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Time for a Sexual Revolution In Health Care Treatment

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Why is care for sexual health issues considered a luxury when it’s a necessary part of population health?

By Zachary Hafner

When Americans seek care for most common health conditions, there is rarely much question about coverage. Every day, consumers—including those on Medicaid and Medicare—seek care for sore joints, depression, and even acne without worrying about whether or not their insurance will cover their doctor visits and medications. For the most part, coverage for sexual health issues is less straightforward—but why? Is it because sexual health issues are not considered legitimate illnesses? Because the costs are significant? Or is it because raising the topic of sexual health can offend certain personal and organizational values? Whatever the reason, it is time for a change.

It’s hard to deny the human and economic burden of sexually transmitted infections (STIs) on this country. The CDC estimates that 110 million Americans are infected with an STI, resulting in direct medical costs of $16 billion annually. The most common and fastest growing STI in this country is human papillomavirus (HPV), and it is estimated that half of sexually active men and women will get HPV at some point in their lives. In 2006, a vaccine for HPV was introduced and now there are several. CDC guidelines recommend administering a multi-dose series, costing about $250–450, to all boys and girls at age 11 or 12. (Some states require the vaccine for school admission.) It was included in mandatory coverage under the ACA. Since the HPV vaccine was first recommended in 2006 there has been a 64% reduction in vaccine-type HPV infections among teen girls in the United States.

It seems clear that this kind of care for sexual health is necessary for public health and is also part of caring for the whole individual, a central tenet of population health. But what about sexual health care that doesn’t involve infectious disease? Is it still a population health issue if there’s no communicable disease involved?

Let’s take erectile dysfunction (ED) for example. It is nearly as common in men over 40 as HPV is in the general population—more than half of men over 40 experience some level of ED, and more than 23 million American men have been prescribed Viagra. With a significant portion of the population suffering from ED, is it important for payers and providers to consider ED treatment to be essential health care and to cover it accordingly? Medications like Viagra and Cialis are an expensive burden at upwards of $50 per pill. Medicare D does not cover any drugs for ED, but some private insurers do when the medications are deemed medically necessary by a doctor. A handful of states require them to do so, but they are typically listed as Tier 3 medications—nonessential and with the highest co-pays.

Almost 7 million American women have used infertility services. Coverage for infertility diagnosis and treatment is not mandated by the ACA, though 15 states require commercial payers to provide various levels of coverage. The cost of infertility treatments is highly variable depending on the methods used but in vitro fertilization treatments, as one measure, average upward of $12,000 per attempt.

Are treatments for ED and infertility elective or necessary? In an age of consumerism and heightened attention to the whole patient across a broader continuum of care, organizations that support the availability of a broad set of sexual health services to a diverse group of consumers will have a big competitive advantage, but they may face challenges balancing the costs. Health care has advanced in both technical and philosophical ways that allow people to manage their diseases, cure their problems, and overcome limitations. It has also shone light on the significant advantages to considering a diagnosis in the context of the whole individual—their social and emotional health as well as coexisting conditions. Studies have shown, for example, that infertility, ED, and STIs all have a significant relationship with depression and anxiety.

It’s time sexual health was folded in to the broader definition of wellness instead of marginalized as a separate issue. For too many Americans, it’s too big an issue not to address.

Complete Article HERE!

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Coming down from the high:

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What I learned about mental health from BDSM

By Jen Chan

Not too long ago, I took my first step into the world of kink. I was a baby gay coming to terms with my borderline personality disorder (BDP) diagnosis, looking for any and every label that could help alleviate the lack of self-identity that comprises my BPD.

I knew I was queer. I knew I identified as femme. But I didn’t know if I was a dominant (top), a submissive (bottom), or a pillow princess; I didn’t even know if I was kinky.

So I tried to find out.

I began to notice a pattern. The sheer rush of euphoria and affection created a high I felt each time I “topped” my partner, and it would sharply drop the minute I got home. I was drained of energy and in a foul mood for days, often skipping work or class. I felt stuck on something because I wanted to feel that intensely blissful sex all over again, but I couldn’t figure out how to get it back.

If you’re familiar with the after-effects of taking MDMA—the crash, the lack of endorphins, the dip in mood for up to a week later—then you’ve got a pretty good idea of how a “drop” felt for me. Just add in an unhealthy serving of guilt and self-doubt, a pinch of worthlessness and a dash of contempt for both myself and my partner, and voila! Top drop: the less talked about counterpart to sub drop where the dominant feels a sense of hopelessness following BDSM—bondage and discipline, domination and submission, sadism and masochism—if after care is neglected.

In the BDSM community, it’s common to talk about the submissive (sub) experience: To communicate the expectations and needs of the submissive partner before engaging in consensual kinky play, to make sure the safety of the sub during intense physical and/or psychological activities is tantamount, to tend and care for the sub after the scene ends and they’re brought back down to earth.

Outside of this, the rush of sadness and anxiety that hits after sex is known as post-coital tristesse, or post-coital dysphoria (PCD). It is potentially linked to the fact that during sex, the amygdala—a part of the brain that processes fearful thoughts—decreases in activity. Researchers have theorized that the rebound of the amygdala after sex is what triggers fear and depression.

A 2015 study published in the Journal of Sexual Medicine found that 46 per cent of the 230 female participants reported experiencing PCD at least once after sex.

Aftercare is crucial and varies for subs, depending on their needs. Some subs appreciate being held or cuddled gently after a scene. Others need to hydrate, need their own space away from their partner or a detailed analysis of everything that happened for future knowledge. But no matter what the specific aftercare is, the goal is still the same: for a top to accommodate a sub and guide them out of “subspace”—a state of mind experienced by a submissive in a BDSM scenario—as directly as they were guided in.

I asked one of my exes, who’s identified as a straight-edge sub for several years, what subspace is like. As someone who doesn’t drink or do drugs, I was curious about what it was like for them to reach that same ephemeral zone of pleasure.

“It gets me to forget pain or worries, it gets me to focus only on what I’m feeling right then,” they told me. “It’s better than drugs.”

My ex gave up all substances in favour of getting fucked by kink, instead. I’m a little impressed by how powerful the bottom high must be for them.

“The high for bottoms is from letting go of all control,” they added. If we’re following that logic, then the top high is all about taking control.

We ended the call on a mildly uncomfortable note, both trying not to remember the dynamics of control that ended our relationship.  Those dynamics were created, in part, by my BPD, and, as I would later discover, top drop.

In the days to follow, I avoided thinking about what being a top had felt like for me and scheduled a lunch date with another friend to hear his perspective.

“Being a dom gives you the freedom to act on repressed desires,” he told me over a plate of chili cheese fries. This is what his ex said to cajole him into being a top—the implied “whatever you want” dangled in front of a young gay man still figuring himself out.

He was new to kink, new to identifying and acting on his desires, and most of all, new to the expectations that were placed on him by his partner. He was expected to be a tough, macho top to his ex’s tender, needy bottom. His after-care, however, didn’t fit into that fantasy. If that had been different, maybe he wouldn’t have spiraled into a place where his mental health was deteriorating, along with his relationship.

The doubt and guilt that he would often feel for days after a kinky session mirrored my own. We both struggled with the idea that the things our partners wanted us to do to them—the things that we enjoyed doing to them—were fucked up. It was hard to reconcile the good people that we thought we were, the ones who follow societal expectations and have a moral compass and know right from wrong, with the people who are capable of hurting other people, and enjoying it.

For my friend, there was always a creeping fear at the back of his mind that the violence or cruelty he was letting loose during sex could rear up in his normal life, outside of a scene.

For me, there was a deep instinct to disengage, to distance myself emotionally from my partner, because I thought that if I didn’t care about them as much, then maybe I wouldn’t hate them for egging me on to do things I was scared of.

My friend has since recognized how unhealthy his relationship with his ex was. These days, he identifies as a switch (someone who alternates between dominant and submissive roles). The deep-seated sense of feeling silenced that was so prevalent in his first kinky relationship, is nowhere to be seen. He communicates his sexual needs and desires and any accompanying emotional fragility with his current partner. He’s happy.

I’m a little envious of him. My second-favourite hobby is rambling about all of the things I’m feeling, and it’s a close second to my favourite, which is crying. I credit my Cancer sun sign for my ability to embrace my insecurities, but there’s still something that makes me feel like I’m not equipped to deal with top drop.

There’s an interesting contrast between how a top is expected to behave—strong, tough, in control—and the realities of the human experience. When a top revels in the high of taking control, but starts to feel some of that control fading afterwards, how do they pinpoint the cause? How do they talk about that insecurity? How do they develop aftercare for themselves?

One of the hallowed tenets of BDSM and kink is the necessity of good communication; to be able to recognize a desire, then comfortably communicate that to a partner. Healthy, consensual, safe kink is predicated on this.

Complete Article HERE!

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How your sex life can be improved with mindfulness

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Being more present with each other can lead to better sex, therapists say

 

By Olivia Blair

People have turned to mindfulness to make them happier, less stressed and even more able to deal with their mental health conditions such as anxiety or depression – but could it improve your sex life too?

Being mindful essentially means being present and aware of both yourself and your surroundings. The brain is trained to deal with negative and anxious or depressive thoughts through breathing and meditation exercises all stemming in part from ancient Buddhist philosophy.

While therapists are increasingly using it as part of their individual counselling, sex and relationship therapists have also adopted the advice.

“In its broad terms, mindfulness means focusing on the present moment so with couples, because they are often so distracted, stressed and over-committed, it can lead to lots of couples’ mind being elsewhere. A classic complaint is that a partner is distracted,” Krystal Woodbridge, a psychosexual therapist and a trustee of the college of relationship and sexual therapists says. “Mindfulness can mean you are really present with your partner and actually experiencing them in the moment and really paying attention to them.”

This in turn can then lead to better sex – because when partners really feel like they are being listened to, focused on and paid attention to is when better trust is going to be built so they are more likely to be intimate with someone.

“Really being in the moment, noticing their partners body language, facial expressions, tone of voice and what is actually being said is hard to do but it is being present,” Woodbridge says. “… It builds rapport. It you don’t have rapport, you don’t have trust. If you don’t have trust you are not going to be intimate with that person as you are not going to allow yourself tp be vulnerable with them.”

When clients put mindfulness into practice with each other, even if it is a struggle because they are so used to being distracted, it often has a “massive impact on their relationship and sex lives”, Woodbridge says.

Additionally, if someone is struggling with an issue in their sex life such as a performance issue like impotence or the inability to orgasm, mindfulness can also help in this aspect.

“In a sexual scenario what can happen is ‘spectatoring’, which is when a person is not paying attention to arousal or enjoyment and are instead observing and over-analysing themselves fearing the worst. If it is an erectile problem they will be hoping it does not fail or will feel anxious about whether their partner is enjoying it,” Woodbridge explains. “Spectatoring is often quite self-fulfilling so the person might not be able to maintain their erection, will experience sexual pain or they will just feel completely unconfident so they get into a horrible cycle.”

Sex therapists will therefore instruct the client to be mindful and to notice how they are feeling, even if that feeling is anxiety. Once they are aware they feel anxious or nervous they can focus on bringing the mind back to the physical feelings, such as arousal, and divert their focus to this instead.

“Mindfulness gets the person to notice when they are ‘spectatoring’, notice that they are distracted and not focusing on their arousal and physical sensations. It is hard in that moment as the person is anxious but if you don’t the mind will wander and go elsewhere,” Ms Woodbridge explains.

Ammanda Major, a trained sex therapist and head of service quality and clinical practice at Relate told The Independent they regularly introduce mindfulness to their sex therapy sessions for couples.

“We use mindfulness in sex therapy to help people experience more pleasure by being able to relax and stay focused and present in the moment.  Mindfulness can also benefit our relationships as a whole by relieving stress, building intimacy and enhancing inner peace. This in turn allows us to have more positive interactions with our partners,” she said.

She says couples can try mindfulness exercises at home, such as the following:

Individually: 

“Set some time aside every day to focus on your breathing. It doesn’t have to be long to begin with – maybe start with just five minutes a day and work your way up to 20. 

A good way to start is on your own with no distractions.  Close your eyes, relax and start to become aware of how you’re breathing. Breathe in slowly through your nose and exhale through your mouth. Repeat this and gradually become aware of sensations in your body. Recognise and welcome them and then allow those thoughts to drift away to be replaced with other feelings as they arise. Notice what you’re experiencing and feeling. The aim is to let go: rather than reject intrusive thoughts, just let them drift away.”

With a partner:

“Once you’ve practised the breathing exercise a few times on your own, why not with your partner?  Sit facing and look into each other’s eyes.  Breathe slowly in through your nose and exhale through your mouth as before but this time synchronise your breathing.  Do this for several minutes – it may feel a little strange at first but stick with it and it can have powerful results, increasing feelings of relaxation and intimacy.”

Complete Article HERE!

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Why are some women never able to orgasm? A gynaecologist explains

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Dr Sherry Ross says there has long been a gender bias in the way women’s sexual dysfunction has been treated compared to men’s

 

By Olivia Blair

Despite modern society being able to openly discuss female sexuality, there remains a number of existing taboos.

One of the most glaring is female orgasms. Women are rarely taught about the intricate details of their anatomy and often work these things out through their own experimenting.

What is the best way to get an orgasm? How often should I have one? Should I be able to have one during penetrative intercourse? Why have I never had one? – questions not uncommon to hear among small friendship groups of women over a bottle of wine.

Dr Sherry A Ross, an LA-based gynaecologist with 25 years experience aims to educate with a complete guide to the vagina in her new book She-ology: The Definitive Guide to Women’s Intimate Health. Period.

In the foreword of her book, Dr Sherry notes that “talking about the mighty V outside of doctor’s offices and bedrooms has remained a major taboo” and devoted an entire chapter to the female orgasm. The Independent asked the gynaecologist and obstetrician all the questions about female orgasms that are rarely spoken about.

Why might some women never orgasm?

Attitudes regarding sex, sexuality and gender vary greatly between different cultures and religions. Certain sexual practices, traditions and taboos are passed down through generations, leaving little to the cause of female pleasure or imagination.

For some women, finding and/or enjoying sexual intimacy and sex is difficult, if not impossible. Research suggests that 43% of women report some degree of difficulty and 12% attribute their sexual difficulties to personal distress. Unfortunately, sexual problems worsen with age, peaking in women 45 to 64.  For many of these women the problems of sexual dysfunction are treatable, which is why it is so important for women to share their feelings and concerns with a health care provider.

Unfortunately, there has been a history of “gender injustice” in the bedroom. Women have long been ignored when it comes to finding solutions to sexual dysfunction. In short, there are twenty-six approved medications for male erectile dysfunction and zero for women. Clearly, little attention has been paid to the sexual concerns of women, other than those concerns that involve procreation.

How many women might never orgasm?

During my 25 years in private practice, I’ve met a number of women in their 30s, 40s and 50s who have never even had an orgasm. In fact, 10 to 20% of all women have never experienced one.

Issues related to sex are not talked about enough even with a health care provider. Let’s just start by saying, 65 per cent of women are embarrassed to say the word vagina and 45 per cent of women never talk about their vagina with anyone, not even with their doctor.

Some patients say they have pain with sex, have problems with lubrication, don’t have a sex drive or don’t enjoy sex.  My first question is “Are you having problems in your relationship?”, “Do you like you partner?” , “Are you able to have an orgasm?”, “ Do you masturbate?” These open-ended questions tend to bring out sexual dysfunction including the inability to have an orgasm.

There is a great deal of embarrassment and shame when a woman admits she has never experienced an orgasm.

Is the inability to not orgasm normal?

The inability not to have had an orgasm can reflect women’s inability to know they own anatomy and may not be a disorder at all. In a survey of women aged 16-25, half could not find the vagina on a medical diagram. A test group of university- aged women didn’t fare much better with one third being unable to find the clitoris on a diagram. Clearly, if you can’t find it, how are you going to seek enjoyment from it?

Women must first understand what brings them pleasure and in their pursuit of happiness they have to understand where their clitoris is and how to stimulate it. Masturbation is a skill.  It has to be learned, just as walking, running, singing and brushing your teeth.

What is an orgasm disorder and how would you categorise one? 

The inability to have an orgasm falls under the category of Female Sexual Dysfunction of which there are five main problems: low libido or hypoactive sexual desire disorder, painful sex, sexual arousal disorder, an aversion to sex and the inability to orgasm.

Hypoactive sexual disorder, the most common female sexual dysfunction, is characterised by a complete absence of sexual desire. For the 16 million women who suffer from this, the factors involved may vary since sexual desire in women is much more complicated than it is for men. Unlike men, women’s sexual desire, excitement and energy tend to begin in that great organ above the shoulders, rather than the one below the waist. The daily stresses of work, money, children, relationships and diminished energy are common issues contributing to low libido in women. Other causes may be depression, anxiety, lack of privacy, medication side effects, medical conditions such as endometriosis or arthritis, menopausal symptoms or a history of physical or sexual abuse.

You are the person in charge of your vagina and clitoris. First and foremost, get to know your female parts intimately. Understanding your sexual response is a necessary health and wellness skill. Make mastery of that skill a priority.

Complete Article HERE!

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Better Sleep Could Mean Better Sex for Older Women

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By Robert Preidt

A more satisfying sex life may be only a good night’s sleep away for women over 50, new research finds.

Researchers led by Dr. Juliana Kling of the Mayo Clinic in Scottsdale, Ariz., tracked data from nearly 94,000 women aged 50 to 79.

The investigators found that 31 percent had insomnia, and a little more than half (56 percent) said they were somewhat or very satisfied with their sex life.

But too little sleep — fewer than seven to eight hours a night — was linked with a lower likelihood of sexual satisfaction, the findings showed.

“This is a very important study since it examines a question which has tremendous potential impact on women’s lives,” said Dr. Jill Rabin, who reviewed the findings. She’s co-chief of the Women’s Health Program at Northwell Health in New Hyde Park, N.Y.

Age played a key role in outcomes. For example, the study found that older women were less likely than younger women to be sexually active if they slept fewer than seven to eight hours per night.

Among women older than 70, those who slept fewer than five hours a night were 30 percent less likely to be sexually active than women sleeping seven to eight hours, Kling’s team found.

The findings highlight how crucial sleep is to many aspects of women’s health, medical experts said.

“Seven hours of sleep per night will improve sexual satisfaction and has been shown to increase sexual responsiveness,” said Dr. JoAnn Pinkerton, executive director of The North American Menopause Society.

Besides putting a damper on sex lives, she said, poor sleep is also tied to an array of health issues, such as “sleep apnea, restless legs syndrome, stress and anxiety.” Other health problems linked to insomnia include “heart disease, hypertension [high blood pressure], arthritis, fibromyalgia, diabetes, depression and neurological disorders,” Pinkerton added.

Dr. Steven Feinsilver directs sleep medicine at Lenox Hill Hospital in New York City. He reviewed the new findings and stressed that they can’t prove cause and effect. “It certainly could be possible that many underlying problems — for example, illness, depression — could be causing both worsened sleep and worsened sex,” he noted.

Rabin agreed, but said there’s been “a paucity of studies” looking into links between sleep and sexual health, especially during menopause.

“We know that obstructive sleep apnea and sexual dysfunction are positively correlated,” she said. “Other factors which may lead to a decreased sleep quality include: a woman’s general health; various life events, which may contribute to her stress; chronic disease; medication; and degree and presence of social supports, just to name a few,” Rabin explained.

And, “in menopause, and due to the hormonal transition, women may experience various symptoms which may impact the duration and quality of their sleep patterns,” Rabin added.

We and our patients need to know that quality sleep is necessary for overall optimum functioning and health, including sexual satisfaction, and that there are effective treatment options — including hormone therapy — which are available for symptomatic women,” she said.

The study was published online Feb. 1 in the journal Menopause.

Complete Article HERE!

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