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Long-term sexual satisfaction: What’s the secret?

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Once the flutters of a new relationship are over, for many, the slog of everyday life sets in. But how do you keep the spark alive?

Sex is a key factor in most romantic relationships. In fact, earlier this year, Medical News Today reported that the “afterglow” that newlywed couples feel for up to 2 days after having sex is associated with greater marital satisfaction.

But last week, a new study showed that 34 percent of women and 15 percent of men who had lived with their partner for at least 1 year had lost interest in sex.

There are many factors that can affect sexual desire. Find out how much sex has the greatest effect on happiness, why some people lose interest, and what factors contribute to long-term sexual satisfaction.

How much sex is enough?

In a 2016 paper, Amy Muise, Ph.D. – a postdoctoral fellow in the Department of Psychology at the University of Toronto Mississauga in Canada – explains that there is plenty of evidence that “[…] the more sex people reported, the happier they felt.”

However, Dr. Muise also questions whether trying to have sex as “frequently as possible” is actually going to have the desired effect, particularly in light of the busy lives that many people lead.

Is the pressure of having frequent sex getting in the way of happiness?

Dr. Muise reports a clear relationship between the frequency of sex and happiness. What she found was that people who had sex once per week or more often were significantly happier than those who had sex less often.

But study participants who had sex on several occasions per week were not happier than those who had sex once each week.

The results were true for individuals who were in a romantic relationship, including women, older participants, and those in long-term relationships who tend to have less sex.

Interestingly, having sex had a greater effect on the participants’ happiness than income. So if sex makes us happy, why do so many people lose interest?

Who loses interest in sex?

There is plenty of evidence that being in a long-term relationship, being a woman, and increasing age are linked to a drop in sexual frequency.

Last year, MNT reported that women’s sexual desire decreased in long-term relationships. However, over the 7-year study period, the participants’ ability to reach orgasm improved – especially in those who had been in the same relationship the entire time.

So, for women, staying with a partner means better orgasms but less interest in sex, according to the research.

Last week, we reported on a new study published in BMJ Open that adds to the body of evidence showing that women’s interest in sex decreases in relationships.

Prof. Cynthia Graham, from the Centre for Sexual Health Research at the University of Southampton in the United Kingdom, found that more than 34 percent of women who had lived with their partner for at least 1 year lacked interest in sex, while only 15 percent of men did.

The biggest turn-offs

Prof. Graham identified a number of factors that were associated with the drop in sexual desire found in her study.

For women, these were having young children, having been pregnant in the past year, living with their partner, being in a longer relationship, not sharing the same level of sexual interest, and not sharing the same sexual preferences.

For both genders, health conditions (including depression), not feeling close to their partner during sex, being less happy with their relationship, and having sex less often than they were interested in all contributed to a drop in sexual interest.

Age was another factor. Men experienced the lowest levels of interest in sex between the ages of 35 and 44, while for women, this was between 55 and 64.

Julia Velten, Ph.D. – a postdoctoral fellow at the Mental Health Research and Treatment Center at Ruhr University Bochum in Germany – reported that when men felt that their partner expected them to always initiate sex, it had a negative effect on their sexual satisfaction.

Sexual desire discrepancy, which is the difference between the actual and desired frequency of sex, was a negative factor for both men and women.

Sexual function also played a role for the couples in Dr. Velten’s study. Men were affected by their partner’s lack of sexual function, such as lack of arousal, while women were more affected by the partner’s distress about their own sexual problem, such as erectile dysfunction.

How does masturbation fit into the picture?

On this topic, research findings do not agree. In a study involving couples living in Prague, Kateřina Klapilová, Ph.D. – from the Department of General Anthropology at Charles University in Prague – found that for women, masturbation negatively affected their sexual satisfaction.

But masturbation had no effect on men in these couples.

Meanwhile, Prof. Graham found that men who had recently masturbated were less interested in sex, while masturbation was not related to a change in women’s sex drive.

Prof. Graham told MNT that in her previous research, she had “found striking gender differences in factors associated with frequency of masturbation in men and women.”

She added that “when men were having less partnered sex, they tended to masturbate more often, whereas the reverse was true for women.”

With 51.7 percent of male and 17.8 percent of female participants reporting to have masturbated in the 7 days prior to study interviews, this is clearly a factor that is important in many relationships.

But just how masturbation contributes to or distracts from long-term sexual satisfaction remains to be seen.

With significant levels of both men and women reporting a drop in sexual interest and satisfaction, is there a secret to keeping the spark alive?

The secret to sexual satisfaction

Dr. Klapilová’s study found that for both men and women, penile-vaginal intercourse and the consistency of being able to reach vaginal orgasm were associated with sexual satisfaction.

She points to the “special role that vaginal orgasm (as distinct from other orgasm triggers) had in maintaining higher-quality intimate relationships.”

Anik Debrot, Ph.D. – alongside Dr. Muise and other colleagues from the University of Toronto Mississauga – recently studied the link between affection and sexual activity.

In her study paper, which was published this year in the journal Personality and Social Psychology Bulletin, she explains that “when engaging in sex, people not only seek an intimate connection, but indeed experience more affection, both when having sex and in the next several hours.”

“Thus, sex within romantic relationships provides a meaningful way for people to experience a strong connection with their partner,” she adds.

To her, this indicates that sex is important in romantic relationships because of the emotional benefits that we feel. Dr. Debrot suggests, “[When sex may be impaired], affection could help maintain well-being despite decreased sex frequency.”

The effect of time

A study by Prof. Julia Heiman, from the Department of Psychological & Brain Sciences at Indiana University in Bloomington, studied 1,000 couples in five countries (Brazil, Germany, Japan, Spain, and the United States).

Although the length of the couples’ relationships ranged from 1 to 51 years, half had been together for at least 25 years.

Prof. Heiman found that “[w]omen reported significantly more sexual satisfaction than men and men more relationship satisfaction.” In particular, “Men who valued their partner’s orgasm were more likely to report relationship happiness.”

Women’s sexual satisfaction increased from 40 percent at the start of the relationship to 86 percent once they had been with their partner for 40 years.

From these studies, penile-vaginal sex, affection, and the time spent in the relationship are key ingredients to a happy sex life. But there is one more factor that could be key: open communication.

Talking about sex

In Dr. Velten’s study, open communication about sexual wishes and frequencies had a positive effect on the quality of sex that the participants reported.

Likewise, participants in Prof. Graham’s study who found it easy to talk about sex with their partner were more interested in sex.

She told MNT that “[their] findings underline that open communication with a partner about sex is one of the most important things you can do to try to maintain sexual interest in a relationship.”

Sexual desires and preferences are, by nature, intrinsically personal and individual. Research in this field is complex, and while studies can show associations and trends, they will not be able to tease apart the reasons for an individual’s sexual satisfaction.

I don’t think that there is any ‘secret’ to long-term sexual satisfaction! Human sexuality is too diverse and ‘fluid’ for this to be the case – but […] open communication about sex with a partner should go some way to preventing sexual problems from developing.”

— Prof. Cynthia Graham

Talking about sex may be a good starting point. Finding a way to fit sex into the pressures of daily life may be challenging, but affection and time together might well help.

Complete Article HERE!

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5 common questions about vaginas answered

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A sexual health nurse reveals all

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We don’t often bring up genitals in polite conversation but learning more about vaginas can empower women to make the right decisions about their general and sexual health – and know when to seek medical advice.

Helen Knox, a clinical nurse specialist in contraception and sexual health – and founder of Sexplained – shares the vaginal health questions she hears most frequently and the advice she gives women about how best to care for their most intimate area:

1. Is my vaginal normal?

“I often get asked if the smell or discharge a woman is experiencing is ‘normal’. Firstly, normal is what is normal to you. Your vagina will have its own smell, regular discharge and shape. If you notice a change from your norm such as a change in discharge, smell or discomfort, then there may be something up. But don’t be embarrassed about it and do nothing. You can ask your pharmacist to help you work out what might be going on and give you an over the counter treatment. But if you are in pain, are bleeding abnormally or have persistent symptoms then you must see your GP.”

2. What should my vagina smell like?

“Your vulva and your vagina should smell like you, if this smell changes then something might be up. Your healthy vagina is all about balance: it is home to millions of micro-organisms, and is normally good at keeping them in balance.”

“When this balance gets disrupted, you’ll start to notice things aren’t quite right and you could be developing bacterial vaginosis (BV) which is a very common condition that often causes a fishy smell. BV is in fact two times more common than thrush and like thrush it can be simply treated with an over the counter treatment. Lactic acid based products such as Balance Activ (available at Amazon.co.uk) help to rebalance the healthy bacterial conditions within the vagina, to gently and effectively treat the symptoms of BV by restoring normal pH and vaginal flora.”

3. What should my vagina look like?

“Just like the rest of our bodies, our vaginas are all unique. The only part you can see is the vulva, and these come in all shapes and sizes. If you are experiencing any soreness, itching or other changes there may be a problem that needs checking out. In general, adding anything to your vagina such as glitters or perfumes is going to upset your natural balance and encourage conditions like BV, so I really wouldn’t recommend it.”

“You can’t see your vagina, as it is inside you, and it runs from your vulva, up to your cervix, but as long as you’re not experiencing any unusual smells or discomfort, it’s very likely to be looking after itself – and doesn’t need to be messed about with.”

4. Is my discharge normal?

“The vagina is a relatively acidic environment which keeps itself healthy by producing a range of secretions, so women will experience natural changes in discharge throughout their monthly cycle.”

A period generally lasts for 4-5 days, followed by slight dryness and then an increase in discharge. This will normally be white at first and then change to a clear, stretchy consistency during peak fertility. After ovulation, it changes to a dryer, thicker white or creamy mucus, which sperm won’t be able to swim through. If you’re pregnant this doesn’t change. If you’re not, it’s back to the next period.”

“Even in a healthy vagina, there will be a variety of changes to your ‘normal’ discharge, and these can also vary depending on your age and other factors. A change in discharge to it becoming really thin and watery, or thick and cottage cheese like, or a fishy or unpleasant smell may be a sign that something is wrong and your natural balance has been upset – you can check your symptoms at via the online symptom checker or speak to your doctor, pharmacist or sexual health clinic if you are worried.”

5. How do I keep my vagina clean?

Your vagina cleans itself. It is a common misconception that having conditions like BV means you are not clean – in fact when women notice an unpleasant smell (especially after sex) they will often reach for the soap or perfumed shower gel – this can actually make things worse! There’s a delicate eco-system up there, working hard to keep a balance of bacteria so douching or washing with perfumed products can upset this balance and cause BV. As part of your daily cleaning routine, washing once a day with just water around the vulva, which is the skin around the opening, is fine.”

“By understanding your own normal and staying in tune with your body it will help you determine whether you have any issues. If you notice any changes, don’t sit with on-going symptoms wishing them way, discuss them with your Pharmacist who will happily help you, or make an appointment to discuss them with your GP. The chances are it will be something easily treated and managed.”

Complete Article HERE!

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Why (Some) Women Love Strap-Ons

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Last week, I found myself at Cafe Gratitude in Los Angeles, eating a gluten-free scone and fuming about gender, as one does in 2016. On the receiving end of my rant was my friend “Lori,” a 23-year-old MFA student studying queer theory. I was saying something like, “Sure, it’s cool that we live in this post-everything world where gender is over and hetero-normativity is off-trend and all the rules of sexuality have been thrown out the window. Life is more free now. But we’re also being forced to ask ourselves some serious questions. Like, ‘Does shaving my armpits make me a bad feminist?’ And, more pressingly, ‘Is my strap-on a symbol of male supremacy?’ And if so, should I set it on fire as a performance art piece?”

Lori sipped her green juice and rolled her eyes. “I love wearing a strap-on,” she said, casually flipping her long curls behind her shoulders. “Even though my dildo is bright pink and it’s this laborious process to strap yourself in, something about it still feels real. It’s some Freudian bullshit, but it just feels so fun and powerful to have a penis.” This wasn’t the “feminist” answer I was expecting.

A few nights later, I met my friend “Claire,” a 31-year-old screenwriter, for drinks at the Sunset Tower. Claire is somewhat of a unicorn in that she’s a straight woman who gets off on wearing a dildo. “Think about it: Men are the ones with a prostate. Why isn’t every woman fucking her boyfriend with a strap-on?” Claire asked, as an elderly man played jazz piano in the background. “It’s crazy, you actually feel like you have a dick. I’ve been pegging this guy I met at a Dave Matthews concert.”

Claire admitted that this was not a bucket-list moment for her. “I knew what pegging was because of that Broad City episode where Abbi pegs her crush, but I was never like, ‘Oh, my God, I can’t wait until the moment when I finally get to peg someone.’ ” Her tone turned almost motherly.“I think every woman should experience fucking a man at some point in her life, even just as a therapeutic tool. It’s very empowering. I never thought this would be part of my life story, but here I am. I’m fucking a man.”

After meeting through friends at said concert last fall, Claire and her pegging partner, “Jim,” bonded on a party-bus ride back to West Hollywood, talking about sex.They ended up back at Jim’s apartment, where he produced a double-sided glass dildo—one end for the pegging, the other end shaped like a hook, to be inserted inside a vagina. “It’s essentially a strapless strap-on,” Claire explained. “It’s the chicest kind. I could never go back from this.”

She liked it far more than she expected to. “It’s such a shift in the power dynamic. I kept thinking, I’m literally penetrating someone right now. Plus, it’s a vaginal workout because you have to grip the dildo with your vagina while you use it. It’s basically exercise, which I love. I’m very health-conscious,” she said, gulping her second martini. For the next two months, the two met up for sex regularly. “He would get a colonic every time before I came over,” she said enthusiastically. “He was really on point about his whole anal grooming and cleansing journey.”

Beyond the thrill of the power shift, what Claire didn’t expect was how intimate the sex would be. “The person has to be very trusting of you. You have to listen to their physical cues and gauge if they’re having pleasure or if you’re hurting them. You have a lot of control, and that became very sexy to me. Before Jim, I’d always thought of myself as submissive, but through that experience I accessed a totally different side of myself.”

She made it sound so bizarrely appealing. I wondered if I should resurrect my strap-on from the junk box under my bed, where it’s been in exile since my breakup with my now ex-girlfriend four months ago. When I met my ex, one of the first things I did was run to a sex store and buy a large purple dildo and leather harness. It was my first same-sex relationship, and I was like, “This is what lesbians do, right?” As it turned out, we used the strap-on only like four times in our three-year relationship—partly because it quickly dawned on me that I didn’t need to imitate heterosexual sex in order to validate my queer sex. In the years that followed, I found it insulting when people would ask me, “But don’t you miss dick?” As if the penis is the holy grail of pleasure. Similarly, my androgynous girlfriend resented the fact that just because she wore boys’ clothes, people assumed she wanted a penis. (One day, I remember, she put on the strap-on, looked down, and said, “Wait, I’m gay and dicks are weird. Why is this thing on me?”)

But my worst fear is being one of those cyber-feminists who’s offended by everything, so in order to challenge my aversion to strap-ons, I organized a queer, roundtable lunch with strap-on loving Lori and my particularly opinionated friend Mel, a 37-year-old queer actress.

“My hand is my sexual object,” said Mel, displaying the hand in question, with its immaculately manicured fingernails. “A lot of women get off wearing a strap-on, either psychologically or because of the way it rubs against their clit, but I don’t. I feel erotic pleasure through my fingers. It’s sexual reiki: If I can make you come with my hand, then can I extend that power five inches in front of my hand? Ten inches? Can I sit across the room from you and make you come? When you’re at that level, a fucking phallus seems like kindergarten for me.” The conversation became heated very quickly.

“So is penis envy actually a thing?” I asked. “I just don’t understand why, if you’re queer, you need to bring a fake dick into the bedroom.”

“I know lesbians who, when they go on a Tinder date, will pack their penis in their bag,” said Mel. “Like, that’s their dick. They’re not trans, but they want to be able to fuck their girl without using their hands. When I was younger I wanted that,” she recalled. “I didn’t want a dick all the time, but I wanted to be able to fuck a girl and choke her with both hands, basically.”

“I don’t care to over-intellectualize or over-politicize it,” said Lori. “If you like being fucked by a strap-on, it’s not a reflection on your sexuality. I get where you’re coming from, but if it feels good, then what’s the problem? My girlfriend and I aren’t secretly wanting to have sex with a man.”

This made sense to me. If the point of sex is to create intimacy and to give and receive pleasure, then why restrict yourself from something that feels good just because of the patriarchy or whatever? After all, being a lesbian isn’t about hating dicks, and using a strap-on isn’t about wanting to be a man.

Through my own queer experience, in fact, I’ve learned that it often isn’t true that the more “masculine” or butch woman would be the one to wear a strap-on in the relationship. Mel put it well: “Our default is to think that, in a power dynamic, masculine is top and feminine is bottom. But a butch woman will often want to be subjugated sexually because she has to armor herself in the world so much. She has to be tough, just like a man does. It’s like the Wall Street guy who sees a dominatrix on the weekend. That’s why they say, ‘Butch in the streets, femme in the sheets.’ ”

Speaking of femme tops, I told them about Claire and her pegging saga, which incited a literal round of applause. “I wish more guys would get into pegging,” Mel said. “I think if men knew more about what it was like to get fucked, they would be better at fucking. The only reason men don’t get pegged more often is because of gay shame and bottom shame. It’s really hard for straight men to bottom because they think it’s emasculating, when in reality it can be super hot.”

Beyond all the politics, one can’t deny that strap-ons have a lot of advantages. You never have to worry about a dildo being soft or too small or diseased, and it won’t accidentally get you pregnant. As Mel put it: “When you’re having sex with a real penis, sex becomes all about what feels good for the penis, and then the penis has to throw up all over your tits. But a strap-on is just for the woman’s pleasure. The dildo doesn’t need to be satisfied.”

“That’s true,” Lori agreed. “Dildos are not demanding at all.”

“It’s just a hands-free device,” added Mel. “Like a selfie stick.”

Complete Article HERE!

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Sex Education Based on Abstinence? There’s a Real Absence of Evidence

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Sex education has long occupied an ideological fault line in American life. Religious conservatives worry that teaching teenagers about birth control will encourage premarital sex. Liberals argue that failing to teach about it ensures more unwanted pregnancies and sexually transmitted diseases. So it was a welcome development when, a few years ago, Congress began to shift funding for sex education to focus on evidence-based outcomes, letting effectiveness determine which programs would get money.

But a recent move by the Trump administration seems set to undo this progress.

Federal support for abstinence-until-marriage programs had increased sharply under the administration of George W. Bush, and focus on it continued at a state and local level after he left office. From 2000 until 2014, the percentage of schools that required education in human sexuality fell to 48 percent from 67 percent. By 2014, half of middle schools and more than three-quarters of high schools were focusing on abstinence. Only a quarter of middle schools and three-fifths of high schools taught about birth control. In 1995, 81 percent of boys and 87 percent of girls reported learning of birth control in school.

Sex education focused on an abstinence-only approach fails in a number of ways.

First, it’s increasingly impractical. Trying to persuade people to remain abstinent until they are married is only getting harder because of social trends. The median age of Americans when they first have sex in the United States is now just under 18 years for women and just over 18 years for men. The median age of first marriage is much higher, at 26.5 years for women and 29.8 for men. This gap has increased significantly over time, and with it the prevalence of premarital sex.

Second, the evidence isn’t there that abstinence-only education affects outcomes. In 2007, a number of studies reviewed the efficacy of sexual education. The first was a systematic review conducted by the National Campaign to Prevent Teen and Unplanned Pregnancy. It found no good evidence to support the idea that such programs delayed the age of first sexual intercourse or reduced the number of partners an adolescent might have.

The second was a Cochrane meta-analysis that looked at studies of 13 abstinence-only programs together and found that they showed no effect on these factors, or on the use of protection like condoms. A third was published by Mathematica, a nonpartisan research organization, and it, too, found that abstinence programs had no effect on sexual abstinence for youth.

In 2010, Congress created the Teen Pregnancy Prevention Program, with a mandate to fund age-appropriate and evidence-based programs. Communities could apply for funding to put in only approved evidence-based teen pregnancy prevention programs, or evaluate promising and innovative new approaches. The government chose Mathematica to determine independently which programs were evidence-based, and the list is updated with new and evolving data.

Of the many programs some groups promote as being abstinence-based, Mathematica has confirmed four as having evidence of being successful. Healthy Futures and Positive Potential had one study each showing mixed results in reducing sexual activity. Heritage Keepers and Promoting Health Among Teens (PHAT) had one study each showing positive results in reducing sexual activity.

But it’s important to note that there’s no evidence to support that these abstinence-based programs influence other important metrics: the number of sexual partners an adolescent might have, the use of contraceptives, the chance of contracting a sexually transmitted infection or even becoming pregnant. There are many more comprehensive programs (beyond the abstinence-only approach) on the Teen Pregnancy Prevention Program’s list that have been shown to affect these other aspects of sexual health.

Since the program began, the teenage birthrate has dropped more than 40 percent. It’s at a record low in the United States, and it has declined faster since then than in any other comparable period. Many believe that increased use of effective contraception is the primary reason for this decline; contraception, of course, is not part of abstinence-only education.

There have been further reviews since 2007. In 2012, the Centers for Disease Control and Prevention conducted two meta-analyses: one on 23 abstinence programs and the other on 66 comprehensive sexual education programs. The comprehensive programs reduced sexual activity, the number of sex partners, the frequency of unprotected sexual activity, and sexually transmitted infections. They also increased the use of protection (condoms and/or hormonal contraception). The review of abstinence programs showed a reduction only in sexual activity, but the findings were inconsistent and that significance disappeared when you looked at the stronger study designs (randomized controlled trials).

This year, researchers published a systematic review of systematic reviews (there have been so many), summarizing 224 randomized controlled trials. They found that comprehensive sex education improved knowledge, attitudes, behaviors and outcomes. Abstinence-only programs did not.

Considering all this accumulating evidence, it was an unexpected setback when the Trump administration recently canceled funding for 81 projects that are part of the Teen Pregnancy Prevention Program, saying grants would end in June 2018, two years early — a decision made without consulting Congress.

Those 81 projects showed promise and could provide us with more data. It’s likely that all the work spent investigating what is effective and what isn’t will be lost. The money already invested would be wasted as well.

The move is bad news in other ways, too. The program represented a shift in thinking by the federal government, away from an ideological approach and toward an evidence-based one but allowing for a variety of methods — even abstinence-only — to coexist.

The Society of Adolescent Health and Medicine has just released an updated evidence report and position paper on this topic. It argues that many universally accepted documents, as well as international human rights treaties, “provide that all people have the right to ‘seek, receive and impart information and ideas of all kinds,’ including information about their health.” The society argues that access to sexual health information “is a basic human right and is essential to realizing the human right to the highest attainable standard of health.” It says that abstinence-only-until-marriage education is unethical.

Instead of debating over the curriculum of sexual education, we should be looking at the outcomes. What’s important are further decreases in teenage pregnancy and in sexually transmitted infections. We’d also like to see adolescents making more responsible decisions about their sexual health and their sexual behavior.

Abstinence as a goal is more important than abstinence as a teaching point. By the metrics listed above, comprehensive sexual health programs are more effective.

Whether for ethical reasons, for evidence-based reasons or for practical ones, continuing to demand that adolescents be taught solely abstinence-until-marriage seems like an ideologically driven mission that will fail to accomplish its goals.

Complete Article HERE!

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What it’s like to talk to your doctor about sexual health when you’re bisexual

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There’s a misconception that bi people are just going through a phase — but what if our doctors believe it too?

“Are you sexually active?”

I’d been dreading this question since losing my virginity to a female friend a few weeks earlier, not long after my 16th birthday. Somehow, the harsh fluorescent lights in my doctor’s examination room made this query seem even more menacing.

“Yes,” I said, but there was an ellipsis in my voice. A hesitation. An unspoken “but . . . ”

“You’re using condoms, right? So you don’t get pregnant?” she prompted, and I didn’t know what to say, because we weren’t. We didn’t need to. It was the wrong question.

“Uh, I’m not having sex with a guy,” I managed to stammer.

My doctor peered at me over her wire-rim glasses, “Oh,” she replied.

There are a lot of things a teenager might be nervous to disclose to their doctor — a marijuana habit, some worrying mental health symptoms, a secret relationship their parents don’t know about. While we should all feel free to tell our doctors what’s really going on with us, it’s particularly egregious that so many of them are still in the dark about something so basic as sexual orientation, making these already-difficult situations even more challenging.

The day of my first difficult conversation about my sexual health, my doctor didn’t give me any medical advice on the sex I was having. She didn’t suggest my partner and I use dental dams or latex gloves. She didn’t suggest we get tested for sexually transmitted infections (STIs). She didn’t ask whether my partner was cis or trans. She didn’t ask what sexual orientation I identified as (bisexual, for the record). She didn’t even ask me if I had any questions for her. She just moved on to the next part of our checkup.

I didn’t recognize these as problems at the time; I was too young and nervous to question the approach of my all-knowing doctor. Everything I later learned about safer sex — with the other cis girl I was seeing at that time, and with other partners later on — I learned from the internet. And while the internet can be a great resource for such information, doctors should be a better one.

Bisexuals are told all the time — both implicitly and explicitly — that we’re not queer enough to align ourselves with queerness, or that we’re too queer to align ourselves with straightness. I still find it hard to push back against these stereotypes today, at 25.

These presumptions are particularly upsetting in medical situations, where many of us already feel nervous and unempowered and, for many queers, apprehensive. The medical system has oftentimes failed us and our queer foreparents: inequitable health care access due to poverty, doctors’ lack of knowledge about LGBT identities and sexuality and the pathologization of queerness are just a few examples.

Two years later, in a different relationship with a person of a different gender, I returned to my doctor. I was a girl on a mission.

“I’m seeing someone new and I’d like to get an IUD,” I told my doc, with all the bravery and resolve I could muster as a meek 18-year-old still coming to terms with her sexuality.

“I thought you were a lesbian?” she replied coolly, barely looking up from her computer screen.

“No, I’m bisexual,” I clarified, my voice only shaking a little.

Medically speaking, it shouldn’t actually matter what word(s) I use to define my sexual orientation; my doctor should want to know, instead, what sexual activities I am participating in. I could’ve been a lesbian having sex with a man (they do exist!). I could’ve been having sex with a trans woman or a nonbinary person who had the ability to get me pregnant. There was no reason for my doctor to assume I was a lesbian in the first place, nor that a risk of pregnancy during sex meant my existing sexual orientation was being challenged.

I was reminded of a story I had read online. An American photographer I followed, Brigid Marz, wrote on Flickr that she and her girlfriend went to a hospital to get treatment for her flu symptoms. A staff member asked Brigid if there was any chance she might be pregnant, and she laughed, indicated her girlfriend, and said no. She’d dated and had sex with men before, but not recently enough that she could be pregnant. Months later, she received a $700 medical bill, $300 of which was for a pregnancy test she’d neither authorized nor needed.

“I am so sick of being treated differently just because I have boobs,” she wrote, but I would argue she was treated differently because she is non-monosexual – she is neither completely straight nor completely gay. Our medical system seems to assume everyone is one or the other, sometimes even when we’re loudly asserting otherwise.

In the end, my doctor refused to prescribe me an IUD on the basis that I was “just casually dating” and should wait until I was “in a serious relationship” before committing to a long-term birth control method that reflected my relationship status. She prescribed me the pill instead — the hormonal content of which exacerbated my mental health conditions for years, something the non-hormonal copper IUD may not have done.

What rankled me was that I was in a serious relationship at the time. My doctor may have assumed my relationship was casual because I was now with a man and I was previously with a woman, or she may have simply thought I was too young for the IUD — but I think it was because of negative stereotypes about bisexual people.

Bi folks’ relationships and attractions are often written off as “just a phase” or “just for fun.” We’re told we don’t know what we really want or who we really like — or, worse, that we’re intentionally playing with partners’ hearts, never intending to pursue commitment or depth in our relationships.

In my experience, this is about as true for bisexual people as it is for straight or gay people — some folks are looking for serious relationships and some just aren’t — but this assumption weighs most heavily on bisexuals. Whether or not my doctor was consciously aware of the stereotypes she was affirming that day, it’s clear to me that my relationship would not have been written off as “casual” if I identified as straight or gay.

If I could go back and talk to myself when I was a shy and shaking 16-year-old in my doctor’s office, I’d tell her to advocate for herself. I’d tell her to ask the questions she wanted answered, and double-check the answers on Scarleteen later. I’d tell her it was okay if she didn’t even know what questions to ask.

I’d tell her to be unashamed of her burgeoning bisexual identity, because it’s nothing to feel shifty about. But mostly, I’d wish I didn’t have to tell her all these things. Her doctor shouldn’t have made her doubt all this in the first place.

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