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Sex, Drugs, and Alcohol

High-risk sex, girl-on-girl experimenting linked among NYC teens

By Susan Edelman

Nearly half the Big Apple’s sexually active high-school girls have had female partners — and many engage in behavior that endangers their health, an alarming new study finds.

Researchers from New York University and the Albert Einstein College of Medicine based their findings on a 2013 survey of public high-school students citywide — but most heavily in “high-risk neighborhoods” in the Bronx, Brooklyn and Manhattan.

Of 4,600 girls surveyed, 1,101, or 27.5 percent, were sexually active. Of those, 513, or 46.6 percent, reported same-sex experiences, according to the study, published this month in the Journal of Pediatric and Adolescent Gynecology.

This “vulnerable population of girls” who engage in same-sex or bisexual activity are twice as likely as heterosexual teens to be sexually active. The researchers also found:

  • These girls start having sex sooner, have more sexual partners and suffer more “intimate partner violence.”
  • They are less likely to use contraceptive methods — putting them at higher risk of unplanned pregnancy if they also have sex with boys.
  • They use more alcohol, marijuana and other illicit drugs.
  • They report more suicidal thoughts or attempts. Girls “not sure” of their sexual orientation are at highest risk of trying to kill themselves.
  • Even though female-to female transmission of HIV is possible, many of these girls do not test for it or other sex-related diseases.

Dr. Chanelle Coble, an adolescent pediatrician and assistant professor at NYU Langone Medical Center, co-authored the study with Einstein assistant professors and psychologists Rosy Chhabra and Ellen Silver.

The researchers found the abundance of same-sex activity even though not all teens who indulged identified themselves as lesbian or bi-sexual.

“Just looking at how someone describes themselves doesn’t tell the whole story,” Coble said. “When they’re young, it’s harder for them to be specific about their identity — they’re still exploring and figuring it out.”

An advocate for lesbian and bisexual youth called the study’s results, “disheartening, but not surprising.”

Lesbian and bisexual girls are often stigmatized and treated with hostility, said Emily Greytak, research director for GLSEN, a Manhattan-based group that promotes safe schools for LGBT students.

“That can lead to more risky behavior, and takes a toll on their health,” she said.

The surveys were conducted by the city Department of Health for the US Centers for Disease Control and Prevention.

Complete Article HERE!

Time for a Sexual Revolution In Health Care Treatment

Why is care for sexual health issues considered a luxury when it’s a necessary part of population health?

By Zachary Hafner

When Americans seek care for most common health conditions, there is rarely much question about coverage. Every day, consumers—including those on Medicaid and Medicare—seek care for sore joints, depression, and even acne without worrying about whether or not their insurance will cover their doctor visits and medications. For the most part, coverage for sexual health issues is less straightforward—but why? Is it because sexual health issues are not considered legitimate illnesses? Because the costs are significant? Or is it because raising the topic of sexual health can offend certain personal and organizational values? Whatever the reason, it is time for a change.

It’s hard to deny the human and economic burden of sexually transmitted infections (STIs) on this country. The CDC estimates that 110 million Americans are infected with an STI, resulting in direct medical costs of $16 billion annually. The most common and fastest growing STI in this country is human papillomavirus (HPV), and it is estimated that half of sexually active men and women will get HPV at some point in their lives. In 2006, a vaccine for HPV was introduced and now there are several. CDC guidelines recommend administering a multi-dose series, costing about $250–450, to all boys and girls at age 11 or 12. (Some states require the vaccine for school admission.) It was included in mandatory coverage under the ACA. Since the HPV vaccine was first recommended in 2006 there has been a 64% reduction in vaccine-type HPV infections among teen girls in the United States.

It seems clear that this kind of care for sexual health is necessary for public health and is also part of caring for the whole individual, a central tenet of population health. But what about sexual health care that doesn’t involve infectious disease? Is it still a population health issue if there’s no communicable disease involved?

Let’s take erectile dysfunction (ED) for example. It is nearly as common in men over 40 as HPV is in the general population—more than half of men over 40 experience some level of ED, and more than 23 million American men have been prescribed Viagra. With a significant portion of the population suffering from ED, is it important for payers and providers to consider ED treatment to be essential health care and to cover it accordingly? Medications like Viagra and Cialis are an expensive burden at upwards of $50 per pill. Medicare D does not cover any drugs for ED, but some private insurers do when the medications are deemed medically necessary by a doctor. A handful of states require them to do so, but they are typically listed as Tier 3 medications—nonessential and with the highest co-pays.

Almost 7 million American women have used infertility services. Coverage for infertility diagnosis and treatment is not mandated by the ACA, though 15 states require commercial payers to provide various levels of coverage. The cost of infertility treatments is highly variable depending on the methods used but in vitro fertilization treatments, as one measure, average upward of $12,000 per attempt.

Are treatments for ED and infertility elective or necessary? In an age of consumerism and heightened attention to the whole patient across a broader continuum of care, organizations that support the availability of a broad set of sexual health services to a diverse group of consumers will have a big competitive advantage, but they may face challenges balancing the costs. Health care has advanced in both technical and philosophical ways that allow people to manage their diseases, cure their problems, and overcome limitations. It has also shone light on the significant advantages to considering a diagnosis in the context of the whole individual—their social and emotional health as well as coexisting conditions. Studies have shown, for example, that infertility, ED, and STIs all have a significant relationship with depression and anxiety.

It’s time sexual health was folded in to the broader definition of wellness instead of marginalized as a separate issue. For too many Americans, it’s too big an issue not to address.

Complete Article HERE!

Coming down from the high:

What I learned about mental health from BDSM

By Jen Chan

Not too long ago, I took my first step into the world of kink. I was a baby gay coming to terms with my borderline personality disorder (BDP) diagnosis, looking for any and every label that could help alleviate the lack of self-identity that comprises my BPD.

I knew I was queer. I knew I identified as femme. But I didn’t know if I was a dominant (top), a submissive (bottom), or a pillow princess; I didn’t even know if I was kinky.

So I tried to find out.

I began to notice a pattern. The sheer rush of euphoria and affection created a high I felt each time I “topped” my partner, and it would sharply drop the minute I got home. I was drained of energy and in a foul mood for days, often skipping work or class. I felt stuck on something because I wanted to feel that intensely blissful sex all over again, but I couldn’t figure out how to get it back.

If you’re familiar with the after-effects of taking MDMA—the crash, the lack of endorphins, the dip in mood for up to a week later—then you’ve got a pretty good idea of how a “drop” felt for me. Just add in an unhealthy serving of guilt and self-doubt, a pinch of worthlessness and a dash of contempt for both myself and my partner, and voila! Top drop: the less talked about counterpart to sub drop where the dominant feels a sense of hopelessness following BDSM—bondage and discipline, domination and submission, sadism and masochism—if after care is neglected.

In the BDSM community, it’s common to talk about the submissive (sub) experience: To communicate the expectations and needs of the submissive partner before engaging in consensual kinky play, to make sure the safety of the sub during intense physical and/or psychological activities is tantamount, to tend and care for the sub after the scene ends and they’re brought back down to earth.

Outside of this, the rush of sadness and anxiety that hits after sex is known as post-coital tristesse, or post-coital dysphoria (PCD). It is potentially linked to the fact that during sex, the amygdala—a part of the brain that processes fearful thoughts—decreases in activity. Researchers have theorized that the rebound of the amygdala after sex is what triggers fear and depression.

A 2015 study published in the Journal of Sexual Medicine found that 46 per cent of the 230 female participants reported experiencing PCD at least once after sex.

Aftercare is crucial and varies for subs, depending on their needs. Some subs appreciate being held or cuddled gently after a scene. Others need to hydrate, need their own space away from their partner or a detailed analysis of everything that happened for future knowledge. But no matter what the specific aftercare is, the goal is still the same: for a top to accommodate a sub and guide them out of “subspace”—a state of mind experienced by a submissive in a BDSM scenario—as directly as they were guided in.

I asked one of my exes, who’s identified as a straight-edge sub for several years, what subspace is like. As someone who doesn’t drink or do drugs, I was curious about what it was like for them to reach that same ephemeral zone of pleasure.

“It gets me to forget pain or worries, it gets me to focus only on what I’m feeling right then,” they told me. “It’s better than drugs.”

My ex gave up all substances in favour of getting fucked by kink, instead. I’m a little impressed by how powerful the bottom high must be for them.

“The high for bottoms is from letting go of all control,” they added. If we’re following that logic, then the top high is all about taking control.

We ended the call on a mildly uncomfortable note, both trying not to remember the dynamics of control that ended our relationship.  Those dynamics were created, in part, by my BPD, and, as I would later discover, top drop.

In the days to follow, I avoided thinking about what being a top had felt like for me and scheduled a lunch date with another friend to hear his perspective.

“Being a dom gives you the freedom to act on repressed desires,” he told me over a plate of chili cheese fries. This is what his ex said to cajole him into being a top—the implied “whatever you want” dangled in front of a young gay man still figuring himself out.

He was new to kink, new to identifying and acting on his desires, and most of all, new to the expectations that were placed on him by his partner. He was expected to be a tough, macho top to his ex’s tender, needy bottom. His after-care, however, didn’t fit into that fantasy. If that had been different, maybe he wouldn’t have spiraled into a place where his mental health was deteriorating, along with his relationship.

The doubt and guilt that he would often feel for days after a kinky session mirrored my own. We both struggled with the idea that the things our partners wanted us to do to them—the things that we enjoyed doing to them—were fucked up. It was hard to reconcile the good people that we thought we were, the ones who follow societal expectations and have a moral compass and know right from wrong, with the people who are capable of hurting other people, and enjoying it.

For my friend, there was always a creeping fear at the back of his mind that the violence or cruelty he was letting loose during sex could rear up in his normal life, outside of a scene.

For me, there was a deep instinct to disengage, to distance myself emotionally from my partner, because I thought that if I didn’t care about them as much, then maybe I wouldn’t hate them for egging me on to do things I was scared of.

My friend has since recognized how unhealthy his relationship with his ex was. These days, he identifies as a switch (someone who alternates between dominant and submissive roles). The deep-seated sense of feeling silenced that was so prevalent in his first kinky relationship, is nowhere to be seen. He communicates his sexual needs and desires and any accompanying emotional fragility with his current partner. He’s happy.

I’m a little envious of him. My second-favourite hobby is rambling about all of the things I’m feeling, and it’s a close second to my favourite, which is crying. I credit my Cancer sun sign for my ability to embrace my insecurities, but there’s still something that makes me feel like I’m not equipped to deal with top drop.

There’s an interesting contrast between how a top is expected to behave—strong, tough, in control—and the realities of the human experience. When a top revels in the high of taking control, but starts to feel some of that control fading afterwards, how do they pinpoint the cause? How do they talk about that insecurity? How do they develop aftercare for themselves?

One of the hallowed tenets of BDSM and kink is the necessity of good communication; to be able to recognize a desire, then comfortably communicate that to a partner. Healthy, consensual, safe kink is predicated on this.

Complete Article HERE!

Have you ever had ‘unjust sex’?

Unthinkable: Examples include ‘women being pressured – not quite to the point of outright coercion – to have sex, or to have sex without contraception’, says philosopher Ann Cahill

“We need to remember that sexual assault is not the only kind of sexual interaction that is ethically problematic,” says author Ann Cahill.

By

Uncertainty surrounding the boundaries of ethical sexual activity is not confined to boozed-up young adults or American presidents. Among academics there is discussion about what distinguishes rape and sexual assault from another category of “ethically problematic” sex.

Examples of “unjust sex” include “women being pressured – not quite to the point of outright coercion, but pressured uncomfortably nonetheless – to have sex, or to have sex without contraception,” explains Ann Cahill, author of a number of books on gender issues including Rethinking Rape.

Cahill, professor of philosophy at Elon University in North Carolina who is visiting Dublin this week, says she has tried to “figure out in more detail” what distinguishes sexual assault from “unjust sex”, drawing on the work of New Zealand psychologist Nicola Gavey.

Her analysis has led her to challenge the traditional feminist concern with “objectification”: treating women’s bodies as objects. Instead, she uses “derivatisation” – treating women as “stunted persons, persons whose identity and behaviour is primarily or entirely limited by the desires of another person” – as a standard by which to measure actions.

Cahill says “we need to remember that sexual assault is not the only kind of sexual interaction that is ethically problematic. Too often our approach to sexual ethics is limited by relying solely on the presence of consent, a reliance that obscures other crucial elements in sexual interactions that are ethically relevant”.

How do you distinguish “unjust sex” from rape?

“Briefly, I argue that examples of unjust sex and incidents of sexual assault share an indifference to women’s sexual preferences, desires and wellbeing, and that’s what explains how unjust sex perpetuates and upholds rape culture. In both cases, the specific sexuality of the woman is not participating robustly in the creation of the sexual interaction.

“What distinguishes the two examples, I then argue, is the specific role that the woman’s sexual subjectivity plays. In the case of examples within the grey area of unjust sex, women’s agency plays an important role: if a man repeats a request for or invitation to sex multiple times, for example, that very repetition indicates that the woman’s consent is important.

“However, I also argue that the role that the woman’s agency plays is a problematically stunted one that limits the kind of influence she can have on the quality of the interaction that ensues, and does so to such an extent that it renders the interaction unethical.

“In the case of sexual assault, the woman’s agency is either overcome – by force, or coercion, or other methods – or undone entirely, by use of drugs or alcohol.”

Where does “objectification” come into this, and does sexual attraction always entail some element of it?

“Feminists have long used the notion of objectification as an ethical lens, and specifically, as an ethically pejorative term. And certainly I do think that many of the social and political phenomena that feminists have criticised by using the term ‘objectification’ – dominant forms of pornography, oppressive medical practices, common representations of women’s bodies – are worthy of ethical critique.

“However, I worry about what the term ‘objectification’ implies, and when I dug into the philosophical literature that sought to really unpack the term, my worries only intensified. If objectification means, roughly, to be treated as a thing – a material entity – and if it is virtually always ethically problematic, then it seems we are committed to a metaphysics that places our materiality in opposition to our humanity or moral worth.

“But what if our materiality, our embodiment, is not contrary to our humanity or moral worth, but an essential part of it? If we approach embodiment in this way, then to be treated like a thing is not necessarily degrading or dehumanising. In fact, having one’s body be the object of a sexualising gaze and/or touch could be deeply affirming.

“Getting back to your question: does sexual attraction require objectification? The short answer is yes: sexual attraction requires treating another body as a material entity. But that does not mean that sexual attraction is necessarily ethically problematic.”

You say women “are encouraged, and in some cases required, to take on identities that are reducible to male heterosexual desires”. How do women avoid being so “derivatised” while in a relationship?

“This is a tricky matter, because human beings are intersubjective.

“Equal and just relationships among individuals require the recognition that they have a substantial contribution to make to those relationships, and that no relationship should position one of the individuals involved in it as the raison d’être of the relationship itself.”

Is the power dynamic always working in one direction, however? Women are capable of objectifying men. Should that concern us too?

“As I state above, objectification is not necessarily ethically problematic. And so to the extent that women have the capacity to treat men’s bodies as material entities, yes, they can objectify them.

“However, in our current political and social situation, women’s objectification of men’s bodies is far less common than men’s objectification of women’s bodies; even more importantly, it rarely amounts to derivatisation and does not serve to undermine men’s political, social, and economic equality.

“When I say that it does not amount to derivatisation, I mean that heterosexual men are less likely to view their bodies solely or persistently through the lens of how they appear to heterosexual women, and they rarely see male bodies represented in dominant media as defined primarily or solely through how those bodies appear to heterosexual women.

“While it’s not impossible for women to derivatise men – one can imagine, for example, a woman evaluating a man as a sexual partner solely on the basis of whether he matches her sexual preferences – structurally, those examples of derivatisation don’t add up to the kind of persistent inequality that still tracks along gender lines.

“For example, as political candidates, men don’t suffer for failing to meet the aesthetic ideals of heterosexual women, while women do suffer for failing to meet the aesthetic ideals of heterosexual men. Of course, they also suffer for meeting those ideals too well, because feminine beauty, while allegedly admirable in women, is also associated with shallowness and lack of intellect.

“Although I haven’t written about this before, however, it seems to me that hegemonic masculinity does have a derivatising effect on heterosexual men, to the extent that it requires them to derivatise women. In this sense, the subjectivity of heterosexual men is stunted to the extent that it is required to engage in the kinds of behaviour that demonstrates disrespect of women as moral equals – behaviour that is necessary for other heterosexual male subjects to be confirmed or affirmed in their own forms of masculinity.

“To the extent that heterosexual men can find their standing within homosocial relations threatened or troubled if they refuse to derivatise women, or at least pretend to, then they are also subject to a failure to recognise their own ontological distinctness.”

Complete Article HEREvi!