Some men may not know as much about their own sexual health because women’s health dominates that public conversation.
That could be important because the Centers for Disease Control and Prevention recently reported that sexually transmitted diseases like syphilis, chlamydia and gonorrhea — all of which can be cured with antibiotics — are spreading more than ever. Gay and bisexual men and young people were particularly affected by the infection increases.
Dr. Arik Marcell, a professor of pediatrics at Johns Hopkins and the paper’s first author, said in the statement that it shows “no one particular factor is responsible for young men’s lack of engagement” in getting sexual and reproductive health care. “We need to think about working at multiple levels to effect change rather than focusing solely on the individual level, which may place undue blame on the individual.”
Study results show that the young men surveyed talk to people in their lives, like their mothers and friends, about their health but didn’t always know where to go for care. Self-consciousness also played a role in their care: “Some participants also discussed needing greater self-confidence when asking and answering questions about their health in general, especially about their sexual health,” the university said.
The authors suggest that a lack of knowledge or health care could have a gender basis: According to the study, the culture around health care in the U.S. is “focused on women’s health” and males are influenced by “traditional masculinity scripts.”
“Few men also have received sexual and reproductive care because historically, few clinical guidelines have outlined care that providers should deliver to this population, and few public health efforts have focused on engaging this population,” Johns Hopkins said.
Care is not the only way men lag behind women when it comes to sexual and reproductive health. Another recent study showed that men don’t know a lot about their own fertility. A survey of hundreds of Canadian men found they were generally not aware of many of the factors that could reduce their sperm counts. And the authors of that study suggested one of the reasons could be that men are not are likely as women to ask questions about their own health.
Although the new study shows men have less knowledge and receive less care than women when it comes to their sexual health, some are getting a level of care. According to Johns Hopkins, about half of the men they surveyed had health insurance and a regular source of health care, and a majority had received a physical exam in the last year. Additionally, 35 of the 70 were tested for HIV.
“I was 17, when I first got sexually intimate with my boyfriend,” says Kriya (name changed), a 23-year-old IT professional from Hyderabad, while speaking to The News Minute.
“Later we were very scared, as it was the first time for both of us,” she recalls. She missed her periods that month. The 17-year old who had never once been to hospital alone, was scared and unsure of what to do next.
Trying to glean more information online just added to her worry over getting pregnant. Finally she discussed the issue with her boyfriend, and both of them decided to consult a gynaecologist.
“I was already very scared. After I told the receptionist my age, she kept staring at me. It made me so uncomfortable. While other patients were called by name, when it was my turn, she said ‘Aey, hello.…go!’ I felt so bad.
I expected at least the doctor to act sensitive. She first asked me what happened. When I told her, she started lecturing to me about our culture, and how young I am. It was a horrible experience. After the check-up, once I reached home, I burst out crying,” she shares.
From then on, Kriya has always felt too scared to discuss any sexual health problem with a gynaecologist. She is now 23, but in her view, nothing much has changed.
“Last month, I had rashes all over my vagina right up to my thigh. I just could not walk. It was painful. In the beginning, I used anti-allergic medication and antiseptic cream. But I was finally forced to go to a doctor. But even this time, I was ill-prepared for those weird looks.
The receptionist first asked for my name, then my husband’s name. For a moment, I panicked. After a pause I said, I am unmarried.”
Kriya feels that such unnecessary queries have nothing to do with a particular health problem and should not be asked: “We are adults and should not be judged for such things. After all, it is my decision. But society does not think so.”
Dr Kalpana Sringra, a Hyderabad-based sexologist agrees:“Doctors should not interfere in a patient’s personal life. But sadly, some do. A few are open-minded. They do not care whether the patient is married or not. We do at times have to ask about how frequently they have sex to ascertain the cause.”
Kalpana believes the rigid cultural restrictions and undue secrecy about anything related to sex are what makes patients uncomfortable sharing sexual health issues with their doctors.
Prapti (name changed), a 21-year old second year engineering student says: “Ï had quite a few relationships, and faced initial problems like bleeding and pain during sex. I sometimes lose interest while having sex, due to this immense pain in the vagina.”
But she does not want to consult a doctor: “I prefer advice from friends. At least, they will not judge me.” She remembers the time she had to consult a doctor two years ago, when after having sex, the pain persisted for a whole day.
“The doctor did not even try to explain the reason. I kept asking her whether it was anything serious. But she deliberately chose to ignore me. Later I heard her murmur ‘this generation….uff’! When I shared this with my friends, I realised they too had been in similar situations.
According to Kalpana, only ten percent women come forward to consult a doctor for sexual well-being, of which the majority are planning to get married soon and want to get themselves checked for infection and related advice.
No woman ever goes to the doctor for this, unless it is absolutely avoidable. Not just unmarried women, but even married ones are ignorant in this regard. Young unmarried women are only more hesitant to ask or seek medical help, fearing society and parents, she says.
“Both married and unmarried women are not comfortable. They mostly come with their partners. To make them feel comfortable, we talk to the women alone. After a while, they open up about their problems.”
She also claims that 20% of women who suffer from vaginal infection like UTI and rashes after marriage too feel shy to discuss it with the doctor: “Men seem more comfortable discussing their sexual problems. 90% of our patients are men. But they tend to come alone.”
That was not the case with Jayesh (name changed), a 27-year old. He used to earlier hesitate to talk about his sexual health: “It was only a year back that I consulted a doctor for premature ejaculation, something that I suffered from the age of 23. I used to think if my friends get to know, they would make fun of me.”
The common issues that men in the age group of 18-80 are premature ejaculation and erectile dysfunction. “Most men confess that they force their wives to use contraceptive pills, as they do not want to wear condoms,” Kalpana says.
Gaurav (name changed), a 29-yearold unmarried man insists that he has never forced his girlfriend to use contraceptive pills, but they do sometimes prefer pills over condoms.
Gaurav who is sexually active does not feel ashamed or uncomfortable consulting a doctor, but that is not the case with his girlfriend: “Four years back, she once started bleeding after we had sex. Honestly, I was clueless how to handle the situation and whom to contact. We did not go the doctor, fearing prejudice.
My girlfriend is not at all comfortable consulting a doctor. She usually avoids going to a gynaecologist, as they ask whether we are married or not. It makes her uncomfortable. It happened a few times with us in Hyderabad. That’s why sometimes she prefers to use emergency contraceptive pills rather than consult a doctor.”
“Sex jokes are allowed, but people are otherwise shy talking about sex. Parents do not talk freely on the topic. It is still a taboo for Indian society,” Gaurav remarks.
When Preeti (name changed) -who is now doing an event management course- was in her final BCom year, she led an active sex life:
“I went for a party and got drunk. That night my friend and I had sex. I did not then realise that we had forgotten to use a condom. After missing my periods, I freaked out. I was confused and went to see a doctor. They first asked if I was married. I lied.”
She also admits to feeling uncomfortable while buying I-pills, condoms or pregnancy test devices: “Once a medical shopkeeper asked whether it was for me, with those around giving me judgmental looks.”
Fearing societal disapproval, several unmarried women tend to take medications, after consulting the internet.
“They go to medical stores or send their partners to buy medicines without consulting a doctor. Emergency contraceptive pills have several side-effects like, dizziness, vomiting etc. Some even try to abort through pills, which is life-threatening and can affect their health in the long run,” warns Kalpana.
It isn’t just Anthony Weiner: There is a big, noisy conversation going on about sex and porn addiction, as a couple quick Googlesearches will readily reveal. Naturally, that conversation has brought with it a growing market for counselors and even clinics specifically oriented toward treating these problems.
The problem is, many sex researchers don’t think sex and porn addiction are useful, empirically backed frameworks for understanding certain compulsive forms of sexual behavior. This has led to a rather fierce debate in some quarters, albeit one the average news consumer is probably unaware of.
Last week, the skeptics won an important victory: The American Association of Sexuality Educators, Counselors, and Therapists, which is the main professional body for those professions, has come out with a position statement arguing that there isn’t sufficient scientific evidence to support the concepts of porn and sex addiction. “When contentious topics and cultural conflicts impede sexual education and health care,” begins the statement, which was sent out to the organization’s members last week, “AASECT may publish position statements to clarify standards to protect consumer sexual health and sexual rights.”
AASECT recognizes that people may experience significant physical, psychological, spiritual and sexual health consequences related to their sexual urges, thoughts or behaviors. AASECT recommends that its members utilize models that do not unduly pathologize consensual sexual problems. AASECT 1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and 2) does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge. Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy.
AASECT advocates for a collaborative movement to establish standards of care supported by science, public health consensus and the rigorous protection of sexual rights for consumers seeking treatment for problems related to consensual sexual urges, thoughts or behaviors.
David Ley, an Albuquerque clinical psychologist whose whose book The Myth of Sex Addiction likely gives you a sense of his views on the subject, and who reviewed the statement for AASECT prior to its publication, described this as “kind of a big deal.” “It hits the credibility of sex-addiction therapists kind of between the legs frankly,” he said in an email. “These are clinicians who claim to [work on] sexuality issues, and the main body of sex therapist says that they are not demonstrating an adequate understanding of sexuality itself.”
Back in August, after the latest Weiner scandal broke, Ley laid out in an email why, even in such an extreme case, describing the disgraced former representative as a “sex addict” isn’t a helpful approach:
Ley’s basic argument is that that “sex addiction” isn’t well-defined, is quite scientifically controversial, and in recent decades has been increasingly used to explain a broad range of bad behavior on the part of (mostly) men. But in a sense, this robs men of their agency, of the possibility that they can control their compulsions and put them in a broader, more meaningful psychological context. “Sex addiction,” in this view, is a lazy and easy way out. […] Someone like Weiner, Ley explained, could obviously “benefit from learning to be more mindful, conscious, and less impulsive in his sexual behaviors. But those are issues resolved by helping him, and others, to become more mindful, conscious, and intentional in his life as a whole.” When you single out sex addiction as the source of the problem rather than taking this more holistic approach, Ley argued, it “ignores the fact that sex is always a complex, overdetermined behavior and that sex is often used by men to cope with negative feelings. Is Weiner getting the help he needs in his career, personal life, and relationship? Does he have other ways to try to make himself feel attractive and valued? Those are the questions that this latest incident raises. Sadly, calling him a sex addict ignores all of these much more important concerns.”
Weiner might not be the most sympathetic figure, but if Ley and the AASECT are correct, many sex-and porn-addiction clinics and clinicians are taking a lot of money from vulnerable people and their families, despite not offering a science-based approach.
Unfortunately, this fits in neatly with a longstanding problem in the broader world of addiction-treatment services: As journalists like Maia Szalavitz have pointed out, this is an under-regulated area of treatment that is rife with pseudoscience and abuse. To take just one example, Science of Us, drawing on reporting by Sarah Beller, noted in June that one court-ordered addiction-treatment regime draws heavily from nonsensical Scientology ideas. If AASECT’s statement is any indication, the world of sex-addiction “treatment” isn’t all that much better.
It’s not always clear if a woman is really having an orgasm, as Meg Ryan demonstrated in When Harry Met Sally.
In the nascent field of orgasm research, much of the data relies on subjects self-reporting, and in men, there’s some pretty clear physiological feedback in the form of ejaculation.
But how do women know for sure if they are climaxing? What if the sensation they have associated with climax is actually one of the the early foothills of arousal? And how does a woman know when if she has had an orgasm?
Neuroscientist Dr Nicole Prause set out to answer these questions by studying orgasms in her private laboratory. Through better understanding of what happens in the body and the brain during arousal and orgasm, she hopes to develop devices that can increase sex drive without the need for drugs.
Understanding orgasm begins with a butt plug. Prause uses the pressure-sensitive anal gauge to detect the contractions typically associated with orgasm in both men and women. Combined with EEG, which measures brain activity, this allows for a more accurate picture of a woman’s arousal and orgasm.
Dr Nicole Prause has founded Liberos to study brain stimulation and desire.
When Prause began studying women in this way she noticed something surprising. “Many of the women who reported having an orgasm were not having any of the physical signs – the contractions – of an orgasm.”
It’s not clear why that is, but it is clear that we don’t know an awful lot about orgasms and sexuality. “We don’t think they are faking,” she said. “My sense is that some women don’t know what an orgasm is. There are lots of pleasure peaks that happen during intercourse. If you haven’t had contractions you may not know there’s something different.”
Prause, an ultramarathon runner and keen motorcyclist in her free time, started her career at the Kinsey Institute in Indiana, where she was awarded a doctorate in 2007. Studying the sexual effects of a menopause drug, she first became aware of the prejudice against the scientific study of sexuality in the US.
When her high-profile research examining porn “addiction” found the condition didn’t fit the same neurological patterns as nicotine, cocaine or gambling, it was an unpopular conclusion among people who believe they do have a porn addiction.
The evolution of design of the anal pressure gauge used in Nicole Prause’s lab to detect orgasmic contractions.
“People started posting stories online that I had falsified my data and I received all kinds of sexist attacks,” she said. Soon anonymous emails of complaint were turning up at the office of the president of UCLA, where she worked from 2012 to 2014, demanding that Prause be fired.
Does orgasm benefit mental health?
Prause pushed on with her research, but repeatedly came up against challenges when seeking approval for studies involving orgasms. “I tried to do a study of orgasms while at UCLA to pilot a depression intervention. UCLA rejected it after a seven-month review,” she said. The ethics board told her that to proceed, she would need to remove the orgasm component – rendering the study pointless.
Undeterred, Prause left to set up her sexual biotech company Liberos, in Hollywood, Los Angeles, in 2015. The company has been working on a number of studies, including one exploring the benefits and effectiveness of “orgasmic meditation”, working with specialist company OneTaste.
Part of the “slow sex” movement, the practice involves a woman having her clitoris stimulated by a partner – often a stranger – for 15 minutes. “This orgasm state is different,” claims OneTaste’s website. “It is goalless, intuitive, and dynamic. It flows all over the place with no set direction. It may include climax, or it may not. In Orgasm 2.0, we learn to listen to what our body wants instead of what we think we ‘should’ want.”
Prause wants to determine whether arousal has any wider benefits for mental health. “The folks that practice this claim it helps with stress and improves your ability to deal with emotional situations even though as a scientist it seems pretty explicitly sexual to me,” she said.
Prause is examining orgasmic meditators in the laboratory, measuring finger movements of the partner, as well as brainwave activity, galvanic skin response and vaginal contractions of the recipient. Before and after measuring bodily changes, researchers run through questions to determine physical and mental states. Prause wants to determine whether achieving a level of arousal requires effort or a release in control. She then wants to observe how Orgasmic Meditation affects performance in cognitive tasks, how it changes reactivity to emotional images and how it compares with regular meditation.
Brain stimulation is ‘theoretically possible’
Another research project is focused on brain stimulation, which Prause believes could provide an alternative to drugs such as Addyi, the “female Viagra”. The drug had to be taken every day, couldn’t be mixed with alcohol and its side-effects can include sudden drops in blood pressure, fainting and sleepiness. “Many women would rather have a glass of wine than take a drug that’s not very effective every day,” said Prause.
Prause is studying whether these technologies can treat sexual desire problems. In one study, men and women receive two types of magnetic stimulation to the reward center of their brains. After each session, participants are asked to complete tasks to see how their responsiveness to monetary and sexual rewards (porn) has changed.
With DCS, Prause wants to stimulate people’s brains using direct currents and then fire up tiny cellphone vibrators that have been glued to the participants’ genitals. This provides sexual stimulation in a way that eliminates the subjectivity of preferences people have for pornography.
“We already have a basic functioning model,” said Prause. “The barrier is getting a device that a human can reliably apply themselves without harming their own skin.”
There is plenty of skepticism around the science of brain stimulation, a technology which has already spawned several devices including the headset Thync, which promises users an energy boost, and Foc.us, which claims to help with endurance.
Neurologist Steven Novella from the Yale School of Medicine uses brain stimulation devices in clinical trials to treat migraines, but he says there’s not enough clinical evidence to support these emerging consumer devices. “There’s potential for physical harm if you don’t know what you’re doing,” he said. “From a theoretical point of view these things are possible, but in terms of clinical claims they are way ahead of the curve here. It’s simultaneously really exciting science but also premature pseudoscience.”
Biomedical engineer Marom Bikson, who uses tDCS to treat depression at the City College of New York, agrees. “There’s a lot of snake oil.”
Sexual problems can be emotional and societal
Prause, also a licensed psychologist, is keen to avoid overselling brain stimulation. “The risk is that it will seem like an easy, quick fix,” she said. For some, it will be, but for others it will be a way to test whether brain stimulation can work – which Prause sees as a more balanced approach than using medication. “To me, it is much better to help provide it for people likely to benefit from it than to try to create fake problems to sell it to everyone.”
Sexual problems can be triggered by societal pressures that no device can fix. “There’s discomfort and anxiety and awkwardness and shame and lack of knowledge,” said psychologist Leonore Tiefer, who specializes in sexuality. Brain stimulation is just one of many physical interventions companies are trying to develop to make money, she says. “There’s a million drugs under development. Not just oral drugs but patches and creams and nasal sprays, but it’s not a medical problem,” she said.
Thinking about low sex drive as a medical condition requires defining what’s normal and what’s unhealthy. “Sex does not lend itself to that kind of line drawing. There is just too much variability both culturally and in terms of age, personality and individual differences. What’s normal for me is not normal for you, your mother or your grandmother.”
And Prause says that no device is going to solve a “Bob problem” – when a woman in a heterosexual couple isn’t getting aroused because her partner’s technique isn’t any good. “No pills or brain stimulation are going to fix that,” she said.
We are accustomed to thinking of human sexuality as definitive. For a long time, heterosexuality was the only acceptable form of sexual preference. Even up until the 1970s, homosexuality was considered abnormal. In the Diagnostic & Statistical Manual of Mental Health, ascribed by the American Psychiatry Association, it was listed as a mental illness. After much protest and education, we have now come to understand that there is nothing wrong with people who take lovers of the same sex.
While most of us held on to man-woman relationship as the norm, Dr Alfred Kinsey, along with his team, proposed an alternative theory that human sexuality is a continuum, and that we can’t hold it in binary terms like heterosexuality and homosexuality. This thought, first put forth in 1940s, was revolutionary at the time.
Now, however, we have moved way past labelling sexual orientation. Human sexuality seems to be far more diverse than researchers initially thought. Current understanding differentiates between sexual and romantic attraction. In light of this, many new terms to describe preferences, have come about. From pansexual to queerplatonic relationships, the glossary is ever-increasing (Read more about this on our website, here).
Dr. Savin Williams, a psychologist at Cornell University, has done extensive research on the sexuality spectrum, and same-sex relationships. He concludes that very few people, in reality, identify as completely straight. In other words, there is a little bit of “gayness” in all of us, whether we’ve explored it or not.
Sigmund Freud said that homophobia is, in fact, a reverse reaction to one’s own homosexual fantasies. He purported that we all have defence mechanisms, which protect us from traits, feelings, thoughts, and fantasies in ourselves, and others, that we find uncomfortable. One of these defence mechanisms is ‘Reaction Formation’. Those of us who are guilty of this, turn a feeling or fantasy that makes us uncomfortable into its opposite. It’s a subconscious process. So, according to Freud, those who are homophobic actually harbour homosexual fantasies, but their desire makes them uncomfortable. So, in order to cope with the discomfort, they go through the unconscious process of turning their wish into something forbidden and disgusting.
Sexuality is fluid and diverse, far from what we have been taught is the norm. There is no sexual expression that is abnormal, except of course, sex without consent, with animals or children. In light of this, where do you stand on the human sexuality spectrum?