Menstrual attitudes in adult women: A cross-sectional study on the association with menstruation factors, contraceptive use, genital self-image, and sexual openness.

BACKGROUND: Menstruation is a central part of the everyday life of most women, and menstrual attitudes may impact health and well-being. OBJECTIVES: This article aimed to map menstrual attitudes among adult women and examine factors associated with these attitudes, such as aspects of menarche and current menstruation, and rarely studied factors, such as genital self-image and sexual openness. STUDY DESIGN: A cross-sectional online survey. METHOD: A sample of 1470 women, aged 18-50 years, were recruited through social media sites. The Menstrual Self-Evaluation Scale was used to measure three different attitudes: menstruation as natural, shameful, and bothersome. Multiple linear regression analysis was used to investigate the relationship between each attitude and factors related to menarche and current menstruation, contraceptive use, genital self-image (assessed by Female Genital Self-Image Scale), and sexual openness (Personal Comfort with Sexuality Scale). Sociodemographic variables were included into the models as covariates. RESULTS: Agreeing with the attitude of menstruation as something natural was predicted primarily by positive emotions at menarche, experiencing less menstrual pain, using no or nonhormonal contraception, and having a positive genital self-image. Perceiving menstruation as bothersome was predicted by a lower educational level, experiencing stronger menstrual pain, having more perimenstrual psychological symptoms, and using hormonal contraceptives. Menstruation as something shameful was chiefly predicted by lower sexual openness and a negative genital self-image. CONCLUSION: Many women held attitudes about menstruation as both something natural and bothersome. Menarche and current menstruation experiences, and contraceptive method, played central roles in shaping attitudes toward menstruation as natural and bothersome. Viewing menstruation as shameful stood out from other attitudes by indicating a triad of self-objectified shame that includes menstruation, sexuality, and genital self-image. Further research into the relationships between menstruation, contraceptive use, sexuality, and body image is needed to enhance our understanding of women's menstrual health.

"It Spread Like Wildfire, as These Things Do": Exploring Mechanisms of Harm in Young Norwegians' Experiences of Image-Based Sexual Abuse.

It is widely reported that image-based sexual abuse (IBSA) victimization is linked to a wide range of detrimental outcomes, including anxiety, depression, and suicidal ideation. However, knowledge about what shapes victims' experiences remains limited. To explore underlying mechanisms of harm in IBSA incidents, the present study drew on the concept of appraisal to elucidate the various meanings that victims attach to IBSA. For this purpose, we carried out a reflexive thematic analysis of 20 individual in-depth interviews with young male and female victims (ages 16-26) of IBSA. Using this approach, we developed four overarching themes that capture participants' experiences of being (1) robbed of bodily autonomy, (2) stripped of privacy, (3) subjected to public scrutiny, and (4) trapped in a state of uncertainty. By delineating the different ways that participants appraised and experienced each of these "layers of victimization," our findings show how the harms of IBSA may be shaped by a complex constellation of situational, personal, and cultural structures and conditions. Importantly, as some of these mechanisms are socially constructed, our findings indicate that efforts aimed at reducing negative outcomes of IBSA should address the interpersonal and cultural context of these incidents, including bystander responses to intimate image dissemination.

Sex Surveys in Europe: Reflections on over Four Decades of Sexual Behavior and Sexual Health Surveillance.

Sexual expression is fundamental to human existence and an important topic of enquiry in its own right. Understanding sexual behavior is also essential to establish effective sexual health prevention activities (e.g., education), services and policies, and to assess the progress of policies and action plans. Questions on sexual health are rarely included in general health surveys, and therefore dedicated population studies are required. Many countries lack both funding and sociopolitical support to conduct such surveys. A tradition of periodic population sexual health surveys exists in Europe but the methods used (e.g., in questionnaire construction, recruiting methods or interview format) vary from one survey to another. This is because the researchers within each country are confronted with conceptual, methodological, sociocultural and budgetary challenges, for which they find different solutions. These differences limit comparison across countries and pooling of estimates, but the variation in approaches provides a rich source of learning on population survey research. In this review, survey leads from 11 European countries discuss how their surveys evolved during the past four decades in response to sociohistorical and political context, and the challenges they encountered. The review discusses the solutions they identified and shows that it is possible to create well designed surveys which collect high quality data on a range of aspects of sexual health, despite the sensitivity of the topic. Herewith, we hope to support the research community in their perennial quest for political support and funding, and ongoing drive to advance methodology in future national sex surveys.

Sexual Debut Ages in Heterosexual Norwegians Across Six Birth Cohorts.

This study aims to estimate six different sexual debut ages in heterosexual Norwegians in six birth cohorts of the general population in Norway. The results are based on a 2020 national web panel survey of 18-89-year-olds in Norway (n = 4160). There was a general decline in the median debut age from those aged 70+ to those 18-29 (born 1991-2002). Oral sex with a female partner has become increasingly common among men at an earlier age across generations. The same pattern was found in women as well with regard to oral sex with a male partner and receptive anal sex. There was a slight increase in median debut age in 18-29-year-olds for receptive vaginal sex (born 1991-2002). The median debut age for vaginal sex was fairly stable for generations of men and women born after 1950.

Gender Differences in Sending Nude Pictures and Videos Across Multiple Relationship Contexts in the Adult Norwegian Population.

This article aims to determine the prevalence of sending nude pictures/videos in the Norwegian population and investigates gender differences regarding consensual, unsolicited, and coerced experiences. Data were obtained from a probability-based web survey of 2181 men and 1967 women between 18 and 89 years old. The majority of participants expressed relatively accepting attitudes toward sending nude pictures/videos, and men expressed more positive attitudes than women. Twenty-nine percent of participants reported having lifetime experience with sending nude pictures/videos, and sending nude pictures/videos was more common in younger individuals than older individuals. More women than men claimed that they sent their most recent nude picture to a committed partner, and twice as many men than women had sent a nude picture to a stranger or a person they only had contact with on the Internet. In addition, more than twice as many women than men reported consensual sending nude pictures/videos, and more men than women sent unsolicited pictures/videos. Consensual sending nude pictures/videos was characterized by the presence of men and women within committed relationships. In Norway, sending nude pictures/videos seems to be a way of being sexual in the context of committed relationships.

Norwegian Data on Prevalence, Sexual Risk Behaviors, Sexual Problems, and Sexual Satisfaction in Women Who Have Sex Exclusively with Women, Women Who Have Sex Exclusively with Men, and Women Who Have Sex with Men and Women.

Objective: The study explores the difference between Women Who Have Sex Exclusively with Men (WSEM), Women Who Have Sex Exclusively with Women (WSEW), and Women Who Have Sex with Women and Men (WSWM). Method: The data were obtained from a survey of a probability-based web sample of 1967 Norwegian women. Results: Most WSWM identified themselves as heterosexuals (76.3%), and three out of 10 used a condom when having sex with a new partner. The highest number of sex partners during the last year was reported by WSWM. More WSEW than the other categories reported premature orgasm. Conclusions: WSWM should be targeted in health campaigns.

A Seemingly Paradoxical Relationship Between Masturbation Frequency and Sexual Satisfaction.

Despite many benefits related to masturbation, we know surprisingly little about how solo sex is associated with sexual satisfaction. Using questionnaire data from a probability-based sample of 4,160 Norwegians aged 18-89 years, we explored subgroups of women and men that differed in their masturbation-sexual satisfaction typology and examined whether sociodemographic, psychological, and sexual behavioral characteristics were associated with distinct masturbation-satisfaction patterns. A cluster analysis revealed four similar groupings for women and men, reflecting sex lives characterized by high masturbation/sexual satisfaction, low masturbation/sexual satisfaction, high masturbation/sexual dissatisfaction, or low masturbation/sexual dissatisfaction. While being younger, higher pornography consumption, and sexual variety were primarily associated with increased masturbation frequency, sexual distress and a negative body and genital self-image were more clearly associated with sexual dissatisfaction. Predicting different masturbation-satisfaction groupings also revealed some gender-specific findings in the use of pornography, and in the association between masturbation and intercourse frequency, which suggested a complementary pattern for women and a compensatory pattern for men. Our findings emphasize that the linkage between masturbation and sexual satisfaction warrants closer focus.

Reduced Sexual Desire in Young Norwegian Women: A Mixed-Methods Study.

Sexuality has become an area of social competence in which individuals strive to be recognized as sexually competent performers. However, a large proportion of young women experience reduced sexual desire. In this study, both quantitative and qualitative methods were applied. Using data from a questionnaire, the aim of this study was to explore the prevalence of, and the factors associated with, lack of sexual interest and desire among young women in Norway. Further, with the help of in-depth interviews, we investigated how young women with reduced sexual desire experience living with their desire problems and what they experience as the cause of their problems. The sample in the quantitative study consisted of 505 Norwegian women between the ages of 18 and 29 years. ANOVA was employed to explore differences in scores on psychological factors and relational factors, as well as between participants who experienced a lack of sexual interest and desire, and those who did not. The results indicate a high prevalence of lack of sexual interest and desire among women (37.1%), while low appearance satisfaction and low relationship satisfaction were central predictors of lack of sexual interest and desire. The sample in the qualitative study consisted of ten Norwegian women with reduced sexual desire between the ages of 18 and 29 years. Through thematic analysis, four themes emerged as experiences of living with reduced sexual desire: (1) physical and mental health, (2) being a young woman in today's society, (3) relational factors, (4) negative experiences, personal expectations toward sexuality, and sexual trauma.

Prevalence of Masturbation and Associated Factors Among Older Adults in Four European Countries.

Solitary sexual activity is a free, safe, and accessible way to experience sexual pleasure. Despite these advantages, research on masturbation in later life is highly understudied. Using data from a cross-sectional probability-based survey of 3816 European adults (mean age 67 years; range 60-75 years), we explored several sociodemographic, health, attitudinal, and sexual behavioral factors associated with reported masturbation frequency. Across all countries, between 41% and 65% of men and 27% and 40% of women reported any masturbation in the preceding month. Satisfaction with sexual activity and attitudes related to disapproval of sex without love were significant predictors of reported masturbation in almost all countries and in both genders. Age, education, self-perceived health, and depression were for the most part predictive of men's reported masturbation, but not women's. Generally, those believing sex is beneficial to older people were more likely to masturbate, while less permissive attitudes decreased the likelihood of reporting masturbation. To improve healthy sexual aging, misinformation about masturbation and sexual attitudes in older people need to be addressed.

Sexual Variety in Norwegian Men and Women of Different Sexual Orientations and Ages.

The purpose of this study was to examine Norwegians' reports of seven varied sexual acts. Data were obtained from a questionnaire survey of a probability-based web sample of 2,181 men and 1,967 women aged 18-89 years. Among seven acts of sexual variety, the most common sexual experiences were trying to watch pornography with a partner, engaging in sex in unusual places, and using sex toys. Older age was negatively associated with all sexual behaviors. Regarding more unorthodox acts of sexual variety, heterosexual men's sexual preferences involved having and desiring group sex, whereas heterosexual women's sexual experiences and desires involved having sex in unusual places. Lesbian, gay, bisexual (LGB) individuals generally showed greater curiosity or experience of having group sex and engaging in BDSM (bondage, discipline, dominance and submission, and sadomasochism) activities than heterosexual adults. However, while LGB men had a high preference for group sex activities, LGB women had more positive attitudes toward BDSM activity. Individuals appear to accumulate more acts of sexual variety over time, thus making the incorporation of sexual variety a function of age. This study supports the idea that sexual variety has expanded among those born from 1960 onwards.

Use of Protection for Unwanted Pregnancy and Sexually Transmitted Infections in Six Birth Cohorts in Norway 2020: A Descriptive Study.

This study describes the use of contraception and protection for sexually transmitted infections (STIs) in six different birth cohorts of the general population in Norway. The results are based on a 2020 national web panel survey among 18-89 year-olds in Norway (n = 4160). For respondents born within 1931-1950 versus those born within 1990-2002, there was a significant increase in the use of protection against unwanted pregnancy and STIs during sexual intercourse, and a significant drop in the proportion of those who did not use any protection at all. More women today (than in previous decades) are using hormonal contraception. The main reason for not using condoms during intercourse was both parties felt safe that they were healthy, especially those born within 1990-2002. To prevent unwanted pregnancy and STIs, it is beneficial to continue to increase the availability of free or subsidized hormonal contraception, including emergency contraception, and free condoms in public arenas that people frequent and where they meet their partners.

BDSM: Does it Hurt or Help Sexual Satisfaction, Relationship Satisfaction, and Relationship Closeness?

This national web-population study from Norway (N = 4,148) assessed 1) the prevalence of BDSM and role-play interests and behaviors, 2) the socio-demographic characteristics of the BDSM-oriented participants, and 3) the associations between a) BDSM and b) role-play interests and behaviors, and sexual satisfaction, relationship satisfaction, and relationship closeness. Over one in three study participants endorsed at least one BDSM interest or behavior variable. There were no gender nor educational level differences between the BDSM-oriented participants and their traditional "vanilla" (non-BDSM-oriented) counterparts, though BDSM and interests were more common among younger and self-identified LGBQ+ participants. Sexual satisfaction was positively associated with role-play and BDSM behaviors while interest in role-play (but not having previously engaged in it) was negatively associated with this outcome. Lower relationship closeness was associated with an interest in role-play (but not having tried it). No BDSM-related variables were significantly associated with relationship closeness. The findings suggest that BDSM interests and behaviors are relatively common and are linked with sexual and relationship satisfaction.

Prevalence of Sexual Difficulties and Related Distress and Their Association with Sexual Avoidance in Norway.

Aim: To assess the prevalence of sexual difficulties and related distress, the association between sexual difficulties and sexual avoidance, and to establish whether sexual difficulties and sexual avoidance are moderated by relationship satisfaction. Methods: This study included a sample of 4160 adults aged 18-89 years enrolled from a randomly selected web panel of 11,685 Norwegians. Results: Sexual difficulties were particularly common among adults aged <30 years. In men and women, lack of interest in sex and general sexual distress were associated with more sexual avoidance. The association between lack of sexual interest and sexual avoidance was, however, buffered by relationship satisfaction. Climaxing too early was related to less sexual avoidance in both genders. Yet for men, this association was only significant among those with lower relationship satisfaction. Conclusion: The findings underline the important links among specific sexual difficulties, sexual distress, and the frequency of avoiding sexual activity.

Non-consensual and Consensual Non-monogamy in Norway.

The paper sets out to study Norwegians' experiences of non-monogamy. Data were collected by questionnaires in a web sample of 4160 Norwegians (18-89 years). 26.3% of men and 17.8% of women reported that they ever had non-consensual non-monogamy. Consensual non-monogamy was reported by 3%. Compared to participants with no or non-consensual experience, consensual non-monogamy was highly related to relationship intimacy and positive sexual attitudes toward sex and sexuality. At the most recent extradyadic event, 21.5% of heterosexual men and 47.1% of gay/bisexual men reported condom use, which implies a risk for sexually transmitted diseases.

Norwegian Data on Prevalence, Sexual Risk Behaviors, Sexual Problems, and Sexual Satisfaction in Men Who Have Sex Exclusively with Women, Men Who Have Sex Exclusively with Men, and Men Who Have Sex with Men and Women.

Objective: This study investigates how men who have sex exclusively with women (MSEW) differ from men who have sex exclusively with men (MSEM), and men who have sex with men and women (MSMW) on selected variables. Methods: A probability-based web sample of 2,181 men was recruited. Results: Most MSEM considered their sexual identity as gay, and most MSMW as heterosexual. The MSEM were the most frequent condom users, while MSMW were the least frequent users and had the highest number of sexual partners. The MSEM and MSMW had a lower likelihood of premature ejaculation than MSEW. Conclusions: MSMW should be targeted in health campaigns.

Appearance Satisfaction as a Predictor of Specific Sexual Problems and Associated Distress.

INTRODUCTION: Appearance dissatisfaction is a sensitive issue and has been tied to depression, dissatisfaction in romantic relationships, and reduced sexual satisfaction. AIM: This study sought to examine associations between appearance satisfaction and specific sexual problems and related distress, testing also the moderating role of relationship satisfaction. METHODS: A large web-sample of Norwegians in romantic relationships (N = 2,903) completed a one-time survey. OUTCOMES: Participants reported on their experience of five different sexual problems and associated level of distress. RESULTS: We found that appearance satisfaction was associated with reporting fewer sexual problems, and specifically, with a smaller likelihood of experiencing problems with lack of enjoyment, lack of excitement, and lack of climax. Furthermore, appearance satisfaction was unrelated to overall sexual problem-related distress, but was associated with feeling less distress about lack of excitement and lack of climax. Relationship satisfaction did not serve as a moderator of the associations. CLINICAL TRANSLATION: These findings suggest the importance of attending to appearance satisfaction when working with clients with multiple sexual problems, particularly those related to excitement and enjoyment. STRENGTHS AND LIMITATIONS: Strengths of the study include a large sample of partnered adults and assessment of specific sexual problems and associated distress. A limitation is that outcomes were assessed using single items, rather than multi-item scales. CONCLUSION: The study highlights the importance of examining the presence of sexual problems and associated distress separately, and to consider appearance satisfaction as a predictor of sexual functioning. Øverup CS, Strizzi JM, Cipric A, et al. Appearance Satisfaction as a Predictor of Specific Sexual Problems and Associated Distress. J Sex Med 2021;18:1532-1544.

Self-Assessed Effects of Pornography Use on Personal Sex Life: Results from a Large-Scale Study of Norwegian Adults.

Objectives: The study explored characteristics associated with the self-assessed effects of pornography use on one's personal sex life. Methods: Data were collected in a probability-based sample of Norwegian adults (n = 4,160). Results: Most participants (41.3%) did not believe that pornography affected their sex life. More participants reported positive (33.2%) than mixed/negative (25.5%) effects of pornography use. Sociodemographic and sexual characteristics that predicted these self-assessments were examined. Among participants in a steady relationship, emotional intimacy and relationship satisfaction were unrelated to the self-assessed effects. Conclusions: The current study findings add to scant literature about the self-assessed effects of pornography usage.

Correction to: Emotional intimacy and sexual well-being in aging European couples: a cross-cultural mediation analysis.

[This corrects the article DOI: 10.1007/s10433-019-00509-x.].

Seeking help for sexual difficulties: findings from a study with older adults in four European countries.

Sexual well-being is an important part of life for many people aged 60 and older. However, older adults often face barriers to seeking and receiving help for sexual difficulties. This study used data from a probability survey (n = 3820) on sexuality and ageing to examine help-seeking in 60-75-year-olds in Norway, Denmark, Belgium, and Portugal. More men (12.2%) than women (6.8%) had sought professional help for a sexual difficulty in the past 5 years. The main reason for help-seeking was that sex was important to the participant and/or their relationship. The main source of professional help was the primary care physician. Of those who had sought professional help, 48% were satisfied or very satisfied with the help received, 31.6% were neither satisfied nor dissatisfied, and 20.4% were dissatisfied or very dissatisfied. Others had sought help from informal sources, particularly partners, friends, or websites. The main reasons for not seeking professional help included not being distressed by the symptoms, and thinking that the difficulty would clear up on its own. Multivariable regression analysis revealed that significant correlates of seeking professional help for women and men were level of distress about the sexual difficulty. With regard to women, those who were married, and/or from Portugal were more likely to have sought help. And regarding men, those who attended religious services were more likely to have sought professional help. These results have important implications for healthcare and can be used to inform the development and delivery of services for older adults who experience sexual difficulties.