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New study finds girls feel unprepared for puberty

Girls from low-income families in the U.S. are unprepared for puberty and have largely negative experiences of this transition, according to researchers at Columbia University’s Mailman School of Public Health and the Johns Hopkins Bloomberg School of Public Health. Their latest paper on the puberty experiences of African-American, Caucasian, and Hispanic girls living mostly in urban areas of the Northeastern U.S. shows that the majority of low-income girls feel they lack the information and readiness to cope with the onset of menstruation. The research is one of the first comprehensive systematic reviews of the literature on puberty experiences of low-income girls in the U.S.

The findings are published online in the Journal of Adolescent Health.

“Puberty is the cornerstone of reproductive development,” said Marni Sommer, DrPH, MSN, RN, associate professor of Sociomedical Sciences at the Mailman School of Public Health. “Therefore, the transition through puberty is a critical period of development that provides an important opportunity to build a healthy foundation for sexual and reproductive health. Given the importance of this transition, the research is striking in its lack of quantity and quality to date.”

The investigators used Qualitative Research guidelines to review the data from peer-reviewed articles with a qualitative study design published between 2000 and 2014. They used a quality assessment form as a further check of the data.

The age of breast development and menarche has declined steadily in the U.S. during the last 25 years, with 48 percent of African-American girls experiencing signs of physical development by age 8. “This trend may mean that increasing numbers of African-American girls are not receiving adequately timed puberty education¬, leaving them uninformed and ill-prepared for this transition,” said Ann Herbert, doctoral candidate at the Bloomberg School of Public Health.

Although many of the girls reported being exposed to puberty topics from at least one source—mothers, sisters, or teachers—most felt that the information was inaccurate, insufficient, or provided too late. Girls also reported being disappointed in the information they received from mothers; meanwhile many mothers said they were unable to fully address their daughters’ needs. Mothers were uncertain about the right time to initiate conversations, uncomfortable with the topic, and uninformed about the physiology of menstruation. The timing of puberty also influenced girls’ puberty experiences.

The researchers noted that despite a strong focus on adolescent sexual health outcomes, such as sexually transmitted infections and teen pregnancy, clinicians and practitioners in the U.S. have yet to capitalize on the issues of puberty onset and menstruation as a window of opportunity to improve adolescent sexual and reproductive health. In addition, the current body of research leaves out many topics entirely. “For example, missing are the voices of adolescents with non-conforming gender role and sexual orientation,” Herbert said.

Earlier research showed that irrespective of race, higher-income girls had more knowledge about puberty, were more prepared for menarche, and had more positive attitudes about menstruation, strongly suggesting socioeconomic disparities related to preparation for puberty.

“Findings from the current review suggest that low-income girls today expressed a sentiment similar to girls studied in the 1980s and 1990s—a feeling that they were largely unprepared for puberty and menarche,” noted Herbert.

“Our review makes it clear that there is a need for new more robust interventions to support and provide information about for low-income , something we are considering for the coming years,” said Sommer.

Complete Article HERE!

Why Generation Tinder won’t go back to dating ‘the old-fashioned way’

By Jenny Noyes

“My most memorable Tinder date?” Kate Iselin gestures as if to say get ready. “It was a gentleman who invited me to lunch, took me to the food court at Martin Place and showed me a photo of his penis. Soft.”

It’s not the fondest memory Iselin – a writer and former sex worker – has of her experiences on the app. But the negative and the bizarre do have a tendency to stick with you.

Horror stories aside, Iselin, 28, is overwhelmingly positive about the impact apps like Tinder have had on the contemporary dating experience. And she’s not alone.

Despite a steady stream of articles about Tinder “killing romance”, making people depressed, or putting them in danger, the app and others like it are as popular as ever (even if some users are loathe to admit it).

Iselin herself has recently returned to 30 Dates of Tinder, a blogging project she’d abandoned a year ago due to “personal stuff” including a relationship. The concept is fairly self-explanatory: she goes on 30 random dates, and writes about them. Now halfway through, she’s accepted every date request received – “provided the date location was safe and they didn’t seem like a closet serial killer,” she says.

Clearly, there’s an appetite for reading stories about Tinder – and part of that is a fascination with what can happen when virtual strangers attempt to light a flame.

But as dating via Tinder increasingly becomes the norm, it’s less about the novelty of using a phone app to date people off the internet. Four years since Tinder launched, Iselin says she’s returning to her project with “a slightly more serious goal”. It’s now more about answering an age-old question than exploring a curious new technology: “To prove that love exists.”

Of course, the proof is already out there among the growing number of successful, lasting relationships launched via Tinder or its myriad competitors. These apps aren’t just facilitating one-night stands. People are finding lasting love in such significant numbers it is no longer considered “weird” to have a partner found online.

Fairfax Media columnist Giselle Au-Nhien Nguyen has met almost all of the people she’s dated, in her 28 years, online. Whereas five to 10 years ago there was a stigma attached to meeting people via the internet, it is now “completely normalised” among Gen-Y.

“Most people I know in relationships that have started in the last few years have met their significant others on Tinder,” she says.

Eliza Berlage, 26, met her boyfriend of 10 months on Tinder. She says it’s really a numbers game. “You could go to so many bars, libraries, music festivals, house parties, and still have as much luck … just swiping it lucky and giving it a chance and seeing how it goes.”

With numbers comes choice. And according to Iselin, it’s the choice these apps offer that makes them truly revolutionary – especially for women, minorities, and people whose preferences lie outside the norm.

Although there are some who feel nostalgic for the pre-Tinder dating scene, Iselin reckons women have never had it better; and she doesn’t see us ever going back.

“I know a lot of people say, ‘I would never use Tinder because I want to meet the love of my life the old-fashioned way’. But when we talk about old-fashioned times, we’re talking about a time when women in particular did not have a lot of choice in meeting partners.”

The same goes for people who may be otherwise constrained from exploring their sexuality ‘the old-fashioned way’, says Senthorun Raj, Grindr enthusiast and academic in law and gender studies.

“For people who are busy, those who have social, mental, or physical mobility issues, or individuals who are worried about ‘outing’ their sexual or gender identity in public spaces, dating apps can be a more comfortable way to chat, socialise, and become intimate than meeting people at clubs or bars,” he says. “For same-sex-attracted and gender-non-conforming people especially, these apps can be lifelines to connect with others dealing with similar experiences.”

What’s more, they have the ability to make connections “with people who we would never encounter in the places or circles we normally frequent,” he adds.

Of course, it’s not all rainbows, love-hearts and wink emojis for women, racial minorities or LGBT people. Prejudice and harassment is a real issue – but Raj says it would be a mistake to suggest apps like Grindr and Tinder have unleashed it.

“While Grindr does not cause these stereotypes, apps do make it easier in some ways to express harmful racial, age, and other ‘preferences’ because of anonymity or because the lack of ‘in-person’ interaction makes you feel like what you say or do online is … subject to less critical scrutiny.”

Nguyen says rape threats and racist, sexist comments are things she’s personally had to deal with just as much offline as on dating apps and social media.

“There’s such a big moral panic when it comes to online dating and safety, and it’s valid but we also need to remember that women face this everywhere. It really comes down to better education in schools about consent and respectful connections, and also the apps ensuring that they take reports of violence seriously.”

Sex and relationships expert Cyndi Darnell agrees that while mobile dating apps have revolutionised the sexual choices available and the ease with which users can access them, ultimately better education is needed to improve the human interaction side of things.

“We’re still operating on a very, very, very limited consent framework in terms of discussions around sex and pleasure … and yet our technology is far more advanced than that,” she says.

“There’s no app for getting over awkwardness. There’s no app for managing sexual anxiety. That’s the thing we need to remember: just because there is more access to sex, it doesn’t mean the quality of the sex has improved. We mustn’t confuse quantity with quality.”

Then again, there’s quality to be found – especially if you’re willing to put in the effort. “I’ve been on excellent dates and I have friends who’ve ended up in the most magical relationships,” says Iselin, who’s confident she’ll achieve her goal in one way or another by the end of her 30 dates.

“We are the generation now going to Tinder weddings. There are Tinder babies. I think that’s really exciting, and that gives me faith.”

Complete Article HERE!

For Veterans, Trauma Of War Can Persist In Struggles With Sexual Intimacy

U.S. Marines march in the annual Veterans Day Parade along Fifth Avenue in 2014 in New York City.

By

Much has been said about the physical and psychological injuries of war, like traumatic brain injury or post-traumatic stress disorder. But what we talk about less is how these conditions affect the sexual relationships of service members after they return from combat.

Since 2000, service members who were deployed received at least 138,000 diagnoses of PTSD. More than 350,000 have been diagnosed with traumatic brain injury since 2000. Evidence suggests the numbers are actually higher because many don’t seek treatment.

These conditions cause their own sexual side effects, such as emotional numbness, loss of libido and erectile dysfunction. And the long list of medications used to treat PTSD, TBI and other medical conditions can worsen those side effects.

‘He would sleep for days’

Chuck and Liz Rotenberry of Baltimore struggled with their own challenges when Chuck returned from Afghanistan in 2011. He’s a former Marine gunnery sergeant who trained military working dogs. He left active duty in 2012.

For Liz and Chuck, sex had never been a problem. They’ve been married for 14 years and they’re still very much in love. Liz says she fell for Chuck in high school. He was that guy who could always make her laugh, who always had a one-liner ready and never seemed sad.

But when Chuck returned from Afghanistan, their relationship would soon face its greatest challenge. Baby No. 4 was just two weeks away; for sure, it was a chaotic time. But Liz noticed pretty quickly, something was terribly wrong with her husband.

“I wouldn’t be able to find him in the house and he wouldn’t be outside, and I’d find him in a separate bedroom just crying,” Liz says. “He would sleep for days. He would have a hoodie on and be just tucked away in the bed, and he wouldn’t be able to get out of bed. He would have migraines that were so debilitating that it kept him in the bed.”

When Chuck was in Afghanistan, an IED — improvised explosive device — exploded 3 feet behind him. Shrapnel lodged into his neck and back.

It would take three years for someone at the Department of Veterans Affairs to explicitly lay out for Liz that Chuck had developed severe post-traumatic stress and suffered a traumatic brain injury — and that she would need to be his caregiver.

The Marine self-image

During that three-year period, there were times Chuck estimates he was taking 15 to 16 different medications twice a day.

Sex was usually the furthest thing from his mind.

“I didn’t think about it. I wanted to be with Liz, I wanted to be near her,” he says. “When the desire was there, it was unique. It was rare, as opposed to the way it was before. And a lot of times, with the mountains of medication I was on, you know, in my head [it was] all systems go, but that message didn’t go anywhere else.”

Liz noticed that Chuck stopped initiating physical affection.

“The thought of him reaching out to me to give me a hug wasn’t existent. It was like I had to give him the hug. I now had to step in and show him love,” she says.

Sometimes months would go by before they would have sex.

“It started off as being pretty embarrassing, pretty emasculating,” Chuck says. “It was like, ‘Really? This too doesn’t work?’ You blame it on, ‘Oh, it’s just the medication,’ or ‘You’re tired,’ or whatever initially, and you don’t realize it’s stress or my brain just doesn’t work like it used to.”

Liz and Chuck had never really talked about sex in any serious way before. So they kept avoiding the conversation — until this year. That’s when Chuck finally asked his primary care provider for help. The doctor prescribed four doses of Viagra a month. Liz and Chuck say the medication has improved things substantially — though they joke about how few doses the VA allots them every month.

But asking for just those four doses took Chuck three or four visits to the doctor before he could work up the nerve. He says it can be especially hard for a Marine to admit he’s having problems with sex because it contradicts a self-image so many Marines have.

“You know, as a Marine, you can do anything. You believe you can do anything, you’ve been trained to do nearly anything,” he says. “You’re physically fit. You’re mentally sound. Those are just the basics about being a Marine.”

If he has any advice for a Marine going through the same thing he and his wife are facing, he says you need to talk about it. Bring it up with your spouse. Bring it up with your doctors.

“Marines always jokingly hand out straws. You got to suck it up. You got to do what you need to do to get it done,” Chuck says. “It’s just a different mission. … Don’t let your pride ruin what you worked so hard for.”

 Complete Article HERE!

Assertive sexuality – yet again, we must fight the politicisation of sex

Everyone has the right to have sex as they choose and we must make sure we protect that right

A gay couple kisses during the Gay Pride Parade in Medellin, Colombia, in 2015.

By Emily Witt

Sexual equality – the right for consenting adults to love who they want, the way they want it – is a human right. In 2017 the right to have the kind of sex we want is still under threat.

Once again gay people, single women, the non-monogamous, the kinky, and many other people whose sexuality does not conform to the heterosexual, child-producing marital bedroom, will be forced to articulate their right to sexual freedom. For many adults, merely having sex, and being sexual, will become a political act. Welcome to the year of assertive sexuality.

In the 21st century the state wields control over sexuality through access to healthcare. In the United States, Donald Trump has appointed an orthopaedic surgeon, Tom Price, as his secretary of health and human services. Price has a record of opposition to LGBTQ and abortion rights and has voted in the past to deprive non-profit organisation Planned Parenthood of taxpayer support.

Even if Trump chooses not to revoke the Affordable Care Act, it’s likely the mandate that covers contraception will be repealed. A woman’s sexual freedom depends on her ability to access affordable contraception, treatment for infections and abortion services. Trump, who has a lifetime of boasting about his sexual promiscuity (both consensual and not), wants to impose a paradigm of risk on women, who will lose autonomy and safety and will face unnecessary and prohibitive expense and inconvenience in their pursuit of sexual happiness.

The United Kingdom also saw an attempt to thwart sexual freedom by denying access to healthcare in 2016. It was only after a successful lawsuit filed by the National Aids Trust and persistent lobbying by activists that the NHS announced in December that it would fund a three-year clinical trial that will make pre-exposure prophylaxis available through the NHS to 10,000 people at risk of contracting HIV. This was a shift from earlier in the year, when the NHS had made it clear that it would limit availability of PrEP to 500 men “most at high risk”.

Denying healthcare to certain populations in a misguided attempt to influence their sexual behaviour is a form of social control and exclusion that arbitrarily codes certain sexual acts as good or bad and certain lives as more dispensable than others. The point of such efforts – and other forms of sexual censorship, like the attempts of the Conservative government to block pornographic websites that show female ejaculation or that break the “four finger rule” – is to assert a hierarchy of sexual cultures in which heteronormativity occupies a place at the top and alternative sexual preferences are maligned as risky or obscene.

Tom Price, US secretary of health and human services, has a record of opposition to LGBTQ rights.

Attempts to re-establish a notion of “normal”, “conventional” and “responsible” sexuality come at a time in which consensus about what an adult life should look like is rapidly dissolving. In the United States and the United Kingdom, adults are getting married later or not at all. In the years of their lives in which they are dating and having shorter-term sexual relationships, technology has offered new ways of meeting people, of fantasising and of finding sexual community.

A shift in cultural morals has opened space for the articulation of a broad spectrum of sexual identities, orientations and gender identifications. If the first decade of the new century was about broadening access to institutions such as marriage, the second might be about taking pride in sex as an end in itself.

The culture finds itself at a crossroads: either attempt to restore a false consensus about what constitutes a legitimate sexuality, an ideal of monogamous fidelity that always contained hypocrisy, that not even the president-elect of the United States can claim to have upheld; or embrace a more honest view of the contemporary way some people relate to each other.

For the growing population of adults who have failed in one way or another to live up to an ideal of what a “good heterosexual” looks like, either because they have never married, or have divorced, or because they are not heterosexual at all, attempts by politicians to marginalise their sex lives would be comical if they didn’t come at such a high cost.

The only response that feels right, at this juncture in history, is to dispense with euphemism. Don’t call contraception “family planning”. Don’t limit the idea of sexual freedom to the right to marry (although even that right remains threatened.)

Don’t let the enjoyment of pornography be pathologised. Don’t meekly try to make your sexuality palatable to the people who are determined to deny its legitimacy.

In 2016 cautious appeals for responsibility lost out to ostentation and lies; 2017 is not a time to be demure.

Complete Article HERE!

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!