Medical Disorders and Sexual Health: A Guide for Healthcare Providers

Contents
Contributors
How to Talk on Sexuality in a Medical Consultation
1 Introduction
2 Clinical Interview
2.1 General Aspects to Take into Account
2.2 Addressing Sexual Issues
2.3 Specific Considerations in a Talk on Sexuality
2.3.1 Healthcare Provider-Patient Interaction
2.3.2 The Interview Management
2.3.3 Burden
3 How to Record a History of Sexual Dysfunction
3.1 Identifying the Problem
3.2 Predisposing, Triggering, and Maintaining Factors
3.3 Assess Psychosocial Problems
References
Gender and Orientation
1 Introduction
2 Definitions
3 Definitions
3.1 Biological Sex
3.1.1 Physical Dimension
3.2 Sexual Orientation: Attraction
3.3 Gender Identity
3.4 Gender Expression
3.5 Transgender
3.6 Gender Transition
3.7 Gender Dysphoria, Gender Incongruence
3.8 Queer
4 Determinants
5 Health Risks for Sexual Minorities
6 Special Needs of the LGBTQIA+ Community
6.1 General Principles
6.2 Health Care for Persons with Various Forms of Nonexclusively Heterosexual Orientation
6.3 Health Care for Persons with Various Forms of Gender Incongruence
7 The Therapeutic Approach [14]
8 Experience in the Desired Gender Role
9 The Achievement of an Endocrine Milieu Consistent with the Desired Gender (Hormone Therapy)
10 Surgery and Other Physical Treatments to Change the Genitalia and Other Sex Characteristics
11 Follow-Up Care
11.1 Specialized Medical Care [14, 26]
11.1.1 Safety in Follow-Up of Hormone Therapy
11.1.2 Follow-Up After Surgical Interventions
11.1.3 Endocrine Changes and Fertility
11.1.4 Contraception
11.1.5 Combination Hormonal Contraceptives
11.1.6 Progestin-Only Contraceptives
12 Mental Health Care [8, 12]
13 Sexual Well-Being
14 Summary
References
Sexuality Across Lifespan: Focus on Women’s Vulnerabilities
1 Sexuality Across Lifespan I: Women’s Vulnerabilities from Intrauterine Life to Adolescence
1.1 Introduction
1.2 Intrauterine Life
1.3 Childhood
1.4 Adolescence
1.5 Conclusion
2 Sexuality Across Lifespan II: FSD Classification and Women’s Vulnerabilities in the Reproductive Age
2.1 Introduction
2.2 Prevalence and Diagnosis of FSDs
2.3 Hypoactive Sexual Desire Disorder (HSDD)
2.3.1 Treatment Strategies
2.4 Female Sexual Arousal Disorder (FSAD)
2.4.1 Treatment Strategies
2.5 Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia (PGAD/GPD)
2.6 Female Orgasm Disorder (FOD)
2.6.1 Therapeutic Strategies
2.7 Pregnancy and Puerperium
2.8 Factors of Sexual Vulnerability in Reproductive Age
2.8.1 Endometriosis
2.8.2 Infertility
2.8.3 Sexual Abuse
2.8.4 Cancer
2.8.5 Gynecological Surgery
2.8.6 Chronic Systemic Conditions
2.9 Conclusion
3 Sexuality Across Lifespan III: Women’s Vulnerabilities from Early Menopause to Senescence
3.1 Introduction
3.2 Symptoms of Perimenopause and Menopause
3.3 Female Sexual Dysfunctions in Menopause and Senescence
3.4 Treatment of Perimenopausal and Menopausal Symptoms
3.5 Genitourinary Syndrome of the Menopause and Topical Hormone Therapy
3.6 Conclusion
References
Sexuality Across Lifespan IV: Focus on Men’s Vulnerabilities
1 Introduction
2 Age-Related Physiological Modification of Male Sexual Response
3 Sexual Function/Dysfunction Across Lifespan
3.1 Epidemiological Data
3.2 Main Determinants
3.2.1 Organic Conditions
3.2.2 Marital and Couple Fitness Determinants
3.2.3 Intrapsychic Determinants
4 Conclusion
References
Chronic Pelvic Pain, Sexual Pain, and Female Sexual Dysfunction
1 Introduction
1.1 The Impact of Chronic Pain and Pain During Sexual Intercourse on Sexual Health
1.2 Pathogenesis of Pelvic Pain
2 Scenario I: The Patient Presents with Sexual Pain as the Leading Symptom
2.1 Sexual Dysfunction
2.2 The Sexual Experience
2.3 The Interaction of Chronic Pain and Sexual Dysfunction
2.3.1 Evaluation and Diagnostic: The Biopsychosocial Approach
2.3.2 The Individualized Treatment Plan
3 Scenario II: Patient with Specific Disease Leading to Chronic Pelvic Pain and Other Symptoms
3.1 The Diagnostic Workup for Patients with Pelvic Pathology Leading to Sexual Dysfunction
3.1.1 The Treatment Plan
Sexual Rehabilitation
Chronic Pain and Sexual Therapy
4 Conclusion
References
Pelvic Floor Disorders and Female Sexuality I: Urinary Caution
1 Introduction
1.1 Urinary Incontinence During Sexual Activity
2 The Impact of Urinary Incontinence on Female Sexual Health
2.1 Sexual Activity Among Women with UI
2.2 Sexual Function Among Women with UI
3 The Impact of Urinary Incontinence Treatments on Female Sexuality
3.1 Coping Strategies
3.2 Conservative Treatment
3.2.1 Pelvic Floor Muscle Training
3.2.2 Intravaginal Devices for SUI
3.3 Pharmacological Treatment
3.4 Surgical Treatment
3.4.1 Bulking Agents
3.4.2 Mid-Urethral Sling
3.4.3 Other Surgical Treatments
4 Cognitive and Behavioral Therapy in Women with Urinary Incontinence
5 Conclusion
References
Pelvic Floor Disorders and Female Sexuality II: Pelvic Organ Prolapse
1 Introduction
2 Sexuality Assessment in Women with POP
3 The Impact of POP on Sexual Activity
4 The Impact of POP on Sexual Function
5 The Impact of Conservative Treatment for POP on Female Sexuality
6 The Impact of Pessaries for POP on Sexual Activity and Function
7 The Impact of the Surgical Treatment for POP on Female Sexuality
7.1 Surgical Treatment and Sexual Activity
7.2 Surgical Treatment and Sexual Function
7.3 Surgical Treatment and Specific Considerations
7.3.1 Mesh Surgery
7.3.2 Obliterative Procedures
7.3.3 Uterine Preservation
8 Biopsychosocial Approach
9 Conclusion
References
Male Sexuality and Prostate Cancer
1 Introduction
2 Part 1: Sexuality Assessment and Effects on Localised Treatments
2.1 Sexuality Assessment in Men with PCa
2.2 Sexuality After Localised Treatments
2.2.1 Radical Prostatectomy
Erectile Dysfunction
Urinary Incontinence
Penile Changes
Ejaculatory and Orgasmic Dysfunction
2.2.2 Radiotherapy
External Beam Radiotherapy
Brachytherapy
2.2.3 Focal Therapy
Cryotherapy
HIFU
3 Part 2: Hormonal Treatment, Biopsychosocial Assessment and Non-Heteronormative Groups
3.1 Sexuality After Hormonal Therapy
3.1.1 Effects on Sexual Functioning
3.1.2 Effect on Body Image
3.1.3 Effect on Libido
3.1.4 Effect on Erectile Function
3.1.5 Effect on Ejaculation
3.2 Biopsychosocial Assessment
3.2.1 Sexual Intimacy
3.2.2 Relationship with Women
3.2.3 Sexual Imaging
3.2.4 Masculinity
3.3 Non-Heteronormative Groups
3.3.1 Men Who Have Sex with Men
3.3.2 Transgender Woman
4 Conclusion
References
Male Sexual Dysfunctions in the Infertile Couple
1 Introduction
2 Male Sexual Dysfunctions
2.1 Erectile Dysfunction
2.2 Peyronie’s Disease
2.3 Ejaculatory Disorders
2.4 Low Sexual Desire
2.5 Anorgasmia
2.6 Psychological Disorders
3 Male Infertility, Male Sexual Dysfunctions and General Health Status
4 Fertility in Transgender and Non-Binary
5 Conclusion
References
Endocrine Disorders and Sexuality I: Hypothalamus-Pituitary Axes and Peripheral Thyroid and Adrenal Glands
1 Hypophysis Disorders and Sexual Dysfunction
1.1 Gonadotropic Axis
1.2 Hypothalamus-Pituitary-Gonadal and Adrenal Axis in the Puberty and Sexual Health
1.3 Somatotropic Axis
1.3.1 Growth Hormone (GH) Excess
1.3.2 GH Deficiency
1.4 Adrenal Axis
1.4.1 Corticotropin (ACTH) Overproduction and Glucocorticoid Excess
1.4.2 ACTH Deficiency and Glucocorticoid Deficiency
1.5 Lactotroph Axis
1.6 Thyrotrophic Axis
1.7 Other HP Hormones
2 Thyroid Disorders and Sexual Dysfunction
2.1 Proposed Mechanisms and Basic Research
2.2 Thyroid Disorders and Male Sexual Dysfunction
2.3 Thyroid Disorders and Female Sexual Dysfunction
3 Adrenal Disorders and Sexual Dysfunction
3.1 Congenital Adrenal Hyperplasia (CAH)
3.2 Other Congenital SDSs of Adrenal Origin
3.3 Adrenal Androgens, Adrenarche, and Sexuality
3.4 Adrenal Hormonal Secretory Tumors and Sexuality
3.5 Adrenal Insufficiency
3.6 Endocrine Disruptors and the Pituitary, Thyroid, and Adrenal Sexual Function
4 Conclusion
References
Endocrine Disorders and Sexuality II: Ovary
1 Introduction
1.1 Evidence of the Role of Estrogens in Sexual Function
1.2 Evidence of the Role of Androgens in Sexual Function
1.3 Evidence of the Role of Progestins in Sexual Function
2 Part I: Sexual Dysfunction in Hypogonadisms
2.1 Menopause
2.2 Premature Ovarian Insufficiency
2.3 Gonadal Dysgenesis
2.4 Hypogonadotropic Ovarian Dysfunction
3 Management of Sexuality in Young Women with Hypogonadism
4 Conclusion
5 Part II: Sexual Dysfunction in Polycystic Ovary Syndrome
5.1 Introduction
5.2 Complaints Related to Sexual Functioning
5.2.1 Treatment
6 Conclusion
References
Endocrine Disorders and Sexuality III: Diabetes and Sexual Disorders
1 Introduction
2 Sexual Dysfunction in Men with Diabetes
2.1 Erectile Dysfunction
2.1.1 Diagnosis
2.1.2 Treatment
Phosphodiesterase Type 5 Inhibitors
Intracavernous Injection of Drugs
Intraurethral Suppositories
Topical Treatments
Vacuum Erection Systems (Vacuum)
Surgical Treatment
2.2 Retrograde Ejaculation
2.3 Low Sexual Desire
2.4 Psychological Interventions
3 Sexual Dysfunction in Women with Diabetes
3.1 Factors Affecting Sexual Dysfunction in Women with Diabetes
3.2 Identification and Assessment of Sexual Dysfunction in Women with Diabetes
3.3 Treatment
3.3.1 Phosphodiesterase 5 Inhibitors
3.3.2 Menopausal Hormone Therapy
3.3.3 Antidepressant Therapy
3.3.4 Weight Loss
3.3.5 Psychological Interventions
4 Conclusion
References
Sexuality in People with Obesity
1 Introduction: Obesity as a Global Health Problem
2 Obesity and Sexual Function
3 General Aspects of the Pathophysiology of Obesity Related to Sexual Function
4 Sexual Dysfunction as a Comorbidity Associated with Obesity
4.1 Obesity, Sexual Orientation, and Identity
4.2 Effects on Female Sexual and Reproductive Function
4.3 Effects on Male Sexual and Reproductive Function
5 Obesity During Sexual Development, Social Exclusion, Risky Behaviors
6 Obesity, Relationships, and Sexual Practices
7 Changes in Sexuality After Obesity Treatment, Bariatric Surgery, and Sexual Function
7.1 Changes in Male and Female Sexuality
7.2 Other Phenomena Observed After Treatment of Obesity
8 Conclusions
References
Sexual Health in Inflammatory Bowel Disease
1 Introduction
2 Sexual Dysfunction Assessment Tools
3 Inflammatory Bowel Disease and Its Impact on Sexual Health
4 Sexual Dysfunction Management and Challenges in Sexual Assessment Among IBD Patients
5 Conclusions and Key Messages
References
Lower Gastrointestinal Cancer and Sexual Function
1 Introduction
2 Pathophysiology of Sexual Dysfunction
3 Risk Factors for Sexual Dysfunction
3.1 Patient-Related Factors
3.1.1 Age
3.1.2 Gender
3.1.3 Psychological and Social Issues
3.1.4 Preoperative Sexual Function
3.2 Tumor-Related Factors
3.2.1 Location
3.2.2 Clinical Stage
3.3 Treatment-Related Factors
3.3.1 Radiation Therapy
3.3.2 Surgical Treatment
3.3.3 Ostomy Creation
4 Clinical Presentation of Sexual Dysfunction
5 Diagnosis of Sexual Dysfunction
6 Management of Sexual Dysfunction
7 Conclusion
References
Sexuality in Adult Patients with Cancer in the Era of Precision Oncology
1 Introduction
2 Cancer Involving Sexual Organs in Females
3 Cancer Involving Sexual Organs in Males
4 Malignancies Other than Those Affecting Sexual Organs
5 Adolescent and Young Adult Cancer Survivors
6 Identification of Areas that Warrant Further Research and Development
6.1 Biological Aspects
6.2 Psychosocial Aspects and Models of Care
6.3 Research and Development to Integrate Diversity
6.4 Sexuality and Palliative Care
6.5 Implementation of Models of Care
7 Conclusions
References
Allogeneic Stem Cell Transplantation and Sexual Disorders
1 Allogeneic Hematopoietic Stem Cell Transplantation
2 Chronic Graft-Versus-Host Disease and Its Impact on Sexual Health
3 Endocrine Dysfunction After AlloHSCT and Its Effects on Sexual Health
4 Sexual Dysfunction in Women Following AlloHSCT
5 Sexual Dysfunction in Men Following AlloHSCT
6 Complexity of Sexual Problems After AlloHSCT
7 Conclusions
References
Sexual Function in Breast Cancer and Sexual Health
1 Introduction
2 Sexual Disfunction in Breast Cancer Survivors
3 Treatment Options
3.1 Local Strategies
3.2 Systemic Pharmacological Treatments
3.3 Physical Therapy
3.4 Educational and Psychotherapeutic Interventions
4 Concerns in the Management of Sexual Health in Breast Cancer Survivors
4.1 Male Breast Cancer and Sexuality
5 Conclusions
References
Autoimmune and Rheumatic Diseases and Sexuality
1 Introduction
2 Fibromyalgia
3 Rheumatoid Arthritis
4 Spondyloarthropathies
5 Juvenile Idiopathic Arthritis
6 Systemic Lupus Erythematosus
7 Sjögren Syndrome
8 Systemic Sclerosis
9 Inflammatory Myopathies
10 Behçet’s Disease
11 Conclusion
References
Chronic Respiratory Diseases and Sexual Function
1 Introduction
2 Chronic Obstructive Diseases
3 Cystic Fibrosis
4 Pulmonary Hypertension
5 SARS-CoV2 Infection
6 Barriers
7 Practical Recommendations
8 Conclusions
References
Sexual Health and Hypertension
1 Introduction
2 Sexual Life, Hypertension, and Cardiovascular Risk
2.1 Erectile Dysfunction and Hypertension
2.1.1 Introduction
2.1.2 Pathophysiology
2.1.3 Antihypertensive Treatment and Erectile Dysfunction
2.1.4 Approach of Erectile Dysfunction Associated to Hypertension
2.1.5 Remaining Gaps in Knowledge
2.2 Sexual Dysfunction and Hypertension in Women
3 Male Hypogonadism, Hypertension, Cardiovascular Risk, and Sexual Health
3.1 Low Testosterone and Cardiovascular Risk
3.2 Low Testosterone and High Blood Pressure (BP)
3.3 Testosterone Replacement Therapy and Hypertension
4 Female Gonadal Function, Hypertension, and Sexual Health
4.1 Perimenopausal and Postmenopausal Periods
4.2 Primary Ovarian Insufficiency and Infertility
4.3 Oral Contraceptives Users
References
Sexuality and Cardiac Disease
1 Introduction
2 Importance of Sexual Well-Being in Patients with Cardiovascular Disease and the Role of Cardiologists
3 Cardiovascular Medication and Sexual Function
4 General Recommendations for the Cardiovascular Patient
4.1 Cardiovascular Responses to Sexual Activity
4.2 Is There a Significant Cardiovascular Risk Associated with Sexual Activity?
5 Sexual Health in Cardiovascular Diseases
5.1 Coronary Artery Disease and Myocardial Infarction
5.2 Cardiac Surgery
5.3 Heart Failure and Heart Transplantation
5.4 Arrhythmia and Implantable Cardioverter Defibrillators
5.5 Congenital Heart Disease
6 Gaps of Knowledge
7 Conclusions
References
Sexual Health in Post-Stroke Patients
1 Stroke
1.1 Clinical Consequences of Stroke
2 Correlation Between the Location of the Stroke and Changes in Sexual Function
3 Sexuality in Post-stroke Patients
4 Factors After a Stroke That Affect Sexual Dysfunction
4.1 Body Image, Self-Esteem, and Self-Efficacy
4.2 Spastic Hypertonia and Fatigue
4.3 Genitourinary Symptoms
4.3.1 Urinary Incontinence
4.3.2 Anal Incontinence
4.3.3 Vaginal Dryness
4.3.4 Erectile Dysfunction
4.4 Psychological Aspects After a Stroke That Affect Sexual Dysfunction
5 Sexuality Assessment Tools in Post-stroke Patients
5.1 Questionnaires for Post-stroke Patients
5.2 Sexual Function Questionnaires
5.3 Structured Interviews or Specifically Designed Questionnaires
5.4 Function and Sexual Activity in Post-stroke Patients’ Partners
6 Role of Healthcare Professionals: Barriers and Limitations in Clinical Practice, Transdisciplinarity
7 Interventions to Address Sexual Dysfunction in Post-stroke Patients
7.1 Pharmacological Interventions
7.2 Non-pharmacological Intervention
8 Conclusion
References
Multiple Sclerosis and Sexual Dysfunction
1 Introduction
2 Characteristics of Sexual Dysfunction in People with MS
3 Etiology of Sexual Dysfunction in People with MS
3.1 Primary Causes
3.2 Secondary Causes
3.3 Tertiary Causes
3.4 Medications as Contributory Factors for SD in pwMS
4 Factors Associated with SD in MS
4.1 Sexual Dysfunction and Quality of Life in People with MS
4.2 Sexual Dysfunction in Sexual Minorities with MS
5 Diagnosis of Sexual Dysfunction in People with MS
5.1 History
5.2 Examination
5.3 Investigations
6 Management of Sexual Dysfunction in People with MS
7 Conclusion
References
Headache and Sexual Dysfunction
1 Introduction
2 Impact of Primary Headache Disorders on Sexual Performance
2.1 Migraine
2.2 Tension-Type Headache
2.3 Cluster Headache
2.4 Primary Headache Associated with Sexual Activity
3 Headache Attributed to Drugs Used in  Sexual Medicine
3.1 Phosphodiesterase-5 (PDE-5) Inhibitors
3.2 Hormone Therapy
4 Sexual and Gender Considerations in Headache
5 Conclusions
References
Anxiety and Sexual Disorders
1 Introduction
1.1 Definition of Anxiety
1.2 Definition of Sexual Dysfunction
2 Possible Links Between Anxiety and Sexual Dysfunction
3 Cognitive and Behavioral Aspects of Anxiety in Sexual Dysfunction
4 Sexual Performance Anxiety (SPA)
5 Anxiety and Erectile Dysfunction
6 Anxiety and Female Sexual Interest/Arousal Disorders
7 Anxiety and Orgasmic Difficulties in Women
8 Anxiety and Delayed Ejaculation
9 Anxiety and Premature Ejaculation
10 Anxiety and Genito-Pelvic Pain/Penetration
11 Sexual Dysfunctions in Patients with Anxiety Disorders
12 Treatments Aimed at Anxiety in Sexual Dysfunctions
13 Cognitive-Behavioral Treatments Targeted Anxiety in Sexual Dysfunction
13.1 Treatments Based on Full Attention (Mindfulness)
13.2 Anxiety, Sexual Disorders, and Psychotropic Drugs
14 Conclusions
References
Depression and Sexual Health
1 Introduction
2 Influence of Depression on Sexual Function
3 Effects of Antidepressants on Sexual Function
3.1 Use of Antidepressants in Depressive Disorders
3.2 Mechanism of Action of Antidepressants on Sexual Function
3.3 Differential Effects of Antidepressants on Sexual Function
3.3.1 Antidepressants with Primarily Serotonergic Actions
3.3.2 Antidepressants with Primarily Noradrenergic Actions
3.3.3 Antidepressants with Serotonergic and Noradrenergic Actions
3.3.4 Antidepressants with Primarily Dopaminergic Actions
3.3.5 Tricyclic Antidepressants
3.3.6 Monoamine Oxidase Inhibitors
3.3.7 Other Antidepressants
4 Effects of Antidepressants on Fertility
4.1 Impact of Antidepressants on Male Fertility
4.2 Impact of Antidepressants on Female Fertility
5 Assessment of Sexual Dysfunction in Depression
5.1 Clinical Assessment
5.2 Objective Assessment
6 Interventions on Sexual Health in Patients with Depression
6.1 Management of Sexual Dysfunction
6.2 Conservative Treatment
6.3 Psychotherapy
6.4 Antidepressant-related Strategies
6.4.1 Antidepressant Selection
6.4.2 Antidepressant Dose Reduction
6.4.3 Drug Holidays
6.4.4 Antidepressant Substitution
6.5 Adjunctive Treatment
6.5.1 Antidepressant Augmentation
6.5.2 Phosphodiesterase 5 Inhibitors
6.5.3 Other Agents
7 Sexual Minorities and Depression
8 Conclusions
References
Psychopathy and Sexuality
1 How to Have Sex
2 Psychopathy and Dark Traits
2.1 A Primer
2.2 Psychopathy and Dark Traits
2.3 The Causes of Psychopathy
3 The Sex Life of Dark Personalities
3.1 Sexual Arousal and Dysfunction
3.2 Sexual Interests and Fantasies
3.3 Risky Sexual Behaviors and Sexual Disgust
4 The Romantic Relationships of Dark Personalities
4.1 Quantity Over Quality
4.2 Attraction and Mate Preferences
5 Dark Personalities in Conflict
5.1 Infidelity and Poaching
5.2 Harsh Couple Acquisition and Retention Tactics
6 The Darkest Side of Dark Personalities
7 Conclusions
References
Parkinson and Sexuality
1 Introduction
2 PD: The Leading Features
3 Risk and Protective Factors
4 Gender and PD
5 Therapy
6 Conclusions
References
Sexual Health in Individuals with Disabilities
1 Introduction
2 Sexuality and Disability: An ICF Perspective
2.1 Body Structures
2.2 Body Functions
2.3 Activities and Participation
2.4 Environmental Factors
2.5 Personal Factors
3 Disability and Sexual Health Challenges
4 Promoting Sexual Health and Inclusion in Disability
5 Collaborative Care and Multidisciplinary Approach
6 Conclusions
References
Sexual Activity After Total Hip Replacement
1 Introduction
2 Hip Osteoarthritis and Sexual Function Impairment
3 Sexual Activity After Total Hip Replacement
4 Could Surgical Approach Play a Role in the Recovery of Sexual Function?
5 A Topic That Is Infrequently Addressed
6 Conclusions
References
Sexual Activity After Hip Preservation Surgery: Hip Arthroscopy for Femoroacetabular Impingement and Periacetabular Osteotomy
1 Introduction
2 Hip Arthroscopy
3 Resuming Sexual Activity After Hip Arthroscopy
4 Periacetabular Osteotomy
5 Impact on Sexual Activity After Periacetabular Osteotomy
6 Resuming Sexual Activity After Periacetabular Osteotomy
7 Factors Influencing Return to Sexual Activity
8 Management of Sexual Concerns
9 Conclusion
References
Sexual Health and Chronic Dermatosis
1 Introduction
2 Hidradenitis Suppurativa and Sexual Health
3 Psoriasis and Sexual Health
4 Atopic Dermatitis and Sexual Health
5 Lichen Sclerosus and Sexual Health
6 Conclusion
References
STI and Sexuality
1 Scope of the Problem
1.1 Introduction
1.2 A Growing Problem
2 Risk Groups
2.1 Adolescence
2.2 Other High-Risk Groups
3 Prevention
3.1 Specific Preventive Measures
3.1.1 Risk Groups
3.1.2 Partner Notification
3.1.3 Condom Use
3.1.4 Vaccines
3.1.5 Telling Partner About STI
4 Repercussions on Sexual Behavior and Mental Health
4.1 HIV
4.2 HPV
4.3 VHS
5 STIs Clinics Attendance and Global Health Services
References