Christian Graugaard

Objectives: To examine, in a nationally representative Danish study, a comprehensive range of sexual characteristics, dysfunctions and relational challenges among men with prostate cancer (PCa) aged ≥50 years and women married to such men, compared with unaffected men and women. Patients/Subjects and Methods: We analysed baseline questionnaire data from the Project SEXUS cohort study (2017–2018) for men aged ≥50 years with ( n = 715) or without ( n = 13 883) a history of PCa, and women married to such men with ( n = 345) or without ( n = 8323) a history of PCa. In sex‐specific analyses, prevalence estimates were calculated for a broad range of sexual and relational outcomes, and logistic regression analyses yielded confounder‐adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Compared with controls without PCa, men with a history of PCa had substantially higher odds of sexual inactivity (aOR 2.03, 95% CI 1.69–2.43), unmet sexual needs (aOR 1.89, 95% CI 1.58–2.28), poorer self‐rated sex life (aOR 1.82, 95% CI 1.46–2.28), and sexual dysfunctions, with particularly elevated odds of erectile (aOR 5.74, 95% CI 4.25–7.74), orgasmic (aOR 3.20, 95% CI 2.09–4.89), and genital pain (aOR 3.07, 95% CI 1.02–9.25) dysfunctions. Among women, sexual needs did not differ between the two groups. However, women married to men with PCa were more likely to report sexual inactivity (aOR 1.85, 95% CI 1.42–2.39), unmet sexual needs (aOR 1.77, 95% CI 1.34–2.34), and poorer marriage quality (aOR 2.84, 95% CI 1.33–6.08). Conclusion: Men with PCa and women married to such men report a substantially increased burden of sexual and relational challenges, underscoring the need for survivorship care that supports sexual well‐being in both patients and their intimate partners.

Background: Intimacy and relationship dynamics are central to health and well‐being and may buffer sexual difficulties in cancer survivors. Still, population‐based evidence comparing intimacy, reasons for having sex, and relational aspects between cancer survivors and individuals without a history of cancer remains limited and inconsistent. Aim: To assess the perceived importance of various types of intimacy, frequent reasons for having sex, and relationship characteristics among partnered individuals with and without a history of cancer. Methods: We analyzed data from 47,718 partnered individuals from the nationally representative Project SEXUS cohort study, including 3177 cancer survivors and 44,541 individuals without a cancer history. Prevalence estimates were calculated for all measures, and logistic regression models were used to obtain demographically weighted, confounder‐adjusted odds ratios with 95% confidence intervals for associations of cancer status with intimacy, sexuality, and relationship indicators, stratified by sex and time since diagnosis. Results: Cancer survivors reported importance of intimacy, frequent reasons for having sex, and relationship characteristics largely comparable to those reported by individuals without a history of cancer. Similar patterns were seen across sexes, both overall and within five years of diagnosis. Conclusion: Our findings indicate that, despite the well‐established impact of cancer on sexual activity and functioning, not all aspects of sexual health are equally affected. In particular, the perceived importance of intimacy, reasons for engaging in sex, and relational characteristics appear largely unaffected by cancer. Together, these results underscore the importance of addressing sexual health holistically in survivorship care, encompassing resources embedded in intimacy and relationship dynamics.

Introduction: Sexuality is integral to most women’s quality of life. However, pregnancy and childbirth often lead to biological, psychological, and relational challenges that can impact sexual health and wellbeing. Research has documented declines in sexual activity, functioning, and satisfaction during the postpartum period, particularly among women who sustained severe perineal injuries during delivery. However, these issues remain scientifically and clinically underrecognized. Objectives: Approximately 90% of primiparous women experience perineal tearing during vaginal delivery, with 5% sustaining an obstetric anal sphincter injury (OASI). This scoping review aims to synthesize existing evidence on the relationship between OASI and postpartum sexual health, focusing on three key dimensions: (1) sexual activity, (2) sexual functioning, and (3) sexual satisfaction. Understanding the impact of OASI on female sexual health is essential for providing tailored postpartum care and support. Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, CINAHL, Cochrane, and “gray literature” sources to identify relevant peer-reviewed studies. The selection process involved three stages: screening of titles and abstracts, full-text evaluation, and final inclusion based on predefined criteria. Original quantitative studies presenting statistical evidence on the impact of OASI on postpartum sexual health were eligible for inclusion. Results: Based on 33 articles, the scoping review revealed that women with OASI experienced delayed resumption of sexual intercourse compared to those with no or minor perineal tears. In addition, most studies reported that OASI increased the risk of dyspareunia, potentially persisting for years after childbirth. Several studies also observed a temporary or long-term decrease in desire, lubrication, orgasm ability, and overall sexual satisfaction. OASI was further associated with a heightened risk of long-lasting complications such as anal incontinence, which could contribute to or exacerbate sexual problems. Conclusion: Women who sustain OASI during childbirth face an increased risk of postpartum sexual health issues. To mitigate these challenges, healthcare providers should encourage open discussions about sexual health and, when necessary, provide referrals to physiotherapy, couples therapy, or specialized sexological support.

Background: Inflammatory bowel diseases (IBD) can affect body image, quality of life, and sexual health. This study examined sexual challenges and dysfunctions among Danish individuals with and without IBD. Methods: In this population-based cross-sectional study, 62 675 participants from the Project SEXUS cohort were linked to the Danish National Patient Register, identifying 655 individuals diagnosed with IBD between 1996 and 2017 (437 with ulcerative colitis [UC] and 218 with Crohn’s disease [CD]). In addition to study-specific measures, the 5-item International Index of Erectile Function and the 6-item Female Sexual Function Index were utilized to assess sexual dysfunctions. Logistic regression was used to compare individuals with UC or CD to those without IBD. Results were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Compared with those without IBD, individuals with IBD reported similar overall sex life satisfaction and relationship quality. However, individuals with UC more often reported hypoactive sexual desire disorder (men: aOR, 2.18; 95% CI, 1.13-4.19; women: aOR, 1.66; 95% CI, 1.04-2.66), and women with UC more often reported genital pain dysfunction (aOR, 2.30; 95% CI, 1.26-4.19). Subgroup analyses revealed that patients with active disease, stoma, or perianal involvement had particularly elevated odds of sexual dysfunctions compared with non-IBD control subjects. Conclusions: Although the 5-item International Index of Erectile Function and 6-item Female Sexual Function Index scores did not indicate an excess of sexual dysfunction in the overall UC and CD populations, individuals with UC as well as patients with IBD experiencing active disease, stoma, or perianal involvement faced more sexual challenges than those without IBD. This highlights the need for gastroenterologists to proactively address sexual health and provide tailored support for patients with IBD.

Background: Population-based studies on the sexual health and behaviors of sexual minorities are scarce. Aim: To assess and compare sexual health and behaviors among homosexual, bisexual, and heterosexual Danes. Methods: We analyzed questionnaire data from 59 838 participants age 15-89 in the Project SEXUS study, including 1577 homosexuals, 1500 bisexuals, and 56 761 heterosexuals. Sex-specific logistic regression analyses with heterosexuals as reference yielded demographically weighted, confounder-adjusted odds ratios (aORs) for measures of sexual health and behaviors. Outcomes: Study-specific and internationally validated sexual outcome measures. Results: Compared with heterosexuals, lesbians were less likely to have had sex with another person in the last year. In contrast, sex partner numbers and frequencies of masturbation and porn consumption were higher among gay and bisexual men and bisexual women. Premature ejaculation was less common among gays (aOR, 0.50; 95% CI, 0.32, 0.81) and bisexual men (aOR, 0.62; 95% CI, 0.41, 0.93), whereas erectile dysfunction was more common among gays in the last 4 weeks (IIEF-5 score ≤ 11) (aOR, 3.01; 95% CI, 1.42, 6.38) and among both gays (aOR, 2.88; 95% CI, 1.87, 4.43) and bisexuals (aOR, 1.91; 95% CI, 1.24, 2.92) in the last year. Also, gays more often reported orgasmic dysfunction (aOR, 1.80; 95% CI, 1.09, 2.99). Overall female sexual dysfunction (FSFI-6 score ≤ 19) was less common among lesbians (aOR, 0.63; 95% CI, 0.40, 0.98) and bisexuals (aOR, 0.65; 95% CI, 0.48, 0.89), although vaginal cramp dysfunction was more common in bisexuals (aOR, 2.16; 95% CI, 1.15, 4.06). Gay and bisexual men and bisexual women reported more sexual risk indicators, with particularly high odds of sexual victimization among gays (aOR, 5.74; 95% CI, 3.72, 8.85), bisexual men (aOR, 5.03; 95% CI, 3.36, 7.54), and bisexual women (aOR, 2.67; 95% CI, 2.25, 3.16). Finally, gay and bisexual men were more often dissatisfied with the appearance of their bodies and genitals. Clinical Implications: Health professionals should be aware of the greater burden of sexual health challenges among gay men and bisexual individuals. Strengths and Limitations: Strengths include the large size, broad coverage, and national representativeness of our study. Limitations include a modest response rate (34.6%), the potential for self-selection and information biases, and uncertain generalizability to other countries. Conclusion: In this Danish study, lesbians exhibited no unusual burden of sexual risk indicators, and sexual dysfunctions along with sexually transmitted infections were less common in this group. In contrast, gay men and bisexuals of both sexes reported significantly more risky sexual behaviors, sexual victimization, sexual dysfunctions, and other adverse outcomes, calling for further investigation and increased clinical attention.

Introduction: Being diagnosed with and treated for cancer often results in physical symptoms and psychosocial distress that may affect sexual health. This population‐based study in Denmark aimed to compare the sexual health of cancer survivors across multiple cancer sites with that of individuals with no history of cancer. Methods: Data were used from 4085 cancer survivors and 58,590 individuals without cancer aged 15 to 89 years, who participated in the nationally representative Project SEXUS cohort study. Prevalence estimates for sexual outcomes were calculated, and logistic regression analyses yielded confounder‐adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for associations of cancer survivorship with sexual outcomes, both overall and across cancer sites. Results: Cancer survivors experienced significantly more sexual challenges than individuals without cancer, both overall and in the first 5 years after their most recent cancer diagnosis. This difference was seen across multiple cancer sites and regardless of age at diagnosis (<60 vs. ≥60 years). Among several statistically significant findings, particularly high aORs were noted for dissatisfaction with breast appearance (aOR: 1.89; CI, 1.49–2.41) and genital pain dysfunction (aOR: 1.74; CI, 1.32–2.28) among women and lack of sexual needs (aOR: 1.93; CI, 1.61–2.30) and erectile dysfunction (aOR: 2.79; CI, 2.30–3.38) among men. Conclusion: Compared to individuals with no history of cancer, sexual health was significantly affected among cancer survivors of both sexes and across cancer sites, time since diagnosis, and age at diagnosis. Health care professionals should recognize and routinely address the sexual challenges experienced by cancer survivors to enhance their biopsychosocial recovery.

Homophobia is considered a central driver of minority stress, mental health problems and suicidality among non-heterosexual people. We used baseline questionnaire data from 31,808 participants aged 15–89 years in the nationally representative Danish cohort study Project SEXUS to identify factors associated with moral disapproval of same-sex sexual behavior, an assumed proxy for homophobia. Respondents who answered that they did “not at all” or only “to a low extent” find same-sex sexual activity morally acceptable were operationally defined as expressing moral disapproval of same-sex sexual behavior, whereas respondents who considered same-sex sexual activity morally acceptable “to a high extent” or “to a very high extent” were considered not to hold such moral reservations. Demographically weighted prevalence estimates of sociodemographic, health-related, sexual, moral, and religious characteristics among individuals with and without moral reservations concerning same-sex sexual behavior were calculated and compared in polytomous logistic regression analyses. Overall, 21.7% (women: 14.4%; men: 29.2%) expressed moral disapproval of same-sex sexual behavior. Upon adjustment for potential confounding variables, such moral reservations were significantly positively associated with late sexual debut, low lifetime number of sex partners, lacking sex education in school, missing communication with parents about sex and, among men, a poor or non-existent sex life within the last year. Individuals expressing moral disapproval of same-sex sexual behavior also expressed significantly more restrictive moral attitudes toward other sexual matters. Religiousness was strongly positively associated with moral reservations concerning same-sex sexual behavior, most notably among followers of Islam, Jehovah’s Witnesses, Danish Inner Mission, or a composite category of minor Christian denominations. In conclusion, even in a sexually liberal country such as Denmark, which decriminalized homosexuality in 1933 and legalized registered same-sex partnerships in 1989, moral disapproval of same-sex sexual behavior remains widespread. To reduce the negative mental health ramifications of homophobia and ensure the health and rights of all citizens, school-based sex education should stimulate social inclusion and destigmatization of sexual minorities, and religious communities should be encouraged to counter homophobia within and outside their circles.

HIV-related stigma remains a major barrier to improving the lives of people with HIV (PWH) and curbing the epidemic globally. This cross-sectional study assessed HIV-related stigma, based on The HIV Stigma Framework, among PWH in Denmark, and examined its potential associations with sociodemographic characteristics, as well as with HIV-related, psychosocial and sexual health measures. Data from 630 participants (486 men and 144 women) in the SHARE study—a nationwide survey on psychosocial and sexual health among PWH in Denmark conducted from 2021 to 2022—were analysed using sex-stratified linear and logistic regression models adjusted for relevant confounders. Results showed that anticipated stigma was the most commonly reported stigma mechanism, with 68% of men and 77% of women expressing high levels of concern about HIV status sharing. In contrast, enacted stigma was reported by 9% of men and 22% of women. The multivariate regression analyses revealed that higher stigma levels were associated with originating from low- or middle-income countries and with a history of mental health problems, whereas non-heterosexual identity and a longer time since HIV diagnosis were linked to lower stigma. In both men and women, stigma was significantly associated with fewer close friends, loneliness, anxiety and reduced sexual desire. Among men, stigma was also significantly associated with sharing one’s HIV status with fewer people, depression, suicidal tendencies and erectile dysfunction. In conclusion, HIV-related stigma, notably stigma related to anticipated stigma, remains prevalent among PWH in Denmark and it is significantly associated with a range of psychosocial and sexual challenges.

Objectives: The HIV/AIDS epidemic has disproportionately affected men who have sex with men (MSM) since its onset. Despite important medical advancements in treatment, the enduring effects of living with HIV continue to adversely impact the health and well‐being of this population. This cross‐sectional nationwide study examined psychosocial and sexual health among MSM in Denmark, comparing those living with and without HIV.Methods: Data from MSM living with HIV were collected from the SHARE study, a Danish nationwide survey that investigated psychosocial, sexual and reproductive health among people with HIV, and compared with data from MSM without HIV, retrieved from the nationally representative cohort study, Project SEXUS. Associations between HIV status and psychosocial and sexual health outcomes were examined using logistic regression models while controlling for potentially confounding variables.Results: Among 369 MSM with HIV and 1002 MSM without HIV, logistic regression analyses revealed that living with HIV was significantly associated with having current symptoms of anxiety and depression and greater dissatisfaction with one's body. Additionally, MSM with HIV significantly more often than MSM without HIV reported low sexual desire, sexual inactivity, a lack of sexual needs in the last year and erectile dysfunction. Having received payment for sex was more frequently reported by MSM with HIV, as was sexualised drug use, including chemsex drugs.Conclusion: Compared with MSM without HIV, MSM with HIV in Denmark report a higher burden of mental health and sex life challenges.