Monthly Archives: January 2016

Zika: Virus may be spread through sex

Sexual Health

Zika: Virus may be spread through sex

2016-01-29

The virus has caused an epidemic in Brazil

Experts fear the Zika virus, which has been linked to brain damage in unborn babies, may be transmitted through sex.

Zika is known to be spread by mosquitos bites and has spread rapidly through Brazil and other South American countries since late 2015.

While it manifests itself as a relatively harmless fever in most patients, it has also been linked to a spike in microcephaly – a condition causing babies to appear to have shrunken heads.

Health officials across the world have warned pregnant women in affected South American countries to take precaution to protect themselves from mosquito bites, with some advising women to put off becoming pregnant.

However, two cases of the virus in medical literature suggest that Zika may also be spread through during sex, prompting experts to call for further investigation into the possibility.

The only known cases of the virus being detected in a man’s semen involved a 44-year-old Tahitian man who contracted Zika during a drink to French Polynesia in 2013, The New York Timesreported.

While his blood was clear, French investigators found traces of the virus in his semen and his urine.

The second case was that of Dr Brain D Foy, an expert in insect-borne diseases at Colorado State University, who unwittingly developed the virus after he travelled to Senegal to collect mosquitos for a study. Both he and his colleague who accompanied him fell ill with a fever when he returned to the US.

Days later, Dr Foy’s wife, a nurse, displayed similar symptoms including headache pains, a rash, and bloodshot eyes.

However, what had infected the three was unclear after the blood samples tested for malaria, dengue fever and yellow fever returned negative.

On the suggestion of another scientist, Dr Foy had the blood samples re-tested and found that he and his colleague, as well as his wife who had remained in the US, had been infected by Zika.

Dr Foy relayed his experience of the virus in the journal ‘Emerging Infectious Diseases’.

Research into Zika is further complicated by the fact that it does not infect common lab animals such as rats and mice, meaning controversial trials on monkeys may need to be used to investigate the condition.

Dr. William Schaffner, chief of preventive medicine at Vanderbilt University Medical School told The New York Times that while two suspected cases do not warrant a health warning from public health officials, he said: “it certainly should be studied.”

However, the World Health Organisation has sought to quell fears and said that

“Zika has been isolated in human semen, and one case of possible person-to-person sexual transmission has been described” but added: “more evidence is needed to confirm whether sexual contact is a means of Zika transmission.”

“The role of Aedes mosquitoes in transmitting Zika is documented and well understood, while evidence about other transmission routes is limited,” it said.

Health officials at the US Centers for Disease Control and Prevention have also said the two apparent instances are a “theoretical risk” and there is insufficient evidence to issue a warning about any concern that the virus may be spread through sex.

Dr Márcio Nehab, a paediatrician and infectious disease specialist at the Fiocruz research institute in Rio de Janeiro said that researchers should focus their efforts on mosquitoes.

zika_0

“We still need a lot of study to conclude that sexual transmission can happen because little is known about the Zika virus.

“At the moment, we have to care more about the known vector, which is the mosquito, as the virus transmission route,” he said according to MailOnline.

Men’s Health Thursday: When Having Sex Is Bad For Your Health

Behaviour, blog-home

Men’s Health Thursday: When Having Sex Is Bad For Your Health

2016-01-25

A lot of us look at all the positive things that comes with having good sex and barely worry about the negative things. If we do worry about it, it will be about coming too fast and not making a fool of ourselves. We should however worry about certain other important things such as headaches which may occur as a result of orgasms or an allergy to your own semen.

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Sounds ridiculous, doesn’t it? These things actually do occur even though they may be rare and far between. Here are three times sex could be bad for your health and what you should do if you ever find yourself in such conditions.

Depression
The feeling after sex should be one of ecstasy and serenity not depression. Some people however feel depressed after sex and this condition is known as post-coital dysphoria. The condition affects fewer men and an antidepressants prescription will do much to reduce the feelings of depression. The drugs however have side effects including delayed ejaculation and low libido. There may also be an underlying cause for the depression which may involve your partner and how you perceive your sexual life. If you suffer from this. You may want to consider discussing whatever sexual issues you have with your partner and solving them. This can help you both to feel happier and better satisfied.

Semen Allergy
Semen allergy may be accompanied with signs and symptoms which include a fever, runny nose, and upset stomach. The condition is known as post-orgasmic illness syndrome (POIS) and occurs when your body incorrectly identifies proteins in your own semen as an antigen or foreign invaders causing your immune system to attack them.

Furthermore, the vagina fluids secreted in women can also trigger an allergic reaction in men, though it is less severe. Also, a man can also develop an allergy to another man’s semen in much rarer cases.

The symptoms for semen allergy may occur immediately or days later. It is essential to see a doctor or immunologist to properly diagnose your allergic condition. However, a study in the journal of Sexual medicine suggests that anti-inflammatory medications when taken before and after sex can go a long way in calming the immune system to prevent any autoimmune reaction that can trigger the symptoms associated with semen allergy.

Headaches
It is estimated that about one in 100 people suffer headaches during or immediately after sexual activity. The research published by the American society of Headache also found out that men were more likely to be sufferers and feel the pain more than women. The headaches sometimes builds up in response to the intensity of the sexual activity or commences the instance orgasm occurs.
The cause of the headaches has been linked to the release of the hormone adrenaline which causes an increase in the blood pressure which may inadvertently, trigger a headache.
It is essential you see a doctor if the headaches occur suddenly, are severe and continues for a long while. Some of these headaches may be a precursor to more serious medical issues such as strokes or aneurysms. Your doctor will be in the best position to determine the best cause of treatment.

Urban myth’ that lesbian women don’t need pap smears is a health risk – study

Behaviour

Urban myth’ that lesbian women don’t need pap smears is a health risk – study

University of Sydney study finds that lesbian women are being tested less for virus that can cause cervical cancer and sexually transmitted disease in general

5474Study co-author Dr Julie Mooney summers said the mistaken belief that, if women didn’t have sex with men, they did not need pap smears was a ‘real frustration’. Photograph: Voisin/Phanie/Rex Shutterstock

An “urban myth” that lesbian women do not need pap smears because they do not have sex with men means they are putting their health at risk, a study from the University of Sydney has found.

Researchers said lesbian women also generally tested less often for sexually transmitted infections than bisexual or queer women.

They said the findings highlighted the importance of targeting health campaigns to specific groups within the lesbian, gay, bisexual, transgender and queer [LGBTQ] community, rather than to that community as a whole.

Researchers analysed data from a survey of 379 women aged between 17 and 30 taken during the Sydney Gay and Lesbian Mardi Gras in 2010 and 2012. The survey, which asks lesbian, bisexual and queer women about their health, sexual identity, sexual relationships and sexual practices, has been conducted every two years since 1996.

While queer women – those who did not identify as lesbian or bisexual in the survey – had the highest rates of illicit drug use, experiences of sexual coercion, and anti-LGBTQ discrimination, they were the group most proactive about their health, the researchers found.

While 58.3% of bisexual women reported being tested for sexually transmitted infections at least once, only 52.9% of lesbian women reported the same, the lowest of the three groups.

Only 65.2% of lesbian women had ever received a pap smear, compared with 70.8% of bisexual women and 79.4% of queer women, the study, led by Rada Germanos from the University of Sydney’s school of medicine and published in the journal, LGBT health, also found.

Pap smears are used to detect cervical cancer, spread by the human papillomavirus (HPV). There are more than 100 different types of HPV and some types, if left untreated, can cause cervical cancer. Most people with HPV don’t have symptoms and while the virus can go away on its own, it can persist and cause harm.

While women most commonly acquire HPV through sex with a man, it can can also be transmitted through genital skin-to-skin contact, or sex toys, making pap smears important for LGBTQ women as well.

Dr Julie Mooney-Somers, one of the authors of the study and a lecturer at the University of Sydney, said almost 60% of lesbian women surveyed had a history of sex with men, which was another reason they should be tested.

“It’s become a bit of an urban myth that women who don’t have sex with men don’t need pap smears, and this is one of the real frustrations about working in this area,” she said.

“Lesbian women also don’t usually need access to contraception so they’re not having those opportunistic discussions with their doctors about screening.”

LGBTQ women were also at higher risk of other cancers, such as lung cancer, due to more prevalent use of tobacco, alcohol and illicit drugs, she said. But the impact of cervical cancer on this group was largely unknown, Mooney-Somers said, because women with cervical cancer were not necessarily asked about their sexual identity.

“The main message is that while we may be doing well around pap smears in general, some women are being left behind,” she said.

“We need to pay attention to them and the reasons behind why they’re not engaging and how we can better target them. Lesbian women may not relate to sexual health campaigns targeting LGBTQ people generally, just like we know some people with problem drinking may not think alcohol campaigns are talking about them.”

Hiranthi Perera, the manager of PapScreen Victoria, has conducted a survey of lesbian, gay, bisexual, transgender and intersex people to analyse cervical screening behaviours.

While the results are still being analysed and are yet to be published, Perera said the aim would be to improve screening services.

“A common misconception is that this group don’t need cervical screening,” Perera said.

“This isn’t the case, as any person with a cervix who participates in any genital-skin to genital-skin contact, needs to have a pap test.”

All infectious diseases could become resistant to antibiotics says Cambridge expert

Sexual Health

All infectious diseases could become resistant to antibiotics says Cambridge expert

2016-01-20

All infectious diseases could potentially become untreatable because of the rise of antibiotic resistance – not just gonorrhoea – according to a Cambridge sexual health expert.

Dr Caroline Cooper, associate specialist in sexual and reproductive health based at the Lime Tree clinic in Cambridge, said antibiotic resistance is a problem across the whole NHS, not just sexual health.

Her comments come after England’s chief medical officer reportedly warned Gonorrhoea could become “untreatable”.

According to the BBC, Dame Sally Davies has written to all GPs and pharmacies to ensure they are prescribing the correct drugs after the rise of a highly drug-resistant strain of the infection in Leeds. The strain, which is resistant to first-line antibiotic azithromycin, was first reported in Leeds in March last year but spread, with cases reported in patients from Macclesfield, Oldham and Scunthorpe.

Read more: http://www.cambridge-news.co.uk/infectious-diseases-resistant-antibiotics-just/story-28554208-detail/story.html#ixzz3xlI3AMQB
Follow us: @CambridgeNewsUK on Twitter | cambridgenews on Facebook

Seminar held on sexual and reproductive health of garment workers –

blog-home, Sexual Health

Seminar held on sexual and reproductive health of garment workers –

Sexual and reproductive health of garment workers is of key importance and must be acknowledged and addressed, health activists said during a seminar held last week.

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The seminar “Media Sensitisation: Value Creation in RMG through embedding Sexual and Reproductive Health and Rights (SRHR) in factories and the need for positive marketing” was organised by the SNV Netherlands Development Organisation’s “Working With Women” project. It was held at BGMEA center last Wednesday.

“SRHR as a topic needs to come out to the public,” said Dr Nazneen Akhter, senior lecturer at North South University while presenting her keynote speech at the seminar.

She added: “We need to get rid of the jargon, and simplify it so that a garment worker can take ownership of the term and say that it is their issue as well.”

Along with Dr Naznee, Shariful Islam, founder of Bangladesh Brand Forum also presented the keynote paper in the seminar, followed by an open discussion session among journalists and hosts.

Engr Md Kawsar Ali, COO of Comfit Composite Ltd, shared his experience of the initiatives taken at his factory. Engr Kawser’s factory has set an exemplary record for volunteering to help SNV with their time on this project.

Members from Kawser’s factory, as well as Southeast Textiles Private Limited, another garment factory, were present during the SNV trainings, and also came forward to invest 60% in this project, according to a SNV representative.

“Often we see that due to lack of certain facilities available at the workplace, the workers become weak themselves,” said Kawser. “Then we lose them from the job market which in turn impedes on the growth of the entire industry.”

“The sector is already suffering because we’re losing a lot of potential workers,” he added, emphasising on the urgent need to address sexual and reproductive health needs of female garment workers, who make up the majority of the garment workforce.

Ashrafur Rahman Ranju, COO, Millennium Textile and Faruque Hassan, senior vice-president, BGMEA were also present at the seminar. Faruque shared remarks from BGMEA about the project and urged the journalists to promote good practices in the RMG sector in order to stimulate growth of the industry.

– See more at: http://www.dhakatribune.com/feature/2016/jan/20/seminar-held-sexual-and-reproductive-health-garment-workers#sthash.1Ppd85hL.dpuf

Syeda Samira Sadeque

Can men experience orgasm without ejaculating?

Sexual Health

Can men experience orgasm without ejaculating?

Forget premature ejaculation, dry orgasm is also be a matter of concern.

Debjani Arora

The dry spell in women is quite common – hormonal imbalances, age, menopause, pregnancy — a number of factors can affect normal vaginal lubrication and lead to dryness. Most women might undergo painful intercourse due to this. In men, it is quite unheard off, but not impossible. Men can also suffer from dry orgasm at times when semen refuses to release, in spite of having a pulsating and pleasurable orgasm. Here is how a male orgasm works.

Is this normal?

The answer is both ‘yes’ and ‘no.’ In younger men this can be passed off as a refractory period, when one experiences two orgasms close to each other. But in older men, this could indicate some trouble. Here are six reasons for pain during sex in men that you should know.

What causes dry orgasm in men?

There are various factors for this sexual phenomenon, like:

Age: Teenagers and men in early twenties are more likely to experience dry orgasm if they have an active sexual life or masturbate frequently. Young men are more likely to recover soon from an orgasm and get ready to go for the act soon again. Like women, young men can also undergo multiple orgasms before the semen builds up in the testis. Sometimes it can take up to a day (in younger males) and experiencing more orgasms could mean a dry spell. However, this isn’t particularly harmful to adolescents and young men. However, men in their 30s or 40s find it difficult to orgasm multiple times or recover from an orgasm quickly [1].

Medical problems: For men who are suffering from prostate problems — surgery, treatment, radiotherapy — dry orgasm can become frequent. This is because the seminal fluid goes backward into the urinary bladder, rather than coming out of the urethra. This is also called retrograde ejaculation. Here are signs of prostate cancer all men should know.

Physiological problems: A weak pelvic structure or a blocked valve in the bladder could also restrict the flow of semen out and make it travel backwards.

Should you worry about this problem?

This depends on how often you experience dry orgasm or retrograde ejaculation. Remember, if semen travels backwards quite often, it could affect conception, as it depletes sperm count. However, dry orgasm could also be a result of psychological trouble, sexual inadequacy triggered by performance anxiety or lack of interest in the partner. However, if you are suffering from dry orgasms, it is better to meet an expert, preferably an andrologist and get yourself evaluated.

Reference:

[1] Kinsey, Alfred C. et al. (1948/1998). Sexual Behavior in the Human Male. Philadelphia: W.B. Saunders; Bloomington, IN: Indiana U. Press.sex-and-relationships-mansexproblem-orgasm-THS

Men’s sexual health: are the supplements safe?

Sexual Health

Men’s sexual health: are the supplements safe?

2016-01-18

Written by 

Over-the-counter dietary supplements and therapies sold to improve male sexual health may be ineffective and even unsafe, says a report published in the Journal of Sexual Medicine.

men-s-sexual-health

Around 40-70% of men experience sexual dysfunction at some time.

To avoid paying for prescription drugs, or the embarrassment of discussing such matters with their physicians, many turn to over-the-counter (OTC) products.

Sales of dietary supplements doubled in the US from 1999-2007, and around 50% of Americans use them for a variety of conditions.

The dazzling array of products, from horny goat weed to ginseng, costs from $0.83 to $5.77 per day. But lack of regulation on dosage, purity or ingredients, and limited information regarding health effects confuses patients and medical practitioners alike.

Researchers from Wake Forest Baptist Medical Center in Winston-Salem, NC, reviewed the scientific evidence for the effectiveness and safety of the most common ingredients in top-selling men’s health products.

They wanted to provide urologists with a guide for counseling patients who present with sexual health problems and who are taking such supplements.

Prescription ingredients sold OTC

There was no scientific evidence to support claims that many products positively impact erectile function, libido and sexual performance, and some were likely to be unsafe.

Some products advertised as “natural” contain traces of phosphodiesterase-5-inhibitors (PDE5Is), the same class of medication that includes prescription drugs such as Viagra, which is used to treat erectile dysfunction. PDE5Is cannot be legally sold over the counter in the US, because using them without a physician’s supervision could be risky.

Patients with advanced heart disease or who take nitrates, such as nitroglycerin, should not use PDE5Is, as it may cause an unsafe drop in blood pressure.

PDE5Is should also be avoided by men with severe liver impairment or end-stage kidney disease. Those with enlarged prostates who take medications such as Flomax (tamsulosin), terazosin or doxazosin should only take it with supervision, as interactions may cause dizziness, leading to falls and fractures.

In one study, 81% of OTC products purchased in the US and Asia contained PDE5Is.

Pros and cons of popular ingredients

The findings on some of the best-selling products can be summarized as follows:

  • DHEA is a hormone naturally made by the human body and produced in laboratories from chemicals found in wild yam and soy. While findings do not suggest a benefit, it appears to be relatively safe, as the impact on hormone levels is not significant
  • Fenugreek features in 1 in 3 top-selling men’s health supplements. It may improve sexual arousal and orgasm, muscle strength, energy and well-being. There was no evidence of adverse effects
  • Ginkgo biloba is taken for numerous conditions, but data does not support its use in erectile dysfunction. It can cause headache, seizures and significant bleeding, especially if taken alongside Coumadin
  • Ginseng is the most common ingredient in top-selling men’s health supplements; it can cause headache, upset stomach,constipation, rash and insomnia. It can also lower blood sugar, risky in cases of diabetes
  • Horny Goat Weed is generally safe with rare reports of toxicity leading to fast heart rate and hypomania; it has no apparent benefit for sexual function
  • L-arginine is the top amino acid in men’s health supplements, featuring in 1 in 3 best sellers. It may improve erectile function in some patients and seems relatively safe. It has been associated with a drop in blood pressure but without significantly changing the heart rate
  • Maca is the most common vegetable among top-selling men’s health supplements. Maca has been associated with increased sexual behavior in animals but not in humans. Rare cases of toxicity and a mild increase in liver enzymes and blood pressure have been reported.

Tribulus promises to treat a range of conditions, but evidence is lacking to prove its effectiveness; two young men suffered liver and kidney toxicity after taking high doses. Yohimbine is a well-established product that may improve male sexual function, but it can also cause hypertension, headache, agitation, insomnia and sweating. Zinc appears to be safe but not beneficial.

Let’s talk about sex

Sexual Health

Let’s talk about sex

By 

A parent would rather feed their child the birds and bees story when it comes to discussing this issue. Gordon Ochieng, Youth Programme Manager at Family Health Option Kenya, explains why they do not mince words

Briefly tell us about Family Health Options Kenya (FHOK)?

FHOK is a local non-governmental organisation that provides Sexual and Reproductive Health Services through clinics and community projects that actively involve beneficiaries. It has a presence in 14 counties, with strong grassroots network.

What motivated the organisation to start youth centres?

We started youth centres after realising most young people don’t visit hospital for check-up because they fear their parents. With the ever increasing sexual and reproductive health problems such as sexually transmitted infections, HIV/Aids, unsafe abortions, high infant mortality rate, escalating adolescent problems and an increasing population, we realised that there is need for a place where youth can gather and learn about their sexual reproductive health in a youth-friendly setting. Our youth centres are located in Nairobi, Mombasa, Eldoret, Nakuru, Meru, Bondo and Kisumu.

If a young person visits the centre today, what kind of services would they get?

In our centres, we offer youth-friendly services such as clinic services, VCT and general counselling, vocational training, capacity building, library, knowledge, informational services and recreational activities.

How many people have benefited from your youth programme?

More than 500,000 youths have benefited from our projects. We hope to reach a bigger number in the next five years through our outreach activities.

What is the criteria for one to join your youth programme?

There is no criteria. Every youth is welcome to our centres and it’s free to access our services. Sex education is a thorny issue here in Kenya.

Why did you choose to go down this path?

The issue of sex education has become an exceptionally controversial one. Our curriculum teaches knowledge, behaviour, attitudes and skills that promote committed family relationships, healthy l relationships, good character and good reproductive health.

Sex education seeks to assist children in understanding a positive view of sexuality, provide them with the skills about taking care of their sexual health and help them to acquire skills to make decisions now and in the future.

One of your initiatives is the Youth Sexuality Education (YES) project. What is its impact?

There has been decrease of pregnancies in schools where this project has been implemented. Further, health service providers have indicated that young people were reporting fewer incidences of sexually transmitted infections.

 

Reorienting adolescent sexual and reproductive health research: reflections from an international conference.

Sexual Health

Reorienting adolescent sexual and reproductive health research: reflections from an international conference.

Abstract

On December 4th 2014, the International Centre for Reproductive Health (ICRH) at Ghent University organized an international conference on adolescent sexual and reproductive health (ASRH) and well-being. This viewpoint highlights two key messages of the conference – 1) ASRH promotion is broadening on different levels and 2) this broadening has important implications for research and interventions – that can guide this research field into the next decade. Adolescent sexuality has long been equated with risk and danger. However, throughout the presentations, it became clear that ASRH and related promotion efforts are broadening on different levels: from risk to well-being, from targeted and individual to comprehensive and structural, from knowledge transfer to innovative tools. However, indicators to measure adolescent sexuality that should accompany this broadening trend, are lacking. While public health related indicators (HIV/STIs, pregnancies) and their behavioral proxies (e.g. condom use, number of partners) are well developed and documented, there is a lack of consensus on indicators for the broader construct of adolescent sexuality, including sexual well-being and aspects of positive sexuality. Furthermore, the debate during the conference clearly indicated that experimental designs may not be the only appropriate study design to measure effectiveness of comprehensive, context-specific and long-term ASRH programmes, and that alternatives need to be identified and applied. Presenters at the conference clearly expressed the need to develop validated tools to measure different sub-constructs of adolescent sexuality and environmental factors. There was a plea to combine (quasi-)experimental effectiveness studies with evaluations of the development and implementation of ASRH promotion initiatives.

Author information

  • 1International Centre for Reproductive Health, Ghent University, Ghent, Belgium. Kristien.Michielsen@UGent.be.
  • 2International Centre for Reproductive Health, Ghent University, Ghent, Belgium. SaraA.DeMeyer@UGent.be.
  • 3International Centre for Reproductive Health, Ghent University, Ghent, Belgium. Olena.ivanova@ugent.be.
  • 4Guttmacher Institute, New York, USA. randerson@guttmacher.org.
  • 5International Centre for Reproductive Health, Ghent University, Ghent, Belgium. Peter.Decat@UGent.be.
  • 6Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium. Peter.Decat@UGent.be.
  • 7Butterfly Works, Amsterdam, The Netherlands. celine@butterflyworks.org.
  • 8African Population and Health Research Center, Nairobi, Kenya. ckabiru@aphrc.org.
  • 9Radboud University, Nijmegen, The Netherlands. e.ketting@tip.nl.
  • 10University of the Western Cape, Cape Town, South Africa. jlees@uwc.ac.za.
  • 11Johns Hopkins Bloomberg School of Public Health, Baltimore, USA. cmoreau2@jhu.edu.
  • 12Hunter College and The Graduate Center, CUNY, New York, USA. deborah.tolman@gmail.com.
  • 13Rutgers & Utrecht University, Utrecht, The Netherlands. i.vanwesenbeeck@rutgers.nl.
  • 14University of Cuenca, Cuenca, Ecuador. bernardo.vegac@ucuenca.edu.ec.
  • 15Sensoa, Antwerp, Belgium. Lies.Verhetsel@sensoa.be.
  • 16Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. chandramouliv@who.int.

Do we need more than two genders?

Sexual Health

Do we need more than two genders?

2016-01-14

A growing number of people refuse to be put into male or female categories, either because they do not identify as male or female, or because they are going through transition to the opposite gender.

Germany, Australia, Nepal and Pakistan now offer a third gender option on official forms with other countries set to follow suit. And scientists are finding more evidence to suggest that even biological sex is a spectrum.

Do we need to re-imagine our binary world and rethink one of the most basic parts of our identity?

Four experts talk to the BBC World Service Inquiry programme.

Brin Bixby: Gender is a cultural construction

Brin Bixby was brought up as a boy, and went on to get married and father children before coming out as bigender. She set up Bigender.net, which reflects the view that gender is a spectrum.

“In college I wore a dress on Halloween, and it was supposed to be a joke, and the people helping me thought it was going to be hyper-real, exaggerated. [But] I didn’t want to be a drag queen, I wanted to be a woman, and I think it took people by surprise.

“It was the first time I looked in the mirror and saw myself. People interacted with me as a woman: they saw me the way I wanted them to.

“I would be most comfortable if I didn’t have to think about my gender, but unfortunately that’s not how it works for me and a lot of other non-binary people.

“We have a cultural understanding of what gender is and looks like, and in the west we have a very binary view of it. My sense of gender as a part of my identity shifts.

“I present as a woman everywhere I go, except for at work and at my children’s school, because it gets very exhausting to have to explain gender fluidity to everyone I meet.

“Ideally we would not make gender such a huge focus of our culture, which would give people the freedom to inhabit their gender in ways that feels most comfortable to them.

“What we’re seeing now is a relaxation of the sense of binary amongst younger people and internet-savvy people who are inhabiting much more fluid spaces.”

Mark Gevisser: Accept the gender continuum

Writer Mark Gevisser explores gender identities across different cultures.

“We know there’s a gender continuum, because there have always been effeminate boys and masculine girls. Transgender is certainly not a western phenomenon. In many cultures all over the world there are traditionally third gender or gender-fluid identities.

Telangana Hijra Intersex Transgender Samiti (THITS) activists in Hyderabad

“There are the Hijras in India, what are known as two-spirited people in Native American culture, Muxe in Mexico, and the Bakla in the Philippines. The space these people have occupied has receded with the spread of the Judeo-Christian ethic and western culture, but they’re still very much there.

“There’s a tendency in the west to idealise these. But the truth is that if you’re Bakla or two-spirited, there are only certain things in your culture you can do. In India, the Hijras are basically cast out of society, only good for begging and sex work. So it’s not necessarily a great life.

“I was talking to a remarkable gender therapist named Diane [Erinsaft] and I suddenly started worrying that if she’d been around when I was a little boy, I might have been turned into a little girl. She laughed and said ‘No, you’re definitely a guy’.

“But we started talking about the potential risk of the transgender movement establishing new binaries where, if you have a girly boy, and you’re worried about how effeminate this child is, you could very easily solve the problem by taking the child to the doctor and the doctor can wave a wand and say ‘Your girly boy is now a princess’.

“Wouldn’t it be better if we had a society that just raised children so that it was okay to be a tomboyish girl, or a girly boy, and to explore that?

“Diane speaks about ‘gender smoothies’; she got this from one of her patients who said ‘I’m not a girl or a boy, I’m a gender smoothie, I mix it all up together’.”

Dr Imran Mushtaq: Doctors increasingly recognise complexity of defining sex

Dr Imran Mushtaq is a consultant paediatric urologist who works with children with differences in sex development (DDS) at Great Ormond Street Hospital in London. Around 1 in 1500 babies are born with DDS but up to 1 in 100 people have less obvious differences.

“Absolutely sex is a spectrum. It’s not binary in any way and we are slowly coming to understand this.

“As a specialist working in this area for the last 12 years, I’ve seen us transitioning so much in the way we think about sex and the way we treat children in whom the sex is not clear, and we are increasingly becoming aware how complex the issue is.

“How do you define what sex a child is? Is it the physical characteristics, the genitalia – do they have testicles, do they have ovaries or do they have both? Is it their chromosomes, is it their hormones?

“You can have a child whose chromosomes are XX, typical of what you’d associate with being female, yet their genitalia looks like a boy.

“Ten or 20 years ago when children were born with these kind of problems, there was very little discussion about not doing surgery. It was almost a given that the child would need surgery to make it a boy or a girl.

“As a doctor and surgeon, I’m increasingly uncomfortable about undertaking what is irreversible surgery.

“We know that the outcomes of surgeries that were undertaken 10, 20 years ago are not necessarily as good as we would like them to be. Now is the next stage: in 10 or 20 years’ time we will find out the outcome of not doing the surgery or maintaining these children in a certain sex, whereas previously they would have been changed to a different sex.

“I don’t think we should have gender categories. I don’t think that sex should be on birth certificates, I don’t think sex should be on driving licences and I don’t think sex should be on passports.

“We are just what we are. We have a name, we have a date of birth, give us a number.”http://www.bbc.com/news/health-35242180