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Women with HIV, after years of isolation, coming out of shadows

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Patti Radigan kisses daughter Angelica after a memorial in San Francisco’s Castro to remember those who died of AIDS.

By Erin Allday

Anita Schools wakes at dawn most days, though she usually lazes in bed, watching videos on her phone, until she has to get up to take the HIV meds that keep her alive. The morning solitude ends abruptly when her granddaughter bursts in and they curl up, bonding over graham crackers.

Schools, 59, lives in Emeryville near the foot of the Bay Bridge, walking distance from a Nordstrom Rack and other big chain stores she can’t afford. Off and on since April, her granddaughter has lived there too, sleeping on a blow-up mattress with Schools’ daughter and son-in-law and another grandchild.

Five is too many for the one-bedroom apartment. But they’re family. They kept her going during the worst times, and that she can help them now is a blessing.

Nearly 20 years ago, when Schools was diagnosed with HIV, it was her daughter Bonnie — then 12 and living in foster care — who gave her hope, saying, “Mama, you don’t have to worry. You’re not going to die, you’re going to be able to live a long, long time.”

“It was her that gave me the push and the courage to keep on,” Schools said.

She had contracted HIV from a man who’d been in jail, who beat her repeatedly until she fled. By then she’d already left another abusive relationship and lost all four of her daughters to child protective services. HIV was just one more burden.

At the time, the disease was a death sentence. That Schools is still here — helping her family, getting to know her grandchildren — is wonderful, she said. But for her, as with tens of thousands of others who have lived two decades or more with HIV, survival comes with its own hardships.

Gay men made up the bulk of the casualties of the early AIDS epidemic, and as the male survivors grow older, they’re dealing with profound complications, including physical and mental health problems. But the women have their own loads to bear.

Whereas gay men were at risk simply by being gay, women often were infected through intravenous drug use or sex work, or by male partners who lied about having unsafe sex with other men. The same issues that put them at risk for HIV made their very survival a challenge.

Today, many women like Schools who are long-term survivors cope with challenges caused or compounded by HIV: financial and housing insecurity, depression and anxiety, physical disability and emotional isolation.

“We’re talking about mostly women of color, living in poverty,” said Naina Khanna, executive director of Oakland’s Positive Women’s Network, a national advocacy group for women with HIV. “And there’s not really a social safety net for them. Gay men diagnosed with HIV already historically had a built-in community to lean on. Women tend to be more isolated around their diagnosis.”

There are far fewer women aging with HIV than men. In San Francisco, nearly 10,000 people age 50 or older are living with HIV; about 500 are women. Not all women survivors have histories of trauma and abuse, of course, and many have done well in spite of their diagnosis.

But studies have found that women with HIV are more than twice as likely as the average American woman to have suffered domestic violence. They have higher rates of mental illness and substance abuse.

What keeps them going now, decades after their diagnoses, varies widely. For some, connections with their families, especially their now-adult children, are critical. For others, HIV advocacy work keeps them motivated and hopeful.

Patti Radigan (righ) instructs daughter Angelica and Angelica’s boyfriend, Jayson Cabanas, on preparing green beans for Thanksgiving while Roman Tom Pierce, 8, watches.

Patti Radigan was living in a cardboard box on South Van Ness Avenue in San Francisco when she tested positive in 1992. By then, she’d lost her husband to a heart attack while a young mother, and not long after that she lost her daughter, too, when her drug use got out of control and her sister-in-law took in the child.

She turned to prostitution in the late 1980s to support a heroin addiction. She’d heard of HIV by then and knew it was deadly. She’d seen people on the streets in the Mission where she worked, wasting away and then disappearing altogether. But she still thought of it as something that affected gay men, not women, even those living on the margins.

Women then, and now, were much more likely than men to contract HIV from intravenous drug use rather than sex — though in Radigan’s case, it could have been either. IV drug use is the cause of transmission for nearly half of all women, according to San Francisco public health reports. It’s the cause for less than 20 percent for men.

Still, when Radigan finally got tested, it wasn’t because she was worried she might be positive, but because the clinic was offering subjects $20. She needed the cash for drugs.

She was scared enough after the diagnosis — and then she got pregnant. It was the early 1990s, and HIV experts at UCSF were just starting to believe they could finesse women through pregnancy and help them deliver healthy babies. Today, it’s widely understood that women with HIV can safely have children; San Francisco hasn’t seen a baby born with HIV since 2004.

But in the 1990s, getting pregnant was considered selfish — even if the baby survived, its mother most certainly wouldn’t live long enough to raise her. For women infected at the time, having children was something else they had to give up.

And so Radigan had an abortion. But she got pregnant again in 1995, and she was desperate to have this child. She was living by then with 10 gay men in a boarding house for recovering addicts. Bracing herself for an onslaught of criticism, she told her housemates. First they were quiet, then someone yelled, “Oh my God, we’re having a baby!”

“It was like having 10 big brothers,” Radigan said, smiling at the memory. Buoyed by their support, she kept the pregnancy and had a healthy girl.

Radigan is 59 now; her daughter, Angelica Tom, is 20. They both live in San Francisco after moving to the East Coast for a while. It was because of her daughter that Radigan stayed sober, that she consistently took her meds, and that she went back to school to tend to her future.

For a long time she told people she just wanted to live long enough to see her daughter graduate high school. Now her daughter is in art school and Radigan is healthy enough to hold a part-time job, to lead yoga classes on weekends, to go out with friends for a Friday night concert.

“Because of HIV, I thought I was never going to do a lot of things,” Radigan said. “The universe is aligning for me. And now I feel like I deserve it. For a long time, I didn’t feel like I deserved anything.”

Anita Schools, who says she is most troubled by finances, listens to an HIV-positive woman speak about her experiences and fears at an Oakland support group that Schools organized.

Anita Schools got tested for HIV because her ex-boyfriend kept telling her she should. That should have been a warning sign, she knows now.

She was first diagnosed in 1998 at a neighborhood clinic in Oakland, but it took two more tests at San Francisco General Hospital for her to accept she was positive. People told her that HIV wasn’t necessarily fatal, but she had trouble believing she was going to live. All she could think was, “Why me? What did I do?”

It was only after her daughter Bonnie reassured her that Schools started to think beyond the immediate anxiety and anger. She joined a support group for HIV-positive women, finding comfort in their stories and shared experiences. Ten years later, she was leading her own group.

She’s never had problems with drugs or alcohol, and she has a network of friends and family for emotional support, she said. Even the HIV hasn’t hit her too hard, physically, though the drugs to treat it have attacked her kidneys, leaving her ill and fatigued.

Like so many of the women she advises in her support group, Schools is most troubled by her finances. She gets by on Social Security and has bounced among Section 8 housing all over the Bay Area for most of her adult life.

Schools’ current apartment is supposed to be permanent, but she worries she could lose it if her daughter’s family stays with her too long. So earlier this month they moved out and are now sleeping in homeless shelters or, some nights, in their car. She hates letting them leave but doesn’t feel she has any other choice.

Reports show that women with HIV are far more likely to live in poverty than men. Khanna, with the Positive Women’s Network, said surveys of her members found that 85 percent make less than $25,000 a year, and roughly half take home less than $10,000.

Schools can’t always afford the bus or BART tickets she needs to get to doctor appointments and support group meetings, relying instead on rides from friends — or sometimes skipping events altogether. She gets her food primarily from food banks. Her wardrobe is dominated by T-shirts she gets from the HIV organizations with which she volunteers.

“With Social Security, $889 a month, that ain’t enough,” Schools said. “You got to pay your rent, and then PG&E, and then you got to pay your cell phone, buy clothes — it’s all hard.”

At a time when other women her age might be thinking about retirement or at least slowing down, advocacy work has taken over Schools’ life. She speaks out for women with HIV and their needs, demanding financial and health resources for them. In her support group and at AIDS conferences, she offers her story of survival as a sort of jagged road map for other women struggling to navigate the complex warren of services they’ll need to get by.

The work gives her confidence and purpose. She feels she can directly influence women’s lives in a way that seemed beyond her when she was young, unemployed and directionless.

“As long as I’m getting help and support,” Schools said, “I want to help other women — help them get somewhere.”

Billie Cooper is tall and striking, loud and brash. Her makeup is polished, her nails flawless. She is, she says with a booming laugh that makes heads turn, “the ultimate senior woman.”

For Cooper, 58, HIV was transformative. Like Radigan, she had to find her way out from under addiction and prostitution to get healthy, and stay healthy. Like Schools, she came to understand the importance of role-modeling and advocacy.

Cooper arrived in San Francisco in the summer of 1980 — almost a year to the day before the first reports of HIV surfaced in the United States. She was fresh out of the Navy and eager to explore her gender identity and sexuality in San Francisco’s burgeoning gay and transgender communities.

Growing up in Philadelphia, she’d known she was different from the boys around her, though it was decades before she found the language to express it and identified as a transgender woman. But seeing the “divas on Post Street, the ladies in the Tenderloin, the transsexual women prostituting on Eddy” — Cooper was awestruck.

She slipped quickly into prostitution and drug use. When she tested positive in 1985, she wasn’t surprised and barely wasted a thought worrying about what it meant for her future — or whether she’d have any future at all.

“I felt as though I still had to keep it moving,” Cooper said. “I didn’t slow down and cry or nothing.”

Transgender women have always been at heightened risk of HIV. Some studies have found that more than 1 in 5 transgender women is infected, and today about 340 HIV-positive trans women live in San Francisco.

What makes them more vulnerable is complicated. Trans women often have less access to health care and less stable housing than others, and they face higher rates of drug addiction and sexual violence, all of which are associated with risk of HIV infection.

Cooper was homeless off and on through the 1980s and ’90s, trapped in a world of drugs and sex work that felt glamorous at the time but in hindsight was crippling. “I was doing things out of loneliness,” she said, “and I was doing things to feel love. That’s why I prostituted, why I did drugs.”

She began to clean up around 2000, though it would take five or six years to fully quit using. She found a permanent place to live. She collected Social Security. She started working in support services for other transgender women battling HIV. In 2013, she founded TransLife, a support group at the San Francisco AIDS Foundation.

“I was coming out as the activist, the warrior, the determined woman I was always meant to be,” she said.

Cooper never developed any of the common, often fatal complications of HIV — including opportunistic infections like pneumonia — that killed millions in the 1980s and 1990s. But she does have neuropathy, an HIV-related nerve condition that causes a constant pins-and-needles sensation in her feet and legs and sometimes makes it hard to walk.

Far more traumatic for her was her cancer diagnosis in 2006. The cancer, which may have been related to HIV, was isolated to her left eye, but after traditional therapies failed, the eye was surgically removed on Thanksgiving Day in 2009.

The cancer and the loss of her eye was a devastating setback for a woman who had always focused on her appearance, on looking as gorgeous as the transgender women she so admired in the Tenderloin, on being loved and wanted for her beauty.

Rising from that loss has been difficult, she said. And she’s continued to suffer new health problems, including blood clots in one of her legs. Recently, she’s fallen several times, in frightening episodes that may be related to the clots, the HIV or something else entirely.

Since Thanksgiving she’s been in and out of the hospital, and though she tries to stay upbeat, it’s clearly trying her patience.

But if HIV and cancer and everything else have tested Cooper’s survival in ways she never anticipated, these trials also have strengthened her resolve. She’s becoming the person she always wanted to be.

“A week before they took my eye, I got my breasts,” she said coyly one recent afternoon, thrusting out her chest. Behind the sunglasses she wears almost constantly now, she was smiling and crying, all at once.

Aging with HIV has been strangely calming, in some ways, giving her a confidence that in her wild youth was elusive.

Now she exults in being a respected elder in the HIV and transgender communities. She loves it when people open doors for her or help her cross the street, offer to carry her bags or give up a seat on a bus.

Simply, she said, “I love being Ms. Billie Cooper.”

Complete Article HERE!

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Research finds that older people’s sexual problems are being dismissed

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Older people’s sexual activity problems and desires are being dismissed by health practitioners due to their age, a new study has suggested.

seniors

Research by The University of Manchester’s MICRA (Manchester Institute for Collaborative Research on Ageing) and Manchester Metropolitan University highlighted the obstacles some older couples face in maintaining fulfilling sexual lives, and how they adapt to these barriers.

The study analysed written comments from over a thousand adults aged 50 to 90 who responded to the English Longitudinal Study of Ageing Sexual Health and Relationships questionnaire. Respondents of both sexes emphasised their anxiety at not being taken seriously by health practitioners as they sought to overcome issues affecting their , such as a drop in sexual desire or physical difficulties. One man in his eighties reported being refused Viagra for erectile dysfunction on the grounds of cost.

Participants in the study, published in Ageing and Society, cited other elements influencing sexual activity, including health conditions and physical impairment, the evolving status of sex in relationships and mental wellbeing. It was also found that men were more likely to talk about the impact of on sexual activities, but women were more likely to talk about health-related sexual difficulties in the context of a relationship.

The study recommends that health care practice should positively engage with issues of sexual function and sexual activity to improve the health and wellbeing of , particularly in the context of long-term health problems.

“This research further improves our understanding of love and intimacy in later life”, said study co-author David Lee, Research Fellow from The University of Manchester. “It builds upon empirical findings published in our earlier paper (Sexual health and wellbeing among older men and women in England; Archives of Sexual Behaviour) which described a detailed picture of the sex lives of older men and women. However, this new research uses narrative data to better understand how changing age, health and relationships interrelate to impact sexual health and satisfaction.”

“Appreciating individual and personal perspectives around sexuality and sexual is of paramount importance if we are to improve services for older people.”

Complete Article HERE!

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Rheumatoid arthritis and sexual dysfunction: Impact and tips

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By: Devon Andre

Close Up Of Senior Couple Holding Hands On Beach

Rheumatoid arthritis (RA) is accompanied by sexual dysfunction in one-third of all RA patients, both men and women. The study found that there are a number of issues that affect RA patients, including low libido, painful intercourse, orgasmic dysfunction, premature ejaculation, and non-satisfactory sexual life.

Dr. Pedro Santos-Moreno, lead author, said, “Sexuality is an important dimension of an individual’s personality, and sexual problems can have a seriously detrimental impact on a couple’s relationship. It is, therefore, rather surprising that, up until now, very little quality research on sexual disturbances in RA patients has been published in the literature, bearing in mind how common the problems are.”

Factors associated with rheumatoid arthritis and sexual dysfunction

There are many factors that affect the prevalence and aggravation of sexual problems, but the relationship between sexual dysfunction and RA disease activity has never been statistically significant. On the other hand, there is a connection between not being sexually active and disease activity.

The study examined three types of factors – precipitating, predisposing, and maintenance – to see how they would influence the prevalence and worsening of sexual disturbances in rheumatoid arthritis.

Precipitating factors for sexual dysfunction in women and men with RA included infidelity, insecurity in a sexual role, and biological or physical causes. The range of predisposing factors in women and men were related to image changes, infidelity, anxiety, and loss of attraction.

Factors believed to be responsible for sexual disturbance in RA included biological causes, infidelity, general alteration of a couple’s relationship, partner’s sexual dysfunction, depression, and anxiety.

The relationship between these factors and disease activity was not found to be statistically significant.

Effects of rheumatoid arthritis on sexual activity

Rheumatoid arthritis may pose some challenges when it comes to sex, but maintaining a healthy sex life while living with RA is very possible. For starters, it’s important to maintain an open conversation with your partner about your needs, feelings, desires, and challenges. Intimacy may have to be changed with different touches, techniques, sexual devices, and new positions to accommodate the condition.

Sexual activity should take place when you are feeling your best throughout the day, which means saving sexual activity for the nighttime may not always be a viable option, as many people feel their worse at this time. Avoid cold temperatures as they can worsen rheumatoid arthritis symptoms. Lastly, keep a good attitude and remember that the goal of intimacy is the emotional closeness.

Aspects that can affect the sexual expression of a rheumatoid arthritis patient include severity of the disease, levels of fatigue, degree of pain, physical limitations, contribution of movement and touch, self-perception, side effects of medications, and effects of surgery.

senior intimacy

Tips to manage sexual function with rheumatoid arthritis

Here’s what you can do to manage sexual function with rheumatoid arthritis:

  • Plan ahead for sex – choose times when you know you are feeling your best and most rested.
  • Nap before sexual activity.
  • Take a warm shower or bath, or use a heating pad to relieve stiffness.
  • Time pain medications so they are at peak effect during sex.
  • Use massage to help relax muscles and joints.
  • Pile up pillows or rolled sheets to offer support.
  • Pace yourself to save energy.

By trying out some of these tips, you can improve your sexual function despite living with rheumatoid arthritis.

Complete Article HERE!

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Hard times – the ups and downs of the penis

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Penises can be problematic. They are powerful, untameable beasts, capable of wielding immense pleasure but also able to cause devastating emotional wounds. And that’s just anal sex

fun, fun, fun

by Liam Murphy

As well as the obvious physical harm that can be inflicted – skinny jeans have cursed a generation to suffer cock-caught-in-fly related trauma – the magnificent meat mallet can also bring mental torment when, like an untrained puppy, it just won’t do as it’s told.

THE HARDER THE BETTER?
Some of the best things are hard: hard-boiled eggs, biscuits, those rhubarb and custard sweets, Tom Hardy and, of course, the penis. However, sometimes they can spring up at the most unexpected and inopportune times, and just won’t go away.

“I call my hard-on issue uncontrollable as such,” says 21-year-old Ian, “let’s say ‘eager’ or ‘keen’. It doesn’t take much and it’s ‘up periscope’ time. I’ve been this way as long as I’ve appreciated the male form. I went through a phase of wearing an over the shoulder bag in my late teens so I could cover the odd bus boner (the vibrations cause a right disturbance). Rather that than poke someone in the eye on the way past, I guess!”

However, impromptu erections can also lead to embarrassing retail situations, as Ian explains. “Recent men’s fashion means that I’ve become accustomed to skinny fit jeans, and for whatever reason, I went commando that day – I’m sure you know where I’m going with this – and I guess it must have been particularly sensitive or whatever. Anyway, I ended up with a lob-on in Tesco. My skinny jeans/tight t-shirt combo meant there was no hiding, so I did what any self-respecting bloke would do. I awkwardly leant over the shopping trolley for the next ten minutes. On the upside, I can also get hard on demand! It’s just a combination of a high sex drive and an involuntary physical reaction, I think.”

For Kieran, 25, his perilously perky penis is just part of his day. “I wouldn’t say it’s an issue – more just a fact of life. Some people sweat a lot, some people yawn a lot… I get boners a lot. Not getting them would be an issue, but getting too many, yeah that’s a ‘problem’ I’m OK with – at least I know it’s all working well. It does pop up at any time. When I was due to be giving a talk, someone gave me a wink and boom… up popped my friend downstairs to take his moment centre stage. I stood behind the lectern desperately thinking of Margaret Thatcher and trying to kill it so I could step out and begin my talk properly. The worst though, is when someone you don’t fancy or don’t want to have sex with tries it on and it just feels like he’s betraying you.”

And how does one manage the curse (or blessing, depending on your perspective) of a perpetual hard-on? “Like everyone else I learned the ‘tuck it behind your belt’ trick, or to hide it behind my belt. Granted, occasionally there have been times when I’ve had to miss my tube stop and stay sitting down while I waited for one to subside.”

Will, 38, didn’t notice the problem cropping up until he was in a relationship. “I was never aware of it until I met my boyfriend and it became apparent early on that I would get erect whenever I was around him. It has settled down a bit now but whenever we kissed in public I would get a twinge. And in bed it still sometimes feels like I have an erection all night. I would generally be embarrassed that I was getting these erections. I felt immature. This is what happens to a teenager, not an adult. I was going through a difficult break-up once – lots of tears – we were cuddling and I was hard. I realised then that my hard-ons were not always about sex – to me they were about love too.”

PENIS PROBLEMS
Erectile dysfunction can happen to a lot of people, in varying degrees and for many reasons, medical or otherwise.

“It happens to me every time I put on a condom,” admits Steven, 34. “I have no problem keeping it up before fucking – wanking and getting sucked off have never been a problem – but when I go to fuck someone and I slide the condom on, I lose the hardness. Not totally, but enough that I can’t properly put it in someone’s arse and enough that the sensation goes for me.”

Steven tried mixing up condom brands. “I’ve used thin, ultra-thin, ribbed, tingle… every version of a condom you could imagine and I still get the same flaccid result. I think it must be a psychological thing, because it’s not like I can’t get hard at all. It’s fine when I bareback with long term boyfriends, but with one nighters I tend to have to bottom now.”

Anxiety can often be a cause of not being able to maintain an erection, as 27-year-old James confirms: “Sex in general makes me anxious. I hate getting naked and I get so nervous when it comes to getting down to it in bed. I was dating a guy I really liked, so much that when he touched me I would physically shake, but when it came to sex I just couldn’t get hard. He thought I didn’t like him! And now I dread having sex. I love the dating side of it but I always know that heading to the bedroom is going to be inevitable.”

dick-words

What can cause you to have trouble getting or staying hard?

  • Stress and anxiety.
  • Depression.
  • Hormone levels.
  • Smoking, recreational drugs and alcohol.
  • Some prescribed drugs – like Prozac and Seroxat.
  • Diabetes, high cholesterol and high blood pressure.
  • Psychological reasons – the more you worry about your erection, the less likely you are to be able to get one.

What can I do to make myself hard?
If you think the reason is psychological – a distraction helps, so encourage your partner to focus on something other than your cock for a while – kissing or nipple play might help to get you back in action.

  • Cockrings can also be used to help maintain a hard-on – leather or rubber straps are safer to use.
  • Counselling.
  • Drugs like Viagra or Cialis – consult your doctor for these.

Matthew Hodson, CEO of GMFA told us: “Rolling a condom onto a rock-hard penis isn’t a problem but if it’s a bit soft and you start to get anxious then it’s easy to spiral with anxiety to the point where a condom is really tricky to use. The more you’re concerned that you won’t be hard enough to use a condom, the more likely it is to happen. If it’s just an occasional problem it’s probably best not to make a big thing of it and just do something else that turns you on while you wait for it to get hard again. If it’s becoming more of a problem, you might want to experiment with cock-rings or talk with your GP about it – there’s no need to be embarrassed, you won’t be the first person who will have approached them with the same problem. Most erection problems can be addressed so there’s no reason why a temporarily soft dick should be a long-term barrier to you enjoying sex safely.”

Everyone should be able to enjoy a penis (which is my campaign slogan if I ever run for Prime Minister), especially their own. Whether it’s too hard or too soft, it doesn’t mean you and your cock have to suffer alone. Confide in your partner/lover/friend/doctor and discuss what you can do to get you and your lifelong pleasure companion talking again.

Step 1: When your cock is hard, take the condom out of the wrapper carefully using your fingers. Using your teeth to tear the packet could damage the condom. Squeeze the air out of the teat on the tip of the condom (if there is one) and put it over the end of your cock. Don’t stretch it and then pull it over your cock as this will make it more likely to break.

Step 2: Roll it down the length of your cock – the further down it goes the less likely it is to slip off. Put some water-based or silicone-based lubricant over your condom-covered cock. Put plenty of lube around his arse too. Don’t put any lube on your cock before you put the condom on, as this can make it slip off.

Step 3: Check the condom occasionally while fucking to ensure it hasn’t come off or split. If you fuck for a long time you will need to keep adding more lube. When you pull out, hold on to the condom and your cock at the base, so that you don’t leave it behind. Pull out before your cock goes soft.

What lube should I use?

When you don’t use enough lube, or use the wrong kind, the likelihood of condom failure is increased, making transmission of HIV and other STIs possible. Water-based lubes (e.g. K-Y, Wet Stuff and ID Glide) and silicone-based lubes (Eros Bodyglide and Liquid Silk) work well with condoms. Oil-based lubricants like cooking oil, moisturisers, sun lotions, baby oil, butter, Crisco, Elbow Grease, etc. can also cause latex condoms to break.

They can however be used with non-latex condoms, like Durex Avanti, Mates Skyn or Pasante Unique. Don’t use spit as it dries up quickly and increases the chance of your condom tearing.

Complete Article HERE!

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How do women really know if they are having an orgasm?

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Dr Nicole Prause is challenging bias against sexual research to unravel apparent discrepancies between physical signs and what women said they experienced

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It’s not always clear if a woman is really having an orgasm, as Meg Ryan demonstrated in When Harry Met Sally.

It’s not always clear if a woman is really having an orgasm, as Meg Ryan demonstrated in When Harry Met Sally.

In the nascent field of orgasm research, much of the data relies on subjects self-reporting, and in men, there’s some pretty clear physiological feedback in the form of ejaculation.

But how do women know for sure if they are climaxing? What if the sensation they have associated with climax is actually one of the the early foothills of arousal? And how does a woman know when if she has had an orgasm?

Neuroscientist Dr Nicole Prause set out to answer these questions by studying orgasms in her private laboratory. Through better understanding of what happens in the body and the brain during arousal and orgasm, she hopes to develop devices that can increase sex drive without the need for drugs.

Understanding orgasm begins with a butt plug. Prause uses the pressure-sensitive anal gauge to detect the contractions typically associated with orgasm in both men and women. Combined with EEG, which measures brain activity, this allows for a more accurate picture of a woman’s arousal and orgasm.

Dr Nicole Prause has founded Liberos to study brain stimulation and desire.

Dr Nicole Prause has founded Liberos to study brain stimulation and desire.

When Prause began studying women in this way she noticed something surprising. “Many of the women who reported having an orgasm were not having any of the physical signs – the contractions – of an orgasm.”

It’s not clear why that is, but it is clear that we don’t know an awful lot about orgasms and sexuality. “We don’t think they are faking,” she said. “My sense is that some women don’t know what an orgasm is. There are lots of pleasure peaks that happen during intercourse. If you haven’t had contractions you may not know there’s something different.”

Prause, an ultramarathon runner and keen motorcyclist in her free time, started her career at the Kinsey Institute in Indiana, where she was awarded a doctorate in 2007. Studying the sexual effects of a menopause drug, she first became aware of the prejudice against the scientific study of sexuality in the US.

When her high-profile research examining porn “addiction” found the condition didn’t fit the same neurological patterns as nicotine, cocaine or gambling, it was an unpopular conclusion among people who believe they do have a porn addiction.

The evolution of design of the anal pressure gauge used in Nicole Prause’s lab to detect orgasmic contractions.

The evolution of design of the anal pressure gauge used in Nicole Prause’s lab to detect orgasmic contractions.

“People started posting stories online that I had falsified my data and I received all kinds of sexist attacks,” she said. Soon anonymous emails of complaint were turning up at the office of the president of UCLA, where she worked from 2012 to 2014, demanding that Prause be fired.

Does orgasm benefit mental health?

Prause pushed on with her research, but repeatedly came up against challenges when seeking approval for studies involving orgasms. “I tried to do a study of orgasms while at UCLA to pilot a depression intervention. UCLA rejected it after a seven-month review,” she said. The ethics board told her that to proceed, she would need to remove the orgasm component – rendering the study pointless.

Undeterred, Prause left to set up her sexual biotech company Liberos, in Hollywood, Los Angeles, in 2015. The company has been working on a number of studies, including one exploring the benefits and effectiveness of “orgasmic meditation”, working with specialist company OneTaste.

Part of the “slow sex” movement, the practice involves a woman having her clitoris stimulated by a partner – often a stranger – for 15 minutes. “This orgasm state is different,” claims OneTaste’s website. “It is goalless, intuitive, and dynamic. It flows all over the place with no set direction. It may include climax, or it may not. In Orgasm 2.0, we learn to listen to what our body wants instead of what we think we ‘should’ want.”

Prause wants to determine whether arousal has any wider benefits for mental health. “The folks that practice this claim it helps with stress and improves your ability to deal with emotional situations even though as a scientist it seems pretty explicitly sexual to me,” she said.

Prause is examining orgasmic meditators in the laboratory, measuring finger movements of the partner, as well as brainwave activity, galvanic skin response and vaginal contractions of the recipient. Before and after measuring bodily changes, researchers run through questions to determine physical and mental states. Prause wants to determine whether achieving a level of arousal requires effort or a release in control. She then wants to observe how Orgasmic Meditation affects performance in cognitive tasks, how it changes reactivity to emotional images and how it compares with regular meditation.

Brain stimulation is ‘theoretically possible’

Another research project is focused on brain stimulation, which Prause believes could provide an alternative to drugs such as Addyi, the “female Viagra”. The drug had to be taken every day, couldn’t be mixed with alcohol and its side-effects can include sudden drops in blood pressure, fainting and sleepiness. “Many women would rather have a glass of wine than take a drug that’s not very effective every day,” said Prause.

The field of brain stimulation is in its infancy, though preliminary studies have shown that transcranial direct current stimulation (tDCS), which uses direct electrical currents to stimulate specific parts of the brain, can help with depression, anxiety and chronic pain but can also cause burns on the skin. Transcranial magnetic stimulation, which uses a magnet to activate the brain, has been used to treat depression, psychosis and anxiety, but can also cause seizures, mania and hearing loss.

Prause is studying whether these technologies can treat sexual desire problems. In one study, men and women receive two types of magnetic stimulation to the reward center of their brains. After each session, participants are asked to complete tasks to see how their responsiveness to monetary and sexual rewards (porn) has changed.

With DCS, Prause wants to stimulate people’s brains using direct currents and then fire up tiny cellphone vibrators that have been glued to the participants’ genitals. This provides sexual stimulation in a way that eliminates the subjectivity of preferences people have for pornography.

“We already have a basic functioning model,” said Prause. “The barrier is getting a device that a human can reliably apply themselves without harming their own skin.”


 
There is plenty of skepticism around the science of brain stimulation, a technology which has already spawned several devices including the headset Thync, which promises users an energy boost, and Foc.us, which claims to help with endurance.

Neurologist Steven Novella from the Yale School of Medicine uses brain stimulation devices in clinical trials to treat migraines, but he says there’s not enough clinical evidence to support these emerging consumer devices. “There’s potential for physical harm if you don’t know what you’re doing,” he said. “From a theoretical point of view these things are possible, but in terms of clinical claims they are way ahead of the curve here. It’s simultaneously really exciting science but also premature pseudoscience.”

Biomedical engineer Marom Bikson, who uses tDCS to treat depression at the City College of New York, agrees. “There’s a lot of snake oil.”

Sexual problems can be emotional and societal

Prause, also a licensed psychologist, is keen to avoid overselling brain stimulation. “The risk is that it will seem like an easy, quick fix,” she said. For some, it will be, but for others it will be a way to test whether brain stimulation can work – which Prause sees as a more balanced approach than using medication. “To me, it is much better to help provide it for people likely to benefit from it than to try to create fake problems to sell it to everyone.”

Sexual problems can be triggered by societal pressures that no device can fix. “There’s discomfort and anxiety and awkwardness and shame and lack of knowledge,” said psychologist Leonore Tiefer, who specializes in sexuality. Brain stimulation is just one of many physical interventions companies are trying to develop to make money, she says. “There’s a million drugs under development. Not just oral drugs but patches and creams and nasal sprays, but it’s not a medical problem,” she said.

Thinking about low sex drive as a medical condition requires defining what’s normal and what’s unhealthy. “Sex does not lend itself to that kind of line drawing. There is just too much variability both culturally and in terms of age, personality and individual differences. What’s normal for me is not normal for you, your mother or your grandmother.”

And Prause says that no device is going to solve a “Bob problem” – when a woman in a heterosexual couple isn’t getting aroused because her partner’s technique isn’t any good. “No pills or brain stimulation are going to fix that,” she said.

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