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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!

4 Women Get Real About How Swinging Affected Their Relationships

What really happens when you open your relationship to another couple

by

For some couples, the idea of having sex with anyone other than your significant other seems unfathomable. It can be hard to understand how “swinging” — when you swap partners with another couple and sleep with someone new — can actually lead to stronger relationship bonds. But believe it or not, it can, and there are more couples interested in doing it than you may realize.

If you’ve ever remotely considered getting into swinging — with your spouse, significant other or just that cool friend with benefits — there are a few things you should know before you dive in. Below, four women get real about what their own swinging experiences were really like.

Nicole has been with her husband for 18 years and they’ve been swinging for 17.

How she got into it: “I grew up with this idea that there’s not just one person for anyone and that we can enjoy being with multiple people, as well as the idea that you can have sex without having emotion tied to it. My husband knew that I was bi-curious when we met, so on the anniversary of our first date, we decided to explore and went to a swingers club.”

How it impacted her relationship: “It’s really helped strengthen our relationship. Not all experiences were 100 percent pleasurable, so we made an effort to have those conversations and keep the lines of communication open. When you talk about [swinging] it makes it so much easier to discuss other issues in the relationship.”

Her advice to those considering the lifestyle: “For couples who are considering it, we suggest that you better have a really good relationship starting out because it doesn’t fix broken relationships, it only breaks them up faster. Also, you need to have conversations with your spouse or partner before you go into it. Know your rules and limits before you get into a situation because you can’t really get upset with your partner if you didn’t talk about.”

Jody was introduced to swinging five years ago and is currently single. She loves her work as a sex coach and says if it weren’t for swinging, she wouldn’t be where she is now.

How she got into it: “I was introduced to swinging by my former husband, and not in a good way. One day he forgot to log off the computer and I looked at his browser. I saw some sites that I was not familiar with, but I was appalled by what a saw. Some time later, I confronted him about it. He explained to me what swinging was, but I furthered my knowledge by reading everything I could. I then told him that if he had just talked to me about it, it was something I could be open to.”

How it impacted her relationship: “[Swinging] honestly had no effect on our relationship, which ended for other reasons. Swinging changed me personally for the better. I have sexual confidence that I didn’t have before. I exclusively date swingers now because I meet a much better class of men. They really honor and respect women.”

Her advice to those considering swinging: “If your marriage is struggling, don’t do it. It will only make things worse. If you have a good marriage, dip your toes in the water. Attend a meet and greet or other event. The swinger couples I know have absolutely amazing marriages. For a single woman, you’ll meet the best men ever, but take it slow and make sure you take the usual dating precautions.”

Julia Allen, co-founder of StockingsVR, was 24 when she first walked into a swingers club and has now been swinging for 25 years.

How she got into it: “My boyfriend thought it would be fun to try. We didn’t do anything except dance and talk to some people the first night, but it was exciting and I couldn’t wait to go back. A few months later, on New Year’s Eve, we had a hotel room and invited a few people up. Well… Everyone came up. It was packed and before I knew it, everyone was having sex all around me. A lovely woman wanted to play with me and my boyfriend. I loved it. I loved watching him with her and having him watch me with her, and then both of us just getting lost in the whole experience. I loved the experience of being able to have sex outside of my relationship.”

How it impacted her relationship: “I’ve never been tempted to stray outside of my relationship by having an affair. Swinging takes care of all of my sex needs. I really feel that it strengthens every relationship. I don’t view sex as something that you only have with someone you love. Sex is recreational. I think every boyfriend I’ve had has felt the same way. Along the way, I started filming myself with various people and decided to take my swinging/exhibitionist/kinky lifestyle and make it full time. I guess you could say that swinging has enriched my relationships and also enriched my life.”

Her advice to those considering swinging: “Don’t feel pressure. Most people who are new to swinging don’t actually have sex. They like to watch. In a swingers club, no really does mean no. Many times, I’ve had men or women approach me and if I don’t feel like it, I just say no. You can explore any fantasy you have at a swingers club. I would suggest for first timers to try a larger club where there are lots of people. People who go to swingers clubs are normal people who you would never guess in a million years are swingers. About 90 percent of people who swing are married with kids and just want to try walking on the wild side together.”

Jessica Drake, an adult superstar and certified sex educator, has been swinging since before she was in the adult industry.

How she got into it: “Depending on the state of each relationship and my boundaries with different partners, I had different experiences. In the beginning, when I was younger, it felt awkward based on my inability to be assertive about my wants and needs. It felt more like that group sex stereotype that you might see on TV or in porn… and definitely more male pleasure-centered.”

How it impacted her relationship: “Sexual jealousy has never really been an issue for me, and as long as my needs are being met, I feel secure and aroused when I watch a partner enjoying someone else. I think one mistake some people make is assuming that swinging has only one meaning, but it’s something that is totally open to interpretation. Some of my most intimate, fulfilling encounters lately have been ‘soft swap’ — meaning I have sex with my primary partner, and have foreplay only with our ‘guests.’”

Her advice to those considering swinging: “If you want to start experimenting with swinging and swapping, you need to take a look at your sexual values and belief system. Compare it to the way your partner perceives things, and before you proceed, have an honest discussion. Overall, if you find yourself wanting to try this later on in life, go for it! It may reawaken you and give you a sexual second wind. It’s never too late. There are people of all ages, all body types, all colors, who come from a variety of backgrounds looking for like-minded people.”

 
Complete Article HERE!

Study finds unequal distribution of power in young adult relationships more harmful to women

“Inequality within a relationship doesn’t cost men as much,” researcher says

 

By Bert Gambini

Power imbalances in heterosexual relationships are common, but having less power takes a greater toll on young women than young men, according to a recently published University at Buffalo study.

The results, appearing in The Journal of Sex Research, suggest “a healthy skepticism when it comes to what looks like gender equality,” says Laina Bay-Cheng, an associate professor in the UB School of Social Work and an expert in young women’s sexuality. “This research refutes the claim that gender equality has been reached and we don’t have to worry about misogyny anymore.”

Bay-Cheng says the dynamics underneath relationships require scrutiny and the often-heard claim that girls and women have reached and in some ways surpassed equality with men unravels quickly when examined in detail.

“We have to look closely at relationships and experiences and stop taking surface indicators as proof of gender equality,” says Bay-Cheng. “When men are subordinate in a relationship, it doesn’t bother them very much. They don’t see those relationships as less intimate or stable than relationships in which they are dominant. But for young women, having less power in a relationship is associated with diminished intimacy and stability and comes with greater risk of abuse.

“Inequality within a relationship doesn’t cost men as much because they are still cushioned by a broader system of male privilege.”

Relationships that develop during emerging adulthood are foundational events. It’s from these early experiences that people learn how to be in a relationship and depending on the nature and quality of the experiences, the effects – both positive and negative – can echo throughout life.

“It’s so important that we understand that it’s not that sex and relationships are at the root of risk or vulnerability. Instead, some young women, because of intersecting forms of oppression – especially misogyny, racism and economic injustice – enter relationships and are already at a disadvantage,” says Bay-Cheng. “For young women, relationships are where all different forms of vulnerability and injustice converge.”

Bay-Cheng developed a novel research method for this study that considered both the objectives of researchers and participants’ experience, which, she says, is as important as the findings.

For this study, Bay-Cheng used a digital, online calendar that participants fill out using all of their sexual experiences from their adolescence and early adulthood. The open-ended digital calendar can be filled out over a month and participants can enter anything they want, not just text, but audio files, images or even emoji.

The result is a more meaningful measure for researchers and participants.

“On the research side we get varied and diverse data,” says Bay-Cheng. “For participants, rather than circling a number on a scale on some survey, they get to express themselves how they want, at their own pace, and then look at their calendars and get different perspective on their sexual histories and how these relate to other parts of their lives. Participants have told us how meaningful that chance to reflect can be. It’s important for researchers to care as much about the quality of participants’ experiences in our studies as the quality of our data.”

Complete Article HERE!

The way we teach sex-ed is old and ineffective. Here’s how to fix it.

By Stephanie Auteri

In a predictable bit of news, the results of a study released this past September show that students consider most sex-education programs to be out-of-touch, outdated, and lacking in the information that might actually prove useful to them. Among the deficiencies reported by teenagers were a focus on fear-based lesson plans, curricula that alienate LGBTQ+ students, instructors untrained in actually providing useful sex-ed, and a failure to acknowledge that some young people are  —  spoiler alert  —  sexually active.

When it comes down to it, though, these inadequacies do not stem from lack of trying on the part of certified sexuality educators. There are disparities in curricula, and in resources: Federal funding for sex-education flows to both abstinence-only and evidence-based approaches, and decisions about curricula are made on a state-by-state  —  and district-by-district  —  basis. There are still only 13 states that require sex-education to be “medically accurate.”

In fact, in the past year, 23 bills were introduced with the intention of restricting the quality of sex-ed. Such restrictions included moves to limit access to information about reproductive health options, and to exclude qualified sexuality educators from schools based upon their affiliation with abortion providers.

While the majority of these bills failed to advance, in many cases, educators continue to be hamstrung by red tape. And they worry that  —  in the wake of the most recent presidential election  —  their jobs will only become more difficult. What is an enterprising, conscientious sex-educator to do?

Recently, I attended the National sex-ed Conference in Atlantic City, New Jersey, where I saw sexuality educator Francisco Ramirez present a keynote on “hacking” sexual health. During his talk, Ramirez spoke about how educators might possibly shake things up, in some cases taking sex-ed outside the classroom in order to reach those who need it most. Happily, many educators are already doing this, systematically toppling many of the barriers that have long stood in their way. Throughout the conference, I was reminded of the many forms such resourcefulness can take. Here are the six most important fixes currently happening in American sex-ed.

1. Where can students get the answers they crave without fear of embarrassment or other negative repercussions? These days: their phones.

Sex-educators often employ anonymous question boxes in their classrooms, but the new-media generation is taking this idea of anonymity to the place where it thrives best: social media. I recently wrote about a variety of new social-media applications, YouTube series, and other online resources that allow teens to seek out accurate sexuality information anonymously. Since then, it seems that not a day goes by where I don’t hear about a new sex-ed app.

What’s important to remember about any of these sex-ed hacks is that just because a program works in one place, that doesn’t mean it will work in every community.

One of the more recent ones to catch my eye is Capptivation’s Reach Out, an app that provides sexual assault survivor resources to college-age students. According to Capptivation, a similar app for high schoolers is on its way. And the Healthy Teen Network — a membership-based advocacy organization  —  is in the process of developing two phone apps, one for high school-aged teens, and one for people who are older. They were inspired to do so after receiving an RFP (a request for proposal — a document from an agency soliciting a proposal for a specific commodity or service) from the Centers for Disease Control and Prevention (CDC). Alongside the United States Department of Health and Human Services, the CDC has been looking to fund the development of a mobile app that would support teen pregnancy prevention.

This push for sex-ed apps is not without precedent. A 2016 study on mobile phone-based interventions for smoking cessation showed that mobile interventions can lead to positive behavioral changes. And additional research  —  including a 2016 paper published in BMC Public Health  —  has shown that sexual-health apps remove certain barriers youth often feel in seeking out sexual-health services: namely, embarrassment. HTN is in the midst of conducting its own randomized control trials in order to determine the efficacy of its apps.

2. How can students take a leadership role in their own sex-education? Through peer-led sex-ed.

A recent review of 15 peer-led sexual-health education programs shows that peer-to-peer sex-ed can be successful at improving teens’ knowledge and attitude about sexual health  —  which is good news, considering that many teens don’t think adults are doing the best job. And just as with social-media apps, new peer-to-peer training programs are popping up all around the country. Teen PEP, which operates in both New Jersey and North Carolina, is one such program that trains teens to provide sex-ed to their peers at school. Another example is the team out of Planned Parenthood of North, Central, and South New Jersey, which leads an annual Teen Conference that students travel to on a one-day field trip.

In Austin, Texas, the Peer 2 Peer Project trains teens to teach both on school grounds and at other locations within their communities, going so far as to pay them for their efforts. In Baltimore, Maryland, the Healthy Teen Network and its subsidiary, the Healthy Teen Leadership Alliance, also empower teens to influence the field of sexual health. These are just a handful of programs among many that are handing the reins over to teens. It can be difficult to keep track of all the peer-led programs popping up around the country, but Advocates for Youth  —  an advocacy organization with its focus on adolescent sexual health  —  has gathered the results of numerous studies on the impact of peer education. These studies show how peer education reduces risky sexual behaviors and empowers teens, who seem to find their peers to be more credible than adult educators.

Complete Article HERE!

How your sex life can be improved with mindfulness

Being more present with each other can lead to better sex, therapists say

 

By Olivia Blair

People have turned to mindfulness to make them happier, less stressed and even more able to deal with their mental health conditions such as anxiety or depression – but could it improve your sex life too?

Being mindful essentially means being present and aware of both yourself and your surroundings. The brain is trained to deal with negative and anxious or depressive thoughts through breathing and meditation exercises all stemming in part from ancient Buddhist philosophy.

While therapists are increasingly using it as part of their individual counselling, sex and relationship therapists have also adopted the advice.

“In its broad terms, mindfulness means focusing on the present moment so with couples, because they are often so distracted, stressed and over-committed, it can lead to lots of couples’ mind being elsewhere. A classic complaint is that a partner is distracted,” Krystal Woodbridge, a psychosexual therapist and a trustee of the college of relationship and sexual therapists says. “Mindfulness can mean you are really present with your partner and actually experiencing them in the moment and really paying attention to them.”

This in turn can then lead to better sex – because when partners really feel like they are being listened to, focused on and paid attention to is when better trust is going to be built so they are more likely to be intimate with someone.

“Really being in the moment, noticing their partners body language, facial expressions, tone of voice and what is actually being said is hard to do but it is being present,” Woodbridge says. “… It builds rapport. It you don’t have rapport, you don’t have trust. If you don’t have trust you are not going to be intimate with that person as you are not going to allow yourself tp be vulnerable with them.”

When clients put mindfulness into practice with each other, even if it is a struggle because they are so used to being distracted, it often has a “massive impact on their relationship and sex lives”, Woodbridge says.

Additionally, if someone is struggling with an issue in their sex life such as a performance issue like impotence or the inability to orgasm, mindfulness can also help in this aspect.

“In a sexual scenario what can happen is ‘spectatoring’, which is when a person is not paying attention to arousal or enjoyment and are instead observing and over-analysing themselves fearing the worst. If it is an erectile problem they will be hoping it does not fail or will feel anxious about whether their partner is enjoying it,” Woodbridge explains. “Spectatoring is often quite self-fulfilling so the person might not be able to maintain their erection, will experience sexual pain or they will just feel completely unconfident so they get into a horrible cycle.”

Sex therapists will therefore instruct the client to be mindful and to notice how they are feeling, even if that feeling is anxiety. Once they are aware they feel anxious or nervous they can focus on bringing the mind back to the physical feelings, such as arousal, and divert their focus to this instead.

“Mindfulness gets the person to notice when they are ‘spectatoring’, notice that they are distracted and not focusing on their arousal and physical sensations. It is hard in that moment as the person is anxious but if you don’t the mind will wander and go elsewhere,” Ms Woodbridge explains.

Ammanda Major, a trained sex therapist and head of service quality and clinical practice at Relate told The Independent they regularly introduce mindfulness to their sex therapy sessions for couples.

“We use mindfulness in sex therapy to help people experience more pleasure by being able to relax and stay focused and present in the moment.  Mindfulness can also benefit our relationships as a whole by relieving stress, building intimacy and enhancing inner peace. This in turn allows us to have more positive interactions with our partners,” she said.

She says couples can try mindfulness exercises at home, such as the following:

Individually: 

“Set some time aside every day to focus on your breathing. It doesn’t have to be long to begin with – maybe start with just five minutes a day and work your way up to 20. 

A good way to start is on your own with no distractions.  Close your eyes, relax and start to become aware of how you’re breathing. Breathe in slowly through your nose and exhale through your mouth. Repeat this and gradually become aware of sensations in your body. Recognise and welcome them and then allow those thoughts to drift away to be replaced with other feelings as they arise. Notice what you’re experiencing and feeling. The aim is to let go: rather than reject intrusive thoughts, just let them drift away.”

With a partner:

“Once you’ve practised the breathing exercise a few times on your own, why not with your partner?  Sit facing and look into each other’s eyes.  Breathe slowly in through your nose and exhale through your mouth as before but this time synchronise your breathing.  Do this for several minutes – it may feel a little strange at first but stick with it and it can have powerful results, increasing feelings of relaxation and intimacy.”

Complete Article HERE!