Category: Health Concerns

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Talking to Your Partner When You Struggle with Hypogonadism

Communication is key for taking on this difficult condition

By Mark Gurarie

Generally unrecognized and often undiagnosed, hypogonadism can significantly impact relationships. Characterized by low levels of sex hormones, especially testosterone, it can arise due to physical injury, congenital defects, cancer or cancer treatmenst, benign tumors, or as a result of other conditions, such as older age, obesity, and metabolic syndrome (a group of conditions that can lead to heart disease, diabetes, and stroke), among others.1

What makes this condition particularly challenging for relationships is the way that hypogonadism impacts intimacy. Among its most prominent symptoms is low libido (sex drive), as well as mood and emotional changes. Men can also experience erectile dysfunction (ED).1 This can lead to severe relationship problems, making it essential that you and your partner are proactive and ready to support each other.

These may not be easy conversations to have, but they’re critical. If you or your partner suffers from hypogonadism, establishing a supportive dialogue is where the road to coping and living well with the condition starts.

The Impact of Hypogonadism

Given the nature of hypogonadism—and the wide range of causes and associated conditions—talking about it means understanding the impact it can have on you or your loved one. In many cases it’s a chronic condition, and ongoing therapy—often taking hormone replacement therapy—is necessary, making management a constant and evolving challenge.

How does hypogonadism affect relationships? Here’s a quick breakdown:2

  • Mental health: Studies have found a distinct association between hypogonadism and depression in both men and women of all ages. Rates of anxiety and bipolar disorder are also higher among this population, which can affect relationship quality, sexual satisfaction, and overall quality of life.
  • Sexual satisfaction: Given its effects on sexual function and libido, this condition significantly impacts assessments of sexual satisfaction. According to a 2021 study, up to 26% of males and 20%–50% of females with hypogonadism were sexually inactive. Problems with sex are often at the root of relationship issues and they can affect other aspects of mental health, as well.  
  • Erectile dysfunction (ED): Males with hypogonadism experience a much higher rate of ED, an inability to obtain or maintain an erection. A study of hypogonadotropic hypogonadism, a chronic congenital form of the condition, found that up to 53.2% of males reported this issue. This can further affect relationship health and is associated with higher levels of depression and anxiety and lower quality of life.

Managing and living with hypogonadism is a multifaceted affair. It means recognizing symptoms, it means getting medical help and keeping up with medications and appointments, and it means tending to mental health and relationships. Communication is crucial in all of these areas. Though it isn’t easy, you and your partner will have to have open discussions about this condition and what it’s like to live with it.

Loss of sexual desire is a hallmark of hypogonadism, as is erectile dysfunction, and it can be a chief source of relationship problems. Though it may not be easy to talk about your sex life, it is very important to do so. For both partners, imbalances in sexual desire are associated with less satisfaction in the relationship and higher levels of tension and frustration.3

What are some approaches to broaching this subject? What are strategies you can use to boost communication? Here are some tips:

  • Educate yourself: Whether you’re the one with hypogonadism or your partner is, it’s important to learn as much as you can about the condition. Your doctor or healthcare provider can direct you to educational resources, and there are many available online.4
  • Kitchen-table conversation: It’s a good idea to broach the topic of sex in a neutral setting. Bringing up sexual problems or dissatisfaction while in bed can cause negative associations with intimacy.5
  • Direct communication: In order to promote effective dialogue, use “I” statements, rather than “you” statements when having the discussion. Explaining how you feel—rather than what your partner is or is not doing—and what your aims are is a good starting point.4
  • Be open: For both partners, managing low libido means being open-minded, both to each other’s needs and to ways of restoring intimacy. It’s also worth discussing other health factors that may be affecting your relationship and whether to consider therapy or other ways to work on the relationship.5

While talking about how you’re being affected by hypogonadism and airing your feelings may seem intimidating, it’s necessary work. When it comes to issues of intimacy and sex, being open is the best policy. What you don’t want to do is hide your condition from your spouse or partner, as this can only make matters worse.

Ultimately, hypogonadism can be medically managed, and most who get treatment are able to live well with it. Good communication with your partner will prove essential as you take it on, and it can lay the groundwork for an even stronger relationship. The most important thing is to not stay silent.

Complete Article ↪HERE↩!

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Yes, You Can Contract an STD Without Having Penetrative Sex

by Gabrielle Kassel

Anilingus. Cunnilingus. Mutual masturbation. Many nonpenetrative sex acts are *veryyy* much worth exploring from a pleasure perspective.

But many sex-havers engage in these sex acts under the assumption that sexually transmitted infections (STIs) can only be transmitted through penetration.

This myth results in many explorers thinking they’re being Safe™, when in fact they’ve put themselves in a position where STI transmission is, indeed, possible.

Confused? Concerned? Don’t be.

Below, experts explain exactly how an STI can be transmitted when a hole isn’t being penetrated. Plus, exactly what you need to know about STI testing.

STDs vs. STIs

Both acronyms refer to conditions that are primarily transmitted through sexual activity. STI stands for sexually transmitted infection, while STD stands for sexually transmitted disease.

Technically, a condition only qualifies as a disease if you have advanced symptoms, while the term infection applies if you don’t have any symptoms at all.

In everyday conversation and medical resources, the two terms are used interchangeably.

Sexually transmitted infectious particles don’t “hide” in the way back of your holes (e.g., mouth, anus, vagina).

Instead, these infectious particles can live on any internal or external skin or in bodily fluids, explains Dr. Felice Gersh, author of “PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones, and Happiness.”

For this reason, “certain STIs can be spread anytime there’s skin-to-skin contact or when body fluids are spread,” she says.

Important: Not every STI can be passed on through contact with every single section of skin or every single bodily fluid.

What segments of skin or which bodily fluids can transmit the STI depends on the particular STI. It also depends on where the STI is located, or if it’s considered a full-body STI.

To be very clear, STIs aren’t weeds: They don’t simply sprout up out of nowhere.

For an STI to be transmitted, someone must be doing the transmitting. And for someone to do the transmitting, they must be STI-positive.

(And the only way to know if you’re STI-positive is to get tested, but more on that below).

According to Gersh, depending on what the STI is and where it’s located, an STI could be transmitted during any sexual activity that involves the following:

  • the mouth, lips, throat, or saliva
  • blood or breast milk
  • vaginal fluid, pre-ejaculation (pre-cum), semen, or anal secretions
  • the internal anal canal, anal entrance, or perineum
  • the vaginal canal, vulva, penis, or testicles

That means that, in theory, an STI can be transmitted during any of the following sex acts:

Anything that involves the ingestion of, exposure to, or swapping of bodily fluids could result in the transmission of infection.

For example:

  • platonic mouth kissing
  • getting a tattoo or piercing
  • sharing sex toys that haven’t been cleaned
  • getting a blood transfusion
  • sharing needles
  • breastfeeding or chestfeeding
  • giving birth
  • self-inoculation

However, most of the fearmongering around nonsexual STI transmissions — for instance, that you can get an STI from a toilet seat, hot tub, or public pool — is *not* based in science under most conditions.

STIs generally cannot exist outside the homeyness of the body’s mucosal membranes for very long. And all the chemicals in pools and hot tubs kill off any infectious agents.

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Before we answer this question, let’s talk about the word ‘dormant’ real quick. Most doctors don’t use it anymore, according to Gersh.

“The concept of a dormant STI isn’t helpful,” she says. “It’s predicated on the idea that you can have an STI that just isn’t doing anything in your body.”

The words doctors like to use instead are “asymptomatic” or “latent.”

An asymptomatic STI occurs when someone isn’t currently experiencing symptoms that they can feel, see, or smell. According to the World Health OrganizationTrusted Source, the majority of STIs are asymptomatic.

“It’s possible to have an STI, not be experiencing symptoms, and still transmit it to someone else,” Gersh explains.

“It’s also possible to have an STI, not be experiencing symptoms that you can feel or see, and still have it be doing something to your body,” she says.

For example, someone can have human papillomavirus (HPV), not be experiencing any symptoms, but still have the cellular makeup of their cervix altered by the virus.

You can also have an STI, not be experiencing symptoms now, but begin experiencing symptoms later.

An STI cannot be detected by an STI test immediately after exposure.

The STI can’t be detected because it hasn’t been in the body long enough for the body to develop antibodies in response to it, which is what most STI tests are looking for.

The incubation period is the amount of time between when someone contracts an STI and when they test positive for that STI on a test.

If you get tested for an STI during its incubation period the test will come back negative. “The incubation period is different for every single STI,” Gersh says. “It ranges from anywhere between 2 days and 3 months.”

This means that, if you have unprotected sex with someone, the move actually isn’t to get tested the next day, she says.

“That test will tell you if you were exposed to any STIs prior to having sex with that person,” Gersh explains. “But the test will not tell you if that person exposed you to any STIs.”

If you had unprotected sex, Gersh recommends getting tested after 2 weeks and then again 2 weeks later.

Some may use the phrase “unprotected sex” to refer to bareback penis-in-vagina intercourse. But here, we’re using it to refer to any sex that took place without a barrier method.

That includes any sex that happened with a broken condom, expired condom, or other condom mishaps.

If you’ve never been screened before and want to, congratulations on deciding to take your sexual health into your own hands. Seriously, the importance of this step can’t be overstated!

Start by finding a testing center near you by checking out this STI testing center guide. Before you head to the testing spot, make sure they test for all the STIs you’re interested in getting tested for. Some clinics only test for HIV, for example.

When you get there, be sure to ask explicitly for all the STIs you want to get tested for, especially if you want to be tested for oral or anal STIs.

Most testing centers only test for genital gonorrhea, genital chlamydia, HIV, and syphilis unless asked otherwise, Gersh notes.

It *is* possible to contract or transmit an STI without having penetrative sex. The best way to protect yourself and your partner(s) from transmission is for everyone to know their current STI status.

Complete Article ↪HERE↩!

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5 common conditions that can lower sex drive

By Charlie Williams

The science is clear: Sex can bring some incredible benefits for your health. Study after study has shown that having sex regularly can improve longevity, reduce the risk of heart disease, stroke, and certain types of cancers, bolster the immune system, improve sleep, enhance mental health, reduce depression symptoms, and improve overall quality of life.

Common conditions, like cancer, diabetes, heart disease, etc, not only affect patients’ physical health, but also their sexual health.

Despite this, sex remains a taboo topic in American culture. We don’t even know how to address it to children in schools. For instance, in the late 1990s, the US government adopted the abstinence-only-until-marriage (AOUM) approach to adolescent sexual and reproductive health. Public schools in 49 of 50 states accepted federal funding from this program. As a result, public school sex education focused on raising awareness of the risks of sex, like sexually transmitted infections and youth pregnancy, rather than balancing the risks with the scientifically supported benefits. What’s more, rigorous research showed that AOUM failed to achieve its goal of delaying sexual initiation, reducing sexual risk behaviors, or improving reproductive health outcomes.

The history of American inhibitions about sex is too complex to detail here. Suffice to say that because of these longstanding cultural mores, modern public discourse about sexuality is often described in a negative light, focusing on the risks and dangers of sex. Meanwhile, discussion about the physiological and psychosocial health benefits of sex is commonly ignored, according to a white paper from Planned Parenthood.

This discussion might be missing in physician’s exam rooms, too. Six in 10 American adults have chronic disease, but it’s likely that they aren’t receiving sufficient education to help them cope with the effects that their conditions can have on their sexual health, and how those effects can change their quality of life. The problem becomes more challenging when considering that cultural mores prevent patients—and physicians, too—from broaching the subject simply because it’s uncomfortable to talk about.

So, next time you suspect a patient has one of these conditions, consider spurning the taboos and help them understand its implications for their sexual health and overall quality of life.

Cardiovascular disease

According to the American Heart Association, decreased sexual activity and function are common in patients with cardiovascular disease (CVD), but not for the reasons you might expect. Patients with CVD often endure psychological distress because of their conditions, which is correlated with negative downstream effects on sexual function. In patients with coronary artery disease, heart failure, congenital heart defects, recent heart attacks, coronary artery bypass grafting, implantable cardioverter defibrillators, and cardiac transplantation, sexual activity frequency and satisfaction often decline because of the anxiety that sexual activity will worsen the underlying cardiac condition or cause death. That anxiety can lead to depression, an important contributor to erectile dysfunction (ED) and decreased libido.

While some patients with severe CVD may be putting themselves at increased risk for complications by having sex, doctors can clear many patients for sex after a simple physical exam or exercise test. For those with depression, anxiety, or decreased libido, physicians can recommend patient and partner counseling, refer to psychiatrists, or prescribe medication.

Diabetes

Long-term poor blood sugar control can damage nerves and blood vessels, inhibiting feeling and the blood flow that is necessary to maintain an erection, according to the Mayo Clinic. As such, some male patients with diabetes are likely to experience ED while managing their condition. Other conditions that are common in men with diabetes can commonly cause ED, like high blood pressure, heart disease, and depression.

Women with diabetes are also likely to experience decreases in sexual function, including reduced libido, decreased vaginal lubrication, and reduced or absent sexual response, including the ability to stay aroused, achieve an orgasm, or maintain feeling in the genital area.

The good news is that diabetes can be a preventable condition, and sometimes reversible in those who have already developed it. Many of the factors that cause symptoms that reduce sexual function and desire in patients with diabetes can also be reversed. Plus, many of the factors, like improving blood sugar levels, have the added benefit of helping patients feel better overall and improving their quality of life.

Obesity

While the health hazards of obesity have been thoroughly studied and are well known to most patients, its effects on sexual health are not frequently discussed. For instance, obesity in men reduces testosterone levels and increases the likelihood that men will experience ED. Moreover, obesity can have negative impacts on fertility—it has been linked to low sperm counts and reduced sperm motility, both of which have been shown to make men less fertile.

Women who are obese experience similar reductions in sexual health. Researchers have shown that obese women have lower sexual function scores, and that weight reduction seems to improve sexual function in young obese women. Moreover, obese women are 4 times more likely to experience an unplanned pregnancy than normal weight women, despite them reporting lower rates of sexual activity.

As with diabetes, the good news is that obesity is a preventable condition. And just like diabetes, reducing obesity will not only bring beneficial effects to sexual health, but to overall health as well.

Cancer

Many types of cancer can have detrimental effects on sex to varying degrees. “Some surgeries and treatments might have very little effect on a person’s sexuality, sexual desire, and sexual function,” according to the American Cancer Society. “Others can affect how a certain body part works, change hormone levels, or damage nerve function that can cause changes in a person’s sexual function.”

Doctors, caregivers, and partners can help patients with cancer confront issues of sexual health by maintaining discretion, helping to talk through emotional issues, helping address problems with self-esteem, and tracking side effects. 

On the upside, sexuality and intimacy have been shown to help patients with cancer bear the burden of their disease by helping them cope with feelings of distress.

Mental health disorders

Healthy and intimate sexual relationships are a key component of mental well-being. But, common mental health problems like anxiety, depression, personality disorder, seasonal affective disorder, and bipolar disorder can all have detrimental effects on sexual health.

Notably, a markedly decreased sex drive is a common indicator of major depressive disorder, according to Jennifer L. Payne, MD, director of the Women’s Mood Disorders Center, Johns Hopkins Hospital, Baltimore, MD.

“Change in sex drive is a key symptom we look at when deciding if someone fits the diagnosis for major depressive episodes,” Dr. Payne wrote. “A primary symptom of depression is the inability to enjoy things you normally enjoy, like sex.”

But mental health disorders don’t exclusively cause a reduction in sex drive and performance. Some individuals, including those with compulsive sexual behavior, can become consumed by sexual thoughts and an out-of-control sex drive. Like most addictions, when sex addiction and compulsive sexual behavior is left untreated, it can damage self-esteem, relationships, careers, and health. 

Time to have ‘the talk’

Both the patient and physician may feel uncomfortable in the exam room broaching the subject of sex. But, consider that studies have shown that most patients with CVD believe they haven’t been appropriately educated about their conditions’ effects on sexual health and desire more information on how to resume their normal sexual activity. Other patients with common conditions most likely feel the same way. 

Having an open discussion or referring patients to counseling can go a long way toward improving sexual health, which in turn can provide both physical and mental health benefits.

Complete Article ↪HERE↩!

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How to deal with post-lockdown intimacy anxiety and low libido

Post-pandemic Sex: Many of us are unsure how to navigate relationships in what feels like a new world

The basic tips still hold true including practicing safe sex by using condoms and birth control.

By Geraldine Walsh

Along with indoor dining and international travel, sex is due to make a comeback as the summer of love apparently, belatedly, unfolds around us. The forward-moving vaccination programme brings hope for a normal life.

Post-pandemic sex and relationships, however, appear to have undergone a significant shift, depending on the age group, but how our post-pandemic sexual behaviour will pan out is not all that easy to predict.

There is a disparity in how we have experienced intimate relationships over the past 18 months. There were those of us in committed relationships who witnessed a rising stress culminating in a low sex drive brought on by the upside-down world. Many entered the pandemic as singletons and are now exiting while still single having missed out on a couple of years of flirtations with the potential of cementing long term relationships.

We’re not expecting a sexual revolution as such, but the effect the opening of society will have on relationships means adjusting not only our expectations but our practices

The crisis cut short liaisons which were never given a chance and, after living in limbo for too long, dating is back on the cards filled with an added anxiety. And there are the teenagers who are now in their twenties and, well, are raring to go with the potential for casual sex to make a 1920s roaring return.

We’re not expecting a sexual revolution as such, but the effect the opening of society will have on relationships means adjusting not only our expectations but our practices. With both the physical and emotional effects of post-pandemic sex likely to come to the fore as we eventually drop statistics on intimacy, it’s safe to say the pandemic has not been conducive to a healthy fulfilling sex life for many of us, single or not. The issue for many now is how to navigate not only new relationships but those sticky sexual exploits in what feels like a new world.

What about physical first dates?

“People are emotionally fatigued with online dating, the chatting, texting, being ghosted and the emotional whirlwind that comes with romantic first encounters online with potential love interests,” says Orlagh Gahan, couples and relationship psychotherapist. “Not having the opportunity to physically date all through lockdown has left many singletons isolated. We are going to see a huge boom in traditional real live dating again with more and more people moving towards professional matchmaking services.”

Gahan is conscious of the overwhelming emotional burden caused by dating websites, particularly for those committed to finding real love. She suggests we be ourselves as much as possible on dates.

“Arrange morning and daytime dates around hobbies and interests you both enjoy,” says Gahan, “or new experiences which will bring out your natural persona rather than dates focused on alcohol and the pub culture. Keep first dates short, but long enough that you give each other time to come out of your shell and loosen up. Romance and chemistry can take time to develop, and first dates are pressurised situations so go with your gut and intuition.”

What about intimacy anxiety?

“The intensity of emotions, fatigue, anticipatory grief can obviously affect our sex drive and all types of romantic intimacy,” says Gahan. “Many of us are in a state of recuperation meaning it will take time to readjust. A sex positive approach promotes proactively addressing blocks associated with body image, sex, intimacy and sexual health, fears and anxieties around sex while also learning more about the subject. When we feel good and positive about ourselves we are naturally more open to connection and in turn romantic intimacy.”

A pandemic addition to our intimate connections and potential intimacy anxiety is disease anxiety. There are those of us who are innately concentrated on how Covid-19 can find its way into the bedroom with lab tests showing SARS-COV-2 has been found in saliva, faecal matter, and semen. The anxiety can be so overwhelming that some are holding off until the pandemic is over to get frisky, which at this stage is a guess at best. Instead of waiting, ground rules can help alleviate the anxiety.

The awkward conversation in an early relationship doesn’t always make for great foreplay but the longer we keep our opinions silent, the harder it may be approach them. Gahan suggests we don’t be afraid to have real in-depth conversations about sex at the beginning of a relationship as “couples can benefit from talking about sexual intimacy, consent, values, sexual health and attitudes about sex and relationships.”

What about low libido?

Low libido is a common occurrence with the overreaching anxiety brought about by the pandemic. But the truth is there are many different factors which affect libido and the desire for intimacy including relationship health.

“We need to move beyond the overly simple and disempowering concept that libido is either high or low,” says Gahan, “and cultivate a mindset more focused around sexual health and healthy sexual attitudes, understanding and practicing what it means and feels like to be a sexually healthy human being with the understanding that libido fluctuates.

“I would encourage people, particularly women, to educate themselves about the different aspects of sexual intimacy, sexual health, and also the very curious and intriguing arousal process. Get to know your own body and build on body confidence, learn about romantic intimacy, and find safe empowering ways to talk openly and honestly about how you feel about sexual intimacy.

To improve your libido, get sex positive, talk about feelings, fears, and needs around sex, understand intimacy at a deeper level, feel good about your body again, get out and exercise and feel fun and joy in simple things, love and look after your body and you will feel more comfortable bonding with your partner.”

What about practising safe sex?

The rules of safe sex have not changed because of a pandemic. They may have shifted however as we are more conscious of who we hook up with considering the risk of Covid-19 transmission in unvaccinated people remains relatively high. It is as vital as ever to take precautions when starting a sexual relationship to protect yourself from STIs, HIV and unplanned pregnancy. See sexualwellbeing.ie for more info.

Talk:
Have the conversation. Talk to your partner about whether or not they have tested positive for STI’s. Discuss safe sex practices and sexual history. Have a chat about consent, and help each other understand your comfort-levels, boundaries, and your likes in the bedroom.

Test:
Get tested if you have any symptoms of sexually transmitted infections. Contact your local STI clinic or GP. In today’s world, add in a Covid-19 test if you have any coronavirus symptoms such as cough, shortness of breath, fever, or changes to your sense of smell or taste. and self-isolate from your partner if possible.

Act:
Practice safe sex by using condoms and birth control. Avoid alcohol or drugs which can inhibit our awareness and result in high-risk sex. Keep an eye on your body and that of your partners for any changes such as a rash, sore, blister, or discharge which may indicate an infection.

Complete Article ↪HERE↩!

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Why does sex hurt?

14 common reasons why intercourse is painful, plus how to prevent it

By Ally Head

So, why does sex hurt? Good question – and, sadly, not one that there’s a straightforward answer too.

Getting intimate and then feeling a stabbing, burning or, well, any kind of pain down there can be a bit of a mood killer, can’t it? Not to mention a worry.

Sex can hurt for a number of reasons, from underlying infections to hidden health conditions. That highlighted, it’s definitely better to deal with it sooner rather than later – no point gritting your teeth and hoping it will go away.

Known medically as dyspareunia, as obstetrician, gynaecologist and ambassador for Wellbeing Sisters doctor Larisa Corda explains, painful sex affects one in ten British women, as per an International Journal of Obstetrics and Gynaecology study.

And, according to doctor Shree Datta, gynaecologist for intimate wellbeing brand INTIMINA, there are two main types. Superficial dyspareunia – pain at the entrance to the vagina or within it at the point of penetration – or deep dyspareunia – which occurs deep in the pelvis. “Remember that pain can range from a mild irritation to debilitating pain, meaning sex can’t be tolerated, and it may be temporary, intermittent or a long term problem,” she explains.

Both female experts stress that it’s important to discover it sooner rather than later why you may be suffering from pain during sex. Keep reading to decode why does sex hurt, once and for all.

1. Too little lubrication

FYI, one of the most common reasons you’re having to Google, ‘why does sex hurt?’, is because you have too little vaginal lubrication during sex. This is totally normal – a lot of women experience vaginal dryness.

Your vagina lacking moisture can be down to the amount of foreplay before penetration, or even a lack of hormones such as oestrogen around the time of menopause, explains Datta. “If you suffer from medical conditions such as diabetes or depression, this can also affect your sexual libido and enjoyment,” she shares.

Bottom line: many women simply do not produce enough vaginal lubrication, including younger women, adds Samantha Evans, sexual health expert, former nurse and co founder of luxury sex toy retailer Jo Divine.

Try this: Rather than keep Googling why does sex hurt, Evans shares that the use of lubricants can really help. Often GPs will prescribe a hormonal cream or pessary, but many gynaecologists advocate using vaginal lubricants to help nourish the delicate tissues of the vagina. Read out guide to the best lubes to buy over the counter, while you’re here.

2. You may be suffering from a skin condition

Did you know? Underlying skin conditions can actually cause irritation during sex, and condoms may also cause discomfort or burning, particularly if you have an allergy, explains Datta. If your vagina burns after sex, you may have eczema and other genital skin conditions, such as lichen sclerosis.

Try this: Make sure you visit your GP to get your skin condition defined, if you think you may be suffering. From there, they can help you decide the best course of action, explains Corda.

3. You may have vaginismus

Ever heard of vaginismus? If you haven’t, it’s the tightening of your vaginal muscles automatically at the time of penetration, explains Datta. But why does this happen? “It can be caused by a combination of physical and psychological issues,” explains Corda. “Physical causes can include urinary tract infections, sexually transmitted diseases, vulvodynia, skin conditions such as psoriasis or eczema, menopause, and birth trauma.”

Psychological problems, on the other hand, can be caused by emotional or sexual trauma. “A previous painful experience with sex might make it harder to feel aroused and enjoy touch,” explains a spokesperson from Brook Advisory. “It can also make the muscles around the vagina and anus clench (to protect you from the pain you’re worried about) and make penetration difficult and more painful.”

Try this: With the appropriate medical intervention and counselling, the experts share that the problem can be alleviated to enable penetrative sex. Treatment usually involves specialist counselling, pelvic floor exercises, biofeedback training with a women’s health physiotherapist and use of medical dilators or a vibrator or dildo to slowly encourage the vagina to relax and open.

4. You may have an STD

Pain during or after sex can also be a sign of a sexually transmitted disease (STI) or vaginal infection, like a urinary tract infection like cystitis.

“Stinging or burning during sex may be as a result of a sexually transmitted infection, especially if you also experience an unusual vaginal discharge, or an unusual odour,” says Professor Ellis Downes, consultant obstetrician and gynaecologist and spokesperson for vSculpt. “If you have a new sexual partner and have had unprotected sex with him, and are experiencing these symptoms it would be a good idea to have it diagnosed and treated by your GP or at a sexual health clinic.”

Try this: STIs such as Chlamydia or gonorrhoea can have little to no symptoms but vaginal itching or burning, as well as painful sex, might be a sign that you are infected. Visit your GP or GUM clinic for a test. Treatments usually involve antibiotics but your doctor can recommend the next course of action.

5. You might have thrush

Three out of four women will suffer with thrush at some point in their lives, although it’s other infections, such as bacterial vaginosis. As above, UTI’s are also a common reason as to why sex is likely to hurt. Vaginal thrush, in particular, is a common yeast infection, and the main symptoms include painful sex, itching, soreness, stinging, burning when peeing and an odourless discharge.

Try this: You can pick up a DIY test in most pharmacies to determine whether you have thrush or BV, and your pharmacist will be able to recommend the best course of action. It’s usually treated with anti-fungal cream, pessaries, pills or a combination.

6. You could be going through the menopause

According to Corda, during the menopause, women experience a reduction in sex hormones which can lead to both vaginal dryness and sexual pain.

Do note here: Don’t feel embarrassed about this or suffer in silence – as Datta points out, lots of people experience sexual problems at different stages of life. “There is a lot of help out there, so there is no need to deal with this difficulty alone,” she shares. Do book an appointment with your GP if you think your painful sex may be because of menopausal symptoms.

7. Your vagina may be irritated

You’ll likely know that genital irritation can be caused by spermicides, latex or vaginal douching. Some women are allergic to certain products or even their partner’s sperm. Latex products, such as condoms or sex toys, can also cause an allergic reaction, so if you’ve ever experienced an itching or burning sensation when trying new products, then you might’ve had an irritation or allergic reaction which can, in turn, lead to painful sex.

Try this: do be aware of what you are applying to the delicate skin of your genitals. Glycerin – which is often found in flavoured lubes – as well as parabens and aspartame, can cause irritation. Similarly, alkali or acidic lubes can mess with the pH balance of your vagina and cause dryness and itching. Instead, switch to a water-based (not silicon-based) lube, such as Pjur. Another alternative is Sliquid, which is also glycerin- and paraben-free.

Similarly, opt for latex-free condoms and, when using a sex toy, make sure you clean if after use (read how to clean your sex toys, here), recommends Downes. “Some cleaning substances can irritate the vaginal lining, though, so do note that it’s best just to use hot water and natural soap.”

8. You may just not be aroused

“If you’re not physically aroused, touch of any kind can be uncomfortable, especially if it’s somewhere sensitive, like your clitoris or the tip of your penis,” says a spokesperson from the Brook Advisory Clinic. “Being well-lubricated, relaxed and with lots of blood flow in the area (you want either an erect penis or a vulva swell) helps with this, so put plenty of focus on foreplay,” they recommend.

FYI, women especially need warming up before penetrative sex, both physically and emotionally. “If you’re not feeling turned on – that is, if you’re not mentally aroused – touch can be unpleasant. For example, being tickled when you’re feeling playful and silly is usually more fun than when you’re tired or angry,” adds the Brook spokesperson.

Try this: The sexpert suggests spending time enjoying foreplay to significantly improve your sexual pleasure. “There may be times when penetrative sex is not possible, but you can still have great sex without intercourse,” they share.

Corda also adds that, if you’re worried about your lack of libido, counselling could be key to treating these factors and reviving the pain associated with sex. But in the first instance, it’s important to see your doctor to rule out medical causes first and provide the correct treatment.

9. You may be injured

Did you know? “Painful sex can be a sign of damage from previous sex, such as tearing or soreness,” explains a spokesperson from the Brook Advisory Clinic.

Think about it – you wouldn’t go running if you’d twisted your ankle, so try not to have sex super quickly after a particularly enthusiastic session, as it may have resulted in friction that has left you sore.

10. He may be too big

“Even if you’re well lubricated and fully aroused, you may experience pain if a man inserts his penis too quickly or deeply,” says Evans. “The vagina relaxes as you warm up to having sex, and will open more comfortably if the penis enters slowly. Guiding your partner in at your own pace can really help avoid any pain.”

Try this: She explains that often, having sex doggy style can be painful, so try backing onto the penis at your own pace. The same can be said when going on top. Don’t let your partner to pull you down onto their penis if you suffer from painful sex: instead, she recommends slowly lower yourself, controlling the speed and depth of insertion that is comfortable. Got it?

11. You may have a female health condition like endometriosis

Painful sex is a common symptom for women with endometriosis symptoms, which affect two million women in the UK, making many avoid sex altogether. Up to 50% of women with endometriosis have cited painful intercourse, ranging from sharp, stabbing, needle-like pain to a deep ache. It can feel mild to intense, either during sexual intercourse or up to 24 to 48 hours post-coitally, or both.

As well as endometriosis (when the lining of the uterus grows outside the uterus or is thicker than normal), painful sex can also be caused by fibroids (growths of muscle and tissue inside the uterus) growing close to your vagina or cervix, irritable bowel syndrome and constipation.

Try this: Endometriosis – and its flare ups – are unpredictable, so often it feels like there’s no knowing when they may occur. Some women experience pain throughout the month whereas others only experience it at certain times, likely – but not definitely – related to their menstrual cycle. There is no cure for endometriosis but there are treatments that can help with the pain – do visit your doctor if you fear you may have it.

12. If you’ve just given birth, your vagina may be recovering

Wondering why does sex hurt after just giving birth? FYI, giving birth is a beautiful and emotional thing – but also an emotional and physical challenge, too, and you’ll need to take time to recover afterwards. “Childbirth is a formative experience for any woman, and for some it can be traumatic,” says Dr Becky Spelman, psychologist and We-Vibe‘s relationship expert. “Insensitive care practitioners or a difficult or dangerous birth can give rise to a heightened fear of birth, pregnancy, and even sexuality itself. Women who have experienced a traumatic birth often struggle to re-engage with their sexual selves, even when they have recovered physically, and can experience pain with no obvious physical cause,” she explains.

So why exactly is sex painful after giving birth? A number of reasons, from bruising to the vaginal wall is a common reason, explains Downes. “You may also have experienced a tear which will need time to heal completely before you have sex again – doctors recommend at least six weeks but it often takes longer,” she shares.

Why is sex painful? Woman with Legs Raised wearing white shorts lying on bed

13. Your relationship might be under strain

Arguing a lot or working through a stressful patch in your relationship? Ill feeling can actually totally cause painful sex, FYI – it’s a vicious cycle.

“Experiencing emotional pain as a result of conflict within your relationship could lead to painful sex,” says Evans. “Many couples go through an emotional disconnect if one of them is unable to have sex, which in turn can increase the pain levels, thus creating a vicious circle.”

Try this: The sexpert advises that consulting a couples’ counsellor or sex therapist may help – and remember, you are not alone.

14. You could have a hidden health condition

Often painful sex is a sign of a more unusual, difficult to diagnose health issue, explains Evans. Some of the lesser known conditions that could be causing you discomfort during sex include:

  • Lichen Schlerosus – a common condition generally affecting postmenopausal women thought to be linked to an overactive immune system.
  • Vestibulodynia – a condition that makes you feel a burning pain thought to affect 12-15% of women.
  • Vulvodynia – spontaneous burning without an itching sensation.

If you’re worried you have any of the above, do see a doctor.

Is painful sex normal?

Now you’ve read the expert answer to why does sex hurt, we’re sure you’re keen to know if pain during intercourse is actually common. Short answer: yes, but it’s important to see your doctor if sex is painful repeatedly. “It can stop you from enjoying sex or lead to you avoiding sex altogether,” shares Datta – which is not good.

“This can be isolating, affect your mood and cause distress,” she shares. “It could also cause problems in your relationship over time. You may be referred to see a Gynaecologist and we may need to examine and exclude both physical and psychological problems.

Bottom line: pain during sex can be down to a number of different causes. “That’s why sometimes a multi-disciplinary approach is needed to reach an adequate diagnosis and to offer appropriate support,” explains Corda. “This may include psychologists, urologists, gynaecologists, and even dermatologists.”

They’ll be able to allow you to explore the various issues affecting your ability to have or enjoy sex, and your relationship with your partner.

Complete Article ↪HERE↩!

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The Porn Crisis That Isn’t

Some states now consider pornography to be a health threat. But stigmatizing porn can do more harm than good.

By Olga Khazan

If you ask some people, America is in the middle of a public-health crisis. No, not that one.

Legislators in 16 states have passed resolutions declaring that pornography, in its ubiquity, constitutes a public-health crisis. The wave of bills started five years ago, with Utah, which went a step further this spring by passing a law mandating that all cellphones and tablets sold in the state block access to pornography by default. (The measure will not go into effect unless five other states pass similar laws, but that’s very possible: Alabama is now considering a similar bill.)

Groups such as the National Center on Sexual Exploitation, an anti-obscenity nonprofit that produced model legislation for the porn-blocking bill and the public-health-crisis bills, argue that pornography increases problematic sexual activity among teens, normalizes violence against women, contributes to sex trafficking, causes problems in intimate relationships, and is “potentially biologically addictive.”

NCOSE seems to have pushed Utah state Senator Todd Weiler to support the public-health-crisis legislation in 2016. “They told me, ‘If you can pass this, we can get this passed in 15 more states. We just need one legislator to stick his neck out,’” Weiler told Governing magazine in 2019. Arizona state Representative Michelle Udall told me that she introduced her state’s public-health-crisis bill in 2019 after hearing from constituents involved with the anti-porn group Fight the New Drug, and that NCOSE gave her a booklet with data and studies on porn. She read that the average age at which children are being exposed to pornography is 11, and she had an 11-year-old at the time. She wanted the resolution “to improve awareness of the issue, especially as we talk about children and their exposure,” she told me.

Content filters that block kids from accessing porn have broad support among public-health experts. But, these same experts say, porn is not a public-health crisis. Though the state-level measures don’t do much beyond “calling for” research and policy changes, they run the risk of stigmatizing adults who watch porn.

Several public-health experts told me they worry that the measures are creating more problems than they solve, by telling people that a small but regular part of their sex life is actually a “crisis.” This stigma will likely disproportionately affect people who already feel ashamed about the porn they watch, but leave relatively unruffled those who embrace porn—even in its most exploitative forms.

That sense of crisis can spur some people who disapprove of porn to commit violence. The man who killed eight people at several spas in Atlanta in March plotted further “similar acts” against “the porn industry,” police said. In April, a mansion owned by the executive of Pornhub, one of the most popular porn sites, burned down in an apparent act of arson.

Whether porn is actually harming the health of adults who watch it is frustratingly hard to determine. Most studies of porn raise questions of correlation and causation: Is someone depressed and lonely because they watch too much porn? Or are depressed, lonely people drawn to porn?

Public-health experts worry that teens, in particular, incorrectly see porn as an instruction guide for having sex. For that reason, researchers, policy makers, and porn stars alike support limiting kids’ access to porn. The best way to do that, and to contextualize whatever they do happen to see, is through a combination of content filters, comprehensive sex education, and conversations about how porn isn’t a realistic view of sex. “You need to instill in your child their own personal brain filters,” Emily Rothman, a health-sciences professor at Boston University, told me.

Porn can be bad for adults too. A small number of adults—roughly 11 percent of men and 3 percent of women—consider themselves somewhat addicted to porn, even though a number of scientists dispute whether “addiction” is an appropriate label for watching lots of porn. Believing that porn is morally “bad” is strongly correlated with feeling like you have an addiction to pornography, regardless of how much porn you actually watch. “The best predictor of self-perceived sexual-use problems, like pornography addiction, is high levels of religiosity,” says Bryant Paul, a media professor at Indiana University and a faculty affiliate of the Kinsey Institute, which studies human sexuality. “It’s a better predictor than actual amounts of use.”

Even setting addiction aside, porn might pose other problems. Some studies have found that watching porn reduces sexual satisfaction, especially for men who watch porn more than once a month. Watching porn is associated with increased aggression in some people, although not in the majority of porn users.

But other studies have found that watching porn can be part of a healthy sex life, especially for sexual minorities, women, and couples. In one study, Taylor Kohut, a psychologist at Western University, in Ontario, found that couples who watched porn together “reported more open sexual communication and greater closeness than those that did not.” Another of his studies found that most partnered people think porn has had “no negative effects” on their relationship, and many also thought that watching porn improved their sexual communication, sexual experimentation, and sexual comfort. “There’s a lot of evidence to suggest that couples that watch porn together, it can improve their sex lives,” says Paul, who wasn’t involved in those studies. If the United States is in a sex recession, pornography could help Americans get back in the black.

Porn might also be helpful for individuals whose sexuality has not always been widely accepted. For LGBTQ people living in conservative areas, watching pornography might be the only sexual experience they’re able to access. One study found that for women, watching porn “was associated with their own and their partner’s higher sexual desire and with higher odds of partnered sexual activity.” In a recent paper arguing that pornography does not qualify as a public-health crisis, Rothman and a colleague write, “For some, pornography use is associated with health-promoting behaviors, including increased intimacy, ‘safer’ sexual behaviors (e.g., solo masturbation), and feelings of acceptance.”

Anti-pornography groups dismiss all of these findings. They say that the porn-positive studies are outliers in a sea of research showing porn’s detrimental effects on relationships.

But here’s the thing: Kohut has observed that in relationships, what seems to matter is that partners have similar opinions about porn. If you both like porn, he suggests, watching it will probably be fine for your sex life. Some couples might even find that they can build intimacy by showing porn to each other, as a way to tell each other what you like. But if only one of you watches porn, and the other hates it, you might encounter relationship tensions like those of couples who fight over marble countertops or in-laws or baby names. The secret to a happy relationship that includes porn, in Kohut’s view, is to find someone who likes it the same amount as you do.

A recent Atlantic/Leger poll of 1,002 Americans largely supported this acceptance of porn. We presented participants with a list of questions about porn, and many of them yawned and said, “So what?” Most Americans have watched porn, according to the poll. But most spend less than 20 minutes a week watching it, and 79 percent of those who watch porn said they don’t feel addicted to it (17 percent of respondents who had watched porn in the past year said they had ever felt like they were addicted to pornography). Only 6 percent of people said they’d begun watching porn when they were younger than 12. Most said that watching porn had no effect on them or their relationships, and 79 percent of those with children said they didn’t struggle to control their children’s access to porn. And just like public-health experts, most respondents—53 percent—said they didn’t think porn was a public-health crisis. Only 25 percent said it was.

Porn makes for an easy target. But legislators focused on labeling it as a public-health crisis should consider what problems they are actually trying to solve. Many researchers and adult-entertainment workers support measures that would reduce kids’ access to porn, ensure that porn videos portray only consenting adults, and mandate fair wages for sex workers. Calling adults’ legal use of pornography a “public-health crisis” doesn’t do any of that.

Complete Article ↪HERE↩!

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Sex Is Different When You’re a Highly Sensitive Person

— Here’s How

by Sarah Lempa

For starters, even feather-light touch hits differently when you’re a highly sensitive person (HSP).

Powerful physical sensations, plus a need for deep concentration and actual connection, are often hallmarks of intimacy for HSPs.

Here’s the deal: An HSP’s nervous system processes external stimuli much deeper than others.

Scientifically named sensory processing sensitivity (SPS), it’s a completely normal genetic trait brought to light by clinical psychologist Elaine Aron in the ‘90s.

Personally, I like to say it turns up the volume of life: emotions, physical touch, sense of smell, you name it.

And, yeah, it sounds fancy and all, but we’re really not uncommon. According to Aron, HSPs make up about 15 to 20 percent of the world’s population.

Of course, high sensitivity isn’t a sole determinant of one’s sexual experiences.

The HSP experience varies so much from person to person, and it’s often dependent on a number of different factors.

These takeaways are based on my own experiences as an HSP.

Trust is a big deal, and having an actual connection is integral. I can’t speak for every sensitive soul out there, but I need to feel both physical and mental attraction to really get into intimacy.

Without it, sex feels incredibly pointless — more like some bizarre type of disconnected, yet mutual, masturbation than an experience of embodied pleasure. Hard pass.

After some trial and error, I finally figured this out in my mid-twenties. Now, I’m just not down to be with anyone I don’t feel a connection with.

And, for that exact reason, I highly recommend keeping a vibrator (or two, or three, or, ya know, seven) nearby until someone you truly fancy saunters into your life.

We might get irrationally bothered over a scratchy clothing tag, but it’s made up for by the undulating waves of pleasure that douse our bodies during intimacy (when we’re with the right people — who can be hard to find).

“The heightened nervous system rewards HSPs with extremely powerful orgasms,” explains Megan Harrison, a licensed marriage and family therapist and the founder of Couples Candy.

“Particularly when slower and drawn-out sexual movements are made around erogenous zones with many nerve endings.”

Our physical pleasure is all in the details. So, that’s a resounding yes to starting slow, subtle, and with consent, as always. Delicate yet deliberate; I can’t think of a more winning combination.

The best sex, to us, is built up over time and ideally has a sprinkle of mystery. That’s not to say there isn’t room for daring adventures — it just takes the right combination and lead up.

Even outside the bedroom, HSP sexuality can be one hell of a force. Our inner worlds can whisk us to faraway places, sometimes delving into deliciously indulgent memories or fantasies for the future.

And, honestly, at this point I’m having a hard time concentrating on writing this section.

Deep pleasure takes a lot of concentration for us. Sometimes, little things can throw off our sensual groove, putting us into a fog of “now I’m not really feeling it.”

“HSPs can move from deeply engaged to disconnected at a moment’s notice,” Harrison explains. “A single rough touch or distracting noise can totally ruin the experience.”

A self-identified HSP, Harrison adds, “we’re so aware of external stimuli and emotions that managing the personal experience can become difficult with interruptions.”

RIP to that one brewing orgasm ruined by my partner’s dog jumping on the foot of the bed.

Lesson learned: Never underestimate the power of a really good sex playlist to minimize background distractions.

The HSP tendency to overthink is rife. Sex is no exception. Even in the most, uh, engaging situations.

Not only are we analyzing every fiber of our own sensations, we’re simultaneously trying to imagine how it’s all going from our partner’s perspective.

Emily Stone, PhD, LMFT, the founder and senior clinician at The Unstuck Group, knows it well. Stone says that HSPs sometimes have a “tendency to endure” in their relationships.

It’s not uncommon for us to neglect our own needs because we’re more so thinking about our partner’s experience, which can lead to getting lost in a sexual sea of thought.

When it all lines up right though, Stone says “an HSP’s gifts can bring delight, passion, and depth to the sexual experience in ways that no one else can.” Damn straight.

A good orgasm can send us into a buzzy haze of indulgence, and we might just devolve into a complete blob afterwards.

In “The Highly Sensitive Person in Love,” Aron explains that HSP folks might “find it difficult to go right back to normal life after sex.”

That’s because we’ve just gone through massive amounts of stimulation, and it’s probably all we’ll think about for at least the next hour or so.

That project you were working on? Yeah, probs not gonna happen anymore.

Open dialogue really is the golden ticket here, and it’s a two-way street.

While it’s taken me time to learn how to speak up about what I like and don’t like in the sheets, that assertion has helped my relationships greatly. It’s something we can all benefit from, regardless of where one falls on the sensitivity scale.

According to Shari Botwin, LCSW, a licensed therapist who’s worked with many HSPs, “non-HSPs need to be open to understanding their partner’s experience.”

“They need to be open to listening and communicating feelings before, during, and after intimacy,” she says.

You heard her: Don’t be shy.

The same goes for HSPs. It’s our responsibility to tell our partners what’s working and what isn’t — without worrying about upsetting them. Again, assert yourself. Your desires are worth it.

High sensitivity is a unique gift, and I’ll always see it that way.

It may take some extra self-discovery and communication to ensure your sexual needs are met. But, hey, what would any sex be without those two things? Nowhere near as good, that’s for sure.

Complete Article ↪HERE↩!

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How to talk to your doctor about sex and cancer

Sexual health is important for every adult — Here are tips for starting the conversation

By Sara Thompson

Sexual health is important for any adult’s well-being, but patients with cancer face a new set of challenges when it comes to sexuality. Laila S. Agrawal, M.D., breast cancer oncologist with Norton Cancer Institute, is spearheading efforts to develop a sexual health clinic at Norton Healthcare.

“The World Health Organization says that sexual health is fundamental to the overall health and well-being of individuals, couples and families, and that this is relevant throughout the individual’s lifespan, not only in reproductive years,” she said.

Cancer’s effects on sexual health

“When we are thinking about sexual health and sexual dysfunction, we look at the big picture,” Dr. Agrawal said. “So many domains affect the body’s sexual function. From hormonal changes, loss of sensation and mastectomies, to changes in body image and low libido, cancer patients face myriad symptoms and experiences.”

Sexual health is the third most common concern for cancer survivors, and issues are associated with poor quality of life and mood disorders. Yet, many doctors are reluctant to bring up the subject, or the cancer diagnosis takes precedence over every other aspect of the patient’s life.

“Sexual health issues caused by cancer and treatments do not magically disappear on their own,” Dr. Agrawal said. “The more I talked to my patients about this, the more I learned. This is a medical issue we need to address.”

How to talk to your doctor

Ask about sexual health and acknowledge its importance.

Despite being such a prevalent and important issue, it often is not discussed with physicians.

In a 2020 survey of over 400 cancer patients (most of them female), 87% of patients said cancer treatment impacted sexual function and/or desire, including pain with sex, body image distortion and the inability to achieve orgasm. Only 28% had been asked by a medical provider about sexual health, and female patients were less likely to be asked than male patients.

It’s normal to feel anxious about bringing up sex, sexual health and sexual function with your medical team. Your health care professionals care about you and your quality of life. They can help you or refer you to another professional who can.

Here are some ways to talk to your doctor about sexual health:

  • Prepare a statement for your doctor before your visit. It could be, “I have concerns about my sexual health,” or “I have symptoms I’d like to talk about.”
  • Be specific. For example, you can mention your level of interest in sex, or say if you have vaginal dryness or pain with sex.
  • Use resources. Magazine articles, stories from friends with similar issues or other related items can get the conversation going.

Self-reporting checklists

A number of checklists have been developed for use in cancer clinics. You can use these to self-assess and begin a conversation with your doctor. These are short surveys, typically beginning with a general question such as “Are you satisfied with your sexual function?”

What you can do right now

  • If you are having any sort of sexual issues related to your health conditions or treatments, make an appointment with your doctor. Use the tips above to start the conversation.
  • Communication is key, not just with your doctor, but your partner as well. Ask for what you need and share your feelings. Your partner may not be aware of changes you are experiencing.
  • Get creative with intimacy. Sex isn’t the only way to be close. Explore new ways to create intimacy with your partner.

Complete Article ↪HERE↩!

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What Are Sperm Telling Us?

Scientists are concerned by falling sperm counts and declining egg quality. Endocrine-disrupting chemicals may be the problem.

By Nicholas Kristof

Something alarming is happening between our legs.

Sperm counts have been dropping; infant boys are developing more genital abnormalities; more girls are experiencing early puberty; and adult women appear to be suffering declining egg quality and more miscarriages.

It’s not just humans. Scientists report genital anomalies in a range of species, including unusually small penises in alligators, otters and minks. In some areas, significant numbers of fish, frogs and turtles have exhibited both male and female organs.

Four years ago, a leading scholar of reproductive health, Shanna H. Swan, calculated that from 1973 to 2011, the sperm count of average men in Western countries had fallen by 59 percent. Inevitably, there were headlines about “Spermageddon” and the risk that humans would disappear, but then we moved on to chase other shiny objects.

Now Swan, an epidemiologist at Mount Sinai Medical Center in New York, has written a book, “Count Down,” that will be published on Tuesday and sounds a warning bell. Her subtitle is blunt: “How our modern world is threatening sperm counts, altering male and female reproductive development, and imperiling the future of the human race.”

Swan and other experts say the problem is a class of chemicals called endocrine disruptors, which mimic the body’s hormones and thus fool our cells. This is a particular problem for fetuses as they sexually differentiate early in pregnancy. Endocrine disruptors can wreak reproductive havoc.

These endocrine disruptors are everywhere: plastics, shampoos, cosmetics, cushions, pesticides, canned foods and A.T.M. receipts. They often aren’t on labels and can be difficult to avoid.

“In some ways, the sperm-count decline is akin to where global warming was 40 years ago,” Swan writes. “The climate crisis has been accepted — at least by most people — as a real threat. My hope is that the same will happen with the reproductive turmoil that’s upon us.”

Chemical companies are as reckless as tobacco companies were a generation ago, or as opioid manufacturers were a decade ago. They lobby against even safety testing of endocrine disruptors, so that we have little idea if products we use each day are damaging our bodies or our children. We’re all guinea pigs.

Aside from the decline in sperm counts, growing numbers of sperm appear defective — there’s a boom in two-headed sperm — while others loll aimlessly in circles, rather than furiously swimming in pursuit of an egg. And infants who have had greater exposures to a kind of endocrine disruptor called phthalates have smaller penises, Swan found.

Uncertainty remains, research sometimes conflicts and biological pathways aren’t always clear. There are competing theories about whether the sperm count decline is real and what might cause it and about why girls appear to be reaching puberty earlier, and it’s sometimes unclear whether an increase in male genital abnormalities reflects actual rising numbers or just better reporting.

Still, the Endocrine Society, the Pediatric Endocrine Society, the President’s Cancer Panel and the World Health Organization have all warned about endocrine disruptors, and Europe and Canada have moved to regulate them. But in the United States, Congress and the Trump administration seemed to listen more to industry lobbyists than to independent scientists.

Patricia Ann Hunt, a reproductive geneticist at Washington State University, has conducted experiments on mice showing that the impact of endocrine disruptors is cumulative, generation after generation. When infant mice were exposed for just a few days to endocrine disrupting chemicals, their testes as adults produced fewer sperm, and this incapacity was transmitted to their offspring. While findings from animal studies can’t necessarily be extended to humans, after three generations of these exposures, one-fifth of the male mice were infertile.

“I find this particularly troubling,” Professor Hunt told me. “From the standpoint of human exposures, you could argue we are hitting the third generation just about now.”

What if anything does all this mean for the future of humanity?

“I do not see humans becoming extinct, but I do see family lines ending for a subset of people who are infertile,” Andrea Gore, a professor of neuroendocrinology at the University of Texas at Austin, told me. “People with impaired sperm or egg quality cannot exercise their right to choose to have a child. That may not devastate our species, but it is certainly devastating to these infertile couples.”

More research is necessary, and government regulation and corporate responsibility are crucial to manage risks, but Swan offers practical suggestions for daily life for those with the resources. Store food in glass containers, not plastic. Above all, don’t microwave foods in plastic or with plastic wrap on top. Avoid pesticides. Buy organic produce if possible. Avoid tobacco or marijuana. Use a cotton or linen shower curtain, not one made of vinyl. Don’t use air fresheners. Prevent dust buildup. Vet consumer products you use with an online guide like that of the Environmental Working Group.

Many issues in headlines today won’t much matter in a decade, let alone in a century. Climate change is one exception, and another may be the risks to our capacity to reproduce.

The epitome of a “low blow” is a kick to the crotch. And that, friends, may be what we as a species are doing to ourselves.

Complete Article ↪HERE↩!

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Some penis microbes may increase the risk of vaginal infections after penetrative sex

By Julia Naftulin

  • A new study found that 10 types of bacteria found on men’s penises were predictors in whether their female partners developed bacterial vaginosis.
  • Bacterial vaginosis is a vaginal infection that affects 1 in 3 women. Experts are unsure what exactly causes bacterial vaginosis.
  • The researchers said that their study suggests men’s sexual health and women’s are inextricably linked, and that heterosexual couples should work together to promote each other’s sexual wellbeing.

Women may have a higher risk of vaginal bacterial infection after penetrative sex with men, depending on the type of microbiota on their partner’s penis, a study has found.

Bacterial vaginosis is a type of vaginal bacterial infection that affects 1 in 3 women, but, according to the CDC, health experts are still unsure what causes it.

For the study, University of Illinois at Chicago researchers looked at 168 heterosexual couples in Kenya over a year. Just over half (56%) of the men they studied had circumcised penises, and circumcision status can affect the amount and types of bacteria on a penis.

None of the women had bacterial vaginosis at the start of the study. The researchers found that 31% of the women in the study developed bacterial vaginosis during the year-long trial.

In addition to testing the bacteria in the women’s vaginas, they also examined each man’s penile microbiota during the initial screening and three follow-up appointments.

The researchers concluded that the men were a defining factor in the women’s risk of infection. They identified 10 species of penile bacteria that appeared to increase a woman’s risk of BV. The men who carried on their penis one or more of the 10 species, his female partner was more likely to develop bacterial vaginosis.

Men should be involved in women’s reproductive health

The study’s findings don’t mean a man’s penis causes bacterial vaginosis in women, according to Dr. Supriya Mehta, lead study author and an epidemiologist at University of Illinois at Chicago.

But his team’s findings suggest male and female sexual health are inextricably linked, especially for heterosexual couples.

“I would like for clinicians, researchers, and the public to be inclusive of male sex partners in their efforts to improve women’s reproductive health,” Mehta said in a statement. “Not to place directionality or blame on one partner or another, but to increase the options and opportunity for improved reproductive health, and hopefully reduce stigma from BV.”

There were caveats to this study. Only 46% of the 168 couples attended all four doctor’s office visits during the year-long trial, so the researchers have incomplete data for some couples, which could cause skewed results. Additionally, the researchers looked at a small sample of only Kenyan couples who were heterosexual, so the results may not be applicable on a universal scale, across countries, cultures, and sexualities.

Mehta said more research should be done to determine how men can look after their own genital health to protect the genital health of women with whom they’re sexually active.

Complete Article ↪HERE↩!

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You’ve Survived Cancer

— Now What About Dating?

Don’t let body image concerns and emotional changes stop you from seeking love

by Susan Moeller

Six years ago, Deanna Savage had breast cancer, followed by a double mastectomy and reconstruction. After more than a year of surgeries and treatment, she returned to online dating.

But her body felt different than in past years of dating: She had new “pucks and dents” in places and lost sensitivity in some areas. And she had something extra accompanying her on dates: her cancer diagnosis.

“I either mentioned it right away or I didn’t mention it for a while,” says Savage, 52, who works for a wine distributor in Milwaukee and founded a nonprofit breast cancer support organization, Savage Support. “Both ways scare people off because everyone has their own relationship or even explanation of what cancer is.… And so they projected that onto me.”

Cancer and its treatments affect not only the look of patients’ bodies but also sensation, mechanics and stamina, says experts like Savage, who is also a mentor with ABCD, or After Breast Cancer Diagnosis, a Milwaukee one-on-one mentoring organization. Yet companionship, romance and intimacy foster healing, says Yanette Tactuk, a licensed clinical social worker with Memorial Sloan Kettering Cancer Center in New York City.

Resources for Dating After Cancer

Here are some places that help with navigating dating and sex in the face of a cancer diagnosis.

• Check with your local cancer center. Many now have survivorship clinics that address issues of wellness and lifestyle, including relationships and sexuality.

• Ask your health care provider or chapter of the American Cancer Society about in-person or online support groups.

• Look for peer mentoring programs at cancer centers or organizations such as ABCD (After Breast Cancer Diagnosis) to connect you one-on-one with someone who has had a similar experience.

• Consider reputable online sources such as Cancer.net, sponsored by the American Society of Clinical Oncologists, which has information on dating and sexuality.

• Find a therapist or certified sex educator. The American Association of Sexuality Educators, Counselors and Therapists has a searchable online directory.

“It’s important to feel comfortable and confident, regardless of where you are in your treatment process and regardless of your relationship status,” Tactuk says. “The advantages of finding ways to love and accept oneself and to connect with others are physical, psychological, emotional and relational.”

Dating after cancer

If you’re ready to start dating, begin by thinking about why, says Jeffrey Gaudet, a licensed clinical social worker in Mashpee, Massachusetts, who has led cancer survivorship programs. Dating could include physical intimacy or not, he says.

“Understand your body, but also understand where you’re coming from emotionally,” he says. “Someone might be looking for a fully developed relationship that might lead to marriage, or they might be saying, ‘Hey, you know what, I just need someone to be with me.’”

Consider issues you’ve had with dating in the past, he says, such as how you communicate or feelings about your body. If you are ready for intimacy, don’t be shy about gathering information on how to make it work. As cancer patients live longer, more resources are available to improve the quality of their lives, including sexually. Don’t worry that you’re the only one who has a body that’s not looking or working quite as it used to.

“This is a really common experience,” says Don Dizon, M.D., professor of medicine at Brown University and founder of the Sexual Health First Responders Program in Providence, Rhode Island. “If you look at survey data, those who report some degree of sexual compromise is anywhere between 50 and 90 percent.”

Physicians and patients rarely discuss relationships or sex because cancer checkups are so focused on survival or treatment plans, Dizon says. Patients may be too distracted or embarrassed to ask questions, or think they are alone in having issues. A survey by the health organization Livestrong found that fewer than half of patients bring up these issues, he says.

“It’s really not until people leave that room that they start thinking, Boy, I really wanted to ask those other questions,” Dizon says. “We, as clinicians, assume things that are important will be brought to our attention by patients themselves, [but] when it comes to sexual health, that’s not going to happen.”

Discussing cancer and sexuality

For starters, he says, understand who you are as a sexual being. What’s your perspective on dating and sex? How do you respond to relationship cues? Are you able to communicate with a partner? Are you one to jump right into a relationship or expose your inner life slowly?

And be flexible about what intimacy might look like, Dizon says.

“What we’re learning is that couples can … find their own ways to experience pleasure and experience satisfaction,” he says.

Ellen Barnard, a social worker and certified sex educator who co-owns; A Woman’s Touch in Madison, Wisconsin, a sex education resource center and sexual health products shop, describes herself as a “problem solver.” One reason she and co-owner Myrtle Wilhite, M.D., started the shop 25 years ago was to help breast cancer patients find ways to improve sexual response without hormone replacement therapy.

Their website has a downloadable resource sheet on “Healthy Sexuality After Cancer,” as well as a place to submit questions. These days, Barnard and Wilhite work with customers with all kinds of cancers and also train health care providers.

“There’s plenty that can be done.… Nobody needs to lose their enjoyment of sexual pleasure,” Barnard says.

And remember, it’s unlikely that anyone over 50 will have a body that works perfectly.

“The most important thing that I try to instill in people is not to see themselves as ‘damaged,’” Dizon says. “Getting older comes with its own complications, but cancer’s not the only complication people will be bringing to the table.”

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Trans people deserve healthy, happy sex lives – and that starts with better health care

By Rory Finn

Understanding my body in a sexual way has been something that’s taken time.

I am a transgender man who identifies as queer, and since I began my transition more than 12 years ago, I found I didn’t fit into the boxes outlined in mainstream sexual health information – if I was able to find that sort of information at all.

Anything targeted towards the kind of sex I was having didn’t include people with bodies and identities like mine, and I ended up having to look at sexual health articles published in women’s magazines to try and filter out what information would be useful for me and what was not.

This has been especially unhelpful being who I am now: a man who has sex with men.

I never really noticed just how much of an issue this was until a few years ago, when I started exploring my sexuality and the fetish community. I started to take increased risks with my sexual health, so was going to clinics more often and realised the lack of knowledge and information some clinicians have about trans people and our bodies.

I had a persistent fear that clinicians would regard me as ‘too difficult’ and I feared the inappropriate questions some asked me – others didn’t ask enough. The experience felt unsafe and eventually deterred me from going, hoping I could find any answers I needed through Google instead.

In fact, the first time I contracted an STI I was in denial; I didn’t even know what an STI symptom would look like on a body like mine and I hoped it would clear up by itself. When I was prescribed medication, I didn’t take it straight away.

The continued lack of knowledge and resources around transgender sexual health made me feel like I didn’t matter, that my body was an oddity and that I didn’t deserve good health – all on top of the stigma of having an STI.

And according to a survey by sexual health charity Terrence Higgins Trust, more than half (52%) of trans, non-binary and gender diverse people who responded said they didn’t feel fully in control of their sex life, with more than 70% saying that feelings of negativity and low mood or depression was a factor in this.

Once while I was travelling in Spain, I caught an infection that I believed to be an STI. I spent most of my time at the clinic explaining that I was a trans man, rather than discussing my medical concerns. I was eventually given some sort of prescription and sent on my way.

Trans people should not have to rely on Google searches and outdated sexual health resources – we should be afforded the same information and representation that cisgender people have

This was distressing; I was alone in a foreign country and I didn’t know what was wrong with me. But I was grateful not to have had to undergo an intimate examination.

Luckily, back in England I was able to go to a clinic specifically for trans people – Clinic T – and find out what medication the doctor gave me and why, which was really reassuring.

I knew about the clinic as I had been living in Brighton, where it is well known within the trans community as they do a lot of outreach at events like Trans Pride. But being in an LGBTQ+ friendly city with trans-inclusive services put me at an advantage. Unfortunately, it isn’t always like that, and I’ve still been in situations with a clinician not as trans aware as they could be.

I’m used to being the ‘expert patient’ who knows more about my healthcare than the person who’s supposed to be caring for me.

Then you have the professionals who, the minute they hear the word ‘trans’, automatically view you as a curiosity. Sometimes you are viewed as ‘high risk’ merely because your identity has changed on paper, rather than your behaviour in the bedroom. I regularly experienced this when I started my transition, and it made me feel more like a number in a database than a human being.

This seems to be an ever-present experience for trans people. It’s like, if we don’t fit into society’s strict gender categories, then we fall through the gaps and it makes accessing healthcare feel impossible.

Frustratingly, it could all easily be avoided if healthcare professionals actively built up their knowledge on trans bodies. Trans-awareness training would be helpful, or peer-to-peer learning and reading up on trans health from the ever-increasing body of research on trans medical issues.

Navigating the world as a trans person can be extremely challenging, but it’s even more difficult without valid sexual health information. It can make us feel like we don’t deserve to be seen or celebrated as authentic sexual beings. This is reinforced by the poor representation, such as overly sexualised porn or predatory tropes.

Trans people should not have to rely on Google searches and outdated sexual health resources – we should be afforded the same information and representation that cisgender people have.

This is why I decided to feature in and co-write the Terrence Higgins Trust trans-specific sexual health resource. It is led by and celebrates us as trans, non-binary and gender diverse people.

The new webpages and leaflet are directed to our specific needs and provide up-to-date information and advice on everything from HIV to contraception. They include the impact of hormones and surgery, considerations when taking HIV-prevention pill PrEP, and how to navigate happy, healthy sex.

It feels empowering to be able to do something proactive about something I care so deeply about. I want trans people to have good sex, good health and a healthcare system with as few barriers as possible.

All trans and non-binary people’s bodies should be celebrated, just like everyone else. We have sex too, and we’re deserving of enjoyable and healthy sex lives.

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Could Probiotics Improve Your Sex Life?

Unpacking the Gut-Sex Connection

by Gabrielle Kassel

What’s the short answer?

Yes. Yes, probiotics have the potential to improve a person’s sex life.

Whether or not they have the potential to improve your sex life, however, depends on your current gut health and your sex life.

When we talk about gut health, we’re typically talking about the composition of the billions of bacteria, archaea, and fungi inside the gut.

This is known as the microbiome, and it affects all sorts of things that contribute to your interest in sex and overall sexual satisfaction.

Mood

Did you know that the majority (about 95 percent!) of serotonin — the happiness hormone — in the body is produced in the gut? Yep!

But for the optimal amount of serotonin to be produced, the gut has to be in tip-top shape. When the gut is in suboptimal health, your serotonin — and overall happiness — levels can dip.

And according to Dr. Anna Cabeca, triple-board certified OB-GYN and author of “The Hormone Fix”: “Low serotonin is associated with lower sex drives.”

Makes sense. Few of us are jonesing to do anything in the sack other than sleep when we’re sad.

Energy

Belly bacteria helps create B vitamins, which are essential for the production of ATP (science-talk for energy). Less B vitamins = less energy.

Plus, some of the bacteria communicate with other cells in charge of blood sugar regulation, says Anthony Thomas, PhD, nutrition researcher and director of scientific affairs with probiotic brand Jarrow Formulas.

If your gut bacteria gets out of whack, your blood sugar levels can crash more easily. This can lead to more — and longer lasting — energy dips.

So, that “too tired for sex” feeling? Well, it might be linked to your gut health in more ways than one.

Desire and arousal

Fun fact: Serotonin is found in the genitals. Seriously!

Some research suggests that when your serotonin levels dip, your physical response to sexual feelings dips, too.

Inflammation

“When our gut microbiome is unhealthy, it can lead to inflammation,” says Dr. William W. Li, a physician, scientist, and author of “Eat to Beat Disease: The New Science of How Your Body Can Heal Itself.”

Sadly, inflammation is quite the c*ck-block.

For example, some research has found that sexual health dysfunction is common among folks with inflammatory arthritis.

Let’s face it: It’s pretty damn hard to be in the mood to bone when you can’t leave the bathroom.

And there are certain gut conditions that cause bathroom troubles to rear their ugly heads. These include:

  • irritable bowel syndrome (IBS)
  • inflammatory bowel disease (IBD)
  • microscopic colitis
  • ulcerative colitis
  • celiac disease
  • Crohn’s disease

In addition to constipation and diarrhea, other common symptoms include:

  • nausea
  • vomiting
  • bloating
  • flatulence
  • fatigue
  • pain

Both the physical and emotional effects of these and other gastrointestinal (GI) conditions have the potential to affect your sex life.

The keyword here is potential.

If you’ve already received a diagnosis or suspect that your symptoms might be a sign of a GI condition, talk with a doctor or other healthcare provider about your concerns.

They can help you find the best management or treatment option for your individual symptoms or side effects.

By now you can probably tell that your microbiome is complicated. Well, so is your libido.

“Libido in general is very complicated and is impacted by many different things,” says Cabeca. “Hormones, lifestyle, and relational factors also have to be considered.”

So finding out if your libido fluctuations are related to your microbiome is similarly tricky. And no matter how well-intentioned, gut health mishaps can have a direct effect on your overall health.

Li recommends meeting a gastroenterologist, the medical specialist that focuses on the gut, if you’re experiencing any of the below symptoms:

  • brain fog
  • achy joints
  • diarrhea
  • constipation
  • shifts in mood
  • exhaustion
  • sleep disruption
  • sugar cravings
  • weight fluctuations

Note: That recommendation stands even if your libido isn’t funked up.

“A gastroenterologist will be able to recommend an endoscopy, colonoscopy, or a scan of your abdomen to find out what’s up,” explains Li.

“They also may be able to check your microbiome for abnormalities by sending a stool sample for testing,” he adds.

Please don’t self-diagnose your gut symptoms or libido mishaps. Why? Well, because they’re both incredibly complex.

Dr. Kimberly Langdon, OB-GYN and medical advisor at telehealth provider Medzino, notes that mental health conditions like depression are often linked with low libido.

In these cases, for example, trying to course correct at home without talking to a healthcare provider may mean delaying access to helpful medications or other necessary treatment.

Many GI conditions are characterized by dysbiosis, which is medical speak for an imbalance of bacteria in your gut.

If your provider has diagnosed dysbiosis, Li says that probiotics — helpful yeasts and bacteria often delivered via certain foods and supplements — may help.

A word of caution: Not all probiotics are created equal.

As a general rule, probiotics that are stored in the refrigerator are higher quality than those stored on the shelf.

Cabeca adds that Lactobacillus strains are typically better than others.

Bacterial imbalance has been linkedTrusted Source to increased inflammation, so it’s thought that probiotics may help alleviate symptoms associated with IBS, IBD, and other inflammatory conditions.

Probiotics may also be helpful for acute digestive conditions like gas, bloating, constipation, and diarrhea.

All that said, even if everything above sounds similar to your situation, you shouldn’t start or increase your probiotic intake without first talking with a doctor or other healthcare provider.

There are two good reasons for this:

  1. Oftentimes, probiotics aren’t enough to completely soothe your symptoms.
  2. And in some cases, starting a supplement or otherwise upping your probiotic intake can do more harm than good.

For example, “if someone has small intestinal bowel overgrowth, adding probiotics can worsen gas and other symptoms,” explains Cabeca.

If you’ve ever been probiotic shopping, you’ve likely stumbled across probiotics marketed for vaginas — they’re all the rage, after all.

According to Langdon, these probiotics typically contain higher levels of Lactobacillus. Some research suggests that Lactobacillus helps support a healthy vaginal pH, as well as keep other pathogens at bay.

Now, if you scroll back up to the previous section, you’ll notice that Lactobacillus is the strain of bacteria that’s best for both improving overall gut health and supporting vaginal health.

That’s why Li says, “it’s just a marketing ploy.” These probiotics are no different than any other probiotics on the market.

So… do probiotics marketed for your genitals actually work? If you have a condition that can be remedied by consuming more Lactobacillus, they may.

But don’t be tricked into thinking these probiotics are a one-stop solution for sexual dysfunction or the only option available.

Yep! In fact, there are quite a few things you should consider using in tandem — or even instead of, in some cases.

That’s because (again, for the people in the back!) gut and sexual health conditions aren’t quick-fix problems.

Monitor meds

The meds and antibiotics you’re on or have been on can affect your gut microbiome, explains Thomas.

It’s also widely known that antidepressant, antipsychotic, anti-epileptic, blood pressure, and cholesterol lowering meds can all impact sexual functioning.

That’s why Thomas recommends making sure your doctor knows what meds you’re currently taking so they can help you troubleshoot if need be.

Diet switcheroo

For gut conditions, most experts will recommend a diet shift, at least for a short period of time.

Cabeca, for example, recommends folks follow a “healthy elimination diet to better understand what foods lead to their gut unrest.” She also recommends incorporating gut-healing foods like bone broth and fermented veggies.

Move more

Regular exercise has been linkedTrusted Source with higher serotonin levels.

Given serotonin’s relationship to both your gut and sex life, if you’re currently on the sedentary side of things, moving your body more may be helpful.

If you have a condition that can be helped with a probiotic, Cabeca says, “often, you can see a significant improvement of symptoms after 21 days.”

And that includes symptoms related to your sex life.

Thomas, however, notes that probiotics need to be taken regularly. “Benefits may ease if supplementation is discontinued,” he adds.

Probiotics aren’t a one-size-fits-all treatment for all folks experiencing gut conditions or sexual dysfunction. But for some, they can be an incredibly beneficial part of a holistic treatment plan.

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The Importance of Gender-Affirming Care for Closing the Gap on LGBTQ+ Health Disparities

By Elly Belle

In doctor’s offices across America, medical professionals often provide care based on the assumption that patients are cisgender and heterosexual. But LGBTQ+ patients—especially those who are trans, gender non-conforming, or nonbinary deserve better, and experts say improvements will only come when LGBTQ+ and gender-affirming health care becomes commonplace.

This type of care—which caters to the needs of these individuals without stigma or shame, and affirms patients’ sexuality and gender identity—is especially important given the significant health disparities the LGBTQ+ community faces, including increased risk for sexually transmitted infections (STIs) and HIV/AIDS, higher rates of mental health disorders, and an increased prevalence of houselessness and intimate partner violence.

While there are many factors that contribute to these disparities, a major one is that many LGBTQ+ folks avoid seeking medical care because they’ve experienced transphobia or homophobia in the past, or because they believe they’ll be discriminated against or don’t think they’ll receive adequate care because of provider ignorance. But the sooner affirming care becomes the standard, the less likely that is to happen.

What is gender-affirming care?

One of the first things Andrew Goodman, MD, does when he sees a patient is say his own pronouns to create a welcoming environment so patients know that their identity and needs matter. Practicing gender-affirming care is about, “not walking in with any assumptions, and understanding that knowing someone’s sex doesn’t mean you know things about their gender identity, who they have sex with, or the care they might need,” says Dr. Goodman, who is the medical director at Callen-Lorde, a health center for New York’s lesbian, gay, bisexual, and transgender communities. “It means that you ask and you’re open. It’s treating a patient like they are the expert of their own experience.”

Affirming care means that patients get the treatment they need for the bodies they have, not what the medical community presumes is appropriate based on the gender they were assigned at birth.

Some medical professionals presume that only women need pap smears, or that a man can’t get pregnant, but affirming care recognizes that certain services aren’t just for cisgender men and women and that trans men, nonbinary people, and intersex people are in need of reproductive care, too. It also acknowledges that patients’ sexual experiences might include people of all genders, and that hormone therapy, STI testing and treatment, contraception, and abortion are important health services for many people, regardless of sexual orientation, gender expression, or gender identity. In short: Affirming care means that patients get the treatment they need for the bodies they have, not what the medical community presumes is appropriate based on the gender they were assigned at birth.

Daria*, a nonbinary survivor of female genital mutilation (FGM), did not receive gender-affirming care when they sought help for FGM-related health care. “My heart dropped when I saw that all of the support information only mentioned women and girls. While they served people regardless of gender, the FGM department only seemed to cater to women and girls,” Daria says. “So in order to receive services, I signed up as a cis woman.” Despite the fact that they got some of the mental health care they needed, and were even offered a free gynecological exam to examine the physical effects of FGM, everything was in the context of womanhood. “Having gender-affirming health care means that as a nonbinary survivor of FGM I don’t have to compromise my gender identity in order to receive the help I need.”

Why education and advocacy are important

Bhavik Kumar, MD, MPH, the medical director of primary and trans care at Planned Parenthood Gulf Coast, explains that making a commitment to providing affirming care means educating and training staff to ensure “all the people involved in a patient’s health-care experience understand and value LGBTQ+ people.” For example, providers are taught to use neutral language and ask what body parts a patient’s sexual partners have, rather than asking if they’re sexually active with men or women. “We strive to make our health centers affirming spaces that are mindful of the indirect messages that can be so important to building trust and making our patients feel comfortable,” Dr. Kumar says.

It’s also important that patients of all ages receive this type of care, says Armonté Butler, the senior program manager of LGBTQ health and rights at Advocates for Youth, a nonprofit advocacy group dedicated to sexuality education and the prevention of HIV and sexually transmitted diseases. LGBTQ+ youth should learn from an early age that they deserve—and can receive—quality treatment, because it will help them feel comfortable seeking medical treatment later in life. Providers should also make it clear to all patients that they offer services like HIV testing and prevention, and they should be transparent about the way their practices handle insurance and confidentiality procedures. “It’s also crucial for health-care organizations to update their websites and social media to include imagery and resources for LGBTQ+ young people, including youth of color and youth living with HIV,” says Butler.

And it shouldn’t be the job of the patient to educate their health-care providers, either. “Finding affirmative and inclusive health care is like finding a needle in a haystack,” says Grey*, a nonbinary student who has received affirming care and also had negative experiences seeking health care. “Many doctors rely on their patients for education and that can cause more harm than healing,” Grey says.

At the bare minimum, providers should make sure they use inclusive language and visuals and that forms provide space for patients to list their names and pronouns. And it would be beneficial if they also offered access to hormone treatments and inclusive screenings for all gender orientations, says Jessica Halem, former Harvard Medical School LGBTQ+ outreach and engagement director.

Above all else, health-care providers should be advocates for their LGBTQ+ patients. “A primary care provider might not be comfortable with HIV care or hormone therapy, but it’s important not to say, ‘I’m not familiar with this and don’t think you should get it.’ Affirming care is, ‘I’m not familiar with this but let me go find out more about it and get you the resources you need,’’ says Dr. Goodman. This type of advocacy is a huge part of Dr. Goodman’s practice. For example, when he knows that he has to send a prescription to an external pharmacy that might use a transgender patient’s legal name instead of their chosen name, he prepares the patient so they aren’t caught off-guard. He’s even helped patients navigate the process of a legal name change so that they don’t have to worry about being deadnamed in official settings outside of health care.

And it’s important to recognize that affirming care goes beyond the front-office and patient-facing aspects of health care; the technology that powers the medical system needs updating as well. Many software systems display a patient’s legal name and sex assigned at birth, which could clash with their identity. Some software also forces doctors to make medical decisions based on assigned sex at birth and that can influence dosage amounts for prescribed medications or prompt the doctor to make improper preventative-care recommendations, explains Susanne Fortunato, founder of Wingspan Health, an inclusive patient portal. But things are changing. New software makes it possible to provide a better experience, by capturing a patient’s legal name and assigned sex and birth for insurance purposes but displaying their correct name to front desk staff, incorporating all gender markers and pronouns, and using displays that look the same for all patients in order to protect their privacy.

Making affirming care the new standard

Often, without the proper systems in place, LGBTQ+ people are left to fend for themselves or accept being misgendered or improperly treated. But it doesn’t need to be this way. “You might think you’re not in the position to question an experience, but you can give feedback to your provider,” Dr. Goodman says. And if you feel comfortable doing so, it might help bring about change. That said, if you’re not getting the care you deserve, you can leave and find a new provider. The Gay and Lesbian Medical Association (GLMA) specifically has a provider directory that lists the affirming and competent practices in the United States.

If you work in health care or feel comfortable sharing resources with your medical providers, you can be a driving force for change. Some resources to consult include the University of California San Francisco’s transgender care guidelines and Essential Access Health’s guide to Providing Inclusive Care for LGBTQ Patients. These guides explain how to avoid stereotypes and assumptions about patients’ sexual orientations and gender identities and offer samples of inclusive intake forms and updated ways of keeping health records. And they don’t just cover the ways that doctors treat patients; they touch on why it’s critical for all staff, especially those who have contact with patients (such as outreach workers, front-desk staff, assistants, and those who handle billing and insurance) to have LGBTQ+ affirming training. Ultimately, any and every interaction in health care sets the foundation for patients to feel cared for.

As things change, there will be providers who worry that implementing inclusive care will push some patients away. But Dr. Goodman explains it’s necessary for health-care professionals to understand that patients who don’t like the changes will probably have access to care elsewhere, while marginalized patients often don’t have that option. That’s why creating a welcoming space for the people who are the least likely to have access to those spaces must be the priority.

“A lot of change starts small and is incremental,” Dr. Goodman says. “Maybe right now all you can change is what happens in your exam room, but that can be so powerful.”

*Name was changed to protect privacy.

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10 sexual health tips for trans and non-binary people

By Ellis K

Everyone has a right to healthy, happy sex. But trans, non-binary and gender diverse people are too often left out of mainstream information relating to health and wellbeing. This means trans and non-binary people are often reliant on guesswork and reading between the lines to find what’s relevant and what’s not.

This came through loud and clear when sexual health charity Terrence Higgins Trust asked more than 200 trans and non-binary people about their sexual health and current provision.

“As trans people, we need to see ourselves in sexual health campaigns and know that the information is written with us in mind,” says sexual health clinician Dr Kate Nambiar.

That’s exactly what the charity put into action – utilising the feedback for the development of its brand new trans and non-binary sexual health information in terms of everything from content to tone.

The information was produced by trans and non-binary staff at Terrence Higgins Trust and developed in conjunction with members of the trans community. Dr Nambiar was the project’s peer reviewer.

The new webpages and print leaflet feature eight trans and non-binary people of different ethnicities, shapes and sizes. In line with feedback, the imagery is empowering and positive – a departure from how trans people are too often depicted.

“I decided to be a part of this resource because I want trans people, however they identify, to know that they are worthy of having an enjoyable and healthy sex life,” says Rory Finn, health promotion specialist at Terrence Higgins Trust who was part of the project group. “Our bodies deserve to be empowered and celebrated, just like everyone else.”

The specialist sexual health information for trans and non-binary people is now available on Terrence Higgins Trust’s website. But – for a flavour – here is the charity’s top 10 sexual health tips for trans and non-binary people.

1) Spend some quality time with yourself

There is no one way to be trans or non-binary, everyone’s different. Masturbation is a good way to get to know what you like and feels good – when you know, you can show your partners what you want. This is true for everyone, but especially so if you’ve just had gender-affirming surgeries and are looking to explore your new body parts. There are a variety of toys on the market that can help with sex. Try different things out. What works for others may not work for you.

2) Checking in

Figured out what you like? Tell your partners. Communication before and during sex can sometimes be awkward and take some practice, but it’s the best way to ensure you are both happy and comfortable with what’s happening. You have the right to enjoy sex and you shouldn’t feel like you have to use parts of your body if you don’t want to. Checking in before sex is also a great time to decide on what barriers and protections you are going to use.

3) Do things your way

Clothing can be affirming, and keeping it on can sometimes mean better sex. Some trans masculine people find that continuing to use clothing like binders and packers during sex feels good. Learning to negotiate the sex that you want, and experience pleasure with potentially new body parts can take time. You might need time to build up confidence and learn new skills to help you negotiate safer sex. You should never be pushed into anything that you are uncomfortable with.

4) Find the best barrier methods for you

STIs can be passed on from all types of sex with all types of body parts and sex toys. Using a barrier such as a condom or dam along with water-based lube is the best way to protect against STIs. Recent lower surgery means unhealed skin, which can make it easier for you to acquire or pass on HIV as bleeding can provide a route into or out of your body. Discuss with your surgeon what kind of activity you can do and how soon. If you’re a trans masculine and on testosterone (T), remember that it’s not an effective form of contraception, but condoms are. The coil, implant, injection or pill can also be safely taken with T. Likewise, hormone therapy for trans feminine people doesn’t provide adequate contraceptive protection.

5) Negotiating condoms

It’s not always easy to discuss condoms before sex, but there are some useful tips to help get them in play. Make sure you have condoms and lube with you and that you’ve practised using them before you have sex. You can make putting on a condom part of play. Passing a condom to a partner can be understood to mean you want to be fucked – it also signals that you want to use a condom for this.

6) Is PrEP right for you

PrEP is a pill that protects you from HIV, taken before and after sex. It doesn’t affect or interact with hormone treatment. PrEP might be right for you if you’re HIV negative and have sex in a variety of situations where condoms are not easily or always used. It gives you empowerment, particularly if you are a receptive partner, or bottom, by taking control over protecting yourself from HIV transmission. There’s also PEP, a treatment that can stop an HIV infection after the virus has entered a person’s body (for example, if you’ve had sex and the condom fails). To work, PEP must be taken within 72 hours (three days), and ideally should be taken within 24 hours. You can get PrEP for free on the NHS from a sexual health clinic, and PEP from a clinic or A&E.

7) Tell a mate you’re hooking up

If you’re planning on meeting someone from a dating app, it’s a good idea to tell a friend where you’re going, when they can expect you to come back and who you’re planning to meet.

8) Be prepared

Just planning on meeting someone for a coffee or quick drink? Plans can change, so make sure you’ve got some condoms and lube with you.

9) Test, test, test

Getting screened regularly is a way to reduce the risk of HIV and other sexually transmitted infections (STIs). Have a sexual health screen at least once every year, and more frequently if you change partners or have casual or new partners. STI screening is quick, free, and painless and you can take your own samples from the body parts you use for sex. These days, there are more ways than ever, including ordering a self-test kit online.

10) Regular check-ups

If you have a cervix then it’s important to get a cervical screening test every three years from the age of 25 (or every five years from 50 to 64). If you’ve changed your name and gender with your GP, you may not receive letters to remind you to go for a screen.

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