Sex and gender both shape your health, in different ways

When you think about gender, what comes to mind? Is it anatomy or the way someone dresses or acts? Do you think of gender as binary — male or female? Do you think it predicts sexual orientation?

Gender is often equated with sex — by researchers as well as those they research, especially in the health arena. Recently I searched a database for health-related research articles with “gender” in the title. Of the 10 articles that came up first in the list, every single one used “gender” as a synonym for sex.

Although gender can be related to sex, it is a very different concept. Gender is generally understood to be socially constructed, and can differ depending on society and culture. Sex, on the other hand, is defined by chromosomes and anatomy — labelled male or female. It also includes intersex people whose bodies are not typically male or female, often with characteristics of both sexes.

Researchers often assume that all biologically female people will be more similar to each other than to those who are biologically male, and group them together in their studies. They do not consider the various sex- and gender-linked social roles and constraints that can also affect their health. This results in policies and treatment plans that are homogenous.

‘Masculine?’ ‘Cisgender?’ ‘Gender fluid?’

The term “gender” was originally developed to describe people who did not identify with their biological sex. John Money, a pioneering gender researcher, explained: “Gender identity is your own sense or conviction of maleness or femaleness; and gender role is the cultural stereotype of what is masculine and feminine.”

There are now many terms used to describe gender — some of the earliest ones in use are “feminine,” “masculine” and “androgynous” (a combination of masculine and feminine characteristics).

More recent gender definitions include: “Bigender” (expressing two distinct gender identities), “gender fluid” (moving between gendered behaviour that is feminine and masculine depending on the situation) and “agender” or “undifferentiated” (someone who does not identify with a particular gender or is genderless).

If a person’s gender is consistent with their sex (e.g. a biologically female person is feminine) they are referred to as “cisgender.”

Gender does not tell us about sexual orientation. For example, a feminine (her gender) woman (her sex) may define herself as straight or anywhere in the LGBTQIA (lesbian, gay, bisexual, transgender, queer or questioning, intersex and asexual or allied) spectrum. The same goes for a feminine man.

Femininity can affect your heart

When gender has actually been measured in health-related research, the labels “masculine,” “feminine” and “androgynous” have traditionally been used.

Research shows that health outcomes are not homogeneous for the sexes, meaning all biological females do not have the same vulnerabilities to illnesses and diseases and nor do all biological males.

Gender is one of the things that can influence these differences. For example, when the gender of participants is considered, “higher femininity scores among men, for example, are associated with lower incidence of coronary artery disease…(and) female well-being may suffer when women adopt workplace behaviours traditionally seen as masculine.”

In another study, quality of life was better for androgynous men and women with Parkinson’s disease. In cardiovascular research, more masculine people have a greater risk of cardiovascular disease than those who are more feminine. And research with cancer patients found that both patients and their caregivers who were feminine or androgynous were at lower risk of depression-related symptoms as compared to those who were masculine and undifferentiated.

However, as mentioned earlier, many health researchers do not measure gender, despite the existence of tools and strategies for doing so. They may try to guess gender based on sex and/or what someone looks like. But it is rare that they ask people.

A tool for researchers

The self-report gender measure (SR-Gender) I developed, and first used in a study of aging, is one simple tool that was developed specifically for health research.

The SR-Gender asks a simple question: “Most of the time would you say you are…?” and offers the following answer choices: “Very feminine,” “mostly feminine,” “a mix of masculine and feminine,” “neither masculine or feminine,” “mostly masculine,” “very masculine” or “other.”

The option to answer “other” is important and reflects the constant evolution of gender. As “other” genders are shared, the self-report gender measure can be adapted to reflect these different categorizations.

It’s also important to note that the SR-Gender is not meant for in-depth gender research, but for health and/or medical studies, where it can be used in addition to, or instead of, sex.

Using gender when describing sex just muddies the waters. Including the actual gender of research participants, as well as their sex, in health-related studies will enrich our understanding of illness.

By asking people to tell us their sex and gender, health researchers may be able to understand why people experience illness and disease differently.

Don’t Put This Up There

2018-06-12

From yogurt to oregano oil to lemon juice (OUCH!), the internet is chock-full of suggestions and remedies for women’s sexual health.

Breaking sex talk taboo in Indian culture

n a nation where sex temples in Khajuraho or Shivling are worshipped, talking about sex in open is still considered a taboo in Indian society. With India having the largest adolescent population in the world, along with a thriving market for contraceptives, the country cannot afford to stay silent about its sexual health anymore, writes: SUBHANGI SINGH

When it comes to sex talk or sex education in India, the government brazenly ignores it, schools disregard it and the adults firmly push it under the carpet. The demographic diversity, in terms of age, sex, marital status, class, religion and cultural context, add the final nail in the coffin. What is absurd that in India where Khajuraho, known as the land of sex temples, is open for the world to worship, visit or make movies inspired from its sex sculptures,discussion on the subject sex, on the other hand, is sidelined considering morally disgraceful in the same society.

Jyoti (name changed) is an 18-year-old newly married girl from Agra. Jyoti shares the same predicament as most young married Indian girls in semi-urban areas. She narrated, “I don’t want to have kids right away. I have heard about contraceptives like Nirodh and Mala-D. But, I dare not bring it up with my husband. He might think I am too forward or that I have a promiscuous past. My mother will also be very pissed if she gets a whiff. Also, I must get pregnant within a year or people might think I am baanjh (infertile).” Such stories echo throughout north India. It is a built-up on multiple social phenomena, almost unique to South Asia and entrenched through its social institutions.

In a country where half the pregnancies are unplanned, a third of which are terminated by choice, the need for unmet contraception is huge. Government-run programs are often cosmetic in nature, only concerned with achieving their targets. In 2012, after a botched up female sterilisation camp in Bihar, resulting in complications experienced by several patients, activist Devika Biswas filed a petition in the Supreme Court of India. The Court finally ruled that such incidents violated components of Article 21 of the Constitution, i.e. the right to health and reproductive rights. The Court also ordered the discontinuation of such sterilisation camps, ensuring that no such fixed targets exist. Adult Indian women, let alone adolescents are mostly unaware about their sexual and reproductive rights.

Dr. Shefali Wadhwani Sharma, a gynaecologist at GMCH, Chandigarh reveals, “We often get girls in critical condition, who come in with a perforated uterus due to mishandled D&C abortions, done by unqualified caregivers like midwives, etc. Such is the social stigma that adolescent girls admitted with ruptured ectopic pregnancies refuse to admit that they have been sexually active. Young girls seldom get intimate checkups done until faced with acute medical emergencies. To avoid such cases, it is imperative that education about menstrual hygiene and sexual health becomes a part of school curriculum. Sexual health is a vital part of holistic healthcare and healthy women a keystone of women empowerment.”

The latest National Family Health Survey (NFHS), 2015-16, bears some good news. Use of contraception in single women has gone up from 2 per cent to 12 per cent in the last decade. Female sterilisation (36 per cent) is still the most popular form of modern contraception used, permanent or otherwise. However, women, especially adolescents, still lack sufficient knowledge about the dangers of unsafe sex and intimate infections. Religious and cultural obligations often dissuade them from practicing proper sexual/menstrual hygiene and/or using contraception. Most women still use ‘traditional’ contraceptive methods like monitoring menstrual cycles and ‘pulling out’, unaware that these methods are not only unreliable tools of family planning but also leave them vulnerable to Sexually Transmitted Infections (STIs) and Reproductive Tract Infections (RTIs).

Even in urban setups, girls admitting to sexual needs are slut-shamed. Trisha (name changed) is a 26-year-old single, financially independent woman who resides in New Delhi. “Once I dropped my bag at my workplace, spilling out a condom amongst other things. After that, the double entendres and indecent proposals continued for a month. I finally changed the job after a few months due to various reasons, this incident being one of them.” said Trisha. She continued, “When I visited a gynaec at a private clinic to get checked for late periods, I was welcomed with questions about my sex life, marital status and warnings about my biological clock ticking away. She also wanted to know if my parents knew! She ignored me when I tried giving background of my general health.” Such moral policing from healthcare providers, misconceptions and lack of trust about regular contraception methods, have led to rampant impetuous use of over the counter emergency contraceptives.

Government and private NGOs are now resorting to innovation to get the message across. Comedian Abish Mathew recently released a funny animated short film about the importance of maintaining good sexual health. Agents of Ishq, a multimedia project about ‘sex, love and desire’, is sprinkled liberally with humour to make it appealing for this generation. Population Foundation of India (PFI) is an NGO which has partnered with Doordarshan to spread awareness about sexual health, contraception and other taboo subjects, through a soap opera titled Mai Kuchh Bhi Kar Sakti Hoon..

Inclusion of Men

Although government programs and even NGOs that focus on youth reproductive and sexual health often limit their focus to females alone, men/boys play key roles as fathers, brothers, and partners. Often the male members of the family are key decision makers of the household in the largely patriarchal Indian society, necessitating participation of the male population in these programs. The patriarchal narrative also restricts men/boys from addressing their own reproductive and sexual health issues, the admission of which can render them weak in a society that teaches them to be macho. Information, education and communication about male sterilisation are inadequate, not only in society but the public health system as well. In the absence of a credible source of information and lack of inclusion in public awareness initiatives, men often ignore their sexual health issues which in turn can lead to mental trauma, male fertility issues and infections.

During the decade (2006-2016) between successive NFHS surveys, condom use declined by 52 per cent while the number of vasectomies conducted fell by 73 per cent, indicating a greater reluctance amongst men to use birth control. Only 5 per cent Indian males use condoms and male sterilisation forms a dismal 0.3 per cent of modern contraception used. Most Indian men consider vasectomy as an equivalent to castration. Majority of them are unaware about the ease of the procedure and the reversible nature of it. India is one of the few countries in the world where female tubal ligation is more popular form of permanent contraception than vasectomies, despite the fact that the ligation procedure is more complicated and requires greater post-operative care. The pitiful picture is worsened by the fact that men are taught from an early age that reproduction and subsequently, fertility, contraception and maternal healthcare are a ‘woman’s affair’.

As Dr. Sumeet Devgan, a consultant urologist at the Grecian Hospital, Mohali points out, “Young Indian men lack the open peer discussions prevalent in women and are reluctant to seek professional medical help for their sexual health needs. We often get cases with mismanaged self-medication for STIs, etc. We need to stop referring to sexual and reproductive health and rights as women’s issues; they are men’s issues as much. Given that use of contraceptives in India is riddled with social barriers, a systematic institutional approach with inclusion of men is required to result in better uptake of contraceptives and safe sex. On-ground work to engage men in taking shared responsibility, while still promoting women’s rights, is vital for sustained behavioural change.”

Half-hearted solutions

To spread sexual health awareness and establish dialogue between sexes, we need comprehensive sexuality education (CSE) at school level. CSE teaches the young about affirmative sexuality, informed consent, safe sex, etc. A similar program called Adolescent Education Program (AEP) was introduced by the government in India in 2007. But after several protests and moral policing, citing ‘inappropriate content’, the program was banned in several states. It was rolled out in select government/private schools with limited implementation. Though it covers issues like body image, gender and sexuality, violence and abuse, STIs, etc, it leaves out issues of negotiation and consent in intimate relationships. Even urban educational institutions are reluctant to include these programs to avoid ‘unnecessary sexualization’ of kids, according to an owner of a reputed private school.

The government also has a National Adolescent Reproduction and Sexual Health (ARSH) strategy, released in 2006 and various states have implemented their own versions of it; e.g. Himachal Pradesh has set up Yuva Paramarsh Kendras (YPKs) which work with health institutions, schools/colleges, youth festivals, etc. In 2008, the National Population Stabilization Fund (Jansankhya Sthirta Kosh) started a helpline (Ph: 1800-11-6555) to provide confidential counselling services regarding sexual and reproductive health problems. Rashtriya Kishor Swasthya Karyakram launched in collaboration with United Nations Population Fund (UNFPA) is a health program for adolescents in the age group of 10-19 years, to provide preventive, curative and counselling services with routine check-ups at primary, secondary and tertiary levels. Last year, the government also started an online distribution service of condoms which met with a good response. Several NGOs like PFI, Mamta and Haiyya are working extensively to raise awareness and remove the stigma attached to discussing sexual health and needs. But a large chunk of our population is unaware of the existence of such programs.

Technology has also helped bring these issues out of the closet by providing anonymity and peer participation. Online portals like Menstrupedia and ‘She and You’ provide a safe and anonymous environment to discuss taboo subjects like menstrual hygiene, STIs, contraception methods, etc. ‘She and You’ has started an initiative #JustSayIt, through which they want to break the awkwardness by hosting a series of events and making women open up about the very things they shy away from like sex, menstruation and their intimate health.  The start of such programs is a welcome change. Sadly, it is restricted to small pockets in India with limited public awareness. The recent government restrictions on advertising for condoms and emergency contraceptive pills don’t help. The lack of proper implementation, poor quality of resources and inadequate training and sensitisation by the government has led to policy failure. According to a 2013 UNPF review, delaying childbearing could reduce India’s projected 2050 population of 1.7 billion by 25.1 per cent. With an ever burgeoning young population, India cannot afford to stay silent about its sexual health anymore.

http://www.tehelka.com/breaking-sex-talk-taboo-in-indian-culture/

There’s No Such Thing As A ‘Normal’ Penis, Says Health Specialist

2018-06-11

But there is such a thing as an average one.

The stereotype holds that men who have penises spend a significant amount of time thinking about them, or thinking with them.

Of course, you can’t think with a penis — it’s got a head, but no brain. And men are capable of thinking beyond the whims of an organ that is pretty important, but not all-controlling.

That doesn’t mean that penises aren’t important, for sexual health and even, if something goes awry, for health in general. But does having a penis mean you know what is or is not “normal”? And what even counts as “normal” for something that can vary so significantly from person to person? On the other hand, when is something definitely abnormal and worth checking out?

Read on for some information — and probably a good amount of reassurance.

What is the average size?

As many as 45 per cent of men are unsatisfied with their penis size, according to one 2006 survey, and most of those men wanted theirs to be larger. But the average range penis sizes is actually pretty, ahem, big.

“There may be no such thing as a ‘normal’ penis, but there is such a thing as an ‘average’ one,” Dr. Oliver Gralla, a men’s health specialist and author of Happy Down Below, told HuffPost Canada via email.

A study from the British Journal of Urology International that looked at 15,000 men from around the world found that the average flaccid penis length was 9.16 centimetres (3.6 inches), and the average erect length was 13.12 centimetres (5.2 inches). For girth, the flaccid average was 9.31 centimetres (3.7 inches) and the erect average was 11.66 centimetres (4.6 inches). Length is measured along the top of the penis, from where the base connects to the torso to the tip.

What’s more, the study found that outliers are pretty rare. Only five out of 100 men would have a penis longer than 16 centimetres (6.3 inches) erect, and only five out of 100 men would have one shorter than 10 centimetres (4 inches) erect. And research has shown that despite some stereotypes, age, race, and height are not accurate predictors of penis size.

So the myth of the superior penis is just that: a myth. Embrace humanity’s natural variations!

Grower or shower?

It is normal to be a grower (what Dr. Gralla refers to as a blood penis) and not a shower (what he calls a flesh penis). But it’s also normal to just be a shower.

The Journal of Urology study of 80 men found no correlation between size when flaccid versus erect, or between size and the age of the men. A Turkish study came to a similar conclusion.

What is a micropenis?

A micropenis is a penis that is well under the average size, about 2.5 standard deviations smaller than mean penis size — one standard is that the erect penis length is less than seven centimetres (2.7 inches).

The condition is rare, occurring in only about an estimated 0.6 per cent of those born with a penis, and there are several possible causes.

In some cases, micropenis can be treated in infancy with hormone injections, though this has no effect if the treatment begins in adults because penis growth stops after puberty. Surgery can also be an option in adults.

Partners are mostly fine with it

It turns out that the way men get to view their own penises — looking down from above — makes it look smaller, versus seeing it straight on or from the side. This may be why men seem more unsure about penis size than their partners do.

One study found that 85 per cent of women were satisfied with the size of their partner’s penis, but 45 per cent of men believed their penis was small. Another study asked women to indicate their preferred penis with a 3D model, and the majority chose a size only slightly above average, just above six inches erect.

There doesn’t seem to be much research on attitudes among same-sex partners about penis size, but one study did find that men who sleep with men were more likely to say they preferred to bottom during anal sex if they also rated their penis size as below average.

Men who rated their penis size as above average were more likely to say they preferred to top, while those who rated their size as average were more likely to say they were versatile on position.

But some things are abnormal

There are some things that are abnormal when it comes to penises, and if they show up they warrant medical attention because they can indicate a health issue.

Erectile dysfunction is an issue for many elderly men, but it doesn’t affect them exclusively. “Although more common in older men, even teenagers can struggle with erection issues,” Dr. Gralla said. In younger people, erectile dysfunction can be the result of a psychological issue, but it can also be the result of medical conditions like clinical depression or medication side effects.

There are other penile abnormalities or changes that can indicate a health issue. “Painful erections, palpable plaques, or slight deviations during erection can be the first signs of Peyronie’s disease, or IPP (induratio penis plastica),” Dr. Gralla said.

The disorder should be treated as early as possible, so see a doctor if you develop those symptoms.

https://www.huffingtonpost.ca/2018/06/08/normal-penis_a_23454201/

It’s 2018, but young men still don’t want to talk about contraception – here’s why

2018-05-23

It’s a Friday night in a midsize university town in the Western US, and for many students, this means one thing: it’s time to party. University students head out for a night of drinking, dancing and often, sex. For many students attending large US universities, it’s more or less expected that they will have casual sex on a night out. But while attitudes toward casual sex have become more liberal, there’s been significantly less change when it comes to attitudes toward contraception.

Since the 1960s, when the birth control pill became widely available in the United States, research and development has focused on generating contraceptive methods for women to use. The feminist movement celebrated female contraceptives for giving women the power to control if and when they become pregnant. But somewhere along the way, a woman’s right to use birth control translated into a woman’s responsibility to use birth control.

Our research, recently published in Culture, Health & Sexuality, found that young men have a difficult time reconciling the idea that women should have control over their own bodies with the ideal that men should play an equal role in making decisions about contraception – especially since most forms of contraception alter women’s bodies to prevent pregnancy, rather than men’s.

A conflict of ideas

For our study, we held in-depth interviews with 44 young men at a large public university in the western United States to understand how they make decisions about contraception during their sexual relationships with women. The men we interviewed clearly articulated two sets of expectations: they thought that men should participate equally in decisions about contraceptive use, but that women should have the final say, since women bear much of the physical and social responsibility if they get pregnant.

Some men were worried that they might disrespect women’s bodily autonomy by bringing up the issue of contraceptives. Women were expected to request that men use a condom or otherwise communicate to men that they were not using a hormonal contraceptive. By deferring to women, men were attempting to be mindful of power dynamics that still privilege them.

We found that being confused about these competing ideas can prevent men from communicating clearly about contraceptives with their partners. As a result, men ultimately tasked women with initiating all communication about contraception, leaving their sexual partners with greater responsibility, work and financial costs related to getting contraception, and preventing pregnancy.

Bringing up birth control

In a culture where almost all forms of contraception are designed for women, most men couldn’t come to a satisfactory resolution between sharing equal responsibility for contraception and respecting a woman’s right to control her own body. What’s more, they said that this conflict contributed to their general reluctance to engage with the issue of contraception at all.

Our findings suggest that sexual health education aimed at young men must go beyond simply telling them to use condoms. Recent efforts to normalise “affirmative consent” and encourage men and women to communicate clearly about sex might also help raise the issue of contraception.

How researchers and sexual health practitioners can help to reconcile these opposing ideas is up for debate. New efforts to develop a birth control pill for men are promising, and would help to reduce the gender disparities in available methods. But the male pill is still in development and won’t be widely available for some time.

In the meantime, when in doubt, men should simply wear a condom. Men shouldn’t just assume that if women don’t say anything about contraception, it means they’re protected. It’s necessary to have the conversation – even if it’s uncomfortable. Men also can also learn more about female forms of contraception, so that they can understand the impact they have on women’s bodies and be more sensitive to women’s needs during these conversations.

Men should never assume that any woman is using a contraceptive method. If you don’t want to discuss contraception, then simply use a condom – and relieve women of the responsibility for requesting one.

In this, and other ways, we must cultivate an understanding of sexual relationships that goes beyond a battle of the sexes approach, in which men’s and women’s needs and desires are seemingly at odds. In this study, men lacked the tools they needed to engage in sex responsibly, which ended up placing greater responsibility on women.

http://theconversation.com/its-2018-but-young-men-still-dont-want-to-talk-about-contraception-heres-why-96951

Why STDs Like Gonorrhea and Syphilis Are on the Rise

2018-05-18

People have blamed dating apps for the rise of gonorrhea and syphilis. But there are a few sneakier factors at play here.

As if dating weren’t hard enough, singles in California have one more thing to worry about: the rise of sexually transmitted infections (STIs).

According to the California Department of Health, more than 300,000 cases of chlamydia, gonorrhea, or syphilis were reported in the state in 2017 alone. Overall, the transmission rate of these three STIs has spiked by a staggering 45 percent over the past five years.

But the rise of STIs isn’t just a concern in the Golden State. Figures from the Centers for Disease Control and Prevention (CDC) show that STIs are rising everywhere. From 2015 to 2016 alone, gonorrhea rates in men increased by 22 percent nationwide, while syphilis rates increased by 14.7 percent.

The biggest problem? Many men might not even know they’re infected with these STIs. About half of men don’t exhibit any symptoms of chlamydia, while many men with gonorrhea are similarly asymptomatic. The early signs of syphilis — small, painless sores around the mouth, genitals, or rectum — also tend to be subtle, and can easily be explained away as an ingrown hair.

The massive spike in STI rates is particularly concerning, given that just a decade ago, STI rates were on the decline. But “progress has since unraveled,” the CDC wrote in a 2016 report.

So what’s to blame for this unraveling? The answer is more complicated than you might think.

Over the past few years, many media outlets have published alarmist stories linking Tinder and Grindr to the rise in STIs. As recently as May 15, the Los Angeles Timesreported that some health experts partially attribute the spike to people having “more sexual partners linked to dating apps.”

But Matthew Prior of the National Coalition of STD Directors says we shouldn’t be so quick to point the finger at Tinder and Grindr. Most experts “don’t think it’s a primary reason that STDs are spreading,” he told MensHealth.com.

Instead, Prior and other public health experts attribute the nationwide spike in STIs to a confluence of different factors.

While STI rates have risen across the board, cases of syphilis in particular are on the rise among men who have sex with other men (MSMs, according to CDC lingo), who accounted for 80.6% of the new syphilis diagnoses between 2000 and 2016. That’s in part because MSMs are more likely to have receptive anal sex, which ups their risk of contracting STIs: the anus is narrow, doesn’t offer natural lubrication, and the skin tears easily, which means that STIs can easily enter the bloodstream.

Dr. Hunter Handsfield, Professor Emeritus of Medicine at the University of Washington Center for AIDS and STD, believes an additional reason why men who have sex with men may have gotten more lax about using condoms is because of PrEP, a daily medication taken to prevent HIV infection.

“Because HIV is now less of a worry, there’s less condom use,” Handsfield tells MensHealth.com. “That’s the biggest single change.”

According to the California data, half of chlamydia cases and a third of gonorrhea cases were among people under 25, indicating that young people in particular are at heightened risk. That’s in part because they simply don’t know that many of the most common STIs are asymptomatic, Heidi Bauer, the chief of the California Department of Public Health, told BuzzFeed News.

“I hear it all the time — they think, Well, if I have something, I will know it and I will just go in and get it treated. But the reality is the vast majority of these infections don’t cause any symptoms at all,” she said. “So people just pass them around without realizing it.”

Over the past decade, federal budget cuts have led to the closure of STI clinics across the country, making it harder for people to get tested and treated. In a 2016 report, for example, the CDC reported that more than 20 health department STI clinics had been shuttered in 2012 alone.