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Lesbian sexual health neglected by healthcare and education, researchers find

Lesbian sexual health neglected by healthcare and education, researchers find


Due to the AIDS crisis and the HIV epidemic, sexual-health initiatives within LGBT communities have historically been heavily geared toward addressing men who have sex with men (MSM). Meanwhile, sex education in schools has used opposite-sex partners as its primary focus.

Unfortunately, research is revealing that several groups have been neglected in the process.

A new study led by researchers from the University of British Columbia reveals that although lesbian and female-bisexual teens face a higher risk of sexually transmitted infections (STIs) than their heterosexual counterparts, raising awareness of safe sex between women has been overlooked.

In the study, published in the Journal of Adolescent Health on December 28, 160 U.S. girls aged 14 to 18 participated in online focus groups based on whether or not they were sexually experienced.

What the researchers discovered was related to the exclusion of LGBT issues from mainstream sexual-health programs and preconceived ideas about gender.

The researchers identified four main themes as to why participants did not use latex barriers during sex.

A recurring theme was a concern about sexual pleasure or mood being reduced by awkwardness or discomfort. The study’s authors pointed out that sexual-health-promotion interventions have faced challenges in raising awareness of how pleasure can be increased by some STI–prevention methods, such as female condoms that stimulate the clitoris or lubrication on the underside of a dental dam.

Despite these issues, participants did express a willingness to use barriers in the future. Nonetheless, many participants preferred to use STI testing as a safe-sex strategy to determine whether or not they needed to use barriers. For instance, if both partners tested “clean” or “STD-free”, participants didn’t feel they needed to use barriers.

Another reason for avoiding barriers was the idea that sex with another female is low-risk due to the impossibility of impregnation. Several participants also stated that they trusted their female partners more than male partners regarding STIs.

However, the researchers pointed out that the exchange of vaginal fluid by mouth, fingers, or sex toys can transmit STIs; the human papilloma virus (HPV) can be spread by skin-to-skin contact; and genital HPV has been found on fingers, sterilized forceps, and surgical gloves (making transmission via sex toys possible).

The researchers also found that the participants often lacked awareness of safe-sex practices for sexual activity between women and lacked knowledge of the risks involved.

One 18-year-old participant said that when she started having sex, she couldn’t find any online information about safe sex for lesbians. A 15-year-old girl pointed out she had never been taught about STI transfer between female partners. Meanwhile, others were unaware of dental dams (for use during oral sex) or where to obtain them, and still others mentioned that LGBT sex was excluded from heterosexual-based sex education at school.

The researchers noted that the bias toward focusing on men as transmitters of STIs was prevalent within health-care systems, as female-to-female transmission of STIs was only considered once male-to-female transmission was ruled out.

The findings of this study recalls themes of a 2016 UBC–led research paper about transgender youth and sexual activity that pointed out similar gaps due to preconceived notions about which sexual issues are relevant to LGBT people. That study revealed—contrary to assumptions that pregnancy concerns were not relevant to transgender youth—that trans teens and their cisgender counterparts were equally at risk of being involved with pregnancy.

Consequently, such analyses highlight the need to rectify these areas of omission and oversight in both health care and education in order to achieve equality in treatment within health-care systems.

Cycling Won’t Sabotage a Man’s Sex Life: Study

Cycling Won’t Sabotage a Man’s Sex Life: Study

Men who are avid cyclists needn’t worry that hours spent on the bike will translate into problems in the bedroom or bathroom, new research claims.

Reportedly the largest study of its kind involving bikers, swimmers and runners, the findings buck prior reports that cycling could harm sexual or urinary function due to prolonged pressure on the buttocks and the perineum (the area between the scrotum and the anus).

The results provide some reassurance that cycling doesn’t harm the perineum any more than swimming and jogging do, said study author Dr. Benjamin Breyer, a urologic surgeon at the University of California, San Francisco.

“Those athletes [swimmers and runners] also have erectile dysfunction,” he explained. “The truth of the matter is, many men develop erectile dysfunction, but I think if you ride safely the health benefits of cycling are tremendous. The benefits to overall health far outweigh other concerns.”

Cycling, whether done for leisure or transportation, has become increasingly popular, Breyer said. But the activity has received much attention for its potential effects on sexual and urinary health.

“I think a lot of effort goes into cycling from some men to protect their perineum by wearing padded shorts and using different seat types,” he said.

The new research on men surveyed 2,774 cyclists, 539 swimmers and 789 runners. All completed several research-validated questionnaires about sexual health, prostate symptoms, urinary tract infections, genital numbness and saddle sores, among other factors.

Cyclists were also asked about their bike type, saddle (seat) type and angle, frequency of wearing padded shorts, percentage of time spent standing out of the saddle, handlebar type and type of surface on which they usually ride. The cyclists were split into a high-intensity group (cycling more than two years more than three times weekly and averaging more than 25 miles per day) and a low-intensity group.

Notably, high-intensity cyclists logged better erectile function scores than low-intensity cyclists.

Also notably, cyclists did experience more than twice the incidence of scarring or narrowing in the urethra — a condition known as urethral strictures — compared to swimmers or runners. The condition can affect the flow of urine from the body. But cyclists’ sexual and urinary health was comparable overall to the other athletes.

Among cyclists, those standing more than 20 percent of the time while cycling significantly cut their odds of experiencing any genital numbness. Additionally, having handlebar height lower than seat height increased the odds of genital numbness and saddle sores.

Urethral strictures “are such an uncommon event that I wouldn’t keep people from riding,” Breyer said. “I would try to avoid riding habits that result in really significant numbness in the perineum for really long periods.” Instead, he suggested men adopt more of these practices: getting out of the saddle, wearing protective shorts, using a seat that has a cutout, and getting an appropriate bike fitting.

Other urologists praised the study design, saying the comparison between cyclists and other athletes added strength to the findings.

“In my experience with bicyclists, this really reflects what I see,” said Dr. Brian Miles, a urologist at Houston Methodist Hospital in Texas. “Erectile dysfunction, of course, happens to men as they age for various reasons, but with cyclists, their rate seems to be no different in my experience.”

Dr. Aaron Katz is chairman of urology at NYU Winthrop Hospital in Mineola, N.Y. He said the findings were a little surprising, “because as a urologist who’s been in the field for many years, we’ve had this notion that prolonged cycling can have an effect on sexual function.

“But those studies were older and didn’t use a [similar] cross-sectional analysis,” Katz added. “I was really happy to see this study. I think it will allow men who are cycling to continue and not be so worried about it.”

The study is published in the March issue of The Journal of Urology.

More information

The American Sexual Health Association offers more on men’s sexual health.

6 Things That Can Cause Penis Allergies After Sex

6 Things That Can Cause Penis Allergies After Sex


Pains on the surface of the penis, redness or itchiness are some common symptoms of a penis allergy and it can have a huge impact on a couple’s sex life.

All couples seek a healthy relationship with a satisfying sexual life. But no matter how sexually compatible they are, there are always chances that allergies or side-effects of the products used while sex, come in the way of happy couple who are having great sex. One such condition is men having penis allergies immediately after having intercourse. Pains on the surface of the penis, redness or itchiness are some common symptoms of a penis allergy and it can have a huge impact on a couple’s sex life.

While an expert medical attention is required to treat the condition, there are some steps that men can take in order to prevent having such allergies.

Here are some common triggers of penis allergies:

1. Diabetes

Rashes and red spots can develop on the skin because of high blood sugar level. An unusual sign of diabetes, this causes burning sensation and redness on the skin. Antibiotics or anti-allergens too seem to show no results. It is a clear symptom of balanitis and patient must get their blood sugar levels checked if this happens.

2. Latex condoms

Many men are allergic to condoms and may develop itchiness or redness on being exposed to condoms. People who work in the healthcare industry are most prone to such allergies as they wear latex gloves all day long. The spermicides that are present on the lining of the condoms and the dyes that are used to colour these products can cause allergic reactions in some men. There are latex-free condoms available in the market, which are slightly more expensive. But these are an effective rash-free solution.

3. Allergies

In some rare cases, some allergic reactions cause burning sensations, pain and itchiness on the penis. These allergies can be aggravated by pubic hair, female secretions or pubic lice.

4. Infections

Sexually transmitted diseases (STDs) are another possible reason for penis allergies after sexual intercourse. These include trichomonalis vaginalis (red spots on the penis), syphilis (boils on the penis after a few days of sexual intercourse with a person suffering from syphilis) and herpes (red spots on the genital area).

5. Products used by women

Many men are under the misconception that vaginal secretions are to be blamed for their penis allergies. But it is actually some of the products that women use which may be triggering these allergies. These products include creams, lotions, lubricants, perfumes, powders and soaps to name a few.

During sexual intercourse, the delicate skin of the penis might come in contact with these irritants, thus leading to rash or redness of the skin. To get the condition properly treated, medical attention is required. But if an emergency situation rises in the odd hours of the night, you can opt for hypoallergenic products or products which mention they are free of allergens and perfumes.

6. Lack of Lubrication

When couples indulge in sex in a hurry, it often leads to lack of lubrication in women. This causes red spots and abrasion of the skin on penis. However, this kind of sexual intercourse is more painful for women than men.

Ways to deal with penis allergies

Wearing breathable fabrics can go a long way in terms of preventing penis allergies. Also, prevent using lotions or creams as they can cause an adverse allergic reaction. You can penis health creams that are available in the market.

However, we do suggest taking medical assistance for treating penis allergies as a long-term method to prevent them.

Indian start-up ‘Buttalks’ is helping men buy better underwear

Indian start-up ‘Buttalks’ is helping men buy better underwear


At a time when internet-based companies are changing the way Indians pay bills, buy groceries, and commute, three Chennai-based entrepreneurs (Brijesh Devareddy, Surej Salim, and Manish Kishore) are using an e-commerce platform to help Indian men buy better underwear.

The start-up, called Buttalks, went live in August 2017, and already boasts of 1,400 customers, of whom 30% are annual subscribers.

What are their unique offerings?

India has had other innerwear start-ups like Zivame and Pretty Secrets, both of which preceded Buttalks. However, Buttalks is the first subscription-based, personalized innerwear start-up focusing solely on men’s innerwear.

Habits of Indian men with regard to underwear shopping

Despite the proliferation of e-commerce platforms, underwear shopping habits of Indian men remain backward, for the most part.

Buttalks’s initial research found that most men buy underwear in a somewhat mechanical manner without paying attention to what they exactly require.

Indian men also often do not know when it’s time to replace their underwear.

The size of the Indian innerwear market

The Indian innerwear market is expected to reach a valuation of Rs. 68,270 crore by 2024. According to consultancy firm Technopak, the men’s innerwear segment is currently worth Rs. 7,450 crore.

Health implicationsHealth implications of underwear habits

Apart from causing discomfort, ill-fitting and old, worn-out underwear has several health implications for men, implications which are often ignored and played down in Indian society.

According to Rajan Bhonsle, a professor and consultant in sexual medicine, wearing right-sized underwear has direct benefits for a man’s sexual health, while a proper fit helps reduce issues related to infertility.

Men’s health issues need to be highlighted too

“I see that there is so much ignorance about something as basic as this [choosing the right underwear]. This is something that’s never spoken about…women’s health issues have their space, but men’s issues lag behind. All these have to be highlighted,” added Bhonsle.

PackagesThe packages offered by Buttalks

Buttalks works through a subscription model wherein subscribers get periodic doorstep deliveries of underwear from the start-up.

The start-up offers three differently priced sampler or annual subscription plans starting at Rs. 999, the prices of which differ based on the brands that are included in a package.

Customers using the annual plan get three pairs of briefs four times a year.

What about Buttalks’s funding?

However, owing to the as yet unsuccessful subscription model, Buttalks faces many challenges in terms of funding. Although the start-up is set to close its first funding round soon, it remains boot-strapped so far. The co-founders also declined to share details of investors and revenues.

PersonalizationHow Buttalks personalizes underwear for a user

Regardless of one’s subscription plan, the briefs which go into boxes are personalized as per a user’s preferences.

Users have to fill out an exhaustive questionnaire while signing up so that Buttalks knows every customer’s preferences.

The questions range from a user’s preferred choice of fabric, colors, styles, and brands, to even users’ lifestyles.

10 Questions Men Should Definitely Ask Their Doctors About Testosterone

10 Questions Men Should Definitely Ask Their Doctors About Testosterone


Before you buy into the myth that “real men” have high testosterone levels, make sure you know the facts. 

Perhaps you’ve tried natural ways to boost your libido and they haven’t worked. Or maybe you’re concerned about aging and are tempted by the “miracle cure” testosterone booster that will keep you young forever (we’ve all seen the ads). But it’s important to look beyond clever marketing campaigns if you’re considering testosterone medication. Before you self-diagnose with low testosterone, here are the questions you need to ask yourself.

What is testosterone?

Derived from cholesterol, testosterone is a steroid hormone, called an androgen, mainly secreted by the testicles in men but also (in much smaller amounts) by the adrenal cortex and ovaries in women. A male fetus begins to produce testosterone as early as seven weeks after conception. Testosterone levels rise during puberty, peak during the late teens to early 20s, and then level off. After age 30 or so, it’s normal for a man’s testosterone levels to decline slowly, but steadily, each year. According to the National Institutes of Health (NIH), testosterone is an important male hormone, regulating sexual development, muscle mass, and red blood cell production. Synthetic testosterone was first used as a clinical drug as early as 1937, and is now widely prescribed to men whose bodies naturally produce low levels.

The levels at which testosterone deficiency becomes medically relevant still aren’t well understood, according to the NIH, though it’s not just an issue for older men: Testosterone is one of the eight sexual health conditions millennial men need to be talking about. Normal testosterone production varies widely in men, and levels of the hormone fluctuate throughout the day—they’re usually highest in the morning. Although there is no standard definition of “low” testosterone—commonly referred to as “low-T”—the Mayo Clinic says a healthy range for an average adult male (30-plus) is between 270 and 1,070 nanograms per deciliter of blood. Possible symptoms of low-T, according to the NIH, include reduced sex drive, erectile dysfunction or impotence, increased breast size, lowered sperm count, hot flashes, depression, irritability and inability to concentrate, shrunken and softened testes, loss of muscle mass or hair, and bones becoming prone to fracture.

How is low-T diagnosed?

Most men have more than enough testosterone, but in some men, the body doesn’t produce enough of the hormone, which leads to a condition called hypogonadism. A blood test can tell your doctor how much free testosterone is circulating in your blood, and also show the total amount of the hormone in your body. However, according to the Endocrine Society in clinical practice guidelines published in The Journal of Clinical Endocrinology & Metabolism, low-T should be diagnosed “only in men with consistent symptoms and signs and unequivocally low serum testosterone levels.” The guidelines advise against screening men in the general population to avoid labeling—and medicating—otherwise healthy men “for whom testing, treatment, and monitoring would represent a burden with unclear benefit.”

Is low-T an inevitable part of aging?

When women go through menopause their estrogen levels plummet and stop almost completely. However, the decline in testosterone levels in men works differently. Typically, levels fall by only 1 to 2 percent per year after the age of 40, and low-T is certainly not inevitable. According to the June 2010 issue of the British Medical Journal’s Drug and Therapeutics Bulletin, about 80 percent of 60-year-old men, and half of those in their 80s, have testosterone levels within the normal range for younger men.

How do you treat low-T?

There are real health risks for men with low-T. The condition can be treated with testosterone replacement therapy (TRT), which requires a doctor’s prescription and careful monitoring. Medications come in the form of gels, topical solutions, transdermal patches placed on the skin, buccal patches applied to the upper gums, injections, and pellets implanted under the skin. The products are available under numerous brand names, including Androderm (marketed by Actavis Pharma), Androgel (AbbVie Inc.), Axiron (Eli Lilly USA), Fortesta (Endo Pharmaceuticals), Striant (Actient Pharmaceuticals), Testim (Auxilium Pharmaceuticals), and Testopel (Auxilium). If you’re thinking of taking testosterone to improve strength, atheltic performance, or physical appearance, or to prevent aging, note that the Food and Drug Administration (FDA) has not approved the drug’s use on those grounds. A 2004 report from the Institute of Medicine, Testosterone and Aging: Clinical Research Directions, called TRT for age-related testosterone decline a “scientifically unproven method.”

What are the side effects of taking testosterone?

There are some scary ones, including an increased risk of heart disease. (Here are signs you might be headed for a heart attack.) If you’re considering TRT, make sure you understand all the possible risks. According to the Mayo Clinic, these include the development of acne or oily skin, fluid retention, possibility of increased urinary symptoms (e.g., urinary urgency or frequency), aggressiveness and mood swings, worsening of sleep apnea, reduction in testicular size, breast enlargement, and increased risk of blood clots. In 2014, the FDA revised testosterone product labels to warn about a possible increased risk of heart attacks and strokes in patients. The FDA recommends that patients using testosterone should seek medical attention right away if they experience chest pain, shortness of breath or trouble breathing, weakness in one part or on one side of the body, or slurred speech.

Can I boost testosterone naturally?

Obese men have lower testosterone, as do men who smoke, are physically inactive, or consume more than 28 drinks per week. So losing weight, being more active and drinking less booze may boost your levels without prescription meds. (Here are 17 simple tips to cut back on alcohol.) According to findings presented at the annual meeting of the Endocrine Society in 2012, obese men who lost an average of 17 pounds saw their testosterone levels increase by 15 percent. A 2014 study published in the International Journal of Sports Medicine found that high intensity interval training (HIIT) can boost testosterone levels.

Are there bad candidates for testosterone?

Men with normal testosterone levels should not consider testosterone therapy, and no one—men or women—should use any testosterone product if they have breast cancer. The belief that testosterone may increase the risk of prostate cancer or worsen the symptoms of enlarged prostate has been debated in the medical community for many years. A 2016 study by NYU Langone Medical Center and New York University School of Medicine, reported on ScienceDaily, found that testosterone therapy does not raise risk of aggressive prostate cancer, however it is advisable to tell your doctor if you have a history of prostate cancer before starting therapy.

Are there dangers to taking testosterone?

There’s a black-box warning on testosterone medication packages for a reason. Children who are accidentally exposed to the hormone are at risk of penis or clitoris enlargement, pubic hair growth, increased erections and libido, aggression, and aging bones, warns the FDA. So it’s really important not to apply the product to areas of the body that may come in contact with kids or pregnant women. Once the product is applied, the area should be covered with clothing, and hands should be washed with soap and water. (Check out the five ways you’re washing your hands wrong.) The area should be washed before any skin-to-skin contact with another person. Your bed sheets, pillows, and clothing may have testosterone on them, so warn anyone who comes into contact with them of the risk of exposure.

New UNFPA Study Outlines Inequalities In Sexual Health & Reproductive Rights Globally

New UNFPA Study Outlines Inequalities In Sexual Health & Reproductive Rights Globally


When it comes to reproductive and sexual health policies and access, it’s easy to focus just on what is happening within our own communities and even countries. Here in the US, the past few months have seen some horrendous and frankly deeply disturbing rollbacks of basic access to important healthcare resources such as teen pregnancy prevention programs and mandated birth control coverage through the Affordable Care Act. Those are just the latest in a string of policies coming from the Trump administration’s Health & Human Services department which is now headed up by anti-choice fanatics who care more about religious and moral imposition than data-driven policies that are proven to be effective.

Looking further afield, the situation is even worse in a number of areas, especially in the developing world. Similar to the way reproductive healthcare advocates are bring the conversation around economic stability to the abortion conversation here in the United States, the UNFPA has just released a new study outlining how a woman’s ability to access crucial sexual and reproductive healthcare is directly tied to the potential to escape poverty.

Titled ‘Worlds Apart: Reproductive Health and Rights in an age of Inequality’, the study underscores how the problem is cyclical and compounded right from early on in a girl’s life. If she is not able to get an education and have basic healthcare needs met, she is more likely to marry earlier, have children early, experience health problems, and not be financially independent or stable due to lack of qualifications. If a woman lives in poverty without the opportunity to escape through job skills, education and healthcare access, her children are also more likely to experience the same outcomes.

The study points out that economic disparity is an umbrella issue, as many other social, racial, political and institutional dimensions feed on each other, giving these disparities a ripple effect throughout families and communities.

“Two critical dimensions are gender inequality, and inequalities in realizing sexual and reproductive health and rights; the latter, in particular, still receives inadequate attention. Neither explains the totality of inequality in the world today, but both are essential pieces that demand much more action. Without such action, many women and girls will remain caught in a vicious cycle of poverty, diminished capabilities, unfulfilled human rights and unrealized potential—especially in developing countries, where gaps are widest,” says the intro to the study.

The ability to access the full range of sexual and reproductive healthcare, as well as determine when and how to have a family, is considered a universal human right. That is what 179 governments agreed at the International Conference on Population and Development in 1994. Yet within most developing countries, women in the poorest 20 per cent of the population have, for example, the least access to sexual and reproductive health services, including contraception, while women at the top of the wealth scale generally have access to a fuller range of high-quality services.

When women are disadvantaged from an early stage in life, it means they are less likely to enter the workforce, and less likely to be represented by policymakers. Education is key, as the study shows that for every additional year of school, not to mention higher education such as vocational college or university, means a girl is more likely to earn a better salary, and decrease her risk of maternal healthcare problems.

“This has long-term implications for labor-force participation and lifetime earnings. Equal access to quality education not only addresses absolute deprivation by providing individuals with a pathway out of poverty, but also increases overall national productivity and innovation, by generating far greater opportunity for all people to develop their skills, find their niche and define their future areas of work,” said the study.

Today, 95% of the world’s births to adolescents occur in developing countries. That must change.

“According to the Guttmacher Institute, each year in developing countries, there are 89 million unintended pregnancies, 48 million abortions, 10 million miscarriages and 1 million stillbirths. An estimated 214 million women in developing countries have an unmet demand for family planning,” says the study.

When it comes to reproductive and sexual healthcare policies having women represented among lawmakers as well as within major health institutions is going to make a world of difference. The recent inaugural Women Leaders in Global Health conference held at Stanford University discussed ways to ensure we see more women in leadership positions.

“At least 75% of the health workforce are female, and looking around this room…there is no shortage of talented women in the pipeline. But the picture looks different at the top,” Michele Barry, MD, director of the Stanford Center for Innovation in Global Health and senior associate dean for global health at Stanford University in California, told the audience.

“With every step up the ladder, the proportion of women shrinks. The World Health Assembly is 68% men; 70% of health leaders are men; and, at least in US medical schools and public health schools and global health institutes, men predominantly hold the top positions, despite the fact that global health has become increasingly feminized. In Fortune 500 countries around the world, 26 out of 27 health center [chief executive officers] are men. How can we succeed when half of the talent sits on the bench, and how can we have a robust dialogue?” she asked.

The leaders present at the conference stated that gender matters when it comes to global health due to certain issues faced by women that were outlined in the UNFPA study – childbirth, reproductive disorders, cervical cancer, violence, and poverty. Every 2 minutes a woman dies in childbirth, and 60% of these deaths are preventable.

Dr. Afaf Meleis, PhD, dean of nursing emeritus, University of Pennsylvania, Philadelphia, spoke about the US not being immune to these problems, considering we have the highest maternal mortality rate in the developed world. However female genital mutilation is still common in some parts of the world, and many women die from abortions. Almost all abortion deaths are due to unsafe abortions, and not the procedure itself, she added.

The recent announcement of the new World Health Organization leadership team being made up of more than 60% women reiterated how certain organizations are realizing the importance of having women’s voices at the table when it comes to healthcare initiatives, studies and policies.

The UNFPA study concluded with action items that are in line with the UN’s 17 Sustainable Development Goals agenda. Noting how the intersection of health, education and gender must be addressed in order to truly alleviate global poverty, they have listed a number of ways each person can do their part to break down barriers that stop women from reaching their full potential.

“Intersecting forms of inequality may have huge consequences for societies as a whole, with large numbers of women suffering ill health or being unable to decide whether, when or how often to become pregnant, and thus lacking the power to enter the paid labour force and realize their full potential. The damaging effects may span a lifetime for individuals and reach into the next generation,” the study says.

You can read an overview of the ‘Worlds Apart’ study by clicking here, and downloading the full report on the website.

Being self-aware

Being self-aware


Age appropriate sexuality education is crucial for adolescents

As girls and boys grow, we help them navigate and engage with their world. We teach them self-management, such as how to dress and keep an orderly room. We teach them about avoiding dangers, such as how to use a stove without burning themselves. We teach them skills related to their expanding independence, such as how to buy something from the local grocery store and come back home with the right change. And we teach them how to manage social relationships, such as how to build supportive friendships and respect adults while recognising inappropriate actions.
Similarly, we need to provide adolescents with information and skills so they can thrive in the new opportunities and challenges they will face as teenagers and adults. As their bodies and minds mature, they need and have a right to information about puberty so that they are prepared for the changes they will experience. As their social networks and the influence of peer groups and the media expand, they need and have a right to develop confidence, competence, and communication skills. And as they move through adolescence, which we know is a period during which inequitable gender norms become further entrenched, they need and have a right to programming about respect, tolerance, and equitable attitudes.

Lack of right information

We know that this is not happening; studies from around the world show that children are not getting the information and education they need. First, many adolescents are poorly informed about the changes taking place in their bodies and minds at puberty, and unprepared to deal with them. Second, many adolescents are unaware and unprepared to protect themselves from sexually transmitted infections and unwanted pregnancies, or lack the skills to refuse unwanted sex from peers or adults who use coercive physical or emotional pressure. Third, they are immersed in widespread inequitable gender norms and attitudes, with almost half of adolescents agreeing that wife-beating is justified in some situations. Finally, they do not know where and how to seek help from adults or health and social services when problems occur. As a result, adolescents in our lives are facing health, psychological and social problems because we adults are shying away from sexuality education.

Contrary to common misconceptions, sexuality education is not about how to have sex. Instead, sexuality education aims to improve knowledge and understanding, and to correct misconceptions by providing age appropriate, scientifically accurate, and culturally relevant information. It aspires to promote self-awareness and norms that are equitable and respectful of others, by providing opportunities to discuss and reflect on thoughts and feelings, attitudes and values. At the same time, it works to build social skills needed to make responsible choices and to carry them out, by providing structured opportunities to practise those skills.

Dr. Venkatraman Chandra-Mouli works on Adolescent Sexual and Reproductive Health in the WHO’s Department of Reproductive Health and Research. Dr. Sunil Mehra is the Executive Director, MAMTA Health Institute for Mother and Child

Number of vasectomies plunges amid fears relationships won’t last

Number of vasectomies plunges amid fears relationships won’t last


The number of vasectomies carried out by NHS hospitals and clinics has dropped by nearly two thirds in a decade, official figures show.

Experts said the trend could reflect social shifts, with greater awareness that relationships might not last, and a reluctance to take steps seen as irreversible.

It could also be a symptom of deepening NHS rationing, they said, or changes in practices with the surgery increasingly offered by GP practices.

The new data from NHS Digital shows 29,344 vasectomies took place in hospitals and sexual health clinics in 2005/6, falling to 10,880 in 2015/16.

Over 2015/16, the number of procedures dropped by two per cent, the statistics show.

Sexual health experts said men were increasingly waiting until they are older to start families, or avoiding the procedure in case relationships failed and they wanted to have more children later in life.

NHS funding for vasectomies has been  restricted in some areas, as part of efforts to reduce spending.

A spokeswoman for the British Pregnancy Advisory Service (BPASA) said: “The fall in vasectomies may reflect the fact that there are more GP practices offering men this service which are not captured in the statistics.

“However, some men may be finding it harder to access the procedure – and we know women sometimes feel under pressure to accept a long-acting reversible contraceptive like a coil or an implant when their partner requests a vasectomy.

“This is not acceptable as vasectomy offers couples a way for a man to take the burden of contraception that his partner may have long shouldered.

“But the decline may also reflect social shifts – couples are waiting longer to start and complete their families, and there may also be greater awareness that relationships can fail and that vasectomy is generally an irreversible choice.”

Natika Halil, chief executive of the Family Planning Association (FPA), said: “Being able to choose the right contraceptive method for you is incredibly important, and given the lack of choices currently available for men, this makes access to vasectomies even more vital.

“Some commissioners in England, in areas including Essex, are now no longer offering vasectomies on the NHS, which means men may have to pay up around £500 for a private procedure.

“Unfortunately evidence shows that cuts to services, a fractured commissioning system, a lack of accountability, and a lack of training for healthcare professionals have all led directly to a reduction in access to contraception.”

She said “dramatic” cuts in public health budgets had exacerbated the problem, with £800m reduction in six years.

The figures show that overall, 1.19 million people had contact with sexual reproductive health services in hospitals and clinics in 2015/16, compared with 2.48 million a decade before. However, some of the change may be because increasing numbers of GPs surgeries are offering the service.

Seven per cent of women aged between 13 and 54 had contact with such services – compared with just one per cent of men of the same age, the statistics show

Vasectomies are more than 99 per cent effective, according to the NHS, and the procedure – which involves cutting, blocking or sealing the tubes that carry sperm from a man’s testicles to the penis – takes around 15 minutes. It is usually carried out while the man is under local anaesthetic, and the NHS warns that it can lead to painful swelling of the scrotum as well as “ongoing pain” in the testicles.

When you and your partner have mismatched libidos

When you and your partner have mismatched libidos


About 15% of men and 34% of women say they’re not really interested in sex, according to a newstudy, statistics that few experts find surprising. In fact, low desire in one partner is probably the top reason couples seek out sex therapy.

When one of you has more interest in sex than the other, it’s easy for the person with the higher sex drive to feel rejected, bruised and undesirable and for the partner who avoids sex to feel pressure, anxious and guilty.
Any number of factors can affect sexual desire, and most of them have little to do with your partner’s attractiveness. In the study I mentioned, researchers found that for both men and women, physical and mental health had an impact on libido. But they may have different motivations for avoiding sex.
“For men, it’s often the appearance of disinterest rather than actual loss of interest,” sex therapist Deborah Fox said. “Men avoid sex frequently due to prior performance issues, such as erectile issues or rapid ejaculation. They may avoid it to escape the anxiety of these issues reoccurring.” In women, hormonal factors and fatigue can contribute to low libido.
And sometimes, life just gets in the way. “In my practice, I see a lot of desire diminish due to interest in porn, boredom of the same sexual routine, the comfort of monogamy and relationship security, and the loss of couple time due to a focus on parenting time,” sex therapist Amanda Pasciucco said.
Here are some other things to consider when you and your partner have mismatched sex drives.
Nagging and anger aren’t helpful. If you’re wondering why your partner isn’t interested in sex, ask from a place of curiosity, sex therapist Holly Richmond said. “Instead of saying, ‘I’m so frustrated that we never have sex anymore. What’s going on with you?’ try, ‘I’m curious about why we have less sex than we used to. Is there something you need from me?’ Open a window of opportunity for communication rather than shoving closed a door of criticism.”
You may need to take sex off the table. Sometimes, the topic of not having sex has become so fraught that you need to start fresh with some simple forms of touch that feel nice but don’t have to lead to sex. “I start by asking a couple be in the same room at the same time for about an hour at least twice a week,” gynecologist and sex counselor Terri Vanderlinde said. “During that time, I have them do something fun and intimate, like playing a game or reading a book together.”
Couples can connect during this window of time, but there should be a rule not to have sex. Some couples will focus on making out above the waist, taking a sensual shower together or giving each other massages. You should also think about ways to stimulate your erotic brain, particularly if you’ve just been going through the motions. Watch ethical porn together, read erotica, share a fantasy or even reminisce about the hot sex you used to have.
Intercourse isn’t always the destination. For most of us, intercourse is often the main entree on the sex menu. Oral sex, manual stimulation and other forms of touch and direct clitoral stimulation are relegated to being optional appetizers. Yet recent studies show that most women prefer a high degree of clitoral stimulation to climax, and prioritizing “outercourse” allows you to discover new paths to pleasure.
Just do it. It’s important remember that sexual desire changes across long-term relationships. In the beginning, sex is usually more spontaneous, and cues such as a look or touch from your partner make you feel aroused more quickly. But over time, spontaneous desire often evolves into responsive desire, which emerges in response to pleasure. In other words, you might not begin with sexual desire but with a willingness to generate it.
“Sometimes, we have to make a conscious effort to be intimate with our partner. If we sit around and wait to be suddenly in the mood, it may never happen,” sex therapist Rachel Needle explained. “Take a chance, even if you aren’t in the mood. Chances are you’ll enjoy yourself once you get started.”
Sex therapist Michael A. Vigorito agrees. “It can help to schedule weekly sex,” he said. “Knowing that sex will occur may help the low-desire partner to turn themselves on in preparation, like they probably did when they were dating. It may also help reduce the high-desire partner’s anxiety about the next time they will have sex.”
Remember, if you’re interested in sex and your partner is not, think of your interest as a precious resource. Without it, without your motivation to have sex, it’s easy to get stuck in a rut. So don’t give up — just refocus your efforts.

Why we must talk to children about sex

Why we must talk to children about sex

In recent days, incidents involving the assault and rape of young adolescents—girls and also boys—have come to attention. On the one hand, two girls, aged 10 and 13, were raped by supposedly “trusted” adults in Chandigarh and Mumbai. They silently bore the abuse until they fell pregnant and could no longer hide their condition.

In Mumbai, two boys swallowed insecticide and committed suicide after being abused and raped by older boys. They couldn’t stand the shame and prospect of further abuse. One boy died before he could tell his parents; the other sought his parents’ help only after he had consumed the fatal potion, but disclosed the names of his abusers before he lost his life.

These incidents should force adults to confront some hard realities. Today, growing up is fraught with physical insecurity, and yet adolescents know little about their bodies— how does one become pregnant, or protect oneself from unwanted pregnancies and infections? How does one confront a sexual predator or distinguish between good and bad touch? Too few girls and boys know these things and fewer still have access to a trusted mentor with whom they can share their experiences and who can take protective action. Most are never told that, if abused, it’s not their fault.

A study conducted by the Population Council on unmarried girls in Bihar and Jharkhand who underwent abortions showed that pregnancy took place after a forced sexual encounter for several of them. The study also sheds light on the reasons why the girls waited till they were well into the fourth or fifth month of pregnancy to seek termination. Several did not know the links between menstruation and pregnancy. Komal and Najma, both of whom were 18 and had experienced a forced sexual encounter, explained: “When I did not have my periods, I did not even think that I could have conceived. I did not feel anything. But one day my employer asked me why my stomach was looking so big… I started having a vomiting sensation. I had no idea that your periods stop when you conceive a child. Then my mother asked me when I had my last period.”

Many girls also described feelings of fear and anxiety about disappointing their family; they were worried about breaking the trust of their parents and losing their reputation. Others feared that their parents would beat them, abuse them or impose restrictions on their freedom of movement. Binita, a 20-year old, said, “My parents’ view towards me would have been shattered. They have full faith in me but had they come to know about this, they would have lost trust in me.”

While research on boys is sparse, it is likely that all four of the adolescents in the news recently, and thousands like them, react similarly to incidents of forced sex.

To prevent such incidents, we must shed the misconception that talking to adolescents about sex will encourage them to experiment with sex. Nothing could be further from the truth, as study after study in every part of the world has shown. Yet in India, teachers and parents shy away from sex education. They refuse to engage adolescents even on topics like pregnancy and menstruation, body changes, and good and bad touch. They believe that there is no need to provide this information, or that talking about these matters will encourage sexual activity. These perceptions are short-sighted, irrelevant in today’s times, and damaging for the adolescents. Informing adolescents about these matters does not lead them “astray”; rather, it empowers them and helps them make healthy choices.

School-based comprehensive sex education and open parent-child communication are urgently needed. Comprehensive sex education informs adolescents in an age-appropriate way about sexual and reproductive health, and unwanted sexual advances. At the same time, it also encourages them to develop notions of gender equality, and an ability to communicate and negotiate.

Parents, likewise, must be persuaded to discard their misconceptions and communicate openly with their children. They must teach their children that, if violated in any way, they must confide in their parents, and promise them unconditional support.

Elsewhere, parenting programmes have succeeded in breaking communication and trust barriers between parents and children, and there is scope for such programmes in India as well.

There are success stories in India too. A police outreach programme in Mumbai schools teaches children about good and bad touch. This month, a six-year-old girl in Mumbai, who had attended this programme, recognized that what a man was doing to her constituted bad touch, and was empowered enough to shout and raise an alarm as she had been taught, and succeeded not only in preventing him from perpetrating rape but also in ensuring his arrest. The little girl acted courageously, and the Mumbai police must be commended for delivering such an effective programme.

Parents and teachers must learn from this example. A three-pronged approach that includes comprehensive sex education, close parent-child interaction, and age-appropriate public awareness campaigns such as the police outreach programme will go a long way in fighting sex abuse.

Shireen Jejeebhoy is a social scientist and demographer.