Sexes doi: 10.3390/sexes7020023

Authors: Anita Padmanabhanunni Tyrone B. Pretorius

First responders are routinely exposed to potentially traumatic events and occupational stress, placing them at heightened risk for mental health difficulties. Despite the prominence of psychological resilience in first responder research, insufficient attention has been given to gender differences in how resilience functions within male-dominated occupations. The present study investigated gender differences in the relationships between perceived stress, resilience, and mental health outcomes among South African first responders (n = 429). Participants completed the Perceived Stress Scale-10, the Connor–Davidson Resilience Scale-10, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Posttraumatic Stress Disorder (PTSD) Checklist for DSM-5. Correlational and mediation analyses were conducted. There were no significant gender differences in overall levels of resilience. Perceived stress was associated with depression, anxiety, and PTSD for both genders. Resilience showed significant direct protective effects for men across all mental health outcomes, whereas for women it was significantly associated only with depression and PTSD but not anxiety. Mediation analyses revealed that resilience mediated the relationship between perceived stress and mental health outcomes for men only. These findings suggest that resilience operates through gender-specific pathways. It underscores the importance of conceptualizing resilience as a contextually shaped process rather than solely an individual capacity in first responder populations.

Sexes doi: 10.3390/sexes7020022

Authors: Viktoria Xega Martina Hong Yang Jun-Li Liu

Environmental chemicals are rarely considered stressors in the way that psychological or physical stressors are. Yet many endocrine-disrupting chemicals (EDCs) interact with the body’s core stress response system. This review examines how EDCs alter hypothalamic–pituitary–adrenal (HPA) regulation and how biological sex influences those responses. Drawing on human epidemiological data and experimental models, we describe how EDC exposure affects cortisol dynamics, feedback sensitivity, and adrenal signaling, with a particular focus on sex-dependent outcomes. We propose the concept of endocrine noise to describe how low-dose, often mixed EDC exposures introduce persistent interference into hormone signaling without necessarily causing overt endocrine deficiency or excess. In this framework, EDCs act as chronic, low-grade stressors that reset the timing, feedback precision, and rhythmic organization of the HPA axis rather than as isolated reproductive toxicants. We argue that EDCs should be understood as chronic, context-dependent stress modifiers that reshape sex-specific “risk architectures” for affective, metabolic, and immune disorders. Recognizing sex-specific HPA architecture and endocrine noise has immediate implications for study design and regulation, including the need for sex-stratified analyses, circadian-sensitive sampling of cortisol, and risk assessments that consider how the same exposure can push female and male stress systems in divergent directions.

Sexes doi: 10.3390/sexes7020021

Authors: Zsuzsanna Kövi Veronika Mészáros Zsuzsanna Mirnics Nahathai Wongpakaran Tinakon Wongpakaran Krisztina Hevesi

Sexual cognitive schemas are central cognitive representations of sexual aspects of self that shape the interpretation of sexual experiences and may contribute to individual differences in sexual functioning. The present study aimed to validate the Questionnaire of Cognitive Schema Activation in Sexual Context (QCSASC) in a Hungarian sample and to examine whether sexual cognitive schemas mediate the relationship between personality traits and sexual functioning. A total of 256 university students (202 females) completed the QCSASC and the Zuckerman–Kuhlman–Aluja Personality Questionnaire. Moreover, the Female Sexual Function Index was administered. The factor structure was examined using exploratory and confirmatory factor analyses, and associations among personality, schemas, and sexual function were tested using correlational, regression, and mediation analyses. Results supported a five-factor structure of the Hungarian QCSASC, identifying Helplessness, Incompetence, Rejection, Unattractiveness, and Unlovability schemas, all showing good internal consistency. Sexual cognitive schemas were positively related to Neuroticism and negatively to Extraversion. Female sexual function was related to the Incompetence schema. Personality traits showed no direct link with female sexual functioning; however, through the sexual cognitive schema, there was a significant indirect link between personality (Extraversion, Neuroticism) and female sexual functioning. These findings suggest that sexual cognitive schemas can represent a pathway between personality traits and sexual functioning.

Sexes doi: 10.3390/sexes7020020

Authors: María Fernández-Martínez Sebastián Sanz-Martos Cristina Fernández-Martínez Ganna Ovsyeyenko Carmen Álvarez-Nieto

Adolescence and youth are key stages for acquiring responsible sexual behaviour. Previous research has focused on measuring knowledge; however, in order to achieve the goal of developing safe sexual behaviour, it is necessary to complement this with measures of attitudes, for which there is currently a lack of valid and reliable measurement tools specifically focused on attitudes toward contraceptive use. The objective of this research is to develop and psychometrically validate the Attitudes Toward Contraceptive Use Scale (ACUS) in university students. A cross-sectional correlational validation study was designed using Item Response Theory. The sample consisted of 411 nursing students aged between 18 and 25 years. The final version of the scale, comprising 12 items, was evaluated using the Rasch Rating Scale Model (Andrich model), and its reliability was assessed in terms of internal consistency and temporal stability. The Rasch model showed an excellent overall fit, high item reliability (0.989), adequate person reliability (0.81), and good temporal stability (ICC = 0.796). The ACUS is a valid and reliable instrument for assessing attitudes toward contraception among university students. It can be used to identify less favourable attitudinal profiles toward contraceptive use and subsequently guide educational interventions.

Sexes doi: 10.3390/sexes7020019

Authors: Rebecca Fisico Margaret C. McKinnon Heather Moulden

Sexual interactions are complex human exchanges that are further complicated in the digital domain. This is because the introduction of technology to sexual interactions has prompted change in not only sexual activity but also communication pertaining to consent. Challenges have emerged in defining, interpreting, and communicating sexual consent within a digital context. Accordingly, it is critical to understand how sexual consent is understood and communicated within digital contexts. Herein, the literature concerning digital sexual consent was reviewed and critically analyzed. This narrative review describes digital sexual consent practices, as well as critically analyzes the literature pertaining to sexual consent to identify similarities and differences between in-person and digital consent practices. It is suggested that digital sexual consent should be viewed as a subset of sexual consent rather than a separate sexual consent practice. Future directions pertaining to research and application are discussed.

Sexes doi: 10.3390/sexes7020018

Authors: Cristina Rizzo Antonella Verrone Sofia Galeazzi Lidia Morgante Giuseppe Morgante

Vulvodynia is a chronic gynecological condition characterized by unexplained vulvar pain, which may significantly impact every aspect of women’s quality of life, encompassing physical, psychological, and social well-being. Due to its heterogeneous clinical presentation and associated comorbidities, vulvodynia is often misdiagnosed and/or not adequately treated. This descriptive observational study was conducted using an anonymous questionnaire, which was distributed through social media channels and included 29 questions (25 multiple-choice and four open-ended questions) and aimed to investigate participants’ most frequent symptoms, comorbidities, impact on quality of life, and treatment efficacy and costs. Analyzing a total of 221 answers, we found that burning (85%) and abrasion/irritation sensation (73%) are the most common symptoms, and they are most frequently localized in the vestibular area, while irritable bowel syndrome (35%) is the most common comorbidity. A significant negative effect on individual functioning was confirmed, also due to a noticeable diagnostic delay (4.5 years on average) and treatments’ prohibitive costs potentially impairing participants’ compliance. Our study provides valuable insights into self-reported aspects of women affected by vulvodynia, raising healthcare professionals’ awareness of this issue. Better knowledge of peculiar aspects of vulvodynia may help improve its diagnosis and promote a more personalized and efficient therapeutic approach.

Sexes doi: 10.3390/sexes7020017

Authors: Anita Tobar-Henríquez Bárbara Berger-Correa Sofía Monsalves Ernesto Guerra

As high rates of sexual violence worldwide have increasingly been met with educational initiatives promoting sexual consent as a core preventive strategy, it becomes crucial to understand how consent is actually conceptualized in specific sociocultural contexts. This study examines how a group of adult women in Chile conceptualize sexual consent and how their understandings align with, expand or diverge from the definition promoted by the World Association for Sexual Health (WAS), a widely adopted international framework. Using a therapeutic writing methodology designed to support emotional safety and reflective depth, 34 women completed a collective writing workshop. For this paper, the main writing exercise was analyzed through thematic analysis. Results show three overarching themes: sexual consent as a self-directed and desire-aligned experience; the intricacies of giving in to sexual encounters as shaped by social expectations, emotional pressures, and relational considerations; and the tensions when differentiating consent from giving in, a distinction experienced as meaningful yet fluid and learned over time. Together, these findings reveal that our participants’ conceptualizations of sexual consent extend beyond normative international models, highlighting the need for attuned consent frameworks and educational approaches designed to prevent sexual violence.

Sexes doi: 10.3390/sexes7020016

Authors: Alejandro Kepp Termini Marta Evelia Aparicio-García

(1) Background: This article explores the qualitative dimensions of bisexual identity through the lived experiences of bisexual individuals. (2) Methods: Drawing on an online questionnaire completed by 226 participants from a Spanish-speaking sample, the study uses a grounded theory-based analysis of participant narratives. (3) Results: The analysis identifies key components of bisexual identity, such as self-recognition, fluidity, and community belonging, as well as recurrent experiences of invalidation, promiscuity stereotypes, and intracommunity discrimination. The findings highlight the processes by which participants navigate and define their bisexuality, emphasizing the interaction between personal introspection, contact with audiovisual media, societal perceptions, and external validation in identity formation. (4) Conclusions: These results provide a nuanced exploration of how bisexual identities are constructed amid persistent challenges of invalidation, erasure, and limited community recognition.

Sexes doi: 10.3390/sexes7010015

Authors: Piet Van Tuijl

Large-scale surveys consistently show there is an orgasm gap in heterosexual partner sex of 20% to 36%—with more women not experiencing orgasm during heterosexual partner sex than men. In two Dutch/Flemish general population convenience samples (N = 1028; 756 women (73.5%), 271 men (26.4%), 1 non-binary (0.1%); Mage = 34.8 years; SDage = 12.7 years) of exclusively and almost exclusively heterosexual respondents, 140 women (20.4%) and 3 men (1.2%) who had sex in the last six months did not regularly experience orgasm during partner sex—representing an orgasm gap of 19.2% (p < 0.001). Women who did regularly experience orgasm during partner sex did more often than men experience orgasm more than once (24.2% of women versus 11.2% of men, a 13% difference; p < 0.001). MANOVA followed by post hoc ANOVAs were used to investigate group differences. Women who did not experience orgasm showed higher levels of sexual distress and sexual inhibition, and lower levels of sexual satisfaction and self-esteem than women who did experience orgasm. Also, higher levels of depressive symptoms and social anxiety were reported by the women not experiencing orgasm during partner sex. The strongest predictor of the number of orgasms during one sex session was the number of orgasms the partner presumably experienced. The current study confirmed the existence of a heterosexual gap, whilst results of this large-scale study also suggest a “reversed” orgasm gap: more women than men experience orgasm more than once during a heterosexual partner sex session.

Sexes doi: 10.3390/sexes7010014

Authors: Taylor Smith Adam Davies Justin Brass Shoshanah Jacobs

This study integrates recent literature with qualitative data from sexual-health outreach workers in the Greater Toronto Area to examine how outreach is delivered to gay, bisexual, transgender, and queer (GBTQ+) men who have sex with men (MSM) in virtual social settings, including social networking applications. Using a symbolic-interactionist framework and reflexive thematic analysis, the study identifies persistent challenges that shape GBTQ+ and MSM users’ engagement with sexual-health services, such as stigma, privacy concerns, and platform-level constraints. Findings highlight mismatches between current outreach practices and community needs in app-based environments and point to opportunities to strengthen the relevance, accessibility, and trustworthiness of digital sexual-health initiatives. The analysis offers practical recommendations for improving service design and delivery in online queer spaces and outlines priorities for future research focused on outreach effectiveness, equity, and user safety.

Sexes doi: 10.3390/sexes7010013

Authors: Titilayo Tatiana Agbadje Marlyse Mbakop Nguebou Loukou Gilbert Konan Mariame Koné Abdoulaye Anne Jean Ramdé Souleymane Diabaté Maman Joyce Dogba

In Côte d’Ivoire, parent–child communication (PCC) about sexual and reproductive health (SRH) is often hindered by cultural and social norms. We aimed to explore parental communication on sexual and reproductive health in the Haut-Sassandra region, Côte d’Ivoire. We used an interpretive description approach. Participants were parents (mothers and fathers), recruited through purposive sampling. Data were collected through individual interviews. We performed a thematic analysis. Overall, 63 parents participated in the study. The mean age of parents was 41.2. Sexuality remains a taboo subject. Sociocultural factors that hinder PCC are tradition, the need for intergenerational respect, and the fear of incitement. Reasons that explain the gap between intention and actual practice are the young age of the child, low parental self-efficacy, child gender, shame and intergenerational respect. Parents who communicate address the following topics: relationships (e.g., stay away from boys); values, rights, culture and sexuality (e.g., don’t date someone else’s husband); skills for health and well-being (e.g., sex has advantages and disadvantages); the human body and development (e.g., menstruation management); sexuality and sexual behaviour (e.g., practice abstinence); and sexual and reproductive health (e.g., protect oneself against disease). This study highlights the need to support parents in their educational role.

Sexes doi: 10.3390/sexes7010012

Authors: Blake A. Kozlowski Ashlyn S. Olson Alizay R. Naqvi Alexis S. Amos Andrew S. Franks

A recently developed nonpartisan authoritarian aggression scale (NAAS) has a robust nomological network that includes attitudes toward women and LGBTQ+ individuals. The current research was meant to further validate the scale by demonstrating its ability to predict unique variance in attitudes relating to sex crimes (i.e., rape myth acceptance) and anti-transgender hate crimes when controlling for potentially relevant cognitive (i.e., need for cognition, intolerance of uncertainty) and cultural (i.e., Christian nationalism) variables. A sample of 100 U.S. participants was recruited from Prolific and completed an online survey via Qualtrics. A series of correlation analyses showed that the NAAS was significantly related to all of the other predictor variables as well as both the sex and hate crime outcomes at the bivariate level, adding to the nomological network of the NAAS. Multiple regression analyses showed that the combination of predictors explained significant variance in both outcomes and that the NAAS was the only predictor to explain unique variance in both sex crime and anti-transgender hate crime attitudes. The results imply that authoritarian aggression poses a danger for women, transgender individuals, and victims of sex crimes and hate crimes more broadly. Future research should examine ways of attenuating authoritarian aggression in individuals and communities to protect those who are vulnerable due to their sex, sexual orientation, or gender identity.

Sexes doi: 10.3390/sexes7010011

Authors: Margaret Salisu

Loneliness poses a significant risk to the physical and mental well-being of older individuals, making it a pressing public health concern. Particularly for minority groups like elderly single and widowed Black women, the consequences of loneliness can be even more pronounced. To gain deeper insights into the experiences of loneliness and coping strategies used by these women, a qualitative phenomenological research study was conducted, involving interviews with fourteen such individuals. The study revealed four main themes: lonelier with age; looking beyond the family for intimacy; family responses to loneliness; and coping with loneliness. Irrespective of living arrangements, all participants acknowledged experiencing varying degrees of loneliness. Despite having extensive social networks, many struggled with feelings of loneliness, alienation, and a lack of emotional closeness and connection. Consequently, these findings emphasize the importance of addressing loneliness in elderly single and widowed Black women, considering the intersectionality of race, gender, and mental health when assessing the risk of loneliness. Practical and policy implications suggest that professionals and physicians working with this group actively screen for loneliness and develop interventions and psychological support to help these women navigate their feelings of isolation.

Sexes doi: 10.3390/sexes7010010

Authors: Piedad Gómez-Torres Amber Mallery Sergio Galarreta-Aperte Germano Vera Cruz Ana Carmen Lucha-López

Male contraceptive options remain largely limited to condoms and vasectomy, while family planning services and monitoring indicators often prioritize women, contributing to inequities in contraceptive responsibility. This review examines how future male hormonal contraceptives (MHCs) could support more equitable, rights-based family planning, and what policy and implementation pathways are needed for responsible integration. We conducted a narrative synthesis of peer-reviewed studies and policy/advocacy guidance on male engagement in family planning and on MHC development (searches in PubMed/Scopus/Google Scholar and key organizational sources; 2000–May 2025), focusing on acceptability, service-delivery readiness, governance, and potential system impacts. Evidence indicates substantial interest in MHCs among men and women in hypothetical studies and trials, but highlights persistent barriers: gender norms, limited routine sex-disaggregated data on men’s participation, provider and service constraints, and insufficient public/private investment. Model-based analyses suggest that novel, reversible male methods could avert unintended pregnancies (with larger effects in settings with lower baseline contraceptive uptake) and that preventing unintended pregnancies can yield cost savings to health systems. Ethical discussions increasingly emphasize a dyadic perspective on risk and decision-making, alongside safeguards for autonomy and rights. We conclude that coordinated policy action—linking regulation, financing, service delivery, communication, and monitoring—is needed to expand couple-focused counselling, reduce stereotyping in care, strengthen indicators, and accelerate implementation pathways for MHCs while safeguarding women’s options and agency.

Sexes doi: 10.3390/sexes7010009

Authors: Jose Juarez-Gómez Pablo A. Cantero-Garlito

Breast cancer entails profound physical, emotional, and relational changes that persist beyond biomedical treatment and may substantially affect women’s body image, sexuality, and engagement in daily occupations. This descriptive phenomenological qualitative study examined the lived experiences of eight Spanish breast cancer survivors through in-depth semi-structured interviews conducted after completion of oncological treatment. Transcripts were analyzed using discourse analysis with iterative interpretation. Three interrelated findings were identified: (1) bodily changes linked to mastectomy and adjuvant therapies disrupted continuity with the previously known body, eliciting estrangement, vulnerability, and grief for the former bodily self; (2) sexuality emerged as a particularly vulnerable domain, shaped by diminished desire, vaginal dryness and pain, shame, altered self-perception, and the need to renegotiate intimacy within the couple; and (3) coping and meaning-making were strengthened by psychological support, efforts to emotionally protect family members, and, notably, peer support and helping other women as key sources of resilience. These findings highlight the need for integrated, culturally sensitive, person-centered survivorship care that explicitly addresses sexuality, body image, and emotional well-being. Occupational therapy may contribute by supporting embodied identity reconstruction, participation in meaningful occupations, and the reconfiguration of intimacy after breast cancer.

Sexes doi: 10.3390/sexes7010008

Authors: Amber Whitmer Tiffany Chenneville Joseph Marshall Elham Azamian Jazi Ananda Myers

Despite widespread support for comprehensive sex education (CSE), abstinence-focused education is the legally mandated standard in Florida public schools. Using a cross-sectional survey design, this study examined the relationship between sex education content and sexual knowledge, attitudes, and behaviors among 117 college students aged 18 to 25 attending predominantly one large Florida public university. Participants completed an anonymous online survey assessing demographics, sex education history, HIV/STI knowledge, sexual attitudes, and condom use. Contrary to expectations and some prior findings, there were no significant differences in HIV/STI knowledge, sexual attitudes, or condom use between students who reported receiving predominantly abstinence-only education (AOE) and those who reported receiving predominantly CSE. While challenging assumptions about the long-term effectiveness of CSE compared to AOE, the data suggest, in part, that the CSE label may be secondary to local implementation, personal experiences, and broader sociopolitical context, in influencing outcomes. Given Florida’s restrictive sex education and reproductive health policies, findings highlight the urgent need for more nuanced, context-sensitive research. Findings also emphasize the importance of evaluating not only the stated content but also the delivery, quality, and accessibility of sex education programs to better support youth sexual health.

Sexes doi: 10.3390/sexes7010007

Authors: P. G. Macioti Jennifer Power Ryan DeVeau Miranda Millen Casey McGlasson Bee Charika Adam Bourne

Based on a qualitative health needs assessment with 31 diverse sex workers and 17 key stakeholders (including two mental health practitioners) in Victoria, Australia, this article adds to the emerging literature on stigma, sex work, and mental health. It does so by focusing on one element that plays a key role in determining sex workers’ experience of mental health support: whether they would disclose their sex work to a practitioner, why so, and what happens as a result. Our study finds that experiences and fears of being stigmatised by health practitioners when disclosing may prevent some sex workers from seeking professional mental health support in the first place and lead others to silence it or obfuscate; thus, potentially complicating access to safe and affirming mental healthcare. The value and role of disclosure is analysed in context by acknowledging the agency and ability of sex workers to understand, or take action in response to, their own mental health needs. Peer-to-peer support and solidarity are identified as key to sex workers’ mental well-being. Criminal restrictions on sex work are found to negatively impact sex workers’ access to mental healthcare. The findings from this study support ongoing efforts aimed at the full decriminalisation of sex work in order to improve sex workers’ access to high-quality mental health support, should they seek it, as well as the implementation of sensitivity training for mainstream mental health providers and the creation of reliable and accessible referral lists of sex worker-friendly mental healthcare providers.

Sexes doi: 10.3390/sexes7010006

Authors: Emme Edmunds

Taboos differentially reinforce socially constructed gender and sexual hierarchies that affect the experiences of all people—women, men, queer, heterosexual, and transgender people. In Delhi, India, institutions of heteropatriarchy, buttressed by colonial history, reproduce and naturalize limits to the agency and economic autonomy of women and queer people. These intimate economics influence and are influenced by people making decisions regarding relationships and have broad repercussions in society. How do individuals and groups simultaneously question, remake, and enlarge gendered categories and experiences? Interviews with middle-class people are discussed in the context of scholarship that considers the social, political, and historical contexts of the region. Interview responses are triangulated with ethnographic participation in Delhi-based events that examine and confront aspects of heteropatriarchal regulation of people regarding categories of gender and sexual expression. Themes emerge regarding how people create and access knowledge, economic autonomy, relationships, and family formation. The conclusion discusses ways in which the erosion of taboos reveals changing roles and identities and how these changes affect the hierarchal gender binary, producing social tensions and paradoxes.

Sexes doi: 10.3390/sexes7010005

Authors: Tina Kogovšek Roman Kuhar Alenka Švab

This study provides valuable insights into the factors influencing attitudes towards homosexuality and people living with Human Immunodeficiency Virus (HIV) among Slovenian high school students. The analysis identifies gender, school type, and religious affiliation as significant predictors of these attitudes. Consistent with previous research, gender differences emerge, with male students displaying more negative attitudes towards homosexuality compared to their female counterparts. This discrepancy is particularly pronounced among students attending vocational schools, aligning with existing data on attitudes towards sexuality. Sociological theories predicting social changes in intimacy, with women at the forefront, contribute to understanding this gender disparity.

Sexes doi: 10.3390/sexes7010004

Authors: Jhonny Acevedo Ayala Constanza Bartolucci Konga Francisca Molero Rodríguez Marcelo Vásquez León Eliana Espinoza Alarcón

Population aging is a reality in Chile that affects the course of life, quality of life, and sexuality of older adults. The objective of this study is to identify the dimensions, characteristics, and underlying contents of sexuality in older adults participating in community-based organizations in Chile. A qualitative study was conducted using grounded theory, based on ten focus groups with N of 85 participants aged 60 and over. Groups of women, men, and mixed groups were organized in the northern, central, and south-central zones of the country. The data were entered and analyzed using MAXQDA 2023 software. The results identified 10 dimensions and 42 sub-dimensions related to the sexuality of older adults. A structural educational deficit in the subject was identified, characterized by a lack of training for health care personnel and care gaps at the primary health care level, among other issues. It is concluded that sexuality in older adults is an emerging issue and a human right subject to social discrimination, with limitations to its full experience which must be studied and addressed to improve sexuality as part of changes in quality of life.

Sexes doi: 10.3390/sexes7010003

Authors: Ashley C. Schuyler Joseph A. Catania Jesse A. Canchola M. Margaret Dolcini

Research suggests that the impact of childhood sexual trauma (CST) on adult well-being varies in relation to characteristics of CST experiences (e.g., age of onset and duration/frequency) that influence the degree of trauma severity. Yet there remains a need for a CST severity measure that consistently delineates survivors with an elevated risk of adverse adult outcomes (AAOs) and accounts for correlations between severity characteristics. We compared two theory-based, categorical proxy measures of CST severity (duration and developmental timing) in their relationship with three AAOs, among a national probability sample of U.S. adult CST survivors (N = 568). We found a strong relationship between CST duration and developmental timing (p < 0.001), and redundancy in their impact on AAOs (i.e., no meaningful difference in how well they predicted AAOs). Participants with more chronic CST (≥4 years duration or occurring across childhood and adolescence) were twice as likely to report AAOs as other participants. Findings support the importance of assessing trauma chronicity in research and practice, to focus prevention and intervention strategies on CST survivors with the greatest long-term health risk. A categorical CST duration measure offers a theory-based assessment strategy that accounts for both the temporal and developmental effects of trauma severity on health outcomes.

Sexes doi: 10.3390/sexes7010002

Authors: Roya Haghiri-Vijeh Judith A. MacDonnell Parmis Mirzadeh Leslie Po Heba Botros Catriona J. Buick

The 2S LGBTQIA+ (Two-Spirit, Lesbian, Gay, Bisexual, Trans, Queer and/or Questioning, Intersex, Asexual, and additional sexually and gender-diverse self-identities) population often faces barriers to care in the context of cervical cancer screening. With the shift from primary cervical cytology (Papanicolaou test) to primary human papillomavirus (HPV)-DNA testing, it is crucial to examine these populations’ healthcare needs. An intersectionality framework with an anti-oppressive lens is needed to restructure a healthcare system whose systems have traditionally erased the care needs of diverse populations through colonial, racialized, and cis-heteronormative practices. Barriers to cervical screening in 2S LGBTQIA+ populations include stigma, discrimination, limited provider guidance and understanding, and high rates of physical, sexual, and medical trauma. Self-sampling for HPV is a less invasive alternative to traditional Pap tests with a high rate of acceptability. The option to self-sample may increase participation in cervical screening based on improved privacy, comfort, and feelings of empowerment. Organizational, psychosocial, and physical recommendations for practice are shared to create a welcoming environment that reflects the diversity of populations in all aspects of healthcare. Affirmative care aims to make clients feel safe and accommodated by prioritizing dignity and respect as essential elements of eliminating cervical cancer in 2S LGBTQIA+ populations.

Sexes doi: 10.3390/sexes7010001

Authors: Jacques J. D. M. van Lankveld Sira ter Steege Piet van Tuijl Andrea Grauvogl

Sexual pleasure has attracted increasing scientific attention in recent years. In this cross-sectional study, we investigated self-esteem and body appreciation as potential determinants of sexual pleasure. We examined data from a community sample of young adult women and men. Specifically, we tested the hypotheses that self-esteem and body appreciation positively predict sexual pleasure, and that body appreciation moderates the association between self-esteem and sexual pleasure. We exploratively investigated the moderation of these effects by gender. Sexual pleasure was measured using seven items from the trait scales of the Amsterdam Sexual Pleasure Index 1.0. Self-esteem was measured with the Dutch translation of the Rosenberg Self-Esteem Scale. Body appreciation was measured using the Dutch translation of the Body Appreciation Scale 2. The results showed that self-esteem positively predicted a substantial proportion (19%) of the variance of sexual pleasure, whereas body appreciation did not directly predict sexual pleasure. Body appreciation did not moderate the association between self-esteem and sexual pleasure in the full sample and in women, but it was found to moderate this association in men; however, in the opposite direction of what was predicted in the hypothesis. The findings were discussed, and suggestions were made for future research.

Sexes doi: 10.3390/sexes6040067

Authors: Joana Andrade Sofia Campos Eduardo Santos Inês Figueiredo Vitor Martins Eugénia Matos Ana Paula Cardoso Manuela Ferreira

Background: This study focused on a community located in Sumbe, in the Kwanza Sul province of Angola. The community’s limited resources significantly affect the healthcare of its residents. Local beliefs and traditions exacerbate this issue. Considering this scenario and a preliminary diagnosis by the research team, the Seigungo project aimed to evaluate the effectiveness of a training programme with different health-related modules. The module addressed in this study focused on sexual and reproductive health. Methods: This exploratory, quantitative, observational before-and-after study employed a descriptive-correlational analysis with a sample of 30 participants (n = 30) who finished the training programme. Statistical analysis was conducted using IBM® SPSS® Statistics, version 29.0. Results: The sexual and reproductive health literacy module of the implemented training programme proved effective. Considering the results before the training, 53.3% of the health promoters presented inadequate literacy levels, and after the training this number decreased to only 3.3%. Conclusions: Our findings demonstrate that education and community engagement may significantly improve the levels of literacy in sexual and reproductive health, which may result in better health decisions and outcomes.

Sexes doi: 10.3390/sexes6040066

Authors: Hannah M. Stremick Lauren M. Walker

Objective: This study aimed to investigate aspects of sexual response in cisgender women by querying what participants deem to be important physiological and subjective components of sexual arousal. It was also explored whether education about the role of genital blood flow influenced participant responses. Methods: Standard sexuality-based questionnaires were administered assessing function, desire, flexibility, satisfaction, and history, prior to administering a short semi-structured interview. Experiences of sexual arousal were explored in the interview in an open-ended fashion. A brief educational video condition was shared with half of the participants at random. We explored whether being presented additional information about genital function changed the way women describe their physiological response. Those in the control group completed the interview questions once. Those in the educational condition group completed the interview, watched the brief educational video and then repeated the interview questions. Following the interview, all participants completed a brief follow-up questionnaire assessing preferred arousal terminology. Results: The sample size included 30 cisgender women with a mean age of 21.10 (4.38), with 70% in a committed relationship. Additionally, there were no group difference found with those who reported a history of sexual trauma/abuse vs. no trauma/abuse in regard to sexual function, satisfaction, distress and flexibility. The physical arousal sensations described most often in the interview included lubrication (n = 27), blood flow (n = 23), and pulsating (n = 9), whereas, in the ranked term analysis, the three most highly ranked genital sensations were wetness, throbbing and tingling. For non-genital sensations, those most often reported in the interviews included nipples/breast changes (n = 17), skin sensitivity (n = 13), and changes in body temperature (n = 12), whereas them most highly ranked non-genital sensations were heart rate increase, hardness of nipples/breast changes, and skin sensitivity. There were no group differences in the reporting of full-body or genital sensations and the frequency of use of terminology related to blood flow. The two most important themes emerging from the qualitative analysis included the distinct themes of subjective and physiological arousal. The majority of participants placed an emphasis on subjective arousal, deeming it the most important part of their sexual response, with physiological arousal largely deemed important only when subjective arousal was also present. Conclusions: The same themes were present in both groups, indicating that the brief educational video was unlikely to have influenced the way women described their physiological arousal. Participants in both groups placed a dominant emphasis on sensations related to genital blood flow and the importance of subjective arousal.

Sexes doi: 10.3390/sexes6040065

Authors: Emanuela Falzia Vincenzo Maria Romeo

This perspective advances a psychoanalytic—embodiment account of the “libido of generativity” (LoG)—future-oriented reorganization of erotic desire that links embodied arousal with caregiving, legacy, and shared projects. We define LoG along four axes (direction of investment: dyad↔triad; temporal horizon: immediacy↔future; outcome modalities: procreative, creative–sublimative, community-forming; affective regulation: shame/guilt↔pride/gratitude). Integrating interoception, body ownership/agency, and self-compassion with reproductive mentalizing, we specify three proximal levers—embodiment, affect regulation, and representation—through which sexual mindfulness can recalibrate bodily salience, blunt shame-based self-objectification, and expand triadic representations (self–partner–child/symbolic offspring). We then translate these mechanisms into a brief, practice-ready relationship guidance (RG) curriculum (6–8 sessions) combining somatic mindfulness, compassion micro-practices, reproductive-mentalizing dialogs, communication skills, and generative rituals. We articulate falsifiable propositions (e.g., mindfulness → ↑couple satisfaction via ↓body-image self-consciousness and ↑reproductive mentalizing) and a sex/gender-attentive reporting plan (SAGER). Primary outcomes include sexual functioning/satisfaction and couple satisfaction/communication; secondary mechanistic endpoints index interoceptive accuracy/awareness (including heartbeat-evoked potentials), self-compassion, and reproductive mentalizing. By aligning contemplative practices with couple-skills training and equity-focused implementation, the LoG framework offers a testable bridge from psychoanalytic theory and embodiment science to measurable improvements in sexual health and couple well-being.

Sexes doi: 10.3390/sexes6040064

Authors: Emily Melvin Satarupa Dasgupta

With most individuals in the U.S. having regular access to an internet connection and/or owning smartphones, digital communication has become an inevitable part of daily life for adults and adolescents. Consequently, forming, maintaining, and ending relationships via digital media is a widespread phenomenon; however, there is also an ongoing risk of technologically facilitated intimate partner violence (IPV) perpetration and victimization. The current paper conducts a traditional narrative review to synthesize the extant research on the nature and scope of technologically facilitated IPV among Generation Z individuals. Four hundred and fifty studies were screened, and a total of thirty-eight studies—that met the inclusion criteria—were reviewed for the study. The current paper endeavors to explore the scope and pattern of technologically facilitated IPV. It examines Generation Z individuals’ vulnerability towards technologically facilitated IPV and assesses the impact of generative artificial intelligence on IPV perpetration and mitigation. The study also investigates any scope of association between online and offline violence victimization and perpetration. Finally, the paper also discusses recommendations to enhance violence mitigation programs and support services for younger victims through technologically facilitated means.

Sexes doi: 10.3390/sexes6040063

Authors: Carolyn Bronstein

This paper reexamines the contested categories of sex addiction and Compulsive Sexual Behavior Disorder (CSBD) through a feminist-critical synthesis of 63 peer-reviewed articles published between 2000 and 2024. Rather than treating these diagnoses as neutral clinical entities, the review situates them within broader systems of normative regulation, emphasizing how psychiatric discourse, cultural anxieties, and digital infrastructures converge to define sexual deviance. The analysis is organized around the following three themes: (1) clinical ambivalence, where blurred thresholds of disorder mirror the opaque judgments of algorithmic moderation; (2) moral panic, which persists less as episodic reaction than as a durable strategy of governance embedded in media and platform logics; and (3) the pathologization of margins, whereby diagnostic and digital regimes disproportionately target queer, racialized, and gender-nonconforming sexualities. The paper introduces the concept of digital moral regulation to describe how platform architectures extend older traditions of moral governance, embedding cultural judgments into technical systems of visibility and suppression. By reframing CSBD as part of this regulatory formation, the review underscores that debates over compulsive sexuality are not solely matters of diagnostic precision, but of power: who defines harm, whose desires are legitimized, and how infrastructures translate cultural unease into regimes of control.

Sexes doi: 10.3390/sexes6040062

Authors: Sadandaula Rose Muheriwa-Matemba Tiwonge Mbeya Munkhondya Lucia Yvonne Collen Grace Chasweka Rosie Hanneke Esther Latif Natasha Crooks

Prepubescent children and young adolescents (ages 7–14) are in a critical developmental stage for establishing the foundations of healthy sexual behavior. Increasing rates of precocious puberty, combined with limited access to accurate and age-appropriate sexual health education, heighten the vulnerability of this age group to sexual health risks. These risks include early and often coerced sexual initiation, exposure to sexual abuse, and consequent outcomes such as sexually transmitted infections and early pregnancies. However, comprehensive cross-regional analyses and evidence-based interventions addressing the sexual health needs of this age group remain limited. Addressing this gap promotes mutual learning, context-specific adaptation, and global alignment of sexual health support efforts, crucial for achieving the Sustainable Development Goal target of universal access to sexual and reproductive health care. This scoping review aims to map the available evidence on the scope and characteristics of sexual health interventions for prepubescents and young adolescents in the United States and Sub-Saharan Africa. The proposed scoping review will be conducted in accordance with the Arksey and O’Malley framework and Joanna Briggs Institute (JBI) methodology for scoping review. A systematic search of English-language articles published from 2010–2025 will be conducted across PubMed, CINAHL, PsycINFO, Scopus, Web of Science, ERIC, and African Index Medicus. Five reviewers will screen the articles in Covidence and independently assess full-text articles using a standardized data extraction form. Discrepancies will be resolved through discussion and with a sixth reviewer. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Data will be summarized and synthesized to identify patterns in interventions, delivery methods, outcomes, and implications for practice, research, and policy. Comparative and gap analyses will highlight similarities, differences, and priorities for future research and interventions. An adolescent sexual health expert will help validate and contextualize findings. Results can guide strategies to address shared challenges and advance universal access to sexual health support for prepubescents and young adolescents.

Sexes doi: 10.3390/sexes6040061

Authors: Titilayo Tatiana Agbadje Marlyse Mbakop Nguebou Loukou Gilbert Konan Mariame Koné Abdoulaye Anne Jean Ramdé Souleymane Diabaté Maman Joyce Dogba

In recent years, the sexual and reproductive health of adolescents and young adults (ages 10–24) in Africa has improved through national and international initiatives. However, major challenges remain in enabling young people to exercise their sexual and reproductive health rights (SRHRs), especially in Côte d’Ivoire. This study aimed to explore the perspectives of stakeholders on the freedom of choice of adolescents and young adults with regard to SRHRs in Haut-Sassandra, Côte d’Ivoire. We conducted this qualitative descriptive study between September and October 2023. Participants were selected using a purposive sampling method. Overall, 137 stakeholders participated in the study: 57 teachers and administrators, 17 community leaders, and 63 parents. Data were collected through interviews and focus groups, using an interview guide. Through a deductive thematic approach, we identified three forms of freedom of choice: conditional, absent, and absolute. The average age of the study participants was 46.1 years. The findings reveal that several factors influence the freedom of choice among adolescents and young adults regarding their SRHRs. These include age, gender, parental involvement, prior education, autonomy, and perceived maturity. Limited freedom was commonly associated with younger age (10–18 years), perceived immaturity, and a lack of autonomy. In contrast, greater freedom was linked to older age (18–24 years) and higher levels of perceived maturity. Stakeholders’ perspectives were shaped by cultural and religious norms, a protective attitude toward youth, and a sense of disengagement from adolescent concerns. This study underscores the importance of interventions aimed at increasing stakeholders’ knowledge and awareness of adolescents’ sexual and reproductive rights.

Sexes doi: 10.3390/sexes6040060

Authors: Lucca Moisés Santiago Silva Ryan Lago Araujo Rieper Vanessa Castro Felix Lima Diana Marcela Aragón Novoa Igor Brasil de Araújo Izabel Almeida Alves Aníbal de Freitas Santos Júnior

Background/Objectives: The main contraceptive options for men are condoms, vasectomy and coitus interruptus. Clinical and preclinical trials are being conducted to develop a new male contraceptive (NMC), which can be either hormonal or non-hormonal. A patent landscape and literature review of clinical studies from the last 10 years were carried out to discuss clinical perspectives and sociocultural aspects related to the use of NMC. Methods: An integrative review of clinical aspects was conducted using eleven clinical trials, and a discussion of sociocultural aspects was conducted using thirteen articles. Results: Studies of non-hormonal contraceptives, particularly vaso-occlusive methods, are in more advanced clinical phases, demonstrating contraceptive potential and reversibility. In addition to clinical trials, efforts to develop NMC include addressing gender disparities and understanding masculinity. Alternative technologies and methods for contraception were identified as key to the development of NMC. Despite clinical and technological advances, there is a need to expand clinical studies on male contraceptives, involving larger samples, long-term follow-ups, and reversibility tests. There is a global social need that both men and women should have a wide variety of contraceptive options. Conclusions: This review emphasizes the importance of exploring new technologies for male contraceptives to expand options while optimizing the satisfaction and safety of these contraceptive options for the population.

Sexes doi: 10.3390/sexes6040059

Authors: Anais Sánchez Arévalo María Polo Alba Rincón Claudia Bravo Nieves Moyano

Sexual consent, although more extensively studied in recent decades, remains a complex and nuanced concept that is often difficult to define and investigate. This study aimed to analyze the relationships between beliefs, attitudes, and behaviors related to sexual consent, and the ability to interpret complex sexual scenarios with varying characteristics. A voluntary sample of 738 individuals over 18 years of age was recruited, mainly through social networks. Data analysis was conducted using descriptive statistics and mean comparison tests. Participants with higher scores for continuous consent, communicative sexuality, and positive attitudes toward consent, as well as lower scores for subtle coercion and (lack of) perceived control, showed more accurate interpretations of sexual assault situations. These findings may contribute to the development and implementation of programs aimed at reducing the use of coercive and violent strategies in sexual relationships.

Sexes doi: 10.3390/sexes6040058

Authors: Sonia Barriuso-Ortega

Background: Sexual and reproductive health promotion is a political and social process that involves not only individual actions but also strategies to change social, environmental and economic factors. It is necessary to know the characteristics of effective interventions in order to design new evidence-based programmes. However, programmes need to follow a holistic approach, hence the importance of Comprehensive Sexuality Education. Methods: An extensive bibliographic search was carried out. Twenty systematic reviews between 2015 and 2025 were selected following PRISMA 2020. Results: This review shows that interventions to promote SRH are effective and have significant results in increasing SRH knowledge, attitudes and skills, the competencies of professionals and improving access to SRH services. It has been possible to extract that it is necessary to promote SRH with the inclusion of young people, the adaptation of interventions according to the needs of each person, the coordination between different areas, the application of the intersectional and gender perspective, the application of a rights-based approach, the use of comprehensive and inclusive education models, the training of professionals and the carrying out of evaluations to disseminate the results. Furthermore, there are shortcomings in the evidence, such as the lack of an intersectional perspective, the lack of inclusion of certain groups and the lack of rigorous evaluations following quality standards. Conclusion: Programmes based on Comprehensive Sexuality Education are effective and have certain common characteristics.

Sexes doi: 10.3390/sexes6040057

Authors: Giuseppe Seminara Marco Alessi Maria Carmela Zagari Francesca Greco Antonino Raffa Marco Leuzzi Ettore D’Aleo Lorenzo Campedelli Mara Lastretti Emanuela A. Greco Cristina Segura-Garcia Antonio Aversa Cristiano Monarca

Gender dysphoria stems from incongruence between gender identity and assigned sex, often causing significant distress related to breast anatomy in transmasculine individuals. Gender-affirming hormone therapy typically precedes mastectomy, which is a fundamental intervention in transgender healthcare. Surgical challenges arise in patients with large breasts on lean frames, requiring customized techniques to achieve a natural, proportional, androgynous chest. This case report describes a 23-year-old transmasculine patient with macromastia and a tall, lean build who underwent gender-affirming mastectomy with free nipple grafts and muscular sculpture aimed at an androgynous esthetic. Pre- and postoperative evaluations showed marked improvements in body image, physical strength performance, and emotional well-being. Psychological assessments revealed significant reductions in body uneasiness and gender dysphoria, while human figure drawings demonstrated increasing bodily integration and identity congruence. A general improvement in physical performance over time was reported, particularly in upper body strength, with minor fluctuations potentially related to the surgical intervention and recovery phase. The narrative literature review supports these outcomes, highlighting satisfaction rates above 90%, minimal regret, and consistent gains in psychosocial functioning and sexual and mental health, including reduced anxiety and depression. This evidence reinforces that gender-affirming mastectomy is medically necessary, particularly when tailored to individual anatomical and esthetic needs, affirming identity and alleviating distress.

Sexes doi: 10.3390/sexes6040056

Authors: Kofi Atakorah-Yeboah Junior Edith Phalane Thomas Agyarko-Poku Kyeremeh Atuahene Yegnanew Alem Shiferaw Refilwe Nancy Phaswana-Mafuya

Despite notable progress in HIV prevention and treatment, men who have sex with men (MSM) continue to bear a disproportionate burden of HIV, particularly in sub-Saharan Africa, where systemic barriers restrict access to HIV testing. This study draws on data from the 2017 Ghana Men’s Study II (GMS II), to examine the socio-demographic, behavioural, and structural factors influencing HIV testing among MSM. The Ghana Men’s Study II dataset, involving 4095 MSM, was de-identified and analysed using STATA (software version 17). Before the analysis, missing information for categorical variables were treated using the mode imputation technique. Chi-square test was done to describe relevant characteristics of the study population, such as socio-demographic/socio-economic variables and behavioural practices. Multivariable logistic regression analysis was performed for variables with p < 0.05 to determine significant predictors of HIV testing among MSM. All the statistical analyses were performed at a 95% confidence interval, with significant differences at p < 0.05. In multivariable logistic regression analysis, age 25–34 (AOR: 1.43; 95% CI: 1.18–1.74, p < 0.001), having a senior high school education (AOR: 1.69; 95% CI: 1.02–2.80, p = 0.040), tertiary education (AOR: 2.03; 95% CI: 1.17–3.55, p = 0.012), being a light drinker of alcohol (AOR: 1.28; 95% CI: 1.04–1.58, p = 0.020), and having a comprehensive knowledge of HIV (AOR: 1.50; 95% CI: 1.26–1.78, p < 0.001) had higher odds for HIV testing. Other factors such as being a Muslim (AOR: 0.69; 95% CI: 0.54–0.90, p = 0.005) and sold sex to other males (AOR: 0.67; 95% CI: 0.50–0.90, p = 0.007) were also positively associated with HIV testing among Ghanaian MSM. The findings revealed a number of socio-demographic and behavioural factors associated with HIV testing among the MSM population in Ghana.

Sexes doi: 10.3390/sexes6040055

Authors: Tyler N. Livingston

The present research assessed university student stakeholders’ perceptions of positive outcomes (i.e., appropriateness and benefits of conferencing) and negative outcomes (i.e., endangerment and revictimization of the complainant) associated with restorative justice-based direct conferencing in sexual misconduct cases. Stakeholders received random assignment to a 2 (allegation severity: more vs. less) × 2 (evidence strength: lower vs. higher) between-participant experimental design. More severe allegations and higher evidence strength were associated with lower ratings of appropriateness; allegation severity and evidence strength interacted to affect ratings of benefits; and more severe allegations, but not stronger evidence, were associated with higher ratings of endangerment and revictimization. Belief in the alleged perpetrator’s guilt explained the relationship between evidence strength and ratings of appropriateness, and desire to punish the alleged perpetrator explained the relationship between allegation severity and ratings of appropriateness. Researchers and Title IX coordinators should evaluate and respond to stakeholder sentiment toward direct conferencing.

Sexes doi: 10.3390/sexes6040054

Authors: Judith I. Ani Lucky Norah Katende-Kyenda

Masculinity norms and gender socialization play a critical role in shaping boys’ attitudes, behaviours, and interactions within society. In South Africa, historical legacies of colonialism and apartheid, coupled with deeply ingrained cultural and societal expectations, have contributed to rigid masculinity norms that emphasize dominance, emotional restraint, and aggression. These constructs not only influence boys’ development but also have significant implications for gender-based violence (GBV). This paper explores how norms of masculinity and processes of gender socialization among boys in South Africa shape attitudes and behaviours that contribute to gender-based violence (GBV). The central aim is to offer a critical theoretical synthesis and contextual analysis that informs the development of gender-equitable policies and interventions. Drawing on theoretical frameworks such as hegemonic masculinities, intersectionality, and social learning theory, this study examines how historical, cultural, and socio-economic factors shape gender socialization and influence boys’ developmental trajectories. Through an intersectional lens, this paper underscores the urgent need to challenge harmful masculinity norms and promote alternative models that encourage emotional expression, empathy, and equitable gender relations. Finally, it provides recommendations on how these harmful norms can be disrupted through educational, community, media, and policy-level reforms to foster healthier masculinity norms and reduce GBV in South Africa.

Sexes doi: 10.3390/sexes6040053

Authors: B. J. Rye Aliyah S. d’Gama Rose

Personal identity is a multidimensional, universal, and ever-developing construct that forms primarily during youth. One domain of identity—gender—manifests quite clearly in terms of developmental course and psychosocial components in the lives of transgender individuals. Members of this population often initiate various social and medical transitions to rework their gendered characteristics to align more authentically with their internal selves. Consequently, healthcare and social service professionals express growing interest in facilitating and fostering the psychological health of transgender youth. Rather than focus on adversity (e.g., depression, suicidality, mental illness), the current study addresses this concern by describing positive components of the gender identity of 120 transmasculine youth participants. To this end, we operationalized gender identity health through three overarching constructs: developmental process, psychological functioning, and the positive outcomes of being a transgender person. Further, we investigate how these components interrelate, plus compare responses by age and gender identity cohorts. For age, we compared adolescent responses to the identity measures to those of transgender emerging adults (n = 166; 20–29 years) and adults (n = 53; 30–39 years). For gender, we partitioned the adolescent participants into binary (n = 91) versus non-binary (n = 29) identities. The descriptive results demonstrated that identity is reasonably developed, functional, and positive in this adolescent sample. Moreover, the three hypothetical components of transgender identity demonstrated modest overlap with each other. The youth did not differ in identity development, functionality, or positivity compared to older cohorts. Binary transmen scored slightly higher on gender authenticity and commitment than their non-binary transmasculine counterparts, but the two gender groups were the same on the other identity components. We discuss some practical implications of these findings as focus areas for healthcare providers and support systems to continue to foster healthy identity development.

Sexes doi: 10.3390/sexes6030052

Authors: Gustav Oppermann Caroline Van Zant Isabel Coughlan Sophie Howarth Nicole Sparapani Kathryn Pedgrift

Despite advances toward disability inclusion, high-quality sex and relationship education (SRE) is often inaccessible for disabled communities. Confounding this issue, each individual’s experience of SRE is shaped by aspects within their environment, such as societal contexts, cultural factors, policy frameworks at the national and local levels, and the attitudes of parents and educators. This informal review of the literature synthesizes historical and contemporary literature—focusing primarily on individuals with intellectual disabilities and autism—to explore the multifaceted barriers and opportunities for effective SRE. We have situated the literature within Bronfenbrenner’s ecological systems theory to illuminate how interactions among and within the environment shape individual experiences with SRE. The literature outlines several barriers to successful SRE programs for the disabled community, including pervasive misconceptions about the sexual and relational needs of disabled individuals, inadequate training for educators, and limited empirical evidence underpinning best practices. Our paper underscores the need for comprehensive, evidence-based curricula that align with the desires of the disabled community, are accessible to people with disabilities and their communities, and employ a variety of instructional methods to support learning across the life course, beginning in adolescence. We conclude by outlining future directions for research and practical solutions for curriculum development, emphasizing the importance of addressing these multi-layered challenges to enhance SRE for disabled people and their communities. Approaching and conceptualizing the literature within a systems framework and through our shared perspectives and experiences is noteworthy, as our review provides a descriptive and unique lens to understanding SRE influences on people with disabilities nationally and internationally.

Sexes doi: 10.3390/sexes6030051

Authors: Dumayi Gutierrez

Background: Sexually expansive (sexual identities beyond traditional monosexual categories) Latina/e/x women navigate intersecting systems of oppression shaped by cultural expectations, gender norms, and heterosexism. Despite their resilience, they remain underrepresented in minority stress research. This study examines how individual (sexual and ethnic identity centrality), relational (social support from family, partners, and friends), and communal (community connectedness) protective factors relate to internalized heterosexism and improved or diminished mental health factors (life satisfaction and psychological distress). Methods: Grounded in an intersectional ecological systems and minority stress framework, this study uses secondary data from the Generations Study, a national longitudinal investigation of sexually expansive adults in the U.S. from 2016 to 2019. A subsample of sexually expansive Latina/e/x women (n = 120) was analyzed using one-way ANOVA, multiple regression, and moderation analyses. Results: Sexual and ethnic identity centrality was independently associated with lower internalized heterosexism. Family, friend, and significant other social support were significantly associated with improved and diminished mental health factors, as was community connectedness with sexual identity centrality. ANOVAs and moderation results were non-significant. Conclusions: These findings highlight the protective impact of identity affirmation and social support on mental health, offering valuable insights for clinicians, researchers, and community leaders supporting a strong yet underrepresented group.

Sexes doi: 10.3390/sexes6030050

Authors: Lahari A. Telang Aoife G. Cotter Abdul Rashid

Malaysia is an upper-middle-income country and one of the few in Asia that has achieved Universal Health Coverage (UHC). Despite this, healthcare in Malaysia is less accessible to marginalized groups, such as transgender women, because a legal framework denies them gender-appropriate identification. Healthcare settings often fall short in addressing transgender-specific health needs. Transgender women face compounded stigma and discrimination, along with unique social and interpersonal challenges that greatly increase their risk of poor overall health. This narrative review explores the barriers to accessing and using primary, sexual, oral, and mental healthcare for transgender women in Malaysia. The discussion covers enabling factors like training healthcare workers, prioritizing transgender health needs, working with community-led organizations, implementing health policy reforms, and utilizing technology-based health interventions.

Sexes doi: 10.3390/sexes6030049

Authors: Adriana Jiménez-Muro Pedro J. Ramos-Villagrasa Ángel Castro

Since the popularization of dating apps, the scientific literature developed in the last decade still has various limitations that concern both the populations studied and the variables evaluated. Therefore, this study aimed to analyze the use of dating apps among adults (25–50 years) and the relationship between the use of these apps and mental, physical and sexual health and substance use. A total of 1004 adults of both sexes (M = 36.61, SD = 7.16; 50.7% women, 49.3% men) participated in the study, filling out a battery of online questionnaires. A 40% prevalence of dating apps use was found. Men, non-heterosexuals, and single people showed higher use of these apps. No relationship was found between the use of dating apps and mental health (self-esteem, anxiety, depression). On the other hand, a direct association was found between being a dating app user and the consumption of substances (tobacco, alcohol, marijuana, cocaine, mental health medication), concern about physical appearance, and the practice of physical exercise. In addition, app users showed better sexual functioning than non-users. The main finding of the study is that there are no differences in mental health (self-esteem, anxiety, depression) between adult users and non-users of dating apps. The results obtained have significant implications both a psychological and social viewpoint. Therefore, they must be considered when implementing prevention and promotion programs for sexual health.

Sexes doi: 10.3390/sexes6030048

Authors: Sijia Huang Julie Yang Pekka Santtila

We examined after-sex behaviors and their associations with relationship satisfaction, sexual satisfaction, intimacy, and sexual dysfunction in heterosexual Chinese couples. Forty-two couples participated in a randomized controlled trial of an online Sensate Focus intervention. They completed survey questions before and after the intervention, reporting on after-sex behaviors, relationship satisfaction, sexual satisfaction, intimacy levels, and sexual dysfunction. The findings revealed that negative after-sex behaviors were associated with decreased relationship satisfaction and sexual satisfaction, particularly for women. Negative after-sex behaviors were also correlated with lower levels of intimacy for both genders studied. Additionally, women who engaged in positive after-sex behaviors reported significantly higher levels of sexual functioning across arousal, desire, and overall satisfaction. Lastly, the Sensate Focus intervention did not influence after-sex behaviors. The findings underscore the therapeutic potential of emphasizing after-sex behaviors in improving sexual functioning and intimacy. Notably, gender differences were observed, with women reporting stronger correlations to these behaviors than men.

Sexes doi: 10.3390/sexes6030047

Authors: Constanza Adrian Parra Valeria Stuardo Ávila Kenny Low Andrade Cristian Lisboa Donoso Débora Solís Danilo Gómez Evelyn Cortés Cecilia Bustos Ibarra Paola Contreras Hernández Jaime Barrientos Delgado Mercedes Carrasco-Portiño

The increasing migration phenomenon and its impact on sexual health highlight the urgency of improving access to preventive services and developing responsive surveillance mechanisms. This study aims to describe the context and define the implementation circuits of a Community-Based Surveillance System (CBSS) focused on social epidemiological aspects related to sexual health in Chile’s migrant population. A two-phase qualitative design was employed: Phase 1 involved formative research, and Phase 2 focused on the design of CBSS implementation circuits. The formative phase led to the selection and characterization of three community-based organizations (CBOs)—two in Santiago and one in Antofagasta—and two primary healthcare centers (PHCs). Findings revealed heterogeneity in institutional capacities, limited coordination between CBOs and the health system, and a high level of willingness to participate. PHCs showed comparable profiles. Based on this, differentiated operational circuits were co-designed and adapted with stakeholders, and formalized through site-specific implementation manuals. This pre-implementation evaluation helped identify critical contextual barriers and generate tailored strategies for CBSS deployment. The active involvement of local actors is essential to ensuring the contextual relevance, institutional acceptability, and future sustainability of the proposed model. These insights offer transferable learning for the design of health interventions in underserved and structurally constrained settings.

Sexes doi: 10.3390/sexes6030046

Authors: Cecilia Benoit Andrea Mellor

The concept of resilience, the capacity to withstand or overcome major stress or hardship despite difficult circumstances [...]

Sexes doi: 10.3390/sexes6030045

Authors: Alejandra Ceballos-Morales Celeste Villalobos-Lermanda Alexis González-Burboa Agustín Ciapponi Ariel Bardach

Progestins have shown to be highly effective, adequately safe contraceptives and a real alternative in the cases with contraindications to estrogen use. This review assesses the effectiveness of treatments for managing uterine bleeding due to the use of progestin-only contraceptives. A systematic review of databases such as Embase, LILACS, CINAHL, and PubMed, with a result of 701 studies published in English between 2005 and 2022, was carried out. 21 randomized clinical trials were analyzed. There were effective non-hormonal alternatives for managing progestin-related bleeding. While several treatments show promise, results must be replicated by studies with longer follow-up periods. Differences came from the five new studies and their good methodological quality—specifically, blinding and assessment of population losses. Benefits were the stop of uterine bleeding and a shortened duration of these episodes, with studies generally reporting satisfaction among their patients. There were few adverse effects seen, with the most common being headaches and nausea, which should be addressed by future studies. These results are expected to be of use for health professionals and midwives working on contraceptive management.

Sexes doi: 10.3390/sexes6030044

Authors: Keith J. Watts Shawndaya S. Thrasher Laneshia R. Conner Kathryn Showalter DeKeitra Griffin Sydney P. Howard Elaine M. Maccio Justin X. Moore

LGBTQ+ individuals face substance use disparities linked to minority stress. While community belongingness may buffer stress, its role is complex. This study examined divergent associations between belongingness within the LGBTQ+ community and lifetime illicit drug use versus past-year alcohol frequency among LGBTQ+ adults in Kentucky (n = 2953), a region with notably high rates of substance use. Methods: Cross-sectional online survey data were analyzed. We measured LGBTQ+ belongingness, lifetime use of cocaine/crack/heroin/methamphetamine, and past-year alcohol frequency. Logistic and linear regressions controlled for age, education, gender identity, and income. Results: Greater belongingness predicted significantly higher odds of lifetime illicit drug use (OR = 1.24) but lower past-year alcohol consumption frequency (B = −0.094). Transgender and gender expansive identity predicted significantly higher illicit drug use odds and higher alcohol frequency. Conclusions: In this Kentucky sample, LGBTQ+ belongingness showed divergent substance use associations: it was protective against frequent alcohol use but, unexpectedly, was associated with higher odds of lifetime illicit drug use. Findings highlight belongingness’s complex, context-dependent nature and the need for nuanced research and interventions considering substance type and specific vulnerabilities, particularly for TGE individuals.

Sexes doi: 10.3390/sexes6030043

Authors: Silvia Di Battista

Some studies have shown that the identities of asexual individuals can be devalued and invalidated through processes of dehumanization. However, research examining dehumanization and attitudes toward asexual parents remains scarce. Drawing on the dual model of dehumanization, this experimental study aimed to investigate the denial of traits associated with human nature (HN; denial of basic human emotions) and human uniqueness (HU; denial of a rational mind), as well as perceptions of parenting competence and warmth attributed to different maternal targets. It was hypothesized that asexual mothers would be judged more negatively on the HN dimension, but not on the HU dimension, compared to allosexual mothers. Furthermore, it was hypothesized that perceived behavior toward children, assessed in terms of warmth, would be associated with the denial of HN (but not HU) for asexual mothers. The study involved 298 participants (Mage = 35.97, SD = 15.04), who read one of three scenarios that were identical except for the sexual orientation of the mother: (1) heterosexual allosexual mother; (2) lesbian allosexual mother; and (3) asexual mother. Participants were then asked to evaluate the target with dehumanization measures and perceived parenting behaviors. Results showed that the asexual mother was perceived more negatively than all other targets across all variables. Moreover, parallel mediation analyses revealed that the perception of a lack of warmth in the asexual mother (compared to the other targets) was mediated by the denial of HN, but not HU. In contrast, both HN and HU were found to mediate judgments of parental competence. These findings provide initial evidence of stigma faced by asexual parents, highlighting the need for further research into the attitudes directed toward them.

Sexes doi: 10.3390/sexes6030042

Authors: Rsha Soud Adam Davies Justin Brass Shoshanah Jacobs

This study examines how Ontario’s Health and Physical Education curriculum addresses the needs of young adults with disabilities. A total of 54 individuals aged 18–35 years old with developmental, learning, or physical disabilities who had completed secondary school in Ontario participated in a cross-sectional mixed-methods survey. Participants were recruited through disability-focused community networks and a university psychology participant pool. They completed the Sex Education subscale of the Sexual Knowledge, Experience, Feelings and Needs Scale, a 35-item sexual knowledge questionnaire, and open-ended questions. Quantitative data were analyzed using descriptive statistics and independent samples t-tests; qualitative responses were examined using thematic analysis. Participants reported limited factual knowledge, minimal classroom representation, and heavy reliance on independent learning. Barriers included inaccessible materials, teacher discomfort, and the absence of disability narratives in sexuality units. Findings point to three priorities: revising curriculum content, expanding educator training, and creating disability-affirming resources. These measures will help ensure comprehensive and rights-based sexuality education that supports the autonomy and well-being of students with disabilities.

Sexes doi: 10.3390/sexes6030041

Authors: Carolyn O’Connor Stephanie Begun

Sexual consent is one of the most important tools used in the prevention of sexual violence, for which adolescents are especially vulnerable. However, it is unclear how sexual consent processes are defined and used by this population. To bridge this gap in knowledge, this scoping review sought to identify and synthesize the existing empirical research findings on sexual consent conceptualizations and processes among adolescents, as well as determine critical gaps in knowledge. Forty-three articles were reviewed following a systematic search of six academic databases. Articles were included if they were original empirical work published in English between January 1990 and March 2020, included adolescents aged 10 to 17 in their sample, and specifically studied sexual consent conceptualization, communication, and/or behavior. Seventeen articles, diverse in study design and geography, met these criteria and were analyzed. The findings suggest a propensity for adolescents to abstractly define sexual consent as verbal and direct in nature while simultaneously espousing indirect and non-verbal behavioral processes when presented with “real life” scenarios (e.g., vignettes, reflections on personal experience). In addition, the results reveal the significance of concepts like gender norms, normative refusals, and silence as key aspects of adolescent sexual consent. This review demonstrates that research on sexual consent among adolescents is highly limited overall, and the findings that are available indicate some concerning perceptions.

Sexes doi: 10.3390/sexes6030040

Authors: Hugh Klein Thomas Alex Washington

Purpose: This paper examines the differences between transgender persons who self-identify as bisexual (n = 4129) and those who self-identify as pansexual (n = 5056) when it comes to experiencing anti-transgender harassment, discrimination, and violence, serious psychological distress, and suicidal ideation. Methods: Data from the 2015 U.S. National Transgender Survey were used to evaluate the differences between bisexual and pansexual persons in a sample of transgender Americans aged 18 or older. The Kessler-6 scale assessed psychological distress, and a dichotomous measure of past-year suicidal ideation was used. A 20-item scale assessed the extent to which people experienced anti-transgender harassment, discrimination, and violence. Multivariate analysis and structural equation analysis were used to analyze the data. Results: Compared to their bisexual counterparts, pansexual persons experienced more anti-transgender harassment, discrimination, and violence, were more likely to experience serious psychological distress, and were more likely to report suicidal ideation. A structural equation analysis revealed that the bisexual–pansexual distinction is important when understanding transgender persons’ likelihood of experiencing suicidal ideation. It operates indirectly through its direct impact on the number of anti-transgender experiences incurred. Conclusions: Pansexual individuals fare more poorly than their bisexual counterparts on measures of anti-transgender experiences, serious psychological distress, and suicidal ideation. The bisexual–pansexual distinction is a meaningful one when trying to understand the transgender persons’ odds of thinking about dying by suicide.

Sexes doi: 10.3390/sexes6030039

Authors: Connie Oxford

This article examines LGBTQI+ asylum claims in the U.S. Circuit Court of Appeals. The data are part of a larger study that has identified 520 LGBTQI+ claims in the U.S. Circuit of Appeals from 1994 to 2023. It focuses on examples from the 115 cases that were granted a review and analyzes the logic that U.S. Circuit Court justices use when deciding to grant a review of a petition that was denied by a lower court, such as the Board of Immigration Appeals (BIA) and immigration courts. This article argues that the U.S. Circuit of Appeals contests lower court rulings from BIA and immigration court judges based on assumptions about credibility, discretion, persecution, and criminalization for LGBTQI+ asylum seekers. By granting reviews, the Circuit Courts provide an opening for the acceptance of queer asylum claims.

Sexes doi: 10.3390/sexes6030038

Authors: Alissa I. Elanjian Sesilia Kammo Lyndsey Braman Aron Liaw

Background: Female Sexual Dysfunction (FSD) encompasses a range of conditions that can profoundly impact quality of life and intimate relationships. The primary classifications of FSD include female sexual interest and arousal disorder (FSIAD), genitopelvic pain and penetration disorder (GPPPD), female orgasmic disorder (FOD), and substance or medication-induced sexual dysfunction (SM-ISD). Despite its prevalence, FSD is often underdiagnosed and undertreated. Objectives: This scoping review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate the existing literature on both U.S. Food and Drug Administration (FDA)-approved and off-label pharmacotherapies for FSD by study type, outcomes, and limitations. Eligibility Criteria: Eligible studies comprised randomized controlled trials (RCTs), systematic reviews, and cohort studies involving adult women (≥18 years) with any subtype of FSD. These studies assessed pharmacologic interventions against a comparator and reported at least one treatment efficacy outcome. Studies outside this scope were excluded. Sources of Evidence: A 25-year literature search was conducted using PubMed/MEDLINE, the Cochrane Library, reference lists of relevant articles, academic handbooks, and targeted journals. Charting Methods: Three independent reviewers screened and extracted data. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Findings were organized into summary tables and categorized by pharmaceutical agent, pertinent study information, outcomes, and limitations. Results: A total of 44 human-based pharmacologic studies met inclusion criteria. FDA-approved agents were the most thoroughly studied pharmacotherapies. Hormonal, topical, and adjunctive agents demonstrated less robust evidence. Heterogeneity in outcome measures and inadequate long-term data were common limitations. Conclusions: Pharmacologic treatment for FSD shows promise but requires further research. Individualized, multifaceted care is essential for optimizing FSD outcomes.

Sexes doi: 10.3390/sexes6030037

Authors: Gloria Alarcón-García Edgardo A. Ayala Gaytán José Manuel Mayor Balsas

This article examines the impact of everyday life infrastructure on well-being through the lens of feminist economics, with a specific focus on gender disparities within the European context. Combining the capability approach (CA) and subjective well-being (SWB) theory, this study introduces a gender-sensitive well-being budget indicator, the Well-being and Infrastructure by Gender Index, or just WIGI, to assess the differential impacts of public expenditures on women and men. Drawing on feminist critiques of infrastructure planning, it highlights how gendered patterns of access and use shape experiences of well-being. The literature review synthesizes recent contributions on well-being measurement, gendered capabilities, and the role of public infrastructure in supporting everyday life. The research utilizes the Benefits of Gender Equality through infrastructure Provision (BGGEIP) survey from the European Institute for Gender Equality (EIGE) from 28 EU member states in 2015 to evaluate the contribution of key public services—such as transport, childcare, and healthcare—to individual capabilities and subjective well-being outcomes. The findings underscore the importance of integrating gender-sensitive methodologies into infrastructure planning and public policy to promote social inclusion and equitable well-being outcomes. This article concludes by advocating for feminist economics-informed policies to enhance the responsiveness of public investments to the lived experiences of women and men across Europe.

Sexes doi: 10.3390/sexes6030036

Authors: Kat Newman-Seymour Roya Haghiri-Vijeh

Gender-independent, intersex, non-binary, and transgender (GIaNT) youth have puberty health and sex education needs that are different from cisgender youth. Unfortunately, this population has historically been excluded from curricula pertaining to these issues in schools throughout the U.S. and Canada. While sex education programs are limited for all youth, and navigating puberty can range from exciting to scary for all youth, GIaNT youth are particularly vulnerable to facing negative outcomes by being omitted from such curricula. Because they are not able to access adequate information in schools and in their family/friend networks, a majority of GIaNT youth turn to the internet to seek out resources for education on puberty health and sex education. To this end, our team is in the process of creating an online educational resource (OER) that is age-appropriate and affirming for GIaNT youth to be provided with resources that are personalized to users’ unique needs. This literature review discusses content suggestions for inclusion of comprehensive puberty health and sex education that caters to GIaNT youth and their unique needs.

Sexes doi: 10.3390/sexes6030035

Authors: Nam Hoang Tran Ngoc Bao Dang Kien Trung Nguyen Tien Minh Bui Quang Ngoc Phan

This study aims to explore the associations between menstrual health, lifestyle behaviors, biological traits, and coping strategies among female students at a Vietnamese medical university. A cross-sectional survey was conducted among 884 female students across five academic majors. Data on demographics, menstrual patterns, biological characteristics, lifestyle behaviors, and coping mechanisms were collected. Statistical analyses included descriptive statistics, correlation, and logistic regression to identify significant predictors of self-reported menstrual changes post university admission. Of the 884 participants, 49.8% reported menstrual changes after entering university. Among the lifestyle-related factors, increased daily electronic use (mean = 5.83 h) and later bedtimes (mean = 23:58) were associated with menstrual change (p < 0.01). Older age and higher academic year emerged as significant predictors of menstrual changes (p < 0.001). Additionally, students with blood groups A and B exhibited a higher risk compared to those with group O (p < 0.05), and Rh-positive status was also significantly associated with menstrual changes (p = 0.05). In terms of knowledge and coping practices, students who had premenstrual syndrome awareness since school were significantly less likely to report menstrual changes (p = 0.003). Although use of pain relief, particularly painkillers, correlated with higher reported pain severity, it was not directly linked to menstrual change. On the other hand, clinic consultations were positively associated with menstrual changes (p = 0.003), while students who relied on their mothers as counselors exhibited a protective association (p = 0.001). Menstrual health in university-aged women is influenced by a complex interplay of lifestyle behaviors, biological traits, and menstrual knowledge. Early education and structured coping support may serve as protective factors. The findings call for targeted menstrual health programs in university settings.

Sexes doi: 10.3390/sexes6030034

Authors: Awnon Bhowmik Mahmudul Hasan Mrinal Saha Goutam Saha

This study examines the trends, impacts, and challenges of HIV in Bangladesh from 2000 to 2024, with a focus on its epidemiology, demographic distribution, and socioeconomic determinants. Despite maintaining one of the lowest HIV prevalence rates globally (<0.1%), Bangladesh faces a concentrated epidemic among high-risk populations, including people who inject drugs (PWID), men who have sex with men (MSM), sex workers, transgender individuals, and migrant workers. Analysis reveals a steady increase in reported infections, attributed to enhanced diagnostic capacities and public awareness. The 25–49 year age group remains the most affected, accounting for over 65% of cases, underscoring the vulnerability of the economically active population. Gender disparities persist, with males representing the majority of infections but lower ART coverage among females and transgender individuals. While interventions such as PMTCT programs, ART expansion, and targeted awareness campaigns have contributed to improved outcomes, barriers such as stigma, healthcare inequities, and limited rural access hinder progress. The study also evaluates Bangladesh’s progress toward the 95-95-95 targets, highlighting significant strides in treatment and viral suppression but gaps in diagnosis. Future research must address behavioral trends, stigma reduction, and integration of HIV services for marginalized populations. This paper emphasizes the need for evidence-based strategies to ensure equitable healthcare delivery and sustainable progress in combating HIV.

Sexes doi: 10.3390/sexes6030033

Authors: Wafaa Sowan Ateret Gewirtz-Meydan Shelly Engdau Ronit Dror Sabaa Masarwe Zeev Wivstok

Objectives: This study examined the association between three sexual motivations—rewarding, intimacy, and enhancement—and their relationship to sexual and relationship satisfaction. A novel conceptualization of sexual reward was introduced and tested. Methods: The sample included 675 individuals in steady intimate relationships (12+ months). Participants completed measures assessing sexual motives and satisfaction levels. A newly developed scale for sexual reward motivation was validated. Findings: The rewarding motive was present among many participants, with approximately 10% reporting frequent use. Rewarding was negatively associated with both relationship satisfaction and sexual satisfaction. It also showed a negative correlation with enhancement motivation and no significant correlation with intimacy motivation. Conclusions: While occasional sexual reward may not impact relationship dynamics, frequent use of this motive appears to undermine both sexual and relational well-being. The findings suggest that sexual reward is a distinct and measurable motivation with potential implications for couple dynamics and therapeutic intervention.

Sexes doi: 10.3390/sexes6030032

Authors: Mashudu Rampilo Edith Phalane Refilwe Nancy Phaswana-Mafuya

Despite having the world’s largest HIV burden, South Africa has yet to attain the 95-95-95 targets. Accurate, complete, and timely data are critical for monitoring a country’s HIV progress. The integration of unique identifier codes (UICs) for key populations (KPs) into routine health information management systems (RHIMS) strengthens data accuracy and completeness, facilitating more targeted HIV interventions and greater accountability. This systematic review assessed how Sub-Saharan African (SSA) countries have integrated KPs’ UICs into RHIMS, highlighting key enablers, challenges, and opportunities. A comprehensive search was conducted across PubMed, Scopus, Google Scholar, MEDLINE, PLOS ONE, and various government and non-government websites to identify the published and grey literature relevant to the study objective from June 2013 to December 2024. References were managed using Zotero version 6.0.36. Two authors independently screened studies using Covidence software. The review was done in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines and was registered with the “International Prospective Register of PROSPERO) Systematic Reviews” with the registration number CRD42023440656. Out of 1735 studies screened, 361 duplicates were removed. The review found that only nine of the fifty-three SSA countries have incorporated UICs for KPs into their RHIMS through alphanumeric codes. They include Burundi, Burkina Faso, Ghana, Mali, Kenya, Uganda, Togo, Malawi, and Liberia. Facilitators for KPs’ UIC adoption included strong data security and political will, whereas barriers encompassed compromised privacy, stigma and discrimination. In South Africa, the UIC for KPs can be integrated into the new electronic medical record (EMR) system.

Sexes doi: 10.3390/sexes6030031

Authors: Becky K. Lynn Julia D. López Morgan E. Link E. Cristian Campian

The purpose of this study is to evaluate the differences in sexual functioning in women who used cannabis before sex and those who used cannabis but not before sex, among those with sexual dysfunction. The cross-sectional study, conducted from August 2019 to January 2020 at an academic sexual dysfunction clinic in the Midwest region of the United States, included 187 participants. Patients completed an anonymous questionnaire during their visit, which included the Female Sexual Function Index (FSFI), cannabis use, and sociodemographic factors. The primary objective of this study was to assess the relationship between cannabis use and female sexual dysfunction (FSD). The secondary objective was to examine the FSFI domains of sexual function with cannabis use over the past four weeks. Among the participants, 90% (n = 168) had sexual dysfunction based on the FSFI scores among those with FSD. Women with FSD who used cannabis before sex reported significantly higher lubrication scores and trends toward higher arousal and total FSFI scores than those who used cannabis but not before sex. However, no significant differences were observed in sexual desire, satisfaction, or pain. Quality of life was statistically significant across cannabis groups, with those who never used cannabis indicating “very good to excellent” health more often than those who used cannabis before sex. In addition, women with FSD who had never smoked cigarettes had a significantly higher proportion of never having used cannabis compared to those who used cannabis not before sex and those who used it before sex. These findings suggest that women with sexual dysfunction who use cannabis before sex may experience improvements in lubrication, arousal, and overall sexual function, highlighting the potential benefits of cannabis use in enhancing specific aspects of sexual health in this population.

Sexes doi: 10.3390/sexes6020030

Authors: Luís Santos Filipa Macedo Ana Isabel Sani

The term BDSM is used to describe a wide range of sexual practices, with previously negotiated and mutually consented rules, which take place through a carefully dramatized exercise of roles and powers in the context of erotic and/or sexual interaction. This qualitative study explores the paths and discourses of 14 Portuguese men who practice BDSM and self-identify as submissive. In-depth online interviews were conducted to contextualize the emergence, development, and self-assessment of their practices. The thematic analysis of the results identified three themes: (1) between the awakening and consolidation of interest in the BDSM universe, (2) contacts, encounters, and (dis)continuities, and (3) erotic and sexual experiences (un)blindfolded. The reading of the results is based on a non-pathologizing perspective and highlights a positive evaluation of the sexual experiences reported, motivated by an intentional and collaborative search for pleasure and eroticism that violates traditional gender boundaries. It is recommended that future empirical studies are carried out using non-pathological models associated with BDSM, which could expand knowledge and legitimize different ways of experiencing sexuality.

Sexes doi: 10.3390/sexes6020029

Authors: Rosa María Mañas Migal Montserrat Monserrat Hernández Ángeles Arjona Garrido

Questioning motherhood as a social mandate has been one of the main objectives of feminism. Motherhood has traditionally been linked to the idea of femininity and the reproductive function, which has led to women being thought of as “compulsory mothers”. However, this idea is currently changing, despite the fact that judgment is exercised on non-mothers. This research is part of a cross-sectional descriptive study, whose objective is to analyze the barriers and incentives to childbearing in the female population. A questionnaire was designed and administered to a representative sample of 318 women who were selected for our analysis, with a confidence level of 95% and a margin of error of 5%. Results: Economic motives correlate positively with other variables, as well as work motives, the couple’s decision to not want to have children, and not having a stable partner, which suggests that these women have different motives for choosing not to have children. The main conclusions are that social and family pressures appear to have a limited impact on the decision not to have children, suggesting a change in social norms and expectations about the role of women in society, as women continue to gain autonomy and control over their reproductive decisions.

Sexes doi: 10.3390/sexes6020028

Authors: Yessica Mestre-Martínez

Research with population groups who have undergone circumstances of vulnerability demands a careful ethical approach to ensure that the study is conducted with the utmost respect and sensitivity, addressing potential challenges not only in regards to safeguarding participants’ rights but also in preserving the well-being of researchers. This paper is based on a qualitative research project. Employing snowball sampling techniques, I contacted 21 participants by e-mail, comprising intersex individuals who had engaged in research, as well as researchers and ethics experts with experience in qualitative intersex-related studies. I conducted semi-structured interviews to gather insights from their respective experiences. The research article focuses on a set of ethical principles that could be valuable in the development of intersex-related studies. While certain principles are directed towards participants and others towards researchers, it is important to note that these categories are not strictly delineated. As the findings suggest, these categories are closely interrelated. Both the literature review and fieldwork underscore the significance of adopting various research methods, such as community-based and trauma-informed approaches, to collaborate in enhancing knowledge production for intersex-related studies.

Sexes doi: 10.3390/sexes6020027

Authors: Corina Schulze

The Death Penalty Information Center’s (DPIC) website states that, since 1608, 576 executions of women under civil authority have been carried out in the United States. The “Espy file”, cited by the DPIC, is widely considered to be the definitive dataset of all executions occurring between 1608 and 2002, but only lists about 365 executions of women. The following two major empirical contributions are offered: (1) source verification of the Espy file, suggesting that black women are especially undercounted and that the total number of executions is closer to 700, and (2) the provision of descriptive statistics demonstrating the variability of women’s to men’s execution ratios over time. This study’s primary purpose is the release and publication of a working dataset, the Women’s Execution Database (WEB), which is meant to generate interest in constructing a narrative that validates the importance of gender-focused theories requiring variables that represent gendered experiences with the death penalty. One example of how such a database can verify women’s erasure in mainstream discussions of capital punishment are WEB statistics demonstrating that active resistance to slavery and racism is verifiable via empirical evidence.

Sexes doi: 10.3390/sexes6020026

Authors: Jintang Li Chaiyun Sakulsriprasert Chidchanok Ruengorn Awirut Oon-Arom Ronald O’Donnell Tinakon Wongpakaran

University students from diverse sexual orientations encounter specific mental health challenges due to academic demands, minority stress, and societal stigma; however, research focusing on these issues is still scarce in Southeast Asia. This research aimed to examine the mental health outcomes of heterosexual and sexuality-diverse students in Thailand, concentrating on both negative aspects—such as depression, anxiety, and perceived stress—and positive aspects—like resilience, inner strength, and perceived social support. A cross-sectional survey was performed with 442 university students aged between 20 and 30, employing validated self-report instruments. Statistical methods, including t-tests and multiple regression analyses, were used to evaluate differences and relationships between sexual orientation and mental health outcomes while controlling for confounding variables. The findings revealed that sexuality-diverse students showed notably higher levels of depression (B = 0.115, p < 0.05) and lower perceived social support (B = −0.10, p < 0.05) when compared to their heterosexual counterparts. Nevertheless, there were no significant differences found in anxiety, perceived stress, resilience, or inner strength. Perceived social support proved to be a crucial protective factor, with greater levels linked to reduced depression, anxiety, and perceived stress (p < 0.01). These results underscore the necessity for inclusive university policies, specific mental health interventions, and peer and family support initiatives to enhance the well-being of sexuality-diverse students in Thailand.

Sexes doi: 10.3390/sexes6020025

Authors: Shakir Adam Kiran Bashir Ahmad Yusra Khan David L. Rowland

Barriers to help-seeking behaviors in transgender populations in non-Western contexts are both understudied and poorly understood. Using a quantitative cross-sectional design, this study examined the psychological help-seeking attitudes of 109 transgender persons from Pakistan in relation to their psychological distress and attitudes toward sexuality. This research further identified which components of distress (stress, anxiety, or depression) were stronger predictors and assessed the role of particular demographic/behavioral factors in help-seeking attitudes. Participants completed three validated assessment tools translated into Urdu: Beliefs about Psychological Services Scale, the Depression, Anxiety, and Stress Scale (DASS-21), and the Sexual Attitude Scale. The results indicated that psychological distress predicted expertness and intent but not stigma tolerance. Post hoc analysis using DASS-21 subscales revealed that stress and anxiety were the stronger predictors of attitudes related to expertness and intent. The Sexual Attitude Scale marginally predicted stigma tolerance directly and also moderated the relationship between psychological distress and help-seeking attitudes for stigma tolerance. Finally, a role for demographic/behavioral factors—possibly serving as a proxy for mental health literacy—was identified for stigma tolerance. These findings reiterate the importance of tailored mental health awareness initiatives within the transgender community in non-Western settings and highlight the need for qualitative research to further understand the dynamics of psychological distress along with other linked factors.

Sexes doi: 10.3390/sexes6020024

Authors: Gottfried Schweiger

Sex education goes far beyond merely conveying biological facts; it encompasses the psychological, social, and cultural aspects of sexuality. A gender-sensitive approach to sex education for boys* aims to address their specific needs and challenges, critically reflect on hegemonic norms of masculinity, and develop alternative, non-toxic models of masculinity. This article explores the foundations and core elements of such a gender-sensitive sex education for boys*, considering theoretical concepts such as sexual socialization, hegemonic masculinity, and sexual scripts, as well as sexual health and rights for boys*. An intersectional perspective enables a nuanced analysis of the diverse social inequalities that shape boys’* sexual development. This paper argues for four key elements of gender-sensitive sex education for boys*: (1) empowerment and self-determination to strengthen boys* in their formation of sexual identity; (2) the development of alternative masculinities to challenge stereotypical gender constraints; (3) the promotion of gender justice by raising boys’* awareness of their societal responsibility; and (4) fostering critical competencies in dealing with media and social norms. These approaches contribute to establishing a holistic and inclusive form of sex education that acknowledges boys* in their diversity and helps create a more just society.

Sexes doi: 10.3390/sexes6020023

Authors: Monideepa B. Becerra

Stealthing, the nonconsensual removal of a condom during sexual intercourse, is a prevalent yet underreported form of sexual misconduct, particularly among college students. This white paper examines the legal landscape, gaps in responses, and the burden of stealthing on college students. It presents actionable strategies for college campuses to combat stealthing, including updating policies, enforcing a zero-tolerance policy, training staff, providing survivor-centered support services, integrating cultural competency, and ensuring transparent enforcement of processes. These strategies aim to empower college campuses to prevent and reduce stealthing, promote informed consent, and enhance survivor support.

Sexes doi: 10.3390/sexes6020022

Authors: Alyssa Lozano Vanessa Morales Elliott R. Weinstein Audrey Harkness Manuel A. Ocasio Tatiana Perrino Ahnalee M. Brincks Guillermo Prado

Measures of sexual orientation and family functioning are widely used among sexual minority populations. However, data on whether these measures are culturally syntonic and responsive to the needs of a particular population, such as Hispanic sexual minority youth (HSMY), are lacking. Therefore, this study assessed whether HSMY understand measures of sexual orientation and family functioning as intended. Authors conducted individual interviews with five HSMY to evaluate the face validity of a measure of sexual orientation (i.e., Klein Sexual Orientation Grid) and measures of family functioning (i.e., Parent–Adolescent Communication Scale, Parenting Practices Scale, Parental Monitoring of Peers). Data were analyzed using a general inductive approach. For the sexual orientation measure, five themes were identified related to the: (1) clarity of questions, (2) challenging nature of questions, (3) difficulty of responses, (4) suggestions to improve response options, and (5) need for questions to include gender identity. For family functioning, three themes were identified: (1) relevance of the measures to sexual minority youth, (2) the importance of understanding family history and cultural context, and (3) capturing the context of how sexual minority status and disclosure impact family functioning. HSMY had generally positive feedback regarding these measures; however, they also suggested specific changes associated with wording and specificity of the measures to make them more relevant to HSMY’s unique needs.

Sexes doi: 10.3390/sexes6020021

Authors: Miriam Belluzzo Veronica Giaquinto Camilla Esposito Erica De Alfieri Anna Lisa Amodeo

Young adults diagnosed with severe mental illness (SMI), intellectual disability (ID), and autism spectrum disorder (ASD) often experience significant barriers in accessing sexual health education, contributing to poor sexual and relational well-being. The Educational Intervention and Training Program on Sexuality and Affectivity (eITPoSA) was developed to address this gap through a structured psycho-educational approach tailored to their cognitive and emotional needs. A pilot study was conducted with 12 participants diagnosed with SMI, ID, and ASD, who attended the training sessions covering topics such as body knowledge, genital sexuality, privacy, and hygiene. Pre- and post-intervention assessments were carried out using structured monitoring grids, with data analyzed through descriptive statistics, paired-samples t-tests, and Cohen’s d to evaluate effect sizes. Results demonstrated statistically significant improvements across all domains, particularly in body knowledge (31.43% to 86.65%), genital sexuality (15% to 90%), and hygiene (47.27% to 96.36%). These findings suggest that the eITPoSA program effectively enhances sexual and relational competencies in young adults diagnosed with SMI, ID, and ASD. Future research should focus on expanding the sample size and exploring long-term retention of educational outcomes to further validate the program’s efficacy.

Sexes doi: 10.3390/sexes6020020

Authors: Joel Palomino-Ccasa Analí Tuanama Shupingahua Lady Pamela Torrejon Chuqui Jhon Kenedy Saldaña Sánchez María Yndrid Tantaruna Diaz Segundo Salatiel Malca-Peralta Dany Yudet Millones-Liza

The sharing of explicit sexual images through virtual platforms has grown exponentially in recent generations, causing various issues such as low self-esteem, sextortion, and cyberbullying, among others. Therefore, it is imperative to have a deeper understanding of this issue. This research aims to construct an instrument that allows for the identification of the motivations that lead to the practice of sexting in young university students. The research had two phases: conducting an Exploratory Factor Analysis, which included 320 university students (48.2% female and 51.8% male) aged between 18 and 30 (M = 20.4; SD = 2.62). In the second phase, 1056 university students (55.9% female and 44.1% male) within the same age range as the first phase participated (M = 22.38; SD = 2.64), for whom a Confirmatory Factor Analysis (CFA) was conducted. The final version of the scale consisted of a unidimensional model comprising eight items that assess internal and external motivations leading to the practice of sexting, with an adequate fit index (CFI = 0.991, TLI = 0.988, and RMSEA = 0.068). Additionally, an omega coefficient of 0.93 was found, indicating adequate reliability. It was concluded that the Sexting Motivation Scale (EMS by its initials in Spanish) demonstrates good reliability and construct validity, making it suitable for measuring motivation for sexting.

Sexes doi: 10.3390/sexes6020019

Authors: Ricarda Veh Paula Fernández García Elena García-Vega

Among the models of romantic relationships, consensual non-monogamy (CNM) is one in which several affective and/or sexual relationships are allowed simultaneously. This type of relationship, still considered non-normative, has experienced a considerable increase in recent years. However, research is still limited, and studies on the subject in Spain are scarce. To better understand the differences and similarities between monogamous and CNM relationships, this study investigated both relational models, divided by sex, for four factors concerning romantic relationships: relationship satisfaction, sexual desire, jealousy, and conflict resolution styles. In a sample of 210 persons, the results showed that CNM females reported significantly higher levels of consensus and dyadic sexual desire than monogamous females. Jealousy levels were similar in both types of relationships. People in CNM relationships displayed greater conflict resolution skills through negotiation and compromise, whereas monogamous females reported using the non-constructive style of conflict engagement more than CNM females and monogamous males. CNM males indicated a greater use of withdrawal compared to CNM females. Overall, females showed more passionate jealousy than males. This investigation highlights the importance of studying romantic relationships and their different models.

Sexes doi: 10.3390/sexes6020018

Authors: Tomoya Mukai

Recent legal reforms incorporating the concept of sexual consent into the Penal Code, alongside high-profile scandals involving male idol groups and comedians, have heightened societal attention to sexual crimes in Japan. Although studies have extensively examined this topic, findings have been predominantly from Western or English-speaking countries, which raises questions regarding their applicability to other cultural contexts. To address this gap, this study examined whether the results of prior research could be generalized to Japan. This study examined six hypotheses derived from previous studies. Using a vignette-based online survey (N = 748), participants read a hypothetical sexual assault case and answered questions on sentencing, negative social reactions, and victim/perpetrator blaming. An analysis revealed that only one hypothesis was supported: respondents recommended longer sentences for perpetrators when the victim was male rather than female. Additionally, women were more likely to exhibit egocentric reactions, such as expressing more anger toward the perpetrators than the victims, than men. No other hypothesized gender-based differences, which included victim-blaming or harsher sentencing by male observers, were supported. These findings highlight the risks of generalizing research findings across cultural contexts and emphasize the importance of conducting culturally specific studies.

Sexes doi: 10.3390/sexes6020017

Authors: I. Joyce Chang Tim S. Welch David Knox Adriatik Likcani Allison C. Tsay

Due to constantly evolving technology, a new challenge has entered the relationship landscape: the inclusion of robots as emotional and intimate partners. This article raises the question of the degree to which companionship and intimacy may be fulfilled by robots. Three hundred and fourteen undergraduates, the majority of whom were first- or second-year college students, responded to an online survey on robot acceptance. Factor analysis identified two constructs, which the authors labeled as simulated companionship (e.g., robots as companions/helpful assistants) and simulated intimacy (e.g., robots as intimate partners–emotional and sexual). Data analysis revealed a difference between companionship and intimacy regarding student robot acceptance for home use. Overall, there was greater acceptance of robots as companions than as intimate partners. Group differences for simulated companionship were found for gender, sexual values, commitment to religion, and sexual orientation. While robots may enhance various elements of human life, the data revealed the limits of outsourcing emotional intimacy, companionship, and sex to machines.

Sexes doi: 10.3390/sexes6020016

Authors: Daniele Mollaioli Tommaso B. Jannini Diana Piga Malaianu Andrea Sansone Elena Colonnello Erika Limoncin Giacomo Ciocca Emmanuele A. Jannini

Bondage/discipline, Dominance/submission, Sadism/Masochism (BDSM) is a multifaceted spectrum of consensual sexual practices, that has long intrigued the psychological community for its implications on mental health and personality. While previous research has shed light on its psychopathological aspects, less is known about the distinct psychosexual dimensions that characterize individuals who assume dominant or submissive roles within these dynamics. Our research aims to identify differences in personality traits between dominant and submissive individuals and explore the relationship between BDSM roles and mental health outcomes. While previous studies have explored personality traits in BDSM practitioners, research specifically examining the associations between BDSM roles and multiple psychological constructs remains limited. To address this, we employed Bayesian methods with non-informative priors, including ANOVA and linear regression, to evaluate the associations between self-identified BDSM roles and psychological constructs with the specific intent to build informative priors for future research. A sample of 99 BDSM practitioners from online forums participated, providing responses across several psychometric instruments. The study utilized comprehensive psychometric evaluations, including the Big Five Inventory for personality assessment, the Hypersexual Behavior Inventory for hypersexuality, the Brief Sensation Seeking Scale for sensation seeking, the Patient Health Questionnaire for depression, and the General Anxiety Disorder scale for anxiety. Bayesian regression analysis revealed that dominant practitioners exhibit lower hypersexuality and agreeableness, while submissive practitioners show higher levels of agreeableness, depression, hypersexuality, and sensation seeking. These findings highlight distinct psychosexual profiles associated with BDSM roles and provide several implications for mental health professionals working with BDSM practitioners, emphasizing the need to assess and address underlying psychological factors. Future research should further explore these psychosexual dynamics to develop targeted interventions for enhancing psychological well-being and relationship satisfaction within the BDSM community.

Sexes doi: 10.3390/sexes6020015

Authors: Michał Godzisz Iga Kuliniec Przemysław Mitura Grzegorz Młynarczyk Marek Bar Paweł Płaza Damian Sudoł Marcel Pogoda Krzysztof Bar

Foreign bodies in urological patients are commonly found in the lower urinary tract, especially in the bladder and urethra. Items such as pens, pencils, wires, and cables are often inserted for erotic stimulation, typically associated with alcohol intoxication or psychiatric disorders. The aim of this study is to present the adverse events of non-conventional sexual manipulation and the harmful effects of using atypical objects for masturbation purposes. The study presents a series of case reports describing patients with self-inflicted foreign bodies in the lower urinary tract, collected over 20 years at a single medical center. Most patients were admitted to the hospital with lower urinary tract symptoms (LUTSs) and signs of infection, such as abdominal pain and fever. Only 6 out of 12 patients revealed their intention regarding foreign body insertion. Additionally, 9 out of 12 patients did not attend the follow-up visit. Self-inflicted foreign bodies in the lower urinary tract vary in type and motive. Patients may be reluctant to disclose these circumstances, complicating diagnosis and treatment, which can lead to serious health risks and a reduced quality of life.

Sexes doi: 10.3390/sexes6020014

Authors: Briahna Yuodsnukis Adam Davies Navy C. Spiecker Jaclyn L. Papadakis Katharine B. Dalke Diane Chen Tim C. van de Grift

Sexual and gender minority (SGM) communities experience an increased risk for sexual victimization. Because these rates are reported in aggregate, little is known about the unique experiences of sexual violence among individuals with differences of sex development/intersex variations (DSD/I). The purpose of this study is to describe the experiences of sexual victimization in adolescents and young adults (AYAs) with DSD/I as part of a larger qualitative study exploring experiences of minority stress, stigma, and resilience. Participants were recruited through multidisciplinary care clinics and DSD/I support groups in the United States and the Netherlands. Data on sexual experiences and sexual health were analyzed thematically, with a specific focus on reports of sexual victimization. Of the 20 participants, 25% reported experiences of sexual violence. Experiences were reported across gender identities and DSD/I diagnoses. Participants described experiences as (a) resulting from DSD/I, (b) exacerbated by DSD/I, or (c) healthcare practices experienced as sexual violence. Medicalization, early loss of (bodily) autonomy, and cisgender heteronormative reproductive societal norms were reported as possible factors associated with sexual victimization experiences. The sexual victimization of individuals with DSD/I appears prevalent and associated with specific risk factors and, therefore, deserves clinical and scientific attention.

Sexes doi: 10.3390/sexes6010013

Authors: Carol Nash

Climate action represents the most comprehensive of the 2015 United Nations 17 Sustainable Development Goals (SDGs) in that climate change impacts all other goals. Urban overpopulation is a primary cause, as energy consumption is a significant source of carbon dioxide emissions directing climate change. The population increase origin is attributable to the agricultural/urban developments that became geographically widespread approximately 6000 years ago. Simultaneously, religious belief stressed multiple children, with women obligated to produce them. This female duty created gender inequality and reduced the health and well-being of women, as pregnancy is a noted risk factor for decreased lifetime health. Regardless of the detrimental risk to their health and well-being, the gender inequality, and the adverse effects of birthing multiple children regarding climate action, women today continue to feel obliged to reproduce appropriately. This burden requires change to meet the three sustainable development goals of good health and well-being (SDG 3), gender equality (SDG 5), and climate action (SDG 13). An author-developed mindfulness-based psychoanalytic narrative research method presents a means for promoting such change based on a qualitative narrative analysis of the responses of several participants regarding its success in clarifying the values of these women in overcoming career-related burnout.

Sexes doi: 10.3390/sexes6010012

Authors: Leso Munala Hannah Resendiz Olson Courtney Johnson

Sexual violence among school-aged girls is a global health problem. Research has shown that school-aged girls experience high rates of sexual violence that often go unreported. In Kenya, one in three girls experiences sexual violence before the age of 18. Sexual violence against girls can prevent them from safely attending school and cause health issues that affect school performance. This qualitative study explored community and environmental factors associated with sexual violence against school-aged girls in Kitui County, Kenya. A total of 25 in-depth interviews were conducted with key stakeholders from Kitui South Sub County. The stakeholders were from six sectors, including the police, health, education, community, religious, and criminal justice sectors. The data were analyzed using conventional content analysis to gain an understanding of the stakeholder’s perspectives and knowledge relating to sexual violence against school-aged girls. Stakeholders frequently identified the criminal justice system, culture and traditional beliefs, and threats to well-being as barriers to reporting sexual violence offenses. Girls who experience sexual violence often contend with shame from the community, and the effects of stigma include loss of resources, additional violence, poorer marriage prospects, unplanned pregnancies, school dropouts, or abandonment. Perpetrators often threatened or bribed the families of girls who experienced sexual violence with gifts or monetary incentives to prevent them from reporting the crime to local authorities, while the criminal justice system itself presents numerous challenges for victims. The reporting of sexual violence could be increased by focusing on intervention strategies that challenge attitudes, norms, and behaviors rooted in gender inequality. By addressing the underlying causes of stigma and inequality, we can create a safer environment for school-aged girls to report sexual violence and seek justice.

Sexes doi: 10.3390/sexes6010011

Authors: Andrea Mellor Cecilia Benoit Brett Koenig

This paper explores the ways that sex workers in one Canadian city cultivate resilience in their workplaces. In 2017–2019, a period following the enactment of Canada’s revised prostitution law, a cross-section of active sex workers (N = 59) from Victoria, Canada, were interviewed about what they do to keep safe in their sex work jobs, including what they do before or during dates, how their strategies for safety have changed over time, how they draw on their larger networks, and what resources they wish they could access to improve their abilities to remain safe. Using an ecological framework of resilience, our findings show that, despite job precarity, stigma, and criminalisation, participants were actively involved in developing strategies to keep safe at work. Their resilience is a combination of factors unique to each worker’s social location and their access to workplace safety measures, including screening techniques and tools, diverse social networks, and safe working locations. We call for a public health approach to sex work that builds on workers’ strengths and enacts policies that aim to dismantle the structural environments of risk in their occupation.

Sexes doi: 10.3390/sexes6010010

Authors: Inmaculada Pérez Rosa M. Cárdaba-García Veronica Velasco-Gonzalez Inés Cárdaba-García Carlos Durantez-Fernández Alba Muñoz-del Caz Raúl Soto-Cámara Marta Evelia Aparicio-García Miguel Madrigal Lucía Pérez-Pérez

(1) Background: The climacteric phase is a crucial period in a woman’s life, due to the changes that affect both her physical and psychological well-being. This study aims to explore the psychological risks associated with the climacteric period in Spanish women, evaluating the influence of conformity to female gender norms. (2) Methods: A descriptive correlational study was conducted with 429 women, using surveys to assess psychological risk (GHQ-12) and conformity to gender norms (CFNI-45). The sample was recruited from central Spain, covering women aged 45–64 years. (3) Results: 20% of the women showed signs or suspicion of psychological pathology, with a higher prevalence in younger women. Participants displayed greater conformity to gender norms related to domestic chores, but less conformity to norms of sexual fidelity and thinness. Health perception was identified as significantly influencing psychological risk and conformity to the norm of thinness, acting as a moderator in this relationship. (4) Conclusions: The study indicates that age and conformity to female gender norms influence psychological risk during the climacteric phase. Younger women and those with greater conformity to the norm of thinness exhibited higher psychological vulnerability. This highlights the need for interventions that address these factors in order to promote emotional well-being and a positive perception of health during this stage of life.

Sexes doi: 10.3390/sexes6010009

Authors: Carlos Piña-García Guadalupe Cruz Armando Espinoza

This study explores the complexities of women’s self-representation on social media, examining its potential detrimental effects and consequences. This study examines image exposure through the lens of Machine Learning, within the framework of Instagram’s visual culture. By examining digital content and its impact on users, this study aims to shed light on the detrimental effects of objectification and harmful stereotypes on individuals and society. In this study, we explore women’s self-representation through the portrayal of their bodies. Leveraging Google Vision API, we investigate the feasibility of automating the identification of imagery among women users located in Mexico. Our findings reveal that Google Vision API is a useful tool for detecting racy and adult content. We identify a quantitative evidence between clothing and body parts in these images, suggesting that women often share photos in revealing attire. Contrasting conventional survey and manual labeling methods, our results highlight the potential use of machine learning techniques to analyze this sort of imagery. The analysis reveals that over 90% of the examined images contain some degree of nudity or provocative poses. These findings provide valuable insights into the self-representation of women on social media, highlighting prevailing visual trends and their potential sociocultural implications.

Sexes doi: 10.3390/sexes6010008

Authors: Mariela Velikova Dimitrova María del Carmen Terol Cantero Maite Martin-Aragón Gelabert Carolina Vázquez Rodríguez

Our study addresses prostitution as a phenomenon linked to the feminization of poverty, the exploitation of women, and gender inequality, highlighting the role of male demand in its perpetuation. Spain is positioned as one of the main destinations for prostitution, with a high incidence of men paying for sex, normalizing this practice. Male motivations, classified in categories such as loneliness, risk attraction, domination, and validation of masculinity, reinforce objectification and violence against women. The aim of this study is to explore the different motivational typologies of prostitution consumption perceived by the Spanish population, as well as the perceived differences between men and women with respect to these typologies. With a sample of 198 young Spaniards (57.1% female, M = 22.5 years), we used the Motives for Prostitution Consumption Scale (MCP). Factor analyses identified two main factors: experimentation and attraction to the forbidden and sexual needs, satisfaction, and companionship, consistent with previous typologies in the literature. Results revealed that women perceive control and dominance as predominant motivations, while men emphasize sexual and affective needs. The MPC demonstrated satisfactory internal consistency indices (α ≥ 0.70) and the ability to discriminate between groups with different perceptions of the motivations of women and men. Limitations include a predominantly young university sample and the need for further validation with more diverse populations. The study reinforces the importance of analyzing male motivations for prostitution use in order to design educational strategies to promote gender equality and reduce prostitution.

Sexes doi: 10.3390/sexes6010007

Authors: Heather Worth Karen McMillan Hilary Gorman Merita Tuari’i Lauren Turner

The notion of resilience has been widely invoked as that essential resource by which sex workers may endure, cope, or thrive despite encountering adversities and stressors. A useful definition within the resilience discourse around sex work is the ability to connect, reconnect, and resist disconnection in response to hardships, adversities, and trauma. In this article, we will examine the history of ‘resilience’ and show how it has been ubiquitously applied to sex workers in some Pacific Island settings. The resounding message of resilience discourse is that sex workers must learn to cope, accommodate, and adapt themselves to conditions that oppress them, and in fact, presuppose a continued acceptance of a degraded place in the world. Rather than resistance as a political action aimed at changing the social, institutional, and economic structures that have placed sex workers there, resilience shifts the onus onto the individual sex worker or her community support to learn to adapt to those conditions. Resilience strategies may be pragmatic but, in the end, to present these as any kind of solution to sex worker struggles becomes little more than victim blaming.

Sexes doi: 10.3390/sexes6010006

Authors: Ana Rodríguez-García Alicia Botello-Hermosa Álvaro Borrallo-Riego María Dolores Guerra-Martín

Background: Adolescence is a critical life period marked by significant vulnerability to risky sexual behaviours. Comprehensive sex education offers better sexual and reproductive health to adolescents. Aim: We aimed to analyse the effectiveness of sex education interventions on reducing risk behaviours among adolescents. Methods: A systematic peer review was conducted. The databases consulted were PubMed, Scopus, Web of Science, and CINAHL. The inclusion criteria were as follows: randomized clinical trials published between 2013 and 2023 and methodological quality ≥ 5 points as per the Van Tulder scale. Results: A total of 255 studies were identified, with 25 finally selected. Of them, sixteen dealt with non-condom use, one was about early sexarche, and eight combined several risk behaviours. There was predominance of in-person teaching at schools with lectures and varied activities. The sample was predominantly comprised by girls aged between 14 and 16 years old. Certain variability regarding content, technique, number of sessions, duration, locus, and teaching modality and staff was observed in the com-prehensive sex education interventions. Almost all the interventions were effective in reducing risky sexual behaviours; however, two studies failed to achieve a reduction in risky sexual behaviours.

Sexes doi: 10.3390/sexes6010005

Authors: Zbigniew Izdebski Alicja Kozakiewicz Joanna Mazur

Understanding the factors influencing the age of sexual initiation among adolescents is crucial for addressing risky behaviours and supporting healthy development. This study aimed to identify determinants of sexual initiation age among Polish adolescents, focusing on gender differences and 15 factors related to lifestyle, family, school, and social environment. The analysis involved 3296 Polish adolescents aged 15–17 who participated in the international Health Behaviour in School-aged Children (HBSC) survey in 2018. The Cox proportional hazard model (aligned with censored data) revealed that frequent use of psychoactive substances is the main predictor of the age of sexual initiation (HR = 5.20; 95% CI: 3.66–7.38), with even moderate use having an impact (HR = 2.81; 95% CI: 2.04–3.86). Gender was not found to significantly influence the age of initiation, but the determinants did vary by gender. For boys, high physical activity and intensive socialising with peers are important factors influencing the age of sexual initiation. For girls, a positive self-assessment of appearance is more strongly associated with earlier initiation, while good academic performance and family support have a delaying effect. Effective intervention programs should consider these diverse determinants since they significantly shape adolescents’ decisions about sexual activity and their ensuing psychological experiences.

Sexes doi: 10.3390/sexes6010004

Authors: Ofer Parchev

Consent is a foundational component of BDSM (Bondage/Discipline, Dominance/Submission, Sadism/Masochism). It distinguishes non-normative, consensual practices from instances of abuse and exploitation. Its centrality within BDSM, however, underscores the complexity of consent as a constitutive mechanism that facilitates varied intersubjective engagements, from continuous negotiation and aftercare to the use of safe words. The ontological basis of consent within BDSM relies on a model of subjective autonomy wherein individuals actively shape their desires and boundaries within a consensual framework. This paper argues that a significant motivation for many BDSM practitioners lies in the desire to subvert autonomy by engaging in acts that challenge traditional consent boundaries. However, reliance on a purely liberal interpretation of consent often marginalizes such subversive expressions, thereby pushing certain BDSM practices and individuals toward pathological or criminal categorization. Here, I propose an ethical framework grounded in a liberal consent model, which is open to the inclusion of these marginalized practices, thus, fostering a more inclusive understanding of BDSM subjectivity.

Sexes doi: 10.3390/sexes6010003

Authors: Luca Pipitò Simona D’Avenia Elisabetta Orlando Antonio Cascio

Background: Syphilis has recently reemerged as a significant public health concern, with rising incidence rates globally. Malignant syphilis is a rare and severe variant of secondary syphilis, often associated with immunocompromised states, particularly HIV infection. Methods: Here, we reported a rare case of malignant syphilis in a young man with well-controlled HIV. Case: A 35-year-old man with well-controlled HIV presented with disseminated ulcerated nodules and plaques, accompanied by fever, asthenia, and mild itching. Histopathology of the scapular ulcer revealed a granulomatous infiltrate. Cutaneous leishmaniasis, atypical mycobacteriosis, and T-cell lymphomas were excluded. Serological testing and polymerase chain reaction confirmed a diagnosis of malignant syphilis.

Sexes doi: 10.3390/sexes6010002

Authors: Nosipho Faith Makhakhe Gift Khumalo

Female sex workers (FSWs) in South Africa have a high HIV prevalence. To reduce the rate of new infections, pre-exposure prophylaxis (PrEP) was introduced to FSWs; however, studies show that FSWs’ uptake and adherence to PrEP has been inconsistent. This study explored existing evidence related to strategies used to encourage PrEP uptake and adherence. Utilizing the scoping review framework, seven peer-reviewed articles were analyzed thematically. The themes were (1) PrEP promotion and distribution, (2) PrEP counselling and using educational resources, and (3) using instant messaging and rewards programs. The suggestions from the literature include a generalized PrEP promotion and distribution approach not aimed towards high-risk groups to avoid stigma. PrEP pick-up points should include sex work-friendly healthcare facilities as well as community-based venues. PrEP counselling should be conducted prior to PrEP administration to prepare users on how to deal with side effects. Information, education, and communication materials should be colorful and consist of catchy phrases targeted to the whole population. Instant messaging has been found to be effective in encouraging adherence. FSWs should be instrumental in informing intervention best practices. Future interventions aimed at FSWs should focus on holistic wellness that incorporates the psychosocial aspects of HIV prevention.

Sexes doi: 10.3390/sexes6010001

Authors: Ana Belén Correa Ángel Castro María Dolores Gil-Llario

Staff attitudes towards the sexuality of adults with mild intellectual and developmental disabilities may influence how the sexuality of service users is dealt with. The present study aimed to examine these attitudes in a Spanish context. A total of 102 staff members from service facilities for adults with intellectual and developmental disabilities, including direct-care and professional staff, responded to an online version of the Attitudes Towards the Sexuality of Individuals with Intellectual Disabilities Scale. In general, the participants demonstrated an understanding that adults with intellectual and developmental disabilities have sexuality. They reported favourable attitudes towards some self- and other-oriented sexual behaviours and sex education. Intermediate scores and variability on some items revealed concerns about these adults’ ability to control their sexual urges, perceptions of sexual abuse, pornography use, and contraception. Some differences appeared in relation to socio-demographic variables, experience and job position. Although generally favourable, differences in dispositional attitudes, such as talking about sexuality, were related to years of experience in the field. Professional staff reported greater acceptance of some sexual behaviours compared to direct-care staff. These findings are relevant to understanding variability in staff perceptions. The need for support to respond to service users’ sexuality, especially among direct-care professionals, is discussed.

Sexes doi: 10.3390/sexes5040051

Authors: Ratif Abdulai Edith Phalane Kyeremeh Atuahene Refilwe Nancy Phaswana-Mafuya

Men who have sex with men (MSM) in sub-Saharan Africa (SSA) are disproportionately affected by the human immunodeficiency virus (HIV) compared to adult men in the general population. Unprotected anal sexual intercourse is a high-risk behavior for HIV infection. This makes the correct and consistent use of condoms with condom-compatible lubricants crucial in reducing further HIV acquisition amongst the MSM population in SSA. However, consolidated data on the scope of the consistency of condom use with lubricants among MSM in SSA is lacking. In this regard, it was necessary to consolidate existing evidence on consistent condom usage with lubricants, as well as associated context-specific factors among the MSM population in SSA. A systematic review was conceptualized and registered with the International Prospective Register of Systematic Reviews (registration number: CRD42023437904). It was compiled following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) principles and guidelines between July 2023 and June 2024. We searched PubMed, Scopus, ScienceDirect, Google Scholar, and governmental and non-governmental institutions to find published and gray literature relevant to the review objectives from 2005 to June 2024. Studies conducted in SSA, published in English, focusing on MSM aged ≥15 years and also reported condom and lubricant use were considered for this review. Following the removal of duplicates and ineligible articles, 40 studies out of 202 reviewed were selected for the study. The most common study designs were cross-sectional surveys (n = 32) followed by prospective cohorts (n = 4), integrated bio-behavioral surveillance surveys (n = 3), and intervention studies (n = 1). Of the 40 eligible studies included in this review, half (n = 20) reported consistent use of condoms but without lubricants, three reported consistent use of condoms with lubricants but did not specify the lubricant type, six reported consistent condom use with water-based condom-compatible lubricants, and 11 reported only condom use but not consistent usage. Factors linked to consistent condom use with lubricants among MSM from various studies included higher educational level, knowing one’s HIV status, accessibility challenges, and older age. Having a high level of self-worth and HIV risk-reduction counseling was also associated with a consistency of condom use amongst MSM who engaged in receptive anal sex. This review indicates that only a few studies reported consistent condom use with lubricants and water-based compatible lubricants.

Sexes doi: 10.3390/sexes5040050

Authors: Robert J. Snowden Poppy Midgley Nicola S. Gray

Sexual stimuli are thought to be highly salient and have been shown to automatically attract attention at the cost of processing other stimuli. We examined whether this effect was greater for men and whether men would show a category-specific effect with greater effects due to female images than male images. In two studies, participants performed a simple perceptual task while trying to ignore a distractor stimulus that could have sexual or neutral content. As expected, sexual stimuli produced a slowing of decision times under all conditions. The effect of erotic stimuli was greater for men (Experiment 1) and was category-specific (Experiment 2) while the response of women was not category specific (Experiment 2). However, all indices of distraction showed poor levels of reliability. The results show that early automatic distraction from sexual images show both quantitative and qualitative gender differences.

Sexes doi: 10.3390/sexes5040049

Authors: Sonja Klumpp Elnaz Guivatchian Ana M. Moser Aron Liaw

Most genotypically XX females born with congenital adrenal hyperplasia (CAH) have undergone feminizing genital reconstructive surgery within their first few years of life or in early childhood. Reconstructive surgery may impact the sexual function of patients later in life, including their satisfaction with sexual activity. A review of the sexual function of CAH patients with previous reconstructive surgery was conducted through PubMed using several search terms, including (((sexual function) AND (female)) AND (congenital adrenal hyperplasia)) AND (reconstruction), and focused on articles published within the past 25 years. Relevant cited references within these articles were reviewed as well. Most studies demonstrated worse sexual function in female CAH patients compared to controls, while some showed comparable sexual function between the two groups. Further research is necessary to clarify these conflicting findings and improve long-term care of these patients, especially as it relates to their sexual health.

Sexes doi: 10.3390/sexes5040048

Authors: Antonio Daniel García-Rojas Angel Hernando Gómez Delia Montero-Fernández Susana Rodríguez-Vargas

The general objective of the study is to study the degree of gender-based violence that exists among students at the University of Huelva. The sample of 678 students (540 women and 138 men) answered an anonymous and voluntary questionnaire, which was made up of several validated questionnaires. The results show that many of the students have rarely suffered or carried out any type of violent behavior in their relationships, although there is a very low percentage who claim to have suffered gender-based violence, so we can affirm that it is a phenomenon present to a greater or lesser extent. It is observed that students easily relate physical aggressions to gender-based violence while they hesitate to relate psychological aggressions to it. This difficulty can be supported by other studies that state that adolescents believe that some actions of psychological violence—such as being jealous—are simply signs of love. This is compounded by the large number of romantic myths that are increasingly spread through social networks, media, family patterns, etc. More educational interventions are therefore needed to prevent these outcomes from leading to unhealthy relationships disguised as excessive romanticism.

Sexes doi: 10.3390/sexes5040047

Authors: Camilla Graziani Meredith L. Chivers

Sexual shame negatively affects women’s sexual functioning, impacting arousal, desire, orgasm, and pain. This review summarizes the existing literature, highlighting the multiple, interacting factors contributing to sexual shame including sociocultural messages, body and genital self-image, sexual self-schemas, sexual pain, comorbid chronic disease, illness, medical disorders, and sexual trauma. The relationship between sexual shame and sexual functioning is often reciprocal, demonstrating sexual shame as a potential causal and maintaining mechanism underlying women’s sexual difficulties. We present a model proposing the mechanisms by which sexual shame affects sexual functioning, underscoring the need for comprehensive approaches to mitigate the impact of sexual shame and foster sexual well-being for women. Growing research emphasizes emotional processes in models of sexual function, and emotional pathways underlying sexual difficulties and dysfunction. Given the impact of sexual shame on women’s sexual functioning, therapeutic approaches that target sexual shame are recommended to help alleviate difficulties with sexual arousal, desire, orgasm, and sexual pain.

Sexes doi: 10.3390/sexes5040046

Authors: Isabel Ortega-Sánchez María Orosia Lucha-López Sofía Monti-Ballano

In recent years, the practice of female genital cosmetic surgery, particularly labiaplasty, has increased in Spain, as reported by aesthetic surgery associations. The aim of this article is to describe and represent the labia minora in online information and assess whether it includes elements that may contribute to body dysmorphia. To achieve this, a qualitative content analysis was conducted on the most accessible Spanish-language websites, selected based on their PageRank. The results show that 71.4% of the analyzed websites promote labial reduction, with the majority being commercial sites from medical aesthetic centers. A significant bias towards the medicalization of female genital diversity is revealed, contributing to the creation of the problem: labial hypertrophy is presented as a pathological condition without objective medical criteria, while critical information regarding risks is often omitted. There is a need to reassess the representations, assumptions, and sociocultural values that inform these medical practices and influence their narratives.

Sexes doi: 10.3390/sexes5040045

Authors: Sophie Gateault Carita Håkansson Anna Oudin

In Belgium, sex work was recently decriminalized to enhance street-based sex workers’ (SSWs’) health. This qualitative study explores stakeholders’ perceptions of the impact of the working environment on street-based sex workers’ occupational safety, health, and well-being in Brussels. In-depth interviews with seven stakeholders directly involved with SSWs were conducted, with data analyzed using qualitative content analysis. The analysis of study data resulted in one theme: “A power imbalance and a lack of concerted efforts among stakeholders are detrimental to the occupational safety, health, and well-being of street-based sex workers”. In Brussels, the majority of SSWs face various challenges due to structural vulnerabilities, thus limiting their choices regarding their work environment and further compromising their health. Limited access to resources and severe constraints within their working environment contribute to a lack of safety and adverse health outcomes. A stigma mechanism fueled by ideology and personal interests prevents the enforcement of their rights regarding their working environment, safety, and health promotion. The lack of involvement of key stakeholders, especially from the public sector, prevents the majority of street-based sex workers in Brussels from benefiting from a sound working environment and the promotion of their health, safety, and well-being.

Sexes doi: 10.3390/sexes5040044

Authors: Patricia Silva Felipe Alckmin-Carvalho António Oliveira Jóni Ledo Verônica Silva Henrique Pereira

Work-related quality of life (WRQoL) was affected by the COVID-19 pandemic, particularly for women. This study sought to evaluate the impacts of COVID-19 on Brazilians’ WRQoL from a gender-based perspective. A sample of 326 participants, 187 women and 139 men, completed an online survey containing the Fear of COVID-19 scale, the Negative Impacts of COVID-19 scale, and the Work-Related Quality of Life scale. t-tests compared the results between genders. Pearson correlation tested the association between the variables. Linear regressions assessed the predictive factors of WRQoL. Women reported significantly higher levels of COVID-19-related fears, and lower levels of all seven dimensions of WRQoL, with significant differences for overall WRQoL, well-being, career satisfaction, and control over work. A negative correlation was found among overall WRQoL, fear of COVID-19, and the negative impact of COVID-19. Gender, fear, and negative impacts of COVID-19 were significant predictors of general well-being (explaining 24.6% of variance); regarding the seven dimensions evaluated, gender explained two of them, fear of COVID-19 explained four, and the negative impact of COVID-19 explained six of them. These results contribute to the analysis of the COVID-19 pandemic’s effects on increasing gender inequality in a manner unfavorable to women in the Brazilian organizational context.

Sexes doi: 10.3390/sexes5040043

Authors: Stella Tamas Zsuzsanna Mirnics Krisztina Hevesi David L. Rowland

The prevalence of premature ejaculation (PE) across different cultures and nationalities has long been a topic of debate, with early studies suggesting that men in such regions as the Middle East and Asia experience higher rates. However, the validity of these claims has been questioned due to methodological inconsistencies and the lack of comparative studies that apply uniform diagnostic criteria across different populations. This narrative review aims to analyze the existing literature to assess whether justifiable support for cultural or national differences regarding PE prevalance truly exists. The review focused on empirical studies spanning from 1995 to 2024 that included men from multiple nationalities or cultures. Studies on patient or specialized populations or that assessed only ejaculation latencies (EL) were excluded. Three categories of studies were reviewed: (1) studies including multiple nationalities within a single analysis, (2) studies from different countries that used an identical method to determine PE status, and (3) studies employing varied methodologies to determine PE status. The review found that differences in PE prevalence across cultures are more likely due to methodological variations than true cultural or national differences. While some trends, such as slightly higher rates in Latin American and Asian countries, were noted, no consistent patterns emerged. Studies using standardized methods, like the PEDT, generally showed prevalence rates between 5% and 15%, with no clear outliers across regions. Thus, current evidence does not support significant cultural or national differences in PE prevalence. Methodological inconsistencies, such as reliance on self-report and non-standardized diagnostic criteria, likely contribute to perceived differences. Future research should focus on using standardized methodologies and include more studies from underrepresented regions, such as Latin America and sub-Saharan Africa.

Sexes doi: 10.3390/sexes5040042

Authors: José Luis Martínez-Álvarez Mᵃ Rosario Pozo-García Judit García-Martín

Adolescence is a stage of significant intrapersonal and interpersonal changes, influenced by cultural and historical shifts. This study aims to analyze the changes in heterosexual behaviors among adolescents in Western countries over the past 50 years approximately. For this purpose, we conducted a systematic review following the PRISMA model, utilizing the online databases EBSCO, WoS, and Scopus, covering the period from 1980 to 2024, across ten European countries. The review focused on studies published in scientific journals with regional or national samples. In addition to the 30 selected studies, three more were included due to their relevance as cited in the selected articles. Despite the considerable methodological heterogeneity, the results showed a relative stabilization of the differences in sexual behaviors of boys and girls throughout time. Those differences were more evident in Southern European countries. Some changes were also noted, such as the delay in the initiation of the first sexual intercourse, a trend observed over the last decade. The findings are discussed in terms of the sexual script theory, highlighting the importance of these mental frameworks in the heteronormative sexual socialization of boys and girls. Future research should emphasize the diversity of heterosexual behaviors, their significance, and the emotional experiences that accompany them.