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  • 1.
    Bodin, Maja
    et al.
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Holmström, Charlotta
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Plantin, Lars
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Schmidt, Lone
    Department of Public Health, University of Copenhagen, Denmark.
    Ziebe, Søren
    Fertility Clinic, Copenhagen University Hospital, Denmark.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Preconditions to parenthood: changes over time and generations2021In: Reproductive Biomedicine & Society Online, ISSN 2405-6618, Vol. 13, p. 14-23Article in journal (Refereed)
    Abstract [en]

    Reproductive decision-making and fertility patterns change with time and place, and are influenced by contemporary societal factors. In this paper, we have studied biosocial aspects of reproductive decision-making over time and generations in a Nordic setting. The aim was to explore intergenerational changes and influences on decision-making, especially regarding preconditions to first birth. Twenty-six focus group interviews were conducted in southern Sweden, including a total of 110 participants aged 17–90 years. The analysis of the interviews resulted in six themes: (i) ‘Providing security – an intergenerational precondition’; (ii) ‘A growing smorgasbord of choices and requirements’; (iii) ‘Parenthood becoming a project’; (iv) ‘Stretched out life stages’; (v) ‘(Im)possibilities to procreate’; and (vi) ‘Intergenerational pronatalism’. Our findings reflect increasing expectations on what it means to be prepared for parenthood. Despite increasing awareness of the precariousness of romantic relationships, people still wish to build new families but try to be as prepared as possible for adverse events. The findings also show how increasing life expectancy and medical advancements have come to influence people’s views on their reproductive timeline.

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  • 2.
    Bodin, Maja
    et al.
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Plantin, Lars
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Elmerstig, Eva
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    A wonderful experience or a frightening commitment? An exploration of men’s reasons to (not) have children2019In: Reproductive Biomedicine & Society Online, ISSN 2405-6618, Vol. 9, p. 19-27Article in journal (Refereed)
    Abstract [en]

    Research on reproductive decision-making mainly focuses on women's experiences and desire for children. Men included in this type of research usually represent one-half of a heterosexual couple and/or men who are involuntarily childless. Perspectives from a broader group of men are lacking. This study is based on the results of a baseline questionnaire answered by 191 men aged 20–50 years who attended two sexual health clinics in two major Swedish cities. The questionnaire included questions about sociodemographic background, reproductive history and fertility, but also two open-ended questions focusing on reasons for having or not having children. The results of these two questions were analysed by manifest content analysis and resulted in five categories: ‘(non-)ideal images’, ‘to pass something on’, ‘personal development and self-image’, ‘the relationship with the (potential) co-parent’ and ‘practical circumstances and prerequisites’. Reasons for having children were mainly based on ideal images of children, family and parenthood. Meanwhile, reasons for not having children usually concerned practical issues. The type of answer given was related to men's procreative intentions but not to background characteristics. In conclusion, men raised many different aspects for and against having children. Therefore, reproductive decision-making should not be considered a non-choice among men.

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  • 3.
    Bodin, Maja
    et al.
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Plantin, Lars
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Schmidt, Lone
    Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark..
    Ziebe, Soren
    Copenhagen Univ Hosp, Fertil Clin, Copenhagen, Denmark..
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    The pros and cons of fertility awareness and information: a generational, Swedish perspective2023In: Human Fertility, ISSN 1464-7273, E-ISSN 1742-8149, Vol. 26, no 2, p. 216-225Article in journal (Refereed)
    Abstract [en]

    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.

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  • 4. Driemeyer, Wiebke
    et al.
    Janssen, Erick
    Elmerstig, Eva
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    Welche Rolle spielt das Alter der ersten Masturbation fur die sexuelle Entwicklung?: Erfahrungen junger Erwachsener in Schweden2015In: Grenzverschiebungen des Sexuellen: Perspektiven einer jungen Sexualwissenschaft / [ed] Wiebke Driemeyer, Benjamin Gedrose, Armin Hoyer, Lisa Rustige, Psychosozial-Verlag , 2015, p. 147-163Chapter in book (Other academic)
  • 5. Driemeyer, Wiebke
    et al.
    Janssen, Erick
    Wiltfang, Jens
    Elmerstig, Eva
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    Masturbation experiences of Swedish Senior High School Students: Gender Differences and similarities2017In: Journal of Sex Research, ISSN 0022-4499, E-ISSN 1559-8519, Vol. 54, no 4-5, p. 631-641Article in journal (Refereed)
    Abstract [en]

    Research about masturbation tends to be limited to the assessment of masturbation incidence and frequency. Consequently, little is known about what people experience connected to masturbation. This might be one reason why theoretical approaches that specifically address the persistent gender gap in masturbation frequency are lacking. The aim of the current study was to explore several aspects of masturbation in young men and women, and to examine possible associations with their social backgrounds and sexual histories. Data from 1,566 women and 1,452 men (ages 18 to 22) from 52 Swedish senior high schools were analyzed. Comparisons between men and women were made regarding incidence of and age at first masturbation, the use of objects (e.g., sex toys), fantasies, and sexual functioning during masturbation, as well as about their attitudes toward masturbation and sexual fantasies. Cluster analysis was carried out to identify similarities between and differences within the gender groups. While overall more men than women reported experience with several of the investigated aspects, cluster analyses revealed that a large proportion of men and women reported similar experiences and that fewer experiences are not necessarily associated with negative attitudes toward masturbation. Implications of these findings are discussed in consideration of particular social backgrounds.

  • 6.
    Ek, Ann-Sofie
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS). Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Holmström, Charlotta
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Sexuality >1 year after brain injury rehabilitation: A cross-sectional study in Sweden2023In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 37, no 1, p. 34-46Article in journal (Refereed)
    Abstract [en]

    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.

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  • 7.
    Ek, Ann-Sofie
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Holmström, Charlotta
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Unmet Need for Sexual Rehabilitation after Acquired Brain Injury (ABI): A Cross-Sectional Study Concerning Sexual Activity, Sexual Relationships, and Sexual Rehabilitation after ABI2023In: Sexuality and disability, ISSN 0146-1044, E-ISSN 1573-6717, Vol. 41, no 2, p. 387-410Article in journal (Refereed)
    Abstract [en]

    In relation to brain injury rehabilitation, research has stressed the importance of including sexuality issues due to increased risk for sexual dysfunctions after Acquired Brain Injury (ABI). This study aims to explore experiences after non-stroke ABI concerning individual and relational aspects of sexuality, received information about sexuality at rehabilitation, and gender differences. A postal nationwide survey was conducted in Sweden, 2018-2019. The sample included individuals who had participated in brain injury rehabilitation 2014-2016, response rate 40% (250/624). Among all participants 78% had resumed sexual activity, and there was a significant difference between males (84%, 118/140) and females (69%, 76/110, p = 0.004). Among all participants, 95% reported physical intimacy as important, 80% considered sex as important on an individual level, and 91% stated sexuality as important for the relationship (no gender differences). Significantly more females (52%) than males (22%) reported that they had tried sexual aids (p = 0.000), and more males (29%) than females (16%) reported that professionals addressed sexuality issues during brain injury rehabilitation (p = 0.024). However, only a few participants were offered specific sexual counseling during brain injury rehabilitation, such as individual counseling (3%), couples counseling (2%), and group counseling (3%). To conclude, the vast majority valued both individual and relational aspects of sex and sexuality highly, and more males than females had resumed sexual activity. Few had received information about sexuality after ABI, and even fewer females compared to males reported that the issue was raised during rehabilitation. Clinical implications are discussed in relation to sexual rehabilitation.

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  • 8.
    Elmerstig, Eva
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Kropp och psyke i den sexuella upplevelsen2012In: Sexualitetsstudier / [ed] Lars Plantin, Sven-Axel Månsson, Liber, 2012, p. 46-62Chapter in book (Other academic)
  • 9.
    Elmerstig, Eva
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Samlagssmärtor hos unga kvinnor ur ett genusperspektiv2010In: Genus och kön inom medicin- och vårdutbildningar / [ed] Barbro Wijma, Goldina Smirthwaite, Katarina Swahnberg, Studentlitteratur AB, 2010, p. 389-400Chapter in book (Other academic)
  • 10.
    Elmerstig, Eva
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Sexuella problem och sexuella dysfunktioner2012In: Sexualitetsstudier / [ed] Lars Plantin, Sven-Axel Månsson, Liber, 2012, p. 235-253Chapter in book (Other academic)
  • 11.
    Elmerstig, Eva
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    Smärtsamma samlag och genusideal2016In: Ungdomar, Sexualitet och Relationer / [ed] Elisabet Häggström-Nordin, Chris Magnusson, Studentlitteratur AB, 2016, p. 221-236Chapter in book (Other academic)
  • 12.
    Elmerstig, Eva
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    Thomtén, Johanna
    Vulvar Pain: Associations Between First-Time Vaginal Intercourse, Tampon Insertion and Later Experiences of Pain2016In: Journal of sex & marital therapy, ISSN 0092-623X, E-ISSN 1521-0715, Vol. 42, no 8, p. 707-720Article in journal (Refereed)
    Abstract [en]

    This study examines associations between the first experience of vaginal intercourse/tampon insertion and later experiences of vulvar pain. The study is based on questionnaire-data from 1259 Swedish female senior high-schools students 18-22 years old. Of these, 592 women reported present vulvar pain. Present vulvar pain was associated with first-time experiences at vaginal intercourse (pain, negative experience, against will) and with pain at tampon insertion. First-time experiences were also related to temporal aspects of present vulvar pain during vaginal intercourse (at the beginning, after a while during and after). Implications of first-time experiences of vaginal intercourse for future symptoms of vulvar pain are discussed.

  • 13.
    Elmerstig, Eva
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    Wijma, Barbro
    Sandell, Kerstin
    Berterö, Carina
    Sexual interaction or a solitary action: young Swedish men’s ideal images of sexual situations in relationships and in one-night stands2014In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 3, p. 149-155Article in journal (Refereed)
    Abstract [en]

    Objective: It seems that traditional gender norms influence young women’s and men’s sexuality differently. However, little attention has been paid to ideal images of sexual situations. This study identifies young heterosexual men’s ideal images of sexual situations and their expectations of themselves in sexual situations. Study design: The present study employs a qualitative design. Twelve Swedish men (aged 16-20) participated in individual in-depth qualitative interviews. The interviews were transcribed verbatim and analysed using the constant comparative method from grounded theory. Results: Our study revealed that the young men’s conceptions of normal sexual situations were divided into two parts: sexual situations in relationships, and sexual situations in one-night stands. Their ideal image, “a balanced state of emotional and physical pleasure”, was influenced by the presence/absence of intimacy, the partner’s response, and their own performance. The greatest opportunities to experience intimacy and the partner’s response were found during sexual situations in relationships. In one-night stands, the men wanted to make a good impression by performing well, and behaved according to masculine stereotypes. Conclusion: Stereotyped masculinity norms regulate young heterosexual men’s sexuality, particularly in one-night stands. Sexual health promotion should emphasize the presence of these masculinity norms, which probably involve costs in relation to young men’s sexual wellbeing.

  • 14.
    Elmerstig, Eva
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Wijma, Barbro
    Sandell, Kerstin
    Berterö, Carina
    "Sexual pleasure on equal terms": young women's ideal sexual situations2012In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 33, no 3, p. 129-134Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify young women´s ideal images of sexual situations and expectations on themselves in sexual situations. We conducted audio-taped qualitative individual interviews with 14 women aged 14 to 20 years, visiting two youth centers in Sweden. Data were analysed with constant comparative analysis, the basis of grounded theory methodology. The women´s ideal sexual situations in heterosexual practice were characterized by sexual pleasure on equal terms, implying that no one dominates and both partners get pleasure. There were obstacles to reaching this ideal, such as influences from social norms and demands, and experiences of the partner´s “own run”. An incentive to reach the ideal sexual situation was the wish to experience the well of pleasure. Our research further accentuates the importance of finding ways to focus on the complexity of unequal gender norms in youth heterosexuality. A better understanding of these cognitions is essential and useful among professionals working with youth´s sexual health.

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  • 15.
    Elmerstig, Eva
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Wijma, Barbro
    Swahnberg, Katarina
    Prioritizing the partner’s enjoyment: a population-based study on young Swedish women with experience of pain during vaginal intercourse2013In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, no 2, p. 82-89Article in journal (Refereed)
    Abstract [en]

    Abstract The present study examines the prevalence of women who continue to have vaginal intercourse (VIC) despite pain, avoid telling the partner, and feign enjoyment. It also considers the reasons for this behavior. A sample of 1566 female senior high school students (aged 18-22 years) completed a questionnaire concerning their experiences and attitudes toward their body and sexuality. Forty-seven percent (270/576) of those women who reported pain during VIC continued to have VIC despite the pain. The most common reasons were that they did not want to spoil sex for or hurt the partner by interrupting VIC. Feigning enjoyment and not telling the partner about their pain were reported by 22% and 33% respectively. Continuing to have VIC despite pain was associated with feelings of being inferior to the partner during sex, dissatisfaction with their own sex lives, and feigning enjoyment while having pain. Pain during VIC is reported by every third young Swedish woman, and almost half of those still continue to have VIC. The major reason given is noteworthy --- prioritizing the partner’s enjoyment before their own --- and indicates that young women who continue to have VIC despite pain take a subordinate position in sexual interactions.

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  • 16.
    Elmerstig, Eva
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    Wijma, Barbro
    Årestedt, Kristofer
    Swahnberg, Katarina
    Being “good in bed”: Body concerns, self-perceptions and gender expectations among Swedish heterosexual female and male senior high school students2017In: Journal of sex & marital therapy, ISSN 0092-623X, E-ISSN 1521-0715, Vol. 43, no 4, p. 326-342Article in journal (Refereed)
    Abstract [en]

    We investigated gender differences regarding body perceptions, self-perceptions, values and expectations in sexual situations, and factors associated with expectations, among Swedish heterosexual female and male high school students. A total of 2765 students (aged 18-22) completed questionnaires. Women reported lower satisfaction with themselves and their body appearance (p<0.001), and felt more inferior to their partner (p<0.001). Men felt more superior to their partner, and felt higher expectations (p<0.001). Male sex, difficulty saying no to sex, dissatisfaction with the body, feeling inferior or superior to partner, and considering partner’s satisfaction as more important, were all associated with feeling expectations during sex.

  • 17.
    Hall, Ida Elisabet
    et al.
    Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Holmström, Charlotta
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Bodin, Maja
    Uppsala University.
    Schmidt, Lone
    Department of Public Health, University of Copenhagen.
    Ziebe, Søren
    Fertility Clinic, Copenhagen University Hospital.
    Elmerstig, Eva
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Experiences of involuntary childlessness during the COVID-19 pandemic2022In: ESC Abstract Book 2022, The European Society of Contraception and Reproductive Health (ESC) , 2022Conference paper (Refereed)
    Abstract [en]

    BACKGROUND

    The overall purpose is to investigate how the COVID-19 pandemic has affected individuals who have been or are going through assessment or treatment for involuntary childlessness, and their processes of trying to have children. Previous research on involuntary childlessness in relation to the pandemic has mainly been medical and quantitative, and there has been a lack of qualitative studies that explore the subject area on a more indepth level. The study is a project in ReproUnion, Challenge 5.

    MATERIALS AND METHODS

    In this qualitative study, we used semistructured interviews to collect data. The study includes individuals who have been or are going through assessment or treatment for involuntary childlessness in Sweden and Denmark during the pandemic. Participants were recruited from both public and private care. 26 individuals took part in the study, of which 18 women and eight men. The participants were between 24 53 years old and the sample consisted of both heterosexual and same sex couples. The interviews addressed experiences of assessment and treatment of involuntary childlessness during the COVID-19 pandemic in relation to e.g.access to care, socioeconomic factors and intimate relationships.

    RESULTS AND CONCLUSION

    The preliminary results show that the pandemic has affected the patients in many ways and made an already challenging process even more difficult.Obstacles mentioned are for example limit access to care with longer queues and uncertainty regarding when the treatment can be resumed. Many of the respondents has also suffered from the absence of partners during care visits. Furthermore, the fear of being infected by the Corona virus, which could cause the treatment to be postponed, has led to isolation and often a weaker support from family and friends. However, these negative consequences have affected patients to varying degrees, some worse than others. The results also show that the pandemic brought some positive consequences. For example, the isolation has been perceived as a relief for some as they easier could avoid being exposed to other people’s pregnancies as well as attending baptisms and baby showers.

    “It has been extremely stressful for me to hear those messages [about delays of the treatment from the clinic], as it has taken so long to get started , and, yes, I am not getting any younger. That's how I feel. For every six months that goes by, I have kind of lost a chance to get pregnant.”

    "We are young and have no underlying health problems, but we still really had to isolate ourselves, and we were very afraid that we would catch a cold or suffer from Corona so that the treatments would be cancelled. So, it was all the time that you were afraid to meet people, and you were afraid to meet your friends”

    “I think the biggest impact was that I was not allowed to accompany and that I was not allowed to participate, also in combination with this stress that you could get sick. That was probably thebiggest impact for me and my wife.”

    CONTACT

    Ida Elisabet Hall

    Research assistant, social worker, master in sexology

    Centre for Sexology and Sexuality Studies, Malmö University

    ida.hall@mau.se

  • 18.
    Hall, Ida Elisabet
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Holmström, Charlotta
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Bodin, Maja
    Uppsala university.
    Schmidt, Lone
    Department of Public Health, University of Copenhagen.
    Ziebe, Søren
    Fertility Clinic, Copenhagen University Hospital.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Experiences of involuntary childlessness during the COVID-19 pandemic2022Conference paper (Other academic)
    Abstract [en]

    BACKGROUND

    The overall purpose is to investigate how the COVID-19 pandemic has affected individuals who have been or are going through assessment or treatment for involuntary childlessness, and their processes of trying to have children. Previous research on involuntary childlessness in relation to the pandemic has mainly been medical and quantitative, and there has been a lack of qualitative studies that explore the subject area on a more indepth level. The study is a project in ReproUnion, Challenge 5.

    MATERIALS AND METHODS

    In this qualitative study, we used semistructured interviews to collect data. The study includes individuals who have been or are going through assessment or treatment for involuntary childlessness in Sweden and Denmark during the pandemic. Participants were recruited from both public and private care. 26 individuals took part in the study, of which 18 women and eight men. The participants were between 24 53 years old and the sample consisted of both heterosexual and same sex couples. The interviews addressed experiences of assessment and treatment of involuntary childlessness during the COVID-19 pandemic in relation to e.g.access to care, socioeconomic factors and intimate relationships.

    RESULTS AND CONCLUSION

    The preliminary results show that the pandemic has affected the patients in many ways and made an already challenging process even more difficult.Obstacles mentioned are for example limit access to care with longer queues and uncertainty regarding when the treatment can be resumed. Many of the respondents has also suffered from the absence of partners during care visits. Furthermore, the fear of being infected by the Corona virus, which could cause the treatment to be postponed, has led to isolation and often a weaker support from family and friends. However, these negative consequences have affected patients to varying degrees, some worse than others. The results also show that the pandemic brought some positive consequences. For example, the isolation has been perceived as a relief for some as they easier could avoid being exposed to other people’s pregnancies as well as attending baptisms and baby showers.

    “It has been extremely stressful for me to hear those messages [about delays of the treatment from the clinic], as it has taken so long to get started , and, yes, I am not getting any younger. That's how I feel. For every six months that goes by, I have kind of lost a chance to get pregnant.”

    "We are young and have no underlying health problems, but we still really had to isolate ourselves, and we were very afraid that we would catch a cold or suffer from Corona so that the treatments would be cancelled. So, it was all the time that you were afraid to meet people, and you were afraid to meet your friends”

    “I think the biggest impact was that I was not allowed to accompany and that I was not allowed to participate, also in combination with this stress that you could get sick. That was probably thebiggest impact for me and my wife.”

    CONTACT

    Ida Elisabet Hall

    Research assistant, social worker, master in sexology

    Centre for Sexology and Sexuality Studies, Malmö University

    ida.hall@mau.se

     

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    Experiences of involuntary childlessness during the Covid-19 pandemic
  • 19.
    Holmström, Charlotta
    et al.
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Plantin, Lars
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Elmerstig, Eva
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Complexities of sexual consent: young people's reasoning in a Swedish context2020In: Psychology & Sexuality, ISSN 1941-9899, E-ISSN 1941-9902, Vol. 11, no 4, p. 342-357Article in journal (Refereed)
    Abstract [en]

    Although previous research and public debate argue that partnered sexual activity is construed in terms of being consensual or not, we know little about young people’s own reasoning on sexual consent. This study aimed to investigate how sexual consent and sexual negotiations are interpreted by young people in Sweden. Forty-four female and male participants, ranging from 18–21 years old, took part in 12 focus groups, organised according to a set of vignettes. All focus groups were analysed using inductive thematic analysis. The findings illustrate the complexity of the interpretation of sexual consent. There was a clear perception among the participants that sex between two individuals is a mutual process, and that sex should be consensual, expressed either through words, body language, or both. They all stated clearly that a ‘No’ has to be respected, independently of context. However, at the same time participants expressed contradictory norms and expectations in relation to the described situations, that showed an ambivalence concerning sexual scripts and consequences of challenging these in specific situations. Reasoning concerning discrepancy between ideals and actual possibilities to act in sexual encounters indicates differences in relation to gender, age and educational background and pathways.

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  • 20.
    Holmström, Charlotta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Plantin, Lars
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Complexities of sexual consent: Young people's reasoning in a Swedish context2022In: Nuances of Sexual Consent / [ed] Malachi Willis, Routledge, 2022, p. 77-92Chapter in book (Refereed)
    Abstract [en]

    Although previous research and public debate argue that partnered sexual activity is construed in terms of being consensual or not, we know little about young people’s own reasoning on sexual consent. This study aimed to investigate how sexual consent and sexual negotiations are interpreted by young people in Sweden. Forty-four female and male participants, ranging from 18–21 years old, took part in 12 focus groups, organised according to a set of vignettes. All focus groups were analysed using inductive thematic analysis. The findings illustrate the complexity of the interpretation of sexual consent. There was a clear perception among the participants that sex between two individuals is a mutual process, and that sex should be consensual, expressed either through words, body language, or both. They all stated clearly that a ‘No’ has to be respected, independently of context. However, at the same time participants expressed contradictory norms and expectations in relation to the described situations, that showed an ambivalence concerning sexual scripts and consequences of challenging these in specific situations. Reasoning concerning discrepancy between ideals and actual possibilities to act in sexual encounters indicates differences in relation to gender, age and educational background and pathways.

  • 21. Lundin, Ulrika
    et al.
    Elmerstig, Eva
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    ”Desire? Who needs desire? Let´s just do it!”: A Qualitative study concerning sexuality and infertility at an Internet support group2015In: Sexual and Relationship Therapy, ISSN 1468-1994, E-ISSN 1468-1749, Vol. 30, no 4, p. 433-447Article in journal (Refereed)
    Abstract [en]

    There is limited information regarding everyday descriptions of experiences of sexual problems linked to childlessness. This study examines communication specific to sexual issues addressed within internet support groups focused on involuntarily childlessness. Qualitative content analysis of posts from 100 discussion threads regarding infertility and sexuality issues in the Swedish internet forum “difficult to conceive” at http://www.familjeliv.se was carried out. The findings indicate that forum participants sought one another’s support to cope with the new realities of involuntary childlessness which negatively impacted aspects of their sexuality. The posts suggested that performance anxiety adversely affected participants’ perceived sexuality, and goals shifted away from desire and pleasure and became more technical and outcome- focused. Forums revealed details of an altered self-image among both women and men, which generated a feeling of meaninglessness. The online forum constitutes an arena offering both solution-focused and emotional coping support for issues linked to infertility and sexuality. It is imperative that health information regarding infertility and sexuality uses a bio-psychosocial approach including both emotional and sexual aspects of infertility treatment, and not merely medical facts. Both women and men experiencing involuntary childlessness need anticipatory guidance regarding the adverse impact that infertility may have on their sexual functioning and behaviour.

  • 22.
    Löfgren, Charlotta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Schröder, Johanna
    Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Psychology, Medical School Hamburg, Hamburg, Germany.
    Chollier, Marie
    APHM, Marseilles University Hospital, Marseille, France.
    Mehulic, Jasmina
    Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia.
    de Graaf, Hanneke
    Rutgers, Dutch Centre of Expertise on Sexuality, Utrecht, The Netherlands.
    Klapilova, Katerina
    National Institute of Mental Health, Klecany, Czech Republic.
    Tavares, Ines
    Faculty of Psychology and Education Sciences, Center for Psychology at the University of Porto, University of Porto, Porto, Portugal.
    Briken, Peer
    Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
    Köse, Özlem
    Independent Relationship and Sex Researcher in Private Practice, Montreal, QC, Canada.
    Nobre, Pedro
    Faculty of Psychology and Education Sciences, Center for Psychology at the University of Porto, University of Porto, Porto, Portugal.
    Stulhofer, Aleksandar
    Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia.
    Changes in Intimacy and Sexuality During the COVID-19 Pandemic: A Qualitative Analysis of Data from a Survey on Partnered Individuals in Eight European Countries2023In: Sexuality & Culture, ISSN 1095-5143, E-ISSN 1936-4822, Vol. 27, no 2, p. 693-714Article in journal (Refereed)
    Abstract [en]

    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.

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  • 23.
    Löfgren-Mårtenson, Lotta
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Tornberg, Jakob
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Sex i Sydverige 2016: sexuella handlingar och livsstilar i Skåne2018Report (Other academic)
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  • 24.
    Mattsson, Kristina
    et al.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden; Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden.
    Nilsson-Condori, Emma
    Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Vassard, Ditte
    Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Schmidt, Lone
    Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Ziebe, Søren
    The Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
    Jöud, Anna
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
    Fertility outcomes in women with pre-existing type 2 diabetes-a prospective cohort study2021In: Fertility and Sterility, ISSN 0015-0282, E-ISSN 1556-5653, Vol. 116, no 2, p. 505-513, article id S0015-0282(21)00127-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study childbirth and the risk of miscarriage and infertility among women who have received a diagnosis of type 2 diabetes before the start of their reproductive journey.

    DESIGN: Register-based cohort study using the Skåne Healthcare Register SETTING: All healthcare visits for the whole population of the southernmost region in Sweden over the past 20 years PATIENT(S): All women who were aged 18-45 years between January 1, 1998 and December 31, 2019 and who received a clinical diagnosis of type 2 diabetes before their first childbirth, miscarriage, or infertility diagnosis (n = 230) were compared with a healthcare-seeking population of women without any type of diabetes, matched for calendar year and age (n = 179,434).

    INTERVENTION(S): None MAIN OUTCOME MEASURE(S): Childbirth, miscarriage, and infertility diagnosis RESULT(S): The birthrate was lower among women with type 2 diabetes (62.6% vs. 83.8%), and they were less likely to give birth (crude risk ratio [RR] = 0.73, 95% confidence interval [CI]: 0.66-0.81). They had a higher risk of experiencing a miscarriage (RR = 1.88, 95% CI: 1.50-2.36). The risk of infertility was increased (RR = 3.44, 95% CI: 2.88-4.10) as was the risk of having infertility and not giving birth (RR = 4.47, 95% CI: 3.44-5.82). All results remained the same after adjustment for polycystic ovary syndrome and obesity.

    CONCLUSION(S): Women with type 2 diabetes with onset before their reproductive journey were more often childless compared with women without diabetes and had a higher risk of experiencing both miscarriage and infertility. This patient group may be in need of targeted information regarding potential fertility issues as part of their clinical treatment.

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  • 25.
    Palm, Camilla
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS). Uppsala Univ, Dept Womens & Childrens Hlth IMHm, Uppsala, Sweden..
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Holmström, Charlotta
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Essen, Birgitta
    Uppsala Univ, Dept Womens & Childrens Hlth IMHm, Uppsala, Sweden..
    The relationship between dominant Western discourse and personal narratives of female genital cutting: exploring storytelling among Swedish-Somali girls and women2023In: Frontiers in Sociology, E-ISSN 2297-7775, Vol. 8, article id 1188097Article in journal (Refereed)
    Abstract [en]

    Introduction: A dominant narrative, referred to as “the standard tale,” prevails in popular representations about female genital cutting (FGC) that often contrast with how cut women traditionally narrate their FGC experience as meaningful in contexts where FGC is customary. However, scholarship has increasingly highlighted how global eradication campaigns and migration to countries where FGC is stigmatized provide women with new frames of understanding which may lead to a reformulation of previous experiences. This article subjects the storytelling itself to analysis and explores how participants narrate and make sense of their FGC experience in a post-migration setting where FGC is stigmatized.

    Methods: Semi-structured focus groups (9) and individual interviews (12) with Swedish-Somali girls and women (53) were conducted.

    Results: The article highlights how the participants navigate their storying in relation to "the standard tale" of FGC in their efforts to make sense of their experiences. Navigation was conducted both at an intrapersonal level through continuous identity work, and in relation to the social context in interpersonal encounters, i.e., with service providers and others, among whom the standard tale has become a truth.

    Discussion: The article places the analysis within broader discussions about anti-FGC work and considers the implications in relation to efforts to end FGC.

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  • 26.
    Palm, Camilla
    et al.
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS). Uppsala University.
    Johnsdotter, Sara
    Malmö University, Centre for Sexology and Sexuality Studies (CSS). Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA).
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Holmström, Charlotta
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Essén, Birgitta
    Uppsala University.
    Adolescent Sexual and Reproductive Health Counselling in Relation to Female Genital Cutting: Swedish Professionals' Approach to Menstrual Pain as an Empirical Example2022In: Sexuality & Culture, ISSN 1095-5143, E-ISSN 1936-4822, Vol. 26, p. 1-25Article in journal (Refereed)
    Abstract [en]

    In Sweden, as well as in an international context, professionals are urged to acquire knowledge about possible health effects of female genital cutting (FGC) in order to tackle prevention and care in relation to the practice. While professionals are guided by policies and interventions focusing on medical effects of FGC, some scholars have cautioned that many popular beliefs about health risks rest on inconclusive evidence. The way professionals understand and respond to health information about FGC has in this context largely been left unexamined. This article aims to provide a qualitative exploration of how professionals in Sweden approach adolescent sexual and reproductive healthcare encounters in relation to acquired knowledge about FGC, using menstrual pain as an empirical example. The analysis shows that there was a tendency in counselling to differentiate young migrant women's menstrual complaints from ordinary menstrual pain, with professionals understanding pain complaints either in terms of FGC or as culturally influenced. The study shows how professionals navigated their various sources of knowledge where FGC awareness worked as a lens through which young women's health complaints were understood. Biomedical knowledge and culture-specific expectations and assumptions regarding menstrual pain also informed counselling. Finally, the article discusses how FGC awareness about health risks was used constructively as a tool to establish rapport and take a history on both menstrual pain and FGC. The analysis also recognises potential pitfalls of the approaches used, if not based in well-informed policies and interventions in the first place.

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  • 27.
    Percat, Ariella
    et al.
    Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    Elmerstig, Eva
    Malmö högskola, Centre for Sexology and Sexuality Studies (CSS).
    “We should be experts, but we´re not”: Sexual counselling at the antenatal care clinic2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 14, no December, p. 85-90Article in journal (Refereed)
    Abstract [en]

    Objective: Several studies show that nurses don’t meet patients’ needs in addressing issues around sexuality and sexual health. However, little attention has been paid to midwives’ views on sexual counselling. This study explores midwives’ views and experiences on sexual counselling during antenatal care. Study design: Semi-structured interviews were conducted with nine midwives at seven different antenatal care clinics in southern Sweden. The interviews were analysed with qualitative content analysis, and script theory was used as a theoretical perspective. Results: The result showed that the midwives considered sexuality important but hard to address. Lack of time, knowledge, and encouragement from the managerial level and/or lack of counselling tools were given as reasons for not bringing it up. In addition, midwives’ insecurity turned out to be even greater with patients that deviated from the heterosexual norm or had another cultural background. Conclusion: There are cultural and interpersonal scripts in the workplace in which sexuality is not expected to be addressed. As long as these are in place, only education will not help to change issues in addressing patients’ sexuality. Organizational and managerial support along with education and opportunities for reflection and dialogue regarding sexual issues might help midwives to approach sexuality and change the cultural and interpersonal scripts.

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  • 28.
    Rasmusson, Else-Marie
    et al.
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Plantin, Lars
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    Elmerstig, Eva
    Malmö högskola, Faculty of Health and Society (HS), Department of Social Work (SA).
    ‘Did they think I would understand all that on my own?’: a questionnaire study about sexuality with Swedish cancer patients2013In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 22, no 3, p. 361-369Article in journal (Refereed)
    Abstract [en]

    This study investigates information about the sexual effects of cancer on patients, irrespective of age or diagnosis, in terms of fertility, sexual desire and sexual function. A quantitative study was conducted and the results are based on responses from 106 questionnaires. The results show that 48% of respondents had not received any information in the areas of inquiry. There was a difference between information wished for and provided, and the largest difference was in the question of whether sexual activity should be avoided. A significantly higher number of men than women received information about effects on fertility and sexual desire. The results also showed that information about sexuality needs to be taken into account to a greater extent than is presently being done.

  • 29.
    Stulhofer, Aleksandar
    et al.
    Univ Zagreb, Fac Humanities & Social Sci, Dept Sociol, Zagreb 10000, Croatia..
    Mehulic, Jasmina
    Univ Zagreb, Fac Humanities & Social Sci, Dept Psychol, Zagreb, Croatia..
    Briken, Peer
    Univ Med Ctr Hamburg Eppendorf, Ctr Psychosocial Med, Inst Sex Res Sexual Med & Forens Psychiat, Hamburg, Germany..
    Klapilova, Katerina
    Natl Inst Mental Hlth, Klecany, Czech Republic..
    de Graaf, Hanneke
    Rutgers, Utrecht, Netherlands..
    Carvalheira, Ana Alexandra
    ISPA Univ, Inst Psychol & Social Sci, Lisbon, Portugal..
    Löfgren-Mårtenson, Charlotta
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Nobre, Pedro
    Univ Porto, Fac Psychol & Educ Sci, Porto, Portugal..
    Chollier, Marie
    Assistance Publ Hop Marseille, Marseilles, France..
    Köse, Özlem
    Private Practice, Montréal, PQ, Canada.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Lancon, Christophe
    Aix Marseille Univ, CEReSS Hlth Serv & Qual Life Res, Marseilles, France..
    Plasilova, Leona
    Natl Inst Mental Hlth, Klecany, Czech Republic..
    Schroeder, Johanna
    Univ Med Ctr Hamburg Eppendorf, Ctr Psychosocial Med, Inst Sex Res Sexual Med & Forens Psychiat, Hamburg, Germany.;Med Sch Hamburg, Dept Psychol, Hamburg, Germany..
    Perceived Changes in Sexual Interest and Distress About Discrepant Sexual Interest During the First Phase of COVID-19 Pandemic: A Multi-Country Assessment in Cohabiting Partnered Individuals2022In: Archives of Sexual Behavior, ISSN 0004-0002, E-ISSN 1573-2800, Vol. 51, p. 231-246Article in journal (Refereed)
    Abstract [en]

    Due to COVID-19 pandemic, different restrictive measures in terms of physical distancing and lockdowns have been introduced in most European countries, affecting all facets of social life. Currently, little is known about how partnered individuals perceive changes in their sexual life during this complex emergency. This study explored retrospectively assessed changes in sexual interest for one's partner and levels of distress related to perceived sexual interest discrepancy during the first phase of the pandemic in a large-scale online sample of partnered individuals (n = 4813; M-age = 38.5 years, SD = 10.74) recruited between May and July 2020 in seven European Union countries and Turkey. We also examined the possible role of approach/avoidance motives for sex in reported changes in sexual interest and associated distress. Most participants (53%) reported no change in their sexual interest during the pandemic, followed by those who reported an increase (28.5%). The pattern was similar across the eight countries. Distress about discrepant sexual interest, which was only weakly related to changes in sexual interest, was significantly associated with relationship quality and emotional closeness with a partner, coping with and worrying about the pandemic, and specific motivation for sex. In contrast to avoidant and relationship-focused approach motivation, ego-focused approach motivation was related to stable sexual interest during the pandemic. The current study contributes to the understanding of the link between sexual interest and complex emergencies. Considering that the COVID-19 pandemic continues, the reported experiences and perceptions are prone to change.

  • 30.
    Åkeflo, Linda
    et al.
    University of Gothenburg.
    Dunberger, Gail
    Ersta Sköndal Bräcke University College.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Skokic, Viktor
    University of Gothenburg.
    Steineck, Gunnar
    University of Gothenburg.
    Bergmark, Karin
    University of Gothenburg.
    Cohort profile: an observational longitudinal data collection of health aspects in a cohort of female cancer survivors with a history of pelvic radiotherapy-a population-based cohort in the western region of Sweden.2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 7, article id e049479Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The study 'Health among women after pelvic radiotherapy' was conducted in response to the need for more advanced and longitudinal data concerning long-term radiotherapy-induced late effects and chronic states among female cancer survivors. The objective of this paper is to detail the cohort profile and the study procedure in order to provide a sound basis for future analyses of the study cohort.

    PARTICIPANTS: Since 2011, and still currently ongoing, participants have been recruited from a population-based study cohort including all female patients with cancer, over 18 years of age, treated with pelvic radiotherapy with curative intent at Sahlgrenska University Hospital in Gothenburg, in the western region of Sweden, which covers 1.7 million of the Swedish population. The dataset presented here consists of baseline data provided by 605 female cancer survivors and 3-month follow-up data from 260 individuals with gynaecological, rectal or anal cancer, collected over a 6-year period.

    FINDINGS TO DATE: Data have been collected from 2011 onwards. To date, three studies have been published using the dataset reporting long-term radiation-induced intestinal syndromes and late adverse effects affecting sexuality, the urinary tract, the lymphatic system and physical activity. These projects include the evaluation of interventions developed by and provided in a nurse-led clinic.

    FUTURE PLANS: This large prospective cohort offers the possibility to study health outcomes in female pelvic cancer survivors undergoing a rehabilitation intervention in a nurse-led clinic, and to study associations between demographics, clinical aspects and long-term late effects. Analysis focusing on the effect of the interventions on sexual health aspects, preinterventions and postinterventions, is currently ongoing. The cohort will be expanded to comprise the entire data collection from 2011 to 2020, including baseline data and data from 3-month and 1-year follow-ups after interventions. The data will be used to study conditions and treatment-induced late effects preintervention and postintervention.

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  • 31.
    Åkeflo, Linda
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol,Div Clin Canc Epidemiol, S-41345 Gothenburg, Sweden..
    Dunberger, Gail
    Univ Coll, Ersta Bracke Skondal, Stockholm, Sweden..
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Skokic, Viktor
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol,Div Clin Canc Epidemiol, S-41345 Gothenburg, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Pelv Canc, Stockholm, Sweden..
    Steineck, Gunnar
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol,Div Clin Canc Epidemiol, S-41345 Gothenburg, Sweden..
    Bergmark, Karin
    Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Oncol,Div Clin Canc Epidemiol, S-41345 Gothenburg, Sweden..
    Sexual health and wellbeing among female pelvic cancer survivors following individualized interventions in a nurse-led clinic2022In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 30, p. 8981-8996Article in journal (Refereed)
    Abstract [en]

    Purpose Treatment-induced sexual and intestinal dysfunctions coexist among women after pelvic radiotherapy. We aimed to explore if sexual health and wellbeing may be improved after radiotherapy following nurse-led interventions and if an association exists between improved intestinal health and sexual health. Methods A population-based cohort of women treated with pelvic radiotherapy underwent interventions at a nurse-led clinic at Sahlgrenska University Hospital, Sweden, from 2011 to 2017. Self-reported questionnaires were used, pre- and post-intervention, to compare self-reported changes in sexual health and wellbeing. A regression model was performed to explore the association between intestinal and wellbeing variables. Results Among the 260 female pelvic cancer survivors included in the study, more women reported increased than decreased satisfaction with overall sexual health post-intervention (26.0% vs. 15.3%, p = 0.035). They also reported significantly reduced superficial genital pain (25.8% vs. 13.1%, p <= 0.025), reduced deep genital pain (23.1% vs. 8.0%, p <= 0.001), increased QoL (42.7% vs. 22.4%, p < 0.001), and reduced levels of depression (43.1% vs. 28.0%, p = 0.003) or anxiety (45.9% vs. 24.4%, p < 0.001) post-intervention. We found a significant association between reduced urgency to defecate and improved satisfaction with overall sexual health (RR 3.12, CI 1.27-7.68, p = 0.004) and between reduced urgency to defecate with fecal leakage and reduced anxious mode (RR 1.56, CI 1.04-2.33, p = 0.021). Conclusion Sexual health and wellbeing can be improved by interventions provided in a nurse-led clinic focusing on physical treatment-induced late effects. Further research to optimize treatment strategies in female pelvic cancer survivors is needed.

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  • 32.
    Åkeflo, Linda
    et al.
    Department of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Bergmark, Karin
    Department of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Science, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .
    Dunberger, Gail
    Marie Cederschiöld University, Stockholm, Sweden.
    Barriers to and strategies for dealing with vaginal dilator therapy - Female pelvic cancer survivors' experiences: A qualitative study2023In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 62, article id 102252Article in journal (Refereed)
    Abstract [en]

    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.

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  • 33.
    Åkeflo, Linda
    et al.
    The Sahlgrenska Academy, University of Gothenburg.
    Elmerstig, Eva
    Malmö University, Faculty of Health and Society (HS), Department of Social Work (SA). Malmö University, Centre for Sexology and Sexuality Studies (CSS).
    Dunberger, Gail
    Ersta Sköndal Bräcke University College.
    Skokic, Viktor
    The Sahlgrenska Academy, University of Gothenburg.
    Arnell, Amanda
    The Sahlgrenska Academy, University of Gothenburg.
    Bergmark, Karin
    The Sahlgrenska Academy, University of Gothenburg.
    Sexual health and wellbeing after pelvic radiotherapy among women with and without a reported history of sexual abuse: important issues in cancer survivorship care2021In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 29, p. 6851-6861Article in journal (Refereed)
    Abstract [en]

    AIMS: Sexual abuse is a women's health concern globally. Although experience of sexual abuse and cancer may constitute risk factors for sexual dysfunction and low wellbeing, the effects of sexual abuse have received little attention in oncology care. This study aims to explore sexual health and wellbeing in women after pelvic radiotherapy and to determine the relationship between sexual abuse and sexual dysfunction, and decreased wellbeing.

    METHODS: Using a study-specific questionnaire, data were collected during 2011-2017 from women with gynaecological, anal, or rectal cancer treated with curative pelvic radiotherapy in a population-based cohort and a referred patient group. Subgroup analyses of data from women with a reported history of sexual abuse were conducted, comparing socio-demographics, diagnosis, aspects of sexual health and wellbeing.

    RESULTS: In the total sample of 570 women, 11% reported a history of sexual abuse and among these women the most common diagnosis was cervical cancer. More women with than without a history of sexual abuse reported feeling depressed (19.4% vs. 9%, p = 0.007) or anxious (22.6% vs. 11.8%, p = 0.007) and suffering genital pain during sexual activity (52% vs. 25.1%, p = 0.011, RR 2.07, CI 1.24-3.16). In the total study cohort, genital pain during sexual activity was associated with vaginal shortness (68.5% vs. 31.4% p ≤ 0.001) and inelasticity (66.6% vs. 33.3%, p ≤ 0.001).

    CONCLUSIONS: Our findings suggest that a history of both sexual abuse and pelvic radiotherapy in women are associated with increased psychological distress and sexual impairment, challenging healthcare professionals to take action to prevent retraumatisation and provide appropriate interventions and support.

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