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Positive Pregnancy Test: “But, I Am Not Sexually Active!”

Positive Pregnancy Test: “But, I Am Not Sexually Active!”

2019-11-26

I can still recall her young face overcome with concern as she learned of her positive pregnancy test. She was just 16 years old and a relatively new patient at the time. Her situation was complicated by the fact that her grandmother, her legal guardian, was sitting in the waiting room. Grandma had met me prior to the appointment and clarified that, although she respected the fact that I wanted to see her ward alone, she absolutely did not want me “putting ideas into the child’s head” by offering her any form of birth control.  Grandma further stated that she would not be here with her granddaughter today if someone had not talked about “these things” with her own teenage daughter 16 years ago.

Confidentiality in our pediatric and adolescent practices 

 is often the key to engendering confidence and trust within our patients.  In their article published in the October issue of Pediatrics in ReviewDrs Maslyanskaya and Alderman discuss the need to educate both adolescents and caregivers about the importance of confidential care to ensure the patient’s emotional and physical wellbeing. This applies particularly in the sensitive domains of sexual health, substance use, and mental health. Research has shown that adolescents, if not guaranteed privacy, are less likely to access health services for reproductive and substance use issues. The authors further describe that physicians should consider multiple factors when weighing the ability of the adolescents to interpret health information and make health care decisions autonomously.

Laws regarding confidentiality and consent may vary drastically from state to state, especially with regards to consent for reproductive health needs (including abortion). Maslyanskaya and Alderman advise that pediatricians faced with these dilemmas understand the limits of confidential care for adolescent patients and provide resources relevant to different states in the United States. Physicians should be aware that minors may gain legal status as adults under certain state and federal laws, including the concepts of “mature” and “emancipated” minors. The authors emphasize that federal laws like HIPPA, Title X , SAMHSA and MEDICAID override state laws and, thus, familiarity with both is essential to the provider. Pediatricians should also be aware that there are instances when they must “break” confidentiality, in the best interest of the patient, as in cases of child abuse or when there is a risk of suicide or homicide. For public health reasons, sexually transmitted infections (STIs) also must be reported to the local health department to ensure that partners are treated and to prevent the spread of the disease.

Finally, the authors discuss that, with the increased use of electronic records, pediatricians should ensure that they are careful to protect confidential information. Strategies may include blocking sensitive information from after-visit summaries and advocating for institutional policies restricting the use of internet portals by parents of teenagers.

In our case, the teenager chose to continue the pregnancy and consented to her grandmother being included in the conversation and planning for the future. She was also made familiar with different long-acting reversible contraceptive methods that are available to prevent future pregnancies.

Nupur Gupta, MD, MPH, Editorial Board Member, Pediatrics in Review November 25, 2019

A staggering one-in-three women, experience physical, sexual abuse

A staggering one-in-three women, experience physical, sexual abuse

Here is the grim reality, in numbers: A third of all women and girls experience physical or sexual violence in their lifetime, half of women killed worldwide were killed by their partners or family, and violence perpetrated against women is as common a cause of death and incapacity for those of reproductive age, as cancer, and a greater cause of ill health than road accidents and malaria combined.

The prevalence of the issue, “means someone around you. A family member, a co-worker, a friend, or even yourself” has experienced this type of abuse, Secretary-General António Guterres said in his message to mark the Day.

“Sexual violence against women and girls is rooted in centuries of male domination”, he added, reminding the world that stigma, misconceptions, under-reporting and poor enforcement of laws perpetuate impunity in rape cases.

“All of this must change…now”, the UN chief urged.

Damaging flesh, imprinted in memory

To spotlight the scale of the problem, on this year’s International Day of the Elimination of Violence against Women, the United Nations is sharing the many ways in which the scourge manifests itself in physical, sexual and psychological forms, and the organisation is underscoring the life-altering, adverse consequences women suffer as a result.

  • intimate partner violence (battering, psychological abuse, marital rape, femicide);
  • sexual violence and harassment (rape, forced sexual acts, unwanted sexual advances, child sexual abuse, forced marriage, street harassment, stalking, cyber- harassment);
  • human trafficking (slavery, sexual exploitation);
  • female genital mutilation
  • child marriage.

The Declaration on the Elimination of Violence Against Women, issued by the UN General Assembly in 1993, defines violence against women as “any act of gender-based violence that results in, or including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”, the UN highlighted on the Day.

Rape isn’t an isolated brief act. It damages flesh and reverberates in memory.–Executive Director of UN Women

Beginning Monday, and for the upcoming two years, the UN chief’s UNiTe to End Violence against Women campaign will focus on the issue of rape as a specific form of harm, encouraging people to join the initiative and “Orange the World.”

UN Women’s Executive Director, Phumzile Mlambo-Ngcuka, expressed her concerns when it comes to rape specifically.

She said the end of the horrendous act would mean eliminating a “significant weapon of war from the arsenal of conflict”, the absence of a daily risk assessment for girls and women who actively work to avoid an incident that could leave them scarred.

“Rape isn’t an isolated brief act. It damages flesh and reverberates in memory. It can have life changing, unchosen results – a pregnancy or a transmitted disease”, Ms. Mlambo-Ngcuka stressed, adding that consequences of a one-time act can sprawl into damaging long-term effects.

“It’s long-lasting, devastating effects reach others: family, friends, partners and colleagues”, she continued. ­

In addition, research by the World Health Organization (WHO), details disturbing impacts of violence on women’s physical, sexual, reproductive and mental health:

Women who experience physical or sexual abuse are twice as likely to have an abortion, and the experience nearly doubles their likelihood of falling into depression. In some regions, they are 1.5 times more likely to acquire HIV, and evidence exists that sexually assaulted women are 2.3 times more likely to have alcohol disorders.

More women abused than not, in US

Some national studies examining incidents in the United States show that up to 70 per cent of women have experienced physical and or sexual violence from an intimate partner, according to UN Women.

The agency cited that nearly a quarter of female college students reported having experienced sexual assault or misconduct in the US, but harm targeting women and girls knows no bounds. 

Multi-country investigations by WHO show partner violence to be a reality for 65 per cent of women in some parts of sub-Saharan Africa, and around 40 per cent of women in South Asia, as well as Andean parts of Latin America.

Meanwhile, even in regions where incidents are less likely, as in East Asia and Western Europe, more than 16 per cent and 19 per cent of women have experienced intimate partner violence, respectively.

Psychological violence is another layer to the problem, with some 82 per cent of women parliamentarians in a recent study, reporting having experienced remarks, gestures, threats, or sexist comments while serving – most often via social media.

While gender-based violence can happen to anyone, women who identify with the LGBTI community, migrants and refugees, indigenous minorities, and those living through humanitarian crises, are particularly vulnerable to gender-based harm.

“Almost universally, most perpetrators of rape go unreported or unpunished”, Ms. Mlambo-Ngcuka explained. “For women to report in the first place requires a great deal of resilience to re-live the attack…In many countries, women know that they are overwhelmingly more likely to be blamed than believed.”

Attacks targeting women continue to be an obstacle to achieving equality, and impede the promise of the Sustainable Development Goals (SDGs) to leave no one behind.

Several public events are being coordinated for this year’s International Day to commemorate the fight against gender-based violence, spotlighting rape specifically.

Criminalizing the offense, placing women in positions of power, and strengthening the capacity of law enforcement, are some steps to increase accountability in incidents of sexual assault.

The effects of such violations suppress voices and traumatize, at “an intolerable cost to society”, said Ms. Mlambo-Ngcuka.

“No further generations must struggle to cope with a legacy of violation.”

What Can Brain Scans Tell Us About Sex?

What Can Brain Scans Tell Us About Sex?

2019-09-19

Men have a far greater appetite for sex and are more attracted to pornography than women are. This is the timeworn stereotype that science has long reinforced. Alfred Kinsey, America’s first prominent sexologist, published in the late 1940s and early 1950s his survey results confirming that men are aroused more easily and often by sexual imagery than women. It made sense, evolutionary psychologists theorized, that women’s erotic pleasure might be tempered by the potential burdens of pregnancy, birth and child rearing — that they would require a deeper emotional connection with a partner to feel turned on than men, whose primal urge is simply procreation. Modern statistics showing that men are still the dominant consumers of online porn seem to support this thinking, as does the fact that men are more prone to hypersexuality, whereas a lack of desire and anorgasmia are more prevalent in women. So it was somewhat surprising when a paper in the prestigious journal P.N.A.S. reported in July that what happens in the brains of female study subjects when they look at sexual imagery is pretty much the same as what happens in the brains of their male counterparts.

Marijuana may undermine fertility treatment success

Marijuana may undermine fertility treatment success

2019-08-22

By Anne Harding

(Reuters Health) – Women undergoing fertility treatment who smoke marijuana may have more success if they quit, recent research suggests.

Marijuana plants are displayed for sale at a medical marijuana dispensary in Seattle, Washington, November 27, 2012. REUTERS/Ant

Among more than 400 women undergoing treatment with assisted-reproduction technology (ART), the small fraction who reported using cannabis at the time were more than twice as likely to lose a pregnancy than those who had never smoked marijuana, or who had only used it in the past, Dr. Jorge E. Chavarro of Harvard T.H. Chan School of Public Health in Boston and his colleagues found.

Unexpectedly, the small fraction of couples in which the man was the only current marijuana user were significantly more likely to have a baby.

But this finding should be seen as showing lack of evidence for harm, rather than as evidence that pot has a positive effect on male fertility, Chavarro and his colleagues conclude in the journal Human Reproduction.

“The bottom line remains that we know way too little about the reproductive health effects of marijuana,” Chavarro said in an email. “The scarcity of information is particularly concerning given the concurrent trends of expanded legalization, increased perception that marijuana poses no health hazards and increased consumption among men and women of reproductive age, including among pregnant women.”

Just three studies have looked at how marijuana smoking by both partners affects fertility, the researchers note. Two of them, in couples trying to conceive naturally, found no effect. The third, in couples using ART, found no effect on pregnancy or live births but did find users had lower egg yields and fertilization rates.

The new study included 421 women who underwent 730 cycles of ART between 2004 and 2017 at a Boston fertility center. Male partners of 200 of the women also enrolled. Forty-four percent of the women and 61% of the men reported ever using marijuana, while 3% of women and 12% of men admitted to being current marijuana smokers.

During the study, 317 women had a positive pregnancy blood test in a total of 395 ART cycles, including nine women (16 cycles) who were marijuana users. Pregnancy loss occurred in 54% of the marijuana smokers and 26% of the non-users.

Among couples in which the male partner was the only current marijuana user (23 couples, 41 cycles), 48% had a baby, versus 29% of couples in which the man was a non-user.

Some animal studies have suggested that activating the endocannabinoid system – naturally occurring signaling molecules that chemically resemble cannabis – at low levels improves testicular function, while higher levels of activation depress it, Chavarro noted.

However, he said, “Most of the human literature to date has been among men on the higher end of use and most show a deleterious effect of marijuana on sperm and testosterone production.”

“The take-home message is still 100% do not use marijuana while pregnant or trying to get pregnant,” said Dr. Nathaniel DeNicola, an assistant professor at The George Washington University in Washington, D.C., who wasn’t involved in the study.

While research is scarce on marijuana use and fertility, he said in a phone interview, 30 studies have looked at marijuana and pregnancy, and the body of evidence shows a “signal” that women who use cannabis in pregnancy are at increased risk of having a low birthweight infant, of delivering pre-term and of stillbirth. “When marijuana is used at least weekly, or more than weekly, that’s when the risk starts to get more concerning,” he said.

In June, a practical guide for physicians published in the journal CMAJ summed up existing evidence on marijuana and fertility, echoing some of these warnings (https://bit.ly/2MvmZnw). Overall, men’s use of cannabis once a week or more was linked to a 29% reduction in total sperm count, and women’s use within the past three months was tied to delayed ovulation.

While the evidence does not show that using marijuana affects the ability to conceive for most couples, for those struggling with infertility, marijuana use “could compound their difficulties,” write Dr. Sara Ilnitsky and Dr. Stan Van Uum of the Schulich School of Medicine and Dentistry at Western University in London, Ontario, Canada.

SOURCE: https://bit.ly/31X0fjY Human Reproduction, online August 14, 2019.

Report shows parents’ failure in talking to children about sex

Report shows parents’ failure in talking to children about sex

2019-06-28

A new report has laid bare parents’ failure to educate their children, especially girls, on sexual reproductive health, leaving the responsibility to the internet.The report by Geopoll has also shown that youths are more worried about contracting Sexually Transmitted Diseases (STDs) than unplanned pregnancies or being sexually abused.

The report, released on June 11, states that while majority of the youth would be interested in sexual reproductive health education, parents play a minimal role in imparting this knowledge to them.For example, 62 per cent of the youths polled said they learnt about menstruation from school, with just 12 per cent saying they were informed of the same by their parents.When asked what had been their “most important” source of information on sexual reproductive health, parents also came a distant second at 17 per cent, the same level with social media, internet, books and magazines.

TV and radio was cited as the “most important” source of information on sexual reproductive health at 42 per cent for the non-educated youths.The picture was even worse when the same question was posed on “educated youth” as parents did not appear among the listed top nine preferred sources of sexual reproductive health.

In this category, social media was cited as the most preferred way of receiving this information at 31 per cent, followed by school extracurricular workshops (23 per cent) and class setting (17 per cent).

“It became apparent that parents are one of the least used sources of information on appropriate sexual reproductive health education at only five per cent in Nairobi and Homa Bay counties, 11 per cent in Kilifi, four per cent in Narok, eight per cent in Nyeri and nine per cent in Wajir County,” the report reads in part.The study involved interviewing 1,125 youths between the ages of 18 and 24 in Nairobi, Kilifi, Homa Bay, Narok, Nyeri and Wajir Counties.A disturbing finding, as revealed by Geopoll Director of Project Management Tavian MacKinnon, is the fact that youths are more frightened by the idea of contracting STDs than unwanted pregnancies or being sexually abused.

“As one of our top concerns, we identified that 38 per cent of respondents said they would want to know more about HIV/Aids, 22 per cent would want to learn more about contraceptives and only 6 per cent wanted to learn more about sex,” said MacKinnon.Further, only 10 per cent were interested in learning about sexual rights.

These findings mirror the situation in Kilifi County, which has been in the news over cases of teenage pregnancies linked to poor knowledge on uptake of contraceptives.As a result, at least 17,000 teenage pregnancies were reported in the county last year, where five per cent of the pregnant teens also contracted HIV.Jiactivate Chairperson Grayson Marwa said Kilifi was one of the counties in which the organisation had rolled out a programme on comprehensive sex education after the survey partnered with Geopoll.

“This survey was informed by the findings from media and a report done by the United Nations Population Fund that put three counties – Kilifi, Narok and Homa Bay – with the highest number of teen pregnancy rates and as such we are rolling out an intense three-year mitigation campaign in those counties,” said Marwa.He said the organisation would similarly extend the conversation online, which has been found to be a major source of sexual reproductive health education, through a campaign dubbed WIWIK (What I Wish I Knew).

https://www.standardmedia.co.ke/article/2001331304/report-shows-parents-failure-in-talking-to-children-about-sex

It’s time to talk about sexual incompatibility

It’s time to talk about sexual incompatibility

2019-06-11

What happens if you meet someone kind, smart and funny, but erotically you just don’t click? Alix Fox explores the frustration of sexual incompatibility

On paper, Rohanna and Dan*, 26, were such a match they’d set the page alight. “I was totally disarmed by the chemistry,” she recalls. “He had a fascinating brain, a sweet soul, a fabulous job and he was as doe-eyed over me as I was over him.”

But when it came to having sex, the man who seemed destined to be Rohanna’s everything did nothing for her. “We both had so much enthusiasm, but it was like our bodies didn’t mesh. I kept waiting for something to kick in. It was a kick in the guts when it didn’t. We stayed together for six months then split up.”

When sex seems hexed in this way, it can be as mysterious as it is heart-wrenching. “Evidence is scant, but it’s been suggested there may be subconscious mechanisms at play in some cases of erotic incompatibility,” says Cynthia Graham, professor of sexual and reproductive health at the University of Southampton. “Evolutionary psychologists have posited that we might experience sexual clashes with people whose genetic complexes are discordant to our own, because it affects the ability of us and our potential offspring to fight disease.

But often, incompatibility comes down to a contrast in sexual tastes and appetites – most notably, a mismatch in libidos. Data from Natsal, the British National Surveys of Sexual Attitudes and Lifestyles (one of the broadest and most detailed scientific studies of its kind worldwide) indicates one in four UK couples are imbalanced in their desire for sex.

“It’s common, but it can be devastatingly destructive,” observes psychosexual therapist Aoife Drury. “If the higher-libido individual pushes for sex, the partner with the lower drive can feel anxious or angry, thus losing desire further. The higher-libido individual may then stop initiating sex for fear of rejection or being seen to nag. Intimacy grinds to a halt, creating feelings of resentment or disconnect.”

A survey by dating site eHarmony found that 20% of Brits feel they’re somehow sexually incompatible with their partners. Problems cited include one person being more focused on the physical rather than emotional side of sex and differences in degrees of erotic adventurousness or allure towards a fetish. Yet there are two commonalities running through virtually all incidences.

“Firstly, people expect sex to be unrealistically harmonised in a way nothing else in relationships, or life, is,” says Kate Moyle, resident therapist on BBC Three’s new counselling series Sex On The Couch. “And secondly, perhaps because Brits find sex excruciating to talk about, they may write issues off as inherent, unfixable incompatibility and move on, rather than attempt to address them in any real, practical manner.”

Graham believes this second factor is key. “Natsal’s report showed the strongest predictor of sexual problems, short and long-term, to be a lack of effective communication,” she adds. Learning to communicate and collaborate is the best thing anyone can do for their love life.

But what does that actually look like? If you and your lover decide that trying to increase your sexual rapport is worth a shot, the following advice – while not comprehensive – is better than taking a clueless shot in the dark. Consider it a jumping-off point. It might give you hope that you don’t need to jump ship. Start by viewing sex as something most people work on, rather than something that should just work. “If we see incompatibility as inevitable, we can remove some of the shame and start to think creatively and constructively about it,” suggests Meg-John Barker, co-author of Enjoy Sex: How, When And If You Want To. 

SEE AN OPPORTUNITY, NOT A TASK

A lot of what makes sex fun is exploring and playing. “The idea of consistently wanting exactly the same type of sex as your partner might ostensibly seem perfect, but as well as being improbable, in the long term it could even get boring. Examining sexual divisions offers unique opportunities for personal development and revelatory discoveries,” says Moyle.

This might seem trite, especially if you’re in a relationship where sexual issues have run on so long and the damage has ploughed so deep that your soul feels sandpapered raw, but it is at least worth heading into the process with a positive head on.

Comedian Fran Bushe’s show Ad Libido centres on her struggle with vaginismus: a condition whereby the vaginal muscles involuntarily clamp shut. “I have to do extensive admin with partners to actively build up our sexual compatibility because of how my body functions,” Bushe says, “but it means we create something special together; they’re not just whipping out the same toolkit of moves that worked on their ex.”

ACKNOWLEDGE THE AWKWARD

Therapeutic exercises can feel excruciatingly contrived when you first attempt them. Many have a tree-huggy vibe that makes you cringe. “Recognising how silly and vulnerable you feel out loud helps break the tension, and laughing about it together is bonding,” says psychosexual therapist Sarah Berry. Studiously pretending that embarrassment doesn’t exist is a form of performance, when your real goal should be to share authentic, honest experiences.

Darrell, 31, was suffering from erectile dysfunction (along with 11.7 million other men in the UK, according to online medical service Zava), in his case caused by anxiety, so he and his partner Sheena, also 31, tried rebooting their strained sex life using the ‘sensate focus’ method.

“You start by touching each other while still fully clothed, avoiding erogenous zones, then gradually build up intensity over a series of weeks, to help you tune into sensations and emotions,” he explains. “We both felt like dicks, but by week four, my dick worked. Removing expectations I had to get it up helped, but so too did giggling at the ridiculousness. For months our bedroom had been the site of tearful rows.”

THINK ABOUT WHY YOU HAVE SEX

“A 2007 paper published by The University of Texas at Austin identified 237 different motivations subjects gave for having sex, from ‘to show thanks for something my partner has done’ to ‘it gets rid of a headache’ to ‘it makes me feel closer to God’,” says Jennifer Gunsaullus, the host of Dr Jenn’s Den, a sex education show on YouTube. “Examining the true reasons we’re seeking sex in each instance – like relief from boredom or stress, or for a self-esteem boost – can highlight where alternative actions may still satisfy our needs.”

SCHEDULE SENSUALITY

Setting out a schedule for sex has a bad rep; it seems clinical and unromantic for lovemaking not to spontaneously spring from burning desire. Yet setting aside predetermined windows for eroticism shows that it’s a priority, and is a damn sight better than leaving things to wither indefinitely on the backburner while life gets in the way.

Plus, knowing when to expect intimacy saves higher-libido partners from the fear their ad hoc come-ons might be crushingly rejected or interpreted as hectoring. It also allows lower libido partners to build the anticipation and get their head in the right place for jumping into bed

EXPAND YOUR IDEA OF WHAT COUNTS AS SEX

“Make sex menus: brainstormed lists of all the sensual and thrilling things you know you like or would be up for trying, and see where you and your partner overlap,” suggests Barker. Download DIY guides from megjohnandjustin.com.

INTRODUCE THE PURPLE PASS

Named after Prince, who in his hit Alphabet Street sings, “Tonight I’m just not in the mood, so if you don’t mind, I would like to watch,” the ‘purple pass’ involves giving your partner permission to masturbate while you witness them approvingly. You might encourage them by enthusing about how hot they look, so they get off and you take part without doing anything physical that you don’t feel up to.

DON’T LET LABELS RESTRICT YOU

“There’s so much power in proudly naming your fetishes and fascinations, but labels like ‘dominant’ can become restrictive cages if they’re interpreted too rigidly – and not the saucy kind of cage,” says Gunsaullus. Before writing someone off because they don’t share your particular kink, examine what you get from it emotionally. You might enjoy being submissive in S&M scenarios because you find relief in relinquishing responsibility, maybe you like to please by fulfilling orders or perhaps a powerful lover fixating upon you makes you feel craved.

There are softer ways to serve these longings if your partner doesn’t always want to take the reins or is still learning the ropes. Think of your kinks as you liking a type of energy rather than having a set identity. But what if you reach an impasse because you and your partner’s kinks are too much in sync and you both want to play the same role? “My girlfriend and I are both submissive,” says Janine*, 24. “When it’s my turn to play domme, I command her to spank me or use a dildo on me while I lay pliant, so I’m in charge but still get a similar physical experience to being the underling.”

MAKE USE OF RESOURCES

“I wish people viewed therapists for sex like they do dentists for their teeth, and visited them as a preventative measure to set their private lives on a healthy course rather than waiting until everything is rotten and they are falling out,” says Moyle.

However, if you’re not at the stage of seeking private counselling but want professional assistance in navigating incompatibilities, resources are out there. Sex coaching site Betty Martin features free videos and printable worksheets for couples. Mindfulness app Headspace offers guided meditations centred on relationships. Where Should We Begin?, a podcast that listeners have dubbed ‘the Rosetta Stone of feelings’, lets you listen in on real-life couples’ sessions with psychotherapist Esther Perel.

Educational site The School Of Life’s Pillow Talk cards help pilot constructive conversations about topics like sexual shame and power dynamics, while the London-based Havelock Clinic provides 45-minute online workshops on sexual desire and you can talk to their medical experts via instant message throughout the session.

MAKE PEACE WITH THE SITUATION

Certain couples do find that they never erotically align, so some decide to draw a line under their relationship. “I grafted at sex for eight years with a man I loved but whose natural drive was far lower and plainer than mine,” says Kathryn, 32. “We both tried so hard, but I hit a stage where whatever I was learning by trying to meet him in the middle was outweighed by what I lost by leaving my satisfaction on the sidelines.”

Yet even if sexual incompatibility remains, ‘sadly stay’ or ‘go, gutted’ are not the only options. “I challenge that binary,” says Barker. “You might consider opening things up. Consensual non-monogamy works for many people by allowing them to maintain wonderful, close relationships while having their sexual needs met elsewhere.

But there are also many folks who simply decide sex isn’t important to them after all, especially over time. I undertook a study into ‘enduring love’ with Jacqui Gabb, professor of sociology and intimacy at The Open University, which found that many, if not most, long-term couples had sincerely happy relationships that didn’t feature much sex together.”

For some ‘incompatible’ pairings, concluding that sex isn’t the be-all and end-all is the key to a happy ending. But for others, taking sex seriously enough to wholeheartedly commit to discovering and nurturing the parts where their individual Venn diagrams of sexuality overlap – that’s what prevents it being over.

Lily says:

“You can have great sex because somebody has a wonderful penis and knows how to use it, even though you’re not that into them. Or you can meet someone you connect with, but their penis is just not doing it. I’m pretty good at faking it, I’ve been doing it for 20 years. But this is a serious issue. There are girls who think there’s something wrong with them because they haven’t had an orgasm yet.”

SERIES

Lily Allen Takes Over

Many marriages in Pakistan are troubled by sexual incompatibility but no one talks about it

Many marriages in Pakistan are troubled by sexual incompatibility but no one talks about it

2019-04-26

Lack of sex education and sexual intimacy has adverse effects on couples’ married lives

BY KAUKAB TAHIR 

KARACHI: Rarely ever taken to experts, sexual incompatibility is dismissed as a non-issue. Sarah Aziz*, a 32-year-old divorcee – 28 at the time of marriage – says the root cause of the failure of her marriage was her partner’s sexual orientation. For the longest time, the couple struggled as her husband insisted that the lack of sexual intimacy between them was due to erectile dysfunction. But the truth was that he was gay.

“Even lying naked in his arms wasn’t enough to arouse him, and not once did he have an erection that lasted longer than five minutes … enough for him to be able to penetrate.”

Just so his orientation remained closeted, he even took Viagra but nothing made the situation better. She says, “I had to live in agony for over two years until one day I caught him doing a Skype session with a man.”

As a set norm in Pakistan, married couples are expected to deal with sexual incompatibility behind closed doors and drawn curtains. In this silent struggle, many red flags go unnoticed until it is too late. Kinza Raza*, who is 23 years old (21 at the time of marriage), spoke to Cutacut about her traumatic, four-month-long relationship with her impotent partner. Crushed under society’s many taboos on the subject, Raza suffered from sexual discontentment silently. She kept quiet out of fear of judgement and blame, thinking that talking about problems in her sex life and sharing what she was going through would worsen things for her.

“Even lying naked in his arms wasn’t enough to arouse him”

“Since my husband was impotent, we could never have sex,” says Raza. But instead of working with her on the problem, her husband would beat her up, threatening her to never speak about it. Raza continued to suffer alone, in silence, until one day she fought back and beat up her husband with a wiper.

These stories are far too common in  Pakistani society. A number of young people, especially women, have heartbreaking accounts surrounding sexual dissatisfaction in wedlock.

Misinformation about sex

But the issue doesn’t only extend to women; men, too, struggle to discern head from tail. Couples aren’t aware of the basic dos and don’ts of having sex. They are yet to inform themselves on what may result in a pregnancy.

“I had a love marriage and despite being extremely fond of my wife, I was scared to penetrate thinking she might get pregnant,” said Mubeen Ahmed*, a 30-year-old working professional. Ahmed said even until the end of their honeymoon, the couple hadn’t had intercourse. Only after coming back from the trip, when his partner sought medical help and was prescribed contraceptives, they felt comfortable enough to consummate the marriage.

Speaking of misconceptions, Dr Kishwar Lucas, a general practitioner and sonologist at Karachi’s Good Samaritan Hospital, shared a harrowing experience where she examined a patient who complained that she was unable to conceive.

After a thorough checkup, it turned out that her hymen was still intact and that she was having anal sex with her husband that whole time.

“Men misuse girls and misbehave with them,” said Dr Lucas. Plenty of similar cases are reported to hospitals on the daily.

Sexual health and emotional well-being

Sometimes, the cause of sexual discomfort between couples is also linked to a person’s previous sexual experience. If diagnosed in a timely manner, it can be treated through cognitive therapy.

Problems around not being able to perform sexually generally stem from psychological ups and downs. Many times, the psychological hangups manifest into adverse effects on a person’s physiological health. So it makes matters worse when treatments such as counseling therapy are shunned by our society when, in fact, they should be readily available.

Neither children nor adults are provided the adequate knowledge. The information should come through a reliable source within their reach instead of porn or gossip, said Dr Humair Yusuf, a psychotherapist and private practitioner based in Karachi.

Read: Does watching too much porn affect your sex life?

“It is about time that torrents are excluded from the list of sources that teenagers (and adults) learn about sex from.”

Learning about sex from unreliable sources 

Curiosity around sex and asking questions about it is discouraged. When compared, this censorship is especially strong among teenage girls as sexual empowerment for women remains a taboo subject in our society.

People can only be prepared on what to expect if they are taught about sex from a young age, preferably their teens. Radio silence about these matters leads teenagers, especially girls, into believing that sex is an unspeakable crime or sexual activity makes them untouchable.

Read: We answer sex questions guys are too afraid to ask

“The problem in our society is that sex has been extremely romanticised, and not educating 17 or 18-year-olds — who are dating and are suffering from peer pressure — often lands them into trouble because they are not aware,” says Amna Imran, a lecturer and a mother of an 11-year-old. “I am open and honest with my daughter. She already knows that babies aren’t sent into this world through angels but in fact come out of the mother’s womb.”

How do we fix this endemic?

It is a norm in Pakistan for people to be exposed to sexual activity only after they are married. Prior to that, most are sexually inactive. They discover their sexuality and learn about their sexual health once they enter wedlock, which makes things a lot more complicated.

Ideally, the government should take up the responsibility to educate masses about healthy sexual habits, added Dr Yusuf.

In the age of the Internet, where people, including teenagers, regularly indulge in pornography, it is crucial that they learn about healthy sexual relations from a young age.

“People aren’t able to flag issues because they don’t have the slightest idea. It is important we conduct timely counseling so couples know when to escalate the problem,” stressed Dr Lucas.

Men are still able to identify the signs but it takes women a long time to figure out what’s going on. By the time they learn, their relationship and sexual chemistry has already worsened irreparably, she adds.

*Names have been changed to protect identity

Here’s how Pakistani women get judged buying contraceptives

Here’s how Pakistani women get judged buying contraceptives

BY SHAHEERA ANWAR 

KARACHI: It’s no surprise that unwanted pregnancies occur all around the world. And to avoid these, people use different types of contraceptives – some of which, also prevent sexually-transmitted diseases from spreading. Birth control pills and condoms are some of the most common types of contraceptives used by both men and women worldwide. However, in a country like Pakistan – where even the use of the word ‘sex’ raises concerns – buying contraceptives can sometimes invite judgmental gazes. Likewise, a young girl based in Karachi, was also judged for buying emergency contraceptive pills (ECP) off the shelf. Sharing her experience, Kulsoom Masood, a 22-year-old university student, posted a status on Facebook.

She wrote, “I went to a medical store to buy ECP for my research and presentation on sexual health in Pakistan. I knew that there will be some reaction but little did I know that things will get so interesting. I went to the counter and asked ‘Sabz Sitara Ki ECP de dein’ (Please give me ECP by Sabz Sitara). The guy, who was smiling and staring at literally every lady in the line, changed his expressions suddenly. He looked at my university bag which also had a student ID card on it and started speaking to the guy next to him in Pashto.”

Kulsoom, being a Pashtun understood every word he said. She continued, ‘He said to the other guy, ‘This girl is asking for ECP, should I give it to her? She doesn’t look like a ‘bad girl’ from the way she is dressed.’ The other man replied, ‘Tell her that the tablets are very expensive.’ The same guy then came towards me and told me in Urdu that the tablets are very costly. I replied to him in Pashto, ‘Pa su dee?’ which meant, ‘How much do they cost?’ which is when both of their expressions changed.”

The 22-year-old then told them that her father was waiting in the car outside the pharmacy and she wouldn’t mind if they gave her the contraceptives in front of him. Kulsoom said that the men later apologised and gave her the pills right away. However, she did school them further in Pashto and added, “I told them, ‘You gave me the pills because I replied to you in Pashto, but normally, you would start taking advantage of such people who are in dire need of contraceptives. You’re going to tell them that they are expensive and if they can’t afford them despite that, you would only be creating problems for them.’ I also said that God has given them a responsibility of helping people out but by doing so, they’re only going against Him.”

Recalling the experience, Kulsoom explained that the stigmatization of sex and not being openly able to discuss topics related to it, has also sexualized medicines/drugs that has something to do with a sexual activity. She said, “The shopkeeper readily judged me for buying it and even though the Pakistani Government has made sure that people could get contraceptives without any prescription, women still go through judgmental eyes of shopkeepers and pharmacists.”

 

4 Things Men Don’t Know About Antidepressants

4 Things Men Don’t Know About Antidepressants

2019-02-20

Including how they don’t have to wreck your sex life.

Last Tuesday was bittersweet. One of my “guys,” a 29-year-old writer, came in for his final session. He was better. When we’d met he’d never seen a psychiatrist and never thought he’d take a medication. “I hear they are addictive, and the side effects…I don’t want to be a zombie.”

Misperceptions about psychiatric medications and mental health treatment kill a lot men. While we have half the risk of depression compared to women, we are four times as likely to die by suicide. I’ve helped hundreds of men with mental health concerns and for many, medications are a part of the path to recovery. A few of the facts I wish men knew about them:

1. Sexual side effects are variable and manageable.

True, between 30 and 50 percent of men have sexual side effects from SSRI antidepressant medications. But sexual side effects can be easy to fix—if they need fixing. The most common side effect is a delay in climax, so for some guys this is a plus. But if the problem is that you can’t get it up, don’t worry; you’re not stuck with it. You can change meds. Different meds affect different people differently (this could be my mantra). I’ve seen men have sexual side effects taking Prozac but not when taking Zoloft and vice versa.

A few antidepressants, namely Wellbutrin (bupropion), Remeron (mirtazapine), and St. John’s Wort, have no sexual side effects. You can also consider taking a medication holiday—the half-life of most antidepressants is 24 to 36 hours (talk to your prescriber before taking days off). Finally, there are medications like Viagra and Cialis if an antidepressant medication is necessary but causes sexual dysfunction.

2. Antidepressants aren’t just for making you happy

Depression is not just a disease of sadness. Instead of being tearful, some men get irritable, isolated, and sleepless. Most antidepressant medications influence serotonin, and can help with those symptoms. In addition, this molecule is involved in more than our moods, namely our sex drive, appetite, sleep, cognition, and creativity. Men are often poor judges of the effects of depression on our own lives. So don’t just consider the medications’ effects on your mood; they can have a much more global impact on your functioning.

3. They work

Look, I take no money from big pharma. I’ve treated folks with depression for almost two decades. Medications don’t work for everyone, but they work. I like to start with low doses and try to avoid complex combinations of medications i.e. “polypharmacy”. Many people have had side effects from medications like weight gain, increased anxiety, and sedation, but many have none. Still, in the right hands, there is little as powerful or rapidly helpful as medications for certain mental health concerns like severe depression, insomnia, and feelings of suicidality.

4. Meds aren’t the whole picture

Patients assume that meds are my first move as a psychiatrist – and sometimes they are. But treatment today is about preference, options, and empowerment. Many things have an antidepressant effect. Talk therapy, lifestyle changes (sleep, exercise, eating right, reducing alcohol consumption), mindfulness and a few supplements all have evidence they help. Medications can help these other options to work. Engaging in psychotherapy and healthy lifestyle changes is much easier without severe symptoms.

Married millennials still need some sex tips

Married millennials still need some sex tips

Sex sells … in advertising. In reality, however, many, especially married millennials, lack knowledge in this area and need guidance. They don’t know how to “satisfy” their spouse.

Humans, similar to numerous other terrestrial life forms, are subject to instinctive sexual desires, triggered by certain criteria.

Although the need for sex is mostly physical, the desire for sex typically begins in the mind and travels to the body. When the mind is stimulated by the object of its desire, it arouses the body.

Sex is a basic element of a happy marriage, but it is more than just a pleasurable calorie-burning activity.

“When it comes to sexuality, it involves five dimensions: physical or biological, cognitive or intellectual, emotional, social and spiritual.

“However, in our society, people tend to talk only about the physical dimension – the climax, G-spot, masturbation, etc,” said Dr Harlina Halizah Siraj, professor of obstetrics and gynaecology, and medical education (clinical teaching), at Universiti Kebangsaan Malaysia’s Faculty of Medicine.

Sexuality is a lifelong learning process and there is no standard formula that can be applied.

“When we talk about the cognitive dimension, we refer to the brain as the most important sexual organ.

“It makes the decision and the sexual organs (genitalia) will just follow. The sexual organs won’t do anything without the brain commanding them.­

“Next, sexuality is intensely connected to emotions – that is why if you want to have a sexual relationship with someone, that person must be consenting, must have the same benefits of satisfaction, respect and love.

“If you force yourself on another person, it will give rise to disrespect, humiliation, hurt feelings, etc.

“In the social dimension – we don’t have to talk about sexuality if you want to live like a hermit in the middle of an island or deep forest without interacting with other human beings.

“Because humans are social animals, we have to interact with people, but those who feel they are ‘good’ and ‘morally correct’ shy away from the subject.

“Lastly, some people interpret sex as spiritual, but actually, it is your significance of existing in this world – how do you define yourself, do you have people who love and respect you?

“In a marital institution, these are all things that give you identity. We can only promote sexual and reproductive health when we give positive input to all these dimensions,” explained Dr Harlina.

Communication is key

Good sex is due to a combination of factors.

Dr Harlina offered, “It is not just one person feeling good; sex must end up with good outcomes.

“For example, if there is going to be pregnancy, it must be planned, intended and wanted.

“If there is a commitment, there should be trust and respect.

“If the woman is menstruating, the man must give her space. If not, it is not good sex.

“In the beginning, the physical component is important in a marriage and you tend to enjoy the act.

“With time, the physical pleasure goes up and down. Towards the end of your marriage, you won’t have sex as frequently as compared to the first few months.

“But you realise that you can connect with that person in other ways.”

Due to the stressors of a high-pressured life these days, many young couples return home late and fatigued.

There are traffic jams to battle, household chores to complete, children to attend to, meals to prepare, etc.

They fail to communicate effectively or have no time for intimacy.

However, Dr Harlina reckoned the mood can be “set up” during the day.

“Nowadays, foreplay can happen during the day via Whatsapp!” she pointed out.

“Sending your husband a message to say ‘Hey, I’m thinking of you’ is good enough. Then he remembers you.

“You don’t have to ‘talk dirty’. Imagine how exciting it would be to finally see each other after work.

“And once everyone is settled in the house, you can have the whole night for yourselves.

“That to me is the manifestation of how good the quality of communication has been throughout the day.

“This can only happen when you can be totally frank with each other. If one person is not feeling up to it that night, then the other party may feel frustrated.

“Remember that the ‘me’ becomes ‘we’ when you get married, so there are a lot of adjustments to make. Sharing is about giving and taking,” she counselled.

It is definitely no fun when one person is giving or taking all the time. Finding that equilibrium is tough.

We all have to live with each other’s idiosyncrasies and imperfections, so every couple has to find their own secret recipe.

Prioritise your sex life, and have it at least once a week.

Some couples don’t enjoy sex because one partner has expectations, a sort of blueprint.

When that blueprint is not followed, one party feels let down. This is where frankness comes in.

“Women are always at the receiving end; men will have successful ejaculation if they have an erection, but women don’t need to have an orgasm; we can fake it.

“I know of women who fake it all the time because they feel obliged to do so. They think if the husband knew they didn’t have an orgasm, he might be frustrated.

“But those are issues we need to be more open about and this can only happen when you are in a stable relationship.

“We all have sexual fantasies – there is nothing wrong with talking about them.

“Knowledge is important – you must know which part of your body is sensitive to sexual arousal.

“Tell your partner where you’d like to be touched – if you can’t even tell that to your sexual partner, then you’re in trouble!” said Dr Harlina.

Women, take control!

Women always assume men don’t care about their sexual needs, but the professor asserted that they do.

“It’s just that they don’t know! They think by doing a certain act, they can fulfil a woman.

“If you tell a man you’re not happy, he will try to please you. Don’t assume they know everything.

“Men are sensitive and reasonable, but you must know how to talk to them. Telling them will prevent a lot of ‘inconveniences’.”

With plenty of singles currently preferring the no-strings-attached concept, Dr Harlina believed it is a trend.

Men are satisfied with physical pleasure without intimacy, but what is more worrying is that women are also following suit.

She said, “Ironically, you need a little bit of attachment for your self-worth. You need an anchor while you’re flying high or else you’ll be like a loose flying kite.

“I feel the sexiest part of the woman’s body is her brain because men are actually very intrigued with a clever woman – one who can challenge him, but in a subtle way.

“He doesn’t want another aggressive person in the relationship, though there are some men who don’t like clever women.

“This is where a woman has to shine. If she is pretty, but has no opinion, then he would be bored.

“He may start looking around for mentally stimulating women and she may not be attractive.

“Also, you get bored with marriage when things are too routine, that’s why people who are meticulous and perfectionists tend to be more moody.

“At the same time, you cannot be too spontaneous and reckless either.”

The stereotypical woman of the past will never make the first move, but times are slowly changing.

“Culturally, it has been ingrained in us not to say no, but a woman has wants too, so take charge!

“Men can force themselves on us because they’re bigger and can push themselves in.

“If you want it the other way round and your husband is not having an erection, there is nothing much you can do. So, perhaps this circumstance is what makes men always have their way.

“If they cannot get an erection, they can have pathological jealousy and think the wife is sleeping with another man.”

On the recent spate of sex parties that take place in high-end condominiums, she said it was also a phase as young people find it thrilling to take part in unlawful activities.

“We want to belong, to see somebody who looks like us. Give these people time and they’ll get tired of their ‘no-strings-attached’ concept.”

To obtain relevant insights and data to educate, engage and empower young adults in sexual and reproductive health, the Federation of Reproductive Health Associations, Malaysia and Durex Malaysia recently launched the “Malaysian Married Millennials Sexual Wellbeing Survey”. All married Malaysians between the ages of 20 and 40 are invited to take part in the online survey and share their views, practices and concerns about intimacy, contraception, and other related areas. Upon completion, respondents will be given access to download a humorous yet informative e-comic booklet titled Drama Kahwin Malam Jumaat.

https://www.durex.com.my/youth-survey/

Read more at https://www.star2.com/health/2019/02/20/married-millennials-still-need-some-sex-tips/#BoeOcdXwVvuerWDk.99