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Time for a Sexual Revolution In Health Care Treatment

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!

Sexual statistics

Studying the intimate relationship between narcissism and satisfaction

by Elaine Smith

If you learned that your next-door neighbours were having sexual relations more frequently than you and your partner, would it bother you?

Three U of T Mississauga researchers set out to understand how people view their sex lives in comparison to those of others and discovered that sexual narcissism colours the way people make and view those comparisons.

“For some people, those comparisons are pretty influential,” said Lisa Day, a PhD candidate at UTM.

In new research published in the Personality and Social Psychology Bulletin, Day, Emily Impett, a UTM psychology professor, and Amy Muise (now a York University professor) looked at how these comparisons affect both relationship satisfaction and sexual satisfaction for people with varying degrees of sexual narcissism.

Sexual narcissism should not be confused with general narcissistic personality traits. It is defined as “the tendency to exploit others, a lack of empathy, feelings of grandiosity and an excessive need for validation in the sexual domain.” They’re the people, for example, who buy you dinner and expect sexual favours in return.

The trio of researchers discovered that many people seemed to be curious about the sex lives of others. Individuals who had a high degree of sexual narcissism were very susceptible to comparisons with others, regardless of whether the source was friends, colleagues, survey data or magazine articles. They tended to make comparisons favourable to themselves (downward comparisons). Comparisons that showed them in a lesser light (upward comparisons) appeared to decrease their satisfaction, both with their sexual relationship and their overall relationship.

“Individuals with a high degree of sexual narcissism tend to make comparisons with those who are less sexually skilled, for example,” Day said. “When they do make comparisons with someone doing better than they were, it gets under their skin.”

By contrast, individuals with a low degree of sexual narcissism weren’t much affected by favourable comparisons; they didn’t have much of an impact on how sexually satisfied they were or how much satisfaction they derived from their relationships.

The researchers reached these conclusions through three studies that used participants from the Amazon survey roster. In the each study, the participants were measured for sexual narcissism and for personality narcissism. In the first study, participants were then asked to recall the most recent comparison they had made between their sex lives and that of others – data show that people make such comparisons on five per cent of the days in the year.

The researchers assessed the direction of these comparisons. “People who were higher in sexual narcissism were more likely to recall a [favourable] social comparison, which in turn predicted greater sexual and relationship satisfaction immediately after recalling that comparison,” they wrote.

In the second study, the researchers asked the participants how much they would be bothered by sexual comparisons with those who had more prowess or more regular if those people were: (a) their best friend, (b) their partner’s best friend, and (c) the average couple. The results, wrote the researchers, “showed that who were higher in sexual narcissism reported that they would be more bothered by upward social comparisons, and, in turn, reported lower sexual and .”

In the third study, subjects were given a doctored magazine article relating to sexuality and randomly asked to compare its findings to their own sex lives in an upward fashion, a downward fashion or not to make any comparison. They were then asked about their satisfaction with their personal relationships and their sexual relationships. As anticipated, those with a high degree of sexual narcissism were very sensitive to such comparisons and were dissatisfied with their sexual and personal relationships when forced to compare themselves in a non-favourable way.

“People are curious about the sexuality of others and make comparisons that impact how they feel about their own relationships,” Day said. “This curiosity has opened a completely new line of research for us.”

Complete Article HERE!

How a Cervical Cancer Scare Made Me Take My Sexual Health More Seriously Than Ever

My doctor’s advice on how to not get HPV again threw me for a loop.

By Rachel Bowyer

Before I had an abnormal Pap smear five years ago, I didn’t even really know what that meant. I’d been going to the gyno since I was a teenager, but I never once really thought about what a Pap smear was actually testing for. I just knew I’d have a “twinge” of discomfort, as my doc always says, and then it would be over. But when my doctor called me to tell me I needed to come back in for more testing, I was pretty concerned. (Here, find more on how to decipher your abnormal Pap smear results.)

She assured me that abnormal Paps are actually quite normal, especially for women in their 20s. Why? Well, the more sexual partners you have, the more likely you are to get human papillomavirus (HPV), which is what generally causes the abnormal results. I quickly found out that it was the cause of mine, too. Most of the time, HPV resolves on its own, but in some cases, it can escalate into cervical cancer. What I didn’t know at the time is that there are several steps between testing positive for HPV and actually having cervical cancer. After having a couple of colposcopies, procedures where a tiny bit of tissue is removed from your cervix for closer examination (yes, it’s as uncomfortable as it sounds), we discovered that I had what’s known as high-grade squamous intraepithelial lesions. That’s just a technical way of saying that the HPV I had was more advanced and more likely to turn into cancer than other kinds. I was scared, and I got even more scared when I found out I had to have a procedure to remove the tissue on my cervix that was affected, and that it needed to be done ASAP—before it got worse. (According to new research, cervical cancer is deadlier than previously thought.)

Within two weeks of finding out about my abnormal Pap, I had something called a loop extrosurgical excision procedure, or LEEP for short. It involves using a very thin wire with an electrical current to cut away precancerous tissue from the cervix. Normally, this can be done with local anesthesia, but after an attempt that went awry (apparently, local anesthetic isn’t as effective for everyone as it’s supposed to be, and I found that out the hard way…), I had to make a second trip to the hospital to have it done. This time, I was sedated. After six weeks, I was declared healthy and ready to go, and told I needed to have a Pap smear every three months for the next year. Then, I’d go back to having them once yearly. Let’s just say I’m not a great patient, so after all was said and done I knew I never wanted to have to go through this process again. Since there are over 100 strains of HPV, I knew it was a real possibility that I could contract it again. Only a small number of the strains cause cancer, but at that point, I really didn’t want to take any chances.

When I asked my doctor how to prevent this situation from happening again, her advice really surprised me. “Become monogamous,” she said. “That’s my only option?” I thought. I was dealing with the perils of the New York City dating scene at the time, and at that point couldn’t even imagine meeting someone I’d want to go on more than five dates with, let alone finding my mate for life. I had always been under the impression that as long as I was *safe* about sex, opting not to settle down wouldn’t be detrimental to my health. I almost always used condoms and got tested for STIs regularly.

Turns out, even if you use a condom every single time you have sex, you can still get HPV because condoms don’t offer complete protection against it. Even when used correctly, you can still have skin-to-skin contact when using a condom, which is how HPV is passed from one person to another. Pretty crazy, right? I didn’t think there was anything wrong with not wanting to be monogamous (and still don’t), so it was hard to grasp the fact that my ideological stance on sex was directly opposed to what was best for my sexual health. Was my only option truly to settle down at 23 and decide to only have sex with one person for the rest of my life? I wasn’t ready for that.

But according to my doctor, the answer was essentially, yes. To me, this seemed extreme. She repeated to me that the fewer partners you have, the lower your risk of contracting HPV. Of course, she was right. Though you can still get HPV from a long-term partner that could take years to show up, once your body clears whatever strains they have, you won’t be able to get it from them again. As long as you and your partner are only having sex with each other, you’re good to go in terms of re-infection. At the time, I was pretty taken aback by the fact that the best thing I could do to protect my sexual health was basically to not have sex until I found “the one.” What if I never found that person? Should I just be celibate forever!? For the next couple of years every time I even thought about having sex with someone, I had to ask myself, “Is this really worth it?” Talk about a mood killer. (FYI, these STIs are much harder to get rid of than they used to be.)

Truthfully, it didn’t turn out to be such a bad thing. Whenever I decided to have sex with someone in the years after that, not only did I follow safe-sex practices to the letter, but I also knew that I had strong enough feelings about the other person for it to be worth the risk I was facing. Basically, that meant I was genuinely emotionally invested in every person I slept with. While some would say that’s how it should be all the time, I don’t really subscribe to that school of thought—in principle. In practice, however, I did save myself a ton of heartache. Since I had fewer partners who I got to know better, I dealt with less post-sex ghosting. Some people might not mind that, but even when I wasn’t super-invested in someone, the ghosting part almost always sucked.

Now, five years later, I happen to be in a long-term monogamous relationship. While I can’t say that it happened directly because of my experience or my doctor’s advice, it’s certainly a relief when what your heart wants and what’s best for your health happen to match up. And not having to constantly worry about HPV the way I once did? Love.

Complete Article HERE!

How our culture of kink-shaming is making us much less sexually liberated than we think

Why do people with fetish preferences feel stigmatised despite the success of Fifty Shades of Grey?

By Olivia Blair

We now live in a society which is more open and positive about sex than ever before, but one expert says we’re not as sexually free and liberated as our post-1960s society would have us believe.

In his new book, Modern Sexuality: The Truth about Sex and Relationships, Dr Michael Aaron suggests that there is still widespread stigma surrounding sexuality in the modern age. People who have unconventional sexual fantasies are forced into the shadows, and often do not reveal them even to their partners.

He adds that the dialogue around sex in society is often one layered with shame, regulation and restriction.

“I think that laws and attitudes towards sexuality are one of the clearest reflections of the level of freedom afforded in a society. That’s because sexuality is so core to our identities, that censoring it also inevitably has the effect of censoring individual expression,” Dr Aaron told The Independent.

The doctor, who lives in New York City, actually singles out UK laws as one of the most prominent examples of ways in which our sexuality is supposedly restricted. He hones in on the Digital Economy Bill which is currently going through the House of Lords.

The bill proposes to ban a large number of “non-conventional sexual acts” in pornography which is believed to include female ejaculation, sexual acts involving menstruation and urination, and spanking, whipping or canning which leave marks.

He says the inclusion of female ejaculation, menstruation and fisting on the ban-list is “nonsense” and says “it is no coincidence that these laws are introduced at a time when British politics is veering more hard right”.

Dr Aaron also points to laws which regulate, and in some cases criminalise, sex work as examples of infringes upon sexual freedoms.

“Perhaps nowhere else is the government regulation of sex more apparent than in the area of sex work,” he writes arguing that government crackdowns on any kind of sexual behaviour “prevent for the possibility for an honest and open discussion on what sex work means for its participants and how society can provide appropriate resources for those who do choose sex work”.

Laws surrounding pornography and sex work are extreme examples of where sexuality is marginalised in society. However, Dr Aaron says in his therapy sessions he encounters lots of patients who feel shamed over their sexual preferences even when it is no longer considered taboo in society.

“I still have a number of clients who have difficulty coming out and are conflicted about their orientation even though same-sex marriage was approved by the US Supreme Court almost two years ago and issues around homosexuality have been brought into public awareness. Similarly, I see a number of individuals ashamed of their fetishistic interests even though Fifty Shades of Grey just came out with a sequel and the trilogy has sold over 100 million copies.

“There is a big difference between externally accepting something and truly believing it and feeling internally congruent. As a result, even though society has made tremendous progress, I believe most individuals, even the most liberated by all appearances, still carry internal remnants of sexual shame and stigma.”

So how do we liberate ourselves and challenge both internal and external restrictions on our sexuality? Dr Aaron says education is key.

“Right now, a number of young adults and teenagers get all of their sex education from porn, which is like trying to learn about geopolitics by watching the latest Bond movie. In many ways, trying to protect individuals from sex only hurts them further.”

He argues education will also ensure those with less mainstream sexual desires experience less shame and stigma and feel part of the conversation.

“Transparency around sex leads to a more humanistic, supportive, and nurturing society, that is accepting of individuality and unique consensual behaviours, rather one that is authoritarian, patriarchal, and punitive. I think our challenge as a society is to evolve past basic group needs that may be anachronistic and no longer necessary.”

Complete Article HERE!

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