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New treatments restoring sexual pleasure for older women

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By Tara Bahrampour

When the FDA approved Viagra in 1998 to treat erectile dysfunction, it changed the sexual landscape for older men, adding decades to their vitality. Meanwhile, older women with sexual problems brought on by aging were left out in the cold with few places to turn besides hormone therapy, which isn’t suitable for many or always recommended as a long-term treatment.

Now, propelled by a growing market of women demanding solutions, new treatments are helping women who suffer from one of the most pervasive age-related sexual problems.

Genitourinary syndrome, brought on by a decrease in sex hormones and a change in vaginal pH after menopause, is characterized by vaginal dryness, shrinking of tissues, itching and burning, which can make intercourse painful. GSM affects up to half of post-menopausal women and can also contribute to bladder and urinary tract infections and incontinence. Yet only 7 percent of post-menopausal women use a prescription treatment for it, according to a recent study.

The new remedies range from pills to inserts to a five-minute laser treatment that some doctors and patients are hailing as a miracle cure.

The lag inaddressing GSM has been due in part to a longstanding reluctance among doctors to see post-menopausal women as sexual beings, said Leah Millheiser, director of the Female Sexual Medicine Program at Stanford University.

“Unfortunately, many clinicians have their own biases and they assume these women are not sexually active, and that couldn’t be farther from the truth, because research shows that women continue to be sexually active throughout their lifetime,” she said.

With today’s increased life expectancy, that can be a long stretch – another 30 or 40 years, for a typical woman who begins menopause in her early 50s. “It’s time for clinicians to understand that they have to bring up sexual function with their patients whether they’re in their 50s or they’re in their 80s or 90s,” Dr. Millheiser said.

By contrast, doctors routinely ask middle-aged men about their sexual function and are quick to offer prescriptions for Viagra, said Lauren Streicher, medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause.

“If every guy, on his 50th birthday, his penis shriveled up and he was told he could never have sex again, he would not be told, ‘That’s just part of aging,’” Dr. Streicher said.

Iona Harding of Princeton, New Jersey, had come to regard GSM, also known as vulvovaginal atrophy, as just that.

For much of their marriage, she and her husband had a “normal, active sex life.” But after menopause sex became so painful that they eventually stopped trying.

“I talked openly about this with my gynecologist every year,” said Mrs. Harding, 66, a human resources consultant. “There was never any discussion of any solution other than using estrogen cream, which wasn’t enough. So we had resigned ourselves to this is how it’s going to be.”

It is perhaps no coincidence that the same generation who first benefited widely from the birth control pill in the 1960s are now demanding fresh solutions to keep enjoying sex.

“The Pill was the first acknowlegement that you can have sex for pleasure and not just for reproduction, so it really is an extension of what we saw with the Pill,” Dr. Streicher said. “These are the women who have the entitlement, who are saying ‘Wait a minute, sex is supposed to be for pleasure and don’t tell me that I don’t get to have pleasure.’”

The push for a “pink Viagra” to increase desire highlighted women’s growing demand for sexual equality. But the drug flibanserin, approved by the FDA in 2015, proved minimally effective.

For years, the array of medical remedies has been limited. Over-the-counter lubricants ease friction but don’t replenish vaginal tissue. Long-acting mosturizers help plump up tissue and increase lubrication, but sometimes not enough. Women are advised to “use it or lose it” – regular intercourse can keep the tissues more elastic – but not if it is too painful.

Systemic hormone therapy that increases the estrogen, progesterone, and testosterone throughout the body can be effective, but if used over many years it carries health risks, and it is not always safe for cancer survivors.

Local estrogen creams, suppositories or rings are safer since the hormone stays in the vaginal area. But they can be messy, and despite recent studies showing such therapy is not associated with cancer, some women are uncomfortable with its long-term use.

In recent years, two prescription drugs have expanded the array of options. Ospemifene, a daily oral tablet approved by the FDA in 2013,activates specific estrogen receptors in the vagina. Side effects include mild hot flashes in a small percentage of women.

Prasterone DHEA, a naturally occurring steroid that the FDA approved last year, is a daily vaginal insert that prompts a woman’s body to produce its own estrogen and testosterone. However, it is not clear how safe it is to use longterm.

And then there is fractional carbon dioxide laser therapy, developed in Italy and approved by the FDA in 2014 for use in the U.S. Similar to treatments long performed on the face, it uses lasers to make micro-abrasions in the vaginal wall, which stimulate growth of new blood vessels and collagen.

The treatment is nearly painless and takes about five minutes; it is repeated two more times at 6-week intervals. For many patients, the vaginal tissues almost immediately become thicker, more elastic, and more lubricated.

Mrs. Harding began using it in 2016, and after three treatments with MonaLisa Touch, the fractional CO2 laser device that has been most extensively studied, she and her husband were able to have intercourse for the first time in years.

Cheryl Edwards, 61, a teacher and writer in Pennington, New Jersey, started using estrogen in her early 50s, but sex with her husband was painful and she was plagued by urinary tract infections requiring antibiotics, along with severe dryness.

After her first treatment with MonaLisa Touch a year and a half ago, the difference was stark.

“I couldn’t believe it… and with each treatment it got better,” she said. “It was like I was in my 20s or 30s.”

While studies on MonaLisa Touch have so far been small, doctors who use it range from cautiously optimistic to heartily enthusiastic.

“I’ve been kind of blown away by it,” said Dr. Streicher, who, along with Dr. Millheiser, is participating in a larger study comparing it to topical estrogen. Using MonaLisa Touch alone or in combination with other therapies, she said, “I have not had anyone who’s come in and I’ve not had them able to have sex.”

Cheryl Iglesia, director of Female Pelvic Medicine & Reconstructive Surgery at MedStar Washington Hospital Center in Washington D.C., was more guarded. While she has treated hundreds of women with MonaLisa Touch and is also participating in the larger study, she noted that studies so far have looked only at short-term effects, and less is known about using it for years or decades.

“What we don’t know is is there a point at which the tissue is so thin that the treatment could be damaging it?” she said. “Is there priming needed?”

Dr. Millheiser echoed those concerns, saying she supports trying local vaginal estrogen first.

So far the main drawback seems to be price. An initial round of treatments can cost between $1,500 and $2,700, plus another $500 a year for the recommended annual touch-up. Unlike hormone therapy or Viagra, the treatment is not covered by insurance.

Some women continue to use local estrogen or lubricants to complement the laser. But unlike hormones, which are less effective if begun many years after menopause, the laser seems to do the trick at any age. Dr. Streicher described a patient in her 80s who had been widowed since her 60s and had recently begun seeing a man.

It had been twenty years since she was intimate with a man, Dr. Streicher said. “She came in and said, ‘I want to have sex.’” After combining MonaLisa Touch with dilators to gradually re-enlarge her vagina, the woman reported successful intercourse. “Not everything is reversible after a long time,” Dr. Streicher said. “This is.”

But Dr. Iglesia said she has seen a range of responses, from patients who report vast improvement to others who see little effect.

“I’m confident that in the next few years we will have better guidelines (but) at this point I’m afraid there is more marketing than there is science for us to guide patients,” she said. “Nobody wants sandpaper sex; it hurts. But at the same time, is this going to help?”

The laser therapy can also help younger women who have undergone early menopause due to cancer treatment, including the 250,000 a year diagnosed with breast cancer. Many cannot safely use hormones, and often they feel uncomfortable bringing up sexual concerns with doctors who are trying to save their lives.

“If you’re a 40-year-old and you get cancer, your vagina might look like it’s 70 and feel like it’s 70,” said Maria Sophocles, founding medical director of Women’s Healthcare of Princeton, who treated Mrs. Edwards and Mrs. Harding.

After performing the procedure on cancer survivors, she said, “Tears are rolling down from their eyes because they haven’t had sex in eight years and you’re restoring their femininity to them.”

The procedure also alleviates menopause-related symptoms in other parts of the pelvic floor, including the bladder, urinary tract, and urethra, reducing infections and incontinence.

Ardella House, a 67-year-old homemaker outside Denver, suffered from incontinence and recurring bladder infections as well as painful sex. After getting the MonaLisa Touch treatment last year, she became a proslyter.

“It was so successful that I started telling all my friends, and sure enough, it was something that was a problem for all of them but they didn’t talk about it either,” she said.

“I always used to think, you reach a certain age and you’re not as into sex as you were in your younger years. But that’s not the case, because if it’s enjoyable, you like to do it just as much as when you were younger.”

Complete Article HERE!

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Some drugs can cause unwanted sexual side effects in men

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You might assume that erectile dysfunction, or ED, is a normal problem that men face as they age. But because men (and women) take more medications as they age, the experts at Consumer Reports’ Best Buy Drugs report that side effects from those drugs are a little-known yet common cause of ED.

“Many medications can affect things like erectile dysfunction, desire and ejaculation in different ways and through different mechanisms of action,” says J. Dennis Fortenberry, former chair of the board of the American Sexual Health Association and the Donald Orr Professor of Adolescent Medicine at Indiana University School of Medicine.

Medications that can have these effects include high blood pressure drugs such as beta blockers, including atenolol (Tenormin), clonidine (Catapres), metoprolol (Lopressor) and methyldopa (Aldomet), and diuretics such as hydrochlorothiazide (Hydrodiuril).

Popular antidepressants and anti-anxiety drugs such as alprazolam (Xanax), diazepam (Valium), duloxetine (Cymbalta), fluoxetine (Prozac) and paroxetine (Paxil) can cause sexual problems such as delayed ejaculation, reduced sexual desire in men and erectile dysfunction. Lesser-known drug types that can also cause such sexual problems include antihistamines such as diphenhydramine (Benadryl) and antifungal drugs such as ketoconazole (Nizoral).

Surprisingly, heartburn drugs, including famotidine (Pepcid) and ranitidine (Zantac) are known to reduce sexual desire in men. In addition, reduced desire and erectile dysfunction have been reported in men taking the powerful painkillers oxycodone (OxyContin) and hydrocodone (Vicodin), muscle relaxers such as baclofen (Lioresal), and even over-the-counter ibuprofen (Advil, Motrin).

And perhaps not surprisingly, the more drugs a man takes, the greater his odds are of experiencing an issue. For example, in a 2012 study of men ages 45 to 69, those who took three to five drugs were 15 percent more likely to have erectile dysfunction than men taking two or fewer. Men who took six to nine drugs were 51 percent more likely to have erection problems.

What you can do

Before making any change to your medications, talk with your doctor, says David Shih, a board-certified emergency medicine physician and executive vice president of strategy on health and innovation at CityMD, a network of urgent care centers in the New York metro area and Seattle.

If appropriate, your physician can make changes such as “lowering the medication dose, switching to a new medication or a combination therapy of lower doses each,” notes Shih.

Your doctor may also suggest temporarily stopping a medication — often referred to as taking a “drug holiday” — before having sex, if that is possible.

If you’ve just started taking a new drug, sexual side effects may disappear as your body adjusts. But if after a few months they don’t, discuss it with your physician. He or she will want to rule out other conditions that could cause your sex drive to take a nose-dive.

“The prescribing physician will need to explore if these symptoms are from cardiovascular disease, depressive disorder, diabetes, neurological disease and other illnesses,” says Shih.

Even suffering from sleep apnea is known to affect sexual interest or response.

That’s why, if you experience ED, it’s important to get to your doctor’s office for a detailed discussion about what could be causing it.

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What Does It Mean to Be Pansexual?

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One of the beautiful things about being a person right now is that there are no limits to the ways you can express your sexual preferences. While there’s still a lot of work to do in terms of representation, people who identify with sexualities and genders beyond binaries are finding it easier than ever to find both partners and communities that support their needs. But since inclusivity, though extremely awesome, can also be a bit overwhelming or confusing for some who haven’t heard certain terms in the past, it can be a little hard determining exactly where you fit. So, for the sake of said representation, let’s look at a term that’s gaining more and more traction nowadays: pansexual.

So what does pansexual mean? It’s actually pretty simple: Pansexuality is a sexual identity used to describe those who could be potentially attracted to all people, regardless of gender. Some people who identify as pansexual put it in the most adorable terms possible and say they care about “hearts and not parts.”

The reason pansexuality is defined as a sexual identity, rather than a gender identity, says Becca Mui, Ms.Ed., education manager at GLSEN, is because “it describes people’s feelings of emotional, physical, romantic, and sexual attraction to others, [whereas] gender identities refer to people’s personal conception of themselves, which may include ‘female,’ ‘androgynous,’ ‘transgender,’ “genderqueer,’ ‘nonbinary,’ ‘male’ and many others, or a combination thereof.”

Obviously, there is a bit of overlap (and therefore some confusion) when it comes to different sexual identities. For instance, what’s the difference between bisexual and pansexual, since doesn’t bisexual mean potential attraction to both genders? It does, but they aren’t the same thing. The term bisexual refers to someone who is attracted to male and female people, or people who are on the gender binary. “Someone who is pansexual may be attracted to someone who is transgender, gender nonbinary, or genderqueer,” Kristie Overstreet, Ph.D., a psychotherapist and clinical sexologist, tells Glamour. Pansexuality does not assume there are only two genders, rejects the binary, and embraces all people as individuals.

That’s not to say that identifying as pansexual means you aren’t attracted to people who do identify as male or female (i.e., within the traditional gender binary)—only that gender is not something you take into consideration when it comes to sexual attraction. If you find you’re attracted to all people, or most people, and gender isn’t something that dictates your desire for someone, you might be pansexual!

For some people, pansexual is a way to accept a sexual descriptor while leaving lots of room for interpretation. “[Pansexual] is the most inclusive type of sexuality and is not limited to attraction to men or women,” Alicia Sinclair, a sex coach and founder of B-Vibe, tells Glamour. “They may find their sexual attraction is much broader than the traditional identifications and labels.” Even so, it’s important to remember that labels are entirely self-regulated and are no one’s business but your own. Even if you may technically fit into a “box,” or some of your behaviors may fall under a label, you still may not be comfortable using any one term to describe yourself. For example, someone might be attracted to men and women, but not wish to be called bisexual. They may prefer the term queer, heteroflexible or homoflexible. Or maybe they don’t want any label at all. You don’t have to call yourself something just to make other people comfortable. Any label you choose should be strictly for your own benefit and self-identification.

Though there isn’t a clear stat on how many people identify as pansexual in the world—it’s a relatively new term and has been more widely accepted as a sexual identity only in the last decade or so (and we’re still working on it, tbh)—as more people feel comfortable coming out on a gender and sexuality spectrum, we’ll likely see a push for more comprehensive population statistics. According to the GLSEN 2015 National School Climate survey, 16.1 percent of the student participants identified themselves as pansexual. That’s a pretty significant number, and one that will probably grow as acceptance permeates popular culture.

If you are pansexual, some people want the next step to be explaining their sexual identity to family or friends. When you live in a world that generally expects that there are men and women, gay and straight people, falling outside of those parameters can be jarring for people you love. If you’re looking for some “coming out” ideas, Overstreet suggests writing a letter to family as a way of expressing who you are. “This is a great way to share your identify with them, as well as your feelings related to it, in a safe way,” she says.

Identifying on the sexuality spectrum may lead to some awkward moments in public. Though it can be disheartening, it happens to plenty of people. “Be prepared that some people may comment or ask inappropriate questions about your identity or your behavior,” Overstreet says. “Remember to keep your boundaries in place and don’t feel that you have to answer any questions that are inappropriate.”

Remember that you have agency, that your sexual identity is totally valid, and that how you choose to label yourself is nobody’s business but your own. We’ll say it again for the seats in the back: Any label you choose is strictly for your own benefit and self-identification.

You got this.

Complete Article HERE!

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We need to talk about the social norms that fuel sexual assault

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The recent spate of sexual harassment accusations against prominent men in Westminster comes as no surprise to many of us. We expect them to know better – to have been better people – but we have also seen this kind of behaviour before … over and over again. It isn’t just powerful men – but it is almost always men.

It’s time to start looking at the deep-rooted causes of harassment. We need to try to understand why sexual harassment is carried out much more by men against women than vice versa. And this is going to involve an evaluation of our sexual norms. Once we’ve done this, we can start a conversation about the kind of sex we do want – and how to create a culture where that is more likely to happen.

Let’s consider three gendered social norms that might have a role in why men sexually harass women.

1) Men are entitled to sex

The view that men are constantly thinking about sex, and feel somehow entitled to it due to their superior status to women, is one that we are familiar with: from sexist chants at universities, to pick-up artists, to lyrics that eroticise sexual coercion (such as Blurred Lines by Robin Thicke) and films that revolve around the “winning over” of an uninterested woman. We also take it for granted that there is a large sex industry, which caters – for the most part – for men’s sexual desires.

2) Men call the shots

It is still a common expectation that men should ask women out on dates, decide where to go, and pay for them. Women, on the other hand, should play hard to get and be submissive. Consider the well-known “Rules” dating book, which has tips for women such as: “don’t tell him what to do” and “let him take the lead”.

Power imbalance.

Men are also expected to be dominant sexually – and this is implicit in the way that we talk about sex: men fuck/screw/bone women. The male dominance norm carries forward into marriage. It is still usual for the woman to wait for the man to ask her to marry him and to take his name when they marry, for example.

3) Women should be sexually pure

Women’s sexuality is controlled through slut shaming. Many men would still be uncomfortable being with a woman who had slept with many more people than he had – and many men still feel comfortable referring to women as “slags” or “sluts” for indulging in behaviour that would make a man a “stud” or a “lad”.

It is implicitly believed that women must help men to control their sexual desire and aggression. They can do this by dressing modestly, and not being too flirtatious with men. Peter Hitchens recently helpfully suggested in the Daily Mail that the niqab is what women will get from all this “squawking about sex pests”, since, as he put it: “No minister would put his hand on the knee of anyone dressed like this; indeed, he’d have trouble finding her knee, or anything else”.

So, let’s talk

These norms are obviously extreme, and are not held by everyone. They are also, I hope, being slowly eroded. But they do exist – and it is not too far-fetched to say that they have a role in creating a culture in which men, much more so than women, feel that they want to and are able to engage in sexual harassment. After all, if there is an implicit assumption that you are entitled to sex (and this view might be held particularly strongly by men who believe they are entitled in all aspects of life), that you call the shots in the sexual arena, and that if a woman is dressed “provocatively”, or acting “flirtatiously”, you just can’t help yourself, then you might feel that you do nothing wrong in harassing her.

The revelations from Westminster have opened up a debate surrounding men’s actions within that small bubble, a debate that needs to be had. But we should also use it as an opportunity to talk about gendered sexual norms, because sex is a part of sexual harassment.

We need to do more than just train men in sexual consent. Consent, after all, is a bare minimum requirement for good sex. What we need is a conversation about what makes good sex – and what kind of gender norms would improve gender relations more broadly. And I think they might end up being quite different to the norms we have now.

Complete Article HERE!

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Why teaching kids about sex is key for preventing sexual violence

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Sex ed can be awkward. It can also be life-changing.

You may think of sex education like it appears in pop culture: A classroom of teens looking nervously at a banana and a condom.

Amid the giggling and awkward questions, maybe the students get some insight into how sex works or how to prevent pregnancy and sexually transmitted infections.

While that’s valuable knowledge, comprehensive and LGBTQ-inclusive sex ed actually has the power to positively influence the way young people see themselves and their sexuality. It may also help prevent sexual violence when it teaches students how to value their own bodily autonomy, ask for consent, and identify unhealthy relationship behavior.

That possibility couldn’t be more important at a time when the public is searching for answers about how to stop sexual violence.

It’s a familiar cycle; one person’s predatory behavior becomes national news (think Harvey Weinstein, Roger Ailes, Donald Trump, and Bill Cosby), the outrage reaches a peak before fading from the headlines, and we end up back in similar territory months or years later.

 

Nicole Cushman, executive director of the comprehensive sex ed nonprofit organization Answer, says that teaching young people about sex and sexuality can fundamentally shift their views on critical issues like consent, abuse, and assault.

When parents and educators wait to have these conversations until children are young adults or off at college, Cushman says, “we are really doing too little, too late.”

Comprehensive sex ed, in contrast, focuses on addressing the physical, mental, emotional, and social dimensions of sexuality starting in kindergarten and lasting through the end of high school. There’s no single lesson plan, since educators and nonprofits can develop curricula that meet varying state standards, but the idea is to cover everything including anatomy, healthy relationships, pregnancy and birth, contraceptives, sexual orientation, and media literacy.

“Comprehensive sex ed builds a foundation for these conversations in age-appropriate ways,” Cushman says. “That [allows] us not to just equip young people with knowledge and definitions, but the ability to recognize sexual harassment and assault … and actually create culture change around this issue.”

Some parents balk at the idea of starting young, but researchers believe that teaching elementary school students basic anatomical vocabulary as well as the concept of consent may help prevent sexual abuse, or help kids report it when they experience it.

If a child, for example, doesn’t know what to call her vagina, she may not know how to describe molestation. And if a boy doesn’t understand that he can only touch others with their permission, and be touched by others upon giving his consent, he may mistake sexual abuse as normal.

It doesn’t take much to imagine how that early education could impart life-long lessons about the boundaries that separate respectful physical contact from abuse and assault.

 

Some adults, however, think children learn these lessons without their explicit help. While they do internalize signals and cues from the behavior they witness, that’s not always a good thing, says Debra Hauser, president of the nonprofit reproductive and sexual health organization Advocates for Youth.

If a child grew up in a household witnessing an emotionally, verbally, or physically abusive relationship, they may not feel they have a right to give or revoke their consent. They may also believe it’s their right to violate someone else. Moreover, young people rarely, if ever, get to watch as the adults around them navigate complicated conversations about things like birth control and sexual preferences.

That’s where comprehensive sex ed can be essential, Hauser explains.

“You want young people to learn knowledge, but you also want them to learn skills,” she says. “There’s a particular art to communicating about boundaries, contraceptive use, likes and dislikes. It’s not something you get to see that often because they’re private conversations.”

So while parents — and some students — grimace at the idea of role-playing such exchanges in the classroom, that technique is a cornerstone of comprehensive sex education. Staging practical interactions that are inclusive of LGBTQ students can help reduce the stigma that keeps people from expressing their desires, whether that’s to stop or start a sexual encounter, use protection, or confront abusive behavior.

But learning and practicing consent isn’t a silver bullet for prevention, Cushman says: “Plenty of young people could spout off the definition of consent, but until we really shift our ideas about gender, power, and sexuality, we’re not going to see lasting change.”

Research does suggest that a curriculum that draws attention to gender or power in relationships, fosters critical thinking about gender norms, helps students value themselves, and drives personal reflection is much more likely to be effective at preventing pregnancy and sexually transmitted infections.

 

There’s also research that indicates that clinging to harmful gender norms is associated with being less likely to use contraceptives and condoms. And women and girls who feel they have less power in a sexual relationship may experience higher rates of sexually transmitted infections and HIV.

While researchers don’t yet know whether comprehensive sex ed can reduce sexual violence, Hauser believes it’s an important part of prevention.

“Comprehensive sex ed is absolutely essential if we’re ever going to be successful in combatting this culture,” she says.

But not all students have access to such a curriculum in their schools. While California, for example, requires schools to provide medically accurate and LGBTQ-inclusive sex ed, more than two dozen states don’t mandate sex ed at all. Some don’t even require medically accurate curricula.

The Trump administration is no fan of comprehensive sex ed, either. It recently axed federal funding for pregnancy prevention programs and appointed an abstinence-only advocate to an important position at the Department of Health and Human Services.

Research shows that abstinence-only education is ineffective. It can also perpetuate traditional gender roles, which often reinforce the idea that girls and women bear the responsibility of preventing sexual assault.

Cushman understands that parents who don’t want their children learning about comprehensive sex ed are just worried for their kids, but she says the knowledge they gain isn’t “dangerous.”

Even if some parents can’t shake the worry that it might be, the firestorm over Harvey Weinstein’s behavior and the outcry from his victims are proof that we need to better educate young people about sex, consent, and healthy relationships.

It’s simply unconscionable to teach girls and women, by design or accident, that sexual violence is their fault.

“We have an obligation to make sure [youth] have the knowledge and skills they need to make the decisions that are best for them,” Cushman says. “Sex ed really does have the power to shift our perceptions.” 

Complete Article HERE!

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