Is there a link between paternity concern and female genital cutting in West Africa?

Here we explore the relationship between female genital cutting (FGC), sexual behaviour, and marriage opportunities in five West African countries. Using large demographic datasets (n 72,438 women, 12,704 men, 10,695 couples) we explore key (but untested) assumptions of an evolutionary proposal that FGC persists because it provides evolutionary fitness benefits for men by reducing non-paternity rates. We identify and test three assumptions implicit in this proposal. We test whether cut women have reduced extra-pair sex before or within marriage; whether FGC is associated with a younger age at marriage as an indication of partner preference; and whether individual and group-level indicators of paternity concern are associated with a stronger preference for marriage to women with FGC.Our results show that FGC status does not affect the odds of women engaging in several indicators of premarital sex, however women with FGC have significantly lower odds of having more than one lifetime sexual partner. We also show that women with FGC get married at a younger age which supports the argument that FGC status influences women's marriage opportunities, even when it does not restrict sexual activity. Finally, we find that in population groups where reported sexual activity and perceived risk of women's extra-pair sex is high, men have higher odds of marrying a first wife with FGC. Together, these results indicate that paternity certainty may be one of several factors contributing to the persistence of FGC in this sample, and that group-level sexual norms are key to maintaining the practice of FGC through the marriage market.     

Female genital cutting and reproductive experience in Minya, Egypt

In African populations practicing female genital cutting (FGC), beliefs exist that these procedures enhance reproduction and that their medicalization may diminish adverse effects, yet available findings are mixed in part for methodological reasons. We use data from a representative sample of ever-married women aged 17-55 years in Minya, Egypt, to examine the effects of type of FGC and type of circumciser on a woman's risks of primary infertility and pregnancy loss. Contrary to previous studies in Egypt, neither type of circumcision nor type of circumciser is associated with adverse fertility outcomes among circumcised women in Minya.     

Male circumcision and sexually transmitted infections in Botswana

This study set out to investigate the influence of male circumcision and other factors on sexually transmitted infections in Botswana. A syndromic approach, which diagnoses a sexually transmitted infection based on the presence of urethral discharge or genital ulcers rather than on laboratory tests, was used. The data were from the 2001 Botswana AIDS Impact Survey where a nationally representative, randomly selected sample of men and women aged 10-64 years were interviewed in both urban and rural areas. The sample selected for this study consisted of 216,480 men aged 15-64 years who had ever had sexual intercourse. The logistic regression technique was executed to examine the association between male circumcision and self-reported urethral discharge or genital ulcers, while controlling for all other independent variables in the analysis. The main finding of this study was that among men who are circumcised, the odds for self-reported urethral discharge or genital ulcers are significantly lower than for those men who are not circumcised in both urban and rural Botswana. The analysis also showed that the odds in favour of self-reported urethral discharge or genital ulcers, for men who drink alcohol, are twice as large as those for men who do not drink alcohol, controlling for all other independent variables in the analysis. Religion and ethnicity also came through as factors exerting a protective influence against self-reported symptoms of sexually transmitted infections. The conclusion is that while male circumcision appears to be significantly associated with the risk for self-reported urethral discharge or genital ulcers, it is man's behaviour, irrespective of ethnicity or religious dictates, that continues to play a vital role in protection against self-reported symptoms of sexually transmitted infections in Botswana.     

Preface: Genetics and the human encounter with alcohol

Abstract

In this paper, we calculate a base line of statistical data on the frequency of sexual activity at various ages of Taiwanese women. A cross‐sectional study using questionnaires administered during personal interviews was conducted on more than seventeen thousand women who attended family planning clinics in the Taipei metropolitan area in 1991 and 1992. Of the women surveyed, 2.8 per cent were sexually inactive in the previous month, 83.67 per cent had intercourse one to nine times in the previous month, and 13.56 per cent had intercourse ten times or more. The mean frequency of sexual activity was 6.8 times a month. Age‐specific mean coital frequencies for the age groups of less than 25 years, of 25–34 years, and of 35–44 years were 10.3, 7.3, and 6.6 times per month, respectively. Increased sexual frequency was associated with the following factors: young age, unmarried, lower educational level, fewer years of marriage and being on the pill. When logistic regression was used to control for confounding variables, we found that a woman's age is the most significant factor in predicting her sexual frequency.     

Coitus, the proximate determinant of conception: inter-country variance in sub-Saharan Africa

There is a general consensus in the literature that fertility differences between populations can be accounted for by differences in just four key proximate determinants: nuptiality, the postpartum non-susceptible period, contraception and abortion. Natural fecundibility is generally assumed to be constant between populations. This paper puts the theoretical and empirical case for a re-evaluation of that assumption, drawing on the under-utilized data on sexual activity collected in the Demographic Health Surveys (DHSs). Using data for married women in nine African countries, the analysis finds substantial population level differences in mean monthly coital frequency, which, if accurate, suggest an important demographic effect. There is a clear regional patterning to these differences, with levels of activity considerably lower among women in the West African populations included in the study than those from East and southern Africa. For West Africa in particular the data indicate the normality of exceptionally long periods of very infrequent or no intercourse by married women outside the period of postpartum abstinence. The findings challenge prevailing presumptions concerning susceptibility to pregnancy in marriage on which statistics for unmet need for family planning are derived. While doubts are raised over the precision of the sexual activity data used, the paper argues for the need for a greater effort to operationalize the 'proximate determinant of conception', not only for more accurate fertility modelling, but also as a planning tool for a more sensitive provision of family planning services in Africa.     

Genital cutting and western discourses on sexuality

This article explores dominant discourses surrounding male and female genital cutting. Over a similar period of time, these genital operations have separately been subjected to scrutiny and criticism. However, although critiques of female circumcision have been widely taken up, general public opinion toward male circumcision remains indifferent. This difference cannot merely be explained by the natural attributes and effects of these practices. Rather, attitudes toward genital cutting reflect historically and culturally specific understandings of the human body. In particular, I suggest that certain problematic understandings of male and female sexuality are deeply implicated in the dominant Western discourses on genital surgery.     

<Emphasis Type="Bold">On Female Genital Cutting: Factors to be Considered When Confronted With a Request to Re-infibulate</Emphasis>

According to the World Health Organization, female genital cutting affects millions of girls and women worldwide, particularly on the African continent and in the Middle East. This paper presents a plausible, albeit hypothetical, clinical vignette and then explores the legal landscape as well as the ethical landscape physicians should use to evaluate the adult patient who requests re-infibulation. The principles of non-maleficence, beneficence, justice, and autonomy are considered for guidance, and physician conscientious objection to this procedure is discussed as well. Analyses of law and predominant principles of bioethics fail to yield a clear answer regarding performing female genital cutting or re-infibulation on an adult in the United States. Physicians should consider the patient’s physical, mental, and social health when thinking about female genital cutting and should understand the deep-rooted cultural significance of the practice.     

Straight but Not Narrow; Within-Gender Variation in the Gender-Specificity of Women’s Sexual Response

Gender differences in the specificity of sexual response have been a primary focus in sexual psychophysiology research, however, within-gender variability suggests sexual orientation moderates category-specific responding among women; only heterosexual women show gender-nonspecific genital responses to sexual stimuli depicting men and women. But heterosexually-identified or “straight” women are heterogeneous in their sexual attractions and include women who are exclusively androphilic (sexually attracted to men) and women who are predominantly androphilic with concurrent gynephilia (sexually attracted to women). It is therefore unclear if gender-nonspecific responding is found in both exclusively and predominantly androphilic women. The current studies investigated within-gender variability in the gender-specificity of women’s sexual response. Two samples of women reporting concurrent andro/gynephilia viewed (Study 1, n = 29) or listened (Study 2, n = 30) to erotic stimuli varying by gender of sexual partner depicted while their genital and subjective sexual responses were assessed. Data were combined with larger datasets of predominantly gyne- and androphilic women (total N = 78 for both studies). In both studies, women reporting any degree of gynephilia, including those who self-identified as heterosexual, showed significantly greater genital response to female stimuli, similar to predominantly gynephilic women; gender-nonspecific genital response was observed for exclusively androphilic women only. Subjective sexual arousal patterns were more variable with respect to sexual attractions, likely reflecting stimulus intensity effects. Heterosexually-identified women are therefore not a homogenous group with respect to sexual responses to gender cues. Implications for within-gender variation in women’s sexual orientation and sexual responses are discussed.     

Possible evolutionary origins of human female sexual fluidity

I propose an evolutionary theory of human female sexual fluidity and argue that women may have been evolutionarily designed to be sexually fluid in order to allow them to have sex with their cowives in polygynous marriage and thus reduce conflict and tension inherent in such marriage. In addition to providing an extensive definition and operationalization of the concept of sexual fluidity and specifying its ultimate function for women, the proposed theory can potentially solve several theoretical and empirical puzzles in evolutionary psychology and sex research. Analyses of the National Longitudinal Study of Adolescent Health (Add Health) confirm the theory's predictions that: (i) women (but not men) who experience increased levels of sexual fluidity have a larger number of children (suggesting that female sexual fluidity, if heritable, may be evolutionarily selected); (ii) women (but not men) who experience marriage or parenthood early in adult life subsequently experience increased levels of sexual fluidity; and (iii) sexual fluidity is significantly positively correlated with known markers of unrestricted sexual orientation among women whereas it is significantly negatively correlated with such markers among men.     

Social and proximate determinants of sexual activity in rural Nigeria

This study analyses the social, physiological and motivational determinants of sexual activity for 644 married women in rural areas of Osun State, Nigeria. The data come from the Fertility Awareness and Pregnancy Avoidance study conducted in 1993-94. Sexual activity is measured by three continuous variables: weekly frequency of (1) total sexual activity, (2) coital-only sex and (3) both coital/non-coital sex. Analyses of variance were performed to test the difference in group means between the predictor variables and measures of sexual activity. Ordinary least squares regression analyses were then performed for the three dependent variables. Two models are used: the first contains only those variables associated with an individual's demographic, social and economic status, and the second adds predictor variables associated with motivational and physiological factors. Results show that while many socioeconomic variables by themselves are significantly associated with sexual activity measures, the addition of physiological and motivational variables weakens their effects and lessens their original statistical significance. Additionally, the socioeconomic and demographic factors associated with frequency of sexual activity are not necessarily the same ones significantly associated with coital-only or combined coital/non-coital sex. While other studies have tended to focus either on socioeconomic or physiological factors, the joint examination of both types of influences seems to indicate that the latter have more proximate effects on the frequency of both coital and non-coital sexual activity of married women in this population. Contraceptive protection is shown to be highly positively associated with all three of the sexual activity measures, empirically confirming the important relationship between contraception and both coital and non-coital forms of sexual activity.     

Male versus female genital alteration: Differences in legal,medical, and socioethical responses

The different legal, social, and medical approaches to ritually based male and female genital circumcision in the United States are highlighted in this article. The religious and historical origins of these practices are briefly examined, as well as the effect of changing policy statements by American medical associations on the number of circumcisions performed. Currently, no state or federal laws single out male circumcision for regulation. The tolerant attitudes toward male circumcision in law, medicine, and societal opinion stand in striking contrast to the attitudes of those disciplines toward even the least invasive form of female genital alteration. US law tacitly condones male circumcision by providing exemptions that are not available for other medical procedures, while criminalizing any similar or even less extensive procedure on females. The increase in immigration, over the past few decades, of people from countries in which female genital alteration is a cultural tradition has brought the issue to the United States. The medical profession's changing approach over time toward male circumcision is primarily responsible for such different legal and societal reactions toward female genital alteration.     

Only Self-Paced Mating Is Rewarding in Rats of Both Sexes

When rats are mated in a traditional mating chamber (with one male and one female) in which the male dictates the pace of the copulatory sequence, males develop a reward state as evaluated by conditioned place preference (CPP). In this mating situation no reward state is induced in females. However, when female rats are able to control (pace) the rate of sexual stimulation, thereby reducing the aversive consequences associated with mating, a clear CPP is observed. In the present study the CPP paradigm was used to determine whether if the reinforced state induced by coital interactions in male rats can be maintained when females pace the sexual interaction. Adult male and female rats were mated in one of two different conditions: (1) where subjects were able to pace their coital interactions or (2) where subjects were not able to pace their sexual contacts. The results showed that when males had control over the sexual interaction they developed a clear place preference while males that mated with females that paced their coital contacts did not develop CPP. Similarly, only females that were able to pace their sexual contacts developed place preference. These results suggest that coital interactions in males, as well as in females, can induce a reward state only when they are able to control the sexual interaction. Under seminatural conditions sexual behavior in rats is highly promiscuous, they mate in groups and repeatedly change partners in the middle of copulation. This behavioral sequence allows both, male and female to control the rate of sexual interaction, assuring the induction of a reward state outlasting the actual performance of coital responses.     

Infertility and age at first coitus: a possible relationship

Reported age at first coitus was shown to be associated with incidence and degree of infertility. Infertility patients reported later first coital ages than gynecological patients in a sample of 792 women seen in a major fertility service. Among the infertility patients, those who had never conceived presented a later first coital age than those who had previously conceived. Routine gynecological patients reported the youngest first coital age of the groups studied.     

Marital coitus across the life course

It remains unclear whether the frequency of marital coitus does in fact decline universally across the life course, what shape that decay normally takes, and what best accounts for it: increasing marriage duration, women's age or age of their partners. Using cross-sectional Demographic and Health Survey (DHS) data of 91,744 non-abstaining women in their first marriage, a generalized linear model is used to determine if there is a consistent pattern in the life course pattern of degradation in the frequency of marital coitus. Datasets were drawn from nineteen countries in Asia, Africa and the Americas. Use of very large samples allows proper disentangling of the effects of women's age, husband's age and marital duration, and use of samples from multiple countries allows consideration of the influence of varied prevailing fertility regimes and fertility-related practices on life course trajectories. It is found that declining coital frequency over time seems a shared demographic feature of human populations, but whether marriage duration, wife's age or husband's age is most responsible for that decline varies by country. In many cases, coital frequency actually increases with women's age into their thirties, once husband's age and marriage duration are taken into account, but in most cases coital frequency declines with husband's age and marital duration.     

Age at menarche, schooling, and sexual debut in northern Malawi

Background

Age at sexual debut is a key behavioural indicator used in HIV behavioural surveillance. Early age at menarche may precipitate early sex through perceived readiness for sex, or through school drop-out, but this is rarely studied. We investigated trends and circumstances of sexual debut in relation to schooling and age at menarche.

Methods and Findings

A cross-sectional sexual behaviour survey was conducted on all individuals age 15–59 within a demographic surveillance site in Karonga District, Malawi. Time trends were assessed using birth cohorts. Survival analysis was used to estimate the median age at menarche, sexual debut and first marriage. The 25^th centile was used to define “early” sex, and analyses of risk factors for early sex were restricted to those who had reached that age, and were done using logistic regression. Of the 8232 women and 7338 men resident in the area, 88% and 78%, respectively, were seen, and, 94% and 92% of these were interviewed. The median reported age at first sex was 17.5 for women and 18.8 for men. For women, ages at menarche, sexual debut and first marriage did not differ by birth cohort. For men, age at sexual debut and first marriage decreased slightly in later birth cohorts. For both men and women increased schooling was associated with later sexual debut and a longer delay between sexual debut and first marriage, but the associations were stronger for women. Earlier age at menarche was strongly associated with earlier sexual debut and marriage and lower schooling levels. In women early sexual debut (<16 years) was less likely in those with menarche at age 14–15 (odds ratio (OR) 0.31, 95%CI 0.26–0.36), and ≥16 (OR 0.04, 95%CI 0.02–0.05) compared to those with menarche at <14. The proportion of women who completed primary school was 46% in those with menarche at <14, 60% in those with menarche at 14–15 and 70% in those with menarche at ≥16. The association between age at menarche and schooling was partly explained by age at sexual debut. The association between age at menarche and early sex was not altered by adjusting for schooling.

Conclusions

Women with early menarche start sex and marry early, leading to school drop-out. It is important to find ways to support those who reach menarche early to access the same opportunities as other young women.     

Patterns of sexual behaviour and reported symptoms of STI/RTIs among young people in Croatia--implications for interventions' planning

This paper describes some of the results of the first national-level survey on sexual behaviour and the distribution of risks to sexually transmitted infections (STIs), including human immunodeficiency virus infection (HIV), among youth in Croatia, and the nature and the extent of their vulnerability to these adverse health outcomes. The study was a cross-sectional, probability-based household survey conducted in 2005, and included 1093 respondents aged 18-24. This paper aims to describe the findings related to the knowledge of HIV transmission, key behavioural outcomes relevant for potential transmission of HIV and STIs, and correlates of genital discharge in young men and young women. More than 80% of young people know that the correct use of condoms protects against HIV and that HIV can be transmitted by someone who looks healthy. Fifty-nine percent of young men and 52.4% of young women reported using condoms during the first sexual intercourse, and 59.3% of men and 46.1% of women used condoms during the last sexual intercourse with a casual partner. This points to the gap between knowledge of condom use and the actual use of condoms as a high proportion of risky sexual contact remain unprotected. Having sexual intercourse frequently or regularly while consuming alcohol was reported by 19.2% of men and 7.6% of women. Much lower proportion are using drugs frequently or regularly during sexual intercourse (3.7% of men and 2.1% of women). Among those sexually experienced, 11.8% of men and 44.1% of women reported ever having a genital discharge. Higher presence of genital discharge in women is suggestive of reproductive tract infections that are not necessarily sexually transmitted. In the multivariate analysis, the lack of knowledge of whether chlamydial infections is an STI and having more than five partners in life were correlates of genital discharge in men, while in women the correlates included having more than five partners in life and not using condoms during the first sexual intercourse. Higher burden of STI-related symptoms was found among men who have men as sexual partners, those who paid for sex, and those with concurrent partnerships. These findings point out to the immediate need to strengthen sexual health education among young people and to the necessity for further development of other broad-based interventions to prevent adverse sexual health outcomes among both men and women, as well as those targeted towards more vulnerable subgroups.     

Circumcision of male children for reduction of future risk for HIV: acceptability among HIV serodiscordant couples in Kampala, Uganda

Introduction

The ultimate success of medical male circumcision for HIV prevention may depend on targeting male infants and children as well as adults, in order to maximally reduce new HIV infections into the future.

Methods

We conducted a cross-sectional study among heterosexual HIV serodiscordant couples (a population at high risk for HIV transmission) attending a research clinic in Kampala, Uganda on perceptions and attitudes about medical circumcision for male children for HIV prevention. Correlates of willingness to circumcise male children were assessed using generalized estimating equations methods.

Results

318 HIV serodiscordant couples were interviewed, 51.3% in which the female partner was HIV uninfected. Most couples were married and cohabiting, and almost 50% had at least one uncircumcised male child of ≤18 years of age. Overall, 90.2% of male partners and 94.6% of female partners expressed interest in medical circumcision for their male children for reduction of future risk for HIV infection, including 79.9% of men and 87.6% of women who had an uncircumcised male child. Among both men and women, those who were knowledgeable that circumcision reduces men''s risk for HIV (adjusted prevalence ratio [APR] 1.34 and 1.14) and those who had discussed the HIV prevention effects of medical circumcision with their partner (APR 1.08 and 1.07) were significantly (p≤0.05) more likely to be interested in male child circumcision for HIV prevention. Among men, those who were circumcised (APR 1.09, p = 0.004) and those who were HIV seropositive (APR 1.09, p = 0.03) were also more likely to be interested in child circumcision for HIV prevention.

Conclusions

A high proportion of men and women in Ugandan heterosexual HIV serodiscordant partnerships were willing to have their male children circumcised for eventual HIV prevention benefits. Engaging both parents may increase interest in medical male circumcision for HIV prevention.     

Female-limited polymorphism in the copulatory organ of a traumatically inseminating insect

Sexual conflict can produce several evolutionary outcomes, one of which is female-limited trait polymorphism. We examine the African bat bug Afrocimex constrictus (Cimicidae), a species where both sexes are subjected to traumatic intromission from males. We show that males possess female genital structures that in related species ameliorate the costs of traumatic insemination. Moreover, the male form of these structures differs morphologically from the standard female form. Examination of females in our isolated study population revealed a discrete polymorphism in female genitalia. Some females had the typical cimicid form, while others had genitalia that more closely resembled the distinctive male form. Males, as well as females with the distinctive male form, experienced fewer traumatic copulations than the typical female morph. We propose that some females mimic the bizarre male condition in order to reduce the frequency of costly traumatic inseminations. To our knowledge this is the first example of a distinct female-limited genital polymorphism: its nature, as well as its association with traumatic sexual interactions, strongly suggests that sexual conflict underpins this unique phenomenon.     

Decline in coital rates with spouses' ages and duration of marriage

Cross-sectional and longitudinal study begun in 1974 of a large U.S. urban sample confirms that mean marital coital rates decline very rapidly over the 1st year of marriage. They seem to halve over the 1st year of marriage, and they they take perhaps another 20 years to halve again. This pattern of decline is interpreted as evidence against the suggestion that coital rates are closely related to female hormone levels. The higher correlation of marital coital rates with wife's age than with husband's age, it is argued here, is because wife's age is more closely associated than husband's age with duration of marriage (here seen as the most important of these 3 variables in the determination of coital rates). This is because of the substantially smaller variance of wife's age at marriage than husband's age at marriage. Maximum age at the beginning of the study was 44 for wives.     

Male axillary secretions influence women's menstrual cycles: a critique

W. B. Cutler et al. report in the December 1986 issue of Hormones and Behavior (20, 463-473), that women treated with axillary extract from male donors showed reduced variability in menstrual cycle lengths and a reduced proportion of aberrant cycles. The initial samples--seven subjects treated with the male extract and nine subjects treated with blank/ethanol--did not differ significantly in the frequency of aberrant and normal cycles. The cycles of four subjects who were having weekly coital activity were removed from the samples, since coital activity has been shown to be associated with normal-length cycles. The frequency differences of aberrant and normal cycles in the reduced extract and placebo samples were statistically significant. The experiment's conclusions are questionable because (1) the decision to remove the cycles of the four women who had weekly coital activity was not justified by the evidence from this experiment and (2) the researchers lacked an observed preexperimental data base from which to measure changes in the women's cycle lengths.