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We must acknowledge adolescents as sexual beings

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As a teenager, Dr. Venkatraman Chandra-Mouli experienced shame and was often denied access when he tried to purchase condoms. Forty years later, adolescents around the world still face barriers to contraceptive access. In this blog, Dr. Chandra-Mouli discusses those barriers and how they can be overcome.

Dr. Venkatraman Chandra-Mouli recalls feeling shame and was often denied access when he tried to purchase condoms as a teenager.

By Dr. Venkatraman Chandra-Mouli

I grew up in India. While in my late teens and studying to be a doctor, I met the girl whom I married some years later. A year or so into our relationship we started to have sex. We decided to use condoms. Getting them at a government-run clinic was out of question. They were known to provide free condoms called Nirodh, which were said to be as smelly and thick as bicycle inner tubes. Asking our family doctor was also out of question. He knew my mother and I had no doubt that he would tell.

So, I used to walk to pharmacies, wait until other customers had left, and then muster up the courage to ask the person behind the counter for upmarket Durex condoms. Sometimes I was successful and walked out feeling like a king. Other times, I was scolded and sent away. I still recall my ears burning with shame. That was 40 years ago, but I know from adolescents around the world with whom I work that they continue to face many barriers to obtaining contraceptives.

Different adolescents, different barriers

In many societies, unmarried adolescents are not supposed to have sex. Laws and policies forbid providing them with contraception. Even when there are no legal or policy restrictions, health workers refuse to provide unmarried adolescents with contraception.

Married adolescents are under pressure to bear children. Many societies require girls to be nonsexual before marriage, fully sexual on their marriage night, and fertile within a year. In this context, there is no discussion of contraception until they have one or more children, especially male children.

Most societies do not acknowledge the sexuality of groups such as adolescents with disabilities or those living with HIV. Neither do they acknowledge the vulnerability of adolescent girls and boys in humanitarian crises situations.

Finally, no one wants to know or deal with non-consensual sex, resulting from either verbal coercion or physical force by adults or peers. Girls who are raped may need post-exposure prophylaxis for HIV, emergency contraception, or safe abortion—all of which are taboo subjects.

Overcoming these barriers

These powerful and widespread taboos have resulted in limited and inconsistent progress on improving adolescent contraception access. This has to change. We must acknowledge adolescents as the sexual beings they are. We must try to remember what a joy it was to discover sex when we were adolescents. We must give adolescents the information, skills, and tools they need to protect themselves from unwanted pregnancies and sexually transmitted infections.

With that in mind, I recommend the following:

  • We need to provide adolescents with sexuality education that meets their needs.
  • We need to change the way we provide adolescents with contraceptives by offering them a range of contraceptives and helping them choose what best meets their needs, and use a mix of communication channels—public, private, social marketing and social franchising to expand their availability. We must go beyond one-off training to use a package of evidence-based actions to ensure that health workers are competent and responsive to their adolescent clients.
  • We need to address the social and economic context of girls’ lives. In many places, adolescent girls do not have the power to make contraception decisions. Even when they are able to obtain and use contraception, an early pregnancy in or out of union may be the best of a limited set of bad options – when they are limited education and employment prospects.

To reach the 1.2 billion adolescents in the world, we must move from small-scale short-lived projects to large-scale and sustained programs. For this, we need national policies and strategies, and work plans and budgets that are evidence-based and tailored to the realities on the ground. Most importantly, we need robust implementation so that programs are high quality and reach a significant scale while paying attention to equity.

We need government led programs that engage and involve a range of players including adolescents. For this to happen, coordination systems must be in place to engage key sectors such as education, draw upon the energy and expertise of civil society, recognize the complementary role that the public, the private sector and social marketing programs can play, and to meaningfully engage young people.

Some countries have shown us that this can be done. Over a 15-year period, employing a multi-component program including active contraceptive promotion, England has reduced teenage pregnancy by over 50%. This decline has occurred in every single district of the country.

Ethiopia is another outstanding example. Civil war and famine in the mid-1980s had catastrophic effects on the country. However, over a 12 year-period, with an ambitious basic health worker program, Ethiopia has increased contraceptive use in married adolescents from 5% to nearly 30% . It has also halved the rate of child marriage and female genital mutilation, although this decline is more marked in some provinces than in others. These countries have shown that with good leadership and strong management progress is possible.

There will be logistic and social challenges in moving forward. Understanding and overcoming them will require leadership and good management, which is why a strong and sustained focus on implementation must be combined with monitoring and program reviews to generate data that could be used in quick learning cycles to shape and reshape policies and programs.

There is likely to be backlash from those that oppose our efforts to provide adolescents with contraceptive information and services, and to empower them to take charge of their lives. We must do our best to bring these individuals and organizations on board. But we must not be silenced or stopped. We must stand our ground and we must prevail. We owe that to the world’s adolescents.

Complete Article HERE!

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5 common questions about vaginas answered

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A sexual health nurse reveals all

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We don’t often bring up genitals in polite conversation but learning more about vaginas can empower women to make the right decisions about their general and sexual health – and know when to seek medical advice.

Helen Knox, a clinical nurse specialist in contraception and sexual health – and founder of Sexplained – shares the vaginal health questions she hears most frequently and the advice she gives women about how best to care for their most intimate area:

1. Is my vaginal normal?

“I often get asked if the smell or discharge a woman is experiencing is ‘normal’. Firstly, normal is what is normal to you. Your vagina will have its own smell, regular discharge and shape. If you notice a change from your norm such as a change in discharge, smell or discomfort, then there may be something up. But don’t be embarrassed about it and do nothing. You can ask your pharmacist to help you work out what might be going on and give you an over the counter treatment. But if you are in pain, are bleeding abnormally or have persistent symptoms then you must see your GP.”

2. What should my vagina smell like?

“Your vulva and your vagina should smell like you, if this smell changes then something might be up. Your healthy vagina is all about balance: it is home to millions of micro-organisms, and is normally good at keeping them in balance.”

“When this balance gets disrupted, you’ll start to notice things aren’t quite right and you could be developing bacterial vaginosis (BV) which is a very common condition that often causes a fishy smell. BV is in fact two times more common than thrush and like thrush it can be simply treated with an over the counter treatment. Lactic acid based products such as Balance Activ (available at Amazon.co.uk) help to rebalance the healthy bacterial conditions within the vagina, to gently and effectively treat the symptoms of BV by restoring normal pH and vaginal flora.”

3. What should my vagina look like?

“Just like the rest of our bodies, our vaginas are all unique. The only part you can see is the vulva, and these come in all shapes and sizes. If you are experiencing any soreness, itching or other changes there may be a problem that needs checking out. In general, adding anything to your vagina such as glitters or perfumes is going to upset your natural balance and encourage conditions like BV, so I really wouldn’t recommend it.”

“You can’t see your vagina, as it is inside you, and it runs from your vulva, up to your cervix, but as long as you’re not experiencing any unusual smells or discomfort, it’s very likely to be looking after itself – and doesn’t need to be messed about with.”

4. Is my discharge normal?

“The vagina is a relatively acidic environment which keeps itself healthy by producing a range of secretions, so women will experience natural changes in discharge throughout their monthly cycle.”

A period generally lasts for 4-5 days, followed by slight dryness and then an increase in discharge. This will normally be white at first and then change to a clear, stretchy consistency during peak fertility. After ovulation, it changes to a dryer, thicker white or creamy mucus, which sperm won’t be able to swim through. If you’re pregnant this doesn’t change. If you’re not, it’s back to the next period.”

“Even in a healthy vagina, there will be a variety of changes to your ‘normal’ discharge, and these can also vary depending on your age and other factors. A change in discharge to it becoming really thin and watery, or thick and cottage cheese like, or a fishy or unpleasant smell may be a sign that something is wrong and your natural balance has been upset – you can check your symptoms at via the online symptom checker or speak to your doctor, pharmacist or sexual health clinic if you are worried.”

5. How do I keep my vagina clean?

Your vagina cleans itself. It is a common misconception that having conditions like BV means you are not clean – in fact when women notice an unpleasant smell (especially after sex) they will often reach for the soap or perfumed shower gel – this can actually make things worse! There’s a delicate eco-system up there, working hard to keep a balance of bacteria so douching or washing with perfumed products can upset this balance and cause BV. As part of your daily cleaning routine, washing once a day with just water around the vulva, which is the skin around the opening, is fine.”

“By understanding your own normal and staying in tune with your body it will help you determine whether you have any issues. If you notice any changes, don’t sit with on-going symptoms wishing them way, discuss them with your Pharmacist who will happily help you, or make an appointment to discuss them with your GP. The chances are it will be something easily treated and managed.”

Complete Article HERE!

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Big Bowel Blues

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Name: Perth Guy
Gender:
Age: 50
Location: Perth Australia
Hey Dr Dick,
I am going to have surgery to fix Diverticular Disease by removal of the sigmoid colon, which may result in a temp or perm stoma (Colostomy). If it’s a permanent colostomy bag I know they basically remove your rectum, so no more anal sex. If it’s a temp stoma/colostomy bag can you still have anal sex? (whilst you rectum is “disconnected from the colon) If they are able to reverse it later and connect the transverse colon to the rectum is it still possible to have anal sex? I don’t know who to ask this very strange question – its not a question you can ask around ” do you have a colostomy – do you have anal sex?”

Hey thanks for your message, Perth Guy. Sorry to hear you’re feeling poorly. For those of us unfamiliar with diverticular (say: die-ver-tick-yoo-ler) disease, it affects the large intestine, or colon. It’s caused by small pouches that form, usually on the wall of the last part of the large intestine — the sigmoid colon. These pouches are called diverticula, don’t ‘cha know.

The terms ostomy and stoma are general descriptive terms that are often used interchangeably though they have different meanings. An ostomy refers to the surgically created opening in the body for the discharge of body wastes. A stoma is the actual end of the small or large bowel that is arranged to protrude through the abdominal wall.

I know it’s difficult to find helpful information about sexual concerns, like butt fucking, when facing a radical and disfiguring medical procedure like a colostomy. Our culture has such difficulty talking about sex even as it applies to healthy folks, it’s no wonder we fail those of us who are sick, maimed, or disabled. I did, however, find a resource for you, Colostomy Pen Pals. http://www.ostomy.evansville.net/ocncolostomy.htm

I suspect that you’ll not readily find the specific information about anal sex that you are looking for on that site. But here’s where you can do yourself and all your fellow ostomy patients a good turn. I want you to march right over to Colostomy Pen Pals and any other ostomy resource you might find online and just come out with it. Just like you did when you wrote to me. You know that if you have a concern about anal sex post surgery, there are a shit-load of others (you should pardon my pun) out there who share your concern and interest and may have first-hand information to share.

Probably, there a lot of other folks who are too timid to ask or share about this concern. So instead of stewing in your isolation and lack of information, why not take the initiative and break open the topic yourself. If you’re gonna wait around for someone else to broach the issue, when you won’t, you’re gonna die waiting, my friend.

And if you think the information you are looking for will come from the medical industry, you really have to wake up and smell the coffee, my friend. The best resource you’re gonna find is gonna be others in the ostomy community. Those folks, who are similarly challenged as you, will be the front line of the information you seek. But like I said, if you fail to put out there what you want, you can be sure no one is gonna spoon feed it to you.

So while it is true what you say: “its not a question you can ask around to the general public do you have a colostomy – do you have anal sex?” It is a very appropriate question to be asking the ostomy community. And if you find resistance in that community for bringing this pressing sexual concern there, stand your ground, darlin’!

And just so you don’t think I’m ducking the question, my experience with ostomy patients suggest that it may very well be more of a question of wanting to have anal sex post surgery, than the ability to do so. I guess you’re just gonna have to wait and see for yourself. Keep me posted and I’ll keep our audience posted on this too.

Good luck

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5 problems sex can (probably) fix

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Everyone’s sex life hits a slump, but if you’re feeling blah, try out these sexy ideas.

By Kimberly M. Aquilina

Lazy please-don’t-smell-my-breath morning sex. Make up sex. Christening your new apartment sex. Sloppy, dirty-talk-fueled drunk sex.

We can make sex fit into whatever situation we’re in, but can it be a quick fix?

“Sex can be a tremendous resource for managing emotions, coping with stress, reducing heart rate, regulating breathing, grounding yourself in the present and connecting with others,” Angie Gunn, clinical social worker and sexuality expert at Talkspace, told She Knows. “Sex can also be a resource for more complex challenges like relationship conflict, boredom or feeling distress in your life.”

OK, so the tango-for-two can’t fix all. Remember the rumors that Jennifer Garner and Ben Affleck were thinking of having a fourth child to save their marriage? That’s an example of something sex can’t fix.

But below are some things it can fix (and if it doesn’t work, at least you’ll have fun trying!)

You and your lady have been bickering.

If you or your partner are feeling nitpicky and are squabbling a lot, try an amped up — and a little kinky — activity to release the stress.

“This can include mutual spanking, hard and enthusiastic penetration and even a bit of BDSM if that’s something you both agree to try,” Coleen Singer, sexpert at Sssh.com, an erotic entertainment website for women, told She Knows.

“The sheer physicality of rough sex can shed some built-up emotional tension between you. Just be careful not to go overboard with this technique and establish a safe word so you can put on the breaks if anything becomes uncomfortable or painful.”

Even in the most intense BDSM play, consent and respect are key. And don’t forget the aftercare! After a rigorous romp, be sure to shower each other with gentle affection and bask in the afterglow together.

 

One (or both) of you have P.M.S.

Studies have shown that the “feel-good hormones” like oxytocin released during sex can help alleviate pain.

“Period cramps put your body under a lot of stress, leading to more pain and mood swings,” Singer told She Knows. “When we orgasm, the body releases oxytocin and dopamine along with other endorphins that can ease any PMS and period-related pains. Those hormones are far stronger than any over-the-counter painkillers.”

Your sex life has lost some of that “oomph.”

No matter how much you love each other, sex can become routine, boring and less of a priority. Bring back that spark with some role playing.

Get dressed up like you would when you were single, go to a bar (or coffee shop) and pretend you are complete strangers. Introduce yourselves, flirt and buy a round of drinks.

Bring sexy to the max and spring for a hotel room to invoke the feel of a forbidden one-night stand.

 

Stress has turned your vagina into a desert.

Stress can zap libido, but it can also give you a jolt better than a 2 p.m. protein bar or coffee break.

If you know you’re going to have a busy week, start your day with a quickie to alleviate anxiety. Your coworkers will be in awe at how cool and collected you stay while facing deadlines.

You’re just in a funk.

If you just feel blah and need some excitement in your life, make a sex life bucket list. Having sex outdoors, roleplaying or trying a new position can give you that extra pep in your step. The orgasms help, but just having something to look forward to can pull you out of your slump.

 

Complete Article HERE!

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Why Embracing Your Sexuality (Fetishes & All) Makes You A More Attractive Partner

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Growing into our sexual selves is a lifelong process, like growing up in general. But because we don’t have a lot of language for our sexual lives, we somehow erroneously expect that sex is something we are born knowing how to do. Like any other physical and emotional skill, our sexual capacity to both give and receive pleasure increases with education and practice.

We begin waking up to our emerging erotic consciousness in our early adolescence. This awakening process is mostly subconscious, as our maturing brain connects the powerful arousal mechanism to historic and unresolved painful events and relationships. Like our fingerprints, or the subtle distinctions in our sense of smell—what turns us on sexually is largely outside of our control and often contradicts the way we view ourselves outside of the bedroom.

With that in mind, it’s no wonder that the first and often the most persistent issue for most of us on our sexual journey is reconciling our interests with our sense of what is “normal.” Quite often, sexual discovery tests the boundaries of normalcy. Our sexual selves are the unique, wild streak in us that cannot be contained and whose full pleasure potential cannot be achieved if we try to rein it in.

“Most people are mirrors, reflecting the moods and emotions of the times; few are windows, bringing light to bear on the dark corners where troubles fester. The whole purpose of education is to turn mirrors into windows.” —Sydney Harris

Instead of healthy dialogue and reliable information about what it means to become and embrace who we are sexually, our curiosity and confusion about emerging sexuality are often met with archaic teachings, generational discomfort from those we trust, misinformation from our peers, and a complex cultural obsession.

The majority of us never have the opportunity to adequately explore the questions that arise from our earliest adolescent erotic awakening. Maturing beyond our initial discomfort requires education, and real sexual education is hard to come by.

For many young people, low-grade anxiety prevents them from engaging in any real conversations, whether with a friend, doctor, or even their partners about their fears and the obstacles they face sexually. Often, even the more progressive will turn their sexual concerns into a joke, laughing at their discomfort and communicating either that sexual concerns are not to be taken seriously or at least not to be discussed seriously.

What we suppress becomes more powerful. Suppressing our sexual nature only exacerbates our preoccupation with it. Asking honest questions about our sexual selves and being able to get reliable information allows us to use sexual privacy in healthy ways. Studies show that the kids who are given the most sexual education are often the last ones to engage sexually. They don’t need to learn about it by doing it—their theoretical learning allows them to make healthy choices about when and with whom they want to do it.

People who have come to terms with this essential aspect of their being are happier and more satisfied in every other aspect of their life as well.

Likewise, adults who move beyond their adolescent sexual anxiety through education gain not only the courage to take ownership of their erotic preferences but also the skills to engage in sexual behavior that is consistently pleasurable. Sexually mature adults are not waiting for someone else to make them feel sexy or give them permission to explore the range of their sexual function.

Taking full responsibility for their own sexual needs allows them to also be truly responsive to the sexual needs of others, which makes them attractive partners that tend to stay partnered. Aspiring to sexual maturity evokes a host of other essential skills for life—sexually mature adults tend to also be emotionally intelligent and capable of dealing with life changes.

Our sexual selves are often perceived as a locked box of bizarre fantasies and out-of-control impulses toward carnal pleasure. While it’s true that a mature sex life employs these tools for pleasure, working at our sexual evolution is more like developing core strength. Because our erotic identity is so central to who we are, people who have come to terms with this essential aspect of their being are happier and more satisfied in every other aspect of their life as well.

Complete Article HERE!

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