Could These 5 Sexual Issues all be in Your Head?

2017-03-28

Many common sexual issues are actually psychological in nature.

Have you ever had problems with sexual desire or sexual performance? Although it’s not something most men openly discuss, the truth is that many men have experienced sex-related difficulties at some time in their lives. While some sexual troubles come about due to health issues, many sexual issues are actually psychological rather than physical.

Lack of sexual desire

Lack of sexual desire, or low libido, can cause problems in romantic relationships for both men and women alike. A man with the low libido may feel anxious about his seeming inability to provide the expected level of sexual desire. A woman who is partnered with a man who has a lack of sexual desire may worry that she is “not good enough,” or that her partner dislikes her. The truth of the matter is that there could be psychological factors at play causing the inhibited sex drive, such as stress, religiosity, or situational anxiety. Low libido isn’t always due to physical factors like an abnormally low testosterone level—sometimes, the cause is all upstairs.

Delayed ejaculation

Delayed ejaculation (DE), also called “inhibited ejaculation,” often has its ties to psychological `causes. DE happens when a man takes an unusually long period of time to have an orgasm. Frequently, men with a porn addiction can fall prey to DE, as well as men who experience performance anxiety. Although DE can be caused by physiological problems such as nerve damage, in many cases the issue is purely tied to the mind. Psychological DE can, however, be treated by enlisting the help of a sex therapist or using guided imagery therapy—whether under the care of a sex expert or in the privacy of your own home.

Premature ejaculation

Premature ejaculation (PE) occurs when the male orgasm takes place too early during sexual activity, typically within one minute of beginning penetration. It is one of the most common sexual issues that affect modern men. According to a 2010 study published in the Primary Care: Clinics in Office Practice journal, as many as 30 percent of men may experience premature ejaculation at some point in their lives. What may come as a surprise is that many cases of PE occurs due to psychological factors, such as stress or anxiety, rather than any underlying physiological issue.

Erectile dysfunction

Erectile dysfunction (ED) happens when a man experiences difficulty with achieving or maintaining an erection during sexual activity. Although some men experience erectile dysfunction due to medical issues such as diabetes or advanced age, many men who are otherwise physically healthy experience erectile dysfunction. How can you tell whether your ED is medical or psychological? If you wake up with normal morning erections, or you don’t have any erectile troubles during masturbation, your ED is more likely to be due to psychological factors such as performance anxiety rather than physiological factors. Luckily, psychological ED is treatable and can be managed over the long term without ever having to set foot inside a doctor’s office.

Fetishism

Fetishism is something that is common among men, yet few of them talk about it. Having a “fetish” means having a paraphilia—a form of sexual disorder that has psychological roots—where an object or non-erotic body part is required in order for a man to become aroused. Common fetishes include foot fetish (sexualizing feet, particularly a sex partner’s feet) and types of clothing fetish (specific types of shoes, for example, or clothing made of specific fabrics). Without the presence of the sexualized body part or object, many fetishists are unable to perform sexually at all, as their arousal depends on the object or body part’s role in their sexual activity.

The bottom line

These problems and other sexual issues can be caused by psychological, rather than physical, means. While this may not seem like the most welcome news, the good thing about psychologically rooted sexual disorders is that treatment doesn’t have to involve medical procedures or taking pills each day for the rest of your life. In fact, many men find they are able to increase their sexual stamina and performance by using treatments such as mindfulness meditation or guided imagery therapy—both of which can be done in privacy, without ever having to leave your home. If you are experiencing sexual difficulties and you think the cause may be “all in your head,” don’t hesitate in seeking help. Many websites offer private, affordable treatment options that can help you regain your sexual prowess and keep it for a lifetime.

3 Experts On Maintaining Bisexual Health

2017-03-13

In some ways, maintaining sexual health as a bisexual is just like maintaining sexual health as someone with any other sexual orientation.

For example, Denarii Monroe of the Bisexual Resource Center says, “Staying sexually healthy for me personally means making sure that I’m getting regular STI and HIV checkups, preferably before starting a new sexual relationship with someone.”

“In terms of tips for the happy, healthy bisexual, my number 1 tip for sexual health is to maintain [it] by getting those exams,” says Amy Andre, who works with the Bisexual Research Collaboration on Health at The Fenway Institute in Boston. She argues that routine screenings and preventative medicine are essential for long-term health.

“Unfortunately,” Andre acknowledges, “studies show that compared to women of other orientations, women who identify as bisexual are less likely to get cancer screenings like Pap smears and mammograms.”

It’s one of the many health disparities between bisexual women and men versus their non-bi counterparts.

“Bi+ sexual health means recognizing the specific systemic obstacles that bi+ people have to [overcome] obtaining adequate health care, including sexual health care,” says Monroe, who prefers the more inclusive “bi+” — a moniker meant to include pansexual, polysexual, and other orientations beyond gay, lesbian, or straight.

One of the main impediments for bisexual health is the “biphobia, bi invisibility, and the discrimination that people face who are out as bisexual,” says Andre. That stigma “impacts our physical and mental health, and even our ability to make choices around sexual health screenings.”

Andre sees being out to healthcare providers as an essential part of maintaining sexual health, but acknowledges, “the unfortunate reality is that many people do experience discrimination in healthcare settings when they come out, so it’s kind of a double-edged sword.”

Monroe says she fights this using “my community as resources to find doctors and other health professionals that aren’t just ‘LGBT’ friendly, but that are specifically bi+ friendly, so that bi+ antagonism doesn’t creep into my doctor’s visits so much when my sexual history and sexual desires are being discussed.”

Andre says health care providers truly committed to serving bisexual clients should publicize that they are nondiscriminatory — and then live up to that promise.

“For so many of us, even within the LGBT community, there are still enormous areas of discrimination. Just because this doctor has a rainbow sticker, or the [Human Rights Campaign] equality sign, does that necessarily mean that I’m welcome? Or that I can come out to them as someone who has male and female partners? Or as someone who identifies as bisexual regardless of the gender of a partner? I think that healthcare providers really need to go the extra mile to make it very clear that they [offer] a welcoming environment for their bisexual patients and clients.”

Preventative sexual health screenings are just the tip of the iceberg, when looking at the health needs of bisexuals, Monroe argues, because “we have higher rates of poverty than both straight people and gays and lesbians, [and] lower rates of health insurance coverage.”

Andre agrees. “There’s very little research on this, but what research there is shows that we tend to have less money, have higher rates of unemployment and underemployment. As we all know, healthcare in the United States can be expensive, and for many people, prohibitively expensive.”

Meanwhile, Andre says, bi folks have perhaps even more need for competent health care. “Bisexual women in particular, have higher rates of being victims of domestic violence. We have higher rates of depression, anxiety, suicidality, alcoholism, and other addiction behaviors. We already have a whole mess of things that we’re dealing with, and then to think, Oh, I better schedule my mammogram. That might not be at the top of someone’s list when they don’t have money, and they’re trying to escape from an abusive relationship, and they’re feeling like shit, and they’re thinking about suicide. I think that all of these things kind of snowball on each other and make it difficult for us to take care of ourselves. That’s just the unfortunate reality.”

“The majority of bi+ people are people of color and the majority of transgender people are bi+,” adds Monroe, who notes that the unique socioeconomic issues that bisexuals face impact “how much we’re able to access to adequately address our needs in a very oppressive set of systems, especially when we’re multiply marginalized. For me, addressing bi+ sexual health means addressing these specific needs, which means specifically acknowledging and then tackling bi+ erasure, bi+ antagonism, and monosexism.”

H. Sharif “Dr. Herukhuti” Williams, Ph.D., who cofounded both BiRCH and the Center for Culture, Sexuality, and Spirituality, says he tries to “practice acceptance and self-love for my sexual fluidity. Part of that also means being able to resist external societal pressures that aim to confine and limit my sexuality, and to pathologize it.”

“If I choose to be with a particular person of a particular gender,” Herukhuti maintains, “the outside world will want to place labels on me that can be internalized. I must stand in the power of my own truth, and give myself the space to be moved sexually across genders.”

Sexual health, for many bisexuals, also involves establishing and maintaining healthy relationships.

“I make sure that I understand my own relationship needs so that I can communicate them clearly and confidently to my partner or partners,” says Monroe. “I stay sexually healthy by only engaging in sexual encounters with sober people when I’m sober.”

Herukhuti adds that “when seeking a relational partner,” he tries to be prepared “for their lack of knowledge, their biphobia, their fears and prejudices that have not been explored. Being able to counter those things and stand in my own truth is a part of my sexual health. I grew up in the ’80s, in the height of fear-based HIV messaging, so I must continue to stand in the power of my own truth, to be rigorously honest about my own fears and anxieties in seeking a partner, and be able to work through those.”

“There are different sexual cultures that exist in our society between men and women,” Herukhuti concludes. “I have learned how to swim in both of those cultures and recognize the problematics of both. The ways that men are not socialized to be emotionally intelligent, or how women are socialized to limit their sexual agency. That also has an impact on my social interactions and relationship possibilities. As a bi man, I am often challenged by the patriarchy and misogyny that men are socialized to uphold. I am personally attracted to women who are sexually empowered — who don’t limit their sexual agency — and to men who have developed their emotional intelligence in ways that are deeply moving. All of these things are involved in maintaining my personal sexual health and wellness.”

Reckless reporting increases HIV risk

Keletso Makofane, MPH

MSM technical adviser: The Anova Health Institute

Member: World Health Organisation Civil Society Reference Group on HIV

“Reckless sexual behaviour among gay teens and men” is being fuelled by the increasing use of PrEP. This claim rests on a conceptual misunderstanding and some factual errors.

I was alarmed to read the article titled Playing with fire (City Press, March 5 2017) on pre-exposure prophylaxis (PrEP) among gay men. It makes the claim that “reckless sexual behaviour among gay teens and men” is being fuelled by the increasing use of PrEP. This claim rests on a conceptual misunderstanding and some factual errors.

The conceptual misunderstanding is to equate sex without a condom among people who are on PrEP with “recklessness”. Accessing PrEP takes planning and resources.

In a context where many doctors are still uninformed about basic sexual health for gay men, never mind PrEP, it takes courage for gay men to bring it up with their doctors and make plans to access it.

Accessing PrEP means one must go for regular HIV testing (you can only be on PrEP if you are HIV-negative). A person who is diligent and courageous in protecting their health is hardly “reckless”.

Further, there has been a bevy of studies that show that PrEP is protective against HIV with or without condoms, and that if someone is HIV-positive and virologically suppressed, they do not transmit HIV. The concept of “recklessness” must change as we learn new ways of preventing HIV transmission.

The claim that there is a spike in sexually transmitted infections (STIs) among young people on PrEP has no basis in data.

In South Africa, there are not enough people on PrEP to draw that conclusion (or at least not enough people whose STI burden we can measure). Further, in settings where STIs among gay men are on the increase, it is not clear that this increase is attributable to expanding PrEP use, or whether STIs are increasing for other reasons.

Large-scale PrEP trials certainly have not found that people who are on PrEP increase their sexual risk. On the contrary, it has been the people who know that they are already at higher risk for HIV who have opted to take PrEP to manage their risk.

Finally, we make a critical omission when we speak about a potential spike in STIs without speaking about the fact that the STIs in question are largely curable, or at least much easier to manage than HIV.

If, as a by-product of protecting people against HIV infection, we end up with more cases of curable STIs, we would still be having a positive effect on people’s lives.

Contracting HIV is no longer a death sentence, but it is a chronic condition that requires strict adherence to the regime of taking daily medication and making regular clinic visits for the rest of one’s life.

In a time when the global HIV epidemic is raging among gay and bisexual men, it is reckless to stigmatise new prevention technologies and the users of these technologies.

It is especially reckless in the South African context to spread misinformation about HIV.

It is not gay men on PrEP who are playing with fire, it is the author of this article and the editors who approved it.

It feels like slut-shaming

Ben van Heerden (via email)

I’m writing in response to an article published on Sunday, March 5 2017, headlined Playing with Fire.

The article is about “reckless sexual behaviour among gay teens and men who are increasingly ditching their condoms, believing their preventive HIV medication will protect them”.

There are several issues with the article:

1. There are not enough people on pre-exposure prophylaxis (PrEP) to draw the conclusion that its use encourages promiscuity. The evidence presented is anecdotal.

2. Even assuming PrEP use does encourage promiscuity, it’s illogical to argue that its use increases the risk exposure of users. By its very design, PrEP reduces the risk of HIV. Of course, there are other ways of reducing risk, like abstaining altogether.

But seriously, this is like arguing that the use of seat belts in cars encourages more driving, thereby increasing risk exposure.

Seat belts, like PrEP, are designed to reduce risk, not increase it. Sure, you can elect to walk (or masturbate), but what about people who want to drive/have sex?

Since there is no logic in this argument, I think it’s coming from a position of moral superiority, as if there is something inherently immoral about promiscuous sex.

It’s sex between two consenting adults, who are taking active steps to reduce their risk exposure. There’s absolutely nothing immoral about this.

3. Lastly, PrEP users are taking active steps to manage their sex lives and their risk exposure. The easy/stupid thing to do would be to simply have unprotected sex without PrEP. It’s cruel to judge people who are taking active control in this way. It feels a lot like slut-shaming.

Stop Missing the Point: Sex Ed Is a Human Right

2017-03-07

Ensuring that all people—and especially young people—have a complete and accurate understanding of how sexuality can shape and affect us is a necessary and moral thing to do.

I’m going to pose an awkward truth: When it comes to sex ed in the United States, supporters and critics alike are missing the point.

Sexuality is a fundamental part of who we are; to deny that is to deny a person’s humanity. That’s why we, as sexual and reproductive health, rights, and justice advocates, must promote sex ed not just as a health need but as a human right. Ensuring that all people—and especially young people—have a complete and accurate understanding of how this core part of our identities can shape and affect us is a necessary and moral thing to do.

Right now, in the United States, too much of the sex ed conversation, instruction (both inside and outside of schools), and funding focuses on risk reduction, as in disease or pregnancy prevention. While promoting medically accurate information about contraception, pregnancy, and sexually transmitted infections (STIs) is critical, it’s not the full A to Zs of sexuality education. That full range includes key components of health and well-being such as being able to communicate needs, wants, and desires; developing relationships with people; setting boundaries; and learning that you have a right to be treated with dignity and respect, no matter your identity.

So how can we ensure young people receive what they need and have a right to? Fortunately, comprehensive sexuality education (CSE), a framework developed more than 25 years ago with the publication of the first Sexuality Information and Education Council of the United States (SIECUS) Guidelines for Comprehensive Sexuality Education: Kindergarten–12th Grade and further fleshed out by the National Sexuality Education Standards: Core Content and Skills, K–12, provide a roadmap.

With CSE, young people are provided medically accurate instruction—which is appropriate based on age, development, and culture—throughout their K–12 school years. Curricula adhering to the minimum criteria outlined in the National Sexuality Education Standards incorporate aspects of sexuality that go beyond sexual health or even sexual behaviors like using condoms and contraception, and yes—of course—abstinence. It’s a holistic approach to learning about your body; about different ways of communicating and establishing relationships of all kinds with peers, partners, parents, and society; and about having autonomy to assess and challenge the injustices that our culture perpetuates around sexuality.

Comprehensive sexuality education is a core building block from which to destigmatize reproductive health-care options, including abortion, and support healthy relationships from a position of equity and empowerment. In short, CSE is foundational in developing and sustaining an equitable and just understanding of ourselves and others.

Let’s be clear, comprehensive sexuality education is happening in some of the nearly public 14,000 school districts across the country. In 2015, California passed the Healthy Youth Act, which requires elements of CSE from middle school onwards. And last year, the Omaha Public Schools district adopted new standards for sex education for middle and high school students.

This patchwork approach, however, leaves far too many young people without access to even the most basic information about sexuality.

National leadership eliminating abstinence-only funding once and for all and supporting comprehensive sexuality education in schools would go a long way toward ensuring the rights of the about 50 million young people in public schools today.

Unfortunately, for far too long, proponents of abstinence-only programs have perpetuated a “just say no” agenda supported by more than $2 billion in federal funding since 1982. For 35 years, the predominant federal (and often state) approach to sex ed has been ideologically driven, shaming and stigmatizing sexuality, whether we are discussing the act of sex itself or a broader understanding of our sexual identities. Not surprisingly, this perspective that sex is dangerous has affected how some parents, educators, policymakers, and advocates have approached discussions about sexuality for young people. Despite progress that was made under the Obama administration in the establishment of funding streams for research-based programs to support adolescent sexual health, which can include sex ed, the perception of sex and sexuality as a risk to young people also enabled a 55 percent increase in abstinence-only funding last year alone.

Now, the threat of a continued resurgence of abstinence-only programs in place of sex ed is all too realunder this administration and a Republican-controlled Congress. By driving funding toward these shaming and stigmatizing programs, the federal government helps perpetuate harmful ideas about young people and sexuality.

Abstinence-only programs not only dictate particular choices to young people (no sex until marriage, only heterosexual marriage can be considered marriage, you’re “damaged goods” if you have sex, getting pregnant as a teen condemns you to a life of poverty, etc.) without regard to their lived experiences, they also perpetuate the endorsement of ideological over educational content. Program content that intentionally or inherently withholds or misconstrues information is not education.

And while all the right phrases are turning up in newer abstinence-only promotional materials, terms like “healthy relationships” and “communication skills” all come back to saying “no” to sexual activity before marriage. These programs are not talking about bodily autonomy, consent, or condom use negotiation, but rather reinforce stereotypically gendered, queer-excluding narratives about sex.

Particularly troubling, abstinence-only programs treat pregnancy as the worst thing that could possibly happen to a young person, with proponents and even federal funding promoting the prescriptive “success sequencing for poverty prevention” (i.e. graduate from high school, get a job, get married, then have children). Perhaps not surprising to many of us, this pathway to “success” generally only holds true if you’re white.

So much of what is ignored in abstinence-only programs is centered around systemic inequities that people of color, those with low-incomes, LGBTQIA+ individuals, and other marginalized communities face. Abstinence-only programs—and, to a greater extent than should make sex ed advocates comfortable, disease and pregnancy prevention evidence-based programs—expect a young person to ignore their whole self and their lived experience to get information in a vacuum.

On the other hand, comprehensive sexuality education addresses a young person’s lived experience and says “I see you. All of you. And you deserve to be treated with dignity and respect so that you can live a healthy, fulfilled life that is right for you.”

If we’re going to make the kind of progress we need at local, state, and federal levels in preventing the spread of abstinence-only programs and encouraging the adoption of comprehensive sexuality education, we as sexual and reproductive health, rights, and justice advocates and activists must embrace this truth: Sexuality education is a human right. It’s time we start fighting for it.