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BDSM Versus the DSM

A history of the fight that got kink de-classified as mental illness

A history of the fight that got kink de-classified as mental illness

By Merissa Nathan Gerson

Asking your partner to tie you to the bedpost, telling them to slap you hard in the throes of lovemaking, dressing like a woman if you are a man, admitting a fetish for feet: Just a few years ago, any of these acts could be used against you in family court.

This was the case until 2010, when the American Psychiatric Association announced that it would be changing the diagnostic codes for BDSM, fetishism, and transvestic fetishism (a variant of cross-dressing) in the next edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM), published in 2013. The new definitions marked a distinction between behavior—for example, playing rough—and actual pathology. Consenting adults were no longer deemed mentally ill for choosing sexual behavior outside the mainstream.

The change was the result of a massive effort from the National Coalition for Sexual Freedom (NCSF), an advocacy group founded in 1997 “to advance the rights of and advocate for consenting adults in the BDSM-Leather-Fetish, Swing, and Polyamory Communities.” At the time, these types of sexual behavior, by virtue of their inclusion in the DSM, were considered markers of mental illness—and, as a result, were heavily stigmatized, often with legal repercussions. In family court, an interest in BDSM was used as justification to remove people’s children from their custody.

“We were seeing the DSM used as a weapon,” says Race Bannon, an NCSF Board Member and the creator of Kink-Aware Professionals, a roster of safe and non-judgmental healthcare professionals for the BDSM and kink community. (The list is now maintained by the NCSF.) “Fifty Shades [of Grey] had not come along,” says Bannon, an early activist in the campaign to change the DSM. “[Kink] was still this dark and secret thing people did.”

Since its first edition was published in 1952, the DSM has often posed a problem for anyone whose sexual preferences fell outside the mainstream. Homosexuality, for example, was considered a mental illness—a “sociopathic personality disturbance”—until the APA changed the language in 1973. More broadly, the DSM section on paraphilias (a blanket term for any kind of unusual sexual interest), then termed “sexual deviations,” attempted to codify all sexual preferences considered harmful to the self or others—a line that, as one can imagine, is tricky in the BDSM community.

The effort to de-classify kink as a psychiatric disorder began in 1980s Los Angeles with Bannon and his then-partner, Guy Baldwin, a therapist who worked mostly with the gay and alternative sexualities communities. Bannon, a self-described “community organizer, activist, writer, and advocate” moved to Los Angeles in 1980 and soon became close with Baldwin through their mutual involvement as open participants in and advocates for the kink community. “I’m fairly confident that I was the first licensed mental-health practitioner anywhere who was out about being a practicing sadomasochist,” Baldwin says.

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The pair was spurred to action after the 1987 edition of the DSM-III-R, which introduced the concept of paraphilias, changed the classifications for BDSM and kink from “sexual deviation” to actual disorders defined by two diagnostic criteria. To be considered a mental illness, the first qualification was: ‘‘Over a period of at least six months, recurrent, intense sexual urges and sexually arousing fantasies involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.’’ The second: ‘‘The person has acted on these urges, or is markedly distressed by them.’’

“1987 was a bad shift,” Wright recalls. “Anyone who was [voluntarily] humiliated, beaten, bound, or any other alternate sexual expression was considered mentally ill.”

With the new language, Baldwin says, he quickly realized that laws regarding alternative sexual behavior would continue to be problematic “as long as the psychiatric community defines these behaviors as pathological.”

“I knew there were therapists around the world diagnosing practicing consensual sadomasochists with mental illness,” he says.

At the time that the new DSM was published, Baldwin and Bannon were planning to attend the 1987 march on Washington, D.C., in support of gay rights; after the new criteria came out, they decided to host a panel discussion for mental-health professionals in the State Department auditorium, where they announced the launch of what would come to be known as “The DSM Revision Project.”

“We asked how many people in the room were mental-health professionals,” Baldwin says, and “two-thirds of the people in the room raised their hands. And we said, ‘The way this needs to happen is, licensed mental-health practitioners need to write the DSM committee that reviews the language of the DSM concerned with paraphilias.’”

Around 40 or 50 people left the session with the information needed to write the letters. “We did not know exactly what would result,” Bannon recalls. “We did not think we would see dramatic changes suddenly.”

They didn’t—but the changes they did see were positive. The next edition of the DSM, published in 1994, added that to be considered part of a mental illness, “fantasies, sexual urges, or behaviors” must “cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

“This was a definite improvement from the DSM-III-R,” says Wright, who later took over leadership of the DSM Revision Project from Bannon and Baldwin.

“These criteria gave [health professionals] wiggle room to say, ‘They have issues, but it is not about their kink. For the vast majority, it is just the way they have sex,’” Bannon explains. “Rather than saying, ‘Because you are into this method of sexuality, you are sick,’ [they could say], ‘Pathologically, if this impacts your life negatively, then you have a problem.’”

But the new language in the 1994 DSM also allowed for wiggle room of a different kind: The threshold of “significant distress” was often loosely interpreted, with the social stigma of kink, rather than kink itself, causing the negative impact on people’s lives. Workplace discrimination and violence were on the rise, according to a 2008 NCSF survey, and people were still being declared unfit parents as a result of their sexual preferences: Eighty of the 100 people who turned to the NCSF for legal assistance in custody battles from 1997-2010 lost their cases.

A few years after the 1994 DSM was published, Wright decided it was time to fight for another revision. When she founded the organization in 1997, the NCSF’s goal was a change to the APA’s diagnostic codes that separated the behavior (e.g., “he likes to restrict his breathing during sex”) from the diagnosis (e.g., “his desire to restrict his breath means that he must be mentally ill”). The next DSM, the group argued, should split the paraphilias from the paraphilic disorders, so that simply enjoying consensual BDSM would not be considered indicative of an illness.

Their efforts were largely ignored by the APA until early 2009, when Wright attended a panel discussion at New York City’s Philosophy Center on why people practice BDSM. Among the panelists was psychiatrist Richard Krueger, whose expertise included the diagnosis and treatment of paraphilias and sexual disorders.

During the meeting, Wright says, “I brought up the point that the DSM manual caused harm to BDSM people because it perpetuated the stigma that we were mentally ill. [Krueger] heard me and said that was not what they intended with the DSM.” Krueger, it turned out, was on the APA’s paraphilias committee, and following the meeting opened up an email dialogue between Wright and the other committee members, in which Wright provided documentation about the violence and discrimination kinky people experienced. “I credited that to the DSM,” she says. “Courts used it. Therapists used it. And it was being misinterpreted.”

Over the next year, “I sent him information, he gave it to the group, they asked questions, and I responded. It was very productive,” Wright recalls. “We [the NCSF] felt we were heard, we were listened to—and they took [our arguments] into account when they changed the wording” of the DSM in 2010.

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Another major factor in the NCSF’s favor was a paper, co-written by sexual-medicine physician Charles Moser and sexologist Peggy J. Kleinplatz and published in 2006 in the Journal of Psychology and Human Sexuality, titled “DSM IV-TR and the Paraphilias: An Argument for Removal.” According to Wright, the paper, which “summed up opinions of mental-health professionals who thought you shouldn’t include sexual activity in the DSM,” played a significant role in the paraphilia committee’s eventual shift in language.

In February 2010 the proposed change was made public—clarifying, Wright says, that “the mental illness [depends on] how it is expressed, not the behavior itself.” The new guidelines drew a clear difference, in other words, between people expressing a healthy range of human sexuality (for example, a couple that likes to experiment, consensually, with whips, chains, and dungeons) and sadists who wish others genuine harm (for example, tying and whipping someone in a basement without their consent).

The DSM-5 was released in May 2013, its contents marking a victory for the NCSF, Bannon, and Baldwin. The final language states: “A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention.”

“Now we are seeing a sharp drop in people having their children removed from their custody,” Wright explains. Since the change, according to the NCSF, less than 10 percent of people who sought the organization’s help in custody cases have had their children removed, and the number of discrimination cases has dropped from more than 600 in 2002 to 500 in 2010 to around 200 over the last year.

“The APA basically came out and said, ‘These people are mentally healthy,’” Wright says. “‘It’s had a direct impact on society.”

Complete Article HERE!

The Pill That Prevents HIV Is As Safe As Daily Aspirin

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

By

Truvada

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Complete Article HERE!

What’s going on w/me?

Name: Paul
Gender: Male
Age: 59
Location: Rhode Island
Dear Dr Dick: I am a 59 yo man, married, masculine and very much attracted to women. I have, however, in the past few years felt an attraction to men as well. I can remember as a pre-puberty boy being turned on to other boys in magazines. Watching male porn does nothing for me and I have no desire to have anal sex. But I do often fantasize about being with a naked man and performing oral sex. I am in my second marriage, which like the first, is not very happy and there is virtually no physical relationship. I have never been much of a “ladies man” although I am very outgoing and have a good sense of humor. Is my inability to score with women turning me towards men, as they are easier to meet? I have not acted on any fantasy although I do go to a gay massage therapist and very much enjoy his hands on my body and the great hand job at the end. Too much to lose to pursue men. What’s going on w/me?

A common enough complaint, Paul. You’re apparently awakening to the realization that there is more to your sexuality than you’ve allowed yourself to consider in the past. And no, I don’t think you’re interest in men is connected to your track record with women. But it certainly could be the other way around. You aren’t overly successful with the ladies, because you’re much more interested in the gents. Does that sound more like it?

You say you haven’t acted on your newly uncovered fantasies, but you do, from time to time, get a nice hand job from the gay masseur you frequent. Aren’t you just splitting hairs with this artificial and arbitrary boundary? And aren’t you saying that if you’re not the “active” partner, you have some credible deniability? Bollocks!  I gotta tell ya, that kind of thinking make my flesh crawl.try-it-youll-like-it

It appears to me that you’re not gonna be satisfied till you finally get some mighty fine cock in your mouth. And there’s any number of ways you can get that to happen. You’re already seeing a sex worker for your massages; why not look for one who will let you blow him. Look for an escort or ask your masseur for a referral. Hell, he may even oblige you himself. All ya gotta do is be upfront with what you are looking for. Tell the provider you are unversed in the whole cock sucking department, but you’ve been wanting to try it. Remember, you’ve not committing yourself to anything, you’re just doing some research. Right?

My only concern is that you seem to have already put the kibosh any possible research when you say: “Too much to lose to pursue men.” Oh really? How much is too much? Is your over all happiness, your sexual fulfillment, or your integrity TOO MUCH? Think about it some and get back to me.

Good luck

Weed Lube Is Not Lube

But It Apparently Works Magic on Vaginas

Sensual cannabis

Sensual cannabis oil magnifies sensitivity and sensation.

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

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

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

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

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

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

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

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

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

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

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

Complete Article HERE!

These Volunteers Give Handjobs to the Severely Disabled

By Nelson Moura and Yun jie Zou

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Hand Angels helping Andy from his wheelchair into bed.

Andy is a muscular dystrophy patient who lives with his parents in southern Taiwan. Due to his severe physical disability, he was home-schooled and couldn’t leave his house alone, so never really had the opportunity to develop either an active social life or a romantic relationship.

When the Taiwanese NGO Hand Angel—an organization promoting the sexual rights of disabled people—first spoke to Andy, they realized this situation meant he’d also never been able to have a frank conversation with anyone about his sexuality. And as a young gay man who didn’t want to speak to his parents about his feelings, this wasn’t exactly the healthiest situation to be in.

So, over the course of a few months, representatives from the NGO counseled Andy online, helping him to understand his own sexuality and place in the world. Next, they “smuggled” him out of his house and took him to a motel for a handjob.

Taiwan—officially known as the Republic of China—has one of the best health systems in the world; its million or so disabled citizens receive some of the most thorough medical attention you’ll find, including everything from long-term care to traditional herbal medicine. What they don’t receive from this system, however, is any kind of aid when it comes to slightly more intimate issues, namely: orgasms.

It was for this reason that a group of social campaigners and volunteers took it upon themselves to create Hand Angel, an NGO whose main service is giving handjobs to the severely disabled. Members say that their work raises awareness of the fact that disabled people are often depicted as desexualized—as well as having their sexuality constantly neglected—despite the fact they share exactly the same desires as anybody else.

In the Netherlands, the national health system provides a grant scheme for people with disabilities to receive public money to pay for sexual services up to 12 times a year. In Taiwan, sex remains a taboo, and some Buddhists—the sovereign state’s primary religion—believe that someone suffering from a disability means they’re paying for bad deeds in a past life. So not the best mix for those like Andy, really.

“I can’t tell my parents that I also have sexual desires, and I can’t come out of the closet in front them,” he told me. “My family’s care puts lots of pressure [on me] and sabotages me from normal romantic relations.”

Vincent, the 50-year-old founder of Hand Angel, lost his legs to polio and says his disability allows him to better empathize with applicants’ needs, without any of the patronization disabled people can sometimes face. He emphasized that “disabled people share the same physical and emotional needs as any others, and therefore should have the right to pursue them.”

In order to decide who’s entitled to use their services, Hand Angel first assess an applicant’s level of disability. The person has to be recognized by the government as having a serious physical impairment, but can’t be mentally disabled. Once they’re cleared, the service is totally free, but each applicant can only receive three bouts of sexual stimulation.

Volunteers—the group of 10 people actually giving the handjobs—come from varied backgrounds; some are gay, some are straight, some are disabled, some are PhD students, some are social campaigners and some work in the media. It’s made very clear to me that these volunteers only use their hands for second-base kind of stuff—that hugging, caressing, and kissing on the face are all fine, but anything penetrative (fingering, oral sex, vaginal sex, and anal sex) is not.

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The hands of Hand Angel volunteers

When Hand Angel took Andy to the motel, the volunteer caressed him thoroughly and gave him a handjob. He described the intimacy being so intense that, for a minute, he believed he was in love. He knew it was only temporary, of course, but the experience provided him with an emotional connection he’d never felt before.

This is part of Hand Angel’s mission: not just providing a sexual service, but also bringing forth an emotional and social transformation in applicants.

“[Andy] was very introverted before, and didn’t really know how to interact with people,” said Vincent. “However, through months of talking online, I discovered something changed inside him. When our group was reported by the media and got lots of criticism, I saw Andy joined the public debate and argued with those [critical] internet users, trying to illustrate his opinions.”

In Taiwan, where a discussion of sexuality is restrained by strict moral codes, there was also plenty of mockery leveled at Hand Angel. Internet users starting posting comments like: “Do they also offer ‘Mouth Angels?'”; “I’m retarded; can I apply for Hand Angel service, too?”; and “Only three times in a lifetime?”

There even appeared to be negativity on an official level. The executive secretary of the Taipei United Social Wealth Alliance, Yi-Ting Hu, commented on the NGO, saying: “Speaking from personal opinion, I don’t think we need to bring up disabled people’s sexuality as an independent issue. There are more important and urgent problems we need to deal with. Don’t you think if you advocate their sexual rights, it is like another form of discrimination?”

Of course, he seemed to only be proving Hand Angels’ point; to suggest that advocating a disabled person’s sexual rights is a form of discrimination is, first, patronizing in itself, and secondly, just completely bizarre—how is consensually receiving a handjob in any way discriminatory?

Andy summed it up: “I didn’t feel I was the target of pity. The whole process was full of respect and equality. This might be deemed as controversial by society, but as long as you’re willing to look into it, what we desire is no different from others. Just ask yourself: do you need to consult your parents before having sex?”

Complete Article HERE!