Category: Birth Control

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Misinformation Is on the Rise.

— Here’s What You Need to Know About Birth Control.

Three Black reproductive experts discuss how to access birth control, navigate the misinformation online, and understand what’s unfolding politically.

By Margo Snipe

It’s been a tricky landscape since Roe v. Wade was overturned almost two years ago, as reproductive health care has become increasingly complicated to navigate — and misinformation is on the rise.

Not only are the attacks on abortion care merging with limits on the availability of infertility treatment, but the same court that reversed the constitutional protection for abortion will hear arguments this week on restricting access to mifepristone, one of two medications commonly used to induce an abortion. And on the state level, new bills are aiming to cut back contraception options.

In Oklahoma, one bill in the state legislature has sparked questions about whether it might ban emergency contraception — like the day-after Plan B pill — and intrauterine devices, or IUDs. Part of it targets contraception that prevents the implantation of a fertilized egg. At the same time, some birth control options are expanding. This month, Opill, the first over-the-counter birth control pill, began sales. And, under a new policy, New York pharmacists can dispense certain hormonal contraceptives without a prescription.

Capital B asked three Black reproductive health care experts some of the big questions about how to access birth control, navigate the misinformation online, and understand what’s unfolding politically. Here’s what you need to know.

What is the difference between abortion care and birth control?

Amid the uptick in misinformation, experts want patients to understand there is a distinct difference between abortion care and birth control. Birth control, like the pill and IUDs, is not abortion inducing, doctors say.

While both are considered a part of reproductive health care, birth control, also called contraception, is intended to prevent pregnancy before it occurs and is often discussed and prescribed by gynecologists, which are doctors who specialize in women’s reproductive health systems. 

“Birth control is acting to fundamentally prevent pregnancy,” said Dr. Alexandra Wells, an OB-GYN in Washington state. It works by stopping sperm from meeting the egg, she said.

Abortion care is separate. It terminates an already existing pregnancy, either out of patient choice up to a certain time period or medical necessity. It takes place after folks know they are pregnant and is typically managed by obstetricians, or doctors that focus on the pregnancy of patients. Many practitioners have their training in both gynecology and obstetrics.

Over the past year, how has the landscape over available birth control changed?

With so many different bills being introduced in states across the country, aiming to both limit and expand access to reproductive health care, the amount of misinformation spreading across social media platforms is surging.

While birth control and abortion care are different, the landscape in terms of access to both is shifting nationwide.

Soon after the 2022 Dobbs decision reversing federal abortion protections, when states began moving to restrict abortion, many physicians were concerned about the implications on birth control, said Dr. Yolanda Lawson, a Texas-based OB-GYN. It was not the first time. Several years prior, in the Burwell v. Hobby Lobby case, the U.S. Supreme Court decided that corporations run by religious families cannot be required to pay for insurance coverage for contraception care.

More recently, changes in abortion care have also trickled into changes in birth control access and infertility treatment for families. When reproductive health care clinics offering abortions close, other  services are impacted, said Wells, who’s also a fellow with Physicians for Reproductive Health. The good news is technology is making online access to birth control options more accessible. Many options can be mailed and are often covered by insurance, she said.

Opill is now available, adding to the many other options, including condoms, spermicide, the ring, IUDs, implants, patches and cycle tracking.

How do I know what’s happening with access to birth control in my state?

There is no comprehensive, central location for all of this information, said Jennifer Driver, senior director of reproductive rights at SiX, an organization that works with elected officials after they win office. The federal Title X family planning websites have a lot of information and resources for patients, said Driver. The best way to find out what is happening with legislation is directly through the state legislator. On each website, you can see what bills are being introduced and which representatives may have brought it forth.

Local news coverage from trusted outlets may also break down what bills are impacting your reproductive health care. Experts caution against relying on social media for health information, given the sheer amount of misinformation and myths.

Do IUDs induce abortions?

No. The devices work by thickening the mucus along the uterine wall, making it difficult for sperm to migrate and meet with the egg, preventing fertilization.

“It’s a simple mechanism, but it really works,” said Lawson, who’s also the president of the National Medical Association. It prevents conception. They are 99.9% effective at preventing pregnancy.

What birth control is now available?

Condoms, spermicide, contraceptive sponges, apps to track your menstrual cycle, emergency contraception like Plan B, and most recently Opill, are all birth control options that do not require a prescription from a doctor.

Some hormonal contraceptives require either a prescription or insertion by a medical provider. Those include the ring, IUDs, implants, contraceptive injections, and birth control pills. Sterilization is also an option regardless of the gender of the patient.

“It’s really amazing that women have so many contraception options,” said Lawson. There is some slight variation in how well each works, she said. “There are options that our grandmothers and even mothers did not have. I hope women are empowered by that.”

It’s also important to make sure you feel comfortable with your provider, said Wells. You should feel free to ask questions about how each contraceptive option works and might impact your body.

A lot of birth control options are covered by insurance, and many clinics and health centers may offer free condoms. Some birth control pill companies offer discounts on their websites.

If you’re uninsured, many freestanding health clinics offer sliding scale payment options based on your household income and ability to pay, which could bring the price down.

How do I know what my best birth control option is?

It’s important to understand your medical history, said Wells. In person or online, your provider may ask about your history with high blood pressure, blood clots, and conditions like lupus. Those conditions may preclude the use of certain forms of contraception.

People should also consider their lifestyle and goals, she said. For example, the IUD requires a one-time insertion every handful of years depending on the types, whereas the pill requires patients to take them at the same time each day. Each option offers a different level of independence. The pill can be stopped at any time. The IUD and implant require an appointment with a provider to remove.

Complete Article ↪HERE↩!

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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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How First US Over-the-Counter Birth Control Pill Could Revolutionize Reproductive Health

— “After a year during which there has been very little good news about people’s reproductive health, this is the first solid win in a long time,” says BU gynecologist

The FDA’s approval of Opill for over-the-counter use makes it the first hormonal contraceptive available without a prescription in the United States.

By Molly Callahan

The FDA’s approval of the first over-the-counter birth control pill in the United States could be a revolutionary change in birth control and reproductive health, says Katharine O’Connell White, an associate professor of obstetrics and gynecology at the Boston University Chobanian & Avedisian School of Medicine.

White, who is also vice chair of academics and associate director of the complex family planning fellowship at Boston Medical Center, says she felt “jubilation and glee” at hearing news of the Food and Drug Administration’s approval of Opill, a hormonal birth control pill, on Thursday.

“After a year during which there has been very little good news about people’s reproductive health, this is the first solid win in a long time,” she says. “And it finally puts the United States on par with most other countries in the world, where people have always had access to pills without a prescription.”

The news was received with support from almost every major reproductive health organization in the country, including the American Medical Association, the American College of Obstetricians and Gynecologists, the North American Society of Pediatric and Adolescent Gynecology, and the American Academy of Family Physicians.

The FDA’s approval comes amid myriad legal battles over reproductive rights—and almost exactly a year after the Supreme Court overturned Roe v. Wade, rescinding the right to abortion nationally.

Perrigo Company, which manufactures the pill, says it will likely be available in stores and from online retailers in the United States in early 2024.

BU Today spoke with White about the safety and effectiveness of Opill, as well as questions that still remain about its rollout and accessibility.

Q&A

with Katharine O’Connell White

BU Today: Based on what you’ve seen or read about Opill, how effective is it compared to other, prescription or nonprescription, birth control options?

White: The pill that got approved for over-the-counter use is a progestin-only pill. There are two types of birth control pills: the vast majority of pills—the ones you think about when you hear “The pill”—have estrogen and progesterone in them. But a few varieties are progestin only, for people who can’t or don’t want to take estrogen. So, this pill looks to be like other progestin pills. And all pills have roughly the same effectiveness rate—that they’re about 97 percent effective when taken perfectly, and about 93 percent effective when taken like a typical human being.

So, it’s a very effective method of contraception. And it’s now the most effective birth control that you can buy at the drugstore without a prescription. When you compare it to condoms and spermicides, or Plan B and other emergency contraception, all of those are effective, but they’re not as effective as a daily birth control pill.

BU Today: It sounds like in terms of effectiveness, it’s not necessarily better to get a prescription birth control pill vs this over-the-counter version. Is that correct?

White: So much of it is about access, which sounds like an advocacy talking point. But access has a real impact on people’s lives.

From the medical perspective, there’s no difference between a pill you take by prescription or a pill that you would then get over the counter. But the best birth control method for any given person is the one they’re most likely to take. And to take consistently. And now, we have a method that is not behind the walls of a doctor’s office. You don’t have to go in for a visit or a pap smear or even just get through on a telephone line in order to access this birth control. You can just walk into a place and get it and take it. That, for a lot of people, is going to be the key to feeling in control of their birth control.

BU Today: Do you see this as a step toward equalizing access to birth control or reproductive healthcare?

White: Hopefully—although I’m hesitant.

What’s really great about this is that it’s finally a highly effective method—a hormonal method—of birth control for which you don’t need medical insurance and you don’t need access to a doctor. This is great news for people who work weekdays and can’t get to a doctor’s office because they can’t take the time off of work. It’s great news for people who don’t have health insurance, or who are underinsured, meaning their insurance doesn’t cover a lot, or any, contraceptive methods. If you are new to this country and don’t have health insurance or if you are in a new job and in a new state and don’t yet have access to your insurance, this is going to help.

I’ll also add that this is birth control that you do not need to persuade [a healthcare provider] that you should take or want to take. It is a completely independent decision that you get to make, and that’s important.

The reason I’m hopeful that this will equalize access, but not certain, is because we don’t know how much it’s going to cost. And so it’s only an equity issue if everyone can actually access it. The company says that it’s committed to widespread access for the pill and that it’s going to have some kind of voucher or savings program for people who don’t have insurance coverage. Along with advocacy groups, it is going to push for coverage by insurance companies so that even though it’s over-the-counter, you can still use your insurance card, like you can in many places for emergency contraception, or until recently, COVID tests. But we need to see what the sticker price is.

BU Today: Besides the price, are there other things that you, or your colleagues in the medical community, are waiting to learn?

White: The implementation of something is always important. For example, when emergency contraception first went over-the-counter, it was actually, in a lot of cases, behind-the-counter. You had to ask a pharmacist for it, which meant that not only did you have to have a conversation, and possibly justify why you wanted something, there was a chance they would say no.

I want to see this product on the shelf, next to Plan B, next to KY jelly. I want it to be as easy as just taking it off the shelf, putting it in your cart, and checking out.

I also wonder: is it going to be behind in a clamshell? Are you going to have to get an employee to unlock it for you? Are you still going to have to deal with people’s judgment? Will mom-and-pop pharmacies refuse to stock it? Will Amazon stock it? Will national pharmacy chains make it available online? Because in that case, I can get it with my ibuprofen when I do an Amazon run. All of this remains to be seen. But I’m hopeful.

BU Today: Are there certain populations who might find an over-the-counter hormonal birth control option especially helpful?

White: Adolescents—you might not want to ask your pediatrician, who’s been seeing you since you were a baby, about the fact that maybe you need birth control. Adolescents are also people who maybe haven’t yet figured out how to get to the doctor on their own. Maybe they don’t have a car or don’t have access or even know how to navigate the system to try to get their own gynecologist. Now, they can just take matters into their own hands and get it.

I also think anyone who is on someone else’s insurance, where an explanation of benefits goes home whenever you have a visit with a provider or get a prescription filled. An over-the-counter option leaves less of a record. So if you are in a situation where you are not wanting your parents to know or not wanting your partner to know, this provides another layer of protection.

For people who have medical problems, whose doctors just tell them not to have sex so you don’t get pregnant—which is actually a thing—and don’t know who to turn to for advice, they can now do their own reading, decide this might be right for them, and then access it on their own. People who just changed jobs and whose new insurance hasn’t kicked in, or who have not yet found a new doctor. People who’ve just moved to a new state.

There are also all these situations during which there can be gaps in birth-control use. Let’s say you are a prescription-pill user or a patch or a ring user, but you find yourself in this position where you’re between insurance providers, between doctors, between homes, you then can just go get a pack [of birth control pills] to bridge that gap.

Or people who travel and forget their pack. You’re crazily packing for the airport, and you realize you’ve forgotten your pills. No worries, you can just go get a pack and take those pills for a week and then resume your birth control back at home.

This means that birth control doesn’t have to be this precious, Hope Diamond–like resource. Now, your birth control pills can be available to you whenever you need them, wherever you are. That is revolutionary. No one should have to fight for birth control. And now you have an option where you can just go get it.

BU Today: What about from a safety viewpoint? Is it safe to take these over-the-counter pills?

White: I think there’s a natural hesitancy to embrace something as safe, especially when, for so long, people have been telling you that it’s not. There’s this idea that, ‘Well, we’ve had birth control pills for 50 years, why hasn’t it been available over the counter until now? Is it actually safe?’

It’s so important for people to know that we have reams of good evidence about how safe the pill is. There are very few people who cannot use this pill, and it is very well labeled for who shouldn’t use it.

There’s a very small group of people who can’t, and everybody else can use it safely. People who have breast cancer or certain kinds of liver disease or certain kinds of benign liver tumors, and some people with lupus, should not use this. But people who have the kinds of conditions on this list are people who are already plugged into a healthcare system where they can get access. The vast majority of healthy people who don’t need to see doctors can all take this.

BU Today: What should people who might use this as their first hormonal birth control know?

White: One of the common side effects of a progesterone-only pill is irregular bleeding. This might be occasional spotting, it might be bleeding more days than not, though not usually as heavy as a period. If people are not prepared for that, it can be very surprising. I’ve had more than one patient who stopped their birth control pills when they were spotting, because they thought that meant either it was making their body sick or that it wasn’t working. My message is that you may have weird bleeding for three months, possibly even a little longer. And that is normal. Weird is normal when it comes to bleeding on this pill. So don’t be alarmed.

Complete Article ↪HERE↩!

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‘The sex ed class you wish you’d had’

— The influencer doctors teaching Americans the basics

With schools failing American students, OB-GYNs use TikTok to tackle questions and dispel myths

By

Some of TikTok’s biggest stars aren’t teen influencers or adorable pets – they are OB-GYNs posting sex education videos.

Need to know if you can continue to take antidepressants while pregnant? Dr Keith L Riggs, a Houston-based OB-GYN, has got you covered. Want to see how an IUD is inserted into the uterus? Check out a demo on the Dallas physician assistant Shay Blue’s page. Have questions on what sex position is most likely to get you pregnant? Dr Ali Rodriguez – aka the Latina Doc – made a video for that. (Spoiler: it’s whatever position you like the most – no method has emerged as a scientifically proven best choice.)

All kinds of doctors have joined TikTok. There are plastic surgeons and dermatologists who gleefully post videos hypothesizing what work an actor has had done. Dentists film videos – equal parts terrifying and mesmerizing – showing what plaque looks like as it’s scraped from teeth. If you really want to see footage from a colonoscopy, hit up the urology corner of #healthtok.

But those who practice #OBGYN – a hashtag that has over 5bn views on the app – enjoy a particular kind of virality. And some of the most popular have parlayed their online fame into other ventures.

Dr Jennifer Lincoln, who has 2.8 million followers and claims to offer “the health class you wish you had in high school”, published a book on reproductive health in 2021 and hosts a podcast where she answers listeners’ questions about all things sex. (Recent episodes include A Summer Period Survival Guide and Myth-Busting the Morning-After Pill.)

Dr Jennifer Lincoln has 2.8 million followers and hosts a podcast.

“There’s just a lot of people out there who do not know how to access things,” Lincoln, who lives in Portland, said. “Commenters have asked about anything from birth control to a pregnancy test. These are basic things we would have hoped to have been covered in sex ed, but that’s not the case in the majority of states.”

Americans have been receiving inadequate sex education for decades – but in the last year, things have become even worse. The supreme court’s reversal of Roe v Wade has led to a flood of abortion misinformation online, and Florida’s “don’t say gay” law means that teachers can no longer lead classroom discussions on gender identity or sexuality. As LGBTQ+ students continue to be marginalized across the country, they lack information that can help them understand their bodies and cultivate a sense of autonomy.

A few years ago, people with concerns about their reproductive health might hit up anonymous Reddit boards for help – now, they can take their pick of TikTok experts to follow.

Dr Danielle Jones, who goes by @mamadoctorjones on TikTok, said she had joined the platform because that’s where the kids are. “It’s a good venue to do some sex education and dispel myths about things that impact people who are younger,” she said. “We know that if we can get into their heads early and dispel misinformation before they encounter it, it can keep them from falling down the rabbit hole.”

And there are a lot of myths to dispel. Though Planned Parenthood reports that the vast majority of parents support having sex education taught in middle and high school, the US is pretty terrible at teaching it. Only 30 states and the district of Columbia require sex education classes in schools, and those that do may stress harmful abstinence-only narratives or spread medically inaccurate information.

Since the fall of Roe, Lincoln’s teen viewers have reached out to her after applying to college in states where abortion rights have been gutted, such as Texas, Florida, or Oklahoma. “They’re really scared, and they’re not sure if they’ll be able to access contraception,” she said. “Parents will also message me saying, ‘My daughter is going to college, she has her heart set on the University of Texas, but I’m scared for her. What should I do?’”

Lincoln’s answer: “Let’s talk about birth control and get Plan B and abortion pills ahead of time, just in case. You may not think this is a conversation you have to have with your daughter, but in 2023, you do.

Only 30 states and DC require sex education in schools.

Jones, who practiced obstetrics in Texas before her family moved to New Zealand in 2021, said many of her followers reach out to her with questions they do not want to ask their primary care physicians.

“In states like Texas, people are concerned about who they can safely ask about contraception,” she said. “If you don’t know how your healthcare provider feels about abortion, you don’t know if you can trust them.”

Tiffany Connolly, a 26-year-old from Grand Rapids, Michigan, has learned helpful information from OB-GYNs on TikTok. “It’s a useful source when it can be difficult to pinpoint certain things within my body,” she said. “I can’t always just call up a doctor or make an appointment right away.”

Connolly, who does not want children, plans to get a tubal ligation after her IUD expires next year. Young people who seek sterilizations often have to visit multiple doctors before finding one who will agree to provide it, but Connolly found a spreadsheet posted by Dr Franziska Haydanek, a Rochester, New York, gynecologist with more than 300,000 followers, that lists the names of doctors across the country who are known to safely and responsibly perform the procedure on unmarried and childless patients.

Haydanek posted the spreadsheet last summer, right as the reversal of Roe v Wade pushed more women to consider the procedure as a means of permanent birth control. Since then, the video has been viewed over 50,000 times.

Krysten Stein, a PhD candidate in media studies, has written about TikTok gynecologists for a communications journal. “I wanted to know why these videos were getting so much traction,” she said. “When people seek these kinds of resources online, it’s often because they don’t have access to health insurance or doctors.

Dr Danielle Jones wants to keep young people from ‘falling down the rabbit hole’.

Stein has polycystic ovary syndrome, which can cause irregular periods and pelvic pain, but often goes undiagnosed by doctors who downplay its symptoms as normal period side effects.

Years ago, Stein found refuge in online forums like Reddit, where she finally engaged with people who took her pain seriously. She suspects that people on TikTok form a similar kind of community on the app. “It’s a platform where you can see other people who might be experiencing the same thing as you are,” she said.

Samantha Broxton lives in southern California and frequents OB-GYN TikTok, where, the 35-year-old mom said, she had learned things she wished her own doctors had told her years ago. It’s been a resource for her, but she also wonders what type of care TikTok OB-GYNs provide their patients offline.

“If they’re talking about inequalities in medicine on TikTok, I want to know if they’re vocal about it too in the workplace,” she said. “Are they working to improve the system, or is it just easy to talk about doing that online?”

The American College of Gynecology and Obstetrics does not give doctors specific rules on how to use TikTok, but some hospitals and institutions have social media policies. For the most part, Stein said, doctors are on their own when it comes to deciding what information is appropriate to include in a TikTok.

They don’t always get it right. Last year, four obstetrics nurses were fired from an Atlanta hospital for making a video mocking expectant mothers. Emory hospital, which employed the nurses, later released a statement saying the video was “disrespectful and unprofessional”.

Should OB-GYN influencers take money from brands? When Stein interviewed some for her paper, there was no general consensus. Certain TikTok OB-GYNs said they would only accept deals with brands that felt aligned with their values – they were not just taking cash from anyone. Others were less judicious.

“Some of them said, ‘I want to be a content creator full time,’” Stein said. “There were a lot of moral questions that came up around that. There are no rules, and right now it’s based upon the specific person’s moral compass.”

And how do you know someone is actually a doctor, and not just playing one on TikTok? Lincoln noted that some creators are misleading in their credentials, calling themselves “hormone experts” in their bio. “That’s a term some people use after reading a book or taking a weekend ‘course’ – so, meaningless,” she said.

There are also chiropractors, anesthesiologists, and generalists who are not reproductive health experts dispensing advice on the subject. “It’s really confusing to people, because they see MD in the handle and think they’re experts, though they’re not experts in the field,” Lincoln said. “This harms the OB-GYN TikTok space because these grifting experts often throw our field under the bus.”

Actual gynecologists worth a 30-second watch, Lincoln says, are ones who cite their sources or at least let their viewers know when something is their opinion rather than a studied fact. “As a rule, when I’m explaining something medical, I always give references,” she said. “We need to be transparent about what we know and what we don’t.”

Jones believes the most urgent part of her job right now is spreading accurate information about abortion rights. She grew up in rural Texas and described herself as pro-life until going to medical school changed her mind. Now, she hopes to help others come to the same conclusion.

“I’ve had people reach out and say that I’ve helped them see abortion rights from a different perspective,” Jones said. “It’s one of the most meaningful things I can hear: ‘Two weeks ago I would have called you a murderer, but now I support the right to choose.’”

Still, she knows the limitations of TikTok activism. “What I do online is valuable, and it’s a great supplement, but it’s not going to fully replace sex education,” she said. “Young people need that, and we know the outcomes are not going to be good when they don’t receive it in schools.”

Complete Article ↪HERE↩!

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Expert Shares Why You May Be Struggling To Orgasm With Your Partner

BY Tessa Somberg

At various points in our lives, orgasms can be the ultimate bliss and the ultimate frustration. Remember that our relationships with our bodies can be fluid and changeable, and sometimes, this can change the sex we have with our partners. For many women, achieving orgasm with a partner can be a challenge — even when achieving orgasm alone, or with the assistance of something akin to a handy-dandy vibrator, comes easily. We may start to blame ourselves, our partners may start to blame themselves, and the bedroom can start to feel anxiety-provoking, rather than a relaxing space to unwind and enjoy all the pleasures our bodies can feel.

Should you be looking for solutions to easier orgasms, but you’re having trouble honing in on what could be addressed, we have some ideas for you. Women spoke exclusively with Aliyah Moore, Ph.D., a certified sex therapist, to better understand what barriers might need to be broken to achieve orgasm with your partner. She said, “Sex is not a performance, and there’s no one-size-fits-all approach. Take the pressure off of yourself and focus on enjoying the moment. Don’t be discouraged if things don’t go as planned; it happens to the best of us.”

Put your body first

Whether you have recently been struggling to orgasm in the bedroom, or have been struggling for some time, the stress of wondering, “Am I going to orgasm this time?” could be enough to stop you from being in the moment. Speaking exclusively with Women, Dr. Aliyah Moore said, “Sometimes, our brains can get in the way of our bodies. If you’re too worried about whether or not you’re going to orgasm, you might end up putting too much pressure on yourself and making it harder to actually get there.” In order to combat this, remind yourself that when it comes to sex, there is no race to the finish; there is no “right” amount of time it “should” take to get to orgasm. Instead, feeling and embracing pleasure throughout the sex act is part of the experience.

Should you feel your mind racing during sex, and the anxiety over your orgasm has set in, try to redirect your thoughts to the physical sensations in your body. Remind yourself that it is okay to let go of the expectation of orgasm. Perhaps you will be surprised how far that can take you.

Prioritize quality stimulation

Remember also that, when engaging in sex with a new partner, it could simply take time to learn about each other’s bodies. And, of course, knowing your own body is key. “Masturbation can be a helpful way to learn what types of touch and stimulation feel good for you,” Dr. Aliyah Moore said, speaking exclusively with Women. “When you know what feels good for you, it can be easier to communicate that to your partner and guide them to provide the stimulation you need to reach orgasm.”

While you might feel self-conscious speaking up to your partner when you want them to do something different, keep in mind that your partner wants to please you. You can communicate before sex, or gently guide your partner through movements that feel good to you during sex as well. “Approach the issue with empathy and an open mind, and work together to find solutions that work for both of you,” Dr. Moore said. “Try to avoid blame or criticism and instead focus on finding ways to support each other and address the issue together.” Do not be afraid to tell your partner when a certain action does not feel good, either. Incorporating longer foreplay into your sexual encounters has also been shown to increase the rate of orgasm, according to a 2014 article published in Human Reproductive Biology.

Review your medications

Being on certain kinds of medications, namely antidepressants such as selective serotonin reuptake inhibitors, aka SSRIs, can also significantly impact one’s ease in having an orgasm. For those whose depression symptoms are significantly improving on medication, but are still having trouble in bed, there are some ways you can work around side effects that might include lack of sex drive, or difficulty reaching orgasm.

First, know that over time, the side effects of SSRIs on your libido can sometimes fade as your body adjusts to the medication. Should you have just started your treatment and feel frustrated with the changes in your sex life, do what you can to be gentle with yourself, and give the circumstances some patience. Should the issue persist, “Talk to your doctor,” Dr. Aliyah Moore suggested, speaking exclusively with Women. “If you’re experiencing difficulty reaching orgasm, it’s a good idea to talk to your doctor to rule out any underlying medical conditions or medication side effects that could be contributing to the problem. Your doctor may be able to suggest treatments or adjustments to your medication that could help,” she said. This could include anything from lowering the dose when appropriate, to switching medications to see if the issue continues.

Assess your physical health issues

A number of physical issues could also hinder your ability to orgasm in bed. One is anorgasmia. According to Mayo Clinic, “Anorgamsia is delayed, infrequent or absent orgasms — or significantly less-intense orgasms — after sexual arousal and adequate sexual stimulation. Women who have problems with orgasms and who feel significant distress about those problems may be diagnosed with anorgasmia.”

There are other issues, too. Speaking exclusively with Women, Dr. Aliyah Moore said, “Unfortunately, certain health conditions can impact our sexual function. Diabetes, multiple sclerosis, and spinal cord injuries are just a few examples. But even things like hormonal imbalances or thyroid issues can play a role.”

There are also several kinds of sexual dysfunction disorders that could contribute to issues with orgasming, where symptoms could include having pain during sex, perhaps caused by ovarian cysts or fibroids, and having a lack of sexual desire or arousal. Age does tend to be a factor in many sexual dysfunction disorders, however. For any number of these concerns, see a doctor or specialist for treatment plans and ideas.

Consider the role of past trauma

ƒsubPast trauma can also be a sensitive barrier to achieving orgasm. When you have had a traumatic experience surrounding sex, reclaiming your body can be a process that necessitates care, love, attention, and trust. Survivors of sexual assault, for example, might experience self-blame, disgust, or otherwise feel disconnected from their bodies, which can make sexual experiences hard to enjoy. Some may even have flashbacks of the traumatic incident. Know that it is possible to repair your relationship with your body and with sex, even when it feels challenging. Understanding your triggers and boundaries, as well as engaging in robust communication, are just a few ideas that can help shape what you want out of your sexual experiences.

Perhaps you might simply be having issues in your relationship that make having an orgasm difficult. “If past trauma or relationship issues are impacting your ability to orgasm, working with a therapist can be helpful in addressing these issues,” said Dr. Aliyah Moore, speaking exclusively with Women. She continued, “A therapist who specializes in sexual issues can help you work through any underlying psychological factors that may be impacting your ability to reach orgasm.” And where therapy is financially unfeasible, explore sexual education resources online. The sex exploration app Ferly, for example, offers expert guides, insight, and community for a small fee each month.

In the end, Dr. Moore advised, “Be gentle with yourself and your partner: It’s important to remember that sexual function can be impacted by various factors, and it’s not necessarily anyone’s fault.”

Complete Article ↪HERE↩!

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Does Birth Control Affect Your Sex Drive?

Here’s What You Should Know

by Crystal Raypole

Considering a new method of birth control? You’ve probably also spared a few thoughts (worries, even) for all those potential side effects you’ve heard about, such as decreased libido.

It’s true that nearly every birth control method could cause some type of side effect. Yet for many people, side effects are relatively minor and worth the benefits of:

Any type of birth control might affect libido, though the specific effects you experience can vary depending on the method you choose.

Condoms might factor into vaginal irritation and other discomfort, while spermicide products could cause itching and other irritation.

Hormonal birth control is incredibly effective at preventing pregnancy, but it can also contribute to some unwanted side effects, including decreased libido.

You might generally agree that the benefits of birth control — namely, preventing pregnancy — outweigh a potential decrease in libido. All the same, a noticeable change in sexual desire may not necessarily be, well, desirable.

When it comes to sexuality, your libido is only one part to consider. Physical arousal, the ability to orgasm, and any pain or irritation you experience during sex can all affect your interest in sexual activity.

You could have a high libido, but find it difficult to feel aroused. (Yep, they’re two different things.) Perhaps you don’t have any trouble getting in the mood or experiencing arousal, but you often experience pain during sex. Maybe you have trouble climaxing easily, if at all.

Birth control, especially hormonal varieties, might factor into some of these issues. But — and this is an important “but” to consider — not everyone experiences a decrease in libido when using birth control. Some people, in fact, notice an increased libido.

A few possible explanations for why you may experience a heightened libido:

  • It’s understandable to feel less interested in sex if you’re worried about getting pregnant. Birth control can help relieve those fears, which might then increase your desire for sex.
  • Choosing a method of birth control you don’t have to use right before sex can make it easier to stay in the moment with your partner(s). This can make it easier to fully enjoy yourself without any distractions or worries about finding the right moment to hit pause.
  • If you use hormonal birth control to help ease symptoms of health conditions like polycystic ovary syndrome (PCOS) or endometriosis, you could also notice a higher libido as your symptoms improve.

A 2013 reviewTrusted Source considered findings from 36 different studies on sexual desire in people using combined oral contraceptives, which are birth control pills that contain both estrogen and progestin.

Among the 8,422 participants who took oral contraceptives, 15 percent, or 1,238 people in total, did report a decrease in libido. But another 1,826 people (just over 21 percent) said their libido increased. The majority of participants reported no change in libido.

Authors of a 2016 reviewTrusted Source considered findings from 103 studies exploring the possible effects of contraceptives on sexuality. They found evidence to support the following positive outcomes:

  • The hormonal IUD may lead to less pain during sex and increased libido after a year of use.
  • Both hormonal and nonhormonal (copper) IUDs may increase libido, physical arousal, satisfaction with sex, and frequency of sexual activity.
  • The vaginal ring has been linked to increased libido, arousal, and sexual satisfaction, along with vaginal lubrication and improved orgasm.
  • The implant may boost arousal, sexual satisfaction, and the ability to achieve orgasm while helping reduce pain during sex and anxiety around sex.
  • Internal condoms can promote greater sexual comfort since they offer improved lubrication, can be placed ahead of time, are less likely to break, and can improve sensation during sex.

Hormonal contraceptives work by releasing pregnancy-preventing hormones into your body. For some people, these hormones might cause various physical and sexual side effects, including:

Any of these side effects can leave you less interested in having sex.

Example

Let’s say you and your partner(s) are cuddling on the sofa. They’re doing that thing you really like with their tongue on your neck, and you think “Yeah, sex might be nice.”

Still, you aren’t all that turned on, and your body isn’t shouting “Yes, now would be good!” like it sometimes does.

Or maybe you started taking the pill to help lighten up painful periods, but over the past several weeks, you’ve started feeling a little low.

In the past, you’ve always aimed to have sex at least once a week, but lately you’ve felt so tired and drained that you haven’t reached out to your partner(s) for nearly a month.

Some experts have theorizedTrusted Source changes in libido may happen because hormonal birth control reduces testosterone in your bodyTrusted Source. But researchers have yet to find conclusive support for this idea.

Many people using contraceptives have lower testosterone levels than those not using contraceptives without experiencing any changes in libido.

To sum up: Researchers haven’t come to any conclusions about how hormonal birth control might directly affect libido. Yet it’s pretty clear that many people do experience some changes.

Complete Article ↪HERE↩!

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Thou Shalt Not

Name: Lynn
Gender: Female
Age: 36
Location: Toronto
I’m a mother of three great kids. My oldest, who is in middle school, went to camp for the first time this past summer. A local church group sponsors the camp every year. When my husband and I asked him about his time away from home, he said rather noncommittally; “It was ok.” He seemed to like it well enough, but you know how uncommunicative kids can be at that stage.
Anyhow, yesterday I was packing away some summer stuff for the winter and discovered a pamphlet in my son’s backpack that he used at camp. It was for an “Abstinence Only” program. It was full of the most dreadful sex-negative fear and shame. It was awful. We are not raising our kids like that; my husband and I were appalled.
Now we’re wondering if this is why our son was so unenthusiastic about his camp experience. Do you think we should quiz him on this?
What gives with this kind of indoctrination anyway? I thought that those “Abstinence Only” programs had been discredited.

So wait; are you sayin’ that you think just because a social engineering strategy, like abstinence-only, has been debunked that it wouldn’t still be employed by certain factions of our culture? Oh hun, I think you oughta rethink that supposition right away, don’t cha know.abstinence_only-1

I mean, come on! There are loads of outdated and discredited philosophies still being promulgated as a means to ensnare the uninformed and gullible. I don’t know about ya’ll up there in Canadaville, but here in Amercanski land we have a whole segment of our population who believes that creationism as a viable explanation for the universe. In fact, one or another of these idiots runs for national office, even for President of these here United States, as a Republican in every election cycle.

So, as you can see, there’s not necessarily a connection between what has been discredited and what is still wildly popular in some segments of our population.

Way back in the spring of 2007, a long-awaited congressionally funded national study concluded that abstinence-only sex education does not keep teenagers from having sex. Nor does it increase the likelihood that, if they do have sex, they will use a condom.

Authorized by Congress in 1997, the study followed 2000 children from elementary and middle school into high school. The children lived in four communities — two urban, two rural. All of the children received the family life services available in their community; in addition, slightly more than half of them also received abstinence-only education.

By the end of the study, when the average child was just shy of 17, half of both groups had remained abstinent. The sexually active teenagers had sex the first time at about age 15. Less than a quarter of them, in both groups, reported using a condom every time they had sex. More than a third of both groups had two or more partners.

So if abstinence-only programs don’t work, at least the way they are supposed to; why do we still have them? Ahhh, good question. We still have them because for a large segment of the population, especially those who are makin’ all them babies, it’s easier to just tell their kids “NO” than to step up to the plate and educate their kids about sex in a wholesome and holistic way.

Bennett editorial cartoonAnother problem is that the word abstinence often means something quite different to kids than it does to adults. That’s one reason why abstinence-only programs do not have strong effects in preventing teenage sexual activity. At least that’s what a University of Washington study found.

The researchers found that interventions that encourage abstinence treat abstinence and sexual activity as opposites. Teenagers, on the other hand, don’t consider them to be mutually exclusive concepts. Like in the congressionally sponsored study, the UW researchers found abstinence-only programs are less likely to work than more comprehensive sex-education programs because they are not speaking the same language as adolescents.

The study also showed that attitudes and intentions about sex were more powerful than attitudes and intentions about being abstinent. No surprise there, I suppose.

Again, I don’t know how things are there in Canada, but down here there is no federal funding for comprehensive sex-education. But there’s a shit-load of funding for abstinence-only programs. Funding mushroomed from $9 million in1997 to $176 million in 2007. Leave it to congress to dump loads of money into a program that doesn’t work. But such is the power of the conservative religious lobby. They are the people who back these programs.

This wouldn’t be such a big issue if it didn’t hold such dire consequences. For example, the United States has the highest teen pregnancy rate among all first-world nations. The rates of sexually transmitted diseases in this country are also astronomical. If we want to keep our young people safe from the negative aspects of casual sex, abstinence-only programs are not the way to go.abstinence

However, more comprehensive programs that include abstinence as one choice are much more likely to have a more productive outcome. Besides, is it ever a good idea to try and motivate people with fear and shame? I don’t think so.

Since abstinence-only programs often only look at the negatives of sex, it doesn’t really empower a young person to take responsibility for his/her behaviors. This is particularly thorny for young women who often bear the brunt the peer pressures to be sexual. And they have way more at stake in terms of pregnancy and sexually transmitted infections (STIs).

When kids aren’t expected to take responsibility for their behaviors, especially in terms of sexuality, it cripples their ability to make good life-affirming choices. Abstinence-only programs disqualify all sexual options, even the relatively innocuous behaviors like mutual masturbation and oral sex. So if all sexual options are equally out of bounds, there’s no way for the average kid to distinguish between harmless and risky behaviors. And this is what leads to the high rate of sexually transmitted infections and unplanned pregnancies.

If we want our kids to grow up with healthy and integrated attitudes about sex, ones that will lead to more loving and fulfilling sexual relationships later in life, we ought teach from a more sex-positive theory.

Back to the other question you raise; the one about quizzing your son about his camp experience. I think that would be great. It would let him know that you care, that you don’t support this fear and shame-based approach to human sexuality and that he doesn’t have to embrace it either.

Good Luck

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Teenage Sexual Assault

Name: TC
Gender: Female
Age: 13
Location: indiana
I really dont know that much about sex, so i let my boyfriend do it all. He keeps calling me a scardy cat cuz i wont touch his dick or give him any pleasure, and he is getting really bored with me

I am so sorry to hear of the trouble you are having with your boyfriend. Actually, he’s no friend at all. Real friends honor their friend’s limits and boundaries, and he’s not doing that.

You can’t be expected, at your tender age, to know much about sex. Hell, you don’t even sound like you are particularly interested in the topic. You don’t mention your boyfriend’s age, but it sure sounds like he is way more advanced than you, at least when it comes to his interest in sex. Unfortunately, he’s not so advanced that he’s man enough to leave you alone when you ask him to. And that really makes me angry. Bullying, belittling or harassing someone for sex, particularly when it’s clear that person is not ready or not interested is abuse. And that is never a good thing.

I hasten to add that in the eyes of the law he is a criminal. He is taking advantage of an underage person for his own sexual gratification and that’s against the law. If you guys get busted, there will be hell to pay.

I know the kind of pressures you are experiencing. You want a BF and you want your BF to like you. But if you let him take advantage of you, it’s not the same thing as him liking you. It’s more an indication that he’s focused on his needs and desires, not yours. I don’t think his behavior indicates he cares for you, but he is showing you that he has power over you and is able to manipulate you into doing what he wants. And what kind of relationship is that?

Listen, TC, you don’t have to submit to him. You can stand tall and tell him NO. He will, in the end, respect you more for your courage to defy and deny him than if you just cave in to his will.

I’m not sure I know what you mean when you say that you “let your boyfriend do it all.” But it sure doesn’t sound like a good thing to me. If he’s having his way with you, even though you are being very passive about it, doesn’t make it right. I hope this isn’t how you intend to interact with other males who will come into your life in the future. And there will be plenty of them. If they sense that you are weak and vulnerable, you will be a goner for sure. You could easily wind up being a victim for the rest of your life. Please, TC, don’t let that happen to you.

I know you’d probably rather be thinking about a lot of other stuff at this time in your life, but the situation with your BF demands that you grow up fast and get savvy about the fundamentals sex right away. I’ll have a number of resources for you in a second, but I can’t emphasize enough how important it is for you to wise up about pregnancy protection. I wish I didn’t have to say that to you, but I must. If you are being sexually active, even if you are just letting your BF do everything, you absolutely must protect yourself from an unwanted and unplanned pregnancy. If you don’t you will find that you will be the one having to deal with the consequences. If your BF is not considerate enough to respect your wishes when it comes to sex in general, you know for sure that he’ll not be around to look after you and your unborn child.

Ok, here are those resources I mentioned. Planned Parenthood, SCARLETEEN, Sex Ed 101 and Midwest Teen Sex Show.

Promise me that you will take this seriously. That you’ll not just roll over (literally or figuratively). Promise me that you will respect yourself and take a stand and not allow your BF to manipulate you into anything you don’t want to do. More hangs in the balance than you can comprehend. You’ll have to trust me on this.

One last thing, if you were wise enough to find my sex advice website and you were mature enough to write to me, then I believe you are strong and resourceful enough, despite your tender age, to stand up to your BF. Do it now. Demand that he respect you, your body and your wishes.

Good luck

Posted on

Trouble in Paradise

Name: Carey
Gender:
Age: 33
Location: Kansas
My fiancée is 27 and in the past 3 to 4 years her libido has become virtually extinct I have tried everything and she just blames her birth control what do I do

You’ve been engaged to a woman for more than 4 years? Oh wait, maybe you’re trying to tell me that you proposed to this woman in spite of knowing she has an extinct libido? Either way, darling, that’s messed up, huh? Are you hoping this is “dry spell” is gonna somehow magically resolve itself once you’re married? I wouldn’t hold my breath for that, if I were you.

It’s true of course, birth control pills can seriously impact on a woman’s desire for sex. Your fiancée is probably one of these women. Maybe she ought to consult her physician about finding another type of pill that may have a less severe impact on her libido.

Many women find that triphasic birth control pills (which deliver differing amounts of hormones every week) interfere much less with their sex drive than monophasic pills (which deliver the same amount of hormones each dose).

She could also decide to discontinue the pill altogether, and choose another form of contraception, such as a condom or diaphragm. Just realize that once off the pill, her sex drive may only return very slowly.

You see how this predicament is a double bind for your fiancée. If she is more lax with her contraceptive efforts, just to please you and your sex drive; then she opens herself up for an unplanned pregnancy. And that’s not good for her, or you. Is there anything YOU can do to free her up from shouldering the full burden of contraception? Have you’ve considered a vasectomy? Probably not, huh? What man ever imagines he ought assume the responsibility for controlling reproduction?

While I wholeheartedly support the notion that married people deserve a rich and fulfilling sex life, unless there’s mutual agreement for another arrangement; that can’t happen if one of the partners is inequitably burdened by one thing or another. Perhaps, it’s time you and the little woman to have a frank talk about sharing the responsibility for contraception. And if this little talk is successful, maybe, just maybe, you’ll get laid again.

Good luck

Name: Tony
Gender:
Age: 40
Location: Houston
I’ve loved several women and even married and divorced one. Over the last few years, I notice having similar feelings for men around me…longing, sweaty palms, difficulty thinking and wanting to be with them alone. Is this love? Am I bisexual? Am I a sick man better of dead? I have not crossed the line and I still having great sex with women. But there’s now a guy that I think about when I’m with her! Am I gay? Bisexual? Sick in the head?

My first reaction is that what you present is not particularly uncommon. Many people, just like you, inexplicably find themselves behaving in a completely unexpected sexual manner. I’d love to know what triggered you to veer off your comfortable and predictable sexual path?

There’s never a scarcity of sexual fascists out there, people who believe that sexual tastes and preferences are carved in stone, or there’s only one “right” way to be sexual. They’ll persecute anyone who doesn’t conform to their strict immutable notions of sexuality and eroticism. Despite the proliferation of these hetero-fascists, homo-fascists, what have you; they are all very wrong about the indomitable human spirit.

For the most part, humans are not sexual automatons. Given a more permissive and sex-positive culture then our own, we’d all be more fluid in our eroticism and sexual expression. Are you one of the lucky few who has discovered the joy of this fluidity? Doesn’t quite sound like it to me, at least not yet. I think you’re still in the “scared shitless” stage.

For a guy who has yet to “cross the line” and actually act on your fantasy, you sure are preoccupied with your identity. Are you afraid that someone will take away your breeder card if you actually touch a dude in a sexual way? Does having same-sex feelings…sweaty palms and all…make you a gay? Doubt it! Being gay entails a lot more than a sense of longing for something you’re not supposed to have. Are you bisexual? I can’t say for sure, but you’re certainly not exclusively straight either. I suppose you have to come to grips with the self-identify thing when you have a bit more information about your burgeoning eroticism. What I know for sure is that you are not sick.

Who knows, your homoeroticism might very well be situational. It might not extend any farther than the guy you think about when you’re fucking chicks. I know all of this is can be pretty disconcerting and it can really mess with your head. But at least you know you are still alive sexually. So many people are sleepwalking through their erotic lives.

Will you act on your inclinations? Will you test the waters, so to speak? What harm could it do? Might just open up a whole new sexual world for you. On the other hand, if you do nothing, or try and repress these natural feelings, you’ll always know in your heart of hearts that you have the desire, if not the capacity, to express yourself sexually with a much wider range of humans than what you are currently used to. And something tells me that if you choose the path of self-denial, it will eat away at you until you satisfy your curiosity.

Good luck