Tag: Sexual Health

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What doctors wish patients knew about getting a vasectomy

By Sara Berg, MS

When discussing reproductive health choices, one procedure has been gaining attention—especially since the fall of Roe v. Wade—for its effectiveness: the vasectomy. As individuals and couples explore long-term contraception options, vasectomies have emerged as a popular choice for those seeking a permanent solution—rates have increased by 26% in the past decade. With its relatively low risks and high success rates, this procedure is reshaping conversations about family planning.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.

In this installment, three physicians took time to discuss what patients need to know about getting a vasectomy. These AMA members are:

  • Jason Jameson, MD, a urologist and chief of urology at the Phoenix Veterans Affairs Medical Center, who serves as a delegate for the American Urological Association in the AMA House of Delegates.
  • Amarnath Rambhatla, MD, a urologist at Henry Ford Health and director of men’s health at the Vattikuti Urology Institute in Detroit.
  • Moshe Wald, MD, a urologist at the University of Iowa Hospitals & Clinics and an associate professor in the department of urology at Carver College of Medicine in Iowa City.

Henry Ford Health and University of Iowa Hospitals & Clinics are members of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

There are seasonal spikes in vasectomies

“We sometimes see seasonal spikes in vasectomies. We see it in March and then also in November and December before the end of the year,” Dr. Rambhatla said. “We think it spikes at the end of the year because everyone has met their deductible for the year.

“In March, it’s been loosely associated with March Madness, he added, noting “the running joke is that men get their vasectomy around the NCAA basketball tournament and ask their wives for permission to lay on the couch for four straight days so they can watch the basketball tournament.”

“The other interesting thing we’ve seen is with the Roe v. Wade reversal. There are studies showing an increase in Google trends, searches and consultations for vasectomies after that,” Dr. Rambhatla said. “So, it seems like some men are more inclined to be in control of their fertility status after that ruling.”

It’s a minor surgical procedure

“A vasectomy is a minor surgical procedure, which is aimed at eventually achieving permanent birth control,” said Dr. Wald, noting “the procedure is typically performed in a clinic setting under local anesthesia, which means injection of numbing medication into the area.

“However, in some cases, based on anatomy and on the patient’s preference it could also potentially be done in the operating room under sedation or general anesthesia,” he added. “But the vast majority are being performed  in the clinic under local anesthesia.”

“The procedure involves the surgical interruption of a tube called the vas deferens. The vas deferens is the tube that drains sperm from the testicle outwards and a man typically has two of them, one on each side,” Dr. Wald said. “So, the idea is to interrupt these tubes, and then allow enough time for  the sperm that at the time of the vasectomy was already beyond the vasectomy site to wash out.”

The procedure “usually takes about 20–30 minutes. One or two small cuts are made in the scrotum with a scalpel or no-scalpel instrument,” Dr. Jameson said, noting “the vas deferens are cut and tied or sealed with heat. The skin may or may not be closed with sutures.”

But “if the vas deferens are not easy to feel due to body characteristics—obesity, previous scarring—the procedure may be more challenging to perform,” Dr. Jameson noted.

It’s OK to drive yourself home

“Most of the time patients are OK to drive themselves home after the procedure. Occasionally I’ll have some patients who are a little nervous or anxious about getting a vasectomy,” said Dr. Rambhatla. “So, we can prescribe them medication to help calm down their anxiety for the procedure.

“In those situations, they need to have a driver with them because that medicine can alter their ability to drive,” he added. “Otherwise yes, you could drive yourself home.”

Don’t be nervous, it’s straightforward

Patients “should definitely relax. It’s a straightforward, easy procedure,” said Dr. Rambhatla. “The most common feedback I get from men after the procedure is: Oh, I thought it was going to be a lot worse than that.”

“Sometimes their friends will mess with them before the procedure and say it’s going to be a terrible experience and it is just good old fun,” he said. “But most of the time, people say it wasn’t so bad and they had nothing to worry about.”

Follow up requires a semen test

A vasectomy is “not immediately effective. If you can imagine a tube through which sperm is passing, the vasectomy is basically occluding that tube so sperm isn’t passing through anymore, but there’s still sperm on the other side of that tube we’ve occluded,” said Dr. Rambhatla. “And so, all that old sperm needs to be cleared out for men to become sterile.”

“We check a post-vasectomy semen analysis about three months after the procedure to make sure all that old sperm has been cleared out,” he said. “And sometimes some men may take longer, so it can take up to six months or so to clear out all the old sperm.”

Vasectomy is very effective

It is important to note that a “vasectomy would never provide a 100% guarantee. The only way to reach a 100% guarantee of no pregnancy is simply to avoid sexual intercourse altogether,” said Dr. Wald. “Even after a man gets a vasectomy and later gets a semen test that will show no sperm cells in the semen, there is still a very small risk for an unwanted pregnancy in the future.

“That risk is estimated in many studies at one in 2,000, which is, for example, much better than condoms. But it’s not zero and never will be,” he added. “That risk of roughly one in 2,000 by most series is after a man has a post-vasectomy semen test that showed no sperm. If somebody had unprotected sexual intercourse after a vasectomy before having such semen test at all, his chances for pregnancy could be close to 100%.”

This is meant to be permanent

“The best candidates for a vasectomy are couples who are done having kids or men who may be single and know that for sure they do not want any kids in the future,” said Dr. Rambhatla. That is “because we do consider it a permanent form of sterilization. It can be reversed, but really we want people going into it with the idea of permanent sterilization.”

Dr. Wald agreed, emphasizing that “If there’s any question about that, then I would advise against the vasectomy at that particular time.”

Vasectomies don’t always work

“There is a risk of failure. Even if done by an experienced physician, vasectomies could fail. Not necessarily due to surgical error—which is a possibility,” Dr. Wald said, noting “there have been multiple studies that showed the potential reconnection that can happen.”

“Sometimes there could be microscopic channels that can sprout from one end of the interrupted tube and at least in a transient manner allow for some sperm to sneak into the other side,” he said. “The risk varies a lot depending on if the patient had or did not have a semen test following the vasectomy that was negative for sperm. If he did that, his risk for such failure is very small.”

It may be covered by insurance

“Most private insurers cover some or all of the cost of vasectomies,” Dr. Jameson said. “For men without coverage, various self-pay options may be available in certain local facilities.”

“It’s a lot cheaper for insurance to pay for men to have a vasectomy than pay for them to have another child,” noted Dr. Rambhatla, emphasizing “most insurance companies are happy to cover a vasectomy.”

Vasectomy reversals are complicated

“Vasectomies are theoretically surgically reversible. The problem is that vasectomy reversals are a very different thing,” Dr. Wald said, noting that “vasectomy reversals are true surgery performed in the operating room. It is very expensive if not covered by insurance and it does not always work, even if done by an expert.”

The success of a vasectomy reversal “depends on various factors such as how long it’s been since the vasectomy, what your fertility status was prior to the vasectomy and what your partner’s fertility status is,” said Dr. Rambhatla. “Because sometimes we see men with new partners who may have different fertility potential than their previous partner or now their same partner is older, and her fertility potential has changed.”

“And the closer you are to the vasectomy period, the better success rates with the reversal,” he said. “Generally, if this is done within 10 years, there’s a good chance that we can get sperm back in the ejaculate. But sperm in the ejaculate doesn’t necessarily translate to a pregnancy.”

There is a risk of bleeding

“From the surgical standpoint, this is a fairly small procedure, so the risks are not to the magnitude of anything life threatening, but there are certainly risks that are worth mentioning,” Dr. Wald said. “There are the most obvious risks of bleeding and infection. Bleeding, if it happens, is not even close to being anything life threatening.

“Such bleeding happens not externally, but rather internally into the scrotal sac and it could cause bruising, swelling and patient discomfort, and it can take a few weeks to gradually absorb,” he added. “It typically involves the surgical wound or the skin, but sometimes can be deeper and even involve the testicle. These are almost always managed by antibiotics, but it’s a risk.”

“The risk of bleeding with vasectomy increases with blood pressure,” Dr. Jameson said. That’s why it is important to have blood pressure controlled before getting a vasectomy.

Watch out for abnormal pain

“What is not that obvious is the risk of chronic testicular pain. I’m not referring to the obvious post-procedural pain, but a chronic condition that can last months, years or even be there for life,” Dr. Wald said.

According to the American Urological Association, about 1% to 2% of men may experience ongoing pain or discomfort, explained Dr. Jameson. The pain is often treated with anti-inflammatory medications such as ibuprofen.

“This chronic type of pain is a treatable condition, but in some men such treatment could involve surgery that could be bigger in its magnitude than the original vasectomy,” Dr. Wald said.

Men can develop antibodies to sperm

“Not all, but most men who undergo a vasectomy do develop antibodies to sperm. This is because sperm is typically separated from the immune system,” Dr. Wald said. “However, a vasectomy is one of the most common causes where sperm is exposed to blood  and the immune system, and that could lead to the formation of anti-sperm antibodies.”

“This is not something that is posing a general health concern and patients will not feel it,” he said. “But the problem is that if somebody does seek fertility later in life and undergoes a vasectomy reversal, even if the vasectomy reversal works, these antibodies do not go away and can coat sperm, slow sperm down and impair its function.”

It should not affect sex

“A vasectomy does not change sexual function. It does not protect against sexually transmitted infections,” said Dr. Rambhatla. “It’s simply a way to prevent sperm from coming out in the ejaculate.”

Additionally, Dr. Jameson noted, according to the Urological Care Foundation, that a vasectomy should also not cause any erection problems—ejaculations and orgasms should feel the same. And while there is no sperm, the amount of semen does not decrease more than 5%.

Avoid extensive activity

“Typically, if the procedure is done towards the end of the week, then the patient can simply take a long weekend and then plan to go back to work Monday,” Dr. Wald said. “It’s not something that requires you to be in bed, but definitely avoid extensive physical activity.”

That means “no heavy lifting, running. Any gym type activities should be refrained from,” said Dr. Rambhatla, noting that “walking is OK. Just no strenuous activity.”

Additionally, “men with more activity and heavy lifting at work may need more time off as you should avoid heavy lifting for a week,” Dr. Jameson said.

Address pain control

“In terms of pain control, usually most people do well with alternating between Tylenol and ibuprofen as needed,” said Dr. Rambhatla, adding that icing for the first couple days also helps.

Patients can “resume sexual activity once the pain and swelling have resolved,” he explained.

Wear snug underwear and ice area

After a vasectomy, it is common to have swelling and minor pain in the scrotum for a few days, Dr. Jameson said, noting that “wearing snug underwear or a jockstrap can help ease discomfort and support the area.”

Additionally, “patients are typically asked to wear a jock strap with a pretty bulky dressing for 48 hours, and also to ice the area intermittently for 48 hours,” Dr. Wald said.

There are other forms of contraception

“Other birth control methods include condoms or birth control pills for females,” Dr. Jameson said, noting “both of these methods are effective but must be consistently used, and the one-time cost of a vasectomy may be cheaper over time than the cost of other birth control methods.”

Additionally, “tubal ligation in females is another surgical option for birth control and is performed by gynecologists,” he said.

Complete Article ↪HERE↩!

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When Makeup Sex Isn’t a Good Idea

By Myisha Battle

A client who is new to dating, sex, and relationships recently asked me “Is makeup sex healthy?” The person, in their late 20’s, has been dating someone seriously for the first time. Things were progressing slowly sexually with his girlfriend, so their question about makeup sex struck me as a great one to ask before ever having the experience firsthand.

We discussed the pros and cons of having an argument that ended with sex, and I explained what I’ve seen as a sex coach. On one hand, it can feel really good to reconnect with a partner after a challenging discussion or verbal disagreement. Sex can be the ultimate display that the fight is over, allowing both partners to move on without any lingering ill will towards each other. On the other hand, makeup sex could be masking deeper issues in the relationship if it’s an ongoing strategy used to resolve conflict in the relationship.

Makeup sex feels like somewhat of a cultural phenomenon. We know it happens, and maybe it’s even happened in our own relationships. But, is it a good thing or something that should be avoided at all costs?

A quick scroll on TikTok reveals a wide range of opinions on the subject. Some people strongly advise against it as it could reinforce bad behavior from your partner. Many posts lean more towards the commonly held belief that makeup sex is a great way to bond after an argument. Other posts suggest that there is something qualitatively different about makeup sex, that includes a heightened state of emotions that you just can’t get to without a fight beforehand. And it’s true that people who see makeup sex as more intense feel a carryover effect from their fight in the sexual experience that follows. This is called “excitation transfer,” which is when you are physiologically aroused by one thing and it transfers over to other areas of your life.

But there’s more to makeup sex than this. A 2020 study of 107 newlywed couples shed some light on what the benefits of makeup sex really are and how sexual quality is impacted by conflict. The study showed that when sex occurred after a flight, it had a greater impact on how people felt about the relationship by reducing the negative effects of conflict. This seems to coincide with the view that makeup sex is a way to feel closer to their partner. What’s surprising is that the study also showed that participants reported that the quality of sex after a fight was actually worse than the sex that occurred without a fight. So even though the sex itself wasn’t perceived as great, there were longer term emotional benefits for the relationship. This helps debunk the assumption that makeup sex is somehow just better than other sex. It also shows the real benefits of sexual connection after healthy conflict.

Where makeup sex gets tricky, though, is when it is used as the sole means for conflict resolution. Given that sex is one of the many ways we bond, it can be seen as an easier way to shift from negative emotions that are stirred up in a flight. But those negative emotions may still be there even after you have sex if you don’t take the time to process them yourself and with your partner. I’ve worked with couples where this dynamic is present and it can become very toxic over time. Feelings pile up that only get relieved through sex, which isn’t necessarily all that satisfying or pleasurable for one or both parties. There can be an aversion to sex for this reason and then feelings have nowhere else to go. This can cause ongoing tension at the least or periodic blow up fights at worst. As a result, people usually have to work with a couple’s therapist to develop healthy conflict resolution skills and be better communicators in general.

There is also a risk of having the perception that the relationship is on solid ground when it isn’t. I’ve heard from people that they have sex regularly, but feel stuck when it comes to day-to-day, non-sexual intimacy with their partner. When sex is the de-facto way to express emotions—joy, sadness, anger, or grief—there can be a lack of emotional closeness in the relationship. Makeup sex could be one way to avoid connecting with each other more deeply, resulting in what looks on the surface like a healthy relationship but is actually one without true intimacy.

Intimacy isn’t just the sex you have with your partner. It’s the ability to recognize the need for healthy conflict and repair. If you are in a healthy relationship where conflicts come up and are worked through, makeup sex can make you feel closer to each other. It’s a way to deepen the intimate connection that’s already there because you made it through something hard together. But it can’t— and shouldn’t—be the only way we connect with our partners. It’s just the cherry on top.

Complete Article ↪HERE↩!

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I’m not surprised women prioritise sleep over orgasms

— A survey has found that more than 85 per cent of women would choose a good night’s sleep over having an orgasm. I understand why

By Bryony Gordon

My friends and I have a game that we like to call “Eight Hours’ Sleep Or…” It’s not a particularly imaginative name and certainly won’t keep the creators of Pictionary or Scrabble up at night, but it’s as good a way as any to while away the spare two and a half minutes we tend to catch between work and parenting.

The idea of the game is to find something you would rather have than eight hours’ sleep a night. It goes something like this:

“Eight hours’ sleep or being best friends with Taylor Swift?”

“Eight hours’ sleep.”

“Eight hours’ sleep or being pursued by Brad Pitt?”

“Eight hours’ sleep.”

“Eight hours’ sleep or an end to mansplaining?’

“Eight hours’ sleep.”

“Eight hours’ sleep or being able to eat all the cheese without any negative impact on your health?”

“Eight hours’ sleep.”

“Eight hours’ sleep or an unlimited supply of confidence and money?”

“Eight hours’ sleep.”

And so on and so forth until you realise that nothing on God’s Earth will ever trump the idea of eight uninterrupted hours of sleep, of waking up feeling rested, recovered and raring to go into the day ahead.

It has been a relief, then, to discover that my group of friends and I are not alone. A major survey of bedroom habits by Good Housekeeping magazine has found that more than 85 per cent of women would choose a good night’s sleep over having an orgasm. Only 52 per cent of men feel the same way, perhaps because of the “gender sleep gap” –  yes, there is such a thing! – with 61 per cent of women saying their sleep quality varied, compared with 53 per cent of men.

Anyway, I think what we can all take from this is that sleep is very, very hard to come by these days. Stress, hormones, the lure of sitting up late at night scrolling through a little screen that sits in the palm of your hand and contains all of the horrors of the world… and then there’s the fact that sleeplessness has become a sort of status symbol, a way of telling people to back the hell off and go easy on you without actually having to tell people to back the hell off and go easy on you.

Saying “I’m tired” over and over and again is the most wonderfully passive-aggressive way of signifying you are busy and pressurised and do not have time for the trifling trivialities everyone seems to be bringing to your doorstep. We say we want eight hours’ sleep, but do we really? If we had eight hours’ sleep a night, then what would our excuse be?

Personally, I’m done with being sleepless in south London. It’s so boring talking about how tired I am all the time, such a waste of energy in itself. And in the past year, I have realised how counter-productive my obsession with sleeplessness is. The more I worry about sleep, the less I actually sleep.

I realised this last spring, when I spent a couple of hundred quid on an Oura ring, which is a sleep tracker that wellbeing experts swear by. Every night, I went to bed in it, and got annoyed by the flashing red and green lights that seemed to emanate from it in the dark. Every morning, I woke up and looked with horror upon the graphs that told me how exhausted I was, and what this might mean for my long-term health (nothing good). Eventually I realised that the presence of the tracker was in itself having a detrimental effect on my sleep. It was fuelling my insomnia, so I took it off, and decided to take radical steps to actually prioritise sleep, as opposed to just talking about the lack of it in my life.

Now, I devote the evening to sleep. I have sacrificed what remained of a social life for it. I don’t go out. I refuse all dinner invitations, choosing instead to eat early with my 10-year-old. I am in bed before her, my phone switched off and on charge, a good book in my hands as I get comfortable in my 200-thread-count Egyptian cotton linen. My friends know that if they text me after 8pm, they are unlikely to get an answer until the next morning. I spend at least 90 minutes reading, and have usually drifted off by 11pm.

I have rules: no more than one coffee a day, and never later than 11am; if I wake in the middle of the night, reading for 15 minutes is a much more effective tool than simply closing my eyes and trying to get back to sleep; my own duvet is essential, as I like to turn it round again and again to find the cool side; and if my husband starts snoring he is immediately out and into the spare room. 

This may seem draconian, but I don’t care. Because nothing – and I mean nothing – is more important than a decent night’s sleep.

Indeed, now I am in my 40s and in menopause, I can see that it is the most important thing of all when it comes to emotional well-being. You can go on anti-depressants, you can sign up for therapy, you can do as much exercise as you want: but if you are not prioritising rest, the chances are you will not start to feel better. It doesn’t have to be eight hours. But in my experience, anything below six and you are going to struggle. You are going to be cranky, short-tempered and extra sensitive. Any resilience you have will be gone by mid-morning. There will likely be tears. This is nothing to be ashamed of: it’s just simple, human biology.

Of course, I suspect many women would sleep much easier if they knew they lived in a world where they were entitled to both eight hours’ kip a night and an orgasm. But that’s another column entirely, and until that moment comes (pardon the pun), you’ll find me of an evening tucked up in bed in my nightie, sipping on a nice mug of Ovaltine.

Complete Article ↪HERE↩!

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Is it ethical to watch AI pornography?

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If you’re in your 20s and 30s, you probably watch pornography. Millennials and gen Z are watching more pornography than any other age group and are also more likely than any other demographic to experiment with AI pornography.

As technology advances, AI-generated tools and techniques are becoming increasingly sophisticated and accessible. This can lead to unethical content, including deepfakes – videos in which a person’s face is replaced with someone else’s likeness, without their consent. Social media platform X (formerly Twitter) recently faced a scandal when it became awash with deepfakes of Taylor Swift.

But what about other kinds of AI pornographic content? How can consuming it affect you, and how can you make sure that you’re consuming it ethically? I’m a sex and relationship therapist, so I’m interested in helping clients with various sexual issues, including porn consumption problems. I am also curious about the ways AI could be used positively to create pornography that is not only ethical, but educational and sexy at the same time.

The impact of watching AI porn

While it’s perfectly normal to be curious about sex, watching a lot of pornography can affect your sexual satisfaction – and AI porn is no different. You might, for example, start comparing your partner to the hyper-realistic, but impossibly perfect, digitally generated actors of AI porn.

Already, research suggests that men who frequently watch online porn may experience erectile dysfunction. This could be due to the idealised unrealistic portrayals in pornography compared to real-life sexual encounters. AI pornography would likely only exacerbate this, with AI porn avatars able to participate in sex acts that wouldn’t be possible, or as accessible, for real people.

Among women who watch porn, opinions vary. Some women have noted positive changes, including a reduction in the shame associated with sexual pleasure. But others have expressed reservations about the beauty standards in pornography, finding them unattainable.

This stance is very much shared by anti-porn campaigners, who claim that porn degrades and objectifies women. They believe it feeds into ideas of male supremacy, potentially leading to violence against women.

Regulating AI pornography

The roles women are given within mainstream pornography often portray a different power imbalance than, for example, gay male porn. For this article, I spoke to porn actor John Thomas. He argued that gay male porn was somewhat more ethical than mainstream straight porn which is [made for men to consume]. “Both roles in a gay scene might be appreciated by the viewer, rather than the pure objectification of the woman in a straight scene.”

One of the many concerns with unregulated AI-generated pornography is that it can distort a viewer’s sense of reality, leading to misinformation, unrealistic expectations around sex and potential harm. However, since the moral landscape surrounding ethical AI porn is a grey area, we are pushed into uncharted territory. As new technology emerges, new challenges arise.

To ensure responsible innovation within the adult entertainment industry, it’s essential to be aware of AI’s ongoing integration into our daily lives. For example, risks could be mitigated by training AI systems to recognise deepfakes, violence or child pornography.

For actors in the adult entertainment industry working pre-AI, consent has always been key. I asked John Thomas about best practice in the industry:

When working for a porn studio [as a freelance worker], I sign a contract which typically includes clauses relating to rights to my image – usually I am signing to give the studio the right to use, and alter, my image [from the photos or video created] and distribute it. AI is not specified in any contract I’ve signed.

But since AI porn is expected to become more mainstream, the topic of consent becomes more ambiguous. As John Thomas adds: “I think one could interpret the contract to include AI … the contracts are written in such an expansive way that, having signed away the rights to your image, and consent to your image being altered, it could [hypothetically be used in AI].”

How to be an ethical porn consumer

Just as there are fair trade brands known for their ethical practices in producing coffee and clothing, there should be a safe space for consumers to explore their sexuality and fantasies.

As a porn viewer, you can be more ethical in your consumption by becoming porn literate, improving your understanding of realistic sexual expectations, gender identities, sexual orientations, relationship styles, kinks and ethical BDSM practices.

And if you decide you want to watch AI porn and want to minimise the risk of consuming unethical content, here are some tips to help enhance your porn literacy skills:

• consider joining online communities where discussions about “feminist porn” and sexualised content are open and encouraged

• if you are a fan of a particular porn actor, consider following them on social media. This will provide you with some insights into their performance activities and their preferred ways for you to access their content

• when coming across porn sites, take a moment to assess if they are recognised for ethical production practices. Some established sites are known for their commitment to ethical pornography. Typically, the ethical emphasis will revolve around aspects such as production standards, consent, representation of diverse body types, genders and races, portrayal of safe sexual practices and prioritising the enjoyment of all involved

• keep in mind the difference between fantasies and real sexual encounters when watching porn. Remember that what you see online may not translate to real life

• keep a close eye on your porn consumption. If you sense it’s becoming overwhelming, or impacting your daily life or sexual experiences, don’t be ashamed. Seek support from a professional, such as a sex therapist.

Complete Article ↪HERE↩!

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How My Sex Life Changed After My Breast Cancer Diagnosis

By Molly Longman

On Dec. 2, 2015, Erin Burnett was two days out from her wedding and existing in the buzzy state of bliss that’s reserved for people who are very much in love. That morning, as she was happily daydreaming in the shower, she noticed something was different about her left nipple. She took a closer look — it seemed to be inverted. She felt an immediate chill; the sudsy water suddenly felt like ice.

She called her doctor, who said Burnett could come in during her lunch break to get her breast checked out, just as a precaution.

After some testing, the doctor told Burnett to come back after her wedding day. She tried to put the experience out of her mind until after the ceremony. Just 12 days after tying the knot, at 28 years old, Burnett got the call. She had stage II, triple-positive, invasive ductal carcinoma. Her honeymoon would be cut short.

The diagnosis impacted Burnett’s life in myriad ways — but a major factor was the impact on her sex life. “I had a brand-new marriage, with no honeymoon phase,” she remembers. “I used to joke around with my friends and say: ‘You guys are having these crazy sex lives where someone pulls your hair, while my husband’s picking my hair up off the ground.'”

Burnett underwent a double mastectomy and a hysterectomy, which induced what’s known as medical menopause. “I didn’t know until it happened that I was gonna have vaginal atrophy, vaginal dryness, pain with intercourse, lack of lubrication, and lack of libido [following the hysterectomy],” she says. She also faced emotional hurdles, especially as she coped with losing her breasts and went through painful attempts at reconstruction.

Throughout the treatment process, Burnett and her medical team were so focused on saving her life that her quality of life often took a backseat. In particular, the quality of her sex life was not top of mind for her or her providers.

This is a common refrain from cancer survivors, who say that the medical establishment tends to leave out or breeze through conversations about the ways cancer can impact your sexual health, especially because they’re rightfully so laser-focused on keeping you alive. But this can have serious ramifications for people’s sexual health, mental health, and relationships, says Ericka Hart, MEd, a sex educator and breast cancer survivor. “They’re usually not concerned about the ways that you are gonna experience pleasure in the future, they just want to fix you — and in their mind, cancer is the issue they’re fixing,” they say.

This often puts the onus on patients to bring up questions about how their diagnosis and treatment will affect their sexual health.

Anna Crollman, a 37-year-old breast cancer survivor from North Carolina, remembers feeling incredibly nervous about asking her provider about the sexual side effects, such as painful intercourse, she was experiencing during and after her treatment. “I like to call it the ‘doorknob question’ that you squeeze in right when they’re about to leave and their hand’s almost on the door,” she says. “You say: ‘Hey, just one more thing.'”

But if sexual health is brought up earlier and more often by providers, it’s not only easier for patients to discuss their issues when they’re ready to do so, but also for them to find more satisfaction with sex in the long run — and to feel less alone, says Don S. Dizon, MD, a professor of medicine at Brown University and director of the Sexual Health First Responders Clinic at Lifespan Cancer Institute.

It’s common, especially for women and nonbinary people, to blame themselves for sexual health issues and feel they have to suffer alone. “Most of the people I see feel like they’re the only ones going through this,” he says. “When I tell a person, ‘This is really common,’ there’s a weight lifted off their shoulders because [until then,] they think they’ve done something wrong.”

But patients shouldn’t be deterred from seeking information about improving their sexual health, despite cancer, and they shouldn’t have to work up extra courage to get answers. As Dr. Dizon puts it: “everyone deserves a sex life.”

The Physical Impacts Cancer Can Have on Sex

Breast cancer treatments can dampen physical desire in several ways. Breasts are an erogenous organ, Dr. Dizon says, and oftentimes a mastectomy is required as part of treatment. “The loss of breast-specific sensuality is something everyone will go through to some degree,” he says. “The process of naming that is really important, because people don’t consciously think of the breast as a sexual organ, and it is.”

Meanwhile, for those with hormone-positive breast cancer, doctors often prescribe drugs called aromatase inhibitors that lower estrogen levels, causing medically induced menopause. “These notoriously have a negative effect on sexuality, whether it’s vaginal dryness, painful activities, or loss of desire,” Dr. Dizon says. “Chemotherapy can also harm body image, because people gain a lot of weight, and it can cause neuropathy and physical side effects like nausea and diarrhea.”

As patients know, these physical impacts can take a real toll.

Shonté Drakeford, a nurse practitioner and patient advocate in Maryland, was diagnosed with stage four metastatic breast cancer in 2015, after being dismissed by providers for six years when she presented with symptoms. Drakeford says that before her diagnosis, her sex life with her high school sweetheart was “amazing.” For the first two years of treatment, she had no major sexual side effects, though she had to be careful about what positions she took part in, as the cancer had spread to her lungs, lymph nodes, ribs, spine, and left hip. “I asked my doctor what I could do that wouldn’t harm me, physically, because I was fragile,” she remembers. “He got all red and was embarrassed to answer.”

About three years into treatment, Drakeford noticed that her libido had lessened, and she was experiencing vaginal dryness. “Even though, mentally, I wanted to [have sex], my mind and vagina didn’t connect,” she says. “It was like a slow transition into a menopausal state.” This was due to her treatments, which she couldn’t stop. “I’ll be on treatment forever; this is lifelong for me,” she says. “I wish they had Viagra for women.”

Drakeford’s doctors told her that vaginal estrogen therapy — which some menopausal people use to help with some sexual side effects — wasn’t an option for her; her cancer was hormone-positive, so it essentially fed on hormones like estrogen. “It’s all about safety,” Drakeford says. “Am I willing to risk my health for sexual satisfaction?”

Cancer Can Cause Mental Health Barriers to Satisfying Sex, Too

Beyond these physical questions, mental hurdles are also prevalent amid cancer treatments. Many of us have ideas about what sex “should” look like, and those are challenged by a life-changing diagnosis like cancer, says Emily Nagoski, PhD, a sex educator and author of “Come as You Are” and “Come Together.”

Hart says that they felt “disconnected from their body” after their cancer diagnosis, something that they believe to be common for other survivors, but that looks different for everyone. As they were being treated for breast cancer in 2014, they struggled with how their body was constantly being touched, especially by white medical staff. Hart, who is Black, found that this challenged their understanding of bodily autonomy and lead to them distancing themself from their romantic partner, who was white. “I didn’t want a white person to touch me sexually,” they remember.

Hart says that something else shifted following their mastectomy: they felt like people could no longer see them as a whole person — they only saw Hart’s illness. At one point in their healing process, Hart went topless in public, baring their double mastectomy scars to end “the lack of Black, brown, LGBTQIA+ representations and visibility in breast cancer awareness.” As important as this messaging was, Hart felt “de-sexualized” by some of the responses their display elicited. “People would see my topless pictures and respond: ‘Oh my God, you’re so inspiring,'” they say. “But if anybody with nipples went topless on the internet, that would not be the response.”

This is a commonly felt sentiment among breast cancer patients — they feel society begins to see them only as patients, rather than sexual beings. Hart points out that you rarely see sex scenes with cancer patients in the media. FWIW, the only one I could think of was in “Desperate Housewives,” which involved a somewhat superficial plot about Tom feeling uncomfortable having sex with Lynette when she wasn’t wearing her wig, and Lynette fearing it meant he was no longer attracted to her. (This is a real fear among patients, though Dr. Nagoski notes: “In a great relationship, we’re attracted to the human being we chose to be with, not to the body parts of that human. It’s normal to have feelings about changes to our bodies and our partners’ bodies, of course, but a strong relationship adapts to those changes with love and trust.”)

Meanwhile, Crollman, who was diagnosed with cancer at 27, adds that the mental barriers to sex after cancer were “the hardest part.” “The pain, of course, is physically uncomfortable, but even though my partner and I tried so hard to stay in open communication, the reality was, we went through a very, very dry spell,” she says. “I was feeling really lost, mentally. I went through a deep depression, and I was seeing a therapist to cope because I really didn’t feel comfortable in my body.” After having a double mastectomy, Crollman felt “vulnerable” being in front of someone else while she was still “struggling to come to terms with the body that I had.”

Plus, not being intimate for a period due to these understandable challenges led to “more physical triggers and trauma around that experience — around the fear of it, around the pain that was related to it because of the side effects,” Crollman remembers. “So it was kind of this multileveled, emotional, psychological challenge.”

Finding Pleasure Again Post-Diagnosis

The physical and emotional stressors surrounding sex are very real, but reframing can help cancer patients to work through them. “The stakes around treatment certainly may be high, but the stakes around sex are not” — or at least, they don’t have to be, Dr. Nagoski says.

Although our culture tells us we can somehow “fail” sexually, especially “if we don’t perform according to some external, bullshit standard, the reality is there is nothing to lose, there is no way to fail,” Dr. Nagoski says. “We only imagine we’re doing it ‘wrong’ when we compare our experiences to some bogus cultural script of what sex ‘should’ be like — a script that was always irrelevant to our lives, but after a cancer diagnosis is just an absurd, pointless, and even cruel standard against which to assess our sexual connections. There is nothing at stake with sex; you have nothing to lose, only pleasure and connection to gain.”< Pleasure can look different to different people, and sex is just one piece of it. In order to maximize satisfaction for all parties involved, Dr. Nagoski says you first need to get on the same page as your partner — and that means getting curious. "If your partner wants sex, ask each other these important questions: What is it that you want, when you want sex with each other? And what is it that you don't want? When don't you want sex with each other? And, perhaps most importantly, what kind of sex is worth having — as in, what makes sex worth not spending that time watching 'Parks & Recreation'?"

Also, “You could decide to take all sex entirely off the table,” Dr. Nagoski says. “That’s a legitimate choice.” Hart adds that some couples may decide to open up their relationship amid cancer.

However, many people with cancer do want to try to explore sex and pleasure again, whatever that looks like for them. But because there are so few good resources out there and so much stigma around the topic, they may do so with varying levels of success.< Hart, for example, discovered that kink and BDSM was a sexual space of healing for them. "After being poked and prodded and having surgeries and chemotherapy literally once a week with a giant needle, I wanted to go into spaces where I could reclaim that pain," they say. "So doing things like impact play — being consensually spanked and hit — I could reclaim the pain after years of feeling like I didn't have a choice of opting into it." Hart also recommends working with a sex therapist to find pleasure again, which may include finding ways to incorporate chest play after a mastectomy, whether you still have nipples or not. Dr. Nagoski recommends the book “Better Sex Through Mindfulness” by Lori Brotto, who specializes in sexual health interventions for those with cancer and for survivors of sexual trauma.

Dr. Dizon adds that some healthcare providers might be more comfortable pointing their patients to resources rather than giving them actual advice about their sex lives, so asking your doctor if they have recommendations for something to read or a support network you could join might be a smart tactic for finding the support you seek.

Drakeford says she hasn’t been shy about asking for resources but still hasn’t felt satisfied with the level of pleasure she’s experienced since her diagnosis. She’s tried vaginal moisturizers, lube, and sex toys and hasn’t seen much success. “I even tried that slippery elm herb — it did nothing. Not a thing!” Drakeford says. “I’ve been going on nine years without things improving. I hope researchers can get on this and find something that actually works for people like me . . . even if it’s not during my lifetime.”

Burnett, for her part, has tried to be intentional about pleasure from the very beginning — though it hasn’t been easy.

While she was undergoing chemo, Burnett says, she and her partner scheduled sex around treatments. “The first couple of days after chemo, your body’s pretty toxic, so you aren’t going to be intimate,” she says. “Then seven to 10 days after is when you’re at your sickest. So for us, it was usually around that two-week mark that we’d schedule time to be intimate, before the next round.”

Since going into medical menopause, Burnett’s tried multiple tactics to make sex post-breast-cancer more pleasurable with her partner, including lubes, moisturizers, and laser therapy. (Dr. Dizon notes it’s important for those with breast cancer to find options that have specifically been studied in people with breast cancer, not the general population.) She also had to mentally get used to the changes in her breasts — though getting a mastectomy scar tattoo helped her regain some confidence, both in general and in the bedroom.

Although Burnett didn’t get the honeymoon phase she’d always dreamed about, she did learn quickly that she’d found a partner who’d keep every word of his vows. “There is something really intimate about someone who can be there for you and hold your hair back as you’re throwing up, and pick it up as it’s falling out,” she adds, nodding to her old joke about her friends having their hair pulled.

The couple’s 10-year anniversary is coming up next year, and they’re planning to finally take that honeymoon they never got. “It’ll be a different kind of honeymoon, because my body is just different from most other 36-year-olds’ out there. But it will also be a celebration of surviving 10 years.”

Complete Article ↪HERE↩!

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My Cervical Cancer Diagnosis Changed the Way I Think About Sex

— I’ll never approach sexual risk the same way again

By Andrea Karr

I’ve long been a fan of condom use and STI testing. I’m the woman who carries a rubber in her wallet *just in case* and heads to the lab a couple times a year to have my blood and urine screened for gonorrhea, syphilis and other sexually transmitted infections.

Occasionally, I’ve foregone the condom. I’d like a guy and we’d sleep together a few times. One night, he’d suggest that it would feel way better if we skipped protection. He’d keep the conversation light but would make it clear that we’d both have more fun if I’d loosen up. I wouldn’t want to come off as a killjoy or prude, so sometimes I’d give in. Each time it happened and I received a clear STI test afterward, I’d sigh with relief and go on with my life.

But then I was diagnosed with cervical cancer after a routine Pap test when I was 35. The fastest increasing cancer in females in Canada and third most common cancer in Canadian women ages 25 to 44, cervical cancer is almost always caused by human papillomavirus (HPV), an STI with more than 200 strains that can also cause vaginal, vulvar, penile, anal and oropharyngeal (a.k.a. throat, tonsils, soft palate and back of the tongue) cancer. HPV often has no symptoms, and cervical cancer can take one or two decades to develop after infection. Though condoms don’t guarantee protection, they reduce the risk of transmission.

Cervical cancer is no joke for a woman’s wellbeing and fertility. I was very lucky that my cancer was caught at the earliest stage: 1a1. I required two small surgical procedures (called LEEPs) to remove the cancerous cells, and now I get checkups every three months. If it was caught later, I might have needed a hysterectomy, radiation and/or chemotherapy, which could have harmed my eggs or put me into early menopause.

The phrase “it’s cancer” is something we hope to never hear in our lifetime. Those little words changed my life. As a result, I spent a lot of time looking back on my sexual relationships. I regretted ever having sex at all at first. Sex is what gave me cancer! But then I realized that just being alive carries risk, and I don’t want to avoid intimate relationships, which can be so crucial to physical, emotional and mental wellbeing, just because I could get hurt.

Instead of abstaining from sex, I decided I wanted to get educated about my risk, then develop clear boundaries that I can confidently communicate to a partner. I also want to break down the guilt or shame I feel about being a “killjoy” or “prude.” I have a great justification: a history of gynecological cancer. But no one should need a life-altering event to justify having sexual boundaries.

Still, it’s not easy. “As a woman, you’ve been told your whole life that if you stand up for yourself, if you don’t go with the flow, you are difficult, and that it’s not feminine to be difficult,” says Frederique Chabot, sexual health educator and acting executive director at national organization Action Canada for Sexual Health and Rights. She’s referring to the way most girls and women are socialized growing up. “In romantic or sexual scenarios, there are many things that can put you at risk of retaliation, of reputational damage, of harassment. There is the pressure put on women to say ‘yes,’ people asking, asking, asking, asking. That’s not consent. That is getting pressured into doing something you’re not willing to do.”

A woman's legs and a man's legs intertwined in bed

I’m now comfortable with having a detailed chat about sexual history, STI testing, HPV vaccination and condom use before I get into bed with someone. Of course, it’s not only on me. Men are at risk for HPV and other STIs too.

So far, I’ve had this conversation with two guys. One responded badly; now he has no place in my life. The second agreed to have a fresh STI test before we had sex. He also looked into the HPV vaccine, which he ended up getting, and he is okay with consistent condom use. We’ve been dating for almost a year.

I know that every woman in the world won’t share the same boundaries as me. That’s okay. But there are potential risks to sexual contact, even though our hook-up culture likes to pretend otherwise. It’s about deciding how much risk you can live with and then feeling empowered to communicate that. I won’t let my desire for acceptance compromise my sexual health going forward. I hope, after hearing my story, no one else will either.

“Instead of abstaining from sex, I decided I wanted to get educated about my risk, then develop clear boundaries that I can confidently communicate to a partner.”

Ways to be proactive

HPV vaccination

In Canada, Gardasil 9 is the go-to HPV vaccine and it protects against nine high-risk strains of HPV that cause cancer and genital warts. Health Canada currently recommends it for everyone aged 9 to 26, and it’s offered for free in schools sometime between grades 4 and 7, depending on the province or territory. Though it’s most effective when administered before becoming sexually active, it can still have benefits later in life. I wasn’t vaccinated at the time I was diagnosed with cervical cancer, and all my healthcare practitioners told me to get vaccinated immediately. The Canadian Cancer Society recommends the HPV vaccine for all girls and women ages 9 to 45Regular Pap tests

In Canada, most provinces and territories rely on Pap tests to check for cellular changes that, if left untreated, may lead to cervical cancer. Generally, the recommendation is to go to your doctor or a free sexual health clinic every three years (if everything looks normal) starting at age 21 or 25. I had no symptoms for cervical cancer; it was caught early thanks to a routine Pap test. You still need to go for regular Pap tests even if you’ve been vaccinated, you’ve only had sex one time or you’re postmenopausal.

HPV testing

Free STI tests that you can get through your family doctor or a sexual health clinic do not check for HPV. They usually test for chlamydia and gonorrhea (and maybe also syphilis, HIV and hepatitis C). If a sexual partner tells you they’ve had a clear STI panel, they’re probably not talking about HPV since it’s a test that comes with a fee.

P.E.I. and B.C. are transitioning from Pap testing every three years to HPV testing every five years. HPV testing is more accurate than Pap testing. It can detect certain strains of high-risk HPV with about 95 per cent accuracy, while Pap tests are only about 55 per cent accurate at detecting cellular changes on the cervix, which is why they need to be done more frequently.

The shift to provincially covered HPV screening in other provinces is slow. Ontario, for example, may be years away from the transition.

DIY testing

Canadian company Switch Health has launched a self-collection HPV test that can be ordered online for $99. You do your own internal swab, mail your results to the lab and get your results from an online portal—it can take as little as a week. It screens for 14 high-risk strains of HPV, including types 16 and 18, which cause 70 per cent of cervical cancers and precancerous cervical lesions. If you test positive for one of the strains, you should see your family doctor, and if you don’t have one, Switch “will work to set you up with one of our partners for a virtual or in-person appointment,” says co-founder Mary Langley.

The cost may be a barrier, plus privately purchased DIY tests aren’t supported by the infrastructure that there is for Pap testing. “There are quality control checks in place. There’s evidence review on a regular basis. Many people will receive letters from [their provincial health agency] telling them they’re due for their Pap,” says Dr. Aisha Lofters, a scientist and family physician at Women’s College Hospital in Toronto. But if you aren’t getting regular Paps because you don’t have easy access to a doctor or you’re uncomfortable going in for the test, it’s a lot better than nothing.

Complete Article ↪HERE↩!

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Female Orgasmic Disorder Could Become a Qualifying Condition for Medical Cannabis in Four States

— Science confirms what many of us discovered on our own.

By Sophie Saint Thomas

Four states—Ohio, Illinois, New Mexico, and Connecticut—are now looking into adding female orgasmic disorder (FOD) to the list of qualifying conditions for medical cannabis. There’s mounting research that suggests that cannabis can help women have more orgasms. For those with FOD, defined by the Merck Manuel as a “lack of or delay in sexual climax (orgasm) or orgasm that is infrequent or much less intense even though sexual stimulation is sufficient and the woman is sexually aroused mentally and emotionally,” medical marijuana could not only make having an orgasm easier, but more satisfying. 

Diagnosis criteria and scientific research aside, stoners have been boasting about the sexual properties of cannabis, probably since the herb was first smoked. Now, we know that cannabis, as a vasodilator, can increase blood flow to the genitals. Because it can also aid in anxiety, using some weed before sex can help people relax into the moment, which can be especially beneficial to those whose sexual dysfunction stems from trauma. After all, we know that cannabis has a well-documented ability to treat PTSD. It even enhances the senses, often making touching and even checking out your partner more fun. And as cannabis can also aid in creativity, it can help you consider and explore more variations in your sex life. 

“Women with FOD have more mental health issues, are on more pharmaceutical medication,” Suzanne Mulvehill, clinical sexologist, and founder and executive director of the nonprofit Female Orgasm Research Institute told Marijuana Moment. “They have more anxiety, depression, PTSD, more sexual abuse histories. It’s not just about pleasure, it’s about a human right,” adding that: “It’s a medical condition that deserves medical treatment.”

Ohio is currently evaluating a proposed amendment to add the condition. Earlier this month, the State Medical Board declared that both FOD and autism spectrum disorder are advancing to the stages of expert assessment and public feedback, following online petition submissions. Public comments will be accepted until Thursday.

In Illinois, regulatory officials are scheduled for a meeting next month to discuss the inclusion of FOD as an eligible condition. New Mexico plans to address the matter in May, as per the nonprofit Female Orgasm Research Institute. The organization also noted that Connecticut is exploring the possibility of adding FOD to its list of qualifying conditions, although a specific date for a meeting has not yet been determined.

Suzanne Mulvehill plays a leading role in the initiatives advancing the therapeutic advantages of cannabis for individuals with FOD. She says that this condition impacts as many as 41% of women globally. She filed a petition last year aiming to include this disorder among Ohio’s list of conditions eligible for medical marijuana.

Present studies suggest that approximately one-third of women who consume cannabis utilize it to enhance sexual experiences—a statistic Mulvehill notes has remained relatively consistent over the years.

She’s aware of the understanding surrounding cannabis’s ability to enhance sex. “It’s not new information,” Mulvehill said in her interview with Marijuana Moment. 

The novelty lies in the readiness of government bodies to address the matter. According to Mulvehill, Ohio appears to be the first state to evaluate FOD as a condition warranting medical marijuana. Moreover, she noted that Ohio’s meeting earlier in the month marked the inaugural instance, to her knowledge, of a public government entity discussing female orgasmic disorders.

A 2020 article published in Sexual Medicine discovered that frequent cannabis use among women correlates with improved sexual experiences. Additionally, various online polls have highlighted a positive correlation between cannabis consumption and sexual satisfaction. There’s even research indicating that the enactment of marijuana legislation correlates with a rise in sexual activity.

And research published last year in the Journal of Cannabis Research revealed that over 70% of adults surveyed reported an increase in sexual desire and enhanced orgasms when using cannabis before intercourse, and 62.5% noted improved pleasure during masturbation with cannabis use. Given previous data showing that women who have sex with men often experience orgasms less frequently than their male counterparts, the researchers suggested that cannabis might help bridge this orgasm equality gap.

For some people, having an orgasm is a challenge in a way that counts as a disorder that deserves treatment, and access to medical marijuana is paramount. For others, this new legal push is just a reminder that weed can make sex better and a reminder that you don’t need a diagnosis to have hot, stoned sex.

Complete Article ↪HERE↩!

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Here’s How Sex and Intimacy Help You Live Longer

— Says Molly Maloof, M.D.

By Molly Maloof

For many, sex is fun and pleasurable—but it’s also pretty important to human existence. Sex plays a significant role in individual well-being, and perhaps even longevity.

Unfortunately, some public health organizations and entities continue to advertise not-so-positive outcomes after having sex, such as sexually transmitted infections, unintended pregnancy, sexual dysfunction, and more. This outdated narrative and outlook on sex (note: sex therapy hasn’t been reinvented since the 1960s, per the American Psychological Association) can be damaging as it overlooks the fact that sexual pleasure is a distinct element of well-being.

Sexual pleasure can play a key role in nurturing healthy relationships and, ultimately, extending your lifespan. In fact, having a good sex life has been shown to improve physical and mental well-being, both of which help you have a vibrant life overall.

Here are just five ways maintaining, or improving, your sex life can have profound effects on your overall health.

5 Benefits of Sex and Intimacy

Although sex and intimacy are often used interchangeably, they’re actually two different things.

Here’s the deal: Intimacy involves openness and acceptance between partners (this can be emotional, such as communicating about what you don’t like, or physical, like post-sex cuddling). On the other hand, sex is solely the physical activity—and of course, it’s possible to have sex without intimacy and vice versa.

1. It Maintains Quality of Life

Research shows that sexual health can improve your quality of life (no big surprise there!) — even if you’re older in age. As a result, it can increase your lifespan, too.

In fact, 62.2 percent of men and 42.8 percent of women reported that sexual health was highly important to quality of life in a 2016 study of 3,515 adults in the Journal of Sexual Medicine. And, people in excellent health had higher satisfaction with their sex lives than those who had fair or poor health. Based on these results, the study authors note that sexual health screenings should be a routine part of physician visits—so if your doc doesn’t bring it up, make sure you do.

Meanwhile, those ages 65 and older who said their sexual relationship was “sufficient” reported better quality of life and lower incidence of sexual dysfunction than those who described their relationship as “moderate” or “poor,” according to a 2023 study. This was also true for those who considered themselves attractive and had sex frequently with their partner or spouse.

What do these studies suggest? When your sex life is better, your overall outlook on life may improve too.

2. It Contributes to Satisfying Relationships & Mental Health

Sexual activity may also contribute to longevity by making your relationships more stable and satisfying—and by boosting your mental health.

Sexual satisfaction is a main factor in predicting relationship satisfaction in both men and women, according to a small-scale study, found in a 2023 issue of the International Journal of Environmental Research and Public Health. For women, interpersonal closeness was also important (measured by statements like “I always consider my partner when making important decisions” or “I miss my partner when we are apart”).

In addition, one 2019 study revealed that frequent, longer lasting bouts of sex was associated with higher sexual satisfaction, which in turn, lead to stronger relationships. This was true for all relationship types, including same-sex, mixed-sex, and gender-diverse relationships.

Beyond its physical implications, sexual activity and intimacy can also contribute to mental health, something that’s increasingly understood to influence longevity.

Researchers examined the impact of sexual activity (or lack thereof) in a study published in a 2021 issue of the Journal of Sexual Medicine. They found that people who didn’t have sex during the COVID-19-related lockdown had a 27 percent higher risk of developing anxiety and a 34 percent higher chance of depression compared to those who did.

3. It May Reduce the Risk of Cancer & Heart Disease

A great sex life can also keep your prostate—and other parts of your body—healthy.

Scientists monitored the frequency of orgasms in nearly 32,000 men over an 18-year period in a 2016 study published in European Urology. Their findings suggested that a higher frequency of orgasms was associated with a reduced risk of developing prostate cancer later in life.

More specifically, men (both in their 20s and 40s) who reported 21 or more orgasms per month had about 20 percent lower risk of developing prostate cancer compared to those who ejaculated four to seven times per month.

What’s more? Engaging in a vibrant sexual life also seems to benefit heart health, even in those with heart disease, per a study from a 2022 issue of the European Journal of Preventive Cardiology.

Heart attack patients who reported having sex at least once per week had a slightly lower risk of dying from heart disease (though more research is needed to determine if that lowered risk is statistically significant) and a more notable 44 percent lower risk of dying from non-heart disease causes—compared to those who had sex less. This is even after researchers adjusted for additional factors, including age, gender, partner status, and smoking.

4. It Can Boost Your Immune System

Research suggests sex can support your immune system, as it offers a shield against illnesses and bolsters your resilience to viruses.

In a study, found in a 2021 issue of Fertility and Sterility, researchers assigned 16,000 participants to one of two groups: those who reported having sex more than three times per month and those who reported having sex less than three times per month. They found that 76.6 percent of those in the first group did not get infected with COVID-19 over the course of four months—and even those who did get infected tended to have milder cases than those in the second group, where nearly half of the group got infected.

These findings suggest that as your sexual activity increases, your immune system may be better equipped to combat pathogens. But of course, sexual activity alone can’t prevent infectious disease, so be sure to take all appropriate measures to avoid infections like COVID-19—particularly if you’re at high risk for serious disease.

5. It May Independently Extend Your Lifespan

While factors like quality of life, a strong immune system, and lowered risk of cancer may all contribute to your longevity, research shows that sex alone may be able to extend your lifespan.

For instance, the findings from a study—found in a 2022 issue of the Journal of Applied Gerontology—showed that sexual well-being was positively associated with longevity in those who perceived sexuality as important to them.

Although research suggests your desire to have sex may begin to decline as you get older, plenty of men and women continue to have sex semi-regularly as they enter those later decades of life. Among those aged 80 and older, 19 percent of men and 32 percent of women reported having sex frequently (which is described as twice a month or more), according to a study from a 2015 edition of Archives of Sexual Behavior.

Complete Article ↪HERE↩!

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Stress of Being Outed to Parents and Caregivers

— What Are the Mental Health Consequences?

‘Policymakers should be aware of the harms that bills targeting LGBTQ+ youth have on the well-being of students and strongly argue for their right to disclose their identities on their own terms’

By Danielle Faipler

In 2023, lawmakers across the U.S. introduced a record number of anti-LGBTQ+ bills. Although the 2024 legislative session has just begun, the American Civil Liberties Union (ACLU) is already tracking 429 bills, a figure on pace to surpass 2023 numbers.

The rise in anti-LGBTQ+ policy rhetoric has coincided with an increase in anti-LBTGQ+ violence. According to data from the Federal Bureau of Investigation’s (FBI) 2022 annual crime report, anti-LGBTQ+ hate crimes increased 13.8% from 2021. As more policy proposals are directed at LGBTQ+ youth, advocates are concerned about how children’s mental and physical well-being will be affected.

Ryan Watson, co-director of the UCOnn
Ryan Watson, co-director of the UConn SHINE Lab

“In recent years, we’ve seen an increase in anti-LGBTQ+ legislation targeting kids, and even though not all of these bills will become law, even the introduction of the bills may have an immediate and real impact on kids’ lives and their mental health,” says Ryan Watson, associate professor in the Department of Human Development and Family Sciences (HDFS).

Thirty-two such proposals have advanced in in the legislatures of Arizona, Hawaii, Missouri, New Hampshire, South Carolina, Oklahoma, Tennessee, Washington, West Virginia, and other states. At least six states have laws on the books to forcibly out students.

Lisa Eaton, co-director of the UConn SHINE Lab
Lisa Eaton, co-director of the UConn SHINE Lab

“It’s critical that as researchers we stay engaged in understanding and speaking out against legislative policies that have the potential to do real harm to LGBTQ+ youth, equally important is supporting policies that protect youth. These policies have the potential to greatly and quickly impact the lives of LGBTQ+ youth,” says Lisa Eaton, professor of Human Development and Family Sciences.

Despite social progress, SGDY experience higher levels of discrimination, bullying, and stress, depression, and anxiety compared to their cisgender and heterosexual peers, and these health disparities continue to grow. SGDY report experiencing bullying, violence, discrimination, and rejection based on their sexual orientation and gender identity. When youth choose to disclose their identity, they often consider the support they may receive.

To investigate the mental health consequences of sexual and gender-diverse youth (SGDY) whose sexual or gender identity is forcibly disclosed to their parents without their permission, a team of researchers at UConn’s Sexuality, Health, and Intersectional Experiences (SHINE) Lab conducted a study that was recently published in the Journal of Research on Adolescence.

Watson and Eaton, both are principal investigators at UConn’s Institute for Collaboration on Health, Intervention, and Policy (InCHIP), co-direct the SHINE Lab. The SHINE Lab conducts research to improve understanding of how sexual orientation and gender identity, family experiences, school contexts, and ethnoracial identity affect health outcomes among sexually and gender-diverse youth and adults.

Peter McCauley, second-year Ph.D. student in the Department of Human Development and Family Sciences
Peter McCauley, second-year Ph.D. student in the Department of Human Development and Family Sciences

“Unique stressors, like bullying based on sexual and gender identities, are experienced at a time when youth are meeting important developmental milestones; at this same time, SGDY are typically financially and legally dependent upon their caregivers. There is a critical gap of knowledge on how the manner of disclosure may be related to the well-being of sexual and gender diverse youth. Our study aimed to understand how experiences of being outed to parents were related to mental health,” says the study’s lead author Peter McCauley, a second-year HDFS Ph.D. student and research assistant at the SHINE Lab.

McCauley and his collaborators used data from the LGBTQ National Teen Survey collected in partnership with the Human Rights Campaign (HRC) between April and December 2017. Respondents were between the ages of 13 and 17, identified as LGBTQ+, spoke English, and were U.S. residents.

The team found that respondents who were outed (about 30%) to their parents were more likely to experience elevated depressive symptoms and lower LGBTQ family support compared to those who were not. Parents who affirmed and supported their child’s identity could potentially mitigate depressive symptoms from the stress of being outed.

The study demonstrates that a lack of agency in disclosing a sexual and/or gender identity to parents can greatly undermine the well-being of SGDY and indicate lower levels of family support. It also underscores the importance of enabling SGDY youth to have greater control over when they disclose their identities.

“A staggering number of anti-LGBTQ+ bills have been proposed that mandate school officials to out students’ identities to parents and caregivers. Policymakers should be aware of the harms these bills have on the well-being of students and strongly argue for their right to disclose their identities on their own terms,” says McCauley.

Complete Article ↪HERE↩!

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Top 10 drugs that may contribute to sexual dysfunction

By Naveed Saleh, MD, MS

Key Takeaways

  • A variety of prescription medications, along with the conditions they treat, may contribute to sexual dysfunction.
  • Some of these drugs are known to interfere with sexual health, such as antidepressants and beta blockers; lesser known culprits include thiazide diuretics or opioids.
  • Clinicians can help by being aware of medications that may affect sexual function, having open discussions with patients, and adjusting medications where needed.

Sexual dysfunction can be an adverse effect of various prescription medications, as well as the conditions that they treat. Some of these treatments, such as antidepressants and certain antihypertensives, likely come as no surprise to the clinician. Others, however, are not as well-known.

Here are 10 types of prescription medicines that contribute to sexual dysfunction.

Antiandrogens

Antiandrogens are used to treat a gamut of androgen-dependent diseases, including benign prostatic hyperplasia, prostate cancer, paraphilias, hypersexuality, and priapism, as well as precocious puberty in boys.

The androgen-blocking effect of these drugs—including cimetidine, cyproterone, digoxin, and spironolactone—decreases sexual desire in both sexes, as well as impacting arousal and orgasm.

Immunosuppressants

Prednisone and other steroids commonly used to treat chronic inflammatory conditions decrease testosterone levels, thus compromising sexual desire in males and leading to erectile dysfunction (ED). 

Sirolimus and everolimus, which are steroid-sparing agents used in the setting of kidney transplant, can mitigate gonadal function and also lead to ED.

HIV meds

The focus of dolutegravir (DTG)-based antiretroviral therapy has been on efficacy, as measured by viral load. Nevertheless, these drugs appear to affect sexual health, which can erode quality of life, according to authors writing in BMC Infectious Diseases.[1]

“Sexual dysfunction following transition to DTG-based regimens is common in both sexes of [people living with HIV], who indicated that they had no prior experience of difficulties in sexual health,” the study authors wrote. “Our findings demonstrate that sexual ADRs negatively impact self-esteem, overall quality of life and impair gender relations. DTG-related sexual health problems merit increased attention from HIV clinicians.”

Cancer treatments

Both cancer and cancer treatment can impair sexual relationships. And cancer treatment itself can further contribute to sexual dysfunction.

For example, long-acting gonadotropin-releasing agonists used to treat prostate and breast cancer can lead to hypogonadism, resulting in lower sexual desire, orgasmic dysfunction, erectile dysfunction in men; and vaginal atrophy/dyspareunia in women.[2]

Hormonal agents given during the course of endocrine therapy in cancer care lead to a sudden and substantial decrease of estrogens via their effects at different regulatory levels. Selective ER modulators (SERMs) are used to treat ER-positive breast cancers and bind ERs α and β. These receptors are crucial in the functioning of reproductive, cardiovascular, bone, muscular, and central nervous systems. Tamoxifen is the most common SERM used.

In females, reduced estrogen levels due to endocrine therapy can lead to vaginal dryness and discomfort, pain when urinating, dyspareunia, and spotting during intercourse.

Antipsychotics

Per the research, males taking antipsychotic medications report ED, less interest in sex, and lower satisfaction with orgasm, with delayed, inhibited, or retrograde ejaculation. Females taking antipsychotics report lower sexual desire, difficulty achieving orgasm, anorgasmia, and impaired orgasm quality. 

“The majority of antipsychotics cause sexual dysfunction by dopamine receptor blockade,” according to the authors of a review article published in the Australian Prescriber.[3] “This causes hyperprolactinaemia with subsequent suppression of the hypothalamic–pituitary–gonadal axis and hypogonadism in both sexes. This decreases sexual desire and impairs arousal and orgasm. It also causes secondary amenorrhoea and loss of ovarian function in women and low testosterone in men,” they continued.

Antipsychotics may also affect other neurotransmitter pathways, including histamine blockade, noradrenergic blockade, and anticholinergic effects.

Anti-epileptic drugs

Many men with epilepsy complain of sexual dysfunction, which is likely multifactorial and due to the pathogenesis of the disease and anti-epileptic drugs, per the results of observational and clinical studies.[4]

Specifically, anti-epileptic drugs such as carbamazepine, phenytoin, and sodium valproate could dysregulate the hypothalamic–pituitary–adrenal axis, thus resulting in sexual dysfunction. Carbamazepine and other liver-inducing anti-epileptic drugs could also heighten blood levels of sex hormone-binding globulin, thus plummeting testosterone bioactivity.

Both sodium valproate and carbamazepine have been linked to disruption in sex-hormone levels, sexual dysfunction, and changes in semen measures.

Antihistamines

Allergic disease is commonly treated with antihistamines and steroids, with both drugs potentially interfering with sexual function by decreasing testosterone levels. In particular, H2 histamine receptor antagonists can disrupt luteinizing hormone/the human chorionic gonadotropin signaling pathway, thus interfering with the relaxation of smooth muscles at the level of the corpus cavernosum.[5]

ß-blockers

ß-blockers contribute to ED likely because they suppress sympathetic outflow.

“Non-cardioselective ß-antagonists like propranolol have a higher incidence of ED than cardioselective ß-antagonists which avoid ß2 inhibition resulting in vasoconstriction of the corpora cavernosa,” per investigators writing in Sexual Medicine.[6] “Nebivolol has the greatest selectivity for ß1 receptors as well as endothelial nitric oxide vasodilatory effects, and has been shown to have a positive effect on erections.”

The authors cite a double-blind randomized comparison in which metoprolol decreased erectile scores after 8 weeks, whereas nebivolol improved them.

As well, he selective β-blocker nebivolol inhibits β1-adrenergic receptors, which may protect against ED vs non-selective β-blockers.[7]

Opioids

The µ opioid receptor agonist oxycodone not only inhibits ascending pain pathways, but also disrupts the hypothalamic-pituitary-gonadal axis by binding to µ receptors in the hypothalamus, thereby resulting in negative feedback and resulting in ED, as noted by the Sexual Medicine authors.

Consequently, less  gonadotropin-releasing hormone is produced, which results in lower levels of  gonadotropins and secondary hypogonadism. 

Loop diuretics

Results of a high-powered study demonstrated that men taking thiazides were twice as likely to experience ED compared with those taking propranolol or placebo. It’s unclear whether furosemide also causes ED. It’s also unclear why thiazides cause ED. Nevertheless, the Sexual Medicine authors stress that prescribers should remain cognizant of the potential for thiazide to interfere with sexual function.

What this means for you

It’s important for clinicians to realize the potential for a wide variety of drugs to contribute to problems in the bedroom. If a patient experiences trouble having sex, they may discontinue use of the drug altogether. Consequently, physicians must tailor treatment plans with patients and their partners in mind.

The key to assessing sexuality is to foster an open discussion with the patient concerning sexual function and providing effective strategies to address these concerns.

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Can Microdosing Help Heal Sexual Trauma?

— Sexual trauma poses unique challenges to clinical treatment. Psychedelic medicine can address healing from sexual trauma through a more holistic lens.

By Kiki Dy

A sexual assault at fifteen changed the contours of Australia-based artist Lydia’s* life. She blamed herself in a haze of adolescent confusion and hid the assault from her loved ones, even when they suspected something was amiss. The next ten years became a barbed loop of trying to forget and then remembering so vividly that she couldn’t sleep. Lydia tight-roped between extremes:— long periods of abstinence splintered by sprints of hypersexuality. In her early 20’s, she pursued therapy but ultimately found the experience “painful with no payoff.” She recognized she needed a spiritually profound route to recast her sense of self and shift the narrative of her assault–that’s when mushrooms entered the picture.

Psychedelics and Sexual Trauma: An Overview

On her podcast Inside Eyes–a series about using entheogens to ease the aberrations of sexual trauma–somatic psychotherapist Laura Mae Northrup describes sexual assault as a form of spiritual abuse. The impact of sexual violence on the survivor is subjective. However, many, like Northrup, would agree that experiencing sexual assault can change how we view humanity, making us question the morality of mankind and the meaning of our existence at large.

Objectively, sexual assault is unconscionable violence against humanity, resulting in feelings of dissociation and disembodiment that can last a lifetime (and even be passed down). As survivors grow up, they frequently learn to suppress the event and its aching emotions as a defense mechanism. But trauma can never truly be suppressed. Until trauma is addressed, one small trigger has the ability to open the gateway back to the grieving phase.

Given the prolonged spiritual distress sexual abuse spurs, western medicine and traditional therapy can often fall short. For some, exploring a more mystical method of healing provides better outcomes. After all, sexual assault is a complicating factor for mental wellness, with survivors displaying psychological responses such as depression, anxiety, and post-traumatic stress disorder (PTSD)—all of which psilocybin is proven to positively benefit.

As a seasoned psychedelic researcher and professor at Johns Hopkins University School of Medicine, Roland Griffiths reports that over 70% of people who took magic mushrooms to treat depression, anxiety, or PTSD cited their psychedelic experience as being among the most impactful events in their lifetime. Additional research echoes these praises, suggesting that psilocybin often induces emotional breakthroughs and profound shifts in perspective for those who choose to use it–and for Lydia, that shift in perspective was life-saving.

“I felt stuck. All my relationships were failing, even the one with myself. I was ready to give up,” she tells us at Retreat. “It felt like one person had stolen my happiness, and I couldn’t get it back, even ten years later.”

Then, a psilocybin retreat changed everything.

Lydia, who lived in Berlin at the time, made a convenient pilgrimage to attend a magic mushroom ceremony in Amsterdam. “The trip cracked me wide open,” she shares, “I was outside my body looking at myself. Which was trippy, but more important is that the filter changed, and suddenly I saw myself with softness and empathy. I sobbed.”

Like Lydia’s anecdotal evidence suggests, psychedelics hold great promise and potential to help people reprocess their trauma in a meaningful manner. In the words of psychedelic integration therapist Dee Dee Goldpaugh, psilocybin allows us to experience a “compassionate recasting of ourselves in the story [of a traumatic event].” By introducing her mind to new ways to think, psilocybin helped Lydia unglue herself from the decade of anguish the assault catalyzed. With the muck cleared off her mind’s windshield, she began to see and accept the truth: it wasn’t her fault, and it doesn’t define her.

The Therapeutic Potential of Microdosing

The heroic dose helped Lydia forgive and reopen herself to pleasure, but microdosing helped her cement her newfound perspectives.

“I didn’t want the trip to be this epiphany that didn’t stick,” she shares. “I was so relieved but also a bit anxious that I was placing a flimsy bandaid over a bullet hole.” So, after research and casual coaching by a seasoned psychonaut friend, she started a new routine three times a week: spiking her morning matcha with psilocybin powder.

Lydia enhanced her microdosing journey with daily journaling, affirmations, and a focused effort to allow the soft voice that spoke to her during the trip to reshape her internal monologue. She insists that microdosing rewired her brain in a way SSRIs failed to achieve.

But does the science behind microdosing support her experience?

While the conclusion is clear on the therapeutic benefits of large doses of psychedelics, such as increased empathy, openness, mood, and life satisfaction—the developing research on microdosing doesn’t allow us to draw any one conclusion. Research suggests that microdosing may lead to a positive mood, increased presence, and enhanced well-being.

However, the findings do not come from controlled trials where one-half of the participants take a microdose, and the other half take a placebo.  Current knowledge is mostly from vocal success stories like Lydia’s and surveys of people who have used microdosing as a tool for mental health and personal growth. (That said, that is changing, with a number of microdosing studies in the works across the industry.)

The Bottom Line

Though universally painful, healing from sexual trauma is personal. Whether you leverage traditional talk therapy, small amounts of psilocybin, or a guided heroic trip that sends you to an alternate reality for eternity and returns you a new person–one fact remains: addressing trauma is a meaningful step toward a happier future.

As for the potential of psychedelics to facilitate healing more holistically, the science is promising. Individuals that have suffered sexual trauma often close down as fear, anxiety, and anger shrink them. In one famously-cited psilocybin study, 61 percent of participants demonstrated a lasting and measurable change in openness after just one dose of mushrooms–a significant finding because lasting personality change is often out of reach with just talk therapy alone.

However you choose to heal, and whoever you choose to help you heal, Retreat wishes you the best and is here to offer a little psychedelic support and a lot of empathy.

*Name has been changed to protect privacy.

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Why Viagra has been linked with better brain health

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Viagra can be a wonder drug for men with erectile dysfunction, helping them maintain their sex lives as they age. Now new research suggests the little blue pill may also be beneficial to aging brains.

The findings are based on a massive study of nearly 270,000 middle-aged men in Britain. Researchers at University College London used electronic medical records to track the health of the men, who were all 40 or older and had been diagnosed with erectile dysfunction between 2000 and 2017. Each man’s health and prescriptions were tracked for at least a year, although the median follow-up time was 5.1 years.

During the study, 1,119 men in the cohort were diagnosed with Alzheimer’s disease.

The researchers noticed a distinctive pattern. The men who were prescribed Viagra or a similar drug had an 18 percent lower risk of developing Alzheimer’s disease, compared with men who weren’t given the medication.

The researchers also found an even larger difference in men who appeared to use Viagra more often. Among the highest users, based on total prescriptions, the risk of being diagnosed with Alzheimer’s was 44 percent lower. (Men with erectile dysfunction are instructed to only take Viagra before sex, and no more than once a day.)

“I’m excited by the findings but more excited because I feel this could lead to further, high-quality studies in a disease area that needs more work,” said Ruth Brauer, a lecturer in pharmacoepidemiology at the University College London School of Pharmacy and the principal investigator of the study.

There’s a limit to how much we can conclude from the study results. The findings show an association between lower Alzheimer’s risk and Viagra use, but don’t prove cause and effect. For instance, it may be that Viagra use is a marker for better overall health, and that men who have more sex also are more physically active as well. Physical activity is independently associated with a lower risk of Alzheimer’s disease, Brauer said.

Why Viagra may be linked with a lower risk of dementia

Sildenafil, the generic name for Viagra, was never supposed to be a sex drug. Pfizer had developed the drug as a cardiovascular medication to treat hypertension and chest pain called angina. The company had been conducting clinical trials using sildenafil as a heart medication when some patients reported an unexpected side-effect — erections.

Viagra is part of a class of drugs known as phosphodiesterase Type 5 Inhibitors, or PDE-5 drugs. The drugs work by dilating blood vessels and increasing blood flow throughout the body, including to the penis. Since its discovery as an erectile dysfunction treatment, sildenafil also has been used to treat pulmonary arterial hypertension for both men and women.

The link between heart health and sexual health is strong. Erectile dysfunction can be an early warning sign of coronary artery disease. And an unhealthy vascular system is one of the reasons men start having problems with erections.

Vascular risk factors have also been linked to certain types of dementia, including Alzheimer’s disease, so researchers have been intrigued about whether erectile dysfunction treatments can affect brain health as well.

Animal studies of PDE-5 inhibitors have shown the drug may help prevent cognitive impairment by, in part, increasing blood flow in the brain, but researchers who conducted a review of the available research say the efficacy of the class of drugs “remains unclear.” And Brauer said the findings in animals are only “possible mechanisms” in humans.

“There is an idea that if we can help with improving blood flow in the brain, maybe we can also reduce the risk for Alzheimer’s disease,” said Sevil Yasar, an associate professor of medicine at Johns Hopkins University and the co-author of an editorial that accompanied the study in Neurology.

Other reasons for the effect

Stanton Honig, a professor of urology at Yale School of Medicine, said the newest study is far from definitive. “You can’t draw any conclusions” from the study because “there are so many other factors” at play besides whether a man takes a pill for erectile dysfunction.

“Someone who is more likely to take a pill like that at 70, they’re probably more active, they’re more likely involved with their partners, things like that,” Honig said. “There’s too many confounding variables to make a definitive statement that it’s the pills or it’s the patients that are taking the pills that are less likely to be neurologically impaired.”

Brauer said the average “pack” per prescription is four tablets. But it’s not clear if the men took all the tablets prescribed and, if so, how often.

“We do not know if people used the prescribed drugs as intended nor could we measure sexual activity or physical activity levels,” Brauer said. “We need further studies to show if our results would hold up in a group of men without erectile dysfunction and — even better — it would be better to run our study in a group of men and women.”

Previous studies on different populations have come to somewhat contradictory conclusions. A Cleveland Clinic study found a significantly reduced risk of Alzheimer’s disease among those using sildenafil, said Feixiong Cheng, the director of the Cleveland Clinic Genome Center and the principal investigator of the study. But a study by researchers at Harvard Medical School and the National Institute on Aging found “no association” between the use of sildenafil, or other PDE-5 inhibitors, and the risk of Alzheimer’s disease, said Rishi Desai, an associate professor at Harvard Medical School.

More study is needed

Rebecca Edelmayer, the senior director of scientific engagement for the Alzheimer’s Association, said in an email that it remains unclear whether Viagra and similar drugs have an effect on Alzheimer’s risk. “Further research and specifically designed, randomized clinical trials are a necessary step,” she said.

For now, the findings don’t suggest that men should start taking Viagra if they don’t need it. But we do know that Viagra is an effective treatment for erectile dysfunction, and men who are experiencing the problem should see a doctor and discuss both their sexual health and cardiovascular health.

“You should not take Viagra to reduce your risk,” Yasar said. “You should eat healthy. You should exercise. There’s plenty of evidence for that.”

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6 Questions to Ask Your Doctor About Sex after 50

— Vaginal dryness, erection challenges, safe sex and more

By Ellen Uzelac

With most physicians ill prepared to talk about sexual health and many patients too embarrassed or ashamed to broach the subject, sex has become this thing we don’t discuss in the examining room.

“So many doctors talk about the benefits of nutrition, sleep, exercise — but they don’t talk about this one really essential thing we all share: our sexuality,” says Evelin Dacker, a family physician in Salem, Oregon, who is dedicated to normalizing sexual health in routine care. “We need to start having this conversation.”

Starting the conversation about sexual health

Sexual wellness experts suggest first talking about a physical problem such as a dry vagina or erectile challenges and then segueing into concerns about desire, low libido and intimacy.

As Joshua Gonzalez, a urologist and sexual medicine physician in Los Angeles, observes: “Patients sometimes need to be their own advocates. If you feel something in your sex life is not happening the way you would like it to, or if you are not able to perform sexually as you would like, never assume that this is somehow normal or inevitable.”

Often, there are physiological issues at play or medications that can alter your sexual experience. “If you’re interested in having sex,” Gonzalez says, “there are often real solutions for whatever the problem may be.”

Here are six questions to help steer the conversation in the right direction.

1. What can I do about unreliable erections?

Erectile dysfunction is common in older men — 50 percent of men in their 50s will experience erectile challenges, Gonzalez says, and 60 percent of men in their 60s, 70 percent of men in their 70s, and on up the ladder.

The good news: There are fixes. “This doesn’t mean giving up on having pleasurable sex at a certain age,” Gonzalez says. The two primary things he evaluates are hormone balance and blood flow to the penis. A treatment plan is then designed based on those results.

Some older men also find it often takes time and effort to ejaculate. Gonzalez suggests decoupling the idea of ejaculation and orgasm. What many men don’t realize: You can have an orgasm with a soft penis and without releasing any fluid at all. “Your orgasm — the pleasure component — is not going to change.”

Also good to know: Sexual health is a marker of overall health. As an example, erectile dysfunction can be a predictor of undiagnosed health issues such as heart disease and diabetes years before any other symptoms arise, says Gonzalez.

2. Sex is different now. My body is no longer young but I still have sexual urges. How do I accommodate this new normal?

Dacker often asks her older patients: How is the quality of your intimacy? Is it what you want it to be? Have you noticed a shift as you’ve gotten older and what does that mean to you?

“Naturally, as we age our bodies start working differently,” she says. “I like to reframe what it means to be sexual by expanding our intimate life, doing things that maybe you haven’t thought of doing before.”

Dacker, who teaches courses on how to be a sex-positive health care provider, suggests exploring each other in new ways: dancing, eye gazing, washing one another while bathing, giving hands-free coconut oil massages using your stomach, arms and chest. She’s also a fan of self-pleasure.

“There’s so much pleasure that doesn’t involve penetration, orgasm and erections,” she adds. “It’s not about performance, it’s about pleasure.”

3. My vagina hurts when I have penetrative sex to the point that I’m now avoiding it. What can I do?

A lack of estrogen in older women can cause the vaginal wall to get really thin, resulting in dryness, irritation and bleeding when there is friction.

“It can be uncomfortable with or without sex,” says Katharine O’Connell White, associate professor of OB/GYN at Boston University and vice chair of academics and the associate director of the Complex Family Planning Fellowship at Boston Medical Center. “What people don’t realize is that what they’re feeling is so incredibly common. A majority of postmenopausal women will experience this.”

White offers a three-part solution for vaginal dryness: If you’re sexually active — and even if you’ve never used a lubricant before — add a water-based lube during sex play. Also, consider using an estrogen-free vaginal moisturizer, sold in stores and online, to help restore the vaginal lining. Finally, think about adding back the estrogen that the body is craving through medically prescribed tablets, rings or creams that are inserted into the vagina.

White also advises patients to engage in 20 to 30 minutes of foreplay before penis-in-vagina sex. “The whole body changes and the vagina gets wet, wider and longer, which can go a long way to alleviating any discomfort,” she says.

4. Urinary incontinence is interfering with my sex life. How can I control it?

Because the bladder is seated on top of the vagina, the thinning of the vaginal wall can also impact the bladder. When you urinate, it can burn or you will want to pee more often, symptoms typical of a urinary tract infection, according to White.

Some women feel like they need to urinate during sex, which, as White says, “can pull you out of the mood.” Her advice? “Pee before sex and pee after sex.” She also suggests using vaginal estrogen to plump up the walls of the vagina and, by extension, the bladder.

5. I’m interested in dating again. What screenings for sexual wellness should I get — and require of a new partner?

Fully understanding the importance of reducing your risk for sexually transmitted infections (STIs) should be front and center as you reenter the dating scene, according to nurse practitioner Jeffrey Kwong, a professor at the School of Nursing at Rutgers University and clinical ambassador for the Centers for Disease Control and Prevention’s “Let’s Stop HIV Together” campaign. 

“Individuals should be screened if they’re engaging in any sort of sexual activity — oral, vaginal, anal — because many times, some of these conditions can be asymptomatic,” he says. “You can transmit without symptoms and vice versa.”

Screening may involve a urine or blood test or swabs of the vagina, throat or rectum. With STIs soaring in older adults, Kwong suggests testing for HIV, hepatitis C, hepatitis B, chlamydia, gonorrhea and syphilis. In early 2024, the CDC reported that syphilis cases had reached their highest level since the 1950s.

6. My doctor was dismissive when I brought up sex, basically saying, At your age, what do you expect? What should I do now?

Sex is a special part of life no matter how old you are. “If you’re with a doctor who brushes aside any of your concerns, it’s time to find a new doctor,” White says.

Finding a good doctor, she adds, is no different from looking for an accomplished hair stylist or a reliable mechanic: Ask your friends.

“I’m horrified when I hear about things like this,” she adds. “Any good doctor really wants you to bring up the things that concern you.“

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Is It Safe to Have Sex If You Have Heart Disease?

by Maggie O’Neill

Key Takeaways

  • Most people with heart disease can safely engage in sexual activity.
  • But sex can exacerbate some specific heart conditions, and anyone with heart disease should be mindful of warning signs like shortness of breath or chest pain during sex.
  • It’s important to speak with a healthcare provider about the benefits and risks of sex after a heart disease diagnosis.

You should be mindful of how you feel during sex—or any other form of physical activity—if you have heart disease. However, having heart disease doesn’t necessarily mean you have to abstain from sex.

“Generally speaking, sexual activity is safe for patients with cardiovascular disease,” Lindsey Rosman, PhD, assistant professor of medicine in the division of cardiology at the University of North Carolina School of Medicine, told Verywell.1

>It may be helpful to think about the risks and benefits of sex the same way you would a workout, Jim Liu, MD, clinical assistant professor of internal medicine at The Ohio State University Wexner Medical Center, told Verywell. “I would think of sexual activity as any other physical activity—your blood pressure goes up, your heart rate goes up, and that’s how [sex] really impacts the heart,” he explained.

While sex is usually safe if you’re living with a heart condition, you should talk with your healthcare provider about any concerning symptoms to look out for during sex.

“Patients and their spouses are very reluctant to ever ask about sexual activity, and doctors are not very good at spontaneously bringing up the topic,” Glenn Levine, MD, professor of medicine in the cardiology department at Baylor College of Medicine, told Verywell. “Both patients and providers should be aware of this and not be afraid to bring this topic up on the part of the patient and their spouse.”

It’s important to know that living with a heart condition doesn’t mean that sex is “dangerous” for you. In fact, it can be good for your overall health and well-being. “Sexual activity is a form of exercise which can help strengthen your heart, reduce stress, and improve sleep,” Rosman said.

It may have benefits beyond the physical, Liu added. “Having sex has an impact on people’s quality of life, and this may have an indirect [positive] impact on heart health,” he said.

“There is a slightly elevated risk of experiencing a cardiac event whenever you’re physically active, whether it’s sexual activity or going for a walk,” Rosman said.

Is It Possible to Have a Heart Attack During Sex?

However, heart attacks during sex do not happen often. “Sex is a relatively rare trigger of heart attack or sudden death,” Rosman said. She added that less than one percent of all heart attacks occur during sexual activity.

Anyone with a heart condition should watch for the following warning signs during or after sexual activity, Rosman said:

  • Chest pain
  • Shortness of breath
  • Rapid heart rate
  • Irregular heart rate
  • Dizziness
  • Insomnia after sexual activity
  • Fatigue the day after sexual activity

If you have heart disease and start to experience these symptoms, contact a healthcare provider.

Does Heart Disease Impact Sexual Function?

A heart disease diagnosis can impact your sex life in many different ways, experts said. The disease itself and the treatments prescribed can affect sexual function.2

“Heart disease and its treatment can change the way blood circulates throughout the body and may reduce the amount of blood supplied by the heart to distant areas of your body, including the genital region,” Rosman said. “Reduced blood flow can lead to erectile dysfunction in men and sexual arousal difficulties in women, [meaning] both men and women may experience difficulty reaching orgasm.”

The toll heart disease takes on your mental health can indirectly affect your sexual health.3 “Emotional stress, depression, and anxiety are common in patients with cardiovascular disease and are associated with increased risk for sexual problems,” Rosman said.

Following a heart disease diagnosis, you may become less physically active than you were before, which could affect your sexual desire and performance, she added.

Partners of people with heart disease may also be affected: “Heart disease can be stressful for patients’ spouses and partners, which can impact intimate relationships,” Rosman explained.

Lastly, the symptoms that come with heart disease—such as palpitations, chest pain, shortness of breath, and fatigue—may make people who experience them less likely to want to engage in sexual activity.

Can People With Heart Disease Take Medications That Affect Sexual Performance?

If you’ve been diagnosed with heart disease, it’s important to speak with a healthcare provider before taking any new medications, including those for sexual performance. In general, most drugs that enhance libido (sex drive) or otherwise impact sexual performance are safe. However, some people who take erectile dysfunction medications should be aware of possible side effects or complications.

“Medications to treat erectile dysfunction such as Viagra [sildenafil], Cialis [tadalafil], Stendra [avanafil], and Levitra [vardenafil] are generally safe for patients with heart disease,” Rosman said. “[But] men with cardiovascular disease should use these medications with caution because they can cause a temporary drop in blood pressure.”

Erectile dysfunction medications can be dangerous for people with heart problems who take nitrate therapy for chest pain, experts said.3 “You can never take nitrates with those kinds of medications,” Liu said. It’s important for people who do take nitrates for chest pain to know there are other treatments for erectile dysfunction, Rosman added.

If you have heart disease, you should talk to a healthcare provider before trying any new medication, including over-the-counter [OTC] therapies. “Patients should not use dietary supplements and other [OTC] pills for erectile dysfunction without discussing these medications with their doctor,” Rosman said.

Who Should Avoid Sex With Heart Disease?

Though sex is typically safe for people with heart disease, sex may exacerbate some specific conditions, Rosman said. For this reason, “patients with advanced [heart] disease, unstable angina, or uncontrolled hypertension should talk to their doctor before engaging in sexual activity,” she explained. Those with advanced disease include people with unstable coronary disease or severe heart failure, Liu said.

Talking to a Healthcare Provider About Sex and Heart Disease

It’s normal to want to resume sexual activity after a heart disease diagnosis. “Returning to sexual activity is a common concern for patients with heart disease,” Rosman said.3

When possible, you should discuss the risks and benefits of sexual activity with your healthcare provider and your partner, Rosman said.

Your cardiologist may suggest therapies outside of heart disease treatments that may help. “If emotional distress, depression, and anxiety are contributing to sexual difficulties, patients may benefit from individual counseling with a licensed psychologist or mental health provider,” Rosman said. “Couples therapy may also be beneficial.”

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Psilocybin, LSD And Other Psychedelics Improve Sexual Satisfaction For Months After Use, New Study Finds

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Psychedelic substances, including psilocybin mushrooms, LSD and others, may improve sexual function—even months after a psychedelic experience, according to a new study.

The findings, published on Wednesday in Nature Scientific Reports, are based largely on a survey of 261 participants both before and after taking psychedelics. Researchers from Imperial College London’s Centre for Psychedelic Research then combined those responses with results of a separate clinical trial that compared psilocybin and a commonly prescribed selective serotonin reuptake inhibitor (SSRIs) for treating depression.

Authors say it’s the first scientific study to formally explore the effects of psychedelics on sexual functioning. While anecdotal reports and and qualitative evidence suggest the substances may be beneficial, the study says, “this has never been formally tested.”

“It’s important to stress our work does not focus on what happens to sexual functioning while people are on psychedelics, and we are not talking about perceived ‘sexual performance,’” said Tommaso Barba, a PhD student at the Centre for Psychedelic Research and the lead author of the study, “but it does indicate there may be a lasting positive impact on sexual functioning after their psychedelic experience, which could potentially have impacts on psychological wellbeing.”

“Both studies and populations reported enhanced sexual functioning and satisfaction following psychedelic use.”

Authors noted that sexual dysfunction is a common symptom of mental health disorders as well as a common side effect of certain medications, such as SSRIs.

“On the surface, this type of research may seem ‘quirky,’” Barba said in a statement, “but the psychological aspects of sexual function—including how we think about our own bodies, our attraction to our partners, and our ability to connect to people intimately—are all important to psychological wellbeing in sexually active adults.”

Co-author Bruna Giribaldi said that while most studies ask whether depression treatments cause sexual dysfunction, this study attempted to go further.

“We wanted to make sure we went deeper than that and explored more aspects of sexuality that could be impacted by these treatments,” Giribaldi added. “We were interested in finding out whether psychedelics could influence people’s experiences of sexuality in a positive way, as it appeared from existing anecdotal evidence.”

The team’s analysis found that respondents typically experienced improvement in sexual function for as long as six months after a psychedelic experience, observing upticks in reported enjoyment of sex, sexual arousal, satisfaction with sex, attraction to their partners, their own physical appearance, communication and their sense of connection.

“Naturalistic use of psychedelics was associated with improvements in several facets of sexual functioning and satisfaction, including improved pleasure and communication during sex, satisfaction with one’s partner and physical appearance.”

The most striking improvements were around seeing sex as “a spiritual or sacred experience,” satisfaction with one’s own appearance and one’s partner as well as the experience of pleasure itself.

“Sexuality is a fundamental human drive. For example, we know that sexual dysfunction is linked to lower well-being in healthy adults, can impact relationship satisfaction, and is even linked to subjective happiness and ‘meaning in life,’” Barba said.

The only marker of sexual function that did not go up significantly was “importance of sex,” which could be read to mean that psychedelics did not cause hypersexuality or an excessive focus on sex.

In the clinical trial portion of the study, which compared psilocybin therapy to the SSRI escitalopram, authors found that while both treatments showed “similar reductions” in depressive symptoms, “patients treated with psilocybin reported positive changes in sexual functioning after treatment, while patients treated with escitalopram did not.”

Barba said that’s especially significant because “sexual dysfunction, often induced by antidepressants, frequently results in people stopping these medications and subsequently relapsing.”

David Erritzoe, clinical director of the Centre for Psychedelic Research at Imperial College London, said the findings “shine more light on the far-reaching effects of psychedelics on an array of psychological functioning” but said more study is still needed, especially in light of the currently illicit nature of psychedelics.

“While the findings are indeed interesting, we are still far from a clear clinical application,” Erritzoe said in a release, “because psychedelics are yet to be integrated into the medical system. In future, we may be able to see a clinical application, but more research is needed.”

As the study itself says, “These findings highlight the need for further research utilizing more comprehensive and validated measures to fully understand the results of psychedelics on sexual functioning. However, the preliminary results do suggest that psychedelics may be a useful tool for disorders that impact sexual functioning.”

“Use of psychedelic drugs might foster an improvement in several facets of sexual functioning and satisfaction, including experienced pleasure, sexual satisfaction, communication of sexual desires and body image.”

The new study comes just a few months after a study published by the American Medical Association reported the apparent “efficacy and safety” of psilocybin-assisted psychotherapy for treatment of bipolar II disorder, a mental health condition often associated with debilitating and difficult-to-treat depressive episodes.

Both studies are part of a growing body of research demonstrating the potential of psilocybin and other entheogens to treat a range of mental health conditions, including PTSD, treatment-resistant depression, anxiety, substance use disorders and others.

A recently published survey of more than 1,200 patients in Canada, for example, suggested use of psilocybin can help ease psychological distress in people who had adverse experiences as children. Researchers said the psychedelic appeared to offer “particularly strong benefits to those with more severe childhood adversity.”

And in September, researchers at Johns Hopkins University, Ohio State University and Unlimited Sciences published findings showing an association between psilocybin use and “persisting reductions” in depression, anxiety and alcohol misuse—as well as increases in emotional regulation, spiritual wellbeing and extraversion.

A separate study from the American Medical Association (AMA) came out in August showing that people with major depression experienced “clinically significant sustained reduction” in their symptoms after just one dose of psilocybin.

As for other entheogens, a separate peer-reviewed study published in the journal Nature recently found that treatment with MDMA reduced symptoms in patients with moderate to severe PTSD—results that position the substance for potential approval by the Food and Drug Administration (FDA).

Another study published in August found that administering a small dose of MDMA along with psilocybin or LSD appears to reduce feelings of discomfort like guilt and fear that are sometimes side effects of consuming so-called magic mushrooms or LSD alone.

A first-of-its-kind analysis released in June, meanwhile, offered novel insights into the mechanisms through which psychedelic-assisted therapy appears to help people struggling with alcoholism.

At the federal level, the National Institute on Drug Abuse (NIDA) recently started soliciting proposals for a series of research initiatives meant to explore how psychedelics could be used to treat drug addiction, with plans to provide $1.5 million in funding to support relevant studies.

As for other research into controlled substances and sex, a report last year in the Journal of Cannabis Research found that marijuana could also enhance sexual enjoyment, especially for women—findings authors said could help close the “orgasm inequality gap” between men and women.

A 2022 study out of Spain, meanwhile, found that young adults who smoke marijuana and drink alcohol had better orgasms and overall sexual function than their peers who abstain or use less.

An earlier 2020 study in the journal Sexual Medicine also found that women who used cannabis more often had better sex.

Numerous online surveys have reported similar positive associations between marijuana and sex. One study even found a connection between the passage of marijuana laws and increased sexual activity.

Yet another, however, cautioned that more marijuana doesn’t necessarily mean better sex. A literature review published in 2019 found that cannabis’s impact on libido may depend on dosage, with lower amounts of THC correlating with the highest levels of arousal and satisfaction. Most studies showed that marijuana has a positive effect on women’s sexual function, the study found, but too much THC can actually backfire.

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