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1.  Sexual dysfunction among Ghanaian men presenting with various medical conditions 
Several medical conditions can affect and disrupt human sexuality. The alteration of sexuality in these medical conditions often hinder effective communication and empathy between the patients and their sexual partners because of cultural attitudes, social norms and negative feelings such as anxiety and guilt. Validated and standardized sexual inventories might therefore help resolve this problem. The objective of this cross-sectional study was to obtain data on the prevalence of male sexual dysfunction (SD) among Ghanaians with various medical conditions residing in Kumasi.
The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was administered to 150 Ghanaian men with various medical conditions between 19 and 66 years old (mean ± standard deviation: 40.01 ± 12.32 years) domiciled in the Kumasi metropolis.
Out of the total 150 questionnaires administered, 105 (70.0%) men returned the questionnaires. Questionnaires from 3 men were incomplete, leaving 102 complete and evaluable questionnaires, indicating a 68.0% response rate. Of the remaining 102 men, 88.2% were married, 70.6% had attained higher education, 88.2% were non-smokers. Whereas 54.9% were engaged in exercise, 61.8% indulged in alcoholic beverages. The prevalence of the various medical conditions include: diabetes (18%), hypertension (24.5%), migraine (11.8%), ulcer (7.8%), surgery (6.9%), STD (3.9) and others (26.5%). The prevalence of SD among the respondents in the study was 59.8%. The highest prevalence of SD was seen among ulcer patients (100%), followed by patients who have undergone surgery (75%), diabetes (70%), hypertension (50%), STD (50%) and the lowest was seen among migraine patients (41.7%).
SD rate is high among Ghanaian men with medical conditions (about 60%) and vary according to the condition and age.
PMCID: PMC2964537  PMID: 20942960
2.  Incidence of sexual dysfunction: a prospective survey in Ghanaian females 
Sexuality is a complex phenomenon that is being influenced by psychological as well as physiological factors. Its dysfunction includes desire, arousal, orgasmic and sex pain disorders. The present study aimed to assess the incidence of sexual dysfunction (SD) and related risk factors in a cohort of Ghanaian women.
The Golombok Rust Inventory of Sexual Satisfaction (GRISS) was administered to 400 healthy women between 18 and 58 years old (mean +/- SD: 30.1 +/- 7.9) domiciled in the Kumasi metropolis.
The response rate was 75.3% after 99 were excluded. Of the remaining 301 women, 50% were engaged in exercise, 26.7% indulge in alcoholic beverages and only 2% were smokers. A total of 62.1% of the women had attained high education, whilst, 28.9% were married. After logistic regression analysis, alcohol emerged (OR: 2.0; CI: 1.0 - 3.8; p = 0.04) as the main risk factor for SD. The overall prevalence of SD in these subjects was 72.8%. Severe difficulties with sexual function were identified in 3.3% of the studied population. The most prevalent areas of difficulty were anorgasmia (72.4%), sexual infrequency (71.4%), dissatisfaction (77.7%), vaginismus (68.1%), avoidance of sexual intercourse (62.5%), non-sensuality (61.5%) and non-communication (54.2%). Whereas 8% had severe difficulties with anorgasmia, only 6% had severe difficulties with vaginismus.
SD affects more than 70% of Ghanaian women who are sexually active. Alcohol significantly influences sexual activity.
PMCID: PMC2936896  PMID: 20809943
3.  Determinants of sexual dysfunction among clinically diagnosed diabetic patients 
Diabetes mellitus is a chronic disease that can result in various medical, psychological and sexual dysfunctions (SD) if not properly managed. SD in men is a common under-appreciated complication of diabetes. This study assessed the prevalence and determinants of SD among diabetic patients in Tema, Greater Accra Region of Ghana.
Sexual functioning was determined in 300 consecutive diabetic men (age range: 18-82 years) visiting the diabetic clinic of Tema General Hospital with the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire, between November, 2010 and March, 2011. In addition to the socio-demographic characteristics of the participants, the level of glycosylated haemoglobin, fasting blood sugar (FBS) and serum testosterone were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study.
Out the 300 participants contacted, the response rate was 91.3% after 20 declined participation and 6 incomplete data were excluded All the respondents had at least basic education, 97.4% were married, 65.3% were known hypertensive, 3.3% smoked cigarettes, 27% took alcoholic beverages and 32.8% did some form of exercise. The 69.3% SD rate observed in this study appears to be related to infrequency (79.2%), non-sensuality (74.5%), dissatisfaction with sexual acts (71.9%), non-communication (70.8%) and impotence (67.9%). Other areas of sexual function, including premature ejaculation (56.6%) and avoidance (42.7%) were also substantially affected. However, severe SD was seen in only 4.7% of the studied population. The perceived "adequate", "desirable", "too short" and "too long intra-vaginal ejaculatory latency time (IELT) are 5-10, 5-10, 1-2 and 15-30 minutes respectively. Testosterone correlates negatively with glycated haemoglobin (HBA1c), FBS, perceived desirable, too short IELT, and weight as well as waist circumference.
SD rate from this study is high but similar to that reported among self-reported diabetic patients in Kumasi, Ghana and vary according to the condition and age. The determinants of SD from this study are income level, exercise, obesity, higher perception of "desirable" and "too short" IELT.
PMCID: PMC3118328  PMID: 21612653
4.  Sexual Risk Behaviour Among HIV-Positive Persons in Kumasi, Ghana 
Ghana Medical Journal  2012;46(1):27-33.
To assess the prevalence and predictors of sexual risk behaviours among HIV-positive individuals in clinical care in Kumasi, Ghana.
Cross-sectional survey of 267 (43 males and 224 females) HIV-positive individuals attending Kumasi South Regional Hospital.
An interviewer-administered questionnaire was used to asses demographic and health characteristics, HIV/AIDS knowledge, attitudes, and beliefs and sexual risk behaviours.
Forty-four percent of the sample reported having sex after testing positive for HIV. Of the 175 participants with regular sex partners, 24% had HIV-positive partners. Majority (67%) had HIV-negative partners (serodiscordant couples) or partners of unknown status. More than half (51%) of the study population with regular sex partners reported that they had unprotected anal or vaginal sex. Participants who scored < 50% on the HIV/AIDS knowledge scale were 90% less likely to have used condoms during their last sexual intercourse. Disclosure of HIV status was associated with protective patterns of condom use (OR=2.2; 95% CI: 1.3–12.9). Participants on ARV were 80% less likely to have used condoms during the last sexual intercourse (OR=0.2; 95% CI: 0.04–0.6).
The high rates of sexual risk behaviour among HIV-positive individuals in this sample place others at risk of HIV infection. It also places these HIV positive individuals at risk for infection with sexually transmitted infections and super-infection with other HIV strains. These findings highlight the need to integrate HIV prevention in routine medical care in Ghana.
PMCID: PMC3353501  PMID: 22605886
HIV-seropositivity; sexual behaviour; Ghana; antiretroviral therapy; condom use
5.  Association between metabolic syndrome and sexual dysfunction among men with clinically diagnosed diabetes 
The worldwide epidemic of diabetes and obesity has resulted in a rapid upsurge in the prevalence of metabolic syndrome (MetS). MetS makes the individual liable to endothelial dysfunction which can initiate sexual dysfunction (SD). This study assessed the association between MetS and SD among clinically diagnosed diabetic subjects in Tema, Greater Accra Region of Ghana.
Sexual functioning was assessed using Golombok Rust Inventory of Sexual Satisfaction in 300 consecutive diabetic men visiting the diabetic clinic of Tema General Hospital between November, 2010 and March, 2011. Anthropometric data including waist and hip circumference as well as blood pressure were measured. The levels of fasting blood glucose and serum lipid profile were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study.
The response rate was 91.3% out of the 300 subjects recruited for the study. Those with SD were significantly older and had diabetes for a longer period as compared to those without SD. The prevalence of MetS as defined by the various criteria was 78.8%, 43.4% and 51.8% for WHO, NCEP ATP III and IDF respectively. Central obesity (p = 0.0482) and raised blood pressure (p = 0.0309) are the significant MetS components when the studied population was stratified according to sexual functioning. Generally, SD as well as its sub-scales correlate positively with age, blood pressure, duration of diabetes and MetS score. Whereas TC and LDL-c correlated positively with non-communication, TG correlates positively with avoidance and infrequency.
SD and its sub-scales have a direct relationship with duration of diabetes, blood pressure and MetS score from this study. Central obesity and raised blood pressure seem to be the link between MetS and SD among this clinically diagnosed diabetic subjects.
PMCID: PMC3733639  PMID: 23895401
6.  Sex and relationships for HIV positive women since HAART: a quantitative study 
Sexually Transmitted Infections  2005;81(4):333-337.
Objective: To investigate current levels of sexual activity, enjoyment, condom use, and other factors affecting sexual behaviour in a sample of women living with HIV.
Method: Participants were self selected. A cross sectional design using semi-structured questionnaires was employed. 82 HIV positive women completed questionnaires asking about demographics, relationships, sexual behaviour, and safer sex practices. The Hospital Anxiety and Depression Scale (HADS) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) were administered.
Results: 28% of women had had no sexual partners since diagnosis. Mean time diagnosed was 69 months, range 4–191 months. Time since diagnosis was not associated with having had a sexual partner. 59% of women had a current sexual partner, half reporting intercourse in the past month. Infrequent sex (84%), avoidance (84%), non-communication (69%), and dysfunction (60%) were among the most prevalent sexual difficulties. Endorsement of HIV impaired sexual enjoyment was associated with reduced sexual frequency (p = 0.006) and sexual dysfunction (p = 0.042). Sexual dissatisfaction was associated with infrequency of sex (p = 0.037), avoidance (p = 0.02), and non-communication (p = 0.032). Clinically significant levels of anxiety and depression were reported in 60% and 38% of cases, respectively. Depression was associated with avoidance of sex and higher total GRISS scores (p = 0.006 and p = 0.042). 60% of respondents stated that they "always" used condoms; a trend was observed between reduced condom use and higher levels of depression and anxiety (p = 0.09 and p = 0.06, respectively).
Conclusion: Sexual difficulties, including abstinence, were prevalent in this sample indicating the potential for interventions addressing the psychosexual needs of HIV positive women and their partners.
PMCID: PMC1745005  PMID: 16061542
7.  Prevalence of Genital Chlamydia and Gonococcal Infections in at Risk Women in the Kumasi Metropolis, Ghana 
Ghana Medical Journal  2010;44(1):21-24.
To study the prevalence of genital chlamydia and gonococcal infections in women at risk of acquiring sexually transmitted infections in the Kumasi metropolis, Ghana.
Structured interviews and clinical examination of participants and obtaining vaginal swabs to test for gonorrhoea and chlamydia infections.
Women aged between 18–35 years (inclusive) with a history of having at least 3 sexual acts per week and having had at least 2 sex partners in the previous 3 months and were willing to be part of the study.
One thousand and seventy (1070) women participated in the study. Genital chlamydia infection was found in 4.8% of participants whilst gonococcal infection was found in 0.9% of participants.
The prevalence of genital chlamydia and gonococcal infections was low in these at-risk women. The prevalence is also lower than reported in other female populations in the country.
PMCID: PMC2956315  PMID: 21326987
Chlamydia trachomatis; Neisseria gonorrhoeae; at-risk women; Kumasi metropolis
8.  Sexual well being in parkinsonian patients after deep brain stimulation of the subthalamic nucleus 
Objectives: To evaluate changes in sexual well being in a group of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN).
Methods: 31 consecutive patients with Parkinson's disease (21 men and 10 women), bilaterally implanted for DBS of STN, were evaluated one month before and 9–12 months after surgery. Sexual functioning was assessed using a reduced form of the Gollombok Rust inventory of sexual satisfaction (GRISS). Depression (Beck depression inventory) and anxiety (STAI-X1/X2) were also evaluated. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease were analysed.
Results: While no modifications were found in female patients, male patients reported slightly but significantly more satisfaction with their sexual life after DBS of STN. When only male patients under 60 years old were considered, a greater improvement in sexual functioning was found, though still small. Modifications in depressive symptoms and anxiety, as well as duration of the disease, reduction in LEDD, and improvement in the severity of disease, showed no relation with changes in sexual functioning after DBS of STN.
Conclusions: DBS of STN appears to affect sexual functioning in a small but positive way. Male patients with Parkinson's disease, especially when under 60, appeared more satisfied with their sexual well being over a short term follow up period.
PMCID: PMC1739238  PMID: 15314111
9.  Sexually transmitted disease among married Zambian women: the role of male and female sexual behaviour in prevention and management. 
Genitourinary Medicine  1997;73(6):555-557.
OBJECTIVES: Few studies have evaluated the relation between male and female sexual behaviour and STD among married African women. The objectives of this study were to identify male and female sexual behaviour associated with female STD, and to explore whether incorporating male and female sexual behaviour and male symptoms can improve algorithms for STD management in married African women. METHODS: 99 married couples with one symptomatic member (58 males, 41 females) attending an STD clinic in Lusaka, Zambia were interviewed separately about sexual and contraceptive behaviour, and had physical examinations. Diagnostic tests for Neisseria gonorrhoeae (GC), Trichomonas vaginalis (TV), and HIV were performed. Bivariate and multivariate odds ratios for the association between sexual behaviour and STD were calculated. Predictive algorithms based on current Zambian guidelines for management of STD in women were created. RESULTS: Among women at baseline, 10% were positive for GC, 14% for TV, 52% for HIV. Female alcohol use before sex, a male's paying for sex, and a couple's having sex unprotected by condoms or spermicides were associated with female STD. Incorporation of these behaviours along with symptoms of urethral discharge and dysuria among husbands increased the predictive ability of algorithms for management of STD in women. CONCLUSIONS: The addition of male and female sexual behaviour and male STD symptoms to diagnostic algorithms for female STD should be explored in other settings. Both husbands' and wives' behaviour independently predict STD in these women; risk reduction programmes should target both men's and women's sexual behaviour.
PMCID: PMC1195947  PMID: 9582483
10.  Neurologic Factors in Female Sexual Function and Dysfunction 
Korean Journal of Urology  2010;51(7):443-449.
Sexual dysfunction affects both men and women, involving organic disorders, psychological problems, or both. Overall, the state of our knowledge is less advanced regarding female sexual physiology in comparison with male sexual function. Female sexual dysfunction has received little clinical and basic research attention and remains a largely untapped field in medicine. The epidemiology of female sexual dysfunction is poorly understood because relatively few studies have been done in community settings. In the United States, female sexual dysfunction has been estimated to affect 40% of women in the general population. Among the elderly, however, it has been reported that up to 87% of women complain of sexual dissatisfaction. Several studies have shown that the prevalence of female sexual arousal disorders correlates significantly with increasing age. These studies have shown that sexual arousal and frequency of coitus in the female decreases with increasing age. The pathophysiology of female sexual dysfunction appears more complex than that of males, involving multidimensional hormonal, neurological, vascular, psychological, and interpersonal aspects. Organic female sexual disorders may include a wide variety of vascular, neural, or neurovascular factors that lead to problems with libido, lubrication, and orgasm. However, the precise etiology and mechanistic pathways of age-related female sexual arousal disorders are yet to be determined. In the past two decades, some advances have been made in exploring the basic hemodynamics and neuroregulation of female sexual function and dysfunction in both animal models and in human studies. In this review, we summarize neural regulation of sexual function and neurological causes of sexual dysfunction in women.
PMCID: PMC2907491  PMID: 20664775
Arousal; Clitoris; Female; Nerve; Vagina
11.  Prevalence and related factors for anorgasmia among reproductive aged women in Hesarak, Iran 
Clinics  2011;66(1):83-86.
Orgasmic dysfunction in women is characterized by persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase. Research has shown that almost two thirds of women have concerns about their sexual relationship. Sexual dysfunction has many problems for couples; some researchers found that up to 67% of divorces related to sexual disorders.
The aim of this cross‐sectional study was to assess the prevalence and related factors of anorgasmia among reproductive age Iranian women.
This study was conducted in 2006–7 in Hesarak, Karaj, Iran. A total of 1200 women were randomly recruited to the study. Sexual satisfaction questions were prepared according to the Enrich Sexual Satisfaction Questionnaire. Orgasms were assessed according to the relevant questions in the Female Sexual Function Index (FSFI) questionnaire. The data were analyzed using SPSS version 11; Chi‐square, Mann–Whitney and independent t‐test were used for statistical purposes.
This study showed that the prevalence of anorgasmia among Iranian women in Hesarak, Karaj, was 26.3%. There was a significant difference between the anorgasmic and normal orgasm groups regarding the women's age, age at marriage, duration of marriage and education during puberty (p<0.05). Some psychological factors, e.g. anxiety, fatigue, pain, feeling of guilt, anti‐masculine feelings and embarrassment in sexual relationships were higher in the anorgasmic group (p<0.001).
The results of this study showed that the prevalence of anorgasmia in Hesarak is high and most of the anorgasmic women were highly unsatisfied with their sexual relationship compared to the normal orgasm group.
The prevalence of anorgasmia among Iranian women in Hesarak, Karaj, is high and some socio‐demographic and psychological factors have a strong relationship with anorgasmia.
PMCID: PMC3044590  PMID: 21437441
Anorgasmia; Psychological factors; Sexual satisfaction; Sexual orgasm; Reproductive age
12.  Predictors of Extra-Marital Partnerships among Women Married to Fishermen along Lake Victoria in Kisumu County, Kenya 
PLoS ONE  2014;9(4):e95298.
The vulnerability of women to HIV infection makes establishing predictors of women's involvement in extra-marital partnerships critical. We investigated the predictors of extra-marital partnerships among women married to fishermen.
The current analyses are part of a mixed methods cross-sectional survey of 1090 gender-matched interviews with 545 couples and 12 focus group discussions (FGDs) with 59 couples. Using a proportional to size simple random sample of fishermen as our index participants, we asked them to enrol in the study with their spouses. The consenting couples were interviewed simultaneously in separate private rooms. In addition to socio-economic and demographic data, we collected information on sexual behaviour including extra-marital sexual partnerships. We analysed these data using descriptive statistics and multivariate logistic regression. For FGDs, couples willing to participate were invited, consented and separated for simultaneous FGDs by gender-matched moderators. The resultant audiofiles were transcribed verbatim and translated into English for coding and thematic content analysis using NVivo 9.
The prevalence of extra-marital partnerships among women was 6.2% within a reference time of six months. Factors that were independently associated with increased likelihood of extra-marital partnerships were domestic violence (aOR, 1.45; 95% CI 1.09–1.92), women reporting being denied a preferred sex position (aOR, 3.34; 95% CI 1.26–8.84) and spouse longer erect penis (aOR, 1.34; 95% CI 1.00–1.78). Conversely, women's age – more than 24years (aOR, 0.33; 95% CI 0.14–0.78) and women's increased sexual satisfaction (aOR, 0.92; 95% CI 0.87–0.96) were associated with reduced likelihood of extra-marital partnerships.
Domestic violence, denial of a preferred sex positions, longer erect penis, younger age and increased sexual satisfaction were the main predictors of women's involvement in extra-marital partnerships. Integration of sex education, counselling and life skills training in couple HIV prevention programs might help in risk reduction.
PMCID: PMC3991629  PMID: 24747951
13.  Sexual dysfnction in Iranian pregnant women 
Background: Sexuality is an important part of women’s health, quality of life, and general well-being. There are many factors influencing the female sexual function, including psychological, physiological, couple relationship, and socio-cultural factors. Pregnancy plays an important role in the sexual function and behavior of women.
Objective: This study aims to evaluate the sexual function and determine the prevalence of sexual dysfunction among women during pregnancy.
Materials and Methods: The present cross-sectional study was conducted on 257 healthy pregnant women aging between18-40 years who had attended the antenatal clinic, Paymaneh Hospital, Jahrom, Iran between April and October 2011 Female Sexual Function Index (FSFI) questionnaire was used for assessing the sexual function
Results: The mean age of the participants was reported as 26.45±4.49 years. In addition, 143, 69, and 45 subjects were in their 1st, 2nd, and 3rd trimesters, respectively. Comparison of the second and the third trimesters revealed a significant difference in the scores of all FSFI domains and the mean total FSFI score was reported as 19.9±22.45. Among the study subjects, 197 ones (79.1%) had sexual dysfunction (FSFI score <26.5), while only 52 (20.9%) had normal sexual function (FSFI score ≥26.5). The sexual dysfunction among pregnant women was rated as 23.4%, 30.5%, and 46.2% in the 1st, 2nd, and 3rd trimesters, respectively.
Conclusion: The prevalence of sexual dysfunction is high during pregnancy and reaches higher levels in the third trimester. Therefore, pregnant women and their partners need counseling about physical and psychological changes in pregnancy.
PMCID: PMC3941320  PMID: 24639782
Sexual dysfunction; Pregnancy; Female Sexual Function Index
14.  Sexual function among married menopausal women in Amol (Iran) 
Journal of Mid-Life Health  2011;2(2):77-80.
Sexual activity is an important part of the human being's life but this instinct could be influenced by some factors such as diseases, drug using, aging, and menopause. But information about that is limited.
The aim of this study is to determine the status of sexual activity among married menopausal women in Amol, Iran.
Materials and Methods:
This descriptive analytical study was conducted to describe the sexual activity and sexual dysfunction of women after menopause. Data were collected from health centers in Amol from 280 married women using a questionnaire (self-completed or by interview).
Mean age of subjects were 55.9 ± 6.02 years. 23.4% of subjects reported that their sexual intercourse had been low. 70% of subjects reported a decrease in their sexual activities after menopause. Sexual dysfunctions includes sexual desire disorder 80% arousal dysfunction 80%, orgasmic dysfunction 25%, dyspareunia 55.6%, and lack of sexual satisfaction 43.2%.
Findings revealed high percentage of sexual desire disorder and sexual arousal disorder in menopausal women. Therefore, we should have emphasis on counseling and education about sexual activities during the menopause period.
PMCID: PMC3296390  PMID: 22408336
Menopause; sexual function; women
15.  HIV Status and Gender: A Brief Report from Heterosexual Couples in Thailand 
Women & health  2012;52(5):472-484.
Although the impact of HIV falls on both partners of a married couple, the burden of stress may not be necessarily shared evenly. This study examined the relations among HIV status, gender and depressive symptoms among 152 married or cohabitating couples living with HIV in the Northern and Northeastern regions of Thailand. Depressive symptoms were assessed using a 15-item depressive symptom screening test that was developed and used previously in Thailand. Among the 152 couples, 59% were couples in which both members were people living with HIV (PLH) (seroconcordant; both PLH couples), 28% had only female members with HIV (serodiscordant; female PLH couples), and 13% had only male members with HIV (serodiscordant; male PLH couples). The prevalence of depressive symptoms between seroconcordant and serodiscordant groups was similar. However, female PLH reported significantly higher levels of depressive symptoms, regardless of their partners’ HIV status. Future prevention programs focusing on serodiscordant couples should be planned to target HIV risk, as well as emphasis on mental health, with a particular focus on women’s increased susceptibility to negative mental health outcomes.
PMCID: PMC3395241  PMID: 22747184
HIV; serodiscordant couples; depressive symptoms; Thailand
16.  Prevalence and pattern of sexual dysfunction in married females receiving antidepressants: An exploratory study 
To study the prevalence and patterns of sexual dysfunctions in female patients receiving antidepressants.
Materials and Methods:
Eighty married female patients with a diagnosis of depressive disorder, currently in remission, and receiving a single antidepressant at least for 3 months, were assessed for sexual dysfunction on female sexual function index (FSFI) scale.
Thirty four patients (42.5%) receiving antidepressants had FSFI score less than 26.55 and were considered to have sexual dysfunction. When only the domain cutoff scores were used for the whole study sample (n=80), it was found that 95% had decreased desire, 60% had decreased arousal, 37.5% had decreased lubrication, 63.8 had decreased orgasm, 55% had decreased satisfaction and 25% had pain during sexual activity.
To conclude, our study suggests that sexual dysfunction is quite prevalent in married female patients receiving antidepressants and all the domains of sexual functioning are impaired by antidepressants.
PMCID: PMC3487275  PMID: 23129962
Antidepressants; depression; sexual dysfunction
17.  Socio-demographic and Behavioral Correlates for HIV and Syphilis Infections among Migrant Men Who Have Sex With Men in Beijing, China 
AIDS care  2012;25(2):249-257.
Migrant men who have sex with men (MSM) may be particularly vulnerable to sexually transmitted infections (STIs) including HIV. This study examines the rates of HIV and syphilis infections and associated socio-demographic and behavioral factors among migrant MSM in China. Data from 307 migrant MSM were collected in Beijing, China. Blood specimens were collected to test for HIV and syphilis infections. HIV and syphilis rates were 5.9% and 20.2%, respectively. Multivariate logistic regression analyses showed that having ever been married, living a longer period in Beijing, having more sexual partners, and having a foreign MSM friend were significantly associated with HIV infection. Migrating from a rural area, experiencing one’s sexual debut at an older age, having a male as first sexual partner, having more sexual partners, and being recruited from peer outreach and social network were associated with syphilis infection. Migrant MSM in China are at high risk for HIV and syphilis infections. HIV prevention programs targeting rural migrant MSM who have been married are needed.
PMCID: PMC3563352  PMID: 22788859
China; men who have sex with men; HIV; syphilis; unprotected anal intercourse; sexual partners
18.  Lipid Disorders in Hospital Attendants in Kumasi, Ghana 
Ghana Medical Journal  2012;46(1):14-21.
Lipid disorders are common worldwide and contribute to a significant proportion of the burden of atherosclerotic cardiovascular diseases.
To determine the prevalence of lipid disorders among patients reporting at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana.
Cross-sectional study.
Directorate of Medicine and Polyclinic outpatient clinics of KATH.
A total of 424 patients, 20 years and over reporting for the first time to KATH were recruited. 77 had neither diabetes mellitus (DM) nor systemic hypertension (HPT) (controls), 94 had only DM, 109 had only HPT and 144 had both.
A questionnaire was administered after informed consent. Anthropometric measurements were then taken and blood investigations including total cholesterol (TC), high-density lipoprotein cholesterol (HDL) and triglycerides (TG) were done. Low-density lipoprotein cholesterol (LDL) was calculated using the Friedwald formula. The atherogenic index or ratio was the ratio of TC to HDL.
The prevalence of lipid abnormalities was 60% for high TC, 32% for high TG, 17% for low HDL and 61% for high LDL. The mean (± standard deviation) TC was 5.33 (± 1.31) mmol/L, mean TG was1.52 (± 0.81) mmol/L, mean HDL was 1.65 (± 0.57) mmol/L and mean LDL was 3.42 (± 1.22) mmol/L. The mean atherogenic index was 3.40 and 9% of the participants had an atherogenic index more than or equal to 5.
The prevalence of lipid disorders was high in adult patients in Kumasi and there is the need to increase awareness, screening, detection, treatment and control of these disorders.
PMCID: PMC3353506  PMID: 22605884
Lipids; Lipid Disorders; Systemic Hypertension; Diabetes Mellitus
19.  Psychosocial Impact of disclosure of HIV Serostatus in heterosexual relationship at the Lagos University teaching Hospital, Nigeria 
To determine the rate and pattern of disclosure and non disclosure of HIV serostatus among people living with HIV and the psychosocial impact of disclosure.
Participants were drawn from the adult HIV clinic at the Lagos University Teaching Hospital, Lagos, Nigeria. An interviewer-administered questionnaire was used to collect data from consenting participants that included socio-demographic information, pattern and reason for non-disclosure and the possible consequences of disclosure of HIV serostatus to their sexual partners.
Four hundred and ninety nine respondents with a mean age of 37.3 ± 9.6 years were recruited into the study. There were 157 males and 342 females. Majority of the participants were married (62%) and belonged to the low socio-economic class. Overall 61.5% (307 of 499) had disclosed their status to sex partner(s). Gender, social class and length of year of diagnosis were not associated with disclosure but number of sexual partners was strongly associated with non disclosure. P=0.0063. The most common reason for non-disclosure was fear of rejection (65%). Majority (96.7%) of those who disclosed their status had no regret and majority (81.1%) of those who had not disclosed had protected sex. After counseling, only18.8% (36 of 192) of those that had not disclosed thought that the counseling had helped them overcome the fear of disclosure and were willing to disclose.
Many people would disclose their HIV serostatus to sex partner(s). Protected sex (through the use of condom) is widely accepted in our setting.
PMCID: PMC3180759  PMID: 21969222
HIV serostatus disclosure; rejection; stigmatization; ‘confidant assisted counseling’
20.  Factors influencing fluoxetine-induced sexual dysfunction in female rats 
Behavioural brain research  2012;235(1):73-81.
Treatment with selective serotonin reuptake inhibitors, such as fluoxetine, produces sexual side effects with low sexual desire being the most prevalent effect in females. In few studies have preclinical models for such antidepressant-induced sexual dysfunction been fruitful. In the current manuscript, the effects of fluoxetine on multiple measures of female sexual motivation and sexual receptivity were examined. Ovariectomized, Fischer rats were primed with 10 μg estradiol benzoate and 500 μg progesterone. Partner preference, active investigation of the male, and measures of sexual behavior were examined after injection with 15 mg/kg fluoxetine. Factors (pretesting for sexual behavior, size of the test arena, non-contact time with a male) that differ among experiments designed to study antidepressant-induced female rat sexual dysfunction were studied.
The male preference ratio was not affected by fluoxetine treatment but active investigation of the male was reduced; lordosis behavior was inhibited and pretesting for sexual receptivity amplified fluoxetine's inhibition; size of the testing arena or non-contact experience with the male had no effect. Regardless of test condition, when given the opportunity to escape from the male, fluoxetine-treated females displayed escape behavior. Measures of male preference and active investigation, but not lordosis behavior, appeared to be affected by fluoxetine's impact on activity. The collective data provided a behavioral profile of fluoxetine-induced sexual dysfunction. These findings reinforce the value of multiple measures when attempting to model antidepressant-induced female sexual dysfunction.
PMCID: PMC3432678  PMID: 22835821
sexual receptivity; sexual motivation; partner preference; active investigation; lordosis; ovariectomized; proceptivity; escape behavior
21.  Help-seeking behaviors for female sexual dysfunction: a cross sectional study from Iran 
BMC Women's Health  2009;9:3.
Female sexual dysfunctions (FSD) are prevalent multifactor problems that in general remain misdiagnosed in primary health care. This population-based study investigated help-seeking behaviors among women with FSD in Iran.
This was a cross sectional study carried out in Kohgilouyeh-Boyer-Ahmad province in Iran. Using quota sampling all sexually active women aged 15 and over registered in primary health care delivery centers were studied. Experience of sexual problems was assessed using an ad-hoc questionnaire (Female sexual dysfunction: help-seeking behaviors survey) containing 14 items. Trained female nurses interviewed all participants after a verbal informed consent. Data were analyzed in a descriptive manner.
In all 1540 women were studied. Of these, 786 (51%) cases had experienced at least one of the FSD problems. Results showed that 35.8% of women with FSD had sought no professional help and the most reasons for not seeking help were identified as: 'time constraints' and believing that it 'did not occur to me' (39.1 and 28.5% respectively). Sixty one percent of women who sought help for FSD reported that 'doctor gave me a definite diagnosis' and 'a definite treatment plan was given' in 57% of cases.
The study findings indicated that FSD problems were prevalent and many women did not seek help for their problem. Finding 'time constraints' and believing that the problem 'did not occur to me' as the most cited reasons for not seeking help might facilitate to understand potential barriers that exist in recognition and treatment of the female sexual dysfunctions. Since FSD might have a negative impact on interpersonal relationships and women's quality of life, it seems that there is need to address the problem both at local and national primary health care services.
PMCID: PMC2651860  PMID: 19250522
22.  Diabetes and sexual dysfunction: current perspectives 
Diabetes mellitus is one of the most common chronic diseases in nearly all countries. It has been associated with sexual dysfunction, both in males and in females. Diabetes is an established risk factor for sexual dysfunction in men, as a threefold increased risk of erectile dysfunction was documented in diabetic men, as compared with nondiabetic men. Among women, evidence regarding the association between diabetes and sexual dysfunction are less conclusive, although most studies have reported a higher prevalence of female sexual dysfunction in diabetic women as compared with nondiabetic women. Female sexual function appears to be more related to social and psychological components than to the physiological consequence of diabetes. Hyperglycemia, which is a main determinant of vascular and microvascular diabetic complications, may participate in the pathogenetic mechanisms of sexual dysfunction in diabetes. Moreover, diabetic people may present several clinical conditions, including hypertension, overweight and obesity, metabolic syndrome, cigarette smoking, and atherogenic dyslipidemia, which are themselves risk factors for sexual dysfunction, both in men and in women. The adoption of healthy lifestyles may reduce insulin resistance, endothelial dysfunction, and oxidative stress – all of which are desirable achievements in diabetic patients. Improved well-being may further contribute to reduce and prevent sexual dysfunction in both sexes.
PMCID: PMC3949699  PMID: 24623985
diabetes mellitus; diabetes complications; erectile dysfunction; female sexual dysfunction; lifestyle changes
23.  The prevalence of metabolic syndrome and its predominant components among pre-and postmenopausal Ghanaian women 
BMC Research Notes  2013;6:446.
Metabolic Syndrome (MetS) is a clump of risk factors for development of type 2 diabetes mellitus and cardiovascular diseases. Menopause and age are thought to predispose women to the development of metabolic syndrome. This study aimed to estimate the prevalence of MetS and identify its predominant components among pre-and postmenopausal women in the Kumasi Metropolis, Ghana.
Two hundred and fifty (250) Ghanaian women were randomly selected for the study. They were evaluated for the prevalence of metabolic syndrome using the World Health Organization (WHO), National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF) and Harmonization (H_MS) criteria.
Out of the total subjects, 143 (57.2%) were premenopausal and 107 (42.8%) menopausal. The study population was between the ages of 20–78 years. The overall percentage prevalence of MetS were 14.4%, 25.6%, 29.2% and 30.4% according to the WHO, NCEP-ATP III, IDF and H_MS criteria, respectively. The prevalence was found to increase with age, irrespective of criterion used. Generally, MetS was significantly higher among postmenopausal women (p < 0.05 by all criteria) compared to their premenopausal cohort, but with marked inter-criteria variations. Abdominal obesity, blood pressure, fasting blood glucose, triglyceride, very low density lipoprotein cholesterol, and triglyceride-high density lipoprotein cholesterol ratio were significantly (p < 0.05) different among the two groups of women.
Central obesity, higher blood pressure and raised fasting blood glucose were the predominant components that contributed to the syndrome in Ghanaian women.
The higher prevalence of the metabolic syndrome in postmenopausal women is an indication that they are at risk of developing cardiovascular disease and type 2 diabetes. Therefore women in that group should be monitored for the two conditions and also be advised to adopt healthy lifestyles to minimize the incidence of these conditions.
PMCID: PMC3843598  PMID: 24206898
MetS; Postmenopausal; Adiposity; Premenopausal; Obesity; Cardiovascular disease
24.  Awareness and Attitudes Towards Face and Organ Transplant in Kumasi, Ghana 
Ghana Medical Journal  2013;47(1):30-34.
This study aimed to determine the level of awareness and attitudes towards face and organ transplant among the people of Kumasi, Ghana.
An observational study was employed, where participants were randomly selected for the study.
The respondents were commuters waiting to board public vehicles at the Kejetia lorry station, Bantama/Komfo Anokye Teaching Hospital taxi station, Buokrom Estate F-line lorry station, traders, and residents of Adum and Bantama, all in Kumasi.
The descriptive study was conducted from 1st February to 30th April 2009. An interview-based questionnaire was used for the convenient sample of respondents. Data obtained included: demographic profile and items covering awareness, attitudes and beliefs towards face and organ transplant.
Out of the 1020 respondents, females (53.2%) outnumbered males. The age of respondents ranged from 10 to 89 years; mean was 27.50± 2.98 years; majority (72.3%) was Christians, whilst 61.8% had gone through tertiary education. Few (33.5%) of the respondents were aware of face transplant; 70.0% and 62.1% were willing to receive a face if their face was disfigured or donate their face when dead respectively. Also, 50.6% were aware of organ transplant, whiles 59.1% would receive/donate an organ when required. Multiple regression analysis shows statistical significant association between attitudes, awareness and demographic variables listed.
Face and organ transplant were found to have a relatively low and high awareness level respectively. However, an affirmative attitude was recorded for face and organ transplant. More education on face and organ donations is needed.
PMCID: PMC3645184  PMID: 23661853
Face; Organ; Transplant; Awareness; Attitudes
25.  Predictors of Condom-use among Young Never-married Males in Nigeria 
This study examined the factors that influence condom-use among young never-married males in Nigeria. Such information can help improve the design of a prevention programme for young never-married, especially, males to reduce their vulnerability to sexually transmitted infections (STIs) and HIV/AIDS transmission. Data were derived from the 2003 Nigeria Demographic and Health Survey (NDHS). Analysis of data was restricted to 827 males aged 15-24 years, who had never married or lived together with a woman. Both descriptive and analytical methods were used for assessing the net effects of socioeconomic factors on condom-use. The analysis used logistic regression models for determining the predictors of sexual behaviour and condom-use among young never-married males in Nigeria. About 43% of the study population was sexually experienced, and the use of a condom remained low. One in five reported the use of a condom at sexual debut. Level of education, place of residence in childhood, urban/rural region, religious affiliation, economic status index, and exposure to mass media were associated with sexual experience and use of protective measures. Economic status index and mass-media exposure were associated with the use of a condom by the respondents during their last sex encounter. About two-fifths (43%) of the young unmarried Nigerian men were sexually experienced but the condom-use remained low, thus making this sub-group of Nigerian population highly vulnerable to STIs, including HIV/AIDS.
PMCID: PMC3131128  PMID: 21766563
Acquired immunodeficiency syndrome; Condom-use; HIV; Sex behaviour; Sexually transmitted infections; Youth; Nigeria

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