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BACKGROUND: The scientific literature on multiple orgasm in males is small. There is little consensus on a definition, and significant controversy about whether multiple orgasm is a unitary experience. AIMS: This study has 2 goals: (i) describing the experience of male multiple orgasm; (ii) investigating whether there are different profiles of multiple orgasm in men. METHODS: Data from a culturally diverse online convenience sample of 122 men reporting multiple orgasm were collected. Data reduction analyses were conducted using principal components analysis (PCA) on 13 variables of interest derived from theory and the existing literature. A K-means cluster analysis followed, from which a 4-cluster solution was retained. RESULTS: While the range of reported orgasms varied from 2 to 30, the majority (79.5%, N = 97) of participants experienced between 2 and 4 orgasms separated by a specific time interval during which further stimulation was required to achieve another orgasm. Most participants reported maintaining their erections throughout and ejaculating with every orgasm. Age was not a significant correlate of the multiple orgasm experience which occurred more frequently in a dyadic context. Four different profiles of multiorgasmic men were described. STRENGTHS & LIMITATIONS: This study constitutes a rare attempt to collect systematic self-report data concerning the experience of multiple orgasm in a relatively large sample. Limitations include the lack of validated measures, memory bias associated with self-reported data and retrospective designs, the lack of a control group and of physiological measurement. CONCLUSION: Our study suggests that multiple orgasm in men is not a unitary phenomenon and sets the stage for future self-report and laboratory study. Griffin-Mathieu G, Berry M, Shtarkshall RA, Amsel R, Binik YM, Gérard M. Exploring Male Multiple Orgasm in a Large Online Sample: Refining Our Understanding. J Sex Med 2021;XX:XXX-XXX.

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This study examined patterns and determinants of seeking online health information among a nationally representative sample of 7,028 Jewish and Arab 7th- through 12th-grade students in 158 schools in Israel. Nearly all respondents (98.7%) reported Internet access, and 52.1% reported having sought online health information in the past year. Arab students (63%) were more likely than Jewish students (48%) to seek online health information. Population-group and sex differences in health topics sought online were identified, although fitness/exercise was most common across groups. Multivariate regression models revealed that having sought health information from other sources was the strongest independent correlate of online health information-seeking among Jews (adjusted odds ratio = 8.93, 95% CI [7.70, 10.36]) and Arabs (adjusted odds ratio = 9.77, 95% CI [7.27, 13.13]). Other factors associated with seeking online health information common to both groups were level of trust in online health information, Internet skill level, having discussed health/medical issues with a health care provider in the past year, and school performance. The most common reasons for not seeking online health information were a preference to receive information from a health professional and lack of interest in health/medical issues. The closing of the digital divide between Jews and Arabs represents a move toward equality. Identifying and addressing factors underpinning online health information-seeking behaviors is essential to improve the health status of Israeli youth and reduce health disparities.

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Cultural competence and cultural adaptation are currently considered important components of the quality of health/ medical services in multi-cultural societies. These include not only treatment of disease, but also primary, secondary and tertiary prevention by professionals, as well as health promotion and management by the population. Migrant populations who are in the processes of transition and acculturation are in much stronger need for cultural specific communication and adaptation. The case of immigrants from Ethiopia to Israel is unique, as the immigrants moved within a short time from highly traditional culture, with its perceptions of health, disease, and their causes, to modern health services, based on bio-medical theory and practice. The paper by Dayan and Shvartzman, discusses the important aspect of women's health and compares the situation of Ethiopian women in Israel to that of other migrant women in different parts of the world.

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BACKGROUND: The Internet is a frequently used source of health information. Adolescents in particular seem to be receptive to online health information (OHI) and often incorporate such information in their decision-making processes. Yet, OHI is often incomplete, inaccurate, or unreliable. This study assessed the quality of Hebrew online (non-user-generated) content on oral contraceptives (OC), with regard to accuracy/completeness, credibility, and usability. METHODS: Twenty-nine websites in Hebrew, including those of the four Israeli HMOs, were identified and evaluated. The websites were categorized as: HMO, health portal, contraception-specific, promotional-commercial, and life style and women's health. A set of established content parameters was selected by a family planning expert to assess accuracy/completeness. The Health on the Net Foundation Code of Conduct (HONcode) principles were used to assess the websites' reliability. Usability was assessed by applying items selected from the Minervation Validation and the University of Michigan's 'Website Evaluation checklist' scale. Mean scores, standard deviations (SD), and ranges were calculated for all websites and for category-specific websites. Correlation between dimensions and Inter-rater reliability were also examined. RESULTS: The mean score for accuracy/completeness was 50.9% for all websites (SD=30.1%, range 8-100%). Many websites failed to provide complete information, or provided inaccurate information regarding what to do when a pill is missed and when to use back-up methods. The average credibility score for all websites was 70.6% (SD=15.1, range=38=98%). The credibility parameters that were most commonly absent were funding source, authoring, date of content creation and last modification, explicit reference to evidence-based information, and references and citations. The average usability score for all websites was 94.5% (SD=6.9%, range 79-100%). A weak correlation was found between the three quality parameters assessed. CONCLUSIONS: Wide variation was noted in the quality of Hebrew-language OC websites. HMOs' websites scored highest on credibility and usability, and contraceptive-specific websites exhibited the greatest accuracy/completeness. The findings highlight the need to establish quality guidelines for health website content, train health care providers in assisting their patients to seek high quality OHI, and strengthen e-health literacy skills among online-information seekers, including perhaps health professionals.

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BACKGROUND: Studies related to condom use among young adults consistently point to substantial gender disparities, although the use has generally increased. This study examined trends in condom use between 1993 and 2005 among 13,988 Israelis aged 18-25 years and the associated sociodemographic factors. METHODS: An HIV/AIDS Knowledge, Attitudes, and Practice survey was self-administered to dischargees from Israel's compulsory military service. Multivariate logistic regression models were used to assess trends in condom use and the association over time of sociodemographic factors and sexual behaviors with consistent condom use. RESULTS: During the 13-year period, consistent condom use increased among men (from 35% to 58%) and women (from 17% to 54%), almost eliminating the gender difference. Among both genders, consistent condom use was associated with being single, being older at the time of sexual debut, and being religious, and was inversely associated with age and education; however, gender differences were found in the strength of the associations over time. CONCLUSIONS: The excess risk of exposure of young women to lack of condom use has minimized, an unusual situation on international comparison, although population risk for HIV and sexually transmitted infections exists in Israel. Further understanding of factors influencing the decreasing gender differences is required to reorient and tailor HIV/AIDS interventions to most effectively reach young adults of both sexes.

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UNLABELLED: The sexual and reproductive behaviors of Ethiopians immigrating to Israel have changed drastically as they transition to a new culture. With the postponement of age of marriage and an increase in sexual activity prior to marriage, there is an increased risk of unplanned pregnancy among young people in this group. The increasing rates of unplanned pregnancy among immigrants in developed countries have become a formidable public health challenge. OBJECTIVE: To examine abortion request rates and trends among young women of Ethiopian origin aged 16-24 years during the period 1995-2005 in order to characterize the relative extent of abortions and the time trends, and also to provide development and intervention recommendations. FINDINGS: During the years 1995-2005 the rate of abortion requests among young women of Ethiopian origin was 3-6 times that of other Israelis. Young women of Ethiopian origin born in Israel requested abortions at 1.3-3 times the rate of Israelis of non-Ethiopian origin. However, the adolescents of Ethiopian origin born in Israel had abortion request rates that were more comparable to other Israelis than to women born in Ethiopia who subsequently immigrated to Israel. However those who have been in Israel 5-9 years, compared to those living in the country for 1-4 years, have lower rates of requests for abortion, most notable in the 20-24 year old age group. CONCLUSIONS: Israeli women of Ethiopian origin have a considerably higher risk of requesting an abortion than other Israeli women of the same age. Although women of Ethiopian origin born in Israel had a lower rate of requests for abortions compared to those born in Ethiopia, this rate is still higher in comparison to other Israelis. Females born in Ethiopia have even higher rates. It is evident that these youth need exposure to appropriate preventive interventions and that this group cannot be considered homogenous. We recommend that appropriate interventions should be based on the specific needs of sub-groups within them and on appropriate analytical and development research.

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The study examines trends in knowledge about HIV/AIDS prevention, perceived need for more information, and knowledge sources among 20,619 Israeli army releasees between 1993 and 2005. HIV/AIDS knowledge was strongly associated with education, lower religiosity and receiving information via the media in both genders, changing non-linearly over time. Need for more information was associated with low knowledge level among men (OR= 2.14; CI: 1.84-2.49; P < .0001) and women (OR 1.48; CI: 1.21-1.81; P < .0001). The findings underscore the need to reach those groups whose knowledge remains low over time utilizing the media, the preferred knowledge source, recognizing that a segment believes they do not need more information despite having low HIV/AIDS knowledge.

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Ambiguous feelings regarding women engaging in formal volunteering and concerns about their exploitation might explain the dearth of studies regarding the volunteering benefits specifically experienced by low socioeconomic status women. The current study examined benefits of volunteering among women participating in Women for Women's Health (WWH), a lay health volunteers (LHV) programme implemented in Jewish and Arab communities in Israel, and aiming at empowering such women to become active volunteers and promote health activities in their communities. Two years after the introduction of WWH in each community, all 45 Jewish and 25 Arab volunteers were contacted by phone and invited to participate in the focus group discussions. Five focus group discussions were conducted with 25/42 Jewish volunteers in 2003 and four with 20/25 Arab volunteers in 2005. The other volunteers could not attend the scheduled meetings or became inactive for personal reasons. Four benefit categories were identified in both ethnic groups: 1. Personal benefits of having increased knowledge, feeling self-satisfaction, mastering new skills and performing healthy behaviours; 2. Group-social benefits of social support and sense of cohesion; 3. Purposive benefits of achieving the WWH mission and goals; 4. Sociopolitical benefits of learning to accept the other and experiencing increased solidarity. However, the relatively less privileged Arab volunteers enumerated more benefits within the personal and purposive categories. They also identified the unique sociocultural category of improving women's status in the community by creating a legitimate space for women by public sphere involvement, traditionally solely a male domain. We conclude that volunteering in community-based health promotion programmes can be an empowering experience for lay women without being exploitative. Positive volunteering benefits will be even more discernable among underprivileged women who enjoy fewer opportunities in the personal and public domains. More studies need to explore volunteering benefits as reported by LHVs, making these benefits more visible and desirable.

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OBJECTIVE: Despite receiving full medical care and many social services, many Ethiopian immigrants in Israel feel frustrated, and even alienated, by the care they receive. This study uses a qualitative approach to explore the obstacles Ethiopian immigrants face regarding effective health seeking behavior and optimal interactions with healthcare providers in Israel. DESIGN: We gained a three-cornered perspective by conducting semi-structured interviews with healthcare providers, immigrants, and interpreters who mediate between the two. An ecological system or socio-ecological model guided the data analysis. It allowed organizing the varied and complex relationship between the factors that influence healthcare delivery and receipt among this population. RESULTS: The advanced analysis of our results delineated four themes which we grouped into two domains: the cultural divide and the interpreters. Within each of these themes, we explored influences on health or healthcare at each level of the socio-ecological model. We demonstrated that the problems surrounding health seeking behaviors and receiving treatment stem mainly from a cultural divide. This cultural incongruity and its effects are apparent at multiple levels of the ecological model and must be recognized and addressed programmatically at these levels. CONCLUSIONS: Necessary program and service modifications include that cultural mediation become an integral part of health personnel's training for healthcare delivery and a necessary criterion for good practices. We recommend that professionals from within the health system be trained to act as interpreters. Lastly, the integration of traditional healers into the allopathic health system should be considered. These modifications require a system-wide change in policy, structure of services, and practices.

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Sexual dysfunctions are common phenomena in healthy as well as in ill populations. The introduction of PDE5-inhibitors gave primary health-care physicians and specialists a tool to treat erectile dysfunction. This focused the attention on the need of physicians to be trained to discuss helpfully sexual issues. Sexual dysfunctions are biopsychosocial phenomena with many causes, including specific diseases and some treatments. These dysfunctions can be a cause for much distress. It seems that nowadays people are more prepared to ask sexual questions than physicians are ready to discuss and answer them. In this issue of Harefuah, we present many aspects of a combined, multi-professional, biopsychosocial model, for identifying and treating sexual dysfunctions. We also propose some ideas that could serve medical professionals in their efforts to better deal with sexual matters.

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In view of the developmental approach to sexual behavior, this article presents the stages of sexual behavior leading to coitus in four grades of high school students in Israel and the sociodemographic factors associated with initiating coitus. Analyses were based on data from the first national study dealing comprehensively with sexuality in 30 years. A self-administered questionnaire was completed by a random sample of 4,609 students of the General Educational (secular) system that included 68% of the Hebrew-speaking sector or 55% of all students in Israel. Our findings indicated a progressive set of stages of sexual behavior forming a Guttman scale, from kissing and petting over the clothes though petting under the clothes and genital touching to coitus. In comparison to results of a 1970 Israeli survey, we found an increase in practice in all Guttman scale stages of sexual behavior, as well as a diminished gap between genders. The gap fully disappeared in the three lower stages. Predictive variables of coitus initiation included gender, religiosity, immigration status, family structure, perceptions of academic achievements, and the proportion of peers practicing coitus. In addition to gender, perception of the proportion of peers that already practiced intercourse was the best predictor followed by grade, perception of academic achievement, and family structure. Marked differences were noticed between genders regarding associations with religiosity and immigration status. The discussion focused on comparisons to findings in other countries, the contribution of the findings to the understanding of Israeli adolescents' sexual behavior, and practical educational implications.

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Data from the 2000 National Health Interview Survey (NHIS) were analyzed to explore barriers to HIV testing, and intentions to be tested among a nationally representative sample (n = 4,261) of the different Hispanic subgroups living in the United States. Weighted proportions and variances accounting for the complex sample design of the NHIS were estimated using the Taylor series linearization method. Regression estimates are expressed as odds ratios and their 95% confidence intervals. Two thirds of sampled Hispanics had never been tested for HIV (excluding blood donations) and 88% expressed no intention to do so in the near future. Many of the factors that influence the likelihood of having been tested in the past also impact on future HIV testing intentions including age, Hispanic subgroup, high-risk status, and self-perceived HIV risk. Compared to Puerto Ricans, Mexicans (odds ratio [OR] = 1.59, 1.1-2.3) and Mexican/Americans (OR = 1.61, 1.1-2.3) were more likely to never have been tested and Cubans were notably more likely to report negative future testing intentions (OR = 5.63, 2.5-12.8). Among Hispanics who reported high-risk status or high/medium self-perceived HIV risk, more than one quarter had never undergone testing and expressed no intention of doing so in the near future. Recognition of the HIV testing barriers identified in this study is valuable for the development and refinement of current strategies that aim to increase HIV testing practices in the heterogeneous U.S. Hispanic population.

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Migration is one of the structural factors associated with HIV infections, but the dynamic and complex role of migrant situations as determinants of HIV-related vulnerability is still a major issue for social science research. Moreover, interventions to address the specific structural and contextual factors inherent in this association are limited and many do not take into account the cultural components. This paper presents a multi-level framework for analysis of the links between migration and HIV. It includes the association of migration with structural macro factors-lower socio-economic status and limited power in the new society; intermediate structural factors-limited social capital and bi-directional interaction of cultural norms; and individual-level factors-stressors unique to the migration context, depleted psychosocial resources, loss of cultural beliefs and low use of health services. All these factors affect risky sexual behaviour and transmission of HIV. The paper utilises those elements of the framework that are relevant to the specific needs of immigrant populations from the former Soviet Union and from Ethiopia in Israel. We demonstrate their application to integrated, multi-level HIV prevention interventions and propose several special principles for development of migration-related HIV prevention programmes.

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This article presents a model-based evaluation of a program designed to reduce HIV transmission from HIV-infected Ethiopian immigrants in Israel. Rather than rely on self-reported variables such as condom use, this study's approach focuses on pregnancy rate reduction, estimated from administrative periodic reporting data, as a measure of unprotected sexual exposure. The models show that among both HIV+ women and the female sex partners of HIV+ men, the ongoing pregnancy rates estimated during the intervention were significantly lower than the estimated baseline pregnancy rates, suggesting reductions in unprotected sexual exposures among those participating in the program.

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