O presente estudo teve como tema a saúde sexual da mulher. O objetivo desse estudo foi saber o que é e como se dá o cuidado para mulheres que são prostitutas. Quis lidar com esta população, considerando que assim como outras mulheres de outras profissões, estas estão suscetíveis a qualquer infecção sexualmente transmissível. Além disso, quis saber se há diferença no tratamento dado a elas em suas consultas ginecológicas, se elas recebem mais orientações quanto aos métodos preventivos de ISTs do que outras mulheres que não são prostitutas. Para tanto realizou-se pesquisa qualitativa com a utilização de entrevistas face a face, com o emprego de um roteiro semiestruturado junto a prostitutas do baixo meretrício na região central da cidade de Santos/SP. As entrevistas foram gravadas, transcritas e os depoimentos de acordo com a análise temática. Foram entrevistadas 11 mulheres com 19 a 59 anos de idade. O cuidado para essas mulheres de forma geral diz respeito ao uso do preservativo masculino com seus clientes, à realização de exames, higiene corporal, ao falar de suas profissões aos profissionais de saúde e também de suas identidades de gênero. Foi observado que as mulheres abordadas nessa pesquisa não receberam orientações específicas referentes a medidas preventivas em saúde, a maioria disse não ter recebido nenhuma informação de seus pais, escola ou serviços de saúde quanto à prevenção de gravidez e ISTs antes da primeira relação sexual. É importante ressaltar que a primeira relação sexual de três das onze entrevistadas foi fruto de estupro na infância, o que contribuiu com a falta de cuidado para com elas mesmas, desde sua infâncias. A grande maioria delas não utiliza o preservativo feminino. No entanto, foi observado que o cuidado para elas, não inclui somente o cuidado com o corpo, com o biológico. Elas em suas falas citam o cuidado com os filhos, com os pais e até presenciei uma situação de cuidado voltada a mim por uma das participantes. Além disto, também identifiquei o meu cuidado para com elas, quando as dei minha atenção e olhar. / The present study had as its theme the sexual health of women. The purpose of this study was to know what care is and how to care for women who are prostitutes. I wanted to deal with this population, considering that like other women in other professions, they are susceptible to any sexually transmitted infections. She also wanted to know if there is a difference in the treatment given to them in their gynecological consultations if they receive more guidance on STI preventive methods than other women who are not prostitutes. Qualitative research was carried out using face-to-face interviews, using a semi-structured script with low-income prostitutes in the central region of the city of Santos / SP. The interviews were recorded, transcribed and the statements according to the thematic analysis. We interviewed 11 women aged 19 to 59 years. The care for these women in general refers to the use of male condoms with their clients, to perform examinations, body hygiene, talking about their professions to health professionals and also their gender identities. It was observed that the women addressed in this research did not receive specific guidelines regarding preventive health measures, most of them said they had not received any information from their parents, school or health services regarding pregnancy prevention and STIs before the first sexual intercourse. It is important to emphasize that the first sexual relation of three of the eleven interviewees was the result of rape in childhood, which contributed to their lack of care for themselves since their infancy. The vast majority of them do not use the female condom. However, it was observed that the care for them does not only include care with the body, with the biological. They in their statements cite the care with the children, with the parents and even witnessed a situation of care directed to me by one of the participants. In addition, I also identified my care for them when I gave them my attention and look.

Expedited partner therapy (EPT) is a strategy for treating the partners of chlamydia index cases by which a health care provider gives an index patient drugs or a prescription for treatment of chlamydia to deliver to their sex partner without an intervening medical evaluation of the partner. Despite routine offer of EPT in New York City Department of Health and Mental Hygiene (DOHMH) sexual health clinics, the majority of patients who are eligible for EPT do not receive it, largely because EPT eligibility requires lab confirmation of chlamydial infection, which is lacking in situations where patients are treated for chlamydia on the same day they are tested for chlamydia (i.e., presumptive treatment). These patients become eligible for EPT after they leave the clinic and often do not return for EPT. This dissertation includes three papers: one systematic review and two original analyses. The objective of the systematic review was to synthesize existing estimates of EPT effectiveness to better understand the impact of biases on these estimates; a meta-analysis provided an aggregate estimate of the effectiveness of EPT for preventing index patient reinfection with chlamydia and/or gonorrhea. We found 6 studies that included some measure of EPT effectiveness. Meta-analysis revealed that EPT significantly reduced the risk of reinfection from chlamydia and/or gonorrhea, but it also revealed a substantial amount of heterogeneity. Systematic review revealed that inclusion of patients whose sex partners were at the clinic or already treated for infection was a common source of bias among existing estimates of EPT effectiveness. The two original analyses used data from NYC DOHMH sexual health clinics where EPT is routinely offered as patient delivered partner therapy (PDPT), a form of EPT where medication is given directly to the index patient. The objective of the first analysis was to identify predictors of presumptive treatment and predictors of being offered PDPT among patients eligible for PDPT in the NYC clinics. This analysis demonstrated that patient diagnosis as a contact to a sexually transmitted infection (STI) that would warrant treatment with azithromycin or doxycycline (termed STI contacts) was the best predictor of presumptive treatment in NYC DOHMH sexual health clinics. Patients who were not contacts to such STIs or who were STI contacts with more than one sex partner were more likely to be offered PDPT compared to patients who were STI contacts and reported ≤ 1 sex partner. Males not diagnosed as STI contacts were identified as a target population for increasing rates of PDPT offer. The objective of the last analysis was to provide an estimate of PDPT effectiveness for preventing index patient reinfection with chlamydia. This analysis was novel compared to existing estimates of EPT effectiveness in that we excluded patients whose sex partners were at the clinics at the time of chlamydia testing, treatment, or PDPT offer. We found that PDPT significantly reduced the risk of repeat chlamydial infection at both 6 months and 1 year after initial infection. This result was unchanged by multiple sensitivity analyses that assessed the validity of our estimate. In this dissertation, we were able to fill gaps in the literature regarding EPT implementation. The results may help to decrease missed opportunities for offering patients EPT and to support the continued scale-up and optimization of EPT.

Bakgrund: I Sverige blir ca 2800 kvinnor diagnostiserade med gynekologisk cancer varje år. Flera kvinnor med gynekologisk cancer får psykiska problem i samband med diagnos och behandling, och den sexuella hälsan påverkas. Efter behandling uppstår ofta fysiska förändringar på kropp och underliv, och för nästan alla kvinnor påverkar det den sexuella hälsan negativt. Information om den sexuella hälsan i samband kan hjälpa kvinnor hantera förändringarna och minska påverkan på den sexuella hälsan. Syfte: Att undersöka hur kvinnor upplever den information de får innan, under eller efter behandlingen av gynekologisk cancer angående den sexuella hälsan samt när de önskar få informationen, hur de önskar få informationen samt vilken information de önskar. Metod: Arbetet är designat som en litteraturstudie och inkluderar 13 artiklar med både kvantitativ och kvalitativ ansats. Resultat: Resultatet visar att kvinnor upplever informationen i samband med behandling för gynekologisk cancer som opersonlig, för medicinsk och ofullständig. Kvinnorna får även för lite information om de fysiska förändringar som kommer efter operationen och inget stöd för att kunna hantera dessa förändringar.  Kvinnorna känner sig sällan bekväma med att själva ta upp ämnet med personal och önskar att personalen talar med dem om sexuell hälsa. Information om följder av behandlingen önskas både fås som skriftligt och muntligt. Slutsats: Resultatet pekar på att kvinnor önskar mer information om hur behandlingen av gynekologisk cancer påverkar den sexuella hälsan. Kvinnorna vill ha information som är anpassad efter hennes behov samt att personalen behöver mer utbildning i ämnet. / Background:  In Sweden, approximately 2800 women are diagnosed with gynecological cancer each year. Several women with gynecological cancer get psychological problems in connection to diagnosis and treatment, and sexual health often affected. Surgical or conservative treatment often result in physical changes in the body and genitals, which affect the sexual health negatively. Information about sexual health before, during and after treatment can help women manage these changes and reduce the impact on the sexual health. Aim: To examine how women experience the information they receive before, during and after treatment of gynecological cancer regarding the sexual health, when they wish to receive information, how they wish to receive the information and which information they would like to receive. Method: The work is designed as a literature review and includes 13 articles with both quantitative and qualitative approaches. Results: The results show that women experience information in connection with the treatment of gynecological cancer as impersonal, too medical and incomplete. Women are given deficient information about the physical changes that come after the operation and no support to manage these changes. Women themselves rarely feels comfortable with bringing up the topic with the staff and wishes that health care-personnel would speak with them about their sexual health. Women want the information both in writing and oral. Conclusion: The results point towards that women would like more information about how the treatment of gynecological cancer affects sexual health. The women want the information to be tailored to her personal needs and that the staff needs more training on the subject.

Sexual pleasure and intimacy are fundamental and innate human needs. Individuals with physical disabilities often find it difficult to meet these needs because of such factors as impaired mobility and lack of knowledge about sexual health. People with physical disabilities are often seen as asexual and not capable of having sex, and sexuality is often not considered a concern among this population. These misconceptions can result in individuals with physical disabilities not receiving basic sex education or advice and guidance when issues arise. Not receiving this attention may impede disabled individuals' sexual potential and personal relationships. This study's focus was on the unique challenges individuals with muscular dystrophy (MD) face regarding sexual pleasure and intimacy. Humanistic psychology and the human rights theory provided the theoretical framework for this study. Using a qualitative multiple case study approach, 4 individuals with MD were asked what sexual education, if any, they received, and if they did receive sexual education, whether it met their needs. Data were analyzed using open and axial coding. Key findings were that there is an overarching theme of sexual silence and lack of sex education for people with MD. These findings can help inform efforts to provide more inclusive education for people with MD and individuals with other types of physical disabilities. Study findings contribute to social change by showing the importance of the need for more inclusive sexual education. Providing such education will better meet the basic human needs of an often undeserved and stigmatized population and end the silence that individuals with physical disabilities have regarding sexual health and intimacy.

<p>Inom området för främjande av sexuell hälsa finns en övertygelse om att självkänsla fungerar som en psykologisk immunisering mot ohälsa. Fortfarande kvarstår dock frågetecken kring såväl självkänsla, sexuell hälsa och sambandet mellan dessa. Syftet med denna studie var att utveckla ett mätinstrument för sexuell hälsa samt att klargöra huruvida det finns ett samband mellan sexuell hälsa och bassjälvkänsla bland unga vuxna. En enkätundersökning genomfördes på 75 högskolestudenter i åldrarna 18 till 30. Resultatet visade att det fanns ett starkt positivt samband mellan sexuell hälsa och bassjälvkänsla. Studien visade även att män hade högre sexuell hälsa än kvinnor och att desto oftare deltagarna hade sexuellt umgänge desto högre sexuell hälsa hade de.</p>

Inom området för främjande av sexuell hälsa finns en övertygelse om att självkänsla fungerar som en psykologisk immunisering mot ohälsa. Fortfarande kvarstår dock frågetecken kring såväl självkänsla, sexuell hälsa och sambandet mellan dessa. Syftet med denna studie var att utveckla ett mätinstrument för sexuell hälsa samt att klargöra huruvida det finns ett samband mellan sexuell hälsa och bassjälvkänsla bland unga vuxna. En enkätundersökning genomfördes på 75 högskolestudenter i åldrarna 18 till 30. Resultatet visade att det fanns ett starkt positivt samband mellan sexuell hälsa och bassjälvkänsla. Studien visade även att män hade högre sexuell hälsa än kvinnor och att desto oftare deltagarna hade sexuellt umgänge desto högre sexuell hälsa hade de.

Since the early 20th Century, epidemiological research has brought benefits and burdens to Aboriginal communities in Canada. Many First Nations, Métis, and Inuit continue to view Western research with distrust; quantitative study methods are perceived as especially inconsistent with indigenous ways of knowing. There is increasing recognition, however, that rigorous epidemiological research can produce evidence that draws attention, and potentially resources, to pressing health issues in Aboriginal communities. The thesis begins by introducing a framework for culturally safe epidemiology, from the identification of research priorities, through fieldwork and analysis, to communication and use of evidence. Drawing on a sexual health research initiative with Inuit in Ottawa as a case study, the thesis examines cognitive mapping as a promising culturally safe method to reviewing indigenous knowledge. Juxtaposing this approach with a systematic review of the literature, the standard protocol to reviewing Western scientific knowledge, the thesis demonstrates the potential for cognitive mapping to identify culturally safe spaces in epidemiological research where neither scientific validity nor cultural integrity is compromised. Modern epidemiology and indigenous knowledge are not inherently discordant; many public health opportunities arise at this interface and good science must begin here too.

Since the early 20th Century, epidemiological research has brought benefits and burdens to Aboriginal communities in Canada. Many First Nations, Métis, and Inuit continue to view Western research with distrust; quantitative study methods are perceived as especially inconsistent with indigenous ways of knowing. There is increasing recognition, however, that rigorous epidemiological research can produce evidence that draws attention, and potentially resources, to pressing health issues in Aboriginal communities. The thesis begins by introducing a framework for culturally safe epidemiology, from the identification of research priorities, through fieldwork and analysis, to communication and use of evidence. Drawing on a sexual health research initiative with Inuit in Ottawa as a case study, the thesis examines cognitive mapping as a promising culturally safe method to reviewing indigenous knowledge. Juxtaposing this approach with a systematic review of the literature, the standard protocol to reviewing Western scientific knowledge, the thesis demonstrates the potential for cognitive mapping to identify culturally safe spaces in epidemiological research where neither scientific validity nor cultural integrity is compromised. Modern epidemiology and indigenous knowledge are not inherently discordant; many public health opportunities arise at this interface and good science must begin here too.

Kvinnans kropp förändras i samband med graviditet och barnafödande. Detta kan leda till sexuell ohälsa första tiden som nybliven mamma. Det är viktigt att barnmorskor kan identifiera och våga diskutera de problemen som kan finnas för att kunna hjälpa kvinnan. Syftet med studien var att belysa faktorer som kan påverka kvinnors upplevelse av sitt sexualliv efter genomgången vaginal förlossning. Metoden är en litteraturstudie som har utförts med en kvalitativ ansats. Artiklarna hade både kvalitativa och kvantitativa ansatser vilket gav studien både djup och bredd. I resultatet framkom att kvinnor funderade över hur deras sexuella samliv påverkades efter vaginal förlossning. De kroppsliga förändringar kvinnan genomgick hade betydelse för hennes upplevelse av sitt sexualliv. Det sexuella samlivet påverkades i negativ riktning av trötthet. Smärta vid samlag hade oftast lagt sig efter tre till sex månader, medan nedsatt lust kunde hålla i sig upp till ett och ett halvt år. Dessa faktorer ledde till att frekvensen samlag minskade. Detta kunde bli ansträngande för den parrelationen kvinnorna levde i då behovet av sexuellt umgänge ofta var ojämnt mellan kvinna och man. Resultatet visade att barnmorskor endast berörde ämnet sexualitet genom att ge kvinnan recept på preventivmedel. Barnmorskor bör aktivt fråga kvinnan om besvär med sexuallivet för att underlätta rollen som nybliven mamma, kvinna och älskarinna.

<p>Kvinnans kropp förändras i samband med graviditet och barnafödande. Detta kan leda till sexuell ohälsa första tiden som nybliven mamma. Det är viktigt att barnmorskor kan identifiera och våga diskutera de problemen som kan finnas för att kunna hjälpa kvinnan. Syftet med studien var att belysa faktorer som kan påverka kvinnors upplevelse av sitt sexualliv efter genomgången vaginal förlossning. Metoden är en litteraturstudie som har utförts med en kvalitativ ansats. Artiklarna hade både kvalitativa och kvantitativa ansatser vilket gav studien både djup och bredd. I resultatet framkom att kvinnor funderade över hur deras sexuella samliv påverkades efter vaginal förlossning. De kroppsliga förändringar kvinnan genomgick hade betydelse för hennes upplevelse av sitt sexualliv. Det sexuella samlivet påverkades i negativ riktning av trötthet. Smärta vid samlag hade oftast lagt sig efter tre till sex månader, medan nedsatt lust kunde hålla i sig upp till ett och ett halvt år. Dessa faktorer ledde till att frekvensen samlag minskade. Detta kunde bli ansträngande för den parrelationen kvinnorna levde i då behovet av sexuellt umgänge ofta var ojämnt mellan kvinna och man. Resultatet visade att barnmorskor endast berörde ämnet sexualitet genom att ge kvinnan recept på preventivmedel. Barnmorskor bör aktivt fråga kvinnan om besvär med sexuallivet för att underlätta rollen som nybliven mamma, kvinna och älskarinna.</p>