with increased sexual interest and orgasm satisfaction. Having had a recent serious partner was significantly associated with sexual interest and global satisfaction. Negative effects were found for having had casual partners and being HIV positive. CLINICAL IMPLICATIONS: Although most YMSM have high sexual functioning, a minority report problems and dissatisfaction that may warrant intervention. STRENGTHS & LIMITATIONS: Our study was limited by its cross-sectional design, measurement limitations, and generalizability to other populations, but it is one of the first to examine sexual functioning among YMSM, using a large, diverse community sample. CONCLUSION: Public health research and practice must continue to combat LGBT stigma and include sexual functioning as integral to healthy sexuality. Li DH, Remble TA, Macapagal K, et al. Stigma on the Streets, Dissatisfaction in the Sheets: Is Minority Stress Associated with Decreased Sexual Functioning Among Young Men Who Have Sex with Men? J Sex Med 2019;16:267-277.

Discordance of Self-report and Laboratory Measures of HIV Viral Load Among Young Men Who Have Sex with Men and Transgender Women in Chicago: Implications for Epidemiology, Care, and Prevention.

Suppressing HIV viral load through daily antiretroviral therapy (ART) substantially reduces the risk of HIV transmission, however, the potential population impact of treatment as prevention (TasP) is mitigated due to challenges with sustained care engagement and ART adherence. For an undetectable viral load (VL) to inform decision making about transmission risk, individuals must be able to accurately classify their VL as detectable or undetectable. Participants were 205 HIV-infected young men who have sex with men (YMSM) and transgender women (TGW) from a large cohort study in the Chicago area. Analyses examined correspondence among self-reported undetectable VL, study-specific VL, and most recent medical record VL. Among HIV-positive YMSM/TGW, 54% had an undetectable VL (< 200 copies/mL) via study-specific laboratory testing. Concordance between self-report and medical record VL values was 80% and between self-report and study-specific laboratory testing was 73%; 34% of participants with a detectable study-specific VL self-reported an undetectable VL at last medical visit, and another 28% reported not knowing their VL status. Periods of lapsed viral suppression between medical visits may represent a particular risk for the TasP strategy among YMSM/TGW. Strategies for frequent viral load monitoring, that are not burdensome to patients, may be necessary to optimize TasP.

Not tonight, I have a headache?

OBJECTIVE: The present study examined the relationship between the diagnosis of migraine and self-reported sexual desire. BACKGROUND: There is evidence for a complex relationship between sexual activity and headache, particularly migraine. The current headache diagnostic criteria even distinguish between several types of primary headaches associated with sexual activity. METHODS: Members of the community or students at the Illinois Institute of Technology (N = 68) were administered the Brief Headache Diagnostic Interview and the Sexual Desire Inventory (SDI). Based on the revised diagnostic criteria established by the International Headache Society (ICHD-II), participants were placed in 1 of the 2 headache diagnostic groups: migraine (n = 23) or tension-type (n = 36). RESULTS: Migraine subjects reported higher SDI scores, and rated their own perceived level of desire higher than those suffering from tension-type headache. The presence of the symptom "headache aggravated by routine physical activity" significantly predicted an elevated SDI score. CONCLUSIONS: Migraine headaches and sexual desire both appear to be at least partially modulated by serotonin (5-HT). The metabolism of 5-HT has been shown to covary with the onset of a migraine attack, and migraineurs appear to have chronically low systemic 5-HT. As sexual desire also has been linked to serotonin levels, the results are consistent with the hypothesis that migraine and sexual desire both may be modulated by similar serotonergic phenomena.

Topiramate for phantom limb pain: a time-series analysis.

There is growing evidence of topiramate's efficacy in treating neuropathic pain. This article reports a detailed analysis of the response of four amputee subjects with phantom limb pain. Individual time-series analyses revealed that three out of four amputee participants receiving topiramate had statistically significant decreases in pain, with the peak effect noted at 800 mg daily. This analysis supports a hypothesis that topiramate may be effective in reducing phantom limb pain, and suggests a definitive study is indicated.

The examination of headache activity using time-series research designs.

The majority of research conducted on headache has utilized cross-sectional designs which preclude the examination of dynamic factors and principally rely on group-level effects. The present article describes the application of an individual-oriented process model using time-series analytical techniques. The blending of a time-series approach with an interactive process model allows consideration of the relationships of intra-individual dynamic processes, while not precluding the researcher to examine inter-individual differences. The authors explore the nature of time-series data and present two necessary assumptions underlying the time-series approach. The concept of shock and its contribution to headache activity is also presented. The time-series approach is not without its problems and two such problems are specifically reported: autocorrelation and the distribution of daily observations. The article concludes with the presentation of several analytical techniques suited to examine the time-series interactive process model.

Medication Quantification Scale Version III: update in medication classes and revised detriment weights by survey of American Pain Society Physicians.

UNLABELLED: The Medication Quantification Scale (MQS) is an instrument with potential clinical and research applications for quantifying medication regimen use in chronic pain populations. The MQS was developed in 1992 and updated in 1998 (MQS II) as a tool to co-quantify 3 relevant aspects of medications prescribed for chronic nonmalignant pain: drug class, dosage, and detriment (risk). This 2003 version (MQS III) is the third iteration of the scale, featuring new detriment weights determined by surveying all physician members of the American Pain Society in the United States via mail. A total of 248 physicians (18%) responded with their opinion as to the detriment of 22 mechanistically distinct medication classes. Overall, the physician ratings of detriment weight were relatively consistent (alpha = .84). The increased number of survey responses encompassed a wide range of disciplines, thus reducing discipline bias and introducing several important changes to MQS scoring. Some medication classes previously rated with low detriment weights (eg, nonsteroidal anti-inflammatory drugs) increased in detriment weight (from 2 to 3.4), whereas other classes previously given high weights (eg, "strong" opioids) received lower detriment ratings (from 5 to 3.4) in this survey. The MQS III must now be validated in clinical and research applications. PERSPECTIVE: The MQS is a tool to objectively quantify pain. It computes a single numeric value for a patient's pain medication profile. This number can be used by both clinicians and researchers to track pain levels through a treatment course or research study.

Biofeedback in the treatment of phantom limb pain: a time-series analysis.

Phantom limb pain (PLP) is a noxious, painful sensation that is perceived to occur in an amputated limb. It has been reported to occur in up to 85% of amputees. This pilot study examined the effectiveness of biofeedback in the treatment of nine individuals with PLP who received up to seven thermal/autogenic biofeedback sessions over the course of 4-6 weeks. Pain was assessed daily using the visual analog scale (VAS), the sum of the sensory descriptors, and the sum of the affective descriptors of the McGill short form. Interrupted time-series analytical models were created for each of the participants, allowing biofeedback sessions to be modeled as discrete interventions. Analyses of the VAS revealed that a 20% pain reduction was seen in five of the nine patients in the weeks after session 4, and that at least a 30% pain reduction (range: 25-66%) was seen in six of the seven patients in the weeks following session 6. Sensory descriptors of pain decreased more than the affective pain descriptors. These preliminary results provide some support for the use of biofeedback in the treatment of PLP and indicate the need for further, definitive study.