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The Pill That Prevents HIV Is As Safe As Daily Aspirin

Taking Truvada every day to prevent HIV isn’t any more dangerous than taking a daily aspirin to prevent heart attacks, a new study finds.



People who take Truvada, the once-a-day pill that prevents HIV, are no more at risk for dangerous side effects than those who take an aspirin a day to prevent heart attacks, according to a new study.

Researchers compared Truvada and aspirin by looking at the drugs’ risk profiles in large, published studies. Although the two drugs come with distinct side effects — Truvada most commonly causes dizziness, vomiting, and weight loss, whereas aspirin is most commonly associated with bleeding problems — the frequency of side effects is roughly equivalent.

But the drugs have very different reputations, among both doctors and the general public. Century-old aspirin, when taken as a preventative tool against heart attacks, is viewed as an everyday medication, no big deal. But Truvada, also known as pre-exposure prophylaxis (or PrEP), is a new pill, intertwined with the loaded issues of HIV and sex habits, and mired in uncertainty.

“Everyone’s got aspirin in their medicine cabinet,” Jeffrey Klausner, professor of medicine and public health at the University of California, Los Angeles, and lead author of the study, told BuzzFeed News. “But as a physician I’ve seen people come into the hospital and die from aspirin overdoses — people can be allergic.”

The side effects of each drug are markedly different, Klausner noted, and affect different organs. But after crunching the numbers, he said, “it really looked like I could say Truvada compared favorably, in terms of its safety profile, to aspirin.”

An estimated 52% of American adults aged 45 to 75 are prescribed a daily aspirin to prevent cardiovascular and gastrointestinal diseases, including heart attacks and cancer.

Truvada, which was approved by the FDA in 2012, has been shown to have roughly 92% efficacy in preventing transmission of HIV. The CDC estimates that about 1.2 million Americans are at high enough risk for contracting HIV that they should be prescribed the drug. But only about 21,000 currently get it.

According to Klausner, who trains doctors around the country on how to treat and prevent HIV, much of this has to do with ambivalence about prescribing otherwise healthy individuals a daily pill.

“A lot of the concerns I hear from providers are about safety,” Klausner said. “There have been continued voices saying, ‘Wouldn’t it just be better if people used condoms, or reduced their number of partners?’ Those are important strategies, but they don’t work for everyone.”

The issue of doctor awareness about PrEP is one of the biggest barriers to its wider use.

The new study “is an interesting thought experiment,” Dawn Smith of the CDC’s Division of HIV/AIDS Prevention, told BuzzFeed News. But, she added, “I’m not sure it addresses the safety concerns that some clinicians have.”

Smith noted a CDC study showing that in 2015, about one-third of primary care doctors and nurses had never heard of Truvada. Beyond the lack of awareness, she said, doctors don’t want to cause any side effects, no matter how minor, in otherwise healthy patients.

In his analysis, Klausner looked at the “NNH” — or “number needed to harm” — meaning the number of people who take the drug before one person experiences a harmful side effect. The NNH for Truvada in gay men or transgender women was 114 for nausea and 96 for unintentional weight loss. In women, side effects appeared more frequently, with 1 in 56 women experiencing nausea, 1 in 41 vomiting, and 1 in 36 mildly elevated liver enzymes.

Rarer adverse events for Truvada include kidney problems and a small decrease in bone mineral density, but Klausner notes that both of those effects have been shown to be reversible once the medication is discontinued.

In contrast, aspirin had an NNH of 15 for bleeding problems and 20 for easy bruising. Rarer problems included ulcers and other gastrointestinal problems.

Because it’s so much older, aspirin has been tested in many more people with many more years of follow-up, Klausner noted. Because Truvada is a relatively new drug, it will take awhile to accrue the data needed to make its long-term safety bulletproof.

In the meantime, however, Klausner hopes more doctors will educate themselves about the HIV prevention drug. And after that, he said, “we should work to make it the same price as aspirin.”

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Weed Lube Is Not Lube

But It Apparently Works Magic on Vaginas

Sensual cannabis

Sensual cannabis oil magnifies sensitivity and sensation.

People are freaking out over weed lube. Rightly so, I guess, because it’s apparently magical. But while weed lube is lubricating, it isn’t lube, per se. As in, its main use is not to facilitate intercourse.

Lena Davidson, the marketing manager for botanicaSEATTLE—the company behind BOND Sensual Oil—told me that what most people would call weed lube is really more of a massage oil. Like other cannabis topicals and unlike a traditional lube, it takes 20 to 40 minutes to work and is a self-contained experience that can be enhanced by sex. Being oil-based, it is also not latex safe. People call it weed lube, she says, because we’re basically all teenage boys and we can’t talk about weed or sex without snickering.

As much fun as it is to giggle about getting one’s “pussy stoned” (as Vice did), weed lube is serious business. Sensual cannabis oil, as it is more accurately called, has all sorts of awesome ramifications for sexual equity. Davidson pointed out that while there are more than 26 products approved by the FDA to treat sexual dysfunction in men, there is only one approved for women, and it is the subject of much controversy. Sensual cannabis oil is a long way off from FDA approval, but judging from testimonials thus far, it seems to be doing consistently what that one drug does inconsistently: increasing female sexual pleasure. Women who have used BOND reported “ethereal, long-lasting, and out of this world” sexual experiences, and the ability to rapidly “peak… and then do it again quite quickly,” according to testimonials on BOND’s website. Multiple orgasms are apparently common.

Cannabis-LubeHow does it work? Davidson writes: “THC is absorbed through the mucous membranes that are in high concentrations in a woman’s vagina. Once applied and absorbed, THC acts locally on the cannabinoid receptors, much like an edible. Functionally, the THC dilates the capillaries and increases blood flow in the smallest blood vessels in our body—this enhanced microcirculation magnifies sensitivity and sensation.” (She also mentioned that this same capillary reaction is what causes stoney red eyes.) The experience is not like the head high one gets from smoking or eating weed, but rather a localized sensation of pleasure, users report.

It’s also important to note that, at least here in Washington, sensual cannabis oil is safe. Davidson cautioned that not all weed lube is created equal, but BOND and Ethos Extracts‘ Temptress are made in a WSDA-approved kitchen with food-grade organic coconut oil and ultra-pure cannabis extracts. Coconut oil, though unfriendly to latex, is ideal for internal use because of its natural pH-balancing and antimicrobial qualities.

While the potential to help women with issues such as vaginismus (vaginal pain) and low libido is great in its own right, perhaps the most exciting thing about sensual cannabis oil is that it is a decidedly non-heteronormative phenomenon. What I mean by that is it takes the focus off of the penis as the center of sexual pleasure, where it has been for far too long.

My good friend Kat, a big proponent of sensual cannabis oil and the source of much of my education on feminism, put it thusly: “It’s unfortunately common during heteronormative sex that women feel like their partner’s ejaculative experience is the focal point. I’m usually acutely aware of the other person’s level of satisfaction, which takes me away from my own body. With the weed lube, I’m like, ‘Fuck yeah, I’m getting it and it feels fucking amazing.’ I’m actually relaxed and stimulated enough to invest in my own delectation.”Cannabis

And though much has been made of sensual cannabis oil not working for men, that’s not entirely true. It doesn’t work well for selfish straight men who are only interested in receiving blowjobs and having vaginal intercourse (because the penis does not absorb the cannabis oil in the same way that the vagina does). It does, however, work really well for men (and women) who are into anal play, as the absorption of THC through the back door is rapid. Used anally, sensual cannabis oil does not offer the same direct enhancement of physical sensation as it does to the vagina, but it does get you high as fuck, which enhances sex in its own right. Also, anyone willing to perform a little enthusiastic cunnilingus—as any self-respecting straight dude should be—will get a light edible-style buzz. Basically, anything that has not traditionally been part of the penis-obsessed, heteronormative sexual canon is made better with sensual cannabis oil. If that isn’t sweet sexual justice, I don’t know what is.

Speaking of sexual justice, sensual cannabis oil also works well for older women—another segment of the population whose sexual lives are often not valued in the heteronormative conversation. Women’s bodies produce less lubrication during and after menopause, and older women can also suffer from decreased libido and other sexual difficulties—problems that sensual cannabis oil can help with. Edward Lafferty, Ethos’s CEO, said that women older than 45 and gay men make up the bulk of his business for the Temptress oil. During product testing of BOND, “nearly every woman had a ‘Eureka!’ moment,” said Davidson. And “for women who had felt estranged from their innate sexuality by age or physical conditions, it instigated a wave of natural physiological desire.”

Davidson worries that those who might benefit most from sensual cannabis oil will not do so because of the continued cultural awkwardness around weed, sex, and weedy sex. She pointed out that women are statistically less likely to try cannabis products in general, let alone walk into a weed store and ask a scruffy dude about something as personal as their sexual health. What’s more, sensual cannabis oil is still perceived as a sex-shop novelty—something for young party people to rub on one another after the rave, not something that can help women have more sexually fulfilling lives.

But, as Lafferty put it, “The people who use it need it. It’s important. We can be squeamish, but it works.” So let’s get one thing straight: Weed lube isn’t lube, and it’s also not a novelty. According to many of those who’ve tried it, it’s a godsend. recommended

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Notching the belt

Hey Doc,

So I’ve asked you a question anonymously before and you were a huge help so here I am again.
My names Mike and I’m 17 years old. For some reason it takes me a ridiculously long time to “finish” with my girlfriend. It’s not her, because this has happened with about 4 or 5 other women before her. It’s an annoying flaw that it takes me about 90 minutes to finish, if I finish at all. My GF and I get tired and eventually just stop because it’s too tiring and just plain tiresome. Is it performance anxiety or something? My first time having sex was anal with a girl, and I have done anal with girls many times before so it was a lot tighter than vaginal intercourse, not sure if that affects anything… I am really tired of lasting so long; I just want to be done when she is, much earlier.

I’ll be glad to answer any questions or anything you might need to know,
Thank you so much in advance, Mike.

finger fuck00445Where to begin, Mike? You’re 17, you’re having performance problems with your GF and you have had with about 4 or 5 other women before her. Holy Cow! you certainly are a sexually precocious lad, aren’t you?

I can’t help but notice a bit of sexual bravado in your message. I don’t know if that’s intended or if it’s more of a subliminal message. Either way, I have a feeling that there is some belt notching goin on here and that may be the root of your problems.

Here’s why I say this. There is nothing in your message that communicates that the sex you’re having is fun, or that it’s play. All I hear is that you’re a young man on a mission. You want to get off in a timely fashion and you’re currently being frustrated in that pursuit. You sound so goal oriented and your sex sounds like a task, rather than a playful adventure.

Us men folk get like this sometimes; and we’re the poorer for it. We’re all about solving a problem instead of enjoying the moment. The curious thing about this is that enjoying the moment is often the best way to solve a sexual performance problem.bryan_tony_box

When I hear men and/or women talking about their sex life like it’s work, I know there will be problems ahead. And you, Mike, sound like your sex is way more work than fun. If you were a sex worker or a porn star, I’d understand your predicament. But I suspect that you are neither a sex worker nor a porn star. You are, however, a young man who has, for one reason or another, scuttled all the joy and wonderment from your sex play. And that, my friend, is a crying shame…and at your tender age too. How do you suppose you’ll behave when you’re an old man of 25?

This path you’re on will continue to lead you into a sexual wilderness. You will become increasingly frustrated in your efforts to cum “on time”…and I use that term in quotes, because you’re all about bangin’ something rather than pleasuring and being pleasured by someone.

The comment you make about the difference between butt sex and pussy sex also tells me a lot about the kind of tightness you need to get off. I’d be willing to guess that you have a death grip on your johnson when you wank; am I right? Obviously your average asshole is a tighter orifice than your average pussy. But, if you were really turned on and enjoying the mutual pleasure available to you and your partner, instead of worrying about busting your nut during the fuck itself, you could jettison all those “shoulds” you have when you’re supposed to be enjoying yourself in the company of your lover.

beltWhy not stop what you are doing and take a look at why and how you are doing it. You may surprise yourself with what you find. And if you are man enough, have a heart-to-heart chat with your GF and get her feedback on what she encounters when she fucks you. Again, I’d be willing to guess she’d have some timely advice to offer you on how to fuck and get fucked.

Good Luck

A Story With A Happy Ending

Name: Nathan
Gender: Male
Age: 37
Location: Dallas
I’m a married guy with a great wife and 3 beautiful kids. A couple of weeks ago, I went to a masseuse I found on Craigslist. I don’t have a lot of experience with massage and thought I would be safe going to a guy instead of a woman. The guy was really nice and did a good massage, but somehow I popped wood near the end of the massage. I was really embarrassed, but he was like totally ok with that. Then he asked if I wanted a happy ending. I didn’t even know what that was till he started to massage my ass and blow me. I have to admit it was totally amazing. I never felt anything like it before in my life. My wife sometimes will give me oral sex, but nothing like this. I blew a load like nothing I ever did before. I though my insides were coming out of my cock. I was amazed and scared and confused and I could hardly sit up. Then the guy said I had a real healthy prostate. I said, WHAT? And he said he was massaging my prostate while he was sucking me off. I can’t stop thinking about this. I want more but I feel really guilty and I’m afraid this is going to make me gay.

What a great story, Nathan. But we need to clear up a few things. A masseuse is a female practitioner of massage. A masseur is a male practitioner. This is a common enough mistake, but I thought you should know the proper usage for further reference. Because you can see how a little unintended slip like this will make all the difference in the world. If you say a masseuse gave you a blowjob that’s totally different from getting a blowjob from a masseur, don’t ‘cha know.massage_butt.jpg

I’m gonna also guess you never had a prostate massage before this encounter with the masseur. A prostate massage coupled with your first blowjob from a guy…hell, you are lucky your insides didn’t shoot out your dick along with your spooge. I’m joking of course, but it does stand to reason that you had such an intense and explosive orgasm and ejaculation. That’s precisely what a prostate massage does, honey.

Now, let’s see if we can figure out why you can’t stop thinking about this. It doesn’t take a rocket scientist to analyze that either. This was a peak sexual experience for you. I mean, beside the mind-blowing release, the means by which you had this orgasm — the guy’s finger in your ass and the guy’s mouth on your dick were both unexpected and apparently unprecedented. So I figure you had very little time to cognitively respond to the stimuli before things came to their explosive climax, so to speak, as it were. And you did say you were already relaxed and aroused by the massage, right?

I’d be willing to bet that if you had some emotional distance from the experience you would realize your body was simply responding to the stimulus it was receiving. Your dick and your prostate weren’t able to distinguish the gender of the person diddlin’ your ass and suckin’ your dick. And since your brain was occupied with all these new sensations you had little time, if any to process and possibly protest. And maybe you wouldn’t have protested even if you could. Maybe you wanted to take this little walk on the wild side. Trust me, lots of guys do.

come as you areNow that the event has passed, you have plenty of time to process. And process you are…to within an inch of its life…if ya ask me. This experience looms so large for you because it is forbidden fruit, so to speak. It upsets the apple cart of your cozy and predictable heterosexuality. I mean it’s one thing to pop wood on a massage table. It’s something totally different to blow a wad while a guy is givin’ you head.

And now that you have all this time on your hands to keep pouring over and over this in you head, the event has taken on a proportion it probably wouldn’t have otherwise.

Let me put your mind to rest, one blowjob from a guy…even an earth-shatterin, prostate-massagin’ blowjob, like the kind you got from this fabulous masseur…won’t make you gay. Nor does wanting to repeat the experience make you gay. All this experience really tells us is that you like a good blowjob and you now know where to get a really fantastic one when next you want one.

Think about it this way. Say you went to a Chinese restaurant and, to your great surprise, had the best dim sum ever. You were so impressed with the food that you’ve been eager to return to this particular eatery for another go at those tasty vittles. Does this desire for yummy dim sum make you Chinese? I don’t think so…that is unless you were Chinese before you went to the restaurant.

Finally, the guilt you’re experiencing, where might that be coming from? There are so many sources one would be hard-pressed to come up with an exhaustive list. But let’s look at the top contenders.hands & butt

  • You’re married with a family. You had a sexual experience…unplanned as it might have been…with someone other than your wife. BINGO!
  • Our culture’s buttoned-down sex and gender stereotypes — who can do what to whom. BINGO!
  • The dictates of our sex-negative society about what is proper and what is not in terms of sexual exploration and experimentation. BINGO!
  • The shame of possibly being labeled a fag. BINGO!
  • The fear of your own desires and where they might lead you. BINGO!
  • The allure of the forbidden and the explosive charge the illicit. BINGO.

The experience you had with that masseur, Nathan, is so highly charged, both culturally and sexually, that it will take some while for you to find your balance once again. In the interim, my I suggest that you postpone any judgments about yourself or what the incident might imply about you until you’ve have some emotional distance and the time to calmly process all of this. In the final analysis, I think you’ll come to the conclusion that this is a relatively harmless sexual outlet. The masseur is providing you a service…I mean beyond the obvious. He is providing you a safe, secure non-judgmental environment to exercise and expand your sexual repertoire. Think of it like a place you go to learn about the wonders of sexual dim sum.

Good luck

No, Scientists Have Not Found the ‘Gay Gene’

By Ed Yong

The media is hyping a study that doesn’t do what it says it does.

A woman works with human genetic material at a laboratory in Munich May 23, 2011. On May 25, 2011 the ethic commission of the German lower house of parliament (Bundestag) will discuss about alternative proposals for a new law on the use of preimplantation genetic diagnosis (PGD). Preimplantation genetic diagnosis (Praeimplantationsdiagnostik) is a technique used to identify genetic defects in embryos created through in vitro fertilization (IVF) before pregnancy, which is banned by German legislation.

This week, a team from the University of California, Los Angeles claimed to have found several epigenetic marks—chemical modifications of DNA that don’t change the underlying sequence—that are associated with homosexuality in men. Postdoc Tuck Ngun presented the results yesterday at the American Society of Human Genetics 2015 conference. Nature News were among the first to break the story based on a press release issued by the conference organisersOthers quickly followed suit. “Have They Found The Gay Gene?” said the front page of Metro, a London paper, on Friday morning.

Meanwhile, the mood at the conference has been decidedly less complimentary, with several geneticists criticizing the methods presented in the talk, the validity of the results, and the coverage in the press.

Ngun’s study was based on 37 pairs of identical male twins who were discordant—that is, one twin in each pair was gay, while the other was straight—and 10 pairs who were both gay. He analysed 140,000 regions in the genomes of the twins and looked for methylation marks—chemical Post-It notes that dictate when and where genes are activated. He whittled these down to around 6,000 regions of interest, and then built a computer model that would use data from these regions to classify people based on their sexual orientation.

The best model used just five of the methylation marks, and correctly classified the twins 67 percent of the time. “To our knowledge, this is the first example of a biomarker-based predictive model for sexual orientation,” Ngun wrote in his abstract.

The problems begin with the size of the study, which is tiny. The field of epigenetics is littered with the corpses of statistically underpowered studies like these, which simply lack the numbers to produce reliable, reproducible results.

Unfortunately, the problems don’t end there. The team split their group into two: a “training set” whose data they used to build their algorithm, and a “testing set”, whose data they used to verify it. That’s standard and good practice—exactly what they should have done. But splitting the sample means that the study goes from underpowered to really underpowered.


There’s also another, larger issue. As far as could be judged from the unpublished results presented in the talk, the team used their training set to build several models for classifying their twins, and eventually chose the one with the greatest accuracy when applied to the testing set. That’s a problem because in research like this, there has to be a strict firewall between the training and testing sets; the team broke that firewall by essentially using the testing set to optimise their algorithms.

If you use this strategy, chances are you will find a positive result through random chance alone. Chances are some combination of methylation marks out of the original 6,000 will be significantly linked to sexual orientation, whether they genuinely affect sexual orientation or not. This is a well-known statistical problem that can be at least partly countered by running what’s called a correction for multiple testing. The team didn’t do that. (In an email to The Atlantic, Ngun denies that such a correction was necessary.)And, “like everyone else in the history of epigenetics studies they could not resist trying to interpret the findings mechanistically,” wrote John Greally from the Albert Einstein College of Medicine in a blog post. By which he means: they gave the results an imprimatur of plausibility by noting the roles of the genes affected by the five epi-marks. One is involved in controlling immune genes that have been linked to sexual attraction. Another is involved in moving molecules along neurons. Could epi-marks on these genes influence someone’s sexual attraction? Maybe. It’s also plausible that someone’s sexual orientation influences epi-marks on these genes. Correlation, after all, does not imply causation.

So, ultimately, what we have is an underpowered fishing expedition that used inappropriate statistics and that snagged results which may be false positives. Epigenetics marks may well be involved in sexual orientation. But this study, despite its claims, does not prove that and, as designed, could not have.

In a response to Greally’s post, Ngun admitted that the study was underpowered. “The reality is that we had basically no funding,” he said. “The sample size was not what we wanted. But do I hold out for some impossible ideal or do I work with what I have? I chose the latter.” He also told Nature News that he plans to “replicate the study in a different group of twins and also determine whether the same marks are more common in gay men than in straight men in a large and diverse population.”Great. Replication and verification are the cornerstones of science. But to replicate and verify, you need a sturdy preliminary finding upon which to build and expand—and that’s not the case here. It may seem like the noble choice to work with what you’ve got. But when what you’ve got are the makings of a fatally weak study, of the kind well known to cause problems in a field, it really is an option—perhaps the best option—to not do it at all. (The same could be said for journalists outside the conference choosing to cover the study based on a press release.)As Greally wrote in his post: “It’s not personal about [Ngun] or his colleagues, but we can no longer allow poor epigenetics studies to be given credibility if this field is to survive. By ‘poor,’ I mean uninterpretable.”

“This is only representative of the broader literature,” he told me. “The problems in the field are systematic. We need to change how epigenomics research is performed throughout the community.”

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