Tanja Tydén

Despite the wide variety of contraceptive methods available and high access to counselling, unmet contraceptive needs remain in Sweden. Around 22% of women have experienced at least one unintended ...

Introduction: The aim was to explore how women in Sweden report use of pornography and how they perceive the impact of pornography on their own sexuality and that of others, particularly in relation to sexual consent. Material and Methods: This cross‐sectional study included 557 women visiting a gynecological clinic for contraceptive counseling in 2023. A mixed‐methods approach was used, combining quantitative and qualitative analyses. Results: Three quarters of women (78%, n = 431) reported having used pornography at least once. Among users, 73% used pornography less than once a month, 20% monthly, and 7% weekly or daily. Participants were more likely to report that others' sexual behavior was influenced by pornography than their own. Thematic analysis of open‐ended answers identified several key perceived effects of pornography, including the creation of unrealistic expectations, impacts on relational intimacy, reinforcement of unattainable beauty standards, normalization of non‐consensual acts and harmful gender roles, as well as its role in sexual discovery. Regarding sexual consent, 63% reported being asked for consent during their most recent sexual encounter, although 98% affirmed having experienced consent on that occasion. Overall, pornography users were less likely to have been asked for consent as compared to non‐users ( p = 0.03), and regular pornography users were more likely to report not experiencing consent during the latest sexual encounter ( p = 0.03) as compared to non‐regular users. Conclusions: Based on the thematic analysis, use of pornography had the potential to influence perceptions of sexuality and intimacy, with both positive and negative aspects. Additionally, pornography use was associated with a decreased likelihood of sexual consent. Considering Sweden's sexual education programs and the Consent Law (2018), these findings highlight the need to integrate pornography literacy into sexual education.

Introduction: Investigating factors associated with contraceptive satisfaction is important to create a basis for tailored contraceptive counseling. In this study, we aimed to explore how sociodemographic characteristics affected women’s level of satisfaction and choice of different contraceptive methods, using data collected during a randomized controlled trial (RCT) in the region Örebro County, Sweden. Methods: This cross-sectional study utilized data from a previously conducted RCT. Eligible participants were women aged 20–40 years who sought contraceptive counseling. All women who participated in the RCT and completed a follow-up questionnaire were included in the analysis. Results: Between February 2015 and March 2016, 1,946, participants were enrolled in the trial, with 1,198 (61.6%) completing the 2-month follow-up questionnaire. Overall, 81.3% of women reported being ‘very satisfied’ or ‘satisfied’ with their contraceptive method. Participants aged 27–40 years used long-acting reversible contraception (LARC) to a higher extent compared with those aged 20–26 years (adjusted odds ratio [aOR] 1.92, 95% confidence interval [CI] 1.44–2.56). Older age was associated with lower satisfaction (aOR 0.55, 95% CI 0.33–0.94). Participants with a body mass index (BMI) ≥ 25 more often used LARC (aOR 1.68, 95% CI 1.24–2.28) but were also more likely to report no use of contraceptives at all (aOR 1.56, 95% CI 1.01–2.43) compared with BMI < 25. The level of satisfaction tended to decrease with increasing BMI. Country of birth and educational level were not associated with satisfaction. Conclusions: The use of LARC was more common among women with BMI ≥ 25 and older women. While BMI, education, and place of birth did not affect satisfaction, women aged 27–40 reported lower satisfaction. These findings contrast with prior studies and highlight the complex sociodemographic influences on contraception experiences.

Globally, women are postponing childbearing and total fertility rates are decreasing. In Sweden, a 2018 law requires consent before sexual activity and LARC is now recommended as a first-hand choice. This study compares sexual behaviour (including consent), contraceptive use and family planning intentions with past surveys. This is a cross-sectional survey that has been repeated every fifth-tenth year since 1989 in Sweden. It explores sexual behaviour, contraceptive use and family planning intentions among women attending a gynaecology clinic for contraceptive counselling and compares these results with previous surveys. Of the 596 women surveyed, 558 were sexually experienced, the majority (98%) of which perceived consent during their most recent sexual activity. Over 30 years, there was a significant trend towards having more sexual partners (p = 0.02). The use of SARC (p = p = 0.04) has increased since 2014, while condom use and emergency contraceptive use have decreased (p = n = 449) wanted children, significantly fewer than 2014. Sexual behaviour and contraceptive use have changed over the last ten years in Sweden. More women use effective forms of contraception and informed consent laws may have positive implications. Yet fewer women have decided to have children in the future.

Background: The spread of sexually transmitted infections (STIs) is an ongoing public health challenge, and awareness of risk factors is essential for designing effective preventive interventions. This study aimed to assess self-reported STI occurrences and identify risk factors and sexual behaviors associated with STIs among female university students. Methods: This is a cross-sectional, online questionnaire study, including 384 female university students seeking contraceptive counseling at a gynecology clinic in Uppsala, Sweden, and reporting having had sex. Associated risk factors and behaviors were assessed by comparing those who reported STIs and those who did not. Results: The mean age of participants was 22.8 years. Seventy-eight (20%) had contracted at least one STI, with seven (9%) experiencing multiple infections. Seventy-three (94%) reported first-date sexual activity without a condom among STI experienced. Chlamydia trachomatis was the most common STI pathogen (68% of all infections), followed by Herpes simplex virus (18%) and Mycoplasma genitalium (13%). Behavioral factors associated with self-reported STIs were first-date sexual activity without a condom, not using condom at first intercourse, younger age at first intercourse, a higher number of sexual partners overall and in the last 12 months, experience of anal sex, dating app usage, and regretting sexual activity after substance use (P < 0.003 for all). Conclusions: Condom use was low among the respondents, and STIs were common regardless of the high level of education in this group. Contraceptive counseling needs to highlight the importance of condom use in addition to contraceptive efficacy. It is also essential to consider the specific risk factors and behaviors prevalent among young adults to reduce the spread of STIs.

Objective: To investigate whether an early need of hormonal contraceptive (HC), or a failure to find a suitable method, are warning signs for endometriosis.Design: A retrospective cohort study.Setting: Sweden.Population: The cohort consisted of 720 805 women aged 12–27 years during the period 2005–2017. All women, regardless of whether they received a diagnosis of endometriosis or not (reference group), were included.Methods: We used data from Swedish national registers. Risks are expressed as crude and adjusted hazard ratios (HRs and aHRs, respectively) with 95% confidence intervals (95% CIs), adjusted for age, education level, civil status, parity, country of birth, and diagnoses of infertility, dysmenorrhea or depression.Main outcome measures: A diagnosis of endometriosis between 12 and 27 years of age.Results: During this period, 3268 women were diagnosed with endometriosis (0.45%). Women who started HC at the ages of 12–14 years had a higher risk of receiving the diagnosis (aHR 2.53, 95% CI 2.21–2.90) than those who began at age 17 years or older. Having tried more types of HCs was associated with a twofold increased risk of endometriosis (more that three types of HC, aHR 2.31, 95% CI 1.71–3.12). Using HC for more than 1 year was associated with a decreased risk of endometriosis (>1 year, aHR 0.53, 95% CI 0.48–0.59). Women with endometriosis more commonly had dysmenorrhea, depression or infertility.Conclusions: The use of HCs at an early age and a failure to find a suitable HC were identified as warning signs of later receiving an endometriosis diagnosis. A longer duration of HC usage reduced the risk of receiving the diagnosis.

Introduction: In spite of societal efforts to strengthen women's sexual and reproductive health in Sweden, many women have unmet contraceptive needs and the abortion rate remains high. The aim of this study was to investigate contraceptive use among abortion‐seeking women.Material and methods: Swedish‐speaking women seeking an induced abortion up to the end of gestational week 12 at seven hospitals filled out an anonymous paper questionnaire between January and June 2021. Data were analyzed using frequencies and cross‐tabulations, and the Chi‐square test was used to compare age‐groups. Valid percentages are presented.Results: In total, 623 women participated. Median age was 29 years and 13% were born outside the Nordic countries. In the year preceding the abortion, condoms (37%, n = 228) were the most commonly used contraceptive method, followed by short‐acting reversible contraception (SARC) (35%, n = 213) and withdrawal (25%, n = 152). Around one in five (n = 113) had not used any method in the year preceding the abortion. Sixteen percent (n = 96) had changed contraceptive method in the last year. At the time around conception, 15% (n = 90) reported use of SARC and 2% (n = 12) of long‐acting reversible contraception (LARC). Four out of 10 women (n = 268) reported non‐use of contraception at the time around conception, with a higher proportion among adolescents (70%, n = 30, P = 0.001). Among the women who responded to why they had not used any method (n = 387), the main reasons were that they did not believe they could become pregnant at that time (37%, n = 144) or had negative experiences from using contraceptives (32%, n = 123). A majority (88%, n = 527) planned to use contraception after the abortion. Of the women who had decided on method, 55% (n = 271) planned to use LARC, and 38% (n = 188) planned to use SARC.Conclusion: The unmet need for contraception appears to be high among abortion‐seeking women in Sweden. Many had discontinued contraception use during the last year, and the main reasons for avoidance were beliefs that one could not become pregnant and negative experiences of contraceptives. The underestimation of pregnancy risk indicates limited fertility awareness, thus our recommendation would be to strengthen the sexual and reproductive knowledge among this group.

Seeking multiple abortions is common in Sweden, and is associated with parity, low education, tobacco use, and exposure to violence. Although Sweden provides high quality and accessible comprehensive abortion care, counselling must be adaptable and address specific needs in vulnerable groups.

To investigate women’s decision-making on induced abortion.A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion wa...