Introdução: A anticoncepção de emergência é um método contraceptivo usado após a relação sexual desprotegida. Apesar da sua alta eficácia e de estar disponível gratuitamente na rede pública de saúde, ainda é subutilizada. Objetivo: Identificar as razões e analisar os determinantes do não uso da anticoncepção de emergência quando indicada. Método: Estudo quantitativo, do tipo transversal, realizado com amostra probabilística de mulheres grávidas usuárias de 12 Unidades Básicas de Saúde da Supervisão Técnica de Saúde do Butantã, São Paulo (n=515), entre março e junho de 2013. O não uso da anticoncepção de emergência quando indicada foi considerado quando as mulheres eram classificadas como tendo gravidez não planejada ou ambivalente segundo o London Measure of Unplanned Pregnancy (n=366). No Stata 12.0, os dados foram analisados por meio de regressão logística multinomial. O grupo de mulheres que usou a anticoncepção de emergência para prevenir a gravidez em curso foi comparado com dois grupos: o de mulheres que estava usando algum método contraceptivo, mas não anticoncepção de emergência no mês em que ficou grávida, e o grupo de mulheres que não usou métodos contraceptivos nem anticoncepção de emergência nesse período. Resultados: Apesar da maioria conhecer a anticoncepção de emergência (96,7%), apenas 9,8% a usou para prevenir a gravidez em curso. A principal razão para o não uso foi pensar que não iria engravidar (47,6%). Outras razões, como querer engravidar/ter um filho no futuro e não pensar ou não se lembrar do método também foram amplamente referidas pelas mulheres. Os determinantes do não uso da anticoncepção de emergência para as mulheres que usavam métodos contraceptivos foram a não consciência do risco de engravidar [OR=3,44; IC95%: 1,48-8,03] e morar com o parceiro [OR=3,23; IC95%: 1,43-7,28]. Para aquelas que não usavam métodos contraceptivos, morar com o parceiro [OR= 3,19; IC95%: 1,40-7,27], gravidez ambivalente [OR: 3,40; IC95%: 1,56-8,54] e o não uso prévio do método [OR=3,52; IC95%: 1,38-8,97] foram associados ao não uso da anticoncepção de emergência. Conclusões: Viver com um parceiro pode fazer com que a mulher se sinta menos preocupada em evitar uma gravidez, ou seja, menos propensa a usar a anticoncepção de emergência. De toda forma, reconhecer as situações em que corre o risco de engravidar, saber por experiência própria como obter e usar o método e ter claras intenções reprodutivas podem aumentar o uso da anticoncepção de emergência quanto indicada / Introduction: Emergency contraception is a contraceptive method to be used after unprotected intercourse. Despite its high efficacy, availability both at primary health care and private pharmacies in Brazil, it is still underutilized. Objective: To identify the reasons and analyze the determinants of emergency contraception non-use when indicated. Method: Cross-sectional, quantitative study conducted with a probabilistic sample of pregnant women from 12 Primary Health Facilities at the Health Supervision of Butantã, São Paulo, Brazil (n=515), from March to June 2013. We considered an emergency contraception non-use when indicated women who were either in an unplanned or ambivalent pregnancy according to the London Measure of Unplanned Pregnancy (n=366). In Stata 12.0, we used multinomial logistic regression to analyze the data. Women who used the method to prevent the current pregnancy were the reference and were compared to two groups of women: those who did not use emergency contraception, but used another method; and those who used no method at all. Results: Although there was a high proportion of emergency contraception awareness (96.7%), only 9.8 % used it to prevent the current pregnancy. The main reason for non-use was believing that she would not become pregnant (47.6%); but wanting to become pregnant in the future and not remembering to use the method were also largely reported. Associated aspects to emergency contraception non-use among women who used a method were not being aware of pregnancy risk [OR=3,44; IC95%: 1,48-8,03] and cohabitation with a partner [OR=3,23; IC95%: 1,43-7,28]. Among women that did not use any contraception, cohabitation with a partner [OR= 3,19; IC95%: 1,40-7,27], ambivalent pregnancy [OR: 3,40; IC95%: 1,56-8,54] and no previous use of emergency contraception [OR=3,52; IC95%: 1,38-8,97] were associated with the method non-use. Conclusions: Living with a partner can make a woman feel less concerned about preventing a pregnancy, which means, less likely to use emergency contraception. Eventually, having skills to recognize pregnancy risk situations, having experience on how to use and when to obtain the pill and a clear pregnancy intention can increase the use of emergency contraception when indicated

A chegada do primeiro filho traduz um cenário de intensas mudanças na rotina das mulheres, o qual é pautado por diferentes percepções a respeito da sexualidade e da maternidade. As formas como as novas mães percebem tais mudanças e, identificam suas necessidades em relação ao exercício da sexualidade exercem influência sobre o cotidiano e a saúde das mulheres. Este estudo teve por objetivo compreender como as mulheres que se tornaram mães pela primeira vez percebem as mudanças e identificam as suas necessidades em relação ao exercício da sexualidade durante o primeiro ano do período pós-parto. Especificamente buscou analisar as perspectivas das participantes sobre a maternidade e a sexualidade; compreender a vivência da sexualidade em função dos significados atribuídos a maternidade; identificar o conhecimento e a importância atribuída aos diferentes métodos contraceptivos e; identificar a importância das orientações profissionais nas questões ligadas à saúde sexual e reprodutiva das mulheres. Em virtude dos fenômenos estudados desenvolvemos uma pesquisa de cunho qualitativo com 12 mulheres primíparas e usuárias de Unidades Básicas de Saúde do município de Ribeirão Preto, interior do estado de São Paulo. O instrumento utilizado para a realização da coleta de dados foi a entrevista semiestruturada e, através da Análise de Conteúdo o material oriundo da transcrição integral das entrevistas foi fragmentado dando origem a categorias, as quais foram reagrupadas por temáticas relevantes ao objeto estudado. Da análise de conteúdo obtivemos categorias que dizem respeito a concepção de sexualidade, ao sexo e maternidade, a concepção de maternidade, a gravidez, ao parceiro e pai e, ao planejamento familiar. Portanto, a compreensão que as mulheres têm acerca do seu novo papel social imprime novos direcionamentos às experiências diárias no ambiente doméstico, nas relações sociais e no relacionamento com o parceiro. Muitas questões permeadas pelo desequilíbrio nas relações de gênero estão envolvidas nesta dinâmica como a qualidade do acesso ao planejamento familiar, a forma como se apropriam das informações recebidas e a qualidade do atendimento pré e pós-natal. A forma como a mulher exerce a sexualidade e a maternidade é indissociável da construção social da identidade feminina, construção esta que determina as práticas relativas a atenção à saúde das mulheres e que pode interferir nas escolhas e no cuidado com a saúde e na procura da assistência. / The coming of a firstborn son represents a scene of intense changes in routine of women which is lined for different perceptions related to sexuality and motherhood. The ways new mothers notice these changes and identify their needs related to sexuality influences their daily lives and the women health. This study had the goal understand how women became mothers for the first time realize the changes and identify their needs in relation to their sexuality during the first year postpartum period. Specifically sought analyze the participants perspective about motherhood and sexuality; understand the experiences of sexuality according to the meanings assigned to motherhood; identify the knowledge and the importance given to different contraceptive methods; identify the importance of professional orientation linked to maters of sexual and reproductive health of the women researched. In view of the phenomena studied we developed a qualitative research with 12 primiparous women and users of public health system in Ribeirão Preto, countryside of São Paulo state. The instrument used to perform the data collection was semi-structured interview and through the content analysis of the material from the whole interviews transcription, it was fragmented originating categories, which were regrouped by relevant themes to the object of study. Content analysis categories obtained concerning the conception of sexuality, sex and motherhood, conception of motherhood, pregnancy, partner and father, and, family planning. Therefore, the understanding women has about their new social role requires new directions to daily experiences in the home environment, in social relations and in the relationship with their partner. Many questions are permeated by the imbalance of gender relation involved in this dynamic with quality familiar planning access, the way they appropriate information received and the quality of pre and postnatal treatment. At long last, the way which the women practice the sexuality and the motherhood is inseparable from the social construction of female identity, construction that determines the practices related to the attention to womens health that could interfere in the choices and care with health and in the search for assistance.

A chegada do primeiro filho traduz um cenário de intensas mudanças na rotina das mulheres, o qual é pautado por diferentes percepções a respeito da sexualidade e da maternidade. As formas como as novas mães percebem tais mudanças e, identificam suas necessidades em relação ao exercício da sexualidade exercem influência sobre o cotidiano e a saúde das mulheres. Este estudo teve por objetivo compreender como as mulheres que se tornaram mães pela primeira vez percebem as mudanças e identificam as suas necessidades em relação ao exercício da sexualidade durante o primeiro ano do período pós-parto. Especificamente buscou analisar as perspectivas das participantes sobre a maternidade e a sexualidade; compreender a vivência da sexualidade em função dos significados atribuídos a maternidade; identificar o conhecimento e a importância atribuída aos diferentes métodos contraceptivos e; identificar a importância das orientações profissionais nas questões ligadas à saúde sexual e reprodutiva das mulheres. Em virtude dos fenômenos estudados desenvolvemos uma pesquisa de cunho qualitativo com 12 mulheres primíparas e usuárias de Unidades Básicas de Saúde do município de Ribeirão Preto, interior do estado de São Paulo. O instrumento utilizado para a realização da coleta de dados foi a entrevista semiestruturada e, através da Análise de Conteúdo o material oriundo da transcrição integral das entrevistas foi fragmentado dando origem a categorias, as quais foram reagrupadas por temáticas relevantes ao objeto estudado. Da análise de conteúdo obtivemos categorias que dizem respeito a concepção de sexualidade, ao sexo e maternidade, a concepção de maternidade, a gravidez, ao parceiro e pai e, ao planejamento familiar. Portanto, a compreensão que as mulheres têm acerca do seu novo papel social imprime novos direcionamentos às experiências diárias no ambiente doméstico, nas relações sociais e no relacionamento com o parceiro. Muitas questões permeadas pelo desequilíbrio nas relações de gênero estão envolvidas nesta dinâmica como a qualidade do acesso ao planejamento familiar, a forma como se apropriam das informações recebidas e a qualidade do atendimento pré e pós-natal. A forma como a mulher exerce a sexualidade e a maternidade é indissociável da construção social da identidade feminina, construção esta que determina as práticas relativas a atenção à saúde das mulheres e que pode interferir nas escolhas e no cuidado com a saúde e na procura da assistência. / The coming of a firstborn son represents a scene of intense changes in routine of women which is lined for different perceptions related to sexuality and motherhood. The ways new mothers notice these changes and identify their needs related to sexuality influences their daily lives and the women health. This study had the goal understand how women became mothers for the first time realize the changes and identify their needs in relation to their sexuality during the first year postpartum period. Specifically sought analyze the participants perspective about motherhood and sexuality; understand the experiences of sexuality according to the meanings assigned to motherhood; identify the knowledge and the importance given to different contraceptive methods; identify the importance of professional orientation linked to maters of sexual and reproductive health of the women researched. In view of the phenomena studied we developed a qualitative research with 12 primiparous women and users of public health system in Ribeirão Preto, countryside of São Paulo state. The instrument used to perform the data collection was semi-structured interview and through the content analysis of the material from the whole interviews transcription, it was fragmented originating categories, which were regrouped by relevant themes to the object of study. Content analysis categories obtained concerning the conception of sexuality, sex and motherhood, conception of motherhood, pregnancy, partner and father, and, family planning. Therefore, the understanding women has about their new social role requires new directions to daily experiences in the home environment, in social relations and in the relationship with their partner. Many questions are permeated by the imbalance of gender relation involved in this dynamic with quality familiar planning access, the way they appropriate information received and the quality of pre and postnatal treatment. At long last, the way which the women practice the sexuality and the motherhood is inseparable from the social construction of female identity, construction that determines the practices related to the attention to womens health that could interfere in the choices and care with health and in the search for assistance.

Sexual expression is a natural act that occurs across the life course, unrestricted by age or physical location. Regardless if a person is 75 and residing in an assisted living facility, sex is a facet of life. Although sexual activity may slow as individuals age, interest in sex does not (Langer, 2009). Older adults maintain healthy sexual desires, yet face unique challenges when it comes to sexual expression and sexual health, which can be further complicated within the margins of a community living facility (i.e., assisted living, residential care, and nursing homes). Aside from the physiological changes that occur in mid-to-late life (e.g., menopause, erectile dysfunction), the older adult population faces growing rates of sexually transmitted infections (Centers for Disease Control and Prevention, 2017), particularly in community living facilities (Warso, 2015). Sexual assault and abuse is another issue facing community living facilities, as well as ambiguous or nonexistent policies that support and protect the rights of older persons to express themselves in a sexual manner (Connoll et al, 2012). Mystification surrounding sex in later life further compounds these issues. Moreover, a plethora of misinformation underscores societal taboos and myths surrounding sexuality and its prevalence in later life, the physical and cognitive changes that occur in later life, and the attitudes and biases (of care workers and residents) involving sexual expression of older adults residing in community living facilities. A current review of the research points to more education needed that incorporates a lifespan approach and attends to older adults in community living facilities (Langer, 2009; Villar, Fabà, Serrat, & Celdrán, 2015). Creating an environment that supports open discussion of safer sex practices, as well as encouragement (and normalization) of healthy sexual expression, can lead to an improvement in the overall wellbeing of residents living at these facilities (Syme, 2017). The current project takes a look at the preliminary stages of developing a sexual health forum for seniors residing in an assisted living facility in northern Louisiana. This project was undertaken by an undergraduate sexual health research team comprised of students majoring in Family and Child Studies or Psychology, and/or minoring in Gerontology. The presentation will detail strategies for creating a forum for seniors, highlighting successes and challenges in navigating limited research on sexuality in late life and program development targeting older adults, as well as community standards surrounding sexual health and expression. Additionally, this presentation will offer reflexive activities for educators and practitioners addressing sexual health in aging populations, particularly in residential community living facilities.

American Indian and Alaska Native (AI/AN) youth are disproportionally burdened by high rates of sexually transmitted infections and teen pregnancy, heightening their need for sexual health interventions that are aligned to their unique culture and social context. Media technologies, including the Internet, cell phones, and video games, offer new avenues for reaching adolescents on a wide range of sensitive health topics. While several studies have informed the development of technology-based interventions targeting mainstream youth, no such data have been reported for AI/AN youth. To fill this gap, I: a) quantified media technology use in a select group of AI/AN teens and young adults living in Pacific Northwest tribes and urban communities; b) identified patterns in their health information-seeking and media preferences; and c) worked with local tribes and partners to develop recommendations for designing culturally-appropriate technology-based interventions targeting Native adolescents. This research included: a) an anonymous, paper-based survey of over 400 AI/AN youths age 13-21 years; b) a systematic review of technology-based sexual health interventions; and c) a variety of community-based participatory research strategies to analyze findings, prioritize options, and generate recommendations for designing interventions that align with the culture, needs, and organizational capacities of the tribes in the Pacific Northwest. Technology use was exceptionally common and diverse among survey respondents, mirroring patterns reported by teens in the general population. Seventy-five percent of AI/AN youth reported using the Internet, 78% reported using cell phones, and 36% reported playing video games on a daily or weekly basis. Thirty-five percent reported that they would feel most comfortable getting sexual health information from the Internet, and 44% reported having done so in the past. Youth expressed interest in a wide array of interactive media features, and culturally-specific content that holistically encompassed their wide-ranging health interests and concerns. Tribal health educators expressed particular interest in adapting Internet-based skill-building modules and informational websites, and teens expressed interest in websites and videos. These findings are now being used by the Northwest Portland Area Indian Health Board to inform the development and adaptation of culturally-appropriate interventions targeting AI/AN youth in the Pacific Northwest.

The number of adults aged 65 years and over has been rising quickly, as has the rate of new onset sexually transmitted diseases within this population. Discussions of sexual health between physicians and older adults are currently lacking in frequency and effectiveness. Using the foundation of stereotype embodiment theory, the purpose of this study was to identify the factors that predict frequency of discussing sexual health with older adult patients. A comparative sample of geriatric physicians and family practitioners completed 2 researcher-developed questions and the Sexual Health Care Scale-Attitude tool that assessed their stereotype beliefs toward discussing sexual health with older adults using the 4 subscales--personal, patient, environmental, and colleague--and the frequency with which they discussed sexual health with their older adult patients. It was hypothesized that non-ageist attitudes would increase the frequency of discussions, and increase the personal factors, such as comfort level, of having such discussions. Multiple regression analysis and the chi-square test were used in data analysis. Frequency of sexual health discussions with older adult patients was dependent upon the physician type, age and gender, and how well the physician believed he or she had been educated to discuss sexual health with older adults. Comparatively, the geriatric physicians had more frequent discussions of sexual health with older adults than the family practitioners. The implications for social change include identifying the need for more specialized physician training in discussing sexual health with older adults to improve overall physical and emotional well-being of older adults and the study's recommendations for future research.

<p>Attityder och beteende i ungdomsåren vad gäller sexualitet kan ha stor betydelse för hur den sexuella hälsan utvecklas. Ungdomsmottagningen är en betydelsefull arena för att förebygga sexuellt överförbara infektioner och oönskade graviditeter samt för att främja ungas sexuella hälsa i helhet. Undersökningen har utförts i samråd med och på uppdrag av Landstinget i Jönköpings län. Syftet med studien var att undersöka ungdomsmottagningarnas verksamhet i Jönköpings län och finna förslag till underlag för att kvalitetssäkra ungdomsmottagningarna i länet. Enkätundersökningen baserades på Socialstyrelsens förslag på indikatorer och Föreningen för Sveriges Ungdomsmottagningars (FSUM) rekommendationer för ungdomsmottagningars verksamhet. Resultatet visade på variationer gällande tillgänglighet och personalresurser. Relevanta arbetsområden berörs men det saknas strukturerade arbetsmetoder och underlag för uppföljning. För att få ytterligare kunskaper och djupare förståelse om enskilda mottagningars behov samt behov i respektive upptagningsområde, skulle en kvalitativ studie med intervjuer av mottagningarnas personal samt ungdomar från olika delar av länet vara önskvärt. Slutsatserna var att basala kvalitetskrav bör gälla för alla mottagningar. Krav avseende personal och öppettider på länets mottagningar bör dock anpassas efter lokala behov och förutsättningar. Mottagningarna är i behov av resurser för att kunna erbjuda länets ungdomar ett likvärdigt stöd för deras sexuella hälsa.</p> / <p>Sexual attitudes and behavior in youth can be of great importance for sexual health development. Youth centers are important settings for preventing sexual transmitted infections and unwanted pregnancies and for promoting sexual health among youths in full. This study was performed in consultation with Landstinget Jönköping. The aim of the study was to examine the work of youth centers in Jönköpings County and find suggestions for quality guarantees for these centers. The survey was based on Socialstyrelsens indicators and Swedish Society for Youth Centers (FSUM) recommendations for youth centers work. The result showed a variation considering personnel resources and accessibility. The work areas are relevant but there is a lack of methods for preventive work and basic data for evaluation. To get further knowledge about separate youth centers needs, and needs in respective areas, a qualitative study is to prefer. The conclusions were that basic quality aspects should be applied for all youth centers. Demands concerning opening hours and personnel recourses should however be adjusted for local needs and conditions. The youth centers are in need of resources to offer the youth an equivalent support for their sexual health.</p>

Attityder och beteende i ungdomsåren vad gäller sexualitet kan ha stor betydelse för hur den sexuella hälsan utvecklas. Ungdomsmottagningen är en betydelsefull arena för att förebygga sexuellt överförbara infektioner och oönskade graviditeter samt för att främja ungas sexuella hälsa i helhet. Undersökningen har utförts i samråd med och på uppdrag av Landstinget i Jönköpings län. Syftet med studien var att undersöka ungdomsmottagningarnas verksamhet i Jönköpings län och finna förslag till underlag för att kvalitetssäkra ungdomsmottagningarna i länet. Enkätundersökningen baserades på Socialstyrelsens förslag på indikatorer och Föreningen för Sveriges Ungdomsmottagningars (FSUM) rekommendationer för ungdomsmottagningars verksamhet. Resultatet visade på variationer gällande tillgänglighet och personalresurser. Relevanta arbetsområden berörs men det saknas strukturerade arbetsmetoder och underlag för uppföljning. För att få ytterligare kunskaper och djupare förståelse om enskilda mottagningars behov samt behov i respektive upptagningsområde, skulle en kvalitativ studie med intervjuer av mottagningarnas personal samt ungdomar från olika delar av länet vara önskvärt. Slutsatserna var att basala kvalitetskrav bör gälla för alla mottagningar. Krav avseende personal och öppettider på länets mottagningar bör dock anpassas efter lokala behov och förutsättningar. Mottagningarna är i behov av resurser för att kunna erbjuda länets ungdomar ett likvärdigt stöd för deras sexuella hälsa. / Sexual attitudes and behavior in youth can be of great importance for sexual health development. Youth centers are important settings for preventing sexual transmitted infections and unwanted pregnancies and for promoting sexual health among youths in full. This study was performed in consultation with Landstinget Jönköping. The aim of the study was to examine the work of youth centers in Jönköpings County and find suggestions for quality guarantees for these centers. The survey was based on Socialstyrelsens indicators and Swedish Society for Youth Centers (FSUM) recommendations for youth centers work. The result showed a variation considering personnel resources and accessibility. The work areas are relevant but there is a lack of methods for preventive work and basic data for evaluation. To get further knowledge about separate youth centers needs, and needs in respective areas, a qualitative study is to prefer. The conclusions were that basic quality aspects should be applied for all youth centers. Demands concerning opening hours and personnel recourses should however be adjusted for local needs and conditions. The youth centers are in need of resources to offer the youth an equivalent support for their sexual health.

There is a paucity of research on the risk for sexually transmitted infections (STIs) and sexual behavior among general populations of men. Research with male populations predominantly has focused on those subgroups considered to be at high risk of disease transmission, such as gay and bisexual men, injection drug users, and adolescents/young adults. Considerably fewer studies have examined factors among men, in general, and heterosexual men, specifically. Therefore, I conducted analyses with a cross-national sample of adult, sexually active men in Brazil, Mexico, and the United States to investigate sexual behaviors and risk factors associated with the human papillomavirus (HPV) and other STIs. The research questions were: 1) How does sexual risk differ among men residing in Brazil, Mexico, and the US by age cohort?; 2) Do men's sexual behaviors change after being tested for HPV and other STIs?; and 3) Do men's sexual behaviors change after being informed of diagnosis with HPV and other STIs? These research questions were explored through a quantitative assessment of secondary data collected through a risk factor questionnaire administered using computer assisted self-interviewing. The study findings underscore the need for public health interventions to address STI risk and transmission among men across the lifespan. Additionally, this study revealed the potential of STI testing as an effective strategy to reduce sexual risk-taking among men. While this research identifies key issues of importance in improving men's sexual health, additional research is needed to provide an enhanced contextual understanding of socio-cultural, interpersonal, and community level factors that affect sexual behaviors and decision-making among men.

Sexual and reproductive health care have become key priorities both within developing and developed nations. Young people have been identified as particularly vulnerable to negative health outcomes. South Africa is one such example of a country that presently faces significant challenges in addressing the unmet sexual and reproductive health needs of young people. With the enormous burden of reproductive health problems and the accelerating HIV epidemic, the provision of sexual and reproductive health services remains a challenge. Though various studies highlight the importance of comprehensive services targeted at youth, there is a lack of adequate research in evaluating the extent to which health services are addressing the health needs of clients. This study aimed to address this gap by examining a health care facility for students at one of the largest tertiary institutions in KwaZulu-Natal. The core objective was to determine the extent to which the health services are responding to the sexual and reproductive needs of young people by, exploring the experiences and perspectives of service providers and young men and women in relation to comprehensive, youth-friendly sexual and reproductive health care. This was assessed using a revised version of the Bruce-Jain quality of care framework. Information for this study was obtained using quantitative and qualitative data collection methods including: an inventory of the facility and services, in-depth interviews with staff and exit interviews with 200 clients aged 18 to 24 years. The findings of the study reveal that logistical constraints hindered effective implementation of comprehensive, youth-friendly services by providers. Providers missed opportunities to provide clients with much needed information and services due to staff shortage, client overload, lack of infrastructure, and poor continuity mechanisms. HIV, STIs and unwanted pregnancies were some of the most important health issues among young people visiting the health facility. Very few young men utilised the services. Some of the key findings were that clients continue to experience barriers in interpersonal relations while many expressed the need for more information from providers. In addition, many young women still have an unmet need for contraception. Policy makers need to incorporate the needs of young clients within sexual and reproductive health initiatives. Ideally young people should be involved in the design and implementation process of comprehensive, youth-friendly health initiatives. This would form a platform for addressing the barriers that hinder health service provision. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.