Monthly Archives: January 2017

8 lies men tell their doctors– and why they need to come clean

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8 lies men tell their doctors– and why they need to come clean

2017-01-25

When it comes to talking to their doctors about their health or admitting that they have a problem, most men stretch the truth, leave out important details or flat-out lie.

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In fact, a little more than 50 percent of men between the ages of 55 and 64 said they’re usually honest with their doctors, while only approximately 38 percent said they’re always honest, a survey by NetQuote found.

What’s more, 53 percent of men said their health isn’t something they talk about, a survey by the Cleveland Clinic found.

Here, experts weigh in with some of the most common lies men tell their doctors and the reasons why they need to come clean.

1. “I don’t have erectile dysfunction.”
Between 15 and 30 million men under age 65 in the U.S. have erectile dysfunction, but most men won’t readily admit it.

“When they come into the office they always come in for another excuse,” said Dr. Dudley Danoff, a urologist in Los Angeles and author of “The Ultimate Guide to Male Sexual Health.”

But when they’re on their way out, they’ll ask for samples of erectile dysfunction medication.

Erectile dysfunction doesn’t only affect a guy’s sex life, it’s also linked to other medical conditions like thyroid dysfunction, type 2 diabetes and atherosclerosis.

“Something can be done about it, but men have to fess up and let their doctor help them,” Danoff said.

2. “I don’t have problems urinating.”
It’s common for men to hold back when it comes to talking about their bathroom habits, but going more frequently and experiencing pain or discomfort can all be signs of prostate problems— which are common in men over 50, said Dr. Berry Pierre, a board-certified internal medicine physician in Boynton Beach, Florida.

3. “I’m not depressed.”
Men who have depression are more likely to brush it off, try to “talk” themselves out of it, or socially withdraw in order to cope.

“Men are less likely than women to express emotional vulnerability,” said Dr. Will Courtenay, a psychotherapist in Oakland, California.

Not only can depression affect their quality of life, but men with depression are at risk for suicide.

In fact, suicide rates in men between 45 and 64 increased 43 percent between 1999 and 2014, according to a report by the Centers for Disease Control and Prevention (CDC).

4. “We have sex all the time.”
A healthy sex life is important for a healthy relationship and overall health and well-being, but a large percentage of couples are in sexless marriages.

In fact, 20 percent of married people between 18 and 60 have not had sex in the last month and 6 percent have not had sex in over a year, according to a survey by The Austin Institute for the Study of Family and Culture.

Men who are not having sex regularly aren’t likely to bring it up because they’re embarrassed, but talking to their doctors about it can rule out medical conditions and help them find solutions.

5. “My bowel habits are normal.”
Men who have bleeding, pain or changes in their bowel habits often downplay their symptoms, don’t disclose all the details, or even deny it, said Dr. Cedrek McFadden, a double-board certified surgeon in colorectal and general surgery in Greenville, South Carolina.

Men are more prone to be tight-lipped because they’re embarrassed or fearful of what their doctors will discover.

Yet it’s important that men tell their doctors about their symptoms because they could be symptoms of things like diverticulitis, inflammatory bowel disease (IBD), a fissure, an abscess or colon cancer.

Although they dread having a colonoscopy, the prep work is the worst part of it and it can detect colon cancer and when found early, be cured, McFadden said.

6. “I don’t snore.”
True, men can’t hear themselves snore, but when their partners tell their doctors that they do, men may deny it or brush it off as insignificant, said Michael J. Breus, Ph.D., a clinical sleep specialist in Los Angeles and author of “The Power of When.”

Yet snoring, and pauses in breathing, are often a tell tale sign of obstructive sleep apnea, a condition which affects more than 18 million Americans and can lead to high blood pressure, heart disease and type-2 diabetes, among others.

7. “I see—and hear—just fine.”
Men consistently lie or aren’t entirely truthful about how poor their vision and hearing have become, probably because of the stigma attached to growing old.

Yet having regular exams and being truthful can identify problems before they become more severe.

8. “My blood pressure is normal.”
It’s common for men with high blood pressure, even if it’s well controlled, to leave it out of the medical history questionnaire, said Dr. Jennifer Dean, a family and cosmetic dentist in San Diego, California.

Yet neglecting to their doctors, especially their dentist, about it could be serious. Anesthetics for dental procedures that contain epinephrine can increase blood pressure and put a middle-aged man at risk for a heart incident, she said.

Julie Revelant is a health journalist and a consultant who provides content marketing and copywriting services for the healthcare industry. She’s also a mom of two. Learn more about Julie at revelantwriting.com.

 

 

Bisexual student: Sex ed classes left me believing lesbian sex wasn’t ‘real’

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Bisexual student: Sex ed classes left me believing lesbian sex wasn’t ‘real’

2017-01-17

My sex education was basically a disaster.

Charlie_Mathers_kitchen_LGBT_Student_Pride

Aged 11, it involved an oversimplified picture book. My teachers were awkward about it, which meant I was awkward about it too.

So my first same-sex experience involved a lot of uneducated fumbling on my part and me not being quite sure what to do. My partner did, but that didn’t stop my nervousness levels being through the roof.

Can lesbians have real sex?

That was around five years ago. And even now I can’t help but feel like I shouldn’t be getting up close and personal with other women, because what can we really do?

I can’t tell you the amount of times I’ve been told that women can’t really have sex with each other.

Thank the lord, though, that the education had my back covered when it came to the first time I slept with a man.

Because all that matters, isn’t it? Remember Mean Girls: If you have sex, you’ll get pregnant or get chlamydia and die.

Wrong.

UK letting LGBTIs down on sex ed

LGBTI students are at even more of a risk than their straight counterparts. Why? Because they’re barely educated about the protection that is there for them. In fact, they may not be educated about sex at all.

They’re not taught how to safely get down and dirty with each other. That is awful. The whole point of sex education is to help keep us all safe, after all.

Unfortunately, the UK education system currently doesn’t cover this. In fact the British government has just decided not to make LGBTI-inclusive sex and relationships education compulsory.

Thousands of people all over the country are just as disappointed as I am by that irresponsible decision.

Sexual health charity The Terrence Higgins Trust’s End The Silence Report, explored the need for LGBTI inclusive sex ed. It found only 5% of young people were taught about LGBTI sex and relationships. But 97% of the students polled thought it should be.

Blocking sex ed for the sake of religious schools

One Conservative Member of Parliament voted against inclusive, compulsory sex ed because there was insufficient protection for religious schools that oppose homosexuality.

I am tolerant of those who follow the mainstream religions, of course. But I’m not tolerant of homophobia. For that MP religious freedom was more important than protecting people from the toxic shame homophobia creates.

A lot of young people start questioning their sexuality towards the end of primary school or in high school. The education system currently does nothing to help them.

Many young people are never told ‘hey there’s this jazzy thing where you can be attracted to men and women and it’s totally fine’. Nobody tells them ‘if you are not interested in having sex at all, you’re not weird, you’re just asexual’.

We’re not promoting homosexuality. It’s not some fancy club where you get a glitter shower on entry and unlimited access to Beyoncé’s albums. We just want to educate and to be educated.

And I have high hopes for exactly that. That is undoubtedly the only way any progress will actually be made.

Students teaching themselves

I am unapologetically an LGBTI activist. And part of my battle involves being an incredibly active committee member at National Student Pride. So I was absolutely ecstatic that our event this year focuses on sex education and the need for good sex and relationships education in schools.

Proper, inclusive sex ed can free people of the stress and mental health issues that can come from having to figure out your sexuality alone. They will no longer be alone. So let’s liberate our youth, and get down and jiggy with sex ed.

Afghan asylum seekers resort to sex work in Athens

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Afghan asylum seekers resort to sex work in Athens

In the rundown Pedion Areos Park, older men walk slowly by young asylum seekers before agreeing on a price for sex.

Athens, Greece – Mahmoud looks out over the chaotic mess of rooftops and aerials and towards the neglected park he now calls home. He’s wearing a red hoodie, blue jeans and a black cap. Everything suggests he is a typical 20-year-old, apart perhaps from the jagged scar on his brow. 

“I am ashamed about what I do for money, but I will tell you,” he says.

The Afghan asylum seeker clasps his hands tightly in front of him as he speaks. “I didn’t know anyone when I arrived in Athens,” he begins. “Life was very difficult and it still is. I don’t have a home so I sleep every night in a park nearby.

“I had only two options when I arrived – one was to become a thief or a drug dealer,” Mahmoud explains. “But I am not that kind of person.

“The other option was to stay in the park and have sex with older men, or anyone … that asked for it for five or 10 euros [around $5 and $10] ….”

His only shelter is a cheap tent that he shares with an Iranian asylum seeker. Perched on the concrete roof of a small maintenance building hidden among the trees of Pedion Areos Park, it offers little protection from the cold. A bag of oranges provides breakfast, lunch and dinner.

Mahmoud says the money he makes selling sex only covers the cost of his daily food. He cannot afford to save anything.

He speaks regretfully about his work but sees no way out.

“This is my only source of money now,” he says. “I’ve made a mistake, and now I’m deep in this s***.”

But Mahmoud isn’t alone. Pedion Areos Park has become a hub of illegal male prostitution, sometimes involving refugees as young as 15. 

Greece has strict laws regulating prostitution. Sex workers must register, be aged over 18, legal residents in Greece and work in a licensed brothel. Despite this, illegal street prostitutes, who are often migrants and refugees, are estimated to outnumber licensed prostitutes by 20 to one.

Licensed sex workers have fortnightly sexual health checks and access to free treatment for sexually transmitted diseases. Unlicensed street sex workers, like Mahmoud, do not.

Shopping for sex

While the majority of Athens’ sex workers are female, Pedion Areos has long been a hot spot for male sex work.

The park, although grand and sprawling, has, like its inhabitants, been largely ignored. The large statue of King Constantine I that stands at its entrance has been covered with graffiti. Used condoms and tissues litter the ground.  

Those familiar with the park say that the majority of the sex workers there are Albanian, Bulgarian and Romanian.

Neno, a Bulgarian Roma, arrived in Athens eight years ago and has been a sex worker in the park ever since. He says he doesn’t particularly mind the work, but that it doesn’t pay well.

“A lot of people hate this job, they don’t want to be here,” he says. “For me, it’s OK. I don’t have a problem with it. Just the money isn’t good.”

Neno isn’t homeless. He lives in a small town to the southeast of Athens which is popular with tourists, and takes the bus into the capital each weekday. The bus stops directly outside the park.

At the weekends, he makes a little extra money playing guitar in tavernas along the coast.  

For Neno, being a sex worker is a job like any other. For Mahmoud and the park’s other homeless residents, it is a desperate attempt to survive. They spend their mornings waiting and warming themselves by fires started in steel cans, into which they put anything that will burn, often producing a choking smoke. 

“The Greek guys [clients] don’t come in the day because they think they might get caught,” Mahmoud explains. “They wait until later to come to the park, when they’ll be safer.”

Business begins in the late afternoon as the winter sun starts to set and the few dog-walkers and runners leave the park. Their busiest time is from dusk until midnight, when the majority of those in the park are sex workers or their clients. 

As the light in the park fades, middle-aged men walk slowly past benches on which young men and boys sit, as though perusing shop windows. By now, a different demographic has arrived: unaccompanied minors, refugees who have been orphaned, are travelling alone or have been separated from their family during the journey, and see the park as a place to make money.

“The main issue is that they have no money, either for their daily lives or to pay for a smuggler,” explains Kenneth Hansen, the programme manager at Faros, an NGO that runs a shelter for unaccompanied minors close to the park.

“Some of them have told [us] that they have sex with men in order to do other things, to have money to go and buy a new phone,” he says.

“One boy told us he had sex with two men and got five euros [$5] so he could buy cigarettes … One guy told us he had sex with a man so he could pay to have sex with a woman.”

The clients are always Greek, explains Mahmoud. Most are in their 60s, but some can be as young as 30; others as old as 90. “You see men of all ages [buying sex],” he says. “Some are young men and some look like they might die the next day.”

Some of the sex workers are clearly on familiar terms with the clients, laughing and chatting openly with the ones they recognise. Others, often the younger ones, sit awkwardly, saying little. 

“Usually the men see me in the park, they come closer to me then ask me, ‘Where are you from?'” says Mahmoud. “I’ve learned a bit of Greek so I understand and we speak a bit. Then they sit down next to me and that’s how it starts.”

Once a price has been agreed, they move somewhere more private – but that usually just means going behind a bush a few metres away.

The clients

Costas is 46 and has good job at a logistics company. Most evenings after work, he goes home to his apartment in a suburb of Athens, where he lives alone. But three or four evenings a month he changes his clothes and drives to the park to look for sex.

His routine has been the same for 10 years, he explains.

“It’s easy to find sex here,” he says. “I normally stay for about an hour before I find someone to go with.”

He is familiar with two or three of the sex workers at the park whom he knows by name and sees regularly. Five euros is the going rate, he says, regardless of nationality.

Costas insists that he never has sex with refugees or anyone under the age of 18. That would be “wrong”, he says. But he does acknowledge that he can’t be sure about the age or nationality of those he does have sex with.

Only his closest friends know about his visits to the park, he says.

Yiorgos says he is 52 but he looks much older. He lives an hour away but comes to visit a friend who lives near the park three times a week. They go for coffee and, on his way home, Yiorgos walks through the park, looking for sex workers.

“[The sex workers] are 17, 18, 20, 30, 50, it depends,” he says. “The day before, there was one that was 16, small,” he adds, before looking around nervously. “They should be 18,” he admits. A sex worker in their 20s could have sex five times a night, earning up to 50 euros, he explains.

He doesn’t believe that what he does is wrong. “If I steal, it’s a problem. But I don’t steal. Neither do I fight …. If I fight or steal, yes, the police will come. But if not, they don’t come. What could they tell me? All they can do is ask me why I am sitting here. Is it wrong?” he says. 

Prices vary, explains Tassos Smetopoulos, a volunteer who organises a weekly food donation in the park. “In Pedion Areos, it starts from five euros [$5] and goes to 200 [$213],” he says. 

“Some of [the clients] say to the boys, ‘OK, you can come to my apartment, to have a little party. Some friends of mine will be there too. You can stay the night.’ Something like this can go up to 200 euros [$213]. It depends on what they’re asking and what the boys accept.”

In search of a better life

Shortly after the US-led invasion of Afghanistan, Mahmoud, who was then five, left his native Herat with his family. “My father went first before us and then the rest of our family followed him,” he says.

“Everybody in Afghanistan then who wanted to seek a good life usually went to Iran, so that’s what we chose to do.”

In Iran, his family lived on the margins, unable to find legal work once their temporary residence permit, which they couldn’t afford to renew, had expired. After five years of schooling, Mahmoud started working to support his family.

At 15, he left Iran ahead of his family to search for work opportunities in Turkey.

“I stayed for five years in Turkey working on a construction site, trying to earn some money and to organise my trip to Greece,” he says.

But so far, he hasn’t found the greater opportunities he had hoped for in Europe.

“If I find any way at all, I want to go to Germany because I know some people there. Maybe I could find a good job,” he says. “I would leave as soon as possible if I just found the road and some money to get there.

“I’ve tried many times to go [illegally] to Italy from Patra, hiding under a truck, but it never worked,” he adds.

He says he’s tried the official, legal routes for asylum in Greece, which would enable him to live and work legally in the country.

“I’ve tried to claim asylum but I can’t. It’s very hard. Many times I’ve been to [the asylum office] but I never get a meeting. They always say I have to wait.”

Using a mobile phone borrowed from a friend, Mahmoud speaks to his family in Iran at least twice a week. He gives them updates on his journey but never tells them the truth about his life in Athens.

“I tell them Athens is a good city, with nice people, but really, it’s like someone has injected this city with filth,” he says.

‘It is going on in front of our eyes and no one is doing anything’

Mahmoud says there are no pimps operating in the park and that it is only the asylum seekers’ desperate situation that forces them into sex work. But Hansen believes that not enough is being done to investigate whether anyone is behind it.

“Many [young refugees] are involved in sex for money,” he says. “But whether they do it for survival sex, or just to get an allowance, or if it is more organised, this we don’t entirely know and it’s an area the authorities don’t really want to touch.

“It’s taking place so obviously. You can just go to the park and solicit a 15-year-old … It is going on in front of our eyes and no one is really doing anything.”

In November, Greek police told CNN that “they had not had any reports of unaccompanied minors involved in the sex trade in [Pedion Areos or Victoria Square],” but said they were “aware of the problem and working to address it”.

The office of the Prosecutor for Juveniles, which is responsible for unaccompanied minors in Greece, told Al Jazeera that it had begun an investigation in December into the issue but that the investigation was ongoing. They declined to answer any further questions about it.

Mahmoud says that uniformed police officers sometimes patrol the park, but that evading them has been easy so far. “When the police come, if they come, we just go into the bushes and hide and they don’t know we are there.”

* The names of sex workers and clients have been changed to protect their identity

Source: Al Jazeera News

Male Sexual Health: Why Young Men Don’t Get The Information They Need About Reproductive And Sexual Health

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Male Sexual Health: Why Young Men Don’t Get The Information They Need About Reproductive And Sexual Health

2017-01-12

Fear is one barrier that keeps some young men from racial and sexual minority groups from getting proper sexual health care.

A study in the Journal of Adolescent Health used information from several dozen black and Hispanic guys between 15 and 24 years old to determine their own perceptions of factors that work for or against their reproductive health care. Of the young men in the study, 16 percent were gay or bisexual. The researchers from Johns Hopkins University School of Medicine found that some young men reported concern about the stigma of being seen at certain clinics, like those where health care professionals test for sexually transmitted diseases. They said that was something that could keep them from getting adequate care for their sexual and reproductive health. They also expressed concerns about long wait times at clinics, privacy issues, and the cost of care.

There were also disparities among the group in terms of what they thought their needs were. Johns Hopkins said in a statement that to prevent or treat STDs, some in the group relied purely on condoms while others got tested based on their own assessment of whether they had engaged in risky behavior. “Many said that in the absence of physical symptoms, they saw no reason to seek care or they feared results of a positive test for an STI.”

That could be important because the Centers for Disease Control and Prevention recently reported that sexually transmitted diseases like syphilis, chlamydia and gonorrhea — all of which can be cured with antibiotics — are spreading more than ever. Gay and bisexual men and young people were particularly affected by the infection increases.

Dr. Arik Marcell, a professor of pediatrics at Johns Hopkins and the paper’s first author, said in the statement that it shows “no one particular factor is responsible for young men’s lack of engagement” in getting sexual and reproductive health care. “We need to think about working at multiple levels to effect change rather than focusing solely on the individual level, which may place undue blame on the individual.”

Study results show that the young men surveyed talk to people in their lives, like their mothers and friends, about their health but didn’t always know where to go for care. Self-consciousness also played a role in their care: “Some participants also discussed needing greater self-confidence when asking and answering questions about their health in general, especially about their sexual health,” the university said.

The authors suggest that a lack of knowledge or health care could have a gender basis: According to the study, the culture around health care in the U.S. is “focused on women’s health” and males are influenced by “traditional masculinity scripts.”

“Few men also have received sexual and reproductive care because historically, few clinical guidelines have outlined care that providers should deliver to this population, and few public health efforts have focused on engaging this population,” Johns Hopkins said.

Care is not the only way men lag behind women when it comes to sexual and reproductive health. Another recent study showed that men don’t know a lot about their own fertility. A survey of hundreds of Canadian men found they were generally not aware of many of the factors that could reduce their sperm counts. And the authors of that study suggested one of the reasons could be that men are not are likely as women to ask questions about their own health.

Although the new study shows men have less knowledge and receive less care than women when it comes to their sexual health, some are getting a level of care. According to Johns Hopkins, about half of the men they surveyed had health insurance and a regular source of health care, and a majority had received a physical exam in the last year. Additionally, 35 of the 70 were tested for HIV.

Source: Marcell AV, Morgan AR, Sanders R, et al. The Socioecology of Sexual and Reproductive Health Care Use Among Young Urban Minority Males. Journal of Adolescent Health. 2017.

 

Barriers to sexual health among male teens and young men

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Barriers to sexual health among male teens and young men

Date:January 9, 2017Source:Johns Hopkins MedicineSummary:Researchers who conducted a dozen focus groups with 70 straight and gay/bisexual Hispanic and African-American males ages 15 to 24 report that gaining a better understanding of the context in which young men grow up will allow health care providers to improve this population’s use of sexual and reproductive health care.

Johns Hopkins researchers who conducted a dozen focus groups with 70 straight and gay/bisexual Hispanic and African-American males ages 15 to 24 report that gaining a better understanding of the context in which young men grow up will allow health care providers to improve this population’s use of sexual and reproductive health care.

In a report of the research, published Jan. 6 in the Journal of Adolescent Health, the investigators say the sessions revealed the important influences of these young men’s social ecology on their use of such care, including the role of personal experiences and social interactions with family, peers and health care providers. For example, fears of sexually transmitted infections testing, having a choice in the provider they see, and a lack of clear messages about why to access the sexual and reproductive health care that young women receive were identified as common barriers to such care among these young men.

The focus groups were conducted between April 2013 and May 2014, and facilitated by trained male staff members matched by race/ethnicity.

“This study tells the story of how the health care system is not well-set up to serve young men’s sexual and reproductive health care because it’s often viewed as women’s domain,” says Arik Marcell, M.D., M.P.H., associate professor of pediatrics at the Johns Hopkins University School of Medicine and the paper’s first author.

Few men also have received sexual and reproductive care (SRH) because historically, few clinical guidelines have outlined care that providers should deliver to this population, and few public health efforts have focused on engaging this population in SRH, he adds.

In an attempt to document young males’ direct perceptions about SRH use, Marcell and his team held 60- to 90-minute focus group discussions with 70 males. Sixty-six percent (46 of 70) of participants were African-American, and the remaining 34 percent were Hispanic. In self-reported histories, 84 percent (59 of 70) were heterosexual, and the remaining 16 percent were gay or bisexual.

The research team recruited participants from eight community settings, such as recreation centers, faith-based organizations and LGBT organizations, across Baltimore. Eight focus groups were conducted in English, and four were conducted in Spanish.

The research team says results of a five-minute self-administered questionnaire participants completed before the focus groups were conducted found that just over half of participants (38 of 70) had a regular source of care and health insurance (36 of 70). In the last year, the majority of participants — 47 of 70 — reported having had a physical exam, 35 said they received HIV testing and 27 received testing for sexually transmitted infections (STIs).

In the focus group sessions, some young men shared the belief that condom use protected them from HIV and other STIs, and they did not see the benefit for STI testing, whereas other young men made decisions to get tested based on self-assessed engagement in risky behaviors. Many said that in the absence of physical symptoms, they saw no reason to seek care or they feared results of a positive test for an STI. These young men also discussed wanting people in their lives to talk about sexual and reproductive health, and cited their mothers and health care providers as being very helpful sources of sexual and reproductive health information. However, some young men, especially adolescents, didn’t always know where to go for sexual and reproductive health care and reported relying on their friends. Some participants also discussed needing greater self-confidence when asking and answering questions about their health in general, especially about their sexual health.

The focus group discussions also revealed that heterosexual male adolescent participants preferred female providers if given a choice, Hispanic participants preferred Spanish-speaking providers and gay/bisexual young adults did not want providers to judge them based solely on their sexual orientation.

Long wait times at clinics, costs and concerns about privacy also emerged as deterrents to seeking sexual and reproductive health care, in addition to the stigma of being seen at certain types of clinics (e.g., STI clinics).

“This study adds to a small body of evidence that no one particular factor is responsible for young men’s lack of engagement in SRH use. We need to think about working at multiple levels to effect change rather than focusing solely on the individual level, which may place undue blame on the individual,” says Marcell.

Future research, Marcell says, focuses in part on a new program called Project Connect Baltimore (www.Y2CONNECT.org) that trains people who work in community settings, rather than only clinics, to talk with young men about SRH care and how to get it.

Story Source:

Materials provided by Johns Hopkins Medicine. Note: Content may be edited for style and length.

Middle-aged sex without the mid-life crisis

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Middle-aged sex without the mid-life crisis

2017-01-10

More people are dating in middle age, but are they looking after their sexual health?

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With more middle-aged people dating, or starting new relationships than ever before, are we taking enough care and consideration of our sexual health?

When we think of the faces behind recent statistics that are showing a rise in sexually transmitted diseases (STDs), we probably picture someone young. Those irresponsible students and twentysomethings playing around and not thinking through the consequences of their actions. But not so much. It is becoming clear that a large proportion of people contributing to those statistics are in fact, middle-aged. The Irish Family Planning Association (IFPA) annual report highlighted an increase in women aged over 50 coming to the clinics for sexual health services, including sexually transmitted infection screening and menopause check-ups.

The association said there was a perception that once women reached menopause, that they no long needed sexual health services. But that’s not the case. Minding our sexual health all through our life is as important as looking after our physical and mental health.

Unplanned pregnancies

For many women, perhaps coming out of a long marriage or relationship, they perhaps don’t seem to think they have to go back to the good old days of contraception and protection. Yet there are more unplanned pregnancies in the 40-plus age group than the younger ages.

“We definitely see an innocence and a lack of knowledge in middle-aged women seeking our services,” says Caitriona Henchion, medical director of the IFPA. “We see women not knowing if they need emergency contraception or whether they are experiencing menopausal symptoms. They’re not sure even in their late 40s and early 50s whether they still need contraception.”

The recommendation for contraception is very simple, yet perhaps not widely known. Until you have not experienced periods for two full years and you are under the age of 50, or one full year without periods after the age of 50, you need to still consider contraception. Amid constant talk of falling fertility as we age, many women are confused about their contraception needs.

This lack of knowledge about sexual health needs is apparent not just in the number of unplanned pregnancies in older women, but the rise of STDs in that age group as well. According to Henchion, advice from GPs can sometimes vary in quality and quantity, and so any sexually active woman over the age of 40 needs to seriously consider both her health risks and contraception needs.

Regular screening

The recommendation is that anyone who is sexually active needs regular screening. This seems to be something that many women feel unable to do. But emerging from a marriage or long-term relationship where the partner may have had other sexual partners means that STD screening is imperative.

“Discovering an unfaithful partner is a really common reason that we see older women coming to our clinics for screening,” says Henchion. “Our advice would be that the first thing to consider when starting with new partners is to ensure you have safer sex with condoms.”

But condoms don’t protect against everything, so the recommendation from the IFPA would be that if in sexual relationships you need to have testing twice a year.

“Obviously the people I see are a self-selecting group who are sexually active and attending our services, but certainly I would see a lot more people in the 50-plus [group] who are openly talking about their wants and needs and their problems with it, which is great,” explains Henchion. Who they do not see are the men and women not seeking sexual health services, or asking openly about their needs.

One of the reasons there is a rise in general of STDs is because far more tests are being carried out, and therefore, more positive results. The tests are better now for chlamydia and gonorrhoea, so whereas a few years ago tests had less than 75 per cent detection rate, today it is 99 per cent. The tests themselves are simple. For men with no symptoms it is a straightforward urine sample and blood test, and for a woman, a vaginal swab and blood test in a nurse-led clinic.

Simple rule

According to Henchion, “the simple rule would be if you have a new partner for a few weeks, get tested.” But for many people, we perhaps don’t even know what to look for.

The top three STDs in terms of prevalence would be chlamydia, warts and herpes, and although many of the symptoms are obvious such as bleeding or physical warts, in more than 50 per cent of cases there are no symptoms. How many cases are picked up is through automatic testing when going for certain contraception options such as the coil.

Henchion believes we need better sex education and awareness for all generations. “I see 21-year-olds coming in with no understanding of how STDs such as herpes and warts can still be spread even though they are using condoms. And for sexually active people in middle age, there is often a significant lack of knowledge.”

For now, until sexual health education is more widely available, there are plenty of support services including GPs, well woman/well man sexual health clinics and the Guide Clinic at St James’s Hospital. The IFPA offers free advice, and there are plenty of online services such as HealthyIreland.ie.

“The key message is that early detection makes a huge difference in reducing risk of pelvic infection and obviously reducing the risk of passing it on,” warns Henchion. “Anyone, whatever age, who is sexually active needs to mind their sexual health.”

Middle-aged, single and on fire – or talking ourselves celibate?

For many women who have reached the supposed sexual prime of their 40s and 50s, their body image is shattered along with their energy. A recent survey suggested some women in this age bracket have the lowest confidence of any other age group regarding body image, and it’s affecting their sex lives. Yet another survey highlighted the fact that some women in middle age are having the best sex of their lives. If both surveys are right, is it all just down to attitude, and can changing your attitude change your sexual mojo?

In the two decades since the iconic shenanigans of the “man-eater” Samantha shocked a nation in Sex and the City (while women everywhere sniggered at the delight of it), middle-age sex is becoming mainstream. The BBC were at it with Happy Valley, and even Cold Feet caught up. First time round, Adam and co were in their youth, but now that they are heading towards 50, who is the one having all the sex? Karen. Middle-aged, single and on fire. Now that ordinary middle-aged women are being shown to be – gasp! – sexual, it begs the question: what does this mean for us? Is this liberating or intimidating?

It seems your answer to that question is the difference between having an active sex life in and beyond middle age and putting away the sexy knickers and taking out the comfy slippers.

Like tight skin and fashionable clothes, sex used to be the domain of the young. But now middle-aged women can have tight skin, fashionable clothes and sex as well. It all depends on your attitude. If you think your sex life is over at 50, it will be.

“Attitude is so important,” says sex therapist Kate McCabe. “I see women challenging traditional values and beliefs that you are past it sexually after a certain age. Women are having babies later, new relationships later, are mentally and physically healthier and anxious to be active and participate fully in every aspect of their lives.”

In fact, a regular, happy sex life can benefit our physical, mental, emotional and social wellbeing, improving health and prolonging life. This generation of middle-aged women have opportunities to redefine what stereotype they fit into, experiencing greater sexual, financial, social and intellectual freedom than at any previous time. Contraception has meant we are not overburdened with childbearing, and openness about sex means that issues which might have caused discomfort and difficulty can be addressed. The increase in divorce and separation now means that middle-aged dating is an acceptable social norm.

So why are all middle-aged women not taking advantage of the chance to flirt their 50s away and sex up their 60s?

“Sex must be worth it,” explains McCabe. “I see women who come into therapy to see how they can best improve their sex life, even to the extent that they’ll bring in their partners and manage to engage in that conversation.”

And it’s women of all ages. McCabe has clients in their 60s and 70s. “They are definitely getting out there, and they want really good, honest information on how to make the most of their sexual potential.”

But what about those women who are talking themselves celibate because of lack of confidence? Media plays a huge part in how women can often rate themselves. According to McCabe, feeling sensual has nothing to do with how you look.

“Finding intimacy is a brave step. Overcoming hang-ups to really explore our own sensuality is vital. And much of it relies on getting the right attitude.”

2016 Brought a Flood of Abortion Restrictions, But Also a Surge of Proactive Measures

blog, Reproductive Health

2016 Brought a Flood of Abortion Restrictions, But Also a Surge of Proactive Measures

2017-01-04

While state legislators pushed through 20-week abortion bans and restrictions against fetal-tissue research in some states, there was progress on measures related to contraceptive access in places such as California, Illinois, and Vermont.

In 2016, 18 states enacted 50 new abortion restrictions, bringing the number of new abortion restrictions enacted since 2010 to 338. Although state-level assaults on abortion access continued, 16 states took important steps in 2016 to expand access to other sexual and reproductive health services, adopting a total of 28 proactive measures. Many of these measures expand access to contraception by requiring health plans to cover an extended supply of contraceptive methods (five states), authorizing pharmacists to dispense contraceptives without a physician’s prescription (one state), or expanding insurance coverage of contraception (three states).

Aside from legislation, the most notable event of 2016 related to reproductive health access was the U.S. Supreme Court’s decision in Whole Woman’s Health v. Hellerstedt in June. That decision struck down Texas restrictions that had required abortion facilities to be the equivalent of ambulatory surgical centers and mandated abortion providers have admitting privileges at a local hospital; these measures had greatly diminished access to services in the state. Notably, the Court’s ruling underscored the need to consider scientific evidence, and not just lawmakers’ beliefs, in evaluating the constitutionality of abortion restrictions.

Unfortunately, just months after that landmark ruling, the election of Donald J. Trump raised the specter that the Supreme Court—if dramatically reconfigured by the new administration—could place abortion rights very much in jeopardy across the country. Moreover, the resurgent Republican Party—having maintained anti-abortion majorities in both chambers of Congress—is undoubtedly planning an aggressive assault on sexual and reproductive health and rights. The Republican platform adopted in 2016 takes its cue from the states, naming many of the abortion restrictions that have received the most attention from state legislators in 2016, including banning abortions at 20 weeks post-fertilization, outlawing dilation and evacuation abortion, restricting fetal tissue donation and research, and banning abortion for purposes of sex selection and genetic anomaly.

Trump’s victory also threatens the federal contraceptive coverage guarantee included in the Affordable Care Act (ACA). Overturning the ACA overall is a key goal of the incoming administration; more specifically, Vice President-elect Mike Pence has repeatedly promised action on the contraceptive coverage guarantee. Regardless of how this drama plays out in the coming months, states will continue to have a critical role to play. Twenty-eight states have a state-level contraceptive coverage guarantee. Most of these measures require insurers to cover the full range of FDA-approved methods, and laws in California, Illinois, Maryland, and Vermont require this coverage with no cost sharing. Expanding insurance coverage of contraceptive services under private insurance has been a significant focus of state legislators supportive of women’s reproductive health care; in the last three years, those same four states have moved to expand access to contraceptive coverage in some form.

Restricting Abortion Access

The 338 state abortion restrictions adopted since 2010—the year anti-abortion forces took control of many state legislatures and governors’ mansions—account for 30 percent of the 1,142 abortion restrictions enacted by states since the 1973 Supreme Court decision in Roe v. Wade. These restrictions greatly shape the landscape facing women seeking to access abortion care.

By 2016, more than half of all states had at least four of the ten major types of abortion restrictions and so are considered hostile to abortion rights. Notably, nearly all the states in the South, along with most of those in the Midwest, are considered hostile. Twenty-two states have six or more restrictions, enough to be classified as extremely hostile to abortion rights

In 2016, 57 percent of American women of reproductive age (15 to 44) lived in a state considered either hostile or extremely hostile to abortion rights. Only 30 percent of women lived in a state supportive of abortion rights (a state with no more than one type of restriction), and 13 percent lived in a middle-ground state (a state with two or three restrictions). For the 38 percent of all reproductive-age women who live in the South, chances of living in a state supportive of abortion rights are particularly low: Only 5 percent live in a supportive state (Maryland), while 93 percent live in a state that is hostile or extremely hostile to abortion rights. By contrast, 62 percent of women in the Northeast live in a supportive state, and only 24 percent of women in that region live in a state that is considered hostile.

Five abortion-related topics received particular attention from state lawmakers in 2016:

  • Banning dilation and evacuation abortion. Four states (Alabama, Louisiana, Mississippi, and West Virginia) banned the use of dilation and evacuation, a common and medically proven method of second-trimester abortion. The new laws in Alabama and Louisiana, along with laws that were passed in 2015 in Kansas and Oklahoma, are not in effect pending the outcome of litigation. Bans are in effect in Mississippi and West Virginia.
  • Restricting fetal tissue donation and research. In the aftermath of the discredited videos targeting Planned Parenthood clinics, eight states (Arizona, Florida, Idaho, Indiana, Louisiana, Michigan, South Dakota, and Tennessee) enacted measures limiting fetal tissue donation; seven of them (all except Michigan) also banned research involving tissue from an abortion. The provisions in Louisiana are not in effect pending the outcome of litigation.
  • Banning abortion for specific circumstances. Indiana and Louisiana enacted laws that would have banned abortion due to a genetic anomaly. Neither law is in effect due to ongoing litigation, leaving North Dakota as the only state with such a ban in effect. The Indiana law would also have banned abortion based on the race or sex of the fetus or because of the fetus’s color, national origin, or ancestry. Seven states (Arizona, Kansas, North Carolina, North Dakota, Oklahoma, Pennsylvania, and South Dakota) have laws in effect banning abortion due to the sex of the fetus; Arizona’s law also bans abortion for purposes of race selection.
  • Banning abortion at 20 weeks post-fertilization. Ohio, South Carolina, and South Dakota enacted measures that ban abortion at 20 weeks post-fertilization (equivalent to 22 weeks after the woman’s last menstrual period). All of these new laws permit an abortion after that point when the woman’s life is endangered or if she has a severe physical health complication; the South Carolina law also permits an abortion in the case of a lethal fetal anomaly. Fifteen states, including South Carolina and South Dakota, have similar restrictions in effect. The Ohio restriction is scheduled to take effect later this year.
  • Requiring fetal tissue to be cremated or buried. Indiana and Louisiana enacted provisions that would have required tissue from an abortion to be cremated or buried; Texas adopted similar requirements through administrative regulations. None of the requirements are in effect due to legal action.

Making Proactive Progress

Between 2001 and 2016, states have enacted 214 legislative measures aimed at expanding access to abortion, contraception, and related services and education. Two-thirds of these provisions fall into five categories: comprehensive sex education (44 measures), contraceptive coverage (30 measures), access to emergency contraception (25 measures), Medicaid family planning expansions (20 measures), and expedited partner treatment for STIs (18 measures). The remaining proactive measures address issues such as criminalizing violence at abortion clinics; repealing pre-Roe abortion restrictions; expanding access to family planning services; requiring insurance coverage of infertility and STI services; protecting enrollee confidentiality with regard to medical care; and allowing minors to consent to reproductive health-care services.

Efforts to make proactive progress picked up dramatically in 2013, after a considerable lull in 2010-2012. Significantly, the 28 proactive measures enacted in 2016 represent the highest number of proactive measures on reproductive health issues enacted in state legislatures in the past 16 years.

Expanding access to contraception was a particular focus of legislators in 2016, with three types of measures commanding major attention:

Extended contraceptive supply. Five states enacted new laws in 2016 that allow a woman to obtain an extended supply of her contraceptive method from a pharmacy; health plans typically limit access to a one-month or three-month supply. The new provisions in California, Hawaii, Illinois, and Vermont allow women to receive up to a year’s worth of their method. The Maryland law allows women to obtain up to a six-month supply. With the addition of these states, a total of six states and the District of Columbia will now require health plans to cover an extended supply.

Access to contraceptives without a prior prescription. In 2014, California enacted a measure authorizing pharmacists to dispense contraceptives without a prescription from a clinician. In 2016, the state expanded this provision to permit Medicaid coverage of methods dispensed by pharmacists without a prior prescription. Oregon, Washington state, and the District of Columbia already have similar laws in place.

Contraceptive coverage. Three states amended their state laws requiring contraceptive coverage to more closely mirror, and build on, the federal contraceptive coverage guarantee included in the Affordable Care Act. Illinois, Maryland, and Vermont adopted new laws that require coverage of all FDA-approved methods, ban the use of techniques such as prior authorization that insurers use to limit coverage, and prohibit cost sharing for contraceptives. Including these states, 28 states have similar laws mandating contraceptive coverage in health plans.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.