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Early study results suggest fertility app as effective as modern family planning methods

Early study results suggest fertility app as effective as modern family planning methods

2018-10-18

GEORGETOWN UNIVERSITY MEDICAL CENTER

Early results from a first-of-its-kind study suggests that typical use of a family planning app called Dot is as effective as other modern methods for avoiding an unplanned pregnancy.

Researchers from the Institute for Reproductive Health (IRH) at Georgetown University Medical Center are studying women’s use of the app for 13 menstrual cycles, or about one year. The ongoing prospective study design is the first to apply best-practice guidelines for assessing fertility awareness based methods in the testing of an app.

The interim results following Dot’s use for six cycles are published in the journal Contraception (title: Estimating six-cycle efficacy of the Dot app for pregnancy prevention.) Dot is owned by Cycle Technologies, which is solely responsible for the app.

Dot provides a woman with information about her fertility status each day of her menstrual cycle. It uses an algorithm and machine learning to identify the fertile days of her cycle based on her cycle lengths.

After women had been in the study for six cycles, the researchers found that the app had a typical-use failure rate of 3.5 percent, which suggests that Dot’s one-year typical efficacy rate will be comparable to other modern family planning methods such as the pill, injections, and vaginal ring.

“Given the growing interest in fertility apps, it was important to provide these early results,” says Victoria Jennings, PhD, principal investigator of the Dot efficacy study and director of the IRH.

718 participants in the United States enrolled in the study, and 419 participants completed six cycles of use. There were 15 confirmed pregnancies from cycles when participants used the method incorrectly (such as having unprotected sex on days of high fertility). No pregnancies occurred in cycles when participants reported correct use of the app during high risk days for pregnancy.

“Our purpose is to provide guidance to women who want to use Dot as well as to health providers and policy makers who are interested in this emerging method of family planning,” Jennings says. “We hope this paper contributes to the on-going discussion about the effectiveness of fertility apps and how their efficacy should be assessed.”

Final efficacy results are expected in early 2019.

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This study was supported by the United States Agency for International Development grant (OAAOAO13O00083).

In addition to Jennings, study authors include Liya T. Haile, Hanley M. Fultz and Dominick Shattuck of the IRH, and Rebecca G. Simmons of the University of Utah. The authors report having no personal financial interests related to the study. The Dot app is a proprietary technology developed by Cycle Technologies, a company owned by a family member of Jennings’.

About the Institute for Reproductive Health

The Institute for Reproductive Health at Georgetown University Medical Center has more than 30 years of experience in designing and implementing evidence-based programs that address critical needs in sexual and reproductive health. The Institute’s areas of research and program implementation include family planning, adolescents, gender equality, fertility awareness, and mobilizing technology for reproductive health. The Institute is highly respected for its focus on the introduction and scale-up of sustainable approaches to family planning and fertility awareness around the world. For more information, visit http://www.irh.org.

About Georgetown University Medical Center

Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis — or “care of the whole person.” The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health. Connect with GUMC on Facebook (Facebook.com/GUMCUpdate), Twitter (@gumedcenter). Connect with Georgetown University School of Medicine on Facebook (Facebook.com/somgeorgetown), Twitter (@gumedicine) and Instagram (@georgetownmedicine).

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

https://www.eurekalert.org/pub_releases/2018-10/gumc-esr101518.php

Dear Men of #MeToo: Abuse Is Behaviour, Not a Symptom of Mental Illness

Dear Men of #MeToo: Abuse Is Behaviour, Not a Symptom of Mental Illness

2018-10-12

When abusers bring mental health issues as an excuse to their behaviours it gives birth to a misinformed and ableist narrative.

Trigger warning: Sexual harassment/abuse

The #MeToo movement has helped many women come out with their stories of sexual harassment and abuse at the hands of powerful men. It has also highlighted the problems associated with mental health. Many women have spoken up about the impact of these incidents on survivors and understanding why women take time to come out in the open with their narratives. At the same time, the more catchy mentions of ‘mental health’ have been furthered by the men accused of sexual harassment and assault themselves, through their carefully-worded apologies.

Mayank Jain, a journalist at the Business Standard, comedian Utsav Chakraborty and Abhishek Upadhya, an editor at India TV, attempted to use their mental health issues as a defence after being accused of predatory behaviour by several women. Words like “struggle”, “disease”, “seeking help” and “therapy” were littered on their Twitter timelines. These words say things that these men want us to know – but do they really matter? And why talk about it now?

Putting bad mental health on the table when you’re accused of misconduct is a common gambit. After the poet Mary Karr wrote about how her former partner David Foster Wallace had abused her physically and emotionally, a lot of backlash focused on Wallace’s mental health issues. In a personal essay for the New Yorker, celebrated author Junot Diaz talked about the repression of his childhood abuse and linked it to the accusations of assaulting and harassing multiple women. The courtroom trials of Roman Polanski mentioned his ‘mental illness’ several times, following his arrest for sexually abusing children.

The similarities are clear. All these men, and many others, influenced generations with their work in literature and the media, suffered from mental health issues and abused those who seemed less powerful. However, it would be amiss to connect abuse and mental health.

First off, there are similar patterns of violence perpetrated by people with as well as without  a mental illness. “The intersection of abusers with mental health issues is very thin,” Sadaf Vidha, a Mumbai-based psychologist whose clientele includes survivors of gender-based violence, says. “Think about it while reversing the roles – when women or minorities suffer from mental health issues, do we see them automatically abusing or assaulting other people?”

Research denies a link

The association of mental illness with abusive behaviour isn’t new; the ‘insanity defence’ is probably its most famous byproduct. Researches have been exploring this relationship for decades and have found prevalence of mental illness in convicted sex offenders, but no signs of a clear cause-effect has been found.

1999 study by Jenny Muzos of the Australian Institute Of Criminology dispels the myth that violent behaviour is associated with mental illness. It found that characteristics of crimes such as homicides committed by offenders diagnosed with a mental disorder were no different from those of crimes committed by other offenders.

After a undertaking series of studies, Nancy Erickson, an attorney and consultant on domestic violence and legal issues, concluded that while mental illness may or may not exist in abusers, the abuse they inflict is a behaviour and not a symptom.

meta-analysis of several studies by Andrew Klein, a professor of law at the Indiana University, Bloomington, and funded by the US Department of Justice, for the Battered Women Justice Project states that men who abuse are no more likely to suffer from mental illnesses than the ordinary population. Their paper reads, “Although batterers may suffer from depression or low self-esteem after being arrested or restrained, these conditions have not been found to have caused the abuse.”

Jaydip Sarkar, of the Institute of Mental Health, Singapore, asserted in a 2013 review of the assessments of mental health of sex offenders in India that rape, sexual harassment and other predatory behaviours are not necessarily the result of having a mental health problem.

The issue of perpetrators using stress as a result of work and/or substance abuse as an excuse was discussed in a 1999 review by Sarah Buel, a lawyer and professor at Arizona State University. Buel spent three decades working with survivors of domestic violence and concluded that though violence cannot be caused by stress, stress could exacerbate violence.

When abusers use mental health issues as a shield, it adds to a frightening, misinformed and ableist narrative. “Men directly or indirectly saying that abusive tendencies are due to mental health issues, is just another version of ‘I couldn’t control my desire/anger’,” Vidha added. “This is a very well-known pattern. Abusers will blame health, external environments or the victims, anything that allows them not to take responsibility for their misuse of power.”

The work of Lundy Bancroft

Jain’s tweet about him seeking therapy to “reform himself” was similar to Mark Halperin’s lengthy apology for reportedly assaulting about half a dozen women during his time at ABC News, in the early 2000s. In his statement, Halperin said he sought mental health counselling after he left ABC.

Lundy Bancroft spent years studying and counselling abusive men. In his 2002 book, Why Does He Do That? Inside the Minds of Angry and Controlling Men, Bancroft discusses the myth behind using mental health as a reason to abuse as well as to feed misguided beliefs that perhaps treatment that can ‘fix’ these men.For example, on Diaz’s reference to his childhood abuse, Bancroft writes, “… abusive men may find that accounts of childhood abuse is one of the best ways to pull heartstrings.”

Bancroft states that people have the potential to overcome emotional injuries from childhood and the impact of these injuries need not push the person to inflict same behaviour on others.

When Chakraborty mentioned his mental health, he was attempting to sneak it into his apology and lay the ground for sympathy. Bancroft pointedly dismisses this, writing “… abuse is a problem of values and not of psychology. Mental illness does not cause abusiveness anymore than alcohol does. Perceptions of life circumstances in these men are accurate, their minds work logically and they understand cause-effect.”

The same goes for Jain’s excuse and Upadhya claiming to seek professional help to address “these issues”. Bancroft continues, “I have yet to meet an abuser who has made any meaningful and lasting changes in his behaviour through therapy regardless of how much insight he may have gained.” He also writes that professional help will only help make them “happy, well-adjusted” abusers because interventions like psychotherapy can only address issues they are devised to address, and abusive behaviour isn’t one of them.

It is also important to differentiate between two types of destructive behaviour. One is where severe mental disorders like mania could cause a person to become destructive, as a result of which they may end up hurting the people around them. The other is where the destruction is intentional and isn’t motivated by the illness.

Of course, none of these means that any mental health issues these men may have are invalid or non-existent. They are likely to be as distressing for these men as they are for anyone else. However, the distress does not have anything to do with their inability to understand consent or the agency of the women.

“We are a patriarchal society and allowing mental health issues to become an excuse for abuse or assault will lead to massive misuse of policies and laws like the Mental Health Act,” Vidha said about the consequences of people buying into these connections. “We need to differentiate between what socialisation teaches men that is ‘okay to do’ and what their mental health conditions lead them to do.”

Mental health issues and predatory behaviour can coexist in a single mind but with some distance between each other. There are people who do suffer from a mental illness and are abusive towards women – and there are also people with a mental illness who do not engage in such behaviour. This is where human psychology takes a step back and calls value systems to the stage.

Prateek Sharma is a student pursuing a master’s degree in clinical psychology, a researcher and a mental health activist working to promote inclusive mental health care in India. He tweets @prateekshawarma.

https://thewire.in/health/dear-men-of-metoo-abuse-is-behaviour-not-a-symptom-of-mental-illness

 

Men’s anxiety: How to combat middle-aged pressures so they don’t reach crisis point

Men’s anxiety: How to combat middle-aged pressures so they don’t reach crisis point

2018-09-25

The mid-life crisis is a common cliche, but an expert today explains how pressure to perform in life is driving many men into mental health difficulties.

our middle years can be a high pressure and confusing time, but don’t bottle up your feelings (or get a tattoo that you’ll regret later).

We all know the cliches of the midlife crisis – the sports car, the wardrobe overhaul, the desire to chuck yourself around at Arctic Monkeys gigs and, um, the affairs.

But there are reasons behind the stereotype.

There’s a wake-up moment in middle age when you realise most of your life is probably behind you.

Plus the stress of caring for a young family as well as ageing parents, while ­shouldering job ­pressure can take its toll on your mental health and relationships .

In fact, a report from the Office for National Statistics found middle-aged people are the least happy, have the lowest levels of life ­satisfaction and suffer the most anxiety.

And men are more vulnerable than women, who reported feeling more satisfied overall.

“There’s always been a clear ­correlation between how the economy is doing and the mental health of middle-aged men,” says Dr Rafael Euba, consultant psychiatrist at The London Psychiatry Centre ­(psychiatrycentre.co.uk).

“There’s pressure to achieve, which isn’t always easy, especially in times of economic hardship, and that can provoke a deep sense of failure.”

While women tend to deal with psychological distress by talking to each other, Dr Euba says men are reluctant: “Most men still think acknowledging they’re suffering is a sign of ­weakness, and so put up with stress which is more likely to come out in other ways, such as drinking.”

Have you reached a crisis point? Our Q&A could help you to find out, and learn how to navigate those rocky years…

Do you fail to embrace new things and feel the best is behind you?

Middle age can actually be a great time to try new things, says Dr Euba: “When you’re young there are many possibilities in the future, but by middle age it’s common to think, ‘this is my life’, and dwell on things you haven’t achieved.

“But you could argue you’re in the peak of life. Yes, if you watch films and read novels you’d think that peak time is the 20s, but people in their 20s make huge mistakes.

“By now, you’re ­experienced, you know what you like and what you don’t, you will ­probably have more money and freedom, so potential to enjoy life is huge. You may also look at life in a balanced way.”

Do you feel overwhelmed by stress, but keep it bottled up?

Planning your goals and reaching out to friends for support are key, says Dr Euba.

He says: “Stress often comes down to economic ­pressure and dealing with the system – providing for your ­family’s future and dealing with authorities over schools and care provided for elderly parents.

“You need to be able to delegate if you can, to compromise where necessary, to negotiate and to plan.

“If you’re feeling overwhelmed, it’s crucial to make use of your social network and don’t regard stress as a sign of weakness, but as a sign you have to plan things and get support from the other people in your life.”

Do you feel trapped or dissatisfied at work?

This is a tough one to sort out, admits Dr Euba: “Most of us can’t just walk out of a job if we have dependents. But it can help to remind ourselves of the norm – that it’s a minority of privileged people who genuinely love their job and earn good money from it. They are the exception to the rule – not you.

“Don’t compare ­yourself to others. These days, largely thanks to social media, if your life isn’t amazing it’s tempting to believe you’re failing. But it’s normal to have difficult days.

“Set yourself smaller, achievable goals and celebrate those wins and, if possible, try to carve out areas of your work that you’re in control of.

“It’s also important to understand there’s much more to being a man than how big your salary is and how far you go in the hierarchy.”

Are you anxious about your physical health?

Our bodies begin to decline in middle age and it can be a painful glimpse of what’s to come.

Dr Euba says: “The knowledge there’s less ahead combined with the onset of physical ailments can cause anxiety. Getting fitter is good for the mind and there’s growing medical evidence that exercise can help people beat depression. The key is, don’t overdo it.

“Pay more attention to lifestyle – don’t smoke and don’t drink too much – and just be aware of your body. Taking responsibility for your health will help you feel in control.”

Do you feel your sex life and relationship are dull? Do you want to cheat?

If you’ve been in a relationship a long time, along with a sense of stability can come a sense that life is, well, just a bit boring.

Dr Euba says: “Men’s sexual potency does start to decline in middle age, and although it’s more subtle than it is for women, it can affect self-image for some men.

“If that’s combined with a lack of sexual interest from their partner, many guys take that as a personal failure. These things make couples more vulnerable to affairs.

“It helps to know these issues are normal and seeking help in therapy doesn’t mean you’re less of a man.”

Do men really exaggerate their number of sexual partners?

Do men really exaggerate their number of sexual partners?

2018-09-07

When it comes to sexual partners, what’s in a number? For one recent survey study, researchers at the University of Glasgow analyzed the responses of over 15,000 men and women and concluded that men are more likely to exaggerate their number of opposite-sex partners, possibly because men estimate rather than count all of their partners.

Men, it turned out, claimed an average of 14 sexual partners over their lifetime, while women reported only seven. The people surveyed were between the ages of 16 and 74.
The investigators claim that such studies are an important part of human sexuality research and in assessing the risk of sexually transmitted infections. But my fellow sex therapists and I aren’t so sure. Rather than focusing on one’s number of partners, “We should be talking about what folks want for their future and what they’ve learned from past relationships,” sex therapist Gracie Landes said.
I asked Landes and several of my other colleagues to weigh in on the continued fascination that the public — and media — seems to have with people’s number of sexual partners.

Are men exaggerating or overestimating their number of partners?

The answer to this question appears to be a resounding “yes.” Indeed, it’s simple math: “Given that there are not significantly more women in the population than men, if men are reporting higher numbers and women are reporting lower numbers, many are reporting inflated or deflated numbers due to the tendency to answer questions in a way that they think they’re supposed to,” sex therapist Dulcinea Pitagora explained.
In fact, statistics released by the dating app Tinder show that men use a broader strategy, indicating their approval of someone’s photo by swiping right on 46% of profiles, while women swipe right on only 14%. A study of raw data from Tinder also found that about 80% of female users are all competing for the same 20% of men.
“This seems to indicate that the number of sex partners would be especially skewed in the male population in favor of the more desirable men and that a majority of men are not having much success,” sex therapist Michael Aaron said. “It’s possible, then, that surveys such as this one, which find higher overall partners amongst men, may be indicative of men inflating their numbers, perhaps due to underlying shame.”

Why would someone inflate or deflate their actual number?

As Aaron suggests, society’s focus on the number of people someone has slept with may lead some to exaggerate — or decrease — their actual number out of embarrassment.
“Women might underreport out of fear of being judged negatively, while men might overreport in order to be looked at more favorably,” sex therapist Rachel Needle said. “In other words, men who have a high number are considered studs, while women are often slut-shamed. In addition, women might round down so their partner feels more important and special.”
Sex therapist Barbara Gold agreed. “I believe this is attributable to shame. It goes back to the gender myths that women aren’t supposed to enjoy or expose their sexuality lest they be judged in a negative way, while whatever sexual shame men may carry, social norms not only allow them to be sexual creatures but expect them to be,” she explained.

Should you ask your partner their ‘number’ — or tell them yours?

Whether you choose to talk numbers with your partner is entirely up to you. “You should do whatever you’re comfortable with,” Gold said. “You might ask why they want to know and what the number represents to them and then decide if or how you want to respond.”
“I find that more men ask this question of their female partners than vice versa,” sex therapist Deborah Fox noted. “Although men make some meaning out of the number they receive, it’s not really the question they want an answer to. They really want to know how they stack up to the previous partners, but that question requires way more nerve to ask. They want to know, ‘Am I the best lover you’ve ever had?’ but they’re also unlikely to ask that question.”

What should couples be discussing instead?

Rather than fixating on the number of people you or your partner have had sex with, I advise turning the conversation so that you’re having an open discussion about your interests.
“Instead of discussing a number, you should be talking about what you know you enjoy sexually, what you’re curious about and what you might want to explore in terms of sensations, types or scenarios, monogamy/non-monogamy and your top erotic triggers,” sex therapist Sari Cooper said.
And while you should certainly ask about your partner’s sexual health — and get tested — the number of sexual partners you’ve both had shouldn’t affect the need to practice safe sex.
It can be tempting to focus on one’s number of sexual partners, and studies like this one allow curious folks to compare themselves to others. But the fact is that there’s no right or wrong number. What matters most is your relationship with your current partner and how you can both make that as satisfying as possible.

https://edition.cnn.com/2018/09/06/health/number-of-sex-partners-kerner/index.html

Porn Makes Men Think Women Will Do Just About Anything

Porn Makes Men Think Women Will Do Just About Anything

2018-08-29

Taxi-driver themed porn makes men think women will have sex with strangers on their commutes, a new study suggests.

en who watch certain porn genres tend to think that women are more likely to engage in unprotected, rough sex with strangers or co-workers, according to a new study. Many prior studies had examined “the association between porn use and various attitudes,” co-author on the study Daniel Miller of James Cook University in Australia told Fatherly. “However, the nature of these studies made it hard to determine causation.” Until now.

Indeed, past research has demonstrated a correlation between violent ideas and a preference for violent pornography, but it is hard to say whether porn influences attitudes. It could be that porn causes men to have colder attitudes towards women, or that men who already felt that way are more likely to consume that type of porn. More concrete studies have shown that men who watch porn in which condom usage is not depicted are less likely to use condoms themselves.

Miller and colleagues added to this body of research with a study of 418 men, conducted online to allow for more candor. “Coming into a lab and watching porn while a researcher is present is a very weird situation,” Miller says. “Porn watching is a private activity.” Participants were surveyed on their porn use over the past six months, and then shown either a 22-minute video of taxi driver-themed porn (where a driver propositions a woman for sex) or a 22-minute non-pornographic educational video. Then men were asked to evaluate how likely a woman was to except a sexual proposition from a taxi driver or her boss.

They found that viewing the taxi-themed porn did not influence how men evaluated women’s willingness to have sex. But past exposure did. Men who had watched taxi-themed or boss-themed pornography within the past six months were more likely to think that women would be interested in having unprotected, rough, porn-like sex with a stranger or manager. “I was surprised by how many participants indicated that they had watched taxi-themed porn in the past,” Miller says.

“I was expecting it to be a little more obscure than that.”

Miller acknowledges that participants were not randomly selected and are not likely representative of all men as a result — older, and less educated men, are unlikely to respond to online surveys. Miller recommends follow up research look at the effects porn has on the propensity to have one-night stands, and how it influences how men interpret women’s willingness to have sex. “If you are a porn user — and according to surveys, very large segments of the population are — it might be worth considering if porn has had an influence over your thinking, even at a very basic level,” Miller says.

“Are there men who just assume the over-the-top, oftentimes rough, sex depicted in pornography is the norm, even among two people who just met? This study would suggest that this is quite possibly the case.”

Drugs affecting sexual health of couples

Drugs affecting sexual health of couples

2018-07-18

 

Drug addiction in Punjab has begun to impact the sexual health of young couples with infertility experts citing it as a reason for 15-20 per cent of them unable to have children.Dr Asmita Bhambri, an infertility specialist based at Mohali, who earlier worked at DMC, Ludhiana, says 20 per cent couples visiting her clinic can’t have children because the man is hooked on drugs. “Most of these patients are from Nawanshahr, Garhshankar and Moga. Further, in 10 per cent drug-related infertility cases, there is no improvement in the male sperm count despite de-addiction and medication.”Infertility expert with the Chandigarh PGI Dr Shalini Gainder says the institute has not carried out any research on the subject. “But it has been observed that sperms of addicts have no motility and poor survival chances. We discourage donor sperm in addiction cases.” Dr Suman Puri from Ludhiana too says sexual dysfunctioning in addicts is common.Jalandhar-based Dr Jasmine Dahiya, an IVF ( in-vitro fertilisation) expert, claims at least 100 infertile couples visit her clinic every month. “In at least 15 such cases, drug addiction emerges as the key factor. Dr Dahiya has been conducting a study on the “Phenomenon of decreasing sperm count in Punjabi males”. The conclusions of the study are expected in two-three months.Another Jalandhar-based IVF expert Dr Shveta Nanda says very few Punjabi women had infertility issues in the past. “But with drug addiction among Punjabi men becoming common, infertility rate has gone up for both men and women.” Former Indian Medical Association (IMA) president and gynaecologist Dr Sushma Chawla agrees with her.“It has become increasingly important to counsel the male partner prior to any infertility treatment. A couple  from Tarn Taran visited my clinic recently. I had a hard time counselling the man that he must quit drugs not only to father a child but to also keep fit to earn enough money to raise the child,” she told The Tribune.

https://www.tribuneindia.com/news/punjab/drugs-affecting-sexual-health-of-couples/621201.html

Sex and gender both shape your health, in different ways

Sex and gender both shape your health, in different ways

2018-06-22

When you think about gender, what comes to mind? Is it anatomy or the way someone dresses or acts? Do you think of gender as binary — male or female? Do you think it predicts sexual orientation?

Gender is often equated with sex — by researchers as well as those they research, especially in the health arena. Recently I searched a database for health-related research articles with “gender” in the title. Of the 10 articles that came up first in the list, every single one used “gender” as a synonym for sex.

Although gender can be related to sex, it is a very different concept. Gender is generally understood to be socially constructed, and can differ depending on society and culture. Sex, on the other hand, is defined by chromosomes and anatomy — labelled male or female. It also includes intersex people whose bodies are not typically male or female, often with characteristics of both sexes.

Researchers often assume that all biologically female people will be more similar to each other than to those who are biologically male, and group them together in their studies. They do not consider the various sex- and gender-linked social roles and constraints that can also affect their health. This results in policies and treatment plans that are homogenous.

‘Masculine?’ ‘Cisgender?’ ‘Gender fluid?’

The term “gender” was originally developed to describe people who did not identify with their biological sex. John Money, a pioneering gender researcher, explained: “Gender identity is your own sense or conviction of maleness or femaleness; and gender role is the cultural stereotype of what is masculine and feminine.”

There are now many terms used to describe gender — some of the earliest ones in use are “feminine,” “masculine” and “androgynous” (a combination of masculine and feminine characteristics).

More recent gender definitions include: “Bigender” (expressing two distinct gender identities), “gender fluid” (moving between gendered behaviour that is feminine and masculine depending on the situation) and “agender” or “undifferentiated” (someone who does not identify with a particular gender or is genderless).

If a person’s gender is consistent with their sex (e.g. a biologically female person is feminine) they are referred to as “cisgender.”

Gender does not tell us about sexual orientation. For example, a feminine (her gender) woman (her sex) may define herself as straight or anywhere in the LGBTQIA (lesbian, gay, bisexual, transgender, queer or questioning, intersex and asexual or allied) spectrum. The same goes for a feminine man.

Femininity can affect your heart

When gender has actually been measured in health-related research, the labels “masculine,” “feminine” and “androgynous” have traditionally been used.

Research shows that health outcomes are not homogeneous for the sexes, meaning all biological females do not have the same vulnerabilities to illnesses and diseases and nor do all biological males.

Gender is one of the things that can influence these differences. For example, when the gender of participants is considered, “higher femininity scores among men, for example, are associated with lower incidence of coronary artery disease…(and) female well-being may suffer when women adopt workplace behaviours traditionally seen as masculine.”

In another study, quality of life was better for androgynous men and women with Parkinson’s disease. In cardiovascular research, more masculine people have a greater risk of cardiovascular disease than those who are more feminine. And research with cancer patients found that both patients and their caregivers who were feminine or androgynous were at lower risk of depression-related symptoms as compared to those who were masculine and undifferentiated.

However, as mentioned earlier, many health researchers do not measure gender, despite the existence of tools and strategies for doing so. They may try to guess gender based on sex and/or what someone looks like. But it is rare that they ask people.

A tool for researchers

The self-report gender measure (SR-Gender) I developed, and first used in a study of aging, is one simple tool that was developed specifically for health research.

The SR-Gender asks a simple question: “Most of the time would you say you are…?” and offers the following answer choices: “Very feminine,” “mostly feminine,” “a mix of masculine and feminine,” “neither masculine or feminine,” “mostly masculine,” “very masculine” or “other.”

Self-report gender tool. (Lisa Carver)Author provided

The option to answer “other” is important and reflects the constant evolution of gender. As “other” genders are shared, the self-report gender measure can be adapted to reflect these different categorizations.

It’s also important to note that the SR-Gender is not meant for in-depth gender research, but for health and/or medical studies, where it can be used in addition to, or instead of, sex.

Using gender when describing sex just muddies the waters. Including the actual gender of research participants, as well as their sex, in health-related studies will enrich our understanding of illness.

By asking people to tell us their sex and gender, health researchers may be able to understand why people experience illness and disease differently.

http://theconversation.com/sex-and-gender-both-shape-your-health-in-different-ways-98293

Don’t Put This Up There

Don’t Put This Up There

2018-06-12

From yogurt to oregano oil to lemon juice (OUCH!), the internet is chock-full of suggestions and remedies for women’s sexual health.

By Jen Gunter

People always want to know the most unusual object I’ve retrieved from a vagina.

I’ll never tell.

One, because the woman involved could recognize herself and feel betrayed. Yes, some items are that unusual.

The other reason is that the unfortunate sequence of events that ends with a visit to my OB-GYN practice or the emergency room is almost always the unanticipated consequence of sexual experimentation. Lots of objects seem sexually adventurous until the moment one realizes they are not. And realizes that they are stuck.

Sexual experimentation with household items is nothing new, though the nature of the object has changed slightly to match the times — think along the lines of a progression from a soda bottle to a diet soda bottle to an energy water bottle to a Kombucha bottle — over my 25 years of practice.

Another change I’ve noticed in that time is the increased touting of various “natural” and “ancient” vaginal remedies with household items. The reasons could range from “vaginal maintenance” (a term that, as an expert, I struggle to further qualify) to the treatment of yeast infections to contraception to improving sex lives.

There are two themes at play that seem simultaneously opposing yet complementary: that natural is best and that the vagina is so dirty, fragile or in need of nourishment (or all three) that it is one wrong pair of underwear or wet bathing suit away from complete catastrophe.

And this is how lemon juice (ouch), yogurt, garlic (double ouch), cucumber and oregano oil (super, mega ouch) are finding their way into vaginas worldwide. No, you are not reading a recipe for tzatziki sauce.

Many of these supposed natural therapies claim to have supporting science, although what is offered as proof is easily dismissed with a cursory knowledge of reproductive physiology. Lemon juice is recommended to acidify the vagina (it cannot). Yogurt is suggested because its bacteria could help repopulate the healthy, vaginal bacteria (commercial yogurts don’t have the right strains). Sea sponges are recommended for menstrual hygiene (testing has revealed they have bacteria and debris and they could introduce far more oxygen — a bad thing — into the vagina than a tampon or menstrual cup).

What is simultaneously fascinating and depressing is that these “newly discovered ancient therapies” are neither ancient nor effective. Instead they are the result of celebrity wellness sites, social media and even some doctors recycling material from health almanacs and digests that used to be found at the grocery store and repackaging their content under the guise of female empowerment.

What is science with its stodgy physiology and evidence-based medicine against the allure of the patient anecdote and the promise of a cure? Stories and confidence are what sells.

It’s possible that remedies like yogurt, garlic and so on were tried centuries ago as medicine, spermicide or sexual custom. But who cares if something was used historically if it has since been deemed ineffective or harmful? Blood letting for fever, mercury for vitality or syphilis, and animal dung as spermicide are all ancient medicinal practices, but that doesn’t mean we’re revisiting those therapies today.

In other words, all these so-called “ancient” sexual remedies were retired for a reason.

I get the allure. So many women are still uncomfortable speaking openly about genital health, and the internet offers privacy — not to mention community and validation. When all these needs are met, accuracy can seem secondary.

It is always best to see a health care professional for a diagnosis. We women do know our bodies, but there is so much crossover with symptoms that when women attempt self- diagnosis they are likely to misdiagnose more than 50 percent of the time. That’s worse than flipping a coin.

Researching symptoms and treatment options is always good, but to keep your internet hygiene in check (which requires far more effort than vaginal hygiene) these are the things that should send you screaming:

  • Run if the therapy is said to be “proven.” The degree to which something is supposedly “proven” to treat a medical condition is inversely proportional to the number of studies supporting that claim.

  • Run if something is being sold. Anyone selling a product is by definition biased, whether it is “Big Pharma” or “Big Natural.”

  • Run if the recommendation is homeopathic products. A recent studytells us that doctors who recommend homeopathy are more likely to deviate from standard medical guidelines. In other words they are more likely to practice bad medicine.

  • Run if the advice relies on testimonials. I would never tell my patient “Well Sarah S. said it worked for her!” Sarah S. is not the same thing as science.

  • Run if it involves inserting food vaginally for health reasons. This is nonsense.

  • Run if they recommend vaginal cleaning of any kind. For instance, I’ve been hearing about “vaginal steaming.” It’s well meaning, but woefully misinformed. If your bottom is sore, use a sitz bath.

It’s stunning that in this great age of information that can we have so much misinformation about our bodies and our sexuality. The internet has changed the speed at which we can acquire medical information, but certainly not the accuracy.

Dr. Jen Gunter is an obstetrician and gynecologist practicing in California. The Cycle, a column on women’s reproductive health, appears regularly in Styles.

 

 

 

 

Breaking sex talk taboo in Indian culture

Breaking sex talk taboo in Indian culture

n a nation where sex temples in Khajuraho or Shivling are worshipped, talking about sex in open is still considered a taboo in Indian society. With India having the largest adolescent population in the world, along with a thriving market for contraceptives, the country cannot afford to stay silent about its sexual health anymore, writes: SUBHANGI SINGH

When it comes to sex talk or sex education in India, the government brazenly ignores it, schools disregard it and the adults firmly push it under the carpet. The demographic diversity, in terms of age, sex, marital status, class, religion and cultural context, add the final nail in the coffin. What is absurd that in India where Khajuraho, known as the land of sex temples, is open for the world to worship, visit or make movies inspired from its sex sculptures,discussion on the subject sex, on the other hand, is sidelined considering morally disgraceful in the same society.

Jyoti (name changed) is an 18-year-old newly married girl from Agra. Jyoti shares the same predicament as most young married Indian girls in semi-urban areas. She narrated, “I don’t want to have kids right away. I have heard about contraceptives like Nirodh and Mala-D. But, I dare not bring it up with my husband. He might think I am too forward or that I have a promiscuous past. My mother will also be very pissed if she gets a whiff. Also, I must get pregnant within a year or people might think I am baanjh (infertile).” Such stories echo throughout north India. It is a built-up on multiple social phenomena, almost unique to South Asia and entrenched through its social institutions.

In a country where half the pregnancies are unplanned, a third of which are terminated by choice, the need for unmet contraception is huge. Government-run programs are often cosmetic in nature, only concerned with achieving their targets. In 2012, after a botched up female sterilisation camp in Bihar, resulting in complications experienced by several patients, activist Devika Biswas filed a petition in the Supreme Court of India. The Court finally ruled that such incidents violated components of Article 21 of the Constitution, i.e. the right to health and reproductive rights. The Court also ordered the discontinuation of such sterilisation camps, ensuring that no such fixed targets exist. Adult Indian women, let alone adolescents are mostly unaware about their sexual and reproductive rights.

Dr. Shefali Wadhwani Sharma, a gynaecologist at GMCH, Chandigarh reveals, “We often get girls in critical condition, who come in with a perforated uterus due to mishandled D&C abortions, done by unqualified caregivers like midwives, etc. Such is the social stigma that adolescent girls admitted with ruptured ectopic pregnancies refuse to admit that they have been sexually active. Young girls seldom get intimate checkups done until faced with acute medical emergencies. To avoid such cases, it is imperative that education about menstrual hygiene and sexual health becomes a part of school curriculum. Sexual health is a vital part of holistic healthcare and healthy women a keystone of women empowerment.”

The latest National Family Health Survey (NFHS), 2015-16, bears some good news. Use of contraception in single women has gone up from 2 per cent to 12 per cent in the last decade. Female sterilisation (36 per cent) is still the most popular form of modern contraception used, permanent or otherwise. However, women, especially adolescents, still lack sufficient knowledge about the dangers of unsafe sex and intimate infections. Religious and cultural obligations often dissuade them from practicing proper sexual/menstrual hygiene and/or using contraception. Most women still use ‘traditional’ contraceptive methods like monitoring menstrual cycles and ‘pulling out’, unaware that these methods are not only unreliable tools of family planning but also leave them vulnerable to Sexually Transmitted Infections (STIs) and Reproductive Tract Infections (RTIs).

Even in urban setups, girls admitting to sexual needs are slut-shamed. Trisha (name changed) is a 26-year-old single, financially independent woman who resides in New Delhi. “Once I dropped my bag at my workplace, spilling out a condom amongst other things. After that, the double entendres and indecent proposals continued for a month. I finally changed the job after a few months due to various reasons, this incident being one of them.” said Trisha. She continued, “When I visited a gynaec at a private clinic to get checked for late periods, I was welcomed with questions about my sex life, marital status and warnings about my biological clock ticking away. She also wanted to know if my parents knew! She ignored me when I tried giving background of my general health.” Such moral policing from healthcare providers, misconceptions and lack of trust about regular contraception methods, have led to rampant impetuous use of over the counter emergency contraceptives.

Government and private NGOs are now resorting to innovation to get the message across. Comedian Abish Mathew recently released a funny animated short film about the importance of maintaining good sexual health. Agents of Ishq, a multimedia project about ‘sex, love and desire’, is sprinkled liberally with humour to make it appealing for this generation. Population Foundation of India (PFI) is an NGO which has partnered with Doordarshan to spread awareness about sexual health, contraception and other taboo subjects, through a soap opera titled Mai Kuchh Bhi Kar Sakti Hoon..

Inclusion of Men

Although government programs and even NGOs that focus on youth reproductive and sexual health often limit their focus to females alone, men/boys play key roles as fathers, brothers, and partners. Often the male members of the family are key decision makers of the household in the largely patriarchal Indian society, necessitating participation of the male population in these programs. The patriarchal narrative also restricts men/boys from addressing their own reproductive and sexual health issues, the admission of which can render them weak in a society that teaches them to be macho. Information, education and communication about male sterilisation are inadequate, not only in society but the public health system as well. In the absence of a credible source of information and lack of inclusion in public awareness initiatives, men often ignore their sexual health issues which in turn can lead to mental trauma, male fertility issues and infections.

During the decade (2006-2016) between successive NFHS surveys, condom use declined by 52 per cent while the number of vasectomies conducted fell by 73 per cent, indicating a greater reluctance amongst men to use birth control. Only 5 per cent Indian males use condoms and male sterilisation forms a dismal 0.3 per cent of modern contraception used. Most Indian men consider vasectomy as an equivalent to castration. Majority of them are unaware about the ease of the procedure and the reversible nature of it. India is one of the few countries in the world where female tubal ligation is more popular form of permanent contraception than vasectomies, despite the fact that the ligation procedure is more complicated and requires greater post-operative care. The pitiful picture is worsened by the fact that men are taught from an early age that reproduction and subsequently, fertility, contraception and maternal healthcare are a ‘woman’s affair’.

As Dr. Sumeet Devgan, a consultant urologist at the Grecian Hospital, Mohali points out, “Young Indian men lack the open peer discussions prevalent in women and are reluctant to seek professional medical help for their sexual health needs. We often get cases with mismanaged self-medication for STIs, etc. We need to stop referring to sexual and reproductive health and rights as women’s issues; they are men’s issues as much. Given that use of contraceptives in India is riddled with social barriers, a systematic institutional approach with inclusion of men is required to result in better uptake of contraceptives and safe sex. On-ground work to engage men in taking shared responsibility, while still promoting women’s rights, is vital for sustained behavioural change.”

Half-hearted solutions

To spread sexual health awareness and establish dialogue between sexes, we need comprehensive sexuality education (CSE) at school level. CSE teaches the young about affirmative sexuality, informed consent, safe sex, etc. A similar program called Adolescent Education Program (AEP) was introduced by the government in India in 2007. But after several protests and moral policing, citing ‘inappropriate content’, the program was banned in several states. It was rolled out in select government/private schools with limited implementation. Though it covers issues like body image, gender and sexuality, violence and abuse, STIs, etc, it leaves out issues of negotiation and consent in intimate relationships. Even urban educational institutions are reluctant to include these programs to avoid ‘unnecessary sexualization’ of kids, according to an owner of a reputed private school.

The government also has a National Adolescent Reproduction and Sexual Health (ARSH) strategy, released in 2006 and various states have implemented their own versions of it; e.g. Himachal Pradesh has set up Yuva Paramarsh Kendras (YPKs) which work with health institutions, schools/colleges, youth festivals, etc. In 2008, the National Population Stabilization Fund (Jansankhya Sthirta Kosh) started a helpline (Ph: 1800-11-6555) to provide confidential counselling services regarding sexual and reproductive health problems. Rashtriya Kishor Swasthya Karyakram launched in collaboration with United Nations Population Fund (UNFPA) is a health program for adolescents in the age group of 10-19 years, to provide preventive, curative and counselling services with routine check-ups at primary, secondary and tertiary levels. Last year, the government also started an online distribution service of condoms which met with a good response. Several NGOs like PFI, Mamta and Haiyya are working extensively to raise awareness and remove the stigma attached to discussing sexual health and needs. But a large chunk of our population is unaware of the existence of such programs.

Technology has also helped bring these issues out of the closet by providing anonymity and peer participation. Online portals like Menstrupedia and ‘She and You’ provide a safe and anonymous environment to discuss taboo subjects like menstrual hygiene, STIs, contraception methods, etc. ‘She and You’ has started an initiative #JustSayIt, through which they want to break the awkwardness by hosting a series of events and making women open up about the very things they shy away from like sex, menstruation and their intimate health.  The start of such programs is a welcome change. Sadly, it is restricted to small pockets in India with limited public awareness. The recent government restrictions on advertising for condoms and emergency contraceptive pills don’t help. The lack of proper implementation, poor quality of resources and inadequate training and sensitisation by the government has led to policy failure. According to a 2013 UNPF review, delaying childbearing could reduce India’s projected 2050 population of 1.7 billion by 25.1 per cent. With an ever burgeoning young population, India cannot afford to stay silent about its sexual health anymore.

 

 

http://www.tehelka.com/breaking-sex-talk-taboo-in-indian-culture/

There’s No Such Thing As A ‘Normal’ Penis, Says Health Specialist

There’s No Such Thing As A ‘Normal’ Penis, Says Health Specialist

2018-06-11

But there is such a thing as an average one.

 

The stereotype holds that men who have penises spend a significant amount of time thinking about them, or thinking with them.

Man holds tape measure by his pelvis, with exaggerated perspective. Does he measure up?

Of course, you can’t think with a penis — it’s got a head, but no brain. And men are capable of thinking beyond the whims of an organ that is pretty important, but not all-controlling.

That doesn’t mean that penises aren’t important, for sexual health and even, if something goes awry, for health in general. But does having a penis mean you know what is or is not “normal”? And what even counts as “normal” for something that can vary so significantly from person to person? On the other hand, when is something definitely abnormal and worth checking out?

Read on for some information — and probably a good amount of reassurance.

What is the average size?

As many as 45 per cent of men are unsatisfied with their penis size, according to one 2006 survey, and most of those men wanted theirs to be larger. But the average range penis sizes is actually pretty, ahem, big.

“There may be no such thing as a ‘normal’ penis, but there is such a thing as an ‘average’ one,” Dr. Oliver Gralla, a men’s health specialist and author of Happy Down Below, told HuffPost Canada via email.

A study from the British Journal of Urology International that looked at 15,000 men from around the world found that the average flaccid penis length was 9.16 centimetres (3.6 inches), and the average erect length was 13.12 centimetres (5.2 inches). For girth, the flaccid average was 9.31 centimetres (3.7 inches) and the erect average was 11.66 centimetres (4.6 inches). Length is measured along the top of the penis, from where the base connects to the torso to the tip.

What’s more, the study found that outliers are pretty rare. Only five out of 100 men would have a penis longer than 16 centimetres (6.3 inches) erect, and only five out of 100 men would have one shorter than 10 centimetres (4 inches) erect. And research has shown that despite some stereotypes, age, race, and height are not accurate predictors of penis size.

So the myth of the superior penis is just that: a myth. Embrace humanity’s natural variations!

Grower or shower?

It is normal to be a grower (what Dr. Gralla refers to as a blood penis) and not a shower (what he calls a flesh penis). But it’s also normal to just be a shower.

The Journal of Urology study of 80 men found no correlation between size when flaccid versus erect, or between size and the age of the men. A Turkish study came to a similar conclusion.

What is a micropenis?

A micropenis is a penis that is well under the average size, about 2.5 standard deviations smaller than mean penis size — one standard is that the erect penis length is less than seven centimetres (2.7 inches).

The condition is rare, occurring in only about an estimated 0.6 per cent of those born with a penis, and there are several possible causes.

In some cases, micropenis can be treated in infancy with hormone injections, though this has no effect if the treatment begins in adults because penis growth stops after puberty. Surgery can also be an option in adults.

Partners are mostly fine with it

It turns out that the way men get to view their own penises — looking down from above — makes it look smaller, versus seeing it straight on or from the side. This may be why men seem more unsure about penis size than their partners do.

One study found that 85 per cent of women were satisfied with the size of their partner’s penis, but 45 per cent of men believed their penis was small. Another study asked women to indicate their preferred penis with a 3D model, and the majority chose a size only slightly above average, just above six inches erect.

There doesn’t seem to be much research on attitudes among same-sex partners about penis size, but one study did find that men who sleep with men were more likely to say they preferred to bottom during anal sex if they also rated their penis size as below average.

Men who rated their penis size as above average were more likely to say they preferred to top, while those who rated their size as average were more likely to say they were versatile on position.

But some things are abnormal

There are some things that are abnormal when it comes to penises, and if they show up they warrant medical attention because they can indicate a health issue.

Erectile dysfunction is an issue for many elderly men, but it doesn’t affect them exclusively. “Although more common in older men, even teenagers can struggle with erection issues,” Dr. Gralla said. In younger people, erectile dysfunction can be the result of a psychological issue, but it can also be the result of medical conditions like clinical depression or medication side effects.

There are other penile abnormalities or changes that can indicate a health issue. “Painful erections, palpable plaques, or slight deviations during erection can be the first signs of Peyronie’s disease, or IPP (induratio penis plastica),” Dr. Gralla said.

The disorder should be treated as early as possible, so see a doctor if you develop those symptoms.

https://www.huffingtonpost.ca/2018/06/08/normal-penis_a_23454201/