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Sexes
Volume 6
Issue 1
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Sexes, Volume 6, Issue 1 (March 2025) – 7 articles

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11 pages, 202 KiB  
Review
Sex Work and the Problem of Resilience
by Heather Worth, Karen McMillan, Hilary Gorman, Merita Tuari’i and Lauren Turner
Sexes 2025, 6(1), 7; https://doi.org/10.3390/sexes6010007 - 24 Jan 2025
Viewed by 374
Abstract
The notion of resilience has been widely invoked as that essential resource by which sex workers may endure, cope, or thrive despite encountering adversities and stressors. A useful definition within the resilience discourse around sex work is the ability to connect, reconnect, and [...] Read more.
The notion of resilience has been widely invoked as that essential resource by which sex workers may endure, cope, or thrive despite encountering adversities and stressors. A useful definition within the resilience discourse around sex work is the ability to connect, reconnect, and resist disconnection in response to hardships, adversities, and trauma. In this article, we will examine the history of ‘resilience’ and show how it has been ubiquitously applied to sex workers in some Pacific Island settings. The resounding message of resilience discourse is that sex workers must learn to cope, accommodate, and adapt themselves to conditions that oppress them, and in fact, presuppose a continued acceptance of a degraded place in the world. Rather than resistance as a political action aimed at changing the social, institutional, and economic structures that have placed sex workers there, resilience shifts the onus onto the individual sex worker or her community support to learn to adapt to those conditions. Resilience strategies may be pragmatic but, in the end, to present these as any kind of solution to sex worker struggles becomes little more than victim blaming. Full article
(This article belongs to the Special Issue Understanding Resilience among People in Sex Work)
15 pages, 627 KiB  
Systematic Review
Effectiveness of Comprehensive Sexuality Education to Reduce Risk Sexual Behaviours Among Adolescents: A Systematic Review
by Ana Rodríguez-García, Alicia Botello-Hermosa, Álvaro Borrallo-Riego and María Dolores Guerra-Martín
Sexes 2025, 6(1), 6; https://doi.org/10.3390/sexes6010006 - 14 Jan 2025
Viewed by 591
Abstract
Background: Adolescence is a critical life period marked by significant vulnerability to risky sexual behaviours. Comprehensive sex education offers better sexual and reproductive health to adolescents. Aim: We aimed to analyse the effectiveness of sex education interventions on reducing risk behaviours among adolescents. [...] Read more.
Background: Adolescence is a critical life period marked by significant vulnerability to risky sexual behaviours. Comprehensive sex education offers better sexual and reproductive health to adolescents. Aim: We aimed to analyse the effectiveness of sex education interventions on reducing risk behaviours among adolescents. Methods: A systematic peer review was conducted. The databases consulted were PubMed, Scopus, Web of Science, and CINAHL. The inclusion criteria were as follows: randomized clinical trials published between 2013 and 2023 and methodological quality ≥ 5 points as per the Van Tulder scale. Results: A total of 255 studies were identified, with 25 finally selected. Of them, sixteen dealt with non-condom use, one was about early sexarche, and eight combined several risk behaviours. There was predominance of in-person teaching at schools with lectures and varied activities. The sample was predominantly comprised by girls aged between 14 and 16 years old. Certain variability regarding content, technique, number of sessions, duration, locus, and teaching modality and staff was observed in the com-prehensive sex education interventions. Almost all the interventions were effective in reducing risky sexual behaviours; however, two studies failed to achieve a reduction in risky sexual behaviours. Full article
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18 pages, 286 KiB  
Article
The Age of Sexual Initiation Among Polish Youth: The Role of Individual and Social Factors
by Zbigniew Izdebski, Alicja Kozakiewicz and Joanna Mazur
Sexes 2025, 6(1), 5; https://doi.org/10.3390/sexes6010005 - 10 Jan 2025
Viewed by 631
Abstract
Understanding the factors influencing the age of sexual initiation among adolescents is crucial for addressing risky behaviours and supporting healthy development. This study aimed to identify determinants of sexual initiation age among Polish adolescents, focusing on gender differences and 15 factors related to [...] Read more.
Understanding the factors influencing the age of sexual initiation among adolescents is crucial for addressing risky behaviours and supporting healthy development. This study aimed to identify determinants of sexual initiation age among Polish adolescents, focusing on gender differences and 15 factors related to lifestyle, family, school, and social environment. The analysis involved 3296 Polish adolescents aged 15–17 who participated in the international Health Behaviour in School-aged Children (HBSC) survey in 2018. The Cox proportional hazard model (aligned with censored data) revealed that frequent use of psychoactive substances is the main predictor of the age of sexual initiation (HR = 5.20; 95% CI: 3.66–7.38), with even moderate use having an impact (HR = 2.81; 95% CI: 2.04–3.86). Gender was not found to significantly influence the age of initiation, but the determinants did vary by gender. For boys, high physical activity and intensive socialising with peers are important factors influencing the age of sexual initiation. For girls, a positive self-assessment of appearance is more strongly associated with earlier initiation, while good academic performance and family support have a delaying effect. Effective intervention programs should consider these diverse determinants since they significantly shape adolescents’ decisions about sexual activity and their ensuing psychological experiences. Full article
20 pages, 275 KiB  
Article
BDSM and the Complexity of Consent: Navigating Inclusion and Exclusion
by Ofer Parchev
Sexes 2025, 6(1), 4; https://doi.org/10.3390/sexes6010004 - 9 Jan 2025
Viewed by 599
Abstract
Consent is a foundational component of BDSM (Bondage/Discipline, Dominance/Submission, Sadism/Masochism). It distinguishes non-normative, consensual practices from instances of abuse and exploitation. Its centrality within BDSM, however, underscores the complexity of consent as a constitutive mechanism that facilitates varied intersubjective engagements, from continuous negotiation [...] Read more.
Consent is a foundational component of BDSM (Bondage/Discipline, Dominance/Submission, Sadism/Masochism). It distinguishes non-normative, consensual practices from instances of abuse and exploitation. Its centrality within BDSM, however, underscores the complexity of consent as a constitutive mechanism that facilitates varied intersubjective engagements, from continuous negotiation and aftercare to the use of safe words. The ontological basis of consent within BDSM relies on a model of subjective autonomy wherein individuals actively shape their desires and boundaries within a consensual framework. This paper argues that a significant motivation for many BDSM practitioners lies in the desire to subvert autonomy by engaging in acts that challenge traditional consent boundaries. However, reliance on a purely liberal interpretation of consent often marginalizes such subversive expressions, thereby pushing certain BDSM practices and individuals toward pathological or criminal categorization. Here, I propose an ethical framework grounded in a liberal consent model, which is open to the inclusion of these marginalized practices, thus, fostering a more inclusive understanding of BDSM subjectivity. Full article
5 pages, 2454 KiB  
Case Report
An Adult with Fever and Progressive Ulcerative Lesions: A Case of Malignant Syphilis
by Luca Pipitò, Simona D’Avenia, Elisabetta Orlando and Antonio Cascio
Sexes 2025, 6(1), 3; https://doi.org/10.3390/sexes6010003 - 8 Jan 2025
Viewed by 880
Abstract
Background: Syphilis has recently reemerged as a significant public health concern, with rising incidence rates globally. Malignant syphilis is a rare and severe variant of secondary syphilis, often associated with immunocompromised states, particularly HIV infection. Methods: Here, we reported a rare case of [...] Read more.
Background: Syphilis has recently reemerged as a significant public health concern, with rising incidence rates globally. Malignant syphilis is a rare and severe variant of secondary syphilis, often associated with immunocompromised states, particularly HIV infection. Methods: Here, we reported a rare case of malignant syphilis in a young man with well-controlled HIV. Case: A 35-year-old man with well-controlled HIV presented with disseminated ulcerated nodules and plaques, accompanied by fever, asthenia, and mild itching. Histopathology of the scapular ulcer revealed a granulomatous infiltrate. Cutaneous leishmaniasis, atypical mycobacteriosis, and T-cell lymphomas were excluded. Serological testing and polymerase chain reaction confirmed a diagnosis of malignant syphilis. Full article
(This article belongs to the Section Sexually Transmitted Infections/Diseases)
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16 pages, 393 KiB  
Review
Mapping Evidence on Strategies Used That Encourage Pre-Exposure Prophylaxis (PrEP) Uptake and Adherence Amongst Female Sex Workers in South Africa
by Nosipho Faith Makhakhe and Gift Khumalo
Sexes 2025, 6(1), 2; https://doi.org/10.3390/sexes6010002 - 7 Jan 2025
Viewed by 447
Abstract
Female sex workers (FSWs) in South Africa have a high HIV prevalence. To reduce the rate of new infections, pre-exposure prophylaxis (PrEP) was introduced to FSWs; however, studies show that FSWs’ uptake and adherence to PrEP has been inconsistent. This study explored existing [...] Read more.
Female sex workers (FSWs) in South Africa have a high HIV prevalence. To reduce the rate of new infections, pre-exposure prophylaxis (PrEP) was introduced to FSWs; however, studies show that FSWs’ uptake and adherence to PrEP has been inconsistent. This study explored existing evidence related to strategies used to encourage PrEP uptake and adherence. Utilizing the scoping review framework, seven peer-reviewed articles were analyzed thematically. The themes were (1) PrEP promotion and distribution, (2) PrEP counselling and using educational resources, and (3) using instant messaging and rewards programs. The suggestions from the literature include a generalized PrEP promotion and distribution approach not aimed towards high-risk groups to avoid stigma. PrEP pick-up points should include sex work-friendly healthcare facilities as well as community-based venues. PrEP counselling should be conducted prior to PrEP administration to prepare users on how to deal with side effects. Information, education, and communication materials should be colorful and consist of catchy phrases targeted to the whole population. Instant messaging has been found to be effective in encouraging adherence. FSWs should be instrumental in informing intervention best practices. Future interventions aimed at FSWs should focus on holistic wellness that incorporates the psychosocial aspects of HIV prevention. Full article
(This article belongs to the Special Issue Understanding Resilience among People in Sex Work)
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13 pages, 274 KiB  
Article
Staff Views Towards the Sexuality of Adults with Mild Intellectual and Developmental Disabilities: The Role of Experience and Job Position
by Ana Belén Correa, Ángel Castro and María Dolores Gil-Llario
Sexes 2025, 6(1), 1; https://doi.org/10.3390/sexes6010001 - 3 Jan 2025
Viewed by 500
Abstract
Staff attitudes towards the sexuality of adults with mild intellectual and developmental disabilities may influence how the sexuality of service users is dealt with. The present study aimed to examine these attitudes in a Spanish context. A total of 102 staff members from [...] Read more.
Staff attitudes towards the sexuality of adults with mild intellectual and developmental disabilities may influence how the sexuality of service users is dealt with. The present study aimed to examine these attitudes in a Spanish context. A total of 102 staff members from service facilities for adults with intellectual and developmental disabilities, including direct-care and professional staff, responded to an online version of the Attitudes Towards the Sexuality of Individuals with Intellectual Disabilities Scale. In general, the participants demonstrated an understanding that adults with intellectual and developmental disabilities have sexuality. They reported favourable attitudes towards some self- and other-oriented sexual behaviours and sex education. Intermediate scores and variability on some items revealed concerns about these adults’ ability to control their sexual urges, perceptions of sexual abuse, pornography use, and contraception. Some differences appeared in relation to socio-demographic variables, experience and job position. Although generally favourable, differences in dispositional attitudes, such as talking about sexuality, were related to years of experience in the field. Professional staff reported greater acceptance of some sexual behaviours compared to direct-care staff. These findings are relevant to understanding variability in staff perceptions. The need for support to respond to service users’ sexuality, especially among direct-care professionals, is discussed. Full article
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