Category Archives: blog

Sexual Identity and Children

September 21, 2016blog, featuredSRH Matters

Sexual Identity and Children

2016-09-21

Posted by Ian Kerner, Ph.D., LMFT

Are younger people more likely to embrace their sexual identity? That’s the implication of findings from a recent large Gallup survey.

The survey, which asked 120,000 American adults whether they identified as lesbian, gay, bisexual or transgender, found that 6.4% of people aged 18 to 29 said they were LGBT: about three times more than people over age 65.

But do results like these indicate that younger adults are more likely to be LGBT, or are they simply more likely to acknowledge it? It’s probably the latter, say my colleagues.

“These numbers might reflect a generational change in social acceptance for LGBT identities,” said psychotherapist Jean Malpas, director of the Gender and Family Project at the New York-based Ackerman Institute for the Family. “Today’s youth and young adults, at least in some communities, are gradually more comfortable being open about their sexual and gender identities.”

Another potential reason for the increase in self-identified LGBT youth is the influence of a new generation of parents who embody a positive attitude and wouldn’t have it any other way.

“Today’s millennial parents are more than just accepting of their children’s sexual identity. They’re comfortable and embracing of it, too,” said Ron Taffel, psychologist and author of the book “Childhood Unbound.” “They want to actively support and engage their children through communication about all aspects of their lives.”

Research, including this survey, also suggests that young women may be more likely than men to identify as bisexual.

“The pattern across surveys is that men are more likely to identify as gay, whereas women are more likely to identify as bisexual,” explained social psychologist Justin Lehmiller. “We don’t know exactly why this is, but many psychologists believe it results from women’s sexuality being somewhat more ‘flexible’ or ‘fluid’ and men’s sexuality being somewhat more ‘fixed.’ “

Many other young people are eschewing traditional descriptors for sexuality and gender completely.

“There’s been a lot of work done on how LGBT youth is more and more frequently rejecting labels altogether, blurring the lines between sexual orientation and gender, creating new labels and identifying as gender-queer, gender-fluid or pansexual, to name a few,” said sex therapist Margie Nichols. “The very term ‘LGBT’ is too confining now, which is why I prefer the term Gender and Sexual Diversity, or GSD.”

That term could also include the 1% of people who identify as asexual, which means they aren’t sexually attracted to anyone.

“While we’re creating space for a variety of sexual identities, we also need to create space for non-sexual identities,” said college sex educator Emily Nagoski.

Indeed, many of the experts I spoke to expressed frustration that Gallup and other surveys limit the options from which a respondent can choose.

“The terms lesbian, gay and bisexual just don’t capture all sexual minority identities,” Lehmiller said.

Nichols agrees. “These studies are missing a tremendous opportunity by not including an ‘other’ category. It’s a shame, because the ‘other’ category is the wave of the future.”

Separate from sexual identity is gender identity. While not addressed in the Gallup survey, experts say, this distinction is increasingly important, particularly for today’s youth.

“Gender nonconforming expression and identity are different from sexual orientation,” Malpas explained.

“Sexual orientation is about who you are attracted to and who you fall in love with. Gender expression and identity refer to the gender you feel comfortable expressing and identifying with, which might or might not be aligned with the biological sex you were assigned at birth.”

As transgender and gender-nonconforming children and teens become more visible, both in communities and in the media, parents are less likely to dismiss them.

“Only a decade ago, a parent would have probably answered ‘stop saying silly things’ to a 6-year-old son who insisted on being a girl,” Malpas added. “Today, the same parent will stop and think about the transgender children they’ve seen on TV or in magazines and may more readily inquire with professionals and other parents.”

More than just stop and think, they’ll also hopefully want to talk. Says Taffel, who specializes in breaking through to teens, “Open communication is a primary value for today’s parents, much more so than setting limits and rules, and the spirit of open communication trumps the content of any conversation.”

While it’s important not to confuse gender and sexual identity, parents can take a similar approach in discussing them with their kids.

“Of course, you should reassure the child of your love, but you’ll also want to find ways to expose your child to others like him or her so the child doesn’t feel different or alone,” Nichols suggested. “Allow yourself to experience mixed or negative feelings if you have them, and consider joining a support group. You’ve also got to be prepared to be your child’s advocate with schools, neighbors and community activities.”

I find the survey results very encouraging, as they indicate not just a shift of differences in human sexuality toward the mainstream but also suggest that the future is promising for people who don’t fit into “the norm.”

“We’re evolving, culturally, beyond the need to impose rules on who’s allowed to do what with their genitals and their hearts,” Nagoski said. “This new generation of young people understands that love is love, that people are people and that the freedom to experience joy and mutually consensual pleasure is a birthright.”

Mutual Masturbation: Another Tool for Your Sex Toy Toolbox

September 21, 2016blog-home, Sexual HealthSRH Matters

Mutual Masturbation: Another Tool for Your Sex Toy Toolbox

For one thing, mutual masturbation can be an unexpected and novel way to shake up your usual bedroom routine. Any time you introduce something new into your sex play, it can add a frisson of excitement to whatever you’re doing.

The element of being “on display” can also be incredibly sexy, especially if you have either voyeuristic or exhibitionistic tendencies. If the signs of your partner’s arousal—his moans, his sighs, the swelling of his penis—are a turn-on for you, why not encourage him to masturbate in front of you? If you enjoy the feel of your partner’s eyes on you, you may find that masturbating in front of him heightens your experience.

Masturbating in front of your partner can also help you become more comfortable with your own masturbation habits. As you do this, you may even discover a new technique!

Mutual masturbation can also ensure you have an orgasm with your partner. Showing your partner how you pleasure yourself can help you teach your partner what you like. It’s the sexiest game of “show not tell” you can imagine.

Okay. You’ve Sold Me. How Can I Proceed in a Non-Awkward Way?

If you’re new to mutual masturbation, try sending your partner this article and asking if they’d be interested in giving it a whirl. As fellow Good in Bed-er Kate McCombs, M.P.H. has previously written, sometimes the best way to approach a conversation like this is to say, “Hey, I read this thing and thought it seemed interesting. You game?”

Or try initiating mutual masturbation as the two of you are already starting to get intimate. Touch your partner with your hands, and then pull away and say, “why don’t you take over for a minute?” You can then continue to switch back and forth to help each other get more comfortable.

Another option is to say something like, “you know what would be really sexy? I’d love to watch you touch yourself.” Or to turn it around, ask your partner, “do you want to watch me while I touch myself? I want to show you what I like to do when I’m thinking about you.”

If you’re feeling shy, you can keep the lights off, or perhaps even light a single candle. You won’t be able to see everything, but you’ll still know what the other person is doing.

And if you’re not ready to display the specific masturbation techniques you use when you’re all alone, you can keep it simple by using slow, sensual strokes. This can be a great way to ease into things.

9 Ways to Take Your Mutual Masturbation to the Next Level

Once you get comfortable touching yourselves in front of each other, there are a ton of easy ways to switch it up:

Have just one partner masturbate at a time, while the other watches. This ups the voyeuristic factor.
Have one partner be the “boss.” For example, perhaps one partner can only touch themselves—or bring themselves to orgasm—when given explicit permission, and then must stop masturbating when their partner tells them to.
Tag team each other’s bodies. If your partner is a woman, try fingering her internally while she strokes her clitoris. If your partner is a man, you can caress his balls or knead his perineum while he strokes his shaft.
Try role-playing by pretending to “catch” your partner in the act. Set up the scene beforehand so you both know the plan. While the one who is masturbating will know what’s coming, the thought that someone can walk in at any time can be a huge turn-on.
Or call your partner into the bedroom and surprise them by being on the bed, masturbating.
Switch up the timing. Try masturbating together before or after whatever activities tend to be your “main event” as a couple. Or try taking breaks from the main event to spend a few minutes masturbating.
Have masturbation be the main event.
Watch erotic movies or read erotica out loud to each other while you masturbate.
Bring toys into the picture. There are a number of great options out there whether you’re a man or a woman.

Because there are so many ways to experiment with mutual masturbation, it holds so much potential for being a source of constant novelty and excitement in the bedroom. So what are you waiting for? Get those fingers going!

What She’s Actually Thinking About During Sex

September 21, 2016blog-home, Sexual HealthSRH Matters

What She’s Actually Thinking About During Sex

The most prevalent thought for both men and women during sex is a fairly obvious one: “How am I doing?” But this question leads to very different thought processes for the sexes. “While you’re worrying about how long you’ll be able to last, she’s worrying that things are taking too long on her end,” says Emily Morse, a sex and relationship expert and host of the top downloaded podcast Sex with Emily. You can thank the orgasm gap: While the average man reaches climax in about five to seven minutes, a woman, on average, requires at least 20 minutes of direct stimulation. But there’s more to it than that. Here, taken from the experts, are some of the more prevalent thoughts you could expect her to be having.

Many women worry that they’re taking too long to reach orgasm and/or that their partner will orgasm before they do. “Women sometimes take longer to get aroused and therefore take longer to orgasm, particularly if they aren’t receiving enough persistent, direct clitoral stimulation — otherwise known as the orgasm gap. Promescent, an OTC spray, is one way men can extend their latency time and prolong intercourse, particularly if they have a partner who generally takes longer to reach orgasm than they do (which is most men),” says Ian Kerner a psychotherapist and sexuality counselor.

Women fantasize more than men do during sex, and many don’t fantasize about the act they’re engaging in or the person they’re having sex with. “This isn’t because they’re bored or disinterested — rather, it helps to quiet the parts of the brain that are associated with anxiety and outside stressors. It’s been shown that women, unlike men, need to turn off parts of their brain in order for the rest of their body to turn on, and fantasizing — even if it’s not about you — is a great way to do that,” says Dr. Kerner.

Flaws with her own body.

Women in general suffer from an epidemic of body-image dissatisfaction. Too many women feel as though their bodies are flawed. During sex, rather than focusing on what they are feeling, they worry about what our partner thinks of our body: Does s/he see this wiggle here, this stretch mark there, the way my boobs flop over there? “We try to hide our body (only having sex in the dark, keeping clothes on during sex, only getting undressed under the covers), sometimes we avoid having sex in positions that could be unflattering, etc. All of this compromises a woman’s pleasure because when our heads are filled with worries and anxieties, we aren’t present in the current moment. When we are busy worrying about how to position the sheets in a way that will flatter our belly or hide our thighs, we aren’t attuned to the pleasurable physical sensations of our partner’s touch, and this can interfere with our ability to derive satisfaction from the sexual experience,” says Alexis Conason, Psy.D., Licensed Psychologist (www.drconason.com).

Your scorecard.

“During intercourse women often think about their man’s performance, what he’s doing that feels good and what doesn’t,” says Dr. Fran Walfish, Beverly Hills child, parenting, and relationship psychotherapist, author, The Self-Aware Parent, and co-star of Sex Box on WE tv. Frequently, women (and men) fantasize about other people and various behaviors that titillate and excite their fire. “Although I am a proponent of open, honest, direct communication, I strongly urge people not to tell their partners their personal bedroom fantasies during intercourse. All it does is fuel jealousy, rivalry, competition, and low self-esteem in your partner, creating a wedge between you and your beloved.”

When it’s going to end.

“This is especially true when they weren’t really into it in the first place, but agreed to engage, hoping that they would get in the mood,” says Rhonda Milrad, a relationship therapist, and founder and CEO of Relationup.

American Men Are Pretty Happy With Their Penises

September 15, 2016blog, Sexual HealthSRH Matters

American Men Are Pretty Happy With Their Penises

2016-09-15

For understandable reasons, society’s conversation about body satisfaction tends to focus on women. Women, it can safely be argued, face a lot more social pressure to look good all the time, to feel ashamed of their bodies, and to harp on minor imperfections.

Men aren’t immune from all that, though. And one particularly painful area where it manifests, according to sexual health researchers, is in insecurity about their penises. This can lead to some bad outcomes. As a team led by Thomas Gaither, a urologist at the University of California, San Francisco, point out in a new study in the Archives of Sexual Behavior, “Case reports have shown men undergo risky procedures, such as silicon injections, to lengthen their penis and increase penile girth.” In addition, “Genital piercings, silicone injection, and subcutaneous implant are increasingly common and are associated with numerous complications.”

Gaither and his colleagues wanted to better understand how men view their penises, so they conducted what they say is the first nationally representative survey using a newly developed scale called the Index of Male Genital Image, or IMGI. It consists of 14 statements ranked on a score of 1–7 involving penis length, girth, and so on — a score of 1–3 is coded as “dissatisfied,” while 4–7 is coded as satisfied. They got results from 3,996 men, the sample drawn from 18-to-65-year-olds who weren’t institutionalized.

Comparing those who landed in the “satisfied” (greater than 4.0) versus “unsatisfied” (4.0 or lower) buckets when the scores were averaged, the researchers didn’t find any statistically significant differences in penile satisfaction when it came to age, “race, marital status, education, location, income, or sexual partners.” Penile (dis)satisfaction appears to be pretty much constant across these categories.

Overall:

A total of 3433 (85.9%) reported an average greater than 4 per item on the IMGI and thus were classified as satisfied. Men reported highest satisfaction with the shape of their glans (64%), followed by circumcision status (62%), girth of erect penis (61%), texture of skin (60%), and size of testicles (59%). Men reported dissatisfaction with the size of their flaccid penis (27 %), length of erect penis (19%), girth of erect penis (15%), amount of pubic hair (14%), and amount of semen (12%). Men reported neutrality with the scent of their genitals (44%), genital veins (43%), location of urethra (42%), color of genitals (40%), and amount of pubic hair (36%). Of note, those who were extremely dissatisfied (score of 1 or 2) reported dissatisfaction with their flaccid penis (10.0%), length of erect penis (5.7 %), and girth of erect penis (4.5%).

There were some decent-size differences in terms of the sexual experiences of men who were satisfied versus dissatisfied with their penises. Those who were satisfied were less likely to be sexually active (73.5 percent versus 86.3 percent), and engaged in less daily and weekly sexual activity. There were also slight but statistically significant differences in the percentage of dissatisfied versus satisfied men who reported having had vaginal or receptive oral sex (85.2 percent versus 89.5 percent, and 61 percent versus 66.2 percent). The obvious question here is what’s causing what: To what extent are men who are dissatisfied with their penises less likely to seek out sex as a result of their insecurity? A correlational self-report study can’t answer that, nor can it answer whether these mens’ likes and dislikes were shared by their sexual partners.

It’s interesting that a sizable minority of men reported dissatisfaction with their testicle size or glans shape. On the one hand, in a survey like this you are explicitly asking about certain features, so these responses don’t mean that they are wandering around obsessing over this stuff. (It would be another thing entirely if you asked men to generate an open-ended list of body features they didn’t like and these kept popping up.) But on the other: It’s an interesting comparison to what women go through, because it highlights the fact that at least some of the things both men and women worry about probably aren’t, in fact, of much import to anyone else. If you’re a guy, the odds that a partner is going to care that much about the size of your testicles or the “shape of your glans” — that’s something I can honestly say I had never even thought about before reading this article, and which the researchers note “has little anatomic variability” — are probably pretty low.

More broadly, the main takeaway, as a first-pass attempt at understanding this stuff, is that men mostly feel pretty happy with their penises. Which can maybe explain the epidemic of unsolicited photos.

By Jesse Singal

Opinion: Sexual health information is a necessity for students

September 15, 2016blog-home, Sexual HealthSRH Matters

Opinion: Sexual health information is a necessity for students

The American River College Health Clinic is working hard to help students take care of themselves by partnering with community provider Women’s Health Specialists to provide a variety of reproductive health care services.

For many students, college is an exciting time, whether you are jumping in right after high school or an older student returning after many years.

It is also a busy time, where we juggle very real responsibilities of work, family and school, rushing through life in pursuit of our goals.

It’s in this harried place where sometimes our attention to our health, especially our sexual and reproductive health, can fall to the wayside.

The numbers are sobering. According to a 2014 report released by the Center for Disease Control, young people ages 25-24 account for nearly half of all new Sexually Transmitted Infections (STI’s) diagnosed every year.

The reasons for the high numbers are complex. Some say it’s because sex education is underfunded in high schools, others say the newly found freedom of college life is a contributing factor, others say that social stigmas regarding STI’s is at fault.

These stigmas may come from many different cultural or religious forces, just talking about sex is still taboo, much less being sexually active or accessing health care services. This can lead to shame or embarrassment when it comes to taking control of our health.

Regardless, accepting the need to value sexual health and talking about it with our partners and with our medical providers is a good first step in taking care of ourselves.

According to Pamela Whipple, a nurse at the Student Health Center, the Sexual Health Clinic is open every Tuesday from 10 a.m. to 3 p.m. by appointment with drop-ins available.

The clinic offers birth control, emergency birth control, pregnancy testing and STI testing for chlamydia and gonorrhea. The clinic is welcoming to students of all gender identities and respects preferred gender pronouns.

George Hillman, a Communications Major, feels that it is important for young men to know where they stand with regards to their sexual reproductive health.

“I think if you are going to be intimate with someone, it’s good to make sure that you are not going to hurt them.” said Hillman. “We need to feel comfortable, so I’m glad that they understand that. I didn’t even know they were here. It’s good to know, makes it easier.”

According to Whipple, there are a variety of reasons people may find it difficult to seek out services or talk about sexual health.

“Fear of stigma and prejudice sometimes prevent people from seeking sexual health services,” Whipple said.

As a long time nurse, she has seen the pendulum swing to the positive side.

“…many of the students we serve regard sexual health services like any other service,” Whipple said.

Malmoud Mahabad, a Business Major, thinks that it’s especially important for everyone to care for themselves. “It would help them if they have any issue. When they come here, they can check with the staff. It’s a natural part of life”

Taking care of your sexual health is a critical part of your overall health care and respect for your sexual health can impact you for years to come.

Coil ‘more effective’ than morning after pill

September 15, 2016blog-home, Sexual HealthSRH Matters

Coil ‘more effective’ than morning after pill

“Women should use the coil rather than the morning-after pill as emergency contraception, according to official new guidelines,” the Mail Online reports.

The guidelines, from the National Institute for Health and Care Excellence (NICE), cite previous research showing the coil has a lower failure rate than other forms ofemergency contraception.

The coil, also known as intrauterine device (IUD), is a small, T-shaped contraceptive device made from plastic and copper. It’s inserted into the uterus by a trained health professional. It may prevent an egg from implanting in your womb or being fertilised.

This isn’t “news” as such – it has long been known that the contraceptive coil is more effective and can prevent unwanted pregnancy up to five days after unprotected intercourse, compared to only a few days with the morning-after pill. It also has other advantages, including that it can be used as an ongoing method of contraception to prevent further need for emergency contraception or unwanted pregnancy.

Where did the guidance come from?

The National Institute for Health and Care Excellence (NICE), is the guideline body that provides national guidance on health and social care issues.

The current guideline on contraception is what is known as a Quality Standard. These documents set out the priority areas for improvements to the quality of care delivery across the country. They give a list of statements that will help improve and standardise care.

The contraception quality standard covers all methods of contraception, not just emergency, but does not cover related sexual health issues such as sexually transmitted infections. Quality Standards accompany other clinical guidelines that give recommendations on how conditions should be diagnosed and managed.

The information on coils, injections and implants has been drawn from NICE’s clinical guideline on long acting reversible contraception.

Information on other contraceptive methods, including pills and condoms, has been drawn from guidelines produced by the Faculty of Sexual and Reproductive Healthcare (FSRH).

Why was the guidance needed?

As NICE says, it is estimated that almost one in five pregnancies are unplanned, with younger people at greater risk. However, things are improving – since 1998 the under-18 conception rate is said to have halved.

Between 2013 and 2014 there was a 6.8% decrease in rates, giving a conception rate of about 23 per 1,000 15-17 year olds, which is the lowest it’s been since the end of the 1960s.

There remains room to improve though. In 2014 there were also 184,571 terminations or abortions, with the highest rate among young women in their early 20s at 28 per 1,000 pregnancies. For under-18s it was 11.1 per 1,000. More than a third of abortions are in women who’ve already had one or more previously.

In 2014/15, the vast majority of emergency contraception issued by sexual and reproductive health services was for the morning-after pill.

What does the guidance say about emergency contraception?

NICE’s second quality statement is that “Women asking for emergency contraception are told that an intrauterine device is more effective than an oral method”.

An intrauterine device (IUD) refers to the copper coil. It shouldn’t be confused with the hormone-releasing intrauterine system (IUS); another long-term method of contraception.

The IUD can be inserted up to five days after unprotected intercourse, and has a lower failure rate than the morning after pill.

Furthermore, it has the advantage that once it’s inserted it provides an ongoing method of contraception which will reduce the risk of further unplanned pregnancies or need for emergency contraception.

If a woman wishes to have an IUD fitted as a form of emergency contraception, but the healthcare practitioner is not able to fit it there and then, NICE advises that the woman is given the morning after pill in the interim, and then directed to a service that can fit the coil.

There are two morning after pills. The standard morning after pill (levonorgestrel, brand name Levonelle) can only be taken up to three days after unprotected sex. The newer pill (ulipristal acetate, brand name ellaOne) is a longer acting pill and is also effective up to five days after unprotected sex.

Conclusions

The quality standard emphasises best medical practice on this issue – women requesting emergency contraception should be advised on the benefits of the copper coil or IUD for several reasons. Namely, it being the method:

with the lowest failure rate
that can be used up to five days after sex
that provides a long-acting ongoing method of contraception

Despite the IUD’s known effectiveness and benefits, in 2014/15, the vast majority of emergency contraception issued by sexual and reproductive health services was for the morning-after pill. It’s worth taking a moment to consider why this may be the case.

The morning after pill can be purchased over the counter at a pharmacy – the woman doesn’t need to see a doctor and they don’t have to have an examination to have a coil fitted, both of which some women could naturally feel embarrassed about or averse to. Also, some women may not like the idea of long-term coil left in place.

It should also be recognised that while IUDs are effective at preventing pregnancy, they do not protect against sexually transmitted infections (STIs) in the same way as barrier methods of contraception such ascondoms. And if you get an STI while you have an IUD, it could lead to a pelvic infection if not treated.

Nevertheless, in terms of effective emergency contraception, as Professor Gillian Leng, deputy chief executive of NICE says: “We want to empower women with the best information about all methods of contraception and their effectiveness so they can make an informed decision … We also want to ensure women are told the coil is more effective than the pill as emergency contraception.”

Dr Jan Wake, GP and member of the guideline development group said: “The advantage of the coil, on top of being more effective is that it can be retained and used as long term contraception, some can even be left in place for 10 years … Timing however is essential and women deciding on the coil should make contact with the clinic they have been advised to attend as soon as is possible.”

For more information on choices about contraception visit the NHS Choices Contraception Guide.

Analysis by Bazian. Edited by NHS Choices. Follow NHS Choices on Twitter. Join the Healthy Evidence forum.

Men, Depression and Sex

August 31, 2016Behaviour, blogSRH Matters

Men, Depression and Sex

2016-08-31

It is an incredibly complex condition which brings with it a whole slew of emotional, mental and physical symptoms with it. For men and women both, part of the problem can revolve around their sexuality – and this in turn can cause problems in a relationship at the time when the depressed person most needs the support. Fortunately, there are ways to help treat this particular problem and restore intimacy and pleasure to a relationship.

Depression and Male Sexuality

It is common for both men and women to experience sexual problems as part of their depression – but the ways in which this presents itself can be different. Healthline notes that in men, depression will often express itself as feelings of low-esteem, anxiety and guilt and this, in turn, can cause problems with erectile dysfunction, delayed orgasm, premature ejaculation or just a loss of interest in sex itself.

There is still a lot we just don’t know about exactly how depression affects the brain. But according to Net Doctor, researchers have learned that the chemical changes which take place when someone has this condition can lead to an increase in emotional withdrawal and low energy levels so that activities like sex, which require a connection to your partner as well as physical energy to perform, can become a challenge. This can be hurtful for the person’s partner and make them feel unwanted or unloved, putting a strain on the relationship that can, in itself, be difficult to deal with.

To make matters worse, many antidepressants are notorious for their side effect of causing sexual dysfunction or loss of interest. Included in this group are MAOI inhibitors, SSRI’s and SSNRI’s and both tetracyclic and tricyclic antidepressants.

What to Do

So the long and short of it is, both depression itself and some of the treatments for depression can both put a damper on a guy’s sex life. So what are some solutions to the problem?

Get the Treatment You Need

Depression is not a choice that people make – and it is usually not a problem that goes away by itself. If you have not yet been diagnosed, talk to your doctor about the symptoms you are having and get started on a plan of care that involves the combination of medications, therapy and lifestyle changes that are right for you.

If you are already being treated for depression and suspect that your anti-depressants might be putting the kybosh on your sex life, find out if you can switch medications. While it might take a little time to take effect, there are some drugs which do not seem to effect one’s libido, including Wellbutrin and Remeron.

Exercise

Both Healthline and Everyday Health recommend regular exercise – preferably with your partner – as part of a program to help reconnect sexually. First, it gives you and your partner time together doing something enjoyable and this alone can be good for a relationship. It also helps to release feel-good chemicals like endorphins that help fight depression naturally and keeps you in good shape so that you feel good about yourself and the way you look. All this can go a long way to enhancing your sex life.

Take Your Time

According to Everyday Health, sex therapist Dr. Sandra Caron also has a few tips for couples who are struggling to overcome the barrier that depression has placed on their sex lives. She recommends, first of all, that couples engage in more foreplay and other physical expressions of intimacy – hand holding, caressing, massage – before engaging in intercourse itself. Depression tends to slow down all responses, so taking this extra time to achieve arousal can help enhance the pleasure for both partners. She also recommends the use, if needed, of estrogen creams or lubricants and even erotica (like lingerie or sexy movies) to help spark the mood.

Open Up

Probably the most important advice for men who are trying to reconnect with their partner sexually is to open up and communicate with your partner. This can be more difficult for men to do in general, but is even more of a challenge when it comes to talking about intimate issues like sexuality, desire and arousal. But being honest about how you are feeling and letting your partner know that it is the depression that is a problem and not a loss of interest or a loss of love can be an incredibly powerful way to overcome this challenges and get support from your loved one at a time when you need it the most. Also, partners can be more understanding and supportive if they understand more about what is going on – otherwise, it is easy to interpret a low mood or lack of responsiveness as being hostile or unloving.

In short, depression is a difficult condition with a whole slew of symptoms that go far beyond just feelings of sadness or being blue. And when depression begins to affect a person’s sexuality, this in turn can lead to a strain on intimate partner relationships. However, while there are no quick solutions to this problem, getting on a treatment program that is tailored to someone’s individual needs as well as exercising regularly, spending time with a partner to engage in more foreplay and simply opening up and talking about the problem can all help to reignite the sexual spark in a relationship – and hopefully make the battle against depression that much easier.

About Dr. Brian W. Wu

Brian W. Wu graduated from the University of Maryland with a Bachelor’s of Science in Physiology and Neurobiology. He earned his Ph.D. in integrative biology and disease for his research in exercise physiology and rehabilitation. He is currently an M.D. candidate at the Keck School of Medicine (University of Southern California). He is the founder ofwww.HealthStoriesForKids.com, a media company changing medicine one story at a time through narrative medicine. Read more at his personal website: www.brianwwu.com.

Do boys know more about sex than girls?

August 31, 2016Behaviour, blogSRH Matters

Do boys know more about sex than girls?

BY SUZANNA PILLAY – 28 AUGUST 2016 @ 3:22 PM

WHAT do Malaysian youths know about sex? Not a whole lot, according to the findings of a survey on Malaysian Youth Sexual and Reproductive Health (SRH). The little that they know about SRH is gleaned from a hodgepodge of sources, including school, the Internet and friends.

Forty-two per cent believe that withdrawal before ejaculation is effective protection against unplanned pregnancy. Thirty-five per cent believe a woman cannot become pregnant when she has sex for the first time. The survey also reveals that boys know more about SRH than girls.

For instance, when asked whether standing up during sex will prevent pregnancies, 51 per cent of the female respondents said they do not know, compared with 20 per cent of the male respondents. Fifty-one per cent do not know that a woman can get pregnant during menstruation.

Many respondents do not know how to protect themselves from sexually transmitted infections and 25 per cent believe that protection is not required when there is mutual trust between partners.

SRH knowledge-driven programmes are focused on helping youths to understand their bodies, protect themselves and inculcate respect for everyone, but 25 per cent of those surveyed have the impression that SRH education is about teaching them how to have sex.

However, the Women’s Aid Organisation (WAO) says the findings of the survey may not be representative of young people in Malaysia as “we must keep in mind that the survey results are based on a limited pool of respondents”.

A WAO spokesman says it is likely that boys are better informed about sex because it is a greater taboo for girls. “In Malaysian society, girls are expected to keep their virginity, abstinence is the only option that is encouraged and sex before marriage, let alone early sexual activity, is not openly acknowledged.

These factors may result in girls being less educated about sex than boys.” All Women’s Action Society (AWAM) programme officer Choong Yong Yi says it is not enough to only promote abstinence to prevent unwanted pregnancies and sexually transmitted infections.

“It is much better to implement comprehensive and age appropriate sex education for teens where they are taught about consent, peer refusal skills, safe sex and how to value their bodies. Contraceptives must also be made available.”

Her colleague, information communications officer Evelynne Gomez says the taboo over sex education must be broken. “It is a big taboo in Malaysia and it is going to be a difficult issue to approach, but looking at how unsure young people are in the survey, there should be more comprehensive sex education for youths on their sexual and reproductive health.

“There’s scarcely any information on sexually transmitted diseases and many sexually active youths would rather not deal with the issue.” The survey found that 11 per cent of sexually active respondents have had a sexually transmitted infection and 24 per cent did not seek treatment.

Federation of Reproductive Health Associations Malaysia (FRHAM) executive director Mary Pang says the organisation has been advocating sex education for a long time. “In fact, the topic of consent is a chapter on its own in our Life’s Journey module, which is a manual on sexual and reproductive health for adolescents.

“We use the module in all our training sessions at FRHAM centres, as well as in outreach sessions.”

In the chapter on consent, titled Are you ready for a sexual relationship?, Pang says the key messages are:

• Every right comes with responsibility.

• Make an informed choice. Think, before you act. Don’t just do it.

• Sexual relationships should be pleasurable and not under pressure.

• Pregnancy should be intended and desired.

School-based reproductive health services linked to higher birth weight for teen mothers

August 31, 2016blog, Reproductive HealthSRH Matters

School-based reproductive health services linked to higher birth weight for teen mothers

Availability of reproductive health care services at high schools may prevent adverse birth outcomes among adolescent mothers, including low birth weight, according to study findings.

“In 2011, there were 31.3 live births for every 1,000 women aged 15 to 19 in the United States,” Aubrey S. Madkour, PhD, associate professor in the department of global community health and behavioral sciences at Tulane University School of Public Health and Tropical Medicine, and colleagues wrote. “Infants born to teen mothers are at an increased risk of both low birth weight and preterm birth compared with infants born to adult mothers. For instance, in 2010, the proportion of infants born with low birth weight was 12.08% among mothers aged less than 15 years, 9.63% among mothers aged 15 to 19, and 8.15% among all mothers.”

The researchers pooled data from Waves I and IV of the National Longitudinal Study of Adolescent Health to assess whether reproductive health services offered at high schools were linked with infant birth weight. Adolescents and women in Wave I were younger than 20 years (n = 402) when they gave birth in the 1994-1995 school year. Participants were interviewed in 1996 (Wave II), 2001 (Wave III) and 2007-2008 (Wave IV). School administrators from the institutions the girls attended at the occurrence of Wave I reported on whether onsite family planning counseling, diagnostic screening, STD treatment andprenatal and postpartum care were available.

Few high schools offered onsite reproductive health care services in Wave I; 8% offered diagnostic screening, 3% STD screening, 9% family planning and 4% prenatal and postpartum health care. Multilevel analyses indicated the availability of prenatal and postpartum health care (est. ß = 0.21, 95% CI 0.02%–0.40%; P < .05) and family planning counseling (est. ß = 0.21, 95% CI 0.04%–0.38%; P < .05) correlated with increased infant birth weight. There was no significant difference linked with an increase in gestational age.

“Attending schools that provided onsite reproductive health services was related to better subsequent birth outcomes in subsequent pregnancies among this nationally representative sample of adolescents,” the researchers said. “In particular, availability of family planning counseling and on-site prenatal/postpartum care were related to increase birth weight, and availability of family planning counseling was borderline associated with increased gestational age.” – by Kate Sherrer

Disclosure: The researchers report no relevant financial disclosures. This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

PERSPECTIVE

School-based health centers (SBHCs) provide convenient, accessible and comprehensive health services for children and adolescents where they spend the majority of their time: in school. The range of services offered by SBHCs varies widely, typically including basic primary care and preventive interventions like immunizations, as well as urgent care services, integrated mental health, nutrition, and sexual and reproductive health (RH) services. They can also be involved in schoolwide education and health promotion campaigns, and they often are linked to other health care organizations in the community.

The Affordable Care Act appropriated $200 million from 2010 to 2013 to expand SBHCs, and currently more than 2,400 SBHCs are serving students and communities in 49 states and Washington, D.C. As SBHCs have doubled during the past 15 years, there is a tremendous need for further research informing best practices and health impacts of SBHCs. A persistently controversial question about SBHC care has been whether RH services should be provided on school grounds.

Madkour and colleagues highlight the public health potential for SBHCs to not only prevent early and unplanned pregnancies, but also to avoid poor obstetric outcomes among pregnant adolescents.

The scope of RH services offered by SBHCs varies widely depending on regional policies and sponsoring organizations. More than 80% of SBHCs self-report offering abstinence counseling while less than 50% offer contraceptive services.

In the last decade, first-line contraceptive options for adolescents have expanded to include highly effective, long-acting reversible contraceptive (LARC) devices — specifically intrauterine devices and subdermal contraceptive implants. Thus, some SBHCs have begun to implement LARC placement, management and removal services, reducing adolescents’ barriers to LARC access. Unfortunately, in many regions, SBHC administrators continue to cite barriers to provision of contraceptive services, including school district or building policies, restrictions from sponsoring health care organizations, or restrictive state laws.

A small, but growing body of evidence supports SBHCs as a key strategy to improve access to RH services and reduce teen pregnancy rates. Broader provision of RH services in SBHCs is warranted, yet these initiatives may need to be combined with other health education interventions to achieve desired health outcomes. Importantly, studies have shown that offering RH services in SBHCs does not increase rates of sexual activity among adolescents, but rather is associated with increased reports of abstinence and less unprotected sex.

Beyond expanding their scope of services, an important priority for SBHCs is to address the current gaps in SBHC coverage found in rural school districts and schools for special populations, and in all schools during summers and holidays when services are severely limited. Strategies are needed to consistently measure service utilization and health outcomes among adolescents with access to SBHCs and understand barriers to utilization. RH services are a key component of preventive health interventions for adolescents, and expanding access within SBHCs should be a priority to ensure better health and social outcomes for our nation’s adolescents.
- Andrea J. Hoopes, MD, MPH
- Assistant professor, department of pediatrics, adolescent medicine section
  Adult and Child Consortium for Health Outcomes Research and Delivery Science
  University of Colorado School of Medicine

Sex mis-education: What young people ask their sexual health nurse

August 26, 2016Behaviour, blog, blog-homeSRH Matters

Sex mis-education: What young people ask their sexual health nurse

2016-08-26

KATIE KENNY

A nurse at a university health centre, Susan* has learnt not to judge the students who appear in her office.

Occasionally, however, she will lean forward, raise her eyebrows, and ask: “Really?”

While she’s often surprised by young people’s lack of knowledge, she’s understanding.

“Our youth have underdeveloped brains yet we are asking them to decide careers, manage money, live away from home for the first time, deal with drugs, sex, alcohol, stress, loneliness, university work load … no wonder they let their hair down.

“Plus they don’t understand consequences. They don’t. That’s why we need to teach good old fashioned communication skills, like talking.”

er day-to-day job involves “a lot of sexual health appointments and smear tests”. It also involves answering a lot of questions. And asking them.

I’m here for the Emergency Contraceptive Pill

Student: “I’m here for the ECP.”

Susan: “Why?”

Student: “I got drunk last night and I think I had sex.”

Susan: “Do you know who you had sex with?”

Student: “Not really”, or, “I woke up beside a guy in bed”, or, “I feel like I’ve had sex but I can’t remember it”.

At this point Susan is wondering if the young woman was drugged, if she passed out, if she gave consent. Susan keeps asking questions. Of course she will give the student the ECP.

Sometimes, Susan will use a diagram to explain basic female anatomy to her patients.

“You tell more than one woman they’ve got three holes. I show them pictures. I explain what a cervix is. There are a lot of things they just don’t get.”

Student: “I think I have chlamydia.”

Susan: “Why do you think that? Are you sexually active?”

Student: “Yes. I’m in a relationship.”

Susan: “How long have you been in a relationship for? And are they your first partner?”

Student: “About 18 months, and yes, she’s my first partner, and I’m her first partner.”

Susan: “Are you using contraception?”

Student: “She’s on the pill.”

Susan: “What makes you think you have chlamydia? Is it because you don’t trust her?”

Student: “Oh no, we’ve just never used condoms. At school we were told if you don’t use condoms you get chlamydia.”

Susan feels for the guy – obviously he had a hard-line health teacher.

I want an STI check

One of the main reasons young men visit a sexual health nurse is for STI checks.

“They might be starting a new relationships and want the all-clear, or their ex-partner has said they’ve got chlamydia, or they’ve had unprotected sex, or they’ve been in a relationship for a while and they want to stop using condoms …”

Student: “I want an STI check.”

Susan: “Why’s that?”

Student: “Because I had sex the other night and we didn’t use condoms.”

Susan: “Why didn’t you use condoms?”

Student: “Because she’s on the pill.”

Susan: “What’s that got to do with anything?”

Student: “Oh.”

Susan: “Why aren’t you using condoms?”

Student: “I don’t need them.”

Susan: “Obviously you do if you think you’ve got an STI.”

If it becomes clear he’s been mistreating a woman, Susan doesn’t hesitate to ask: “How would you like if that was being done to your sister?”

That really gets them, she says. “They can get quite aggressive but most just sit back and go, ‘woah’.”

Peer pressure is often to blame, she says. “That’s the biggest thing kids have got to rise above.”

Many parents ring the clinic to try to get the goss on their kids – details which the centre is prohibited from releasing. A better strategy, Susan says, is to stay in touch with your kids and discuss “the ups and downs”.

“It’s got a lot to do with your parents … being taught about respect and morals and staying safe and that sort of thing.

“Maybe as parents we do have a lot to answer for, in that our kids are being sent out into the world unprepared.”

*To protect the nurse’s identity and that of her patients we have used a pseudonym.

– Stuff