Monthly Archives: February 2016

Bacteria swabbing trend for newborns medically in doubt

Bacteria swabbing trend for newborns medically in doubt


‘re getting ready to give birth. Should the mother get an epidural? Is saving umbilical cord blood worth it? They may even ponder eating the placenta.

Now add to the list whether to follow a trend known as “vaginal seeding.” The practice involves swabbing the vagina of women who are going to have a cesarean delivery and then wiping the fluids on the baby. The hope is to give the baby the bacteria it would have been exposed to during vaginal delivery and help kickstart a healthy gut microbiome.

Although few doctors in the United States seem to be offering this simple procedure, a growing number of women are inquiring about it.

“It’s certainly happening more frequently (whereas) maybe like five or 10 years ago, I don’t think anybody really asked about this,” said Dr. Leonardo Pereira, chief of maternal-fetal medicine at Oregon Health & Science University.

Interest in the practice seems to be percolating overseas as well. “(By) taking a straw poll amongst colleagues at our hospital and other hospitals (in the United Kingdom), it seems in the last year or two almost all of the obstetricians and neonatologists here have encountered women asking for this to be done,” said Dr. Aubrey J. Cunnington, a pediatrician at Imperial College London.

large body of research points to an association between C-section delivery and increased risk of asthma, obesity and other health conditions. On the other hand, there has been an “absolute explosion of research on the role of the microbiota in health and disease,” Cunnington said.

However, experts say it is far too soon to say whether the vaginal microbiome gives babies a healthier start, and if so, whether seeding has the same beneficial effect as a vaginal delivery. Of greater concern is whether the practice could expose babies to some disease-causing bacteria in the bypassed birth canal.

In spite of the growing interest in vaginal seeding, there is a lack of data on its safety and benefits, and a lack of guidance for women and their doctors, Cunnington said. He and his colleagues in the United Kingdom and Australia took a close look at the issues surrounding the practice in an article that was published on Tuesday in the British Medical Journal.

“I think it would be helpful to have some guidelines on this, [but] it’s very hard to make guidelines when you have almost no evidence,” said Cunnington, who delivered babies before he started specializing in pediatric infectious disease. “Hopefully (the article) will help the medical profession to feel they have a little support,” whether they decide to practice vaginal seeding or not, he said.

Seeding a bad infection?


The main qualm doctors have with vaginal seeding is that it could infect babies with dangerous bugs at the same time it is bestowing them with potentially healthy bacteria. Topping the list of pathogens of concern are group B streptococcus, chlamydia and gonorrhea.

The Centers for Disease Control and Prevention recommends testing all pregnant women for these bacteria, as well as a number of other pathogens. About a quarter of all women harbor group B streptococcus, and while they may not experience symptoms, the bacteria could cause pneumoniaand meningitis in their newborns.

All women should get screened, even those planning to have a C-section, in case they end up having an unexpected vaginal delivery, Pereira said. If they are infected, women can receive antibiotics during labor to prevent passing the infection to their baby. However, some women decline screening, even those who are interested in vaginal seeding, Pereira said. “(In those cases) there’s a concern of taking group b strep from the birth canal and wiping it all over the baby,” he added. In addition to bacterial infections, experts worry vaginal seeding could infect babies with herpes virus if the mother has genital herpes.

While it is true that vaginal seeding probably only exposes babies to the same pathogens they would have gotten had they been delivered vaginally, these pathogens could have been avoided by C-section delivery. “If they had [a C-section] because it was the way they had to be delivered for the safety of the baby or the mother, why would you want to impose on them an increased risk of infection if it’s not going to benefit them?” Cunnington said.

What doctors should tell mothers


While doctors might not be doing a lot of vaginal seeding themselves, some mothers are taking the matter into their own hands. In one report, a woman in Brooklyn planned to insert a piece of gauze in her vagina before her C-section operation that her husband would wipe on their newborn shortly after delivery. Although there are no guidelines for how to perform vaginal seeding, the studies of the practice generally insert the gauze one hour before delivery and then wipe the fluids around the baby’s mouth, face and body.

It is important to tell these mothers that seeding might not have any benefit and might be increasing the risk of infection, Cunnington said. If they still want to do it, “They just need to be very aware that if their baby is unwell and they go to see a doctor, they should tell them they have performed vaginal seeding because it may change the doctor’s assessment,” he said. For example, a doctor may otherwise have ruled out the likelihood of a group B strep infection knowing that the baby was delivered via C-section.

Even though there is little evidence so far, it is also too soon to close the book on vaginal seeding. A small study recently provided the first evidence the practice might be able to give babies gut microbiomes that more closely resemble those of vaginally delivered infants.

However, “even if you can show their gut is colonized preferentially with labtobacillus or other organisms if you do that swab, you don’t really know if that really has any clinical health benefits, or if in a year from now that really matters,” Pereira said. More studies are needed, following babies who received vaginal seeding for years, to answer that question.

“It’s a fascinating area of research and it holds a lot of promise,” said David Hackney, assistant professor and medical director of labor and delivery at University Hospitals Case Medical Center.

“If someone said to me 10 to 15 years down the road this would be a routine thing we’ll be doing, that would be great and I don’t even know that I’d be surprised. But you can also imagine that in 10 to 15 years, we’ll look back and say what is that crazy thing we were doing,” Hackney said.

Giving babies healthier microbiomes

Until we have more answers about vaginal seeding, the potential for passing along healthy bacteria from the birth canal — while treating women to avoid passing along disease-causing bugs — could be just one more reason to encourage vaginal deliveries, Hackney said. C-sections are known toincrease the risk of complications for both mother and baby, and increase the recovery time for the mothers.

And while vaginal seeding might not be ready for prime time just yet, there are other well-studied practices that could help ensure babies start life with a healthy microbiome. Breastfeeding and skin-to-skin contact between mother and baby are known to “help newborns be colonized with healthy bacteria pretty quickly,” Pereira said.

Cleveland Clinic performs first uterus transplant in the U.S.

Cleveland Clinic performs first uterus transplant in the U.S.

A team of surgeons at the Cleveland Clinic performed the first uterus transplant in the United States this week.

A 26-year-old woman received the new womb in a nine-hour operation, the hospital said in a statement. She was reported in stable condition Thursday.

The transplanted uterus came from a deceased organ donor.

Clinical trial

The Cleveland Clinic announced a research study in November in which it would perform uterus transplants on 10 women with uterine factor infertility.

UFI is a condition where a woman cannot carry a pregnancy because she was born without a uterus, has lost her uterus, or has a uterus that no longer functions. It’s an irreversible condition affecting 3% to 5% of women worldwide.

“Women who are coping with UFI have few existing options,” Tommaso Falcone, chairman of the Department of Obstetrics-Gynecology at Cleveland Clinic, said when the clinical trial was announced. “Although adoption and surrogacy provide opportunities for parenthood, both pose logistical challenges and may not be acceptable due to personal, cultural or legal reasons.”

The transplant is one of many steps in a complex process.

Before it takes place, the woman’s eggs are harvested, fertilized and frozen for implantation later in the new uterus.

These are some of the other steps, according to the Cleveland Clinic:

— Over 12 months, the transplanted uterus fully heals.

— One year after transplant, the frozen embryos are then thawed and implanted, one at a time, into the patient until she becomes pregnant.

— During her pregnancy, she takes anti-rejection drugs.

— She is monitored by a high-risk obstetrics team throughout pregnancy and delivery.

— She has a monthly cervical biopsy to check for organ rejection.

— The baby is delivered by cesarean section.

— After one to two babies, she has a hysterectomy to remove the transplanted uterus.

— Her anti-rejection drugs are stopped after the hysterectomy.

Pioneered in Sweden


While this is the first uterus transplant in the United States, a team of doctors at the University of Gothenburg in Sweden has performed nine of them.

Five of the women have gotten pregnant, resulting in four live births.

The Cleveland Clinic is hopeful for its own program after taking part in the Swedish trials.

“The exciting work from the investigators in Sweden demonstrated that uterine transplantation can result in the successful delivery of healthy infants,” said Andreas Tzakis, the lead investigator in the Cleveland study.

Let’s talk about sex to save lives

Let’s talk about sex to save lives


Ariela Zibiah

Monday, February 22, 2016

A REPORT on sexual and reproductive health of young people in Asia and the Pacific released last month affirms that a significant proportion of young people, 15 to 24-year-olds, are sexually-active, and premarital sex is more common in the Pacific.

The report which was collaboratively produced by the UNFPA, UNESCO and WHO provides analysis based on several variables but among other factors, the report states young people in urban setting are more likely to have earlier sexual debut than their rural counterparts and those who leave schools are more likely to commence rather than those who are still in school.

The report affirms how adolescents across the countries discussed in the report remain discriminated against by gate keepers of essential services particularly the health services and/or those who are supposed to ensure timely and correct sexual and reproductive health and reproductive rights information.

Adolescence in limbo

Adolescence is a minefield of emotions that will require a lot more open discussion around sexual and reproductive health and reproductive rights issues. It is a critical time of self-defining processes when influencers of world views crowd thought-processes, and in this day and age, parents, guardians and or teachers compete with the rush of the information highway.

Adolescence has historically referred to those between 10-19 and youth between 15 to 24-year-olds. It is a time of transition from childhood to adulthood. For the United Nations Population Fund, UNFPA, this is also a time when good sexual and reproductive health and reproductive rights fundamentals must be established.

It is not only a basic human right to ensure our young people are able to achieve the highest attainable sexual and reproductive health standards, but investing in it will eventuate in inclusive national progress.

The report found an increasing number of young people are initiating sexual debut before marriage. A clash between the diverse factors which inform young people’s world views and the sociocultural realities of their communities are inevitably becoming barriers to good sexual and reproductive health.

The region is home to numerous communities where faith-based ideals give power to moral policing without serious consideration or acknowledgment to what is actually driving attitudes, decision-making processes and behaviour of young people in relation to sexual and reproductive health and reproductive rights. The religiosity is compounded by gender dynamics that not surprisingly tilts the burden of poor sexual and reproductive health and reproductive rights to girls and women.

It should be no surprise therefore that in the region we are part of, one in seven girls in the region would have given birth by the age 18 in the context of high unmet need of contraceptives (failure to access vital reproductive health service to ensure a lived reproductive right to decide for herself if she wants to have children, how many and at what intervals), in terms of child marriages (a despicable cultural practice with irreparable damage to girls with a rippling effect which impacts national indicators of development) and also in relation to the lack of access to critical information (age-appropriate comprehensive sexuality education delays sexual debut as opposed to popular belief that it encourages sexual debut).

Norms as barriers

Entrenched sociocultural practices and attitudes to issues around sexual and reproductive health and reproductive rights are the reason why less than half of the 15 to 24-year-olds are reporting not using a condom at the last high-risk sexual encounter.

Taboos which disallows frank discussions around reproductive health and rights is an example of sociocultural barrier to a safer space for our young people. A faith-based consideration should allow the discussion of sexual and reproductive health as a gift for pro-creation and a symbol of love between two people, as Reverend Jeremaia Waqainabete, superintendent minister of the Wesley Division of the Fiji Methodist Church, describes it.

The report emphasises how gender norms have a “profound influence” on young people’s sexual and reproductive health. Most countries indicate a more relaxed attitudes to young men having premarital sex then young women but both sexes are permissive of male premarital sex rather than female premarital sex.

High-risk behaviour which includes multiple sex partners, intergenerational sex and/or sex under the influence of alcohol will increase the likelihood of sexually-transmitted infection including HIV.

The report states: “Young men are more likely to report multiple sexual partners particularly in the Pacific where up to half of young men who have ever had sex reports two or more partners in the last 12 months.”

The relationship between alcohol or substance use and risky sexual behaviour is well-documented. For countries with national data, young men reported much higher rates of sex while drunk than young women “most significantly in the Pacific”.

The Pacific is also well-represented in binge drinking data in the report (entitled Sexual and reproductive health of young people in Asia and the Pacific: A review of issues, policies and programmes) with the highest rate reported in Fiji (21 per cent), PNG (18 per cent) and Solomon Islands (16 per cent). In all countries, risky alcohol use is more common among males than females, with binge drinking rates two-three times higher among adolescent boys.

It is evident that high-risk behaviour has successfully lodged itself into our collective psyche as “normal”. Depriving one of critical sexual and reproductive health information and services like the provision of contraceptives from nurse posts based on socioculturally-influenced reasoning is “normal”.

Serious consideration of these norms which are becoming barriers to both life-saving information and services is urgent for a population that is fundamentally unhealthy cannot be a resilient and productive population.

Family support

and gender equality

The report affirms that families can be important protective influences on our youths. Studies in Indonesia, Thailand and Philippines ascertained a relationship between delayed sexual debut and a close relationship with parents.

Family support will be particularly important for girls. Studies in India, Vietnam, Cambodia and the Philippines suggested a connectedness between adolescent girls and their parents, particularly their mothers, and a family environment that supported gender equality corresponded with delayed first sex among girls.

The Pacific is part of a region that is home to 60 per cent of 1.8 billion people aged 10 to 24-year-olds in the world today.

We may not be a landlocked area but there is significant interaction by air and sea. If the lack of forthrightness in issues related to sexual and reproductive health and the rather high levels of sexually-transmitted infections is anything to go by, then an underlying albeit inconspicuous consequence awaits.

The inability to accept the fact that our children are being exposed to issues around sexual and reproductive health and reproductive rights at a much earlier age will continue to throw back data as reported in the report like 10 per cent of males and 20 per cent of females in the age group of 15-24, report having a sexually-transmitted infection or its symptoms in a period of 12 months.

It is a sociocultural and economic imperative to shed ourselves of the façade of taboo. The consequences of inaction is unfathomable and a deadly legacy to leave behind as a people.

* This is the first article in a series of four.

* Ariela Zibiah is the communication analyst at the UNFPA Pacific subregional office.

Indonesian Youths Want to Be Heard on Family Planning

Indonesian Youths Want to Be Heard on Family Planning

Jakarta. Years ago, when Angraini Sari Astuti was diagnosed with ovarian cancer, she experienced first-hand how difficult it can be for Indonesian adolescent girls to visit a qualified health professional when they desperately need one. Not because there were no doctors where Angraini lived, near Solo in Central Java, but because of the stigma associated with anything related to premarital sex in the world’s most populous Muslim-majority nation.

“In 2008, when I checked into [the office of] a gynecologist in preparation of my tumor surgery, other patients stared at me,” now-25-year-old Angraini said at a youth event on the sidelines of the International Conference on Family Planning held in Nusa Dua, Bali, late last month. “They were wondering: why would such a young girl come to a gynecologist?”

Angraini, who fully recovered, is now an energetic and outspoken youth activist working with the United Nations as a volunteer to call on the Indonesian government to give youngsters a seat at the table when policies are made that directly affect them.

Activists like her say empowerment and education are more necessary now than ever before, because while the country’s family planning program has been widely hailed as a great developing-world success story, the numbers on adolescent sexual and reproductive health in Indonesia remain disheartening.

65 million young people  

Indonesia’s successful family planning program, which lowered the country’s total fertility rate from 5.6 in 1967 to 2.6 in recent years, has cleared the way for a much-anticipated demographic dividend.

There are over 65 million people in Indonesia today aged between 10 and 24: almost 30 percent of the population. But even as this may be good news in terms of economic growth potential, illegal abortions abound and HIV transmission rates are on the rise, while the government is not legally allowed to provide any means of contraception to people who are not married. Regular health clinics tell youngsters that abstinence until marriage is the only way to stay out of trouble.

According to data from the United Nations Population Fund (UNFPA), people between the ages of 20 and 29 account for almost 40 percent of newly confirmed cases of AIDS in Indonesia. These numbers suggest that many get infected with HIV between the ages of 15 and 24.

UNFPA also notes that more than half of reported HIV cases in the country are due to unprotected sexual intercourse, with intravenous drug abuse being another major cause.

Maternal mortality

Reliable numbers are hard to come by, but experts estimate there are at least two million abortions per year in Indonesia. The fact that these abortions mostly involve married women in Indonesia indicates that access to contraception is hardly something that only affects adolescent girls.

As abortion is illegal in Indonesia except in cases of rape, foetal abnormality or when the pregnancy threatens the mother’s life, most of these procedures are carried out unsafely. Indonesian girls and women with an unwanted pregnancy ingest menstruation-inducing herbs, are given a uterine massage or even have foreign objects inserted into their uterus.

Indonesia’s maternal mortality ratio (MMR), or the number of maternal deaths per 100,000 live births, remains high, at an estimated 126, and unsafe abortions cause an estimated 16 percent of these deaths.

In other words: some 6,400 women died from pregnancy-related causes throughout the archipelago last year, and over 1,000 of these women died because of an unsafe abortion.

Even though Southeast Asia’s largest economy is performing better than countries like Laos (197) and Cambodia (161) in terms of MMR, it still lags far behind neighbors such as Vietnam (54), Malaysia (40), Thailand (20) and Singapore (10).

Child marriage

One of the ways Indonesian authorities are trying to prevent unwanted pregnancies and stem the rise of sexually transmitted infections such as HIV/AIDS, is by promoting abstinence until marriage, for instance by limiting the availability of contraceptives for unmarried people.

However, one of the consequences of this policy – which is generally accepted by people across the country because it is considered to be in line with religious teachings and tradition – is that many people marry young.

In many parts of Indonesia, unmarried girls are being labeled perawan tua, or “old virgin,” as early as in their late teens andchild marriage remains very common, despite the many dangers associated with the practice.

Humairah Samad, a senior high school student from Makassar, in South Sulawesi, confirmed that where she lives, too, many tie the knot at a young age.

“Our culture has been like that for generations,” she told the Jakarta Globe at the family planning conference in Bali, citing the need for better education on issues of sexual and reproductive health to break that tradition.

Another Indonesian youth activist, Nanda Fitri Wardani, a young MD from Lampung who studied at Bandung’s Padjadjaran University, says many girls in Indonesia have plenty of dreams but are often not empowered by their parents and sometimes end up getting married as early as age 13.

Such a young marriage usually means the end of school and any prospect of a career beyond motherhood.

Harm reduction

Nanda says she believes the Indonesian government should be supported in its decision to not provide contraceptives to unmarried people, citing the state ideology of Pancasila and its first principle: belief in God.

“Having sexual intercourse before marriage is forbidden based on the religions that we follow here,” Nanda said in Bali, stressing that abstinence remains the best way to stop the spread of HIV/AIDS among young people.

Siswanto Agus Wilopo, a professor of reproductive health at Gadjah Mada University (UGM)’s faculty of medicine, however, says the government needs to approach the issue differently.

Siswanto told the Globe he was quite confident that the legal situation would not change anytime soon, as a majority of legislators in the House of Representatives believes that the law can prevent unmarried people from engaging in sexual intercourse.

Faced with such unfavorable odds, the professor says the country needs a harm reduction policy, because the numbers suggest there clearly is a problem, regardless of what politicians say. A start would be the provision of contraceptives to unmarried couples, as part of an emergency regulation, he said.

“You have to go step by step,” said Siswanto.

“One kind of harm reduction policy is the availability of ECP [emergency contraception pills] which will prevent unprotected sex ending in abortion. It is better to use a pill compared to having an abortion, isn’t it?”

“We start with that, campaign about it. If you present the facts, if you present the data – people in Indonesia are smart … I believe that at least harm reduction can be promoted.”

For now, however, the Indonesian government is adopting a hands-off approach. Although some believe the sale of such prophylactics needs to be limited to prevent people from engaging in premarital sex, condoms are still available in supermarkets and convenience stores in major urban areas.

Youth-friendly services

UNFPA in 2014 launched an initiative in cooperation with the private sector that is aimed specifically at helping adolescents. As part of the Unala program, which is being piloted in Yogyakarta, affiliated clinics specialize in providing youth-friendly physical and mental health services.

At the Unala clinics, selected GPs offer health services for youngsters who might be afraid of the social stigma attached to extramarital sexual activity, real or perceived. One way of doing this, for instance, is by using an appointment-only system – which is very unusual in the Indonesian health sector – to avoid prying eyes in the waiting room.

Besides Unala, there are other initiatives to help people in need, such as a hotline run by Yogyakarta-based activists that allows girls and women with an unwanted pregnancy to discuss – free of charge and judgment – what options are available.

Such sessions are aimed at preventing tragic but all-too-common situations where girls or women end up having unsafe abortions at one of the many illegal clinics in Jakarta or at the hands of a local midwife.

Meaningful participation

Babatunde Osotimehin, the executive director of UNFPA, says youngsters all over the world should be given the space to express themselves, so that governments and NGOs understand what they want, and what they need.

And one of the most important things that young people need, is comprehensive sexuality education (CSE), he says, stressing that this in fact is the right of every young person.

In Indonesia, only few schools offer such programs, however. Some others do teach children about sexuality, but take a fear-based approach instead of one that stresses a young person’s rights.

Apart from CSE, another important step is greater involvement of men, the UN under-secretary-general said, speaking at the family planning conference in Bali.

“There is no man in this world who would like to see his daughter die,” said Babatunde, “or see his wife die.”

Angraini, the Indonesian youth activist, told the Globe that for family planning and sexual and reproductive health programs to work, meaningful participation of young people at all levels of the policy-making process is essential.

“Listen to the young people themselves,” she said. “Don’t just ask them to attend a seminar when everything is already settled.”

Apart from empowerment, there is a clear need for adequate, youth-friendly health services across the country, she said, to clear all hurdles for young people “concerned about confidentiality and judgmental opinions from others.”

“Involving young people, both married and unmarried, in family planning education, and raising their awareness on this issue, will have a positive impact in lowering maternal and child mortality and morbidity,” Angraini said, “as well as equip young people with the information they need to make their own decisions.”

But she stressed that young Indonesians should not just remain passive while waiting for change to happen.

“Let us … work together with parents, families, government health personnel, teachers [and] educational institutions … [so that they all] fully recognize young people’s need for non-judgmental understanding, the right information, adequate health services and comprehensive sexuality education,” Angraini said.

“We are the future of family planning.”

C.D.C. Investigating 14 New Reports of Zika Transmission Through Sex

C.D.C. Investigating 14 New Reports of Zika Transmission Through Sex

Health authorities in the United States said they were investigating 14 new reports of the Zika virus possibly being transmitted by sex, including to pregnant women. If confirmed, the unexpectedly high number would have major implications for controlling the virus, which is usually spread by mosquito bites.

Scientists had believed sexual transmission of Zika to be extremely rare. Only a few cases have ever been documented. But if all the women in the cases the Centers for Disease Control and Prevention is examining test positive for the virus — as two women already have, and four others have done in preliminary lab tests — officials believe there is no way other than sex that they could have contracted it.

The specter of so many cases — all in the continental United States — brings fresh complexity to the medical mystery of Zika. The virus is suspected to cause birth defects and a rare condition of temporaryparalysis.

Does Misogyny Lead to Unhealthy Sexuality?

Does Misogyny Lead to Unhealthy Sexuality?


February 16, 2016 by  

To best understand the relationship between misogyny and sexual health I’ll begin this piece with a comprehensive definition for each term.

Misogyny: “[M]isogyny is primarily a property of social systems or environments as a whole, in which women will tend to face hostility of various kinds because they are women in a man’s world  (i.e., a patriarchy), who are held to be failing to live up to men‘s standards (i.e., tenets of patriarchal ideology which have some purchase in this environment)” (Manne, p.2). In other words, misogyny is systemic oppression of women, within patriarchal societies in which women are expected to adhere to patriarchal expectations, otherwise face punishment.

Sexual health: Sexual health “is a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled” (World Health Organization, 2006).

We all are aware that sexual health is not something which is explicitly discussed in Muslim communities. However, subtle messages and lessons regarding sexuality and sexual health are being relayed to women constantly and these messages place a heavy burden on them.

  • “Wear a long shirt when you go to the mosque. You don’t want the men to see your curves.”
  • “Don’t get too comfortable/friendly with the boys in your class.”
  • “Keep your voice down in the mosque. The men shouldn’t be able to hear you.”
  • “If a man sees your hair your wudu is invalidated.” (Yes, I was told this once.)
  • “Don’t stay out past dark. People will talk.”
  • “You don’t need to know those things until you get married. And then, your husband will teach you.” (Though this message may not be explicitly stated, there are ways in which this message is relayed.)

None of these statements mention sex or sexuality explicitly, but they all send a clear message. “You, woman, are a sexual being whose curves and voice will sexually excite and distract men, who, upon seeing your hair, will have thoughts so dirty YOUR wudu will be invalidated. Also, getting friendly with the boys in your class will inevitably lead to sexual relations and if you stay out past dark people will assume you’re out there having sex with men. Oh, and if you know about sex before you get married then your husband will assume you were out having sex with men and he won’t respect you. So just let him teach you because he knows from all the sex he was out having with women, like most guys do.”

Women’s sexuality, in Muslim communities, is too often defined in relation to men. The attitudes, views, opinions, and thoughts of men are given priority over the reality of women’s lives. Women’s behaviour is strictly regulated to the meet the patriarchal expectations laid out by men. And, as a result, women’s behaviour is often viewed in sexual terms such that women are policed to behave in ways that do not “force” men to behave in sexually “haram” ways or that ensure people know you are not engaging in “unlawful” sex. When women do not adhere to these expectations, or are assumed to not be adhering to them, they are faced with derision, disrespect, and sometimes ostracization and isolation.

This is misogyny. And enacting this misogyny in the name of religious duty or obligation is a form of spiritual violence, in which women are denied access to religious and spiritual attainment because they fail to meet patriarchal expectations of women’s behaviour.

So how is this misogyny harmful to women’s sexual health? Because it denies women bodily autonomy, having a detrimental impact on the physical, emotional, mental and social well-being related to sexuality. It denies women the choice to decide what is and isn’t sexual, safe, coercive, pleasurable, violence. It conflates non-sexual behaviours (how long our shirts are) with sexual ones and disguises sexually violent ones (coercion) as sexually healthy (sexual education) or natural (men can’t control themselves).

It places the burden of modesty and honour on the shoulders of women,consequently victim-blaming women for any sexual disrespect and sexual violence they may endure.

It assumes women to be recipients of sex placing them in danger of being abused and manipulated, or in a situation of unpleasurable and uncomfortable sex. It shames women regarding their own sexuality and their bodies, a shame which can have an impact on their self-image, including their sexual self-image, and confidence.

So how do we address this? The answer is simple, yet one that meets a lot of resistance. Stop being misogynistic. Obviously, this is much, much easier said than done. We have had centuries of misogyny built into not only our culture, but also our interpretations of religion. This will take a lot of work and will require that we challenge those very patriarchal notions that so many of our values and beliefs are premised upon. But this needs to be done, one little action, one little step at a time, if we want healthy communities.


A few steps to begin this process:

Stop sending girls and women these harmful messages and start sending boys and men messages that instill the unconditional respect of women.

Educate girls and women on sexual health and give them the tools to make their own decisions on what is and isn’t healthy for them.

Stop defining women’s sexuality in relation to men. Women do not exist to sexually please men. It seems like it should not need to be said, but women are whole and holistic people, and sexuality only one part of our being. Let women, and girls, define and decide what we want.

Recognize women’s right to bodily autonomy. A woman can choose to do with her body what she wishes. No one else has the right to decide for her nor to infringe upon her autonomy.

This is just the beginning, the tip of the iceberg. However, if we, as a community, begin with these few basic steps, we will be on the road to a sexually healthier community.

Sobia Ali-Faisal received her PhD in Applied Psychology from the University of Windsor in 2014. She currently resides in Canada.

Young Men’s Sexual Behavior May Predict Teen Pregnancy Risk, The Kind Of Dad They’ll Be

Young Men’s Sexual Behavior May Predict Teen Pregnancy Risk, The Kind Of Dad They’ll Be


For years, researchers have investigated young women’s views on motherhood in an effort to reduce teen pregnancies. But in a new study from Northwestern University, they shift their attention to young men and their behavioral patterns, which can shed light not only on their chances of becoming fathers, but also the kind of fathers they’d be.

Past research into young men and sex had primarily focused on the link between risky behaviors and sexually transmitted diseases (STDs). But co-author Dr. Craig Garfield and his team were more interested in seeing how attitudes toward risky sex, pregnancy, and birth control related to their future parental outcomes. They found teens and young men with more nonchalant attitudes toward sex were more likely to be nonresident fathers — men who didn’t live with their children.

“I was very surprised that, based on what adolescent males tell us in their teenage years, we could predict whether they would later become a teen father or a nonresident father,” said Garfield, an associate professor of pediatrics at Northwestern, in a press release. “We’re expanding male reproductive health across the lifespan and beginning to see how early beliefs relate to later outcomes and health, including fatherhood.”


The research team interviewed 10,253 male teenagers and young adults. Participants were asked to respond to statements, like “If you had sexual intercourse, your friends would respect you more;” “it wouldn’t be all that bad if you got someone pregnant at this time in your life;” and “using birth control interferes with sexual enjoyment.” Then 20 years later, they followed up with the participants to compare their responses from the initial interview to whether they had a child, if they lived with the child, and their age when they impregnated the mother.

Those who practiced riskier sexual behavior “significantly increased” their odds of becoming a nonresident father, especially when it was an unintended pregnancy, the researchers found. Specifically, young men who were less concerned about risky sex were 30 percent more likely to become a father who did not live with his child. Teens who felt it “wouldn’t be that bad” if they impregnated a girl were 20 percent more likely to become nonresident fathers.

These findings served as a way to predict the likelihood of young men becoming fathers in their teenage years. But they also show a correlation between boys’ attitudes about sex and the type of fathers they’d grow up to be 14 years later. While it’s unclear what causes this correlation, research shows teen fathers are less likely to finish school, and more likely to rely on public assistance and have lower-income jobs throughout their lives.

The researchers also found teenage boys who understood the pros and cons of using birth control were 28 percent less likely to become nonresident fathers, suggesting sex education may help as an intervention. According to the Sexuality Information and Education Council of the United States, young people who receive comprehensive sex education are 50 percent less likely to become pregnant or get a woman pregnant, and significantly more likely to delay a pregnancy and invest time in a planned pregnancy.

But first, Garfield says we must get teen boys to change their views on pregnancy. He says interventions that focus on this will reduce the number of teens who go on to become fathers and reduce their chances of becoming nonresident fathers. “That’s a role the school system and health care workers can play when seeing young men for physicals,” he said. “Together we can help young men think about their futures.”

Source: Garfield C, Duncan G, Peters S, et al. Adolescent Reproductive Knowledge, Attitudes and Beliefs and Future Fatherhood. Journal of Adolescent Health. 2016.

Testosterone helps older men with low sexual desire, study shows

Testosterone helps older men with low sexual desire, study shows

By Lynne Terry | The Oregonian/OregonLive 
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When it comes to treating older men with testosterone therapy, physicians have largely been on their own. There just haven’t been any good studies.

That changed Wednesday.

Research published in the New England Journal of Medicine shows that testosterone therapy boosted the sexual activity and desire in older men with low levels and no health issues.

But the hormone replacement therapy did little to increase their physical ability or energy level.

The study included nearly 800 men aged 65 and older at dozens of academic medical centers, health care institutions and Veterans Affairs facilities from Seattle to Boston. All of them had low testosterone levels and symptoms such as low sexual desire. They also had no health issues that would mean they shouldn’t get testosterone, such as cardiovascular problems or high levels of a protein produced by the prostate.

Over a year, one group received a testosterone gel that raised their levels to that of a 19 -to 40-year-old. The others got a placebo. The men participated in trials that measured sexual function, physical ability and vitality, or energy level.

They took a quiz every three months. The questionnaires showed that men in the testosterone replacement group experienced an increase in sexual activity, desire and erectile function compared with the placebo group. They also reported an improved mood but the results were minimal, said Dr. Eric Orwoll, an endocrinologist at Oregon Health & Science University.

“It’s not like they went from sad to overwhelmingly happy,” said Orwoll, who wrote an accompanying editorial about the study.

Men reported enjoying exercise more, but the testosterone group didn’t fare better in a six-minute walking test compared to the placebo group. The testosterone therapy didn’t affect their energy level, either.

Though the results weren’t dramatic, the study did break new ground, Orwoll said.

“This is the first really well done study,” Orwoll said. “That in and of itself is really important.”

He said it will give physicians solid data to help them guide a discussion with patients about whether testosterone therapy is the right choice for them.

He cautioned that the results only apply to men who have the same characteristics as the study group. It doesn’t apply to men with normal testosterone levels.

The likely benefactors: men with low testosterone levels who have complaints about sexual function, Orwoll said.

“We know that testosterone therapy is safe for a year,” Orwoll said.

There were four cases of prostate cancer diagnosed during the study. But the group wasn’t large enough to conclude an association with the testosterone therapy, the study said. Researchers also noted that men with a high risk of developing prostate cancer were excluded along with those with moderately severe urinary tract symptoms.

More studies are needed to determine any potential long-term risks and effects, Orwoll said.

“There are a lot of other things that testosterone might have an effect on like anemia or bone strength,” Orwoll said. “There are a lot of still unanswered questions out there.”

New Drug Combo Wakes HIV in Order to Kill It

New Drug Combo Wakes HIV in Order to Kill It

esearchers at the Sanford Burnham Prebys Medical Discovery Institute (SBP) in La Jolla, Calif., have made a fascinating discovery which may help finally cure HIV. When the virus enters the body, it hides in certain cells where it may lie dormant for months, years, even decades. Today, antiretroviral therapy (ART) can eliminate the virus’s ability to replicate itself. But it cannot eliminate hidden viruses lying dormant in host cells—safe from the immune system. Now researchers may have found a way to wake up these latent viruses in order to kill them and eliminate the disease from the body. Though this shock and kill strategy is not new, previous attempts either have either been too weak or have caused the immune system to become overactive, which can be dangerous to the patient. This study published the journal Cell Host & Microbe, surrounds two classes of drugs. The first is called smac mimetics.

A previous class, latency reversing agents (LRAs) were thought to be effective. But according to the lead author of this latest study Lars Pache, PhD, LRAs are either not strong enough to cause an immune response, or trigger over-activity. SBP investigators first examined the genes within host cells. They isolated one gene called BIRC2. Smac mimetics block BIRC2 and all molecules associated with it. Researchers wanted to see if by eliminating this gene the virus would once again become activated, and in doing so allow the immune system to recognize and eliminate it.

Another reason HIV is hard for the immune system to spot is because it contains “tightly wound DNA.” The SBP team suggested the use of another class of drugs called histone deacetylase inhibitors. These can unwind DNA, which reveals the virus underneath for the immune system to recognize and eliminate. Researchers at SBP believe that using these two classes of drugs together could help the immune system identify and erase HIV from an infected person’s body. When testing their theory, they found that the drug combination reawakened HIV without causing the immune system to go into overdrive. The next step is for the team to work together with a drug company and bring the drug combination to clinical trials. There are still a few hurdles ahead. In the meantime, every sexually active adult should get tested for HIV at least once per year, according to the CDC. Those in at-risk groups should be tested more often. Visit a clinic, physician, or urologist if it is time to do so.shutterstock_236439424

Flagging sex life? How watching reality TV or wearing high heels may be to blame

Flagging sex life? How watching reality TV or wearing high heels may be to blame


  • Maintaining your libido can be a delicate balance of health and desire
  • Numerous things – from everyday foods to gadgets – may interfere 
  • Good Health looks at surprising reasons your love life could be off-kilter

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When your relationship has gone beyond the first flush of passion, maintaining your libido can be a delicate balance of health and desire.

And it doesn’t help that numerous things – from everyday foods to gadgets – may interfere with your sexual performance.

Here, Good Health looks at some of the more surprising reasons your love life could be off-kilter…




Smell plays an important role in our recognition of pheromones – the scents given off by a partner’s body through sweat – and affects sexual behaviour.


A 2012 study at the University of Gothenburg in Sweden found that men with no sense of smell had significantly fewer sexual partners than those with a normal nasal function, and women with no sense of smell felt less secure in their relationships.


Psychologist Dr Ilona Croy, who led the study, says having impaired smell will give you a disadvantage in the mating game.


‘A lot of social signals are transported through the olfactory channel (the nose lining and associated nerves) and a depleted sense of smell makes it likely that you might miss them,’ she says.

Simply having a cold could also affect the sex drive of both men and women, adds Dr David Edwards, an Oxfordshire GP and sexual health specialist.

‘Viral infections can temporarily reduce testosterone levels,’ he explains.


If you’re trying to slim down, it could have an unwanted side-effect.

Losing weight too quickly puts stress on the body – even if you are a healthy weight – which can trigger the release of a hormone called prolactin, a powerful suppressor of sex drive.

‘Stress like this can also mean a reduction in oestrogen and testosterone levels, which is why a woman’s menstrual cycle can become irregular,’ says Dr Sarah Brewer, a GP and the author of Overcoming Low Sex Drive.

Losing more than 10 per cent of your body weight too quickly can make the body think it’s starving, which can cause sexual interest to fall, she adds.


They may look sexy, but high heels could make sex less enjoyable for some women.

Dr Eden Fromberg, a New York-based gynaecologist, says that because heeled shoes tip the body forwards, this forces the postural muscles to contract as the body works to maintain an upright posture.

‘If the pelvic floor muscles are chronically contracted, they can become tight and therefore restrict the passage of nerve impulses going through them to the reproductive organs and arousal tissue,’ she says.

‘Wearing high heels all day can affect a woman’s orgasm – there is a reported improvement in female patients who retire their heels or use them only rarely.’


A sedentary job is just as bad for a woman’s potential to orgasm, warns Dr Fromberg.

‘If you sit with rounded shoulders and your tail tucked under for hours, the muscles of your pelvic floor and the psoas muscle (which runs diagonally from the lower back through to the groin) remain chronically at “half mast” – not stretched or contracted,’ she says.

This can affect the signals passing along important nerves leading to the reproductive organs. ‘Bucket chairs and recliners are the worst for exacerbating the sorts of postural problems that can lead to compromised sexual pleasure,’ she adds.

The body is designed to move constantly, so the more active you are, the more effectively blood supply and nerve signalling can work.


People who have a TV in their bedroom have sex half as often as those who don’t, according to a 2006 study of 523 Italian couples.

The effect is more marked for the over-50s, with the average of seven couplings a month falling to just 1.5 on average.

The study found certain programmes – violent films and reality shows – impede passion.

According to Dr Edwards, good sexual relations depend on couples communicating with each other, not sitting side by side watching television.

‘If whatever you are watching makes you sad or grumpy, it is more likely to affect your libido,’ he says.

Technology can affect your love life in other ways, too. Sitting and spending more than seven hours a day on an electronic gadget (such as a phone or tablet) can trigger back pain, according to the British Chiropractic Association, and a recent survey of 2,000 people by found that 25 per cent had avoided sex because of back pain.

Men who carry a mobile phone switched on for at least four hours a day are at greater risk of erectile dysfunction than men who use phones intermittently, reported a study last year in the Central European Journal of Urology.

One suggestion is that heat could be to blame.


As well as triggering energy slumps, excess sugar in the diet is laid down as fat, which can raise oestrogen levels, reducing the effect of testosterone in women and men.

‘The more body fat you have, the more chance the testosterone in your system will be bound into the fat, which means less “free testosterone”,’ says Dr Edwards.

‘Not only will this reduce libido, it makes you more likely to gather fat in your abdomen, which binds to any remaining testosterone, so diminishing your available supply.’

Fat around the middle is a particular problem, because it can lead to a reduction in a sex hormone-binding protein called globulin, which is produced by your liver, explains Dr Mark Vanderpump, a consultant endocrinologist at the Royal Free Hospital, London.

This protein attaches itself to testosterone, transporting it around the body. ‘Men with lower levels tend to have a lower concentration of testosterone,’ he says.


Men who exercise regularly have a 70 per cent reduced risk of erectile dysfunction compared with men who do none – but serious cyclists are more likely to suffer impotence.

It seems the firm, angular saddles can put pressure on nerves and arteries around the groin, reducing blood flow to the penis.

‘If there is bruising to the pudendal nerve (a major nerve in the groin that runs from the genitals to the base of the spine), erectile dysfunction can last for up to two years,’ says Dr Edwards.

But it’s more typically seen on Mondays or Tuesdays after a weekend in the saddle, he adds.

He recommends saddles with a deep groove down the middle – to relieve pressure on the nerve – or putting a cushioned gel pad on top. ‘If cycling leaves you with a numbness or tingling in your groin, it’s time to adjust your seating arrangements.’


Women need warm feet for orgasm, suggested a Dutch study published in 2005. Researchers revealed that 80 per cent of women were able to achieve orgasm when they wore socks, compared with 50 per cent when barefoot.

According to Professor Gert Holstege, a neuroscientist at the University of Groningen who led the stud: ‘The feet play a significant role in maintaining body temperature, and by regulating internal climate the mind and body can come into a relaxed state needed for an orgasmic release.’


The popular perception is that beer puts a downer on a man’s love life. However, Dr Kat Van Kirk, a sex therapist and associate professor at the Institute for the Advanced Study of Human Sexuality in Los Angeles, says that beer can actually make men better in bed because the plant chemicals (phytoestrogens) it contains may help to delay orgasm.

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