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Why Sex Education for Disabled People Is So Important

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“Just because a person has a disability does not mean they don’t still have the same hormones and sexual desires as other individuals.”

 

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“Sex and disability, disability and sex; the two words may seem incompatible,” Michael A. Rembis wrote in his 2009 paper on the social model of disabled sexuality. Though roughly 15% of adults around the world (that’s nearly one billion people), and over 20 million adults in the U.S. between the ages of 18 and 64 have a disability, when it comes to disability and sex, there’s a disconnect. People with disabilities often have rich and satisfying sex lives. So why are they frequently treated as though they are incapable of having sexual needs and desires, and are excluded from sexual health education curriculum?

According to Kehau Gunderson, the lead trainer and senior health educator at Health Connected, a non-profit organization dedicated to providing comprehensive sexual health education programs throughout the state of California, the sexual health and safety of students with disabilities is often not prioritized because educators are more focused on other aspects of the students’ well-being. “Educators are thinking more about these students’ physical needs. They don’t see them as being sexual people with sexual needs and desires. They don’t see them as wanting relationships,” Gunderson told me when I met her and the rest of the Health Connected team at their office in Redwood City, California.

When I asked why students with disabilities have historically been excluded from sexual education, Jennifer Rogers, who also works as a health education specialist at Health Connected, chimed in. “In general, the topic of sex is something that is challenging for a lot of people to talk about. I think that aspect compounded with someone with specialized learning needs can be even more challenging if you’re not a teacher who’s really comfortable delivering this kind of material,” she said.

But it was the third health education specialist I spoke with, DeAnna Quan, who really hit the nail on the head: “I think sometimes it also has to do with not having the materials and having trouble adapting the materials as well. While people often just don’t see disabled people as being sexual beings, they are. And this is a population who really needs this information.”

The complete lack of sexual education in many schools for students with disabilities is particularly alarming given the fact that individuals with disabilities are at a much higher risk of sexual assault and abuse. In fact, children with disabilities are up to four times more likely to face abuse and women with disabilities are nearly 40% more likely to face abuse in adulthood. Yet students in special education classes are often denied the option to participate in sex education at all. When these students are included in mainstream health courses, the curriculum is often inaccessible.

Disability activist Anne Finger wrote, “Sexuality is often the source of our deepest pain. It’s easier for us to talk about and formulate strategies for changing discrimination in employment, education, and housing than to talk about our exclusion from sexuality and reproduction.” But as Robert McRuer wrote in Disabling Sex: Notes for a Crip Theory of Sexuality, “What if disability were sexy? And what if disabled people were understood to be both subjects and objects of a multiplicity of erotic desires and practices, both within and outside the parameters of heteronormative sexuality?”

When it comes to disability and sexuality, a large part of the issue lies in the fact that disabled people are so infrequently included in the decisions made about their bodies, their education, and their care. So what do people with disabilities wish they had learned in sex ed? This is what students and adults with disabilities said about their experience in sexual health courses and what they wish they had learned.

People with disabilities are not automatically asexual.

“The idea of people with disabilities as asexual beings who have no need for love, sex, or romantic relationships is ridiculous. However, it is one that has a stronghold in most people’s minds,” wrote disability activist Nidhi Goyal in her article, “Why Should Disability Spell the End of Romance?” That may be because disabled people are often seen as being innocent and childlike, one disabled activist said.

“As a society, we don’t talk about sex enough from a pleasure-based perspective. So much is focused on fertility and reproduction — and that’s not always something abled people think disabled people should or can do. We’re infantilized, stripped of our sexuality, and presumed to be non-sexual beings. Plenty of us are asexual, but plenty of us are very sexual as well, like me. Like anyone of any ability, we hit every spot on the spectrum from straight to gay, cis to trans, sexual to asexual, romantic to aromantic, and more.” Kirsten Schultz, a 29-year-old disabled, genderqueer, and pansexual health activist, sexuality educator, and writer, said via email.

Kirsten, who due to numerous chronic illnesses has lived with disability since she was five years old, was not exposed to information regarding her sexual health and bodily autonomy. “I dealt with sexual abuse from another child right after I fell ill, and this continued for years. I bring this up because my mother didn’t share a lot of sex ed stuff with me at home because of illness. This infantilization is not uncommon in the disability world, especially for kids,” she said.

Growing up in Oregon, Kirsten said she was homeschooled until the age of 13 and didn’t begin seeing medical professionals regularly until she turned 21. “This means all sexual education I learned until 13 was on my own, and from 13 to 21, it was all stuff I either sought out or was taught in school.” Schultz explained. But even what she learned about sex in school was limited. “School-based education, even in the liberal state of Oregon, where I grew up, was focused on sharing the potential negatives of sex — STIs, pregnancy, etc. Almost none of it was pleasure-based and it wasn’t accessible. Up until I was in college, the few positions I tried were all things I had seen in porn…AKA they weren’t comfortable or effective for me,” she added.

Internet safety matters, too.

While many disabled people are infantilized, others are often oversexualized. K Wheeler, a 21-year-old senior at the University of Washington, was only 12 the first time their photos were stolen off of the Internet and posted on websites fetishizing amputees. K, who was born with congenital amputation and identifies as demisexual, panromantic, and disabled, thinks this is something students with disabilities need to know about. “There’s a whole side of the Internet where people will seek out people with disabilities, friend them on Facebook, steal their photos, and use them on websites,” she said.

These groups of people who fetishize amputees are known as “amputee devotees.” K had heard of this fetish thanks to prior education from her mother, but not everyone knows how to keep themselves safe on the Internet. “This is something that people with disabilities need to know, that a person without a disability might not think of, ” K said.

K also believes more general Internet privacy information should also be discussed in sex ed courses. “In the technological age that we’re in, I feel like Internet privacy should be talked about,” they said. This includes things like consent and sending naked photos with a significant other if you’re under 18. “That is technically a crime. It’s not just parents saying ‘don’t do it because we don’t want you to.’ One or both of you could get in trouble legally,” K added.

Understanding what kinds of sexual protection to use.

Isaac Thomas, a 21-year-old student at Valencia College in Orlando, lives with a visual impairment and went to a high school that he said didn’t even offer sexual education courses. “I did go to a school for students with disabilities and, unfortunately, during my entire time there, there was never any type of sexual education class,” he said.

And Isaac noted that sexual awareness plays a large role in protection. “They should understand that just because a person has a disability, does not mean they don’t still have the same hormones and sexual desires as other individuals. It’s even more important that they teach sex education to people that have disabilities so they’re not taken advantage of in any kind of sexual way. If anything, it should be taught even more among the disabled community. Ignoring this problem will not make it go away. If this problem is not addressed, it will increase,” Isaac said.

Before entering college, Isaac said he wishes he had received more information about condoms. “I wish I had learned what types of condoms are best for protection. I should’ve also learned the best type of contraceptive pills to have in case unplanned sexual activity happens with friends or coworkers.”

Body image matters.

Nicole Tencic, a 23-year-old senior at Molloy College in New York, who is disabled, fine-motor challenged, and hearing impaired, believes in the importance of exploring and promoting positive body image for all bodies. Nicole, who became disabled at the age of six after undergoing high-dose chemotherapy, struggled to accept herself and her disability. “I became disabled when I was old enough to distinguish that something was wrong. I was very self-conscience. Accepting my disability was hard for me and emotionally disturbing,” she shared. “I was always concerned about what other people thought of me, and I was always very shy and quiet.”

It was when she entered college that Nicole really came to accept her body, embrace her sexuality, and develop an interest in dating. “I had my first boyfriend at 21. The reason I waited so long to date is because I needed to accept myself and my differences before I cared for anyone else. I couldn’t allow myself to bring someone into my life if I was unaccepting of myself, and if I did, I would be selfish because I would be more concerned about myself,” Nicole said. She also recognized the fact that while sexuality and disability are separate topics that need to be addressed differently, they can impact each other. “Disability may influence sexuality in terms of what you like and dislike, and can and cannot do,” but overall, “one’s sexuality does not have to do with one’s disability,” she clarified.

It’s important to make sex ed inclusive to multi-marginalized populations.

Dominick Evans, a queer and transgender man living with Spinal Muscular Atrophy, various chronic health disabilities, and OCD, believes in the importance of sexual education stretching beyond the cisgender, heteronormative perspective. He also understands the dangers associated with being a member of a marginalized group. “The more marginalized you are, the less safe you are when it comes to sex,” he said in an email.

Dominick, who works as a filmmaker, writer, and media and entertainment advocate for the Center for Disability Rights, has even developed policy ideas related to increased inclusion for students with disabilities — especially LGBTQ students with disabilities. “These students are at higher risk of sexual assault and rape, STIs like HIV, unplanned pregnancies, and manipulation in sexual situations,” Dominick said. “Since disabled LGBTQIA students do not have access to sexual education, sometimes at all, let alone education that makes sense for their bodies and sexual orientation, it makes sense the rates for disabled people when it comes to sexual assault and STIs are so much higher.”

According to Dominick, the fact that many disabled students are denied access to sexual health curriculum is at the root of the problem. “When it comes to disparities in the numbers of sexual assault, rape, STIs, etc. for all disabled students, not having access to sexual education is part of the problem. We know this is specifically linked to lack of sex ed, which is why sex ed must begin addressing these disparities.”

So what does Dominick have in mind in terms of educational policies to help improve this issue? “The curriculum would highlight teaching students how to protect themselves from sexual abuse, STI and pregnancy prevention campaigns geared specifically at all disabled and LGBTQIA youth, ensuring IEPs (individualized education programs) cover sex ed inclusion strategies, access to information about sexuality and gender identity, and additional education to address disparities that affect disabled LGBTQIA students who are people of color.”

Understanding power dynamics and consent.

It’s important to understand the power dynamic that often exists between people with disabilities and their caretakers. Many people with disabilities rely on their caretakers to perform basic tasks, like getting ready in the morning. Women with disabilities are 40% more likely to experience intimate partner violence compared to non-disabled women. This includes sexual, emotional, financial, and physical abuse, as well as neglect. For this reason, women with disabilities are less likely to report their abusers.

“Sometimes they’re more likely to think ‘this is the only relationship I can get,’ so they’re more likely to stay in these abusive relationships or have less access to even pursue courses of action to get out of the relationship. Especially if there is dependence on their partner in some way,” said K.

Dominick agreed. “Many of us often grow up believing we may not even be able to have sexual relationships. We often grow up believing our bodies are disgusting and there is something wrong with them,” he said. “So, when someone, especially someone with some type of power over us like a teacher or caregiver, shows us sexual attention and we believe we don’t deserve anything better or will never have the opportunity for sex again, it is easy to see why some disabled people are able to be manipulated or harmed in sexual situations.”

Dominick said this ideology led to his first sexual experience. “I probably should not have been having sex because I lost [my virginity] believing I had to take whatever opportunities I received,” he said, before going on to acknowledge the falsehood in these assumptions. “I’ve had many other relationships since then, and my last partner, I’ve been with for 15 years.”

But when it comes to disability, consent can be tricky. Some disabilities make communication a challenge. The lack of sexual education for many developmentally disabled students means they often don’t understand the concept of consent.

People with disabilities are more at risk for sexual exploitation and abuse.

According to the United States Department of Health and Human Services, children with disabilities also face a much higher risk of abuse. In 2009, 11% of all child abuse victims had a behavioral, cognitive, or physical disability. In fact, when compared to non-disabled children, children with disabilities are twice as likely to be physically or sexually abused. Those living with developmental disabilities are anywhere from 4 to 10 times more likely to face abuse.

Deni Fraser, the assistant principal at the Lavelle School for the Blind, a school in New York City dedicated to teaching students with visual impairment and developmental disabilities, believes it’s important for all students to understand the importance of boundaries, both other people’s and their own. Many students at the school, who range in age from 2 to 21, also have co-morbid diagnoses, making the students’ needs varied.

“It’s important for our students to know that we want them to be safe at all times,” Fraser said. “Letting them know what’s appropriate touch, not only them touching others, but other people touching them; saying things to them; for people not taking advantage of them; knowing who is safe to talk to and who is safe to be in your personal space; if there’s anything going on with your body, who would be the appropriate person to talk to; not sharing private information — so what is privacy; and the importance of understanding safe strangers, like doctors, versus non-safe strangers.”

The portrayal of disabled bodies matters.

The media also plays a part in perpetuating the idea that individuals with disabilities do not have sex. Sexuality is often viewed as unnatural for individuals with disabilities, and many disabled students internalize that. “Even Tyrion Lannister, one of the most sexual disabled characters on television, usually has to pay for sex, and even he was horribly deceived the first time he had a sexual experience,” Dominick noted. “If the media is not even saying sex is normal or natural for disabled people, and sex education is not inclusive, then often disabled people are having to learn about and understand sex on their own,” he added.

Many students with disabilities also want to see their bodies reflected in sexual education materials. “Part of the curriculum at a lot of different schools includes showing some level of video,” K said. But including a person with a visible physical disability in these videos would go a long way in helping to shatter the stigma surrounding sex and disability, she said. According to K, this would help people understand that sex isn’t only for able-bodied people.

People with disabilities make up a large part of the population. They’re the one minority group any person can become a part of at any time. Therefore, incorporating disability-related information into sexual education curriculum not only benefits students who are already disabled, but it can help students who, at some point in their lives, will experience disability. Embracing an inclusive approach and keeping bias out of the classroom would help raise awareness, create empathy, and celebrate diversity. By listening to disabled voices, we can work toward a society that values inclusivity.

Complete Article HERE!

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8 Things Bisexual People Are Tired of Hearing

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It’s NOT a phase.

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It has been almost two years since I came out as bisexual, and I have never been happier. My bi identity is incredibly important to me and I can honestly say that I would not change my sexual orientation even if I did have the choice. As much as I love being bi, there are still rough days. Like all identities within the LGBTQ+ community, being bi comes with plenty of annoying misconceptions that I’d rather ignore, but still we have to talk about these misconceptions in order to spread awareness that they are not only inaccurate, but also hurtful. Here are 8 misconceptions that bisexuals are tired of hearing.

Being bisexual means that you are half gay and half straight.

I get that this probably seems very logical to a person who is not attracted to people of multiple gender identities, but this is just not correct. You can be half Polish and half Irish. You can be a half sibling. You cannot be half of one sexual orientation and half of another. That’s not how this works. Bisexuality is not a combination of two sexualities; someone who is bi is whole in their identity. Saying otherwise invalidates their sexuality. As Berly R., who is a college senior, tells Teen Vogue, “it’s frustrating that there always has to be a line to that heterosexuality. I am bisexual, meaning that I am 100% bisexual.”

You have straight sex when you’re with someone of the opposite gender and you have gay sex with someone of the same gender.

Um, no. Incorrect. This statement is insinuating that a bi person’s sexuality changes based on who they’re sleeping with. It doesn’t. While sexuality is fluid and could potentially change over time, it doesn’t suddenly change based on the gender of the person you are having sex with. I am bi when I sleep with a girl, a boy, someone who is agender, someone who is gender nonconforming, etc. This statement is also insinuating that there are two genders, which is incorrect. But I will address this in the next statement.

Bisexuality is not an inclusive sexual identity.

When people hear the prefix “bi,” they automatically assume it means that the person is only attracted to men and women. While that may have been the original definition of the sexual orientation, times have changed and people understand that there are more than two genders. Today, many people define bisexuality as being attracted to people of similar gender identities to theirs and gender identities that are different than theirs. There are many gender identities out there and a bi person can choose to date someone who identifies with any of them. “Those who say it’s not inclusive are stuck on an outdated definition”, college sophomore Catie P. tells Teen Vogue. If you want a quality definition of bisexuality, check out Robyn Ochs’ definition of the term. She is an amazing bi activist who knows what she is talking about.

People who are bisexual only identify that way because they are greedy.

I have never understood this misconception. I mean, yes, I’m sure there are plenty of greedy bisexuals out there. But, I am positive that there are also plenty of straight people who are greedy, too. The two are unrelated. The label we each choose to use to describe our attractions to people does not inherently dictate that we want to engage in more sex. Our label just describes the people we are attracted to; that’s it. But if bisexual people want to engage in more sex, that’s our choice too.

In itself, the term “greedy” is problematic. People can choose how much sex they have, and whether it’s more or less than other people doesn’t say anything about them. Having sex with people doesn’t make someone of any orientation “greedy.”

Bisexuals are more likely to cheat.

ANYONE can cheat on their significant other(s); straight people can, gay people can, pansexual people can. You get the picture. My attraction to people of multiple gender identities does not make me more likely to cheat. With that logic, then people who do not identify as bisexual would never cheat, because the decision to cheat on your partner(s) would boil down to being bi. Obviously that is not true because I know multiple people who are not bisexual and have cheated on their significant other. College sophomore Kate S. tells Teen Vogue that she especially hates this stereotype because “you get [hate] from both sides… Lesbians are worried you’ll cheat because you miss guys, and guys are thinking that they need to be twice as overprotective and controlling because both guys and girls could ‘steal’ you away.” You cheat because you make the choice to do so, end of story.

All bisexuals are into polyamorous relationships.

Nope, not even close. While there are many bisexuals who are involved or would be willing to be involved in a polyamorous relationship, there are also many bisexuals who do not wish to be in a polyamorous relationship. I am one of them. The type of relationship setting someone is looking for is not dictated by who they are attracted to.

You are only bisexual if you have dated all of the different gender identities you are attracted to.

No, no, no, and no. Just no. Is a person any less gay if they have never dated someone of the same gender? Is a person any less straight if they haven’t dated anyone at all? This statement is born out of ignorance, plain and simple. A person knows who they are attracted to, regardless of who they choose to date in the end. For example, I have been attracted to multiple nonbinary people over the years. It just so happens that I never had the opportunity to date any of them. I still knew I was attracted to them, I just didn’t act on that attraction.

Bisexuality is just a phase.

This misconception is often the most hurtful in comparison to the rest of the ones listed here. Telling someone that their sexual orientation is a phase is invalidating. I have no doubt that there are people who used “bisexual” as their label for a period of time in their life, before moving on to a different label. Still, that’s no less legitimate. For over a decade, I thought I was straight. It was the label I used until I found a different label that better explained the attractions I felt toward other people. As we grow and learn more about sexuality and gender, we are better able to identify exactly how we feel, and that’s OK.

Complete Article HERE!

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Adolescents with autism need access to better sex education

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Intimacy is part of being human. There are well-documented benefits to positive relationships, from emotional security to good mental health1. Those who want relationships and can’t develop them face low self-esteem, depression, loneliness and isolation from the wider society2.

For adolescents, learning how to navigate sex and sexuality can be a minefield. How do you figure out the nuances of sexuality without experience? How do you approach a potential partner? And once you do, how do you communicate with him or her?

This path is especially fraught for adolescents with autism. For example, people with autism tend to report higher levels of sexual abuse and sexual exploitation than their neurotypical peers3. And yet there is a gap between what these young people need and what schools provide. According to a 2012 study, adolescents with autism know less about sex than do their peers and have less access to sex education4.

My team of researchers and I are documenting the experiences of adolescents with autism in relation to sex, sexuality and their schools’ sex education requirements. Our research suggests schools should provide sex education tailored to the needs of young people with autism.

These classes should include both the standard fare — from human development to safe sex — and additional instruction on topics such as how teens can express themselves to their potential partners and how to decode innuendos and other language used to describe sex. This education is vital to ensure that these adolescents can approach relationships in a way that is safe, confident and healthy.

Role play:

One common misconception about individuals with autism is that they prefer to be alone. My research suggests this simply isn’t true.

In an ongoing study, for example, my team conducted interviews related to sex and relationships with 40 adults with autism. Only three expressed ambivalence about relationships, mostly due to worries about coping with the needs of another person. Nearly half of the respondents had not yet had a relationship but expressed a strong desire for one.

Despite the desire to form relationships, this group expressed limited knowledge about how they would meet someone or show their interest. They found the idea of going out to a pub or club frightening, and socializing with groups of people provoked high anxiety. Some of them expressed a disdain for small talk, and others admitted they had little idea of how to engage in general conversation. They also found the use of dating apps unappealing and said they thought there was an inherent danger in meeting strangers.

Sex education could help these individuals feel confident in approaching others using role-play. For example, they could use techniques created by the late Augusto Boal, a Brazilian theater director who created plays in which audiences could participate.

In the context of sex education, an actor would play the part of the individual with autism and re-create one of that person’s real-life experiences, such as trying to talk to someone new in a bar. The individual with autism would then give the actor new directions — such as “What if I offer to buy her a drink?” — allowing the person with autism to try out many approaches, and witness potential consequences, in a safe environment.

Advice network:

Although instructors may help with some aspects of communication, it’s profoundly difficult to teach someone how to read the intentions and desires of others. Most teenagers rely on peers to work through some of these social complexities.

Teens get feedback from their peers on how to interact, meet new people and gauge the appropriateness of a relationship. Teens with autism struggle with close relationships, but sex education classes could facilitate that learning.

Our research suggests that they desire this guidance. For example, one individual in our study commented that schools should provide students with the “skills on how to find the right sort of partner.” To accomplish this goal, a school could provide an advice network, including regular group meetings in which young people with autism share and reflect upon their experiences. Social networking could extend this support.

For most adolescents, peers also fill in gaps such as helping to define sexual slang. In our study, another participant commented that hearing “dirty talk” from other students made her feel left behind. She was also unsure how to decode the words she heard, and said her school should explain what people might say in a sexual context and what these terms mean. With this context, she could decide to get involved or not.

Moderated discussions in a peer network could help address such slang and provide a safe space for students to ask questions about unfamiliar words.

Different sexualities:

To be effective, sex education in schools must take into consideration that some individuals with autism do not conform to traditional sex roles. When we interviewed 40 young adults with autism as part of an ongoing study, we found that 20 percent identified as gay or bisexual — more than is reported in national surveys of the general population. Gender fluidity may also be more common in individuals with autism: In a study we conducted this year (but is not yet published), we found an unusually high incidence of autism and autism traits in individuals who identify as transsexual or non-binary.

Despite these high numbers, some people with autism find it hard to accept different sexualities. As one male participant explained: “I have a rigid way of seeing the world, and this prevented me from accepting my sexuality. I sort of denied it to myself because I have very concrete black-and-white thinking and it didn’t quite fit in.” This early inability to accept his sexuality and identify as a gay man led to severe depression and admittance to a psychiatric ward.

In some ways, people with autism may even fall outside the ever-expanding range of sexual identities we see today, such as gay, straight, bisexual, pansexual and asexual. For example, one of our participants explained that her wonderful relationship with another girl with autism often involved sitting together for up to 10 hours reading in silence, or spending hours discussing Greek history.

Autism represents a profoundly different way of seeing and being in the world, and individuals with autism often expend great mental and physical effort just trying to appear ‘normal.’ Sex education in school needs to move away from suggesting that people with autism should fit in, and instead explore alternatives to traditional types of romantic relationships.

Awareness gaps:

Our work also suggests that individuals with autism aren’t always aware that they are sexual beings. This lack of self-awareness manifests both in the sexual cues they give off and how they may be perceived by others.

For example, two participants in our study reported behavior that could be perceived as stalking, such as continually following strangers, although they didn’t indicate that they understood how this could seem threatening. One described it this way: “I literally just saw him on the street. And then pretty much just stalked him.”

Not having a sense of one’s own sexuality can be harmful in other ways. For example, individuals with autism are three times as likely to experience sexual exploitation as their peers5. In our study, participants spoke of times when they had been extremely vulnerable and open to abuse. One woman reported that others had gotten her drunk and encouraged her to have sex with girls even though she doesn’t identify as gay. In the interview, she did not appear to be aware that these incidents could be perceived as someone taking advantage of her.

Sex educators need to understand these gaps in awareness to build confidence in young people with autism and to protect them from harm and from unintentionally harming others. For example, young people with autism need to be aware of the law on issues such as stalking, which they themselves may not see as a problem. Their education needs to include lessons on the language of sex and draw distinctions between playful and threatening behavior. It also needs to address issues of abuse and signs that a relationship or encounter is abusive.

Research such as ours can offer insight into this area and provide the tools for effective sex education for people with autism. With the right support, adolescents with autism can feel more comfortable building relationships and exploring their sexuality. This support will help them develop healthy relationships and experience their benefits to well-being, self-esteem and happiness.

Complete Article HERE!

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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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What it’s like to talk to your doctor about sexual health when you’re bisexual

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There’s a misconception that bi people are just going through a phase — but what if our doctors believe it too?

“Are you sexually active?”

I’d been dreading this question since losing my virginity to a female friend a few weeks earlier, not long after my 16th birthday. Somehow, the harsh fluorescent lights in my doctor’s examination room made this query seem even more menacing.

“Yes,” I said, but there was an ellipsis in my voice. A hesitation. An unspoken “but . . . ”

“You’re using condoms, right? So you don’t get pregnant?” she prompted, and I didn’t know what to say, because we weren’t. We didn’t need to. It was the wrong question.

“Uh, I’m not having sex with a guy,” I managed to stammer.

My doctor peered at me over her wire-rim glasses, “Oh,” she replied.

There are a lot of things a teenager might be nervous to disclose to their doctor — a marijuana habit, some worrying mental health symptoms, a secret relationship their parents don’t know about. While we should all feel free to tell our doctors what’s really going on with us, it’s particularly egregious that so many of them are still in the dark about something so basic as sexual orientation, making these already-difficult situations even more challenging.

The day of my first difficult conversation about my sexual health, my doctor didn’t give me any medical advice on the sex I was having. She didn’t suggest my partner and I use dental dams or latex gloves. She didn’t suggest we get tested for sexually transmitted infections (STIs). She didn’t ask whether my partner was cis or trans. She didn’t ask what sexual orientation I identified as (bisexual, for the record). She didn’t even ask me if I had any questions for her. She just moved on to the next part of our checkup.

I didn’t recognize these as problems at the time; I was too young and nervous to question the approach of my all-knowing doctor. Everything I later learned about safer sex — with the other cis girl I was seeing at that time, and with other partners later on — I learned from the internet. And while the internet can be a great resource for such information, doctors should be a better one.

Bisexuals are told all the time — both implicitly and explicitly — that we’re not queer enough to align ourselves with queerness, or that we’re too queer to align ourselves with straightness. I still find it hard to push back against these stereotypes today, at 25.

These presumptions are particularly upsetting in medical situations, where many of us already feel nervous and unempowered and, for many queers, apprehensive. The medical system has oftentimes failed us and our queer foreparents: inequitable health care access due to poverty, doctors’ lack of knowledge about LGBT identities and sexuality and the pathologization of queerness are just a few examples.

Two years later, in a different relationship with a person of a different gender, I returned to my doctor. I was a girl on a mission.

“I’m seeing someone new and I’d like to get an IUD,” I told my doc, with all the bravery and resolve I could muster as a meek 18-year-old still coming to terms with her sexuality.

“I thought you were a lesbian?” she replied coolly, barely looking up from her computer screen.

“No, I’m bisexual,” I clarified, my voice only shaking a little.

Medically speaking, it shouldn’t actually matter what word(s) I use to define my sexual orientation; my doctor should want to know, instead, what sexual activities I am participating in. I could’ve been a lesbian having sex with a man (they do exist!). I could’ve been having sex with a trans woman or a nonbinary person who had the ability to get me pregnant. There was no reason for my doctor to assume I was a lesbian in the first place, nor that a risk of pregnancy during sex meant my existing sexual orientation was being challenged.

I was reminded of a story I had read online. An American photographer I followed, Brigid Marz, wrote on Flickr that she and her girlfriend went to a hospital to get treatment for her flu symptoms. A staff member asked Brigid if there was any chance she might be pregnant, and she laughed, indicated her girlfriend, and said no. She’d dated and had sex with men before, but not recently enough that she could be pregnant. Months later, she received a $700 medical bill, $300 of which was for a pregnancy test she’d neither authorized nor needed.

“I am so sick of being treated differently just because I have boobs,” she wrote, but I would argue she was treated differently because she is non-monosexual – she is neither completely straight nor completely gay. Our medical system seems to assume everyone is one or the other, sometimes even when we’re loudly asserting otherwise.

In the end, my doctor refused to prescribe me an IUD on the basis that I was “just casually dating” and should wait until I was “in a serious relationship” before committing to a long-term birth control method that reflected my relationship status. She prescribed me the pill instead — the hormonal content of which exacerbated my mental health conditions for years, something the non-hormonal copper IUD may not have done.

What rankled me was that I was in a serious relationship at the time. My doctor may have assumed my relationship was casual because I was now with a man and I was previously with a woman, or she may have simply thought I was too young for the IUD — but I think it was because of negative stereotypes about bisexual people.

Bi folks’ relationships and attractions are often written off as “just a phase” or “just for fun.” We’re told we don’t know what we really want or who we really like — or, worse, that we’re intentionally playing with partners’ hearts, never intending to pursue commitment or depth in our relationships.

In my experience, this is about as true for bisexual people as it is for straight or gay people — some folks are looking for serious relationships and some just aren’t — but this assumption weighs most heavily on bisexuals. Whether or not my doctor was consciously aware of the stereotypes she was affirming that day, it’s clear to me that my relationship would not have been written off as “casual” if I identified as straight or gay.

If I could go back and talk to myself when I was a shy and shaking 16-year-old in my doctor’s office, I’d tell her to advocate for herself. I’d tell her to ask the questions she wanted answered, and double-check the answers on Scarleteen later. I’d tell her it was okay if she didn’t even know what questions to ask.

I’d tell her to be unashamed of her burgeoning bisexual identity, because it’s nothing to feel shifty about. But mostly, I’d wish I didn’t have to tell her all these things. Her doctor shouldn’t have made her doubt all this in the first place.

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