A “Bloody” Tradition

GWMCHstudents

I just wept, and called out to my mother for help. But the worst shock of all was when I looked around and found her standing by my side. Yes. It was her, I wasn’t mistaken.

I just wept, and called out to my mother for help. But the worst shock of all was when I looked around and found her standing by my side. Yes. It was her, I wasn’t mistaken. In flesh and blood, right in the midst of these strangers, talking to them and smiling at them as though they had not participated in slaughtering her daughter just a few minutes ago. Now we know where the tragedy lies. We are born of a special sex, the female sex. ” These are the words of El-Salami, one of the 3 million girls who fall victim to “Female Genital Mutilation” every year.

Violence against women and girls is one of the most widespread violations of human rights. It can include physical, sexual, psychological and economic abuse, and it cuts across boundaries of age, race, culture, wealth and geography. Female Genital Mutilation (FGM) or Circumcision is an extreme case of all these violations, where the suffering lasts a life-time. Often performed without anesthetic under septic/aseptic conditions by lay practitioners with little or no knowledge of human anatomy or medicine, female circumcision can cause death or permanent health problems as well as severe pain. Despite these grave risks, its practitioners look on it as an integral part of their cultural and ethnic identity, and some perceive it as a religious obligation. Between 100 million and 140 million women, mostly in 28 African and Middle Eastern countries, and others living as immigrants in Australia, Canada, Europe, New Zealand and the USA have experienced genital mutilation. This ancient practice contrary to popular belief is not encouraged by any religion. A recent lunch time discussion on migration and health came as a surprise to me. It is evident that not many individuals living outside this tradition are aware of its consequences.

Female Circumcision is a matter of universal concern. FGM is done by partial or total removal of the clitoris, partial or total removal of the clitoris and the labia minora (the lips that surround the vagina), and narrowing of the vaginal opening through the creation of a covering seal. They form the seal by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris. This leaves an opening that may be as small as a matchstick for the passage of urine and menstrual blood. This apathetic mutilation of female genitalia has severe consequences. Even the less extensive types of genital cutting can lead to potentially fatal complications, such as hemorrhage, infection and shock. The inability to pass urine because of pain, swelling and inflammation following the operation may lead to urinary tract infection. A woman may suffer from abscesses and pain from damaged nerve endings long after the initial wound has healed.

Infibulation or sealing off vaginal opening is particularly likely to cause long-term health problems. Because the urethral opening is covered, repeated urinary tract infections are common, and stones may form in the urethra and bladder because of obstruction and infection. Without deinfibulation before childbirth, obstructed labor may occur, causing life-threatening complications for both mother and infant, and hence a woman’s infibulation scar may be cut and resewn many times during her reproductive years. In addition, the amputation of the clitoris and other sensitive tissue reduces a woman’s ability to experience sexual pleasure. Despite the fact that FGM causes pain and suffering to millions of women and girls and can be life-threatening, it remains deeply entrenched in certain social value systems.

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It is important to understand that no social problem is isolated. It exists in harmonium with the elements in ecology. Efforts to eliminate female genital mutilation have often been unsuccessful because opponents of the practice ignored its social and economic context. In societies where people cannot read or write, what is the point of telling them about infection and hemorrhage? We cannot fight the practice just by invoking the health risks or legal arguments. We have to adopt a cultural approach to addressing this barbaric tradition.  Empowerment and awareness have to start from an individual and extend to the society as a whole. Also patriarchal authority and control of female sexuality and fertility in these societies is highly prevalent. Hence, designing prevention strategies to involve men have utmost importance. Religious leaders can play an important role in eliminating the misconceptions held by the public. It is critical to clarify that no religion encourages and accepts FGM. Political commitment is important too. Unless the government is committed, it will not be possible to enforce the law and to penalize those who perform the procedure. Changing this reality to bring about positive and protective social behavior requires a holistic and integrated approach. There is no clear enemy in this war against FGM. But all this time, I just had one thought in my head. In spite of all the social pressure and opposition, why would any women/mother, want to circumcise her daughter?

Vishnu Priya Navuluri


Roundups Sexual Health

This Week in Sex: Women Want More Sex Than Men Think, and Who Needs a $15K Vibrator?

Martha Kempner

This week, there's not enough of an important syphilis drug to go around, a new study shows that men don't know how much sex their female partners want, a beer company unveils a new same-sex marriage ad, and a sex toy recommended by Gwyneth Paltrow's website is gold (literally).

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Temporary Penicillin Shortage Could Be Dangerous for Pregnant Women with Syphilis

The development of antibiotics in the 1940s ushered in a new era in which bacterial infections—including syphilis, one of the oldest sexually transmitted infections (STIs)—could be treated or cured. With that came the ability to prevent congenital syphilis, which occurs when a pregnant woman passes the bacteria to her infant. Congenital syphilis can cause miscarriage, stillbirth, severe illness in the infant, and even early infant death. And, as Rewire recently reported, it is on the rise; between 2012 and 2014, there was a 38 percent increase in the rate of congenital syphilis.

The good news is that if a pregnant woman is treated with an antibiotic at least 30 days before giving birth, there is a 98 percent cure rate, meaning her infant would not be born infected. The bad news is that, until next month, there is a shortage of the one antibiotic approved for treating syphilis in pregnant women.

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Bicillin L-A, an injectable form of penicillin that is also used to treat other infections such as strep throat, is manufactured by Pfizer. The company said in April that it was experiencing “an unanticipated delay in manufacturing,” and that it would be shipping just 30 percent of the usual supply until July.

Typically, pregnant women are tested for syphilis during their first prenatal visit. If infected, they are treated with three injections of Bicillin L-A. In an attempt to keep these routine “test and treat” efforts going despite the shortage, the Centers for Disease Control and Prevention (CDC) has asked that health-care providers refrain from prescribing Bicillin L-A for any infection other than syphilis if other treatments are available.

Supply issues are unfortunately common in the pharmaceutical industry. NPR explains that generic, injectable drugs—like Bicillin L-A—are particularly susceptible to shortages because they are difficult to make but cheap to purchase, meaning few drug companies manufacture them. If those companies experience a difficulty in manufacturing that forces them to shut down temporarily, such as rust in the equipment or mold in the factory, there is no other supplier to pick up the slack.

Luckily, Pfizer expects to be back to full capacity on Bicillin L-A by July, which will help make sure there are no disruptions to efforts to prevent congenital syphilis. This is particularly important given the number of cases that have been seen in recent years and the seriousness of the outcomes. In 2014, there were 438 nationwide cases of congenital syphilis, which led to 25 stillbirths and eight deaths within 30 days of birth.

Women Want More Sex than Their Male Partners Think

There is an enduring myth that men always want sex and women, well, not so much. It turns out that women in long-term relationships with men want more sex than their partners realize. To determine if perception and reality differed, researchers conducted three studies with couples—44 couples in the first study, 84 in the second, and 101 in the third. All but ten were opposite-sex couples.

Though questions varied according to the study, each participant was asked to keep a diary that recorded some combination of the following factors: their own sexual desire; relationship satisfaction; commitment to their partner; and their perception of their partner’s sexual desire, relationship satisfaction, and commitment. Couples were also asked to keep a log of their sexual activity. Couples in the third study were asked to record how motivated they were to avoid sexual rejection on any given day.

While men in the study did report higher levels of sexual desire than their female partners, what was more striking was that across all three studies men consistently underestimated their partner’s desire. The researchers are not sure why men’s perceptions were so frequently off but they have at least two theories.

First, as Amy Muise, the lead author on the study, told Fusion via email it might be about avoiding complacency: “We don’t know exactly what men do when they underperceive, but it’s possible that this keeps them from becoming lazy about maintaining their partner’s interest.”

Alternatively, men may perceive less desire from their partners as a way to avoid sexual rejection. This is supported by the additional finding that men were particularly likely to underestimate their partner’s desire on days when they felt ill-equipped to handle rejection.

Of course, it could just be that men have been trained by every television show, movie, and magazine to believe that women just don’t want sex as much as they do.

No matter where the misperception comes from, the results of this study once again point out how important it is for couples to communicate openly and honestly about what they want and how often they want it.

Bud Light Ad Celebrates Same-Sex Marriage

While Budweiser ads of the past seem to have mostly celebrated bikini-clad women and Clydesdale horses, a new ad released in honor of LGBT Pride Month takes a big turn for the beer company. The ad depicts scenes of a wedding and features actor Seth Rogan and comedienne Amy Schumer leading a beer-bottle toast to the groom and the groom.

The company said in a press release: “June is the height of wedding season, and it is also LGBT Pride [M]onth in America. That’s why right now is the time to spark a national conversation by celebrating every kind of wedding—and everyone’s right to marry whoever they choose.”

The ad was released in partnership with Ellen DeGeneres and first appeared on her social media channels. The company will continue to air the ad on social media and plans a primetime television airing as well.

Gwyneth Paltrow’s Goop Suggests a Gold-Plated Vibrator

You may remember when Goop, the lifestyle site launched by Oscar-winning actress Gwyneth Paltrow, suggested steam-cleaning vaginas with the herb multwort, a practice that was roundly criticized by experts as unnecessary (the vagina cleans itself) and potentially dangerous (steam is hot). Goop made news again recently with a sexual-health suggestion that may be good for vaginas, but not so great for bank accounts.

Suggested on the website’s list of favorite sex toys was the LELO INEZ, a 24-karat gold vibrator that costs $15,000. Other pricey toys included a whip for $535 and a vibrating necklace for $395.

We here at This Week in Sex are all for sex toys. But we want to assure you that there a lot of good sex toys out there that won’t break the bank. You should be able to find some reliable toys for between $35 and $65 and even less, if you want to visit a local pharmacy and find vibrating rings (which, as an added bonus, are often packaged with a condom).

Commentary Sexual Health

Fewer Young People Are Getting Formal Sex Education, But Can a New Federal Bill Change That?

Martha Kempner

Though the Real Education for Healthy Youth Act has little chance of passing Congress, its inclusive and evidence-based approach is a much-needed antidote to years of publicly funded abstinence-only-until-marriage programs, which may have contributed to troubling declines in youth knowledge about sexual and reproductive health.

Recent research from the Guttmacher Institute finds there have been significant changes in sexuality education during the last decade—and not for the better.

Fewer young people are receiving “formal sex education,” meaning classes that take place in schools, youth centers, churches, or community settings. And parents are not necessarily picking up the slack. This does not surprise sexuality education advocates, who say shrinking resources and restrictive public policies have pushed comprehensive programs—ones that address sexual health and contraception, among other topics—out of the classroom, while continued funding for abstinence-only-until-marriage programs has allowed uninformative ones to remain.

But just a week before this research was released in April, Sen. Cory Booker (D-NJ) introduced the Real Education for Healthy Youth Act (REHYA). If passed, REHYA would allocate federal funding for accurate, unbiased sexuality education programs that meet strict content requirements. More importantly, it would lay out a vision of what sexuality education could and should be.

Can this act ensure that more young people get high-quality sexuality education?

In the short term: No. Based on the track record of our current Congress, it has little chance of passing. But in the long run, absolutely.

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Less Sexuality Education Today

The Guttmacher Institute’s new study compared data from two rounds of a national survey in the years 2006-2010 and 2011-2013. It found that even the least controversial topics in sex education—sexually transmitted diseases (STDs) and HIV and AIDS—are taught less today than a few years ago. The proportion of young women taught about STDs declined from 94 percent to 90 percent between the two time periods, and young women taught about HIV and AIDS declined from 89 percent to 86 percent during the same period.

While it may seem like a lot of young people are still learning about these potential consequences of unprotected sex, few are learning how to prevent them. In the 2011-2013 survey, only 50 percent of teen girls and 58 percent of teen boys had received formal instruction about how to use a condom before they turned 18. And the percentage of teens who reported receiving formal education about birth control in general decreased from 70 percent to 60 percent among girls and from 61 percent to 55 percent among boys.

One of the only things that did increase was the percentage of teen girls (from 22 percent to 28 percent) and boys (from 29 to 35 percent) who said they got instruction on “how to say no to sex”—but no corresponding instruction on birth control.

Unfortunately, many parents do not appear to be stepping in to fill the gap left by formal education. The study found that while there’s been a decline in formal education, there has been little change in the number of kids who say they’ve spoken to their parents about birth control.

Debra Hauser, president of Advocates for Youth, told Rewire that this can lead to a dangerous situation: “In the face of declining formal education and little discussion from their parents, young people are left to fend for themselves, often turning to their friends or the internet-either of which can be fraught with trouble.”

The study makes it very clear that we are leaving young people unprepared to make responsible decisions about sex. When they do receive education, it isn’t always timely: It found that in 2011-2013, 43 percent of teen females and 57 percent of teen males did not receive information about birth control before they had sex for the first time.

It could be tempting to argue that the situation is not actually dire because teen pregnancy rates are at a historic low, potentially suggesting that young people can make do without formal sex education or even parental advice. Such an argument would be a mistake. Teen pregnancy rates are dropping for a variety of reasons, but mostly because because teens are using contraception more frequently and more effectively. And while that is great news, it is insufficient.

Our goals in providing sex education have to go farther than getting young people to their 18th or 21st birthday without a pregnancy. We should be working to ensure that young people grow up to be sexually healthy adults who have safe and satisfying relationships for their whole lives.

But for anyone who needs an alarming statistic to prove that comprehensive sex education is still necessary, here’s one: Adolescents make up just one quarter of the population, but the Centers for Disease Control and Prevention estimate they account for more than half of the 20 million new sexually transmitted infections (STIs) that occur each year in this country.

The Real Education for Healthy Youth Act

The best news about the REHYA is that it takes a very broad approach to sexuality education, provides a noble vision of what young people should learn, and seems to understand that changes should take place not just in K-12 education but through professional development opportunities as well.

As Advocates for Youth explains, if passed, REHYA would be the first federal legislation to ever recognize young people’s right to sexual health information. It would allocate funding for education that includes a wide range of topics, including communication and decision-making skills; safe and healthy relationships; and preventing unintended pregnancy, HIV, other STIs, dating violence, sexual assault, bullying, and harassment.

In addition, it would require all funded programs to be inclusive of lesbian, gay, bisexual, and transgender students and to meet the needs of young people who are sexually active as well as those who are not. The grants could also be used for adolescents and young adults in institutes of higher education. Finally, the bill recognizes the importance of teacher training and provides resources to prepare sex education instructors.

If we look at the federal government’s role as leading by example, then REHYA is a great start. It sets forth a plan, starts a conversation, and moves us away from decades of focusing on disproven abstinence-only-until-marriage programs. In fact, one of the fun parts of this new bill is that it diverts funding from the Title V program, which received $75 million dollars in Fiscal Year 2016. That funding has supported programs that stick to a strict eight-point definition of “abstinence education” (often called the “A-H definition”) that, among other things, tells young people that sex outside of marriage is against societal norms and likely to have harmful physical and psychological effects.

The federal government does not make rules on what can and cannot be taught in classrooms outside of those programs it funds. Broad decisions about topics are made by each state, while more granular decisions—such as what curriculum to use or videos to show—are made by local school districts. But the growth of the abstinence-only-until-marriage approach and the industry that spread it, researchers say, was partially due to federal funding and the government’s “stamp of approval.”

Heather Boonstra, director of public policy at the Guttmacher Institute and a co-author of its study, told Rewire: “My sense is that [government endorsement] really spurred the proliferation of a whole industry and gave legitimacy—and still does—to this very narrow approach.”

The money—$1.5 billion total between 1996 and 2010—was, of course, at the heart of a lot of that growth. School districts, community-based organizations, and faith-based institutions created programs using federal and state money. And a network of abstinence-only-until-marriage organizations grew up to provide the curricula and materials these programs needed. But the reach was broader than that: A number of states changed the rules governing sex education to insist that schools stress abstinence. Some even quoted all or part of the A-H definition in their state laws.

REHYA would provide less money to comprehensive education than the abstinence-only-until-marriage funding streams did to their respective programs, but most advocates agree that it is important nonetheless. As Jesseca Boyer, vice president at the Sexuality Information and Education Council of the United States (SIECUS), told Rewire, “It establishes a vision of what the government could do in terms of supporting sex education.”

Boonstra noted that by providing the model for good programs and some money that would help organizations develop materials for those programs, REHYA could have a broader reach than just the programs it would directly fund.

The advocates Rewire spoke with agree on something else, as well: REHYA has very little chance of passing in this Congress. But they’re not deterred. Even if it doesn’t become law this year, or next, it is moving the pendulum back toward the comprehensive approach to sex education that our young people need.

CORRECTION: This article has been updated to clarify Jesseca Boyer’s position at the Sexuality Information and Education Council of the United States.