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Reproductive coercion is abuse. But many women don’t even know it

Reproductive coercion is abuse. But many women don’t even know it

2019-01-10

Studies are revealing the shocking extent of abuse in which a woman’s reproductive choices are controlled by another.

Just when we thought we’d heard it all, along comes evidence of yet another way that men are controlling women, denying them bodily autonomy and sexually abusing them. It’s one you might not have heard of; certainly it’s been little discussed and does not appear to have been highlighted by the #MeToo movement. Arguably though, it has a far more serious and potentially life-changing impact on women’s lives than many of the abuses that movement has documented. It’s called reproductive coercion and, as a shocking new report in the journal BMJ Sexual & Reproductive Heath has found, as many as one in four women presenting at sexual health clinics is a victim of it.

Reproductive coercion is not a new phenomenon. But it was very recently recognised as a distinct type of domestic abuse, and only defined as a concept in 2010, in a study in the journal Contraception. It describes a type of abuse in which someone else controls your reproductive choices, such as deciding whether you can use contraception, choose to become pregnant, or continue with a pregnancy. This can manifest as either psychological abuse or physical violence, or both, and ranges from emotional blackmail to sabotaging contraception to, at the extreme end, deliberately bringing on an abortion by spiking a woman’s food or drink.

The new BMJ report reviews all the currently available evidence and brings it up to date, collating information from worldwide medical and social sciences research databases. It reveals that the problem is more common than previously acknowledged, and that younger women are particularly vulnerable to it, as (in the US at least) are black and ethnic minority women. And it shows that while male partners are predominantly responsible for acts of reproductive coercion, they’re not the only perpetrators. In some cultures, other family members, particularly older female relatives, frequently interfere with another woman’s reproductive autonomy.

Reproductive control covers such a wide spectrum of behaviour that many women might not realise they’ve been a victim of it, not least because some of its myriad forms present passively, or very subtly. Take your friend who confides to you that her boyfriend hates wearing condoms and sweet-talks her until she’ll let him have sex with her without, because it feels so much nicer, and she gives in because he really loves her, and she knows she can trust him … Or the woman unlucky enough to have sex with a man who covertly removes his condom midway during sex, without her consent or knowledge – an act known as “stealthing” – and which he (and perhaps she) probably doesn’t know is a form of rape, for which men have been convicted.

And then there’s the guy who lied to you about having had a vasectomy, or the one who swore on his life that he’d withdraw during unprotected sex but “got carried away in the moment”. And the bloke who said he’d break up with his girlfriend if she didn’t have an abortion, so she did, even though she wanted the baby. Conversely, there’s the man who wanted a(nother) child, when his partner did not, who pierced holes in the condoms and feigned surprise when she became pregnant.

There are still, it seems, an awful lot of men who like to keep their women “barefoot and pregnant”. Perhaps that casual, jokey attitude to reproductive control is part of the problem. Recently, Saturday Night Live cast member Pete Davidson quipped about messing around with his (now ex) fiancee, Ariana Grande’s birth control. “Last night I switched her birth control with Tic Tacs,” he said. “I believe in us and all, but I just want to make sure that she can’t go anywhere.” Hilarious.

And last year, actor Ian Somerhalder brazenly admitted he’d decided to start a family with wife Nikki Reed by taking the birth control pack from her purseand throwing the pills in the toilet. Yes, women have been known to do this type of thing too, most famously in the case of notorious columnist, Liz Jones, who confessed to being so desperate for a baby that she had stolen her (then) husband’s sperm from his used condoms in the dead of night, and inseminated herself. But she represents a tiny minority. The reason is blindingly obvious: it’s mainly women who suffer the consequences of reproductive abuse. They’re the ones who need a prescription for the morning-after pill, who need to go through abortions, get pregnant, endure childbirth. They’re the ones who are kept in poverty by having unwanted children, who can’t get a job or improve their education.

Like all forms of sexual abuse, this isn’t about sex, it’s about power. The BMJ report calls for more international research on the non-physical elements of abusive relationships and into how coercive control can be resisted. GPs and other health workers need to be more aware of it, and women need to be able to spot the signs so they can get out, or get help. The pill might be almost 60 years old, but we still have a long way to go before we’re in total control over our own reproductive lives.

 Hilary Freeman is a journalist and author

https://www.theguardian.com/commentisfree/2019/jan/09/reproductive-coercion-abuse-women-control-choices

5 Reproductive Health Issues We Should Be Talking About

5 Reproductive Health Issues We Should Be Talking About

We asked readers which health topics they felt needed to be discussed openly, and got answers from an obstetrician-gynecologist.

If someone speaks to you about your body with anything but kindness and concern, it is he who has a problem.”
— Dr. Jen Gunter, an obstetrician-gynecologist

Premenstrual dysphoria. Pelvic floor disordersEndometriosis.

These can be serious health conditions for women, yet many of us are reluctant to discuss them, even with our doctors. In fact, the bulk of my knowledge on these and many other issues that affect women’s reproductive health have been passed along to me through word of mouth like some kind of lore.

How extensively women are uninformed, to the point that some struggle to articulate possible symptoms, hit home with me recently, after I wrote a column on menopause. (Specifically, it was about how women who were looking to find any information or camaraderie beyond the clinical were generally out of luck.

As part of the column, I asked readers if there were any other health issues we needed to start talking about more openly — and I received an onslaught of emails.

Did you know, for example, that about 50 percent of women will develop some form of pelvic organ prolapse in their lifetimes? More on that below.

Here are five conditions, which affect millions of women, explained by Dr. Jen Gunter, an obstetrician-gynecologist in the San Francisco Bay-area who writes The Cycle, a Times column on women’s reproductive health.

Premenstrual Dysphoric Disorder

What is it? It’s a severe form of PMS, but PMDD generally includes severe depression, irritability and tension. Like PMS, it starts a week or two before your period, and ends abruptly when your period ends.

What to know: For about two weeks of the month, PMDD should be gone. Keep a symptom diary to gauge how long you’re experiencing these symptoms and, as always, consult your doctor.

Endometriosis

What is it? It is when tissue that normally lines the uterus grows outside of the uterus, in the pelvic cavity. While this tissue doesn’t shed blood as it would inside the uterus, it does undergo inflammatory changes that it would during one’s period.

What to know: It affects 6 to 10 percent of women. For some, it can cause infertility. For some, a few specks of the disease can cause severe pain. For other women, it takes a massive amount of disease to cause pain. And other women have no symptoms at all. Treatments include hormones or excision surgery.

Pelvic floor disorders

What is it? Pelvic floor disorders primarily fall into two categories: the floor being too weak or too tense. (The floor consists of a group of muscles located at the base of the pelvis.) Either condition can result in symptoms that are hard to describe and therefore hard to diagnose, such as incontinence or pelvic organ prolapse, as well as pain, particularly during sex.

What to know: A common feeling with a weak pelvic floor is that there’s something stuck in the vagina. Childbirth can exacerbate or cause a weak floor, since tissue that stretches is more vulnerable to age and injury. There is also a big genetic component, and smoking can weaken the floor.

A tense floor is more complex, in that women can have it from birth or develop it at an early age. A floor can also tighten or spasm after sexual trauma or an event that caused pain, including a yeast infection.

Pelvic organ prolapse

What is it? It’s the sagging of one’s cervix and vaginal wall toward the vaginal opening.

What to know: It occurs normally with age since pelvic tissue, stretchy by nature, is more vulnerable to gravity and aging. Fifty percent of women will develop some form of it over time, and most women don’t get symptoms until it has progressed.

The most common symptom is the feeling that something is falling out. But it’s important to note that a pelvic floor spasm, which in many ways is an opposite condition, can cause the same sensation.

Incontinence

What is it? There are two main types: stress incontinence, when urine leaks when pressure is exerting on the bladder by coughing, sneezing, laughing, exercising or lifting something. And there’s overactive bladder, or having to urinate even though there’s only a small amount of liquid in the bladder. It’s possible to have both conditions at the same time.

What to know: A lot of women are not screened for incontinence, and ignoring it can lead to a lot of issues. If it gets severe, it can lead to social isolation. There are effective treatments, including medication, physical therapy or bladder retraining. It can also be controlled with an incontinence ring called a pessary. Injecting Botox into the bladder, a treatment for overactive bladder, is extremely effective by preventing muscles in the bladder from spasming from low volume of urine.

This article was take from www.nytimes.com

 

 

Can I Get a Pelvic Exam or Pap Smear on My Period?

Can I Get a Pelvic Exam or Pap Smear on My Period?

If you feel pretty damn proud of yourself for scheduling a Pap smear or pelvic exam, we don’t blame you. This kind of preventive care is incredibly important but also easy to put off or cut from your schedule the moment you get too busy. So, kudos to you. But what are you supposed to do if you realize your period happens to coincide with your appointment?

First, let’s go over the difference between a pelvic exam and Pap smear.

You might mentally lump these together under the category Important Vaginal Exams You Know You Should Get, but they’re a little different.

A pelvic exam is usually performed as part of your annual well-woman visit, although you may need one outside of that if you’re experiencing symptoms like unusual vaginal discharge or pelvic

During the exam, your doctor will check your vulva, vagina, cervix, ovaries, uterus, rectum, and pelvis for any abnormalities, the Mayo Clinic says. This typically involves performing a visual inspection of your vulva to look for anything like irritation or sores, inserting a speculum to hold the walls of your vagina apart to view your vagina and cervix, and doing a manual exam to feel your pelvis, inside your vagina, and possibly inside your rectum.

A Pap smear, also known as a Pap test, involves collecting cells from your cervix to detect cervical cancer and to look for cellular changes that suggest this kind of cancer may develop in the future, per the Mayo Clinic.

To perform a Pap, a medical professional will insert a speculum into your vagina, then take samples of your cervical cells using a soft brush and a flat device called a spatula, the Mayo Clinicexplains. Not exactly the kind you cook with, but the same basic idea. Those samples go to a lab that can check for any potentially concerning changes in your cervical cells.

You can get a Pap during a pelvic exam, but it’s unlikely you’ll have one during every pelvic exam. Current guidelines recommend that people with vaginas start getting Pap smears at age 21 and get another one every three years until age 65. People with vaginas who are 30 to 65 can opt for a Pap smear every three years, a Pap plus HPV test every five years, or just the HPV test every five years, according to the most recent guidelines from the U.S. Preventive Services Task Force. (While a Pap looks for changes to cervical cells that can result from HPV, an HPV test specifically looks for the presence of this sexually transmitted infection, which is less common and more potentially concerning after age 30. Here’s more about how HPV tests work.)

You might need to have a Pap more frequently if you get an abnormal Pap result or have risk factors like a history of cervical cancer.

OK, but what happens if you have your period?

It’s usually OK to get both a pelvic exam and Pap smear when you have your period, but it may affect the results of your Pap.

Doctors say there’s usually no reason why you need to avoid getting a pelvic exam while on your period with one exception: if you’re having a pelvic exam because you’re dealing with weird discharge. “If someone is on their period, it’s going to be difficult to do an appropriate evaluation of an abnormal discharge,” Dr. Streicher says.

That doesn’t mean you should just cancel your visit, since abnormal discharge can happen for a variety of reasons that benefit from prompt treatment, like sexually transmitted infections. But it does make sense to call beforehand and discuss the specifics with your doctor or a member of their team so they can tell you whether or not to come in based on the full scope of your symptoms.

As for a Pap, you can technically still get one during your period, but it can still be better to schedule the test for a time when you don’t expect you’ll be menstruating. Depending on how heavy your flow is, your period may affect the results of your test.

“Usually if it’s during the lighter part of the cycle it shouldn’t be a problem,” Jessica Shepherd, M.D., a minimally invasive gynecologist at Baylor University Medical Center at Dallas, tells SELF. “[However], sometimes women can bleed too much to get an adequate sample of cells for the Pap.”

Of course, you may not always know when your period is going to show up. “For women with irregular periods, there’s no way of knowing when they’ll get their period—I see that a lot,” Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF. “We may not get the best representation of cervical cells given that there will be an additional amount of red blood cells, but if this is the only time you can take to get your Pap test, you should still get it.”

The world won’t end if you decide to get a Pap even on your heaviest flow day. “The worst that will happen is you’ll have to go back to get retested,” Lauren Streicher, M.D., a professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF.

If your flow is heavy and you don’t want to take the chance that you’ll have to retake your Pap, it’s 100 percent OK to do a pelvic exam and then come back for your Pap when your period is done, Dr. Greves says.

Also, you shouldn’t feel like you can’t have these exams while on your period because it’s “gross” for your doctor. It’s not.

There’s nothing shameful or disgusting about your period. Bloody vaginas are basically a gynecologist’s bread and butter. “That’s what we do—we see people bleed all the time,” Dr. Streicher says.

With that said, it’s normal if you don’t quite feel comfortable getting examined while on your period. A good doctor will understand that, and while they might try to explain why you shouldn’t feel ashamed, they won’t (or shouldn’t) judge you for it. “Some women request not to be examined when they’re bleeding, and that’s fine,” Dr. Greves says.

As always, if you’re not sure what to do, call your doctor. And, ultimately, if you’re having any concerns about your sexual or reproductive health, you should see your ob/gyn whether you have your period or not.

https://www.self.com/story/pelvic-exam-pap-period

5 Mental Health Benefits Of Using Sex Toys In The Bedroom

5 Mental Health Benefits Of Using Sex Toys In The Bedroom

2018-11-30

Although sex toys may be a 15 billion dollar business, that doesn’t mean everyone is using them. While reasons why someone might not use a sex toy vary, for those who identify as male, sex toys may seem emasculating. Women, on the other hand, generally have an easier time with owning, using, and fully enjoying sex toys.

“There are, surprisingly, a good number of psychological benefits associated with incorporating sex toys into relationships and self-pleasure,” Dr. Chris Donaghue, Ph.D., LCSW, CST, licensed sex and relationship expert, author, and TENGAambassador, tells Bustle.

As Dr. Donaghue notes, many men, both in the States and abroad, feel pressure about performing at “top-notch level in the bedroom.” It’s this pressure that can keep men from experimenting with sex toys, either alone or with their partner.

“For example, the TENGA 2018 Global Self-Pleasure Report found that almost half of millennial men (47 percent) feel they’ve been pressured to act a certain way… this includes keeping quiet about their masturbation habits, hiding their emotions, and pushing aside any yearning to better know their bodies,” Dr. Donaghue says. “This leads them to avoid using toys as aid with partners or their own pleasure, as they think that reflects on their ability to achieve orgasm or make their partners feel satisfied.”

In a world where sex toys and the innovation behind them is truly mind-blowing, they’re definitely something worth giving a try. Here are five mental health benefits of using sex toys in the bedroom.

Sex Toys Lead To More Sexual Satisfaction

“People who have used sex toys report being more satisfied with their sex life across all metrics, including quality of orgasm and quality of masturbation,” Dr. Donaghue says.

The more you explore your body and experiment with toys, the more likely you are to know how to get yourself off — whether you’re rolling solo or with a partner.

According to Dr. Donaghue, Americans report a 90 percent satisfaction level when they sleep with men who use sex toys. As for those men who shy away from toys and don’t use them, that satisfaction level is 76 percent.

Sex Toy Use Helps With Body Confidence

When you know the ins and outs of your body — literally — you gain an appreciation for it. The human body is a fine-tuned work of art. Just the fact that the clitoris exists solely for pleasure is, in itself, extraordinary.

“Those who masturbate weekly are more likely to feel positively about their looks and body than those who don’t,” Dr. Donaghue says. “Sex toys allow you to experiment with different sensations, stimulation areas and simultaneous pleasure points in a safe manner, giving you the gift of knowing what makes you feel good. Then, you can repeat this roadmap with yourself or know exactly what to communicate to your partner.”

Sex Toys Can Help You Sleep Better

Sleep is essential to our well-being. Not just because it keeps us from being cranky monsters, but it strengthens our immune systems, keeps our cognitive skills up to par, lowers depression and anxiety, and increases our libido — or at least prevents it from decreasing.

“Sex and masturbation can assist with insomnia and restlessness,” Dr. Donaghue says. “Since the activity releases oxytocin and endorphins, masturbation can help people feel calm and experience less stress. Both men and women report better sleep after incorporating masturbation into their nighttime routine, and using a sex toy can help you achieve your bedtime orgasm more quickly and effectively.”

Sex Toys Aid In Relationship Satisfaction

“Couples who incorporate variety in the bedroom are more likely to stay together long-term, and be open and honest about their desires,” Dr. Donaghue says. “Trying new sexual endeavors alleviates boredom, lessens the likelihood of cheating, and improves overall communication between partners.”

When we open ourselves up to new things, it evokes communication between partners, which is essential to relationship satisfaction and overall health of the partnership.

According to Dr. Donaghue, sex toys are both a safe and reliable way to keep things spicy in bed. It’s just all about taking that first step toward getting that first sex toy.

“After becoming comfortable incorporating toys in the bedroom,” Dr. Donaghue says, “couples and individuals can continue to explore the sex toy category and what it has to offer.”

Sex Toys Help In Sexual Dysfunction

Sexual dysfunction is real, and both men and women can suffer from it. This where sex toys can lend a helping hand. According to Dr. Donaghue, research has found that “masturbatory tools” can really help common sexual issues, such as erectile dysfunction and performance anxiety.

The Womanizer Deluxe, for example, is used to help women who struggle to orgasm. If both men and women can learn to make themselves climax through the use of toys while masturbating, it will give them more confidence in reaching orgasm with a partner, because their mind will be at ease.

Although orgasms shouldn’t be the only goal during sex, as it’s also about the journey, there’s no denying that they can be the icing on an already delicious cake. Sex toys, because of the positive effect they have on mental health, can help you enjoy that journey even more — no matter what the outcome may be.

Five reasons why men visit the gynecologist

Five reasons why men visit the gynecologist

2018-11-29

While gynecologists are known to deal with sexual and reproductive health of women, they at times find themselves having to attend to male patients. Studies conducted over a period of time in different geographical areas show that at least 10% of people who seek professional advice and services from gynas are men.For men’s reproductive system queries, men are advised to see an urologist or an andrologist since they are trained in the field and are bound to give ways forward from their experience in the field. However, some men still find themselves straying into a gynecologist’s office once in a while.

Some of the reasons men who confessed to vising a gynecologist gave include;

Fertility problems

Being unable to sire children is a major problem for married couples and it prompts need for medial insights. Men who have issues with making their partners pregnant due to low sperm count or other infertility issues often find themselves seeing gynas. This can be as a couple or individually depending on a number of factors. Here, they get advised on why they can’t be fathers and how to go about it.

To accompany their spouse

Men and women have different needs at different times in their lives. This means that no matter how close you are to your partner, there are times you’ll be away from him and vice versa. Things like going to the salon, seeing your gyna and such are all female and most men do not even stop to wonder how it goes. For some though, accompanying you to your endeavors is not a task to them.

STDs/STIs

Sexually transmitted Diseases and Infections have bothered mankind for ages. Not keen to choose gender, they affect both men and women, often forcing them to seek health attention. According to gynecologists who talked about seeing male patients, some of the men who walk in through their doors are often in search for ways to handle STIs or such. Common diseases and infections bothering these men include Yeast infection, Gonorrhea and even Syphilis.

To know what women go through

Curiosity knows neither age nor boundaries. Just like some people want to know how some machinery works, there are men who are eager to know what happens to women at the gynecologists. These men will bear the stares they get once they walk into a gyna’s waiting roomful of women just to go through the experience. They necessarily do not have an issue to present to the gyna, they are just curious of the services offered.

Matters sexual health

Most men, almost all men are concern about their sexual life more than anything else. They want to know what is healthy for their reproductive system and its functionality from specialist. From ejaculation disorders, erectile dysfunction, low libido and such, some men get the impression that talking to a doctor who knows much about women reproductive health may give them a more satisfactory sex life.

https://www.standardmedia.co.ke/evewoman/article/2001304315/five-interesting-reasons-why-men-visit-the-gynecologist

How Long Do Most Men Need to Reset Between Orgasms?

How Long Do Most Men Need to Reset Between Orgasms?

2018-11-26

Porn might have you convinced that men are like Energizer bunnies that keep going and going and going, but the reality is a lot more human, and a lot more realistic: Even at their youngest or most virile, everyone needs some recovery time between sessions.

The male refractory period, a.k.a. the time between orgasms, can last minutes to days, says board-certified urologic surgeon Jamin Brahmbhatt, M.D. After sex, your penis becomes flaccid from neural signals telling your body to relax, especially the organ that’s been doing most of the work (yep, the penis), Brahmbhatt says.

Just like our computers or phones sometimes need a reboot, our bodies need that time as well. The excited fight-or-flight nervous system recedes, and the rest-and-restore system comes forward,” explains board-certified urologist and men’s sexual health expert Paul Turek, M.D.

After orgasming, a man’s dopamine and testosterone levels drop, while serotonin and prolactin increase. “If prolactin levels are lower, his refractory period will be shorter,” says sex expert Antonia Hall. “Other variables include stress and energy levels, arousal levels, and drug and alcohol use—including antidepressants and other prescription drugs that can hinder sexual desire.”

Individual recovery time also depends on your overall health and age, Brahmbhatt says. “Generally speaking, men in their 20s often need only a few minutes, while men in their 30s and 40s may need 30 minutes to an hour,” says Xanet Pailet, sex and intimacy educator and author of the new book Living An Orgasmic Life.

Many of the factors that impact MRP are out of men’s control. But being extremely aroused can shorten the length of the refractory period, Pailet says.

Gaining control of your orgasms can be a start to managing your recovery times.

“My best recommendation to men who want to be able to have sex multiple times in a short period is to learn ejaculatory control, which allows them to still experience an orgasm without ejaculating,” Pailet says. Ejaculatory control can be learned through breathwork, according to Pailet. There are tantric breathing techniques that can help you delay orgasm (and some breathing techniques that just make for better sex, tbh).

Of course, being your healthiest never hurts. “The best you can do is to keep that body of yours as healthy as possible by eating right, exercising regularly, and treating it like a temple,” Turek says. “A healthy body will reboot quicker than an unhealthy one.” That also includes avoiding too much alcohol, which is known to act as a depressant.

Maybe the best motivation to order that salad… ever.

Aly Walansky is a New York-based lifestyle writer. Follow her on Instagram and Twitter @alywalansky.

https://greatist.com/live/how-long-between-orgasms

‘Iran 9th country with lowest maternity death worldwide’

‘Iran 9th country with lowest maternity death worldwide’

2018-11-12

It’s a big achievement because to end the death during childbirth is a goal that UNFPA has set for the whole world – or, as we say, zero maternal deaths. There are just a handful of countries who have achieved this milestone, Dr. Natalia Kanem said.

“We have to trust women to make choices in planning their families,” a key message from the Executive Director of UNFPA.

“The woman should be the one to decide, and of course it’s natural for the woman to confer. This is the whole point: We have to trust women to make these decisions because the woman is one half of a couple and is the one who bears a child; the woman also understands how many children she already has and she also understands her responsibilities for looking after the next generation,” Dr. Kanem explained.

Dr. Kanem travelled to Iran to attend the HelpAge Asia-Pacific Regional Conference on Population Ageing which was held in Tehran from October 23 to 25, with the main theme of “Family, Community and State in Ageing Societies.”

UNFPA is the United Nations sexual and reproductive health agency. Its mission is to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.

Here is the full text of the interview:

1) Based on the latest census figures in 2016, older persons currently constitute almost 9 percent of the total population in Iran and demography experts predict that by 2050 some 20 to 30 percent of the population will be 60 years or older. How can this inevitable demographic transition be addressed with regard to the Sustainable Development Goals?

Everywhere in the world have demographic challenges that are different from each other, of course. UNFPA is quite convinced that the demographic challenges that the world is facing are really closely linked to the issue of choice. The choices that we are making today are going to influence older people as they age, but they are also linked to the cycle of life. So those same choices have to do with how we deal with young people today. Demographic transition typically refers to the phenomenon that we see in populations. In earlier times, a high birth rate was accompanied by a high death rate. Many countries had the high birth rates, women often had 8, 10, even 15 children. Even in Iran, less than 50 years ago, birth and death rates were much higher than today.

People were dying at the age of 50 or 55 and this was considered normal – something we certainly wouldn’t consider normal today. But with development we see that as choices expand typically people would choose to have smaller families so that you can invest more in each child. And as advances in medical care, nutrition and quality of life occur then the death rate also comes down. So this is the demographic transition: you have high birth rate and high death rate and then slowly over time fewer and fewer children, but also people are living much longer. So all of these change the structure of the population.

In less developed countries where UNFPA is working – for example, in parts of Asia and Africa — the “many children paradigm” is still there. The death rate is still relatively high and so the structure of the population in those countries presents a different challenge.

Iran is a very good example of a country where you’ve had these advances in development and medical care. People are now living much longer- on average 20 years longer than a few decades ago- and it’s a big achievement for Iran and for similar countries. And of course [people are having] fewer children but more children are surviving and you are not having a lot of early deaths. Then when you’ve got to the stage where Iran is now and as you look to the year 2050, for the first time you are going to have a high proportion of older people.

At the meeting I attended here we joined other partners, including the government, to develop ideas, regionally, as to how we will address some of these challenges. The Sustainable Development Goals have that word “sustainable.” It means that it should be something that is going to endure over time. Sometimes you can fix things quickly but it’s not going to last. It’s a short-term Band-Aid [solution]. What the Sustainable Development Goals are talking about is prosperity that is going to be long-lasting into the future. So in thinking about the Sustainable Development Goals, there are 17 of them. Of course there are many noble goals of the United Nations embedded in them. Every country wants peace, wants to have productive partnerships, things like health, the end to poverty, the end to hunger, etc. This everyone can agree on. It is not an issue.

But there are some other interesting SDGs which are less known like the SDG 10 which is about an end to inequality; or the SDG 5 which talks about men and women and making sure that the services of the country, of a community and of a family cover both men and women. And as we think about the ideals of climate and the environment there are sustainable goals for water and life in the sea, and there are sustainable goals for agriculture and life on Earth.

For UNFPA the relevance of all of these goals to an ageing population is that you have to strengthen not just the body and mind but the attitude of everybody to understand the cycle of life. If the baby is healthy in the mother’s womb this is a stronger child who is going to be a stronger adult and who is going to avoid some of the health problems when they become 60-70 or 80 years old. But if you have no good nutrition, lots of diseases may occur and if there’s not an understanding about the relationship of men, women, older people and younger people in the family then as you get older you are not going to be well integrated into the society. You will suffer great loneliness which is a problem, which can be even a health problem, and you are also not going to be able to be productive. The big point that we make about the demographic transition is that older people can and should continue to contribute to society.

They contribute to their family, of course, because of love. But they can also contribute to their community economically by their wisdom that they have acquired over so much life experience and also to be able to give guidance to the next generation that’s coming up.

So in a nutshell we also want to stress that these Sustainable Development Goals stand for having a world that is just, and in that just world women are half the population and therefore women are half the solution. The solution to the economic problems, because prosperity comes with more women contributing and more women in the workforce. More women being supported by childcare and other things that are going to allow them to make their contributions all the better. The relationship between healthy old age and providing and planning and protecting women all along a chain makes a difference because women tend to outlive men, so when you look at the population over 60 typically there are more women than men as opposed to half and half. But normally women do not have the chance to have pensions, for example, so poverty among older people tends to have more women represented. These are the type of questions that the Sustainable Development Goals ask us to address and these were some of the things that were discussed in the conference.

2) How does UNFPA evaluate Iran’s effort to address population ageing including increased inclusion of the older persons in the community, making cities more accessible for them, and financial support for health services?

UNFPA has worked very closely with some of the ministries that are in the lead on thinking about the family. We were much honored to have with us the Vice President who has taken leadership on some of the issues on family dialogues that you are having in this country. It’s a very enlightened way of looking at problems that every society has by trying to encourage dialogue among the generations and also to think about family life and family relationships. Iran is doing well when it comes to concentrating on better health for all, including the challenges that you face because of the migrant population and other factors.

UNFPA’s role is to assist governments as we think of what are some of the measures that we can put in place. For example, if something like an earthquake or another type of natural disaster happens, usually women are more affected than men in any country, so UNFPA works with women and girls so that together with government, we can position lifesaving supplies and how we can assure that we are ready to assist the population if, God forbid, something happens in terms of a humanitarian crisis.

We also help government to analyze some of the trends that are happening in the population, not just ageing and but also on the other side of what’s happening with the younger people in the country. Iran has a highly educated population, including women who go to school. This is something that is a model for other countries in the region and UNFPA is helping to share the experience that you have had with other countries in the region. We’ve been very gratified and happy to see that when it comes to women’s health issues Iran takes them very seriously. Your midwifery programs have been very successful, so you have fewer deaths during childbirth than other areas which had started from the same indicators where Iran did.

Iran achieved MDG 5 [United Nations Millennium Development Goals] by being the 9th country with lowest maternity death worldwide. It’s a big achievement because to end the death during childbirth is a goal that UNFPA has set for the whole world – or, as we say, zero maternal deaths. But you are already there. There are just a handful of countries who have achieved this milestone and now we are working feverishly to try to share that example, in particular, the benefits of midwives and safe delivery and antenatal care. All of these are factors that helped Iran to have women survive. No woman should die while giving birth.

Of course there is always more to do and among these is trying to strengthen key policies; we are working with government and together we are encouraging policies that seek to address and end violence against women, for example, and there are other areas that we have been working on very closely with Iran.

3) In the UNFPA State of World Population 2018 report you mention that “choice can change the world”, could you please elaborate on that?

The State of World Population report was published just a few days ago [October 17]. In this report UNFPA analyses choices – including why choices are in short supply everywhere. We looked at every country and we were looking at fertility levels and number of children per woman and we noticed that in the countries that are still very poor and are trying to raise their economic prospects they still have very high fertility. Like I was describing before, women in such countries are having more children that they actually desire. When you have a big family you have big challenges especially in a poor country, so UNFPA is working together with governments to provide contraception and also information. So that women would be aware of the things that they could do safely in order to plan their family.

Now this type of guidance is not ‘one-size-fits-all.’ It has to be done sensitively; you have to work with the culture and religion and social norms of the country and you have to understand what it is that women prefer because it should be their choice. A simple example is if a women wants to use contraception to plan her family size it should not be just one type of contraception. You should have 5 or 6 or 7 modern methods of contraception for family planning, and she will pick the one that works for her and her husband.

Now on the side of countries where fertility is on average two or three children we’ve done an analysis to see choices there and choice is relevant because very often a woman does not have a choice to work; she would like to but there is not enough social support. If there is no grandmother to look after the children, for example, what is she going to do? If there is no consideration for all of the different options, she may have the education and she may have the preparation to achieve her potential, but she may not be able to ultimately participate in the economy of her country. And this is going to make sustainable development much more difficult.

And then we also talk about developed countries where the options of not only future income but things like the policy for maternity and paternity leave are discussed. If you have a job and now you have a child will you lose your job because you now have taken leave while you were pregnant and while the child is young? And we are also very bold about saying that fathers should also have adequate paternity leave, so they can bond with the new baby and be a family together when the baby is very young. This is very helpful for the baby as they are growing to have a few weeks or a month, for example, with their father and not just the mother.

So these are some of the things the report is bringing out. And then lastly in some places – many of them in Asia-Pacific, the average fertility rate is very, very low. In Taiwan, for example, it’s an average of one child per woman – It’s the lowest in the world. In other parts of Asia like Korea and Japan where families are very small, or a country like Finland which also has low fertility, the concern is why women are not choosing to have more children. So we did an analysis to look at choices. Sometimes a woman would like to have two children but she is not able to afford. So this is a type of choice which is limited for her. There are other women whose choices are limited because of, I would say, ignorance about transmitted infections that can lead to problems of reproductive health. This is what UNFPA has to work with not just in Iran but in every country where UNFPA works. We attend to these issues of women’s health.

The current fertility rate in Iran is 2.01. From our perspective what’s normal is what the woman wants, so we don’t have targets labelled good or bad. We look at the spectrum and we provide advice based on what it is that any woman in Iran would want. I would observe that many countries see two as the ideal because you have a stable population. It’s not growing too fast and it’s not shrinking too fast. But again a lot depends on what women themselves want. If a woman wants a bigger family, we should help her to have the support to have the ability to be able to afford more children. If a woman wants a smaller family and that is her choice then we should support that choice. But for Iran your fertility rate of 2 is in balance because that’s considered “replacement rate” of the population.

4) Would you please explain why reproductive health and rights remain in the 2030 Sustainable Development Agenda?

There is no country on earth that can claim that they have made reproductive health and rights a reality for everyone. Even when a country is doing well we see that there are shortfalls, maybe a farmer who is trying to have her farm in a rural area, maybe it’s a migrant or refugee etc. We always know that choices can be limited and the goal of UNFPA is to make sure that these millions and millions of people have more choices, not fewer. This is what I said earlier. It’s not good to try to tell a woman you must have two-and-a-half children

so that the statistics look good. We have to analyze what is happening with your family. Can you afford four or five children if you want that many? Well, this may be a blessing for you. But maybe you cannot afford five children, so maybe you would like contraception because you are afraid everybody will stay in poverty and you won’t be able to invest in each child well, so you should receive the help to exercise your choice accordingly.

Ultimately the point about the Sustainable Development Goals is to make sure that women are able to speak and that women are able to understand what is the future for them and for their daughter or for their son for that matter. Because of course the girl is going to marry the boy and we want to make sure the boy knows about the respect for women, we want to make sure that the boy is in good health, and also in every country we face the challenge of domestic violence and this means that raising awareness among men and boys is very important. They are the ones that are also going to share that understanding.

So as we think about the SDGs and the goal of ending poverty, women have to be an integral part of that equation. As we think about the second SDG to end hunger, for example, you know that many times women are active as farmers, women are the ones who are purchasing the food and cooking the food, so understanding about health and nutrition is good for them personally but it’s also good for the family and it’s good for the community.

And as we go through all of the SDGs, on education for example, I think we want to celebrate examples like Iran where woman have achieved and they can finish their education. This is not true in a lot of the world. In a lot of the world girls are discriminated against, they don’t get to go to school or they finish half way and then they would never go to the university. It’s not just girls that are in school; for many reasons there are girls that are also out of school, and today I saw a wonderful example in Iran of a community center [called Ofogh for adolescents where they can go and to learn to communicate and acquire life skills] where young girls are being taught through workshops and taught through interacting with each other about good health and how to avoid social problems in the future.

And we were accompanied by Dr. [Mohammad Mehdi] Gouya, Director of the Health Ministry’s Communicable Diseases Control Department, who is a brilliant scientist but who is also helping the people in Iran to understand life skills which is so important for their future.

And the last observation I made about Sustainable Development Goals in reproductive health is that it was in Tehran 50 years ago that the first International Conference on Human Rights took place and during this very famous conference that was the first time when the United Nations and all the countries agreed that it is the right of couples to freely and responsibly plan their family. So for UNFPA this was kind of our beginning and we will be 50 years old next year because we were born from this conference so this is why we are very happy to be in Iran and we know it’s a historic location for choice, for women and for couples to be able to plan their families.

5) Why has UNFPA put greater emphasis on women’s role in planning their families regarding the number of children, spacing, etc.?

The woman should be the one to decide and of course it’s natural for the woman to confer. This is the whole point: we have to trust women to make these decisions because the woman is one half of the couple and is the one who bears a child; the woman also understands how many children she already has and she also understands her responsibilities for looking after the next generation, so it’s her body and the right of the woman over her body has been established. So the woman always has the good sense to confer with everyone who is involved. Now when you say the couple it becomes a little ambiguous – you cannot dictate to a woman to either have or not have a child. The world at times had got into troubles by trying to force women against their will either to have a child or not to have a child and this is why we say that reproductive health should be women-centered and when we are talking about fertility the woman that carries the child should be the one to decide.

This is getting very interesting in a time of technology, for example with the new technology we have to be very sure to respect the right of the woman, as you know there are possibilities to either carry the baby or to be a surrogate mother. There are many things that are coming on the horizon where we feel that for the community and for the woman, herself, she should be knowing that’s her choice if she likes to have contraception it should be available; if she would like to have a baby we should support her with all the good care and support and the aftercare in the aftermath as well.

It’s interesting that as we think about the configuration of the family and as we think about the demographic transition- as I have described- the danger when you get into a low fertility environment is that there is a temptation to insist that, “Well, you should have three children – the country needs you.”

Ultimately, if you have a healthy productive ageing population that’s contributing, a smaller population can be better than a bigger one. There are many countries that have a big population but they are very poor – they have too much of a population to be able to care for them, so these are the kinds of issues that UNFPA helps to discuss with governments – and in any case I think governments would want to take good decisions based on what’s good for women in their country.

https://www.tehrantimes.com/news/429414/Iran-9th-country-with-lowest-maternity-death-worldwide

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.”