Revista Brasileira de Psiquiatria
Sigar bugawa ISSN 1516-4446Sigar kan layi ISSN 1809-452X
Rev. Bras. Psiquiatr., Gabanin bugawa Epub Yuni 07, 2018
http://dx.doi.org/10.1590/1516-4446-2017-2476
TALIFOFIN
1Ambulantrio de Impulso Sexual Extracão da Dessechos Negativos Associations da Asusun Jima'i (AISEP), Cibiyar Nazarin (IPq), asibitin das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
2Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
3Cibiyar Cibiyar Nazarin Ilimin HIV da Horarwa ta HIV (CHEST), New York, NY, Amurka
4Ma'aikatar Ilimin Kimiyya, Hunter College, Jami'ar City na New York (CUNY), New York, NY, Amurka
5Sashen Ilimi na Lafiya da Harkokin Kimiyya na Cibiyar Nazarin Harkokin Kimiyya, Cibiyar Ilimin, CUNY, New York, NY, Amurka
ABDRACT
Manufa:
Akwai rashin karatu a kan labarun yanayi da halayyar jima'i a cikin mazajen jima'i da ke neman maganin tashin hankali (ESB). Muna nufin yin la'akari da tilasta jima'i (SC), damuwa, damuwa, da halayyar haɗarin jima'i a cikin samfurin neman samfurin maza da iko.
Hanyar:
Mun shigar da 88 (37 [42%] gay ko bisexual da 51 [58%] namiji) Masu bincike ESB da kuma 64 controls. Ƙididdigar sun haɗa da Siffar Ƙarƙwarar Jima'i (SCS), Inventory Inventory (BAI), Binciken Beck Depression (BDI), da kuma halayen halayen jima'i.
results:
Idan aka kwatanta da sarrafawa, masu fitowa na ESB sun nuna karuwar SC, damuwa, da ciki, waɗanda aka haɗu. Game da jima'i da abokan hulɗa, masu kwastar na ESB sun ba da rahoton karin jima'i, yawancin abokan hulɗa, karin jima'i mai jima'i, da kuma jima'i maras lafiya. Raguwa, damuwa, da kuma SC sun haɗa da haɗin da ke haɗuwa da haɗin gwiwa tare da abokin tarayya, yayin da suke haɗuwa da halayen halayya mai tsabta da ba tare da abokin tarayya ba. An lalata damuwa tare da haɗuwa da bala'i ba tare da abokin tarayya ba. Hakanan SC ya zana kwakwalwa mai yaduwar cutar kwakwalwa kuma an bayar da rahoto ta hanyar sakonnin ESB na maza da mata (36%).
Kammalawa:
Bayanai suna taimakawa filin ta hanyar samar da bayanai game da mazajen jima'i da suke neman lafiyar jiki. Hanyoyin da ke tsakanin waɗannan dalilai na kwakwalwa da halayyar haɗarin jima'i suna da tasiri ga lafiyar jama'a, likitoci, da bincike.
Key kalmomi: Jima'i compulsivity; shafi; damuwa; bakin ciki; HIV; halayyar haɗarin jima'i
Gabatarwa
Tun da 2013, lokacin da aka samar da ka'idodin bincike game da rashin daidaituwa tsakanin mazauni a cikin DSM-5,1 an kara yawan karatun sunyi bincike ga mutanen da suke neman magani don halayen jima'i (ESB) a cikin ƙoƙari na rinjayar al'amura masu rikitarwa da ke kewaye da misalai na ESB. Nazarin ya nuna cewa babban canji a cikin mutane da ESB shine impulsivity,2,3 wanda ke goyi bayan ka'idodin bincike na jima'i a cikin ICD-10.2,4 Sauran nazarin sun lura cewa sauye-sauye na psychopathological ya hada da ƙarfafawa don magance matsalolin, kamar kamuwa da ƙwayar cuta (OCD),5,6 wanda ya fi dacewa da ka'idodin da aka tsara a halin yanzu a cikin ICD-11 a matsayin mummunan halin halayen jima'i.7 Wasu bayanan bayanan sun goyi bayan ra'ayin ESB yana aiki daidai da jita-jita,8 wanda ya shafi dukkanin motsa jiki da kuma tilastawa, yana goyon bayan ka'idodin bincike na jima'i.9 Sabuwar ma'anar rashin daidaituwa ta maza da mata ta kasance bisa la'akari da nazarin dabba wanda ke tattare da gyare-gyare na kwakwalwar ƙwararrun ƙwayar cuta guda daya da kuma masu sauraron testosterone da ke haifar da wani nau'in sha'awar jima'i,10 wanda yake goyon bayan sabon binciken.11 Duk da bambance-bambance, dukkanin abubuwan da ke tattare da ESB sun lura cewa, bayan gabatar da jima'i da jima'i, jarabawa, da kuma hali a cikin wani lokaci, waɗannan mutane suna bayar da rahoto game da cututtuka saboda bayyanar cututtuka da kuma fuskantar mummunan sakamako a yankunan rayuwa, irin su a matsayin aiki, kiwon lafiya, da kuma dangantaka.
Dangane da abubuwan da ba su da haɓakawa da hasara-da-kula,12 An gano ESB a matsayin hangen nesa game da mummunar hali na jima'i a cikin al'ummomi da dama a Amurka, musamman a tsakanin maza da mata.13,14 Musamman ma, waɗannan binciken sun gano haɗin kai tsakanin cin zarafin jima'i (SC) da kuma sakamakon jima'i da yawa, irin su jima'i na jima'i mai kwakwalwa tare da abokan hulɗa da yawa, cutar mafi girma daga cutar kwayar cutar dan Adam (HIV) da sauran cututtuka da aka kamu da jima'i (STIs)15,16 da kuma gangancin neman fitar da jima'i na jima'i.17 Duk da haka, waɗannan binciken sun tantance samfurori na SC a yawancin mutane maimakon maimakon samin samfurori.
Ga wasu mutane tare da ESB, halayyarsu ta jima'i ba ta haɗu da abokiyar jima'i, amma dai an mayar da shi ne akan tsauraran matsala da / ko yin amfani da batsa. Duk da haka, yawanci fiye da rabin wadanda ke da rahoton rahoton rahoton na ESB game da jima'i da jima'i da abokan hulɗa18 kuma a cikin binciken daya game da gay da maza da ke dauke da SC, 92% ya ruwaito cewa jima'i da abokan tarayya ba su da iko.19 Mutanen da ke tare da ESB wadanda ke shiga cikin matsaloli masu yawa da suka yarda da su tare da masu yarda da su suna ci gaba da haɗari ga mummunan cututtuka na likita da kuma mace-mace da ke haɗa da ESB, wanda shine watsawa na STI, ciki har da HIV.17,20,21 Binciken da aka yi a Amurka ya nuna cewa ƙananan ƙididdiga a kan ma'auni mai amfani na ESB, Siffar Jima'i (SCS), hangen nesa da jima'i tare da abokan hulɗa mafi yawa, halayen haɗari da haɗari (misali, amfani da ɗan kwasfa mai amfani da ƙima) da kuma sayen STIs.3,22 Abin takaici, bayanai ba su da yawa a kan haɗin tsakanin ESB da halayyar haɗarin jima'i a mazaje masu tsaida.13,23 Ƙananan bayanai ba su da alaƙa da samfurori masu neman magani tare da ESB kuma sun gabatar da cikakkun bayanai.
Maganganun rashin kyau, musamman matsalolin da bala'in rai, sun haɗa da ESB.24 Abubuwa irin su ci karo da nau'o'in jima'i masu yawa da kuma ƙara yawan al'aurawa an ruwaito su a cikin maza da ke fama da wadannan jihohi.25 Irin wadannan dabi'un dabi'un da aka yi zaton suna aiki ne a matsayin masu haɗari ga ESB26 kuma zai iya sauƙaƙe ƙarin ɓangarorin jima'i na jima'i, kara haɗarin kamuwa da cutar HIV da STIs. Duk da haka, wasu masu bincike sun gano cewa kawai 'yan tsiraru (15-25%) na mutane suna ba da labarin yawan halayyar jima'i yayin da suke fuskantar damuwa ko rashin ciki.27
Wasu bayanai sun nuna cewa fuskantar damuwa, damuwa, ko fushi yana iya rinjayar yanke shawarar jima'i cikin hanyoyi masu ban sha'awa.28 A wasu lokuta, wasu nazarin sun gano cewa wasu mutane da ke fama da mummunar yanayi suna iya yin yanke shawara don hana haɗari.29 Game da haɗarin jima'i da ke faruwa, waɗannan bayanai zasu bada shawara cewa mutane da ke fama da damuwa ko damuwa ba zasu iya yin halayyar halayyar jima'i ba. Duk da haka, Mustanski28 ya gano cewa ƙara yawan damuwa sun danganci haɗarin jima'i da haɗari da wasu maza da mata da maza da tsinkayen rai kuma suna tsammanin cewa za a iya haɗuwa da abubuwan da ke cikin damuwa da jin daɗin jin daɗin da zai iya haifar da mummunar hali.
Yayin da aka gudanar da nazarin binciken na ESB a Amurka, cikakkun bayanai game da ESB a Brazil da sauran sassa na duniya suna da iyakancewa, suna jituwa da fahimtar ilimin, tun da batun halayen jinsi ya danganci bambancin al'adu. Akwai ƙananan rashin karatu game da tasiri na ESB da halin da ke ciki game da halayyar cutar HIV a cikin samfurori na neman magani.
Manufar binciken yanzu shine bincika ESB, damuwa, damuwa, da halayyar haɗarin jima'i tsakanin masu dauke da cutar ta ESB da kuma iko a babban birnin jihar São Paulo, Brazil. Bisa ga shaida daga Amurka, mun yi tunanin cewa mutanen da ke tare da ESB za su ba da ƙari ga rashin jin tsoro da damuwa da kuma bayar da rahoto game da halayen halayen jima'i fiye da rikici. Har ila yau, mun yi tsammanin cewa mummunar tashin hankali, damuwa, da kuma ESB, za a ha] a da halayen halayen jima'i.
Hanyar
Masu shiga da hanyoyin
Wannan takarda ya gabatar da bayanai daga binciken da aka gudanar a Ambulantrio de Impulso Sexual Excessivo da Prevenção de Desfechos Negativos Associations da Comportamento Sexual (AISEP), Instituto de Psiquiatria (IPq), asibitin das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP) . An hade masu halartar ta hanyar tallan tallace-tallace a cikin ma'aikata da kuma al'ummomin da ke kusa ta hanyar dabarun watsa labaru, irin su rediyo, mujallu, da mujallu. Hanya na farko na daukar nauyin da aka zartar da mahalarta tare da bayyanar ESB, kuma waɗanda suka nemi magani ga ESB sun cancanci nazarin idan an ce su suna da jima'i da yawa bisa ka'idar ICD-10 mai suna F52.7, wanda ke nufin sun yi kuka game da jima'i drive wanda yakan jagoranci zuwa ESB,4 da kuma jaraba da jima'i bisa ga ka'idar Goodman, wanda ke nufin cewa akwai ESB mai laushi wanda ke haifar da rashin lafiya ko rashin lafiya a cikin watanni 12 ta uku ko fiye daga cikin wadannan: haƙuri (haɓaka halayyar jima'i); janyewa (cututtukan jiki da / ko magunguna, irin su fuskantar abstinence); al'ada jima'i; Gudanar da nasara; lalata lokaci a shirye-shiryen yin jima'i; rage ayyukan zamantakewa ko sana'a; kuma ci gaba duk da sakamakon sakamako mai kyau.9 Hanya na biyu na daukar nauyin da aka yi wa mahalarta ba tare da bayyanar cutar ba. Mutanen da suka nemi haɗin kai a matsayin jagororin sun cancanta idan ba su cika ka'idodi don yin jima'i ba bisa ka'idar ICD-10 F52.7 ko don jaraba da jima'i bisa ga ka'idar Goodman. Bugu da kari, mahalarta sun kasance shekarun 18 da suka fi girma, karatun, kuma suna da zama a Brazil don shekaru 10 na karshe. Hanyoyin warwarewa don bincike sun haɗa da ganewar asali na kowane ɓangaren da ke faruwa: paraphilias (ICD-10 F65), matsalar ainihin jinsi (ICD-10 F64), schizophrenia, schizotypal da disordulum disorders (ICD-10 F20-F29), manic na yanzu ko magungunan hypomanic (F 30.0, F31.0, da F 31.1, F 31.2), da kuma sauran cututtukan lahani saboda rashin ciwon kwakwalwa ko rauni ko cuta na jiki (ICD-10 F0.6).
Dukan mutanen 204 sun amsa wa tallar tallace-tallace a lokacin yunkurin farko kuma 130 ya zo ne don hira da aka yi. Daga cikin wadannan, 114 maza da 10 mata sun cancanci cancanta kuma sun shiga cikin binciken, amma mutanen 26 basu kammala dukkan kima don dalilai daban-daban, ciki har da motsi zuwa wani birni, neman magani don yanayin daban-daban, ko ƙwarewar fahimtar matakan da suka dace. Dukkan mutanen 121 sun nemi su zama jagorori kuma 78 ya zo ne don ganawar da aka yi. Duk da haka, biyar daga cikin waɗannan sun sadu da ka'idoji don jima'i da jima'i kuma an cire su daga samfurin samfurin. Sauran 'yan takarar 73 masu zuwa, 64 maza da mata tara, an dauki su a matsayin jagororin kuma sun shiga cikin binciken. A cikin wannan takarda, muna bayar da rahoto daga mazaunan 88 wadanda suka cika ka'idoji don zubar da jima'i da jima'i, wanda za mu kira masu bincike na ESB, da kuma mazaunin 64 waɗanda basu cika ka'idoji don yin jima'i da kuma jima'i ba, wanda za mu kiran sarrafawa. Dukkan nazarin binciken sun kammala daga watan Oktoba 2010 zuwa Nuwamba 2011.
Duk mahalarta sun ba da sanarwar izini kuma sun kammala nazarin 2 hour daya wanda ya ƙunshi tsarin kai-tsaye da kai tsaye da kuma nazarin kulawa da hankali. Masu shiga sun kammala matakan kan kansu ta amfani da takarda da fensir. Ma'aikatan bincike sun ba da cikakken bayani game da matakan da suka dace da rahoto da kuma tattara bayanai na zamantakewar al'umma. Wani likitan ilimin likita ya jagoranci nazarin binciken asibiti don bincika ka'idodin cancanta. Gudanarwa sun sami tallafin kudi don sufuri. An bayar da magani ga waɗanda ke tare da ESB. Wannan nazarin ya sake nazari kuma ya amince da shi daga kwamiti na asibitin asibitin das Clínicas, Faculdade de Medicina, USP.
Matakan
An tambayi masu halartar su ba da rahoto game da shekarunsu, jinsi, matsayin auren aure, jinsi, shekarun ilimi, aikin aiki, samun kudin iyali a kowane lokaci, daidaitawar jima'i, da kuma yanayin da ke kan hanyar HIV.
Yanayin jima'i da yawa (ESB)
Cibiyar ta SCS ta samo asali don kimanta dabi'u na jima'i da jima'i.30 Ƙididdiga ta ƙunshi maganganun 10 (misali, "tunanin tunani da halayen kaina na haifar da matsalolin rayuwata.") Wanda aka kiyasta a kan ma'auni hudu daga 1 = ba a kowane abu ba kamar ni, zuwa 4 = sosai kamar ni. Yana da ma'auni mai amfani na ESB. An nuna alamar Brazil ta kasance mai aminci (Cronbach's alpha na 0.95).31
Ka'idojin ƙwararraji
An fassara fassarar harshen Turanci na Beck Anxiety Inventory (BAI) don amfani a Brazil32 kuma an samo ya zama abin dogara (Cronbach's alpha = 0.76). Wannan samfurin 21 ne wanda aka lasafta shi don auna ma'auni na bayyanar cututtuka na juyayi tare da ma'auni mai mahimmanci huɗu: 0 = ba cikakke ba, 1 = kadan, 2 = Daidai, da kuma 3 = mai tsanani. An fassara fassarar fassarar littafin Beck-Depression Inventory (BDI) a Brazil (Cronbach's alpha = 0.81)33 Wannan samfurin 21 ne wanda aka ba da rahoton kansa wanda aka tsara don auna yawan tsananin bayyanar cututtuka, kamar m, matsakaicin, da kuma mai tsanani.
Halin haɗarin jima'i
An samo asali ne na farko na wannan takarda ta hanyar binciken bincike na baya-bayan nan34,35 don tattara bayanai game da halayen jima'i tare da abokan hulɗa da masu haɗaka, ciki har da murnar kowane lokaci na jima'i da jima'i na ciki, amfani da robaron roba, da kuma yawan abokan hulɗa. An tsara matakan haɗarin haɓurwar jima'i a matsayin tambayoyin kai rahoto don tantance halin halayen jima'i a cikin watanni shida kafin zuwan. Wannan tambayoyin ya yi gwagwarmaya tare da mutanen 20 don bincika abubuwan da ke ciki da kuma abubuwan da ke ciki kuma suna da haruffa na Cronbach na 83.35%. Har ila yau, ya haɗa da abubuwan da suka dace game da yin jima'i a ƙarƙashin rinjayar barasa da magunguna.
Nazarin lissafi
An gudanar da nazarin ilimin lissafi ta amfani da sigar STATA 10 tare da mahimmin matakin p <0.05. Ana gabatar da ƙididdigar kwatancen azaman gwargwado don ƙididdigar sauye-sauye da ma'ana da daidaitattun ƙa'idodin ci gaba da masu canji. An yi amfani da kwatancen rukuni ta amfani da gwaje-gwajen murabba'i ɗaya ko raunin rashin daidaito da ƙarancin amincewa na 95% (95% CI) don masu canji iri-iri, kuma t-iyyata don ci gaba da canje-canje.
Don gwada gwagwarmayarmu ta farko cewa masu bincike na ESB za su bayar da rahoto na karuwa da tashin hankali da damuwa da kuma yawan halayen halayen jima'i fiye da sarrafawa, mun bincika bambance-bambance a cikin halaye na mahalarta, damuwa, damuwa da kuma SC, da kuma halayyar jima'i tsakanin masu amfani da ESB da kuma iko. Don gwada gwajinmu na biyu cewa rashin lafiya, damuwa, da kuma SC za su haɗu da halayen haɗarin jima'i, mun yi nazarin lissafi na al'ada don haka muyi la'akari da yadda za muyi nazari game da halayen halin jinin (tashin hankali, damuwa) ) da kuma SC game da halayen haɗari na jima'i, wato: 1) haɗin gwiwar kullun tare da abokin tarayya; 2) jima'i marar zubar da ciki tare da abokin tarayya; 3) jima'i na jima'i maras lafiya tare da abokin tarayya maras kyau; da kuma 4) jima'i maras amfani da jima'i tare da abokin tarayya. Dukkanin matakan da aka gyara don tsufa, tsere, matsayi na shari'a, daidaitawar jima'i, da matsayi na serological.
results
Abokan halaye suna gabatarwa Table 1. Masu bincike na ESB sun kasance sun fi girma fiye da controls (t(150) = 2.53; p = 0.006). Shekaru na masu kwakwalwa na ESB sun kasance tsakanin 21 da 66 shekaru da kuma shekarun jigilar da ke tsakanin 18 da 59 shekaru. Ƙwararrun masu bincike na ESB fiye da masu sarrafa su Caucasian (χ2(2) = 8.20; p = 0.01). Game da ainihin jima'i, mafi yawan masu bincike na ESB sun nuna cewa jima'i ne ko bisexual fiye da iko (χ2(1) = 12.10; p = 0.001) da kuma karin masu amfani da ESB (χ2(2) = 16.66; p <0.001). Akwai bambanci tsakanin yanayin aure tsakanin marasa lafiya na ESB da sarrafawa, tare da marasa lafiya na ESB wadanda zasu iya yin aure (χ2(2) = 4.64; shafi na <0.09).
Shafin 1 bayanan zamantakewar zamantakewar maza 88 marasa lafiya na ESB da kulawar maza 64 a São Paulo, Brazil
| Masu bincike na ESB (n = 88) | Gudanarwar (n = 64) | Ƙidaya (n = 152) | χ2/t gwajin gwajin | |
|---|---|---|---|---|
| race | ||||
| Caucasian | 70 (79.5) | 38 (59.4) | 108 (71.1) | |
| Zuriyar Afirka | 16 (18.2) | 25 (39.1) | 41 (27.0) | |
| Other | 2 (2.3) | 1 (1.6) | 3 (2.0) | 8.20* |
| Matsayin auren doka | ||||
| aure | 38 (43.2) | 17 (26.6) | 55 (36.2) | |
| single | 42 (47.7) | 41 (64.1) | 83 (54.6) | |
| saki | 9 (9.1) | 6 (9.4) | 15 (9.87) | 4.64† |
| Harkokin jima'i | ||||
| Gay da bisexual | 37 (42.1) | 10 (15.0) | 47 (30.9) | |
| Namiji | 51 (58.0) | 54 (84.4) | 105 (69.1) | 12.10‡ |
| Matsayin aiki | ||||
| Ba a yi aiki ba | 14 (15.9) | 1 (1.6) | 15 (9.9) | |
| aiki | 69 (78.4) | 48 (75.0) | 117 (77.0) | |
| Student | 5 (5.7) | 15 (23.4) | 20 (13.2) | 16.66‡ |
| Matsayi mai yakin da aka ruwaito | ||||
| unknown | 15 (17.0) | 13 (20.3) | 28 (18.4) | |
| korau | 64 (72.7) | 48 (75.0) | 112 (73.7) | |
| m | 9 (10.2) | 3 (4.7) | 12 (7.9) | 0.43 |
| Shekaru, ma'ana (SD) | 38.17 (8.91) | 33.98 (11.41) | 36.40 (10.21) | 2.53* |
| Shekaru na ilimi, ma'ana (SD) | 14.20 (4.18) | 13.47 (4.02) | 13.89 (4.12) | 1.09 |
| Rawan kuɗi na wata (R $), median (95% CI)§ | 3,000 (2,500-3,942) | 3,000 (2,700-4,000) | 3,000 (3,000-3,800) | 0.90 |
| Jima'i compulsivity, nufin (SD) | 31.93 (5.02) | 15.44 (5.44) | 24.99 (9.67) | 19.30‡ |
| Rashin tsoro, ma'ana (SD) | 13.43 (9.98) | 6.48 (8.42) | 10.51 (9.94) | 4.52‡ |
| Dama, ma'ana (SD) | 16.51 (8.60) | 6.21 (5.66) | 12.18 (9.06) | 8.88‡ |
Bayanan da aka gabatar a matsayin n (%), sai dai idan an rarrabe.
95% CI = 95% haɗin kai tsaye; ESB = hali mai haɗari; SD = daidaituwa na yau da kullum.
*p <0.05;
†p <0.10;
‡p <0.001.
§Mann Whitney U gwajin.
Masu bincike na ESB sun fi girma SC (t(150) = 19.30; p <0.001), damuwa (t(150) = 4.51; p <0.001), da kuma yawan damuwa (t(149) = 8.88; p <0.001) fiye da sarrafawa. Mun sami manyan alaƙa tsakanin SC da ɓacin rai (marasa lafiya na ESB: r = 0.38; p <0.001; controls: r = 0.25; p = 0.04), SC da tashin hankali (marasa lafiya na ESB: r = 0.27; p = 0.01; controls: r = 0.33; p = 0.007), da damuwa da damuwa (marasa lafiya na ESB: r = 0.66; p <0.001; controls: r = 0.70; p <0.001).
Ana kwatanta kwatanta tsakanin masu kwakwalwa na ESB da kuma iko don halayyar jima'i a cikin watanni shida kafin gabatarwa Table 2. Masu bincike na ESB sun kasance mafi kuskure na yin jima'i a ƙarƙashin rinjayar kwayoyi fiye da magunguna. Ƙungiyar ta rukuni ta ba da rahoton yadda ake yin halayyar jima'i da manyan abokan tarayya, haɗuwar haɗaka da haɗin kai tare da abokan tarayya, da kuma sauran alaƙa da ba tare da kariya ba tare da abokan hulɗa. Masu bincike na ESB sun ruwaito karin jima'i da abokan hulɗa da kuma mafi yawan abokan tarayya. Masu ba da rahoton na ESB sun bayar da rahoton yawancin jima'i da abokan hulɗar da ba tare da su ba. Daga wadanda suka bayar da rahoton jima'i na kwakwalwa tare da abokan tarayya (n = 28), 18 (64%) da kansu da aka gano su ne gay ko bisexual, yayin da 10 (36%) kai tsaye a matsayin madaidaiciya. Table 3 yana nuna rarraba dabi'un jima'i na masu kwakwalwa ta ESB bisa ga jima'i. Game da dangantakar jima'i tare da abokan hulɗa, wadanda suke da kansu a matsayin mutumin da aka ba da labarin sun hada da jima'i, jima'i, da kuma abokiyar haɓaka. Game da dangantakar jima'i tare da abokan hulɗa, wadanda suke da kansu a matsayin maza da namiji sun yi bayanin yadda za su kasance da jima'i da haɗuwa da haɗari, yayin da waɗanda suke da kansu suna cewa gay ko bisexual sun haɗu da ƙananan abokan hulɗa da kuma ba da labari game da jima'i.
Table 2 Halin jima'i na 88 ESB marasa lafiya da masu kula da 64, São Paulo, Brazil
| Masu bincike na ESB (n = 88) | Gudanarwar (n = 64) | OR | 95% CI | p-darajar | |
|---|---|---|---|---|---|
| Jima'i a cikin watanni shida na ƙarshe | 74 (84.1) | 50 (78.1) | 1.48 | 0.65-3.37 | 0.350 |
| Jima'i da abokin tarayya a cikin watanni shida na ƙarshe | 39 (44.3) | 43 (67.2) | 0.39 | 0.20-0.76 | 0.006 |
| Jima'i mai haɗuwa da abokin tarayya | 32 (36.4) | 39 (60.9) | 0.37 | 0.19-0.71 | 0.003 |
| Amfani da kwaroron roba ba tare da jimawa ba tare da abokan hulɗa | 26 (29.6) | 29 (45.3) | 0.51 | 0.26-0.99 | 0.047 |
| Jima'i mai jima'i tare da abokin tarayya | 21 (23.9) | 17 (26.6) | 0.87 | 0.41-1.82 | 0.710 |
| Amfani da kwaroron roba ba tare da jimawa ba tare da haɗin gwiwa tare da manyan abokan | 14 (15.9) | 10 (15.6) | 1.02 | 0.42-2.47 | 0.960 |
| Yin jima'i da abokin tarayya a cikin watanni shida na ƙarshe | 62 (70.5) | 22 (34.4) | 4.55 | 2.28-9.07 | <0.001 |
| Yawan masu yin jima'i a cikin watanni shida na ƙarshe, ma'ana (SD) | 12.63 (27.98) | 0.86 (1.76) | t (150) = -3.36 | 0.001 | |
| 0 | 26 (29.6) | 42 (65.6) | 1 | ||
| 1 | 10 (11.4) | 12 (18.8) | 1.35 | 0.51-3.56 | 0.550 |
| 2 ko fiye | 52 (59.1) | 10 (15.6) | 8.4 | 3.64-19.36 | <0.001 |
| Saduwa da jima'i da abokin tarayya | 35 (39.8) | 18 (28.1) | 1.69 | 0.84-3.37 | 0.140 |
| Amfani da kwaroron roba ba tare da jimawa ba tare da abokan hulɗa | 23 (26.1) | 12 (18.8) | 0.62 | 0.70-3.37 | 0.290 |
| Jima'i mai jima'i tare da abokin tarayya marar kyau | 46 (52.3) | 17 (26.6) | 3.03 | 1.51-6.07 | 0.020 |
| Amfani da kwaroron roba ba tare da jimawa ba lokacin hulɗa mai tsanani da abokan hulɗa | 28 (31.8) | 9 (14.1) | 2.85 | 1.24-6.58 | 0.010 |
| Jima'i a ƙarƙashin rinjayar barasa | |||||
| A'a | 55 (63.2) | 38 (59.4) | 1 | ||
| Wani lokaci | 29 (32.9) | 25 (39.1) | 0.76 | 0.39-1.50 | 0.440 |
| Sau da yawa | 4 (4.6) | 1 (1.6) | 1.14 | 0.58-2.21 | 0.700 |
| Jima'i ƙarƙashin rinjayar kwayoyi | |||||
| A'a | 74 (84.1) | 63 (98.4) | 1 | ||
| Wani lokaci | 11 (12.8) | 1 (1.6) | 9.00 | 1.07-75.27 | 0.010 |
| Sau da yawa | 3 (3.5) | 0 | - |
Bayanan da aka gabatar a matsayin n (%), sai dai idan an rarrabe.
95% CI = 95% haɗin kai tsaye; ESB = hali mai haɗari; OR = rashin daidaito.
Kwaroron roba ba tare da amfani ba yana nufin amfani da robaron roba a 0-75% lokuta.
Shafin 3 Halin jima'i na 37 gay / bisexual da 51 mata da maza na ESB, São Paulo, Brazil
| Gay / bisexual | Namiji | p-darajar | |
|---|---|---|---|
| Jima'i a cikin watanni shida na ƙarshe | 31 (83.8) | 43 (84.3) | 0.950 |
| Jima'i da abokin tarayya a cikin watanni shida na ƙarshe | 8 (21.6) | 31 (60.8) | <0.001 |
| Jima'i mai haɗuwa da abokin tarayya | 2 (5.4) | 30 (58.8) | <0.001 |
| Kwaroron roba ba tare da yin amfani da ita ba a lokacin haɗuwar mata da manyan abokan | 1 (2.7) | 25 (49) | <0.001 |
| Jima'i mai jima'i tare da abokin tarayya | 8 (21.6) | 13 (25.5) | 0.670 |
| Kwaroron roba ba tare da yin amfani da ita ba a yayin da yake yin tasiri tare da manyan abokan | 6 (16.2) | 8 (15.7) | 0.950 |
| Yin jima'i da abokin tarayya a cikin watanni shida na ƙarshe | 31 (83.8) | 31 (60.8) | 0.020 |
| Yawan masu yin jima'i a cikin watanni shida na ƙarshe, ma'ana (SD) | 23.8 (39.5) | 4.5 (8.9) | 0.006 |
| Saduwa da jima'i da abokin tarayya | 6 (16.2) | 29 (56.9) | <0.001 |
| Kwaroron roba ba tare da yin amfani da ita ba a lokacin haɗuwar haɗaka da abokan hulɗa | 4 (10.8) | 19 (37.6) | 0.007 |
| Jima'i mai jima'i tare da abokin tarayya marar kyau | 29 (78.4) | 17 (33.3) | <0.001 |
| Kwaroron roba ba tare da yin amfani da ita ba a yayin da yake da dangantaka mai tsanani da abokan hulɗa | 18 (48.7) | 10 (19.6) | 0.004 |
Bayanan da aka gabatar a matsayin n (%), sai dai idan an rarrabe.
ESB = halayyar jima'i.
Kwaroron roba ba tare da amfani ba yana nufin amfani da robaron roba a 0-75% lokuta.
Figure 1 yana nuna alamar bambance-bambancen da za a iya canzawa tsakanin mahaifa da kuma jima'i tare da abokan hulɗa. Wadannan rahotanni ba su da amfani da kwaroron roba da manyan abokan tarayya sun ba da ƙananan ƙwayar magunguna fiye da wadanda suke yin amfani da kwaroron roba. A wasu lokuta, wadanda suke yin amfani da kundin roba ba tare da abokan hulɗa ba sun ba da mahimmanci fiye da wadanda suke yin amfani da kwaroron roba.
Hoto 1: Yin amfani da kwaroron roba tare da manyan abokan hulɗa tsakanin halayen jima'i da yawa (ESB) marasa lafiya da sarrafawa (n = 152). A: amfani da robaron roba wajen saduwa da babban abokin zama. Wadanda ke bayar da rahoton yin amfani da kwaroron roba ba safai ba da aka gabatar da raguwar damuwa (yana nufin [M] = 9.3; daidaitaccen kaucewa [SD] = 7.5 vs. 13.8; SD = 9.5) (t[134.5] = 3.2; p = 0.001) da kuma matsanancin damuwa (M = 8.0, SD = 9.3 vs. M = 11.9; SD = 10.0) (t[150] = 2.4; p = 0.02); B: robaron roba ya yi amfani da haɗin gwiwa tare da abokin tarayya; C: robaron roba ya yi amfani da shi a cikin haɗuwar haɗaka tare da abokin tarayya. Wadannan rahotanni ba tare da amfani da kwaroron roba ba sunyi amfani da ƙwaƙwalwar ƙyama (M = 14.8; SD = 9.0 vs. 11.4; SD = 9.0) (t[150] = -2.0; p = 0.05); D: robaron roba ya yi amfani da jima'i mai tsanani tare da abokin tarayya. Wadannan rahotanni ba tare da amfani da kwaroron roba ba sun yi amfani da karuwanci (SC) (M = 29.8; SD = 9.8 vs. 23.5, SD = 9.5) (t[150] = -3.6; p <0.001), damuwa (M = 17.6; SD = 8.9 vs. M = 10.4; SD = 8.4) (t[150] = -4.4; p <0.001), da kuma yawan damuwa (M = 15.4; SD = 10.6 vs. M = 8.9; SD = 9.2) (t[150] = -3.6; shafi na <0.001). Babu wani bambanci mai mahimmanci na lissafi da aka gani a cikin SC a cikin A, a cikin kowane batun tabin hankali a cikin B, ko cikin damuwa da SC a cikin C. Mahimmanci yana nufin 76-100% na lokuta. Ba sau da yawa yana nufin 0-75% na lokuta.
Ana gabatar da dabi'un halayen halayen halayyar halayyar halayen halayen jima'i Table 4. An nuna SC a matsayin mai hangen nesa wanda yake da alaƙa da dangantaka marar lafiya tare da abokan hulɗa ba tare da kula da shekarun haihuwa, tsere, matsayi na auren doka ba, daidaitawar jima'i, da matsayi na serological. Ƙididdigar kowace ƙwayar SC ta ƙara ƙananan rashin daidaituwa ta jima'i tare da abokan hulɗa ta 7%.
Tebur na 4 Tsarin yin amfani da kwaroron roba na yin amfani da jima'i ta hanyar shigar da ɗaliban marasa lafiya da sarrafawa (n = 152), São Paulo, Brazil
| Misalin ƙwaroron roba ya yi amfani da shi a cikin haɗuwar haɗaka tare da abokin tarayya | Misalin ƙwaroron roba ya yi amfani da shi a cikin hulɗa mai tsabta tare da abokin tarayya | Misalin ƙwaroron roba ya yi amfani da shi a cikin haɗuwar mata da abokin tarayya | Misalin ƙwaroron roba ya yi amfani da jima'i mai tsanani tare da abokin tarayya | |||||
|---|---|---|---|---|---|---|---|---|
| m* | Ba daidai ba | m* | Ba daidai ba | m* | Ba daidai ba | m* | Ba daidai ba | |
| Jima'i compulsivity | ||||||||
| OR | reference | 1.00 | reference | 1.04 | reference | 0.98 | reference | 1.07† |
| 95% CI | - | 0.94-1.06 | - | 0.98-1.11 | - | 0.91-1.05 | - | 1.01-1.14 |
| mawuyacin | ||||||||
| OR | reference | 0.95 | reference | 0.90† | reference | 1.03 | reference | 1.05 |
| 95% CI | - | 0.87-1.03 | - | 0.81-1.00 | - | 0.93-1.15 | - | 0.97-1.13 |
| juyayi | ||||||||
| OR | reference | 1.00 | reference | 1.03 | reference | 1.00 | reference | 1.02 |
| 95% CI | - | 0.95-1.07 | - | 0.96-1.11 | - | 0.92-1.09 | - | 0.96-1.08 |
95% CI = 95% haɗin kai tsaye; OR = rashin daidaito.
*76-100%.
†p <0.05.
Dukkan tsarin an daidaita don shekarun, tseren, matsayi na aure, daidaitawar jima'i, da matsayi na serological.
tattaunawa
Nau'i biyu na halayen halayen jima'i za a iya bambanta. Na farko, game da jima'i tare da abokin tarayya, magunguna sun nuna mahimmancin halayen haɗuwar mata, wanda mafi yawansu ba shi da dangantaka. Wannan yana yiwuwa saboda akwai karin mutane masu daidaitawa a cikin samfurin samfurin, wanda ke yin jima'i tare da abokin tarayya ba tare da kwaroron roba ba, wanda yake a cikin mahallin dangantaka da kwanciyar hankali na dogon lokaci. Na biyu, game da jima'i tare da abokan tarayya, masu bincike na ESB sun ba da rahoton wasu abokan tarayya, ƙananan halayen jima'i tare da abokan tarayya, ƙananan halayen maɗaukaki na jima'i, da kuma ƙananan halayen rikice-rikicen rikice-rikice maras lafiya fiye da magunguna. Wannan haɗin yana damuwa saboda hadarin STIs da HIV. Wani bincike-bincike yayi nazari akan muhimmancin jima'i a cikin kwayar cutar HIV kuma ya tabbatar da cewa jima'i mai jima'i shine babban haɗari ga cutar HIV har ma a lokacin magungunan rigakafi mai karfi.36 Bugu da ƙari kuma, sun sami karuwar yawancin maza da mata da suke yin jima'i tare da ƙananan farashin amfani da robar roba,36 wanda ya dace da bayananmu, wanda 36% na mahalarta na ESB suka bayar da rahoton rashin jituwa tare da abokan hulɗar da aka haɗu sun kasance mutane masu dacewa. Yayin da muka mayar da hankalinmu game da halin jima'i na masu kwakwalwa na ESB, mun kuma lura da yadda mazauna maza da mata ke shiga cikin jima'i da kuma yadda za a yi tare da abokan hulɗa.
Yana da muhimmanci a nuna cewa 16% na masu kwakwalwa ta ESB da 22% na controls basu shiga cikin jima'i da abokan tarayya a cikin watanni shida da suka wuce ba. Sabili da haka, bincike game da halayen haɗarin jima'i ba shi da asusun duk samfurin kuma yana iya jaddada ikonsa na tantancewa don gane bambance-bambance. Wataƙila wannan shine dalilin da yasa bambance-bambance bambance-bambance ba tare da bambanci tsakanin kungiyoyi ba dangane da haɗuwar haɗuwa da hauka da kuma jima'i maras amfani da kwakwalwa tare da abokan tarayya, kodayake masu fitowa na ESB, musamman mutanen da suka dace, sun ruwaito wasu daga cikin waɗannan halayen fiye da controls.
Hanyar daban-daban na bayyanuwar tunanin mutum ta samo asali ne daga nazarin halin halayen jima'i tare da abokan hulɗa da maɗaukaka. Abin damuwa mai girma, wadanda ke yin rahoto ba tare da amfani da kwaroron roba ba tare da yin amfani da abokan hulɗa ba su ba da matsayi mafi mahimmanci, musamman ma lokacin da suke yin jima'i. Wadannan binciken sunyi daidai da nazarin da ke bayar da rahoton tasirin tasiri (damuwa, damuwa)28,37 da SC17,30 game da halayyar cutar HIV. Saboda haka, damuwa yana iya haɗuwa da haɗarin jima'i, musamman a lokacin la'akari da ka'idar juyin juya hali, inda tashin hankali da jima'i suka raba wasu kayan aiki, wasu kuma suna aiki da jima'i don magance matsalolin tashin hankali,38 Ta haka ne ke kasancewa da ƙari ga hadarin jima'i.28 Halin damuwa na iya taimakawa wajen kunnawa hali na jima'i,25 wanda, a gefe guda, yana da mahimmanci a yayin da yake faruwa tare da mafi girma SC.39 Bugu da ƙari, da yawa nazarin sun bayar da rahoton ƙara ƙarfafa halin jima'i a cikin mutane tare da ESB,40 wanda ya dace da SC. Wadanda ke gabatar da mafi yawan jima'i da halayyar jima'i sukan fi haɗari da cutar HIV.26,28 Sabili da haka, SC tana da wata tasiri game da halayen haɗari da jima'i, tun da yake ya yi annabci game da jima'i maras lafiya tare da abokan tarayya a cikin bincikenmu. Dama da damuwa ba su kula da wata ƙungiya tare da halayen haɗari a cikin rikici ba. Wannan yana iya kasancewa saboda an haɗa su tare da SC kuma suna iya taka rawa a cikin halin haɗari na jima'i, misali, ƙãra ƙwayar SC. Bayanan mu sun yarda da nazarin yawan mutane game da maza da suka yi jima'i da maza (MSM)17 kuma tare da nazarin asibitin kan HIV,21 inda SC ke annabta halin halayen jima'i.
Bayanin mu yana da alamun lafiyar jama'a, likitoci, da kuma bincike. Daidaita tsakanin damuwa, damuwa, da SC da ƙungiyoyi masu zaman kansu tare da abokan hulɗar da suke tare da su na tallafawa nazarin kwanan nan suna nuna cewa cutar ta HIV za ta iya bayyanawa ta hanyar fahimtar juna, wanda ke nufin cewa hadarin samun yanayin zai haifar da ƙarin daga hulɗar da dama abubuwan haɗari fiye da sakamako mai zaman kanta na abubuwan mutum.22 Wadannan bayanan suna da matukar muhimmanci ga lafiyar jama'a, tun da yake suna da dangantaka da mazajen duk jima'i a cikin asibiti. Daidaita tsakanin waɗannan ka'idodin tunanin mutum yana mahimmanci game da dalilai na asibiti, tun da yake yana kara ƙananan zuciya kuma ya sa magani yafi kalubale,41 musamman la'akari da cewa irin wadannan mutane suna magance matsalolin magance maganin. A ƙarshe, daidaitawar tsakanin alamun kimiyya na jiki (juyayi, ciki, da kuma SC) na taimakawa wajen bincike a fagen, domin yana goyon bayan wani ɓangare na rashin daidaito tsakanin mata da maza: "Sau da yawa cikin abubuwan da ke cikin jima'i, misali, tashin hankali, rashin tausayi, rashin tausayi, rashin jin dadi). "Haɗakarwar jima'i da ke haɗaka da waɗannan yanayin bayyanar sun nuna muhimmancin bincike na gaba game da hanyoyin jima'i da haɗin kai a cikin mutane da ESB don inganta fahimtar babban ilimin psycho-psychological da pathophysiological dalilai da suka shafi.
Bincikenmu ya dogara ne a kan wani asibiti mai sauƙin samfurin, wanda ya haifar da bayan wasu mutane da suka tuntube mu ba su ci gaba da aiwatarwa ba, kuma, saboda haka, ba mu iya tattara bayanai akan su ba. Wadanda suka gama aiwatarwa sun hada da, idan sun kasance ilimi. Wadannan hanyoyi suna hana karuwar bayanai ɗinmu. Abin takaici, akwai ƙananan bambance-bambancen zamantakewar zamantakewa tsakanin masu kwakwalwa na ESB da kuma iko. Musamman, zai fi kyau idan muna da karin daidaituwa a rarraba jima'i a tsakanin kungiyoyi, tun da yake maza da yara maza suna ba da labarin yawan damuwa, damuwa, da kuma jima'i.17 Bugu da ƙari kuma, mun daidaita halin kirkirar da ke tattare da halayen jima'i a cikin shekaru, tseren, matsayin auren doka, matsayi na sakonni, da kuma jima'i don kawar da sakamakon rikicewa. Wani iyakancewar wannan binciken ba a bincika wahalar matasan ba. Magungunan mahaifa suna bayar da rahoto game da matsalar ƙananan yara, wanda ke da alaƙa da depressive bayyanar cututtuka,42 kuma dukkanin abubuwan guda biyu na iya kara yawan halayen halayen halayen jima'i. Ga mafi kyawun iliminmu, wannan shine binciken farko game da SC, yanayin mummunar yanayi, da kuma halayen haɗarin jima'i a cikin asibitoci na ƙwararruci wanda ya hada da mazaje maza da mata. Bayananmu sun jaddada muhimmancin bincike na SC, damuwa, da damuwa ga mutane da ke neman maganin ESB, tun da yake magance waɗannan al'amurra na tunanin mutum na iya taimakawa wajen yaduwar cutar HIV.
Godiya
Wannan binciken ya tallafawa Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP; bayar da 2010 / 15921-6).
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An samu: Agusta 30, 2017; An karɓa: Disamba 07, 2017
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