All posts by SRH Matters

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

January 12, 2017blog, Sexual HealthSRH Matters

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

January 12, 2017Behaviour, blogSRH Matters

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

January 10, 2017blog, blog-home, Sexual HealthSRH Matters

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?

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

January 4, 2017blog, Reproductive HealthSRH Matters

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.

Fearful of parents, many teens still avoid sex-related health care

December 20, 2016Behaviour, blog, blog-homeSRH Matters

Fearful of parents, many teens still avoid sex-related health care

2016-12-20

Nearly one in five U.S. teens between the ages of 15 and 17 are not seeking out sexual or reproductive health care because they’re afraid their parents will find out, according to a data analysis by the National Center for Health Statistics.

“This research really falls in line with a lot of other research that a lot of other reproductive health organizations have done,” said Casey Copen, one of the study’s authors. “So it’s not surprising, but it does make the statistics more current.”

Under California law, teenagers can get reproductive care and treatment for sexual issues confidentially, without parental consent or notification.

The Center for Health Statistics studied 2013-2015 data compiled by the National Survey of Family Growth. It found that nearly 18 percent of youths between 15 and 17 won’t go to a provider at all because of confidentiality concerns.

Celinda Vasquez of Planned Parenthood L.A. said this is why her organization has changed its sex education curriculum into one that has what she calls a “rights-based framework.”

“It goes above and beyond the birds and the bees,” Vasquez said. “It’s really about advocating for their own healthcare needs … and fostering a dialogue about gender roles, healthy relationships and media stereotypes.”

Additionally, Planned Parenthood L.A. now has sexual education programs for adolescents and parents.

The survey also found that teenagers who spend time alone with a health care provider are significantly more likely to receive contraceptive care and treatment for sexual diseases than those who don’t.

Privacy concerns keep young people from sexual health services

December 19, 2016blog, blog-home, Sexual HealthSRH Matters

Privacy concerns keep young people from sexual health services

2016-12-19

By Karen Pallarito, HealthDay News

Young people may abstain from seeking sexual and reproductive health care because they fear their parents will find out, a U.S. government report suggests.

About 7 percent of teens and young adults said they would not seek that care due to confidentiality concerns, the U.S. National Center for Health Statistics (NCHS) reported Friday.

he youngest teens expressed the greatest reluctance. Almost one in five 15- to 17-year-olds said they would not seek that care because their parents could find out, according to the report.

“It is concerning,” said Casey Copen, an NCHS health scientist and lead author of the report. The NCHS is part of the U.S. Centers for Disease Control and Prevention.

The CDC estimates that 15- to 24-year-olds account for half of all cases of sexually transmitted diseases in the United States.

“It’s important that we monitor any barriers that youth may experience to obtaining health care,” Copen said.

The report provides data from two new measures of confidentiality included in a nationally representative household survey involving face-to-face interviews.

Copen said these questions were added to get a sense of young people’s confidentiality concerns and any barriers to sexual and reproductive health care.

The survey revealed that young women with confidentiality concerns were less likely to receive sexual and reproductive health services in the past year compared to those without such concerns. Among females aged 18 to 25, for example, 53 percent with concerns received these services, compared with nearly 73 percent of those without such worries.

Among males, there were no large differences in the percentages receiving sexual and reproductive services based on confidentiality concerns.

Abigail English is director of the Center for Adolescent Health & the Law in Chapel Hill, N.C. She said the new report is “extremely important and useful” because it confirms findings from older and smaller studies and provides new data.

Concerns about young people’s health privacy and confidentiality have been around for decades, English explained.

Every state has a law allowing minors to consent to some range of health services, most commonly diagnosis and treatment of sexually transmitted diseases, she said. Most states also allow minors to consent to contraception services, she added.

The federal HIPAA law — short for Health Insurance Portability and Accountability Act — safeguards a patient’s medical information and also provides some confidentiality protection for minors, English said.

For example, when a teenager goes for her annual physician visit, the doctor may explain that it’s appropriate to have some time to talk privately and ask mom if she’d mind stepping out to the waiting room.

“That is recognized under the HIPAA privacy rule as having some significance, and affording, then, the young person some protection for those discussions,” English said.

Most health professional organizations already have guidelines on appropriate communications with young patients, Copen said.

Michael Resnick, immediate past president of the Society for Adolescent Health and Medicine, said confidentiality is the “keystone of effective communication between provider and patient.”

Doctors and other health providers also have a role to play in improving communication between parents and their adolescent children, said Resnick, chair of adolescent health and development at the University of Minnesota.

Still, only 38 percent of teens spent some time alone — without a parent or guardian — during a visit with a doctor or other health care provider in the past year, according to the new report.

With limited time during an office visit, it could be that the topic “gets short shrift,” English said. Or, it could be that parents are reluctant to leave the room, physicians are uncomfortable asking them to leave, or teens want a parent to stay, she added.

But having that one-on-one time seems to make a difference, the survey suggested.

Teens aged 15 to 17 who spent some time alone with a doctor were more likely to receive sexual or reproductive health services in the past year, compared to those who lacked the opportunity for a private discussion.

“It’s important for young people to know that they can consent for certain services on their own and not be afraid to seek services in a confidential way,” English said.

More information

The Society for Adolescent Health and Medicine has information on sexual and reproductive health for teens and young adults.

Masturbation, penis size, rough sex: What Indians ask doctors online since no one will tell them at home

December 15, 2016blog, blog-home, Sexual HealthSRH Matters

Masturbation, penis size, rough sex: What Indians ask doctors online since no one will tell them at home

2016-12-15

Even before Saurabh Arora got his online healthcare platform off the ground, the former Facebook data scientist had an inkling of what Indians might want to ask doctors—especially if they could send questions via a smartphone app and in complete privacy.

The low-hanging fruits, as Arora described them, were mental health, women’s health, and well-being of children. But the subject that would probably provoke most curiosity, Arora felt, was sexual health.

Arora’s instincts were not off the mark. Two years after the launch of Lybrate, an online doctor database that connects physicians to patients through a mobile app, user data from the platform shows that an overwhelming number of Indians have many, many questions about sex.

Lybrate allows users to post general health queries, consult doctors in real time, search for doctors in the neighbourhood, and book appointments online. Users can choose to remain anonymous for online interactions.

Lybrate, of course, is not entirely representative of India’s patient population. But with an enrolled base of 100,000 doctors who interact with a daily patient load of 200,000 individuals, according to the company’s estimates, the user data still provides a significant insight into what health issues Indians are concerned about.

“I’m sure these discussions are not new,” Arora said, referring to the overwhelming interest in sexual health among Lybrate’s users. “Particularly in metros, the need has been there, and it has been circulating in private groups, one-to-one phone conversations, and things like that.”

Conversations around sex are still largely taboo in India. Sex education is not part of the curriculum in most schools. Few parents will openly talk about it and even doctors can be hesitant to ask patients about their sexual habits.

On the other hand, the environment that many young, smartphone-wielding Indians grow up in involves a liberal dose of pornography. Indians—and not just the men—are among the world’s most prolific consumers of online porn, with a special liking for smut involving “Indian bhabhi,” “Indian wife,” and “Indian aunty.” Obviously, all of this happens behind closed doors with little room elsewhere for serious discussion about sex.

So, in a country where over 40% of the population is under 20 years of age, people seem to be taking the discussion online. And platforms like Lybrate, which allows individuals to consult doctors without necessarily surrendering their privacy, provide a window into that exchange.

Lybrate’s data shows that across tier I, tier II, and tier III cities, the most common questions are on erectile dysfunction, premature ejaculation, menopause, and low libido.

The absence of an open conversation about sex and sexuality in India is an overwhelming concern for sex educators like Anju Kishinchandani who focuses on educating school-going children in Mumbai. For the lack of better options, children are turning to the internet for answers and there, pornography is often the first thing they find.

The recent smartphone boom in India, the world’s second largest smartphone market where 77% of users aged between 15 and 24 years surf the internet every day, has made matters worse.

“It’s very, very scary,” said Kishinchandani, “If they (children) are learning about sex and sexuality mostly through porn films, then they’re getting a very, very warped view because what they’re seeing there is not reality.”

The extent of misinformation can be frightening. Kishinchandani, for instance, recalls teenagers aged between the ages of 16 and 18 explaining how porn has shaped their assumptions about contraception.

“I’ve had children of that age group tell me ‘Why are you saying that we need to use contraception? Because when we watch porn films on our phones, those people don’t use contraception,’” she said.

Silence over sex

Meanwhile, parents are still unwilling or unable to broach the topic with their children. “Parents are still unfortunately clueless,” said Kishinchandani. “A lot of them want to talk to their kids but they don’t know how, so they don’t end up talking to them.”

The taboo is so overwhelming that even doctors sometimes hesitate to ask their patients about their sex lives. “They (doctors) say, ‘how can I ask? They (patients) might find the question irrelevant. They may think that I’m raising too personal a query’,” said Rajan Bhonsle, a sexologist. “This open dialogue between a parent and child, the teacher and student or a doctor and patient has to happen.”

The consequences of a lack of dialogue on sex can be serious.

“I meet people in their 40s and 50s and 60s, when they have avoided getting into relationships or getting married only out of some myths and misconceptions they carry about themselves, or about the sexual act,” explained Bhonsle, also a professor at the department of sexual medicine at Mumbai’s Seth GS Medical College and KEM Hospital.

Then, there is the possibility of individuals developing fetishes, paraphilias (abnormal sexual behaviour), and fixations related to sex, according to Bhonsle, only because they were not informed at the right time in the right manner.

The obvious risk of sexually-transmitted diseases, including HIV/AIDS, is also aggravated by the silence around sex.

Stigma and crime

Suppression of an accessible discussion on sex in India may have an even more wide-ranging manifestation: the endless wave of sexual crimes against women.

“This kind of taboo around talking about sex means people don’t understand what sexual relationships are about,” said Paromita Vohra, founder and creative director at Agents of Ishq, an online sex education project. “Because when there is a silence on a subject, then all kinds of hierarchies continuously get played out. And all of the stigma also (gets) attached to things.”

Men in India, Vohra explained, often have no idea what women’s pleasure is, what women’s consent entails, and how to negotiate that consent. So when they are rejected, it sometimes translates into violent reactions, like acid attacks or other acts of aggression.

Also, among women, who usually do not have space to speak about their own sexual desires and comfort, there is little awareness. “When you don’t ever talk about what is a healthy sexual relationship or a healthy sexual interaction, how do you learn to recognise it?” Vohra asked. “How do you learn to say, ‘No, this is not OK for me?’”

In a country where 95% rape accused are family, friends, co-workers or persons known to the victim one way or the other, this lack of information about sex—and stifled discussion on the subject—can evidently be dangerous.

And that is why the conversation that platforms like Lybrate are provoking is important. It is a fact that Arora recognises, although he is also acutely aware of its limitations.

“Tools like ours are obviously a great help but we understand that we cannot fulfil everything,” he said. “We still believe that to truly solve the problem, more and more people should know (about the subject). But more and more people should become aware at an earlier stage.”

WRITTEN BY

Devjyot Ghoshal

Most College Students Use Contraception Inconsistently — And Don’t Think They’re At Risk For Unplanned Pregnancy

December 15, 2016blog, Sexual HealthSRH Matters

Most College Students Use Contraception Inconsistently — And Don’t Think They’re At Risk For Unplanned Pregnancy

By MICHELLE TOGLIA

The second time I ever had sex, the condom broke. I was 16, turning 17 the next day, and I wasn’t on The Pill. I started panicking. While my high school boyfriend’s (very cool) parents tried to calm us down and comfort us, I knew I had to do something to make sure I wasn’t pregnant ASAP. I had friends who had been in similar situations and just crossed their fingers until their next period, hoping they wouldn’t get pregnant. But I couldn’t take that chance. I still had my bottom braces in, I thought, how could I possibly have a child right now? The next day, we went to Planned Parenthood during our lunch break and I took emergency contraception Plan B on my seventeenth birthday during study hall.

Back in 2004, Plan B wasn’t available over the counter and there was an age restriction. Had I not known about my options (or had access to a Planned Parenthood), I don’t know what would’ve happened, but I’m so thankful I did. But as a new survey found, too many people still don’t. The survey of 3,600 female and male undergraduate and graduate students in the United States, ages 18-25, from Teva Women’s Health, the makers of Plan B One-Step, and The Kinsey Institute at Indiana University, found that 62 percent of sexually active college students are not using contraception consistently, and only 15 percent of students felt like they were at a high risk of an an unplanned pregnancy.

But a not-so-fun fact: In the U.S, 45 percent of all pregnancies in the U.S. are unintended — and out of all the unintended pregnancies in the U.S., 41 percent are due to inconsistent use of contraception. So what’s up — why aren’t we taking advantage of effective birth control options? Is is laziness? Inaccessibility? Lack of comprehensive sex ed?

62% of college students surveyed incorrectly believed they have to be at least 18 years of age or older to purchase OTC EC.

“I was surprised to see nearly three out of five sexually active college students in the study reported using contraception inconsistently,” Justin Garcia, PhD, Associate Director for Research and Education with the Kinsey Institute. “It’s hard to say why exactly, as we didn’t specifically ask participants in the current study about their reasons for contraceptive use and non-use. But our study did find that college students surveyed held a considerable amount of misinformation about contraceptive-related issues, so it’s possible that knowledge gaps related to sexual and reproductive health contribute to these relatively high rates of inconsistent use. Other research has also pointed to a variety of factors, including socio-demographics, relationship factors, arousal, alcohol and other drug use, so those are all factors that we will need to further investigate in future research specifically on college students’ knowledge, attitudes, and practices with contraception, including EC.”

So why do so few students think they’re at risk for pregnancy? Is it misinformation? The — totally false — “it can’t happen to me” attitude that people also have over contracting STIs? “Based on the scientific literature there are likely a variety of reasons related to individual knowledge about sexual and reproductive health, attitudes, and experiences,” Dr. Garcia says. “The data from the current survey isn’t able to tease that out, but it’s definitely one of the primary questions that could be addressed in future research.”

Major study: Sex-ed programs don’t reduce STI’s, teen pregnancy, HIV

December 15, 2016blog, blog-home, Sexual HealthSRH Matters

Major study: Sex-ed programs don’t reduce STI’s, teen pregnancy, HIV

A new peer-reviewed study of multiple “sexual and reproductive health” educational programs in several countries finds no evidence of improved health outcomes in any program studied.

According to the authors of the study, “School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents,” published in the Cochrane Database of Systematic Reviews, “There is little evidence that educational curriculum-based programs alone are effective in improving sexual and reproductive health outcomes for adolescents.”

The study’s authors reviewed eight studies that examined sex-education programs in schools in Africa, Latin America and Europe with a total of 55,157 participants, and performed randomized controlled trials on their data. They found the programs had no measurable impact on the rate of sexually-transmitted diseases among participants or rates of pregnancy.

“In these trials, the educational programs evaluated had no demonstrable effect on the prevalence of HIV or other STIs (Sexually Transmitted Infections),” the authors write, noting that in addition to HIV infection they also looked at results regarding herpes and syphilis. “There was also no apparent effect on the number of young women who were pregnant at the end of the trial,” they add.

The authors note that many studies of adolescent sex-education programs measure the programs’ effectiveness by examining their “effects on knowledge or self-reported behavior” rather than “biological outcomes” such as the rates of pregnancy and sexually transmitted diseases among program participants. In examining biological outcomes, the authors could find no benefit from such programs.

The findings of the study are consonant with other studies of “comprehensive” sex-education programs that show them to be ineffective or even counterproductive, particularly in comparison with abstinence-only programs.

A 2004 study conducted in the UK by the Family Education Trust, “Sex Education or Indoctrination,” examined teen pregnancy rates in different areas of the country to determine how they correlated with sex-education programs. It found that teenage pregnancy rates were highest in the areas that were most aggressive in promoting sex-ed.

A 2007 study conducted in the U.S. by the Institute for Research and Evaluation found that “comprehensive” sex-education programs had little impact on the behavior of teens during their education and no long-term effects whatsoever, noting “Of 50 rigorous studies spanning the past 15 years, only one of them reports an improvement in consistent condom use after a period of at least one year.”

The same study found that abstinence-based sex-education programs “can reduce teen sexual activity by as much as one half for periods of one to two years” at the conclusion of the programs.

Here is how excessive porn is bad for you

December 7, 2016blog, featuredSRH Matters

Here is how excessive porn is bad for you

2016-12-07

According to science, consistently watching porn can lead to erectile dysfunction, sorry to be bearer of the bad news.

We all know that this is probably true. This is one news I hoped that I wouldn’t write but the truth is watching porn can adversely affect your sexual health especially for the guy.

And you don’t have to take my word for it. Dr. Andrew Smiler, a masculinity expert believes that men get erectile dysfunction after constantly beating one too many to porn. Your right hand or left hand whichever you prefer totally gets you and this might feel like the best and sometimes even feel better than sex, especially because you’re doing it to a porn, and those are might unrealistic, especially with how unrealistic they can be compared to the actual sex that you’re having.

“The guys I see, most of them are between 13 and 25. The vast majority are, for the most part, the picture of physical health,” he told The Independent, he insinuated that watching porn can lead to limp dick and depressed men according to Zeynep Yenisey, Maxim.

Dr. Angela Gregory is a Psychosexual therapist had this to say “Men are becoming both physically and psychologically desensitized to normal sexual stimulation and arousal with a sexual partner.”

A lot of times, the false image of pornography can mislead a lot of guys. For example, you can be with the girl of your dreams, someone you’ve always wanted to be with and be unimpressed that she isn’t moaning like Mia Khalifa, so your dick game is low. One big disclaimer here, everyone doesn’t moan like a porn star and you can still have a great time.

Plus, the fact that porn stars usually look much different than everyone else apparently puts many men off too, because it “alters perceptions and expectations of who is attractive,” says Dr. Smiler. Because of this, some men who watch a lot of porn get used to seeing fake boobs and bleached buttholes, too much of this might lead to my-girlfriend/wife-isn’t-this-sexy syndrome.

To be honest, this doesn’t affect everyone, some people are well aware of the situation and therefore the scenes aren’t taken to heart, they’re still not desensitized, and still horny as usual.

“It’s like an itch they can’t scratch and is always on their minds,” Dr. Gregory says. But this isn’t as bad as being desensitized to normal sex. In fact, it’s not really bad at all.

For some good news, Dr. Gregory says it’s very easy to get back to normal after falling into a porn-induced funk. All you need to do is stop jerking off, and you’ll be good as new!

“If you can stop [masturbating], you can reboot your system to normal arousal,” she says, suggesting refraining from porn and masturbation for 90 days.

Haha, no thanks.

So, that is it, if you feel your jerking off is under check and doesn’t affect your sexual health but if its affecting you, it might just be the time to stop and reset your sexual clock

H/T: The Independent