Trans people deserve healthy, happy sex lives – and that starts with better health care

By Rory Finn

Understanding my body in a sexual way has been something that’s taken time.

I am a transgender man who identifies as queer, and since I began my transition more than 12 years ago, I found I didn’t fit into the boxes outlined in mainstream sexual health information – if I was able to find that sort of information at all.

Anything targeted towards the kind of sex I was having didn’t include people with bodies and identities like mine, and I ended up having to look at sexual health articles published in women’s magazines to try and filter out what information would be useful for me and what was not.

This has been especially unhelpful being who I am now: a man who has sex with men.

I never really noticed just how much of an issue this was until a few years ago, when I started exploring my sexuality and the fetish community. I started to take increased risks with my sexual health, so was going to clinics more often and realised the lack of knowledge and information some clinicians have about trans people and our bodies.

I had a persistent fear that clinicians would regard me as ‘too difficult’ and I feared the inappropriate questions some asked me – others didn’t ask enough. The experience felt unsafe and eventually deterred me from going, hoping I could find any answers I needed through Google instead.

In fact, the first time I contracted an STI I was in denial; I didn’t even know what an STI symptom would look like on a body like mine and I hoped it would clear up by itself. When I was prescribed medication, I didn’t take it straight away.

The continued lack of knowledge and resources around transgender sexual health made me feel like I didn’t matter, that my body was an oddity and that I didn’t deserve good health – all on top of the stigma of having an STI.

And according to a survey by sexual health charity Terrence Higgins Trust, more than half (52%) of trans, non-binary and gender diverse people who responded said they didn’t feel fully in control of their sex life, with more than 70% saying that feelings of negativity and low mood or depression was a factor in this.

Once while I was travelling in Spain, I caught an infection that I believed to be an STI. I spent most of my time at the clinic explaining that I was a trans man, rather than discussing my medical concerns. I was eventually given some sort of prescription and sent on my way.

Trans people should not have to rely on Google searches and outdated sexual health resources – we should be afforded the same information and representation that cisgender people have

This was distressing; I was alone in a foreign country and I didn’t know what was wrong with me. But I was grateful not to have had to undergo an intimate examination.

Luckily, back in England I was able to go to a clinic specifically for trans people – Clinic T – and find out what medication the doctor gave me and why, which was really reassuring.

I knew about the clinic as I had been living in Brighton, where it is well known within the trans community as they do a lot of outreach at events like Trans Pride. But being in an LGBTQ+ friendly city with trans-inclusive services put me at an advantage. Unfortunately, it isn’t always like that, and I’ve still been in situations with a clinician not as trans aware as they could be.

I’m used to being the ‘expert patient’ who knows more about my healthcare than the person who’s supposed to be caring for me.

Then you have the professionals who, the minute they hear the word ‘trans’, automatically view you as a curiosity. Sometimes you are viewed as ‘high risk’ merely because your identity has changed on paper, rather than your behaviour in the bedroom. I regularly experienced this when I started my transition, and it made me feel more like a number in a database than a human being.

This seems to be an ever-present experience for trans people. It’s like, if we don’t fit into society’s strict gender categories, then we fall through the gaps and it makes accessing healthcare feel impossible.

Frustratingly, it could all easily be avoided if healthcare professionals actively built up their knowledge on trans bodies. Trans-awareness training would be helpful, or peer-to-peer learning and reading up on trans health from the ever-increasing body of research on trans medical issues.

Navigating the world as a trans person can be extremely challenging, but it’s even more difficult without valid sexual health information. It can make us feel like we don’t deserve to be seen or celebrated as authentic sexual beings. This is reinforced by the poor representation, such as overly sexualised porn or predatory tropes.

Trans people should not have to rely on Google searches and outdated sexual health resources – we should be afforded the same information and representation that cisgender people have.

This is why I decided to feature in and co-write the Terrence Higgins Trust trans-specific sexual health resource. It is led by and celebrates us as trans, non-binary and gender diverse people.

The new webpages and leaflet are directed to our specific needs and provide up-to-date information and advice on everything from HIV to contraception. They include the impact of hormones and surgery, considerations when taking HIV-prevention pill PrEP, and how to navigate happy, healthy sex.

It feels empowering to be able to do something proactive about something I care so deeply about. I want trans people to have good sex, good health and a healthcare system with as few barriers as possible.

All trans and non-binary people’s bodies should be celebrated, just like everyone else. We have sex too, and we’re deserving of enjoyable and healthy sex lives.

Complete Article HERE!

Could Probiotics Improve Your Sex Life?

Unpacking the Gut-Sex Connection

by Gabrielle Kassel

What’s the short answer?

Yes. Yes, probiotics have the potential to improve a person’s sex life.

Whether or not they have the potential to improve your sex life, however, depends on your current gut health and your sex life.

When we talk about gut health, we’re typically talking about the composition of the billions of bacteria, archaea, and fungi inside the gut.

This is known as the microbiome, and it affects all sorts of things that contribute to your interest in sex and overall sexual satisfaction.

Mood

Did you know that the majority (about 95 percent!) of serotonin — the happiness hormone — in the body is produced in the gut? Yep!

But for the optimal amount of serotonin to be produced, the gut has to be in tip-top shape. When the gut is in suboptimal health, your serotonin — and overall happiness — levels can dip.

And according to Dr. Anna Cabeca, triple-board certified OB-GYN and author of “The Hormone Fix”: “Low serotonin is associated with lower sex drives.”

Makes sense. Few of us are jonesing to do anything in the sack other than sleep when we’re sad.

Energy

Belly bacteria helps create B vitamins, which are essential for the production of ATP (science-talk for energy). Less B vitamins = less energy.

Plus, some of the bacteria communicate with other cells in charge of blood sugar regulation, says Anthony Thomas, PhD, nutrition researcher and director of scientific affairs with probiotic brand Jarrow Formulas.

If your gut bacteria gets out of whack, your blood sugar levels can crash more easily. This can lead to more — and longer lasting — energy dips.

So, that “too tired for sex” feeling? Well, it might be linked to your gut health in more ways than one.

Desire and arousal

Fun fact: Serotonin is found in the genitals. Seriously!

Some research suggests that when your serotonin levels dip, your physical response to sexual feelings dips, too.

Inflammation

“When our gut microbiome is unhealthy, it can lead to inflammation,” says Dr. William W. Li, a physician, scientist, and author of “Eat to Beat Disease: The New Science of How Your Body Can Heal Itself.”

Sadly, inflammation is quite the c*ck-block.

For example, some research has found that sexual health dysfunction is common among folks with inflammatory arthritis.

Let’s face it: It’s pretty damn hard to be in the mood to bone when you can’t leave the bathroom.

And there are certain gut conditions that cause bathroom troubles to rear their ugly heads. These include:

  • irritable bowel syndrome (IBS)
  • inflammatory bowel disease (IBD)
  • microscopic colitis
  • ulcerative colitis
  • celiac disease
  • Crohn’s disease

In addition to constipation and diarrhea, other common symptoms include:

  • nausea
  • vomiting
  • bloating
  • flatulence
  • fatigue
  • pain

Both the physical and emotional effects of these and other gastrointestinal (GI) conditions have the potential to affect your sex life.

The keyword here is potential.

If you’ve already received a diagnosis or suspect that your symptoms might be a sign of a GI condition, talk with a doctor or other healthcare provider about your concerns.

They can help you find the best management or treatment option for your individual symptoms or side effects.

By now you can probably tell that your microbiome is complicated. Well, so is your libido.

“Libido in general is very complicated and is impacted by many different things,” says Cabeca. “Hormones, lifestyle, and relational factors also have to be considered.”

So finding out if your libido fluctuations are related to your microbiome is similarly tricky. And no matter how well-intentioned, gut health mishaps can have a direct effect on your overall health.

Li recommends meeting a gastroenterologist, the medical specialist that focuses on the gut, if you’re experiencing any of the below symptoms:

  • brain fog
  • achy joints
  • diarrhea
  • constipation
  • shifts in mood
  • exhaustion
  • sleep disruption
  • sugar cravings
  • weight fluctuations

Note: That recommendation stands even if your libido isn’t funked up.

“A gastroenterologist will be able to recommend an endoscopy, colonoscopy, or a scan of your abdomen to find out what’s up,” explains Li.

“They also may be able to check your microbiome for abnormalities by sending a stool sample for testing,” he adds.

Please don’t self-diagnose your gut symptoms or libido mishaps. Why? Well, because they’re both incredibly complex.

Dr. Kimberly Langdon, OB-GYN and medical advisor at telehealth provider Medzino, notes that mental health conditions like depression are often linked with low libido.

In these cases, for example, trying to course correct at home without talking to a healthcare provider may mean delaying access to helpful medications or other necessary treatment.

Many GI conditions are characterized by dysbiosis, which is medical speak for an imbalance of bacteria in your gut.

If your provider has diagnosed dysbiosis, Li says that probiotics — helpful yeasts and bacteria often delivered via certain foods and supplements — may help.

A word of caution: Not all probiotics are created equal.

As a general rule, probiotics that are stored in the refrigerator are higher quality than those stored on the shelf.

Cabeca adds that Lactobacillus strains are typically better than others.

Bacterial imbalance has been linkedTrusted Source to increased inflammation, so it’s thought that probiotics may help alleviate symptoms associated with IBS, IBD, and other inflammatory conditions.

Probiotics may also be helpful for acute digestive conditions like gas, bloating, constipation, and diarrhea.

All that said, even if everything above sounds similar to your situation, you shouldn’t start or increase your probiotic intake without first talking with a doctor or other healthcare provider.

There are two good reasons for this:

  1. Oftentimes, probiotics aren’t enough to completely soothe your symptoms.
  2. And in some cases, starting a supplement or otherwise upping your probiotic intake can do more harm than good.

For example, “if someone has small intestinal bowel overgrowth, adding probiotics can worsen gas and other symptoms,” explains Cabeca.

If you’ve ever been probiotic shopping, you’ve likely stumbled across probiotics marketed for vaginas — they’re all the rage, after all.

According to Langdon, these probiotics typically contain higher levels of Lactobacillus. Some research suggests that Lactobacillus helps support a healthy vaginal pH, as well as keep other pathogens at bay.

Now, if you scroll back up to the previous section, you’ll notice that Lactobacillus is the strain of bacteria that’s best for both improving overall gut health and supporting vaginal health.

That’s why Li says, “it’s just a marketing ploy.” These probiotics are no different than any other probiotics on the market.

So… do probiotics marketed for your genitals actually work? If you have a condition that can be remedied by consuming more Lactobacillus, they may.

But don’t be tricked into thinking these probiotics are a one-stop solution for sexual dysfunction or the only option available.

Yep! In fact, there are quite a few things you should consider using in tandem — or even instead of, in some cases.

That’s because (again, for the people in the back!) gut and sexual health conditions aren’t quick-fix problems.

Monitor meds

The meds and antibiotics you’re on or have been on can affect your gut microbiome, explains Thomas.

It’s also widely known that antidepressant, antipsychotic, anti-epileptic, blood pressure, and cholesterol lowering meds can all impact sexual functioning.

That’s why Thomas recommends making sure your doctor knows what meds you’re currently taking so they can help you troubleshoot if need be.

Diet switcheroo

For gut conditions, most experts will recommend a diet shift, at least for a short period of time.

Cabeca, for example, recommends folks follow a “healthy elimination diet to better understand what foods lead to their gut unrest.” She also recommends incorporating gut-healing foods like bone broth and fermented veggies.

Move more

Regular exercise has been linkedTrusted Source with higher serotonin levels.

Given serotonin’s relationship to both your gut and sex life, if you’re currently on the sedentary side of things, moving your body more may be helpful.

If you have a condition that can be helped with a probiotic, Cabeca says, “often, you can see a significant improvement of symptoms after 21 days.”

And that includes symptoms related to your sex life.

Thomas, however, notes that probiotics need to be taken regularly. “Benefits may ease if supplementation is discontinued,” he adds.

Probiotics aren’t a one-size-fits-all treatment for all folks experiencing gut conditions or sexual dysfunction. But for some, they can be an incredibly beneficial part of a holistic treatment plan.

Complete Article HERE!

The Importance of Gender-Affirming Care for Closing the Gap on LGBTQ+ Health Disparities

By Elly Belle

In doctor’s offices across America, medical professionals often provide care based on the assumption that patients are cisgender and heterosexual. But LGBTQ+ patients—especially those who are trans, gender non-conforming, or nonbinary deserve better, and experts say improvements will only come when LGBTQ+ and gender-affirming health care becomes commonplace.

This type of care—which caters to the needs of these individuals without stigma or shame, and affirms patients’ sexuality and gender identity—is especially important given the significant health disparities the LGBTQ+ community faces, including increased risk for sexually transmitted infections (STIs) and HIV/AIDS, higher rates of mental health disorders, and an increased prevalence of houselessness and intimate partner violence.

While there are many factors that contribute to these disparities, a major one is that many LGBTQ+ folks avoid seeking medical care because they’ve experienced transphobia or homophobia in the past, or because they believe they’ll be discriminated against or don’t think they’ll receive adequate care because of provider ignorance. But the sooner affirming care becomes the standard, the less likely that is to happen.

What is gender-affirming care?

One of the first things Andrew Goodman, MD, does when he sees a patient is say his own pronouns to create a welcoming environment so patients know that their identity and needs matter. Practicing gender-affirming care is about, “not walking in with any assumptions, and understanding that knowing someone’s sex doesn’t mean you know things about their gender identity, who they have sex with, or the care they might need,” says Dr. Goodman, who is the medical director at Callen-Lorde, a health center for New York’s lesbian, gay, bisexual, and transgender communities. “It means that you ask and you’re open. It’s treating a patient like they are the expert of their own experience.”

Affirming care means that patients get the treatment they need for the bodies they have, not what the medical community presumes is appropriate based on the gender they were assigned at birth.

Some medical professionals presume that only women need pap smears, or that a man can’t get pregnant, but affirming care recognizes that certain services aren’t just for cisgender men and women and that trans men, nonbinary people, and intersex people are in need of reproductive care, too. It also acknowledges that patients’ sexual experiences might include people of all genders, and that hormone therapy, STI testing and treatment, contraception, and abortion are important health services for many people, regardless of sexual orientation, gender expression, or gender identity. In short: Affirming care means that patients get the treatment they need for the bodies they have, not what the medical community presumes is appropriate based on the gender they were assigned at birth.

Daria*, a nonbinary survivor of female genital mutilation (FGM), did not receive gender-affirming care when they sought help for FGM-related health care. “My heart dropped when I saw that all of the support information only mentioned women and girls. While they served people regardless of gender, the FGM department only seemed to cater to women and girls,” Daria says. “So in order to receive services, I signed up as a cis woman.” Despite the fact that they got some of the mental health care they needed, and were even offered a free gynecological exam to examine the physical effects of FGM, everything was in the context of womanhood. “Having gender-affirming health care means that as a nonbinary survivor of FGM I don’t have to compromise my gender identity in order to receive the help I need.”

Why education and advocacy are important

Bhavik Kumar, MD, MPH, the medical director of primary and trans care at Planned Parenthood Gulf Coast, explains that making a commitment to providing affirming care means educating and training staff to ensure “all the people involved in a patient’s health-care experience understand and value LGBTQ+ people.” For example, providers are taught to use neutral language and ask what body parts a patient’s sexual partners have, rather than asking if they’re sexually active with men or women. “We strive to make our health centers affirming spaces that are mindful of the indirect messages that can be so important to building trust and making our patients feel comfortable,” Dr. Kumar says.

It’s also important that patients of all ages receive this type of care, says Armonté Butler, the senior program manager of LGBTQ health and rights at Advocates for Youth, a nonprofit advocacy group dedicated to sexuality education and the prevention of HIV and sexually transmitted diseases. LGBTQ+ youth should learn from an early age that they deserve—and can receive—quality treatment, because it will help them feel comfortable seeking medical treatment later in life. Providers should also make it clear to all patients that they offer services like HIV testing and prevention, and they should be transparent about the way their practices handle insurance and confidentiality procedures. “It’s also crucial for health-care organizations to update their websites and social media to include imagery and resources for LGBTQ+ young people, including youth of color and youth living with HIV,” says Butler.

And it shouldn’t be the job of the patient to educate their health-care providers, either. “Finding affirmative and inclusive health care is like finding a needle in a haystack,” says Grey*, a nonbinary student who has received affirming care and also had negative experiences seeking health care. “Many doctors rely on their patients for education and that can cause more harm than healing,” Grey says.

At the bare minimum, providers should make sure they use inclusive language and visuals and that forms provide space for patients to list their names and pronouns. And it would be beneficial if they also offered access to hormone treatments and inclusive screenings for all gender orientations, says Jessica Halem, former Harvard Medical School LGBTQ+ outreach and engagement director.

Above all else, health-care providers should be advocates for their LGBTQ+ patients. “A primary care provider might not be comfortable with HIV care or hormone therapy, but it’s important not to say, ‘I’m not familiar with this and don’t think you should get it.’ Affirming care is, ‘I’m not familiar with this but let me go find out more about it and get you the resources you need,’’ says Dr. Goodman. This type of advocacy is a huge part of Dr. Goodman’s practice. For example, when he knows that he has to send a prescription to an external pharmacy that might use a transgender patient’s legal name instead of their chosen name, he prepares the patient so they aren’t caught off-guard. He’s even helped patients navigate the process of a legal name change so that they don’t have to worry about being deadnamed in official settings outside of health care.

And it’s important to recognize that affirming care goes beyond the front-office and patient-facing aspects of health care; the technology that powers the medical system needs updating as well. Many software systems display a patient’s legal name and sex assigned at birth, which could clash with their identity. Some software also forces doctors to make medical decisions based on assigned sex at birth and that can influence dosage amounts for prescribed medications or prompt the doctor to make improper preventative-care recommendations, explains Susanne Fortunato, founder of Wingspan Health, an inclusive patient portal. But things are changing. New software makes it possible to provide a better experience, by capturing a patient’s legal name and assigned sex and birth for insurance purposes but displaying their correct name to front desk staff, incorporating all gender markers and pronouns, and using displays that look the same for all patients in order to protect their privacy.

Making affirming care the new standard

Often, without the proper systems in place, LGBTQ+ people are left to fend for themselves or accept being misgendered or improperly treated. But it doesn’t need to be this way. “You might think you’re not in the position to question an experience, but you can give feedback to your provider,” Dr. Goodman says. And if you feel comfortable doing so, it might help bring about change. That said, if you’re not getting the care you deserve, you can leave and find a new provider. The Gay and Lesbian Medical Association (GLMA) specifically has a provider directory that lists the affirming and competent practices in the United States.

If you work in health care or feel comfortable sharing resources with your medical providers, you can be a driving force for change. Some resources to consult include the University of California San Francisco’s transgender care guidelines and Essential Access Health’s guide to Providing Inclusive Care for LGBTQ Patients. These guides explain how to avoid stereotypes and assumptions about patients’ sexual orientations and gender identities and offer samples of inclusive intake forms and updated ways of keeping health records. And they don’t just cover the ways that doctors treat patients; they touch on why it’s critical for all staff, especially those who have contact with patients (such as outreach workers, front-desk staff, assistants, and those who handle billing and insurance) to have LGBTQ+ affirming training. Ultimately, any and every interaction in health care sets the foundation for patients to feel cared for.

As things change, there will be providers who worry that implementing inclusive care will push some patients away. But Dr. Goodman explains it’s necessary for health-care professionals to understand that patients who don’t like the changes will probably have access to care elsewhere, while marginalized patients often don’t have that option. That’s why creating a welcoming space for the people who are the least likely to have access to those spaces must be the priority.

“A lot of change starts small and is incremental,” Dr. Goodman says. “Maybe right now all you can change is what happens in your exam room, but that can be so powerful.”

*Name was changed to protect privacy.

Complete Article HERE!

10 sexual health tips for trans and non-binary people

By Ellis K

Everyone has a right to healthy, happy sex. But trans, non-binary and gender diverse people are too often left out of mainstream information relating to health and wellbeing. This means trans and non-binary people are often reliant on guesswork and reading between the lines to find what’s relevant and what’s not.

This came through loud and clear when sexual health charity Terrence Higgins Trust asked more than 200 trans and non-binary people about their sexual health and current provision.

“As trans people, we need to see ourselves in sexual health campaigns and know that the information is written with us in mind,” says sexual health clinician Dr Kate Nambiar.

That’s exactly what the charity put into action – utilising the feedback for the development of its brand new trans and non-binary sexual health information in terms of everything from content to tone.

The information was produced by trans and non-binary staff at Terrence Higgins Trust and developed in conjunction with members of the trans community. Dr Nambiar was the project’s peer reviewer.

The new webpages and print leaflet feature eight trans and non-binary people of different ethnicities, shapes and sizes. In line with feedback, the imagery is empowering and positive – a departure from how trans people are too often depicted.

“I decided to be a part of this resource because I want trans people, however they identify, to know that they are worthy of having an enjoyable and healthy sex life,” says Rory Finn, health promotion specialist at Terrence Higgins Trust who was part of the project group. “Our bodies deserve to be empowered and celebrated, just like everyone else.”

The specialist sexual health information for trans and non-binary people is now available on Terrence Higgins Trust’s website. But – for a flavour – here is the charity’s top 10 sexual health tips for trans and non-binary people.

1) Spend some quality time with yourself

There is no one way to be trans or non-binary, everyone’s different. Masturbation is a good way to get to know what you like and feels good – when you know, you can show your partners what you want. This is true for everyone, but especially so if you’ve just had gender-affirming surgeries and are looking to explore your new body parts. There are a variety of toys on the market that can help with sex. Try different things out. What works for others may not work for you.

2) Checking in

Figured out what you like? Tell your partners. Communication before and during sex can sometimes be awkward and take some practice, but it’s the best way to ensure you are both happy and comfortable with what’s happening. You have the right to enjoy sex and you shouldn’t feel like you have to use parts of your body if you don’t want to. Checking in before sex is also a great time to decide on what barriers and protections you are going to use.

3) Do things your way

Clothing can be affirming, and keeping it on can sometimes mean better sex. Some trans masculine people find that continuing to use clothing like binders and packers during sex feels good. Learning to negotiate the sex that you want, and experience pleasure with potentially new body parts can take time. You might need time to build up confidence and learn new skills to help you negotiate safer sex. You should never be pushed into anything that you are uncomfortable with.

4) Find the best barrier methods for you

STIs can be passed on from all types of sex with all types of body parts and sex toys. Using a barrier such as a condom or dam along with water-based lube is the best way to protect against STIs. Recent lower surgery means unhealed skin, which can make it easier for you to acquire or pass on HIV as bleeding can provide a route into or out of your body. Discuss with your surgeon what kind of activity you can do and how soon. If you’re a trans masculine and on testosterone (T), remember that it’s not an effective form of contraception, but condoms are. The coil, implant, injection or pill can also be safely taken with T. Likewise, hormone therapy for trans feminine people doesn’t provide adequate contraceptive protection.

5) Negotiating condoms

It’s not always easy to discuss condoms before sex, but there are some useful tips to help get them in play. Make sure you have condoms and lube with you and that you’ve practised using them before you have sex. You can make putting on a condom part of play. Passing a condom to a partner can be understood to mean you want to be fucked – it also signals that you want to use a condom for this.

6) Is PrEP right for you

PrEP is a pill that protects you from HIV, taken before and after sex. It doesn’t affect or interact with hormone treatment. PrEP might be right for you if you’re HIV negative and have sex in a variety of situations where condoms are not easily or always used. It gives you empowerment, particularly if you are a receptive partner, or bottom, by taking control over protecting yourself from HIV transmission. There’s also PEP, a treatment that can stop an HIV infection after the virus has entered a person’s body (for example, if you’ve had sex and the condom fails). To work, PEP must be taken within 72 hours (three days), and ideally should be taken within 24 hours. You can get PrEP for free on the NHS from a sexual health clinic, and PEP from a clinic or A&E.

7) Tell a mate you’re hooking up

If you’re planning on meeting someone from a dating app, it’s a good idea to tell a friend where you’re going, when they can expect you to come back and who you’re planning to meet.

8) Be prepared

Just planning on meeting someone for a coffee or quick drink? Plans can change, so make sure you’ve got some condoms and lube with you.

9) Test, test, test

Getting screened regularly is a way to reduce the risk of HIV and other sexually transmitted infections (STIs). Have a sexual health screen at least once every year, and more frequently if you change partners or have casual or new partners. STI screening is quick, free, and painless and you can take your own samples from the body parts you use for sex. These days, there are more ways than ever, including ordering a self-test kit online.

10) Regular check-ups

If you have a cervix then it’s important to get a cervical screening test every three years from the age of 25 (or every five years from 50 to 64). If you’ve changed your name and gender with your GP, you may not receive letters to remind you to go for a screen.

Complete Article HERE!

4 Things Every Woman Needs to Do for Her Sexual Health

Women’s well-being has lagged behind men’s for far too long, but there are steps you can take to empower yourself — and all womxn.

By Pam O’Brien

“Every woman deserves good sexual health and a robust sex life,” says Jessica Shepherd, M.D., an ob-gyn and a gynecologic surgeon at Baylor University Medical Center in Dallas and the founder of Her Viewpoint, a social media forum for women to discuss topics like sex and menopause. “Yet in the medical field, women’s health is often put on the back burner. Even today, innovations and treatments that affect women take significantly longer to get approved than those for men do.”

For Black women, the situation is worse, as there are inequalities in care and treatment, says Dr. Shepherd. Black women are more likely to get conditions like fibroids and to have worse outcomes. And the medical field tends to be white and male. Black female physicians make up less than 3 percent of U.S. doctors, according to the Association of American Medical Colleges. That’s why it’s so vital to be your own advocate. Here’s what you need to know.

Speak Up About Treatment Options

If you’re experiencing discomfort, painful sex, or bleeding, see your doctor. You might have fibroids, which affect 70 percent of white women and 80 percent of Black women by the time they’re 50. “We’ve developed minimally invasive surgeries that can really help. But women still say, ‘I’ve been to several doctors, and I was given one option.’ For African American women, research shows that option is usually hysterectomy,” says Dr. Shepherd. “Ask your doctor about all the available treatments, so you can choose the best one for you.”

For younger women, the cause of pelvic pain may be endometriosis. “One in 10 women suffers from it,” says Dr. Shepherd. “Now there are gynecologists who specialize in surgery for the condition, and we have a research-backed medication [called Orilissa] that treats it.”

Understand Your Screenings

Cervical cancer is the most preventable and treatable type of pelvic cancer because we can screen for it with Pap smears,” says Dr. Shepherd. “But most women have no idea that’s what a Pap smear is for. Screening tests are so important. Women are still dying from cervical cancer, and they shouldn’t be.”

Remember to Enjoy Yourself

“What we experience during intimate moments and how we feel about ourselves as sexual beings starts in our head,” says Dr. Shepherd. “Sexual wellness takes brainpower. Being confident and enjoying yourself is empowering.”

Advocate for Change

“When someone is disadvantaged because of inequality in education, housing, jobs, income, and criminal justice, that affects their health,” says Dr. Shepherd. “As a Black physician, I have a responsibility to navigate the system and fight for my patients so they can get what they need. By speaking out, I can make an impact, but I’m counting on white physicians to amplify the message and be part of the change.” As a patient, you can make your voice heard too. Says Dr. Shepherd, “All of us working together is how change is going to happen.”

Complete Article HERE!

Sexual health during cancer treatment

Many patients don’t want to talk about sexual health while being treated for cancer — here’s why they should.

Changes in sexual health may not be top of mind when you’ve been diagnosed with cancer, but it might be more important than you expect. It’s important to talk to your health care providers about sexual health and cancer.

By: Sara Thompson

Cancer treatment and sexual health

Depending on the treatment you are given, sexual side effects range from mildly annoying to downright debilitating. For instance, hormone-blocking medications can cause vaginal dryness, which can lead to painful sex or lowered sex drive. Patients who have mastectomy (breast removal) may no longer have feeling in the chest area. Changes in body image affect sexual well-being. Young women may face infertility or early menopause with cancer treatments.

“This topic isn’t discussed enough,” said Laila S. Agrawal, M.D., medical oncologist with Norton Cancer Institute. “But sexual health affects your quality of life, and there are ways to address those issues.”

You’re not alone

Patients tend to feel their cancer diagnosis sets them apart from others. They may feel like their issues are theirs alone, but they’re not.

“Sexual health concerns are common issues for cancer survivors,” Dr. Agrawal said. “A Livestrong survey in 2010 listed this as the third most important issue for cancer survivors.”

Many times, patients also feel they shouldn’t discuss their sexual issues with their doctor. Patients may feel uncomfortable asking, or they may be afraid to make their doctors uncomfortable. They may believe sexual health issues are not as “important” as their physical cancer treatments and therefore may be reluctant to bring it up with the doctor.

Practical tips for today

Dr. Agrawal has some ideas to help you open the lines of communication with your doctor, care team and partner.

“It is understandable that this may a sensitive topic to discuss with your doctor,” she said. “Just know that this is a very common issue among cancer survivors, and medical treatments are available that may help.”

It may help to write down your questions before you see your doctor. Here are some questions to get you started.

  • Is there a risk of infertility with this treatment? What can I do about it?
  • Is it safe to have sex while I am going through chemotherapy? What precautions do we need to take?
  • Is it possible to get pregnant while on this treatment? Would there be any increased risks or negative effects on the baby?
  • What method to prevent pregnancy would be right for me?
  • Will this treatment have effects on sexual function?
  • Can anything be done about low interest in sex?
  • Can anything be done to help with my body image?
  • Sex has become painful. Is there anything that can help?
  • What is pelvic floor physical therapy, and would it be helpful for me?

Further resources

“In the near future, we hope to open a sexual health clinic at Norton Healthcare for a more comprehensive assessment and treatment program,” Dr. Agrawal said. “The behavioral oncology program can assist with issues that affect sexual functioning, including body image, libido, depression, anxiety and relationship concerns. Some conditions must be checked and treated by a gynecologist.”

Many sexual health concerns after cancer are very common and can be treated. Just like many things are not the same after a cancer diagnosis, your sex life may not be the same either. Having patience with yourself, having honest communication with your partner and looking at intimacy in new and creative ways can help restore a healthy sex life.

Complete Article HERE!

Exactly what happens to your body when you don’t have sex for a long time

– or at all

by Paisley Gilmour

We often hear terms like ‘blue balls’ and ‘sexual frustration’ – but what are the real physical and mental effects of a dry spell?

In our sex-obsessed society, people who don’t have sex ever or for a very long time are often seen as abnormal or unusual.

For people who find pleasure and enjoyment in masturbating and having partnered sex, the idea that someone chooses not to or just doesn’t feel sexual attraction can be quite hard to understand. But many asexuals and people who are celibate are perfectly healthy despite not having sex for long periods (or ever, in some cases).

Yet still, people feel concerned about the effects – both mental and physical – of not having sex for a long time. We all often overhear people using terms like ‘blue balls’ and ‘sexual frustration’ – so what exactly are the effects of not having sex for a long time?

Asexuality and celibacy

Asexuals are people who do not feel or experience sexual attraction. Asexuality is a valid sexual orientation, and is not a choice despite being regularly confused with celibacy. Some asexual people do still masturbate and have sex. Asexuality is a spectrum and everyone experiences it differently.

Celibacy is when someone chooses not to have sex, for an extended period of time or forever. People choose to be celibate for a number of reasons, ranging from religious beliefs to simply wanting to focus more on other aspects of life.

Physical effects of not having sex for a long time

When someone does not have sex for a while, it is unlikely there will be a negative physical side effect, according to Dr Earim Chaudry, medical director at Manual. ‘A study showed that compared males and females who have not had sex in the last year against males and females who have not had sex for more than five years. Results showed that “sexless Americans reported very similar happiness levels as their sexually active counterparts”.’

However, Chaudry points out that there are physical benefits that are associated with sex. ‘Sex can make your body release hormones, like oxytocin and endorphins which are known as “happy hormones” which help with reducing your blood pressure and lowering stress levels.’

Stress and sexual frustration

‘Not having sex for a long time can result in sexual frustration and pent up emotions because the hormone changes that occur during sex and orgasm are not happening. This is more common in men but applicable for all genders,’ says Dr Shirin Lakhani, a cosmetic doctor and a recognised expert in the field of intimate health at Elite Aesthetics.

Research has shown that sexual intercourse is more effective at relieving stress than masturbation.

This can result in people of all and any genders feeling frustrated and experiencing dips in their mood. ‘Research has also shown that sexual intercourse is more effective at relieving stress than masturbation, so people who are not having sex may feel more stressed than usual,’ she adds. ‘This is because sex increases the levels of endorphins and the hormone oxytocin produced by the brain. Oxytocin can offset the effects of the stress-causing hormone cortisol.’

Arousal and orgasm

Lakhani says women and people with vaginas may experience changes in their bodies as a response to a decrease in sexual intercourse and orgasm. ‘Women who are less stimulated may experience a loss of lubrication, and it can also lead to problems getting aroused or reaching orgasm,’ she explains.

Circulation

Not having sex regularly can also negatively affect the circulation and blood vessels, according to Lakhani. ‘Studies have shown that having sex just twice a week halves a man’s chances of getting clogged arteries, compares to those who only do it less than once a month,’ she says.

‘A study showed that males who regularly ejaculate have shown a reduction in the risk of prostate cancer,’ says Chaudry.

Incontinence

For women and people with vulvas, Chaudry says ‘regular sex can strengthen the pelvic floor and in turn reduce likelihood of incontinence’.

Blue balls or epididymal hypertension

The term blue balls is actually an informal and colloquial term used to describe the condition epididymal hypertension (EH). ‘It affects people with male genitals and causes pain and aching of the testicles after having an erection without an orgasm,’ Lakhani explains. ‘It is often accompanied by a faint blue colour in the testicles, which is where it gets the nickname. It’s not serious but can cause pain and aching.’

Treatment for EH is by becoming unaroused and therefore moving blood flow to another area. Lakhani suggests exercising or taking a cold shower as well as listening to music or engaging in any activity that provides a distraction.

If you are easily stimulated you’re more likely to develop the condition, she adds, explaining that you don’t typically need to see a doctor unless it is regularly causing pain and impacting the enjoyment of your sex life.

Can women get blue balls?

‘Females and people with a vulva can experience a condition that is referred to colloquially as “blue vulva”,’ Lakhani says. The medical name for this condition is vasocongestion. In the same way as blue balls does, it occurs when the blood flow to the genitals increases with sexual arousal.

‘It can result in an aching feeling or a sensation of heaviness around the clitoris and vulva. It can be treated in a similar way to blue balls, with distraction techniques,’ she says.

Mental health effects of not having sex for a long time

‘Sex is a vital component of overall health. Not only does sex allow for human connection and intimacy, but it is important for a series of biological and psychological processes that contribute to our continuing wellbeing. Sexual frustration and the associated difficulties which arise can cause a great deal of distress and sadness,’ explains Daniel Sher, clinical psychologist and sex therapy expert at Between Us premature ejaculation clinic.

Depression and anxiety

Sher says the phenomenon of sexual frustration is an important one to consider from a psychological perspective, however he points out that research into this topic is sparse.

‘Animal studies have suggested that sexual frustration leads to a spike in cortisol levels. It is likely that the same is true for humans. Cortisol is a stress hormone and chronic activation of this chemical can lead to a series of psychiatric health problems. These include depression, anxiety, weight gain, elevated blood-sugar, insomnia and heart problems.’

He adds that for people who already experience low self-esteem, ‘sexual frustration can lead to severe feelings of shame and isolation. People in this situation frequently express a sense of being different, alone and unloveable.’

Low libido and sexual desire

A Between Us Clinic survey found women rated low libido as the most distressing sexual disorder in their male partner. Sher says this ‘likely speaks to the level of distress that can arise in a “sexless” relationship.’ He adds, ‘In fact, 29 per cent of the sample said that having a partner with low libido could lead them to end the relationship, which again demonstrates the psychological importance of having a healthy sexual relationship.’

Celibacy and mental health

Those who choose to be celibate are ‘likely to have alternate support structures in place in order to compensate for this,’ he says. ‘For example, someone who abstains for religious reasons is able to frame their experience of frustration in the context of their spiritual needs, which will make that experience of frustration more bearable.’

If someone is in involuntarily celibate, they may experience often experience shame, anger and disconnectedness. ‘They may feel embittered toward and shunned by mainstream culture. Within the online incel communities, for example, these sorts of feelings and experiences have inspired dangerous ideology that has led people (such as Eliot Roger, for example) to commit murder.’

If sexual frustration is causing you emotional distress

Sher says sexual frustration is easy to treat by ‘having massage or masturbating more frequently’. He adds, ‘It’s also important to remember that the psychological underpinning of sexual frustration is a sense of disconnection. Therefore, it’s a good idea to find alternate ways of connecting socially. Reach out to friends and family members. Volunteer with people or do some charity work. Alternatively, speak to a therapist in order to experience some of that much needed connection, while also exploring other proactive ways of coping.’

Complete Article HERE!

How Gen Zers are confronting feminine health and sexual wellness

by Emma Sandler

Sexual wellness and feminine health have become dominating topics within the broader beauty and wellness industries, but Gen Z’s response to these products and its marketing is still undetermined.

According to Pew Research Center, there are approximately 67 million Gen Zers in the U.S., of which 35% are older than 18. As this group of consumers enters puberty and menstruation, and eventually experiences sexual activity, they engage with these products with a wildly different set of views and values compared to their millennial counterparts.

Rebecca Alvarez Story, founder of Bloomi, a sexual and intimate care online retailer, said she noticed that while Gen Zers are not a big customer group for her business, they make up a significant chunk of readers of the site’s blog. Gen Zers make up about 8% of Bloomi’s customer base and typically purchase menstrual products like period underwear and yoni eggs. Meanwhile, Gen Zers make up more than 25% of the blog’s readership, and that readership is 73% female and 27% male. The most popular stories read relate to menstrual cycles and more fringe sexual topics like anal sex. Bloomi’s monthly virtual workshops that began in April have seen an equal number of millennials and Gen Zers attend, she said.

“What we understand based on what we’re seeing is that 18- to 24-year-olds are coming into their sexual selves,” she said. “They have a desire [to read] foundational information, like safe sex practices, but then with that curiosity comes also desire to engage with more outlier topics that millennials [don’t read],” she said. She explained that millennial women typically have to unlearn many sexual stigmas or behaviors in Bloomi virtual workshops, while Gen Zers are coming into their sexuality more confidently.

When it comes to merchandising, Gen Zers are also critical of euphemistic terms such as “feminine wash,” as they prefer something more open about what a product is. Therefore Bloomi has a category called “moisturize vulva skin,” even though brands like Lady Suite and Healthy Hoohoo within that category still rely on phrases like “intimate cleanser” or “feminine wash.”

Product descriptions are just one example of how Gen Zers are approaching feminine health and sexual wellness. Gen Z has proven to be more progressive on the topic of gender identity, compared to millennials, too. They’re also having less sex. According to the annual Youth Risk Behavior Surveillance System from the Center for Disease Control, only 40% of students were having sex in 2017, a decline from 48% in 2007. The Atlantic, in a 2018 story, spotlighted that young people were retreating from intimacy in favor of having sex only as they got older or by participating in sexual activity through masturbation. Given this trend, the consumer are on a trajectory that sexual wellness and feminine care markets might not be prepared to handle given these radical shifts in not only sexual expression and identity but also in participation. Marketing narratives can adapt quickly, but whether consumers will desire the products for sale is another question.

In April, Vagisil soft-launched a sub-brand for teen girls called OMV before expanding the brand nationwide in July through retailers like Walmart. The brand offers an intimate wash, wipes and anti-itch serum for the bikini line. According to Keech Combe Shetty, Vagisil CEO, Vagisil and OMV conducted consumer research throughout 2019 with 2,500 girls and mothers to understand what teen girls wanted from personal care products. She said they wanted to feel “confident and secure around their period,” as well as “fresh and clean,” for example. Combe Shetty said that outreach to Gen Z and their parents (who ultimately have the purchasing power) is through linear television ads on channels like ABC, CBS and Bravo, citing placement on shows that mothers and teens watch. OMV is also working with influencers like mother-and-daughter duo Kendal and Evie Rich on Instagram (who together have 115,000 followers), and plans to launch a TikTok account at an undetermined time.

Dr. Lauren Streicher, a clinical professor and doctor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University, said such products are not only medically unnecessary but also “offensive on every level” because they suggest that a woman needs perfume in the genital area to cover up her scent. She added that the pH balance of the vagina is critically important to health and that any odor stems from the vagina itself, meaning that the pH balance washes used for the vulva have no impact on vaginal health or scent.

“If you had bad breath, you could wash your face all day long, and it’s not going to change your bad breath; it’s the same thing with the vulva and vagina,” she said. “It is sending an inappropriate message to these very vulnerable women who are already feeling insecure about their changing bodies.”

When asked about the criticisms of products like Vagisil and OMV, Combe Shetty responded by pointing out that many women can find it hard to remember how difficult entering puberty is and that girls’ confidence levels can decline significantly during this time. This line of thinking underscores a chicken-or-egg problem with products and a person’s entrance into these types of consumer categories: Do their concerns exist inherently and outside societal influence or are they precisely a product of social stigma? It is not the first time the beauty and personal care industry has faced issues with selling products that seem to push unrealistic beauty standards while simultaneously providing solutions to customer’s legitimate desires. It will likely not be the last.

“When people think about sexual wellness and health, they generally focus on product. Data tends to show that people buy products and use them a few times, but then put them away,” said Isharna Walsh, founder and CEO of sexual wellness and health app Coral. “But products are not the thing that’s going to change society and our relationships.”

Launched in Nov. 2019, Coral offers a $60 for an annual subscription for stories, educational articles, quizzes and other content around topics like desire, arousal and how to give and receive physical pleasure, among others. Walsh said Coral has raised $3 million in fundraising and that downloads increased 300% during Covid-19. The most significant cohort of subscribers is women ages 21-25, said Walsh. She was surprised by how much Gen Zers were engaging with Coral, as she assumed it would be a millennial-geared product and created the app with that in mind. A significant number of people younger than 20 have also download the app, though they subscribe at a lower rate than those older than 25-years-old, she said. Coral declined to provide specific data.

“We resonate because we’re speaking to that younger demographic with a level of maturity that they appreciate. They want to understand more about their bodies, and this age group is a lot more thoughtful (than I was at that age) around mental health and around living their best lives,” said Walsh.

Complete Article HERE!

10 Men’s Sexual Health Questions That Are Too Embarrassing to Ask

Sex, Viagra, & Ejaculation

1. Do Different Sex Positions Increase or Decrease Chances of Pregnancy? 

No. Regardless of what sexual position you use, vaginal sex can cause pregnancy. 

2. Can I Drink Alcohol With Viagra and Cialis?

Yes. There will not be a bad interaction between the two; but, keep in mind that when you drink alcohol, your erection may not be as firm and the medication may not work as well.

3. Is There a Surgery That Can Increase the Size of My Penis?

Even an implanted penile prosthetic will not increase the size of your penis. If you are overweight, getting to your ideal body weight will help restore some of the length you have lost since gaining weight.

Many men will ask about injections to add girth and if there is a procedure to increase penis length. The AUA (American Urological Association) considers fat injections, to increase penile girth, and suspensory ligament division surgery, which can increase length, to be unsafe and ineffective.

4. Is My Penis Average in Size Compared to Other Men?

This is a question that is hard to answer, and one that many men wonder about. There are many different techniques to measure penis length, including the amount of force the clinician uses to stretch the penis.

Also, some men will see a significant change in penis length once it is erect. Others will notice that their penis only becomes more rigid. There is not a number that men should set as their benchmark.

Some medical conditions and surgical procedures can reduce the length of your penis. We cannot always restore the length you lose. 

The biggest take-home for patients regarding this is to keep a healthy weight. Get care if you feel like your erections are not rigid enough or if you have other concerns about your penis.

5. How Long Should My Erection Last During Sex?

The answer to this question is completely different per person. There is not a standard time that all men should be able to maintain an erection.

For most men, the goal is to get an erection that is rigid enough for penetrative sex and that lasts until both partners are satisfied. We counsel patients that if an erection has lasted over three to four hours, they should get care with the nearest emergency room. (This is called priapism.)

6. What Is Considered Premature Ejaculation?

There is not a standard amount of time that an erection should last before ejaculating. The AUA defines premature ejaculation as “ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners”.

There is not a lab test that can determine this. We make this diagnosis based on your report and a physician assessment. Treatment options are available. Your provider can help you decide which is best for you.

7. You Don’t Ejaculate After an Orgasm—What Causes This?

Various surgeries or medications can cause a man not to ejaculate after an orgasm. (The means the penis does not expel any semen). This is called aspermia. The semen can also go backwards into the bladder, which is called retrograde ejaculation. Common causes of aspermia can be a:

  • Prostatectomy or other prostate procedures such as transurethral resection of the prostate (TURP),
  • taking Flomax (Tamsulosin),
  • diabetes, or
  • nerve injuries.

8. Are Orgasms and Ejaculation Different?

Yes. Typically, an orgasm is the pleasure you experience while ejaculating. Men can have an orgasm without ejaculation. On the flip side, men can ejaculate before orgasm. It is also possible to have an orgasm and ejaculation without an erection that is satisfying for sex.

These conditions can have various causes, some that we can identify and treat, and some that we can’t.

9. How Much Ejaculate Should I Have?

Ideally, men should have at least 1.5mL of ejaculate. This is equal to 0.304 US teaspoons, so it is not a large volume. As men age, the amount of ejaculate begins to decrease, but if you notice a big difference, suddenly, you’ll want to contact your provider.

It’s OK to have more, but if you are noticing significantly less over time, especially during the time you are trying to get pregnant, we recommend seeking care with a urologist.

10. Is a Curved Penis Normal?

Some men have a slightly curved penis that has lasted for quite some time. If it is not painful and does not bother you, that is normal. If it is painful or bothers you, then make an appointment with a men’s health doctor. You doctor will evaluate your condition and discuss your treatment options.

If you notice a new curve to your penis and that bothers you with either pain or appearance, come see us. We can discuss next steps. This curve can impact your erections, which is another element we can evaluate and treat.

Complete Article HERE!

Sexual Health Alert:

Some penis microbes may increase the risk of vaginal infections after penetrative sex

by

  • A new study found that 10 types of bacteria found on men’s penises were predictors in whether their female partners developed bacterial vaginosis.
  • Bacterial vaginosis is a vaginal infection that affects 1 in 3 women. Experts are unsure what exactly causes bacterial vaginosis.
  • The researchers said that their study suggests men’s sexual health and women’s are inextricably linked, and that heterosexual couples should work together to promote each other’s sexual wellbeing.

Women may have a higher risk of vaginal bacterial infection after penetrative sex with men, depending on the type of microbiota on their partner’s penis, a study has found.

Bacterial vaginosis is a type of vaginal bacterial infection that affects 1 in 3 women, but, according to the CDC, health experts are still unsure what causes it.

For the study, University of Illinois at Chicago researchers looked at 168 heterosexual couples in Kenya over a year. Just over half (56%) of the men they studied had circumcised penises, and circumcision status can affect the amount and types of bacteria on a penis.

None of the women had bacterial vaginosis at the start of the study. The researchers found that 31% of the women in the study developed bacterial vaginosis during the year-long trial.

In addition to testing the bacteria in the women’s vaginas, they also examined each man’s penile microbiota during the initial screening and three follow-up appointments.

The researchers concluded that the men were a defining factor in the women’s risk of infection. They identified 10 species of penile bacteria that appeared to increase a woman’s risk of BV. The men who carried on their penis one or more of the 10 species, his female partner was more likely to develop bacterial vaginosis.

Men should be involved in women’s reproductive health

The study’s findings don’t mean a man’s penis causes bacterial vaginosis in women, according to Dr. Supriya Mehta, lead study author and an epidemiologist at University of Illinois at Chicago.

But his team’s findings suggest male and female sexual health are inextricably linked, especially for heterosexual couples.

“I would like for clinicians, researchers, and the public to be inclusive of male sex partners in their efforts to improve women’s reproductive health,” Mehta said in a statement. “Not to place directionality or blame on one partner or another, but to increase the options and opportunity for improved reproductive health, and hopefully reduce stigma from BV.”

There were caveats to this study. Only 46% of the 168 couples attended all four doctor’s office visits during the year-long trial, so the researchers have incomplete data for some couples, which could cause skewed results. Additionally, the researchers looked at a small sample of only Kenyan couples who were heterosexual, so the results may not be applicable on a universal scale, across countries, cultures, and sexualities.

Mehta said more research should be done to determine how men can look after their own genital health to protect the genital health of women with whom they’re sexually active.

Complete Article HERE!

LGBTQI+ populations face unique challenges during pandemic

Global conversations about the impact of the pandemic on gender equality have left out sexual and gender minorities. COVID-19 is a threat multiplier.

By Yvonne Su, Yuriko Cowper-Smith, Tyler Valiquette

As global leaders begin to recognize the inequalities that are being exposed as a result of COVID-19, it is important to consider who is included and who is excluded when we talk about gender. An analysis of the global conversation thus far reveals that the gender dimensions of COVID-19 and the push for gender equality during the recovery phase have largely only focused on how the pandemic has and will continue to disproportionately impact women and girls.

However, gender and sexual minorities are rarely included in discussions about vulnerable populations, and global responses have largely failed to consider the unique needs and challenges that LGBTQI+ (lesbian, gay, bisexual, transgender, queer, intersex) populations face. This disappearance of sexual and gender minorities from international discourse is significant because research has shown that LGBTQI+ people are particularly vulnerable to crises like a pandemic.

The United Nations (UN), International Labour Organization, World Bank, Doctors Without Borders and UNICEF have all put out various statements and reports on the impact of COVID-19 on gender equality, but their focus is concentrated solely on women and girls. While some organizations, such as Care International and the Pan American Health Organization, add LGBTQI+ people to their list of vulnerable groups, only a few have addressed LGBTQI+ rights head on in some of their publications: UN Women, Oxfam Canada and the United Nations Human Rights Office of the High Commissioner.

While publications by international organizations and NGOs advocate for a better understanding of the effects of COVID-19 on gender equality, the sidelining of LGBTQI+ concerns makes it more difficult for organizations to advocate for enhanced protections during the pandemic.

In order to understand the gendered-impacts of COVID-19 beyond women, we draw on findings from a case study of Venezuelan LGBTQI+ asylum seekers in Brazil, an epicentre of the pandemic. As of July 23, 2020, there have been at least 2,227,514 cases of COVID-19 in Brazil and 82,771 deaths. Our analysis of 23 interviews with Venezuelan LGBTQI+ asylum-seekers, politicians and workers in non-governmental organizations and UN staff, shows that asylum seekers are experiencing increasing violence, transphobia and xenophobia in Brazil during the pandemic.

Venezuelan LGBQTI+ asylum seekers in Brazil

Since 2015, more than 5 million people have fled violence, persecution and economic ruin in Venezuela and 264,000 people have applied for asylum in Brazil. Among them, LGBTQI+ asylum seekers are commonly directed to the only LGBTQI refugee centre in Brazil, Casa Miga. Run by volunteers and supported by a national LGBTQI+ charity, Casa Miga was already under-resourced and over-stretched prior to the pandemic. But with COVID-19, myriad inequities that disproportionately affect the physical, mental and financial well-being of LGBTQI+ people have overwhelmed the centre’s capacity and increased the risk of gender-based violence and abuse against its resident asylum seekers.

With limited local, national or international focus on the challenges faced by LGBTQI+ people as well as refugee populations, the shelter’s staff and its residents feel hopeless, ignored and disempowered in their fight against the COVID-19.

Asylum seekers at Casa Miga experienced homophobic, transphobic and xenophobic violence in Brazil prior to the onset of the pandemic. Many asylum seekers referenced experiences of discrimination while at work or while searching for employment, in public or in interactions with the police.

Asylum seekers recounted experiences of having homophobic slurs hurled at them, being assaulted by locals and being both physically harmed and dismissed by the police. One asylum seeker had a near-death experience after he was left alone in the Amazonian rainforest following a mugging by a group of men. In the most egregious example, one of the asylum seekers had his jaw broken by two police officers in Manaus. The violence faced by trans-asylum seekers is further notable. A trans asylum seeker shared that she was assaulted while working as a sex worker, and that when she reported her attack to the police, she thought the officers did not care to investigate because she was both trans and Venezuelan. Beyond this one incident, all asylum seekers interviewed claimed to have faced LGBTQI+ based violence and xenophobia while living in Brazil.

COVID-19 acted as a threat multiplier

The threat and danger of contracting COVID-19 is very real for the asylum seekers. A resident of Casa Miga was infected with the virus in May 2020. In addition, the refugee shelter is located in Manaus, the city with the highest mortality rate of any Brazilian capital city. With over 100 people dying daily in April and being buried in mass graves in Manaus, the city’s mayor, Arthur Virgílio who recently contracted COVID-19, pleaded for urgent international help. As one asylum seeker shared: “It has impacted me gravely. I am in a constant state of fear. I don’t know when this is going to end. I know people who have become sick and who have died from this. Manaus is very badly hit by the pandemic. I will continue taking the precautions and keeping my distance from people, but despite these actions, the fear continues.”

The asylum seekers face both the fear of contracting COVID-19 and false narratives propagated by fake news stories on social media claiming they are spreading the virus. These allegations caused the asylum seekers to be even more worried about their safety and less likely to leave the shelter.

The economic stability and mental health of the asylum seekers also suffered as a result of the pandemic. Those asylum seekers who had been able to find informal work such as sex work and selling crafts, were left financially destitute when their work was banned. When the pandemic began, many asylum seekers were cut off from their monthly allowances from the government. It took over a month from the time of the cut off for Brazil to institute their Auxilio Emergencial (emergency fund) but many asylum seekers were unable to benefit from it due to the documentation and resources required (such as a cell phone) for access. As one asylum seeker shared: “It is impossible to sustain a job now and I can afford nothing for myself.”

Meanwhile, the settlement process has been temporarily halted, spurred on by the closure of the main refugee determination centre in Manaus. All of these factors compound the stress around asylum seekers’ tenuous positions in Brazil. These interruptions, lack of resources and access to services such as health care, have left asylum seekers feeling desperate and in limbo.

When governments fumble, vulnerable people suffer

Despite success in handling previous public health crises, the Brazilian government was completely underprepared for COVID-19. The administration has so far failed to provide any leadership on how to tackle this pandemic, choosing to focus on the supposed economic health of the country over the well-being of its own citizens. With the administration turning a blind eye to its own citizens, asylum seekers and the centres that care for them were largely left abandoned to manage on their own.

All the politicians interviewed stated that the government does not recognize distinct vulnerable groups within the larger refugee population in their policies, or when formulating Brazil’s strategy to respond to refugee flows and COVID-19. Without financial resources from the government, international organizations, or NGOs, Casa Miga is barely operational, relying on volunteers and local, haphazard and unpredictable donations.

When international actors blend LGBTQI+ considerations into other gender-based discussions, the ability of LGBTQI+ people and organizations to appeal for support during the pandemic is greatly limited. Facing increased violence and challenges during COVID-19, LGBTQI+ asylum seekers need more protection but are often unable to advocate for themselves.

Ultimately, when asylum seekers face increased violence based on their gender identity and sexuality, the reporting and response by the international humanitarian community, including Canada’s, must include their voices and considerations.

Complete Article HERE!

Sex and Dating During Coronavirus

– From Masks to Kissing, a Guide to Your Risks

By Carly Severn

Let’s get this straight: during the COVID-19 pandemic, there is no “safe way” to have sex with someone you don’t live with.

But humans are humans, and we know some folks will still make the choice to get physically intimate with other people, despite the presence of a highly contagious disease in our midst. So we asked for your anonymous questions, and created this guide to sex and dating during the coronavirus pandemic.

Because there’s no 100%-safe way to date or have sex outside your household right now, you’ll see the super-unsexy — yet super-important — phrase “harm reduction strategies” throughout this guide. That’s because when it comes to engaging in social and physical intimacy, it’s all about weighing your risk factors, assessing them against the risk factors of the person (or people) you’d like to have sex with and doing everything you can to further reduce the potential harm.

We’ve consulted with these sex and health experts:

  • Stephanie Cohen, medical director of San Francisco City Clinic
  • Nenna Joiner, owner of Oakland sex store Feelmore and former adult filmmaker
  • Julia Feldman, Bay Area sex educator and consultant at Giving the Talk
  • What bodily fluids can carry COVID-19?

    So many aspects of the coronavirus remain mysterious to scientists, and that includes the full scope of COVID-19’s relationship with sex. But here’s what we do know.

    If someone has COVID-19, they can transmit the virus via particles in:

    • Their saliva
    • Their mucus
    • Their breath

    The coronavirus has also been found in the semen and feces of people with COVID-19. It hasn’t been found in vaginal fluid.

    Can COVID-19 be spread through sex, whether vaginal or anal? The scientific community actually doesn’t know for sure yet. What we do know is that “sex is the definition of close contact,” as Stephanie Cohen puts it. So if you’re close enough to get physically intimate with someone with COVID-19, you’re definitely close enough to have a high risk of being infected via those particles they’re exhaling.

    How dangerous is kissing?

    Kissing someone outside of your household is one of the most risky things you can do right now, Cohen says, because of how much exchange of saliva it involves.

    For this reason, she says, kissing might actually present a higher risk of transmission than vaginal or anal sex. And anything that increases your respiration and your respiratory rate “will likely result in the release of more respiratory droplets,” thus increasing the risk of transmission — think heavy breathing.

    Are certain types of sex riskier?

    Because the coronavirus has been found in feces — and because gastrointestinal symptoms like diarrhea can occur sometimes with COVID-19 infection — Cohen says there’s a likely chance that anal sex or oral-anal contact would pose more of a transmission risk than other forms of sex such as penile-vaginal contact, for example.

    That said, medical professionals just don’t know for sure. COVID-19 transmission risk would also be impacted by a number of other factors, such as the degree of face-to-face contact and how infectious the person with COVID-19 is at the time of the sexual encounter. Right now, there just isn’t enough data to be definitive, Cohen says — so it’s all about assessing those various risk indicators we do know about.

    If I do have sex, what are some things I can do to reduce my risk of catching COVID-19?

    If you’re utterly determined to have sex outside of your household right now, these precautions represent harm reduction strategies:

    • Wearing a mask: Remember, a mask protects the other person in how it limits the spread of your respiratory droplets. For masks to truly reduce the risks of either sexual partner getting COVID-19, both people would have to wear a mask: a mutual masking, if you will. “It might not be a strategy that works for everyone,” Cohen says, “but certainly I think it’s one that could reduce risk.” Remember though: as Nenna Joiner reminds us, masks are like condoms in the sense that you “still need to know how to put [them] on correctly.”
    • Choosing positions that minimize face-to-face contact: Spooning sex, doggy-style, reverse-cowboy/cowgirl/cowperson — consider agreeing to stick to sexual arrangements that keep your faces far apart, and ideally with one person faced completely away from the other. (It’s a bit of a spontaneity-killer, yes, but it’s a good idea to agree to this one before you start having sex, to avoid ‘the heat of the moment’ making the decisions for you.)
    • Remember cleanliness: “Washing up really well, both before and after sex” is another way sexual partners can potentially reduce their risk to each other, Cohen says. Wash your hands often with soap and water for at least 20 seconds. If you don’t have soap and water on hand, use a hand sanitizer that contains at least 60% alcohol and rub your hands together until they feel dry. Don’t use sanitizer anywhere intimate — it will really irritate that delicate skin. If you have someone else’s bodily fluids on your body, be sure to wash them off thoroughly. You cannot “absorb” the coronavirus through your skin, but you might touch your skin and then touch your face. If you’re using sex toys, wash those with soap and warm water.
    • Using condoms and other barriers: Wearing a condom during sex will decrease your exposure to saliva or feces. For oral sex, using a condom or dental dam similarly provides a barrier. This is especially important for any anal contact.
    • Keep it quick: Minimizing the length of a sexual encounter is a harm reduction strategy in how it’s reducing the amount of time you’re potentially being exposed to the virus.
    • Consider things that don’t exchange fluids: Mutual masturbation could be considered a harm reduction strategy, Cohen says. But don’t forget that if you’re simultaneously making out, “that could actually be higher risk than a quick session of oral sex,” she says.

    And remember: Don’t forget to practice the safe sex you usually would before the pandemic.

    With all this in mind, we’ll say it again: right now, during the COVID-19 pandemic, there is no way of having sex with someone outside your household that carries zero risk of transmitting or obtaining the virus.

    “Everyone’s looking for a magic loophole,” acknowledges Julia Feldman, “and it doesn’t really exist.”

    And here’s another tricky thing. Even if you and your partner agree to abide by all of the above harm reduction strategies in the cold light of day, things can shift in the heat of the moment. Previously agreed-upon plans can fall apart when inhibitions are lowered and you’re turned on, especially if alcohol is involved — and in these circumstances “you’re less likely to use your prefrontal cortex to really analyze the risk involved in the situation,” Feldman stresses. “Especially if you haven’t had sex in a long time and you’re very excited to do it.”

    So if you’re concerned that your safety boundaries might be in any way reduced or made negotiable during sex… back away, and prioritize your health.

OK… I had sex anyway. How long should I wait to get a COVID-19 test?

If you aren’t sure whether your sexual partner had COVID-19, the best time to get tested for the coronavirus would be between five and 14 days after the encounter, says Stephanie Cohen.

That’s because the median average time from exposure to coronavirus symptom onset is five days — so testing any earlier than that might not yield an accurate result — but the incubation period (the amount of time you can be infected before showing symptoms) is up to 14 days.

Is isolating for 14 days between sexual partners a good idea?

Here’s the idea: you have sex with someone, and then wait for 14 days to see if you develop symptoms of COVID-19. If you don’t, you’re good to move on to a new partner safe in the knowledge you don’t have the disease and aren’t passing it on — right?

Not quite.

“It’s a good strategy; it’s a harm reduction strategy,” Cohen says, but “it’s not a zero-risk strategy.” That’s because of the large numbers of people who get COVID-19 but never show any symptoms.

What about sex with more than one person?

Having multiple people that you have sex with is a definite risk factor for transmitting COVID-19. These kinds of overlapping sexual relationships with different people — going back and forth between people, basically — is called “concurrency” in the sexual health world, and it’s something experts say will heighten your risk of spreading the disease.

“To minimize that concurrency,” Cohen says, “decrease the network size — which decreases the spread of coronavirus.” Basically, consider reducing the number of people you’re having sex with during the pandemic.

Where does that leave you if you practice polyamory, which is all about having multiple sexual relationships?

Nenna Joiner says that yes, some folks are deciding to take a break from polyamorous intimacy during the pandemic owing to the heightened risks of having different partners right now. But other poly people are choosing to isolate together “as a poly family,” they say, and agreeing to only have sex “within that sphere of people.” Ultimately, it’s about finding the solution that works best for your health, and that of others.

What about group sex?

If group sex (having sex with multiple people at the same time) was your thing before the pandemic, Stephanie Cohen has a message for you: “The fewer people, the better.”

That’s because with every additional person in a situation — social or sexual — you’re adding a potential COVID-19 case, whether they know they have it or not. In a group sex situation, that person is then potentially transmitting the coronavirus to multiple people at one time — who could then go on to infect others, who then go on to… you get the picture.

If you do continue to choose group sex, New York City’s public health department advises you to “Go with a consistent sex partner” in such a situation, and “pick larger, more open, and well-ventilated spaces.”

What about sex workers? How can they make it work right now?

Is there a way to safely engage in sex work in the midst of a pandemic?

It’s “a profession that certainly carries risk,” Cohen stresses, due to the amount of close physical contact involved. In addition to the other strategies discussed here, some additional harm reduction strategies sex workers might consider are to limit the number of clients they see during the pandemic, to opt for a smaller circle of regular clients and “more spacing out in-between partners.”

Who is ‘safe’ to date right now?

As if finding a match with someone you’re emotional and physically compatible with in all the expected ways wasn’t fraught enough — you now have the coronavirus risk compatibility to consider, too.

This is, Feldman admits, “a really unfortunate layer to add to dating.”

Get ready for some frank communication with partners, both current and potential ones, about your circumstances and behaviors around contact with other people. How many people are they seeing, socially or sexually? How does their daily life look in terms of interactions with other people? Are they an essential worker? If so, what kind of traffic does their place of work experience?

In a nutshell, this is not the time for mystery — and in many ways, you’ll have to be your own contact tracer, says Nenna Joiner.

How much do I need to talk about COVID-19 with potential partners?

Open, honest communication about your health has never been more crucial than right now. And, as Julia Feldman notes, if you’re getting sexually intimate with somebody, you should already be talking to that person about your health and sexual health status. COVID-19 is now another communicable disease for you and your sexual partner(s) to be discussing, without holding anything back. (Remember though: somebody can have the coronavirus and have zero symptoms. Just because somebody thinks they don’t have COVID-19 doesn’t mean they are definitely COVID-19-free.)

Starting these conversations can feel tricky, especially with someone you barely know, so Feldman advises you initiate the conversation by leading with your own experience — a time you were concerned you might have been at risk for contracting COVID-19, perhaps, or a recent decision to seek out a test for the disease. Leading with your own vulnerability, she says, can really open up a conversation without putting your prospective partner on the spot. You don’t want them to feel grilled, or accused. “That definitely doesn’t set the mood, and it doesn’t build trust,” Feldman says.

“Ultimately, at the end of the day, people are trying to figure out how to get all of their needs met as safely as possible,” reminds Feldman. “That’s a lot to navigate! This is brand new stuff. We are going to be messy.”

In being thoughtful though, don’t forget to acknowledge your own boundaries — and forget about anyone who doesn’t respect them, especially during a pandemic.

Being an advocate for your own safety — and working to limit community transmission of the coronavirus — means not letting any potential partners pressure you into meeting up in person, or engaging in any sexual contact you don’t want to have.

I live with other people. What do they need to know about my dating and sex life?

If you’re sharing your living situation with roommates or family, sorry: your business is now their business, especially if their own health places them in a vulnerable category.

That means you should be as transparent as possible with the people you live with about your relationship(s), and the types of activities and the type of risks that you’re involved in, Feldman says.

The first step in navigating this should be talking with the person you’re dating or having sex with, to establish their level of risk. You need to work out the potential COVID-19 risk their behavior and circumstances pose not just to you, but therefore to the people you cohabit with.

You should be prepared to discuss how you propose to minimize your roommates’ risk, whether that’s avoiding shared spaces in your home, relentless sanitizing of your living environment — or whether your cohabitees are prepared to not do this and accept the heightened risk, and the potential consequences of that.

Basically, get used to communicating because “you need to have some very frank conversations about how you’re going to try to keep everyone safe, and prioritize everyone’s health and well-being,” Feldman says. It’s that big a deal that ultimately, Cohen says, your roommates or family “should have veto power in terms of you engaging in risky behavior and bringing it back to them.”

Is ‘distanced sex’ a thing?

Totally, says Joiner: social distancing and forgoing physical touch does not have to be a barrier to sexual intimacy. Sex toys which use Bluetooth connectivity can be used or worn by one partner and activated remotely by their partner from six feet or more away, without any physical contact. If you want to increase that distance, Joiner says you could use these kinds of toys in conjunction with phone sex, or voyeurism.

It might sound impersonal, but Joiner says distanced products actually require just as much effort and communication, if not more.

“You’ve got to turn on a person to make them feel confident and comfortable and warm like you’re there,” they say. (Joiner’s pro tip: If you’re purchasing this kind of remote toy for the first time, try it out solo first to really get to grips with it — and minimize any awkwardness when you come to use it with your partner.)

I know I am ‘my own safest partner.’ How can I make the most of that?

Nenna Joiner reminds that some people might actually welcome the break from active dating that COVID-19 enforces. Some people with anxiety can often find the machinery of dating — conversation, sex with someone new — stressful and anxiety-provoking. If that’s you, Joiner says to take advantage of this “buffer,” to get some respite. They also want to remind you that not everyone in the world is into self-pleasure — and if that’s you, that’s totally fine.

If limiting your physical intimacy with others is something you’re committed to, you may be considering acquiring sex toys to concentrate on your personal pleasure instead. Joiner says many sex shops, including their own, offer online chat services, where you can consult with an expert about exactly what you’re looking for. Joiner says some of Feelmore’s live chats can get “crazy,” so don’t worry about being frank with the professionals. Online deliveries or courier services are also available in many stores, to enable you to maintain social distancing.

Joiner’s entry-level advice with your purchases: “Stay on the lower end (on price), figure your body out for yourself and then progress from there.”

What about taking everything online?

If you decide to take your sex life fully online to eliminate any close contact or in-person elements, New York City’s public health experts advise that if you normally meet your sexual partners online (or make a living on the internet), “video dates, sexting, subscription-based fan platforms, sexy ‘Zoom parties’ or chat rooms may be options for you.”

If you choose this option, don’t forget to keep your environments clean in a way you would if someone else was present, and disinfect any keyboards and touch screens you’re using that you share with other other people.

Also, don’t let the possibilities of the internet (and let’s face it, lockdown-induced frustrations) override your normal judgment around your online privacy and personal safety. Especially when it comes to sending nudes or other intimate material to someone you don’t know and trust.

How can I ‘have’ intimacy if it’s not safe to touch someone right now?

Don’t be deterred or dismayed by how new all this feels either, Joiner says. The pandemic means many of us have had to learn new ways of living in general, and these adaptations to our sexual lives are in many ways “an opportunity to create a new life sexually for ourselves as well,” they say.

Joiner believes that this might even be a spur to regain intimacy for many people, because of the extra imagination and effort required. It’s a chance, they say, to make sure that you’re really focusing on your own emotional needs.

Julia Feldman advises that this is also a potential moment to redefine what intimacy means for you, beyond mere physical touch: “We can’t say that intimacy is dead!” she says. “It just has to function slightly differently.”

I live with my partner but we’re not having much sex. Help!

It’s not just single folks who aren’t necessarily having the quantity or quality of physical contact they’d prefer during quarantine. For a couple who lives together, even a previously harmonious relationship can be severely tested by 24/7 cohabitation during COVID-19 — and result in a drop in intimacy.

It’s all about switching up your timing to reinvigorate a dynamic, Joiner says. They recommend taking separate breaks outside of your shared accommodation — like a solo lunch break at the park — but also occasionally meeting up in a fresh setting that’s not where you live together. Joiner recommends trying a joint picnic, or a driving date — shared experiences that “will actually lead you to have to know why you’re in a relationship with your partner, and then to lead towards more intimacy, which leads to more sex.”

Don’t forget the power of dressing up slightly too, Joiner says, who warns against “the rut of seeing each other in certain clothes” (e.g. your work-from-home sweats.)

Even making a little effort for regular activities can go a long way, they say. “Like my partner: Yesterday we went to church online, and she puts on a dress. I’m like, ‘shit!'”

My live-in partner is really bad at social distancing, and I’m worried to kiss or have sex with them. What can I do?

If you’re covering your face in public and maintaining social distance, but your partner doesn’t, they’re not only heightening their own risk of contracting COVID-19 but bringing their risk home to you. How can you have that conversation in a way that makes change?

In a sense, this conversation is an extension of the dialogues you and your partner have already (hopefully!) had about trust and fidelity of all kinds within your relationship, and the things that matter to you, whether that’s strict monogamy or communication around other partnerships you may have. Agreeing to even be in a relationship is about declaring an intent to care for that other person’s wellbeing and safety in certain regards, and any breach of that — like bringing home a risk of COVID-19 without discussion — represents a decision to disregard that agreement.

So if you’re in this situation, try explicitly framing this with your partner as a fidelity issue, Feldman recommends: “We made a commitment to protect each other through the good and bad, and right now this is pretty bad.”

She advises aiming to come to a reaffirmed agreement with your partner about “what level of risk you’re both willing to take on, and to really sign onto that.” Then, if there’s still a breach, you really need to talk about respect within your relationship, and whether you’re both really committed to each other.

When opening up these dialogues with your partner, Feldman also advises emphasizing that these are not “normal times,” and this is not forever. These restrictions and limitations for which you’re advocating on the grounds of your shared health — and the trust in your relationship — are temporary. “You’re not saying your husband can never, for example, go play poker with the guys ever again, or whatever it is that he wants to do.”

Complete Article HERE!

How prison and police discrimination affect Black sexual minority men’s health

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Incarceration and police discrimination may contribute to HIV, depression and anxiety among Black gay, bisexual and other sexual minority men, according to a Rutgers led study.

The study, funded by the National Institute of Health (NIH) and published in the journal Social Science & Medicine, examined associations between incarceration, and law enforcement discrimination and recent arrest with Black sexual mens’ psychological distress, risk for HIV and willingness to take pre-exposure prophylaxis (PrEP) for HIV prevention.

“Evidence suggests Black sexual minority men in the United States may face some of the highest rates of policing and incarceration in the world,” said lead author, Devin English, assistant professor at the Rutgers School of Public Health. “Despite this, research examining the health impacts of the U.S. carceral system rarely focuses on their experiences. This study helps to address this gap.”

“We examined how incarceration and police discrimination, which have roots in enforcing White supremacy and societal heterosexism, are associated with some of the most pressing health crises among Black sexual minority men like depression, anxiety, and HIV,” English added.

The researchers surveyed 1,172 Black, gay, bisexual, and other sexual minority men over the age of 16 from across the U.S. who reported behaviors that increased their risk for HIV over the previous six months. Participants reported on their incarceration history, experiences of police and law enforcement discrimination, anxiety and depression, sexual behavior, and willingness to take PrEP.

They found that 43 percent of study participants reported police discrimination within the previous year, which was most frequent among those with a history of incarceration. Respondents who faced high levels of police discrimination within the previous year also tended to show high levels of psychological distress and HIV risk, and a low willingness to take PrEP compared with their peers. The study also found that respondents who were previously incarcerated or recently arrested had a heightened HIV risk and lower willingness to take PrEP.

“These findings transcend individual-level only explanations to offer structural-level insights about how we think about Black sexual minority men’s HIV risk,” says co-author Lisa Bowleg, professor of psychology at The George Washington University. “The study rightly directs attention to the structural intersectional discrimination that negatively affects Black sexual minority men’s health.”

The article states that the findings support the need for anti-racist and anti-heterosexist advocacy and interventions focused on reducing discrimination in U.S. society, and the carceral system specifically.

“Despite experiencing a disproportionate burden of violence and discrimination at the hands of the police, and extremely high carceral rates, Black queer men are largely invisible in discourse on anti-Black policing and ,” says co-author Joseph Carter, doctoral student of health psychology at the City University of New York’s Graduate Center. “Our study provides empirical support for the intersectional health impacts of police and carceral that have been systemically perpetrated onto Black queer men.”

Is Testosterone Therapy Safe for Women?

Testosterone is often prescribed to boost a low sex drive, but the research on its long-term effects remains questionable.

by Sarah Ellis

The hormone testosterone (called “T” for short in medical circles) has long been associated with the male physique, athleticism, and a heightened sex drive. But now, there’s an idea making the internet search rounds that testosterone therapy may be the secret sauce to revamping a woman’s shuttered sex drive.

Even health-conscious celebrities have gotten in on the hype. In 2011, Jane Fonda told The Sunday Telegraph that she started taking the hormone in her 70s to boost her sex drive. But before you run to your doctor to ask for a prescription, you should know that testosterone therapy is a controversial approach that is not FDA-regulated for women at this time. Despite its mythical reputation, this hormone isn’t a cure-all for sexual dysfunction, and it could even be dangerous for your health if not taken carefully. Let us explain.

How Does Testosterone Work in Women?

Testosterone may be known as a male hormone, but women’s bodies naturally produce it, too. It’s one of many hormones that work together to control our mood, metabolism, sexual desire, bone and muscle growth, and reproductive system. As you age, your hormone levels change, with one of the biggest shifts occurring during menopause when your menstrual cycle stops for good. Menopause causes your estrogen and progesterone levels to decrease, but interestingly, it is not associated with a sudden decrease in testosterone, according to the North American Menopause Society.

That said, there is evidence that testosterone decreases throughout your life. “Testosterone drops with age more than with menopause,” says Margaret Wierman, M.D., professor at the University of Colorado Anschutz Medical Campus in Aurora, CO and former Vice President of Clinical Sciences at the Endocrine Society. This may explain why testosterone pills, gels, and patches are sometimes touted by drug marketing campaigns (and celebs) as a sex drive booster for older men and women whose testosterone is naturally lower than it used to be.

The problem with this approach, according to Chrisandra Shufelt, M.D., associate director of the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Smidt Heart Institute in Los Angeles, CA, is that testosterone is not necessarily the miracle drug you may be reading about on the internet. “If you search online, it seems like testosterone could be the panacea of all hormones, relieving everything from fatigue to weight gain to depression,” Dr. Shufelt says. But interestingly, she notes, there is no scientifically proven list of symptoms directly correlated to low T in women. Everyone’s hormone levels are naturally different, and what looks “low” on a testosterone test for one woman may be a perfectly normal T level for another.

Does Testosterone Impact Sex Drive?

To some extent, yes—but it’s not the end all, be all. Dr. Wierman explains that there are many different causes of sexual dysfunction (the term for when you’re no longer craving or enjoying sex). “There are mechanical hardware causes, there are relationship causes, there are mood causes,” she says. “There are rarely hormonal causes, and [in those cases] it’s usually estrogen deficiency that is causing abnormalities.”

What Is Testosterone Therapy?

Testosterone products are supplemental versions of the hormone that people take to increase their existing T levels. They come as a patch, gel, pill, tablet, or injection. Prescription testosterone products are FDA-approved for men whose bodies cannot produce adequate testosterone, due to genetic conditions like Klinefelter syndrome or damage from infection or chemotherapy. Testosterone products are not–we repeat, not!–approved for people whose testosterone is decreasing with age.

Nevertheless, this hasn’t stopped people from taking T (and doctors from prescribing T) for reasons other than it is officially intended. This practice has become so widespread, in fact, that the FDA issued a safety announcement in March 2015 urging doctors not to prescribe testosterone to anyone other than men with testosterone-lowering medical conditions. The statement noted that testosterone therapy could possibly increase your risk of cardiovascular problems or stroke.

For women, the risks of testosterone therapy are even less clear. “What we know about safety and what has been studied in women is the short-term effects, up to two years,” Dr. Shufelt says. “Longer effects are not known, and we do not know the effects in women who have risk factors for heart disease and breast cancer.” She stresses that longer-term studies will be necessary to determine whether low-dose testosterone therapy has detrimental effects on a woman’s body.

When testosterone is taken in excess quantities, Dr. Shufelt explains, it can lead to some pretty severe medical issues for women. “Too much testosterone in women can result in deepening of voice, hair loss, acne, anger, and negative changes to the cholesterol panel,” she says. Dr. Wierman remembers seeing a perimenopausal patient who had been given testosterone pellets at an anti-aging clinic. The high levels of T caused an increase in bad cholesterol, increase in blood pressure, excessive body hair growth, and loss of scalp hair.

Yikes! Are There Any Medical Guidelines for Women and T?

In September 2019, the Endocrine Society, International Menopause Society, European Menopause and Andropause Society, and others got together to publish a global consensus statement on the safety and efficacy of testosterone therapy for women. Dr. Wierman, one of the principal authors, explains the major takeaway: testosterone therapy has only proven to be useful for one specific subset of women–post-menopausal women with hypoactive sexual desire disorder.

Hypoactive sexual desire disorder (HSDD) is characterized by an absence of sexual desire, to an extent that it causes emotional distress and relationship problems for a couple. HSDD can be caused by a variety of factors, from medication use and chronic health conditions, to chemical imbalances and hormone deficiencies. It is diagnosed by a healthcare provider using a questionnaire and treated with anything from counseling to hormone replacement therapy, depending on the situation.

Dr. Wierman says that for post-menopausal women with HSDD, “controlled studies showed that getting high physiologic doses [of testosterone] increased satisfying sexual relations by one per month, with some other potentially good effects on sexual function,” such as arousal and ability to orgasm. The consensus statement specified that these doses should mimic – not exceed – natural levels of testosterone in premenopausal women. The statement authors urged that more research be done on testosterone therapy for women, and that testosterone products for HSDD should be created specifically with women in mind.

So, What Does This Mean for Me?

If you’re curious about testosterone therapy and wondering if you fit into the subset of women who may benefit, Dr. Wierman suggests talking to your regular women’s healthcare provider. “I think that most providers, whether they’re gynecologists or endocrinologists or primary care doctors who specialize in menopausal women, can discuss the issues related to testosterone pros and cons,” she says.

But before you walk away with a prescription, keep in mind that your low sex drive may not have to do with your hormones. “The first thing when someone has abnormalities in their sexual function is to discuss all the different other causes of it, and try to be a detective,” Dr. Wierman says. “If she is having painful intercourse, maybe it’s local vaginal estrogen she needs. If there’s stress in the relationship, maybe therapy is what they need.” Testosterone therapy is one option to increase libido, but it’s certainly not a foolproof key to amazing sex. And unless you’re a postmenopausal woman with HSDD, you probably want to steer clear.

Complete Article HERE!

Isolation could improve how we think about and navigate sex and relationships

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The coronavirus pandemic has already profoundly changed many of our lives. And it is certain that the virus will change some things forever. Some industries will fail, others will prosper. We will learn new ways of working and new ways of understanding the impact of capitalism. We will reconsider who the most vulnerable people are in our global society.

Other things may change too – things not so well documented. I study sex – and I’m sure that this crisis will have some significant effects in terms of the way society sees it. This is because requirements to practice social distancing and isolation have meant that the way we think about sex has been turned upside down.

A third of the global population is on lockdown and we must stay apart from each other not for ambiguous or contested moral reasons, but to save lives. As such, many ways in which we navigate, understand and talk about sex and relationships is likely to change as a result.

1. Masturbation, sex tech and porn

Some sex toy companies are reporting that their sales have surged since the requirement to isolate, with some companies offering isolation giveaways. Access to pornography is on the rise too, with companies capitalising on the opportunity isolation brings to encourage us to watch more porn.

Before the crisis, these industries would hardly have been thought of as essential. Conversation around porn, sex toys and masturbation is conventionally seen as taboo, but an inadvertent consequence of the pandemic is that masturbation is not only being more freely discussed, but might be considered an important part of our wellbeing – even life saving.

So the conversation has begun to shift in interesting ways since isolation was imposed, but also by virtue of the willingness by normally prudish governments and officials to talk explicitly and in a detailed way about sex. The pandemic has seen the NYC Department of Health and Mental Hygiene stating that “you are your safest sex partner” and warning against kissing and poorly cleaned sex toys.

2. New understandings

Social distancing means that we have been forced apart, yet sexual desire and our desire to touch, and be touched, continues. Cohabiting couples might find themselves divided due to advice to be three steps apart even within the same home if they become ill. And single people have inevitably been shut off from opportunities to connect sexually, which has caused a surge in (virtual) online dating.

Expert in sex and public health Carlos Rodríguez-Díaz has suggested that it is necessary to consider and recognise forms of virtual sexual contact as ways of expressing erotic desire, such as sexting, video calls, and reading erotica. This move away from physical touch as the centre of sex shifts conventional understandings of sex as only physical penetration.

It will be necessary to experiment with ways of not only connecting sexually, but also of appreciating these forms of sex as being meaningful.

3. Non-monogamous relationships

Under these unique conditions, we will be pushed to reconsider enduring questions around fidelity and non-monogamous relationships. Consider a situation where a partner within a long-term cohabiting relationship has an additional partner whom they do not live with, perhaps it is through an affair, or perhaps the relationship is polyamorous. The impact of isolation may provoke the possibility of break ups of some affairs, through a new understanding of risk in light of the pandemic.

Covert affairs and polyamorous relationships are already more emotionally complex than monogamous relationships, given the inherent challenge they bring to accepted and conventional ways of loving, as well as their unusual hierarchical structures. Physical presence is important, since it can often be the only way of communicating (particularly in covert affairs), and maintaining intimacy and equality among partners.

Isolation and this global crisis will trigger new conversations based on people’s lived experiences of the challenges and possibilities of such relationships.

4. Home as a dangerous space

While people must remain at home to preserve themselves and others, many governments have recognised that some may find their wellbeing jeopardised if they are isolating while in an abusive relationship. The risks to people in these situations can be physical, but they are also psychological and emotional. Shelters and hotels are being made available but access to these options will not be easy for all, since leaving the home at all will be difficult when under the control of an abusive partner.

Questions about the ethics of remaining in the space of such a relationship are now different. Outsiders might suggest that the person should now stay in the relationship, rather than criticise them for not leaving. COVID-19 should open up discussions, and bring focus back onto what causes harm in these relationships, rather than blaming the actions of the survivor.

5. Thinking about consent

To understand more about consent, it is important to understand more about the impact of touch. COVID-19 has made everyone more conscious of how their body might affect others, while also recognising our capacity for kindness towards one another through mutual aid groups compiled of volunteers, who in turn also need to be conscious of how they deliver aid with minimal touch.

COVID-19 forces the debate to focus on the impact of our actions on other people and those connected with our partners – parents, family members, friends. Isolation makes the consequences of breaches of consent visible and clear. The world therefore is presented with a unique opportunity to understand the impact of touch to have unintended consequences and chain reactions.

We are also forced into awareness of our capacity to be kind and put others first: a cornerstone of navigating good sex.

Complete Article HERE!