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Visualizing Sex as a Spectrum

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Infographic reveals the startling complexity of sex determination

Infographic by Pitch Interactive and Amanda Montañez

By Amanda Montañez

Sex and gender pervade nearly every aspect of our lives. Each time we use a public restroom, shop for clothes, or fill out a form, we are insistently reminded that we must be either male or female; men or women; boys or girls. Even things that ostensibly have nothing to do with sex or gender—what we eat, for example, or the books we read—are often sold to us as if they are necessarily feminine or masculine.

Some of these conventions currently face challenges, some more polarizing than others. On the milder end of things, enterprising online retailers promote gender-neutral clothing for babies, and city transport authorities mercifully abolish the phrase “ladies and gentlemen” from public announcements. And on the other side of the controversy scale, U.S. state legislators debate so-called “bathroom bills,” which would prohibit transgender individuals from using public restrooms corresponding to their gender identity. This dispute has prompted some venues to offer a gender-neutral restroom option, or simply to do away with gender distinctions altogether in their facilities.

Much of the public discourse in this arena centers on gender rather than sex, presumably because gender is understood to be somewhat subjective; it is a social construct that can be complex, fluid, multifaceted. Biological sex, on the other hand, appears to leave less room for debate. You either have two X chromosomes or an X and a Y; ovaries or testes; a vagina or a penis. Regardless of how an individual ends up identifying, they are assigned to one sex or the other at birth based on these binary sets of characteristics.

But of course, sex is not that simple either.

The September issue of Scientific American explores the fascinating and evolving science of sex and gender. One of the graphics I had the pleasure of working on breaks down the idea of biological sex as a non-binary attribute, focusing largely on what clinicians refer to as disorders of sex development (DSD), also known as intersex.

The project was originally conceived as a data-driven graphic exploring the spectra of sex and gender. I wondered, for instance, what data could tell us about the frequency of transgender and non-binary identities, what proportion of the population is intersex, and how that value might break down into rates of specific DSDs.

I hired the researcher Amanda Hobbs to look into these questions, and what she came back with, rather than answers, looked more like a series of new questions. The search for solid data on transgender and intersex populations proved challenging, and was confounded by a variety of factors. For example, surveys often lump transgender in with gay, lesbian, and bisexual identities. And DSDs, in addition to being variously defined by different entities, sometimes go undetected or emerge unexpectedly, either during sexual development or later in life.

The project abruptly transformed into an exercise in visualizing complexity. First, it seemed imperative to define a few terms. Sex, gender, and sexuality are all distinct from one another (although they are often related), and each exists on its own spectrum. Moreover, sex cannot be depicted as a simple, one-dimensional scale. In the world of DSDs, an individual may shift along the spectrum as development brings new biological factors into play. The density of science underlying this phenomenon compelled a shift towards intersex as the primary focus of the visualization.

Now that my task was clear, I set about assembling the content of the graphic and putting it down on paper. In part, this process clarified how much I could include, as the complete list of known DSDs and their various manifestations proved unwieldy for a single spread in a print magazine. I ended up with a visual outline of sorts depicting a diverse selection of conditions and their convoluted pathways of development over time. Although not an especially pretty sketch, it captured the sense of intricacy the topic demanded.

Visual outline

Next I consulted with Dr. Amy Winsiewski, a DSD specialist at the University of Oklahoma, who was kind enough to review the content of my sketch for accuracy. And finally, I called upon the visualization experts at Pitch Interactive to help bring the project to life.

[caption id="attachment_2328558" align="aligncenter" width="600"] Sketch

Once the aesthetic of the graphic had been established, I continued to refine both the text and design elements, guided by feedback from my colleagues who helped identify areas that were unclear or difficult to follow.

The finished print graphic

Detail of the finished print graphic

The resulting visualization is a source of pride for me, as I hope it is for everyone who contributed to its development. (You can see a larger version here in the September digital issue.) Design and visual communication feats aside, I believe the content itself is of critical importance from a social and policy perspective.

DSDs—which, broadly defined, may affect about one percent of the population—represent a robust, evidence-based argument to reject rigid assignations of sex and gender. Certain recent developments, such as the Swedish adoption of a gender-neutral singular pronoun, and the growing call to stop medically unnecessary surgeries on intersex babies, indicate a shift in the right direction. I am hopeful that raising public awareness of intersex, along with transgender and non-binary identities, will help align policies more closely with scientific reality, and by extension, social justice.

Complete Article HERE!

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‘Why won’t you have sex with me?’ A real look at disability and relationships

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Louise Bruton’s Dublin Fringe Festival show examines our ignorance and prejudices, and takes a real look at disability, sex and relationships

Louise Bruton: ‘We all have our dry spells. We all get heartbroken . . . all the emotional things, they’re all similar to everybody else.’

Louise Bruton is on her way to buy Buckfast ahead of a visit to a friend’s festival on Inishturk island. Standard. Bruton is a writer and journalist who rose to prominence with her website Legless In Dublin (leglessindublin.com) detailing accessibility issues and reviews of venues and events. As a wheelchair user, she has managed to harness a way of communicating that undercuts preconceptions, prejudices and presumptions.

Bruton is blunt and hilarious. A pinned tweet on her Twitter account is a series of photos of her hugging and dancing with Grace Jones.

But there are also rage-inducing snippets of the reality of being a wheelchair user. Sample line: “Last one on the train in Heuston. Not a staff member or ramp in sight. Doors have been closed again. Guess I live here now.” Hard to stomach, but so necessary. Bruton calls this ridiculousness out.

It’s a meditation on disability, sex, relationships, and the misconceptions of non-disabled people hold about the sex lives of disabled people

Her latest project is a show for the Dublin Fringe Festival, excellently titled Why Won’t You Have Sex With Me?, which plays September 8th-11th at the Project Arts Centre in Temple Bar, Dublin. It’s a meditation on disability, sex, relationships, and the misconceptions of non-disabled people hold about the sex lives of disabled people.

In the show, she’ll talk to the audience – “there will be a lot of interaction with visuals” – and it will also deal with sex and relationships in general.

Bruton hopes that people might leave the show checking themselves a little, wondering if they’ve ever been that person who has figuratively (or literally) “patted someone on the head, or spoken about them in front of them.”

The Fringe show is also inspired by how the media attempts to tap into the “issue” of sex and disability.

A while ago, after the Guardian ran a piece about disabled people and sex – something Bruton identifies as an “evergreen”, annual story – a couple of journalists from Irish outlets contacted her asking if she would be up for discussing the “stigma” associated with having sex with a disabled person.

We all have our dry spells. We all get heartbroken . . . all the emotional things, they’re all similar to everybody else

“That came in as a very loaded question,” Bruton says, “assuming that there is a stigma. And if there is a stigma, I’m unaware of it. I think it’s pretty unfair to blame anything going on in your love life purely on the fact of a disability. I think that kind of erases everything else about you.”

Bruton sees that story as just another entry point for discussing other people’s relationships and sex lives. Those kinds of articles, she thinks, feel like they use disability as leverage for voyeurism, “I just think it’s a really lazy way to be kind of a pervert about it!”

“We all go through the feast or famine spells when it comes to sex and dating. That’s something that applies to everyone. In the week those journalists contacted me – what if I was going through the famine time? Do I tell them that? ‘Nothing’s happening for me right now, I’m in the famine stages!’ It’s challenging that, pointing out how ridiculous those articles are. They’re done on an annual basis. There’s no evidence to support that our love lives are any different just because we’re disabled.”

“The way this is framed in the media,” Bruton says, “is that if you’re disabled and you’re not having sex, you’re going to die alone, and if you’re disabled and you are having sex, then you’re some sort of a freak or a fetishist.

“You’re put in these two categories, whereas I’m like ‘we’re the same as everybody else’. We all have our dry spells. We all get heartbroken . . . all the emotional things, they’re all similar to everybody else. The elements that do make it different or difficult, have been created by non-disabled people.

“That is the physical structure of society, where we don’t get into every single pub with everybody else in it, or nightclubs that everybody else is in. There’s also the fact that non-disabled people have a very wrong and archaic view of disabled people. They’re looking at us as if we’re completely different, whereas we go through the exact emotions as everybody else.”

Bruton is the type of person who is up the front at gigs, and when she arrives at parties, the energy in the room fizzes. Her busy social life creates the opportunity for a lot of encounters.

“People will come up to me anyway, because I’m in a wheelchair, and they’ll be like, ‘what happened you?’ And I don’t really want to go into my entire personal history and tell them, because it’s none of their business. I know a lot of my male friends who are in wheelchairs, a lot of people come up to them and very specifically ask them does their penis work.

There’s a manipulative attitude that people have towards disabled people

“I didn’t realise how bad it was for guys. That’s just not what you ask anybody. That is such a juvenile thing, firstly, and it’s just really rude as well.

“It seems to be that men are put on the spot in a much more invasive way,” she says. “People I know who are disabled and are in relationships, they have mentioned times where they’ve felt unsure if their partner is comfortable with them being disabled, and that has gone on for years.”

Bruton says that there seems to be a general feeling that disabled people “should ‘take what you can get’” when it comes to sex and relationships.

“There’s a manipulative attitude that people have towards disabled people – ‘you’re lucky to be getting anyone at all’ – and if you’ve any relationship issues, it’s like ‘you should be glad they’re going out with you’. It might create this fear that they [disabled people] mightn’t have many options so they might have to ‘settle’. Nobody should ever feel that settling is an option.”

A non-disabled person Bruton interviewed as research for the show said that if they ended a relationship with a disabled person, they would be afraid it would be because of the disability, and not a personality clash. “There’s a lot of double takes going on in people’s minds,” Bruton says, “you really are questioning how things are being perceived by other people.”

The superficiality of online dating causes issues, Bruton says. “Because the way that dating has changed – because online dating is such a big part of it now – there is a superficial element to dating now more than ever. You’re basing things on three photos and one sentence that describes your entire life.

“I’m hesitant in the online world . . . I don’t shy away from having my wheelchair in photos. The guys are immediately like ‘why are you in a wheelchair? What happened you?’ There’s no way to brush that off politely. I’ve tried.

“In real life you can say ‘oh I’ll tell you another time!’, but in a message on your phone, they find that rude, or don’t know what to say next.”

If you’re so concerned with taking advantage of someone with a disability, you should be concerned about taking advantage of all other people

As part of the making of the show, Bruton interviewed non-disabled people about disabled people, sex and dating. One word kept repeating. “The word ‘vulnerable’ came up a lot,” Bruton explains. “This is mostly men who said this. Men felt that if they were to date or have sex with a woman with a disability or a man with a disability, they would somehow be taking advantage of a vulnerable person.

“So that goes back to that old-fashioned idea of disability that we weren’t in the same schools, we were sent away to homes to live and be looked after. That idea stuck with people…

“We’re no more vulnerable than the next person. Of course there are different levels to disability. But generally, if you’re so concerned with taking advantage of someone with a disability, you should be concerned about taking advantage of all other people. There’s a lot of hypocrisy with it.”

Something that has been said to Bruton has been the idea that, “‘it takes a very special person to go out with someone who has a disability’.

“The way I interpret that, is that means you have to be a carer almost, instead of being a boyfriend or a girlfriend. I think that’s at the back of people’s minds – they think they’re going to have to look after the person, rather than just spending time with them.”

I think a lot of people see relationships as a status thing

Regarding her own experiences, a not exactly infrequent one is strangers inviting themselves to discuss aspects of her personal life with her – asking if a friend is a boyfriend, or manufacturing a love story out of nowhere. “A lot of people go straight into asking if you’re in a relationship. I think a lot of people see relationships as a status thing, that you can only be truly accepted if you’re loved in that way.”

When Bruton was on crutches before using a wheelchair, she sometimes experienced guys freaking out and backing away when they realised she didn’t just have a sprained ankle or a sports injury. “Maybe they thought I was lying to them or something. Like I was tricking them. That was the vibe I got, that I had lied to them to get their attention.”

At this point, she realises there is an advantage to being able to identify such shallowness from the get-go. It’s like an extra layer of insight to character judgement that non-disabled people may not have, “It’s a really key indicator. Someone else, it could take them a few months to find out if they’re an asshole or not, but I can find out in a second.”

Complete Article HERE!

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Sex Education Based on Abstinence? There’s a Real Absence of Evidence

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Sex education has long occupied an ideological fault line in American life. Religious conservatives worry that teaching teenagers about birth control will encourage premarital sex. Liberals argue that failing to teach about it ensures more unwanted pregnancies and sexually transmitted diseases. So it was a welcome development when, a few years ago, Congress began to shift funding for sex education to focus on evidence-based outcomes, letting effectiveness determine which programs would get money.

But a recent move by the Trump administration seems set to undo this progress.

Federal support for abstinence-until-marriage programs had increased sharply under the administration of George W. Bush, and focus on it continued at a state and local level after he left office. From 2000 until 2014, the percentage of schools that required education in human sexuality fell to 48 percent from 67 percent. By 2014, half of middle schools and more than three-quarters of high schools were focusing on abstinence. Only a quarter of middle schools and three-fifths of high schools taught about birth control. In 1995, 81 percent of boys and 87 percent of girls reported learning of birth control in school.

Sex education focused on an abstinence-only approach fails in a number of ways.

First, it’s increasingly impractical. Trying to persuade people to remain abstinent until they are married is only getting harder because of social trends. The median age of Americans when they first have sex in the United States is now just under 18 years for women and just over 18 years for men. The median age of first marriage is much higher, at 26.5 years for women and 29.8 for men. This gap has increased significantly over time, and with it the prevalence of premarital sex.

Second, the evidence isn’t there that abstinence-only education affects outcomes. In 2007, a number of studies reviewed the efficacy of sexual education. The first was a systematic review conducted by the National Campaign to Prevent Teen and Unplanned Pregnancy. It found no good evidence to support the idea that such programs delayed the age of first sexual intercourse or reduced the number of partners an adolescent might have.

The second was a Cochrane meta-analysis that looked at studies of 13 abstinence-only programs together and found that they showed no effect on these factors, or on the use of protection like condoms. A third was published by Mathematica, a nonpartisan research organization, and it, too, found that abstinence programs had no effect on sexual abstinence for youth.

In 2010, Congress created the Teen Pregnancy Prevention Program, with a mandate to fund age-appropriate and evidence-based programs. Communities could apply for funding to put in only approved evidence-based teen pregnancy prevention programs, or evaluate promising and innovative new approaches. The government chose Mathematica to determine independently which programs were evidence-based, and the list is updated with new and evolving data.

Of the many programs some groups promote as being abstinence-based, Mathematica has confirmed four as having evidence of being successful. Healthy Futures and Positive Potential had one study each showing mixed results in reducing sexual activity. Heritage Keepers and Promoting Health Among Teens (PHAT) had one study each showing positive results in reducing sexual activity.

But it’s important to note that there’s no evidence to support that these abstinence-based programs influence other important metrics: the number of sexual partners an adolescent might have, the use of contraceptives, the chance of contracting a sexually transmitted infection or even becoming pregnant. There are many more comprehensive programs (beyond the abstinence-only approach) on the Teen Pregnancy Prevention Program’s list that have been shown to affect these other aspects of sexual health.

Since the program began, the teenage birthrate has dropped more than 40 percent. It’s at a record low in the United States, and it has declined faster since then than in any other comparable period. Many believe that increased use of effective contraception is the primary reason for this decline; contraception, of course, is not part of abstinence-only education.

There have been further reviews since 2007. In 2012, the Centers for Disease Control and Prevention conducted two meta-analyses: one on 23 abstinence programs and the other on 66 comprehensive sexual education programs. The comprehensive programs reduced sexual activity, the number of sex partners, the frequency of unprotected sexual activity, and sexually transmitted infections. They also increased the use of protection (condoms and/or hormonal contraception). The review of abstinence programs showed a reduction only in sexual activity, but the findings were inconsistent and that significance disappeared when you looked at the stronger study designs (randomized controlled trials).

This year, researchers published a systematic review of systematic reviews (there have been so many), summarizing 224 randomized controlled trials. They found that comprehensive sex education improved knowledge, attitudes, behaviors and outcomes. Abstinence-only programs did not.

Considering all this accumulating evidence, it was an unexpected setback when the Trump administration recently canceled funding for 81 projects that are part of the Teen Pregnancy Prevention Program, saying grants would end in June 2018, two years early — a decision made without consulting Congress.

Those 81 projects showed promise and could provide us with more data. It’s likely that all the work spent investigating what is effective and what isn’t will be lost. The money already invested would be wasted as well.

The move is bad news in other ways, too. The program represented a shift in thinking by the federal government, away from an ideological approach and toward an evidence-based one but allowing for a variety of methods — even abstinence-only — to coexist.

The Society of Adolescent Health and Medicine has just released an updated evidence report and position paper on this topic. It argues that many universally accepted documents, as well as international human rights treaties, “provide that all people have the right to ‘seek, receive and impart information and ideas of all kinds,’ including information about their health.” The society argues that access to sexual health information “is a basic human right and is essential to realizing the human right to the highest attainable standard of health.” It says that abstinence-only-until-marriage education is unethical.

Instead of debating over the curriculum of sexual education, we should be looking at the outcomes. What’s important are further decreases in teenage pregnancy and in sexually transmitted infections. We’d also like to see adolescents making more responsible decisions about their sexual health and their sexual behavior.

Abstinence as a goal is more important than abstinence as a teaching point. By the metrics listed above, comprehensive sexual health programs are more effective.

Whether for ethical reasons, for evidence-based reasons or for practical ones, continuing to demand that adolescents be taught solely abstinence-until-marriage seems like an ideologically driven mission that will fail to accomplish its goals.

Complete Article HERE!

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4 things we really need to stop saying (and believing) about depression and sex

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It’s time to change your mind

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I always say that sex and depression is the intersection of two taboo topics.

It’s especially hard to talk about the two together because, frankly, it can be hard to talk about either topic separately.

Today, we’re going to look at some commonly held (and oft-repeated) beliefs that really need to be retired in the name of destroying the stigma around these important topics.

Also, they are just not true.

Depression is hard enough to cope with on its own. Don’t make it worse by piling on unfair, untrue cliches. Know the truth about sex and depression and help end the stigma.

Depressed people don’t want to have sex anyway

In 2014, I launched a survey on the impact of depression and its treatment on sexual function and relationships.

A total of 1,100 people took that survey.

In 2015, I started interviewing participants and only then did I spot the massive flaw in my survey: it only allowed for people to give responses about decreased libido.

When I conducted a second round of interviews in 2016 I asked, ‘Did depression impact your sex life? If so, how?’ and more than 29% of the respondents reported increased sexual activity during depressive episodes.

Don’t stick it in the crazy

Stop with this. It’s ableist and frankly it’s ridiculous.

Depression is not an STI and we don’t need to quarantine all the people with depression so they don’t sexually infect you.

Certainly you get to choose who you do and do not engage in sexual activity with, but reciting a (not at all clever) catchphrase, that is based in nothing, about dismissing an entire group of people just helps further stigma and makes people feel like they need to hide their own mental illness struggles.

Sex isn’t important enough to worry about when you’re fighting depression

A scenario that came up over and over in my research was patients being dismissed by doctors or the other people in their lives when they objected to sexual side effects because sex isn’t important enough to worry about ‘at a time like this’.

In some cases, the respondents believed it – ‘I didn’t worry about sex because there were more important things to worry about!’

Listen, yes, sometimes depression treatment is a fight to stay alive and we do whatever it takes, other times, it’s about maintenance and we are allowed to want more than just survival.

People with depression are allowed to want to actually live, and for a lot of people that includes sex.

You have to love yourself first before you can love anyone else

A lot of people will never love themselves.

When we tell people they are ineligible for love until they have hit this self-love goal (I know no one who has done this), what we are really doing is telling them that they have to be a better person in order to be loved.

Another variation on this is, ‘you have to get yourself together first’.

These are all nonsense, and the domain of people who want others to believe that relationships shouldn’t involve any baggage.

Everyone’s got baggage. You don’t need to pretend yours isn’t there to be loveable.

Complete Article HERE!

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Young entrepreneurs launch a handy online guide to all things sex

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A team of millennial entrepreneurs have pulled together a ‘BuzzFeed of sex ed’. About time too.

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Fumble describes itself as a ‘handy guide to sex’ (pun intended). It offers curious teens social content like blogs, videos, games, galleries and quizzes.

The team behind Fumble say it responds to the lack of engaging digital platforms for good quality sex and relationships content for young people. They work with Brook, a leading sexual health charity, to make sure all the content is top notch.

It sets out to answer all the questions on sex, relationships, identity and bodies that young people are asking the internet during puberty, and is aimed at anyone under 20 (boys and girls alike).

The Fumble gang say their lightbulb moment for the project came from being some of the first to grow up with the internet, and being very aware of the challenges that poses for young people.

They explain that nearly every teen as young as 14 has accessed online porn, according to the NSPCC, and many teenagers say they’re using this content (at least in part) because they’re not getting answers to questions about sex, relationship and intimacy elsewhere.

Young people definitely need a hand: a whopping half of teen girls don’t know what’s happening when they first start their period and teachers describe sexting as fast becoming an ‘epidemic’ on primary school playgrounds.

‘Young people turn to the internet with questions, and the internet responds with a whole load of unhealthy content,’ co-founder Emily Burt explains.

‘We want to redress the balance, and offer an alternative (and excellent) voice in the digital landscape.’

The site launched a few months ago and it’s pulling in thousands of pageviews.

The team is currently running a crowdfunder to get the project up and running properly, and keen supporters of the idea have donated over two grand already.

Fumble is running a social campaign alongside, asking people to share any horror stories from their sex and relationships education (SRE) in school, along with the hashtag #WhyIFumble.

Fancy a Fumble? Seems like a great idea.

Complete Article HERE!

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