Doctor of Philosophy (PhD) / ABSTRACT This thesis reports on a study which explored the sexual health needs of men and teenage boys with a moderate to profound intellectual disability. Qualitative in design, this study was exploratory in nature as it sought to develop theoretical knowledge in male sexual health as a broad concept as opposed to testing a theory or hypothesis related to sexual health. Literature on sexuality and intellectual disability was reviewed in addition to male-specific literature on intellectual disability. In addition, mainstream literature on sexuality, sexual health, masculinity and men’s health was also reviewed. The literature review highlighted that the intellectual disability specific literature had largely ignored mainstream literature and had failed to acknowledge emerging work in men’s health and masculinities. Moreover, the literature identified a problematised focus toward sexual matters and males with an intellectual disability. The topic of enquiry was explored via an ethnomethodological design. Data consisted of interviews with 17 paid support staff, over 100 hours participant observation in community group homes, and triangulated with relevant artefacts from the field. The constant comparative method was used to analyse the data. Participants described the notion of men and teenage boys with a moderate to profound intellectual disability as being Conditionally Sexual. Conditionally Sexual was framed by three interconnected themes: 1) sexual development, 2) conditionally masculine, and 3) gendered service delivery. Through consideration of the implications to theory, practice, research, and policy, a propositional framework for a masculine health environment has been outlined. This framework is based on a salutogenic notion of male sexual health and the development of a healthy masculinity.

Building upon feminist and sexual health research, this dissertation shows how the positioning of women in various discourses as somehow ‘lacking’ actually constrains what researchers are able to hear in their sexual stories. Using interviews with 26 heterosexually active young women, I seek to upset traditional approaches to understanding young women’s sexual stories and theorizing heterosexuality. To analyze the interviews, I first employ a Foucauldian-inspired discourse analysis that focuses on the power that circulates through discourses and our positioning within them. Our positioning in various discourses both enables and limits various courses of action, understandings and experiences. This power of discourse is illustrated by an emergent hybrid discourse that is apparent in young women’s sexual narratives. I discuss what I call the ‘competent feminine sexuality’ discourse and show how this discourse smoothes over contradictions between liberal and gendered discourses. Secondly, I show how psychoanalytic insights allow us to explore the processes of subjectification by which young women constitute themselves as (hetero)sexual women. Specifically, this dissertation explores processes of abjection, disavowal and ambivalence in participants’ narratives. In conclusion, the dissertation outlines the practical implications for sexual health education in Canada. / Arts, Faculty of / Sociology, Department of / Graduate

Sexual health education (SHE) in Canadian schools is a controversial subject. Thirty years have passed since the government mandated that SHE be taught in Canadian schools, yet the subject still struggles to secure its place in education as curriculum design remains stagnated. In British Columbia, the 2016 - 2018 curriculum update relocated health topics, specifically SHE, to physical education (PE), the subject now known as physical and health education (PHE). To date, little research is available on the implementation of SHE curriculum within Canadian schools. This qualitative case study examined how major stakeholders (district, administration, and teachers) are implementing SHE in one school district within British Columbia. Data collection methods included interviews with district staff, administrative staff and teachers as well as district documentation analysis. Data were analyzed using content comparison. Three resulting themes explicated how the school district utilized components of a top-down implementation approach, identified deficiencies in the sustainability of SHE and factors that supported and hindered the implementation of SHE. Comments from all three stakeholders highlighted the value of SHE delivery in schools but where and how to best intergrade this topic remains unclear. / Graduate

Background: Research showed that older people's sexual health is not addressed adequately in the health sector. It is a subject that is very limited or non-existent during basic training for nursing students. Older peoples sexually health has improved and hence there will be an even more important area for the nurse, who is responsible for the patient's health. Existing prejudices about sexuality of elderly people means that more knowledge is needed. Aim: The aim was to describe: 1. elderly person's experience of their sexual health and the health care receptions. 2. health care workers' attitudes towards older patients' sexual health. Method: A literature overview. Four qualitative and six quantitative studies between the years 2000- 2015 were analyzed. Results: Three main themes were identified; older people's experiences, that showed that older patients are healthier and more sexually active than before. The second main theme; health care workers experience of older people's sexual health showed that the patient's greatest obstacles to exercising their sexuality is the lack of private spaces. The nurse usually had a negative attitude to the elderly persons' sexual health, which could be due to nurses' ignorance and that sexuality is a sensitive subject. The third theme showed factors which affect sexual health in elderly. Conclusion: More information is needed about the elderly person's sexual health for patients and more training in nursing. Many older suppress their sexuality because of different standards and taboos in society, which may lead to unnecessary suffering.

The aim of this study was to investigate the sexual health needs of undergraduate women aged 18-25 years old who were sexually active but not married or cohabiting; in order to put forward recommendations for a health promotion intervention which may be applied in the practice setting. The thesis consists of three linked qualitative studies. The Part 1 study was an in-depth exploration of the women’s sexual lifestyles and behaviours to identify their health promotion needs. This study was conducted using a phenomenological approach employing Interpretative Phenomenological Analysis (IPA). The Part 2 study was the systematic development of theoretically robust, evidence based intervention to respond to the health promotion needs identified in the Part 1 study. The third study was a consultation review of the initial materials with focus groups of undergraduate women aged 18-25 years old. The aim of which was to refine and amend the intervention to reflect the women’s perspectives. To undertake these tasks Intervention Mapping (IM) (Bartholomew et al., 2006) a health promotion programme planning framework was used as a guiding framework for the thesis. This study revealed the women traversed different types of sexual relationships. Within all types of relationships the women reported being risk averse and valued positive sexual health. Where a threat to sexual health was identified, they took action to reduce the threat. The threats identified differed depending on the relationship type. The distinct relationship types presented differing patterns of decision making, influenced by their values, emotional salience of the relationships and perception of sexual health risk. As such the different sexual health practices presented differing sexual health challenges and health promotion needs. This thesis suggests a quaternary model of female sexual agency outlining four distinct types of relationships - type (1) sexual debut and initial relationships, characterised by high emotion, type (2) casual sexual relationships, characterised by increasing sexual confidence and hedonistic attitudes, type (3) established but not permanent relationships, characterised by relationship stability but not sexual exclusivity (i.e. biological concurrency/behavioural concurrency) and type(4) marriage/cohabitation type relationships, characterised by increased sexual exclusivity. Many women described moving from type 1 relationships into type 2 relationships and then onto a type 3 relationship. However, once beyond type 1 the relationship types were not linear, the women described movement back and forth between type 2 and type 3 relationships. These were frequently with different partners, but could be with the same partner, for example; previous type 3 partners (established) could become a type 2 (casual partner). The study brought to light differing social constructs and expressions of female sexuality and sexual agency within the different relationship types. This enabled the identification of risk behaviours and their determinants, which in turn facilitated the process of intervention development. This enabled the creation of a tailored response to the women’s sexual health needs; thereby assisting the women to make fully informed contraceptive and sexual health choices. The study revealed how each step of the IM process contributes to the whole, augmenting the potential efficacy of the health promotion tools produced.

Sexual behavior is a normative part of adolescence and it is important to understand how familial factors influence Latina/o adolescents’ sexual health. The current study examined two structural equation models (SEM) and the associations between familial cultural values (i.e., familismo and filial piety), maternal and paternal monitoring (i.e., disclosure and solicitation) and Latina/o adolescent’s sexual behavior (i.e., intentions to have sex, sexual behavior, sexual responsibility). A hypothesized SEM examined whether paternal/maternal monitoring mediated the relation between familial cultural values and adolescents’ sexual health, while an alternative SEM examined whether familial cultural values mediated the association between paternal/maternal monitoring and adolescents’ sexual health. Participants included 1,024 Mexican adolescents (54% female) between the ages 12-18. Results showed that the overall hypothesized SEM had excellent fit indices. Filial piety was associated with favorable sexual health outcomes and increased parental monitoring. Maternal disclosure was associated with lower intention to have sex and more sexual responsibility, while paternal solicitation was associated higher intention to have sex. Sex differences were found after conducting a chi-square difference tests and partially constraining the model. For Latino adolescents, paternal child disclosure and solicitation was associated with intentions to have sex. For Latina adolescents, familismo was associated with more maternal disclosure. Mediational analysis showed that for Latino adolescents, more reported filial piety was associated with more paternal solicitation and disclosure, which was then associated with lower and higher intentions to have sex, respectively. The alternative SEM had excellent fit indices, however, no sex differences were found. Mediational analyses were conducted with the unconstrained model while controlling for sex. Mediational pathways showed that maternal disclosure was positively associated with filial piety, which was associated with lower intention to have sex sexual intention and more sexual responsibility. Findings indicate that family cultural values and paternal monitoring may influence Latino adolescent’s intention to have sex. Additionally, filial piety should be considered as a protective factor for Latina/o adolescents’ sexual health. These findings can inform prevention programs targeting Latina/o families. Furthermore, a greater emphasis should be placed on the importance paternal monitoring and filial piety given their associations with Latino adolescents’ sexual health.

This study is the first to collect detailed empirical data on sexual practice among backpackers while exploring the material and social context of backpacking using an ethnographic framework. The theoretical concepts of liminality and sexual scripts were drawn on to analyse the findings. Backpackers were recruited from hostels in Sydney and Cairns; 559 backpackers (243 women, 316 men) completed an anonymous self-administered questionnaire. In addition, 25 in-depth one-to-one interviews with backpackers and 25 semi-structured interviews were conducted with sexual health and travel clinic staff and hostel service providers. Participant and non-participant observation in backpacker hostels also informed the analysis. Drinking alcohol, often to excess, was central to the backpacking setting and was both a reason for and a post-facto justification of unprotected sex. The backpacking setting encouraged transient liaisons. More than half (55%) of backpackers had sex with someone new during their trip and for 71% of them it was with someone that they had just met that day. Twenty-five per cent of those with no expectations to have casual sex on their trip and 22% of those with no previous experience of casual sex had casual sex during their trip. More than half (53%) of those who had sex with a someone new did so while other people were in the room. Only 55% always used a condom with their last new partner. While most backpackers carried condoms and intended to use them, unprotected sex was common. Perception of risk was low: 78% of those who did not use a condom the last time they had casual sex on the trip perceived their risk of getting HIV to be ??low?? to ??nil??. Three participants acquired HIV during their trip. The culture of backpacking encourages more sexually permissive attitudes but does not encourage condom use, especially for those who did not consistently use condoms at home. These findings highlight the need for more broad-based dissemination of information on STIs to young people, and for future sexual health campaigns to specifically target backpackers in the context in which they travel.

Cigarette smoking represents the most preventable cause of morbidity and mortality in the world today, and is responsible for enormous health-related economic burdens. Among other medical sequelae, erectile impairment has been shown to be associated with chronic tobacco use. The primary aim of the present study was to provide the first empirical investigation of the effects of smoking cessation on physiological and subjective indices of sexual health. Sixty-five long-term, heavy smoking men participated in a smoking cessation program and were assessed at baseline (while smoking regularly), at mid-treatment (while using a high dose nicotine transdermal patch), and at 4-week follow-up. Physiological and subjective sexual arousal indices, as well as self-reported sexual functioning (as measured by the International Index of Erectile Functioning (IIEF)) were assessed during each visit. Intent-to-treat analyses indicated that at followup successful quitters (n = 20), compared to those who relapsed (n = 45), showed significant improvements in physiological and subjective sexual arousal. Specifically, men demonstrated enhanced erectile responses, decreased latencies to reach maximum erectile capacity, and faster onset to reach maximum subjective sexual arousal. Although participants displayed across-session enhancements in self reported sexual function, successful quitters did not show a differential improvement compared to participants who relapsed. The results of the present investigation provide the first empirical evidence that smoking cessation significantly enhances both physiological and self-reported indices of sexual health in long-term male smokers, irrespective of baseline erectile impairment. It is hoped that these results may serve as a novel and enticing means to influence men to quit smoking. Increasing successful smoking cessation in men would significantly enhance quality of life, substantially reduce premature death, and alleviate enormous economic burdens caused by smoking-related diseases. / text

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Background Sexual health is affected by disease, dysfunction and disability but can also be experienced in spite of illness. To get a deeper knowledge of what the nurse does for the patients the background is written with the support of the holistic care and Katie Eriksson theoretical perspectives health and suffering. Aim The aim of this study is to describe the factors to why nurses do not prioritize patients' sexual health in the nursing care. Method A literature review based on nine qualitative and quantitative studies focusing on the barriers perceived by the nurses to address sexual health. Result The result of this study showed that the barriers were many. Factors related to nurses unwillingness to talk to patients about sexuality and sexual health were difficulties in nurses' psychosocial work environment and lacking competence concerning sexual health. The fact that sexuality is a sensitive subject, factors related to the patient and that it was someone else's responsibility to raise the topic were other factors that made it difficult. Conclusion We conclude that a stressed workplace where there is a lack of time and stress along with a poor education and uncertainty leads to no grasp of the subject and the problem slides between health professionals. Patients' sexual health remains untreated. If sexual health is not involved in the nursing care increases the risk for larger problems and that the patients are exposed to unnecessary suffering.