Roundups Sexual Health

Sexual Health Roundup: Psychiatrist Apologizes for Study on Reparative Therapy, CDC Wants to Test Boomers for Hep-C

Martha Kempner

Sexual Health Round-up: A renowned psychiatrist who is paradoxically responsible for both the biggest advance in gay rights and one of the studies most often used to deny these rights apologizes to the gay community; CDC recommends that everyone ages 47 to 67 be tested for Hep-C; and a new study warns that young men who abuse Viagra (and its cousins) are less satisfied with their sex lives.

Psychiatrist Responsible for Often-Misrepresented Study of Reparative Therapy Apologizes to the Gay Community

The front page of Saturday’s New York Times includes an in-depth interview with Dr. Robert L. Spitzer, a psychiatrist who is paradoxically responsible for both the biggest advance in gay rights and one of the studies most often used to deny these rights. In the interview the 80-year-old, who is now suffering from severe Parkinson’s disease, says he feels he owes the gay community an apology.

Spitzer was a psychiatrist and professor at Columbia University in 1970 when a group of gay rights activists heckled a meeting he was attending arguing that homosexuality should not be treated as a mental illness. He says their arguments made sense to him and, “I began to think, well, if it is a mental disorder, then what makes it one?” He went on to compare it to other conditions that were also defined as disorders and, according to the article:

“saw immediately that the latter [alcohol dependence and depression] caused marked distress or impairment, while homosexuality often did not.”

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Spitzer was in a position to make change because he was serving as a member of the American Psychiatric Association committee that was charged with rewriting the diagnostics manual. He organized a symposium to discuss homosexuality and led the charge to get it removed from the list of mental disorders. In 1973, he was successful and the revised Diagnostic and Statistical Manual of Mental Disorders (which came out in 1980) did not classify homosexuality itself as a disorder. Instead it included “sexual orientation disturbance” which applied to individuals — gay or straight — who were distressed by their sexual orientation. This was celebrated as a major victory throughout the gay community because until then legitimate psychiatrists and therapists often sought to “cure” homosexuality through therapy.

Some of Spitzer’s colleagues, however, felt this new classification was a mistake and continued to champion therapy to cure homosexuality which came to be known as “reparative” or “conversion” therapy.” Spitzer describes himself as being drawn to controversy and, like the gay rights advocates decades before, some ex-gays (those who believe their sexual orientation was, in fact, changed through therapy) caught his ear and his interest in the nineties. He went on to conduct and publish a study about reparative therapy in which he interviewed 200 patients who had gone through it and asked them how they would classify their sexual orientation before and after. 

The results, which were released at a meeting in 2001 before they were published without peer review in the Archives of Sexual Behavior, found that most participants felt their sexual orientation had changed with treatment. Those involved in the reparative therapy movement — a movement which is politically enmeshed with religious conservatives and others opposed to gay rights — hailed this as a major victory and seized on Spitzer’s reputation and career history as proof that he wasn’t biased. They used it this study to argue for everything from removing GSAs in schools to banning gay marriage and civil unions. 

Many of Spitzer’s colleagues, on the other hand, jumped on this study as bad science noting that it didn’t test any particular method of conversion therapy (some of the participants weren’t even in therapy but had simply done independent bible study) and that it relied on self-reported feelings. They argued that the participants may have been lying not just to Spitzer but to themselves. 

This was the criticism that really got to Spitzer:

“As I read these commentaries, I knew this was a problem, a big problem, and one I couldn’t answer. How do you know someone has really changed?”

But it took over a decade to admit this publicly.  In his letter of apology, Spitzer acknowledges that his study had a fatal flaw: “the simple fact is that there was no way to determine if the subject’s accounts of change were valid.”  He went on to say:

“I believe I owe the gay community an apology for my study making unproven claims of the efficacy of reparative therapy. I also apologize to any gay person who wasted time and energy undergoing some form of reparative therapy because they believed that I had proven that reparative therapy works with some “highly motivated” individuals.”

Spitzer ended his New York Times interview by pointing out that he didn’t know of any other psychiatrist who had admitted his mistake and apologized for it saying, “that’s something isn’t it?” People seem to be having very different reactions to what exactly it is though. The comment section after the online version of the article is full of people who accept his apology as better late than never and hail him as brave, as well as those who feel the damage is done and his apology is useless at this point. 

Baby Boomers Should Get Tested for Hepatitis C

The Centers for Disease Control and Prevention (CDC) is recommending that all Americans who were born between 1945 and 1965 be tested for Hepatitis C. This strain of Hepatitis is most often spread through sharing infected needles for drug use, needle sticks in health care workers, and from mother-to-child. Other possible means of transmission include snorted cocaine and shared personal care items like razor blades and tooth brushes. Though it can be spread through sexual activity the CDC describes the risk as low and explains:

The risk increases for those who have multiple sex partners, have a sexually transmitted disease, engage in rough sex, or are infected with HIV. More research is needed to better understand how and when Hepatitis C can be spread through sexual contact.

Hepatitis C infects the liver and causes a gradual deterioration of the organ leading to cirrhosis and liver cancer. It is the most common reason for liver transplants. And it is most common in baby boomers — 2 million of the 3.2 million cases occur in this age group. The CDC believes that most of these individuals were infected in their twenties before the virus was official discovered (which happened in 1989) and the blood supply was screened. 

This new effort aims to have all individuals ages 47 to 67 take a one-time blood test. Until now the CDC had only recommended routine testing for people with known risk factors—such as HIV, drug use, or existing liver disease. But this often meant that individuals did not become aware of their infection until symptoms began to emerge. The CDC estimates that the new effort could test 800,000 individuals and save 120,000 lives because once detected Hepatitis C can be treated with anti-viral medications. Up to 75 percent of cases can, in fact, be cured and these odds may improve with the introduction of two new drugs to the market.

Hepatitis C is related to Hepatitis A and Hepatitis B but unlike the other two, there is no vaccine available to prevent infection with this strand.

Young Men who Abuse ED Drugs Are Less Satisfied with Their Sex Lives

I suppose it shouldn’t come as a surprise to hear that college students are taking a prescription drug without a prescription — after all college is a time that many young people experiment with alcohol, marijuana, and other illegal substances — but it’s also the peak of young men’s sexual performance so I admit I was a little surprised to learn just how many of them have tried Viagra and other erectile dysfunction (ED) medications. 

A new study published in the Journal of Sexual Health surveyed 1,200 college-age men from across the country and found that six percent of them had used ED as a recreational drug.  The study asked the young men a variety of questions about their sex lives and compared their answers to those of their peers who had not tried these drugs. The results show that young men who have used ED drugs are more likely to be dissatisfied with and anxious about their sex lives. In fact the more ED drugs they took, the worse they felt.

The study found that the young men who used ED drugs had the same level of functioning as their peers who did not but were less confident about their ability to sustain an erection and less satisfied with their overall sex lives even if they enjoyed intercourse in the moment. Researchers could not determine whether this anxiety was what caused them to use the drugs or if the drugs caused the anxiety but one expert who was not involved in the study suggested that when men take these drugs they spend more time and energy during sex monitoring their erection. This “spectatoring,” as he called it, can interfere with their pleasure not only because it requires attention but because it increases the activity of the sympathetic nervous system which is normally decreased by the body during sexual activity.   

Moreover, the drugs can create an unrealistic expectation for the future and men can become convinced that they can’t have an erection without the drugs. As one urologist (who was also not involved in the study) explained: “We understand how they work, and I don’t think there’s any lasting physical harm for a young man who doesn’t need them, or for an older man who does. But it does sometimes create these psychological problems – and they stick around.” Medical professionals also fear that recreational use of the drugs can mask underlying health issues such as high cholesterol, high blood pressure, or diabetes that are actually causing erectile issues. 

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