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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!

Sex and parenthood for people with disabilities

By Kristin Linton

Do people with disabilities have sex? Should they marry and have children?

As part of a research project, Emily Hops, a graduate of CSU Channel Islands, and I interviewed eight college students with disabilities about their general experiences with intimacy and sexual health last spring.

Each student expressed his or her own internal struggle with whether or not they should bear children themselves.

One said, “Is it selfish to have a kid? Even if your kid doesn’t have a disability, are you putting that burden on that kid to one day take care of you because you have a disability?”

Some students shared stories about professionals, even teachers, who dissuaded them from developing intimate relationships with others.

Even though California passed the Healthy Youth Act of 2015, which mandates adapted sex education for students with disabilities, I wonder if we have fully embraced the sexual rights of people with disabilities — especially considering California’s dark past with something called the “eugenics movement.”

Eugenics is essentially selective breeding in order to increase the occurrence of desirable inherited characteristics. California was a leader in the eugenics movement, which resulted in the sexual sterilization of 20,000 people in the state between 1909 and 1979. Seventy percent of those sterilized without their consent had various disabilities, spanning from schizophrenia to a casual diagnosis of being “feeble-minded.”

With a total of 60,000 sterilizations across the U.S., California was responsible for a third of all the procedures. Castrations and tubal ligations were common procedures performed. Some even argue that the U.S. led the way for Nazi Germany’s mass use of sexual sterilizations during the Holocaust.

Along with sexual sterilization laws in the eugenics movement came laws prohibiting marriage between people with disabilities, with the assumption being that reproduction was the reason for marriage.

California passed an annulment law, which specifically stated physical or mental capacity and consent as reasons for deeming a marriage null and void.

While there were other reasons that a marriage could be annulled, physical and mental capacity as well as lack of consent were the only reasons that involved third parties, such as parents or physicians.

These third parties could argue that either the bride or groom was “physically incapable of entering into the marriage state” or “was of unsound mind” at the time of marriage, and the marriage could be annulled.

If third parties were aware of a couple with disabilities planning a marriage, those third parties could make an argument about the incapacity of the bride and/or groom before the marriage date and shut it down altogether. In the early 1900s, 28 percent of marriages were annulled on these grounds.

The law is still on the books. Although rarely enforced today, these reasons for annulment remain in the wording of California Family Code Section 2210.

Not only is marriage annulment due to disability still lawful, but our history of perceiving people with disabilities as “asexual” beings still lives on today.

My hope is that we can learn to appreciate all people with disabilities as sexual beings with full sexual citizenship in hopes that they themselves do not question their own rights as human beings.

Complete Article HERE!

If You’re Totally Clueless When It Comes to BDSM, This Video Clarifies a Lot

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Think of the things you might have learned about BDSM from Fifty Shades of Grey. OK, now forget pretty much all of that. While the books and movies got a few things right, there’s a lot more to the multifaceted world of BDSM that people should know (and try out, if they’re interested!).

BDSM is an umbrella term comprising the words describing the erotic practices of Bondage and Discipline (B and D), Domination and Submission (D and S), and Sadism and Masochism (S and M). Carvaka Sex Toys — creators of the informational and ultra-classy Butt Plugs 101 video — just released another instructional video that breaks down the basics of BDSM. Here’s what anyone interested in delving into the kinky world should know.

Words to know:

  • Bondage — The act of tying someone up. This is done to render the submissive or “sub” vulnerable to the desires and actions of the dominant.
  • Dom — The dominant partner.
  • Sub — The submissive partner.
  • Switch — Someone who switches between the roles of dominant and submissive.
  • Discipline — When the submissive obeys the commands of the dominant.
  • Sadism — Enjoying the act of inflicting pain.
  • Masochism — Enjoying the act of having pain inflicted on you (ex: flogging, spanking).
  • Safe word — A word that is decided upon before the session and is said when the sub wants the act to stop. A safe word is used in place of “stop” because the safe word is supposed to be something that wouldn’t come up naturally during a session, in order to ensure that the word, when spoken, is taken seriously and that the action is stopped.
  • Hard limit — An act that can’t be tolerated and that cannot be done. Doing the action may provoke the usage of the safe word and can also end the session/relationship.
  • Soft limit — An act that stresses a sub but that he or she can “take in moderation.”

And one of the most common questions: why do people enjoy bondage? Well, it’s pretty simple. It’s fun!

BDSM can be exciting and can even allow participants to feel like they are experiencing a new world. Many subs enjoy the feeling of security they get from being controlled, and oftentimes doms enjoy the feeling of power that comes along with being the one in control. BDSM may not be for everyone, but for many, it’s the perfect way to explore their sexuality and add excitement to their sex lives and relationships.

Complete Article HERE!

A new study quantifies straight women’s “orgasm gap”—and explains how to overcome it

By Leah Fessler

Ever faked an orgasm? Or just had orgasm-less sex? If you’re a woman—especially if you’re straight—your answer is probably “Ugh.” Followed by “Yes.”

Not reaching orgasm during sex is, obviously, a real bummer. Not only does it make the sex itself unfulfilling, but can lead to envy, annoyance, and regret. Thoughts like “Stop grinning you idiot, your moves were not like Jagger!” and “I didn’t ask him to go down on me…does that mean I’m not actually a feminist?” come to mind. It’s exhausting.

Traditional western culture hasn’t focused on female pleasure—society tells women not to embrace their sexuality, or ask for what they want. As a result many men (and women) don’t know what women like. Meanwhile, orgasming from penetrative sex alone is, for many women, really hard.

Many studies have shown that men, in general, have more orgasms than women—a concept known as the orgasm gap. But a new study published Feb. 17 in Archives of Sexual Behavior went beyond gender, exploring the orgasm gap between people of different sexualities in the US. The results don’t dismantle the orgasm gap, but they do alter it.

Among the approximately 52,600 people surveyed, 26,000 identified as heterosexual men; 450 as gay men; 550 as bisexual men; 24,00 as heterosexual women; 350 as lesbian women; and 1,100 as bisexual women. Notably, the vast majority of participants were white—meaning the sample size does not exactly represent the US population.

The researchers asked participants how often they reached orgasm during sex in the past month. They also asked how often participants gave and received oral sex, how they communicated about sex (including asking for what they want, praising their partner, giving and receiving feedback), and what sexual activities they tried (including new sexual positions, anal stimulation, using a vibrator, wearing lingerie, etc).

Men orgasmed more than women, and straight men orgasmed more than anyone else: 95% of the time. Gay men orgasmed 89% of the time, and bisexual men orgasmed 89% of the time. But hold the eye-roll: While straight and bisexual women orgasmed only 65% and 66% of the time, respectively, lesbian women orgasmed a solid 86% of the time.

These data suggest, contrary to unfounded biological and evolutionary explanations for women’s lower orgasmic potential, women actually can orgasm just as much as men. So, how do we crush the orgasm gap once and for all?

According to the study, the women who orgasmed most frequently in this study had a lot in common. They:

  • more frequently received oral sex
  • had sex for a longer duration of time
  • asked their partners for what they wanted
  • praised their partners
  • called and/or emailed to tease their partners about doing something sexual
  • wore sexy lingerie
  • tried new sexual positions
  • incorporated anal stimulation
  • acted out fantasies
  • incorporated sexy talk
  • expressed love during sex

And regardless of sexuality, the women most likely to have orgasmed in their last sexual encounter reported that particular encounter went beyond vaginal sex, incorporating deep kissing, manual genital stimulation, and/or oral sex.

The study’s authors noted that “lesbian women are in a better position to understand how different behaviors feel for their partner (e.g., stimulating the clitoris) and how these sensations build toward orgasm,” and that these women may be more likely to hold social norms of “equity in orgasm occurrence, including a ‘turn-taking’ culture.”

That might be true. But the study is pretty clear on the fact that anyone in a relationship of any kind can increase their partner’s orgasm frequency—and that it depends on caring about your partner’s pleasure enough to ask about what they want, enact those desires, and be receptive to feedback. Such communicative techniques—whether implemented by straight, gay, bisexual, or lesbian people—are what stimulate orgasm.

 Complete Article HERE!

4 Women Get Real About How Swinging Affected Their Relationships

What really happens when you open your relationship to another couple

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For some couples, the idea of having sex with anyone other than your significant other seems unfathomable. It can be hard to understand how “swinging” — when you swap partners with another couple and sleep with someone new — can actually lead to stronger relationship bonds. But believe it or not, it can, and there are more couples interested in doing it than you may realize.

If you’ve ever remotely considered getting into swinging — with your spouse, significant other or just that cool friend with benefits — there are a few things you should know before you dive in. Below, four women get real about what their own swinging experiences were really like.

Nicole has been with her husband for 18 years and they’ve been swinging for 17.

How she got into it: “I grew up with this idea that there’s not just one person for anyone and that we can enjoy being with multiple people, as well as the idea that you can have sex without having emotion tied to it. My husband knew that I was bi-curious when we met, so on the anniversary of our first date, we decided to explore and went to a swingers club.”

How it impacted her relationship: “It’s really helped strengthen our relationship. Not all experiences were 100 percent pleasurable, so we made an effort to have those conversations and keep the lines of communication open. When you talk about [swinging] it makes it so much easier to discuss other issues in the relationship.”

Her advice to those considering the lifestyle: “For couples who are considering it, we suggest that you better have a really good relationship starting out because it doesn’t fix broken relationships, it only breaks them up faster. Also, you need to have conversations with your spouse or partner before you go into it. Know your rules and limits before you get into a situation because you can’t really get upset with your partner if you didn’t talk about.”

Jody was introduced to swinging five years ago and is currently single. She loves her work as a sex coach and says if it weren’t for swinging, she wouldn’t be where she is now.

How she got into it: “I was introduced to swinging by my former husband, and not in a good way. One day he forgot to log off the computer and I looked at his browser. I saw some sites that I was not familiar with, but I was appalled by what a saw. Some time later, I confronted him about it. He explained to me what swinging was, but I furthered my knowledge by reading everything I could. I then told him that if he had just talked to me about it, it was something I could be open to.”

How it impacted her relationship: “[Swinging] honestly had no effect on our relationship, which ended for other reasons. Swinging changed me personally for the better. I have sexual confidence that I didn’t have before. I exclusively date swingers now because I meet a much better class of men. They really honor and respect women.”

Her advice to those considering swinging: “If your marriage is struggling, don’t do it. It will only make things worse. If you have a good marriage, dip your toes in the water. Attend a meet and greet or other event. The swinger couples I know have absolutely amazing marriages. For a single woman, you’ll meet the best men ever, but take it slow and make sure you take the usual dating precautions.”

Julia Allen, co-founder of StockingsVR, was 24 when she first walked into a swingers club and has now been swinging for 25 years.

How she got into it: “My boyfriend thought it would be fun to try. We didn’t do anything except dance and talk to some people the first night, but it was exciting and I couldn’t wait to go back. A few months later, on New Year’s Eve, we had a hotel room and invited a few people up. Well… Everyone came up. It was packed and before I knew it, everyone was having sex all around me. A lovely woman wanted to play with me and my boyfriend. I loved it. I loved watching him with her and having him watch me with her, and then both of us just getting lost in the whole experience. I loved the experience of being able to have sex outside of my relationship.”

How it impacted her relationship: “I’ve never been tempted to stray outside of my relationship by having an affair. Swinging takes care of all of my sex needs. I really feel that it strengthens every relationship. I don’t view sex as something that you only have with someone you love. Sex is recreational. I think every boyfriend I’ve had has felt the same way. Along the way, I started filming myself with various people and decided to take my swinging/exhibitionist/kinky lifestyle and make it full time. I guess you could say that swinging has enriched my relationships and also enriched my life.”

Her advice to those considering swinging: “Don’t feel pressure. Most people who are new to swinging don’t actually have sex. They like to watch. In a swingers club, no really does mean no. Many times, I’ve had men or women approach me and if I don’t feel like it, I just say no. You can explore any fantasy you have at a swingers club. I would suggest for first timers to try a larger club where there are lots of people. People who go to swingers clubs are normal people who you would never guess in a million years are swingers. About 90 percent of people who swing are married with kids and just want to try walking on the wild side together.”

Jessica Drake, an adult superstar and certified sex educator, has been swinging since before she was in the adult industry.

How she got into it: “Depending on the state of each relationship and my boundaries with different partners, I had different experiences. In the beginning, when I was younger, it felt awkward based on my inability to be assertive about my wants and needs. It felt more like that group sex stereotype that you might see on TV or in porn… and definitely more male pleasure-centered.”

How it impacted her relationship: “Sexual jealousy has never really been an issue for me, and as long as my needs are being met, I feel secure and aroused when I watch a partner enjoying someone else. I think one mistake some people make is assuming that swinging has only one meaning, but it’s something that is totally open to interpretation. Some of my most intimate, fulfilling encounters lately have been ‘soft swap’ — meaning I have sex with my primary partner, and have foreplay only with our ‘guests.’”

Her advice to those considering swinging: “If you want to start experimenting with swinging and swapping, you need to take a look at your sexual values and belief system. Compare it to the way your partner perceives things, and before you proceed, have an honest discussion. Overall, if you find yourself wanting to try this later on in life, go for it! It may reawaken you and give you a sexual second wind. It’s never too late. There are people of all ages, all body types, all colors, who come from a variety of backgrounds looking for like-minded people.”

 
Complete Article HERE!