There is some evidence for a genetic influence on sexual orientation. However, gay men have fewer children than heterosexual men. Increased fecundity in the biological relatives of gay men could offset this selection pressure. We measured family size in gay (n = 301) and heterosexual (n = 404) men, attending clinics for sexually transmitted infections. The main outcome measure was the number of each man's uncles and aunts, first cousins, siblings, nephews and nieces, and his own children. With the exception of the participants' own offspring, mean family size of each category of relatives was significantly larger for gay men (paternal and maternal total OR = 1.02, CI = 1.01-1.03). This remained the case after adjustment for other predictors of family size (paternal and maternal total OR = 1.02, CI = 1.00-1.03). We found increased fecundity in the relatives of gay men and this is one explanation of how a genetic influence might persist in spite of reduced reproductive fitness in the gay phenotype. There are, however, a number of alternative explanations for our finding, including unknown psychological and social factors, which might mediate the association between family size and sexual orientation.
We used qualitative methods to explore factors, which might explain increased anxiety in patients attending a sexually transmitted infection (STI) clinic. Twenty patients, who scored significantly for anxiety on the Hospital Anxiety and Depression Scale (HADS) attended a 20-minute interview. This explored factors contributing to their current psychological symptoms. Transcripts revealed three main themes. First were factors related to possible STIs and the clinic visit. These included health anxieties about HIV or fertility and clinic factors, including staff attitudes and clinic location. Second were factors unrelated to the clinic, including previous emotional difficulties or substance misuse. Third were issues concerning stigma, embarrassment and shame. The origins of anxiety in STI patients are multifactorial and difficult to identify during brief appointments. Despite modern clinics and attitudes, stigma and embarrassment remain prominent. Interventions to address these factors could improve psychological health in this patient group.
Service providers' views were congruent with each other, NICE guidelines and quality standards as proposed by the Royal College. Although clinicians feel that their service fulfils many practice guidelines, there remains areas in which adherence is felt to be lacking.
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