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Sexual pain after cancer treatment an unspoken affliction for many women, UC Davis oncologist says

Sexual pain is a common, but unspoken, aftermath of women’s cancer treatment. Doctors can be reluctant and patients too embarrassed to discuss it.

But it’s an all-too-real aspect of cancer treatment for women, according to Dr. Vanessa Kennedy, a gynecological oncologist for the UC Davis Health System.

Dr. Vanessa Kennedy, assistant professor in gynecological oncology, UC Davis Health System, Sacramento.

Dr. Vanessa Kennedy, assistant professor in gynecological oncology, UC Davis Health System, Sacramento.

“Some patients are two to three years out of treatment and they’re dealing with sexual pain and no one’s talked about it. Patients hesitate to bring it up because it’s a sensitive issue,” said Kennedy, who recently discussed the problem in the journal Obstetrics & Gynecology. Her co-author, Dr. Deborah Coady of New York University Langone Medical Center in New York, is author of the book, “Healing Painful Sex: A Woman’s Guide to Confronting, Diagnosing and Treating Sexual Pain.”

Kennedy estimates that about 50 percent of female patients with cancer – of any type – experience some form of sexual pain, due to physical changes caused by surgery, chemotherapy and radiation. It can range from vaginal dryness caused by early menopause to anatomical changes that can make sex uncomfortable.

Some women feel guilty they’re even concerned about their sex lives, given what they’ve been through battling cancer. “There’s some guilt that they should just feel lucky to be alive and shouldn’t ask about these other things,” she said. But when sexual health is addressed, “They’re actually relieved to know they’re not alone.”

Twice a month on Fridays, Kennedy holds a regular clinic, seeing UC Davis patients who’ve been referred for post-cancer problems with sex. She works with patients on a number of interventions, including physical therapy, lubricants (even coconut or olive oil), vaginal dilators and couples counseling to re-establish intimacy.

Kennedy said doctors and medical students need to learn to be comfortable broaching the topic. “A lot of students and providers are still a little bit nervous asking about sex,” she said. “How do you get comfortable talking about these things? You just do it. It’s just like asking a patient about changes in appetite or changes in sleep. Sex is another thing (on the list). Get over it and ask about it.”

There’s a difference in how men and women cancer patients deal with sexual health, Kennedy contends. For men who’ve undergone prostate cancer treatment, there’s an emphasis on restoring their sexual function. For women, there’s often physical pain and a loss of intimacy, along with the added fear by some that their partners view them as less desirable. In some cases, where sex has become nonexistent, patients confide that their partners have threatened to leave or cheat on them.

Kennedy, who did fellowship training at the University of Chicago, which has a sexual health program for women cancer patients, says research on women’s sexual health issues is lagging, compared with that for men with prostate cancer. Next April, she’s hosting a national gathering of the Scientific Network on Female Sexual Health and Cancer, which promotes research and information for women patients and their providers.

“Sex is a quality-of-life issue and a core of our well-being,” Kennedy concludes. “We have to bring back the intimacy and make this a part of the body that’s associated with pleasure, rather than an uncomfortable, negative place.”

Complete Article HERE!

A graphic history of sex: ‘There is no gene that drives sexuality. All sexuality is learned’

Changes in sexuality over time have made the modern family what it is. What next? Homa Khaleeli asks the authors of a groundbreaking graphic guide, The Story of Sex

The Story of Sex … some images from the book. Illustration: Laetitia Coryn

The Story of Sex … some images from the book. Illustration: Laetitia Coryn

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Philip Larkin famously announced that sexual intercourse began in 1963 (“Between the end of the ‘Chatterley’ ban / And the Beatles’ first LP”). Being French, and a psychiatrist to boot, Philippe Brenot takes a rather longer view. In his latest book, The Story of Sex, a bestseller in France, he runs an anthropological eye over the sexual mores of human societies from prehistoric times to today. Yet Brenot believes that the sexual revolution did spark a dramatic change, creating the modern couple, which is the basis of our families today. Now, however, he thinks this partnership of equals is under assault from all sides.

The academic, who has the wonderful title of director of sexology at Paris Descartes University, has spent his life studying sexuality. The Story of Sex is an irreverent, graphic novel (in both senses), filled with fascinating – if alarming – history. Cleopatra used a vibrator filled with bees; the word “trousers” was considered to be positively pornographic in Victorian England. Illustrator Laetitia Coryn’s extremely cheeky, but never sordid, pictures liven up the page and keep the narrative zipping along. The book was a real collaboration, says Coryn, who says it was made easier by Brenot’s firm ideas – and the fact he liked her jokes.

The illustrator admits she hesitated slightly over collaborating on the book. “I told my publisher we have to be careful with the drawings and with the jokes – we have to be sensitive,” she says, because she wanted the book to have as wide an audience as possible. “I didn’t put any porn in it!” As a reader, however, the frankness of the pictures still shocked me (you, er, might not want to whip out the book on public transport or in the office).

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Philippe Brenot and Laeticia Cory.

Talking to Brenot over the phone (through charmingly accented English that becomes somewhat eccentric as he struggles with the complexities of his ideas) it’s impossible to escape the psychiatrist’s anxiety about our attitudes to love and intimacy today. We have never been freer to define our own relationships, and follow our own pleasure, he says, but despite this we are far from satisfied; and the modern couple is looking dangerously fragile.

“It’s incredible the difficulties couples have,” Brenot declares, in a tone that makes me imagine he is throwing his hands in the air in despair. Of the couples he sees in therapy, he says, “there is nothing wrong with them psychologically, but still they cannot communicate quietly, live calmly and have sexual fulfilment”.

While we think of lovers as a timeless relationship model, it has been the family that has been paramount in society for most of history, the 68-year-old says. “The couple used to get together for the sake of the family,” he explains. And the idea of equality in long-term pairings is even more recent, with “traditional” marriages putting men firmly in charge of their spouses.

“Love marriages have only been widespread for a century or so, and homosexuality was condemned until very recently,” Brenot notes.

“Since the 1970s, we have begun to invent modern couples with respect for each other and equality between the sexes,” he says. “This only came about after ‘marriage’ as a concept began dying out. Not because people stopped getting married, but because marriage stopped being seen as a sacred union – couples instead started developing on their own terms.”

Yet the rise in divorces since the 1970s and breakups of long-term relationships shows that the modern couple is not surviving, Brenot argues. In part, he says, this is because we are demanding more than ever before.

“It is difficult to live intimately, because we want perfect love and perfect sex and that is very difficult in a long-term relationship. We want a lot more than a reliable person to raise kids with.”

The solution, he says, is for us all to learn more about sex – which is where his book comes in. “It’s not possible to understand our intimate sex lives without looking at centuries of history, and even the origins of human life,” he says. “We understand what we live today if we understand from where we came.”

For instance, he says, if we look at the way relationships were formed in early human societies we can see echoes of our own problems. “We came from primates, but in chimp society there are never couples or families. There are lone males and females with children.” It was only as our brains evolved and emotions developed – including love – that monogamous relationships set in. For the first time (“somewhere between 1 million BC and 100,000BC”), it was possible to know the paternity of a child.

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While the beginning of family life may sound like a wonderful moment, Brenot argues that it was also the start of women’s subjugation, with men taking possession of their female partner and offspring – which traditional marriage legalised. “Paternity is the beginning of male domination,” says Brenot simply. “The day that happened, men took possession of women.”

In the animal kingdom, Brenot argues, there is none of the domination of female partners that has been a hallmark of human societies through history, nor is there domestic violence. Instead, among animals “males fight against other males and females fight with other females,” he says.

“Violence between men and women is only in humans – because of marriage, which puts men above women.”

During antiquity, meanwhile, a woman’s role was to provide a child – and female sexual pleasure was dismissed. But this role was also a dangerous one. “There were so many impediments to female pleasure. In the 18th and 19th centuries, one in six pregnant women died in childbirth. Then there were the infections and sexual violence.”

For men, of course, things were different. “Men have always done what they wanted,” says Brenot.

Even for men, sex for pleasure was something that happened “outside the home – for instance with prostitutes. Women were seen either to provide offspring or pleasure.” In ancient Rome, these rules were so strictly upheld that women could take their husbands to court for ejaculating anywhere but inside her body during intercourse, “because sex within marriage was for procreation, and the wife’s role was to receive sperm”.

Even during periods that today we think of as being golden ages for same-sex relationships, such pleasures were “reserved for the elite” – and the reality was often less accepting than we think. In ancient Greece, for instance, it was only the man who was “receiving” who was not stigmatised in a pairing. Similarly for the libertines in the 18th century, “there was a fluid sexuality, but it was also the top end of society – the intelligentsia and aristocracy. Throughout the centuries and the world’s rural populations, to be gay – or for women to have control of their own sexuality – has always been frowned upon.”

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Today too, Brenot argues, while much has been written about more people exploring fluid sexualities, entering polyamorous relationships and breaking down gender norms, “we shouldn’t make the mistake of thinking that this is trickling down to all sections of society”. And he warns too about a backlash from “new moralists” who oppose gay marriage, and will, no doubt, do the same for trans rights and alternative relationships as they gain more legal rights. Coryn says this is one of the reasons she enjoyed creating the book. “In France, people who don’t want gay people to be married, is a huge phenomenon. It’s awful. We say in the book this is a misunderstanding of sexuality; homosexuality is normal. I hope this is one topic on which people will change their mind in reading the book.”

For heterosexual couples, relationships began to look up about the time of the Renaissance and Enlightenment. Up until this period, “men were having fun outside the home – hunting animals or chasing women. While women were always at home,” says Brenot. But the new spirit of education and the pursuit of knowledge changed this. Finally, says Brenot, men and women could be friends and even have platonic love.

Yet it took contraception for men and women to gain a semblance of equality. Previously “women were immobilised by marriage. They can’t get out of it, they don’t have the possibility of working or being free. The story of sex is, first of all, the story of marriage and the difficulties [it creates] for women.”

To start combating the problems that these historical inequalities have left us with, the psychiatrist insists, we need better sexual education, and one that starts at an early age. “People think sexuality is just an instinct,” he says, “that it is natural like eating and drinking. No. There is no gene that drives sexuality. All sexuality is learned.”

Because of this, says Brenot, the models for our sexuality are very important. Today, talking about sex is still taboo, and the dissemination of pornography has filled the void. “People say pornography changes adolescent life. But it changes everyone’s sexuality,” he says. “We have sex differently now; we try to imitate what we see [on our screens]. People feel bad and say, ‘I can’t do what they do.’”

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To displace this dangerous model, “sexual education should teach the rules that should govern relationships; it should teach us about communication, about consent and respect. This is not natural [to us]. We have to learn this.”

Coryn says that while the Story of Sex is not a sexual education manual, “we wanted it to be uninhibited”, to make talking about sex seem as natural as it should be.

“From the time children are little girls and boys, we have to teach them that everyone should be respected and to start accepting difference,” says Brenot. But, he says, while men and women are equal, that does not mean that they are the same. Railing against the teaching of “gender studies” departments, he says that a refusal to admit this difference is allowing gender inequality to become entrenched.

“They say, ‘Don’t speak of differences – a man is the same as a woman. Society is guilty of making differences, but underneath we are the same.’”

Unpicking these ideas, he says, is the only way to combat our most pressing problems. For example, “physical strength is different from a very young age. So [children] need to understand boys are stronger and take that into account – because that is the start of domestic violence, which is a real problem.”

If we leave this teaching too late, he says, the battle is already lost: “In children’s fairy stories it is the boy who seduces the girl, so there is power play early on.” Then there is the fact men have always been free to have multiple partners throughout history, because men don’t get pregnant. It is only by introducing the idea early on that “contraception is a joint responsibility” that we can challenge this.

Today’s modern couple, he points out, faces new challenges from the rise in options for dating to “new forms of relationship,” says Brenot. Yet Coryn stresses, as does Brenot, that there has never been a better time for people to live in terms of sexuality. Yet one thing has not changed, says Brenot – everyone still wants to find somebody to love. “People are afraid to be alone at the end of their life. They are afraid not to find the perfect person to live with. It is a difficult problem for everyone today.

“We have to learn how to live together anew.”

Complete Article HERE!

Why Can’t I Orgasm During Sex? Chronic Pain And 5 Other Factors That Affect Ability To Climax

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Imagine this: You and your partner are getting hot and heavy in between the sheets. You’re feeling sexually aroused — but you’re unable to climax. In frustration you ask yourself: “Why can’t I orgasm during sex?”

The Kinsey Institute indicates 20 to 30 percent of women don’t have orgasms during intercourse, compared to only 5 percent of men who don’t climax every time they have sex. Men and women who are unable to sustain an erection or reach orgasm, respectively, are usually labeled as having some type of sexual dysfunction. However, the inability to orgasm could be triggered by several issues that range from physiological to psychological.

Below are six causes of why you have trouble orgasming during sex.

Tight Condoms

Condoms are often seen as an “evil” necessity that reduces sensitivity and sensations for men. The truth is condoms can inhibit male orgasm if they do not fit properly. A condom that is too tight can feel like the penis is in a chokehold, which can be distraction, and make it difficult to keep an erection. A 2015 study in journal Sexual Health found about 52 percent of men report losing an erection before, or while putting a condom on or after inserting into the vagina while wearing a condom.

Stress

High levels of stress impact your psychological and physiological health, which can interfere with the ability to orgasm. This makes it harder to concentrate on the sensation and relax during sex. Women with high salivary cortisol and stress levels have significantly less desire to masturbate or have sex with their partner.

Stress causes us to produce fewer sex hormones, like estrogen and testosterone, and more cortisol and stress hormones. When the body releases cortisol, a fight-or-flight response kicks in, and redirects the blood flow away from the sex organs, causing you to breathe shallowly.

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Depression

Depression affects your mood, and even the desire to have sex. A 2000 study in the American Family Physician found 70 percent of adults facing depression without treatment had problems with their sex drive. This is because sexual desire starts in the brain as sex organs rely on chemicals in the brain to jumpstart your libido, and change blood flow. Depression disrupts these brain chemicals, making sexual activity more difficult to initiate and enjoy.

Chronic Pain

More than 75 million people live  with persistent or debilitating pain, according to the national pain foundation, which can often lead to a low sex drive. Chronic pain sufferers find it difficult to feel pleasure during sex since the body hurts all the time. This is unfortunate since having an orgasm can alleviate some pains and aches.

Prescription Meds

Drugs tend to be among the most common causes of sexual problems. Prescription meds are responsible for as many as one of every four cases of sexual dysfunction. A 2002 study published in Family Practice found statins and fibrates (used in lowering LDL “bad” cholesterol) may cause erectile dysfunction, while later research has found both men and women taking statins showed increased difficulty achieving orgasm. The levels of sexual pleasure declined along with LDL cholesterol.

Negative Body Image

When you feel good about your body, you tend to feel better psychologically as well. The mind-body connection is imperative in sexual pleasure. For example, if you feel bad about your body, it;ll become more difficult to enjoy sex and have orgasms. A 2009 study in The Journal of Sexual Medicine found women between the ages 18 to 49 who scored high on a body image scale were the most sexually satisfied. Positive feelings associated with weight, physical condition, sexual attractiveness, and thoughts about our body during sex help promote healthy sexual functioning.

Complete Article HERE!

A BDSM Game That Lets Me Explore A New Type Of Sexual Experience

By Heather Alexandra

ladykiller

Ladykiller in a Bind is a visual novel by Christine Love. It’s about affection, sex, consent, manipulation, and expression. Video games can often be a vector for experimentation and escapism. Playing Ladykiller in a Bind has taught me a surprising amount about myself.

The core conceit of Ladykiller can feel a bit flimsy. You play as a woman impersonating her brother on a school cruise. There’s a contest going on; whoever gets the most votes will receive a heap of cash. This conflict ends up feeling largely secondary to the main interactions you have with many characters, which often focus more on sex and power dynamics.

There is a message at the title screen: “In real life, all power exchange must be negotiated. That is to say, there’s nothing more important than clearly communicating your desires and limits in advance, without either party feeling uncomfortable or pressured.

Mystic Messenger’s Jumin Han

Mystic Messenger’s Jumin Han

A focus on power dynamics is what makes me far more comfortable with Ladykiller in a Bind than my previous visual novel/otome game Mystic Messenger. While many of the routes in that game are tame, things escalate quickly during the route for Jumin Han. Jumin is a detached billionaire who gets very possessive once you start a relationship. At a later point in the route, he refuses to let you leave his apartment. You remain there for days.

In our discussion about the game, I mentioned my discomfort with this moment. My co-worker Cecilia D’Anastasio pointed out that some people might be into it. This is a completely fair point. Captivity and notions of ownership can be very powerful as a sexual fetish. Viewed in this light, Jumin functions as an incredibly commanding dominant.

The thing that made me uncomfortable with Jumin was my inability to approach the situation with nuance. My choices were to gleefully assent to his domination or largely equivocate and rationalize his possessiveness in a way that felt incredibly enabling. I felt forced into a role that I was not ready for and ill equipped to handle.

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Ladykiller in a Bind has a mechanic were you generate suspicion for acting differently than your brother might. A way to remove all accrued suspicion is to spend the night with another classmate. These liaisons are distinctly BDSM affairs. Unlike Mystic Messenger, I had much more ability to express myself. I could get greedy and press for kisses, I could struggle when tied, or I could completely submit. If I felt uncomfortable, I had the option to signal my discomfort. The power dynamics flowed in multiple directions. I was not helpless.

I eventually found myself submitting more and more often in these scenes. Safe within the confines of a virtual realm, I was free to experiment with sexual exchanges far different than any real world experience I’ve had. Without kissing and telling too much, it is enough to say that I’ve never particularly considered sexual submissiveness as a significant form of intimate expression. Yet here I was actively, excitedly, and consensually submitting in scenes. Game or no, I was engaging in a form of sexual exploration, sampling an experience previous foreign to me. I liked it.

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A notable thing about Ladykiller’s interactions is how much they still stress the act of being a sub as an active decision. To be submissive is to make a choice and it’s actually pretty remarkable how clear the mechanics of a visual novel make this. While video game systems can often feel reductive and lacking when it comes to simulating the real world, Ladykiller’s format makes decision making incredibly clear.

I had my character largely remain silent during these scenes. To do so I still had to make a conscious and continued decision to pass up dialog options up in favor of remaining passive. The process was still engaging and deliberate. I was never forced to do anything. I chose to play along. I trusted that the situation would never move beyond a point where I did not feel secure.

I’m not suggesting that my exploration in Ladykiller constitutes anything equal to real world experience but I do believe that the game provided a significant vector for me to experiment with certain sexual arrangements and behaviors while maintain a remarkably safe space for said experimentation. It was illuminating and respectful to me as a player. That respect is appreciated and I hope that more games might extend the same courtesy to me in the future.

How did evolution change our sexual organs? It’s time to learn the history of sex

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Porn images are everywhere but we need better ways to teach children about love, intimacy and yes, masturbation

evolution

At the start of this third millennium, sex seems to be all around us – within easy reach, on our screens, constantly talked about in the media. What used to be concealed, shameful and forbidden only a century ago is today regarded as evidence of progress in the freedom of thought. Artists use sex to push the limits of creativity: Paul McCarthy’s “butt plug” sculpture, for example, was installed at the Place Vendôme in Paris in 2014, even though it provoked outrage among residents.

The sexual metaphor is ever-present. Paradoxically, however, sex is rarely explained and almost never taught. Do you know how our sexual organs changed when we evolved from animal to human? When did the first couple show up? Where does our sense of modesty come from? Or eroticism? Or love, that most momentous of human concerns? What about our earliest customs? Which ancient civilisation championed equality between men and women? And why was masturbation frowned upon?

Sex is one of those realities that for a long time we neither wanted to see nor hear about. The sexual liberation of the 1970s – which was, in my opinion, the biggest social revolution in the history of humanity – signalled the transition from a traditional male-dominated society to one in which sex with all its nuances could finally be examined openly and understood. But as sex has dared to uncover itself, to live, to speak, we face the challenge of expressing what for so long has been kept under wraps. How are we to communicate what so recently caused so much shock and outrage?

In the west, the union of two individuals is in complete flux, with a drop in those getting married (in France 57% of births now happen outside marriage); same-sex marriage; and the option of “slices of life”, relationships with different partners in the course of a lifetime. But however free our customs may be, censorship persists when it comes to the communication of sex, the words, the particular way of defining sexuality and the idea of sensuality. Literature and fiction have always attempted to push the boundaries of this censorship: in the 18th century we had Pierre Choderlos de Laclos’s Dangerous Liaisons; and in the 21st, EL James’s Fifty Shades of Grey. But mostly our discussions fall somewhere between sincerity and provocation as we attempt to understand intimacy and the fullest expression of sexual pleasure.

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No history book will delve too deeply into the sexual realm, yet it’s clear that history is a timeline of instructions and condemnations about sexuality. Each culture, each religion, each era has defined its own normality.

But without learning the history of love and intimacy, how can we understand the extraordinary evolution in customs that has led us from an existence ordered by family and society, and reinforced by religion, to the freedoms we know today? In his collection of aphorisms, Monogamy, the psychoanalyst Adam Phillips says that “most people would not live as a couple if they had never heard of it”. In this, he is reflecting the artificial nature of our customs and the need for a way to express our thoughts on sex, intimacy and being with other people.

We know today that human sexuality is not innate: it is learned and constructed through the images that society offers us. Even among our cousins, the primates, who live in a natural habitat, sexuality is learned through experience – young monkeys witness the courting and frolicking of the adults. The need for a model is evident: a young chimpanzee isolated from its peers is incapable of mating when it reaches adulthood.

Yet there is a fundamental difference: we invented modesty. Humans always make love away from the group. This is one of the great problems with sexuality: on the one hand it requires education; on the other, culture and religion collude to suppress sexual education.

The physician Thomas Beddoes was probably the first person to teach a course in sex education, complete with public demonstrations on the differences between men and women, in the early 19th century. But in the following two centuries, sex education failed to gain ground. Opposition was widespread and aggressive, on the part of the church as well as among teachers.

Sex education classes were subsequently written into law, but, in reality, rarely delivered. Sex education is today well established in Quebec and the Scandinavian countries, where primary school-age children are educated about gender differences and roles, as well as sexual orientation. In the Netherlands, where a complete programme of sex education is delivered from primary school, the rates of teenage pregnancies and abortions are among the lowest in the world.

But other western countries such as France and the UK provide little more than a perfunctory discourse on contraception and safeguarding against STDs. In France, a 2001 law stipulates three classes of sex education a year in middle and secondary school. However, as teachers have no training in this very particular field, it is often organisations such as those devoted to family planning that ensure these classes go ahead. In most cases, they rarely take place at all, and when they do they are limited to the three Ps: “prevention, pill, protection”, in other words, information on fertility and STDs. In this educational void the internet and porn offer themselves as models.

This is quite evidently the worst possible model, and the reason why a more reliable source of knowledge is indispensable, from primary school through to the last year of secondary. The average age at which children are first exposed to pornography is 11. Such an artificial vision of sex has altered our most intimate behaviour and has become the frame of reference not just for our teenagers but for us all. It makes us ask ourselves: am I sexy enough, am I the best lover?intimacy2

Nothing could be more damaging than these images devoid of explanation. We can’t stop young people from encountering porn, but a formal, educational approach would allow our society to explain its context and prevent misunderstandings that could otherwise compromise a fragile or still developing personality.

A genuine sex education should take the bio-psychological, emotional and social aspects of sexuality into account, should allow children to understand differences between the sexes, interpersonal relationships, the importance of developing critical thinking, an open mind and respect for the other. We must banish negative terms (sin, adultery, prostitution, Aids and STDs) in favour of positive schooling that allows children to understand desire, pleasure and excitement; the importance of sensitivity in love; the importance of masturbation, even. We must understand that everything can be taught, even the practicalities of how people live together, and we should start in primary school with discussions not only of genital differences but about the variations between boys and girls, the significance of love and of respect that may help with later relationships, notions of gender equality and domestic violence.

Only by speaking frankly, lightheartedly and wide-rangingly about sex, love and intimacy can we provide an education that enables adolescents, both boys and girls, to begin their lives with a better understanding of human relationships.

Complete Article HERE!