[Factors Influencing Sexual Experiences in Adolescents Using a Random Forest Model: Secondary Data Analysis of the 2019~2021 Korea Youth Risk Behavior Web-based Survey Data].

PURPOSE: The objective of this study was to develop a predictive model for the sexual experiences of adolescents using the random forest method and to identify the "variable importance." METHODS: The study utilized data from the 2019 to 2021 Korea Youth Risk Behavior Web-based Survey, which included 86,595 man and 80,504 woman participants. The number of independent variables stood at 44. SPSS was used to conduct Rao-Scott χ² tests and complex sample t-tests. Modeling was performed using the random forest algorithm in Python. Performance evaluation of each model included assessments of precision, recall, F1-score, receiver operating characteristics curve, and area under the curve calculations derived from the confusion matrix. RESULTS: The prevalence of sexual experiences initially decreased during the COVID-19 pandemic, but later increased. "Variable importance" for predicting sexual experiences, ranked in the top six, included week and weekday sedentary time and internet usage time, followed by ease of cigarette purchase, age at first alcohol consumption, smoking initiation, breakfast consumption, and difficulty purchasing alcohol. CONCLUSION: Education and support programs for promoting adolescent sexual health, based on the top-ranking important variables, should be integrated with health behavior intervention programs addressing internet usage, smoking, and alcohol consumption. We recommend active utilization of the random forest analysis method to develop high-performance predictive models for effective disease prevention, treatment, and nursing care.

Subjective Reactions to First Coitus in Relation to Participant Sex, Partner Age, and Context in a German Nationally Representative Sample of Adolescents and Young Adults.

Analysis of a Finnish nationally representative student sample found that subjective reactions to first intercourse (mostly heterosexual; usually in adolescence) were highly positive for boys and mostly positive for girls, whether involved with peers or adults (Rind, 2022). The present study examined the generality of these findings by examining subjective reactions to first coitus (heterosexual intercourse) in a German nationally representative sample of young people (data collected in 2014). Most first coitus was postpubertal. Males reacted mostly positively and uncommonly negatively in similar fashion in all age pairings: boy-girl (71% positive, 13% negative); boy-woman (73% positive; 17% negative); man-woman (73% positive, 15% negative). Females' reactions were more mixed, similar in the girl-boy (48% positive; 37% negative) and woman-man (46% positive, 36% negative) groups, but less favorable in the girl-man group (32% positive, 47% negative). In logistic regressions, adjusting for other factors, rates of positive reactions were unrelated to age groups. These rates did increase, in order of importance, when participants were male, their partners were close, they expected the coitus to happen, and they affirmatively wanted it. Reaction rates were computed from the Finnish sample, restricting cases to first coitus occurring in the 2000s, and then compared to minors' reactions in the German sample. The Finns reacted more favorably, similarly in both minor-peer and minor-adult coitus, with twice the odds of reacting positively. It was argued that this discrepancy was due to cultural differences (e.g., Finnish culture is more sex-positive). To account for the reaction patterns shown in the adolescent-adult coitus, sizably at odds with expectations from mainstream professional thinking, an evolutionary framework was employed.

Trends in Early Sexual Initiation and Its Association with Socio-Environmental Factors among Korean Adolescents.

There has been no research on the trends in early sexual initiation associated with socio-environmental factors in Korea. This study aimed to examine the trends of early sexual initiation with various socio-environmental factors among adolescents. The Korea Youth Risk Behavior Web-based Survey data were used, and two pooled datasets extracted from the 2006-2008 and 2014-2016 waves were conducted and compared. In this study, early sexual initiation was defined as sexual intercourse at the age of 13 years or younger. The weighted percentage and 95% confidence interval reporting early sexual initiation were estimated, and multiple logistic regression was performed for each subgroup of socio-environmental variables with the 2006-2008 pooled data as a reference. Regardless of sex, the weighted percentage of adolescents with sexual experience who reported early sexual initiation increased in 2014-2016 with statistical significance in most cases. Moreover, the possibility of experiencing early sexual intercourse overtime was more prominent among girls than boys. While indifference to adolescent sexual behavior continues, more adolescents become involved in early sexual initiation. Socio-environmental considerations, such as the establishment of safe environments for adolescents' sexual activity, along with systematized monitoring mechanisms, should be administered.

Factores asociados al inicio de las relaciones sexuales en los adolescentes de los centros educativos de Cushcanday-Agallpampa y San Isidro-Otuzco, en el año 2021-2022

Objetivo: Determinar los factores asociados al inicio de las actividades sexuales en adolescentes de los centros educativos de Cushcanday-Agallpampa y San Isidro-Otuzco. Material y métodos: Entre septiembre de 2021 y marzo de 2022, se realizó un estudio observacional, analítico transversal en 265 escolares del nivel secundario de los centros educativos de Cushcanday-Agallpampa y San Isidro-Otuzco que cumplieron los criterios de inclusión aplicando como instrumento la encuesta sobre sexualidad. Resultados: 129 hombres y 126 mujeres. Con una edad media de 15.41 años. Con un 11% que ha iniciado su vida sexual. El factor de riesgo asociado de mayor peso para el inicio de la vida sexual es la nomofobia con un OR de 22.55 (IC = 5.24 - 96.97), seguido del analfabetismo, con un OR de 6.41 (IC = 1.22 - 6.74). La visita de páginas web sin contenido erótico es un factor protector para la coitarquia. Conclusiones: 1 de cada 10 adolescentes de la zona rural Cushcanday-Agallpampa y San Isidro-Otuzco-La Libertad ha iniciado su vida sexual. La nomofobia moderada en la adolescencia incrementa 22 veces el riesgo de tener relaciones sexuales. Los hijos de padres analfabeto tienen 6.41 veces mayor probabilidad de iniciar las relaciones sexuales en la adolescencia.

Objective: To determine the factors associated with the beginning of sexual activities in adolescents from the educational centers of Cushcanday-Agallpampa and San Isidro-Otuzco. Material and methods: Between September 2021 and March 2022, an observational, cross-sectional analytical study was carried out in 265 secondary school students from the educational centers of CushcandayAgallpampa and San Isidro-Otuzco who met the inclusion criteria applying as an instrument the sexuality survey. Results: 129 men and 126 women with an average age of 15.41 years. With 11% who have started their sexual life. The risk factor associated with the greatest weight for the beginning of sexual life is nomophobia with an OR of 22.55 (CI = 5.24 - 96.97), followed by illiteracy, with an OR of 6.41 (CI = 1.22 - 6.74). Visiting web pages without erotic content is a protective factor for coitarche. Conclusions: 1 out of every 10 adolescents in the rural area Cushcanday-Agallpampa and San Isidro-Otuzco-La Libertad has started their sexual life. Moderate level nomophobia in adolescence increases the risk of having sexual intercourse by 22 times. Children of illiterate parents are 6.41 times more likely to start sexual relations in adolescence.

Evaluation of hymenal adhesions resection in the treatment of recurrent post-coital cystitis.

OBJECTIVE: To describe and evaluate the technique of hymenal adhesions resection in the treatment of recurrent post-coital cystitis. MATERIALS AND METHODS: Monocentric retrospective observational study including patients operated for hymenal adhesions resection between 2013 and 2020. The indication was based on the association of 4 conditions: at least 3 episodes of documented cystitis per year, a post-coital rhythm, a failure of preventing hygienic and dietary rules, a negative etiological assessment except for the existence of hymenal adhesions. RESULTS: Twenty-three patients were included. The procedures were performed on an outpatient basis. With a mean follow-up of 36.5 months (standard deviation: 22.3), 21 patients (91%) reported a correction of recurrent post-coital cystitis, 16 (70%) had 1 to 2 annual episodes of cystitis, 19 (83%) reported improvement with surgery and satisfaction was rated on average at 8.5/10 (standard deviation: 2.15). None of the 23 patients had persistent documented recurrent cystitis after surgery, 12 (52%) had 1 to 2 documented episodes annually, and 11 (48%) had no documented recurrence. Three cases of postoperative complications were observed: vulvovaginitis, delayed healing, and pyelonephritis. No cases of dyspareunia were reported during the follow-up. CONCLUSION: In case of post-coital cystitis, accompanied by hymenal adhesions, and without any other identified cause, the removal of hymenal adhesions could be an alternative to iterative antibiotic therapy.

Factors Related to Sexual Intercourse Among Korean Middle and High School Students.

Background: Social interest in sexual intercourse among teenagers is increasing in Korea. This study aimed to identify factors related to sexual intercourse among adolescents. Methods: This is a secondary analysis study using data from the 2020 Korea Youth Risk Behavior Survey, with information regarding 54,948 middle school and high school students in Korea having been analyzed. Demographics, health behavior, and mental health characteristics were included. Data evaluation involved chi-square test and binary multivariable logistic regression analysis. Results: For middle school students, sexual intercourse was related to their housing type [Odds Ratio (OR) = 10.698], smoking (OR = 5.165) and drinking (OR = 2.229) experience, suicide attempt (OR = 1.920), gender (OR = 1.632), loneliness (OR = 1.501), sadness and despair (OR = 1.493), year level (OR = 1.457), happiness (OR = 0.772), sleep status (OR = 0.716), economic status (OR = 0.705). For high school students, sexual intercourse was related to their smoking experience (OR = 4.746), housing type (OR = 3.661), drinking experience (OR = 2.840), drug use (OR = 2.511), suicide attempt (OR = 2.071), year level (OR = 1.989), sadness and despair (OR = 1.506), gender (OR = 1.429), suicide plan (OR = 1.402), loneliness (OR = 1.270), academic performance (OR = 1.165), happiness (OR = 0.865), subjective health status (OR = 0.814), and economic status (OR = 0.727). However, sleep status was statistically significant for middle school students, but not for high school students. Academic performance, drug use, suicide plan, and subjective health status were statistically significant in high school students, but not in middle school students. Conclusion: A program that can directly mediate these factors must be prepared. When conducting sex education for adolescents, mental health-related factors must also be considered.

Alcohol, age at first sexual intercourse and number of sexual partners in young Mexican women.

AIM: To identify the relationship between use of alcohol, number of sexual partners and age of sexual initiation. METHOD: Descriptive-correlational study. A random sample of 319 young women (age 18-25) from Nuevo Laredo, Mexico was recruited. A sociodemographic data sheet and the AUDIT questionnaire were used. Non-parametric Spearman's rank correlation coefficient and Kruskal-Wallis H test were selected. RESULTS: On average the participants were 20.70 years old (±2.1), had 1.86 sexual partners (±1.27), started drinking alcohol at the age of 16.82 (±1.79), and their first sexual intercourse was at the age of 17.38 (±1.65). There was a decrease in the age of onset of alcohol use (H=16.646, p<.001) and the age at first sexual intercourse (H=26.749, p<.001) on the lower their current age. The overall AUDIT score negatively correlated with the age of the participants on their first sexual intercourse (rs=-.168, p<.001) and positively correlated with the number of sexual partners (rs=.243, p<.001). The aforementioned correlations were more intense among the younger participants (18- and 19-year olds; p<.01). CONCLUSIONS: There was an association between higher use of alcohol, early age of sexual initiation and number of sexual partners. Nursing professionals may address such variables simultaneously through preventive strategies directed specifically at young women.

Factors associated with sexual intercourse among brazilian men during the covid-19 pandemic: a cross-sectional study / Fatores associados à relação sexual entre homens brasileiros durante a pandemia de covid-19: um estudo transversal

INTRODUCTION: Transmission of COVID-19 occurs from person to person through respiratory droplets and aerosol, through contact and direct transmission, through kissing, handshaking, etc. In this perspective, several countries have implemented actions and strategies to reduce the risks of transmission. Because of this, there are several widespread reflexes and concerns resulting from the COVID-19 pandemic. One change in behavior that can be affected due to the social distance that occurred during the COVID-19 pandemic is sexual activity. OBJECTIVE: To analyze the factors associated with the sexual intercourse of Brazilian men during the COVID-19 pandemic. METHODS: 518 men over 18 years of age responded to the online survey that included sociodemographic, clinical, behavioral, and anthropometric characteristics and the International Index of Erectile Function (IIEF). The sample was divided into two groups according to the practice of sexual intercourse during the COVID-19 pandemic. RESULTS: Through multivariate regression analysis, being satisfied or equally dissatisfied/satisfied with sex life and being in a stable relationship were the factors associated with the sexual intercourse of Brazilian men during the COVID-19 pandemic. In addition, not drinking alcohol was a protective factor for sexual intercourse in this sample. CONCLUSION: In our study, being satisfied or equally dissatisfied/satisfied with the overall sex life and having a stable relationship were associated with intercourse during a COVID-19 pandemic. On the other hand, not drinking alcohol was considered a protective factor.

INTRODUÇÃO: A transmissão da COVID-19 ocorre de pessoa para pessoa por meio de gotículas respiratórias e aerossol, por contato e por transmissão direta, por meio de beijo, aperto de mão, etc. Nessa perspectiva, vários países têm implementado ações e estratégias para reduzir os riscos de transmissão. Por causa disso, existem vários reflexos e preocupações generalizadas resultantes da pandemia de COVID-19. Uma mudança de comportamento que pode ser afetada devido o distanciamento social que ocorreu durante a pandemia de COVID-19 é a atividade sexual. OBJETIVO: Analisar os fatores associados às relações sexuais de homens brasileiros durante a pandemia do COVID-19. MÉTODO: 518 homens maiores de 18 anos responderam à pesquisa online que incluiu características sociodemográficas, clínicas, comportamentais e antropométricas e o Índice Internacional de Função Erétil (IIFE). A amostra foi dividida em dois grupos de acordo com a prática de relações sexuais durante a pandemia de COVID-19. RESULTADOS: Por meio da análise de regressão multivariada, estar satisfeito ou igualmente insatisfeito/satisfeito com a vida sexual e estar em união estável foram os fatores associados à relação sexual de homens brasileiros durante a pandemia de COVID-19. Além disso, não consumir bebidas alcoólicas foi fator de proteção para a relação sexual nesta amostra. CONCLUSÃO: Em nosso estudo, estar satisfeito ou igualmente insatisfeito/satisfeito com a vida sexual geral e ter uma relação estável foram fatores associados à relação sexual durante a pandemia de COVID-19. Por outro lado, não beber álcool foi considerado fator de proteção.

What Are the Physical Demands of Sexual Intercourse? A Systematic Review of the Literature.

The aim of this study was to systematically review the literature investigating the physical demands of sexual intercourse and to synthesize the evidence related to this research topic. Original studies published on PubMed, Scopus, and Web of Science up until April 2020 were examined. The Effective Public Health Practice Project scale was used to assess the methodological quality of each study. Eighteen studies analyzed physical demands during sexual intercourse through the physiological demands (n = 14) and kinematics (n = 4) of sexual intercourse. Sexual intercourse can elicit an energy expenditure of ~ 100 kcal (or ~ 6 metabolic equivalent units, METs) during the activity, mean heart rates between ~ 90 and ~ 130 beats per minute (bpm), and peak heart rates up to ~ 170 bpm. However, these physical demands may vary depending on health status, intercourse position, activity duration, intercourse phase, and sex differences. The movement pattern was cyclic in all positions and the greatest demands in lumbar spine flexion were found in the missionary positions for women. Missionary and side-lying positions elicited the greatest lumbar flexion movement in men. Regarding the movement of the hip joint during sexual intercourse, flexion, abduction, and external rotation mainly characterized the woman's movement while external rotation did so in the man. In conclusion, sexual intercourse may elicit moderate intensity physical demands, but these demands vary depending on contextual variables. In addition, not only studies combining physiological and kinematic analyses are necessary but also more high-quality studies need to be published in order to have a better understanding of the physical demands of sexual intercourse.

Gelfoam embolization of high-flow priapism due to coitus: A case report.

Priapism is a condition in which a person has an erection without sexual arousal and lasts for at least 4 hours. High flow priapism (HFP) usually follows blunt trauma to the penis or perineum, causing arterial-lacunar fistula. HFPs are rare after sexual intercourse, and early treatment by embolization can prevent erectile dysfunction (ED). The use of gel foam has good results and has shown the least side effects.

Post-coital internal carotid artery dissection associated with acute cerebral infarction in a Filipino female: A case report

@#Carotid arterial dissections may result from spontaneous or traumatic causes. Postcoital arterial dissections have been reported in both the vertebral and coronary arteries. We report a rare case of spontaneous dissection on the extracranial internal carotid artery in a Filipino female after sexual intercourse, leading to a fulminant middle cerebral artery (MCA) territory infarct. Although postcoital carotid artery dissection is a very rare cause of neck vessel dissections, its rapid progressive course can lead to massive cerebral infarction and prompt management must be initiated.

Prevalencia y caracterización de los factores asociados a dispareunia en mujeres con antecedente de parto vaginal o cesárea / Prevalence and characterization of factors associated with dyspareunia in women with a history of vaginal delivery or cesarean section

INTRODUCCIÓN: El deterioro de la función sexual asociado a la dispareunia después del parto es una importante preocupación para muchas mujeres. OBJETIVO: Establecer la prevalencia y caracterizar los factores asociados a la dispareunia en mujeres con antecedente de parto vaginal o cesárea. MÉTODO: Estudio de corte transversal realizado en 975 mujeres mayores de 18 años, residentes en Armenia (Colombia), con 6 meses o más en posparto (vaginal o cesárea), sexualmente activas, entre 2013 y 2017. Se utilizó como instrumento el Índice de Función Sexual Femenino Abreviado (IFSFA-6). Se midieron variables sociodemográficas y obstétricas relacionadas con la dispareunia. Se hizo estadística descriptiva. Los factores asociados se evaluaron comparando los dos grupos mediante odds ratio (OR) e intervalo de confianza del 95% (IC95%). RESULTADOS: La edad promedio fue de 27,12 ± 4,48 años. La prevalencia de dispareunia fue del 35,69%. Los factores de riesgo más involucrados fueron la episiotomía (OR: 1,58; IC95%: 1,29-2,15; p = 0,003), el parto instrumentado (OR: 1,91; IC95%: 1,31-3,17; p = 0,027), haber tenido tres o más partos vaginales (OR: 1,85; IC95%: 1,42-2,46; p < 0,001)] y haber tenido dos o más cesáreas (OR: 1,64; IC95%: 1,27-2,18; p < 0,001). Las mujeres con dispareunia tienen menos encuentros sexuales semanales (2; rango: 0-3) que las mujeres sin dispareunia (5; rango: 2-7) (p = 0,003). CONCLUSIONES: La prevalencia de dispareunia en el posparto, en las mujeres de Armenia, sobrepasa un tercio de la población. Se hace necesario promover programas preventivos, dirigidos a los profesionales de la salud que asisten a la mujer durante el parto, acerca del análisis de la verdadera necesidad de la episiotomía o la cesárea.

INTRODUCTION: The deterioration of sexual function, associated with dyspareunia after childbirth, is an important concern for many women. OBJECTIVE: To establish the prevalence and characterize the factors associated with dyspareunia in women, with a history of vaginal delivery or cesarean section. METHOD: Cross-sectional study, carried out in 975 sexually active women older than 18 years, residents in Armenia (Colombia), with 6 or more months postpartum (vaginal deliveries and cesarean sections); between 2013 and 2017. The Abbreviated Female Sexual Function Index (IFSFA-6) was used as an instrument. Sociodemographic and obstetric variables related to dyspareunia were measured. Descriptive statistics were made. Associated factors were evaluated comparing the two groups using odds ratio (OR) and 95% confidence interval (95%CI). RESULTS: The average age was 27.12 ± 4.48 years. The prevalence of dyspareunia was 35.69%. The risk factors most involved were: episiotomy (OR: 1.58; 95% CI: 1.29-2.15; p = 0.003), instrumented delivery (OR: 1.91; 95% CI: 1.31-3.17; p = 0.027), three or more vaginal deliveries (OR: 1.85; 95% CI: 1.42-2.46; p < 0.001) and two or more caesarean sections (OR: 1.64; 95% CI: 1.27-2.18; p < 0.001). Women with dyspareunia have fewer weekly sexual encounters (2; range: 0-3) than women without dyspareunia (5; range: 2-7) (p = 0.003). CONCLUSIONS: The prevalence of dyspareunia in postpartum, in Armenian women, exceeds 1/3 of the population. It is necessary to promote preventive programs, aimed at health professionals who assist women during childbirth, regarding the analysis of the true need for episiotomy or cesarean section.

Colposcopic outcomes for symptomatic patients with a negative oncogenic human papillomavirus test.

This study assesses outcomes of colposcopy referrals for post-coital, intermenstrual, or other abnormal bleeding with negative oncogenic human papillomavirus and negative to low-grade cytology. Of 112 cases with median age of 34.5 years, cervical biopsy occurred in 19%, treatment of ectropion in 19%, endometrial sampling in 8%, polypectomy in 4%, and contraceptive change in 2%. No cervical or endometrial neoplasia was detected. Patients with bleeding symptoms and reassuring co-test may instead attend a general gynaecology clinic.

Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey.

BACKGROUND: Probability-based surveys of college students typically assess sexual behaviors such as oral, vaginal, and anal sex. Little is known about the broader range of sexual behaviors in which students engage. AIMS: In a random sample survey of undergraduate students, we aimed to: (1) describe how recently participants had engaged in solo and partnered sexual behaviors, (2) examine how frequently participants enacted certain rough sex sexual behaviors (e.g., light spanking, hard spanking, choking, slapping, and others), (3) assess participants' frequency of experiencing certain rough sex behaviors, (4) describe participants' frequency of threesome/group sex, (5) assess the characteristics of participants' experiences with choking during sex; and (6) examine choking and face slapping in regard to consent. METHODS: A confidential, online cross-sectional survey of 4,989 randomly sampled undergraduate students at a large U.S. university. OUTCOMES: Participants reported having engaged in a broad range of solo and partnered sexual activities, including rough sex behaviors. RESULTS: The most prevalent general sexual behaviors were solo masturbation (88.6%), oral sex (79.4% received, 78.4% performed), penile-vaginal intercourse (73.5%), and partnered masturbation (71.1%). Anal intercourse was the least prevalent of these behaviors (16.8% received, 25.3% performed). Among those with any partnered sexual experience, 43.0% had choked a partner, 47.3% had been choked, 59.1% had been lightly spanked and 12.1% had been slapped on the face during sex. CLINICAL TRANSLATION: College health clinicians and educators need to be aware of the diverse and evolving range of solo and partnered sexual behaviors reported by students. In addition to counseling students about pregnancy and sexually transmitted infection risk, clinicians might assess patients' engagement in diverse sexual behaviors, such as choking/strangulation during sex, given the risk for serious outcomes including death. STRENGTHS AND LIMITATIONS: Strengths of our research include the large sample size, use of random sampling, high response rate for college populations, broad range of behaviors assessed, and novel data on choking during sex. Among our limitations, we did not assess to what extent the experiences were wanted, pleasurable, or appealing to participants. Except for in relation to choking and slapping, we also did not assess issues of consent. CONCLUSION: Participants reported engaging in diverse sexual behaviors, some of which have important clinical implications, are understudied, and warrant further research. Herbenick D, Patterson C, Beckmeyer J, et al. Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey. J Sex Med 2021;18:1024-1041.

Lesion of the urethra and corpus spongiosum in the event of a misstep of the coitus without fracture of the corpus cavernosum: About one case.

INTRODUCTION: Traumatic lesions of the anterior urethra during coitus strikes are essentially described as lesions associated with 20 percent of corpus cavernosum fractures. However, no cases of isolated lesions of the urethra and corpus spongiosum in the context of sexual trauma seem to be reported in the literature. Thus, we report the observation of a patient who was diagnosed with a corpus spongiosum fracture associated with a penile urethra injury during a coitus lapse. PRESENTATION OF CASE: Patient aged 36 years with no particular pathological history, other than unprotected sexual intercourse, who has been admitted to the urology service for urethrorrhagia due to a sexual traumatism. A forced angulation and then a cracking followed by an instantaneous detumescence was described by the patient. On examination we noted a normal-looking penis without angulation or eggplant haematoma, with the presence on palpation of a small infra-centimetric hematoma on the ventral surface of the middle part of the penis. Surgical exploration was therefore indicated in front of the isolated urethrorrhagia, and which objectified a fracture of the corpus spongiosum measuring 1 cm at the level of the distal part of the penis. A linear lesion of the urethra was associated at the same level. The patient was therefore sutured with these two lesions. The postoperative course was simple with removal of the bladder catheter three weeks later with satisfactory urination and urinary stream. DISCUSSION: sexual trauma is described as a rupture of the corpora cavernosa, resulting from forced flexion or twisting of the erect penis that can be associated in about 20 % of cases with ruptures of the urethra. We described a trauma occurrence that is similar to the one in the definition responsible of a lesion of the anterior urethra but no lesions of the corpora cavernosa have been objectified. CONCLUSION: the absence of similar cases reported in the literature leaves this type of lesion subject to ambiguous behaviour. Indeed, this brings us back to questions about the pathophysiological mechanisms of sexual lesions of the urethra in order to better codify the indication for surgical exploration, even in front of a normal looking penis.

[Neurological complications of coitus: Review of literature]. / Complications neurologiques du coït : revue de la littérature.

INTRODUCTION: Sexual activity is composed of different phases (excitation, plateau, resolution). Each phase is associated with cardiovascular, respiratory, muscular and hormonal modification which can have an influence on the nervous system. This impact has been studied many times in literature, but no study has synthetized the complications related to coitus or orgasm. METHOD: Systematic review of literature on neurological complications, except headache, of coitus based on Medline and Embase. RESULTS: We screened 1424 articles and selected 46 for this review. 7 (15 %) were clinical or epidemiologic studies, 6 (13 %) were reviews of literature and 33 (72 %) were cases or series of cases reports. 12 articles (26 %) talked about strokes, 10 (22 %) about subarachnoid hemorrhage, 9 (20 %) about reversible cerebral vasoconstriction syndrome. We found 3 (7 %) articles for each of the following complication: intraparenchymal, hematoma and epilepsy. Autonomic hypereflexia was treated in 3 articles (7 %). Only 1 article was included concerning ictus, spinal cord injury, neuralgia and cataplexia. These events can be considered as rare as emergencies related to sexual activity represent only 0.1 % of all emergencies and among these, 12 % are neurological. 31 of the reported cases concerned vascular events (stroke or hemorrhage) and 18 (58 %) of these patients had a patent malformation (aneurism, intracardiac shunt, foramen ovale). CONCLUSION: This is one of the first review of literature trying to synthetise the neurological complications of coitus. Many articles exist in literature. It is necessary to prevent the occurrence of these complications in a population already at risk of neurological events.

Forensic Analysis of Sudden Death Associated with Sexual Activity.

OBJECTIVES: To analyze the characteristics of sudden death associated with sexual activity to provide recommendations for forensic identification. METHODS: A retrospective analysis was conducted on autopsy cases accepted by Forensic Identification Center of Huazhong University of Science and Technology from 1998 to 2018, and a total of 15 cases of sudden death associated with sexual activity were screened out. The general information, case data and pathological changes of 15 cases were collected to find the relationship between sexual activity and sudden death. RESULTS: The ratio of male to female was 1.5∶1. The average age of males was 50.1 years and that of females was 35.0 years. Coronary artery diseases and brain diseases accounted for most of the cases (12/15). Sexual partners were associated with locations of deaths and body dumping behaviors. CONCLUSIONS: Sudden death associated with sexual activity, although rare, may occur in people over 30 years old with pre-existing heart or brain diseases, which should be paid attention to in forensic practice.

Sporadic anovulation is not an important determinant of becoming pregnant and time to pregnancy among eumenorrheic women: A simulation study.

BACKGROUND: Attaining pregnancy is conditional upon a series of complex processes, including adequately timed intercourse, ovulation, fertilisation, and implantation. Anovulation is a first-line treatment target for couples with difficulty conceiving and is frequently examined in studies of fecundability. OBJECTIVES: To identify whether sporadic anovulation is an important determinant of cumulative pregnancy rates and time to pregnancy among fertile women with regular menstrual cycles. METHODS: We simulated cumulative pregnancy rates and time to pregnancy for 12 consecutive menstrual cycles among 100 000 women based on data-driven probabilities of implantation, fertilisation, ovulation, and intercourse occurring in the fertile window. We assumed anovulation probabilities of 1%, 8%, or 14.5% and intercourse averaging once per week, every other day, or daily. The model incorporated reductions in implantation and fertilisation rates for successive cycles of non-pregnancy. RESULTS: After 12 cycles, a reduction in the per cycle incidence of anovulation from 14.5% to 1% resulted in a 4.0% higher cumulative pregnancy rate (86.7% vs 90.7%) and similar time to pregnancy (1-cycle median difference). In contrast, increasing mean unscheduled sexual intercourse frequency from weekly to every other day was associated with a 5-cycle median reduction in time to pregnancy (weekly: 7 cycles; every other day or daily: 2 cycles) and a 28.9% increase in the cumulative pregnancy rate (weekly: 59.9%, every other day: 88.8%; daily: 91.6%). CONCLUSIONS: In presumed fertile women with regular menstrual cycles, routine investigation of anovulation may not be an informative outcome in studies of fecundability, and routine testing to ensure ovulation and treatment of anovulation are unlikely to be medically necessary. While biomarkers or cervical fluid may help time intercourse to the fertile window, time to pregnancy can also be improved through increasing the frequency of unscheduled intercourse. These findings need corroboration in large preconception time to pregnancy studies.

Results of bladder neck reconstruction using bladder flaps in complex female urethral defects.

INTRODUCTION AND HYPOTHESIS: Female urethral defects are rare, congenital defects being more uncommon than acquired, and difficult to manage. Most female urethral defects are associated with incontinence or acute urinary retention. There is a lack of standard protocol-based management of female urethral defects because of limited experience. In this study, we describe our results of using anterior or posterior bladder wall flaps in the management of a variety of female urethral defects. METHODS: We reviewed the case records of 22 patients who had undergone either anterior or posterior bladder wall-based flap procedures for complex urethral defects at our institute. Patients were assessed by taking a comprehensive history including aetiological factors and details of prior surgical intervention, thorough physical and pelvic examination, cysto-urethroscopy and relevant imaging. These factors, along with availability and status of tissue available for reconstruction affected the selection of procedure for reconstruction. RESULTS: Out of 22 patients, anterior and posterior bladder flaps were used in 16 and 6 patients respectively. A total of 18 patients became socially dry and 15 achieved complete continence after removal of the catheter and were voiding satisfactorily, whereas the remaining 4 patients had incontinence postoperatively. An additional 3 out of 18 patients had minimal stress incontinence requiring conservative treatment and 2 patients developed voiding difficulty requiring self-calibration. CONCLUSIONS: Female urethral defects with bladder neck involvement are complex and challenging to manage. Bladder wall-based flaps offer a good chance of successful repair of these complex urethral defects.

Forensic Analysis of Sudden Death Associated with Sexual Activity / 法医学杂志

OBJECTIVES@#To analyze the characteristics of sudden death associated with sexual activity to provide recommendations for forensic identification.@*METHODS@#A retrospective analysis was conducted on autopsy cases accepted by Forensic Identification Center of Huazhong University of Science and Technology from 1998 to 2018, and a total of 15 cases of sudden death associated with sexual activity were screened out. The general information, case data and pathological changes of 15 cases were collected to find the relationship between sexual activity and sudden death.@*RESULTS@#The ratio of male to female was 1.5∶1. The average age of males was 50.1 years and that of females was 35.0 years. Coronary artery diseases and brain diseases accounted for most of the cases (12/15). Sexual partners were associated with locations of deaths and body dumping behaviors.@*CONCLUSIONS@#Sudden death associated with sexual activity, although rare, may occur in people over 30 years old with pre-existing heart or brain diseases, which should be paid attention to in forensic practice.