Aantekeningen Werkgroep 3
- Je moet uitleggen van een casus in welk systeem van Bronfenbrenner het zich bevindt
- Sexualized = expressing more sexuality. So all the images we get from implicit and explicit
sexuality
- Nancy Friday: what you fantasies is not correlated with what you want. Women fantasies
more about aggressive things (rape/sex with your dad).
Hoorcollege 4 – Sexual health: Risks and interventions
Disclaimer
- This lecture is about sexual health in the NARROW sense: risks, unwanted health outcomes.
That does not mean that this is the way to define sexual health (in fact, it’s not)
- Some parts of this lecture are exclusively or mostly relevant for penis-in-vagina sex
- I will sometimes just say ‘women’ or ‘men’, but that includes all people with wombs or
penises
- This lecture is about topics that might touch upon your personal beliefs, ethics and
experiences
What is ‘sexual risk behavior’?
- Sexual behavior that puts one at risk for adverse health outcomes. Adverse health
outcomes:
o STI (including HIV) and unwanted pregnancy (abortion/ carrying to term)
- The risk level depends on
o the outcome (e.g., oral sex is high risk for gonorrhoea, low risk for HIV)
o with whom (e.g., sex workers, casual partners)
o number of partners
- The risk is not only individual, but may also have consequences for others and the
environment (e.g., treatment of gonorrhoea may lead to resistance to antibiotics in general
population)
In General
- Dutch youth is doing relatively ‘well’, if you consider unintended pregnancy and STIs
unwanted outcomes
o Low teenage (unwanted) pregnancy rate
o Low abortion rate
o Low rate of non-users of any contraception
o Low HIV/ STI prevalence
- So, sexually healthy country in general
There are many factors on different levels that can affect HIV-related behaviour. Those factors also
interact. If you want to change this behaviour, you have to take a lot of factors into account
- Individual: risk perception, motivation, substance use, perceived social norms ect
- Interpersonal/Network: relationship power/equality/satisfaction, social support ect
- Community: Stigma, peer pressure, social/cultural norms, community organization ect
- Institutional/Health system: Peer advisors, provision of appropriate services, privacy ect
- Structural: Poverty, access to services, gender equality, public policy, funding for
interventions, education ect
,STIs (or STDs) among youth
- 15-24 y/o account for half of all new STD infections
- Why are youth at elevated risk?
o Young women’s bodies more prone to STIs
o More (casual) sex partners
o Not always getting tested (insurance, access)
o Hesitant to talk to medical professionals about sex
Adolescent pregnancy and abortion
- Compared to other countries, we have a very low rate of adolescent pregnancy rate
(currently even lower)
- Most unwanted pregnancies/ abortions happen among adult women, not adolescents, so
this does not seem a ‘typical youth/adolescent risk’
- However, adolescent pregnancy is often seen as problematic
Prevention of unwanted pregnancy: contraception
- Only two are for male, the rest is all for female. Why are many methods being developed and
promising, but never make it to the market?
Use of contraceptive methods by women by age (%)
older more IUD
Youth contraception: “Doctor, I want the pill please”
- Typically young girls start using OCP (oral contraception pill)
- They often choose the pill, because this is most common among peers
- Yet they want to be properly informed about the options and side effects
- Changing information need: Often they are not open to contraception counseling at first
consultation with the GP, but after they start use they wish they would have had more
information --> follow up recommended
Intervention programs
- 2/3 of of sex education / prevention programs are effective (Kirby et al., 2007)
, - Abstinence only → no effect (Underhill et al., 2007a)
o Just postponing having sex (eg until marriage)
- Abstinence-plus → effective (Underhill et al., 2007b)
o When they also say if you have sex, do it safely
- Safe sex promotion → highly effective, and do not lead to earlier initiation or more
promiscuity (Smoak et al., 2006)
- Peer group interventions with influential peer educators most successful in MSM (Review of
reviews, Lorimer et al., 2013)
- Attention for pleasure has added benefit (Zaneva et al., 2021)
What is the added value of incorporating pleasure in sexual health interventions? (systematic review
by Zaneva et al., 2022)
- Identified 33 interventions that incorporated pleasure
- Selected studies with standard care or matched control group to isolate role of pleasure
- Overall moderate effect of pleasure in interventions on condom use → reduction HIV/ STI
- Qualitative data: adding pleasure in interventions can have positive effects on knowledge
and attitudes
Abortion among youth
- Approx 2,300 in 2020
- Approx 60 in 2020 <16 (0,2%)
- Over 70% is >25, almost half is >30
- Over 50% already has children
- So, a very small proportion of women in abortion clinic is under 20 & it’s declining over time
Does abortion increase the risk on mental disorders?
- Prospective longitudinal cohort study (6 years)
- No increased risk on first-incidence of mental disorders in the five years post abortion
- In case women do develop MD’s, this is related to previous Mental Health, unstable
relationships and negative life events
- Women who have abortions, more often have a history of mental disorders than women
who never experienced abortion
- In other words, having mental disorders may increase the risk on unwanted pregnancy and
abortion rather than the other way around
- Many women experience the abortion as emotional/intense, but that does not mean they
will come to regret it (regret is rare) or develop mental disorders (e.g. depression)
And what about…. Carrying an unwanted pregnancy to term?
Compared to women who had abortions, women who want an abortion but are turned away:
- Have more mental health problems
- More financial issues
- More often stay with a violent partner
- More often single parent
- Less secure attachment with children
Yet…. Not all unwanted pregnancies that are carried to term have adverse consequences
- Pregnancy intentions are fluid
- Je moet uitleggen van een casus in welk systeem van Bronfenbrenner het zich bevindt
- Sexualized = expressing more sexuality. So all the images we get from implicit and explicit
sexuality
- Nancy Friday: what you fantasies is not correlated with what you want. Women fantasies
more about aggressive things (rape/sex with your dad).
Hoorcollege 4 – Sexual health: Risks and interventions
Disclaimer
- This lecture is about sexual health in the NARROW sense: risks, unwanted health outcomes.
That does not mean that this is the way to define sexual health (in fact, it’s not)
- Some parts of this lecture are exclusively or mostly relevant for penis-in-vagina sex
- I will sometimes just say ‘women’ or ‘men’, but that includes all people with wombs or
penises
- This lecture is about topics that might touch upon your personal beliefs, ethics and
experiences
What is ‘sexual risk behavior’?
- Sexual behavior that puts one at risk for adverse health outcomes. Adverse health
outcomes:
o STI (including HIV) and unwanted pregnancy (abortion/ carrying to term)
- The risk level depends on
o the outcome (e.g., oral sex is high risk for gonorrhoea, low risk for HIV)
o with whom (e.g., sex workers, casual partners)
o number of partners
- The risk is not only individual, but may also have consequences for others and the
environment (e.g., treatment of gonorrhoea may lead to resistance to antibiotics in general
population)
In General
- Dutch youth is doing relatively ‘well’, if you consider unintended pregnancy and STIs
unwanted outcomes
o Low teenage (unwanted) pregnancy rate
o Low abortion rate
o Low rate of non-users of any contraception
o Low HIV/ STI prevalence
- So, sexually healthy country in general
There are many factors on different levels that can affect HIV-related behaviour. Those factors also
interact. If you want to change this behaviour, you have to take a lot of factors into account
- Individual: risk perception, motivation, substance use, perceived social norms ect
- Interpersonal/Network: relationship power/equality/satisfaction, social support ect
- Community: Stigma, peer pressure, social/cultural norms, community organization ect
- Institutional/Health system: Peer advisors, provision of appropriate services, privacy ect
- Structural: Poverty, access to services, gender equality, public policy, funding for
interventions, education ect
,STIs (or STDs) among youth
- 15-24 y/o account for half of all new STD infections
- Why are youth at elevated risk?
o Young women’s bodies more prone to STIs
o More (casual) sex partners
o Not always getting tested (insurance, access)
o Hesitant to talk to medical professionals about sex
Adolescent pregnancy and abortion
- Compared to other countries, we have a very low rate of adolescent pregnancy rate
(currently even lower)
- Most unwanted pregnancies/ abortions happen among adult women, not adolescents, so
this does not seem a ‘typical youth/adolescent risk’
- However, adolescent pregnancy is often seen as problematic
Prevention of unwanted pregnancy: contraception
- Only two are for male, the rest is all for female. Why are many methods being developed and
promising, but never make it to the market?
Use of contraceptive methods by women by age (%)
older more IUD
Youth contraception: “Doctor, I want the pill please”
- Typically young girls start using OCP (oral contraception pill)
- They often choose the pill, because this is most common among peers
- Yet they want to be properly informed about the options and side effects
- Changing information need: Often they are not open to contraception counseling at first
consultation with the GP, but after they start use they wish they would have had more
information --> follow up recommended
Intervention programs
- 2/3 of of sex education / prevention programs are effective (Kirby et al., 2007)
, - Abstinence only → no effect (Underhill et al., 2007a)
o Just postponing having sex (eg until marriage)
- Abstinence-plus → effective (Underhill et al., 2007b)
o When they also say if you have sex, do it safely
- Safe sex promotion → highly effective, and do not lead to earlier initiation or more
promiscuity (Smoak et al., 2006)
- Peer group interventions with influential peer educators most successful in MSM (Review of
reviews, Lorimer et al., 2013)
- Attention for pleasure has added benefit (Zaneva et al., 2021)
What is the added value of incorporating pleasure in sexual health interventions? (systematic review
by Zaneva et al., 2022)
- Identified 33 interventions that incorporated pleasure
- Selected studies with standard care or matched control group to isolate role of pleasure
- Overall moderate effect of pleasure in interventions on condom use → reduction HIV/ STI
- Qualitative data: adding pleasure in interventions can have positive effects on knowledge
and attitudes
Abortion among youth
- Approx 2,300 in 2020
- Approx 60 in 2020 <16 (0,2%)
- Over 70% is >25, almost half is >30
- Over 50% already has children
- So, a very small proportion of women in abortion clinic is under 20 & it’s declining over time
Does abortion increase the risk on mental disorders?
- Prospective longitudinal cohort study (6 years)
- No increased risk on first-incidence of mental disorders in the five years post abortion
- In case women do develop MD’s, this is related to previous Mental Health, unstable
relationships and negative life events
- Women who have abortions, more often have a history of mental disorders than women
who never experienced abortion
- In other words, having mental disorders may increase the risk on unwanted pregnancy and
abortion rather than the other way around
- Many women experience the abortion as emotional/intense, but that does not mean they
will come to regret it (regret is rare) or develop mental disorders (e.g. depression)
And what about…. Carrying an unwanted pregnancy to term?
Compared to women who had abortions, women who want an abortion but are turned away:
- Have more mental health problems
- More financial issues
- More often stay with a violent partner
- More often single parent
- Less secure attachment with children
Yet…. Not all unwanted pregnancies that are carried to term have adverse consequences
- Pregnancy intentions are fluid
