Transgender Actors Effective in Teaching Residents to Provide Respectful and Effective Health Care

MedicalResearch.com Interview with:

Richard E. Greene, MD, FACP Medical Director, Bellevue Adult Primary Care Center Assistant Professor, NYU School of Medicine Associate Program Director, Primary Care Residency Program Director, Gender and Health Education, Office of Diversity Affairs, NYU School of Medicine, OUTList Medical Director, CHIBPS, The Center for Health, Identity, Behavior and Prevention Studies VP of Membership and Development, GLMA-Health Professionals Advancing LGBT Equality 

Dr. Greene

Richard E. Greene, MD, FACP
Medical Director, Bellevue Adult Primary Care Center
Assistant Professor, NYU School of Medicine
Associate Program Director, Primary Care Residency Program
Director, Gender and Health Education, Office of Diversity Affairs, NYU School of Medicine, OUTList
Medical Director, CHIBPS, The Center for Health, Identity, Behavior and Prevention Studies
VP of Membership and Development, GLMA-Health Professionals Advancing LGBT Equality 

MedicalResearch.com: What is the background for this study?

Response: Transgender individuals face complex health disparities and have historically been mistreated and even denied care in medical settings. As a provider in New York City, I saw how this affected my trans patients, resulting in mistrust of the health care system, resulting in negative health outcomes. This sparked my interest in improving medical education to serve the needs of trans patients. It’s important to teach medical students and residents that they are not just treating a set of symptoms, they are working with a individuals with complex lived experiences who deserve compassionate care.

I found with traditional didactic methods, like lectures, learners smiled and nodded in agreement, but when faced with a patient who was transgender, they would stammer and feel uncomfortable with aspects of the cases that were specific to transgender patients, from pronouns to hormones.

Residents should be prepared to treat transgender patients not only with dignity, but also in medically appropriate ways. Without exposure to the transgender community, it’s difficult for providers to decipher their trans patients’ health care needs and contextualize them within a care plan.

In order to provide a low stakes environment for residents to practice these skills, we developed an OSCE focused on a transgender woman with health care needs specific to her transition. The goal of the case was to discuss the patient’s medical concerns while also taking into consideration her goals around her hormone therapy and surgical interests.

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Frequent Sex In Older Adults Linked To Better Cognitive Function

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Dr Hayley Wright BSc(Hons) MSc PhD C.Psychol Research Associate Faculty of Health and Life Sciences, Coventry University Centre for Research in Psychology, Behaviour and Achievement, Coventry University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Last year, we published a study that showed a significant association between sexual activity and cognitive function (Wright & Jenks, 2016). This study showed that sex is linked to cognition, even after we account for other factors such as age, education, and physical and mental wellbeing. One important question that emerged from this study was centred around the role of frequency with which we engage in sexual activity. In the current study (Wright, Jenks & Demeyere, 2017), we found that engaging in sexual activity on a weekly basis is associated with better scores on specific cognitive tasks. MedicalResearch.com: What should clinicians and patients take away from your report? Response: We have demonstrated that sexual activity in later life may have measurable benefits that stretch beyond pleasure-seeking. We - society at large, and individual researchers - should challenge notions of embarrassment around sexuality that may prevent older people from accessing help and support for sexual or relationship issues. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: It may be advisable to take relationship factors into account when conducting studies around cognitive ageing. Researchers often make statistical adjustments for factors that are known to influence cognition and health (such as age, education and health problems), but actually, more personal factors may also have an effect on how our brain works. MedicalResearch.com: Is there anything else you would like to add? Response: The research so far has been cross-sectional (or correlational), and so we cannot say at this time whether sexual activity is causing better scores on cognitive tests. This issue of causality is something that we will address in future research as more data becomes available. We are currently researching whether all types of sexual activities are associated with cognitive function to the same extent. We are also working with support services to address barriers to relationship and sex therapy for older people and marginalised groups. MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: Hayley Wright, Rebecca A. Jenks, Nele Demeyere. Frequent Sexual Activity Predicts Specific Cognitive Abilities in Older Adults. The Journals of Gerontology: Series B, 2017; DOI: 10.1093/geronb/gbx065 Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

Dr. Wright

Dr Hayley Wright BSc(Hons) MSc PhD C.Psychol
Research Associate
Faculty of Health and Life Sciences, Coventry University
Centre for Research in Psychology, Behaviour and Achievement,
Coventry University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Last year, we published a study that showed a significant association between sexual activity and cognitive function (Wright & Jenks, 2016). This study showed that sex is linked to cognition, even after we account for other factors such as age, education, and physical and mental wellbeing. One important question that emerged from this study was centred around the role of frequency with which we engage in sexual activity. In the current study (Wright, Jenks & Demeyere, 2017), we found that engaging in sexual activity on a weekly basis is associated with better scores on specific cognitive tasks.

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Flibanserin- Addyi -Improved Sexual Health in Women With Hypoactive Sexual Desire Disorder

MedicalResearch.com Interview with:

Dr. Michael Krychman, MD Executive Director: The Southern California Center for Sexual Health and Survivorship, Medical Director: Sexual Medicine at Hoag Hospital Newport Beach CA Clinical faculty member University of Southern California Los Angeles, CA

Dr. Krychman

Dr. Michael Krychman, MD
Executive Director: The Southern California Center for Sexual Health and Survivorship,
Medical Director: Sexual Medicine at Hoag Hospital Newport Beach CA
Clinical faculty member
University of Southern California
Los Angeles, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This post hoc analysis pooled data from three 24-week, double-blind, placebo-controlled studies (VIOLET, DAISY, and BEGONIA) of flibanserin in premenopausal women with acquired, generalized HSDD5-7. Patients who received flibanserin 100 mg once daily at bedtime (qhs) or placebo were included in the analysis. The Female Sexual Function Index (FSFI) consists of 19 items across 6 domains. Scores range from 2 to 36. Higher scores indicate better sexual functioning. Scores under 26 indicate sexual dysfunction. Analysis of covariance was used to evaluate changes from the first week to week 24 in the FSFI domain and total scores were compared for flibanserin 100 mg qhs versus placebo. For patients who discontinued study participation prior to week 24, the last postbaseline observation was carried forward (LOCF).

Results found that treatment with flibanserin 100 mg qhs produced statistically significant improvement, relative to placebo, on all domains of the FSFI (desire, arousal, lubrication, orgasm, satisfaction and pain) in premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD).

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LGBTQ+ Patients Have Poor Sleep Compared to Heterosexuals

MedicalResearch.com Interview with:

Jen-Hao Chen PhD Assistant Professor Department of Health Sciences and School of Public Affairs University of Missouri - Columbia

Dr. Jen-Hao Chen

Jen-Hao Chen PhD
Assistant Professor
Department of Health Sciences and School of Public Affairs
University of Missouri – Columbia

MedicalResearch.com: What is the background for this study?

Response: It has been well known that sexual minority adults in the US have worse health as compared with heterosexual peers. Queer folks are found to have poorer physical, mental and behavioral health outcomes because of their marginalized status and social environments. But we know very little about prevalence of sleep problems in the population of sexual minorities compared to heterosexual people. Do sexual minorities lose sleep? Do they wake up more often during the night? Do they sleep less? This study aims to address this important gap in the LGBT health literature. Using recent nationally representative data, we exam whether sexual minority adults have greater odds of having short sleep duration and poor sleep quality. In addition, we also investigate sexual minorities’ sleep in the context of gender and race/ethnicity  Continue reading

Too Busy? Too Tired? Not in a Relationship? Why are Americans Having Less Sex?

MedicalResearch.com Interview with:

Brooke E. Wells, Ph.D. Associate Professor & PhD Program Director Center for Human Sexuality Studies Widener University One University Place Chester, PA 19013

Dr. Brooke Wells

Brooke E. Wells, Ph.D.
Associate Professor & PhD Program Director
Center for Human Sexuality Studies
Widener University
One University Place
Chester, PA 19013

MedicalResearch.com: What is the background for this study?

Response: It is widely believed that Americans today are more sexually liberated and open than ever before. While research indicates that Americans do indeed have more liberal attitudes about a range of sexual behaviors, Americans are actually reporting fewer sexual partners and higher rates of adult sexual abstinence. But are Americans reporting similar levels of sexual frequency with fewer partners? Our research set out to examine changes over time in sexual frequency to better understand our changing sexual landscape.

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Radiofrequency Therapy For The Treatment Of Vaginal Laxity

MedicalResearch.com Interview with:

Dr. Michael Krychman

Dr. Michael Krychman

Dr. Krychman is Executive Director, President, and CEO of the Southern California Center for Sexual Health and Survivorship Medicine and Associate Clinical Professor at the University of California, Irvine, Department of Obstetrics and Gynecology. He is a Member of the International Society for the Study of Women’s Sexual Health (ISSWSH), The International Society for Sexual Medicine (ISSM) and a Certified Sexual Counselor by the American Association of Sexuality Educators, Counselors and Therapists (AASECT). He served as a member of the Standards Committee for the International Society for Sexual Medicine during their 2016 International Consensus Meeting.  

MedicalResearch.com:  What is the background for this technology and study? What are the main findings?

Response: Viveve Medical, Inc. is a women’s health and wellness company committed to advancing new solutions to improve women’s overall well-being and quality of life.  The internationally patented Viveve® technology and the GENEVEVE™ treatment, incorporates clinically-proven, cryogen-cooled monopolar radiofrequency (CMRF) energy to uniformly deliver non-ablative, deep penetrating volumetric heat into the submucosal layer of the vaginal introitus (opening) while gently cooling surface tissue to generate robust neocollagenesis.  One 30-minute in-office session tightens and restores the tissue around the vaginal introitus addressing the common medical condition of vaginal laxity and can improve a woman’s sexual function.

VIVEVE I is a landmark study.  Results of the VIVEVE I clinical study, “Effect of Single-Treatment, Surface-Cooled Radiofrequency Therapy on Vaginal Laxity and Female Sexual Function: The VIVEVE I Randomized Controlled Trial,” were recently published in the February 2017 issue of the Journal of Sexual Medicine (JSM) under the Female Sexual Function category.   Some of my high-level thoughts to reiterate from this study are:

It is the first-ever large, randomized, sham-controlled study to demonstrate the safety and efficacy of energy-based procedures in gynecological applications, including vaginal laxity, which is a significant medical condition affecting millions of women worldwide that may lead to a reduction in sexual function.

The primary endpoint of the VIVEVE I study was a comparison of the proportion of women reporting no vaginal laxity in the treatment group versus the sham group at 6 months post-treatment.

Subjects receiving the active treatment were three times more likely to report no vaginal laxity at six months versus the sham group (p-value = 0.006).

Statistically significant and sustained improvement in sexual function (baseline FSFI total score ≤26.5) after a single treatment, with an adjusted mean difference in the active group vs sham group of 3.2 at 6 months (p-value = 0.009). “Placebo Effect” in the sham group did not rise above dysfunctional (FSFI ≤26.5) and diminished at 6 months.

Statistically significant improvement in sexual function was achieved in 93% of subjects in the active group vs the sham group in two individual key domains of FSFI (p-value = 0.007).

Bottom line: Geneveve is a safe effective treatment that can be performed as an outpatient in one 30-minute visit to improve sexual function as it has been affected by vaginal laxity.

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Does HAART Treatment for HIV Contribute To Rapid Rise in Syphilis Infections?

MedicalResearch.com Interview with:

Michael Rekart, MD, DTM&H Clinical Professor, Medicine and Global Health The University of British Columbia .... On behalf of my co-authors

Dr. Michael Rekart

Michael Rekart, MD, DTM&H
Clinical Professor, Medicine and Global Health
The University of British Columbia
…. On behalf of my co-authors

MedicalResearch.com: What is the background for this study?

Response: The background for this study is the observation that new syphilis cases over the last decade in British Columbia, Canada, have been escalating more rapidly than anyone could have predicted and that syphilis incidence has outpaced the incidence of other sexually transmitted diseases (STDs), including gonorrhea and chlamydia. This unexpected increase in syphilis has been almost wholly concentrated in men who have sex with men (MSM). Most of these MSM are HIV-1 infected and many are taking highly active antiretroviral therapy (HAART). In fact, the expansion in HAART coverage in MSM parallels the growth in syphilis in the same population. In addition, my co-authors and I had serious doubts as to whether ‘treatment optimism’, the generally accepted explanation for this phenomenon, was robust enough to account for such a dramatic increase in new syphilis cases. Treatment optimism posits that HAART availability and effectiveness have led to the perception in both HIV-1-infected and HIV-1-uninfected individuals that HIV-1 transmission has become much less likely, and the effects of HIV-1 infection less deadly. This is expected to result in increased sexual risk-taking, especially unprotected anal intercourse, leading to more non-HIV-1 STDs, including gonorrhea, chlamydia and syphilis.

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About 1 in 189 US Americans Identify as Transgender

MedicalResearch.com Interview with:

Halley Crissman, MD, MPH University of Michigan Resident Physician Department of Obstetrics and Gynecology University of Michigan Ann Arbor, Michigan

Dr. Halley Crissman

Halley Crissman, MD, MPH
University of Michigan
Resident Physician
Department of Obstetrics and Gynecology
University of Michigan
Ann Arbor, Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been very little data on the epidemiology of the transgender population in the U.S., including basic information regarding the proportion of adults that identify as transgender. Transgender is an identity term for individuals whose gender expression and gender identity does not align with culture expectations and gender norms associated with sex assigned at birth.

Our study used data from the Centers for Disease Control and Prevention 2014 Behavioral Risk Factor Surveillance System to estimate the demographic characteristics of the U.S. adult transgender population compared to the non-transgender population. We found that 0.53% of U.S. adults identified as transgender. Transgender individuals were more likely to be non-white and below the poverty line, were less likely to attend college, and were as likely to be married, living in a rural area, and employed, compared to non-transgender individuals.

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Bright Light Therapy Might Reduce Sexual Dysfunction in Men

MedicalResearch.com Interview with:

Professor Andrea Fagiolini, MD University of Siena Italy

Prof. Andrea Fagiolini

Professor Andrea Fagiolini, MD
University of Siena
Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have tested sexual and physiological responses to bright light and found that regular, early-morning, use of a light box – the same that we used to treat Seasonal Affective Disorder – led both to increased testosterone levels and greater reported levels of sexual satisfaction in man with difficulty with sexual desire or with sexual arousal.

We recruited 38 men who had been attending the Urology Department of the University of Siena and had a diagnosis of hypoactive sexual desire disorder or sexual arousal disorder – both conditions which are characterised by a lack of interest in sex. The 38 subjects were then divided the men into two groups. One group received regular treatment with a light box whereas the control (placebo) group was treated via a light box which had been adapted to give out significantly less light. Both groups were treated early in the morning, with treatment lasting half an hour per day. After two weeks of treatment or placebo, we found fairly significant differences between those who received the active light treatment and the controls.

Before treatment, both groups averaged a sexual satisfaction score of around 2 out of 10, but after treatment the group exposed to the bright light was scoring sexual satisfaction scores of around 6.3 – a more than 3-fold increase on the scale we used. In contrast, the control group only showed an average score of around 2.7 after treatment. Also, we found that testosterone levels increased in men who had been given active light treatment. The average testosterone levels in the control group showed no significant change over the course of the treatment – it was around 2.3 ng/ml at both the beginning and the end of the experiment. However, the group given active treatment showed an increase from around 2.1 ng/ml to 3.6 ng/ml after two weeks.

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Sexual Assaults More Common Against Gay, Lesbian, and Bisexual High School Students

MedicalResearch.com Interview with:

Laura Kann, Ph.D. Chief of the School-Based Surveillance Branch Division of Adolescent and School Health CDC

Dr. Laura Kann

Laura Kann, Ph.D.
Chief of the School-Based Surveillance Branch
Division of Adolescent and School Health
CDC

MedicalResearch.com: What is the background for this study?

Response: CDC has been using the Youth Risk Behavior Survey (YRBS) to collect data on the sexual identity of high school students at the state and local levels and on the prevalence of health risk behaviors among gay, lesbian, and bisexual students for many years. Starting with the 2015 YRBS cycle, we had enough support to add questions to the national YRBS to provide the first ever nationally representative look at health risk behaviors among these students.

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