The proposed thesis is comprised of eleven papers connected by the employment of the evolutionary psychological approach in research on various aspects of human sexuality. The aim of the first monothematic part is to demonstrate the evolutionary-psychological approach to one recent phenomenon in female sexuality - the use of oral contraceptives (OC). OC use has been shown to suppress psychological mechanisms that are considered to be adaptive in the fertile period of the natural menstrual cycle. In particular, OC users' ratings of male stimuli that provide the cues of genetic quality and compatibility are lower in comparison with normally cycling women. Moreover, the increase in sexual desire and in the prevalence of proceptive behaviour observed during mid-cycle in normally cycling women is diminished. However, the impact of this phenomenon on mate-choice and relationship dynamics in an ecological context has not been studied. In the first study, we have analyzed the data of Czech women obtained via representative sampling within the Czech National Survey of Sexual Behavior. Results indicated that normally cycling women had a significantly higher number of one-night stands during the last year in comparison to OC users even when living in a long-term relationship. OC usage was also shown to have...

L’hypothèse de l’hormono-dépendance du mélanome cutané est en débat dans la littérature depuis de nombreuses années. Dans ce contexte, il est essentiel de mieux connaître l’influence potentielle de la prise de traitements hormonaux sur le risque de ce cancer.L’objectif de ce projet de thèse était d’étudier l’influence de la prise de traitements hormonaux (contraceptifs oraux, traitements de l’infertilité, progestatifs pris seuls avant la ménopause et traitements hormonaux de la ménopause) sur le risque de mélanome cutané chez les femmes.Le projet a été conduit principalement à partir de la cohorte prospective E3N (Étude épidémiologique auprès de femmes de l’Éducation nationale) portant sur environ100 000 femmes âgées de 40 à 65 ans à l’inclusion en 1990. L’étude E3N inclut des données détaillées sur le profil pigmentaire, l’exposition solaire et la prise de traitements hormonaux des participantes, ainsi que sur la survenue éventuelle de mélanome cutané, dont les cas ont été confirmés par histologie (761 cas confirmés entre 1990 et 2011). Des données complémentaires sur l’exposition solaire, disponibles pour une fraction de la cohorte E3N, ont également été utilisées. Ces données détaillées sont issues de l’enquête cas-témoin nichée E3N-SunExp menée en 2008. Les analyses ont ensuite été étendues au consortium de cohortes européennes prospectives EPIC (European Prospective Investigation into Cancer and Nutrition), sur près de 334 500 femmes parmi lesquelles 1 734 cas de mélanomes incidents ont été diagnostiqués.Les résultats mettent en évidence des associations modestes entre la prise de traitements hormonaux et le risque de mélanome et ne soutiennent pas l’hypothèse de l’hormono-dépendance de ce cancer. Cependant, ils suggèrent un comportement d’exposition intentionnelle aux UV chez leurs utilisatrices, ce qui ouvre une nouvelle perspective pour les recherches futures dans ce domaine. / The hypothesis of a hormonal dependence of cutaneous melanoma has been debated in the literature over past decades. Within this context, it is critical to increase our knowledge on the influence of exogenous hormone use on the risk of this cancer.The aim of this project was to explore the influence of hormonal treatments (oral contraceptives, fertility drugs, premenopausal use of progestogens, and menopause hormone therapy) on the risk of cutaneous melanoma in women.The project was mainly based on the large E3N (Étude épidémiologique auprès de femmes de l’Éducation Nationale) prospective cohort, which included about 100,000 women aged 40-65 years at inclusion in 1990. The cohort collected data on pigmentary phenotype, sun exposure, hormonal treatment use, and medical data including cutaneous melanomas, which were ascertained through pathology reports (761 incident cases between 1990 and 2011). Additional information on sun exposure, available for a portion of the E3N cohort, was used. These detailed data were collected as part of the E3N-SunExp case-control study launched in 2008.Analyses were extended to the EPIC consortium (European Prospective Investigation into Cancer and Nutrition), which includes about 334 500 women and 1,734 incident melanoma cases.The results arising from this project show modest associations between exogenous hormone use and melanoma risk and suggest no strong direct influence of hormones on melanoma development. However, results suggest intentional UV exposure behaviors in exogenous hormone users, which opens new perspectives for future investigations in this field.

In Tennessee (TN), the rate of unintended pregnancies remains higher than the national rate (32.4% vs. 30.3%). Although long-acting reversible contraceptives (LARCs) are 99% effective in preventing undesired pregnancies; uptake remains low in rural and underserved communities. Previous research has provided some insight into women’s perceptions of LARCs; however, those guided by conceptual frameworks to understand the multiple influences that impact perceptions towards LARCs, especially among rural regions, are scarce. This multimethod qualitative study explored multiple influences that impact northeast Tennessee women’s perceptions and attitudes toward LARCs using the Socio-ecological Model (SEM) as a guiding framework. The study comprised six focus groups and seven individual interviews of women aged 18-44, not pregnant, and current residents of five counties in Northeast TN. Participants’ demographics were administered through REDCap, while qualitative data from focus groups and interviews were recorded via Zoom. Focus groups and interview data were combined, and an a priori list of codes identified from the constructs of the SEM was initially used to deductively code the data. Subsequently, the data were analyzed inductively for new codes and themes that did not apply to the a priori categories. Seventeen themes and 23 sub-themes were identified using the SEM; On the intrapersonal level of the SEM, participants’ contraception utilization history, attitudes towards a method, perception of method features, and perceived side effects were identified as themes that delineate influences on their LARC utilization. Perception of partner support, perceived support from peer/social networks, and provider trust themes were identified on the interpersonal level. On the community level, the cost of the method, access to information, perceived accessibility to a method, social services, and cultural norms themes were identified. The availability of preferred methods in a clinic, the need for multiple clinic visits to use a method, and provider counseling practices were identified as organizational-level themes. On the policy level, insurance, and billing policies, sex education policies were identified as impacting LARC utilization. Study findings highlight the areas of influence that can be addressed to increase LARC uptake and enable women in rural and underserved regions to achieve their personal reproductive goals.

Sweden has a high rate of unintended pregnancies (UP) despite being a rather open society regarding sexual health education. New technology provides new possibilities to improve access by providing contraceptive consultations online, but will that lower the rate of UP? Very few studies have been done on the people working with the young women to find out what can be done to improve the quality of the contraceptive counseling. That is why this study involved two midwives practicing at a youth center at an early stage of the design process. Cultural Probes was used as method to better understand what needs midwives experience in their daily work. Three key findings stating the needs of the midwives were knowledge, missed appointments and trust. In addition, a service evaluation was done to investigate when and how midwives and young women interact. Making the contraceptive consultations available online with a digital care provider would make it more accessible for the young women and the results of this study do not contradict that hypothesis. However, availability is not the sole influencing factor on contraceptive usage. This study shows that encouragement for young women to seek general knowledge and information about contraceptives prior to the consultation is an important factor in order to improve the quality of contraceptive counselling. / Trots Sveriges relativt öppna samhälle gällande sex och sexualundervisning så har vi en väldigt hög frekvens av oönskade graviditeter. Ny teknik möjliggör att hålla preventivmedel konsultationer online vilket leder bättre tillgänglighet, men frågan är om det räcker för att sänka frekvensen oönskade graviditeter? Väldigt få studier har gjort på barnmorskorna som jobbar med de unga kvinnorna för att får reda på vad mer som kan göras för att höja kvaliteten på preventivmedelsrådgivningen. Därför har denna studie, i ett tidigt stadie av designprocessen, involverat två barnmorskor praktiserande på en ungdomsmottagning. Cultural Probes användes som metod för att bättre förstå vilka behov barnmorskor upplever i deras dagliga arbete. Det främsta resultatet summeras i tre teman: kunskap, missade besök och förtroende. Dessutom utfördes en serviceutvärdering av hela kundresan för att ta reda på när och hur barnmorskor och unga kvinnor interagerar. Genom att möjliggöra preventivmedelsrådgivning online genom digital vård så skulle tillgängligheten förbättras för de unga kvinnorna och denna hypotes är inget som denna studie motsätter sig. Men tillgänglighet är inte den enda faktorn som påverkar användandet av preventivmedel. Denna studie visar att uppmuntran till att få unga kvinnor att söka kunskap och information om preventivmedel innan själva besöket är en viktig del som skulle kunna förbättra kvaliteten på preventivmedelsrådgivningen

Introduction and Background: Between 1999 and 2014 the number of patients in the labor and delivery that were on medication for opioid use disorder (MOUD) quadrupled. The rate of unintended pregnancies in pregnant patients of mOUD is at a tremendous high due to inconsistencies in the use of reliable contraception in this population. Purpose Statement: To reduce the number of unintended pregnancies and infants born with neonatal abstinence syndrome there is a need for prevention and required education for men and women in medication-assisted facilities. Literature Review: Twenty research studies were reviewed and evaluated. These articles were found by utilizing PubMed, CINAHL, One Search, and Google Scholar. Most articles were discovered in the following Journals: Medical, Contraceptive, Preventative Medicine, Women's Health, Addiction, and Neonatal Nursing Journals. Findings: Through this research, we found there is a need for prevention services and required education onsite at the facility where patients are receiving medication for opioid addiction (mOUD). The following articles show the lack of contraceptive education, and misinformation about reproduction while on methadone or other medication-assisted drugs. Conclusion: The accessibility of having contraceptives onsite with required education for patients who are in treatment has been proven to be more effective and can decrease the number of unintended pregnancies or infants born with Neonatal Abstinence Syndrome. To be able to give better patient care for this specific demographic it is crucial that nurses are allowed to educate clients.

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Genus, kön och sexualitet präglar oss från dagen vi föds och föreställningarna om hur en individ bör bete sig konstruerar människor i den sociala sfären. Den svenska marknaden för kvinnliga preventivmedel har vuxit sig stor med åren och majoriteten av unga kvinnor använder idag hormonella preventivmedel. Användningen riskerar att leda till biverkningar som påverkar hälsan samtidigt som den stora marknaden skapat förväntningar om att kvinnor i heterosexuella relationer bör ta ansvaret över preventivmedel. Syftet med denna kvalitativa intervjustudie var att skapa en djupare förståelse av unga kvinnors upplevelser av hormonella preventivmedel i en heterosexuell relation samt att utforska hur samhällets konstruktion av genus och sexualitet påverkar deras beslutsfattande kring preventivmedel. Genom en socialpsykologisk ansats studerades detta genom teorier om subjektiv hälsa, genusteori med fokus på heteronormativitet, genusidentitet, genusroll, sexualitet samt social påverkan. Elva stycken semistrukturerade intervjuer med unga kvinnor genomfördes. Resultatet visade att kvinnors insikter om den egna hälsan i relation till användningen av hormonella preventivmedel kommer med åldern. Hormonella preventivmedel kan även leda till både positiva och negativa effekter på hälsan. Normer i sjukvården och normer från sexuella partners har ofta en inverkan på beslutsfattandet kring hormonella preventivmedel. Till sist kan beslutsfattandet påverkas av kvinnliga ideal, normer från omgivningen samt viljan att upprätthålla förväntningar om den kvinnliga sexualiteten. / Gender, sex and sexuality marks us from the day we are born and conceptions about how an individual should behave construct people in the social sphere. The Swedish market for female contraception has grown over the years and the majority of women today use hormonal contraceptives. The use of contraceptives risks leading to side effects that affect health, simultaneously, market availability creates expectations that women in heterosexual relationships should take responsibility for contraception. The aim of this qualitative interview study is to create a deeper understanding of young women's experience of hormonal contraceptives in a heterosexual relationship and to explore how society's construction of gender and sexuality affects their decision-making regarding contraceptives. Through a social psychological approach, this is examined through theories of subjective health, gender theory with focus on heteronormativity, gender identity and gender role, sexuality and social influence. Eleven semi-structured interviews with young women were conducted. The results showed that women’s perspectives on their own health in relation to the use of hormonal contraceptives comes with age. Hormonal contraceptives can also lead to both positive and negative effects on health. Norms in healthcare and norms from sexeual partners often have an impact on decision-making around hormonal contraceptives. Finally, decision-making can be influenced by female ideals, norms from the environment and the desire to maintain expectations about female sexuality.

Twenty-nine college females, aged 18-29, participated in a six month boron supplementation protocol to evaluate mineral and hormone status of athletes and non-athletes. All subjects were classified into activity and oral contraceptive groups as follows: athletes (n=16), non-athletes (n=13), oral contraceptives (n=12), and no oral contraceptives (n=17). Subjects were randomly assigned to receive a placebo or 3 mg of boron per day. Subjects' maximal oxygen consumption (VO₂max) was assessed as a baseline measurement and was used to confirm a difference between activity groups. Body fat, height, bone mineral density, and serum calcitonin and parathyroid also were baseline measurements. Subjects were measured at baseline and six months for the following: dietary intake, body weight, serum levels of 17-f-estradiol, progesterone, and testosterone, and plasma and urine levels of calcium, phosphorus, magnesium, and boron. Athletes had a Significantly greater VO₂max (p < 0.01) than did non-athletes. Subjects taking oral contraceptives had significantly lower serum estradiol (p < 0.05) as compared to subjects not taking oral contraceptives. Boron supplemented non-athletes had a significantly greater change in plasma calcium levels (p < 0.05) as compared to boron supplemented athletes, although the athletes had a significantly higher plasma calcium level (p < 0.05) at the baseline measurement. Control subjects (n=6) had a significantly greater change in dietary carbohydrate (p < 0.01) and protein intake (p < 0.05) as compared to subjects taking boron (n=23). Boron supplementation did not appear to significantly influence any of the parameters measured. However, boron supplementation combined with activity appeared to influence plasma calcium, while serum estradiol may be influenced by oral contraceptives. / Master of Science

Objectif : Étudier l'association entre l’utilisation de contraceptifs hormonaux et le risque d'acquisition du VIH-1 chez les femmes au Malawi, en Afrique du Sud, en Zambie et au Zimbabwe. Devis : Analyses secondaires de 2887 femmes âgées de 17-55 ans ayant participé à l’étude HPTN 035, une étude de phase II/IIb sur l’efficacité de deux gels microbicides pour prévenir la transmission du VIH chez les femmes à risque. Méthodes : L'association entre l'utilisation de contraceptifs hormonaux et le risque d'acquisition du VIH-1 a été évaluée en utilisant des modèles de Cox. Des risques relatifs sont estimés où le groupe de référence est celui des femmes qui n’utilisent pas de contraceptifs hormonaux. De plus, un modèle multivarié de Cox est utilisé afin de contrôler pour les facteurs potentiellement confondants. Résultats : Les contraceptifs injectables ont été utilisés par 52,1% des femmes, alors que les contraceptifs oraux ont été utilisés par 20,7% de celles-ci. Pendant l'étude, il y a eu 192 séroconversions. L'incidence observée du VIH était de 2,28; 4,19 et 4,69 pour 100 personne-années pour les contraceptifs oraux, injectables et non hormonaux, respectivement. Lors de l’analyse multivariée, nous n'avons trouvé aucune association significative entre l’usage des contraceptifs hormonaux et l’acquisition du VIH-1. Le risque relatif ajusté (RRa) pour les contraceptifs oraux est de 0,573 (IC de 95% : [0,31-1,06]) et 0,981 (IC de 95% : [0,69 ; 1,39]) pour les contraceptifs injectables. Conclusions : Bien que cette étude ne démontre pas d’association entre l’usage des contraceptifs hormonaux et le VIH-1, nous concluons toutefois que ces méthodes de contraception ne protègent pas contre le VIH-1, et il est ainsi recommandé aux femmes utilisant des hormones contraceptives de toujours utiliser le condom pour prévenir l'infection au VIH-1. / Objective: To investigate the association between the use of hormonal contraceptive and the risk of acquiring HIV-1 infection in women from Malawi, South Africa, Zambia and Zimbabwe. Design: Secondary analyses of 2887 women aged 17-55 years who participated in the HPTN 035 trial, a Phase II/IIb trial on the efficacy of two microbicide gels to prevent HIV transmission in women at risk in Africa. Methods: The association between the use of hormonal contraceptive and the risk of acquiring HIV-1 was evaluated using Cox proportionnal models. Relative risks of exposed women were estimated using as a reference group the women who do not use hormonal contraceptives. In addition, a multivariate Cox model was used to control for potentially confounding factors. Results: Injectable contraceptives were used by 52.1 % of women, while oral contraceptives were used by 20.7% of them. During the study, there were 192 seroconversions. The observed HIV-1 incidence was 2.28, 4.19 and 4.69 per 100 woman-years for oral, injectable and non-hormonal contraceptive users, respectively. In multivariate analysis, we found no significant association between the use of hormonal contraceptives and HIV-1 acquisition. The adjusted relative risk (aRR) for oral contraceptives was 0.573 (95% CI: [0.31 to 1.06]) and 0.981 (95% CI: [0.69, 1.39]) for injectable contraceptives. Conclusions: Although this study did not demonstrate an association between hormonal contraceptive use and the risk of HIV-1 infection, we conclude, however, that these methods of contraception do not protect against HIV-1, and it is thus recommended that women using contraceptive hormones always use condoms to prevent HIV-1.