Isn’t it self-evident that gender would always be uniquely expressed in each person?
Gender is not binary, but alters from culture to culture, from generation to generation
By Allyson Jule
I know we’ve all heard this stuff before: men and women and boys and girls are “different”: they think differently, they think about different things, and they interact with the world in different ways. But those are dangerous ideas. Why? Because they simplify both women and/or men as stereotypical, and we know that stereotypes flatten the complexity of the human person. Each of us is complicated, amazing, contradictory, mysterious, hopeful, sad – and in all other matters of being human. We have already left other stereotypes behind us. For instance, we know not all Canadians are polite or Irish people good singers and dancers. Furthermore, we as individuals appreciate being taken as we are, in our own lives as ourselves, and not as representations of all women and/or all men in all circumstances, all of the time.
So why is it that we have so much difficulty in accepting the variety of gender expressions and in being nice about it? Isn’t it self-evident that gender would always be uniquely expressed in each person? For a long time feminist and cultural studies scholars have made the convincing case that sex is primarily the biological reality of someone as male and/or female, while gender is what is socialised. Gender is not binary, but alters from culture to culture, from generation to generation, from family to family and community to community.
It is time to embrace the incredible variety of gender identities and gender expressions as part of societal change. In Canada, a bill was introduced by Justin Trudeau’s government in May of 2016, passed the legislative process and, upon receiving Royal Assent in June of 2017, became law. The purpose of Bill C-16 was to amend the Canadian Human Rights Act and Criminal Code by adding “gender expression and gender identity” as protected grounds to the Canadian Human Rights Act and the Criminal Code.
Seems like a no-brainer but there was a backlash in regards to the use of pronouns (he, him, his or she, her, hers or they, them, theirs). The backlash rested on an argument about government infringing on freedom of speech and enacting something called “compelled speech”. The protesters wanted to be able to refuse to use different pronouns for those who do not subscribe to binary gender. If someone asked them to refer to them as “they” or “them”, they didn’t want to feel “compelled” to honour this because of freedom of expression.
But what’s so difficult about it? If Elizabeth Jones at the bookstore, say, asked me to call her Mrs Jones, why would I say “Nope. I am more comfortable with calling you Betty”? And if Pat asked you to call Pat “them”, wouldn’t you?
It’s not a big ask, and the world would be a better place if we were nice to each other. In any event, the Canadian Bar Association argued that the Bill C-16 provides necessary protections for transgender people in particular and posed no risk to freedom of expression. Thankfully, the debate seems to have settled down but, sad to say, often rages elsewhere.
Ours is a world of incredible social change. We will need to make necessary adjustments as we go forward as a society. We should all get to decide how we are to be addressed. This matters because our words reveal us and create us. Words reveal how we see the world, how we see and understand others and can create our views and attitudes.
A civilised society respects all people. We live our lives as free agents who love, work, rest and think in our own unique ways. If we can’t see the commonalities of all people and the uniqueness of each person, if we always see sex and gender as the biggest deal in who someone is, then we are doomed to this gender/sexuality conflict forever.
To be kind and gracious with some added Canadian politeness to all persons through thoughtful language, regardless of gender expressions, sexuality, sex, religion, ethnicity, race and socio-economic status, is the only way forward. Whether we be men and/or women, teachers and/or lawyers, straight and/or gay, conservative and/or liberal, we can respect all persons. Basic respect for others is necessary for all of us to live good, just and peaceful lives with those around us. Let’s play nice.
A decade-long debate seemed settled in June when the World Health Organization officially added “compulsive sexual behavior disorder” to the newest edition of the International Classification of Diseases. Unfortunately, in the aftermath, many publications declared “sex addiction” was officially a mental health disorder. Technically, that’s wrong, but the blunder sheds light on the controversy surrounding the diagnosis. Even now, scientists are still trying to figure out the best way to think about people with very strong sexual urges.
It was a calculated choice by the WHO to replace the existing ICD-10 category of “excessive sexual drive” with “compulsive sexual behavior disorder” — not “sex addiction” or “hypersexuality.” It’s also very purposefully classified as an “impulse control disorder” instead of a disorder related to addiction. Impulse disorders, wrote members of the WHO ICD-11 Working Group in a 2014 paper, are defined by the repeated failure to resist a craving despite knowing the action can cause long-term harm.
The reason for this linguistic and categorical change is to make clear there’s no “right amount of sexuality” and to acknowledge that “it is important that the classification does not pathologize normal behavior.” Ultimately, the goal is to help identify repetitive behavior that can shut down a person’s life, though the language we use about it continues to be controversial. Despite the vagaries, Marc Potenza, Ph.D., M.D., a professor of psychiatry at the Yale School of Medicine, says the WHO’s move is a good thing.
“I believe that the inclusion of compulsive sexual behavior disorder within the ICD-11 is a positive step,” Potenza tells Inverse. “My experience as a clinician indicates that there are many people who experience difficulties controlling their sexual urges and then engage in sex compulsively and problematically. Having a defined set of diagnostic criteria should help significantly with respect to advancing prevention, treatment, research, education, and other efforts.”
Why Some Think It’s an “Addiction”
Potenza co-authored a 2016 paper questioning whether compulsive sexual behavior should be considered an addiction, concluding that significant gaps in the understanding of the disorder mean that it can’t technically be called an addiction yet. Today, however, the disorder continues to be described as “sex addiction” by universities, medical centers, and researchers. It’s unclear whether the word addiction here is colloquial or clinical.
For his part, Potenza suspects compulsive sexual behavior disorder may eventually be reclassified as an addictive disorder in future editions of the ICD. It’s not currently in the Diagnostic and Statistical Manual of Mental Disorders (DSM), but he predicts it might likewise be introduced and classified as an addictive order there once more data is gathered.
The central elements of addictions, he explains, include continued engagement in a behavior despite adverse consequences, appetitive urges or cravings that often immediately precede engagement, compulsive or habitual engagement, and difficulties controlling the extent of engagement in the behavior.
“From this perspective,” Potenza says, “compulsive sexual behavior disorder demonstrates the core features of addictions.”
Why Some Think It’s Not an Addiction
But Nicole Prause, Ph.D., a neuroscientist and sexual psychophysiologist who founded the sexual biotechnology company Liberos LLC, argues that sex is not addictive and that “compulsive sexual behavior” shouldn’t have been included in the ICD-11. In 2017, Prause and her colleagues published a paper in The Lancet in response to Potenza’s study, arguing that while “sex has components of liking and wanting that share neural systems with many other motivated behaviors,” experimental studies don’t actually demonstrate that excessive sexual behavior can be classified as addiction.
“Scientists generally were glad to see ‘sex addiction’ was kept out of the ICD-11,” Prause tells Inverse. “Therapists created ‘sex addiction’ training 40 years ago and were pushing to get it in with no good evidence.”
Prause generally doesn’t believe “compulsive sexual behavior” needs a name at all. Creating a means for diagnosis, she says, can increase “shame on sexual behaviors,” and people conditioned to think that sex is bad are more likely to think they have a problem. She argues that the population most likely to be classified as sexually compulsive are gay men, noting that there are even “examples of ‘sex addiction’ therapists offering to help gay men stop being gay,” which is “reparative, anti-gay therapy all over again.”
“The diagnosis has never been tested,” Prause says. “We have no idea if these patients even exist. The committee invented a new diagnosis and added it without ever seeing if anyone would meet the criteria.”
She argues that the grounds for such a diagnosis haven’t been backed up by research on actual sex in a lab. So far, estimates of how many people who identify as having a compulsive sexual behavior disorder vary and are predominantly based on self-reports. Epidemiological estimates have the number at three to six percent of adults, writes the WHO ICD-11 Working Group in a paper released this year, but more recent studies have suggested that range is closer to one to three percent of adults. Researchers at the University of Cambridge, meanwhile, reported in 2014 that compulsive sexual behavior can affect as many as one in 25 adults.
Now that it’s in the ICD-11, researchers are waiting to see how that will affect the official rates of identification.
“Growing evidence suggests that compulsive sexual behavior disorder is an important clinical problem with potentially serious consequences if left untreated,” writes the ICD-11 Working Group. “We believe that including the disorder in the ICD-11 will improve the consistency with which health professionals approach the diagnosis, and treatment of persons with this condition, including consistency regarding when a disorder should be diagnosed.”
Potenza says that it can be hard for a specialist to diagnose a person with compulsive sexual behavior disorder because, like alcoholism or a gambling addiction, it probably doesn’t have visible signs. But Potenza says the disorder can seep into and negatively impact other parts of a person’s life.
Global health body not yet ready to acknowledge ‘sex addiction’, saying more research is needed
The World Health Organisation logo at the headquarters in Geneva.
The World Health Organisation has recognised “compulsive sexual behaviour” as a mental disorder, but said on Saturday it was unclear whether it was an addiction on a par with gambling or drug abuse.
Dr. Geoffrey M. Reed
The contentious term “sex addiction” has been around for decades but experts disagree about whether the condition exists.
In the latest update of its catalogue of diseases and injuries around the world, the WHO takes a step towards legitimising the concept, by acknowledging “compulsive sexual behaviour disorder”, or CSBD, as a mental illness.
But the UN health body insisted more research is needed before describing the disorder as an addiction.
“Conservatively speaking, we don’t feel that the evidence is there yet … that the process is equivalent to the process with alcohol or heroin,” said WHO expert Geoffrey Reed.
In the update of its International Classification of Diseases (ICD), published last month, WHO said CSBD was “characterised by persistent failure to control intense, repetitive sexual impulses or urges … that cause marked distress or impairment”
But it said the scientific debate was still going on as to “whether or not the compulsive sexual behaviour disorder constitutes the manifestation of a behavioural addiction”.
Maybe eventually we will say, yeah, it is an addiction, but that is just not where we are at this point
Geoffrey Reed, World Health Organisation
Reed said it was important that the ICD register, which is widely used as a benchmark for diagnosis and health insurers, includes a concise definition of compulsive sexual behaviour disorder to ensure those affected can get help.
“There is a population of people who feel out of control with regards to their own sexual behaviour and who suffer because of that,” he said pointing out that their sexual behaviour sometimes had “very severe consequences”.
“This is a genuine clinical population of people who have a legitimate health condition and who can be provided services in a legitimate way,” he said.
It is unclear how many people suffer from the disorder, but Reed said the ICD listing would probably prompt more research into the condition and its prevalence, as well as into determining the most effective treatments.
“Maybe eventually we will say, yeah, it is an addiction, but that is just not where we are at this point,” Reed said.
But even without the addiction label, he said he believed the new categorisation would be “reassuring”, since it lets people know they have “a genuine condition” and can seek treatment.
Claims of “sex addiction” have increasingly been in the headlines in step with the so-called #MeToo movement, which has seen people around the world coming forward and claiming they have been sexually abused.
The uprising has led to the downfall of powerful men across industries, including disgraced Hollywood mogul Harvey Weinstein, who has reportedly spent months in treatment for sex addiction.
[Film producer Harvey Weinstein arriving at Manhattan Criminal Court on Monday, July 9, 2018. Photo: TNS]
Reed said he did not believe there was reason to worry that the new CSBD listing could be used by people like Weinstein to excuse alleged criminal behaviours.
“It doesn’t excuse sexual abuse or raping someone … any more than being an alcoholic excuses you from driving a car when you are drunk. You have still made a decision to act,” he said.
While it did not recognise sex addiction in the first update of its ICD catalogue since the 1990s, the WHO did for the first time recognise video gaming as an addiction, listing it alongside addictions to gambling and drugs like cocaine – but only among a tiny fraction of gamers.
The document, which member states will be asked to approve during the World Health Assembly in Geneva next May, will take effect from January 1, 2022 if it is adopted.
Occasional jealousy is natural and can even be motivating. But if you find yourself getting upset when seeing Instagram photos of clothes, jobs, or cars that you envy, you might need to work through this issue. Or maybe your jealousy is making you paranoid and causing problems with you and your significant other. Curbing these emotions can be difficult, but it’s often necessary to move forward and feel secure and confident. Work through your jealousy by addressing it, finding a new focus, and improving yourself. You got this!
Method 1 Handling Jealousy in the Short Term
1 Take a few deep breaths when you start feeling jealous. Perhaps you see your boyfriend talking to another girl or find out your friend got the exact truck you want. Instead of freaking out, calm yourself instead. Take a deep breath in through your nose for five seconds, and then exhale slowly through your mouth. Do this until you feel calm.[1]
If you want to address the issue, do so only when you’ve calmed down. For instance, if you see your boyfriend talking to a girl, calm down first, then approach him and say ‘hello’ to both of them. She may just be a friend or classmate.
2 Stay off social media. Social media floods you with images of people sharing fragments of their lives that might spark your jealousy. But, what you may not know is the girl who constantly posts pics of the flowers her boyfriend gets her may be unhappy in her relationship. People tend to only post things that show them in a positive light, so stay off social media while you’re overcoming your jealousy.[2]
If you can’t stay off of social media, unfollow or unfriend the people you’re jealous of.
3 Avoid criticizing or using sarcasm. When you’re feeling jealous, you might resort to name-calling or trying to diminish the accomplishments of others. However, this only shows your insecurity and makes others feel bad. Instead of being negative, keep your comments to yourself or compliment them.[3]
For instance, if your girlfriend comes home telling you about her new coworker, don’t say something like, “Oh, so since he’s so smart, you wanna go out with him now?” Allow your significant other to tell you things without fear of rudeness.
4 Confess your feelings if the person is close to you. If you’re very jealous of a sibling, best friend, or significant other, and have been for years, tell them. Getting it off your chest can help you move on from this negative feeling and clear the air.[4]
For instance, you might say, “Sis, I know that I’ve been a bit rude to you for a while. But when you got into Stanford and I didn’t, it hurt me. I’ve been so jealous of you because I feel like you’re living my dream. I know it’s not your fault, and I wish I didn’t feel this way.”
5 Focus on what you have in common with the person you’re jealous of. Unravel your jealousy by looking at the similarities you and the person you envy share. The more you two are alike, the less you have to feel jealous over![5]
For example, maybe you’re jealous of your neighbor because they have a nice car. But remember that the two of you live in the same neighborhood and probably have similar houses. Maybe you went to the same school, too, and have friends in common.
Method 2 Refocusing Your Attention
1 Identify the source of your jealousy. Understanding why you are jealous can help you overcome it. Is it because of low self-esteem and insecurity? Do you have a past history with infidelity? Or are you placing unreasonable standards on your relationship? Once you have identified the source, reflect on ways that you can improve upon or fix the issue.
Writing in a journal every day can help you discover where your jealousy might be coming from.
Professional therapy can help with this process. A therapist may be able to help you find the source of your jealousy while working through the issue.
2 Praise those who are doing well. Hating on someone’s accomplishments won’t put you closer to your own goals. When you see others doing the things you want to do, give them kudos. This shows respect and humility.[6]
For instance, if your friend has an awesome career, say, “Molly, your job seems so cool. It seems like you’re always getting awards and promotions, too. You’re really killing it! Got any tips?”
Perhaps your boyfriend has been doing a great job lately of being more affectionate; tell him you appreciate his effort.
3 Reflect on your own strengths. Instead of harping on what others are doing, focus on yourself! Take a moment to either list or think about at least three things that you are good at. These can range from organizing or cooking to being a good listener or hard worker.[7]
Do one thing related to your strengths list today to build your confidence, like cook an awesome meal.
4 Compile a list of what you’re grateful for. Every day that you wake up is truly a blessing. Remember that and think about one thing that you’re thankful for each day. This will help reduce your feelings of jealousy because you’ll become more appreciative of what you do have.[8]
Maybe you have an awesome mom who supports and loves you. Or perhaps you got into a really good school and you’re starting soon. Be thankful for these blessings!
5 Meditate daily. Meditation can clear your mind and help you focus on what’s important. Your thoughts of jealousy might cloud your headspace daily, but get some relief by sitting quietly in an uninterrupted space in the mornings for at least ten minutes. During this time, focus only on your breathing and how your body feels.
If you’re unfamiliar with meditation, you can also download an app like Simple Habit or Calm.
6 Call the shots. You might have a rich friend who’s always asking you to go to expensive restaurants or on extravagant trips. This might make you feel jealous of their money. Instead of letting that control you, take the reins! Pick the restaurants you go to and choose not to go on vacations if you can’t afford it. Plan something locally, instead.[9]
You can say, “Hey Josh, I enjoy eating at five-star restaurants with you, but to be honest, it’s a little out of my price range. If you still wanna get dinner once a week, that’s cool, but you’ll have to let me pick the place most of the time. I hope you understand.”
7 Have fun daily to distract you from your jealousy. You won’t be able to think about your jealousy as much if you’re out having fun! Schedule something to look forward to every day, like watching your favorite show, getting ice cream, or going shopping. Life is short, so make the most of it every day!
Method 3 Improving Your Own Life
1 Set short- and long-term goals. Use your jealousy to motivate you to become the best version of yourself. Based on the things you want in life, create action steps to help you achieve it. Set goals that you can achieve within the next five days and things to focus on for the next five years.[10]
For instance, maybe you want to get a high paying job. As a short-term goal, try to get A’s in all your classes for the semester. A long-term goal could be finding a mentor or getting an internship in your field.
2 Plan a fun getaway. Maybe you’re jealous because it seems like everyone else is having all the fun. Create some fun for you! Plan a fun weekend away for you and your bae, go to a theme park, or go hang out on the beach. Do whatever makes you happy![11]
3 Take care of your health. You’ll be a lot less worried about others if you’re focused on your own health. Build your confidence up by exercising at least three times a week. Eat a healthy meal by having veggies, fruits and lean meat. Be sure to get at least eight hours of sleep per night.[12]
Drink a lot of water, too!
4 Surround yourself with positive people. Maybe your jealousy comes from hanging around friends who try to make you jealous on purpose. That’s definitely not cool. Instead of being around that negativity, spend more time with your kind-hearted, honest, and down-to-earth friends!
A positive person will be supportive, honest, kind and helpful. A negative person will insult, criticize, and drain you.
5 Consider seeing a counselor to work through your jealousy. If your jealousy is making it hard for you to enjoy life anymore, it might be time to seek outside help. There are many therapists who are trained to help their clients work through feelings of envy or inadequacy. Remember, there’s nothing wrong with getting help! It’s much worse to suffer in silence.[13]
Search online for therapists or counselors in your area. You can also get a referral from your doctor’s office or insurance provider.
Is it okay to put a boy and a girl in the bathtub together? What should you do if a classmate from your kid’s preschool comes over for a play date and you find the two of them “playing doctor” from the waist down? And what if your child asks to examine your private parts and that makes you feel weird?
There are lots of books and resources for talking to kids about their bodies and sexuality and reproduction. But they’re usually geared towards parents whose children are about to hit puberty—and that’s way too late. Sexual health educator Deborah Roffman tells me that kids have “a normal, natural curiosity” about these topics starting at age four, and if adults aren’t there to guide them, they’ll eventually turn to peers, older kids and the media to get their information. (You can’t just wait for school to clear things up either—in one Reddit thread, people shared the very inaccurate information they were taught in sex ed class, like how condoms increase the risk of pregnancy, a girl can’t get pregnant while on top, and that the clitoris is a myth.)
The Talk shouldn’t just be one sweaty sit-down conversation—instead, it needs to be an ongoing discussion that starts earlier than you probably think. That’s why Roffman, the author of Talk to Me First: Everything You Need to Know to Become Your Kids’ Go-To Person about Sex, has helped develop a series of animated videos for parents of kids ages 4-9. They’re produced the sex ed project AMAZE, which has brought us videos for tweens and teens on topics such as consent, gender identity and sexual assault.
Called the AMAZE Parent Playlist, the series helps parents navigate real, sometimes confusing scenarios with their little ones. Say, you’re in the car listening to NPR and your young kid suddenly asks, “Mommy, what’s rape?” (You can say something like “Rape is something that’s against the law,” the video suggests, which is a totally truthful answer.) Or maybe you’re walking through the toy store and there are aisles “for girls” and “for boys.” (Take the opportunity to help kids notice and think about gender labels.) This video—“Is Playing Doctor OK?”—explains what’s normal and healthy when it comes to kids’ curiosity about bodies and private areas.
Roffman says a lot of parents have an irrational fearful that “too much information too soon” might somehow be harmful for young kids, but the opposite is actually true. Better educated kids are more likely to make better decisions about everything, she says—including sexuality.
Antidepressants are widely prescribed, commonly used for depression and recommended to treat a range of other issues, from anxiety disorders to pain. But the medications aren’t without risk – and some potentially serious side effects start, or continue, after a person has stopped taking them.
These effects vary by the individual and the drug, but for the most commonly prescribed antidepressants – selective serotonin reuptake inhibitors, or SSRIs, and serotonin-norepinephrine reuptake inhibitors, or SSNIs – side effects, or adverse events reported by patients, range from headache, nausea and fatigue to paresthesia, or an abnormal sensation that can feel, to some, like electrical shocks, to insomnia to seizures. And though less widely recognized, some patients also report another enduring effect of SSRIs and SSNIs: sexual dysfunction.
To be sure, sexual side effects ranging from lower libido to erectile dysfunction are known and detailed in drug labeling information. But though online support groups have cropped up for people who experience persistent sexual dysfunction after going off antidepressants – post-SSRI sexual dysfunction, or PSSD – it’s not clear how common the concern is.
However, one recent paper co-authored by researchers linked with an independent drug safety website RxISK.org that collects reports of side effects – including after people stop medications – recently reported on 300 cases of enduring sexual dysfunction. These were reported by people from around the world who were taking SSRIs, SSNIs and tricyclic antidepressants, as well as drugs called 5α-reductase inhibitors and isotretinoin. which are used to treat male hair loss (baldness) and benign (non-cancerous) prostate enlargement, and acne respectively. Reports by patients who’d taken 5α-reductase inhibitors and isotretinoin to RxISK of enduring problems with sexual function after stopping these medications appeared to have similar characteristics to those related to antidepressants, notes co-author Dr. Dee Mangin, the David Braley and Nancy Gordon Chair in Family Medicine at McMaster University in Hamilton, Ontario, and chief medical officer for RxISK.org.
“We were really looking at sexual dysfunction both on and after taking medication, because some of the reports we were getting were suggesting that sexual dysfunction, which is a known side effect of a number of drugs, seemed to be persisting once the drugs were stopped,” Mangin says.
As noted in the paper published in the International Journal of Risk & Safety in Medicine, there have been limited references to the potential for such issues to occur after patients stopped antidepressants. In the U.S., the product information for Prozac (fluoxetine) – the oldest of the SSRIs – was updated in 2011 to warn, “Symptoms of sexual dysfunction occasionally persist after discontinuation of fluoxetine treatment.” What’s more, the authors noted, “The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, states that ‘In some cases, serotonin reuptake inhibitor-induced sexual dysfunction may persist after the agent is discontinued.'”
But the authors go further in detailing reports of enduring sexual dysfunction such as the onset of premature ejaculation and persistent genital arousal disorder (whereby a person becomes aroused without any stimulation) as well as losing genital sensation, or genital anaesthesia, pleasureless or weak orgasm, loss of libido and impotence. “Secondary consequences included relationship breakdown and impaired quality of life,” the authors note.
The individuals weren’t independently evaluated before, during or after taking the medication, and more study is needed. Still, Mangin asserts, “The study provides the strong signal that there is a group of people who seem to experience enduring side effects that affect their sexual function after they’ve stopped taking the drug.”
Experts say just as patients should never stop antidepressants abruptly, or without consulting with their provider – since doing so is known to increase side effect risk and worsen those effects – patient and provider should discuss any adverse effects that start or continue after stopping a medication.
Dr. Eliza Menninger, who directs a behavioral health program at McLean Hospital in Boston, says she hasn’t heard from patients voicing serious concerns about sexual side effects after stopping their medication. For the most part, sexual side effects seem to go away after patients stop taking the medication, Menninger says. “Some will indicate it’s still an issue, but they don’t seem as bothered by it – and I don’t know if it’s as bad an issue as when they were on the SSRI,” she says.
However, clinicians say, it would be helpful to have more clarity on the issue – including how likely it may be that patients could experience enduring sexual side effects. In part due to the sensitive nature of sexual complaints, experts point out, these effects often go unacknowledged in patient-provider conversations.
One problem is that sexual side effects aren’t tracked in a systematic way like other drug side effects – even though they can be severely damaging to intimate relationships and undermine a person’s overall quality of life and well-being. “There’s no requirement, for example, for drug companies to track sexual side effects. They’re not considered serious adverse events, although the potential for them to continue post-medication I would consider extremely serious – even a disability,” says Audrey Bahrick, staff psychologist at the University of Iowa’s counseling service.
Bahrick recently signed onto a petition, along with Mangin and others who’ve researched enduring sexual side effects, asking the U.S. Food and Drug Administration and other regulatory bodies to require makers of SSRIs and SSNIs to update drug labeling to warn that such legacy effects can occur and continue for years or even indefinitely.
Sandy Walsh, a spokesperson for the FDA, said it would review the petition and respond to the petitioner, but declined to comment further regarding the petition. Drugmakers who responded to a request for comment say they work closely with regulatory agencies to keep information updated.
Mads Kronborg, a spokesman for pharmaceutical firm Lundbeck, notes that summary production information for its SSRIs, citalopram (Celexa) and escitalopram (Lexapro), “already states that side effects can occur upon discontinuation, and that such side effects may be severe and prolonged.” Specifically, it’s stated that “generally these events are mild to moderate and are self-limiting, however, in some patients they may be severe and/or prolonged.” The side effects listed for citalopram and escitalopram “include sexual side effects,” he says, though he adds that sexual side effects are not among the most commonly reported reactions to discontinuation. “So information about potential enduring side effects is actually already included.”
But the petition asserts drug companies aren’t going far enough to acknowledge these concerns.
Bahrick says though the prevalence of enduring sexual side effects remains unknown, “My own impression clinically is that it’s not at all uncommon, and that it can range from subtle – not returning to sexual baseline – to really a complete sexual anesthesia, where a person who has been without any significant sexual problems prior to taking the medication might be rendered unable to experience sexual pleasure, unable to have sensation in the genitals, having orgasms that are not associated with pleasure,” she says. “These are clearly, I think, drug effects. [Issues] like genital anaesthesia and pleasureless orgasm – these are not symptoms that are associated with any sexual problems, say, that are commonly associated with depression. We can see these as legacy effects of the SSRIs.”
In the absence of prevalence data, clinicians continue to debate the potential extent of enduring sexual side effects for those who have stopped antidepressants. Some worry about unnecessarily scaring patients away from antidepressants who may benefit from taking the drugs.
“These medications are used to treat symptoms of illnesses that are potentially quite debilitating and can be lethal, so while I want to encourage a discussion of side effects, the intent is to use medications to help improve significant symptoms,” Menninger says. She points out, as the petition notes, that to date no prospective studies have been done assessing sexual dysfunction prior to SSRI and then during and after SSRI use. Though certainly side effects are real and concerning, she says, “there is clinical evidence the medications make a significant difference in helping [and/or] saving a life.” That’s something some clinicians emphasize shouldn’t get lost in the discussion.
But Bahrick says for patients, not having information that these effects may occur undermines their ability to make a fully informed decision when deciding to go on antidepressants, and deciding whether to try alternative treatment options first. “It’s so important to get this information out there on the front end. Because these injuries are very real and can be lifelong and seriously limit intimacy and create a lot of shame and isolation and despair,” she says. While for some the side effects go away on their own, for others they persist – and Bahrick says there’s no known cure for PSSD. “So this is in service of informed consent that is quite lacking at this time.”
Alfred Kinsey’s spectrum of human sexuality shocked the world when he published it in 1948. His book, Sexual Behavior in the Human Male featured extensive interviews with 5300 people—almost exclusively white males along with a paltry number of racial and ethnic minorities about their sexual histories and fantasies. The second volume, Sexual Behavior in the Human Female, came out five years later and made equally shocking claims about the inner lives of 5940 women, also almost exclusively white.
Kinsey’s ethical standards were questionable, especially by today’s standards—much of his research involved sexual contact with his subjects—but he also introduced the world to an idea that previously had little publicity: Human sexuality isn’t confined to the binary hetero- and homosexual standards; rather, it exists on a broad spectrum. Today, most people know that as the Kinsey Scale (though that’s just one way to measure sexuality). It runs from zero to six, with zero being exclusively heterosexual and six being exclusively homosexual. A seventh category, just called “X,” is often interpreted as representing asexuality.
It’s by far the best-known sexuality scale, both for its creator’s fame and for its simplicity, but it’s far from the most accurate or most helpful. In fact, it probably wasn’t ever intended to be a test for participants to take themselves.
Kinsey and his colleagues (among them, his wife) generally assigned their subjects a number based on the interview they conducted. This may be surprising. Many people, sex researchers included, mistakenly believe it was some kind of psychological test conducted exclusively to determine someone’s sexuality. But in a 2014 journal article James Weinrich, a sex researcher and psychobiologist at San Diego State University, dug back into the original Kinsey reports to investigate and found that only a small portion of Kinsey’s subjects were asked to assign themselves a number on the scale. “It was a self-rating only for those asked the question—those who had significant homosexual experience. Otherwise, it was assigned by the interviewer,” he writes.
Since most people’s score on the Kinsey Scale wasn’t their own assessment, it was more or less based on the subjective decision of the expert conductors. That means those online quizzes purportedly telling where you fall on the Kinsey Scale aren’t official in any way.
But that’s not to say that they can’t be useful. Plenty of people—perhaps even most—question their sexuality at some point in their lives. It’s natural. And it’s equally natural to feel anxious, unnerved, or uncomfortable about having feelings that you’re not sure how to categorize or think about. Society has a plethora of negative judgments for anyone who deviates outside of the cisgendered, heterosexual bucket.
Of course, no one has to fall under specific labels. Many men interviewed for sex research, for example, avoid using the term “bisexual” even if they’ve had multiple sexual encounters with other men. San Diego State’s Weinrich spoke extensively with Thomas Albright, one of Kinsey’s original collaborators, who painted a likely far more accurate picture of how the interviews went and the challenges that the study presented. He wrote that a significant percentage of men in the Kinsey sample self-reported that they had “extensive” homosexual experiences, but when asked to rate themselves (men with homosexual experiences were the only ones asked to rate themselves) would self-identify as a zero (exclusively heterosexual) on the Kinsey scale when first asked. If pushed, they might push that back to a one or perhaps a two even as they acknowledge that they receive oral sex from other men.
While just one example, it highlights some of the inadequacies of the Kinsey Scale and of many other attempts to quantify human sexuality. One is that all answers are self-reported, and so rely on people to self-examine. Another is that there may be a disconnect between the attractions a person feels and the label they identify with. Perhaps they only have romantic feelings for people of the opposite sex, but are sexually aroused by men and women.
All of this intricacy is only magnified when you add the spectrum of gender identity. Transgender people, those identifying as gender-fluid or really anything outside of the traditional binary genders are often left out of these sexuality scales.
If you’re questioning your own sexuality, looking at some of these scales might be helpful in getting you to consider aspects of yourself that you might not think of. And if you’re not yet comfortable confiding in another person, these tests and quizzes may be a way of testing ideas and identities. Probably the healthiest way to explore would be with a psychologist who specializes in sexuality (you can find one here, as well as locate all manner of bisexuality-aware health professionals), but if you’re not ready for that step or can’t afford to see someone, these scales may be of some use.
The Kinsey Scale
The oldest and most basic spectrum, the Kinsey Scale is a straightforward numerical scale:
0 – Entirely heterosexual 1 – Mainly heterosexual, little homosexual 2 – Mainly heterosexual, but substantial homosexual 3 – Equally hetero and homosexual 4 – Mainly homosexual, but substantial heterosexual 5 – Mainly homosexual, little heterosexual 6 – Entirely homosexual X – “have no sociosexual contacts or reactions” (Kinsey didn’t use the word “asexual,” but modern researchers interpret the X this way)
Kinsey and colleagues allowed for intermediate numbers, like 1.5, along the scale in keeping with the idea that sexuality is a smooth spectrum. The Kinsey Scale is nice and simple—and that may make it useful to some—but it also focuses on behavior. Cisgender -women who have some unexplored feelings towards other cisgender -women or towards a transgender -woman may not find a place for themselves on the scale if they’ve never acted on those feelings.
The Klein Sexual Orientation Grid
The KSOG tries to remedy some of the nuance that’s not included in the Kinsey Scale. Rather than a single number line, the KSOG is a grid that asks you about sexual attraction, behavior, and fantasies along with emotional and social preferences (and even a few more variables) along a scale from 1 to 7. Importantly, it also asks about these variables in different time scales—past, present, and ideal. (It’s easiest to understand if you take a look at the grid on this page). Perhaps you have historically thought of yourself as an exclusively straight, cisgender male, but now feel some sexual attraction to men like yourself, though you still feel emotionally attached only to cisgender -women. There’s a place for you on the KSOG. There’s also a place for a cisgender -woman who feels equally attracted sexually and romantically to men and women.
It’s downfall is gender identity. In two studies of the KSOG, researchers asked non-cis participants to evaluate the scale on its ability to capture their own sexuality. Many felt it did not. One wrote that “it still does not capture my sexual expression as a genderqueer transwoman for whom the labels “same” and “opposite” sex are incoherent.” Another noted that “As a person who is gender queer and who prefers the same in partners, I have a hard time figuring out if I am homosexual or not! It depends on the solidity of your gender category which I don’t have.”
Multidimensional Scale of Sexuality & MoSIEC
As a reaction to the Kinsey Scale’s limitations, researchers in the 90s developed the MSS and later a more modern version called the Measure of Sexual Identity Exploration and Commitment (MoSIEC). It’s now one of the few (or perhaps the only) scale in the official Handbook of Sexuality-Related Measures.
MoSIEC measures sexuality across four subscales—commitment, exploration, sexual orientation identity uncertain, and synthesis—where participants score themselves on each of 22 statements based on how characteristic they find it. So for example, statement 1 says “my sexual orientation is clear to me,” and you as the test-taker would score yourself on a scale from 1 (very uncharacteristic of me) to 6 (very characteristic of me).
The MoSIEC questions are really intended for researchers, not self-exploration, so we’ll give you the warning here that this isn’t supposed to be a take-at-home quiz. But if you’re curious, you can find the full questionnaire on pages 101-2 of this pdf. The subscores are the averages of the scores for the questions in each subscale, but they’re not divided evenly nor are they in any particular order. For example, the “exploration” subscale is made of up questions 2, 3, 5, 6, 8, 9, 12, and 19. A higher score indicates “higher levels of the measured construct present in the individual” (we did warn you it was for researchers!).
Again, this isn’t a tool intended for lay people, but if you’re really motivated here are the breakdowns for the subscores:
Exploration: 2, 3, 5, 6, 8, 9, 12, 19 Commitment: 10, 11, 15, 16, 18, 20 (#15, 16, and 18 are reverse-scored) Synthesis: 4, 7, 13, 17, 22 Sexual orientation identity uncertain: 1, 15, 21 (#1 is also reverse-scored)
The final option: no scoring at all
All of these measures play into both our desire to categorize ourselves as well as our peers, and the necessity of measuring sexuality when it comes to research. But numbers, like labels, can’t possibly capture the complex nature of human sexuality. A quiz or a test can prompt you to consider important questions, but it can’t give you any concrete answers. Don’t stress if you don’t feel like you belong in any one category—nobody really does.
With Pride Month coming to a close, Lifehacker has released a video featuring folks discussing coming out and the process of identifying as non-binary. The individuals include Nandi Kayyy, Dane Calabro, Divesh Brahmbhatt, and Kei Williams, all of whom use the pronouns they/them, but describe their gender identity in a variety of different ways. The video touches on gender, sexuality, identity, and the struggles of coming out as non-binary.
Simply put, gender non-forming is “a term used to describe some people whose gender expression is different from conventional expectations of masculinity and femininity.” Similar terms like genderqueer, gender fluid, non-binary, and gender variant express the recognition of a gender spectrum that exists beyond the male/female binary.
Another important distinction is the difference between sex and gender, two concepts often used interchangeably with each other. Sex is simply the medical assignment made at birth based on a baby’s external anatomy. Gender however, is how you feel inside, your sense of self. Sex and gender are entirely separate from sexuality/orientation, which is about who you are(or aren’t) sexually or romantically attracted to.
Despite being acknowledged across cultures and countries, the concept of gender variance is still widely misunderstood and dismissed. While gender variance has existed for centuries, many people struggle with upending and exploring identities beyond the binary.
It’s hard to break out of a system that’s been reinforced as a cornerstone of our identity since before we’re born. Just look at the rise in popularity of gender reveal parties, where parents and families gather together to cut open a cake or bust a pinata or smash a watermelon in an alligator’s mouth to get those pink vs. blue results.
But progress is happening: states like Oregon, Washington, New York and California have passed laws officially recognizing a third gender, and gender variant characters are appearing in popular culture (one of our faves, Steven Universe, gets a shout-out in the video).
For some people, gender identity is a fixed constant, while others experience gender as a fluid and ever-changing experience. There’s no wrong answer and no wrong way to identify: everyone moves at their own personal velocity. If you want to learn more, check out resources like GLAAD, The Non-Binary Resource and the Trevor Project or reach out to your local LGBTQ center.
When you think about gender, what comes to mind? Is it anatomy or the way someone dresses or acts? Do you think of gender as binary — male or female? Do you think it predicts sexual orientation?
Gender is often equated with sex — by researchers as well as those they research, especially in the health arena. Recently I searched a database for health-related research articles with “gender” in the title. Of the 10 articles that came up first in the list, every single one used “gender” as a synonym for sex.
Although gender can be related to sex, it is a very different concept. Gender is generally understood to be socially constructed, and can differ depending on society and culture. Sex, on the other hand, is defined by chromosomes and anatomy — labelled male or female. It also includes intersex people whose bodies are not typically male or female, often with characteristics of both sexes.
Researchers often assume that all biologically female people will be more similar to each other than to those who are biologically male, and group them together in their studies. They do not consider the various sex- and gender-linked social roles and constraints that can also affect their health. This results in policies and treatment plans that are homogenous.
‘Masculine?’ ‘Cisgender?’ ‘Gender fluid?’
The term “gender” was originally developed to describe people who did not identify with their biological sex. John Money, a pioneering gender researcher, explained: “Gender identity is your own sense or conviction of maleness or femaleness; and gender role is the cultural stereotype of what is masculine and feminine.”
There are now many terms used to describe gender — some of the earliest ones in use are “feminine,” “masculine” and “androgynous” (a combination of masculine and feminine characteristics).
Research shows that gender, as well as sex, can influence vulnerability to disease.
More recent gender definitions include: “Bigender” (expressing two distinct gender identities), “gender fluid” (moving between gendered behaviour that is feminine and masculine depending on the situation) and “agender” or “undifferentiated” (someone who does not identify with a particular gender or is genderless).
If a person’s gender is consistent with their sex (e.g. a biologically female person is feminine) they are referred to as “cisgender.”
Gender does not tell us about sexual orientation. For example, a feminine (her gender) woman (her sex) may define herself as straight or anywhere in the LGBTQIA (lesbian, gay, bisexual, transgender, queer or questioning, intersex and asexual or allied) spectrum. The same goes for a feminine man.
Femininity can affect your heart
When gender has actually been measured in health-related research, the labels “masculine,” “feminine” and “androgynous” have traditionally been used.
Research shows that health outcomes are not homogeneous for the sexes, meaning all biological females do not have the same vulnerabilities to illnesses and diseases and nor do all biological males.
However, as mentioned earlier, many health researchers do not measure gender, despite the existence of tools and strategies for doing so. They may try to guess gender based on sex and/or what someone looks like. But it is rare that they ask people.
A tool for researchers
The self-report gender measure (SR-Gender) I developed, and first used in a study of aging, is one simple tool that was developed specifically for health research.
The SR-Gender asks a simple question: “Most of the time would you say you are…?” and offers the following answer choices: “Very feminine,” “mostly feminine,” “a mix of masculine and feminine,” “neither masculine or feminine,” “mostly masculine,” “very masculine” or “other.”
It’s also important to note that the SR-Gender is not meant for in-depth gender research, but for health and/or medical studies, where it can be used in addition to, or instead of, sex.
Using gender when describing sex just muddies the waters. Including the actual gender of research participants, as well as their sex, in health-related studies will enrich our understanding of illness.
By asking people to tell us their sex and gender, health researchers may be able to understand why people experience illness and disease differently.
[F]eeling some sort of physical pain during intercourse is incredibly common — according to The American College of Obstetricians and Gynecologists, nearly three out of four women experience painful sex at some point in their lives.
Though it might make you feel slightly better to know you’re not alone, this fact likely offers little comfort when you’re in the middle of a sexual encounter and things just aren’t feeling right. Whether you’re dealing with muscle aches due to a position that doesn’t work for your body, irritation or burning on your skin, or a gynecologic condition like vaginismus or vulvodynia, there are definitely ways to help ease your pain so you can enjoy the pain-free, happy sex you deserve.
Here are nine ways you can make sex less painful.
1. Take things slowly — very slowly.
Foreplay is important.
Some people can just go right into sex as soon as the opportunity presents itself, but others require lots of foreplay before they’re ready to go. There is absolutely nothing wrong with this, but if you start having sex before you’re adequately turned on, you might feel pain, especially when it comes to penis in vagina intercourse.
“Many women think that if they feel excited, then they’re ready for sex,” Debby Herbenick, Ph.D., associate director of the Center for Sexual Health Promotion at Indiana University, told Women’s Health magazine in 2014. “But your body needs time to lift the uterus and make room for the vagina to expand. The latter can stretch from four inches long to a fully aroused seven inches.”
Quickies are great under the right circumstances, but if you rush into the main attraction without enjoying some previews before the show, you might feel pain, soreness, or irritation down below, so be sure to slow things down as needed. Herbenick recommended 20 minutes of foreplay to adequately prepare your body.
2. Be sure you’re using enough lubrication.
Vaginal dryness is common.
Although you still need to be sure that your body is ready for sex before your partner enters you, vaginal dryness can occur even if you’re fully ready to go. This is where lube comes in, so you’ll want to snag a silicone- or water-based lubricant, particularly one without harsh chemicals or fragrances so that you won’t risk irritating your genitals or skin.
Also, if you’re bathing in hot water pre-sex, you could be inadvertently drying out vaginal tissue. Checking with your doctor about any discomfort due to dryness is always the best option.
3. Check for allergies or other health conditions.
You could have a latex allergy.
If you’re feeling itchiness, burning, or irritation down below, you could be dealing with a number of health issues, so you’ll want to check with your doctor.
An itchy rash or hives can be symptoms of a latex allergy, as can vaginal irritation or burning. As Jonathan Schaffir, M.D., an OB-GYN at the Ohio State University Wexner Medical Center, told SELF magazine in 2016, “it is also possible to have a more severe form of allergy that leads to anaphylaxis, which involves system-wide swelling, dropping blood pressure, and difficulty breathing. That would be rare, but needs immediate medical attention.”
But acute reactions aside, latex allergies aren’t a huge deal, and you can safely switch to polyurethane condoms without issue. Still, pain, itchiness or irritation can be signs of other health conditions, including a yeast infection, STIs, vaginismus, vulvodynia, or an ovarian cyst, so paying a visit to your doctor is never a bad idea.
4. Try a different position.
Some positions may hurt more than others.
Unfortunately, some sex positions are more likely to cause pain during sex than others, which means you might need to get creative. Positions that allow for deep thrusting (such as doggie style) are often more painful for women, while those that allow the woman more control of the pace (such as woman-on-top, missionary, or side-by-side spooning) are often helpful if you’re experiencing painful sex.
Experiment with different positions to see which ones feel the most comfortable for you and your body.
5. Change things up completely.
Props are your friend.
If you’ve tried different positions but are still experiencing discomfort, Health suggested using props, pillows, or toys to make things feel better. Pillows are great to help align your body in a more comfortable position, and there are no shortage of sex toys and props out there to help alleviate any tension or stress in your muscles and joints. Getting a bit creative can help you explore new options while also helping to reduce pain.
6. Create a relaxing, sex-positive environment.
Clear your mind.
For many people, it can be hard to fully relax and enjoy the moment, which leads to tension in our bodies as we are having sex. So doing some things to help yourself feel connected in the moment is a great way to have more pleasurable sex.
Relaxation looks different for everyone, but some helpful tips include keeping a space free of clutter and mess, so you won’t be worried about getting cozy on top of a pile of clothes. Playing relaxing music, lighting candles, and keeping a comfortable temperature and linens might sound like a scene from a cheesy romance novel, but these things can all truly help you feel more at ease and able to be more present in the moment.
Trying out different mindfulness techniques can also help, and MindyBodyGreen reports that plenty of people enjoy meditation or breathing techniques to help their brain stay present and connected. Most of us lead such busy, hectic lifestyles that it can be hard to truly disconnect and enjoy sex, which could unknowingly be causing you pain or discomfort.
Meditation is a proven stress reliever, and research shows that when your body is producing too much of the stress hormone cortisol, it can be hard to get aroused. When you meditate, you’re naturally lowering the levels of cortisol in your body, which can help your mental health both in the sheets and outside of them.
7. Take a break from intercourse.
There are other ways to have intimacy.
It might sound obvious, but pain can often be a signal that your body needs a break, so it won’t hurt to listen to your body and explore other options for a little while. That doesn’t mean you can’t enjoy other forms of intimacy — if you haven’t enjoyed a makeout session in a long time, it can be a surprisingly fun way to keep the spark alive without the worries of pain down below.
Sometimes, all it takes is a little exploration of your bodies to figure out what works best — without pressure to climax or have a full-on sex session. It’s entirely possible you’re trying to have too much sex, which is especially common in the early stages of a relationship.
You should never push through pain or something that doesn’t feel right — forcing yourself to do something you’re not enjoying is not okay, so taking notice of your body and brain during sex is crucial.
8. Communication is key, so you’ll want to speak openly with your partner.
When you talk about it, you can take some of the scariness away.
No matter the reason you’re experiencing pain during sex, talking it out with your partner is a great way to help get you to a place where you’re both enjoying sex … without wincing in pain.
No one deserves to engage in sexual activity that makes them feel pain or discomfort, so sitting down with your partner is a good way to brainstorm solutions to help you both feel great. Maybe it’s a matter of changing up the speed or pace of sex, or you’re hoping to try new things.
Experimenting and giving honest feedback is never a bad idea, but it’s especially important if things haven’t been feeling right.
Also, if you have experienced sexual abuse of any kind, it can be understandably difficult to enjoy sex. It’s entirely up to you whether you discuss your feelings with your partner and when, but know this: your feelings are absolutely valid, and you have every right to discontinue sexual activity at any point, no matter the reason.
9. Be honest with yourself about what you want.
It may not be sex.
Our bodies are all different, and we all have different wants and needs, especially when it comes to sex. People of all genders are entitled to the sexual experiences they want, but it’s also OK if you’re not interested in sex right now or ever.
Pop culture might have you think that people want to have sex all the time, but there are plenty of reasons you might not want to, and they’re all perfectly valid.
If you’re recovering from illness or trauma, or simply don’t enjoy sex and think you might identify as asexual, you have every right to explore your feelings without forcing yourself to have painful sex. Talking with your partner can help, as can seeking the advice of a doctor or therapist you trust. You don’t have to do anything you don’t want to do sexually, no matter what movies or porn might suggest to the contrary.
[T]he #MeToo movement has pushed issues of consent to the foreground of our cultural zeitgeist. Confoundingly, though, some of the movement’s most vocal champions seem to be the worst at respecting the very conventions they are espousing. Shortly after now-former New York attorney general Eric Schneiderman filed a lawsuit against Hollywood producer Harvey Weinstein, for example, Schneiderman resigned in the face of four sexual-abuse allegations. In a public statement, he claimed that he had simply been engaged in “role-playing and other consensual sexual activities.”
If Schneiderman really believes that to be true, his understanding of what consent actually involves seems to be fundamentally confused. Consent demands thoughtful communication, careful reflection and sometimes takes practice. Few know this better than people who deal with consent every day as part of their jobs: sex workers, for whom negotiating consent and setting boundaries is central to the work of sex work. It’s our ability to tackle these issues that makes us good at what we do. As the conversation around consent moves ahead, it’s time others start learning from our own hard-won experience.
If turning to sex workers for conceptual clarity and moral guidance rings odd to you, it may be because we sex workers have been systematically excluded from these discussions. Many refuse to acknowledge that sex workers are even capable of exercising consent. This is the rhetoric of what anthropologist Laura Agustín calls the “rescue industry”— a term used to describe people and institutions who conceptualize all sex workers as victims in need of saving. Catherine MacKinnon has argued, for example, that “in prostitution, women have sex with men they would never otherwise have sex with. The money thus acts as a form of force, not as a measure of consent. It acts like physical force does in rape.” More recently, Julie Bindel has proposed, “In almost every case it’s actually slavery. The women who work as prostitutes are in hock and in trouble. They’re in need of rescue just as much as any of the more fashionable victims of modern slavery.”
This thinking casts sex workers as victims, entirely without agency of our own, while ironically speaking authoritatively about us without asking for our input. It’s a stance that parallels the hypocrisy behind Schneiderman purporting to champion consent for women while allegedly ignoring it in practice.
This is a mistake. As Lola Davina, former sex worker and author of several books, including “Thriving in Sex Work: Heartfelt Advice for Staying Sane in the Sex Industry,” put it to me in an email, she views “sex workers as soldiers on the front lines of the consent wars.” That squares with my own experience, which suggests that the lessons we teach may be broadly applicable. In my own work as a phone-sex operator, which I also write and podcast about under the name Jessie Sage, I’ve had numerous clients who have called me to rehearse future conversations or negotiations with their wives or partners. And my experiences merely scratch the surface of what’s possible.
With this premise in mind, I recently reached out to community organizer and writer Chanelle Gallant to ask what she thinks sex workers can offer. “Something unique about sex work is that consent is seen as a collective responsibility,” she said. “Sex workers organize to build their power and the ability to prevent abuse.” In some cases, that might involve exchanging information about bad customers, workplaces or managers. In others, it might be about collaborating to improve workplace conditions.
This collective organizing also translates to the interactions of individual sex workers with their clients. Stripper and journalist Reese Piper told me that she has had to learn how to avoid situations with people who will violate her. “Sex workers know how to walk away from people or situations that are dangerous or not worth our time,” she said. “It’s part of our job to detect dangerous customers. And it’s also our job to invest in customers that will value our labor.”
Alex Bishop, a sex worker and activist, talks about gaining these insights and skills as a gift that sex work has given her. She told me, “Before I did sex work, I didn’t think as deeply about sexuality and consent. I was still young and naive and slept with men because they bought me dinner or were nice.” It was her job that helped her change her way of thinking, so much so that she suggested she would like to see everyone try out sex work “for a few weeks,” if only to help open their eyes. To her way of thinking, “sex work instills a lot of confidence in those that do the work. It becomes easy to say no because you find yourself saying it all day long to clients.”
Piper agrees, telling me, “Stripping taught me how to value my time, my emotional energy and my body. It taught me how to stand up for myself. I never used to tell men who accosted me on the street to go away. Now it’s easy. I don’t feel bad about valuing my space and soul.”
Mistress Eva, who specializes in domme work, describes her interactions with clients as safer and defined than those outside of sex work. At the airport on the way home from DomCon, she took a few minutes to write to me: “I never have to hesitate about entering an interaction as a sex worker, because our interaction is always preceded by negotiation and an understanding of our combined desires and limits.”
Circling back to Davina, I asked for specific examples of how sex work has taught her how to negotiate consent. She explains, “Here’s what sex work taught me: I can say ‘yes’ to a lap dance then say ‘no’ to kissing. I can say ‘yes’ to kissing, then say ‘no’ to a blowjob. I can say ‘yes’ to a blowjob, then say ‘no’ to intercourse. … Saying ‘yes’ to one sexual act is saying ‘yes’ to that particular sexual act, and nothing more. Sex workers navigate these waters all day, every day.”
Recognizing that they can add a lot to our conversations around consent, many sex workers have taken it upon themselves to teach consent in their sex work practices. Ginger Banks, who has been a sex worker for eight years, told me, “After learning more about consent [as a sex worker] I see so many different ways that we violate it, possibly [unintentionally]. I think it is important to discuss this topic of consent with our fan bases.” Reflecting on her experience as a porn performer, she explained, “This is why I try and integrate the consent into my films, compared to just having it done just off camera. This way I can teach people about consent while they watch my films.”
It should be clear, then, that despite what the rescues industry assumes, we sex workers spend a great deal of our time both exercising and practicing consent. Significantly, we do so in the context of our relationships with clients. These sort of low stakes transactional interactions are fertile ground for productive consent work. Sex workers can, and often do, walk away from interactions with clients who fail to value consent. Accordingly, clients must practice negotiating consent in order for a transaction to continue. And, as my own experiences suggest, those are skills that they can transfer to their other relationships.
Given all of this, I’d argue that we need to empower sex workers to continue to do the sort of valuable, consent-focused work that we are already doing. In relationship to consent, we need to stop thinking about sex work as the problem, and start thinking about sex workers as part of the solution.
[A] few months ago over Sunday brunch, my 18-year-old daughter and I fell into a discussion about sex and dating. Between the omelets and crepes, she described how she felt about her new boyfriend, and I gave advice on enjoying their young love while retaining her independence and sense of self.
From the time she was in middle school, I have spoken to my daughter about how to stay safe on dates — never let anyone else get your drink, no means no, you do not have to do anything you do not want to do, always practice safe sex — and other rules I wanted her to live by. Every discussion we have had and every piece of advice I have given originated from our shared identity as cisgender, straight females.
Not long after that brunch, I read about a recent set of online focus groups conducted by Northwestern University that examined heterosexual parents’ attitudes toward talking about sex with their lesbian, gay, bisexual, transgender and queer teens. Some of the remarks from those parents made me realize how easy I have had it, in a way, talking with my teenage daughter. Few parents feel comfortable broaching the subject of sex with their children, but parents of LGBTQ teens have the added challenge of not always feeling equipped to talk about an experience they themselves have not had.
“I have no idea what sex is really like for men, especially for gay men,” one mother commented.
Another parent reported sending her bisexual daughter to a lesbian friend to talk to her about “gay sex.”
“I felt challenged that I’m straight, my daughter is dating a gal, and I didn’t know anything about that,” the mom wrote. “All my sex talks were about how not to get pregnant and how babies are conceived.”
Aside from sexual education in schools (which is not universal) teens learn about sex from their parents and peers, so if no one in their life knows what it is like to have the sex that corresponds to their orientation, they are left to fend for themselves. Michael Newcomb, lead author of the focus-group study and an assistant professor of medical social sciences at Northwestern University Feinberg School of Medicine, says it is difficult for heterosexual parents of an LGBTQ teen to give advice about how to stay safe when having sex. In fact, parents who participated in the Northwestern focus groups reported sexual safety was the most challenging subject for them when giving advice to their LGBTQ teens.
“The mechanics of sex are different for LGBTQ people in some ways, so those young people could be unprepared the first time they have sex and could get into unsafe situations,” Newcomb says. “Most often with safety, we think about prevention of things like HIV and STDs, but safety encompasses much more than that. It’s about not feeling coerced into having sex, it’s about feeling comfortable while you’re having sex, not being in pain; all of those kinds of things that would be very difficult to prepare for if no one in your life knew what it was like for you to have sex.”
About a quarter of the 44 parents in the focus groups expressed concerns about predators, with one parent of a 16-year-old, questioning, gender-nonconforming teen writing. “They are in a very vulnerable place, and sometimes I feel they are desperate for a true friendship/relationship. If they were to let someone in, I would really want to get to know the person and understand their intentions.”
Newcomb says because there are fewer LGBTQ people than there are heterosexuals, it can be difficult to find partners in more traditional settings, such as schools. So they may be more likely to meet partners online.
“Navigating who you can or cannot trust online can be very challenging, particularly when most people on those sites are adults,” Newcomb says. “If LGBTQ youth are highly motivated to meet partners online because they feel isolated, they may overlook some indicators that potential partners may not be trustworthy.”
I spoke with one mother who, with her husband, has two sons, one who is straight and the other who is gay. Long before her son came out to her when he was 14, she suspected he was gay.
“It was a matter of him getting comfortable talking to me about it,” says the mom, who asked to remain anonymous to protect her family’s privacy.
In the five years since, she has talked openly with him about sex and relationships and says she is lucky she has a lot of gay friends whom she often turned to for advice.
While acknowledging she needed some assistance with the more mechanical aspects of gay sex, she says she spoke to both her sons in the same way when it came to how good relationships work.
“It has nothing to do with being gay, but about keeping the lines of communication open and letting your kids understand that they are being listened to,” she says.
Newcomb, who is also a clinical psychologist, advises parents — whatever their teen’s sexual orientation — to initiate conversations about sex and dating, regardless of how uncomfortable they or their teenagers feel.
“The more frequently parents initiate conversations about sex and dating, the more likely it is that their child will come to them when they have a question or when they could potentially be in trouble,” Newcomb says.
He added it is important for parents to tell their LGBTQ teen their experience as a heterosexual person might be different and to acknowledge what they do not know. Newcomb suggests parents and their LGBTQ teen do research together online because parents may be better prepared to evaluate the credibility of the information. It also gives parents the opportunity to teach Internet literacy.
“Parents may need to help their teens figure out who they can and cannot trust online, as well as put in place strategies for staying safe when meeting people in person who they met online initially (for example, meet in public places or have a parent meet the other person first),” Newcomb says in an email.
He also recommends reaching out to organizations such as PFLAG, a national nonprofit that provides information and resources to LGBTQ people and their families.
“It’s a great support system for parents — particularly with a child who is first coming out — to be around other parents who are much more experienced. It can help in providing role models for how to effectively parent LGBTQ teens,” Newcomb says.
[L]et’s talk about how to talk about sex. When you think of ‘the talk’ what do you think of? Most people probably think of an awkward conversation about sex with a parent, teacher, or other adult, and it probably left much to be desired, quite literally. A new initiative from the National Coalition for Sexual Health (NCHS) and Altarum, called the Five Action Steps, aims to flip the unhealthy and often silent culture around sexual pleasure on its head. The action steps focus on normalizing conversations around sex, and provide the real-life skills and information that people need to have healthy conversations about physical intimacy and sex.
Telling someone what you do and don’t like or want isn’t a mood killer, but a lack of comprehensive sex education has made young people feel like they’re in the dark about how to have a healthy, consensual romantic or sexual relationship. According to a recent study from Harvard, 70% of the 18 to 25-year-olds who responded wished they received more information from their parents about some emotional aspect of a romantic relationship, and 65% wished they received more emotional guidance from sex education classes in school. As the study notes, “sex education also tends not to engage young people in any depth about what mature love is or about how one develops a mature, healthy relationship.”
Being able to talk honestly and openly with partners about your sexual desires, boundaries, and safe sex and sexual health care are all elements of a healthy relationship. Good sex should is just as much about communication as the physical act. Sex educator Shan Boodram talked to Teen Vogue and gave three key tips on how to talk about your stimulation of choice, your partners likes and dislikes, and more.
Know your body’s recipe for pleasure
“You need specific instructions on how it can work. It might be different depending on the heat, the flour, the temperature. Results can vary,” she told Teen Vogue. “You could cook something and throw some salt and cheese on there and it might be okay, but what would happen if you had a recipe and knew exactly what ingredients you needed to mix together and how to bake them just right to give you pleasure?” Finding out what kind of stimulation your partner enjoys, what positions they like, and how you both feel most comfortable practicing safe sex can be pleasurable in and of itself. However, according to Shan, “If you’re not talking about it with your partner, you’re doing a drastic disservice to the act and the potential it could have.”
Start the conversation by talking about your own likes and dislikes
Having too much pride and not knowing how to advocate for yourself are two barriers that might make talking about sex feel terrifying or awkward, Shan explained. Starting the conversation by talking about your own likes and dislikes, fantasies, and ideas can make it easier. “It can be, ‘What’s the hottest thing someone’s ever done for you before?’ Start asking the questions you want to ask. And hopefully that person will pick up on it and start doing the same things for you,” Shan told Teen Vogue, adding, “You want to ensure this conversation feels like good sex. You’ve gotta approach it with curiosity. Good sex is when you’re a tourist and not a tour guide. And you also want to be a tourist in this conversation. You’re curious and in this new space and you should be excited because you don’t have all the answers.”
The Five Action Steps suggests that talking to your partner about sex is a part of learning to treat your partner well and expecting them to treat you well. Shan explains that learning how to advocate for yourself can begin with talking about smaller desires with your partner, like what you want to watch on Netflix or what you want to eat for dinner. Starting small can help you talk about things that feel more complicated, according to Shan.
Give feedback
Part of talking to your partner about sex is also establishing boundaries. The most important thing to remember is that you deserve to be in a relationship where the amount of sex you’re having and the ways you’re being intimate align with what both you and your partner want and need. Sex, like any part of a relationship, is something that requires work, but talking about it can be as simple as telling someone when they do something you really like.
“You can say ‘I don’t like what you’re doing,” or wait for a moment when they do something you like and say, ‘More of that,’” Shan says. Positive reinforcement can make your partner feel confident about their abilities. Learning together is an option, too. Shan suggests that mutual masturbation is a great way to “show each other how you like to be touched.”
Ultimately, the Five Action Steps provide a framework for how to begin that conversation, and build a fulfilling relationship or partnership. And while sex and physical intimacy don’t necessarily have to be present in a relationship to make it healthy, talking to your partner is the only way to know how high of a priority sex is, and what your partner does or doesn’t like. That means it’s also an opportunity to help your partner understand exactly what you find most pleasurable.
[A] study has revealed that 36% of young men between the ages of 16 and 24 have experienced sexual performance problems in the last year.
The figures are higher for men between 25 and 34, with nearly 40% of those surveyed admitting to having issues in bedroom.
Sexual dysfunction is often linked to older men and Viagra use in the public consciousness, but it’s not just the over 50s who can have problems with sexual function.
The Sexual Function in Britain study shows that men of all ages are experiencing a range of sexual issues, including lack of interest in sex, lack of enjoyment in sex, feeling no arousal in sex, experiencing physical pain, difficulty getting or maintaining an erection and difficulty climaxing or climaxing too early.
Between 36% and 40% of men under 35 are experiencing one or more of these problems.
An honest conversation around these issues is long overdue.
‘When it comes to young people’s sexuality, professional concern is usually focused on preventing sexually transmitted infections and unplanned pregnancy. However, we should be considering sexual health much more broadly.’
Due to the sensitive and potentially embarrassing nature of the issue, it’s likely that many young men are not confiding in their partners or friends about it or visiting their GP.
Lewis, 32, has suffered from several of the problems mentioned in the Sexual Function study. He tells Metro.co.uk: ‘It can become a real issue in the bedroom but being completely open with your partner is always the best solution’.
After Lewis discussed what was going on with his girlfriend, they talked about how they could take the pressure off him to perform. Just being able to communicate the problem made it feel ‘less of a big deal’ and in turn made sex easier.
Men are far less likely to visit the GP than their female counterparts, with men only visiting the doctor four times a year compared to women who go to the GP six times annually. This can be potentially devastating for physical and mental health, and it also means that there are likely to be many men suffering in silence from serious sexual dysfunction issues who don’t feel able to reach out for professional help.
Last year, the government announced plans to make sex and relationships education compulsory for all schools in England. If young people are taught about the importance of consent and healthy relationships early on, it’s much easier for them to communicate with their partners without embarrassment and have positive, respectful sexual interactions.
Aoife Drury, a sex and relationships therapist based in London, blames the rise in sexual dysfunction among young men on easy access to porn without high-quality sex ed to offer a more balanced perspective on relationships.
She tells us: ‘Young men who lack sex education may be comparing themselves to porn stars on a physical and performance level (size of penis and how long they seem to last).
‘This can cause anxiety and self-esteem issues and can make intercourse with their sexual partner difficult. Erectile dysfunction may be the result alongside low libido.
‘The younger the age of the male when they begin to regularly watch porn, the greater the chance of it becoming their preference over partnered sex and the likelihood of developing a sexual dysfunction increases.
‘These is still more research needed around sex education, the ease of access to porn, potential for viewing preferences to escalate to more extreme material and the consequences for the younger generation.’
However, not everyone sees a direct correlation between porn viewing and problems in the bedroom. Kris Taylor, a doctoral student at the University of Auckland, writes for VICE: ‘While searching in vain for research that supported the position that pornography causes erectile dysfunction, I found a variety of the most common causes of erectile dysfunction.
‘Pornography is not among them. These included depression, anxiety, nervousness, taking certain medications, smoking, alcohol and illicit drug use, as well as other health factors like diabetes and heart disease.’
According to a 2017 Los Angeles research study, sexual dysfunction may be driving porn use, not the other way around. Out of 335 men surveyed, 28% said they preferred masturbation to intercourse with a partner. The study’s author, Dr Nicole Prause, concluded that excessive pornography viewing was a side effect of a sexual issue already being present as men who were avoiding sex with their significant others due to a problem would watch it when masturbating alone.
Of course, there’s nothing wrong with masturbating or watching videos of consenting adults having sex. The issue is choosing this because you’re unable to perform with a partner and feeling too ashamed to talk about it or seek help.
24-year-old Jack from London agrees. He told Metro.co.uk that he’d experienced sexual problems when he was with new partners.
He said: ‘After one month, you think you’re worthless and that she will leave you – this can cause a downward spiral and once you start thinking negatively, you’re even less likely to perform.
‘I talked with my partner about this (she was relieved it wasn’t something she’d done wrong) and opened up to my trusted friends. It felt like I really needed to do both of these to stop a shadow following me around.’
Jack spoke about growing up with male friends who wouldn’t talk about their feelings.
‘It was considered “gay” to do so. This whole culture needs to change.’
It’s absolutely essential that young people are given access to comprehensive sex and relationships education that emphasises the importance of communication and mutual respect. Partners who can effectively communicate with one another are more likely to have pleasurable and rewarding sexual experiences.
If you can’t ask for what you want in bed or speak up when there’s an issue, there’s a risk that sex will be dull, awkward, uncomfortable or worse.
Toxic masculinity also plays a role here, preventing men from opening up to friends or partners, or going to seek professional help. This can keep young men trapped in a cycle of sexual dysfunction and propagate the myth that sex issues are something that only old blokes need to worry about.
It can be a tricky subject to broach with your mates or your partner, but it doesn’t need to be. If you’re struggling in the bedroom, you’re certainly not on your own.
Ben Edwards, a relationship coach, is clear that the stigma around sexual dysfunction needs to change.
‘We need to accept that mental illness, anxiety and sexual difficulties are not weaknesses,’ he tells us. ‘They’re actually very common and should be dealt with. Admitting you need help is a great step and you’ll reap the rewards.
‘Men often feel they shouldn’t show their emotions, but it’s important to put egos aside and fix these issues for our own benefit.’
Basically, stress and shame are huge boner-killers. Ditch them in favour of openness, honesty and mutual pleasure.
[M]edical experts, sexologists, and other sexperts had a lot to say when a Twitter user named La Sirena tweeted on Monday morning that all women should be able to have orgasms from penetrative sex alone. “When a woman can’t have an orgasm from pure penetration she’s usually suffering from some deep-seated mental [and] spiritual blockages regarding her sexuality [and] her worth. She probably doesn’t trust her sexual partner much either,” she tweeted.
In addition to her tweet simply being inaccurate (it’s well-known that a majority of people who have vaginas don’t orgasm from penetration alone), it also caused outrage because, La Sirena is putting the blame 100% on women. That’s a problem, says Vanessa Marin, a sex therapist who specializes in teaching women how to orgasm, because many people who struggle to have orgasms already blame themselves. “A lot of women are beating themselves up,” she says. Her clients have told her things like: “I feel like I’m the only woman in the world who hasn’t figured this out.” “What’s wrong with me?” and “I feel like I’m broken,” Marin says.
These kinds of insecurities are common, especially since women’s sexuality is still so taboo. But Marin says that even though we’re talking about women’s pleasure more than ever, the way we’re talking about it isn’t helpful. Often, information about having orgasms if you have a vagina involves something simplistic like “relax and it’ll happen,” she says. So, that makes people who can’t just relax and let their orgasms flow feel as if there’s something wrong with them.
That’s the same kind of rhetoric we see in La Sirena’s tweet. She goes on to say that once a woman releases her trauma, she should be able to orgasm on demand. She suggests kegels and womb massages to release physical trauma, but stresses that mental blockages need to be cleared, too. While there is some truth to what La Sirena is saying — i.e. doing regular kegelscan cause stronger orgasms from penetrative sex and feeling emotionally distant or untrusting of a partnercan make it difficult to reach climax — the problem lays in how she’s saying it.
Many people on Twitter have called La Sirena out for spouting “misogynistic shit under the guise of female empowerment,” as Jennifer Gunter, MD, an ob/gyn and a pain medicine physician, tweeted. And her critics have a point. If Marin could rewrite the tweet, she’d say, “Hey look, there’s a lot that can get wrapped up in our orgasm and it’s important for us to try to explore what comes up for us [during sex] and prioritize learning about our bodies and our sexuality.” That way, there’s no judgement about people who can’t climax from penetration alone. Because, FYI, there are lots of other (just as amazing) ways to orgasm.
Reed said it was important that the ICD register, which is widely used as a benchmark for diagnosis and health insurers, includes a concise definition of compulsive sexual behaviour disorder to ensure those affected can get help.
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