Sex and gender both shape your health, in different ways

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When you think about gender, what comes to mind? Is it anatomy or the way someone dresses or acts? Do you think of gender as binary — male or female? Do you think it predicts sexual orientation?

Gender is often equated with sex — by researchers as well as those they research, especially in the health arena. Recently I searched a database for health-related research articles with “gender” in the title. Of the 10 articles that came up first in the list, every single one used “gender” as a synonym for sex.

Although gender can be related to sex, it is a very different concept. Gender is generally understood to be socially constructed, and can differ depending on society and culture. Sex, on the other hand, is defined by chromosomes and anatomy — labelled male or female. It also includes intersex people whose bodies are not typically male or female, often with characteristics of both sexes.

Researchers often assume that all biologically female people will be more similar to each other than to those who are biologically male, and group them together in their studies. They do not consider the various sex- and gender-linked social roles and constraints that can also affect their health. This results in policies and treatment plans that are homogenous.

‘Masculine?’ ‘Cisgender?’ ‘Gender fluid?’

The term “gender” was originally developed to describe people who did not identify with their biological sex. John Money, a pioneering gender researcher, explained: “Gender identity is your own sense or conviction of maleness or femaleness; and gender role is the cultural stereotype of what is masculine and feminine.”

There are now many terms used to describe gender — some of the earliest ones in use are “feminine,” “masculine” and “androgynous” (a combination of masculine and feminine characteristics).

Research shows that gender, as well as sex, can influence vulnerability to disease.

More recent gender definitions include: “Bigender” (expressing two distinct gender identities), “gender fluid” (moving between gendered behaviour that is feminine and masculine depending on the situation) and “agender” or “undifferentiated” (someone who does not identify with a particular gender or is genderless).

If a person’s gender is consistent with their sex (e.g. a biologically female person is feminine) they are referred to as “cisgender.”

Gender does not tell us about sexual orientation. For example, a feminine (her gender) woman (her sex) may define herself as straight or anywhere in the LGBTQIA (lesbian, gay, bisexual, transgender, queer or questioning, intersex and asexual or allied) spectrum. The same goes for a feminine man.

Femininity can affect your heart

When gender has actually been measured in health-related research, the labels “masculine,” “feminine” and “androgynous” have traditionally been used.

Research shows that health outcomes are not homogeneous for the sexes, meaning all biological females do not have the same vulnerabilities to illnesses and diseases and nor do all biological males.

Gender is one of the things that can influence these differences. For example, when the gender of participants is considered, “higher femininity scores among men, for example, are associated with lower incidence of coronary artery disease…(and) female well-being may suffer when women adopt workplace behaviours traditionally seen as masculine.”

In another study, quality of life was better for androgynous men and women with Parkinson’s disease. In cardiovascular research, more masculine people have a greater risk of cardiovascular disease than those who are more feminine. And research with cancer patients found that both patients and their caregivers who were feminine or androgynous were at lower risk of depression-related symptoms as compared to those who were masculine and undifferentiated.

However, as mentioned earlier, many health researchers do not measure gender, despite the existence of tools and strategies for doing so. They may try to guess gender based on sex and/or what someone looks like. But it is rare that they ask people.

A tool for researchers

The self-report gender measure (SR-Gender) I developed, and first used in a study of aging, is one simple tool that was developed specifically for health research.

The SR-Gender asks a simple question: “Most of the time would you say you are…?” and offers the following answer choices: “Very feminine,” “mostly feminine,” “a mix of masculine and feminine,” “neither masculine or feminine,” “mostly masculine,” “very masculine” or “other.”

The option to answer “other” is important and reflects the constant evolution of gender. As “other” genders are shared, the self-report gender measure can be adapted to reflect these different categorizations.

It’s also important to note that the SR-Gender is not meant for in-depth gender research, but for health and/or medical studies, where it can be used in addition to, or instead of, sex.

Using gender when describing sex just muddies the waters. Including the actual gender of research participants, as well as their sex, in health-related studies will enrich our understanding of illness.

By asking people to tell us their sex and gender, health researchers may be able to understand why people experience illness and disease differently.

Complete Article HERE!

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6 Things Every Transgender Person Should Know About Going to the Doctor

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You deserve sensitive, comprehensive care.

By Nathan Levitt, FNP-BC

[T]ransgender patients often experience tremendous barriers to health care, including discrimination and an unfortunate lack of providers who are knowledgeable about and sensitive to this population. As a result, many transgender and nonbinary people avoid seeking care for preventive and life-threatening conditions out of fear.

According to a report from the National Transgender Discrimination Survey of more than 6,450 transgender and gender nonconforming people, nearly one in five (19 percent) reported being refused care because they were transgender or gender nonconforming. Survey participants also reported very high levels of postponing medical care when sick or injured due to discrimination and disrespect (28 percent). Half of the sample reported having to teach their medical providers about transgender care.

As a transgender person myself, I know how difficult it can be to access sensitive care.

That’s why it’s essential for trans and gender nonconforming people to be empowered with the knowledge and information that will help them find the best providers they possibly can, who are knowledgeable and sensitive, and will advocate for their gender nonconforming patients.

It can be hard to know where to start, so I’d recommend looking into the following resources online to help you find trans-friendly medical care near you:

And here are a few questions you might want to consider when looking for a doctor or health care provider who is accessible, inclusive, and who can responsibly and knowledgably care for you:

  • Do they have signs or brochures representing the transgender community?
  • Have the care providers been trained on issues specific to transgender health?
  • Does the organization have a nondiscrimination policy that covers sexual orientation and gender identity?
  • Do they have experience caring for transgender patients? Specifically, are they able to provide medical advice on how to manage hormones, after-surgery care, and health screenings in the trans population?
  • Are they able to provide the necessary accommodations you need to feel comfortable (For instance: a gender-neutral bathroom, a safe and comfortable waiting room environment, willingness to use your requested name and pronoun, etc.)?
  • Has their staff (including the office staff) received training on transgender sensitivity?

Even after you’ve found a medical provider, the reality is that transgender patients often still have to teach them about transgender care.

It’s your responsibility to communicate your medical history and needs so that you can get the best, most appropriate care. That can be intimidating and overwhelming, so I’ve outlined a few of the most important things you should go over with your doctor or medical provider.

1. Make sure your provider has a baseline medical history for you.

Once you find a transgender-sensitive health provider, think of this person as your medical ally—someone who can help you with any changes your body is experiencing. In that vein, you’ll want to tell them about your family and personal health history so they can better manage your health care screenings, such as cardiovascular, bone health, diabetes, and cancer screenings.

Cancer screening for transgender people can require a modified approach to current mainstream guidelines. If your provider isn’t sure what that looks like, you can point them towards UCSF Center of Excellence for Transgender Health.

Unfortunately, I know from professional experience that transgender people are often less likely to have routine screenings and cancer screenings due to discomfort with health care providers’ use of gendered language, providers’ lack of knowledge about surgery and hormones, gender-segregated systems, and insensitive care.

2. Discuss your goals and expectations around medical transition, whether it’s something you have done, are in the process of doing, or are interested in pursuing.

Of course, not all transgender and gender nonbinary individuals are interested in medical transition—including surgery and/or hormones—but for those who are considering these options, it’s important to select health care providers who understand how to administer and monitor hormones and who are knowledgeable about what is needed for pre- and post-operative care.

So it’s a good idea to ask your provider about their experiences with transition-related medical care or if they can refer you to someone who is experienced in that field. You’ll want to talk with your provider about your goals of hormone therapy, any lab work needed, and any relevant information from your and your family’s medical history.

There are many different surgeries that transgender individuals may undergo to align their body with their gender identity. Share with your medical provider any gender affirming surgeries you have had or are interested in. You deserve to feel comfortable with your surgeon and feel that your health care team is working together.

As your body changes, stay informed about what additional screenings may be needed. For instance, although the data linking hormone therapy to cancer is inconclusive (when taken correctly and monitored by a medical provider), it is still important to discuss risks with your provider.

For patients who currently have hormone-dependent cancers, it is imperative that you discuss with your oncologist and your primary care provider any past history or current use of hormones.

I know that some cancer screenings such as Pap smears and prostate screenings can be incredibly uncomfortable for some transgender and gender nonbinary people. Finding sensitive providers is essential to not delay important screenings.

3. As awkward as it may be, discuss your sexual history and activity in a way that allows your medical provider to accurately assess your sexual health needs.

It’s unfortunately not uncommon for transgender men to skip pelvic exams (whether they fear discrimination, think they don’t need them, or avoid them for dysphoria-related reasons). It’s also not uncommon to forego preventive health care, such as STI screenings, out of fear of discrimination or disrespect. This can hurt the transgender population’s health.

Of course it can be awkward, but your sexual health is an important topic to discuss with your provider, so they shouldn’t make you feel too uncomfortable to talk about it. If you feel your provider is not conducting transgender-sensitive sexual histories, you should feel empowered to give them this feedback. You can even ask your provider to use the language you feel most comfortable with to describe your and your partner’s bodies. This is important because they can help you to understand how to have sex that is safe, affirming, and specific to your body and identity.

It’s also important to tell your provider the nitty gritty details about your sex life and history (like: how many sexual partners you have had, whether you’re using condoms or dental dams during sex, what kind of sex you are having, and if and when you were last tested for STIs and HIV).

Unfortunately, surveys tell us that transgender people are less likely to get tested for STIs because of the discrimination and fear they face when talking about their bodies and identity. According to the CDC, in 2015, the percent of transgender people who were newly diagnosed with HIV was more than three times the national average. Trans women are at an especially high risk for HIV; in particular, African American trans women have the highest newly diagnosed HIV rates within the transgender community.

Be proactive and ask what you should be doing to reduce your risk of STIs and HIV. One option your physician may discuss with you is pre-exposure prophylaxis (PrEP), which is a daily pill that can greatly reduce your risk of HIV infection, and may be appropriate for some patients

I know it can be uncomfortable to have these conversations with a medical provider, and it can be just as difficult to have them with your partner. To help get you started, here are some helpful resources on sexual health for trans women and trans men.

4. If you’re using substances, ask your medical provider for trans-sensitive resources and referrals for substance support services.

Substance and tobacco use can often be the result of depression and anxiety associated with discrimination by the community. In fact, the National Transgender Discrimination Survey showed that 26 percent of transgender individuals use or have used alcohol and drugs frequently, compared with 7.3 percent of the general population according to a National Institute of Health’s report. In addition, 30 percent of the transgender participants reported smoking regularly compared with 20.6 percent of U.S. adults.

There are many risks associated with substance and tobacco use, especially in combination with hormone therapy. Smoking can cause an increased risk of some cancers, blood clots, and heart disease, and it may negatively impact the outcome of hormone therapy, among other complications. Talk to your provider about resources to help decrease substance dependency.

5. If you’re experiencing anxiety, depression, or any other mental health symptoms, bring it up to your health care provider.

When it comes to getting help or making that first call, you don’t have to wait until things get “bad enough.” Unfortunately, mental health issues can be prevalent in the transgender community as a result of isolation, rejection, lack of resources, and discrimination. Share with your provider any feelings of depression or anxiety you may be having. They can help manage your care and recommend a trans-sensitive mental health professional, which can be challenging to navigate on your own.

If you are in crisis, contact Trans Lifeline at 877-565-8860.

6. Tell your physician if you’re interested in potentially having children someday.

Transgender populations have fertility concerns that are often unaddressed by providers. If you are interested in potentially starting a family someday, make sure to talk to your provider about your reproductive health and fertility options early on, especially if you’re considering medical transition or have transitioned.

Transgender men may need to discuss cessation of testosterone if they are interested in becoming pregnant. And if transgender women are interested in having children using their own sperm, they may need to use sperm banking services because of estrogen’s potential effect on sperm production.

Finding trans-sensitive ob/gyn care, birth control resources specific to the trans population, and trans-sensitive fertility support can be difficult, but there are resources that can make it easier, like the ones listed at the beginning of this article.

Finally, remember that you are deserving of a responsible, knowledgeable health care team.

While patients often initially come into a medical office nervous, when they find a healthcare team they trust, they are able to open up more—sharing more information and asking more questions.

As a healthcare provider, I’ve witnessed that those patients who become increasingly empowered to take control of their own health have lasting positive effects, including better overall wellness and greater confidence and self-esteem. Everyone deserves that level of care.

Complete Article HERE!

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Consensual sex is key to happiness and good health, science says

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[I]t’s not just that sex is fun – it’s also good for your physical and mental health.

Some of my research is focused on how men and women differ in the links between sexuality, mental and physical health, and relationship quality. In this article, I write from my findings and that of others on how sex is important to our love, mental health, relations and survival. At the end, I suggest a solution for individuals who are avoiding sex for a common reason – chronic disease.

Good sex makes us happy

Good sex is an inseparable part of our well-being and happiness. Those of us who engage in more sex report better quality of life. Sexual intercourse is linked to high satisfaction across life domains. In one of my studies on 551 married patients with heart disease, individuals who had a higher frequency of sexual intercourse reported higher marital quality, marital consensus, marital coherence, marital affection expression and overall marital satisfaction. These results are replicated in multiple studies.

In a study by another team, partners who both experienced orgasm during sex were considerably happier. These findings are shown inside and outside of the United States.

Sex keeps us alive

Although early initiation of sex such as during adolescence is a risk factor for mortality, having a sound sexual life in adulthood is linked to low mortality. In a seven-year follow-up study of men 17 years old or older, erectile dysfunction and having no sexual activity at baseline predicted increased mortality over time. Similar findings were shown in younger men. This is probably because more physically healthy individuals are sexually active.

No sex and forced sex makes us depressed

There is a two-way road between bad sex and depression. Depression is also a reason for bad sex, particularly for women. And, men who are depressed are more likely to sexually abuse their partners.

And it’s important to note, in the wake of continuing news of sexual assault and abuse, that forced sex in intimate relations make people depressed, paranoid, jealous, and ruins relationships. Couples who experience unwanted sex have a higher risk for experiencing other types of abuse, as bad habits tend to cluster.

Sex different for men and women?

Men and women differ in the degree to which their sexual act is attached to their physical, emotional, and relational well-being. Various reasons play a role among both genders, but for women, sexual function is heavily influenced by mental health and relationship quality.

By contrast, for men sexual health reflects physical health. This is also intuitive as the most common sexual disorders are due to problems with desire and erection for women and men, respectively.

Reasons for avoiding sex

As I explained in another article in The Conversation, sexual avoidance for those who have a partner or are in a relationship happens for a long list of reasons, including pain, medications, depression and chronic disease. Common diseases such as heart disease interfere with sex by causing fear and anxiety of sexual intercourse.

Aging should not be considered as a sexless age. Studies have shown that older adults acquire skills and strategies that can buffer age-related declines in their sexual life, particularly when they are in a positive relationship. This is called seniors’ sexual wisdom.

Back on track

Because people avoid sex for a variety of reasons, there is no single answer for those who want to become sexually active again. For many men, physical health problems are barriers. If they suffer from erectile dysfunction, they can seek medical help for that.

If fear of sex in the presence of chronic disease is a problem, there can be medical help for that as well. For many women, common barriers are relational dissatisfaction and mental health. For both men and women, the first step is to talk about their sexual life with their physician, counselor or therapist.

At least half of all medical visits do not cover any discussion about sexual life of patients. Embarrassment and lack of time are among the most common barrier. So make sure you make time to talk to your doctor or health care provider.

Neither the doctor nor the patient should wait for the other person to start a dialogue about their sexual concerns. The “don’t tell, don’t ask” does not take us anywhere. The solution is “do tell, do ask.”

Complete Article HERE!

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9 reasons having sex is good for you, according to science

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By Alexandra Thompson

[S]cience reveals nine ways having sex benefits your health.

According to California-based obstetrician-gynaecologist Dr Sherry Ross, few things in life are better for people’s hearts, bodies and souls than getting intimate between the sheets.

From burning calories to boosting the immune system and even fighting the signs of ageing, numerous studies reveal regular love making seriously boosts people’s wellbeing.

Sex is even a natural painkiller and could help combat insomnia, Dr Ross adds.

Below, Dr Ross outlines the nine ways, proven by science, being active between the sheets boosts people’s health and wellbeing.

Burns calories

Researchers from the University of Quebec at Montreal analysed 21 heterosexual couples with an average age of 22.

Results revealed women burn, on average, 69.1 calories when they have sex for just under 25 minutes.

This calorie-burning number climbs higher still if you are on top, in a squat position or having an orgasm.

Dr Ross told NetDoctor: ‘The act of sexual intimacy can be a great workout and counts as such for many as their daily exercise regimen.’

Boosts the immune system

A study by Indiana University found women with healthy sex lives produce higher levels of antibodies, which fight off infections.

Dr Ross said: ‘Regular sex makes for a stronger immune system, fighting off common illnesses such as colds and having less sick days from work.

‘Sex also helps lower your blood pressure and lowers your risk of heart attacks.’

Prevents incontinence

For women suffering from urinary incontinence, which is common after childbirth, incorporating Kegel exercises into your sex life can strengthen your pelvic floor and improve bladder control, according to Dr Ross.

If this isn’t enough, such exercises also heighten orgasms for both you and your partner, she adds.

Is a natural painkiller

Contracting genital muscles generate a pleasurable feeling that can reduce the discomfort of menstrual cramps, headaches and joint pain, according to Dr Ross.

She adds tracking your menstrual cycle and scheduling in an orgasm before your first period could prevent crippling discomfort.

Aids insomnia

After an orgasm, endorphins and the hormone prolactin are released, which relax the body and mind to promote sleep, Dr Ross claims.

Boosts pregnancy chances – even if you’re not ovulating!

Researchers from the Kinsey Institute and Indiana University found women who have sex when not ovulating create an environment in their wombs that make it more hospitable for growing embryos.

This is due to orgasms activating the immune system, which then seems to prepare women for even the possibility of pregnancy.

Improves mental health

According to the sex therapist Vanessa Marin, skin-to-skin contact releases oxytocin, which is also known as the ‘cuddle hormone’.

This can reduce anxiety and stress, while promoting feelings of closeness.

Prevents wrinkles

In 2013, UK-based neuropsychologist Dr David Weeks questioned more than 3,500 people about their sex lives over 10 years.

Results revealed those who have regular, healthy sex lives look up to seven years younger than people who do not get intimate two-to-three times a week.

Dr Weeks believes this is due to the release of endorphins that boost circulation and reduce stress, as well as the production of human growth hormones, which promote skin elasticity.

Makes you brainier

According to a study published in the Journals of Gerontology, sexually-active older adults perform better in verbal and visual tests.

This may be due to the release of oxytocin and ‘the happy hormone’ dopamine, which have both been linked to improved cognitive function.

Complete Article HERE!

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