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When we talk about sex-whether great, good, bad, or unlawful-we often turn to consent as both our erotic and moral savior. We ask questions like, What counts as sexual consent? How do we teach consent to impressionable youth, potential predators, and victims? How can we make consent sexy?What if these are all the wrong questions? What if our preoccupation with consent is hindering a safer and better sexual culture? By foregrounding sex on the social margins (bestial, necrophilic, cannibalistic, and other atypical practices),Screw Consentshows how a sexual politics focused on consent can often obscure, rather than clarify, what is wrong about wrongful sex.Joseph J. Fischel argues that the consent paradigm, while necessary for effective sexual assault law, diminishes and perverts our ideas about desire, pleasure, and injury. In addition to the criticisms against consent leveled by feminist theorists of earlier generations, Fischel elevates three more: consent is insufficient, inapposite, and riddled with scope contradictions for regulating and imagining sex. Fischel proposes instead that sexual justice turns more productively on concepts of sexual autonomy and access. Clever, witty, and adeptly researched,Screw Consentpromises to change how we understand consent, sexuality, and law in the United States today.

Penile fracture involves rupture of the tunica albuginea of the corpora cavernosa. It is typically the result of flexion-based trauma of the erect penis during intercourse, whereby the penis strikes the pubic symphysis or perineum. Classic presentation includes report of a sudden “pop” or “snap” followed by pain, rapid detumescence, and subsequent development of a darkly discolored and swollen penis (the so called “eggplant” deformity). Urethral trauma is seen in up to 38 % of cases. Diagnosis is primarily clinical. Early surgical intervention remains the gold standard and is typically associated with a positive outcome. Herein, we offer a review of the most up-to-date data on this topic, along with guidance from clinical practice.

The ex-copula penile dorsiflexion reflex (PDFR) is an established measure of sexual dysfunction in male rat models of spinal cord injury. Although the PDFR after complete spinal transection is well described, information regarding the more clinically relevant incomplete spinal contusion injury model is limited. This study examined, using two-dimensional (2D) kinematic analysis, the relationship between the PDFR and degree of white matter sparing (WMS). Male Wistar rats received a T9 contusion with varying degrees of impactor forces. Weekly kinematic recordings of the PDFR were made 3-8 weeks postinjury. Sexual reflex components examined included maximum angle of penile dorsiflexion, total penile event duration, and penile ascent speed. Post hoc comparison between animals grouped based upon injury severity (moderate-severe: 13.33%-17.15% WMS vs moderate: 20.85%-33.50% WMS) indicated PDFR effects. Specifically, the numbers of animals with more moderate contusions having data points above the median in both maximum angle of penile dorsiflexion and penile ascent speed were significantly lower than animals with more severe injuries. Total penile event duration was also affected but only at more chronic time points (6-8 weeks). Thus, 2D kinematic analysis of the PDFR allows for more consistent and quantifiable analysis of the subtle differences that can occur between injury severity groups in the rat contusion model.

Background A 23-year-old man presented with a painful penis following sexual intercourse. On examination he had a swollen, bruised penis that was tender on palpation, most markedly on the right lateral aspect. Investigations Urinalysis. Diagnosis Rupture of right corpus cavernosum. Management Immediate surgical repair.

This chapter contains sections titled: Child abuse and neglect Child sexual abuse Management of suspected or actual child abuse Conclusions References

BackgroundSpinal cord injury (SCI) is a life-changing experience that comes with multiple health challenges such as bowel, bladder and sexual health problems. Studies on the experiences of people with SCI based in rural South Africa are scarce.ObjectivesThis study aimed to explore the experience and long-term care needs related to sexual, bowel and bladder problems in people with SCI in a rural setting.MethodAn exploratory qualitative design was employed. Semi-structured interviews were conducted with people with SCI living in rural KwaZulu-Natal. The interviews were transcribed verbatim and coded. The content analysis steps were followed to identify categories and themes.ResultsA total of 12 individuals with SCI were interviewed. Frustration was the main theme that emerged with three sub-themes: types, management and effects of sexual, and bladder and bowel problems on individuals with SCI. The expressed long-term care needs were medication specific to SCI conditions, health information on secondary health conditions and prevention care, and resources such as nappies and quality catheters.ConclusionThe findings confirm that secondary health conditions such as bowel, bladder and sexual health problems affect the well-being of people with SCI in rural settings. Prevention care is urgently needed.ContributionPatient education information on bowel, bladder and sexual health problems, and access to medication is imperative to support self-management practice.

The purpose of this study was to assess predictors of injury in a preliminary model with victim and forensic characteristics as variables. Assessment of predictors will fill gaps in the literature, help clinicians improve data‐gathering methods, and identify characteristics associated with rape‐related injury of women who may be at higher risk for subsequent poor health.

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228). The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response. Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

Objectives. To examine how sexual orientation change efforts (SOCE) are associated with suicide morbidity after controlling for adverse childhood experiences (ACEs). Methods. Cross-sectional survey data are from the Generations survey, a nationally representative sample of 1518 nontransgender sexual minority adults recruited between March 28, 2016, and March 30, 2018, in the United States. Self-identified transgender individuals were included in a separate, related TransPop study. We used weighted multiple logistic regression analyses to assess the independent association of SOCE with suicidal ideation and suicide attempt while controlling for demographics and ACEs. Results. Approximately 7% experienced SOCE; of them, 80.8% reported SOCE from a religious leader. After adjusting for demographics and ACEs, sexual minorities exposed to SOCE had nearly twice the odds of lifetime suicidal ideation, 75% increased odds of planning to attempt suicide, and 88% increased odds of a suicide attempt with minor injury compared with sexual minorities who did not experience SOCE. Conclusions. Over the lifetime, sexual minorities who experienced SOCE reported a higher prevalence of suicidal ideation and attempts than did sexual minorities who did not experience SOCE. Public Health Implications. Evidence supports minimizing exposure of sexual minorities to SOCE and providing affirming care with SOCE-exposed sexual minorities.

Purpose Although vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study. Methods Four oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults). Results Twenty participants were 26–71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills. Conclusions According to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial.