CÁC BỆNH LÂY TRUYỀN BẰNG ĐƯỜNG SINH DỤC THÔNG THƯỜNG NHẤT Tỷ lệ mắc bệnh thật sự của hầu hết các bệnh lây truyền bằng đường sinh dục (sexually transmitted diseases) không được biết rõ bởi vì không phải tất cả các trường hợp đều được báo cáo. Nhìn toàn bộ, người ta ước tính rằng các bệnh lây truyền bằng đường sinh dục ảnh hưởng lên khoảng 12 triệu người ở Hoa Kỳ mỗi năm.
Intimate partner and sexual violence affect a large proportion of the population – with
the majority of those directly experiencing such violence being women and the majority
perpetrating it being men. The harm they cause can last a lifetime and span generations,
with serious adverse affects on health, education and employment.
Approach to the Patient: Erectile Dysfunction
A good physician-patient relationship helps to unravel the possible causes of ED, many of which require discussion of personal and sometimes embarrassing topics. For this reason, a primary care provider is often ideally suited to initiate the evaluation. A complete medical and sexual history should be taken in an effort to assess whether the cause of ED is organic, psychogenic, or multifactorial (Fig. 492). Initial questions should focus on the onset of symptoms, the presence and duration of partial erections, and the progression of ED.
Female Sexual Dysfunction: Treatment
General An open discussion with the patient is important as couples may need to be educated about normal anatomy and physiologic responses, including role of orgasm in sexual encounters. Physiologic changes associated with aging and/or disease should be explained. Couples may need to be reminded that clitoral stimulation rather than coital intromission may be more beneficial.
Behavioral modification and nonpharmacologic therapies should be a first step. Patient and partner counseling may improve communication and relationship strains.
Male Sexual Dysfunction: Treatment
Patient Education Patient and partner education is essential in the treatment of ED. In goaldirected therapy, education facilitates understanding of the disease, results of the tests, and selection of treatment. Discussion of treatment options helps to clarify how treatment is best offered and stratify first- and second-line therapies. Patients with high-risk lifestyle issues, such as smoking, alcohol abuse, or recreational drug use, should be counseled on the role these factors play in the development of ED.
Physiology of the Female Sexual Response
The female sexual response requires the presence of estrogens. A role for androgens is also likely but less well-established. In the CNS, estrogens and androgens work synergistically to enhance sexual arousal and response. A number of studies report enhanced libido in women during preovulatory phases of the menstrual cycle, suggesting that hormones involved in the ovulatory surge (e.g., estrogens) increase desire.
Sexual motivation is heavily influenced by context, including the environment and partner factors.
Funders and lawmakers are increasingly requiring that adolescent pregnancy and
STI/HIV prevention programs be based on effective prevention strategies to be considered
for funding. Moreover, for funding to continue, programs are now generally
expected to document their own effectiveness in preventing adolescent pregnancy
or STI/HIV or in changing the risky sexual behaviors antecedent to these problems.
Behavioral change, as opposed to knowledge or attitudinal change alone, is the
standard criterion of effectiveness....
In Africa, as in many parts of the world, adolescent reproductive health is a controversial issue for policy makers and programme planners. Adolescents are particularly vulnerable to HIV and AIDS and to a host of other problems such as sexually transmitted infection, unwanted pregnancy, unsafe abortions, sexual abuse, female genital mutilation and unsafe circumcision. Yet many countries don’t have adolescent health policies and much remains to be done to ensure that adolescents can access appropriate sexual and reproductive health services....
An expert panel was convened, consisting of individuals with expertise in the areas of media use and its measurement, adolescent sexual health, and media effects on sexual health. Panelists were also expert in the use of new media in sexual health interventions. One goal was to identify gaps and set priorities for
Harrison's Internal Medicine Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach
Classification and Epidemiology
Worldwide, most adults acquire at least one sexually transmitted infection (STI), and many remain at risk for complications. Each year, for example, an estimated 6.2 million persons in the United States acquire a new genital human papillomavirus (HPV) infection, and many of these individuals are at risk for genital neoplasias.
This syndrome (formerly termed nonspecific vaginitis, Haemophilus vaginitis, anaerobic vaginitis, or Gardnerella-associated vaginal discharge) is characterized by symptoms of vaginal malodor and a slightly to moderately increased white discharge, which appears homogeneous, is low in viscosity, and evenly coats the vaginal mucosa. An interesting observation is that new genital HPV infection in young women is associated with increased subsequent risk of developing bacterial vaginosis.
Pelvic Inflammatory Disease: Treatment
The 2006 CDC guidelines recommend initiation of empirical treatment for PID in sexually active young women and other women at risk for PID if they are experiencing pelvic or lower abdominal pain, if no other cause for the pain can be identified, and if pelvic examination reveals one or more of the following criteria for PID: cervical motion tenderness, uterine tenderness, or adnexal tenderness.
Women with suspected PID can be treated as either outpatients or inpatients.
The modern era in sexual medicine started in the
1970s when a few devoted pioneers and visionaries
began to revolutionize our thinking and understanding
in this field.
Prior to that time, sexual dysfunctions in men,
particularly erectile disorders, were thought to be
purely psychogenic or in rare cases caused by testosterone
deficiency. Treatment of sexual disorders was
considered to be predominantly the business of sextherapists
or rarely of endocrinologists.
A plethora of corroborative genetic studies led to the view that, across the
animal kingdom, the gene-regulatory cascades triggering sexual develop-ment bear little resemblance to each other. As a result, the common emerg-ing picture is that the genes at the top of the cascade are not conserved
Sexual risk behavior among U.S. adolescents is a major public health concern, with young people accounting for a disproportionate number of unplanned pregnancies and sexually transmitted infection diagnoses. Although a great deal of research attention has been devoted to understanding what puts adolescents at risk for these
Treat urethritis promptly, while test results are pending.
Table 124-4 summarizes the steps in management of sexually active men with urethral discharge and/or dysuria.
Table 124-4 Management of Urethral Discharge in Men
Usual initial evaluation
Chlamydia trachomatis pyuria Neisseria gonorrhoeae
Demonstration of urethral discharge or
Mycoplasma genitalium complications
Urethral Gram's stain to confirm urethritis, detect gram-negative diplococci
Test for N. gonorrhoeae, C.
I have spent most of my professional career since the 1980s working on
reproductive and sexual health programs, but I first developed a passion
for these issues while working on a project in Chile from 1972 to 1973 at
the time of Salvador Allende’s government. A multinational group of women
friends got together to adapt Our Bodies Ourselves1 for a Chilean audience,
which was to appear in the government’s women’s magazine, Paloma.
In this volume, experts – including service providers, therapists, children’s advocates, and the research community – summarise and evaluate the problem of the sexual abuse of prepubescent children in southern Africa. It is the first attempt to synthesise southern African research, treatment and policy literature on the topic. The book confronts the realities of sexual abuse, and its representation in the press. It presents the main findings concerning the individual, socio-economic and sociocultural correlates of sexual abuse, and covers legal and policy responses to the problem.
n the Democratic Republic of Congo (DRC), tens of thousands of girls and women have suffered horrific acts of sexual violence. The government army is one of the main perpetrators. Commanders, even when confronted with abuses, have frequently failed to stop sexual violence and may themselves be guilty of war crimes or crimes against humanity as a consequence. In this report, Human Rights Watch looks at sexual violence committed by the army and more specifically the 14th brigade whose case illustrates the failure to enforce respect for humanitarian law.