This study explored the forced circumstances contributing to early sexual debut among primary school learners in Musina, Limpopo, focussing on the socio-economic, cultural, and educational factors shaping this phenomenon. A qualitative cross-sectional design was adopted, involving 320 learners (Grades 5-7) and 20 Life Orientation teachers from eight schools. Data collection for learners involved classroom-based group discussions conducted in a developmentally appropriate manner, while teachers participated in a separate workshop to provide contextual insights on learner experiences. Thematic content analysis was conducted using Bronfenbrenner's social-ecological model, Ajzen's theory of planned behaviour, and Galtung's structural violence framework. Learners reported that early sexual debut was primarily influenced by forced circumstances such as poverty, lack of basic needs, coercion, and peer pressure, rather than voluntary risky behaviours. Cultural expectations, familial pressures, and gender power imbalances further constrained their agency. Teachers highlighted barriers, including insufficient training and socio-cultural taboos, that limited their ability to support learners. Early sexual debut among primary school learners in Musina is largely a result of external forced circumstances occurring outside the school environment, particularly linked to socio-economic deprivation and coercive pressures. Addressing this requires public health interventions that are multi-level and contextually tailored, including socio-economic support for vulnerable families, community-based sexual health education, and policies that protect children from exploitation and coercion.
Reports from the literature indicate parental concern that sexual education and HPV vaccine may encourage early initiation of sexual activity. In this context, the present study aims to evaluate possible associations between sexual education, adherence to HPV (Human Papillomavirus) vaccination, and the initiation of sexual activity among Brazilian students. This study is based on the analysis of data from the 2019 National Survey of School Health, involving 165,838 participants of both sexes, and representative of the Brazilian school population. Data on demographics, sexual education [guidance on sexually transmitted infections (STIs) and pregnancy prevention], HPV vaccine uptake, and age of sexual initiation were collected. Frequency analyses, logistic regression, and the survey-adjusted Wald test were employed. A significance level of p < 0.05 was adopted. Among individuals aged 13 to 15 years who received counseling regarding STIs or Pregnancy Prevention, HPV vaccination was more likely in both males (STI prevention: aOR 1.69, 95% CI 2.03-1.40, p < 0.001; pregnancy prevention: aOR 1.22, 95% CI 1.45-1.03, p = 0.021) and females (STI prevention: aOR 1.60, 95% CI 1.98-1.30, p < 0.001; pregnancy prevention: aOR 1.44, 95% CI 1.76-1.20, p < 0.001). The survey-adjusted Wald test indicated differences in the mean age of sexual initiation associated with both STI and pregnancy prevention counseling. In both cases, these interventions were associated with a slightly later sexual debut, with mean differences of approximately two months. Sexual education in the form of guidance on STIs and pregnancy prevention is associated with higher HPV vaccine uptake, although no causal relationship or chronological relation can be stated on a cross-sectional dataset. STI education, pregnancy prevention counseling, or HPV vaccine uptake showed no clinically relevant association with early or late initiation of sexual activity, as the magnitude of the differences in means is negligible.
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Few studies examine Black women-loving women's (Black WLW) sexual identity development and same-gender sexual debut. Using semi-structured interviewing and open-ended surveys, this qualitative analysis examines how Black WLW interpret experiences that contributed to their sexual identity development, including childhood attractions, same-gender sexual encounters, and later-life relational experiences. Depending on whether these early sexual encounters were desired or undesired, these experiences continue to shape affirming or ambivalent feelings regarding the acceptance of sexual identity in adulthood. These novel findings are important since they reveal how Black WLW conceptualize their sexual identities through how they have negotiated their childhood same-gender sexual encounters.
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This cross-sectional study examined the timing and multilevel correlates of first sexual intercourse among 3,151 Polish adolescents (49.8% boys; mean age = 15.7 ± 1.6 years). Using Cox proportional hazards regression and structural equation modeling (SEM), gender-specific associations and pathways linking community, family, and individual factors to sexual debut were assessed. The median age at first sex was 17.49 years for boys and 18.08 years for girls. Cox regression identified key predictors of earlier sexual debut: for boys, higher peer popularity (HR = 1.44, 95% CI: 1.18-1.76), vigorous physical activity (HR = 3.36, 95% CI: 1.40-5.09), and alcohol use (HR = 2.95, 95% CI: 2.56-3.40); for girls, lower subjective well-being (HR = 1.69, 95% CI: 1.26-2.04), poorer self-rated health (HR = 1.69, 95% CI: 1.26-2.04), greater body dissatisfaction (HR = 1.66, 95% CI: 1.07-1.95), and substance use (HR = 2.40, 95% CI: 1.60-3.61). SEM showed that family and community factors had weak direct effects but acted indirectly through risky behaviors and, for girls, via subjective well-being, explaining 41.5% of the variance in boys and 36.3% in girls. Most associations operated additively, however, limited synergistic effects amplified the role of risky behaviors in less supportive contexts. Multi-group analysis revealed shared (behavioral) and different pathways to sexual debut: girls' well-being was more affected by family and community contexts; boys' risky behaviors were more strongly related to school type and urban residence. The findings highlight common and gender-specific mechanisms of sexual debut emphasizing the need for context-sensitive interventions to promote healthy sexual development.
The relative age effect (RAE) is well-documented in traditional sport, but its applicability to professional esports remains largely unexplored. The two existing studies examined only the entry question, without controlling for birth seasonality, testing causal mechanisms, or analyzing post-entry career trajectories. This study examined (1) whether RAE exists in professional esports after adjusting for birth seasonality; (2) whether academic cutoff dates causally influence esports career outcomes; (3) whether birth quarter affects career longevity and earnings after professional entry; and (4) whether birth quarter operates indirectly through debut age. The sample comprised 15,065 professional esports players with confirmed birthdates from the Esports Earnings database, spanning 177 countries and 609 game titles. Methods included chi-square tests with population-adjusted expected frequencies, a cross-national quasi-experiment exploiting cutoff variation across 20 countries, Kaplan-Meier survival analysis and Cox regression, propensity score matching, and Baron-Kenny mediation analysis with the Sobel test. After adjusting for birth seasonality, no aggregate RAE was detected [χ2(3) = 1.38, p = 0.711]. A cohort reversal emerged: players born after 2006 exhibited a traditional RAE (OR = 1.92, p < 0.001), while those born in 1991-2000 showed an inverse RAE (OR = 0.81-0.85, p < 0.05). Cross-national analyses revealed no causal effect of cutoff dates on career outcomes. Post-entry, birth quarter had no direct effect on career duration (log-rank p = 0.593) or earnings (propensity-score-matched p = 0.487). Birth quarter operated indirectly through debut age: late-born players debuted 0.16 years earlier, mediating 48.5% of the total association with earnings (Sobel z = 2.57, p = 0.010). At the aggregate level, professional esports shows no relative age effect after adjusting for birth seasonality, and cross-national evidence is consistent with academic cutoff dates having no causal effect on career outcomes. Birth quarter is associated with career earnings only indirectly, through the timing of debut. The traditional RAE pattern emerging in the youngest cohort (born after 2006) may warrant attention as esports adopts more structured youth development systems.
Men with acquired premature ejaculation (APE) develop the condition after a period of normal ejaculatory function. This is the first article to focus on the developmental course of APE. To retrospectively detail the developmental course of foreplay duration, ejaculatory latencies over multiple partnered sexual activities, and changes in PE symptomology in men with APE from age of sexual debut to the present. From March 2024 through February 2025, 411 volunteers, aged 18-80 years, responded to an online sexual health and behavior questionnaire posted on multiple social media platforms. These men also met the preliminary qualifying criteria of having PE based on responses to an abridged Premature Ejaculation Diagnostic Tool (PEDT) and meeting other inclusion criteria. Of these, 77 men (mean age = 40 years, range 19-66) met the criterion of having APE as their symptoms developed only after an extended period of normal ejaculatory control. Significant changes in partnered ejaculatory latencies from the men's sexual debut to the present are reported. Sexual debut typically occurred around age 19, with PE first reported on average at age 31. Overall, vaginal and anal ejaculatory latencies (EL) at sexual debut were 5.98, 5.01, and 4.7 min, respectively, but the overall, vaginal and anal ELs at the present time were 1.86, 0.97, and 0.75 min (P < .001). Foreplay duration of approximately 12-13 min remained unchanged over the lifespan despite large decreases in ELs. Nearly 34% of the participants reported that their symptomology continued to worsen after it first appeared. Clinical Implications: The data highlight the major differences between present-day partnered sexual behaviors and time spent in foreplay and masturbation compared to sexual activities earlier in life. It suggests that under specific circumstances men have the ability to delay ejaculation. The strength of this article is its developmental perspective in terms of examining the men's past and present sexual behaviors. The major limitations are the retrospective-present-day methodology and recruitment via social media, which could lead to sample biases and reliance on men's recall. This study both confirms the presumed developmental course of ELs in men with APE and adds new insights regarding these men's sexual experiences, including the comparability of their ELs with men having lifelong PE, the relationship between ELs and types of partnered sexual activity, and the lack of association between foreplay duration and EL. It also documents that one-third of men with APE experienced continued deterioration of their condition with age.
Risky sexual behaviors (RSB) remain one of the major causes of unintended pregnancies and sexually transmitted infections. This study aimed to assess the prevalence of various RSB and their correlates among sexually active men in Rwanda, one of the poorest countries in the world. Using data from the 2020 Rwanda Demographic and Health Survey, a nationally representative sample of sexually active males (n = 4735) was examined for the prevalence of non-condom use, having multiple sex partners, engagement in commercial sex, and sexual debut before age 18. Multivariable logistic regression was conducted to explore 17 factors associated with various patterns of RSB. Results indicated that non-condom use, early sexual debut, multiple sex partners, and engagement in commercial sex were reported by 55.3%, 17.4%, 8.3%, and 7.3%, respectively. Older, married, and uncircumcised males with no internet access, and those from large female-headed households and the Western region, were more likely to engage in RSB without condoms (AOR: 1.28-6.20, p < 0.05). In contrast, those engaging in RSB with condoms were less likely to be married and from the Southern region (AOR = 0.03 and 0.52, both p < 0.05), but more likely to have a secondary education (AOR = 2.29, p < 0.05). Those reporting an early sexual debut were more likely to be younger, unmarried, from large households, with no education, and non-Catholic (AOR: 1.24-2.72, p < 0.05). There are differing groupings of Rwandan males that engage in various patterns of RSB that may partly reflect issues of access, changing cultural values, and geographic variations. These results indicate the need for segmented risk reduction interventions targeting each of these high-risk groups.
Unsafe induced abortion contributes a significant public health concern in Ethiopia and is one of the leading causes of maternal morbidity and mortality. Previous studies have explored the burden of induced abortion. However, little evidence exists in the context of Hawassa city. To identify the Risk factors associated with induced abortion among women attending health facilities in Hawassa city, Sidama Region, southern Ethiopia, 2024. An institution-based unmatched case-control study design. A multistage sampling technique was employed to select 513 women of reproductive age attending public health facilities in Hawassa city from June 25 to August 25, 2024. Data were collected electronically through face-to-face interviews via a structured questionnaire adapted from previous studies. Descriptive analysis was conducted to describe the participants. Bivariable and multivariable binary logistic regression were used to identify risk factors associated with induced abortion. In this study, 513 (172 cases and 341 controls) women were included, for a response rate of 95.4%. Primary education (adjusted odds ratio (AOR) = 2.58, 95% CI: 1.20, 5.53), early sexual debut before age 18 (AOR = 5.40, 95% CI: 2.80, 10.41), previous history of abortion (AOR = 3.50, 95% CI: 1.78, 6.90), poor knowledge about contraceptives (AOR = 5.11, 95% CI: 2.69, 9.72), and alcohol consumption (AOR = 2.76, 95% CI: 1.53, 4.98) were associated with increased odds of induced abortion. Conversely, ever use of contraceptives was associated with lower odds of induced abortion (AOR = 0.38, 95% CI: 0.21, 0.72). The current study points out that early sexual debut before age 18, previous history of abortion, poor knowledge about contraceptives, and alcohol consumption were factors associated with induced abortion. These findings highlight further investigation in longitudinal studies. Risk factors associated with induced abortion • Induced abortion remains a significant public health problem in developing country particularly Ethiopia and is one of the leading causes of maternal mortality and morbidity. • An institution-based unmatched case-control study design was employed among 513 reproductive-age groups of women attending public health facilities in Hawassa city from June 25 to August 25, 2024. • The current study figure out pertinent risk factors for induced abortion such as Primary education, early sexual debut before age 18, previous history of abortion, poor knowledge about contraceptives, and alcohol consumption, were associated with increased odds of induced abortion. Conversely, ever use of contraceptives was associated with lower odds of induced abortion. • These findings underscore highlights the need for further investigation in longitudinal studies to explore more in detail causal risk factors. Comprehensive interventions targeting education, sexual and reproductive health awareness, contraceptive knowledge and use, and alcohol consumption to reduce the prevalence of induced abortion and its associated health risks in this population.
Sexually transmitted infections (STIs) continue to pose a significant public health challenge globally, negatively impacting reproductive health and increasing the likelihood of infertility, complications during pregnancy, and mother-to-child transmission. Despite the increasing burden of self-reported (SR) STIs, there is limited evidence on their prevalence and associated factors across Africa. Applying the socio-ecological model (SEM), this study sought to estimate the prevalence and identify the factors associated with SR-STIs among sexually active women in Africa. The study used the most recent Demographic and Health Surveys (DHS) conducted in 29 African countries. A weighted sample of 340,179 sexually active women who had ever had sexual intercourse in the past 12 months and had complete information on all variables of interest were included. Guided by SEM, explanatory variables were conceptually mapped onto its four levels (individual, interpersonal, community, and societal/structural). The analysis was conducted using Stata version 14.2. Descriptive, chi-square, and multilevel regression analyses were carried out. Frequencies, percentages, and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) and p-values were used to present the results. The pooled prevalence of SR-STIs among sexually active women in Africa was 18.43% (95% CI: 18.00%-18.70%), ranging from 47.9% in Liberia to 3.9% in Ethiopia. Guided by the SEM levels, significant associations were identified at the individual, interpersonal, and societal/structural levels. At the individual level, women aged 45-49 [aOR = 0.71; 95% CI = 0.66-0.76] and women whose sexual debut occurred at age 20 or older [aOR = 0.76, 95% CI = 0.73-0.79] had lower odds of SR-STIs than women aged 15-19 years and those whose sexual debut occurred before age 20 years, respectively. At the interpersonal level, women living in female-headed households had lower odds of SR-STIs [aOR = 0.96, 95% CI = 0.93-0.99]. At the societal/structural level, women in Southern Africa had lower odds of SR-STIs [aOR = 0.35; 95% CI = 0.32-0.39] than those in West Africa. This research revealed a high prevalence (18.43%) of SR-STIs among sexually active women in Africa, with substantial cross-country and sub-regional variation. The findings demonstrate the utility of the SEM in understanding SR-STIs, as significant factors were identified across individual, interpersonal, community, and societal/structural levels, highlighting that SR-STI risk is shaped by a complex interplay of multilevel determinants. These findings call for targeted, context-specific interventions that address factors at multiple levels, including enhancing STI education and screening as part of routine reproductive health and HIV services. Additionally, governments should implement region-specific strategies to improve reproductive health outcomes.
This study applied a two-sample Mendelian randomization framework to investigate the potential association between age at first sexual intercourse (AFS) and the risk of Human Immunodeficiency Virus (HIV) infection. Summary-level Genome-Wide Association Study (GWAS) data from European populations were analyzed, including 214,547 individuals for AFS and 357 HIV cases with 218,435 controls from the FinnGen R5 dataset. Independent single-nucleotide polymorphisms significantly associated with AFS were selected as instrumental variables following linkage disequilibrium clumping and instrument-strength assessment. Causal estimates were evaluated using inverse-variance weighting (IVW), MR-Egger regression, weighted median, weighted mode, and simple mode. Cochran's Q test, MR-Egger intercept analysis, MR-PRESSO assessment, and leave-one-out sensitivity analyses were performed to evaluate heterogeneity, pleiotropy, and robustness. The IVW analysis suggested that genetically predicted later AFS was associated with reduced HIV infection risk (OR = 0.192, 95% CI = 0.062-0.592, P = 0.004), whereas earlier sexual debut corresponded to increased HIV susceptibility. Directionally consistent findings across multiple Mendelian randomization methods supported the stability of the observed association. However, the findings should be interpreted cautiously because the HIV outcome analysis relied on a single dataset with a limited number of HIV cases. These results support a potential association between earlier sexual debut and HIV susceptibility and demonstrate the utility of Mendelian randomization for investigating behavioral risk factors associated with infectious disease outcomes.
This study aimed to evaluate human papillomavirus (HPV) prevalence and genotype distribution among vaccinated women and to identify the factors associated with post-vaccination HPV infection. Women who received HPV vaccine and had the thin-layer liquid-based cytology test (TCT) and HPV genotype testing before HPV vaccination were recruited. Each participant was required to complete an online questionnaire, and cervical specimen was collected for TCT and HPV genotype testing. The epidemiology of HPV infection and genotype was described. The factors associated with HPV infection post-vaccination were identified through multivariate analysis, presenting the adjusted odds ratio (AOR) with its 95% confidence interval (95%CI). A total of 893 eligible women participated. The prevalence of HPV post-vaccination was 8.51%. The common high-risk HPV (hr-HPV) were HPV52, HPV59, HPV58 and the common low-risk HPV (lr-HPV) was HPV53. Factors associated with HPV infection post-vaccination included aged ≥40y (AOR = 2.92), married status (AOR = 1.56), receiving the first dose of HPV vaccine after sexual debut (OR = 2.57), lr-HPV positive pre-vaccination (AOR = 2.35) and hr-HPV positive pre-vaccination (AOR = 5.72). The prevalence of HPV post-vaccination was lower than that of pre-vaccination and the common genotypes changed to those not covered by HPV vaccine administrated. Age, marital status, timing of HPV vaccination and prior HPV infection before HPV vaccination were identified as the factors associated with HPV infection post-vaccination. Receiving HPV vaccination before sexual debut and ongoing HPV screening after vaccination were recommended.
To identify associated factors, to unplanned pregnancies (UP) among pregnant adolescents in the Southeast region of Brazil. A cross-sectional survey was conducted among 12-20 years old pregnant adolescents at the antenatal care services of the Women's Hospital, State University of Campinas, Brazil. We included 101 female adolescents with a median age of 17 years, a median age of 14 years at sexual debut, and a median age of 16 years at first pregnancy. Most participants were self-reported as Pardas (Bi-racial) (49/101), students (59/101), and reported between 10 and 12 years of schooling (79/101). Eighty-five of them (84.0%) reported that the present pregnancy was unplanned. Living with a partner [OR 0.12; 95% CI 0.01; 0.53] and delaying age at first pregnancy [OR 0.65; 95% CI 0.40;0.98] were associated with protective factors to UP. We believe both the public and private sectors should implement actions to strengthen the capacity of the health system to foster adequate contraceptive methods counselling and methos availability, particular long-acting reversible contraceptives, to adolescents throughout Brazil. Also, educational interventions should focus on encouraging the postponement of sexual debut and first pregnancy. These interventions should be recommended, among those adolescents involved in a romantic relationship, foster relationships based on respect, communication and stability. We believe these efforts may result in better sexual and reproductive health through life for this population. We found that 8 out of 10 adolescents reported having an unplanned pregnancy at the time of the survey.
Early sexual debut poses significant risks to adolescent health. This study investigated the prevalence and factors associated with adolescent sexual activity among secondary school students in Addis Ketema, Addis Ababa, Ethiopia. A quantitative cross-sectional study was conducted using self-administered questionnaires from November to December 2021. Data were analyzed using frequency distributions and logistic regression. The primary outcomes were the prevalence of adolescent sexual activity and the adjusted odds ratios (AOR) for its significant associated factors. The prevalence of adolescent sexual activity was 17.3%, with a majority being male (77%). The most common reason for initiation was self-desire (36.1%). Significant predictors were having a boyfriend/girlfriend (AOR = 4.58), alcohol consumption (AOR = 5.42), school type (AOR = 3.15), and watching pornography (AOR = 21.25). A considerable prevalence of adolescent sexual activity exists in this setting, driven by identifiable relational, behavioral, and environmental factors. Key strengths include direct measurement of a sensitive public health issue. Limitations comprise potential social desirability bias in self-reported data, limited qualitative depth, and possible underreporting due to parental consent requirements for minors. Targeted interventions should address modifiable risk factors, particularly pornography consumption and substance use, to reduce early sexual activity.
Neurofibromatosis (NF) is a hereditary disease characterized by the formation and growth of benign tumors of neuroectodermal origin. There are three main nosological forms: NF1, NF2, NF3. It is believed that the disease debuts in childhood and significantly reduces the life expectancy of patients. The main cause of death in middle age are cardiovascular diseases and malignant neoplasms. There are isolated publications on NF in patients over 60 years old. The relationship between NF and cardiorenal syndrome has not been sufficiently studied. The development of vasculitis with vasculopathy is described, which leads to narrowing and occlusion of the coronary, renal, cerebral and other arteries. The article presents a description of an 85-year-old patient with NF and the development of cardiorenal syndrome. Нейрофиброматоз (НФ) – это наследственное заболевание, характеризующееся образованием и ростом доброкачественных опухолей нейроэктодермального происхождения. Различают три основные нозологические формы: НФ1, НФ2, НФ3. Считается, что заболевание дебютирует в детском возрасте и значительно сокращает продолжительность жизни пациентов. Основной причиной смерти в среднем возрасте являются сердечно-сосудистые заболевания и злокачественные новообразования. Имеются единичные публикации про НФ у пациентов старше 60 лет. Взаимосвязь НФ и кардиоренального синдрома изучена недостаточно. Описано развитие васкулита с васкулопатией, что приводит к сужению и окклюзии коронарных, почечных, мозговых и других артерий. В статье представлено описание пациента 85 лет с НФ и развитием кардиоренального синдрома.
Memories are widely thought to be encoded by sparse populations of neurons, often referred to as engrams. My entry into this field began with a 2001 report in this journal showing that overexpression of the transcription factor CREB in the amygdala enhances fear memory in rats (Josselyn et al., 2001). Over the following two decades, work from my laboratory and others converged on a central idea: neurons compete for inclusion in an engram, and this competition is strongly influenced by their relative intrinsic excitability and recent activity. In this Progression article, I reflect on the scientific "eras" that shaped this view, tracing a path from early molecular manipulations of CREB (the Debut era) to more modern approaches that identify, image, and manipulate memory-relevant neuronal ensembles. Together, these studies suggest that memories are not written onto a blank neural slate but emerge from competitive interactions within preexisting neural circuits. By revisiting these discoveries through a personal lens (and with occasional inspiration from Taylor Swift's "Eras"), this article reflects on how our ideas about engrams evolved from pure speculation and theory to experimentally testable mechanisms.