Strategies for Staying Sexual After Menopause

Rebecca Chalker

Women's health advocates vigorously question unrealistic projections for sexuality and aging - bleak sexual desert or pharmaceutical Niagara - and have identified helpful strategies for maintaining and enhancing sexuality after menopause.

This article was first published in the Women’s Health Activist.

When was the last time you
heard a joke suggesting that sex invariably goes ever downhill or totally
crashes after menopause? Like yesterday? This concept was boldly reaffirmed – without
reference to reliable research – at a conference on menopause held by
the National Institutes of Health in 2005! So, if you ask your doctor
about sex after menopause, she or he will likely agree that the outlook
is gloomy. On the flip side, the golden-years myth is heavily promoted
by TV ads for erection drugs, which portray the "Cialis woman" always
blissfully ready for intercourse whenever her partner drops a pill. 

Fortunately, women’s health
advocates, sexologists, and researchers vigorously question these equally
unrealistic projections for sexuality and aging – of a bleak sexual
desert or a pharmaceutical Niagara – and have identified numerous helpful
strategies for maintaining and enhancing sexuality after menopause.
Here’s a survey of some of the most common problems and strategies
to help make sex during this life phase more comfortable and rewarding. 

Vaginal Dryness 

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By far the most common sexual
problem that women report in their post-reproductive years is dyspareunia – pain
or discomfort during or after intercourse or insertion of fingers or
sex toys into the vagina. After menopause, reduced levels of the hormones
estrogen and progesterone result in less natural lubrication that may
result in bleeding, tightening of the vaginal opening, and/or narrowing
and shortening of the vagina. All of these can make intercourse uncomfortable
or even intolerable. 

Solutions: Many women and sex
therapists report the reality of the use-it-or-lose-it factor: regular
sex, either with a partner, through masturbation, or a combination of
the two, definitely helps keep vaginal tissues more supple and moist.
Extended sex play before insertion is always helpful even if discomfort
isn’t severe. Liberal use of a water soluble lubricant is often enough
to make intercourse more comfortable. Having intercourse after a long
time without it can be painful or impossible, but don’t give up. You
may need to work up to it. Over a few weeks, the vaginal opening can
be comfortably stretched using lubricants and successively larger blunt
objects such as vibrators or dildos, or a set of vaginal dilators (available
without a prescription at medical supply stores). Alternatively, daily
use of nonprescription Replens (a nonhormonal lubricant) may provide
sufficient relief. Some women turn to medical treatment and use a small
amount of low dose estrogen cream applied at the opening and inside
of the vagina. Women who have a personal plastic speculum may find looking
inside the vagina helpful to assess the normal appearance of vaginal
tissues and to monitor response to self-help or medical remedies. You
can order a speculum from the Feminist
Women’s Health Centers

Low or Absent Sexual Desire 

Many older women also report
slower response to mental or physical sexual stimulation; a longer time
to become sufficiently aroused; or, in severe cases, a total lack of
interest in or revulsion to sex. Decreased interest in sex may be temporary
or long term, but surgical removal of the ovaries (due to cancer, endometriosis,
uterine prolapse, or other reasons) can cause these changes to be sudden
and sometimes devastating. Numerous drugs, especially selective serotonin
reuptake inhibitors (SSRIs), are known to cause reduced sexual interest.
On top of this, the lower systemic availability of testosterone, the
key promoter of desire in both women and men, can cause less interest
in sex. 

Solutions: First, ask your
doctor to review all of your medications and discontinue any that are
not essential. For certain medications, taking a "drug holiday"
on weekends, or for a few days during a vacation, can be helpful if
your doctor approves. The SSRI citalopram (Celexa) is reported to have
a lower negative impact on desire, so switching to it may be an option.
If you have a partner, it’s important to talk about lower sexual interest
so that he or she does not feel that sexual coolness is personal. In
addition, you can use any of the suggestions in Strategies for Staying
Sexual, below. 

Urinary Incontinence 

Involuntary loss of urine can
occur at any age but, after the age of sixty-five, 10 percent of the
population experiences mild to severe leakage. There are different types
of incontinence, but by far the most common in women is stress or "giggle"
incontinence, in which sudden movements or vigorous activity – such
as sex – can result in leaks. Urinary leaks can be disconcerting, and
the possibility of this happening during sex can cause some women to
avoid partner sex altogether. Primary causes of urinary incontinence
include changes in bladder position after vaginal childbirth, lax pelvic
muscle tone, involuntary bladder contractions (called "overactive
bladder"), the usage of some medications, and pelvic surgery (especially
hysterectomy). 

Solutions: The gold standard
of incontinence treatment is pelvic floor muscle exercises, commonly
called "Kegel exercises," after Dr. Arnold Kegel, who researched
and popularized them in the 1950s. Doing these exercises several times
a day may be all that is needed to check surprise leaks. A common myth
is that Kegels don’t work. They do, especially for mild to moderate
urine loss. And the huge plus of well toned genital muscles is the possibility
of having more intense orgasms! If doing Kegels on your own does not
improve continence, a biofeedback program can be very effective in strengthening
continence muscles and monitoring progress. (Sometimes biofeedback is
covered by insurance.) Biofeedback can be combined with bladder retraining,
which helps you hold urine comfortably for longer periods of time. In
addition, several medications are available to control overactive bladders. 

Pelvic Surgery 

Pelvic surgery can result in
a host of dramatic changes in sexuality. This is particularly true for
hysterectomy, especially if one or both of the ovaries are removed.
Cancer is the only absolute medical indication for surgical removal
of the uterus and/or ovaries, so if your doctor recommends hysterectomy
for any other reason, definitely seek a second opinion. Until recently,
hysterectomy was the recommended remedy for uterine fibroids, but newer
techniques are now available that preserve the uterus. (See the National Women’s
Health Network’s fibroids fact sheet
.)
Sexual changes associated with hysterectomy, as with menopause in general,
may include vaginal dryness, reduced or lost sexual desire, noticeable
changes in time to orgasm, less intense orgasms, and loss of ability
to have multiple orgasms. 

Solutions: See the suggestions
for alleviating vaginal dryness and loss of desire noted above and Strategies
for Staying Sexual, below. 

Strategies for Staying Sexual 

In addition to the techniques
suggested here, many women use a variety of self-help solutions to enhance
their interest in, and comfort during, sex. Heterosexual women and lesbians
certainly have the same problems, but lesbians may find it easier to
negotiate solutions because their partners may have similar issues.
If intercourse is painful and/or male partners don’t get erections
readily, consider taking the focus of sex off of intercourse and indulge
in the much heralded pleasures of outercourse, which includes every
sexual activity except penis-in-vagina sex. If orgasm isn’t as reliable
as before, why not make pleasure the goal of sex rather than orgasm?
Sex therapist JoAnn Loulan asserts that sex should begin with willingness
and end with pleasure, with or without orgasm in between. It’s the
brain, anyway, not the genitals, that’s the chief sex organ, so starting
there should be key to sexual enhancement. Rewarding sex can be as simple
as cuddling, trading sensual massages, sharing fantasies, genital stroking,
or watching or reading erotica alone or together. If the genitals respond
to such activities, whether or not they are touched, it’s still sex!

Many sex therapists recommend the use of filmed or written erotica to
encourage sexual interest, and erotic material is readily available
for every taste and interest. In addition, there is a wealth of sexuality
self-help material in books, magazines, and on the Internet. My personal
favorites are sexual techniques based on the ancient Asian traditions
of Tantra and Tao, which take the focus off of the genitals and use
ritual, extended sex play, and full body sexual stimulation to create
more intense sexual response. Books and workshops by Margot Anand are
particularly popular. For those with more serious disability issues,
there are several excellent books on sex and disability; you might start
with The
Ultimate Guide to Sex and Disability: For All of Us Who Live with Disabilities,
Chronic Pain, and Illness

Masturbation: Masturbation
isn’t just a crutch to use in place of partner sex. It is a self-affirming
sexual activity and is eminently useful in helping to discover different
routes to sexual pleasure. In national studies, up to 40 percent of
women report that they masturbate on a regular basis, but this incidence
may be lower for older women. Many older women may remember being discouraged
(or even punished) for masturbating as children, and may still be reluctant
to engage in this pleasurable sexual activity. Ultrasound images have
captured male and female fetuses masturbating in the uterus; these images
confirm that masturbation is an innate and entirely normal part of sex! 

Safer Sex: The explicit truth
is: regardless of age, in partner sex, we are all at some risk for contracting
a sexually transmitted infection (STI), including HIV/AIDS. In fact,
one in ten people diagnosed with AIDS in the United States are over
the age of fifty (although transmission rates are much lower among lesbians
than among gay men and heterosexuals). Discuss a new partner’s sexual
history, keep condoms handy, and don’t take any risks. Outercourse,
as described above, greatly reduces the risk of STIs, without reducing
pleasure. 

Websites: Countless websites
devoted to sex and aging provide information on every conceivable topic.
Long time NWHN member Betty Dodson, a very youthful eighty, is celebrating
forty years of helping women explore and enhance their sexuality. Recently,
Dodson teamed up with Carlin Ross to build a new interactive
website
that provides
resources on a wide array of topics. Dodson also appears in Still Doing It:
The Intimate Lives of Women Over Sixty
,
a film and book of the same title by Deirdre Fishel and Diana Holtzberg. 

Women-friendly Sexuality Boutiques:
Incorporating sex toys, especially vibrators, into masturbation or partner
sex can be extremely helpful in altering sexual routines. All sexuality
boutiques have extensive online and printed catalogs to enable shopping
in the privacy of one’s own home. For a start, Babeland, Good
Vibrations
, and Eve’s Garden have especially wide selections. 

Sex Therapy: If these strategies
aren’t sufficient, you might consider seeing a sex therapist. One
source for a trained therapist in your area is American Association
of Sexuality Educators, Counselors and Therapists
‘ website. Your therapist can help
you sort through feelings about sex and aging, issues with a partner,
or medical conditions that impact on sex, and she or he can make additional
suggestions about how to cope with other problems and can suggest additional
strategies for staying sexual. 

Life Changes that Impact
Sexuality
 

Clearly, there are many ways
to cushion or fix the physical changes that may occur after menopause.
But truth be told, changes in relationships, as well as complex life
situations caused by diminished income, divorce, illness, or death can
be vexing and more difficult to resolve. Such changes can deprive us
of the comforts and intimacy afforded by sex in a long term relationship,
or for many women, they might provide the opportunity to explore new
sexual possibilities where rewarding sex has been lacking. 

"Good sex" is different
for many people and in later years, many are happy to say goodbye to
the hormone driven sex of their youth and live with "good enough"
sex that focuses on emotional and quiet physical pleasures, which may
or may not include orgasm. The key here is to identify what is pleasurable
for you and then look at what is possible given your situation. 

Traditionally, "sex" has
been defined as heterosexual intercourse, but feminists and sex educators
have successfully redefined sex to include any activity that results
in sexual pleasure. With a partner, as noted above, we always have cuddling,
petting, kissing, sharing fantasies and stories, bathing together, dancing,
even dressing up and playing games! And don’t forget about adding
sex toys to your repertoire.  

For those who are single (I
like to think of it as "independent"), the possibilities for new
connections and friendships are there for the asking. Joining an interest
group is an easy way to slip into a new social current. Take a class.
If you can afford it, take a cruise. Volunteer! Visit a larger congregation.
Others in similar situations are seeking partnerships too! 

If fetuses can masturbate in
the uterus, and we know that they do, then, at the most basic level,
we are sexual throughout our lives. Sexuality is a part of our humanity;
it’s why we are here today. Menopause may reduce our reproductive
hormones, but it does not rob us of our sexuality. It’s still there
to be relished, enjoyed, and, perhaps, shared.

Culture & Conversation Media

Filmmaker Tracy Droz Tragos Centers Abortion Stories in New Documentary

Renee Bracey Sherman

The film arrives at a time when personal stories are center stage in the national conversation about abortion, including in the most recent Supreme Court decision, and rightly so. The people who actually have and provide abortions should be driving the narrative, not misinformation and political rhetoric.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

A new film by producer and director Tracy Droz Tragos, Abortion: Stories Women Tell, profiles several Missouri residents who are forced to drive across the Mississippi River into Illinois for abortion care.

The 93-minute film features interviews with over 20 women who have had or are having abortions, most of whom are Missouri residents traveling to the Hope Clinic in Granite City, Illinois, which is located about 15 minutes from downtown St. Louis.

Like Mississippi, North Dakota, South Dakota, and Wyoming, Missouri has only one abortion clinic in the entire state.

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The women share their experiences, painting a more nuanced picture that shows why one in three women of reproductive age often seek abortion care in the United States.

The film arrives at a time when personal stories are center stage in the national conversation about abortion, including in the most recent U.S. Supreme Court decision, and rightly so. The people who actually have and provide abortions should be driving the narrative, not misinformation and political rhetoric. But while I commend recent efforts by filmmakers like Droz Tragos and others to center abortion stories in their projects, these creators still have far to go when it comes to presenting a truly diverse cadre of storytellers if they really want to shift the conversation around abortion and break down reproductive stigma.

In the wake of Texas’ omnibus anti-abortion law, which was at the heart of the Whole Woman’s Health v. Hellerstedt Supreme Court case, Droz Tragos, a Missouri native, said in a press statement she felt compelled to document how her home state has been eroding access to reproductive health care. In total, Droz Tragos interviewed 81 people with a spectrum of experiences to show viewers a fuller picture of the barriersincluding legislation and stigmathat affect people seeking abortion care.

Similar to HBO documentaries about abortion that have come before it—including 12th & Delaware and Abortion: Desperate ChoicesAbortion: Stories Women Tell involves short interviews with women who are having and have had abortions, conversations with the staff of the Hope Clinic about why they do the work they do, interviews with local anti-choice organizers, and footage of anti-choice protesters shouting at patients, along with beautiful shots of the Midwest landscape and the Mississippi River as patients make road trips to appointments. There are scenes of clinic escorts holding their ground as anti-choice protesters yell Bible passages and obscenities at them. One older clinic escort carries a copy of Living in the Crosshairs as a protester follows her to her car, shouting. The escort later shares her abortion story.

One of the main storytellers, Amie, is a white 30-year-old divorced mother of two living in Boonville, Missouri. She travels over 100 miles each way to the Hope Clinic, and the film chronicles her experience in getting an abortion and follow-up care. Almost two-thirds of people seeking abortions, like Amie, are already a parent. Amie says that the economic challenges of raising her other children make continuing the pregnancy nearly impossible. She describes being physically unable to carry a baby and work her 70 to 90 hours a week. Like many of the storytellers in the film, Amie talks about the internalized stigma she’s feeling, the lack of support she has from loved ones, and the fear of family members finding out. She’s resilient and determined; a powerful voice.

The film also follows Kathy, an anti-choice activist from Bloomfield, Missouri, who says she was “almost aborted,” and that she found her calling in the anti-choice movement when she noticed “Anne” in the middle of the name “Planned Parenthood.” Anne is Kathy’s middle name.

“OK Lord, are you telling me that I need to get in the middle of this?” she recalls thinking.

The filmmakers interview the staff of the Hope Clinic, including Dr. Erin King, a pregnant abortion provider who moved from Chicago to Granite City to provide care and who deals with the all-too-common protesting of her home and workplace. They speak to Barb, a talkative nurse who had an abortion 40 years earlier because her nursing school wouldn’t have let her finish her degree while she was pregnant. And Chi Chi, a security guard at the Hope Clinic who is shown talking back to the protesters judging patients as they walk into the clinic, also shares her abortion story later in the film. These stories remind us that people who have abortions are on the frontlines of this work, fighting to defend access to care.

To address the full spectrum of pregnancy experiences, the film also features the stories of a few who, for various reasons, placed their children for adoption or continued to parent. While the filmmakers interview Alexis, a pregnant Black high school student whose mother died when she was 8 years old, classmates can be heard in the distance tormenting her, asking if she’s on the MTV reality show 16 and Pregnant. She’s visibly distraught and crying, illustrating the “damned if you do, damned if you don’t” conundrum women of color experiencing unintended pregnancy often face.

Te’Aundra, another young Black woman, shares her story of becoming pregnant just as she received a college basketball scholarship. She was forced to turn down the scholarship and sought an adoption, but the adoption agency refused to help her since the child’s father wouldn’t agree to it. She says she would have had an abortion if she could start over again.

While anti-choice rhetoric has conflated adoption as the automatic abortion alternative, research has shown that most seeking adoption are personally debating between adoption and parenting. This is illustrated in Janet’s story, a woman with a drug addiction who was raising one child with her partner, but wasn’t able to raise a second, so she sought an adoption. These stories are examples of the many societal systems failing those who choose adoption or students raising families, in addition to those fighting barriers to abortion access.

At times, the film feels repetitive and disjointed, but the stories are powerful. The range of experiences and reasons for having an abortion (or seeking adoption) bring to life the data points too often ignored by politicians and the media: everything from economic instability and fetal health, to domestic violence and desire to finish an education. The majority of abortion stories featured were shared by those who already had children. Their stories had a recurring theme of loneliness and lack of support from their loved ones and friends at a time when they needed it. Research has shown that 66 percent of people who have abortions tend to only tell 1.24 people about their experience, leaving them keeping a secret for fear of judgment and shame.

While many cite financial issues when paying for abortions or as the reason for not continuing the pregnancy, the film doesn’t go in depth about how the patients come to pay for their abortions—which is something my employer, the National Network for Abortion Funds (NNAF), directly addresses—or the systemic issues that created their financial situations.

However, it brings to light the hypocrisy of our nation, where the invisible hand of our society’s lack of respect for pregnant people and working parents can force people to make pregnancy decisions based on economic situations rather than a desire to be pregnant or parent.

“I’m not just doing this for me” is a common phrase when citing having an abortion for existing or future children.

Overall, the film is moving simply because abortion stories are moving, especially for audiences who don’t have the opportunity to have someone share their abortion story with them personally. I have been sharing my abortion story for five years and hearing someone share their story with me always feels like a gift. I heard parts of my own story in those shared; however, I felt underrepresented in this film that took place partly in my home state of Illinois. While people of color are present in the film in different capacities, a racial analysis around the issues covered in the film is non-existent.

Race is a huge factor when it comes to access to contraception and reproductive health care; over 60 percent of people who have abortions are people of color. Yet, it took 40 minutes for a person of color to share an abortion story. It seemed that five people of color’s abortion stories were shown out of the over 20 stories, but without actual demographic data, I cannot confirm how all the film’s storytellers identify racially. (HBO was not able to provide the demographic data of the storytellers featured in the film by press time.)

It’s true that racism mixed with sexism and abortion stigma make it more difficult for people of color to speak openly about their abortion stories, but continued lack of visual representation perpetuates that cycle. At a time when abortion storytellers themselves, like those of NNAF’s We Testify program, are trying to make more visible a multitude of identities based on race, sexuality, immigration status, ability, and economic status, it’s difficult to give a ringing endorsement of a film that minimizes our stories and relegates us to the second half of a film, or in the cases of some of these identities, nowhere at all. When will we become the central characters that reality and data show that we are?

In July, at the progressive conference Netroots Nation, the film was screened followed by an all-white panel discussion. I remember feeling frustrated at the time, both because of the lack of people of color on the panel and because I had planned on seeing the film before learning about a march led by activists from Hands Up United and the Organization for Black Struggle. There was a moment in which I felt like I had to choose between my Blackness and my abortion experience. I chose my Black womanhood and marched with local activists, who under the Black Lives Matter banner have centered intersectionality. My hope is that soon I won’t have to make these decisions in the fight for abortion rights; a fight where people of color are the backbone whether we’re featured prominently in films or not.

The film highlights the violent rhetoric anti-choice protesters use to demean those seeking abortions, but doesn’t dissect the deeply racist and abhorrent comments, often hurled at patients of color by older white protesters. These racist and sexist comments are what fuel much of the stigma that allows discriminatory laws, such as those banning so-called race- and sex-selective abortions, to flourish.

As I finished the documentary, I remembered a quote Chelsea, a white Christian woman who chose an abortion when her baby’s skull stopped developing above the eyes, said: “Knowing you’re not alone is the most important thing.”

In her case, her pastor supported her and her husband’s decision and prayed over them at the church. She seemed at peace with her decision to seek abortion because she had the support system she desired. Perhaps upon seeing the film, some will realize that all pregnancy decisions can be quite isolating and lonely, and we should show each other a bit more compassion when making them.

My hope is that the film reaches others who’ve had abortions and reminds them that they aren’t alone, whether they see themselves truly represented or not. That we who choose abortion are normal, loved, and supported. And that’s the main point of the film, isn’t it?

Abortion: Stories Women Tell is available in theaters in select cities and will be available on HBO in 2017.

News Health Systems

Anti-Choice Group Files Lawsuit Over Newly Signed Law That Protects Illinois Patients

Michelle D. Anderson

The policy, which is an amendment to the Illinois Health Care Right of Conscience Act, requires physicians and medical facilities to to provide patients upon request with information about their medical circumstances and treatment options consistent with "current standards of medical care," in cases where the doctor or institution won’t offer services on religious grounds.

CORRECTION: This piece has been updated to clarify the scope of SB 1564 and which groups are opposing it.

A conservative Christian legal group has followed through on its threat to use litigation to fight against a new state policy that protects patients at religiously-sponsored hospitals in Illinois.

The Alliance Defending Freedom (ADF) on Friday filed a lawsuit in the Circuit Court of the 17th Judicial Circuit in Winnebago County against Illinois Gov. Bruce Rauner and Bryan A. Schneider, the secretary of the Illinois Department of Financial & Professional Regulation.

Rauner, a Republican, signed the contested policy, SB 1564, into law on July 29.

The ADF, which warned Rauner about signing the bill in a publicized letter and statement in May, filed the complaint on behalf of several fake clinics, also known as crisis pregnancy centers. These included the Pregnancy Care Center of Rockford and Aid for Women, Inc. Anti-choice physician Dr. Anthony Caruso of A Bella Baby OBGYN—also known as Best Care for Women—was also named as a plaintiff.

“Alliance Defending Freedom is ready and willing to represent Illinois pro-life pregnancy centers if SB 1564 becomes law,” the group said in May. The ADF wrote on behalf of several anti-choice groups, claiming SB 1564 violated the Illinois state law and constitution and risked putting federal funding, such as Medicaid reimbursements, in jeopardy.

In February 2015, state Sen. Daniel Biss (D-Skokie) introduced the policy, which is an amendment to the Illinois Health Care Right of Conscience Act.

The revised law requires physicians and medical facilities to provide patients upon request with information about their medical circumstances and treatment options consistent with “current standards of medical care,” in cases where the doctor or institution won’t offer services on religious grounds.

The new policy also gives doctors and medical institutions the option to provide a referral or transfer the patient.

Unlike an earlier version of the legislation, the version passed by Rauner does not require hospitals to confirm that providers they share with patients actually perform procedures the institutions will not perform; they must only have a “reasonable belief” that they do, Rewire previously reported.

As previously noted by Rewire:

Catholic facilities often follow U.S. Conference of Catholic Bishops religious directives that generally bar treatments such as sterilization, in vitro fertilization, and abortion care. The federal Church Amendment and some state laws protect these faith-based objections.

The plaintiffs, which are also being represented by Mauck & Baker LLC attorney Noel Sterett, argued in a statement that the Illinois Constitution protects “liberty of conscience,” and quoted a passage from state law that says “no person shall be denied any civil or political right, privilege or capacity, on account of his religious opinions.”

Illinois Right to Life and the Thomas More Society joined the ADF in protesting the bill. The Catholic Conference of Illinois (CCI) and the Illinois Catholic Health Association (ICHA) initially protested the bill after it was introduced early last year. However, the two groups later negotiated with the ACLU to pass a different version of the bill that was introduced.

In support of the bill around the time of its introduction in early 2015, the American Civil Liberties Union of Illinois pushed its Put Patients First initiative to help stop the use of religion to deny health care to patients. The advocacy group noted that patients who are miscarrying or facing ectopic pregnancies, same-sex couples, and transgender people and persons seeking contraception such as vasectomies and tubal ligations are particularly vulnerable to these harmful practices.

A new study, “Referrals for Services Prohibited in Catholic Health Care Facilities,” set to be published in Perspectives on Sexual and Reproductive Health in September, suggested that Catholic hospitals often “dump” abortion patients and deny them critical referrals as result of following religious directives outlined by the U.S. Conference of Catholic Bishops (USCCB).

Recent figures from an ACLU and MergerWatch advocacy group collaboration suggest Catholic hospitals make up one in six hospital beds nationwide.

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