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What gay trans guys wish their doctors knew

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Vancouver study peers into the lives and troubles of trans MSM

Sam Larkham organizes sexual health clinics across Metro Vancouver with the Health Initiative for Men (HIM). He says he was once referred by his doctor to a trans health care clinic that had been closed for years.

By Niko Bell

Speaking to gay and bisexual trans men, the word “invisibility” comes up a lot. Invisibility in the bathhouse and on dating apps, invisibility among cisgender people, straight people, trans people and gay people. And, too often, invisibility in the doctor’s office.

“I have tried just going to walk-in clinics and stuff like that to ask questions or request tests,” one trans man recently told researchers in Vancouver. “And I just found the doctors were generally confused about me and my body. And I had to go into great detail. That made me not so comfortable talking to them about it because they were just kind of sitting there confused.”

“People have tried to talk me out of testing . . . saying I was low-risk behaviour,” another man told the researchers. “They didn’t understand my behaviour really. . . I’ve had practitioners as well say they don’t know what to do; they don’t know what to look for.”

Both men were speaking to researchers for a new study on the sexual health of trans men who have sex with men — a group social scientists know remarkably little about. Many of the men spoke about being on the margins of mainstream culture, gay culture and of the healthcare system.

It should be no surprise, then, that the study happened almost by accident. When PhD student Ashleigh Rich started work with the Momentum Health Study — a five-year, in-depth research project on the sexual health of men who have sex with men (MSM) conducted out of the BC Centre for Excellence in HIV/AIDS — she never intended to write a paper about trans MSM.

But a small group of trans men volunteered for the study, some pointing out ways the Momentum researchers could change their surveys to be more inclusive.

There were too few for quantitative research — only 14 — but Rich asked if they would sit down for an hour and talk about their experiences. Eleven agreed.

The result is a slim, 11-page paper that hints at a world of things we don’t yet know about transgender gay and bisexual men. We do know they form a large part of the trans population; nearly two thirds of trans men say they are not straight. We also know trans MSM participate in the same rich world of sexuality as other men who have sex with men — from dating apps to anonymous sex to sex work and a broad range of sexual behaviour.

We don’t know much about trans MSM risk for HIV; estimates range from much less than cisgender gay and bi men to somewhat more. We also don’t know much about how a combination of stigma, invisibility and limited healthcare options may be affecting trans men’s health.

Rich is cautious about drawing any broad conclusions from her study. Not only is it a tiny sample, but the men she spoke to are also mostly urban, white and educated. This study was less about answering questions, and more about figuring out which questions to ask.

A few themes, though, emerge clearly. One is that trans MSM often find themselves falling through the cracks when it comes to sexual health. Doctors are increasingly aware of how to talk to gay men, but don’t always see trans gay men as “real” MSM. They assume trans men are heterosexual, or fail to bring up sexual health altogether.

Some doctors give trans men information on PrEP — a preventative anti-HIV medication that can drastically reduce the risk of contracting HIV if taken every day — based on studies on cisgender men, without checking to see if different anatomy requires different doses. When trans men come in for HIV tests, they are sometimes urged to get pap smears instead.

“We come in with specific issues we want to talk about in a health care consult, and sometimes once people discover we’re trans they’ll want to do a pregnancy test or something,” says Kai Scott, a trans inclusivity consultant who collaborated on the study with Rich. “And we’re not there for that. They’re giving us things we don’t want, and not telling us the things we do need to know.”

Sam Larkham, a trans man who organizes sexual health clinics across Metro Vancouver with the Health Initiative for Men (HIM), says he was once referred by his doctor to a trans health care clinic that had been closed for years. Experiences like that make him think the best path for trans MSM is to rely on queer-focused health care providers like HIM.

“It would be ideal if it were the whole medical system, but that’s impossible,” Larkham says. “I think we have to look at what we can do, and that’s have specific places where we have nurses who are well trained to handle trans MSM. I think that’s the more doable thing. I would love to have every clinic be culturally competent, but that’s not the reality and never will be.”

Scott is more sanguine. He points to Trans Care BC, a provincial health program that has pushed for more education for doctors. Education needs to happen on both fronts, Scott says, among MSM organizations and in the health care system at large.

Lauren Goldman is a nurse educator for Trans Care BC. Since she was hired last fall, she’s been giving workshops to healthcare providers on how to treat trans patients. For now, though, the workshops are aimed at small groups of sexual health professionals, such as at the BC Centre for Disease Control or HIM. Goldman wants the program to expand to include everyone.

“We know trans patients are accessing care through a number of places all across the province,” she says. “We want everyone to have access to this information as soon as possible.”

Goldman says Trans Care is designing an online course that could bring trans cultural competency to primary care doctors everywhere as part of mandatory continuing education. Trans Care has also designed a primary care “toolkit” for doctors, and is in talks with UBC’s medical school about including trans-focused sexual health education for doctors in training.

Without specialized knowledge, Goldman says, there’s a lot doctors can miss. Testosterone can make vaginal tissue more sensitive and inflexible, for example, meaning trans men might have special difficulties with genital sex. Bacterial vaginosis is more common, and the usual antibiotics given to cis women may not solve the problem. Vaginal and rectal tissue may need different doses of PrEP to be effective.

And, most importantly, doctors need trans patients to know they will be heard.

“We need to be providing really obvious cues that show people that our services are trans inclusive,” Goldman says. “Including how we design our services, how we market our services, how we educate our clinicians, what signs we hang up, letting people know that our clinicians have a greater understanding of gender diversity.”

While Goldman is educating doctors, the trans men Rich studied were already very well educated about their own sexual health. They told Rich about careful risk assessments they make around sex, sharing information with other men, and advocating for STI screening to their reluctant doctors.

One man described slipping in HIV tests while getting regular testosterone-level screening: “Yeah, oh, I’m already getting blood drawn. I probably need to get tested, let’s just draw two more vials for HIV and syphilis.”

It’s not surprising that many trans men are so health-conscious, Scott says. “We’ve had to be champions of our own bodies for a while, and so that ethos carries through when it comes to health information.”

But it would be a mistake to overstate how safe trans MSM are, he adds. For one, the urban, white and well-educated men in Rich’s study may be more likely to have access to resources and care than less wealthy or more rural trans people. Also, the very reason trans MSM seem so safe might be because they aren’t getting the opportunities for sex they want.

“To some extent, we’re still on the sidelines,” Scott says. “I don’t think that systemic rejection should be the means of HIV prevention for trans and nonbinary people. We’re dealing with a lot of rejection, and so I don’t think we’ve really had the opportunity to be exposed to that risk.”

The theme of rejection is echoed frequently by the study subjects.

“I remember meeting this one guy at a friend’s party and we were flirting the whole time,” one participant recounted. “He was like, ‘Oh we should totally go for a beer’ and so we connected and then I told him I was trans and he was like, ‘Oh I’m not looking for anything.’”

“Cis men often shut down immediately, out of a sort of fear of the unknown, and being unaware of what can and can’t happen,” Scott says. “They can assume all trans guys are bottoms, which isn’t true.”

Constant rejection can wear trans men down, Larkham says. Not only does it damage mental health, but constant rejection can weaken trans men’s resolve to negotiate sexual safety.

Many trans men, the study notes, rely on online hookup sites, where they can be upfront about being trans, and avoid rejection by anyone who isn’t interested.

The burden of rejection is one reason trans MSM need better mental health services too, Larkham says. Too many men show up to sexual health clinics after being exposed to sexual risks. Mental health support, he thinks, could reach people earlier.

But again, Scott strikes a positive note. “It’s a source of celebration to me that despite huge barriers we’re still having the sex that we want,” he says.

In the end, the clearest message to emerge from Rich’s study is that there’s a lot more to learn. She hopes to get more answers from the next stage of the Momentum study, which will recruit a larger sample of MSM from across Canada. That study, she hopes, will be large enough to deliver the kind of precise, quantitative answers that this one couldn’t.

Scott is also eager to move forward.

“There’s so much you want to pack in and so much you want to report on,” he says. “There’s such a dire need to research these issues. People are really hurting, and I really feel that. But you’ve got to take it one step at a time.”

Complete Article HERE!

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Should sex toys be prescribed by doctors?

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Talk about good vibrations

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They are far more likely to be found in your bedside drawer than your local surgery, but sex toys can bring more than just benefits in the bedroom; they could boost your health too.

So should GPs stop being shy and recommend pleasure products? Samantha Evans, former nurse and co-founder of ‘luxury sex toy and vibrator shop’ Jo Divine certainly believes so. Challenging stuffy attitudes could change people’s lives for the better.

“I have encountered several doctors including GPs and gynaecologists who will not recommend sex toys because of their own personal views and embarrassment about sex. However, once healthcare professionals learn about sex toys and sexual lubricants and see what products can really help, they often change their mind.”

Samantha says increasingly doctors are seeing vibrators as the way forward for helping people overcome intimate health issues.

In 2015, she was asked to put together a sexual product brochure for the NHS at the request of Kent-based gynaecologist Mr Alex Slack. The document contains suitable sex toys, lubricants and pelvic floor exercisers that can help with a range of gynaecological problems.

But sex toys can also be beneficial for many other illnesses too, Samantha reveals.

“Often people feel their body is being hijacked by their illness such as cancer and being able to enjoy sexual pleasure is something they can take back control of, beyond popping a pill. Using a sex toy is much more fun and has far fewer side effects than medication!”

Here are just some of the reasons it’s worth exploring your local sex shop (or browsing online) to benefit your health:

1. Great sex is good for you

One area sex toys can help with is simply making sex more enjoyable, helping couples discover what turns them on.

“Having great sex can promote health and wellbeing by improving your mood and physically making you feel good. Using a sex toy can spice up a flagging sex life and bring a bit of fun into your life. A sex toy will make you feel great as well as promoting your circulation and the release of the “feel good factors” during an orgasm.”

2. Sex toys can rejuvenate vaginas

Some of the most uncomfortable symptoms of the menopause are gynaecological. Declining levels of the hormone oestrogen can lead to vaginal tightness, dryness and atrophy. This can lead to painful sex and decreased sex drive.

But vibrators can alieve these symptoms (by improving the tone and elasticity of vaginal walls and improving sexual sensation) and also promote vaginal lubrication.

Sex toys can also be useful following gynaecological surgery or even after childbirth to keep the vaginal tissue flexible, preventing it from becoming too tight and also promoting to blood flow to the area to speed up healing, says Samantha.

3. Sex toys help men too

Men can benefit from toys too, says Samantha. She says men who use them are less likely to be burdened with erectile dysfunction, difficulty orgasming and low sex drive.

“They are also more likely to be aware of their sexual health, making them more likely to notice any abnormalities and seek medical advice,” she points out.

Male products can help men overcome erectile dysfunction, following prostate surgery or treatment, diabetes, heart disease, spinal cord injury and neurological conditions by promoting the blood flow into the erectile tissues and stimulating the nerves to help the man have an erection without them having to take Viagra.

4. Sex isn’t just about penetration

There’s a reason sexperts stress the importance of foreplay. Most women just cannot orgasm through penetration alone no matter how turned on they are. Stimulating the clitoris can be the key to satisfying climaxes and sex toys can make that easier. Vibrators can be really useful for vulval pain conditions such as vulvodynia where penetration can be tricky to achieve.

“By becoming aware of how her body feels through intimate massage and exploration using a vibrator and lubricant and relaxation techniques, a woman who has vulvodynia can become more relaxed and comfortable with her body and her symptoms may lessen. It also allows intimate sex play when penetration is not possible,” says Samantha.

5. Vibrators can be better than medical dilators for vaginismus

Vaginismus, a condition in which a woman’s vaginal muscles tense up involuntarily, when penetration is attempted is generally treated using medical dilators of increasing sizes to allow the patient to begin with the thinnest dilator and slowly progress to the next size. But not all women get on with these, reveals Samantha.

Women’s health physiotherapist Michelle Lyons, says she often tries to get her sexual health patients to use a vibrator instead of a standard dilator.

“They (hopefully) already associate the vibrator with pleasure, which can be a significant help with their recovery from vaginismus/dyspareunia. We know from the research that low frequency vibrations can be sedative for the pelvic floor muscles, whereas higher frequencies are more stimulating. After all, the goal of my sexual rehab clients is to return to sexual pleasure, not just to ‘tolerate’ the presence of something in their vagina!”

Samantha Evans’ sex toy starter pack

1. YES organic lubricant

“One of the best sexual lubricants around being pH balanced and free from glycerin, glycols and parabens, all of which are vaginal irritants and have no place in the vagina, often found in many commercial sexual lubricants and even some on prescription.”

2. A bullet style vibrator

“This a good first step into the world of sex toys as these are very small but powerful so offer vibratory stimulation for solo or couples play, especially if you are someone who struggles to orgasm through penetrative sex.”

3. A skin safe slim vibrator

“A slim vibrator can allow you to enjoy comfortable penetration as well as being used for clitoral stimulation too. Great for using during foreplay or when penetration is uncomfortable.”

Complete Article HERE!

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Oncologists need to discuss sexual issues with patients, says doctor

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Dr. Anne Katz was in Windsor on May 11, 2017, to address Windsor Regional Hospital staff about cancer, intimacy and sexuality.

By Chris Thompson

A Winnipeg doctor who specializes in treating sexual issues with cancer patients is hoping to spread the word about doctors being up front with their patients.

Dr. Anne Katz held an online forum for Windsor Regional Hospital workers about cancer, intimacy and sexuality.

Katz is the author of several books dealing with the issue.

“Really the message is that sexually it is really important for people, for all of us, and I really want to encourage oncology care providers to raise the topic of it with their patients, because when we don’t talk about it, the patients thinks it’s a taboo,” said Katz.

“And 80 per cent of cancer survivors experience sexual difficulty after cancer treatment.”

Katz said doctors should be more willing to bring up sex issues with their cancer patients.

“So it really is something where we have to expose people to having that conversation,” said Katz.

“All cancers, all people, men, women, gay, straight, people recognize things aren’t going right during treatment, but all more commonly sexual problems aren’t recognized until after treatment.”

Katz said many people undergoing cancer treatment don’t realize there is an issue until later.

“Usually people during treatment are really not feeling that well, so it’s kind of on the back burner but it really is a sentinel of survivorship,” Katz said.

“People come to see me and we know certainly that most men who experience prostate cancer are going to experience erectile difficulties, most women with breast cancer often experience body issues, early menopause, or exaggerated menopausal symptoms, people with colorectal cancer have problems.”

Katz said everyone who is experiencing cancer needs to address the issue.

“It really is all cancers,” Katz said. “We’re all sexual beings, literally, from cradle to grave, whether you act on it or not.

“Even if you’re not partnered. It’s so much a part of quality of life for cancer survivors. So it goes away, there are some couples that lose that connectedness, there are some couples that use sex to make up after fights. They are fighting a lot because there is no way to resolve the fights.

“Unless oncology workers can address it and talk about it, patients are very reluctant to bring up the topic.”

Complete Article HERE!

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Romping 50 Shades of Grey-Style? Rope in your Doctor

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Whips. Chains. Paddles. Rope. Thanks to the pop culture explosion that is 50 Shades of Grey, these words are now part of the mainstream sexual lexicon. But while the book and film franchise has increased awareness about kink, many people are still keeping their bedroom habits secret, and it’s impacting their health.

Amy in Winnipeg has lived the BDSM lifestyle (that’s bondage/discipline, dominance/submission, and sadism/masochism) and she’s the first to admit that, “it’s nothing like the tame version of the books or movies.” She’s experienced, abrasions, rope burn, sciatic nerve pain and spankings that left her so raw that “it got to the point where I had huge pieces of flesh missing…I couldn’t sit for a week.”

As Amy explains, “if not looked after properly, abrasions can lead to bacterial infections,” which is exactly what happened to her after a particularly painful spanking injury. “I went to the doctor to get cream and I explained myself,” she says.

While Amy wasn’t afraid to open up to her healthcare practitioner, she’s in a minority. According to a new study published in the Journal of Sexual Medicine titled “Fifty Shades of Stigma: Exploring the Health Care Experiences of Kink-Oriented Patients,” less than half of individuals surveyed were open with their doctors about their kinky sexual practices. The main reason for keeping quiet? Fear of judgement. Also, as the study highlights, many individuals are afraid their physician will misinterpret their consensual sexual acts as partner abuse.

It makes sense. While my experience with anything kink-oriented is extremely limited, years ago I sustained some gnarly carpet burns after an encounter with an ex. When I went to see my family doctor for my annual exam, I blurted out, “I slipped while playing a game of Twister with friends!” I have no idea why I thought this sounded remotely plausible to anyone, but it was the first thing that came to mind. In retrospect, I think she knew what the deal was, but chose to be discrete. However, not everyone is so lucky.

Despite increased visibility in pop culture, the stigma associated with BDSM is still very real. However, so are the potential risks. Injuries that arise from BDSM can potentially mushroom into more serious issues if left unattended. Anna M. Randall, LCSW, MPH, is a San Francisco-based sex therapist and the executive director of The Alternative Sexualities Health Research Alliance (TASHRA), the team behind the study. As she told Cosmopolitan magazine recently, “big bruises can develop into hematomas, for example.” She goes on to say that “there are rare injuries from rough sex that may lead to serious complications, such as torn vaginal tissue or scrotum injuries, and because more risky sexual BDSM behaviors may include controlling the breathing of

a partner, those with asthma face real risks if they’re not treated for attacks immediately.”

However, for Cassandra J. Perry, an advocate, researcher and writer, her injuries were all due to health conditions she didn’t realize she had at the time. Perry’s first injury occurred when she shredded the cartilage in her left hip joint (an injury called a labral tear.) She says, “even if you think you’re sex-savvy smart, you could probably be and likely should be safer!” Also, as she points out, “If we practice bdsm, that’s a good reason why we should have our annual physicals. And it’s a really good reason to pay attention to what our mind-body tells us. If something seems off, we need to be persistent with getting answers and care (when possible) and to be cautious when engaging in BDSM activities that may interact with some part of our health that concerns us.”

However, as Stella Harris, a Sex Educator & Intimacy Coach explains, “The risks of BDSM aren’t just physical.

Make sure to look out for the emotional implications, as well. Some of this play can be very intense, and you want to make sure you’ve planned all the necessary aftercare.” This is going to look different for everyone and can include everything from cuddling with your partner to routine check-ins with them over the following days.

Lastly, Harris reminds us, “I always advocate honesty with your medical professionals. When you’re finding a doctor, screen for someone you can be open and honest with, who has passing knowledge of kink, and who isn’t judgmental. If you go to the doctor with visible bruises, just be honest about it and tell them the bruises are from consensual kink activities. They might have questions, but it’s best to be clear and upfront, before they assume the worst.”

Complete Article HERE!

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

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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!

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