Category Archives: Sexual Health

Coming out — as a couple

Coming out — as a couple

2013-06-14


Between celebratory parades for Pride Month and increased calls for marriage equality, it would seem that, for the lesbian, gay, bisexual and transgendered community, things are indeed getting better.

But what happens if you’re in relationship with a partner who just isn’t comfortable being “out” with his or her sexual identity? Does the desire to keep your sexuality private create tension, or can an LGBT couple still succeed when one person isn’t ready to go public? I recently asked some of my colleagues for their insight on this issue.

“With most of the LGBT couples that I see, both partners are out, but to varying degrees,” said New Jersey-based psychotherapist Israel Martinez, who specializes in LGBT therapy. “One partner may be out with his or her family but not at work, and the other is out in both situations but is shy about holding hands in public, for example.”

That may not always pose a problem for couples, but it can certainly be an issue when one partner doesn’t publicly acknowledge being homosexual at all.

“In my experience, the partner who is more ‘out’ tends to see the partner who is more ‘closeted’ as less emotionally healthy,” explained Gordon Powell, a psychotherapist in New York. “Meanwhile, the closeted partner may feel judged and criticized.”

Such emotions can simmer, creating tension for even the happiest couples. “If the couple is closeted because of one partner, that person often feels guilt, anxiety and fear of abandonment,” sex therapist Margie Nichols added. “And the ‘out’ partner may feel anger and eventually distance and disconnection from the relationship.”

How Vinegar Could Save 73,000 Women A Year From Cancer

How Vinegar Could Save 73,000 Women A Year From Cancer

2013-06-04

Almost two decades ago, a doctor named Surendra S. Shastri was put in charge of preventative oncology at Tata Memorial Hospital in Mumbai, India. One of his biggest jobs: to figure out how to cut the toll from cervical cancer, which kills 200,000 women a year in the developing world but is rare in developed countries.

In the United States, that death toll is just 4,000, the result of the most successful story of early detection preventing cancer death. Unlike most other cancers, cervical cancer starts as a pre-cancerous lesion that accumulates mutations. The Pap smear, a technique invented in the 1920s by George Papanicolau, a Greek pathologist at Cornell University, involves a doctor taking cells from the lining of the cervix and sending them to a lab to be analyzed under a microscope. Annual pap smears mean most cases of cervical cancer that would happen in the U.S. are caught before they become deadly tumors. In India, which has the world’s worst cervical cancer burden, the introduction of annual Pap smears for all women seems impossible.

“We don’t have the kind of laboratories or the kind of trained manpower needed for having a Pap smear. The Pap smear has succeeded in the countries where it has because of good quality control and frequency of screening,” Shastri says. He needed something far cheaper. The idea that he and others hit upon was to steal a step from from the procedure that follows a suspicious Pap smear. Doctors pour acetic acid – basically a sterile vinegar solution – onto the cervix and look at it under a magnifier. Cancer and precancer cells have less of the gooey cytoplasm than healthy cervix, and the acetic acid makes them actually turn white after just a minute. The normal cells remain a healthy pink.

Shastri skipped the magnifier and the doctor, and decided to train the same health care workers who give immunizations and other basic preventative measures to apply an acetic acid solution in the field. In 1998, he obtained funding from the National Cancer Institute, one of the U.S. National Institutes of Health, to conduct a fifteen-year clinical trial comparing using the vinegar screen once every two years to not screening in 150,000 women. The results are being presented today here at the annual meeting of the American Society for Clinical Oncology. The vinegar test reduced the rate of cervical cancer death from 16.2 women per 100,000 to 11.1 women per 100,000, a 31% reduction.

“It’s amazing,” says Carol Aghajanian, chief of gynecologic oncology at Memorial Sloan-Kettering Cancer Center in New York. “Thousands of lives could be saved by this inexpensive technique.”

Shastri and his co-authors estimate that in India alone, the introduction of acetic acid screening could prevent 22,000 cervical cancer deaths annually. If it could be instituted across the developing world, that would save 73,000 lives.

Based on those results, the national government in India and the state government of Maharashtra, the state of which Mumbai is the capital, are instituting screening programs for all women. But translating this procedure from Tata Memorial Hospital to the rest of India or from India to the rest of the world does pose challenges.

Ted Trimble, the Director of the Center for Global Health at the NCI, notes that the health care workers did more than just use tests. They made innovative use of new technology – using digital cameras to record exams so they could be reviewed later and geomapping of the slums of Mumbai so women could be found – and of super-organized records. More than that, he says, the workers did a great job of making sure women who were screened as potentially having cancer did get to Tata Memorial for their exams. Will other hospitals in other countries be as diligent outside of a controlled clinical trial? It’s impossible to know.

Still, this is a striking example of how a low-tech, low-cost intervention can sometimes take the place of a more high-tech innovation. In 2009, Shastri co-authored a paper in the New England Journal of Medicine showing that a single round of acetic acid screening was about the same as a single pap smear for detecting cervical cancer, but neither were as good as a newer invention, which tests for the viral DNA of the strains of the human papilloma virus that are the main cause of cervical cancer.

But the viral DNA test is expensive. Even in the U.S., it is so costly that it has not replaced Pap smears. The Bill & Melinda Gates Foundation has partnered with Qiagen QGEN -0.38%, the Dutch diagnostics company, to create a cheaper version that might be useful in the developing world. Irma Alfaro-Beitz, a senior director of global health at Qiagen, says that Qiagen worries about introducing the test in countries that lack the equipment and processes to perform it or the ability to make sure women are helped once cervical cancer is found. “It is very important that when we introduce a test into a country that country is ready for the test,” she says.

The Gates Foundation still says that the new test should cost about $5, and that it has received regulatory approval from the European Union and been granted marketing authorization in many emerging markets, including India. But approval from the World Health Organization is still pending, and that will be necessary to allow agencies of the United Nations to procure the test.

Shastri says that even if the test becomes available, he is likely to use it only as a second step after the acetic acid screen. The current cost of screening one woman is about 30 Indian rupees, about half a U.S. dollar. Even if the cost of HPV viral testing can drop to $2, it will still best be used to make sure that cancer is detected in women whose cervixes show white areas after being exposed to acetic acid.

Other methods are also being used to help to reduce the number of cervical cancer deaths, too. Last month, Merck and GlaxoSmithKline dropped the prices of the two vaccines against HPV, Gardasil and Cervarix, to $4.50 and $4.60 per dose for use in the developing world. That’s less than one-twentieth the price in the developed world.

There is also some good news on the treatment front: researchers at the ASCO meeting announced that Roche’s Avastin can extend the life of an average woman with late-stage cervical cancer by four months to 17 months. It is not yet clear what can be done to get Avastin, which costs tens of thousands per year, available to rural women in the developing world.

Yes, oral sex can lead to cancer

Yes, oral sex can lead to cancer

Actor Michael Douglas made headlines on Monday after telling The Guardian that his throat cancer may have been caused by the human papillomavirus transmitted through oral sex.

The link between oral sex, HPV and cancer has been receiving more attention in recent years.

HPV is a virus that’s transmitted through sexual contact — genital or oral. There are more than 40 types, according to the Centers for Disease Control and Prevention, and approximately 79 million Americans are currently infected. Most people have no symptoms.

“HPV is so common that nearly all sexually active men and women will get at least one type of HPV at some point in their lives,” the CDC’s website states. “In most cases, the virus goes away and it does not lead to any health problems. There is no certain way to know which people infected with HPV will go on to develop cancer.”

Douglas’ publicist told CNN that the actor did not intend to point to HPV as the sole cause of his throat cancer, but was suggesting it as one possible cause.

HPV is thought to cause 1,700 oropharyngeal, or throat, cancers in women and 6,700 oropharyngeal cancers in men each year, according to the CDC. Tobacco and alcohol use may play a role in who develops cancer from the virus, the government agency notes.

A 2011 study found that the proportion of oropharyngeal cancers related to HPV increased from 16.3% to 71.7% between 1984 and 2004. Data presented that same year at the American Association for the Advancement of Science annual meeting suggested HPV was overtaking tobacco as the leading cause of oral cancers in Americans under the age of 50.

The virus is transmissible regardless of whether the sexual contact is heterosexual or homosexual.

Approximately 42,000 people in the United States will be newly diagnosed with oral cancer in 2013, according to the Oral Cancer Foundation. This includes neck, mouth and throat cancers. When they’re found early, oral cancers have an 80 to 90% survival rate, the foundation says.

“Patients with HPV-positive cancers have better survival rates,” Dr. Anil Chaturvedi of the National Cancer Institute told CNN in 2011. “The precise reasons for the survival benefits are not clear, but tumors in HPV-positive patients tend to have less genetic damage. Because of that, they are more responsive to cancer therapies like radiation treatment.”

The CDC and the American Academy of Pediatrics recommend both boys and girls get the HPV vaccine between the ages of 11 and 12. Doctors say the vaccine is most effective if administered before a child becomes sexually active.

HPV has also been linked to cervical cancer, penile cancer and anal cancer, according to the CDC. The HPV vaccine prevents the most common types of the virus. There are two approved for use in the United States: Gardasil and Cervarix.

Of course, HPV is not the only danger of having unprotected oral sex. Sexually transmitted diseases like herpes, syphilis, gonorrhea and HIV can be also be spread through the act.

To stay safe, the CDC recommends always using a condom and getting tested regularly.

“The good news is that all STIs are preventable and most are curable,” writes Gail Bolan, the CDC’s director of STD prevention division. “But, because most STIs have no symptoms, testing is the necessary first step to treatment.”

High-tech tools for STDs

High-tech tools for STDs

2013-05-15

Ramin Bastani believed he was about to get lucky. A woman he’d met earlier that night was making her way toward his bedroom.

Suddenly, he hesitated. It didn’t go unnoticed.

“What’s your deal? Are you gay?” the woman asked.

No. He wasn’t gay.

“What is it?” she wondered. “Oh my gosh! Do you have an STD?”

No, it wasn’t that either.

Alarmed, she stepped away from him.

“Oh my God! Yes, you do. You have an STD,” he recalls her saying emphatically.

Bastani confessed what was bothering him — he barely knew this woman.

“No,” he told her. “I’m afraid you might.”

She slapped him across the face and walked out of the room.

It’s the kind of awkward moment a lot of men might prefer to forget, but for Bastani it was the impetus for starting his company, Qpid.me, a free website that lets users text and share their verified sexually transmitted disease results with potential partners.

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When your child walks in during sex

When your child walks in during sex

2013-04-25

By Ian Kerner, CNN Contributor

It’s a moment that not all parents have experienced, but that many of us fear: You’re enjoying a passionate encounter with your partner, oblivious to the pitter-patter of little feet until it’s too late.

Have you just scarred your kid for life? Certainly not — but, depending on your child’s age, you might have some explaining to do.

“Being walked in on during sex is a very common experience — and a great example of why it is important to knock first, and always respect someone’s privacy,” says sexologist Logan Levkoff. “But before you say anything to your child, you are going to need to determine what they heard, saw, and if they even care about what was going on.”

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Why Circumcision Lowers Risk of HIV

Why Circumcision Lowers Risk of HIV

2013-04-18

Promising trials hinted that circumcision could lower rates of HIV infection, but until now, researchers didn’t fully understand why.

Now, in a study published in the journal mBio, scientists say that changes in the population of bacteria living on and around the penis may be partly responsible.

Relying on the latest technology that make sequencing the genes of organisms faster and more accessible, Lance Price of the Translational Genomics Research institute (TGen) and his colleagues conducted a detailed genetic analysis of the microbial inhabitants of the penis among a group of Ugandan men who provided samples before circumcision and again a year later.

While the men showed similar communities of microbes before the operation, 12 months later, the circumcised men harbored dramatically fewer bacteria that survive in low oxygen conditions. They also had 81% less bacteria overall compared to the uncircumcised men, and that could have a dramatic effect on the men’s ability to fight off infections like HIV, says Price. Previous studies showed that circumcised men lowered their risk of transmitting HIV by as much as 50%, making the operation an important tool in preventing infection with the virus. Why? A high burden of bacteria could disrupt the ability of specialized immune cells known as Langerhans cells to activate immune defenses. Normally, Langerhans are responsible for grabbing invading microbes like bacteria or viruses and presenting them to immune cells for training, to prime the body to recognize and react against the pathogens. But when the bacterial load increases, as it does in the uncircumcised penile environment, inflammatory reactions increase and these cells actually start to infect healthy cells with the offending microbe rather than merely present them.

That may be why uncircumcised men are more likely to transmit HIV than men without the foreskin, says Price, since the Langerhans cells could be feeding HIV directly to healthy cells. His group is also investigating how changes in the levels of cytokines, which are the signaling molecules that immune cells use to communicate with each other, might be influenced by bacterial populations.

“There is a real revolution going on in our understanding of the microbiome,” says Price, who is also professor of occupational and environmental health at George Washington University. “The microbiome is almost like another organ system, and we are just scratching the surface of understanding the interplay between the microbiome and the immune system.”

Previous work suggested that changes in the bacterial populations in the gut, for example, could affect obesity, and other studies found potential connections between microbial communities and the risk for cancer, asthma and other chronic conditions.

by Alice Park

Youth: Straight, LBGT or ‘other’?

Youth: Straight, LBGT or ‘other’?

2013-04-08

By Ian Kerner, Special to CNN

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 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.”

Sex Mistakes for Men to Avoid

Sex Mistakes for Men to Avoid

2013-04-01

By Stacy Lloyd
Both genders are guilty of sex mistakes, according to FoxNews.com. In the article FOXSexpert: The Top 10 Sex Mistakes That Men Make, though, well-known sex experts were sharing ways that men can avoid common sex mistakes with women.

Just because a man is ready for sex doesn’t mean the woman is. This is the single, biggest mistake men make, iVillage sex expert Tracey Cox told NBC News.

They underestimate how long women take to orgasm. Remember foreplay isn’t a luxury, it’s a necessity.

Thinking foreplay begins in the bedroom. Foreplay is best approached as an all-day affair Dr. Yvonne Kristín Fulbright, sex educator, relationship expert and author, wrote on FoxNews.com.

Don’t assume what pleases one woman works for all women. Every woman responds differently to sensation and every woman’s anatomy is a bit different.

What feels amazing to one may do nothing – or even cause discomfort – for another, Tristan Taormino, author of The Secrets of Great G-Spot Orgasms and Female Ejaculation told WebMD.

Don’t ignore the clitoris. Many men think a woman’s orgasmic ability is due to penetration, Fulbright wrote in FoxNews.com. More than 70 percent of women experience clitoral orgasm when it comes to maximum reaction.

WebMD said that the whole body of the clitoris including the glans, is packed with nerves and highly sensitive. Note however that for many women, the glans is actually too sensitive to touch.

Don’t miss the G-spot. Found on the front wall of the vagina, a woman’s G-spot may be more to one side than the other, or a little higher or lower, than is often depicted, said Fulbright. Its size may also vary, from as small as a pea to as large as a quarter wrote FoxNews.com.

Remember her “other” erogenous zones. AskMen.com wrote that it’s easy to forget a woman’s body is full of less obvious erogenous zones. Try kissing her collar bone, back, hips and go from there.

Talk about sex. Most couples don’t talk to each other about sex.

Often that’s because they don’t have the words, sex therapist Chris Donaghue told WebMD. If it’s hard for your partner to say what she wants sexually, try asking her specific rather than open-ended questions, Taormino said on WebMD.

She’s not a porn star. As seen in porn films, many men expect their lovers to fulfill their every fantasy. Remember porn is fantasy, not reality, wrote FoxNews.com.

Don’t think of sex as a mission. It’s much more than that.

Erection, foreplay, penetration – all are aimed at achieving the main objective: orgasm. It’s a mistake to focus solely on orgasm since sometimes it doesn’t happen even for men, said WebMD. When this happens, people can end up feeling bad about sex that was most likely good in other ways.

The Sex Drives of Men and Women

The Sex Drives of Men and Women

2013-03-27

An exhaustive review of studies on sexuality published from the 1960s to 2000, asserted in every sex-drive-related metric, men demonstrated stronger urges than women, according to Discovery’s How Things Work.

Psychologists from a Case Western Reserve University review emphasized the male sex drive doesn’t just represent a moment of time. Rather it spans age groups, marital status and sexuality.

Roy Baumeister, a Florida State University social psychologist, wrote WebMD, found that men reported more spontaneous sexual arousal and had more frequent and varied sexual fantasies.

Masturbation is considered by sex researchers to be one of the purest measures of sex drive, because it isn’t constrained by external factors such pregnancy or disease, said PsychologyToday.com.

Discovery wrote that 94.6 percent of males 25 to 29 masturbate. For women it’s 84.6 percent.

PsychologyToday.com wrote that men initiate sex often and rarely refuse it. Women initiate it much more rarely and refuse it more often than men.

Women don’t always seem to know what turns them on, reported WebMD.

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Pediatric Group Supports Same-Sex Marriage

Pediatric Group Supports Same-Sex Marriage

2013-03-22

By

The American Academy of Pediatrics (AAP) says it’s “in the best interests” of the children.

The influential group of pediatricians released a policy statement in support of same-sex parents’ right to wed as well as to foster or adopt children. The policy was guided by the organization’s belief in gay marriage “to promote optimal health and well-being of all children.”

We know enough about child development that we can say that children are nurtured when they have two loving, supportive, committed-to-each-other adults to take care of them,” says Dr. Ben Siegel, a professor of pediatrics and psychiatry at Boston University School of Medicine and a co-author of the policy statement. ”Kids growing up with two same-sex parents are as normally developed as the rest of the population.”

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