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Caught in the modesty bind: Why women feel shy to consult doctors for their sexual well-being

By Aditi Mallick

“I was 17, when I first got sexually intimate with my boyfriend,” says Kriya (name changed), a 23-year-old IT professional from Hyderabad, while speaking to The News Minute.

“Later we were very scared, as it was the first time for both of us,” she recalls. She missed her periods that month. The 17-year old who had never once been to hospital alone, was scared and unsure of what to do next.

Trying to glean more information online just added to her worry over getting pregnant. Finally she discussed the issue with her boyfriend, and both of them decided to consult a gynaecologist.

“I was already very scared. After I told the receptionist my age, she kept staring at me. It made me so uncomfortable. While other patients were called by name, when it was my turn, she said ‘Aey, hello.…go!’ I felt so bad.

I expected at least the doctor to act sensitive. She first asked me what happened. When I told her, she started lecturing to me about our culture, and how young I am. It was a horrible experience. After the check-up, once I reached home, I burst out crying,” she shares.

From then on, Kriya has always felt too scared to discuss any sexual health problem with a gynaecologist. She is now 23, but in her view, nothing much has changed.

“Last month, I had rashes all over my vagina right up to my thigh. I just could not walk. It was painful. In the beginning, I used anti-allergic medication and antiseptic cream. But I was finally forced to go to a doctor. But even this time, I was ill-prepared for those weird looks.

The receptionist first asked for my name, then my husband’s name. For a moment, I panicked. After a pause I said, I am unmarried.”

Kriya feels that such unnecessary queries have nothing to do with a particular health problem and should not be asked: “We are adults and should not be judged for such things. After all, it is my decision. But society does not think so.”

Dr Kalpana Sringra, a Hyderabad-based sexologist agrees:“Doctors should not interfere in a patient’s personal life. But sadly, some do. A few are open-minded. They do not care whether the patient is married or not. We do at times have to ask about how frequently they have sex to ascertain the cause.”

Kalpana believes the rigid cultural restrictions and undue secrecy about anything related to sex are what makes patients uncomfortable sharing sexual health issues with their doctors.

Prapti (name changed), a 21-year old second year engineering student says: “Ï had  quite a few relationships, and faced initial problems like bleeding and pain during sex. I sometimes lose interest while having sex, due to this immense pain in the vagina.”

But she does not want to consult a doctor: “I prefer advice from friends. At least, they will not judge me.” She remembers the time she had to consult a doctor two years ago, when after having sex, the pain persisted for a whole day.

“The doctor did not even try to explain the reason. I kept asking her whether it was anything serious. But she deliberately chose to ignore me. Later I heard her murmur ‘this generation….uff’! When I shared this with my friends, I realised they too had been in similar situations.

According to Kalpana, only ten percent women come forward to consult a doctor for sexual well-being, of which the majority are planning to get married soon and want to get themselves checked for infection and related advice.

No woman ever goes to the doctor for this, unless it is absolutely avoidable. Not just unmarried women, but even married ones are ignorant in this regard. Young unmarried women are only more hesitant to ask or seek medical help, fearing society and parents, she says.

“Both married and unmarried women are not comfortable. They mostly come with their partners. To make them feel comfortable, we talk to the women alone. After a while, they open up about their problems.”

She also claims that 20% of women who suffer from vaginal infection like UTI and rashes after marriage too feel shy to discuss it with the doctor: “Men seem more comfortable discussing their sexual problems. 90% of our patients are men. But they tend to come alone.”

That was not the case with Jayesh (name changed), a 27-year old. He used to earlier hesitate to talk about his sexual health: “It was only a year back that I consulted a doctor for premature ejaculation, something that I suffered from the age of 23. I used to think if my friends get to know, they would make fun of me.”

The common issues that men in the age group of 18-80 are premature ejaculation and erectile dysfunction. “Most men confess that they force their wives to use contraceptive pills, as they do not want to wear condoms,” Kalpana says.

Gaurav (name changed), a 29-yearold unmarried man insists that he has never forced his girlfriend to use contraceptive pills, but they do sometimes prefer pills over condoms.

Gaurav who is sexually active does not feel ashamed or uncomfortable consulting a doctor, but that is not the case with his girlfriend: “Four years back, she once started bleeding after we had sex. Honestly, I was clueless how to handle the situation and whom to contact. We did not go the doctor, fearing prejudice.

My girlfriend is not at all comfortable consulting a doctor. She usually avoids going to a gynaecologist, as they ask whether we are married or not. It makes her uncomfortable. It happened a few times with us in Hyderabad. That’s why sometimes she prefers to use emergency contraceptive pills rather than consult a doctor.”

“Sex jokes are allowed, but people are otherwise shy talking about sex. Parents do not talk freely on the topic. It is still a taboo for Indian society,” Gaurav remarks.

When Preeti (name changed) -who is now doing an event management course- was in her final BCom year, she led an active sex life:

“I went for a party and got drunk. That night my friend and I had sex. I did not then realise that we had forgotten to use a condom. After missing my periods, I freaked out. I was confused and went to see a doctor. They first asked if I was married. I lied.”

She also admits to feeling uncomfortable while buying I-pills, condoms or pregnancy test devices: “Once a medical shopkeeper asked whether it was for me, with those around giving me judgmental looks.”

Fearing societal disapproval, several unmarried women tend to take medications, after consulting the internet.

“They go to medical stores or send their partners to buy medicines without consulting a doctor. Emergency contraceptive pills have several side-effects like, dizziness, vomiting etc. Some even try to abort through pills, which is life-threatening and can affect their health in the long run,” warns Kalpana.

Complete Article HERE!

Is His Semen Normal?

All spunk is funky, but sometimes it is *too* funky.

By

jizz

Very many things about the male human body are a mystery. Penises, hy? Those tiny nipples, what!? But dip beneath the hairy surface of a man’s skin, and even more mysteries await, hiding away in his male depths.

While usually contained, safe and sound inside of the body, semen is a fluid most people eventually come into contact with, but also do not know very much about. If it weren’t for Samantha Jones calling attention to the phenomenon of funky spunk in the “Easy Come, Easy Go” episode of Sex and the City in 2000, women the world over may have lived in quiet misery, forever perplexed by the unpleasantness of the male sex fluid.

To help educate the masses on the contents, and, yes, healthy range of funkiness in semen, Cosmopolitan.com spoke with a urology specialist and sexual health counselor about all things semen.

How semen should look

Aleece Fosnight, a urology physician’s assistant and sex counselor with AASECT, explained that healthy semen should be a milky white or slightly grayish color. “Right after ejaculation, it’s pretty thick,” Fosnight said. “And 25-30 minutes later, it becomes clear and runny.” The change in fluidity is to help aid in reproduction, and thin out the cervical mucous to aid in the implantation of a ~fertilized egg~.

How semen should (generally) smell and taste

Semen is a bodily fluid. Can you name any bodily fluids that smell like roses or taste like freshly baked cookies? No! There are none. So as a bodily fluid, you can expect semen to have a specific taste and odor that isn’t necessarily going to be lovely. Just to clear that right up.

The thing to note about semen is that it’s a vehicle for delivering sperm through a vagina. So everything in it is meant to aid in that process. Semen is mostly made up of sperm, proteins, fructose (to help energize the sperm for transport), and seminal fluid. Fosnight said the typical pH of semen is somewhere around 7-8, or slightly alkaline. The vagina, on the other hand, has a pH between 3-5, or slightly acidic, so the alkaline nature of semen helps keep the sperm alive in an acidic vaginal environment (are you having fun yet?).

Because of it’s slightly alkaline pH, Fosnight said healthy semen should have an “ammonia or bleach-like kind of a smell,” and will taste a bit sweet (because of the fructose) and salty — like the perfect trail mix, in drinkable liquid form, straight out of a penis!

Something Fosnight clarified was that semen left dormant for too long will start to develop a more concentrated taste or smell. Think of it like a stagnant body of water, collecting film and attracting flies. To keep semen from developing a stronger taste or odor — and also to promote prostate health — studies have found that ejaculating at least twice a week is beneficial to a man’s health.

That thing about food changing his taste is true

Remember when Samantha Jones makes the guy with the spunky funk choke down a series of wheatgrass shots in an attempt to improve his semen flavor profile? According to Fosnight, that wasn’t the smartest move.

Although there’s been very little research done on the subject, health care professionals often hear anecdotally from patients that certain foods can slightly affect the taste of semen. While Fosnight said it’s normal for fruits, which are high in sugar content, to change the taste of a person’s semen, vegetables generally don’t have much of an effect.

“Smoking can change the taste,” Fosnight added. “It will have more of a bitter taste to it with smoking and with alcohol.” So, no one’s saying you should avoid ingesting a mouthful of piping hot semen after your partner’s spent the night having too many drinks and then *whoops!* accidentally chain-smoking outside of the bar, but know that semen might taste especially bitter and, ahem, spunky after such an occasion.

When the spunkiness is trying to tell you something

Though there aren’t very many health issues that can be spotted based on a person’s semen, there are a few things to look out for. “A lot of times guys won’t notice it, so partners report if there’s something wrong,” Fosnight said. She also added that at her practice, they call this “when semen goes bad.”

The things to look out for are changes in color. “The biggest thing is if it has a yellow or green appearance to it,” Fosnight said. “Like a prominent yellow or opaque consistency.” An opaque yellow or green color is typically a sign of an STI — usually gonorrhea. A guy whose semen has changed colors like this should definitely see a doctor, and avoid sex until any sort of infection is either ruled out or treated.

It doesn’t happen all too often — Fosnight estimated maybe once in a lifetime for most men — but a busted blood vessel in the prostate (which is responsible for carrying semen out of the body) can cause the semen to have a red or brownish color. If that color normalizes within a few days, there’s nothing really to worry about. But as with any health concern, a persistent discoloration should result in a doctor’s appointment.

While not super common, blood in the semen is often indicative of a prostate injury, explained Fosnight. These can be caused by using anal toys or putting pressure on the prostate, and if the bleeding subsides and doesn’t come with any other symptoms like high blood pressure, things are fine.

As long as a man is doing his due diligence by having regular STI tests, regular prostate exams when he turns 40, and just FORCING himself to ejaculate a couple times a week, semen should be pretty healthy. It may never taste like frozen yogurt, but at least it will be healthy.

Complete Article HERE!

Low sexual desire, related distress not uncommon in older women

By Kathryn Doyle

senior intimacy

Just because social attitudes toward sex at older ages are more positive than in the past doesn’t mean all older women have positive feelings about sex, according to a new Australian study.

Researchers found that nearly 90 percent of women over 70 in the study had low sexual desire and a much smaller proportion were distressed about it. The combination of low desire and related distress is known as hypoactive sexual desire dysfunction (HSDD) and nearly 14 percent of women had it.

Older people are increasingly remaining sexually active and sexual wellbeing is important to them, said senior author Susan R. Davis of Monash University in Melbourne.

“This is probably because people for this age are healthier now than people of this age in past decades,” Davis told Reuters Health by email.

A random national sample of women ages 65 to 79 was contacted by phone and invited to take part in a women’s health study. Those who agreed received questionnaires asking about demographic data, partner status and health history, including menopausal symptoms, vaginal dryness, pelvic floor dysfunction, depression symptoms, sexual activity and sexual distress.

Of the 1,548 women who completed and returned the questionnaires, about half were married or partnered, 43 percent had pelvic surgery and 26 percent had cancer of some kind. About a third had menopausal symptoms and one in five had vaginal dryness during intercourse.

In the entire sample, 88 percent reported having low sexual desire, 15.5 percent had sex-related personal distress, and women with both, who qualified for HSDD, made up 13.6 percent of the group, as reported in Menopause.

That’s lower than has been reported for this age group in the past, and similar to how many women report HSDD at midlife, Davis noted.

“Considering how conservative women of this age are, we were surprised that over 85 percent of the women completed all the questions on desire and sexual distress so we could actually assess this on most of the study participants,” Davis said.

Vaginal dryness, pelvic floor dysfunction, moderate to severe depressive symptoms and having a partner were all associated with a higher likelihood of HSDD. Sexually active women, partnered or not, more often had HSDD than others.

“We would never label women with low/diminished sex drive as having HSDD,” Davis said. “In our study 88 percent had low desire and only 13.6 percent had HSDD, this is because low desire is not an issue if you are not bothered by it.”

Vaginal dryness, associated with HSDD in this study, can easily treated by low dose vaginal estrogen which is effective and safe, she said.

HSDD was also associated with urinary incontinence, depressive symptoms and hot flashes and sweats, she said.

“Even talking about the problem with a health care professional who is interested and sympathetic is a good start,” Davis said. “Conversely health care professionals need to realize that many older women remain sexually active and do care about this issue.”

Complete Article HERE!

Rape Culture and the Concept of Affirmative Consent

March against rape culture

March against rape culture

Throughout most of our history, rape was a property crime.

Today we do not, in the modern United States at least, think of a woman’s sexuality as a financial asset. But that is a recent phenomenon. For most of our history, rape was not treated the same way as other violent assaults because it wasn’t just a violent assault, it was also a crime against property.

You can see this view–of a woman’s sexuality belonging to her father and later her husband–in laws concerning rape and sexual assault. It was even possible for a father to sue a man who had consensual sex with his daughter because he had lost the value of his daughter. Based on this view, value is lost in terms of her work if she became pregnant and was no longer able to earn wages, or in terms of a future wife for someone else because of this stain on her character. Men could not be held accountable for raping their wives because a wife was a man’s property and consent to sex–at any time of his choosing–was part of the arrangement.

Lest you think that these laws are ancient examples of a culture that no longer bears relation to our current policies on rape, spousal rape was not made illegal in all fifty states until 1993, where it still may carry a less severe sentence than other rape offenses. The tort of seduction was technically on the books in North Carolina in 2003.

This context is important given our current cultural attitudes toward sexual assault. To understand this culture and how it can be amended, we need to look more deeply at the historical understandings of rape and consent.


Force Means No

The framework for defining rape underpins our understanding of who is required to prove consent or non-consent. The Hebrew Scriptures, which established longstanding cultural norms that helped form a basis for what was morally and legally acceptable in early America, make a distinction between a woman who was raped within a city and one who was raped outside of the city limits. The first woman was stoned to death and the second considered blameless (assuming she was a virgin). This distinction is based on the idea that it was the woman’s responsibility to cry out for help and show that she was non-consenting. A woman who was raped in the city obviously had not screamed because if she had someone would have come to her rescue and stopped the rape. The woman outside the city had no one to rescue her so she could not be blamed for being victimized.

This brutal logic, which is completely inconsistent with how we know some victims of rape react to an attack, was continued in the American legal system when our laws on rape were formulated. Rape was defined as a having a male perpetrator and a female victim and involving sexual penetration and a lack of consent. But it was again the woman’s responsibility to prove that she had not consented and the way that this was demonstrated was through her resistance. She was only actually raped if she had attempted to fight off her attacker. Different jurisdictions required different levels of force to show a true lack of consent. For example, fighting off an assailant to your utmost ability or even up to the point where the choice was either to submit to being raped or to being killed. Indeed, the cultural significance of chastity as a virtue that the female was expected to guard was so profound that many female Christian saints are saints at least in part because they chose to die rather than be raped or be a bride to anyone but Christ.

Potential canonization aside, it was consistently the responsibility of the woman alleging that she was the victim of a rape to prove that she had fought off her attacker in order to show that she had not consented. If she could not show that she had sufficiently resisted, she was deemed to not have been raped. Her chastity was someone else’s property, either her father’s or her husband’s/future husband’s, so it was always understood that someone, other than her, had the right to her sexuality. The assailant had assumed that he had the right to use her sexually and was only a rapist if she acted in such a way that a reasonable man would have known that she did not belong to him. Her failure to communicate that fact, that she was the property of some other man, was a sign that she had in fact consented. Therefore the rape was not his moral failing in stealing another man’s property but her moral failing in not protecting that property from being stolen.


Culture Wars

We can see the effects of this ideology in how we treat rape victims today. Although we don’t necessarily require evidence of forceful resistance, it is considered helpful in prosecuting a rape case. Rape shield laws may have eliminated the most egregious examples of slut-shaming victims, but an innocent or even virginal victim is certainly what the prosecution could hope for if they were trying to design their most favorable case. One of the first questions that will be asked of the victim is “did you say no?” In other words “what did YOU do to prevent this from happening to you?” The burden is still often legally and almost always culturally on the victim to show that they did not consent.

There is an alternative approach that has been gaining traction on college campuses and elsewhere known as the concept of “affirmative consent.” Take a look at the video below, which elucidates the differences between the “no versus no” approach compared to affirmative consent, which is often described as “yes means yes.”

In this video, Susan Patton and Rush Limbaugh both represent examples of rape culture. The contrast between the views of Savannah Badlich, the advocate of affirmative consent, and Patton, who is against the idea, could not be starker. To Badlich, consent is an integral part of what makes sex, sex. If there isn’t consent then whatever happened to you, whether most people would have enjoyed it or indeed whether or not you orgasmed, was rape. It is your consent that is the foundation of a healthy sexual experience, not the types of physical actions involved. In contrast, Patton expressed the view that good sex is good sex and consent seems to not play a role in whether it was good sex, or even whether it should be defined as sex at all. The only thing that could indicate if something is an assault versus a sexual encounter is whatever physical evidence exists, because otherwise, the distinction is based only on the assertions of each individual. Again we are back to evidence of force.


What is “Rape Culture”?

Rape culture refers to a culture in which sexuality and violence are linked together and normalized. It perpetuates the idea that male sexuality is based on the use of violence against women to subdue them to take a sexual experience, as well as the idea that female sexuality is the effort to resist or invite male sexuality under certain circumstances. It overgeneralizes gender roles in sexuality, demeans men by promoting their only healthy sexuality as predatory, and also demeans women by considering them objects without any positive sexuality at all.

According to this school of thought, the “no means no” paradigm fits in perfectly with rape culture because it paints men as being predators who are constantly looking for a weak member of the herd to take advantage of sexually, while also teaching women that they need to be better than the rest of the herd at fending off attacks, by clearly saying no, to survive. If they can’t do that, because they were drinking or not wearing proper clothing, then the attack was their fault.


“Yes Means Yes”

Affirmative consent works differently. Instead of assuming that you can touch someone until they prove otherwise, an affirmative consent culture assumes that you may not touch someone until you are invited to do so. This would be a shocking idea to some who assume that gamesmanship and predation are the cornerstones of male sexuality and the perks of power, but it works out better for the majority of men and women, who would prefer and who should demand equality in sex.

This video gives a brief highlight of some of the issues that are brought up when affirmative consent is discussed and the difficulties that can still arise even with affirmative consent as a model.


Evaluating Criticism of Affirmative Consent

The arguments are important so let’s unpack some of the key ones in more detail. The first objection, expressed in both videos, is how exactly do you show consent? Whenever the affirmative consent approach comes up, one of the first arguments is that it is unenforceable because no one is going to stop sexual activity to get written consent, which is the only way to really prove that a person consented. We still end up in a “he said, she said” situation, which is exactly where we are now, or a world where the government is printing out sex contracts.

The idea that affirmative consent will by necessity lead to written contracts for sex is a logical fallacy that opponents to affirmative consent use to make the proposition seem ridiculous. Currently, we require the victim to prove non-consent. Often the victim is asked if they gave a verbal no or if they said they did not want the contact. The victim is never asked: did you put the fact that you didn’t want to be touched in writing and have your assailant read it? The idea that a written explanation of non-consent would be the only way we would take it seriously is absurd, so it would be equally absurd to assume that requiring proof of consent would necessitate written documentation. Advocates for affirmative consent don’t want sex contracts.

In addition, even under our current framework we accept a variety of pieces of evidence from the prosecution to show that the victim did not consent. A clear “no” is obviously the strongest kind of evidence, just as under an affirmative consent framework an enthusiastic verbal “yes” would be the best evidence, but that is just what the best evidence is. That is certainly not the only kind of evidence available. Courts already look at the entire context surrounding the incident to try to determine consent. The process would be virtually the same under an affirmative consent model. The only difference would be that the burden would be on the defendant to show that they believed they had obtained consent based on the context of the encounter instead of placing the burden on the victim to show that, although they didn’t say “no,” they had expressed non-verbally that they were unwilling to participate.

The shift in the burden of proof is sometimes cited as a reason not to adopt an affirmative consent model. Critics argue that this affects the presumption that the accused is innocent until proven guilty. Which is, rightly, a cornerstone of our judicial system. If this model did, in fact, change that presumption then it wouldn’t be an appropriate answer to this problem. But it does not.

Take another crime as an example. A woman’s car is stolen. The police issue a BOLO on the car, find it, and bring the suspect in and sit him down. They ask him “did you have permission to take that car?” and he replies “Yes, officer, she gave me the keys!”

He is still presumed innocent and, as far as this brief hypothetical tells us, hasn’t had his rights violated. It looks as though he is going to get a fair trial at this point. That trial may still devolve into another he said, she said situation. She may allege that she didn’t give him the keys but merely left them on the kitchen table. At that point, it will be up to the jury to decide who they believe, but that would have been the case in any event. He is presenting her giving the keys to him as one of the facts to show his innocence.

If a woman’s car is stolen we don’t question her about how many miles are on the odometer. We don’t ask if she wore a seatbelt the last time she drove it. We don’t care if she had been drinking because her alcohol consumption doesn’t negate the fact that she was a victim of a crime. We certainly wouldn’t force her to prove that she didn’t give the thief the keys. That burden would rightly be on him and we would be able to both place that burden on him and at the same time presume him to be innocent until he failed to meet that burden.

Adopting an affirmative consent model changes how consent is perceived. It is primarily a cultural change in understanding who is responsible for consent. Rather than making the non-initiating party responsible for communicating a lack of consent, affirmative consent requires that the initiating party obtains obvious consent.

That is how affirmative consent works. It wouldn’t require a written contract or even necessarily a verbal assertion. Context would always matter and the cases would still often become two competing stories about what the context meant. And it doesn’t mean that we are assuming that person is guilty before they have the chance to show that they did, in fact, get that consent. It just means that we are placing the burden of proving that consent was obtained on the party claiming that consent had been obtained.


Conclusion

There is no other category of crime where we ask the victim to show that they didn’t want to be the victim of that crime. A man who is stabbed in a bar fight, regardless of whether he was drunk or belligerent, isn’t asked to prove that he didn’t want a knife wound.

We need to change our cultural framework of rape and consent. When we are working under an affirmative consent framework what we are doing is changing the first question. Currently, our first question is for the victim: did you say no? Under an affirmative consent model our first question is for the suspect: did you get a yes?

Complete Article HERE!

Report: Gender Equality On Sexual Desire And Intimacy Behaviour

I had the good fortune to be asked to participate in this report.  I’m delighted to offer you the first look at the results.

001

Click on this image to find the full report.

PURPOSE.
To understand if there are differences between genders regarding intimacy, sexual behaviour and sexual desire, and the reasons behind these differences.

METHOD.
This report is divided in to two parts. The first part analyses anonymous and public data from women and men that play Desire (intimate mobile game for couples—Android and iOS application). The report analyses data from 253,205 users to demonstrate key insights such as which gender creates an account more often, the differences between the top 50 predefined dares by gender, the differences in public comments on the app and more.
The second part of the report consists of findings from 17 interviews conducted with professionals on human sexuality in six different countries and their personal point of view on the differences and similarities between genders on sexual desire and intimacy behaviour.

FINDINGS.
The outcome of the analysis is that sexual desires are very similar for both women and men with no significant differences. However, there are evident differences between genders in regards to intimacy behaviour that arise from personal experience of culture, history, religion, schooling and sex education. All of these factors determine and dictate how people behave in their sexual and intimate life.
Finally, the analysis also shows that long standing stereotypes about men being more sexual and women more romantic are changing and that on an individual level, sexual desires, desire to connect and have great sex with our partners, is universal and not limited to gender or culture.

marta-plaza

Marta Plaza

Leading this report: Marta Plaza.
Plaza is co-founder of Desire Technologies, a company with the mission to bring new, smart adult games, fueled with love and gender equality.
Site and contact: www.desire.games

Thanks, Marta, for this wonderful contribution to our common effort.