Category: SEXUAL HEALTH

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What doctors wish patients knew about getting a vasectomy

By Sara Berg, MS

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

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

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

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

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

There are seasonal spikes in vasectomies

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

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

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

It’s a minor surgical procedure

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

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

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

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

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

It’s OK to drive yourself home

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

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

Don’t be nervous, it’s straightforward

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

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

Follow up requires a semen test

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

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

Vasectomy is very effective

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

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

This is meant to be permanent

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

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

Vasectomies don’t always work

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

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

It may be covered by insurance

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

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

Vasectomy reversals are complicated

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

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

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

There is a risk of bleeding

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

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

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

Watch out for abnormal pain

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

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

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

Men can develop antibodies to sperm

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

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

It should not affect sex

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

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

Avoid extensive activity

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

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

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

Address pain control

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

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

Wear snug underwear and ice area

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

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

There are other forms of contraception

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

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

Complete Article ↪HERE↩!

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When Makeup Sex Isn’t a Good Idea

By Myisha Battle

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

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

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

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

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

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

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

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

Complete Article ↪HERE↩!

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I’m not surprised women prioritise sleep over orgasms

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

By Bryony Gordon

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

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

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

“Eight hours’ sleep.”

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

“Eight hours’ sleep.”

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

“Eight hours’ sleep.”

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

“Eight hours’ sleep.”

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

“Eight hours’ sleep.”

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

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

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

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

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

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

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

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

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

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

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

Complete Article ↪HERE↩!

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How My Sex Life Changed After My Breast Cancer Diagnosis

By Molly Longman

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

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

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

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

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

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

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

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

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

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

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

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

The Physical Impacts Cancer Can Have on Sex

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

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

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

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

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

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

Cancer Can Cause Mental Health Barriers to Satisfying Sex, Too

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

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

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

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

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

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

Finding Pleasure Again Post-Diagnosis

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

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

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

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

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

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

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

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

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

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

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

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My Cervical Cancer Diagnosis Changed the Way I Think About Sex

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

By Andrea Karr

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

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

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

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

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

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

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

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

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

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

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

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

Ways to be proactive

HPV vaccination

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

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

HPV testing

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

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

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

DIY testing

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

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

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Here’s How Sex and Intimacy Help You Live Longer

— Says Molly Maloof, M.D.

By Molly Maloof

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

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

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

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

5 Benefits of Sex and Intimacy

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

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

1. It Maintains Quality of Life

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

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

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

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

2. It Contributes to Satisfying Relationships & Mental Health

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

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

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

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

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

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

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

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

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

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

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

4. It Can Boost Your Immune System

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

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

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

5. It May Independently Extend Your Lifespan

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

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

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

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Stress of Being Outed to Parents and Caregivers

— What Are the Mental Health Consequences?

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

By Danielle Faipler

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Top 10 drugs that may contribute to sexual dysfunction

By Naveed Saleh, MD, MS

Key Takeaways

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

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

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

Antiandrogens

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

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

Immunosuppressants

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

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

HIV meds

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

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

Cancer treatments

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

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

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

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

Antipsychotics

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

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

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

Anti-epileptic drugs

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

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

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

Antihistamines

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

ß-blockers

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

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

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

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

Opioids

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

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

Loop diuretics

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

What this means for you

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

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

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Why Viagra has been linked with better brain health

By

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

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

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

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

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

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

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

Why Viagra may be linked with a lower risk of dementia

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

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

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

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

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

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

Other reasons for the effect

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

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

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

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

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

More study is needed

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

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

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

Complete Article ↪HERE↩!

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6 Questions to Ask Your Doctor About Sex after 50

— Vaginal dryness, erection challenges, safe sex and more

By Ellen Uzelac

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

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

Starting the conversation about sexual health

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

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

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

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

1. What can I do about unreliable erections?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Complete Article ↪HERE↩!

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

by Maggie O’Neill

Key Takeaways

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

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

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

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

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

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

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

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

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

Is It Possible to Have a Heart Attack During Sex?

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

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

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

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

Does Heart Disease Impact Sexual Function?

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

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

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

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

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

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

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

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

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

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

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

Who Should Avoid Sex With Heart Disease?

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

Talking to a Healthcare Provider About Sex and Heart Disease

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

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

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

Complete Article ↪HERE↩!

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Can You Have a Sex Life After Breast Cancer?

— Experts Say Yes.

With patience and treatment, you and your partner can rekindle your sexual spark.

You may find yourself facing physical changes and emotional challenges, but you can overcome them.

By Abby McCoy, RN

If you’ve recently gone through lifesaving breast cancer treatment, you may be looking forward to better days ahead. But as you try to get back to “normal life,” you might notice a change in your libido.

“Cancer treatment across the board can take a significant toll on the body, and breast cancer is no different,” says Gabriel Cartagena, PhD, a clinical psychologist at Smilow Cancer Hospital at Yale New Haven and an assistant professor at Yale School of Medicine in New Haven, Connecticut.

About 60 to 70 percent of breast cancer survivors report sexuality issues after treatment, according to a study published in 2019 in Breast Cancer, so if you’re having that experience, know that many other women are, too. We asked the experts and have some treatments and tips to help you fire up your sex life after breast cancer.

How Breast Cancer Affects Your Libido

So you can understand how to combat a low libido after breast cancer treatment and take back your sexuality, let’s look at the causes.

Premature Menopause

Several cancer therapies can lead to premature menopause, according to a study published in 2022 in the Journal of Clinical Medicine. Chemotherapy and radiation therapy, for example, can decrease hormone levels in your body and make your menstrual cycle slow down or stop altogether, says Mary Jane Minkin, MD, a codirector of the sexuality, intimacy, and menopause program for cancer survivors at Yale Cancer Center and Smilow Cancer Hospital. For women whose breast cancer is fueled by estrogen, treatment may include medication to block the production of estrogen, or surgical removal of the ovaries. These measures, too, can bring on premature menopause. With menopause symptoms like hot flashes, insomnia, and dry mouth, sex may be the last thing on your mind.

Emotional Distress

A breast cancer diagnosis comes with a lot of emotions. Women diagnosed with breast cancer can be at a higher risk for mental health issues like depression and anxiety, neither of which are conducive to a high libido, according to a study published in 2021.

Vaginal Dryness

When your estrogen takes a nosedive during and after treatment, your vagina can become very dry, says Dr. Minkin. Lack of lubrication in this area can make sex uncomfortable or even painful, according to the American Cancer Society (ACS).

Painful Sex

Painful sex can also arise from pelvic floor dysfunction, which means the muscles in and around your pelvis can be too tight or too loose. That’s according to the research published in the Journal of Clinical Medicine, which also found that women may experience chronic pelvic pain syndrome (unexplained pain in your pelvis) after breast cancer treatment.

Body Changes

If you have had surgery or other body changes during treatment, such as removal or reconstruction of one or both breasts, you may not feel like revealing the new you in a sexual encounter, and new or missing sensations can make it hard to get in the mood. “Many women who have lost breast tissue, particularly if they have lost nipples, may feel [less] sensation in their breasts, and many women find breast stimulation important for sex,” says Minkin.

How to Get Your Groove Back

This list may feel discouraging to read, but you shouldn’t lose hope. “The important thing is that we can help with most of these issues,” says Minkin.

Medications Minkin recommends nonhormonal (estrogen-free) medications to help with symptoms of early menopause. “An over-the-counter herbal product called Ristela can help improve pelvic blood flow and enhance libido,” Minkin says. One meta-analysis published in 2021 found that women who took Ristela and similar products that contain the amino acid L-arginine experienced more sexual arousal, better lubrication, more frequent orgasms, and less discomfort or pain. Many participants reported no side effects at all, but a few experienced an upset stomach, heavier menstrual bleeding, and headache.

“Women can also consult with their providers about using prescription nonhormonal medications called flibanserin (Addyi) or bremelanotide (Vyleesi),” Minkin says. Addyi may be less effective than other options, and can cause fatigue and drowsiness, according to a meta-analysis published in 2022 in Sexual Medicine. Vyleesi, on the other hand, has shown more promise, according to a study published in 2019, with uncommon mild side effects like nausea, flushing, and headaches.

If your low libido stems from feelings of depression or anxiety, medications, often in combination with psychotherapy, are an option you can discuss with your healthcare provider.

Vaginal moisturizers For vaginal dryness, Minkin often suggests over-the-counter nonhormonal vaginal moisturizers, like Replens and Revaree, which are inserted into the vagina with an applicator a few times a week. “[These] work very nicely for many women,” Minkin says.

Toys A vibrator or similar device could be a worthwhile investment. They can boost sensation and increase blood flow to your pelvis, says Minkin, both of which can amplify desire.

Therapy One or more sessions with a counselor can be helpful, says Minkin. Sexual health counselors often use cognitive behavioral techniques to discover the “why” behind your low libido, and help you unlock thought patterns that may be blocking your sexual drive, according to a study published in 2020. Therapy is also an effective treatment for depression and anxiety.

Vaginal hormones Hormone replacement therapy is often used to treat menopause symptoms. But if you’ve had breast cancer, it may increase the risk that it will come back, especially if your cancer is sensitive to hormones. With vaginal hormonal treatments, a cream, tablet, or ring containing low-dose estrogen is placed directly in your vagina to aid lubrication and strengthen the vaginal lining. Because much less estrogen gets into your bloodstream, this option is generally considered safe, according to the North American Menopause Society. Your healthcare provider can help you decide if hormone treatments are right for you.

Get Reacquainted With Your Body

Breast cancer treatment can leave you feeling like you’re living in a stranger’s body. “A stark change like a mastectomy can leave women feeling separated from themselves,” says Dr. Cartagena. But every woman can get to know and accept her new body.

Reintroduce Yourself Gradually

“The process to reknow your body takes time and begins in small steps,” says Cartagena, who suggests a first step could be to get dressed in the morning with the lights on. After a few days or weeks of this, you might try spending 10 seconds observing your body in the mirror.

“Exposing yourself to your body little by little can allow you to gradually grieve what is different and take notice of what is new that is still important to you,” explains Cartagena.

Reframe Your Sexual Desires

Sex after cancer may look different, and mourning lost sensations is very important, says Cartagena. Looking forward, he encourages breast cancer survivors to study what sex means to them by asking questions like, “What feels good now?”

“If penetrative sex still evokes pain, a patient can explore foreplay, different forms of stimulation, or other forms of intimacy to induce different, fulfilling sensations,” says Cartegena. Sex doesn’t have to mean one thing — it can be whatever you need or want it to be.

Complete Article ↪HERE↩!

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The sexual health checkup older adults didn’t know they needed

— STD cases have risen among adults age 65 and older. Should you get screened?

By

Adults have sex at every age, so it follows that STDs can spread at every age. But my older patients who have new sexual partners are sometimes bewildered when I ask if they want to get screened.

It’s healthy to be sexually active as an older adult, and it correlates with greater enjoyment of life. My patients tell me that nursing homes can present really exciting opportunities to make new friends in this regard.

In fact, 40 percent of adults aged 65-80 are sexually active and about 10 percent of people older than 90 are sexually active, though it bears noting that the latter figure is based on a survey limited to one municipality in Sweden.

But STDs spare no one. Few people I’ve seen whose STD testing comes back positive were expecting that result. And from 2007 to 2017, STD cases more than doubled among adults age 65 and over.

That is why it is important to get screened and always use a condom. Condoms are infrequently utilized among older people, but they do reduce, yet not eliminate, risk of STDs.

Why are STD cases rising among older adults?

Researchers speculate STD cases are rising simply because older adults are having more sex than in generations past.

One factor at play is how people are meeting each other and forming relationships, including with web- or app-based dating services that are increasingly attracting older people.

The market for devices and medications that address sexual health problems is also flourishing — and not just for men. In the past several years, the Food and Drug Administration has approved more treatments aimed at postmenopausal women who may have trouble with sex due to vaginal dryness and pain.

This all may be impacting how often older adults have sex and subsequently get STDs. After the introduction of sildenafil — known by the brand name Viagra — in 1998, for example, the risk of STDs increased significantly among widowed men.

How do I know if I need STD screening?

The United States Preventive Services Task Force advises all women aged 24 and younger to get screened for gonorrhea and chlamydia regularly — and thereafter, when you have new sexual partners or other situations that increase risk. Everyone should be tested for HIV at least once. The Centers for Disease Control and Prevention recommends men who have sex with men to get screened at least once a year for syphilis, chlamydia, gonorrhea and HIV.

But there’s a lot of leeway among other groups, so much of STD screening is left to common sense.

Here’s my advice:

  • Got a new partner? I’d check.
  • Have multiple recent partners? Let’s definitely check.
  • Got a new partner who only had one prior long-term partner before you? You know me. If it were me, I’d check.
  • Found out your partner has been cheating? You know the drill (and I’m truly so sorry).
  • Just oral or anal sex? You can still get STDs. Shall we check?

In other words, if you’re even thinking about getting screened, just do it.

What STDs should I get screened for?

Chlamydia and gonorrhea are two classic STDs that have been rising among older adults in recent years. There were more than 2,000 cases of each among people 65 and older in 2017. Syphilis, while rarer, is also rising in this population, and in 2018, the majority of people diagnosed with HIV were age 50 and older.

There are also other conditions that get less attention, such as trichomoniasis and bacterial vaginosis (the latter is not quite considered an STD but is linked to sexual activity). Both can produce a distinctive “fishy” smelling discharge in women. Discuss which STDs to check for with your health-care provider since your personal history plays a role as well.

What STD symptoms should I look out for?

Sure, painful genital sores raise a red flag pretty quickly, but most people with STDs don’t actually have any symptoms. If you have symptoms like burning with urination, itching or unusual discharge, consider the possibility of an STD with your provider before immediately presuming it’s a urinary tract or yeast infection.

Also keep the following in mind:

  • Most people with a new HIV infection experience a brief flu-like illness about two to four weeks after exposure. Then they tend to feel perfectly normal for several years before their CD4 cells — important immune cells in your body destroyed by HIV — drop low enough to draw medical attention.
  • Chlamydia is known as a “silent infection” because as few as 5 percent of women and about 10 percent of men develop symptoms. Most men and women with gonorrhea are similarly asymptomatic.
  • The first stage of syphilis infection involves a painless round genital sore that can infect others who come into contact with it. These sores are often not as noticeable as you’d think (they may be inside a skin fold and can be as small as a few millimeters). Later, the latent stage of syphilis can last for years with absolutely no symptoms.

Who is at highest risk for STDs?

To be clear, cases of STDs among the elderly are going up, but they’re still much fewer than those among older teenagers and adults in their 20s. But everyone, regardless of age, should take precautions and test appropriately.

Age aside, men who have sex with men, users of intravenous drugs and people who have a prior history of another STD are all at higher risk. A study from Vanderbilt University, where I went to medical school, recently found what I had long observed as a student: Compared to other groups, Black women are losing the most years of life to HIV (and 91 percent of new HIV infections among Black women nationwide are reported from heterosexual contact).

There’s another striking discrepancy within the country: Southern states account for about half of new HIV cases annually. These states, not coincidentally, also have the highest rates of poverty nationally and tend to focus on abstinence-based sex education that has been shown to be ineffective in STD prevention.

What I want my patients to know

I never enjoy telling someone they have something like chlamydia. But I do like what I can say next, which is that most STDs can be fully cured with medication, and for those we can’t cure, like HIV, we have excellent medications to treat. You only stand to win by knowing.

Complete Article ↪HERE↩!

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6 astonishing penis facts they didn’t teach you in biology

We bet they didn’t teach you you’re erection is 30% longer than you can see

By

School biology lessons can sometimes be a case of a teacher trying to impart the basic facts about sex to a group of giggly teenagers.

And while the trusty basics are a great place to start, there is so much more about penises and erections that we bet they didn’t teach you.

Our sexual health is something we should be all clued up about and our favourite Dr Danae Maragouthakis, from Yoxly, an Oxford-based sexual health start-up, is an Instagram doctor who knows all their is to know about our genitals.

We’ve already covered penis misconceptions, now it’s the time for the hard facts…

There are three types of erection

If you get an erection you may not think much about how you actually became aroused.

But, when your penis gets hard there are actually three different categories of erection it can fall into.

A bunch of bananas with one banana sticking up, suggestive of an erection
There are three different types of erections men can have

A subconscious erection is the first type. These hard ons usually occur when you’re dreaming – you won’t need physiological or physical stimulations.

Psychogenic erections are the result of sexual fantasies either fulfilled in reality or in porn, where your body responds to visual stimuli.

The third and final type of erection is the reflexogenic erection. This is an erection which happens because of direct physical stimulation to the penis.

You don’t need an erection to orgasm

We usually associate an orgasm with an erection but you don’t necessarily need to be hard to finish.

So if you can’t get it up, that doesn’t mean you can’t sometimes still have a satisfying end to getting it on.

Some people can experience an orgasm without being fully erect, while some men have reported being able to orgasm with just their prostate being massaged.

Penile stimulation isn’t always a necessity.

Up to half your erection is hidden

Your penis is actually a lot longer than it looks
Your penis is actually a lot longer than it looks

Men, your penis is actually a lot longer than it looks.

About 30% of the tissues that make up the male erection are internal, so you can’t see it from the outside.

This means a third or even up to a half of your hard on is hidden.

Penises have penile spines

Don’t panic, your penis doesn’t actually have spines! But, while humans don’t have penile spines, plenty of closely related animals do.

These spines are pointed, keratinised structures found in the genitalia of several animals, which may help to induce ovulation or enhance sensation during sexual activity.

Our distant relative – the chimpanzee – has penile spines, as well as cats, bats and cute fluffy koalas down under.

Myth: The penis is a muscle

Wrong.

Danae tells Metro.co.uk: ‘Some people believe that the penis is a muscle that can be exercised to increase size or improve sexual performance.

‘The penis is not a muscle. It looks like muscle because it gets hard when it fills with blood when it gets an erection but it’s actually made predominantly of spongey tissue and blood vessels.

‘When someone fractures their penis, they break the blood vessels that run in the penis and tear the soft tissue. It’s incredibly painful and really dangerous, that’s a medical emergency.

‘Seek medical attention immediately because if you compromise the blood flow to those tissues, they can die.’

Beetroot and oysters could give you better erections

Dr Danae also said that consuming foods that are high in Nitric Oxide can help blood flow, thus improving your erections.

Foods high in Nitric Oxide are dark chocolate, beets, garlic, watermelon and leafy green veggies.

You might finally have a reason to try oysters too! Foods that are high in zinc are important for good testosterone levels and sperm production.

This includes the divisive shellfish, as well as beef, chicken, nuts and beans.

As seems to be the rule of thumb for every part of your body, drinking plenty of water means you’ll be hydrated and promote healthy blood flow, which can only be good for your erections.

Beetroot and leafy greens could help give you better erections
Beetroot and leafy greens could help give you better erections

Smoking-related erectile dysfunction can be reversed

While there is a misconception that smoking can actually shrink your penis there is no scientific evidence to that point.

However, this doesn’t mean the effects of smoking on your body don’t take their toll on your sexual performance and satisfaction.

What you probably did learn in biology is that smoking constricts your blood flow, but they may not have touched upon the fact that means you won’t always get sufficient blood flow to your genitals.

Complete Article ↪HERE↩!

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What Are the Benefits of a Prostate Massage?

By Wendy Wisner

A prostate massage involves stimulating and massaging the prostate gland with a finger or sex toy for either sexual release or to treat a medical condition like prostatitis, an enlarged prostate, urinary hesitancy, or erectile dysfunction. 1

The prostate gland is a small, walnut-shaped organ located just below the bladder and in front of the rectum. Its main job is to make the seminal fluid — semen — that helps sperm travel and survive in the acidic environment of a vagina. 2

Although major medical organizations and independent healthcare providers don’t often promote a prostate massage as a medical procedure or therapy, it’s been used for over 100 years to treat conditions such as chronic prostatitis. 3

A prostate massage can be a circular type of motion, or an application of gentle pressure. It’s usually performed by a medical professional, or can also be performed by a significant other. Some people choose to self-stimulate their prostate with sex toys or fingers.

Here are the health benefits of a prostate massage, risks, and how to safely and effectively perform a prostate massage.

The health benefits of prostate massage are based on very limited studies and many of the studies are old studies. However, there is some evidence that massaging the prostate has medical advantages.

May Help With Urinary Flow

The prostate can become enlarged as people age, a condition known as benign prostatic hyperplasia (BPH).2 BPH can cause the urethra to be compressed, and lead to issues with urination, such as incomplete bladder emptying, trouble starting urine, or dribbling at the end of urination.

An older 2006 study that looked at urine retention in older males found that prostate massage, combined with antimicrobial therapy and alpha-blocker therapy, helped resolve urinary retention, and allowed for effective urination in all study participants. 4

Any urination issues such as painful urination, limited flow, feeling of not being able to empty your bladder, incontinence, or blood in urine warrants a visit to a healthcare provider such an urologist.

May Help Treat Prostatitis

Prostatitis is swelling and inflammation of the prostate gland. It can be caused by a urinatiry tract infection (UTI) or a bladder infection. Although prostate massages have historically been used to treat prostatitis, research is mixed on its effectiveness.

For example, an older study from 2006 found that prostate massages were helpful for some people with chronic prostatitis, but these improvements were not significant and the study researchers deemed it needed more research.5 Another old study found that prostate massages may be helpful in treating prostatitis — specifically when combined with antibiotics.6

However, a more recent systematic review from 2018 concluded that it’s unclear whether prostate massages decrease or increase prostatitis symptoms. 7

Does it Improve Erectile Dysfunction?

People often cite prostate massages as a treatment for erectile dysfunction. However, there is no clear evidence linking prostate massage with improved sexual function.7 Still, an older published case study from 2004 found that prostate massages improved the sexual function of an elderly man.4 Other anecdotal reports similar to this have circulated, leading people to believe that prostate massage may help with sexual dysfunction. 4

May Enhance Sexual Pleasure

The prostate gland is often referred to as the male “G spot” or “P spot.” There is evidence to back up the notion that stimulation of the prostate during sex can be highly pleasurable and result in more intense orgasms. Although there is little understanding of the medical reasons behind this, studies describe rectal stimulation of the prostate as producing “ecstatic feelings” that may be even more pleasurable than stimulating the penis. 1

Prostate massage and prostate milking are similar, and both involve stimulation of the prostate through the rectum. Prostate milking is usually associated with sexual pleasure, and  its goal is to release seminal fluid from the prostate, which is released during an orgasm. Whereas prostate massage is sometimes medical in nature. 2

There are no known adverse effects associated with prostate massage.7 But the tissues lining the prostate and rectum are delicate and vulnerable to tears and abrasions. Massaging the prostate too roughly can easily lead to discomfort and soreness. A 2009 study that looked at self-administered prostate massages for the treatment of urinary tract symptoms among older males found that about 8% of study participants complained of rectal soreness with treatment. 8

Prostate massage is advised against certain medical conditions. For example, the American Academy of Family Physicians Foundation (AAFP) has warned that prostate massage should be avoided if you have acute bacterial prostatitis, or if you have a suspected case. 9< Anyone who is interested in having a prostate massage performed should check with their healthcare provider first, especially if they have any known medical conditions. Prostate massage should not be substituted for proper medical care or medical screenings of the prostate. Periodic prostate cancer screening is recommended for males aged 55 through 69. 10

Prostate massages may be performed by your healthcare provider, by your partner, or yourself. When performed by a healthcare provider, the massage may be similar to a rectal exam, where your healthcare provider inserts a gloved finger into your rectum, examines your prostate, and gently massages.

If you or your partner are performing a prostate massage, here are some things to keep in mind:

  • The massage should be done with clear consent, and should be stopped if discomfort or pain is experienced.
  • It’s important to thoroughly wash your hands or sex toys before insertion; some people prefer to wear gloves.
  • Liberal use of lubricant is advised.
  • To begin, insert your finger a few inches into the anus.
  • Locate the prostate, which will feel like a small lump.
  • Gently massage the prostate by moving your finger in a circular motion, or whatever motion feels comfortable and/or pleasurable.
  • For people who are uncomfortable with rectal stimulation, the prostate can be stimulated by massage and pressure on the perineum, which is the area located between the anus and scrotum.11 However, it may not be easy to find it that way. 

A prostate massage involves gentle stimulation of the prostate gland by inserting a finger or sex toy into the rectum, locating the prostate, and massaging. Prostate massages may have some medical benefits, such as reducing symptoms of prostatitis and helping with urine flow.74 However, the evidence for medical benefits is limited.

Many find prostate massage highly pleasurable and prostate massage may result in more intense orgasms. 1 Although prostate massage appears to be a relatively safe practice, it’s important to touch base with your healthcare provider before getting a prostate massage, especially if you have any underlying medical conditions. 7

Complete Article ↪HERE↩!