Sex, technology and disability – it’s complicated

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Media portrayals of sexuality often focus on a visual and verbal vocabulary that is young, white, cisgender, heterosexual and…not disabled.

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People living with disability are largely excluded from conversations about sexuality, and face overlapping barriers to sexual expression that are both social and physical.

Media portrayals of sexuality often focus on a visual and verbal vocabulary that is young, white, cisgender, heterosexual and … not disabled.

My research into inclusive design explores how design can – intentionally or unintentionally – exclude marginalised or vulnerable people, as well as how design can ensure that everyone is included. That might mean design of the built environment, everyday products, or even how information is presented.

UTS has been collaborating for over a year with Northcott Innovation, a nonprofit organisation based in NSW that focuses on solutions for people with disability, to understand the barriers people face, and how inclusive design can help break them down.

When it comes to sexuality, new technologies have a role to play – but we need to look at both the opportunities and risks that these developments bring.

Starting the conversation

David* is a young man living with cerebral palsy who expresses a deep frustration about being unable to have his sexual desires met. He revealed his thoughts during discussions around sex and disability.

I can’t get into a lot clubs in my wheelchair – or restaurant or cafés for that matter. So where do I go to meet someone? Or go on a date? Let alone if we wanted to be intimate!

Northcott Innovation’s executive director Sam Frain isn’t surprised by what these conversations are revealing:

People with disability want to date, fall in love, or even fall out of love. They want to be recognised as the adults they are. In acknowledging their capacity for meaningful relationships, we must also acknowledge their sexuality – in whatever form that takes.

David faces complex social barriers too. Because it’s hard to for him to discuss his sexuality at all, coming out to his mother feels particularly fraught:

My mum doesn’t really know that I want to meet a future husband, not wife. I want to go on more dates. I don’t just want to meet other men with disability either. I want to meet lots of guys – but where can I go and how do I do this?

Inclusive sex toys

People living with disability have diverse physical and social support needs when it comes to expressing their sexuality. That means there isn’t going to be a one-size-fits-all solution. Rather we need a design approach that allows for customisation.

A new research project at RMIT, led by industrial design lecturer Judith Glover, is investigating the design of customised, inclusive sex toys.

Aside from some engineering research undertaken earlier this year at the University of São Paulo into the neurodildo – a sex toy operated remotely by brain waves – inclusive sex toys are an under-explored area of design research.

Glover feels strongly that designing sexual health products or services – whether for therapy or for recreation – should be treated as any other area of design. She acknowledges that the sex toy industry has barely started to address sex toys for an ageing population, let alone solutions for people with various disabilities:

Some of the people I meet, who are physically incapable of holding and moving objects, may have trouble communicating verbally – yet who really yearn to be able to develop their own sexual practice. Plus who doesn’t need to just get off every once in a while?

David agrees:

I really want to explore the option of sex toys more, but I don’t know what to try, or how to use it.

Social media and intellectual disability

Connecting communities together is an important strategy to overcome marginalisation and amplify the voices of people with disability.

Social media is a space where technology brings like-minded people together. But creating safe online spaces for people to express their sexuality can create unforeseen challenges – particularly for people with intellectual disability.

Deakin University and the Intellectual Disability Rights Service (IDRS) set up a closed Facebook support group earlier this year for people with intellectual disability who identify as LGBTQI. Jonathon Kellaher, an educator with IDRS, says:

Group administrators quickly realised that people who were not “out” and did not understand that group members can be viewed publicly were at risk of accidentally “outing” themselves when requesting to join the group.

To address this issue, the group privacy setting was set to “secret”. But this meant new members had to wait to be added, so it became a barrier to the group’s potential as a social connector. Deakin is now working on a project with GALFA to learn more about how people connect in this space.

Technology must promote inclusion

Then there is the elephant in the room: sex robots.

Manufacturers claim sex robots provide health and social benefits for people with disability, but researchers have been quick to point out that there’s no evidence to support the range of claims that have been made.

While it’s possible to see the introduction of sex robots as a form of assistive technology – a new way to experience pleasure, or to explore preferences and body capabilities – there’s another, more tragic, side.

Viewing sex robots as a solution to the loneliness of people with disability (or anyone for that matter), or as a remedy for a lack of available dates, risks perpetuating and exacerbating the social and sexual exclusion of people with disability.

Technology can’t replace human connection, so it’s critical that new technologies support greater inclusion for people living with disability. It’s a human right to be able to safely express and enjoy sexuality, and have the choice to live a life with pleasure.

For David, that fits in to his ideal world very clearly:

One day I really want a husband to love me, two children, and to own my own restaurant.

Complete Article HERE!

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Men, like women, can have post-sex blues

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By Cheryl Platzman Weinstock

After sex, men can sometimes experience a myriad of confusing negative feelings, a phenomenon called post-coital dysphoria (PCD), which can interfere with relationships, researchers say.

The research team analyzed responses from over 1,200 men to an anonymous international online survey that asked whether they had ever experienced symptoms of PCD, which can include tearfulness, sadness or irritability following otherwise satisfactory consensual sex.

The men, aged between 18 and 81 years, were primarily in Australia and the U.S., but the sample also included men in the UK, Russia, New Zealand, Germany and 72 other countries.

The study team, led by Joel Maczkowiack, a master’s student at Queensland University of Technology in Brisbane, Australia, found that 41 percent of the men reported having experienced PCD in their lifetime, with 20 percent saying they had experienced it in the previous four weeks. Between 3 percent and 4 percent of the men reported experiencing PCD on a regular basis.

“I would like to think that this study will help males (and females) reflect on their experience of sex, as well as encourage communication between partners about their experience,” Maczkowiack told Reuters Health by email.

“In addition, we hope that this type of research will help people whose experience of sex is dysphoric (or dysphoric at times) to know that they are not the only ones who feel this way. In this sense, we hope this study normalizes a variety of human experiences following sex,” he said.

Past research has found that PCD is common among women. This is the first time it has been documented in men, Maczkowiack said.

PCD can occur despite satisfying and enjoyable sex. One man in the study reported that PCD made him feel “self-loathing.” Another reported, “I feel a lot of shame.” One participant said, “I usually have crying fits and full on depressive episodes following coitus that leave my significant other worried . . . .”

The study, published in the Journal of Sex and Marital Therapy, found that PCD may be related to previous and current psychological distress and past abuse, including sexual, emotional and physical abuse in childhood and adulthood.

Emotional abuse was the most common form of abuse reported by the men both before and after age 16, researchers found. Sexual abuse in childhood was reported by 12.7 percent of the men and sexual abuse in adulthood was reported by 3.5 percent of the men. Their most common reported mental health concern was depression (36.9 percent), followed by anxiety (32.5 percent) and bipolar disorder (3 percent).

Current psychological distress was the strongest variable associated with lifetime and four-week PCD. Higher levels of psychological distress were more strongly associated with PCD.

The data for this study was collected from February to June 2017 and drawn from a larger questionnaire that examined the post-coital experience of men and women.

“While this research is interesting, the study of PCD needs psychometrically valid instruments, said Rory Reid, an assistant professor of psychiatry and research psychologist at the University of California, Los Angeles, who was not involved in the study.

The study used a few questions to measure PCD, but there is ambiguity in those items, Reid said in a phone interview. “They lack precision and there was no specificity about frequency in responses as to exactly how often was ‘a little’ or ‘some of the time’,” he noted.

“Future studies of PCD need to utilize qualitative approaches where participants are interviewed about their PCD experiences so we can further understand this phenomenon, why people might experience it, the extent to which it is causing individuals psychological distress, and whether it is negatively impacting their romantic relationship,” Reid added.

One of limitations of the study was that the men self-reported their emotional response to previous sexual experiences. “This information can be difficult for participants to recall,” Maczkowiack, said.

“The findings of this study could influence marital therapy by normalizing different responses. In addition, it may open up communication between partners,” he said.

Complete Article HERE!

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Yes, we can.

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And we can also change the way we talk about disability and sex

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There are major barriers for disabled people who want to pursue sex and relationships. They are real and deeply felt. Yet the stigmatising tone of public conversation makes me wary, writes Henrietta Bollinger

“Um … advice? From me? Yes, we can,” was my cautious, then tongue-in-cheek answer. “As Obama would say!”

The others laughed. It was a joke. But I’d just been asked what advice I might have for young people like me who were exploring sex and sexuality. It was also a pithy summary of what 16-year-old me had needed to know.

As a disabled woman this was not something I’d been sure of: could sex be part of my life? When I later conducted research on the experience of young disabled people in sexuality education the question repeated itself. Being unsure if sex and relationships would feature in their lives meant they were unsure if any of the information about safe sex or healthy relationships applied either. They largely disregarded what they had learnt as irrelevant , increasing the risk of abuse. So, I know how important it is to clearly say: “Yes. As a disabled person sex is for you, too.”

This sentiment in the piece headlined “The reality of having sex when you live with a disability” I had to agree with. I also agree that there are major barriers for disabled people who want to pursue sex and relationships. These range from a lack of affirmative education, to the inaccessibility of places where people usually meet potential partners, disabled people’s social isolation and stigma towards disabled people, including assumptions that may come from their own families or the people who support them. There are related issues too, like people’s rights to marriage, fertility or to have children. In this country, it is still legal under the Adoption Act for children to be removed from their parents’ care on the grounds of parental disability. Disabled people are also still far too frequently subjected to sterilization.

The barriers are real and deeply felt. They absolutely need addressing as part of realising equitable and full lives for disabled people. I would absolutely advocate for the removal of all barriers that inhibit us from exploring sexuality or entering sexual relationships as equals to non-disabled people. Yet the tone of public conversation makes me wary. On the rare occasions we do talk about disability and sex it is either to highlight the barriers or to equivocate about sex work. Advocacy which claims the act of sex as something we are entitled to often misses the fact that good sex should be a negotiation, a social interaction. Nobody – including those who work in the sex industry – owes it to anyone.

Sex work as a way for disabled people to access sex has been brought to popular attention by films like The Sessions or Touching Base. The Sessions was a dramatization of Mark O’Brien’s life; a man with polio who decided he wanted to have sex before he died. Touching Base is a documentary about an Australian sex worker who visits disabled clients. Stories like these have a lot of value in terms of amplifying the “Yes we can” message. For many disabled people working with sex workers provides intimacy they may not have and the opportunity to explore their own bodies, take “safe-risks”. But these stories are told into a context where sex workers continue to be stigmatised and so do disabled people.

When this is made the dominant narrative, it allows the rest of “able” society off the hook in terms of examining its own prejudices. Instead of asking hard questions about attitudinal, social, educational and physical barriers that exist to all people being full sexual citizens – we outsource. We tell sex workers that there are morally more and less acceptable ways of doing their jobs, instead of constantly supporting them in their choice of work.

Disabled people, we say to ourselves, are entitled to sex as a service, the uncomplicated meeting of a need. But as partners, lovers in their own right?

There is another story, too, a story that we tell less often – maybe because it is more mundane.

This is the idea that disabled people can and do have sex – without the help of any support or sex workers. We are straight, queer, alone, together. We are partners, lovers, parents and all the rest. It is the kind of conversation that is happening privately, or being just lived. It is the mundane story we need to make sure people know is out there too.

Because after we understand that “Yes we can” we ask: how? And we have to know there is not one reality of sex and disability but many. The more varied the stories we tell, the more will seem possible to the disabled kid in their sex ed class, as well as to their potential partners.

Complete Article HERE!

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The first app to get approved as birth control in Europe has now been green-lit in the US, despite controversy

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  • Birth-control app Natural Cycles has been approved by the US Food and Drug Administration — the first app to be approved for contraception in North America.
  • The app uses an algorithm to tell women when they have the highest and lowest chances of getting pregnant, but it ultimately relies on men and women changing their behavior.
  • The app recently came under fire in Sweden when 37 women reported getting pregnant while using it.

A birth-control app called Natural Cycles has been approved by the US Food and Drug Administration, marking the first time an app has been approved for contraception in North America.

Designed by physicist couple Elina Berglund and Raoul Scherwitzl, the app doesn’t involve a pill and contains no medication. It works by giving heterosexual couples recommendations about when to avoid sex or use protection, based on a woman’s daily temperature measurements and the regularity of her period.

“Consumers are increasingly using digital health technologies to inform their everyday health decisions, and this new app can provide an effective method of contraception if it’s used carefully and correctly,” Terri Cornelison, assistant director for women’s health at the FDA’s Center for Devices, said in a statement. “But women should know that no form of contraception works perfectly, so an unplanned pregnancy could still result from correct usage of this device.”

Natural Cycles only helps prevent pregnancy if people using it behave in the way it prescribes. The app also recently gained regulatory approval in Europe — the first app to do so there as well — but it came under fire in Sweden several months later when 37 women reported getting pregnant while using it.

Those pregnancies ignited a small controversy about how the app works and what it can — and can’t — do. But Scherwitzl told Business Insider in January that he was not surprised women had become pregnant.

“We give red and green days and clear recommendations on which days to abstain and which days we consider the risk of pregnancy to be negligible,” he said.

The problem with saying ‘as effective as the pill using only math’

Natural Cycles was initially portrayed by multiple news outlets — including Business Insider — as being “as effective as the pill using only math.”

When is used properly, Natural Cycles may be comparable in effectiveness to the pill. But that doesn’t always happen, as the controversy in Sweden revealed.

So the problem with these types of statements is that the app relies on couples to change their behavior and either not have sex or use protection based on the app’s recommendations.

“Just like with the pill, you have scenarios where women take the pill everyday” and it’s as reliable as possible, Scherwitzl said, and then there are “scenarios where they don’t take it every day” and the reliability decreases.

How Natural Cycles compares with simply using a calendar

Natural Cycles’ approach puts it in a larger category of birth control known as fertility awareness, which is similar to the calendar-based approach people have used for decades.

The company’s founders published a study on the app’s effectiveness in the European Journal of Contraception and Reproductive Health Care in 2016. The research involved 4,000 women between the ages of 18 and 45, and the results showed that out of every 100 women who used the app in a “typical” way for a year (meaning certain common slip-ups were accounted for), seven of them got pregnant.

That rate is and significantly lower than the traditional calendar method, which has an average fail rate of 24%, according to the CDC.

The “typical use” scenario for the pill leads to about nine out of 100 women getting pregnant within a year, so the study suggests Natural Cycles is on par with an oral contraceptive. But the app still leads to more pregnancies than would be seen among people using injectable birth control or an IUD. The typical use fail rate for an IUD is 0.2-0.8%, or less than one out of 100 women getting pregnant each year.

Apps can ‘provide encouragement,’ but still have key limitations

As far as the women who got pregnant while using the Natural Cycles app are concerned, the same European study found that more than half of them had unprotected sex with men on the days when the app advised against it. Those instances are evidence of a longstanding human reality: behavioral control is difficult, especially when it comes to sex, and not a guaranteed way to prevent pregnancy.

“While smartphone apps may provide encouragement, they can’t stop [men and women] from … sex altogether,” Susan Walker, a professor of sexual health at Anglia Ruskin University, wrote in an article for The Conversation.

A handful of other factors can also get in the way of the app working correctly, including having multiple sex partners and having a partner who is not equally committed to birth control.

So if you’re planning on using the app — or one of the dozens like it that have not been approved as medical devices — experts say you should have a predictable sex schedule, regular periods, be willing to check your temperature every day, and have the ability to abstain from sexual activity on consecutive days every month.

If you can do all that, the app could work for you.

“In the end, what we want to do is add a new method of contraception that women can choose from without side effects,” Scherwitzl said. “I think there are many women who this will be great for.”

Complete Article HERE!

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What Do You Do If You Have An STI?

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Stay Calm, Here Are 3 Steps To Take

By Laura Moses

Years ago, a friend raged into my apartment with bad news: the guy she had been hooking up with had given her an STI. She knew he was seeing other people, but he had just written her a lovey-dovey email from his business trip, asking about her upcoming schedule, and saying how much he missed her. She was gobsmacked about what to do. I mean… what do you do if you have an STI? Like a good friend, I made her a drink and then we made a plan. She wrote a nice email back to him saying she’d check her schedule, hoped he had a nice trip, and ended with “P.S. We have gonhorrea.” Boom.

Although we still laugh about that to this day, your sexual health is something to take very seriously. If you think you might have an STI, you probably feel anxious, scared and pretty physically uncomfortable. I connected with Dr. Gillian Dean, Senior Director of Medical Services at Planned Parenthood Federation of America, about this topic. She observes, “The reality is that there are 20 million new STI cases each year. Getting an STI or having a partner with an STI is extremely common — it’s the result of intimate contact with other people and not something to be embarrassed about. It doesn’t make you any less valuable or worthy of love, and your STI status doesn’t make you “clean” or “dirty.” So take a deep breath, you got this, and read on for steps to take to address what might be going down… down there.

Step One: Get Tested

It’s important to note what your specific symptoms are and when they first occured. While a girl’s gotta pay attention to everything going on below her belt, keep in mind that not every itch or sore spot is caused by an STI. Dr. Dean explains, “painful or frequent urination could be a symptom of an STI — or it could be caused by a urinary tract infection or vaginitis. Both yeast infections and pubic lice cause itching. Is that bump a wart or a pimple? It can be hard to tell sometimes.”

While noting and keeping track of your symptoms is important, most common STIs out there — chlamydia, gonorrhea, HPV — often don’t have any symptoms, Dr. Dean says. That’s why there’s no accurate way to tell if you have an STI without being tested. STI testing is quick, easy and painless. All STIs are treatable, while many are curable — but you have to know your status before you can get treated. So go.

Step Two: For Real, Get Tested

Let’s say you feel fairly fine, just a little irritation down south, but you would rather wait it out and hope it goes away than trek to your gyno’s office and do the whole pelvic exam thing. Most of the time, STIs have no symptoms or may be so mild that they don’t bother you, but that doesn’t mean they’re not harmful.

Dr. Dean cautions, “Just because you don’t have physical symptoms doesn’t mean you can’t pass it [an STI] to a partner or that it can’t lead to more serious health problems in the future. If you’ve had vaginal, anal, or oral sex with a new sexual partner or multiple sexual partners, you should talk with a nurse or doctor about getting tested.”

Now, if you have physical symptoms such as sores or bumps on and around your genitals, burning or irritation when you pee or flu-like symptoms like fever, body ache, and swollen glands… then please put your phone in your bag and go right to the doctor. (You can finish reading this later!) You can also get rested — often for a reduced rate or even for free — at Planned Parenthood or a sexual health clinic.

Once you’ve been tested and you know exactly what you’re dealing with, the treatment your doctor prescribed to you will get to work. Going forward, be sure you take all precautions to protect your precious health, like using protection and getting tested regularly. Dr. Dean explains, “At a minimum, sexually active people should get tested once a year — but it also depends on your personal risk factors, such as if you use protection or if you have a new sexual partner since you last got tested.” She suggests talking with your doctor about what makes sense for your life.

Also, you should talk to your sexual partner or partners about this. If you’re unsure how to have this super fun talk with a sexual partner about STI testing and protection, or that you have an STI, Planned Parenthood created a set of videos to help you out. If you truly don’t want to have a face-to-face chat, you can always do it in an email postscript, like my dear friend once did. Your sexual health is part of your physical, emotional and mental health, so being able to communicate with your sexual partners is key.

Complete Article HERE!

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Disabled LGBT+ young people face a battle just to be taken seriously

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Following their own path.

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As young people navigate adolescence, they ask questions about their sexual attractions and how they understand gender. If they are fortunate, they have access to sex and relationship educators or mentors and support networks. But my research with young people who identify as LGBT+ and disabled shows that they are often treated as though their gender or sexuality is just a phase.

In my research looking at the experiences of young people aged between 16 and 25, we’ve seen how harmful this approach can be. Not recognising that young disabled people can be LGBT+ can reduce their ability to have fulfilling sexual lives. It also reduces the chance that they will receive appropriate help and support in relation to their sexuality or gender throughout their lives.

Seeing sexuality or gender as a phase is not new. But for the young people we work with, it comes as a result of misconceptions about their disability, sexuality and their age. As one young person put it, with regards to their disability:

I do sometimes think that my mum thinks my whole mental health issues and my autism…I think she hopes it’ll go away, she goes on about me getting a job which makes me feel even worse. It makes me feel panicky. It makes me feel like she wants a better child than I am, like I am not good enough because I don’t want work.

These ideas about disability often work alongside misconceptions about sexuality. One young person explained how being gay was “blamed” on their disability. They felt that people think you are LGBT+ “because you are ill or have autism”.

In addition to confusion about disability and sexuality, young people reported challenges due to their age. One interviewee was told to hold off on identifying in one way until they’re older and more mature; “so that you know for sure, so it gives you time”.

These reactions suggest that there is resistance to young disabled people identifying as LGBT+. There seems to be a perception that young disabled people cannot understand LGBT+ sexuality. But the stories the young people told me show a long process of working to understand sexuality and gender. Such decisions were not trivial or a result of trends.

It’s not a phase

Labelling sexuality as a phase suggests that it is something through which one will pass, emerging on other side as heterosexual. This frames anything other than heterosexuality as being flawed and suggests that there is something undesirable about being LGBT+. One young person said that they thought being “LGBT in the heterosexual world is a bad thing”. As a society, we appear to be more accepting of LGBT+ identities. Yet not for young disabled LGBT+ people who are seen as non-sexual and unable to understand what LGBT+ means.

Young people have thought this through.

We need to think about sexuality and gender as part of life and not a passing moment. This is important because young disabled LGBT+ people need appropriate support. Labelling their sexuality as a phase denies them access to information and support as their sexuality is not seen as being valid. They may suffer physical and mental violence and discrimination because of who they are, and are left to fight on their own because no one recognises them for who they are.

In order to work against societal attitudes and misconceptions, we need to listen to the experiences of young disabled LGBT+ people and understand that they are experts in their own lives. Dismissing sexuality as a phase says a lot about societal attitudes towards what it means to be young, disabled and LGBT+. Yet most importantly, such reactions have a direct impact upon the intimate lives of young disabled people as they work against such challenges to make sense of who they are.

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How mental health issues are preventing couples from having sex

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Unconsummated relationships, where couples don’t have sex due to difficulties, trauma or sexual dysfunction are not often spoken about.

Usually, the couple feel embarrassed to discuss their sexual difficulties – but they are not alone.

According to an AXA PPP survey, a third of Brits are fearful of getting naked, largely due to body image and self esteem issues.

But nerves around body image aren’t the only reason couples aren’t able to consummate their relationships.

Why aren’t couples having sex?

Sarah-Jane Otoo, psychosexual therapist at Priory Wellbeing Centre Birmingham, tells Metro.co.uk: ‘Unconsummated relationships including marriages are largely unspoken about and the reasons behind them are often complex.

‘Some of the most common reasons are from a psychological viewpoint and include a general lack of education around sexual intercourse, fear, anxiety, shame and/or past trauma.

‘In addition, sexual dysfunction like erectile dysfunction, premature ejaculation, performance anxiety in males and vaginismus in females has been reported in several studies as well as vulvodynia, an often unbearable pain when the genitals are touched’.

Relationships expert Ben Edwards expands on this, telling us: ‘Post-traumatic stress and the psychological damage from past sexual abuse, low self-esteem or unhealthy relationships can be very hard to overcome.’

We must not overlook the impact of sexual trauma and mental health issues.

Aubrey Good has bipolar disorder, which dramatically affects her sex drive.

‘I can sometimes see a decreased or lack of libido, due to my bipolar disorder,’ Aubrey tells Metro.co.uk. ‘During periods of depression, my self-esteem tends to plummet.

‘Mixed with decreased energy and an increase in apathy, my body rejects physical intimacy in favour of seeking emotional nourishment.

‘I suffer from frequent bouts of hypersexuality. I am unable to receive any satisfaction from sexual intimacy and am often in pain or discomfort because of this.’

Aubrey takes medication, but like many taking pills for their mental wellbeing, has found that this has an effect on her sex drive, too.

‘A medication increase has caused me to have loss of libido,’ she explains. ‘Gaining weight from medication has contributed to my struggles.’

For Aubrey, the key is being able to communicate with a partner who understands her struggles.

‘Libido changes are a chronic challenge,’ says Aubrey. ‘Maintaining open dialogue with my partner has helped to ease the anxiety.

‘Sex is an emotional act as well as physical; we discuss the struggles and have seen progress. Therapy has also been a relief. Our strong emotional connection has allowed us to make it through.’

For Emma (name has been changed), anorexia has brought on issues with intimacy.

‘My body image is awful,’ she tells us. ‘I am embarrassed and ashamed of the way I look and it takes me an extremely long time to feel comfortable with men.

‘It’s been the cause of many of relationships endings. Ironically, my eating disorder started at age 19 in large part due to a guy telling me I was overweight so it’s something I’ve never shaken off.

‘I had a lot of negative thoughts about my body during sex so wasn’t able to enjoy the moment, don’t enjoy being touched or looked at, and have difficulty relaxing.

‘If I had eaten too much, was having a bad day or  stressed, then the eating disorder symptoms would creep in and I wouldn’t be able to have sex.

‘Counselling has helped me somewhat and taking things very slowly so I build up trust.’

Kate Moyle, a sexual and relationship psychotherapist, explains that anxiety is a common factor for a lack of sex in a relationship.

‘Every couple is unique and will have their own reasons and experiences for not consummating their relationship,’ she tells us. ‘These situations are often linked to some form of anxiety around sex which can in some instances impact sexual functioning. Some people may struggle with intimacy.’

For Sarah, 35, who has borderline personality disorder, that anxiety comes from a lack of self-confidence as well as a lingering shame around sex.

‘My husband and I have been together for 16 years, married for 12,’ Sarah tells us. ‘I always felt very prudish talking about sex due to my family background, before, during or after.

‘I was told not to have sex before marriage, so it always felt dirty and wrong.

‘My mental health issues mean my self confidence is rock bottom. I’m at my heaviest weight and although occasionally I enjoy sex, I mainly do it so he doesn’t leave me.

‘We had marriage counselling which helped for a while, but nothing really helps.

‘My husband manages to stay with me. He says he misses not having more sex but he says it would never be a cause to leave me. I wish I could be more confident.’

So what can you do if you need help with psychosexual issues?

The main remedies are psychosexual therapy, counselling and working on communication, touch and intimacy.

Sarah Jane Otoo says: ‘It is important to remember that not one person in the relationship has the “problem”; you are both impacted. Psychosexual relationship therapy can be beneficial to help support couples that are experiencing problems with sex.

‘People may choose to enter therapy individually; however it is often advised for couples to enter therapy together. By giving them a safe and confidential space, they may be able to come to a place of understanding.’

Ben Edwards recommends understanding each other’s reasons for a lack of sexual desire or drive, and to avoid blame or shame.

‘When working with my clients on their relationships, I encourage them to understand each other’s “why”,’ he states. ‘We all have our reasons for wanting certain things and you must communicate this to your partner.

‘Lack of communication could be detrimental and to your partners own self-esteem. When it comes to abstaining from sex, the last thing you want is for a partner to harbour feelings of rejection because of an emotional barrier.’

It’s crucial to have a safe space where both parties feel comfortable talking about difficult issues.

‘Doing this work with couples is about opening up a safe space and the hopes and fears to do with sex to be discussed,’ explains Kate. ‘It’s important to see what has been tried and not tried and the ways that couples express intimacy.

‘Integrating touch slowly and becoming more comfortable with each other in states of undress is also a gradual process.

‘I aim to help couples understand desire and arousal so that we can try and get them to a place where they can meet sexually.’

Complete Article HERE!

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Gay men: Finally, sex without fear

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PrEP is effective as a protection against HIV – though condoms can still be used to prevent STDs. Why can’t we celebrate the idea that men can have sex without fear of death?

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Have you heard of the anti-AIDS drug PrEP? Most straight people are unaware of it. In 2015, the World Health Organization said “the efficacy of oral PrEP has been shown in four randomized control trials and is high when the drug is used as directed.

PrEP (Pre-exposure Prophylaxis) is a drug that allows you to have as much sex as you want, without a condom, and remain HIV-negative. If you use it, you probably won’t catch HIV. POZ magazine says that it has “100 per cent efficacy for those who stick to the treatment.”

Doctors recommend everyone use condoms, because although PrEP is very effective as a protection against HIV, it does not guard against the transmission of other sexually transmitted diseases.

Recently, Patrick William Kelly — a gay academic from Northwestern University who is writing a “global history of AIDS” — sounded the alarm about PrEP. For many straight people, Kelly’s discussion of PrEP may be the first they have heard of this revolutionary drug.

Kelly’s concern is that the popularity of PrEP will cause gay men to stop using condoms. He worries:

“An entire generation of gay men has no memory or interest in the devastation [AIDS] wrought. AIDS catalyzed a culture of sexual health that has begun to disintegrate before our eyes. What is there to be done to bring it back?…The nonchalant dismissal of the condom today flies in the face of the very culture of sexual health that gay men and lesbians constructed in the 1980s.”

Doctors still recommend that everyone use condoms because although PrEP is effective as protection against HIV, it does not guard against the transmission of other sexually transmitted diseases.

There is one sentiment that is missing from Kelly’s article. Why doesn’t he celebrate the fact that gay men — and everyone else — can now have sex without fear of death? PrEP makes sex safer for everyone. It is just one new tool in the “safe sex arsenal.” Why not be happy about the fact that PrEP will undoubtedly save many lives?

Not a lethal illness anymore

Some might ask — isn’t AIDS still a lethal illness? Not so much.

The gold standard in HIV treatment” (highly active antiretroviral therapy or HAART) was first introduced at the 1996 Vancouver International AIDS Society (IAS) Conference. According to Dr. Julio Montaner, director of the British Columbia Centre for Excellence in HIV/AIDS, “this was a pivotal moment, when HIV infection became a chronic manageable condition.

In 2014, The Globe and Mail reported that worldwide deaths from AIDS were massively decreasing:

“In 2013, 1.5 million people died from AIDS-related causes worldwide, compared with 2.4 million in 2005, a 35 per cent decrease.”

This state of affairs seems particularly significant when one considers hysterical early predictions concerning the effects of the disease. In 1987, Oprah Winfrey stated confidently that “research studies now project that one in five — listen to me, hard to believe — one in five heterosexuals could be dead from AIDS at the end of the next three years.”

This never happened.

It’s absolutely true that AIDS affects different demographics,

In this 1989 photo, protesters lie on the street in front of the New York Stock Exchange in a demonstration against the high cost of the AIDS treatment drug AZT. The protest was organized by ACT UP, a gay rights activist group.

ethnicities and geographies differently, and that gay men are not the only population to be affected by it worldwide. But the improvement in the lives of HIV-positive people everywhere is only in part due to the tireless efforts of doctors, researchers and health-care workers.

It is also due to the tireless efforts of gay men everywhere — many of whom became safe-sex activists during the last 35 years, distributing pamphlets, marching and just generally spreading the news.

So why would a gay professor characterize PrEP as a bad thing? Why is he worried that gay men — en masse — will suddenly start practising unsafe sex?

Kelly is the victim of another kind of infection — the notion that gay men are criminals whose desires must be controlled.

This criminalization of homosexuals goes back as far as the notion of sodomy.

Viewing homosexuality as criminal

In the England of Henry VIII, the punishment for sodomy was death; India today is still struggling to legalize same-sex encounters.

In 1972, gay liberation theorist Guy Hocquenghem flatly stated in his book Homosexual Desire: “Homosexuality is first of all a criminal category.”

Hocquenghem went on to suggest that even though the late 19th century brought a tendency to view homosexuality through the more “tolerant” lens of illness, the human need to view homosexuality as criminal is persistent.

“Certainly as we shall see later, psychiatry tends to replace legal repression with the internalization of guilt. But the passage of sexual repression from the penal to the psychiatric stage has never actually brought about the disappearance of the penal aspect.”

Both the sexuality of gay men and the sexuality of women are a threat to the primacy of patriarchal male heterosexual desire. Heterosexist culture believes this threat must be controlled. The LaBouchere Amendment in England (1885) was used to incarcerate Oscar Wilde for his homosexuality as a crime of “gross indecency.”

But Labouchere was an amendment to legislation designed to control female prostitution — a law that angered many 19th-century trailblazing feminists.

When AIDS appeared in the early 1980s, some heterosexuals saw it as primarily a gay disease (AIDS was first called GRID — gay-related immune deficiency). They worried that gay men might infect straight people, especially children.

In his influential book of essays, Is The Rectum A Grave?, Leo Bersani suggests that when small-town Americans wanted to ban HIV-positive hemophiliac children in schools, what they actually feared was the spectre of “killer gay men” acting too much like women:

Women and gay men spread their legs with an unquenchable appetite for destruction. This is an image with extraordinary power; and if the good citizens of Arcadia, Florida could chase from their midst a very law-abiding family it is, I would suggest, because in looking at three hemophiliac children they may have seen — that is unconsciously represented — the infinitely more seductive and intolerable image of a grown man, legs high in the air, unable to refuse the suicidal ecstasy of being a woman.

AIDS was not the first thing to make straight people think gay men

A doctor holds Truvada pills, shown to help prevent HIV infection.

had to be controlled. It simply fit like a glove on a fear of homosexuality that was already culturally endemic.

Our society seems addicted to the notion that homosexuality is something uncontrollable and potentially lethal. So when AIDS came along, as the long-time AIDS worker Simon Watney wrote, it was “effectively being used as a pretext throughout the West to justify calls for increased legislation and regulation of those who are considered to be socially unacceptable.”

The concern over gay male imagined libidinal insanity is a throwback to an old trope. Gay men don’t need to be controlled; at least not any more than anyone else. And if you think otherwise? Well, it’s based on prejudice. Not fact.

Complete Article HERE!

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Gay or bi men who disclose sexual history may get better healthcare

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By Anne Harding

Young men who have sex with men (MSM) who disclose their sexual orientation or behavior to a health care provider are more likely to receive appropriate healthcare, new data suggest.

Dr. Elissa Meites of the Centers for Disease Control and Prevention (CDC) and her colleagues studied 817 MSM, ages 18 to 26, who had seen a healthcare provider in the past year.

Men who had disclosed were more than twice as likely as those who had not to have received the full panel of recommended screenings and vaccines, the researchers found.

The CDC and the Advisory Committee on Immunization Practices recommend that MSM be screened for HIV, syphilis, gonorrhea and chlamydia at least once a year, and immunized against hepatitis A and B and human papillomavirus (HPV), Meites and her colleagues note the journal Sexually Transmitted Diseases.

Overall, 67 percent of the study participants had received all four recommended STI screenings, but that was true for only 51 percent of the MSM who had never disclosed.

Nine percent overall had received all vaccinations, compared to six percent of those who hadn’t disclosed.

The pattern was similar when researchers looked to see how many participants received all seven recommended services. The rate was just seven percent for the overall study population, but it was even lower – at less than four percent – for the MSM who hadn’t disclosed.

About two-thirds of study participants (64.2 percent) said they had disclosed their sexual behavior or orientation to a healthcare provider, while roughly nine in 10 (91.7 percent) said they would do so if it was important to their health.

“This shows us that the patients are doing all the right things. They are going to the doctor regularly and they are willing to speak about their sexual behaviors,” Meites told Reuters Health in a telephone interview. “It looks like health care providers may be missing some opportunities to provide the best health care to these young men.”

Doctors can encourage disclosure among MSM by asking about sexual history, and “fostering a clinical environment where people can be comfortable revealing their sexual behavior,” Meites said. And doctors should be aware of the panel of health care services that are recommended for MSM, she added.

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Pelvic floor physio: Treating pain during sex and other common women’s health issues

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Anniken Chadwick is a physiotherapist who focuses on the muscles and ligaments in the pelvic region.

By Maryse Zeidler

Pain during intercourse. Incontinence. A prolapsed uterus.

Pelvic floor physiotherapist Anniken Chadwick helps her clients with problems rarely discussed at the dinner table, but that are common nonetheless.

“Mostly my job is oriented around women’s health, and we just don’t do that well with women’s health in our medical system,” Chadwick said, sitting on a chair in her small, quiet office on West Broadway in Vancouver.

Chadwick, 33, specializes in healing and strengthening the muscles, ligaments and connective tissues in the pelvic area. Her job can be quite intimate, with her often working internally in those areas.

Her most typical clients are pre- and post-natal women, although she also works with men for similar issues like sexual disfunction, incontinence and pelvic pain.

Anniken Chadwick sometimes uses a model to show her patients the muscles, fascia and ligaments around the pelvis.

Physiotherapy centred on the pelvic floor is a mainstay in countries like France, where women routinely see practitioners like Chadwick after they’ve given birth.

Here in Canada, physiotherapy is often recommended after surgery or trauma on other parts of the body. But Chadwick says the taboo of pelvic issues makes her field of work less normalized — and that’s something she’s hoping to change.

Chadwick says up to one in four women will experience pain during intercourse in their lifetime.

Her female clients sometimes come to her after years of pain and discomfort. Their doctors just tell them to relax and have a glass of wine, she said.

“I would love for pelvic floor physio to be a routine part of obstetrics care,” she said. “I would also love for particularly sexual pain and dysfunction to be understood as a physical thing and not just a mental thing.”

Chadwick grew up in Nottingham, England, where she trained to become a physiotherapist.

She briefly practised in the public health system there, then she moved to Canada. A few years into her private practice in Vancouver, she began to notice a pattern — young and middle-aged women who said they were “never the same” after having children. 

“I just wanted to learn more about why that was,” Chadwick said.

The more she started learning about pelvic floor issues, the more she realized how much more she — and the people around her — needed to know. 

“And so I started down that track, and now it’s all I do,” she said. 

“As soon as I started helping women regain continence or be able to have sex with their partner again without pain … it was just hard to get passionate about an ankle sprain after that.”

Holistic approach

Chadwick’s training for pelvic floor problems included specialty post-graduate courses and independent learning. 

She likes to take a holistic approach to her work. In her specialty area, injuries often have an emotional or psychological component to them. For women who experience pain after sexual assault, for example, she ensures they’re also seeking help from a counsellor or psychologist.

Because of the intimate nature of her treatment, Chadwick is mindful about creating a calm, quiet environment for her clients to feel comfortable in. 

But the one aspect of her job that Chadwick really wants people to know about is that pelvic floor issues are relevant to everybody. And although those problems can be scary, getting treatment for them doesn’t have to be. 

“I get so much satisfaction when people get better. It really gives me a lot of energy,” she said.

Complete Article HERE!

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Sex workers offer intimacy and connection for disabled clients in the age of the dating app

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Oliver Morton-Evans visits sex workers as he says potential partners cannot see past his wheelchair.

By Sarah Matthews

Oliver Morton-Evans has sought the services of sex workers over the years, because dating can be especially tough for anyone with a disability.

Despite having tried “every dating app out there”, Oliver, 39, has never been in a long-term relationship.

The Sydneysider, now a successful tech entrepreneur, said despite looking for a partner ever since finishing high school, he has had no luck.

In the modern dating world, in which apps such as Tinder rely on appearance and snap judgements, Mr Morton-Evans said most people could not see past his wheelchair.

“It’s been really hard because I’m kind of always in a quandary of, ‘do I disclose my disability straight up or do I not?’,” he said.

“I kind of don’t want to, because although it’s a part of me it’s not all of who I am.

“The moment they see a wheelchair, people tend to create a story in their head of what that might mean.”

But he said visiting sex workers was not just about the physical pleasure.

“I have no shame or anything like that, but that’s just not what I most deeply desire,” he said.

“There’s so much more to sex than just the physical activity.”

Mr Morton-Evans said everybody needed the feel of human touch to feel connected.

Mr Morton-Evans said seeing sex workers provided him with the intimacy he craved in his everyday life, and motivated him to keep looking for a partner.

“I think for an able-bodied person they forget about how much, particularly touch for example … humans need touch to feel connected with others,” he said.

“So when I would see a sex worker, it tends to make me feel a lot more able to then go out and find the kind of relationship I want.”

People with disabilities seek intimacy from sex workers

Although often viewed as taboo, many people with disabilities seek the services of sex workers as an outlet for their sexual and intimate desires.

Brisbane escort Lisa said she regularly saw clients with disabilities and was proud to provide a service for people struggling to find intimacy in their everyday lives.

“I see this job as just an extension of the caring person that I am,” she said.

Brisbane escort Lisa says clients with disabilities may want affection or a chat, not always sex.

“Not everyone wants to have sex. They just want a bit of affection, or to chat to someone, all that sort of thing.

“It’s just me giving to the person what they need, and I feel that I’m doing a worthwhile job by helping other people.”

She said access to sexual services, especially for marginalised people, was vital for their health and wellbeing.

“It’s a genuine health issue,” she said.

“Like a baby needs affection, needs cuddles, needs touch, needs food, needs all these things [so too] an adult does.

“It doesn’t matter what age you are … it’s so basic of a human need.”

Noriel works as an escort and is the Cairns representative for Respect Inc, the Queensland sex worker support group.

She said she believed access to sex workers for people with disabilities should be covered under the NDIS.

Cairns escort Noriel believes access to sex workers for people with disabilities should be covered under the NDIS.

“Whether you are a wage-earner or you’re on any type of benefit from the government, you have a right to spend your money however you want,” she said.

“And if you would like to spend your money hiring the services of a sex worker, I think you should be able to do that.”

Social attitudes have harmful impacts

Counsellor and registered NDIS provider Casey Payne said it was a common misconception that people with disabilities were non-sexual.

“Just because you live with something that’s different to everybody else doesn’t mean that your life can’t still be the same in every aspect, especially in sexual health.

“Everybody deserves the right to have a pleasurable, sexual, healthy life.”

Deakin University Associate Professor in disability and inclusion Dr Patsie Frawley said research had found people with disabilities were disproportionately affected by breast and cervical cancer — but also by sexually transmitted infection (STI).

“If you’re not seen as sexual and as a sexual person, the range of sexual health screenings, sexual health prevention and response services won’t be offered to you,” she said.

“It’s been identified in research that men with an intellectual disability have eight times greater rates of STIs than their non-disabled peers.”

Sex worker with a disability challenges perceptions

Raivynn DarqueAngel has met the stereotypes of both sex workers and people with disabilities head on.

Raivynn has cerebral palsy and has worked in Melbourne’s sex industry for more than 20 years.

Raivyn, who has cerebral palsy and uses an electric wheelchair, has worked in Melbourne’s sex industry for more than 20 years, mostly as a dominant escort.

“I chose to be a dominant to … change perceptions,” she said.”

The submissive people that I see make me feel strong and in charge and I like that. I’ve taken it back home and I’m much more confident saying what I need with my support workers.

“It’s given me the confidence to trust that I’m worth my needs.”

Despite his disappointing dating experiences, Mr Morton-Evans insisted he had not given up on finding love.

He had one thing to say to potential partners: “Don’t judge a book by its cover.”

Complete Article HERE!

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Being paralyzed does not mean I can’t have sex…

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and six other myths about sex and disability debunked

Samantha Baines, Matt Tuckey and Shannon Murray debunk some of the biggest misconceptions they come across

By Poorna Bell

Despite pockets of progress, such as online fashion retailer ASOS recently releasing wheelchair-friendly clothing, there is a long way to go when it comes to representation of people with disabilities.

Ignorance abounds because of narrow depictions of living with a disability. Nowhere is this more evident than when it comes to sex.

To counter this, people such as disability awareness consultant Andrew Gurza are driving candid conversations about sex and sexuality. Andrew’s Disability After Dark podcast addresses all kinds of stories around disability and sex. Andrew, who has cerebral palsy, told the Huffington Post last year: “Whenever we talk about sex and disability ― if we dare ― it is in this painfully sanitised way that tends to tell you nothing about the person with a disability, their sex or what they actually want ― it doesn’t shed any light on how it really feels.”

Here, four men and women debunk some of the myths and misconceptions they encounter about sex and disability.

1: ‘Sex with a disabled person must be pretty boring’

Actress Shannon Murray, 41, who experienced a spinal cord injury when she was 14, tells misconceptions about sex and disability still come at her from all corners. “Just like any other human being, disabled people have desire. We want to be touched, to touch, to feel pleasure – why is that still such a ridiculous taboo? Why are intelligent people genuinely shocked when they learn that I have sex?

“If anything, I’d say some of my disabled friends are some of the more sexually adventurous and confident people I know. We have to be creative and find different techniques that work for us and spend every waking hour being adaptable to the environment around us.

“Sex is no different, though it’s much more fun.”

2: ‘I’m not a sexual being’

“There has been a real disservice done to disabled people by the mainstream media who have only told very one-dimensional stories,”  Shannon adds. “You see disabled men who use sex workers, or people who are frustrated and angry at their bodies.

“It can feel very marginalising; it’s all very woe is me. I think that suits the idea that non-disabled people have about our lives: that we’re asexual, incapable or it’s too complicated. However if you venture on to websites or publications aimed at a disabled audience you’ll see a much more rounded and interesting experience.”

3: ‘Being paralysed means I can only have sex missionary style’

Shannon says: “Some of the misconceptions I’ve faced is that I can’t have sex; that I am incapable of having sex; that I must be numb from the waist down; that because I’m paraplegic I can only have sex in the missionary position; that I can only have sex in my chair; that I can’t feel pleasure; that I can’t give pleasure; that orgasms are impossible and that I can’t have children. All of which are untrue.

“It’s also interesting how frequently strangers think it’s perfectly acceptable to ask me about my sex life within an hour of meeting me.”

4: ‘I must be shy in bed because I have a disability’

Far from it, says Joanne*, 51, a housewife who is profoundly deaf. “When I first started having sex, because I could not hear anything, the sounds I was making were extremely loud. I only found out because the man I was having sex with put his finger on his lips in a ‘sssh’ motion. I got really self-conscious – I mean, how loud was I?

“So I decided to record myself masturbating, and asked my best friend to listen to it. To my embarrassment she said I was very, very loud! I soon met my now-husband and our first sexual encounters were strained as I always stopped before things got to a point where I thought I would start getting ‘excited’.

“Finally, I decided to tell him and he laughed because he thought it was his fault and was relieved. In a sensitive way, he said he would always let me know if I was getting too loud and I’ve sort of trained myself to be less noisy.”

5: ‘My hearing aid must be a turn-off’

“I love sex and hearing aids don’t stop me from loving it,” says comedian Samantha Baines, 31, who acquired her disability at the age of 30. “I mean, I do need to take my hearing aid out before sex as they aren’t good with fluids – I don’t want to see my audiologist and explain how I got spunk in my hearing aid.

“Taking your hearing aid out isn’t a very sexy procedure when you are in the moment. It’s a bit like taking your socks off or peeing after sex – it just has to be done.”

@samanthabaines 

6: ‘It’s ok for disability to be treated as a sexual fetish’

Joanne says: “Growing up as a child I was made to wear hearing aids which really were of no benefit to me at all. When I used to go out I always was conscious of it and deliberately made sure that I wore my hair to cover them.

“When I got older, I looked just like any other woman, I just couldn’t hear. Except one guy I dated for a few months always wanted me to wear my hearing aids during sex. I think he found my deafness a turn-on which was strange.”

Shannon adds: “When the odd TV drama includes a story about disability and sex it is always negative or traumatic, or conversely our bodies are fetishised for the non-disabled gaze.

“People with disabilties are not curiosities, we are humans with wants, needs and desires. Treat us with the same respect you would any other person that you’re interested in. It’s really not rocket science.”

7: ‘You don’t look disabled so you don’t have to tell sexual partners about it’

“I’ve been guilty as anyone else of not seeing disabled people as sexual beings,” says Matt, “but I’ve realised keeping it hidden is so much harder than being honest about it. Around the time I was correctly diagnosed, I met someone in a club.

“After a couple of conversations over the next few days she started to realise that I had short term memory loss. For the first time I could be open with a woman about my memory difficulties, rather than pretending I’d just forgotten something as a one-off. Two weeks later, I’d lost my virginity to her.”

Complete Article HERE!

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Gay, Straight, Or Bisexual – Which Group Of Men Are More At Risk Of Heart Failure?

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By

Can your sexuality increase or decrease your risk of heart failure?  A new study released by the NYU Rory Meyers College of Nursing states that Bisexual men have a higher risk for heart disease compared with heterosexual men.

Now, of course it is not because you’re sleeping with men, but it’s because of everything else that may come with it.

In a new study published online in the journal LGBT Health, Billy Caceres, the study’s lead author, states:

Our findings highlight the impact of sexual orientation, specifically sexual identity, on the cardiovascular health of men and suggest clinicians and public health practitioners should develop tailored screening and prevention to reduce heart disease risk in bisexual men.

More than 30 percent of men in the US have some form of heart disease making it a leading cause of death for American men. Not many studies have been done to understand the impact of sexual orientation on heart disease risk for men.

In this study, NYU researchers examined differences in modifiable risk factors for heart disease and heart disease diagnoses in men of different sexual orientations. Risk factors measured included:

mental distress
health behaviors such as

  •       tobacco use
  •       binge drinking
  •       diet
  •       exercise

biological risk factors such as

  •       obesity
  •       hypertension
  •       diabetes
  •       cholesterol.

Responses from 7,731 men ages 20 to 59 were part of the National Health and Nutrition Examination Survey (2001-2012). Differences were analyzed across four groups based on their sexual identities: gay men, bisexual men, heterosexual men who have sex with men, and heterosexual men.

The researchers found no differences in heart disease diagnoses based on sexual orientation, but risk for heart disease was more complicated.

  • Gay men, heterosexual men, and heterosexual men who have sex with men had similar heart disease risk.
  • Gay men reported lower binge drinking compared with heterosexual men, but otherwise few differences in health behaviors were noted.
  • Bisexual men, however, had higher rates of several risk factors for heart disease relative to heterosexual men: mental distress, obesity, elevated blood pressure, and three different measures of diabetes (medication use, medical history, and average glycosylated hemoglobin level).

“Poor mental health is a recognized risk factor for the development of heart disease,” said Caceres. “Clinicians should be educated about sexual minority health and should routinely screen bisexual men for mental distress as a risk factor for heart disease. This is particularly important as healthcare organizations increasingly include sexual orientation as part of demographic questionnaires in electronic health records.”

Complete Article HERE!

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Do You Have Sexual Side Effects From Antidepressants You Stopped Taking?

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From low libido to erectile dysfunction, some people report suffering from enduring sexual problems.

From low libido to erectile dysfunction, some people report suffering from enduring sexual problems.

By Michael O. Schroeder

Antidepressants are widely prescribed, commonly used for depression and recommended to treat a range of other issues, from anxiety disorders to pain. But the medications aren’t without risk – and some potentially serious side effects start, or continue, after a person has stopped taking them.

These effects vary by the individual and the drug, but for the most commonly prescribed antidepressants – selective serotonin reuptake inhibitors, or SSRIs, and serotonin-norepinephrine reuptake inhibitors, or SSNIs – side effects, or adverse events reported by patients, range from headache, nausea and fatigue to paresthesia, or an abnormal sensation that can feel, to some, like electrical shocks, to insomnia to seizures. And though less widely recognized, some patients also report another enduring effect of SSRIs and SSNIs: sexual dysfunction.

To be sure, sexual side effects ranging from lower libido to erectile dysfunction are known and detailed in drug labeling information. But though online support groups have cropped up for people who experience persistent sexual dysfunction after going off antidepressants – post-SSRI sexual dysfunction, or PSSD – it’s not clear how common the concern is.

However, one recent paper co-authored by researchers linked with an independent drug safety website RxISK.org that collects reports of side effects – including after people stop medications – recently reported on 300 cases of enduring sexual dysfunction. These were reported by people from around the world who were taking SSRIs, SSNIs and tricyclic antidepressants, as well as drugs called 5α-reductase inhibitors and isotretinoin. which are used to treat male hair loss (baldness) and benign (non-cancerous) prostate enlargement, and acne respectively. Reports by patients who’d taken 5α-reductase inhibitors and isotretinoin to RxISK of enduring problems with sexual function after stopping these medications appeared to have similar characteristics to those related to antidepressants, notes co-author Dr. Dee Mangin, the David Braley and Nancy Gordon Chair in Family Medicine at McMaster University in Hamilton, Ontario, and chief medical officer for RxISK.org.

“We were really looking at sexual dysfunction both on and after taking medication, because some of the reports we were getting were suggesting that sexual dysfunction, which is a known side effect of a number of drugs, seemed to be persisting once the drugs were stopped,” Mangin says.

As noted in the paper published in the International Journal of Risk & Safety in Medicine, there have been limited references to the potential for such issues to occur after patients stopped antidepressants. In the U.S., the product information for Prozac (fluoxetine) – the oldest of the SSRIs – was updated in 2011 to warn, “Symptoms of sexual dysfunction occasionally persist after discontinuation of fluoxetine treatment.” What’s more, the authors noted, “The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, states that ‘In some cases, serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued.'”

But the authors go further in detailing reports of enduring sexual dysfunction such as the onset of premature ejaculation and persistent genital arousal disorder (whereby a person becomes aroused without any stimulation) as well as losing genital sensation, or genital anaesthesia, pleasureless or weak orgasm, loss of libido and impotence. “Secondary consequences included relationship breakdown and impaired quality of life,” the authors note.

The individuals weren’t independently evaluated before, during or after taking the medication, and more study is needed. Still, Mangin asserts, “The study provides the strong signal that there is a group of people who seem to experience enduring side effects that affect their sexual function after they’ve stopped taking the drug.”

Experts say just as patients should never stop antidepressants abruptly, or without consulting with their provider – since doing so is known to increase side effect risk and worsen those effects – patient and provider should discuss any adverse effects that start or continue after stopping a medication.

Dr. Eliza Menninger, who directs a behavioral health program at McLean Hospital in Boston, says she hasn’t heard from patients voicing serious concerns about sexual side effects after stopping their medication. For the most part, sexual side effects seem to go away after patients stop taking the medication, Menninger says. “Some will indicate it’s still an issue, but they don’t seem as bothered by it – and I don’t know if it’s as bad an issue as when they were on the SSRI,” she says.

However, clinicians say, it would be helpful to have more clarity on the issue – including how likely it may be that patients could experience enduring sexual side effects. In part due to the sensitive nature of sexual complaints, experts point out, these effects often go unacknowledged in patient-provider conversations.

One problem is that sexual side effects aren’t tracked in a systematic way like other drug side effects – even though they can be severely damaging to intimate relationships and undermine a person’s overall quality of life and well-being. “There’s no requirement, for example, for drug companies to track sexual side effects. They’re not considered serious adverse events, although the potential for them to continue post-medication I would consider extremely serious – even a disability,” says Audrey Bahrick, staff psychologist at the University of Iowa’s counseling service.

Bahrick recently signed onto a petition, along with Mangin and others who’ve researched enduring sexual side effects, asking the U.S. Food and Drug Administration and other regulatory bodies to require makers of SSRIs and SSNIs to update drug labeling to warn that such legacy effects can occur and continue for years or even indefinitely.

Sandy Walsh, a spokesperson for the FDA, said it would review the petition and respond to the petitioner, but declined to comment further regarding the petition. Drugmakers who responded to a request for comment say they work closely with regulatory agencies to keep information updated.

Mads Kronborg, a spokesman for pharmaceutical firm Lundbeck, notes that summary production information for its SSRIs, citalopram (Celexa) and escitalopram (Lexapro), “already states that side effects can occur upon discontinuation, and that such side effects may be severe and prolonged.” Specifically, it’s stated that “generally these events are mild to moderate and are self-limiting, however, in some patients they may be severe and/or prolonged.” The side effects listed for citalopram and escitalopram “include sexual side effects,” he says, though he adds that sexual side effects are not among the most commonly reported reactions to discontinuation. “So information about potential enduring side effects is actually already included.”

But the petition asserts drug companies aren’t going far enough to acknowledge these concerns.

Bahrick says though the prevalence of enduring sexual side effects remains unknown, “My own impression clinically is that it’s not at all uncommon, and that it can range from subtle – not returning to sexual baseline – to really a complete sexual anesthesia, where a person who has been without any significant sexual problems prior to taking the medication might be rendered unable to experience sexual pleasure, unable to have sensation in the genitals, having orgasms that are not associated with pleasure,” she says. “These are clearly, I think, drug effects. [Issues] like genital anaesthesia and pleasureless orgasm – these are not symptoms that are associated with any sexual problems, say, that are commonly associated with depression. We can see these as legacy effects of the SSRIs.”

In the absence of prevalence data, clinicians continue to debate the potential extent of enduring sexual side effects for those who have stopped antidepressants. Some worry about unnecessarily scaring patients away from antidepressants who may benefit from taking the drugs.

“These medications are used to treat symptoms of illnesses that are potentially quite debilitating and can be lethal, so while I want to encourage a discussion of side effects, the intent is to use medications to help improve significant symptoms,” Menninger says. She points out, as the petition notes, that to date no prospective studies have been done assessing sexual dysfunction prior to SSRI and then during and after SSRI use. Though certainly side effects are real and concerning, she says, “there is clinical evidence the medications make a significant difference in helping [and/or] saving a life.” That’s something some clinicians emphasize shouldn’t get lost in the discussion.

But Bahrick says for patients, not having information that these effects may occur undermines their ability to make a fully informed decision when deciding to go on antidepressants, and deciding whether to try alternative treatment options first. “It’s so important to get this information out there on the front end. Because these injuries are very real and can be lifelong and seriously limit intimacy and create a lot of shame and isolation and despair,” she says. While for some the side effects go away on their own, for others they persist – and Bahrick says there’s no known cure for PSSD. “So this is in service of informed consent that is quite lacking at this time.”

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The End of Safe Gay Sex?

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By Patrick William Kelly

June is Pride Month, a ripe time to reflect on one of the most startling facts about our sexual culture today: Condom use is all but disappearing among large numbers of gay men.

Many rightly attribute the condom’s decline to the rise of PrEP — an acronym for pre-exposure prophylaxis, a two-drug cocktail that inoculates a person from contracting H.I.V. But another crucial component is the fading memory of the AIDS crisis that once defined what it meant to be gay.

After tracking the sexual practices of 17,000 gay and bisexual Australian men from 2014 to 2017, a team of researchers this month unveiled the most convincing evidence to date. While the number of H.I.V.-negative men who are on PrEP increased to 24 percent from 2 percent, the rate of condom use decreased to 31 percent from 46 percent. More troubling, condom use among non-gay men is also down significantly</a

Although public health advocates have been sounding the alarm on condom use for the last decade, their calls have gone largely unheeded. Part of that is because of a shift in how we talk about risky sex: The Centers for Disease Control and Prevention has replaced “unprotected” with “condomless” sex.

The dangerous implication is that PrEP alone may ward off all sexually transmitted infections. Indeed, studies have shown a strong correlation between PrEP use and the contraction of S.T.I.s. PrEP enthusiasts counter that PrEP mandates testing for S.T.I.s every three months, a practice that promotes rather than discourages a culture of sexual health.

But a 2016 study by the University of California, Los Angeles illustrated that PrEP users were 25.3 times more likely to acquire gonorrhea and a shocking 44.6 times more likely to develop a syphilis infection (other studies have found no significant uptick in S.T.I. rates, however).

More than the specific public-health risks of declining condom use among gay men is the shocking speed with which a sort of historical amnesia has set in.

The very idea of “safe sex” emerged from the gay community in the early 1980s, in response to the AIDS crisis. Drag queens once ended performances with catchy one-liners like, “If you’re going to tap it, wrap it.”

AIDS indelibly shaped what it meant to be gay in the 1980s and 1990s. When I came out at the tender age of 14 in 1998, I recall my mother’s reaction. As tears welled up in her eyes, she buried her face in her hands and said, “I just don’t want you to get H.I.V.” No stranger to controversial allusions, the AIDS activist and author Larry Kramer famously called it a homosexual “holocaust.” Condom use, therefore, was never a negotiating chip.

Until it was. PrEP, which the Food and Drug Administration approved in 2012, replaces the condom’s comforting shield. Liberated from the stigma of AIDS, gay men, many people think, are now free to revert to their carnivorous sexual selves. In this rendering, the condom is kryptonite, a relic that saps the virile homosexual of his primordial sexual power.

AIDS is no longer a crisis, at least in the United States, and that is a phenomenal public-health success story. But it also means that an entire generation of gay men has no memory or interest in the devastation it wrought. AIDS catalyzed a culture of sexual health that has begun to disintegrate before our eyes. What is there to be done to bring it back?

One answer is to recall the gay culture of the 1970s that gave rise to the AIDS crisis in the first place. The myth of a world of sex without harm is not new. The 1970s were a time of unprecedented sexual freedom for gay men, during which diseases were traded rampantly, fueled by a libertine culture that saw penicillin as the panacea for all ills.

The nonchalant dismissal of the condom today flies in the face of the very culture of sexual health that gay men and lesbians constructed in the 1980s. If a hyper-resistant strand of another life-threatening S.T.I. develops, we will rue the day that we forgot the searing legacies of our past. We might also recognize that PrEP has not proved nearly as effective a prevention strategy for women as it has for men, and that some strains of H.I.V. have developed resistance to the drug.

While we debate the utility of latex, what are we to think about the millions of sex workers, injecting-drug users and marginalized populations (in particular, black men who have sex with men) without adequate access to costly and coveted drugs like PrEP? If they develop AIDS, they also struggle to acquire the triple drug therapies that have since 1996 turned AIDS into a manageable if chronic condition. Millions have died from lack of access while pharmaceutical companies rake in billions every year.

We might also pivot away from the individualistic and privileged approach of our dominant L.G.B.T. organizations — what one scholar called the “price of gay marriage.” We might, then, regain a radical sense of queer community that we lost in the wake of AIDS.

Complete Article HERE!

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