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A new way to think about dementia and sex

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There’s an urgent need for a new ethic of dementia care that supports the facilitation of sexual expression.

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Persons living with dementia don’t have sex. Or they have weird sex. Or they have dangerous sex, in need of containment.

When it comes to dementia and sexuality, negative language and apocalyptic warnings abound. The aging population has been described in the media as a “rape case time-bomb.” Health practitioners often respond in punishing ways to sexual activity in residential care. And the sexual rights of persons living with dementia are largely ignored within residential care policy, professional training and clinical guidelines.

As critical social researchers, we argue that a new ethic of dementia care is urgently needed, one that supports the facilitation of sexual expression.

Practitioners and administrators often hold negative and judgmental attitudes about dementia and aged sexuality

Our research at the University of Toronto and the Toronto Rehabilitation Institute-University Health Network investigates embodiment, relationality, ethics and dementia. We are motivated by a shared concern about the reductive focus of dementia care on basic physical needs, and our desire to foster a more humane and life-enriching culture of care. We have explored how the sexualities of persons living with dementia are poorly supported in long-term residential care settings such as nursing homes.

Sex and dementia in the media

When we see persons living with dementia and sex linked in the media, it tends to be in high profile cases of

Institutional policies, structures and practices must support sexual expression.

alleged abuse. One example is the legal trial of Henry Rayhons, an Iowa lawmaker found not guilty of sexually abusing his wife who at the time was living with dementia in a nursing home. Another example is the wider investigation into sexual assaults in nursing homes in Ontario.

Vital as such investigations are to the safety of residents in long-term care, we rarely see sexual expression valued or as fundamental to human flourishing.

Our research has explored how these negative representations of the sexualities of persons living with dementia are also found within long-term residential care settings such as nursing homes.

Practitioners and administrators often hold negative and judgmental attitudes about dementia and aged sexuality. When faced with sexual activity, they can intervene in threatening and punishing ways. And long-term care policies, professional training and clinical guidelines tend to ignore the sexual rights of persons with dementia.

The problem with biomedical ethics

The sexualities of persons living with dementia are considered troubling partly because long-term care polices are shaped by biomedical ethics. This ethical approach relies on four core principles: autonomy, beneficence, non-maleficence and justice. These principles support intervening in residents’ sexual expression if it will cause harm to themselves or cause harm or offence to others.

However, this approach sets the bar for practitioners’ interference excessively high. It can restrict voluntary sexual expression by residents living with dementia in nursing homes.

Biomedical ethics also ignore the performative, embodied and relational aspects of ethical reasoning. It assumes that people are rational autonomous beings. It also assumes that self-expression, including sexuality, results only from cognitive and reflective decision making. Given that dementia involves progressive cognitive impairment, persons living with dementia may be unfairly discriminated against by this approach to sexual decision making.

A duty to support sexual expression

We use a model of relational citizenship to create an alternative ethic in which sexuality is seen as embodied self-expression. It is an ethic that recognizes human beings as embodied and embedded in a lifeworld. And one that views sexuality as an important part of being human.

Social and leisure activities supportive of the development of intimate relationships are essential within nursing homes.

This new ethic broadens the goals of dementia care. No longer do health professionals just have the duty to protect persons with dementia from harm. There is also a duty to support their right to sexual expression.

We argue that institutional policies, structures and practices must also support sexual expression. These should facilitate sexual rights. We must also introduce education for health professionals and the broader public — and policy initiatives to counteract the stigma associated with sexuality and dementia.

Social and leisure activities that are supportive of sexual expression and the development of intimate relationships are also essential within nursing homes.

Of course, protection from unwanted contact or sexual harm is still important. However, freedom of sexual expression should only be restricted when necessary to protect the health and safety of the individuals involved.

Complete Article HERE!

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Here Are The Best Places In The World To Take A Sex Vacation

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By Bobby Box

Weather, affordability and sight-seeing and shopping opportunities are all definitive factors when planning a vacation, but have you ever considered the level of a city’s sex-positiveness? . undefined

If you’re on the hunt for a sex-fuelled sabbatical and need some direction, you’re in luck. Adult mobile app portfolio Lazeeva has put in a ton of work and consulted an assemblage of permissable research to determine which cities around the world are the most “sex-positive,” which Lazeeva describes as “having or promoting an open, tolerant, or progressive attitude towards sex.”

To quantify how sexual a city is, Lazeeva’s team began by researching 10 critical factors in over 200 cities from around the world. These components include: gender equality, LGBT friendliness, access to contraception, swinger-friendliness, adult entertainment, porn consumption, sex toy consumption, sexual satisfaction, willingness to experiment and sexual activeness.

To quantify how sexual a city is, Lazeeva’s team began by researching 10 critical factors in over 200 cities from around the world. These components include: gender equality, LGBT friendliness, access to contraception, swinger-friendliness, adult entertainment, porn consumption, sex toy consumption, sexual satisfaction, willingness to experiment and sexual activeness.

After attributing a rank for each category, Lazeeva used in-house data and combined it with research from the UN, the World Bank, as well as various listings in each city for sex and sexual health resources available for swingers, LGBTQ groups and charities, to give a comprehensive and decidedly fair score to each city studied. They then crafted a near-encyclopedic ranking of the 100 most sex positive cities worth the stamp in your passport. We’ve narrowed it down to the top 10.

The most sex-positive city in the world is–drum roll, please…–Paris, France! Which proved to be exceptionally sexually-active and gay-friendly. The city of love also boasts quite a thriving swingers scene.

In a very close second comes Rio de Janeiro, Brazil, which received top scores in sexual activeness and willingness to experiment. However, their paltry score in gender equality brought the overall average down significantly.

London, England came third, thanks, in great part, to their thriving adult entertainment scene and praiseworthy scores in LGBT friendliness.

The first American entry is none other than Los Angeles, USA, ranking fourth overall. The porn capital recieved top scored in–you guessed it–porn consumption, as well as very imposing scores in its willingness to experiment sexaully. We should add that both Playboy HQ and the Playboy Mansion are located here and, in case you couldn’t tell, we love us some sex.

If you like to swing, you might want to book a trip to Berlin, Germany, which ranks fifth. In addition to a prosperous swingers scene, they also received soaring scores in adult entertainment. But be warned: Berlin has horrible access to contraception. So bring rubbers.

New York City comes sixth. The Big Apple was impressive across the board, but boasted exceptionally high scores in porn and remarkably low scores in gender equality, which evened themselves out.

In seventh comes Sao Paulo, Brazil, who earned the highest possible score in sex toy consumption and a commendable score in their willingness to experiment. No doubt a winning combination for the sexually dauntless.

Vegas, baby! Coming in eighth overall, sin city proved prolific in–duh–adult entertainment and–double duh–its swingers score.

Ibiza, Spain, is known to be a party place, so it makes perfect sense that they’re sexually progressive. That is, if you’re a man. Gender equality in Ibiza, however, proved upsetting.

Bookending the top 10 is one I’m willing many of us predicted would be higher on the list. This is, of course, Amsterdam in the Netherlands. Surprising, considering the city is host to the world’s only (legal) Red Light District and lax laws around drug use.

Understandably, if you didn’t want to book a nine-hour flight in the interest of sexual exploits, a number of American cities broke the top 10, most of which are located across the map, making them a fun little road trip. These sex-positive American cities include: San Francisco (11th), Miami (14th), Austin (19th), Chicago (25th), Seattle (35th), Portland (36th) and Boston (49th).

To see the full list of sex-positive cities, click here.

Complete Article HERE!

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How to introduce BDSM to the bedroom without terrifying your partner

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Everything you need to know about adding a bit of kink to your bedroom

First things first, let’s clear up exactly what BDSM means: bondage and discipline (B&D); dominance and submission (D&S); sadism and masochism (S&M).

It’s split up this way because BDSM means a lot of different things to the people who identify with it. And don’t believe the 50 Shades Of Grey hype – when performed consensually, those people aren’t mentally unstable or have a history of abusive behaviour, they just have a kinkier nighttime ritual.

Another 50 Shades misconception is that BDSM involves pain or sex at all. It doesn’t (unless you both want that). The only requirement involved with BDSM is trust and consent. There is always a dominant person (gives orders, is in complete control) and a submissive participant (receives orders and does as they’re told by the dominant). EL James obviously wasn’t a fan of fact-checking.

Yet the book, which is generally looked down on by BDSM fans, has helped it become more mainstream, High Street even – some Ann Summers stores now have their own BDSM sections selling all the impedimenta you need, which, plainly, is great if you always wanted to partake but were too afraid to ask. But there’s still a slight stigma attached to it, so you’ll need to plan this carefully.

First of all, research is key. Settle in for a long session on a BDSM tube, hit a BDSM chat room (yep, they still exist), read BDSM erotic fiction – expose yourself to as much of it as you can and work out exactly what it is you like. Once you’ve got your head around it, share it with your other half. This is not the time for shock and awe – start gently, maybe showing them a video you’ve seen. Say, “Looks kind of sexy, don’t you think?” and gauge their reaction. If they’re into it, great. If not, park it. It may plant a seed in their mind that does eventually flower, it may not. You can’t force them. That’s not what BDSM’s about.

Assuming they’re happy, it’s time to introduce it to the bedroom. BDSM isn’t an impulsive act; it takes planning, research and preparation, but a good transitional device is a mask. Buy one and ask if they want to wear it/mind you wearing it during sex. It might seem trivial, but whoever’s wearing the mask (the submissive) has to put all of their trust into the person who isn’t (the dominant) and that’s where things should get sexy. If it felt good, suggest a massage with a vibrator while their eye mask is on.

If that’s the extent of your fantasy, great. Mission accomplished. But if you want to edge towards the kinkier side of things, you need to keep establishing that trust by never exploiting it, obviously, but also by having plenty of post-coital discussions about what you both liked and what else you could try. Then you need to prepare yourself. When I said BDSM wasn’t impulsive, I meant it – you need an awful lot of gear if you want to explore BDSM more broadly.

Want to tie someone up? You’ll need a specialist product that reduces the risk of rope burn. Then you’ve got to think about adjustments. Things like spreader bars (Ann Summers sells out of these every Valentine’s Day) and nipple clamps aren’t necessarily designed for pain because you can change how tightly they fasten, and some days you or they may wish to be in more or less pain than the time before. Then there’s putting on the BDSM uniform. Whether that’s just lingerie or, well, a uniform – it all takes time and a very free schedule. But if procuring the products, setting them up and getting dressed up is worked into the ritual of kinkier sex, the prep can become its own pleasure.

By now, you should be in full swing, enjoying all the safe, sexy delights BDSM can offer, whatever that might mean to you. I bet they put Christian Grey‘s efforts to shame.

Complete Article HERE!

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What gay trans guys wish their doctors knew

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Vancouver study peers into the lives and troubles of trans MSM

Sam Larkham organizes sexual health clinics across Metro Vancouver with the Health Initiative for Men (HIM). He says he was once referred by his doctor to a trans health care clinic that had been closed for years.

By Niko Bell

Speaking to gay and bisexual trans men, the word “invisibility” comes up a lot. Invisibility in the bathhouse and on dating apps, invisibility among cisgender people, straight people, trans people and gay people. And, too often, invisibility in the doctor’s office.

“I have tried just going to walk-in clinics and stuff like that to ask questions or request tests,” one trans man recently told researchers in Vancouver. “And I just found the doctors were generally confused about me and my body. And I had to go into great detail. That made me not so comfortable talking to them about it because they were just kind of sitting there confused.”

“People have tried to talk me out of testing . . . saying I was low-risk behaviour,” another man told the researchers. “They didn’t understand my behaviour really. . . I’ve had practitioners as well say they don’t know what to do; they don’t know what to look for.”

Both men were speaking to researchers for a new study on the sexual health of trans men who have sex with men — a group social scientists know remarkably little about. Many of the men spoke about being on the margins of mainstream culture, gay culture and of the healthcare system.

It should be no surprise, then, that the study happened almost by accident. When PhD student Ashleigh Rich started work with the Momentum Health Study — a five-year, in-depth research project on the sexual health of men who have sex with men (MSM) conducted out of the BC Centre for Excellence in HIV/AIDS — she never intended to write a paper about trans MSM.

But a small group of trans men volunteered for the study, some pointing out ways the Momentum researchers could change their surveys to be more inclusive.

There were too few for quantitative research — only 14 — but Rich asked if they would sit down for an hour and talk about their experiences. Eleven agreed.

The result is a slim, 11-page paper that hints at a world of things we don’t yet know about transgender gay and bisexual men. We do know they form a large part of the trans population; nearly two thirds of trans men say they are not straight. We also know trans MSM participate in the same rich world of sexuality as other men who have sex with men — from dating apps to anonymous sex to sex work and a broad range of sexual behaviour.

We don’t know much about trans MSM risk for HIV; estimates range from much less than cisgender gay and bi men to somewhat more. We also don’t know much about how a combination of stigma, invisibility and limited healthcare options may be affecting trans men’s health.

Rich is cautious about drawing any broad conclusions from her study. Not only is it a tiny sample, but the men she spoke to are also mostly urban, white and educated. This study was less about answering questions, and more about figuring out which questions to ask.

A few themes, though, emerge clearly. One is that trans MSM often find themselves falling through the cracks when it comes to sexual health. Doctors are increasingly aware of how to talk to gay men, but don’t always see trans gay men as “real” MSM. They assume trans men are heterosexual, or fail to bring up sexual health altogether.

Some doctors give trans men information on PrEP — a preventative anti-HIV medication that can drastically reduce the risk of contracting HIV if taken every day — based on studies on cisgender men, without checking to see if different anatomy requires different doses. When trans men come in for HIV tests, they are sometimes urged to get pap smears instead.

“We come in with specific issues we want to talk about in a health care consult, and sometimes once people discover we’re trans they’ll want to do a pregnancy test or something,” says Kai Scott, a trans inclusivity consultant who collaborated on the study with Rich. “And we’re not there for that. They’re giving us things we don’t want, and not telling us the things we do need to know.”

Sam Larkham, a trans man who organizes sexual health clinics across Metro Vancouver with the Health Initiative for Men (HIM), says he was once referred by his doctor to a trans health care clinic that had been closed for years. Experiences like that make him think the best path for trans MSM is to rely on queer-focused health care providers like HIM.

“It would be ideal if it were the whole medical system, but that’s impossible,” Larkham says. “I think we have to look at what we can do, and that’s have specific places where we have nurses who are well trained to handle trans MSM. I think that’s the more doable thing. I would love to have every clinic be culturally competent, but that’s not the reality and never will be.”

Scott is more sanguine. He points to Trans Care BC, a provincial health program that has pushed for more education for doctors. Education needs to happen on both fronts, Scott says, among MSM organizations and in the health care system at large.

Lauren Goldman is a nurse educator for Trans Care BC. Since she was hired last fall, she’s been giving workshops to healthcare providers on how to treat trans patients. For now, though, the workshops are aimed at small groups of sexual health professionals, such as at the BC Centre for Disease Control or HIM. Goldman wants the program to expand to include everyone.

“We know trans patients are accessing care through a number of places all across the province,” she says. “We want everyone to have access to this information as soon as possible.”

Goldman says Trans Care is designing an online course that could bring trans cultural competency to primary care doctors everywhere as part of mandatory continuing education. Trans Care has also designed a primary care “toolkit” for doctors, and is in talks with UBC’s medical school about including trans-focused sexual health education for doctors in training.

Without specialized knowledge, Goldman says, there’s a lot doctors can miss. Testosterone can make vaginal tissue more sensitive and inflexible, for example, meaning trans men might have special difficulties with genital sex. Bacterial vaginosis is more common, and the usual antibiotics given to cis women may not solve the problem. Vaginal and rectal tissue may need different doses of PrEP to be effective.

And, most importantly, doctors need trans patients to know they will be heard.

“We need to be providing really obvious cues that show people that our services are trans inclusive,” Goldman says. “Including how we design our services, how we market our services, how we educate our clinicians, what signs we hang up, letting people know that our clinicians have a greater understanding of gender diversity.”

While Goldman is educating doctors, the trans men Rich studied were already very well educated about their own sexual health. They told Rich about careful risk assessments they make around sex, sharing information with other men, and advocating for STI screening to their reluctant doctors.

One man described slipping in HIV tests while getting regular testosterone-level screening: “Yeah, oh, I’m already getting blood drawn. I probably need to get tested, let’s just draw two more vials for HIV and syphilis.”

It’s not surprising that many trans men are so health-conscious, Scott says. “We’ve had to be champions of our own bodies for a while, and so that ethos carries through when it comes to health information.”

But it would be a mistake to overstate how safe trans MSM are, he adds. For one, the urban, white and well-educated men in Rich’s study may be more likely to have access to resources and care than less wealthy or more rural trans people. Also, the very reason trans MSM seem so safe might be because they aren’t getting the opportunities for sex they want.

“To some extent, we’re still on the sidelines,” Scott says. “I don’t think that systemic rejection should be the means of HIV prevention for trans and nonbinary people. We’re dealing with a lot of rejection, and so I don’t think we’ve really had the opportunity to be exposed to that risk.”

The theme of rejection is echoed frequently by the study subjects.

“I remember meeting this one guy at a friend’s party and we were flirting the whole time,” one participant recounted. “He was like, ‘Oh we should totally go for a beer’ and so we connected and then I told him I was trans and he was like, ‘Oh I’m not looking for anything.’”

“Cis men often shut down immediately, out of a sort of fear of the unknown, and being unaware of what can and can’t happen,” Scott says. “They can assume all trans guys are bottoms, which isn’t true.”

Constant rejection can wear trans men down, Larkham says. Not only does it damage mental health, but constant rejection can weaken trans men’s resolve to negotiate sexual safety.

Many trans men, the study notes, rely on online hookup sites, where they can be upfront about being trans, and avoid rejection by anyone who isn’t interested.

The burden of rejection is one reason trans MSM need better mental health services too, Larkham says. Too many men show up to sexual health clinics after being exposed to sexual risks. Mental health support, he thinks, could reach people earlier.

But again, Scott strikes a positive note. “It’s a source of celebration to me that despite huge barriers we’re still having the sex that we want,” he says.

In the end, the clearest message to emerge from Rich’s study is that there’s a lot more to learn. She hopes to get more answers from the next stage of the Momentum study, which will recruit a larger sample of MSM from across Canada. That study, she hopes, will be large enough to deliver the kind of precise, quantitative answers that this one couldn’t.

Scott is also eager to move forward.

“There’s so much you want to pack in and so much you want to report on,” he says. “There’s such a dire need to research these issues. People are really hurting, and I really feel that. But you’ve got to take it one step at a time.”

Complete Article HERE!

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This sex ed series tackles LGBTQ issues in an honest, groundbreaking way

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While the fight for LGBTQ rights might make headline news, that doesn’t mean queer education is making it into schools. For most Americans, sex ed courses barely talk about the ins and outs of being gay, bisexual, queer, or transgender, making it hard for many students to learn about themselves, their bodies, and their sexual preferences.

To fix that problem, Advocates for Youth, Youth Tech Health, and Answer at Rutgers University have teamed up to launch AMAZE. Dedicated to making sex education “approachable, engaging, and informative for very young adolescents,” AMAZE talks about a variety of issues impacting teens. From forming healthy relationships, to understanding queer sexual orientations, to discussing cisgender, transgender, and non-binary gender identities, AMAZE breaks down topics into simple lessons that are perfect for middle and high school students.

Many videos also explore sex ed topics through a scientific lens, explaining everything from mood swings to male erections. Seeing how public school classrooms rarely talk about these issues, and some schools are still stuck in abstinence-only mindsets, AMAZE is serving as a true trailblazer for reforming American sex education.

Interested viewers can check out AMAZE’s videos on its official YouTube page. And through My AMAZE, educators can create their own playlist to share with students for lessons and discussions.

Complete Article HERE!

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