Research shows that young adults with intellectual disabilities struggle to understand the social codes embedded in sexual situations. This may lead to an incomprehension of sexual consent, or when consenting to sex may lead to abuse. This qualitative study aimed to gain an in-depth understanding of sexual experiences and perceptions about sexual consent among Swedish young adults with intellectual disabilities. The data comprise 22 semi-structured interviews with young adults aged 18-35 with intellectual disabilities, thematically analyzed using sexual script theory as a theoretical framework. Four themes emerged from the analysis: Setting the sexual scene, Sexual self-awareness, Sexual communication and the necessity of clarification and Striving for a balance. The results show that the participants had a variety of sexual experiences and challenges associated with sexual consent, but also an agency that favors sexual situations. Further research is necessary to understand the complexities of sexual consent in this population.

Background Pandemics are linked with declining birth rates, but little is known about how the COVID-19 pandemic has influenced childbearing decisions. We aimed to investigate the associations between the COVID-19 pandemic and reproductive decisions, specifically to identify potential changes in the frequency of deliveries and induced abortions in Sk & aring;ne, Sweden.Methods Using the Sk & aring;ne Healthcare Register, we identified women aged 15-45 years who had at least one pregnancy-related care visit registered between 1 January 2013 and 11 November 11 2021. Deliveries and induced abortions were identified, and changes in weekly delivery and abortion counts were assessed using an interrupted time series design. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated from a Poisson regression model.Results During the study period we identified 129 131 deliveries and 38 591 abortions. Compared with the counterfactual (exposed interval assuming COVID-19 had not occurred), pandemic exposure was associated with fewer deliveries (RR 0.93; 95% CI 0.89 to 0.98). For abortions, pandemic exposure appeared to be associated with fewer abortions (RR 0.95; 95% CI 0.90 to 1.00); however, age-related differences were found. Among women aged 25 years and over, pandemic exposure was more strongly associated with fewer abortions. Contrastingly, among women aged under 25 years, abortions appeared to increase.Conclusions The COVID-19 pandemic seemed to have contributed to a decline in births in Southern Sweden. During the same period, abortions declined in women in the older age range, but contrastingly increased among younger women.

Sexual health concerns, experiences of violence, and risk-taking behaviors significantly impact various aspects of life, leading to adverse health outcomes. Unfortunately, few patients disclose these problems to healthcare providers (HCPs) due to shame and fear. While HCPs recognize the importance of addressing sexual and reproductive health related issues, time constraints, lack of knowledge, and fear of embarrassing patients often hinder thorough investigation. SEXIT (SEXual health Identification Tool) was developed to facilitate and initiate conversations about sexual health, experiences of violence, and risk-taking behaviors between youths aged 13–24 and HCPs. However, no comparable methods exist for adults. This study aimed to explore which questions professionals believe HCPs should ask adult patients. Using a Delphi methodology, 19 academic and/or clinical experts participated in two online questionnaire rounds and a web meeting. The panel identified 25 highly relevant questions covering diverse areas (e.g., sexual and gender identity, sexual satisfaction, experiences of violence, and substance use). These questions may empower adult patients to disclose sexual health concerns, enabling HCPs to comprehensively address these issues during medical history assessments. The identified questions have been incorporated into the development of the SEXIT Adult questionnaire.

Objectives: Few patients voluntarily disclose problems with sexual health, experiences of violence, and risk-taking behaviors to their health care providers. Despite health care providers being aware of the importance of these topics, few regularly address these areas in outpatient settings. This is often due to a lack of knowledge about sexual health among providers and a fear of embarrassing patients by asking questions that might be perceived as private or intrusive.To address these challenges, the SEXual health Identification Tool (SEXIT) was developed. Initially designed to identify sexual ill health, experiences of violence, and risk-taking behaviors among youth through a structured questionnaire and follow-up conversation, SEXIT has proven effective in these demographics. However, there is an absence of comparable methods tailored for adult populations.

Methods: This study aimed to identify the specific questions that health care providers should ask concerning sexual health, experiences of violence, and risk-taking behaviors in adult outpatient settings. Utilizing a modified Delphi methodology, a panel of 19 experts from clinical and academic fields was recruited.

Results: In the end, 25 questions were identified as highly relevant. These questions cover topics including sexual and gender identity, sexual satisfaction, experiences of violence, and substance use.The findings from this study provide a deeper understanding of the pertinent questions that should be integrated into medical history taking to address sexual health, experiences of violence, and risk-taking behaviors. By incorporating these questions, health care providers can bridge the knowledge gaps commonly experienced in the Sexual and Reproductive Health and Rights (SRHR) field. Moreover, this approach can remove the barriers that patients face when attempting to discuss these sensitive issues.

Conclusions: The questions identified have been included in the development of the first version of the SEXIT Adult questionnaire. This tool, along with the accompanying guidance for health care providers, is currently undergoing clinical evaluation. The implementation of SEXIT Adult holds promise for enhancing the identification and management of sexual health issues, experiences of violence, and risk-taking behaviors in adult outpatient settings, ultimately contributing to improved patient well-being.

Conflicts of Interest: There are no potential conflicts of interests.

Summary: Research shows that young adults with intellectual disabilities are eager to engage in conversations about sexuality and intimacy, but the nuances of these discussions from their own perspective remain unexplored. This study aims to understand the challenges, facilitators, and dynamics that influence these young adults' engagement in conversations about sexuality and intimacy with family, friends, and support networks. The data comprise 22 qualitative interviews with Swedish young adults aged 18-35 with intellectual disabilities.

Findings: Thematic analysis revealed four themes: (1) Sharing is caring-motivating and initiating conversations about sexuality and intimacy; (2) Safe spaces-facilitators of sexual and intimate communication; (3) Being overlooked and feeling unheard; and (4) Overprotection and self-blame. The findings show that young adults with intellectual disabilities encounter additional challenges when engaging in conversations about sexual or intimate matters with their broader support networks. Trust plays a pivotal role in determining with whom they choose to have conversations about these topics, and societal norms can impede the occurrence of crucial conversations. In the discussion, the findings are explored further guided by Ken Plummer's theoretical framework, which outlines four levels in the process of producing and consuming socially constructed sexual narratives.

Applications: These insights are vital for enhancing social work practices, informing policy development, and guiding the creation of supportive interventions that foster inclusive environments. By recognizing and addressing these barriers, professionals can better support the sexual health and well-being of young adults with intellectual disabilities, promoting their agency and self-determination in intimate matters.

PURPOSE: Vaginal changes, a frequently reported late effect among women treated with pelvic radiotherapy, can result in sexual dysfunction and distress. Women are recommended vaginal dilator therapy after completed radiotherapy; however, low adoption has been recognized. This study aims to provide insight into women's difficulties with carrying out vaginal dilator therapy and their experiences of information.

METHODS: Face-to-face, semi-structured interviews were undertaken with 12 pelvic cancer survivors in a selected sample of women with difficulties adopting the therapy. Interviews were audio-recorded, transcribed and analyzed using qualitative content analysis.

RESULTS: One overarching theme, Being unprepared, emerged from three identified categories relating to Experience of received information, Experience of performing the therapy, and Motivation to perform the therapy. The women experienced the information as unrealistic and insufficient, and requested clearer and earlier information. Bleeding, pain, fear of cancer recurrence, and recalling memories from treatments were experienced. Women described intestinal symptoms, fatigue, and feeling that the therapy was self-harm as barriers to performing the therapy. They described creating routines, breathing exercises, relaxation, pre-warming the dilator and performing therapy together with their partner as helpful strategies.

CONCLUSIONS: Careful discussion, early and clear communication, psychoeducation and supportive follow-up of vaginal changes should be integrated into cancer treatment and follow up. Healthcare professionals should be aware of potential difficulties with vaginal dilator therapy and identify women in need of extended support. Research is required to investigate interventions that suit the needs of female pelvic cancer survivors.

This qualitative study explores experiences of intimacy and sexuality during the first phase of the COVID-19 pandemic of 3357 participants from Croatia, the Czech Republic, the Netherlands, France, Germany, Portugal, Sweden, and Turkey. Data were collected through open-ended questions within a survey on sexuality during the pandemic. Based on a reflexive thematic analysis three themes occurred. The first theme No change was described by 41% when summarizing their sex life during the pandemic. The second theme Positive change was experienced by 25%, and the third theme Negative change by 21%. An overarching theme then emerged as: "Still the same trajectories, but the pandemic could be a catalyst for improved or worsened sex- life." For those intimate partnered individuals who already had problems with intimacy and sexuality before the COVID-19 pandemic it seemed to remain the same or deteriorated throughout the pandemic. For those with positive experiences of intimacy and sexuality before the COVID-19 pandemic it remained the same or improved throughout the pandemic. These findings are relevant for researchers and clinicians in developing preventive and supportive interventions in the context of crisis and social isolation.

PURPOSE: This study investigates whether Acquired Brain Injury (ABI) is associated with changes in sexual function and satisfaction and how such changes are experienced, focusing on invisible impairments after ABI.

MATERIALS AND METHODS: A study-specific questionnaire was distributed in 2018-2019. The sample included individuals aged 20-90 years diagnosed with ABI due to subarachnoid hemorrhage (SAH), trauma, infection, or anoxia (ischemic stroke and intracerebral hemorrhage excluded), who participated in brain injury rehabilitation in Sweden, 2014-2016. Chi-square and Logistic regression analyses were used.

RESULTS: The study consists of 250 participants (response rate was 40%). Among participants 78% (194/250) had resumed sexual life. Participants reporting sexual changes also experienced more consequences related to ABI. Those with decreased sexual desire (63%, 148/234) reported more ABI consequences, including decreased memory (86% vs 65%, p = 0.000), decreased concentration ability (82% vs 65%, p = 0.003), and increased tiredness (91% vs 70%, p = 0.000) compared to those with intact desire. Such consequences can be invisible to others.

CONCLUSION: Visible impairments are known to impact sexual functions and satisfaction after ABI. Our results show how invisible impairments also have a great impact. From a biopsychosocial perspective, these results imply that individuals should receive sexual rehabilitation, irrespective of ABI impairment.

Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.