Talking sexual health with older patients

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Dr Sue Malta and her research team want to promote more positive social perceptions of older people’s sexuality, in general practice and beyond.

By Amanda Lyons

It is no secret that Australia’s population is ageing.

But that doesn’t mean older Australians are leaving the pleasures of the bedroom behind – and nor should they, argues Dr Sue Malta.

‘Having a healthy sex life when you’re older, even when you do have disability and disease, is actually really good for your health and wellbeing, and also your overall cognition and cognitive function,’ the Melbourne School of Population and Global Health research fellow told newsGP.

‘So there’s lots of reasons for people to remain sexually active in later life, and for GPs to encourage them to be so, if that’s what the older patient wants.’

Our culture contains many deeply embedded stereotypes about older people, and one of the strongest is that they are asexual. But, as shown by Sex, Age & Me, a national study conducted on the sexual and romantic relationships of over 2000 Australians aged 60 and older, this is very far from the case: almost three-quarters (72%) of respondents reported having engaged in a variety of sexual practices in the preceding year, ranging from penetrative intercourse to mutual masturbation.

Despite this kind of eye-opening data, stereotypes about older people’s sexuality – or lack of – persist, even among older people themselves and the health professionals who treat them.

The Sexual Health and Ageing, Perspective and Education (SHAPE) project, for which Dr Malta is a researcher and project coordinator, also revealed these stereotypes could cause significant barriers in discussion of sexual health between GPs and older patients.

‘GPs don’t want to initiate these conversations, they want them to be patient-led,’ Dr Malta said.
‘But older patients won’t talk to GPs because they are embarrassed, and for reasons that go back to an historical lack of sex education when they grew up: the context and eras these patients were born into, they just didn’t talk about sex.

‘So it leads to this Catch-22 situation.’

The SHAPE team wanted to further investigate the reluctance of GPs to raise sexual health issues with older patients, so they conducted semi-structured interviews with 15 GPs and six practice nurses throughout Victoria. The resulting paper, ‘Do you talk to your older patients about sexual health?’ was published in the most recent edition of The Australian journal of general practice (AJGP).

Dr Malta explained that semi-structured interviews allowed the researchers to access richer and more detailed information from their GP respondents.

‘It’s very easy to say ‘“yes, no” in a survey. We don’t really find out people’s underlying or unconscious views and attitudes,’ she said.

Researchers ultimately found many of the GPs feel uncomfortable broaching the subject of sexuality with older patients, and some found it difficult to reconcile sexuality with ageing.

As one GP said, ‘It’s a bit like you don’t really want to know your mum and dad have sex, you know? Because that’s just gross’.

However, as Australia’s ageing population grows, and divorce, online dating and sexually transmissible infections (STIs) become more common among older people, neglecting issues of sexual health can lead to harms.

There’s a whole issue around [the fact that] they’re not practising safer sex, so the STI rates are going up,’ Dr Malta said. ‘It has gone up 50% in five years, but from a low base.

‘But if we continue in this vein, with more and more single older adults coming into the population, this could potentially be more of an issue in the future.’

Furthermore, if GPs and other health professionals are unaware that they should be looking out for sexual health issues in older patients, they may miss important signs.

‘A lot of the symptomology [of STIs] actually mimic diseases of ageing,’ Dr Malta said. ‘So if there is a stereotype of the asexual older person in the GP’s mind, and an [older patient] has a symptom that might or might not be an STI, which side do you think the GP is going to err on? Not the possible STI.’

A vivid anecdote that Dr Malta encountered during her teaching work is a telling illustration of the importance of not making assumptions.

‘One of the registrars at a presentation I gave had a consultation with an older man, a gentleman on a walking frame, who was 90 or so, and presented with what looked like an STI,’ she said.

‘The consultant the registrar was working under said, “No, it wouldn’t be an STI, just look at him, he’s past it. That’s ridiculous.” But the registrar decided she would ask him.

‘So she asked and he said, “Yes, actually, it could be an STI. I went to see a prostitute last week and it was the best thing I’ve done in ages”.

‘So the registrar then had the opportunity to have that discussion about safer sex and give him some treatment.’

Many of the GPs interviewed for Dr Malta’s paper felt they would appreciate interventions designed to help facilitate discussions about sexual health during consultations with older patients.

Dr Malta agrees this would be helpful, but believes it would also be useful to start earlier, with better information about ageing and sexuality provided during general practice (and other medical) training.

‘In training, you learn about ageing, but in the context of disease and dysfunction,’ she said.

‘So the only thing about sex and ageing you might learn is about erectile dysfunction, how beta blockers affect your ability, vaginal dryness, menopause, prolapse. You don’t actually learn about positive sexuality in later life.’

Dr Malta has found that most older patients would like sexual health screening to become a normalised part of routine care in general practice. She also believes it is necessary to make changes in overall health policy to make it more inclusive.

‘There is no sexual health policy targeting older adults,’ she said. ‘They get lumped into general sexual and reproductive health policy, and the only mention that’s made of them is about menopause and the like.

‘There should be a specific sexual health policy for older adults because the issue is more involved than we think.’

Complete Article HERE!

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Encourage teens to discuss relationships, experts say

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BY Carolyn Crist</a

Healthcare providers and parents should begin talking to adolescents in middle school about healthy romantic and sexual relationships and mutual respect for others, a doctors’ group urges.

Obstetrician-gynecologists, in particular, should screen their patients routinely for intimate partner violence and sexual coercion and be prepared to discuss it, the Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists advises.

“Our aim is to give the healthcare provider a guide on how to approach adolescents and educate them on the importance of relationships that promote their overall wellbeing,” said Dr. Oluyemisi Adeyemi-Fowode of Texas Children’s Hospital and Baylor College of Medicine in Houston, Texas, who co-authored the committee’s opinion statement and resource for doctors published in Obstetrics & Gynecology.

“We want to recognize the full spectrum of relationships and that not all adolescents are involved in sexual relationships,” she said in an email. “This acknowledges the sexual and non-sexual aspects of relationships.”

Adeyemi-Fowode and her coauthor Dr. Karen Gerancher of Wake Forest School of Medicine in Winston-Salem, North Carolina, suggest creating a nonjudgmental environment for teens to talk and recommend educating staff about unique concerns that adolescents may have as compared to adult patients. Parents and caregivers should be provided with resources, too, they write.

“As individuals, our days include constant interaction with other people,” Adeyemi-Fowode told Reuters Health. “Learning how to effectively communicate is essential to these exchanges, and it is a skill that we begin to develop very early in life.”

In middle school, when self-discovery develops, parents, mentors and healthcare providers can help adolescents build on these communication skills. As they spend more time on social networking sites and other electronic media, teens could use guidance on how to recognize relationships that positively encourage them and relationships that hurt them emotionally or physically.

Primarily, healthcare providers and parents should discuss key aspects of a healthy relationship, including respect, communication and the value of people’s bodies and personal health. Equality, honesty, physical safety, independence and humor are also good qualities in a positive relationship.

As doctors interact with teens, they should also be aware of how social norms, religion and family influence could play a role in their relationships.

Although the primary focus of counseling should help teens define a healthy relationship, it’s important to discuss unhealthy characteristics, too, the authors write. This includes control, disrespect, intimidation, dishonesty, dependence, hostility and abuse. They cite a 2017 Centers for Disease Control and Prevention study of young women in high school that found about 11 percent had been forced to engage in sexual activities they didn’t want, including kissing, touching and sexual intercourse. About 9 percent said they were physically hurt by someone they were dating.

For obstetrician-gynecologists, the initial reproductive health visit recommended for girls at ages 13-15 could be a good time to begin talking about romantic and sexual health concerns, the authors write. They also offer doctors a list of questions that may be helpful for these conversations, including “How do you feel about relationships in general or about your own sexuality?” and “What qualities are important to someone you would date or go out with?”

Health providers can provide confidentiality for teens but also talk with parents about their kids’ relationships. The committee opinion suggests that doctors encourage parents to model good relationships, discuss sex and sexual risk, and monitor media to reduce exposure to highly sexualized content.

“Without intentionally talking to them about respectful, equitable relationships, we’re leaving them to fend for themselves,” said Dr. Elizabeth Miller, chief of adolescent and young adult medicine at Children’s Hospital of Pittsburgh of UPMC, who wasn’t involved in the opinion statement.

Miller recommends FuturesWithoutViolence.org, a website that offers resources on dating violence, workplace harassment, domestic violence and childhood trauma. She and colleagues distribute the organization’s “Hanging Out or Hooking Up?” safety card (bit.ly/2PQfxEM), which offers tips to recognize and address adolescent relationship abuse, to patients and parents, Miller said.

“More than 20 years of research shows the impact of abusive relationships on young people’s health,” Miller said in a phone interview. “Unintended pregnancies, sexually-transmitted infections, HIV, depression, anxiety, suicide, disordered eating and substance abuse can stem from this.”

Complete Article HERE!

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How to have the talk with your partner

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Since the most common symptom is actually having no symptoms, talking to any partners about sexual health is even more important than it is awkward. The good news is talking about sexually transmitted infections (STIs) and getting tested leads to more honesty, open communication and better relationships (and health) in the long run. Here’s how to start that particular conversation.

Taking the lead

“Just so you know, I got tested for STIs last month…” is a strong start. Taking the initiative yourself to get tested, get treated if necessary and know your status keeps you and your partner safer. Then, when you’re ready to have the conversation, you can open by sharing your results and normalizing getting tested for your partner.

If they respond that they haven’t been tested or it’s been a while since their last appointment, encourage them to do it, too, so you can be on the same page. This also is a good time to remind them that getting tested doesn’t mean they do have an STI, and if they do, most are curable and all are treatable (and having one doesn’t say anything about them).

Jumping in together

If you haven’t been tested recently either, start a conversation with your partner about both of you getting tested. You can even introduce it as something uncomfortable if that’s where you are, i.e., “This is awkward, but I care about our health and I think it’s time for us to get tested for STIs. Would you want to go get tested together?”

This kind of conversation lets you share an awkward experience while empowering you both to take care of yourselves and each other, creating stronger communication in the long run. It’s also a quick way to hear from your partner if they have recently been tested, and if so, they can serve as your support system in taking on your health.

Sharing results

Talking about an STI you had or have, or hearing about one from your partner, can be a stressful situation. A few things to keep in mind: STIs don’t define people or behaviors, many are curable and all are treatable, millions of people contract STIs every year and even in monogamous relationships an STI doesn’t necessarily mean someone cheated (in some cases, it can take years for symptoms to show up, if at all).

Start a conversation like this one in a safe place where you won’t be interrupted and practice what you’d like to say ahead of time. “I had chlamydia and took medicine, so I don’t have it anymore, but it made me realize we should be getting tested more…” or “I was just diagnosed with gonorrhea and my doctor said you can also get a prescription for the antibiotics…”

Sometimes people need time to process this information, and that’s okay—let them know you’d like to continue talking about it when they feel ready.

If your partner is disclosing an STI to you, remember these facts and consider how you’d want to be treated on the other side. Be compassionate, avoid judgment and take on your health as a team. If you have questions or would like to get tested, Medical Services offers STI testing by appointment with a health care provider and on a walk-in basis through the lab.

Free safer sex supplies (condoms, lubricant, etc.) are available through Health Promotion on the first floor of Wardenburg Health Center. For general information on sexual health and sexually transmitted infections, visit beforeplay.org

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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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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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?

By

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

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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.”

Complete Article HERE!

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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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Embrace And Then Move Past Your Scaring

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Name: NIta
Gender: female
Age: 40
Location: South Africa
I recently had abdominal surgery to remove a cancer. I’m recovering pretty well, and the prognosis for my future is also pretty good. But I am noticing two problems. The surgery left a really big scar. It’s still not fully healed yet, but I can tell it’s always going to be ugly. And my belly is really misshapen now. I felt pretty okay about my body before hand, but this scar really makes me look really unattractive. Also, my sex drive has completely gone away. I used to be a pretty sexual person, but now nothing excites me. Would you say this is normal?

How long ago was your surgery, I wonder? It’s got to be pretty recent, if you say the incision is still healing.

Darlin’, may I suggest that you’ve been through quite a trauma — a cancer diagnosis, recent surgery and all. This would throw anyone for a loop. I’d be willing to guess you’ve not had the proper time to process all of this. It comes as no surprise to me that your libido has gone south. I wouldn’t expect otherwise.

If you’re still healing on the outside, you know for sure your insides have a much longer way to go. You’re probably still feeling some discomfort, right? That’s enough to put the kibosh on sexual interest right there. You’re body is consumed with the job of healing itself. It probably hasn’t any energy to spare for sex. And why have a libido if ya can’t be sexual, right? So you see, your body is actually protecting itself and concentrating on the task at hand.

Maybe at this point in your recovery a little pampering would be better for you than a pursuit of sexual pleasure. Long luxurious baths will help soothe the tension, as well as giving your easy access to your fine pussy. Even folks with no discernable libido find touching themselves enjoyable. And just to keep your head in the game, even though you’re sitting on the sidelines, you could read some erotica or watch some sexy smut.

Some modest exercise like walking or swimming can perk up the libido too. Treat yourself to an erotic massage. Let a pro get his or her hands on you and make you glow. This may also help bring back some of the sensitivity to areas effected by the surgery. One things for sure, doing something is better than doing nothing but sitting there wondering what’s up.

An invasive and disfiguring surgery will always have a profound effect on one’s body image, which goes without saying. Feeling unattractive because of a scar? No doubt about it, it’s a bummer. But consider for a moment that you are here writing to me about it, instead of napping six-feet under. So I guess the scar is not the worst thing that could have happened, right? As you probably know, I hear from a number of my country’s war vets returning home with shattered bodies and lives. My advice to them is what I offer you now. Move through the scar’s impact…with a therapist if need be. And find within yourself the other things that make you beautiful, attractive, alluring and desirable. Who knows, you might luck out and find a scar fetishist out there who will worship you for what you find loathsome.

Embracing and then moving past your scaring will open you to find the myriad pleasures your body can still provide you and others. So while your body works on healing itself, your mind can do likewise. No need to have two scars, on one your belly and another one on your psyche. In the end you may find that flaunting your scar, like some women do with their mastectomy scars, will liberate you from feeling unattractive. After all, that scare and misshapen abdomen are your red badges of courage, honey. Not only do they make you distinct, but also they testify to you being a survivor.

Good luck

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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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Can You Get An STI From Anal Sex?

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That itch in your butt? It may not just be a harmless rash.

By Isadora Baum

[W]hen you think of sexually transmitted infections, symptoms like vaginal itching and pelvic pain probably come to mind. But the same STIs that threaten your health down below can infect other body areas. They’re typically transmitted through oral sex or anal sex, but some can be picked up after direct skin contact.

The scary thing about getting an STI in another part of your body is that you’re less likely to recognize signs, so you don’t seek the right treatment—and the infection potentially gets worse. Here are four body areas that can play host to an STI, plus the symptoms to look for.

On your face

You already know that genital herpes can spread to your lips if you have oral sex with someone who has this STI. What you may not know is that the same type of herpes that shows up below the belt can infect other parts of your face, such as around your mouth, Amesh Adalja, MD, an infectious disease physician and senior scholar at Johns Hopkins Center for Health Security, tells Health. Herpes can also appear on your tongue or nose.

How do you know if a sore on your face is herpes? Early signs are the same as genital herpes: tingling and itching, and then as the sore develops, it blisters and scabs over. If you’re unsure, check in with a dermatologist. You can treat herpes with over-the-counter cold sore remedies; your doctor can also prescribe antiviral meds that cut the duration of an outbreak.

In your butt

Yep, we have to go there. Chlamydia, gonorrhea, and syphilis can be transmitted to the rectum if you have anal sex with an infected partner, Karen Brodman, MD, a gynecologist in New York City, tells Health. Your risk of one of these backdoor STIs increases if you develop small tears or nicks in the thin skin of the anus, through which the bacteria can get into your system.

STIs transmitted through skin contact, such as genital herpes or HPV, can develop in or outside the anus and rectum, says Dr. Brodman. Herpes may also show up as sores on the skin of the buttocks. And of course, HIV is spread via anal sex, as are blood-borne viruses such as hepatitis B and C.

Signs of an STI in your behind include rectal burning, unusual discharge, bleeding, pain, or a fissure, says Dr. Brodman. You might also notice blisters or achiness in the groin, she adds. If any of these develop, let your doctor know. And don’t be embarrassed—she’s seen it all before.

In your eyes

STIs that trigger eye infections include herpes, gonorrhea, chlamydia, and syphilis, says Dr. Adalja. The signs of many of these conditions mimic pink eye: think pain, swelling, redness, and discharge.

An eye herpes infection, however, can present differently. If the herpes virus is in your eye, it may result in an outbreak of one or more lesions on the eyelids or even the cornea, triggering pain and sensitivity that could jeopardize your vision by causing scarring. If you have any symptoms, see your ophthalmologist promptly, says Dr. Adalja.

In your throat

STI infections in the soft, moist tissues of the back of the mouth and throat are more prevalent than you might think. Chlamydia and gonorrhea (including the drug-resistant strain known as “super gonorrhea”) can set up shop here if a person contracts either of these infections during oral sex. Scarily, you may not even know it; sometimes the only symptom is a sore throat, according to the Centers for Disease Control.

HPV is another infection that invades the throat—and it’s thought to be behind the recent rise in cases of head and neck cancers, especially among men. While there are more than 100 types of HPV, the type that causes many cases of cervical cancer, HPV 16, is also responsible for most head and neck cancers. Though HPV of the throat is becoming more common, a 2017 study emphasizes that the overall lifetime odds of cancer is low. Still, if you think you might be at risk, talk to your doctor.

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